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At least 595 records · Page 33
All sourcesNASA NTRSDOE OSTI
DOE OSTI2017

Influence of computed tomography contrast agent on radiotherapy dose calculation for pancreatic carcinoma: A dosimetric study based on tomotherapy and volumetric-modulated arc therapy techniques

The main purpose of our investigation was to quantify the dosimetric influence of intravenous contrast agent for pancreatic cancer radiotherapy treatment. This study focused on complex modulated irradiation techniques of tomotherapy (TOMO) and volumetric-modulated arc therapy (VMAT) to investigate if novel conformal treatment methods could reduce the influence of contrast agent. In our study, patients with pancreatic cancer were enrolled to have 2 computed tomography (CT) scans in the same position without and with intravenous contrast agent for treatment planning. Then tumors and organ at risks were countered on contrast-enhanced CT (CECT) images. Each patient's CECT was assigned a TOMO plan and a VMAT plan. Then these plans were copied onto the non-CECT image and dose distribution was calculated with the same algorithm and structure sets. Finally, the dose distribution and the dose difference were analyzed for the target volume and organs at risk between the 2 sets of images. The statistic dosimetric result showed that for both TOMO and VMAT, no significant dose difference between CECT and non-CECT-based plan was observed. Dose difference was clinically negligible because the average relative percentage dose difference was 1% ± 1% for target volume, except a blurring effect at the higher dose region of the target volume. It implied that intravenous contrast agent will not affect dose calculation for pancreatic cancer radiotherapy significantly. Also the dose deviation based on TOMO showed no statistical difference compared with that on VMAT. For both superposition/conversation algorithm used by TOMO and Monte Carlo algorithm used by VMAT, the dosimetric difference was nonsignificant. A full analysis demonstrated a negligible dose difference of less than 1% between CECT-based plan and non-CECT-based plan. Therefore, contrast-enhanced CT image can be used directly for dose calculation of TOMO and VMAT plans for pancreatic cancer. It is unnecessary to scan twice then make a fusion of CECT and non-CECT, which would result to additional unnecessary radiation dose to patient and decrease work efficiency.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2012

A simplified technique for delivering total body irradiation (TBI) with improved dose homogeneity

Purpose: Total body irradiation (TBI) with megavoltage photon beams has been accepted as an important component of management for a number of hematologic malignancies, generally as part of bone marrow conditioning regimens. The purpose of this paper is to present and discuss the authors' TBI technique, which both simplifies the treatment process and improves the treatment quality. Methods: An AP/PA TBI treatment technique to produce uniform dose distributions using sequential collimator reductions during each fraction was implemented, and a sample calculation worksheet is presented. Using this methodology, the dosimetric characteristics of both 6 and 18 MV photon beams, including lung dose under cerrobend blocks was investigated. A method of estimating midplane lung doses based on measured entrance and exit doses was proposed, and the estimated results were compared with measurements. Results: Whole body midplane dose uniformity of {+-}10% was achieved with no more than two collimator-based beam modulations. The proposed model predicted midplane lung doses 5% to 10% higher than the measured doses for 6 and 18 MV beams. The estimated total midplane doses were within {+-}5% of the prescribed midplane dose on average except for the lungs where the doses were 6% to 10% lower than the prescribed dose on average. Conclusions: The proposed TBI technique can achieve dose uniformity within {+-}10%. This technique is easy to implement and does not require complicated dosimetry and/or compensators.

61 RADIATION PROTECTION AND DOSIMETRY↗
DOE OSTI2012

Measured dose rate constant from oncology patients administered 18F for positron emission tomography

Purpose: Patient exposure rate measurements verify published patient dose rate data and characterize dose rates near 2-18-fluorodeoxyglucose ({sup 18}F-FDG) patients. A specific dose rate constant based on patient exposure rate measurements is a convenient quantity that can be applied to the desired distance, injection activity, and time postinjection to obtain an accurate calculation of cumulative external radiation dose. This study reports exposure rates measured at various locations near positron emission tomography (PET) {sup 18}F-FDG patients prior to PET scanning. These measurements are normalized for the amount of administered activity, measurement distance, and time postinjection and are compared with other published data. Methods: Exposure rates were measured using a calibrated ionization chamber at various body locations from 152 adult oncology patients postvoid after a mean uptake time of 76 min following injection with a mean activity of 490 MBq {sup 18}F-FDG. Data were obtained at nine measurement locations for each patient: three near the head, four near the chest, and two near the feet. Results: On contact with, 30 cm superior to and 30 cm lateral to the head, the mean (75th percentile) dose rates per unit injected activity at 60 min postinjection were 0.482 (0.511), 0.135 (0.155), and 0.193 (0.223) {mu}Sv/MBq h, respectively. On contact with, 30 cm anterior to, 30 cm lateral to and 1 m anterior to the chest, the mean (75th percentile) dose rates per unit injected activity at 60 min postinjection were 0.623 (0.709), 0.254 (0.283), 0.190 (0.218), and 0.067 (0.081) {mu}Sv/MBq h respectively. 30 cm inferior and 30 cm lateral to the feet, the mean (75th percentile) dose rates per unit injected activity at 60 min postinjection were 0.024 (0.022) and 0.039 (0.044) {mu}Sv/MBq h, respectively. Conclusions: The measurements for this study support the use of 0.092 {mu}Sv m{sup 2}/MBq h as a reasonable representation of the dose rate anterior from the chest of patients immediately following injection. This value can then be reliably scaled to the desired time and distance for planning and staff dose evaluation purposes. At distances closer than 1 m, a distance-specific dose rate constant of 0.367 {mu}Sv/MBq h at 30 cm is recommended for accurate calculations. An accurate patient-specific dose rate constant that accounts for patient-specific variables (e.g., distribution and attenuation) will allow an accurate evaluation of the dose rate from a patient injected with an isotope rather than simply utilizing a physical constant.

07 ISOTOPE AND RADIATION SOURCES↗
DOE OSTI2012

A method of dose reconstruction for moving targets compatible with dynamic treatments

Purpose: To develop a method that allows a commercial treatment planning system (TPS) to perform accurate dose reconstruction for rigidly moving targets and to validate the method in phantom measurements for a range of treatments including intensity modulated radiation therapy (IMRT), volumetric arc therapy (VMAT), and dynamic multileaf collimator (DMLC) tracking. Methods: An in-house computer program was developed to manipulate Dicom treatment plans exported from a TPS (Eclipse, Varian Medical Systems) such that target motion during treatment delivery was incorporated into the plans. For each treatment, a motion including plan was generated by dividing the intratreatment target motion into 1 mm position bins and construct sub-beams that represented the parts of the treatment that were delivered, while the target was located within each position bin. For each sub-beam, the target shift was modeled by a corresponding isocenter shift. The motion incorporating Dicom plans were reimported into the TPS, where dose calculation resulted in motion including target dose distributions. For experimental validation of the dose reconstruction a thorax phantom with a moveable lung equivalent rod with a tumor insert of solid water was first CT scanned. The tumor insert was delineated as a gross tumor volume (GTV), and a planning target volume (PTV) was formed by adding margins. A conformal plan, two IMRT plans (step-and-shoot and sliding windows), and a VMAT plan were generated giving minimum target doses of 95% (GTV) and 67% (PTV) of the prescription dose (3 Gy). Two conformal fields with MLC leaves perpendicular and parallel to the tumor motion, respectively, were generated for DMLC tracking. All treatment plans were delivered to the thorax phantom without tumor motion and with a sinusoidal tumor motion. The two conformal fields were delivered with and without portal image guided DMLC tracking based on an embedded gold marker. The target dose distribution was measured with a radiochromic film in the moving rod and compared with the reconstructed doses using gamma tests. Results: Considerable interplay effects between machine motion and target motion were observed for the treatments without tracking. For nontracking experiments, the mean 2 mm/2% gamma pass rate over all investigated scenarios was 99.6% between calculated and measured doses. For tracking experiments, the mean gamma pass rate was 99.4%. Conclusions: A method for accurate dose reconstruction for moving targets with dynamic treatments was developed and experimentally validated in a variety of delivery scenarios. The method is suitable for integration into TPSs, e.g., for reconstruction of the dose delivered to moving tumors or calculation of target doses delivered with DMLC tracking.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2013

Dosimetric evaluation of photon dose calculation under jaw and MLC shielding

Purpose: The accuracy of photon dose calculation algorithms in out-of-field regions is often neglected, despite its importance for organs at risk and peripheral dose evaluation. The present work has assessed this for the anisotropic analytical algorithm (AAA) and the Acuros-XB algorithms implemented in the Eclipse treatment planning system. Specifically, the regions shielded by the jaw, or the MLC, or both MLC and jaw for flattened and unflattened beams have been studied.Methods: The accuracy in out-of-field dose under different conditions was studied for two different algorithms. Measured depth doses out of the field, for different field sizes and various distances from the beam edge were compared with the corresponding AAA and Acuros-XB calculations in water. Four volumetric modulated arc therapy plans (in the RapidArc form) were optimized in a water equivalent phantom, PTW Octavius, to obtain a region always shielded by the MLC (or MLC and jaw) during the delivery. Doses to different points located in the shielded region and in a target-like structure were measured with an ion chamber, and results were compared with the AAA and Acuros-XB calculations. Photon beams of 6 and 10 MV, flattened and unflattened were used for the tests.Results: Good agreement between calculated and measured depth doses was found using both algorithms for all points measured at depth greater than 3 cm. The mean dose differences (±1SD) were −8%± 16%, −3%± 15%, −16%± 18%, and −9%± 16% for measurements vs AAA calculations and −10%± 14%, −5%± 12%, −19%± 17%, and −13%± 14% for Acuros-XB, for 6X, 6 flattening-filter free (FFF), 10X, and 10FFF beams, respectively. The same figures for dose differences relative to the open beam central axis dose were: −0.1%± 0.3%, 0.0%± 0.4%, −0.3%± 0.3%, and −0.1%± 0.3% for AAA and −0.2%± 0.4%, −0.1%± 0.4%, −0.5%± 0.5%, and −0.3%± 0.4% for Acuros-XB. Buildup dose was overestimated with AAA, while Acuros-XB gave results more consistent with measurements. From RapidArc plan analysis the average difference between calculation and measurement in the shielded region was −0.3%± 0.4% and −2.5%± 1.2% for AAA and Acuros-XB, respectively, relative to the mean target dose value (1.6%± 2.3%, −12.7%± 4.0% if relative to each local value). These values were compared with the corresponding differences in the target structure: −0.7%± 2.3% for AAA, and −0.5%± 2.3% for Acuros-XB.Conclusions: The two algorithms analyzed showed encouraging results in predicting out-of-field region dose for clinical use.

61 RADIATION PROTECTION AND DOSIMETRY↗
DOE OSTI2013

Patient dose simulations for scanning-beam digital x-ray tomosynthesis of the lungs

Purpose: An improved method of image guidance for lung tumor biopsies could help reduce the high rate of false negatives. The aim of this work is to optimize the geometry of the scanning-beam digital tomography system (SBDX) for providing real-time 3D tomographic reconstructions for target verification. The unique geometry of the system requires trade-offs between patient dose, imaging field of view (FOV), and tomographic angle.Methods: Tomosynthetic angle as a function of tumor-to-detector distance was calculated. Monte Carlo Software (PCXMC) was used to calculate organ doses and effective dose for source-to-detector distances (SDDs) from 90 to 150 cm, patient locations with the tumor at 20 cm from the source to 20 cm from the detector, and FOVs centered on left lung and right lung as well as medial and distal peripheries of the lungs. These calculations were done for two systems, a SBDX system and a GE OEC-9800 C-arm fluoroscopic unit. To evaluate the dose effect of the system geometry, results from PCXMC were calculated using a scan of 300 mAs for both SBDX and fluoroscopy. The Rose Criterion was used to find the fluence required for a tumor SNR of 5, factoring in scatter, air-gap, system geometry, and patient position for all models generated with PCXMC. Using the calculated fluence for constant tumor SNR, the results from PCXMC were used to compare the patient dose for a given SNR between SBDX and fluoroscopy.Results: Tomographic angle changes with SDD only in the region near the detector. Due to their geometry, the source array and detector have a peak tomographic angle for any given SDD at a source to tumor distance that is 69.7% of the SDD assuming constant source and detector size. Changing the patient location in order to increase tomographic angle has a significant effect on organ dose distribution due to geometrical considerations. With SBDX and fluoroscopy geometries, the dose to organs typically changes in an opposing manner with changing patient location. When tumor SNR is held constant (i.e., x-ray fluence is scaled appropriately), SBDX gives 2–10 times less dose than fluoroscopy for the same conditions within the typical range of patient locations. The relative position of the patient (as a percent of SDD) has a much more significant impact on dose than either SDD or patient position. The patient position providing the minimum dose for a given tumor SNR and SDD is approximately the same as the position of maximum tomographic angle.Conclusions: SBDX offers a significant dose advantage over currently used C-arm fluoroscopy. The patient location with lowest dose coincides with the location of maximum tomographic angle. In order to provide adequate space for the patient and for the pulmonologists’ equipment, a SDD of 100 cm is recommended.

61 RADIATION PROTECTION AND DOSIMETRY↗
DOE OSTI2014

SU-E-T-29: A Web Application for GPU-Based Monte Carlo IMRT/VMAT QA with Delivered Dose Verification

Purpose: To enable an existing web application for GPU-based Monte Carlo (MC) 3D dosimetry quality assurance (QA) to compute “delivered dose” from linac logfile data. Methods: We added significant features to an IMRT/VMAT QA web application which is based on existing technologies (HTML5, Python, and Django). This tool interfaces with python, c-code libraries, and command line-based GPU applications to perform a MC-based IMRT/VMAT QA. The web app automates many complicated aspects of interfacing clinical DICOM and logfile data with cutting-edge GPU software to run a MC dose calculation. The resultant web app is powerful, easy to use, and is able to re-compute both plan dose (from DICOM data) and delivered dose (from logfile data). Both dynalog and trajectorylog file formats are supported. Users upload zipped DICOM RP, CT, and RD data and set the expected statistic uncertainty for the MC dose calculation. A 3D gamma index map, 3D dose distribution, gamma histogram, dosimetric statistics, and DVH curves are displayed to the user. Additional the user may upload the delivery logfile data from the linac to compute a 'delivered dose' calculation and corresponding gamma tests. A comprehensive PDF QA report summarizing the results can also be downloaded. Results: We successfully improved a web app for a GPU-based QA tool that consists of logfile parcing, fluence map generation, CT image processing, GPU based MC dose calculation, gamma index calculation, and DVH calculation. The result is an IMRT and VMAT QA tool that conducts an independent dose calculation for a given treatment plan and delivery log file. The system takes both DICOM data and logfile data to compute plan dose and delivered dose respectively. Conclusion: We sucessfully improved a GPU-based MC QA tool to allow for logfile dose calculation. The high efficiency and accessibility will greatly facilitate IMRT and VMAT QA.

07 ISOTOPE AND RADIATION SOURCES↗
DOE OSTI2014

SU-E-T-356: Accuracy of Eclipse Electron Macro Monte Carlo Dose Algorithm for Use in Bolus Electron Conformal Therapy

Purpose: To evaluate the accuracy of electron dose distribution calculated by the Varian Eclipse electron Monte Carlo (eMC) algorithm for use with recent commercially available bolus electron conformal therapy (ECT). Methods: eMC-calculated electron dose distributions for bolus ECT have been compared to those previously measured for cylindrical phantoms (retromolar trigone and nose), whose axial cross sections were based on the mid-PTV CT anatomy for each site. The phantoms consisted of SR4 muscle substitute, SR4 bone substitute, and air. The bolus ECT treatment plans were imported into the Eclipse treatment planning system and calculated using the maximum allowable histories (2×10{sup 9}), resulting in a statistical error of <0.2%. Smoothing was not used for these calculations. Differences between eMC-calculated and measured dose distributions were evaluated in terms of absolute dose difference as well as distance to agreement (DTA). Results: Results from the eMC for the retromolar trigone phantom showed 89% (41/46) of dose points within 3% dose difference or 3 mm DTA. There was an average dose difference of −0.12% with a standard deviation of 2.56%. Results for the nose phantom showed 95% (54/57) of dose points within 3% dose difference or 3 mm DTA. There was an average dose difference of 1.12% with a standard deviation of 3.03%. Dose calculation times for the retromolar trigone and nose treatment plans were 15 min and 22 min, respectively, using 16 processors (Intel Xeon E5-2690, 2.9 GHz) on a Varian Eclipse framework agent server (FAS). Results of this study were consistent with those previously reported for accuracy of the eMC electron dose algorithm and for the .decimal, Inc. pencil beam redefinition algorithm used to plan the bolus. Conclusion: These results show that the accuracy of the Eclipse eMC algorithm is suitable for clinical implementation of bolus ECT.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

WE-D-BRE-06: Quantification of Dose-Response for High Grade Esophagtis Patients Using a Novel Voxel-To-Voxel Method

Purpose: Radiation induces an inflammatory response in the esophagus, discernible on CT studies. This work objectively quantifies the voxel esophageal radiation-response for patients with acute esophagitis. This knowledge is an important first-step towards predicting the effect of complex dose distributions on patient esophagitis symptoms. Methods: A previously validated voxel-based methodology of quantifying radiation esophagitis severity was used to identify the voxel dose-response for 18 NSCLC patients with severe esophagitis (CTCAE grading criteria, grade2 or higher). The response is quantified as percent voxel volume change for a given dose. During treatment (6–8 weeks), patients had weekly 4DCT studies and esophagitis scoring. Planning CT esophageal contours were deformed to each weekly CT using a demons DIR algorithm. An algorithm using the Jacobian Map from the DIR of the planning CT to all weekly CTs was used to quantify voxel-volume change, along with corresponding delivered voxel dose, to the planning voxel. Dose for each voxel for each time-point was calculated on each previous weekly CT image, and accumulated using DIR. Thus, for each voxel, the volume-change and delivered dose was calculated for each time-point. The data was binned according to when the volume-change first increased by a threshold volume (10%–100%, in 10% increments), and the average delivered dose calculated for each bin. Results: The average dose resulting in a voxel volume increase of 10–100% was 21.6 to 45.9Gy, respectively. The mean population dose to give a 50% volume increase was 36.3±4.4Gy, (range:29.8 to 43.5Gy). The average week of 50% response was 4.1 (range:4.9 to 2.8 weeks). All 18 patients showed similar dose to first response curves, showing a common trend in the initial inflammatoryresponse. Conclusion: We extracted the dose-response curve of the esophagus on a voxel-to-voxel level. This may be useful for estimating the esophagus response (and patient symptoms) to complicated dose distributions.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

WE-E-BRE-04: Dual Focal Spot Dose Painting for Precision Preclinical Radiobiological Investigations

Purpose: Recent progress in small animal radiotherapy systems has provided the foundation for delivering the heterogeneous, millimeter scale dose distributions demanded by preclinical radiobiology investigations. Despite advances in preclinical dose planning, delivery of highly heterogeneous dose distributions is constrained by the fixed collimation systems and large x-ray focal spot common in small animal radiotherapy systems. This work proposes a dual focal spot dose optimization and delivery method with a large x-ray focal spot used to deliver homogeneous dose regions and a small focal spot to paint spatially heterogeneous dose regions. Methods: Two-dimensional dose kernels were measured for a 1 mm circular collimator with radiochromic film at 10 mm depth in a solid water phantom for the small and large x-ray focal spots on a recently developed small animal microirradiator. These kernels were used in an optimization framework which segmented a desired dose distribution into low- and high-spatial frequency regions for delivery by the large and small focal spot, respectively. For each region, the method determined an optimal set of stage positions and beam-on times. The method was demonstrated by optimizing a bullseye pattern consisting of 0.75 mm radius circular target and 0.5 and 1.0 mm wide rings alternating between 0 and 2 Gy. Results: Compared to a large focal spot technique, the dual focal spot technique improved the optimized dose distribution: 69.2% of the optimized dose was within 0.5 Gy of the intended dose for the large focal spot, compared to 80.6% for the dual focal spot method. The dual focal spot design required 14.0 minutes of optimization, and will require 178.3 minutes for automated delivery. Conclusion: The dual focal spot optimization and delivery framework is a novel option for delivering conformal and heterogeneous dose distributions at the preclinical level and provides a new experimental option for unique radiobiological investigations. Funding Support: this work is supported by funding the National Sciences and Engineering Research Council of Canada, and a Mitacs-accelerate fellowship. Conflict of Interest: Dr. Lindsay and Dr. Jaffray are listed as inventors of the small animal microirradiator described herein. This system has been licensed for commercial development.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

Sci—Thur AM: YIS - 05: 10X-FFF VMAT for Lung SABR: an Investigation of Peripheral Dose

Flattening Filter Free (FFF) beams exhibit high dose rates, reduced head scatter, leaf transmission and leakage radiation. For VMAT lung SABR, treatment time can be significantly reduced using high dose rate FFF beams while maintaining plan quality and accuracy. Another possible advantage offered by FFF beams for VMAT lung SABR is the reduction in peripheral dose. The focus of this study was to investigate and quantify the reduction of peripheral dose offered by FFF beams for VMAT lung SABR. The peripheral doses delivered by VMAT Lung SABR treatments using FFF and flattened beams were investigated for the Varian Truebeam linac. This study was conducted in three stages, (1): ion chamber measurement of peripheral dose for various plans, (2): validation of AAA, Acuros XB and Monte Carlo for peripheral dose using measured data, and (3): using the validated Monte Carlo model to evaluate peripheral doses for 6 VMAT lung SABR treatments. Three energies, 6X, 10X, and 10X-FFF were used for all stages. Measured data indicates that 10X-FFF delivers the lowest peripheral dose of the three energies studied. AAA and Acuros XB dose calculation algorithms were identified as inadequate, and Monte Carlo was validated for accurate peripheral dose prediction. The Monte Carlo-calculated VMAT lung SABR plans show a significant reduction in peripheral dose for 10X-FFF plans compared to the standard 6X plans, while no significant reduction was showed when compared to 10X. This reduction combined with shorter treatment time makes 10X-FFF beams the optimal choice for superior VMAT lung SABR treatments.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

Radiation dose calculations for CT scans with tube current modulation using the approach to equilibrium function

Purpose: The approach to equilibrium function has been used previously to calculate the radiation dose to a shift-invariant medium undergoing CT scans with constant tube current [Li, Zhang, and Liu, Med. Phys. 39, 5347–5352 (2012)]. The authors have adapted this method to CT scans with tube current modulation (TCM). Methods: For a scan with variable tube current, the scan range was divided into multiple subscan ranges, each with a nearly constant tube current. Then the dose calculation algorithm presented previously was applied. For a clinical CT scan series that presented tube current per slice, the authors adopted an efficient approach that computed the longitudinal dose distribution for one scan length equal to the slice thickness, which center was at z = 0. The cumulative dose at a specific point was a summation of the contributions from all slices and the overscan. Results: The dose calculations performed for a total of four constant and variable tube current distributions agreed with the published results of Dixon and Boone [Med. Phys. 40, 111920 (14pp.) (2013)]. For an abdomen/pelvis scan of an anthropomorphic phantom (model ATOM 701-B, CIRS, Inc., VA) on a GE Lightspeed Pro 16 scanner with 120 kV, N × T = 20 mm, pitch = 1.375, z axis current modulation (auto mA), and angular current modulation (smart mA), dose measurements were performed using two lines of optically stimulated luminescence dosimeters, one of which was placed near the phantom center and the other on the surface. Dose calculations were performed on the central and peripheral axes of a cylinder containing water, whose cross-sectional mass was about equal to that of the ATOM phantom in its abdominal region, and the results agreed with the measurements within 28.4%. Conclusions: The described method provides an effective approach that takes into account subject size, scan length, and constant or variable tube current to evaluate CT dose to a shift-invariant medium. For a clinical CT scan, dose calculations may be performed with a water-containing cylinder whose cross-sectional mass is equal to that of the subject. This method has the potential to substantially improve evaluations of patient dose from clinical CT scans, compared to CTDI{sub vol}, size-specific dose estimate (SSDE), or the dose evaluated for a TCM scan with a constant tube current equal to the average tube current of the TCM scan.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2015

SU-E-I-06: A Dose Calculation Algorithm for KV Diagnostic Imaging Beams by Empirical Modeling

Purpose: To develop accurate three-dimensional (3D) empirical dose calculation model for kV diagnostic beams for different radiographic and CT imaging techniques. Methods: Dose was modeled using photon attenuation measured using depth dose (DD), scatter radiation of the source and medium, and off-axis ratio (OAR) profiles. Measurements were performed using single-diode in water and a diode-array detector (MapCHECK2) with kV on-board imagers (OBI) integrated with Varian TrueBeam and Trilogy linacs. The dose parameters were measured for three energies: 80, 100, and 125 kVp with and without bowtie filters using field sizes 1×1–40×40 cm2 and depths 0–20 cm in water tank. Results: The measured DD decreased with depth in water because of photon attenuation, while it increased with field size due to increased scatter radiation from medium. DD curves varied with energy and filters where they increased with higher energies and beam hardening from half-fan and full-fan bowtie filters. Scatter radiation factors increased with field sizes and higher energies. The OAR was with 3% for beam profiles within the flat dose regions. The heal effect of this kV OBI system was within 6% from the central axis value at different depths. The presence of bowtie filters attenuated measured dose off-axis by as much as 80% at the edges of large beams. The model dose predictions were verified with measured doses using single point diode and ionization chamber or two-dimensional diode-array detectors inserted in solid water phantoms. Conclusion: This empirical model enables fast and accurate 3D dose calculation in water within 5% in regions with near charge-particle equilibrium conditions outside buildup region and penumbra. It considers accurately scatter radiation contribution in water which is superior to air-kerma or CTDI dose measurements used usually in dose calculation for diagnostic imaging beams. Considering heterogeneity corrections in this model will enable patient specific dose calculation.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-92: Achieving Desirable Lung Doses in Total Body Irradiation Based On in Vivo Dosimetry and Custom Tissue Compensation

Purpose: To achieve desirable lung doses in total body irradiation (TBI) based on in vivo dosimetry and custom tissue compensation. Methods: The 15 MV photon beam of a Varian TrueBeam STx linac was used for TBI. Patients were positioned in the lateral decubitus position for AP/PA treatment delivery. Dose was calculated using the midpoint of the separation distance across the patient’s umbilicus. Patients received 200 cGy twice daily for 3 days. The dose rate at the patient’s midplane was approximately 10 cGy/min. Cerrobend blocks with a 5-HVL thickness were used for the primary lung shielding. A custom styrofoam holder for rice-flour filled bags was created based on the lung block cutouts. This was used to provide further lung shielding based on in vivo dose measurements. Lucite plates and rice-flour bags were placed in the head, neck, chest, and lower extremity regions during the treatment to compensate for the beam off-axis output variations. Two patients were included in the study. Patients 1 and 2 received a craniospinal treatment (1080 cGy) and a mediastinum treatment (2520 cGy), respectively, before the TBI. During the TBI nanoDot dosimeters were placed on the patient skin in the forehead, neck, umbilicus, and lung regions for dose monitoring. The doses were readout immediately after the treatment. Based on the readings, fine tuning of the thickness of the rice-flour filled bags was exploited to achieve the desirable lung doses. Results: For both patients the mean lung doses, which took into consideration all treatments, were controlled within 900 +/−10% cGy, as desired. Doses to the forehead, neck, and umbilicus were achieved within +/−10% of the prescribed dose (1200 cGy). Conclusion: A reliable and robust method was developed to achieve desirable lung doses and uniform body dose in TBI based on in vivo dosimetry and custom tissue compensator.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-135: Assessing the Clinical Impact of Approximations in Analytical Dose Calculations for Proton Therapy

Purpose: To estimate the clinical relevance of approximations made in analytical dose calculation methods (ADCs) used for treatment planning on tumor coverage and tumor control probability (TCP) in proton therapy. Methods: We compared dose distributions planned with ADC to delivered dose distributions (as determined by TOPAS Monte Carlo (MC) simulations). We investigated 10 patients per site for 5 treatment sites (head-and-neck, lung, breast, prostate, liver). We evaluated differences between the two dose distributions analyzing dosimetric indices based on the dose-volume-histograms, the γ-index and the TCP. The normal tissue complication probability (NTCP) was estimated for the bladder and anterior rectum for the prostate patients. Results: We find that the target doses are overestimated by the ADC by 1–2% on average for all patients considered. All dosimetric indices (the mean dose, D95, D50 and D02, the dose values covering 95%, 50% and 2% of the target volume, respectively) are predicted within 5% of the delivered dose. A γ-index with a 3%/3mm criteria had a passing rate for target volumes above 96% for all patients. The TCP predicted by the two algorithms was up to 2%, 2.5%, 6%, 6.5%, and 11% for liver and breast, prostate, head-and-neck and lung patients, respectively. Differences in NTCP for anterior-rectum and bladder for prostate patients were less than 3%. Conclusion: We show that ADC provide adequate dose distributions for most patients, however, they can Result in underdosage of the target by as much as 5%. The TCP was found to be up to 11% lower than predicted. Advanced dose-calculation methods like MC simulations may be necessary in proton therapy to ensure target coverage for heterogeneous patient geometries, in clinical trials comparing proton therapy to conventional radiotherapy to avoid biases due to systematic discrepancies in calculated dose distributions, and, if tighter range margins are considered. Fully funded by NIH grants.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-256: Development of a Monte Carlo-Based Dose-Calculation System in a Cloud Environment for IMRT and VMAT Dosimetric Verification

Purpose: Intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) are techniques that are widely used for treating cancer due to better target coverage and critical structure sparing. The increasing complexity of IMRT and VMAT plans leads to decreases in dose calculation accuracy. Monte Carlo simulations are the most accurate method for the determination of dose distributions in patients. However, the simulation settings for modeling an accurate treatment head are very complex and time consuming. The purpose of this work is to report our implementation of a simple Monte Carlo simulation system in a cloud-computing environment for dosimetric verification of IMRT and VMAT plans. Methods: Monte Carlo simulations of a Varian Clinac linear accelerator were performed using the BEAMnrc code, and dose distributions were calculated using the DOSXYZnrc code. Input files for the simulations were automatically generated from DICOM RT files by the developed web application. We therefore must only upload the DICOM RT files through the web interface, and the simulations are run in the cloud. The calculated dose distributions were exported to RT Dose files that can be downloaded through the web interface. The accuracy of the calculated dose distribution was verified by dose measurements. Results: IMRT and VMAT simulations were performed and good agreement results were observed for measured and MC dose comparison. Gamma analysis with a 3% dose and 3 mm DTA criteria shows a mean gamma index value of 95% for the studied cases. Conclusion: A Monte Carlo-based dose calculation system has been successfully implemented in a cloud environment. The developed system can be used for independent dose verification of IMRT and VMAT plans in routine clinical practice. The system will also be helpful for improving accuracy in beam modeling and dose calculation in treatment planning systems. This work was supported by JSPS KAKENHI Grant Number 25861057.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-288: Dose Volume Population Histogram (DVPH): A New Method to Evaluate Intensity Modulated Proton Therapy Plans With Geometrical Uncertainties

Purpose: In Proton therapy, especially intensity modulated proton therapy(IMPT), the dose distribution shape is very sensitive to errors due to sharp dose gradients at the Bragg peaks. The concept of the conventional margin is based on the assumption that dose distribution is shifted rather than deformed due to geometrical uncertainties. The goal of this study is to access the validity of the margin concept as well as propose a new approach using Dose Volume Population Histogram (DVPH) in evaluating IMPT plans. Methods: For a prostate case, an intensity modulated proton therapy is optimized based on the conventional PTV based objective function. The plan is evaluated based on the PTV DVH and CTV DVPH (dose volume population histogram) which explicitly taking into account geometric uncertainties. The DVPH is calculated based on 2197 dose distributions at different CTV possible positions for both random and systematic errors. The DVPH with a 90% confidence level is used for the comparison. Results: The minimum dose of the CTV DVPH with a 90% confidence level is only about 18% of the prescribed dose, while the minimum dose of the PTV is 95%. For bladder DVHs, the D50 and D35 is 26% and 30%, compared to 65% and 70% of the prescribed dose from the bladder DVPH with 90% confidence level. Conclusion: The results showed that the PTV concept for ensuring the prescribed dose actually delivered to the CTV is invalid in proton therapy. The good PTV DVH might Result in an underdose to the target and should not be used for IMPT optimization. For OARs, the conventional evaluation approach underestimates dose volume end points. The new concept DVPH has been proved to provide a more accurate DVH evaluation in proton therapy.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-762: Toward Volume-Based Independent Dose Verification as Secondary Check

Purpose: Lung SBRT plan has been shifted to volume prescription technique. However, point dose agreement is still verified using independent dose verification at the secondary check. The volume dose verification is more affected by inhomogeneous correction rather than point dose verification currently used as the check. A feasibility study for volume dose verification was conducted in lung SBRT plan. Methods: Six SBRT plans were collected in our institute. Two dose distributions with / without inhomogeneous correction were generated using Adaptive Convolve (AC) in Pinnacle3. Simple MU Analysis (SMU, Triangle Product, Ishikawa, JP) was used as the independent dose verification software program, in which a modified Clarkson-based algorithm was implemented and radiological path length was computed using CT images independently to the treatment planning system. The agreement in point dose and mean dose between the AC with / without the correction and the SMU were assessed. Results: In the point dose evaluation for the center of the GTV, the difference shows the systematic shift (4.5% ± 1.9 %) in comparison of the AC with the inhomogeneous correction, on the other hands, there was good agreement of 0.2 ± 0.9% between the SMU and the AC without the correction. In the volume evaluation, there were significant differences in mean dose for not only PTV (14.2 ± 5.1 %) but also GTV (8.0 ± 5.1 %) compared to the AC with the correction. Without the correction, the SMU showed good agreement for GTV (1.5 ± 0.9%) as well as PTV (0.9% ± 1.0%). Conclusion: The volume evaluation for secondary check may be possible in homogenous region. However, the volume including the inhomogeneous media would make larger discrepancy. Dose calculation algorithm for independent verification needs to be modified to take into account the inhomogeneous correction.

60 APPLIED LIFE SCIENCES↗