Results for “physicists” — Page 36

DOE OSTI2015

SU-E-T-484: In Vivo Dosimetry Tolerances in External Beam Fast Neutron Therapy

Purpose: Optical stimulated luminescence (OSL) dosimetry with Landauer Al2O3:C nanodots was developed at our institution as a passive in vivo dosimetry (IVD) system for patients treated with fast neutron therapy. The purpose of this study was to establish clinically relevant tolerance limits for detecting treatment errors requiring further investigation. Methods: Tolerance levels were estimated by conducting a series of IVD expected dose calculations for square field sizes ranging between 2.8 and 28.8 cm. For each field size evaluated, doses were calculated for open and internal wedged fields with angles of 30°, 45°, or 60°. Theoretical errors were computed for variations of incorrect beam configurations. Dose errors, defined as the percent difference from the expected dose calculation, were measured with groups of three nanodots placed in a 30 x 30 cm solid water phantom, at beam isocenter (150 cm SAD, 1.7 cm Dmax). The tolerances were applied to IVD patient measurements. Results: The overall accuracy of the nanodot measurements is 2–3% for open fields. Measurement errors agreed with calculated errors to within 3%. Theoretical estimates of dosimetric errors showed that IVD measurements with OSL nanodots will detect the absence of an internal wedge or a wrong wedge angle. Incorrect nanodot placement on a wedged field is more likely to be caught if the offset is in the direction of the “toe” of the wedge where the dose difference in percentage is about 12%. Errors caused by an incorrect flattening filter size produced a 2% measurement error that is not detectable by IVD measurement alone. Conclusion: IVD with nanodots will detect treatment errors associated with the incorrect implementation of the internal wedge. The results of this study will streamline the physicists’ investigations in determining the root cause of an IVD reading that is out of normally accepted tolerances.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

SU-E-T-554: Monte Carlo Calculation of Source Terms and Attenuation Lengths for Neutrons Produced by 50–200 MeV Protons On Brass

Purpose: We used TOPAS (TOPAS wraps and extends Geant4 for medical physicists) to compare Geant4 physics models with published data for neutron shielding calculations. Subsequently, we calculated the source terms and attenuation lengths (shielding data) of the total ambient dose equivalent (TADE) in concrete for neutrons produced by protons in brass. Methods: Stage1: The Bertini and Binary nuclear models available in Geant4 were compared with published attenuation at depth of the TADE in concrete and iron. Stage2: Shielding data of the TADE in concrete was calculated for 50– 200 MeV proton beams on brass. Stage3: Shielding data from Stage2 was extrapolated for 235 MeV proton beams. This data was used in a point-line-source analytical model to calculate the ambient dose per unit therapeutic dose at two locations inside one treatment room at the Francis H Burr Proton Therapy Center. Finally, we compared these results with experimental data and full TOPAS simulations. Results: At larger angles (∼130o) the TADE in concrete calculated with the Bertini model was about 9 times larger than that calculated with the Binary model. The attenuation length in concrete calculated with the Binary model agreed with published data within 7%±0.4% (statistical uncertainty) for the deepest regions and 5%±0.1% for shallower regions. For iron the agreement was within 3%±0.1%. The ambient dose per therapeutic dose calculated with the Binary model, relative to the experimental data, was a ratio of 0.93±0.16 and 1.23±0.24 for two locations. The analytical model overestimated the dose by four orders of magnitude. These differences are attributed to the complexity of the geometry. Conclusion: The Binary and Bertini models gave comparable results, with the Binary model giving the best agreement with published data at large angle. Shielding data we calculated using the Binary model is useful for fast shielding calculations with other analytical models. This work was supported by National Cancer Institute Grant R01CA140735.

61 RADIATION PROTECTION AND DOSIMETRY↗

DOE OSTI2015

SU-E-T-649: Quality Assurances for Proton Therapy Delivery Equipment

Purpose: The number of proton therapy centers has increased dramatically over the past decade. Currently, there is no comprehensive set of guidelines that addresses quality assurance (QA) procedures for the different technologies used for proton therapy. The AAPM has charged task group 224 (TG-224) to provide recommendations for QA required for accurate and safe dose delivery, using existing and next generation proton therapy delivery equipment. Methods: A database comprised of QA procedures and tolerance limits was generated from many existing proton therapy centers in and outside of the US. These consist of proton therapy centers that possessed double scattering, uniform scanning, and pencil beams delivery systems. The diversity in beam delivery systems as well as the existing devices to perform QA checks for different beam parameters is the main subject of TG-224. Based on current practice at the clinically active proton centers participating in this task group, consensus QA recommendations were developed. The methodologies and requirements of the parameters that must be verified for consistency of the performance of the proton beam delivery systems are discussed. Results: TG-224 provides procedures and QA checks for mechanical, imaging, safety and dosimetry requirements for different proton equipment. These procedures are categorized based on their importance and their required frequencies in order to deliver a safe and consistent dose. The task group provides daily, weekly, monthly, and annual QA check procedures with their tolerance limits. Conclusions: The procedures outlined in this protocol provide sufficient information to qualified medical physicists to perform QA checks for any proton delivery system. Execution of these procedures should provide confidence that proton therapy equipment is functioning as commissioned for patient treatment and delivers dose safely and accurately within the established tolerance limits. The report will be published in late 2015.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

DOE OSTI2015

SU-E-T-662: Quick and Efficient Daily QA for Compact PBS Proton Therapy Machine

Purpose: As proton therapy machines become widespread the need for a quick simple routine daily QA like that for linear accelerators becomes more important. Willis-Knighton has developed an accurate and efficient daily QA that can be performed in 15 minutes. Methods: A holder for a 2D ionization chamber array (MatriXX PT) was created that is indexed to the couch to allow for quick setup, lasers accuracy with respect to beam isocenter, and couch reproducibility. Image position/reposition was performed to check Isocentricity accuracy by placing BBs on the MatriXX. The couch coordinates are compared to that of commissioning. Laser positions were confirmed with the MatriXX isocenter. After IGRT, three beams were separately delivered according to setup. For the first beam, range shifter was inserted and dose at R90, field size, flatness and symmetry in X and Y direction was measured. R90 was used so any minor changes in the range shifter can be detected. For the open beam, dose at center of SOBP, flatness and symmetry in X and Y direction was measured. Field size was measured in ±X and ±Y direction at FWHM. This is measured so any variation in spot size will be detected. For the third beam additional solid water was added and dose at R50 was measured so that any variation in beam energy will be detected. Basic mechanical and safety checks were also performed. Results: Medical physicists were able to complete the daily QA and reduce the time by half to two-third from initial daily QA procedure. All the values measured were within tolerance of that of the baseline which was established from water tank and initial MatriXX measurements. Conclusion: The change in daily QA procedure resulted in quick and easy setup and was able to measure all the basic functionality of the proton therapy PBS.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

DOE OSTI2015

SU-E-T-669: Radiosurgery Failure for Trigeminal Neuralgia: A Study of Radiographic Spatial Fidelity

Purpose: Management of Trigeminal Neuralgia with radiosurgery is well established, but often met with limited success. Recent advancements in imaging afford improvements in target localization for radiosurgery. Methods: A Trigeminal Neuralgia radiosurgery specific protocol was established for MR enhancement of the trigeminal nerve using a CISS scan with slice spacing of 0.7mm. Computed Tomography simulation was performed using axial slices on a 40 slice CT with slice spacing of 0.6mm. These datasets were registered using a mutual information algorithm and localized in a stereotactic coordinate system. Image registration between the MR and CT was evaluated for each patient by a Medical Physicist to ensure accuracy. The dorsal root entry zone target was defined on the CISS MR by a Neurosurgeon and dose calculations performed on the localized CT. Treatment plans were reviewed and approved by a Radiation Oncologist and Neurosurgeon. Image guided radiosurgery was delivered using positioning tolerance of 0.5mm and 1°. Eight patients with Trigeminal Neuralgia were treated with this protocol. Results: Seven patients reported a favorable response to treatment with average Barrow Neurological Index pain score of four before treatment and one following treatment. Only one patient had a BNI>1 following treatment and review of the treatment plan revealed that the CISS MR was registered to the CT via a low resolution (5mm slice spacing) T2 MR. All other patients had CISS MR registered directly with the localized CT. This patient was retreated 6 months later using direct registration between CISS MR and localized CT and subsequently responded to treatment with a BNI of one. Conclusion: Frameless radiosurgery offers an effective solution to Trigeminal Neuralgia management provided appropriate technology and imaging protocols (utilizing submillimeter imaging) are established and maintained.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

DOE OSTI2015

SU-E-T-785: Using Systems Engineering to Design HDR Skin Treatment Operation for Small Lesions to Enhance Patient Safety

Purpose: Using systems engineering to design HDR skin treatment operation for small lesions using shielded applicators to enhance patient safety. Methods: Systems engineering is an interdisciplinary field that offers formal methodologies to study, design, implement, and manage complex engineering systems as a whole over their life-cycles. The methodologies deal with human work-processes, coordination of different team, optimization, and risk management. The V-model of systems engineering emphasize two streams, the specification and the testing streams. The specification stream consists of user requirements, functional requirements, and design specifications while the testing on installation, operational, and performance specifications. In implementing system engineering to this project, the user and functional requirements are (a) HDR unit parameters be downloaded from the treatment planning system, (b) dwell times and positions be generated by treatment planning system, (c) source decay be computer calculated, (d) a double-check system of treatment parameters to comply with the NRC regulation. These requirements are intended to reduce human intervention to improve patient safety. Results: A formal investigation indicated that the user requirements can be satisfied. The treatment operation consists of using the treatment planning system to generate a pseudo plan that is adjusted for different shielded applicators to compute the dwell times. The dwell positions, channel numbers, and the dwell times are verified by the medical physicist and downloaded into the HDR unit. The decayed source strength is transferred to a spreadsheet that computes the dwell times based on the type of applicators and prescribed dose used. Prior to treatment, the source strength, dwell times, dwell positions, and channel numbers are double-checked by the radiation oncologist. No dosimetric parameters are manually calculated. Conclusion: Systems engineering provides methodologies to effectively design the HDR treatment operation that minimize human intervention and improve patient safety.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

MO-A-213-00: Economics Update

The purpose of this session is to introduce attendees to the healthcare reimbursement system and how it applies to the clinical work of a Medical Physicist. This will include general information about the different categories of payers and payees, how work is described by CPT© codes, and how various payers set values for this work in different clinical settings. 2015 is a year of significant changes to the payment system. Many CPT© codes have been deleted and replaced with new CPT© codes. These codes define some of the most common work performed in our clinics including treatment planning and delivery. This presentation will describe what work is encompassed in these codes and will give attendees an overview of the changes for 2015 as they apply to radiation oncology. Finally, some insight into what can be expected during 2016 will be presented. This includes what information is typically released by the Centers for Medicaid & Medicare Services (CMS) during the year and how we as an organization respond. This will include ways members can interact with the AAPM professional economics committee and other resources members may find helpful. Learning Objectives: Basics of how Medicare is structured and how reimbursement rates are set. Basic understanding of proposed changes to the 2016 Medicare rules. What resources are available from the AAPM and how to interact with the professional economics committee. Ownership in pxAlpha, LLC, a medical device start up company.

29 ENERGY PLANNING, POLICY, AND ECONOMY↗

DOE OSTI2015

MO-A-213-01: 2015 Economics Update Part 1

The purpose of this session is to introduce attendees to the healthcare reimbursement system and how it applies to the clinical work of a Medical Physicist. This will include general information about the different categories of payers and payees, how work is described by CPT© codes, and how various payers set values for this work in different clinical settings. 2015 is a year of significant changes to the payment system. Many CPT© codes have been deleted and replaced with new CPT© codes. These codes define some of the most common work performed in our clinics including treatment planning and delivery. This presentation will describe what work is encompassed in these codes and will give attendees an overview of the changes for 2015 as they apply to radiation oncology. Finally, some insight into what can be expected during 2016 will be presented. This includes what information is typically released by the Centers for Medicaid & Medicare Services (CMS) during the year and how we as an organization respond. This will include ways members can interact with the AAPM professional economics committee and other resources members may find helpful. Learning Objectives: Basics of how Medicare is structured and how reimbursement rates are set. Basic understanding of proposed changes to the 2016 Medicare rules. What resources are available from the AAPM and how to interact with the professional economics committee. Ownership in pxAlpha, LLC, a medical device start up company.

61 RADIATION PROTECTION AND DOSIMETRY↗

DOE OSTI2015

MO-A-213-02: 2015 Economics Update Part 2

The purpose of this session is to introduce attendees to the healthcare reimbursement system and how it applies to the clinical work of a Medical Physicist. This will include general information about the different categories of payers and payees, how work is described by CPT© codes, and how various payers set values for this work in different clinical settings. 2015 is a year of significant changes to the payment system. Many CPT© codes have been deleted and replaced with new CPT© codes. These codes define some of the most common work performed in our clinics including treatment planning and delivery. This presentation will describe what work is encompassed in these codes and will give attendees an overview of the changes for 2015 as they apply to radiation oncology. Finally, some insight into what can be expected during 2016 will be presented. This includes what information is typically released by the Centers for Medicaid & Medicare Services (CMS) during the year and how we as an organization respond. This will include ways members can interact with the AAPM professional economics committee and other resources members may find helpful. Learning Objectives: Basics of how Medicare is structured and how reimbursement rates are set. Basic understanding of proposed changes to the 2016 Medicare rules. What resources are available from the AAPM and how to interact with the professional economics committee. Ownership in pxAlpha, LLC, a medical device start up company.

29 ENERGY PLANNING, POLICY, AND ECONOMY↗

DOE OSTI2015

MO-DE-BRA-02: From Teaching to Learning: Systems-Based-Practice and Practice-Based-Learning Innovations in Medical Physics Education Programs

Purpose: The increasing complexity in the field of radiation medicine and concomitant rise in patient safety concerns call for enhanced systems-level training for future medical physicists and thus commensurate innovations in existing educational program curricula. In this work we report on the introduction of three learning opportunities to augment medical physics educational programs towards building systems-based practice and practice-based learning competencies. Methods: All initiatives were introduced for senior -level graduate students and physics residents in an institution with a newly established medical-physics graduate program and therapeutic-physics residency program. The first, centered on incident learning, was based on a spreadsheet tool that incorporated the reporting structure of the Radiation Oncology-incident Learning System (ROILS), included 120 narratives of published incidents and enabled inter-rater variability calculations. The second, centered on best-practices, was a zero-credit seminar course, where students summarized select presentations from the AAPM virtual library on a weekly basis and moderated class discussions using a point/counterpoint approach. Presentation styles were critiqued. The third; centered on learning-by-teaching, required physics residents to regularly explain fundamental concepts in radiological physics from standard textbooks to board certified physics faculty members. Results: Use of the incident-learning system spreadsheet provided a platform to recast known accidents into the framework of ROILS, thereby increasing awareness of factors contributing to unsafe practice and appreciation for inter-rater variability. The seminar course enhanced awareness of best practices, the effectiveness of presentation styles and encouraged critical thinking. The learn-by-teaching rotation allowed residents to stay abreast of and deepen their knowledge of relevant subjects. Conclusion: The incorporation of systems-driven initiatives broadens comprehension of the wider systems context of medical physics, enhances awareness of resources for innovation, communication and sustained learning while maintaining a metric-driven focus on patient safety within the formative phase of student careers. The initiatives were well-received, feasible, and utilized available or shared-resources translatable across educational programs.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

MO-DE-BRA-03: TOPAS-edu: A Window Into the Stochastic World Through the TOPAS Tool for Particle Simulation

Purpose: The stochastic nature of the subatomic world presents a challenge for physics education. Even experienced physicists can be amazed at the varied behavior of electrons, x-rays, protons, neutrons, ions and the any short-lived particles that make up the overall behavior of our accelerators, brachytherapy sources and medical imaging systems. The all-particle Monte Carlo particle transport tool, TOPAS Tool for Particle Simulation, originally developed for proton therapy research, has been repurposed into a physics teaching tool, TOPAS-edu. Methods: TOPAS-edu students set up simulated particle sources, collimators, scatterers, imagers and scoring setups by writing simple ASCII files (in the TOPAS Parameter Control System format). Students visualize geometry setups and particle trajectories in a variety of modes from OpenGL graphics to VRML 3D viewers to gif and PostScript image files. Results written to simple comma separated values files are imported by the student into their preferred data analysis tool. Students can vary random seeds or adjust parameters of physics processes to better understand the stochastic nature of subatomic physics. Results: TOPAS-edu has been successfully deployed as the centerpiece of a physics course for master’s students at Queen’s University Belfast. Tutorials developed there takes students through a step by step course on the basics of particle transport and interaction, scattering, Bremsstrahlung, etc. At each step in the course, students build simulated experimental setups and then analyze the simulated results. Lessons build one upon another so that a student might end up with a full simulation of a medical accelerator, a water-phantom or an imager. Conclusion: TOPAS-edu was well received by students. A second application of TOPAS-edu is currently in development at Zurich University of Applied Sciences, Switzerland. It is our eventual goal to make TOPAS-edu available free of charge to any non-profit organization, along with associated tutorial materials developed by the TOPAS-edu community. Work supported in part by the U.S. Department of Energy under contract number DE-AC02-76SF00515. B. Villagomez-Bernabe is supported by CONACyT (Mexican Council for Science and Technology) project 231844.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

MO-DE-BRA-05: Developing Effective Medical Physics Knowledge Structures: Models and Methods

Purpose: Develop a method and supporting online resources to be used by medical physics educators for teaching medical imaging professionals and trainees so they develop highly-effective physics knowledge structures that can contribute to improved diagnostic image quality on a global basis. Methods: The different types of mental knowledge structures were analyzed and modeled with respect to both the learning and teaching process for their development and the functions or tasks that can be performed with the knowledge. While symbolic verbal and mathematical knowledge structures are very important in medical physics for many purposes, the tasks of applying physics in clinical imaging--especially to optimize image quality and diagnostic accuracy--requires a sensory conceptual knowledge structure, specifically, an interconnected network of visually based concepts. This type of knowledge supports tasks such as analysis, evaluation, problem solving, interacting, and creating solutions. Traditional educational methods including lectures, online modules, and many texts are serial procedures and limited with respect to developing interconnected conceptual networks. A method consisting of the synergistic combination of on-site medical physics teachers and the online resource, CONET (Concept network developer), has been developed and made available for the topic Radiographic Image Quality. This was selected as the inaugural topic, others to follow, because it can be used by medical physicists teaching the large population of medical imaging professionals, such as radiology residents, who can apply the knowledge. Results: Tutorials for medical physics educators on developing effective knowledge structures are being presented and published and CONET is available with open access for all to use. Conclusion: An adjunct to traditional medical physics educational methods with the added focus on sensory concept development provides opportunities for medical physics teachers to share their knowledge and experience at a higher cognitive level and produce medical professionals with the enhanced ability to apply physics to clinical procedures.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

TU-AB-BRD-03: Fault Tree Analysis

Current quality assurance and quality management guidelines provided by various professional organizations are prescriptive in nature, focusing principally on performance characteristics of planning and delivery devices. However, published analyses of events in radiation therapy show that most events are often caused by flaws in clinical processes rather than by device failures. This suggests the need for the development of a quality management program that is based on integrated approaches to process and equipment quality assurance. Industrial engineers have developed various risk assessment tools that are used to identify and eliminate potential failures from a system or a process before a failure impacts a customer. These tools include, but are not limited to, process mapping, failure modes and effects analysis, fault tree analysis. Task Group 100 of the American Association of Physicists in Medicine has developed these tools and used them to formulate an example risk-based quality management program for intensity-modulated radiotherapy. This is a prospective risk assessment approach that analyzes potential error pathways inherent in a clinical process and then ranks them according to relative risk, typically before implementation, followed by the design of a new process or modification of the existing process. Appropriate controls are then put in place to ensure that failures are less likely to occur and, if they do, they will more likely be detected before they propagate through the process, compromising treatment outcome and causing harm to the patient. Such a prospective approach forms the basis of the work of Task Group 100 that has recently been approved by the AAPM. This session will be devoted to a discussion of these tools and practical examples of how these tools can be used in a given radiotherapy clinic to develop a risk based quality management program. Learning Objectives: Learn how to design a process map for a radiotherapy process Learn how to perform failure modes and effects analysis analysis for a given process Learn what fault trees are all about Learn how to design a quality management program based upon the information obtained from process mapping, failure modes and effects analysis and fault tree analysis. Dunscombe: Director, TreatSafely, LLC and Center for the Assessment of Radiological Sciences; Consultant to IAEA and Varian Thomadsen: President, Center for the Assessment of Radiological Sciences Palta: Vice President of the Center for the Assessment of Radiological Sciences.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

TU-AB-BRD-04: Development of Quality Management Program

Current quality assurance and quality management guidelines provided by various professional organizations are prescriptive in nature, focusing principally on performance characteristics of planning and delivery devices. However, published analyses of events in radiation therapy show that most events are often caused by flaws in clinical processes rather than by device failures. This suggests the need for the development of a quality management program that is based on integrated approaches to process and equipment quality assurance. Industrial engineers have developed various risk assessment tools that are used to identify and eliminate potential failures from a system or a process before a failure impacts a customer. These tools include, but are not limited to, process mapping, failure modes and effects analysis, fault tree analysis. Task Group 100 of the American Association of Physicists in Medicine has developed these tools and used them to formulate an example risk-based quality management program for intensity-modulated radiotherapy. This is a prospective risk assessment approach that analyzes potential error pathways inherent in a clinical process and then ranks them according to relative risk, typically before implementation, followed by the design of a new process or modification of the existing process. Appropriate controls are then put in place to ensure that failures are less likely to occur and, if they do, they will more likely be detected before they propagate through the process, compromising treatment outcome and causing harm to the patient. Such a prospective approach forms the basis of the work of Task Group 100 that has recently been approved by the AAPM. This session will be devoted to a discussion of these tools and practical examples of how these tools can be used in a given radiotherapy clinic to develop a risk based quality management program. Learning Objectives: Learn how to design a process map for a radiotherapy process Learn how to perform failure modes and effects analysis analysis for a given process Learn what fault trees are all about Learn how to design a quality management program based upon the information obtained from process mapping, failure modes and effects analysis and fault tree analysis. Dunscombe: Director, TreatSafely, LLC and Center for the Assessment of Radiological Sciences; Consultant to IAEA and Varian Thomadsen: President, Center for the Assessment of Radiological Sciences Palta: Vice President of the Center for the Assessment of Radiological Sciences.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

TU-A-304-00: Imaging, Treatment Planning, and QA for Stereotactic Body Radiation Therapy (SBRT)

Increased use of SBRT and hypo fractionation in radiation oncology practice has posted a number of challenges to medical physicist, ranging from planning, image-guided patient setup and on-treatment monitoring, to quality assurance (QA) and dose delivery. This symposium is designed to provide updated knowledge necessary for the safe and efficient implementation of SBRT in various linac platforms, including the emerging digital linacs equipped with high dose rate FFF beams. Issues related to 4D CT, PET and MRI simulations, 3D/4D CBCT guided patient setup, real-time image guidance during SBRT dose delivery using gated/un-gated VMAT or IMRT, and technical advancements in QA of SBRT (in particular, strategies dealing with high dose rate FFF beams) will be addressed. The symposium will help the attendees to gain a comprehensive understanding of the SBRT workflow and facilitate their clinical implementation of the state-of-art imaging and planning techniques. Learning Objectives: Present background knowledge of SBRT, describe essential requirements for safe implementation of SBRT, and discuss issues specific to SBRT treatment planning and QA. Update on the use of multi-dimensional (3D and 4D) and multi-modality (CT, beam-level X-ray imaging, pre- and on-treatment 3D/4D MRI, PET, robotic ultrasound, etc.) for reliable guidance of SBRT. Provide a comprehensive overview of emerging digital linacs and summarize the key geometric and dosimetric features of the new generation of linacs for substantially improved SBRT. Discuss treatment planning and quality assurance issues specific to SBRT. Research grant from Varian Medical Systems.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

TU-A-304-01: Introduction and Workflow of Image-Guided SBRT

Increased use of SBRT and hypo fractionation in radiation oncology practice has posted a number of challenges to medical physicist, ranging from planning, image-guided patient setup and on-treatment monitoring, to quality assurance (QA) and dose delivery. This symposium is designed to provide updated knowledge necessary for the safe and efficient implementation of SBRT in various linac platforms, including the emerging digital linacs equipped with high dose rate FFF beams. Issues related to 4D CT, PET and MRI simulations, 3D/4D CBCT guided patient setup, real-time image guidance during SBRT dose delivery using gated/un-gated VMAT or IMRT, and technical advancements in QA of SBRT (in particular, strategies dealing with high dose rate FFF beams) will be addressed. The symposium will help the attendees to gain a comprehensive understanding of the SBRT workflow and facilitate their clinical implementation of the state-of-art imaging and planning techniques. Learning Objectives: Present background knowledge of SBRT, describe essential requirements for safe implementation of SBRT, and discuss issues specific to SBRT treatment planning and QA. Update on the use of multi-dimensional (3D and 4D) and multi-modality (CT, beam-level X-ray imaging, pre- and on-treatment 3D/4D MRI, PET, robotic ultrasound, etc.) for reliable guidance of SBRT. Provide a comprehensive overview of emerging digital linacs and summarize the key geometric and dosimetric features of the new generation of linacs for substantially improved SBRT. Discuss treatment planning and quality assurance issues specific to SBRT. Research grant from Varian Medical Systems.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

TU-A-304-02: Treatment Simulation, Planning and Delivery for SBRT

Increased use of SBRT and hypo fractionation in radiation oncology practice has posted a number of challenges to medical physicist, ranging from planning, image-guided patient setup and on-treatment monitoring, to quality assurance (QA) and dose delivery. This symposium is designed to provide updated knowledge necessary for the safe and efficient implementation of SBRT in various linac platforms, including the emerging digital linacs equipped with high dose rate FFF beams. Issues related to 4D CT, PET and MRI simulations, 3D/4D CBCT guided patient setup, real-time image guidance during SBRT dose delivery using gated/un-gated VMAT or IMRT, and technical advancements in QA of SBRT (in particular, strategies dealing with high dose rate FFF beams) will be addressed. The symposium will help the attendees to gain a comprehensive understanding of the SBRT workflow and facilitate their clinical implementation of the state-of-art imaging and planning techniques. Learning Objectives: Present background knowledge of SBRT, describe essential requirements for safe implementation of SBRT, and discuss issues specific to SBRT treatment planning and QA. Update on the use of multi-dimensional (3D and 4D) and multi-modality (CT, beam-level X-ray imaging, pre- and on-treatment 3D/4D MRI, PET, robotic ultrasound, etc.) for reliable guidance of SBRT. Provide a comprehensive overview of emerging digital linacs and summarize the key geometric and dosimetric features of the new generation of linacs for substantially improved SBRT. Discuss treatment planning and quality assurance issues specific to SBRT. Research grant from Varian Medical Systems.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

TU-A-304-03: Quality Assurance, Safety, and Other Practical Aspects of SBRT

Increased use of SBRT and hypo fractionation in radiation oncology practice has posted a number of challenges to medical physicist, ranging from planning, image-guided patient setup and on-treatment monitoring, to quality assurance (QA) and dose delivery. This symposium is designed to provide updated knowledge necessary for the safe and efficient implementation of SBRT in various linac platforms, including the emerging digital linacs equipped with high dose rate FFF beams. Issues related to 4D CT, PET and MRI simulations, 3D/4D CBCT guided patient setup, real-time image guidance during SBRT dose delivery using gated/un-gated VMAT or IMRT, and technical advancements in QA of SBRT (in particular, strategies dealing with high dose rate FFF beams) will be addressed. The symposium will help the attendees to gain a comprehensive understanding of the SBRT workflow and facilitate their clinical implementation of the state-of-art imaging and planning techniques. Learning Objectives: Present background knowledge of SBRT, describe essential requirements for safe implementation of SBRT, and discuss issues specific to SBRT treatment planning and QA. Update on the use of multi-dimensional (3D and 4D) and multi-modality (CT, beam-level X-ray imaging, pre- and on-treatment 3D/4D MRI, PET, robotic ultrasound, etc.) for reliable guidance of SBRT. Provide a comprehensive overview of emerging digital linacs and summarize the key geometric and dosimetric features of the new generation of linacs for substantially improved SBRT. Discuss treatment planning and quality assurance issues specific to SBRT. Research grant from Varian Medical Systems.

60 APPLIED LIFE SCIENCES↗