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SU-F-T-674: In Vitro Study of 5-Aminolevulinic Acid-Mediated Photo Dynamic Therapy in Human Cancer Cell Lines

Purpose: Photodynamic therapy (PTD) is a promising cancer treatment modality. 5-sminolevulinic acid (ALA) is a clinically approved photosensitizer. Here we studied the effect of 5-ALA administration with irradiation on several cell lines in vitro. Methods: Human head and neck (FaDu), lung (A549) and prostate (LNCaP) cancer cells (104/well) were seeded overnight in 96-well plates (Figure 1). 5-ALA at a range from 0.1 to 30.0mg/ml was added to confluent cells 3h before irradiation in 100ul of culture medium. 15MV photon beams from a Siemens Artiste linear accelerator were used to deliver 2 Gy dose in one fraction to the cells. Cell viability was evaluated by WST1 assay. The development of orange color was measured 3h after the addition of WST-1 reagent at 450nm on an Envision Multilabel Reader (Figure 2) and directly correlated to cell number. Control, untreated cells were incubated without 5-ALA. The experiment was performed twice for each cell line. Results: The cell viability rates for the head and neck cancer line are shown in Figure 3. FaDu cell viability was reduced significantly to 36.5% (5-ALA) and 18.1% (5-ALA + RT) only at the highest concentration of 5-ALA, 30mg/ml. This effect was observed in neither A549, nor LNCaP cell line. No toxicity was detected at lower 5-ALA concentrations. Conclusion: Application of 5-ALA and subsequent PDT was found to be cytotoxic at the highest dose of the photosensitizer used in the FaDu head and neck cell line, and their effect was synergistic. Further efforts are necessary to study the potential therapeutic effects of 5-ALA PTD in vitro and in vivo. Our results suggest 5-ALA may improve the efficacy of radiotherapy by acting as a radiomediator in head and neck cancer.

60 APPLIED LIFE SCIENCES↗

SU-G-IeP4-06: Feasibility of External Beam Treatment Field Verification Using Cherenkov Imaging

Purpose: Cherenkov light emission has been shown to correlate with ionizing radiation (IR) dose delivery in solid tissue. In order to properly correlate Cherenkov light images with real time dose delivery in a patient, we must account for geometric and intensity distortions arising from observation angle, as well as the effect of monitor units (MU) and field size on Cherenkov light emission. To test the feasibility of treatment field verification, we first focused on Cherenkov light emission efficiency based on MU and known field size (FS). Methods: Cherenkov light emission was captured using a PI-MAX4 intensified charge coupled device(ICCD) system (Princeton Instruments), positioned at a fixed angle of 40° relative to the beam central axis. A Varian TrueBeam linear accelerator (linac) was operated at 6MV and 600MU/min to deliver an Anterior-Posterior beam to a 5cm thick block phantom positioned at 100cm Source-to-Surface-Distance(SSD). FS of 10×10, 5×5, and 2×2cm{sup 2} were used. Before beam delivery projected light field images were acquired, ensuring that geometric distortions were consistent when measuring Cherenkov field discrepancies. Cherenkov image acquisition was triggered by linac target current. 500 frames were acquired for each FS. Composite images were created through summation of frames and background subtraction. MU per image was calculated based on linac pulse delay of 2.8ms. Cherenkov and projected light FS were evaluated using ImageJ software. Results: Mean Cherenkov FS discrepancies compared to light field were <0.5cm for 5.6, 2.8, and 8.6 MU for 10×10, 5×5, and 2×2cm{sup 2} FS, respectably. Discrepancies were reduced with increasing field size and MU. We predict a minimum of 100 frames is needed for reliable confirmation of delivered FS. Conclusion: Current discrepancies in Cherenkov field sizes are within a usable range to confirm treatment delivery in standard and respiratory gated clinical scenarios at MU levels appropriate to standard MLC position segments.

60 APPLIED LIFE SCIENCES↗

Poster — Thur Eve — 21: Off-axis dose perturbation effects in water in a 5 × 5 cm{sup 2} 18 MV photon beam for the PTW microLion and Exradin A1SL ionization chambers

A PTW microLion liquid ionization chamber and an Exradin A1SL air-filled ionization chamber have been modeled using the egs-chamber user code of the EGSnrc system to determine their perturbation effects in water in a 5 × 5 cm{sup 2} 18 MV photon beam. A model of the Varian CL21EX linear accelerator was constructed using the BEAMnrc Monte Carlo code, and was validated by comparing measured PDDs and profiles from the microLion and A1SL chambers to calculated results that included chamber models. Measured PDDs for a 5 × 5 cm{sup 2} field for the microLion chamber agreed with calculations to within 1.5% beyond a depth of 0.5 cm, and the A1SL PDDs agreed within 1.0% beyond 1.0 cm. Measured and calculated profiles at 10 cm depth agreed within 1.0% for both chambers inside the field, and within 4.0% near the field edge. Local percent differences increased up to 15% at 4 cm outside the field. The ratio of dose to water in the absence of the chamber relative to dose in the chamber's active volume as a function of off-axis distance was calculated using the egs-chamber correlated sampling technique. The dose ratio was nearly constant inside the field and consistent with the stopping power ratios of water to detector material, but varied up to 3.3% near the field edge and 5.2% at 4 cm outside the field. Once these perturbation effects are fully characterized for more field sizes and detectors, they could be applied to clinical water tank measurements for improved dosimetric accuracy.

07 ISOTOPE AND RADIATION SOURCES↗

SU-E-T-479: IMRT Plan Recalculation in Patient Based On Dynalog Data and the Effect of a Single Failing MLC Motor

Purpose: Using Linac dynamic logs (Dynalogs) we evaluate the impact of a single failing MLC motor on the deliverability of an IMRT plan by assessing the recalculated dose volume histograms (DVHs) taking the delivered MLC positions and beam hold-offs into consideration. Methods: This is a retrospective study based on a deteriorating MLC motor (leaf 36B) which was observed to be failing via Dynalog analysis. To investigate further, Eclipse-importable MLC files were generated from Dynalogs to recalculate the actual delivered dose and to assess the clinical impact through DVHs. All deliveries were performed on a Varian 21EX linear accelerator equipped with Millennium-120 MLC. The analysis of Dynalog files and subsequent conversion to Eclipse-importable MLC files were all performed by in-house programming in Python. Effects on plan DVH are presented in the following section on a particular brain-IMRT plan which was delivered with a failing MLC motor which was then replaced. Results: Global max dose increased by 13.5%, max dose to the brainstem PRV increased by 8.2%, max dose to the optic chiasm increased by 7.6%, max dose to optic nerve increased by 8.8% and the mean dose to the PTV increased by 7.9% when comparing the original plan to the fraction with the failing MLC motor. The reason the dose increased was due to the failure being on the B-bank which is the lagging side on a sliding window delivery, therefore any failures on this side will cause an over-irradiation as the B-bank leaves struggles to keep the window from growing. Conclusion: Our findings suggest that a single failing MLC motor may jeopardize the entire delivery. This may be due to the bad MLC motor drawing too much current causing all MLCs on the same bank to underperform. This hypothesis will be investigated in a future study.

60 APPLIED LIFE SCIENCES↗

SU-C-201-02: Dosimetric Verification of SBRT with FFF-VMAT Using a 3-D Radiochromic/Optical-CT Dosimetry System

Purpose: With an increasing use of small field size and high dose rate irradiation in the advances of radiotherapy techniques, such as stereotactic body radiotherapy (SBRT) and stereotactic radiosurgery (SRS), an in-depth quality assurance (QA) system is required. The purpose of this study is to investigate a high resolution optical CT-based 3D radiochromic dosimetry system for SBRT with intensity modulated radiotherapy (IMRT) and flattening filter free (FFF) volumetric modulated arc therapy (VMAT). Methods: Cylindrical PRESAGE radiochromic dosimeters of 10cm height and 11cm diameter were used to validate SBRT. Four external landmarks were placed on the surface of each dosimeter to define the isocenter of target. SBRT plans were delivered using a Varian TrueBeam™ linear accelerator (LINAC). Three validation plans, SBRT with IMRT (6MV 600MU/min), FFF-VMAT (10MV 2400MU/min), and mixed FFF-VMAT (6MV 1400MU/min, 10MV 2400MU/min), were delivered to the PRESAGE dosimeters. Each irradiated PRESAGE dosimeter was scanned using a single laser beam optical CT scanner and reconstructed with a 1mm × 1mm high spatial resolution. The comparison of measured dose distributions of irradiated PRESAGE dosimeters to those calculated by Pinnacle{sup 3} treatment planning system (TPS) were performed with a 10% dose threshold, 3% dose difference (DD), and 3mm distance-to-agreement (DTA) Gamma criteria. Results: The average pass rates for the gamma comparisons between PRESAGE and Pinnacle{sup 3} in the transverse, sagittal, coronal planes were 94.6%, 95.9%, and 96.4% for SBRT with IMRT, FFF-VMAT, and mixed FFF-VMAT plans, respectively. A good agreement of the isodose distributions of those comparisons were shown at the isodose lines 50%, 70%, 80%, 90% and 98%. Conclusion: This study demonstrates the feasibility of the high resolution optical CT-based 3D radiochromic dosimetry system for validation of SBRT with IMRT and FFF-VMAT. This dosimetry system offers higher precision QA with 3D dose information for small beams compared to what is currently available.

60 APPLIED LIFE SCIENCES↗

Sci-Thur PM – Colourful Interactions: Highlights 01: Design to delivery of spatially fractionated mini-beam canine radiotherapy

Spatial fractionation of radiation using arrays of narrow parallel micro-planar beams (less than 1 mm), is a relatively new concept with many unknowns specifically within the underlying biology of cell death. A tungsten collimator has been designed to produce mini-beams with a Varian linear accelerator for translational animal research into the effectiveness of spatial fractionation mini-beam radiotherapy (MBRT). This work presents the treatment planning process and workflow for the application of MBRT treatments within a clinical study. For patient dose calculations, the MBRT collimator was incorporated into a Monte Carlo based treatment planning system called MMCTP. Treatment planning was split between Eclipse and MMCTP, as the field apertures were determined within Eclipse prior to being sent to MMCTP for dose calculations. The calculated plan was transferred back into Aria with updated MUs per field for patient treatment. Patients were positioned within a vac-lock bag lying prone with a bite block and a thermoplastic mask to immobilize the head. Prior to treatment, a delivery verification plan was created within MMCTP. DQA output measurements of the treatment fields agreed with the calculated dose to within 1.5%. We have presented a workflow for MBRT treatments that include the planning technique, dose calculation method, DQA process and data integration into a record and verify system. The clinical study following this workflow represent the first series of linac based MBRT patients and depending on the clinical outcome of the study, our technique could be applied to human MBRT treatments.

60 APPLIED LIFE SCIENCES↗

SU-E-T-409: Evaluation of Tissue Composition Effect On Dose Distribution in Radiotherapy with 6 MV Photon Beam of a Medical Linac

Purpose: The aim of this study is to evaluate soft tissue composition effect on dose distribution for various soft tissues and various depths in radiotherapy with 6 MV photon beam of a medical linac. Methods: A phantom and Siemens Primus linear accelerator were simulated using MCNPX Monte Carlo code. In a homogeneous cubic phantom, six types of soft tissue and three types of tissue-equivalent materials were defined separately. The soft tissues were muscle (skeletal), adipose tissue, blood (whole), breast tissue, soft tissue (9-component) and soft tissue (4-component). The tissue-equivalent materials included: water, A-150 tissue-equivalent plastic and perspex. Photon dose relative to dose in 9-component soft tissue at various depths on the beam’s central axis was determined for the 6 MV photon beam. The relative dose was also calculated and compared for various MCNPX tallies including,F8, F6 and,F4. Results: The results of the relative photon dose in various materials relative to dose in 9-component soft tissue and using different tallies are reported in the form of tabulated data. Minor differences between dose distributions in various soft tissues and tissue-equivalent materials were observed. The results from F6 and F4 were practically the same but different with,F8 tally. Conclusion: Based on the calculations performed, the differences in dose distributions in various soft tissues and tissue-equivalent materials are minor but they could be corrected in radiotherapy calculations to upgrade the accuracy of the dosimetric calculations.

60 APPLIED LIFE SCIENCES↗

SU-E-T-61: Capabilities and Considerations for the Clinical Use of Flattening Filter Free (FFF) Beams for Volumetric Modulated Arc Therapy (VMAT)

Purpose: Machines with FFF beams are becoming more prevalent. As technology evolves, guidelines for its use need to be developed. FFF beams have the potential for much greater dose rates and lower out-of-field dose. The use of VMAT with FFF adds additional complexity. This work attempts to define the capabilities and limitations of FFF when applied to VMAT fields and characterize the situations which this technology is best suited. Methods: The total monitor units of a VMAT delivery is modified to determine the minimum deliverable dose rate for FFF and non-FFF beams on an Elekta VersaHD linear accelerator. The minimum dose rate limits the minimum dose per segments, thus reducing the available modulation. Time is assessed by recording the beam-on time for FFF and non-FFF beams. For 10 plans with standard fraction sizes (180–212 cGy/Fx) maximum dose rate per control point and number of control points exceeding 400 MU/min are recorded. Results: VMAT minimum dose rate is related to the pulse rate. The minimum deliverable dose rate is ∼36 MU/min (0.12 MU/deg) for 6x-FFF (max 1400 MU/min) and ∼75 MU/min (0.27 MU/deg) for 10x-FFF (max 2400 MU/min) beams. Delivery time is independent of dose rate for dose rates below 1500 MU/min as it is limited by gantry speed. The maximum dose rate across in all plans according to Pinnacle is 1170 MU/min for FFF plans and 800 MU/min for non-FFF plans. The percentage of control points exceeding 400 MU/min is 13.3% for FFF and 9% for non-FFF beams. Conclusion: FFF does not improve delivery time of VMAT fields for conventional fraction sizes, since the dominant factor is gantry speed instead of dose rate. However, there may be potential for speed improvement for very large fraction sizes. Due to pulse rate dependency, FFF beams require a higher minimum dose rate.

60 APPLIED LIFE SCIENCES↗

SU-E-T-318: Dosimetric Evaluation of ArcCHECK and 3DVH System Using Customized Polymer Gel Dosimeter

Purpose: ArcCHECK and 3DVH system (Sun Nuclear) can reconstruct the three-dimensional (3D) dose distribution and provide the DVH analysis in a patient. The aim of this study was to evaluate dosimetric accuracy of this system using customized polymer gel dosimeter, and also Gafchromic EBT3 films. Methods: Polyacrylamide-based gel contained magnesium chloride as a sensitizer (iPAGAT) was used in this study. Volumetric-modulated arc therapy (VMAT) plan was performed for the C-shape structure by the Eclipse treatment planning system (Varian) and used to irradiate the ArcCHECK by the Novalis Tx linear accelerator (Varian/BrainLAB). The cubic phantom filled with iPAGAT and EBT3 films placed in three orthogonal planes (axial, sagittal, and coronal) inserted into the I’mRT Phantom (IBA Dosimetry) simulated a patient were irradiated with the same VMAT plan. The measurement-guided 3D dose distribution was reconstructed using 3DVH software from the measured data of the ArcCHECK. The 3D dose distribution in iPAGAT was read out by Signa 1.5 T MRI system (GE), and 2D dose distribution on EBT3 was read out by color scanner (Epson). The comparison of all the dose distributions was performed with dose profiles and gamma index analysis in orthogonal planes using in-house developed software. Results: A good agreement was observed by overlaying the dose profiles of 3DVH, EBT3, and iPAGAT. The mean pass rates by gamma index analysis with 3%/3 mm criteria in orthogonal planes were 94.3% (3DVH vs EBT3), 91.1% (3DVH vs iPAGAT), and 96.4% (iPAGAT vs EBT3), respectively. Conclusion: 3D dose distribution reconstructed by ArcCHECK and 3DVH system was estimated accurately in a patient. However, slightly differences were observed between 3DVH and iPAGAT because of MRI noise, therefore further study is required to improve the accuracy of MRI based polymer gel dosimetry for the DVH analysis.

60 APPLIED LIFE SCIENCES↗

SU-F-T-415: Differences in Lung Sparing in Deep Inspiration Breath-Hold and Free Breathing Breast Plans Calculated in Pinnacle and Monaco

Purpose: Deep inspiration breath-hold (DIBH) is used for left-sided breast radiotherapy to spare the heart and lung. The magnitude of sparing has been shown to be significant. Monte Carlo, furthermore, has the potential to calculate most accurately the dose in the heterogeneous lung medium at the interface with the lung wall. The lung dose was investigated in Monaco to determine the level of sparing relative to that calculated in Pinnacle{sup 3}. Methods: Five patients undergoing DIBH radiotherapy on an Elekta Versa HD linear accelerator in conjunction with the Catalyst C-RAD surface imaging system were planned using Phillips Pinnacle{sup 3}. Free breathing plans were also created to clinically assure a benefit. Both plans were re-calculated in Monaco to determine if there were any significant differences. The mean heart dose, mean left lung, and mean total lung dose were compared in addition to the V20 for left and both lungs. Dose was calculated as dose to medium as well as dose to water with a statistical precision of 0.7%. Results: Mean lung dose was significantly different (p < 0.003) between the two calculations for both DIBH (11.6% higher in Monaco) and free breathing (14.2% higher in Monaco). V20 was also higher in Monaco (p < 0.05) for DIBH (5.7% higher) and free breathing (4.9% higher). The mean heart dose was not significantly different between the dose calculations for either DIBH or free breathing. Results were no more than 0.1% different when calculated as dose to water. Conclusion: The use of Monte Carlo can provide insight on the lung dose for both free breathing and DIBH techniques for whole breast irradiation. While the sparing (dose reductions with DIBH as compared to free breathing) is equivalent for either planning system, the lung doses themselves are higher when calculated with Monaco.

60 APPLIED LIFE SCIENCES↗

SU-F-T-479: Estimation of the Accuracy in Respiratory-Gated Radiotherapy

Purpose: Irregular respiratory patterns affects dose outputs in respiratorygated radiotherapy and there is no commercially available quality assurance (QA) system for it. We designed and developed a patient specific QA system for respiratory-gated radiotherapy to estimate irradiated output. Methods: Our in-house QA system for gating was composed of a personal computer with the USB-FSIO electronic circuit connecting to the linear accelerator (ONCOR-K, Toshiba Medical Systems). The linac implements a respiratory gating system (AZ-733V, Anzai Medical). During the beam was on, 4.2 V square-wave pulses were continually sent to the system. Our system can receive and count the pulses. At first, our system and an oscilloscope were compared to check the performance of our system. Next, basic estimation models were generated when ionization-chamber measurements were performed in gating using regular sinusoidal wave patterns (2.0, 2.5, 4.0, 8.0, 15 sec/cycle). During gated irradiation with the regular patterns, the number of the pulses per one gating window was measured using our system. Correlation between the number of the pulses per one gating and dose per the gating window were assessed to generate the estimation model. Finally, two irregular respiratory patterns were created and the accuracy of the estimation was evaluated. Results: Compared to the oscilloscope, our system worked similarly. The basic models were generated with the accuracy within 0.1%. The results of the gated irradiations with two irregular respiratory patterns show good agreement within 0.4% estimation accuracy. Conclusion: Our developed system shows good estimation for even irregular respiration patterns. The system would be a useful tool to verify the output for respiratory-gated radiotherapy.

60 APPLIED LIFE SCIENCES↗

SU-E-J-29: Automatic Image Registration Performance of Three IGRT Systems for Prostate Radiotherapy

Purpose: To compare the performance of an automatic image registration algorithm on image sets collected on three commercial image guidance systems, and explore its relationship with imaging parameters such as dose and sharpness. Methods: Images of a CIRS Virtually Human Male Pelvis phantom (VHMP) were collected on the CBCT systems of Varian TrueBeam/OBI and Elekta Synergy/XVI linear accelerators, across a range of mAs settings; and MVCT on a Tomotherapy Hi-ART accelerator with a range of pitch. Using the 6D correlation ratio algorithm of XVI, each image was registered to a mask of the prostate volume with a 5 mm expansion. Registrations were repeated 100 times, with random initial offsets introduced to simulate daily matching. Residual registration errors were calculated by correcting for the initial phantom set-up error. Automatic registration was also repeated after reconstructing images with different sharpness filters. Results: All three systems showed good registration performance, with residual translations <0.5mm (1σ) for typical clinical dose and reconstruction settings. Residual rotational error had larger range, with 0.8°, 1.2° and 1.9° for 1σ in XVI, OBI and Tomotherapy respectively. The registration accuracy of XVI images showed a strong dependence on imaging dose, particularly below 4mGy. No evidence of reduced performance was observed at the lowest dose settings for OBI and Tomotherapy, but these were above 4mGy. Registration failures (maximum target registration error > 3.6 mm on the surface of a 30mm sphere) occurred in 5% to 10% of registrations. Changing the sharpness of image reconstruction had no significant effect on registration performance. Conclusions: Using the present automatic image registration algorithm, all IGRT systems tested provided satisfactory registrations for clinical use, within a normal range of acquisition settings.

60 APPLIED LIFE SCIENCES↗

SU-E-T-796: Variation of Surface Photon Energy Spectra On Bone Heterogeneity and Beam Obliquity Between Flattened and Unflattened Beam

Purpose: This study investigates the spectra of surface photon energy and energy fluence in the bone heterogeneity and beam obliquity using flattened and unflattened photon beams. The spectra were calculated in a bone and water phantom using Monte Carlo simulation (the EGSnrc code). Methods: Spectra of energy, energy fluence and mean energy of the 6 MV flattened and unflattened photon beams (field size = 10 × 10 cm{sup 2}) produced by a Varian TrueBEAM linear accelerator were calculated at the surfaces of a bone and water phantom using Monte Carlo simulations. The spectral calculations were repeated with the beam angles turned from 0° to 15°, 30° and 45° in the phantoms. Results: It is found that the unflattened photon beams contained more photons in the low-energy range of 0 – 2 MeV than the flattened beams with a flattening filter. Compared to the water phantom, both the flattened and unflattened beams had slightly less photons in the energy range < 0.4 MeV when a bone layer of 1 cm is present under the phantom surface. This shows that the presence of the bone decreased the low-energy photons backscattered to the phantom surface. When the photon beams were rotated from 0° to 45°, the number of photon and mean photon energy increased with the beam angle. This is because both the flattened and unflattened beams became more hardened when the beam angle increased. With the bone heterogeneity, the mean energies of both photon beams increased correspondingly. This is due to the absorption of low-energy photons by the bone, resulting in more significant beam hardening. Conclusion: The photon spectral information is important in studies on the patient’s surface dose enhancement when using unflattened photon beams in radiotherapy.

60 APPLIED LIFE SCIENCES↗

Quality of Intensity Modulated Radiation Therapy Treatment Plans Using a {sup 60}Co Magnetic Resonance Image Guidance Radiation Therapy System

Purpose: This work describes a commercial treatment planning system, its technical features, and its capabilities for creating {sup 60}Co intensity modulated radiation therapy (IMRT) treatment plans for a magnetic resonance image guidance radiation therapy (MR-IGRT) system. Methods and Materials: The ViewRay treatment planning system (Oakwood Village, OH) was used to create {sup 60}Co IMRT treatment plans for 33 cancer patients with disease in the abdominal, pelvic, thorax, and head and neck regions using physician-specified patient-specific target coverage and organ at risk (OAR) objectives. Backup plans using a third-party linear accelerator (linac)-based planning system were also created. Plans were evaluated by attending physicians and approved for treatment. The {sup 60}Co and linac plans were compared by evaluating conformity numbers (CN) with 100% and 95% of prescription reference doses and heterogeneity indices (HI) for planning target volumes (PTVs) and maximum, mean, and dose-volume histogram (DVH) values for OARs. Results: All {sup 60}Co IMRT plans achieved PTV coverage and OAR sparing that were similar to linac plans. PTV conformity for {sup 60}Co was within <1% and 3% of linac plans for 100% and 95% prescription reference isodoses, respectively, and heterogeneity was on average 4% greater. Comparisons of OAR mean dose showed generally better sparing with linac plans in the low-dose range <20 Gy, but comparable sparing for organs with mean doses >20 Gy. The mean doses for all {sup 60}Co plan OARs were within clinical tolerances. Conclusions: A commercial {sup 60}Co MR-IGRT device can produce highly conformal IMRT treatment plans similar in quality to linac IMRT for a variety of disease sites. Additional work is in progress to evaluate the clinical benefit of other novel features of this MR-IGRT system.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

SU-E-J-47: Development of a High-Precision, Image-Guided Radiotherapy, Multi- Purpose Radiation Isocenter Quality-Assurance Calibration and Checking System

Purpose: To develop a system that can define the radiation isocenter and correlate this information with couch coordinates, laser alignment, optical distance indicator (ODI) settings, optical tracking system (OTS) calibrations, and mechanical isocenter walkout. Methods: Our team developed a multi-adapter, multi-purpose quality assurance (QA) and calibration device that uses an electronic portal imaging device (EPID) and in-house image-processing software to define the radiation isocenter, thereby allowing linear accelerator (Linac) components to be verified and calibrated. Motivated by the concept that each Linac component related to patient setup for image-guided radiotherapy based on cone-beam CT should be calibrated with respect to the radiation isocenter, we designed multiple concentric adapters of various materials and shapes to meet the needs of MV and KV radiation isocenter definition, laser alignment, and OTS calibration. The phantom's ability to accurately define the radiation isocenter was validated on 4 Elekta Linacs using a commercial ball bearing (BB) phantom as a reference. Radiation isocenter walkout and the accuracy of couch coordinates, ODI, and OTS were then quantified with the device. Results: The device was able to define the radiation isocenter within 0.3 mm. Radiation isocenter walkout was within ±1 mm at 4 cardinal angles. By switching adapters, we identified that the accuracy of the couch position digital readout, ODI, OTS, and mechanical isocenter walkout was within sub-mm. Conclusion: This multi-adapter, multi-purpose isocenter phantom can be used to accurately define the radiation isocenter and represents a potential paradigm shift in Linac QA. Moreover, multiple concentric adapters allowed for sub-mm accuracy for the other relevant components. This intuitive and user-friendly design is currently patent pending.

07 ISOTOPE AND RADIATION SOURCES↗

SU-E-T-464: Implementation and Validation of 4D Acuros XB Dose Calculations

Purpose: In this abstract we implement and validate a 4D VMAT Acuros XB dose calculation using Gafchromic film. Special attention is paid to the physical material assignment in the CT dataset and to reported dose to water and dose to medium. Methods: A QUASAR phantom with a 3 cm sinusoidal tumor motion and 5 second period was scanned using 4D computed tomography. A CT was also obtained of the static QUASAR phantom with the tumor at the central position. A VMAT plan was created on the average CT dataset and was delivered on a Varian TrueBeam linear accelerator. The trajectory log file from this treatment was acquired and used to create 10 VMAT subplans (one for each portion of the breathing cycle). Motion for each subplan was simulated by moving the beam isocentre in the superior/inferior direction in the Treatment Planning System on the static CT scan. The 10 plans were calculated (both dose to medium and dose to water) and summed for 1) the original HU values from the static CT scan and 2) the correct physical material assignment in the CT dataset. To acquire a breathing phase synchronized film measurements the trajectory log was used to create a VMAT delivery plan which includes dynamic couch motion using the Developer Mode. Three different treatment start phases were investigated (mid inhalation, full inhalation and full exhalation). Results: For each scenario the coronal dose distributions were measured using Gafchromic film and compared to the corresponding calculation with Film QA Pro Software using a Gamma test with a 3%/3mm distance to agreement criteria. Good agreement was found between calculation and measurement. No statistically significant difference in agreement was found between calculations to original HU values vs calculations to over-written (material-assigned) HU values. Conclusion: The investigated 4D dose calculation method agrees well with measurement.

60 APPLIED LIFE SCIENCES↗

Measurement of time delays in gated radiotherapy for realistic respiratory motions

Purpose: Gated radiotherapy is used to reduce internal motion margins, escalate target dose, and limit normal tissue dose; however, its temporal accuracy is limited. Beam-on and beam-off time delays can lead to treatment inefficiencies and/or geographic misses; therefore, AAPM Task Group 142 recommends verifying the temporal accuracy of gating systems. Many groups use sinusoidal phantom motion for this, under the tacit assumption that use of sinusoidal motion for determining time delays produces negligible error. The authors test this assumption by measuring gating time delays for several realistic motion shapes with increasing degrees of irregularity. Methods: Time delays were measured on a linear accelerator with a real-time position management system (Varian TrueBeam with RPM system version 1.7.5) for seven motion shapes: regular sinusoidal; regular realistic-shape; large (40%) and small (10%) variations in amplitude; large (40%) variations in period; small (10%) variations in both amplitude and period; and baseline drift (30%). Film streaks of radiation exposure were generated for each motion shape using a programmable motion phantom. Beam-on and beam-off time delays were determined from the difference between the expected and observed streak length. Results: For the system investigated, all sine, regular realistic-shape, and slightly irregular amplitude variation motions had beam-off and beam-on time delays within the AAPM recommended limit of less than 100 ms. In phase-based gating, even small variations in period resulted in some time delays greater than 100 ms. Considerable time delays over 1 s were observed with highly irregular motion. Conclusions: Sinusoidal motion shapes can be considered a reasonable approximation to the more complex and slightly irregular shapes of realistic motion. When using phase-based gating with predictive filters even small variations in period can result in time delays over 100 ms. Clinical use of these systems for patients with highly irregular patterns of motion is not advised due to large beam-on and beam-off time delays.

60 APPLIED LIFE SCIENCES↗

SU-F-T-264: VMAT QA with 2D Radiation Measuring Equipment Attached to Gantry

Purpose: To introduce a method of VMAT QA by 2D measuring device. The 2D device is attached to the gantry throughout measurement duration. This eliminates error caused by the angular dependence of the radiation detectors. Methods: A 2D radiation measuring device was attached to the gantry of linear accelerator. The center of the detector plane was at the isocenter. For each patient plan, two verification plans were created for QA purpose. One was like an ordinary VMAT plan, to be used for radiation delivery. The other is a plan with gantry angle fixed at zero, so the dose distribution as seen by the rotating 2D device. Points above 10% dose threshold were analyzed. Data is in tolerance if it fits within the 3 mm or 3% dose gamma criteria. For each patient, the plan was passed when 95% of all the points in the 2D matrix fit the gamma criteria. The following statistics were calculated: number of patient plans passed, percentage of all points passed, average percentage difference of all points. Results: VMAT QA was performed for patients during one year in our department, and the results were analyzed. All irradiation was with 6 MV photon beam. Each plan has calculated and measured doses compared. After collecting one year’s result, with 81 patient plans analyzed, all (100%) of the plans passed the gamma criteria. Of the points analyzed from all plans, 98.8% of all points passed. Conclusion: This method of attaching a 2D measuring device on the linac gantry proves to be an accurate way for VMAT QA. It is simple to use and low cost, and it eliminates the problem of directional dependence.

60 APPLIED LIFE SCIENCES↗