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At least 865 records · Page 48
All sourcesNASA NTRSDOE OSTI
DOE OSTI2014

SU-E-J-235: Varian Portal Dosimetry Accuracy at Detecting Simulated Delivery Errors

Purpose: To use receiver operating characteristic (ROC) analysis to quantify the Varian Portal Dosimetry (VPD) application's ability to detect delivery errors in IMRT fields. Methods: EPID and VPD were calibrated/commissioned using vendor-recommended procedures. Five clinical plans comprising 56 modulated fields were analyzed using VPD. Treatment sites were: pelvis, prostate, brain, orbit, and base of tongue. Delivery was on a Varian Trilogy linear accelerator at 6MV using a Millenium120 multi-leaf collimator. Image pairs (VPD-predicted and measured) were exported in dicom format. Each detection test imported an image pair into Matlab, optionally inserted a simulated error (rectangular region with intensity raised or lowered) into the measured image, performed 3%/3mm gamma analysis, and saved the gamma distribution. For a given error, 56 negative tests (without error) were performed, one per 56 image pairs. Also, 560 positive tests (with error) with randomly selected image pairs and randomly selected in-field error location. Images were classified as errored (or error-free) if percent pixels with γ<κ was < (or ≥) τ. (Conventionally, κ=1 and τ=90%.) A ROC curve was generated from the 616 tests by varying τ. For a range of κ and τ, true/false positive/negative rates were calculated. This procedure was repeated for inserted errors of different sizes. VPD was considered to reliably detect an error if images were correctly classified as errored or error-free at least 95% of the time, for some κ+τ combination. Results: 20mm{sup 2} errors with intensity altered by ≥20% could be reliably detected, as could 10mm{sup 2} errors with intensity was altered by ≥50%. Errors with smaller size or intensity change could not be reliably detected. Conclusion: Varian Portal Dosimetry using 3%/3mm gamma analysis is capable of reliably detecting only those fluence errors that exceed the stated sizes. Images containing smaller errors can pass mathematical analysis, though may be detected by visual inspection. This work was not funded by Varian Oncology Systems. Some authors have other work partly funded by Varian Oncology Systems.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-J-236: Feasibility of Using Infrared Imaging to Verify the Accuracy of the Radiotherapy Delivery

Purpose: To assess whether infrared imaging can be used to verify the accuracy of the radiation treatment delivery. Methods: Radiation treatment induced skin reactions include acute changes (erythema and pigmentation) and chronic changes (telangiectasia and ulceration). Thermal imaging can detect these reactions before they become visible. A thermal camera with infrared spectral band 7.5 μm to 14 μm, and temperature measurement range from −20 °C to +150 °C and accuracy of ±2 °C was used. Beams-eye-view images were taken by the end of each treatment for a head and neck patient. The temperature changes of three points were monitored throughout the treatment course, including two points in the field (canthus and vessel) and one point outside of the field. The thermal images were warped and registered to the corresponding planning CT skin rendering. Dose map was exported from the treatment planning system and warped and registered to the planning CT skin rendering as well. The correlation between these two warped and registered images was calculated. The time spent to take the images was recorded. Results: The temperatures of the two points inside the field were always higher than the temperature of the point outside of the field. The temperature inside the field tended to increase as more fractions delivered to the patient. A correlation of 0.90 was found between the registered thermal image and the 3D dose map. On average, half minute was needed to take the images after each treatment. Conclusion: Thermal imaging can monitor the temperature variations of the skin, and the temperatures were proportional to the dose map. It can therefore potentially be an inexpensive and non-ionization tool to verify the accuracy of the radiation treatment delivery.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-J-264: Comparison of Two Commercially Available Software Platforms for Deformable Image Registration

Purpose: To evaluate and compare the deformable image registration algorithms available in the Velocity (Velocity Medical Solutions, Atlanta, GA) and RayStation (RaySearch Americas, Inc., Garden city NY). Methods: Ten consecutive patient cone beam CTs (CBCT) for each fraction were collected. The CBCTs along with the simulation CT were exported to the Velocity and the RayStation software. Each CBCT was registered using deformable image registration to the simulation CT and the resulting deformable vector matrix was generated. Each registration was visually inspected by a physicist and the prescribing physician. The volumes of the critical organs were calculated for each deformable CT and used for comparison. Results: The resulting deformable registrations revealed differences between the two algorithms. These differences were realized when the organs at risk were contoured on each deformed CBCT. Differences in the order of 10% ±30% in volume were observed for bladder, 17 ±21% for rectum and 16±10% for sigmoid. The prostate and PTV volume differences were in the order of 3±5%. The volumetric differences observed had a respective impact on the DVHs of all organs at risk. Differences of 8–10% in the mean dose were observed for all organs above. Conclusion: Deformable registration is a powerful tool that aids in the definition of critical structures and is often used for the evaluation of daily dose delivered to the patient. It should be noted that extended QA should be performed before clinical implementation of the software and the users should be aware of advantages and limitations of the methods.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-04: 3D Printed Patient-Specific Surface Mould Applicators for Brachytherapy Treatment of Superficial Lesions

Purpose: Evaluate the feasibility of constructing 3D-printed patient-specific surface mould applicators for HDR brachytherapy treatment of superficial lesions. Methods: We propose using computer-aided design software to create 3D printed surface mould applicators for brachytherapy. A mould generation module was developed in the open-source 3D Slicer ( http://www.slicer.org ) medical image analysis platform. The system extracts the skin surface from CT images, and generates smooth catheter paths over the region of interest based on user-defined start and end points at a specified stand-off distance from the skin surface. The catheter paths are radially extended to create catheter channels that are sufficiently wide to ensure smooth insertion of catheters for a safe source travel. An outer mould surface is generated to encompass the channels. The mould is also equipped with fiducial markers to ensure its reproducible placement. A surface mould applicator with eight parallel catheter channels of 4mm diameters was fabricated for the nose region of a head phantom; flexible plastic catheters of 2mm diameter were threaded through these channels maintaining 10mm catheter separations and a 5mm stand-off distance from the skin surface. The apparatus yielded 3mm thickness of mould material between channels and the skin. The mould design was exported as a stereolithography file to a Dimension SST1200es 3D printer and printed using ABS Plus plastic material. Results: The applicator closely matched its design and was found to be sufficiently rigid without deformation during repeated application on the head phantom. Catheters were easily threaded into channels carved along catheter paths. Further tests are required to evaluate feasibility of channel diameters smaller than 4mm. Conclusion: Construction of 3D-printed mould applicators show promise for use in patient specific brachytherapy of superficial lesions. Further evaluation of 3D printing techniques and materials is required for constructing sufficiently thin, rigid and durable surface moulds suitable for clinical deployment.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-05: A 2D EPID Transit Dosimetry Model Based On An Empirical Quadratic Formalism

Purpose: To describe a 2D electronic portal imaging device (EPID) transit dosimetry model, based on an empirical quadratic formalism, that can predict either EPID or in-phantom dose distribution for comparisons with EPID captured image or treatment planning system (TPS) dose respectively. Methods: A quadratic equation can be used to relate the reduction in intensity of an exit beam to the equivalent path length of the attenuator. The calibration involved deriving coefficients from a set of dose planes measured for homogeneous phantoms with known thicknesses under reference conditions. In this study, calibration dose planes were measured with EPID and ionisation chamber (IC) in water for the same reference beam (6MV, 100mu, 20×20cm{sup 2}) and set of thicknesses (0–30cm). Since the same calibration conditions were used, the EPID and IC measurements can be related through the quadratic equation. Consequently, EPID transit dose can be predicted from TPS exported dose planes and in-phantom dose can be predicted using EPID distribution captured during treatment as an input. The model was tested with 4 open fields, 6 wedge fields, and 7 IMRT fields on homogeneous and heterogeneous phantoms. Comparisons were done using 2D absolute gamma (3%/3mm) and results were validated against measurements with a commercial 2D array device. Results: The gamma pass rates for comparisons between EPID measured and predicted ranged from 93.6% to 100.0% for all fields and phantoms tested. Results from this study agreed with 2D array measurements to within 3.1%. Meanwhile, comparisons in-phantom between TPS computed and predicted ranged from 91.6% to 100.0%. Validation with 2D array device was not possible for inphantom comparisons. Conclusion: A 2D EPID transit dosimetry model for treatment verification was described and proven to be accurate. The model has the advantage of being generic and allows comparisons at the EPID plane as well as multiple planes in-phantom.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-106: Development of a Collision Prediction Algorithm for Determining Problematic Geometry for SBRT Treatments Using a Stereotactic Body Frame

Purpose: Collision between the gantry and the couch or patient during Radiotherapy is not a common concern for conventional RT (static fields or arc). With the increase in the application of stereotactic planning techniques to the body, collisions have become a greater concern. Non-coplanar beam geometry is desirable in stereotatic treatments in order to achieve sharp gradients and a high conformality. Non-coplanar geometry is less intuitive in the body and often requires an iterative process of planning and dry runs to guarantee deliverability. Methods: Purpose written software was developed in order to predict the likelihood of collision between the head of the gantry and the couch, patient or stereotatic body frame. Using the DICOM plan and structures set, exported by the treatment planning system, this software is able to predict the possibility of a collision. Given the plan's isocenter, treatment geometry and exterior contours, the software is able to determine if a particular beam/arc is clinically deliverable or if collision is imminent. Results: The software was tested on real world treatment plans with untreatable beam geometry. Both static non-coplanar and VMAT plans were tested. Of these, the collision prediction software could identify all as having potentially problematic geometry. Re-plans of the same cases were also tested and validated as deliverable. Conclusion: This software is capable of giving good initial indication of deliverability for treatment plans that utilize complex geometry (SBRT) or have lateral isocenters. This software is not intended to replace the standard pre-treatment QA dry run. The effectiveness is limited to those portions of the patient and immobilization devices that have been included in the simulation CT and contoured in the planning system. It will however aid the planner in reducing the iterations required to create complex treatment geometries necessary to achieve ideal conformality and organ sparing.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-212: Influence of the Modulation Index On Daily Quality Assurance in Rapid Arc Treatments

Purpose: At our Institute some measured parameters for daily quality assurance (DQA) of dynamic arc therapy plans showed an unexpected behavior, therefore an investigation of the influence of the magnitude of modulation was conducted. Methods: In our clinical practice all DQAs of dynamic arc therapy plans are measured and analyzed prior to treatments using commercial software. For this study these plans were additionally exported to our in-house software written in MATLAB.The developed software extracted the leaf position, gantry angle, cumulative meterset weight of each control point (CP) and the total number of Monitor Units (MU) of each arc. Based on this information we calculated the leaf travel distance, irradiated segment area, number of MUs and dose rate for each CP. These data allowed us to calculate the modulation indexes (MI) of the plans, applying five different definitions of MI. The results were then correlated to the results of our DQA measurements.To validate the software, additional plans of known MIs were created and analyzed. For confirmation, the calculated parameters were compared to the segmented treatment table (STT) coming from the treatment planning system. Results: All calculated CP-parameters matched the STT by 99% or better. For linac 1, the comparison of the MI evaluation and the DQA results showed a slight tendency: 91.3% failed DQA plans had a MI lower than the average value. For this definition we consider that the lower the MI the higher the modulation. The results of the linac 2 present no significant relevance due to the low sample sizes for each DQA software. Conclusion: Available data and given definitions of the modulation index do not bring conclusive results; one cannot find a clear and distinct correlation with the failure of the DQA. The ongoing analysis with an increased sample size might lead to another conclusion.

07 ISOTOPE AND RADIATION SOURCES↗
DOE OSTI2014

SU-E-T-213: Initial Experience with VMAT Plan and Delivery Verification Using a DICOM-RT Framework and Linac Delivery Log Files

Purpose: Mobius3D/MobiusFX (M3D/MFX), a commercial DICOM-RT based plan and delivery verification system, was used to compare calculated and delivered volumetric modulated arc therapy (VMAT) dose distributions using TrueBeam delivery log files (TrajectoryLogs). Methods: M3D/MFX utilizes measured linac commissioning data to generate institution specific beam models for evaluating planned and delivered dose distributions. 30 RapidArc prostate plans and 30 head and neck SmartArc plans were used in this study. For every plan, CT images, contoured structure sets, RT-plan, and RT-dose files were exported to M3D, which recalculated the patients’ planning CT dose distributions using a collapsed-cone-convolutionsuperposition algorithm. MFX utilized the acquired TrajectoryLogs to compute patients’ delivered dose distributions based on actual treatment delivery parameters. The agreement between computed and delivered dose distributions was evaluated utilizing a (3%, 3mm) global 3D-gamma analysis and dose-volume histogram changes for targets and organs at risk. Results: Excellent 3D-gamma agreements were observed for all VMAT plans. On average, for computed and delivered RapidArc and SmartArc plans the gamma passing rates were (99.0%±1.4%) and (96.8%±1.8%), respectively. The average difference for primary target prescription dose percent-coverage between calculated and delivered plans was (− 0.09%±2.52%) for RapidArc and (−2.71%±4.62%) for SmartArc cases. Similarly, the planning target mean dose differences were (1.38%±0.96%) for RapidArc and (1.17%±0.72%) for SmartArc plans. For the prostate plans, the calculated and delivered variations of the maximum dose for a 2cc volume for bladder and rectum were (1.32%±1.26%) and (0.65%±1.44%), respectively. The spinal-cord 2cc maximum dose differences of (3.26%±1.68%) were observed for the SmartArc plans. Conclusions: Clinical quality assurance practice based on linac treatment log files for verification of delivered 3D dose distributions in the patients’ geometries represents a paradigm shift from dose measurements in a phantom. This approach captures treatment planning beam modeling differences as well as the linac uncertainties during treatment delivery of the plan.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-252: On the Evaluation of Patient Specific IMRT QA Using EPID, Dynalog Files and Patient Anatomy

Purpose: This research, investigates the viability of using the Electronic portal imaging device (EPID) coupled with the treatment planning system (TPS), to calculate the doses delivered and verify agreement with the treatment plan. The results of QA analysis using the EPID, Delta4 and fluence calculations using the multi-leaf collimator (MLC) dynalog files on 10 IMRT patients are presented in this study. Methods: EPID Fluence Images in integrated mode and Dynalog files for each field were acquired for 10 IMRT (6MV) patients and processed through an in house MatLab program to create an opening density matrix (ODM) which was used as the input fluence for dose calculation with the TPS (Pinnacle3, Philips). The EPID used in this study was the aSi1000 Varian on a Novalis TX linac equipped with high definition MLC. The resulting dose distributions were then exported to VeriSoft (PTW) where a 3D gamma was calculated using 3mm-3% criteria. The Scandidos Delta4 phantom was also used to measure a 2D dose distribution for all 10 patients and a 2D gamma was calculated for each patient using the Delta4 software. Results: The average 3D gamma for all 10 patients using the EPID images was 98.2% ± 2.6%. The average 3D gamma using the dynalog files was 94.6% ± 4.9%. The average 2D gamma from the Delta4 was 98.1% ± 2.5%. The minimum 3D gamma for the EPID and dynalog reconstructed dose distributions was found on the same patient which had a very large PTV, requiring the jaws to open to the maximum field size. Conclusion: Use of the EPID, combined with a TPS is a viable method for QA of IMRT plans. A larger ODM size can be implemented to accommodate larger field sizes. An adaptation of this process to Volumetric Arc Therapy (VMAT) is currently under way.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-314: The Application of Cloud Computing in Pencil Beam Scanning Proton Therapy Monte Carlo Simulation

Purpose: Monte Carlo simulation plays an important role for proton Pencil Beam Scanning (PBS) technique. However, MC simulation demands high computing power and is limited to few large proton centers that can afford a computer cluster. We study the feasibility of utilizing cloud computing in the MC simulation of PBS beams. Methods: A GATE/GEANT4 based MC simulation software was installed on a commercial cloud computing virtual machine (Linux 64-bits, Amazon EC2). Single spot Integral Depth Dose (IDD) curves and in-air transverse profiles were used to tune the source parameters to simulate an IBA machine. With the use of StarCluster software developed at MIT, a Linux cluster with 2–100 nodes can be conveniently launched in the cloud. A proton PBS plan was then exported to the cloud where the MC simulation was run. Results: The simulated PBS plan has a field size of 10×10cm{sup 2}, 20cm range, 10cm modulation, and contains over 10,000 beam spots. EC2 instance type m1.medium was selected considering the CPU/memory requirement and 40 instances were used to form a Linux cluster. To minimize cost, master node was created with on-demand instance and worker nodes were created with spot-instance. The hourly cost for the 40-node cluster was $0.63 and the projected cost for a 100-node cluster was $1.41. Ten million events were simulated to plot PDD and profile, with each job containing 500k events. The simulation completed within 1 hour and an overall statistical uncertainty of < 2% was achieved. Good agreement between MC simulation and measurement was observed. Conclusion: Cloud computing is a cost-effective and easy to maintain platform to run proton PBS MC simulation. When proton MC packages such as GATE and TOPAS are combined with cloud computing, it will greatly facilitate the pursuing of PBS MC studies, especially for newly established proton centers or individual researchers.

07 ISOTOPE AND RADIATION SOURCES↗
DOE OSTI2014

SU-E-T-349: Verification of a Monte Carlo Simulation Tool as a Second Check for TomoTherapy Treatment Planning

Purpose: To verify a virtual source model used in Monte Carlo (MC) TomoTherapy simulations and to provide a tool for the dose distribution second check for TomoTherapy treatment planning. Methods: Published studies adopted the full MC model to simulate helical TomoTherapy which use phase space files (PSFs) at different scoring planes to facilitate patient dose calculations. We have developed a simple virtual source model (VSM) based on the commissioning data of helical TomoTherapy unit which can be exported from the treatment planning station (TPS). To calculate the patient dose distribution, TPS-generated sinograms are extracted from archived patient XML files and fluence maps are created by incorporating the openclose leaf time with leaf filter, jaw penumbra, and leaf latency. The VSM has been validated for various geometrical set-ups including open fields, heterogeneous media and clinical DQA cases. Results: Good agreement was obtained between our VSM and a published full MC model for the test case of heterogeneous media. For the complex clinical head and neck (HN) case, the MC simulation of the DQA plan agreed with the film measurement with 98% of planar dose pixels passing the 2%/2 mm gamma value test. For the patient treatment plan itself, the MC simulation showed comparable DVHs for the planning target volumes (PTVs) and organs-at-risk (OARs). Deviations observed were consistent with literature. Conclusion: The proposed VSM can be used in the MC method to accurately simulate the patient dose distributions for helical TomoTherapy.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-404: Simple Field-In-Field Technique for Total Body Irradiation in Large Patients

Purpose: A simple Field-in-Field technique for Total Body Irradiation (TBI) was developed for traditional AP/PA TBI treatments to improve dosimetric uniformity in patients with large separation. Methods: TBI at our institution currently utilizes an AP/PA technique at an extended source-to-surface distance (SSD) of 380cm with patients in left decubitus position during the AP beam and in right decubitus during the PA beam. Patients who have differences in thickness (separation) between the abdomen and head greater than 10cm undergo CT simulation in both left and right decubitus treatment positions. One plan for each CT is generated to evaluate dose to patient midline with both AP and PA fields, but only corresponding AP fields will be exported for treatment for patient left decubitus position and PA fields for patient right decubitus position. Subfields are added by collimating with the x-ray jaws according to separation changes at 5–7% steps to minimize hot regions to less than 10%. Finally, the monitor units (MUs) for the plans are verified with hand calculation and water phantom measurements. Results: Dose uniformity (+/−10%) is achieved with field-in-field using only asymmetric jaws. It is dosimetrically robust with respect to minor setup/patient variations inevitable due to patient conditions. MUs calculated with Pinnacle were verified in 3 clinical cases and only a 2% difference was found compared to homogeneous calculation. In-vivo dosimeters were also used to verify doses received by each patient with and confirmed dose variations less than 10%. Conclusion: We encountered several cases with separation differences that raised uniformity concerns — based on a 1% dose difference per cm separation difference assumption. This could Resultin an unintended hot spot, often in the head/neck, up to 25%. This method allows dose modulation without adding treatment complexity nor introducing radiobiological variations, providing a reasonable solution for this unique TBI situation.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-453: A Novel Daily QA System for Robotic Image Guided Radiosurgery with Variable Aperture Collimator

Purpose: A novel end-to-end system using a CCD camera and a scintillator based phantom that is capable of measuring the beam-by-beam delivery accuracy of Robotic Radiosurgery has been developed and reported in our previous work. This work investigates its application to end-to-end type daily QA for Robotic Radiosurgery (Cyberknife) with Variable Aperture Collimator (Iris). Methods: The phantom was first scanned with a CT scanner at 0.625 slice thickness and exported to the Cyberknife Muliplan (v4.6) treatment planning system. An isocentric treatment plan was created consisting of ten beams of 25 Monitor Units each using Iris apertures of 7.5, 10, 15, 20, and 25 mm. The plan was delivered six times in two days on the Cyberknife G4 system with fiducial tracking on the four metal fiducials embedded in phantom with re-positioning between the measurements. The beam vectors (X, Y, Z) are measured and compared with the plan from the machine delivery file (XML file). The Iris apertures (FWHM) were measured from the beam flux map and compared with the commissioning data. Results: The average beam positioning accuracies of the six deliveries are 0.71 ± 0.40 mm, 0.72 ± 0.44 mm, 0.74 ± 0.42 mm, 0.70 ± 0.40 mm, 0.79 ± 0.44 mm and 0.69 ± 0.41 mm respectively. Radiation beam width (FWHM) variations are within ±0.05 mm, and they agree with the commissioning data within 0.22 mm. The delivery time for the plan is about 7 minutes and the results are given instantly. Conclusion: The experimental results agree with stated sub-millimeter delivery accuracy of Cyberknife system. Beam FWHM variations comply with the 0.2 mm accuracy of the Iris collimator at SAD. The XRV-100 system has proven to be a powerful tool in performing end-to-end type tests for Robotic Image Guided Radiosurgery Daily QA.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗
DOE OSTI2014

SU-E-T-461: Validation of Planning Algorithms in Dynamic Conformal Arc in IPlan Using ArcCHECK and 3DVH

Purpose: To study the effect of limited angular resolution of pencil beam calculation (PBC) on dynamic conformal arc plan (DCAP) in iPlan (BrainLab) using the ArcCHECK sytem and 3DVH software (Sun Nuclear Corporation). Methods: Four DCAPs were generated in iPlan RT Dose 4.5 treatment planning system on the ArcCHECK cylindrical phantom with central planning target volume (PTV). A cylindrical shell structure (SHELL) 2.85cm from phantom surface and 1.5 mm thickness was created to simulate the ArcCHECK diode array. Planned doses were calculated using both Monte Carlo calculation (MCC) and PBC algorithms, and exported to 3DVH software for global and target based comparisons using the 3Dgamma index. Four additional DCAPs were created and calculated on patient CT images and mapped onto the ArcCHECK phantom for measurement using a Varian TrueBeam STx. The measurements were compared against both MC and PB calculation using gamma index analysis. Results: For the ArcCHECK phantom, the dose distribution agreement quantified with 3D-gamma index is better (average-gamma (<γ>)=99.9%vs.79.1% and 96.8%vs45.7%, p=0.0294, 0.0286 for gamma (2mm,2%) and (1mm,1%) criteria respectively using Mann-Whitney U test) in the PTV than in the SHELL. The measurements show better agreement with MCC than the PB (<γ>=100%vs.86.7%, 99.6%vs.72.3%, 85.5%vs.50.8%, p=0.021, 0.026, 0.029 for gamma (3mm,3%), (2mm,2%) and (1mm,1%) criteria using Mann-Whitney U test respectively). The effect due to limited (10 degree) angular resolution of the PBC was observed, and it can be one of the possible reasons for poor agreement between measurement and PB calculation. Conclusion: The PBC of iPlan shows poor peripheral dose calculation accuracy for dynamic conformal arc plans due to limited angular resolution, but it performs well in the area close to target volume without considering heterogeneity. Since the user cannot change the 10 degree angular resolution of PBC, MCC is more appropriate for dynamic conformal arc plans.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-473: A Patient-Specific QC Paradigm Based On Trajectory Log Files and DICOM Plan Files

Purpose: To evaluate a remote QC tool for monitoring treatment machine parameters and treatment workflow. Methods: The Varian TrueBeamTM linear accelerator is a digital machine that records machine axis parameters and MLC leaf positions as a function of delivered monitor unit or control point. This information is saved to a binary trajectory log file for every treatment or imaging field in the patient treatment session. A MATLAB analysis routine was developed to parse the trajectory log files for a given patient, compare the expected versus actual machine and MLC positions as well as perform a cross-comparison with the DICOM-RT plan file exported from the treatment planning system. The parsing routine sorts the trajectory log files based on the time and date stamp and generates a sequential report file listing treatment parameters and provides a match relative to the DICOM-RT plan file. Results: The trajectory log parsing-routine was compared against a standard record and verify listing for patients undergoing initial IMRT dosimetry verification and weekly and final chart QC. The complete treatment course was independently verified for 10 patients of varying treatment site and a total of 1267 treatment fields were evaluated including pre-treatment imaging fields where applicable. In the context of IMRT plan verification, eight prostate SBRT plans with 4-arcs per plan were evaluated based on expected versus actual machine axis parameters. The average value for the maximum RMS MLC error was 0.067±0.001mm and 0.066±0.002mm for leaf bank A and B respectively. Conclusion: A real-time QC analysis program was tested using trajectory log files and DICOM-RT plan files. The parsing routine is efficient and able to evaluate all relevant machine axis parameters during a patient treatment course including MLC leaf positions and table positions at time of image acquisition and during treatment.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-480: Radiobiological Dose Comparison of Single Fraction SRS, Multi-Fraction SRT and Multi-Stage SRS of Large Target Volumes Using the Linear-Quadratic Formula

Purpose: To compare the radiobiological effect on large tumors and surrounding normal tissues from single fraction SRS, multi-fractionated SRT, and multi-staged SRS treatment. Methods: An anthropomorphic head phantom with a centrally located large volume target (18.2 cm{sup 3}) was scanned using a 16 slice large bore CT simulator. Scans were imported to the Multiplan treatment planning system where a total prescription dose of 20Gy was used for a single, three staged and three fractionated treatment. Cyber Knife treatment plans were inversely optimized for the target volume to achieve at least 95% coverage of the prescription dose. For the multistage plan, the target was segmented into three subtargets having similar volume and shape. Staged plans for individual subtargets were generated based on a planning technique where the beam MUs of the original plan on the total target volume are changed by weighting the MUs based on projected beam lengths within each subtarget. Dose matrices for each plan were export in DICOM format and used to calculate equivalent dose distributions in 2Gy fractions using an alpha beta ratio of 10 for the target and 3 for normal tissue. Results: Singe fraction SRS, multi-stage plan and multi-fractionated SRT plans had an average 2Gy dose equivalent to the target of 62.89Gy, 37.91Gy and 33.68Gy, respectively. The normal tissue within 12Gy physical dose region had an average 2Gy dose equivalent of 29.55Gy, 16.08Gy and 13.93Gy, respectively. Conclusion: The single fraction SRS plan had the largest predicted biological effect for the target and the surrounding normal tissue. The multi-stage treatment provided for a more potent biologically effect on target compared to the multi-fraction SRT treatments with less biological normal tissue than single-fraction SRS treatment.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-551: PTV Is the Worst-Case of CTV in Photon Therapy

Purpose: To examine the supposition of the static dose cloud and adequacy of the planning target volume (PTV) dose distribution as the worst-case representation of clinical target volume (CTV) dose distribution for photon therapy in head and neck (H and N) plans. Methods: Five diverse H and N plans clinically delivered at our institution were selected. Isocenter for each plan was shifted positively and negatively in the three cardinal directions by a displacement equal to the PTV expansion on the CTV (3 mm) for a total of six shifted plans per original plan. The perturbed plan dose was recalculated in Eclipse (AAA v11.0.30) using the same, fixed fluence map as the original plan. The dose distributions for all plans were exported from the treatment planning system to determine the worst-case CTV dose distributions for each nominal plan. Two worst-case distributions, cold and hot, were defined by selecting the minimum or maximum dose per voxel from all the perturbed plans. The resulting dose volume histograms (DVH) were examined to evaluate the worst-case CTV and nominal PTV dose distributions. Results: Inspection demonstrates that the CTV DVH in the nominal dose distribution is indeed bounded by the CTV DVHs in the worst-case dose distributions. Furthermore, comparison of the D95% for the worst-case (cold) CTV and nominal PTV distributions by Pearson's chi-square test shows excellent agreement for all plans. Conclusion: The assumption that the nominal dose distribution for PTV represents the worst-case dose distribution for CTV appears valid for the five plans under examination. Although the worst-case dose distributions are unphysical since the dose per voxel is chosen independently, the cold worst-case distribution serves as a lower bound for the worst-case possible CTV coverage. Minor discrepancies between the nominal PTV dose distribution and worst-case CTV dose distribution are expected since the dose cloud is not strictly static. This research was supported by the NCI through grant K25CA168984, by The Lawrence W. and Marilyn W. Matteson Fund for Cancer Research, and by the Fraternal Order of Eagles Cancer Research Fund, the Career Development Award Program at Mayo Clinic.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-572: Beam Characteristics and Treatment Planning Commissioning for a New Proton Therapy Unit

Purpose: A single-room proton system, the Mevion S250, was introduced into the arena of proton radiotherapy by Mevion Medical Systems. The first unit was installed and operates at the S. Lee Kling Proton Therapy Center at Barnes-Jewish Hospital. The objective of this abstract is to report the system's beam characteristics and Eclipse commissioning. Methods: Commissioning data were acquired for modelling longitudinal fluence, virtual source position, effective source position, source size and Bragg peaks in Eclipse. Stoichiometric CT calibration was generated via ICRU44 human. Spread-out Bragg peaks (SOBP) were measured with Parallel Plate Chamber and profiles with solid state detector for model validation. Heterogeneity effects were measured with bone and lung inserts in the beam line. RT dose was computed in a virtual water phantom, and exported from Eclipse to compare with measurements at various depths and axis. SOBPs were fine-tuned with partial shining correction and entry correction to match measurements. Output factor was measured for each individual field with an ADCL ion chamber in a water tank and fitted to a polynomial function to cross-check the monitor unit verification. Results: Ranges of all 24 options were measured within ±1mm tolerance. Modulations met a ±1mm or ±2% tolerance. SOBP flatness met a ±3% tolerance. Distal fall off (80%-20%) were measured between 6mm and 7mm for all options. Virtual source positions varied between 177cm and 195cm, decreasing with field size and range. SOBP generated by Eclipse agreed with measurements within ±3% in the entry region, and ±1%/±1mm in other regions. Sanity check for output achieved 5% accuracy in 98% of cases. Conclusion: The commissioning of the first Mevions S250 proton therapy system met specifications. The unit has been put in clinical operation since 12/17/2013.

60 APPLIED LIFE SCIENCES↗