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DOE OSTI2015

SU-E-T-149: Brachytherapy Patient Specific Quality Assurance for a HDR Vaginal Cylinder Case

Purpose: Commonly Ir-192 HDR treatment planning system commissioning is only based on a single absolute measurement of source activity supplemented by tabulated parameters for multiple factors without independent verification that the planned distribution corresponds to the actual delivered dose. The purpose on this work is to present a methodology using Gafchromic film with a statistically valid calibration curve that can be used to validate clinical HDR vaginal cylinder cases by comparing the calculated plan dose distribution in a plane with the corresponding measured planar dose. Methods: A vaginal cylinder plan was created with Oncentra treatment planning system. The 3D dose matrix was exported to a Varian Eclipse work station for convenient extraction of a 2D coronal dose plane corresponding to the film position. The plan was delivered with a sheet of Gafchromic EBT3 film positioned 1mm from the catheter using an Ir-192 Nucletron HDR source. The film was then digitized with an Epson 10000 XL color scanner. Film analysis is performed with MatLab imaging toolbox. A density to dose calibration curve was created using TG43 formalism for a single dwell position exposure at over 100 points for statistical accuracy. The plan and measured film dose planes were registered using a known dwell position relative to four film marks. The plan delivered 500 cGy to points 2 cm from the sources. Results: The distance to agreement of the 500 cGy isodose between the plan and film measurement laterally was 0.5 mm but can be as much as 1.5 mm superior and inferior. The difference between the computed plan dose and film measurement was calculated per pixel. The greatest errors up to 50 cGy are near the apex. Conclusion: The methodology presented will be useful to implement more comprehensive quality assurance to verify patient-specific dose distributions.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

SU-E-T-220: Computational Accuracy of Adaptive Convolution (AC) and Collapsed Cone Convolution (CCC) Algorithms in the Presence of Air Gaps

Purpose: To compare the percentage depth dose (PDD) computational accuracy of Adaptive Convolution (AC) and Collapsed Cone Convolution (CCC) algorithms in the presence of air gaps. Methods: A 30×30×30 cm{sup 3} solid water phantom with two 5cm air gaps was scanned with a CT simulator unit and exported into the Phillips Pinnacle™ treatment planning system. PDDs were computed using the AC and CCC algorithms. Photon energy of 6 MV was used with field sizes of 3×3 cm{sup 2}, 5×5 cm{sup 2}, 10×10 cm{sup 2}, 15×15 cm{sup 2}, and 20×20 cm{sup 2}. Ionization chamber readings were taken at different depths in water for all the field sizes. The percentage differences in the PDDs were computed with normalization to the depth of maximum dose (dmax). The calculated PDDs were then compared with measured PDDs. Results: In the first buildup region, both algorithms overpredicted the dose for all field sizes and under-predicted for all other subsequent buildup regions. After dmax in the three water media, AC under-predicted the dose for field sizes 3×3 and 5×5 cm{sup 2} and overpredicted for larger field sizes, whereas CCC under-predicted for all field sizes. Upon traversing the first air gap, AC showed maximum differences of –3.9%, −1.4%, 2.0%, 2.5%, 2.9% and CCC had maximum differences of −3.9%, −3.0%,–3.1%, −2.7%, −1.8% for field sizes 3×3, 5×5, 10×10, 15×15, and 20×20 cm{sup 2} respectively. Conclusion: The effect of air gaps causes a significant difference in the PDDs computed by both the AC and CCC algorithms in secondary build-up regions. AC computed larger values for the PDDs except at smaller field sizes. For CCC, the size of the errors in prediction of the PDDs has an inverse relationship with respect to field size. These effects should be considered in treatment planning where significant air gaps are encountered.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

SU-E-T-241: Design and Implement of An Information Management System for Radiation Workers in a Hospital

Purpose: To meet the special needs of Medical Administration Division, an information management system for radiation workers in a hospital(IMSRWH) has been developed. Methods: There are about 200 radiation workers in 20 departments, such as department of radiology, department of radiation oncology, department of nuclear medicine, and so on. An IMSRWH server was used to run a database and web service of Apache+PHP+MySQL. The IMSRWH web service could be accessed with Internet Explorer(IE) to input, search, count, and print the radiation workers’ data. Every worker’s data information includes the following tables: registration, personal dose monitoring records, personnel certificate, training certificate, personnel license, medical examination, etc, and each table includes more optional detail information. Results: In the past year, the IMSRWH has been successfully developed and implemented in the hospital. According to the needs, the user rights are divided into: the system administrator, office manager, department manager and radiation worker. The different users have the different interfaces, and the appropriate authority permissions mean corresponding operations. The administrator and office manager could manage all personnel information, department manager could manage the staff information of his department, and the workers could view or modify their own information. Because information updates, involving hundreds of each entry and modification are complicated, each table information of all workers can be batch import from or export to a Microsoft Excel CSV format file, to update all together. However, it has only Chinese version now. Conclusion: It was demonstrated to be user-friendly and was proven to significantly improve the efficiency of the hospital management. Since it is an in-house developed system, more functions can be added or modified to further enhance its potentials in research and clinical practice.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

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

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

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

SU-E-T-277: Dose Calculation Comparisons Between Monaco, Pinnacle and Eclipse Treatment Planning Systems

Purpose: Monaco treatment planning system (TPS) version 5.0 uses a Monte-Carlo based dose calculation engine. The aim of this study is to verify and compare the Monaco based dose calculations with both Pinnacle{sup 3} collapsed cone convolution superposition (CCC) and Eclipse analytical anisotropic algorithm (AAA) calculations. Methods: For this study, previously treated SBRT lung, head and neck and abdomen patients were chosen to compare dose calculations between Pinnacle, Monaco and Eclipse. Plans were chosen from those that had been treated using the Elekta VersaHD or a NovalisTX linac. The plans included 3D conventional and IMRT beams using 6MV and 6MV Flattening filter free (FFF) photon beams. The original plans calculated with CCCS or AAA along with the recalculated ones using MC from the three TPS were exported into Velocity software for inter-comparison. Results: To compare the dose calculations, Mean Lung Dose (MLD), lung V5 and V20 values, and PTV Heterogeneity indexes (HI) and Conformity indexes (CI) were all calculated and recorded from the dose volume histograms (DVH). For each patient, the CI values were identical but there were differences in all other parameters. The HI was computed higher by 5 and 4% for calculated plans AAA and CCCS respectively, compared to the MC ones. The DVH graphs showed large differences between the CCCS and AAA and Monaco for 3D FFF, VMAT and IMRT plans. Better DVH agreement between was observed for 3D conventional plans. Conclusion: Better agreement was observed between CCCS and MC calculations than AAA and MC calculations. Those differences were more profound as the field size was decreasing and in the presence of inhomogeneities.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

SU-E-T-372: Evaluation and Comparison of Second-Check Monitor Unit Calculation Software with Pinnacle Treatment Planning System

Purpose: The purpose of this study was to evaluate and compare the accuracy of dose calculation algorithms in the second check software programs Radcalc, Diamond, IMSure, and MUcheck, against the Pinnacle3 treatment planning system (TPS). Methods: Baseline accuracy of the second check software was established by comparison against Pinnacle TPS data using open square fields of 5, 10, 20, 30 and 40cm in a SAD setup. 18 previously treated patients’ files were exported from the Pinnacle3 TPS to each of the four second check softwares, consisting of 146 step and shoot intensity modulated radiotherapy (IMRT) beams and 60 Smart Arcs. Monitor unit (MU) calculated in each of the software were compared with the TPS and the values were represented as a percent difference. Open fields were calculated as a baseline for each software’s accuracy using 5×5, 10×10, 20×20, 30×30, and 40×40 fields. Box plots, Pearson correlation, and Bland-Altman analysis were used for comparison of the results. Results: The baseline accuracy was established to within 0.6%, −1.4%, −0.2%, and −1.0% for Diamond, IMSure,MUcheck, and Radcalc, respectively. In the clinical data, the dose difference represented as mean ± 1 standard deviation were 0.7%±0.1%, −0.3%±0.1%, −1.5%±0.1%, and 0.4%±0.0% for Diamond, IMSure, MUcheck, and Radcalc, respectively Conclusion: The implementation of Clarkson algorithm for the dose calculation between each of the software in question can vary considerably. The currently used second check software, Radcalc has shown the best agreement on average, variance, and smallest percent range from Pinnacle3 TPS values. The closest in average percent difference from the TPS data was the IMSure software, but has significantly larger variance and percent range. The mean percent differences in Diamond and MUcheck were significantly larger than Radcalc and IMSure.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

SU-E-T-382: Evaluation of Clinical Application and Dosimetric Comparison for Treatment Plans of Gamma Knife and CyberKnife for Arteriovenous Malformations

Purpose: To analyze and compare the characteristics of dose distributions between Gamma Knife (GK) and CyberKnife (CK), in treating arteriovenous malformations (AVMs), and evaluate the influences on their clinical applications. Methods: Twenty four patients with AVMs treated with CK of prescribed dose (PD) of 16–25 Gy in single fraction were selected. Each patient’s CT images used for CK treatment planning with contours of targets and critical organs were exported and then loaded into the GK planning system. GK treatment plan with the same PD used in CK was generated for each patient. The metrics for dose comparison between GK and CK included conformity index (CI), gradient index (GI) of 75%, 50% and 25% of the PD, heterogeneity index (HI), volume of brain tissues covered by 10 Gy and 12 Gy, maximum dose to brainstem and beam-on time. Paired Samples t-test was used to analyze these metrics for significance (p value). Results: The CI were 0.744 ± 0.075 (GK) and 0.768 ± 0.086 (CK), p = 0.281. The GI75%, GI50%, and GI25% in GK and CK were 1.735 ± 0.100 and 2.439 ± 0.338 (p < 0.001), 3.169 ± 0.265 and 4.972 ± 0.852 (p < 0.001), and 8.650 ± 0.914 and 14.261 ± 2.476 (p < 0.001). The HI were 0.728 ± 0.072 (GK) and 0.313 ± 0.069 (CK), p < 0.001. There were significant differences both for volume of brain tissues covered by 10 Gy and 12 Gy in GK and CK (p < 0.001). GK had smaller maximum dose to brainstem. CK had shorter beam-on time. Conclusion: GK has similar dose conformity as CK, and has better normal tissue sparing but is less efficient than CK.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

SU-E-T-429: Feasibility Study On Three-Dimensional GRID Therapy in Conventional Linacs

Purpose: Two-dimensional GRID therapy, traditionally planned and delivered using a dedicated GRID block or MLC modulation, has shown clinical efficacy in treating bulky tumors. However, the large dose to normal tissues outside target can be limiting. We hypothesize that modulation in the third dimension will improve dose sparing of normal tissues, maximize the bystander effect within the target, and ultimately improve the therapy effectiveness. This study aims to investigate the feasibility of a three-dimensional GRID technique using conventional LINACs to achieve a 3D lattice of high dose volumes within a target. Methods: Datasets of patient’s having large tumor sizes were used to investigate the planning and delivering of 3D GRID using a Varian TrueBeam linac. Original patient contours of PTV are exported from a TPS to DICOManTX where 3D GRID targets are generated in programmable configurations. A structure of avoidance (SOA), i.e., PTV minus GRID targets, is also generated to facilitate inverse planning to achieve the desired pattern. The artificial structures were sent back to the TPS where an IMRT or VMAT plan is designed to deliver a desired high dose to GRID targets while minimizing the dose to the SOA as much as possible. Results: The programmable GRID target generator enables us to modify the target geometry to maximize the peak-to-valley ratio. Preliminary results show that plans based on spherical GRID targets achieve a higher peak-to-valley dose ratio compared with cylindrical targets. High dose spillage outside the target was eliminated. IMRT planning requires the number of beams to be larger than 16, while for VMAT the number of arcs should be at least 4 in order to achieve dosimetric goals. Conclusion: Planning and delivering 3D GRID therapy using conventional LINACs was shown to be feasible. More research and development are required before this new modality can be implemented clinically.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

SU-E-T-500: Initial Implementation of GPU-Based Particle Swarm Optimization for 4D IMRT Planning in Lung SBRT

Purpose 4D-IMRT planning, combined with dynamic MLC tracking delivery, utilizes the temporal dimension as an additional degree of freedom to achieve improved OAR-sparing. The computational complexity for such optimization increases exponentially with increase in dimensionality. In order to accomplish this task in a clinically-feasible time frame, we present an initial implementation of GPU-based 4D-IMRT planning based on particle swarm optimization (PSO). Methods The target and normal structures were manually contoured on ten phases of a 4DCT scan of a NSCLC patient with a 54cm3 right-lower-lobe tumor (1.5cm motion). Corresponding ten 3D-IMRT plans were created in the Eclipse treatment planning system (Ver-13.6). A vendor-provided scripting interface was used to export 3D-dose matrices corresponding to each control point (10 phases × 9 beams × 166 control points = 14,940), which served as input to PSO. The optimization task was to iteratively adjust the weights of each control point and scale the corresponding dose matrices. In order to handle the large amount of data in GPU memory, dose matrices were sparsified and placed in contiguous memory blocks with the 14,940 weight-variables. PSO was implemented on CPU (dual-Xeon, 3.1GHz) and GPU (dual-K20 Tesla, 2496 cores, 3.52Tflops, each) platforms. NiftyReg, an open-source deformable image registration package, was used to calculate the summed dose. Results The 4D-PSO plan yielded PTV coverage comparable to the clinical ITV-based plan and significantly higher OAR-sparing, as follows: lung Dmean=33%; lung V20=27%; spinal cord Dmax=26%; esophagus Dmax=42%; heart Dmax=0%; heart Dmean=47%. The GPU-PSO processing time for 14940 variables and 7 PSO-particles was 41% that of CPU-PSO (199 vs. 488 minutes). Conclusion Truly 4D-IMRT planning can yield significant OAR dose-sparing while preserving PTV coverage. The corresponding optimization problem is large-scale, non-convex and computationally rigorous. Our initial results indicate that GPU-based PSO with further software optimization can make such planning clinically feasible. This work was supported through funding from the National Institutes of Health and Varian Medical Systems.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

SU-E-T-549: Modeling Relative Biological Effectiveness of Protons for Radiation Induced Brain Necrosis

Purpose: To develop a model of the relative biological effectiveness (RBE) of protons as a function of dose and linear energy transfer (LET) for induction of brain necrosis using clinical data. Methods: In this study, treatment planning information was exported from a clinical treatment planning system (TPS) and used to construct a detailed Monte Carlo model of the patient and the beam delivery system. The physical proton dose and LET were computed in each voxel of the patient volume using Monte Carlo particle transport. A follow-up magnetic resonance imaging (MRI) study registered to the treatment planning CT was used to determine the region of the necrosis in the brain volume. Both, the whole brain and the necrosis volumes were segmented from the computed tomography (CT) dataset using the contours drawn by a physician and the corresponding voxels were binned with respect to dose and LET. The brain necrosis probability was computed as a function of dose and LET by dividing the total volume of all necrosis voxels with a given dose and LET with the corresponding total brain volume resulting in a set of NTCP-like curves (probability as a function of dose parameterized by LET). Results: The resulting model shows dependence on both dose and LET indicating the weakness of the constant RBE model for describing the brain toxicity. To the best of our knowledge the constant RBE model is currently used in all clinical applications which may Result in increased rate of brain toxicities in patients treated with protons. Conclusion: Further studies are needed to develop more accurate brain toxicity models for patients treated with protons and other heavy ions.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

DOE OSTI2015

SU-E-T-616: Plan Quality Assessment of Both Treatment Planning System Dose and Measurement-Based 3D Reconstructed Dose in the Patient

Purpose: Systematic radiotherapy plan quality assessment promotes quality improvement. Software tools can perform this analysis by applying site-specific structure dose metrics. The next step is to similarly evaluate the quality of the dose delivery. This study defines metrics for acceptable doses to targets and normal organs for a particular treatment site and scores each plan accordingly. The input can be the TPS or the measurement-based 3D patient dose. From this analysis, one can determine whether the delivered dose distribution to the patient receives a score which is comparable to the TPS plan score, otherwise replanning may be indicated. Methods: Eleven neuroblastoma patient plans were exported from Eclipse to the Quality Reports program. A scoring algorithm defined a score for each normal and target structure based on dose-volume parameters. Each plan was scored by this algorithm and the percentage of total possible points was obtained. Each plan also underwent IMRT QA measurements with a Mapcheck2 or ArcCheck. These measurements were input into the 3DVH program to compute the patient 3D dose distribution which was analyzed using the same scoring algorithm as the TPS plan. Results: The mean quality score for the TPS plans was 75.37% (std dev=14.15%) compared to 71.95% (std dev=13.45%) for the 3DVH dose distribution. For 3/11 plans, the 3DVH-based quality score was higher than the TPS score, by between 0.5 to 8.4 percentage points. Eight/11 plans scores decreased based on IMRT QA measurements by 1.2 to 18.6 points. Conclusion: Software was used to determine the degree to which the plan quality score differed between the TPS and measurement-based dose. Although the delivery score was generally in good agreement with the planned dose score, there were some that improved while there was one plan whose delivered dose quality was significantly less than planned. This methodology helps evaluate both planned and delivered dose quality. Sun Nuclear Corporation has provded a license for the software described.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

DOE OSTI2015

SU-E-T-776: Use of Quality Metrics for a New Hypo-Fractionated Pre-Surgical Mesothelioma Protocol

Purpose: The “SMART” (Surgery for Mesothelioma After Radiation Therapy) approach involves hypo-fractionated radiotherapy of the lung pleura to 25Gy over 5 days followed by surgical resection within 7. Early clinical results suggest that this approach is very promising, but also logistically challenging due to the multidisciplinary involvement. Due to the compressed schedule, high dose, and shortened planning time, the delivery of the planned doses were monitored for safety with quality metric software. Methods: Hypo-fractionated IMRT treatment plans were developed for all patients and exported to Quality Reports™ software. Plan quality metrics or PQMs™ were created to calculate an objective scoring function for each plan. This allows for an objective assessment of the quality of the plan and a benchmark for plan improvement for subsequent patients. The priorities of various components were incorporated based on similar hypo-fractionated protocols such as lung SBRT treatments. Results: Five patients have been treated at our institution using this approach. The plans were developed, QA performed, and ready within 5 days of simulation. Plan Quality metrics utilized in scoring included doses to OAR and target coverage. All patients tolerated treatment well and proceeded to surgery as scheduled. Reported toxicity included grade 1 nausea (n=1), grade 1 esophagitis (n=1), grade 2 fatigue (n=3). One patient had recurrent fluid accumulation following surgery. No patients experienced any pulmonary toxicity prior to surgery. Conclusion: An accelerated course of pre-operative high dose radiation for mesothelioma is an innovative and promising new protocol. Without historical data, one must proceed cautiously and monitor the data carefully. The development of quality metrics and scoring functions for these treatments allows us to benchmark our plans and monitor improvement. If subsequent toxicities occur, these will be easy to investigate and incorporate into the metrics. This will improve the safe delivery of large doses for these patients.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

SU-F-BRB-02: Towards Quantitative Clinical Decision On Deep Inspiration Breath Hold (DIBH) Or Prone for Left-Sided Breast Irradiation

Purpose: To develop quantitative clinical guidelines between supine Deep Inspiratory Breath Hold (DIBH) and prone free breathing treatments for breast patients, we applied 3D deformable phantoms to perform Monte Carlo simulation to predict corresponding Dose to the Organs at Risk (OARs). Methods: The RPI-adult female phantom (two selected cup sizes: A and D) was used to represent the female patient, and it was simulated using the MCNP6 Monte Carlo code. Doses to OARs were investigated for supine DIBH and prone treatments, considering two breast sizes. The fluence maps of the 6-MV opposed tangential fields were exported. In the Monte Carlo simulation, the fluence maps allow each simulated photon particle to be weighed in the final dose calculation. The relative error of all dose calculations was kept below 5% by simulating 3*10{sup 7} photons for each projection. Results: In terms of dosimetric accuracy, the RPI Adult Female phantom with cup size D in DIBH positioning matched with a DIBH treatment plan of the patient. Based on the simulation results, for cup size D phantom, prone positioning reduced the cardiac dose and the dose to other OARs, while cup size A phantom benefits more from DIBH positioning. Comparing simulation results for cup size A and D phantom, dose to OARs was generally higher for the large breast size due to increased scattering arising from a larger portion of the body in the primary beam. The lower dose that was registered for the heart in the large breast phantom in prone positioning was due to the increase of the distance between the heart and the primary beam when the breast was pendulous. Conclusion: Our 3D deformable phantom appears an excellent tool to predict dose to the OARs for the supine DIBH and prone positions, which might help quantitative clinical decisions. Further investigation will be conducted. National Institutes of Health R01EB015478.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

SU-F-BRB-07: A Plan Comparison Tool to Ensure Robustness and Deliverability in Online-Adaptive Radiotherapy

Purpose: To develop a plan comparison tool that will ensure robustness and deliverability through analysis of baseline and online-adaptive radiotherapy plans using similarity metrics. Methods: The ViewRay MRIdian treatment planning system allows export of a plan file that contains plan and delivery information. A software tool was developed to read and compare two plans, providing information and metrics to assess their similarity. In addition to performing direct comparisons (e.g. demographics, ROI volumes, number of segments, total beam-on time), the tool computes and presents histograms of derived metrics (e.g. step-and-shoot segment field sizes, segment average leaf gaps). Such metrics were investigated for their ability to predict that an online-adapted plan reasonably similar to a baseline plan where deliverability has already been established. Results: In the realm of online-adaptive planning, comparing ROI volumes offers a sanity check to verify observations found during contouring. Beyond ROI analysis, it has been found that simply editing contours and re-optimizing to adapt treatment can produce a delivery that is substantially different than the baseline plan (e.g. number of segments increased by 31%), with no changes in optimization parameters and only minor changes in anatomy. Currently the tool can quickly identify large omissions or deviations from baseline expectations. As our online-adaptive patient population increases, we will continue to develop and refine quantitative acceptance criteria for adapted plans and relate them historical delivery QA measurements. Conclusion: The plan comparison tool is in clinical use and reports a wide range of comparison metrics, illustrating key differences between two plans. This independent check is accomplished in seconds and can be performed in parallel to other tasks in the online-adaptive workflow. Current use prevents large planning or delivery errors from occurring, and ongoing refinements will lead to increased assurance of plan quality.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

SU-F-BRA-11: An Experimental Commissioning Test of Brachytherapy MBDCA Dosimetry, Based On a Commercial Radiochromic Gel/optical CT System

Purpose: To implement a 3D dose verification procedure of Model-Based Dose Calculation Algorithms (MBDCAs) for {sup 192}Ir HDR brachytherapy, based on a novel Ferrous Xylenol-orange gel (FXG) and optical CT read-out. Methods: The TruView gel was employed for absolute dosimetry in conjunction with cone-beam optical CT read-out with the VISTA scanner (both from Modus Medical Inc, London, ON, Canada). A multi-catheter skin flap was attached to a cylindrical PETE jar (d=9.6cm, h=16cm) filled with FXG, which served as both the dosimeter and the water equivalent phantom of bounded dimensions. X- ray CT image series of the jar with flap attached was imported to Oncentra Brachy v.4.5. A treatment plan consisting of 8 catheters and 56 dwell positions was generated, and Oncentra-ACE MBDCA as well as TG43 dose results were exported for further evaluation. The irradiation was carried out with a microSelecton v2 source. The FXG dose-response, measured via an electron irradiation of a second dosimeter from the same batch, was linear (R2>0.999) at least up to 12Gy. A MCNP6 input file was prepared from the DICOM-RT plan data using BrachyGuide to facilitate Monte Carlo (MC) simulation dosimetry in the actual experimental geometry. Agreement between experimental (reference) and calculated dose distributions was evaluated using the 3D gamma index (GI) method with criteria (5%-2mm applied locally) determined from uncertainty analysis. Results: The TG-43 GI failed, as expected, in the majority of voxels away from the flap (pass rate 59% for D>0.8Gy, corresponding to 10% of prescribed dose). ACE performed significantly better (corresponding pass rate 92%). The GI evaluation for the MC data (corresponding pass rate 97%) failed mainly at low dose points of increased uncertainty. Conclusion: FXG gel/optical CT is an efficient method for level-2 commissioning of brachytherapy MBDCAs. Target dosimetry is not affected from uncertainty introduced by TG43 assumptions in 192Ir skin brachytherapy. Research co-financed by the ESF and Greek funds through the Operational Program Education and Lifelong Learning Investing in Knowledge Society of the NSRF. Research Funding Program: Aristeia. Modus Medical Devices Inc. provided a TruView dosimeter batch and Nucletron, and Elekta company, provided access to Oncentra Brachy v4.5, for research purposes.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

SU-F-BRA-12: End-User Oriented Tools and Procedures for Testing Brachytherapy TPSs Employing MBDCAs

Purpose: To develop user-oriented tools for commissioning and dosimetry testing of {sup 192}Ir brachytherapy treatment planning systems (TPSs) employing model based dose calculation algorithms (MBDCAs). Methods: A software tool (BrachyGuide) has been developed for the automatic generation of MCNP6 input files from any CT based plan exported in DICOM RT format from Elekta and Varian TPSs. BrachyGuide also facilitates the evaluation of imported Monte Carlo (MC) and TPS dose distributions in terms of % dose differences and gamma index (CT overlaid colormaps or relative frequency plots) as well as DVHs and related indices. For users not equipped to perform MC, a set of computational models was prepared in DICOM format, accompanied by treatment plans and corresponding MCNP6 generated reference data. BrachyGuide can then be used to compare institutional and reference data as per TG186. The model set includes a water sphere with the MBDCA WG {sup 192}Ir source placed centrically and in two eccentric positions, a water sphere with cubic bone and lung inhomogeneities and a five source dwells plan, and a patient equivalent model with an Accelerated Partial Breast Irradiation (APBI) plan. Results: The tools developed were used for the dosimetry testing of the Acuros and ACE MBDCAs implemented in BrachyVision v.13 and Oncentra Brachy v.4.5, respectively. Findings were consistent with previous results in the literature. Besides points close to the source dwells, Acuros was found to agree within type A uncertainties with the reference MC results. Differences greater than MC type A uncertainty were observed for ACE at distances >5cm from the source dwells and in bone. Conclusion: The tools developed are efficient for brachytherapy MBDCA planning commissioning and testing. Since they are appropriate for distribution over the web, they will be put at the AAPM WG MBDCA’s disposal. Research co-financed by the ESF and Greek funds. NSRF operational Program: Education and Lifelong Learning Investing in Knowledge Society-Aristeia. Varian Medical Systems and Nucletron, an Elekta company provided access to TPSs for research purposes. Miss Peppa was supported by IKY-fellowships of excellence for postgraduate studies in Greece,Siemens Program.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

MO-B-BRB-00: Optimizing the Treatment Planning Process

The radiotherapy treatment planning process has evolved over the years with innovations in treatment planning, treatment delivery and imaging systems. Treatment modality and simulation technologies are also rapidly improving and affecting the planning process. For example, Image-guided-radiation-therapy has been widely adopted for patient setup, leading to margin reduction and isocenter repositioning after simulation. Stereotactic Body radiation therapy (SBRT) and Radiosurgery (SRS) have gradually become the standard of care for many treatment sites, which demand a higher throughput for the treatment plans even if the number of treatments per day remains the same. Finally, simulation, planning and treatment are traditionally sequential events. However, with emerging adaptive radiotherapy, they are becoming more tightly intertwined, leading to iterative processes. Enhanced efficiency of planning is therefore becoming more critical and poses serious challenge to the treatment planning process; Lean Six Sigma approaches are being utilized increasingly to balance the competing needs for speed and quality. In this symposium we will discuss the treatment planning process and illustrate effective techniques for managing workflow. Topics will include: Planning techniques: (a) beam placement, (b) dose optimization, (c) plan evaluation (d) export to RVS. Planning workflow: (a) import images, (b) Image fusion, (c) contouring, (d) plan approval (e) plan check (f) chart check, (g) sequential and iterative process Influence of upstream and downstream operations: (a) simulation, (b) immobilization, (c) motion management, (d) QA, (e) IGRT, (f) Treatment delivery, (g) SBRT/SRS (h) adaptive planning Reduction of delay between planning steps with Lean systems due to (a) communication, (b) limited resource, (b) contour, (c) plan approval, (d) treatment. Optimizing planning processes: (a) contour validation (b) consistent planning protocol, (c) protocol/template sharing, (d) semi-automatic plan evaluation, (e) quality checklist for error prevention, (f) iterative process, (g) balance of speed and quality Learning Objectives: Gain familiarity with the workflow of modern treatment planning process. Understand the scope and challenges of managing modern treatment planning processes. Gain familiarity with Lean Six Sigma approaches and their implementation in the treatment planning workflow.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

MO-B-BRB-01: Optimize Treatment Planning Process in Clinical Environment

60 APPLIED LIFE SCIENCES↗