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At least 955 records · Page 53

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

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

62 RADIOLOGY AND NUCLEAR MEDICINE↗

SU-F-T-448: Use of Mixed Photon Energy Beam in Volumetric Modulated Arc Therapy (VMAT) Treatment Plan for Prostate Cancer

Purpose: To study the impact of different photon beam combination during VMAT planning and treatment delivery. Methods: Five prostate patients with no nodal involvement were chosen for the study and only prostate was considered as target (7920cGy/44fractions). In each case, three different VMAT plans were generated with two arcs (200°–160°&160°–200°). First plan used only 6MV in both arcs (6X-6X) and second utilized 6MV&15MV (6X-15X), whereas third one used 15MV&15MV (15X-15X). For consistency, all the plans were generated by the same planner using Monaco− treatment planning system (V5.1) for Elekta Synergy− linear accelerator with 1cm leaf-width. For plan comparison, target mean dose, conformity index (CI)=Planning target volume (PTV) covered by 95% of prescription dose/PTV were analyzed. Mean doses of bladder, rectum, left femur and right femur were analyzed. Integral dose (liter-Gray) to normal tissue (patient volume minus PTV), total monitor unit (MU) required to deliver a plan and gamma pass rate for each plan was analyzed. Results: The CI for PTV was 0.9937±0.0037, 0.9917±0.0033, and 0.9897±0.0048 for 6X-6X, 6X-15X and 15X-15X, respectively. Mean dose to target slightly increases with the decrease of energy. Mean doses to bladder were 3546.23±692.13cGy, 3487.43±715.53cGy and 3504.40±683.1cGy for 6X-6X, 6X-15X and 15X-15X, respectively. Mean doses to rectum were 4294.60±309.5cGy, 4277.07±279.93cGy and 4290.77±379.07cGy. Mean doses to left femur were 2737.13±545.93cGy, 2668.67±407.12cGy and 2416.77±300.73cGy and mean doses to the right femur were 2682.70±460.81cGy, 2722.58±541.92cGy and 2598.57±481.83cGy. Higher Integral doses to normal tissue observed for 6X-6X (163.06±24.6 Litre-Gray) followed by 6X-15X (154.35±24.74 Litre-Gray) and 15X-15X (145.84±26.03 Litre-Gray). Average MU required to deliver one fraction was 680.75±72.09, 634.81±95.07 and 605.06±114.65. Gamma pass rates were 99.83±0.21, 99.53±0.27 and 99.2±0.20. Conclusion: 6X-15X VMAT plan offer dosimetric advantage compared to 6X-6X in terms of lesser MU and integral dose without significant compromise in plan quality, where as in 15X-15X, neutron contamination risk is relatively higher.

60 APPLIED LIFE SCIENCES↗

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↗

SU-F-T-227: A Comprehensive Patient Specific, Structure Specific, Pre-Treatment 3D QA Protocol for IMRT, SBRT and VMAT - Clinical Experience

Purpose: To present a 3D QA method and clinical results for 550 patients. Methods: Five hundred and fifty patient treatment deliveries (400 IMRT, 75 SBRT and 75 VMAT) from various treatment sites, planned on Raystation treatment planning system (TPS), were measured on three beam-matched Elekta linear accelerators using IBA’s COMPASS system. The difference between TPS computed and delivered dose was evaluated in 3D by applying three statistical parameters to each structure of interest: absolute average dose difference (AADD, 6% allowed difference), absolute dose difference greater than 6% (ADD6, 4% structure volume allowed to fail) and 3D gamma test (3%/3mm DTA, 4% structure volume allowed to fail). If the allowed value was not met for a given structure, manual review was performed. The review consisted of overlaying dose difference or gamma results with the patient CT, scrolling through the slices. For QA to pass, areas of high dose difference or gamma must be small and not on consecutive slices. For AADD to manually pass QA, the average dose difference in cGy must be less than 50cGy. The QA protocol also includes DVH analysis based on QUANTEC and TG-101 recommended dose constraints. Results: Figures 1–3 show the results for the three parameters per treatment modality. Manual review was performed on 67 deliveries (27 IMRT, 22 SBRT and 18 VMAT), for which all passed QA. Results show that statistical parameter AADD may be overly sensitive for structures receiving low dose, especially for the SBRT deliveries (Fig.1). The TPS computed and measured DVH values were in excellent agreement and with minimum difference. Conclusion: Applying DVH analysis and different statistical parameters to any structure of interest, as part of the 3D QA protocol, provides a comprehensive treatment plan evaluation. Author G. Gueorguiev discloses receiving travel and research funding from IBA for unrelated to this project work. Author B. Crawford discloses receiving travel funding from IBA for unrelated to this project work.

60 APPLIED LIFE SCIENCES↗

SU-F-T-338: Flattening Filter Free Photon Beams Can Achieve the Same Plan Quality as Conventional Flattened Beams for Prostate Radiotherapy

Purpose: Some modern linear accelerators are equipped with one low energy flat beam and two flattening filter free (FFF) beams at high and low energies. The purpose of this study is to investigate whether the high energy FFF beam can produce the same plan quality as the conventional low energy flat beam, using a volumetric modulated arc (VMAT) technique for prostate patients. Methods: Ten prostate cancer patients were selected with a prescription of 78Gy. For each patient, three plans were created: (a) double arc flat 6MV plan used clinically; (b) double arc 10MV FFF plan; (c) single arc 10MV FFF plan. Each plan was prescribed so that at least 95% of the PTV received the prescription dose. The following dosimetric endpoints were evaluated: volume receiving 78Gy (V78) of the CTV and PTV, PTV conformality index (CI, ratio of prescription isodose volume to the PTV volume), bladder volume receiving 70Gy (V70) and 60Gy (V60), rectum volume receiving 70Gy (V70) and 50Gy (V50), dose to 10cc of the rectum, and volume of both femoral heads receiving 50Gy (V50). Total monitor units for each plan were recorded. Results: No significant difference was found for all dosimetric endpoints between all plans (p>0.05). Compared to the 6MV plans, monitor units were higher with the double arc 10MV FFF plans and lower with the single arc 10MV FFF plans, 29% and 4% respectively. Conclusion: Both single arc and double arc 10MV FFF VMAT can achieve equivalent plan quality as 6MV flat beam double arc treatment plans. With the gantry speed restriction, a high dose rate of 2400MU/min may allow the optimizer to use more MUs than actually needed. Single arc 10MV FFF VMAT plans are a reasonable alternative to double arc 6MV flat beam VMAT plans.

60 APPLIED LIFE SCIENCES↗

Temporal regularization of ultrasound-based liver motion estimation for image-guided radiation therapy

Purpose: Ultrasound-based motion estimation is an expanding subfield of image-guided radiation therapy. Although ultrasound can detect tissue motion that is a fraction of a millimeter, its accuracy is variable. For controlling linear accelerator tracking and gating, ultrasound motion estimates must remain highly accurate throughout the imaging sequence. This study presents a temporal regularization method for correlation-based template matching which aims to improve the accuracy of motion estimates. Methods: Liver ultrasound sequences (15–23 Hz imaging rate, 2.5–5.5 min length) from ten healthy volunteers under free breathing were used. Anatomical features (blood vessels) in each sequence were manually annotated for comparison with normalized cross-correlation based template matching. Five sequences from a Siemens Acuson™ scanner were used for algorithm development (training set). Results from incremental tracking (IT) were compared with a temporal regularization method, which included a highly specific similarity metric and state observer, known as the α–β filter/similarity threshold (ABST). A further five sequences from an Elekta Clarity™ system were used for validation, without alteration of the tracking algorithm (validation set). Results: Overall, the ABST method produced marked improvements in vessel tracking accuracy. For the training set, the mean and 95th percentile (95%) errors (defined as the difference from manual annotations) were 1.6 and 1.4 mm, respectively (compared to 6.2 and 9.1 mm, respectively, for IT). For each sequence, the use of the state observer leads to improvement in the 95% error. For the validation set, the mean and 95% errors for the ABST method were 0.8 and 1.5 mm, respectively. Conclusions: Ultrasound-based motion estimation has potential to monitor liver translation over long time periods with high accuracy. Nonrigid motion (strain) and the quality of the ultrasound data are likely to have an impact on tracking performance. A future study will investigate spatial uniformity of motion and its effect on the motion estimation errors.

61 RADIATION PROTECTION AND DOSIMETRY↗

SU-E-J-209: Geometric Distortion at 3T in a Commercial 4D MRI-Compatible Phantom

Purpose: There are very few commercial 4D phantoms that are marketed as MRI compatible. We are evaluating one such commercial phantom, made to be used with an MRI-Linear accelerator. The focus of this work is to characterize the geometric distortions produced in this phantom at 3T using 3 clinical MR pulse sequences. Methods: The CIRS MRI-Linac Dynamic Phantom (CIRSTM) under investigation in this study consists of a softwaredriven moving tumour volume within a thorax phantom body and enables dose accumulation by placing a dosimeter within the tumour volume. Our initial investigation is to evaluate the phantom in static mode prior to examining its 4D capability. The water-filled thorax phantom was scanned using a wide-bore Philips 3T Achieva MRI scanner employing a Thoracic xl coil and clinical 2D T1W FFE, 2D T1W TSE and 3D T1W TFE pulse sequences. Each of the MR image sets was rigidly fused with a reference CT image of the phantom employing a rigid registration with 6 degrees of freedom. Geometric distortions between the MR and CT image sets were measured in 3 dimensions at selected points along the periphery of the distortion grid embedded within the phantom body (11.5, 7.5 and 3 cm laterally, ant/post and sup/inf of magnetic isocenter respectively). Results: The maximal measured geometric distortions between the MR and reference CT points of interest were 0.9, 1.8 and 1.3 mm in the lateral, anteriorposterior and cranio-caudal directions, respectively. For all 3 spatial dimensions, the maximal distortions occurred for the FFE pulse sequence. Maximal distortions for the 2D FFE, 2D TSE and 3D TFE sequences were 1, 0.7 and 1.8 mm, respectively. Conclusion: Our initial static investigation of this phantom shows minimal geometric distortions at 3T along the periphery of the embedded grid. CIRS has provided us with a phantom at no charge for evaluation at 3 Tesla.

60 APPLIED LIFE SCIENCES↗

MO-FG-CAMPUS-TeP2-02: First Experiences and Perspectives in Using Direct Multicriteria Optimization (MCO) On Volumetric-Modulated Arc Therapy (VMAT) for Head and Neck Cancer

Purpose: To report the first experiences and perspectives in using direct multicriteria optimization (MCO) on volumetric-modulated arc therapy (VMAT) for head and neck (H&N) cancer. Methods: Ten prior patients with tumors in representative H&N regions were selected to evaluate direct MCO-VMAT in RayStation v5.0 beta. The patients were previously treated by intensity-modulated radiation therapy (IMRT) with MCO on an Elekta linear accelerator with Agility multileaf collimator. To avoid radiating eyes and shoulders, MCO-VMAT required one to three partial-arc groups, with each group consisting of single or dual arcs. All MCO-VMAT plans were approved by a radiation oncologist. The MCO-VMAT and MCO-IMRT plans were compared using V{sub 100}, D{sub 5}, homogeneity index (HI) and conformity index (CI) for planning target volume (PTV), D{sub mean} and D{sub 50} for six parallel organs and D{sub max} for five serial organs. Patient-specific quality assurance (QA) was performed using ArcCHECK for MCO-VMAT and Matrixx for MCO-IMRT with results analyzed using gamma criteria of 3%/3mm. Results: MCO-VMAT provided better V{sub 100} (+0.8%) lower D{sub 5}(− 0.3 Gy), lower HI (−0.27) and comparable CI (+0.05). MCO-VMAT decreased D{sub mean} and D{sub 50} for multiple parallel organs in seven of the ten patients. On average the reduction ranged from 2.1 (larynx) to 7.6 Gy (esophagus). For the nasal cavity and nasopharynx plans significant reduction in D{sub max} was observed for optics (up to 11 Gy) brainstem (6.4 Gy), cord (2.1 Gy) and mandible (6.7 Gy). All MCO-VMAT and -IMRT plans passed clinical QA. MCO-VMAT required slightly longer planning time due to the more complex VMAT optimization. The net beam-on time for the MCO-VMAT plans ranged from 80 to 242 seconds, up to 9 minutes shorter than MCO-IMRT. Conclusion: With similar target coverage, reduced organ dose, comparable planning time, and significantly faster treatment, MCO-VMAT is very likely to become the modality of choice in RayStation v5.0 for H&N cancer.

60 APPLIED LIFE SCIENCES↗

SU-E-J-233: A Facility for Radiobiological Experiments in a Large Magnetic Field

Purpose: There is considerable interest in developing medical linear accelerators with integrated image guidance by MRI. Less work has been done on the fundamental biology of cell survival in the presence of a strong magnetic field. The purpose of this work is to describe an experimental system capable of measuring cell survival response in the types of MRI-linac systems currently under development. Methods: We have integrated a cobalt irradiator with a solenoid magnet. The solenoid magnet has inner diameter of 10 cm. To enable measurement of the biological effects as a function of depth, we are utilizing the sliced gel technique, in which cells are embedded and fixed within a gelatin matrix. Irradiated cells at defined positions (sub mm resolution) can subsequently be recovered and assessed for cell survival or other biological effects. Results: The magnetic field profile in the solenoid has a peak magnetic field 36 cm below the top edge of the magnet bore and can be placed at and SAD of 100 cm. At a solenoid current of 35 A, the peak magnetic field is 0.25 T. The dose rate of the cobalt irradiator is 16 cGy/min at 100 cm SAD. EBT3 film was used to demonstrate the system functionality. It was irradiated at 1 cm depth at 100 cm SSD with a 4×4 field to 1.5 Gy in a 0.25 T magnetic field. The dose profile was similar between this film and the control exposure without magnetic field. Conclusion: Integrating a cobalt irradiator with a high field magnet is demonstrated. The magnetic field at the cobalt defining head was minimal and did not interfere with the functioning of this unit. Cell survival experiments can be reproduced exactly in the presence or absence of a magnetic field since a resistive magnet is used.

60 APPLIED LIFE SCIENCES↗

TU-C-BRE-03: Aggregation of Linac Measurement Data

Purpose: Accurate data of linear accelerator radiation characteristics is important for treatment planning system commissioning as well as regular quality assurance of the machine. The RPC has performed site visits of numerous machines . Data gathered from Varian machines from the past 15 years are presented. The data collected can be used as a secondary check or when commissioning a new machine to verify that values are reasonable. Methods: Data from the past 15 years of RPC site visits was compiled and analyzed. Data was composed from measurements from approximately 400 Varian machines. Each dataset consists of several point measurements at various locations in a water phantom to measure percentage depth dose, output factors, including small MLC fields, off-axis factors, and wedge factors if applicable. Common statistical values are presented for each machine type. Where applicable, data was compared to other reference data given by the vendor or a select number of previous researchers. Results: Data is separated by energy and parameter and then analyzed by machine class. Data distributions of the parameter data were normal except occasionally at the tails. Distributions of the data for each class and parameter are tabulated to give not simply a singular reference value, but metrics about the distribution: 5th and 95th percentile values and the standard deviation as well as the median. Conclusion: The RPC has collected numerous data on Varian linacs and presented the finding of the past 15 years. The data can be used as a reference data set for physicists to compare against. A linac that deviates from the values does not necessarily indicate there is a problem as long as the treatment planning system correlates to the machine. Comparison of linac and treatment planning system data to external reference data can prevent serious treatment errors.

07 ISOTOPE AND RADIATION SOURCES↗

SU-F-J-42: Comparison of Varian TrueBeam Cone-Beam CT and BrainLab ExacTrac X-Ray for Cranial Radiotherapy

Purpose: To compare online image registrations of TrueBeam cone-beam CT (CBCT) and BrainLab ExacTrac x-ray imaging systems for cranial radiotherapy. Method: Phantom and patient studies were performed on a Varian TrueBeam STx linear accelerator (Version 2.5), which is integrated with a BrainLab ExacTrac imaging system (Version 6.1.1). The phantom study was based on a Rando head phantom, which was designed to evaluate isocenter-location dependence of the image registrations. Ten isocenters were selected at various locations in the phantom, which represented clinical treatment sites. CBCT and ExacTrac x-ray images were taken when the phantom was located at each isocenter. The patient study included thirteen patients. CBCT and ExacTrac x-ray images were taken at each patient’s treatment position. Six-dimensional image registrations were performed on CBCT and ExacTrac, and residual errors calculated from CBCT and ExacTrac were compared. Results: In the phantom study, the average residual-error differences between CBCT and ExacTrac image registrations were: 0.16±0.10 mm, 0.35±0.20 mm, and 0.21±0.15 mm, in the vertical, longitudinal, and lateral directions, respectively. The average residual-error differences in the rotation, roll, and pitch were: 0.36±0.11 degree, 0.14±0.10 degree, and 0.12±0.10 degree, respectively. In the patient study, the average residual-error differences in the vertical, longitudinal, and lateral directions were: 0.13±0.13 mm, 0.37±0.21 mm, 0.22±0.17 mm, respectively. The average residual-error differences in the rotation, roll, and pitch were: 0.30±0.10 degree, 0.18±0.11 degree, and 0.22±0.13 degree, respectively. Larger residual-error differences (up to 0.79 mm) were observed in the longitudinal direction in the phantom and patient studies where isocenters were located in or close to frontal lobes, i.e., located superficially. Conclusion: Overall, the average residual-error differences were within 0.4 mm in the translational directions and were within 0.4 degree in the rotational directions.

60 APPLIED LIFE SCIENCES↗

SU-E-T-347: Effect of MLC Leaf Position Inaccuracy On Dose Distribution for Spinal SBRT with Different Energies and Dose Rates

Purpose: To evaluate dosimetric impact of spinal SBRT when MLC leaf positions deviate from planning positions for different energies and doserates. Methods and Materials: 18 localized spinal metastases patients were selected for SBRT using IMRT planning with 9 posterior beams delivered at gantry angles ranging between 100°–260°. A modern linear accelerator(Varian Turebeam STX with HDMLC 2.5 mm thick leaf at isocenter) IMRT plans were generated using both 6X and 6X-FFF(Flattening filter free) beams with a nominal prescription dose of 6 Gy/fraction to PTV. Doserates ranging from 200–600 MU/min for 6X and 400–1400 MU/min for 6X-FFF, with 200 increments were examined. A fixed amount(0.3, 0.5, 1, and 2 mm) of MLC-leaf position deviation was simulated to each plan under following conditions: 1)only along X1 collimator; 2)with increments at both X1 and X2 collimator directions;3)with reductions at both X1 and X2 collimator directions. Dose was recalculated for each modified plans. Both original and modified plans were delivered using Turebeam STX machine and measured using both portal dosimetry and a 3D dosimeter(Delta4 of ScandiDos). Each field’s Result were compared using following three parameters: the 95% iso-dose level Conformal Index(95%CI), the spinal cord maximum dose(SCDmax), and the planned target volume(PTV) mean dose. Results: Dosimetric impacts on the 95%CI, SCDmax and the PTV mean dose are: 1)negligible if MLC-leaf position deviation only along a single collimator direction ≥1.0 mm,2)substantial if MLC-leaf position increment along both collimator directions ≥0.3 mm(95% CI decreases while SCDmax and PTV mean-dose increase), 3)substantial if MLC-leaf position reduction along both collimator directions ≥0.3 mm(95% CI first increases and then decreases while SCDmax and PTV mean-dose decrease). Different energies and doserates demonstrated comparable dosimetric impacts. Conclusion: Substantial dose deviations could happen for spinal SBRT using IMRT plan with HD-MLC if leaf position deviation ≥0.3 mm. The effects of different energy and doserate are negligible.

60 APPLIED LIFE SCIENCES↗

SU-E-T-560: Monte Carlo Simulation of the Neutron Radiation Field Around a Medical 18 MV Linac

Purpose: Today the majority of radiation therapy treatments are performed at medical electron linear accelerators (linacs). The accelerated electrons are used for the generation of bremsstrahlung photons. The use of higher electron respectively photon energies has some advantages over lower energies such as the longer dose build-up. However photons with energies higher than ∼7 MeV can additionally to the interaction with bound electrons undergo inelastic reactions with nuclei. These photonuclear reactions lead to the emission of fast neutrons which contaminate the primary photon field. The neutrons might penetrate through the collimators and deliver out-of-field dose to the patient. Furthermore the materials inside the linac head as well as the air inside the treatment room get activated which might deliver dose to the medical employees even when the linac is not in operation. A detailed knowledge of these effects is essential for adequate radiation protection of the employees and an optimal patient treatment. Methods: It is a common method to study the radiation fields of such linacs by means of Monte Carlo simulations. For the investigation of the effects caused by photonuclear reactions a typical linac in high energy mode (Varian Clinac 18 MV-X) as well as the surrounding bunker were modelled and simulated using the Monte Carlo code FLUKA which includes extensive nuclear reaction and neutron transport models additional to electron-photon transport as well as capabilities for a detailed study of effective dose distributions and activation yields. Results: Neutron spectra as well as neutron effective dose distributions within the bunker were obtained, reaching up to some mSv/Gy in the patient’s plane. The results are normalized per Gy in the depth dose maximum at 10×10 cm{sup 2} field size. Therefore an absolute interpretation is possible. Conclusion: The obtained data gives a better understanding of the photonuclear reaction caused effects.

61 RADIATION PROTECTION AND DOSIMETRY↗

SU-F-T-626: Intracranial SRS Re-Treatment Without Acquisition of New CT Images

Purpose: Linear accelerator based stereotactic radiosurgery (SRS) for multiple intracranial lesions with frequent surveillance is becoming a popular treatment option. This strategy leads to retreatment with SRS as new lesions arise. Currently, each course of treatment uses magnetic resonance (MR) and computed tomography (CT) images for treatment planning. We propose that new MR images, with course 1 CT images, may be used for future treatment plans with negligible loss of dosimetric accuracy. Methods: Ten patients that received multiple courses of SRS were retrospectively reviewed. The treatment plans and contours from non-initial courses were copied to the initial CTs and recalculated. Doses metrics for the plans calculated on the initial CTs and later CTs were compared. All CT scans were acquired on a Philips CT scanner with a 600 mm field of view and 1 mm slice thickness (Philips Healthcare, Andover, MA). All targets were planned to 20 Gy and calculated in Eclipse V. 13.6 (Varian, Palo Alto, CA) using analytic anisotropic algorithm with 1 mm calculation grid. Results: Sixteen lesions were evaluated. The mean time between courses was 250 +/− 215 days (range 103–979). The mean target volume was 2.0 +/− 2.9 cc (range 0.1–10.1). The average difference in mean target dose between the two calculations was 0.2 +/− 0.3 Gy (range 0.0 – 1.0). The mean conformity index (CI) was 1.28 +/− 0.14 (range 1.07 – 1.82). The average difference in CI was 0.03 +/− 0.16 (range 0.00 – 0.44). Targets volumes < 0.5 cc showed the largest changes in both metrics. Conclusion: Continued treatment based on initial CT images is feasible. Dose calculation on the initial CT for future treatments provides reasonable dosimetric accuracy. Changes in dose metrics are largest for small volumes, and are likely dominated by partial volume effects in target definition.

60 APPLIED LIFE SCIENCES↗

SU-F-P-09: A Global Medical Physics Collaboration for Implementation of Modern Radiotherapy in Botswana

Purpose: The global burden of cancer is considerable, particularly in low and middle-income countries. Massachusetts General Hospital (MGH) and Botswana-Harvard AIDS Institute have partnered with the oncology community and government of Botswana to form BOTSOGO (BOTSwana Oncology Global Outreach) to address the rising burden of cancer in Botswana. Currently, radiation therapy (RT) is only available at a single linear accelerator (LINAC) in Gaborone Private Hospital (GPH). BOTSOGO worked to limit the absence of RT during a LINAC upgrade and ensure a safe transition to modern radiotherapy techniques. Methods: The existing Elekta Precise LINAC was decommissioned in November 2015 and replaced with a new Elekta VERSA-HD with IMRT/VMAT/CBCT capability. Upgraded treatment planning and record-and-verify systems were also installed. Physicists from GPH and MGH collaborated during an intensive on-site visit in Botswana during the commissioning process. Measurements were performed using newly purchased Sun Nuclear equipment. Photon beams were matched with an existing model to minimize the time needed for beam modeling and machine down time. Additional remote peer review was also employed. Independent dosimetry was performed by irradiating OSLDs, which were subsequently analyzed at MGH. Results: Photon beam quality agreed with reference data within 0.2%. Electron beam data agreed with example clinical data within 3%. Absolute dose calibration was performed using both IAEA and AAPM protocols. Absolute dose measurements with OSLDs agreed within 5%. Quentry cloud-based software was installed to facilitate remote review of treatment plans. Patient treatments resumed in February 2016. The time without RT was reduced, therefore likely resulting in reduced patient morbidity/mortality. Conclusion: A global physics collaboration was utilized to commission a modern LINAC in a resource-constrained setting. This can be a useful model in other areas with limited resources. Further use of technology and on-site exchanges will facilitate the introduction of more advanced techniques in Botswana. We acknowledge funding support from the AAPM International Educational Activities Committee and the NCI Federal Share Proton Beam Program Income Grant.

60 APPLIED LIFE SCIENCES↗

TH-AB-209-04: 3D Light Sheet Luminescence Imaging with Cherenkov Radiation

Purpose: To recover a three-dimensional density distribution of luminescent molecular probes located several centimeters deep within a highly scattering tissue. Methods: We developed a novel sheet beam Cherenkov-excited luminescence scanned imaging (CELSI) methodology. The sample was irradiated by a horizontally oriented, vertically scanned 6 MV X-ray sheet beam (200mm × 5mm, 0.2mm vertical step) from a radiotherapy linear accelerator. The resulting Cherenkov light emission – and thus luminescent probe excitation – occurred exclusively along the irradiation plane due to a short diffusion path of secondary particles and Cherenkov photons. Cherenkov-excited luminescence was detected orthogonally to the sheet beam by gated, intensified charge coupled device camera. Analogously to light sheet microscopy, a series of luminescence images was taken for varied axial positions (depths) of the Cherenkov light sheet in sample. Knowledge of the excitation plane position allowed a 3D image stack deconvolution and depth-variant attenuation correction. The 3D image post-processing yielded a true spatial density distribution of luminescent molecules in highly scattering tissue. Results: We recovered a three-dimensional shape and position of 400 µL lesion-mimicking phantom tubes containing 25 µM solution of PtG4 molecular probe from 3 centimeter deep tissue-like media. The high sensitivity of CELSI also allowed resolving 100 micron capillaries of test solution. Functional information of partial oxygen pressure at the site of PtG4 molecular probe was recovered from luminescence lifetime CELSI. Finally, in-vivo sheet beam CELSI localized milimeter-sized PtG4-labelled tumor phantoms in multiple biological objects (hairless mice) from single scan. Conclusion: Presented sheet beam CELSI technique greatly extended the useful depth range of luminescence molecular imaging. More importantly, the light sheet microscopy approach was successfully adapted to CELSI, providing means to recover a completely attenuation-corrected 3D image of luminescent probe distribution. Gated CELSI acquisition yielded functional information of a spatially resolved oxygen concentration map of deep lying targets. This work was supported by NIH research grant R01CA109558 and R21EB017559, as well as by Pilot Grant Funds from the Norris Cotton Cancer Center.

60 APPLIED LIFE SCIENCES↗

TH-C-19A-08: PDD Discrepancies at Opposite Biases From Very Small Volume Ion Chambers When Using Water Scanners

Purpose: As more so-called micro ion chambers become commercially available, medical physicists may be inclined to use them during the linear accelerator commissioning process, in an attempt to better characterize the beam in steep dose gradient areas. The purpose of this work is to inform the medical physics community of a non-trivial, anomalous behavior observed when very small chambers are used in certain beam scanning configurations. Methods: A total of six ion chambers (0.007cc to 0.6cc) were used to scan PDDs from a 10×10cm2 field at both +300V and −300V biases. PDDs were scanned using three different water tank scanning systems to determine whether different scanners exhibit the same abnormality. Finally, PDDs were sampled using an external electrometer to bypass the internal electrometer of the scanner to determine the potential contributions of the scanner electronics to the abnormality observed. Results: We observed a reproducible, significant difference (over-response with depth) in PDDs acquired when using very small ion chambers with certain bias and watertank combinations, on the order of 3–5% at a depth of 25 cm in water. This difference was not observed when the PDDs were sampled using the ion chambers in conjunction with an external electrometer. This suggests a contribution of interference produced by the controller box and scanning system, which becomes significant for the very small signals collected by very small ion chambers, especially at depth, as the signal level is reduced even further. Conclusion: Based on the results observed here, if currently available very small ion chambers are used with specific bias and scanning water-tank combinations, erroneous PDD data may be collected. If this data is used as input to the Treatment Planning System, systematic errors on the order of 3%–5% may be introduced into the treatment planning process.

07 ISOTOPE AND RADIATION SOURCES↗

SU-E-J-47: Comparison of Online Image Registrations of Varian TrueBeam Cone-Beam CT and BrainLab ExacTrac Imaging Systems

Purpose To compare online image registrations of TrueBeam cone-beam CT (CBCT) and BrainLab ExacTrac imaging systems. Methods Tests were performed on a Varian TrueBeam STx linear accelerator (Version 2.0), which is integrated with a BrainLab ExacTrac imaging system (Version 6.0.5). The study was focused on comparing the online image registrations for translational shifts. A Rando head phantom was placed on treatment couch and immobilized with a BrainLab mask. The phantom was shifted by moving the couch translationally for 8 mm with a step size of 1 mm, in vertical, longitudinal, and lateral directions, respectively. At each location, the phantom was imaged with CBCT and ExacTrac x-ray. CBCT images were registered with TrueBeam and ExacTrac online registration algorithms, respectively. And ExacTrac x-ray image registrations were performed. Shifts calculated from different registrations were compared with nominal couch shifts. Results The averages and ranges of absolute differences between couch shifts and calculated phantom shifts obtained from ExacTrac x-ray registration, ExacTrac CBCT registration with default window, ExaxTrac CBCT registration with adjusted window (bone), Truebeam CBCT registration with bone window, and Truebeam CBCT registration with soft tissue window, were: 0.07 (0.02–0.14), 0.14 (0.01–0.35), 0.12 (0.02–0.28), 0.09 (0–0.20), and 0.06 (0–0.10) mm, in vertical direction; 0.06 (0.01–0.12), 0.27 (0.07–0.57), 0.23 (0.02–0.48), 0.04 (0–0.10), and 0.08 (0– 0.20) mm, in longitudinal direction; 0.05 (0.01–0.21), 0.35 (0.14–0.80), 0.25 (0.01–0.56), 0.19 (0–0.40), and 0.20 (0–0.40) mm, in lateral direction. Conclusion The shifts calculated from ExacTrac x-ray and TrueBeam CBCT registrations were close to each other (the differences between were less than 0.40 mm in any direction), and had better agreements with couch shifts than those from ExacTrac CBCT registrations. There were no significant differences between TrueBeam CBCT registrations using different windows. In ExacTrac CBCT registrations, using bone window led to better agreements than using default window.

60 APPLIED LIFE SCIENCES↗