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At least 973 records · Page 54
All sourcesNASA NTRSDOE OSTI
DOE OSTI2014

Effect of Acuros XB algorithm on monitor units for stereotactic body radiotherapy planning of lung cancer

Stereotactic body radiotherapy (SBRT) is a curative regimen that uses hypofractionated radiation-absorbed dose to achieve a high degree of local control in early stage non–small cell lung cancer (NSCLC). In the presence of heterogeneities, the dose calculation for the lungs becomes challenging. We have evaluated the dosimetric effect of the recently introduced advanced dose-calculation algorithm, Acuros XB (AXB), for SBRT of NSCLC. A total of 97 patients with early-stage lung cancer who underwent SBRT at our cancer center during last 4 years were included. Initial clinical plans were created in Aria Eclipse version 8.9 or prior, using 6 to 10 fields with 6-MV beams, and dose was calculated using the anisotropic analytic algorithm (AAA) as implemented in Eclipse treatment planning system. The clinical plans were recalculated in Aria Eclipse 11.0.21 using both AAA and AXB algorithms. Both sets of plans were normalized to the same prescription point at the center of mass of the target. A secondary monitor unit (MU) calculation was performed using commercial program RadCalc for all of the fields. For the planning target volumes ranging from 19 to 375 cm{sup 3}, a comparison of MUs was performed for both set of algorithms on field and plan basis. In total, variation of MUs for 677 treatment fields was investigated in terms of equivalent depth and the equivalent square of the field. Overall, MUs required by AXB to deliver the prescribed dose are on an average 2% higher than AAA. Using a 2-tailed paired t-test, the MUs from the 2 algorithms were found to be significantly different (p < 0.001). The secondary independent MU calculator RadCalc underestimates the required MUs (on an average by 4% to 5%) in the lung relative to either of the 2 dose algorithms.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2014

Correlating planned radiation dose to the cochlea with primary site and tumor stage in patients with head and neck cancer treated with intensity-modulated radiation therapy

The aim of the study was to determine tumor characteristics that predict higher planned radiation (RT) dose to the cochlea in patients with head and neck cancer (HNC) treated with intensity-modulated radiotherapy (IMRT). From 2004 to 2012, 99 patients with HNC underwent definitive IMRT to a median dose of 69.96 Gy in 33 fractions, with the right and left cochlea-vestibular apparatus contoured for IMRT optimization as avoidance structures. If disease involvement was adjacent to the cochlea, preference was given to tumor coverage by prescription dose. Descriptive statistics were calculated for dose-volume histogram planning data, and mean planning dose to the cochlea (from left or right cochlea, receiving the greater amount of RT dose) was correlated to primary site and tumor stage. Mean (standard deviation) cochlear volume was 1.0 (0.60) cm{sup 3} with maximum and mean planned doses of 31.9 (17.5) Gy and 22.1 (13.7) Gy, respectively. Mean planned dose (Gy) to cochlea by tumor site was as follows: oral cavity (18.6, 14.4), oropharynx (21.7, 9.1), nasopharynx (36.3, 10.4), hypopharynx (14.9, 7.1), larynx (2.1, 0.62), others including the parotid gland, temporal bone, and paranasal sinus (33.6, 24.0), and unknown primary (25.6, 6.7). Average mean planned dose (Gy) to the cochlea in T0-T2 and T3-T4 disease was 22.0 and 29.2 Gy, respectively (p = 0.019). By site, a significant difference was noted for nasopharynx and others (31.6 and 50.7, p = 0.012) but not for oropharynx, oral cavity, and hypopharynx. Advanced T category predicted for higher mean cochlear dose, particularly for nasopharyngeal, parotid gland, temporal bone, and paranasal sinus HNC sites.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2017

Bladder radiotherapy treatment: A retrospective comparison of 3-dimensional conformal radiotherapy, intensity-modulated radiation therapy, and volumetric-modulated arc therapy plans

To examine tumor's and organ's response when different radiotherapy plan techniques are used. Ten patients with confirmed bladder tumors were first treated using 3-dimensional conformal radiotherapy (3DCRT) and subsequently the original plans were re-optimized using the intensity-modulated radiation treatment (IMRT) and volumetric-modulated arc therapy (VMAT)-techniques. Targets coverage in terms of conformity and homogeneity index, TCP, and organs' dose limits, including integral dose analysis were evaluated. In addition, MUs and treatment delivery times were compared. Better minimum target coverage (1.3%) was observed in VMAT plans when compared to 3DCRT and IMRT ones confirmed by a statistically significant conformity index (CI) results. Large differences were observed among techniques in integral dose results of the femoral heads. Even if no statistically significant differences were reported in rectum and tissue, a large amount of energy deposition was observed in 3DCRT plans. In any case, VMAT plans provided better organs and tissue sparing confirmed also by the normal tissue complication probability (NTCP) analysis as well as a better tumor control probability (TCP) result. Our analysis showed better overall results in planning using VMAT techniques. Furthermore, a total time reduction in treatment observed among techniques including gantry and collimator rotation could encourage using the more recent one, reducing target movements and patient discomfort.

61 RADIATION PROTECTION AND DOSIMETRY↗
DOE OSTI2018

Dose-volume and radiobiological dependence on the calculation grid size in prostate VMAT planning

This study evaluated the effects of dose-volume and radiobiological dependence on the calculation grid size in prostate volumetric-modulated arc therapy (VMAT) planning. Ten patients with prostate cancer were selected for this retrospective treatment planning study. Prostate VMAT plans were created for the patients using the 6 MV photon beam produced by a Varian TrueBEAM linac with the calculation grid size equal to 1, 2, 2.5, 3, 4, and 5 mm. Dose-volume histograms (DVHs) of targets and organs at risk were generated for different grid sizes. We calculated the radiobiological parameters of the tumor control probability (TCP) of clinical target volume (CTV) and planning target volume (PTV), and the normal tissue complication probability (NTCP) of organs at risk (rectal wall, rectum, bladder wall, bladder, left femur, and right femur). The homogeneity, conformity, and gradient indexes of CTV and PTV were calculated for different grid sizes. The TCP of PTV was found decreasing with a rate of 0.06%/mm when the calculation grid size increased from 1 to 5 mm. On the other hand, both NTCPs of rectal wall and rectum were found decreasing with rates of 0.03%/mm and 0.05%/mm, respectively, with an increase of grid size. The homogeneity index of PTV increased with a rate of 0.57/mm of the calculation grid size, whereas the conformity index of PTV decreased with a rate of 0.0075/mm. The gradient index of PTV was found increasing with a rate equal to 0.05/mm. In prostate VMAT planning, variations of dose-volume and radiobiological parameters with calculation grid size on PTV, rectal wall, and rectum were more significant than those of CTV and other organs at risk such as bladder wall, bladder, and femurs. Results in this study are important in the treatment planning quality assurance when the calculation grid size is varied to compromise a shorter dose computing time.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2018

3D treatment planning on helical tomotherapy delivery system

The helical tomotherapy is a technologically advanced radiation dose delivery system designed to perform intensity-modulated radiation therapy (IMRT). It is mechanistically unique, based on a small 6-MV linear accelerator mounted on a ring gantry that rotates around the patient while the patient moves through a bore, ultimately yielding a helical path of radiation dose delivery. The helical pattern of dose delivery differentiated tomotherapy from other contemporary radiation therapy systems at the time of its inception. The accompanying 3-dimensional (3D) treatment planning system has been developed to solely support this specific type of dose delivery system. The treatment planning system has 2 modules identified as TomoHelical and TomoDirect to perform IMRT and conformal radiation therapy, respectively. The focus of this work within the scope of this special issue on 3D treatment planning systems is to assess the use of planning tools to generate treatment plans for helical tomotherapy. Clinical examples are used throughout to demonstrate the quality and differences of various clinical scenarios planned with tomotherapy.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2022

Climate-aware decision-making: lessons for electric grid infrastructure planning and operations

Abstract Climate change poses significant risks to large-scale infrastructure systems and brings considerable uncertainties that challenge historical planning approaches. Here we focus on how climate awareness might be better incorporated into planning and decision-making in the electric power sector. To do so, we consider lessons from decision science literature where researchers have specifically focused on how to make better decisions under uncertainty. We perform a three-part review: of decision science literature on best practices for decision-making under uncertainty, of industry practice documents to understand how new uncertainties may affect the types of decisions electric utilities are making today, and of literature on electricity sector planning under climate change to assess how lessons from decision science might fit into sector-specific analyses. We discuss how characterizations of uncertainty from the decision science literature might guide approaches in the electricity sector to appropriately capture climate-related uncertainties. We also distill three key ideas from the decision science literature that can be incorporated into electricity sector planning to manage these new uncertainties: robustness, adaptive planning, and multi-stakeholder engagement. We offer example recommendations for how these key ideas might be incorporated into one essential type of planning activity, capacity expansion.

32 ENERGY CONSERVATION, CONSUMPTION, AND UTILIZATI↗
DOE OSTI2021

Planning for a Resilient Home Electricity Supply System

Resilience of power systems is already a key issue that is getting frequent attention all over the world. It is useful to analyze resilience issues not only for bulk supply, but at all levels including at a customer level. This is because distributed energy resources can play a prominent role in enhancing resilience. Although the literature on planning models, tools and data for bulk supply and distribution systems have expanded in recent years, customer-centric planning, e.g., for an individual household, is yet to receive adequate attention. Although solar PV and battery storage at a household level have been analyzed, how these resources can be optimally combined, together with grid supply, from a resilience perspective is the focus of this study. The study demonstrates how a conceptual framework can be developed to show the trade-off between system costs and resilience including its dimensions such as duration, depth and frequency of service outages. A planning model is developed that incorporates multiple facets of resilience and individual customer preferences. The model considers power system resilience explicitly as a constraint. The model is implemented for a household level case study in Miami, Florida. The results show there are complex trade-offs among different dimensions of resilience. The study demonstrates how combined resilience metrics can be formulated and evaluated using the proposed least-cost planning model at a household level to optimize grid supply together with solar, battery storage and diesel generators. The model allows a planner to directly embed a resilience standard to drive the optimal supply mix. These concepts and the modeling construct can also be applied at other levels of planning, including community level and bulk supply system planning.

24 POWER TRANSMISSION AND DISTRIBUTION↗
DOE OSTI2026

Integrated System Planning: Emerging Software Requirements in the Power Industry

Power system planning software remains fragmented across organizational boundaries, with specialized tools for capacity expansion, production cost modeling, power flow, and dynamic analysis operating on incompatible data models and assumptions. This article argues that the fragmentation is not merely a technical problem but a predictable consequence of Conway's law: software architectures mirror the departmental structures within which they are developed. Regulatory milestones like Federal Energy Regulatory Commission (FERC) Order 888 formalized these divisions, but the roots trace back to the distinct engineering disciplines-mechanical, chemical, and electrical-that staffed generation and transmission planning departments in vertically integrated utilities. As the industry moves toward integrated system planning (ISP) that coordinates generation, transmission, and distribution investment decisions, the software ecosystem must evolve accordingly. We identify five categories of software requirements to enable this transition: coherent data inputs decoupled from individual applications, unified and extensible data schemas, modular component representations that support multiple abstraction levels, lifecycle management of planning datasets, and well-defined application programming interface (API) contracts that separate data exchange from algorithmic control. We examine how these requirements interact with three common workflow patterns-serial gate clearing, sequential multiapplication, and convergence oriented-and discuss the interface design principles each demands. We then outline a vision for platform-based planning architectures where specialized analytical services compose through standardized interfaces and where artificial intelligence (AI)/machine learning (ML) tools augment decision support within a disciplined software infrastructure. The practices proposed here offer a path from today's siloed tool collections toward collaborative planning ecosystems capable of handling the complexity of modern power system transformation.

24 POWER TRANSMISSION AND DISTRIBUTION↗
DOE OSTI2019

Coordinated Planning Strategy for Integrated Energy Systems in a District Energy Sector

With the ever-growing integration of diverse distributed energy resources, modern district energy sectors are transitioning into integrated energy systems (IESs), which generally consist of various energy carriers such as electric power, natural gas, and heat. Instead of modeling individual energy carriers, the emergence of IESs requires comprehensive consideration of all involved energy systems in both planning and operation phases. This paper proposes a comprehensive planning strategy for a district energy sector to address the challenges of IES planning considering the coupling of power, gas, and heat systems. The proposed planning model contains an operational module that develops a steady-state optimal multi-energy flow (OMEF) for the IES considered and a multi-stage expansion module that optimizes the investment decisions. To efficiently solve the proposed planning model, which is formulated as a mixed-integer nonlinear programming problem, an improved generalized Benders decomposition algorithm that utilizes dynamic dual multipliers to improve the convergence speed is employed. The effectiveness of the proposed planning model and the feasibility of the improved Benders decomposition algorithm are verified in case studies.

coordinated planning↗
DOE OSTI2013

Feasibility study of real-time planning for stereotactic radiosurgery

Purpose: 3D rotational setup errors in radiotherapy are often ignored by most clinics due to inability to correct or simulate them accurately and efficiently. There are two types of rotation-related problems in a clinical setting. One is to assess the affected dose distribution in real-time if correction is not applied and the other one is to correct the rotational setup errors prior to the initiation of the treatment. Here, the authors present the analytical solutions to both problems. Methods: (1) To assess the real-time dose distribution, eight stereotactic radiosurgery (SRS) cases were used as examples. For each plan, two new sets of beams with different table, gantry, and collimator angles were given in analytical forms as a function of patient rotational errors. The new beams simulate the rotational effects of the patient during the treatment setup. By using one arbitrary set of beams, SRS plans were recomputed with a series of different combinations of patient rotational errors, ranging from (-5 Degree-Sign , -5 Degree-Sign , -5 Degree-Sign ) to (5 Degree-Sign , 5 Degree-Sign , 5 Degree-Sign ) (roll, pitch, and yaw) with an increment of 1 Degree-Sign and compared with those without rotational errors. For each set of rotational errors, its corresponding equivalent beams were computed using the analytical solutions and then used for dose calculation. (2) To correct for the rotational errors, two new sets of table, gantry, and collimator angles were derived analytically to validate the previously published derivation. However, in the derivation, a novel methodology was developed and two sets of table, gantry, and collimator angles were obtained in analytical forms. The solutions provide an alternative approach to rotational error correction by rotating the couch, gantry, and collimator rather than the patient. Results: For demonstration purpose, the above-derived new beams were implemented in a treatment planning system (TPS) to study the rotational effects on the SRS cases. For each case, the authors have generated ten additional plans that accounted for different rotations of the patient. They have found that rotations have an insignificant effect on the minimal, maximum, mean doses, and V{sub 80%} of the planning target volume (PTV) when the rotations were relatively small. This was particularly true for the small and near-spherical targets. They, however, did change V{sub 95%} significantly when the rotations approached 5 Degree-Sign . The theory has been validated with clinical SRS cases and proven to be practical and viable. The preliminary results demonstrate that the rotational effects are patient-specific and depend on several important factors, such as the PTV size, the PTV location, and the beam configuration. The solutions given in this paper are of great potential values in clinical applications. Conclusions: They have derived the analytical solutions to a new set of table, gantry, and collimator angles for a given treatment beam configuration as a function of patient rotational errors. One solution was used to assess the dosimetric effects of an imperfect patient setup and the other one was used to correct for the setup errors without rotating the patient. Compared to the widely adopted method of rotation effect assessment by importing the rotational CT images into TPS, the equivalent beam approach is simple and accurate. The analytical solutions to correcting for rotational setup errors prior to treatment were also derived. Based on the initial clinical investigations, they firmly believe that clinically viable real-time treatment planning and adaptive radiation therapy are feasible with this novel method.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2013

A gEUD-based inverse planning technique for HDR prostate brachytherapy: Feasibility study

Purpose: The purpose of this work was to study the feasibility of a new inverse planning technique based on the generalized equivalent uniform dose for image-guided high dose rate (HDR) prostate cancer brachytherapy in comparison to conventional dose-volume based optimization. Methods: The quality of 12 clinical HDR brachytherapy implants for prostate utilizing HIPO (Hybrid Inverse Planning Optimization) is compared with alternative plans, which were produced through inverse planning using the generalized equivalent uniform dose (gEUD). All the common dose-volume indices for the prostate and the organs at risk were considered together with radiobiological measures. The clinical effectiveness of the different dose distributions was investigated by comparing dose volume histogram and gEUD evaluators. Results: Our results demonstrate the feasibility of gEUD-based inverse planning in HDR brachytherapy implants for prostate. A statistically significant decrease in D{sub 10} or/and final gEUD values for the organs at risk (urethra, bladder, and rectum) was found while improving dose homogeneity or dose conformity of the target volume. Conclusions: Following the promising results of gEUD-based optimization in intensity modulated radiation therapy treatment optimization, as reported in the literature, the implementation of a similar model in HDR brachytherapy treatment plan optimization is suggested by this study. The potential of improved sparing of organs at risk was shown for various gEUD-based optimization parameter protocols, which indicates the ability of this method to adapt to the user's preferences.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2013

Automated treatment planning for a dedicated multi-source intra-cranial radiosurgery treatment unit accounting for overlapping structures and dose homogeneity

Purpose: The purpose of this work is to advance the two-step approach for Gamma Knife{sup ®} Perfexion™ (PFX) optimization to account for dose homogeneity and overlap between the planning target volume (PTV) and organs-at-risk (OARs).Methods: In the first step, a geometry-based algorithm is used to quickly select isocentre locations while explicitly accounting for PTV-OARs overlaps. In this approach, the PTV is divided into subvolumes based on the PTV-OARs overlaps and the distance of voxels to the overlaps. Only a few isocentres are selected in the overlap volume, and a higher number of isocentres are carefully selected among voxels that are immediately close to the overlap volume. In the second step, a convex optimization is solved to find the optimal combination of collimator sizes and their radiation duration for each isocentre location.Results: This two-step approach is tested on seven clinical cases (comprising 11 targets) for which the authors assess coverage, OARs dose, and homogeneity index and relate these parameters to the overlap fraction for each case. In terms of coverage, the mean V{sub 99} for the gross target volume (GTV) was 99.8% while the V{sub 95} for the PTV averaged at 94.6%, thus satisfying the clinical objectives of 99% for GTV and 95% for PTV, respectively. The mean relative dose to the brainstem was 87.7% of the prescription dose (with maximum 108%), while on average, 11.3% of the PTV overlapped with the brainstem. The mean beam-on time per fraction per dose was 8.6 min with calibration dose rate of 3.5 Gy/min, and the computational time averaged at 205 min. Compared with previous work involving single-fraction radiosurgery, the resulting plans were more homogeneous with average homogeneity index of 1.18 compared to 1.47.Conclusions: PFX treatment plans with homogeneous dose distribution can be achieved by inverse planning using geometric isocentre selection and mathematical modeling and optimization techniques. The quality of the obtained treatment plans are clinically satisfactory while the homogeneity index is improved compared to conventional PFX plans.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2014

SU-D-BRD-07: Automatic Patient Data Audit and Plan Quality Check to Support ARIA and Eclipse

Purpose: To ensure patient safety and treatment quality in RT departments that use Varian ARIA and Eclipse, we developed a computer software system and interface functions that allow previously developed electron chart checking (EcCk) methodologies to support these Varian systems. Methods: ARIA and Eclipse store most patient information in its MSSQL database. We studied the contents in the hundreds database tables and identified the data elements used for patient treatment management and treatment planning. Interface functions were developed in both c-sharp and MATLAB to support data access from ARIA and Eclipse servers using SQL queries. These functions and additional data processing functions allowed the existing rules and logics from EcCk to support ARIA and Eclipse. Dose and structure information are important for plan quality check, however they are not stored in the MSSQL database but as files in Varian private formats, and cannot be processed by external programs. We have therefore implemented a service program, which uses the DB Daemon and File Daemon services on ARIA server to automatically and seamlessly retrieve dose and structure data as DICOM files. This service was designed to 1) consistently monitor the data access requests from EcCk programs, 2) translate the requests for ARIA daemon services to obtain dose and structure DICOM files, and 3) monitor the process and return the obtained DICOM files back to EcCk programs for plan quality check purposes. Results: EcCk, which was previously designed to only support MOSAIQ TMS and Pinnacle TPS, can now support Varian ARIA and Eclipse. The new EcCk software has been tested and worked well in physics new start plan check, IMRT plan integrity and plan quality checks. Conclusion: Methods and computer programs have been implemented to allow EcCk to support Varian ARIA and Eclipse systems. This project was supported by a research grant from Varian Medical System.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-J-179: Prediction of Pelvic Nodal Coverage Using Mutual Information Between Cone-Beam and Planning CTs

Purpose: To investigate if pelvic nodal coverage for prostate patients undergoing intensity modulated radiotherapy (IMRT) can be predicted using mutual image information computed between planning and cone-beam CTs (CBCTs). Methods: Four patients with high-risk prostate adenocarcinoma were treated with IMRT on a Varian TrueBeam. Plans were designed such that 95% of the nodal planning target volume (PTV) received the prescription dose of 45 Gy (N=1) or 50.4 Gy (N=3). Weekly CBCTs (N=25) were acquired and the nodal clinical target volumes and organs at risk were contoured by a physician. The percent nodal volume receiving prescription dose was recorded as a ground truth. Using the recorded shifts performed by the radiation therapists at the time of image acquisition, CBCTs were aligned with the planning kVCT. Mutual image information (MI) was calculated between the CBCT and the aligned planning CT within the contour of the nodal PTV. Due to variable CBCT fields-of-view, CBCT images covering less than 90% of the nodal volume were excluded from the analysis, resulting in the removal of eight CBCTs. Results: A correlation coefficient of 0.40 was observed between the MI metric and the percent of the nodal target volume receiving the prescription dose. One patient's CBCTs had clear outliers from the rest of the patients. Upon further investigation, we discovered image artifacts that were present only in that patient's images. When those four images were excluded, the correlation improved to 0.81. Conclusion: This pilot study shows the potential of predicting pelvic nodal dosimetry by computing the mutual image information between planning CTs and patient setup CBCTs. Importantly, this technique does not involve manual or automatic contouring of the CBCT images. Additional patients and more robust exclusion criteria will help validate our findings.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-40: Analysis of Composite MVCT Planning Dosimetry with SBRT of Upper Peripheral Lung Cancer

Purpose: Quantitatively evaluate and compare the final adaptive planning doses of upper peripherally located lung SBRT treated with Tomotherapy using 3rd party software tool. Methods: With tumor located in the upper quadrant of lung, a 3rd party software tool was implemented to evaluate the Tomotherapy composite dosimetry created by adaptive fan beam MVCT images described by RTOG 0915 dose criteria (48 Gy / 4 fractions). The composite doses was then summarized with deformable registration in this package with corresponding target and critical structures. The final dosimetry variation, both for target and critical structures, were evaluated in a tabular format and isodose distribution comparisons. Results: Composite SBRT treatment doses were evaluated with adaptive planning. The PTV and several critical structures were mapped/deformed into the package via DICOM from Tomotherapy after the final composite doses were created. Initial plan versus the final composite plan calculated from verification images were compared. The ITV defined by 4D CT and contoured on MVCT images were correlated in patient repositioning. Final composite dose calculated for PTV coverage has shown 0.1–0.17 cGy coverage (0.2–0.4% of prescription dose) variation. Total lung and cord were both less than 0.17 Gy which represented <0.4% difference. All other critical structure were within statistical significance. The adaptive plans justified/included the breathing and motion during the treatment process. Final 95% isotope line coverage from prescription has been met without issues. Conclusions: With lung tumor location in the upper peripheral area, breathing control was not necessary required during SBRT treatment using Tomotherapy technique. Slow fan beam CT provides definitive ITV information and the adaptive composite plan for all fractions were suitable for final dose delivery. The final composite dose calculated with Tomotherapy adaptive tool indicated that the composite dosimetry justified the target location with SBRT delivery, safe with minimum margin of errors.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-73: Commissioning of a Treatment Planning System for Proton Spot Scanning

Purpose: A treatment planning system (TPS) was commissioned for clinical use with a fixed beam line proton delivery system. An outline of the data collection, modeling, and verification is provided. Methods: Beam data modeling for proton spot scanning in CMS Xio TPS requires the following measurements: (i) integral depth dose curves (IDDCs); (ii) absolute dose calibration; and (iii) beam spot characteristics. The IDDCs for 18 proton energies were measured using an integrating detector in a single spot field in a water phantom. Absolute scaling of the IDDCs were performed based on ion chamber measurements in mono-energetic 10×10 cm{sup 2} fields in water. Beam spot shapes were measured in air using a flat panel scintillator detector at multiple planes. For beam model verification, more than 45 uniform dose phantom and patient plans were generated. These plans were used to measure range, point dose, and longitudinal and lateral profiles. Tolerances employed for verification are: point dose and longitudinal profiles, ±2%; range, ±1 mm; FWHM for lateral profiles, ±2 mm; and patient plan dose distribution, gamma index of >90% at 3%/3 mm criteria. Results: More than 97% of the point dose measurements out of 115 were within +/-2% with maximum deviation of 3%. 98% of the ranges measured were within 1 mm with maximum deviation of 1.4mm. The normalized depth doses were within 2% at all depths. The maximum error in FWHM of lateral profiles was found to be less than 2mm. For 5 patient plans representing different anatomic sites, a total of 38 planes for 12 beams were analyzed for gamma index with average value of 99% and minimum of 94%. Conclusions: The planning system is successfully commissioned and can be safely deployed for clinical use. Measurements of IDDCs on user beam are highly recommended instead of using standard beam IDDCs.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-154: Establishment and Implement of 3D Image Guided Brachytherapy Planning System

Purpose: Cannot observe the dose intuitionally is a limitation of the existing 2D pre-implantation dose planning. Meanwhile, a navigation module is essential to improve the accuracy and efficiency of the implantation. Hence a 3D Image Guided Brachytherapy Planning System conducting dose planning and intra-operative navigation based on 3D multi-organs reconstruction is developed. Methods: Multi-organs including the tumor are reconstructed in one sweep of all the segmented images using the multiorgans reconstruction method. The reconstructed organs group establishs a three-dimensional visualized operative environment. The 3D dose maps of the three-dimentional conformal localized dose planning are calculated with Monte Carlo method while the corresponding isodose lines and isodose surfaces are displayed in a stereo view. The real-time intra-operative navigation is based on an electromagnetic tracking system (ETS) and the fusion between MRI and ultrasound images. Applying Least Square Method, the coordinate registration between 3D models and patient is realized by the ETS which is calibrated by a laser tracker. The system is validated by working on eight patients with prostate cancer. The navigation has passed the precision measurement in the laboratory. Results: The traditional marching cubes (MC) method reconstructs one organ at one time and assembles them together. Compared to MC, presented multi-organs reconstruction method has superiorities in reserving the integrality and connectivity of reconstructed organs. The 3D conformal localized dose planning, realizing the 'exfoliation display' of different isodose surfaces, helps make sure the dose distribution has encompassed the nidus and avoid the injury of healthy tissues. During the navigation, surgeons could observe the coordinate of instruments real-timely employing the ETS. After the calibration, accuracy error of the needle position is less than 2.5mm according to the experiments. Conclusion: The speed and quality of 3D reconstruction, the efficiency in dose planning and accuracy in navigation all can be improved simultaneously.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-205: Improving Quality Assurance of HDR Brachytherapy: Verifying Agreement Between Planned and Delivered Dose Distributions Using DICOM RTDose and Advanced Film Dosimetry

Purpose: HDR brachytherapy is undergoing significant development, and quality assurance (QA) checks must keep pace. Current recommendations do not adequately verify delivered against planned dose distributions: This is particularly relevant for new treatment planning system (TPS) calculation algorithms (non TG-43 based), and an era of significant patient-specific plan optimisation. Full system checks are desirable in modern QA recommendations, complementary to device-centric individual tests. We present a QA system incorporating TPS calculation, dose distribution export, HDR unit performance, and dose distribution measurement. Such an approach, more common in external beam radiotherapy, has not previously been reported in the literature for brachytherapy. Methods: Our QA method was tested at 24 UK brachytherapy centres. As a novel approach, we used the TPS DICOM RTDose file export to compare planned dose distribution with that measured using Gafchromic EBT3 films placed around clinical brachytherapy treatment applicators. Gamma analysis was used to compare the dose distributions. Dose difference and distance to agreement were determined at prescription Point A. Accurate film dosimetry was achieved using a glass compression plate at scanning to ensure physically-flat films, simultaneous scanning of known dose films with measurement films, and triple-channel dosimetric analysis. Results: The mean gamma pass rate of RTDose compared to film-measured dose distributions was 98.1% at 3%(local), 2 mm criteria. The mean dose difference, measured to planned, at Point A was -0.5% for plastic treatment applicators and -2.4% for metal applicators, due to shielding not accounted for in TPS. The mean distance to agreement was 0.6 mm. Conclusion: It is recommended to develop brachytherapy QA to include full-system verification of agreement between planned and delivered dose distributions. This is a novel approach for HDR brachytherapy QA. A methodology using advanced film dosimetry and gamma comparison to DICOM RTDose files has been demonstrated as suitable to fulfil this need.

07 ISOTOPE AND RADIATION SOURCES↗