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

SU-E-T-226: Junction Free Craniospinal Irradiation in Linear Accelerator Using Volumetric Modulated Arc Therapy : A Novel Technique Using Dose Tapering

Purpose: Spatially separated fields are required for craniospinal irradiation due to field size limitation in linear accelerator. Field junction shits are conventionally done to avoid hot or cold spots. Our study was aimed to demonstrate the feasibility of junction free irradiation plan of craniospinal irradiation (CSI) for Meduloblastoma cases treated in linear accelerator using Volumetric modulated arc therapy (VMAT) technique. Methods: VMAT was planned using multiple isocenters in Monaco V 3.3.0 and delivered in Elekta Synergy linear accelerator. A full arc brain and 40° posterior arc spine fields were planned using two isocentre for short (<1.3 meter height ) and 3 isocentres for taller patients. Unrestricted jaw movement was used in superior-inferior direction. Prescribed dose to PTV was achieved by partial contribution from adjacent beams. A very low dose gradient was generated to taper the isodoses over a long length (>10 cm) at the conventional field junction. Results: In this primary study five patients were planned and three patients were delivered using this novel technique. As the dose contribution from the adjacent beams were varied (gradient) to create a complete dose distribution, therefore there is no specific junction exists in the plan. The junction were extended from 10–14 cm depending on treatment plan. Dose gradient were 9.6±2.3% per cm for brain and 7.9±1.7 % per cm for spine field respectively. Dose delivery error due to positional inaccuracy was calculated for brain and spine field for ±1mm, ±2mm, ±3mm and ±5 mm were 1%–0.8%, 2%–1.6%, 2.8%–2.4% and 4.3%–4% respectively. Conclusion: Dose tapering in junction free CSI do not require a junction shift. Therefore daily imaging for all the field is also not essential. Due to inverse planning dose to organ at risk like thyroid kidney, heart and testis can be reduced significantly. VMAT gives a quicker delivery than Step and shoot or dynamic IMRT.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-324: The Influence of Patient Positioning Uncertainties in Proton Radiotherapy On Proton Range and Dose Distributions

Purpose: Proton radiotherapy allows radiation treatment delivery with high dose gradients. The nature of such dose distributions increases the influence of patient positioning uncertainties on their fidelity when compared to photon radiotherapy. The present work quantitatively analyzes the influence of setup uncertainties on proton range and dose distributions. Methods: 38 clinical passive scattering treatment fields for small lesions in the head were studied. Dose distributions for shifted and rotated patient positions were Monte Carlo-simulated. Proton range uncertainties at the 50% and 90%-dose falloff position were calculated considering 18 arbitrary combinations of maximal patient position shifts and rotations for two patient positioning methods. Normal tissue complication probabilities (NTCPs), equivalent uniform doses (EUDs) and tumor control probabilities (TCPs) were studied for organs at risk (OARs) and target volumes of eight patients. Results: We identified a median 1σ proton range uncertainty at the 50%-dose falloff of 2.8 mm for anatomy-based patient positioning and 1.6 mm for fiducial-based patient positioning as well as 7.2 mm and 5.8 mm for the 90%-dose falloff position respectively. These range uncertainties were correlated to heterogeneity indices (HIs) calculated for each treatment field (38% < R{sup 2} < 50%). A NTCP increase of more than 10% (absolute) was observed for less than 2.9% (anatomy-based positioning) and 1.2% (fiducial-based positioning) of the studied OARs and patient shifts. TCP decreases larger than 10% (absolute) were seen for less than 2.2% of the target volumes or non-existent. EUD changes were up to 178% for OARs and 35% for target volumes. Conclusion: The influence of patient positioning uncertainties on proton range in therapy of small lesions in the human brain and target and OAR dosimetry were studied. Observed range uncertainties were correlated with HIs. The clinical practice of using multiple compensator-smeared treatment beams selected to avoid distal OAR sparing is considered to be safe. J. L. was supported by a scholarship of the University of Vienna.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-386: A Monte Carlo Dose Calculation Framework for Electron Beams On Varian TrueBeam

Purpose: The design of the linac head is different for TrueBeam than Clinac, and there are differences in measured dose distributions in water phantoms between TrueBeam and Clinac for electron beams. Therefore, MC models for Clinac may not be applied directly to the Truebeam linac. The purpose of this study is to validate a Monte Carlo (MC) dose calculation framework for electron beams on Varian TrueBeam with phase space files provided by Varian. Methods: The particle histories from the phase space file were used as input for the down-stream simulation including jaws, applicators, and water phantom. MC packages BEAMnrc/DOSYXZnrc were used. The down-stream beam components were modeled according to manufacturer specifications and the dose distributions were compared with the measured data of standard cones. The measurements were performed in a water phantom with a p-type electron field diode (diameter 0.2cm) and ion chamber (CC13). Depth dose and orthogonal profiles at depths defined by R{sub 1} {sub 0} {sub 0}, R{sub 5} {sub 0}, Rp were compared. Results: Preliminary results for a 16 MeV phase space and 10x10, 15x15, and 20x20 cm{sup 2} applicator are presented. Simulations were run for a statistical uncertainty of <2% at depth of maximum dose for a voxel resolution of 0.5x0.5x0.2cm{sup 2}. Dose and range differences for the PDD profiles were within 2% and 1 mm, respectively. Dose differences within the central 80% of the beam width for the orthogonal profiles at depth of maximum dose were less than 2% for the 10x10, 15x15, and 20x20 cm{sup 2} applicator, respectively. Conclusion: Varian electron phase space files simulations are in agreement with measured commissioning data. These phase space files can be used in the simulation of TrueBeam linacs, and will provide reproducibility across publications. Analyses for all electron energies and standard applicators are under way and results will be included in the presentation.

07 ISOTOPE AND RADIATION SOURCES↗
DOE OSTI2014

SU-E-T-516: Measurement of the Absorbed Dose Rate in Water Under Reference Conditions in a CyberKnife Unit

Purpose: This paper aims to measure the absorbed-dose-rate in a CyberKnife unit reference-field (6cm diameter) using three ionization chambers (IC) following the new IAEA/AAPM formalism and Gafchromic film (MD-V3-55 and EBT3) protocol according to our work reported previously. Methods: The absorbed-dose-rates were measured at 90cm and 70cm SSD in a 10cmx10cm field and at 70cm SSD in a 5.4cmx5.4cm equivalent to 6cm diameter field using a linac Varian iX. All measurements were performed at 10cm depth in water. The correction factors that account for the difference between the IC response on the reference field and the CyberKnife reference field, k-(Q-msr,Q)^(f-msr,f-ref), were evaluated and Gafchromic film were calibrated using the results obtained above. Under the CyberKnife reference conditions, the factors were used to measure the absorbed-dose-rate with IC according to the new formalism and the calibrated film was irradiated in water. The film calibration curve was used to evaluate the absorbed-dose-rate in the CyberKnife unit. Results: Difference up to 2.56% is observed between dose-rate measured with IC in the reference 10cmx10cm field, depending where the chamber was calibrated, which was not reflected in the correction factor k-(Q-msr,Q)^(f-msr,f-ref ) where variations of ~0.15%-0.5% were obtained. Within measurements uncertainties, maximum difference of 1.8% on the absorbed-dose-rate in the CyberKnife reference field is observed between all IC and the films Conclusion: Absorbed-dose-rate to water was measured in a CyberKnife reference field with acceptable accuracy (combined uncertainties ~1.32%-1.73%, k=1) using three IC and films. The MD-V3-55 film as well as the new IAEA/AAPM formalism can be considered as a suitable dosimetric method to measure absorbed-dose-rate to water in small and non-standard CyberKnife fields used in clinical treatments However, the EBT3 film is not appropriated due to the high uncertainty provided (combined uncertainty ~9%, k=1) This work is partially supported by Conacyt grant 127409 and PAPIITUNAM grant IN10581.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-633: Dose Differences in Lung Cancer SBRT: The Influences of MLC Width

Purpose: The aim is to compare the plan dose distribution of lung SBRT with MLCs in different width. Methods: Cases with phase INSCLC were enrolled. 9 cases were undergone 4D-CT scanning in the supine position with both arms raised. 3D-CT images without IV contrast were afterwards acquired with 3mm thickness and used for dose calculations. ITV was generated by using the inspiration and expiration images. The ITV can be expanded by geometric set-up uncertainty (5 mm) to generate the PTV. All chest normal tissues including chest wall were contoured by doctors. A total dose of 55 Gy will be given in 5 fractions within 10–14 days with an inter fraction interval of 2–3 days. Guided by the RTOG trial 3502 protocol, 11–13 non-coplanar fields with 6MV photon were arranged. Three types of MLCs with width of 3mm, 5mm and 10mm at isocenter position, were used separately to generate a CRT plan for each case. Monte Carlo algorithm was applied to dose calculation. All plans were adjusted as possible to meet the dose constraints. Dose-volume parameters from plans as followed were compared and analysized: PTV V55Gy, COMPTV D70% (70% of normalization dose), volume A (body minus PTV), and R100% and R50% (the ratio of x% of prescription dose isoline volume to PTV volume). Results: MLCs, 3mm and 5mm wide, played the identical roles on dosimetry of the plans, excluding the parameter volume A (p<0.05). On the contrary, MLC with width of 10mm was significantly inferior to the other two types on most parameters (p<0.05). For R50%, all types contributed equally (p>0.05). Conclusion: For lung cancer SBRT, MLC width had influence to dosimetry, especially in irradiation area. Small size MLC, e.g. 3mm and 5mm, are helpful to generate a high quality treatment plan, which could meet the strict criteria for targets and OAR.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-CAMPUS-T-01: Analysis of the Precision of Patient Set-Up, and Fidelity of the Delivered Dose Distribution in Proton Therapy of Ocular Tumors

Purpose: To quantify daily set-up variations in fractionated proton therapy of ocular melanomas, and to assess the effect on the fidelity of delivered distribution to the plan. Methods: In a typical five-fraction course, daily set-up is achieved by matching the position of fiducial markers in orthogonal radiographs to the images generated by treatment planning program. A patient maintains the required gaze direction voluntarily, without the aid of fixation devices. Confirmation radiographs are acquired to assess intrafractional changes. For this study, daily radiographs were analyzed to determine the daily iso-center position and apparent gaze direction, which were then transferred to the planning system to calculate the dose delivered in individual fractions, and accumulated dose for the entire course. Dose-volume metrics were compared between the planned and accumulated distributions for the tumor and organs at risk, for representative cases that varied by location within the ocular globe. Results: The analysis of the first set of cases (3 posterior, 3 transequatorial and 4 anterior tumors) revealed varying dose deviation patterns, depending on the tumor location. For anterior and posterior tumors, the largest dose increases were observed in the lens and ciliary body, while for the equatorial tumors, macula, optic nerve and disk, were most often affected. The iso-center position error was below 1.3 mm (95%-confidence interval), and the standard deviation of daily polar and azimuthal gaze set-up were 1.5 and 3 degrees, respectively. Conclusion: We quantified interfractional and intrafractional set-up variation, and estimated their effect on the delivered dose for representative cases. Current safety margins are sufficient to maintain the target coverage, however, the dose delivered to critical structures often deviates from the plan. The ongoing analysis will further explore the patterns of dose deviation, and may help to identify particular treatment scenarios which are at a higher risk for such deviations.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-F-19A-01: APBI Brachytherapy Treatment Planning: The Impact of Heterogeneous Dose Calculations

Purpose: To quantify the difference in dose to PTV-EVAL and OARs (skin and rib) as calculated by (TG43) and heterogeneous calculations (CCC). Methods: 25 patient plans (5 Contura and 20 SAVI) were selected for analysis. Clinical dose distributions were computed with a commercially available treatment planning algorithm (TG43-D-(w,w)) and then recomputed with a pre-clinical collapsed cone convolution algorithm (CCCD-( m,m)). PTV-EVAL coverage (V90%, V95%), and rib and skin maximum dose were compared via percent difference. Differences in dose to normal tissue (V150cc, V200cc of PTV-EVAL) were also compared. Changes in coverage and maximum dose to organs at risk are reported in percent change, (100*(TG43 − CCC) / TG43)), and changes in maximum dose to normal tissue are absolute change in cc (TG43 − CCC). Results: Mean differences in V90, V95, V150, and V200 for the SAVI cases were −0.2%, −0.4%, −0.03cc, and −0.14cc, respectively, with maximum differences of −0.78%, −1.7%, 1.28cc, and 1.01cc, respectively. Mean differences in the 0.1cc dose to the rib and skin were −1.4% and −0.22%, respectively, with maximum differences of −4.5% and 16%, respectively. Mean differences in V90, V95, V150, and V200 for the Contura cases were −1.2%, −2.1%, −1.8cc, and −0.59cc, respectively, with maximum differences of −2.0%, −3.16%, −2.9cc, and −0.76cc, respectively. Mean differences in the 0.1cc dose to the rib and skin were −2.6% and −3.9%, respectively, with maximum differences of −3.2% and −5.7%, respectively. Conclusion: The effects of translating clinical knowledge based on D-(w,w) to plans reported in D-(m,m) are minimal (2% or less) on average, but vary based on the type and placement of the device, source, and heterogeneity information.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-F-BRD-16: Under Dose Regions Recalculated by Monte Carlo Cannot Predict the Local Failure for NSCLC Patients Treated with SBRT

Purpose: To investigate whether Monte Carlo (MC) recalculated dose distributions can predict the geometric location of the recurrence for nonsmall cell lung cancer (NSCLC) patients treated with stereotactic body radiotherapy (SBRT). Methods: Thirty NSCLC patients with local recurrence were retrospectively selected for this study. The recurred gross target volumes (rGTV) were delineated on the follow-up CT/PET images and then rigidly transferred via imaging fusion to the original planning CTs. Failure pattern was defined according to the overlap between the rGTV and planning GTV (pGTV) as: (a) in-field failure (≥80%), (b) marginal failure (20%–80%), and (c) out-of-field failure (≤20%). All clinical plans were calculated initially with pencil beam (PB) with or without heterogeneity correction dependent of protocols. These plans were recalculated with MC with heterogeneity correction. Because of non-uniform dose distributions in the rGTVs, the rGTVs were further divided into four regions: inside the pGTV (GTVin), inside the PTV (PTVin), outside the pGTV (GTVout), and outside the PTV (PTVout). The mean doses to these regions were reported and analyzed separately. Results: Among 30 patients, 10 patients had infield recurrences, 15 marginal and 5 out-of-field failures. With MC calculations, D95 and D99 of the PTV were reduced by (10.6 ± 7.4)% and (11.7 ± 7.9)%. The average MC calculated mean doses of GTVin, GTVout, PTVin and PTVout were 48.2 ± 5.3 Gy, 48.2 ± 5.5 Gy, 46.3 ± 6.2 Gy and 46.6 ± 5.6 Gy, respectively. No significant dose differences between GTVin and GTVout (p=0.65), PTVin and PTVout (p=0.19) were observed, using the paired students t-test. Conclusion: Although the PB calculations underestimated the tumor target doses, the geometric location of the recurrence did not correlate with the mean doses of subsections of the recurrent GTV. Under dose regions recalculated by MC cannot predict the local failure for NSCLC patients treated with SBRT.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

Dose-to-water conversion for the backscatter-shielded EPID: A frame-based method to correct for EPID energy response to MLC transmitted radiation

Purpose: To develop a frame-by-frame correction for the energy response of amorphous silicon electronic portal imaging devices (a-Si EPIDs) to radiation that has transmitted through the multileaf collimator (MLC) and to integrate this correction into the backscatter shielded EPID (BSS-EPID) dose-to-water conversion model. Methods: Individual EPID frames were acquired using a Varian frame grabber and iTools acquisition software then processed using in-house software developed inMATLAB. For each EPID image frame, the region below the MLC leaves was identified and all pixels in this region were multiplied by a factor of 1.3 to correct for the under-response of the imager to MLC transmitted radiation. The corrected frames were then summed to form a corrected integrated EPID image. This correction was implemented as an initial step in the BSS-EPID dose-to-water conversion model which was then used to compute dose planes in a water phantom for 35 IMRT fields. The calculated dose planes, with and without the proposed MLC transmission correction, were compared to measurements in solid water using a two-dimensional diode array. Results: It was observed that the integration of the MLC transmission correction into the BSS-EPID dose model improved agreement between modeled and measured dose planes. In particular, the MLC correction produced higher pass rates for almost all Head and Neck fields tested, yielding an average pass rate of 99.8% for 2%/2 mm criteria. A two-sample independentt-test and fisher F-test were used to show that the MLC transmission correction resulted in a statistically significant reduction in the mean and the standard deviation of the gamma values, respectively, to give a more accurate and consistent dose-to-water conversion. Conclusions: The frame-by-frame MLC transmission response correction was shown to improve the accuracy and reduce the variability of the BSS-EPID dose-to-water conversion model. The correction may be applied as a preprocessing step in any pretreatment portal dosimetry calculation and has been shown to be beneficial for highly modulated IMRT fields.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

Validation of OSLD and a treatment planning system for surface dose determination in IMRT treatments

Purpose: To evaluate the accuracy of skin dose determination for composite multibeam 3D conformal radiation therapy (3DCRT) and intensity modulated radiation therapy (IMRT) treatments using optically stimulated luminescent dosimeters (OSLDs) and Eclipse treatment planning system. Methods: Surface doses measured by OSLDs in the buildup region for open field 6 MV beams, either perpendicular or oblique to the surface, were evaluated by comparing against dose measured by Markus Parallel Plate (PP) chamber, surface diodes, and calculated by Monte Carlo simulations. The accuracy of percent depth dose (PDD) calculation in the buildup region from the authors’ Eclipse system (Version 10), which was precisely commissioned in the buildup region and was used with 1 mm calculation grid, was also evaluated by comparing to PP chamber measurements and Monte Carlo simulations. Finally, an anthropomorphic pelvic phantom was CT scanned with OSLDs in place at three locations. A planning target volume (PTV) was defined that extended close to the surface. Both an 8 beam 3DCRT and IMRT plan were generated in Eclipse. OSLDs were placed at the CT scanned reference locations to measure the skin doses and were compared to diode measurements and Eclipse calculations. Efforts were made to ensure that the dose comparison was done at the effective measurement points of each detector and corresponding locations in CT images. Results: The depth of the effective measurement point is 0.8 mm for OSLD when used in the buildup region in a 6 MV beam and is 0.7 mm for the authors’ surface diode. OSLDs and Eclipse system both agree well with Monte Carlo and/or Markus PP ion chamber and/or diode in buildup regions in 6 MV beams with normal or oblique incidence and across different field sizes. For the multiple beam 3DCRT plan and IMRT plans, the differences between OSLDs and Eclipse calculations on the surface of the anthropomorphic phantom were within 3% and distance-to-agreement less than 0.3 mm. Conclusions: The authors’ experiment showed that OSLD is an accurate dosimeter for skin dose measurements in complex 3DCRT or IMRT plans. It also showed that an Eclipse system with accurate commissioning of the data in the buildup region and 1 mm calculation grid can calculate surface doses with high accuracy and has a potential to replacein vivo measurements.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

Poster — Thur Eve — 33: The Influence of a Modeled Treatment Couch on Dose Distributions During IMRT and RapidArc Treatment Delivery

Treatment couches have been known to perturb dose delivery in patients. This effect is most pronounced in techniques such as IMRT and RapidArc. Although modern treatment planning systems (TPS) include data for a “default” treatment couch, actual couches are not manufactured identically. Thus, variations in their Hounsfield Unit (HU) values may exist. This study demonstrates a practical and simple method of acquiring reliable HU data for any treatment couch. We also investigate the effects of both the default and modeled treatment couches on absorbed dose. Experimental verifications show that by neglecting to incorporate the treatment couch in the TPS, dose differences of up to 9.5% and 7.3% were present for 4 MV and 10 MV photon beams, respectively. Furthermore, a clinical study based on a cohort of 20 RapidArc and IMRT (brain, pelvis and abdominal) cases is performed. 2D dose distributions show that without the couch in the planning phase, differences ≤ 4.6% and 5.9% for RapidArc and IMRT cases are present for the same cases that the default couch was added to. Additionally, in comparison to the default couch, employing the modeled couch in the calculation process influences dose distributions by ≤ 2.7% and 8% for RapidArc and IMRT cases, respectively. This result was found to be site specific; where an accurate couch proves to be preferable for IMRT brain plans. As such, adding the couch during dose calculation decreases dose calculation errors, and a precisely modeled treatment couch offers higher dose delivery accuracy for brain treatment using IMRT.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-C-BRD-07: Three-Dimensional Dose Reconstruction in the Presence of Inhomogeneities Using Fast EPID-Based Back-Projection Method

Purpose: Three-dimensional dose verification can detect errors introduced by the treatment planning system (TPS) or differences between planned and delivered dose distribution during the treatment. The aim of the study is to extend a previous in-house developed three-dimensional dose reconstructed model in homogeneous phantom to situtions in which tissue inhomogeneities are present. Methods: The method was based on the portal grey images from an electronic portal imaging device (EPID) and the relationship between beamlets and grey-scoring voxels at the position of the EPID. The relationship was expressed in the form of grey response matrix that was quantified using thickness-dependence scatter kernels determined by series of experiments. From the portal grey-value distribution information measured by the EPID the two-dimensional incident fluence distribution was reconstructed based on the grey response matrix using a fast iterative algorithm. The accuracy of this approach was verified using a four-field intensity-modulated radiotherapy (IMRT) plan for the treatment of lung cancer in anthopomorphic phantom. Each field had between twenty and twenty-eight segments and was evaluated by comparing the reconstructed dose distribution with the measured dose. Results: The gamma-evaluation method was used with various evaluation criteria of dose difference and distance-to-agreement: 3%/3mm and 2%/2 mm. The dose comparison for all irradiated fields showed a pass rate of 100% with the criterion of 3%/3mm, and a pass rate of higher than 92% with the criterion of 2%/2mm. Conclusion: Our experimental results demonstrate that our method is capable of accurately reconstructing three-dimensional dose distribution in the presence of inhomogeneities. Using the method, the combined planning and treatment delivery process is verified, offing an easy-to-use tool for the verification of complex treatments.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-J-23: Characteristics of X-Rays From ExacTrac and Patient Dose From Imaging Procedures

Purpose: The purpose of this investigation is 1) provide the beam characteristics of x-rays produced by a Novalis TX ExacTrac system; 2) present a method to commission such beams, 3) present radiation dose to patients resulting from the imaging procedures. Methods: The Monte Carlo simulations were used to obtain the characteristics of kV beams and validated by measurements. The calculated beam HVLs, profiles and depth-dose curves were benchmarked against measurements. Twelve different image acquisition protocols were studied. The x-ray tube voltage ranges from 70 - 145 kV and milliampere-second (mAs) ranges from 8 - 80 mAs depending on the selection of Cranium, Head & Neck, Thorax or Abdomen imaging protocols. The beam output of each image acquisition protocol was determined by using an ionization chamber. The air kerma calibration factors of the ion chamber were obtained from an Accredited Dosimetry Calibration Laboratory for specified HVLs. Results: The agreements between measured and simulated results were within the uncertainties for HVLs, dose profiles and depth-dose curves. When %dd was normalized at 1 cm depth, its values at depth of 5 cm ranged from 45% to 66% of in water for kV beams range from 70 kVp to 145 kVp respectively. For head images, a typical dose to eye resulting from single projection ranged from 0.008 cGy to 0.025 cGy depending on the cranial image protocols selected. For a single pelvic image the skin dose could reach up to 0.1 cGy from an abdominal protocol. Conclusion: Although multiple pairs of x-ray images are commonly acquired during a daily patient treatment, the imaging doses to patients resulting from the sum of these projected x-rays are generally much less than 0.5 cGy. The knowledge obtained from this investigation can be used to estimate the image dose and optimize the used of the system.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-J-100: The Combination of Deformable Image Registration and Regions-Of-Interest Mapping Technique to Accomplish Accurate Dose Calculation On Cone Beam Computed Tomography for Esophageal Cancer

Purpose: We introduce a new method combined with the deformable image registration (DIR) and regions-of-interest mapping (ROIM) technique to accurately calculate dose on daily CBCT for esophageal cancer. Methods: Patients suffered from esophageal cancer were enrolled in the study. Prescription was set to 66 Gy/30 F and 54 Gy/30 F to the primary tumor (PTV66) and subclinical disease (PTV54) . Planning CT (pCT) were segmented into 8 substructures in terms of their differences in physical density, such as gross target volume (GTV), venae cava superior (SVC), aorta, heart, spinal cord, lung, muscle and bones. The pCT and its substructures were transferred to the MIM software to readout their mean HU values. Afterwards, a deformable planning CT to daily KV-CBCT image registration method was then utilized to acquire a new structure set on CBCT. The newly generated structures on CBCT were then transferred back to the treatment planning system (TPS) and its HU information were overridden manually with mean HU values obtained from pCT. Finally, the treatment plan was projected onto the CBCT images with the same beam arrangements and monitor units (MUs) to accomplish dose calculation. Planning target volume (PTV) and organs at risk (OARs) from both of the pCT and CBCT were compared to evaluate the dose calculation accuracy. Results: It was found that the dose distribution in the CBCT showed little differences compared to the pCT, regardless of whether PTV or OARs were concerned. Specifically, dose variation in GTV, PTV54, PTV66, SVC, lung and heart were within 0.1%. The maximum dose variation was presented in the spinal cord, which was up to 2.7% dose difference. Conclusion: The proposed method combined with DIR and ROIM technique to accurately calculate dose distribution on CBCT for esophageal cancer is feasible.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-J-146: A Research of PET-CT SUV Range for the Online Dose Verification in Carbon Ion Radiation Therapy

Purpose: Positron-emitting isotope distributions can be used for the image fusion of the carbon ion planning CT and online target verification PETCT, after radiation in the same decay period,the relationship between the same target volume and the SUV value of different every single fraction dose can be found,then the range of SUV for the radiation target could be decided.So this online range also can provide reference for the correlation and consistency in planning target dose verification and evaluation for the clinical trial. Methods: The Rando head phantom can be used as real body,the 10cc cube volume target contouring is done,beam ISO Center depth is 7.6cm and the 90 degree fixed carbon ion beams should be delivered in single fraction effective dose of 2.5GyE,5GyE and 8GyE.After irradiation,390 seconds later the 30 minutes PET-CT scanning is performed,parameters are set to 50Kg virtual weight,0.05mCi activity.MIM Maestro is used for the image processing and fusion,five 16mm diameter SUV spheres have been chosen in the different direction in the target.The average SUV in target for different fraction dose can be found by software. Results: For 10cc volume target,390 seconds decay period,the Single fraction effective dose equal to 2.5Gy,Ethe SUV mean value is 3.42,the relative range is 1.72 to 6.83;Equal to 5GyE,SUV mean value is 9.946,the relative range is 7.016 to 12.54;Equal or above to 8GyE,SUV mean value is 20.496,the relative range is 11.16 to 34.73. Conclusion: Making an evaluation for accuracy of the dose distribution using the SUV range which is from the planning CT with after treatment online PET-CT fusion for the normal single fraction carbon ion treatment is available.Even to the plan which single fraction dose is above 2GyE,in the condition of other parameters all the same,the SUV range is linearly dependent with single fraction dose,so this method also can be used in the hyper-fraction treatment plan.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-50: A Multi-Institutional Study of Independent Dose Verification Software Program for Lung SBRT

Purpose: The accuracy of dose distribution depends on treatment planning system especially in heterogeneity-region. The tolerance level (TL) of the secondary check using the independent dose verification may be variable in lung SBRT plans. We conducted a multi-institutional study to evaluate the tolerance level of lung SBRT plans shown in the AAPM TG114. Methods: Five institutes in Japan participated in this study. All of the institutes used a same independent dose verification software program (Simple MU Analysis: SMU, Triangle Product, Ishikawa, JP), which is Clarkson-based and CT images were used to compute radiological path length. Analytical Anisotropic Algorithm (AAA), Pencil Beam Convolution with modified Batho-method (PBC-B) and Adaptive Convolve (AC) were used for lung SBRT planning. A measurement using an ion-chamber was performed in a heterogeneous phantom to compare doses from the three different algorithms and the SMU to the measured dose. In addition to it, a retrospective analysis using clinical lung SBRT plans (547 beams from 77 patients) was conducted to evaluate the confidence limit (CL, Average±2SD) in dose between the three algorithms and the SMU. Results: Compared to the measurement, the AAA showed the larger systematic dose error of 2.9±3.2% than PBC-B and AC. The Clarkson-based SMU showed larger error of 5.8±3.8%. The CLs for clinical plans were 7.7±6.0 % (AAA), 5.3±3.3 % (AC), 5.7±3.4 % (PBC -B), respectively. Conclusion: The TLs from the CLs were evaluated. A Clarkson-based system shows a large systematic variation because of inhomogeneous correction. The AAA showed a significant variation. Thus, we must consider the difference of inhomogeneous correction as well as the dependence of dose calculation engine.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-57: A Novel Method to Improve Dose Heterogeneity of Target and Organs at Risk Sparing in the Intensity-Modulated Radiotherapy for Stage III Lung Cancer

Purpose: Intensity-modulated radiotherapy (IMRT) treatment for lung cancer is difficult due to the heterogeneous dose distribution and excessive dose to the organs at risk (OARs). We introduce a simple method based on the base dose function (BDF) in Eclipse treatment planning system to overcome the difficulties. Methods: Thirteen patients suffered from stage III non-small cell lung cancer (NSCLC) were enrolled in the study. Three kinds of approaches were applied to obtain clinically acceptable treatment plans: 1) conventionally optimizing method with hot and cold spots re-optimization (CO); 2) target-divided optimizing method (TDO) in which the optimization objective in the lung density of planning target volume (PTV) was set to 2 to 4 Gy higher than in the soft tissue density; 3) base dose function (BDF) in which the treatment plan was produced based on the original plan for re-optimization. CO, TDO and BDF methods were then compared in terms of conformity index (CI), homogeneity index (HI), OARs sparing and monitor units (MUs). Additionally, delta4, portal dosimetry and IMSure were used to measure the dose delivering accuracy. Results: The BDF technique provided more superior CI and HI than the other two methods. Moreover, the new method also reduced the lung, esophagus, heart and spinal cord dose. However, the BDF plans needed extra 15% and 10% MUs than the CO and TDO methods. Dose verification results demonstrated good and comparable γ pass rates among the three methods. Conclusion: The proposed BDF method greatly improves the dose homogeneity and OARs sparing in the IMRT treatment for lung cancer.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-64: A Programmable Moving Insert for the ArcCHECK Phantom for Dose Verification of Respiratory-Gated VMAT

Purpose: To present a customized programmable moving insert for the ArcCHECK™ phantom that can, in a single delivery, check both entrance dosimetry, while simultaneously verifying the delivery of respiratory-gated VMAT. Methods: The cylindrical motion phantom uses a computer-controlled stepping motor to move an insert inside a stationery sleeve. Insert motion is programmable and can include rotational motion in addition to linear motion along the axis of the cylinder. The sleeve fits securely in the bore of the ArcCHECK™. Interchangeable inserts, including an A1SL chamber, optically-stimulated luminescence dosimeters, radiochromic film, or 3D gels, allow this combination to be used for commissioning, routine quality assurance, and patient-specific dosimetric verification of respiratory-gated VMAT. Before clinical implementation, the effect of a moving insert on the ArcCHECK™ measurements was considered. First, the measured dose to the ArcCHECK™ containing multiple inserts in the static position was compared to the calculated dose during multiple VMAT treatment deliveries. Then, dose was measured under both sinusoidal and real-patient motion conditions to determine any effect of the moving inserts on the ArcCHECK™ measurements. Finally, dose was measured during gated VMAT delivery to the same inserts under the same motion conditions to examine any effect of various beam “on-and-off” and dose rate ramp “up-and-down”. Multiple comparisons between measured and calculated dose to different inserts were also considered. Results: The pass rate for the static delivery exceeded 98% for all measurements (3%/3mm), suggesting a valid setup for entrance dosimetry. The pass rate was not altered for any measurement delivered under motion conditions. A similar Result was observed under gated VMAT conditions, including agreement of measured and calculated dose to the various inserts. Conclusion: Incorporating a programmable moving insert within the ArcCHECK™ phantom provides an efficient verification of respiratory-gated VMAT delivery that is useful during commissioning, routine quality assurance, and patient-specific dose verification. Prototype phantom development and testing was performed in collaboration with Modus Medical Devices Inc. (London, ON). No financial support was granted.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗