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At least 991 records · Page 55
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DOE OSTI2015

SU-E-T-593: Outcomes and Toxicities From a Clinical Trial of APBI Using MERT+IMRT with the Same XMLC

Purpose: We present the results from a clinical trial of accelerated partial breast irradiation (APBI), using mixed modulated photon and electron beams (MERT+IMRT) with the same photon multileaf collimator (xMLC). Methods: Seven patients were enrolled in the first year of the APBI clinical trial. Patients were selected following the conditions included in the NSABP B-39/RTOG 0413 protocol. The targets and clinically relevant normal structures were contoured on the CT images following this protocol for APBI-EBRT. All treatments were delivered using combined modulated electron and photon beams by means of the same xMLC installed in a SIEMENS Primus linac, with a reduced SSD equal to 60 cm for electron beams. The plans were performed with a treatment planning system based on full Monte Carlo simulations, called CARMEN, developed by our group. Simultaneously, an alternative IMRT plan was calculated with the commercial TPS PINNACLE v8.0m (Philips), and both plans were compared. An ad-hoc breast phantom with semi-spherical geometry called NAOMI was designed for a specific QA protocol. Patients received a total dose of 38.5 Gy, delivered in 10 fractions over 5 consecutive days, with a twice-a-day hypofractionated schema.Follow-up visits during 2.5 years on average were repeated at 1 month post-treatment, every 3 months for the first year, and every 6 months for the second year. Toxicity was scored according to National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE version 3.0). Results: This APBI technique achieved high loco-regional control rates and showed low acute toxicity (grade 1 of CTCAE) and no toxicities from first month onwards. Photographic assessment of cosmesis showed skin excellent results. Conclusion: The clinical results achieved with MERT+IMRT by using the same xMLC are comparable or even better than those obtained with other APBI techniques, thanks to a software solution without any additional equipment or specific device.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2015

SU-E-T-598: Parametric Equation for Quick and Reliable Estimate of Stray Neutron Doses in Proton Therapy and Application for Intracranial Tumor Treatments

Purpose: Development of a parametric equation suitable for a daily use in routine clinic to provide estimates of stray neutron doses in proton therapy. Methods: Monte Carlo (MC) calculations using the UF-NCI 1-year-old phantom were exercised to determine the variation of stray neutron doses as a function of irradiation parameters while performing intracranial treatments. This was done by individually changing the proton beam energy, modulation width, collimator aperture and thickness, compensator thickness and the air gap size while their impact on neutron doses were put into a single equation. The variation of neutron doses with distance from the target volume was also included in it. Then, a first step consisted in establishing the fitting coefficients by using 221 learning data which were neutron absorbed doses obtained with MC simulations while a second step consisted in validating the final equation. Results: The variation of stray neutron doses with irradiation parameters were fitted with linear, polynomial, etc. model while a power-law model was used to fit the variation of stray neutron doses with the distance from the target volume. The parametric equation fitted well MC simulations while establishing fitting coefficients as the discrepancies on the estimate of neutron absorbed doses were within 10%. The discrepancy can reach ∼25% for the bladder, the farthest organ from the target volume. Finally, the validation showed results in compliance with MC calculations since the discrepancies were also within 10% for head-and-neck and thoracic organs while they can reach ∼25%, again for pelvic organs. Conclusion: The parametric equation presents promising results and will be validated for other target sites as well as other facilities to go towards a universal method.

61 RADIATION PROTECTION AND DOSIMETRY↗
DOE OSTI2015

SU-E-T-629: Prediction of the ViewRay Radiotherapy Treatment Time for Clinical Logistics

Purpose: An algorithm is developed in our clinic, given a new treatment plan, to predict treatment delivery time for radiation therapy (RT) treatments of patients on ViewRay magnetic resonance-image guided radiation therapy (MR-IGRT) delivery system. This algorithm is necessary for managing patient treatment appointments, and is useful as an indicator to assess the treatment plan complexity. Methods: A patient’s total treatment delivery time, not including time required for localization, may be described as the sum of four components: (1) the treatment initialization time; (2) the total beam-on time; (3) the gantry rotation time; and (4) the multileaf collimator (MLC) motion time. Each of the four components is predicted separately. The total beam-on time can be calculated using both the planned beam-on time and the decay-corrected delivery dose rate. To predict the remaining components, we quantitatively analyze the patient treatment delivery record files. The initialization time is demonstrated to be random since it depends on the final gantry angle and MLC leaf positions of the previous treatment. Based on modeling the relationships between the gantry rotation angles and the corresponding rotation time, and between the furthest MLC leaf moving distance and the corresponding MLC motion time, the total delivery time is predicted using linear regression. Results: The proposed algorithm has demonstrated the feasibility of predicting the ViewRay treatment delivery time for any treatment plan of any patient. The average prediction error is 0.89 minutes or 5.34%, and the maximal prediction error is 2.09 minutes or 13.87%. Conclusion: We have developed a treatment delivery time prediction algorithm based on the analysis of previous patients’ treatment delivery records. The accuracy of our prediction is sufficient for guiding and arranging patient treatment appointments on a daily basis. The predicted delivery time could also be used as an indicator to assess the treatment plan complexity. This work was supported by a research grant from Viewray Inc.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2015

SU-E-T-676: Reproducibility and Consistency of Two SunNuclear 3D Scanning Tanks

Purpose: To determine if two Sun Nuclear 3D Scanning (SNC 3DS) tanks collect reproducible and consistent data and test the precision of the SNC Dosimetry auto-setup. Methods: Percent depth doses (PDDs) and profiles were collected on two SNC 3DS tanks with a Varian TrueBeam linear accelerator. SNC Dosimetry auto-setup application was used with CC13 ionization chambers. After auto-setup, collimator light field was checked manually against the position of the chamber. Comparing measured data for repeated measurements with tank 1 allowed evaluation of SNC-3DS auto-setup and tank reproducibility. Comparing measured data between tanks 1 and 2 allowed evaluation of consistency between tanks. Results: Preliminary results showed reproducibility of depth of maximum dose (Dmax) of 0.38mm for a 10cmx10cm field and 0.67mm for 30cmx30cm on a single tank. PDD values at 5cm, 10cm, and 20cm depths were reproducible within 0.26%. Consistency of Dmax between tanks was 0.17mm for a 10cmx10cm field and 0.44mm for 30cmx30cm. PDD values at 5cm, 10cm, and 20cmwere consistent within 0.06%. Profiles showed reproducibility in field width within 0.4mm for a 10cmx10cm field and 0.7mm for a 30cmx30cm field. Profiles showed consistency in field width within 0.2mm for 10cmx10cm and 30cmx30cm field sizes. Penumbra width was reproducible and consistent to under 0.5mm except for 30cmx30cm field size at 30cm depth where the reproducibility was 2.2mm and the consistency was 2.6mm. Conclusion: In conclusion, the SNC 3DS tank shows good reproducibility in measured data. Since the tank to tank variation in measured data is within the uncertainty of repeated single tank measurements the tanks also perform consistently.

07 ISOTOPE AND RADIATION SOURCES↗
DOE OSTI2015

SU-E-T-761: TOMOMC, A Monte Carlo-Based Planning VerificationTool for Helical Tomotherapy

Purpose: Present a new Monte Carlo code (TOMOMC) to calculate 3D dose distributions for patients undergoing helical tomotherapy treatments. TOMOMC performs CT-based dose calculations using the actual dynamic variables of the machine (couch motion, gantry rotation, and MLC sequences). Methods: TOMOMC is based on the GEPTS (Gama Electron and Positron Transport System) general-purpose Monte Carlo system (Chibani and Li, Med. Phys. 29, 2002, 835). First, beam models for the Hi-Art Tomotherpy machine were developed for the different beam widths (1, 2.5 and 5 cm). The beam model accounts for the exact geometry and composition of the different components of the linac head (target, primary collimator, jaws and MLCs). The beams models were benchmarked by comparing calculated Pdds and lateral/transversal dose profiles with ionization chamber measurements in water. See figures 1–3. The MLC model was tuned in such a way that tongue and groove effect, inter-leaf and intra-leaf transmission are modeled correctly. See figure 4. Results: By simulating the exact patient anatomy and the actual treatment delivery conditions (couch motion, gantry rotation and MLC sinogram), TOMOMC is able to calculate the 3D patient dose distribution which is in principal more accurate than the one from the treatment planning system (TPS) since it relies on the Monte Carlo method (gold standard). Dose volume parameters based on the Monte Carlo dose distribution can also be compared to those produced by the TPS. Attached figures show isodose lines for a H&N patient calculated by TOMOMC (transverse and sagittal views). Analysis of differences between TOMOMC and TPS is an ongoing work for different anatomic sites. Conclusion: A new Monte Carlo code (TOMOMC) was developed for Tomotherapy patient-specific QA. The next step in this project is implementing GPU computing to speed up Monte Carlo simulation and make Monte Carlo-based treatment verification a practical solution.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

MO-AB-BRA-07: Prompt Gamma-Ray Spectroscopy for Range Verification of Clinical Proton Beams

Purpose: We developed a pre-clinical prototype system for range verification of proton pencil-beam scanning fields. The system was evaluated using phantom treatment plans delivered with a clinical dose rate. Methods: The absolute range of proton pencil-beams was verified through an optimization procedure, which matches energy- and time-resolved prompt gamma-ray measurements with models, based on cross sections for discrete prompt gamma-ray line excitations. Phantom experiments were performed with a pre-clinical prototype detector, using treatment plans delivered with a clinical pencil-beam scanning system. The detector consisted of an actively shielded lanthanum(III) bromide scintillator. Tungsten was used to collimate the gamma-rays. To support high event rates, the detector readout featured custom amplifiers and an active voltage divider for the photomultiplier. The detector signals were acquired by fast analog-to-digital converters and processed using digital algorithms. The data acquisition was also synchronized with the pencil-beam scanning and dosimetry systems. Results: We successfully acquired prompt gamma-ray spectra during the delivery of proton pencil-beams with a clinical beam current of 2 nA at the exit of the treatment head. The number of events in the primary detector ranged from 1 x 10{sup 6} to 2 x 10{sup 6} per second. In phantom experiments, non-uniform range errors were introduced by placing strips of plastic in the beam path. The magnitudes and positions of these range errors were correctly detected in two-dimensional range maps that were generated from the measurements. With our small scale prototype, a 1.0 mm standard deviation on the absolute range required about 5 x 10{sup 8} protons per delivered pencil-beam. Conclusions: Prompt gamma-ray spectroscopy to verify the absolute range of proton beams was demonstrated under clinical pencil-beam delivery conditions. A 1 mm to 2 mm range verification accuracy for a field delivering 1 Gy, appears feasible with a full scale system. This work was supported by the Federal Share of program income earned on C06-CA059267, Proton Therapy Research and Treatment Center.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

MO-DE-BRA-03: TOPAS-edu: A Window Into the Stochastic World Through the TOPAS Tool for Particle Simulation

Purpose: The stochastic nature of the subatomic world presents a challenge for physics education. Even experienced physicists can be amazed at the varied behavior of electrons, x-rays, protons, neutrons, ions and the any short-lived particles that make up the overall behavior of our accelerators, brachytherapy sources and medical imaging systems. The all-particle Monte Carlo particle transport tool, TOPAS Tool for Particle Simulation, originally developed for proton therapy research, has been repurposed into a physics teaching tool, TOPAS-edu. Methods: TOPAS-edu students set up simulated particle sources, collimators, scatterers, imagers and scoring setups by writing simple ASCII files (in the TOPAS Parameter Control System format). Students visualize geometry setups and particle trajectories in a variety of modes from OpenGL graphics to VRML 3D viewers to gif and PostScript image files. Results written to simple comma separated values files are imported by the student into their preferred data analysis tool. Students can vary random seeds or adjust parameters of physics processes to better understand the stochastic nature of subatomic physics. Results: TOPAS-edu has been successfully deployed as the centerpiece of a physics course for master’s students at Queen’s University Belfast. Tutorials developed there takes students through a step by step course on the basics of particle transport and interaction, scattering, Bremsstrahlung, etc. At each step in the course, students build simulated experimental setups and then analyze the simulated results. Lessons build one upon another so that a student might end up with a full simulation of a medical accelerator, a water-phantom or an imager. Conclusion: TOPAS-edu was well received by students. A second application of TOPAS-edu is currently in development at Zurich University of Applied Sciences, Switzerland. It is our eventual goal to make TOPAS-edu available free of charge to any non-profit organization, along with associated tutorial materials developed by the TOPAS-edu community. Work supported in part by the U.S. Department of Energy under contract number DE-AC02-76SF00515. B. Villagomez-Bernabe is supported by CONACyT (Mexican Council for Science and Technology) project 231844.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

MO-F-CAMPUS-I-04: Characterization of Fan Beam Coded Aperture Coherent Scatter Spectral Imaging Methods for Differentiation of Normal and Neoplastic Breast Structures

Purpose: This study intends to characterize the spectral and spatial resolution limits of various fan beam geometries for differentiation of normal and neoplastic breast structures via coded aperture coherent scatter spectral imaging techniques. In previous studies, pencil beam raster scanning methods using coherent scatter computed tomography and selected volume tomography have yielded excellent results for tumor discrimination. However, these methods don’t readily conform to clinical constraints; primarily prolonged scan times and excessive dose to the patient. Here, we refine a fan beam coded aperture coherent scatter imaging system to characterize the tradeoffs between dose, scan time and image quality for breast tumor discrimination. Methods: An X-ray tube (125kVp, 400mAs) illuminated the sample with collimated fan beams of varying widths (3mm to 25mm). Scatter data was collected via two linear-array energy-sensitive detectors oriented parallel and perpendicular to the beam plane. An iterative reconstruction algorithm yields images of the sample’s spatial distribution and respective spectral data for each location. To model in-vivo tumor analysis, surgically resected breast tumor samples were used in conjunction with lard, which has a form factor comparable to adipose (fat). Results: Quantitative analysis with current setup geometry indicated optimal performance for beams up to 10mm wide, with wider beams producing poorer spatial resolution. Scan time for a fixed volume was reduced by a factor of 6 when scanned with a 10mm fan beam compared to a 1.5mm pencil beam. Conclusion: The study demonstrates the utility of fan beam coherent scatter spectral imaging for differentiation of normal and neoplastic breast tissues has successfully reduced dose and scan times whilst sufficiently preserving spectral and spatial resolution. Future work to alter the coded aperture and detector geometries could potentially allow the use of even wider fans, thereby making coded aperture coherent scatter imaging a clinically viable method for breast cancer detection. United States Department of Homeland Security; Duke University Medical Center - Department of Radiology; Carl E Ravin Advanced Imaging Laboratories; Duke University Medical Physics Graduate Program.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

TU-F-CAMPUS-I-01: Investigation of the Effective Dose From Bolus Tracking Acquisitions at Different Anatomical Locations in the Chest for CT

Purpose: Stationary table acquisitions (Bolus tracking) in X-ray Computed Tomography (CT) can Result in dose length products (DLP) comparable to spiral scans. It is today unclear whether or not the effective dose (E) for Bolus Tracking can be approximated using target region specific conversion factors (E/DLP). The purpose of this study was to investigate how E depends on the anatomical location of the Bolus Tracking in relation to Chest CT scans with the same DLP. Methods: Effective doses were approximated for the ICRP 110 adult Reference Male (AM) and adult Reference Female (FM) computational voxel phantoms using software for CT dose approximations (pre-simulated MC data). The effective dose was first approximated for a Chest CT scan using spiral technique and a CTDIvol (32 cm) of 6 mGy. The effective dose from the spiral scan was then compared to E approximated for contiguous Bolus Tracking acquisitions (1 cm separation), with a total collimation of 1 cm, over different locations of the chest of the voxel phantoms. The number of rotations used for the Bolus Tracking acquisitions was adjusted to yield the same DLP (32 cm) as the spiral scan. Results: Depending on the anatomical location of the Bolus Tracking, E ranged by factors of 1.3 to 6.8 for the AM phantom and 1.4 to 3.3 for the AF phantom, compared to the effective dose of the spiral scans. The greatest E for the Bolus Tracking acquisitions was observed for anatomical locations coinciding with breast tissue. This can be expected as breast tissue has a high tissue weighting factor in the calculation of E. Conclusion: For Chest CT scans, the effective dose from Bolus Tracking is highly dependent on the anatomical location where the scan is administered and will not always accurately be represented using target region specific conversion factors.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

TU-F-CAMPUS-I-04: A Novel Phantom to Evaluate Longitudinal and Angular Automatic Tube Current Modulation (ATCM) in CT

Purpose: To manufacture a phantom specifically designed for the purpose of evaluating the performance of the longitudinal and angular automatic tube current modulation (ATCM) on modern CT scanners. Methods: In order to evaluate angular ATCM, the phantom has an elliptical cross section (aspect ratio 3:2). To evaluate longitudinal ATCM, the phantom consists of 3 sections, with different major axes (25 cm, 30 cm and 35 cm). Each section is 15 cm long in the longitudinal direction. Between each section is a smooth transition. The phantom was milled from a solid block of PMMA. ATCM performance is evaluated by 1) analyzing the applied tube current for each slice of the phantom and 2) analyzing the distribution of image noise (σ) along the scan direction at different positions in the phantom. A demonstration of the ATCM performance evaluation is given by investigating the effects of miscentering during a CT scan. Results: The developed phantom has proven useful for evaluating both the longitudinal and angular ATCM on modern CT scanners (spiral collimations ≥ 4 cm). Further benefits are the smooth transitions between the sections that prevent abnormal responses in the ATCM and the invariant sections that provide a means for investigating the stability of image noise. The homogeneity of the phantom makes image noise at different positions along the scan direction easy to quantify, which is crucial to understand how well the applied ATCM can produce a desired image quality. Conclusion: It is important to understand how the ATCM functions on CT scanners as it can directly affect dose and image quality. The phantom that has been developed is a most valuable tool to understand how different variables during a scan can affect the outcome of the longitudinal and angular ATCM.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

WE-AB-BRB-03: Investigation of a Small Photomultiplier-Based Probe for Use in Beam Diagnostics and Medical Dosimetry

Purpose: Investigate the use of a small photomultiplier-based probe as a possible beam diagnostic and medical dosimetry tool. Methods: Cerenkov emission produced by clinical accelerator beams was detected by a small photomultiplier tube (PMT). Measurements of Clinac beams were made both in air and by inserting the PMT directly into a water phantom. A conical collimator placed in front of the PMT reduced the angular acceptance and the detection of scattered light. With this arrangement, we obtained response curves as a function of depth along the central axis similar in shape and magnitude to those obtained with ionization chambers. Subsequent measurements were made with the PMT covered in aluminum foil, obtaining a signal arising primarily from direct Cerenkov light produced in the glass entrance window. With an oscilloscope and amplifier/MCA system, we were able to monitor the response to individual beam pulses and observe variations in the beam pulse shape and magnitude as a function of dose rate. Results: Using Cerenkov signals detected by a PMT, we were able to obtain reasonable beam quality metrics, and the response was found to be linear over a range of dose rates. The fast response of the PMT allowed for the observation of small changes in the shape and magnitude of the beam pulse. With this system we were able to detect small changes in the dose per pulse delivered by the accelerator. Conclusion: A small PMT probe has shown promise as a beam diagnostic and medical dosimetry tool. Its fast response allows for real time beam pulse monitoring, and the integrated response can yield relative and perhaps even absolute dose information with a properly calibrated system. For accelerator diagnostics, monitoring of the beam pulse shape can aid in beam tuning, particularly in electron mode, where no target current pulse is available.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

WE-AB-303-03: A Scheme for Real-Time, Marker-Less and Low-Dose Tumor Tracking Using Scattering Imaging: Monte Carlo Simulation Study

Purpose: In-treatment tumor localization is critical for the management of tumor motion in lung cancer radiotherapy. Conventional tumor-tracking methods using a kV or MV x-ray projection has limited contrast. To facilitate real-time, marker-less and low-dose in-treatment image tumor tracking, we propose a novel scheme using Compton scatter imaging. This study reports Monte Carlo (MC) simulations on this scheme for the purpose of proof-of-principle. Methods: A slit x-ray beam along the patient superior-inferior (SI) direction is directed to the patient, intersecting the patient lung at a 2D plane containing majority part of the tumor motion trajectory. X-ray photons are scattered due to Compton effect from this plane, which are spatially collimated by, e.g., a pinhole, on one side of the plane and then captured by a detector behind it. The captured image, after correcting for x-ray attenuation and scatter angle variation, reflects the electron density, which allows visualization of the instantaneous anatomy on this plane. We performed MC studies on a phantom and a patient case for the initial test of this proposed method. Results: In the phantom case, the contrast-resolution calculated using tumor/lung as foreground/background for kV fluoroscopy, cone-beam CT, and scattering image were 0.0625, 0.6993, and 0.5290, respectively. In the patient case, tumor motion can be clearly observed in the scatter images. Compared to fluoroscopy, scattering imaging also significantly reduced imaging dose because of its narrower beam design. Conclusion: MC simulation studies demonstrated the potential of the proposed scheme in terms of capturing the instantaneous anatomy of a patient on a 2D plane. Clear visualization of the tumor will probably facilitate ‘marker-less’ and ‘real-time’ tumor tracking with low imaging dose. NIH (1R01CA154747-01, 1R21CA178787-01A1 and 1R21EB017978-01A1)

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

WE-EF-BRA-09: Microbeam Radiation Therapy Enhances Tumor Drug Uptake of PEGylated Liposomal Doxorubicin (PLD) in a Triple Negative Breast Cancer GEM Model

Purpose: Overcoming low anti-cancer drug uptake in tumors is a key challenge limiting its clinical use. We propose to enhance the drug delivery using upfront Microbeam Radiation Therapy (MRT). MRT is a preclinical cancer therapy that utilizes microplanar beams to deliver spatially oscillating planes of high and low doses. Animal studies have demonstrated that ultrahigh dose (100s Gy) MRT eradicates tumors without damaging the function of normal tissue exposed to the same radiation. Our previous study indicated that MRT induces intense angiogenesis in tumor rim and surrounding normal tissue 1–2 days post radiation. We hypothesize that the tumor microenvironment modulation induced by MRT may enhance carrier-mediated agent drug delivery to tumors with inherent poor drug uptake. We thus investigated MRT-induced pharmacokinetics (PK) of PEGylated liposomal doxorubicin (PLD), a nano-scale doxorubicin, in T11 genetically engineered mouse model of triple negative breast cancer. Methods: A research irradiator (160kVp, RadSource Technologies) with a customized collimator was used to produce the MRT microbeam of in average 390µm width and 1190µm peak-to-peak distance. The peak dose rate of 1–2Gy/min. Dosimetry is by EBT3 film cross-calibrated with ion chamber at large fields. All mice were administered PLD at 6mg/kg IV x1 at 16h post MRT and sacrificed at 5min, 6h, 24h, and 96h post PLD administration (n=3 or 4 per group). Results: The MRT(28Gy)+PLD group mice had a total doxorubicin tumor concentration (area-under-the concentration-curve, AUC) of 206,040ng/mL•h, 3.71 times the concentration of the PLD-alone group. The MRT(34Gy)+PLD group had a higher mean total doxorubicin concentration in tumor (20,779ng/ml) than the MRT(28Gy)+PLD group (10,665ng/ml). Conclusion: Our preliminary results indicate that microbeam radiation therapy (MRT) can enhance nano-scale anti-cancer drug delivery to tumors approximately 4-fold. The exact working mechanism, the comparison with broad beam irradiation, and optimization of MRT for drug delivery enhancement are under investigation.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

Comparison and uncertainty evaluation of different calibration protocols and ionization chambers for low-energy surface brachytherapy dosimetry

Purpose: A surface electronic brachytherapy (EBT) device is in fact an x-ray source collimated with specific applicators. Low-energy (<100 kVp) x-ray beam dosimetry faces several challenges that need to be addressed. A number of calibration protocols have been published for x-ray beam dosimetry. The media in which measurements are performed are the fundamental difference between them. The aim of this study was to evaluate the surface dose rate of a low-energy x-ray source with small field applicators using different calibration standards and different small-volume ionization chambers, comparing the values and uncertainties of each methodology. Methods: The surface dose rate of the EBT unit Esteya (Elekta Brachytherapy, The Netherlands), a 69.5 kVp x-ray source with applicators of 10, 15, 20, 25, and 30 mm diameter, was evaluated using the AAPM TG-61 (based on air kerma) and International Atomic Energy Agency (IAEA) TRS-398 (based on absorbed dose to water) dosimetry protocols for low-energy photon beams. A plane parallel T34013 ionization chamber (PTW Freiburg, Germany) calibrated in terms of both absorbed dose to water and air kerma was used to compare the two dosimetry protocols. Another PTW chamber of the same model was used to evaluate the reproducibility between these chambers. Measurements were also performed with two different Exradin A20 (Standard Imaging, Inc., Middleton, WI) chambers calibrated in terms of air kerma. Results: Differences between surface dose rates measured in air and in water using the T34013 chamber range from 1.6% to 3.3%. No field size dependence has been observed. Differences are below 3.7% when measurements with the A20 and the T34013 chambers calibrated in air are compared. Estimated uncertainty (with coverage factor k = 1) for the T34013 chamber calibrated in water is 2.2%–2.4%, whereas it increases to 2.5% and 2.7% for the A20 and T34013 chambers calibrated in air, respectively. The output factors, measured with the PTW chambers, differ by less than 1.1% for any applicator size when compared to the output factors that were measured with the A20 chamber. Conclusions: Measurements using both dosimetric protocols are consistent, once the overall uncertainties are considered. There is also consistency between measurements performed with both chambers calibrated in air. Both the T34013 and A20 chambers have negligible stem effect. Any x-ray surface brachytherapy system, including Esteya, can be characterized using either one of these calibration protocols and ionization chambers. Having less correction factors, lower uncertainty, and based on measurements, performed in closer to clinical conditions, the TRS-398 protocol seems to be the preferred option.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

Daily QA of linear accelerators using only EPID and OBI

Purpose: As treatment delivery becomes more complex, there is a pressing need for robust quality assurance (QA) tools to improve efficiency and comprehensiveness while simultaneously maintaining high accuracy and sensitivity. This work aims to present the hardware and software tools developed for comprehensive QA of linear accelerator (LINAC) using only electronic portal imaging devices (EPIDs) and kV flat panel detectors. Methods: A daily QA phantom, which includes two orthogonally positioned phantoms for QA of MV-beams and kV onboard imaging (OBI) is suspended from the gantry accessory holder to test both geometric and dosimetric components of a LINAC and an OBI. The MV component consists of a 0.5 cm water-equivalent plastic sheet incorporating 11 circular steel plugs for transmission measurements through multiple thicknesses and one resolution plug for MV-image quality testing. The kV-phantom consists of a Leeds phantom (TOR-18 FG phantom supplied by Varian) for testing low and high contrast resolutions. In the developed process, the existing LINAC tools were used to automate daily acquisition of MV and kV images and software tools were developed for simultaneous analysis of these images. A method was developed to derive and evaluate traditional QA parameters from these images [output, flatness, symmetry, uniformity, TPR{sub 20/10}, and positional accuracy of the jaws and multileaf collimators (MLCs)]. The EPID-based daily QA tools were validated by performing measurements on a detuned 6 MV beam to test its effectiveness in detecting errors in output, symmetry, energy, and MLC positions. The developed QA process was clinically commissioned, implemented, and evaluated on a Varian TrueBeam LINAC (Varian Medical System, Palo Alto, CA) over a period of three months. Results: Machine output constancy measured with an EPID (as compared against a calibrated ion-chamber) is shown to be within ±0.5%. Beam symmetry and flatness deviations measured using an EPID and a 2D ion-chamber array agree within ±0.5% and ±1.2% for crossline and inline profiles, respectively. MLC position errors of 0.5 mm can be detected using a picket fence test. The field size and phantom positioning accuracy can be determined within 0.5 mm. The entire daily QA process takes ∼15 min to perform tests for 5 photon beams, MLC tests, and imaging checks. Conclusions: The exclusive use of EPID-based QA tools, including a QA phantom and simultaneous analysis software tools, has been demonstrated as a viable, efficient, and comprehensive process for daily evaluation of LINAC performance.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

Detector dose response in megavoltage small photon beams. II. Pencil beam perturbation effects

Purpose: To quantify detector perturbation effects in megavoltage small photon fields and support the theoretical explanation on the nature of quality correction factors in these conditions. Methods: In this second paper, a modern approach to radiation dosimetry is defined for any detector and applied to small photon fields. Fano’s theorem is adapted in the form of a cavity theory and applied in the context of nonstandard beams to express four main effects in the form of perturbation factors. The pencil-beam decomposition method is detailed and adapted to the calculation of perturbation factors and quality correction factors. The approach defines a perturbation function which, for a given field size or beam modulation, entirely determines these dosimetric factors. Monte Carlo calculations are performed in different cavity sizes for different detection materials, electron densities, and extracameral components. Results: Perturbation effects are detailed with calculated perturbation functions, showing the relative magnitude of the effects as well as the geometrical extent to which collimating or modulating the beam impacts the dosimetric factors. The existence of a perturbation zone around the detector cavity is demonstrated and the approach is discussed and linked to previous approaches in the literature to determine critical field sizes. Conclusions: Monte Carlo simulations are valuable to describe pencil beam perturbation effects and detail the nature of dosimetric factors in megavoltage small photon fields. In practice, it is shown that dosimetric factors could be avoided if the field size remains larger than the detector perturbation zone. However, given a detector and beam quality, a full account for the detector geometry is necessary to determine critical field sizes.

07 ISOTOPE AND RADIATION SOURCES↗
DOE OSTI2015

The development and verification of a highly accurate collision prediction model for automated noncoplanar plan delivery

Purpose: Significant dosimetric benefits had been previously demonstrated in highly noncoplanar treatment plans. In this study, the authors developed and verified an individualized collision model for the purpose of delivering highly noncoplanar radiotherapy and tested the feasibility of total delivery automation with Varian TrueBeam developer mode. Methods: A hand-held 3D scanner was used to capture the surfaces of an anthropomorphic phantom and a human subject, which were positioned with a computer-aided design model of a TrueBeam machine to create a detailed virtual geometrical collision model. The collision model included gantry, collimator, and couch motion degrees of freedom. The accuracy of the 3D scanner was validated by scanning a rigid cubical phantom with known dimensions. The collision model was then validated by generating 300 linear accelerator orientations corresponding to 300 gantry-to-couch and gantry-to-phantom distances, and comparing the corresponding distance measurements to their corresponding models. The linear accelerator orientations reflected uniformly sampled noncoplanar beam angles to the head, lung, and prostate. The distance discrepancies between measurements on the physical and virtual systems were used to estimate treatment-site-specific safety buffer distances with 0.1%, 0.01%, and 0.001% probability of collision between the gantry and couch or phantom. Plans containing 20 noncoplanar beams to the brain, lung, and prostate optimized via an in-house noncoplanar radiotherapy platform were converted into XML script for automated delivery and the entire delivery was recorded and timed to demonstrate the feasibility of automated delivery. Results: The 3D scanner measured the dimension of the 14 cm cubic phantom within 0.5 mm. The maximal absolute discrepancy between machine and model measurements for gantry-to-couch and gantry-to-phantom was 0.95 and 2.97 cm, respectively. The reduced accuracy of gantry-to-phantom measurements was attributed to phantom setup errors due to the slightly deformable and flexible phantom extremities. The estimated site-specific safety buffer distance with 0.001% probability of collision for (gantry-to-couch, gantry-to-phantom) was (1.23 cm, 3.35 cm), (1.01 cm, 3.99 cm), and (2.19 cm, 5.73 cm) for treatment to the head, lung, and prostate, respectively. Automated delivery to all three treatment sites was completed in 15 min and collision free using a digital Linac. Conclusions: An individualized collision prediction model for the purpose of noncoplanar beam delivery was developed and verified. With the model, the study has demonstrated the feasibility of predicting deliverable beams for an individual patient and then guiding fully automated noncoplanar treatment delivery. This work motivates development of clinical workflows and quality assurance procedures to allow more extensive use and automation of noncoplanar beam geometries.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

Technical Note: Immunohistochemical evaluation of mouse brain irradiation targeting accuracy with 3D-printed immobilization device

Purpose: Small animal immobilization devices facilitate positioning of animals for reproducible imaging and accurate focal radiation therapy. In this study, the authors demonstrate the use of three-dimensional (3D) printing technology to fabricate a custom-designed mouse head restraint. The authors evaluate the accuracy of this device for the purpose of mouse brain irradiation. Methods: A mouse head holder was designed for a microCT couch using CAD software and printed in an acrylic based material. Ten mice received half-brain radiation while positioned in the 3D-printed head holder. Animal placement was achieved using on-board image guidance and computerized asymmetric collimators. To evaluate the precision of beam localization for half-brain irradiation, mice were sacrificed approximately 30 min after treatment and brain sections were stained for γ-H2AX, a marker for DNA breaks. The distance and angle of the γ-H2AX radiation beam border to longitudinal fissure were measured on histological samples. Animals were monitored for any possible trauma from the device. Results: Visualization of the radiation beam on ex vivo brain sections with γ-H2AX immunohistochemical staining showed a sharp radiation field within the tissue. Measurements showed a mean irradiation targeting error of 0.14 ± 0.09 mm (standard deviation). Rotation between the beam axis and mouse head was 1.2° ± 1.0° (standard deviation). The immobilization device was easily adjusted to accommodate different sizes of mice. No signs of trauma to the mice were observed from the use of tooth block and ear bars. Conclusions: The authors designed and built a novel 3D-printed mouse head holder with many desired features for accurate and reproducible radiation targeting. The 3D printing technology was found to be practical and economical for producing a small animal imaging and radiation restraint device and allows for customization for study specific needs.

60 APPLIED LIFE SCIENCES↗