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All sourcesNASA NTRSDOE OSTI
DOE OSTI2016

TH-AB-201-05: Determining the Direction Distribution of the Primary Radiation for a Cyberknife-M6

Purpose: Radiation protection regulatory differentiates between primary and scatter radiation. Whereas for conventional clinical linear accelerators the solid angle for primary radiation is planar, the Cyberknife (Accuray Inc., Sunnyvale, CA) may point its beam in all spatial directions. In order to be able to judge on radiation protection calculations for a Cyberknife-M6 vault, the direction distribution for delivered plans was evaluated based on clinical experiences. Methods: The log-files of 121 delivered patient treatment plans were exported, divided into cranial and extra-cranial treatments and the delivered monitor units (MU) together with the corresponding beam directions were analyzed. This MU-weighted spatial distribution was then projected to a 9.5 × 5.9 × 3.9 m{sup 3} vault, generating an “intensity map” using a binning of 50 × 50 cm{sup 2}. The factor of direction (FOD) is reported as a fraction of the total applied MUs to the walls, ceiling and floor in the perspective of a patient lying in head-first-supine position on the couch. In this study, the term intFOD refers to the integral FOD and maxFOD refers to the maximal FOD for a single bin. Results: For all kind of treatments and collimators, intFOD and maxFOD for the wall behind the patient’s head is 0.0. The intFOD for the floor varies between 0.65 and 0.74. For the ceiling, maxFOD is 0.002 and 0.0 for cranial and extra-cranial cases, respectively. The intFOD for the wall at the patient’s feet, is 0.094 for cranial and 0.005 for extra-cranial cases. There is nearly no difference between the maxFOD of the right and left wall for cranial cases, whereas for extra-cranial cases these numbers differ by a factor of 1.75. Conclusion: The varying FODs for the Cyberknife were quantified based on delivered treatment plans. These findings are helpful regarding the design of Cyberknife vaults.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

Constituent Components of Out-of-Field Scatter Dose for 18-MV Intensity Modulated Radiation Therapy Versus 3-Dimensional Conformal Radiation Therapy: A Comparison With 6-MV and Implications for Carcinogenesis

Purpose: To characterize and compare the components of out-of-field dose for 18-MV intensity modulated radiation therapy (IMRT) versus 3-dimensional conformal radiation therapy (3D-CRT) and their 6-MV counterparts and consider implications for second cancer induction. Methods and Materials: Comparable plans for each technique/energy were delivered to a water phantom with a sloping wall; under full scatter conditions; with field edge abutting but outside the bath to prevent internal/phantom scatter; and with shielding below the linear accelerator head to attenuate head leakage. Neutron measurements were obtained from published studies. Results: Eighteen-megavolt IMRT produces 1.7 times more out-of-field scatter than 18-MV 3D-CRT. In absolute terms, however, differences are just approximately 0.1% of central axis dose. Eighteen-megavolt IMRT reduces internal/patient scatter by 13%, but collimator scatter (C) is 2.6 times greater than 18-MV 3D-CRT. Head leakage (L) is minimal. Increased out-of-field photon scatter from 18-MV IMRT carries out-of-field second cancer risks of approximately 0.2% over and above the 0.4% from 18-MV 3D-CRT. Greater photoneutron dose from 18-MV IMRT may result in further maximal, absolute increased risk to peripheral tissue of approximately 1.2% over 18-MV 3D-CRT. Out-of-field photon scatter remains comparable for the same modality irrespective of beam energy. Machine scatter (C+L) from 18 versus 6 MV is 1.2 times higher for IMRT and 1.8 times for 3D-CRT. It is 4 times higher for 6-MV IMRT versus 3D-CRT. Reduction in internal scatter with 18 MV versus 6 MV is 27% for 3D-CRT and 29% for IMRT. Compared with 6-MV 3D-CRT, 18-MV IMRT increases out-of-field second cancer risk by 0.2% from photons and adds 0.28-2.2% from neutrons. Conclusions: Out-of-field photon dose seems to be independent of beam energy for both techniques. Eighteen-megavolt IMRT increases out-of-field scatter 1.7-fold over 3D-CRT because of greater collimator scatter despite reducing internal/patient scatter. Out-of-field carcinogenic risk is thus increased (but improved in-field dose conformity may offset this). Potentially increased carcinogenic risk should be weighed against any benefit 18-MV IMRT may provide.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2015

SU-E-T-99: An Analysis of the Accuracy of TPS Extrapolation of Commissioning Data

Purpose: To investigate discrepancies between measured percent depth dose curves of a linear accelerator at depths beyond the commissioning data and those generated by the treatment planning system (TPS) via extrapolation. Methods: Relative depth doses were measured on an Elekta Synergy™ linac for photon beams of 6 -MV and 10-MV. SSDs for all curves were 100-cm and field sizes ranged from 4×4 to 35×35-cm{sup 2}. As most scanning tanks cannot provide depths greater than about 30-cm, percent depth dose measurements, extending 45-cm depths, were performed in Solid Water™ using a 0.125-cc ionization chamber (PTW model TN31012). The buildup regions of the curves were acquired with a parallel plate chamber (PTW model TN34001). Extrapolated curves were generated by the TPS (Phillips Pinnacle{sup 3} v. 9.6) by applying beams to CT images of 50-cm of Solid Water™ with density override set to 1.0-g/cc. Results: Percent difference between the two sets of curves (measured and TPS) was investigated. There is significant discrepancy in the buildup region to a depth of 7-mm. Beyond this depth, the two sets show good agreement. When analyzing the tail end of the curves, we saw percent difference of between 1.2% and 3.2%. The highest disagreement for the 6-MV curves was 10×10-cm{sup 2} (3%) and for the 10-MV curves it was the 35×35-cm{sup 2} (3.2%). Conclusion: A qualitative analysis of the measured data versus PDD curves generated by the TPS shows generally good agreement beyond 1-cm. However, a measurable percent difference was observed when comparing curves at depths beyond that provided by the commissioning data and at depths in the buildup region. Possible explanations for this include inaccuracies in modeling of the Solid Water™ or drift in beam energy since commissioning. Additionally, closer attention must be paid for measurements in the buildup region.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

TU-FG-201-01: 18-Month Clinical Experience of a Linac Daily Quality Assurance (QA) Solution Using Only EPID and OBI

Purpose: To describe the clinical use of a Linear Accelerator (Linac) DailyQA system with only EPID and OBI. To assess the reliability over an 18-month period and improve the robustness of this system based on QA failure analysis. Methods: A DailyQA solution utilizing an in-house designed phantom, combined EPID and OBI image acquisitions, and a web-based data analysis and reporting system was commissioned and used in our clinic to measure geometric, dosimetry and imaging components of a Varian Truebeam Linac. During an 18-month period (335 working days), the Daily QA results, including the output constancy, beam flatness and symmetry, uniformity, TPR20/10, MV and KV imaging quality, were collected and analyzed. For output constancy measurement, an independent monthly QA system with an ionization chamber (IC) and annual/incidental TG51 measurements with ADCL IC were performed and cross-compared to Daily QA system. Thorough analyses were performed on the recorded QA failures to evaluate the machine performance, optimize the data analysis algorithm, adjust the tolerance setting and improve the training procedure to prevent future failures. Results: A clinical workflow including beam delivery, data analysis, QA report generation and physics approval was established and optimized to suit daily clinical operation. The output tests over the 335 working day period cross-correlated with the monthly QA system within 1.3% and TG51 results within 1%. QA passed with one attempt on 236 days out of 335 days. Based on the QA failures analysis, the Gamma criteria is revised from (1%, 1mm) to (2%, 1mm) considering both QA accuracy and efficiency. Data analysis algorithm is improved to handle multiple entries for a repeating test. Conclusion: We described our 18-month clinical experience on a novel DailyQA system using only EPID and OBI. The long term data presented demonstrated the system is suitable and reliable for Linac daily QA.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

Broadly Applicable Dose Model for Radiotherapy Beams from 6-25 MV

The goal of modern external beam radiotherapy is to deliver a highly targeted radiation dose to a specified treatment volume while sparing the healthy surrounding tissue as much as possible. However, some healthy tissue radiation exposure is unavoidable. Healthy tissue in the margin of the treatment field will receive absorbed doses on the order of the prescribed dose, and tissue far out of field will receive stray dose from scattered and leakage radiation. These doses can lead to late effects such as secondary cancers both near the treatment field and far out of field in tissues only receiving stray radiation dose. Many researchers have investigated algorithms to model absorbed dose from external beam photon radiation therapy; however, none of these works have fully addressed the stray dose far from the treatment field. The AAPM Task Group Report No. 36 described three main sources of stray radiation from external beam radiation therapy delivered with electron linear accelerators. Radiation scattered from the treatment head, known as head scatter, is primarily important within about 10 cm from the field edge. Patient scatter is an important source up to around 30 cm from the field edge. Finally, leakage radiation emanates from the treatment enclosure and predominates the stray radiation dose beyond about 30 cm. Monte Carlo simulations have been a useful research tool for modeling stray dose, but these methods have not found use in clinical settings due to their complexity and long computational times. The feasibility of analytical models to predict stray dose from radiation therapy has been supported by several works, but few attempts have been made at developing models accurate for both in-field and out-of-field doses. Jagetic and Newhauser reported on one such model that predicts absorbed dose from therapeutic, scatter, and leakage radiation with promising results. This model was validated at 6 MV for Conformal Radiation Therapy (CRT) beams from an Elekta linac. Intensity Modulated Radiation Therapy (IMRT) was not considered, and the model has not been tested at beam energies greater than 6 MV. Additionally, this model relies on proprietary, machine specific parameters, and so adapting the model for use on treatment units from other manufacturers is not straightforward. In this study we aim to test whether a physics-based analytical modeling approach is broadly applicable and if sufficient accuracy can be achieved without the need for proprietary, machine specific parameters. In order to accomplish this, a new analytical model was developed that does not rely on machine specific parameters, so that it can easily be trained on measurements from whatever treatment machine is available at a given clinic. This model was tested using measured data from a variety of treatment machines and techniques in the 6 MV to 25 MV energy interval. (authors)

61 RADIATION PROTECTION AND DOSIMETRY↗
DOE OSTI2016

MO-FG-BRA-01: 4D Monte Carlo Simulations for Verification of Dose Delivered to a Moving Anatomy

Purpose: To validate 4D Monte Carlo (MC) simulations of dose delivery by an Elekta Agility linear accelerator to a moving phantom. Methods: Monte Carlo simulations were performed using the 4DdefDOSXYZnrc/EGSnrc user code which samples a new geometry for each incident particle and calculates the dose in a continuously moving anatomy. A Quasar respiratory motion phantom with a lung insert containing a 3 cm diameter tumor was used for dose measurements on an Elekta Agility linac with the phantom in stationary and moving states. Dose to the center of tumor was measured using calibrated EBT3 film and the RADPOS 4D dosimetry system. A VMAT plan covering the tumor was created on the static CT scan of the phantom using Monaco V.5.10.02. A validated BEAMnrc model of our Elekta Agility linac was used for Monte Carlo simulations on stationary and moving anatomies. To compare the planned and delivered doses, linac log files recorded during measurements were used for the simulations. For 4D simulations, deformation vectors that modeled the rigid translation of the lung insert were generated as input to the 4DdefDOSXYZnrc code as well as the phantom motion trace recorded with RADPOS during the measurements. Results: Monte Carlo simulations and film measurements were found to agree within 2mm/2% for 97.7% of points in the film in the static phantom and 95.5% in the moving phantom. Dose values based on film and RADPOS measurements are within 2% of each other and within 2σ of experimental uncertainties with respect to simulations. Conclusion: Our 4D Monte Carlo simulation using the defDOSXYZnrc code accurately calculates dose delivered to a moving anatomy. Future work will focus on more investigation of VMAT delivery on a moving phantom to improve the agreement between simulation and measurements, as well as establishing the accuracy of our method in a deforming anatomy. This work was supported by the Ontario Consortium of Adaptive Interventions in Radiation Oncology (OCAIRO), funded by the Ontario Research Fund Research Excellence program.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-J-105: Towards a Novel Treatment Planning Pipeline Delivering Pareto- Optimal Plans While Enabling Inter- and Intrafraction Plan Adaptation

Purpose: To develop a new IMRT treatment planning methodology suitable for the new generation of MR-linear accelerator machines. The pipeline is able to deliver Pareto-optimal plans and can be utilized for conventional treatments as well as for inter- and intrafraction plan adaptation based on real-time MR-data. Methods: A Pareto-optimal plan is generated using the automated multicriterial optimization approach Erasmus-iCycle. The resulting dose distribution is used as input to the second part of the pipeline, an iterative process which generates deliverable segments that target the latest anatomical state and gradually converges to the prescribed dose. This process continues until a certain percentage of the dose has been delivered. Under a conventional treatment, a Segment Weight Optimization (SWO) is then performed to ensure convergence to the prescribed dose. In the case of inter- and intrafraction adaptation, post-processing steps like SWO cannot be employed due to the changing anatomy. This is instead addressed by transferring the missing/excess dose to the input of the subsequent fraction. In this work, the resulting plans were delivered on a Delta4 phantom as a final Quality Assurance test. Results: A conventional static SWO IMRT plan was generated for two prostate cases. The sequencer faithfully reproduced the input dose for all volumes of interest. For the two cases the mean relative dose difference of the PTV between the ideal input and sequenced dose was 0.1% and −0.02% respectively. Both plans were delivered on a Delta4 phantom and passed the clinical Quality Assurance procedures by achieving 100% pass rate at a 3%/3mm gamma analysis. Conclusion: We have developed a new sequencing methodology capable of online plan adaptation. In this work, we extended the pipeline to support Pareto-optimal input and clinically validated that it can accurately achieve these ideal distributions, while its flexible design enables inter- and intrafraction plan adaptation. This research is financially supported by Elekta AB, Stockholm, Sweden.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

Active Interrogation using Photofission Technique for Nuclear Materials Control and Accountability

Innovative systems with increased sensitivity and resolution are in great demand to detect diversion and to prevent misuse in support of nuclear materials management for the U.S. fuel cycle. Nuclear fission is the most important multiplicative process involved in non-destructive active interrogation. This process produces the most easily recognizable signature for nuclear materials. In addition to thermal or high-energy neutrons, high-energy gamma rays can also excite a nucleus and cause fission through a process known as photofission. Electron linear accelerators (linacs) are widely used as the interrogating photon sources for inspection methods involving photofission technique. After photofission reactions, prompt signals are much stronger than the delayed signals, but it is difficult to quantify them in practical measurements. Delayed signals are easily distinguishable from the interrogating radiation. Linac-based, advanced inspection techniques utilizing the delayed signals after photofission have been extensively studied for homeland security applications. Previous research also showed that a unique delayed gamma ray energy spectrum exists for each fissionable isotope. In this work, high-energy delayed γ-rays were demonstrated to be signatures for detection, identification, and quantification of special nuclear materials. Such γ-rays were measured in between linac pulses using independent data acquisition systems. A list-mode system was developed to measure low-energy delayed γ-rays after irradiation. Photofission product yields of 238 U and 239 Pu were determined based on the measured delayed γ-ray spectra. The differential yields of delayed γ-rays were also proven to be able to discriminate nuclear from non-nuclear materials. The measurement outcomes were compared with Monte Carlo simulation results. It was demonstrated that the current available codes have capabilities and limitations in the simulation of photofission process. A two-fold approach was used to address the high-rate challenge in used nuclear fuel assay based on photofission technique. First, a standard HPGe preamplifier was modified to improve its capabilities in high-rate pulsed photofission environment. Second, advanced pulse processing algorithms were shown to greatly improve throughput rate without large sacrifice in energy resolution at ultra-high input count rate. Two customized gamma spectroscopy systems were also developed in real-time on FPGAs. They were shown to have promising performance matching available commercial units.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗
DOE OSTI2016

Volume of interest CBCT and tube current modulation for image guidance using dynamic kV collimation

Purpose: The focus of this work is the development of a novel blade collimation system enabling volume of interest (VOI) CBCT with tube current modulation using the kV image guidance source on a linear accelerator. Advantages of the system are assessed, particularly with regard to reduction and localization of dose and improvement of image quality. Methods: A four blade dynamic kV collimator was developed to track a VOI during a CBCT acquisition. The current prototype is capable of tracking an arbitrary volume defined by the treatment planner for subsequent CBCT guidance. During gantry rotation, the collimator tracks the VOI with adjustment of position and dimension. CBCT image quality was investigated as a function of collimator dimension, while maintaining the same dose to the VOI, for a 22.2 cm diameter cylindrical water phantom with a 9 mm diameter bone insert centered on isocenter. Dose distributions were modeled using a dynamic BEAMnrc library and DOSXYZnrc. The resulting VOI dose distributions were compared to full-field CBCT distributions to quantify dose reduction and localization to the target volume. A novel method of optimizing x-ray tube current during CBCT acquisition was developed and assessed with regard to contrast-to-noise ratio (CNR) and imaging dose. Results: Measurements show that the VOI CBCT method using the dynamic blade system yields an increase in contrast-to-noise ratio by a factor of approximately 2.2. Depending upon the anatomical site, dose was reduced to 15%–80% of the full-field CBCT value along the central axis plane and down to less than 1% out of plane. The use of tube current modulation allowed for specification of a desired SNR within projection data. For approximately the same dose to the VOI, CNR was further increased by a factor of 1.2 for modulated VOI CBCT, giving a combined improvement of 2.6 compared to full-field CBCT. Conclusions: The present dynamic blade system provides significant improvements in CNR for the same imaging dose and localization of imaging dose to a predefined volume of interest. The approach is compatible with tube current modulation, allowing optimization of the imaging protocol.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-F-18C-10: Clinical Implementation of Radiochromic Film Based CTDI Measurements

Purpose: To evaluate accuracy and reproducibility of a radiochromic film-based protocol to measure computer tomography dose index (CTDI) as a part of annual QA on CT scanners and kV CBCT systems attached to linear accelerators. Methods: Energy dependence of Gafchromic XR-QA2(R) film model was tested over imaging beam qualities (50 – 140 kVp). Film pieces were irradiated in air to known values of air kerma in air (up to 10 cGy). Change in film reflectance was determined with an in-house written code using images produced by a flatbed document scanner. Calibration curves for each beam quality were created, and film responses for same air-kerma values were compared.Sets of film strips were placed into holes of a CTDI phantom and irradiated for several clinical scanning protocols on CT-simulators and CBCT systems. Film reflectance change was converted into dose to water and used to calculate CTDIvol values. Measured CTDIvol values were compared to tabulated CTDIvol values. Results: Average variations of ±5.2% in the mean film reflectance change were observed in the energy range of 80 to 140 keV, and 11.1% between 50 and 140 keV. The averaged measured CTDI values presented a mean variation for the same machine and protocol of 2.6%. However, measured CTDI values were in average 10% lower than tabulated CTDI values for CT-simulators, and 44% higher for CBCT systems. Conclusion: We found that in relatively broad range of beam qualities used in diagnostic radiology variation of film response is within ±5% resulting in ±15% systematic error in dose estimates if a single calibration curve is used. Relatively large discrepancy between measured and tabulated CTDI values for different protocols and imaging systems used within radiotherapy department strongly support the trend towards replacing CTDI value with equilibrium dose measurement in the center of cylindrical phantom as suggested by TG-111. This work was supported by the Natural Sciences and Engineering Research Council of Canada, Contract No. 386009; Partial support by CREATE, Medical Physics Research Training Network grant of the Natural Science and Engineering Research Council, Contract No. 432290.

07 ISOTOPE AND RADIATION SOURCES↗
DOE OSTI2016

Frame average optimization of cine-mode EPID images used for routine clinical in vivo patient dose verification of VMAT deliveries

Purpose: The in vivo 3D dose delivered to a patient during volumetric modulated arc therapy (VMAT) delivery can be calculated using electronic portal imaging device (EPID) images. These images must be acquired in cine-mode (i.e., “movie” mode) in order to capture the time-dependent delivery information. The angle subtended by each cine-mode EPID image during an arc can be changed via the frame averaging number selected within the image acquisition software. A large frame average number will decrease the EPID’s angular resolution and will result in a decrease in the accuracy of the dose information contained within each image. Alternatively, less EPID images acquired per delivery will decrease the overall 3D patient dose calculation time, which is appealing for large-scale clinical implementation. Therefore, the purpose of this study was to determine the optimal frame average value per EPID image, defined as the highest frame averaging that can be used without an appreciable loss in 3D dose reconstruction accuracy for VMAT treatments. Methods: Six different VMAT plans and six different SBRT-VMAT plans were delivered to an anthropomorphic phantom. Delivery was carried out on a Varian 2300ix model linear accelerator (Linac) equipped with an aS1000 EPID running at a frame acquisition rate of 7.5 Hz. An additional PC was set up at the Linac console area, equipped with specialized frame-grabber hardware and software packages allowing continuous acquisition of all EPID frames during delivery. Frames were averaged into “frame-averaged” EPID images using MATLAB. Each frame-averaged data set was used to calculate the in vivo dose to the patient and then compared to the single EPID frame in vivo dose calculation (the single frame calculation represents the highest possible angular resolution per EPID image). A mean percentage dose difference of low dose (<20% prescription dose) and high dose regions (>80% prescription dose) was calculated for each frame averaged scenario for each plan. The authors defined their unacceptable loss of accuracy as no more than a ±1% mean dose difference in the high dose region. Optimal frame average numbers were then determined as a function of the Linac’s average gantry speed and the dose per fraction. Results: The authors found that 9 and 11 frame averages were suitable for all VMAT and SBRT-VMAT treatments, respectively. This resulted in no more than a 1% loss to any of the dose region’s mean percentage difference when compared to the single frame reconstruction. The optimized number was dependent on the treatment’s dose per fraction and was determined to be as high as 14 for 12 Gy/fraction (fx), 15 for 8 Gy/fx, 11 for 6 Gy/fx, and 9 for 2 Gy/fx. Conclusions: The authors have determined an optimal EPID frame averaging number for multiple VMAT-type treatments. These are given as a function of the dose per fraction and average gantry speed. These optimized values are now used in the authors’ clinical, 3D, in vivo patient dosimetry program. This provides a reduction in calculation time while maintaining the authors’ required level of accuracy in the dose reconstruction.

61 RADIATION PROTECTION AND DOSIMETRY↗
DOE OSTI2014

SU-E-J-123: Targeting Accuracy of Image-Guided Radiosurgery for Intracranial Lesions

Purpose: To evaluate the setup accuracies of image-guided intracranial radiosurgery across several different linear accelerator platforms. Methods: A CT scan with a slice thickness of 1.0 mm was acquired of a Rando head phantom (The Phantom Laboratory) in a U-frame mask (BrainLAB AG). The phantom had three embedded BBs, simulating a central, left, and anterior lesion. The phantom was setup with each BB placed at the radiation isocenter under image guidance. Four different setup procedures were investigated: (1) NTX-ExacTrac: 6 degree-of-freedom (6D) correction on a Novalis Tx (BrainLAB AG) with ExacTrac localization (BrainLAB AG); (2) NTX-CBCT: 4D correction on the Novalis Tx with cone-beam computed tomography (CBCT); (3) TrueBeam-CBCT: 4D correction on a TrueBeam (Varian) with CBCT; (4) Edge-CBCT: 6D correction on an Edge (Varian) with CBCT. The experiment was repeated 5 times with different initial setup error at each BB location on each platform, and the mean (μ) and one standard deviation (σ) of the residual error was compared.The congruence between radiation and imaging isocenters on each platform was evaluated by acquiring Winston Lutz (WL) images of a WL jig followed by imaging using ExacTrac or CBCT. The difference in coordinates of the jig relative to radiation and imaging isocenters was then recorded. Results: Averaged over all three BB locations, the residual vector setup errors (μ±σ) of the phantom in mm were 0.6±0.2, 1.0±0.5, 0.2±0.1, and 0.3±0.1 on NTX-ExacTrac, NTX-CBCT, TrueBeam-CBCT, and Edge-CBCT, with their ranges in mm being 0.4∼1.1, 0.4∼1.9, 0.1∼0.5, and 0.2∼0.6, respectively. And imaging isocenter was found stable relative to radiation isocenter, with the congruence to radiation isocenter in mm being 0.6±0.1, 0.7±0.1, 0.3±0.1, 0.2±0.1, respectively, on the four systems in the same order. Conclusion: Millimeter accuracy can be achieved with image-guided radiosurgery for intracranial lesions based on this set of experiments.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2018

A novel IMRT planning study by using the fixed-jaw method in the treatment of peripheral lung cancer with mediastinal lymph node metastasis

Intensity-modulated radiotherapy (IMRT) is an important technology in cancer radiotherapy. In the current planning system, such as in the Pinnacle{sup 3} system, jaw positions are automatically set to cover all target volumes, and many medical centers in developing countries are not equipped with linear accelerators with a jaw tracing function. As solitary lesions are often located in patients, the resulting radiation leakage and transmission increase the dose exposure in surrounding critical organs, although blocked by multileaf collimator (MLC) leaves. We therefore designed a method to manually fix jaw positions, which further reduces doses. We particularly focused on the patients of peripheral lung cancer combined with mediastinal lymph node metastasis, as our medical center mainly targets lung cancer. We designed 2 treatment plans for each patient with the same optimization parameters, i.e., the plan of automatically chosen jaw positions (jaw auto-chosen plan) and the plan of fixed-jaw positions (fixed-jaw plan). In the latter plan, jaws were manually fixed for tumors in lung and in mediastinal lymph node metastases, respectively. We found that both plans met the clinical requirements, and the D{sub 2}, D{sub 98}, conformation number (CN), and homogeneity index (HI) for planning target volume (PTV) had no significant differences between the 2 plans. Importantly, the machine units (MUs) for fixed-jaw plans were 50%~60% more than routine jaw auto-chosen plans, whereas the V{sub 5}, V{sub 10}, V{sub 20}, V{sub 30}, and the mean dose in the total lung and the ipsilateral lung were less than the routine jaw auto-chosen plans. Dose-volume values D{sub 1} for the spinal cord and D{sub 2}, V{sub 40}, V{sub 60} for the heart existed no significant differences for 2 plans. In the fixed-jaw method, the total lung TLV{sub 5}-â–³V{sub ab} and TLV{sub 10}-â–³V{sub ab} values had a moderate positive correlation with the lung radiation leakage and the transmission area reduction. We concluded that the fixed-jaw plan is superior to the routine jaw auto-chosen plan in reducing the radiation exposure of surrounding critical organs, which will benefit the IMRT application.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2015

Technical Note: A Monte Carlo study of magnetic-field-induced radiation dose effects in mice

Purpose: Magnetic fields are known to alter radiation dose deposition. Before patients receive treatment using an MRI-linear accelerator (MRI-Linac), preclinical studies are needed to understand the biological consequences of magnetic-field-induced dose effects. In the present study, the authors sought to identify a beam energy and magnetic field strength combination suitable for preclinical murine experiments. Methods: Magnetic field dose effects were simulated in a mouse lung phantom using various beam energies (225 kVp, 350 kVp, 662 keV [Cs-137], 2 MV, and 1.25 MeV [Co-60]) and magnetic field strengths (0.75, 1.5, and 3 T). The resulting dose distributions were compared with those in a simulated human lung phantom irradiated with a 6 or 8 MV beam and orthogonal 1.5 T magnetic field. Results: In the human lung phantom, the authors observed a dose increase of 45% and 54% at the soft-tissue-to-lung interface and a dose decrease of 41% and 48% at the lung-to-soft-tissue interface for the 6 and 8 MV beams, respectively. In the mouse simulations, the magnetic fields had no measurable effect on the 225 or 350 kVp dose distribution. The dose increases with the Cs-137 beam for the 0.75, 1.5, and 3 T magnetic fields were 9%, 29%, and 42%, respectively. The dose decreases were 9%, 21%, and 37%. For the 2 MV beam, the dose increases were 16%, 33%, and 31% and the dose decreases were 9%, 19%, and 30%. For the Co-60 beam, the dose increases were 19%, 54%, and 44%, and the dose decreases were 19%, 42%, and 40%. Conclusions: The magnetic field dose effects in the mouse phantom using a Cs-137, 3 T combination or a Co-60, 1.5 or 3 T combination most closely resemble those in simulated human treatments with a 6 MV, 1.5 T MRI-Linac. The effects with a Co-60, 1.5 T combination most closely resemble those in simulated human treatments with an 8 MV, 1.5 T MRI-Linac.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-J-149: Beam and Cryostat Scatter Characteristics of the Elekta MR-Linac

Purpose: The Elekta MR-Linac combines a digital linear accelerator system with a 1.5T Philips MRI machine. This study aimed to determine key characteristic information regarding the MR-Linac beam and in particular it evaluated the effect of the MR cryostat on the out of field scatter dose. Methods: Tissue phantom ratios, profiles and depth doses were acquired in plastic water with an IC-profiler or with an MR compatible water tank using multiple system configurations (Full (B0= 1.5T), Full (B0=0T) and No cryostat). Additionally, an in-house CAD based Monte Carlo code based on Penelope was used to provide comparative data. Results: With the cryostat in place and B0=0T, the measured TPR for the MR Linac system was 0.702, indicating an energy of around 7MV. Without the cryostat, the measured TPR was 0.669. For the Full (B0=0T) case, out of field dose at a depth of 10 cm in the isocentric plane, 5 cm from the field edge was 0.8%, 3.1% and 5.4% for 3×3 cm{sup 2}, 10×10 cm{sup 2} and 20×20 cm{sup 2} fields respectively.The out of field dose (averaged between 5 cm and 10 cm beyond the field edges) in the “with cryostat” case is 0.78% (absolute difference) higher than without the cryostat for clinically relevant field sizes (i.e. 10×10 cm{sup 2}) and comparable to measured conventional 6MV treatment beams at a depth of 10 cm (within 0.1% between 5 cm and 6 cm from field edge). At dose maximum and at 5 cm from the field edge, the “with cryostat” out of field scatter for a 10×10 cm{sup 2} field is 1.5% higher than “without cryostat', with a modest increase (0.9%) compared to Agility 6MV in the same conditions. Conclusion: The study has presented typical characteristics of the MR-Linac beam and determined that out of field dose is comparable to conventional treatment beams. All authors are employed by Elekta Ltd., who are developing an MR-Linac.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

MO-F-CAMPUS-J-04: Radiation Heat Load On the MR System of the Elekta Atlantic System

Purpose: The Elekta Atlantic system combines a digital linear accelerator system with a 1.5T Philips MRI machine.This study aimed to assess the energy deposited within the cryostat system when the radiation beam passes through the cryostat. The cryocooler on the magnet has a cooling capacity which is about 1 Watt in excess of the cryogenic heat leak into the magnet’s cold mass. A pressure-controlled heater inside the magnet balances the excess refrigeration power such that the helium pressure in the tank is kept slightly above ambient air pressure. If radiation power is deposited in the cold mass then this heater will need less power to maintain pressure equilibrium and if the radiation heat load exceeds the excess cryocooler capacity the pressure will rise. Methods: An in-house CAD based Monte Carlo code based on Penelope was used to model the entire MR-Linac system to quantify the heat load on the magnet’s cold mass. These results were then compared to experimental results obtained from an Elekta Atlantic system installed in UMC-Utrecht. Results: For a field size of 25 cm x 22 cm and a dose rate of 107 mu.min-1, the energy deposited by the radiation beam led to a reduction in heater power from 1.16 to 0.73 W. Simulations predicted a reduction to 0.69 W which is in good agreement. For the worst case field size (largest) and maximum dose rate the cryostat cooler capacity was exceeded. This resulted in a pressure rise within the system but was such that continuous irradiation for over 12 hours would be required before the magnet would start blowing off helium. Conclusion: The study concluded that the Atlantic system does not have to be duty cycle restricted, even for the worst case non-clinical scenario and that there are no adverse effects on the MR system. Stephen Towe and David Roberts Both work for Elekta; Ezra Van Lanen works for Philips Healthcare; Johan Overweg works for Philips Innovative Technologies.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

Monte Carlo simulation of a quantum noise limited Čerenkov detector based on air-spaced light guiding taper for megavoltage x-ray imaging

Purpose: Electronic Portal Imaging Devices (EPIDs) have been widely used in radiation therapy and are still needed on linear accelerators (Linacs) equipped with kilovoltage cone beam CT (kV-CBCT) or MRI systems. Our aim is to develop a new high quantum efficiency (QE) Čerenkov Portal Imaging Device (CPID) that is quantum noise limited at dose levels corresponding to a single Linac pulse. Methods: Recently a new concept of CPID for MV x-ray imaging in radiation therapy was introduced. It relies on Čerenkov effect for x-ray detection. The proposed design consisted of a matrix of optical fibers aligned with the incident x-rays and coupled to an active matrix flat panel imager (AMFPI) for image readout. A weakness of such design is that too few Čerenkov light photons reach the AMFPI for each incident x-ray and an AMFPI with an avalanche gain is required in order to overcome the readout noise for portal imaging application. In this work the authors propose to replace the optical fibers in the CPID with light guides without a cladding layer that are suspended in air. The air between the light guides takes on the role of the cladding layer found in a regular optical fiber. Since air has a significantly lower refractive index (∼1 versus 1.38 in a typical cladding layer), a much superior light collection efficiency is achieved. Results: A Monte Carlo simulation of the new design has been conducted to investigate its feasibility. Detector quantities such as quantum efficiency (QE), spatial resolution (MTF), and frequency dependent detective quantum efficiency (DQE) have been evaluated. The detector signal and the quantum noise have been compared to the readout noise. Conclusions: Our studies show that the modified new CPID has a QE and DQE more than an order of magnitude greater than that of current clinical systems and yet a spatial resolution similar to that of current low-QE flat-panel based EPIDs. Furthermore it was demonstrated that the new CPID does not require an avalanche gain in the AMFPI and is quantum noise limited at dose levels corresponding to a single Linac pulse.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗
DOE OSTI2014

MO-PIS-Exhibit Hall-01: Tools for TG-142 Linac Imaging QA I

Partners in Solutions is an exciting new program in which AAPM partners with our vendors to present practical “hands-on” information about the equipment and software systems that we use in our clinics. The therapy topic this year is solutions for TG-142 recommendations for linear accelerator imaging QA. Note that the sessions are being held in a special purpose room built on the Exhibit Hall Floor, to encourage further interaction with the vendors. Automated Imaging QA for TG-142 with RIT Presentation Time: 2:45 – 3:15 PM This presentation will discuss software tools for automated imaging QA and phantom analysis for TG-142. All modalities used in radiation oncology will be discussed, including CBCT, planar kV imaging, planar MV imaging, and imaging and treatment coordinate coincidence. Vendor supplied phantoms as well as a variety of third-party phantoms will be shown, along with appropriate analyses, proper phantom setup procedures and scanning settings, and a discussion of image quality metrics. Tools for process automation will be discussed which include: RIT Cognition (machine learning for phantom image identification), RIT Cerberus (automated file system monitoring and searching), and RunQueueC (batch processing of multiple images). In addition to phantom analysis, tools for statistical tracking, trending, and reporting will be discussed. This discussion will include an introduction to statistical process control, a valuable tool in analyzing data and determining appropriate tolerances. An Introduction to TG-142 Imaging QA Using Standard Imaging Products Presentation Time: 3:15 – 3:45 PM Medical Physicists want to understand the logic behind TG-142 Imaging QA. What is often missing is a firm understanding of the connections between the EPID and OBI phantom imaging, the software “algorithms” that calculate the QA metrics, the establishment of baselines, and the analysis and interpretation of the results. The goal of our brief presentation will be to establish and solidify these connections. Our talk will be motivated by the Standard Imaging, Inc. phantom and software solutions. We will present and explain each of the image quality metrics in TG-142 in terms of the theory, mathematics, and algorithms used to implement them in the Standard Imaging PIPSpro software. In the process, we will identify the regions of phantom images that are analyzed by each algorithm. We then will discuss the process of the creation of baselines and typical ranges of acceptable values for each imaging quality metric.

07 ISOTOPE AND RADIATION SOURCES↗