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At least 1,027 records · Page 57
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DOE OSTI2016

SU-F-J-38: Dose Rates and Preliminary Evaluation of Contouring Similarity Metrics Using 4D Cone Beam CT

Purpose: 4D imaging modalities require detailed characterization for clinical optimization. The On-Board Imager mounted on the linear accelerator was used to investigate dose rates in a tissue mimicking phantom using 4D-CBCT and assess variability of contouring similarity metrics between 4D-CT and 4D-CBCT retrospective reconstructions. Methods: A 125 kVp thoracic protocol was used. A phantom placed on a motion platform simulated a patient’s breathing cycle. An ion chamber was affixed inside the phantom’s tissue mimicking cavities (i.e. bone, lung, and soft tissue). A sinusoidal motion waveform was executed with a five second period and superior-inferior motion. Dose rates were measured at six ion chamber positions. A preliminary workflow for contouring similarity between 4D-CT and 4D-CBCT was established using a single lung SBRT patient’s historical data. Average intensity projection (Ave-IP) and maximum intensity projection (MIP) reconstructions generated offline were compared between the 4D modalities. Similarity metrics included Dice similarity coefficient (DSC), Hausdorff distance, and center of mass (COM) deviation. Two isolated lesions were evaluated in the patient’s scans: one located in the right lower lobe (ITVRLL) and one located in the left lower lobe (ITVLLL). Results: Dose rates ranged from 2.30 (lung) to 5.18 (bone) E-3 cGy/mAs. For fixed acquisition parameters, cumulative dose is inversely proportional to gantry speed. For ITVRLL, DSC were 0.70 and 0.68, Hausdorff distances were 6.11 and 5.69 mm, and COM deviations were 1.24 and 4.77 mm, for Ave-IP and MIP respectively. For ITVLLL, DSC were 0.64 and 0.75, Hausdorff distances were 10.74 and 8.00 mm, and COM deviations were 7.55 and 4.3 mm, for Ave-IP and MIP respectively. Conclusion: While the dosimetric output of 4D-CBCT is low, characterization is necessary to assure clinical optimization. A basic workflow for comparison of simulation and treatment 4D image-based contours was established. This work was partially supported by a Research Scholar Grant (RSG-15-137-01-CCE) from the American Cancer Society.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

Commissioning of a Varian Clinac iX 6 MV photon beam using Monte Carlo simulation

Monte Carlo modelling of a linear accelerator is the first and most important step in Monte Carlo dose calculations in radiotherapy. Monte Carlo is considered today to be the most accurate and detailed calculation method in different fields of medical physics. In this research, we developed a photon beam model for Varian Clinac iX 6 MV equipped with MilleniumMLC120 for dose calculation purposes using BEAMnrc/DOSXYZnrc Monte Carlo system based on the underlying EGSnrc particle transport code. Monte Carlo simulation for this commissioning head LINAC divided in two stages are design head Linac model using BEAMnrc, characterize this model using BEAMDP and analyze the difference between simulation and measurement data using DOSXYZnrc. In the first step, to reduce simulation time, a virtual treatment head LINAC was built in two parts (patient-dependent component and patient-independent component). The incident electron energy varied 6.1 MeV, 6.2 MeV and 6.3 MeV, 6.4 MeV, and 6.6 MeV and the FWHM (full width at half maximum) of source is 1 mm. Phase-space file from the virtual model characterized using BEAMDP. The results of MC calculations using DOSXYZnrc in water phantom are percent depth doses (PDDs) and beam profiles at depths 10 cm were compared with measurements. This process has been completed if the dose difference of measured and calculated relative depth-dose data along the central-axis and dose profile at depths 10 cm is ≤ 5%. The effect of beam width on percentage depth doses and beam profiles was studied. Results of the virtual model were in close agreement with measurements in incident energy electron 6.4 MeV. Our results showed that photon beam width could be tuned using large field beam profile at the depth of maximum dose. The Monte Carlo model developed in this study accurately represents the Varian Clinac iX with millennium MLC 120 leaf and can be used for reliable patient dose calculations. In this commissioning process, the good criteria of dose difference in PDD and dose profiles were achieve using incident electron energy 6.4 MeV.

61 RADIATION PROTECTION AND DOSIMETRY↗
DOE OSTI2015

FEM design and simulation of a short, 10 MV, S-band Linac with Monte Carlo dose simulations

Purpose: Current commercial 10 MV Linac waveguides are 1.5 m. The authors’ current 6 MV linear accelerator–magnetic resonance imager (Linac–MR) system fits in typical radiotherapy vaults. To allow 10 MV treatments with the Linac–MR and still fit within typical vaults, the authors design a 10 MV Linac with an accelerator waveguide of the same length (27.5 cm) as current 6 MV Linacs. Methods: The first design stage is to design a cavity such that a specific experimental measurement for breakdown is applicable to the cavity. This is accomplished through the use of finite element method (FEM) simulations to match published shunt impedance, Q factor, and ratio of peak to mean-axial electric field strength from an electric breakdown study. A full waveguide is then designed and tuned in FEM simulations based on this cavity design. Electron trajectories are computed through the resulting radio frequency fields, and the waveguide geometry is modified by shifting the first coupling cavity in order to optimize the electron beam properties until the energy spread and mean energy closely match values published for an emulated 10 MV Linac. Finally, Monte Carlo dose simulations are used to compare the resulting photon beam depth dose profile and penumbra with that produced by the emulated 10 MV Linac. Results: The shunt impedance, Q factor, and ratio of peak to mean-axial electric field strength are all matched to within 0.1%. A first coupling cavity shift of 1.45 mm produces an energy spectrum width of 0.347 MeV, very close to the published value for the emulated 10 MV of 0.315 MeV, and a mean energy of 10.53 MeV, nearly identical to the published 10.5 MeV for the emulated 10 MV Linac. The depth dose profile produced by their new Linac is within 1% of that produced by the emulated 10 MV spectrum for all depths greater than 1.5 cm. The penumbra produced is 11% narrower, as measured from 80% to 20% of the central axis dose. Conclusions: The authors have successfully designed and simulated an S-band waveguide of length of 27.5 cm capable of producing a 10 MV photon beam. This waveguide operates well within the breakdown threshold determined for the cavity geometry used. The designed Linac produces depth dose profiles similar to those of the emulated 10 MV Linac (waveguide-length of 1.5 m) but yields a narrower penumbra.

07 ISOTOPE AND RADIATION SOURCES↗
DOE OSTI2015

Simultaneous beam sampling and aperture shape optimization for SPORT

Purpose: Station parameter optimized radiation therapy (SPORT) was recently proposed to fully utilize the technical capability of emerging digital linear accelerators, in which the station parameters of a delivery system, such as aperture shape and weight, couch position/angle, gantry/collimator angle, can be optimized simultaneously. SPORT promises to deliver remarkable radiation dose distributions in an efficient manner, yet there exists no optimization algorithm for its implementation. The purpose of this work is to develop an algorithm to simultaneously optimize the beam sampling and aperture shapes. Methods: The authors build a mathematical model with the fundamental station point parameters as the decision variables. To solve the resulting large-scale optimization problem, the authors devise an effective algorithm by integrating three advanced optimization techniques: column generation, subgradient method, and pattern search. Column generation adds the most beneficial stations sequentially until the plan quality improvement saturates and provides a good starting point for the subsequent optimization. It also adds the new stations during the algorithm if beneficial. For each update resulted from column generation, the subgradient method improves the selected stations locally by reshaping the apertures and updating the beam angles toward a descent subgradient direction. The algorithm continues to improve the selected stations locally and globally by a pattern search algorithm to explore the part of search space not reachable by the subgradient method. By combining these three techniques together, all plausible combinations of station parameters are searched efficiently to yield the optimal solution. Results: A SPORT optimization framework with seamlessly integration of three complementary algorithms, column generation, subgradient method, and pattern search, was established. The proposed technique was applied to two previously treated clinical cases: a head and neck and a prostate case. It significantly improved the target conformality and at the same time critical structure sparing compared with conventional intensity modulated radiation therapy (IMRT). In the head and neck case, for example, the average PTV coverage D99% for two PTVs, cord and brainstem max doses, and right parotid gland mean dose were improved, respectively, by about 7%, 37%, 12%, and 16%. Conclusions: The proposed method automatically determines the number of the stations required to generate a satisfactory plan and optimizes simultaneously the involved station parameters, leading to improved quality of the resultant treatment plans as compared with the conventional IMRT plans.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2014

Effect of dosimeter type for commissioning small photon beams on calculated dose distribution in stereotactic radiosurgery

Purpose: To assess the impact of the detector used to commission small photon beams on the calculated dose distribution in stereotactic radiosurgery (SRS). Methods: In this study, six types of detectors were used to characterize small photon beams: three diodes [a silicon stereotactic field diode SFD, a silicon diode SRS, and a silicon diode E], an ionization chamber CC01, and two types of radiochromic film models EBT and EBT2. These detectors were used to characterize circular collimated beams that were generated by a Novalis linear accelerator. This study was conducted in two parts. First, the following dosimetric data, which are of particular interest in SRS, were compared for the different detectors: the total scatter factor (TSF), the tissue phantom ratios (TPRs), and the off-axis ratios (OARs). Second, the commissioned data sets were incorporated into the treatment planning system (TPS) to compare the calculated dose distributions and the dose volume histograms (DVHs) that were obtained using the different detectors. Results: The TSFs data measured by all of the detectors were in good agreement with each other within the respective statistical uncertainties: two exceptions, where the data were systematically below those obtained for the other detectors, were the CC01 results for all of the circular collimators and the EBT2 film results for circular collimators with diameters below 10.0 mm. The OAR results obtained for all of the detectors were in excellent agreement for all of the circular collimators. This observation was supported by the gamma-index test. The largest difference in the TPR data was found for the 4.0 mm circular collimator, followed by the 10.0 and 20.0 mm circular collimators. The results for the calculated dose distributions showed that all of the detectors passed the gamma-index test at 100% for the 3 mm/3% criteria. The aforementioned observation was true regardless of the size of the calculation grid for all of the circular collimators. Finally, the dose volume histogram results were independent of the size of the calculation grid used. Conclusions: The results of this study showed that all of the studied detectors produced similar commissioned data sets for the TPS dose calculations. However, this result only validated the dose distribution calculation in the TPS and could not be used to assess the dose delivery to the target in which the TFS data were used to calculate the monitor units (the TFS data were not used in the TPS dose distribution calculation). Therefore, this study could not be used to determine the most accurate detector commissioning data set; however, all of the detectors exhibited superior performance for the relative dosimetry of small photon beams.

07 ISOTOPE AND RADIATION SOURCES↗
DOE OSTI2016

SU-F-T-615: Comparison of Plan Quality for Linac-Based Stereotactic Radiosurgery (SRS) Using Single- and Multi-Isocenter Techniques

Purpose: To compare the plan quality of linear accelerator (linac)-based stereotactic radiosurgery (SRS) using single-isocenter volumetric arc therapy (SI-VMAT), restricted single-isocenter dynamic-arc (RSI-DARC), and multi-isocenter DARC (MI-DARC) techniques. Methods: Fifteen SRS cases were randomly selected and re-planned using the SI-VMAT (Pinnacle), RSI-DARC (iPlanNet) and MI-DARC (iPlanNet). The number of planning target volumes (PTVs) for each plan ranged from 1 to 6. For SI-VMAT, a single isocenter and 3-4 VMAT beams are used for all PTVs, while for MI-DARC, each PTV has its own isocetner with 3 DARC beams. RSI-DARC uses one isocnter with 3-6 DARC beams to irradiate all PTVs within 2.5-cm radius. Both SI-DARC and RSI-DARC plans were optimized manually. The prescription dose was 20 Gy to each PTV. The maximal dose was 25 Gy for RSI-DARC and MI-DARC, but could not be controlled for SI-VMAT due to the nature of VMAT planning. Plan quality indexes including PTV coverage, mean dose of PTV (PTVmean) and tissue (Tmean), V12Gy, conformity index (CI), and V10Gy/VPTV were calculated and compared. Results: Full PTV coverage was achieved for all three techniques. Using the MI-DARC plans as the gold standard, the PTVmean of the SI-VMAT plans was 12.5%±8.3% (mean±standard deviation) higher, in comparison to 0.7%±1.4% for the RSI-DARC plans. Similar trend was observed for other indexes including V12Gy (39.4%±27.3% vs. 9.3%±7.8%), Tmean (35.0%±26.8% vs. 2.8%±3.4%), and V10Gy/VPTV (42.2%±31.5% vs. 9.9%±8.2%). CI is comparable (6.2%±14.2% vs. 6.3%±7.2%). Assuming the treatment time is proportional to the number of isocenters, the reduction of the treatment time in comparison to MI-DARC was 70% for SI-VMAT and 42% for RSI-DARC. Conclusion: Although the SI-VMAT can save a considerable amount of treatment time, the plan indexes also significantly deviates from the gold standard, MI-DARC. RSI-DARC, on the other hand, provides a good compromise between the treatment time and plan quality.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

Application of a radiophotoluminescent glass dosimeter to nonreference condition dosimetry in the postal dose audit system

Purpose: The purpose of this study was to obtain a set of correction factors of the radiophotoluminescent glass dosimeter (RGD) output for field size changes and wedge insertions. Methods: Several linear accelerators were used for irradiation of the RGDs. The field sizes were changed from 5 × 5 cm to 25 × 25 cm for 4, 6, 10, and 15 MV x-ray beams. The wedge angles were 15°, 30°, 45°, and 60°. In addition to physical wedge irradiation, nonphysical (dynamic/virtual) wedge irradiations were performed. Results: The obtained data were fitted with a single line for each energy, and correction factors were determined. Compared with ionization chamber outputs, the RGD outputs gradually increased with increasing field size, because of the higher RGD response to scattered low-energy photons. The output increase was about 1% per 10 cm increase in field size, with a slight difference dependent on the beam energy. For both physical and nonphysical wedged beam irradiation, there were no systematic trends in the RGD outputs, such as monotonic increase or decrease depending on the wedge angle change if the authors consider the uncertainty, which is approximately 0.6% for each set of measured points. Therefore, no correction factor was needed for all inserted wedges. Based on this work, postal dose audits using RGDs for the nonreference condition were initiated in 2010. The postal dose audit results between 2010 and 2012 were analyzed. The mean difference between the measured and stated doses was within 0.5% for all fields with field sizes between 5 × 5 cm and 25 × 25 cm and with wedge angles from 15° to 60°. The standard deviations (SDs) of the difference distribution were within the estimated uncertainty (1SD) except for the 25 × 25 cm field size data, which were not reliable because of poor statistics (n = 16). Conclusions: A set of RGD output correction factors was determined for field size changes and wedge insertions. The results obtained from recent postal dose audits were analyzed, and the mean differences between the measured and stated doses were within 0.5% for every field size and wedge angle. The SDs of the distribution were within the estimated uncertainty, except for one condition that was not reliable because of poor statistics.

07 ISOTOPE AND RADIATION SOURCES↗
DOE OSTI2015

Improved quality of intrafraction kilovoltage images by triggered readout of unexposed frames

Purpose: The gantry-mounted kilovoltage (kV) imager of modern linear accelerators can be used for real-time tumor localization during radiation treatment delivery. However, the kV image quality often suffers from cross-scatter from the megavoltage (MV) treatment beam. This study investigates readout of unexposed kV frames as a means to improve the kV image quality in a series of experiments and a theoretical model of the observed image quality improvements. Methods: A series of fluoroscopic images were acquired of a solid water phantom with an embedded gold marker and an air cavity with and without simultaneous radiation of the phantom with a 6 MV beam delivered perpendicular to the kV beam with 300 and 600 monitor units per minute (MU/min). An in-house built device triggered readout of zero, one, or multiple unexposed frames between the kV exposures. The unexposed frames contained part of the MV scatter, consequently reducing the amount of MV scatter accumulated in the exposed frames. The image quality with and without unexposed frame readout was quantified as the contrast-to-noise ratio (CNR) of the gold marker and air cavity for a range of imaging frequencies from 1 to 15 Hz. To gain more insight into the observed CNR changes, the image lag of the kV imager was measured and used as input in a simple model that describes the CNR with unexposed frame readout in terms of the contrast, kV noise, and MV noise measured without readout of unexposed frames. Results: Without readout of unexposed kV frames, the quality of intratreatment kV images decreased dramatically with reduced kV frequencies due to MV scatter. The gold marker was only visible for imaging frequencies ≥3 Hz at 300 MU/min and ≥5 Hz for 600 MU/min. Visibility of the air cavity required even higher imaging frequencies. Readout of multiple unexposed frames ensured visibility of both structures at all imaging frequencies and a CNR that was independent of the kV frame rate. The image lag was 12.2%, 2.2%, and 0.9% in the first, second, and third frame after an exposure. The CNR model predicted the CNR with triggered image readout with a mean absolute error of 2.0% for the gold marker. Conclusions: A device that triggers readout of unexposed frames during kV fluoroscopy was built and shown to greatly improve the quality of intratreatment kV images. A simple theoretical model successfully described the CNR improvements with the device.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

An in vivo dose verification method for SBRT–VMAT delivery using the EPID

Purpose: Radiation treatments have become increasingly more complex with the development of volumetric modulated arc therapy (VMAT) and the use of stereotactic body radiation therapy (SBRT). SBRT involves the delivery of substantially larger doses over fewer fractions than conventional therapy. SBRT–VMAT treatments will strongly benefit from in vivo patient dose verification, as any errors in delivery can be more detrimental to the radiobiology of the patient as compared to conventional therapy. Electronic portal imaging devices (EPIDs) are available on most commercial linear accelerators (Linacs) and their documented use for dosimetry makes them valuable tools for patient dose verification. In this work, the authors customize and validate a physics-based model which utilizes on-treatment EPID images to reconstruct the 3D dose delivered to the patient during SBRT–VMAT delivery. Methods: The SBRT Linac head, including jaws, multileaf collimators, and flattening filter, were modeled using Monte Carlo methods and verified with measured data. The simulation provides energy spectrum data that are used by their “forward” model to then accurately predict fluence generated by a SBRT beam at a plane above the patient. This fluence is then transported through the patient and then the dose to the phosphor layer in the EPID is calculated. Their “inverse” model back-projects the EPID measured focal fluence to a plane upstream of the patient and recombines it with the extra-focal fluence predicted by the forward model. This estimate of total delivered fluence is then forward projected onto the patient’s density matrix and a collapsed cone convolution algorithm calculates the dose delivered to the patient. The model was tested by reconstructing the dose for two prostate, three lung, and two spine SBRT–VMAT treatment fractions delivered to an anthropomorphic phantom. It was further validated against actual patient data for a lung and spine SBRT–VMAT plan. The results were verified with the treatment planning system (TPS) (ECLIPSE AAA) dose calculation. Results: The SBRT–VMAT reconstruction model performed very well when compared to the TPS. A stringent 2%/2 mm χ-comparison calculation gave pass rates better than 91% for the prostate plans, 88% for the lung plans, and 86% for the spine plans for voxels containing 80% or more of the prescribed dose. Patient data were 86% for the lung and 95% for the spine. A 3%/3 mm χ-comparison was also performed and gave pass rates better than 93% for all plan types. Conclusions: The authors have customized and validated a robust, physics-based model that calculates the delivered dose to a patient for SBRT–VMAT delivery using on-treatment EPID images. The accuracy of the results indicates that this approach is suitable for clinical implementation. Future work will incorporate this model into both offline and real-time clinical adaptive radiotherapy.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

Treatment planning strategy for whole-brain radiotherapy with hippocampal sparing and simultaneous integrated boost for multiple brain metastases using intensity-modulated arc therapy

Purpose: To retrospectively evaluate the accuracy, plan quality and efficiency of intensity-modulated arc therapy (IMAT) for hippocampal sparing whole-brain radiotherapy (HS-WBRT) with simultaneous integrated boost (SIB) in patients with multiple brain metastases (m-BM). Materials and methods: A total of 5 patients with m-BM were retrospectively replanned for HS-WBRT with SIB using IMAT treatment planning. The hippocampus was contoured on diagnostic T1-weighted magnetic resonance imaging (MRI) which had been fused with the planning CT image set. The hippocampal avoidance zone (HAZ) was generated using a 5-mm uniform margin around the paired hippocampi. The m-BM planning target volumes (PTVs) were contoured on T1/T2-weighted MRI registered with the 3D planning computed tomography (CT). The whole-brain planning target volume (WB-PTV) was defined as the whole-brain tissue volume minus HAZ and m-BM PTVs. Highly conformal IMAT plans were generated in the Eclipse treatment planning system for Novalis-TX linear accelerator consisting of high-definition multileaf collimators (HD-MLCs: 2.5-mm leaf width at isocenter) and 6-MV beam. Prescription dose was 30 Gy for WB-PTV and 45 Gy for each m-BM in 10 fractions. Three full coplanar arcs with orbit avoidance sectors were used. Treatment plans were evaluated using homogeneity (HI) and conformity indices (CI) for target coverage and dose to organs at risk (OAR). Dose delivery efficiency and accuracy of each IMAT plan was assessed via quality assurance (QA) with a MapCHECK device. Actual beam-on time was recorded and a gamma index was used to compare dose agreement between the planned and measured doses. Results: All 5 HS-WBRT with SIB plans met WB-PTV D{sub 2%}, D{sub 98%}, and V{sub 30} {sub Gy} NRG-CC001 requirements. The plans demonstrated highly conformal and homogenous coverage of the WB-PTV with mean HI and CI values of 0.33 ± 0.04 (range: 0.27 to 0.36), and 0.96 ± 0.01 (range: 0.95 to 0.97), respectively. All 5 hippocampal sparing patients met protocol guidelines with maximum dose and dose to 100% of hippocampus (D{sub 100%}) less than 16 and 9 Gy, respectively. The dose to the optic apparatus was kept below protocol guidelines for all 5 patients. Highly conformal and homogenous radiosurgical dose distributions were achieved for all 5 patients with a total of 33 brain metastases. The m-BM PTVs had a mean HI = 0.09 ± 0.02 (range: 0.07 to 0.19) and a mean CI = 1.02 ± 0.06 (range: 0.93 to 1.2). The total number of monitor units (MU) was, on average, 1677 ± 166. The average beam-on time was 4.1 ± 0.4 minute . The IMAT plans demonstrated accurate dose delivery of 95.2 ± 0.6%, on average, for clinical gamma passing rate with 2%/2-mm criteria and 98.5 ± 0.9%, on average, with 3%/3-mm criteria. Conclusions: All hippocampal sparing plans were considered clinically acceptable per NRG-CC001 dosimetric compliance criteria. IMAT planning provided highly conformal and homogenous dose distributions for the WB-PTV and m-BM PTVs with lower doses to OAR such as the hippocampus. These results suggest that HS-WBRT with SIB is a clinically feasible, fast, and effective treatment option for patients with a relatively large numbers of m-BM lesions.

61 RADIATION PROTECTION AND DOSIMETRY↗
DOE OSTI2016

Technical Note: Dose effects of 1.5 T transverse magnetic field on tissue interfaces in MRI-guided radiotherapy

Purpose: The integration of MRI with a linear accelerator (MR-linac) offers great potential for high-precision delivery of radiation therapy (RT). However, the electron deflection resulting from the presence of a transverse magnetic field (TMF) can affect the dose distribution, particularly the electron return effect (ERE) at tissue interfaces. The purpose of the study is to investigate the dose effects of ERE at air-tissue and lung-tissue interfaces during intensity-modulated radiation therapy (IMRT) planning. Methods: IMRT and volumetric modulated arc therapy (VMAT) plans for representative pancreas, lung, breast, and head and neck (HN) cases were generated following commonly used clinical dose volume (DV) criteria. In each case, three types of plans were generated: (1) the original plan generated without a TMF; (2) the reconstructed plan generated by recalculating the original plan with the presence of a TMF of 1.5 T (no optimization); and (3) the optimized plan generated by a full optimization with TMF = 1.5 T. These plans were compared using a variety of DV parameters, including V{sub 100%}, D{sub 95%}, DHI [dose heterogeneity index: (D{sub 20%}–D{sub 80%})/D{sub prescription}], D{sub max}, and D{sub 1cc} in OARs (organs at risk) and tissue interface. All the optimizations and calculations in this work were performed on static data. Results: The dose recalculation under TMF showed the presence of the 1.5 T TMF can slightly reduce V{sub 100%} and D{sub 95%} for PTV, with the differences being less than 4% for all but one lung case studied. The TMF results in considerable increases in D{sub max} and D{sub 1cc} on the skin in all cases, mostly between 10% and 35%. The changes in D{sub max} and D{sub 1cc} on air cavity walls are dependent upon site, geometry, and size, with changes ranging up to 15%. The VMAT plans lead to much smaller dose effects from ERE compared to fixed-beam IMRT in pancreas case. When the TMF is considered in the plan optimization, the dose effects of the TMF at tissue interfaces (e.g., air-cavity wall, lung-tissue interfaces, skin) are significantly reduced in most cases. Conclusions: The doses on tissue interfaces can be significantly changed by the presence of a TMF during MR-guided RT when the magnetic field is not included in plan optimization. These changes can be substantially reduced or even eliminated during VMAT/IMRT optimization that specifically considers the TMF, without deteriorating overall plan quality.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2013

Comparison of methods for the measurement of radiation dose distributions in high dose rate (HDR) brachytherapy: Ge-doped optical fiber, EBT3 Gafchromic film, and PRESAGE{sup Registered-Sign} radiochromic plastic

Purpose: Dose distribution measurement in clinical high dose rate (HDR) brachytherapy is challenging, because of the high dose gradients, large dose variations, and small scale, but it is essential to verify accurate treatment planning and treatment equipment performance. The authors compare and evaluate three dosimetry systems for potential use in brachytherapy dose distribution measurement: Ge-doped optical fibers, EBT3 Gafchromic film with multichannel analysis, and the radiochromic material PRESAGE{sup Registered-Sign} with optical-CT readout. Methods: Ge-doped SiO{sub 2} fibers with 6 {mu}m active core and 5.0 mm length were sensitivity-batched and their thermoluminescent properties used via conventional heating and annealing cycles. EBT3 Gafchromic film of 30 {mu}m active thickness was calibrated in three color channels using a nominal 6 MV linear accelerator. A 48-bit transmission scanner and advanced multichannel analysis method were utilized to derive dose measurements. Samples of the solid radiochromic polymer PRESAGE{sup Registered-Sign }, 60 mm diameter and 100 mm height, were analyzed with a parallel beam optical CT scanner. Each dosimetry system was used to measure the dose as a function of radial distance from a Co-60 HDR source, with results compared to Monte Carlo TG-43 model data. Each system was then used to measure the dose distribution along one or more lines through typical clinical dose distributions for cervix brachytherapy, with results compared to treatment planning system (TPS) calculations. Purpose-designed test objects constructed of Solid Water and held within a full-scatter water tank were utilized. Results: All three dosimetry systems reproduced the general shape of the isolated source radial dose function and the TPS dose distribution. However, the dynamic range of EBT3 exceeded those of doped optical fibers and PRESAGE{sup Registered-Sign }, and the latter two suffered from unacceptable noise and artifact. For the experimental conditions used in this study, the useful range from an isolated HDR source was 5-40 mm for fibers, 3-50 mm for EBT3, and 4-21 mm for PRESAGE{sup Registered-Sign }. Fibers demonstrated some over-response at very low dose levels, suffered from volume averaging effects in the dose distribution measurement, and exhibited up to 9% repeatability variation over three repeated measurements. EBT3 demonstrated excellent agreement with Monte Carlo and TPS dose distributions, with up to 3% repeatability over three measurements. PRESAGE{sup Registered-Sign} gave promising results, being the only true 3D dosimeter, but artifacts and noise were apparent. Conclusions: The comparative response of three emerging dosimetry systems for clinical brachytherapy dose distribution measurement has been investigated. Ge-doped optical fibers have excellent spatial resolution for single-direction measurement but are currently too large for complex dose distribution assessment. The use of PRESAGE{sup Registered-Sign} with optical-CT readout gave promising results in the measurement of true 3D dose distributions but further development work is required to reduce noise and improve dynamic range for brachytherapy dose distribution measurements. EBT3 Gafchromic film with multichannel analysis demonstrated accurate and reproducible measurement of dose distributions in HDR brachytherapy. Calibrated dose measurements were possible with agreement within 1.5% of TPS dose calculations. The suitability of EBT3 as a dosimeter for 2D quality control or commissioning work has been demonstrated.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2014

Three-dimensional liver motion tracking using real-time two-dimensional MRI

Purpose: Combined magnetic resonance imaging (MRI) systems and linear accelerators for radiotherapy (MR-Linacs) are currently under development. MRI is noninvasive and nonionizing and can produce images with high soft tissue contrast. However, new tracking methods are required to obtain fast real-time spatial target localization. This study develops and evaluates a method for tracking three-dimensional (3D) respiratory liver motion in two-dimensional (2D) real-time MRI image series with high temporal and spatial resolution. Methods: The proposed method for 3D tracking in 2D real-time MRI series has three steps: (1) Recording of a 3D MRI scan and selection of a blood vessel (or tumor) structure to be tracked in subsequent 2D MRI series. (2) Generation of a library of 2D image templates oriented parallel to the 2D MRI image series by reslicing and resampling the 3D MRI scan. (3) 3D tracking of the selected structure in each real-time 2D image by finding the template and template position that yield the highest normalized cross correlation coefficient with the image. Since the tracked structure has a known 3D position relative to each template, the selection and 2D localization of a specific template translates into quantification of both the through-plane and in-plane position of the structure. As a proof of principle, 3D tracking of liver blood vessel structures was performed in five healthy volunteers in two 5.4 Hz axial, sagittal, and coronal real-time 2D MRI series of 30 s duration. In each 2D MRI series, the 3D localization was carried out twice, using nonoverlapping template libraries, which resulted in a total of 12 estimated 3D trajectories per volunteer. Validation tests carried out to support the tracking algorithm included quantification of the breathing induced 3D liver motion and liver motion directionality for the volunteers, and comparison of 2D MRI estimated positions of a structure in a watermelon with the actual positions. Results: Axial, sagittal, and coronal 2D MRI series yielded 3D respiratory motion curves for all volunteers. The motion directionality and amplitude were very similar when measured directly as in-plane motion or estimated indirectly as through-plane motion. The mean peak-to-peak breathing amplitude was 1.6 mm (left-right), 11.0 mm (craniocaudal), and 2.5 mm (anterior-posterior). The position of the watermelon structure was estimated in 2D MRI images with a root-mean-square error of 0.52 mm (in-plane) and 0.87 mm (through-plane). Conclusions: A method for 3D tracking in 2D MRI series was developed and demonstrated for liver tracking in volunteers. The method would allow real-time 3D localization with integrated MR-Linac systems.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2015

Using Radiochromic Films to Characterize the Dispersion of ZrO{sub 2} Nano-sized Grain Clusters in Protective Polymer Composites

Radiation dosimetry is commonly used to prevent deterministic radiation effects in high dose medical procedures. Radiochromic films find nowadays widely application in radiotherapy, interventional procedures and CT exams for isodose and maximum skin dose measurements. Moreover the size of the irradiated area and its distribution can be performed through the reading of the individual components in the RGB-spectrum. Particularly, radiochromic film has multiple advantages over alternative dosimeters for low-kV X-rays dosimetry. Concerned to spatial resolution it is far superior to that of ionization chambers and thermoluminescent dosimeters. For high energy photon fields (keV to MeV) the most used radiochromic film commercially available belongs to the EBT Gafchromic{sup R} series. On the other hand, for low energy photon fields in the x-ray range (20 kVp to 200 kVp) the best choice belongs to the XR-QA Gafchromic{sup R} film series. In this work we demonstrate the possibility of generating 2D images of thin polymeric composites films using EBT3 and XR-QA2 Gafchromic{sup R} films exposed to 6 MeV and 40 keV x-ray photons, respectively, using the digital filtering tools of the ImageJ{sup R} free software. In this context, EBT3 films were placed on the surface of a rigid anthropomorphic phantom. Then, they were covered with a thermoplastic mask made of PCL polymer. This setup was then exposed to 2.0 Gy absorbed dose in the Linear Accelerator beam. The EBT3 films were then scanned in the high resolution mode in a commercial scanner and the images subsequently treated with digital filters. It is somehow possible to see the image of the thermoplastic mask in the scanned image. However, in the treated image it is easy to observe the mask arrangement. The unexpected phenomenon here is the EB3 film ability to detect the attenuation of high energy photons by a plastic material, which in turn has a very low mass-energy attenuation coefficient, producing a very clear 2D image. This result is discussed in terms of the high Z halides added to the sensitive layer of EB3 film, once the main components are C (42.3%), H (39.7%) and O (16.0%)1-2. Based on the above results, we have speculated about the abilities of XR-AQ films in the detection of the distribution of nano-sized particles that has high mass-energy attenuation coefficients for low energy x-rays, in polymer composites. In another investigation we tested the ability of XR-QA2 Gafchromic{sup R} films to evaluate the dispersion of ZrO{sub 2} nano-sized grain clusters in protective composites. The P(VDFTrFE)/ ZrO{sub 2} film was sandwiched between two XR-QA2 radiochromic films. In this setup, one radiochromic film is directly exposed to 100 mGy of the x-rays beam and another one measures the attenuated beam. After storage for 24 hours at room temperature under no light conditions, the irradiated radiochromic films were scanned under the same conditions in order to obtain a more reliable result. All films were scanned using the same size ROI in high resolution mode and saved as tagged image file format (TIFF). The untreated scanned image of the XR-AQ2 film directed exposed to the X-ray beam and the correspondent treated image with digital filters are shown. The untreated and treated image of the XR-AQ2 film that was exposed to the attenuated x-ray beam is shown. The image treated with digital filters seems to reproduce the dispersion of ZrO{sub 2} nano-sized grain clusters in the P(VDF-TrFE) copolymer matrix. This result is also discussed in terms of the high Z halides added to the sensitive layer of XR-AQ2 film and compared to the MEV images obtained from the P(VDF-TrFE)/ZrO{sub 2} composites. The results indicate a clear correlation between the 2D radiochromic image and the MEV photography.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗
DOE OSTI2016

Modification and validation of an analytical source model for external beam radiotherapy Monte Carlo dose calculations

Purpose: A dose calculation tool, which combines the accuracy of the dose planning method (DPM) Monte Carlo code and the versatility of a practical analytical multisource model, which was previously reported has been improved and validated for the Varian 6 and 10 MV linear accelerators (linacs). The calculation tool can be used to calculate doses in advanced clinical application studies. One shortcoming of current clinical trials that report dose from patient plans is the lack of a standardized dose calculation methodology. Because commercial treatment planning systems (TPSs) have their own dose calculation algorithms and the clinical trial participant who uses these systems is responsible for commissioning the beam model, variation exists in the reported calculated dose distributions. Today’s modern linac is manufactured to tight specifications so that variability within a linac model is quite low. The expectation is that a single dose calculation tool for a specific linac model can be used to accurately recalculate dose from patient plans that have been submitted to the clinical trial community from any institution. The calculation tool would provide for a more meaningful outcome analysis. Methods: The analytical source model was described by a primary point source, a secondary extra-focal source, and a contaminant electron source. Off-axis energy softening and fluence effects were also included. The additions of hyperbolic functions have been incorporated into the model to correct for the changes in output and in electron contamination with field size. A multileaf collimator (MLC) model is included to facilitate phantom and patient dose calculations. An offset to the MLC leaf positions was used to correct for the rudimentary assumed primary point source. Results: Dose calculations of the depth dose and profiles for field sizes 4 × 4 to 40 × 40 cm agree with measurement within 2% of the maximum dose or 2 mm distance to agreement (DTA) for 95% of the data points tested. The model was capable of predicting the depth of the maximum dose within 1 mm. Anthropomorphic phantom benchmark testing of modulated and patterned MLCs treatment plans showed agreement to measurement within 3% in target regions using thermoluminescent dosimeters (TLD). Using radiochromic film normalized to TLD, a gamma criteria of 3% of maximum dose and 2 mm DTA was applied with a pass rate of least 85% in the high dose, high gradient, and low dose regions. Finally, recalculations of patient plans using DPM showed good agreement relative to a commercial TPS when comparing dose volume histograms and 2D dose distributions. Conclusions: A unique analytical source model coupled to the dose planning method Monte Carlo dose calculation code has been modified and validated using basic beam data and anthropomorphic phantom measurement. While this tool can be applied in general use for a particular linac model, specifically it was developed to provide a singular methodology to independently assess treatment plan dose distributions from those clinical institutions participating in National Cancer Institute trials.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2013

Feasibility of an image planning system for kilovoltage image-guided radiation therapy

Purpose: Image guidance has become a standard of care for many treatment scenarios in radiation therapy. This is most typically accomplished by use of kV x-ray devices mounted onto the linear accelerator (Linac) gantry that yield planar, fluoroscopic, and cone-beam computed tomography (CBCT) images. Image acquisition parameters are chosen via preset techniques that rely on broad categorizations in patient anatomy and imaging goal. However, the optimal imaging technique results in detectability of the features of interest while exposing the patient to minimum dose. Herein, the authors present an investigation into the feasibility of developing an image planning system (IPS) for radiotherapy.Methods: In this first phase, the authors focused on developing an algorithm to predict tissue contrast produced by a common radiotherapy planar imaging chain. Input parameters include a CT dataset and simulated planar imaging technique settings that include kV and mAs. Energy-specific attenuation through each voxel of the CT dataset was calculated in the algorithm to derive a net transmitted intensity. The response of the flat panel detector was integrated into the image simulation algorithm. Verification was conducted by comparing simulated and measured images using four phantoms. Comparisons were made in both high and low contrast settings, as well as changes in the geometric appearance due to image saturation. Results: The authors studied a lung nodule test object to assess the planning system's ability to predict object contrast and detectability. Verification demonstrated that the slope of the pixel intensities is similar, the presence of the nodule is evident, and image saturation at high mAs values is evident in both images. The appearance of the lung nodule is a function of the image detector saturation. The authors assessed the dimensions of the lung nodule in measured and simulated images. Good quantitative agreement affirmed the algorithm's predictive capabilities. The invariance of contrast with kVp and mAs prior to saturation was predicted, as well as the gradual loss of object detectability as saturation was approached. Small changes in soft tissue density were studied using a mammography step wedge phantom. Data were acquired at beam qualities of 80 and 120 kVp and over exposure values ranging from 0.04 to 500 mAs. The data showed good agreement in terms of the absolute value of pixel intensities predicted, as well as small variations across the step wedge pattern. The saturation pixel intensity was consistent between the two beam qualities studied. Boney tissue contrast was assessed using two abdominal phantoms. Measured and calculated values agree in terms of predicting the mAs value at which detector saturation, and subsequent loss of contrast occurs. The lack of variation in contrast over mAs values lower than 10 suggests that there is wide latitude for minimizing patient dose. Conclusions: The authors developed and tested an algorithm that can be used to assist in kV imaging technique selection during localization for radiotherapy. Phantom testing demonstrated the algorithm's predictive accuracy for both low and high contrast imaging scenarios. Detector saturation with subsequent loss of imaging detail, both in terms of object size and contrast were accurately predicted by the algorithm.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2013

A line-source method for aligning on-board and other pinhole SPECT systems

Purpose: In order to achieve functional and molecular imaging as patients are in position for radiation therapy, a robotic multipinhole SPECT system is being developed. Alignment of the SPECT system—to the linear accelerator (LINAC) coordinate frame and to the coordinate frames of other on-board imaging systems such as cone-beam CT (CBCT)—is essential for target localization and image reconstruction. An alignment method that utilizes line sources and one pinhole projection is proposed and investigated to achieve this goal. Potentially, this method could also be applied to the calibration of the other pinhole SPECT systems.Methods: An alignment model consisting of multiple alignment parameters was developed which maps line sources in three-dimensional (3D) space to their two-dimensional (2D) projections on the SPECT detector. In a computer-simulation study, 3D coordinates of line-sources were defined in a reference room coordinate frame, such as the LINAC coordinate frame. Corresponding 2D line-source projections were generated by computer simulation that included SPECT blurring and noise effects. The Radon transform was utilized to detect angles (α) and offsets (ρ) of the line-source projections. Alignment parameters were then estimated by a nonlinear least squares method, based on the α and ρ values and the alignment model. Alignment performance was evaluated as a function of number of line sources, Radon transform accuracy, finite line-source width, intrinsic camera resolution, Poisson noise, and acquisition geometry. Experimental evaluations were performed using a physical line-source phantom and a pinhole-collimated gamma camera attached to a robot.Results: In computer-simulation studies, when there was no error in determining angles (α) and offsets (ρ) of the measured projections, six alignment parameters (three translational and three rotational) were estimated perfectly using three line sources. When angles (α) and offsets (ρ) were provided by the Radon transform, estimation accuracy was reduced. The estimation error was associated with rounding errors of Radon transform, finite line-source width, Poisson noise, number of line sources, intrinsic camera resolution, and detector acquisition geometry. Statistically, the estimation accuracy was significantly improved by using four line sources rather than three and by thinner line-source projections (obtained by better intrinsic detector resolution). With five line sources, median errors were 0.2 mm for the detector translations, 0.7 mm for the detector radius of rotation, and less than 0.5° for detector rotation, tilt, and twist. In experimental evaluations, average errors relative to a different, independent registration technique were about 1.8 mm for detector translations, 1.1 mm for the detector radius of rotation (ROR), 0.5° and 0.4° for detector rotation and tilt, respectively, and 1.2° for detector twist.Conclusions: Alignment parameters can be estimated using one pinhole projection of line sources. Alignment errors are largely associated with limited accuracy of the Radon transform in determining angles (α) and offsets (ρ) of the line-source projections. This alignment method may be important for multipinhole SPECT, where relative pinhole alignment may vary during rotation. For pinhole and multipinhole SPECT imaging on-board radiation therapy machines, the method could provide alignment of SPECT coordinates with those of CBCT and the LINAC.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2017

On the use of volumetric-modulated arc therapy for single-fraction thoracic vertebral metastases stereotactic body radiosurgery

To retrospectively evaluate quality, efficiency, and delivery accuracy of volumetric-modulated arc therapy (VMAT) plans for single-fraction treatment of thoracic vertebral metastases using image-guided stereotactic body radiosurgery (SBRS) after RTOG 0631 dosimetric compliance criteria. After obtaining credentialing for MD Anderson spine phantom irradiation validation, 10 previously treated patients with thoracic vertebral metastases with noncoplanar hybrid arcs using 1 to 2 3D-conformal partial arcs plus 7 to 9 intensity-modulated radiation therapy beams were retrospectively re-optimized with VMAT using 3 full coplanar arcs. Tumors were located between T2 and T12. Contrast-enhanced T1/T2-weighted magnetic resonance images were coregistered with planning computed tomography and planning target volumes (PTV) were between 14.4 and 230.1 cc (median = 38.0 cc). Prescription dose was 16 Gy in 1 fraction with 6 MV beams at Novalis-TX linear accelerator consisting of micro multileaf collimators. Each plan was assessed for target coverage using conformality index, the conformation number, the ratio of the volume receiving 50% of the prescription dose over PTV, R50%, homogeneity index (HI), and PTV-1600 coverage per RTOG 0631 requirements. Organs-at-risk doses were evaluated for maximum doses to spinal cord (D{sub 0.03} {sub cc}, D{sub 0.35} {sub cc}), partial spinal cord (D{sub 10%}), esophagus (D{sub 0.03} {sub cc} and D{sub 5} {sub cc}), heart (D{sub 0.03} {sub cc} and D{sub 15} {sub cc}), and lung (V{sub 5}, V{sub 10}, and maximum dose to 1000 cc of lung). Dose delivery efficiency and accuracy of each VMAT-SBRS plan were assessed using quality assurance (QA) plan on MapCHECK device. Total beam-on time was recorded during QA procedure, and a clinical gamma index (2%/2 mm and 3%/3 mm) was used to compare agreement between planned and measured doses. All 10 VMAT-SBRS plans met RTOG 0631 dosimetric requirements for PTV coverage. The plans demonstrated highly conformal and homogenous coverage of the vertebral PTV with mean HI, conformality index, conformation number, and R{sub 50%} values of 0.13 ± 0.03 (range: 0.09 to 0.18), 1.03 ± 0.04 (range: 0.98 to 1.09), 0.81 ± 0.06 (range: 0.72 to 0.89), and 4.2 ± 0.94 (range: 2.7 to 5.4), respectively. All 10 patients met protocol guidelines with maximum dose to spinal cord (average: 8.83 ± 1.9 Gy, range: 5.9 to 10.9 Gy); dose to 0.35 cc of spinal cord (average: 7.62 ± 1.7 Gy, range: 5.4 to 9.6 Gy); and dose to 10% of partial spinal cord (average 6.31 ± 1.5 Gy, range: 3.5 to 8.5 Gy) less than 14, 10, and 10 Gy, respectively. For all 10 patients, the maximum dose to esophagus (average: 9.41 ± 4.3 Gy, range: 1.5 to 14.9 Gy) and dose to 5 cc of esophagus (average: 7.43 ± 3.8 Gy, range: 1.1 to 11.8 Gy) were kept less than protocol requirements 16 Gy and 11.9 Gy, respectively. In a similar manner, all 10 patients met protocol compliance criteria with maximum dose to heart (average: 4.62 ± 3.5 Gy, range: 1.3 to 10.2 Gy) and dose to 15 cc of heart (average: 2.23 ± 1.8 Gy, range: 0.3 to 5.6 Gy) less than 22 and 16 Gy, respectively. The dose to the lung was retained much lower than protocol guidelines for all 10 patients. The total number of monitor units was, on average, 6919 ± 1187. The average beam-on time was 11.5 ± 2.0 minutes. The VMAT plans demonstrated dose delivery accuracy of 95.8 ± 0.7%, on average, for clinical gamma passing rate with 2%/2 mm criteria and 98.3 ± 0.8%, on average, with 3%/3 mm criteria. All VMAT-SBRS plans were considered clinically acceptable per RTOG 0631 dosimetric compliance criteria. VMAT planning provided highly conformal and homogenous dose distributions for the lower-dose vertebral PTV and the spinal cord as well as organs-at-risk such as esophagus, heart, and lung. Higher QA pass rates and shorter beam-on time suggest that VMAT-SBRS is a clinically feasible, fast, and effective treatment option for patients with thoracic vertebral metastases.

61 RADIATION PROTECTION AND DOSIMETRY↗