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At least 1,063 records · Page 59
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DOE OSTI2016

SU-F-T-656: Monte Carlo Study On Air Activation Around a Medical Electron Linac

Purpose: In high energy photon therapy, several radiation protection issues result from photonuclear reactions. The activation of air - directly by photonuclear reactions as well as indirectly by capture of photoneutrons generated inside the linac head - is a major point of concern for the medical staff. The purpose of this study was to estimate the annual effective dose to medical workers due to activated air around a medical high energy electron linac by means of Monte Carlo simulations. Methods: The treatment head of a Varian Clinac in 18 MV-X mode as well as the surrounding concrete bunker were modeled and the radiation transport was simulated using the Monte Carlo code FLUKA, starting from the primary electron striking the bremsstrahlung target. The activation yields in air from photo-disintegration of O-16 and N-14 nuclei as well as from neutron capture on Ar-40 nuclei were obtained from the simulations. The activation build-up, radioactive decay and air ventilation were studied using a mathematical model. The annual effective dose to workers was estimated by using published isotope specific conversion factors. Results: The oxygen and nitrogen activation yields were in contrast to the argon activation yield found to be field size dependent. The impact of the treatment room ventilation on the different air activation products was investigated and quantified. An estimate with very conservative assumptions gave an annual effective dose to workers of < 1 mSv/a. Conclusion: From the results of this study it can be concluded that the contribution of air activation to the radiation exposure to medical workers should be negligible in modern photon therapy, especially when it is compared to the dose due to prompt neutrons and the activation of heavy solid materials such as the jaws and the collimators inside the linac head.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-G-BRB-17: Dosimetric Evaluation of the Respiratory Interplay Effect During VMAT Delivery Using IPAGAT Polymer Gel Dosimeter

Purpose: To evaluate the dosimetric impact of the interplay effect between multileaf collimator (MLC) movement and tumor respiratory motion during delivery of volumetric modulate arc therapy (VMAT) by using customized polymer gel dosimeter. Methods: Polyacrylamide-based gel dosimeter contained magnesium chloride as a sensitizer (iPAGAT) was used in this study. An excellent gas barrier PAN (BAREX) techno bottle (φ8 cm, 650 mL) filled with iPAGAT was set to the QUASAR™ respiratory motion phantom, and was moved with motion amplitudes of 1 and 2 cm with a 4 second period during VMAT delivery by the Novalis Tx linear accelerator (Varian/BrainLAB). Two spherical tumors with a 2 cm diameter (GTV1 and GTV2) were defined, and ITV1 (GTV1+1 cm) and ITV2 (GTV2+2 cm) with expansion in the superior-inferior (S-I) direction were also defined with simulated respiratory motion. PTV margin was 2 mm around the ITV considering the setup uncertainty. Two single arc VMAT plans with 30 Gy at 3 Gy per fraction (GTV: D98>100%, PTV: D95=100%) were generated by the Varian Eclipse treatment planning system. Three-dimensional dose distribution in iPAGAT was read out by the Signa 1.5T MRI system (GE), and was evaluated by dose-volume histogram (DVH) using in-house developed software. Results: According to DVH analysis by iPAGAT, D98 of GTV1 and GTV2 were more than 100% of the prescribed dose. In contrast, D95 of PTV1 and PTV2 were about 85% and 65%, respectively. Furthermore, low-to-intermediate dose was widespread with motion amplitude of 2 cm. Conclusion: DVH analysis using iPAGAT polymer gel dosimeter was performed in this study. As a result, interplay effect was negligible, since dose coverage of GTV was sufficient during VMAT delivery with simulated respiratory motion. However, the dose reduction of PTV and the spread of low-to-intermediate dose compared to the planned dose require scrupulous attention for large tumor respiratory motion.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-G-BRA-16: Target Dose Comparison for Dynamic MLC Tracking and Mid- Ventilation Planning in Lung Radiotherapy Subject to Intrafractional Baseline Drifts

Purpose: Lung tumor motion during radiotherapy can be accounted for by expanded treatment margins, for example using a mid-ventilation planning approach, or by localizing the tumor in real-time and adapting the treatment beam with multileaf collimator (MLC) tracking. This study evaluates the effect of intrafractional changes in the average tumor position (baseline drifts) on these two treatment techniques. Methods: Lung stereotactic treatment plans (9-beam IMRT, 54Gy/3 fractions, mean treatment time: 9.63min) were generated for three patients: either for delivery with MLC tracking (isotropic GTV-to-PTV margin: 2.6mm) or planned with a mid-ventilation approach and delivered without online motion compensation (GTV-to-PTV margin: 4.4-6.3mm). Delivery to a breathing patient was simulated using DynaTrack, our in-house tracking and delivery software. Baseline drifts in cranial and posterior direction were simulated at a rate of 0.5, 1.0 or 1.5mm/min. For dose reconstruction, the corresponding 4DCT phase was selected for each time point of the delivery. Baseline drifts were accounted for by rigidly shifting the CT to ensure correct relative beam-to-target positioning. Afterwards, the doses delivered to each 4DCT phase were accumulated deformably on the mid-ventilation phase using research RayStation v4.6 and dose coverage of the GTV was evaluated. Results: When using the mid-ventilation planning approach, dose coverage of the tumor deteriorated substantially in the presence of baseline drifts. The reduction in D98% coverage of the GTV in a single fraction ranged from 0.4-1.2, 0.6-3.3 and 4.5-6.2Gy, respectively, for the different drift rates. With MLC tracking the GTV D98% coverage remained unchanged (+/− 0.1Gy) regardless of drift. Conclusion: Intrafractional baseline drifts reduce the tumor dose in treatments based on mid-ventilation planning. In rare, large target baseline drifts tumor dose coverage may drop below the prescription, potentially affecting clinical outcome in hypofractionated treatment protocols. Dynamic MLC tracking preserves tumor dose coverage even in the presence of extreme baseline drifts. We acknowledge financial and technical support of the MLC tracking research from Elekta AB. Research at ICR is supported by CRUK under Programme C33589/A19727 and NHS funding to the NIHR Biomedical Research Centre at RMH and ICR. MFF is supported by CRUK under Programme C33589/A19908.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-G-206-03: CTDI Per KV at Phantom Center and Periphery: Comparison Between Major CT Manufacturers

Purpose: The purpose of this study was to: 1) compare scanners output by measuring normalized CTDIw (mGy/100mAs) in different CT makes and models and at different kV’s, and 2) quantify the relationship between kV and CTDI and compare this relationship between the different manufacturers. Methods: Study included forty scanners of major CT manufacturers and of various models. Exposure was measured at center and 12 o’clock holes of head and body CTDI phantoms, at all available kV’s, and with the largest or second largest available collimation in each scanner. Average measured CTDI’s from each CT manufacturer were also plotted against kV and the fitting equation: CTDIw (normalized) = a.kVb was calculated. The power (b) value may be considered as an indicator of spectral filtration, which affects the degree of beam hardening. Also, HVLs were measured at several scanners. Results: Results showed GE scanners, on average, had higher normalized CTDIw than those of Siemens and Philips, in both phantom sizes and at all kV’s. ANOVA statistic indicated the difference was statistically significant (p < 0.05). Comparison between Philips and Siemens, however, was not statistically significant. Curve fitting showed b values ranged from 2.4 to 2.9 (for Head periphery and center, respectively); and was about 2.8 for Body phantom periphery, and 3.2 at the center of Body phantom. Fitting equations (kV vs. CTDI) will be presented and discussed. GE’s CTDIw vs. HVL showed very strong correlation (r > 0.99). Conclusion: Partial characterization of scanners output was performed which may be helpful in dose estimation to internal organs. The relatively higher output from GE scanners may be attributed to lower filtration. Work is still in progress to obtain CTDI values from other scanners as well as to measure their HVLs.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-G-206-15: Effects of Dose Reduction On Emphysema Score

Purpose: The purpose of this study was to investigate the effects of reducing radiation dose levels on emphysema scores from lung cancer screening CT exams. Methods: 52 cases were selected from the National Lung Screening Trial (NLST) patients for which we had both the image series and the raw CT data. All scans were acquired with fixed effective mAs (25 for standard-sized patients, 40 for large patients) on a 64-slice scanner (Sensation 64, Siemens Healthcare) using 120kV, 64×0.6mm collimation and pitch 1.0. All images were reconstructed with 1mm slice thickness, B50 kernel. Based on a previously-published technique, we added noise to the raw data to simulate reduced-dose versions at 50% and 25% of the original dose (approximately 1.0- and 0.5-mGy CTDIvol). Lung segmentations were obtained via region growing from manual seed point at a threshold of 600HU followed by manual removal of trachea and major airways. Lung segmentations were only performed on original dose scans, and mapped to simulated reduced-dose scans. Emphysema scores based on relative area of lung with attenuation values lower than −950HU (RA950) were computed for all cases. Results: Average RA950 of all 50 cases were 31.6 (±5.5), 32.5 (±4.9) and 32.8 (±4.6) for 100%, 50% and 25% dose level respectively. The average absolute difference in RA950 between simulated and original dose scans were 1.0 (±0.7) and 1.4 (±1.1) for 50% and 25% dose level respectively. Conclusion: RA950 is relatively robust to dose level, with a difference of no more than 5 from the original dose scans. The average RA950 of this population was high for a two reasons: This was a high risk population of patients with substantial smoking history; The use of B50 kernel, which may be biased towards high emphysema scores. Further exploration with smoother kernels will be conducted in the future. Institutional research agreement, Siemens Healthcare; Past recipient, research grant support, Siemens Healthcare; Consultant, Toshiba America Medical Systems; Consultant, Samsung Electronics; NIH grant support from U01 CA181156.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-G-JeP1-05: Clinical Impact of MLC Tracking for Lung SABR

Purpose: The objective of this study was to investigate the dosimetric benefits of multi-leaf collimator (MLC) tracking for lung SABR treatments in end-to-end clinically realistic planning and delivery scenarios. Methods: The clinical benefits of MLC tracking were assessed using previously delivered treatment plans and physical experiments. The 10 most recent single lesion lung SABR patients were re-planned following a 4D-GTV-based real-time adaptive protocol (PTV defined as the end-of-exhalation GTV plus 5.0 mm margins). The plans were delivered on a Trilogy Varian linac. Electromagnetic transponders (Calypso, Varian Medical Systems, USA) were embedded into a programmable moving phantom (HexaMotion platform) tracked with the Varian Calypso system. For each physical experiment, the MLC positions were collected and used as input for dose reconstruction. For both planned and physical experiments, the OAR dose metrics from the conventional and real-time adaptive SABR plans (Mean Lung Dose (MLD), V20 for lung, and near-maximum dose (D2%) for spine and heart) were statistically compared. The Wilcoxon test was used to compare plan and physical experiment dose metrics. Results: While maintaining target coverage, percentage reductions in dose metrics to the OARs were observed for both planned and physical experiments. Comparing the two plans showed MLD percentage reduction (MLDr) of 25.4% (absolute differences of 1.41 Gy) and 28.9% (1.29%) for the V20r. D2% percentage reduction for spine and heart were respectively 27.9% (0.3 Gy) and 20.2% (0.3 Gy). For the physical experiments, MLDr was 23.9% (1.3 Gy), and V20r 37.4% (1.6%). D2% reduction for spine and heart were respectively 27.3% (0.3 Gy) and 19.6% (0.3 Gy). For both plans and physical experiments, significant OAR dose differences (p<0.05) were found between the conventional SABR and real-time adaptive plans. Conclusion: Application of MLC tracking for lung SABR patients has the potential to reduce the dose to OARs during radiation therapy.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-G-TeP1-08: LINAC Head Geometry Modeling for Cyber Knife System

Purpose: Knowledge of the LINAC head information is critical for model based dose calculation algorithms. However, the geometries are difficult to measure precisely. The purpose of this study is to develop linac head models for Cyber Knife system (CKS). Methods: For CKS, the commissioning data were measured in water at 800mm SAD. The measured full width at half maximum (FWHM) for each cone was found greater than the nominal value, this was further confirmed by additional film measurement in air. Diameter correction, cone shift and source shift models (DCM, CSM and SSM) are proposed to account for the differences. In DCM, a cone-specific correction is applied. For CSM and SSM, a single shift is applied to the cone or source physical position. All three models were validated with an in-house developed pencil beam dose calculation algorithm, and further evaluated by the collimator scatter factor (Sc) correction. Results: The mean square error (MSE) between nominal diameter and the FWHM derived from commissioning data and in-air measurement are 0.54mm and 0.44mm, with the discrepancy increasing with cone size. Optimal shift for CSM and SSM is found to be 9mm upward and 18mm downward, respectively. The MSE in FWHM is reduced to 0.04mm and 0.14mm for DCM and CSM (SSM). Both DCM and CSM result in the same set of Sc values. Combining all cones at SAD 600–1000mm, the average deviation from 1 in Sc of DCM (CSM) and SSM is 2.6% and 2.2%, and reduced to 0.9% and 0.7% for the cones with diameter greater than 15mm. Conclusion: We developed three geometrical models for CKS. All models can handle the discrepancy between vendor specifications and commissioning data. And SSM has the best performance for Sc correction. The study also validated that a point source can be used in CKS dose calculation algorithms.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-G-IeP4-12: Performance of In-111 Coincident Gamma-Ray Counting: A Monte Carlo Simulation

Purpose: The decay of In-111 results in a non-isotropic gamma-ray cascade, which is normally imaged using a gamma camera. Creating images with a gamma camera using coincident gamma-rays from In-111 has not been previously studied. Our objective was to explore the feasibility of imaging this cascade as coincidence events and to determine the optimal timing resolution and source activity using Monte Carlo simulations. Methods: GEANT4 was used to simulate the decay of the In-111 nucleus and to model the gamma camera. Each photon emission was assigned a timestamp, and the time delay and angular separation for the second gamma-ray in the cascade was consistent with the known intermediate state half-life of 85ns. The gamma-rays are transported through a model of a Siemens dual head Symbia “S” gamma camera with a 5/8-inch thick crystal and medium energy collimators. A true coincident event was defined as a single 171keV gamma-ray followed by a single 245keV gamma-ray within a specified time window (or vice versa). Several source activities (ranging from 10uCi to 5mCi) with and without incorporation of background counts were then simulated. Each simulation was analyzed using varying time windows to assess random events. The noise equivalent count rate (NECR) was computed based on the number of true and random counts for each combination of activity and time window. No scatter events were assumed since sources were simulated in air. Results: As expected, increasing the timing window increased the total number of observed coincidences albeit at the expense of true coincidences. A timing window range of 200–500ns maximizes the NECR at clinically-used source activities. The background rate did not significantly alter the maximum NECR. Conclusion: This work suggests coincident measurements of In-111 gamma-ray decay can be performed with commercial gamma cameras at clinically-relevant activities. Work is ongoing to assess useful clinical applications.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-G-IeP4-14: Prostate Brachytherapy Activity Measurement and Source Localization by Using a Dual Photon Emission Computed Tomography System: A Feasibility Study

Purpose: To monitor the activity distribution and needle position during and after implantation in operating rooms. Methods: Simulation studies were conducted to assess the feasibility of measurement activity distribution and seed localization using the DuPECT system. The system consists of a LaBr3-based probe and planar detection heads, a collimation system, and a coincidence circuit. The two heads can be manipulated independently. Simplified Yb-169 brachytherapy seeds were used. A water-filled cylindrical phantom with a 40-mm diameter and 40-mm length was used to model a simplified prostate of the Asian man. Two simplified seeds were placed at a radial distance of 10 mm and tangential distance of 10 mm from the center of the phantom. The probe head was arranged perpendicular to the planar head. Results of various imaging durations were analyzed and the accuracy of the seed localization was assessed by calculating the centroid of the seed. Results: The reconstructed images indicate that the DuPECT can measure the activity distribution and locate the seeds dwelt in different positions intraoperatively. The calculated centroid on average turned out to be accurate within the pixel size of 0.5 mm. The two sources were identified when the duration is longer than 15 s. The sensitivity measured in water was merely 0.07 cps/MBq. Conclusion: Preliminary results show that the measurement of the activity distribution and seed localization are feasible using the DuPECT system intraoperatively. It indicates the DuPECT system has potential to be an approach for dose-distribution-validation. The efficacy of acvtivity distribution measurement and source localization using the DuPECT system will evaluated in more realistic phantom studies (e.g., various attenuation materials and greater number of seeds) in the future investigation.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-G-TeP4-08: Automating the Verification of Patient Treatment Parameters

Purpose: To automate the daily verification of each patient’s treatment by utilizing the trajectory log files (TLs) written by the Varian TrueBeam linear accelerator while reducing the number of false positives including jaw and gantry positioning errors, that are displayed in the Treatment History tab of Varian’s Chart QA module. Methods: Small deviations in treatment parameters are difficult to detect in weekly chart checks, but may be significant in reducing delivery errors, and would be critical if detected daily. Software was developed in house to read TLs. Multiple functions were implemented within the software that allow it to operate via a GUI to analyze TLs, or as a script to run on a regular basis. In order to determine tolerance levels for the scripted analysis, 15,241 TLs from seven TrueBeams were analyzed. The maximum error of each axis for each TL was written to a CSV file and statistically analyzed to determine the tolerance for each axis accessible in the TLs to flag for manual review. The software/scripts developed were tested by varying the tolerance values to ensure veracity. After tolerances were determined, multiple weeks of manual chart checks were performed simultaneously with the automated analysis to ensure validity. Results: The tolerance values for the major axis were determined to be, 0.025 degrees for the collimator, 1.0 degree for the gantry, 0.002cm for the y-jaws, 0.01cm for the x-jaws, and 0.5MU for the MU. The automated verification of treatment parameters has been in clinical use for 4 months. During that time, no errors in machine delivery of the patient treatments were found. Conclusion: The process detailed here is a viable and effective alternative to manually checking treatment parameters during weekly chart checks.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

MO-FG-BRA-06: Electromagnetic Beacon Insertion in Lung Cancer Patients and Resultant Surrogacy Errors for Dynamic MLC Tumour Tracking

Purpose: To assess endo-bronchial electromagnetic beacon insertion and to quantify the geometric accuracy of using beacons as a surrogate for tumour motion in real-time multileaf collimator (MLC) tracking of lung tumours. Methods: The LIGHT SABR trial is a world-first clinical trial in which the MLC leaves move with lung tumours in real time on a standard linear accelerator. Tracking is performed based on implanted electromagnetic beacons (CalypsoTM, Varian Medical Systems, USA) as a surrogate for tumour motion. Five patients have been treated and have each had three beacons implanted endo-bronchially under fluoroscopic guidance. The centre of mass (C.O.M) has been used to adapt the MLC in real-time. The geometric error in using the beacon C.O.M as a surrogate for tumour motion was measured by measuring the tumour and beacon C.O.M in all phases of the respiratory cycle of a 4DCT. The surrogacy error was defined as the difference in beacon and tumour C.O.M relative to the reference phase (maximum exhale). Results: All five patients have had three beacons successfully implanted with no migration between simulation and end of treatment. Beacon placement relative to tumour C.O.M varied from 14 to 74 mm and in one patient spanned two lobes. Surrogacy error was measured in each patient on the simulation 4DCT and ranged from 0 to 3 mm. Surrogacy error as measured on 4DCT was subject to artefacts in mid-ventilation phases. Surrogacy error was a function of breathing phase and was typically larger at maximum inhale. Conclusion: Beacon placement and thus surrogacy error is a major component of geometric uncertainty in MLC tracking of lung tumours. Surrogacy error must be measured on each patient and incorporated into margin calculation. Reduction of surrogacy error is limited by airway anatomy, however should be taken into consideration when performing beacon insertion and planning. This research is funded by Varian Medical Systems via a collaborative research agreement.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

MO-FG-CAMPUS-IeP1-04: Kerma Area Product Calculation for Non-Uniform X-Ray Fields Using a Skin Dose Tracking System

Purpose: The functionality of the Dose-Tracking System (DTS) has been expanded to include the calculation of the Kerma-Area Product (KAP) for non-uniform x-ray fields such as result from the use of compensation filters during fluoroscopic procedures Methods: The DTS calculates skin dose during fluoroscopic interventions and provides a color-coded dose map on a patient-graphic model. The KAP is the integral of air kerma over the x-ray field and is usually measured with a transmission-ionization chamber that intercepts the entire x-ray beam. The DTS has been modified to determine KAP when there are beam non-uniformities that can be modeled. For example, the DTS includes models of the three compensation filters with tapered edges located in the collimator assembly of the Toshiba Infinix fluoroscopic C-Arm and can track their movement. To determine the air kerma after the filters, DTS includes transmission factors for the compensation filters as a function of kVp and beam filtration. A virtual KAP dosimeter is simulated in the DTS by an array of graphic vertices; the air kerma at each vertex is corrected by the field non-uniformity, which in this case is the attenuation factor for those rays which pass through the filter. The products of individual vertex air-kerma values for all vertices within the beam times the effective-area-per-vertex are summed for each x-ray pulse to yield the KAP per pulse and the cumulative KAP for the procedure is then calculated. Results: The KAP values estimated by DTS with the compensation filter inserted into the x-ray field agree within ± 6% with the values displayed on the fluoroscopy unit monitor, which are measured with a transmission chamber. Conclusion: The DTS can account for field non-uniformities such as result from the use of compensation filters in calculating KAP and can obviate the need for a KAP transmission ionization chamber. Partial support from NIH Grant R01-EB002873 and Toshiba Medical Systems Corp.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

MO-FG-CAMPUS-JeP1-02: Proton Range Verification of Scanned Pencil Beams Using Prompt Gamma Imaging

Purpose: Prompt gammas are emitted along the proton beam path and have an emission profile correlated with the depth dose profile. In this study, the accuracy of in-vivo proton range verification using a 1-D prompt gamma camera is assessed. Methods: The 1-D camera is comprised of a tungsten slit collimator positioned in front of a linear array of LYSO scintillating crystals coupled to silicon photomultipliers. The imaged gamma profiles of individual pencil beam spots and energy layers were analyzed by determining the relative shifts from the expected gamma profiles based on analytic prediction or reference measurements. The range retrieval precision was evaluated by reproducibility measurements and by irradiation through a heterogeneous phantom composed of materials with known stopping power ratios. The camera was evaluated at clinical doses in pencil beam scanning mode on a head-and-neck phantom (HN). Two scenarios were studied: 5 mm systematic range error; and setup error of 10 mm transverse to the proton beam. Results: The camera range retrieval precision was 2 mm at clinical doses. For the heterogeneous phantom and HN phantom studies, the discrepancies between the analytic model and measurements were less than 2 mm for both spot and iso-energy layer analysis. For the simulated 5 mm range error, the retrieved shifts were 4.3±2.0 mm. For the 10 mm setup error, large shifts (> 4 mm) were observed for some spots due to differences in the irradiated and expected beam path from the measurements without setup error. Conclusion: Our studies demonstrated that in-vivo proton range verification is feasible using a 1D prompt gamma camera with a 2 mm range retrieval precision. Pencil beam spot under or over ranging can be detected via comparison between measured and expected profiles.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

MO-FG-CAMPUS-TeP1-03: Pre-Treatment Surface Imaging Based Collision Detection

Purpose: Modern radiotherapy increasingly employs large immobilization devices, gantry attachments, and couch rotations for treatments. All of which raise the risk of collisions between the patient and the gantry / couch. Collision detection is often achieved by manually checking each couch position in the treatment room and sometimes results in extraneous imaging if collisions are detected after image based setup has begun. In the interest of improving efficiency and avoiding extra imaging, we explore the use of a surface imaging based collision detection model. Methods: Surfaces acquired from AlignRT (VisionRT, London, UK) were transferred in wavefront format to a custom Matlab (Mathworks, Natick, MA) software package (CCHECK). Computed tomography (CT) scans acquired at the same time were sent to CCHECK in DICOM format. In CCHECK, binary maps of the surfaces were created and overlaid on the CT images based on the fixed relationship of the AlignRT and CT coordinate systems. Isocenters were added through a graphical user interface (GUI). CCHECK then compares the inputted surfaces to a model of the linear accelerator (linac) to check for collisions at defined gantry and couch positions. Note, CCHECK may be used with or without a CT. Results: The nominal surface image field of view is 650 mm × 900 mm, with variance based on patient position and size. The accuracy of collision detections is primarily based on the linac model and the surface mapping process. The current linac model and mapping process yield detection accuracies on the order of 5 mm, assuming no change in patient posture between surface acquisition and treatment. Conclusions: CCHECK provides a non-ionizing method to check for collisions without the patient in the treatment room. Collision detection accuracy may be improved with more robust linac modeling. Additional gantry attachments (e.g. conical collimators) can be easily added to the model.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

MO-FG-CAMPUS-TeP2-02: First Experiences and Perspectives in Using Direct Multicriteria Optimization (MCO) On Volumetric-Modulated Arc Therapy (VMAT) for Head and Neck Cancer

Purpose: To report the first experiences and perspectives in using direct multicriteria optimization (MCO) on volumetric-modulated arc therapy (VMAT) for head and neck (H&N) cancer. Methods: Ten prior patients with tumors in representative H&N regions were selected to evaluate direct MCO-VMAT in RayStation v5.0 beta. The patients were previously treated by intensity-modulated radiation therapy (IMRT) with MCO on an Elekta linear accelerator with Agility multileaf collimator. To avoid radiating eyes and shoulders, MCO-VMAT required one to three partial-arc groups, with each group consisting of single or dual arcs. All MCO-VMAT plans were approved by a radiation oncologist. The MCO-VMAT and MCO-IMRT plans were compared using V{sub 100}, D{sub 5}, homogeneity index (HI) and conformity index (CI) for planning target volume (PTV), D{sub mean} and D{sub 50} for six parallel organs and D{sub max} for five serial organs. Patient-specific quality assurance (QA) was performed using ArcCHECK for MCO-VMAT and Matrixx for MCO-IMRT with results analyzed using gamma criteria of 3%/3mm. Results: MCO-VMAT provided better V{sub 100} (+0.8%) lower D{sub 5}(− 0.3 Gy), lower HI (−0.27) and comparable CI (+0.05). MCO-VMAT decreased D{sub mean} and D{sub 50} for multiple parallel organs in seven of the ten patients. On average the reduction ranged from 2.1 (larynx) to 7.6 Gy (esophagus). For the nasal cavity and nasopharynx plans significant reduction in D{sub max} was observed for optics (up to 11 Gy) brainstem (6.4 Gy), cord (2.1 Gy) and mandible (6.7 Gy). All MCO-VMAT and -IMRT plans passed clinical QA. MCO-VMAT required slightly longer planning time due to the more complex VMAT optimization. The net beam-on time for the MCO-VMAT plans ranged from 80 to 242 seconds, up to 9 minutes shorter than MCO-IMRT. Conclusion: With similar target coverage, reduced organ dose, comparable planning time, and significantly faster treatment, MCO-VMAT is very likely to become the modality of choice in RayStation v5.0 for H&N cancer.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

MO-FG-CAMPUS-TeP2-03: Multi-Criteria Optimization Using Taguchi Method for SRS of Multiple Lesions by Single Isocenter

Purpose: This study utilizes the Taguchi Method to evaluate the VMAT planning parameters of single isocenter treatment plans for multiple brain metastases. An optimization model based on Taguchi and utility concept is employed to optimize the planning parameters including: arc arrangement, calculation grid size, calculation model, and beam energy on multiple performance characteristics namely conformity index and dose to normal brain. Methods: Treatment plans, each with 4 metastatic brain lesions were planned using single isocenter technique. The collimator angles were optimized to avoid open areas. In this analysis four planning parameters (a–d) were considered: (a)-Arc arrangements: set1: Gantry 181cw179 couch0; gantry179ccw0, couch315; and gantry0ccw181, couch45. set2: set1 plus additional arc: Gantry 0cw179, couch270. (b)-Energy: 6-MV; 6MV-FFF (c)-Calculation grid size: 1mm; 1.5mm (d)-Calculation models: AAA; Acuros Treatment planning was performed in Varian Eclipse (ver.11.0.30). A suitable orthogonal array was selected (L8) to perform the experiments. After conducting the experiments with the combinations of planning parameters the conformity index (CI) and the normal brain dose S/N ratio for each parameter was calculated. Optimum levels for the multiple response optimizations were determined. Results: We determined that the factors most affecting the conformity index are arc arrangement and beam energy. These tests were also used to evaluate dose to normal brain. In these evaluations, the significant parameters were grid size and calculation model. Using the utility concept we determined the combination of each of the four factors tested in this study that most significantly influence quality of the resulting treatment plans: (a)-arc arrangement-set2, (b)-6MV, (c)-calc.grid 1mm, (d)-Acuros algorithm. Overall, the dominant significant influences on plan quality are (a)-arcarrangement, and (b)-beamenergy. Conclusion: Results were analyzed using ANOVA and were found to be within the confidence interval. Further investigation using this methodology. Such parameters might include: virtual OAR and optimization criterion such as normal tissue objective.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

TU-AB-BRA-12: Quality Assurance of An Integrated Magnetic Resonance Image Guided Adaptive Radiotherapy Machine Using Cherenkov Imaging

Purpose: To investigate the viability of using Cherenkov imaging as a fast and robust method for quality assurance tests in the presence of a magnetic field, where other instruments can be limited. Methods: Water tank measurements were acquired from a clinically utilized adaptive magnetic resonance image guided radiation therapy (MR-IGRT) machine with three multileaf-collimator equipped 60Co sources. Cherenkov imaging used an intensified charge coupled device (ICCD) camera placed 3.5m from the treatment isocenter, looking down the bore of the 0.35T MRI into a water tank. Images were post-processed to make quantitative comparison between Cherenkov light intensity with both film and treatment planning system predictions, in terms of percent depth dose curves as well as lateral beam profile measurements. A TG-119 commissioning test plan (C4: C-Shape) was imaged in real-time at 6.33 frames per second to investigate the temporal and spatial resolution of the Cherenkov imaging technique. Results: A .33mm/pixel Cherenkov image resolution was achieved across 1024×1024 pixels in this setup. Analysis of the Cherenkov image of a 10.5×10.5cm treatment beam in the water tank successfully measured the beam width at the depth of maximum dose within 1.2% of the film measurement at the same point. The percent depth dose curve for the same beam was on average within 2% of ionization chamber measurements for corresponding depths between 3–100mm. Cherenkov video of the TG-119 test plan provided qualitative agreement with the treatment planning system dose predictions, and a novel temporal verification of the treatment. Conclusions: Cherenkov imaging was successfully used to make QA measurements of percent depth dose curves and cross beam profiles of MRI-IGRT radiotherapy machines after only several seconds of beam-on time and data capture; both curves were extracted from the same data set. Video-rate imaging of a dynamic treatment plan provided new information regarding temporal dose deposition. This study has been funded by NIH grants R21EB17559 and R01CA109558, as well as Norris Cotton Cancer Center Pilot funding.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

TU-FG-201-04: Computer Vision in Autonomous Quality Assurance of Linear Accelerators

Purpose: Routine quality assurance (QA) of linear accelerators represents a critical and costly element of a radiation oncology center. Recently, a system was developed to autonomously perform routine quality assurance on linear accelerators. The purpose of this work is to extend this system and contribute computer vision techniques for obtaining quantitative measurements for a monthly multi-leaf collimator (MLC) QA test specified by TG-142, namely leaf position accuracy, and demonstrate extensibility for additional routines. Methods: Grayscale images of a picket fence delivery on a radioluminescent phosphor coated phantom are captured using a CMOS camera. Collected images are processed to correct for camera distortions, rotation and alignment, reduce noise, and enhance contrast. The location of each MLC leaf is determined through logistic fitting and a priori modeling based on knowledge of the delivered beams. Using the data collected and the criteria from TG-142, a decision is made on whether or not the leaf position accuracy of the MLC passes or fails. Results: The locations of all MLC leaf edges are found for three different picket fence images in a picket fence routine to 0.1mm/1pixel precision. The program to correct for image alignment and determination of leaf positions requires a runtime of 21– 25 seconds for a single picket, and 44 – 46 seconds for a group of three pickets on a standard workstation CPU, 2.2 GHz Intel Core i7. Conclusion: MLC leaf edges were successfully found using techniques in computer vision. With the addition of computer vision techniques to the previously described autonomous QA system, the system is able to quickly perform complete QA routines with minimal human contribution.

60 APPLIED LIFE SCIENCES↗