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At least 1,099 records · Page 61
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DOE OSTI2014

SU-E-T-451: Accuracy and Application of the Standard Imaging W1 Scintillator Dosimeter

Purpose: To evaluate the Standard Imaging W1 scintillator dosimeter in a range of clinical radiation beams to determine its range of possible applications. Methods: The W1 scintillator is a small perturbation-free dosimeter which is of interest in absolute and relative clinical dosimetry due to its small size and water equivalence. A single version of this detector was evaluated in Co-60 and linac photon and electron beams to investigate the following: linearity, sensitivity, precision, and dependence on electrometer type. In addition, depth-dose and cross-plane profiles were obtained in both photon and electron beams and compared with data obtained with wellbehaved ionization chambers. Results: In linac beams the precision and linearity was very impressive, with typical values of 0.3% and 0.1% respectively. Performance in a Co-60 beam was much poorer (approximately three times worse) and it is not clear whether this is due to the lower signal current or the effect of the continuous beam (rather than pulsed beam of the linac measurements). There was no significant difference in the detector reading when using either the recommended SI Supermax electrometer or two independent high-quality electrometers, except for low signal levels, where the Supermax exhibited an apparent threshold effect, preventing the measurement of the bremsstrahlung background in electron depth-dose curves. Comparisons with ion chamber measurements in linac beams were somewhat variable: good agreement was seen for cross-profiles (photon and electron beams) and electron beam depth-dose curves, generally within the 0.3% precision of the scintillator but systematic differences were observed as a function of measurement depth in photon beam depth-dose curves. Conclusion: A first look would suggest that the W1 scintillator has applications beyond small field dosimetry but performance appears to be limited to higher doserate and/or pulsed radiation beams. Further work is required to resolve discrepancies compared to ion chambers.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-475: An Accurate Linear Model of Tomotherapy MLC-Detector System for Patient Specific Delivery QA

Purpose: An accurate leaf fluence model can be used in applications such as patient specific delivery QA and in-vivo dosimetry for TomoTherapy systems. It is known that the total fluence is not a linear combination of individual leaf fluence due to leakage-transmission, tongue-and-groove, and source occlusion effect. Here we propose a method to model the nonlinear effects as linear terms thus making the MLC-detector system a linear system. Methods: A leaf pattern basis (LPB) consisting of no-leaf-open, single-leaf-open, double-leaf-open and triple-leaf-open patterns are chosen to represent linear and major nonlinear effects of leaf fluence as a linear system. An arbitrary leaf pattern can be expressed as (or decomposed to) a linear combination of the LPB either pulse by pulse or weighted by dwelling time. The exit detector responses to the LPB are obtained by processing returned detector signals resulting from the predefined leaf patterns for each jaw setting. Through forward transformation, detector signal can be predicted given a delivery plan. An equivalent leaf open time (LOT) sinogram containing output variation information can also be inversely calculated from the measured detector signals. Twelve patient plans were delivered in air. The equivalent LOT sinograms were compared with their planned sinograms. Results: The whole calibration process was done in 20 minutes. For two randomly generated leaf patterns, 98.5% of the active channels showed differences within 0.5% of the local maximum between the predicted and measured signals. Averaged over the twelve plans, 90% of LOT errors were within +/−10 ms. The LOT systematic error increases and shows an oscillating pattern when LOT is shorter than 50 ms. Conclusion: The LPB method models the MLC-detector response accurately, which improves patient specific delivery QA and in-vivo dosimetry for TomoTherapy systems. It is sensitive enough to detect systematic LOT errors as small as 10 ms.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-625: Use and Choice of Ionization Chambers for the Commissioning of Flattened and Flattening-Filter-Free Photon Beams: Determination of Recombination Correction Factor (ks)

Purpose: To evaluate the recombination effect for some ionization chambers to be used for linacs commissioning for Flattened Filter (FF) and Flattening Filter Free (FFF) photon beams. Methods: A Varian TrueBeam linac with five photon beams was used: 6, 10 and 15 MV FF and 6 and 10 MV FFF. Measurements were performed in a water tank and in a plastic water phantom with different chambers: a mini-ion chamber (IC CC01, IBA), a plane-parallel ion chamber (IC PPC05, IBA) and two Farmer chambers (NE2581 and FPC05-IBA). Measurement conditions were Source- Surface Distance of 100 cm, two field sizes (10x10 and 40x40 cm2) and five depths (1cm, maximum buildup, 5cm, 10cm and 20cm). The ion recombination factors (kS), obtained from the Jaffe's plots (voltage interval 50-400 V), were evaluated at the recommended operating voltage of +300V. Results: Dose Per Pulse (DPP) at dmax was 0.4 mGy/pulse for FF beams, 1.0 mGy/pulse and 1.9 mGy/pulse for 6MV and 10 MV FFF beams respectively. For all measurement conditions, kS ranged between 0.996 and 0.999 for IC PPC05, 0.997 and 1.008 for IC CC01. For the FPC05 IBA Farmer IC, kS varied from 1.001 to 1.011 for FF beams, from 1.004 to 1.015 for 6 MV FFF and from 1.009 to 1.025 for 10 MV FFF. Whereas, for NE2581 IC the values ranged from 1.002 to 1.009 for all energy beams and measurement conditions. Conclusion: kS depends on the chamber volume and the DPP, which in turn depends on energy beam but is independent of dose rate. Ion chambers with small active volume can be reliably used for dosimetry of FF and FFF beams even without kS correction. On the contrary, for absolute dosimetry of FFF beams by Farmer ICs it is necessary to evaluate and apply the kS correction. Partially supported by Lega Italiana Lotta contro i Tumori (LILT)

07 ISOTOPE AND RADIATION SOURCES↗
DOE OSTI2014

SU-E-T-626: Accuracy of Dose Calculation Algorithms in MultiPlan Treatment Planning System in Presence of Heterogeneities

Purpose: Advanced stereotactic radiotherapy (SRT) treatments require accurate dose calculation for treatment planning especially for treatment sites involving heterogeneous patient anatomy. The purpose of this study was to evaluate the accuracy of dose calculation algorithms, Raytracing and Monte Carlo (MC), implemented in the MultiPlan treatment planning system (TPS) in presence of heterogeneities. Methods: First, the LINAC of a CyberKnife radiotherapy facility was modeled with the PENELOPE MC code. A protocol for the measurement of dose distributions with EBT3 films was established and validated thanks to comparison between experimental dose distributions and calculated dose distributions obtained with MultiPlan Raytracing and MC algorithms as well as with the PENELOPE MC model for treatments planned with the homogenous Easycube phantom. Finally, bones and lungs inserts were used to set up a heterogeneous Easycube phantom. Treatment plans with the 10, 7.5 or the 5 mm field sizes were generated in Multiplan TPS with different tumor localizations (in the lung and at the lung/bone/soft tissue interface). Experimental dose distributions were compared to the PENELOPE MC and Multiplan calculations using the gamma index method. Results: Regarding the experiment in the homogenous phantom, 100% of the points passed for the 3%/3mm tolerance criteria. These criteria include the global error of the method (CT-scan resolution, EBT3 dosimetry, LINAC positionning …), and were used afterwards to estimate the accuracy of the MultiPlan algorithms in heterogeneous media. Comparison of the dose distributions obtained in the heterogeneous phantom is in progress. Conclusion: This work has led to the development of numerical and experimental dosimetric tools for small beam dosimetry. Raytracing and MC algorithms implemented in MultiPlan TPS were evaluated in heterogeneous media.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-631: Commissioning and Comprehensive Evaluation of the ArcCHECK Cylindrical Diode Array for VMAT QA

Purpose: Commissioning and comprehensive evaluation of ArcCHECK phantom for dosimetry of VMAT QA, using 6MV photon beam with and without the flattening filter. Methods: ArcCHECK was evaluated for response dependency on linac dose rate, instantaneous dose rate, radiation field size, beam angle and couch insertion. Scatter dose characterization, consistency and symmetry of response, dosimetric accuracy of fixed aperture arcs and clinical VMAT plans were investigated. Measurements were done using TrueBeam™ STx accelerator (Console version 1.6) with a 6 MV beam with and without flattening filter. Reference dose-grids were calculated using Eclipse TPS Analytical Anisotropic Algorithm (AAA version 10.0.39). Planned doses were calculated using symmetric 2mm 3D dose grids with 4 degree angular resolution defaulted to each control point. Gamma evaluations were performed in absolute dose mode, with default normalization to maximum dose in the curved plane and a low dose threshold of 10% to restrict the analysis to clinically relevant areas. Global and local gamma indices at 3mm/3% and 2mm/2% level were computed using SNC software (version 6.0). Results: Results of gamma analysis demonstrated an overall agreement between ArcCHECK measured and TPS calculated reference doses. Field size dependency was within 0.5% of the reference. Dose-rate based dependency was well within 1% of the TPS reference and the angular dependency was ±3% of the reference, as tested for BEV angles. At the level of 3%/3mm, narrow and wide open arcs as well as clinical VMAT cases demonstrated high level of dosimetry accuracy in global gamma passing rates for both 6X and 6F beams. At the level of 2%/2mm two VMAT cases involving the narrow heavily modulated arcs demonstrated lower passing rates. Conclusion: ArcCHECK phantom with latest software and hardware upgrades is suitable for VMAT QA. For higher sensitivity of 2%/2mm gamma analysis, we intend to use it as one of the VMAT QA evaluation metrics.

07 ISOTOPE AND RADIATION SOURCES↗
DOE OSTI2014

SU-F-19A-02: Comparison of Absorbed Dose to Water Standards for HDR Ir-192 Brachytherapy Between the LCR, Brazil and NRC, Canada

Purpose: To compare absorbed dose to water standards for HDR brachytherapy dosimetry developed by the Radiological Science Laboratory of Rio de Janeiro State University (LCR) and the National Research Council, Canada (NRC). Methods: The two institutions have separately developed absorbed dose standards based on the Fricke dosimetry system. There are important differences between the two standards, including: preparation and read-out of the Fricke solution, irradiation geometry of the Fricke holder in relation to the Ir-192 source, and determination of the G-value to be used at Ir-192 energies. All measurements for both standards were made directly at the NRC laboratory (i.e., no transfer instrument was used) using a single Ir-192 source (microSelectron v2). In addition, the NRC group has established a self-consistent method to determine the G-value for Ir-192, based on an interpolation between G-values obtained at Co-60 and 250kVp X-rays, and this measurement was repeated using the LCR Fricke solution to investigate possible systematic uncertainties. Results: G-values for Co-60 and 250 kVp x-rays, obtained using the LCR Fricke system, agreed with the NRC values within 0.5 % and 1 % respectively, indicating that the general assumption of universal G-values is appropriate in this case. The standard uncertainty in the determination of G for Ir-192 is estimated to be 0.6 %. For the comparison of absorbed dose measurements at the reference point for Ir-192 (1 cm depth in water, perpendicular to the seed long-axis), the ratio Dw(NRC)/Dw(LCR) was found to be 1.011 with a combined standard uncertainty of 1.7 %, k=1. Conclusion: The agreement in the absorbed dose to water values for the LCR and NRC systems is very encouraging. Combined with the lower uncertainty in this approach compared to the present air-kerma approach, these results reaffirm the use of Fricke solution as a potential primary standard for HDR Ir-192 brachytherapy.

07 ISOTOPE AND RADIATION SOURCES↗
DOE OSTI2014

SU-F-BRE-12: Optical Resonator Water Calorimeter

Purpose: Water calorimetry based on resistance thermometry has matured as a primary standard. Developing an optical technique hold the promise to push the boundaries of what is currently achievable with dosimetry. We will present a feasibility study and the current progress of construction of a Fabry-Perot resonator for dose to water measurement. Additionally, estimations of the theoretical limits resonator sensitivity and potential sources of noise for the system are described. Methods: A temperature change from the dose to water would be measured by the change in the index of refraction from the water in the cavity. Calculations are presented of the expected signal from the resonator for dose to water. The Fabry-Perot resonator constructed from optical quality narrowband mirrors is described. A water cell will be inserted into the cavity gap to provide the medium swept cavity length technique is explored as a specific implementation of this technique. Results: Calculations indicate that a dose to water on the order of a Gray is measureable with a reasonably implementable system. A resonator is currently under construction and progress towards a proof of principle measurement will be presented. The primary sources of noise, in order of importance, are expected to be; optical absorption by the medium, mechanical perturbations of the cavity length and thermal expansion of the optical mounts. Estimations of these noise sources and mitigation techniques will be discussed. Conclusion: A Fabry-Perot resonator is a promising technique for measuring the absorbed dose to water from a radiotherapy beam. This technique has the potential to serve as a check on the current primary standard for dose to water measurements. As well, i0074 may be the foundation for a new class of optical property based dosimetry measurement.

07 ISOTOPE AND RADIATION SOURCES↗
DOE OSTI2014

MO-E-17A-12: Direct Realization of the CT Dose to Phantom: Energy to Heat Conversion in Polyethylene Using Calorimetry

Purpose: To develop a primary reference standard for absorbed dose to phantom for medical CT dosimetry. CT dosimetry relies on the implementation of the CTDI standard based on air kerma. We are taking a step toward an absorbed dose to water standard by first investigating the dose in a solid phantom. By directly measuring the heat converted from the incident radiation, the absorbed dose in the phantom at a point can be assessed with primary methods without relying on indirect conversions. Methods: The calorimeter contains two small thermistors embedded in a removable PE “core” inserted into the cylindrical HDPE phantom. A core made with polystyrene (PS) was also tested because of its purportedly negligible heat defect. Measurements were made using the two cores and with a calibrated ionization chamber in a CT beam. The air chamber values were converted to the dose to medium using appropriate stopping-power ratios from the literature, and then compared to the thermal data. Results: The PS core data yielded a dose of 1.3 times (4-run average, 3% std. dev.) higher than the converted chamber value, whereas the PE core data were inexplicably higher. The possible systematic errors include 1) excess heat from the thermistors, 2) in PE the exothermic chemical reactions, 3) uncertainties of the specific heat capacities of the materials, 4) thermal drift, and 5) theoretical conversion of chamber values. Monte Carlo simulations and finite element heat transfer calculations were performed to address some of these issues. The general validity was assessed in a 6 MV photon beam with an entirely different calibration scheme. Conclusion: This study demonstrates the feasibility but also revealed the difficulty in developing a new primary reference standard for absorbed dose to material for CT. Additional experimental and theoretical work is planned to achieve our goal.

07 ISOTOPE AND RADIATION SOURCES↗
DOE OSTI2014

WE-G-17A-06: A Water Calorimeter for Use in MRI Linacs

Purpose: At VSL, Dutch Metrology Institute, a new water calorimeter was developed with the purpose to replace the existing primary standard for absorbed dose to water in the Netherlands. The new water calorimeter is designed to be operable in medium- to high energy photon beams, electrons, protons as well as MRI integrated linear accelerators. VSL has operated a water calorimeter since 2001. This calorimeter formed the basis for the NCS-18 dosimetry protocol, which is commonly applied by medical physicists in the Netherlands and Belgium. Methods: The unit Gray is the unit of interest for measurement of the absorbed dose to water. Water calorimetry involves the measurement of a small temperature rise (0.24 mK/Gy) with an uncertainty of less than 1 μK/Gy at a temperature of 4 °C. Using extensive multi-physics simulations the new calorimeter's thermal performance was simulated before it was constructed at the end of 2013. With the advent of radiotherapy treatment units incorporating MR imaging the performance of the thermistor temperature sensors were characterized in a 1.5 T magnetic field. Results: A change of thermistor resistance was observed of less than 0.004% as a Result of the magneto-resistance effect in a 1.5 T magnetic field. Although a magneto-resistance effect was detectable, the effect on the temperature response in the water calorimeter was found to be negligible. Conclusion: With the realization of the new calorimeter operable in MRI linacs and designed for use in a variety of beam modalities, VSL is ready for accurate dosimetry in new advanced radiotherapy modalities. Due to the small form factor the calorimeter can be used on location in the actual therapy beam inside a 68 cm linac bore. This work was supported by EMRP grant HLT06. The EMRP is jointly funded by the EMRP participating countries within EURAMET and the European Union.

07 ISOTOPE AND RADIATION SOURCES↗
DOE OSTI2014

TH-C-12A-07: Implementation of a Pulsed Low Dose Date Radiotherapy (PLRT) Protocol for Recurrent Cancers Using Advanced Beam Delivery

Purpose: Recent in vitro and in vivo experimental findings provided strong evidence that pulsed low-dose-rate radiotherapy (PLDR) produced equivalent tumor control as conventional radiotherapy with significantly reduced normal tissue toxicities. This work aimed to implement a PLDR clinical protocol for the management of recurrent cancers utilizing IMRT and VMAT. Methods: Our PLDR protocol requires that the daily 2Gy dose be delivered in 0.2Gy×10 pulses with a 3min interval between the pulses. To take advantage of low-dose hyper-radiosensitivity the mean dose to the target is set at 0.2Gy and the maximum dose is limited to 0.4Gy per pulse. Practical planning strategies were developed for IMRT and VMAT: (1) set 10 ports for IMRT and 10 arcs for VMAT with each angle/arc as a pulse; (2) set the mean dose (0.2Gy) and maximum dose (0.4Gy) to the target per pulse as hard constraints (no constraints to OARs); (3) select optimal port/arc angles to avoid OARs; and (4) use reference structures in or around target/OARs to reduce maximum dose to the target/OARs. IMRT, VMAT and 3DCRT plans were generated for 60 H and N, breast, lung, pancreas and prostate patients and compared. Results: All PLDR treatment plans using IMRT and VMAT met the dosimetry requirements of the PLDR protocol (mean target dose: 0.20Gy±0.01Gy; maximum target dose < 0.4Gy). In comparison with 3DCRT, IMRT and VMAT exhibited improved target dose conformity and OAR dose sparing. A single arc can minimize the difference in the target dose due to multi-angle incidence although the delivery time is longer than 3DCRT and IMRT. Conclusion: IMRT and VMAT are better modalities for PLDR treatment of recurrent cancers with superior target dose conformity and critical structure sparing. The planning strategies/guidelines developed in this work are practical for IMRT/VMAT treatment planning to meet the dosimetry requirements of the PLDR protocol.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

TH-E-BRE-05: Analysis of Dosimetric Characteristics in Two Leaf Motion Calculator Algorithms for Sliding Window IMRT

Purpose: The Smart leaf motion calculator (SLMC) in Eclipse treatment planning system is an advanced fluence delivery modeling algorithm as it takes into account fine MLC features including inter-leaf leakage, rounded leaf tips, non-uniform leaf thickness, and the spindle cavity etc. In this study, SLMC and traditional Varian LMC (VLMC) algorithms were investigated, for the first time, in dosimetric characteristics and delivery accuracy of sliding window (SW) IMRT. Methods: The SW IMRT plans of 51 cancer cases were included to evaluate dosimetric characteristics and dose delivery accuracy from leaf motion calculated by SLMC and VLMC, respectively. All plans were delivered using a Varian TrueBeam Linac. The DVH and MUs of the plans were analyzed. Three patient specific QA tools - independent dose calculation software IMSure, Delta4 phantom, and EPID portal dosimetry were also used to measure the delivered dose distribution. Results: Significant differences in the MUs were observed between the two LMCs (p≤0.001).Gamma analysis shows an excellent agreement between the planned dose distribution calculated by both LMC algorithms and delivered dose distribution measured by three QA tools in all plans at 3%/3 mm, leading to a mean pass rate exceeding 97%. The mean fraction of pixels with gamma < 1 of SLMC is slightly lower than that of VLMC in the IMSure and Delta4 results, but higher in portal dosimetry (the highest spatial resolution), especially in complex cases such as nasopharynx. Conclusion: The study suggests that the two LMCs generates the similar target coverage and sparing patterns of critical structures. However, SLMC is modestly more accurate than VLMC in modeling advanced MLC features, which may lead to a more accurate dose delivery in SW IMRT. Current clinical QA tools might not be specific enough to differentiate the dosimetric discrepancies at the millimeter level calculated by these two LMC algorithms. NIH/NIGMS grant U54 GM104944, Lincy Endowed Assistant Professorship.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

Poster — Thur Eve — 77: Implanted Brachythearpy Seed Movement due to Transrectal Ultrasound Probe-Induced Prostate Deformation

The study investigated the movement of implanted brachytherapy seeds upon transrectal US probe removal, providing insight into the underlying prostate deformation and an estimate of the impact on prostate dosimetry. Implanted seed distributions, one obtained with the prostate under probe compression and another with the probe removed, were reconstructed using C-arm fluoroscopy imaging. The prostate, delineated on ultrasound images, was registered to the fluoroscopy images using seeds and needle tracks identified on ultrasound. A deformation tensor and shearing model was developed to correlate probe-induced seed movement with position. Changes in prostate TG-43 dosimetry were calculated. The model was used to infer the underlying prostate deformation and to estimate the location of the prostate surface in the absence of probe compression. Seed movement patterns upon probe removal reflected elastic decompression, lateral shearing, and rectal bending. Elastic decompression was characterized by expansion in the anterior-posterior direction and contraction in the superior-inferior and lateral directions. Lateral shearing resulted in large anterior movement for extra-prostatic seeds in the lateral peripheral region. Whole prostate D90 increased up to 8 Gy, mainly due to the small but systematic seed movement associated with elastic decompression. For selected patients, lateral shearing movement increased prostate D90 by 4 Gy, due to increased dose coverage in the anterior-lateral region at the expense of the posterior-lateral region. The effect of shearing movement on whole prostate D90 was small compared to elastic decompression due to the subset of peripheral seeds involved, but is expected to have greater consequences for local dose coverage.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

Ultraviolet radiation therapy and UVR dose models

Ultraviolet radiation (UVR) has been an effective treatment for a number of chronic skin disorders, and its ability to alleviate these conditions has been well documented. Although nonionizing, exposure to ultraviolet (UV) radiation is still damaging to deoxyribonucleic acid integrity, and has a number of unpleasant side effects ranging from erythema (sunburn) to carcinogenesis. As the conditions treated with this therapy tend to be chronic, exposures are repeated and can be high, increasing the lifetime probability of an adverse event or mutagenic effect. Despite the potential detrimental effects, quantitative ultraviolet dosimetry for phototherapy is an underdeveloped area and better dosimetry would allow clinicians to maximize biological effect whilst minimizing the repercussions of overexposure. This review gives a history and insight into the current state of UVR phototherapy, including an overview of biological effects of UVR, a discussion of UVR production, illness treated by this modality, cabin design and the clinical implementation of phototherapy, as well as clinical dose estimation techniques. Several dose models for ultraviolet phototherapy are also examined, and the need for an accurate computational dose estimation method in ultraviolet phototherapy is discussed.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

Clinical evaluation of the iterative metal artifact reduction algorithm for CT simulation in radiotherapy

Purpose: To clinically evaluate an iterative metal artifact reduction (IMAR) algorithm prototype in the radiation oncology clinic setting by testing for accuracy in CT number retrieval, relative dosimetric changes in regions affected by artifacts, and improvements in anatomical and shape conspicuity of corrected images. Methods: A phantom with known material inserts was scanned in the presence/absence of metal with different configurations of placement and sizes. The relative change in CT numbers from the reference data (CT with no metal) was analyzed. The CT studies were also used for dosimetric tests where dose distributions from both photon and proton beams were calculated. Dose differences and gamma analysis were calculated to quantify the relative changes between doses calculated on the different CT studies. Data from eight patients (all different treatment sites) were also used to quantify the differences between dose distributions before and after correction with IMAR, with no reference standard. A ranking experiment was also conducted to analyze the relative confidence of physicians delineating anatomy in the near vicinity of the metal implants. Results: IMAR corrected images proved to accurately retrieve CT numbers in the phantom study, independent of metal insert configuration, size of the metal, and acquisition energy. For plastic water, the mean difference between corrected images and reference images was −1.3 HU across all scenarios (N = 37) with a 90% confidence interval of [−2.4, −0.2] HU. While deviations were relatively higher in images with more metal content, IMAR was able to effectively correct the CT numbers independent of the quantity of metal. Residual errors in the CT numbers as well as some induced by the correction algorithm were found in the IMAR corrected images. However, the dose distributions calculated on IMAR corrected images were closer to the reference data in phantom studies. Relative spatial difference in the dose distributions in the regions affected by the metal artifacts was also observed in patient data. However, in absence of a reference ground truth (CT set without metal inserts), these differences should not be interpreted as improvement/deterioration of the accuracy of calculated dose. With limited data presented, it was observed that proton dosimetry was affected more than photons as expected. Physicians were significantly more confident contouring anatomy in the regions affected by artifacts. While site specific preferences were detected, all indicated that they would consistently use IMAR corrected images. Conclusions: IMAR correction algorithm could be readily implemented in an existing clinical workflow upon commercial release. While residual errors still exist in IMAR corrected images, these images present with better overall conspicuity of the patient/phantom geometry and offer more accurate CT numbers for improved local dosimetry. The variety of different scenarios included herein attest to the utility of the evaluated IMAR for a wide range of radiotherapy clinical scenarios.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

A generic high-dose rate {sup 192}Ir brachytherapy source for evaluation of model-based dose calculations beyond the TG-43 formalism

Purpose: In order to facilitate a smooth transition for brachytherapy dose calculations from the American Association of Physicists in Medicine (AAPM) Task Group No. 43 (TG-43) formalism to model-based dose calculation algorithms (MBDCAs), treatment planning systems (TPSs) using a MBDCA require a set of well-defined test case plans characterized by Monte Carlo (MC) methods. This also permits direct dose comparison to TG-43 reference data. Such test case plans should be made available for use in the software commissioning process performed by clinical end users. To this end, a hypothetical, generic high-dose rate (HDR) {sup 192}Ir source and a virtual water phantom were designed, which can be imported into a TPS. Methods: A hypothetical, generic HDR {sup 192}Ir source was designed based on commercially available sources as well as a virtual, cubic water phantom that can be imported into any TPS in DICOM format. The dose distribution of the generic {sup 192}Ir source when placed at the center of the cubic phantom, and away from the center under altered scatter conditions, was evaluated using two commercial MBDCAs [Oncentra{sup ®} Brachy with advanced collapsed-cone engine (ACE) and BrachyVision ACUROS{sup TM}]. Dose comparisons were performed using state-of-the-art MC codes for radiation transport, including ALGEBRA, BrachyDose, GEANT4, MCNP5, MCNP6, and PENELOPE2008. The methodologies adhered to recommendations in the AAPM TG-229 report on high-energy brachytherapy source dosimetry. TG-43 dosimetry parameters, an along-away dose-rate table, and primary and scatter separated (PSS) data were obtained. The virtual water phantom of (201){sup 3} voxels (1 mm sides) was used to evaluate the calculated dose distributions. Two test case plans involving a single position of the generic HDR {sup 192}Ir source in this phantom were prepared: (i) source centered in the phantom and (ii) source displaced 7 cm laterally from the center. Datasets were independently produced by different investigators. MC results were then compared against dose calculated using TG-43 and MBDCA methods. Results: TG-43 and PSS datasets were generated for the generic source, the PSS data for use with the ACE algorithm. The dose-rate constant values obtained from seven MC simulations, performed independently using different codes, were in excellent agreement, yielding an average of 1.1109 ± 0.0004 cGy/(h U) (k = 1, Type A uncertainty). MC calculated dose-rate distributions for the two plans were also found to be in excellent agreement, with differences within type A uncertainties. Differences between commercial MBDCA and MC results were test, position, and calculation parameter dependent. On average, however, these differences were within 1% for ACUROS and 2% for ACE at clinically relevant distances. Conclusions: A hypothetical, generic HDR {sup 192}Ir source was designed and implemented in two commercially available TPSs employing different MBDCAs. Reference dose distributions for this source were benchmarked and used for the evaluation of MBDCA calculations employing a virtual, cubic water phantom in the form of a CT DICOM image series. The implementation of a generic source of identical design in all TPSs using MBDCAs is an important step toward supporting univocal commissioning procedures and direct comparisons between TPSs.

07 ISOTOPE AND RADIATION SOURCES↗
DOE OSTI2015

Development of an accurate EPID-based output measurement and dosimetric verification tool for electron beam therapy

Purpose: To develop an efficient and robust tool for output measurement and absolute dose verification of electron beam therapy by using a high spatial-resolution and high frame-rate amorphous silicon flat panel electronic portal imaging device (EPID). Methods: The dosimetric characteristics of the EPID, including saturation, linearity, and ghosting effect, were first investigated on a Varian Clinac 21EX accelerator. The response kernels of the individual pixels of the EPID to all available electron energies (6, 9, 12, 16, and 20 MeV) were calculated by using Monte Carlo (MC) simulations, which formed the basis to deconvolve an EPID raw images to the incident electron fluence map. The two-dimensional (2D) dose distribution at reference depths in water was obtained by using the constructed fluence map with a MC simulated pencil beam kernel with consideration of the geometric and structural information of the EPID. Output factor measurements were carried out with the EPID at a nominal source–surface distance of 100 cm for 2 × 2, 3 × 3, 6 × 6, 10 × 10, and 15 × 15 cm{sup 2} fields for all available electron energies, and the results were compared with that measured in a solid water phantom using film and a Farmer-type ion chamber. The dose distributions at a reference depth specific to each energy and the flatness and symmetry of the 10 × 10 cm{sup 2} electron beam were also measured using EPID, and the results were compared with ion chamber array and water scan measurements. Finally, three patient cases with various field sizes and irregular cutout shapes were also investigated. Results: EPID-measured dose changed linearly with the monitor units and showed little ghosting effect for dose rate up to 600 MU/min. The flatness and symmetry measured with the EPID were found to be consistent with ion chamber array and water scan measurements. The EPID-measured output factors for standard square fields of 2 × 2, 3 × 3, 6 × 6, 10 × 10, 15 × 15 cm{sup 2} agreed with film and ion chamber measurements. The average discrepancy between EPID and ion chamber/film measurements was 0.81% ± 0.60% (SD) and 1.34% ± 0.75%, respectively. For the three clinical cases, the difference in output between the EPID- and ion chamber array measured values was found to be 1.13% ± 0.11%, 0.54% ± 0.10%, and 0.74% ± 0.11%, respectively. Furthermore, the γ-index analysis showed an excellent agreement between the EPID- and ion chamber array measured dose distributions: 100% of the pixels passed the criteria of 3%/3 mm. When the γ-index was set to be 2%/2 mm, the pass rate was found to be 99.0% ± 0.07%, 98.2% ± 0.14%, and 100% for the three cases. Conclusions: The EPID dosimetry system developed in this work provides an accurate and reliable tool for routine output measurement and dosimetric verification of electron beam therapy. Coupled with its portability and ease of use, the proposed system promises to replace the current film-based approach for fast and reliable assessment of small and irregular electron field dosimetry.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-P-46: Clinical Acceptance Testing and Implementation of a Portable CT Unit

Purpose: Planning for the first installation in New England of a new portable CT unit to be used in the Operating Room required the integration of many departments including Surgery, Neurosurgery, Information Services, Clinical Engineering, Radiology and Medical Physics/Radiation Safety. Acceptance testing and the quality assurance procedures were designed to optimize image quality and patient and personnel radiation exposure. Methods: The vendor’s protocols were tested using the CT Dosimetry phantoms. The system displayed the CTDIw instead of the CTDIvol while testing the unit. Radiation exposure was compared to existing CT scanners from installed CT units throughout the facility. Brainlab measures all 4 periphery slots on the CT Dosimetry phantom. The ACR measures only the superior slot for the periphery measurement. A comprehensive radiation survey was also performed for several locations. Results: The CTDIvol measurements were comparable for the following studies: brain, C-Spine, and sinuses. However, the mobile CT measurements were slightly higher than other CT units but within acceptable tolerance if measured using the ACR method.Based on scatter measurements, it was determined if any personnel were to stay in the OR Suite during image acquisition that the appropriate lead apron and thyroid shields had to be worn.In addition, to reduce unnecessary scatter, there were two mobile 6 foot wide shields (1/16″ lead equivalent) available to protect personnel in the room and adjacent areas. Conclusion: Intraoperative CT provides the physician new opportunities for evaluation of the progression of surgical resections and device placement at the cost of increasing the amount of trained personnel required to perform this procedure. It also brings with it challenges to keep the radiation exposure to the patients and staff within reasonable limits.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-J-202: Performance of the Patient QA Systems in a Hybrid MRI-Linac

Purpose: The first clinical MR-linac will soon become operational, therefore patient plan QA procedures and equipment have to become MRcompatible. Reference dosimetry is affected by the magnetic field, however, relative dosimetry using patient QA systems haven’t been investigated extensively. The purpose of this study was to examine the performance characteristics of the MR-compatible ArcCHECK and Delta4 systems in a transverse 1.5 T magnetic field. Methods: Recently MR-compatible versions of both ArcCheck (Sun Nuclear) and Delta4 (Scandidos) have been developed. To examine the performance characteristics within the magnetic field, the reproducibility, dose linearity, dose rate dependence, field size and angular dependence were evaluated on the MR-linac (8 MV FFF beam, SAD of 142 cm) and a conventional linac (Elekta, 6MV). To allow comparison of the measurements with and without magnetic field, the measurement setup for the conventional linac is adapted to mimic the setup at the MR-linac if possible (e.g. SAD, dose rate). The results from the MR-linac were benchmarked to the results from the conventional linac as being the clinical reference. Results: At the moment of writing, measurements for the Delta4 are still running. Therefore, only the results of the ArcCheck are presented in this abstract. No significant difference was observed in the reproducibility of the ArcCheck (<0.06%) between both linacs. The maximum dose response difference when measuring the dose linearity was less than 0.4% and the varying dose rate resulted in maximal dose differences of 1.0% for both linacs. Response variation for varying field sizes was <2.6% at the conventional linac, and <1.0% at the MR-linac. Angular response was similar for both linacs. Conclusion: The reproducibility, dose linearity, dose rate dependence, field size and angular dependence of the MR compatible ArcCheck were not influenced by the presence of a transverse 1.5 T magnetic field. The results for the Delta4 are about to follow. Equipment is generously provided by Sun Nuclear Corporation (Melbourne, USA) and Scandidos (Uppsala, Sweden)

60 APPLIED LIFE SCIENCES↗