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At least 1,117 records · Page 62
All sourcesNASA NTRSDOE OSTI
DOE OSTI2014

CBCT with specification of imaging dose and CNR by anatomical volume of interest

Purpose: A novel method has been developed for volume of interest (VOI) cone-beam CT (CBCT) imaging using a 2.35 MV/Carbon target linac imaging beam line combined with dynamic multileaf collimator sequences. Methods: The authors demonstrate the concept of acquisition of multiple, separate imaging volumes, where volumes can be either completely separated or nested, and are associated with predetermined imaging dose and contrast-to-noise ratio (CNR) characteristics. Two individual MLC sequences were established in the planning system (Eclipse, Varian Medical) to collimate the beam according to a defined inner VOI (e.g., containing a target volume under image guidance) and an outer VOI (e.g., including surrounding landmarks or organs-at-risk). MLC sequences were interleaved as a function of gantry angle to produce a reconstructed CBCT image with nested VOIs. By controlling the ratio of inner-to-outer ratio of MLC segments (and thus Monitor Units) during acquisition, the relative dose and CNR in the two volumes can be controlled. Inner-to-outer ratios of 2:1 to 6:1 were examined. Results: The concept was explored using an anatomical head phantom to assess image quality. A geometric phantom was used to quantify absolute dose and CNR values for the various sequences. The authors found that the dose in the outer VOI decreased by a functional relationship dependent on the inner-to-outer sequence ratio, while the CNR varied by the square root of dose, as expected. Conclusions: In this study the authors demonstrate flexibility in VOI CBCT by tailoring the imaging dose and CNR distribution in separate volumes within the patient anatomy. This would allow for high quality imaging of a target volume for alignment purposes, with simultaneous low dose imaging of the surrounding anatomy (e.g., for coregistration)

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2014

SU-E-J-44: Design a Platform and Phantom Model for Photoacoustic Imaging in Combination with CT

Purpose: Our (long-term) objective is to develop a US manipulator that will provide in situ radiation response and image-guided therapy for bladder cancer based on photoacoustic molecular imaging. Methods: A platform was devised to provide a reproducible positional frame of reference for targeting anatomic structure between MDCT and US scans, in lieu of CBCT, and to fuse photoacoustic molecular imaging. US and photoacoustic scans are taken of a patient while in the CT scanner and IRMT. Through co-registration, based on anatomical positions, we identified a common coordinate system to be used in Eclipse. A bladder phantom was constructed to validate anatomical tracking via US and photoacoustic imaging. We tested the platform using phantom model to demonstrate validity once moved from the CT couch to the linear accelerator couch. Results: This platform interlocks with Varian exact couch index points for reproducibility of positioning. Construction from low Z material and sized appropriately to fit in CT/IMRT gantry. Error in conversion from cylindrical coordinates of the manipulator to X, Y, Z coordinates of the treatment couch was less than 1mm. We measured the bladder size in 3 different directions in both Eclipse from the CT and Acuson from US. The error was less than 2mm in all directions. CT and US images were co-registered in MATLAB. Co-registration of photoacoustic images is still being developed. Conclusion: For Linear Accelerators without on board imaging, MV portal images are not a viable option for the localization of soft tissue anatomy. We believe our manipulator provides an alternative using US imaging, which will be examined in an upcoming clinical trial. We plan to examine the value of hypoxia guided treatment through photoacoustic imaging during this trial.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-J-64: Evaluation of a Commercial EPID-Based in Vivo Dosimetric System in the Presence of Lung Tissue Heterogeneity

Purpose: To study the performance of Dosimetry Check (DC), an EPID-based dosimetry software, which allows performing transit dosimetry, in low density medium, by comparing calculations in-phantom, and analysing results for 15 lung patients. Methods: DC software (v.3.8, pencil beam-based algorithm) has been tested, for plans (Eclipse v.10.0 TPS) delivered in two Varian Clinac iX equipped with aS1000 EPIDs.In the CIRS lung phantom, comparisons between DC and Eclipse (Acuros) were performed for several plans: (1) four field box; (2) square field delivered in arc mode; (3) RapidArc lung patient plan medially centred; (4) RapidArc lung patient plan centred in one lung. Reference points analysed: P1 (medial point, plans 1–3) and P2 (located inside one lung, plan 4).For fifteen lung patients treated with RapidArc, the isocentre and 9 additional points inside the PTV as well as the gamma passing rate (3%/3mm) for the PTV and at the main planes were studied. Results: In-phantom:P1: Per-field differences in plan 1: good agreement for AP-PA fields; discrepancy of 7% for the lateral fields. Global differences (plans 1–3): about 4%, showing a compensating effect of the individual differences.P2: Global difference (plan 4): 15 %. This represents the worst case situation as it is a point surrounded by lung tissue, where the DC pencil beam algorithm is expected to give the greater difference against Acuros.Lung patients: Mean point difference inside the PTV:(5.4±4.2) %. Gamma passing rate inside the PTV:(45±12) %. Conclusion: The performance of DC in heterogeneous lung medium was studied with a special phantom and the results for 15 patients were analysed. The found deviations show that even though DC is a highly promising in vivo dosimetry tool, there is a need of incorporating a more accurate algorithm mainly for plans with low density regions involved.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-J-164: An Investigation of a Low-Cost ‘dry’ Optical-CT Scanning System for 3D Dosimetry

Purpose: To characterize and explore the efficacy of a novel low-cost, lowfluid, broad-beam optical-CT system for 3D-dosimetry in radiochromic Presage dosimeters. Leading current optical-CT systems incorporate expensive glass-based telecentric lens technology, and a fluid bath with substantial amounts of fluid (which introduces an inconvenience factor) to minimize refraction artifacts. Here we introduce a novel system which addresses both these limitations by: (1) the use of Fresnel lenses in a telecentric arrangement, and (2) a ‘solid’ fluid bath which dramatically reduces the amount of fluid required for refractive-index (RI) matching. Materials Methods: A fresnel based telecentric optical-CT system was constructed which expands light from a single red LED source into a nominally parallel beam into which a cubic ‘dry-tank’ is placed. The drytank consists of a solid polyurethane cube (with the same RI as Presage) but containing a cylindrical cavity (11.5cm diameter × 11cm ) into which the dosimeter is placed for imaging. A narrow (1-3mm) gap between the walls of the dosimeter and dry-tank is filled with a fluid of similar RI. This arrangement reduces the amount of RI fluid from about 1000cc to 75cc, yielding substantial practical benefit in convenience and cost. The new system was evaluated in direct comparison against Eclipse planning system from a 4-field parallel-opposed treatmen Results: Gamma calculations of dose from DFOS-dry system versus Eclipse showed 92% and 97% agreement with 4mm/4% and 5mm/5% criteria, respectively, in the central 80% of dose distribution. Reconstructions showed some edge artifacts, as well as some dose underestimation towards the dosimeter edge. Conclusion: The implementation of Fresnel based ‘dry’ optical-CT for 3Ddosimetry would represent an important advance enhancing costeffectiveness and practical viability. The performance of the prototype presented here is not yet comparable to the state-of-the-art, but shows sufficient promise for further investigation to elevate image quality to match gold-standard optical-CT systems. This work was supported by NIH R01CA100835.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2014

SU-E-T-80: Comparison of Fluence-Based RapidArc QAs Using EPID and MapCHECK 2

Purpose: To compare the Varian aS-1000 EPID imager to the isocentrically mounted MapCHECK 2 diode array for RapidArc QAs as a function of photon beam energy. Methods: A Varian TrueBeam STx with an aS-1000 digital imaging panel was used to acquire RapidArc QA images for 13 patient plans; each plan QA was performed at 6, 8, 10 and 15MV energies. The Portal Dose Image Prediction algorithm in the Varian Eclipse treatment planning system (TPS) was used to create the comparison image for the EPID acquisition. A Sun Nuclear MapCHECK 2 diode array on an isocentric mounting fixture with 5 cm water-equivalent buildup was also used for the RapidArc QAs. A composite dose plane was taken from the Eclipse TPS for comparison to the MapCHECK 2 measurements. A gamma test was implemented in the Sun Nuclear Patient software with 10% threshold and absolute comparison for both QA methods. The two-tailed paired t-test was employed to analyze the statistical significance between two methods at the 95% confidence level. Results: The average gamma passing rates were greater than 95% at 3%/3mm using both methods for all four energies. The average passing rates were within 2.5% and 1.1% of each other when analyzed at 2%/2mm and 3%/3mm conditions, respectively. The EPID passing rates were somewhat better than the MapCHECK 2 when analyzed at 1%/1mm condition; this difference decreased with increasing energy (9.1% at 6MV to 2.7% at 15MV). The differences were not statistically significant for all criteria and energies (p-value ã 0.05). Conclusion: EPID-based RapidArc QA results are comparable to MapCHECK 2 when using 3%/3mm criteria at all four energies. EPID-based QA shows potential for being the superior device under strict gamma criteria.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-93: Creation of Standardized APBI SAVI Cavities Using CT Registration

Purpose: Develop a consistent and rapid method of generating the initial cavity structure for Accelerated Partial Breast Irradiation (APBI) using the SAVI applicator. Methods: Four SAVI (Cianna Medical) applicators (6-1 Mini, 6-1, 8-1, and 10-1) were scanned on a CT simulator. The applicators were scanned in air with the CT slices (0.625mm axial thickness) perpendicular to the long axis of the applicator. Following scanning the CT images were transferred to Eclipse (Varian Medical Systems) and contours of the cavity were drawn. The cavity proximal and distal locations were defined according to MD specification. The scans and contours were then re-imported into the CT virtual simulation workstation.At the time of patient planning the appropriate applicator scan is anonymized and imported into Eclipse. In Brachytherapy Planning two Marker points are placed, one at the distal band location (cavity start) and the second at a defined distance along the applicator (cavity end). The actual patient scan is then registered to the applicator scan. A three point match is used to quickly get the two scans in approximate alignment. Manually matching is then used to fine tune the alignment of the cavity contour and Marker points. Results: The standard applicator scans have shown to agree well with the applicators in the patient scans. The time taken to register the scans has shown to be less than generating the cavities using the standard methods of contouring on the axial slices or using the dose shaper with sources in the central channel. Conclusion: The registration of a standard applicator scan and contour has improved the consistency in the generation of the initial cavity (SAVI) structure. Planning structures used for dose calculation are created with that structure as a starting point so accuracy and consistency are important for dose evaluation and plan comparison.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-159: Evaluation of a Patient Specific QA Tool Based On TG119

Purpose: To evaluate the accuracy of a 3D patient specific QA tool by analysis of the results produced from associated software in homogenous phantom and heterogonous patient CT. Methods: IMRT and VMAT plans of five test suites introduced by TG119 were created in ECLIPSE on a solid water phantom. The ten plans -of increasing complexity- were delivered to Delta4 to give a 3D measurement. The Delta4's “Anatomy” software uses the measured dose to back-calculate the energy fluence of the delivered beams, which is used for dose calculation in a patient CT using a pencilbeam algorithm. The effect of the modulated beams' complexity on the accuracy of the “Anatomy” calculation was evaluated. Both measured and Anatomy doses were compared to ECLIPSE calculation using 3% - 3mm gamma criteria.We also tested the effect of heterogeneity by analyzing the results of “Anatomy” calculation on a Brain VMAT and a 3D conformal lung cases. Results: In homogenous phantom, the gamma passing rates were found to be as low as 74.75% for a complex plan with high modulation. The mean passing rates were 91.47% ± 6.35% for “Anatomy” calculation and 99.46% ± 0.62% for Delta4 measurements.As for the heterogeneous cases, the rates were 96.54%±3.67% and 83.87%±9.42% for Brain VMAT and 3D lung respectively. This increased error in the lung case could be due to the use of the pencil beam algorithm as opposed to the AAA used by ECLIPSE.Also, gamma analysis showed high discrepancy along the beam edge in the “Anatomy” calculated results. This suggests a poor beam modeling in the penumbra region. Conclusion: The results show various sources of errors in “Anatomy” calculations. These include beam modeling in the penumbra region, complexity of a modulated beam (shown in homogenous phantom and brain cases) and dose calculation algorithms (3D conformal lung case)

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-188: Film Dosimetry Verification of Monte Carlo Generated Electron Treatment Plans

Purpose: The purpose of this study was to compare dose distributions from film measurements to Monte Carlo generated electron treatment plans. Irradiation with electrons offers the advantages of dose uniformity in the target volume and of minimizing the dose to deeper healthy tissue. Using the Monte Carlo algorithm will improve dose accuracy in regions with heterogeneities and irregular surfaces. Methods: Dose distributions from GafChromic{sup ™} EBT3 films were compared to dose distributions from the Electron Monte Carlo algorithm in the Eclipse{sup ™} radiotherapy treatment planning system. These measurements were obtained for 6MeV, 9MeV and 12MeV electrons at two depths. All phantoms studied were imported into Eclipse by CT scan. A 1 cm thick solid water template with holes for bonelike and lung-like plugs was used. Different configurations were used with the different plugs inserted into the holes. Configurations with solid-water plugs stacked on top of one another were also used to create an irregular surface. Results: The dose distributions measured from the film agreed with those from the Electron Monte Carlo treatment plan. Accuracy of Electron Monte Carlo algorithm was also compared to that of Pencil Beam. Dose distributions from Monte Carlo had much higher pass rates than distributions from Pencil Beam when compared to the film. The pass rate for Monte Carlo was in the 80%–99% range, where the pass rate for Pencil Beam was as low as 10.76%. Conclusion: The dose distribution from Monte Carlo agreed with the measured dose from the film. When compared to the Pencil Beam algorithm, pass rates for Monte Carlo were much higher. Monte Carlo should be used over Pencil Beam for regions with heterogeneities and irregular surfaces.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-197: Helical Cranial-Spinal Treatments with a Linear Accelerator

Purpose: Craniospinal irradiation (CSI) of systemic disease requires a high level of beam intensity modulation to reduce dose to bone marrow and other critical structures. Current helical delivery machines can take 30 minutes or more of beam-on time to complete these treatments. This pilot study aims to test the feasibility of performing helical treatments with a conventional linear accelerator using longitudinal couch travel during multiple gantry revolutions. Methods: The VMAT optimization package of the Eclipse 10.0 treatment planning system was used to optimize pseudo-helical CSI plans of 5 clinical patient scans. Each gantry revolution was divided into three 120° arcs with each isocenter shifted longitudinally. Treatments requiring more than the maximum 10 arcs used multiple plans with each plan after the first being optimized including the dose of the others (Figure 1). The beam pitch was varied between 0.2 and 0.9 (couch speed 5- 20cm/revolution and field width of 22cm) and dose-volume histograms of critical organs were compared to tomotherapy plans. Results: Viable pseudo-helical plans were achieved using Eclipse. Decreasing the pitch from 0.9 to 0.2 lowered the maximum lens dose by 40%, the mean bone marrow dose by 2.1% and the maximum esophagus dose by 17.5%. (Figure 2). Linac-based helical plans showed dose results comparable to tomotherapy delivery for both target coverage and critical organ sparing, with the D50 of bone marrow and esophagus respectively 12% and 31% lower in the helical linear accelerator plan (Figure 3). Total mean beam-on time for the linear accelerator plan was 8.3 minutes, 54% faster than the tomotherapy average for the same plans. Conclusions: This pilot study has demonstrated the feasibility of planning pseudo-helical treatments for CSI targets using a conventional linac and dynamic couch movement, and supports the ongoing development of true helical optimization and delivery.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-296: Single Field Per Day Vs. Multiple Fields Per Day and the Impact On BED in Proton Therapy Treatment

Purpose: A common practice, in proton therapy, is to deliver a rotating subset of fields from the treatment plan for the daily fractions. This study compares the impact this practice has on the biological effective dose (BED) versus delivering all planned fields daily. Methods: For two scenarios (a phantom with a geometry approximating the anatomy of a prostate treatment with opposing lateral beams, and a clinical 3-field brain treatment), treatment plans were produced in Eclipse (Varian) to simulate delivery of one, two, and three fields per fraction. The RT-Dose file, structure set, and α/β ratios were processed using in-house MATLAB code to return a new RT-Dose file containing the BED (including a proton RBE of 1.1) which was imported back into Eclipse for analysis. Results: For targets and regions of field overlap in the treatment plan, BED is not affected by delivery regimen. In the phantom, BED in the femoral heads showed increased by 20% when a single field was used rather than two fields. In the brain treatment, the minimum BED to the left optic nerve and the pituitary gland increased by 13% and 10% respectively, for a one-field regime compared to three-fields per fraction. Comparing the two-field and threefield regimes, the optic nerve BED was not significantly affected and the minimum pituitary BED was 4% higher for two fields per day. Conclusion: Hypo-fractionation effects, in regions of non-overlap of fields, significantly increase the BED to the involved tissues by as much as 20%. Care should be taken to avoid inadvertently sacrificing plan effectiveness in the interest of reduced treatment time.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-367: Optimization of DLG Using TG-119 Test Cases and a Weighted Mean Approach

Purpose: Optimization of the dosimetric leaf gap (DLG) is an important step in commissioning the Eclipse treatment planning system for sliding window intensity-modulated radiation therapy (SW-IMRT) and RapidArc. Often the values needed for optimal dose delivery differ markedly from those measured at commissioning. We present a method to optimize this value using the AAPM TG-119 test cases. Methods: For SW-IMRT and RapidArc, TG-119 based test plans were created using a water-equivalent phantom. Dose distributions measured on film and ion chamber (IC) readings taken in low-gradient regions within the targets were analyzed separately. Since DLG is a single value per energy, SW-IMRT and RapidArc must be considered simultaneously. Plans were recalculated using a linear sweep from 0.02cm (the minimum DLG) to 0.3 cm. The calculated point doses were compared to the measured doses for each plan, and based on these comparisons an optimal DLG value was computed for each plan. TG-119 cases are designed to push the system in various ways, thus, a weighted mean of the DLG was computed where the relative importance of each type of plan was given a score from 0.0 to 1.0. Finally, SW-IMRT and RapidArc are assigned an overall weight based on clinical utilization. Our routine patient-QA (PQA) process was performed as independent validation. Results: For a Varian TrueBeam, the optimized DLG varied with σ = 0.044cm for SW-IMRT and σ = 0.035cm for RapidArc. The difference between the weighted mean SW-IMRT and RapidArc value was 0.038cm. We predicted utilization of 25% SW-IMRT and 75% RapidArc. The resulting DLG was ~1mm different than that found by commissioning and produced an average error of <1% for SW-IMRT and RapidArc PQA test cases separately. Conclusion: The weighted mean method presented is a useful tool for determining an optimal DLG value for commissioning Eclipse.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-425: Spherical Dose Distributions for Radiosurgery Using a Standardized MLC Plan

Purpose: To investigate a standardized MLC treatment plan to generate small spherical dose distributions. Methods: The static virtual cone plan comprised six table positions with clockwise and counterclockwise arcs having collimator angles 45 and 135 degrees, respectively, at each position. The central two leaves of a 2.5 mm leaf width MLC were set to a constant gap. Control points were weighted proportional to the sine of the gantry angle. Plans were created for the 10 MV flattening-filter-free beam of a TrueBeam STx (Varian Medical Systems) with gaps of 1, 1.5, 2, and 3 mm and were delivered to a phantom containing radiochromic film. Dose was calculated using the Eclipse AAA (Varian Medical Systems). A dynamic plan in which the table and gantry moved simultaneously with 1.5 mm gap was also created and delivered using the TrueBeam developer mode. Results: The full-width-half-max (FWHM) varied with leaf gap, ranging from 5.2 to 6.2 mm. Calculated FWHM was smaller than measured by 0.7 mm for the 1 mm gap and ≤ 0.4 mm for the larger gaps. The measured-to-calculated dose ratio was 0.93, 0.96, 1.01, and 0.99 for 1 mm, 1.5 mm, 2 mm, and 3 mm gaps, respectively. The dynamic results were the same as the static. The position deviations between the phantom target position and the center of the dose distribution were < 0.4 mm. Conclusion: The virtual cone can deliver spherical dose distributions suitable for radio surgery of small targets such as the trigeminal nerve. The Eclipse AAA accurately calculates the expected dose, particularly for leaf gap ≥ 1.5 mm. The measured dose distribution is slightly larger than the calculation, which is likely due to systematic leaf position error, isocenter variation due to gantry sag and table eccentricity, and inaccuracy in MLC leaf end modeling.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-545: A MLC-Equipped Robotic Radiosurgery-Radiotherapy Combined System in Treating Hepatic Lesions: Delivery Efficiency as Compared to a Standard Linac for Treating Hepatic Lesions

Purpose: The CyberKnife (CK) M6 Series introduced a mulitleaf collimator (MLC) beam for extending its capability to the conventional radiotherapy. This work is to investigate delivery efficiency of this system as compared to a standard Varian linac when treating hepatic lesions. Methods: Nine previously treated patients were divided into three groups with three patients in each. Group one: fractionated radiotherapy; Group two: SBRT-like treatments and Group three: fractionated radiotherapy targeting two PTVs. The clinically used plans were generated with the Eclipse treatment planning system (TPS). We re-planned these cases using a Mulitplan (MP) TPS for the CK M6 and normalized to the same PTV dose coverage. CK factors (CF) (defined as modulation scaling factor in this work), number of nodes (NN), number of MLC segments (NS) and beam delivery time (BT) with an estimated image interval of 60 seconds, were used for evaluation of delivery efficiency. Results: Generated plans from the MP and Eclipse TPS demonstrated the similar quality in terms of PTV confomality index, minimum and maximum PTV doses, and doses received by critical structures. Group one: CF ranged from 8.1 to 8.7, NN from 30 to 40, NS from 120 to 155 and BT from 20 to 23 minutes; group two: CF from 4.7 to 8.5, NN from 15 to 19, NS from 82 to 141 and BT from 18 to 24 minutes; and group three: CF from 7.9 to 10, NN from 47 to 49, NS from 110 to 113 and BT from 20 to 22 minutes. Conclusions: Delivery time is longer for the CK M6 than for the Varian linac (7.8 to 13.7 minutes). Further investigation will be necessary to determine if a PTV reduction from the tracking feature will shorten the delivery time without decreasing plan quality.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-CAMPUS-T-03: Development and Implementation of An Anthropomorphic Pediatric Spine Phantom for the Assessment of Craniospinal Irradiation Procedures in Proton Therapy

Purpose: To design an anthropomorphic pediatric spine phantom for use in the evaluation of proton therapy facilities for clinical trial participation by the Imaging and Radiation Oncology Core (IROC) Houston QA Center (formerly RPC). Methods: This phantom was designed to perform an end-to-end audit of the proton spine treatment process, including simulation, dose calculation by the treatment planning system (TPS), and proton treatment delivery. The design incorporated materials simulating the thoracic spinal column of a pediatric patient, along with two thermoluminescent dosimeter (TLD)-100 capsules and radiochromic film embedded in the phantom for dose evaluation. Fourteen potential materials were tested to determine relative proton stopping power (RSP) and Hounsfield unit (HU) values. Each material was CT scanned at 120kVp, and the RSP was obtained from depth ionization scans using the Zebra multilayer ion chamber (MLIC) at two energies: 160 MeV and 250 MeV. To determine tissue equivalency, the measured RSP for each material was compared to the RSP calculated by the Eclipse TPS for a given HU. Results: The materials selected as bone, tissue, and cartilage substitutes were Techron HPV Bearing Grade (Boedeker Plastics, Inc.), solid water, and blue water, respectively. The RSP values did not differ by more than 1.8% between the two energies. The measured RSP for each selected material agreed with the RSP calculated by the Eclipse TPS within 1.2%. Conclusion: An anthropomorphic pediatric proton spine phantom was designed to evaluate proton therapy delivery. The inclusion of multiple tissue substitutes increases heterogeneity and the level of difficulty for institutions to successfully treat the phantom. The following attributes will be evaluated: absolute dose agreement, distal range, field width, junction match and right/left dose profile alignment. The phantom will be tested at several institutions using a 5% dose agreement criterion, and a 5%/3mm gamma analysis criterion for the film planes. Work supported by grants CA10953, CA059267, and CA81647 (NCI, DHHS)

07 ISOTOPE AND RADIATION SOURCES↗
DOE OSTI2014

SU-F-BRE-10: Methods to Simulate and Measure the Attenuation for Modeling a Couch Top with Rails for FFF Treatment Delivery On the Varian Edge Linac

Purpose: To measure attenuation for modelling of the KVue Couchtop for 6X and 10X FFF SRS/SBRT treatment Methods: Treatment planning simulation studies were done using 6X FFF beams to estimate the dosimetric impact of KVue couchtops (including the Q-Fix IGRT [carbon fiber] and Calypso [nonconductive Kevlar material]) with a structure model obtained from a research workstation (Eclipse, advanced planning interface (API) v13). Prior to installation on the Varian Edge linac, the couchtop along with (Kevlar) rails were CT scanned with the rails at various positions. An additional scan with the couchtop 15cm above the CT table top was obtained with 20cm solid water to facilitate precised/indexed data acquisition. Measurements for attenuation were obtained for field sizes of 2, 4 and 10 cm{sup 2} at 42 gantry angles including 6 pairs of opposing fields and other angles for oblique delivery where the beams traversed the couchtop and or rails. The delivery was fully automated with xml scripts running in developer mode. The results were then used to determine an accurate structure model for AAA (Eclipse v11) planning of IMRT and RapidArc delivery. Results: The planning simulation relative dose attenuation for oblique entry was not significantly different than the Exact IGRT or BrainLab iBeam couch except that the rails added 6% additional attenuation. The relative attenuation measurements for PA, PA (rails: inner position), oblique, oblique (rails: outer position), oblique (rails: inner position) were: −2.0%, −2.5%, −15.6%, −2.5%, −5.0% for 6X FFF and −1.4%, −1.5%, −12.2%, − 2.5%, −5.0% for 10X FFF with slight decrease in attenuation versus field size. A Couch structure model (with HU values) was developed. Calculation compared to measurement showed good agreement except for oblique (rails: outer position) where differences approached a magnitude of 6%. Conclusion: A model of the couch structures has been developed accounting for attenuation for FFF beams.

07 ISOTOPE AND RADIATION SOURCES↗
DOE OSTI2014

SU-F-BRF-13: Investigating the Feasibility of Accurate Dose Measurement in a Deforming Radiochromic Dosimeter

Purpose: Presage-Def, a deformable radiochromic 3D dosimeter, has been previously shown to have potential for validating deformable image registration algorithms. This work extends this effort to investigate the feasibility of using Presage-Def to validate dose-accumulation algorithms in deforming structures. Methods: Two cylindrical Presage-Def dosimeters (8cm diameter, 4.5cm length) were irradiated in a water-bath with a simple 4-field box treatment. Isocentric dose was 20Gy. One dosimeter served as control (no deformation) while the other was laterally compressed during irradiation by 21%. Both dosimeters were imaged before and after irradiation with a fast (∼10 minutes for 1mm isotropic resolution), broad beam, high resolution optical-CT scanner. Measured dose distributions were compared to corresponding distributions calculated by a commissioned Eclipse planning system. Accuracy in the control was evaluated with 3D gamma (3%/3mm). The dose distribution calculated for the compressed dosimeter in the irradiation geometry cannot be directly compared via profiles or 3D gamma to the measured distribution, which deforms with release from compression. Thus, accuracy under deformation was determined by comparing integral dose within the high dose region of the deformed dosimeter distribution versus calculated dose. Dose profiles were used to study temporal stability of measured dose distributions. Results: Good dose agreement was demonstrated in the control with a 3D gamma passing rate of 96.6%. For the dosimeter irradiated under compression, the measured integral dose in the high dose region (518.0Gy*cm3) was within 6% of the Eclipse-calculated integral dose (549.4Gy*cm3). Elevated signal was noted on the dosimeter edge in the direction of compression. Change in dosimeter signal over 1.5 hours was ≤2.7%, and the relative dose distribution remained stable over this period of time. Conclusion: Presage-Def is promising as a 3D dosimeter capable of accurately measuring dose in a deforming structure, and warrants further study to quantify comprehensive accuracy at different levels of deformation. This work was supported by NIH R01CA100835. John Adamovics is the president of Heuris Inc., which commercializes PRESAGE.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗
DOE OSTI2014

TU-C-BRE-05: Clinical Implications of AAA Commissioning Errors and Ability of Common Commissioning ' Credentialing Procedures to Detect Them

Purpose: To test the ability of the TG-119 commissioning process and RPC credentialing to detect errors in the commissioning process for a commercial Treatment Planning System (TPS). Methods: We introduced commissioning errors into the commissioning process for the Anisotropic Analytical Algorithm (AAA) within the Eclipse TPS. We included errors in Dosimetric Leaf Gap (DLG), electron contamination, flattening filter material, and beam profile measurement with an inappropriately large farmer chamber (simulated using sliding window smoothing of profiles). We then evaluated the clinical impact of these errors on clinical intensity modulated radiation therapy (IMRT) plans (head and neck, low and intermediate risk prostate, mesothelioma, and scalp) by looking at PTV D99, and mean and max OAR dose. Finally, for errors with substantial clinical impact we determined sensitivity of the RPC IMRT film analysis at the midpoint between PTV and OAR using a 4mm distance to agreement metric, and of a 7% TLD dose comparison. We also determined sensitivity of the 3 dose planes of the TG-119 C-shape IMRT phantom using gamma criteria of 3% 3mm. Results: The largest clinical impact came from large changes in the DLG with a change of 1mm resulting in up to a 5% change in the primary PTV D99. This resulted in a discrepancy in the RPC TLDs in the PTVs and OARs of 7.1% and 13.6% respectively, which would have resulted in detection. While use of incorrect flattening filter caused only subtle errors (<1%) in clinical plans, the effect was most pronounced for the RPC TLDs in the OARs (>6%). Conclusion: The AAA commissioning process within the Eclipse TPS is surprisingly robust to user error. When errors do occur, the RPC and TG-119 commissioning credentialing criteria are effective at detecting them; however OAR TLDs are the most sensitive despite the RPC currently excluding them from analysis.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

TU-C-17A-05: Dose Domain Optimization of MLC Leaf Patterns for Highly Complicated 4Ï€ IMRT Plans

Purpose: Highly conformal non-coplanar 4π radiotherapy plans typically require more than 20 intensity-modulated fields to deliver. A novel method to calculate multileaf collimator (MLC) leaf patterns is introduced to maximize delivery efficiency, accuracy and plan quality. Methods: 4 GBM patients, with a prescription dose of 59.4 Gy or 60 Gy, were evaluated using the 4π algorithm using 20 beams. The MLC calculation utilized a least square minimization of the dose distribution, with an anisotropic total variation regularization term to encourage piecewise continuity in the fluence maps. Transforming the fluence to the dose domain required multiplying the fluence with a sparse matrix. Exploiting this property made it feasible to solve the problem using CVX, a MATLAB-based convex modeling framework. The fluence was stratified into even step sizes, and the MLC segments, limited to 300, were calculated. The patients studied were replanned using Eclipse with the same beam angles. Results: Compared to the original 4π plan, the stratified 4π plan increased the maximum/mean dose for, in Gy, by 1.0/0.0 (brainstem), 0.5/0.2 (chiasm), 0.0/0.0 (spinal cord), 1.9/0.3 (L eye), 0.7/0.2 (R eye), 0.4/0.4 (L lens), 0.3/0.3 (R lens), 1.0/0.8 (L Optical Nerve), 0.5/0.3 (R Optical Nerve), 0.3/0.2 (L Cochlea), 0.1/0.1 (R Cochlea), 4.6/0.2 (brain), 2.4/0.1 (brain-PTV), 5.1/0.9 (PTV). Compared to Eclipse, which generated an average of 607 segments, the stratified plan reduced (−) or increased (+) the maximum/mean dose, in Gy, by −10.2/−4.1 (brainstem), −10.5/−8.9 (chiasm), +0.0/−0.1 (spinal cord), −4.9/−3.4 (L eye), −4.1/−2.5 (R eye), −2.8/−2.7 (L lens), −2.1/−1.9 (R lens), −7.6/−6.5 (L Optical Nerve), −8.9/−6.1 (R Optical Nerve), −1.3/−1.9 (L Cochlea), −1.8/−1.8 (R Cochlea), +1.7/−2.1 (brain), +3.2/−2.6 (brain-PTV), +1.8/+0.3 Gy (PTV. The stratified plan was also more homogeneous in the PTV. Conclusion: This novel solver can transform complicated fluence maps into significantly fewer deliverable MLC segments than the commercial system while achieving superior dosimetry. Funding support partially contributed by Varian.

60 APPLIED LIFE SCIENCES↗