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At least 1,153 records · Page 64
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DOE OSTI2014

SU-F-BRD-16: Under Dose Regions Recalculated by Monte Carlo Cannot Predict the Local Failure for NSCLC Patients Treated with SBRT

Purpose: To investigate whether Monte Carlo (MC) recalculated dose distributions can predict the geometric location of the recurrence for nonsmall cell lung cancer (NSCLC) patients treated with stereotactic body radiotherapy (SBRT). Methods: Thirty NSCLC patients with local recurrence were retrospectively selected for this study. The recurred gross target volumes (rGTV) were delineated on the follow-up CT/PET images and then rigidly transferred via imaging fusion to the original planning CTs. Failure pattern was defined according to the overlap between the rGTV and planning GTV (pGTV) as: (a) in-field failure (≥80%), (b) marginal failure (20%–80%), and (c) out-of-field failure (≤20%). All clinical plans were calculated initially with pencil beam (PB) with or without heterogeneity correction dependent of protocols. These plans were recalculated with MC with heterogeneity correction. Because of non-uniform dose distributions in the rGTVs, the rGTVs were further divided into four regions: inside the pGTV (GTVin), inside the PTV (PTVin), outside the pGTV (GTVout), and outside the PTV (PTVout). The mean doses to these regions were reported and analyzed separately. Results: Among 30 patients, 10 patients had infield recurrences, 15 marginal and 5 out-of-field failures. With MC calculations, D95 and D99 of the PTV were reduced by (10.6 ± 7.4)% and (11.7 ± 7.9)%. The average MC calculated mean doses of GTVin, GTVout, PTVin and PTVout were 48.2 ± 5.3 Gy, 48.2 ± 5.5 Gy, 46.3 ± 6.2 Gy and 46.6 ± 5.6 Gy, respectively. No significant dose differences between GTVin and GTVout (p=0.65), PTVin and PTVout (p=0.19) were observed, using the paired students t-test. Conclusion: Although the PB calculations underestimated the tumor target doses, the geometric location of the recurrence did not correlate with the mean doses of subsections of the recurrent GTV. Under dose regions recalculated by MC cannot predict the local failure for NSCLC patients treated with SBRT.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

Dose-to-water conversion for the backscatter-shielded EPID: A frame-based method to correct for EPID energy response to MLC transmitted radiation

Purpose: To develop a frame-by-frame correction for the energy response of amorphous silicon electronic portal imaging devices (a-Si EPIDs) to radiation that has transmitted through the multileaf collimator (MLC) and to integrate this correction into the backscatter shielded EPID (BSS-EPID) dose-to-water conversion model. Methods: Individual EPID frames were acquired using a Varian frame grabber and iTools acquisition software then processed using in-house software developed inMATLAB. For each EPID image frame, the region below the MLC leaves was identified and all pixels in this region were multiplied by a factor of 1.3 to correct for the under-response of the imager to MLC transmitted radiation. The corrected frames were then summed to form a corrected integrated EPID image. This correction was implemented as an initial step in the BSS-EPID dose-to-water conversion model which was then used to compute dose planes in a water phantom for 35 IMRT fields. The calculated dose planes, with and without the proposed MLC transmission correction, were compared to measurements in solid water using a two-dimensional diode array. Results: It was observed that the integration of the MLC transmission correction into the BSS-EPID dose model improved agreement between modeled and measured dose planes. In particular, the MLC correction produced higher pass rates for almost all Head and Neck fields tested, yielding an average pass rate of 99.8% for 2%/2 mm criteria. A two-sample independentt-test and fisher F-test were used to show that the MLC transmission correction resulted in a statistically significant reduction in the mean and the standard deviation of the gamma values, respectively, to give a more accurate and consistent dose-to-water conversion. Conclusions: The frame-by-frame MLC transmission response correction was shown to improve the accuracy and reduce the variability of the BSS-EPID dose-to-water conversion model. The correction may be applied as a preprocessing step in any pretreatment portal dosimetry calculation and has been shown to be beneficial for highly modulated IMRT fields.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

Validation of OSLD and a treatment planning system for surface dose determination in IMRT treatments

Purpose: To evaluate the accuracy of skin dose determination for composite multibeam 3D conformal radiation therapy (3DCRT) and intensity modulated radiation therapy (IMRT) treatments using optically stimulated luminescent dosimeters (OSLDs) and Eclipse treatment planning system. Methods: Surface doses measured by OSLDs in the buildup region for open field 6 MV beams, either perpendicular or oblique to the surface, were evaluated by comparing against dose measured by Markus Parallel Plate (PP) chamber, surface diodes, and calculated by Monte Carlo simulations. The accuracy of percent depth dose (PDD) calculation in the buildup region from the authors’ Eclipse system (Version 10), which was precisely commissioned in the buildup region and was used with 1 mm calculation grid, was also evaluated by comparing to PP chamber measurements and Monte Carlo simulations. Finally, an anthropomorphic pelvic phantom was CT scanned with OSLDs in place at three locations. A planning target volume (PTV) was defined that extended close to the surface. Both an 8 beam 3DCRT and IMRT plan were generated in Eclipse. OSLDs were placed at the CT scanned reference locations to measure the skin doses and were compared to diode measurements and Eclipse calculations. Efforts were made to ensure that the dose comparison was done at the effective measurement points of each detector and corresponding locations in CT images. Results: The depth of the effective measurement point is 0.8 mm for OSLD when used in the buildup region in a 6 MV beam and is 0.7 mm for the authors’ surface diode. OSLDs and Eclipse system both agree well with Monte Carlo and/or Markus PP ion chamber and/or diode in buildup regions in 6 MV beams with normal or oblique incidence and across different field sizes. For the multiple beam 3DCRT plan and IMRT plans, the differences between OSLDs and Eclipse calculations on the surface of the anthropomorphic phantom were within 3% and distance-to-agreement less than 0.3 mm. Conclusions: The authors’ experiment showed that OSLD is an accurate dosimeter for skin dose measurements in complex 3DCRT or IMRT plans. It also showed that an Eclipse system with accurate commissioning of the data in the buildup region and 1 mm calculation grid can calculate surface doses with high accuracy and has a potential to replacein vivo measurements.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

Poster — Thur Eve — 33: The Influence of a Modeled Treatment Couch on Dose Distributions During IMRT and RapidArc Treatment Delivery

Treatment couches have been known to perturb dose delivery in patients. This effect is most pronounced in techniques such as IMRT and RapidArc. Although modern treatment planning systems (TPS) include data for a “default” treatment couch, actual couches are not manufactured identically. Thus, variations in their Hounsfield Unit (HU) values may exist. This study demonstrates a practical and simple method of acquiring reliable HU data for any treatment couch. We also investigate the effects of both the default and modeled treatment couches on absorbed dose. Experimental verifications show that by neglecting to incorporate the treatment couch in the TPS, dose differences of up to 9.5% and 7.3% were present for 4 MV and 10 MV photon beams, respectively. Furthermore, a clinical study based on a cohort of 20 RapidArc and IMRT (brain, pelvis and abdominal) cases is performed. 2D dose distributions show that without the couch in the planning phase, differences ≤ 4.6% and 5.9% for RapidArc and IMRT cases are present for the same cases that the default couch was added to. Additionally, in comparison to the default couch, employing the modeled couch in the calculation process influences dose distributions by ≤ 2.7% and 8% for RapidArc and IMRT cases, respectively. This result was found to be site specific; where an accurate couch proves to be preferable for IMRT brain plans. As such, adding the couch during dose calculation decreases dose calculation errors, and a precisely modeled treatment couch offers higher dose delivery accuracy for brain treatment using IMRT.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-C-BRD-07: Three-Dimensional Dose Reconstruction in the Presence of Inhomogeneities Using Fast EPID-Based Back-Projection Method

Purpose: Three-dimensional dose verification can detect errors introduced by the treatment planning system (TPS) or differences between planned and delivered dose distribution during the treatment. The aim of the study is to extend a previous in-house developed three-dimensional dose reconstructed model in homogeneous phantom to situtions in which tissue inhomogeneities are present. Methods: The method was based on the portal grey images from an electronic portal imaging device (EPID) and the relationship between beamlets and grey-scoring voxels at the position of the EPID. The relationship was expressed in the form of grey response matrix that was quantified using thickness-dependence scatter kernels determined by series of experiments. From the portal grey-value distribution information measured by the EPID the two-dimensional incident fluence distribution was reconstructed based on the grey response matrix using a fast iterative algorithm. The accuracy of this approach was verified using a four-field intensity-modulated radiotherapy (IMRT) plan for the treatment of lung cancer in anthopomorphic phantom. Each field had between twenty and twenty-eight segments and was evaluated by comparing the reconstructed dose distribution with the measured dose. Results: The gamma-evaluation method was used with various evaluation criteria of dose difference and distance-to-agreement: 3%/3mm and 2%/2 mm. The dose comparison for all irradiated fields showed a pass rate of 100% with the criterion of 3%/3mm, and a pass rate of higher than 92% with the criterion of 2%/2mm. Conclusion: Our experimental results demonstrate that our method is capable of accurately reconstructing three-dimensional dose distribution in the presence of inhomogeneities. Using the method, the combined planning and treatment delivery process is verified, offing an easy-to-use tool for the verification of complex treatments.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-J-23: Characteristics of X-Rays From ExacTrac and Patient Dose From Imaging Procedures

Purpose: The purpose of this investigation is 1) provide the beam characteristics of x-rays produced by a Novalis TX ExacTrac system; 2) present a method to commission such beams, 3) present radiation dose to patients resulting from the imaging procedures. Methods: The Monte Carlo simulations were used to obtain the characteristics of kV beams and validated by measurements. The calculated beam HVLs, profiles and depth-dose curves were benchmarked against measurements. Twelve different image acquisition protocols were studied. The x-ray tube voltage ranges from 70 - 145 kV and milliampere-second (mAs) ranges from 8 - 80 mAs depending on the selection of Cranium, Head & Neck, Thorax or Abdomen imaging protocols. The beam output of each image acquisition protocol was determined by using an ionization chamber. The air kerma calibration factors of the ion chamber were obtained from an Accredited Dosimetry Calibration Laboratory for specified HVLs. Results: The agreements between measured and simulated results were within the uncertainties for HVLs, dose profiles and depth-dose curves. When %dd was normalized at 1 cm depth, its values at depth of 5 cm ranged from 45% to 66% of in water for kV beams range from 70 kVp to 145 kVp respectively. For head images, a typical dose to eye resulting from single projection ranged from 0.008 cGy to 0.025 cGy depending on the cranial image protocols selected. For a single pelvic image the skin dose could reach up to 0.1 cGy from an abdominal protocol. Conclusion: Although multiple pairs of x-ray images are commonly acquired during a daily patient treatment, the imaging doses to patients resulting from the sum of these projected x-rays are generally much less than 0.5 cGy. The knowledge obtained from this investigation can be used to estimate the image dose and optimize the used of the system.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-J-100: The Combination of Deformable Image Registration and Regions-Of-Interest Mapping Technique to Accomplish Accurate Dose Calculation On Cone Beam Computed Tomography for Esophageal Cancer

Purpose: We introduce a new method combined with the deformable image registration (DIR) and regions-of-interest mapping (ROIM) technique to accurately calculate dose on daily CBCT for esophageal cancer. Methods: Patients suffered from esophageal cancer were enrolled in the study. Prescription was set to 66 Gy/30 F and 54 Gy/30 F to the primary tumor (PTV66) and subclinical disease (PTV54) . Planning CT (pCT) were segmented into 8 substructures in terms of their differences in physical density, such as gross target volume (GTV), venae cava superior (SVC), aorta, heart, spinal cord, lung, muscle and bones. The pCT and its substructures were transferred to the MIM software to readout their mean HU values. Afterwards, a deformable planning CT to daily KV-CBCT image registration method was then utilized to acquire a new structure set on CBCT. The newly generated structures on CBCT were then transferred back to the treatment planning system (TPS) and its HU information were overridden manually with mean HU values obtained from pCT. Finally, the treatment plan was projected onto the CBCT images with the same beam arrangements and monitor units (MUs) to accomplish dose calculation. Planning target volume (PTV) and organs at risk (OARs) from both of the pCT and CBCT were compared to evaluate the dose calculation accuracy. Results: It was found that the dose distribution in the CBCT showed little differences compared to the pCT, regardless of whether PTV or OARs were concerned. Specifically, dose variation in GTV, PTV54, PTV66, SVC, lung and heart were within 0.1%. The maximum dose variation was presented in the spinal cord, which was up to 2.7% dose difference. Conclusion: The proposed method combined with DIR and ROIM technique to accurately calculate dose distribution on CBCT for esophageal cancer is feasible.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-J-146: A Research of PET-CT SUV Range for the Online Dose Verification in Carbon Ion Radiation Therapy

Purpose: Positron-emitting isotope distributions can be used for the image fusion of the carbon ion planning CT and online target verification PETCT, after radiation in the same decay period,the relationship between the same target volume and the SUV value of different every single fraction dose can be found,then the range of SUV for the radiation target could be decided.So this online range also can provide reference for the correlation and consistency in planning target dose verification and evaluation for the clinical trial. Methods: The Rando head phantom can be used as real body,the 10cc cube volume target contouring is done,beam ISO Center depth is 7.6cm and the 90 degree fixed carbon ion beams should be delivered in single fraction effective dose of 2.5GyE,5GyE and 8GyE.After irradiation,390 seconds later the 30 minutes PET-CT scanning is performed,parameters are set to 50Kg virtual weight,0.05mCi activity.MIM Maestro is used for the image processing and fusion,five 16mm diameter SUV spheres have been chosen in the different direction in the target.The average SUV in target for different fraction dose can be found by software. Results: For 10cc volume target,390 seconds decay period,the Single fraction effective dose equal to 2.5Gy,Ethe SUV mean value is 3.42,the relative range is 1.72 to 6.83;Equal to 5GyE,SUV mean value is 9.946,the relative range is 7.016 to 12.54;Equal or above to 8GyE,SUV mean value is 20.496,the relative range is 11.16 to 34.73. Conclusion: Making an evaluation for accuracy of the dose distribution using the SUV range which is from the planning CT with after treatment online PET-CT fusion for the normal single fraction carbon ion treatment is available.Even to the plan which single fraction dose is above 2GyE,in the condition of other parameters all the same,the SUV range is linearly dependent with single fraction dose,so this method also can be used in the hyper-fraction treatment plan.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-50: A Multi-Institutional Study of Independent Dose Verification Software Program for Lung SBRT

Purpose: The accuracy of dose distribution depends on treatment planning system especially in heterogeneity-region. The tolerance level (TL) of the secondary check using the independent dose verification may be variable in lung SBRT plans. We conducted a multi-institutional study to evaluate the tolerance level of lung SBRT plans shown in the AAPM TG114. Methods: Five institutes in Japan participated in this study. All of the institutes used a same independent dose verification software program (Simple MU Analysis: SMU, Triangle Product, Ishikawa, JP), which is Clarkson-based and CT images were used to compute radiological path length. Analytical Anisotropic Algorithm (AAA), Pencil Beam Convolution with modified Batho-method (PBC-B) and Adaptive Convolve (AC) were used for lung SBRT planning. A measurement using an ion-chamber was performed in a heterogeneous phantom to compare doses from the three different algorithms and the SMU to the measured dose. In addition to it, a retrospective analysis using clinical lung SBRT plans (547 beams from 77 patients) was conducted to evaluate the confidence limit (CL, Average±2SD) in dose between the three algorithms and the SMU. Results: Compared to the measurement, the AAA showed the larger systematic dose error of 2.9±3.2% than PBC-B and AC. The Clarkson-based SMU showed larger error of 5.8±3.8%. The CLs for clinical plans were 7.7±6.0 % (AAA), 5.3±3.3 % (AC), 5.7±3.4 % (PBC -B), respectively. Conclusion: The TLs from the CLs were evaluated. A Clarkson-based system shows a large systematic variation because of inhomogeneous correction. The AAA showed a significant variation. Thus, we must consider the difference of inhomogeneous correction as well as the dependence of dose calculation engine.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-57: A Novel Method to Improve Dose Heterogeneity of Target and Organs at Risk Sparing in the Intensity-Modulated Radiotherapy for Stage III Lung Cancer

Purpose: Intensity-modulated radiotherapy (IMRT) treatment for lung cancer is difficult due to the heterogeneous dose distribution and excessive dose to the organs at risk (OARs). We introduce a simple method based on the base dose function (BDF) in Eclipse treatment planning system to overcome the difficulties. Methods: Thirteen patients suffered from stage III non-small cell lung cancer (NSCLC) were enrolled in the study. Three kinds of approaches were applied to obtain clinically acceptable treatment plans: 1) conventionally optimizing method with hot and cold spots re-optimization (CO); 2) target-divided optimizing method (TDO) in which the optimization objective in the lung density of planning target volume (PTV) was set to 2 to 4 Gy higher than in the soft tissue density; 3) base dose function (BDF) in which the treatment plan was produced based on the original plan for re-optimization. CO, TDO and BDF methods were then compared in terms of conformity index (CI), homogeneity index (HI), OARs sparing and monitor units (MUs). Additionally, delta4, portal dosimetry and IMSure were used to measure the dose delivering accuracy. Results: The BDF technique provided more superior CI and HI than the other two methods. Moreover, the new method also reduced the lung, esophagus, heart and spinal cord dose. However, the BDF plans needed extra 15% and 10% MUs than the CO and TDO methods. Dose verification results demonstrated good and comparable γ pass rates among the three methods. Conclusion: The proposed BDF method greatly improves the dose homogeneity and OARs sparing in the IMRT treatment for lung cancer.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-64: A Programmable Moving Insert for the ArcCHECK Phantom for Dose Verification of Respiratory-Gated VMAT

Purpose: To present a customized programmable moving insert for the ArcCHECK™ phantom that can, in a single delivery, check both entrance dosimetry, while simultaneously verifying the delivery of respiratory-gated VMAT. Methods: The cylindrical motion phantom uses a computer-controlled stepping motor to move an insert inside a stationery sleeve. Insert motion is programmable and can include rotational motion in addition to linear motion along the axis of the cylinder. The sleeve fits securely in the bore of the ArcCHECK™. Interchangeable inserts, including an A1SL chamber, optically-stimulated luminescence dosimeters, radiochromic film, or 3D gels, allow this combination to be used for commissioning, routine quality assurance, and patient-specific dosimetric verification of respiratory-gated VMAT. Before clinical implementation, the effect of a moving insert on the ArcCHECK™ measurements was considered. First, the measured dose to the ArcCHECK™ containing multiple inserts in the static position was compared to the calculated dose during multiple VMAT treatment deliveries. Then, dose was measured under both sinusoidal and real-patient motion conditions to determine any effect of the moving inserts on the ArcCHECK™ measurements. Finally, dose was measured during gated VMAT delivery to the same inserts under the same motion conditions to examine any effect of various beam “on-and-off” and dose rate ramp “up-and-down”. Multiple comparisons between measured and calculated dose to different inserts were also considered. Results: The pass rate for the static delivery exceeded 98% for all measurements (3%/3mm), suggesting a valid setup for entrance dosimetry. The pass rate was not altered for any measurement delivered under motion conditions. A similar Result was observed under gated VMAT conditions, including agreement of measured and calculated dose to the various inserts. Conclusion: Incorporating a programmable moving insert within the ArcCHECK™ phantom provides an efficient verification of respiratory-gated VMAT delivery that is useful during commissioning, routine quality assurance, and patient-specific dose verification. Prototype phantom development and testing was performed in collaboration with Modus Medical Devices Inc. (London, ON). No financial support was granted.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗
DOE OSTI2015

SU-E-T-91: Accuracy of Dose Calculation Algorithms for Patients Undergoing Stereotactic Ablative Radiotherapy

Purpose: The purpose of this study was to investigate and quantify the variation in dose distributions in small field lung cancer radiotherapy using seven different dose calculation algorithms. Methods: The study was performed in 21 lung cancer patients who underwent Stereotactic Ablative Body Radiotherapy (SABR). Two different methods (i) Same dose coverage to the target volume (named as same dose method) (ii) Same monitor units in all algorithms (named as same monitor units) were used for studying the performance of seven different dose calculation algorithms in XiO and Eclipse treatment planning systems. The seven dose calculation algorithms include Superposition, Fast superposition, Fast Fourier Transform ( FFT) Convolution, Clarkson, Anisotropic Analytic Algorithm (AAA), Acurous XB and pencil beam (PB) algorithms. Prior to this, a phantom study was performed to assess the accuracy of these algorithms. Superposition algorithm was used as a reference algorithm in this study. The treatment plans were compared using different dosimetric parameters including conformity, heterogeneity and dose fall off index. In addition to this, the dose to critical structures like lungs, heart, oesophagus and spinal cord were also studied. Statistical analysis was performed using Prism software. Results: The mean±stdev with conformity index for Superposition, Fast superposition, Clarkson and FFT convolution algorithms were 1.29±0.13, 1.31±0.16, 2.2±0.7 and 2.17±0.59 respectively whereas for AAA, pencil beam and Acurous XB were 1.4±0.27, 1.66±0.27 and 1.35±0.24 respectively. Conclusion: Our study showed significant variations among the seven different algorithms. Superposition and AcurosXB algorithms showed similar values for most of the dosimetric parameters. Clarkson, FFT convolution and pencil beam algorithms showed large differences as compared to superposition algorithms. Based on our study, we recommend Superposition and AcurosXB algorithms as the first choice of algorithms in lung cancer radiotherapy involving small fields. However, further investigation by Monte Carlo simulation is required to confirm our results.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-95: An Alternative Option for Reducing Lung Dose for Electron Scar Boost Irradiation in Post-Mastectomy Breast Cancer Patients with a Thin Chest Wall

Purpose: Breast cancer patients who undergo a mastectomy often require post-mastectomy radiation therapy (PMRT) due to high risk disease characteristics. PMRT usually accompanies scar boost irradiation (10–16Gy in 5–8 fractions) using en face electrons, which often results in increased dose to the underlying lungs, thereby potentially increasing the risk of radiation pneumonitis. Hence, this study evaluated water-equivalent phantoms as energy degraders and as an alternative to a bolus to reduce radiation dose to the underlying lungs for electron scar boost irradiation. Methods: Percent depth dose (PDD) profiles of 6 MeV (the lowest electron energy available in most clinics) were obtained without and with commercial solid water phantoms (1 to 5mm by 1mm increments) placed on top of electron cones. Phantom attenuation was measured by taking a ratio of outputs with to without the phantoms in 10×10cm2 cone size for monitor unit (MU) calculation. In addition, scatter dose to contralateral breast was measured on a human-like phantom using two selected scar (short and long) boost patient setups. Results: The PDD plots showed that the solid water phantoms and the bolus had similar dosimetric effects for the same thickness. Lower skin dose (up to 3%) to ipsilateral breast was observed with a 5mm phantom compared with a 5mm bolus (up to 10%) for all electron cones. Phantom attenuation was increased by 50% with about a 4.5mm phantom. Also, the energy degraders caused scatter dose to contralateral breast by a factor of 3 with a 5mm phantom. Conclusion: Our results demonstrate the feasibility of using water-equivalent phantoms to reduce lung dose using en face electrons in patients with a thin chest wall undergoing PMRT. The disadvantages of this treatment approach (i.e., the increase in MUs and treatment time, and clinically insignificant scatter dose to the contralateral breast given usually 10Gy) are outweighed by its above clinical benefits.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-286: Dose Verification of Spot-Scanning Proton Beam Using GafChromic EBT3 Film

Purpose: Dose verification of spot-scanning proton pencil beam is performed via planar dose measurements at several depths using an ionization-chamber array, requiring repeat irradiations of each field for each depth. Here we investigate film dosimetry which has two advantages: higher resolution and efficiency from one-shot irradiation for multiple depths. Methods: Film calibration was performed using an EBT3 film at 20-cm depth of Plastic Water (CIRS, Norfolk, VA) exposed by a 10-level step wedge on a Proteus Plus proton system (IBA, Belgium). The calibration doses ranged from 25–250 cGy(RBE) for proton energies of 170–200 MeV. A uniform 1000 cm{sup 3} dose cube and a clinical prostate combined with seminal-vesicle and pelvic-nodes plan were used for this study. All treatment plans were generated in the RayStation (RaySearch Lab, Sweden). The planar doses at different depths for both cases were measured with film using triple-channel dosimetry and the MatriXX PT (IBA Dosimetry, Germany). The Gamma passing rates, dose-difference maps, and profiles of 2D planar doses measured with EBT3 film and MatriXX, versus treatment planning system (TPS) calculations were analyzed and compared using the FilmQA Pro (Ashland Inc., Bridgewater, NJ). Results: The EBT3 film measurement results matched well with the TPS calculation data with an average passing rate >95% for 2%/2mm and are comparable with the MatriXX measurements (0.7%, 1.8%, 3.8% mean differences corresponding to 3%/3mm, 3%/2mm, 2%/2mm, respectively). Overall passing rates for EBT3 films appear higher than those with MatriXX detectors. Conclusion: The energy dependence of the film response could be minimized by calibration using proton beam with mixed energies. The greater efficiency of the dose verification using GafChromic EBT3 results in a potential cost trade-off between room capacity and film cost. EBT3 film may offer distinct advantages in highly intensity-modulated fields due to its higher resolution compared to 2D ionization-chamber array detectors. One of the authors has a research grant from Ashland Inc., the manufacturer of GafChromic film.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-357: Electronic Compensation Technique to Deliver Total Body Dose

Purpose: Total body irradiation (TBI) uses large parallel-opposed radiation fields to suppress the patient’s immune system and eradicate the residual cancer cells in preparation of recipient for bone marrow transplant. The manual placement of lead compensators has conventionally been used to compensate for the varying thickness through the entire body in large-field TBI. The goal of this study is to pursue utilizing the modern electronic compensation technique to more accurately and efficiently deliver dose to patients in need of TBI. Methods: Treatment plans utilizing electronic compensation to deliver a total body dose were created retrospectively for patients for whom CT data had been previously acquired. Each treatment plan includes two, specifically weighted, pair of opposed fields. One pair of open, large fields (collimator=45°), to encompass the patient’s entire anatomy, and one pair of smaller fields (collimator=0°) focused only on the thicker midsection of the patient. The optimal fluence for each one of the smaller fields was calculated at a patient specific penetration depth. Irregular surface compensators provide a more uniform dose distribution within the smaller opposed fields. Results: Dose-volume histograms (DVH) were calculated for the evaluating the electronic compensation technique. In one case, the maximum body doses calculated from the DVH were reduced from the non-compensated 195.8% to 165.3% in the electronically compensated plans, indicating a more uniform dose with the region of electronic compensation. The mean body doses calculated from the DVH were also reduced from the non-compensated 120.6% to 112.7% in the electronically compensated plans, indicating a more accurate delivery of the prescription dose. All calculated monitor units were well within clinically acceptable limits. Conclusion: Electronic compensation technique for TBI will not substantially increase the beam on time while it can significantly reduce the compensator setup time and the potential risk of errors in manually placing lead compensators.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-375: Evaluation of a MapCHECK2(tm) Planar 2-D Diode Array for High-Dose-Rate Brachytherapy Treatment Delivery Verifications

Purpose: Despite improvements of HDR brachytherapy delivery systems, verification of source position is still typically based on the length of the wire reeled out relative to the parked position. Yet, the majority of errors leading to medical events in HDR treatments continue to be classified as missed targets or wrong treatment sites. We investigate the feasibility of using dose maps acquired with a two-dimensional diode array to independently verify the source locations, dwell times, and dose during an HDR treatment. Methods: Custom correction factors were integrated into frame-by-frame raw counts recorded for a Varian VariSource™ HDR afterloader Ir-192 source located at various distances in air and in solid water from a MapCHECK2™ diode array. The resultant corrected counts were analyzed to determine the dwell position locations and doses delivered. The local maxima of polynomial equations fitted to the extracted dwell dose profiles provided the X and Y coordinates while the distance to the source was determined from evaluation of the full width at half maximum (FWHM). To verify the approach, the experiment was repeated as the source was moved through dwell positions at various distances along an inclined plane, mimicking a vaginal cylinder treatment. Results: Dose map analysis was utilized to provide the coordinates of the source and dose delivered over each dwell position. The accuracy in determining source dwell positions was found to be +/−1.0 mm of the preset values, and doses within +/−3% of those calculated by the BrachyVision™ treatment planning system for all measured distances. Conclusion: Frame-by-frame data furnished by a 2 -D diode array can be used to verify the dwell positions and doses delivered by the HDR source over the course of treatment. Our studies have verified that measurements provided by the MapCHECK2™ can be used as a routine QA tool for HDR treatment delivery verification.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-409: Evaluation of Tissue Composition Effect On Dose Distribution in Radiotherapy with 6 MV Photon Beam of a Medical Linac

Purpose: The aim of this study is to evaluate soft tissue composition effect on dose distribution for various soft tissues and various depths in radiotherapy with 6 MV photon beam of a medical linac. Methods: A phantom and Siemens Primus linear accelerator were simulated using MCNPX Monte Carlo code. In a homogeneous cubic phantom, six types of soft tissue and three types of tissue-equivalent materials were defined separately. The soft tissues were muscle (skeletal), adipose tissue, blood (whole), breast tissue, soft tissue (9-component) and soft tissue (4-component). The tissue-equivalent materials included: water, A-150 tissue-equivalent plastic and perspex. Photon dose relative to dose in 9-component soft tissue at various depths on the beam’s central axis was determined for the 6 MV photon beam. The relative dose was also calculated and compared for various MCNPX tallies including,F8, F6 and,F4. Results: The results of the relative photon dose in various materials relative to dose in 9-component soft tissue and using different tallies are reported in the form of tabulated data. Minor differences between dose distributions in various soft tissues and tissue-equivalent materials were observed. The results from F6 and F4 were practically the same but different with,F8 tally. Conclusion: Based on the calculations performed, the differences in dose distributions in various soft tissues and tissue-equivalent materials are minor but they could be corrected in radiotherapy calculations to upgrade the accuracy of the dosimetric calculations.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-470: Importance of HU-Mass Density Calibration Technique in Proton Pencil Beam Dose Calculation

Purpose: Stoichiometric calibration of Hounsfield Units (HUs) for conversion to proton relative stopping powers (RStPs) is vital for accurate dose calculation in proton therapy. However proton dose distributions are not only dependent on RStP, but also on relative scattering power (RScP) of patient tissues. RScP is approximated from material density but a stoichiometric calibration of HU-density tables is commonly neglected. The purpose of this work was to quantify the difference in calculated dose of a commercial TPS when using HU-density tables based on tissue substitute materials and stoichiometric calibrated ICRU tissues. Methods: Two HU-density calibration tables were generated based on scans of the CIRS electron density phantom. The first table was based directly on measured HU and manufacturer quoted density of tissue substitute materials. The second was based on the same CT scan of the CIRS phantom followed by a stoichiometric calibration of ICRU44 tissue materials. The research version of Pinnacle{sup 3} proton therapy was used to compute dose in a patient CT data set utilizing both HU-density tables. Results: The two HU-density tables showed significant differences for bone tissues; the difference increasing with increasing HU. Differences in density calibration table translated to a difference in calculated RScP of −2.5% for ICRU skeletal muscle and 9.2% for ICRU femur. Dose-volume histogram analysis of a parallel opposed proton therapy prostate plan showed that the difference in calculated dose was negligible when using the two different HU-density calibration tables. Conclusion: The impact of HU-density calibration technique on proton therapy dose calculation was assessed. While differences were found in the calculated RScP of bony tissues, the difference in dose distribution for realistic treatment scenarios was found to be insignificant.

60 APPLIED LIFE SCIENCES↗