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At least 1,351 records · Page 75
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DOE OSTI2015

SU-E-T-296: Dosimetric Analysis of Small Animal Image-Guided Irradiator Using High Resolution Optical CT Imaging of 3D Dosimeters

Purpose: To verify the dosimetric characteristics of a small animal image-guided irradiator using a high-resolution of optical CT imaging of 3D dosimeters. Methods: PRESAEGE 3D dosimeters were used to determine dosimetric characteristics of a small animal image-guided irradiator and compared with EBT2 films. Cylindrical PRESAGE dosimeters with 7cm height and 6cm diameter were placed along the central axis of the beam. The films were positioned between 6×6cm{sup 2} cubed plastic water phantoms perpendicular to the beam direction with multiple depths. PRESAGE dosimeters and EBT2 films were then irradiated with the irradiator beams at 220kVp and 13mA. Each of irradiated PRESAGE dosimeters named PA1, PA2, PB1, and PB2, was independently scanned using a high-resolution single laser beam optical CT scanner. The transverse images were reconstructed with a 0.1mm high-resolution pixel. A commercial Epson Expression 10000XL flatbed scanner was used for readout of irradiated EBT2 films at a 0.4mm pixel resolution. PDD curves and beam profiles were measured for the irradiated PRESAGE dosimeters and EBT2 films. Results: The PDD agreements between the irradiated PRESAGE dosimeter PA1, PA2, PB1, PB2 and the EB2 films were 1.7, 2.3, 1.9, and 1.9% for the multiple depths at 1, 5, 10, 15, 20, 30, 40 and 50mm, respectively. The FWHM measurements for each PRESAEGE dosimeter and film agreed with 0.5, 1.1, 0.4, and 1.7%, respectively, at 30mm depth. Both PDD and FWHM measurements for the PRESAGE dosimeters and the films agreed overall within 2%. The 20%–80% penumbral widths of each PRESAGE dosimeter and the film at a given depth were respectively found to be 0.97, 0.91, 0.79, 0.88, and 0.37mm. Conclusion: Dosimetric characteristics of a small animal image-guided irradiator have been demonstrated with the measurements of PRESAGE dosimeter and EB2 film. With the high resolution and accuracy obtained from this 3D dosimetry system, precise targeting small animal irradiation can be achieved.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-320: Dosimetric Evaluation of Intracranial Stereotactic Radiotherapy Plans Using Jaws-Only Collimation On a LINAC

Purpose: To evaluate the dosimetry of cranial stereotactic radiotherapy (SRT) plans using jaws-only collimation on linac that meets appropriate TG-142 tolerances. Methods: Seventeen spherical targets were generated in the center of a head phantom with diameters ranging from 8 mm to 40 mm. Plans balanced treatment time with dose gradient and conformity using 13 static fields and 3 couch angles: 9 non-opposed and coplanar fields and 4 non-coplanar fields. The symmetrical jaws field size was target diameter plus 2 mm. The prescription (Rx) was 7 Gy per fraction to the 80% isodose line. Two plans were created for each target: one kept the collimator at 0° (C0), one adjusted the collimator angle 40° for each field to create a 360° sweep over the 9 coplanar fields (CR).Conformity of the Rx to the target was evaluated using a ratio of Rx to target volume (PITV). Heterogeneity was determined using a ratio of maximum dose to Rx dose. Falloff was scored using CGIg: the difference of effective radii of spheres equal to half and full Rx volumes. Results: All plans met RTOG SRS criteria for conformity and heterogeneity. The use of collimator rotation improved conformity by 3.2% on average, the mean PITV was 1.7±0.1 for C0 plans and 1.6±0.1 for CR. Mean heterogeneity was 1.25±0.0 for both C0 and CR. The mean CGIg was 75.9±16.4 for C0 plans and 74.4±17.0 for CR; with a mean dose falloff degradation of 2.5% by CR. Conclusion: Clinically acceptable SRT plans for spherical targets were created using jaws-only collimation with static fields. The addition of sweeping collimator rotation improves conformity at the expense of gradient. This technique can expand the availability of SRT to patients especially to those who cannot travel to a facility with a dedicated stereotactic radiosurgery machine.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-337: Dosimetric Study of TMI Using Helical Tomotherapy

Purpose: The purpose of this study is to evaluate the dosimtry of TMI using Helical Tomotherapy (HT). Methods: Whole body CT data sets of 4 patients (median age : range:12–37 years) with 5mm slice thickness were used for planning in HT (TPS version 4.2.3). The contouring of the target and organ at risks (OAR) were delineated ( Oncentra Master Plan v 4.1). Two plans were generated using 5cm and 2.5 cm field widths.The modulation factor and pitch was 3 and 0.3 respectively. Dose to PTV, OARs and the dose homogeneity were evaluated. The doses obtained were compared with the existimg literature. Dose delivery verification was carried out by point dose and 2D array measurements with ion chamber and Arc check dosimetry (Sun NuclearTM) system repectively. The prescribed dose was 14.4 Gy in 8 fractions. Results: The mean PTV volume was 7341.28cc (sd=2353) The dose homogeneity index of PTV was 12.03(sd=2.98) for 2.5cm-FW and 14.61 (sd=1.33) for 5cm-FW.The conformation number for 2.5 and 5 cm plans are 0.6328(sd=0.09) and 0.5915 (sd=0.0376) respectively. The mean dose(Gy) to the OARs were as follows for 2.5cm-FW : eyes, lens, lungs, kidneys, heart, liver,thyroid and testes for are 4.12,1.9,6.61,4.04,4.85,6.06,7.17 and 1.27. The mean dose(Gy) to the OARs were as follows for 5cm-FW :eyes, lens, lungs, kidneys, heart, liver,thyroid and testes for are 4.45,3.14,6.79,4.02,5.01,6.01,10.8 and 1.33. The mean variation of the point dose as compared to the expected dose was within 2% and the gamma analysis was at 91%. Conclusion: It was concluded that 5cm field width plans produces optimal dose volume parameters with deliverable treatment time. From this initial dissymmetric study, it was concluded that the treatment planning and the dose delivery verification was feasible considering the complexity of the TMI.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-347: Effect of MLC Leaf Position Inaccuracy On Dose Distribution for Spinal SBRT with Different Energies and Dose Rates

Purpose: To evaluate dosimetric impact of spinal SBRT when MLC leaf positions deviate from planning positions for different energies and doserates. Methods and Materials: 18 localized spinal metastases patients were selected for SBRT using IMRT planning with 9 posterior beams delivered at gantry angles ranging between 100°–260°. A modern linear accelerator(Varian Turebeam STX with HDMLC 2.5 mm thick leaf at isocenter) IMRT plans were generated using both 6X and 6X-FFF(Flattening filter free) beams with a nominal prescription dose of 6 Gy/fraction to PTV. Doserates ranging from 200–600 MU/min for 6X and 400–1400 MU/min for 6X-FFF, with 200 increments were examined. A fixed amount(0.3, 0.5, 1, and 2 mm) of MLC-leaf position deviation was simulated to each plan under following conditions: 1)only along X1 collimator; 2)with increments at both X1 and X2 collimator directions;3)with reductions at both X1 and X2 collimator directions. Dose was recalculated for each modified plans. Both original and modified plans were delivered using Turebeam STX machine and measured using both portal dosimetry and a 3D dosimeter(Delta4 of ScandiDos). Each field’s Result were compared using following three parameters: the 95% iso-dose level Conformal Index(95%CI), the spinal cord maximum dose(SCDmax), and the planned target volume(PTV) mean dose. Results: Dosimetric impacts on the 95%CI, SCDmax and the PTV mean dose are: 1)negligible if MLC-leaf position deviation only along a single collimator direction ≥1.0 mm,2)substantial if MLC-leaf position increment along both collimator directions ≥0.3 mm(95% CI decreases while SCDmax and PTV mean-dose increase), 3)substantial if MLC-leaf position reduction along both collimator directions ≥0.3 mm(95% CI first increases and then decreases while SCDmax and PTV mean-dose decrease). Different energies and doserates demonstrated comparable dosimetric impacts. Conclusion: Substantial dose deviations could happen for spinal SBRT using IMRT plan with HD-MLC if leaf position deviation ≥0.3 mm. The effects of different energy and doserate are negligible.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-362: Enhanced Dynamic Wedge Output Factors for Varian 2300CD and the Case for a Reference Database

Purpose: Dose inhomogeneity in treatment planning can be compensated using physical wedges. Enhanced dynamic wedges (EDW) were introduced by Varian to overcome some of the short comings of physical wedges. The objectives of this study were to measure EDW output factors for 6 MV and 20 MV photon energies for a Varian 2300CD. Secondly to review the literature in terms of published enhanced dynamic wedge output factors (EDWOF) for different Varian models and thereby adding credence to the case of the validity of reference databases. Methods: The enhanced dynamic wedge output factors were measured for the Varian 2300CD for both 6 MV and 20 MV photon energies. Twelve papers with published EDWOF for different Varian Linac models were found in the literature. Results: The EDWOF for 6 MV varied from 0.980 for a 5×5 cm 10 degree wedge to 0.424 for 20×20 cm 60 degree wedge. Similarly for 20 MV, the EDWOF varied from 0.986 for 5×5 cm 10 degree wedge to 0.529 for 20×20 cm 60 degree wedge. EDWOF are highly dependent on field size. Comparing our results with the published mean, we found an excellent agreement for 6 MV EDWOF with the percentage differences ranging from 0.01% to 0.57% with a mean of 0.03%. The coefficient of variation of published EDWOF ranged from 0.17% to 0.85% and 0.1% to 0.9% for the for 6 MV and 18MV photon energies respectively. This paper provides the first published EDWOF for 20 MV photon energy. In addition, we have provided the first compendium of EDWOFs for different Varian linac models. Conclusion: The consistency of EDWOF across models and institution provide further support that, a standard data set of basic photon and electron dosimetry could be established, as a guide for future commissioning, beam modeling and quality assurance purposes.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-367: Evaluate the Dosimetric Impacts On Patient Specific Treatment Plans Due to Set Up Uncertainties During LINAC Annual QA and Commission

Purpose: To quantify the dosimetric impact on patient’s specific treatment plans due to set up uncertainties during LINAC commission and annual QA and to determine the maximum set up uncertainty allowance range. Methods: A 60×60×60 cm{sup 3} solid water cube was created in Varian Eclipse TPS. Beam data profiles (crossline and diagonal) and PDDs for field sizes ranging from 2×2 cm{sup 2} to 40×40 cm{sup 2} were simulated. Three main uncertainty scenarios were purposely introduced for gantry position tilts (0–5°), source axis distance changes (100–105 cm), and iso-center position shifts (0–5 mm) during the simulation. A gamma analysis was used to compare the correct simulated profiles with the profiles for each scenario. Two static IMRT treatment plans (H&N and GYN) with tumors at 5 cm and 15 cm depths were compared using similar set up uncertainties. Results: A gamma analysis using ±3%/±3mm with 90% passing rate criteria is included to show the passing rate for each scenario. Crossline and diagonal profiles showed a gamma passing rating of ≥ 90% at depth ≤10 cm for these scenarios: gantry tilted from 0–5°, SAD changed from 100–105 cm, and iso-center shifted ≤ 4 mm. From 10 to 20 cm depths, all three scenarios failed with gamma passing ≤ 90% excepted for diagonal profiles at Gantry =2°, SAD =1 cm, and iso-center =1 mm off center. Diagonal profiles showed a higher gamma passing rating compared to crossline profiles for all three scenarios. PDD differences also increased as depth increased. For patient’s specific treatment plans, maximum uncertainties allowed to obtain a ≥90% gamma passing rating are: gantry tilts ±1 degree, SAD shifts ±2 cm, and iso-center moves ±3 mm. Conclusion: This study validated AAPM TG 142 recommendations on the mechanical and dosimetry uncertainties and provided proofs on maximum acceptance tolerances for LINAC annual QA and commission.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-370: Evaluating Plan Quality and Dose Delivery Accuracy of Tomotherapy SBRT Treatments for Lung Cancer

Purpose: This study evaluated the plan quality and dose delivery accuracy of stereotactic body radiotherapy (SBRT) helical Tomotherapy (HT) treatments for lung cancer. Results were compared with those previously reported by our group for flattening filter (FF) and flattening filter free (FFF) VMAT treatments. This work forms part of an ongoing multicentre and multisystem planning and dosimetry audit on FFF beams for lung SBRT. Methods: CT datasets and DICOM RT structures delineating the target volume and organs at risk for 6 lung cancer patients were selected. Treatment plans were generated using the HT treatment planning system. Tumour locations were classified as near rib, near bronchial tree or in free lung with prescribed doses of 48Gy/4fr, 50Gy/5fr and 54Gy/3fr respectively. Dose constraints were specified by a modified RTOG0915 protocol used for an Australian SBRT phase II trial. Plan quality was evaluated using mean PTV dose, PTV volume receiving 100% of the prescribed dose (V100%), target conformity (CI=VD100%/VPTV) and low dose spillage (LDS=VD50%/VPTV). Planned dose distributions were compared to those measured using an ArcCheck phantom. Delivery accuracy was evaluated using a gamma-index pass rate of 95% with 3% (of max dose) and 3mm criteria. Results: Treatment plans for all patients were clinically acceptable in terms of quality and accuracy of dose delivery. The following DVH metrics are reported as averages (SD) of all plans investigated: mean PTV dose was 115.3(2.4)% of prescription, V100% was 98.8(0.9)%, CI was 1.14(0.03) and LDS was 5.02(0.37). The plans had an average gamma-index passing rate of 99.3(1.3)%. Conclusion: The results reported in this study for HT agree within 1 SD to those previously published by our group for VMAT FF and FFF lung SBRT treatments. This suggests that HT delivers lung SBRT treatments of comparable quality and delivery accuracy as VMAT using both FF and FFF beams.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-374: Evaluation and Verification of Dose Calculation Accuracy with Different Dose Grid Sizes for Intracranial Stereotactic Radiosurgery

Purpose: In this study, we aim to evaluate the effect of dose grid size on the accuracy of calculated dose for small lesions in intracranial stereotactic radiosurgery (SRS), and to verify dose calculation accuracy with radiochromic film dosimetry. Methods: 15 intracranial lesions from previous SRS patients were retrospectively selected for this study. The planning target volume (PTV) ranged from 0.17 to 2.3 cm{sup 3}. A commercial treatment planning system was used to generate SRS plans using the volumetric modulated arc therapy (VMAT) technique using two arc fields. Two convolution-superposition-based dose calculation algorithms (Anisotropic Analytical Algorithm and Acuros XB algorithm) were used to calculate volume dose distribution with dose grid size ranging from 1 mm to 3 mm with 0.5 mm step size. First, while the plan monitor units (MU) were kept constant, PTV dose variations were analyzed. Second, with 95% of the PTV covered by the prescription dose, variations of the plan MUs as a function of dose grid size were analyzed. Radiochomic films were used to compare the delivered dose and profile with the calculated dose distribution with different dose grid sizes. Results: The dose to the PTV, in terms of the mean dose, maximum, and minimum dose, showed steady decrease with increasing dose grid size using both algorithms. With 95% of the PTV covered by the prescription dose, the total MU increased with increasing dose grid size in most of the plans. Radiochromic film measurements showed better agreement with dose distributions calculated with 1-mm dose grid size. Conclusion: Dose grid size has significant impact on calculated dose distribution in intracranial SRS treatment planning with small target volumes. Using the default dose grid size could lead to under-estimation of delivered dose. A small dose grid size should be used to ensure calculation accuracy and agreement with QA measurements.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-388: Evaluation of Electronic Brachytherapy Dose Distributions in Tissue Equivalent Materials

Purpose: To study the measured and calculated dose distributions for electronic brachytherapy (EBT) in various tissue equivalent homogenous materials. Methods: Calculated dose distributions in water were generated using published TG-43 parameters in Varian BrachyVision software for a 50 kVp, 50 cm Xoft source. Dose distributions were measured within a 3D-scanning tank using dosimeters including: PTW 0.125 cc, pin-point, and parallel-plate ion chambers, Sun Nuclear “Edge” diode and Gafchromic EBT3 film. Multi-channel film dosimetry was used in film analysis. EBT3 film curves were calibrated via radial dose comparison to both independently measured and published data. The resulting film calibration was utilized to measure dose distributions created by titanium filtered source utilized in clinical brachytherapy applications. Data was collected within homogenous PMMA, vinyl, polystyrene, paraffin, and water-equivalent plastic phantoms. Results: Ion-chamber data was corrected to effective points of measurement and normalized prior to comparison between calculated and measured dose distributions. Measurements made in water and water equivalent materials compared well with results from treatment planning software. The maximum percent differences (relative to water) observed between 1 cm and 3.5 cm depth from source for each of the phantom materials are as follows: PMMA 35%, polystyrene 41%, plastic-water 23%, vinyl 115%, and paraffin 46%. Conclusion: The increased probability of photoelectric interactions occurring within the patient during electronic brachytherapy will emphasize the radiological differences between varying human tissues in dose deposition. These differences can Result in clinically significant dose perturbations and it is therefore recommended to move to a model based dose calculation, as outlined in TG-186, to improve the dosimetric accuracy of low energy EBT.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-392: Evaluation of Ion Chamber/film and Log File Based QA to Detect Delivery Errors

Purpose: Ion chamber and film (ICAF) is a method used to verify patient dose prior to treatment. More recently, log file based QA has been shown as an alternative for measurement based QA. In this study, we delivered VMAT plans with and without errors to determine if ICAF and/or log file based QA was able to detect the errors. Methods: Using two VMAT patients, the original treatment plan plus 7 additional plans with delivery errors introduced were generated and delivered. The erroneous plans had gantry, collimator, MLC, gantry and collimator, collimator and MLC, MLC and gantry, and gantry, collimator, and MLC errors. The gantry and collimator errors were off by 4{sup 0} for one of the two arcs. The MLC error introduced was one in which the opening aperture didn’t move throughout the delivery of the field. For each delivery, an ICAF measurement was made as well as a dose comparison based upon log files. Passing criteria to evaluate the plans were ion chamber less and 5% and film 90% of pixels pass the 3mm/3% gamma analysis(GA). For log file analysis 90% of voxels pass the 3mm/3% 3D GA and beam parameters match what was in the plan. Results: Two original plans were delivered and passed both ICAF and log file base QA. Both ICAF and log file QA met the dosimetry criteria on 4 of the 12 erroneous cases analyzed (2 cases were not analyzed). For the log file analysis, all 12 erroneous plans alerted a mismatch in delivery versus what was planned. The 8 plans that didn’t meet criteria all had MLC errors. Conclusion: Our study demonstrates that log file based pre-treatment QA was able to detect small errors that may not be detected using an ICAF and both methods of were able to detect larger delivery errors.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-418: Explore the Sensitive of the Planar Quality Assurance to the MLC Error with Different Beam Complexity in Intensity-Modulate Radiation Therapy

Purpose: The purpose of this study is to investigate the sensitivity of the planar quality assurance to MLC errors with different beam complexities in intensity-modulate radiation therapy. Methods: sixteen patients’ planar quality assurance (QA) plans in our institution were enrolled in this study, including 10 dynamic MLC (DMLC) IMRT plans measured by Portal Dosimetry and 6 static MLC (SMLC) IMRT plans measured by Mapcheck. The gamma pass rate was calculated using vender’s software. The field numbers were 74 and 40 for DMLC and SMLC, respectively. A random error was generated and introduced to these fields. The modified gamma pass rate was calculated by comparing the original measured fluence and modified fields’ fluence. A decreasing gamma pass rate was acquired using the original gamma pass rate minus the modified gamma pass rate. Eight complexity scores were calculated in MATLAB based on the fluence and MLC sequence of these fields. The complexity scores include fractal dimension, monitor unit of field, modulation index, fluence map complexity, weighted average of field area, weighted average of field perimeter, and small aperture ratio ( <5cm{sup 2} and <50cm{sup 2}). The Spearman’s rank correlation coefficient was implemented to analyze the correlation between these scores and decreasing gamma rate. Results: The relation between the decreasing gamma pass rate and field complexity was insignificant for most complexity scores. The most significant complexity score was fluence map complexity for SMLC, which have ρ =0.4274 (p-value=0.0063). For DMLC, the most significant complex score was fractal dimension, which have ρ=−0.3068 (p-value=0.0081). Conclusions: According to the primarily Result of this study, the sensitivity gamma pass rate was not strongly relate to the field complexity.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-435: Flattening Filter Free Beams for Head and Neck IMRT and VMAT Optimization

Purpose: To investigate if there is benefits of using flattening filter free (FFF) versus flattening filter (FF) beams during plan optimization for head and neck targets. Methods: Five head and neck cancer patients previously treated were selected for this study. Each plan was optimized for volumetric modulated arc therapy (VMAT) using 2 full arcs. Target volumes and the organs at risk (OAR) were outlined by the same physician. The prescription doses for each patient and the dose limits for each OAR were specified by the physician. For each patient four plans were created by varying the photon beam energy (6MV vs 10MV) and the use of FF or FFF. For each patient the prescription dose and OAR dose limits remained unchanged. Furthermore, the number of optimization iterations remained the same for each plan without user interference. The plans were compared using dose volume histograms, conformity and homogeneity indices. Results: Our results showed that the plans optimized with FF beams produced more homogeneous dose distributions in the PTV than the ones with FFF beams (0.92 vs. 0.86 and 0.92 vs.85 for 6MVFF, 6MVFFF, 10MVFF and 10MVFFF respectively). The conformity was better for FFF beams than for FF beams (1.26 vs. 1.20 and 1.27 vs. 1.21 for 6MVFF, 6MVFFF, 10MVFF and 10MVFFF respectively). The overall minimum, maximum and means doses were reduced for the FFF plans by approximately 4% to 6%. All FFF plans allowed more sparing of organs at risk by 7% to 9% on average. Only one 10MVFFF plan had a 1% higher dose than the respective 10MVFF for the spinal cord. Conclusion: The 6MVFFF and 10MVFFF beams illustrated the improvement of normal tissue sparing while achieving similar target dose distribution compared to 6MVFF and 10MVFF beams. Further investigation is required to determine the magnitude of improvement. case specific, fluence-based optimization improved both PTV and OAR dosimetry in 80% of cases.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-436: Fluence-Based Trajectory Optimization for Non-Coplanar VMAT

Purpose: To investigate a fluence-based trajectory optimization technique for non-coplanar VMAT for brain cancer. Methods: Single-arc non-coplanar VMAT trajectories were determined using a heuristic technique for five patients. Organ at risk (OAR) volume intersected during raytracing was minimized for two cases: absolute volume and the sum of relative volumes weighted by OAR importance. These trajectories and coplanar VMAT formed starting points for the fluence-based optimization method. Iterative least squares optimization was performed on control points 24° apart in gantry rotation. Optimization minimized the root-mean-square (RMS) deviation of PTV dose from the prescription (relative importance 100), maximum dose to the brainstem (10), optic chiasm (5), globes (5) and optic nerves (5), plus mean dose to the lenses (5), hippocampi (3), temporal lobes (2), cochleae (1) and brain excluding other regions of interest (1). Control point couch rotations were varied in steps of up to 10° and accepted if the cost function improved. Final treatment plans were optimized with the same objectives in an in-house planning system and evaluated using a composite metric - the sum of optimization metrics weighted by importance. Results: The composite metric decreased with fluence-based optimization in 14 of the 15 plans. In the remaining case its overall value, and the PTV and OAR components, were unchanged but the balance of OAR sparing differed. PTV RMS deviation was improved in 13 cases and unchanged in two. The OAR component was reduced in 13 plans. In one case the OAR component increased but the composite metric decreased - a 4 Gy increase in OAR metrics was balanced by a reduction in PTV RMS deviation from 2.8% to 2.6%. Conclusion: Fluence-based trajectory optimization improved plan quality as defined by the composite metric. While dose differences were case specific, fluence-based optimization improved both PTV and OAR dosimetry in 80% of cases.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-439: Fundamental Verification of Respiratory-Gated Spot Scanning Proton Beam Therapy

Purpose: The spot-scanning proton beam irradiation with respiratory gating technique provides quite well dose distribution and requires both dosimetric and geometric verification prior to clinical implementation. The purpose of this study is to evaluate the impact of gating irradiation as a fundamental verification. Methods: We evaluated field width, flatness, symmetry, and penumbra in the gated and non-gated proton beams. The respiration motion was distinguished into 3 patterns: 10, 20, and 30 mm. We compared these contents between the gated and non-gated beams. A 200 MeV proton beam from PROBEAT-III unit (Hitachi Co.Ltd) was used in this study. Respiratory gating irradiation was performed by Quasar phantom (MODUS medical devices) with a combination of dedicated respiratory gating system (ANZAI Medical Corporation). For radiochromic film dosimetry, the calibration curve was created with Gafchromic EBT3 film (Ashland) on FilmQA Pro 2014 (Ashland) as film analysis software. Results: The film was calibrated at the middle of spread out Bragg peak in passive proton beam. The field width, flatness and penumbra in non-gated proton irradiation with respiratory motion were larger than those of reference beam without respiratory motion: the maximum errors of the field width, flatness and penumbra in respiratory motion of 30 mm were 1.75% and 40.3% and 39.7%, respectively. The errors of flatness and penumbra in gating beam (motion: 30 mm, gating rate: 25%) were 0.0% and 2.91%, respectively. The results of symmetry in all proton beams with gating technique were within 0.6%. Conclusion: The field width, flatness, symmetry and penumbra were improved with the gating technique in proton beam. The spot scanning proton beam with gating technique is feasible for the motioned target.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-450: How Important Is a Reproducible Breath Hold for DIBH Breast Radiotherapy?

Purpose: Deep inspiration breath hold (DIBH) for left-sided breast cancer has been shown to reduce heart dose. Surface imaging helps to ensure accurate breast positioning, but does not guarantee a reproducible breath hold (BH) at DIBH treatments. We examine the effects of variable BH positions for DIBH treatments. Methods: Twenty-Five patients with free breathing (FB) and DIBH scans were reviewed. Four plans were created for each patient: 1) FB, 2) DIBH, 3) FB-DIBH – the DIBH plans were copied to the FB images and recalculated (image registration was based on breast tissue), and 4) P-DIBH – a partial BH with the heart shifted midway between the FB and DIBH positions. The FB-DIBH plans give “worst case” scenarios for surface imaging DIBH, where the breast is aligned by surface imaging but the patient is not holding their breath. Students t-tests were used to compare dose metrics. Results: The DIBH plans gave lower heart dose and comparable breast coverage versus FB in all cases. The FB-DIBH plans showed no significant difference versus FB plans for breast coverage, mean heart dose, or maximum heart dose (p >= 0.10). The mean heart dose differed between FB-DIBH and FB by < 2 Gy for all cases, the maximum heart dose differed by < 2 Gy for 21 cases. The P-DIBH plans showed significantly lower mean heart dose than FB (p = 0.01). The mean heart doses for the P-DIBH plans were < FB for 22 cases, the maximum dose < FB for 18 cases. Conclusions: A DIBH plan delivered to a FB patient set-up with surface imaging will yield similar dosimetry to a plan created and delivered FB. A DIBH plan delivered with even a partial BH can give reduced heart dose compared to FB techniques when the breast tissue is well aligned.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-453: Image-Guided Patient-Specific Quality Assurance for Multi-Target Single Isocenter Intracranial VMAT Radiosurgery

Purpose: To demonstrate a patient specific, image-guided quality assurance method that tests both dosimetric and geometric accuracy for single-isocenter multiple-target VMAT radiosurgery (SIMT-VMAT-SRS) Method: We used a new film type, EBT-XD (optimal range 0.4–40Gy), and an in-house PMMA phantom having a coronal plane for film and a 0.125 cm3 ionization chamber (IC). The phantom contained fiducial features for kV image guided setup and for accurate film marking. Five patient plans with multiple targets sizes ranging from 3 to 21mm in diameter and prescribed doses from 14 to 18 Gy were selected. Two verification plans were generated for each case with the film plane passing through the center of the largest and smallest targets. For the four largest targets we obtained an IC measurement. For each case, a calibration film was irradiated using a custom designed step pattern. The films were scanned using a flatbed color scanner and converted to dose using the calibration film and the three channel calibration method. Image registration was performed between film and treatment planning system calculations to evaluate the geometric accuracy. Results: The mean registration vector had an average magnitude of 0.47 mm (range from 0.13mm to 0.64 mm). For the four largest targets, the mean ratio of the IC and film measurement to expected dose was 0.990 (range 0.968 to 1.009) and 1.032 (1.021 to 1.046), respectively. The fraction of pixels having gamma index < 1 for criteria of 3%/3mm, 3%/2mm, 3%/1mm was 98.8%, 97.5% and 87.2% before geometric registration and 99.1%, 98.3% and 94.8% after registration. Conclusion: We have demonstrated an image-guided QA method can assess both geometric and dosimetric accuracy. The phantom was positioned with sub-millimeter accuracy. Absolute film dosimetry using EBT-XD film was sufficiently accurate for assessment of dose to multi-targets too small for IC measurement in SRS VMAT plans.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-490: Independent Three-Dimensional (3D) Dose Verification of VMAT/SBRT Using EPID and Cloud Computing

Purpose: Dosimetric verification of VMAT/SBRT is currently performed on one or two planes in a phantom with either film or array detectors. A robust and easy-to-use 3D dosimetric tool has been sought since the advent of conformal radiation therapy. Here we present such a strategy for independent 3D VMAT/SBRT plan verification system by a combined use of EPID and cloud-based Monte Carlo (MC) dose calculation. Methods: The 3D dosimetric verification proceeds in two steps. First, the plan was delivered with a high resolution portable EPID mounted on the gantry, and the EPID-captured gantry-angle-resolved VMAT/SBRT field images were converted into fluence by using the EPID pixel response function derived from MC simulations. The fluence was resampled and used as the input for an in-house developed Amazon cloud-based MC software to reconstruct the 3D dose distribution. The accuracy of the developed 3D dosimetric tool was assessed using a Delta4 phantom with various field sizes (square, circular, rectangular, and irregular MLC fields) and different patient cases. The method was applied to validate VMAT/SBRT plans using WFF and FFF photon beams (Varian TrueBeam STX). Results: It was found that the proposed method yielded results consistent with the Delta4 measurements. For points on the two detector planes, a good agreement within 1.5% were found for all the testing fields. Patient VMAT/SBRT plan studies revealed similar level of accuracy: an average γ-index passing rate of 99.2± 0.6% (3mm/3%), 97.4± 2.4% (2mm/2%), and 72.6± 8.4 % ( 1mm/1%). Conclusion: A valuable 3D dosimetric verification strategy has been developed for VMAT/SBRT plan validation. The technique provides a viable solution for a number of intractable dosimetry problems, such as small fields and plans with high dose gradient.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-497: Initial Characterization of a Novel 2D Computed Radiography (CR) Dosimeter for SBRT

Purpose For 2D, sub-mm resolution dose measurements Gafchromic™ film is currently a standard in radiotherapy; mainly because of its energy independence and water equivalence. However, EBT film is disposable. Therefore, the dosimetric and uniformity characteristics needs to be estimated from a second, possibly different, (calibration) film. Moreover, EBT has a post-irradiation coloration and a non-linear dose dependence with saturation, which limits the applicable time interval and dose range. CR technology forms an interesting alternative for EBT. Dose dependent CRplates have a sub-mm resolution, and additionally a linear dose dependence over decades of dose. But, CR has an inherent signal fading and energy dependence. Here, for the first time, a radiotherapy 2D CR prototype was characterized for an extended dose range (up to 35Gy), signal fading, and basic energy dependence. Methods The prototype was irradiated with a standard 10×10cm 6MV photon beam, and scanned with a commercial CR 15-X(R) scanner. The time between the start of irradiation and scanning (T-Scan) was monitored. The linearity of the dose response was evaluated between 0 and 35Gy using a fixed T-Scan of 4min, if possible (i.e. ≤10Gy). Next, the signal fading was characterized for a T-Scan-range of 4 to 20min. The energy dependence was assessed by a comparison of out-of-field measurements of CR, EBT, and TLD. Results The radiotherapy CR prototype has a linear response over the complete SBRT dose range (0– 35Gy). The prototype had a small (5%), but linear signal fading over the time interval of interest (4–20min). Out-of-field, the prototype has a 8% over response due to an increased amount of low energy photons. The impact of the over response on intensity modulated radiotherapy remains to be evaluated. Conclusion CR technology is promising for SBRT dose measurements up to 35Gy. It is a reusable linear alternative for film dosimetry.

60 APPLIED LIFE SCIENCES↗