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DOE OSTI2015

WE-D-213-03: Preparing for Part 3 of the ABR Diagnostic Physics Exam

Adequate, efficient preparation for the ABR Diagnostic and Nuclear Medical Physics exams is key to successfully obtain ABR professional certification. Each part of the ABR exam presents its own challenges: Part I: Determine the scope of basic medical physics study material, efficiently review this material, and solve related written questions/problems. Part II: Understand imaging principles, modalities, and systems, including image acquisition, processing, and display. Understand the relationship between imaging techniques, image quality, patient dose and safety, and solve related written questions/problems. Part III: Gain crucial, practical, clinical medical physics experience. Effectively communicate and explain the practice, performance, and significance of all aspects of clinical medical physics. All three parts of the ABR exam require specific skill sets and preparation: mastery of basic physics and imaging principles; written problem solving often involving rapid calculation; responding clearly and succinctly to oral questions about the practice, methods, and significance of clinical medical physics. This symposium focuses on the preparation and skill sets necessary for each part of the ABR exam. Although there is some overlap, the nuclear exam covers a different body of knowledge than the diagnostic exam. A separate speaker will address those aspects that are unique to the nuclear exam. Medical physicists who have recently completed each of part of the ABR exam will share their experiences, insights, and preparation methods to help attendees best prepare for the challenges of each part of the ABR exam. In accordance with ABR exam security policy, no recalls or exam questions will be discussed. Learning Objectives: How to prepare for Part 1 of the ABR exam by determining the scope of basic medical physics study material and related problem solving/calculations How to Prepare for Part 2 of the ABR exam by understanding diagnostic and/or nuclear imaging physics, systems, dosimetry, safety and related problem solving/calculations How to Prepare for Part 3 of the ABR exam by effectively communicating the practice, methods, and significance of clinical diagnostic and/or nuclear medical physics.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

WE-D-BRA-04: Online 3D EPID-Based Dose Verification for Optimum Patient Safety

Purpose: To develop an online 3D dose verification tool based on EPID transit dosimetry to ensure optimum patient safety in radiotherapy treatments. Methods: A new software package was developed which processes EPID portal images online using a back-projection algorithm for the 3D dose reconstruction. The package processes portal images faster than the acquisition rate of the portal imager (∼ 2.5 fps). After a portal image is acquired, the software seeks for “hot spots” in the reconstructed 3D dose distribution. A hot spot is in this study defined as a 4 cm{sup 3} cube where the average cumulative reconstructed dose exceeds the average total planned dose by at least 20% and 50 cGy. If a hot spot is detected, an alert is generated resulting in a linac halt. The software has been tested by irradiating an Alderson phantom after introducing various types of serious delivery errors. Results: In our first experiment the Alderson phantom was irradiated with two arcs from a 6 MV VMAT H&N treatment having a large leaf position error or a large monitor unit error. For both arcs and both errors the linac was halted before dose delivery was completed. When no error was introduced, the linac was not halted. The complete processing of a single portal frame, including hot spot detection, takes about 220 ms on a dual hexacore Intel Xeon 25 X5650 CPU at 2.66 GHz. Conclusion: A prototype online 3D dose verification tool using portal imaging has been developed and successfully tested for various kinds of gross delivery errors. The detection of hot spots was proven to be effective for the timely detection of these errors. Current work is focused on hot spot detection criteria for various treatment sites and the introduction of a clinical pilot program with online verification of hypo-fractionated (lung) treatments.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

WE-EF-303-08: Proton Radiography Using Pencil Beam Scanning and Novel Micromegas Detectors

Purpose: While the energy of therapeutic proton beams can be adjusted to penetrate to any given depth in water, range uncertainties arise in patients due in part to imprecise knowledge of the stopping power of protons in human tissues. Proton radiography is one approach to reduce the beam range uncertainty, thereby allowing for a reduction in treatment margins and dose escalation. Methods: The authors have adapted a novel detector technology based on Micromesh Gaseous Structure (“Micromegas”) for proton therapy beams and have demonstrated fine spatial and time resolution of magnetically scanned proton pencil beams, as well as wide dynamic range for dosimetry. In this work, proton radiographs were obtained using Micromegas 2D planes positioned downstream of solid water assemblies. The position-sensitive monitor chambers in the IBA proton delivery nozzle provide the beam entrance position. Results: Radiography with Micromegas detectors and actively scanned beams provide spatial resolution of up to 300 µm and water-equivalent thickness (WET) resolution as good as 0.02% (60 µm out of 31 cm total thickness), with the dose delivered to the patient kept below 2 cGy. The spatial resolution as a function of sample rate and number of delivered protons is found to be near the theoretical Cramer-Rao lower bound. Using the CR bound, we argue that the imaging dose could be further lowered to 1 mGy, while still achieving sub-mm spatial resolution, by relatively simple instrumentation upgrades and beam delivery modifications. Conclusion: For proton radiography, high spatial and WET resolution can be achieved, with minimal additional dose to patient, by using magnetically scanned proton pencil beams and Micromegas detectors.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

WE-G-BRA-05: IROC Houston On-Site Audits and Parameters That Affect Performance

Purpose: To highlight the IROC Houston on-site dosimetry audit program, and to investigate the impact of clinical conditions on the frequency of errors/recommendations noted by IROC Houston. Methods: The results of IROC Houston on-site audits from 2000-present were abstracted and compared to clinical parameters, this included 409 institutions and 1020 linacs. In particular, we investigated the frequency of recommendations versus year, and the impact of repeat visits on the number of recommendations. We also investigated the impact on the number of recommendations of several clinical parameters: the number and age of the linacs, the linac/TPS combination, and the scope of the QA program. Results: The number of recommendations per institution (3.1 average) has shown decline between 2000 and present, although the number of recommendations per machine (0.89) has not changed. Previous IROC Houston site visits did not Result in fewer recommendations on a repeat visit, but IROC Houston tests have changed substantially during the last 15 years as radiotherapy technology has changed. There was no impact on the number of recommendations based on the number of machines at the institution or the age of a given machine. The fewest recommendations were observed for Varian-Eclipse combinations (0.71 recs/machine), while Elekta- Pinnacle combinations yielded the most (1.62 recs/machine). Finally, in the TG-142 era (post-2010), those institutions that had a QA recommendation (n=77) had significantly more other recommendations (1.83 per institution) than those that had no QA rec (n=12, 1.33 per institution). Conclusion: Establishing and maintaining a successful radiotherapy program is challenging and areas of improvement can routinely be identified. Clinical conditions such as linac-TPS combinations and the establishment of a good QA program impact the frequency of errors/deficiencies identified by IROC Houston during their on-site review process.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

WE-G-BRA-09: Microsphere Brachytherapy Failure Mode and Effects Analysis in a Dual-Vendor Environment

Purpose: To improve the safety and quality of a dual-vendor microsphere brachytherapy program with failure mode and effects analysis (FMEA). Methods: A multidisciplinary team including physicists, dosimetrists, a radiation oncologist, an interventional radiologist, and radiation safety personnel performed an FMEA for our dual-vendor microsphere brachytherapy program employing SIR-Spheres (Sirtex Medical Limited, Australia) and Theraspheres (BTG, England). We developed a program process tree and step-by-step instructions which were used to generate a comprehensive list of failure modes. These modes were then ranked according to severity, occurrence rate, and detectability. Risk priority numbers (RPNs) were calculated by multiplying these three scores together. Three different severity scales were created: one each for harmful effects to the patient, staff, or the institution. Each failure mode was ranked on one or more of these scales. Results: The group identified 164 failure modes for the microsphere program. 113 of these were ranked using the patient severity scale, 52 using the staff severity scale, and 50 using the institution severity scale. The highest ranked items on the patient severity scale were an error in the automated dosimetry worksheet (RPN = 297.5), and the incorrect target specified on the planning study (RPN = 135). Some failure modes ranked differently between vendors, especially those corresponding to dose vial preparation because of the different methods used. Based on our findings, we made several improvements to our QA program, including documentation to easily identify which product is being used, an additional hand calculation during planning, and reorganization of QA steps before treatment delivery. We will continue to periodically review and revise the FMEA. Conclusion: We have applied FMEA to our dual-vendor microsphere brachytherapy program to identify potential key weaknesses in the treatment chain. Our FMEA results were used to improve the effectiveness of our overall microsphere program.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

Commissioning optically stimulated luminescence in vivo dosimeters for fast neutron therapy

Purpose: Clinical in vivo dosimeters intended for use with photon and electron therapies have not been utilized for fast neutron therapy because they are highly susceptible to neutron damage. The objective of this work was to determine if a commercial optically stimulated luminescence (OSL) in vivo dosimetry system could be adapted for use in fast neutron therapy. Methods: A 50.5 MeV fast neutron beam generated by a clinical neutron therapy cyclotron was used to irradiate carbon doped aluminum oxide (Al{sub 2}O{sub 3}:C) optically simulated luminescence dosimeters (OSLDs) in a solid water phantom under standard calibration conditions, 150 cm SAD, 1.7 cm depth, and 10.3 × 10.0 cm field size. OSLD fading and electron trap depletion studies were performed with the OSLDs irradiated with 20 and 50 cGy and monitored over a 24-h period to determine the optimal time for reading the dosimeters during calibration. Four OSLDs per group were calibrated over a clinical dose range of 0–150 cGy. Results: OSLD measurement uncertainties were lowered to within ±2%–3% of the expected dose by minimizing the effect of transient fading that occurs with neutron irradiation and maintaining individual calibration factors for each dosimeter. Dose dependent luminescence fading extended beyond the manufacturer’s recommended 10 min period for irradiation with photon or electron beams. To minimize OSL variances caused by inconsistent fading among dosimeters, the observed optimal time for reading the OSLDs postirradiation was between 30 and 90 min. No field size, wedge factor, or gantry angle dependencies were observed in the OSLDs irradiated by the studied fast neutron beam. Conclusions: Measurements demonstrated that uncertainties less than ±3% were attainable in OSLDs irradiated with fast neutrons under clinical conditions. Accuracy and precision comparable to clinical OSL measurements observed with photons can be achieved by maintaining individual OSLD calibration factors and minimizing transient fading effects.

61 RADIATION PROTECTION AND DOSIMETRY↗
DOE OSTI2016

Energy dependent calibration of XR-QA2 radiochromic film with monochromatic and polychromatic x-ray beams

Purpose: This work investigates the energy response and dose-response curve determinations for XR-QA2 radiochromic film dosimetry system used for synchrotron radiation work and for quality assurance in diagnostic radiology, in the range of effective energies 18–46.5 keV. Methods: Pieces of XR-QA2 films were irradiated, in a plane transverse to the beam axis, with a monochromatic beam of energy in the range 18–40 keV at the ELETTRA synchrotron radiation facility (Trieste, Italy) and with a polychromatic beam from a laboratory x-ray tube operated at 80, 100, and 120 kV. The film calibration curve was expressed as air kerma (measured free-in-air with an ionization chamber) versus the net optical reflectance change (netΔR) derived from the red channel of the RGB scanned film image. Four functional relationships (rational, linear exponential, power, and logarithm) were tested to evaluate the best curve for fitting the calibration data. The adequacy of the various fitting functions was tested by using the uncertainty analysis and by assessing the average of the absolute air kerma error calculated as the difference between calculated and delivered air kerma. The sensitivity of the film was evaluated as the ratio of the change in net reflectance to the corresponding air kerma. Results: The sensitivity of XR-QA2 films increased in the energy range 18–39 keV, with a maximum variation of about 170%, and decreased in the energy range 38–46.5 keV. The present results confirmed and extended previous findings by this and other groups, as regards the dose response of the radiochromic film XR-QA2 to monochromatic and polychromatic x-ray beams, respectively. Conclusions: The XR-QA2 radiochromic film response showed a strong dependence on beam energy for both monochromatic and polychromatic beams in the range of half value layer values from 0.55 to 6.1 mm Al and corresponding effective energies from 18 to 46.5 keV. In this range, the film response varied by 170%, from a minimum sensitivity of 0.0127 to a maximum sensitivity of 0.0219 at 10 mGy air kerma in air. The more suitable function for air kerma calibration of the XR-QA2 radiochromic film was the power function. A significant batch-to-batch variation, up to 55%, in film response at 120 kV (46.5 keV effective energy) was observed in comparison with published data.

61 RADIATION PROTECTION AND DOSIMETRY↗
DOE OSTI2016

Effect of reconstruction methods and x-ray tube current–time product on nodule detection in an anthropomorphic thorax phantom: A crossed-modality JAFROC observer study

Purpose: To evaluate nodule detection in an anthropomorphic chest phantom in computed tomography (CT) images reconstructed with adaptive iterative dose reduction 3D (AIDR{sup 3D}) and filtered back projection (FBP) over a range of tube current–time product (mAs). Methods: Two phantoms were used in this study: (i) an anthropomorphic chest phantom was loaded with spherical simulated nodules of 5, 8, 10, and 12 mm in diameter and +100, −630, and −800 Hounsfield units electron density; this would generate CT images for the observer study; (ii) a whole-body dosimetry verification phantom was used to ultimately estimate effective dose and risk according to the model of the BEIR VII committee. Both phantoms were scanned over a mAs range (10, 20, 30, and 40), while all other acquisition parameters remained constant. Images were reconstructed with both AIDR{sup 3D} and FBP. For the observer study, 34 normal cases (no nodules) and 34 abnormal cases (containing 1–3 nodules, mean 1.35 ± 0.54) were chosen. Eleven observers evaluated images from all mAs and reconstruction methods under the free-response paradigm. A crossed-modality jackknife alternative free-response operating characteristic (JAFROC) analysis method was developed for data analysis, averaging data over the two factors influencing nodule detection in this study: mAs and image reconstruction (AIDR{sup 3D} or FBP). A Bonferroni correction was applied and the threshold for declaring significance was set at 0.025 to maintain the overall probability of Type I error at α = 0.05. Contrast-to-noise (CNR) was also measured for all nodules and evaluated by a linear least squares analysis. Results: For random-reader fixed-case crossed-modality JAFROC analysis, there was no significant difference in nodule detection between AIDR{sup 3D} and FBP when data were averaged over mAs [F(1, 10) = 0.08, p = 0.789]. However, when data were averaged over reconstruction methods, a significant difference was seen between multiple pairs of mAs settings [F(3, 30) = 15.96, p < 0.001]. Measurements of effective dose and effective risk showed the expected linear dependence on mAs. Nodule CNR was statistically higher for simulated nodules on images reconstructed with AIDR{sup 3D} (p < 0.001). Conclusions: No significant difference in nodule detection performance was demonstrated between images reconstructed with FBP and AIDR{sup 3D}. mAs was found to influence nodule detection, though further work is required for dose optimization.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

Development of a method to estimate organ doses for pediatric CT examinations

Purpose: To develop a method for estimating doses to primarily exposed organs in pediatric CT by taking into account patient size and automatic tube current modulation (ATCM). Methods: A Monte Carlo CT dosimetry software package, which creates patient-specific voxelized phantoms, accurately simulates CT exposures, and generates dose images depicting the energy imparted on the exposed volume, was used. Routine head, thorax, and abdomen/pelvis CT examinations in 92 pediatric patients, ranging from 1-month to 14-yr-old (49 boys and 43 girls), were simulated on a 64-slice CT scanner. Two sets of simulations were performed in each patient using (i) a fixed tube current (FTC) value over the entire examination length and (ii) the ATCM profile extracted from the DICOM header of the reconstructed images. Normalized to CTDI{sub vol} organ dose was derived for all primary irradiated radiosensitive organs. Normalized dose data were correlated to patient’s water equivalent diameter using log-transformed linear regression analysis. Results: The maximum percent difference in normalized organ dose between FTC and ATCM acquisitions was 10% for eyes in head, 26% for thymus in thorax, and 76% for kidneys in abdomen/pelvis. In most of the organs, the correlation between dose and water equivalent diameter was significantly improved in ATCM compared to FTC acquisitions (P < 0.001). Conclusions: The proposed method employs size specific CTDI{sub vol}-normalized organ dose coefficients for ATCM-activated and FTC acquisitions in pediatric CT. These coefficients are substantially different between ATCM and FTC modes of operation and enable a more accurate assessment of patient-specific organ dose in the clinical setting.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

Polarity effects and apparent ion recombination in microionization chambers

Purpose: Microchambers demonstrate anomalous voltage-dependent polarity effects. Existing polarity and ion recombination correction factors do not account for these effects. As a result, many commercial microchamber models do not meet the specification of a reference-class ionization chamber as defined by the American Association of Physicists in Medicine. The purpose of this investigation is to determine the cause of these voltage-dependent polarity effects. Methods: A series of microchamber prototypes were produced to isolate the source of the voltage-dependent polarity effects. Parameters including ionization-chamber collecting-volume size, stem and cable irradiation, chamber assembly, contaminants, high-Z materials, and individual chamber components were investigated. Measurements were performed with electrodes coated with graphite to isolate electrode conductivity. Chamber response was measured as the potential bias of the guard electrode was altered with respect to the collecting electrode, through the integration of additional power supplies. Ionization chamber models were also simulated using COMSOL Multiphysics software to investigate the effect of a potential difference between electrodes on electric field lines and collecting volume definition. Results: Investigations with microchamber prototypes demonstrated that the significant source of the voltage-dependent polarity effects was a potential difference between the guard and collecting electrodes of the chambers. The voltage-dependent polarity effects for each prototype were primarily isolated to either the guard or collecting electrode. Polarity effects were reduced by coating the isolated electrode with a conductive layer of graphite. Polarity effects were increased by introducing a potential difference between the electrodes. COMSOL simulations further demonstrated that for a given potential difference between electrodes, the collecting volume of the chamber changed as the applied voltage was altered, producing voltage-dependent polarity effects in the chamber response. Ionization chamber measurements and COMSOL simulations demonstrated an inverse relationship between the chamber collecting volume size and the severity of voltage-dependent polarity effects on chamber response. The effect of a given potential difference on chamber polarity effects was roughly ten times greater for microchambers as compared to Farmer-type chambers. Stem and cable irradiations, chamber assembly, contaminants, and high-Z materials were not found to be a significant source of the voltage-dependent polarity effects. Conclusions: A potential difference between the guard and collecting electrodes was found to be the primary source of the voltage-dependent polarity effects demonstrated by microchambers. For a given potential difference between electrodes, the relative change in the collecting volume is smaller for larger-volume chambers, illustrating why these polarity effects are not seen in larger-volume chambers with similar guard and collecting electrode designs. Thus, for small-volume chambers, it is necessary to reduce the potential difference between the guard and collecting electrodes in order to reduce polarity effects for reference dosimetry measurements.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

Technical Note: Evaluation of the systematic accuracy of a frameless, multiple image modality guided, linear accelerator based stereotactic radiosurgery system

Purpose: To evaluate the total systematic accuracy of a frameless, image guided stereotactic radiosurgery system. Methods: The localization accuracy and intermodality difference was determined by delivering radiation to an end-to-end prototype phantom, in which the targets were localized using optical surface monitoring system (OSMS), electromagnetic beacon-based tracking (Calypso®), cone-beam CT, “snap-shot” planar x-ray imaging, and a robotic couch. Six IMRT plans with jaw tracking and a flattening filter free beam were used to study the dosimetric accuracy for intracranial and spinal stereotactic radiosurgery treatment. Results: End-to-end localization accuracy of the system evaluated with the end-to-end phantom was 0.5 ± 0.2 mm with a maximum deviation of 0.9 mm over 90 measurements (including jaw, MLC, and cone measurements for both auto and manual fusion) for single isocenter, single target treatment, 0.6 ± 0.4 mm for multitarget treatment with shared isocenter. Residual setup errors were within 0.1 mm for OSMS, and 0.3 mm for Calypso. Dosimetric evaluation based on absolute film dosimetry showed greater than 90% pass rate for all cases using a gamma criteria of 3%/1 mm. Conclusions: The authors’ experience demonstrates that the localization accuracy of the frameless image-guided system is comparable to robotic or invasive frame based radiosurgery systems.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

Technical Note: Dosimetric effects of couch position variability on treatment plan quality with an MRI-guided Co-60 radiation therapy machine

Purpose: Magnetic resonance imaging (MRI) guidance in radiation therapy brings real-time imaging and adaptive planning into the treatment vault where it can account for interfraction and intrafraction movement of soft tissue. The only commercially available MRI-guided radiation therapy device is a three-head {sup 60}Co and MRI system with an integrated treatment planning system (TPS). Couch attenuation of the beam of up to 20% is well modeled in the TPS. Variations in the patient’s day-to-day position introduce discrepancies in the actual couch attenuation as modeled in the treatment plan. For this reason, the authors’ institution avoids plans with beams that pass through or near the couch edges. This study investigates the effects of differential beam attenuation by the couch due to couch shifts in order to determine whether couch edge avoidance restrictions can be lifted. Couch shifts were simulated using a Monte Carlo treatment planning system and ion chamber measurements performed for validation. Methods: A total of 27 plans from 23 patients were investigated. Couch shifts of 1 and 2 cm were introduced in combinations of lateral and vertical directions to simulate patient position variations giving 16 shifted plans per reference plan. The 1 and 2 cm shifts were based on shifts recorded in 320 treatment fractions. Results: Following TG176 recommendations for measurement methods, couch attenuation measurements agreed with TPS modeled attenuation to within 2.1%. Planning target volume D95 changed less than 1% for 1 and 2 cm couch shifts in only the x-direction and less than 3% for all directions. Conclusions: Dosimetry of all plans tested was robust to couch shifts up to ±2 cm. In general, couch shifts resulted in clinically insignificant dosimetric deviations. It is conceivable that in certain cases with large systematic couch shifts and plans that are particularly sensitive to shifts, dosimetric changes might rise to a clinically significant level.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-C-201-05: Silicon Array Dosimeter in Situ with Electronic Portal Image Device for Simultaneous Transit Dose and Image Verification in Radiotherapy

Purpose: To investigate an Electronic Portal Imaging Device (EPID) coupled to a 2D array dosimeter to provide simultaneous imaging and dose verification. Methods: The novel dual detector configuration comprised of a 2D diode array dosimeter, referred to as a Magic Plate (MP) placed directly on a standard EPID. Dose response of the MP was evaluated by measuring the detector’s response with respect to off-axis position and field size with 30 cm of solid water (SW) acting as a transit object in the beam. Measurements were performed with 3, 5, 10 and 15 mm SW build-up and compared to 2D ionisation chamber array (ICA) measurements and the PinnacleTM treatment planning system (TPS) at a source to detector distance of 150 cm with a 6 MV beam. Clinical dosimetric performance was evaluated by measuring a number of intensity-modulated radiation therapy (IMRT) beams in transit geometry. Imaging performance of the EPID was quantified by measuring the contrast-to-noise ratio (CNR) and spatial resolution. Images of a Rando phantom were used for qualitative assessment. Results: Measured MP off-axis and field size response agreed within 2% of TPS and ICA responses when measured using 15 mm SW build-up. Clinical IMRT beams had gamma pass rates of ≥95% at 3%/3mm criteria. Measured CNR and spatial resolution (f50) were 264.96, 210.6, and 0.41, 0.40 with build-up of 5 and 15 mm respectively for the dual detector configuration. CNR and spatial resolution of 643.9 and 0.41 were measured for standard EPID. CNR was quantitatively worse in the dual detector configuration. Differences in imaging performance were not visible in a qualitative assessment using a Rando phantom. Conclusion: Combining a prototype MP 2D dosimeter with a conventional EPID did not significantly detract from the performance of either device and has the potential for simultaneous on-line patient transit dosimetry and image assessment in radiation therapy. Cancer Institute NSW Australia(Research Equipment Grant 10/REG/1-20) and Cancer Council NSW (Grant ID RG 1-06)

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-C-207A-02: Proton Radiography Using Pencil Beam Scanning and a Novel, Low-Cost Range Telescope

Purpose: While the energy of therapeutic proton beams can be adjusted to penetrate to any given depth in water, range uncertainties arise in patients due in part to imprecise knowledge of the stopping power of protons in human tissues [1]. Proton radiography is one approach to reduce the beam range uncertainty [2], thereby allowing for a reduction in treatment margins and dose escalation. Methods: The authors have adapted a novel detector technology based on Micromesh Gaseous Structure (“Micromegas”) for proton therapy beams and have demonstrated fine spatial and time resolution of magnetically scanned proton pencil beams, as well as wide dynamic range for dosimetry [3]. The authors have constructed a prototype imaging system comprised of 5 Micromegas layers. Proton radiographs were obtained downstream of solid water assemblies. The position-sensitive monitor chambers in the IBA proton delivery nozzle provide the beam entrance position. Results: Our technique achieves spatial resolution as low as 300 µm and water-equivalent thickness (WET) resolution as good as 0.02% (60 µm out of 31 cm total thickness). The dose delivered to the patient is kept below 2 cGy. The spatial resolution as a function of sample rate and number of delivered protons is found to be near the theoretical Cramer-Rao lower bound. By extrapolating the CR bound, we argue that the imaging dose could be further lowered to 1 mGy, while still achieving submillimeter spatial resolution, by achievable instrumentation and beam delivery modifications. Conclusion: For proton radiography, high spatial and WET resolution can be achieved, with minimal additional dose to patient, by using magnetically scanned proton pencil beams and Micromegas detectors.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-SPS-04: Dosimetric Evaluation of the Dose Calculation Accuracy of Different Algorithms for Two Different Treatment Techniques During Whole Breast Irradiation

Purpose: In this study, dosimetric comparison of field in field (FIF) and intensity modulated radiation therapy (IMRT) techniques used for treatment of whole breast radiotherapy (WBRT) were made. The dosimetric accuracy of treatment planning system (TPS) for Anisotropic Analytical Algorithm (AAA) and Acuros XB (AXB) algorithms in predicting PTV and OAR doses was also investigated. Methods: Two different treatment planning techniques of left-sided breast cancer were generated for rando phantom. FIF and IMRT plans were compared for doses in PTV and OAR volumes including ipsilateral lung, heart, left ascending coronary artery, contralateral lung and the contralateral breast. PTV and OARs doses and homogeneity and conformality indexes were compared between two techniques. The accuracy of TPS dose calculation algorithms was tested by comparing PTV and OAR doses measured by thermoluminescent dosimetry with the dose calculated by the TPS using AAA and AXB for both techniques. Results: IMRT plans had better conformality and homogeneity indexes than FIF technique and it spared OARs better than FIF. While both algorithms overestimated PTV doses they underestimated all OAR doses. For IMRT plan, PTV doses, overestimation up to 2.5 % was seen with AAA algorithm but it decreased to 1.8 % when AXB algorithm was used. Based on the results of the anthropomorphic measurements for OAR doses, underestimation greater than 7 % is possible by the AAA. The results from the AXB are much better than the AAA algorithm. However, underestimations of 4.8 % were found in some of the points even for AXB. For FIF plan, similar trend was seen for PTV and OARs doses in both algorithm. Conclusion: When using the Eclipse TPS for breast cancer, AXB the should be used instead of the AAA algorithm, bearing in mind that the AXB may still underestimate all OAR doses.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-E-06: Dosimetric Characterization of Small Photons Beams of a Novel Linear Accelerator

Purpose: The aim of the present contribution was to measure the main dosimetric quantities of small fields produced by UNIQUE and evaluate its matching with the corresponding dosimetric data of one 21EX conventional linear accelerator (Varian) in operation at the same center. The second step was to evaluate comparative performance of the EDGE diode detector and the PinPoint micro-ionization chamber for dosimetry of small fields. Methods: UNIQUE is configured with MLC (120 leaves with 0.5 cm leaf width) and a single low photon energy of 6 MV. Beam data were measured with scanning EDGE diode detector (volume of 0.019 mm{sup 3}), a PinPoint micro-ionization chamber (PTW) and for larger fields (≥ 4×4cm{sup 2}) a PTW Semi flex chamber (0.125 cm{sup 3}) was used. The scanning system used was the 3D cylindrical tank manufactured by Sun Nuclear, Inc. The measurement of PDD and profiles were done at 100 cm SSD and 1.5 depth; the relative output factors were measured at 10 cm depth. Results: PDD and the profile data showed less than 1% variation between the two linear accelerators for fields size between 2×2 cm{sup 2} and 5×5cm{sup 2}. Output factor differences was less than 1% for field sizes between 3×3 cm{sup 2} and 10×10 cm{sup 2} and less of 1.5 % for fields of 1.5×1.5 cm{sup 2} and 2×2 cm{sup 2} respectively. The dmax value of the EDGE diode detector, measured from the PDD, was 8.347 mm for 0.5×0,5cm{sup 2} for UNIQUE. The performance of EDGE diode detector was comparable for all measurements in small fields. Conclusion: UNIQUE linear accelerator show similar dosimetrics characteristics as conventional 21EX Varian linear accelerator for small, medium and large field sizes.EDGE detector show good performance by measuring dosimetrics quantities in small fields typically used in IMRT and radiosurgery treatments.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-P-27: The Study of Actual DVH for Target and OARs During the Radiotherapy of Non-Small Cell Lung Cancer

Purpose: To analyze the changes of the volume and dosimetry of target and organs at risk (OARs) by comparing the daily CBCT images and planning CT images of the patients with Non-Small Cell Lung Cancer (NSCLC) and analyze the difference between planned dose and accumulated dose. Methods: This study retrospectively analyzed eight cases of non-small cell lung cancer patients who accepted CRT or IMRT treatment and KV-CBCT. For each patient, the prescription dose was 60Gy and the fraction dose was 2Gy. Deform the daily CBCT images to planning CT images by the mapping of registration to compare the planning dose with cumulative dose of targets and organs at risk in RayStation. Results: The average volume of GTV of 8 patients with CBCT was 88.26% of the original volume. The average plan dose of GTV was 64.49±2.40Gy. The accumulated dose of GTV was 60.13±2.70Gy (P≤0.05). The average volume of PTV to reach the prescription dose was 95.59% for original plan and 81.47% for accumulated plan (P≤0.05). The volume changes of the left and right lung of the original volume was 88.95% and 80.32%, respectively. The average dose of the left and right lung of original plan was 9.31±1.75Gy and 4.33±1.10Gy, respectively(P≥0.05). The average accumulated dose was 9.63±1.96Gy and 4.63±1.36Gy, respectively(P≥0.05). The average plan dose and accumulated dose of heart was 6.88±1.70Gy and 6.38±0.91Gy, respectively (P≥0.05). The average plan maximum dose and accumulated dose for spinal cord was 24.62±5.91Gy and 26.00±5.14Gy, respectively (P≥0.05). Conclusion: The changes of target anatomical structure with NSCLC make difference between the planned dose and cumulative dose. With the dose deformation method, the dose gap can be found between planning dose and delivery dose.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-P-33: Combining Research and Professional Practice in the Clinical Setting: A Medical Physicist Personal Experience

Purpose: To initiate a discussion on the current and evolving role of Medical Physicists based on author’s professional and research experience in patient safety and quality control. Methods: Several professionals of the departments of Medical Physics and Radiation Oncology, chiefly devoted to clinical tasks, began a research program on patient safety and quality control in a framework provided by the implementation of intraoperative radiotherapy (IORT). We performed studies on virtual simulation for IORT, in vivo dosimetry, failure mode and effect analysis (FMEA), statistical process control (SPC), and receiver operating characteristics of dosimetric equipment. This was done with the support of our research foundation and different grants while continuing with our departmental clinical routine involving about 1600 annual treatments with two linacs and different brachytherapy techniques. Results: We published 5 papers in international journals in the last two years. This author conducted a doctoral research which resulted in a dissertation in 2015. The extra time spent after treatments was essential to succeed. Funding and support achieved via our foundation played a crucial role; but this would have not been possible without punctual external mentoring and partnership. FMEA conclusions were able to be implemented only with staff commitment; however, conclusions concerning equipment cannot be easily communicated to manufacturers. These tasks required extra training in the appropriated methods. Conclusion: Research needed the support of a dedicated foundation, which would have been very difficult to obtain with the sole participation of our departments. FMEA and SPC results may need engagement of staff and manufacturers, respectively, hard to achieve without strong recommendations or even a regulatory framework. All these fields need evolution of Medical Physicists’ roles and additional training. Devotion to both clinical tasks and research could be unfeasible for Medical Physicists in the clinical setting without the appropriate rearrangement of their schedules and tasks. Supported by grants IPT-300000-2010-3 and PI11/01659. ERDF funds and Spanish Government.

60 APPLIED LIFE SCIENCES↗