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DOE OSTI2016

SU-F-P-34: Commission of Enhanced Dynamic Wedge of Varian Truebeam Linac System with Feature Study

Purpose: To evaluate an Enhanced Dynamic Wedge (EDW) as part of machine commission process with feature study. Methods: The EDW system in this study was from a Truebeam, which is the Linear accelerator manufactured by Varian Medical Systems. The EDW feature vectors includes selected elements. These elements were dosimetric output spots check, field size, wedge angles, dose rate, collimator orientation, and different energy settings. Point dose measurement was done by a PTW farmer chamber, and profiles were measured by Gafchromic EBT2 films positing at different depths of the Solidwater based on the study elements. The output spot measurements were done with PTW farmer chamber with Solidwater setting for all orientation and wedge angles in the EDW system. The profiles comparisons were done by IMRT measurement function in RIT software at version 6.3. And the films were scanned by Vidar scanner. Dosimetry calculation were done by using the same Solidwater scanned by GE LightSpeed CT in Eclipse Treatment Planning System (TPS). Then measurements were compared to simulation results in TPS. Results: The energy average percentage difference between chamber measurement and TPS was 0.16% with standard deviation (SD) at 0.93%. For selected features, the average percentage difference between film measurement and computation was 0.93% with SD at 1.55% in horizontal profiles, and 1.18% with SD at 0.98% at vertical profiles. The average gamma difference for film measurement and TPS computing results was at 0.924 with SD at 0.314. Conclusion: A feature vector was developed to describe the commission of EDW, and developing a complete set of features for sufficiency of commission of a LINAC function could provide optimal commission instance with acceptable confident level of clinical application of the machine. Given the institution specific vector pattern and big data process, it could provide wide range clinical outcome comparison information in application of EDW.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-P-37: Implementation of An End-To-End QA Test of the Radiation Therapy Imaging, Planning and Delivery Process to Identify and Correct Possible Sources of Deviation

Purpose: To implement an end-to-end QA test of the radiation therapy imaging, planning and delivery process, aimed to assess the dosimetric agreement accuracy between planned and delivered treatment, in order to identify and correct possible sources of deviation. To establish an internal standard for machine commissioning acceptance. Methods: A test involving all steps of the radiation therapy: imaging, planning and delivery process was designed. The test includes analysis of point dose and planar dose distributions agreement between TPS calculated and measured dose. An ad hoc 16 cm diameter PMMA phantom was constructed with one central and four peripheral bores that can accommodate calibrated electron density inserts. Using Varian Eclipse 10.0 and Elekta XiO 4.50 planning systems, IMRT, RapidArc and 3DCRT with hard and dynamic wedges plans were planned on the phantom and tested. An Exradin A1SL chamber is used with a Keithley 35617EBS electrometer for point dose measurements in the phantom. 2D dose distributions were acquired using MapCheck and Varian aS1000 EPID.Gamma analysis was performed for evaluation of 2D dose distribution agreement using MapCheck software and Varian Portal Dosimetry Application.Varian high energy Clinacs Trilogy, 2100C/CD, 2000CR and low energy 6X/EX where tested.TPS-CT# vs. electron density table were checked for CT-scanners used. Results: Calculated point doses were accurate to 0.127% SD: 0.93%, 0.507% SD: 0.82%, 0.246% SD: 1.39% and 0.012% SD: 0.01% for LoX-3DCRT, HiX-3DCRT, IMRT and RapidArc plans respectively. Planar doses pass gamma 3% 3mm in all cases and 2% 2mm for VMAT plans. Conclusion: Implementation of a simple and reliable quality assurance tool was accomplished. The end-to-end proved efficient, showing excellent agreement between planned and delivered dose evidencing strong consistency of the whole process from imaging through planning to delivery. This test can be used as a first step in beam model acceptance for clinical use.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-I-01: Normalized Mean Glandular Dose Values for Dedicated Breast CT Using Realistic Breast-Shaped Phantoms

Purpose: To estimate normalized mean glandular dose values for dedicated breast CT (DgN-CT) using breast CT-derived phantoms and compare to estimations using cylindrical phantoms. Methods: Segmented breast CT (bCT) volume data sets (N=219) were used to measure effective diameter profiles and were grouped into quintiles by volume. The profiles were averaged within each quintile to represent the range of breast sizes found clinically. These profiles were then used to generate five voxelized computational phantoms (V1, V2, V3, V4, V5 for the small to large phantom sizes, respectively), and loaded into the MCNP6 lattice geometry to simulate normalized mean glandular dose coefficients (DgN-CT) using the system specifications of the Doheny-prototype bCT scanner in our laboratory. The DgN-CT coefficients derived from the bCT-derived breast-shaped phantoms were compared to those generated using a simpler cylindrical phantom using a constant volume, and the following constraints: (1) Length=1.5*radius; (2) radius determined at chest wall (Rcw), and (3) radius determined at the phantom center-of-mass (Rcm). Results: The change in Dg-NCT coefficients averaged across all phantom sizes, was - 0.5%, 19.8%, and 1.3%, for constraints 1–3, respectively. This suggests that the cylindrical assumption is a good approximation if the radius is taken at the breast center-of-mass, but using the radius at the chest wall results in an underestimation of the glandular dose. Conclusion: The DgN-CT coefficients for bCT-derived phantoms were compared against the assumption of a cylindrical phantom and proved to be essentially equivalent when the cylinder radius was set to r=1.5/L or Rcm. While this suggests that for dosimetry applications a patient’s breast can be approximated as a cylinder (if the correct radius is applied), this assumes a homogenous composition of breast tissue and the results may be different if the realistic heterogeneous distribution of glandular tissue is considered. Research reported in this paper was supported in part by the National Cancer Institute of the National Institutes of Health under award R01CA181081. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institue of Health.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-I-13: Correction Factor Computations for the NIST Ritz Free Air Chamber for Medium-Energy X Rays

Purpose: The National Institute of Standards and Technology (NIST) uses 3 free-air chambers to establish primary standards for radiation dosimetry at x-ray energies. For medium-energy × rays, the Ritz free-air chamber is the main measurement device. In order to convert the charge or current collected by the chamber to the radiation quantities air kerma or air kerma rate, a number of correction factors specific to the chamber must be applied. Methods: We used the Monte Carlo codes EGSnrc and PENELOPE. Results: Among these correction factors are the diaphragm correction (which accounts for interactions of photons from the x-ray source in the beam-defining diaphragm of the chamber), the scatter correction (which accounts for the effects of photons scattered out of the primary beam), the electron-loss correction (which accounts for electrons that only partially expend their energy in the collection region), the fluorescence correction (which accounts for ionization due to reabsorption ffluorescence photons and the bremsstrahlung correction (which accounts for the reabsorption of bremsstrahlung photons). We have computed monoenergetic corrections for the NIST Ritz chamber for the 1 cm, 3 cm and 7 cm collection plates. Conclusion: We find good agreement with other’s results for the 7 cm plate. The data used to obtain these correction factors will be used to establish air kerma and it’s uncertainty in the standard NIST x-ray beams.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-J-111: A Novel Distance-Dose Weighting Method for Label Fusion in Multi- Atlas Segmentation for Prostate Radiation Therapy

Purpose: A novel distance-dose weighting method for label fusion was developed to increase segmentation accuracy in dosimetrically important regions for prostate radiation therapy. Methods: Label fusion as implemented in the original SIMPLE (OS) for multi-atlas segmentation relies iteratively on the majority vote to generate an estimated ground truth and DICE similarity measure to screen candidates. The proposed distance-dose weighting puts more values on dosimetrically important regions when calculating similarity measure. Specifically, we introduced distance-to-dose error (DDE), which converts distance to dosimetric importance, in performance evaluation. The DDE calculates an estimated DE error derived from surface distance differences between the candidate and estimated ground truth label by multiplying a regression coefficient. To determine the coefficient at each simulation point on the rectum, we fitted DE error with respect to simulated voxel shift. The DEs were calculated by the multi-OAR geometry-dosimetry training model previously developed in our research group. Results: For both the OS and the distance-dose weighted SIMPLE (WS) results, the evaluation metrics for twenty patients were calculated using the ground truth segmentation. The mean difference of DICE, Hausdorff distance, and mean absolute distance (MAD) between OS and WS have shown 0, 0.10, and 0.11, respectively. In partial MAD of WS which calculates MAD within a certain PTV expansion voxel distance, the lower MADs were observed at the closer distances from 1 to 8 than those of OS. The DE results showed that the segmentation from WS produced more accurate results than OS. The mean DE error of V75, V70, V65, and V60 were decreased by 1.16%, 1.17%, 1.14%, and 1.12%, respectively. Conclusion: We have demonstrated that the method can increase the segmentation accuracy in rectum regions adjacent to PTV. As a result, segmentation using WS have shown improved dosimetric accuracy than OS. The WS will provide dosimetrically important label selection strategy in multi-atlas segmentation. CPRIT grant RP150485.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-J-125: Effects of Couch Position Variability On Dosimetric Accuracy 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 60Co and MRI system with an integrated treatment planning system (TPS). An up to 20% attenuation of the beam by the couch is well modeled in the TPS. However, variations in the patient’s day-to-day position introduce discrepancies in the actual couch position relative its location as modeled in the treatment plan. For this reason, our institution avoids plans with beams that pass through or near the couch edges. This study looks at plans without restriction on beam angles and investigates the effects of couch shift by simulating shifts of the couch relative to the patient, in order to determine whether couch edge avoidance restrictions can be lifted. 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 direction to simulate variations in patient positioning on the couch giving 16 shifted plans per reference plan. The shift values of 1 and 2 cm were based on shifts recorded in 320 treatment fractions. Results: Measured couch attenuation versus TPS modeled agreed within 2.1%. Planning Target Volume (PTV) D95 changed less than 1% for 1 and 2 cm couch shifts in only the x-direction and less than 3% for all directions. Conclusion: The dosimetry of all plans with shifts up to ±2 cm was within reasonable clinical tolerances. Robustness of a plan to couch shifts can be tested in the TPS. Inclusion of beams traversing the couch edges should be considered if an improvement in plan quality or delivery time can be achieved.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-J-144: Scatter and Leakage Survey of An Integrated MR-Linac System

Purpose: To assess the scatter and leakage radiation of an integrated 1.5T MRI-Linac system. Methods: A 150cc chamber (model 96020C, Inovision) was used in all the scatter and leakage measurements, after being recalibrated for MV energy by the Accredited Dosimetry Calibration Laboratory at MD Anderson. The scatter radiation was measured by placing a 25 cm stack of solid-water materials at iso-center on the patient couch to simulate patient scatter. Gantry angles were positioned at 0 degree (beam pointing downward) and 270 (beam pointing laterally). Scatter radiation was measured at selective locations inside the RF room. Beam stopper leakage was measured at the exterior panel of the gantry. The head leakage was measured at 1 meter away from the Linac head in the direction which was determined to be the area of maximum leakage by wrapped films test. All measurements were repeated with the 1.5T magnetic field turned off to study the effect of magnetic field. Results: When the magnet was on (B=1.5T), the maximum head leakage at 1 meter was 191.6mR/1000MU. The scatter radiation at 1 meter from the iso-center was 1.091R/1000MU when the radiation beam was pointing downward, 1.296R/1000MU when the beam pointed laterally. The beam stopper leakage was measured as 299.4 mR/1000MU at the exterior panel of the gantry. When magnet was off (B=0), the head leakage was measured as 198.6mR/1000MU. The scatter radiation at 1 meter was 1.153R/1000MU when beam pointed downward, 1.287R/1000MU when beam pointed laterally. The beam stopper leakage was measured as 309.4 mR/1000MU at the exterior panel of the gantry. Conclusion: The measurements indicate that the scatter and leakage radiation from the integrated MR-Linac system are in-line with the expected values. The beam stopper leakage is approximately 300 mR/1000MU. The leakage and scatter difference with the magnetic field ON and OFF was within 5%. The authors received a corporate sponsored grant from Elekta which is the vendor of the MR-Linac system studied in this work.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-J-167: Use of MR for Permanent Prostate Implant Preplanning

Purpose: To study the feasibility using MR imaging to improve target definition on ultrasound during permanent prostate implants and aid in source strength determination for treatment planning in the OR. Methods: Patients who receive permanent prostate implants undergo MR and CT imaging prior to the implant procedure to determine the volume of the prostate, bony restriction to the procedure, bladder extension, external sphincter length and neurovascular bundle. The volume of the prostate is generally used to order seeds for the procedure. In 10 patients, the MR was used as the preplanning study with the PTV defined as a 2 mm expansion of the MR prostate in all directions except the posterior. Various dose volume parameters for the MR prostate and the PTV were compared to the actual preplan developed and executed in the OR. In addition, there parameters were compared to the post implant dosimetry performed 3 weeks after the implant procedure. Results: The results show that the number of seeds used using MR and US (ultrasound) planning was generally with 2 seeds and the maximum difference was 7 seeds. There is no significant difference between any of the dose index parameters of V100, V150, V200, D99 and D90 parameters between MR planning, US planning and postimplant evaluation There was a significant difference between planned D99 (avg of 105%) and achieved D99 (avg 91%). Conclusion: MR imaging is an invaluable tool to improve target definition for permanent prostate implants. Use of MR images for preplanning improves the confidence with which source can be ordered for the procedure that is OR planned. Ordering a maximum of 10 seeds more than planned would be sufficient to deliver a plan in the OR using US. Moving ahead to non-rigid registration between MR ad US images could further increase the confidence level of MR planning.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-T-22: Clinical Implications When Using TG-186 (ACE) Heterogeneity Software

Purpose: The purpose of this study is to compare dosimetric calculations using traditional TG-43 formalism and Oncentra Brachy Advanced Collapsed cone Engine (ACE) TG-186 calculation algorithm in clinical setting. Methods: We analyzed dosimetry of four patients treated with accelerated partial breast irradiation using a multi-channel intracavitary device (SAVI). All patients were treated to 34 Gy in 10 fractions using a high-dose-rate (192) Ir source. The plans were designed and treated using the TG-43 model. ACE was used to assess the effect heterogeneity correction on various dosimetric parameters. Mass density was estimated using Hounsfield units. Results: Compared to TG-43 formalism, ACE estimated lower doses to targets and organs at risk. The mean difference was 19.8% (range 15.3–24.1%) for PTV-eval V200, 12.0% (range 9.7–17.7%) for PTV-eval V150, 4.3% (range 3.3–6.5%) for PTV-eval D95, 3.3% (range 1.4–5.4%) for PTV-eval D90, 5.4% (range 2.9–9.9%) for maximum rib dose, and 5.7% (2.4–7.4%) for maximum skin dose. There was no correlation between the magnitude of the difference and the PTV-eval volume, air volume, or tissue-applicator conformance. Conclusion: Based on our preliminary study, the TG-43 algorithm appears to overestimate the dose to targets and organs at risk when compared to the ACE TG-186 software. We hypothesize that air adjacent to the SAVI struts contributes to lack of scatter thereby contributing a significant difference in dose calculation when using ACE. We believe that ACE calculation provides a more realistic isodose distribution than TG-43. We plan to further investigate the impact of heterogeneity correction on brachytherapy planning for a wide variety of clinical scenarios, include skin, cervix/uterus, prostate, and lung.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-T-45: Dosimetric Effects of Saline Filled Balloons During IORT Using Xoft Electronic Brachytherapy

Purpose: The portability of Xoft Axxent Electronic Brachytherapy (EBx) System has made it a viable option for intraoperative radiation therapy (IORT) treatment of early-stage breast cancer. The low energy (50kVp) of the X-ray source makes the shielding easy, but also means its dose distribution is sensitive to the medium’s composition. Current treatment planning systems (TPS) typically assume homogenous water for brachytherapy dose calculations, including the pre-calculated atlas plans for the Xoft IORT cases. However, Xoft recommends using saline to fill the balloon applicator. This study investigates the dosimetric difference due to the increased effective atomic number (Zeff) from water (7.42) to saline (7.56). Methods: The diameter of the balloon applicators ranges from 3–6cm, with 4cm being most frequently used. For the 4-cm and 6-cm diameter applicators, MCNP Monte Carlo program was used to calculate the dose at the surface (Ds) of the middle section of the balloon and 1 cm away (D1cm) for water- and saline-filled balloons: one plan with a single dwell at the center and another with multiple dwells as in the atlas plans. The single dwell plan is a simple estimation of the dosimetry, while the atlas plan is representative of the actual dose distribution. Results: The single-dwell plan showed a 5.1% and 6.1% decrease in Ds for the 4- and 6-cm applicators, respectively, due to the saline. The atlas plan showed similar Results: 4.8% and 6.4% decrease, respectively. The decrease in D1cm is 4.3%–5.2% and 3.3%–5.3s% in the single-dwell and atlas plans, respectively, for the 4- and 6-cm applicator. Conclusion: The dosimetric effect introduced by saline is on the order of 5%. This effect should be taken into account during both treatment planning and patient outcome studies.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-T-176: Therapeutic Proton Beam Range Measurement Method with EBT3 Film

Purpose: Ocular proton therapy has the following advantages: i) sparing optic nerve, ii) the minimal dose is delivered to surrounding normal tissues. Since the proton therapy center was opened in 2007, 30 patients with ocular tumor have been treated at National Cancer Center using single scattering technique. To develop a solid eye phantom which can verify the output and the beam range with EBT3 film for independent patient QA in ocular proton therapy. Methods: The proton therapy is very effective to treat ocular tumor, because of the Bragg peak feature. In general, the beam shape of eye treatment is about 3 cm in diameter and the beam range is under 5 cm. However, proton therapy has uncertainty of beam range problem due to various stopping power of normal tissue, bone, air and so on, so that we should verify the beam range before treatment. For this purpose, a new PMMA phantom with wedge has been developed to use the film dosimetry and the ionization chamber. It is able to place a film on the slope of the phantom, which the spread out Bragg Peak by the water equivalent thickness value of PMMA can be made on the film. We considered to relation with quenching effect of proton energy and range for simple second check. In addition, the ionization chamber (Pin-point chamber, PTW 31014) can be inserted into a hole in the phantom to measure the absolute dose. Results: The output difference and beam range difference were less than 2% and 1.0 mm, respectively, between the measurement and the plan. Conclusion: An eye phantom was developed and its performance was evaluated successfully and it was useful to verify the output. Also with EBT3 film with the quenching effect for measurement depth-dose profile, range to patient QA.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-T-304: Complex Multi-PTV Treatment Evaluation Using a Remotely Processed 3D Gel Dosimeter

Purpose: A new 3D gel dosimeter (ClearView™, Modus Medical Systems) was investigated for use as a QA tool for stereotactic radiosurgery (SRS) plans exhibiting high dose gradients and spatially separated treatment targets. The unique feature of this gel dosimeter is the remote processing service provided by Modus Medical Systems. Methods: The gel dosimeters were filled in either 10 cm diameter or 15 cm diameter clear plastic jars. The jars were then shipped in ice-cooled containers to our department for irradiation. Clinical SRS plans for treatment of multiple metastases and plans with simulated concave structures were applied to a CT scan of the gel dosimeter. The gel was irradiated in treatment position using modulated arcs and then returned in the cooled container for processing. The 3D gel dose was compared to the DICOM-RT dose from the treatment plan to assess dosimetric and geometric agreement. Results: There was no discernible difference between the planned and measured dose for dose gradients as high as 10%/mm, which was the highest gradient we evaluated. Geometric agreement for distant metastases separated by 6 cm was within 1.5 mm. Among three identically irradiated gels using a plan intended for nine metastases, the 3%/3mm gamma passing rate was 84.5% with a range of 14.7%, measured over the entire volume of the dosimeter. Regions of larger gamma values correlated with geometric offsets between the planned and measured data. Conclusion: The gel dosimeter exhibits the dosimetric and geometric characteristics necessary for 3D evaluation of treatment plan deliverability. The range of observed gamma passing rates suggests a high sensitivity to geometric registration. With proper management of geometric registration between planned and measured data, this service should enable a radiation oncology department to use 3D dosimetry in end-to-end testing or patient plan delivery QA without the expense of an in-house processing system.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-T-305: Clinical Effects of Dosimetric Leaf Gap (DLG) Values Between Matched Varian Truebeam (TB) Linacs

Purpose: The dosimetric leaf gap (DLG) is an important parameter to be measured for dynamic beam delivery of modern linacs, like the Varian Truebeam (TB). The clinical effects of DLG-values on IMRT and/or VMAT commissioning of two “matched” TB linacs will be presented.Methods and Materials: The DLG values on two TB linacs were measured for all energy modalities (filtered and FFF-modes) as part of the dynamic delivery mode commissioning (IMRT and/or VMAT. After the standard beam data was modeled in eclipse treatment planning system (TPS) and validated, IMRT validation was performed based on TG1191 benchmark, IROC Head-Neck (H&N) phantom and sample of clinical cases, all measured on both linacs. Although there was a single-set of data entered in the TPS, a noticeable difference was observed for the DLG-values between the linacs. The TG119, IROC phantom and selected patient plans were furnished with DLG-values of TB1 for both linacs and the delivery was performed on both TB linacs for comparison. Results: The DLG values of TB1 was first used for both linacs to perform the testing comparisons. The QA comparison of TG119 plans revealed a great dependence of the results to the DLG-values used for the linac for all energy modalities studied, especially when moving from 3%/3mm to 2%/2mm γ-analysis. Conclusion: The DLG-values have a definite influence on the dynamic dose, delivery that increases with the plan complexity. We recommend that the measured DLG-values are assigned to each of the “matched” linacs, even if a single set of beam data describes multiple linacs. The user should perform a detail test of the dynamic delivery of each linac based on end-to-end benchmark suites like TG119 and IROC phantoms.1Ezzel G., et al., “IMRT commissioning: Multiple institution planning and dosimetry comparisons, a report from AAPM Task Group 119.” Med. Phys. 36:5359–5373 (2009). partly supported by CAMC Cancer Center and Alliance Oncology.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-T-342: Dosimetric Constraint Prediction Guided Automatic Mulit-Objective Optimization for Intensity Modulated Radiotherapy

Purpose: For intensity modulated radiotherapy, the plan optimization is time consuming with difficulties of selecting objectives and constraints, and their relative weights. A fast and automatic multi-objective optimization algorithm with abilities to predict optimal constraints and manager their trade-offs can help to solve this problem. Our purpose is to develop such a framework and algorithm for a general inverse planning. Methods: There are three main components contained in this proposed multi-objective optimization framework: prediction of initial dosimetric constraints, further adjustment of constraints and plan optimization. We firstly use our previously developed in-house geometry-dosimetry correlation model to predict the optimal patient-specific dosimetric endpoints, and treat them as initial dosimetric constraints. Secondly, we build an endpoint(organ) priority list and a constraint adjustment rule to repeatedly tune these constraints from their initial values, until every single endpoint has no room for further improvement. Lastly, we implement a voxel-independent based FMO algorithm for optimization. During the optimization, a model for tuning these voxel weighting factors respecting to constraints is created. For framework and algorithm evaluation, we randomly selected 20 IMRT prostate cases from the clinic and compared them with our automatic generated plans, in both the efficiency and plan quality. Results: For each evaluated plan, the proposed multi-objective framework could run fluently and automatically. The voxel weighting factor iteration time varied from 10 to 30 under an updated constraint, and the constraint tuning time varied from 20 to 30 for every case until no more stricter constraint is allowed. The average total costing time for the whole optimization procedure is ∼30mins. By comparing the DVHs, better OAR dose sparing could be observed in automatic generated plan, for 13 out of the 20 cases, while others are with competitive results. Conclusion: We have successfully developed a fast and automatic multi-objective optimization for intensity modulated radiotherapy. This work is supported by the National Natural Science Foundation of China (No: 81571771)

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-T-381: Fast Calculation of Three-Dimensional Dose Considering MLC Leaf Positional Errors for VMAT Plans

Purpose: In this study, we developed a system to calculate three dimensional (3D) dose that reflects dosimetric error caused by leaf miscalibration for head and neck and prostate volumetric modulated arc therapy (VMAT) without additional treatment planning system calculation on real time. Methods: An original system called clarkson dose calculation based dosimetric error calculation to calculate dosimetric error caused by leaf miscalibration was developed by MATLAB (Math Works, Natick, MA). Our program, first, calculates point doses at isocenter for baseline and modified VMAT plan, which generated by inducing MLC errors that enlarged aperture size of 1.0 mm with clarkson dose calculation. Second, error incuced 3D dose was generated with transforming TPS baseline 3D dose using calculated point doses. Results: Mean computing time was less than 5 seconds. For seven head and neck and prostate plans, between our method and TPS calculated error incuced 3D dose, the 3D gamma passing rates (0.5%/2 mm, global) are 97.6±0.6% and 98.0±0.4%. The dose percentage change with dose volume histogram parameter of mean dose on target volume were 0.1±0.5% and 0.4±0.3%, and with generalized equivalent uniform dose on target volume were −0.2±0.5% and 0.2±0.3%. Conclusion: The erroneous 3D dose calculated by our method is useful to check dosimetric error caused by leaf miscalibration before pre treatment patient QA dosimetry checks.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-T-433: Evaluation of a New Dose Mimicking Application for Clinical Flexibility and Reliability

Purpose: Clinical workflow and machine down time occasionally require patients to be temporarily treated on a system other than the initial treatment machine. A new commercial dose mimicking application provides automated cross-platform treatment planning to expedite this clinical flexibility. The aim of this work is to evaluate the feasibility of automatic plan creation and establish a robust clinical workflow for prostate and pelvis patients. Methods: Five prostate and five pelvis patients treated with helical plans were selected for re-planning with the dose mimicking application, covering both simple and complex scenarios. Two-arc VMAT and 7- and 9-field IMRT plans were generated for each case, with the objective function of achieving similar dose volume histogram from the initial helical plans. Dosimetric comparisons include target volumes and organs at risk (OARs) (rectum, bladder, small bowel, femoral heads, etc.). Dose mimicked plans were evaluated by a radiation oncologist, and patient-specific QAs were performed to validate delivery. Results: Overall plan generation and transfer required around 30 minutes of dosimetrist’s time once the dose-mimicking protocol is setup for each site. The resulting VMAT and 7- and 9-field IMRT plans achieved equivalent PTV coverage and homogeneity (D99/DRx = 97.3%, 97.2%, 97.2% and HI = 6.0, 5.8, and 5.9, respectively), compared to helical plans (97.6% and 4.6). The OAR dose discrepancies were up to 6% in rectum Dmean, but generally lower in bladder, femoral heads, bowel and penile bulb. In the context of 1–5 fractions, the radiation oncologist evaluated the dosimetric changes as not clinically significant. All delivery QAs achieved >90% pass with a 3%/3mm gamma criteria. Conclusion: The automated dose-mimicking workflow offers a strategy to avoid missing treatment fractions due to machine down time with non-clinically significant changes in dosimetry. Future work will further optimize dose mimicking plans and investigate other cross-platform treatment delivery options.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-T-437: 3 Field VMAT Technique for Irradiation of Large Pelvic Tumors

Purpose: VMAT treatment planning for large pelvic volume irradiation could be suboptimal due to inability of Varian linac to split MLC carriage during VMAT delivery for fields larger than 14.5cm in X direction (direction of leaf motion). We compare the dosimetry between 3 VMAT planning techniques, two 2-arc field techniques and a 3-arc field technique: a) two small in X direction (less than 14.5cm) arc fields, complementing each other to cover the whole lateral extent of target during gantry rotation, b) two large arc fields, each covering the targets completely during the rotation, c) a 3 field technique with 2 small in X direction arcs and 1 large field covering whole target. Methods: 5 GYN cancer patients were selected to evaluate the 3 VMAT planning techniques. Treatment plans were generated using Varian Eclipse (ver. 11) TPS. Dose painting technique was used to deliver 5300 cGy to primary target and 4500 cGy to pelvic/abdominal node target. All the plans were normalized so that the prescription dose of 5300 cGy covered 95% of primary target volume. PTV and critical structures DVH curves were compared to evaluate all 3 planning techniques. Results: The dosimetric differences between the two 2-arc techniques were minor. The small field 2-arc technique showed a colder hot spot (0.4% averaged), while variations in maximum doses to critical structures were statistically nonsignificant (under 1.3%). In comparison, the 3-field technique demonstrated a colder hot spot (1.1% less, 105.8% averaged), and better sparing of critical structures. The maximum doses to larger bowel, small bowel and gluteal fold were 3% less, cord/cauda sparing was 4.2% better, and bladder maximum dose was 4.6% less. The differences in maximum doses to stomach and rectum were statistically nonsignificant. Conclusion: 3-arc VMAT technique for large field irradiation of pelvis demonstrates dosimetric advantages compared to 2-arc VMAT techniques.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-T-506: Development and Commissioning of the Effective and Efficient Grid Therapy Using High Dose Rate Flattening Filter Free Beam and Multileaf Collimator

Purpose: Treating bulky tumors with grid therapy (GT) has demonstrated high response rates. Long delivery time (∼15min), with consequent increased risk of intrafraction motion, is a major disadvantage of conventional MLC-based GT (MLC-GT). The goal of this study was to develop and commission a MLC-GT technique with similar dosimetric characteristics, but more efficient delivery. Methods: Grid plan was designed with 10X-FFF (2400MU/min) beam and MLC in a commercial treatment planning system (TPS). Grid size was 1cm by 1cm and grid-to-grid distance was 2cm. Field-in-field technique was used to flatten the dose profile at depth of 10cm. Prescription was 15Gy at 1.5cm depth. Doses were verified at depths of 1.5cm, 5cm and 10cm. Point dose was measured with a plastic scintillator detector (PSD) while the planar dose was measured with calibrated Gafchromic EBT3 films in a 20cm think, 30cmx30cm solid water phantom. The measured doses were compared to the doses calculated in the treatment planning system. Percent depth dose (PDD) within the grid was also measured using EBT3 film. Five clinical cases were planned to compare beam-on time. Results: The valley-to-peak dose ratio at the 3 depths was approximately 10–15%, which is very similar to published result. The average point dose difference between the PSD measurements and TPS calculation is 2.1±0.6%. Film dosimetry revealed good agreement between the delivered and calculated dose. The average gamma passing rates at the 3 depths were 95% (3%, 1mm). The average percent difference between the measured PDD and calculated PDD was 2.1% within the depth of 20cm. The phantom plan delivery time was 3.6 min. Average beam-on time was reduced by 66.1±5.6% for the 5 clinical cases. Conclusion: An effective and efficient GT technique was developed and commissioned for the treatment of bulky tumors using FFF beam combined with MLC and automation. The Department of Radiation Oncology at Henry Ford Health System receives research support from Varian Medical Systems and Philips Health Care.

60 APPLIED LIFE SCIENCES↗