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At least 1,423 records · Page 79

DNA nanostructures coordinate gene silencing in mature plants

Delivery of biomolecules to plants relies on Agrobacterium infection or biolistic particle delivery, the former of which is amenable only to DNA delivery. The difficulty in delivering functional biomolecules such as RNA to plant cells is due to the plant cell wall, which is absent in mammalian cells and poses the dominant physical barrier to biomolecule delivery in plants. DNA nanostructure-mediated biomolecule delivery is an effective strategy to deliver cargoes across the lipid bilayer of mammalian cells; however, nanoparticle-mediated delivery without external mechanical aid remains unexplored for biomolecule delivery across the cell wall in plants. Herein, we report a systematic assessment of different DNA nanostructures for their ability to internalize into cells of mature plants, deliver siRNAs, and effectively silence a constitutively expressed gene in Nicotiana benthamiana leaves. We show that nanostructure internalization into plant cells and corresponding gene silencing efficiency depends on the DNA nanostructure size, shape, compactness, stiffness, and location of the siRNA attachment locus on the nanostructure. We further confirm that the internalization efficiency of DNA nanostructures correlates with their respective gene silencing efficiencies but that the endogenous gene silencing pathway depends on the siRNA attachment locus. Our work establishes the feasibility of biomolecule delivery to plants with DNA nanostructures and both details the design parameters of importance for plant cell internalization and also assesses the impact of DNA nanostructure geometry for gene silencing mechanisms.

59 BASIC BIOLOGICAL SCIENCES↗

Gantry-angle resolved VMAT pretreatment verification using EPID image prediction

Purpose: Pretreatment verification of volumetric modulated arc therapy (VMAT) dose delivery with electronic portal imaging device (EPID) uses images integrated over the entire delivery or over large subarcs. This work aims to develop a new method for gantry-angle-resolved verification of VMAT dose delivery using EPID.Methods: An EPID dose prediction model was used to calculate EPID images as a function of gantry angle for eight prostate patient deliveries. EPID image frames at 7.5 frames per second were acquired during delivery via a frame-grabber system. The gantry angle for each image was encoded in kV frames which were synchronized to the MV frames. Gamma analysis results as a function of gantry angle were assessed by integrating the frames over 2° subarcs with an angle-to-agreement tolerance of 0.5° about the measured image angle.Results: The model agreed with EPID images integrated over the entire delivery with average Gamma pass-rates at 2%, 2 mm of 99.7% (10% threshold). The accuracy of the kV derived gantry angle for each image was found to be 0.1° (1 SD) using a phantom test. For the gantry-resolved analysis all Gamma pass-rates were greater than 90% at 3%, 3 mm criteria (with only two exceptions), and more than 90% had a 95% pass-rate, with an average of 97.3%. The measured gantry angle lagged behind the predicted angle by a mean of 0.3°± 0.3°, with a maximum lag of 1.3°.Conclusions: The method provides a comprehensive and highly efficient pretreatment verification of VMAT delivery using EPID. Dose delivery accuracy is assessed as a function of gantry angle to ensure accurate treatment.

61 RADIATION PROTECTION AND DOSIMETRY↗

Dosimetric effects of multileaf collimator leaf width on intensity-modulated radiotherapy for head and neck cancer

Purpose: The authors evaluated the effects of multileaf collimator (MLC) leaf width (2.5 vs. 5 mm) on dosimetric parameters and delivery efficiencies of intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) for head and neck (H and N) cancers. Methods: The authors employed two types of mock phantoms: large-sized head and neck (LH and N) and small-sized C-shape (C-shape) phantoms. Step-and-shoot IMRT (S and S-IMRT) and VMAT treatment plans were designed with 2.5- and 5.0-mm MLC for both C-shape and LH and N phantoms. Their dosimetric characteristics were compared in terms of the conformity index (CI) and homogeneity index (HI) for the planning target volume (PTV), the dose to organs at risk (OARs), and the dose-spillage volume. To analyze the effects of the field and arc numbers, 9-field IMRT (9F-IMRT) and 13-field IMRT (13F-IMRT) plans were established for S and S-IMRT. For VMAT, single arc (VMAT{sub 1}) and double arc (VMAT{sub 2}) plans were established. For all plans, dosimetric verification was performed using the phantom to examine the relationship between dosimetric errors and the two leaf widths. Delivery efficiency of the two MLCs was compared in terms of beam delivery times, monitor units (MUs) per fraction, and the number of segments for each plan. Results: 2.5-mm MLC showed better dosimetric characteristics in S and S-IMRT and VMAT for C-shape, providing better CI for PTV and lower spinal cord dose and high and intermediate dose-spillage volume as compared with the 5-mm MLC (p < 0.05). However, no significant dosimetric benefits were provided by the 2.5-mm MLC for LH and N (p > 0.05). Further, beam delivery efficiency was not observed to be significantly associated with leaf width for either C-shape or LH and N. However, MUs per fraction were significantly reduced for the 2.5-mm MLC for the LH and N. In dosimetric error analysis, absolute dose evaluations had errors of less than 3%, while the Gamma passing rate was greater than 95% according to the 3%/3 mm criteria. There were no significant differences in dosimetric error between the 2.5- and 5-mm MLCs. Conclusions: As compared with MLC of 5-mm leaf widths, MLC with finer leaf width (2.5-mm) can provide better dosimetric outcomes in IMRT for C-shape. However, the MLC leaf width may only have minor effects on dosimetric characteristics in IMRT for LH and N. The results of the present study will serve as a useful assessment standard when assigning or introducing equipment for the treatment of H and N cancers.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

A limited-angle intrafraction verification (LIVE) system for radiation therapy

Purpose: Currently, no 3D or 4D volumetric x-ray imaging techniques are available for intrafraction verification of target position during actual treatment delivery or in-between treatment beams, which is critical for stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT) treatments. This study aims to develop a limited-angle intrafraction verification (LIVE) system to use prior information, deformation models, and limited angle kV-MV projections to verify target position intrafractionally. Methods: The LIVE system acquires limited-angle kV projections simultaneously during arc treatment delivery or in-between static 3D/IMRT treatment beams as the gantry moves from one beam to the next. Orthogonal limited-angle MV projections are acquired from the beam's eye view (BEV) exit fluence of arc treatment beam or in-between static beams to provide additional anatomical information. MV projections are converted to kV projections using a linear conversion function. Patient prior planning CT at one phase is used as the prior information, and the on-board patient volume is considered as a deformation of the prior images. The deformation field is solved using the data fidelity constraint, a breathing motion model extracted from the planning 4D-CT based on principal component analysis (PCA) and a free-form deformation (FD) model. LIVE was evaluated using a 4D digital extended cardiac torso phantom (XCAT) and a CIRS 008A dynamic thoracic phantom. In the XCAT study, patient breathing pattern and tumor size changes were simulated from CT to treatment position. In the CIRS phantom study, the artificial target in the lung region experienced both size change and position shift from CT to treatment position. Varian Truebeam research mode was used to acquire kV and MV projections simultaneously during the delivery of a dynamic conformal arc plan. The reconstruction accuracy was evaluated by calculating the 3D volume percentage difference (VPD) and the center of mass (COM) difference of the tumor in the true on-board images and reconstructed images. Results: In both simulation and phantom studies, LIVE achieved substantially better reconstruction accuracy than reconstruction using PCA or FD deformation model alone. In the XCAT study, the average VPD and COM differences among different patient scenarios for LIVE system using orthogonal 30° scan angles were 4.3% and 0.3 mm when using kV+BEV MV. Reducing scan angle to 15° increased the average VPD and COM differences to 15.1% and 1.7 mm. In the CIRS phantom study, the VPD and COM differences for the LIVE system using orthogonal 30° scan angles were 6.4% and 1.4 mm. Reducing scan angle to 15° increased the VPD and COM differences to 51.9% and 3.8 mm. Conclusions: The LIVE system has the potential to substantially improve intrafraction target localization accuracy by providing volumetric verification of tumor position simultaneously during arc treatment delivery or in-between static treatment beams. With this improvement, LIVE opens up a new avenue for margin reduction and dose escalation in both fractionated treatments and SRS and SBRT treatments.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Application of Emerging Pharmaceutical Technologies for Therapeutic Challenges of Space Exploration Missions

An important requirement of therapeutics for extended duration exploration missions beyond low Earth orbit will be the development of pharmaceutical technologies suitable for sustained and preventive health care in remote and adverse environmental conditions. Availability of sustained, stable and targeted delivery pharmaceuticals for preventive health of major organ systems including gastrointestinal, hepato-renal, musculo-skeletal and immune function are essential to offset adverse effects of space environment beyond low Earth orbit. Specifically, medical needs may include multi-drug combinations for hormone replacement, radiation protection, immune enhancement and organ function restoration. Additionally, extended stability of pharmaceuticals dispensed in space must be also considered in future drug development. Emerging technologies that can deliver stable and multi-therapy pharmaceutical preparations and delivery systems include nanotechnology based drug delivery platforms, targeted-delivery systems in non-oral and non-parenteral formulation matrices. Synthetic nanomaterials designed with molecular precision offer defined structures, electronics, and chemistries to be efficient drug carriers with clear advantages over conventional materials of drug delivery matricies. Nano-carrier materials like the bottle brush polymers may be suitable for systemic delivery of drug cocktails while Superparamagnetic Iron Oxide Nanoparticles or (SPIONS) have great potential to serve as carriers for targeted drug delivery to a specific site. These and other emerging concepts of drug delivery and extended shelf-life technologies will be reviewed in light of their application to address health-care challenges of exploration missions. Innovations in alternate treatments for sustained immune enhancement and infection control will be also discussed.

Putcha, Lakshmi↗

SU-F-T-307: Peripheral Dose Comparison Between Static and Dynamic Jaw Tracking On a High Definition MLC System

Purpose: To investigate the effect of dynamic and static jaw tracking on patient peripheral doses. Materials and Methods: A patient plan with a large sacral metastasis (volume 800cm3, prescription 600cGyx5) was selected for this study. The plan was created using 2-field RapidArc with jaw tracking enabled (Eclipse, V11.0.31). These fields were then exported and edited in MATLAB with static jaw positions using the control point with the largest field size for each respective arc, but preserving the optimized leaf sequences for delivery. These fields were imported back into Eclipse for dose calculation and comparison and copied to a Rando phantom for delivery analysis. Points were chosen in the phantom at depth and on the phantom surface at locations outside the primary radiation field, at distances of 12cm, 20cm, and 30cm from the isocenter. Measurements were acquired with OSLDs placed at these positions in the phantom with both the dynamic and static jaw deliveries for comparison. Surface measurements included an additional 1cm bolus over the OSLDs to ensure electron equilibrium. Results: The static jaw deliveries resulted in cumulative jaw-defined field sizes of 17.3% and 17.4% greater area than the dynamic jaw deliveries for each arc. The static jaw plan resulted in very small differences in calculated dose in the treatment planning system ranging from 0–16cGy. The measured dose differences were larger than calculated, but the differences in absolute dose were small. The measured dose differences at depth (surface) between the two deliveries showed an increase for the static jaw delivery of 2.2%(11.4%), 15.6%(20.0%), and 12.7%(12.7%) for distances of 12cm, 20cm, and 30cm, respectively. Eclipse calculates a difference of 0–3.1% for all of these points. The largest absolute dose difference between all points was 6.2cGy. Conclusion: While we demonstrated larger than expected differences in peripheral dose, the absolute dose differences were small.

60 APPLIED LIFE SCIENCES↗

SU-F-T-518: Development and Characterization of a Gated Treatment System Implemented with An In-House Optical Tracking System and the Elekta Response Interface

Purpose: To report the development and characterization of the first in-house gating system implemented with an optical tracking system (OTS) and the Elekta Response™ interface. Methods: The Response™ connects a patient tracking system with a linac, enabling the tracking system to control radiation delivery. The developed system uses an in-house OTS to monitor patient breathing. The OTS consists of two infrared-based cameras, tracking markers affixed on patient. It achieves gated or breath-held (BH) treatment by calling beam ON/OFF functions in the Response™ dynamic-link library (DLL). A 4D motion phantom was used to evaluate its dosimetric and time delay characteristics. Two FF- and two FFF-IMRT beams were delivered in non-gated, BH and gated mode. The sinusoidal gating signal had a 6 sec period and 15 mm amplitude. The duty cycle included 10%, 20%, 30% and 50%. The BH signal was adapted from the sinusoidal wave by inserting 15 sec BHs. Each delivery was measured with a 2D diode array (MapCHECK™) and compared with the non-gated delivery using gamma analysis (3%). The beam ON/OFF time was captured using the service graphing utility of the linac. Results: The gated treatments were successfully delivered except the 10% duty cycle. The BH delivery had perfect agreement (100%) with non-gated delivery; the agreement of gated delivery decreased from 99% to 88% as duty cycle reduced from 50% to 20%. The beam on/off delay was on average 0.25/0.06 sec. The delivery time for the 50%, 30% and 20% duty cycle increased by 29%, 71% and 139%, respectively. No dosimetric or time delay difference was noticed between FF- and FFF-IMRT beams. Conclusion: The in-house gating system was successfully developed with dosimetric and time delay characteristics in line with published results for commercial systems. It will be an important platform for further research and clinical development of gated treatment.

43 PARTICLE ACCELERATORS↗

Efficacy and Safety of Prophylactic Uterine Artery Embolization in Pregnancy Termination with Placenta Previa

PurposeTo appraise the efficacy and safety of prophylactic uterine artery embolization in pregnancy termination with placenta previa.MethodsA cohort of 54 consecutive patients with placenta previa underwent prophylactic uterine artery embolization before vaginal delivery from February 2012 to March 2015. Vaginal delivery was attempted in all patients. Cesarean section or hysterectomy was introduced when vaginal delivery failed.ResultsVaginal delivery succeeded in 50 patients (93.6%) and failed in 4 patients (6.4%), thereupon converted to cesarean delivery. No patients resorted to hysterectomy. Six patients (11.1%) underwent blood transfusion. None of clinical characteristics, including maternal age, gestational age, history of abortion, history of cesarean delivery, and volume of vaginal bleeding, was significantly associated with complete placenta previa (P > 0.05). However, patients with complete placenta previa had a significantly lower successful rate of vaginal delivery than did patients without complete placenta previa (81 vs 100%, P = 0.038). The rate of complications was 3.7%. No major complications were observed.ConclusionUterine artery embolization is an effective and safe technique to assist pregnancy termination with placenta previa, which may lower the risk of cesarean section, hysterectomy, and blood transfusion.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Influence of tumor location on the intensity-modulated radiation therapy plan of helical tomotherapy

Given the design of the Helical TomoTherapy device, the patient's central axis is routinely aligned with the machine's rotational axis to prevent the patient's body from colliding with the machine walls. However, for treatment of tumors located away from the patient's central axis, this position may not be optimal as the adequate radiation dose may not reach the affected site. Our study aimed to investigate the influence of tumor location on dose quality and delivery efficiency of tomotherapy plans. A phantom and 15 patients were selected for this study. Two plans, A and B, were implemented for each case. In plan A, the patient's central axis was aligned with the machine's rotational axis, whereas in plan B, the center of the planning target volume (PTV) was aligned with the machine's rotational axis. Both plans were optimized with the same planning parameters, and the dose quality of the plans was evaluated using dosimetrics. The delivery efficiency was determined from delivery time and monitor units (MUs). A paired t-test or nonparametric Wilcoxon signed-rank test was performed for statistical comparison. In the phantom study, the median delivery times were 358 and 336 seconds for plans A and B, respectively, and this difference was significant (p = 0.005). In the patient study, the median delivery times were 348 and 317 seconds for plans A and B, respectively, and this difference was also significant (p = 0.001). The dose qualities of both plans for each patient were nearly identical. No significant differences were found in the conformal index, heterogeneity index, and mean dose delivered to normal tissue between the plans. Both phantom and patient studies showed that for normal-sized patients, the delivery time reduced as the distance between the PTV and the patient's central axis increased when the PTV center was aligned with the machine axis. In conclusion, aligning the PTV center with the machine's rotational axis by shifting the patient during tomotherapy reduces the delivery time without compromising the dose quality of intensity-modulated radiation therapy.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

MO-G-BRD-01: Point/Counterpoint Debate: Arc Based Techniques Will Make Conventional IMRT Obsolete

A variety of intensity modulated radiation therapy (IMRT) delivery techniques have been developed that have provided clinicians with the ability to deliver highly conformal dose distributions. The delivery techniques include compensators, step-and-shoot IMRT, sliding window IMRT, volumetric modulated arc therapy (VMAT), and tomotherapy. A key development in the field of IMRT was the introduction of new planning algorithms and delivery control systems in 2007 that made it possible to coordinate the gantry rotation speed, dose rate, and multileaf collimator leaf positions during the delivery of arc therapy. With these developments, VMAT became a routine clinical tool. The use of VMAT has continued to grow in recent years and some would argue that this will soon make conventional IMRT obsolete, and this is the premise of this debate. To introduce the debate, David Shepard, Ph.D. will provide an overview of IMRT delivery techniques including historical context and how they are being used today. The debate will follow with Richard Popple, Ph.D. arguing FOR the Proposition and Peter Balter, Ph.D. arguing AGAINST it. Learning Objectives: Understand the different delivery techniques for IMRT. Understand the potential benefits of conventional IMRT. Understand the potential benefits of arc-based IMRT delivery.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

TU-C-BRE-01: KEYNOTE PRESENTATION - Emerging Frontiers in IMRT QA

As IMRT treatment processes advance and mature, so must the quality assurance processes being used to validate their delivery. In some respects, treatment delivery advancements (e.g. VMAT) have out-paced QA advancements. The purpose of this session is to describe new processes that are being implemented to bring IMRT QA up-to-date with the treatment delivery advances. It would explore emerging IMRT QA paradigms, including requirements-based IMRT QA which necessitates definition of delivery errors (e.g. patient dose error, leaf positioning error) and development of processes to ensure reliable error detection. Engineeringbased QA approaches, including use of IMRT treatment delivery process trees, fault tree analysis and failure modes effects analysis would be described. Approaches to detect errors such as (1) during treatment delivery validation using exit fluence detectors (e.g. EPIDs); (2) analysis of treatment delivery via use of machine parameter log files; (3) dose recalculation using (3a) treatment planning system; (3b) record-and-verify; or (3c) entrance and exit fluence measurement parameters would be explained. The relative advantages and disadvantages of each method would be discussed. Schemes for error classification and root cause analysis would be described – steps which are essential for future error prevention. For each QA method, testing procedures and results would be presented indicating the types of errors that can be detected, those that cannot be detected, and the reliability of the error detection method (for example determined via ROC analysis). For speakers, we are seeking to engage non-commercially biased experts. Those listed below are a sub-sample of possible qualified individuals.

60 APPLIED LIFE SCIENCES↗

WE-B-19A-01: SRT II: Uncertainties in SRT

SRS delivery has undergone major technical changes in the last decade, transitioning from predominantly frame-based treatment delivery to imageguided, frameless SRS. It is important for medical physicists working in SRS to understand the magnitude and sources of uncertainty involved in delivering SRS treatments for a multitude of technologies (Gamma Knife, CyberKnife, linac-based SRS and protons). Sources of SRS planning and delivery uncertainty include dose calculation, dose fusion, and intra- and inter-fraction motion. Dose calculations for small fields are particularly difficult because of the lack of electronic equilibrium and greater effect of inhomogeneities within and near the PTV. Going frameless introduces greater setup uncertainties that allows for potentially increased intra- and interfraction motion, The increased use of multiple imaging modalities to determine the tumor volume, necessitates (deformable) image and contour fusion, and the resulting uncertainties introduced in the image registration process further contribute to overall treatment planning uncertainties. Each of these uncertainties must be quantified and their impact on treatment delivery accuracy understood. If necessary, the uncertainties may then be accounted for during treatment planning either through techniques to make the uncertainty explicit, or by the appropriate addition of PTV margins. Further complicating matters, the statistics of 1-5 fraction SRS treatments differ from traditional margin recipes relying on Poisson statistics. In this session, we will discuss uncertainties introduced during each step of the SRS treatment planning and delivery process and present margin recipes to appropriately account for such uncertainties. Learning Objectives: To understand the major contributors to the total delivery uncertainty in SRS for Gamma Knife, CyberKnife, and linac-based SRS. Learn the various uncertainties introduced by image fusion, deformable image registration, and contouring variation. Learn a variety of strategies for dealing with uncertainty, including margin recipes and explicit visualization of uncertainty. Understand how the assessment of PTV margins differs from regular fractionation (van Herk recipe) for 1–5 fraction deliveries.

60 APPLIED LIFE SCIENCES↗

WE-G-BRF-01: Adaptation to Intrafraction Tumor Deformation During Intensity-Modulated Radiotherapy: First Proof-Of-Principle Demonstration

Purpose: Intrafraction tumor deformation limits targeting accuracy in radiotherapy and cannot be adapted to by current motion management techniques. This study simulated intrafractional treatment adaptation to tumor deformations using a dynamic Multi-Leaf Collimator (DMLC) tracking system during Intensity-modulated radiation therapy (IMRT) treatment for the first time. Methods: The DMLC tracking system was developed to adapt to the intrafraction tumor deformation by warping the planned beam aperture guided by the calculated deformation vector field (DVF) obtained from deformable image registration (DIR) at the time of treatment delivery. Seven single phantom deformation images up to 10.4 mm deformation and eight tumor system phantom deformation images up to 21.5 mm deformation were acquired and used in tracking simulation. The intrafraction adaptation was simulated at the DMLC tracking software platform, which was able to communicate with the image registration software, reshape the instantaneous IMRT field aperture and log the delivered MLC fields.The deformation adaptation accuracy was evaluated by a geometric target coverage metric defined as the sum of the area incorrectly outside and inside the reference aperture. The incremental deformations were arbitrarily determined to take place equally over the delivery interval. The geometric target coverage of delivery with deformation adaptation was compared against the delivery without adaptation. Results: Intrafraction deformation adaptation during dynamic IMRT plan delivery was simulated for single and system deformable phantoms. For the two particular delivery situations, over the treatment course, deformation adaptation improved the target coverage by 89% for single target deformation and 79% for tumor system deformation compared with no-tracking delivery. Conclusion: This work demonstrated the principle of real-time tumor deformation tracking using a DMLC. This is the first step towards the development of an image-guided radiotherapy system to treat deforming tumors in real-time. The authors acknowledge funding support from the Australian NHMRC Australia Fellowship, Cure Cancer Australia Foundation, NHMRC Project Grant APP1042375 and US NIH/NCI R01CA93626.

60 APPLIED LIFE SCIENCES↗

Poster — Thur Eve — 28: Enabling trajectory-based radiotherapy on a TrueBeam accelerator with the Eclipse treatment planning system

The TrueBeam linear accelerator platform has a developer's mode which permits the user dynamic control over many of the machine's mechanical and radiation systems. Using this research tool, synchronous couch and gantry motion can be programmed to simulate isocentric treatment with a shortened SAD, with benefits such as smaller projected MLC leaf widths and an increased dose rate. In this work, water tank measurements were used to commission a virtual linear accelerator with an 85 cm SAD in Eclipse, from which several arc-based radiotherapy treatments were generated, including an inverse optimized VMAT delivery. For each plan, the pertinent treatment delivery information was extracted from control points specified in the Eclipse-exported DICOM files using the pydicom package in Python, allowing construction of an XML control file. The dimensions of the jaws and MLC positions, defined for an 85 cm SAD in Eclipse, were scaled for delivery on a conventional SAD linear accelerator, and translational couch motion was added as a function of gantry angle to simulate delivery at 85 cm SAD. Ionization chamber and Gafchromic film measurements were used to compare the radiation delivery to dose calculations in Eclipse. With the exception of the VMAT delivery, ionization chamber measurements agreed within 3.3% of the Eclipse calculations. For the VMAT delivery, the ionization chamber was located in an inhomogeneous region, but gamma evaluation of the Gafchromic film plane resulted in a 94.5% passing rate using criteria of 3 mm/3%. The results indicate that Eclipse calculation infrastructure can be used.

07 ISOTOPE AND RADIATION SOURCES↗

SU-E-T-76: A Software System to Monitor VMAT Plan Complexity in a Large Radiotherapy Centre

Purpose: To develop a system that analyses and reports the complexity of Volumetric Modulated Arc Therapy (VMAT) plans to aid in the decision making for streamlining patient specific dosimetric quality assurance (QA) tests. Methods: A software system, Delcheck, was developed in-house to calculate VMAT plan and delivery complexity using the treatment delivery file. Delcheck has the functionality to calculate multiple plan complexity metrics including the Li-Xing Modulation Index (LI-MI), multiplicative combination of Leaf Travel and Modulation Complexity Score (LTMCSv), Monitor Units per prescribed dose (MU/D) and the delivery complexity index (MIt) that incorporates the modulation of dose rate, leaf speed and gantry speed. Delcheck includes database functionality to store and compare plan metrics for a specified treatment site. The overall plan and delivery complexity is assessed based on the 95% conformance limit of the complexity metrics as Similar, More or Less complex. The functionality of the software was tested using 42 prostate conventional, 10 prostate SBRT and 15 prostate bed VMAT plans generated for an Elekta linear accelerator. Results: The mean(σ) of LI-MI for conventional, SBRT and prostate bed plans were 1690(486), 3215.4(1294) and 3258(982) respectively. The LTMCSv of the studied categories were 0.334(0.05), 0.325(0.07) and 0.3112(0.09). The MU/D of the studied categories were 2.4(0.4), 2.7(0.7) and 2.5(0.5). The MIt of the studied categories were 21.6(3.4), 18.2(3.0) and 35.9(6.6). The values of the complexity metrics show that LI-MI appeared to resolve the plan complexity better than LTMCSv and MU/D. The MIt value increased as the delivery complexity increased. Conclusion: The developed software was shown to be working as expected. In studied treatment categories Prostate bed plans are more complex in both plan and delivery and SBRT is more complex in plan and less complex in delivery as demonstrated by LI-MI and MIt. This project was funded through a Cancer Council NSW Project Grant (RG14-11)

60 APPLIED LIFE SCIENCES↗

Paddle-based rotating-shield brachytherapy

Purpose: The authors present a novel paddle-based rotating-shield brachytherapy (P-RSBT) method, whose radiation-attenuating shields are formed with a multileaf collimator (MLC), consisting of retractable paddles, to achieve intensity modulation in high-dose-rate brachytherapy. Methods: Five cervical cancer patients using an intrauterine tandem applicator were considered to assess the potential benefit of the P-RSBT method. The P-RSBT source used was a 50 kV electronic brachytherapy source (Xoft Axxent™). The paddles can be retracted independently to form multiple emission windows around the source for radiation delivery. The MLC was assumed to be rotatable. P-RSBT treatment plans were generated using the asymmetric dose–volume optimization with smoothness control method [Liu et al., Med. Phys. 41(11), 111709 (11pp.) (2014)] with a delivery time constraint, different paddle sizes, and different rotation strides. The number of treatment fractions (fx) was assumed to be five. As brachytherapy is delivered as a boost for cervical cancer, the dose distribution for each case includes the dose from external beam radiotherapy as well, which is 45 Gy in 25 fx. The high-risk clinical target volume (HR-CTV) doses were escalated until the minimum dose to the hottest 2 cm{sup 3} (D{sub 2cm{sup 3}}) of either the rectum, sigmoid colon, or bladder reached their tolerance doses of 75, 75, and 90 Gy{sub 3}, respectively, expressed as equivalent doses in 2 Gy fractions (EQD2 with α/β = 3 Gy). Results: P-RSBT outperformed the two other RSBT delivery techniques, single-shield RSBT (S-RSBT) and dynamic-shield RSBT (D-RSBT), with a properly selected paddle size. If the paddle size was angled at 60°, the average D{sub 90} increases for the delivery plans by P-RSBT on the five cases, compared to S-RSBT, were 2.2, 8.3, 12.6, 11.9, and 9.1 Gy{sub 10}, respectively, with delivery times of 10, 15, 20, 25, and 30 min/fx. The increases in HR-CTV D{sub 90}, compared to D-RSBT, were 16.6, 12.9, 7.2, 3.7, and 1.7 Gy{sub 10}, respectively. P-RSBT HR-CTV D{sub 90}-values were insensitive to the paddle size for paddles angled at less than 60°. Increasing the paddle angle from 5° to 60° resulted in only a 0.6 Gy{sub 10} decrease in HR-CTV D{sub 90} on average for five cases when the delivery times were set to 15 min/fx. The HR-CTV D{sub 90} decreased to 2.5 and 11.9 Gy{sub 10} with paddle angles of 90° and 120°, respectively. Conclusions: P-RSBT produces treatment plans that are dosimetrically and temporally superior to those of S-RSBT and D-RSBT, although P-RSBT systems may be more mechanically challenging to develop than S-RSBT or D-RSBT. A P-RSBT implementation with 4–6 shield paddles would be sufficient to outperform S-RSBT and D-RSBT if delivery times are constrained to less than 15 min/fx.

60 APPLIED LIFE SCIENCES↗

Technical aspects of real time positron emission tracking for gated radiotherapy

Purpose: Respiratory motion can lead to treatment errors in the delivery of radiotherapy treatments. Respiratory gating can assist in better conforming the beam delivery to the target volume. We present a study of the technical aspects of a real time positron emission tracking system for potential use in gated radiotherapy. Methods: The tracking system, called PeTrack, uses implanted positron emission markers and position sensitive gamma ray detectors to track breathing motion in real time. PeTrack uses an expectation–maximization algorithm to track the motion of fiducial markers. A normalized least mean squares adaptive filter predicts the location of the markers a short time ahead to account for system response latency. The precision and data collection efficiency of a prototype PeTrack system were measured under conditions simulating gated radiotherapy. The lung insert of a thorax phantom was translated in the inferior–superior direction with regular sinusoidal motion and simulated patient breathing motion (maximum amplitude of motion ±10 mm, period 4 s). The system tracked the motion of a {sup 22}Na fiducial marker (0.34 MBq) embedded in the lung insert every 0.2 s. The position of the was marker was predicted 0.2 s ahead. For sinusoidal motion, the equation used to model the motion was fitted to the data. The precision of the tracking was estimated as the standard deviation of the residuals. Software was also developed to communicate with a Linac and toggle beam delivery. In a separate experiment involving a Linac, 500 monitor units of radiation were delivered to the phantom with a 3 × 3 cm photon beam and with 6 and 10 MV accelerating potential. Radiochromic films were inserted in the phantom to measure spatial dose distribution. In this experiment, the period of motion was set to 60 s to account for beam turn-on latency. The beam was turned off when the marker moved outside of a 5-mm gating window. Results: The precision of the tracking in the IS direction was 0.53 mm for a sinusoidally moving target, with an average count rate ∼250 cps. The average prediction error was 1.1 ± 0.6 mm when the marker moved according to irregular patient breathing motion. Across all beam deliveries during the radiochromic film measurements, the average prediction error was 0.8 ± 0.5 mm. The maximum error was 2.5 mm and the 95th percentile error was 1.5 mm. Clear improvement of the dose distribution was observed between gated and nongated deliveries. The full-width at halfmaximum of the dose profiles of gated deliveries differed by 3 mm or less than the static reference dose distribution. Monitoring of the beam on/off times showed synchronization with the location of the marker within the latency of the system. Conclusions: PeTrack can track the motion of internal fiducial positron emission markers with submillimeter precision. The system can be used to gate the delivery of a Linac beam based on the position of a moving fiducial marker. This highlights the potential of the system for use in respiratory-gated radiotherapy.

61 RADIATION PROTECTION AND DOSIMETRY↗

SU-F-T-190: Homogeneity Study of Proton and Heavy Ion Scanning Beams Based On Different Compositions of Spot Sizes (FWHM) and Grid Sizes

Purpose: Different particle scanning beam delivery systems have different delivery accuracies. This study was performed to determine, for our particle treatment system, an appropriate composition (n=FWHM/GS) of spot size(FWHM) and grid size (GS), which can provide homogenous delivered dose distributions for both proton and heavy ion scanning beam radiotherapy. Methods: We analyzed the delivery errors of our beam delivery system using log files from the treatment of 28 patients. We used a homemade program to simulate square fields for different n values with and without considering the delivery errors and analyzed the homogeneity. All spots were located on a rectilinear grid with equal spacing in the × and y directions. After that, we selected 7 energy levels for both proton and carbon ions. For each energy level, we made 6 square field plans with different n values (1, 1.5, 2, 2.5, 3, 3.5). Then we delivered those plans and used films to measure the homogeneity of each field. Results: For program simulation without delivery errors, when n≥1.1 the homogeneity can be within ±3%. For both proton and carbon program simulations with delivery errors and film measurements, the homogeneity can be within ±3% when n≥2.5. Conclusion: For our facility with system errors, the n≥2.5 is appropriate for maintaining homogeneity within ±3%.

60 APPLIED LIFE SCIENCES↗