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At least 1,459 records · Page 81
All sourcesNASA NTRSDOE OSTI
DOE OSTI2015

TU-F-CAMPUS-T-04: Using Gold Nanoparticles to Target Mitochondria in Radiation Therapy

Purpose: The mitochondrion, like the cell nucleus, contains genetic material and plays several critical roles that determine the cell viability, including neutralization of free radicals within the cell. Studies have shown that irradiated cells with impaired mitochondria will incur more damage to the cell nucleus. This study investigates the potential use of GNPs to enhance radiation-induced damage to the organelle. Methods: The compositions of the organelles of a JURKAT cell were determined experimentally. Using Monte Carlo simulations, we investigate the significance of dose enhancement in a monoenergetic (10–50 keV and 6 MeV) x-ray irradiated cell cytoplasm, consisting of the experimentally determined composition. We also investigate the track structure of secondary electrons in the mitochondria using Geant4-DNA in the presence and absence of GNPs for incident protons and photons. The biological effect was determined using an approach based on the local effect model, assuming the mitochondrial DNA (mtDNA) was the primary target. Results: Adding 0.01% of gold to the cell cytoplasm material can cause substantial dose enhancement, dependent on the incident x-ray energy. Track structure Monte Carlo (MC) simulations show an increased number of ionization events within the mitochondrion structure. The close proximity of GNPs to the mtDNA storing nucleoid may cause the mtDNA to receive doses above ∼100 Gy for keV x-rays, leading to mitochondrial dysfunction. Conclusion: A substantial increase in ionization events can occur in the mitochondria in the presence of GNPs. If GNPs can be delivered to tumors and attached to a sufficient number of mitochondria inside the tumor cells, mitochondrial induced cell death could be a prevalent cause of cell death. The biological structures developed here will be included in the biological MC toolkit, TOPAS-nBio.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

Robotic path-finding in inverse treatment planning for stereotactic radiosurgery with continuous dose delivery

Purpose: Continuous dose delivery in radiation therapy treatments has been shown to decrease total treatment time while improving the dose conformity and distribution homogeneity over the conventional step-and-shoot approach. The authors develop an inverse treatment planning method for Gamma Knife® Perfexion™ that continuously delivers dose along a path in the target. Methods: The authors’ method is comprised of two steps: find a path within the target, then solve a mixed integer optimization model to find the optimal collimator configurations and durations along the selected path. Robotic path-finding techniques, specifically, simultaneous localization and mapping (SLAM) using an extended Kalman filter, are used to obtain a path that travels sufficiently close to selected isocentre locations. SLAM is novelly extended to explore a 3D, discrete environment, which is the target discretized into voxels. Further novel extensions are incorporated into the steering mechanism to account for target geometry. Results: The SLAM method was tested on seven clinical cases and compared to clinical, Hamiltonian path continuous delivery, and inverse step-and-shoot treatment plans. The SLAM approach improved dose metrics compared to the clinical plans and Hamiltonian path continuous delivery plans. Beam-on times improved over clinical plans, and had mixed performance compared to Hamiltonian path continuous plans. The SLAM method is also shown to be robust to path selection inaccuracies, isocentre selection, and dose distribution. Conclusions: The SLAM method for continuous delivery provides decreased total treatment time and increased treatment quality compared to both clinical and inverse step-and-shoot plans, and outperforms existing path methods in treatment quality. It also accounts for uncertainty in treatment planning by accommodating inaccuracies.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-T-274: Modified Dose Calibration Methods for IMRT QA

Purpose: To investigate IMRT QA uncertainties caused by dose calibration and modify widely used dose calibration procedures to improve IMRT QA accuracy and passing rate. Methods: IMRT QA dose measurement is calibrated using a calibration factor (CF) that is the ratio between measured value and expected value corresponding to the reference fields delivered on a phantom. Two IMRT QA phantoms were used for this study: a 30×30×30 cm3 solid water cube phantom (Cube), and the PTW Octavius phantom. CF was obtained by delivering 100 MUs to the phantoms with different reference fields ranging from 3×3 cm2 to 20×20 cm{sup 2}. For Cube, CFs were obtained using the following beam arrangements: 2-AP Field - chamber at dmax, 2-AP Field - chamber at isocenter, 4-beam box - chamber at isocenter, and 8 equally spaced fields and chamber at isocenter. The same plans were delivered on Octavius and CFs were derived for the dose at the isocenter using the above beam arrangements. The Octavius plans were evaluated with PTW-VeriSoft (Gamma criteria of 3%/3mm). Results: Four head and neck IMRT plans were included in this study. For point dose measurement with Cube, the CFs with 4-Field gave the best agreement between measurement and calculation within 4% for large field plans. All the measurement results agreed within 2% for a small field plan. Compared with calibration field sizes, 5×5 to 15×15 were more accurate than other field sizes. For Octavius, 4-Field calibration increased passing rate by up to 10% compared to AP calibration. Passing rate also increased by up to 4% with the increase of field size from 3×3 to 20×20. Conclusion: IMRT QA results are correlated with calibration methods used. The dose calibration using 4-beam box with field sizes from 5×5 to 20×20 can improve IMRT QA accuracy and passing rate.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-T-275: A Correlation Study On 3D Fluence-Based QA and 2D Dose Measurement-Based QA

Purpose: The aim of this paper was to demonstrate the feasibility and creditability of computing and verifying 3D fluencies to assure IMRT and VMAT treatment deliveries, by correlating the passing rates of the 3D fluence-based QA (P(ά)) to the passing rates of 2D dose measurementbased QA (P(Dm)). Methods: 3D volumetric primary fluencies are calculated by forward-projecting the beam apertures and modulated by beam MU values at all gantry angles. We first introduce simulated machine parameter errors (MU, MLC positions, jaw, gantry and collimator) to the plan. Using passing rates of voxel intensity differences (P(Ir)) and 3D gamma analysis (P(γ)), calculated 3D fluencies, calculated 3D delivered dose, and measured 2D planar dose in phantom from the original plan are then compared with those from corresponding plans with errors, respectively. The correlations of these three groups of resultant passing rates, i.e. 3D fluence-based QA (P(ά,Ir) and P(ά,γ)), calculated 3D dose (P(Dc,Ir) and P(Dc,γ)), and 2D dose measurement-based QA (P(Dm,Ir) and P(Dm,γ)), will be investigated. Results: 20 treatment plans with 5 different types of errors were tested. Spearman’s correlations were found between P(ά,Ir) and P(Dc,Ir), and also between P(ά,γ) and P(Dc,γ), with averaged p-value 0.037, 0.065, and averaged correlation coefficient ρ-value 0.942, 0.871 respectively. Using Matrixx QA for IMRT plans, Spearman’s correlations were also obtained between P(ά,Ir) and P(Dm,Ir) and also between P(ά,γ) and P(Dm,γ), with p-value being 0.048, 0.071 and ρ-value being 0.897, 0.779 respectively. Conclusion: The demonstrated correlations improve the creditability of using 3D fluence-based QA for assuring treatment deliveries for IMRT/VMAT plans. Together with advantages of high detection sensitivity and better visualization of machine parameter errors, this study further demonstrates the accuracy and feasibility of 3D fluence based-QA in pre-treatment QA and daily QA. Research reported in this study is supported by the Agency for Healthcare Research and Quality (AHRQ) under award 1R01HS0222888. The senior author received research grants from ViewRay Inc. and Varian Medical System.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-T-345: Quasi-Dead Beams: Clinical Relevance and Implications for Automatic Planning

Purpose: Beam direction selection for fixed-beam IMRT planning is typically a manual process. Severe dose-volume limits on critical structures in the thorax often result in atypical selection of beam directions as compared to other body sites. This work demonstrates the potential consequences as well as clinical relevance. Methods: 21 thoracic cases treated with 5–7 beam directions, 6 cases including non-coplanar arrangements, with fractional doses of 150–411cGy were analyzed. Endpoints included per-beam modulation scaling factor (MSF), variation from equal weighting, and delivery QA passing rate. Results: During analysis of patient-specific delivery QA a sub-standard passing rate was found for a single 5-field plan (90.48% of pixels evaluated passing 3% dose, 3mm DTA). During investigation it was found that a single beam demonstrated a MSF of 34.7 and contributed only 2.7% to the mean dose of the target. In addition, the variation from equal weighting for this beam was 17.3% absolute resulting in another beam with a MSF of 4.6 contributing 41.9% to the mean dose to the target; a variation of 21.9% from equal weighting. The average MSF for the remaining 20 cases was 4.0 (SD 1.8) with an average absolute deviation of 2.8% from equal weighting (SD 3.1%). Conclusion: Optimization in commercial treatment planning systems typically results in relatively equally weighted beams. Extreme variation from this can result in excessively high MSFs (very small segments) and potential decreases in agreement between planned and delivered dose distributions. In addition, the resultant beam may contribute minimal dose to the target (quasi-dead beam); a byproduct being increased treatment time and associated localization uncertainties. Potential ramifications exist for automatic planning algorithms should they allow for user-defined beam directions. Additionally, these quasi-dead beams may be embedded in the libraries for model-based systems potentially resulting in inefficient and less accurate deliveries.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-T-387: A Novel Optimization Technique for Field in Field (FIF) Chestwall Radiation Therapy Using a Single Plan to Improve Delivery Safety and Treatment Planning Efficiency

Purpose: A novel optimization technique was developed for field-in-field (FIF) chestwall radiotherapy using bolus every other day. The dosimetry was compared to currently used optimization. Methods: The prior five patients treated at our clinic to the chestwall and supraclavicular nodes with a mono-isocentric four-field arrangement were selected for this study. The prescription was 5040 cGy in 28 fractions, 5 mm bolus every other day on the tangent fields, 6 and/or 10 MV x-rays, and multileaf collimation.Novelly, tangents FIF segments were forward planned optimized based on the composite bolus and non-bolus dose distribution simultaneously. The prescription was spilt into 14 fractions for both bolus and non-bolus tangents. The same segments and monitor units were used for the bolus and non-bolus treatment. The plan was optimized until the desired coverage was achieved, minimized 105% hotspots, and a maximum dose of less than 108%. Each tangential field had less than 5 segments.Comparison plans were generated using FIF optimization with the same dosimetric goals, but using only the non-bolus calculation for FIF optimization. The non-bolus fields were then copied and bolus was applied. The same segments and monitor units were used for the bolus and non-bolus segments. Results: The prescription coverage of the chestwall, as defined by RTOG guidelines, was on average 51.8% for the plans that optimized bolus and non-bolus treatments simultaneous (SB) and 43.8% for the plans optimized to the non-bolus treatments (NB). Chestwall coverage of 90% prescription averaged to 80.4% for SB and 79.6% for NB plans. The volume receiving 105% of the prescription was 1.9% for SB and 0.8% for NB plans on average. Conclusion: Simultaneously optimizing for bolus and non-bolus treatments noticeably improves prescription coverage of the chestwall while maintaining similar hotspots and 90% prescription coverage in comparison to optimizing only to non-bolus treatments.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-T-440: The Feasibility Research of Checking Cervical Cancer IMRT Pre- Treatment Dose Verification by Automated Treatment Planning Verification System

Purpose: To assess the preliminary feasibility of automated treatment planning verification system in cervical cancer IMRT pre-treatment dose verification. Methods: The study selected randomly clinical IMRT treatment planning data for twenty patients with cervical cancer, all IMRT plans were divided into 7 fields to meet the dosimetric goals using a commercial treatment planning system(PianncleVersion 9.2and the EclipseVersion 13.5). The plans were exported to the Mobius 3D (M3D)server percentage differences of volume of a region of interest (ROI) and dose calculation of target region and organ at risk were evaluated, in order to validate the accuracy automated treatment planning verification system. Results: The difference of volume for Pinnacle to M3D was less than results for Eclipse to M3D in ROI, the biggest difference was 0.22± 0.69%, 3.5±1.89% for Pinnacle and Eclipse respectively. M3D showed slightly better agreement in dose of target and organ at risk compared with TPS. But after recalculating plans by M3D, dose difference for Pinnacle was less than Eclipse on average, results were within 3%. Conclusion: The method of utilizing the automated treatment planning system to validate the accuracy of plans is convenientbut the scope of differences still need more clinical patient cases to determine. At present, it should be used as a secondary check tool to improve safety in the clinical treatment planning.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-T-446: Improving Craniospinal Irradiation Technique Using Volumetric Modulated Arc Therapy (VMAT) Planning and Its Dosimetric Verification

Purpose: The purpose of this study is to investigate a volumetric modulated arc therapy (VMAT) treatment planning technique for supine craniospinal irradiation (CSI). Evaluate the suitability of VMAT for CSI with dosimetric measurements and compare it to 3D conformal planning using specific plan metrics such as dose conformity, homogeneity, and dose of organs at risk (OAR). Methods: Ten CSI patients treated with conventional 3D technique were re-planned with VMAT. The PTV was contoured to include the whole contents of the brain and spinal canal with a uniform margin of 5 mm. VMAT plans were generated with two partial arcs covering the brain, two partial arcs for the superior portion of the spinal cord and two partial arcs covering the remaining inferior portion of the spinal cord. Conformity index (CI), heterogeneity indexes (HI) and max and mean doses of OAR were compared to 3D plans. VMAT plans were delivered onto an anthropomorphic phantom loaded with Gafchromic films and OSLDs placed at specific positions to evaluate the plan dose at the junctions and as well as the plan dose distributions. Results: This VMAT technique was validated with a clinical study of 10 patients. The average CI was 1.03±0.02 for VMAT plans and 1.96±0.32 for conformal plans. And the average HI was 1.15±0.01 for VMAT plans and 1.51±0.21 for conformal plans. The mean and max doses to the all OARs for VMAT plans were significantly lower than conformal plans. The measured dose in phantom for VAMT plans was comparable to the calculated dose in Eclipse and the doses at junctions were verified. Conclusion: VMAT CSI was able to achieve better dose conformity and heterogeneity as well as significantly reducing the dose to Heart, esophagus and larynx. VMAT CSI appears to be a dosimterically advantageous, faster delivery, has better reproducibility CSI treatment.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-T-447: The Impact of Treatment Planning Methods On RapidPlan Modeling for Rectum Cancer

Purpose: To investigate the dose volume histogram (DVH) prediction varieties based on intensity modulate radiotherapy (IMRT) plan or volume arc modulate radiotherapy (VMAT) plan models on the RapidPlan. Methods: Two DVH prediction models were generated in this study, including an IMRT model trained from 83 IMRT rectum plans and a VMAT model trained from 60 VMAT rectum plans. In the internal validation, 20 plans from each training database were selected to verify the clinical feasibility of the model. Then, 10 IMRT plans (PIMRT-by-IMRT-model) generated from IMRT model and 10 IMRT plans generated from VMAT model (PIMRT-by-VMAT-model) were compared on the dose to organs at risk (OAR), which included bladder, left and right femoral heads. The similar comparison was also performed on the VMAT plans generated from IMRT model (PVMAT-by-IMRT-model) and VMAT plans generated from VMAT (PVMAT-by-VMAT-model) model. Results: For the internal validation, all plans from IMRT or VMAT model shows significantly improvement on OAR sparing compared with the corresponded clinical ones. Compared to the PIMRT-by-VMAT-model, the PIMRT-by-IMRT-model has a reduction of 6.90±3.87%(p<0.001) on V40 6.63±3.62%(p<0.001) on V45 and 4.74±2.26%(p<0.001) on V50 in bladder; and a mean dose reduction of 2.12±1.75Gy(p=0.004) and 2.84±1.53Gy(p<0.001) in right and left femoral head, respectively. There was no significant difference on OAR sparing between PVMAT-by-IMRT-model and PVMAT-by-VMAT-model. Conclusion: The IMRT model for the rectal cancer in the RapidPlan can be applied to for VMAT planning. However, the VMAT model is not suggested to use in the IMRT planning. Cautions should be taken that the planning model based on some technique may not feasible to other planning techniques.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-T-588: Asymmetries in the CyberKnife Iris 2 Collimator

Purpose: The Iris 2 dodecahedral collimator in the CyberKnife unit can demonstrate visible asymmetry in the shaped radiation field, as seen on routine films. Specifically some edges of the collimator project longer than others. PDDs and output factors remain unaffected by this asymmetry. An in-house program was written to analyze the impact of this asymmetry on profiles. Methods: Two years of routine chromodynamic films were retrospectively analyzed using an in-house developed program. Films were obtained on a weekly basis in a plastic phantom on the vendor-provided mount. Profiles were obtained every degree. A dodecahedron was fitted to the 50% isodose line and the positions and sizes of the upper and lower hexagonal collimators were derived. The collimators’ profiles at every degree, symmetry and centering were calculated and trended over the months. Results: Asymmetries in the obtained profiles were apparent. The upper and lower collimators were off-centered (0.31 mm, p<10–8), they did not project the same field size at 80 cm (0.46 mm difference, p<10–31). Profiles as a function of angle demonstrate a periodicity, but short and long profiles are rarely 15° apart, but vary from 9° to 21°. In addition, a second, intermediate minimum is seen at every other short profile. A trend in the field size over time is noted and can be monitored to identify servicing needs. Conclusion: Despite its differences, the asymmetric Iris 2 collimator did not demonstrate large deviations in PDDs and output factors. Due to the asymmetry, the 15° apart profiles obtained at commissioning do not represent the true large and short blade profiles of the collimator. Averaging of the profiles in the commissioning process hides this difference.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-T-589: HybridArc Planning Criteria for Brain SRS

Purpose: To compare VMAT SRS plans, dynamic conformal arc (DCA) plans, and Brainlab iPlan’s capability of planning and delivering brain SRS plans by employing HybridArc. HybridArc utilizes both DCA and IMRT. Using HybridArc, the amount of DCA versus IMRT needs to be optimized. Methods: Four SRS patients with the aim of reducing brainstem dose were selected for this study. All patients were contoured in iPlan and transferred to Eclipse for VMAT planning. In iPlan, DCA plans were created for each case. Moreover, nine HybridArc plans with DCA-IMRT ratios between 9:1 through 1:9 were created with a single ring structure generated by subtracting 3 mm expansion of target from a 10 mm expansion of the target. Two static IMRT beams were used in each of the five DCA arcs for HybridArc. The dose was prescribed to DCA only and HybridArc plans and normalized so that the target volume (TV) receives 100% dose to 99.5% of the TV to achieve 120% ∼ 130% max dose within targets. Following metrics were compared: PITV, V12Gy, CGIc, CGIg, CGI, brainstem max dose, and total monitor units (MUs). Results: A brainstem max dose comparable with VMAT from 30% IMRT and less with 50% or more IMRT could be achieved. PITV decreased with increasing IMRT portion and begins to saturate past an IMRT portion of 30%. The CGIg index, which represents how fast the dose falls off, was better with HybridArc in all HybridArc plans. Total MUs increased with increasing IMRT but less than VMAT in all cases. Conclusion: Overall, a lower brainstem max dose and a lower V12Gy with fewer MUs can be achieved with HybridArc. Considering all factors, it would be best to use a DCA-IMRT ratio of either 7:3 or 6:4.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-T-616: Comparison of Different Techniques Using RTOG0631 Guidelines in Spine SBRT

Purpose: Stereotactic body radiosurgery (SBRT) for spine metastases involves irradiation using a single high dose fraction. The purpose of this study was to investigate a Hybrid VMAT/IMRT technique which combines volumetric modulated arc therapy (VMAT) and intensity modulated radiation therapy (IMRT) for spine SBRT in terms of its dosimetric quality and treatment efficiency using Radiation Therapy Oncology Group (RTOG) 0631 guidelines. Methods: 7 fields IMRT, 2 full arcs VMAT and Hybrid VMAT/IMRT were created for ten previously treated patients. The Hybrid VMAT/IMRT technique consisted of 1 full VMAT arc and 5 IMRT fields. Hybrid VMAT/IMRT plans were compared with IMRT and VMAT plans in terms of the dose distribution, spinal cord sparing, homogeneity, conformity and gradient indexies, monitor unit (MU) and beam on time (BOT). RTOG 0631 recommendations were applied for treatment planning. All plans were normalized and prescribed to deliver 18.0 Gy in a single fraction to 90% of the target volume. Results: The Hybrid VMAT/IMRT technique significantly improved target dose homogeneity and conformity compared with IMRT and VMAT techniques. Providing sharp dose gradient Hybrid VMAT/IMRT plans spare the spinal cord and healthy tissue more effectively. Although, both MU and BOT slightly increased in Hybrid VMAT/IMRT plans there is no statistically meaningful difference between VMAT and Hybrid VMAT/IMRT plans. Conclusion: In IMRT, a smaller volume of healthy tissue can be irradiated in the low dose region, VMAT plans provide better target volume coverage, favorable dose gradient, conformity and better OAR sparing and also they require a much smaller number of MUs and thus a shorter treatment time than IMRT plans. Hybrid plan offers a sinergy through combination of these two techniques with slightly increased number of MU and thus more treatment time.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-T-621: Impact of Vacuum and Treatment Couch On Surface Dose in Stereotactic Body Radiation Therapy With and Without a Flattening Filter

Purpose: When treating lung cancer patients with stereotactic body radiation therapy (SBRT), better immobilization is needed for accurate delivery of high-dose radiation. However, using a treatment couch (TrueBeamTM) and vacuum bag (BlueBAGTM) may increase the surface dose and skin toxicity. This study investigated the influence of couch and vacuum bag on the surface dose. Methods: The relative surface dose (D{sub 0}/DMAX) was measured in an ion-chamber (Markus-type PTW, 0.05cm{sup 3}) with a solid water phantom and SSD to 100 cm. A comprehensive comparison of different parameter settings, including the different energies (6MV-FFF, 10MV-FF, and 10MV-FFF), field sizes (3 X 3 cm{sup 2}, 5 × 5 cm{sup 2}, 8 × x cm{sup 2} , 10 × 10 cm{sup 2}, and 15 × 15 cm{sup 2}), thickness of the vacuum bag (5mm, 15mm, 30mm, 39mm and 55mm), and couch (with and without), was performed. Results: The FFF increases the surface dose as compared to FF mode. In a similar setting with field of 10 × 10 cm{sup 2}, FFF mode increases the surface dose from 26.0% to 32.8% for 6 MV, and 17.4% to 21.5% for 10 MV. When the beam passes through the couch, the surface dose increases to 3.6, 4.6, 2.9, and 3.7 times for 6 MV-FF, 10 MV-FF, 6 MV-FFF, and 10 MV-FFF, respectively. At the same energy, the surface dose increases to 3.93, 4.11, 4.23, 4.16 and 4.24 times at 5 mm, 15 mm, 30 mm, 39 mm and 55 mm thickness of the vacuum, respectively. Conclusion: Using a couch and vacuum significantly increases the surface dose. For SBRT with a superficial target close to the couch and immobilization vacuum, reduction of vacuum thickness and careful attention to skin dose in planning would be helpful in avoiding severe skin toxicity.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-T-625: Optimal Treatment Planning Strategy Among Arc Arrangements for Prostate SBRT with VMAT Technique

Purpose: The purpose of this study is to determine the optimal treatment planning strategy among the different arc arrangements for prostate stereotactic body radiotherapy (SBRT) plans with volumetric modulated arc therapy (VMAT). Methods: Ten patients with prostate cancer were selected. The SBRT-VMAT plans for each patient were generated with single-full (181° to 179°; 1FA), single-partial (240° to 120°; 1PA), double-full (181° to 179° and 179° to 181°; 2FA), and double-partial (240° to 120° and 120° to 240°; 2PA) arc arrangements. The prescription dose was 42.7 Gy in 7 fractions. Dose distribution was calculated using a 10-MV flattening-filter-free beam and the Acuros XB algorithm. Dosimetric parameters of target volume and organs at risk (OARs) were evaluated from cumulative dose-volume histograms on prostate SBRT-VMAT plans between single-arc (1FA and 1PA) and double-arc (2FA and 2PA) arrangements. Results: All plans using four arc arrangements were highly conformal with conformity index (CI)<1.05 and conformation number (CN)=0.91, and the doses to target volume were homogeneous (homogeneity index (HI)= 0.09 0.12). Pertaining to the dose to the OARs, there were significant differences in the rectum, left and right femoral head doses while having no difference in the bladder dose. The partial-arc (1PA and 2PA) had relatively high reductions for the mean rectum dose compared to full-arc (1FA and 2FA). The near-to-maximum dose (D2%) and mean dose of the left and right femoral head were always lower on prostate SBRT-VMAT plan using the full-arc, when compared to the partial-arc arrangement. Conclusion: This study confirmed that prostate SBRT-VMAT using 1PA was feasible fast delivery time and produced equivalent target coverage and better rectum sparing, although the D2% and mean dose of the left and right femoral head increased slightly. Therefore, the results of this study suggest that the use of 1PA is an attractive choice for delivering prostate SBRT-VMAT.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-T-635: Lung SBRT: Dosimetric and Treatment Time Comparison of Volumetric-Modulated Arc Therapy and Three-Dimensional Conformal Radiotherapy in Clinically Treated Cases

Purpose: To compare three-dimensional conformal radiotherapy (3D CRT) and volumetric-modulated arc therapy (VMAT) in lung stereotactic body radiation therapy (SBRT) Methods: A retrospective study of clinically treated lung SBRT cases treated between 2010 and 2015 at our hospital was performed. All treatment modalities were included in this evaluation (VMAT, 3D CRT, static IMRT, and dynamic conformal arc therapy). However, the majority of treatment modalities were either VMAT or 3D CRT. Treatment times of patients and dosimetric plan quality metrics were compared. Treatment times were calculated based on the time the therapist opened and closed the patient’s treatment plan. This treatment time closely approximates the utilization time of the treatment room. The dosimetric plan quality metrics evaluated include ICRU conformity index, the volume of 105% prescribed dose outside PTV, the ratio of volume of 50% prescribed dose to the volume of PTV, the percentage of maximum dose at 2 cm away from PTV to the prescribed dose, and the V20 (percentage of lung volume receiving 20 Gy or more). Results: Treatment time comparisons show that on average VMAT has shorter treatment times than 3D CRT. Dose conformity, defined by the ICRU conformity index, and high dose spillage, defined by the volume of 105% dose outside the PTV, is reduced when using VMAT compared to 3D CRT. V20 and intermediate dose spillage/fall-off metrics of VMAT and 3D are not significantly different. Conclusion: Clinically treated lung SBRT cases indicate VMAT is superior to 3D with regard to shorter treatment times, plan dose conformity, and plan high dose spillage.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-T-663: Cerenkov Radiation Enhanced Radiotherapy with Titanium Dioxide Nanoparticle: A Monte Carlo Study

Purpose: A recent publication has shown that by delivering titanium dioxide nanoparticles (titania) as a photosensitizer into tumors, Cerenkov radiation (CR) produced by radionuclides could be used for substantially boosting damage to cancer cells. The present work compares CR production by various clinically relevant radiation sources including internal radionuclides and external beam radiotherapy (EBRT), and provides preliminarily computational results of CR absorption by titania. Methods: 1) Geant4.10.1 was used to simulate ionizing radiation-induced CR production in a 1cm diameter spherical volume using external radiotherapy sources: Varian Clinac IX 6MV and Eldorado {sup 60}Co, both with 10*10 cm{sup 2} field size. In each case the volume was placed at the maximum dose depth (1.5cm for 6MV source and 0.5cm for {sup 60}Co). In addition, {sup 18}F, {sup 192}Ir and {sup 60}Co were simulated using Geant4 radioactive decay models as internal sources. Dose deposition and CR production spectra in 200nm-400nm range were calculated as it is the excitation range of titania. 2) Using 6MV external source, the absorption by titania was calculated via the track length of CR in the spherical volume. The nanoparticle concentration was varied from 0.25 to 5µg/g. Results: Among different radioactive sources, results showed that {sup 18}F induced the highest amount of CR per disintegration, but {sup 60}Co had the highest yield per unit dose. When compared with external sources, 6MV source was shown to be the most efficient for the the same delivered dose. Simulations indicated increased absorption for increasing concentrations, with up to 68% absorption of generated CR for 5µg/g titania concentration. Conclusion: The results demonstrate that 6MV beam is favored with a higher CR yield, compared to radionuclides, and that the use of higher concentrations of titania may increase photosensitization. From the findings, we propose that if sufficiently potent concentrations of titania are delivered to tumors this could substantially boost EBRT.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-G-201-07: Dosimetric Verification of a 3D Printed HDR Skin Brachytherapy Applicator

Purpose: The use of radiation as a treatment modality for skin cancer has increased significantly over the last decade with standardized applicators. Utilizing 3D printing, the ability to make applicators specifically designed for each patient’s anatomy has become economically feasible. With this in mind it was the aim of this study to determine the dosimetric accuracy of a 3-D printed HDR brachytherapy applicator for the skin. Methods: A CT reference image was used to generate a custom applicator based on an anthropomorphic head and neck phantom. To create the applicator a 1cm expansion anteriorly with 0.5cmX0.5cm trenches on the outer surface that were spaced 1cm sup-inf to accommodate standard 6F flexible catheters. The applicator was printed using PLA material using a printrbot simple printer. A treatment plan optimized to deliver a clinically representative volume was created in Oncentra and delivered with a nucletron afterloader. Measurements were made using TLDs and EBT3 gafchromic film that were placed between the applicator and the phantom’s forehead. An additional piece of film was also used to qualitatively asses the dose distribution in the transverse plane. Using a standard vaginal cylinder and bolus, a standardized curve correlating TLD and film exposure-to-radiation dose was established by irradiating film to known doses (200,500,700 cGy) at a 3.5 cm radius distance. Results: Evaluated TLDs showed the absolute dose delivered to the skin surface using the 3-D printed bolus was 615cGy±6%, with a mean predicted TPS value in the measured area of 617.5±7%. Additionally, planar dose distributions had good qualitative agreement with calculated TPS isodoses. Conclusion: This work demonstrates patient specific 3-D printed HDR brachytherapy applicators for skin cancer treatments are practical and accurate in TPS calculations but additional measurements are needed to verify additional sites and dose at depth.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-G-JeP1-02: A New Intra-Fractional Prostate Motion Tracking Method in Volumetric Modulated Arc Therapy (VMAT) Via 2D/3D Registration

Purpose: Intra-fractional prostate motion leads uncertainty on delivered dose in radiotherapy and may cause significant dose deviation from the planned dose distribution. This is especially a concern in scenarios with a high dose per fraction and hence a long delivery time, e.g. stereotactic body radiotherapy. Knowledge about intra-fractional prostate motion is valuable to address this problem, e.g. by reconstructing delivered dose and performing adaptation. This study proposes a new approach to determine intra-fractional prostate motion in VMAT via 2D/3D maker registration. Methods: At our institution, each patient has three markers implanted in the prostate. During treatment delivery, kV triggered images were taken every three seconds to acquire 2D projection of 3D anatomy at the direction orthogonal to the therapeutic beam. Projected marker locations were identified on each projection image using template matching with geometric constraints. 3D prostate translation and rotation for each triggered image were obtained by solving an optimization problem, such that the calculated marker locations match the measured ones. Inter-image motion smoothness was employed as a constraint. We tested this method in simulation studies with five realistic prostate motion trajectories acquired via Calypso and in real phantom experiments. Results: For the simulation case, the motion range for these patients was 0.5∼6.0 mm. Root mean square (RMS) error of calculated motion along left-right (LR), anterior-posterior (AP) and cranial-caudal (CC) directions were 0.26mm, 0.36mm, and 0.016mm, respectively. The motion range in the phantom study along LR, AP, and CC directions were 15mm, 20mm and 10mm. The mean RMS errors along these directions were 1.99mm, 1.37mm and 0.22mm. Conclusion: A new prostate motion tracking algorithm based on kV triggered images has been developed and validated. Clinically acceptable accuracy has been achieved.

60 APPLIED LIFE SCIENCES↗