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At least 1,513 records · Page 84
All sourcesNASA NTRSDOE OSTI
DOE OSTI2013

Stereotactic body radiation therapy planning with duodenal sparing using volumetric-modulated arc therapy vs intensity-modulated radiation therapy in locally advanced pancreatic cancer: A dosimetric analysis

Stereotactic body radiation therapy (SBRT) achieves excellent local control for locally advanced pancreatic cancer (LAPC), but may increase late duodenal toxicity. Volumetric-modulated arc therapy (VMAT) delivers intensity-modulated radiation therapy (IMRT) with a rotating gantry rather than multiple fixed beams. This study dosimetrically evaluates the feasibility of implementing duodenal constraints for SBRT using VMAT vs IMRT. Non–duodenal sparing (NS) and duodenal-sparing (DS) VMAT and IMRT plans delivering 25 Gy in 1 fraction were generated for 15 patients with LAPC. DS plans were constrained to duodenal D{sub max} of<30 Gy at any point. VMAT used 1 360° coplanar arc with 4° spacing between control points, whereas IMRT used 9 coplanar beams with fixed gantry positions at 40° angles. Dosimetric parameters for target volumes and organs at risk were compared for DS planning vs NS planning and VMAT vs IMRT using paired-sample Wilcoxon signed rank tests. Both DS VMAT and DS IMRT achieved significantly reduced duodenal D{sub mean}, D{sub max}, D{sub 1cc}, D{sub 4%}, and V{sub 20} {sub Gy} compared with NS plans (all p≤0.002). DS constraints compromised target coverage for IMRT as demonstrated by reduced V{sub 95%} (p = 0.01) and D{sub mean} (p = 0.02), but not for VMAT. DS constraints resulted in increased dose to right kidney, spinal cord, stomach, and liver for VMAT. Direct comparison of DS VMAT and DS IMRT revealed that VMAT was superior in sparing the left kidney (p<0.001) and the spinal cord (p<0.001), whereas IMRT was superior in sparing the stomach (p = 0.05) and the liver (p = 0.003). DS VMAT required 21% fewer monitor units (p<0.001) and delivered treatment 2.4 minutes faster (p<0.001) than DS IMRT. Implementing DS constraints during SBRT planning for LAPC can significantly reduce duodenal point or volumetric dose parameters for both VMAT and IMRT. The primary consequence of implementing DS constraints for VMAT is increased dose to other organs at risk, whereas for IMRT it is compromised target coverage. These findings suggest clinical situations where each technique may be most useful if DS constraints are to be employed.

61 RADIATION PROTECTION AND DOSIMETRY↗
DOE OSTI2013

Circumferential or sectored beam arrangements for stereotactic body radiation therapy (SBRT) of primary lung tumors: Effect on target and normal-structure dose-volume metrics

To compare 2 beam arrangements, sectored (beam entry over ipsilateral hemithorax) vs circumferential (beam entry over both ipsilateral and contralateral lungs), for static-gantry intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) delivery techniques with respect to target and organs-at-risk (OAR) dose-volume metrics, as well as treatment delivery efficiency. Data from 60 consecutive patients treated using stereotactic body radiation therapy (SBRT) for primary non–small-cell lung cancer (NSCLC) formed the basis of this study. Four treatment plans were generated per data set: IMRT/VMAT plans using sectored (-s) and circumferential (-c) configurations. The prescribed dose (PD) was 60 Gy in 5 fractions to 95% of the planning target volume (PTV) (maximum PTV dose ∼ 150% PD) for a 6-MV photon beam. Plan conformality, R{sub 50} (ratio of volume circumscribed by the 50% isodose line and the PTV), and D{sub 2} {sub cm} (D{sub max} at a distance ≥2 cm beyond the PTV) were evaluated. For lungs, mean doses (mean lung dose [MLD]) and percent V{sub 30}/V{sub 20}/V{sub 10}/V{sub 5} Gy were assessed. Spinal cord and esophagus D{sub max} and D{sub 5}/D{sub 50} were computed. Chest wall (CW) D{sub max} and absolute V{sub 30}/V{sub 20}/V{sub 10}/V{sub 5} {sub Gy} were reported. Sectored SBRT planning resulted in significant decrease in contralateral MLD and V{sub 10}/V{sub 5} {sub Gy}, as well as contralateral CW D{sub max} and V{sub 10}/V{sub 5} {sub Gy} (all p < 0.001). Nominal reductions of D{sub max} and D{sub 5}/D{sub 50} for the spinal cord with sectored planning did not reach statistical significance for static-gantry IMRT, although VMAT metrics did show a statistically significant decrease (all p < 0.001). The respective measures for esophageal doses were significantly lower with sectored planning (p < 0.001). Despite comparable dose conformality, irrespective of planning configuration, R{sub 50} significantly improved with IMRT-s/VMAT-c (p < 0.001/p = 0.008), whereas D{sub 2} {sub cm} significantly improved with VMAT-c (p < 0.001). Plan delivery efficiency improved with sectored technique (p < 0.001); mean monitor unit (MU)/cGy of PD decreased from 5.8 ± 1.9 vs 5.3 ± 1.7 (IMRT) and 2.7 ± 0.4 vs 2.4 ± 0.3 (VMAT). The sectored configuration achieves unambiguous dosimetric advantages over circumferential arrangement in terms of esophageal, contralateral CW, and contralateral lung sparing, in addition to being more efficient at delivery.

61 RADIATION PROTECTION AND DOSIMETRY↗
DOE OSTI2013

An overview of craniospinal axis fields and field matching

Many methods are implemented for craniospinal axis (CSA) radiation treatment (RT). This paper’s goal is to define correctly matched CSA RT fields. Overlap or a space between matched RT fields can create variances of dose and the possibility of negative side effects or disease recurrence, respectively. An accurate CSA RT match procedure is created with localization markers, immobilization devices, equations, feathered matches, safety gap, and portal imaging. A CS match angle is predetermined to optimize patient position before immobilization device fabrication. Various central axis (CA) placements within the brain and spine fields that effect gantry, table, and collimator rotation are described. An overview of the methods used to create CSA RT fields and matches is presented for optimal CSA RT implementation. In addition, to the author’s knowledge, this is the first time that a prone CSA RT with anesthesia has been described.

61 RADIATION PROTECTION AND DOSIMETRY↗
DOE OSTI2014

Dosimetric comparison of IMRT rectal and anal canal plans generated using an anterior dose avoidance structure

To describe a dosimetric method using an anterior dose avoidance structure (ADAS) during the treatment planning process for intensity-modulated radiation therapy (IMRT) for patients with anal canal and rectal carcinomas. A total of 20 patients were planned on the Elekta/CMS XiO treatment planning system, version 4.5.1 (Maryland Heights MO) with a superposition algorithm. For each patient, 2 plans were created: one employing an ADAS (ADAS plan) and the other replanned without an ADAS (non-ADAS plan). The ADAS was defined to occupy the volume between the inguinal nodes and primary target providing a single organ at risk that is completely outside of the target volume. Each plan used the same beam parameters and was analyzed by comparing target coverage, overall plan dose conformity using a conformity number (CN) equation, bowel dose-volume histograms, and the number of segments, daily treatment duration, and global maximum dose. The ADAS and non-ADAS plans were equivalent in target coverage, mean global maximum dose, and sparing of small bowel in low-dose regions (5, 10, 15, and 20 Gy). The mean difference between the CN value for the non-ADAS plans and ADAS plans was 0.04 ± 0.03 (p < 0.001). The mean difference in the number of segments was 15.7 ± 12.7 (p < 0.001) in favor of ADAS plans. The ADAS plan delivery time was shorter by 2.0 ± 1.5 minutes (p < 0.001) than the non-ADAS one. The ADAS has proven to be a powerful tool when planning rectal and anal canal IMRT cases with critical structures partially contained inside the target volume.

61 RADIATION PROTECTION AND DOSIMETRY↗
DOE OSTI2018

Clinical analysis of the approximate, 3-dimensional, biological effective dose equation in multiphase treatment plans

A multiphase, approximate biological effective dose (BED{sub A}) equation was introduced because most treatment planning systems (TPS) are incapable of calculating the true BED (BED{sub T}). This work investigates the accuracy and precision of the multiphase BED{sub A} relative to the BED{sub T} in clinical cases. Ten patients with head and neck cancer and 10 patients with prostate cancer were studied using their treatment plans from Pinnacle{sup 3} 9.2 (Philips Medical, Fitchburg, WI). The organs at risk (OARs) that were studied are the normal brain, left and right optic nerves, optic chiasm, spinal cord, brainstem, bladder, and rectum. BED{sub A} and BED{sub T} distributions were calculated using MATLAB 2010b (MathWorks, Natick, MA) and analyzed on a voxel basis for percent error, percent error volume histograms (PEVHs), Pearson correlation coefficient, and Bland-Altman analysis. The maximum BED values that were calculated using the BED{sub A} and BED{sub T} methods were also analyzed. BED{sub A} was found to always underestimate BED{sub T}. The accuracy and precision of BED{sub A} distributions varied between the organs: for optic chiasm and brainstem, 50% of the patients had an overall BED{sub A} percent error of A percent error of A percent error of A distributions had maximum errors ranging from 2% to 11%, with the 11% error occurring for bladder. BED{sub A} produced much more accurate maximum BED values with adjacent organs such as normal brain, bladder, and rectum. This study has shown that BED{sub A} can calculate BED distributions with acceptable accuracy under certain circumstances. However, its consistency and accuracy strongly depend on the dose distributions of the different treatment phases. One should be cautious when using BED{sub A}.

61 RADIATION PROTECTION AND DOSIMETRY↗
DOE OSTI2022

Cutaneous and local radiation injuries

The threat of a large-scale radiological or nuclear (R/N) incident looms in the present-day climate, as noted most recently in an editorial in Scientific American (March 2021). These large-scale incidents are infrequent but affect large numbers of people. Smaller-scale R/N incidents occur more often, affecting smaller numbers of people. There is more awareness of acute radiation syndrome (ARS) in the medical community; however, ionising radiation-induced injuries to the skin are much less understood. Here, this article will provide an overview of radiation-induced injuries to the skin, deeper tissues, and organs. The history and nomenclature; types and causes of injuries; pathophysiology; evaluation and diagnosis; current medical management; and current research of the evaluation and management are presented. Cutaneous radiation injuries (CRI) or local radiation injuries (LRI) may lead to cutaneous radiation syndrome, a sub-syndrome of ARS. These injuries may occur from exposure to radioactive particles suspended in the environment (air, soil, water) after a nuclear detonation or an improvised nuclear detonation (IND), a nuclear power plant incident, or an encounter with a radioactive dispersal or exposure device. These incidents may also result in a radiation-combined injury; a chemical, thermal, or traumatic injury, with radiation exposure. Skin injuries from medical diagnostic and therapeutic imaging, medical misadministration of nuclear medicine or radiotherapy, occupational exposures (including research) to radioactive sources are more common but are not the focus of this manuscript. Diagnosis and evaluation of injuries are based on the scenario, clinical picture, and dosimetry, and may be assisted through advanced imaging techniques. Research-based multidisciplinary therapies, both in the laboratory and clinical trial environments, hold promise for future medical management. Great progress is being made in recognising the extent of injuries, understanding their pathophysiology, as well as diagnosis and management; however, research gaps still exist.

61 RADIATION PROTECTION AND DOSIMETRY↗
DOE OSTI2023

EPR-based uncertainty validation of the calculated external doses for population exposed in the urals region

Tooth enamel Electron Paramagnetic Resonance (EPR) spectroscopy was used as a method for external dosimetry in the territories contaminated in the 1950s by PA ‘Mayak’ (Urals region) to validate the mean dose estimates predicted by the Techa River Dosimetry System (TRDS). The purpose of this study is to validate the uncertainties of TRDS doses. Ninety percent confidence intervals (90% confidence interval, CI) of dose estimated with both methods were compared for 220 people. All data were grouped according to the width of 90%CI, viz.: (1) 90%CI of EPR-based dose ≤ 90%CI of TRDS prediction (38 cases); (2) 90%CI of EPR-based dose > 90%CI of TRDS prediction (182 cases). About 91% of 90%CIs overlap. In group 1, 100% cases overlap. In group 2, 80% of the cases were non-contradictive (the calculated 90%CI is completely within the measured one). Interval comparison of doses predicted retrospectively and estimated based on individual measurements are non-contradictory and demonstrate a good agreement.

61 RADIATION PROTECTION AND DOSIMETRY↗
DOE OSTI2015

SU-E-T-408: Evaluation of the Type and Frequency of Variations Discovered During Routine Secondary Patient Chart Review

Purpose: Desire to improve efficiency and throughput inspired a review of our physics chart check procedures. Departmental policy mandates plan checks pre-treatment, after first treatment and weekly every 3–5 days. This study examined the effectiveness of the “after first” check with respect to improving patient safety and clinical efficiency. Type and frequency of variations discovered during this redundant secondary review was examined over seven months. Methods: A community spreadsheet was created to record variations in care discovered during chart review following the first fraction of treatment and before the second fraction (each plan reviewed prior to treatment). Entries were recorded from August 2014 through February 2015, amounting to 43 recorded variations out of 906 reviewed charts. The variations were divided into categories and frequencies were assessed month-to-month. Results: Analysis of recorded variations indicates an overall variation rate of 4.7%. The initial rate was 13.5%; months 2–7 average 3.7%. The majority of variations related to discrepancies in documentation at 46.5%, followed by prescription, plan deficiency, and dose tracking related variations at 25.5%, 12.8%, and 12.8%, respectively. Minor variations (negligible consequence on patient treatment) outweighed major variations 3 to 1. Conclusion: This work indicates that this redundant secondary check is effective. The first month spike in rates could be due to the Hawthorne/observer effect, but the consistent 4% variation rate suggests the need for periodical re-training on variations noted as frequent to improve awareness and quality of the initial chart review process, which may lead to improved treatment quality, patient safety and increased clinical efficiency. Utilizing these results, a continuous quality improvement process following Deming’s Plan-Do-Study-Act (PDSA) methodology was generated. The first iteration of this PDSA was adding a specific dose tracking checklist item in the pre-treatment plan check assessment; the ramification of which will be assessed in future data.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

TU-CD-303-03: Localized Radiation Can Induce Systemic Anti-Cancer Immune and Non-Immune Responses and How We Might Utilize It

Recent advances in cancer research have shed new light on the complex processes of how therapeutic radiation initiates changes at cellular, tissue, and system levels that may lead to clinical effects. These new advances may transform the way we use radiation to combat certain types of cancers. For the past two decades many technological advancements in radiation therapy have been largely based on the hypothesis that direct radiation-induced DNA double strand breaks cause cell death and thus tumor control and normal tissue damage. However, new insights have elucidated that in addition to causing cellular DNA damage, localized therapeutic radiation also initiates cascades of complex downstream biological responses in tissue that extend far beyond where therapeutic radiation dose is directly deposited. For instance, studies show that irradiated dying tumor cells release tumor antigens that can lead the immune system to a systemic anti-cancer attack throughout the body of cancer patient; targeted irradiation to solid tumor also increases the migration of tumor cells already in bloodstream, the seeds of potential metastasis. Some of the new insights may explain the long ago discovered but still unexplained non-localized radiation effects (bystander effect and abscopal effect) and the efficacy of spatially fractionated radiation therapy (microbeam radiation therapy and GRID therapy) where many “hot” and “cold” spots are intentionally created throughout the treatment volume. Better understanding of the mechanisms behind the non-localized radiation effects creates tremendous opportunities to develop new and integrated cancer treatment strategies that are based on radiotherapy, immunology, and chemotherapy. However, in the multidisciplinary effort to advance new radiobiology, there are also tremendous challenges including a lack of multidisciplinary researchers and imaging technologies for the microscopic radiation-induced responses. A better grasp of the essence of these advances in cancer biology research will give medical physicists a new perspective in daily clinical physics practice and in future radiation therapy technological development. Furthermore, academic medical physics should continue to be an integral part of the multidisciplinary cancer research community, harnessing our newly acquired understanding of radiation effects, and developing novel cost-effective treatment strategies to better combat cancer. Learning Objectives: Understand that localized radiation can lead to non-localized secondary effects such as radiation-induced immune response, bystander effect, and abscopal effect. Understand that the non-localized radiation effects may be harnessed to improve cancer treatment. Learn examples of physics participation in multidisciplinary research to advance cancer biology. Recognize the challenges and possibilities of physics applications in cancer research. Chang: NIH 5RC2CA148487-02 and 1U54CA151652-01 Graves: IDEA award (19IB-0106) from the California Breast Cancer Research Program (CBCRP), and by NIH P01 CA67166.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

TU-CD-303-05: Unveiling Tumor Heterogeneity by Molecular Imaging

Recent advances in cancer research have shed new light on the complex processes of how therapeutic radiation initiates changes at cellular, tissue, and system levels that may lead to clinical effects. These new advances may transform the way we use radiation to combat certain types of cancers. For the past two decades many technological advancements in radiation therapy have been largely based on the hypothesis that direct radiation-induced DNA double strand breaks cause cell death and thus tumor control and normal tissue damage. However, new insights have elucidated that in addition to causing cellular DNA damage, localized therapeutic radiation also initiates cascades of complex downstream biological responses in tissue that extend far beyond where therapeutic radiation dose is directly deposited. For instance, studies show that irradiated dying tumor cells release tumor antigens that can lead the immune system to a systemic anti-cancer attack throughout the body of cancer patient; targeted irradiation to solid tumor also increases the migration of tumor cells already in bloodstream, the seeds of potential metastasis. Some of the new insights may explain the long ago discovered but still unexplained non-localized radiation effects (bystander effect and abscopal effect) and the efficacy of spatially fractionated radiation therapy (microbeam radiation therapy and GRID therapy) where many “hot” and “cold” spots are intentionally created throughout the treatment volume. Better understanding of the mechanisms behind the non-localized radiation effects creates tremendous opportunities to develop new and integrated cancer treatment strategies that are based on radiotherapy, immunology, and chemotherapy. However, in the multidisciplinary effort to advance new radiobiology, there are also tremendous challenges including a lack of multidisciplinary researchers and imaging technologies for the microscopic radiation-induced responses. A better grasp of the essence of these advances in cancer biology research will give medical physicists a new perspective in daily clinical physics practice and in future radiation therapy technological development. Furthermore, academic medical physics should continue to be an integral part of the multidisciplinary cancer research community, harnessing our newly acquired understanding of radiation effects, and developing novel cost-effective treatment strategies to better combat cancer. Learning Objectives: Understand that localized radiation can lead to non-localized secondary effects such as radiation-induced immune response, bystander effect, and abscopal effect. Understand that the non-localized radiation effects may be harnessed to improve cancer treatment. Learn examples of physics participation in multidisciplinary research to advance cancer biology. Recognize the challenges and possibilities of physics applications in cancer research. Chang: NIH 5RC2CA148487-02 and 1U54CA151652-01 Graves: IDEA award (19IB-0106) from the California Breast Cancer Research Program (CBCRP), and by NIH P01 CA67166.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

TU-EF-304-07: Monte Carlo-Based Inverse Treatment Plan Optimization for Intensity Modulated Proton Therapy

Purpose: Intensity-modulated proton therapy (IMPT) is increasingly used in proton therapy. For IMPT optimization, Monte Carlo (MC) is desired for spots dose calculations because of its high accuracy, especially in cases with a high level of heterogeneity. It is also preferred in biological optimization problems due to the capability of computing quantities related to biological effects. However, MC simulation is typically too slow to be used for this purpose. Although GPU-based MC engines have become available, the achieved efficiency is still not ideal. The purpose of this work is to develop a new optimization scheme to include GPU-based MC into IMPT. Methods: A conventional approach using MC in IMPT simply calls the MC dose engine repeatedly for each spot dose calculations. However, this is not the optimal approach, because of the unnecessary computations on some spots that turned out to have very small weights after solving the optimization problem. GPU-memory writing conflict occurring at a small beam size also reduces computational efficiency. To solve these problems, we developed a new framework that iteratively performs MC dose calculations and plan optimizations. At each dose calculation step, the particles were sampled from different spots altogether with Metropolis algorithm, such that the particle number is proportional to the latest optimized spot intensity. Simultaneously transporting particles from multiple spots also mitigated the memory writing conflict problem. Results: We have validated the proposed MC-based optimization schemes in one prostate case. The total computation time of our method was ∼5–6 min on one NVIDIA GPU card, including both spot dose calculation and plan optimization, whereas a conventional method naively using the same GPU-based MC engine were ∼3 times slower. Conclusion: A fast GPU-based MC dose calculation method along with a novel optimization workflow is developed. The high efficiency makes it attractive for clinical usages.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

Development and clinical evaluation of an ionization chamber array with 3.5 mm pixel pitch for quality assurance in advanced radiotherapy techniques

Purpose: To characterize a new air vented ionization chamber technology, suitable to build detector arrays with small pixel pitch and independence of sensitivity on dose per pulse. Methods: The prototype under test is a linear array of air vented ionization chambers, consisting of 80 pixels with 3.5 mm pixel pitch distance and a sensitive volume of about 4 mm{sup 3}. The detector has been characterized with {sup 60}Co radiation and MV x rays from different linear accelerators (with flattened and unflattened beam qualities). Sensitivity dependence on dose per pulse has been evaluated under MV x rays by changing both the source to detector distance and the beam quality. Bias voltage has been varied in order to evaluate the charge collection efficiency in the most critical conditions. Relative dose profiles have been measured for both flattened and unflattened distributions with different field sizes. The reference detectors were a commercial array of ionization chambers and an amorphous silicon flat panel in direct conversion configuration. Profiles of dose distribution have been measured also with intensity modulated radiation therapy (IMRT), stereotactic radiosurgery (SRS), and volumetric modulated arc therapy (VMAT) patient plans. Comparison has been done with a commercial diode array and with Gafchromic EBT3 films. Results: Repeatability and stability under continuous gamma irradiation are within 0.3%, in spite of low active volume and sensitivity (∼200 pC/Gy). Deviation from linearity is in the range [0.3%, −0.9%] for a dose of at least 20 cGy, while a worsening of linearity is observed below 10 cGy. Charge collection efficiency with 2.67 mGy/pulse is higher than 99%, leading to a ±0.9% sensitivity change in the range 0.09–2.67 mGy/pulse (covering all flattened and unflattened beam qualities). Tissue to phantom ratios show an agreement within 0.6% with the reference detector up to 34 cm depth. For field sizes in the range 2 × 2 to 15 × 15 cm{sup 2}, the output factors are in agreement with a thimble chamber within 2%, while with 25 × 25 cm{sup 2} field size, an underestimation of 4.0% was found. Agreement of field and penumbra width measurements with the flat panel is of the order of 1 mm down to 1 × 1 cm{sup 2} field size. Flatness and symmetry values measured with the 1D array and the reference detectors are comparable, and differences are always smaller than 1%. Angular dependence of the detector, when compared to measurements taken with a cylindrical chamber in the same phantom, is as large as 16%. This includes inhomogeneity and asymmetry of the design, which during plan verification are accounted for by the treatment planning system (TPS). The detector is capable to reproduce the dose distributions of IMRT and VMAT plans with a maximum deviation from TPS of 3.0% in the target region. In the case of VMAT and SRS plans, an average (maximum) deviation of the order of 1% (4%) from films has been measured. Conclusions: The investigated technology appears to be useful both for Linac QA and patient plan verification, especially in treatments with steep dose gradients and nonuniform dose rates such as VMAT and SRS. Major limitations of the present prototype are the linearity at low dose, which can be solved by optimizing the readout electronics, and the underestimation of output factors with large field sizes. The latter problem is presently not completely understood and will require further investigations.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-T-207: Does the Greater Flexibility of Pencil Beam Scanning Reduce the Need for a Proton Gantry?

Purpose: Gantry-less proton treatment facility could lower the capital cost of proton therapy. This study investigates the dosimetric feasibility of using only coplanar pencil beam scanning (PBS) beams for those patients who had beam angles that would not have been deliverable without the gantry. Those coplanar beams are implemented on gantry-less horizontal beam-line with patients in sitting or standing positions. Methods: We have selected ten patients (seven head-and-neck, one thoracic, one abdominal and one pelvic case) with clinically delivered double scattering (DS) or PBS treatment plans with beam angles that were challenging to achieve without a gantry. After removing these beams angles, PBS plans were optimized for gantry-less intensity modulated proton therapy (IMPT) or single field optimization (SFO) with multi-criteria optimization (MCO). For head-and-neck patients who were treated by DS, we generated PBS plans with non-coplanar beams for comparison. Dose-volume-histograms (DVHs), target homogeneity index (HI), mean dose, D-2 and D-98 were reported. Robustness analysis was performed with ±2.5 mm setup errors and ±3.5% range uncertainties for three head-and-neck patients. Results: PBS-gantry-less plans provided more homogenous target coverage and significant improvements on organs-at-risk (OARs) sparing, compared to passive scattering treatments with a gantry. The PBS gantry-less treatments reduced the HI for target coverage by 1.3% to 47.2%, except for a suprasellar patient and a liver patient. The PBS-gantry-less plans reduced the D-mean of OARs by 3.6% to 67.4%. The PBS-gantry plans had similar target coverage and only marginal improvements on OAR sparing as compared to the PBS-gantry-less plans. These two PBS plans also had similar robustness relative to range uncertainties and setup errors. Conclusion: The gantry-less plans have with less mean dose to OARs and more homogeneous target coverage. Although the PBS-gantry plans have slightly improved target coverage and OARs sparing, the overall benefit of having a gantry to provide non-coplanar beams is debatable.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-T-301: Planar Dose Pass Rate Inflation Due to the MapCHECK Measurement Uncertainty Function

Purpose: To quantify the effect of the Measurement Uncertainty function on planar dosimetry pass rates, as analyzed with Sun Nuclear Corporation analytic software (“MapCHECK” or “SNC Patient”). This optional function is toggled on by default upon software installation, and automatically increases the user-defined dose percent difference (%Diff) tolerance for each planar dose comparison. Methods: Dose planes from 109 IMRT fields and 40 VMAT arcs were measured with the MapCHECK 2 diode array, and compared to calculated planes from a commercial treatment planning system. Pass rates were calculated within the SNC analytic software using varying calculation parameters, including Measurement Uncertainty on and off. By varying the %Diff criterion for each dose comparison performed with Measurement Uncertainty turned off, an effective %Diff criterion was defined for each field/arc corresponding to the pass rate achieved with MapCHECK Uncertainty turned on. Results: For 3%/3mm analysis, the Measurement Uncertainty function increases the user-defined %Diff by 0.8–1.1% average, depending on plan type and calculation technique, for an average pass rate increase of 1.0–3.5% (maximum +8.7%). For 2%, 2 mm analysis, the Measurement Uncertainty function increases the user-defined %Diff by 0.7–1.2% average, for an average pass rate increase of 3.5–8.1% (maximum +14.2%). The largest increases in pass rate are generally seen with poorly-matched planar dose comparisons; the MapCHECK Uncertainty effect is markedly smaller as pass rates approach 100%. Conclusion: The Measurement Uncertainty function may substantially inflate planar dose comparison pass rates for typical IMRT and VMAT planes. The types of uncertainties incorporated into the function (and their associated quantitative estimates) as described in the software user’s manual may not accurately estimate realistic measurement uncertainty for the user’s measurement conditions. Pass rates listed in published reports or otherwise compared to the results of other users or vendors should clearly indicate whether the Measurement Uncertainty function is used.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

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↗
DOE OSTI2016

SU-F-T-347: An Absolute Dose-Volume Constraint Based Deterministic Optimization Framework for Multi-Co60 Source Focused Radiotherapy

Purpose: Treatment plan optimization in multi-Co60 source focused radiotherapy with multiple isocenters is challenging, because dose distribution is normalized to maximum dose during optimization and evaluation. The objective functions are traditionally defined based on relative dosimetric distribution. This study presents an alternative absolute dose-volume constraint (ADC) based deterministic optimization framework (ADC-DOF). Methods: The initial isocenters are placed on the eroded target surface. Collimator size is chosen based on the area of 2D contour on corresponding axial slice. The isocenter spacing is determined by adjacent collimator sizes. The weights are optimized by minimizing the deviation from ADCs using the steepest descent technique. An iterative procedure is developed to reduce the number of isocenters, where the isocenter with lowest weight is removed without affecting plan quality. The ADC-DOF is compared with the genetic algorithm (GA) using the same arbitrary shaped target (254cc), with a 15mm margin ring structure representing normal tissues. Results: For ADC-DOF, the ADCs imposed on target and ring are (D100>10Gy, D50,10, 0<12Gy, 15Gy and 20Gy) and (D40<10Gy). The resulting D100, 50, 10, 0 and D40 are (9.9Gy, 12.0Gy, 14.1Gy and 16.2Gy) and (10.2Gy). The objectives of GA are to maximize 50% isodose target coverage (TC) while minimize the dose delivered to the ring structure, which results in 97% TC and 47.2% average dose in ring structure. For ADC-DOF (GA) techniques, 20 out of 38 (10 out of 12) initial isocenters are used in the final plan, and the computation time is 8.7s (412.2s) on an i5 computer. Conclusion: We have developed a new optimization technique using ADC and deterministic optimization. Compared with GA, ADC-DOF uses more isocenters but is faster and more robust, and achieves a better conformity. For future work, we will focus on developing a more effective mechanism for initial isocenter determination.

60 APPLIED LIFE SCIENCES↗