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

Validation of mathematical models for the prediction of organs-at-risk dosimetric metrics in high-dose-rate gynecologic interstitial brachytherapy

Purpose: Given the complicated nature of an interstitial gynecologic brachytherapy treatment plan, the use of a quantitative tool to evaluate the quality of the achieved metrics compared to clinical practice would be advantageous. For this purpose, predictive mathematical models to predict the D{sub 2cc} of rectum and bladder in interstitial gynecologic brachytherapy are discussed and validated.Methods: Previous plans were used to establish the relationship between D2cc and the overlapping volume of the organ at risk with the targeted area (C0) or a 1-cm expansion of the target area (C1). Three mathematical models were evaluated: D{sub 2cc}=α*C{sub 1}+β (LIN); D{sub 2cc}=α– exp(–β*C{sub 0}) (EXP); and a mixed approach (MIX), where both C{sub 0} and C{sub 1} were inputs of the model. The parameters of the models were optimized on a training set of patient data, and the predictive error of each model (predicted D{sub 2cc}− real D{sub 2cc}) was calculated on a validation set of patient data. The data of 20 patients were used to perform a K-fold cross validation analysis, with K = 2, 4, 6, 8, 10, and 20.Results: MIX was associated with the smallest mean prediction error <6.4% for an 18-patient training set; LIN had an error <8.5%; EXP had an error <8.3%. Best case scenario analysis shows that an error ≤5% can be achieved for a ten-patient training set with MIX, an error ≤7.4% for LIN, and an error ≤6.9% for EXP. The error decreases with the increase in training set size, with the most marked decrease observed for MIX.Conclusions: The MIX model can predict the D{sub 2cc} of the organs at risk with an error lower than 5% with a training set of ten patients or greater. The model can be used in the development of quality assurance tools to identify treatment plans with suboptimal sparing of the organs at risk. It can also be used to improve preplanning and in the development of real-time intraoperative planning tools.

61 RADIATION PROTECTION AND DOSIMETRY↗
DOE OSTI2013

Experimental validation of the van Herk margin formula for lung radiation therapy

Purpose: To validate the van Herk margin formula for lung radiation therapy using realistic dose calculation algorithms and respiratory motion modeling. The robustness of the margin formula against variations in lesion size, peak-to-peak motion amplitude, tissue density, treatment technique, and plan conformity was assessed, along with the margin formula assumption of a homogeneous dose distribution with perfect plan conformity.Methods: 3DCRT and IMRT lung treatment plans were generated within the ORBIT treatment planning platform (RaySearch Laboratories, Sweden) on 4DCT datasets of virtual phantoms. Random and systematic respiratory motion induced errors were simulated using deformable registration and dose accumulation tools available within ORBIT for simulated cases of varying lesion sizes, peak-to-peak motion amplitudes, tissue densities, and plan conformities. A detailed comparison between the margin formula dose profile model, the planned dose profiles, and penumbra widths was also conducted to test the assumptions of the margin formula. Finally, a correction to account for imperfect plan conformity was tested as well as a novel application of the margin formula that accounts for the patient-specific motion trajectory.Results: The van Herk margin formula ensured full clinical target volume coverage for all 3DCRT and IMRT plans of all conformities with the exception of small lesions in soft tissue. No dosimetric trends with respect to plan technique or lesion size were observed for the systematic and random error simulations. However, accumulated plans showed that plan conformity decreased with increasing tumor motion amplitude. When comparing dose profiles assumed in the margin formula model to the treatment plans, discrepancies in the low dose regions were observed for the random and systematic error simulations. However, the margin formula respected, in all experiments, the 95% dose coverage required for planning target volume (PTV) margin derivation, as defined by the ICRU; thus, suitable PTV margins were estimated. The penumbra widths calculated in lung tissue for each plan were found to be very similar to the 6.4 mm value assumed by the margin formula model. The plan conformity correction yielded inconsistent results which were largely affected by image and dose grid resolution while the trajectory modified PTV plans yielded a dosimetric benefit over the standard internal target volumes approach with up to a 5% decrease in the V20 value.Conclusions: The margin formula showed to be robust against variations in tumor size and motion, treatment technique, plan conformity, as well as low tissue density. This was validated by maintaining coverage of all of the derived PTVs by 95% dose level, as required by the formal definition of the PTV. However, the assumption of perfect plan conformity in the margin formula derivation yields conservative margin estimation. Future modifications to the margin formula will require a correction for plan conformity. Plan conformity can also be improved by using the proposed trajectory modified PTV planning approach. This proves especially beneficial for tumors with a large anterior–posterior component of respiratory motion.

61 RADIATION PROTECTION AND DOSIMETRY↗
DOE OSTI2014

SU-E-T-347: Validation of the Condensed History Algorithm of Geant4 Using the Fano Test

Purpose: To validate the condensed history algorithm and physics of the Geant4 Monte Carlo toolkit for simulations of ionization chambers (ICs). This study is the first step to validate Geant4 for calculations of photon beam quality correction factors under the presence of a strong magnetic field for magnetic resonance guided linac system applications. Methods: The electron transport and boundary crossing algorithms of Geant4 version 9.6.p02 were tested under Fano conditions using the Geant4 example/application FanoCavity. User-defined parameters of the condensed history and multiple scattering algorithms were investigated under Fano test conditions for three scattering models (physics lists): G4UrbanMscModel95 (PhysListEmStandard-option3), G4GoudsmitSaundersonMsc (PhysListEmStandard-GS), and G4WentzelVIModel/G4CoulombScattering (PhysListEmStandard-WVI). Simulations were conducted using monoenergetic photon beams, ranging from 0.5 to 7 MeV and emphasizing energies from 0.8 to 3 MeV. Results: The GS and WVI physics lists provided consistent Fano test results (within ±0.5%) for maximum step sizes under 0.01 mm at 1.25 MeV, with improved performance at 3 MeV (within ±0.25%). The option3 physics list provided consistent Fano test results (within ±0.5%) for maximum step sizes above 1 mm. Optimal parameters for the option3 physics list were 10 km maximum step size with default values for other user-defined parameters: 0.2 dRoverRange, 0.01 mm final range, 0.04 range factor, 2.5 geometrical factor, and 1 skin. Simulations using the option3 physics list were ∼70 – 100 times faster compared to GS and WVI under optimal parameters. Conclusion: This work indicated that the option3 physics list passes the Fano test within ±0.5% when using a maximum step size of 10 km for energies suitable for IC calculations in a 6 MV spectrum without extensive computational times. Optimal user-defined parameters using the option3 physics list will be used in future IC simulations to calculate beam quality correction factors under the presence of a magnetic field. Elekta-MD Anderson Research Agreement.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗
DOE OSTI2014

SU-E-CAMPUS-T-05: Validation of High-Resolution 3D Patient QA for Proton Pencil Beam Scanning and IMPT by Polymer Gel Dosimetry

Purpose: Validation of high-resolution 3D patient QA for proton pencil beam scanning and IMPT by polymer gel dosimetry. Methods: Four BANG3Pro polymer gel dosimeters (manufactured by MGS Research Inc, Madison, CT) were used for patient QA at the Robert's Proton Therapy Center (RPTC, Philadelphia, PA). All dosimeters were sealed in identical thin-wall Pyrex glass spheres. Each dosimeter contained a set of markers for 3D registration purposes. The dosimeters were mounted in a consistent and reproducible manner using a custom build holder. Two proton pencil beam scanning plans were designed using Varian Eclipse™ treatment planning system: 1) A two-field intensity modulated proton therapy (IMPT) plan and 2) one single field uniform dose (SFUD) plan. The IMPT fields were evaluated as a composite plan and individual fields, the SFUD plan was delivered as a single field plan.Laser CT scanning was performed using the manufacturer's OCTOPUS-IQ axial transmission laser CT scanner using a 1 mm slice thickness. 3D registration, analysis, and OD/cm to absorbed dose calibrations were perfomed using DICOM RT-Dose and CT files, and software developed by the manufacturer. 3D delta index, a metric equivalent to the gamma tool, was used for dose comparison. Results: Very good agreement with single IMPT fields and with SFUD was obtained. Composite IMPT fields had a less satisfactory agreement. The single fields had 3D delta index passing rates (3% dose difference, 3 mm DTA) of 98.98% and 94.91%. The composite 3D delta index passing rate was 80.80%. The SFUD passing rate was 93.77%. Required shifts of the dose distributions were less than 4 mm. Conclusion: A formulation of the BANG3Pro polymer gel dosimeter, suitable for 3D QA of proton patient plans is established and validated. Likewise, the mailed QA analysis service provided by the manufacturer is a practical option when required resources are unavailable. We fully disclose that the subject of this research regards a production of MGS Research, Inc.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-F-BRE-07: Experimental Validation of a Lung SBRT Technique Using a Novel, True Volumetric Plenoptic-Plastic-Scintillator Detector

Purpose: Lung SBRT is being used by an increasing number of clinics, including our center which recently treated its first patient. In order to validate this technique, the 3D dose distribution of the SBRT plan was measured using a previously developed 3D detector based on plenoptic camera and plastic scintillator technology. The excellent agreement between the detector measurement and the expected dose from the treatment planning system Pinnacle{sup 3} shows great promise and amply justify the development of the technique. Methods: The SBRT treatment comprised 8 non-coplanar 6MV photon fields with a mean field size of 12 cm{sup 2} at isocentre and a total prescription dose of 12Gy per fraction for a total of 48Gy. The 3D detector was composed of a 10×10×10 cm{sup 2} EJ-260 water-equivalent plastic scintillator embedded inside a truncated cylindrical acrylic phantom of 10cm radius. The scintillation light was recorded using a static R5 light-field camera and the 3D dose was reconstructed at a 2mm resolution in all 3 dimensions using an iterative backprojection algorithm. Results: The whole 3D dose distribution was recorded at a rate of one acquisition per second. The mean absolute dose difference between the detector and Pinnacle{sup 3} was 1.3% over the region with more than 10% of the maximum dose. 3D gamma tests performed over the same region yield passing rates of 98.8% and 96.6% with criteria of 3%/1mm and 2%/1mm, respectively. Conclusion: Experimental results showed that our beam modeling and treatment planning system calculation was adequate for the safe administration of small field/high dose techniques such as SBRT. Moreover, because of the real-time capability of the detector, further validation of small field rotational, dynamic or gated technique can be monitored or verified by this system.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

MO-G-BRE-09: Validating FMEA Against Incident Learning Data: A Study in Stereotactic Body Radiation Therapy

Purpose: Though FMEA (Failure Mode and Effects Analysis) is becoming more widely adopted for risk assessment in radiation therapy, to our knowledge it has never been validated against actual incident learning data. The objective of this study was to perform an FMEA analysis of an SBRT (Stereotactic Body Radiation Therapy) treatment planning process and validate this against data recorded within an incident learning system. Methods: FMEA on the SBRT treatment planning process was carried out by a multidisciplinary group including radiation oncologists, medical physicists, and dosimetrists. Potential failure modes were identified through a systematic review of the workflow process. Failure modes were rated for severity, occurrence, and detectability on a scale of 1 to 10 and RPN (Risk Priority Number) was computed. Failure modes were then compared with historical reports identified as relevant to SBRT planning within a departmental incident learning system that had been active for two years. Differences were identified. Results: FMEA identified 63 failure modes. RPN values for the top 25% of failure modes ranged from 60 to 336. Analysis of the incident learning database identified 33 reported near-miss events related to SBRT planning. FMEA failed to anticipate 13 of these events, among which 3 were registered with severity ratings of severe or critical in the incident learning system. Combining both methods yielded a total of 76 failure modes, and when scored for RPN the 13 events missed by FMEA ranked within the middle half of all failure modes. Conclusion: FMEA, though valuable, is subject to certain limitations, among them the limited ability to anticipate all potential errors for a given process. This FMEA exercise failed to identify a significant number of possible errors (17%). Integration of FMEA with retrospective incident data may be able to render an improved overview of risks within a process.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

WE-A-17A-09: Exploiting Electromagnetic Technologies for Real-Time Seed Drop Position Validation in Permanent Implant Brachytherapy

Purpose: To report on preliminary results validating the performance of a specially designed LDR brachytherapy needle prototype possessing both electromagnetic (EM) tracking and seed drop detection abilities. Methods: An EM hollow needle prototype has been designed and constructed in collaboration with research partner Philips Healthcare. The needle possesses conventional 3D tracking capabilities, along with a novel seed drop detection mechanism exploiting local changes of electromagnetic properties generated by the passage of seeds in the needle's embedded sensor coils. These two capabilities are exploited by proprietary engineering and signal processing techniques to generate seed drop position estimates in real-time treatment delivery. The electromagnetic tracking system (EMTS) used for the experiment is the NDI Aurora Planar Field Generator. The experiment consisted of dropping a total of 35 seeds in a prismatic agarose phantom, and comparing the 3D seed drop positions of the EMTS to those obtained by an image analysis of subsequent micro-CT scans. Drop position error computations and statistical analysis were performed after a 3D registration of the two seed distributions. Results: Of the 35 seeds dropped in the phantom, 32 were properly detected by the needle prototype. Absolute drop position errors among the detected seeds ranged from 0.5 to 4.8 mm with mean and standard deviation values of 1.6 and 0.9 mm, respectively. Error measurements also include undesirable and uncontrollable effects such as seed motion upon deposition. The true accuracy performance of the needle prototype is therefore underestimated. Conclusion: This preliminary study demonstrates the potential benefits of EM technologies in detecting the passage of seeds in a hollow needle as a means of generating drop position estimates in real-time treatment delivery. Such tools could therefore represent a potentially interesting addition to existing brachytherapy protocols for rapid dosimetry validation. Equipments and fundings for this project were provided by Philips Medical.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2014

SU-C-BRF-05: Design and Geometric Validation of An Externally and Internally Deformable, Programmable Lung Motion Phantom

Purpose: Most clinically-deployed strategies for respiratory motion management in lung radiotherapy (e.g., gating, tracking) use external markers that serve as surrogates for tumor motion. However, typical lung phantoms used to validate these strategies are rigid-exterior+rigid-interior or rigid-exterior+deformable-interior. Neither class adequately represents the human anatomy, which is deformable internally as well as externally. We describe the construction and experimental validation of a more realistic, externally- and internally-deformable, programmable lung phantom. Methods: The outer shell of a commercially-available lung phantom (RS- 1500, RSD Inc.) was used. The shell consists of a chest cavity with a flexible anterior surface, and embedded vertebrae, rib-cage and sternum. A 3-axis platform was programmed with sinusoidal and six patient-recorded lung tumor trajectories. The platform was used to drive a rigid foam ‘diaphragm’ that compressed/decompressed the phantom interior. Experimental characterization comprised of mapping the superior-inferior (SI) and anterior-posterior (AP) trajectories of external and internal radioopaque markers with kV x-ray fluoroscopy and correlating these with optical surface monitoring using the in-room VisionRT system. Results: The phantom correctly reproduced the programmed motion as well as realistic effects such as hysteresis. The reproducibility of marker trajectories over multiple runs for sinusoidal as well as patient traces, as characterized by fluoroscopy, was within 0.4 mm RMS error for internal as well as external markers. The motion trajectories of internal and external markers as measured by fluoroscopy were found to be highly correlated (R=0.97). Furthermore, motion trajectories of arbitrary points on the deforming phantom surface, as recorded by the VisionRT system also showed a high correlation with respect to the fluoroscopically-measured trajectories of internal markers (R=0.92). Conclusion: We have developed a realistic externally- and internally-deformable lung phantom that will serve as a valuable tool for clinical QA and motion management research. This work was supported through funding from the NIH and VisionRT Ltd. Amit Sawant has research funding from Varian Medical Systems, VisionRT and Elekta.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

Signal-to-noise assessment for diffusion tensor imaging with single data set and validation using a difference image method with data from a multicenter study

Purpose: To describe a quantitative method for determination of SNR that extracts the local noise level using a single diffusion data set. Methods: Brain data sets came from a multicenter study (eight sites; three MR vendors). Data acquisition protocol required b = 0, 700 s/mm{sup 2}, fov = 256 × 256 mm{sup 2}, acquisition matrix size 128 × 128, reconstruction matrix size 256 × 256; 30 gradient encoding directions and voxel size 2 × 2 × 2 mm{sup 3}. Regions-of-interest (ROI) were placed manually on the b = 0 image volume on transverse slices, and signal was recorded as the mean value of the ROI. The noise level from the ROI was evaluated using Fourier Transform based Butterworth high-pass filtering. Patients were divided into two groups, one for filter parameter optimization (N = 17) and one for validation (N = 10). Six white matter areas (the genu and splenium of corpus callosum, right and left centrum semiovale, right and left anterior corona radiata) were analyzed. The Bland–Altman method was used to compare the resulting SNR with that from the difference image method. The filter parameters were optimized for each brain area, and a set of “global” parameters was also obtained, which represent an average of all regions. Results: The Bland–Altman analysis on the validation group using “global” filter parameters revealed that the 95% limits of agreement of percent bias between the SNR obtained with the new and the reference methods were −15.5% (median of the lower limit, range [−24.1%, −8.9%]) and 14.5% (median of the higher limits, range [12.7%, 18.0%]) for the 6 brain areas. Conclusions: An FT-based high-pass filtering method can be used for local area SNR assessment using only one DTI data set. This method could be used to evaluate SNR for patient studies in a multicenter setting.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗
DOE OSTI2015

SU-E-T-129: Are Knowledge-Based Planning Dose Estimates Valid for Distensible Organs?

Purpose: Knowledge-based planning programs have become available to assist treatment planning in radiation therapy. Such programs can be used to generate estimated DVHs and planning constraints for organs at risk (OARs), based upon a model generated from previous plans. These estimates are based upon the planning CT scan. However, for distensible OARs like the bladder and rectum, daily variations in volume may make the dose estimates invalid. The purpose of this study is to determine whether knowledge-based DVH dose estimates may be valid for distensible OARs. Methods: The Varian RapidPlan™ knowledge-based planning module was used to generate OAR dose estimates and planning objectives for 10 prostate cases previously planned with VMAT, and final plans were calculated for each. Five weekly setup CBCT scans of each patient were then downloaded and contoured (assuming no change in size and shape of the target volume), and rectum and bladder DVHs were recalculated for each scan. Dose volumes were then compared at 75, 60,and 40 Gy for the bladder and rectum between the planning scan and the CBCTs. Results: Plan doses and estimates matched well at all dose points., Volumes of the rectum and bladder varied widely between planning CT and the CBCTs, ranging from 0.46 to 2.42 for the bladder and 0.71 to 2.18 for the rectum, causing relative dose volumes to vary between planning CT and CBCT, but absolute dose volumes were more consistent. The overall ratio of CBCT/plan dose volumes was 1.02 ±0.27 for rectum and 0.98 ±0.20 for bladder in these patients. Conclusion: Knowledge-based planning dose volume estimates for distensible OARs are still valid, in absolute volume terms, between treatment planning scans and CBCT’s taken during daily treatment. Further analysis of the data is being undertaken to determine how differences depend upon rectum and bladder filling state. This work has been supported by Varian Medical Systems.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

Geometric validation of self-gating k-space-sorted 4D-MRI vs 4D-CT using a respiratory motion phantom

Purpose: MRI is increasingly being used for radiotherapy planning, simulation, and in-treatment-room motion monitoring. To provide more detailed temporal and spatial MR data for these tasks, we have recently developed a novel self-gated (SG) MRI technique with advantage of k-space phase sorting, high isotropic spatial resolution, and high temporal resolution. The current work describes the validation of this 4D-MRI technique using a MRI- and CT-compatible respiratory motion phantom and comparison to 4D-CT. Methods: The 4D-MRI sequence is based on a spoiled gradient echo-based 3D projection reconstruction sequence with self-gating for 4D-MRI at 3 T. Respiratory phase is resolved by using SG k-space lines as the motion surrogate. 4D-MRI images are reconstructed into ten temporal bins with spatial resolution 1.56 × 1.56 × 1.56 mm{sup 3}. A MRI-CT compatible phantom was designed to validate the performance of the 4D-MRI sequence and 4D-CT imaging. A spherical target (diameter 23 mm, volume 6.37 ml) filled with high-concentration gadolinium (Gd) gel is embedded into a plastic box (35 × 40 × 63 mm{sup 3}) and stabilized with low-concentration Gd gel. The phantom, driven by an air pump, is able to produce human-type breathing patterns between 4 and 30 respiratory cycles/min. 4D-CT of the phantom has been acquired in cine mode, and reconstructed into ten phases with slice thickness 1.25 mm. The 4D images sets were imported into a treatment planning software for target contouring. The geometrical accuracy of the 4D MRI and CT images has been quantified using target volume, flattening, and eccentricity. The target motion was measured by tracking the centroids of the spheres in each individual phase. Motion ground-truth was obtained from input signals and real-time video recordings. Results: The dynamic phantom has been operated in four respiratory rate (RR) settings, 6, 10, 15, and 20/min, and was scanned with 4D-MRI and 4D-CT. 4D-CT images have target-stretching, partial-missing, and other motion artifacts in various phases, whereas the 4D-MRI images are visually free of those artifacts. Volume percentage difference for the 6.37 ml target ranged from 5.3% ± 4.3% to 10.3% ± 5.9% for 4D-CT, and 1.47 ± 0.52 to 2.12 ± 1.60 for 4D-MRI. With an increase of respiratory rate, the target volumetric and geometric deviations increase for 4D-CT images while remaining stable for the 4D-MRI images. Target motion amplitude errors at different RRs were measured with a range of 0.66–1.25 mm for 4D-CT and 0.2–0.42 mm for 4D-MRI. The results of Mann–Whitney tests indicated that 4D-MRI significantly outperforms 4D-CT in phase-based target volumetric (p = 0.027) and geometric (p < 0.001) measures. Both modalities achieve equivalent accuracy in measuring motion amplitude (p = 0.828). Conclusions: The k-space self-gated 4D-MRI technique provides a robust method for accurately imaging phase-based target motion and geometry. Compared to 4D-CT, the current 4D-MRI technique demonstrates superior spatiotemporal resolution, and robust resistance to motion artifacts caused by fast target motion and irregular breathing patterns. The technique can be used extensively in abdominal targeting, motion gating, and toward implementing MRI-based adaptive radiotherapy.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

Technical Note: Validation and implementation of a wireless transponder tracking system for gated stereotactic ablative radiotherapy of the liver

Purpose: Tracking soft-tissue targets has recently been cleared as a new application of Calypso, an electromagnetic wireless transponder tracking system, allowing for gated treatment of the liver based on the motion of the target volume itself. The purpose of this study is to describe the details of validating the Calypso system for wireless transponder tracking of the liver and to present the clinical workflow for using it to deliver gated stereotactic ablative radiotherapy (SABR). Methods: A commercial 3D diode array motion system was used to evaluate the dynamic tracking accuracy of Calypso when tracking continuous large amplitude motion. It was then used to perform end-to-end tests to evaluate the dosimetric accuracy of gated beam delivery for liver SABR. In addition, gating limits were investigated to determine how large the gating window can be while still maintaining dosimetric accuracy. The gating latency of the Calypso system was also measured using a customized motion phantom. Results: The average absolute difference between the measured and expected positional offset was 0.3 mm. The 2%/2 mm gamma pass rates for the gated treatment delivery were greater than 97%. When increasing the gating limits beyond the known extent of planned motion, the gamma pass rates decreased as expected. The 2%/2 mm gamma pass rate for a 1, 2, and 3 mm increase in gating limits was measured to be 97.8%, 82.9%, and 61.4%, respectively. The average gating latency was measured to be 63.8 ms for beam-hold and 195.8 ms for beam-on. Four liver patients with 17 total fractions have been successfully treated at our institution. Conclusions: Wireless transponder tracking was validated as a dosimetrically accurate way to provide gated SABR of the liver. The dynamic tracking accuracy of the Calypso system met manufacturer’s specification, even for continuous large amplitude motion that can be encountered when tracking liver tumors close to the diaphragm. The measured beam-hold gating latency was appropriate for targets that will traverse the gating limit each respiratory cycle causing the beam to be interrupted constantly throughout treatment delivery.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

Modification and validation of an analytical source model for external beam radiotherapy Monte Carlo dose calculations

Purpose: A dose calculation tool, which combines the accuracy of the dose planning method (DPM) Monte Carlo code and the versatility of a practical analytical multisource model, which was previously reported has been improved and validated for the Varian 6 and 10 MV linear accelerators (linacs). The calculation tool can be used to calculate doses in advanced clinical application studies. One shortcoming of current clinical trials that report dose from patient plans is the lack of a standardized dose calculation methodology. Because commercial treatment planning systems (TPSs) have their own dose calculation algorithms and the clinical trial participant who uses these systems is responsible for commissioning the beam model, variation exists in the reported calculated dose distributions. Today’s modern linac is manufactured to tight specifications so that variability within a linac model is quite low. The expectation is that a single dose calculation tool for a specific linac model can be used to accurately recalculate dose from patient plans that have been submitted to the clinical trial community from any institution. The calculation tool would provide for a more meaningful outcome analysis. Methods: The analytical source model was described by a primary point source, a secondary extra-focal source, and a contaminant electron source. Off-axis energy softening and fluence effects were also included. The additions of hyperbolic functions have been incorporated into the model to correct for the changes in output and in electron contamination with field size. A multileaf collimator (MLC) model is included to facilitate phantom and patient dose calculations. An offset to the MLC leaf positions was used to correct for the rudimentary assumed primary point source. Results: Dose calculations of the depth dose and profiles for field sizes 4 × 4 to 40 × 40 cm agree with measurement within 2% of the maximum dose or 2 mm distance to agreement (DTA) for 95% of the data points tested. The model was capable of predicting the depth of the maximum dose within 1 mm. Anthropomorphic phantom benchmark testing of modulated and patterned MLCs treatment plans showed agreement to measurement within 3% in target regions using thermoluminescent dosimeters (TLD). Using radiochromic film normalized to TLD, a gamma criteria of 3% of maximum dose and 2 mm DTA was applied with a pass rate of least 85% in the high dose, high gradient, and low dose regions. Finally, recalculations of patient plans using DPM showed good agreement relative to a commercial TPS when comparing dose volume histograms and 2D dose distributions. Conclusions: A unique analytical source model coupled to the dose planning method Monte Carlo dose calculation code has been modified and validated using basic beam data and anthropomorphic phantom measurement. While this tool can be applied in general use for a particular linac model, specifically it was developed to provide a singular methodology to independently assess treatment plan dose distributions from those clinical institutions participating in National Cancer Institute trials.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-R-36: Validating Quantitative Radiomic Texture Features for Oncologic PET: A Digital Phantom Study

Purpose: Radiomic texture features derived from the oncologic PET have recently been brought under intense investigation within the context of patient stratification and treatment outcome prediction in a variety of cancer types; however, their validity has not yet been examined. This work is aimed to validate radiomic PET texture metrics through the use of realistic simulations in the ground truth setting. Methods: Simulation of FDG-PET was conducted by applying the Zubal phantom as an attenuation map to the SimSET software package that employs Monte Carlo techniques to model the physical process of emission imaging. A total of 15 irregularly-shaped lesions featuring heterogeneous activity distribution were simulated. For each simulated lesion, 28 texture features in relation to the intensity histograms (GLIH), grey-level co-occurrence matrices (GLCOM), neighborhood difference matrices (GLNDM), and zone size matrices (GLZSM) were evaluated and compared with their respective values extracted from the ground truth activity map. Results: In reference to the values from the ground truth images, texture parameters appearing on the simulated data varied with a range of 0.73–3026.2% for GLIH-based, 0.02–100.1% for GLCOM-based, 1.11–173.8% for GLNDM-based, and 0.35–66.3% for GLZSM-based. For majority of the examined texture metrics (16/28), their values on the simulated data differed significantly from those from the ground truth images (P-value ranges from <0.0001 to 0.04). Features not exhibiting significant difference comprised of GLIH-based standard deviation, GLCO-based energy and entropy, GLND-based coarseness and contrast, and GLZS-based low gray-level zone emphasis, high gray-level zone emphasis, short zone low gray-level emphasis, long zone low gray-level emphasis, long zone high gray-level emphasis, and zone size nonuniformity. Conclusion: The extent to which PET imaging disturbs texture appearance is feature-dependent and could be substantial. It is thus advised that use of PET texture parameters for predictive and prognostic measurements in oncologic setting awaits further systematic and critical evaluation.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-T-152: Experimental Validation and Calculation Benchmark for a Commercial Monte Carlo Pencil BeamScanning Proton Therapy Treatment Planning System in Heterogeneous Media

Purpose: Eclipse AcurosPT 13.7, the first commercial Monte Carlo pencil beam scanning (PBS) proton therapy treatment planning system (TPS), was experimentally validated for an IBA dedicated PBS nozzle in the CIRS 002LFC thoracic phantom. Methods: A two-stage procedure involving the use of TOPAS 1.3 simulations was performed. First, Geant4-based TOPAS simulations in this phantom were experimentally validated for single and multi-spot profiles at several depths for 100, 115, 150, 180, 210 and 225 MeV proton beams, using the combination of a Lynx scintillation detector and a MatriXXPT ionization chamber array. Second, benchmark calculations were performed with both AcurosPT and TOPAS in a phantom identical to the CIRS 002LFC, with the exception that the CIRS bone/mediastinum/lung tissues were replaced with similar tissues that are predefined in AcurosPT (a limitation of this system which necessitates the two stage procedure). Results: Spot sigmas measured in tissue were in agreement within 0.2 mm of TOPAS simulation for all six energies, while AcurosPT was consistently found to have larger spot sigma (<0.7 mm) than TOPAS. Using absolute dose calibration by MatriXXPT, the agreements between profiles measurements and TOPAS simulation, and calculation benchmarks are over 97% except near the end of range using 2 mm/2% gamma criteria. Overdosing and underdosing were observed at the low and high density side of tissue interfaces, respectively, and these increased with increasing depth and decreasing energy. Near the mediastinum/lung interface, the magnitude can exceed 5 mm/10%. Furthermore, we observed >5% quenching effect in the conversion of Lynx measurements to dose. Conclusion: We recommend the use of an ionization chamber array in combination with the scintillation detector to measure absolute dose and relative PBS spot characteristics. We also recommend the use of an independent Monte Carlo calculation benchmark for the commissioning of a commercial TPS. Partially supported by Varian Medical System under the master agreement between Varian and University of pennsylvania.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-T-153: Experimental Validation and Calculation Benchmark for a Commercial Monte Carlo Pencil Beam Scanning Proton Therapy Treatment Planning System in Water

Purpose: Eclipse proton Monte Carlo AcurosPT 13.7 was commissioned and experimentally validated for an IBA dedicated PBS nozzle in water. Topas 1.3 was used to isolate the cause of differences in output and penumbra between simulation and experiment. Methods: The spot profiles were measured in air at five locations using Lynx. PTW-34070 Bragg peak chamber (Freiburg, Germany) was used to collect the relative integral Bragg peak for 15 proton energies from 100 MeV to 225 MeV. The phase space parameters (σx, σθ, ρxθ) number of protons per MU, energy spread and calculated mean energy provided by AcurosPT were identically implemented into Topas. The absolute dose, profiles and field size factors measured using ionization chamber arrays were compared with both AcurosPT and Topas. Results: The beam spot size, σx, and the angular spread, σθ, in air were both energy-dependent: in particular, the spot size in air at isocentre ranged from 2.8 to 5.3 mm, and the angular spread ranged from 2.7 mrad to 6 mrad. The number of protons per MU increased from ∼9E7 at 100 MeV to ∼1.5E8 at 225 MeV. Both AcurosPT and TOPAS agree with experiment within 2 mm penumbra difference or 3% dose difference for scenarios including central axis depth dose and profiles at two depths in multi-spot square fields, from 40 to 200 mm, for all the investigated single-energy and multi-energy beams, indicating clinically acceptable source model and radiation transport algorithm in water. Conclusion: By comparing measured data and TOPAS simulation using the same source model, the AcurosPT 13.7 was validated in water within 2 mm penumbra difference or 3% dose difference. Benchmarks versus an independent Monte Carlo code are recommended to study the agreement in output, filed size factors and penumbra differences. This project is partially supported by the Varian grant under the master agreement between University of Pennsylvania and Varian.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-T-218: Validation of An In-Vivo Proton Range Verification Method for Reducing the Risk of Permanent Alopecia in the Treatment of Pediatric Medulloblastoma

Purpose: The clinical commissioning of a workflow for pre-treatment range verification/adjustment for the head treatment of pediatric medulloblastoma patients, including dose monitoring during treatment. Methods: An array of Si-diodes (DIODES Incorporated) is placed on the patient skin on the opposite side to the beam entrance. A “scout” SOBP beam, with a longer beam range to cover the diodes in its plateau, is delivered; the measured signal is analyzed and the extracted water equivalent path lengths (WEPL) are compared to the expected values, revealing if a range correction is needed. Diodes stay in place during treatment to measure dose. The workflow was tested in solid water and head phantoms and validated against independent WEPL measurements. Both measured WEPL and skin doses were compared to computed values from the TPS (XiO); a Markus chamber was used for reference dose measurements. Results: The WEPL accuracy of the method was verified by comparing it with the dose extinction method. It resulted, for both solid water and head phantom, in the sub-millimeter range, with a deviation less than 1% to the value extracted from the TPS. The accuracy of dose measurements in the fall-off part of the dose profile was validated against the Markus chamber. The entire range verification workflow was successfully tested for the mock-treatment of head phantom with the standard delivery of 90 cGy per field per fraction. The WEPL measurement revealed no need for range correction. The dose measurements agreed to better than 4% with the prescription dose. The robustness of the method and workflow, including detector array, hardware set and software functions, was successfully stress-tested with multiple repetitions. Conclusion: The performance of the in-vivo range verification system and related workflow meet the clinical requirements in terms of the needed WEPL accuracy for pretreatment range verification with acceptable dose to the patient.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-G-IeP2-04: Dosimetric Accuracy of a Monte Carlo-Based Tool for Cone-Beam CT Organ Dose Calculation: Validation Against OSL and XRQA2 Film Measurements

Purpose: The intensive use of Cone-Beam Computed Tomography (CBCT) during radiotherapy treatments raise some questions about the dose to healthy tissues delivered during image acquisitions. We hence developed a Monte Carlo (MC)-based tool to predict doses to organs delivered by the Elekta XVI kV-CBCT. This work aims at assessing the dosimetric accuracy of the MC tool, in all tissue types. Methods: The kV-CBCT MC model was developed using the PENELOPE code. The beam properties were validated against measured lateral and depth dose profiles in water, and energy spectra measured with a CdTe detector. The CBCT simulator accuracy then required verification in clinical conditions. For this, we compared calculated and experimental dose values obtained with OSL nanoDots and XRQA2 films inserted in CIRS anthropomorphic phantoms (male, female, and 5-year old child). Measurements were performed at different locations, including bone and lung structures, and for several acquisition protocols: lung, head-and-neck, and pelvis. OSLs and film measurements were corrected when possible for energy dependence, by taking into account for spectral variations between calibration and measurement conditions. Results: Comparisons between measured and MC dose values are summarized in table 1. A mean difference of 8.6% was achieved for OSLs when the energy correction was applied, and 89.3% of the 84 dose points were within uncertainty intervals, including those in bones and lungs. Results with XRQA2 are not as good, because incomplete information about electronic equilibrium in film layers hampered the application of a simple energy correction procedure. Furthermore, measured and calculated doses (Fig.1) are in agreement with the literature. Conclusion: The MC-based tool developed was validated with an extensive set of measurements, and enables the organ dose calculation with accuracy. It can now be used to compute and report doses to organs for clinical cases, and also to drive strategies to optimize imaging protocols.

60 APPLIED LIFE SCIENCES↗