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At least 1,585 records · Page 88
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DOE OSTI2014

SU-E-T-187: Feasibility Study of Stereotactic Liver Radiation Therapy Using Multiple Divided Partial Arcs in Volumetric Modulated Arc Therapy

Purpose: To verify volumetric modulated arc therapy (VMAT) using flattening filter free (FFF) mode with jaw tracking (JT) feature for single breath hold as long as 15 s per arc in liver stereotactic body radiation therapy (SBRT) against intensity modulated radiation therapy (IMRT) FFF-JT. Methods: Ten hepatocellular carcinoma (HCC) cases were planned with 10 MV FFF using Pinnacle3 treatment planning system which delivered by TrueBeam to administer 48 Gy/ 4 fractions. Eight non-coplanar beams were assigned to IMRT using step-and-shoot technique. For VMAT, two or three non-coplanar partial arcs (up to 180 degrees) were further divided into subarcs with gantry rotation less than 80 degrees to limit delivery time within 15 s. Dose distributions were verified using OCTAVIUS II system and pass rates were evaluated using gamma analysis with criteria of 3%/3 mm at threshold of 5% to the maximum dose. The actual irradiation time was measured. Results: The VMAT-FFF-JT of partial-arcs with sub-divided arcs was able to produce a highly conformal plan as well as IMRT-FFF-JT. Isodose lines and DVH showed slight improvement in dosimetry when JT was employed for both IMRT and VMAT. Consequently, VMAT-FFF-JT was superior in reducing the dose to liver minus gross tumor volume. VMAT-FFF-JT has shorter total treatment time compared with 3D conformal radiation therapy (3D-CRT) FFF because the gantry was rotated simultaneously with the beam delivery in VMAT. Moreover, due to the small and regular shape of HCC, VMAT-FFF-JT offered less multileaf collimator motion, thus the interplay effect is expected to be reduced. The patient specific QA of IMRT and VMAT acquired the pass rates higher than 90%. Conclusion: VMAT-FFF-JT could be a promising technique for liver SBRT as the sub-divided arcs method was able to accommodate a single breath hold irradiation time of less than 15 s without deterioration of the dose distribution compared with IMRT-FFF-JT.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-194: From Dicom-RT to Radiobiological Dose Metrics in 5 Minutes

Purpose: To develop a flexible and standalone framework for batch calculation of radiobiological dose metrics from Dicom-RT. Methods: Software has been developed which allows (1) The calculation of DVH data from DICOM dose and structure files (DVHgenerator), (2) Calculation of a wide range of radiobiological metrics from this data (CompPlanGui). Both these tools are run via graphical user interface (GUI), making them fast and simple. Part 1 is a new tool which has not previously been published, whilst part 2 is a GUI overlay for the previously published software ‘Comp-Plan’ (Holloway et. al., Medical Dosimetry, 2012), previously reliant on command line interface. The time taken for an experienced user to evaluate a test case of 6 plans with and without CompPlanGUI was quantified. Results: The DVH-generator has been found to be faster, more robust and require far less physical memory then using alternative software solutions for the same purpose. The Comp Plan GUI significantly reduces the amount of time required to set up a base directory, eliminates code crashes arising from typographical errors, and renders the code far more accessible to non-expert users. It took an experienced user of the code around 3 minutes to set up a base directory of 6 plans compared around 8 minutes without, indicating that using CompPlanGUI reduced setup time by over 50%. Conclusion: A standalone GUI based framework has developed which allows for the batch calculation of radiobiological dose metrics directly from Dicom-RT files. As with the original code, this work will be made freely available on request, as well as via matlab file exchange.

07 ISOTOPE AND RADIATION SOURCES↗
DOE OSTI2014

SU-E-T-199: How Number of Control Points Influences the Dynamic IMRT Plan Quality and Deliverability

Purpose: To study the influence of number of control points on plan quality and deliverability. Methods: Five previously treated patients of carcinoma of rectum were selected. Planning target volume (PTV) and organs at risk (OARs) i.e. bladder and bowel were contoured. Dynamic IMRT plans (6MV, 7-fields, 45Gy/25 fractions and prescribed at 95% isodose) were created in Eclipse (Varian medical system, Palo Alto, CA) treatment planning system (TPS) for Varian CL2300C/D linear-accelerator. Base plan was calculated with 166 control points, variable mode (Eclipse Default). For generating other plans, all parameters were kept constant, only number of control points (Fixed mode) was varied as follows: 100, 166 and 200. Then, plan quality was analyzed in terms of maximum and mean dose received by the PTV and OARs. For plan deliverability, TPS calculated fluence was verified with I’matriXX (IBA Dosimetry, Germany) array and compared with TPS dose-plane using gamma index criteria of 3% dose difference and 3mm distance to agreement (DTA). Total number of monitor units (MU) required to deliver a plan was also noted. Results: The maximum variation for the PTV maximum with respect to eclipse default control point (166) was 0.28% (0.14Gy). Similarly, PTV mean varied only up to 0.22 %( 0.11Gy). Bladder maximum and bladder mean varied up to 0.51% (0.24Gy) and 0.16% (0.06Gy). The variation for the bowel maximum and bowel mean was also only 0.39% (0.19Gy) and 0.33% (0.04Gy). Total MU was within 0.32 % (4MU). Average gamma pass rate using different control points for five patients are 98.75±0.33%, 99.37±0.09%, 99.29±0.12%, 98.14±0.13% and 99.25±0.14% respectively. Conclusion: Slight variation (<1%) in PTV and OARs maximum and mean doses was observed with varying number of control points. Monitor unit was also not varied much. Reducing number of control points did not showed any comprise in plan deliverability in terms of gamma index pass rate.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-268: Proton Radiosurgery End-To-End Testing Using Lucy 3D QA Phantom

Purpose: To check the overall accuracy of proton radiosurgery treatment delivery using ready-made circular collimator inserts and fixed thickness compensating boluses. Methods: Lucy 3D QA phantom (Standard Imaging Inc. WI, USA) inserted with GaFchromicTM film was irradiated with laterally scattered and longitudinally spread-out 126.8 MeV proton beams. The tests followed every step in the proton radiosurgery treatment delivery process: CT scan (GE Lightspeed VCT), target contouring, treatment planning (Odyssey 5.0, Optivus, CA), portal calibration, target localization using robotic couch with image guidance and dose delivery at planned gantry angles. A 2 cm diameter collimator insert in a 4 cm diameter radiosurgery cone and a 1.2 cm thick compensating flat bolus were used for all beams. Film dosimetry (RIT114 v5.0, Radiological Imaging Technology, CO, USA) was used to evaluate the accuracy of target localization and relative dose distributions compared to those calculated by the treatment planning system. Results: The localization accuracy was estimated by analyzing the GaFchromic films irradiated at gantry 0, 90 and 270 degrees. We observed 0.5 mm shift in lateral direction (patient left), ±0.9 mm shift in AP direction and ±1.0 mm shift in vertical direction (gantry dependent). The isodose overlays showed good agreement (<2mm, 50% isodose lines) between measured and calculated doses. Conclusion: Localization accuracy depends on gantry sag, CT resolution and distortion, DRRs from treatment planning computer, localization accuracy of image guidance system, fabrication of ready-made aperture and cone housing. The total deviation from the isocenter was 1.4 mm. Dose distribution uncertainty comes from distal end error due to bolus and CT density, in addition to localization error. The planned dose distribution was well matched (>90%) to the measured values 2%/2mm criteria. Our test showed the robustness of our proton radiosurgery treatment delivery system using ready-made collimator inserts and fixed thickness compensating boluses.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2014

SU-E-T-277: Raystation Electron Monte Carlo Commissioning and Clinical Implementation

Purpose: To evaluate the Raystation v4.0 Electron Monte Carlo algorithm for an Elekta Infinity linear accelerator and commission for clinical use. Methods: A total of 199 tests were performed (75 Export and Documentation, 20 PDD, 30 Profiles, 4 Obliquity, 10 Inhomogeneity, 55 MU Accuracy, and 5 Grid and Particle History). Export and documentation tests were performed with respect to MOSAIQ (Elekta AB) and RadCalc (Lifeline Software Inc). Mechanical jaw parameters and cutout magnifications were verified. PDD and profiles for open cones and cutouts were extracted and compared with water tank measurements. Obliquity and inhomogeneity for bone and air calculations were compared to film dosimetry. MU calculations for open cones and cutouts were performed and compared to both RadCalc and simple hand calculations. Grid size and particle histories were evaluated per energy for statistical uncertainty performance. Acceptability was categorized as follows: performs as expected, negligible impact on workflow, marginal impact, critical impact or safety concern, and catastrophic impact of safety concern. Results: Overall results are: 88.8% perform as expected, 10.2% negligible, 2.0% marginal, 0% critical and 0% catastrophic. Results per test category are as follows: Export and Documentation: 100% perform as expected, PDD: 100% perform as expected, Profiles: 66.7% perform as expected, 33.3% negligible, Obliquity: 100% marginal, Inhomogeneity 50% perform as expected, 50% negligible, MU Accuracy: 100% perform as expected, Grid and particle histories: 100% negligible. To achieve distributions with satisfactory smoothness level, 5,000,000 particle histories were used. Calculation time was approximately 1 hour. Conclusion: Raystation electron Monte Carlo is acceptable for clinical use. All of the issues encountered have acceptable workarounds. Known issues were reported to Raysearch and will be resolved in upcoming releases.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗
DOE OSTI2014

SU-E-T-319: The Effect of Slice Thickness On IMRT Planning

Purpose: The accuracy of volume estimated of a treatment planning system is investigated in this study. In addition, the effect of slice thickness on IMRT planning is also studied. Methods: The accuracy in volume determination was investigated using a water phantom containing various objects with known volumes ranging from 1–100cm{sup 3}. The phantom was scanned with different slice thickness (1–10 mm). The CT data sets were sent to Eclipse TPS for contour delineation and volume calculation. The effect of slice thickness on IMRT planning was studied using a commercial phantom containing four different shaped objects. The phantom was scanned with different slice thickness (1–5 mm). IMRT plans were generated for the different CT datasets to calculate TCP, homogeneity (HI) and conformity indices (CI). Results: The variability of volumes with CT slice thickness was significant especially for small volume structures. The minimum and maximum error in the volume estimation is in the range of −2.3% to 92%. On the other hand, with increasing slice thickness, the PTV mean dose and TCP values decreases. Maximum variation of ∼5% was observed in mean dose and ∼2% in TCP with slice thickness change from 1–5 mm. The relative decrease in target volume receiving 95% of prescribed dose is ∼5% slice thickness change from 1–5 mm. HI increases up to 163% and CI decreases by 4% between 1–5 mm slice thickness change, producing highly inhomogeneous and least conformal plan. Conclusion: Accuracy of volume estimation is dependent on CT slice thickness and the contouring algorithm in a TPS. During TPS commissioning and for all clinical protocols, evaluation of volume should be included to provide the limit of accuracy in DVH calculation. A smaller slice thickness provides superior dosimetry with improved TCP values. Thus, the smallest possible slice thickness should be used for IMRT planning.

07 ISOTOPE AND RADIATION SOURCES↗
DOE OSTI2014

SU-E-T-324: The Influence of Patient Positioning Uncertainties in Proton Radiotherapy On Proton Range and Dose Distributions

Purpose: Proton radiotherapy allows radiation treatment delivery with high dose gradients. The nature of such dose distributions increases the influence of patient positioning uncertainties on their fidelity when compared to photon radiotherapy. The present work quantitatively analyzes the influence of setup uncertainties on proton range and dose distributions. Methods: 38 clinical passive scattering treatment fields for small lesions in the head were studied. Dose distributions for shifted and rotated patient positions were Monte Carlo-simulated. Proton range uncertainties at the 50% and 90%-dose falloff position were calculated considering 18 arbitrary combinations of maximal patient position shifts and rotations for two patient positioning methods. Normal tissue complication probabilities (NTCPs), equivalent uniform doses (EUDs) and tumor control probabilities (TCPs) were studied for organs at risk (OARs) and target volumes of eight patients. Results: We identified a median 1σ proton range uncertainty at the 50%-dose falloff of 2.8 mm for anatomy-based patient positioning and 1.6 mm for fiducial-based patient positioning as well as 7.2 mm and 5.8 mm for the 90%-dose falloff position respectively. These range uncertainties were correlated to heterogeneity indices (HIs) calculated for each treatment field (38% < R{sup 2} < 50%). A NTCP increase of more than 10% (absolute) was observed for less than 2.9% (anatomy-based positioning) and 1.2% (fiducial-based positioning) of the studied OARs and patient shifts. TCP decreases larger than 10% (absolute) were seen for less than 2.2% of the target volumes or non-existent. EUD changes were up to 178% for OARs and 35% for target volumes. Conclusion: The influence of patient positioning uncertainties on proton range in therapy of small lesions in the human brain and target and OAR dosimetry were studied. Observed range uncertainties were correlated with HIs. The clinical practice of using multiple compensator-smeared treatment beams selected to avoid distal OAR sparing is considered to be safe. J. L. was supported by a scholarship of the University of Vienna.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-328: The Volume Effect Correction of Probe-Type Dosimetric Detectors Derived From the Convolution Model

Purpose: To derive and introduce a new correction factor kV, the “volume effect correction factor”, that accounts for not only the dose averaging over the detector's sensitive volume but also the secondary electron generation and transport inclusive of the disturbance of the field of secondary electrons within the detector. Materials and Methods: Mathematical convolutions and Fourier's convolution theorem have been used. Monte Carlo simulations of photon pencil beams were performed using EGSnrc. Detector constructions were adapted from manufacturers' information. Results: For the calculation of kV, the three basic convolution kernels have to be taken into account: the dose deposition kernel KD(x) (fluence to dose), the photon fluence response kernel KM(x) (photon fluence to detector signal) and the “dose response kernel” K(x) (dose to detector signal). K(x) is calculated from FT[K(x)] = [1/sqrt(2”)]FT[KM(x)]/FT[KD(x)], where the magnitude of kV(x) can be thereby calculated for arbitrary photon beam profiles and the areanormalized K(x). Conclusions: n order to take into account for the dimensions of dosimetric detectors in narrow photon beams, the “volume effect correction factor” kV has been introduced into the fundamental equation of probe-type dosimetry, and the convolution method has proven to be a method for the derivation of its numerical values. For narrow photon beams, whose width is comparable to the secondary electron ranges, kV can reach very high values, but it can be shown that the signals of small diamond detectors are well representing the absorbed dose to water averaged over the detector volume.

07 ISOTOPE AND RADIATION SOURCES↗
DOE OSTI2014

SU-E-T-408: Determination of KQ,Q0-Factors From Water and Graphite Calorimetry in a 60 MeV Proton Beam

Purpose: To reduce the uncertainty of the beam quality correction factor k Q,Q0 , for scattered proton beams (SPB). This factor is used in dosimetry protocols, to determine absorbed dose-to-water with ionization chambers. For the Roos plane parallel chambers (RPPICs), the IAEA TRS-398 protocol estimates k Q,Q0 -factor to be 1.004(for a beam quality Rres=2 g.cm{sup 2}), with an uncertainty of 2.1%. Methods: A graphite calorimeter (GCal), a water calorimeter (WCal) and RPPICs were exposed, in a single experiment, to a 60 MeV non-modulated SPB. RPPICs were calibrated in terms of absorbed dose-to-water in a 20 MeV electron beam. The calibration coefficient is traceable to NPL's absorbed dose standards. Chamber measurements were corrected for environmental conditions, recombination and polarity. The WCal corrections include heat loss, heat defect and vessel perturbation. The GCal corrections include heat loss and absorbed dose conversion. Except for heat loss correction and its uncertainty in the WCal system, all major corrections were included in the analysis. Other minor corrections, such as beam profile non-uniformity, are still to be evaluated. Experimental k Q,Q0 -factors were derived by comparing the results obtained with both calorimeters and ionometry. Results: The absorbed dose-to-water from both calorimeters was found to be within 1.3% with an uncertainty of 1.2%. k Q,Q0 -factor for a RPPIC was found to be 0.998 and 1.011, with a standard uncertainty of 1.4% and 0.9% when the dose is based on the GCal and the WCal, respectively. Conclusion: Results suggest the possibility to determine k Q,Q0 -values for PPICs in SPB with a lower uncertainty than specified in the TRS-398 thereby helping to reduce uncertainty on absorbed dose-to-water. The agreement between calorimeters confirms the possibility to use GCal or WCal as primary standard in SPB. Because of the dose conversion, the use of GCal may lead to slightly higher uncertainty, but is, at present, considerably easier to operate.

07 ISOTOPE AND RADIATION SOURCES↗
DOE OSTI2014

SU-E-T-444: Quantitatively Comparison of Low Dose Spillage Outside of PTV Edge in Arc Therapy Modalities

Purpose: To quantitatively compare low dose spillage outside of PTV edge in arc therapy modalities Methods: The machines used in the study are Tomotherapy Hi-Arc and Varian 21EX with millennium120 MLC. TPS are TomoPlaning and RayStation for VMAT, respectively. The phantom is a 30cm diameter cylindrical solid water (TOMOTHERAPY, TOMOPHANTOM ASSY). The PTV is 4cm length with ellipsoidal sectional shape with major axis=5cm, minor axis=3cm in the axial plane and reversed in the coronal plane. The PTV volume is created with interpolation. It is located at the center of the phantom. The prescribed dose is 1000x5 cGy to 95% the PTV. The isocenter is set co-centered with the PTV. EBT-3 film was used to measure iso-dose lines at the center plane. Film dosimetry is performed with the RIT, v6.2. Results: the study shows: (1) dose falloff gradient is usually uneven, depending on the PTV shape in the gantry rotation plane. For an elliptical shape, the low dose spillage is wider in the minor axis direction than that in the major axis direction. The more a shape is closer to circular, the more even gradient is all directions; (2)for a circular shape (CAX plane in this study), the maximum dose in % of Rx dose at 2cm from PTV is 55% for Tomo, vs. 70% for VMAT (3) the most rapid dose falloff rang is between 95%–80% IDL for both modalities. Conclusion: Tomo has more rapid dose falloff outside of PTV. In some areas, the gradient is double for Tomo helical than that for LINAC VMAT at same points. Future work will examine the differences between optimization of doses and inherent delivery limitations.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-445: Lateral Optical Density Variation in Flatbed Scanners in Combination with Gafchromic Film

Purpose This study investigates the origin of lateral optical density (OD) variation for Gafchromic film (EBT and EBT2) scanned in transmission mode with Epson flatbed scanners (1680 Expression Pro and 10000XL). Effects investigated are: cross talk, optical path length and polarization. Methods Cross talk has been examined with triangular shaped light-transmission sheets with OD ranging from 0 to opaque. Optical path length has been studied with absorptive and reflective OD-filters (OD range 0.2 to 2.0). Dependency on light-polarization on the scanner read out has been investigated using linear polarizer sheets. All experiments have been performed at centre scanner position (norm point) and at several lateral scan positions, without and with (un)irradiated EBT-film. Dose values used ranged between 0.2 to 9 Gy, yielding an OD-range between 0.25 to 1.1. Results The lateral OD variation is dose dependent and increases up to 14% at most lateral position for dose up to 9 Gy. Cross talk effect contributes to 0.5% in clinical used OD ranges but equals 2% for extreme high dose gradients. Film induced optical path length will effect the lateral OD variation up to 3% at most lateral points. Light polarization is inherent present in these scanners due to multiple reflection on mirrors. In addition film induced polarization is the most important effect generating the observed lateral OD variation. Both Gafchromic film base and sensitive layer have polarizing capabilities; for the sensitive layer its influence is dose dependent. Conclusions Lateral OD variation origins from optical physics (i.e. polarization and reflection) related to scanner and film construction. Cross talk can be ignored in film dosimetry for clinical used dose values and gradients. Therefore it is recommended to determine the lateral OD variation per film type and scanner.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-456: Development of An EPID-Based Output Measurement and Dosimetric Verification Tool for Electron Beam Therapy

Purpose: To develop an efficient and robust method for output and absolute dosimetric measurements of electron beam therapy by using a high spatialresolution and high frame-rate amorphous silicon flat-panel electronic portal imaging device (EPID). Methods: A previously-established EPID dosimetry system was extended to measure the output factors of electron beams of various sizes and their planar dose distributions at reference depths. Specific EPID responses to different electron energies were derived from Monte Carlo (MC) simulations to de-convolve the EPID raw images to the incident electron fluence map. To reconstruct the 2D water-based dose distribution map at reference depths for different energies, the fluence map was further convolved with a MC simulated pencil beam kernel. Different energies of 6, 9, 12, 16, and 20 MeV from a Varian C-series linac were tested. Standard square fields ranging from 2×2 to 15×15 cm{sup 2} were measured and validated against film/ion chamber measurements. Small fields of different patient cases with irregular cutout shapes were also tested. Results: The EPIDmeasured output factors for 2×2, 3×3, 6×6, and 10×10 cm{sup 2} fields with all electron energies agree with the film/ion chamber data within 2.7%. The average discrepancy between EPID and film/ion chamber measurements was 1.4%. The differences for the three patient cases were 0.1%, 2.1%, and 1.6%. Deliveries with different monitor units were tested and the results exhibited good linearity. Measurements with different dose rate showed that the dose rate dependence was less than 1%. Using the proposed method, 2D absolute dose maps were created from the EPID raw images and the results were consistent with film measurements. Conclusion: The efficient data readout and portability of the newly developed EPID system provides an efficient and accurate solution for electron beam therapy. It addresses an important unmet clinical need for a fast and reliable small field output factor measurement.

07 ISOTOPE AND RADIATION SOURCES↗
DOE OSTI2014

SU-E-T-469: A Practical Approach for the Determination of Small Field Output Factors Using Published Monte Carlo Derived Correction Factors

Purpose: Output factor determination for small fields (less than 20 mm) presents significant challenges due to ion chamber volume averaging and diode over-response. Measured output factor values between detectors are known to have large deviations as field sizes are decreased. No set standard to resolve this difference in measurement exists. We observed differences between measured output factors of up to 14% using two different detectors. Published Monte Carlo derived correction factors were used to address this challenge and decrease the output factor deviation between detectors. Methods: Output factors for Elekta's linac-based stereotactic cone system were measured using the EDGE detector (Sun Nuclear) and the A16 ion chamber (Standard Imaging). Measurements conditions were 100 cm SSD (source to surface distance) and 1.5 cm depth. Output factors were first normalized to a 10.4 cm × 10.4 cm field size using a daisy-chaining technique to minimize the dependence of field size on detector response. An equation expressing the relation between published Monte Carlo correction factors as a function of field size for each detector was derived. The measured output factors were then multiplied by the calculated correction factors. EBT3 gafchromic film dosimetry was used to independently validate the corrected output factors. Results: Without correction, the deviation in output factors between the EDGE and A16 detectors ranged from 1.3 to 14.8%, depending on cone size. After applying the calculated correction factors, this deviation fell to 0 to 3.4%. Output factors determined with film agree within 3.5% of the corrected output factors. Conclusion: We present a practical approach to applying published Monte Carlo derived correction factors to measured small field output factors for the EDGE and A16 detectors. Using this method, we were able to decrease the percent deviation between both detectors from 14.8% to 3.4% agreement.

07 ISOTOPE AND RADIATION SOURCES↗
DOE OSTI2014

SU-E-T-472: A Multi-Dimensional Measurements Comparison to Analyze a 3D Patient Specific QA Tool

Purpose: To quantitatively evaluate a 3D patient specific QA tool using 2D film and 3D Presage dosimetry. Methods: A brain IMRT case was delivered to Delta4, EBT2 film and Presage plastic dosimeter. The film was inserted in the solid water slabs at 7.5cm depth for measurement. The Presage dosimeter was inserted into a head phantom for 3D dose measurement. Delta4's Anatomy software was used to calculate the corresponding dose to the film in solid water slabs and to Presage in the head phantom. The results from Anatomy were compared to both calculated results from Eclipse and measured dose from film and Presage to evaluate its accuracy. Using RIT software, we compared the “Anatomy” dose to the EBT2 film measurement and the film measurement to ECLIPSE calculation. For 3D analysis, DICOM file of “Anatomy” was extracted and imported to CERR software, which was used to compare the Presage dose to both “Anatomy” calculation and ECLIPSE calculation. Gamma criteria of 3% - 3mm and 5% - 5mm was used for comparison. Results: Gamma passing rates of film vs “Anatomy”, “Anatomy” vs ECLIPSE and film vs ECLIPSE were 82.8%, 70.9% and 87.6% respectively when 3% - 3mm criteria is used. When the criteria is changed to 5% - 5mm, the passing rates became 87.8%, 76.3% and 90.8% respectively. For 3D analysis, Anatomy vs ECLIPSE showed gamma passing rate of 86.4% and 93.3% for 3% - 3mm and 5% - 5mm respectively. The rate is 77.0% for Presage vs ECLIPSE analysis. The Anatomy vs ECLIPSE were absolute dose comparison. However, film and Presage analysis were relative comparison Conclusion: The results show higher passing rate in 3D than 2D in “Anatomy” software. This could be due to the higher degrees of freedom in 3D than in 2D for gamma analysis.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-473: A Patient-Specific QC Paradigm Based On Trajectory Log Files and DICOM Plan Files

Purpose: To evaluate a remote QC tool for monitoring treatment machine parameters and treatment workflow. Methods: The Varian TrueBeamTM linear accelerator is a digital machine that records machine axis parameters and MLC leaf positions as a function of delivered monitor unit or control point. This information is saved to a binary trajectory log file for every treatment or imaging field in the patient treatment session. A MATLAB analysis routine was developed to parse the trajectory log files for a given patient, compare the expected versus actual machine and MLC positions as well as perform a cross-comparison with the DICOM-RT plan file exported from the treatment planning system. The parsing routine sorts the trajectory log files based on the time and date stamp and generates a sequential report file listing treatment parameters and provides a match relative to the DICOM-RT plan file. Results: The trajectory log parsing-routine was compared against a standard record and verify listing for patients undergoing initial IMRT dosimetry verification and weekly and final chart QC. The complete treatment course was independently verified for 10 patients of varying treatment site and a total of 1267 treatment fields were evaluated including pre-treatment imaging fields where applicable. In the context of IMRT plan verification, eight prostate SBRT plans with 4-arcs per plan were evaluated based on expected versus actual machine axis parameters. The average value for the maximum RMS MLC error was 0.067±0.001mm and 0.066±0.002mm for leaf bank A and B respectively. Conclusion: A real-time QC analysis program was tested using trajectory log files and DICOM-RT plan files. The parsing routine is efficient and able to evaluate all relevant machine axis parameters during a patient treatment course including MLC leaf positions and table positions at time of image acquisition and during treatment.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-489: Plan Comparisons of Re-Irradiation Treatment of Three Intensity Modulated Techniques

Purpose: There have been controversial reports on the comparison of dosimetric quality of TomoTherapy (Tomo), VMAT and IMRT. One of the main reasons is the sampled cases are often not dosimetrically challenging enough to test the limit of optimization/delivery modalities. We chose difficult re-irradiation cases when certain organ at risk (OAR) requires extremely low dose to examine the ability of OAR sparing of three main intensity modulated techniques. Methods: Three previous treated patients with disease site on head and neck (HN), brain and lung are planned for reirradiation treatment. The Tomo planning used jaw 2.5cm and pitch 0.3. VMAT and IMRT were planned on Pinnacle for a Varian 21iX Linac with MLC leaf width 5mm. VMAT plan used 2 Arcs and IMRT plan had beams 11–13. The dosimetric endpoints and treatment time were compared for each technique of each patient. Results: Plans of three techniques cover PTV similarly. The HN case requires PTV dose 60Gy but to limit dose of cord which is 8mm away <12Gy. The cord dose of Tomo, VMAT and IMRT plan is 11.6Gy, 11.3Gy and 11.0Gy, respectively. The brain case has PTV prescription 50.4 Gy while requiring the dose of brainstem < 28Gy. Tomo, VMAT and IMRT plan generate brainstem dose 27.6Gy, 27.6Gy and 27.1Gy respectively. For the lung case, PTV was prescribed 42.5Gy but cord dose constraint was 22.5Gy. The cord dose is optimized to 22.3Gy, 20.8Gy and 21.4Gy by Tomo, VMAT and IMRT, respectively. The delivery time if normalized to Tomo is 47.0%/145.6% (VMAT/IMRT), 33.3%/106.3% and 74.1%/245.4% for HN, brain and lung case, respectively. Conclusion: Difficult re-irradiation cases were used to test the limit of three intensity modulated techniques. Tomo, VMAT and IMRT show similar dosimetry while VMAT is the most efficient one and IMRT is the least.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-521: Feasibility Study of a Rotational Step-And-Shoot IMRT Treatment Planning Approach

Purpose: Rotational step-and-shot IMRT (r-IMRT) could improve delivery efficiency with good dose conformity, especially if it can leverage the burst mode of the accelerator where radiation is turned on/off momentarily while the gantry rotates continuously. The challenge for the r-IMRT planning is to minimize the number of beams to achieve a fast and smooth rotational delivery. Methods: Treatment plans for r-IMRT were created using an in-house treatment planning system. To generate the plan using a very few beams, gantry angle was optimized by weighting the beam monitoring unit (MU), and beam shape optimization was a combination of column search with k-means clustering. A prostate case and a head and neck case were planned using r-IMRT. The dosimetry is compared to s-IMRT planned with Varian Eclipse treatment planning system. Results: With the same PTV dose coverage D95=100%, the r-IMRT plans shows comparable sparing as the s-IMRT plans in the prostate for the rectum D10cc and the bladder Dmean, and in the head and neck for the spinal cord Dmax, the brain stem Dmax, the left/right parotid Dmean, the larynx Dmean, and the mandible Dmean. Both plans meet the established institutional clinical dosimetric criteria. The r-IMRT plan uses 19 beam/405 MU for the prostate, and 68 beam/880 MU for the head and neck, while the s-IMRT uses 7 beam/724 MU and 9 beam/1812 MU, respectively. Compared to the corresponding s-IMRT, r-IMRT has a reduction of MUs of 44% for the prostate case and 41% for the head and neck case. Conclusions: We have demonstrated the feasibility of a rotational step and shoot IMRT treatment planning approach that significantly shortens the conventional IMRT treatment beam-on time without degrading the dose comformity.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-540: Volumetric Modulated Total Body Irradiation Using a Rotational Lazy Susan-Like Immobilization System

Purpose: Traditional extended SSD total body irradiation (TBI) techniques can be problematic in terms of patient comfort and/or dose uniformity. This work aims to develop a comfortable TBI technique that achieves a uniform dose distribution to the total body while reducing the dose to organs at risk for complications. Methods: To maximize patient comfort, a lazy Susan-like couch top immobilization system which rotates about a pivot point was developed. During CT simulation, a patient is immobilized by a Vac-Lok bag within the body frame. The patient is scanned head-first and then feet-first following 180° rotation of the frame. The two scans are imported into the Pinnacle treatment planning system and concatenated to give a full-body CT dataset. Treatment planning matches multiple isocenter volumetric modulated arc (VMAT) fields of the upper body and multiple isocenter parallel-opposed fields of the lower body. VMAT fields of the torso are optimized to satisfy lung dose constraints while achieving a therapeutic dose to the torso. The multiple isocenter VMAT fields are delivered with an indexed couch, followed by body frame rotation about the pivot point to treat the lower body isocenters. The treatment workflow was simulated with a Rando phantom, and the plan was mapped to a solid water slab phantom for point- and film-dose measurements at multiple locations. Results: The treatment plan of 12Gy over 8 fractions achieved 80.2% coverage of the total body volume within ±10% of the prescription dose. The mean lung dose was 8.1 Gy. All ion chamber measurements were within ±1.7% compared to the calculated point doses. All relative film dosimetry showed at least a 98.0% gamma passing rate using a 3mm/3% passing criteria. Conclusion: The proposed patient comfort-oriented TBI technique provides for a uniform dose distribution within the total body while reducing the dose to the lungs.

60 APPLIED LIFE SCIENCES↗