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All sourcesNASA NTRSDOE OSTI
DOE OSTI2013

A COMPOUND MODEL FOR THE ORIGIN OF EARTH'S WATER

One of the most important subjects of debate in the formation of the solar system is the origin of Earth's water. Comets have long been considered as the most likely source of the delivery of water to Earth. However, elemental and isotopic arguments suggest a very small contribution from these objects. Other sources have also been proposed, among which local adsorption of water vapor onto dust grains in the primordial nebula and delivery through planetesimals and planetary embryos have become more prominent. However, no sole source of water provides a satisfactory explanation for Earth's water as a whole. In view of that, using numerical simulations, we have developed a compound model incorporating both the principal endogenous and exogenous theories, and investigating their implications for terrestrial planet formation and water delivery. Comets are also considered in the final analysis, as it is likely that at least some of Earth's water has cometary origin. We analyze our results comparing two different water distribution models, and complement our study using the D/H ratio, finding possible relative contributions from each source and focusing on planets formed in the habitable zone. We find that the compound model plays an important role by showing greater advantage in the amount and time of water delivery in Earth-like planets.

54 ENVIRONMENTAL SCIENCES↗
DOE OSTI2019

Hollow pellet injection for magnetic fusion

The precise delivery of mass to burning plasmas is an area of growing interest in magnetic fusion (MF). The amount of mass that is necessary and sufficient can vary depending on such parameters as the type of atoms involved, the type of applications, plasma conditions, mass injector, and injection timing. Motivated by edge localized mode (ELM) control in H-mode plasmas, disruption mitigation and other applications in MF, we report the progress and new possibilities in mass delivery based on hollow pellets. Here, a hollow pellet refers to a spherical shell mass structure with a hollow core. Based on an empirical model of pellet ablation, coupled with BOUT++ simulations of the ELM triggering threshold, hollow pellets are found to be attractive in comparison with solid spheres for ELM control. By using hollow pellets, it is possible to tailor mass delivery to certain regions of edge plasmas while minimizing core contamination and reducing the total amount of mass needed. We also include the experimental progress in mass delivery experiments, in situ diagnostics and hollow pellet fabrication, and emphasize new experimental possibilities for ELM control based on hollow pellets. A related application is the disruption mitigation scheme using powder encapsulated inside hollow shells. Further experiments will also help to resolve known discrepancies between theoretical predictions and experiments in using mass injection for ELM control and leading to better predictive models for ELM stability and triggering.

70 PLASMA PHYSICS AND FUSION TECHNOLOGY↗
DOE OSTI2021

The clinical path to deliver encapsulated phages and lysins

ABSTRACT The global emergence of multidrug-resistant pathogens is shaping the current dogma regarding the use of antibiotherapy. Many bacteria have evolved to become resistant to conventional antibiotherapy, representing a health and economic burden for those afflicted. The search for alternative and complementary therapeutic approaches has intensified and revived phage therapy. In recent decades, the exogenous use of lysins, encoded in phage genomes, has shown encouraging effectiveness. These two antimicrobial agents reduce bacterial populations; however, many barriers challenge their prompt delivery at the infection site. Encapsulation in delivery vehicles provides targeted therapy with a controlled compound delivery, surpassing chemical, physical and immunological barriers that can inactivate and eliminate them. This review explores phages and lysins' current use to resolve bacterial infections in the respiratory, digestive and integumentary systems. We also highlight the different challenges they face in each of the three systems and discuss the advances towards a more expansive use of delivery vehicles.

Pinto, Ana Mafalda↗
DOE OSTI2013

Assessment and characterization of the total geometric uncertainty in Gamma Knife radiosurgery using polymer gels

Purpose: This work proposes and implements an experimental methodology, based on polymer gels, for assessing the total geometric uncertainty and characterizing its contributors in Gamma Knife (GK) radiosurgery. Methods: A treatment plan consisting of 26, 4-mm GK single shot dose distributions, covering an extended region of the Leksell stereotactic space, was prepared and delivered to a polymer gel filled polymethyl methacrylate (PMMA) head phantom (16 cm diameter) used to accurately reproduce every link in the GK treatment chain. The center of each shot served as a 'control point' in the assessment of the GK total geometric uncertainty, which depends on (a) the spatial dose delivery uncertainty of the PERFEXION GK unit used in this work, (b) the spatial distortions inherent in MR images commonly used for target delineation, and (c) the geometric uncertainty contributor associated with the image registration procedure performed by the Leksell GammaPlan (LGP) treatment planning system (TPS), in the case that registration is directly based on the apparent fiducial locations depicted in each MR image by the N-shaped rods on the Leksell localization box. The irradiated phantom was MR imaged at 1.5 T employing a T2-weighted pulse sequence. Four image series were acquired by alternating the frequency encoding axis and reversing the read gradient polarity, thus allowing the characterization of the MR-related spatial distortions. Results: MR spatial distortions stemming from main field (B{sub 0}) inhomogeneity as well as from susceptibility and chemical shift phenomena (also known as sequence dependent distortions) were found to be of the order of 0.5 mm, while those owing to gradient nonlinearities (also known as sequence independent distortions) were found to increase with distance from the MR scanner isocenter extending up to 0.47 mm at an Euclidean distance of 69.6 mm. Regarding the LGP image registration procedure, the corresponding average contribution to the total geometric uncertainty ranged from 0.34 to 0.80 mm. The average total geometric uncertainty, which also includes the GK spatial dose delivery uncertainty, was found equal to (0.88 {+-} 0.16), (0.88 {+-} 0.26), (1.02 {+-} 0.09), and (1.15 {+-} 0.24) mm for the MR image series acquired with the read gradient polarity (direction) set toward right, left, posterior, and anterior, respectively. Conclusions: The implemented methodology seems capable of assessing the total geometric uncertainty, as well as of characterizing its contributors, ascribed to the entire GK treatment delivery (i.e., from MR imaging to GK dose delivery) for an extended region of the Leksell stereotactic space. Results obtained indicate that the selection of both the frequency encoding axis and the read gradient polarity during MRI acquisition may affect the magnitude as well as the spatial components of the total geometric uncertainty.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2013

An algorithm to calculate a collapsed arc dose matrix in volumetric modulated arc therapy

Purpose: The delivery of volumetric modulated arc therapy (VMAT) is more complex than other conformal radiotherapy techniques. In this work, the authors present the feasibility of performing routine verification of VMAT delivery using a dose matrix measured by a gantry mounted 2D ion chamber array and corresponding dose matrix calculated by an inhouse developed algorithm.Methods: Pinnacle, v9.0, treatment planning system (TPS) was used in this study to generate VMAT plans for a 6 MV photon beam from an Elekta-Synergy linear accelerator. An algorithm was developed and implemented with inhouse computer code to calculate the dose matrix resulting from a VMAT arc in a plane perpendicular to the beam at isocenter. The algorithm was validated using measurement of standard patterns and clinical VMAT plans with a 2D ion chamber array. The clinical VMAT plans were also validated using ArcCHECK measurements. The measured and calculated dose matrices were compared using gamma ({gamma}) analysis with 3%/3 mm criteria and {gamma} tolerance of 1.Results: The dose matrix comparison of standard patterns has shown excellent agreement with the mean {gamma} pass rate 97.7 ({sigma}= 0.4)%. The validation of clinical VMAT plans using the dose matrix predicted by the algorithm and the corresponding measured dose matrices also showed good agreement with the mean {gamma} pass rate of 97.6 ({sigma}= 1.6)%. The validation of clinical VMAT plans using ArcCHECK measurements showed a mean pass rate of 95.6 ({sigma}= 1.8)%.Conclusions: The developed algorithm was shown to accurately predict the dose matrix, in a plane perpendicular to the beam, by considering all possible leaf trajectories in a VMAT delivery. This enables the verification of VMAT delivery using a 2D array detector mounted on a treatment head.

61 RADIATION PROTECTION AND DOSIMETRY↗
DOE OSTI2014

Dosimetric properties of a proton beamline dedicated to the treatment of ocular disease

Purpose: A commercial proton eyeline has been developed to treat ocular disease. Radiotherapy of intraocular lesions (e.g., uveal melanoma, age-related macular degeneration) requires sharp dose gradients to avoid critical structures like the macula and optic disc. A high dose rate is needed to limit patient gazing times during delivery of large fractional dose. Dose delivery needs to be accurate and predictable, not in the least because current treatment planning algorithms have limited dose modeling capabilities. The purpose of this paper is to determine the dosimetric properties of a new proton eyeline. These properties are compared to those of existing systems and evaluated in the context of the specific clinical requirements of ocular treatments. Methods: The eyeline is part of a high-energy, cyclotron-based proton therapy system. The energy at the entrance of the eyeline is 105 MeV. A range modulator (RM) wheel generates the spread-out Bragg peak, while a variable range shifter system adjusts the range and spreads the beam laterally. The range can be adjusted from 0.5 up to 3.4 g/cm{sup 2}; the modulation width can be varied in steps of 0.3 g/cm{sup 2} or less. Maximum field diameter is 2.5 cm. All fields can be delivered with a dose rate of 30 Gy/min or more. The eyeline is calibrated according to the IAEA TRS-398 protocol using a cylindrical ionization chamber. Depth dose distributions and dose/MU are measured with a parallel-plate ionization chamber; lateral profiles with radiochromic film. The dose/MU is modeled as a function of range, modulation width, and instantaneous MU rate with fit parameters determined per option (RM wheel). Results: The distal fall-off of the spread-out Bragg peak is 0.3 g/cm{sup 2}, larger than for most existing systems. The lateral penumbra varies between 0.9 and 1.4 mm, except for fully modulated fields that have a larger penumbra at skin. The source-to-axis distance is found to be 169 cm. The dose/MU shows a strong dependence on range (up to 4%/mm). A linear increase in dose/MU as a function of instantaneous MU rate is observed. The dose/MU model describes the measurements with an accuracy of ±2%. Neutron dose is found to be 146 ± 102 μSv/Gy at the contralateral eye and 19 ± 13 μSv/Gy at the chest. Conclusions: Measurements show the proton eyeline meets the requirements to effectively treat ocular disease.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2014

On the interplay effects with proton scanning beams in stage III lung cancer

Purpose: To assess the dosimetric impact of interplay between spot-scanning proton beam and respiratory motion in intensity-modulated proton therapy (IMPT) for stage III lung cancer. Methods: Eleven patients were sampled from 112 patients with stage III nonsmall cell lung cancer to well represent the distribution of 112 patients in terms of target size and motion. Clinical target volumes (CTVs) and planning target volumes (PTVs) were defined according to the authors' clinical protocol. Uniform and realistic breathing patterns were considered along with regular- and hypofractionation scenarios. The dose contributed by a spot was fully calculated on the computed tomography (CT) images corresponding to the respiratory phase that the spot is delivered, and then accumulated to the reference phase of the 4DCT to generate the dynamic dose that provides an estimation of what might be delivered under the influence of interplay effect. The dynamic dose distributions at different numbers of fractions were compared with the corresponding 4D composite dose which is the equally weighted average of the doses, respectively, computed on respiratory phases of a 4DCT image set. Results: Under regular fractionation, the average and maximum differences in CTV coverage between the 4D composite and dynamic doses after delivery of all 35 fractions were no more than 0.2% and 0.9%, respectively. The maximum differences between the two dose distributions for the maximum dose to the spinal cord, heart V40, esophagus V55, and lung V20 were 1.2 Gy, 0.1%, 0.8%, and 0.4%, respectively. Although relatively large differences in single fraction, correlated with small CTVs relative to motions, were observed, the authors' biological response calculations suggested that this interfractional dose variation may have limited biological impact. Assuming a hypofractionation scenario, the differences between the 4D composite and dynamic doses were well confined even for single fraction. Conclusions: Despite the presence of interplay effect, the delivered dose may be reliably estimated using the 4D composite dose. In general the interplay effect may not be a primary concern with IMPT for lung cancers for the authors' institution. The described interplay analysis tool may be used to provide additional confidence in treatment delivery.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2014

SU-E-P-06: A Novel Hybrid Planning Approach to Allow More Patients Benefited by the Intensity Modulated Proton Therapy

Purpose: We report a hybrid scattering and scanning beam delivery approach, termed as (HimpsPT), which demonstrated that majority IMPT delivery can be potentially replaced with hybrid IMPT and PSPT delivery with similar or better plan quality. Methods: Three representative clinical cases, including head and neck (HN), skull base chordoma (CNS) and lung cancer, treated in MDACC Proton Therapy Center with IMPT were retrospectively redesigned using HimpsPT. The PSPT plans are designed with the same prescriptions as those of IMPT plans. The whole treatment can be delivered by either alternating or sequential PSPT and IMPT delivery. The dosimetric data and dose distributions of HimpsPT plans are compared with those of IMPT plans. We also performed a worst-case robust analysis for all plans. Results: The target coverages for all cases are comparable. For the HN case, the mean dose of esophagus larynx, left parotid and right submandibular, oral cavity V20, the max dose of cord is 18.0, 36.1, 23.6, 47.2, 0.1, 31.7 Gy in HimpsPT plan, and 25.5, 33.8, 24.9, 49.1, 0.2, 33.8 Gy in IMPT plan. For the lung case, the lung V5, V20, V30, mean lung dose, heart V40, esophagus V70, cord maximum dose are 50.5%, 37.0%, 31.7%, 21.3 Gy, 7.2%, 4.9%, 35.5 Gy in HimpsPT plan, and 55.4%, 36.7%, 30.1%, 21.3 Gy, 7.7%, 8.4%, 36.8Gy in IMPT plans. For the CNS case, brainstem maximum dose is 50.5 Gy in HimpsPT plan and 55.4 Gy in IMPT plan due to sharp penumbra offered by the aperture of the PSPT plan in HimpsPT technique. Conclusion: For majority disease sites, the dosimetric advantage of IMPT technique can be achieved by the hybrid PSPT and IMPT technique, which enables the centers equipped with both scattering and scanning beam facilities to treat more patients which can be benefited by the scanning beam.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-100: Designing a QA Tool for Enhance Dynamic Wedges Based On Dynalog Files

Purpose: A robust quality assurance (QA) program for computer controlled enhanced dynamic wedge (EDW) has been designed and tested. Calculations to perform such QA test is based upon the EDW dynamic log files generated during dose delivery. Methods: Varian record and verify system generates dynamic log (dynalog) files during dynamic dose delivery. The system generated dynalog files contain information such as date and time of treatment, energy, monitor units, wedge orientation, and type of treatment. It also contains the expected calculated segmented treatment tables (STT) and the actual delivered STT for the treatment delivery as a verification record. These files can be used to assess the integrity and precision of the treatment plan delivery. The plans were delivered with a 6 MV beam from a Varian linear accelerator. For available EDW angles (10°, 15°, 20°, 25°, 30°, 45°, and 60°) Varian STT values were used to manually calculate monitor units for each segment. It can also be used to calculate the EDW factors. Independent verification of fractional MUs per segment was performed against those generated from dynalog files. The EDW factors used to calculate MUs in TPS were dosimetrically verified in solid water phantom with semiflex chamber on central axis. Results: EDW factors were generated from the STT provided by Varian and verified against practical measurements. The measurements were in agreement of the order of 1 % to the calculated EDW data. Variation between the MUs per segment obtained from dynalog files and those manually calculated was found to be less than 2%. Conclusion: An efficient and easy tool to perform routine QA procedure of EDW is suggested. The method can be easily implemented in any institution without a need for expensive QA equipment. An error of the order of ≥2% can be easily detected.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-421: Feasibility Study of Volumetric Modulated Arc Therapy with Constant Dose Rate for Endometrial Cancer

Purpose: To investigate the feasibility, efficiency, and delivery accuracy of volumetric modulated arc therapy with constant dose rate (VMAT-CDR) for whole-pelvic radiotherapy (WPRT) of endometrial cancer. Methods: The nine-Field intensity-modulated radiotherapy (IMRT), VMAT with variable dose-rate (VMAT-VDR), and VMAT-CDR plans were created for 9 patients with endometrial cancer undergoing WPRT. The dose distribution of planning target volume (PTV), organs at risk (OARs), and normal tissue (NT) were compared. The monitor units (MUs) and treatment delivery time were also evaluated. For each VMAT-CDR plan, a dry Run was performed to assess the dosimetric accuracy with MatriXX from IBA. Results: Compared with IMRT, the VMAT-CDR plans delivered a slightly greater V20 of the bowel, bladder, pelvis bone, and NT, but significantly decreased the dose to the high-dose region of the rectum and pelvis bone. The MUs Decreased from 1105 with IMRT to 628 with VMAT-CDR. The delivery time also decreased from 9.5 to 3.2 minutes. The average gamma pass rate was 95.6% at the 3%/3 mm criteria with MatriXX pretreatment verification for 9 patients. Conclusion: VMAT-CDR can achieve comparable plan quality with significant shorter delivery time and smaller number of MUs compared with IMRT for patients with endometrial cancer undergoing WPRT. It can be accurately delivered and be an alternative to IMRT on the linear accelerator without VDR capability. This work is supported by the grant project, National Natural; Science Foundation of China (No. 81071237)

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-462: Fixed-Jaw Optimization for Critical Structure Sparing in IMRT Treatment Planning: Beam Modeling Cautions for Non-Routine Use

Purpose: Multiple publications exist concerning fixed-jaw utilization to avoid linac carriage shifts and reduce intensity modulated radiotherapy (IMRT) treatment times. The purpose of this work is to demonstrate delivery QA discrepancies and illustrate the need for improved treatment planning system (TPS) commissioning for non-routine use. Methods: A 6cm diameter spherical target was delineated on a virtual phantom containing the Iba Matrixx linear array within the Varian Eclipse TPS. Optimization was performed for target coverage for the following 3 scenarios: a single open, zero degree field where the X and Y jaws completely cover the target; the same field using an asymmetric, fixed-jaw technique where the upper Y jaw does not cover the superior 2cm of the target; and both of the aforementioned directed at the target at 315 and 45 degree gantry angles, respectively. This final orientation was also irradiated on a linac for delivery analysis. A sarcoma patient case was also analyzed where the fixed jaw technique was utilized for kidney sparing. Results: The open beam results were as predicted but the fixed-jaw results demonstrate a pronounced fluence increase along the asymmetric, upper jaw. Analysis of the delivery of the combined beam plan Resultin 83% of pixels evaluated passing gamma criteria of 3%, 3mm DTA. Analysis for the sarcoma patient, in the plane of the shielded kidney, indicated 93% passing although the maximum dose discrepancies in this region were approximately 23%. Conclusion: Optimization within the target is routinely performed using MLC leaf-end characteristics. The fixed-jaw technique forces optimization of target coverage to utilize the penumbra profiles of the associated beamdefining jaw. If the profiles were collected using a common 0.125cc ionization chamber, the resolution may be insufficient resulting in a planvs.-delivery mismatch. It is recommended that high-resolution beam characteristics be considered when non-routine planning methods are utilized.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-470: Beam Performance of the Radiance 330 Proton Therapy System

Purpose: The ProTom Radiance 330 proton radiotherapy system is a fully functional, compact proton radiotherapy system that provides advanced proton delivery capabilities. It supports three-dimensional beam scanning with energy and intensity modulation. A series of measurements have been conducted to characterize the beam performance of the first installation of the system at the McLaren Proton Therapy Center in Flint, Michigan. These measurements were part of the technical commissioning of the system. Select measurements and results are presented. Methods: The Radiance 330 proton beam energy range is 70–250 MeV for treatment, and up to 330 MeV for proton tomography and radiography. Its 3-D scanning capability, together with a small beam emittance and momentum spread, provides a highly efficient beam delivery. During the technical commissioning, treatment plans were created to deliver uniform maps at various energies to perform Gamma Index analysis. EBT3 Gafchromic films were irradiated using the Planned irradiation maps. Bragg Peak chamber was used to test the dynamic range during a scan in one layer for high (250 MeV) and Low (70 MeV) energies. The maximum and minimum range, range adjustment and modulation, distal dose falloff (80%–20%), pencil beam spot size, spot placement accuracy were also measured. The accuracy testing included acquiring images, image registration, receiving correction vectors and applying the corrections to the robotic patient positioner. Results: Gamma Index analysis of the Treatment Planning System (TPS) data vs. Measured data showed more than 90% of points within (3%, 3mm) for the maps created by the TPS. At Isocenter Beam Size (One sigma) < 3mm at highest energy (250 MeV) in air. Beam delivery was within 0.6 mm of the intended target at the entrance and the exit of the beam, through the phantom. Conclusion: The Radiance 330 Beam Performance Measurements have confirmed that the system operates as designed with excellent clinical performance specifications. Hovakim Nazaryan, Vahagn Nazaryan and Fuhua Wang are employees of ProTom International, Inc. who contributed to the development and completed the technical commissioning of the Radiance 330 proton therapy delivery system manufactured by ProTom International.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-494: A MOSFET-Based In-Vivo Dosimetry System for MR Image-Guided Radiation Therapy (MR-IGRT)

Purpose: To determine if a MOSFET based in-vivo dosimetry system can be used for patients undergoing MR-IGRT. Methods: Standard and high sensitivity MOSFET detectors were used for in-field and out-of-field measurements respectively. The systems were benchmarked and calibrated against a calibrated ionization chamber on a standard 6 MV linear accelerator, and then on the MR-IGRT system. Known doses were delivered to a water phantom with the MOSFETs placed between the top of the phantom and underneath a layer of bolus and water equivalent plastic, using a 6 MV beam and a {sup 6} {sup 0}Co MR-IGRT beam. The latter was performed with and without real-time MRI-guidance during the beam delivery (MRIGRT). Results: The in-field dosimeter response was linear from 50-500 cGy with little evidence of energy dependence or change in response due to the permanent static magnetic field of the MR-IGRT system. The detector response varied by < 2% between 6 MV and {sup 6} {sup 0}Co without image guided delivery. The out-of-field dosimeter response was linear from 1-50 cGy; however the detectors did display dose rate and energy dependence as the response varied by > 20% depending on distance from isocenter used during calibration. Therefore, to use the dosimeters for out-of-field measurements they must be calibrated out-of-field. Regardless of the detector orientation in the coronal plan, the response of the MOSFETs during MRI-guided delivery increased by 5% due to induced currents from the dynamic magnetic field present with image guidance. During the MRI-guided delivery, some loss in image quality was seen when the MOSFETs were present in the imaging plane. This was mitigated by using a handheld reader without a transmitting wireless receiver. Conclusion: A MOSFET-based in-vivo dosimetry system can be used for patients receiving MR-IGRT; however the change in detector response due to the dynamic magnetic field requires a special calibration.

07 ISOTOPE AND RADIATION SOURCES↗
DOE OSTI2014

SU-E-T-508: End to End Testing of a Prototype Eclipse Module for Planning Modulated Arc Therapy On the Siemens Platform

Purpose: The latest clinical implementation of the Siemens Artiste linac allows for delivery of modulated arcs (mARC) using full-field flattening filter free (FFF) photon beams. The maximum doserate of 2000 MU/min is well suited for high dose treatments such as SBRT. We tested and report on the performance of a prototype Eclipse TPS module supporting mARC capability on the Artiste platform. Method: our spine SBRT patients originally treated with 12/13 field static-gantry IMRT (SGIMRT) were chosen for this study. These plans were designed to satisfy RTOG0631 guidelines with a prescription of 16Gy in a single fraction. The cases were re-planned as mARC plans in the prototype Eclipse module using the 7MV FFF beam and required to satisfy RTOG0631 requirements. All plans were transferred from Eclipse, delivered on a Siemens Artiste linac and dose-validated using the Delta4 system. Results: All treatment plans were straightforwardly developed, in timely fashion, without challenge or inefficiency using the prototype module. Due to the limited number of segments in a single arc, mARC plans required 2-3 full arcs to yield plan quality comparable to SGIMRT plans containing over 250 total segments. The average (3%/3mm) gamma pass-rate for all arcs was 98.5±1.1%, thus demonstrating both excellent dose prediction by the AAA dose algorithm and excellent delivery fidelity. Mean delivery times for the mARC plans(10.5±1.7min) were 50-70% lower than the SGIMRT plans(26±2min), with both delivered at 2000 MU/min. Conclusion: A prototype Eclipse module capable of planning for Burst Mode modulated arc delivery on the Artiste platform has been tested and found to perform efficiently and accurately for treatment plan development and delivered-dose prediction. Further investigation of more treatment sites is being carried out and data will be presented.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-541: Bolus Effect of Thermoplastic Masks in IMRT and VMAT Head and Neck Treatments

Purpose: To quantitatively evaluate the bolus effect of thermoplalstic mask on patient skin dose during multi-field IMRT and VMAT treatment. Methods: The clinically approved target contours for five head and neck patients were deformably registered to an anthropomorphic Rando phantom. Two plans: Multifield IMRT plan with 7-9 beams and VMAT plan with 2-4 arcs were created for each patient following same dose constraints. 3mm skin was excluded from PTVs but not constrained during optimization. The prescription dose was 200-220 cGy/fraction. A thermoplastic head and shoulder mask was customized for the Rando phantom. Each plan was delivered to the phantom twice with and without mask. During each delivery, two rectangular strips of EBT3 films (1cm x 6.8cm) were placed across the anterior upper and lower neck near PTVs to measure the surface dose. For consistency films were positioned at same locations for same patient. A total of 8 film strips were obtained for each patient. Film dose was calibrated in the range of 0-400cGy on the day of plan delivery. For dose comparison 3 regions of interests (ROIs) of 1×1 cm{sup 2} were selected at left, right and middle part of each film, resulting in 6 point doses at each plan delivery. Results: The films without mask show relatively uniform dose distribution while those with mask clearly show mesh pattern of mask, usually indicating an increase in skin dose. On average the increase in skin dose over all ROIs with mask was 31.9%(±14.8%) with a range of 11.4%- 58.4%. There is no statistically significant difference (p=0.44) between skin dose increase in VMAT (30.8%±15.3%) and IMRT delivery (33.0%±14.9%). Conclusion: Thermoplastic immobilization masks increase surface dose for HN patient by around 30%. The magnitude is comparable between multi-field IMRT and VMAT. Radiochromic EBT3 film serves as an effective tool to quantify bolus effect.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

TH-E-BRE-05: Analysis of Dosimetric Characteristics in Two Leaf Motion Calculator Algorithms for Sliding Window IMRT

Purpose: The Smart leaf motion calculator (SLMC) in Eclipse treatment planning system is an advanced fluence delivery modeling algorithm as it takes into account fine MLC features including inter-leaf leakage, rounded leaf tips, non-uniform leaf thickness, and the spindle cavity etc. In this study, SLMC and traditional Varian LMC (VLMC) algorithms were investigated, for the first time, in dosimetric characteristics and delivery accuracy of sliding window (SW) IMRT. Methods: The SW IMRT plans of 51 cancer cases were included to evaluate dosimetric characteristics and dose delivery accuracy from leaf motion calculated by SLMC and VLMC, respectively. All plans were delivered using a Varian TrueBeam Linac. The DVH and MUs of the plans were analyzed. Three patient specific QA tools - independent dose calculation software IMSure, Delta4 phantom, and EPID portal dosimetry were also used to measure the delivered dose distribution. Results: Significant differences in the MUs were observed between the two LMCs (p≤0.001).Gamma analysis shows an excellent agreement between the planned dose distribution calculated by both LMC algorithms and delivered dose distribution measured by three QA tools in all plans at 3%/3 mm, leading to a mean pass rate exceeding 97%. The mean fraction of pixels with gamma < 1 of SLMC is slightly lower than that of VLMC in the IMSure and Delta4 results, but higher in portal dosimetry (the highest spatial resolution), especially in complex cases such as nasopharynx. Conclusion: The study suggests that the two LMCs generates the similar target coverage and sparing patterns of critical structures. However, SLMC is modestly more accurate than VLMC in modeling advanced MLC features, which may lead to a more accurate dose delivery in SW IMRT. Current clinical QA tools might not be specific enough to differentiate the dosimetric discrepancies at the millimeter level calculated by these two LMC algorithms. NIH/NIGMS grant U54 GM104944, Lincy Endowed Assistant Professorship.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

The evaluation of a 2D diode array in “magic phantom” for use in high dose rate brachytherapy pretreatment quality assurance

Purpose: High dose rate (HDR) brachytherapy is a treatment method that is used increasingly worldwide. The development of a sound quality assurance program for the verification of treatment deliveries can be challenging due to the high source activity utilized and the need for precise measurements of dwell positions and times. This paper describes the application of a novel phantom, based on a 2D 11 × 11 diode array detection system, named “magic phantom” (MPh), to accurately measure plan dwell positions and times, compare them directly to the treatment plan, determine errors in treatment delivery, and calculate absorbed dose. Methods: The magic phantom system was CT scanned and a 20 catheter plan was generated to simulate a nonspecific treatment scenario. This plan was delivered to the MPh and, using a custom developed software suite, the dwell positions and times were measured and compared to the plan. The original plan was also modified, with changes not disclosed to the primary authors, and measured again using the device and software to determine the modifications. A new metric, the “position–time gamma index,” was developed to quantify the quality of a treatment delivery when compared to the treatment plan. The MPh was evaluated to determine the minimum measurable dwell time and step size. The incorporation of the TG-43U1 formalism directly into the software allows for dose calculations to be made based on the measured plan. The estimated dose distributions calculated by the software were compared to the treatment plan and to calibrated EBT3 film, using the 2D gamma analysis method. Results: For the original plan, the magic phantom system was capable of measuring all dwell points and dwell times and the majority were found to be within 0.93 mm and 0.25 s, respectively, from the plan. By measuring the altered plan and comparing it to the unmodified treatment plan, the use of the position–time gamma index showed that all modifications made could be readily detected. The MPh was able to measure dwell times down to 0.067 ± 0.001 s and planned dwell positions separated by 1 mm. The dose calculation carried out by the MPh software was found to be in agreement with values calculated by the treatment planning system within 0.75%. Using the 2D gamma index, the dose map of the MPh plane and measured EBT3 were found to have a pass rate of over 95% when compared to the original plan. Conclusions: The application of this magic phantom quality assurance system to HDR brachytherapy has demonstrated promising ability to perform the verification of treatment plans, based upon the measured dwell positions and times. The introduction of the quantitative position–time gamma index allows for direct comparison of measured parameters against the plan and could be used prior to patient treatment to ensure accurate delivery.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

Time-resolved dosimetry using a pinpoint ionization chamber as quality assurance for IMRT and VMAT

Purpose: To develop a method to verify the dose delivery in relation to the individual control points of intensity modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT) using an ionization chamber. In addition to more effective problem solving during patient-specific quality assurance (QA), the aim is to eventually map out the limitations in the treatment chain and enable a targeted improvement of the treatment technique in an efficient way. Methods: Pretreatment verification was carried out for 255 treatment plans that included a broad range of treatment indications in two departments using the equipment of different vendors. In-house developed software was used to enable calculation of the dose delivery for the individual beamlets in the treatment planning system (TPS), for data acquisition, and for analysis of the data. The observed deviations were related to various delivery and measurement parameters such as gantry angle, field size, and the position of the detector with respect to the field edge to distinguish between error sources. Results: The average deviation of the integral fraction dose during pretreatment verification of the planning target volume dose was −2.1% ± 2.2% (1 SD), −1.7% ± 1.7% (1 SD), and 0.0% ± 1.3% (1 SD) for IMRT at the Radboud University Medical Center (RUMC), VMAT (RUMC), and VMAT at the Wellington Blood and Cancer Centre, respectively. Verification of the dose to organs at risk gave very similar results but was generally subject to a larger measurement uncertainty due to the position of the detector at a high dose gradient. The observed deviations could be related to limitations of the TPS beam models, attenuation of the treatment couch, as well as measurement errors. The apparent systematic error of about −2% in the average deviation of the integral fraction dose in the RUMC results could be explained by the limitations of the TPS beam model in the calculation of the beam penumbra. Conclusions: This study showed that time-resolved dosimetry using an ionization chamber is feasible and can be largely automated which limits the required additional time compared to integrated dose measurements. It provides a unique QA method which enables identification and quantification of the contribution of various error sources during IMRT and VMAT delivery.

60 APPLIED LIFE SCIENCES↗