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DOE OSTI2014

SU-E-T-575: Isocenter Shifts in Treatment Planning and Its Clinical Implications

Purpose: To investigate causes of isocenter shifts in treatment planning and its clinical impact on patient treatment efficiency and safety. Methods/Materials: Treatment planning data of 340 patients under treatment over 8 weeks period were gathered to identify isocenter shifts according to site of the treatment, types of treatment plan or types of the machine used. Treatment plans included inversed and forward IMRT, as well as 3D plans. Treatment sites included pelvis, chest, abdomen, breasts, head and necks and extremities. Re-planning were performed without the isocenter shift for pelvis and chest plans, the dosimetric parameters such as PTV coverage, and dose sparing of OARs of these plans were analyzed and compared. Results/Discussions: Results showed that the isocenter shift was always necessary for some of sites such as breasts, two or more distinctive PTVs, or special cases such as large PTV treated with enhanced dynamic wedge. Many other cases, the re-planning results indicated 53% of the plans that the same quality of the plan can be achieved without the shift of the isocenter. Repositioning patients on a daily basis demanded unambiguous instructions for therapists for patient setups, and additional time to perform the shifts before treatment. Opportunities for error propagation exist during the communication and hand-over of such plans. Conclusion: Isocenter shifts demanded unambiguous instructions and times for therapists for daily patient setups, therefore it impacted both safety and efficiency of the patient treatment. Based on the analysis, the isocenter shifts were unavoidable for cases such as treatment of multiple sites, overcoming limitations of treatment machines, and/or sometime better dosimetry. However, we found many initially proposed shifts may have been eliminated either by careful planning or by improved CT simulation process such as detailed review of the images and localization of the PTV during simulation.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-590: An Activation Study of Materials and Devices Present in a Proton Treatment Room

Purpose: The use of protons for radiation therapy is growing rapidly. One consequence of protons interacting with different media is activation. These nuclear reactions induced by the protons, scattered neutrons, and gamma rays, activate different materials encountered, particularly by the therapists. The purpose of this study was to examine the derived nuclides from the activation, and also the decay rate. Methods: The study was conducted in our proton therapy facility. Protons are derived from a synchrocyclotron and pass through field shipping systems, apertures, and range compensators to define the beam within the patient.Included materials of concerns measured; the patient support couch, sheet rock in the wall, solid plastics used for quality assurance and dosimetry, and the passive scattering system itself, which includes brass apertures, and Lucite or blue wax compensators. All devices were studied post irradiation using gamma spectroscopy to determine the nuclides, and a sodium iodine scintillation detector to measure decay, particularly when the dose rate fell to background levels. Results: We have also determined from the measurements we will maintain brass apertures for three months before sending them for scrap. Some of the radionuclides arrived from these measurements included Na-22 for the blue wax compensator, C1-34m for the sheetrock, and Sc-44 and Co-60 for the brass apertures. We found compensators made out of Lucite or wax decayed to background in 2 hours. The patient support couch decayed to background in approximately 40 minutes, and sheet rock decayed in 80 minutes. In terms of the aperture layers, the most proximal aperture slab had much higher activity than the distal slab. Also the proximal sides of the slabs were much more activate than the distal. Conclusion: We have given proper instruction to therapists performing quality assurance in terms of the handled plastics, and to handle apertures rapidly as possible.

07 ISOTOPE AND RADIATION SOURCES↗
DOE OSTI2014

SU-E-T-634: Analysis of Volume Based GYN HDR Brachytherapy Plans for Dose Calculation to Organs At Risk(OAR)

Purpose: We have analyzed the dose volume histogram of 140 CT based HDR brachytherapy plans and evaluated the dose received to OAR ; rectum, bladder and sigmoid colon based on recommendations from ICRU and Image guided brachytherapy working group for cervical cancer . Methods: Our treatment protocol consist of XRT to whole pelvis with 45 Gy at 1.8Gy/fraction followed by 30 Gy at 6 Gy per fraction by HDR brachytherapy in 2 weeks . The CT compatible tandem and ovoid applicators were used and stabilized with radio opaque packing material. The patient was stabilized using special re-locatable implant table and stirrups for reproducibility of the geometry during treatment. The CT scan images were taken at 3mm slice thickness and exported to the treatment planning computer. The OAR structures, bladder, rectum and sigmoid colon were outlined on the images along with the applicators. The prescription dose was targeted to A left and A right as defined in Manchester system and optimized on geometry . The dosimetry was compared on all plans using the parameter Ci.sec.cGy-1 . Using the Dose Volume Histogram (DVH) obtained from the plans the doses to rectum, sigmoid colon and bladder for ICRU defined points and 2cc volume were analyzed and reported. The following criteria were used for limiting the tolerance dose by volume (D2cc) were calculated. The rectum and sigmoid colon doses were limited to <75Gy. The bladder dose was limited to < 90Gy from both XRT and HDR brachytherapy. Results: The average total (XRT+HDRBT) BED values to prescription volume was 120 Gy. Dose 2cc to rectum was 70Gy +/− 17Gy, dose to 2cc bladder was 82+/−32 Gy. The average Ci.sec.cGy-1 calculated for the HDR plans was 6.99 +/− 0.5 Conclusion: The image based treatment planning enabled to evaluati volume based dose to critical structures for clinical interpretation.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-CAMPUS-I-03: Dosimetric Comparison of the Hypoxia Agent Iodoazomycin Arabinoside (IAZA) Labeled with the Radioisotopes I-123, I-131 and I-124

Purpose: To compare the radiation dose to normal organs from the radio-iodinated, hypoxia-binding radiosensitizer iodoazomycin arabinoside (IAZA) for three different isotopes of iodine. Methods: Dosimety studies with normal volunteers had been carried out with [{sup 123}I]IAZA, a drug binding selectively to hypoxic sites. Two other isotopes of iodine, {sup 131}I and {sup 124}I, offer the opportunity to use IAZA as an agent for radioisotope therapy and as an imaging tracer for Positron Emission Tomography. Radioisotope dosimetry for {sup 131}I and {sup 124}I was performed by first deriving from the [{sup 123}I]IAZA studies biological uptake and excretion data. The cumulated activities for {sup 131}I or {sup 124}I where obtained by including their half-lives when integrating the biological data and then extrapolating to infinite time points considering a) physical decay only or b) physical and biological excretion. Doses were calculated using the Medical Internal Radiation Dose (MIRD) schema (OLINDA1.1 code, Vanderbilt 2007). Results: Compared to {sup 123}I, organ doses were elevated on average by a factor 6 and 9 for {sup 131}I and {sup 124}I, respectively, if both physical decay and biological excretion were modeled. If only physical decay is considered, doses increase by a factor 18 ({sup 131}I) and 19 ({sup 124}I). Highest organ doses were observed in intestinal walls, urinary bladder and thyroid. Effective doses increased by a factor 11 and 14 for {sup 131}I and {sup 124}I, respectively, if biological and physical decay are present. Purely physical decay yields a 23-fold increase over {sup 123}I for both, {sup 131}I and {sup 124}I. Conclusion: Owing to the significant dose increase, caused by their longer half life and the approximately 10 times larger electronic dose deposited in tissue per nuclear decay, normal tissue doses of IAZA labeled with {sup 131}I and {sup 124}I need to be carefully considered when designing imaging and therapy protocols for clinical trials. Effective blocking of iodine uptake in the thyroid is essential. Alberta Innovates - Health Solutions (AIHS) and Canadian Institutes of Health Research (CIHR)

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-F-19A-07: Is a Day30 Scan Necessary to Evaluate Activity-Based Regulatory Compliance in Permanent Interstitial Brachytherapy for Prostate Cancer?

Purpose: To evaluate the Medical Event (ME) criteria for I-125 prostate implants based on the assessment of post implant dosimetry on “Day0”/“Day30” imaging. The new ME criteria do not mandate a timeframe for this assessment. The compliance criteria are: more than 80% of the activity from the written directive for treatment site (TS) must be implanted inside TS, and doses to 1cc of either uninvolved rectum (D1-UR) or uninvolved bladder (D1-UB), or 2cc of other non-specified tissue (D2-UT) must be less than 150% of the planned dose. Methods: “Day0”/“Day30” post-implant analyses for 25 patients were evaluated. Treatment plans had a peripheral loading pattern with 2 core needles placed at least 10 mm away from urethra, with several seeds planned outside of the prostate for adequate target coverage. TS were a uniform 5 mm expansion of the prostate, except posteriorly (no expansion). Results: “Day0”/“Day30”analyses found no MEs. The relative changes for D1-UR, D1-UB, and D2-UT were (ranges): [−37.0, 38.2]%, [−96.5, 74.7]%, and [−41.2, 37.7]%. Furthermore, changes did not correlate with prostate volume changes of −18.7% [σ:16.0%, range:−60.5%, +6.4%]. These unfavorable changes did not lead to ME at “Day30” because these values were generally well below 150% at “Day0”. However, D2-UT dose values exceeded those for D1-UR and D1-UB at both “Day0”/“Day30”. Conclusion: The total activity was relatively insensitive to changes in target volume from “Day0” to ”Day30”. The dose metrics of interest, albeit susceptible to large, often unfavorable changes, remained less than the 150% threshold. Data from this study suggest that “Day0” can be used for the regulatory compliance evaluation. However, further evaluation at “Day30” is advisable if D2-UT is 110% or above (based on the largest D2-UT increase of 37.7% observed in this patient population). Future rigorous statistical analysis of a larger cohort will afford a refinement of this recommendation.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-F-BRE-02: Characterization of a New Commercial Single Crystal Diamond Detector in Photon, Electron and Proton Beams

Purpose: Diamond detectors even with superior characteristics have become obsolete due to poor design, selection of crystal and cost. Recently, microDiamond using synthetic single crystal diamond detector (SCDD) is commercially available which is characterized in various radiation beams in this study. Methods: The characteristics of a commercial SCDD model 60019 (PTW) to a 6- and 15-MV photon beams, 6- and 20-MeV electron beams, and 208 MeV proton beams were investigated and compared to the pre-characterized detectors: TN31010 (0.125 cm{sup 3}) and TN30006 (pinpoint) ionization chambers (PTW), EDGE detector (Sun Nuclear Corp), and SFD Stereotactic Dosimetry Diode Detector (IBA). The depth-dose and profiles data were collected for various field sizes and depths. The dose linearity and dose rate dependency were also evaluated. To evaluate the effects of the preirradiation, the diamond detector which had not been irradiated on the day was set up in the water tank and the response to 100 MU was measured every 20 s. The temperature dependency was tested for the range of 4–60 °C. Angular dependency was evaluated in water phantom by rotating the SCDD. Results: For all radiation types and field sizes, the depth-dose data of the diamond chamber showed identical curve to those of ionization chambers. The profile of the diamond detector was very similar to those of the Edge and SFD detectors, although the 0.125 cm{sup 3} and pinpoint chambers showed averaging effects in the penumbrae region. The temperature dependency was within 0.7% in the range of 4–41°C. A dose of 900 cGy and 1200 cGy were needed to stabilize the chamber to the level within 0.5% and 0.2%, respectively. Conclusion: The type 60019 SCDD detector showed suitable characteristics for depth-dose and profile measurements for wide range of field sizes. However, at least 1000 cGy of pre-irradiation is needed for accurate measurements.

07 ISOTOPE AND RADIATION SOURCES↗
DOE OSTI2014

SU-F-BRE-03: Consideration of a Track-Interaction Model for Radiochromic Film Response

Purpose: Conventional methods for characterizing the energy response of radiochromic film (RCF) typically involve assessing changes in response when exposed to various beam qualities and use Monte Carlo to determine absorbed dose. These methods represent RCF as a dose integrator of a homogeneous energy deposition volume. Apparent film saturation, nonlinearity, and intrinsic energy dependence are unpredicted with conventional methods. Recent work has shown significant RCF intrinsic energy dependence, which limits its use in absolute dosimetry. This work introduces a track-interaction model (TIM) for RCF and assesses its ability to predict total energy response. Methods: A TIM based on Katz single-hit theory was developed to accumulate energy flux along particle tracks within active crystals, represented as (1×1×20)um{sup 3} prisms about the Gafchromic™ EBT3 active volume using MCNP5 and Matlab. Energy flux contributed to film response only if near the threshold energy for polymerization in polydiacetylenes (2.5eV/monomer). Energy deposition in excess of maximum efficiency represented crystal saturation and did not contribute to film response. The TIM was applied to RCF exposed in air to various monoenergetic photon beams and Co-60. Geometric distribution of energy flux was found for each beam quality in a (1×1)mm{sup 2} RCF area. RCF response relative to Co-60 absorbed dose-to-water (S-TIM) was determined and compared to published values (S-PUB). Results: TIM successfully predicted that lower energy radiation is less effective at inducing polymerization, though the magnitude of the phenomenon was overpredicted. S-TIM was −29% and +20% for 20 and 40 keV, respectively. This agreed qualitatively with S-PUB of −27% and +16%. TIM-generated sensitometric curves contained the non-linearity and saturation apparent in RCF. Conclusion: This work indicates the possibility for TIMs to predict changes in RCF response to various energies. Future work will refine TIM by considering size distributions of active elements, other RCF formulations, and response in complex treatment fields. Acknowledgements: The authors wish to thank Dr. Christopher Soares at NIST (Gaithersburg, MD) for performing film measurements and Dr. David Lewis of Ashland, Inc. (Wayne, NJ) for making the EBT3 film available to us.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗
DOE OSTI2014

SU-F-BRD-06: Dosimetric Cost of a GTV Margin for Simultaneous Integrated Intra- Prostatic Boost Treatments

Purpose: Quantify the dosimetric cost for a margin around the MRI-defined high risk GTV for simultaneous integrated intra-prostatic boosts (SIIB) treated with RapidArc. Methods: For external beam radiotherapy of the prostate, a 3-7 mm PTV margin is typically used to account for setup and intra-fraction uncertainties after adjusting for inter-fraction motion. On the other hand, our current paradigm is to treat the MRI-defined high risk GTV with no margin. In this work, 11 patients treated SIIB (7 post-prostatectomy, 4 intact prostate) with RapidArc were re-planned with 1-5 mm margins around the GTV to quantify dosimetric effects. Two 358 degree, 10 MV RapidArcs were used to deliver 68 Gy (76.5 Gy boost) to the post-prostatectomy patients and 80 Gy (86 Gy boost) to the intact prostates. Paired, two tail t-tests were used to determine if there were any significant differences (p<0.05) in the total MUs and dosimetric parameters used to evaluate rectum, bladder, and PTV dose with and without margin. Results: The average GTV volume without margin was 8.1cc (2.8% of the PTV volume) while the average GTV volume with a 5 mm margin was 20.1cc (9.0% of the PTV volume). GTV volumes ranged from 0.2% of the PTV volume up to 33.0%. Despite these changes in volume, the only statistical difference was found for the rectal V65 Gy with a 5 mm margin (18.6% vs. 19.4%; p-value = 0.026) when all patients were considered as a single group. No difference was found when analyzed as two groups. The rectum V40Gy, bladder V40Gy and V65Gy, PTV Dmax and D95% or the total MUs did not show any significant difference for any margin. Conclusion: A 4 mm margin on the high risk GTV is possible with no statistically significant change in dosimetry or total MUs. Further work will assess the appropriate margin required for intra-prostatic boosts.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-F-18C-12: On the Relationship of the Weighted Dose to the Surface Dose In Abdominal CT - Patient Size Dependency

Purpose: It is possible to measure the patient surface dose non-invasively using radiolucent dosimeters. However, the patient size specific weighted dose remains unknown. We attempted to study the weighted dose to surface dose relationship as the patient size varies in abdominal CT. Methods: Seven abdomen phantoms (CIRS TE series) simulating patients from an infant to a large adult were used. Size specific doses were measured with a 100 mm CT chamber under axial scans using a Siemens Sensation 64 (mCT) and a GE 750 HD. The scanner settings were 120 kVp, 200 mAs with fully opened collimations. Additional kVps (80, 100, 140) were added depending on the phantom sizes. The ratios (r) of the weighted CT dose (Dw) to the surface dose (Ds) were related to the phantom size (L) defined as the diameter resulting the equivalent cross-sectional area. Results: The Dw versus Ds ratio (r) was fitted to a linear relationship: r = 1.083 − 0.007L (R square = 0.995), and r = 1.064 − 0.007L (R square = 0.953), for Siemens Sensation 64 and GE 750 HD, respectively. The relationship appears to be independent of the scanner specifics. Conclusion: The surface dose to the weighted dose ratio decreases linearly as the patient size increases. The result is independent of the scanner specifics. The result can be used to obtain in vivo CT dosimetry in abdominal CT.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

MO-E-BRE-01: Determination, Minimization and Communication of Uncertainties in Radiation Therapy

Medical Physicists have a general understanding of uncertainties in the radiation treatment process, both with respect to dosimetry and geometry. However, there is a desire to be more quantitative about uncertainty estimation. A recent International Atomic Energy Agency (IAEA) report (about to be published) recommends that we should be as “accurate as reasonably achievable, technical and biological factors being taken into account”. Thus, a single recommendation as a goal for accuracy in radiation therapy is an oversimplification. That report also suggests that individual clinics should determine their own level of uncertainties for their specific treatment protocols. The question is “how do we implement this in clinical practice”? AAPM Monograph 35 (2011 AAPM Summer School) addressed many specific aspects of uncertainties in each of the steps of a course of radiation treatment. The intent of this symposium is: (1) to review uncertainty considerations in the entire radiation treatment process including uncertainty determination for each step and uncertainty propagation for the total process, (2) to consider aspects of robust optimization which optimizes treatment plans while protecting them against uncertainties, and (3) to describe various methods of displaying uncertainties and communicating uncertainties to the relevant professionals. While the theoretical and research aspects will also be described, the emphasis will be on the practical considerations for the medical physicist in clinical practice. Learning Objectives: To review uncertainty determination in the overall radiation treatment process. To consider uncertainty modeling and uncertainty propagation. To highlight the basic ideas and clinical potential of robust optimization procedures to generate optimal treatment plans that are not severely affected by uncertainties. To describe methods of uncertainty communication and display.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

MO-G-17A-04: Internal Dosimetric Calculations for Pediatric Nuclear Imaging Applications, Using Monte Carlo Simulations and High-Resolution Pediatric Computational Models

Purpose: Our purpose is to evaluate the administered absorbed dose in pediatric, nuclear imaging studies. Monte Carlo simulations with the incorporation of pediatric computational models can serve as reference for the accurate determination of absorbed dose. The procedure of the calculated dosimetric factors is described, while a dataset of reference doses is created. Methods: Realistic simulations were executed using the GATE toolkit and a series of pediatric computational models, developed by the “IT'IS Foundation”. The series of the phantoms used in our work includes 6 models in the range of 5–14 years old (3 boys and 3 girls). Pre-processing techniques were applied to the images, to incorporate the phantoms in GATE simulations. The resolution of the phantoms was set to 2 mm3. The most important organ densities were simulated according to the GATE “Materials Database”. Several used radiopharmaceuticals in SPECT and PET applications are being tested, following the EANM pediatric dosage protocol. The biodistributions of the several isotopes used as activity maps in the simulations, were derived by the literature. Results: Initial results of absorbed dose per organ (mGy) are presented in a 5 years old girl from the whole body exposure to 99mTc - SestaMIBI, 30 minutes after administration. Heart, kidney, liver, ovary, pancreas and brain are the most critical organs, in which the S-factors are calculated. The statistical uncertainty in the simulation procedure was kept lower than 5%. The Sfactors for each target organ are calculated in Gy/(MBq*sec) with highest dose being absorbed in kidneys and pancreas (9.29*10{sup 10} and 0.15*10{sup 10} respectively). Conclusion: An approach for the accurate dosimetry on pediatric models is presented, creating a reference dosage dataset for several radionuclides in children computational models with the advantages of MC techniques. Our study is ongoing, extending our investigation to other reference models and evaluating the results with clinical estimated doses.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

TU-C-17A-05: Dose Domain Optimization of MLC Leaf Patterns for Highly Complicated 4Ï€ IMRT Plans

Purpose: Highly conformal non-coplanar 4π radiotherapy plans typically require more than 20 intensity-modulated fields to deliver. A novel method to calculate multileaf collimator (MLC) leaf patterns is introduced to maximize delivery efficiency, accuracy and plan quality. Methods: 4 GBM patients, with a prescription dose of 59.4 Gy or 60 Gy, were evaluated using the 4π algorithm using 20 beams. The MLC calculation utilized a least square minimization of the dose distribution, with an anisotropic total variation regularization term to encourage piecewise continuity in the fluence maps. Transforming the fluence to the dose domain required multiplying the fluence with a sparse matrix. Exploiting this property made it feasible to solve the problem using CVX, a MATLAB-based convex modeling framework. The fluence was stratified into even step sizes, and the MLC segments, limited to 300, were calculated. The patients studied were replanned using Eclipse with the same beam angles. Results: Compared to the original 4π plan, the stratified 4π plan increased the maximum/mean dose for, in Gy, by 1.0/0.0 (brainstem), 0.5/0.2 (chiasm), 0.0/0.0 (spinal cord), 1.9/0.3 (L eye), 0.7/0.2 (R eye), 0.4/0.4 (L lens), 0.3/0.3 (R lens), 1.0/0.8 (L Optical Nerve), 0.5/0.3 (R Optical Nerve), 0.3/0.2 (L Cochlea), 0.1/0.1 (R Cochlea), 4.6/0.2 (brain), 2.4/0.1 (brain-PTV), 5.1/0.9 (PTV). Compared to Eclipse, which generated an average of 607 segments, the stratified plan reduced (−) or increased (+) the maximum/mean dose, in Gy, by −10.2/−4.1 (brainstem), −10.5/−8.9 (chiasm), +0.0/−0.1 (spinal cord), −4.9/−3.4 (L eye), −4.1/−2.5 (R eye), −2.8/−2.7 (L lens), −2.1/−1.9 (R lens), −7.6/−6.5 (L Optical Nerve), −8.9/−6.1 (R Optical Nerve), −1.3/−1.9 (L Cochlea), −1.8/−1.8 (R Cochlea), +1.7/−2.1 (brain), +3.2/−2.6 (brain-PTV), +1.8/+0.3 Gy (PTV. The stratified plan was also more homogeneous in the PTV. Conclusion: This novel solver can transform complicated fluence maps into significantly fewer deliverable MLC segments than the commercial system while achieving superior dosimetry. Funding support partially contributed by Varian.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

TU-F-BRE-03: Application of a Novel Mass-Density Compensation Optimization Method to Improve the Response of a Liquid-Filled Ionization Chamber in Nonstandard Fields

Purpose: To improve the response of the microLion detector (PTW 31018) in small field conditions by optimizing the density of the detector's non-sensitive components using a novel method based on the detector's dose response function. Methods: The central values h(0,0) of the perturbation functions for the microLion detector and a volume of water equivalent to its sensitive volume were calculated using the Monte Carlo user code egs-chamber by scoring the dose absorbed by a 6 MV photon pencil beam incident on their centroids. Values of h(0,0) were plotted as a function of the density of the microLion's graphite electrode with the detector placed in the axial orientation. The optimized density was found by finding the minimal value of h(0,0). Results: A density of 1.37 g/cm3 was found to minimize the perturbation function of the microLion detector. The modified microLion's response was then evaluated in small square fields with sides in the range of 5 – 40 mm and found to be consistent with highly watere-quivalent detectors such as a scintillating detector (Exradin W1) and a generic alanine detector in both axial and radial orientations. Conclusion: This work illustrates a novel method which can used to optimize the design of radiation detectors in small fields. This method should also work with other optimization parameters (e.g. thickness of electrode). Density-compensated detectors have the potential to eliminate the need to evaluate nonstandard field correction factors as described by the IAEA-AAPM formalism (Alfonso et al.) and simplify future dosimetry protocols for SRS/SBRT modalities. Finally, we also expect an improvement in the response of density-compensated detectors for composite IMRT fields.

07 ISOTOPE AND RADIATION SOURCES↗
DOE OSTI2014

TU-F-BRE-06: Flattening-Filter-Free Beam Quality Correction Factor Determination Using Experimental and Monte Carlo Methods

Purpose: To investigate beam quality correction factors for the flattening-filter-free (FFF) energies of the TrueBeam™ accelerator based on a dosimetry formalism for small and nonstandard fields. Methods: Three detectors - an Exradin W1 scintillator, Sun Nuclear EDGE diode, and LiF(Mg,Tl) TLD-100 chips - were investigated to determine their applicability as tools to measure quality correction factors for ionization chambers in the small and nonstandard fields of the TrueBeam™. Volume-averaging effects and energy dependence were observed in fields ranging from 1×1 to 40×40 cm{sup 2} for 6 MV and 10 MV beam energies using both FFF and flattened beam modes. Correction factors were determined for three ionization chambers: an Exradin A12 Farmer-type chamber, an Exradin A1SL scanning chamber, and an Exradin A26 reference-class microchamber. Beam quality corrections were also obtained using a benchmarked model of the TrueBeam™ created with the BEAMnrc user code of EGSnrc. Results: All three detectors demonstrated measureable energy dependence in the megavoltage range. The EDGE diode was deemed the most appropriate tool for beam quality correction factor measurements due to its low energy dependence and small size; however, alanine will be used in the future to reduce energy dependent effects even further. Measured k{sub Qmsr,Q} corrections of up to 4% were found for the 6MV FFF and 10 MV FFF beams, corresponding to a discrepancy of up to 3% compared to TG-51-determined dose. Up to a 10% k{sub Qclin,Qmsr} correction was measured for small fields referenced to a 10×10 cm{sup 2} field of the same energy. Much larger corrections were determined using the Monte Carlo model, and these discrepancies require further investigation. Conclusion: Progress has been made toward determining beam quality correction factors for the small and nonstandard fields of the TrueBeam™ accelerator. Further work must be done to ensure greater accuracy in patient treatments with this new modality.

07 ISOTOPE AND RADIATION SOURCES↗
DOE OSTI2014

WE-A-BRE-01: Debate: To Measure or Not to Measure

Recent studies have highlighted some of the limitations of patient-specific pre-treatment IMRT QA measurements with respect to assessing plan deliverability. Pre-treatment QA measurements are frequently performed with detectors in phantoms that do not involve any patient heterogeneities or with an EPID without a phantom. Other techniques have been developed where measurement results are used to recalculate the patient-specific dose volume histograms. Measurements continue to play a fundamental role in understanding the initial and continued performance of treatment planning and delivery systems. Less attention has been focused on the role of computational techniques in a QA program such as calculation with independent dose calculation algorithms or recalculation of the delivery with machine log files or EPID measurements. This session will explore the role of pre-treatment measurements compared to other methods such as computational and transit dosimetry techniques. Efficiency and practicality of the two approaches will also be presented and debated. The speakers will present a history of IMRT quality assurance and debate each other regarding which types of techniques are needed today and for future quality assurance. Examples will be shared of situations where overall quality needed to be assessed with calculation techniques in addition to measurements. Elements where measurements continue to be crucial such as for a thorough end-to-end test involving measurement will be discussed. Operational details that can reduce the gamma tool effectiveness and accuracy for patient-specific pre-treatment IMRT/VMAT QA will be described. Finally, a vision for the future of IMRT and VMAT plan QA will be discussed from a safety perspective. Learning Objectives: Understand the advantages and limitations of measurement and calculation approaches for pre-treatment measurements for IMRT and VMAT planning Learn about the elements of a balanced quality assurance program involving modulated techniques Learn how to use tools and techniques such as an end-to-end test to enhance your IMRT and VMAT QA program.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

WE-A-17A-01: Absorbed Dose Rate-To-Water at the Surface of a Beta-Emitting Planar Ophthalmic Applicator with a Planar, Windowless Extrapolation Chamber

Purpose: Currently there is no primary calibration standard for determining the absorbed dose rate-to-water at the surface of β-emitting concave ophthalmic applicators and plaques. Machining tolerances involved in the design of concave window extrapolation chambers are a limiting factor for development of such a standard. Use of a windowless extrapolation chamber avoids these window-machining tolerance issues. As a windowless extrapolation chamber has never been attempted, this work focuses on proof of principle measurements with a planar, windowless extrapolation chamber to verify the accuracy in comparison to initial calibration, which could be extended to the design of a hemispherical, windowless extrapolation chamber. Methods: The window of an extrapolation chamber defines the electrical field, aids in aligning the source parallel to the collector-guard assembly, and decreases the backscatter due to attenuation of lower electron energy. To create a uniform and parallel electric field in this research, the source was made common to the collector-guard assembly. A precise positioning protocol was designed to enhance the parallelism of the source and collector-guard assembly. Additionally, MCNP5 was used to determine a backscatter correction factor to apply to the calibration. With these issues addressed, the absorbed dose rate-to-water of a Tracerlab 90Sr planar ophthalmic applicator was determined using National Institute of Standards and Technology's (NIST) calibration formalism, and the results of five trials with this source were compared to measurements at NIST with a traditional extrapolation chamber. Results: The absorbed dose rate-to-water of the planar applicator was determined to be 0.473 Gy/s ±0.6%. Comparing these results to NIST's determination of 0.474 Gy/s yields a −0.6% difference. Conclusion: The feasibility of a planar, windowless extrapolation chamber has been demonstrated. A similar principle will be applied to developing a primary calibration standard for concave applicators and plaques. This research is funded by the customers of the University of Wisconsin Accredited Dosimetry Calibration Laboratory.

07 ISOTOPE AND RADIATION SOURCES↗
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

WE-F-16A-01: Commissioning and Clinical Use of PC-ISO for Customized, 3D Printed, Gynecological Brachytherapy Applicators

Purpose: (1) Evaluate the safety and radiation attenuation properties of PCISO, a bio-compatible, sterilizable 3D printing material by Stratasys, (2) establish a method for commissioning customized multi- and single-use 3D printed applicators, (3) report on use of customized vaginal cylinders used to treat a series of serous endometrial cancer patient. Methods: A custom film dosimetry apparatus was designed to hold a Gafchromic radio film segment between two blocks of PC-ISO and 3D-printed using a Fortus 400mc (StrataSys). A dose plan was computed using 13 dwell positions at 2.5 mm spacing and normalized to 1500 cGy at 1 cm. Film exposure was compared to control tests in only air and only water. The average Hounsfield Unit (HU) was computed and used to verify water equivalency. For the clinical use cases, the physician specifies the dimensions and geometry of a custom applicator from which a CAD model is designed and printed. Results: The doses measured from the PC-ISO Gafchromic film test were within 1% of the dose measured in only water between 1cm and 6cm from the channel. Doses increased 7–4% measured in only air. HU range was 11–43. The applicators were sterilized using the Sterrad system multiple times without damage. As of submission 3 unique cylinders have been designed, printed, and used in the clinic. A standardizable workflow for commissioning custom 3D printed applicators was codified and will be reported. Conclusions: Quality assurance (QA) evaluation of the PC-ISO 3D-printing material showed that PC-ISO is a suitable material for a gynecological brachytherapy vaginal cylinder in a clinical setting. With the material commissioning completed, if the physician determines that a better treatment would Result, a customized design is fabricated with limited additional QA necessary. Although this study was specific to PC-ISO, the same setup can be used to evaluate other 3D-printing materials.

60 APPLIED LIFE SCIENCES↗