Polaris-LAMP: Multi-Modal 3-D Image Reconstruction With a Commercial Gamma-Ray Imager
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3D gamma-ray imaging↗
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Gafchromic EBT2 film dosimetry in reflection mode with a novel plan-based calibration method
Purpose:A dosimetric system formed by Gafchromic EBT2 radiochromic film and Epson Expression 10000XL flatbed scanner was commissioned for dosimetry. In this paper, several open questions concerning the commissioning of radiochromic films for dosimetry were addressed: (a) is it possible to employ this dosimetric system in reflection mode; (b) if so, can the methods used in transmission mode also be used in reflection mode; (c) is it possible to obtain accurate absolute dose measurements with Gafchromic EBT2 films; (d) which calibration method should be followed; (e) which calibration models should be used; and (f) does three-color channel dosimetry offer a significant improvement over single channel dosimetry. The purpose of this paper is to help clarify these questions. Methods: In this study, films were scanned in reflection mode, the effect of surrounding film was evaluated and the feasibility of EBT2 film dosimetry in reflection mode was studied. EBT2's response homogeneity has been reported to lead to excessive dose uncertainties. To overcome this problem, a new plan-based calibration method was implemented. Plan-based calibration can use every pixel and each of the three color channels of the scanned film to obtain the parameters of the calibration model. A model selection analysis was conducted to select lateral correction and sensitometric curve models. The commonly used calibration with fragments was compared with red-channel plan-based calibration and with three-channel plan-based calibration. Results: No effect of surrounding film was found in this study. The film response inhomogeneity in EBT2 films was found to be important not only due to differences in the fog but also due to differences in sensitivity. The best results for lateral corrections were obtained using absolute corrections independent of the dose. With respect to the sensitometric curves, an empirical polynomial fit of order 4 was found to obtain results equivalent to a gamma-distributed single hit model based on physical assumptions. Three-channel dosimetry was found to be substantially superior to red-channel dosimetry. Conclusions: Reflection mode with Gafchromic EBT2 radiochromic film was found to be a viable alternative to transmission mode. The same methods that are used in transmission mode can be followed in reflection mode. A novel plan-based method was developed for calibration and multichannel dosimetry. This novel method offers increased robustness against film response inhomogeneities and reduces considerably the time required for calibration.
60 APPLIED LIFE SCIENCES↗
SU-E-P-01: An Informative Review On the Role of Diagnostic Medical Physicist in the Academic and Private Medical Centers
Purpose: The role of physicist in the academic and private hospital environment continues to evolve and expand. This becomes more obvious with the newly revised requirements of the Joint Commission (JC) on imaging modalities and the continued updated requirements of ACR accreditation for medical physics (i.e., starting in June 2014, a physicists test will be needed before US accreditation). We provide an informative review on the role of diagnostic medical physicist and hope that our experience will expedite junior physicists in understanding their role in medical centers, and be ready to more opportunities. Methods: Based on our experience, diagnostic medical physicists in both academic and private medical centers perform several clinical functions. These include providing clinical service and physics support, ensuring that all ionizing radiation devices are tested and operated in compliance with the State and Federal laws, regulations and guidelines. We also discuss the training and education required to ensure that the radiation exposure to patients and staff is as low as reasonably achievable. We review the overlapping roles of medical and health physicist in some institutions. Results: A detailed scheme on the new requirements (effective 7/1/2014) of the JC is provided. In 2015, new standards for fluoroscopy, cone beam CT and the qualifications of staff will be phased in. A summary of new ACR requirements for different modalities is presented. Medical physicist have other duties such as sitting on CT and fluoroscopy committees for protocols design, training of non-radiologists to meet the new fluoroscopy rules, as well as helping with special therapies such as Yittrium 90 cases. Conclusion: Medical physicists in both academic and private hospitals are positioned to be more involved and prominent. Diagnostic physicists need to be more proactive to involve themselves in the day to day activities of the radiology department.
60 APPLIED LIFE SCIENCES↗
SU-C-19A-02: An Innovative Critical Organ Repositioner Device for Use During Radiotherapy Treatments
Purpose: In most radiation oncology applications the use of shape memory alloy (SMA) actuation can be extremely beneficial in sparing normal structures by relocating them away from the path of the external beam, or placing distance between the structure and radiation source such as in Brachytherapy. Implementation of this organ repositioner device in conjunction with IMRT could open new possibilities for dose escalation and significant dose reduction to normal tissues. Similarly, in high dose rate brachytherapy applications, the ideal effective dose may not be delivered to the target volume due to toxicity concerns to adjacent critical structures. Here we present a dual functioning device manufactured from SMA materials to: 1) provide a desirable tool to reposition the organ at risk away from the radiation source, and 2) facilitate localization when imaging the area. Methods: A Nitinol based actuator with controlled force and displacement will be incorporated in the design of an organ repositioner (e.g., a rectal marker) with the ability to recall a pre-defined shape at temperature T1 (body temp) and shift back to its original shape at temperature T2 (to facilitate removal). An open distal end permits the marker to function as a part of a barium delivery system. Results: An example of this SMA manufactured in our laboratory for atrial fibrillation radio frequency ablation is the esophagus SMA positioner, designed to position the esophagus away from the ablation area. This device shows the maximum strain in the deflected esophagus to be less than 3%. The prototype positioner deflected the organ at risk by 5 cm away from the site of ablation. Conclusions: The organ repositioner device is feasible for use in clinics, provides patient comfort due to its gradual deflection, and has dual functionality in repositioning the organ at risk as well as serving as a localization device.
60 APPLIED LIFE SCIENCES↗
SU-E-T-278: Dose Conformity Index for the Target in a Multitarget Environment
Purpose: The existing conformity index formulations are failing when multiple targets present outside the target of interest with same or different dose prescriptions. In the present study a novel methodology is introduced to solve this issue. Methods: The conformity index used by Nakamura et al (Int J Radiat Oncol Biol Phys 2001; 51(5):1313–1319) is taken as the base for this methodology. In this proposal, the prescription isodose volume (PIV) which normally includes the normal tissue and other target regions is restricted as PIV in annular regions of different thickness around the target of interest. The graphical line plotted between the thickness of annular region and the corresponding conformity index, will increase in the beginning and will reach a flat region, then it will increase again. The second increase in the conformity index depends basically on the distance between the targets, dose prescriptions, and size of the targets. The conformity index in the flat region should be the conformity index of the target of interest. This methodology was validated on dual target environment on a skull phantom in Multiplan planning system (Accuray Inc. Sunnyvale, USA) Results: When the surrounding target’s (sphere) size is changed from 1.5cm to 6cm diameter, the conformity index of the target of interest (3cm diameter) changed from 1.09 to 1.25. When the distance between the targets changed from 7.5cm to 2.5cm, the conformity index changed from 1.10 to 1.17. Similarly, when the prescribed dose changed from 25Gy to 50Gy the conformity index changed from 1.09 to 1.42. These values were above 2.0 when Nakamura et al formula was used. Conclusion: The proposed conformity index methodology eliminates the influence of surrounding targets to a greater extend. However, the limitations of this method should be studied further. Application of this method in clinical situations is the future scope.
60 APPLIED LIFE SCIENCES↗
MO-F-CAMPUS-J-02: Commissioning of Radiofrequency Tracking for Gated SBRT of the Liver Using Novel Motion System
Purpose: Tracking soft tissue targets has recently been approved as a new application of the Calypso radiofrequency tracking system allowing for gated treatment of the liver based on the motion of the target volume itself. As part of the commissioning process, an end-to-end test was performed using a 3D diode array and 6D motion platform to verify the dosimetric accuracy and establish the workflow of gated SBRT treatment of the liver using Calypso. Methods: A 4DCT scan of the ScandiDos Delta4 phantom was acquired using the HexaMotion motion platform to simulate realistic breathing motion. A VMAT plan was optimized on the end of inspiration phase of the 4DCT scan and delivered to the Delta4 phantom using the Varian TrueBeam. The treatment beam was gated by Calypso to deliver dose at the end of inspiration. The expected dose was compared to the delivered dose using gamma analysis. In addition, gating limits were investigated to determine how large the gating range can be while still maintaining dosimetric accuracy. Results: The 3%/3mm and 2%/2mm gamma pass rate for the gated treatment delivery was 100% and 98.4%, respectively. When increasing the gating limits beyond the known extent of planned motion from the 4DCT, the gamma pass rates decreased as expected. The 3%/3mm gamma pass rate for a 1, 2, and 3mm increase in gating limits were measured to be 96.0%, 92.7%, and 78.8%, respectively. Conclusion: Radiofrequency tracking was shown to be an effective way to provide gated SBRT treatment of the liver. Baseline gating limits should be determined by measuring the extent of target motion during the respiratory phases used for planning. We recommend adding 1mm to the baseline limits to provide the proper balance between treatment efficiency and dosimetric accuracy.
60 APPLIED LIFE SCIENCES↗
TU-AB-BRB-03: Coverage-Based Treatment Planning to Accommodate Organ Deformable Motions and Contouring Uncertainties for Prostate Treatment
The accepted clinical method to accommodate targeting uncertainties inherent in fractionated external beam radiation therapy is to utilize GTV-to-CTV and CTV-to-PTV margins during the planning process to design a PTV-conformal static dose distribution on the planning image set. Ideally, margins are selected to ensure a high (e.g. >95%) target coverage probability (CP) in spite of inherent inter- and intra-fractional positional variations, tissue motions, and initial contouring uncertainties. Robust optimization techniques, also known as probabilistic treatment planning techniques, explicitly incorporate the dosimetric consequences of targeting uncertainties by including CP evaluation into the planning optimization process along with coverage-based planning objectives. The treatment planner no longer needs to use PTV and/or PRV margins; instead robust optimization utilizes probability distributions of the underlying uncertainties in conjunction with CP-evaluation for the underlying CTVs and OARs to design an optimal treated volume. This symposium will describe CP-evaluation methods as well as various robust planning techniques including use of probability-weighted dose distributions, probability-weighted objective functions, and coverage optimized planning. Methods to compute and display the effect of uncertainties on dose distributions will be presented. The use of robust planning to accommodate inter-fractional setup uncertainties, organ deformation, and contouring uncertainties will be examined as will its use to accommodate intra-fractional organ motion. Clinical examples will be used to inter-compare robust and margin-based planning, highlighting advantages of robust-plans in terms of target and normal tissue coverage. Robust-planning limitations as uncertainties approach zero and as the number of treatment fractions becomes small will be presented, as well as the factors limiting clinical implementation of robust planning. Learning Objectives: To understand robust-planning as a clinical alternative to using margin-based planning. To understand conceptual differences between uncertainty and predictable motion. To understand fundamental limitations of the PTV concept that probabilistic planning can overcome. To understand the major contributing factors to target and normal tissue coverage probability. To understand the similarities and differences of various robust planning techniques To understand the benefits and limitations of robust planning techniques.
60 APPLIED LIFE SCIENCES↗
TU-G-BRD-03: IMRT Dosimetry Differences in An Institution with Community and Academic Model
Purpose: Radiation outcome among institutions can be interpreted meaningfully if the dose delivery and prescription to the target volume is documented accurately and consistently. ICRU-83 recommended specific guidelines in IMRT for target volume definitions and dose reporting. This retrospective study evaluates the pattern of IMRT dose prescription and recording in an academic institution (AI) and a community hospital (CH) models in a single institution with reference to ICRU-83 recommendation. Materials & Methods: Dosimetric information of 625 (500 from academic and 125 from community) patients treated with IMRT was collected retrospectively from the AI and a CH. The dose-volume histogram (DVH) for the target volume of each patient was extracted. Standard dose parameters such as D2, D50, D95, D98, D100, as well as the homogeneity index (HI) defined as (D2-D98)/D50 and monitor units (MUs) were collected. Results: Significant dosimetric variations were observed in disease sites and between AI and CH. The variation in the mean value of D95 for AI is 98.48±4.12 and for CH is 96.41±4.13. A similar pattern was noticed for D50 (104.18±6.04 for AI and 101.05±3.49 for CH). Thus, nearly 95% of patients received dosage higher than 100% to the site viewed by D50 and varied between AI and CH models. The average variation of HI is found to be 0.12±0.08 and 0.11±0.08 for AI and CH model, showing better IMRT treatment plans for academic model compared to community. Conclusion: Even with the implementation of ICRU-83 guidelines, there is a large variation in dose prescription and delivery in IMRT. The variation is institution and site specific. For any meaningful comparison of the IMRT outcome, strict guidelines for dose reporting should be maintained in every institution.
60 APPLIED LIFE SCIENCES↗
A contactless approach for respiratory gating in PET using continuous-wave radar
Purpose: Respiratory gating is commonly used to reduce motion artifacts in positron emission tomography (PET). Clinically established methods for respiratory gating in PET require contact to the patient or a direct optical line between the sensor and the patient’s torso and time consuming preparation. In this work, a contactless method for capturing a respiratory signal during PET is presented based on continuous-wave radar. Methods: The proposed method relies on the principle of emitting an electromagnetic wave and detecting the phase shift of the reflected wave, modulated due to the respiratory movement of the patient’s torso. A 24 GHz carrier frequency was chosen allowing wave propagation through plastic and clothing with high reflections at the skin surface. A detector module and signal processing algorithms were developed to extract a quantitative respiratory signal. The sensor was validated using a high precision linear table. During volunteer measurements and [{sup 18}F] FDG PET scans, the radar sensor was positioned inside the scanner bore of a PET/computed tomography scanner. As reference, pressure belt (one volunteer), depth camera-based (two volunteers, two patients), and PET data-driven (six patients) signals were acquired simultaneously and the signal correlation was quantified. Results: The developed system demonstrated a high measurement accuracy for movement detection within the submillimeter range. With the proposed method, small displacements of 25 μm could be detected, not considerably influenced by clothing or blankets. From the patient studies, the extracted respiratory radar signals revealed high correlation (Pearson correlation coefficient) to those derived from the external pressure belt and depth camera signals (r = 0.69–0.99) and moderate correlation to those of the internal data-driven signals (r = 0.53–0.70). In some cases, a cardiac signal could be visualized, due to the representation of the mechanical heart motion on the skin. Conclusions: Accurate respiratory signals were obtained successfully by the proposed method with high spatial and temporal resolution. By working without contact and passing through clothing and blankets, this approach minimizes preparation time and increases the convenience of the patient during the scan.
46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗
Technical Note: Effect of explicit M and N-shell atomic transitions on a low-energy x-ray source
Purpose: In EGSnrc, atomic transitions to and from the M and N-shells are treated in an average way by default. This approach is justified in which the energy difference between explicit and average M and N-shell binding energies is less than 1 keV, and for most applications can be considered negligible. However, for simulations of low energy x-ray sources on thin, high-Z targets, characteristic x-rays can make up a significant portion of the source spectra. As of release V4-2.4.0, EGSnrc has included an option to enable a more complete algorithm of all atomic transitions available in the EADL compilation. In this paper, the effect of M and N-shell averaging on the calculation of half-value layer (HVL) and relative depth dose (RDD) curve of a 50 kVp intraoperative x-ray tube with a thin gold target was investigated. Methods: A 50 kVp miniature x-ray source with a gold target (The INTRABEAM System, Carl Zeiss, Germany) was modeled with the EGSnrc user code cavity, both with and without M and N-shell averaging. From photon fluence spectra simulations, the source HVLs were determined analytically. The same source model was then used with egs-chamber to calculate RDD curves in water. Results: A 4% increase of HVL was reported when accounting for explicit M and N-shell transitions, and up to a 9% decrease in local relative dose for normalization at 3 mm depth in water. Conclusions: The EGSnrc default of using averaged M and N-shell binding energies has an observable effect on the HVL and RDD of a low energy x-ray source with high-Z target. For accurate modeling of this class of devices, explicit atomic transitions should be included.
60 APPLIED LIFE SCIENCES↗
Data and methods to estimate fetal dose from fluoroscopically guided prophylactic hypogastric artery balloon occlusion
Purpose: To provide data for estimation of fetal radiation dose (D{sub F}) from prophylactic hypogastric artery balloon occlusion (HABO) procedures. Methods: The Monte-Carlo-N-particle (MCNP) transport code and mathematical phantoms representing a pregnant patient at the ninth month of gestation were employed. PA, RAO 20° and LAO 20° fluoroscopy projections of left and right internal iliac arteries were simulated. Projection-specific normalized fetal dose (NFD) data were produced for various beam qualities. The effects of projection angle, x-ray field location relative to the fetus, field size, maternal body size, and fetal size on NFD were investigated. Presented NFD values were compared to corresponding values derived using a physical anthropomorphic phantom simulating pregnancy at the third trimester and thermoluminescence dosimeters. Results: NFD did not considerably vary when projection angle was altered by ±5°, whereas it was found to markedly depend on tube voltage, filtration, x-ray field location and size, and maternal body size. Differences in NFD < 7.5% were observed for naturally expected variations in fetal size. A difference of less than 13.5% was observed between NFD values estimated by MCNP and direct measurements. Conclusions: Data and methods provided allow for reliable estimation of radiation burden to the fetus from HABO.
60 APPLIED LIFE SCIENCES↗
SU-C-BRB-01: Automated Dose Deformation for Re-Irradiation
Purpose: An objective of retreatment planning is to minimize dose to previously irradiated tissues. Conventional retreatment planning is based largely on best-guess superposition of the previous treatment’s isodose lines. In this study, we report a rigorous, automated retreatment planning process to minimize dose to previously irradiated organs at risk (OAR). Methods: Data for representative patients previously treated using helical tomotherapy and later retreated in the vicinity of the original disease site were retrospectively analyzed in an automated fashion using a prototype treatment planning system equipped with a retreatment planning module (Accuray, Inc.). The initial plan’s CT, structures, and planned dose were input along with the retreatment CT and structure set. Using a deformable registration algorithm implemented in the module, the initially planned dose and structures were warped onto the retreatment CT. An integrated third-party sourced software (MIM, Inc.) was used to evaluate registration quality and to contour overlapping regions between isodose lines and OARs, providing additional constraints during retreatment planning. The resulting plan and the conventionally generated retreatment plan were compared. Results: Jacobian maps showed good quality registration between the initial plan and retreatment CTs. For a right orbit case, the dose deformation facilitated delineating the regions of the eyes and optic chiasm originally receiving 13 to 42 Gy. Using these regions as dose constraints, the new retreatment plan resulted in V50 reduction of 28% for the right eye and 8% for the optic chiasm, relative to the conventional plan. Meanwhile, differences in the PTV dose coverage were clinically insignificant. Conclusion: Automated retreatment planning with dose deformation and definition of previously-irradiated regions allowed for additional planning constraints to be defined to minimize re-irradiation of OARs. For serial organs that do not recover from radiation damage, this method provides a more precise and quantitative means to limit cumulative dose. This research is partially supported by Accuray, Inc.
60 APPLIED LIFE SCIENCES↗
SU-F-I-34: How Does Longitudinal Dose Profile Change with Tube Current Distribution in CT?
Purpose: To investigate how longitudinal dose profile D{sub L}(z) in 30 cm-diameter water cylinder change with tube current (mA) distribution and scan length. Methods: A constant and four variable mA distributions from two previous papers [Dixon et al., Med. Phys. 40, 111920 (14pp.) (2013); Zhang et al., Med. Phys. 41, 091911 (9pp.) (2014)] were adopted in three scan lengths of 10, 28.6, and 50 cm, and all mA distributions had the same average mA over scan ranges. Using the symmetry based dose calculation algorithms and the previously published CT dose equilibration data [Li et al., Med. Phys. 40, 031903 (10pp.) (2013); 41, 111910 (5pp.) (2014)], the authors calculated DL(z) on the phantom central and peripheral axes. Kolmogorov-Smirnov (K-S) test was used to compare the lineshapes of two arbitrary distributions. Results: In constant mA scans, D{sub L}(z) was “bell-shaped”. In variable mA scans, D{sub L}(z) approximately followed the mA lineshape, and the K-S distance generally changed with mA distribution. The distance decreased with scan length, and was larger on the central axis than on the peripheral axis. However, the opposite trends were found in the K-S distance between the D{sub L}(z) distributions of constant and variable mA distributions. Conclusion: Radiation dose from TCM scan is best evaluated using the specific tube current distribution. A constant mA based evaluation may lead to inconsistent longitudinal dose profile with that of TCM scan. Their difference in lineshape is larger on the phantom peripheral axis than on the central axis and increases with scan length. This work confirms that radiation dose in CT depends on not only local mA but also the overall mA distribution and scan length. On the other hand, the concept of regional tube current may be useful when scan length is large, tube current peaks near scan range edge, or the target site is superficial.
60 APPLIED LIFE SCIENCES↗
SU-F-T-172: A Method for Log File QA On An IBA Proteus System for Patient Specific Spot Scanning Quality Assurance
Purpose: The use of log files to perform patient specific quality assurance for both protons and IMRT has been established. Here, we extend that approach to a proprietary log file format and compare our results to measurements in phantom. Our goal was to generate a system that would permit gross errors to be found within 3 fractions until direct measurements. This approach could eventually replace direct measurements. Methods: Spot scanning protons pass through multi-wire ionization chambers which provide information about the charge, location, and size of each delivered spot. We have generated a program that calculates the dose in phantom from these log files and compares the measurements with the plan. The program has 3 different spot shape models: single Gaussian, double Gaussian and the ASTROID model. The program was benchmarked across different treatment sites for 23 patients and 74 fields. Results: The dose calculated from the log files were compared to those generate by the treatment planning system (Raystation). While the dual Gaussian model often gave better agreement, overall, the ASTROID model gave the most consistent results. Using a 5%–3 mm gamma with a 90% passing criteria and excluding doses below 20% of prescription all patient samples passed. However, the degree of agreement of the log file approach was slightly worse than that of the chamber array measurement approach. Operationally, this implies that if the beam passes the log file model, it should pass direct measurement. Conclusion: We have established and benchmarked a model for log file QA in an IBA proteus plus system. The choice of optimal spot model for a given class of patients may be affected by factors such as site, field size, and range shifter and will be investigated further.
60 APPLIED LIFE SCIENCES↗
SU-F-T-192: Study of Robustness Analysis Method of Multiple Field Optimized IMPT Plans for Head & Neck Patients
Purpose: Proton therapy is more sensitive to uncertainties than photon treatments due to protons’ finite range depending on the tissue density. Worst case scenario (WCS) method originally proposed by Lomax has been adopted in our institute for robustness analysis of IMPT plans. This work demonstrates that WCS method is sufficient enough to take into account of the uncertainties which could be encountered during daily clinical treatment. Methods: A fast and approximate dose calculation method is developed to calculate the dose for the IMPT plan under different setup and range uncertainties. Effects of two factors, inversed square factor and range uncertainty, are explored. WCS robustness analysis method was evaluated using this fast dose calculation method. The worst-case dose distribution was generated by shifting isocenter by 3 mm along x,y and z directions and modifying stopping power ratios by ±3.5%. 1000 randomly perturbed cases in proton range and x, yz directions were created and the corresponding dose distributions were calculated using this approximated method. DVH and dosimetric indexes of all 1000 perturbed cases were calculated and compared with the result using worst case scenario method. Results: The distributions of dosimetric indexes of 1000 perturbed cases were generated and compared with the results using worst case scenario. For D95 of CTVs, at least 97% of 1000 perturbed cases show higher values than the one of worst case scenario. For D5 of CTVs, at least 98% of perturbed cases have lower values than worst case scenario. Conclusion: By extensively calculating the dose distributions under random uncertainties, WCS method was verified to be reliable in evaluating the robustness level of MFO IMPT plans of H&N patients. The extensively sampling approach using fast approximated method could be used in evaluating the effects of different factors on the robustness level of IMPT plans in the future.
60 APPLIED LIFE SCIENCES↗
SU-F-T-194: Analyzing the Effect of Range Shifter Air Gap On TPS Dose Modeling Accuracy in Superficial PBS Proton Therapy
Purpose: Treatment planning systems (TPS) may not accurately model superficial dose distributions of range shifted proton pencil beam scanning (PBS) treatments. Numerous patient-specific QA tests performed on superficially treated PBS plans have shown a consistent overestimate of dose by the TPS. This study quantifies variations between TPS planned dose and measured dose as a function of range shifter air gap and treatment depths up to 5 cm. Methods: PBS treatment plans were created in the TPS to uniformly irradiate a volume of solid water. One plan was created for each range shifter position analyzed, and all plans utilized identical dose optimization parameters. Each optimized plan was analyzed in the TPS to determine the planned dose at varying depths. A PBS proton therapy system with a 3.5 cm lucite range shifter delivered the treatment plans, and a parallel plate chamber embedded in RW3 solid water measured dose at shallow depths for each air gap. Differences between measured and planned doses were plotted and analyzed. Results: The data show that the TPS more accurately models superficial dose as the air gap between the range shifter and patient surface decreases. Air gaps less than 10 cm have an average dose difference of only 1.6%, whereas air gaps between 10 and 20 cm differ by 3.0% and gaps greater than 20 cm differ by 4.4%. Conclusion: This study has shown that the TPS is unable to accurately model superficial dose with a large range shifter air gap. Dose differences greater than 3% will likely cause QA failure, as many institutions analyze patient QA with a 3%/3mm gamma analysis. For superficial PBS therapy, range shifter positions should be chosen to keep the air gap less then 10 cm when patient setup and gantry geometry allow.
60 APPLIED LIFE SCIENCES↗
SU-F-T-208: An Efficient Planning Approach to Posterior Fossa Tumor Bed Boosts Using Proton Pencil Beam Scanning in Fixed-Beam Room
Purpose: A fixed-beam room could be underutilized in a multi-room proton center. We investigated the use of proton pencil beam scanning (PBS) on a fixed-beam as an alternative for posterior fossa tumor bed (PF-TB) boost treatments which were usually treating on a gantry with uniform scanning. Methods: Five patients were treated with craniospinal irradiation (CSI, 23.4 or 36.0 Gy(RBE)) followed by a PF-TB boost to 54 Gy(RBE) with proton beams. Three PF-TB boost plans were generated for each patient: (1) a uniform scanning (US) gantry plan with 4–7 posterior fields shaped with apertures and compensators (2) a PBS plan using bi-lateral and vertex fields with a 3-mm planning organ-at-risk volume (PRV) expansion around the brainstem and (3) PBS fields using same beam arrangement but replacing the PRV with robust optimization considering a 3-mm setup uncertainty. Results: A concave 54-Gy(RBE) isodose line surrounding the brainstem could be achieved using all three techniques. The mean V95% of the PTV was 99.7% (range: 97.6% to 100%) while the V100% of the PTV ranged from 56.3% to 93.1% depending on the involvement of the brainstem with the PTV. The mean doses received by 0.05 cm{sup 3} of the brainstem were effectively identical: 54.0 Gy(RBE), 53.4 Gy(RBE) and 53.3 Gy(RBE) for US, PBS optimized with PRV, and PBS optimized with robustness plans respectively. The cochlea mean dose increased by 23% of the prescribed boost dose in average from the bi-lateral fields used in the PBS plan. Planning time for the PBS plan with PRV was 5–10 times less than the US plan and the robustly optimized PBS plan. Conclusion: We have demonstrated that a fixed-beam with PBS can deliver a dose distribution comparable to a gantry plan using uniform scanning. Planning time can be reduced substantially using a PRV around the brainstem instead of robust optimization.
60 APPLIED LIFE SCIENCES↗