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Search indexed NASA NTRS and DOE OSTI research on propulsion, heat transfer, battery materials and energy systems. Follow report and document links to the original sources.

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At least 1,657 records · Page 92
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DOE OSTI2014

SU-E-T-09: A Dosimetric Analysis of Various Clinically Used Bolus Materials

Purpose: To evaluate the dosimetric effect of various clinically used bolus materials. Methods: Materials investigated include solid water, superflab, wet gauze, wet sheets, Play-Doh{sup ™}, and gauze embedded with petroleum jelly. Each bolusing material was scanned in a Philips CT to determine the Hounsfield unit (HU) and to verify uniformity throughout the material. Using the corresponding HU, boluses of 0.5 cm and 1.0 cm thicknesses were created in the Eclipse treatment planning system (TPS) on a solid water phantom. Dose was calculated at various depths for beam energies 6 MV, 6 MeV, 9 MeV, and 12 MeV to determine the effects of each material on deposition of dose. In addition, linac-based measurements at these energies were made using a farmer chamber in solid water. Wet sheets and wet gauze were measured with various water content to quantify the effects on dose. Results: Preliminary CT scans find a range in HU of bolus materials from −120 to almost 300. There is a trend in the dose at depth based on the HU of the material; however inconsistencies are found when the bolus materials have a negative HU value. The measured data indicates that there is a linear relationship between the mass of water in a material and the dose reading, the slope of which is material dependent. Conclusion: Due to the variation in HU of the bolus materials studied, it is recommended that any new bolus be evaluated before clinical use to determine physical and dosimetric properties. If possible, patients should have bolus included in their CT scans; or if the bolus is created in the TPS, the HU should correspond to the material used. For water-soaked materials, once the bolus material is selected (gauze or sheet), the bolusing effect is only dependent on the amount of water applied to the material.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-28: A Treatment Planning Comparison of Volumetric Modulated Arc Therapy Vs. Proton Therapy for Post-Mastectomy Radiotherapy

Purpose: The delivery of post-mastectomy radiotherapy (PMRT) can be challenging for patients with left-sided breast cancer due to the PTV size and proximity to critical organs. This study investigates the use of protons for PMRT in a clinically-representative cohort of patients, and quantitatively compares volumetric modulated arc therapy (VMAT) to proton therapy to have an evidence-based rationale for selecting a treatment modality for these patients. Methods: Eight left-sided PMRT patients previously treated at our clinic with VMAT were identified for the study. PTVs included the chest wall and regional lymph nodes. Passively scattered (PS) and intensity modulated proton therapy (IMPT) plans were constructed using the Eclipse proton planning system. The resulting plans were compared to the original VMAT plan on the basis of PTV coverage; dose homogeneity index (DHI) and conformity index (CI); dose to organs at risk (OAR); tumor control probability (TCP), normal tissue complication probability (NTCP) and secondary cancer complication probability (SCCP). Differences were tested for significance using the paired Student's t-test (p<0.01). Results: All modalities produced clinically acceptable PMRT plans. The comparison demonstrated proton treatment plans provide significantly lower NTCP values for the heart and the lung while maintaining significantly better CI and DHI. At a prescribed dose of 50.4 Gy (RBE) in the PTV, the calculated mean NTCP value for the patients decreased from 1.3% to 0.05% for the whole heart (cardiac mortality) and from 3.8% to 1.1% for the lungs (radiation pneumonitis) for both proton therapy plans from VMAT plans. Both proton modalities showed a significantly lower SCCP for the contralateral breast compared to VMAT. Conclusion: All three plans (VMAT, PS, and IMPT) provide acceptable treatment plans for PMRT. However, proton therapy shows a significant advantage over VMAT with regards to sparing OARs and may be more advantageous for patients with unfavorable anatomy.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-31: Alternative VMAT Technique Reduces Total Monitor Units for Lung SBRT

Purpose: To investigate an alternative approach to VMAT optimization for hypofractionation lung treatment which increases average aperture opening and results in lower total Monitor Units (MU) without significantly sacrificing plan quality. Methods: Benchmark Volumetric Modulated Arc Therapy (bVMAT) plans were generated for 10 lung Stereotactic Body radiotherapy (SBRT) cases using Eclipse Version 11.0.42 (Varian Medical Systems) without a maximum MU constraint. Prescriptions ranged from 40 to 54Gy in 3 to 5 fractions. AAA dose calculation and PRO fluence based optimization was utilized. Two comparison VMAT plans were generated for each case, one that forced an initial “open” mlc aperture conformal to the tumor as a starting condition (oVMAT) with similar optimization parameters and arc geometries, and one that repeated the bVMAT optimization but added a maximum MU constraint (muVMAT). All plans used two arcs with lengths between 168 to 230 degrees. PTV D 95% and Dmean, lung V20 Gy, chest wall V30 Gy, average aperture opening and MU's were compared. Statistical significance was evaluated using Wilcoxon signed rank test. Results: Average PTV D(95), PTV mean and lung V20Gy over all plans was 99.2 ± 1.7%, 103.3 ± 0.6% and 7.8 ± 2.4% respectively. The average chest wall V30Gy was 61 ± 61 cc and ranged between 0 to 166 cc. There were no significant differences between the three techniques for the dosimetric quantities. MUs were reduced by 11 ±11% (p<0.01) and 25 ± 5% (p<0.01) and the average aperture size was increased by 13.7 ± 14% (p=0.02) and 35.8 ± 10% (p<0.01) with muVMAT and oVMAT, respectively, compared to bVMAT. Conclusion: oVMAT and muVMAT techniques were both able to increase average aperture size and reduce total MU compared to the benchmark VMAT plan, but the magnitude of the changes observed for oVMAT was larger.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-50: Automatic Validation of Megavoltage Beams Modeled for Clinical Use in Radiation Therapy

Purpose: To automatically validate megavoltage beams modeled in XiO™ 4.50 (Elekta, Stockholm, Sweden) and Varian Eclipse™ Treatment Planning Systems (TPS) (Varian Associates, Palo Alto, CA, USA), reducing validation time before beam-on for clinical use. Methods: A software application that can automatically read and analyze DICOM RT Dose and W2CAD files was developed using MatLab integrated development environment.TPS calculated dose distributions, in DICOM RT Dose format, and dose values measured in different Varian Clinac beams, in W2CAD format, were compared. Experimental beam data used were those acquired for beam commissioning, collected on a water phantom with a 2D automatic beam scanning system.Two methods were chosen to evaluate dose distributions fitting: gamma analysis and point tests described in Appendix E of IAEA TECDOC-1583. Depth dose curves and beam profiles were evaluated for both open and wedged beams. Tolerance parameters chosen for gamma analysis are 3% and 3 mm dose and distance, respectively.Absolute dose was measured independently at points proposed in Appendix E of TECDOC-1583 to validate software results. Results: TPS calculated depth dose distributions agree with measured beam data under fixed precision values at all depths analyzed. Measured beam dose profiles match TPS calculated doses with high accuracy in both open and wedged beams. Depth and profile dose distributions fitting analysis show gamma values < 1. Relative errors at points proposed in Appendix E of TECDOC-1583 meet therein recommended tolerances.Independent absolute dose measurements at points proposed in Appendix E of TECDOC-1583 confirm software results. Conclusion: Automatic validation of megavoltage beams modeled for their use in the clinic was accomplished. The software tool developed proved efficient, giving users a convenient and reliable environment to decide whether to accept or not a beam model for clinical use. Validation time before beam-on for clinical use was reduced to a few hours.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-52: Beam Data Comparison for 20 Linear Accelerators in One Network

Purpose: To compare photon beam data for the 20 Varian linear accelerators (TrueBeam, iX, and EX models) in use at five centers in the same network with the intent to model with one set of beam data in Eclipsec. Methods: Varian linear accelerators, TrueBeam (3), 21 EX, iX, and Trilogy (14), and 6 EX (3), installed between 1999 and 2014 have their 6 MV and 15 MV x-ray beams reevaluated. Full commissioning, including output factors (St), percent depth doses (PDD), and off-axis profiles, was recently performed for a TrueBeam with a cc04 ion chamber in an IBA Blue phantom. Similarly, a subset of beam data for each of the other accelerators was measured recently as follows: for 3×3, 10×10, and 30×30 cm{sup 2} field sizes, flatness and penumbra (80–20%) were measured at dmax and 10 cm depths, PDD were measured at 10 and 20 cm depths, and St were measured at 5 cm depth. Measurement results for all machines were compared. Results: For 15 high-energy (6 and 15 MV) and 3 low-energy machines (6MV only): 1) PDD agreed within 1.4% at 10 and 20 cm depths; 2) penumbra agreed within 1.0 mm at dmax and 10 cm depths; 3) flatness was within 1.3% at dmax and 10 cm depths; and 4) with exception of the three low energy machines, output factors were within 1.1% and 0.5% for 3×3 and 30×30 cm{sup 2}, respectively. Measurement uncertainty, not quantified here, accounts for some of these differences. Conclusion: Measured beam data from 15 high-energy Varian linacs are consistent enough that they can be classified using one beam data set in Eclipse. Two additional high-energy machines are removed from this group until their data are further confirmed. Three low-energy machines will be in a separate class based upon differences in output factors (St)

07 ISOTOPE AND RADIATION SOURCES↗
DOE OSTI2014

SU-E-T-66: Characterization of Radiation Dose Associated with Dark Currents During Beam Hold for Respiratory-Gated Electron Therapy

Purpose: The main objective of this study was to estimate the radiation dose contributed by dark currents associated with the respiratory-gated electron therapy during beam hold. The secondary aim was to determine clinical benefits of using respiratory-gated electron therapy for left-sided breast cancer patients with positive internal mammary nodes (IMN). Methods: Measurements of the dark current-induced dose in all electron modes were performed on multiple Siemens and Varian linear accelerators by manually simulating beam-hold during respiratory gating. Dose was quantified at the machine isocenter by comparing the collected charge to the known output for all energies ranging from 6 to 18 MeV for a 10cm × 10cm field at 100 SSD with appropriate solid-water buildup. Using the Eclipse treatment planning system, we compared the additional dose associated with dark current using gated electron fields to the dose uncertainties associated with matching gated photon fields and ungated electron fields. Dose uncertainties were seen as hot and cold spots along the match line of the fields. Results: The magnitude of the dose associated with dark current is highly correlated to the energy of the beam and the amount of time the beam is on hold. For lower energies (6–12 MeV), there was minimal dark current dose (0.1–1.3 cGy/min). Higher energies (15–18 MeV) showed measurable amount of doses. The dark current associated with the electron beam-hold varied between linear accelerator vendors and depended on dark current suppression and the age of the linear accelerator. Conclusion: For energies up to 12 MeV, the dose associated with the dark current for respiratorygated electron therapy was shown to be negligible, and therefore should be considered an option for treating IMN positive left-sided breast cancer patients. However, at higher energies the benefit of respiratory gating may be outweighed by dose due to the dark current.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-67: Clinical Implementation and Evaluation of the Acuros Dose Calculation Algorithm

Purpose: The main aim of the current study is to present a detailed description of the implementation of the Acuros XB Dose Calculation Algorithm, and subsequently evaluate its clinical impacts by comparing it with AAA algorithm. Methods: The source models for both Acuros XB and AAA were configured by importing the same measured beam data into Eclipse treatment planning system. Both algorithms were evaluated by comparing calculated dose with measured dose on a homogeneous water phantom for field sizes ranging from 6cm × 6cm to 40cm × 40cm. Central axis and off-axis points with different depths were chosen for the comparison. Similarly, wedge fields with wedge angles from 15 to 60 degree were used. In addition, variable field sizes for a heterogeneous phantom were used to evaluate the Acuros algorithm. Finally, both Acuros and AAA were tested on VMAT patient plans for various sites. Does distributions and calculation time were compared. Results: On average, computation time is reduced by at least 50% by Acuros XB compared with AAA on single fields and VMAT plans. When used for open 6MV photon beams on homogeneous water phantom, both Acuros XB and AAA calculated doses were within 1% of measurement. For 23 MV photon beams, the calculated doses were within 1.5% of measured doses for Acuros XB and 2% for AAA. When heterogeneous phantom was used, Acuros XB also improved on accuracy. Conclusion: Compared with AAA, Acuros XB can improve accuracy while significantly reduce computation time for VMAT plans.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-71: Commissioning and Acceptance Testing of a Commercial Monte Carlo Electron Dose Calculation Model (eMC) for TrueBeam

Purpose: To provide commissioning and acceptance test data of the Varian Eclipse electron Monte Carlo model (eMC v.11) for TrueBeam linac. We also investigated the uncertainties in beam model parameters and dose calculation results for different geometric configurations. Methods: For beam commissioning, PTW CC13 thimble chamber and IBA Blue Phantom2 were used to collect PDD and dose profiles in air. Cone factors were measured with a parallel plate chamber (PTW N23342) in solid water. GafChromic EBT3 films were used for dose calculation verifications to compare with parallel plate chamber results in the following test geometries: oblique incident, extended distance, small cutouts, elongated cutouts, irregular surface, and heterogeneous layers. Results: Four electron energies (6e, 9e, 12e, and 15e) and five cones (6×6, 10×10, 15×15, 20×20, and 25×25) with standard cutouts were calculated for different grid sizes (1, 1.5,2, and 2.5 mm) and compared with chamber measurements. The results showed calculations performed with a coarse grid size underestimated the absolute dose. The underestimation decreased as energy increased. For 6e, the underestimation (max 3.3 %) was greater than the statistical uncertainty level (3%) and was systematically observed for all cone sizes. By using a 1mm grid size, all the calculation results agreed with measurements within 5% for all test configurations. The calculations took 21s and 46s for 6e and 15e (2.5mm grid size) respectively distributed on 4 calculation servants. Conclusion: In general, commissioning the eMC dose calculation model on TrueBeam is straightforward and thedose calculation is in good agreement with measurements for all test cases. Monte Carlo dose calculation provides more accurate results which improves treatment planning quality. However, the normal acceptable grid size (2.5mm) would cause systematic underestimation in absolute dose calculation for lower energies, such as 6e. Users need to be cautious in this situation.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-97: Dependence Of Optically Stimulated Luminescent Dosimeter (OSLD) Out Of Field Response On Volumetric Modulated Arc Therapy (VMAT) Field Modulation

Purpose: To determine the out of field response of Microstar ii OSLDs as a function of field modulation and distance in VMAT plan delivery. This work has potential application in fetal dose monitoring or measurements on cardiac pacemakers Methods: VMAT plans were created in Eclipse and optimized to varying degrees of modulation. Three plans were chosen to represent low, medium and high degrees of modulation (modulation factors as defined by MU/cGy). Plans were delivered to slabs of solid water with dimensions 60cm length, 30cm width, and 10cm height. For each modulation factor, 2 OSLDs were placed at 1cm depth with out of field distances of 1, 2, 3, 5, 8 and 10cm and the plan delivered isocentrically to a depth of 5cm. This technique was repeated for a Farmer Chamber by incrementing the table by the appropriate distance. The charge readings for the Farmer Chamber were converted to dose and the ratios taken as functions of modulation factors and distances out of field Results: Examination of the results as a function of out of field distance shows a trend of increasing OSLD/Farmer Chamber ratios for all modulation factors. The slopes appear to be roughly equivalent for all modulation factors investigated. Results as a function of modulation showed a downward trend for all out of field distances, with the greatest differences seen at 5cm and 8cm Conclusion: This study demonstrates that the response of OSLD dosimeters change as a function of out of field distance and modulation. The differences seen are within the stated accuracy of the system for the out of field distances and modulations investigated. Additional investigation is warranted to see if the OSLD response changes appreciably with longer out of field distances or wider ranges of modulation.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-101: Determination and Comparison of Correction Factors Obtained for TLDs in Small Field Lung Heterogenous Phantom Using Acuros XB and EGSnrc

Purpose: To determine and compare the correction factors obtained for TLDs in 2 × 2cm{sup 2} small field in lung heterogenous phantom using Acuros XB (AXB) and EGSnrc. Methods: This study will simulate the correction factors due to the perturbation of TLD-100 chips (Harshaw/Thermoscientific, 3 × 3 × 0.9mm{sup 3}, 2.64g/cm{sup 3}) in small field lung medium for Stereotactic Body Radiation Therapy (SBRT). A physical lung phantom was simulated by a 14cm thick composite cork phantom (0.27g/cm{sup 3}, HU:-743 ± 11) sandwiched between 4cm thick Plastic Water (CIRS,Norfolk). Composite cork has been shown to be a good lung substitute material for dosimetric studies. 6MV photon beam from Varian Clinac iX (Varian Medical Systems, Palo Alto, CA) with field size 2 × 2cm{sup 2} was simulated. Depth dose profiles were obtained from the Eclipse treatment planning system Acuros XB (AXB) and independently from DOSxyznrc, EGSnrc. Correction factors was calculated by the ratio of unperturbed to perturbed dose. Since AXB has limitations in simulating actual material compositions, EGSnrc will also simulate the AXB-based material composition for comparison to the actual lung phantom. Results: TLD-100, with its finite size and relatively high density, causes significant perturbation in 2 × 2cm{sup 2} small field in a low lung density phantom. Correction factors calculated by both EGSnrc and AXB was found to be as low as 0.9. It is expected that the correction factor obtained by EGSnrc wlll be more accurate as it is able to simulate the actual phantom material compositions. AXB have a limited material library, therefore it only approximates the composition of TLD, Composite cork and Plastic water, contributing to uncertainties in TLD correction factors. Conclusion: It is expected that the correction factors obtained by EGSnrc will be more accurate. Studies will be done to investigate the correction factors for higher energies where perturbation may be more pronounced.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-105: Development of 3D Dose Verification System for Volumetric Modulated Arc Therapy Using Improved Polyacrylamide-Based Gel Dosimeter

Purpose: The aim of this dosimetric study was to develop 3D dose verification system for volumetric modulated arc therapy (VMAT) using polyacrylamide-based gel (PAGAT) dosimeter improved the sensitivity by magnesium chloride (MgCl{sub 2}). Methods: PAGAT gel containing MgCl{sub 2} as a sensitizer was prepared in this study. Methacrylic-acid-based gel (MAGAT) was also prepared to compare the dosimetric characteristics with PAGAT gel. The cylindrical glass vials (4 cm diameter, 12 cm length) filled with each polymer gel were irradiated with 6 MV photon beam using Novalis Tx linear accelerator (Varian/BrainLAB). The irradiated polymer gel dosimeters were scanned with Signa 1.5 T MRI system (GE), and dose calibration curves were obtained using T{sub 2} relaxation rate (R{sub 2} = 1/T{sub 2}). Dose rate (100-600 MU min{sup −1}) and fractionation (1-8 fractions) were varied. In addition, a cubic acrylic phantom (10 × 10 × 10 cm{sup 3}) filled with improved PAGAT gel inserted into the IMRT phantom (IBA) was irradiated with VMAT (RapidArc). C-shape structure was used for the VMAT planning by the Varian Eclipse treatment planning system (TPS). The dose comparison of TPS and measurements with the polymer gel dosimeter was accomplished by the gamma index analysis, overlaying the dose profiles for a set of data on selected planes using in-house developed software. Results: Dose rate and fractionation dependence of improved PAGAT gel were smaller than MAGAT gel. A high similarity was found by overlaying the dose profiles measured with improved PAGAT gel dosimeter and the TPS dose, and the mean pass rate of the gamma index analysis using 3%/3 mm criteria was achieved 90% on orthogonal planes for VMAT using improved PAGAT gel dosimeter. Conclusion: In-house developed 3D dose verification system using improved polyacrylamide-based gel dosimeter had a potential as an effective tool for VMAT QA.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-109: Development of An End-To-End Test for the Varian TrueBeamtm with a Novel Multiple-Dosimetric Modality H and N Phantom

Purpose: To develop a comprehensive end-to-end test for Varian's TrueBeam linear accelerator for head and neck IMRT using a custom phantom designed to utilize multiple dosimetry devices. Methods: The initial end-to-end test and custom H and N phantom were designed to yield maximum information in anatomical regions significant to H and N plans with respect to: i) geometric accuracy, ii) dosimetric accuracy, and iii) treatment reproducibility. The phantom was designed in collaboration with Integrated Medical Technologies. A CT image was taken with a 1mm slice thickness. The CT was imported into Varian's Eclipse treatment planning system, where OARs and the PTV were contoured. A clinical template was used to create an eight field static gantry angle IMRT plan. After optimization, dose was calculated using the Analytic Anisotropic Algorithm with inhomogeneity correction. Plans were delivered with a TrueBeam equipped with a high definition MLC. Preliminary end-to-end results were measured using film and ion chambers. Ion chamber dose measurements were compared to the TPS. Films were analyzed with FilmQAPro using composite gamma index. Results: Film analysis for the initial end-to-end plan with a geometrically simple PTV showed average gamma pass rates >99% with a passing criterion of 3% / 3mm. Film analysis of a plan with a more realistic, ie. complex, PTV yielded pass rates >99% in clinically important regions containing the PTV, spinal cord and parotid glands. Ion chamber measurements were on average within 1.21% of calculated dose for both plans. Conclusion: trials have demonstrated that our end-to-end testing methods provide baseline values for the dosimetric and geometric accuracy of Varian's TrueBeam system.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-137: Dosimetric Validation for Pinnacle, Acuros, AAA, and Brainlab Algorithms with Induced Inhomogenieties

Purpose: To compare the dosimetric accuracy of the Eclipse 11.0 Acuros XB and Anisotropic Analytical Algorithm (AAA), Pinnacle-3 9.2 Collapsed Cone Convolution, and the iPlan 4.1 Monte Carlo (MC) and Pencil Beam (PB) algorithms using measurement as the gold standard. Methods: Ion chamber and diode measurements were taken for 6, 10, and 18 MV beams in a phantom made up of slab densities corresponding to solid water, lung, and bone. The phantom was setup at source-to-surface distance of 100 cm, and the field sizes were 3.0 × 3.0, 5.0 × 5.0, and 10.0 × 10.0 cm2. Data from the planning systems were computed along the central axis of the beam. The measurements were taken using a pinpoint chamber and edge diode for interface regions. Results: The best agreement between data from the algorithms and our measurements occurs away from the slab interfaces. For the 6 MV beam, iPlan 4.1 MC software performs the best with 1.7% absolute average percent difference from measurement. For the 10 MV beam, iPlan 4.1 PB performs the best with 2.7% absolute average percent difference from measurement. For the 18 MV beam, Acuros performs the best with 2.0% absolute average percent difference from measurement. It is interesting to note that the steepest drop in dose occurred the at lung heterogeneity-solid water interface of the18 MV, 3.0 × 3.0 cm2 field size setup. In this situation, Acuros and AAA performed best with an average percent difference within −1.1% of measurement, followed by iPlan 4.1 MC, which was within 4.9%. Conclusion: This study shows that all of the algorithms perform reasonably well in computing dose in a heterogeneous slab phantom. Moreover, Acuros and AAA perform particularly well at the lung-solid water interfaces for higher energy beams and small field sizes.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-138: Dosimetric Verification For Volumetric Modulated Arc Therapy Cranio-Spinal Irradiation Technique

Purpose: Dosimetric feasibility of cranio-spinal irradiation with volumetric modulated arc therapy (VMAT-CSI) technique in terms of dose distribution accuracy was investigated using a humanlike phantom. Methods: The OARs and PTV volumes for the Rando phantom were generated on supine CT images. Eclipse (version 8.6) TPS with AAA algorithm was used to create the treatment plan with VMAT-CSI technique. RapidArc plan consisted of cranial, upper spinal (US) and lower spinal (LS) regions that were optimized in the same plan. US field was overlapped by 3cm with cranial and LS fields. Three partial arcs for cranium and 1 full arc for each US and LS region were used. The VMAT-CSI dose distribution inside the Rando phantom was measured with thermoluminescent detectors (TLD) and film dosimetry, and was compared to the calculated doses of field junctions, target and OARs. TLDs were placed at 24 positions throughout the phantom. The measured TLD doses were compared to the calculated point doses. Planar doses for field junctions were verified with Gafchromic films. Films were analyzed in PTW Verisoft application software using gamma analysis method with the 4 mm distance to agreement (DTA) and 4% dose agreement criteria. Results: TLD readings demonstrated accurate dose delivery, with a median dose difference of -0.3% (range: -8% and 12%) when compared with calculated doses for the areas inside the treatment portal. The maximum dose difference was 12% higher in testicals that are outside the treatment region and 8% lower in lungs where the heterogeinity was higher. All planar dose verifications for field junctions passed the gamma analysis and measured planar dose distributions demonstrated average 97% agreement with calculated doses. Conclusion: The dosimetric data verified with TLD and film dosimetry shows that VMAT-CSI technique provides accurate dose distribution and can be delivered safely.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-150: End to End Tests On the First Clinical EDGETM

Purpose: To quantify the sub millimeter overall accuracy of EDGETM, the dedicated linac based SRS/SABR treatment platform from Varian, using a novel End-to-End (E2E) test phantom. Methods: The new E2E test phantom developed by Varian consists of a cube with an outer dimension of 15x15x15 cm3. The phantom is equipped with an exchangable inner cube (7×7×7 cm3) to hold radiochromic films or a tungsten ball (diameter = 5 mm) for Winston-Lutz tests. 16 ceramic balls (diameter = 5 mm) are embedded in the outer cube. Three embedded Calypso transponders allow for Calypso based monitoring. The outer surface of the phantom is tracked using the Optical Surface Monitoring System (OSMS). The phantom is positioned using kV, MV and CBCT images. A simCT of the phantom was acquired and SRS/SABR plans were treated using the new phantom on the first clinical installed EDGETM. As a first step a series of EPID based Winston-Lutz tests have been performed. As a second step the calculated dose distribution applied to the phantom was verified with radiochromic films in orthogonal planes. The measured dose distribution is compared with the calculated (Eclipse) one based on the known isocenter on both dose distributions. The geometrical shift needed to match both dose distributions is the overall accuracy and is determined using dose profiles, isodose lines or gamma pass rates (3%, 1 mm). Results: Winston-Lutz tests using the central tungsten BB demonstrated a targeting accuracy of 0.44±0.18mm for jaw (2cm × 2cm) defined 0.39±0.19mm for MLC (2cm × 2cm) defined and 0.37±0.15mm for cone (12.5 mm) defined fields. A treated patient plan (spinal metastases lesion with integrated boost) showed a dosimetric dose localization accuracy of 0.6mm. Conclusion: Geometric and dosimetric E2E tests on EDGETM, show sub-millimeter E2E targeting and dose localisation accuracy.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-153: Establish a Comprehensive Patient-Specific Plan QA Database for Instituitional Quality Control Program

Purpose: Since the publication of TG-119, several new treatment techniques requiring new QA devices have been implemented in the clinic. To monitor and analyze our institutional QA performance, we have created a comprehensive QA database using Research Electronic Data Capture (REDCap). The database will also assist us in creating IMRT QA Analysis practice guidelines. Methods: Since Oct. 2013, 336 patient plan QA results were entered into the database. Plan parameters such as plan ID, treatment site, technique, energy, optimization constraints, modulation factor, leaf speed, leaf opening.etc were automatically extracted from the Varian Eclipse database to allow us to refine our evaluation and analysis method. Specific QA device, LINAC-related information, and measurement and analysis results were manually entered by the QA team. IMRT plans were measured using MapCHECK2 while RapidArc plans were measured using ArcCHECK. Distance-To-Agreement 3%/3mm without global maximum normalization was used. Results: The data indicates that different treatment techniques might benefit from a different site-specific action level(AL) depending on the complexity of the plan and optimization parameter used (e.g., breast IMRT QA= 97.8% and pelvis IMRT QA=93.1%). Different QA devices may also benefit from a different AL (MapCHECK2 = 94.1% while ArcCHECK = 83.0%). The relationship between the parameters and passing rate suggests that the complexity of each plan, characterized by leaf travel, leaf opening and modulation factor, affect the passing rate significantly. The database is reviewed regularly, and any abnormal point of the QA result or a trend of lower QA passing rate on a specific LINAC is further investigated. Conclusion: Establishing a comprehensive QA database provides an overview of the quality assurance program. It not only helps in answering the question “what is a reasonable and achievable standard for each institution”, but also saves time in monitoring and investigating the daily machine and QA performance.

07 ISOTOPE AND RADIATION SOURCES↗
DOE OSTI2014

SU-E-T-178: Experimental Study of Acceptable Movement Conditions for SBRT Lung Treatments

Purpose: To experimentally study the acceptable movement conditions for SBRT lung treatments we quantified with film dosimetry the change in dose distributions due to periodic movements of 5 different amplitudes and 4 respiratory gating duty cycles on a SBRT treatment plan. Methods: We planned a SBRT treatment plan for the QUASAR™ (Modus Medical) phantom equipped with the respiratory motion device. We placed a 3 mm water-equivalent sphere simulating a tumour inside the lung-equivalent insert. This sphere is divided in two hemispheres that allow placing films in between. We used radiochromic EBT2™ (Ashland) films. We oriented the lung insert in such a way that sagittal dose distributions could be measured. We applied a sinusoidal movement with 3 s period for 5 different amplitudes of 0(static), 5, 7, 10, 15 and 20 mm without gating. For the 20 mm amplitude we studied the gating technique with 4 duty cycles of 20, 40, 60 and 80% of the respiratory cycle. Each situation was irradiated in a Clinac 2100 linac (Varian) equipped with the RPM™ system. FilmQA Pro™ (Ashland) software together with an Expression 10000XL scanner (EPSON) were used to analyze and compare the measured dose distributions with those planned by the Eclipse™ TPS v. 8.9 (Varian) by means of gamma analysis with 6 criteria: 5%/3mm, 5%/2mm, 5%/1mm, 3%/3mm, 3%/2mm and 2%/2mm (threshold of 10%). Results: Movements with amplitude of less than 7mm do not significantly modified the dosimetry. Gating duty cycles of less than 40% yielded also acceptable results for a 2 cm amplitude movement. Conclusion: To safely perform daily accurate SBRT treatments, movements have to be restricted to 7 mm amplitude (±3.5 mm). Otherwise, a gating strategy should be considered.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-181: Feasibility and Robustness of Using Overlapping VMAT Arcs for Conformal Irradiation of Large Irregular PTVs

Purpose: To investigate the feasibility and robustness of using multiple overlapping arcs for delivering volumetric modulated arc therapy (VMAT) to irregular PTVs with large superior-inferior (SI) dimensions. Methods: A patient with stage IV alveolar rhabdomyosarcoma, with a combined PTV length of 56 cm in SI direction, was planned and treated in our department using two VMAT arcs overlapped along the SI direction to take advantage of the much needed dose sculpting capabilities of VMAT. The overlapping VMATs, each consisted of two arcs, were optimized simultaneously using Varian Eclipse system. The susceptibility of the resulting plan to uncertainties associated the set up of two separate isocenters during treatment was investigated by comparing the dose distributions resulted from small shifts introduced into the isocenter position. The robustness of this technique was further assessed for plans generated using different amount of overlap between the overlapping arcs. Results: When the plan was generated with 6 cm overlap between adjacent arcs, maximum dose variations observed near overlapping edges was up to 9.2%, 10%, and 26.7% for setup uncertainties of 2 mm, 3 mm, and 5 mm, respectively. By increasing the junction overlap to 16 cm, maximum dose variations was reduced to 4.2%, 6.5%, and 10.2% for setup uncertainties of 2 mm, 3 mm, and 5 mm, respectively. In general, dose variation was found to increase dramatically with increasing magnitude of setup uncertainty. The technique can be made more robust against setup uncertainty by using large overlap between adjacent VMAT arcs. Conclusion: Overlapping VMAT arcs can be used effectively for conformal irradiation of PTVs with large SI dimension. The dosimetric impact of uncertainties in required isocenter shifts can be minimized by planning with large overlap between adjacent arcs and by keeping setup uncertainty ≤ 2mm.

60 APPLIED LIFE SCIENCES↗