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At least 1,693 records · Page 94
All sourcesNASA NTRSDOE OSTI
DOE OSTI2014

SU-E-T-426: Dose Delivery Accuracy in Breast Field Junction for Free Breath and Deep Inspiration Breath Hold Techniques

Purpose: The purpose of this work was to verify the accuracy of the dose distribution along the field junction in a half beam irradiation technique for breast cancer patients receiving radiation to the breast or chest wall (CW) and the supraclavicular LN region for both free breathing and deep inspiration breath hold (DIBH) technique. Methods: We performed in vivo measurements for nine breast cancer patients receiving radiation to the breast/CW and to the supraclavicular LN region. Six patients were treated to the left breast/CW using DIBH technique and three patients were treated to the right breast/CW in free breath. We used five microMOSFET dosimeters: three located along the field junction, one located 1 cm above the junction and the fifth microMOSFET located 1 cm below the junction. We performed consecutive measurements over several days for each patient and compared the measurements to the TPS calculation (Eclipse, Varian™). Results: The calculated and measured doses along the junction were 0.97±0.08 Gy and 1.02±0.14 Gy, respectively. Above the junction calculated and measured doses were 0.91±0.08 Gy and 0.98±0.09 Gy respectively, and below the junction calculated and measured doses were 1.70±0.15 Gy and 1.61±0.09 Gy, respectively. All differences were not statistically significant. When comparing calculated and measured doses for DIBH patients only, there was still no statistically significant difference between values for all dosimeter locations. Analysis was done using the Mann-Whitney Rank-Sum Test. Conclusion: We found excellent correlation between calculated doses from the TPS and measured skin doses at the junction of several half beam fields. Even for the DIBH technique, where there is more potential for variance due to depth of breath, there is no over or underdose along the field junction. This correlation validates the TPS, as well an accurate, reproducible patient setup.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-431: Vertically-Oriented Farmer-Type Chamber for Small-Field Applications

Purpose: To introduce a non-conventional measurement setup using Farmer-type chambers to accommodate several situations of small-field dose measurements without compromising accuracy. The validation of this technique was demonstrated for photon small-field output measurements, and electron small-field percentage depth-dose (PDD) measurements. Methods: Initial chamber alignment was performed using the conventional (horizontally-oriented) chamber setup. A PDD was acquired for a 4×4 cm{sup 2} field size using this arrangement. This PDD was used as a positional reference for the vertically-oriented chamber (VOC) configuration. Next, a PDD was acquired for a 4×4 cm{sup 2} field size with the VOC. The PDD's were superimposed to find the effective shift of the VOC. Using the shifted VOC setup, photon small-field output factors were measured and compared to stereotactic diode output factor measurements. Additionally, electron smallfield PDD's were acquired using the VOC setup and results were compared to electron Monte Carlo (eMC) predictions in the Eclipse treatment planning system (TPS). Results: (1) For photon small-field output factors field-sizes 2×2 cm{sup 2} and larger, the difference between the VOC setup and SFD measurements were less than 0.8%. For field sizes less than 2×2 cm{sup 2} discrepancies ranged from 4.0 to 10.6%. (2) PDD's measured by VOC setup show better than 1.6% agreement as compared to eMC for all electron energies measured down to the 80% depth on the 2×2 cm{sup 2} PDD curve. Disagreement between the VOC setup measurement and eMC calculations for depths down to the 50% depth on the PDD curve is 3.6% or less. Conclusion: Using the VOC setup, it is possible to use a conventional farmer chamber for small field-size measurements down to 2×2 cm{sup 2} field size without sacrificing the accuracy of measurements.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-440: Elliptical Source Model for IMRT and VMAT with Complex Modulation

Purpose: To improve dose calculation accuracy for highly modulated fields in IMRT and VMAT using an elliptical source model. Methods: For 2 TrueBeam linacs equipped with Millennium and HD MLCs, the source model of 6 and 15 MV beams was optimized with adjustments of the focal spot dimensions in the Varian Eclipse TPS. Starting from the measured focal spot size of 1.75 × 1.75 mm, the y-dimension of the source was varied while the x-dimension was kept constant. In addition, all other modeling parameters such as the extrafocal source and dosimetric leaf gap remained unchanged. The different models were compared with measured penumbra for jaws and MLC using ion chamber and diode. For 2 IMRT and 2 VMAT cases, the calculated doses were compared with radiochromic film and EPID measurements. Results: A source size of 1.75 × 0.75 mm was found to be optimal for beam modeling. The calculated penumbra (80–20) of a MLCdefined open field was within 0.8 mm compare to measurement for both the inline and crossline profile for various field sizes and depths. The dose gradients in the direction perpendicular to the MLC travel direction was better modeled compared to the source model with a circular focal spot of 1.75 mm for the fields with rigorous MLC modulation. Local differences up to 8% were found in those regions. Conclusion: The conventional source model using a symmetric focal spot tends to overestimate the penumbra perpendicular to the MLC travel direction, resulting in an inaccurate dose calculation especially for fields with complex MLC modulation. This can be improved with an elliptical source model and it can be considered as a standard as IMRT and VMAT treatments are becoming a norm for the clinic.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-450: Dosimetric Impact of Rotational Error On Multiple-Target Intensity-Modulated Radiosurgery (IMRS) with Single-Isocenter

Purpose: Evaluating the dosimetric-impact on multiple-targets placed away from the isocenter-target with varying rotational-error introduced by initial setup uncertainty and/or intrafractional-movement Methods: CyberKnife-Phantom was scanned with the Intracranial SRS-protocol of 1.25mm slice-thickness and the multiple-targets(GTV) of 1mm and 10mm in diameter were contoured on the Eclipse. PTV for distal-target only was drawn with 1mm expansion around the GTV to find out how much margin is needed to compensate for the rotational-error. The separation between the isocenter-target and distal-target was varied from 3cm to 7cm. RapidArc-based IMRS plans of 16Gy single-fraction were generated with five non-coplanar arcs by using Varian TrueBeam-STx equipped with high resolution MLC leaves of 2.5mm at center and with dose-rate of 1400MU/min at 6MV for flatteringfilter- free(FFF). An identical CT image with intentionally introduced 1° rotational-error was registered with the planning CT image, and the isodose distribution and Dose-Volume-Histogram(DVH) were compared with the original plans. Additionally, the dosimetric-impact of rotational error was evaluated with that of 6X photon energy which was generated with the same target-coverage. Results: For the 1mm-target with 6X-FFF, PTV-coverage(D100) of the distal-target with 1° rotational-error decreased from 1.00 to 0.35 as the separation between isocenter-target and distal-target increased from 3cm to 7cm. However, GTV-coverage(D100) was 1.0 except that of 7cm-separation(0.55), which resulted from the 1mm-margin around the distal-target. For 6X photon, GTV-coverage remained at 1.0 regardless of the separation of targets, showing that the dosimetric-impact of rotational error depends on the degree of rotational-error, separation of targets, and dose distribution around targets. For 10mm-target, PTV-coverage of distaltarget located 3cm-away was better than that of 1mm-target(0.93 versus 0.7) and GTV-coverage was 1.0 regardless of 6X-FFF/6X photon beams. Conclusion: RapidArc-based Multiple-target IMRS may Resultin a compromised outcome due to the setup-error for distal-targets. With 1mm-margin, GTV-coverage of distal-target was 1.0 although the separation of targets was up to 5cm.

07 ISOTOPE AND RADIATION SOURCES↗
DOE OSTI2014

SU-E-T-454: Impact of Calculation Grid Size On Dosimetry and Radiobiological Parameters for Head and Neck IMRT

Purpose: IMRT has become standard of care for complex treatments to optimize dose to target and spare normal tissues. However, the impact of calculation grid size is not widely known especially dose distribution, tumor control probability (TCP) and normal tissue complication probability (NTCP) which is investigated in this study. Methods: Ten head and neck IMRT patients treated with 6 MV photons were chosen for this study. Using Eclipse TPS, treatment plans were generated for different grid sizes in the range 1–5 mm for the same optimization criterion with specific dose-volume constraints. The dose volume histogram (DVH) was calculated for all IMRT plans and dosimetric data were compared. ICRU-83 dose points such as D2%, D50%, D98%, as well as the homogeneity and conformity indices (HI, CI) were calculated. In addition, TCP and NTCP were calculated from DVH data. Results: The PTV mean dose and TCP decreases with increasing grid size with an average decrease in mean dose by 2% and TCP by 3% respectively. Increasing grid size from 1–5 mm grid size, the average mean dose and NTCP for left parotid was increased by 6.0% and 8.0% respectively. Similar patterns were observed for other OARs such as cochlea, parotids and spinal cord. The HI increases up to 60% and CI decreases on average by 3.5% between 1 and 5 mm grid that resulted in decreased TCP and increased NTCP values. The number of points meeting the gamma criteria of ±3% dose difference and ±3mm DTA was higher with a 1 mm on average (97.2%) than with a 5 mm grid (91.3%). Conclusion: A smaller calculation grid provides superior dosimetry with improved TCP and reduced NTCP values. The effect is more pronounced for smaller OARs. Thus, the smallest possible grid size should be used for accurate dose calculation especially in H and N planning.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-458: Determining Threshold-Of-Failure for Dead Pixel Rows in EPID-Based Dosimetry

Purpose: A pixel correction map is applied to all EPID-based applications on the TrueBeam (Varian Medical Systems, Palo Alto, CA). When dead pixels are detected, an interpolative smoothing algorithm is applied using neighboring-pixel information to supplement missing-pixel information. The vendor suggests that when the number of dead pixels exceeds 70,000, the panel should be replaced. It is common for entire detector rows to be dead, as well as their neighboring rows. Approximately 70 rows can be dead before the panel reaches this threshold. This study determines the number of neighboring dead-pixel rows that would create a large enough deviation in measured fluence to cause failures in portal dosimetry (PD). Methods: Four clinical two-arc VMAT plans were generated using Eclipse's AXB algorithm and PD plans were created using the PDIP algorithm. These plans were chosen to represent those commonly encountered in the clinic: prostate, lung, abdomen, and neck treatments. During each iteration of this study, an increasing number of dead-pixel rows are artificially applied to the correction map and a fluence QA is performed using the EPID (corrected with this map). To provide a worst-case-scenario, the dead-pixel rows are chosen so that they present artifacts in the highfluence region of the field. Results: For all eight arc-fields deemed acceptable via a 3%/3mm gamma analysis (pass rate greater than 99%), VMAT QA yielded identical results with a 5 pixel-width dead zone. When 10 dead lines were present, half of the fields had pass rates below the 99% pass rate. With increasing dead rows, the pass rates were reduced substantially. Conclusion: While the vendor still suggests to request service at the point where 70,000 dead rows are measured (as recommended by the vendor), the authors suggest that service should be requested when there are greater than 5 consecutive dead rows.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

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

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

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-483: Treatment Planning Study of Volumetric Modulated Arc Therapy for Left-Sided Breast and Chestwall Cancers

Purpose: To perform the comparison of dose distributions and dosevolume- histograms generated by VMAT and conventional field-in-field technique for left-sided breast and chestwall cancers; to determine whether VMAT offers more dosimetric benefits than does the field-in-field technique. Methods: All VMAT and field-in-filed plans were produced in Eclipse(version 10). Five plans were generated for left-sided breast and leftsided chestwall with supraclavicular nodes, respectively. A clockwise arc (CW) and a counter-clockwise arc (CCW) were used with start and stop angles being 310o±10o and 140o±10o. Collimator angles were 30o for CW and 330o for CCW. The conformity index (CI) is the ratio of V95% over PTV. The homogeneity index (HI) is the ratio of the difference between D2% and D98% over the prescribed dose. The V5, as an indicator of low dose bath to organs-at-risk, was used for ipsilateral lung, heart, contralateral lung, and contralateral breast. The V20, as an indicator of radiation pneumonitis, was used for ipsilateral lung. Results: Breast/chestwall VMAT delivers much higher low dose bath to ipsilateral lung, contralateral lung and contralateral breast/chestwall for both intact breast and chestwall with nodes. V5 for heart is increased in VMAT plans. V20 for ipsilateral lung is lower in VMAT plans. PTV coverage is similar for both techniques. For one particular chestwall patient with supraclavicular and internal mammary nodes, VMAT offers superior dose coverage of PTVs with slightly more low-dose-wash to heart, contralateral lung and contralateral breast. Conclusion: This study indicates that there is generally no benefit using VMAT for left-sided intact breast, due to large low-dose-bath (5Gy) to normal tissues with insignificant improvement in PTV coverage. Dosimetric benefits will be seen in VMAT plans for some chestwall patients with large size, and/or internal mammary nodes, etc. Whether a chestwall patient is treated with VMAT should be carefully analyzed on an individual basis.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-493: Analysis of the Impact of Range and Setup Uncertainties On the Dose to Brain Stem and Whole Brain in the Passively Scattered Proton Therapy Plans

Purpose: To quantify the impact of range and setup uncertainties on various dosimetric indices that are used to assess normal tissue toxicities of patients receiving passive scattering proton beam therapy (PSPBT). Methods: Robust analysis of sample treatment plans of six brain cancer patients treated with PSPBT at our facility for whom the maximum brain stem dose exceeded 5800 CcGE were performed. The DVH of each plan was calculated in an Eclipse treatment planning system (TPS) version 11 applying ±3.5% range uncertainty and ±3 mm shift of the isocenter in x, y and z directions to account for setup uncertainties. Worst-case dose indices for brain stem and whole brain were compared to their values in the nominal plan to determine the average change in their values. For the brain stem, maximum dose to 1 cc of volume, dose to 10%, 50%, 90% of volume (D10, D50, D90) and volume receiving 6000, 5400, 5000, 4500, 4000 CcGE (V60, V54, V50, V45, V40) were evaluated. For the whole brain, maximum dose to 1 cc of volume, and volume receiving 5400, 5000, 4500, 4000, 3000 CcGE (V54, V50, V45, V40 and V30) were assessed. Results: The average change in the values of these indices in the worst scenario cases from the nominal plan were as follows. Brain stem; Maximum dose to 1 cc of volume: 1.1%, D10: 1.4%, D50: 8.0%, D90:73.3%, V60:116.9%, V54:27.7%, V50: 21.2%, V45:16.2%, V40:13.6%,Whole brain; Maximum dose to 1 cc of volume: 0.3%, V54:11.4%, V50: 13.0%, V45:13.6%, V40:14.1%, V30:13.5%. Conclusion: Large to modest changes in the dosiemtric indices for brain stem and whole brain compared to nominal plan due to range and set up uncertainties were observed. Such potential changes should be taken into account while using any dosimetric parameters for outcome evaluation of patients receiving proton therapy.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-496: A Study of Two Commercial Dose Calculation Algorithms in Low Density Phantom

Purpose: Some lung cancer patients have very low lung density due to comorbidities. We investigate calculation accuracy of Eclipse AAA and Acuros(AXB) using a phantom that simulates this situation. Methods: A 2.5 x 5.0 x 5 cm (long) solid water inhomogeneity positioned 10 cm deep in a Balsa lung phantom (density 0.099 gm/cc) was irradiated with an off-center field such that the central axis was parallel to one side of the inhomogeneity. Radiochromic films were placed at 2.5cm(S1) and 5cm(S2) depths. After CT scanning, Hounsfield Units(HU) were converted to electron(ρe) and mass(ρm) density using in-house(IH) and vendor-supplied(V) calibration curves. IH electron densities were generated using a commercial electron density phantom. The phantom was exposed to 6 MV 3x3 and 20x20 fields. Dose distributions were calculated using the AAA and AXB algorithms. Results: The HU of BW is -910±40 which translates to ρe of 0.088±0.050(IH) and 0.090±0.050(V), and ρm of 0.101±0.045(IH) and 0.103±0.039(V). Both ρe(V) and ρm(V) are higher than ρe(IH) and ρm(IH) respectively by 1.4-5.3% and 0.5-12.3%. The average calculated dose inside the solid water ‘tumor’ are within 3.7% and 2.4% of measurements for both calibrations and field sizes using AAA and AXB. Within 10mm outside the ‘tumor’, AAA on average underestimates by 18.3% and 17.0% respectively for 3x3 using IH and V. AXB underestimates by 5.9%(S1)-6.6%(S2) and 13.1%(S1)-16.0%(S2) respectively using IH and V. For 20x20, AAA and AXB underestimate by 2.8%(S1)-4.4%(S2) and 0.3%(S1)-1.4%(S2) respectively with either calibration. Conclusion: The difference in the HU calibration between V and IH is not of clinical significance in normal field sizes. In the low density region of small fields, the calculations from both algorithms differ significantly from measurements. This may be attributed to the insufficient lateral electron transport modeled by two algorithms resulting in the over-estimation in penumbra expansion.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-504: Usefulness of CT-MR Fusion in Radiotherapy Planning for Prostate Cancer Patient with Bilateral Hip Replacements

Purpose: Target localization of prostate for Intensity Modulated Radiation Therapy (IMRT) in patients with bilateral hip replacements is difficult due to artifacts in Computed Tomography (CT) images generated from the prostheses high Z materials. In this study, Magnetic Resonance (MR) images fused with CT images are tested as a solution. Methods: CT images of 2.5 mm slice thickness were acquired on a GE Lightspeed scanner with a flat-topped couch for a prostate cancer patient with bilateral hip replacements. T2 weighted images of 5 mm separation were acquired on a MR Scanner. After the MR-CT registration on a radiotherapy treatment planning system (Eclipse, Varian), the target volumes were defined by the radiation oncologists on MR images and then transferred to CT images for planning and dose calculation. The CT Hounsfield Units (HU) was reassigned to zero (as water) for artifacts. The Varian flat panel treatment couch was modeled for dose calculation accuracy with heterogeneity correction. A Volume Matrix Arc Therapy (VMAT) and a seven-field IMRT plans were generated, each avoiding any beam transversing the prostheses; the two plans were compared. The superior VMAT plan was used for treating the patient. In-vivo dosimetry was performed using MOSFET (Best Canada) placed in a surgical tube inserted into the patient rectum during therapy. The measured dose was compared with planned dose for MOSFET location. Results: The registration of MR-CT images and the agreement of target volumes were confirmed by three physicians. VMAT plan was deemed superior to IMRT based on dose to critical nearby structures and overall conformality of target dosing. In-vivo measured dose compared with calculated dose was -4.5% which was likely due to attenuation of the surgical tube surrounding MOSFET. Conclusion: When artifacts are present on planning CT due to bilateral hip prostheses, MR-CT image fusion is a feasible solution for target delineation.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

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

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

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-532: Validation and Implementation of Model-Based Patient Specific Quality Assurance Using Mobius3D and MobiusFX in a Clinical Setting

Purpose: This work carries out the commissioning and validation of the Mobius3D and MobiusFX software tools, which can replace the time-consuming measurement-based patient specific quality assurance (PSQA). Methods: The beam model supplied by Mobius3D was validated against a 21EX linac's beam measured data. Complex patient (VMAT) plans using Eclipse treatment planning system (TPS) was used to test the consistency between Mobius3D (calculates dose using patient image and field data) and MobiusFx (calculates dose using treatment dynalog files). Dose difference and gamma analysis (3%/3mm) between Mobius3D and MobiusFx were used to assess treatment plan and treatment delivery consistency. An end-to-end test was performed to validate Mobius3D and MobiusFx against ion chamber measurements. Effect of the dosimetric leaf gap (DLG) on Mobius3D dose calculation was additionally investigated. Results: Mobius3D beam model parameters matched within 1%-3% with our beam measured data. A comparison of Mobius3D and MobiusFx dose matrices for VMAT planned prostate cases showed (0.33±0.07)% mean dose difference with gamma values above 95%. The end-to-end test showed dose differences of 1% between Mobius3D and MobiusFx. Dependence of Mobius3D dose calculation upon DLG was explored by introducing a ±0.5 mm change in the default value for DLG. This change resulted in agreement differences above 2% Conclusion: Use of reference beam data would appear to speed up commissioning process for the clinical implementation of Mobius3D. However, careful consideration is required when comparing the information provided by the software, since large dose variations can be seen when the proper parameters are not optimized. The plan and delivered dose were in good agreement; hence MobiusFx has the potential to significantly speed up the PSQA process and at the same time helps to verify treatment parameters that are not possible with measurement-based PSQA.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-533: Evaluation of Dose Calculation Accuracy for Small Elongated Targets On the Edge Linac

Purpose: To evaluate output factors and dose calculation accuracy on a novel SRS linear accelerator, the Edge (Varian), for treatments of small, elongated targets using flattening filter free (FFF) beam. Methods: Total scatter/output factors (OF’s) for 24 elongated, small, high definition multi-leaf collimator (HDMLC)-defined fields were measured on the Edge machine using 6X FFF beam. 3 detectors were used in water tank: CC01 ion chamber (active volume 10cc), stereotactic photon diode (SFD) (active diameter 0.6mm, active thickness 0.06mm), Edge detector (active volume 0.0019cc). The 24 MLC apertures have widths ranging from 5 to 20mm and length/width ratio from 0.25 to 5. Readings were cross calibrated with CC04 at field size 3×3 cm. A beam model was developed using commissioning measurements for treatment planning in Eclipse (AAA, version 11). One representative patient case (IMRT, target volume 0.2cc, 4×4×14mm) was calculated using AAA 11 and delivered on the Edge. Results: Due to volume averaging effects, CC01 readings were 11.2±0.9% lower than SFD readings for 5mm field sizes. The Edge diode showed a uniform over-response of 2.6±0.7% compared to SFD. Calculation using AAA v11 showed the best agreement with SFD measurements (2.4±1.7% lower than SFD). The largest difference between AAA v11 and SFD occurs at 5mm field sizes. For the patient plan, dose delivered on Edge was measured to be 2.2% higher than AAA v11 calculation. Conclusion: Cross-calibrated SFD output measurements presented the best agreement with commissioned AAA v11 beam model. Field sizes smaller than 1cm posed challenges to both the detectors and the calculation algorithm. For the representative patient with small elongated target, AAA v11 and measurements agreed within ~2% on the Edge linac. Although encouraging, a more comprehensive study is required to validate the overall algorithmic accuracy.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-548: How To Decrease Spine Dose In Patients Who Underwent Sterotactic Spine Radiosurgery?

Purpose: Stereotactic radiosurgery for spine metastases involves irradiation using a single high dose fraction. The purpose of this study was to dosimetrically compare stereotactic spine radiosurgery(SRS) plans using a recently new volumetric modulated arc therapy(VMAT) technique against fix-field intensity-modulated radiotherapy(IMRT). Plans were evaluated for target conformity and spinal cord sparing. Methods: Fifteen previously treated patients were replanned using the Eclipse 10.1 TPS AAA calculation algorithm. IMRT plans with 7 fields were generated. The arc plans used 2 full arc configurations. Arc and IMRT plans were normalized and prescribed to deliver 16.0 Gy in a single fraction to 90% of the planning target volume(PTV). PTVs consisted of the vertebral body expanded by 3mm, excluding the PRV-cord, where the cord was expanded by 2mm.RTOG 0631 recommendations were applied for treatment planning. Partial spinal cord volume was defined as 5mm above and below the radiosurgery target volume. Plans were compared for conformity and gradient index as well as spinal cord sparing. Results: The conformity index values of fifteen patients for two different treatment planning techniques were shown in table 1. Conformity index values for 2 full arc planning (average CI=0.84) were higher than that of IMRT planning (average CI=0.79). The gradient index values of fifteen patients for two different treatment planning techniques were shown in table 2. Gradient index values for 2 full arc planning (average GI=3.58) were higher than that of IMRT planning (average GI=2.82).The spinal cord doses of fifteen patients for two different treatment planning techniques were shown in table 3. D0.35cc, D0.03cc and partial spinal cord D10% values in 2 full arc plannings (average D0.35cc=819.3cGy, D0.03cc=965.4cGy, 10%partial spinal=718.1cGy) were lower than IMRT plannings (average D0.35cc=877.4cGy, D0.03c=1071.4cGy, 10%partial spinal=805.1cGy). Conclusions: The two arc VMAT technique is superior to 7 field IMRT technique in terms of both spinal cord sparing and better conformity and gradient indexes.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-551: PTV Is the Worst-Case of CTV in Photon Therapy

Purpose: To examine the supposition of the static dose cloud and adequacy of the planning target volume (PTV) dose distribution as the worst-case representation of clinical target volume (CTV) dose distribution for photon therapy in head and neck (H and N) plans. Methods: Five diverse H and N plans clinically delivered at our institution were selected. Isocenter for each plan was shifted positively and negatively in the three cardinal directions by a displacement equal to the PTV expansion on the CTV (3 mm) for a total of six shifted plans per original plan. The perturbed plan dose was recalculated in Eclipse (AAA v11.0.30) using the same, fixed fluence map as the original plan. The dose distributions for all plans were exported from the treatment planning system to determine the worst-case CTV dose distributions for each nominal plan. Two worst-case distributions, cold and hot, were defined by selecting the minimum or maximum dose per voxel from all the perturbed plans. The resulting dose volume histograms (DVH) were examined to evaluate the worst-case CTV and nominal PTV dose distributions. Results: Inspection demonstrates that the CTV DVH in the nominal dose distribution is indeed bounded by the CTV DVHs in the worst-case dose distributions. Furthermore, comparison of the D95% for the worst-case (cold) CTV and nominal PTV distributions by Pearson's chi-square test shows excellent agreement for all plans. Conclusion: The assumption that the nominal dose distribution for PTV represents the worst-case dose distribution for CTV appears valid for the five plans under examination. Although the worst-case dose distributions are unphysical since the dose per voxel is chosen independently, the cold worst-case distribution serves as a lower bound for the worst-case possible CTV coverage. Minor discrepancies between the nominal PTV dose distribution and worst-case CTV dose distribution are expected since the dose cloud is not strictly static. This research was supported by the NCI through grant K25CA168984, by The Lawrence W. and Marilyn W. Matteson Fund for Cancer Research, and by the Fraternal Order of Eagles Cancer Research Fund, the Career Development Award Program at Mayo Clinic.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-576: Evaluation of Patient Specific VMAT QA Using Dynalog Files and Treatment Planning System

Purpose: This research investigates the use of Mult-ileaf Collimator (MLC) dynalog files to modify a Volumetric Arc Therapy (VMAT) DICOM Radiotherapy Treatment file from the Treatment Planning System (TPS) for quality assurance and treatment plan verification. Methods: Actual MLC positions and gantry angles where retrieved from the MLC Dynalog files of an approved and treated VMAT plan. The treatment machine used was a Novalis TX linac equipped with high definition MLC. The DICOM RT file of the plan was exported from the TPS (Eclipse, Varian Medical Systems) and the actual MLC leaf positions and gantry angles were inserted in place of the planned positions for each control point. The modified DICOM RT file was then imported back into the TPS where dose calculations were performed. The resulting dose distributions were then exported to VeriSoft (PTW) where a 3D gamma was calculated using 3mm-3% and 2mm-2% criteria. A 2D gamma was also calculated using dose measurements on the Delta4 (Sandidose) phantom. Results: A 3D gamma was calculated in Verisoft at 3mm-3% of 99.5% and at 2mm-2% of 99.2%. The pretreatment verification on the Delta4 yielded a 2D gamma at 3mm-3% of 97.9% and at 2mm-2% of 88.5%. The dose volume histograms of the approved plan and the dynalog plan are virtually identical. Conclusion: Initial results show good agreement of the dynalog dose distribution with the approved plan. Future work on this research will aim to increase the number of patients and replace the planned fractionated dose per control point with the actual fractionated dose.

07 ISOTOPE AND RADIATION SOURCES↗
DOE OSTI2014

SU-E-T-578: MCEBRT, A Monte Carlo Code for External Beam Treatment Plan Verifications

Purpose: Present a new Monte Carlo code (MCEBRT) for patient-specific dose calculations in external beam radiotherapy. The code MLC model is benchmarked and real patient plans are re-calculated using MCEBRT and compared with commercial TPS. Methods: MCEBRT is based on the GEPTS system (Med. Phys. 29 (2002) 835–846). Phase space data generated for Varian linac photon beams (6 – 15 MV) are used as source term. MCEBRT uses a realistic MLC model (tongue and groove, rounded ends). Patient CT and DICOM RT files are used to generate a 3D patient phantom and simulate the treatment configuration (gantry, collimator and couch angles; jaw positions; MLC sequences; MUs). MCEBRT dose distributions and DVHs are compared with those from TPS in absolute way (Gy). Results: Calculations based on the developed MLC model closely matches transmission measurements (pin-point ionization chamber at selected positions and film for lateral dose profile). See Fig.1. Dose calculations for two clinical cases (whole brain irradiation with opposed beams and lung case with eight fields) are carried out and outcomes are compared with the Eclipse AAA algorithm. Good agreement is observed for the brain case (Figs 2-3) except at the surface where MCEBRT dose can be higher by 20%. This is due to better modeling of electron contamination by MCEBRT. For the lung case an overall good agreement (91% gamma index passing rate with 3%/3mm DTA criterion) is observed (Fig.4) but dose in lung can be over-estimated by up to 10% by AAA (Fig.5). CTV and PTV DVHs from TPS and MCEBRT are nevertheless close (Fig.6). Conclusion: A new Monte Carlo code is developed for plan verification. Contrary to phantombased QA measurements, MCEBRT simulate the exact patient geometry and tissue composition. MCEBRT can be used as extra verification layer for plans where surface dose and tissue heterogeneity are an issue.

60 APPLIED LIFE SCIENCES↗