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At least 1,711 records · Page 95
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DOE OSTI2014

SU-E-T-618: Dosimetric Comparison of Manual and Beam Angle Optimization of Gantry Angles in IMRT for Cervical Cancer

Purpose: To evaluate the dosimetric characteristics of intensity-modulated radiotherapy (IMRT) treatment plan with beam angle optimization. Methods: Ten post-operation patients with cervical cancer were included in this analysis. Two IMRT plans using seven beams were designed in each patient. A standard coplanar equi-space beam angles were used in the first plan (plan 1), whereas the selection of beam angle was optimized by beam angle optimization algorithm in Varian Eclipse treatment planning system for the same number of beams in the second plan (plan 2). Two plans were designed for each patient with the same dose-volume constraints and prescription dose. All plans were normalized to the mean dose to PTV. The dose distribution in the target, the dose to the organs at risk and total MU were compared. Results: For conformity and homogeneity in PTV, no statistically differences were observed in the two plans. For the mean dose in bladder, plan 2 were significantly lower than plan 1(p<0.05). No statistically significant differences were observed between two plans for the mean doses in rectum, left and right femur heads. Compared with plan1, the average monitor units reduced 16% in plan 2. Conclusion: The IMRT plan based on beam angle optimization for cervical cancer could reduce the dose delivered to bladder and also reduce MU. Therefore there were some dosimetric advantages in the IMRT plan with beam angle optimization for cervical cancer.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-628: Effect of Dose Rate and Leakage Correction for Dosimetric Leaf Gap Measurement

Purpose: To study the dose rate response of Mapcheck and quantify/correct dose rate/leakage effect on IMRT QA. Evaluate the dose rate/leakage effect on dosimetric leaf gap (DLG) measurement. Methods: Varian Truebeam Linac with HD120 MLC was used for all measurement, it is capable to adjust dose rate from 600MU/min to 5MU/min. Fluke Advanced Therapy Doisemter and PTW 30013 Farmer chamber for chamber measurement; SunNuclear Mapcheck2 with 5cm total buildup for diode measurement. DLG was measured with both chamber and diode.Diode response was measured by varies dose rate, while fixed mapcheck setup and total MU. MLC Leakage was measured with both chamber and diode. Mapcheck measurement was saved as movie file (mcm file), which include measurement updated every 50mSec. The difference between intervals can be converted to dose and dose rate and leakage response correction can be applied to them. Results: DLG measurement results with chamber and diode were showed as follows, the DLG value is 0.36 vs. 0.24mm respectively. Diode dose rate response drops from 100% at 600MU/min to 95.5% at 5MU/min as follows. MLC Leakage measured with diode is 1.021%, which is 9% smaller than 1.112% from chamber measurement. By apply the dose rate and leakage correction, the residue error reduced 2/3. Conclusions: Diode has lower response at lower dose rate, as low as 4.5% for 5MU/min; diode has lower energy response for low energy too, 5% lower for Co-60 than 6MV. It partially explains the leakage difference of 9% between chamber and diode. Lower DLG with diode is because of the lower response at narrower gap, in Eclipse however DLG need to increase to makeup lower response, which is over correction for chamber though. Correction can reduce error by 2/3, the rest 1/3 can be corrected by scatter effect, which is under study.

07 ISOTOPE AND RADIATION SOURCES↗
DOE OSTI2014

SU-E-T-630: Commissioning for SRS Planning Systems

Purpose: This study will try to find optimal procedures to collect small fields beam data for commissioning in treatment planning systems (TPS), and to provide a protocol to collect output factors for very small field sizes: 0.5 cm × 0.5 cm to 4.0 cm × 4.0 cm.This will help in determining the correct beam configuration methods in TPS planning intensity modulated radiation therapy (IMRT), and stereotactic radiosurgery SRS using mini multileaf collimation (mMLC). Methods: Data has been collected for a mMLC linear accelerator (linac) Novalis from 0.5 cm × 0.5 cm to 10 cm × 10 cm (its maximum field size). The TPS chosen is BrainLab, Eclipse and Cyberknife. The beam data collected was modeled and imported in the TPS. Verification plans were generated in solid water to confirm the goodness of the data. 3D and IMRT plans on regular CT scans were generated and verified using Mapcheck. All 3D plans with field sizes above 4 cm × 4 cm verified excellent using a distance to agreement of 2 mm and a 2% tolerance. IMRT plans gave an error of -8%. New scans with new detectors have been taken, new field sizes were introduced, and focus has been applied on determining the dosimetric leaf gap. Results: Although this is still a work in progress, this study brings several issues to light: the importance of the correct technique in beam data collection from the correct watertank to the correct detectors. Readings for rectangular fields have to be taken especially for fields which one side is under 4 cm. Conclusion: The use of equivalent square fields will not provide correct readings for the fields with large differences between the length and the width.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2014

SU-E-T-631: Commissioning and Comprehensive Evaluation of the ArcCHECK Cylindrical Diode Array for VMAT QA

Purpose: Commissioning and comprehensive evaluation of ArcCHECK phantom for dosimetry of VMAT QA, using 6MV photon beam with and without the flattening filter. Methods: ArcCHECK was evaluated for response dependency on linac dose rate, instantaneous dose rate, radiation field size, beam angle and couch insertion. Scatter dose characterization, consistency and symmetry of response, dosimetric accuracy of fixed aperture arcs and clinical VMAT plans were investigated. Measurements were done using TrueBeam™ STx accelerator (Console version 1.6) with a 6 MV beam with and without flattening filter. Reference dose-grids were calculated using Eclipse TPS Analytical Anisotropic Algorithm (AAA version 10.0.39). Planned doses were calculated using symmetric 2mm 3D dose grids with 4 degree angular resolution defaulted to each control point. Gamma evaluations were performed in absolute dose mode, with default normalization to maximum dose in the curved plane and a low dose threshold of 10% to restrict the analysis to clinically relevant areas. Global and local gamma indices at 3mm/3% and 2mm/2% level were computed using SNC software (version 6.0). Results: Results of gamma analysis demonstrated an overall agreement between ArcCHECK measured and TPS calculated reference doses. Field size dependency was within 0.5% of the reference. Dose-rate based dependency was well within 1% of the TPS reference and the angular dependency was ±3% of the reference, as tested for BEV angles. At the level of 3%/3mm, narrow and wide open arcs as well as clinical VMAT cases demonstrated high level of dosimetry accuracy in global gamma passing rates for both 6X and 6F beams. At the level of 2%/2mm two VMAT cases involving the narrow heavily modulated arcs demonstrated lower passing rates. Conclusion: ArcCHECK phantom with latest software and hardware upgrades is suitable for VMAT QA. For higher sensitivity of 2%/2mm gamma analysis, we intend to use it as one of the VMAT QA evaluation metrics.

07 ISOTOPE AND RADIATION SOURCES↗
DOE OSTI2014

SU-E-T-639: A Study On the Response of 2D Array Detector for VMAT Delivery for a Period of Two Years

Purpose: To evaluate the 2D array for radiation response for a period of 2 years. Methods: 45 VMAT plans already treated and quality assured before 2 years, 1.5 years and 1 year were selected for the study. Quality assurances of the plans were done using 2D array combined with Octavius phantom. Verification plans were recalculated without changing any parameters in Eclipse 10.0 TPS using the AAA algorithm. Response of 2D array to the plans treated before 2 years, 1.5 years and 1 year where evaluated. The results were analyzed using the Gamma analysis method with the standard gamma passing criteria of 3mm distance to agreement (DTA) and 3% dose difference (DD). Results: All the plans evaluated passed the gamma analysis with a percentage greater than 95, except for three cases. Higher gamma passing criteria where observed for all the analyzed plans, when analysis done before 2 years, 1.5 years and 1 year. The standard deviation of ± 1.38, ± 1.40,± 0.97 where observed between the plans when verification plans did before 2 years, 1.5 years and 1 year respectively. Same set of plans shows a standard deviation of ± 0.70, ± 1.36, and ± 1.18, when analysis done recently. A significance difference in response of the array when analysis done recently for the verification plans treated and quality assured before 2 years.This indicates a slightly reduced response of 2D array towards radiation response as the array gets older. Conclusion: It is found that 2D array shows a reduced response against radiation detection over a period of years. An onsite calibration of the instrument is recommended before the measurements. A dose correction factor can be applied if necessary to the results if the radiation response and efficiency of the array is very poor.

07 ISOTOPE AND RADIATION SOURCES↗
DOE OSTI2014

SU-E-CAMPUS-T-01: Automation of the Winston-Lutz Test for Stereotactic Radiosurgery

Purpose: To optimize clinical efficiency and shorten patient wait time by minimizing the time and effort required to perform the Winston-Lutz test before stereotactic radiosurgery (SRS) through automation of the delivery, analysis, and documentation of results. Methods: The radiation fields of the Winston-Lutz (WL) test were created in a “machine-QA patient” saved in ARIA for use before SRS cases. Images of the BRW target ball placed at mechanical isocenter are captured with the portal imager for each of four, 2cm×2cm, MLC-shaped beams. When the WL plan is delivered and closed, this event is detected by in-house software called EventNet which automates subsequent processes with the aid of the ARIA web services. Images are automatically retrieved from the ARIA database and analyzed to determine the offset of the target ball from radiation isocenter. The results are posted to a website and a composite summary image of the results is pushed back into ImageBrowser for review and authenticated documentation. Results: The total time to perform the test was reduced from 20-25 minutes to less than 4 minutes. The results were found to be more accurate and consistent than the previous method which used radiochromic film. The images were also analyzed with DoseLab for comparison. The difference between the film and automated WL results in the X and Y direction and the radius were (−0.17 +/− 0.28) mm, (0.21 +/− 0.20) mm and (−0.14 +/− 0.27) mm, respectively. The difference between the DoseLab and automated WL results were (−0.05 +/− 0.06) mm, (−0.01 +/− 0.02) mm and (0.01 +/− 0.07) mm, respectively. Conclusions: This process reduced patient wait times by 15–20 minutes making the treatment machine available to treat another patient. Accuracy and consistency of results were improved over the previous method and were comparable to other commercial solutions. Access to the ARIA web services is made possible through an Eclipse co-development agreement with Varian Medical Systems.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-CAMPUS-T-05: Validation of High-Resolution 3D Patient QA for Proton Pencil Beam Scanning and IMPT by Polymer Gel Dosimetry

Purpose: Validation of high-resolution 3D patient QA for proton pencil beam scanning and IMPT by polymer gel dosimetry. Methods: Four BANG3Pro polymer gel dosimeters (manufactured by MGS Research Inc, Madison, CT) were used for patient QA at the Robert's Proton Therapy Center (RPTC, Philadelphia, PA). All dosimeters were sealed in identical thin-wall Pyrex glass spheres. Each dosimeter contained a set of markers for 3D registration purposes. The dosimeters were mounted in a consistent and reproducible manner using a custom build holder. Two proton pencil beam scanning plans were designed using Varian Eclipse™ treatment planning system: 1) A two-field intensity modulated proton therapy (IMPT) plan and 2) one single field uniform dose (SFUD) plan. The IMPT fields were evaluated as a composite plan and individual fields, the SFUD plan was delivered as a single field plan.Laser CT scanning was performed using the manufacturer's OCTOPUS-IQ axial transmission laser CT scanner using a 1 mm slice thickness. 3D registration, analysis, and OD/cm to absorbed dose calibrations were perfomed using DICOM RT-Dose and CT files, and software developed by the manufacturer. 3D delta index, a metric equivalent to the gamma tool, was used for dose comparison. Results: Very good agreement with single IMPT fields and with SFUD was obtained. Composite IMPT fields had a less satisfactory agreement. The single fields had 3D delta index passing rates (3% dose difference, 3 mm DTA) of 98.98% and 94.91%. The composite 3D delta index passing rate was 80.80%. The SFUD passing rate was 93.77%. Required shifts of the dose distributions were less than 4 mm. Conclusion: A formulation of the BANG3Pro polymer gel dosimeter, suitable for 3D QA of proton patient plans is established and validated. Likewise, the mailed QA analysis service provided by the manufacturer is a practical option when required resources are unavailable. We fully disclose that the subject of this research regards a production of MGS Research, Inc.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-CAMPUS-T-06: Initial Experience of Patient-Specific QA Using a Pencil Beam Scanning Proton Therapy System

Purpose: To illustrate patient QA results for the first 10 patients treated at Scripps Proton Center by comparing point dose measurement using an ion chamber and in-house developed secondary MU program, and the measurement of 2D dose distribution using an ion chamber array. Methods: At the time of writing, 10 patient plans were approved for treatment using Varian ProBeam pencil beam scanning system and Eclipse treatment planning software. We used the IBA CC04 0.04 cm3 ion chamber and PTW Unidos E electrometer for point dose measurement in a small water tank (Sun Nuclear 1D scanner). We developed independent MU check software based on measured pencil beam dose profiles for various energies. We used PTW Octavius 729 XDR array to evaluate 2D planar dose distribution. The 3D gamma at 3%/3 mm local dose was used to compare a 3D calculated dose plan with a 2D measured dose distribution using PTW Verisoft software. All fields were exported to a verification phantom plan and delivered at 0 degrees for simplicity. Results: Comparisons between the CC04 ion chamber measurement and calculated dose agree well within 1%. The PTW Octavius 729 XDR array exhibited some dose rate dependence in high dose rate pencil beam delivery. Nevertheless, the results, used as a relative measurement, passed the gamma criteria of 3%/3mm for greater than 90% of area in all patient fields. Visual inspection showed good agreement between ion chamber dose profile and the calculated plan. The in-house secondary check for MU agreed very well with the plan dose and measurement. The results will be updated with more patients treated. Conclusion: The initial patient specific QA results are encouraging for a new pencil beam scanning only proton therapy system.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-CAMPUS-J-06: The Impact of CT-Scan Energy On Range Uncertainty in Proton Therapy Planning

Purpose: To investigate the impact of tube potential (kVp) on the CTnumber (HU) to proton stopping power ratio (PSPR) conversion table; the range uncertainty and the dosimetric change introduced by a mismatch in kVp between the CT and the HU to PSPR table used to calculate dose are analyzed. Methods: A CIRS CT-ED phantom was scanned with a Philips Brilliance 64-slice scanner under 90kVp and 120kVp tube potentials. Two HU to PSPR curves were then created. Using Eclipse (Varian) a treatment plan was created for a single beam in a water phantom (HU=0) passing through a wedge-shaped heterogeneity (HU=1488). The dose was recalculated by changing only the HU to PSPR table used in the dose calculation. The change in range (the distal 90% isodose line) relative to a distal structure was recorded as a function of heterogeneity thickness in the beam. To show the dosimetric impact of a mismatch in kVp between the CT and the HU to PSPR table, we repeated this procedure using a clinical plan comparing DVH data. Results: The HU to PSPR tables diverge for low-density bone and higher density structures. In the phantom plan, the divergence of the tables results in a change in range of ~1mm per cm of bone in the beam path for the HU used. For the clinical plan, a mismatch in kVp showed a 28% increase in mean dose to the brainstem along with a 10% increase in maximum dose to the brainstem center. Conclusion: A mismatch in kVp between the CT and the HU to PSPR table can introduce significant uncertainty in the proton beam range. For dense bone, the measured range uncertainty is about 1mm per cm of bone in the beam. CT-scan energy verification should be employed, particularly when high-density media is in the proton beam path.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-F-BRD-15: The Impact of Dose Calculation Algorithm and Hounsfield Units Conversion Tables On Plan Dosimetry for Lung SBRT

Purpose: To assess dosimetric differences in IMRT lung stereotactic body radiotherapy (SBRT) plans calculated with Varian AAA and Acuros (AXB) and with vendor-supplied (V) versus in-house (IH) measured Hounsfield units (HU) to mass and HU to electron density conversion tables. Methods: In-house conversion tables were measured using Gammex 472 density-plug phantom. IMRT plans (6 MV, Varian TrueBeam, 6–9 coplanar fields) meeting departmental coverage and normal tissue constraints were retrospectively generated for 10 lung SBRT cases using Eclipse Vn 10.0.28 AAA with in-house tables (AAA/IH). Using these monitor units and MLC sequences, plans were recalculated with AAA and vendor tables (AAA/V) and with AXB with both tables (AXB/IH and AXB/V). Ratios to corresponding AAA/IH values were calculated for PTV D95, D01, D99, mean-dose, total and ipsilateral lung V20 and chestwall V30. Statistical significance of differences was judged by Wilcoxon Signed Rank Test (p<0.05). Results: For HU<−400 the vendor HU-mass density table was notably below the IH table. PTV D95 ratios to AAA/IH, averaged over all patients, are 0.963±0.073 (p=0.508), 0.914±0.126 (p=0.011), and 0.998±0.001 (p=0.005) for AXB/IH, AXB/V and AAA/V respectively. Total lung V20 ratios are 1.006±0.046 (p=0.386), 0.975±0.080 (p=0.514) and 0.998±0.002 (p=0.007); ipsilateral lung V20 ratios are 1.008±0.041(p=0.284), 0.977±0.076 (p=0.443), and 0.998±0.018 (p=0.005) for AXB/IH, AXB/V and AAA/V respectively. In 7 cases, ratios to AAA/IH were within ± 5% for all indices studied. For 3 cases characterized by very low lung density and small PTV (19.99±8.09 c.c.), PTV D95 ratio for AXB/V ranged from 67.4% to 85.9%, AXB/IH D95 ratio ranged from 81.6% to 93.4%; there were large differences in other studied indices. Conclusion: For AXB users, careful attention to HU conversion tables is important, as they can significantly impact AXB (but not AAA) lung SBRT plans. Algorithm selection is also important for small targets in low density lung.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-F-BRF-04: Evaluation of Five Commercially-Available Algorithms for Deformable Image Registration

Purpose: Deformable image registration (DIR) is increasingly being used in various clinical applications. Although there are several DIR packages all making successful attempts at modeling complex anatomical changes using even more complex mathematical approximations, they are all subject to various uncertainties. Many studies have attempted to quantify the spatial uncertainty with DIR. This is the first study to compare the uncertainty for interfraction DIR for 5 different commercially-available algorithms. The aim of this study was to benchmark the performance of the most commonlyused DIR algorithms offered through these 5 software packages: Eclipse, MIM, Pinnacle, RaySearch, and Velocity. Methods: A set of 10 virtual H'N phantoms [Pukala et al. MedPhys. 40(11) 2013] with known deformations were used to determine the spatial errors that might be seen when performing DIR. The “ground-truth” deformation vector field (DVF) was compared to the DVF output of the 5 commercially-available algorithms in order to evaluate spatial errors for six regions of interest (ROIs): brainstem, cord, mandible, left parotid, right parotid, and the external body contour. Results: We found that each software package had varying uncertainties with the various ROIs, but were generally all comparable to one another – with mean spatial errors for each algorithm below 3.5 mm for each ROI (averaged across all phantoms). We also found that no single algorithm was the clear winner over the other 4 algorithms. However, at times, we found huge maximum errors in our results (e.g. phantom #9 maximum errors: right parotid = 22.9 mm, external contour = 30.5mm) with the varying DIR algorithms. Conclusion: Although our evaluation was limited to H'N patients, we show that our methods are a single-assessment analysis tool that could be used by any physicist, within any type of facility, to compare their DIR software before initiating widespread use within their daily radiotherapy practice.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

MO-A-BRD-06: In Vivo Cherenkov Video Imaging to Verify Whole Breast Irradiation Treatment

Purpose: To show in vivo video imaging of Cherenkov emission (Cherenkoscopy) can be acquired in the clinical treatment room without affecting the normal process of external beam radiation therapy (EBRT). Applications of Cherenkoscopy, such as patient positioning, movement tracking, treatment monitoring and superficial dose estimation, were examined. Methods: In a phase 1 clinical trial, including 12 patients undergoing post-lumpectomy whole breast irradiation, Cherenkov emission was imaged with a time-gated ICCD camera synchronized to the radiation pulses, during 10 fractions of the treatment. Images from different treatment days were compared by calculating the 2-D correlations corresponding to the averaged image. An edge detection algorithm was utilized to highlight biological features, such as the blood vessels. Superficial dose deposited at the sampling depth were derived from the Eclipse treatment planning system (TPS) and compared with the Cherenkov images. Skin reactions were graded weekly according to the Common Toxicity Criteria and digital photographs were obtained for comparison. Results: Real time (fps = 4.8) imaging of Cherenkov emission was feasible and feasibility tests indicated that it could be improved to video rate (fps = 30) with system improvements. Dynamic field changes due to fast MLC motion were imaged in real time. The average 2-D correlation was about 0.99, suggesting the stability of this imaging technique and repeatability of patient positioning was outstanding. Edge enhanced images of blood vessels were observed, and could serve as unique biological markers for patient positioning and movement tracking (breathing). Small discrepancies exists between the Cherenkov images and the superficial dose predicted from the TPS but the former agreed better with actual skin reactions than did the latter. Conclusion: Real time Cherenkoscopy imaging during EBRT is a novel imaging tool that could be utilized for patient positioning, movement tracking, treatment monitoring, superficial dose and skin reaction estimation and prediction.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

MO-F-16A-05: Spot-Scanning Proton Therapy Patient-Specific Quality Assurance: Our Methodology and Results From 295 Treatment Plans

Purpose: To report on the patient-specific quality assurance (PSQA) results for 295 spot-scanning proton therapy treatment plans from the MD Anderson PTC-Houston. We show how the results differed by treatment site and how they were affected by the treatment plan optimization method and by a range shifter in the treatment field. We also discuss some causes of PSQA problems. Methods: The PSQA procedure, which is designed to verify both the accuracy of the treatment planning system's (Eclipse™ v8.9) dose calculations and the dose delivery of the Hitachi PROBEAT synchrotron, consists of (1) an end-to-end test in which the beam is delivered and measured at the prescribed gantry angle, and (2) additional dose plane measurements made from gantry angle 270°. HPlusQA™ software automatically performs the gamma analysis with criteria 3% (dose tolerance), 3 mm (distance-to-agreement, DTA) and 2%, 2 mm. Passing is defined as at least 90% of the pixels having a gamma score less than 1. Results: The PSQA gamma passing rate was 96.2% for 3%, 3 mm, and 85.3% for 2%, 2 mm. The rate depended on the treatment site. For example, the 3%, 3 mm passing rate was 95% for head and neck plans, vs 100% for prostate plans. The passing rates of multi- vs. single-field optimization plans did not significantly differ. However, the rate for fields with range shifters was 94.8±0.6%, vs 99.0±0.6% for those without (p = 0.002). Longitudinal dose gradients caused most of the low scores. Overestimation of the calculated dose proximal to the spread-out Bragg peak (SOBP) caused many of the others. Conclusion: The planned and delivered doses consistently agreed within tolerance levels. Minor dose modeling deficiencies remain proximal to the SOBP. The 3% dose tolerance, 3 mm DTA, with 90% pixel passing rate is a reasonable action level for 2D gamma comparisons.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

TU-C-BRE-07: Quantifying the Clinical Impact of VMAT Delivery Errors Relative to Prior Patients’ Plans and Adjusted for Anatomical Differences

Purpose: There is increased interest in the Radiation Oncology Physics community regarding sensitivity of pre-treatment IMRT/VMAT QA to delivery errors. Consequently, tools mapping pre-treatment QA to the patient DVH have been developed. However, the quantity of plan degradation that is acceptable remains uncertain. Using DVHs adapted from prior patients’ plans, we developed a technique to determine the magnitude of various delivery errors required to degrade a treatment plan to outside the clinically accepted range. Methods: DVHs for relevant organs at risk were adapted from a population of prior patients’ plans using a machine learning algorithm to establish the clinically acceptable DVH range specific to the patient’s anatomy. We applied this technique to six low-risk prostate cancer patients treated with single-arc VMAT and compared error-induced DVH changes to the adapted DVHs to determine the magnitude of error required to push the plan outside of the acceptable range. The procedure follows: (1) Errors (systematic ' random shift of MLCs, gantry-MLC desynchronization, dose rate fluctuations, etc.) were simulated and degraded DVHs calculated using the Varian Eclipse TPS. (2) Adapted DVHs and acceptable ranges for DVHs were established. (3) Relevant dosimetric indices and corresponding acceptable ranges were calculated from the DVHs. Key indices included NTCP (Lyman-Kutcher-Burman Model) and QUANTEC’s dose-volume Objectives: s of V75Gy≤0.15 for the rectum and V75Gy≤0.25 for the bladder. Results: Degradations to the clinical plan became “unacceptable” for 19±29mm and 1.9±2.0mm systematic outward shifts of a single leaf and leaf bank, respectively. All other simulated errors fell within the acceptable range. Conclusion: Utilizing machine learning and prior patients’ plans one can predict a clinically acceptable range of DVH degradation for a specific patient. Comparing error-induced DVH degradations to this range, it is shown that single-arc VMAT plans for low-risk prostate are relatively insensitive to many potential delivery errors.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

WE-F-16A-03: 3D Printer Application in Proton Therapy: A Novel Method to Deliver Passive-Scattering Proton Beams with a Fixed Range and Modulation for SRS and SRT

Purpose: To present a novel technique to deliver passive-scattering proton beam with fixed range and modulation using a 3D printed patient-specific bolus for proton stereotactic radiosurgery and radiotherapy. Methods: A CIRS head phantom was used to simulate a patient with a small brain lesion. A custom bolus was created in the Eclipse Treatment Planning System (TPS) to compensate for the different water equivalent depths from the patient surface to the target from multiple beam directions. To simulate arc therapy, a plan was created on the initial CT using three passive-scattering proton beams with a fixed range and modulations irradiating from different angles. The DICOM-RT structure file of the bolus was exported from the TPS and converted to STL format for 3D printing. The phantom was rescanned with the printed custom bolus and head cup to verify the dose distribution comparing to the initial plan. EBT3 films were placed in the sagital plane of the target to verify the delivered dose distribution. The relative stopping power of the printing material(ABSplus-P430) was measured using the Zebra multi-plate ion chamber. Results: The relative stopping power of the 3D printing material, ABSplus-P430 was 1.05 which is almost water equivalent. The dose difference between verification CT and Initial CT is almost negligible. Film measurement also confirmed the accuracy for this new proton delivery technique. Conclusion: Our method using 3D printed range modifiers simplify the treatment delivery of multiple passive-scattering beams in treatment of small lesion in brain. This technique makes delivery of multiple beam more efficient and can be extended to allow arc therapy with proton beams. The ability to create and construct complex patient specific bolus structures provides a new dimension in creating optimized quality treatment plans not only for proton therapy but also for electron and photon therapy.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

TH-A-BRF-08: Deformable Registration of MRI and CT Images for MRI-Guided Radiation Therapy

Purpose: To evaluate the quality of a commercially available MRI-CT image registration algorithm and then develop a method to improve the performance of this algorithm for MRI-guided prostate radiotherapy. Methods: Prostate contours were delineated on ten pairs of MRI and CT images using Eclipse. Each pair of MRI and CT images was registered with an intensity-based B-spline algorithm implemented in Velocity. A rectangular prism that contains the prostate volume was partitioned into a tetrahedral mesh which was aligned to the CT image. A finite element method (FEM) was developed on the mesh with the boundary constraints assigned from the Velocity generated displacement vector field (DVF). The resultant FEM displacements were used to adjust the Velocity DVF within the prism. Point correspondences between the CT and MR images identified within the prism could be used as additional boundary constraints to enforce the model deformation. The FEM deformation field is smooth in the interior of the prism, and equal to the Velocity displacements at the boundary of the prism. To evaluate the Velocity and FEM registration results, three criteria were used: prostate volume conservation and center consistence under contour mapping, and unbalanced energy of their deformation maps. Results: With the DVFs generated by the Velocity and FEM simulations, the prostate contours were warped from MRI to CT images. With the Velocity DVFs, the prostate volumes changed 10.2% on average, in contrast to 1.8% induced by the FEM DVFs. The average of the center deviations was 0.36 and 0.27 cm, and the unbalance energy was 2.65 and 0.38 mJ/cc3 for the Velocity and FEM registrations, respectively. Conclusion: The adaptive FEM method developed can be used to reduce the error of the MIbased registration algorithm implemented in Velocity in the prostate region, and consequently may help improve the quality of MRI-guided radiation therapy.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

TH-A-9A-02: BEST IN PHYSICS (THERAPY) - 4D IMRT Planning Using Highly- Parallelizable Particle Swarm Optimization

Purpose: We present a particle swarm optimization (PSO)-based 4D IMRT planning technique designed for dynamic MLC tracking delivery to lung tumors. The key idea is to utilize the temporal dimension as an additional degree of freedom rather than a constraint in order to achieve improved sparing of organs at risk (OARs). Methods: The target and normal structures were manually contoured on each of the ten phases of a 4DCT scan acquired from a lung SBRT patient who exhibited 1.5cm tumor motion despite the use of abdominal compression. Corresponding ten IMRT plans were generated using the Eclipse treatment planning system. These plans served as initial guess solutions for the PSO algorithm. Fluence weights were optimized over the entire solution space i.e., 10 phases × 12 beams × 166 control points. The size of the solution space motivated our choice of PSO, which is a highly parallelizable stochastic global optimization technique that is well-suited for such large problems. A summed fluence map was created using an in-house B-spline deformable image registration. Each plan was compared with a corresponding, internal target volume (ITV)-based IMRT plan. Results: The PSO 4D IMRT plan yielded comparable PTV coverage and significantly higher dose—sparing for parallel and serial OARs compared to the ITV-based plan. The dose-sparing achieved via PSO-4DIMRT was: lung Dmean = 28%; lung V20 = 90%; spinal cord Dmax = 23%; esophagus Dmax = 31%; heart Dmax = 51%; heart Dmean = 64%. Conclusion: Truly 4D IMRT that uses the temporal dimension as an additional degree of freedom can achieve significant dose sparing of serial and parallel OARs. Given the large solution space, PSO represents an attractive, parallelizable tool to achieve globally optimal solutions for such problems. This work was supported through funding from the National Institutes of Health and Varian Medical Systems. Amit Sawant has research funding from Varian Medical Systems, VisionRT Ltd. and Elekta.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

TH-C-19A-03: Characterization of the Dose Per Pulse Dependence of Various Detectors Used in Quality Assurance of FFF Treatment Plans

Purpose: To present the dose per pulse dependence of various QA devices under Flattening Filter Free (FFF) conditions. Methods: Air and liquid filled ion chamber arrays, diode arrays, radiochromic film and optically stimulated luminescence detectors were investigated. All detectors were irradiated under similar conditions of varying dose per pulse on a TrueBeam linac. Dose per pulse was controlled by varying SSD from 70 to 160 cm providing a range from ~0.5 to ~3 mGy per pulse. MU rates of up to 2400 MU/min for 10X FFF and 1400 MU/min for the 6X FFF beam were used. Beam pulses were counted using the Profiler™ diode array and pulse timing was confirmed by examining linac node files. Delivered doses were calculated with the Eclipse™ treatment planning system. Results: The detectors show a range of behaviors depending on the detector type, as expected. Diode arrays show up to 4% change in sensitivity (sensitivity increases with increasing dose per pulse) over the range tested. Air and liquid ion chambers arrays show a change in sensitivity of up to 3% (air) and 6% (liquid) (sensitivity decreases with increasing dose per pulse) while film and OSLD do not demonstrate a dependence on dose per pulse. Conclusion: Dependence of detector response on dose per pulse varies considerably depending on detector design. Interplay between dose per pulse and MU rate also exists for some detectors. Due diligence is required to characterize detector response prior to implementation of a QA protocol for FFF treatment delivery. During VMAT delivery, the MU rate may also vary dramatically within a treatment fraction. We intend to further investigate the implications of this for VMAT FFF patient specific quality assurance. T Karan and F Viel have received partial funding through the Varian Research program.

60 APPLIED LIFE SCIENCES↗