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DOE OSTI2014

TH-C-17A-03: Dynamic Visualization and Dosimetry of IMRT and VMAT Treatment Plans by Video-Rate Imaging of Cherenkov Radiation in Pure Water

Purpose: A novel optical dosimetry technique for the QA and verification of intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) radiotherapy plans was investigated for the first time by capturing images of the induced Cherenkov radiation in water. Methods: An intensified CCD camera (ICCD) was used to acquire a two-dimensional (2D) projection image of the Cherenkov radiation induced by IMRT and VMAT plans, based on the Task Group 119 C-Shape geometry. Plans were generated using the Varian Eclipse treatment planning system (TPS) and delivered using 6 MV x-rays from a Varian TrueBeam Linear Accelerator (Linac) incident on a water tank. The ICCD acquisition was gated to the Linac, operated for single pulse imaging, and binned to a resolution of 512×512 pixels. The resulting videos were analyzed temporally for regions of interest (ROI) covering the planning target volume (PTV) and organ at risk (OAR) and summed to obtain an overall light distribution, which was compared to the expected dose distribution from the TPS using a gammaindex analysis. Results: The chosen camera settings resulted in data at 23.5 frames per second. Temporal intensity plots of the PTV and OAR ROIs confirmed the preferential delivery of dose to the PTV versus the OAR, and the gamma analysis yielded 95.2% and 95.6% agreement between the light distribution and expected TPS dose distribution based upon a 3% / 3 mm dose difference and distance-to-agreement criterion for the IMRT and VMAT plans respectively. Conclusion: The results from this initial study demonstrate the first documented use of Cherenkov radiation for optical dosimetry of dynamic IMRT and VMAT treatment plans. The proposed modality has several potential advantages over alternative methods including the real-time nature of the acquisition, and upon future refinement may prove to be a robust and novel dosimetry method with both research and clinical applications. NIH R01CA109558 and R21EB017559.

07 ISOTOPE AND RADIATION SOURCES↗
DOE OSTI2014

TH-E-BRE-05: Analysis of Dosimetric Characteristics in Two Leaf Motion Calculator Algorithms for Sliding Window IMRT

Purpose: The Smart leaf motion calculator (SLMC) in Eclipse treatment planning system is an advanced fluence delivery modeling algorithm as it takes into account fine MLC features including inter-leaf leakage, rounded leaf tips, non-uniform leaf thickness, and the spindle cavity etc. In this study, SLMC and traditional Varian LMC (VLMC) algorithms were investigated, for the first time, in dosimetric characteristics and delivery accuracy of sliding window (SW) IMRT. Methods: The SW IMRT plans of 51 cancer cases were included to evaluate dosimetric characteristics and dose delivery accuracy from leaf motion calculated by SLMC and VLMC, respectively. All plans were delivered using a Varian TrueBeam Linac. The DVH and MUs of the plans were analyzed. Three patient specific QA tools - independent dose calculation software IMSure, Delta4 phantom, and EPID portal dosimetry were also used to measure the delivered dose distribution. Results: Significant differences in the MUs were observed between the two LMCs (p≤0.001).Gamma analysis shows an excellent agreement between the planned dose distribution calculated by both LMC algorithms and delivered dose distribution measured by three QA tools in all plans at 3%/3 mm, leading to a mean pass rate exceeding 97%. The mean fraction of pixels with gamma < 1 of SLMC is slightly lower than that of VLMC in the IMSure and Delta4 results, but higher in portal dosimetry (the highest spatial resolution), especially in complex cases such as nasopharynx. Conclusion: The study suggests that the two LMCs generates the similar target coverage and sparing patterns of critical structures. However, SLMC is modestly more accurate than VLMC in modeling advanced MLC features, which may lead to a more accurate dose delivery in SW IMRT. Current clinical QA tools might not be specific enough to differentiate the dosimetric discrepancies at the millimeter level calculated by these two LMC algorithms. NIH/NIGMS grant U54 GM104944, Lincy Endowed Assistant Professorship.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

TH-E-17A-04: Geometric Validation of K-Space Self-Gated 4D-MRI Vs. 4D-CT Using A Respiratory Motion Phantom

Purpose: 4D-CT is often limited by motion artifacts, low temporal resolution, and poor phase-based target definition. We recently developed a novel k-space self-gated 4D-MRI technique with high spatial and temporal resolution. The goal here is to geometrically validate 4D-MRI using a MRI-CT compatible respiratory motion phantom and comparison to 4D-CT. Methods: 4D-MRI was acquired using 3T spoiled gradient echo-based 3D projection sequences. Respiratory phases were resolved using self-gated k-space lines as the motion surrogate. Images were reconstructed into 10 temporal bins with 1.56×1.56×1.56mm3. A MRI-CT compatible phantom was designed with a 23mm diameter ball target filled with highconcentration gadolinium(Gd) gel embedded in a 35×40×63mm3 plastic box stabilized with low-concentration Gd gel. The whole phantom was driven by an air pump. Human respiratory motion was mimicked using the controller from a commercial dynamic phantom (RSD). Four breathing settings (rates/depths: 10s/20mm, 6s/15mm, 4s/10mm, 3s/7mm) were scanned with 4D-MRI and 4D-CT (slice thickness 1.25mm). Motion ground-truth was obtained from input signals and real-time video recordings. Reconstructed images were imported into Eclipse(Varian) for target contouring. Volumes and target positions were compared with ground-truth. Initial human study was investigated on a liver patient. Results: 4D-MRI and 4D-CT scans for the different breathing cycles were reconstructed with 10 phases. Target volume in each phase was measured for both 4D-CT and 4D-MRI. Volume percentage difference for the 6.37ml target ranged from 6.67±5.33 to 11.63±5.57 for 4D-CT and from 1.47±0.52 to 2.12±1.60 for 4D-MRI. The Mann-Whitney U-test shows the 4D-MRI is significantly superior to 4D-CT (p=0.021) for phase-based target definition. Centroid motion error ranges were 1.35–1.25mm (4D-CT), and 0.31–0.12mm (4D-MRI). Conclusion: The k-space self-gated 4D-MRI we recently developed can accurately determine phase-based target volume while avoiding typical motion artifacts found in 4D-CT, and is being further studied for use in GI targeting and motion management. This work supported in part by grant 1R03CA173273-01.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

TH-C-12A-06: Feasibility of a MLC-Based Inversely Optimized Multi-Field Grid Therapy Technique

Purpose: Grid therapy (GT), which generates highly spatially modulated dose distributions, can deliver single- or hypo-fractionated radiotherapy for large tumors without causing significant toxicities. GT may be applied in combination with immunotherapy, in light of recent preclinical data of synergetic interaction between radiotherapy and immunotherapy. However, conventional GT uses only one field, which does not have the advantage of multi-fields in 3D conformal-RT or IMRT. We have proposed a novel MLC-based, inverse-planned multi-field 3D GT technique. This study aims to test its deliverability and dosimetric accuracy. Methods: A lattice of small spheres was created as the boost volume within a large target. A simultaneous boost IMRT plan with 8-Gy to the target and 20-Gy to the boost volume was generated in the Eclipse treatment planning system (AAA v10) with a HD120 MLC. Nine beams were used, and the gantry and couch angles were selected so that the spheres were perfectly aligned in every beams eye view. The plan was mapped to a phantom with dose scaled. EBT3 films were calibrated and used to measure the delivered dose. Results: The IMRT plan generated a highly spatially modulated dose distribution in the target. D95%, D50%, D5% for the spheres and the targets in Gy were 18.5, 20.0, 21.4 and 7.9, 9.8, 16.1, respectively. D50% for a 1cm ring 1cm outside the target was 2.9-Gy. Film dosimetry showed good agreement between calculated and delivered dose, with an overall gamma passing rate of 99.6% (3%/1mm). The point dose differences for different spheres varied from 1–6%. Conclusion: We have demonstrated the deliverability and dose calculation accuracy of the MLC-based inversely optimized multi-field GT technique, which achieved a brachytherapy-like dose distribution. Single-fraction high dose can be delivered to the spheres in a large target with minimal dose to the surrounding normal tissue.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

Dosimetric comparison of Acuros XB, AAA, and XVMC in stereotactic body radiotherapy for lung cancer

Purpose: To compare the dosimetric performance of Acuros XB (AXB), anisotropic analytical algorithm (AAA), and x-ray voxel Monte Carlo (XVMC) in heterogeneous phantoms and lung stereotactic body radiotherapy (SBRT) plans. Methods: Water- and lung-equivalent phantoms were combined to evaluate the percentage depth dose and dose profile. The radiation treatment machine Novalis (BrainLab AG, Feldkirchen, Germany) with an x-ray beam energy of 6 MV was used to calculate the doses in the composite phantom at a source-to-surface distance of 100 cm with a gantry angle of 0°. Subsequently, the clinical lung SBRT plans for the 26 consecutive patients were transferred from the iPlan (ver. 4.1; BrainLab AG) to the Eclipse treatment planning systems (ver. 11.0.3; Varian Medical Systems, Palo Alto, CA). The doses were then recalculated with AXB and AAA while maintaining the XVMC-calculated monitor units and beam arrangement. Then the dose-volumetric data obtained using the three different radiation dose calculation algorithms were compared. Results: The results from AXB and XVMC agreed with measurements within ±3.0% for the lung-equivalent phantom with a 6 × 6 cm{sup 2} field size, whereas AAA values were higher than measurements in the heterogeneous zone and near the boundary, with the greatest difference being 4.1%. AXB and XVMC agreed well with measurements in terms of the profile shape at the boundary of the heterogeneous zone. For the lung SBRT plans, AXB yielded lower values than XVMC in terms of the maximum doses of ITV and PTV; however, the differences were within ±3.0%. In addition to the dose-volumetric data, the dose distribution analysis showed that AXB yielded dose distribution calculations that were closer to those with XVMC than did AAA. Means ± standard deviation of the computation time was 221.6 ± 53.1 s (range, 124–358 s), 66.1 ± 16.0 s (range, 42–94 s), and 6.7 ± 1.1 s (range, 5–9 s) for XVMC, AXB, and AAA, respectively. Conclusions: In the phantom evaluations, AXB and XVMC agreed better with measurements than did AAA. Calculations differed in the density-changing zones (substance boundaries) between AXB/XVMC and AAA. In the lung SBRT cases, a comparative analysis of dose-volumetric data and dose distributions with XVMC demonstrated that the AXB provided better agreement with XVMC than AAA. The computation time of AXB was faster than that of XVMC; therefore, AXB has better balance in terms of the dosimetric performance and computation speed for clinical use than XVMC.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

Effects of minimum monitor unit threshold on spot scanning proton plan quality

Purpose: To investigate the influence of the minimum monitor unit (MU) on the quality of clinical treatment plans for scanned proton therapy. Methods: Delivery system characteristics limit the minimum number of protons that can be delivered per spot, resulting in a min-MU limit. Plan quality can be impacted by the min-MU limit. Two sites were used to investigate the impact of min-MU on treatment plans: pediatric brain tumor at a depth of 5–10 cm; a head and neck tumor at a depth of 1–20 cm. Three-field, intensity modulated spot scanning proton plans were created for each site with the following parameter variations: min-MU limit range of 0.0000–0.0060; and spot spacing range of 2–8 mm. Comparisons were based on target homogeneity and normal tissue sparing. For the pediatric brain, two versions of the treatment planning system were also compared to judge the effects of the min-MU limit based on when it is accounted for in the optimization process (Eclipse v.10 and v.13, Varian Medical Systems, Palo Alto, CA). Results: The increase of the min-MU limit with a fixed spot spacing decreases plan quality both in homogeneous target coverage and in the avoidance of critical structures. Both head and neck and pediatric brain plans show a 20% increase in relative dose for the hot spot in the CTV and 10% increase in key critical structures when comparing min-MU limits of 0.0000 and 0.0060 with a fixed spot spacing of 4 mm. The DVHs of CTVs show min-MU limits of 0.0000 and 0.0010 produce similar plan quality and quality decreases as the min-MU limit increases beyond 0.0020. As spot spacing approaches 8 mm, degradation in plan quality is observed when no min-MU limit is imposed. Conclusions: Given a fixed spot spacing of ≤4 mm, plan quality decreases as min-MU increased beyond 0.0020. The effect of min-MU needs to be taken into consideration while planning proton therapy treatments.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

The Octavius1500 2D ion chamber array and its associated phantoms: Dosimetric characterization of a new prototype

Purpose: The purpose of the study is to characterize the prototype of the new Octavius1500 (PTW, Freiburg, Germany) 2D ion chamber array, covering its use in different phantom setups, from the most basic solid water sandwich setup to the more complex cylindrical Octavius{sup ®} 4D (Oct4D) (PTW) phantom/detector combination. The new detector houses nearly twice the amount of ion chambers as its predecessors (Seven29 and Octavius729), thereby tackling one of the most important limitations of ion chamber (or diode) arrays, namely the limited detector density. The 0.06 cm{sup 3} cubic ion chambers are now arranged in a checkerboard pattern, leaving no lines (neither longitudinally nor laterally) without detectors. Methods: All measurements were performed on a dual energy (6 MV and 18 MV) iX Clinac (Varian Medical Systems, Palo Alto, CA) and all calculations were done in the Eclipse treatment planning system (Varian) with the Anisotropic Analytical Algorithm. First, the basic characteristics of the 2D array, such as measurement stability, dose rate dependence and dose linearity were investigated in the solid water sandwich setup. Second, the directional dependence was assessed to allow the evaluation of the new Octavius2D phantom (Oct2D{sup 1500}) for planar verification measurements of composite plans. Third, measurements were performed in the Oct4D phantom to evaluate the impact of the increased detector density on the accuracy of the volumetric dose reconstruction. Results: While showing equally good dose linearity and dose rate independence, the Octavius1500 outperforms the previous models because of its instantaneous measurement stability and its twofold active area coverage. Orthogonal field-by-field measurements immediately benefit from the increased detector density. The 3.9 cm wide compensation cavity in the new Oct2D{sup 1500} phantom prototype adequately corrects for directional dependence from the rear, resulting in good agreement within the target dose. Discrepancies may arise towards the sides of the array because of uncompensated lateral beam incidence. The beneficial impact of the detector density is most prominent in the Oct4D system, for which the average pass rate (PR) is now nearly 100% (99.31 ± 0.37) when using gamma criteria of 2%G,2 mm (10% dose threshold). In search of gamma analysis criteria that are not too lenient to detect possibly relevant deviations, the authors conclude that for our radiotherapy environment, the authors choose to adopt 3%L,3 mm PR97% (threshold 10%) criteria for the Oct2D{sup 1500}/Octavius1500 system and 2%L,3 mm PR97% (threshold 10%) for the Oct4D/Octavius1500 system. These are first line pass/check criteria and plans that fail are not necessarily rejected, but submitted to a more detailed investigation. Conclusions: When irradiated from the front, the Octavius1500 array has two main advantages over its 729 predecessors: its instantaneous measurement stability and-–most importantly—its twofold detector density. In the Oct2D1500 phantom, these advantages are counterbalanced by the more pronounced directional dependence. The measurement-based 3D dose reconstruction in the Oct4D system, however, benefits considerably from the higher detector density in the checkerboard panel design.

07 ISOTOPE AND RADIATION SOURCES↗
DOE OSTI2014

Poster — Thur Eve — 31: Dosimetric Effect of Respiratory Motion on RapidArc Lung SBRT Treatment Delivered by TrueBeam Linear Accelerator

Volumetric modulated arc therapy (VMAT) allows fast delivery of stereotactic radiotherapy. However, the discrepancies between the calculated and delivered dose distributions due to respiratory motion and dynamic multileaf collimators (MLCs) interplay are not avoidable. The purpose of this study is to investigate RapidArc lung SBRT treatment delivered by the flattening filter-free (FFF) beam and flattened beam with Varian TrueBeam machine. CIRS Dynamic Thorax Phantom with in-house made lung tumor insertion was CT scanned both in free breathing and 4DCT. 4DCT was used to determine the internal target volume. The free breathing CT scan was used for treatment planning. A 5 mm margin was given to ITV to generate a planning target volume. Varian Eclipse treatment planning was used to generate RapidArc plans based on the 6 MV flattened beam and 6MV FFF beam. The prescription dose was 48 Gy in 4 fractions. At least 95% of PTV was covered by the prescribed dose. The RapidArc plans with 6 MV flattened beam and 6MV FFF beam were delivered with Varian TrueBeam machine. The dosimetric measurements were performed with Gafchromic XR-RV3 film, which was placed in the lung tumor insertion. The interplay between the dynamic MLC-based delivery of VMAT and the respiratory motion of the tumor degraded target coverage and created undesired hot or cold dose spots inside the lung tumor. Lung SBRT RapidArc treatments delivered by the FFF beam of TrueBeam linear accelerator is superior to the flattened beam. Further investigation will be performed by Monte Carlo simulation.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

Poster — Thur Eve — 32: Stereotactic Body Radiation Therapy for Peripheral Lung Lesion: Treatment Planning and Quality Assurance

Stereotactic body radiation therapy (SBRT), due to its high precision for target localizing, has become widely used to treat tumours at various locations, including the lungs. Lung SBRT program was started at our institution a year ago. Eighteen patients with peripheral lesions up to 3 cm diameter have been treated with 48 Gy in 4 fractions. Based on four-dimensional computed tomography (4DCT) simulation, internal target volume (ITV) was delineated to encompass the respiratory motion of the lesion. A margin of 5 mm was then added to create the planning target volume (PTV) for setup uncertainties. There was no expansion from gross tumour volume (GTV) to clinical target volume (CTV). Pinnacle 9.6 was used as the primary treatment planning system. Volumetric modulated arc therapy (VMAT) technique, with one or two coplanar arcs, generally worked well. For quality assurance (QA), each plan was exported to Eclipse 10 and dose calculation was repeated. Dose volume histograms (DVHs) of the targets and organs at risk (OARs) were then compared between the two treatment planning systems. Winston-Lutz tests were carried out as routine machine QA. Patient-specific QA included ArcCheck measurement with an insert, where an ionization chamber was placed at the centre to measure dose at the isocenter. For the first several patients, and subsequently for the plans with extremely strong modulation, Gafchromic film dosimetry was also employed. For each patient, a mock setup was scheduled prior to treatments. Daily pre- and post-CBCT were acquired for setup and assessment of intra-fractional motion, respectively.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

Poster — Thur Eve — 58: Dosimetric validation of electronic compensation for radiotherapy treatment planning

In this study we investigate the deliverability of dosimetric plans generated by the irregular surface compensator (ISCOMP) algorithm for 6 MV photon beams in Eclipse (Varian Medical System, CA). In contrast to physical tissue compensation, the electronic ISCOMP uses MLCs to dynamically modulate the fluence of a photon beam in order to deliver a uniform dose at a user defined plane in tissue. This method can be used to shield critical organs that are located within the treatment portal or improve dose uniformity by tissue compensation in inhomogeneous regions. Three site specific plans and a set of test fields were evaluated using the γ-metric of 3%/ 3 mm on Varian EPID, MapCHECK, and Gafchromic EBT3 film with a clinical tolerance of >95% passing rates. Point dose measurements with an NRCC calibrated ionization chamber were also performed to verify the absolute dose delivered. In all cases the MapCHECK measured plans met the gamma criteria. The mean passing rate for the six EBT3 film field measurements was 96.2%, with only two fields at 93.4 and 94.0% passing rates. The EPID plans passed for fields encompassing the central ∼10 × 10 cm{sup 2} region of the detector; however for larger fields and greater off-axis distances discrepancies were observed and attributed to the profile corrections and modeling of backscatter in the portal dose calculation. The magnitude of the average percentage difference for 21 ion chamber point dose measurements and 17 different fields was 1.4 ± 0.9%, and the maximum percentage difference was −3.3%. These measurements qualify the algorithm for routine clinical use subject to the same pre-treatment patient specific QA as IMRT.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

Sci—Sat AM: Stereo — 06: Dosimetric Comparison of 3D Conformai, Flattened and Flattening Filter-Free TrueBeam RapidArc Planning for Lung SBRT

The major advantages of the VMAT SBRT plans compared to the conventional 3D conformai plan include faster delivery and improved target dose conformity. This study quantifies the dosimetric differences among 3D conformai plan; flattened beam and flattening filter-free (FFF) beam RapidArc Plans for lung SBRT. Five early stage lung cancer patients with various tumor positions and sizes previously treated with 3D non-coplanar SBRT were randomly selected. 4DCT was used for each patient to determine the internal target volume. Abdominal compression was applied to minimize respiratory motion for SBRT patients. For treatment planning, a 5 mm margin was given to the ITV to generate a planning target volume. The prescription dose was 48 Gy in 4 fractions and normalized to 95% of the PTV. Organs at risk (OAR) included spinal cord, esophagus, heart, trachea, bilateral lung, and great vessels. Optimization constraints were set to meet the criteria of the RTOG-0915 protocol. All VMAT plans were optimized with the RapidArc technique using two full arcs in Eclipse treatment planning system. The RapidArc SBRT plans with flattened 6MV beam and 6MV FFF beam were generated and dosimetric results were compared with the previous treated 3D non-coplanar plans. RapidArc plans demonstrated better conformity to target, sharper dose fall-off in normal tissues and lower dose to normal lung and other OARs than the 3D conformai plans. RapidArc SBRT for FFF beam showed comparable target conformity, adequate tumor dose, and clinically acceptable DVHs of OARs to flattened beams and significantly reduced treatment delivery time.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

Sci—Sat AM: Stereo — 08: Stereotactic Ablative Radiotherapy (SABR) for low, intermediate and high risk prostate cancer using Volumetric Modulated Arc Therapy (VMAT) with a 10x Flattening Filter Free (FFF) beam

Purpose: To determine the feasibility of using Volumetric Modulated Arc Therapy (VMAT) with a 10x Flattening Filter Free (FFF) beam for Stereotactic Ablative Radiotherapy (SABR) for low, intermediate and high risk prostate cancer. Methods and Materials: Ten anonymized patient CT data sets were used in this planning study. For each patient CT data set, three sets of contours were generated: 1) low risk, 2) intermediate risk, and 3) high risk scenarios. For each scenario, a single-arc and a double-arc VMAT treatment plans were created. Plans were generated with the Varian Eclipse™ treatment planning system for a Varian TrueBeam™ linac equipped with Millenium 120 MLC. Plans were created using a 10x-FFF beam with a maximum dose rate of 2400 MU/min. Dose prescription was 36.25Gy/5 fractions with the planning objective of covering 99% of the Planning Target Volume with the 95% of the prescription dose. Normal tissue constraints were based on provincial prostate SABR planning guidelines, derived from national and international prostate SABR protocols. Plans were evaluated and compared in terms of: 1) dosimetric plan quality, and 2) treatment delivery efficiency. Results: Both single-arc and double-arc VMAT plans were able to meet the planning goals for low, intermediate and high risk scenarios. No significant dosimetric differences were observed between the plans. However, the treatment time was significantly lower for a single-arc VMAT plans. Conclusions: Prostate SABR treatments are feasible with 10x-FFF VMAT technique. A single-arc VMAT offers equivalent dosimetric plan quality and a superior treatment delivery efficiency, compared to a double-arc VMAT.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

Sci—Thur PM: Planning and Delivery — 06: Real-Time Interactive Treatment Planning

Purpose: To describe and evaluate a novel system for generalized Real-Time Interactive Planning (RTIP) applied to head and neck (H and N) VMAT. Methods: The clinician interactively manipulates dose distributions using DVHs, isodoses, or rate of dose fall-off, which may be subjected to user-defined constraints. Dose is calculated using a fast Achievable Dose Estimate (ADE) algorithm, which simulates the limits of what can be achieved during treatment. After each manipulation contributing fluence elements are modified and the dose distribution updates in effectively real-time. For H and N VMAT planning, structure sets for 11 patients were imported into RTIP. Each dose distribution was interactively modified to minimize OAR dose while constraining target DVHs. The resulting RTIP DVHs were transferred to the Eclipse™ VMAT optimizer, and conventional VMAT optimization was performed. Results: Dose calculation and update times for the ADE algorithm ranged from 2.4 to 22.6 milliseconds, thus facilitating effectively real-time manipulation of dose distributions. For each of the 11 H and N VMAT cases, the RTIP process took ∼2–10 minutes. All RTIP plans exhibited acceptable PTV coverage, mean dose, and max dose. 10 of 11 RTIP plans achieved substantially improved sparing of one or more OARs without compromising dose to targets or other OARs. Importantly, 10 of the 11 RTIP plans required only one or two post-RTIP optimizations. Conclusions: RTIP is a novel system for manipulating and updating achievable dose distributions in real-time. H and N VMAT plans generated using RTIP demonstrate improved OAR sparing and planning efficiency. Disclosures: One author has a commercial interest in the presented materials.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

Poster — Thur Eve — 13: Inter-Fraction Target Movement in Image-Guided Radiation Therapy of Prostate Cancer

We investigated the setup variations over the treatment courses of 113 patients with intact prostate treated with 78Gy/39fx. Institutional standard bladder and bowel preparation and image guidance protocols were used in CT simulation and treatment. The RapidArc treatment plans were optimized in Varian Eclipse treatment planning system and delivered on Varian 2100X Clinacs equipped with On-Board Imager to localize the target before beam-on. The setup variations were calculated in terms of mean and standard deviation of couch shifts. No correlation was observed between the mean shift and standard deviation over the treatment course and patient age, initial prostate volume and rectum size. The mean shifts in the first and last 5 fractions are highly correlated (P < 10{sup −10}) while the correlation of the standard deviations cannot be determined. The Mann-Kendall tests indicate trends of the mean daily Ant-Post and Sup-Inf shifts of the group. The target is inferior by ∼1mm to the planned position when the treatment starts and moves superiorly, approaching the planned position at 10th fraction, and then gradually moves back inferiorly by ∼1mm in the remain fractions. In the Ant-Post direction, the prostate gradually moves posteriorly during the treatment course from a mean shift of ∼2.5mm in the first fraction to ∼1mm in the last fraction. It may be related to a systematic rectum size change in the progress of treatment. The biased mean shifts in Ant-Post and Sup-Inf direction of most patients suggest systematically larger rectum and smaller bladder during the treatment than at CT simulation.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

Optical cone beam tomography of Cherenkov-mediated signals for fast 3D dosimetry of x-ray photon beams in water

Purpose: To test the use of a three-dimensional (3D) optical cone beam computed tomography reconstruction algorithm, for estimation of the imparted 3D dose distribution from megavoltage photon beams in a water tank for quality assurance, by imaging the induced Cherenkov-excited fluorescence (CEF). Methods: An intensified charge-coupled device coupled to a standard nontelecentric camera lens was used to tomographically acquire two-dimensional (2D) projection images of CEF from a complex multileaf collimator (MLC) shaped 6 MV linear accelerator x-ray photon beam operating at a dose rate of 600 MU/min. The resulting projections were used to reconstruct the 3D CEF light distribution, a potential surrogate of imparted dose, using a Feldkamp–Davis–Kress cone beam back reconstruction algorithm. Finally, the reconstructed light distributions were compared to the expected dose values from one-dimensional diode scans, 2D film measurements, and the 3D distribution generated from the clinical Varian ECLIPSE treatment planning system using a gamma index analysis. A Monte Carlo derived correction was applied to the Cherenkov reconstructions to account for beam hardening artifacts. Results: 3D light volumes were successfully reconstructed over a 400 × 400 × 350 mm{sup 3} volume at a resolution of 1 mm. The Cherenkov reconstructions showed agreement with all comparative methods and were also able to recover both inter- and intra-MLC leaf leakage. Based upon a 3%/3 mm criterion, the experimental Cherenkov light measurements showed an 83%–99% pass fraction depending on the chosen threshold dose. Conclusions: The results from this study demonstrate the use of optical cone beam computed tomography using CEF for the profiling of the imparted dose distribution from large area megavoltage photon beams in water.

07 ISOTOPE AND RADIATION SOURCES↗
DOE OSTI2015

SU-C-BRD-03: Closing the Loop On Virtual IMRT QA

Purpose: To develop an algorithm that predicts a priori IMRT QA passing rates. Methods: 416 IMRT plans from all treatment sites were planned in Eclipse version 11 and delivered using a dynamic sliding window technique on Clinac iX or TrueBeam linacs (Varian Medical Systems, Palo Alto, CA). The 3%/3mm and 2%/2mm local distance to agreement (DTA) were recorded during clinical operations using a commercial 2D diode array (MapCHECK 2, Sun Nuclear, Melbourne, FL). Each plan was characterized by 37 metrics that describe different failure modes between the calculated and measured dose. Machine-learning algorithms (MLAs) were trained to learn the relation between the plan characteristics and each passing rate. Minimization of the cross validated error, together with maximum a posteriori estimation (MAP), were used to choose the model parameters. Results: 3%/3mm local DTA can be predicted with an error smaller than 3% for 98% of the plans. For the remaining 2% of plans, the residual error was within 5%. For 2%/2mm local DTA passing rates, 96% percent of the plans were successfully predicted with an error smaller than 5%. All high-risk plans that failed the 2%/2mm local criteria were correctly identified by the algorithm. The most important metric to describe the passing rates was determined to be the MU per Gray (modulation factor). Conclusions: Logs files and independent dose calculations have been suggested as possible substitutes for measurement based IMRT QA. However, none of these methods answer the fundamental question of whether a plan can be delivered with a clinically acceptable error given the limitations of the linacs and the treatment planning system. Predicting the IMRT QA passing rates a priori closes that loop. For additional robustness, virtual IMRT QA can be combined with Linac QA and log file analysis to confirm appropriate delivery.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-C-BRD-04: Comparison of Shallow Fluence to Deep Point Dose Measurements for Spine VMAT SBRT Patient-Specific QA

Purpose: To investigate the sensitivity of traditional gamma-index-based fluence measurements for patient-specific measurements in VMAT delivered spine SBRT. Methods: The ten most recent cases for spine SBRT were selected. All cases were planned with Eclipse RapidArc for a TrueBeam STx. The delivery was verified using a point dose measurement with a Pinpoint 3D micro-ion chamber in a Standard Imaging Stereotactic Dose Verification Phantom. Two points were selected for each case, one within the target in a low dose-gradient region and one in the spinal cord. Measurements were localized using on-board CBCT. Cumulative and separate arc measurements were acquired with the ArcCheck and assessed using the SNC patient software with a 3%/3mm and 2%/2mm gamma analysis with global normalization and a 10% dose threshold. Correlations between data were determined using the Pearson Product-Moment Correlation. Results: For our cohort of patients, the measured doses were higher than calculated ranging from 2.2%–9.7% for the target and 1.0%–8.2% for the spinal cord. There was strong correlation between 3%/3mm and 2%/2mm passing rates (r=0.91). Moderate correlation was found between target and cord dose with a weak fit (r=0.67, R-Square=0.45). The cumulative ArcCheck measurements showed poor correlation with the measured point doses for both the target and cord (r=0.20, r=0.35). If the arcs are assessed separately with an acceptance criteria applied to the minimum passing rate between all arcs, a moderate negative correlation was found for the target and cord (r=−0.48, r= −0.71). The case with the highest dose difference (9.7%) received a passing rate of 97.2% for the cumulative arcs and 87.8% for the minimum with separate arcs. Conclusion: Our data suggest that traditional passing criteria using ArcCheck with cumulative measurements do not correlate well with dose errors. Separate arc analysis shows better correlation but may still miss large dose errors. Point dose verifications are recommended.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-C-BRB-02: Symmetric and Asymmetric MLC Based Lung Shielding and Dose Optimization During Translating Bed TBI

Purpose: The primary aim was to introduce a dose optimization method for translating bed total body irradiation technique that ensures lung shielding dynamically. Symmetric and asymmetric dynamic MLC apertures were employed for this purpose. Methods: The MLC aperture sizes were defined based on the radiological depth values along the divergent ray lines passing through the individual CT slices. Based on these RD values, asymmetrically shaped MLC apertures were defined every 9 mm of the phantom in superior-inferior direction. Individual MLC files were created with MATLAB™ and were imported into Eclipse™ treatment planning system for dose calculations. Lungs can be shielded to an optimum level by reducing the MLC aperture width over the lungs. The process was repeated with symmetrically shaped apertures. Results: Dose-volume histogram (DVH) analysis shows that the asymmetric MLC based technique provides better dose coverage to the body and optimum shielding of the lungs compared to symmetrically shaped beam apertures. Midline dose homogeneity is within ±3% with asymmetric MLC apertures whereas it remains within ±4.5% with symmetric ones (except head region where it drops down to −7%). The substantial over and under dosage of ±5% at tissue interfaces has been reduced to ±2% with asymmetric MLC technique. Lungs dose can be reduced to any desired limit. In this experiment lungs dose was reduced to 80% of the prescribed dose, as was desired. Conclusion: The novel asymmetric MLC based technique assures optimum shielding of OARs (e.g. lungs) and better 3-D dose homogeneity and body-dose coverage in comparison with the symmetric MLC aperture optimization. The authors acknowledge the financial and infrastructural support provided by Pakistan Institute of Engineering & Applied Sciences (PIEAS), Islamabad and Aga Khan University Hospital (AKUH), Karachi during the course of this research project. Authors have no conflict of interest with any national / international body for the presented work.

60 APPLIED LIFE SCIENCES↗