Results for “DOSIMETRY” — Page 97

DOE OSTI2016

A Monte Carlo study on {sup 223}Ra imaging for unsealed radionuclide therapy

Purpose: Radium-223 ({sup 223}Ra), an α-emitting radionuclide, is used in unsealed radionuclide therapy for metastatic bone tumors. The demand for qualitative {sup 223}Ra imaging is growing to optimize dosimetry. The authors simulated {sup 223}Ra imaging using an in-house Monte Carlo simulation code and investigated the feasibility and utility of {sup 223}Ra imaging. Methods: The Monte Carlo code comprises two modules, HEXAGON and NAI. The HEXAGON code simulates the photon and electron interactions in the tissues and collimator, and the NAI code simulates the response of the NaI detector system. A 3D numeric phantom created using computed tomography images of a chest phantom was installed in the HEXAGON code. {sup 223}Ra accumulated in a part of the spine, and three x-rays and 19 γ rays between 80 and 450 keV were selected as the emitted photons. To evaluate the quality of the {sup 223}Ra imaging, the authors also simulated technetium-99m ({sup 99m}Tc) imaging under the same conditions and compared the results. Results: The sensitivities of the three photopeaks were 147 counts per unit of source activity (cps MBq{sup −1}; photopeak: 84 keV, full width of energy window: 20%), 166 cps MBq{sup −1} (154 keV, 15%), and 158 cps MBq{sup −1} (270 keV, 10%) for a low-energy general-purpose (LEGP) collimator, and those for the medium-energy general-purpose (MEGP) collimator were 33, 13, and 8.0 cps MBq{sup −1}, respectively. In the case of {sup 99m}Tc, the sensitivity was 55 cps MBq{sup −1} (141 keV, 20%) for LEGP and 52 cps MBq{sup −1} for MEGP. The fractions of unscattered photons of the total photons reflecting the image quality were 0.09 (84 keV), 0.03 (154 keV), and 0.02 (270 keV) for the LEGP collimator and 0.41, 0.25, and 0.50 for the MEGP collimator, respectively. Conversely, this fraction was approximately 0.65 for the simulated {sup 99m}Tc imaging. The sensitivity with the LEGP collimator appeared very high. However, almost all of the counts were because of photons that penetrated or were scattered in the collimator; therefore, the proportions of unscattered photons were small. Conclusions: Their simulation study revealed that the most promising scheme for {sup 223}Ra imaging is an 84-keV window using an MEGP collimator. The sensitivity of the photopeaks above 100 keV is too low for {sup 223}Ra imaging. A comparison of the fractions of unscattered photons reveals that the sensitivity and image quality are approximately two-thirds of those for {sup 99m}Tc imaging.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

A clinically observed discrepancy between image-based and log-based MLC positions

Purpose: To present a clinical case in which real-time intratreatment imaging identified an multileaf collimator (MLC) leaf to be consistently deviating from its programmed and logged position by >1 mm. Methods: An EPID-based exit-fluence dosimetry system designed to prevent gross delivery errors was used to capture cine during treatment images. The author serendipitously visually identified a suspected MLC leaf displacement that was not otherwise detected. The leaf position as recorded on the EPID images was measured and log-files were analyzed for the treatment in question, the prior day’s treatment, and for daily MLC test patterns acquired on those treatment days. Additional standard test patterns were used to quantify the leaf position. Results: Whereas the log-file reported no difference between planned and recorded positions, image-based measurements showed the leaf to be 1.3 ± 0.1 mm medial from the planned position. This offset was confirmed with the test pattern irradiations. Conclusions: It has been clinically observed that log-file derived leaf positions can differ from their actual position by >1 mm, and therefore cannot be considered to be the actual leaf positions. This cautions the use of log-based methods for MLC or patient quality assurance without independent confirmation of log integrity. Frequent verification of MLC positions through independent means is a necessary precondition to trust log-file records. Intratreatment EPID imaging provides a method to capture departures from MLC planned positions.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

Source strength verification and quality assurance of preloaded brachytherapy needles using a CMOS flat panel detector

Purpose: Current methods of low dose rate brachytherapy source strength verification for sources preloaded into needles consist of either assaying a small number of seeds from a separate sample belonging to the same lot used to load the needles or performing batch assays of a subset of the preloaded seed trains. Both of these methods are cumbersome and have the limitations inherent to sampling. The purpose of this work was to investigate an alternative approach that uses an image-based, autoradiographic system capable of the rapid and complete assay of all sources without compromising sterility. Methods: The system consists of a flat panel image detector, an autoclavable needle holder, and software to analyze the detected signals. The needle holder was designed to maintain a fixed vertical spacing between the needles and the image detector, and to collimate the emissions from each seed. It also provides a sterile barrier between the needles and the imager. The image detector has a sufficiently large image capture area to allow several needles to be analyzed simultaneously.Several tests were performed to assess the accuracy and reproducibility of source strengths obtained using this system. Three different seed models (Oncura 6711 and 9011 {sup 125}I seeds, and IsoAid Advantage {sup 103}Pd seeds) were used in the evaluations. Seeds were loaded into trains with at least 1 cm spacing. Results: Using our system, it was possible to obtain linear calibration curves with coverage factor k = 1 prediction intervals of less than ±2% near the centre of their range for the three source models. The uncertainty budget calculated from a combination of type A and type B estimates of potential sources of error was somewhat larger, yielding (k = 1) combined uncertainties for individual seed readings of 6.2% for {sup 125}I 6711 seeds, 4.7% for {sup 125}I 9011 seeds, and 11.0% for Advantage {sup 103}Pd seeds. Conclusions: This study showed that a flat panel detector dosimetry system is a viable option for source strength verification in preloaded needles, as it is capable of measuring all of the sources intended for implantation. Such a system has the potential to directly and efficiently estimate individual source strengths, the overall mean source strength, and the positions within the seed-spacer train.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

A GPU-accelerated Monte Carlo dose calculation platform and its application toward validating an MRI-guided radiation therapy beam model

Purpose: The clinical commissioning of IMRT subject to a magnetic field is challenging. The purpose of this work is to develop a GPU-accelerated Monte Carlo dose calculation platform based on PENELOPE and then use the platform to validate a vendor-provided MRIdian head model toward quality assurance of clinical IMRT treatment plans subject to a 0.35 T magnetic field. Methods: PENELOPE was first translated from FORTRAN to C++ and the result was confirmed to produce equivalent results to the original code. The C++ code was then adapted to CUDA in a workflow optimized for GPU architecture. The original code was expanded to include voxelized transport with Woodcock tracking, faster electron/positron propagation in a magnetic field, and several features that make gPENELOPE highly user-friendly. Moreover, the vendor-provided MRIdian head model was incorporated into the code in an effort to apply gPENELOPE as both an accurate and rapid dose validation system. A set of experimental measurements were performed on the MRIdian system to examine the accuracy of both the head model and gPENELOPE. Ultimately, gPENELOPE was applied toward independent validation of patient doses calculated by MRIdian’s KMC. Results: An acceleration factor of 152 was achieved in comparison to the original single-thread FORTRAN implementation with the original accuracy being preserved. For 16 treatment plans including stomach (4), lung (2), liver (3), adrenal gland (2), pancreas (2), spleen(1), mediastinum (1), and breast (1), the MRIdian dose calculation engine agrees with gPENELOPE with a mean gamma passing rate of 99.1% ± 0.6% (2%/2 mm). Conclusions: A Monte Carlo simulation platform was developed based on a GPU- accelerated version of PENELOPE. This platform was used to validate that both the vendor-provided head model and fast Monte Carlo engine used by the MRIdian system are accurate in modeling radiation transport in a patient using 2%/2 mm gamma criteria. Future applications of this platform will include dose validation and accumulation, IMRT optimization, and dosimetry system modeling for next generation MR-IGRT systems.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

Effect of pulse sequence parameter selection on signal strength in positive-contrast MRI markers for MRI-based prostate postimplant assessment

Purpose: For postimplant dosimetric assessment, computed tomography (CT) is commonly used to identify prostate brachytherapy seeds, at the expense of accurate anatomical contouring. Magnetic resonance imaging (MRI) is superior to CT for anatomical delineation, but identification of the negative-contrast seeds is challenging. Positive-contrast MRI markers were proposed to replace spacers to assist seed localization on MRI images. Visualization of these markers under varying scan parameters was investigated. Methods: To simulate a clinical scenario, a prostate phantom was implanted with 66 markers and 86 seeds, and imaged on a 3.0T MRI scanner using a 3D fast radiofrequency-spoiled gradient recalled echo acquisition with various combinations of scan parameters. Scan parameters, including flip angle, number of excitations, bandwidth, field-of-view, slice thickness, and encoding steps were systematically varied to study their effects on signal, noise, scan time, image resolution, and artifacts. Results: The effects of pulse sequence parameter selection on the marker signal strength and image noise were characterized. The authors also examined the tradeoff between signal-to-noise ratio, scan time, and image artifacts, such as the wraparound artifact, susceptibility artifact, chemical shift artifact, and partial volume averaging artifact. Given reasonable scan time and managable artifacts, the authors recommended scan parameter combinations that can provide robust visualization of the MRI markers. Conclusions: The recommended MRI pulse sequence protocol allows for consistent visualization of the markers to assist seed localization, potentially enabling MRI-only prostate postimplant dosimetry.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

Ion recombination correction in carbon ion beams

Purpose: In this work, ion recombination is studied as a function of energy and depth in carbon ion beams. Methods: Measurements were performed in three different passively scattered carbon ion beams with energies of 62 MeV/n, 135 MeV/n, and 290 MeV/n using various types of plane-parallel ionization chambers. Experimental results were compared with two analytical models for initial recombination. One model is generally used for photon beams and the other model, developed by Jaffé, takes into account the ionization density along the ion track. An investigation was carried out to ascertain the effect on the ion recombination correction with varying ionization chamber orientation with respect to the direction of the ion tracks. The variation of the ion recombination correction factors as a function of depth was studied for a Markus ionization chamber in the 62 MeV/n nonmodulated carbon ion beam. This variation can be related to the depth distribution of linear energy transfer. Results: Results show that the theory for photon beams is not applicable to carbon ion beams. On the other hand, by optimizing the value of the ionization density and the initial mean-square radius, good agreement is found between Jaffé’s theory and the experimental results. As predicted by Jaffé’s theory, the results confirm that ion recombination corrections strongly decrease with an increasing angle between the ion tracks and the electric field lines. For the Markus ionization chamber, the variation of the ion recombination correction factor with depth was modeled adequately by a sigmoid function, which is approximately constant in the plateau and strongly increasing in the Bragg peak region to values of up to 1.06. Except in the distal edge region, all experimental results are accurately described by Jaffé’s theory. Conclusions: Experimental results confirm that ion recombination in the investigated carbon ion beams is dominated by initial recombination. Ion recombination corrections are found to be significant and cannot be neglected for reference dosimetry and for the determination of depth dose curves in carbon ion beams.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗

DOE OSTI2016

A comprehensive formulation for volumetric modulated arc therapy planning

Purpose: Volumetric modulated arc therapy (VMAT) is a widely employed radiation therapy technique, showing comparable dosimetry to static beam intensity modulated radiation therapy (IMRT) with reduced monitor units and treatment time. However, the current VMAT optimization has various greedy heuristics employed for an empirical solution, which jeopardizes plan consistency and quality. The authors introduce a novel direct aperture optimization method for VMAT to overcome these limitations. Methods: The comprehensive VMAT (comVMAT) planning was formulated as an optimization problem with an L2-norm fidelity term to penalize the difference between the optimized dose and the prescribed dose, as well as an anisotropic total variation term to promote piecewise continuity in the fluence maps, preparing it for direct aperture optimization. A level set function was used to describe the aperture shapes and the difference between aperture shapes at adjacent angles was penalized to control MLC motion range. A proximal-class optimization solver was adopted to solve the large scale optimization problem, and an alternating optimization strategy was implemented to solve the fluence intensity and aperture shapes simultaneously. Single arc comVMAT plans, utilizing 180 beams with 2° angular resolution, were generated for a glioblastoma multiforme case, a lung (LNG) case, and two head and neck cases—one with three PTVs (H&N{sub 3PTV}) and one with foue PTVs (H&N{sub 4PTV})—to test the efficacy. The plans were optimized using an alternating optimization strategy. The plans were compared against the clinical VMAT (clnVMAT) plans utilizing two overlapping coplanar arcs for treatment. Results: The optimization of the comVMAT plans had converged within 600 iterations of the block minimization algorithm. comVMAT plans were able to consistently reduce the dose to all organs-at-risk (OARs) as compared to the clnVMAT plans. On average, comVMAT plans reduced the max and mean OAR dose by 6.59% and 7.45%, respectively, of the prescription dose. Reductions in max dose and mean dose were as high as 14.5 Gy in the LNG case and 15.3 Gy in the H&N{sub 3PTV} case. PTV coverages measured by D95, D98, and D99 were within 0.25% of the prescription dose. By comprehensively optimizing all beams, the comVMAT optimizer gained the freedom to allow some selected beams to deliver higher intensities, yielding a dose distribution that resembles a static beam IMRT plan with beam orientation optimization. Conclusions: The novel nongreedy VMAT approach simultaneously optimizes all beams in an arc and then directly generates deliverable apertures. The single arc VMAT approach thus fully utilizes the digital Linac’s capability in dose rate and gantry rotation speed modulation. In practice, the new single VMAT algorithm generates plans superior to existing VMAT algorithms utilizing two arcs.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

An integrated model-driven method for in-treatment upper airway motion tracking using cine MRI in head and neck radiation therapy

Purpose: For the first time, MRI-guided radiation therapy systems can acquire cine images to dynamically monitor in-treatment internal organ motion. However, the complex head and neck (H&N) structures and low-contrast/resolution of on-board cine MRI images make automatic motion tracking a very challenging task. In this study, the authors proposed an integrated model-driven method to automatically track the in-treatment motion of the H&N upper airway, a complex and highly deformable region wherein internal motion often occurs in an either voluntary or involuntary manner, from cine MRI images for the analysis of H&N motion patterns. Methods: Considering the complex H&N structures and ensuring automatic and robust upper airway motion tracking, the authors firstly built a set of linked statistical shapes (including face, face-jaw, and face-jaw-palate) using principal component analysis from clinically approved contours delineated on a set of training data. The linked statistical shapes integrate explicit landmarks and implicit shape representation. Then, a hierarchical model-fitting algorithm was developed to align the linked shapes on the first image frame of a to-be-tracked cine sequence and to localize the upper airway region. Finally, a multifeature level set contour propagation scheme was performed to identify the upper airway shape change, frame-by-frame, on the entire image sequence. The multifeature fitting energy, including the information of intensity variations, edge saliency, curve geometry, and temporal shape continuity, was minimized to capture the details of moving airway boundaries. Sagittal cine MR image sequences acquired from three H&N cancer patients were utilized to demonstrate the performance of the proposed motion tracking method. Results: The tracking accuracy was validated by comparing the results to the average of two manual delineations in 50 randomly selected cine image frames from each patient. The resulting average dice similarity coefficient (93.28% ± 1.46%) and margin error (0.49 ± 0.12 mm) showed good agreement between the automatic and manual results. The comparison with three other deformable model-based segmentation methods illustrated the superior shape tracking performance of the proposed method. Large interpatient variations of swallowing frequency, swallowing duration, and upper airway cross-sectional area were observed from the testing cine image sequences. Conclusions: The proposed motion tracking method can provide accurate upper airway motion tracking results, and enable automatic and quantitative identification and analysis of in-treatment H&N upper airway motion. By integrating explicit and implicit linked-shape representations within a hierarchical model-fitting process, the proposed tracking method can process complex H&N structures and low-contrast/resolution cine MRI images. Future research will focus on the improvement of method reliability, patient motion pattern analysis for providing more information on patient-specific prediction of structure displacements, and motion effects on dosimetry for better H&N motion management in radiation therapy.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

SU-A-BRA-01: Introduction

Vic Montemayor - No one has been more passionate about improving the quality and effectiveness of the teaching of Medical Physics than Bill Hendee. It was in August of 2008 that the first AAPM Workshop on Becoming a Better Teacher of Medical Physics was held, organized and run by Bill Hendee. This was followed up in July of 2010 with a summer school on the same topic, again organized by Bill. There has been continued interest in alternate approaches to teaching medical physics since those initial gatherings. The momentum established by these workshops is made clear each year in the annual Innovation in Medical Physics Education session, which highlights work being done in all forms of medical physics education, from one-on-one residencies or classroom presentations to large-scale program revisions and on-line resources for international audiences. This symposium, presented on behalf of the Education Council, highlights the work of three finalists from past Innovation in Education sessions. Each will be presenting their approaches to and innovations in teaching medical physics. It is hoped that audience members interested in trying something new in their teaching of medical physics will find some of these ideas and approaches readily applicable to their own classrooms. Rebecca Howell - The presentation will discuss ways to maximize classroom learning, i.e., increasing the amount of material covered while also enhancing students’ understanding of the broader implications of the course topics. Specifically, the presentation will focus on two teaching methodologies, project based learning and flip learning. These teaching methods will be illustrated using an example of graduate medical physics course where both are used in conjunction with traditional lectures. Additionally, the presentation will focus on our experience implementing these methods including challenges that were overcome. Jay Burmeister - My presentation will discuss the incorporation of active learning techniques into a traditional medical physics classroom course. I will describe these techniques and how they were implemented as well as student performance before and after implementation. Student feedback indicated that these course changes improved their ability to actively assimilate the course content, thus improving their understanding of the material. Shahid Naqvi - My talk will focus on ways to help students visualize crucial concepts that lie at the core of radiation physics. Although particle tracks generated by Monte Carlo simulations have served as an indispensable visualization tool, students often struggle to resolve the underlying physics from a simultaneous jumble of tracks. We can clarify the physics by “coding” the tracks, e.g., by coloring the tracks according to their “starting” or “crossing” regions. The regionally-coded tracks when overlaid with dose distributions help the students see the elusive connection between dose, kerma and electronic disequilibrium. Tracks coded according to local energy or energy-loss rate can illustrate the need for stopping power corrections in electron beams and explain the Bragg peak in a proton beam. Coding tracks according to parent interaction type and order can clarify the often misunderstood distinction between primary and scatter dose. The students can thus see the “whole” simultaneously with the “sum of the parts,” which enhances their physical insight and creates a sustainable foundation for further learning. After the presentations the speakers and moderator will be open to questions and discussion with the audience members. Learning Objectives: Be able to explain Project-Based Learning and how can it be incorporated into a Medical Physics classroom. Be able to explain Flipped Learning and how can it be incorporated into a Medical Physics classroom. Be able to explain active-learning strategies for the teaching of Medical Physics. Be able to explain how Monte Carlo simulations can be used to deepen a student’s understanding of radiation physics and dosimetry.

07 ISOTOPE AND RADIATION SOURCES↗

DOE OSTI2016

SU-A-BRA-02: Making the Most of a One Hour Lecture with Alternative Teaching Methodologies: Implementing Project-Based and Flipped Learning

Vic Montemayor - No one has been more passionate about improving the quality and effectiveness of the teaching of Medical Physics than Bill Hendee. It was in August of 2008 that the first AAPM Workshop on Becoming a Better Teacher of Medical Physics was held, organized and run by Bill Hendee. This was followed up in July of 2010 with a summer school on the same topic, again organized by Bill. There has been continued interest in alternate approaches to teaching medical physics since those initial gatherings. The momentum established by these workshops is made clear each year in the annual Innovation in Medical Physics Education session, which highlights work being done in all forms of medical physics education, from one-on-one residencies or classroom presentations to large-scale program revisions and on-line resources for international audiences. This symposium, presented on behalf of the Education Council, highlights the work of three finalists from past Innovation in Education sessions. Each will be presenting their approaches to and innovations in teaching medical physics. It is hoped that audience members interested in trying something new in their teaching of medical physics will find some of these ideas and approaches readily applicable to their own classrooms. Rebecca Howell - The presentation will discuss ways to maximize classroom learning, i.e., increasing the amount of material covered while also enhancing students’ understanding of the broader implications of the course topics. Specifically, the presentation will focus on two teaching methodologies, project based learning and flip learning. These teaching methods will be illustrated using an example of graduate medical physics course where both are used in conjunction with traditional lectures. Additionally, the presentation will focus on our experience implementing these methods including challenges that were overcome. Jay Burmeister - My presentation will discuss the incorporation of active learning techniques into a traditional medical physics classroom course. I will describe these techniques and how they were implemented as well as student performance before and after implementation. Student feedback indicated that these course changes improved their ability to actively assimilate the course content, thus improving their understanding of the material. Shahid Naqvi - My talk will focus on ways to help students visualize crucial concepts that lie at the core of radiation physics. Although particle tracks generated by Monte Carlo simulations have served as an indispensable visualization tool, students often struggle to resolve the underlying physics from a simultaneous jumble of tracks. We can clarify the physics by “coding” the tracks, e.g., by coloring the tracks according to their “starting” or “crossing” regions. The regionally-coded tracks when overlaid with dose distributions help the students see the elusive connection between dose, kerma and electronic disequilibrium. Tracks coded according to local energy or energy-loss rate can illustrate the need for stopping power corrections in electron beams and explain the Bragg peak in a proton beam. Coding tracks according to parent interaction type and order can clarify the often misunderstood distinction between primary and scatter dose. The students can thus see the “whole” simultaneously with the “sum of the parts,” which enhances their physical insight and creates a sustainable foundation for further learning. After the presentations the speakers and moderator will be open to questions and discussion with the audience members. Learning Objectives: Be able to explain Project-Based Learning and how can it be incorporated into a Medical Physics classroom. Be able to explain Flipped Learning and how can it be incorporated into a Medical Physics classroom. Be able to explain active-learning strategies for the teaching of Medical Physics. Be able to explain how Monte Carlo simulations can be used to deepen a student’s understanding of radiation physics and dosimetry.

07 ISOTOPE AND RADIATION SOURCES↗

DOE OSTI2016

SU-A-BRA-03: Creative Stimulation: A Flexible Hands-On Approach to Building a Deeper Understanding of Critical Concepts in Radiation Physics

Vic Montemayor - No one has been more passionate about improving the quality and effectiveness of the teaching of Medical Physics than Bill Hendee. It was in August of 2008 that the first AAPM Workshop on Becoming a Better Teacher of Medical Physics was held, organized and run by Bill Hendee. This was followed up in July of 2010 with a summer school on the same topic, again organized by Bill. There has been continued interest in alternate approaches to teaching medical physics since those initial gatherings. The momentum established by these workshops is made clear each year in the annual Innovation in Medical Physics Education session, which highlights work being done in all forms of medical physics education, from one-on-one residencies or classroom presentations to large-scale program revisions and on-line resources for international audiences. This symposium, presented on behalf of the Education Council, highlights the work of three finalists from past Innovation in Education sessions. Each will be presenting their approaches to and innovations in teaching medical physics. It is hoped that audience members interested in trying something new in their teaching of medical physics will find some of these ideas and approaches readily applicable to their own classrooms. Rebecca Howell - The presentation will discuss ways to maximize classroom learning, i.e., increasing the amount of material covered while also enhancing students’ understanding of the broader implications of the course topics. Specifically, the presentation will focus on two teaching methodologies, project based learning and flip learning. These teaching methods will be illustrated using an example of graduate medical physics course where both are used in conjunction with traditional lectures. Additionally, the presentation will focus on our experience implementing these methods including challenges that were overcome. Jay Burmeister - My presentation will discuss the incorporation of active learning techniques into a traditional medical physics classroom course. I will describe these techniques and how they were implemented as well as student performance before and after implementation. Student feedback indicated that these course changes improved their ability to actively assimilate the course content, thus improving their understanding of the material. Shahid Naqvi - My talk will focus on ways to help students visualize crucial concepts that lie at the core of radiation physics. Although particle tracks generated by Monte Carlo simulations have served as an indispensable visualization tool, students often struggle to resolve the underlying physics from a simultaneous jumble of tracks. We can clarify the physics by “coding” the tracks, e.g., by coloring the tracks according to their “starting” or “crossing” regions. The regionally-coded tracks when overlaid with dose distributions help the students see the elusive connection between dose, kerma and electronic disequilibrium. Tracks coded according to local energy or energy-loss rate can illustrate the need for stopping power corrections in electron beams and explain the Bragg peak in a proton beam. Coding tracks according to parent interaction type and order can clarify the often misunderstood distinction between primary and scatter dose. The students can thus see the “whole” simultaneously with the “sum of the parts,” which enhances their physical insight and creates a sustainable foundation for further learning. After the presentations the speakers and moderator will be open to questions and discussion with the audience members. Learning Objectives: Be able to explain Project-Based Learning and how can it be incorporated into a Medical Physics classroom. Be able to explain Flipped Learning and how can it be incorporated into a Medical Physics classroom. Be able to explain active-learning strategies for the teaching of Medical Physics. Be able to explain how Monte Carlo simulations can be used to deepen a student’s understanding of radiation physics and dosimetry.

07 ISOTOPE AND RADIATION SOURCES↗

DOE OSTI2016

SU-A-BRA-04: Incorporating Active Learning Into Medical Physics Education

Vic Montemayor - No one has been more passionate about improving the quality and effectiveness of the teaching of Medical Physics than Bill Hendee. It was in August of 2008 that the first AAPM Workshop on Becoming a Better Teacher of Medical Physics was held, organized and run by Bill Hendee. This was followed up in July of 2010 with a summer school on the same topic, again organized by Bill. There has been continued interest in alternate approaches to teaching medical physics since those initial gatherings. The momentum established by these workshops is made clear each year in the annual Innovation in Medical Physics Education session, which highlights work being done in all forms of medical physics education, from one-on-one residencies or classroom presentations to large-scale program revisions and on-line resources for international audiences. This symposium, presented on behalf of the Education Council, highlights the work of three finalists from past Innovation in Education sessions. Each will be presenting their approaches to and innovations in teaching medical physics. It is hoped that audience members interested in trying something new in their teaching of medical physics will find some of these ideas and approaches readily applicable to their own classrooms. Rebecca Howell - The presentation will discuss ways to maximize classroom learning, i.e., increasing the amount of material covered while also enhancing students’ understanding of the broader implications of the course topics. Specifically, the presentation will focus on two teaching methodologies, project based learning and flip learning. These teaching methods will be illustrated using an example of graduate medical physics course where both are used in conjunction with traditional lectures. Additionally, the presentation will focus on our experience implementing these methods including challenges that were overcome. Jay Burmeister - My presentation will discuss the incorporation of active learning techniques into a traditional medical physics classroom course. I will describe these techniques and how they were implemented as well as student performance before and after implementation. Student feedback indicated that these course changes improved their ability to actively assimilate the course content, thus improving their understanding of the material. Shahid Naqvi - My talk will focus on ways to help students visualize crucial concepts that lie at the core of radiation physics. Although particle tracks generated by Monte Carlo simulations have served as an indispensable visualization tool, students often struggle to resolve the underlying physics from a simultaneous jumble of tracks. We can clarify the physics by “coding” the tracks, e.g., by coloring the tracks according to their “starting” or “crossing” regions. The regionally-coded tracks when overlaid with dose distributions help the students see the elusive connection between dose, kerma and electronic disequilibrium. Tracks coded according to local energy or energy-loss rate can illustrate the need for stopping power corrections in electron beams and explain the Bragg peak in a proton beam. Coding tracks according to parent interaction type and order can clarify the often misunderstood distinction between primary and scatter dose. The students can thus see the “whole” simultaneously with the “sum of the parts,” which enhances their physical insight and creates a sustainable foundation for further learning. After the presentations the speakers and moderator will be open to questions and discussion with the audience members. Learning Objectives: Be able to explain Project-Based Learning and how can it be incorporated into a Medical Physics classroom. Be able to explain Flipped Learning and how can it be incorporated into a Medical Physics classroom. Be able to explain active-learning strategies for the teaching of Medical Physics. Be able to explain how Monte Carlo simulations can be used to deepen a student’s understanding of radiation physics and dosimetry.

07 ISOTOPE AND RADIATION SOURCES↗

DOE OSTI2016

SU-A-BRA-05: Panel Discussion

Vic Montemayor - No one has been more passionate about improving the quality and effectiveness of the teaching of Medical Physics than Bill Hendee. It was in August of 2008 that the first AAPM Workshop on Becoming a Better Teacher of Medical Physics was held, organized and run by Bill Hendee. This was followed up in July of 2010 with a summer school on the same topic, again organized by Bill. There has been continued interest in alternate approaches to teaching medical physics since those initial gatherings. The momentum established by these workshops is made clear each year in the annual Innovation in Medical Physics Education session, which highlights work being done in all forms of medical physics education, from one-on-one residencies or classroom presentations to large-scale program revisions and on-line resources for international audiences. This symposium, presented on behalf of the Education Council, highlights the work of three finalists from past Innovation in Education sessions. Each will be presenting their approaches to and innovations in teaching medical physics. It is hoped that audience members interested in trying something new in their teaching of medical physics will find some of these ideas and approaches readily applicable to their own classrooms. Rebecca Howell - The presentation will discuss ways to maximize classroom learning, i.e., increasing the amount of material covered while also enhancing students’ understanding of the broader implications of the course topics. Specifically, the presentation will focus on two teaching methodologies, project based learning and flip learning. These teaching methods will be illustrated using an example of graduate medical physics course where both are used in conjunction with traditional lectures. Additionally, the presentation will focus on our experience implementing these methods including challenges that were overcome. Jay Burmeister - My presentation will discuss the incorporation of active learning techniques into a traditional medical physics classroom course. I will describe these techniques and how they were implemented as well as student performance before and after implementation. Student feedback indicated that these course changes improved their ability to actively assimilate the course content, thus improving their understanding of the material. Shahid Naqvi - My talk will focus on ways to help students visualize crucial concepts that lie at the core of radiation physics. Although particle tracks generated by Monte Carlo simulations have served as an indispensable visualization tool, students often struggle to resolve the underlying physics from a simultaneous jumble of tracks. We can clarify the physics by “coding” the tracks, e.g., by coloring the tracks according to their “starting” or “crossing” regions. The regionally-coded tracks when overlaid with dose distributions help the students see the elusive connection between dose, kerma and electronic disequilibrium. Tracks coded according to local energy or energy-loss rate can illustrate the need for stopping power corrections in electron beams and explain the Bragg peak in a proton beam. Coding tracks according to parent interaction type and order can clarify the often misunderstood distinction between primary and scatter dose. The students can thus see the “whole” simultaneously with the “sum of the parts,” which enhances their physical insight and creates a sustainable foundation for further learning. After the presentations the speakers and moderator will be open to questions and discussion with the audience members. Learning Objectives: Be able to explain Project-Based Learning and how can it be incorporated into a Medical Physics classroom. Be able to explain Flipped Learning and how can it be incorporated into a Medical Physics classroom. Be able to explain active-learning strategies for the teaching of Medical Physics. Be able to explain how Monte Carlo simulations can be used to deepen a student’s understanding of radiation physics and dosimetry.

07 ISOTOPE AND RADIATION SOURCES↗

DOE OSTI2016

SU-A-BRA-00: Education Council Symposium: Revitalizing Your Medical Physics Classroom: Some Examples and Thoughts from the Trenches

Vic Montemayor - No one has been more passionate about improving the quality and effectiveness of the teaching of Medical Physics than Bill Hendee. It was in August of 2008 that the first AAPM Workshop on Becoming a Better Teacher of Medical Physics was held, organized and run by Bill Hendee. This was followed up in July of 2010 with a summer school on the same topic, again organized by Bill. There has been continued interest in alternate approaches to teaching medical physics since those initial gatherings. The momentum established by these workshops is made clear each year in the annual Innovation in Medical Physics Education session, which highlights work being done in all forms of medical physics education, from one-on-one residencies or classroom presentations to large-scale program revisions and on-line resources for international audiences. This symposium, presented on behalf of the Education Council, highlights the work of three finalists from past Innovation in Education sessions. Each will be presenting their approaches to and innovations in teaching medical physics. It is hoped that audience members interested in trying something new in their teaching of medical physics will find some of these ideas and approaches readily applicable to their own classrooms. Rebecca Howell - The presentation will discuss ways to maximize classroom learning, i.e., increasing the amount of material covered while also enhancing students’ understanding of the broader implications of the course topics. Specifically, the presentation will focus on two teaching methodologies, project based learning and flip learning. These teaching methods will be illustrated using an example of graduate medical physics course where both are used in conjunction with traditional lectures. Additionally, the presentation will focus on our experience implementing these methods including challenges that were overcome. Jay Burmeister - My presentation will discuss the incorporation of active learning techniques into a traditional medical physics classroom course. I will describe these techniques and how they were implemented as well as student performance before and after implementation. Student feedback indicated that these course changes improved their ability to actively assimilate the course content, thus improving their understanding of the material. Shahid Naqvi - My talk will focus on ways to help students visualize crucial concepts that lie at the core of radiation physics. Although particle tracks generated by Monte Carlo simulations have served as an indispensable visualization tool, students often struggle to resolve the underlying physics from a simultaneous jumble of tracks. We can clarify the physics by “coding” the tracks, e.g., by coloring the tracks according to their “starting” or “crossing” regions. The regionally-coded tracks when overlaid with dose distributions help the students see the elusive connection between dose, kerma and electronic disequilibrium. Tracks coded according to local energy or energy-loss rate can illustrate the need for stopping power corrections in electron beams and explain the Bragg peak in a proton beam. Coding tracks according to parent interaction type and order can clarify the often misunderstood distinction between primary and scatter dose. The students can thus see the “whole” simultaneously with the “sum of the parts,” which enhances their physical insight and creates a sustainable foundation for further learning. After the presentations the speakers and moderator will be open to questions and discussion with the audience members. Learning Objectives: Be able to explain Project-Based Learning and how can it be incorporated into a Medical Physics classroom. Be able to explain Flipped Learning and how can it be incorporated into a Medical Physics classroom. Be able to explain active-learning strategies for the teaching of Medical Physics. Be able to explain how Monte Carlo simulations can be used to deepen a student’s understanding of radiation physics and dosimetry.

07 ISOTOPE AND RADIATION SOURCES↗

DOE OSTI2016

SU-F-E-16: A Specific Training Package for Medical Physicists in Support to Nuclear and Radiological Emergency Situations

Purpose: To provide the professional medical physicists with adequate competencies and skills in order to help them get prepared to support Nuclear or Radiological Emergency (NRE) situations. Methods: Although clinical medical physicists working have in-depth knowledge in radiation dosimetry, including dose reconstruction and dose measurements, they are usually not involved in NRE situations. However, in a few instances where medical physicists were involved in NREs, it appeared that many lacked specific knowledge and skills that are required in such situations. This lack of specific knowledge and skills is probably due to the fact that most current medical physics curricula do not include a specific module on this topic. As a response to this finding, the IAEA decided to initiate a project to develop a specific training package to help prepare medical physicists to support NRE situations. The training package was developed with the kind support of the Government of Japan and in collaboration with Fukushima Medical University (FMU) and the National Institute of Radiological Sciences (NIRS). Results: The first International Workshop to test the training package was held in Fukushima, Japan in June 2015. It consisted of lectures, demonstrations, simulation, role play, and practical sessions followed by discussions. The training was delivered through 14 modules which were prepared with the support of 12 lecturers. A knowledge assessment test was done before the workshop, followed by the same test done at the end of the Workshop, to assess the knowledge acquired during the training. Conclusion: The Workshop was successfully implemented. The overall rating of the workshop by the participants was excellent and all participants reported that they acquired a good understanding of the main issues that are relevant to medical physics support in case of NRE situations. They are expected to disseminate the knowledge to other medical physicists in their countries.

07 ISOTOPE AND RADIATION SOURCES↗

DOE OSTI2016

SU-F-P-09: A Global Medical Physics Collaboration for Implementation of Modern Radiotherapy in Botswana

Purpose: The global burden of cancer is considerable, particularly in low and middle-income countries. Massachusetts General Hospital (MGH) and Botswana-Harvard AIDS Institute have partnered with the oncology community and government of Botswana to form BOTSOGO (BOTSwana Oncology Global Outreach) to address the rising burden of cancer in Botswana. Currently, radiation therapy (RT) is only available at a single linear accelerator (LINAC) in Gaborone Private Hospital (GPH). BOTSOGO worked to limit the absence of RT during a LINAC upgrade and ensure a safe transition to modern radiotherapy techniques. Methods: The existing Elekta Precise LINAC was decommissioned in November 2015 and replaced with a new Elekta VERSA-HD with IMRT/VMAT/CBCT capability. Upgraded treatment planning and record-and-verify systems were also installed. Physicists from GPH and MGH collaborated during an intensive on-site visit in Botswana during the commissioning process. Measurements were performed using newly purchased Sun Nuclear equipment. Photon beams were matched with an existing model to minimize the time needed for beam modeling and machine down time. Additional remote peer review was also employed. Independent dosimetry was performed by irradiating OSLDs, which were subsequently analyzed at MGH. Results: Photon beam quality agreed with reference data within 0.2%. Electron beam data agreed with example clinical data within 3%. Absolute dose calibration was performed using both IAEA and AAPM protocols. Absolute dose measurements with OSLDs agreed within 5%. Quentry cloud-based software was installed to facilitate remote review of treatment plans. Patient treatments resumed in February 2016. The time without RT was reduced, therefore likely resulting in reduced patient morbidity/mortality. Conclusion: A global physics collaboration was utilized to commission a modern LINAC in a resource-constrained setting. This can be a useful model in other areas with limited resources. Further use of technology and on-site exchanges will facilitate the introduction of more advanced techniques in Botswana. We acknowledge funding support from the AAPM International Educational Activities Committee and the NCI Federal Share Proton Beam Program Income Grant.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

SU-F-P-39: End-To-End Validation of a 6 MV High Dose Rate Photon Beam, Configured for Eclipse AAA Algorithm Using Golden Beam Data, for SBRT Treatments Using RapidArc

Purpose: To use end-to-end testing to validate a 6 MV high dose rate photon beam, configured for Eclipse AAA algorithm using Golden Beam Data (GBD), for SBRT treatments using RapidArc. Methods: Beam data was configured for Varian Eclipse AAA algorithm using the GBD provided by the vendor. Transverse and diagonals dose profiles, PDDs and output factors down to a field size of 2×2 cm2 were measured on a Varian Trilogy Linac and compared with GBD library using 2% 2mm 1D gamma analysis. The MLC transmission factor and dosimetric leaf gap were determined to characterize the MLC in Eclipse. Mechanical and dosimetric tests were performed combining different gantry rotation speeds, dose rates and leaf speeds to evaluate the delivery system performance according to VMAT accuracy requirements. An end-to-end test was implemented planning several SBRT RapidArc treatments on a CIRS 002LFC IMRT Thorax Phantom. The CT scanner calibration curve was acquired and loaded in Eclipse. PTW 31013 ionization chamber was used with Keithley 35617EBS electrometer for absolute point dose measurements in water and lung equivalent inserts. TPS calculated planar dose distributions were compared to those measured using EPID and MapCheck, as an independent verification method. Results were evaluated with gamma criteria of 2% dose difference and 2mm DTA for 95% of points. Results: GBD set vs. measured data passed 2% 2mm 1D gamma analysis even for small fields. Machine performance tests show results are independent of machine delivery configuration, as expected. Absolute point dosimetry comparison resulted within 4% for the worst case scenario in lung. Over 97% of the points evaluated in dose distributions passed gamma index analysis. Conclusion: Eclipse AAA algorithm configuration of the 6 MV high dose rate photon beam using GBD proved efficient. End-to-end test dose calculation results indicate it can be used clinically for SBRT using RapidArc.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

SU-F-J-114: On-Treatment Imagereconstruction Using Transit Images of Treatment Beams Through Patient and Thosethrough Planning CT Images

Purpose: To reconstruct patient images at the time of radiation delivery using measured transit images of treatment beams through patient and calculated transit images through planning CT images. Methods: We hypothesize that the ratio of the measured transit images to the calculated images may provide changed amounts of the patient image between times of planning CT and treatment. To test, we have devised lung phantoms with a tumor object (3-cm diameter) placed at iso-center (simulating planning CT) and off-center by 1 cm (simulating treatment). CT images of the two phantoms were acquired; the image of the off-centered phantom, unavailable clinically, represents the reference on-treatment image in the image quality of planning CT. Cine-transit images through the two phantoms were also acquired in EPID from a non-modulated 6 MV beam when the gantry was rotated 360 degrees; the image through the centered phantom simulates calculated image. While the current study is a feasibility study, in reality our computational EPID model can be applicable in providing accurate transit image from MC simulation. Changed MV HU values were reconstructed from the ratio between two EPID projection data, converted to KV HU values, and added to the planning CT, thereby reconstructing the on-treatment image of the patient limited to the irradiated region of the phantom. Results: The reconstructed image was compared with the reference image. Except for local HU differences>200 as a maximum, excellent agreement was found. The average difference across the entire image was 16.2 HU. Conclusion: We have demonstrated the feasibility of a method of reconstructing on-treatment images of a patient using EPID image and planning CT images. Further studies will include resolving the local HU differences and investigation on the dosimetry impact of the reconstructed image.

60 APPLIED LIFE SCIENCES↗