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At least 1,747 records · Page 97

A high-transparency, micro-patternable chip for X-ray diffraction analysis of microcrystals under native growth conditions

A highly X-ray-transparent, silicon nitride-based device has been designed and fabricated to harvest protein microcrystals for high-resolution X-ray diffraction data collection using microfocus beamlines and XFELs. Microcrystals present a significant impediment to the determination of macromolecular structures by X-ray diffraction methods. Although microfocus synchrotron beamlines and X-ray free-electron lasers (XFELs) can enable the collection of interpretable diffraction data from microcrystals, there is a need for efficient methods of harvesting small volumes (<2 µl) of microcrystals grown under common laboratory formats and delivering them to an X-ray beam source under native growth conditions. One approach that shows promise in overcoming the challenges intrinsic to microcrystal analysis is to pair so-called ‘fixed-target’ sample-delivery devices with microbeam-based X-ray diffraction methods. However, to record weak diffraction patterns it is necessary to fabricate devices from X-ray-transparent materials that minimize background scattering. Presented here is the design of a new micro-diffraction device consisting of three layers fabricated from silicon nitride, photoresist and polyimide film. The chip features low X-ray scattering and X-ray absorption properties, and uses a customizable blend of hydrophobic and hydrophilic surface patterns to help localize microcrystals to defined regions. Microcrystals in their native growth conditions can be loaded into the chips with a standard pipette, allowing data collection at room temperature. Diffraction data collected from hen egg-white lysozyme microcrystals (10–15 µm) loaded into the chips yielded a complete, high-resolution (<1.6 Å) data set sufficient to determine a high-quality structure by molecular replacement. The features of the chip allow the rapid and user-friendly analysis of microcrystals grown under virtually any laboratory format at microfocus synchrotron beamlines and XFELs.

75 CONDENSED MATTER PHYSICS, SUPERCONDUCTIVITY AND↗

An Evaluation of One-Sided and Two-Sided Communication Paradigms on Relaxed-Ordering Interconnect

The Cray Gemini interconnect hardware provides multiple transfer mechanisms and out-of-order message delivery to improve communication throughput. In this paper we quantify the performance of one-sided and two-sided communication paradigms with respect to: 1) the optimal available hardware transfer mechanism, 2) message ordering constraints, 3) per node and per core message concurrency. In addition to using Cray native communication APIs, we use UPC and MPI micro-benchmarks to capture one- and two-sided semantics respectively. Our results indicate that relaxing the message delivery order can improve performance up to 4.6x when compared with strict ordering. When hardware allows it, high-level one-sided programming models can already take advantage of message reordering. Enforcing the ordering semantics of two-sided communication comes with a performance penalty. Furthermore, we argue that exposing out-of-order delivery at the application level is required for the next-generation programming models. Any ordering constraints in the language specifications reduce communication performance for small messages and increase the number of active cores required for peak throughput.

97 MATHEMATICS AND COMPUTING↗

Halloysite Clay Nanotubes as Carriers for Curcumin: Characterization and Application

Halloysite is a nanostructured clay mineral with hollow tubular structure, which has recently found an important role as delivery system for drugs or other active molecules. One of these is curcumin, main constituent in the rhizome of the plant Curcuma Longa, with a series of useful pharmacological activities, hindered by its poor bioavalaibility and solubility in water. In this study, Halloysite clay nanotubes (HNTs) were characterized in terms of both structure and biocompatibility and they were used for curcumin delivery to cancer cells. The performed 3-(4, 5-dimethythiazol-2-yl)-2, 5-diphenyl-tetrazolium bromide (MTT) assay showed that HNTs have a high biocompatibility, also when coated with polymers, while curcumin is highly toxic for cancer cells. The release kinetics of curcumin from HNTs was investigated by the dialysis bag method, showing a slow and constant release of the drug, which can be further controlled by adding layers of polyelectrolytes to the external surface of the tubes. Successful polymer coating was followed by Zeta potential. The Trypan Blue assay showed a cytotoxic effect of loaded HNTs, proportional to the concentration of tubes and the incubation time. Successful HNTs uptake by breast cancer cells was demonstrated by Confocal Laser Scanning Microscopy images. All results indicate that HNTs are a promising carriers for polyphenol delivery and release.

77 NANOSCIENCE AND NANOTECHNOLOGY↗

A Quasi-Periodic Linear Feeder for the Impurity Granular Injection on DIII-D

Injection of solid nonfuel pellets has been actively used as a tool for pacing and mitigation of edge localized modes (ELMs). In DIII-D, effective ELM pacing has been demonstrated by the high-frequency injection of lithium and carbon submillimeter spheres, using the impurity granule injector (IGI). This device injects granules into the plasma at speeds up to 150 m/s, through impact with a rotating impeller. In the IGI, high-frequency granule delivery was accomplished through a vibrational granule dropper, in which high time-average rates are obtained at the cost of lack of period control. Here, we present a new in-line granule feeder, capable of delivering granules of size 0.2-2 mm with no restriction of material properties, at quasi-periodic rates of up to 150 Hz, for 0.7-mm diameter lithium granules (600 Hz using 0.3-mm granules). The new dropper mechanism combines two piezo-in-line units; one which feeds the impeller and one which circulates granules that are filtered out of the feeder path. A remotely adjustable filter eliminates granules that are stacked, oversized, or side by side allowing the formation of a single moving granule injection line. The granules fall off the in-line feeder exit one at a time, achieving a quasi-periodic delivery rate proportional to the exit speed. At higher rates, the periodicity deteriorates. This behavior was studied using high-speed cameras and electrostatic measurements, and it was found that at drop rates <60 Hz, the granule delivery period has a variation of ±25% which appears to be caused by gaps which develop in the last centimeter of the injection line, as granules exit off the moving track. The linear feeder concept is robust against bridge instabilities and clogging issues, thanks to the simple diverter filter and constant recirculation of granules. Furthermore, the open-top design of the device facilitates refilling the device from separate reservoirs and has easy access for directly monitoring operation and adjustment. This paper describes the details of the in-line feeder design, along with several design iterations. The goal is a robust in-vacuum mechanism that can deliver granule flow ranging from a single particle to a line of particles at 150 per second, using different sizes and materials from the same apparatus.

42 ENGINEERING↗

Offering of Variable Resources in Regulation Markets with Performance Targets: An Analysis

To date, wind and solar power plants have mainly provided energy. Going forward, with the application of appropriate controls, they can offer additional grid services, such as regulating reserves. Additional grid services can present an opportunity for additional value streams to wind and solar power plants. However, the additional value might not be realized when operator-determined performance targets and settlement adjustments for the delivery of regulation capacity are disregarded. Additionally, this article studies the participation of variable resources in centralized regulation markets. We derive analytical results for regulation offers in terms of quantity and price considering that a variable resource does not want to risk being disqualified as a regulation provider, incurring losses, or foregoing more profitable opportunities. Our analysis suggests that U.S. operator-determined performance targets impose an upper bound on the quantity of a variable resource’s regulation offer; and settlement adjustments for the delivery of regulation affect the price at which variable resources offer and the calculations of opportunity costs in case of imperfect regulation delivery.

24 POWER TRANSMISSION AND DISTRIBUTION↗

Cooperation between two periplasmic copper chaperones is required for full activity of the cbb 3 -type cytochrome c oxidase and copper homeostasis in Rhodobacter capsulatus

Copper (Cu) is an essential micronutrient that functions as a cofactor in several important enzymes, like respiratory heme-copper oxygen reductases. Yet, Cu is also toxic and therefore cells engage a highly coordinated Cu uptake and delivery system to prevent the accumulation of toxic Cu concentrations. In the current work we analyzed Cu delivery to the cbb 3 -type cytochrome c oxidase ( cbb 3 -Cox) of Rhodobacter capsulatus . We identified the PCu A C-like periplasmic chaperone PccA and analyzed its contribution to cbb 3 -Cox assembly. Our data demonstrate that PccA is a Cu-binding protein with a preference for Cu(I), which is required for efficient cbb 3 -Cox assembly, in particular at low Cu concentrations. By using in vivo and in vitro crosslinking we show that PccA forms a complex with the Sco1-homologue SenC. This complex is stabilized in the absence of the cbb 3 -Cox specific assembly factors CcoGHIS. In cells lacking SenC, the cytoplasmic Cu content is significantly increased, but the simultaneous absence of PccA prevents this Cu accumulation. Lastly, these data demonstrate that the interplay between PccA and SenC is not only required for Cu delivery during cbb 3 -Cox assembly, but that it also regulates Cu homeostasis in R. capsulatus .

59 BASIC BIOLOGICAL SCIENCES↗

PlanHab * : hypoxia does not worsen the impairment of skeletal muscle oxidative function induced by bed rest alone

Key points Superposition of hypoxia on 21 day bed rest did not worsen the impairment of skeletal muscle oxidative function induced by bed rest alone. A significant impairment of maximal oxidative performance was identified downstream of cardiovascular O 2 delivery, involving both the intramuscular matching between O 2 supply and utilization and mitochondrial respiration. These chronic adaptations appear to be relevant in terms of exposure to spaceflights and reduced gravity habitats (Moon or Mars), as characterized by low gravity and hypoxia, in patients with chronic diseases characterized by hypomobility/immobility and hypoxia, as well as in ageing. Abstract Skeletal muscle oxidative function was evaluated in 11 healthy males (mean ± SD age 27 ± 5 years) prior to (baseline data collection, BDC) and following a 21 day horizontal bed rest (BR), carried out in normoxia ( = 133 mmHg; N‐BR) and hypoxia ( = 90 mmHg; H‐BR). H‐BR was aimed at simulating reduced gravity habitats. The effects of a 21 day hypoxic ambulatory confinement ( = 90 mmHg; H‐AMB) were also assessed. Pulmonary O 2 uptake ( ), vastus lateralis fractional O 2 extraction (changes in deoxygenated haemoglobin + myoglobin concentration, Δ[deoxy(Hb + Mb)]; near‐infrared spectroscopy) and femoral artery blood flow (ultrasound Doppler) were evaluated during incremental one‐leg knee‐extension exercise (reduced constraints to cardiovascular O 2 delivery) carried out to voluntary exhaustion in a normoxic environment. Mitochondrial respiration was evaluated ex vivo by high‐resolution respirometry in permeabilized vastus lateralis fibres. decreased ( P < 0.05) after N‐BR (0.98 ± 0.13 L min −1 ) and H‐BR (0.96 ± 0.17 L min −1 ) vs . BDC (1.05 ± 0.14 L min −1 ). In the presence of a decreased (by ∼6–8%) thigh muscle volume, normalized per unit of muscle mass was not affected by both interventions. Δ[deoxy(Hb + Mb)] peak decreased ( P < 0.05) after N‐BR (65 ± 13% of limb ischaemia) and H‐BR (62 ± 12%) vs . BDC (73 ± 13%). H‐AMB did not alter or Δ[deoxy(Hb + Mb)] peak . An overshoot of Δ[deoxy(Hb + Mb)] was evident during the first minute of unloaded exercise after N‐BR and H‐BR. Arterial blood flow to the lower limb during both unloaded and peak knee extension was not affected by any intervention. Maximal ADP‐stimulated mitochondrial respiration decreased ( P < 0.05) after all interventions vs . control. In 21 day N‐BR, a significant impairment of oxidative metabolism occurred downstream of cardiovascular O 2 delivery, affecting both mitochondrial respiration and presumably the intramuscular matching between O 2 supply and utilization. Superposition of H on BR did not worsen the impairment induced by BR alone.

Salvadego, Desy↗

EPID-based verification of the MLC performance for dynamic IMRT and VMAT

Purpose: In advanced radiotherapy treatments such as intensity modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT), verification of the performance of the multileaf collimator (MLC) is an essential part of the linac QA program. The purpose of this study is to use the existing measurement methods for geometric QA of the MLCs and extend them to more comprehensive evaluation techniques, and to develop dedicated robust algorithms to quantitatively investigate the MLC performance in a fast, accurate, and efficient manner. Methods: The behavior of leaves was investigated in the step-and-shoot mode by the analysis of integrated electronic portal imaging device (EPID) images acquired during picket fence tests at fixed gantry angles and arc delivery. The MLC was also studied in dynamic mode by the analysis of cine EPID images of a sliding gap pattern delivered in a variety of conditions including different leaf speeds, deliveries at fixed gantry angles or in arc mode, and changing the direction of leaf motion. The accuracy of the method was tested by detection of the intentionally inserted errors in the delivery patterns. Results: The algorithm developed for the picket fence analysis was able to find each individual leaf position, gap width, and leaf bank skewness in addition to the deviations from expected leaf positions with respect to the beam central axis with sub-pixel accuracy. For the three tested linacs over a period of 5 months, the maximum change in the gap width was 0.5 mm, the maximum deviation from the expected leaf positions was 0.1 mm and the MLC skewness was up to 0.2 Degree-Sign . The algorithm developed for the sliding gap analysis could determine the velocity and acceleration/deceleration of each individual leaf as well as the gap width. There was a slight decrease in the accuracy of leaf performance with increasing leaf speeds. The analysis results were presented through several graphs. The accuracy of the method was assessed as 0.01 mm for both the gap size and peak position determination. Conclusions: This study provides fast, easy, and accurate test methods for routine QA of the MLC performance and helps in faster troubleshooting of MLC problems in both IMRT and VMAT treatments.

60 APPLIED LIFE SCIENCES↗

2D lag and signal nonlinearity correction in an amorphous silicon EPID and their impact on pretreatment dosimetric verification

Purpose: This investigation provides measurements of signal lag and nonlinearity separately for the Varian aS500 electronic portal imaging device (EPID), and an algorithm to correct for these effects in 2D; their potential impact on intensity modulated radiation therapy (IMRT) verification is also investigated. The authors quantify lag, as a function of both delivered monitor units (MU) and time, by using a range of MUs delivered at a clinically used rate of 400 MU/min. Explicit cumulative lag curves are thus determined for a range of MUs and times between the end of irradiation and the end of image acquisition. Signal nonlinearity is also investigated as a function of total MUs delivered. The family of cumulative lag curves and signal nonlinearity are then used to determine their effects on dynamic multileaf collimator (MLC) (IMRT) deliveries, and to correct for theses effects in 2D. Methods: Images acquired with an aS500 EPID and Varis Portal-Vision software were used to quantify detector lag and signal-nonlinearity. For the signal lag investigation, Portal-Vision's service monitor was used to acquire EPID images at a rate of 8 frames/s. The images were acquired during irradiation and 66 s thereafter, by inhibiting the M-holdoff-In signal of the Linac for a range of 4.5-198.5 MUs. Relative cumulative lag was calculated by integrating the EPID signal for a time after beam-off, and normalizing this to the integrated EPID signal accumulated during radiation. Signal nonlinearity was studied by acquiring 10 Multiplication-Sign 10 cm{sup 2} open-field EPID images in 'integrated image' mode for a range of 2-500 MUs, and normalized to the 100 MU case. All data were incorporated into in-house written software to create a 2D correction map for these effects, using the field's MLC file and a field-specific calculated 2D 'time-map,' which keeps track of the time elapsed from the last fluence delivered at each given point in the image to the end of the beam delivery. Results: Relative cumulative lag curves reveal that the lag alone can deviate the EPID's perceived dose by as large as 6% (1 MU delivery, 60 s postirradiation). For signal nonlinearity relative to 100 MU, EPID signals per MU of 0.84 and 1.01 were observed for 2 and 500 MUs, respectively. Correction maps were applied to a 1 cm sweeping-window 14 Multiplication-Sign 14 cm{sup 2} field and clinical head-and-neck IMRT field. A mean correction of 1.028 was implemented in the head-and-neck field, which significantly reduced lag-related asymmetries in the EPID images, and restored linearity to the EPID imager's dose response. Corrections made to the sweeping-field showed good agreement with the treatment planning system-predicted field, yielding an average percent difference of 0.05%{+-} 0.91%, compared to the -1.32%{+-} 1.02% before corrections, or 1.75%{+-} 1.04% when only a signal nonlinearity correction is made. Conclusions: Lag and signal-nonlinearity have been quantified for an aS500 EPID imager, and an effective 2D correction method has been developed which effectively removes nonlinearity and lag effects. Both of these effects were shown to negatively impact IMRT verifications. Especially fields that involve prolonged irradiation and small overall MUs should be corrected for in 2D.

60 APPLIED LIFE SCIENCES↗

Use of treatment log files in spot scanning proton therapy as part of patient-specific quality assurance

Purpose: The purpose of this work was to assess the monitor unit (MU) values and position accuracy of spot scanning proton beams as recorded by the daily treatment logs of the treatment control system, and furthermore establish the feasibility of using the delivered spot positions and MU values to calculate and evaluate delivered doses to patients. Methods: To validate the accuracy of the recorded spot positions, the authors generated and executed a test treatment plan containing nine spot positions, to which the authors delivered ten MU each. The spot positions were measured with radiographic films and Matrixx 2D ion-chambers array placed at the isocenter plane and compared for displacements from the planned and recorded positions. Treatment logs for 14 patients were then used to determine the spot MU values and position accuracy of the scanning proton beam delivery system. Univariate analysis was used to detect any systematic error or large variation between patients, treatment dates, proton energies, gantry angles, and planned spot positions. The recorded patient spot positions and MU values were then used to replace the spot positions and MU values in the plan, and the treatment planning system was used to calculate the delivered doses to patients. The results were compared with the treatment plan. Results: Within a treatment session, spot positions were reproducible within {+-}0.2 mm. The spot positions measured by film agreed with the planned positions within {+-}1 mm and with the recorded positions within {+-}0.5 mm. The maximum day-to-day variation for any given spot position was within {+-}1 mm. For all 14 patients, with {approx}1 500 000 spots recorded, the total MU accuracy was within 0.1% of the planned MU values, the mean (x, y) spot displacement from the planned value was (-0.03 mm, -0.01 mm), the maximum (x, y) displacement was (1.68 mm, 2.27 mm), and the (x, y) standard deviation was (0.26 mm, 0.42 mm). The maximum dose difference between calculated dose to the patient based on the plan and recorded data was within 2%. Conclusions: The authors have shown that the treatment log file in a spot scanning proton beam delivery system is precise enough to serve as a quality assurance tool to monitor variation in spot position and MU value, as well as the delivered dose uncertainty from the treatment delivery system. The analysis tool developed here could be useful for assessing spot position uncertainty and thus dose uncertainty for any patient receiving spot scanning proton beam therapy.

60 APPLIED LIFE SCIENCES↗

Dependence of diode sensitivity on the pulse rate of delivered radiation

Purpose: It has been reported that diode sensitivity decreases by as much as 2% when the average dose rate set at the accelerator console was decreased from 600 to 40 MU/min. No explanation was given for this effect in earlier publications. This work is a detailed investigation of this phenomenon: the change of diode sensitivity versus the rate of delivery of dose pulses in the milliseconds and seconds range. Methods: X-ray beams used in this work had nominal energies of 6 and 15 MV and were generated by linear accelerators. The average dose rate was varied from 25 to 600 MU/min, which corresponded to time between microsecond-long dose pulses of 60-2.7 ms, respectively. The dose-per-pulse, dpp, was changed by positioning the detector at different source-to-detector distance. A variety of diodes fabricated by a number of manufacturers were tested in this work. Also, diodes in three different MapCHECKs (Sun Nuclear, Melbourne, FL) were tested. Results: For all diodes tested, the diode sensitivity decreases as the average dose rate is decreased, which corresponds to an increase in the pulse period, the time between radiation pulses. A sensitivity decrease as large as 5% is observed for a 60-ms pulse period. The diode sensitivity versus the pulse period is modeled by an empirical exponential function. This function has a fitting parameter, t{sub eff}, defined as the effective lifetime. The values of t{sub eff} were found to be 1.0-14 s, among the various diodes. For all diodes tested, t{sub eff} decreases as the dpp decreases and is greater for 15 MV than for 6 MV x rays. The decrease in diode sensitivity after 20 s without radiation can be reversed by as few as 60 radiation pulses. Conclusions: A decrease in diode sensitivity occurs with a decrease in the average dose rate, which corresponds to an increase in the pulse period of radiation. The sensitivity decrease is modeled by an empirical exponential function that decreases with an effective lifetime, t{sub eff}, of 1.0-14 s. t{sub eff} varies widely for different diodes, dpp, and x-ray energy. It is hypothesized that the capture of excess minority carriers by charge traps, cause the observed decrease in diode sensitivity. Also, it is hypothesized that the slow reopening of these traps occurs in the hundreds of milliseconds to seconds range at ambient temperature and this underlies the slow decrease in the diode sensitivity. Calibration of a diode is best done at the average dose rate with which it will be used. This is easily accomplished for radiation deliveries in which the average dose rate is a constant. However, for a VMAT delivery the average dose rate is a variable. For measurements made under these conditions diodes can be calibrated with a median or average dose rate which splits the difference in diode sensitivity that is known to occur with changes in average dose rate.

60 APPLIED LIFE SCIENCES↗

Upgrade and benchmarking of a 4D treatment planning system for scanned ion beam therapy

Purpose: Upgrade and benchmarking of a research 4D treatment planning system (4DTPS) suitable for realistic patient treatment planning and treatment simulations taking into account specific requirements for scanned ion beam therapy, i.e., modeling of dose heterogeneities due to interplay effects and range changes caused by patient motion and dynamic beam delivery. Methods: The 4DTPS integrates data interfaces to 4D computed tomography (4DCT), deformable image registration and clinically used motion monitoring devices. The authors implemented a novel data model for 4D image segmentation using Boolean mask volume datasets and developed an algorithm propagating a manually contoured reference contour dataset to all 4DCT phases. They further included detailed treatment simulation and dose reconstruction functionality, based on the irregular patient motion and the temporal structure of the beam delivery. The treatment simulation functionality was validated against experimental data from irradiation of moving radiographic films in air, 3D moving ionization chambers in a water phantom, and moving cells in a biological phantom with a scanned carbon ion beam. The performance of the program was compared to results obtained with predecessor programs. Results: The measured optical density distributions of the radiographic films were reproduced by the simulations to (-2 {+-} 12)%. Compared to earlier versions of the 4DTPS, the mean agreement improved by 2%, standard deviations were reduced by 7%. The simulated dose to the moving ionization chambers in water showed an agreement with the measured dose of (-1 {+-} 4)% for the typical beam configuration. The mean deviation of the simulated from the measured biologically effective dose determined via cell survival was (617 {+-} 538) mGy relative biological effectiveness corresponding to (10 {+-} 9)%. Conclusions: The authors developed a research 4DTPS suitable for realistic treatment planning on patient data and capable of simulating dose delivery to a moving patient geometry for scanned ion beams. The accuracy and reliability of treatment simulations improved considerably with respect to earlier versions of the 4DTPS.

60 APPLIED LIFE SCIENCES↗

FusionArc optimization: A hybrid volumetric modulated arc therapy (VMAT) and intensity modulated radiation therapy (IMRT) planning strategy

Purpose: To introduce a hybrid volumetric modulated arc therapy/intensity modulated radiation therapy (VMAT/IMRT) optimization strategy called FusionArc that combines the delivery efficiency of single-arc VMAT with the potentially desirable intensity modulation possible with IMRT.Methods: A beamlet-based inverse planning system was enhanced to combine the advantages of VMAT and IMRT into one comprehensive technique. In the hybrid strategy, baseline single-arc VMAT plans are optimized and then the current cost function gradients with respect to the beamlets are used to define a metric for predicting which beam angles would benefit from further intensity modulation. Beams with the highest metric values (called the gradient factor) are converted from VMAT apertures to IMRT fluence, and the optimization proceeds with the mixed variable set until convergence or until additional beams are selected for conversion. One phantom and two clinical cases were used to validate the gradient factor and characterize the FusionArc strategy. Comparisons were made between standard IMRT, single-arc VMAT, and FusionArc plans with one to five IMRT/hybrid beams.Results: The gradient factor was found to be highly predictive of the VMAT angles that would benefit plan quality the most from beam modulation. Over the three cases studied, a FusionArc plan with three converted beams achieved superior dosimetric quality with reductions in final cost ranging from 26.4% to 48.1% compared to single-arc VMAT. Additionally, the three beam FusionArc plans required 22.4%-43.7% fewer MU/Gy than a seven beam IMRT plan. While the FusionArc plans with five converted beams offer larger reductions in final cost-32.9%-55.2% compared to single-arc VMAT-the decrease in MU/Gy compared to IMRT was noticeably smaller at 12.2%-18.5%, when compared to IMRT.Conclusions: A hybrid VMAT/IMRT strategy was implemented to find a high quality compromise between gantry-angle and intensity-based degrees of freedom. This optimization method will allow patients to be simultaneously planned for dosimetric quality and delivery efficiency without switching between delivery techniques. Example phantom and clinical cases suggest that the conversion of only three VMAT segments to modulated beams may result in a good combination of quality and efficiency.

61 RADIATION PROTECTION AND DOSIMETRY↗

Experimentally studied dynamic dose interplay does not meaningfully affect target dose in VMAT SBRT lung treatments

Purpose: The effects of respiratory motion on the tumor dose can be divided into the gradient and interplay effects. While the interplay effect is likely to average out over a large number of fractions, it may play a role in hypofractionated [stereotactic body radiation therapy (SBRT)] treatments. This subject has been extensively studied for intensity modulated radiation therapy but less so for volumetric modulated arc therapy (VMAT), particularly in application to hypofractionated regimens. Also, no experimental study has provided full four-dimensional (4D) dose reconstruction in this scenario. The authors demonstrate how a recently described motion perturbation method, with full 4D dose reconstruction, is applied to describe the gradient and interplay effects during VMAT lung SBRT treatments.Methods: VMAT dose delivered to a moving target in a patient can be reconstructed by applying perturbations to the treatment planning system-calculated static 3D dose. Ten SBRT patients treated with 6 MV VMAT beams in five fractions were selected. The target motion (motion kernel) was approximated by 3D rigid body translation, with the tumor centroids defined on the ten phases of the 4DCT. The motion was assumed to be periodic, with the period T being an average from the empirical 4DCT respiratory trace. The real observed tumor motion (total displacement ≤8 mm) was evaluated first. Then, the motion range was artificially increased to 2 or 3 cm. Finally, T was increased to 60 s. While not realistic, making T comparable to the delivery time elucidates if the interplay effect can be observed. For a single fraction, the authors quantified the interplay effect as the maximum difference in the target dosimetric indices, most importantly the near-minimum dose (D{sub 99%}), between all possible starting phases. For the three- and five-fractions, statistical simulations were performed when substantial interplay was found.Results: For the motion amplitudes and periods obtained from the 4DCT, the interplay effect is negligible (<0.2%). It is also small (0.9% average, 2.2% maximum) when the target excursion increased to 2–3 cm. Only with large motion and increased period (60 s) was a significant interplay effect observed, with D{sub 99%} ranging from 16% low to 17% high. The interplay effect was statistically significantly lower for the three- and five-fraction statistical simulations. Overall, the gradient effect dominates the clinical situation.Conclusions: A novel method was used to reconstruct the volumetric dose to a moving tumor during lung SBRT VMAT deliveries. With the studied planning and treatment technique for realistic motion periods, regardless of the amplitude, the interplay has nearly no impact on the near-minimum dose. The interplay effect was observed, for study purposes only, with the period comparable to the VMAT delivery time.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Characteristics of flattening filter free beams at low monitor unit settings

Purpose: Newer linear accelerators (linacs) have been equipped to deliver flattening filter free (FFF) beams. When FFF beams are used for step-and-shoot intensity-modulated radiotherapy (IMRT), the stability of delivery of small numbers of monitor units (MU) is important. The authors developed automatic measurement techniques to evaluate the stability of the dose profile, dose linearity, and consistency. Here, the authors report the performance of the Artiste™ accelerator (Siemens, Erlangen, Germany) in delivering low-MU FFF beams.Methods: A 6 MV flattened beam (6X) with 300 MU/min dose rate and FFF beams of 7 (7XU) and 11 MV (11XU), each with a 500 MU/min dose rate, were measured at 1, 2, 3, 5, 8, 10, and 20 MU settings. For the 2000 MU/min dose rate, the 7 (7XUH) and 11 MV (11XUH) beams were set at 10, 15, 20, 25, and 30 MU because of the limits of the minimum MU settings. Beams with 20 × 20 and 10 × 10 cm{sup 2} field sizes were alternately measured ten times in intensity modulated (IM) mode, with which Siemens linacs regulate beam delivery for step-and-shoot IMRT. The in- and crossplane beam profiles were measured using a Profiler™ Model 1170 (Sun Nuclear Corporation, Melbourne, FL) in multiframe mode. The frames of 20 × 20 cm{sup 2} beams were identified at the off-axis profile. The 6X beam profile was normalized at the central axis. The 7 and 11 MV FFF beam profiles were rescaled to set the dose at the central axis at 145% and 170%, respectively. Point doses were also measured using a Farmer-type ionization chamber and water-equivalent solid phantom to evaluate the linearity and consistency of low-MU beam delivery. The values displayed on the electrometer were recognized with a USB-type camera and read with open-source optical character recognition software.Results: The symmetry measurements of the 6X, 7XU, and 11XU beam profiles were better than 2% for beams ≥2 MU and improved with increasing MU. The variations in flatness of FFF beams ≥2 MU were ±5%. The standard deviation of the symmetry and flatness also decreased with increasing MU. The linearity of the 6X beam was ±1% and ±2% for the beams of ≥5 and ≥3 MU, respectively. The 7XU and 11XU beams of ≥2 MU showed linearity with ±2% except the 7XU beam of 8 MU (+2.9%). The profiles of the FFF beams with 2000 and 500 MU/min dose rate were similar.Conclusions: The characteristics of low-MU beams delivered in IM mode were evaluated using an automatic measurement system developed in this study. The authors demonstrated that the profiles of FFF beams of the Artiste™ linac were highly stable, even at low MU. The linearity of dose output was also stable for beams ≥2 MU.

61 RADIATION PROTECTION AND DOSIMETRY↗

Four-dimensional Monte Carlo simulations demonstrating how the extent of intensity-modulation impacts motion effects in proton therapy lung treatments

Purpose: To compare motion effects in intensity modulated proton therapy (IMPT) lung treatments with different levels of intensity modulation.Methods: Spot scanning IMPT treatment plans were generated for ten lung cancer patients for 2.5Gy(RBE) and 12Gy(RBE) fractions and two distinct energy-dependent spot sizes (σ∼8–17 mm and ∼2–4 mm). IMPT plans were generated with the target homogeneity of each individual field restricted to <20% (IMPT{sub 20%}). These plans were compared to full IMPT (IMPT{sub full}), which had no restriction on the single field homogeneity. 4D Monte Carlo simulations were performed upon the patient 4DCT geometry, including deformable image registration and incorporating the detailed timing structure of the proton delivery system. Motion effects were quantified via comparison of the results of the 4D simulations (4D-IMPT{sub 20%}, 4D-IMPT{sub full}) with those of a 3D Monte Carlo simulation (3D-IMPT{sub 20%}, 3D-IMPT{sub full}) upon the planning CT using the equivalent uniform dose (EUD), V{sub 95} and D{sub 1}-D{sub 99}. The effects in normal lung were quantified using mean lung dose (MLD) and V{sub 90%}.Results: For 2.5Gy(RBE), the mean EUD for the large spot size is 99.9%± 2.8% for 4D-IMPT{sub 20%} compared to 100.1%± 2.9% for 4D-IMPT{sub full}. The corresponding values are 88.6%± 8.7% (4D-IMPT{sub 20%}) and 91.0%± 9.3% (4D-IMPT{sub full}) for the smaller spot size. The EUD value is higher in 69.7% of the considered deliveries for 4D-IMPT{sub full}. The V{sub 95} is also higher in 74.7% of the plans for 4D-IMPT{sub full}, implying that IMPT{sub full} plans experience less underdose compared to IMPT{sub 20%}. However, the target dose homogeneity is improved in the majority (67.8%) of plans for 4D-IMPT{sub 20%}. The higher EUD and V{sub 95} suggests that the degraded homogeneity in IMPT{sub full} is actually due to the introduction of hot spots in the target volume, perhaps resulting from the sharper in-target dose gradients. The greatest variations between the IMPT{sub 20%} and IMPT{sub full} deliveries are observed for patients with the largest motion amplitudes. These patients would likely be treated using gating or another motion mitigation technique, which was not the focus of this study.Conclusions: For the treatment parameters considered in this study, the differences between IMPT{sub full} and IMPT{sub 20%} are only likely to be clinically significant for patients with large (>20 mm) motion amplitudes.

61 RADIATION PROTECTION AND DOSIMETRY↗

A comprehensive investigation of the accuracy and reproducibility of a multitarget single isocenter VMAT radiosurgery technique

Purpose: Recent trends in stereotactic radiosurgery use multifocal volumetric modulated arc therapy (VMAT) plans to simultaneously treat several distinct targets. Conventional verification often involves low resolution measurements in a single plane, a cylinder, or intersecting planes of diodes or ion chambers. This work presents an investigation into the consistency and reproducibility of this new treatment technique using a comprehensive commissioned high-resolution 3D dosimetry system (PRESAGE{sup ®}/Optical-CT).Methods: A complex VMAT plan consisting of a single isocenter but five separate targets was created in Eclipse for a head phantom containing a cylindrical PRESAGE{sup ®} dosimetry insert of 11 cm diameter and height. The plan contained five VMAT arcs delivering target doses from 12 to 20 Gy. The treatment was delivered to four dosimeters positioned in the head phantom and repeated four times, yielding four separate 3D dosimetry verifications. Each delivery was completely independent and was given after image guided radiation therapy (IGRT) positioning using Brainlab ExacTrac and cone beam computed tomography. A final delivery was given to a modified insert containing a pin-point ion chamber enabling calibration of PRESAGE{sup ®} 3D data to dose. Dosimetric data were read out in an optical-CT scanner. Consistency and reproducibility of the treatment technique (including IGRT setup) was investigated by comparing the dose distributions in the four inserts, and with the predicted treatment planning system distribution.Results: Dose distributions from the four dosimeters were registered and analyzed to determine the mean and standard deviation at all points throughout the dosimeters. A dose standard deviation of <3% was found from dosimeter to dosimeter. Global 3D gamma maps show that the predicted and measured dose matched well [3D gamma passing rate was 98.0% (3%, 2 mm)].Conclusions: The deliveries of the irradiation were found to be consistent and matched the treatment plan, demonstrating high accuracy and reproducibility of both the treatment machine and the IGRT procedure. The complexity of the treatment (multiple arcs) and dosimetry (multiple strong gradients) pose a substantial challenge for comprehensive verification. 3D dosimetry can be uniquely effective in this scenario.

61 RADIATION PROTECTION AND DOSIMETRY↗

Dosimetric comparison of flattened and unflattened beams for stereotactic ablative radiotherapy of stage I non-small cell lung cancer

Purpose: To compare contribution and accuracy of delivery for two flattening filter free (FFF) beams of the nominal energy 6 and 10 MV and a 6 MV flattened beam for early stage lung cancer. Methods: For each of 11 patients with stage I nonsmall cell lung cancer three volumetric modulated arc therapy plans were prepared utilizing a 6 MV flattened photon beam (X6FF) and two nonflattened beams of nominal energy 6 and 10 MV (X6FFF, X10FFF). Optimization constraints were set to produce dose distributions that meet the criteria of the RTOG-0915 protocol. The radiation schedule used for plan comparison in all patients was 50 Gy in five fractions. Dosimetric parameters of planning target volume (PTV) and organs-at-risk and delivery times were assessed and compared. All plans were subject to verification using Delta{sup 4} unit (Scandidos, Sweden) and absolutely calibrated gafchromic films in a thorax phantom. Results: All plans had a qualitatively comparable outcome. Obtained dose distributions were conformal (CI < 1.17) and exhibited a steep dose fall-off outside the PTV. The ratio of monitor units for FFF versus FF plans in the authors' study ranged from 0.95 to 1.21 and from 0.93 to 1.25 for X6FFF/X6FF and X10FFF/X6FF comparisons, respectively. The ratio systematically increased with increasing size of the PTV (up to +25% for 150 cm{sup 3} PTV). Yet the integral dose to healthy tissue did not follow this trend. Comparison of cumulative dose volume histograms for a patient's body showed that X6FFF plans exhibit improved conformity and reduced the volume of tissue that received more than 50% of the prescription dose. Parameters related to dose gradient showed statistically significant improvement. CI{sub 50%}, CI{sub 60%}, CI{sub 80%}, and CI{sub 100%} were on average reduced by 4.6% (p < 0.001), 4.6% (p = 0.002), 3.1% (p = 0.002), and 1.2% (p = 0.039), respectively. Gradient measure was on average reduced by 4.2% (p < 0.001). Due to dose reduction in the surrounding lung tissue, the V{sub 20} {sub Gy} and V{sub 12.5} {sub Gy} were reduced by 5.5% (p = 0.002) and 4.5% (p < 0.001). These dosimetric improvements in the fall-off were not observed for the X10FFF plans. Differences in sparing of normal tissues were not found to be statistically significant for either of the two FFF beams. Mean beam-on times were 111 s (2SD = 11 s) for X10FFF, 128 s (2SD = 19 s) for X6FFF, and X6FF plans required on average 269 s (2SD = 71 s). While the mean dose rate was 1555 ± 264 and 1368 ± 63 MU/min, for X10FFF and X6FFF, plans using the conventional X6FF were delivered with the constant maximum dose rate of 600 MU/min. Verification of all plans showed acceptable and comparable results for all plans in homogeneous as well as heterogeneous phantoms. Mean GS (3%, 2 mm) using the Delta{sup 4} phantom were 98.9% (2SD = 3.2%), 99.2% (2SD = 2.3%), and 99.2% (2SD = 2.3%) for X6FFF, X6FF, and X10FFF modalities. Verification using a thorax phantom showed GS > 98% in all cases. Conclusions: The use of FFF beams for stereotactic radiation therapy of nonsmall cell lung cancer patients yielded dose distributions qualitatively comparable to flattened beams and significantly reduced treatment delivery time. Utilizing the X6FFF beam improved conformity of dose distribution. On the other hand, X10FFF beam offered a slight improvement in treatment efficiency, and lower skin and peripheral dose. All effects were relatively small.

62 RADIOLOGY AND NUCLEAR MEDICINE↗