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At least 1,783 records · Page 99
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DOE OSTI2016

SU-F-T-339: Comparison Between Coplanar and Non-Coplanar RapidArc Approach of Hippocampal-Sparing Whole Brain Radiotherapy

Purpose: To compare the dosimetry of coplanar and non-coplanar RapidArc whole brain plans for hippocampal sparing Methods: We studied the RapidArc plans of patient with brain metastases, with the prescription of 3750 cGy in 15 fractions. The coplanar approach used a full clockwise (CW) arc and a full counterclockwise (CCW) arc, with the couch angle to be 0°. The non-coplanar approach used a full arc with a couch angle of 0°, and a partial arc with a couch angle of 90°. Treatment planning system is Eclipse Ver. 11. Constraints for eyes, lens, brainstem, optical nerves and chiasm are employed in the optimization so that these OARs’ dose are below tolerance. Constraints for hippocampus are employed so that they receive dose as low as possible while maintain good coverage to whole brain. The beam delivery machine is Varian 21 IX. T1-weighted MRI images were used for hippocampus contouring. Results: The target coverage index for coplanar and non-coplanar RapidArc plans are 94.9% and 95.4%, respectively, with homogeneity index of 0.223 vs 0.226, which is defined as (D2% – D98%)/Dmean of target volume. V95 and V100 are 99.0% and 94.8% for coplanar plan, vs 99.1% and 95.4% for non-coplanar plan, while the mean dose of hippocampus are 1244.5 cGy for coplanar plan vs 1212.3 cGy for non-coplanar plan. Dose for eyes, lens, optical nerves, optical chiasm and brainstem are all below tolerance. Conclusion: Coplanar RapidArc plan provides good target coverage while achieves good hippocampal sparing, and there is no benefit to use non-coplanar approach.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-T-344: Commissioning Constant Dose Rate VMAT in the Raystation Treatment Planning System for a Varian Clinac IX

Purpose: To demonstrate the commissioning of constant dose rate volumetric modulated arc therapy (VMAT) in the Raystation treatment planning system for a Varian Clinac iX with Exact couch. Methods: Constant dose rate (CDR) VMAT is an option in the Raystation treatment planning system, enabling VMAT delivery on Varian linacs without a RapidArc upgrade. Raystation 4.7 was used to commission CDR-VMAT for a Varian Clinac iX. Raystation arc model parameters were selected to match machine deliverability characteristics. A Varian Exact couch model was added to Raystation 4.7 and commissioned for use in VMAT optimization. CDR-VMAT commissioning checks were performed on the linac, including patient-specific QA measurements for 10 test patients using both the ArcCHECK from Sun Nuclear Corporation and COMPASS from IBA Dosimetry. Multi-criteria optimization (MCO) in Raystation was used for CDR-VMAT planning. Results: Raystation 4.7 generated clinically acceptable and deliverable CDR-VMAT plans for the Varian Clinac. VMAT plans were optimized including a model of the Exact couch with both rails in the out positions. CDR-VMAT plans generated with MCO in Raystation were dosimetrically comparable to Raystation MCO-generated IMRT plans. Patient-specific QA measurements with the ArcCHECK on the couch showed good agreement with the treatment planning system prediction. Patient-specific, structure-specific, multi-statistical parameter 3D QA measurements with gantry-mounted COMPASS also showed good agreement. Conclusion: Constant dose rate VMAT was successfully modeled in Raystation 4.7 for a Varian Clinac iX, and Raystation’s multicriteria optimization generated constant dose rate VMAT plans which were deliverable and dosimetrically comparable to IMRT plans.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-T-387: A Novel Optimization Technique for Field in Field (FIF) Chestwall Radiation Therapy Using a Single Plan to Improve Delivery Safety and Treatment Planning Efficiency

Purpose: A novel optimization technique was developed for field-in-field (FIF) chestwall radiotherapy using bolus every other day. The dosimetry was compared to currently used optimization. Methods: The prior five patients treated at our clinic to the chestwall and supraclavicular nodes with a mono-isocentric four-field arrangement were selected for this study. The prescription was 5040 cGy in 28 fractions, 5 mm bolus every other day on the tangent fields, 6 and/or 10 MV x-rays, and multileaf collimation.Novelly, tangents FIF segments were forward planned optimized based on the composite bolus and non-bolus dose distribution simultaneously. The prescription was spilt into 14 fractions for both bolus and non-bolus tangents. The same segments and monitor units were used for the bolus and non-bolus treatment. The plan was optimized until the desired coverage was achieved, minimized 105% hotspots, and a maximum dose of less than 108%. Each tangential field had less than 5 segments.Comparison plans were generated using FIF optimization with the same dosimetric goals, but using only the non-bolus calculation for FIF optimization. The non-bolus fields were then copied and bolus was applied. The same segments and monitor units were used for the bolus and non-bolus segments. Results: The prescription coverage of the chestwall, as defined by RTOG guidelines, was on average 51.8% for the plans that optimized bolus and non-bolus treatments simultaneous (SB) and 43.8% for the plans optimized to the non-bolus treatments (NB). Chestwall coverage of 90% prescription averaged to 80.4% for SB and 79.6% for NB plans. The volume receiving 105% of the prescription was 1.9% for SB and 0.8% for NB plans on average. Conclusion: Simultaneously optimizing for bolus and non-bolus treatments noticeably improves prescription coverage of the chestwall while maintaining similar hotspots and 90% prescription coverage in comparison to optimizing only to non-bolus treatments.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-T-405: Development of a Rapid Cardiac Contouring Tool Using Landmark-Driven Modeling

Purpose: This study aims to develop a tool to rapidly delineate cardiac substructures for use in dosimetry for large-scale clinical trial or epidemiological investigations. The goal is to produce a system that can semi-automatically delineate nine cardiac structures to a reasonable accuracy within a couple of minutes. Methods: The cardiac contouring tool employs a Most Similar Atlas method, where a selection criterion is used to pre-select the most similar model to the patient from a library of pre-defined atlases. Sixty contrast-enhanced cardiac computed tomography angiography (CTA) scans (30 male and 30 female) were manually contoured to serve as the atlas library. For each CTA 12 structures were delineated. Kabsch algorithm was used to compute the optimum rotation and translation matrices between the patient and atlas. Minimum root mean squared distance between the patient and atlas after transformation was used to select the most-similar atlas. An initial study using 10 CTA sets was performed to assess system feasibility. Leave-one patient out method was performed, and fit criteria were calculated to evaluate the fit accuracy compared to manual contours. Results: For the pilot study, mean dice indices of .895 were achieved for the whole heart, .867 for the ventricles, and .802 for the atria. In addition, mean distance was measured via the chord length distribution (CLD) between ground truth and the atlas structures for the four coronary arteries. The mean CLD for all coronary arteries was below 14mm, with the left circumflex artery showing the best agreement (7.08mm). Conclusion: The cardiac contouring tool is able to delineate cardiac structures with reasonable accuracy in less than 90 seconds. Pilot data indicates that the system is able to delineate the whole heart and ventricles within a reasonable accuracy using even a limited library. We are extending the atlas sets to 60 adult males and females in total.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-T-407: Artifact Reduction with Dual Energy Or IMAR: Who’s Winning?

Purpose: The purpose of this abstract was to evaluate the performance of commercial strategies for artifact reduction in radiation oncology settings. The iterative metal artifact reduction (Siemens iMAR) algorithm and monoenergetic virtual datasets reconstructed from dual energy scans are compared side-by-side in their ability to image in the presence of metal inserts. Methods: A CIRS ATOM Dosimetry Verification Phantom was scanned with and without a metal insert on a SOMATOM Definition AS dual energy scanner. Images with the metal insert were reconstructed with (a) a tradition single energy CT scan with the iMAR option implemented, using different artifact reduction settings and (b) a monoenergetic scan calculated from dual energy scans by recovering differences in the energy-dependence of the attenuation coefficients of different materials and then creating a virtual monoenergetic scan from these coefficients. The iMAR and monoenergetic scans were then compared with the metal-free scan to assess changes in HU numbers and noise within a region around the metal insert. Results: Both the iMAR and dual energy scans reduced artifacts produced by the metal insert. However the iMAR results are dependent of the selected algorithm settings, with a mean HU difference ranging from 0.65 to 90.40 for different options. The mean differences without the iMAR correction were 38.74. When using the dual energy scan, the mean differences were 4.53, that is however attributed to increased noise and not artifacts, as the dual energy scan had the lowest skewness (2.52) compared to the iMAR scans (ranging from 3.90 to 4.88) and the lowest kurtosis (5.72 for dual energy, range of 18.19 to 27.36 for iMAR). Conclusion: Both approaches accurately recovered HU numbers, however the dual energy method provided smaller residual artifacts.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-T-418: Evaluation of Organs at Risk (OAR) Sparing in Left Breast Irradiation Techniques

Purpose: To compare dose to organs at risk (OAR) for left sided breast radiation therapy with comparable planning target volume (PTV) coverage in three techniques; free breathing in supine position (FB), deep inspirational breath hold in supine (DIBH) and free breathing in prone position (PP). Methods: Ten left sided breast cancer patients suitable for this study underwent a CT scan in three techniques e.g. supine, FB and DIBH and prone position (PP). One radiation oncologist contoured the PTV and OAR (cardiac components) based on RTOG guidelines. Treatment plans were optimized using field-in-field technique with AAA algorithm. Each plan was optimized to provide identical coverage to PTV such that a reasonable comparison in OAR dosimetry can be evaluated. The prescribed dose to PTV were 42.56 Gy; 2.66 Gy in 16 fractions. Results: Average lung dose parameters; Dmean, V10, V20 and V30 were 0.5 Gy, 0.6%, 0.2%, and 0.1% respectively in PP which is significantly lower than FB (5.9 Gy, 14.2%, 10.7 %, and 8.4%) and DIBH (5.8 Gy, 14.3%, 10.2%, 7.8%). Similarly average heart Dmean, V2.5, V5, V10, and V20 were much lower in PP (1.2Gy, 9.1%, 2.1%, 0.8%, and 0.4%), and in DIBH (1.2 Gy, 10.6%, 1.7%, 0.5%, and 0.1%) compared to FB (2.6 Gy, 21%, 7.2%, 4.4% and 3.3%) respectively. Similar findings were also noted in the heart component left anterior descending artery (LAD) and Left ventricle (LV) which are correlated to radiation related toxicity. Conclusion: Based on the calculated dose, FB technique provides highest heart and lung dose. Prone has lowest lung dose, and DIBH has lowest LAD dose. It is found that PP is always superior for heart, LV, LAD and lung as compared to FB. This conclusion is in contrast to some published study concluding that prone position has no benefit for heart sparing.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-T-442: Dose Distribution Comparison for Post-Laryngectomy Stoma Area Between Conventional AP and VMAT Plans with Or Without Bolus

Purpose: To compare dose distributions of conventional AP vs. VMAT treatment plans with or without bolus around post-laryngectomy stoma. Methods: Radiation dose coverage for post-laryngectomy stoma was analyzed using a set of real-case CT-simulation images. After meticulous contouring of the catheter cuff, stoma lumen, peri-stoma skin and subclinical tumor bed at the larynx, the resulting dosimetry plans were analyzed with or without a 5 mm bolus placement. Wet gauze was used to minimize the effect of any air gap. Four plans were generated: AP superclavicular (SCV) plan with or without bolus, and VMAT plan with or without bolus. A dose of 60Gy in 30 fractions was prescribed at 3 cm depth for AP SCV plan, and to 95% of the PTV volume for VMAT plan. Results: For the conventional AP SCV plan, the peri-stoma skin dose is sensitive to bolus placement as well as air gap compensation by wetted gauze (V95% of 20.7%, 33.0% and 94.8% for no bolus, bolus without and with air gap compensation, respectively). For stoma lumen, the dose drops off rapidly in depth. The catheter cuff may have certain dose-buildup effect, but air gap around it and under the bolus placed can pose a more serious problem. The dose distributions of the two VMAT plans are moderately different for peri-stoma skin (V95% of 95.0% with bolus and air gap compensation, and 82.3% without bolus), but nearly identical for stoma lumen (V95% of 91.5% and 92.0%, respectively). VMAT allows beamlets with different angles of incidence that helped achieve such dose distribution around the stoma even without bolus placement. Conclusion: Overall, the dose coverage around the stoma in the VMAT plan is better than the conventional AP SCV plan. To achieve optimal dose distribution, it is still recommended to place physical bolus and reduce the air gaps.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-T-464: Development of a Secondary Check Procedure to Evaluated Flatness and Symmetry Discrepancies Detected During Daily Morning QA

Purpose: A daily QA device is used to monitor output, flatness and symmetry constancy for all linac photon and electron energies. If large deviations from baseline in flatness or symmetry are reported it becomes necessary to crosscheck the measurements with a second device. Setting up another device such as Matrixx (IBA Dosimetry) can be time consuming, due to its warm-up time, and trained personnel may not be readily available to analyze the results. Furthermore, this discrepancy is frequently isolated to a single energy. Unaffected energies could still be used, avoiding further patient delays, if a method to gather data for offline analysis could be developed. We find that optically stimulated luminescent dosimeters (OSLDs) provide a quick, simple, and inexpensive solution to this important clinical problem. Methods: The exact geometry of the detectors on the daily tracker (Keithley Therapy Beam Evaluator) was reproduced by placing nanoDot OSLDs (Landauer) on a solid water phantom. A combination of bolus and solid water was placed on top to provide buildup and prevent air gaps. Standard daily measurements of output, flatness and symmetry were taken for 2 photon energies (6x,10x) and 5 electron energies (6e,9e,12e,15e,18e) using the tracker. These measurements were then repeated with the OSLD phantom. Results: The time it took to set up the OSLD phantom was comparable to that of the tracker. The inline and crossline OSLD phantom measurements of flatness and symmetry agreed with the tracker results to within 2%. Conclusion: OSLDs provide a good solution for a quick second check when questionable flatness and symmetry results are detected with the tracker during daily QA.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-T-469: A Clinically Observed Discrepancy Between Image-Based and Log- Based MLC Position

Purpose: To present a clinical case which challenges the base assumption of log-file based QA, by showing that the actual position of a MLC leaf can suddenly deviate from its programmed and logged position by >1 mm as observed with real-time imaging. Methods: An EPID-based exit-fluence dosimetry system designed to prevent gross delivery errors was used in cine mode to capture portal images during treatment. Visual monitoring identified an anomalous MLC leaf pair gap not otherwise detected by the automatic position verification. The position of the erred leaf was measured on EPID images 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. Conclusion: It has been clinically observed that log-file derived leaf positions can differ from their actual positions 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 trusting log file records. Intra-treatment EPID imaging provides a method to capture departures from MLC planned positions. Work was supported in part by Varian Medical Systems.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-T-472: Validation of Absolute Dose Measurements for MR-IGRT With and Without Magnetic Field

Purpose: To validate absolute dose measurements for a MR-IGRT system without presence of the magnetic field. Methods: The standard method (AAPM’s TG-51) of absolute dose measurement with ionization chambers was tested with and without the presence of the magnetic field for a clinical 0.32-T Co-60 MR-IGRT system. Two ionization chambers were used - the Standard Imaging (Madison, WI) A18 (0.123 cc) and the PTW (Freiburg, Germany). A previously reported Monte Carlo simulation suggested a difference on the order of 0.5% for dose measured with and without the presence of the magnetic field, but testing this was not possible until an engineering solution to allow the radiation system to be used without the nominal magnetic field was found. A previously identified effect of orientation in the magnetic field was also tested by placing the chamber either parallel or perpendicular to the field and irradiating from two opposing angles (90 and 270). Finally, the Imaging and Radiation Oncology Core provided OSLD detectors for five irradiations each with and without the field - with two heads at both 0 and 90 degrees, and one head at 90 degrees only as it doesn’t reach 0 (IEC convention). Results: For the TG-51 comparison, expected dose was obtained by decaying values measured at the time of source installation. The average measured difference was 0.4%±0.12% for A18 and 0.06%±0.15% for Farmer chamber. There was minimal (0.3%) orientation dependence without the magnetic field for the A18 chamber, while previous measurements with the magnetic field had a deviation of 3.2% with chamber perpendicular to magnetic field. Results reported by IROC for the OSLDs with and without the field had a maximum difference of 2%. Conclusion: Accurate absolute dosimetry was verified by measurement under the same conditions with and without the magnetic field for both ionization chambers and independently-verifiable OSLDs.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-T-503: Trajectory Modulated Arc Therapy of Intracranial Lesions: Development of a Standardized Path-Based Technique for Fully Dynamic Couch-Gantry Modulated Treatments

Purpose: The integration of couch motion during arc delivery is necessitated to enable irradiation trajectories such as coronal arcs, and to enhance the geometrical sampling for dynamic deliveries to the highest extent. To enable such capability, a platform of Trajectory Modulated Arc Therapy (TMAT) is developed in conjunction with standardized noncollisional dynamic path-set for irradiation of intracranial lesions. Methods: A generalized path-set was constructed through the combination of sagittal arcs (45 degrees from the CAX), axial arcs, and coronal arcs produced through modulation of the dynamic rotation of couch. The standardized path was implemented in a contiguous manner enabling the formation of fully automated sub-trajectories to provide maximal geometrical convergence with minimal number of arcs. Progressive sampling technique is used for direct aperture optimization of the MLCs and the selection of couch positions across the control points. Dosimetry of the resulting plans was assessed relative to clinically delivered plans. Using the TrueBeam Developer Mode, plan deliverability was tested. Results: Treatment planning of TMAT sub-trajectories for central, anterior and posterior tumor sites with volumes ranging from 4.75cc to 107cc demonstrated radically reduced doses to the critical OARs when compared to the clinically treated VMAT. Specifically, percentage reduction in mean dose for critical organs such as brainstem, cochlea, and optic nerve are found to be as low as 74±15%, 50±26% and 74±30% respectively as compared to VMAT. Conformity Index, defined as the ratio of tumor volume (VPTV) and 100% dose volume (V(D100%)), was reduced up to 12% while the Gradient Index, defined as V(D100%)/V(D50%), was concurrently improved by up to 14%. Conclusion: An automated standardized trajectory with dynamically modulated couch-gantry arcs has been developed for intracranial radiotherapy. Through the incorporation of coronal arcs, it is demonstrated that significantly reduced OAR doses can be achieved relative to clinically treated patient plans via VMAT. Research Grant Funding Support by Varian Medical Systems.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-T-522: Dosimetric Study of Junction Dose in Double Isocenter Flatten and Flatten Filter Free IMRT and VMAT Plan Delivery

Purpose: To quantify the dosimetric accuracy of junction dose in double isocenter flattened and flatten filter free(FFF) intensity modulated radiation therapy(IMRT) and volumetric modulated arc therapy(VMAT) plan delivery using pelvis phantom. Methods: Five large field pelvis patients were selected for this study. Double isocenter IMRT and VMAT treatment plans were generated in Eclipse Treatment planning System (V.11.0) using 6MV FB and FFF beams. For all the plans same distance 17.0cm was kept between one isocenter to another isocenter. IMRT Plans were made with 7 coplanar fields and VMAT plans were made with full double arcs. Dose calculation was performed using AAA algorithms with dose grid size of 0.25 cm. Verification plans were calculated on Scanditronix Wellhofer pelvis slab phantom. Measurement point was selected and calculated, where two isocenter plan fields are overlapping, this measurement point was kept at distance 8.5cm from both isocenter. The plans were delivered using Varian TrueBeamTM machine on pelvis slab phantom. Point dose measurements was carried out using CC13 ion chamber volume of 0.13cm3. Results: The measured junction point dose are compared with TPS calculated dose. The mean difference observed was 4.5%, 6.0%, 4.0% and 7.0% for IMRT-FB,IMRT-FFF, VMAT-FB and VMAT-FFF respectively. The measured dose results shows closer agreement with calculated dose in Flatten beam planning in both IMRT and VMAT, whereas in FFF beam plan dose difference are more compared with flatten beam plan. Conclusion: Dosimetry accuracy of Large Field junction dose difference was found less in Flatten beam compared with FFF beam plan delivery. Even though more dosimetric studies are required to analyse junction dose for FFF beam planning using multiple point dose measurements and fluence map verification in field junction area.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-T-587: Quality Assurance of Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT) for Patient Specific Plans: A Comparison Between MATRIXX and Delta4 QA Devices

Purpose: Patient-specific quality assurance (QA) is necessary to accurately deliver high dose radiation to the target, especially for stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT). Unlike previous 2 dimensional (D) array QA devices, Delta{sup 4} can verify the dose delivery in 3D. In this study, the difference between calculated and measured dose distribution was compared with two QA devices (MATRIXX and Delta{sup 4}) to evaluate the delivery accuracy. Methods: Twenty-seven SRS/SBRT plans with VMAT were verified with point-dose and dose-map analysis. We use an ion chamber (A1SL, 0.053cc) for point-dose measurement. For verification of the dose map, the differences between the calculated and measured doses were analyzed with a gamma index using MATRIXX and Delta{sup 4} devices. The passing criteria for gamma evaluation were set at 3 mm for distance-to-agreement (DTA) and 3% for dose-difference. A gamma index less than 1 was defined as the verification passing the criteria and satisfying at least 95% of the points. Results: The mean prescribed dose and fraction was 40 ± 14.41 Gy (range: 16–60) and 10 ± 2.35 fractions (range: 1–8), respectively. In point dose analysis, the differences between the calculated and measured doses were all less than 5% (mean: 2.12 ± 1.13%; range: −0.55% to 4.45%). In dose-map analysis, the average passing rates were 99.38 ± 0.96% (range: 95.31–100%) and 100 ± 0.12% (range: 99.5%–100%) for MATRIXX and Delta{sup 4}, respectively. Even using criteria of 2%/2 mm, the passing rate of Delta{sup 4} was still more than 95% (mean: 99 ± 1.08%; range: 95.6%–100%). Conclusion: Both MATRIXX and Delta{sup 4} offer accurate and efficient verification for SRS/SBRT plans. The results measured by MATRIXX and Delta{sup 4} dosimetry systems are similar for SRS/SBRT performed with the VMAT technique.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-T-591: SBRT Treatment of Multiple Extracranial Oligometastases Using a Single-Isocenter with Distinct Optimizations (SIDO)

Purpose: A new development in linac-based intracranial radiosurgery is treatment of multiple targets using single isocenter VMAT, which dramatically reduces treatment time while maintaining high conformality and dose gradient. Our purpose is to translate this technique to extracranial SBRT of oligometastases and address additional challenges such as interplay from motion and setup uncertainties. Methods: We propose SIDO (Single Isocenter with Distinct Optimizations) planning in which all VMAT arcs share an isocenter but each arc treats only one target. Setup uncertainties from rotations and deformations are mitigated by applying a couch translation between VMAT arcs, while interplay is minimized by using dynamic conformal arcs (DCAs) as the starting point for VMAT optimization. We compared SIDO to single (VMAT) and dual (VMAT & DCA) isocenter plans for phantom and patient (N=2) cases. Dose statistics included conformity index (CI), gradient index (GI), and modulation factor (MLC opening & total MU). Finally, we determined likelihood of needing a translational shift between SIDO arcs to correct rotational uncertainties using CBCTs from eleven previous SBRT cases. Results: For phantoms with target separations of 5–15cm, CI was 0.87±0.02, 0.89±0.05, and 0.91±0.02, for SIDO, single, and dual-isocenter VMAT respectively. GI was 6.83±1.0, 7.45±1.0 and 5.94±0.7 respectively. SIDO conformity did not trend with increasing distance between PTVs, while gradient decreased for all planning techniques. Using DCAs as the starting point of VMAT optimization decreased modulation, with a 39.4% reduction in monitor units. SIDO had 4.9% and 39% less MU than single and dual-isocenter VMAT respectively. A translational shift between SIDO arcs would be required in 10–28% of cases due to rotational uncertainties to stay within a 5mm margin, for targets separated by ≥10cm. Conclusion: SIDO for extracranial oligometastases has comparable dosimetry to traditional VMAT with low modulation similar to DCAs. Future work will quantify decrease in dosimetric interplay.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-T-600: Influence of Acuros XB and AAA Dose Calculation Algorithms On Plan Quality Metrics and Normal Lung Doses in Lung SBRT

Purpose: To study the influence of superposition-beam model (AAA) and determinant-photon transport-solver (Acuros XB) dose calculation algorithms on the treatment plan quality metrics and on normal lung dose in Lung SBRT. Methods: Treatment plans of 10 Lung SBRT patients were randomly selected. Patients were prescribed to a total dose of 50-54Gy in 3–5 fractions (10?5 or 18?3). Doses were optimized accomplished with 6-MV using 2-arcs (VMAT). Doses were calculated using AAA algorithm with heterogeneity correction. For each plan, plan quality metrics in the categories- coverage, homogeneity, conformity and gradient were quantified. Repeat dosimetry for these AAA treatment plans was performed using AXB algorithm with heterogeneity correction for same beam and MU parameters. Plan quality metrics were again evaluated and compared with AAA plan metrics. For normal lung dose, V{sub 20} and V{sub 5} to (Total lung- GTV) were evaluated. Results: The results are summarized in Supplemental Table 1. PTV volume was mean 11.4 (±3.3) cm{sup 3}. Comparing RTOG 0813 protocol criteria for conformality, AXB plans yielded on average, similar PITV ratio (individual PITV ratio differences varied from −9 to +15%), reduced target coverage (−1.6%) and increased R50% (+2.6%). Comparing normal lung doses, the lung V{sub 20} (+3.1%) and V{sub 5} (+1.5%) were slightly higher for AXB plans compared to AAA plans. High-dose spillage ((V105%PD - PTV)/ PTV) was slightly lower for AXB plans but the % low dose spillage (D2cm) was similar between the two calculation algorithms. Conclusion: AAA algorithm overestimates lung target dose. Routinely adapting to AXB for dose calculations in Lung SBRT planning may improve dose calculation accuracy, as AXB based calculations have been shown to be closer to Monte Carlo based dose predictions in accuracy and with relatively faster computational time. For clinical practice, revisiting dose-fractionation in Lung SBRT to correct for dose overestimates attributable to algorithm may very well be warranted.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-G-201-02: Application of RayStretch in Clinical Cases: A Calculation for Heterogeneity Corrections in LDR Permanent I-125 Prostate Brachytherapy

Purpose: Tissue heterogeneities and calcifications have significant impact on the dosimetry of low energy brachytherapy (BT). RayStretch is an analytical algorithm developed in our institution to incorporate heterogeneity corrections in LDR prostate brachytherapy. The aim of this work is to study its application in clinical cases by comparing its predictions with the results obtained with TG-43 and Monte Carlo (MC) simulations. Methods: A clinical implant (71 I-125 seeds, 15 needles) from a real patient was considered. On this patient, different volumes with calcifications were considered. Its properties were evaluated in three ways by i) the Treatment planning system (TPS) (TG-43), ii) a MC study using the Penelope2009 code, and iii) RayStretch. To analyse the performance of RayStretch, calcifications located in the prostate lobules covering 11% of the total prostate volume and larger calcifications located in the lobules and underneath the urethra for a total occupied volume of 30% were considered. Three mass densities (1.05, 1.20, and 1.35 g/cm3) were explored for the calcifications. Therefore, 6 different scenarios ranging from small low density calcifications to large high density ones have been discussed. Results: DVH and D90 results given by RayStretch agree within 1% with the full MC simulations. Although no effort has been done to improve RayStretch numerical performance, its present implementation is able to evaluate a clinical implant in a few seconds to the same level of accuracy as a detailed MC calculation. Conclusion: RayStretch is a robust method for heterogeneity corrections in prostate BT supported on TG-43 data. Its compatibility with commercial TPSs and its high calculation speed makes it feasible for use in clinical settings for improving treatment quality. It will allow in a second phase of this project, its use during intraoperative ultrasound planning. This study was partly supported by a fellowship grant from the Spanish Ministry of Education, by the Generalitat Valenciana under Project PROMETEOII/2013/010, by the Spanish Government under Project No. FIS2013-42156 and by the European Commission within the SeventhFramework Program through ENTERVISION (grant agreement number 264552).

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-G-BRB-08: Investigation On the Magnetic Field Effect On TLDs, OSLDs, and Gafchromic Films Using An MR-Linac

Purpose: To investigate whether a strong magnetic field (B=1.5 T) can affect dose responses of thermoluminescent dosimeters (TLDs), optically stimulated luminescence dosimeters (OSLDs) and Gafchromic films using an MR-Linac (Elekta) before and after the magnet was ramped down from 1.5 T to 0 T. Methods: Three types of dosimeters (TLDs, OSLDs, EBT3 films) were divided into two groups. Group 1 was first irradiated in a phantom of Solid Water slabs (Standard Imaging) inside a B=1.5 T field with a 7 MV beam from an MR-Linac system. The radiation output at the location of the dosimeters (isocenter at 10 cm depth) was measured using an ion chamber (NE2571, Phoenix Dosimetry). Three doses (150, 300, 600 MU, corresponding to 1.18, 2.36, and 4.74 Gy) were delivered to the dosimeters. A week later the MR magnet was ramped down to zero field and dosimeters in Group 2 were irradiated with the same MUs. Dosimeters of each type were read out during the same session (about 4 weeks post irradiation in the B field, and 3 weeks with no B field). The ratios of signals between Group 1 and Group 2 were calculated. Results: Radiation output measured with the chamber was within 1% before and after ramping down the MR magnet. For TLDs, the ratio of signals with B field to signals without B field averaged over three dose levels was 1.003±0.016; for OSLDs, the ratio was 0.994±0.022; for films, the ratios of two batches (different manufacturing dates) were 0.997 and 0.985. Conclusion: Dose responses of all three dosimeters seem not affected by the presence of a 1.5 T magnetic field within uncertainty of ∼2%. More measurements will be conducted to test reproducibility. We acknowledge research support from Elekta AB.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-G-BRB-10: New Generation of High Frame-Rate and High Spatial-Resolution EPID QA System for Full-Body MLC-Based Robotic Radiosurgery

Purpose: To systematically investigate an ultra-high spatial-resolution amorphous silicon flat-panel electronic portal imaging device (EPID) for MLC-based full-body robotic radiosurgery geometric and dosimetric quality assurance (QA). Methods: The high frame-rate and ultra-high spatial resolution EPID is an outstanding detector for measuring profiles, MLC-shaped radiosurgery field aperture verification, and small field dosimetry. A Monte Carlo based technique with a robotic linac specific response and calibration is developed to convert a raw EPID-measured image of a radiosurgery field into water-based dose distribution. The technique is applied to measure output factors and profiles for 6MV MLC-defined radiosurgery fields with various sizes ranging from 7.6mm×7.7mm to 100mm×100.1mm and the results are compared with the radiosurgery diode scan measurements in water tank. The EPID measured field sizes and the penumbra regions are analyzed to evaluate the MLC positioning accuracy. Results: For all MLC fields, the EPID measured output factors of MLC-shaped fields are in good agreement with the diode measurements. The mean output difference between the EPID and diode measurement is 0.05±0.87%. The max difference is −1.33% for 7.6mm×7.7mm field. The MLC field size derived from the EPID measurements are in good agreement comparing to the diode scan result. For crossline field sizes, the mean difference is −0.17mm±0.14mm with a maximum of −0.35mm for the 30.8mm×30.8mm field. For inline field sizes, the mean difference is +0.08mm±0.18mm with a maximum of +0.45mm for the 100mm×100.1mm field. The high resolution EPID is able to measure the whole radiation field, without the need to align the detector center perfectly at field center as diode or ion chamber measurement. The setup time is greatly reduced so that the whole process is possible for machine and patient-specific QA. Conclusion: The high spatial-resolution EPID is proved to be an accurate and efficient tool for QA of MLC-equipped robotic radiosurgery system.

60 APPLIED LIFE SCIENCES↗