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At least 1,783 records · Page 99
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DOE OSTI2014

TH-E-BRE-04: An Online Replanning Algorithm for VMAT

Purpose: To develop a fast replanning algorithm based on segment aperture morphing (SAM) for online replanning of volumetric modulated arc therapy (VMAT) with flattening filtered (FF) and flattening filter free (FFF) beams. Methods: A software tool was developed to interface with a VMAT planning system ((Monaco, Elekta), enabling the output of detailed beam/machine parameters of original VMAT plans generated based on planning CTs for FF or FFF beams. A SAM algorithm, previously developed for fixed-beam IMRT, was modified to allow the algorithm to correct for interfractional variations (e.g., setup error, organ motion and deformation) by morphing apertures based on the geometric relationship between the beam's eye view of the anatomy from the planning CT and that from the daily CT for each control point. The algorithm was tested using daily CTs acquired using an in-room CT during daily IGRT for representative prostate cancer cases along with their planning CTs. The algorithm allows for restricted MLC leaf travel distance between control points of the VMAT delivery to prevent SAM from increasing leaf travel, and therefore treatment delivery time. Results: The VMAT plans adapted to the daily CT by SAM were found to improve the dosimetry relative to the IGRT repositioning plans for both FF and FFF beams. For the adaptive plans, the changes in leaf travel distance between control points were < 1cm for 80% of the control points with no restriction. When restricted to the original plans' maximum travel distance, the dosimetric effect was minimal. The adaptive plans were delivered successfully with similar delivery times as the original plans. The execution of the SAM algorithm was < 10 seconds. Conclusion: The SAM algorithm can quickly generate deliverable online-adaptive VMAT plans based on the anatomy of the day for both FF and FFF beams.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

TH-E-BRE-09: TrueBeam Monte Carlo Absolute Dose Calculations Using Monitor Chamber Backscatter Simulations and Linac-Logged Target Current

Purpose: To simulate and measure radiation backscattered into the monitor chamber of a TrueBeam linac; establish a rigorous framework for absolute dose calculations for TrueBeam Monte Carlo (MC) simulations through a novel approach, taking into account the backscattered radiation and the actual machine output during beam delivery; improve agreement between measured and simulated relative output factors. Methods: The ‘monitor backscatter factor’ is an essential ingredient of a well-established MC absolute dose formalism (the MC equivalent of the TG-51 protocol). This quantity was determined for the 6 MV, 6X FFF, and 10X FFF beams by two independent Methods: (1) MC simulations in the monitor chamber of the TrueBeam linac; (2) linac-generated beam record data for target current, logged for each beam delivery. Upper head MC simulations used a freelyavailable manufacturer-provided interface to a cloud-based platform, allowing use of the same head model as that used to generate the publicly-available TrueBeam phase spaces, without revealing the upper head design. The MC absolute dose formalism was expanded to allow direct use of target current data. Results: The relation between backscatter, number of electrons incident on the target for one monitor unit, and MC absolute dose was analyzed for open fields, as well as a jaw-tracking VMAT plan. The agreement between the two methods was better than 0.15%. It was demonstrated that the agreement between measured and simulated relative output factors improves across all field sizes when backscatter is taken into account. Conclusion: For the first time, simulated monitor chamber dose and measured target current for an actual TrueBeam linac were incorporated in the MC absolute dose formalism. In conjunction with the use of MC inputs generated from post-delivery trajectory-log files, the present method allows accurate MC dose calculations, without resorting to any of the simplifying assumptions previously made in the TrueBeam MC literature. This work has been partially funded by Varian Medical Systems.

07 ISOTOPE AND RADIATION SOURCES↗
DOE OSTI2014

TH-E-17A-10: Markerless Lung Tumor Tracking Based On Beams Eye View EPID Images

Purpose: Dynamic tumor tracking or motion compensation techniques have proposed to modify beam delivery following lung tumor motion on the flight. Conventional treatment plan QA could be performed in advance since every delivery may be different. Markerless lung tumor tracking using beams eye view EPID images provides a best treatment evaluation mechanism. The purpose of this study is to improve the accuracy of the online markerless lung tumor motion tracking method. Methods: The lung tumor could be located on every frame of MV images during radiation therapy treatment by comparing with corresponding digitally reconstructed radiograph (DRR). A kV-MV CT corresponding curve is applied on planning kV CT to generate MV CT images for patients in order to enhance the similarity between DRRs and MV treatment images. This kV-MV CT corresponding curve was obtained by scanning a same CT electron density phantom by a kV CT scanner and MV scanner (Tomotherapy) or MV CBCT. Two sets of MV DRRs were then generated for tumor and anatomy without tumor as the references to tracking the tumor on beams eye view EPID images. Results: Phantom studies were performed on a Varian TrueBeam linac. MV treatment images were acquired continuously during each treatment beam delivery at 12 gantry angles by iTools. Markerless tumor tracking was applied with DRRs generated from simulated MVCT. Tumors were tracked on every frame of images and compared with expected positions based on programed phantom motion. It was found that the average tracking error were 2.3 mm. Conclusion: This algorithm is capable of detecting lung tumors at complicated environment without implanting markers. It should be noted that the CT data has a slice thickness of 3 mm. This shows the statistical accuracy is better than the spatial accuracy. This project has been supported by a Varian Research Grant.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-C-16A-06: Optimum Radiation Source for Radiation Therapy of Skin Cancer

Purpose: Recently, different applicators are designed for treatment of the skin cancer such as scalp and legs, using Ir-192 HDR Brachytherapy Sources (IR-HDRS), Miniature Electronic Brachytherapy Sources (MEBXS), and External Electron Beam Radiation Therapy (EEBRT). Although, all of these methodologies may deliver the desired radiation dose to the skin, the dose to the underlying bone may become the limiting factor for selection of the optimum treatment technique. In this project the radiation dose delivered to the underlying bone has been evaluated as a function of the radiation source and thickness of the underlying bone. Methods: MC simulations were performed using MCNP5 code. In these simulations, the mono-energetic and non-divergent photon beams of 30 keV, 50 keV, and 70 keV for MEBXS, 380 keV photons for IR-HDRS, and 6 MeV mono-energetic electron beam for EEBRT were modeled. A 0.5 cm thick soft tissue (0.3 cm skin and 0.2 cm adipose) with underlying 0.5 cm cortical bone followed by 14 cm soft tissue are utilized for simulations. Results: Dose values to bone tissue as a function of beam energy and beam type, for a delivery of 5000 cGy dose to skin, were compared. These results indicate that for delivery of 5000 cGy dose to the skin surface with 30 keV, 50 keV, 70 keV of MEBXS, IR-HDRS, and EEBRT techniques, bone will receive 31750 cGy, 27450 cGy, 18550 cGy, 4875 cGy, and 10450 cGy, respectively. Conclusion: The results of these investigations indicate that, for delivery of the same skin dose, average doses received by the underlying bone are 5.2 and 2.2 times larger with a 50 keV MEBXS and EEBRT techniques than IR-HDRS, respectively.

07 ISOTOPE AND RADIATION SOURCES↗
DOE OSTI2014

SU-C-BRE-06: Radiobiological Advantage of Very Rapid Irradiation

Purpose: To characterize the effect of very rapid dose delivery as compared to conventional therapeutic irradiation times on clonogenic cell survival. Methods: We used a Varian Trilogy linear accelerator to deliver doses up to 10 Gy using a 6 MV SRS photon beam. We irradiated four cancer cell lines in times ranging from 30 sec to 30 min. We also used a Varian TrueBeam linear accelerator to deliver 9 MeV electrons at 10 Gy in 10 s to 30 min to determine the effect of irradiation time on cell survival. We then evaluated the effect of using 60 and 120 MeV electrons on cell survival using the Next Linear Collider Test Accelerator (NLCTA) beam line at the SLAC National Accelerator Laboratory. During irradiation, adherent cells were maintained at 37oC with 20%O2/5%CO2. Clonogenic assays were completed following irradiation to determine changes in cell survival due to dose delivery time and beam quality, and the survival data were fitted with the linear-quadratic model. Results: Cell lines varied in radiosensitivity, ranging from two to four logs of cell kill at 10 Gy for both conventional and very rapid irradiation. Delivering radiation in shorter times decreased survival in all cell lines. Log differences in cell kill ranged from 0.2 to 0.7 at 10 Gy for the short compared to the long irradiation time. Cell kill differences between short and long irradiations were more pronounced as doses increased for all cell lines. Conclusion: Our findings suggest that shortening delivery of therapeutic radiation doses to less than 1 minute may improve tumor cell kill. This study demonstrates the potential advantage of technologies under development to deliver stereotactic ablative radiation doses very rapidly. Bill Loo and Peter Maxim have received Honoraria from Varian and Research Support from Varian and RaySearch.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

Multiple anatomy optimization of accumulated dose

Purpose: To investigate the potential advantages of multiple anatomy optimization (MAO) for lung cancer radiation therapy compared to the internal target volume (ITV) approach. Methods: MAO aims to optimize a single fluence to be delivered under free-breathing conditions such that the accumulated dose meets the plan objectives, where accumulated dose is defined as the sum of deformably mapped doses computed on each phase of a single four dimensional computed tomography (4DCT) dataset. Phantom and patient simulation studies were carried out to investigate potential advantages of MAO compared to ITV planning. Through simulated delivery of the ITV- and MAO-plans, target dose variations were also investigated. Results: By optimizing the accumulated dose, MAO shows the potential to ensure dose to the moving target meets plan objectives while simultaneously reducing dose to organs at risk (OARs) compared with ITV planning. While consistently superior to the ITV approach, MAO resulted in equivalent OAR dosimetry at planning objective dose levels to within 2% volume in 14/30 plans and to within 3% volume in 19/30 plans for each lung V20, esophagus V25, and heart V30. Despite large variations in per-fraction respiratory phase weights in simulated deliveries at high dose rates (e.g., treating 4/10 phases during single fraction beams) the cumulative clinical target volume (CTV) dose after 30 fractions and per-fraction dose were constant independent of planning technique. In one case considered, however, per-phase CTV dose varied from 74% to 117% of prescription implying the level of ITV-dose heterogeneity may not be appropriate with conventional, free-breathing delivery. Conclusions: MAO incorporates 4DCT information in an optimized dose distribution and can achieve a superior plan in terms of accumulated dose to the moving target and OAR sparing compared to ITV-plans. An appropriate level of dose heterogeneity in MAO plans must be further investigated.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-C-303-06: Treatment Planning Study for Non-Invasive Cardiac Arrhythmia Ablation with Scanned Carbon Ions in An Animal Model

Purpose: Scanned carbon ion beams might offer a non-invasive alternative treatment for cardiac arrhythmia, which are a major health-burden. We studied the feasibility of this procedure in an animal model. The underlying treatment planning and motion mitigation strategies will be presented. Methods: The study was carried out in 15 pigs, randomly distributed to 3 target groups: atrioventricular node (AVN, 8 animals with 25, 40, and 55 Gy target dose), left ventricular free-wall (LV, 4 animals with 40 Gy) and superior pulmonary vein (SPV, 3 animals with 40 Gy). Breathing motion was suppressed by repeated enforced breathholds at end exhale. Cardiac motion was mitigated by an inhomogeneous rescanning scheme with up to 15 rescans. The treatment planning was performed using the GSI in-house software TRiP4D on cardiac-gated 4DCTs, applying a range-considering ITV based on an extended CTV. For AVN and SPV isotropic 5 mm margins were applied to the CTV, while for the LV 2mm+2% range margins were used. The opposing fields for AVN and LV targets were optimized independently (SFUD), while SPV treatments were optimized as IMPT deliveries, including dose restrictions to the radiosensitive AVN. Results: Median value of D{sub 95} over all rescanning simulations was 99.1% (AVN), 98.0% (SPV) and 98.3% (LV) for the CTV and 94.7% (AVN) and 92.7% (SPV) for the PTV, respectively. The median D{sub 5}-D{sub 95} was improved with rescanning compared to unmitigated delivery from 13.3 to 6.5% (CTV) and from 23.4 to 11.6% (PTV). ICRP dose limits for aorta, trachea, esophagus and skin were respected. The maximal dose in the coronary arteries was limited to 30 Gy. Conclusion: We demonstrated the feasibility of a homogeneous dose delivery to different cardiac structures in a porcine model using a time-optimized inhomogeneous rescanning scheme. The presented treatment planning strategies were applied in a pig study with the analysis ongoing. Funding: This work was supported in part by the Helmholtz Association, the American Heart Association Midwest Affiliate Postdoctoral Fellowship Grant, the Mayo Clinic Foundation, and the Goldsmith Foundation.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-C-204-03: In-Vivo Range Verification and Tissue Response to Proton Radiotherapy Using Prompt Gamma Volume Histograms

Purpose: To study if prompt gamma (PG) volume histograms created from PG images acquired during treatment delivery can be used to identify changes to beam range and tissue composition in response to proton radiotherapy. Methods: Monte Carlo simulations of a single field from a single treatment fraction (100 cGy) for prostate cancer were performed for the cases of: 1) an ideal patient setup, 1) a setup shift in the superior direction and 2) a reduction in oxygen concentration in the tumor. For each case, the 3 -Dimsional dose delivery and elemental PG emission in the patient for the treatment fraction were recorded and imported into a commercial treatment planning system. Changes in the dose volume histograms (DVH), as well as the PG volume histograms (PG-VH) for the PG emission from oxygen and for the total PG emission (from all elements) were analyzed. Results: For the 1 cm superior shift, the prostate DVH and total PG-VH both shifted toward lower doses with the shape of the curves remaining nearly unchanged, resulting in the DVH V95 dropping from 100 cGy to 90 cGy. For the total PG-VH, the V95 fell from 50 to 38. For the reduced oxygen case, both the DVH and PG-VH had a much different shape than for the ideal case, with a significant downward slope in the curves as a function of dose. Conclusions: The shift in the prostate PG-VH for a superior shift in the patient setup correlated well with the DVH indicating it is possible to detect setup errors by analyzing the PG-VH from prompt gamma images obtained during daily proton treatment delivery. Additionally, it may be possible to detect changes in the elemental concentrations of irradiated tissues by analyzing the shape of the PG-VH.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-C-204-05: Simulations of a Portal Imaging System for Conformal and Intensity Modulated Fast Neutron Therapy

Purpose: The University of Washington Medical Center offers neutron therapy for the palliative and definitive treatment of selected cancers. In vivo field verification has the potential to improve the safe and effective delivery of neutron therapy. We propose a portal imaging method that relies on the creation of positron emitting isotopes (11C and 15O) through (n, 2n) reactions with a PMMA plate placed below the patient. After field delivery, the plate is retrieved from the vault and imaged using a reader that detects annihilation photons. The spatial pattern of activity produced in the PMMA plate provides information to reconstruct the neutron fluence map needed to confirm treatment delivery. Methods: We used MCNP to simulate the accumulation of 11C activity in a slab of PMMA 2 mm thick, and GATE was used to simulate the sensitivity and spatial resolution of a prototype imaging system. BGO crystal thicknesses of 1 cm, 2 cm and 3 cm were simulated with detector separations of 2 cm. Crystal pitches of 2 mm and 4 mm were evaluated. Back-projection of the events was used to create a planar image. The spatial resolution was taken to be the FWHM of the reconstructed point source image. Results: The system sensitivity for a point source in the center of the field of view was found to range from 58% for 1 cm thick BGO with 2 mm crystal pitch to 74% for the 3 cm thick BGO crystals with 4 mm crystal pitch. The spatial resolution at the center of the field of view was found to be 1.5 mm for the system with 2 mm crystal pitch and 2.8 mm for the system with the 4 mm crystal pitch. Conclusion: BGO crystals with 4 mm crystal pitch and 3 cm length would offer the best sensitivity reader.

07 ISOTOPE AND RADIATION SOURCES↗
DOE OSTI2015

SU-E-J-03: Characterization of the Precision and Accuracy of a New, Preclinical, MRI-Guided Focused Ultrasound System for Image-Guided Interventions in Small-Bore, High-Field Magnets

Purpose: MRI-guided focused ultrasound (MRgFUS) has many potential and realized applications including controlled heating and localized drug delivery. The development of many of these applications requires extensive preclinical work, much of it in small animal models. The goal of this study is to characterize the spatial targeting accuracy and reproducibility of a preclinical high field MRgFUS system for thermal ablation and drug delivery applications. Methods: The RK300 (FUS Instruments, Toronto, Canada) is a motorized, 2-axis FUS positioning system suitable for small bore (72 mm), high-field MRI systems. The accuracy of the system was assessed in three ways. First, the precision of the system was assessed by sonicating regular grids of 5 mm squares on polystyrene plates and comparing the resulting focal dimples to the intended pattern, thereby assessing the reproducibility and precision of the motion control alone. Second, the targeting accuracy was assessed by imaging a polystyrene plate with randomly drilled holes and replicating the hole pattern by sonicating the observed hole locations on intact polystyrene plates and comparing the results. Third, the practicallyrealizable accuracy and precision were assessed by comparing the locations of transcranial, FUS-induced blood-brain-barrier disruption (BBBD) (observed through Gadolinium enhancement) to the intended targets in a retrospective analysis of animals sonicated for other experiments. Results: The evenly-spaced grids indicated that the precision was 0.11 +/− 0.05 mm. When image-guidance was included by targeting random locations, the accuracy was 0.5 +/− 0.2 mm. The effective accuracy in the four rodent brains assessed was 0.8 +/− 0.6 mm. In all cases, the error appeared normally distributed (p<0.05) in both orthogonal axes, though the left/right error was systematically greater than the superior/inferior error. Conclusions: The targeting accuracy of this device is sub-millimeter, suitable for many preclinical applications including focused drug delivery and thermal therapy. Funding support provided by Philips Healthcare.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-J-73: Extension of a Clinical OIS/EMR/R&V System to Deliver Safe and Efficient Adaptive Plan-Of-The-Day Treatments Using a Fully Customizable Plan-Library-Based Workflow

Purpose: To extend a clinical Record and Verify (R&V) system to enable a safe and fast workflow for Plan-of-the-Day (PotD) adaptive treatments based on patient-specific plan libraries. Methods: Plan libraries for PotD adaptive treatments contain for each patient several pre-treatment generated treatment plans. They may be generated for various patient anatomies or CTV-PTV margins. For each fraction, a Cone Beam CT scan is acquired to support the selection of the plan that best fits the patient’s anatomy-of-the-day. To date, there are no commercial R&V systems that support PotD delivery strategies. Consequently, the clinical workflow requires many manual interventions. Moreover, multiple scheduled plans have a high risk of excessive dose delivery. In this work we extended a commercial R&V system (MOSAIQ) to support PotD workflows using IQ-scripting. The PotD workflow was designed after extensive risk analysis of the manual procedure, and all identified risks were incorporated as logical checks. Results: All manual PotD activities were automated. The workflow first identifies if the patient is scheduled for PotD, then performs safety checks, and continues to treatment plan selection only if no issues were found. The user selects the plan to deliver from a list of candidate plans. After plan selection, the workflow makes the treatment fields of the selected plan available for delivery by adding them to the treatment calendar. Finally, control is returned to the R&V system to commence treatment. Additional logic was added to incorporate off-line changes such as updating the plan library. After extensive testing including treatment fraction interrupts and plan-library updates during the treatment course, the workflow is running successfully in a clinical pilot, in which 35 patients have been treated since October 2014. Conclusion: We have extended a commercial R&V system for improved safety and efficiency in library-based adaptive strategies enabling a wide-spread implementation of those strategies. This work was in part funded by a research grant of Elekta AB, Stockholm, Sweden.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-J-175: Comparison of the Treatment Reproducibility of Tumors Affected by Breathing Motion

Purpose: The aim of the dose distribution simulations was to form a global idea of intensity-modulated radiation therapy (IMRT) realization, by its comparison to three-dimensional conformal radiation therapy (3DCRT) delivery for tumors affected by respiratory motion. Methods: In the group of 10patients both 3DCRT and IMRT plans were prepared.For each field the motion kernel was generated with the largest movement amplitude of 4;6 and 8mm.Additionally,the sets of reference measurements were made in no motion conditions(0 mm).The evaluation of plan delivery,using a diode array placed on moving platform,was based on the Gamma Index analysis with distance to agreement of 3mm and dose difference of 3%. Results: IMRT plans tended to spare doses delivered to lungs compared to 3DCRT.Nonetheless,analyzed volumes showed no significant difference between the static and dynamic techniques,except for the volumes of both lungs receiving 10 and 15Gy.After adding the components associated with the respiratory movement,all IMRT lung parameters evaluated for the ipsilateral,contralateral and both lungs together,revealed considerable differences between the 0vs.6, 0vs.8 and 4vs.8-mm amplitudes.Similar results were obtained for the 3DCRT lung measurements,but without significance between the 0vs.6-mm amplitude.Taking into account the CTV score parameter in 3DCRT and IMRT plans,there was no statistically significant difference between the motion patterns with the smallest amplitudes.The differences were found for the 8-mm amplitude when it was compared both with static conditions and 4-mm amplitude (for 3DCRT) and between 0vs.6, 0vs.8 and 4vs.8-mm amplitudes (for IMRT).All accepted and measured 3DCRT and IMRT doses to spinal cord,esophagus and heart were always below the QUANTEC limits. Conclusion: The application of IMRT technique in lung radiotherapy affords possibilities for reducing the lung doses.For maximal amplitudes of breathing trajectory below 4mm,the disagreement between CTV planned and delivered dose distribution can be neglected.Whereas respiratory motion with an amplitude above 5mm leads to significant changes in IMRT delivery.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-J-274: Responses of Medulloblastoma Cells to Radiation Dosimetric Parameters in Intensity-Modulated Radiation Therapy

Purpose: To evaluate radiation responses of the medulloblastoma cell line Daoy in intensity-modulated radiation therapy (IMRT), quantitative variations to variable radiation dosimetic parameters were tracked by bioluminescent images (BLIs). Methods: The luciferase and green fluorescent protein positive Daoy cells were cultured on dishes. The medulloblastoma cells irradiated to different dose rate, interval of fractionated doses, field margin and misalignment, and dose uniformity in IMRT were monitored using bioluminescent images. The cultured cells were placed into a dedicated acrylic phantom to deliver intensity-modulated fluences and calculate accurate predicted dose distribution. The radiation with dose rate from 0.5 Gy/min to 15 Gy/min was irradiated by adjusting monitor unit per minute and source-to-surface distances. The intervals of fractionated dose delivery were changed considering the repair time of double strand breaks (DSB) revealed by straining of gamma-H2AX.The effect of non-uniform doses on the cells were visualized by registering dose distributions and BLIs. The viability according to dosimetric parameters was correlated with bioluminescent intensities for cross-check of radiation responses. Results: The DSB and cell responses due to the first fractionated dose delivery significantly affected final tumor control rather than other parameters. The missing tumor volumes due to the smaller field margin than the tumor periphery or field misalignment caused relapse of cell responses on BLIs. The dose rate and gradient had effect on initial responses but could not bring out the distinguishable killing effect on cancer cells. Conclusion: Visualized and quantified bioluminescent images were useful to correlate the dose distributions with spatial radiation effects on cells. This would derive the effective combination of dose delivery parameters and fractionation. Radiation responses in particular IMRT configuration could be reflected to image based-dose re-optimization.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-52: A New Device for Quality Assurance of a Single Isocenter Technique for the Simultaneous Treatment of Multiple Brain Metastases

Purpose: Comprehensive quality assurance (QA) of a single isocenter technique for the simultaneous treatment of multiple brain metastases is presently impractical due to the time consuming nature of measuring each lesion’s dose on film or with a micro-chamber. Three dimensional diode array and full field film measurements are sometimes used to evaluate these plans, but gamma analysis may not reveal local errors that have significant effects on one or a few of several targets. This work aimed to design, build and test a phantom to simplify comprehensive measurement and evaluation. Methods: A phantom was designed with 28 stackable slabs. The top and bottom slabs are 1.5 centimeters (cm) in thickness, and central 26 slabs are 0.5 cm thick. When assembled with radiochromic film in all 27 gaps, the phantom measures 16.5 x 15 x 19 cm. Etchings were designed to aide in identification of specific film planes on computed tomography (CT) images and correlation of individual PTVs with closest bisecting planes. Patient verification plans with a total of 16 PTVs were calculated on the phantom CT, and test deliveries both with and without couch kicks were performed to test the ability to identify correct film placements and subsequent PTV specific dose distributions on the films. Results: Bisecting planes corresponding to PTV locations were easily identified, and PTV specific dose distributions were clear for all 16 targets. For deliveries with couch kicks, the phantom PTV dose distributions closely approximated those calculated on the patient’s CT. For deliveries without couch kicks, PTV specific dosimetry was also possible, although the distributions had ‘ghosts’ equaling the number of couch kicks, with distance between ghosts increasing with distance from the isocenter. Conclusion: A new phantom facilitates fast comprehensive commissioning validation and PTV specific dosimetry for a single isocenter technique for treating multiple brain metastases. This work was partially funded by CIRS, Inc.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-158: Catching Errors with Trajectory Log Files

Purpose: To present our single institution experience on catching errors with trajectory log file analysis. The reported causes of failures, probability of occurrences (O), severity of effects (S), and the probability of the failures to be undetected (D) could be added to guidelines of FMEA analysis. Methods: From March 2013 to March 2014, 19569 patient treatment fields/arcs were analyzed. This work includes checking all 131 treatment delivery parameters for all patients, all treatment sites and all treatment delivery fractions. TrueBeam trajectory log files for all treatment field types as well as all imaging types were accessed, read in every 20ms, and every control point (total of 37 million parameters) compared to the physician approved plan in the planning system. Results: Couch angle outlier occurrence: N= 327, range = −1.7 −1.2 deg; gantry angle outlier occurrence: N =59, range = 0.09 – 5.61 deg, collimator angle outlier occurrence: N = 13, range = −0.2 – 0.2 deg. VMAT cases have slightly larger variations in mechanical parameters. MLC: 3D single control point fields have a maximum deviation of 0.04 mm, 39 step and shoot IMRT cases have MLC −0.3 – 0.5 mm deviations, all (1286) VMAT cases have −0.9 – 0.7 mm deviations. Two possible serious errors were found: 1) A 4 cm isocenter shift for the PA beam of an AP-PA pair, under-dosing a portion of PTV by 25%. 2) Delivery with MLC leaves abutted behind the jaws as opposed to the midline as planned, leading to a under-dosing of a small volume of the PTV by 25%, by just the boost plan. Due to their error origin, neither of these errors could have been detected by pre-treatment verification. Conclusion: Performing Trajectory Log file analysis could catch typically undetected errors to avoid potentially adverse incidents.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-302: Dosimetric Comparison Between Volumetric Modulated Arc Radiotherapy and Intensity-Modulated Radiotherapy for Locally Recurrent Nasopharyngeal Carcinoma

Purpose: To compare volumetric modulated arc radiotherapy (VMAT) technique with fixed-gantry intensity-modulated radiotherapy (IMRT) technique for locally recurrent nasopharyngeal carcinoma. Methods: CT datasets of eleven nasopharyngeal-carcinoma patients were included. Dual-arc VMAT and seven-field IMRT plans were created for each case, and were then compared in terms of conformity index (CI), homogeneity index (HI) of the planning target volume (PTV), organ-at-risk (OAR) sparing, monitor unit (MU) and delivery time. Results: The D98% (near-minimal dose) of PTV in the VMAT plans was slightly lower than that of the IMRT plans (P < 0.05), while the CI was higher than that of the IMRT plans (P < 0.05). No significant difference was found in the HI between the two plans (P > 0.05). Compared with the IMRT plans, the VMAT plans demonstrated lower Dmean (mean dose) of the bilateral temporal lobes and the whole surrounding normal tissue (P < 0.05), but slightly higher Dmean of brainstem (P < 0.05). In terms of the other OARs, no significant differences were found (P > 0.05). The MUs of the VMAT plans (672 ± 112) was significantly lower than that of the IMRT plans (917 ± 206), by 25 ± 13% (P < 0.05). The average delivery time of the VMAT plans (2.3 ± 0.1 min) was less than that of the IMRT plans (5.1 ± 0.4 min), by 54 ± 3%. Conclusion: For locally recurrent nasopharyngeal carcinoma, the VMAT technique could achieve equivalent or superior dose distribution of the target and better protect the bilateral temporal lobes, compared with the IMRT technique. Moreover, it could reduce the MU and delivery time effectively.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-303: Dosimetric Comparison of a LINAC Fallback Plan Generated From Tomotherapy System

Purpose: Quantitatively evaluate the Multi Criteria Optimization (MCO) based MLC step and shoot (sMLC) fallback plan derived from Tomotherapy of multiple lesions lung SBRT Methods: Inter-comparison of various IMRT planning systems tends to be difficult due to the vendor-specific functionalities. The methodology of defining dose constraints and beam geometries is challenging. Raysearch™ planning system offers an alternative replanning to deliver same intensity map from Tomotherapy without modifying original fluence. This intuitive comparison comes from the final fluence map converted without any embedded system dependent dose optimization. This planner independent approach could be utilized to study the merits of individual machines. The term “fallback” was utilized to (A) transfer plans in among treatment delivery systems; (B) maintain acceptable plan qualities; and (C) minimize the biological dose impact due to machine breakdown. The Tomotherapy specific DICOM RT dose and plan are retrieved into Raystation’s pre-defined sMLC protocol. Based on specific machine characteristics, same fluence maps were converted to generate equivalent deliverable segments. Therefore, the treatment plans were evaluated among two planning tools, Tomotherapy and MCO based sMLC delivery plans. Results: By converting the fluence map with the pre-defined machine characteristics, the 9-fields fallback plan has similar ITV coverage compared to the original Tomotherapy plan. ITV average doses, the D95 consisted of 0.9% variation. The total lung doses of fallback plan drifted from 17.4% to 30.5% which represents the limitations of the static beam delivery. D2 of fallback spinal cord increased from 22.4% to 36.4% but still within tolerances. Ipsilateral lung changed from 11.0% to 22.6%. Low dose region between ITVs presented increased dose to the normal lung tissues. Conclusion: Acceptable fallback plan for Tomotherapy SBRT has similar ITVs coverage, but lack of the normal tissues avoidance due to the limitation of geometrical factors to reduce doses in between ITVs.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-309: Dosimetric Comparison of Simultaneous Integrated Boost Treatment Plan Between Intensity Modulated Radiotherapies (IMRTs), Dual Arc Volumetric Modulated Arc Therapy (DA-VMAT) and Single Arc Volumetric Modulated Arc Therapy (SA-VMAT) for Nasopharyngeal Carcinoma (NPC)

Purpose: To compare the plan quality and performance of Simultaneous Integrated Boost (SIB) Treatment plan between Seven field (7F) and Nine field(9F) Intensity Modulated Radiotherapies and Single Arc (SA) and Dual Arc (DA) Volumetric Modulated Arc Therapy( VMAT). Methods: Retrospective planning study of 16 patients treated in Elekta Synergy Platform (mlci2) by 9F-IMRT were replanned with 7F-IMRT, Single Arc VMAT and Dual Arc VMAT using CMS, Monaco Treatment Planning System (TPS) with Monte Carlo simulation. Target delineation done as per Radiation Therapy Oncology Protocols (RTOG 0225&0615). Dose Prescribed as 70Gy to Planning Target Volumes (PTV70) and 61Gy to PTV61 in 33 fraction as a SIB technique. Conformity Index(CI), Homogeneity Index(HI) were used as analysis parameter for Target Volumes as well as Mean dose and Max dose for Organ at Risk(OAR,s).Treatment Delivery Time(min), Monitor unit per fraction (MU/fraction), Patient specific quality assurance were also analysed. Results: A Poor dose coverage and Conformity index (CI) was observed in PTV70 by 7F-IMRT among other techniques. SA-VMAT achieved poor dose coverage in PTV61. No statistical significance difference observed in OAR,s except Spinal cord (P= 0.03) and Right optic nerve (P=0.03). DA-VMAT achieved superior target coverage, higher CI (P =0.02) and Better HI (P=0.03) for PTV70 other techniques (7F-IMRT/9F-IMRT/SA-VMAT). A better dose spare for Parotid glands and spinal cord were seen in DA-VMAT. The average treatment delivery time were 5.82mins, 6.72mins, 3.24mins, 4.3mins for 7F-IMRT, 9F-IMRT, SA-VMAT and DA-VMAT respectively. Significance difference Observed in MU/fr (P <0.001) and Patient quality assurance pass rate were >95% (Gamma analysis (Γ3mm, 3%). Conclusion: DA-VAMT showed better target dose coverage and achieved better or equal performance in sparing OARs among other techniques. SA-VMAT offered least Treatment Time than other techniques but achieved poor target coverage. DA-VMAT offered shorter delivery time than 7F-IMRT and 9F-IMRT without compromising the plan quality.

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