Engineering topics

Chan, M

Publications and source records attributed to Chan, M.

At least 19 records

DOE OSTI2016

SU-F-J-27: Segmentation of Prostate CBCT Images with Implanted Calypso Transponders Using Double Haar Wavelet Transform

Purpose: Segmentation of prostate CBCT images is an essential step towards real-time adaptive radiotherapy. It is challenging For Calypso patients, as more artifacts are generated by the beacon transponders. We herein propose a novel wavelet-based segmentation algorithm for rectum, bladder, and prostate of CBCT images with implanted Calypso transponders. Methods: Five hypofractionated prostate patients with daily CBCT were studied. Each patient had 3 Calypso transponder beacons implanted, and the patients were setup and treated with Calypso tracking system. Two sets of CBCT images from each patient were studied. The structures (i.e. rectum, bladder, and prostate) were contoured by a trained expert, and these served as ground truth. For a given CBCT, the moving window-based Double Haar transformation is applied first to obtain the wavelet coefficients. Based on a user defined point in the object of interest, a cluster algorithm based adaptive thresholding is applied to the low frequency components of the wavelet coefficients, and a Lee filter theory based adaptive thresholding is applied to the high frequency components. For the next step, the wavelet reconstruction is applied to the thresholded wavelet coefficients. A binary/segmented image of the object of interest is therefore obtained. DICE, sensitivity, inclusiveness and ΔV were used to evaluate the segmentation result. Results: Considering all patients, the bladder has the DICE, sensitivity, inclusiveness, and ΔV ranges of [0.81–0.95], [0.76–0.99], [0.83–0.94], [0.02–0.21]. For prostate, the ranges are [0.77–0.93], [0.84–0.97], [0.68–0.92], [0.1–0.46]. For rectum, the ranges are [0.72–0.93], [0.57–0.99], [0.73–0.98], [0.03–0.42]. Conclusion: The proposed algorithm appeared effective segmenting prostate CBCT images with the present of the Calypso artifacts. However, it is not robust in two scenarios: 1) rectum with significant amount of gas; 2) prostate with very low contrast. Model based algorithm might improve the segmentation in these two scenarios.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

SU-F-T-16: Experimental Determination of Ionization Chamber Correction Factors for In-Phantom Measurements of Reference Air Kerma Rate and Absorbed Water Dose Rate of Brachytherapy 192Ir Source

Purpose: Following the method of in-phantom measurements of reference air kerma rate (Ka) at 100cm and absorbed water dose rate (Dw1) at 1cm of high-dose-rate 192Ir brachytherapy source using 60Co absorbed-dose-to-water calibrated (ND,w,60Co) ionization chamber (IC), we experimentally determined the in-phantom correction factors (kglob) of the PTW30013 (PTW, Freiburg, Germany) IC by comparing the Monte Carlo (MC)-calculated kglob of the other PTW30016 IC. Methods: The Dw1 formalism of in-phantom measurement is: M*ND,w,60Co*(kglob)Dw1, where M is the collected charges, and (kglob)Dw1 the in-phantom Dw1 correction factor. Similarly, Ka is determined by M*ND,w,60Co*(kglob)ka, where (kglob)ka the in-phantom Ka correction factor. Two thimble ICs PTW30013 and another PTW30016 having a ND,w,60Co from the German primary standard laboratory (PTB) were simultaneously exposed to the microselectron 192Ir v2 source at 8cm in a PMMA phantom. A reference well chamber (PTW33004) with a PTB transfer Ka calibration Nka was used for comparing the in-phantom measurements to derive the experimental (kglob)ka factors. We determined the experimental (kglob)Dw1 of the PTW30013 by comparing the PTW30016 measurements with MC-calculated (kglob)Dw1. Results: Ka results of the PTW30016 based on ND,w,60Co and MC-calculated (kglob)ka differ from the well chamber results based on Nka by 1.6% and from the manufacturer by 1.0%. Experimental (kglob)ka factors for the PTW30016 and two other PTW30013 are 0.00683, 0.00681 and 0.00679, and vary <0.5% with 1mm source positioning uncertainty. Experimental (kglob)Dw1 of the PTW30013 ICs are 75.3 and 75.6, and differ by 1.6% from the conversion by dose rate constant from the AAPM report 229. Conclusion: The 1.7% difference between MC and experimental (kglob)ka for the PTW30016 IC is within the PTB 2.5% expanded uncertainty in Ka calibration standard. Using a single IC with ND,w,60Co to calibrate the brachytherapy source and dose output in external radiotherapy is feasible. MC validation of the PTW30013(kglob)Dw1 is warranted.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

SU-F-T-173: One-Scan Protocol: Verifying the Delivery of Spot-Scanning Proton Beam

Purpose: Radiochromic film for spot-scanning QA provides high spatial resolution and efficiency gains from one-shot irradiation for multiple depths. However, calibration can be a tedious procedure which may limit widespread use. Moreover, since there may be an energy dependence, which manifests as a depth dependence, this may require additional measurements for each patient. We present a one-scan protocol to simplify the procedure. Methods: We performed the calibration using an EBT3 film at depths of 18, 20, 24cm of Plastic Water exposed by a 6-level step-wedge plan on a Proteus Plus proton system (IBA, Belgium). The calibration doses ranged 65–250 cGy(RBE) for proton energies of 170–200MeV. A clinical prostate+nodes plan was used for validation. The planar doses at selected depths were measured with EBT3 films and analyzed using one-scan protocol (one-scan digitization of QA film and at least one film exposed to known dose). The Gamma passing rates, dose-difference maps, and profiles of 2D planar doses measured with EBT3 film, IBA MatriXX PT, versus TPS calculations were analyzed and compared. Results: The EBT3 film measurement results matched well with the TPS calculation data with an average passing rate of ∼95% for 2%/2mm and slightly lower passing rates were obtained from an ion chamber array detector. We were able to demonstrate that the use of a proton step-wedge provided clinically acceptable results and minimized variations between film-scanner orientation, inter-scan, and scanning conditions. Furthermore, it could be derived from no more than two films exposed to known doses (one could be zero) for rescaling the master calibration curve at each depth. Conclusion: The use of a proton step-wedge for calibration of EBT3 film increases efficiency. The sensitivity of the calibration to depth variations has been explored. One-scan protocol results appear to be comparable to that of the ion chamber array detector. One author has a research grant from Ashland Inc., the manufacturer of the GafChromic film.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

SU-F-T-226: QA Management for a Large Institution with Multiple Campuses for FMEA

Purpose: To redesign our radiation therapy QA program with the goal to improve quality, efficiency, and consistency among a growing number of campuses at a large institution. Methods: A QA committee was established with at least one physicist representing each of our six campuses (22 linacs). Weekly meetings were scheduled to advise on and update current procedures, to review end-to-end and other test results, and to prepare composite reports for internal and external audits. QA procedures for treatment and imaging equipment were derived from TG Reports 142 and 66, practice guidelines, and feedback from ACR evaluations. The committee focused on reaching a consensus on a single QA program among all campuses using the same type of equipment and reference data. Since the recommendations for tolerances referenced to baseline data were subject to interpretation in some instances, the committee reviewed the characteristics of all machines and quantified any variations before choosing between treatment planning system (i.e. treatment planning system commissioning data that is representative for all machines) or machine-specific values (i.e. commissioning data of the individual machines) as baseline data. Results: The configured QA program will be followed strictly by all campuses. Inventory of available equipment has been compiled, and additional equipment acquisitions for the QA program are made as needed. Dosimetric characteristics are evaluated for all machines using the same methods to ensure consistency of beam data where possible. In most cases, baseline data refer to treatment planning system commissioning data but machine-specific values are used as reference where it is deemed appropriate. Conclusion: With a uniform QA scheme, variations in QA procedures are kept to a minimum. With a centralized database, data collection and analysis are simplified. This program will facilitate uniformity in patient treatments and analysis of large amounts of QA data campus-wide, which will ultimately facilitate FMEA.

43 PARTICLE ACCELERATORS↗

DOE OSTI2016

SU-F-T-253: Volumetric Comparison Between 4D CT Amplitude and Phase Binning Mode

Purpose: Motion artifact in 4DCT images can affect radiation treatment quality. To identify the most robust and accurate binning method, we compare the volume difference between targets delineated on amplitude and phase binned 4DCT scans. Methods: Varian RPM system and CT scanner were used to acquire 4DCTs of a Quasar phantom with embedded cubic and spherical objects having superior-inferior motion. Eight patients’ respiration waveforms were used to drive the phantom. The 4DCT scan was reconstructed into 10 phase and 10 amplitude bins (2 mm slices). A scan of the static phantom was also acquired. For each waveform, sphere and cube volumes were generated automatically on each phase using HU thresholding. Phase (amplitude) ITVs were the union of object volumes over all phase (amplitude) binned images. The sphere and cube volumes measured in the static phantom scan were V{sub sphere}=4.19cc and V{sub cube}=27.0cc. Volume difference (VD) and dice similarity coefficient (DSC) of the ITVs, and mean volume error (MVE) defined as the average target volume percentage difference between each phase image and the static image, were used to evaluate the performance of amplitude and phase binning. Results: Averaged over the eight breathing traces, the VD and DSC of the internal target volume (ITV) between amplitude and phase binning were 3.4%±3.2% (mean ± std) and 95.9%±2.1% for sphere; 2.1%±3.3% and 98.0% ±1.5% for cube, respectively.For all waveforms, the average sphere MVE of amplitude and phase binning was 6.5% ± 5.0% and 8.2%±6.3%, respectively; and the average cube MVE of amplitude and phase binning was 5.7%±3.5%and 12.9%±8.9%, respectively. Conclusion: ITV volume and spatial overlap as assessed by VD and DSC are similar between amplitude and phase binning. Compared to phase binning, amplitude binning results in lower MVE suggesting it is less susceptible to motion artifact.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

SU-F-T-377: Monte Carlo Re-Evaluation of Volumetric-Modulated Arc Plans of Advanced Stage Nasopharygeal Cancers Optimized with Convolution-Superposition Algorithm

Background: Commercial treatment planning system Pinnacle3 (Philips, Fitchburg, WI, USA) employs a convolution-superposition algorithm for volumetric-modulated arc radiotherapy (VMAT) optimization and dose calculation. Study of Monte Carlo (MC) dose recalculation of VMAT plans for advanced-stage nasopharyngeal cancers (NPC) is currently limited. Methods: Twenty-nine VMAT prescribed 70Gy, 60Gy, and 54Gy to the planning target volumes (PTVs) were included. These clinical plans achieved with a CS dose engine on Pinnacle3 v9.0 were recalculated by the Monaco TPS v5.0 (Elekta, Maryland Heights, MO, USA) with a XVMC-based MC dose engine. The MC virtual source model was built using the same measurement beam dataset as for the Pinnacle beam model. All MC recalculation were based on absorbed dose to medium in medium (Dm,m). Differences in dose constraint parameters per our institution protocol (Supplementary Table 1) were analyzed. Results: Only differences in maximum dose to left brachial plexus, left temporal lobe and PTV54Gy were found to be statistically insignificant (p> 0.05). Dosimetric differences of other tumor targets and normal organs are found in supplementary Table 1. Generally, doses outside the PTV in the normal organs are lower with MC than with CS. This is also true in the PTV54-70Gy doses but higher dose in the nasal cavity near the bone interfaces is consistently predicted by MC, possibly due to the increased backscattering of short-range scattered photons and the secondary electrons that is not properly modeled by the CS. The straight shoulders of the PTV dose volume histograms (DVH) initially resulted from the CS optimization are merely preserved after MC recalculation. Conclusion: Significant dosimetric differences in VMAT NPC plans were observed between CS and MC calculations. Adjustments of the planning dose constraints to incorporate the physics differences from conventional CS algorithm should be made when VMAT optimization is carried out directly with MC dose engine.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

SU-F-T-562: Validation of EPID-Based Dosimetry for FSRS Commissioning

Purpose: The prevailing approach to frameless SRS (fSRS) small field dosimetry is Gafchromic film. Though providing continuous information, its intrinsic uncertainties in fabrication, response, scan, and calibration often make film dosimetry subject to different interpretations. In this study, we explored the feasibility of using EPID portal dosimetry as a viable alternative to film for small field dosimetry. Methods: Plans prescribed a dose of 21 Gy were created on a flat solid water phantom with Eclipse V11 and iPlan for small static square fields (1.0 to 3.0 cm). In addition, two clinical test plans were computed by employing iPlan on a CIRS Kesler head phantom for target dimensions of 1.2cm and 2.0cm. Corresponding portal dosimetry plans were computed using the Eclipse TPS and delivered on a Varian TrueBeam machine. EBT-XD film dosimetry was performed as a reference. The isocenter doses were measured using EPID, OSLD, stereotactic diode, and CC01 ion chamber. Results: EPID doses at the center of the square field were higher than Eclipse TPS predicted portal doses, with the mean difference being 2.42±0.65%. Doses measured by EBT-XD film, OSLD, stereotactic diode, and CC01 ion chamber revealed smaller differences (except OSLDs), with mean differences being 0.36±3.11%, 4.12±4.13%, 1.7±2.76%, 1.45±2.37% for Eclipse and −1.36±0.85%, 2.38±4.2%, −0.03±0.50%, −0.27±0.78% for iPlan. The profiles measured by EPID and EBT-XD film resembled TPS (Eclipse and iPlan) predicted ones within 3.0%. For the two clinical test plans, the EPID mean doses at the center of field were 2.66±0.68% and 2.33±0.32% higher than TPS predicted doses. Conclusion: We found that results obtained with EPID portal dosimetry were slightly higher (∼2%) than those obtained with EBT-XD film, diode, and CC01 ion chamber with the exception of OSLDs, but well within IROC tolerance (5.0%). Therefore, EPID has the potential to become a viable real-time alternative method to film dosimetry.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

SU-F-T-581: The Effect of Scanning Orientation On New EBT-XD Film Using Vidar and Epson Scanners

Purpose: To study the effect of film scanning orientation for new EBT-XD film using Vidar and Epson scanners, compared with EBT3 films. Methods: The EBT-XD (lot#01081501) and EBT3 films (lot#11031501) were cut into 4cm×7cm pieces and each film piece was uniformly exposed to a 6MV photon beam (15×15cm{sup 2}) at 5 cm depth and 100cm SAD in polystyrene phantom, one at a time. The doses delivered were 0,2.5,5,10,20,30,40 and 50 Gy for EBT-XD films, and 0,0.5,1,2,4,8,12 and 16 Gy for EBT3 films, respectively. All films were scanned at least 16 hours after irradiation, one at a time, in portrait or landscape orientation, using a Vidar DosimetryPro Advantage Red and an Epson 10000XL scanner (red channel). Each film piece was positioned at the center of a frame (36cm×36cm) with a cutout slightly larger than the film size for scanning. The scanned data (71 dpi), were analyzed using ImageJ and the average in the ROI (3cm×3cm) of each film at the center was obtained. Results: Dose response curves (netOD vs. dose) were established and compared with EBT-XD and EBT3 film in portrait or landscape orientation using these two scanners. The portrait to landscape (P/L) ratio for each film/scanner combination was determined. The EBT-XD film is about three times less sensitive than EBT3 film. The netOD is higher for portrait than landscape orientation for all the film/scanner combinations. For EBT-XD and EBT3, the average P/L ratios are 1.02 and 1.03 using Vidar scanner, and 1.03 and 1.05 using Epson scanner (red channel), respectively. Conclusion: The effect of film scanning orientation for new EBT-XD film using Vidar Advantage Red and Epson 10000XL scanners has been studied, in comparison with EBT3 film. The portrait/landscape ratios are the lowest for EBT-XD film using Vidar Advantage Red scanner among the four film/scanner combinations.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

SU-F-T-643: Feasibility of Performing Patient Specific VMAT QA On Single Linac for Plans Treated in Beam-Matched Elekta Agility Linacs

Purpose: The increasing application of VMAT demands a more efficient workflow and QA solution. This study aims to investigate the feasibility of performing VMAT QA measurements on one linac for plans treated on other beam-matched Elekta Agility linacs. Methods: A single model was used to create 24 clinically approved VMAT plans (12 head-and-neck and 12 prostate using 6MV and 10MV respectively) on Pinnacle v9.10 (Philips, Einhoven, Netherlands). All head-and-neck plans were delivered on three beam-matched machines while all prostate cases were delivered on two beam-matched 10MV Agility machines. All plans were delivered onto PTW Octavius 4D phantom with 1500 detector array (PTW, Freiburg, Germany). Reconstructed volume doses were then compared with the Pinnacle reference plans in Verisoft 6.1 under 3%/3mm gamma criteria at local dose. Plans were considered clinically acceptable if >90% of the voxels passing the gamma criteria. Results: All measurements were passed (3D gamma passing rate >90%) and the result shows that the mean difference of 3D gamma of 12 head-and-neck cases is 1.2% with standard deviation of 0.6%. While for prostate cases, the mean difference of 3D gamma is 0.9% with standard deviation of 0.7%. Maximum difference of 3D gamma of all measurements between beam-matched machines is less than 2.5%. The differences of passing rates between different machines were statistically insignificant (p>0.05). Conclusion. The result suggests that ther Conclusion: The result suggests that there exists a 3D gamma threshold, in our case 92.5%, above which the VMAT QA performed in any one of beam-matched machine will also pass in another one. Therefore, VMAT QA efficiency may be increased and phantom set up time can be saved by implementing such method. A constant performance across all beam matched machines must be maintained to make this QA approach feasible.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

SU-G-TeP2-01: Can EPID Based Measurement Replace Traditional Daily Output QA On Megavoltage Linac?

Purpose: To investigate the long term stability and viability of using EPID-based daily output QA via in-house and vendor driven protocol, to replace conventional QA tools and improve QA efficiency. Methods: Two Varian TrueBeam machines (TB1&TB2) equipped with electronic portal imaging devices (EPID) were employed in this study. Both machines were calibrated per TG-51 and used clinically since Oct 2014. Daily output measurement for 6/15 MV beams were obtained using SunNuclear DailyQA3 device as part of morning QA. In addition, in-house protocol was implemented for EPID output measurement (10×10 cm fields, 100 MU, 100cm SID, output defined over an ROI of 2×2 cm around central axis). Moreover, the Varian Machine Performance Check (MPC) was used on both machines to measure machine output. The EPID and DailyQA3 based measurements of the relative machine output were compared and cross-correlated with monthly machine output as measured by an A12 Exradin 0.65cc Ion Chamber (IC) serving as ground truth. The results were correlated using Pearson test. Results: The correlations among DailyQA3, in-house EPID and Varian MPC output measurements, with the IC for 6/15 MV were similar for TB1 (0.83–0.95) and TB2 (0.55–0.67). The machine output for the 6/15MV beams on both machines showed a similar trend, namely an increase over time as indicated by all measurements, requiring a machine recalibration after 6 months. This drift is due to a known issue with pressurized monitor chamber which tends to leak over time. MPC failed occasionally but passed when repeated. Conclusion: The results indicate that the use of EPID for daily output measurements has the potential to become a viable and efficient tool for daily routine LINAC QA, thus eliminating weather (T,P) and human setup variability and increasing efficiency of the QA process.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

SU-G-TeP2-10: Feasibility of Newly Designed Applicator for High Dose Rate Brachytherapy Treatment of Patients with Vaginal Vault Recurrence

Purpose: To compare the dose of an in-house 3D-printed gynecology applicator (TMHGA) for vaginal vault recurrence of corpus cancer patients after operation for high dose rate brachytherapy treatment with commercially available applicators. Methods: A newly designed applicator is made from 3D-printing methods using ABSM30i. The isodose of the applicator is compared with Elekta multi-channel (MC) applicator and titanium Rotterdam applicator with coupling central tube and vaginal cylinder (RC). Three plans are created using three applicators in a CT set of water phantom. The applicators are anchored using the applicator library and implant library in the Elekta Oncentra treatment planning system (ver.4.5). The rectum is mimicked by creating a 2cm diameter cylinder, with a distance 1mm posteriorly away from the high risk CTV (HR-CTV). Similarly, the bladder is replicated by a 6cm diameter cylinder with distance 1mm anteriorly from the HR-CTV. Three plans are all normalized 1.5cm superior, 0.5cm anterior and 0.5cm posterior of the applicator surface. By fixing D90 of HR-CTV to 6Gy, the D2cc of rectum and bladder of three plans are compared. Results: The D2cc of the bladder for using TMHGA is lower than MC and RC by 14.0% and 11.9% respectively. While the D2cc of the rectum for using TMHGA is lower than MC and RC by 18.9% and 12.4% respectively. The total treatment time of TMHGA plan is shorter than MC and RC by 11.2% and 12.9%. Conclusion: The applicator created via 3D printing delivers a lower dose to the bladder and the rectum while keeping the same coverage to HR-CTV as other commercially available applicators. Additionally, the new applicator resulted in a reduction of treatment time, which is always welcome.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

SU-G-JeP4-05: Effects of Irregular Respiratory Motion On the Positioning Accuracy of Moving Target with Free Breathing Cone-Beam Computerized Tomography

Purpose: Average or maximum intensity projection (AIP or MIP) images derived from 4DCT images are often used as a reference image for target alignment when free breathing Cone-beam CT (FBCBCT) is used for positioning a moving target at treatment. This method can be highly accurate if the patient has stable respiratory motion. However, a patient’s breathing pattern often varies irregularly. The purpose of this study is to investigate the effect of irregular respiration on the positioning accuracy of a moving target with FBCBCT. Methods: Eight patients’ respiratory motion curves were selected to drive a Quasar phantom with embedded cubic and spherical targets. A 4DCT of the moving phantom was acquired on a CT scanner (Philips Brilliance 16) equipped with a Varian RPM system. The phase binned 4DCT images and the corresponding MIP and AIP images were transferred into Eclipse for analysis. CBCTs of the phantom driven by the same breathing curves were acquired on a Varian TrueBeam and fused such that the zero positions of moving targets are the same on both CBCT and AIP images. The sphere and cube volumes and centrioid differences (alignment error) determined by MIP, AIP and FBCBCT images were compared. Results: Compared to the volume determined by FBCBCT, the volumes of cube and sphere in MIP images were 22.4%±8.8% and 34.2%±6.2% larger while the volumes in AIP images were 7.1%±6.2% and 2.7%±15.3% larger, respectively. The alignment errors for the cube and sphere with center-center matches between MIP and FBCBCT were 3.5±3.1mm and 3.2±2.3mm, and the alignment errors between AIP and FBCBCT were 2.1±2.6mm and 2.1±1.7mm, respectively. Conclusion: AIP images appear to be superior reference images than MIP images. However, irregular respiratory motions could compromise the positioning accuracy of a moving target if the target center-center match is used to align FBCBCT and AIP images.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

MO-FG-202-09: Virtual IMRT QA Using Machine Learning: A Multi-Institutional Validation

Purpose: To validate a machine learning approach to Virtual IMRT QA for accurately predicting gamma passing rates using different QA devices at different institutions. Methods: A Virtual IMRT QA was constructed using a machine learning algorithm based on 416 IMRT plans, in which QA measurements were performed using diode-array detectors and a 3%local/3mm with 10% threshold. An independent set of 139 IMRT measurements from a different institution, with QA data based on portal dosimetry using the same gamma index and 10% threshold, was used to further test the algorithm. Plans were characterized by 90 different complexity metrics. A weighted poison regression with Lasso regularization was trained to predict passing rates using the complexity metrics as input. Results: In addition to predicting passing rates with 3% accuracy for all composite plans using diode-array detectors, passing rates for portal dosimetry on per-beam basis were predicted with an error <3.5% for 120 IMRT measurements. The remaining measurements (19) had large areas of low CU, where portal dosimetry has larger disagreement with the calculated dose and, as such, large errors were expected. These beams need to be further modeled to correct the under-response in low dose regions. Important features selected by Lasso to predict gamma passing rates were: complete irradiated area outline (CIAO) area, jaw position, fraction of MLC leafs with gaps smaller than 20 mm or 5mm, fraction of area receiving less than 50% of the total CU, fraction of the area receiving dose from penumbra, weighted Average Irregularity Factor, duty cycle among others. Conclusion: We have demonstrated that the Virtual IMRT QA can predict passing rates using different QA devices and across multiple institutions. Prediction of QA passing rates could have profound implications on the current IMRT process.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

SU-E-T-05: 4D Measurement-Guided Dose Reconstruction (4D-MGDR) in End-End Quality Assurance (E2E QA) for Assessing Safety Margin in Radiosurgery (SRS) From Clinical Perspectives

Purpose: To assess the plan robustness and safety margin in SRS from 4DMGDR in E2E QA based on clinical objectives. Methods: OCTAVIUS SRS 1000 detector array and 4D phantom (PTW, Freiburg, Germany) were used to measure 5 coplanar SRS plans with 1 and 2 mm planning target volume (PTV). 3 targets were clinical, and 2 were virtual simulated to be 1mm from the brainstem (BS), and between chiasm (CS) and optic nerve (ON). Planning was done on Monaco v5.0 (Elekta, Maryland Heights, MO) to achieve 95–99% PTV and 100% gross tumor volume (GTV) prescription dose coverage. CBCT setup of the 4D phantom by 6D robotic couch was performed as for real patient. 4D-MGDR in patient CT and dosimetric analysis were performed in PTW Verisoft v6.1. The safety margin that achieved 100% GTV coverage was determined, and doses to 2% (D2%) of BS, ON and CS were assessed from E2E QA. Results: 100% GTV coverage was achieved with 1mm margin for 2 plans and 2mm margin for all plans. 98.3% and 99.4% GTV coverage were found in E2E QA for 1mm PTVs that either had sharp changing contour, or was nearby CS and ON or BS, and had either low planned minimum GTV dose (∼101% of the prescribed dose vs.∼106%) or compromised PTV coverage (95% vs. 99%). D2% to CS obtained with 4D-MGDR for one virtual target were 18.8Gy for 1mm PTV and 19.2Gy for 2mm PTV, exceeding the planned tolerance of 18Gy/3 fractions for prescription dose of 24Gy. Conclusion: 1mm margin is generally sufficient for dose planning and machine delivery errors. Irregular GTV with just enough dose coverage to spare critical organs may need 2mm margin at the costs of possible higher organ doses. 4D MGDR in an E2E QA approach can put the treatment plan evaluation in clinical perspectives.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

SU-E-T-202: Comparison of 4D-Measurement-Guided Dose Reconstructions (MGDR) with COMPASS and OCTAVIUS 4D System

Purpose: To cross-validate the MGDR of COMPASS (IBA dosimetry, GmbH, Germany) and OCTAVIUS 4D system (PTW, Freiburg, Germany). Methods: Volumetric-modulated arc plans (5 head-and-neck and 3 prostate) collapsed to 40° gantry on the OCTAVIUS 4D phantom in QA mode on Monaco v5.0 (Elekta, CMS, Maryland Heights, MO) were delivered on a Elekta Agility linac. This study was divided into two parts: (1) error-free measurements by gantry-mounted EvolutionXX 2D array were reconstructed in COMPASS (IBA dosimetry, GmbH, Germany), and by OCTAVIUS 1500 array in Versoft v6.1 (PTW, Freiburg, Germany) to obtain the 3D doses (COM4D and OCTA4D). COM4D and OCTA4D were compared to the raw measurement (OCTA3D) at the same detector plane for which OCTAVIUS 1500 was perpendicular to 0° gantry axis while the plans were delivered at gantry 40°; (2) beam steering errors of energy (Hump=-2%) and symmetry (2T=+2%) were introduced during the delivery of 5 plans to compare the MGDR doses COM4D-Hump (COM4D-2T), OCTA4D-Hump (OCTA4D-2T), with raw doses OCTA3D-Hump (OCTA3D-2T) and with OCTA3D to assess the error reconstruction and detection ability of MGDR tools. All comparisons used Υ-criteria of 2%(local dose)/2mm and 3%/3mm. Results: Averaged Υ passing rates were 85% and 96% for COM4D,and 94% and 99% for OCTA4D at 2%/2mm and 3%/3mm criteria respectively. For error reconstruction, COM4D-Hump (COM4D-2T) showed 81% (93%) at 2%/2mm and 94% (98%) at 3%/3mm, while OCTA4D-Hump (OCTA4D-2T) showed 96% (96%) at 2%/2mm and 99% (99%) at 3%/3mm. For error detection, OCTA3D doses were compared to COM4D-Hump (COM4D-2T) showing Υ passing rates of 93% (93%) at 2%/2mm and 98% (98%), and to OCTA4D-Hump (OCTA4D -2T) showing 94% (99%) at 2%/2mm and 81% (96%) at 3%/3mm, respectively. Conclusion: OCTAVIUS MGDR showed better agreement to raw measurements in both error- and error-free comparisons. COMPASS MGDR deviated from the raw measurements possibly owing to beam modeling uncertainty.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

SU-E-T-286: Dose Verification of Spot-Scanning Proton Beam Using GafChromic EBT3 Film

Purpose: Dose verification of spot-scanning proton pencil beam is performed via planar dose measurements at several depths using an ionization-chamber array, requiring repeat irradiations of each field for each depth. Here we investigate film dosimetry which has two advantages: higher resolution and efficiency from one-shot irradiation for multiple depths. Methods: Film calibration was performed using an EBT3 film at 20-cm depth of Plastic Water (CIRS, Norfolk, VA) exposed by a 10-level step wedge on a Proteus Plus proton system (IBA, Belgium). The calibration doses ranged from 25–250 cGy(RBE) for proton energies of 170–200 MeV. A uniform 1000 cm{sup 3} dose cube and a clinical prostate combined with seminal-vesicle and pelvic-nodes plan were used for this study. All treatment plans were generated in the RayStation (RaySearch Lab, Sweden). The planar doses at different depths for both cases were measured with film using triple-channel dosimetry and the MatriXX PT (IBA Dosimetry, Germany). The Gamma passing rates, dose-difference maps, and profiles of 2D planar doses measured with EBT3 film and MatriXX, versus treatment planning system (TPS) calculations were analyzed and compared using the FilmQA Pro (Ashland Inc., Bridgewater, NJ). Results: The EBT3 film measurement results matched well with the TPS calculation data with an average passing rate >95% for 2%/2mm and are comparable with the MatriXX measurements (0.7%, 1.8%, 3.8% mean differences corresponding to 3%/3mm, 3%/2mm, 2%/2mm, respectively). Overall passing rates for EBT3 films appear higher than those with MatriXX detectors. Conclusion: The energy dependence of the film response could be minimized by calibration using proton beam with mixed energies. The greater efficiency of the dose verification using GafChromic EBT3 results in a potential cost trade-off between room capacity and film cost. EBT3 film may offer distinct advantages in highly intensity-modulated fields due to its higher resolution compared to 2D ionization-chamber array detectors. One of the authors has a research grant from Ashland Inc., the manufacturer of GafChromic film.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

SU-E-T-579: On the Relative Sensitivity of Monte Carlo and Pencil Beam Dose Calculation Algorithms to CT Metal Artifacts in Volumetric-Modulated Arc Spine Radiosurgery (RS)

Purpose: Investigating the relative sensitivity of Monte Carlo (MC) and Pencil Beam (PB) dose calculation algorithms to low-Z (titanium) metallic artifacts is important for accurate and consistent dose reporting in post¬operative spinal RS. Methods: Sensitivity analysis of MC and PB dose calculation algorithms on the Monaco v.3.3 treatment planning system (Elekta CMS, Maryland Heights, MO, USA) was performed using CT images reconstructed without (plain) and with Orthopedic Metal Artifact Reduction (OMAR; Philips Healthcare system, Cleveland, OH, USA). 6MV and 10MV volumetric-modulated arc (VMAT) RS plans were obtained for MC and PB on the plain and OMAR images (MC-plain/OMAR and PB-plain/OMAR). Results: Maximum differences in dose to 0.2cc (D0.2cc) of spinal cord and cord +2mm for 6MV and 10MV VMAT plans were 0.1Gy between MC-OMAR and MC-plain, and between PB-OMAR and PB-plain. Planning target volume (PTV) dose coverage changed by 0.1±0.7% and 0.2±0.3% for 6MV and 10MV from MC-OMAR to MC-plain, and by 0.1±0.1% for both 6MV and 10 MV from PB-OMAR to PB-plain, respectively. In no case for both MC and PB the D0.2cc to spinal cord was found to exceed the planned tolerance changing from OMAR to plain CT in dose calculations. Conclusion: Dosimetric impacts of metallic artifacts caused by low-Z metallic spinal hardware (mainly titanium alloy) are not clinically important in VMAT-based spine RS, without significant dependence on dose calculation methods (MC and PB) and photon energy ≥ 6MV. There is no need to use one algorithm instead of the other to reduce uncertainty for dose reporting. The dose calculation method that should be used in spine RS shall be consistent with the usual clinical practice.

61 RADIATION PROTECTION AND DOSIMETRY↗

DOE OSTI2015

SU-E-T-790: Validation of 4D Measurement-Guided Dose Reconstruction (MGDR) with OCTAVIUS 4D System

Purpose: To validate the MGDR of OCTAVIUS 4D system (PTW, Freiburg, Germany) for quality assurance (QA) of volumetric-modulated arc radiotherapy (VMAT). Methods: 4D-MGDR measurements were divided into two parts: 1) square fields from 2×2 to 25×25 cm{sup 2} at 0°, 10° and 45° gantry, and 2) 8 VMAT plans (5 nasopharyngeal and 3 prostate) collapsed to gantry 40° in QA mode in Monaco v5.0 (Elekta, CMS, Maryland Heights, MO) were delivered on the OCTAVIUS 4D phantom with the OCTAVIUS 1500 detector plane perpendicular to either the incident beam to obtain the reconstructed dose (OCTA4D) or the 0° gantry axis to obtain the raw doses (OCTA3D) in Verisoft 6.1 (PTW, Freiburg, Germany). Raw measurements of OCTA3D were limited to < 45° gantry to avoid >0.5% variation of detector angular response with respect to 0° gantry as determined previously. Reconstructed OCTA4D and raw OCTA3D doses for all plans were compared at the same detector plane using γ criteria of 2% (local dose)/2mm and 3%/3mm criteria. Results: At gantry 0° and 10°, the γ results for all OCTA4D on detector plane coinciding with OCTA3D were over 90% at 2%/2mm except for the largest field (25×25 cm{sup 2} ) showing >88%. For square field at 45° gantry, γ passing rate is > 90% for fields smaller than 15x 15cm2 but < 80% for field size of 20 x20 cm{sup 2} upward. For VMAT, γ results showed 94% and 99% passing rate at 2%/2mm and 3%/3mm, respectively. Conclusion: OCTAVIUS 4D system has compromised accuracy in reconstructing dose away from the central beam axis, possibly due to the off-axis softening correction and errors of the percent depth dose data necessary as input for MGDR. Good results in VMAT delivery suggested that the system is relatively reliable for VMAT with small segments.

60 APPLIED LIFE SCIENCES↗