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Sintay, B

Publications and source records attributed to Sintay, B.

SU-F-T-468: Efficient Scanning Data Analysis for TomoTherapy

Purpose: The standard TomoTherapy 2D scanning system requires manual analysis using spreadsheets or similar software. Manual analysis is time consuming and does not allow efficient use of the medical physicist or timely results that may indicate issues during the acquisition of data. The purpose of this study is to determine if an in-house solution can provide timely analysis of TomoTherapy scan data. Methods: A custom MATLAB program utilizing a streamlined graphical interface was developed to interpret the native scanning data acquired by the TomoTherapy Electrometer Measurement System (TEMS). The gold beam data provided by the manufacturer was used as a baseline for the acquired data. Two separate sets of scan data were used including longitudinal, transverse, and percent depth dose (PDD). The scan data were compared visually in an overlay and analytically for each beam width using the full width half max (FWHM) for longitudinal profiles and difference inside the field core for the transverse profiles as recommended by TG-148. A plot of the PDD percent error at each point along the curve was generated to show agreement. The time to analysis was measured on a laptop running an Intel i5 processor with 8GB of RAM. Results: The software program required on average less than 5 seconds to load and analyze the results. No conversion or reformatting of the data was required. This allowed real-time visualization of the comparison to the gold beam data as well as the parameters recommended by TG-148. The average percent difference was 0.3% for the longitudinal profiles and 0.1% for the transverse profiles. All PDD data was less than 1% different beyond dmax. Conclusion: We have developed a tool to analyze TomoTherapy scan data in real-time. This allows an efficient method to perform beam commissioning, annual QA, and adjust the beam parameters if necessary.

61 RADIATION PROTECTION AND DOSIMETRY↗

SU-F-T-510: Single Isocenter Radiosurgery for the Simultaneous Treatment of Multiple Brain Metastases: Volumetric Modulated Arc Therapy Or Dynamic Conformal Arc?

Purpose: This study evaluates a novel algorithm that can be used with any treatment planning system for simple and rapid generation of stereotactic radiosurgery (SRS) plans for treating multiple brain metastases using a single isocenter dynamic conformal arc (DCA) approach. This technique is compared with a single isocenter volumetric modulated arc therapy (VMAT) technique in terms of delivery time, conformity, low dose spread and delivery accuracy. Methods: Five patients, with a total of 37 (5 – 11) targets were planned using a previously published method for generating optimal VMAT plans and using the proposed DCA algorithm. All planning target volumes (PTVs) were planned to 20 Gy, meeting a minimum 99% coverage and maximum 135 % hot spot for both techniques. Quality assurance was performed using radiochromic film, with films placed in the high dose regions of each PTV. Normal tissue volumes receiving 12 Gy and 6 Gy (V12 and V6) were computed for each plan. Conformity index (CI) and gamma evaluations (95% of points passing 4%/0.5mm) were computed for each PTV. Results: Delivery times, including beam on and table rotation times, were comparable: 17 – 22 minutes for all deliveries. V12s for DCA plans were (18.5±15.2 cc) vs. VMAT (19.7±14.4 cc). V6s were significantly lower for DCA (69.0±52.0 cc) compared with VMAT (154.0±91.0 cc) (p <<0.05). CIs for VMAT targets were (1.38±0.50) vs. DCA (1.61±0.41). 36 of 37 DCA planned targets passed gamma tests, while 29 of 37 VMAT planned targets passed. Conclusion: Single isocenter DCA plans were easily achieved. The evaluation suggests that DCA may represent a favorable technique compared with VMAT for multiple target SRS by reducing dose to normal tissue and more accurately depicting deliverable dose.

60 APPLIED LIFE SCIENCES↗

SU-F-T-626: Intracranial SRS Re-Treatment Without Acquisition of New CT Images

Purpose: Linear accelerator based stereotactic radiosurgery (SRS) for multiple intracranial lesions with frequent surveillance is becoming a popular treatment option. This strategy leads to retreatment with SRS as new lesions arise. Currently, each course of treatment uses magnetic resonance (MR) and computed tomography (CT) images for treatment planning. We propose that new MR images, with course 1 CT images, may be used for future treatment plans with negligible loss of dosimetric accuracy. Methods: Ten patients that received multiple courses of SRS were retrospectively reviewed. The treatment plans and contours from non-initial courses were copied to the initial CTs and recalculated. Doses metrics for the plans calculated on the initial CTs and later CTs were compared. All CT scans were acquired on a Philips CT scanner with a 600 mm field of view and 1 mm slice thickness (Philips Healthcare, Andover, MA). All targets were planned to 20 Gy and calculated in Eclipse V. 13.6 (Varian, Palo Alto, CA) using analytic anisotropic algorithm with 1 mm calculation grid. Results: Sixteen lesions were evaluated. The mean time between courses was 250 +/− 215 days (range 103–979). The mean target volume was 2.0 +/− 2.9 cc (range 0.1–10.1). The average difference in mean target dose between the two calculations was 0.2 +/− 0.3 Gy (range 0.0 – 1.0). The mean conformity index (CI) was 1.28 +/− 0.14 (range 1.07 – 1.82). The average difference in CI was 0.03 +/− 0.16 (range 0.00 – 0.44). Targets volumes < 0.5 cc showed the largest changes in both metrics. Conclusion: Continued treatment based on initial CT images is feasible. Dose calculation on the initial CT for future treatments provides reasonable dosimetric accuracy. Changes in dose metrics are largest for small volumes, and are likely dominated by partial volume effects in target definition.

60 APPLIED LIFE SCIENCES↗

MO-FG-CAMPUS-TeP1-03: Pre-Treatment Surface Imaging Based Collision Detection

Purpose: Modern radiotherapy increasingly employs large immobilization devices, gantry attachments, and couch rotations for treatments. All of which raise the risk of collisions between the patient and the gantry / couch. Collision detection is often achieved by manually checking each couch position in the treatment room and sometimes results in extraneous imaging if collisions are detected after image based setup has begun. In the interest of improving efficiency and avoiding extra imaging, we explore the use of a surface imaging based collision detection model. Methods: Surfaces acquired from AlignRT (VisionRT, London, UK) were transferred in wavefront format to a custom Matlab (Mathworks, Natick, MA) software package (CCHECK). Computed tomography (CT) scans acquired at the same time were sent to CCHECK in DICOM format. In CCHECK, binary maps of the surfaces were created and overlaid on the CT images based on the fixed relationship of the AlignRT and CT coordinate systems. Isocenters were added through a graphical user interface (GUI). CCHECK then compares the inputted surfaces to a model of the linear accelerator (linac) to check for collisions at defined gantry and couch positions. Note, CCHECK may be used with or without a CT. Results: The nominal surface image field of view is 650 mm × 900 mm, with variance based on patient position and size. The accuracy of collision detections is primarily based on the linac model and the surface mapping process. The current linac model and mapping process yield detection accuracies on the order of 5 mm, assuming no change in patient posture between surface acquisition and treatment. Conclusions: CCHECK provides a non-ionizing method to check for collisions without the patient in the treatment room. Collision detection accuracy may be improved with more robust linac modeling. Additional gantry attachments (e.g. conical collimators) can be easily added to the model.

60 APPLIED LIFE SCIENCES↗

TU-FG-201-09: Predicting Accelerator Dysfunction

Purpose: To develop an integrated statistical process control (SPC) framework using digital performance and component data accumulated within the accelerator system that can detect dysfunction prior to unscheduled downtime. Methods: Seven digital accelerators were monitored for twelve to 18 months. The accelerators were operated in a ‘run to failure mode’ with the individual institutions determining when service would be initiated. Institutions were required to submit detailed service reports. Trajectory and text log files resulting from a robust daily VMAT QA delivery were decoded and evaluated using Individual and Moving Range (I/MR) control charts. The SPC evaluation was presented in a customized dashboard interface that allows the user to review 525 monitored parameters (480 MLC parameters). Chart limits were calculated using a hybrid technique that includes the standard SPC 3σ limits and an empirical factor based on the parameter/system specification. The individual (I) grand mean values and control limit ranges of the I/MR charts of all accelerators were compared using statistical (ranked analysis of variance (ANOVA)) and graphical analyses to determine consistency of operating parameters. Results: When an alarm or warning was directly connected to field service, process control charts predicted dysfunction consistently on beam generation related parameters (BGP)– RF Driver Voltage, Gun Grid Voltage, and Forward Power (W); beam uniformity parameters – angle and position steering coil currents; and Gantry position accuracy parameter: cross correlation max-value. Control charts for individual MLC – cross correlation max-value/position detected 50% to 60% of MLCs serviced prior to dysfunction or failure. In general, non-random changes were detected 5 to 80 days prior to a service intervention. The ANOVA comparison of BGP determined that each accelerator parameter operated at a distinct value. Conclusion: The SPC framework shows promise. Long term monitoring coordinated with service will be required to definitively determine the effectiveness of the model. Varian Medical System, Inc. provided funding in support of the research presented.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗