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Wu, X

Publications and source records attributed to Wu, X.

At least 19 records

Machine Learning-based Prediction of Departure from Nucleate Boiling Power for the PSBT Benchmark

Machine Learning (ML) has seen an exponential growth in its applications due to its advanced data driven prediction capabilities. The study presents a data-driven approach as a preliminary attempt to predict the power at which departure from nucleate boiling (DNB) occurs in pressurized water reactors (PWRs) by constructing an advanced ML algorithm that takes outlet pressure, inlet temperature and inlet mass flux as the input features. DNB is a critical heat flux (CHF) phenomenon seen in PWRs. The experimental data from the PWR subchannel and bundle tests (PSBT) benchmark is first used to train an artificial neural network (ANN) to predict the DNB power, which produces a root mean square error (RMSE) of 6.89 kW/m when tested on a blind subset of the PSBT data. Since the PSBT dataset is relatively small to train an accurate ANN, a data augmentation methodology based on generative adversarial networks (GANs) is used to expand the training dataset. By assuming that the real data follows a certain distribution, GANs try to learn that underlying distribution to generate similar synthetic data to augment the database and to improve the predictive capabilities of the ANN. The data generated from GANs are validated using 1-nearest neighbor and kernel maximum mean discrepancy. To further ensure data from GAN is similar to PSBT, the data is tested and filtered out using the sub-channel thermal-hydraulic code CTF. The results indicate that with the addition of 120 data points from GAN the RMSE reduces to 4.84 kW/m showing promising results for future developments.

11 NUCLEAR FUEL CYCLE AND FUEL MATERIALS↗

SU-D-BRC-03: Development and Validation of an Online 2D Dose Verification System for Daily Patient Plan Delivery Accuracy Check

Purpose: All plan verification systems for particle therapy are designed to do plan verification before treatment. However, the actual dose distributions during patient treatment are not known. This study develops an online 2D dose verification tool to check the daily dose delivery accuracy. Methods: A Siemens particle treatment system with a modulated scanning spot beam is used in our center. In order to do online dose verification, we made a program to reconstruct the delivered 2D dose distributions based on the daily treatment log files and depth dose distributions. In the log files we can get the focus size, position and particle number for each spot. A gamma analysis is used to compare the reconstructed dose distributions with the dose distributions from the TPS to assess the daily dose delivery accuracy. To verify the dose reconstruction algorithm, we compared the reconstructed dose distributions to dose distributions measured using PTW 729XDR ion chamber matrix for 13 real patient plans. Then we analyzed 100 treatment beams (58 carbon and 42 proton) for prostate, lung, ACC, NPC and chordoma patients. Results: For algorithm verification, the gamma passing rate was 97.95% for the 3%/3mm and 92.36% for the 2%/2mm criteria. For patient treatment analysis,the results were 97.7%±1.1% and 91.7%±2.5% for carbon and 89.9%±4.8% and 79.7%±7.7% for proton using 3%/3mm and 2%/2mm criteria, respectively. The reason for the lower passing rate for the proton beam is that the focus size deviations were larger than for the carbon beam. The average focus size deviations were −14.27% and −6.73% for proton and −5.26% and −0.93% for carbon in the x and y direction respectively. Conclusion: The verification software meets our requirements to check for daily dose delivery discrepancies. Such tools can enhance the current treatment plan and delivery verification processes and improve safety of clinical treatments.

60 APPLIED LIFE SCIENCES↗

SU-F-J-43: Positional Variation of Implanted Fiducial Markers Over the Course of Image Guided Radiotherapy for Pancreatic Cancer

Purpose: Pancreas is a soft-tissue organ, implanted fiducials can change positions due to migration or tissue deformation. This study quantified positional variation of fiducials in IGRT for pancreatic cancer. Methods: 20 patients had at least 3 gold fiducials implanted in pancreas under EUS guidance. Patients had 4D-CT simulation for gated treatment. Daily gated OBI kV images (Turebeam) were used for positional alignment with fiducials for total of 25 or 28 fractions. Relative distances among 3 fiducials (d{sub 1–} {sub 2}, d{sub 1–3}, d{sub 2–3}) were measured from 4D-CT end-of-expiration phase bin; and from gated kV images in first, mid, and last fraction (n=180). Results: The median duration between implant and simulation was 11 (range 0–41) days. The median duration between simulation and first fraction was 17 (range 8–24) days. The median relative distance was 12 (range 4–78) mm for d{sub 1–2}, 24 (range 6–80) mm for d{sub 1–3}, and 19 (range 5–63) mm for d{sub 2–3}. The median deviation was 1 mm for d{sub 1–2}, d{sub 1–3}, d{sub 2–3} between simulation and first fraction, first and mid fraction, mid and last fraction (n=180). Two patients (10%) had deviation >= 5 mm (5, 11 mm) between simulation and first fraction. One patient (5%) had deviation >= 5 mm (11 mm) between first and mid fraction. No patient (0%) had deviation >= 5 mm between mid and last fraction. In all 3 cases with deviation >=5 mm, only one fiducial was significantly deviated. No clear evidence that deviation size was associated with time interval between implant and first fraction. Conclusion: Implanted gold fiducials were quite stable over time in their relative positions in pancreas. Our data suggested at least 3 fiducials are needed. In cases that one fiducial was significantly deviated in daily kV images, this fiducial should be excluded in image guidance.

60 APPLIED LIFE SCIENCES↗

SU-F-J-96: Comparison of Frame-Based and Mutual Information Registration Techniques for CT and MR Image Sets

Purpose: To compare the accuracy of CT-MR registration using a mutual information method with registration using a frame-based localizer box. Methods: Ten patients having the Leksell head frame and scanned with a modality specific localizer box were imported into the treatment planning system. The fiducial rods of the localizer box were contoured on both the MR and CT scans. The skull was contoured on the CT images. The MR and CT images were registered by two methods. The frame-based method used the transformation that minimized the mean square distance of the centroids of the contours of the fiducial rods from a mathematical model of the localizer. The mutual information method used automated image registration tools in the TPS and was restricted to a volume-of-interest defined by the skull contours with a 5 mm margin. For each case, the two registrations were adjusted by two evaluation teams, each comprised of an experienced radiation oncologist and neurosurgeon, to optimize alignment in the region of the brainstem. The teams were blinded to the registration method. Results: The mean adjustment was 0.4 mm (range 0 to 2 mm) and 0.2 mm (range 0 to 1 mm) for the frame and mutual information methods, respectively. The median difference between the frame and mutual information registrations was 0.3 mm, but was not statistically significant using the Wilcoxon signed rank test (p=0.37). Conclusion: The difference between frame and mutual information registration techniques was neither statistically significant nor, for most applications, clinically important. These results suggest that mutual information is equivalent to frame-based image registration for radiosurgery. Work is ongoing to add additional evaluators and to assess the differences between evaluators.

60 APPLIED LIFE SCIENCES↗

SU-F-T-190: Homogeneity Study of Proton and Heavy Ion Scanning Beams Based On Different Compositions of Spot Sizes (FWHM) and Grid Sizes

Purpose: Different particle scanning beam delivery systems have different delivery accuracies. This study was performed to determine, for our particle treatment system, an appropriate composition (n=FWHM/GS) of spot size(FWHM) and grid size (GS), which can provide homogenous delivered dose distributions for both proton and heavy ion scanning beam radiotherapy. Methods: We analyzed the delivery errors of our beam delivery system using log files from the treatment of 28 patients. We used a homemade program to simulate square fields for different n values with and without considering the delivery errors and analyzed the homogeneity. All spots were located on a rectilinear grid with equal spacing in the × and y directions. After that, we selected 7 energy levels for both proton and carbon ions. For each energy level, we made 6 square field plans with different n values (1, 1.5, 2, 2.5, 3, 3.5). Then we delivered those plans and used films to measure the homogeneity of each field. Results: For program simulation without delivery errors, when n≥1.1 the homogeneity can be within ±3%. For both proton and carbon program simulations with delivery errors and film measurements, the homogeneity can be within ±3% when n≥2.5. Conclusion: For our facility with system errors, the n≥2.5 is appropriate for maintaining homogeneity within ±3%.

60 APPLIED LIFE SCIENCES↗

SU-F-T-570: Comparison of Synthetic Diamond, Microionization Chamber, and Radiochromic Film for Absolute Dosimetry of VMAT Radiosurgery

Purpose: Patient specific quality assurance of stereotactic radiosurgery (SRS) plans is challenging because of small target sizes and high dose gradients. We compared three detectors for dosimetry of VMAT SRS plans. Methods: The dose at the center of seventeen targets was measured using a synthetic diamond detector (2.2 mm diameter, 1 µm thickness), a 0.007 cm{sup 3} ionization chamber, and radiochromic film. Measurements were made in a PMMA phantom in the clinical geometry – all gantry and table angles were delivered as planned. The diamond and chamber positions were offset by 1 cm from the film plane, so the isocenter was shifted accordingly to place the center of the target at the detector of interest. To ensure accurate detector placement, the phantom was positioned using kV images. To account for the shift-induced difference in geometry and differing prescription doses between plans, the measurements were normalized to the expected dose calculated by the treatment planning system. Results: The target sizes ranged from 2.8 mm to 34.8 mm (median 14.8 mm). The mean measurement-to-plan ratios were 1.054, 1.076, and 1.023 for RCF, diamond, and chamber, respectively. The mean difference between the chamber and film was −3.2% and between diamond and film was 2.2%. For targets larger than 15 mm, the mean difference relative to film was −0.8% and 0.1% for chamber and diamond, respectively, whereas for targets smaller than 15 mm, the difference was −5.3% and 4.2% for chamber and diamond, respectively. The difference was significant (p=0.005) using the two-sample Kolmogorov-Smirnov test. Conclusion: The detectors agree for target sizes larger than 15 mm. Relative to film, for smaller targets the diamond detector over-responds, whereas the ionization chamber under-responds. Further work is needed to characterize detector response in modulated SRS fields.

60 APPLIED LIFE SCIENCES↗

SU-F-T-629: Effect of Multi-Leaf Collimator (MLC) Width On Plan Quality of Single-Isocenter VMAT Intracranial Stereotactic Radiosurgery for Multiple Metastases

Purpose: Single-isocenter VMAT has been shown able to create high quality plans for complex intracranial multiple metastasis SRS cases. Linacs capable of the technique are typically outfitted with an MLC that consists of a combination of 5 mm and 10 mm leaves (standard) or 2.5 mm and 5 mm leaves (high-definition). In this study, we test the hypothesis that thinner collimator leaves are associated with improved plan quality. Methods: Ten multiple metastasis cases were identified and planned for VMAT SRS using a 10 MV flattening filter free beam. Plans were created for a standard (std) and a high-definition (HD) MLC. Published values for leaf transmission factor and dosimetric leaf gap were utilized. All other parameters were invariant. Conformity (plan and individual target), moderate isodose spill (V50%), and low isodose spill (mean brain dose) were selected for analysis. Results: Compared to standard MLC, HD-MLC improved overall plan conformity (median: Paddick CI-HD = 0.83, Paddick CI-std = 0.79; p = 0.004 and median: RTOG CI-HD =1.18, RTOG CI-std =1.24; p = 0.01 ), improved individual lesion conformity (median: Paddick CI-HD,i =0.77, Paddick CI-std,i =0.72; p < 0.001 and median: RTOG CI-HD,i = 1.28, RTOG CI-std,i =1.35; p < 0.001), improved moderate isodose spill (median: V50%-HD = 37.0 cc, V50%-std = 45.7 cc; p = 0.002), and improved low dose spill (median: dmean-HD = 2.90 Gy, dmean-std = 3.19 Gy; p = 0.002). Conclusion: For the single-isocenter VMAT SRS of multiple metastasis plans examined, use of HD-MLC modestly improved conformity, moderate isodose, and low isodose spill compared to standard MLC. However, in all cases we were able to generate clinically acceptable plans with the standard MLC. More work is need to further quantify the difference in cases with higher numbers of small targets and to better understand any potential clinical significance. This research was supported in part by Varian Medical Systems.

60 APPLIED LIFE SCIENCES↗

SU-F-T-645: To Test Spatial Anddosimetric Accuracy of Small Cranial Target Irradiation Based On 1.5 T MRIscans Using Static Arcs with MLCDefined Fields

Purpose: To test spatial and dosimetric accuracy of small cranial target irradiation based on 1.5 T MRI scans using static arcs with MLC-defined fields Methods: A plastic (PMMA) phantom simulating a small brain lesion was mounted on a GammaKnife headframe equipped with MRI localizer. The lesion was a 3 mm long, 3.175 mm diameter cylindrical cavity filled with MRI contrast. Radiochromic film passing through the cavity was marked with pin pricks at the cavity center. The cavity was contoured on an MRI image and fused with CT to simulate treatment of a lesion not visible on CT. The transfer of the target to CT involved registering the MRI contrast cannels of the localizer that were visible on both modalities. Treatments were planned to deliver 800 cGy to the cavity center using multiple static arcs with 5.0×2.4 mm MLC-defined fields. The phantom was aligned on a STx accelerator by registering the conebeam CT with the planning CT. Films from coronal and sagittal planes were scanned and evaluated using ImageJ software Results: Geographic errors in treatment based on 1.5 T scans agreed within 0.33, −0.27 and 1.21 mm in the vertical, lateral and longitudinal dimensions, respectively. The doses delivered to the cavity center were 7.2% higher than planned. The dose distributions were similar to those of a GammaKnife. Conclusion: Radiation can be delivered with an accelerator at mm accuracy to small cranial targets based on 1.5 MRI scans fused to CTs using a standard GammaKnife headframe and MRI localizer. MLC-defined static arcs produce isodose lines very similar to the GammaKnife.

60 APPLIED LIFE SCIENCES↗

SU-G-BRA-07: An Innovative Fiducial-Less Tracking Method for Radiation Treatment of Abdominal Tumors by Diaphragm Disparity Analysis

Purpose: To investigate the feasibility of tracking abdominal tumors without the use of gold fiducial markers Methods: In this simulation study, an abdominal 4DCT dataset, acquired previously and containing 8 phases of the breathing cycle, was used as the testing data. Two sets of DRR images (45 and 135 degrees) were generated for each phase. Three anatomical points along the lung-diaphragm interface on each of the Digital Reconstructed Radiograph(DRR) images were identified by cross-correlation. The gallbladder, which simulates the tumor, was contoured for each phase of the breathing cycle and the corresponding centroid values serve as the measured center of the tumor. A linear model was created to correlate the diaphragm’s disparity of the three identified anatomical points with the center of the tumor. To verify the established linear model, we sequentially removed one phase of the data (i.e., 3 anatomical points and the corresponding tumor center) and created new linear models with the remaining 7 phases. Then we substituted the eliminated phase data (disparities of the 3 anatomical points) into the corresponding model to compare model-generated tumor center and the measured tumor center. Results: The maximum difference between the modeled and the measured centroid values across the 8 phases were 0.72, 0.29 and 0.30 pixels in the x, y and z directions respectively, which yielded a maximum mean-squared-error value of 0.75 pixels. The outcomes of the verification process, by eliminating each phase, produced mean-squared-errors ranging from 0.41 to 1.28 pixels. Conclusion: Gold fiducial markers, requiring surgical procedures to be implanted, are conventionally used in radiation therapy. The present work shows the feasibility of a fiducial-less tracking method for localizing abdominal tumors. Through developed diaphragm disparity analysis, the established linear model was verified with clinically accepted errors. The tracking method in real time under different radiation therapy platforms will be further investigated.

60 APPLIED LIFE SCIENCES↗

WE-DE-201-08: Multi-Source Rotating Shield Brachytherapy Apparatus for Prostate Cancer

Purpose: To introduce a novel multi-source rotating shield brachytherapy (RSBT) apparatus for the precise simultaneous angular and linear positioning of all partially-shielded 153Gd radiation sources in interstitial needles for treating prostate cancer. The mechanism is designed to lower the detrimental dose to healthy tissues, the urethra in particular, relative to conventional high-dose-rate brachytherapy (HDR-BT) techniques. Methods: Following needle implantation, the delivery system is docked to the patient template. Each needle is coupled to a multi-source afterloader catheter by a connector passing through a shaft. The shafts are rotated by translating a moving template between two stationary templates. Shaft walls as well as moving template holes are threaded such that the resistive friction produced between the two parts exerts enough force on the shafts to bring about the rotation. Rotation of the shaft is then transmitted to the shielded source via several keys. Thus, shaft angular position is fully correlated with the position of the moving template. The catheter angles are simultaneously incremented throughout treatment as needed, and only a single 360° rotation of all catheters is needed for a full treatment. For each rotation angle, source depth in each needle is controlled by a multi-source afterloader, which is proposed as an array of belt-driven linear actuators, each of which drives a source wire. Results: Optimized treatment plans based on Monte Carlo dose calculations demonstrated RSBT with the proposed apparatus reduced urethral D{sub 1cc} below that of conventional HDR-BT by 35% for urethral dose gradient volume within 3 mm of the urethra surface. Treatment time to deliver 20 Gy with multi-source RSBT apparatus using nineteen 62.4 GBq {sup 153}Gd sources is 117 min. Conclusions: The proposed RSBT delivery apparatus in conjunction with multiple nitinol catheter-mounted platinum-shielded {sup 153}Gd sources enables a mechanically feasible urethra-sparing treatment technique for prostate cancer in a clinically reasonable timeframe.

60 APPLIED LIFE SCIENCES↗

SU-E-J-38: Improved DRR Image Quality Using Polyetheretherketone (PEEK) Fiducial in Image Guided Radiotherapy (IGRT)

Purpose Fiducial-based imaging is often used in IGRT. Traditional gold fiducial marker often has substantial reconstruction artifacts. These artifacts Result in poor image quality of DRR for online kV-to-DRR matching. This study evaluated the image quality of PEEK in DRR in static and moving phantom. Methods CT scan of the Gold and PEEK fiducial (both 1×3 mm) was acquired in a 22 cm cylindrical phantom filled with water. Image artifacts was evaluated with maximum CT value deviated from water due to artifacts; volume of artifacts in 10×10 cm in the center slice; maximum length of streak artifacts from the fiducial. DRR resolution were measured using FWHM and FWTM. 4DCT of PEEK fiducial was acquired with the phantom moving sinusoidally in superior-inferior direction. Motion artifacts were assessed for various 4D phase angles. Results The maximum CT value deviation was −174 for Gold and −24 for PEEK. The volume of artifacts in a 10x10 cm 3 mm slice was 0.369 for Gold and 0.074 cm3 for PEEK. The maximum length of streak artifact was 80mm for Gold and 7 mm for PEEK. PEEK in DRR, FWHM was close to actual (1.0 mm for Gold and 1.1 mm for PEEK). FWTM was 1.8 mm for Gold and 1.3 mm for PEEK in DRR. Barrel motion artifact of PEEK fiducial was noticeable for free-breathing scan. The apparent PEEK length due to residual motion was in close agreement with the calculated length (13 mm for 30–70 phase, 10 mm in 40–60 phase). Conclusion Streak artifacts on planning CT associated with use of gold fiducial can be significantly reduced by PEEK fiducial, while having adequate kV image contrast. DRR image resolution at FWTM was improved from 1.8 mm to 1.3 mm. Because of this improvement, we have been routinely use PEEK for liver IGRT.

60 APPLIED LIFE SCIENCES↗

SU-E-J-244: Development and Validation of a Knowledge Based Planning Model for External Beam Radiation Therapy of Locally Advanced Non-Small Cell Lung Cancer

Purpose: The study aims to develop and validate a knowledge based planning (KBP) model for external beam radiation therapy of locally advanced non-small cell lung cancer (LA-NSCLC). Methods: RapidPlan™ technology was used to develop a lung KBP model. Plans from 65 patients with LA-NSCLC were used to train the model. 25 patients were treated with VMAT, and the other patients were treated with IMRT. Organs-at-risk (OARs) included right lung, left lung, heart, esophagus, and spinal cord. DVH and geometric distribution DVH were extracted from the treated plans. The model was trained using principal component analysis and step-wise multiple regression. Box plot and regression plot tools were used to identify geometric outliers and dosimetry outliers and help fine-tune the model. The validation was performed by (a) comparing predicted DVH boundaries to actual DVHs of 63 patients and (b) using an independent set of treatment planning data. Results: 63 out of 65 plans were included in the final KBP model with PTV volume ranging from 102.5cc to 1450.2cc. Total treatment dose prescription varied from 50Gy to 70Gy based on institutional guidelines. One patient was excluded due to geometric outlier where 2.18cc of spinal cord was included in PTV. The other patient was excluded due to dosimetric outlier where the dose sparing to spinal cord was heavily enforced in the clinical plan. Target volume, OAR volume, OAR overlap volume percentage to target, and OAR out-of-field volume were included in the trained model. Lungs and heart had two principal component scores of GEDVH, whereas spinal cord and esophagus had three in the final model. Predicted DVH band (mean ±1 standard deviation) represented 66.2±3.6% of all DVHs. Conclusion: A KBP model was developed and validated for radiotherapy of LA-NSCLC in a commercial treatment planning system. The clinical implementation may improve the consistency of IMRT/VMAT planning.

60 APPLIED LIFE SCIENCES↗

SU-E-T-291: Dosimetric Accuracy of Multitarget Single Isocenter Radiosurgery

Purpose: To evaluate the accuracy of single-isocenter multiple-target VMAT radiosurgery (SIMT-VMAT-SRS) by analysis of pre-treatment verification measurements. Methods: Our QA procedure used a phantom having a coronal plane for EDR2 film and a 0.125 cm3 ionization chamber. Film measurements were obtained for the largest and smallest targets for each plan. An ionization chamber measurement (ICM) was obtained for sufficiently large targets. Films were converted to dose using a patient-specific calibration curve and compared to treatment planning system calculations. Alignment error was estimated using image registration. The gamma index was calculated for 3%/3 and 3%/1 mm criteria. The median dose in the target region and, for plans having an ICM, the average dose in the central 5 mm was calculated. Results: The average equivalent target diameter of the 48 targets was 15 mm (3–43 mm). Twenty of the 24 plans had an ICM for the plan corresponding to the largest target (diameter 11–43 mm) with a mean ratio of chamber reading to expected dose (ED) and the mean ratio of film to ED (averaged over the central 5 mm) was 1.001 (0.025 SD) and 1.000 (0.029 SD), respectively. For all plans, the mean film to ED (from the median dose in the target region) was 0.997 (0.027 SD). The mean registration vector was (0.15,0.29) mm, with an average magnitude of 0.96 mm. Before (after) registration, the average fraction of pixels having gamma < 1 was 99.3% (99.6%) and 89.1% (97.6%) for 3%/3mm and 3%/1mm, respectively. Conclusion: Our results demonstrate dosimetric accuracy of SIMT-VMAT-SRS for targets as small as 3 mm. Film dosimetry provides accurate assessment of the absolute dose delivered to targets too small for an ionization chamber measurement; however, the relatively large registration vector indicates that image-guidance should replace laser-based setup for patient-specific evaluation of geometric accuracy.

60 APPLIED LIFE SCIENCES↗

SU-E-T-345: Effect of DLG and MLC Transmission Value Set in the Treatment Planning System (TPS) On Dosimetric Accuracy of True Beam Hypofractionated SRT/SBRT and 2Gy/fx Prostate Rapid Arc Plans

Purpose: Due to limited commissioning time, we previously only released our True beam non-FFF mode for prostate treatment. Clinical demand now pushes us to release the non-FFF mode for SRT/SBRT treatment. When re-planning on True beam previously treated SRT/SBRT cases on iX machine we found the patient specific QA pass rate was worse than iX’s, though the 2Gy/fx prostate Result had been as good. We hypothesize that in TPS the True beam DLG and MLC transmission values, of those measured during commissioning could not yet provide accurate SRS/SBRT dosimetry. Hence this work is to investigate how the TPS DLG and transmission value affects Rapid Arc plans’ dosimetric accuracy. Methods: We increased DLG and transmission value of True beam in TPS such that their percentage differences against the measured matched those of iX’s. We re-calculated 2 SRT, 1 SBRT and 2 prostate plans, performed patient specific QA on these new plans and compared the results to the previous. Results: With DLG and transmission value set respectively 40 and 8% higher than the measured, the patient specific QA pass rate (at 3%/3mm) improved from 95.0 to 97.6% vs previous iX’s 97.8% in the case of SRT. In the case of SBRT, the pass rate improved from 75.2 to 93.9% vs previous iX’s 92.5%. In the case of prostate, the pass rate improved from 99.3 to 100%. The maximum dose difference in plans before and after adjusting DLG and transmission was approximately 1% of the prescription dose among all plans. Conclusion: The impact of adjusting DLG and transmission value on dosimetry might be the same among all Rapid Arc plans regardless hypofractionated or not. The large variation observed in patient specific QA pass rate might be due to the data analysis method in the QA software being more sensitive to hypofractionated plans.

60 APPLIED LIFE SCIENCES↗

SU-E-T-453: Image-Guided Patient-Specific Quality Assurance for Multi-Target Single Isocenter Intracranial VMAT Radiosurgery

Purpose: To demonstrate a patient specific, image-guided quality assurance method that tests both dosimetric and geometric accuracy for single-isocenter multiple-target VMAT radiosurgery (SIMT-VMAT-SRS) Method: We used a new film type, EBT-XD (optimal range 0.4–40Gy), and an in-house PMMA phantom having a coronal plane for film and a 0.125 cm3 ionization chamber (IC). The phantom contained fiducial features for kV image guided setup and for accurate film marking. Five patient plans with multiple targets sizes ranging from 3 to 21mm in diameter and prescribed doses from 14 to 18 Gy were selected. Two verification plans were generated for each case with the film plane passing through the center of the largest and smallest targets. For the four largest targets we obtained an IC measurement. For each case, a calibration film was irradiated using a custom designed step pattern. The films were scanned using a flatbed color scanner and converted to dose using the calibration film and the three channel calibration method. Image registration was performed between film and treatment planning system calculations to evaluate the geometric accuracy. Results: The mean registration vector had an average magnitude of 0.47 mm (range from 0.13mm to 0.64 mm). For the four largest targets, the mean ratio of the IC and film measurement to expected dose was 0.990 (range 0.968 to 1.009) and 1.032 (1.021 to 1.046), respectively. The fraction of pixels having gamma index < 1 for criteria of 3%/3mm, 3%/2mm, 3%/1mm was 98.8%, 97.5% and 87.2% before geometric registration and 99.1%, 98.3% and 94.8% after registration. Conclusion: We have demonstrated an image-guided QA method can assess both geometric and dosimetric accuracy. The phantom was positioned with sub-millimeter accuracy. Absolute film dosimetry using EBT-XD film was sufficiently accurate for assessment of dose to multi-targets too small for IC measurement in SRS VMAT plans.

60 APPLIED LIFE SCIENCES↗

SU-E-T-564: Multi-Helix Rotating Shield Brachytherapy for Cervical Cancer

Purpose: To present a novel and practical brachytherapy technique, called multi-helix rotating shield brachytherapy (H-RSBT), for the precise positioning of a partial shield in a curved applicator. H-RSBT enables RSBT delivery using only translational motion of the radiation source/shield combination. H-RSBT overcomes the challenges associated with previously proposed RSBT approaches based on a serial (S-RSBT) step-and-shoot delivery technique, which required independent translational and rotational motion. Methods: A Fletcher-type applicator, compatible with the combination of a Xoft Axxent™ electronic brachytherapy source and a 0.5 mm thick tungsten shield, is proposed. The wall of the applicator contains six evenly-spaced helical keyways that rigidly define the emission direction of the shield as a function of depth. The shield contains three protruding keys and is attached to the source such that it rotates freely. S-RSBT and H-RSBT treatment plans with 180° and 45° azimuthal emission angles were generated for five cervical cancer patients representative of a wide range of high-risk clinical target volume (HR-CTV) shapes and applicator positions. The number of beamlets used in the treatment planning process was nearly constant for S-RSBT and H-RSBT by using dwell positions separated by 5 and 1.7 mm, respectively, and emission directions separated by 22.5° and 60°, respectively. For all the treatment plans the EQD2 of the HR-CTV was escalated until the EQD{sub 2cc} tolerance of either the bladder, rectum, or sigmoid colon was reached. Results: Treatment times for H-RSBT tended to be shorter than for S-RSBT, with changes of −38.47% to 1.12% with an average of −8.34%. The HR-CTV D{sub 90} changed by −8.81% to 2.08% with an average of −2.46%. Conclusion: H-RSBT is a mechanically feasible technique in the curved applicators needed for cervical cancer brachytherapy. S-RSBT and H-RSBT dose distributions were clinically equivalent for all patients considered, with the H-RSBT deliveries tending to be faster. Ryan Flynn has ownership interest in pxAlpha, LLC, which is a startup company developing a rotating shield brachytherapy system.

62 RADIOLOGY AND NUCLEAR MEDICINE↗