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All sourcesNASA NTRSDOE OSTI
DOE OSTI2016

SU-G-BRC-06: Evaluation of a Novel Radiosurgery Software for Treating Multiple Brain Metastases Simultaneously in a Single Fraction

Purpose: To evaluate a new, automated brain metastases planning software designed to treat up to ten brain metastases simultaneously. Methods: We treated 61 patients with multiple brain metastases using the Elements software by BrainLab (Munich, Germany). Patients had between 2–10 metastases ranging from 0.01–8.64 cc. Dose prescription was 18–24 Gy. Plans use up to 5 non-coplanar arcs with a single isocenter at the metastases’ center of mass. The high degree of automation shortens the planning time to 15–20 minutes per patient.For comparison we planned 21 of the patients using Rapid Arc (Varian, Palo Alto CA) (RA). We used two coplanar arcs so as to keep planning times comparable to the Elements. We also planned 8 patients using iPlan software (BrainLab). We compared conformity index (CI), volume of brain receiving over 12 Gy (V{sub 12}) and mean brain dose (MBD) for the three different planning systems (TPSs). Results: Plans from all TPSs were judged clinically acceptable. V{sub 12} and MBD were not statistically significantly different between TPSs.CI between RA and Elements was similar, however for iPlan CI was significantly worse compared to both RA and Elements (p<0.001). RA plans took approximately 40 minutes to plan (despite fusion and contouring being done in the Elements), and iPlan plans over an hour each. Delivery times were approximately 30 minutes for Elements, 10 minutes for RA, and up to 300 minutes for iPlan. Conclusion: Elements plans had good CI values and low brain doses. While treatment times for Elements were longer than for RA, 30 minutes is a significant improvement over conventional radiosurgery techniques where each metastasis is treated individually and delivery times to 10 metastases are close to 300 minutes.BrainLab Elements is a novel software allowing fast, automated planning and efficient irradiation of multiple brain metastases with minimal dose to healthy brain.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

Organ and effective dose coefficients for cranial and caudal irradiation geometries: Neutrons

Dose coefficients based on the recommendations of International Commission on Radiological Protection (ICRP) Publication 103 were reported in ICRP Publication 116, the revision of ICRP Publication 74 and ICRU Publication 57 for the six reference irradiation geometries: anterior–posterior, posterior–anterior, right and left lateral, rotational and isotropic. In this work, dose coefficients for neutron irradiation of the body with parallel beams directed upward from below the feet (caudal) and downward from above the head (cranial) using the ICRP 103 methodology were computed using the MCNP 6.1 radiation transport code. The dose coefficients were determined for neutrons ranging in energy from 10 –9 MeV to 10 GeV. Here, at energies below about 500 MeV, the cranial and caudal dose coefficients are less than those for the six reference geometries reported in ICRP Publication 116.

61 RADIATION PROTECTION AND DOSIMETRY↗
DOE OSTI2013

Analysis Approach and Data Package for Mayak Public Doses: Data Supporting the Calculation of Representative Doses to Members of the Public from Airborne Releases of 131 I at the Mayak Production Association from 1948 through 1972

Historical activities at facilities producing nuclear materials for weapons released radioactivity into the air and water. Past studies in the United States have evaluated the release, atmospheric transport and environmental accumulation of 131 I from the nuclear facilities at Hanford in Washington State and the resulting dose to members of the public (Farris et al. 1994). A multi-year dose reconstruction effort (Mokrov et al. 2004) is also being conducted to produce representative dose estimates for members of the public living near Mayak, Russia, from atmospheric releases of 131 I at the facilities of the Mayak Production Association. The approach to calculating individual doses to members of the public from historical releases of airborne 131 I has the following general steps: • Construct estimates of releases 131 I to the air from production facilities. • Model the transport of 131 I in the air and subsequent deposition on the ground and vegetation. • Model the accumulation of 131 I in soil, water and food products (environmental media). • Calculate the dose for an individual by matching the appropriate lifestyle and consumption data for the individual to the concentrations of 131 I in environmental media at their residence location. A number of computer codes were developed to facilitate the study of airborne 131 I emissions at Hanford. Of particular interest is DESCARTES code that modeled accumulation of 131 I in environmental media (Miley et al. 1994). In addition, the CIDER computer code estimated annual doses to individuals (Eslinger et al. 1994) using the equations and parameters specific to Hanford (Snyder et al. 1994). Several of the computer codes developed to model 131 I releases from Hanford are general enough to be used for other facilities. Additional codes have been developed, including the new individual dose code CiderF (Eslinger and Napier 2013), and applied to historical releases of 131 I from Mayak. This document provides a data package that identifies computer code runs and associated input and output files prepared for the purpose of calculating doses to members of the public from atmospheric releases of 131 I at the Mayak Production Association for the time period 1948 through 1972.

Mayak↗
DOE OSTI2015

SU-F-303-15: Ion Chamber Dose Response in Magnetic Fields as a Function of Incident Photon Energy

Purpose: In considering the continued development of synergetic MRI-radiation therapy machines, we seek to quantify the variability of ion chamber response per unit dose in the presence of magnetic fields of varying strength as a function of incident photon beam quality and geometric configuration. Methods: To account for the effect of magnetic fields on the trajectory of charged particles a new algorithm was introduced into the EGSnrc Monte Carlo code. In the egs-chamber user code the dose to the cavity of an NE2571 ion chamber is calculated in two configurations, in 0 to 2 T magnetic fields, with an incoming parallel 10×10 cm{sup 2} photon beam with energies ranging between 0.5 MeV and 8 MeV. In the first, the photon beam is incident on the long-axis of the ion chamber (config-1), and in the second the beam is parallel to the long-axis and incident from the conical end of the chamber (config-2). For both, the magnetic field is perpendicular to the direction of the beam and the long axis of the chamber. Results: The ion chamber response per unit dose to water at the same point is determined as a function of magnetic field and is normalized to the 0T case for each of incoming photon energies. For both configurations, accurate modeling of the ion chamber yielded closer agreement with the experimental results obtained by Meijsing et. al (2009). Config-1 yields a gradual increase in response with increasing field strength to a maximum of 13.4% and 1.4% for 1 MeV and 8 MeV photon beams, respectively. Config-2 produced a decrease in response of up to 6% and 13% for 0.5 MeV and 8 MeV beams, respectively. Conclusion: These results provide further support for ion chamber calibration in MRI-radiotherapy coupled systems and demonstrates noticeable energy dependence for clinically relevant fields.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2012

Investigating the dosimetric and tumor control consequences of prostate seed loss and migration

Purpose: Low dose-rate brachytherapy is commonly used to treat prostate cancer. However, once implanted, the seeds are vulnerable to loss and movement. The goal of this work is to investigate the dosimetric and radiobiological effects of the types of seed loss and migration commonly seen in prostate brachytherapy. Methods: Five patients were used in this study. For each patient three treatment plans were created using Iodine-125, Palladium-103, and Cesium-131 seeds. The three seeds that were closest to the urethra were identified and modeled as the seeds lost through the urethra. The three seeds closest to the exterior of prostatic capsule were identified and modeled as those lost from the prostate periphery. The seed locations and organ contours were exported from Prowess and used by in-house software to perform the dosimetric and radiobiological evaluation. Seed loss was simulated by simultaneously removing 1, 2, or 3 seeds near the urethra 0, 2, or 4 days after the implant or removing seeds near the exterior of the prostate 14, 21, or 28 days after the implant. Results: Loss of one, two or three seeds through the urethra results in a D{sub 90} reduction of 2%, 5%, and 7% loss, respectively. Due to delayed loss of peripheral seeds, the dosimetric effects are less severe than for loss through the urethra. However, while the dose reduction is modest for multiple lost seeds, the reduction in tumor control probability was minimal. Conclusions: The goal of this work was to investigate the dosimetric and radiobiological effects of the types of seed loss and migration commonly seen in prostate brachytherapy. The results presented show that loss of multiple seeds can cause a substantial reduction of D{sub 90} coverage. However, for the patients in this study the dose reduction was not seen to reduce tumor control probability.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2010

Dose mapping of the rectal wall during brachytherapy with an array of scintillation dosimeters

Purpose: In pelvic brachytherapy treatments, the rectum is an organ at risk. The authors have developed an array of scintillation dosimeters suitable for in vivo use that enables quality assurance of the treatment delivery and provides an alert to potential radiation accidents. Ultimately, this will provide evidence to direct treatment planning and dose escalation and correlate dose with the rectal response. Methods: An array of 16 scintillation dosimeters in an insertable applicator has been developed. The dosimeters were calibrated simultaneously in a custom designed circular jig before use. Each dosimeter is optically interfaced to a set of pixels on a CCD camera located outside the treatment bunker. A customized software converts pixel values into dose rate and accumulates dose for presentation during treatment delivery. The performance of the array is tested by simulating brachytherapy treatments in a water phantom. The treatment plans were designed to deliver a known dose distribution on the surface of the rectal applicator, assumed to represent the dose to the rectal wall. Results: The measured doses were compared to those predicted by the treatment plan and found to be in agreement to within the uncertainty in measurement, usually within 3%. The array was also used to track the progression of the source as it moved along the catheter. The measured position was found to agree with the position reported by the afterloader to within the measurement uncertainty, usually within 2 mm. Conclusions: This array is capable of measuring the actual dose received by each region of the rectal wall during brachytherapy treatments. It will provide real time monitoring of treatment delivery and raise an alert to a potential radiation accident. Real time dose mapping in the clinical environment will give the clinician additional confidence to carry out dose escalation to the tumor volume while avoiding rectal side effects.

61 RADIATION PROTECTION AND DOSIMETRY↗
DOE OSTI2016

SU-F-T-559: High-Resolution Scintillating Fiber Array for In-Vivo Real-Time SRS and SBRT Patient QA

Purpose: A high-resolution scintillating fiber detector was built for in-vivo real-time patient specific quality assurance (QA). The detector is designed for stereotactic body radiotherapy (SBRT) and stereotactic radiosurgery (SRS) to monitor treatment delivery and detect real-time deviations from planned dose to increase patient safety and treatment accuracy. Methods: The detector consists of two high-density scintillating fiber arrays layered to form an X-Y grid which can be attached to the accessory tray of a medical linac for SBRT and cone SRS treatment QA. Fiber arrays consist of 128 scintillating fibers embedded within a precision-machined, high-transmission polymer substrate with 0.8mm pitch. The fibers are coupled on both ends to high-sensitivity photodetectors and the output is recorded through a high-speed analog-to-digital converter to capture the linac pulse sequence as treatment delivery progresses. The detector has a software controlled 360 degree rotational system to capture angular beam projections for high-resolution beam profile reconstruction. Results: The detector was validated using SRS cone sizes from 6mm to 34mm and MLC defined field sizes from 5×5mm2 to 100×100mm2. The detector output response is linear with dose and is dose rate independent. Each field can be reconstructed accurately with a spatial resolution of 0.8mm and the current beam output is displayed every 50msec. Dosimetric errors of 1% with respect to the treatment plan can be identified and clinically significant deviations from the expected treatment can be displayed in real-time to alert the therapists. Conclusion: The high resolution detector is capable of reconstructing beam profiles in real-time with submillimeter resolution and 1% dose resolution. This system has the ability to project in-vivo both spatial and dosimetric errors during SBRT and SRS treatments when only a non-clinically significant fraction of the intended dose was delivered. The device has the potential to establish new standards for in-vivo patient specific QA.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2013

Characterization of a novel 2D array dosimeter for patient-specific quality assurance with volumetric arc therapy

Purpose: In this study, the authors are evaluating a new, commercially available 2D array that offers 3D dose reconstruction for patient specific intensity modulated radiation therapy quality assurance (IMRT QA).Methods: The OCTAVIUS 4D system and its accompanying software (VERISOFT) by PTW were evaluated for the accuracy of the dose reconstruction for patient specific pretreatment IMRT QA. OCTAVIUS 4D measures the dose plane at the linac isocenter as the phantom rotates synchronously with the gantry, maintaining perpendicularity with the beam, by means of an inclinometer and a motor. The measurements collected during a volumetric modulated arc therapy delivery (VMAT) are reconstructed into a 3D dose volume. The VERISOFT application is used to perform the analysis, by comparing the reconstructed dose against the 3D dose matrix from the treatment planning system (TPS) that is computed for the same geometry and beam arrangement as that of the measurement. In this study, the authors evaluated the 3D dose reconstruction algorithm of this new system using a series of tests. Using the Octavius 4D phantom as the patient, dose distributions for various field sizes, beam orientations, shapes, and combination of fields were calculated using the Pinnacle3, TPS, and the respective DICOMRT dose was exported to the VERISOFT analysis software. Measurements were obtained by delivering the test treatment plans and comparisons were made based on gamma index, dose profiles, and isodose distribution analysis. In addition, output factors were measured and the dose linearity of the array was assessed. Those measurements were compared against measurements in water using a single, calibrated ionization chamber as well as calculations from Pinnacle for the same delivery geometries.Results: The number of voxels that met the 3%/3 mm criteria for the volumetric 3D gamma index analysis ranged from 92.3% to 98.9% for all the patient plans that the authors evaluated. 2D gamma analysis in the axial, sagittal, and coronal planes produced similar results to those in the 3D gamma analysis. The new detector system does not require an angular dependence correction because it rotates in synchrony with the gantry and the detector array maintains a constant SAD while always perpendicular to the beam axis. Output factors were within 2% when compared to ionization chamber measurements and Pinnacle calculations. Similar agreement was observed when testing the MU linearity (for MU values above 2) as well as dose rate effect.Conclusions: The OCTAVIUS 4D system has some unique characteristics that can potentially improve the patient specific pretreatment IMRT QA data collection and analysis. The ability of the software to reconstruct from the measurements the true 3D dose distribution in the phantom, provides a unique perspective for the medical physicist that evaluates a patient's QA plan.

61 RADIATION PROTECTION AND DOSIMETRY↗
DOE OSTI2010

Sensitivity of low energy brachytherapy Monte Carlo dose calculations to uncertainties in human tissue composition

Purpose: The objective of this work is to assess the sensitivity of Monte Carlo (MC) dose calculations to uncertainties in human tissue composition for a range of low photon energy brachytherapy sources: {sup 125}I, {sup 103}Pd, {sup 131}Cs, and an electronic brachytherapy source (EBS). The low energy photons emitted by these sources make the dosimetry sensitive to variations in tissue atomic number due to the dominance of the photoelectric effect. This work reports dose to a small mass of water in medium D{sub w,m} as opposed to dose to a small mass of medium in medium D{sub m,m}. Methods: Mean adipose, mammary gland, and breast tissues (as uniform mixture of the aforementioned tissues) are investigated as well as compositions corresponding to one standard deviation from the mean. Prostate mean compositions from three different literature sources are also investigated. Three sets of MC simulations are performed with the GEANT4 code: (1) Dose calculations for idealized TG-43-like spherical geometries using point sources. Radial dose profiles obtained in different media are compared to assess the influence of compositional uncertainties. (2) Dose calculations for four clinical prostate LDR brachytherapy permanent seed implants using {sup 125}I seeds (Model 2301, Best Medical, Springfield, VA). The effect of varying the prostate composition in the planning target volume (PTV) is investigated by comparing PTV D{sub 90} values. (3) Dose calculations for four clinical breast LDR brachytherapy permanent seed implants using {sup 103}Pd seeds (Model 2335, Best Medical). The effects of varying the adipose/gland ratio in the PTV and of varying the elemental composition of adipose and gland within one standard deviation of the assumed mean composition are investigated by comparing PTV D{sub 90} values. For (2) and (3), the influence of using the mass density from CT scans instead of unit mass density is also assessed. Results: Results from simulation (1) show that variations in the mean compositions of tissues affect low energy brachytherapy dosimetry. Dose differences between mean and one standard deviation of the mean composition increasing with distance from the source are observed. It is established that the {sup 125}I and {sup 131}Cs sources are the least sensitive to variations in elemental compositions while {sup 103}Pd is most sensitive. The EBS falls in between and exhibits complex behavior due to significant spectral hardening. Results from simulation (2) show that two prostate compositions are dosimetrically equivalent to water while the third shows D{sub 90} differences of up to 4%. Results from simulation (3) show that breast is more sensitive than prostate with dose variations of up to 30% from water for 70% adipose/30% gland breast. The variability of the breast composition adds a {+-}10% dose variation. Conclusions: Low energy brachytherapy dose distributions in tissue differ from water and are influenced by density, mean tissue composition, and patient-to-patient composition variations. The results support the use of a dose calculation algorithm accounting for heterogeneities such as MC. Since this work shows that variations in mean tissue compositions affect MC dosimetry and result in increased dose uncertainties, the authors conclude that imaging tools providing more accurate estimates of elemental compositions such as dual energy CT would be beneficial.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-250: Determining VMAT Machine Limitations of An Elekta Linear Accelerator with Agility MLC for Accurate Modeling in RayStation and Robust Delivery

Purpose: To implement VMAT in RayStation with the Elekta Synergy linac with the new Agility MLC, and to utilize the same vendor softwares to determine the optimum Elekta VMAT machine parameters in RayStation for accurate modeling and robust delivery. Methods: iCOMCat is utilized to create various beam patterns with user defined dose rate, gantry, MLC and jaw speed for each control point. The accuracy and stability of the output and beam profile are qualified for each isolated functional component of VMAT delivery using ion chamber and Profiler2 with isocentric mounting fixture. Service graphing on linac console is used to verify the mechanical motion accuracy. The determined optimum Elekta VMAT machine parameters were configured in RayStation v4.5.1. To evaluate the system overall performance, TG-119 test cases and nine retrospective VMAT patients were planned on RayStation, and validated using both ArcCHECK (with plug and ion chamber) and MapCHECK2. Results: Machine output and profile varies <0.3% when only variable is dose rate (35MU/min-600MU/min). <0.9% output and <0.3% profile variation are observed with additional gantry motion (0.53deg/s–5.8deg/s both directions). The output and profile variation are still <1% with additional slow leaf motion (<1.5cm/s both direction). However, the profile becomes less symmetric, and >1.5% output and 7% profile deviation is seen with >2.5cm/s leaf motion. All clinical cases achieved comparable plan quality as treated IMRT plans. The gamma passing rate is 99.5±0.5% on ArcCheck (<3% iso center dose deviation) and 99.1±0.8% on MapCheck2 using 3%/3mm gamma (10% lower threshold). Mechanical motion accuracy in all VMAT deliveries is <1°/1mm. Conclusion: Accurate RayStation modeling and robust VMAT delivery is achievable on Elekta Agility for <2.5cm/s leaf motion and full range of dose rate and gantry speed determined by the same vendor softwares. Our TG-119 and patient results have provided us with the confidence to use VMAT clinically.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-J-269: Assessing the Precision of Dose Delivery in CBCT-Guided Stereotactic Body Radiation Therapy for Lung and Soft Tissue Metastatic Lesions

Purpose: Ensuring reproducibility of target localization is critical to accurate stereotactic body radiation treatment (SBRT) for lung and soft tissue metastatic lesions. To characterize interfraction variability in set-up and evaluate PTV margins utilized for SBRT, daily CBCTs were used to calculate delivered target and OAR doses compared to those expected from planning. Methods: CBCT images obtained prior to each fraction of SBRT for a lung and thyroid metastatic lesion were evaluated. The target CTV/ITV and OARs on each of 8 CBCT data sets were contoured. Using MIM fusion software and Pinnacle{sup 3} RTP system, delivered dose distribution was reconstructed on each CBCT, utilizing translational shifts performed prior to treatment. Actual delivered vs. expected doses received by target CTV/ITV and adjacent critical structures were compared to characterize accuracy of pre-treatment translational shifts and PTV margins. Results: The planned CTV/ITV D95% and V100% were 4595cGy and 91.47% for the lung lesion, and 3010cGy and 96.34% for the thyroid lesion. Based on CBCT analysis, actual mean D95% and V100% for lung ITV were 4542±344.4cGy and 91.54±3.45%; actual mean D95% and V100% for thyroid metastasis CTV were 3005±25.98cGy and 95.20±2.522%. For the lung lesion, ipsilateral lung V20, heart V32 (cc) and spinal cord (.03 cc) max were 110.15cc, 3.33cc, and 1680cGy vs. 110.27±14.79cc, 6.74±3.76cc, and 1711±46.56cGy for planned vs. delivered doses, respectively. For the thyroid metastatic lesion, esophagus V18, trachea (.03 cc) max, and spinal cord (.03 cc) max were 0.35cc, 2555cGy, and 850cGy vs. 0.16±0.13cc, 2147±367cGy, and 838±45cGy for planned vs. delivered treatments, respectively. Conclusion: Minimal variability in SBRT target lesion dose delivered based on pre-treatment CBCT-based translational shifts suggests tighter PTV margins may be considered to further decrease dose to surrounding critical structures. Guidelines for optimal target alignment during CBCT-guidance for lung and soft tissue metastatic lesions treated with SBRT are being established.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-G-IeP4-05: Experience with a Practical Approach to the Release of Radioactive Patients from Radiation Safety Isolation

Purpose: The radioactive patient releases of the nuclear medicine department in a large cancer center were analyzed to compare the estimated doses to others to the regulatory limit and institutional targets and to gauge how onerous the patients’ instructions were. Methods: In-house software that implements the NUREG 1556 approach and further considers fellow travelers, children and pregnant women and members of the public following Siegel, et al., is used to calculate release timing and to provide patients with individualized instructions. A retrospective analysis of the 218 releases in 2015 that required instructions included all I-131 and Lu-177 treatments. Results: There were 87 male and 131 female patients. They were 45.5±16.5 (8-84) years old, weighed 83.3±21.8 kg and stood 168±10 cm tall with a body mass index of 29.3±6.7 kg/m2. 195 patients received 2.96±2.23 GBq of I-131-NaI for differentiated thyroid carcinoma and eight received 636±231 MBq of I-131-NaI for hyperthyroidism. There were eight administrations of 18.5 GBq of I-131-mIBG and seven administrations of 7.4 GBq of Lu-177-DOTATATE. The dose to the most exposed person was 1.67±1.05 (mode=0.60, median=1.15) mSv. The dose to a fellow traveler was 0.31±0.31 (mode=0.1, median=0.17) mSv. The dose to children and pregnant women was 0.51±0.34 (mode=1.0, median=0.42) mSv. The duration of isolation was 7.7±17.3 (mode=2, median=1.7) hours. The duration of sleeping alone was 60.4±127 (mode=0, median=15.5) hours. The time to delay traveling was 12.2±11 (mode=median=0) hours. The time to completely avoid children and pregnant women was 23.3±26.5 (0–254, mode=median=24) hours followed by limited contact for 20.6±68.1 (0–491, mode=median=0) hours. The time to avoid others (e.g., to wait to return to work) was 12.1±101 (0–1465, mode=median=0) hours. Conclusion: The estimated doses to others were often well below the limits set by regulation, 5 mSv, or prudent practice, 1 mSv. Most patients’ instructions were not hard to comply with.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2018

Comparison of neutron organ and effective dose coefficients for PIMAL stylized phantom in bent postures in standard irradiation geometries

Neutron dose coefficients for standard irradiation geometries have been reported in International Commission on Radiological Protection (ICRP) Publication 116 for the ICRP Publication 110 adult reference phantoms. In the present paper, organ and effective dose coefficients have been calculated for a receptor in both upright and articulated (bent) postures representing more realistic working postures exposed to a mono-energetic neutron radiation field. This work builds upon prior work by Dewji and co-workers comparing upright and bent postures for exposure to mono-energetic photon fields. Simulations were conducted using the Oak Ridge National Laboratory’s articulated stylized adult phantom, “Phantom wIth Moving Arms and Legs” (PIMAL) software package, and the Monte Carlo N-Particle (MCNP) version 6.1.1 radiation transport code. Organ doses were compared for the upright and bent (45° and 90°) phantom postures for neutron energies ranging from 1 × 10 -9 to 20 MeV for the ICRP Publication 116 external exposure geometries—antero-posterior (AP), postero-anterior (PA), and left and right lateral (LLAT, RLAT). Using both male and female phantoms, effective dose coefficients were computed using ICRP Publication 103 methodology. The resulting coefficients for articulated phantoms were compared to those of the upright phantom. Computed organ and effective dose coefficients are discussed as a function of neutron energy, phantom posture, and source irradiation geometry. For example, it is shown here that for the AP and PA irradiation geometries, the differences in the organ coefficients between the upright and bent posture become more pronounced with increasing bending angle. In the AP geometry, the brain dose coefficients are expectedly higher in the bent postures than in the upright posture, while all other organs have lower dose coefficients, with the thyroid showing the greatest difference. Finally and overall, the effective dose estimated for the upright phantom is more conservative than that for the articulated phantom, which may have ramifications in the estimation or reconstruction of radiation doses.

61 RADIATION PROTECTION AND DOSIMETRY↗
DOE OSTI2014

SU-C-18C-04: Evaluation of Effective Dose During Ureteroscopy for Obese and Non-Obese Patients

Purpose: Ureteroscopy involves fluoroscopy which potentially results in considerable amount of radiation dose to the patient. Purpose of this study was two-fold: (a) to develop the effective dose computational model for obese and non-obese patients undergoing left and right ureteroscopy, and (b) to evaluate the utility of a commercial Monte Carlo software for dose assessment in ureteroscopy. Methods: Organ dose measurements were performed on an adult male anthropomorphic phantom, representing the non-obese patients, with 20 high-sensitivity MOSFET detectors and two 0.18cc ionization chambers placed in selected organs. Fat-equivalent paddings were placed around the abdominal region to simulate for obese patients. Effective dose (ED) was calculated using ICRP 103 tissue weighting factors and normalized to the effective dose rate in miliSivert per second (mSv/s). In addition, a commercial Monte Carlo (MC) dose estimation program was used to estimate ED for the non-obese model, with table attenuation correction applied to simulate clinical procedure. Results: For the equipment and protocols involved in this study, the MOSFETderived ED rates for the obese patient model (‘Left’: 0.0092±0.0004 mSv/s; ‘Right’: 0.0086±0.0004 mSv/s) was found to be more than twice as much as that to the non-obese patient model (‘Left’: 0.0041±0.0003 mSv/s; ‘Right’: 0.0036±0.0007 mSv/s). The MC-derived ED rates for the non-obese patient model (‘Left’: 0.0041 mSv/s; ‘Right’: 0.0036 mSv/s; with statistical uncertainty of 1%) showed a good agreement with the MOSFET method. Conclusion: The significant difference in ED rate between the obese and non-obese patient models shows the limitation of directly applying commercial softwares for obese patients and leading to considerable underestimation of ED. Although commercial softwares offer a convenient means of dose estimation, but the utility may be limited to standard-man geometry as the software does not account for table attenuation, obese patient geometry, and differences between the anthropomorphic phantom and MC mathematical phantom.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-P-55: The Reaserch of Cervical Cancer Delivered with Constant Dose Rate and Gantry Speed Arc Therapy(CDR-CAS-IMAT) On Conventional Linac

Purpose: Postoperative cervical cancer patients with large target volume and the target shape is concave, treatmented with static intensity-modulated radiotherapy (IMRT) is time consuming. The purpose of this study is to investigate using constant dose rate and gantry speed arc therapy(CDR-CAS-IMAT) on conventional linear accelrator, by comparing with the IMRT technology to evaluate the performance of CDR-CAS-IMAT on postoperative cervical cancer patients. Methods: 18 cervical cancer patients treated with IMRT on Varian 23IX were replanted using CDR-CAS-IMAT. The plans were generated on Oncentra v4.1 planning system, PTV was prescribed to 50.4 Gy in 28 fractions. Plans were evaluated based on the ability to meet the dose volume histogram. The homogeneity index (HI), conformity index (CI) of target volume, the dose of organs at risk, radiation delivery time and monitor units were also compared. SPSS 19.0 software paired T-test analysis was carried out on the two sets of data. Results: Compared with the IMRT plans PTV’s CI (t= 3.85, P =0.001), CTV’s CI, HI, D90, D95, D98, V95, V98, V100 (t=4.21, −3.18, 2.13, 4.65, 7.79, 2.29, 6.00, 2.13, p=0.001, 0.005, 0.049, 0.000, 0.000, 0.035, 0.000, 0.049), and cord D2 and rectum V40 (t=−2.65, −2.47, p= P =0.017, 0.025), and treatment time and MU (t=−36.0, −6.26, P =0.000, 0.000) were better than that of IMRT group. But the IMRT plans in terms of decreasing bladder V50, bowel V30 (t=2.14, 3.00, P =0.048, 0.008) and low dose irradiation volume were superior to that of CDR-CAS-IMAT plans. There were no significant differences in other statistical index. Conclusion: Cervical cancer patients with CDR-CAS-IMAT on Varian Clinical 23IX can get equivalent or superior dose distribution compared with the IMRT technology. IMAT have much less treatment time and MU can reduce the uncertainty factor and patient discomfort in treatment. This work was supported by the Medical Science Foundation of the health department of Hebei Province (No. 20130253)

60 APPLIED LIFE SCIENCES↗
DOE OSTI2017

HDTS 2017.0 Testing and verification document

This report is a continuation of the series of Hunter Dose Tracking System (HDTS) Quality Assurance documents including (Foley and Powell, 2010; Dixon, 2012). In this report we have created a suite of automated test cases and a system to analyze the results of those tests as well as documented the methodology to ensure the field system performs within specifications. The software test cases cover all of the functions and interactions of functions that are practical to test. With the developed framework, if software defects are discovered, it will be easy to create one or more test cases to reproduce the defect and ensure that code changes correct the defect. These tests con rm HDTS version 2017.0 performs according to its specifications and documentation and that its performance meets the needs of its users at the Savannah River Site.

97 MATHEMATICS AND COMPUTING↗
DOE OSTI2017

HDTS 2017.1 Testing and Verification Document

This report is a continuation of the series of Hunter Dose Tracking System (HDTS) Quality Assurance documents including (Foley and Powell, 2010; Dixon, 2012; Whiteside, 2017b). In this report we have created a suite of automated test cases and a system to analyze the results of those tests as well as documented the methodology to ensure the field system performs within specifications. The software test cases cover all of the functions and interactions of functions that are practical to test. With the developed framework, if software defects are discovered, it will be easy to create one or more test cases to reproduce the defect and ensure that code changes correct the defect.

97 MATHEMATICS AND COMPUTING↗
DOE OSTI2011

Introduction to benchmark dose methods and U.S. EPA's benchmark dose software (BMDS) version 2.1.1

Traditionally, the No-Observed-Adverse-Effect-Level (NOAEL) approach has been used to determine the point of departure (POD) from animal toxicology data for use in human health risk assessments. However, this approach is subject to substantial limitations that have been well defined, such as strict dependence on the dose selection, dose spacing, and sample size of the study from which the critical effect has been identified. Also, the NOAEL approach fails to take into consideration the shape of the dose-response curve and other related information. The benchmark dose (BMD) method, originally proposed as an alternative to the NOAEL methodology in the 1980s, addresses many of the limitations of the NOAEL method. It is less dependent on dose selection and spacing, and it takes into account the shape of the dose-response curve. In addition, the estimation of a BMD 95% lower bound confidence limit (BMDL) results in a POD that appropriately accounts for study quality (i.e., sample size). With the recent advent of user-friendly BMD software programs, including the U.S. Environmental Protection Agency's (U.S. EPA) Benchmark Dose Software (BMDS), BMD has become the method of choice for many health organizations world-wide. This paper discusses the BMD methods and corresponding software (i.e., BMDS version 2.1.1) that have been developed by the U.S. EPA, and includes a comparison with recently released European Food Safety Authority (EFSA) BMD guidance.

60 APPLIED LIFE SCIENCES↗