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Dosimetric Verification Using Monte Carlo Calculations for Tissue Heterogeneity-Corrected Conformal Treatment Plans Following RTOG 0813 Dosimetric Criteria for Lung Cancer Stereotactic Body Radiotherapy

Purpose: The recently activated Radiation Therapy Oncology Group (RTOG) studies of stereotactic body radiation therapy (SBRT) for non-small-cell lung cancer (NSCLC) require tissue density heterogeneity correction, where the high and intermediate dose compliance criteria were established based on superposition algorithm dose calculations. The study was aimed at comparing superposition algorithm dose calculations with Monte Carlo (MC) dose calculations for SBRT for NSCLC and to evaluate whether compliance criteria need to be adjusted for MC dose calculations. Methods and Materials: Fifteen RTOG 0236 study sets were used. The planning tumor volumes (PTV) ranged from 10.7 to 117.1 cm{sup 3}. SBRT conformal treatment plans were generated using XiO (CMS Inc.) treatment planning software with superposition algorithm to meet the dosimetric high and intermediate compliance criteria recommended by the RTOG 0813 protocol. Plans were recalculated using the MC algorithm of a Monaco (CMS, Inc.) treatment planning system. Tissue density heterogeneity correction was applied in both calculations. Results: Overall, the dosimetric quantities of the MC calculations have larger magnitudes than those of the superposition calculations. On average, R{sub 100%} (ratio of prescription isodose volume to PTV), R{sub 50%} (ratio of 50% prescription isodose volume to PTV), D{sub 2cm} (maximal dose 2 cm from PTV in any direction as a percentage of prescription dose), and V{sub 20} (percentage of lung receiving dose equal to or larger than 20 Gy) increased by 9%, 12%, 7%, and 18%, respectively. In the superposition plans, 3 cases did not meet criteria for R{sub 50%} or D{sub 2cm}. In the MC-recalculated plans, 8 cases did not meet criteria for R{sub 100%}, R{sub 50%}, or D{sub 2cm}. After reoptimization with MC calculations, 5 cases did not meet the criteria for R{sub 50%} or D{sub 2cm}. Conclusions: Results indicate that the dosimetric criteria, e.g., the criteria for R{sub 50%} recommended by RTOG 0813 protocol, may need to be adjusted when the MC dose calculation algorithm is used.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

SU-E-T-616: Plan Quality Assessment of Both Treatment Planning System Dose and Measurement-Based 3D Reconstructed Dose in the Patient

Purpose: Systematic radiotherapy plan quality assessment promotes quality improvement. Software tools can perform this analysis by applying site-specific structure dose metrics. The next step is to similarly evaluate the quality of the dose delivery. This study defines metrics for acceptable doses to targets and normal organs for a particular treatment site and scores each plan accordingly. The input can be the TPS or the measurement-based 3D patient dose. From this analysis, one can determine whether the delivered dose distribution to the patient receives a score which is comparable to the TPS plan score, otherwise replanning may be indicated. Methods: Eleven neuroblastoma patient plans were exported from Eclipse to the Quality Reports program. A scoring algorithm defined a score for each normal and target structure based on dose-volume parameters. Each plan was scored by this algorithm and the percentage of total possible points was obtained. Each plan also underwent IMRT QA measurements with a Mapcheck2 or ArcCheck. These measurements were input into the 3DVH program to compute the patient 3D dose distribution which was analyzed using the same scoring algorithm as the TPS plan. Results: The mean quality score for the TPS plans was 75.37% (std dev=14.15%) compared to 71.95% (std dev=13.45%) for the 3DVH dose distribution. For 3/11 plans, the 3DVH-based quality score was higher than the TPS score, by between 0.5 to 8.4 percentage points. Eight/11 plans scores decreased based on IMRT QA measurements by 1.2 to 18.6 points. Conclusion: Software was used to determine the degree to which the plan quality score differed between the TPS and measurement-based dose. Although the delivery score was generally in good agreement with the planned dose score, there were some that improved while there was one plan whose delivered dose quality was significantly less than planned. This methodology helps evaluate both planned and delivered dose quality. Sun Nuclear Corporation has provded a license for the software described.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

SU-G-BRB-06: Commissioning and Evaluation of EPID-Based in Vivo Dosimetry Software Using a Tissue-Maximum Ratio Approach

Purpose: To commission and evaluate an in vivo EPID-based transit dosimetry software (EPIgray, DOSIsoft, Cachan, France) using simple fields and TG119-based IMRT treatment plans. Methods: EPIgray was commissioned on a Truebeam based on finite tissue-maximum ratio (fTMR) measurements with solid water blocks of thicknesses between 0 and 37 cm. Field sizes varied from 2×2 to 20×20 cm{sup 2}. Subsequently, treatment plans of single and opposed beams with field sizes between 4×4 and 15×15 cm{sup 2} as well as IMRT plans were measured to evaluate the dose reconstruction accuracy. Single field dose predictions were made for anterior-posterior and lateral beams. IMRT plans were created based on TG119 recommendations. The reconstructed dose was compared to the planned dose for selected points at isocenter and away from isocenter. Results: For single square fields, the dose in EPIgray was reconstructed within 3% accuracy at isocenter relative to the planned dose. Similarly, the relative deviation of the total dose was accurately reconstructed within 3% for all IMRT plans with points placed inside a high dose region near the isocenter. Predictions became less accurate than 5% when the evaluation point was outside the majority of IMRT beam segments. Additionally, points 5 cm or more away from the isocenter or within an avoidance structure were predicted less reliably. Conclusion: EPIgray formalism accuracy is adequate for an efficient error detection system. It provides immediate intra-fractional feedback on the delivery of treatment plans without affecting the treatment beam. Besides the EPID, no additional hardware is required, which makes it accessible to all clinics. The software evaluates point dose measurements to verify treatment plan delivery and patient positioning within 5% accuracy, depending on the placement of evaluation points. EPIgray is not intended to replace patient-specific quality assurance but should be utilized as an additional layer of safety for continuous patient treatment verification. This research is supported by DOSIsoft.

60 APPLIED LIFE SCIENCES↗

SU-E-T-203: Comparison of a Commercial MRI-Linear Accelerator Based Monte Carlo Dose Calculation Algorithm and Geant4

Purpose: An MRI-linear accelerator is currently being developed by the vendor Elekta™. The treatment planning system that will be used to model dose for this unit uses a Monte Carlo dose calculation algorithm, GPUMCD, that allows for the application of a magnetic field. We tested this radiation transport code against an independent Monte-Carlo toolkit Geant4 (v.4.10.01) both with and without the magnetic field applied. Methods: The setup comprised a 6 MeV mono-energetic photon beam emerging from a point source impinging on a homogeneous water phantom at 100 cm SSD. The comparisons were drawn from the percentage depth doses (PDD) for three different field sizes (1.5 x 1.5 cm{sup 2}, 5 x 5 cm{sup 2}, 10 x 10 cm{sup 2}) and dose profiles at various depths. A 1.5 T magnetic field was applied perpendicular to the direction of the beam. The transport thresholds were kept the same for both codes. Results: All of the normalized PDDs and profiles agreed within ± 1 %. In the presence of the magnetic field, PDDs rise more quickly reducing the depth of maximum dose. Near the beam exit point in the phantom a hot spot is created due to the electron return effect. This effect is more pronounced for the larger field sizes. Profiles selected parallel to the external field show no effect, however, the ones selected perpendicular to the direction of the applied magnetic field are shifted towards the direction of the Lorentz force applied by the magnetic field on the secondary electrons. It is observed that these profiles are not symmetric which indicates a lateral build up of the dose. Conclusion: There is a good general agreement between the PDDs/profiles calculated by both algorithms thus far. We are proceeding towards clinically relevant comparisons in a heterogeneous phantom for polyenergetic beams. Funding for this work has been provided by Elekta.

60 APPLIED LIFE SCIENCES↗

SU-F-T-657: In-Room Neutron Dose From High Energy Photon Beams

Purpose: To estimate neutron dose inside the treatment room from photodisintegration events in high energy photon beams using Monte Carlo simulations and experimental measurements. Methods: The Monte Carlo code MCNP6 was used for the simulations. An Eberline ESP-1 Smart Portable Neutron Detector was used to measure neutron dose. A water phantom was centered at isocenter on the treatment couch, and the detector was placed near the phantom. A Varian 2100EX linear accelerator delivered an 18MV open field photon beam to the phantom at 400MU/min, and a camera captured the detector readings. The experimental setup was modeled in the Monte Carlo simulation. The source was modeled for two extreme cases: a) hemispherical photon source emitting from the target and b) cone source with an angle of the primary collimator cone. The model includes the target, primary collimator, flattening filter, secondary collimators, water phantom, detector and concrete walls. Energy deposition tallies were measured for neutrons in the detector and for photons at the center of the phantom. Results: For an 18MV beam with an open 10cm by 10cm field and the gantry at 180°, the Monte Carlo simulations predict the neutron dose in the detector to be 0.11% of the photon dose in the water phantom for case a) and 0.01% for case b). The measured neutron dose is 0.04% of the photon dose. Considering the range of neutron dose predicted by Monte Carlo simulations, the calculated results are in good agreement with measurements. Conclusion: We calculated in-room neutron dose by using Monte Carlo techniques, and the predicted neutron dose is confirmed by experimental measurements. If we remodel the source as an electron beam hitting the target for a more accurate representation of the bremsstrahlung fluence, it is feasible that the Monte Carlo simulations can be used to help in shielding designs.

60 APPLIED LIFE SCIENCES↗

SU-E-T-167: Evaluation of Mobius Dose Calculation Engine Using Out of the Box Preconfigured Beam Data

Purpose: Determine the dose calculation accuracy of a preconfigured Mobius server for use in secondary checks of a treatment planning system. Methods: 10 plans were created for irradiation on two of the IROC (formerly RPC) accreditation phantoms: 4 for the head and neck phantom and 6 for the lung phantom. The plans each were created using one of four different photon energies (6FFF, 10 FFF, 6X, and 15X) and were varied in treatment type including VMAT, step and shoot IMRT, dynamic MLC IMRT (DMLC), and conformal RT (CRT). The TLDs in the phantoms were contoured, and each plan was sent for calculation to Mobius software (Mobius Medical Systems, Houston, TX) with a default configuration. Each plan was then irradiated on the planned phantom 3 times to create an average reading across 56 TLDs. These readings were then compared against the corresponding Mobius calculation at each TLD location. Results: The mean difference (MD) normalized to the plan prescription dose between each TLD and Mobius calculation for all measurements was 0.5 ± 3.3%, with a maximum difference of 8.4%. The MD was 0.6 ± 3.8%, − 2.0 ± 1.9%, 1.7 ± 3.7%, and 1.9 ± 1.2% across the 6FFF, 10FFF, 6X and 15X energies respectively. The MD was −1.2 ± 2.3% for lung plans and 1.8 ± 3.5% for head/neck plans. Across treatment types, the MD ranged from − 1.8 ± 1.7% for CRT to 4.3 ± 2.4 % for DMLC. Conclusion: Out of the box and preconfigured, Mobius provides accurate dose calculations with respect to beam energy, treatment type, and treatment site.

60 APPLIED LIFE SCIENCES↗

Changes in dose with segmentation of breast tissues in Monte Carlo calculations for low-energy brachytherapy

Purpose: To investigate the use of various breast tissue segmentation models in Monte Carlo dose calculations for low-energy brachytherapy. Methods: The EGSnrc user-code BrachyDose is used to perform Monte Carlo simulations of a breast brachytherapy treatment using TheraSeed Pd-103 seeds with various breast tissue segmentation models. Models used include a phantom where voxels are randomly assigned to be gland or adipose (randomly segmented), a phantom where a single tissue of averaged gland and adipose is present (averaged tissue), and a realistically segmented phantom created from previously published numerical phantoms. Radiation transport in averaged tissue while scoring in gland along with other combinations is investigated. The inclusion of calcifications in the breast is also studied in averaged tissue and randomly segmented phantoms. Results: In randomly segmented and averaged tissue phantoms, the photon energy fluence is approximately the same; however, differences occur in the dose volume histograms (DVHs) as a result of scoring in the different tissues (gland and adipose versus averaged tissue), whose mass energy absorption coefficients differ by 30%. A realistically segmented phantom is shown to significantly change the photon energy fluence compared to that in averaged tissue or randomly segmented phantoms. Despite this, resulting DVHs for the entire treatment volume agree reasonably because fluence differences are compensated by dose scoring differences. DVHs for the dose to only the gland voxels in a realistically segmented phantom do not agree with those for dose to gland in an averaged tissue phantom. Calcifications affect photon energy fluence to such a degree that the differences in fluence are not compensated for (as they are in the no calcification case) by dose scoring in averaged tissue phantoms. Conclusions: For low-energy brachytherapy, if photon transport and dose scoring both occur in an averaged tissue, the resulting DVH for the entire treatment volume is reasonably accurate because inaccuracies in photon energy fluence are compensated for by inaccuracies in localized dose scoring. If dose to fibroglandular tissue in the breast is of interest, then the inaccurate photon energy fluence calculated in an averaged tissue phantom will result in inaccurate DVHs and average doses for those tissues. Including calcifications necessitates the use of proper tissue segmentation.

61 RADIATION PROTECTION AND DOSIMETRY↗

SU-F-T-658: Out-Of-Field Dose Comparison for TrueBeam Low Energy Beams for Extended Distances: Measurement Vs Monte Carlo Simulation

Purpose: Patient dose far from the treatment field is comprised of scatter from within the patient, and treatment head leakage. We quantify the treatment head leakage for TrueBeam linear accelerator for 6X and 6X-FFF beams by comparing measurements to Monte Carlo simulations for a variety of jaw sizes and collimator rotations. This work is conceptually similar to that of Kry et al. (Medical Physics 2006; 33: 4405), who considered a Clinac linear accelerator. Methods: Measurements were made using an EXRADIN A101 ion chamber positioned in the patient plane, at distances up to 100 cm from isocenter. Simulations were done using VirtuaLinac, the GEANT4-based Monte Carlo model of the TrueBeam treatment head, and an in-house (U. Virginia) GEANT4-based code. In-house code modelled an ion chamber with build-up, based on a CT scan of the chamber. VirtuaLinac included a detailed model of the treatment head shielding, and was run on the Amazon Web Services cloud to generate spherical phase space files surrounding the treatment head. These phase space files were imported into the in-house code. Results: Initial comparisons between measurements and simulation showed an excess of dose in the in-plane direction, away from the gantry, in the simulations. This was traced to an incomplete model of the shielding—specifically, the component holding the primary collimator was smaller in the model than in the TrueBeam. Modifications were made to VirtuaLinac to more closely match the engineering drawings. In the in-plane direction, the lowest out of field dose was away from gantry (negative abscissa values) at around 60 cm from isocenter, for fields smaller than 10×10 cm2. Out of field dose decreased with decreasing jaw size. Flattening-filter free beam produced out-of-field doses as low as 65% of those with flattened beam. Conclusion: Doses determined from simulation and measurement were in close agreement. Funding support from the Jefferson Trust Foundation.

60 APPLIED LIFE SCIENCES↗

Dose calculations using MARS for Bremsstrahlung beam stops and collimators in APS beamline stations.

The Monte Carlo radiation transport code MARS is used to model the generation of gas bremsstrahlung (GB) radiation from 7-GeV electrons which scatter from residual gas atoms in undulator straight sections within the Advanced Photon Source (APS) storage ring. Additionally, MARS is employed to model the interactions of the GB radiation with components along the x-ray beamlines and then determine the expected radiation dose-rates that result. In this manner, MARS can be used to assess the adequacy of existing shielding or the specifications for new shielding when required. The GB radiation generated in the 'thin-target' of an ID straight section will consist only of photons in a 1/E-distribution up to the full energy of the stored electron beam. Using this analytical model, the predicted GB power for a typical APS 15.38-m insertion device (ID) straight section is 4.59 x 10{sup -7} W/nTorr/mA, assuming a background gas composed of air (Z{sub eff} = 7.31) at room temperature (293K). The total GB power provides a useful benchmark for comparisons between analytical and numerical approaches. We find good agreement between MARS and analytical estimates for total GB power. The extended straight section 'target' creates a radial profile of GB, which is highly peaked centered on the electron beam. The GB distribution reflects the size of the electron beam that creates the radiation. Optimizing the performance of MARS in terms of CPU time per incident trajectory requires the use of a relatively short, high-density gas target (air); in this report, the target density is {rho}L = 2.89 x 10{sup -2} g/cm{sup 2} over a length of 24 cm. MARS results are compared with the contact dose levels reported in TB-20, which used EGS4 for radiation transport simulations. Maximum dose-rates in 1 cc of tissue phantom form the initial basis for comparison. MARS and EGS4 results are approximately the same for maximum 1-cc dose-rates and attenuation in the photon-dominated regions; for thicker targets, however, the dose-rate no longer depends only on photon attenuation, as photoneutrons (PNs) begin to dominate. The GB radiation-induced photoneutron measurements from four different metals (Fe, Cu, W, and Pb) are compared with MARS predictions. The simulated dose-rates for beamline 6-ID are approximately 3-5 times larger than the measured values, whereas those for beamline 11-ID are much closer. Given the uncertainty in local values of pressure and Z, the degree of agreement between MARS and the PN measurements is good. MARS simulations of GB-induced radiation in and around the FOE show the importance of using actual pressure and gas composition (Z{sub eff}) to obtain accurate PN dose. For a beam current of 300 mA, extrapolating pressure data measured in previously published studies predicts an average background gas pressure of 27 nTorr. An average atomic number of Z{sub eff} = 4.0 is obtained from the same studies. In addition, models of copper masks presently in use at the APS are included. Simulations show that inclusion of exit masks make significant differences in both the radiation spatial distribution within the FOE, as well as the peak intensity. Two studies have been conducted with MARS to assess shielding requirements. First, dose levels in contact with the outside wall of the FOE are examined when GB radiation strikes Pb or W beam stops of varying transverse size within the FOE. Four separate phantom regions are utilized to measure the dose, two at beam elevation and two at the horizontal beam position. The first two phantoms are used for scoring FOE dose along the outside and back walls, horizontally; the second two collect dose on the roof and vertically on the back wall. In all cases, the beam stop depth is maintained at 30 cm. Inclusion of front end (FE) exit masks typically cause a 1-2 order-of-magnitude increase in the dose-rates relative to the case with no masks. Masks place secondary bremsstrahlung sources inside the FOE, and therefore they must be shielded appropriately. The MARS model does not fully account for all shielding present in the hutches; localized shielding is employed in individual hutches. Typically, a collimator, placed downstream of the FE exit masks, mitigates the possible increase in dose. Regarding beam stop transverse size, a modest reduction in dose on the back wall is noted as the stop dimension (square cross section) is increased from 12 cm to 24 cm. In the second study, the thickness of Pb required to shield against the GB extremal ray is determined. In this study, we are interested in finding the thickness of material necessary to add at the edge of a stop to adequately block GB radiation; therefore, we look at the case of no masks in order to have a well-defined GB beam edge. Simulations show the separation between the extremal ray and the edge of the shielding should be 2R{sub m}, where R{sub m} is the Moliere radius.

43 PARTICLE ACCELERATORS↗

Design of an Yb-169 source optimized for gold nanoparticle-aided radiation therapy

Purpose: To find an optimum design of a new high-dose rate ytterbium (Yb)-169 brachytherapy source that would maximize the dose enhancement during gold nanoparticle-aided radiation therapy (GNRT), while meeting practical constraints for manufacturing a clinically relevant brachytherapy source. Methods: Four different Yb-169 source designs were considered in this investigation. The first three source models had a single encapsulation made of one of the following materials: aluminum, titanium, and stainless steel. The last source model adopted a dual encapsulation design with an inner aluminum capsule surrounding the Yb-core and an outer titanium capsule. Monte Carlo (MC) simulations using the Monte Carlo N-Particle code version 5 (MCNP5) were conducted initially to investigate the spectral changes caused by these four source designs and the associated variations in macroscopic dose enhancement across the tumor loaded with gold nanoparticles (GNPs) at 0.7% by weight. Subsequent MC simulations were performed using the EGSnrc and NOREC codes to determine the secondary electron spectra and microscopic dose enhancement as a result of irradiating the GNP-loaded tumor with the MCNP-calculated source spectra. Results: Effects of the source filter design were apparent in the current MC results. The intensity-weighted average energy of the Yb-169 source varied from 108.9 to 122.9 keV, as the source encapsulation material changed from aluminum to stainless steel. Accordingly, the macroscopic dose enhancement calculated at 1 cm away from the source changed from 51.0% to 45.3%. The sources encapsulated by titanium and aluminum/titanium combination showed similar levels of dose enhancement, 49.3% at 1 cm, and average energies of 113.0 and 112.3 keV, respectively. While the secondary electron spectra due to the investigated source designs appeared to look similar in general, some differences were noted especially in the low energy region (<50 keV) of the spectra suggesting the dependence of the photoelectron yield on the atomic number of source filter material, consistent with the macroscopic dose enhancement results. A similar trend was also shown in the so-called microscopic dose enhancement factor, for example, resulting in the maximum values of 138 and 119 for the titanium- and the stainless steel-encapsulated Yb-169 sources, respectively. Conclusions: The current results consistently show that the dose enhancement achievable from the Yb-169 source is closely related with the atomic number (Z) of source encapsulation material. While the observed range of improvement in the dose enhancement may be considered moderate after factoring all uncertainties in the MC results, the current study provides a reasonable support for the encapsulation of the Yb-core with lower-Z materials than stainless steel, for GNRT applications. Overall, the titanium capsule design can be favored over the aluminum or dual aluminum/titanium capsule designs, due to its superior structural integrity and improved safety during manufacturing and clinical use.

07 ISOTOPE AND RADIATION SOURCES↗

SU-E-T-81: A Study On Correlation Between Gamma Analysis for Midline and Lateralized Tumors Using VMAT

Purpose: To evaluate the fluence for the midline and lateralized tumors for VMAT technique using 2D seven29 detector array combined with the Octavius phantom. Methods: 60 cases that are already being treated with volumetric modulated arc therapy (VMAT) have selected for this study. This includes tumors situated at the medial and lateral. Medial refers to the tumor situated at the midline of the body and lateral means toward the side or away from the midline of the body. Verification plans were created for each treatment plan in Varian Eclipse treatment planning system (version10, Varian medical systems, Palo Alto,CA) with the 2D Seven29 detector array and the Octavius phantom(PTW, Freiburg, Germany). Measurements were performed on a Varian Clinac 2100 iX, linear accelerator equipped with a millennium 120 leaf collimator. Analysis was done by comparing the fluence measured for the tumors situated on the midline and tumors situated laterally. Results: Fluence measured for all the delivered plans were analyzed using Verisoft software (PTW, Freiburg, Germany). The gamma pass percentage for midline tumors were found to be higher compared with the lateralized ones. The standard deviation between gamma values for midline and lateralized tumors is 2.18 and 3.5 respectively. Also the standard deviation between the point doses for midline and lateralized tumors is 0.38 and 0.29 respectively. The average gamma passing rate for midline tumors is 96.55% and for lateralized tumors are 94.94% for 3%DD and 3mm DTA criteria. From the T test, it was found that there is no significant difference between the gamma pass percentage between midline and lateralized tumors with p value of 0.28. Conclusion: There is no particular correlation found in the gamma pass criteria for midline and lateralized tumors.

60 APPLIED LIFE SCIENCES↗

SU-F-T-49: Dosimetry Parameters and TPS Commissioning for the CivaSheet Directional Pd-103 Brachytherapy Source

Purpose: The CivaSheet is a new LDR Pd-103 brachytherapy device offering directional-radiation for preferentially irradiating malignancies with healthy-tissue sparing. Observations are presented on dosimetric characterization, TPS commissioning, and evaluation of the dosesuperposition- principle for summing individual elements comprising a planar CivaSheet Methods: The CivaSheet comprises individual sources (CivaDots, 0.05cm thick and 0.25cm diam.) inside a flexible bioabsorbable substrate with a 0.8cm center-to-center rectangular array. All non-radioactive components were measured to ensure accuracy of manufacturer-provided dimensional information. The Pd spatial distribution was gleaned from radioactive and inert samples, then modeled with the MCNP6 radiation-transport-code. A 6×6 array CivaSheet was modeled to evaluate the dose superposition principle for treatment planning. Air-kerma-strength was estimated using the NIST WAFAC geometry. Absorbed dose was estimated in water with polar sampling covering 0.05≤r≤15cm in 0.05cm increments and 0°≤θ≤180° in 1° increments. These data were entered into VariSeed9.0 and tested for the dose-superposition-principle. Results: The dose-rate-constant was 0.579 cGy/h/U with g(r) determined along the rotational-axis of symmetry (0°) instead of 90°. gP(r) values at 0.1, 0.5, 2, 5, and 10cm were 1.884, 1.344, 0.558, 0.088, and 0.0046. F(r,θ) decreased between 0° and 180° by factors of 270, 23, and 5.1 at 0.1, 1, and 10cm. The highest dose-gradient was at 92°, changing by a factor of 3 within 1° due to Au-foil shielding. TPS commissioning from 0.1≤r≤11cm and 0°≤θ≤180° demonstrated 2% reproducibility of input data except at the high-dose-gradient where interpolations caused 3% differences. Dose superposition of CivaDots replicated a multi-source CivaSheet array within 2% except where another CivaDot was present. Following implantation, the device is not perfectly planar. TPS accuracy utilizing the dose-superposition-principle through geometric repositioning of CivaDots supersedes TPS limitations of intersource shielding effects Conclusion: Dosimetric characterization, source commissioning, and evaluation of the dose-superposition-principle with VariSeed9.0 permits treatment planning for the CivaSheet brachytherapy device. Research supported in part by CivaTech Oncology, Inc.

60 APPLIED LIFE SCIENCES↗

SU-F-T-185: Study of the Robustness of a Proton Arc Technique Based On PBS Beams

Purpose: One potential technique to realize proton arc is through using PBS beams from many directions to form overlaid Bragg peak (OBP) spots and placing these OBP spots throughout the target volume to achieve desired dose distribution. In this study, we analyzed the robustness of this proton arc technique. Methods: We used a cylindrical water phantom of 20 cm in radius in our robustness analysis. To study the range uncertainty effect, we changed the density of the phantom by ±3%. To study the setup uncertainty effect, we shifted the phantom by 3 & 5 mm. We also combined the range and setup uncertainties (3mm/±3%). For each test plan, we performed dose calculation for the nominal and 6 disturbed scenarios. Two test plans were used, one with single OBP spot and the other consisting of 121 OBP spots covering a 10×10cm{sup 2} area. We compared the dose profiles between the nominal and disturbed scenarios to estimate the impact of the uncertainties. Dose calculation was performed with Gate/GEANT based Monte Carlo software in cloud computing environment. Results: For each of the 7 scenarios, we simulated 100k & 10M events for plans consisting of single OBP spot and 121 OBP spots respectively. For single OBP spot, the setup uncertainty had minimum impact on the spot’s dose profile while range uncertainty had significant impact on the dose profile. For plan consisting of 121 OBP spots, similar effect was observed but the extent of disturbance was much less compared to single OBP spot. Conclusion: For PBS arc technique, range uncertainty has significantly more impact than setup uncertainty. Although single OBP spot can be severely disturbed by the range uncertainty, the overall effect is much less when a large number of OBP spots are used. Robustness optimization for PBS arc technique should consider range uncertainty with priority.

60 APPLIED LIFE SCIENCES↗

Technical Note: Implementation of biological washout processes within GATE/GEANT4—A Monte Carlo study in the case of carbon therapy treatments

Purpose: The imaging of positron emitting isotopes produced during patient irradiation is the only in vivo method used for hadrontherapy dose monitoring in clinics nowadays. However, the accuracy of this method is limited by the loss of signal due to the metabolic decay processes (biological washout). In this work, a generic modeling of washout was incorporated into the GATE simulation platform. Additionally, the influence of the washout on the β{sup +} activity distributions in terms of absolute quantification and spatial distribution was studied. Methods: First, the irradiation of a human head phantom with a {sup 12}C beam, so that a homogeneous dose distribution was achieved in the tumor, was simulated. The generated {sup 11}C and {sup 15}O distribution maps were used as β{sup +} sources in a second simulation, where the PET scanner was modeled following a detailed Monte Carlo approach. The activity distributions obtained in the presence and absence of washout processes for several clinical situations were compared. Results: Results show that activity values are highly reduced (by a factor of 2) in the presence of washout. These processes have a significant influence on the shape of the PET distributions. Differences in the distal activity falloff position of 4 mm are observed for a tumor dose deposition of 1 Gy (T{sub ini} = 0 min). However, in the case of high doses (3 Gy), the washout processes do not have a large effect on the position of the distal activity falloff (differences lower than 1 mm). The important role of the tumor washout parameters on the activity quantification was also evaluated. Conclusions: With this implementation, GATE/GEANT 4 is the only open-source code able to simulate the full chain from the hadrontherapy irradiation to the PET dose monitoring including biological effects. Results show the strong impact of the washout processes, indicating that the development of better models and measurement of biological washout data are essential.

60 APPLIED LIFE SCIENCES↗

SU-F-T-340: Direct Editing of Dose Volume Histograms: Algorithms and a Unified Convex Formulation for Treatment Planning with Dose Constraints

Purpose: To develop a procedure for including dose constraints in convex programming-based approaches to treatment planning, and to support dynamic modification of such constraints during planning. Methods: We present a mathematical approach that allows mean dose, maximum dose, minimum dose and dose volume (i.e., percentile) constraints to be appended to any convex formulation of an inverse planning problem. The first three constraint types are convex and readily incorporated. Dose volume constraints are not convex, however, so we introduce a convex restriction that is related to CVaR-based approaches previously proposed in the literature. To compensate for the conservatism of this restriction, we propose a new two-pass algorithm that solves the restricted problem on a first pass and uses this solution to form exact constraints on a second pass. In another variant, we introduce slack variables for each dose constraint to prevent the problem from becoming infeasible when the user specifies an incompatible set of constraints. We implement the proposed methods in Python using the convex programming package cvxpy in conjunction with the open source convex solvers SCS and ECOS. Results: We show, for several cases taken from the clinic, that our proposed method meets specified constraints (often with margin) when they are feasible. Constraints are met exactly when we use the two-pass method, and infeasible constraints are replaced with the nearest feasible constraint when slacks are used. Finally, we introduce ConRad, a Python-embedded free software package for convex radiation therapy planning. ConRad implements the methods described above and offers a simple interface for specifying prescriptions and dose constraints. Conclusion: This work demonstrates the feasibility of using modifiable dose constraints in a convex formulation, making it practical to guide the treatment planning process with interactively specified dose constraints. This work was supported by the Stanford BioX Graduate Fellowship and NIH Grant 5R01CA176553.

60 APPLIED LIFE SCIENCES↗

Analysis of Dose Consequences Arising from the Release of Spent Nuclear Fuel from Dry Storage Casks

The resulting dose consequences from releases of spent nuclear fuel (SNF) residing in a dry storage casks are examined parametrically. The dose consequences are characterized by developing dose versus distance curves using simplified bounding assumptions. The dispersion calculations are performed using the MELCOR Accident Consequence Code System (MACCS2) code. Constant weather and generic system parameters were chosen to ensure that the results in this report are comparable with each other and to determine the relative impact on dose of each variable. Actual analyses of site releases would need to accommodate local weather and geographic data. These calculations assume a range of fuel burnups, release fractions (RFs), three exposure scenarios (2 hrs and evacuate, 2 hrs and shelter, and 24 hrs exposure), two meteorological conditions (D-4 and F-2), and three release heights (ground level – 1 meter (m), 10 m, and 100 m). This information was developed to support a policy paper being developed by U.S. Nuclear Regulatory Commission (NRC) staff on an independent spent fuel storage installation (ISFSI) and monitored retrievable storage installation (MRS) security rulemaking.

Durbin, Samuel G.↗

An MCNPX Monte Carlo model of a discrete spot scanning proton beam therapy nozzle

Purpose: The purposes of this study were to validate a discrete spot scanning proton beam nozzle using the Monte Carlo (MC) code MCNPX and use the MC validated model to investigate the effects of a low-dose envelope, which surrounds the beam's central axis, on measurements of integral depth dose (IDD) profiles. Methods: An accurate model of the discrete spot scanning beam nozzle from The University of Texas M. D. Anderson Cancer Center (Houston, Texas) was developed on the basis of blueprints provided by the manufacturer of the nozzle. The authors performed simulations of single proton pencil beams of various energies using the standard multiple Coulomb scattering (MCS) algorithm within the MCNPX source code and a new MCS algorithm, which was implemented in the MCNPX source code. The MC models were validated by comparing calculated in-air and in-water lateral profiles and percentage depth dose profiles for single pencil beams with their corresponding measured values. The models were then further tested by comparing the calculated and measured three-dimensional (3-D) dose distributions. Finally, an IDD profile was calculated with different scoring radii to determine the limitations on the use of commercially available plane-parallel ionization chambers to measure IDD. Results: The distance to agreement, defined as the distance between the nearest positions of two equivalent distributions with the same value of dose, between measured and simulated ranges was within 0.13 cm for both MCS algorithms. For low and intermediate pencil beam energies, the MC simulations using the standard MCS algorithm were in better agreement with measurements. Conversely, the new MCS algorithm produced better results for high-energy single pencil beams. The IDD profile calculated with cylindrical tallies with an area equivalent to the area of the largest commercially available ionization chamber showed up to 7.8% underestimation of the integral dose in certain depths of the IDD profile. Conclusions: The authors conclude that a combination of MCS algorithms is required to accurately reproduce experimental data of single pencil beams and 3-D dose distributions for the scanning beam nozzle. In addition, the MC simulations showed that because of the low-dose envelope, ionization chambers with radii as large as 4.08 cm are insufficient to accurately measure IDD profiles for a 221.8 MeV pencil beam in the scanning beam nozzle.

60 APPLIED LIFE SCIENCES↗

Comparison of the MCNP6 and FLUKA Codes in Shielding Calculation at ProNova Proton Therapy Facility

The Monte Carlo method is a powerful tool to simulate particle transport in materials, and can be effectively used to design radiation shielding. The purpose of this study is to compare the results from two Monte Carlo codes (MCNP6 and FLUKA ) in shielding design. The calculation was also compared with the measured results from the ProNova Superconducting 360 degrees (SC360) installation at the Knoxville Provision Center for Proton Therapy (PCPT) facility. The SC360 230 MeV continue wave (CW) proton beam is produced by an isochronous cyclotron, the Sumitomo P235. The maximum beam that is extracted into the beamline is 300 nA, which is of 60% of the full current generated in cyclotron. The SC360 facility has an energy selection system for adjusting the proton range, one fixed beam and one gantry room for rotating the beam around the stationary patient. At the entrance to each treatment room beamline, a thickness adjustable Beryllium degrader inserted in the beam path is used to achieve the desirable beam energy. When protons interact with beamline components, the secondary neutrons become the dominant source to determine the radiation shielding. In this study, the dose rate outside the lateral wall of the beamline vault was discussed. The calculations from two Monte Carlo codes were compared and they agreed very well. The dose rates measured by a Wendi-II Neutron Detector agreed within a factor of less than seven compared with the calculation results. The difference may be explained by a variety of factors such as the uncertainty in knowing the exact composition of shielding materials, geometry difference, and the measurement uncertainty due to instrumentation. (authors)

61 RADIATION PROTECTION AND DOSIMETRY↗