Results for “Dose Code” — Page 43

DOE OSTI2010

Study of encapsulated {sup 170}Tm sources for their potential use in brachytherapy

Purpose: High dose-rate (HDR) brachytherapy is currently performed with {sup 192}Ir sources, and {sup 60}Co has returned recently into clinical use as a source for this kind of cancer treatment. Both radionuclides have mean photon energies high enough to require specific shielded treatment rooms. In recent years, {sup 169}Yb has been explored as an alternative for HDR-brachytherapy implants. Although it has mean photon energy lower than {sup 192}Ir, it still requires extensive shielding to deliver treatment. An alternative radionuclide for brachytherapy is {sup 170}Tm (Z=69) because it has three physical properties adequate for clinical practice: (a) 128.6 day half-life, (b) high specific activity, and (c) mean photon energy of 66.39 keV. The main drawback of this radionuclide is the low photon yield (six photons per 100 electrons emitted). The purpose of this work is to study the dosimetric characteristics of this radionuclide for potential use in HDR-brachytherapy. Methods: The authors have assumed a theoretical {sup 170}Tm cylindrical source encapsulated with stainless steel and typical dimensions taken from the currently available HDR {sup 192}Ir brachytherapy sources. The dose-rate distribution was calculated for this source using the GEANT4 Monte Carlo (MC) code considering both photon and electron {sup 170}Tm spectra. The AAPM TG-43 U1 brachytherapy dosimetry parameters were derived. To study general properties of {sup 170}Tm encapsulated sources, spherical sources encapsulated with stainless steel and platinum were also studied. Moreover, the influence of small variations in the active core and capsule dimensions on the dosimetric characteristics was assessed. Treatment times required for a {sup 170}Tm source were compared to those for {sup 192}Ir and {sup 169}Yb for the same contained activity. Results: Due to the energetic beta spectrum and the large electron yield, the bremsstrahlung contribution to the dose was of the same order of magnitude as from the emitted gammas and characteristic x rays. Moreover, the electron spectrum contribution to the dose was significant up to 4 mm from the source center compared to the photon contribution. The dose-rate constant {Lambda} of the cylindrical source was 1.23 cGy h{sup -1} U{sup -1}. The behavior of the radial dose function showed promise for applications in brachytherapy. Due to the electron spectrum, the anisotropy was large for r<6 mm. Variations in manufacturing tolerances did not significantly influence the final dosimetry data when expressed in cGy h{sup -1} U{sup -1}. For typical capsule dimensions, maximum reference dose rates of about 0.2, 10, and 2 Gy min{sup -1} would then be obtained for {sup 170}Tm, {sup 192}Ir, and {sup 169}Yb, respectively, resulting in treatment times greater than those for HDR {sup 192}Ir brachytherapy. Conclusions: The dosimetric characteristics of source designs exploiting the low photon energy of {sup 170}Tm were studied for potential application in HDR-brachytherapy. Dose-rate distributions were obtained for cylindrical and simplified spherical {sup 170}Tm source designs (stainless steel and platinum capsule materials) using MC calculations. Despite the high activity of {sup 170}Tm, calculated treatment times were much longer than for {sup 192}Ir.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

DOE OSTI2016

SU-D-204-01: A Methodology Based On Machine Learning and Quantum Clustering to Predict Lung SBRT Dosimetric Endpoints From Patient Specific Anatomic Features

Purpose: To develop a data-mining methodology based on quantum clustering and machine learning to predict expected dosimetric endpoints for lung SBRT applications based on patient-specific anatomic features. Methods: Ninety-three patients who received lung SBRT at our clinic from 2011–2013 were retrospectively identified. Planning information was acquired for each patient, from which various features were extracted using in-house semi-automatic software. Anatomic features included tumor-to-OAR distances, tumor location, total-lung-volume, GTV and ITV. Dosimetric endpoints were adopted from RTOG-0195 recommendations, and consisted of various OAR-specific partial-volume doses and maximum point-doses. First, PCA analysis and unsupervised quantum-clustering was used to explore the feature-space to identify potentially strong classifiers. Secondly, a multi-class logistic regression algorithm was developed and trained to predict dose-volume endpoints based on patient-specific anatomic features. Classes were defined by discretizing the dose-volume data, and the feature-space was zero-mean normalized. Fitting parameters were determined by minimizing a regularized cost function, and optimization was performed via gradient descent. As a pilot study, the model was tested on two esophageal dosimetric planning endpoints (maximum point-dose, dose-to-5cc), and its generalizability was evaluated with leave-one-out cross-validation. Results: Quantum-Clustering demonstrated a strong separation of feature-space at 15Gy across the first-and-second Principle Components of the data when the dosimetric endpoints were retrospectively identified. Maximum point dose prediction to the esophagus demonstrated a cross-validation accuracy of 87%, and the maximum dose to 5cc demonstrated a respective value of 79%. The largest optimized weighting factor was placed on GTV-to-esophagus distance (a factor of 10 greater than the second largest weighting factor), indicating an intuitively strong correlation between this feature and both endpoints. Conclusion: This pilot study shows that it is feasible to predict dose-volume endpoints based on patient-specific anatomic features. The developed methodology can potentially help to identify patients at risk for higher OAR doses, thus improving the efficiency of treatment planning. R01-184173.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

SU-F-T-367: Using PRIMO, a PENELOPE-Based Software, to Improve the Small Field Dosimetry of Linear Accelerators

Purpose: To calculate output correction factors for Varian Clinac 2100iX beams for seven small field detectors and use the values to determine the small field output factors for the linacs at Karolinska university hospital. Methods: Phase space files (psf) for square fields between 0.25cm and 10cm were calculated using the PENELOPE-based PRIMO software. The linac MC-model was tuned by comparing PRIMO-estimated and experimentally determined depth doses and lateral dose-profiles for 40cmx40cm fields. The calculated psf were used as radiation sources to calculate the correction factors of IBA and PTW detectors with the code penEasy/PENELOPE. Results: The optimal tuning parameters of the MClinac model in PRIMO were 5.4 MeV incident electron energy and zero energy spread, focal spot size and beam divergence. Correction factors obtained for the liquid ion chamber (PTW-T31018) are within 1% down to 0.5 cm fields. For unshielded diodes (IBA-EFD, IBA-SFD, PTW-T60017 and PTW-T60018) the corrections are up to 2% at intermediate fields (>1cm side), becoming down to −11% for fields smaller than 1cm. The shielded diode (IBA-PFD and PTW-T60016) corrections vary with field size from 0 to −4%. Volume averaging effects are found for most detectors in the presence of 0.25cm fields. Conclusion: Good agreement was found between correction factors based on PRIMO-generated psf and those from other publications. The calculated factors will be implemented in output factor measurements (using several detectors) in the clinic. PRIMO is a userfriendly general code capable of generating small field psf and can be used without having to code own linac geometries. It can therefore be used to improve the clinical dosimetry, especially in the commissioning of linear accelerators. Important dosimetry data, such as dose-profiles and output factors can be determined more accurately for a specific machine, geometry and setup by using PRIMO and having a MC-model of the detector used.

43 PARTICLE ACCELERATORS↗

DOE OSTI2015

SU-E-T-43: A Methodology for Quality Control of IMPT Treatment Plan Based On VMAT Plan

Purpose: IMPT plan design is highly dependent on planner’s experiences. VMAT plan design is relatively mature and can even be automated. The quality of IMPT plan designed by in-experienced planner could be inferior to that of VMAT plan designed by experienced planner or automatic planning software. Here we introduce a method for designing IMPT plan based on VMAT plan to ensure the IMPT plan be superior to IMRT/VMAT plan for majority clinical scenario. Methods: To design a new IMPT plan, a VMAT plan is first generated either by experienced planner or by in-house developed automatic planning system. An in-house developed tool is used to generate the dose volume constrains for the IMPT plan as plan template to Eclipse TPS. The beam angles for IMPT plan are selected based on the preferred angles in the VMAT plan. IMPT plan is designed by importing the plan objectives generated from VMAT plan. Majority thoracic IMPT plans are designed using this plan approach in our center. In this work, a thoracic IMPT plan under RTOG 1308 protocol is selected to demonstrate the effectiveness and efficiency of this approach. The dosimetric indices of IMPT are compared with VMAT plan. Results: The PTV D95, lung V20, MLD, mean heart dose, esophagus D1, cord D1 are 70Gy, 31%, 17.8Gy, 25.5Gy, 73Gy, 45Gy for IMPT plan and 65.3Gy, 34%, 21.6Gy, 35Gy, 74Gy, 48Gy for VMAT plan. For majority cases, the high dose region of the normal tissue which is in proximity of PTV is comparable between IMPT and VMAT plan. The low dose region of the IMPT plan is significantly better than VMAT plan. Conclusion: Using the knowledge gained in VMAT plan design can help efficiently and effectively design high quality IMPT plan. The quality of IMPT plan can be controlled to ensure the superiority of IMPT plan compared to VMAT/IMRT plan.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2010

Experimental determination of the radial dose distribution in high gradient regions around {sup 192}Ir wires: Comparison of electron paramagnetic resonance imaging, films, and Monte Carlo simulations

Purpose: The experimental determination of doses at proximal distances from radioactive sources is difficult because of the steepness of the dose gradient. The goal of this study was to determine the relative radial dose distribution for a low dose rate {sup 192}Ir wire source using electron paramagnetic resonance imaging (EPRI) and to compare the results to those obtained using Gafchromic EBT film dosimetry and Monte Carlo (MC) simulations. Methods: Lithium formate and ammonium formate were chosen as the EPR dosimetric materials and were used to form cylindrical phantoms. The dose distribution of the stable radiation-induced free radicals in the lithium formate and ammonium formate phantoms was assessed by EPRI. EBT films were also inserted inside in ammonium formate phantoms for comparison. MC simulation was performed using the MCNP4C2 software code. Results: The radical signal in irradiated ammonium formate is contained in a single narrow EPR line, with an EPR peak-to-peak linewidth narrower than that of lithium formate ({approx}0.64 and 1.4 mT, respectively). The spatial resolution of EPR images was enhanced by a factor of 2.3 using ammonium formate compared to lithium formate because its linewidth is about 0.75 mT narrower than that of lithium formate. The EPRI results were consistent to within 1% with those of Gafchromic EBT films and MC simulations at distances from 1.0 to 2.9 mm. The radial dose values obtained by EPRI were about 4% lower at distances from 2.9 to 4.0 mm than those determined by MC simulation and EBT film dosimetry. Conclusions: Ammonium formate is a suitable material under certain conditions for use in brachytherapy dosimetry using EPRI. In this study, the authors demonstrated that the EPRI technique allows the estimation of the relative radial dose distribution at short distances for a {sup 192}Ir wire source.

61 RADIATION PROTECTION AND DOSIMETRY↗

DOE OSTI2014

TH-A-19A-08: Intel Xeon Phi Implementation of a Fast Multi-Purpose Monte Carlo Simulation for Proton Therapy

Purpose: Recent studies have demonstrated the capability of graphics processing units (GPUs) to compute dose distributions using Monte Carlo (MC) methods within clinical time constraints. However, GPUs have a rigid vectorial architecture that favors the implementation of simplified particle transport algorithms, adapted to specific tasks. Our new, fast, and multipurpose MC code, named MCsquare, runs on Intel Xeon Phi coprocessors. This technology offers 60 independent cores, and therefore more flexibility to implement fast and yet generic MC functionalities, such as prompt gamma simulations. Methods: MCsquare implements several models and hence allows users to make their own tradeoff between speed and accuracy. A 200 MeV proton beam is simulated in a heterogeneous phantom using Geant4 and two configurations of MCsquare. The first one is the most conservative and accurate. The method of fictitious interactions handles the interfaces and secondary charged particles emitted in nuclear interactions are fully simulated. The second, faster configuration simplifies interface crossings and simulates only secondary protons after nuclear interaction events. Integral depth-dose and transversal profiles are compared to those of Geant4. Moreover, the production profile of prompt gammas is compared to PENH results. Results: Integral depth dose and transversal profiles computed by MCsquare and Geant4 are within 3%. The production of secondaries from nuclear interactions is slightly inaccurate at interfaces for the fastest configuration of MCsquare but this is unlikely to have any clinical impact. The computation time varies between 90 seconds for the most conservative settings to merely 59 seconds in the fastest configuration. Finally prompt gamma profiles are also in very good agreement with PENH results. Conclusion: Our new, fast, and multi-purpose Monte Carlo code simulates prompt gammas and calculates dose distributions in less than a minute, which complies with clinical time constraints. It has been successfully validated with Geant4. This work has been financialy supported by InVivoIGT, a public/private partnership between UCL and IBA.

07 ISOTOPE AND RADIATION SOURCES↗

DOE OSTI2012

Dosimetric Benefit of a New Ophthalmic Radiation Plaque

Purpose: To determine whether the computed dosimetry of a new ophthalmic plaque, EP917, when compared with the standard Collaborative Ocular Melanoma Study (COMS) plaques, could reduce radiation exposure to vision critical structures of the eye. Methods and Materials: One hundred consecutive patients with uveal melanoma treated with COMS radiation plaques between 2007 and 2010 were included in this study. These treatment plans were generated with the use of Bebig Plaque Simulator treatment-planning software, both for COMS plaques and for EP917 plaques using I-125. Dose distributions were calculated for a prescription of 85 Gy to the tumor apex. Doses to the optic disc, opposite retina, lens, and macula were obtained, and differences between the 2 groups were analyzed by standard parametric methods. Results: When compared with the COMS plaques, the EP917 plaques used fewer radiation seeds by an average difference of 1.94 (P<.001; 95% confidence interval [CI], -2.8 to -1.06) and required less total strength of radiation sources by an average of 17.74 U (air kerma units) (P<.001; 95% CI, -20.16 to -15.32). The total radiation doses delivered to the optic disc, opposite retina, and macula were significantly less by 4.57 Gy, 0.50 Gy, and 11.18 Gy, respectively, with the EP917 plaques vs the COMS plaques. Conclusion: EP917 plaques deliver less overall radiation exposure to critical vision structures than COMS treatment plaques while still delivering the same total therapeutic dose to the tumor.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

DOE OSTI2015

WE-F-304-01: Overview of the Working Group On Stereotactic Body Radiation Therapy (WGSBRT)

Stereotactic Body Radiation Therapy (SBRT) was introduced clinically more than twenty years ago, and many subsequent publications have reported safety and efficacy data. The AAPM Working Group on Biological Effects of Hypofractionated Radiotherapy/SBRT (WGSBRT) extracted published treatment outcomes data from extensive literature searches to summarize and construct tumor control probability (TCP) and normal tissue complication probability (NTCP) models for six anatomical regions: Cranial, Head and Neck, Thoracic, Abdominal, Pelvic, and Spinal. In this session, we present the WGSBRT’s work for cranial sites, and recurrent head and neck cancer. From literature-based data and associated models, guidelines to aid with safe and effective hypofractionated radiotherapy treatment are being determined. Further, the ability of existing and proposed radiobiological models to fit these data is considered as to the ability to distinguish between the linear-quadratic and alternative radiobiological models such as secondary cell death from vascular damage, immunogenic, or bystander effects. Where appropriate, specific model parameters are estimated. As described in “The lessons of QUANTEC,” (1), lack of adequate reporting standards continues to limit the amount of useful quantitative information that can be extracted from peer-reviewed publications. Recommendations regarding reporting standards are considered, to enable such reviews to achieve more complete characterization of clinical outcomes. 1 Jackson A, Marks LB, Bentzen SM, Eisbruch A, Yorke ED, Ten Haken RK, Constine LS, Deasy JO. The lessons of QUANTEC: recommendations for reporting and gathering data on dose-volume dependencies of treatment outcome. Int J Radiat Oncol Biol Phys. 2010 Mar 1;76(3 Suppl):S155–60. Learning Objectives: Describe the techniques, types of cancer and dose schedules used in treating recurrent H&N cancers with SBRT List the radiobiological models that compete with the linear-quadratic model in explaining the results of hypofractionated RT Describe the dose/volume metrics that are considered safe in SBRT treatment of tumors near the optic structures. Discuss the efficacy of hypofractionation and dosing schedules used in treating vestibular schwannomas Identify some difficulties in modeling TCP and NTCP for cranial tumors treated with hypofractionation. One moderator, Dr. Grimm, designed and holds intellectual property rights to the DVH Evaluator software tool which is an FDA-cleared product in commercial use, and can analyze some of this data. No others have relevant conflicts of interest.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

SU-G-TeP3-11: Radiobiological-Cum-Dosimetric Quality Assurance of Complex Radiotherapy Plans

Purpose: Dosimetric gamma-analysis used for QA of complex radiotherapy plans tests the dosimetric equivalence of a delivered plan with the treatment planning system (TPS) optimized plan. It does not examine whether a dosimetric difference results in any radiobiological difference. This study introduces a method to test the radiobiological and dosimetric equivalence between a delivered and the TPS optimized plan. Methods: Six head and neck and seven lung cancer VMAT or IMRT plans optimized for patient treatment were calculated and delivered to an ArcCheck phantom. ArcCheck measured dose distributions were compared with the TPS calculated dose distributions using a 2-D gamma-analysis. Dose volume histograms (DVHs) for various patient structures were obtained by using measured data in 3DVH software and compared against the TPS calculated DVHs using 3-D gamma analysis. DVH data were used in the Poisson model to calculate tumor control probability (TCP) for the treatment targets and in the sigmoid dose response model to calculate normal tissue complication probability (NTCP) for the normal structures. Results: Two-D and three-D gamma passing rates among six H&N patient plans differed by 0 to 2.7% and among seven lung plans by 0.1 to 4.5%. Average ± SD TCPs based on measurement and TPS were 0.665±0.018 and 0.674±0.044 for H&N, and 0.791±0.027 and 0.733±0.031 for lung plans, respectively. Differences in NTCPs were usually negligible. The differences in dosimetric results, TCPs and NTCPs were insignificant. Conclusion: The 2-D and 3-D gamma-analysis based agreement between measured and planned dose distributions may indicate their dosimetric equivalence. Small and insignificant differences in TCPs and NTCPs based on measured and planned dose distributions indicate the radiobiological equivalence between the measured and optimized plans. However, patient plans showing larger differences between 2-D and 3-D gamma-analysis can help us make a more definite conclusion through our ongoing research with a larger number of patients.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

WE-F-304-02: Recurrent HNC Treated with SBRT: TCP-Based Outcome Estimates

Stereotactic Body Radiation Therapy (SBRT) was introduced clinically more than twenty years ago, and many subsequent publications have reported safety and efficacy data. The AAPM Working Group on Biological Effects of Hypofractionated Radiotherapy/SBRT (WGSBRT) extracted published treatment outcomes data from extensive literature searches to summarize and construct tumor control probability (TCP) and normal tissue complication probability (NTCP) models for six anatomical regions: Cranial, Head and Neck, Thoracic, Abdominal, Pelvic, and Spinal. In this session, we present the WGSBRT’s work for cranial sites, and recurrent head and neck cancer. From literature-based data and associated models, guidelines to aid with safe and effective hypofractionated radiotherapy treatment are being determined. Further, the ability of existing and proposed radiobiological models to fit these data is considered as to the ability to distinguish between the linear-quadratic and alternative radiobiological models such as secondary cell death from vascular damage, immunogenic, or bystander effects. Where appropriate, specific model parameters are estimated. As described in “The lessons of QUANTEC,” (1), lack of adequate reporting standards continues to limit the amount of useful quantitative information that can be extracted from peer-reviewed publications. Recommendations regarding reporting standards are considered, to enable such reviews to achieve more complete characterization of clinical outcomes. 1 Jackson A, Marks LB, Bentzen SM, Eisbruch A, Yorke ED, Ten Haken RK, Constine LS, Deasy JO. The lessons of QUANTEC: recommendations for reporting and gathering data on dose-volume dependencies of treatment outcome. Int J Radiat Oncol Biol Phys. 2010 Mar 1;76(3 Suppl):S155–60. Learning Objectives: Describe the techniques, types of cancer and dose schedules used in treating recurrent H&N cancers with SBRT List the radiobiological models that compete with the linear-quadratic model in explaining the results of hypofractionated RT Describe the dose/volume metrics that are considered safe in SBRT treatment of tumors near the optic structures. Discuss the efficacy of hypofractionation and dosing schedules used in treating vestibular schwannomas Identify some difficulties in modeling TCP and NTCP for cranial tumors treated with hypofractionation. One moderator, Dr. Grimm, designed and holds intellectual property rights to the DVH Evaluator software tool which is an FDA-cleared product in commercial use, and can analyze some of this data. No others have relevant conflicts of interest.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2012

The effects of variations in the density and composition of eye materials on ophthalmic brachytherapy dosimetry

In ophthalmic brachytherapy dosimetry, it is common to consider the water phantom as human eye anatomy. However, for better clinical analysis, there is a need for the dose determination in different parts of the eye. In this work, a full human eye is simulated with MCNP-4C code by considering all parts of the eye, i.e., the lens, cornea, retina, choroid, sclera, anterior chamber, optic nerve, and bulk of the eye comprising vitreous body and tumor. The average dose in different parts of this full model of the human eye is determined and the results are compared with the dose calculated in water phantom. The central axes depth dose and the dose in whole of the tumor for these 2 simulated eye models are calculated as well, and the results are compared.

61 RADIATION PROTECTION AND DOSIMETRY↗

NASA NTRS2003

A Comparison of Model Calculation and Measurement of Absorbed Dose for Proton Irradiation

With the increase in the amount of time spent EVA that is necessary to complete the construction and subsequent maintenance of ISS, it will become increasingly important for ground support personnel to accurately characterize the radiation exposures incurred by EVA crewmembers. Since exposure measurements cannot be taken within the organs of interest, it is necessary to estimate these exposures by calculation. To validate the methods and tools used to develop these estimates, it is necessary to model experiments performed in a controlled environment. This work is such an effort. A human phantom was outfitted with detector equipment and then placed in American EMU and Orlan-M EVA space suits. The suited phantom was irradiated at the LLUPTF with proton beams of known energies. Absorbed dose measurements were made by the spaceflight operational dosimetrist from JSC at multiple sites in the skin, eye, brain, stomach, and small intestine locations in the phantom. These exposures are then modeled using the BRYNTRN radiation transport code developed at the NASA Langley Research Center, and the CAM (computerized anatomical male) human geometry model of Billings and Yucker. Comparisons of absorbed dose calculations with measurements show excellent agreement. This suggests that there is reason to be confident in the ability of both the transport code and the human body model to estimate proton exposure in ground-based laboratory experiments.

Zapp, N.↗

DOE OSTI2016

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↗

NASA NTRS1966

The Lewis proton shielding code

Fortran IV computer program for calculation of primary proton and secondary proton and neutron particle spectra and dose behind multilayer radiation shielding

RADIATION SHIELDING↗

DOE OSTI2014

SU-E-J-56: Dosimetric Impact of Patient Roll Variability in Peripheral-Lung SBRT

Purpose: Positional variation about the patient longitudinal axis may introduce deleterious effects to clinical treatment plans, the effects of which are exacerbated by hypo-fractionated treatment regimens. Our goal is to evaluate the dosimetric impact of rotational setup error in stereotactic body radiation therapy (SBRT) for peripherally-located lung lesions. Methods: Six patients who had been treated for peripheral lung lesions using varying SBRT techniques were analyzed. Each patient's planning CT was processed using custom in-house software to simulate 1, 3, and 5 degree roll in both directions about their longitudinal axis. The original plan was fused and re-calculated. Agreement between planned and error-simulated dose distributions was quantified using 3%, 3mm criteria for the 3-dimensional gamma metric, and changes in target coverage and adjacent normal anatomy were also quantified. Results: Increased rotational setup error resulted in reduced target coverage, with changes in equivalent uniform dose ranging from −1.24% to −6.11% for simulated roll greater than or equal to 3 degrees, increasing with magnitude of error and skewed for roll directed toward the involved side. Changes to normal tissue metrics are linearly related to simulated roll, with rib D(1cc) changes ranging from −4.23% to 3.27% relative to the original treatment plan. Error-simulated dose distributions demonstrate agreement by the gamma metric in the planned target of 72.56%, 81.02%, and 99.52% for 5, 3, and 1 degree simulated roll scenarios, respectively. Corresponding agreement for the regional dose in excess of 50% of the maximum were 65.71%,70.77%, and 97.88%. Conclusion: This study suggests that the ability to detect and compensate for rotational positioning variations beyond a threshold level may improve care for patients with peripherally-located lesions beyond that which may be accomplished using only translational axes. Positional error of one degree of roll had little influence, though three or more degrees of error introduced significant discrepancy.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2014

SU-E-T-252: On the Evaluation of Patient Specific IMRT QA Using EPID, Dynalog Files and Patient Anatomy

Purpose: This research, investigates the viability of using the Electronic portal imaging device (EPID) coupled with the treatment planning system (TPS), to calculate the doses delivered and verify agreement with the treatment plan. The results of QA analysis using the EPID, Delta4 and fluence calculations using the multi-leaf collimator (MLC) dynalog files on 10 IMRT patients are presented in this study. Methods: EPID Fluence Images in integrated mode and Dynalog files for each field were acquired for 10 IMRT (6MV) patients and processed through an in house MatLab program to create an opening density matrix (ODM) which was used as the input fluence for dose calculation with the TPS (Pinnacle3, Philips). The EPID used in this study was the aSi1000 Varian on a Novalis TX linac equipped with high definition MLC. The resulting dose distributions were then exported to VeriSoft (PTW) where a 3D gamma was calculated using 3mm-3% criteria. The Scandidos Delta4 phantom was also used to measure a 2D dose distribution for all 10 patients and a 2D gamma was calculated for each patient using the Delta4 software. Results: The average 3D gamma for all 10 patients using the EPID images was 98.2% ± 2.6%. The average 3D gamma using the dynalog files was 94.6% ± 4.9%. The average 2D gamma from the Delta4 was 98.1% ± 2.5%. The minimum 3D gamma for the EPID and dynalog reconstructed dose distributions was found on the same patient which had a very large PTV, requiring the jaws to open to the maximum field size. Conclusion: Use of the EPID, combined with a TPS is a viable method for QA of IMRT plans. A larger ODM size can be implemented to accommodate larger field sizes. An adaptation of this process to Volumetric Arc Therapy (VMAT) is currently under way.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

WE-F-304-00: Outcomes of Hypofractionated Treatments - Results of the WGSBRT

Stereotactic Body Radiation Therapy (SBRT) was introduced clinically more than twenty years ago, and many subsequent publications have reported safety and efficacy data. The AAPM Working Group on Biological Effects of Hypofractionated Radiotherapy/SBRT (WGSBRT) extracted published treatment outcomes data from extensive literature searches to summarize and construct tumor control probability (TCP) and normal tissue complication probability (NTCP) models for six anatomical regions: Cranial, Head and Neck, Thoracic, Abdominal, Pelvic, and Spinal. In this session, we present the WGSBRT’s work for cranial sites, and recurrent head and neck cancer. From literature-based data and associated models, guidelines to aid with safe and effective hypofractionated radiotherapy treatment are being determined. Further, the ability of existing and proposed radiobiological models to fit these data is considered as to the ability to distinguish between the linear-quadratic and alternative radiobiological models such as secondary cell death from vascular damage, immunogenic, or bystander effects. Where appropriate, specific model parameters are estimated. As described in “The lessons of QUANTEC,” (1), lack of adequate reporting standards continues to limit the amount of useful quantitative information that can be extracted from peer-reviewed publications. Recommendations regarding reporting standards are considered, to enable such reviews to achieve more complete characterization of clinical outcomes. 1 Jackson A, Marks LB, Bentzen SM, Eisbruch A, Yorke ED, Ten Haken RK, Constine LS, Deasy JO. The lessons of QUANTEC: recommendations for reporting and gathering data on dose-volume dependencies of treatment outcome. Int J Radiat Oncol Biol Phys. 2010 Mar 1;76(3 Suppl):S155–60. Learning Objectives: Describe the techniques, types of cancer and dose schedules used in treating recurrent H&N cancers with SBRT List the radiobiological models that compete with the linear-quadratic model in explaining the results of hypofractionated RT Describe the dose/volume metrics that are considered safe in SBRT treatment of tumors near the optic structures. Discuss the efficacy of hypofractionation and dosing schedules used in treating vestibular schwannomas Identify some difficulties in modeling TCP and NTCP for cranial tumors treated with hypofractionation. One moderator, Dr. Grimm, designed and holds intellectual property rights to the DVH Evaluator software tool which is an FDA-cleared product in commercial use, and can analyze some of this data. No others have relevant conflicts of interest.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2014

SU-E-T-200: IBA ProteusOne Compact Proton Therapy System Radiation Survey Results

Purpose: This study summarizes the results of an initial radiation survey of the Willis-Knighton Cancer Center in Shreveport, Louisiana. The facility houses an IBA ProteusOne compact single room proton therapy unit coupled with a C230 cyclotron that operates at a maximum energy of 230 MeV. Methods: A calibrated survey meter was used for the photon measurements to obtain reliable results. A neutron detector was used as the measuring instrument for neutrons. The locations of the survey and measurements were planned carefully in order to get a proper evaluation of the facility shielding configuration. The walls, ceiling, vault entrance, and the adjacent environment were each surveyed with suitable measurement instruments. A total of 22 locations were chosen for radiation survey. Dose equivalent values were calculated for both the photon and the neutron radiation using measured data. Results: All measured dose values are presented in millisievert per year. The highest dose measured at the vault entrance is 0.34 mSv/year. A dedicated shielding door was not present at the time of the measurement. The vault entrance area is considered as a controlled area. The shielding design goals are not to exceed 5 mSv/year for the controlled area and 1 mSv/year the uncontrolled area. The total combined neutron and photon dose equivalent values were found to be compliant with the Louisiana Department of Environmental Quality radiation protection regulatory codes. Conclusion: In our efforts to evaluate the radiation levels at the Willis-Knighton Cancer Center proton treatment facility, we have found that all the measured values of the radiation shielding are below the critical radiation limits per year. Since the total dose measured at the vault entrance is below the shielding design goal, a shielding door is not required at this proton treatment vault.

60 APPLIED LIFE SCIENCES↗