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DOE OSTI2016

SU-F-T-327: Total Body Irradiation In-Vivo Dose Measurements Using Optically Stimulated Luminescence (OSL) NanoDots and Farmer Type Ion Chamber

Purpose: This study was performed to analyze the agreement between optically stimulated luminescence (OSL) nanoDots measured doses and 0.6 cc Farmer type ionization chamber measured doses during total body irradiation (TBI). Methods: In-vivo dose measurements using OSL nanoDots and Farmer chamber were done in a total of twelve patients who received TBI at our center by bilateral parallel-opposed beams technique. In this technique, the patient is kept inside the TBI box which is filled with rice bags and irradiated using two bilateral parallel opposed beams of 40×40 cm{sup 2} size with 45° collimator rotation at an SSD of 333.5 cm in an Elekta Synergy linear accelerator. All patients received a dose of 2 Gy in single fraction as conditioning regimen. The beams were equally weighted at the midplane of the box. The nanoDots were placed over forehead, right and left neck, right and left lung, umbilicus, right and left abdomen, medial part of thigh, knee and toe. A 0.6 cc Farmer chamber was placed in between the thighs of the patient. Measured doses are reported along with the statistical comparisons using paired sample t-test. Results: For the above sites the mean doses were 212.2±21.1, 218.2±7.6, 218.7±9.3, 215.6±9.5, 217.5±11.5, 214.5±7.7, 218.3±6.8, 221.5±15, 229.1±11.0, 220.5±7.7 and 223.3±5.1 cGy respectively. For all OSL measurements the mean dose was 218.6±11.8 cGy. Farmer chamber measurements yielded a mean dose of 208.8±15.6 cGy. Statistical analysis revealed that there was no significant difference between OSL measured doses in forehead, right and left neck, right and left lung, umbilicus, right and left abdomen and toe and Farmer chamber measured doses (0.72≤p≤0.06). However the mean OSL doses at thigh and knee were statistically different (p<0.05) from the Farmer chamber measurements. Conclusion: OSL measurements were found to be in agreement with Farmer type ionization chamber measurements in in-vivo dosimetry of TBI.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2012

Online Image-based Monitoring of Soft-tissue Displacements for Radiation Therapy of the Prostate

Purpose: Emerging prolonged, hypofractionated radiotherapy regimens rely on high-dose conformality to minimize toxicity and thus can benefit from image guidance systems that continuously monitor target position during beam delivery. To address this need we previously developed, as a potential add-on device for existing linear accelerators, a novel telerobotic ultrasound system capable of real-time, soft-tissue imaging. Expanding on this capability, the aim of this work was to develop and characterize an image-based technique for real-time detection of prostate displacements. Methods and Materials: Image processing techniques were implemented on spatially localized ultrasound images to generate two parameters representing prostate displacements in real time. In a phantom and five volunteers, soft-tissue targets were continuously imaged with a customized robotic manipulator while recording the two tissue displacement parameters (TDPs). Variations of the TDPs in the absence of tissue displacements were evaluated, as was the sensitivity of the TDPs to prostate translations and rotations. Robustness of the approach to probe force was also investigated. Results: With 95% confidence, the proposed method detected in vivo prostate displacements before they exceeded 2.3, 2.5, and 2.8 mm in anteroposterior, superoinferior, and mediolateral directions. Prostate pitch was detected before exceeding 4.7 Degree-Sign at 95% confidence. Total system time lag averaged 173 ms, mostly limited by ultrasound acquisition rate. False positives (FPs) (FP) in the absence of displacements did not exceed 1.5 FP events per 10 min of continuous in vivo imaging time. Conclusions: The feasibility of using telerobotic ultrasound for real-time, soft-tissue-based monitoring of target displacements was confirmed in vivo. Such monitoring has the potential to detect small clinically relevant intrafractional variations of the prostate position during beam delivery.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

DOE OSTI2012

Correlation of dosimetric parameters obtained with the analytical anisotropic algorithm and toxicity of chest chemoradiation in lung carcinoma

The purpose of this study was to analyze and revisit toxicity related to chest chemoradiotherapy and to correlate these side effects with dosimetric parameters obtained using analytical anisotropic algorithm (AAA) in locally unresectable advanced lung cancer. We retrospectively analyzed data from 47 lung cancer patients between 2005 and 2008. All received conformal 3D radiotherapy using high-energy linear accelerator plus concomitant chemotherapy. All treatment planning data were transferred into Eclipse 8.05 (Varian Medical Systems, Palo Alto, CA) and dosimetric calculations were performed using AAA. Thirty-three patients (70.2%) developed acute pneumopathy after radiotherapy (grades 1 and 2). One patient (2.1%) presented with grade 3 pneumopathy. Thirty-one (66%) presented with grades 1-2 lung fibrosis, and 1 patient presented with grade 3 lung fibrosis. Thirty-four patients (72.3%) developed grade 1-2 acute oesophagic toxicity. Four patients (8.5%) presented with grades 3 and 4 dysphagia, necessitating prolonged parenteral nutrition. Median prescribed dose was 64 Gy (range 50-74) with conventional fractionation (2 Gy per fraction). Dose-volume constraints were respected with a median V20 of 23.5% (maximum 34%) and a median V30 of 17% (maximum 25%). The median dose delivered to healthy contralateral lung was 13.1 Gy (maximum 18.1 Gy). At univariate analysis, larger planning target volume and V20 were significantly associated with the probability of grade {>=}2 radiation-induced pneumopathy (p = 0.022 and p = 0.017, respectively). No relation between oesophagic toxicity and clinical/dosimetric parameters could be established. Using AAA, the present results confirm the predictive value of the V20 for lung toxicity as already demonstrated with the conventional pencil beam convolution approach.

61 RADIATION PROTECTION AND DOSIMETRY↗

DOE OSTI2013

Clinical experience transitioning from IMRT to VMAT for head and neck cancer

To quantify clinical differences for volumetric modulated arc therapy (VMAT) versus intensity modulated radiation therapy (IMRT) in terms of dosimetric endpoints and planning and delivery time, twenty head and neck cancer patients have been considered for VMAT using Nucletron Oncentra MasterPlan delivered via an Elekta linear accelerator. Differences in planning time between IMRT and VMAT were estimated accounting for both optimization and calculation. The average delivery time per patient was obtained retrospectively using the record and verify software. For the dosimetric comparison, all contoured organs at risk (OARs) and planning target volumes (PTVs) were evaluated. Of the 20 cases considered, 14 had VMAT plans approved. Six VMAT plans were rejected due to unacceptable dose to OARs. In terms of optimization time, there was minimal difference between the two modalities. The dose calculation time was significantly longer for VMAT, 4 minutes per 358 degree arc versus 2 minutes for an entire IMRT plan. The overall delivery time was reduced by 9.2 ± 3.9 minutes for VMAT (51.4 ± 15.6%). For the dosimetric comparison of the 14 clinically acceptable plans, there was almost no statistical difference between the VMAT and IMRT. There was also a reduction in monitor units of approximately 32% from IMRT to VMAT with both modalities demonstrating comparable quality assurance results. VMAT provides comparable coverage of target volumes while sparing OARs for the majority of head and neck cases. In cases where high dose modulation was required for OARs, a clinically acceptable plan was only achievable with IMRT. Due to the long calculation times, VMAT plans can cause delays during planning but marked improvements in delivery time reduce patient treatment times and the risk of intra-fraction motion.

61 RADIATION PROTECTION AND DOSIMETRY↗

DOE OSTI2014

WE-A-BRF-01: Dual-Energy CT Imaging in Diagnostic Imaging and Radiation Therapy

The quantification accuracy of dual-energy imaging is influenced by the fundamentals of x-ray physics, system geometry, data acquisition hardware/protocol, system calibration, and image processing technique. This symposium will provide updates on the following advanced application areas: Mammography. Volumetric breast density techniques based on standard mammograms require estimation of breast thickness, which is difficult to accurately measure. By comparison, calculation of breast density using dual energy mammography does not require measurement of breast thickness. Dual energy mammography has been implemented using both energy integrating flat panel detectors in conjunction with beam energy switching and energy resolved photon counting detectors. These techniques have been optimized using simulation studies and validated using physical phantoms and postmortem breasts. Chemical decomposition was used as the gold standard for volumetric breast density measurement in postmortem breasts. Breast density measurements have also been compared with results from four-category BI-RADS density rankings, standard image thresholding and Fuzzy k-mean clustering techniques. These studies indicate that dual energy mammography can be used to accurately measure volumetric breast density. Cardiovascular CT. The predicative accuracy of risk models for recurrent stroke and cardiac arrest depends heavily on accurate differentiation of thrombus or calcium from iodine in left atrial appendage or coronary arteries. The amount of energy separation is constrained by image noise; therefore, optimal kVp, beam filtration, and balanced flux are essential for the quantification accuracy of iodine and calcium. The basis materials are combined linearly to generate monochromatic energy images, where CT# accuracy and CNR are energy dependent. With optimal monochromatic energy, the mean iodine concentration for the thrombus, circulatory stasis, and control groups are significantly different. Risk classification based on calcium scores shows excellent agreement with classification on the basis of conventional coronary artery calcium scoring. These studies demonstrate dual-energy cardiovascular CT can potentially be a noninvasive and sensitive modality in high risk patients. On-board KV/MV Imaging. To enhance soft tissue contrast and reduce metal artifacts, we have developed a dual-energy CBCT technique and a novel on-board kV/MV imaging technique based on hardware available on modern linear accelerators. We have also evaluated the feasibility of these two techniques in various phantom studies. Optimal techniques (energy, beam filtration, # of overlapping projections, etc) have been investigated with unique calibration procedures, which leads to successful decomposition of imaged material into acrylic-aluminum basis material pair. This enables the synthesis of virtual monochromatic (VM) CBCT images that demonstrate much less beam hardening, significantly reduced metal artifacts, and/or higher soft tissue CNR compared to single-energy CBCT. Adaptive Radiation Therapy. DECT could actually contribute to the area of Dose-Guided Radiation Therapy (or Adaptive Therapy). The application of DECT imaging using 80kV and 140 kV combinations could potentially increase the image quality by reducing the bone or high density material artifacts and also increase the soft tissue contrast by a light contrast agent. The result of this higher contrast / quality images is beneficial for deformable image registration / segmentation algorithm to improve its accuracy hence to make adaptive therapy less time consuming in its recontouring process. The real time re-planning prior to per treatment fraction could become more realistic with this improvement especially in hypofractional SBRT cases. Learning Objectives: Learn recent developments of dual-energy imaging in diagnosis and radiation therapy; Understand the unique clinical problem and required quantification accuracy in each application; Understand the different approaches to optimize dual-energy imaging techniques for different applications.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2012

Three-Dimensional Conformal Radiotherapy in Prostate Cancer Patients: Rise in Interleukin 6 (IL-6) but not IL-2, IL-4, IL-5, Tumor Necrosis Factor-{alpha}, MIP-1-{alpha}, and LIF Levels

Purpose: To investigate the effect of radiotherapy (RT) on serum levels of interleukin-2 (IL-2), IL-4, IL-5, IL-6, tumor necrosis factor alpha (TNF-{alpha}), macrophage inflammatory protein-1-alpha (MIP-1-{alpha}) and leukemia inhibitory factor (LIF) in patients with prostate cancer. Methods and Materials: Forty eight patients with prostate cancer received three-dimensional conformal blocking radiation therapy with a linear accelerator. IL-2, IL-4, IL-5, IL-6, TNF-{alpha}, MIP-1-{alpha}, and LIF levels were measured by the related immunoassay kit 1 day before the beginning of RT and during RT at days 15 and 30. Results: The mean IL-2 values were elevated before and during the RT in contrast with those of IL-4, IL-5, IL-6, TNF-{alpha}, MIP-1-{alpha}, and LIF, which were within the normal range under the same conditions. Regarding markers IL-2, IL-4, IL-5, TNF-{alpha}, MIP-1-{alpha}, and LIF, comparisons among the three groups (before treatment and 15 and 30 days during RT) did not show significant differences. Although values were within the normal range, there was a significant rise in IL-6 levels at day 15 of RT (p = 0.0049) and a decline at day 30 to levels that were similar to those observed before RT. Conclusions: IL-6 appeared to peak after 15 days of RT before returning to pre-RT levels. In contrast, IL-2, IL-4, IL-5, TNF-{alpha}, MIP-1-{alpha}, and LIF levels were not sensitive to irradiation. The increased levels of IL-6 following RT without the concurrent elevation of other cytokines involved in the acute phase reaction did not suggest a classical inflammatory response to radiation exposure. Further studies should be designed to elucidate the role of IL-6 levels in patients with prostate cancer treated with RT.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

DOE OSTI2012

Prevention of a wrong-location misadministration through the use of an intradepartmental incident learning system

Purpose: A series of examples are presented in which potential errors in the delivery of radiation therapy were prevented through use of incident learning. These examples underscore the value of reporting near miss incidents. Methods: Using a departmental incident learning system, eight incidents were noted over a two-year period in which fields were treated 'out-of-sequence,' that is, fields from a boost phase were treated, while the patient was still in the initial phase of treatment. As a result, an error-prevention policy was instituted in which radiation treatment fields are 'hidden' within the oncology information system (OIS) when they are not in current use. In this way, fields are only available to be treated in the intended sequence and, importantly, old fields cannot be activated at the linear accelerator control console. Results: No out-of-sequence treatments have been reported in more than two years since the policy change. Furthermore, at least three near-miss incidents were detected and corrected as a result of the policy change. In the first two, the policy operated as intended to directly prevent an error in field scheduling. In the third near-miss, the policy operated 'off target' to prevent a type of error scenario that it was not directly intended to prevent. In this incident, an incorrect digitally reconstructed radiograph (DRR) was scheduled in the OIS for a patient receiving lung cancer treatment. The incorrect DRR had an isocenter which was misplaced by approximately two centimeters. The error was a result of a field from an old plan being scheduled instead of the intended new plan. As a result of the policy described above, the DRR field could not be activated for treatment however and the error was discovered and corrected. Other quality control barriers in place would have been unlikely to have detected this error. Conclusions: In these examples, a policy was adopted based on incident learning, which prevented several errors, at least one of which was potentially severe. These examples underscore the need for a rigorous, systematic incident learning process within each clinic. The experiences reported in this technical note demonstrate the value of near-miss incident reporting to improve patient safety.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2014

SU-E-T-644: Evaluation of Angular Dependence Correction for 2D Array Detector Using for Quality Assurance of Volumetric Modulated Arc Therapy

Purpose: To evaluate the angular dependence correction for Matrix Evolution 2D array detector in quality assurance of volumetric modulated arc therapy(VMAT). Methods: Total ten patients comprising of different sites were planned for VMAT and taken for the study. Each plan was exposed on Matrix Evolution 2D array detector with Omnipro IMRT software based on the following three different methods using 6MV photon beams from Elekta Synergy linear accelerator. First method, VMAT plan was delivered on Matrix Evolution detector as it gantry mounted with dedicated holder with build-up of 2.3cm. Second, the VMAT plan was delivered with the static gantry angle on to the table mounted setup. Third, the VMAT plan was delivered with actual gantry angle on Matrix Evolution detector fixed in Multicube phantom with gantry angle sensor and angular dependence correction were applied to quantify the plan quality. For all these methods, the corresponding QA plans were generated in TPS and the dose verification was done for both point and 2D fluence analysis with pass criteria of 3% dose difference and 3mm distance to agreement. Results: The measured point dose variation for the first method was observed as 1.58±0.6% of mean and SD with TPS calculated. For second and third method, the mean and standard deviation(SD) was observed as 1.67±0.7% and 1.85±0.8% respectively. The 2D fluence analysis of measured and TPS calculated has the mean and SD of 97.9±1.1%, 97.88±1.2% and 97.55±1.3% for first, second and third methods respectively. The calculated two-tailed Pvalue for point dose and 2D fluence analysis shows the insignificance with values of 0.9316 and 0.9015 respectively, among the different methods of QA. Conclusion: The qualitative evaluation of angular dependence correction for Matrix Evolution 2D array detector shows its competency in accuracy of quality assurance measurement of composite dose distribution of volumetric modulated arc therapy.

07 ISOTOPE AND RADIATION SOURCES↗

DOE OSTI2015

SU-D-BRD-07: Evaluation of the Effectiveness of Statistical Process Control Methods to Detect Systematic Errors For Routine Electron Energy Verification

Purpose: To evaluate the ability of statistical process control methods to detect systematic errors when using a two dimensional (2D) detector array for routine electron beam energy verification. Methods: Electron beam energy constancy was measured using an aluminum wedge and a 2D diode array on four linear accelerators. Process control limits were established. Measurements were recorded in control charts and compared with both calculated process control limits and TG-142 recommended specification limits. The data was tested for normality, process capability and process acceptability. Additional measurements were recorded while systematic errors were intentionally introduced. Systematic errors included shifts in the alignment of the wedge, incorrect orientation of the wedge, and incorrect array calibration. Results: Control limits calculated for each beam were smaller than the recommended specification limits. Process capability and process acceptability ratios were greater than one in all cases. All data was normally distributed. Shifts in the alignment of the wedge were most apparent for low energies. The smallest shift (0.5 mm) was detectable using process control limits in some cases, while the largest shift (2 mm) was detectable using specification limits in only one case. The wedge orientation tested did not affect the measurements as this did not affect the thickness of aluminum over the detectors of interest. Array calibration dependence varied with energy and selected array calibration. 6 MeV was the least sensitive to array calibration selection while 16 MeV was the most sensitive. Conclusion: Statistical process control methods demonstrated that the data distribution was normally distributed, the process was capable of meeting specifications, and that the process was centered within the specification limits. Though not all systematic errors were distinguishable from random errors, process control limits increased the ability to detect systematic errors using routine measurement of electron beam energy constancy.

07 ISOTOPE AND RADIATION SOURCES↗

DOE OSTI2016

SU-F-T-578: Characterization of Vidar DosimetryPro Advantage RED Scanner with Application to SBRT and SRS QA

Purpose: To use Gafchromic EBT3 film to quantify key dosimetric characteristics of the Vidar DosimetryPro Advantage RED film scanner for use in SBRT/SRS QA, by analyzing scanner uniformity and dose sensitivity. Method: Gafchromic EBT3 film was used in this study. Films were irradiated using 6MV FFF and 10MV FFF beams from a Varian Edge linear accelerator, with setup of 100cm SAD at depth 5 cm. Nine doses were delivered per film, with calibration dose ranges of 1–10 Gy and 3–24 Gy for 6MV FFF, and 3–27 Gy for 10MV FFF. Films were scanned with the long side of the film parallel to the detector array. Dose calibration curves were fitted to a 3rd degree polynomial. The derivative of a calibration curve was taken to determine the scanner’s sensitivity per dose delivered (OD/Gy). Scanner non-uniformity was calculated in 2 dimensions by taking the mean of standard deviation in each row and column. Absolute dose SRS/SBRT Gamma analyses were performed with passing criteria of 3% and 1mm DTA. For comparison, Gamma analyses were also performed using an Epson Expression 10000 XL. Results: Uniformity for the Vidar scanner was 0.37% +/− 0.03% in the perpendicular to scan direction and 0.67% +/− 0.05% in the parallel to scan direction, with an overall uniformity of 0.52% +/− 0.03%. Epson red channel uniformity was 0.85% +/− 0.05% and 0.88% +/− 0.08% for the green channel. The Vidar average dose sensitivity from 1–10 Gy was 0.112 OD/Gy and 0.061 OD/Gy for 3–24 Gy. SBRT/SRS Gamma pass rates were 97.8 +/− 1.4 for Vidar and 97.5 +/− 1.4 for Epson. Conclusion: The Vidar scanner has 41% less non-uniformity compared to Epson XL10000 green channel. The dose sensitivity is 2–3 time greater for the Vidar scanner compared to the Epson in the SRS/SBRT dose range of 5–24 Gy.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2012

Verification of dosimetric accuracy on the TrueBeam STx: Rounded leaf effect of the high definition MLC

Purpose: The dosimetric leaf gap (DLG) in the Varian Eclipse treatment planning system is determined during commissioning and is used to model the effect of the rounded leaf-end of the multileaf collimator (MLC). This parameter attempts to model the physical difference between the radiation and light field and account for inherent leakage between leaf tips. With the increased use of single fraction high dose treatments requiring larger monitor units comes an enhanced concern in the accuracy of leakage calculations, as it accounts for much of the patient dose. This study serves to verify the dosimetric accuracy of the algorithm used to model the rounded leaf effect for the TrueBeam STx, and describes a methodology for determining best-practice parameter values, given the novel capabilities of the linear accelerator such as flattening filter free (FFF) treatments and a high definition MLC (HDMLC). Methods: During commissioning, the nominal MLC position was verified and the DLG parameter was determined using MLC-defined field sizes and moving gap tests, as is common in clinical testing. Treatment plans were created, and the DLG was optimized to achieve less than 1% difference between measured and calculated dose. The DLG value found was tested on treatment plans for all energies (6 MV, 10 MV, 15 MV, 6 MV FFF, 10 MV FFF) and modalities (3D conventional, IMRT, conformal arc, VMAT) available on the TrueBeam STx. Results: The DLG parameter found during the initial MLC testing did not match the leaf gap modeling parameter that provided the most accurate dose delivery in clinical treatment plans. Using the physical leaf gap size as the DLG for the HDMLC can lead to 5% differences in measured and calculated doses. Conclusions: Separate optimization of the DLG parameter using end-to-end tests must be performed to ensure dosimetric accuracy in the modeling of the rounded leaf ends for the Eclipse treatment planning system. The difference in leaf gap modeling versus physical leaf gap dimensions is more pronounced in the more recent versions of Eclipse for both the HDMLC and the Millennium MLC. Once properly commissioned and tested using a methodology based on treatment plan verification, Eclipse is able to accurately model radiation dose delivered for SBRT treatments using the TrueBeam STx.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2014

SU-E-T-211: Induced Release of Nanocarrier Encapsulated Chemotherapeutic Drugs Using Proton Radiotherapy Beams

Purpose: The purpose of this work was to develop and validate an open source independent MU dose calculation software for S and S IMRT based in the algorithm proposed by Kung et.al. Methods: Treatment plans were done using Iplan v4.5 BrainLAB TPS and S and S IMRT modality. A 6MV photon beam produced by a Primus linear accelerator equipped with an Optifocus MLC was used. TPS dose calculation algorithms were pencil beam and Monte Carlo. 230 IMRT treatments plans were selected for the study. The software was written under MALTLAB environment. Treatment plans were imported by the software using RTP format. Field fluences were reconstructed adding all segments.The algorithm implemented in the software calculates the dose at a reference point as the sum of primary and scatter dose. The primary dose is obtained by masking the fluence map with a circle of radius 1cm. The scatter dose is obtained through a shaped ring mask around the previous circle with a thickness of 0.5cm; the rings are increased one after another with constant thickness until cover the entire map of influence. The dosimetric parameters Sc, Sp and TPR vary depending on radio, the transmission effect of the MLC, inverse square law and dose profile are used for the calculation. Results: The average difference between measured and independent calculated dose was 0.4% ± 2.2% [−6.8%, 6.4%]. For 91% of the studied plans the difference was less than 3%. The difference between the measured and TPS dose with pencilbeam algorithm was 2.6% ± 1.41% [−2.0%, 5.6%] and Monte Carlo algorithm was 0.4% ± 1.5% [−4.9%, 3.7%]. The differences obtained are comparable to that obtained with the ionization chamber and TPS. Conclusion: The developed software is suitable for use in S and S IMRT dose calculation. This application is open and can be downloading under request.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

SU-E-T-115: Analysis of Patient Specific QA for VMAT by Disease Site and Planning-Delivery System Using the ScandiDos Delta4 Phantom

Purpose: To evaluate patient specific quality assurance (PSQA) for the delivery of volumetric modulated arc therapy (VMAT) by disease site. To compare planning-delivery system (PDS) PSQA pass rates in a dual vendor institution. Methods: PSQA is performed for VMAT plans using a ScandiDos Delta4 phantom. Verification plans are calculated using Varian Eclipse and Elekta Monaco treatment planning systems (TPS) for patients treated using Varian Truebeam and Elekta linear accelerators respectively. Individual arcs are delivered to the Delta4 phantoms and assessed using the gamma index pass criterion(3% Dose Deviation(DD%), 3mm Distance to Agreement(DTA),10% dose threshold and 90% gamma index). Results: A total of 287 VMAT plans and 680 arcs were analyzed. The passing rates for VMAT QA plans were 95% and 98% for head/neck and pelvis/prostate plans respectively, and 100% for chest/abdomen, spine, lung Stereotactic Body Radiotherapy (SBRT) and Stereotactic Radiosurgery(SRS) plans. Average gamma indices were: (99 ± 2) % for pelvis/prostate, chest/abdomen and lung SBRT plans, (97 ± 4) % for head and neck plans and (98 ± 3) % for spine plans. The average DD% and DTA pass rates ranged from 82% to 90% and 98% to 99% respectively for plans in different disease sites. Paired t-test analysis (two tails) indicated no significant differences in the gamma indices between plans delivered using different PDS; the P values were: 0.08, 0.45, and 0.94 for lung SBRT, head/neck and pelvis/prostate plans respectively. The statistical power for comparing PDS in different disease sites with an alpha of 0.05 is 1. Conclusion: The Gamma indices based on 3% DD%, 3 mm DTA and 10% dose threshold for the VMAT QA plans in all disease sites were well above 90%, suggesting the possibility of using a more stringent PSQA criterion. No significant differences were observed in the QA of VMAT plans delivered using different PDS.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2014

SU-E-J-167: Improvement of Time-Ordered Four Dimensional Cone-Beam CT; Image Mosaicing with Real and Virtual Projections

Purpose: In the previous study, we developed time-ordered fourdimensional (4D) cone-beam CT (CBCT) technique to visualize nonperiodic organ motion, such as peristaltic motion of gastrointestinal organs and adjacent area, using half-scan reconstruction method. One important obstacle was that truncation of projection was caused by asymmetric location of flat-panel detector (FPD) in order to cover whole abdomen or pelvis in one rotation. In this study, we propose image mosaicing to extend projection data to make possible to reconstruct full field-of-view (FOV) image using half-scan reconstruction. Methods: The projections of prostate cancer patients were acquired using the X-ray Volume Imaging system (XVI, version 4.5) on Synergy linear accelerator system (Elekta, UK). The XVI system has three options of FOV, S, M and L, and M FOV was chosen for pelvic CBCT acquisition, with a FPD panel 11.5 cm offset. The method to produce extended projections consists of three main steps: First, normal three-dimensional (3D) reconstruction which contains whole pelvis was implemented using real projections. Second, virtual projections were produced by reprojection process of the reconstructed 3D image. Third, real and virtual projections in each angle were combined into one extended mosaic projection. Then, 4D CBCT images were reconstructed using our inhouse reconstruction software based on Feldkamp, Davis and Kress algorithm. The angular range of each reconstruction phase in the 4D reconstruction was 180 degrees, and the range moved as time progressed. Results: Projection data were successfully extended without discontinuous boundary between real and virtual projections. Using mosaic projections, 4D CBCT image sets were reconstructed without artifacts caused by the truncation, and thus, whole pelvis was clearly visible. Conclusion: The present method provides extended projections which contain whole pelvis. The presented reconstruction method also enables time-ordered 4D CBCT reconstruction of organs with non-periodic motion with full FOV without projection-truncation artifacts. This work was partly supported by the JSPS Core-to-Core Program(No. 23003). This work was partly supported by JSPS KAKENHI 24234567.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2014

Sci—Thur PM: Imaging — 03: A novel Čerenkov detector based on air-spaced light guiding taper for megavoltage x-ray imaging

Electronic Portal Imaging Devices (EPIDs) have been used in radiation therapy and are still needed on linear accelerators (Linacs) equipped with kilovoltage cone beam CT (kV-CBCT) or MRI systems. Recently a new concept of a high quantum efficiency (QE) Čerenkov Portal Imaging Device (CPID) for MV x-ray imaging in radiation therapy was introduced. It relies on Čerenkov effect for x-ray detection. The proposed design consisted of a matrix of optical fibres aligned with the incident x-rays and coupled to an active matrix flat panel imager (AMFPI) for image readout. A weakness of such design is that too few Čerenkov light photons reach the AMFPI for each incident x-ray and an AMFPI with an avalanche gain is required. In this work we propose to replace the optical fibers in the CPID with light guides without a cladding layer that are suspended in air. The air between the light guides takes on the role of the cladding layer found in a regular optical fiber. Since air has a significantly lower refractive index, a much superior light collection efficiency is achieved. Our Monte Carlo studies have shown that the modified new CPID has a QE more than an order of magnitude greater than that of current clinical systems and yet a spatial resolution similar to that of current flat-panel based EPIDs. Furthermore it has been demonstrated that the new CPID does not require an avalanche gain in the AMFPI and is quantum noise limited at dose levels corresponding to a single Linac pulse.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗

DOE OSTI2015

SU-E-T-465: Implementation of An Automated Collision Detection Program Using Open Source Software for the Pinnacle Treatment Planning System

Purpose: Potential collisions between the gantry head and the patient or table assembly are difficult to detect in most treatment planning systems. We have developed and implemented a novel software package for the representation of potential gantry collisions with the couch assembly at the time of treatment planning. Methods: Physical dimensions of the Varian Edge linear accelerator treatment head were measured and reproduced using the Visual Python display package. A script was developed for the Pinnacle treatment planning system to generate a file with the relevant couch, gantry, and isocenter positions for each beam in a planning trial. A python program was developed to parse the information from the TPS and produce a representative model of the couch/gantry system. Using the model and the Visual Python libraries, a rendering window is generated for each beam that allows the planner to evaluate the possibility of a collision. Results: Comparison against heuristic methods and direct verification on the machine validated the collision model generated by the software. Encounters of <1 cm between the gantry treatment head and table were visualized as collisions in our virtual model. Visual windows were created depicting the angle of collision for each beam, including the anticipated table coordinates. Visual rendering of a 6 arc trial with multiple couch positions was completed in under 1 minute, with network bandwidth being the primary bottleneck. Conclusion: The developed software allows for quick examination of possible collisions during the treatment planning process and helps to prevent major collisions prior to plan approval. The software can easily be implemented on future planning systems due to the versatility and platform independence of the Python programming language. Further integration of the software with the treatment planning system will allow the possibility of patient-gantry collision detection for a range of treatment machines.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2014

SU-E-T-95: Delivery Time Estimator

Purpose: The development and testing of a tool for the inclusion of delivery time as a parameter in plan optimization. Methods: We developed an algorithm that estimates the time required for the machine and personnel movements required to deliver a treatment plan on a linear accelerator. We included dose rate, leaf motion, collimator motion, gantry motion, and couch motions (including time to enter the room to rotate the couch safely). Vault-specific parameters to account for time to enter and perform couch angle adjustments were also included. This algorithm works for static, step and shoot IMRT, and VMAT beams photon beams and for fixed electron beams. This was implemented as a script in our treatment planning system. We validated the estimator against actual recorded delivery time from our R and V system as well as recorded times from our IMRT QA delivery. Results: Data was collected (Figure 1) for 12 treatment plans by examining the R and V beam start times, and by manually timing the QA treatment for a reference, but the QA measurements were only significant to the nearest minute. The average difference between the estimated and R and V times was 15%, and 11% when excluding the major outliers. Outliers arose due to respiratory aides and gating techniques which could not be accounted for in the estimator. Conclusion: Non-mechanical factors such as the time a therapist needs to walk in and out of the room to adjust the couch needed to be fine-tuned and cycled back into the algorithm to improve the estimate. The algorithm has been demonstrated to provide reasonable and useful estimates for delivery time. This estimate has provided a useful additional input for clinical decision-making when comparing several potential radiation treatment options.

07 ISOTOPE AND RADIATION SOURCES↗

DOE OSTI2014

SU-E-T-210: Independent MU Dose Calculation Software for S and S IMRT Using Modified Clarkson Integration Sector

07 ISOTOPE AND RADIATION SOURCES↗