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DOE OSTI2015

Development of intelligent instruments with embedded HTTP servers for control and data acquisition in a cryogenic setup—The hardware, firmware, and software implementation

The power of Ethernet for control and automation technology is being largely understood by the automation industry in recent times. Ethernet with HTTP (Hypertext Transfer Protocol) is one of the most widely accepted communication standards today. Ethernet is best known for being able to control through internet from anywhere in the globe. The Ethernet interface with built-in on-chip embedded servers ensures global connections for crate-less model of control and data acquisition systems which have several advantages over traditional crate-based control architectures for slow applications. This architecture will completely eliminate the use of any extra PLC (Programmable Logic Controller) or similar control hardware in any automation network as the control functions are firmware coded inside intelligent meters itself. Here, we describe the indigenously built project of a cryogenic control system built for linear accelerator at Inter University Accelerator Centre, known as “CADS,” which stands for “Complete Automation of Distribution System.” CADS deals with complete hardware, firmware, and software implementation of the automated linac cryogenic distribution system using many Ethernet based embedded cryogenic instruments developed in-house. Each instrument works as an intelligent meter called device-server which has the control functions and control loops built inside the firmware itself. Dedicated meters with built-in servers were designed out of ARM (Acorn RISC (Reduced Instruction Set Computer) Machine) and ATMEL processors and COTS (Commercially Off-the-Shelf) SMD (Surface Mount Devices) components, with analog sensor front-end and a digital back-end web server implementing remote procedure call over HTTP for digital control and readout functions. At present, 24 instruments which run 58 embedded servers inside, each specific to a particular type of sensor-actuator combination for closed loop operations, are now deployed and distributed across control LAN (Local Area Network). A group of six categories of such instruments have been identified for all cryogenic applications required for linac operation which were designed to build this medium-scale cryogenic automation setup. These devices have special features like remote rebooters, daughter boards for PIDs (Proportional Integral Derivative), etc., to operate them remotely in radiation areas and also have emergency switches by which each device can be taken to emergency mode temporarily. Finally, all the data are monitored, logged, controlled, and analyzed online at a central control room which has a user-friendly control interface developed using LabVIEW{sup ®}. This paper discusses the overall hardware, firmware, software design, and implementation for the cryogenics setup.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗
DOE OSTI2013

Three independent one-dimensional margins for single-fraction frameless stereotactic radiosurgery brain cases using CBCT

Purpose: Setting a proper margin is crucial for not only delivering the required radiation dose to a target volume, but also reducing the unnecessary radiation to the adjacent organs at risk. This study investigated the independent one-dimensional symmetric and asymmetric margins between the clinical target volume (CTV) and the planning target volume (PTV) for linac-based single-fraction frameless stereotactic radiosurgery (SRS).Methods: The authors assumed a Dirac delta function for the systematic error of a specific machine and a Gaussian function for the residual setup errors. Margin formulas were then derived in details to arrive at a suitable CTV-to-PTV margin for single-fraction frameless SRS. Such a margin ensured that the CTV would receive the prescribed dose in 95% of the patients. To validate our margin formalism, the authors retrospectively analyzed nine patients who were previously treated with noncoplanar conformal beams. Cone-beam computed tomography (CBCT) was used in the patient setup. The isocenter shifts between the CBCT and linac were measured for a Varian Trilogy linear accelerator for three months. For each plan, the authors shifted the isocenter of the plan in each direction by ±3 mm simultaneously to simulate the worst setup scenario. Subsequently, the asymptotic behavior of the CTV V{sub 80%} for each patient was studied as the setup error approached the CTV-PTV margin.Results: The authors found that the proper margin for single-fraction frameless SRS cases with brain cancer was about 3 mm for the machine investigated in this study. The isocenter shifts between the CBCT and the linac remained almost constant over a period of three months for this specific machine. This confirmed our assumption that the machine systematic error distribution could be approximated as a delta function. This definition is especially relevant to a single-fraction treatment. The prescribed dose coverage for all the patients investigated was 96.1%± 5.5% with an extreme 3-mm setup error in all three directions simultaneously. It was found that the effect of the setup error on dose coverage was tumor location dependent. It mostly affected the tumors located in the posterior part of the brain, resulting in a minimum coverage of approximately 72%. This was entirely due to the unique geometry of the posterior head.Conclusions: Margin expansion formulas were derived for single-fraction frameless SRS such that the CTV would receive the prescribed dose in 95% of the patients treated for brain cancer. The margins defined in this study are machine-specific and account for nonzero mean systematic error. The margin for single-fraction SRS for a group of machines was also derived in this paper.

61 RADIATION PROTECTION AND DOSIMETRY↗
DOE OSTI2016

TH-CD-207A-10: Using the Gamma Index to Flag Changes in Anatomy During Radiation Therapy of Head and Neck Cancer

Purpose: This article presents a fast algorithm for comparing 3-D anatomy from Cone-Beam CT (CBCT) imaging using the gamma comparison index and to demonstrate how this can be used to flag patients for possible re-planning of treatment. Methods: CBCT scans acquired on a Varian linear accelerator during treatment were used as input to the gamma comparator using thresholds of 5 mm distance to agreement and 30 Hounsfield Unit CT number difference. The fraction 1 CBCT study was initially used as the reference. Should there be a re-plan during treatment, the reference resets to the CBCT study acquired on the day 1 of the re-plan. Histograms of failing pixels (γ > 1) were generated from each 3-D gamma map. An indicator of anatomy congruence, the match quality parameter (MQP), was derived from failed pixel histograms using the 90th percentile gamma value. The MQP was plotted versus fraction number and related to actual repeat computed tomography (re-CT) order dates as decided by a radiation oncologist. From this, decision criteria were derived for the algorithm to “trigger” re-CT consideration and predictive power was scored using receiver-operator characteristic (ROC) analysis. Results: The MQP plot generally showed that the on-line match from CBCT image guidance deteriorated as the treatment progressed due to weight loss and tumor regression. The optimized MQP criteria for triggering re-CT consideration demonstrated high sensitivity and specificity, consistent with actual re-CT order dates within ± 3 fractions. Out of 20 patients that were actually re-planned, the algorithm failed to trigger a re-CT recommendation only twice and this was caused by CBCT ring artifacts. Conclusion: We have demonstrated that gamma comparisons can be used to evaluate CBCT-acquired anatomy pairs and, from this, an algorithm can be “trained” to flag patients for possible re-planning in a manner consistent with local radiation oncology practice.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

Skin Dosimetry in Breast Teletherapy on a Phantom Anthropomorphic and Anthropometric Phantom

This paper addresses the breast teletherapy dosimetry. The goal is to evaluate and compare absorbed doses in equivalent skin tissue, TE-skin, of an anthropomorphic and anthropometric breast phantom submitted to breast radiotherapy. The methodology involved the reproduction of a set of tomographic images of the phantom; the elaboration of conformational radiotherapy planning in the SOMAVISION and CadPlan (TPS) software; and the synthetic breast irradiation by parallel opposed fields in 3D conformal teletherapy at 6 MV linear accelerator Clinac-2100 C from VARIAN with prescribed dose (PD) of 180 cGy to the target volume (PTV), referent to the glandular tissue. Radiochromic films EBT2 were selected as dosimeters. Two independent calibration processes of films with solid water Gammex 457 plates and water filled box were produced. Curves of optical density (OD) versus absorbed dose were produced. Dosimeters were positioned in the external region of the breast phantom in contact with TE-skin, area of 4.0 cm{sup 2} each. The irradiation process was prepared in duplicate to check the reproducibility of the technique. The radiochromic films were scanned and their response in RGB (Red, Green, Blue) analyzed by the ImageJ software. The optical density was obtained and converted to dose based on the calibration curves. Thus, the spatial dose distribution in the skin was reproduced. The absorbed doses measured on the radiochromic films in TE-skin showed values between upper and lower quadrants at 9 o'clock in the range of 54% of PD, between the upper and lower quadrants 3 o'clock in the range of 72% and 6 o'clock at the lower quadrant in the range of 68 % of PD. The values are ±64% (p <0.05) according to the TPS. It is concluded that the depth dose measured in solid water plates or water box reproduce equivalent dose values for both calibration processes of the radiochromic films. It was observed that the skin received doses ranging from 50% to 78% of the prescribed dose after two parallel opposed irradiation fields. (authors)

61 RADIATION PROTECTION AND DOSIMETRY↗
DOE OSTI2015

SU-E-T-53: A New Method for Characterizing the Stability of the Treatment Couch Isocentre

Purpose: In this work we propose a new method for characterizing the accuracy of a linear accelerator treatment couch’s isocentre. This is accomplished by a direct determination of the coordinates of the center of rotation as a function of rotation angle. Methods: A phantom consisting of five metallic BBs arranged in a plane was constructed. The phantom was positioned on the treatment couch such that the plane of the BBs was horizontal, while the central BB was aligned with the linac isocentre. With the gantry in the vertical position, the couch was rotated through its full range of rotation while EPID images were acquired every 10 degrees. For each rotation angle, the coordinates of the rotation center were calculated from the displacement of each of the four off-center BBs identified on a pair of EPID images taken between successive rotations. The accuracy of the couch isocentre was evaluated from the distribution of the rotation center coordinates. Our results were compared with film based star-shot measurements of the couch isocentre. Results: The measured couch center of rotation consisted of a cloud of points clustered around the linac isocentre within < 0.7 mm distance. The deviations of these points from the linac isocentre were in the range of 0.01 to 0.20 mm in the cross-plane direction, and 0.10 to 0.61 mm in the in-plane direction, with mean values of 0.09 mm and 0.32 mm. These results were consistent with the results obtained from the star-shot method. Conclusion: A new method for determining the location and accuracy of the couch center of rotation has been successfully implemented. This method gives explicit values of the location and the stability of the couch isocentre, and it can be extended to gantry and collimator rotations.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

MO-FG-202-03: Efficient Data Collection of Continuous 2D and Discrete Relative Dosimetric Data for Annual LINAC QA Using TrueBeam Developer Mode and a 1D Scanning Tank

Purpose: To develop a method to exploit real-time dynamic machine and couch parameter control during linear accelerator (LINAC) beam delivery to facilitate efficient performance of TG-142 suggested, Annual LINAC QA tests. Methods: Varian’s TrueBeam Developer Mode (Varian Medical Systems, Palo Alto, CA) facilitates control of Varian’s TrueBeam LINAC via instructions provided in Extensible Markup Language (XML) files. This allows machine and couch parameters to be varied dynamically, in real-time, during beam delivery. Custom XML files were created to allow for the collection of (1) continuous Tissue Maximum Ratios (TMRs), (2) beam profiles, and (3) continuous output factors using a 1D-scanning tank. TMRs were acquired by orienting an ionization chamber (IC) at isocenter (depth=25cm) and synchronizing a depth scan towards the water surface while lowering the couch at 1mm/s. For beam profiles, the couch was driven laterally and longitudinally while logging IC electrometer readings. Output factors (OFs) where collected by continually varying field sizes (4×4 to 30×30-cm{sup 2}) at a constant speed of 6.66 mm/s. To validate measurements, comparisons were made to data collected using traditional methods (e.g. 1D or 3D tank). Results: All data collecting using the proposed methods agreed with traditionally collected data (TMRs within 1%, OFs within 0.5% and beam profile agreement within 1% / 1mm) while taking less time to collect (factor of approximately 1/10) and with a finer sample resolution. Conclusion: TrueBeam developer mode facilitates collection of continuous data with the same accuracy as traditionally collected data with a finer resolution in less time. Results demonstrate an order of magnitude increase in sampled resolution and an order of magnitude reduction in collection time compared to traditional acquisition methods (e.g. 3D scanning tank). We are currently extending this approach to perform other TG-142 tasks.

61 RADIATION PROTECTION AND DOSIMETRY↗
DOE OSTI2015

SU-E-T-108: An Investigation of Cerenkov Light Production in the Exradin W1 Scintillator Under Various Measurement Conditions

Purpose: To investigate the effects of depth, fiber-optic cable bends, and incident radiation angle on Cerenkov production in the Standard Imaging Exradin W1. Methods: Measurements were completed using a Varian Clinac 21EX linear accelerator with an Exradin W1 scintillator as well as a cable-only scintillator (no scintillation material) to isolate the Cerenkov signal. The effects of cable bend radius and location were investigated by bending the fiber-optic cable into a circle with radii ranging from 1.0 to 10.8 cm and positioning the center of the coil at distances ranging from 10.0 to 175.0 cm from the photodiode. The effects of depth and incident radiation angle were investigated by performing measurements in water at depths ranging from 1.0 cm to 25.0 cm and angles ranging from 0° to 80°. Eclipse treatment-planning software was utilized to ensure a consistent dose was delivered to the W1 regardless of depth or angle. Results: Measured signal in both channels of the cable-only scintillator decreased as the bend radius decreased and as the distance between the bend and photodiode increased. A fiber bend of 1.0 cm radius produced a 17.1% decrease in the green channel response in the cable-only scintillator. The effect of depth was less severe; a maximum increase of 6.6% in the green channel response was observed at a depth of 25.0 cm in the W1. In the angular dependence investigation, the signal in both channels of the W1 peaked at an angle of 40°; which is in agreement with the nominal Cerenkov emission angle of 45°. Conclusion: The green channel response in the W1 (mainly Cerenkov signal) varied with depth, fiber-optic cable bends, and incident radiation angle. Fully characterizing Cerenkov production is essential to ensure it is properly accounted for in scintillator measurements. Research funding and materials received by Standard Imaging, Inc. (Middleton WI)

07 ISOTOPE AND RADIATION SOURCES↗
DOE OSTI2015

SU-E-T-662: Quick and Efficient Daily QA for Compact PBS Proton Therapy Machine

Purpose: As proton therapy machines become widespread the need for a quick simple routine daily QA like that for linear accelerators becomes more important. Willis-Knighton has developed an accurate and efficient daily QA that can be performed in 15 minutes. Methods: A holder for a 2D ionization chamber array (MatriXX PT) was created that is indexed to the couch to allow for quick setup, lasers accuracy with respect to beam isocenter, and couch reproducibility. Image position/reposition was performed to check Isocentricity accuracy by placing BBs on the MatriXX. The couch coordinates are compared to that of commissioning. Laser positions were confirmed with the MatriXX isocenter. After IGRT, three beams were separately delivered according to setup. For the first beam, range shifter was inserted and dose at R90, field size, flatness and symmetry in X and Y direction was measured. R90 was used so any minor changes in the range shifter can be detected. For the open beam, dose at center of SOBP, flatness and symmetry in X and Y direction was measured. Field size was measured in ±X and ±Y direction at FWHM. This is measured so any variation in spot size will be detected. For the third beam additional solid water was added and dose at R50 was measured so that any variation in beam energy will be detected. Basic mechanical and safety checks were also performed. Results: Medical physicists were able to complete the daily QA and reduce the time by half to two-third from initial daily QA procedure. All the values measured were within tolerance of that of the baseline which was established from water tank and initial MatriXX measurements. Conclusion: The change in daily QA procedure resulted in quick and easy setup and was able to measure all the basic functionality of the proton therapy PBS.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2016

SU-F-T-448: Use of Mixed Photon Energy Beam in Volumetric Modulated Arc Therapy (VMAT) Treatment Plan for Prostate Cancer

Purpose: To study the impact of different photon beam combination during VMAT planning and treatment delivery. Methods: Five prostate patients with no nodal involvement were chosen for the study and only prostate was considered as target (7920cGy/44fractions). In each case, three different VMAT plans were generated with two arcs (200°–160°&160°–200°). First plan used only 6MV in both arcs (6X-6X) and second utilized 6MV&15MV (6X-15X), whereas third one used 15MV&15MV (15X-15X). For consistency, all the plans were generated by the same planner using Monaco− treatment planning system (V5.1) for Elekta Synergy− linear accelerator with 1cm leaf-width. For plan comparison, target mean dose, conformity index (CI)=Planning target volume (PTV) covered by 95% of prescription dose/PTV were analyzed. Mean doses of bladder, rectum, left femur and right femur were analyzed. Integral dose (liter-Gray) to normal tissue (patient volume minus PTV), total monitor unit (MU) required to deliver a plan and gamma pass rate for each plan was analyzed. Results: The CI for PTV was 0.9937±0.0037, 0.9917±0.0033, and 0.9897±0.0048 for 6X-6X, 6X-15X and 15X-15X, respectively. Mean dose to target slightly increases with the decrease of energy. Mean doses to bladder were 3546.23±692.13cGy, 3487.43±715.53cGy and 3504.40±683.1cGy for 6X-6X, 6X-15X and 15X-15X, respectively. Mean doses to rectum were 4294.60±309.5cGy, 4277.07±279.93cGy and 4290.77±379.07cGy. Mean doses to left femur were 2737.13±545.93cGy, 2668.67±407.12cGy and 2416.77±300.73cGy and mean doses to the right femur were 2682.70±460.81cGy, 2722.58±541.92cGy and 2598.57±481.83cGy. Higher Integral doses to normal tissue observed for 6X-6X (163.06±24.6 Litre-Gray) followed by 6X-15X (154.35±24.74 Litre-Gray) and 15X-15X (145.84±26.03 Litre-Gray). Average MU required to deliver one fraction was 680.75±72.09, 634.81±95.07 and 605.06±114.65. Gamma pass rates were 99.83±0.21, 99.53±0.27 and 99.2±0.20. Conclusion: 6X-15X VMAT plan offer dosimetric advantage compared to 6X-6X in terms of lesser MU and integral dose without significant compromise in plan quality, where as in 15X-15X, neutron contamination risk is relatively higher.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-473: A Patient-Specific QC Paradigm Based On Trajectory Log Files and DICOM Plan Files

Purpose: To evaluate a remote QC tool for monitoring treatment machine parameters and treatment workflow. Methods: The Varian TrueBeamTM linear accelerator is a digital machine that records machine axis parameters and MLC leaf positions as a function of delivered monitor unit or control point. This information is saved to a binary trajectory log file for every treatment or imaging field in the patient treatment session. A MATLAB analysis routine was developed to parse the trajectory log files for a given patient, compare the expected versus actual machine and MLC positions as well as perform a cross-comparison with the DICOM-RT plan file exported from the treatment planning system. The parsing routine sorts the trajectory log files based on the time and date stamp and generates a sequential report file listing treatment parameters and provides a match relative to the DICOM-RT plan file. Results: The trajectory log parsing-routine was compared against a standard record and verify listing for patients undergoing initial IMRT dosimetry verification and weekly and final chart QC. The complete treatment course was independently verified for 10 patients of varying treatment site and a total of 1267 treatment fields were evaluated including pre-treatment imaging fields where applicable. In the context of IMRT plan verification, eight prostate SBRT plans with 4-arcs per plan were evaluated based on expected versus actual machine axis parameters. The average value for the maximum RMS MLC error was 0.067±0.001mm and 0.066±0.002mm for leaf bank A and B respectively. Conclusion: A real-time QC analysis program was tested using trajectory log files and DICOM-RT plan files. The parsing routine is efficient and able to evaluate all relevant machine axis parameters during a patient treatment course including MLC leaf positions and table positions at time of image acquisition and during treatment.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-T-227: A Comprehensive Patient Specific, Structure Specific, Pre-Treatment 3D QA Protocol for IMRT, SBRT and VMAT - Clinical Experience

Purpose: To present a 3D QA method and clinical results for 550 patients. Methods: Five hundred and fifty patient treatment deliveries (400 IMRT, 75 SBRT and 75 VMAT) from various treatment sites, planned on Raystation treatment planning system (TPS), were measured on three beam-matched Elekta linear accelerators using IBA’s COMPASS system. The difference between TPS computed and delivered dose was evaluated in 3D by applying three statistical parameters to each structure of interest: absolute average dose difference (AADD, 6% allowed difference), absolute dose difference greater than 6% (ADD6, 4% structure volume allowed to fail) and 3D gamma test (3%/3mm DTA, 4% structure volume allowed to fail). If the allowed value was not met for a given structure, manual review was performed. The review consisted of overlaying dose difference or gamma results with the patient CT, scrolling through the slices. For QA to pass, areas of high dose difference or gamma must be small and not on consecutive slices. For AADD to manually pass QA, the average dose difference in cGy must be less than 50cGy. The QA protocol also includes DVH analysis based on QUANTEC and TG-101 recommended dose constraints. Results: Figures 1–3 show the results for the three parameters per treatment modality. Manual review was performed on 67 deliveries (27 IMRT, 22 SBRT and 18 VMAT), for which all passed QA. Results show that statistical parameter AADD may be overly sensitive for structures receiving low dose, especially for the SBRT deliveries (Fig.1). The TPS computed and measured DVH values were in excellent agreement and with minimum difference. Conclusion: Applying DVH analysis and different statistical parameters to any structure of interest, as part of the 3D QA protocol, provides a comprehensive treatment plan evaluation. Author G. Gueorguiev discloses receiving travel and research funding from IBA for unrelated to this project work. Author B. Crawford discloses receiving travel funding from IBA for unrelated to this project work.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-T-338: Flattening Filter Free Photon Beams Can Achieve the Same Plan Quality as Conventional Flattened Beams for Prostate Radiotherapy

Purpose: Some modern linear accelerators are equipped with one low energy flat beam and two flattening filter free (FFF) beams at high and low energies. The purpose of this study is to investigate whether the high energy FFF beam can produce the same plan quality as the conventional low energy flat beam, using a volumetric modulated arc (VMAT) technique for prostate patients. Methods: Ten prostate cancer patients were selected with a prescription of 78Gy. For each patient, three plans were created: (a) double arc flat 6MV plan used clinically; (b) double arc 10MV FFF plan; (c) single arc 10MV FFF plan. Each plan was prescribed so that at least 95% of the PTV received the prescription dose. The following dosimetric endpoints were evaluated: volume receiving 78Gy (V78) of the CTV and PTV, PTV conformality index (CI, ratio of prescription isodose volume to the PTV volume), bladder volume receiving 70Gy (V70) and 60Gy (V60), rectum volume receiving 70Gy (V70) and 50Gy (V50), dose to 10cc of the rectum, and volume of both femoral heads receiving 50Gy (V50). Total monitor units for each plan were recorded. Results: No significant difference was found for all dosimetric endpoints between all plans (p>0.05). Compared to the 6MV plans, monitor units were higher with the double arc 10MV FFF plans and lower with the single arc 10MV FFF plans, 29% and 4% respectively. Conclusion: Both single arc and double arc 10MV FFF VMAT can achieve equivalent plan quality as 6MV flat beam double arc treatment plans. With the gantry speed restriction, a high dose rate of 2400MU/min may allow the optimizer to use more MUs than actually needed. Single arc 10MV FFF VMAT plans are a reasonable alternative to double arc 6MV flat beam VMAT plans.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

Temporal regularization of ultrasound-based liver motion estimation for image-guided radiation therapy

Purpose: Ultrasound-based motion estimation is an expanding subfield of image-guided radiation therapy. Although ultrasound can detect tissue motion that is a fraction of a millimeter, its accuracy is variable. For controlling linear accelerator tracking and gating, ultrasound motion estimates must remain highly accurate throughout the imaging sequence. This study presents a temporal regularization method for correlation-based template matching which aims to improve the accuracy of motion estimates. Methods: Liver ultrasound sequences (15–23 Hz imaging rate, 2.5–5.5 min length) from ten healthy volunteers under free breathing were used. Anatomical features (blood vessels) in each sequence were manually annotated for comparison with normalized cross-correlation based template matching. Five sequences from a Siemens Acuson™ scanner were used for algorithm development (training set). Results from incremental tracking (IT) were compared with a temporal regularization method, which included a highly specific similarity metric and state observer, known as the α–β filter/similarity threshold (ABST). A further five sequences from an Elekta Clarity™ system were used for validation, without alteration of the tracking algorithm (validation set). Results: Overall, the ABST method produced marked improvements in vessel tracking accuracy. For the training set, the mean and 95th percentile (95%) errors (defined as the difference from manual annotations) were 1.6 and 1.4 mm, respectively (compared to 6.2 and 9.1 mm, respectively, for IT). For each sequence, the use of the state observer leads to improvement in the 95% error. For the validation set, the mean and 95% errors for the ABST method were 0.8 and 1.5 mm, respectively. Conclusions: Ultrasound-based motion estimation has potential to monitor liver translation over long time periods with high accuracy. Nonrigid motion (strain) and the quality of the ultrasound data are likely to have an impact on tracking performance. A future study will investigate spatial uniformity of motion and its effect on the motion estimation errors.

61 RADIATION PROTECTION AND DOSIMETRY↗
DOE OSTI2012

High-dose MVCT image guidance for stereotactic body radiation therapy

Purpose: Stereotactic body radiation therapy (SBRT) is a potent treatment for early stage primary and limited metastatic disease. Accurate tumor localization is essential to administer SBRT safely and effectively. Tomotherapy combines helical IMRT with onboard megavoltage CT (MVCT) imaging and is well suited for SBRT; however, MVCT results in reduced soft tissue contrast and increased image noise compared with kilovoltage CT. The goal of this work was to investigate the use of increased imaging doses on a clinical tomotherapy machine to improve image quality for SBRT image guidance. Methods: Two nonstandard, high-dose imaging modes were created on a tomotherapy machine by increasing the linear accelerator (LINAC) pulse rate from the nominal setting of 80 Hz, to 160 Hz and 300 Hz, respectively. Weighted CT dose indexes (wCTDIs) were measured for the standard, medium, and high-dose modes in a 30 cm solid water phantom using a calibrated A1SL ion chamber. Image quality was assessed from scans of a customized image quality phantom. Metrics evaluated include: contrast-to-noise ratios (CNRs), high-contrast spatial resolution, image uniformity, and percent image noise. In addition, two patients receiving SBRT were localized using high-dose MVCT scans. Raw detector data collected after each scan were used to reconstruct standard-dose images for comparison. Results: MVCT scans acquired using a pitch of 1.0 resulted in wCTDI values of 2.2, 4.7, and 8.5 cGy for the standard, medium, and high-dose modes respectively. CNR values for both low and high-contrast materials were found to increase with the square root of dose. Axial high-contrast spatial resolution was comparable for all imaging modes at 0.5 lp/mm. Image uniformity was improved and percent noise decreased as the imaging dose increased. Similar improvements in image quality were observed in patient images, with decreases in image noise being the most notable. Conclusions: High-dose imaging modes are made possible on a clinical tomotherapy machine by increasing the LINAC pulse rate. Increasing the imaging dose results in increased CNRs; making it easier to distinguish the boundaries of low contrast objects. The imaging dose levels observed in this work are considered acceptable at our institution for SBRT treatments delivered in 3-5 fractions.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-J-209: Geometric Distortion at 3T in a Commercial 4D MRI-Compatible Phantom

Purpose: There are very few commercial 4D phantoms that are marketed as MRI compatible. We are evaluating one such commercial phantom, made to be used with an MRI-Linear accelerator. The focus of this work is to characterize the geometric distortions produced in this phantom at 3T using 3 clinical MR pulse sequences. Methods: The CIRS MRI-Linac Dynamic Phantom (CIRSTM) under investigation in this study consists of a softwaredriven moving tumour volume within a thorax phantom body and enables dose accumulation by placing a dosimeter within the tumour volume. Our initial investigation is to evaluate the phantom in static mode prior to examining its 4D capability. The water-filled thorax phantom was scanned using a wide-bore Philips 3T Achieva MRI scanner employing a Thoracic xl coil and clinical 2D T1W FFE, 2D T1W TSE and 3D T1W TFE pulse sequences. Each of the MR image sets was rigidly fused with a reference CT image of the phantom employing a rigid registration with 6 degrees of freedom. Geometric distortions between the MR and CT image sets were measured in 3 dimensions at selected points along the periphery of the distortion grid embedded within the phantom body (11.5, 7.5 and 3 cm laterally, ant/post and sup/inf of magnetic isocenter respectively). Results: The maximal measured geometric distortions between the MR and reference CT points of interest were 0.9, 1.8 and 1.3 mm in the lateral, anteriorposterior and cranio-caudal directions, respectively. For all 3 spatial dimensions, the maximal distortions occurred for the FFE pulse sequence. Maximal distortions for the 2D FFE, 2D TSE and 3D TFE sequences were 1, 0.7 and 1.8 mm, respectively. Conclusion: Our initial static investigation of this phantom shows minimal geometric distortions at 3T along the periphery of the embedded grid. CIRS has provided us with a phantom at no charge for evaluation at 3 Tesla.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

MO-FG-CAMPUS-TeP2-02: First Experiences and Perspectives in Using Direct Multicriteria Optimization (MCO) On Volumetric-Modulated Arc Therapy (VMAT) for Head and Neck Cancer

Purpose: To report the first experiences and perspectives in using direct multicriteria optimization (MCO) on volumetric-modulated arc therapy (VMAT) for head and neck (H&N) cancer. Methods: Ten prior patients with tumors in representative H&N regions were selected to evaluate direct MCO-VMAT in RayStation v5.0 beta. The patients were previously treated by intensity-modulated radiation therapy (IMRT) with MCO on an Elekta linear accelerator with Agility multileaf collimator. To avoid radiating eyes and shoulders, MCO-VMAT required one to three partial-arc groups, with each group consisting of single or dual arcs. All MCO-VMAT plans were approved by a radiation oncologist. The MCO-VMAT and MCO-IMRT plans were compared using V{sub 100}, D{sub 5}, homogeneity index (HI) and conformity index (CI) for planning target volume (PTV), D{sub mean} and D{sub 50} for six parallel organs and D{sub max} for five serial organs. Patient-specific quality assurance (QA) was performed using ArcCHECK for MCO-VMAT and Matrixx for MCO-IMRT with results analyzed using gamma criteria of 3%/3mm. Results: MCO-VMAT provided better V{sub 100} (+0.8%) lower D{sub 5}(− 0.3 Gy), lower HI (−0.27) and comparable CI (+0.05). MCO-VMAT decreased D{sub mean} and D{sub 50} for multiple parallel organs in seven of the ten patients. On average the reduction ranged from 2.1 (larynx) to 7.6 Gy (esophagus). For the nasal cavity and nasopharynx plans significant reduction in D{sub max} was observed for optics (up to 11 Gy) brainstem (6.4 Gy), cord (2.1 Gy) and mandible (6.7 Gy). All MCO-VMAT and -IMRT plans passed clinical QA. MCO-VMAT required slightly longer planning time due to the more complex VMAT optimization. The net beam-on time for the MCO-VMAT plans ranged from 80 to 242 seconds, up to 9 minutes shorter than MCO-IMRT. Conclusion: With similar target coverage, reduced organ dose, comparable planning time, and significantly faster treatment, MCO-VMAT is very likely to become the modality of choice in RayStation v5.0 for H&N cancer.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-J-233: A Facility for Radiobiological Experiments in a Large Magnetic Field

Purpose: There is considerable interest in developing medical linear accelerators with integrated image guidance by MRI. Less work has been done on the fundamental biology of cell survival in the presence of a strong magnetic field. The purpose of this work is to describe an experimental system capable of measuring cell survival response in the types of MRI-linac systems currently under development. Methods: We have integrated a cobalt irradiator with a solenoid magnet. The solenoid magnet has inner diameter of 10 cm. To enable measurement of the biological effects as a function of depth, we are utilizing the sliced gel technique, in which cells are embedded and fixed within a gelatin matrix. Irradiated cells at defined positions (sub mm resolution) can subsequently be recovered and assessed for cell survival or other biological effects. Results: The magnetic field profile in the solenoid has a peak magnetic field 36 cm below the top edge of the magnet bore and can be placed at and SAD of 100 cm. At a solenoid current of 35 A, the peak magnetic field is 0.25 T. The dose rate of the cobalt irradiator is 16 cGy/min at 100 cm SAD. EBT3 film was used to demonstrate the system functionality. It was irradiated at 1 cm depth at 100 cm SSD with a 4×4 field to 1.5 Gy in a 0.25 T magnetic field. The dose profile was similar between this film and the control exposure without magnetic field. Conclusion: Integrating a cobalt irradiator with a high field magnet is demonstrated. The magnetic field at the cobalt defining head was minimal and did not interfere with the functioning of this unit. Cell survival experiments can be reproduced exactly in the presence or absence of a magnetic field since a resistive magnet is used.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

TU-C-BRE-03: Aggregation of Linac Measurement Data

Purpose: Accurate data of linear accelerator radiation characteristics is important for treatment planning system commissioning as well as regular quality assurance of the machine. The RPC has performed site visits of numerous machines . Data gathered from Varian machines from the past 15 years are presented. The data collected can be used as a secondary check or when commissioning a new machine to verify that values are reasonable. Methods: Data from the past 15 years of RPC site visits was compiled and analyzed. Data was composed from measurements from approximately 400 Varian machines. Each dataset consists of several point measurements at various locations in a water phantom to measure percentage depth dose, output factors, including small MLC fields, off-axis factors, and wedge factors if applicable. Common statistical values are presented for each machine type. Where applicable, data was compared to other reference data given by the vendor or a select number of previous researchers. Results: Data is separated by energy and parameter and then analyzed by machine class. Data distributions of the parameter data were normal except occasionally at the tails. Distributions of the data for each class and parameter are tabulated to give not simply a singular reference value, but metrics about the distribution: 5th and 95th percentile values and the standard deviation as well as the median. Conclusion: The RPC has collected numerous data on Varian linacs and presented the finding of the past 15 years. The data can be used as a reference data set for physicists to compare against. A linac that deviates from the values does not necessarily indicate there is a problem as long as the treatment planning system correlates to the machine. Comparison of linac and treatment planning system data to external reference data can prevent serious treatment errors.

07 ISOTOPE AND RADIATION SOURCES↗