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DOE OSTI2014

SU-E-T-284: Revisiting Reference Dosimetry for the Model S700 Axxent 50 KV{sub p} Electronic Brachytherapy Source

Purpose: The model S700 Axxent electronic brachytherapy source by Xoft was characterized in 2006 by Rivard et al. The source design was modified in 2006 to include a plastic centering insert at the source tip to more accurately position the anode. The objectives of the current study were to establish an accurate Monte Carlo source model for simulation purposes, to dosimetrically characterize the new source and obtain its TG-43 brachytherapy dosimetry parameters, and to determine dose differences between the source with and without the centering insert. Methods: Design information from dissected sources and vendor-supplied CAD drawings were used to devise the source model for radiation transport simulations of dose distributions in a water phantom. Collision kerma was estimated as a function of radial distance, r, and polar angle, θ, for determination of reference TG-43 dosimetry parameters. Simulations were run for 10{sup 10} histories, resulting in statistical uncertainties on the transverse plane of 0.03% at r=1 cm and 0.08% at r=10 cm. Results: The dose rate distribution the transverse plane did not change beyond 2% between the 2006 model and the current study. While differences exceeding 15% were observed near the source distal tip, these diminished to within 2% for r>1.5 cm. Differences exceeding a factor of two were observed near θ=150° and in contact with the source, but diminished to within 20% at r=10 cm. Conclusions: Changes in source design influenced the overall dose rate and distribution by more than 2% over a third of the available solid angle external from the source. For clinical applications using balloons or applicators with tissue located within 5 cm from the source, dose differences exceeding 2% were observed only for θ>110°. This study carefully examined the current source geometry and presents a modern reference TG-43 dosimetry dataset for the model S700 source.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-472: A Multi-Dimensional Measurements Comparison to Analyze a 3D Patient Specific QA Tool

Purpose: To quantitatively evaluate a 3D patient specific QA tool using 2D film and 3D Presage dosimetry. Methods: A brain IMRT case was delivered to Delta4, EBT2 film and Presage plastic dosimeter. The film was inserted in the solid water slabs at 7.5cm depth for measurement. The Presage dosimeter was inserted into a head phantom for 3D dose measurement. Delta4's Anatomy software was used to calculate the corresponding dose to the film in solid water slabs and to Presage in the head phantom. The results from Anatomy were compared to both calculated results from Eclipse and measured dose from film and Presage to evaluate its accuracy. Using RIT software, we compared the “Anatomy” dose to the EBT2 film measurement and the film measurement to ECLIPSE calculation. For 3D analysis, DICOM file of “Anatomy” was extracted and imported to CERR software, which was used to compare the Presage dose to both “Anatomy” calculation and ECLIPSE calculation. Gamma criteria of 3% - 3mm and 5% - 5mm was used for comparison. Results: Gamma passing rates of film vs “Anatomy”, “Anatomy” vs ECLIPSE and film vs ECLIPSE were 82.8%, 70.9% and 87.6% respectively when 3% - 3mm criteria is used. When the criteria is changed to 5% - 5mm, the passing rates became 87.8%, 76.3% and 90.8% respectively. For 3D analysis, Anatomy vs ECLIPSE showed gamma passing rate of 86.4% and 93.3% for 3% - 3mm and 5% - 5mm respectively. The rate is 77.0% for Presage vs ECLIPSE analysis. The Anatomy vs ECLIPSE were absolute dose comparison. However, film and Presage analysis were relative comparison Conclusion: The results show higher passing rate in 3D than 2D in “Anatomy” software. This could be due to the higher degrees of freedom in 3D than in 2D for gamma analysis.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-476: Quality Assurance for Gamma Knife Perfexion Using the Exradin W1 Plastic Scintillation Detector

Purpose: To perform dose profile and output factor measurements for the Exradin W1 plastic scintillation detector (PSD) for the Gamma Knife Perfexion (GKP) collimators in a Lucy phantom and to compare these values to an Exradin A16 ion chamber, EBT3 radiochromic film and treatment planning system (TPS) data. Methods: We used the Exradin W1 PSD which has a small volume, near-water equivalent sensitive element. It has also been shown to be energy independent. This new detector is manufactured and distributed by Standard Imaging, Inc. Measurements were performed for all three collimators (4 mm, 8 mm and 16 mm) for the GKP. The Lucy phantom with the PSD inserted was moved in small steps to acquire profiles in all three directions. EBT3 film was inserted in the Lucy phantom and exposed to a single shot for each collimator. Relative output factors were measured using the three detectors while profiles acquired with the PSD were compared to the ones measured with EBT3 radiochromic film. Results: Measured output factors relative to the largest collimator are as followsCollimator PS EBT3 A1616mm 1.000 1.000 1.0008mm 0.892 0.881 0.8834mm 0.795 0.793 0.727 The nominal (vendor) OFs for GKP are 1.000, 0.900, and 0.814, for collimators 16 mm, 8 mm and 4 mm, respectively. There is excellent agreement between all profiles measured with the PSD and EBT3 as well as with the TPS data provided by the vendor. Conclusion: Output factors measured with the W1 were consistent with the ones measured with EBT3 and A16 ion chamber. Measured profiles are in excellent agreement. The W1 detector seems well suited for beam QA for Gamma Knife due to its dosimetric characteristics. Sam Beddar would like to disclose a NIH/NCI SBIR Phase II grant (2R44CA153824-02A1) with Standard Imaging, Title: “Water-Equivalent Plastic Scintillation Detectors for Small Field Radiotherapy”.

07 ISOTOPE AND RADIATION SOURCES↗
DOE OSTI2014

SU-E-T-607: An Experimental Validation of Gamma Knife Based Convolution Algorithm On Solid Acrylic Anthropomorphic Phantom

Purpose: To perform dosimetric evaluation of convolution algorithm in Gamma Knife (Perfexion Model) using solid acrylic anthropomorphic phantom. Methods: An in-house developed acrylic phantom with ion chamber insert was used for this purpose. The middle insert was designed to fit ion chamber from top(head) as well as from bottom(neck) of the phantom, henceforth measurement done at two different positions simultaneously. Leksell frame fixed to phantom simulated patient treatment. Prior to dosimetric study, hounsfield units and electron density of acrylic material were incorporated into the calibration curve in the TPS for convolution algorithm calculation. A CT scan of phantom with ion chamber (PTW Freiberg, 0.125cc) was obtained with following scanning parameters: Tube voltage-110kV, Slice thickness-1mm and FOV-240mm. Three separate single shot plans were generated in LGP TPS (Version 10.1.) with collimators 16mm, 8mm and 4mm respectively for both ion chamber positions. Both TMR10 and Convolution algorithm based planning (CABP) were used for dose calculation. A dose of 6Gy at 100% isodose was prescribed at centre of ion chamber visible in the CT scan. The phantom with ion chamber was positioned in the treatment couch for dose delivery. Results: The ion chamber measured dose was 5.98Gy for 16mm collimator shot plan with less than 1% deviation for convolution algorithm whereas with TMR10 measured dose was 5.6Gy. For 8mm and 4mm collimator plan merely a dose of 3.86Gy and 2.18Gy respectively were delivered at TPS calculated time for CABP. Conclusion: CABP is expected to perform accurate prediction of time for dose delivery for all collimators, but significant variation in measured dose was observed for 8mm and 4mm collimator which may be due collimator size effect. Effect of metal artifacts caused by pins and frame on the CT scan also may have role in misinterpreting CABP. The study carried out requires further investigation.

07 ISOTOPE AND RADIATION SOURCES↗
DOE OSTI2014

SU-E-T-615: Investigation of the Dosimetric Impact of Tandem Loading in the Treatment of Cervical Cancer for HDR Brachytherapy Procedures

Purpose: To quantify the dosimetric impact of the tandem loading in the treatment of cervical cancer for HDR brachytherapy procedures. Methods: Ten patients were evaluated, each of whom received 5 fractions of treatment. Tandem and ovoid sets were inserted into the uterine cavity based on institutional protocols and procedures. Following insertion and stabilization, CT image sets of 1.5mm slice thickness were acquired and sent to the Oncentra V4.3 Treatment Planning System. Critical structures such as the CTV, bladder, rectum, sigmoid, and bowel were contoured and a fractional dose of 5.5Gy was prescribed to Point A for each patient. Six different treatment plans were created for each fraction using varying tandem weightings; from 0.5 to 1.4 times that of the ovoids. Surface dose evaluation of various ovoid diameters, 2.0-3.5cm, at the vaginal fornices was also investigated. Results: Critical structures were evaluated based on varying dose and volume constraints, in particular the 2.0 cc volume recommendation cited by the gynecological GEC-ESTRO working group. Based on dose volume histogram evaluation, a reduction of dose to the critical structures was most often discovered when the tandem weighting was increased. CTV coverage showed little change as the tandem weighting was varied. Ovoid surface dose decreased by 50-65% as the tandem weighting increased. Conclusion: The advantage of 3D planning with HDR brachytherapy is the dose optimization for each individual treatment plan. This investigation shows that by utilizing large tandem weightings, 1.4 times greater than the ovoid, one can still achieve adequate coverage of the CTV and relatively low doses to the critical structures. In some cases, one would still have to optimize further per individual case. In addition, the ovoid surface dose was greatly decreased when large tandem weighting was utilized; especially for small ovoid diameters.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

TU-F-18A-01: Preliminary Results of a Prototype Quality Control Process for Spectral CT

Purpose: A prototype quality control (QC) phantom and analysis process has been designed specifically to monitor dual-energy CT and address the current lack of quantitative oversight of the spectral capabilities of these scanners. Methods: A prototype solid water phantom was designed with multiple material inserts, and to support both head and body protocols. Inserts included tissue equivalent and material rods (iodine, iron, calcium) at various concentrations. The oval body phantom, measuring 30cm×40cm×15cm, was scanned using four dual-energy protocols with CTDIvol ranges of 19.6–62mGy (0.516 pitch) and 10.3–32.5mGy (0.984 pitch), and rotation times ranging from 0.5-1sec. The circular head phantom, measuring 22cm in diameter by 15cm, was scanned using three dual-energy protocols with CTDIvol ranges of 67–132.6mGy (0.531 pitch) and 36.7–72.7mGy (0.969 pitch), and rotation times ranging from 0.5–0.9sec. All images were reconstructed at 50, 70, 110 and 140 keV, and using a water-iodine material basis pair. The images were evaluated for iodine quantification accuracy and stability of monoenergetic reconstructions. The phantom was scanned twice on ten GE 750HD CT scanners to evaluate inter-scanner agreement, as well as ten times on a single scanner over a oneweek period to evaluate intra-scanner repeatability. Results: Preliminary analysis revealed consistent (inter- and intra-scanner) iodine quantification accuracy within 10% was only achieved for protocols in the upper half of dose levels assessed when grouped by pitch. Although all scanners undergo rigorous daily single-energy QC, iodine quantification accuracy from one scanner unexpectedly deviated from the other nine substantially. In general, inter-scanner agreement and intra-scanner repeatability varied with dose, rotation time and reconstructed keV. Conclusion: Preliminary results indicate the need for a dual-energy QC process to ensure inter-scanner agreement and intra-scanner repeatability. In particular, iodine quantification accuracy within 10% may not be achievable using lower dose techniques. Future plans include longer term dual-energy CT QC data collection. In-kind financial support was provided by GE Healthcare.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

WE-F-16A-04: Micro-Irradiator Treatment Verification with High-Resolution 3D-Printed Rodent-Morphic Dosimeters

Purpose: Pre-clinical micro-radiation therapy studies often utilize very small beams (∼0.5-5mm), and require accurate dose delivery in order to effectively investigate treatment efficacy. Here we present a novel high-resolution absolute 3D dosimetry procedure, capable of ∼100-micron isotopic dosimetry in anatomically accurate rodent-morphic phantoms Methods: Anatomically accurate rat-shaped 3D dosimeters were made using 3D printing techniques from outer body contours and spinal contours outlined on CT. The dosimeters were made from a radiochromic plastic material PRESAGE, and incorporated high-Z PRESASGE inserts mimicking the spine. A simulated 180-degree spinal arc treatment was delivered through a 2 step process: (i) cone-beam-CT image-guided positioning was performed to precisely position the rat-dosimeter for treatment on the XRad225 small animal irradiator, then (ii) treatment was delivered with a simulated spine-treatment with a 180-degree arc with 20mm x 10mm cone at 225 kVp. Dose distribution was determined from the optical density change using a high-resolution in-house optical-CT system. Absolute dosimetry was enabled through calibration against a novel nano-particle scintillation detector positioned in a channel in the center of the distribution. Results: Sufficient contrast between regular PRESAGE (tissue equivalent) and high-Z PRESAGE (spinal insert) was observed to enable highly accurate image-guided alignment and targeting. The PRESAGE was found to have linear optical density (OD) change sensitivity with respect to dose (R{sup 2} = 0.9993). Absolute dose for 360-second irradiation at isocenter was found to be 9.21Gy when measured with OD change, and 9.4Gy with nano-particle detector- an agreement within 2%. The 3D dose distribution was measured at 500-micron resolution Conclusion: This work demonstrates for the first time, the feasibility of accurate absolute 3D dose measurement in anatomically accurate rat phantoms containing variable density PRESAGE material (tissue equivalent and bone equivalent). This method enables precise treatment verification of micro-radiation therapies, and enhances the robustness of tumor radio-response studies. This work was supported by NIH R01CA100835.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

WE-G-17A-05: Real-Time Catheter Localization Using An Active MR Tracker for Interstitial Brachytherapy

Purpose: To develop a novel active MR-tracking system which can provide accurate and rapid localization of brachytherapy catheters, and assess its reliability and spatial accuracy in comparison to standard catheter digitization using MR images. Methods: An active MR tracker for brachytherapy was constructed by adding three printed-circuit micro-coils to the shaft of a commercial metallic stylet. A gel phantom with an embedded framework was built, into which fifteen 14-Gauge catheters were placed, following either with parallel or crossed paths. The tracker was inserted sequentially into each catheter, with MR-tracking running continuously. Tracking was also performed during the tracker's removal from each catheter. Catheter trajectories measured from the insertion and the removal procedures using the same micro-coil were compared, as well as trajectories obtained using different micro-coils. A 3D high-resolution MR image dataset of the phantom was acquired and imported into a treatment planning system (TPS) for catheter digitization. A comparison between MR-tracked positions and positions digitized from MR images by TPS was performed. Results: The MR tracking shows good consistency for varying catheter paths and for all micro-coils (mean difference ∼1.1 mm). The average distance between the MR-tracking trajectory and catheter digitization from the MR images was 1.1 mm. Ambiguity in catheter assignment from images due to crossed paths was resolved by active tracking. When tracking was interleaved with imaging, real-time images were continuously acquired at the instantaneous tip positions and displayed on an external workstation. Conclusion: The active MR tracker may be used to provide an independent measurement of catheter location in the MR environment, potentially eliminating the need for subsequent CT. It may also be used to control realtime imaging of catheter placement. This will enable MR-based brachytherapy planning of interstitial implants without ionizing radiation, with the potential to enable dosimetric guidance of catheter placement. We gratefully acknowledge support from the American Heart Association SDG 10SDG2610139, NIH 1R21CA158987-01A1, U41-RR019703, and R21 CA 167800, as well as a BWH Department of Radiation Oncology post-doctoral fellowship support. Li Pan and Wesley Gilson are employees of Siemens Corporation, Corporate Technology. Ravi Seethamraju is an employee of Siemens Healthcare.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

Poster — Thur Eve — 31: Dosimetric Effect of Respiratory Motion on RapidArc Lung SBRT Treatment Delivered by TrueBeam Linear Accelerator

Volumetric modulated arc therapy (VMAT) allows fast delivery of stereotactic radiotherapy. However, the discrepancies between the calculated and delivered dose distributions due to respiratory motion and dynamic multileaf collimators (MLCs) interplay are not avoidable. The purpose of this study is to investigate RapidArc lung SBRT treatment delivered by the flattening filter-free (FFF) beam and flattened beam with Varian TrueBeam machine. CIRS Dynamic Thorax Phantom with in-house made lung tumor insertion was CT scanned both in free breathing and 4DCT. 4DCT was used to determine the internal target volume. The free breathing CT scan was used for treatment planning. A 5 mm margin was given to ITV to generate a planning target volume. Varian Eclipse treatment planning was used to generate RapidArc plans based on the 6 MV flattened beam and 6MV FFF beam. The prescription dose was 48 Gy in 4 fractions. At least 95% of PTV was covered by the prescribed dose. The RapidArc plans with 6 MV flattened beam and 6MV FFF beam were delivered with Varian TrueBeam machine. The dosimetric measurements were performed with Gafchromic XR-RV3 film, which was placed in the lung tumor insertion. The interplay between the dynamic MLC-based delivery of VMAT and the respiratory motion of the tumor degraded target coverage and created undesired hot or cold dose spots inside the lung tumor. Lung SBRT RapidArc treatments delivered by the FFF beam of TrueBeam linear accelerator is superior to the flattened beam. Further investigation will be performed by Monte Carlo simulation.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

Impact of CT attenuation correction method on quantitative respiratory-correlated (4D) PET/CT imaging

Purpose: Respiratory-correlated positron emission tomography (PET/CT) 4D PET/CT is used to mitigate errors from respiratory motion; however, the optimal CT attenuation correction (CTAC) method for 4D PET/CT is unknown. The authors performed a phantom study to evaluate the quantitative performance of CTAC methods for 4D PET/CT in the ground truth setting. Methods: A programmable respiratory motion phantom with a custom movable insert designed to emulate a lung lesion and lung tissue was used for this study. The insert was driven by one of five waveforms: two sinusoidal waveforms or three patient-specific respiratory waveforms. 3DPET and 4DPET images of the phantom under motion were acquired and reconstructed with six CTAC methods: helical breath-hold (3DHEL), helical free-breathing (3DMOT), 4D phase-averaged (4DAVG), 4D maximum intensity projection (4DMIP), 4D phase-matched (4DMATCH), and 4D end-exhale (4DEXH) CTAC. Recovery of SUV{sub max}, SUV{sub mean}, SUV{sub peak}, and segmented tumor volume was evaluated as RC{sub max}, RC{sub mean}, RC{sub peak}, and RC{sub vol}, representing percent difference relative to the static ground truth case. Paired Wilcoxon tests and Kruskal–Wallis ANOVA were used to test for significant differences. Results: For 4DPET imaging, the maximum intensity projection CTAC produced significantly more accurate recovery coefficients than all other CTAC methods (p < 0.0001 over all metrics). Over all motion waveforms, ratios of 4DMIP CTAC recovery were 0.2 ± 5.4, −1.8 ± 6.5, −3.2 ± 5.0, and 3.0 ± 5.9 for RC{sub max}, RC{sub peak}, RC{sub mean}, and RC{sub vol}. In comparison, recovery coefficients for phase-matched CTAC were −8.4 ± 5.3, −10.5 ± 6.2, −7.6 ± 5.0, and −13.0 ± 7.7 for RC{sub max}, RC{sub peak}, RC{sub mean}, and RC{sub vol}. When testing differences between phases over all CTAC methods and waveforms, end-exhale phases were significantly more accurate (p = 0.005). However, these differences were driven by the patient-specific respiratory waveforms; when testing patient and sinusoidal waveforms separately, patient waveforms were significantly different between phases (p < 0.0001) while the sinusoidal waveforms were not significantly different (p = 0.98). When considering only the subset of 4DMATCH images that corresponded to the end-exhale image phase, 4DEXH, mean and interquartile range were similar to 4DMATCH but variability was considerably reduced. Conclusions: Comparative advantages in accuracy and precision of SUV metrics and segmented volumes were demonstrated with the use of the maximum intensity projection and end-exhale CT attenuation correction. While respiratory phase-matched CTAC should in theory provide optimal corrections, image artifacts and differences in implementation of 4DCT and 4DPET sorting can degrade the benefit of this approach. These results may be useful to guide the implementation, analysis, and development of respiratory-correlated thoracic PET/CT in the radiation oncology and diagnostic settings.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

Technical Note: Experimental carbon ion range verification in inhomogeneous phantoms using prompt gammas

Purpose: The purpose of this study was to experimentally assess the possibility to monitor carbon ion range variations—due to tumor shift and/or elongation or shrinking—using prompt-gamma (PG) emission with inhomogeneous phantoms. Such a study is related to the development of PG monitoring techniques to be used in a carbon ion therapy context. Methods: A 95 MeV/u carbon ion beam was used to irradiate phantoms with a variable density along the ion path to mimic the presence of bone and lung in homogeneous humanlike tissue. PG profiles were obtained after a longitudinal scan of the phantoms. A setup comprising a narrow single-slit collimator and two detectors placed at 90° with respect to the beam axis was used. The time of flight technique was applied to allow the selection between PG and background events. Results: Using the positions at 50% entrance and 50% falloff of the PG profiles, a quantity called prompt-gamma profile length (PGPL) is defined. It is possible to observe shifts in the PGPL when there are absolute ion range shifts as small as 1–2 mm. Quantitatively, for an ion range shift of −1.33 ± 0.46 mm (insertion of a Teflon slab), a PGPL difference of −1.93 ± 0.58 mm and −1.84 ± 1.27 mm is obtained using a BaF{sub 2} and a NaI(Tl) detector, respectively. In turn, when an ion range shift of 4.59 ± 0.42 mm (insertion of a lung-equivalent material slab) is considered, the difference is of 4.10 ± 0.54 and 4.39 ± 0.80 mm for the same detectors. Conclusions: Herein, experimental evidence of the usefulness of employing PG to monitor carbon ion range using inhomogeneous phantoms is presented. Considering the homogeneous phantom as reference, the results show that the information provided by the PG emission allows for detecting ion range shifts as small as 1–2 mm. When considering the expected PG emission from an energy slice in a carbon ion therapy scenario, the experimental setup would allow to retrieve the same PGPL as the high statistics of the full experimental dataset in 58% of the times. However, this success rate increases to 93% when using a better optimized setup by means of Monte Carlo simulations.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-J-224: Using UTE and T1 Weighted Spin Echo Pulse Sequences for MR-Only Treatment Planning; Phantom Study

Purpose: Investigating a new approach in MRI based treatment planning using the combination of (Ultrashort Echo Time) UTE and T1 weighted spin echo pulse sequences to delineate air, bone and water (soft tissues) in generating pseudo CT images comparable with CT. Methods: A gel phantom containing chicken bones, ping pang balls filled with distilled water and air bubbles, was made. It scanned with MRI using UTE and 2D T1W SE pulse sequences with (in plane resolution= 0.53mm, slice thickness= 2 mm) and CT with (in plane resolution= 0.5 mm and slice thickness= 0.75mm) as a ground truth for geometrical accuracy. The UTE and T1W SE images were registered with CT using mutual information registration algorithm provided by Philips Pinnacle treatment planning system. The phantom boundaries were detected using Canny edge detection algorithm for CT, and MR images. The bone, air bubbles and water in ping pong balls were segmented from CT images using threshold 300HU, - 950HU and 0HU, respectively. These tissue inserts were automatically segmented from combined UTE and T1W SE images using edge detection and relative intensity histograms of the phantom. The obtained segmentations of air, bone and water inserts were evaluated with those obtained from CT. Results: Bone and air can be clearly differentiated in UTE images comparable to CT. Combining UTE and T1W SE images successfully segmented the air, bone and water. The maximum segmentation differences from combine MRI images (UTE and T1W SE) and CT are within 1.3 mm, 1.1mm for bone, air, respectively. The geometric distortion of UTE sequence is small less than 1 pixel (0.53 mm) of MR image resolution. Conclusion: Our approach indicates that MRI can be used solely for treatment planning and its quality is comparable with CT.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-38: A Head to Head Comparison of Two Commercial Phantoms Used for SRS QA

Purpose: To compare and contrast two commercial SRS QA phantoms. Methods: Both phantoms were evaluated in terms of their ease of setup as well as the time required to switch inserts for different tests. They were both used to evaluate the coincidence of the radiation and laser isocenters of a linear accelerator. End-to-end dosimetric tests were also performed using both ion chambers and films along two planes through the center of the phantoms. Since one phantom allows for multiple ion chamber orientations, a test was also performed to determine the effect of having the chamber oriented along the radiation beam axis’. Results: Changing inserts took 2 minutes on average for one phantom compared to 5 minutes for the other. The laser/radiation isocenter coincidence as determined from each phantom showed a maximum difference of 0.2mm. Ion chamber results were within 0.5% of the expected values when the chamber was perpendicular to the beams but measured a 3% underdose when the chamber was along the beam direction. Gamma (2%,2mm) pass rates of corresponding films were within 1% between phantoms. Conclusion: The results of the corresponding tests run on both phantoms were comparable, showing that the phantoms were equivalent for the subset of SRS QA tests run here. However, the under dose observed when the chamber was parallel to the beam direction suggests that this configuration should be avoided.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-89: Accuracy of Absolute Three-Dimensional Dose Distribution Measurement Using the Delta4

Purpose: In this study, we investigated the accuracy of the absolute dose distribution measurement using the Delta4 phantom compared to the measurements using a ionization chamber and EDR2 film Methods: Several conventional and intensity-modulated radiation therapy plans were used to compare the dose distribution measured using the Delta4 phantom to the absolute point dose using the chamber and the relative two-dimensional dose distribution using the EDR2 film. For the absolute dose distribution evaluation, the measurements using the Delta4, the chamber and the film were performed in similar measurement geometry. For point dose measurement using the chamber, an acrylic slab phantom with the PTW Semiflex chamber was inserted into the Delta4 phantom, alternative to the Delta4 main unit. Similarly, for dose distribution measurement using the film, the EDR2 film sandwiched with two acrylic slab phantoms were inserted to the phantom. Dose difference and gamma analysis were done for point dose and relative dose distribution comparisons, respectively. Results: The point dose measurements show slight negative systematic dose difference of −0.5 ± 0.1% and −1.0 ± 0.4% in the conventional and the IMRT plans, respectively. The additional measurement for direction dependency for Delta4 shows similar negative systematic dose difference even the phantom analysis software consider the directional dependency. The pass rate of the gamma evaluation was 77.7 ± 5.8% and 88.8±3.3% in the conventional and the IMRT plans, respectively. Conclusions: The Delta4 phantom shows a 1%-systematic dose difference derived from directional dependency and lower resolution compared to the film. Thus it is necessary to comprehensively evaluate the phantom to verify the IMRT/VMAT plans. Especially, the dosimetry tool is needed to have high resolution and high measurement accuracy in IMRT/VMAT-SBRT plan with small fields using intensity modulation in which the analysis area is limited and the higher correspondence between calculation and measurement is needed.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-280: Dose Evaluation in Using CT Density Versus Relative Stopping Power for Pencil Beam Planning and Treating IROC Proton Phantom

Purpose: The purpose of this study is to evaluate any effects of converted CT density variation in treatment planning system (TPS) of spot scanning proton therapy with an IROC proton prostate phantom at our new ProteusOne Proton Therapy Center. Methods: A proton prostate phantom was requested from the Imaging and Radiation Oncology Core Houston (IROC), The University of Texas MD Anderson Cancer Center, Houston, TX, where GAF Chromic films and couples of thermo luminescent dosemeter (TLD) capsules in target and adjacent structures were embedded for imaging and dose monitoring. Various material such as PVC, PBT HI polystyrene as dosimetry inserts and acrylic were within phantom. Relative stopping power (SP) were provided. However our treatment planning system (TPS) doesn’t require SP instead relative density was converted relative to water in TPS. Phantom was irradiated and the results were compared with IROC measurements. The range of relative density was converted from SP into relative density of water as a new assigned material and tested. Results: The summary of TLD measurements of the prostate and femoral heads were well within 2% of the TPS and met the criteria established by IROC. The film at coronal plane was found to be shift in superior-inferior direction due to locking position of cylinder insert was off and was corrected. The converted CT density worked precisely to correlated relative stopping power. Conclusion: The proton prostate phantom provided by IROC is a useful methodology to evaluate our new commissioned proton pencil beam and TPS within certain confidence in proton therapy. The relative stopping power was converted into relative physical density relatively to water and the results were satisfied.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-519: Investigation of the CyberKnife MultiPlan Monte Carlo Dose Calculation Using EBT3 Film Absolute Dosimetry for Delivery in a Heterogeneous Thorax Phantom

Purpose To characterize the Cyberknife (CK) robotic system’s dosimetric accuracy of the delivery of MultiPlan’s Monte Carlo dose calculations using EBT3 radiochromic film inserted in a thorax phantom. Methods The CIRS XSight Lung Tracking (XLT) Phantom (model 10823) was used in this study with custom cut EBT3 film inserted in the horizontal (coronal) plane inside the lung tissue equivalent phantom. CK MultiPlan v3.5.3 with Monte Carlo dose calculation algorithm (1.5 mm grid size, 2% statistical uncertainty) was used to calculate a clinical plan for a 25-mm lung tumor lesion, as contoured by the physician, and then imported onto the XLT phantom CT. Using the same film batch, the net OD to dose calibration curve was obtained using CK with the 60 mm fixed cone by delivering 0– 800 cGy. The test films (n=3) were irradiated using 325 cGy to the prescription point. Films were scanned 48 hours after irradiation using an Epson v700 scanner (48 bits color scan, extracted red channel only, 96 dpi). Percent absolute dose and relative isodose distribution difference relative to the planned dose were quantified using an in-house QA software program. Multiplan Monte Carlo dose calculation was validated using RCF dosimetry (EBT3) and gamma index criteria of 3%/3mm and 2%/2mm for absolute dose and relative isodose distribution measurement comparisons. Results EBT3 film measurements of the patient plans calculated with Monte Carlo in MultiPlan resulted in an absolute dose passing rate of 99.6±0.4% for the Gamma Index of 3%/3mm, 10% dose threshold, and 95.6±4.4% for 2%/2mm, 10% threshold criteria. The measured central axis absolute dose was within 1.2% (329.0±2.5 cGy) of the Monte Carlo planned dose (325.0±6.5 cGy) for that same point. Conclusion MultiPlan’s Monte Carlo dose calculation was validated using the EBT3 film absolute dosimetry for delivery in a heterogeneous thorax phantom.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-563: Multi-Fraction Stereotactic Radiosurgery with Extend System of Gamma Knife: Treatment Verification Using Indigenously Designed Patient Simulating Multipurpose Phantom

Purpose: Aim of the study is to evaluate mechanical and radiological accuracy of multi-fraction regimen and validate Gamma knife based fractionation using newly developed patient simulating multipurpose phantom. Methods: A patient simulating phantom was designed to verify fractionated treatments with extend system (ES) of Gamma Knife however it could be used to validate other radiotherapy procedures as well. The phantom has options to insert various density material plugs and mini CT/MR distortion phantoms to analyze the quality of stereotactic imaging. An additional thorax part designed to predict surface doses at various organ sites. The phantom was positioned using vacuum head cushion and patient control unit for imaging and treatment. The repositioning check tool (RCT) was used to predict phantom positioning under ES assembly. The phantom with special inserts for film in axial, coronal and sagittal plane were scanned with X-Ray CT and the acquired images were transferred to treatment planning system (LGP 10.1). The focal precession test was performed with 4mm collimator and an experimental plan of four 16mm collimator shots was prepared for treatment verification of multi-fraction regimen. The prescription dose of 5Gy per fraction was delivered in four fractions. Each fraction was analyzed using EBT3 films scanned with EPSON 10000XL Scanner. Results: The measurement of 38 RCT points showed an overall positional accuracy of 0.28mm. The mean deviation of 0.28% and 0.31 % were calculated as CT and MR image distortion respectively. The radiological focus accuracy test showed its deviation from mechanical center point of 0.22mm. The profile measurement showed close agreement between TPS planned and film measured dose. At tolerance criteria of 1%/1mm gamma index analysis showed a pass rate of > 95%. Conclusion: Our results show that the newly developed multipurpose patient simulating phantom is highly suitable for the verification of fractionated stereotactic radiosurgery using ES of Gamma knife. The study is a part of intramural research project of Research Section, All India Institute of Medical Sciences New Delhi India (A 247)

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2015

SU-E-T-648: Quality Assurance Using the RADPOS System for 4D Radiotherapy with CyberKnife

Purpose: The CyberKnife robotic radiosurgery system uses Synchrony respiratory motion compensation, which requires independent performance verification. In this work, the RADPOS 4D dosimetry system’s motion measurements are compared with internal fiducial position measurements. In addition, RADPOS measurements are compared with Synchrony’s predictive correlation model, which is based on internal fiducial and external LED marker position measurements. Methods: A treatment plan was created for a lung insert containing fiducials, RADPOS detector, and Solid Water tumor phantom. Two Quasar Respiratory Motion Phantoms (Q1 and Q2) and two RADPOS detectors (R1 and R2) were used: Q1 simulated lung motion with a lung insert moving in the superior/inferior direction, while Q2 simulated chest motion with a chest platform moving in the anterior/posterior direction. Before treatment, R1 was secured inside of the tumor phantom within Q1, while LED markers and R2 were positioned on the chest platform of Q2. Two treatment delivery cases were studied: isocentric plan (I) and non-isocentric patient plan (P). Four motion cases were studied: no motion (0), sinusoidal and in-phase (1), sinusoidal and out-of-phase (2), patient waveform and out-of-phase (3). A coordinate alignment algorithm was implemented, allowing RADPOS and model position data to be compared within the fiducial coordinate system. Results: The standard deviation of the differences between RADPOS and fiducial position measurements was below 0.6 mm for all experimental cases. The standard deviation of the differences between RADPOS and model position data was 1.0, 1.5, and 1.6 mm along the primary direction of motion for case I1, I2, and P3, respectively. Conclusion: Our work demonstrates that RADPOS is a useful tool for independent quality assurance of CyberKnife treatment with Synchrony respiratory compensation. RADPOS and fiducial position measurement closely match, and RADPOS confirms the effectiveness of CyberKnife’s Synchrony motion tracking. This work was supported by OCAIRO (Ontario Consortium for Adaptive Interventions in Radiation Oncology) grant.

62 RADIOLOGY AND NUCLEAR MEDICINE↗