A Sarfehnia

Insight gained from responses to surveys on reference dosimetry practices

Purpose To present the results and discuss potential insights gained through surveys on reference dosimetry practices. Methods Two surveys were sent to medical physicists to learn about the current state of reference dosimetry practices at radiation oncology clinics worldwide. A short survey designed to maximize response rate was made publicly available and distributed via the AAPM website and a medical physics list server. Another, much more involved survey, was sent to a smaller group of physicists to gain insight on detailed dosimetry practices. The questions were diverse, covering reference dosimetry practices on topics like measurements required for beam quality specification, the actual measurement of absorbed dose and ancillary equipment required like electrometers and environment monitoring measurements. Results There were 190 respondents to the short survey and seven respondents to the detailed survey. The diversity of responses indicates nonuniformity in reference dosimetry practices and differences in interpretation of reference dosimetry protocols. Conclusions The results of these surveys offer insight on clinical reference dosimetry practices and will be useful in identifying current and future needs for reference dosimetry.

SU-E-T-416: Experimental Evaluation of a Commercial GPU-Based Monte Carlo Dose Calculation Algorithm

Purpose: A new commercial GPU-based Monte Carlo dose calculation algorithm (GPUMCD) developed by the vendor Elekta™ to be used in the Monaco Treatment Planning System (TPS) is capable of modeling dose for both a standard linear accelerator and for an Elekta MRI-Linear accelerator (modeling magnetic field effects). We are evaluating this algorithm in two parts: commissioning the algorithm for an Elekta Agility linear accelerator (the focus of this work) and evaluating the algorithm’s ability to model magnetic field effects for an MRI-linear accelerator. Methods: A beam model was developed in the Monaco TPS (v.5.09.06) using the commissioned beam data for a 6MV Agility linac. A heterogeneous phantom representing tumor-in-lung, lung, bone-in-tissue, and prosthetic was designed/built. Dose calculations in Monaco were done using the current clinical algorithm (XVMC) and the new GPUMCD algorithm (1 mm3 voxel size, 0.5% statistical uncertainty) and in the Pinnacle TPS using the collapsed cone convolution (CCC) algorithm. These were compared with the measured doses using an ionization chamber (A1SL) and Gafchromic EBT3 films for 2×2 cm2, 5×5 cm2, and 10×10 cm2 field sizes. Results: The calculated central axis percentage depth doses (PDDs) in homogeneous solid water were within 2% compared to measurements for XVMC and GPUMCD. For tumor-in-lung and lung phantoms, doses calculated by all of the algorithms were within the experimental uncertainty of the measurements (±2% in the homogeneous phantom and ±3% for the tumor-in-lung or lung phantoms), except for 2×2 cm2 field size where only the CCC algorithm differs from film by 5% in the lung region. The analysis for bone-in-tissue and the prosthetic phantoms are ongoing. Conclusion: The new GPUMCD algorithm calculated dose comparable to both the XVMC algorithm and to measurements in both a homogeneous solid water medium and the heterogeneous phantom representing lung or tumor-in-lung for 2×2 cm2-10×10 cm2 field sizes. Funding support was obtained from Elekta.

Performance characterization of an integrated cone-beam CT system for dedicated gamma radiosurgery

PURPOSE This work describes the performance characterization of a cone-beam CT-guided radiosurgery device, the Gamma Knife® Icon™. METHODS The performance tests have been categorized into: (a) image quality and mechanical integrity; (b) image coregistration fidelity; (c) adaptive treatment delivery quality; (d) high definition motion management performance characterization; (e) software communication performance testing of the integrated cone-beam CT (CBCT) system. RESULTS All image quality performance characterization satisfied or exceeded manufacturer specifications. The image quality and mechanical stability of the CBCT system over a 3-month period was within tolerance with negligible (<0.1°) detector tilt angle. The CBCT definition of the stereotactic space had a measured average discrepancy of 0.15-0.16 mm in x, y, and z directions. On average, the high definition motion management system performance was within 0.05 mm with a residual offset of 0.15 mm when large displacements in a given direction were taken. The adaptive treatment delivery component as measured with CBCT coregistration of daily setups against reference setup images was accurate to within 0.2°. Comprehensive end-to-end testing showed a total uncertainty of better than 0.2 mm in positioning and 0.4% in dosimetry for treatment of centrally located lesions. CONCLUSIONS A set of system performance characterization tests spanning all aspects of the Gamma Knife Icon are presented. Overall, the system performance was in line with manufacturer specifications.

Sci-Sat AM: Radiation Dosimetry and Practical Therapy Solutions - 03: Energy dependence of a clinical probe-format calorimeter and its pertinence to absolute photon and electron beam dosimetry

Purpose: To evaluate the intrinsic and absorbed-dose energy dependence of a small-scale graphite calorimeter probe (GPC) developed for use as a routine clinical dosimeter. The influence of charge deposition on the response of the GPC was also assessed by performing absolute dosimetry in clinical linac-based electron beams. Methods: Intrinsic energy dependence was determined by performing constant-temperature calorimetry dose measurements in a water-equivalent solid phantom, under otherwise reference conditions, in five high-energy photon (63.5 < %dd(10)X < 76.3), and five electron (2.3 cm < R50 < 8.3 cm) beams. Reference dosimetry was performed for all beams in question using an Exradin A19 ion chamber with a calibration traceable to national standards. The absorbed-dose component of the overall energy dependence was calculated using the EGSnrc egs_chamber user code. Results: A total of 72 measurements were performed with the GPC, resulting in a standard error on the mean absorbed dose of better than 0.3 % for all ten beams. For both the photon and electron beams, no statistically-significant energy dependence was observed experimentally. Peak-to-peak, variations in the relative response of the GPC across all beam qualities of a given radiation type were on the order of 1 %. No effects, either transient or permanent, were attributable to the charge deposited by the electron beams. Conclusions: The GPCs apparent energy-independence, combined with its well-established linearity and dose rate independence, make it a potentially useful dosimetry system capable measuring photon and electron doses in absolute terms at the clinical level.

TH-AB-BRA-03: Backscatter Dose Factors Re-Evaluated for Inhomogeneities in the Presence of a 1.5 T Magnetic Field Using the GPUMCD Monte Carlo Algorithm

PURPOSE To quantify the backscatter dose factors near the interfaces for clinically relevant high atomic number materials using GPUMCD for the Elekta MRI Linac. METHODS Backscatter dose factors (BSDF) were calculated as the ratio of the dose with and without the presence of the heterogeneity. The BSDFs were calculated either in the absence or presence of an orthogonal 1.5 T magnetic field. Doses were scored in small voxels of side 1 mm in a water phantom with dimensions of 20×20×20 cm using GPUMCD (Elekta). The minimum uncertainty in dose calculations was kept to 0.5%. A slab of thickness 2 cm, representing the inhomogeneity, was placed inside the phantom with variable position from the surface of the phantom. The slab was filled with either bone, aluminum, titanium, stainless steel, or dental amalgam. The phantom was irradiated using particles sampled from a histogram which represented the true MRI Linac spectrum. RESULTS With the application of the 1.5 T magnetic field (B-On), all of the BSDFs were reduced by at least 8% compared to the no magnetic field (B-Off) cases. For the B-Off case, the BSDF decreases exponentially with the upstream distance away from the interface. With B-On, the BSDF decreases exponentially for titanium, SS, and amalgam. However, it remains constant for Aluminum. In the case of bone, the BSDF increases up to a distance of 4 mm away from the interface in the presence of the magnetic field. CONCLUSION The BSDF does not depend upon the thickness of the homogeneous material above the inhomogeneity for either the B-Off or B-On cases. For all the materials investigated, the BSDF is lower at the interface for the B-On case. The exponential fall-off of the BSDF away from the interface is not valid for all the materials when the magnetic field is turned ON. Funding support for this research was provided by Elekta.

TH-AB-BRA-10: The Physics of Interface Effects for Radiation Treatments in a MRI-Linac: A Monte Carlo Study

PURPOSE To investigate and explain the interface effects for clinically relevant materials being irradiated in the presence of a 1.5 T transverse magnetic field. METHODS Interface effects were investigated using Geant4.10.1 both with (B-On) and without (B-Off) a magnetic field for an Elekta MRI-Linac. A slab of thickness 8 cm, representing inhomogeneity, was placed at a depth of 4 cm in a 20×20×20 cm water phantom. Backscattered electron fluence was calculated through a 20×20 cm plane aligned with the surface of the inhomogeneity. Inhomogeneities investigated were lung, bone, aluminum, titanium, stainless steel, and dental filling. A photon beam with field size of 2×2 cm at the isocenter and SAD of 143.5 cm was generated from a point source with energy distribution sampled from a histogram representing the true Elekta MRI-Linac photon spectrum. RESULTS In the B-On case, if the heterogeneity is a low Zeff material, such as lung, the backscattered electron fluence is increased considerably, i.e. by 54 %, and the corresponding dose is expected to be higher near the interface compared to the B-Off case. On the contrary, if the heterogeneity is a high Zeff material then the backscattered electron fluence is reduced in the B-On electron fluence is reduced in the B-On case. This reduction leads to a lower dose deposition at the interface compared to the B-Off case. CONCLUSION The reduction in dose at the interface, in the B-On case, is directly related to the reduction in backscattered electron fluence. The reduction in backscattered electron fluence occurs due to two different reasons. First, the electron energy spectrum hitting the interface is changed for the B-On case which changes the electron scattering probability. Second, some electrons that are looping under the influence of the magnetic field are captured by the higher density side of the interface and no longer contribute to the backscattered electron stream. Funding support for this study was provided by ElektaTM.

SU-F-T-374: Dosimetric Effects of Irradiation Through a Bilateral Hip Prosthesis in a MRI Linac

PURPOSE To evaluate the interface effects when irradiating through a hip prosthesis in the presence of an orthogonal 1.5 T magnetic field using Monte Carlo simulations. METHODS A 20×20×38 cm virtual phantom with two 5×5×5 cm sections of bilateral titanium hip prosthesis was created in GPU-based Monte Carlo (MC) algorithm (GPUMCD, Elekta AB, Stockholm Sweden). The lateral prosthesis spacing was based on a representative patient CT scan. A treatment SAD of 143.5 cm was chosen, corresponding to the Elekta AB MRI Linac and the beam energy distribution was sampled from a histogram representing the true MRI Linac spectrum. A magnetic field of 1.5 T was applied perpendicular to the plane of irradiation. Dose was calculated, in voxels of side 1 mm, for 2×2, 5×5, and 10×10 cm treatment field sizes with normal beam incidence (gantry at 90° or 270°) and at 5° and 10° from normal, representing the range of incidence through the bilateral prosthesis. RESULTS With magnetic field ON (B-On) and normal beam incidence the backscatter dose at the interfaces of proximal and distal implants is reduced for all the field sizes compared to the magnetic field OFF (B-Off) case. The absolute reduction in doses at the interface was in the range of 12.93% to 13.16% for the proximal implant and 13.57% to 16.12% for the distal implant. Similarly for the oblique incidences of 5o and 10o the dose in the plane adjacent to the prosthetic implants is lower when the magnetic field is ON. CONCLUSION The dosimetric effects of irradiating through a hip prosthesis in the presence of a transverse magnetic field have been determined using MC simulation. The backscatter dose reduction translates into significantly lower hot spots at the prosthetic interfaces, which are otherwise substantially high in the absence of the magnetic field. This project was supported through funding provided by ElektaTM.

TU‐D‐201‐03: Results of a Survey On the Implementation of the TG‐51 Protocol and Associated Addendum On Reference Dosimetry of External Beams

PURPOSE The working group on the review and extension of the TG-51 protocol (WGTG51) collected data from American Association of Physicists in Medicine (AAPM) members with respect to their current TG-51 and associated addendum usage in the interest of considering future protocol addenda and guidance on reference dosimetry best practices. This study reports an overview of this survey on dosimetry of external beams. METHODS Fourteen survey questions were developed by WGTG51 and released in November 2015. The questions collected information on reference dosimetry, beam quality specification, and ancillary calibration equipment. RESULTS Of the 190 submissions completed worldwide (U.S. 70%), 83% were AAPM members. Of the respondents, 33.5% implemented the TG-51 addendum, with the maximum calibration difference for any photon beam, with respect to the original TG-51 protocol, being <1% for 97.4% of responses. One major finding is that 81.8% of respondents used the same cylindrical ionization chamber for photon and electron dosimetry, implying that many clinics are foregoing the use of parallel-plate chambers. Other evidence suggests equivalent dosimetric results can be obtained with both cylindrical and parallel-plate chambers in electron beams. This, combined with users comfort with cylindrical chambers for electrons will likely impact recommendations put forward in an upcoming electron beam addendum to the TG-51 protocol. Data collected on ancillary equipment showed 58.2% (45.0%) of the thermometers (barometers) in use for beam calibration had NIST traceable calibration certificates, but 48.4% (42.7%) were never recalibrated. CONCLUSION This survey provides a snapshot of TG-51 external beam reference dosimetry practice in radiotherapy centers. Findings demonstrate the rapid take-up of the TG-51 photon beam addendum and raise issues for the WGTG51 to focus on going forward, including guidelines on ancillary equipment and the choice of chamber for electron beam dosimetry.

Poster — Thur Eve — 22: A water calorimeter for low-energy particle beams

In this work, the feasibility of absolute dose to water measurements in low-energy electron beams using a water calorimeter specifically developed for shallow measurements is established. The calorimeter design consists of a cylindrical glass vessel encased in a block of expanded polystyrene. The vessel has a front window thickness of 1.1 mm, a 4 cm radius, and is 2.5 cm in depth. The vessel-block assembly sits inside a thermally-insulated box and is air-cooled to an operating temperature of 4 °C. Radiation-induced thermal gradients were simulated in a geometric model of the calorimeter using a finite element analysis software package. 52 absorbed dose to water measurements were performed in a 6 and 8 MeV electron beam (z max of 1.32 and 1.76 cm, respectively) for 60 seconds at a repetition rate of 400 MU/min and an SSD of 120 cm. Within the vessel, the depth of measurement was set to 1.08 cm relative to the inner front window. The average measured dose to water was 59.6 ± 0.2 cGy/100 MU (6 MeV), and 63.7 ± 0.3 cGy/100 MU (8 MeV). The associated heat transfer corrections were determined to be 1.026 ± 0.003 and 1.017 ± 0.004 for the 6 and 8 MeV beams, respectively. The most significant source of uncertainty in this study was the repeatability (type A, 0.42%). It is expected that performing fewer consecutive measurements under higher dose rate conditions will improve the stability of the thermal background, thereby improving the repeatability and reducing the overall standard uncertainty.