A Thomas

Commissioning and dosimetric characteristics of TrueBeam system: Composite data of three TrueBeam machines

PURPOSE A TrueBeam linear accelerator (TB-LINAC) is designed to deliver traditionally flattened and flattening-filter-free (FFF) beams. Although it has been widely adopted in many clinics for patient treatment, limited information is available related to commissioning of this type of machine. In this work, commissioning data of three units were measured, and multiunit comparison was presented to provide valuable insights and reliable evaluations on the characteristics of the new treatment system. METHODS The TB-LINAC is equipped with newly designed waveguide, carousel assembly, monitoring control, and integrated imaging systems. Each machine in this study has 4, 6, 8, 10, 15 MV flattened photon beams, and 6 MV and 10 MV FFF photon beams as well as 6, 9, 12, 16, 20, and 22 MeV electron beams. Dosimetric characteristics of the three new TB-LINAC treatment units are systematically measured for commissioning. High-resolution diode detectors and ion chambers were used to measure dosimetric data for a range of field sizes from 10 × 10 to 400 × 400 mm(2). The composite dosimetric data of the three units are presented in this work. The commissioning of intensity modulated radiotherapy (IMRT), volumetric modulated arc therapy (VMAT), image-guided radiation therapy, and gating systems are also illustrated. Critical considerations of P(ion) of FFF photon beams and small field dosimetric measurements were investigated. RESULTS The authors found all PDDs and profiles matched well among the three machines. Beam data were quantitatively compared and combined through average to yield composite beam data. The discrepancies among the machines were quantified using standard deviation (SD). The mean SD of the PDDs among the three units is 0.12%, and the mean SD of the profiles is 0.40% for 10 MV FFF open fields. The variations of P(ion) of the chamber CC13 is 1.2 ± 0.1% under 6 MV FFF and 2.0 ± 0.5% under 10 MV FFF from dmax to the 18 cm-off-axis point at 35 cm depth under 40 × 40 cm(2). The mean penumbra of crossplane flattened photon beams at collimator angle of 0° is measured from 5.88 ± 0.09 to 5.99 ± 0.13 mm from 4 to 15 MV at 10 cm depth of 100 × 100 mm(2). The mean penumbra of crossplane beams at collimator angle of 0° is measured as 3.70 ± 0.21 and 4.83 ± 0.04 mm for 6 MV FFF and 10 MV FFF, respectively, at 10 cm depth with a field size of 5 × 5 cm(2). The end-to-end test procedures of both IMRT and VMAT were performed for various energy modes. The mean ion chamber measurements of three units showed less than 2% between measurement and calculation; the mean MultiCube ICA measurements demonstrated over 90% pixels passing gamma analysis (3%, 3 mm, 5% threshold). The imaging dosimetric data of KV planar imaging and CBCT demonstrated improved consistency with vendor specifications and dose reduction for certain imaging protocols. The gated output verification showed a discrepancy of 0.05% or less between gating radiation delivery and nongating radiation delivery. CONCLUSIONS The commissioning data indicated good consistency among the three TB-LINAC units. The commissioning data provided us valuable insights and reliable evaluations on the characteristics of the new treatment system. The systematically measured data might be useful for future reference.

Toward acquiring comprehensive radiosurgery field commissioning data using the PRESAGE®/optical-CT 3D dosimetry system

Achieving accurate small field dosimetry is challenging. This study investigates the utility of a radiochromic plastic PRESAGE read with optical-CT for the acquisition of radiosurgery field commissioning data from a Novalis Tx system with a high-definition multileaf collimator (HDMLC). Total scatter factors (Sc, p), beam profiles, and penumbrae were measured for five different radiosurgery fields (5, 10, 20, 30 and 40 mm) using a commercially available optical-CT scanner (OCTOPUS, MGS Research). The percent depth dose (PDD), beam profile and penumbra of the 10 mm field were also measured using a higher resolution in-house prototype CCD-based scanner. Gafchromic EBT film was used for independent verification. Measurements of Sc, p made with PRESAGE and film agreed with mini-ion chamber commissioning data to within 4% for every field (range 0.2-3.6% for PRESAGE, and 1.6-3.6% for EBT). PDD, beam profile and penumbra measurements made with the two PRESAGE/optical-CT systems and film showed good agreement with the high-resolution diode commissioning measurements with a competitive resolution (0.5 mm pixels). The in-house prototype optical-CT scanner allowed much finer resolution compared with previous applications of PRESAGE. The advantages of the PRESAGE system for small field dosimetry include 3D measurements, negligible volume averaging, directional insensitivity, an absence of beam perturbations, energy and dose rate independence.

Commissioning a small-field biological irradiator using point, 2D, and 3D dosimetry techniques

PURPOSE To commission a small-field biological irradiator, the XRad225Cx from Precision x-Ray, Inc., for research use. The system produces a 225 kVp x-ray beam and is equipped with collimating cones that produce both square and circular radiation fields ranging in size from 1 to 40 mm. This work incorporates point, 2D, and 3D measurements to determine output factors (OF), percent-depth-dose (PDD) and dose profiles at multiple depths. METHODS Three independent dosimetry systems were used: ion-chambers (a farmer chamber and a micro-ionisation chamber), 2D EBT2 radiochromic film, and a novel 3D dosimetry system (DLOS∕PRESAGE®). Reference point dose rates and output factors were determined from in-air ionization chamber measurements for fields down to ∼13 mm using the formalism of TG61. PDD, profiles, and output factors at three separate depths (0, 0.5, and 2 cm), were determined for all field sizes from EBT2 film measurements in solid water. Several film PDD curves required a scaling correction, reflecting the challenge of accurate film alignment in very small fields. PDDs, profiles, and output factors were also determined with the 3D DLOS∕PRESAGE® system which generated isotropic 0.2 mm data, in scan times of 20 min. RESULTS Surface output factors determined by ion-chamber were observed to gradually drop by ∼9% when the field size was reduced from 40 to 13 mm. More dramatic drops were observed for the smallest fields as determined by EBT∼18% and ∼42% for the 2.5 mm and 1 mm fields, respectively. PRESAGE® and film output factors agreed well for fields <20 mm (where 3D data were available) with mean deviation of 2.2% (range 1%-4%). PDD values at 2 cm depth varied from ∼72% for the 40 mm field, down to ∼55% for the 1 mm field. EBT and PRESAGE® PDDs agreed within ∼3% in the typical therapy region (1-4 cm). At deeper depths the EBT curves were slightly steeper (2.5% at 5 cm). These results indicate good overall consistency between ion-chamber, EBT2 and PRESAGE® measured OFs, PDDs, and profiles. CONCLUSIONS The combination of independent 2D and 3D measurements was found to be valuable to ensure accurate and comprehensive commissioning. Film measurements were time consuming and challenging due to the difficulty of film alignment in small fields. PRESAGE® 3D measurements were comprehensive and efficient, because alignment errors are negligible, and all parameters for multiple fields could be obtained from a single dosimeter and scan. However, achieving accurate superficial data (within 4 mm) is not yet feasible due to optical surface artifacts.

A Quality Assurance Method that Utilizes 3D Dosimetry and Facilitates Clinical Interpretation

PURPOSE To demonstrate a new three-dimensional (3D) quality assurance (QA) method that provides comprehensive dosimetry verification and facilitates evaluation of the clinical significance of QA data acquired in a phantom. Also to apply the method to investigate the dosimetric efficacy of base-of-skull (BOS) intensity-modulated radiotherapy (IMRT) treatment. METHODS AND MATERIALS Two types of IMRT QA verification plans were created for 6 patients who received BOS IMRT. The first plan enabled conventional 2D planar IMRT QA using the Varian portal dosimetry system. The second plan enabled 3D verification using an anthropomorphic head phantom. In the latter, the 3D dose distribution was measured using the DLOS/Presage dosimetry system (DLOS = Duke Large-field-of-view Optical-CT System, Presage Heuris Pharma, Skillman, NJ), which yielded isotropic 2-mm data throughout the treated volume. In a novel step, measured 3D dose distributions were transformed back to the patients CT to enable calculation of dose-volume histograms (DVH) and dose overlays. Measured and planned patient DVHs were compared to investigate clinical significance. RESULTS Close agreement between measured and calculated dose distributions was observed for all 6 cases. For gamma criteria of 3%, 2 mm, the mean passing rate for portal dosimetry was 96.8% (range, 92.0%-98.9%), compared to 94.9% (range, 90.1%-98.9%) for 3D. There was no clear correlation between 2D and 3D passing rates. Planned and measured dose distributions were evaluated on the patients anatomy, using DVH and dose overlays. Minor deviations were detected, and the clinical significance of these are presented and discussed. CONCLUSIONS Two advantages accrue to the methods presented here. First, treatment accuracy is evaluated throughout the whole treated volume, yielding comprehensive verification. Second, the clinical significance of any deviations can be assessed through the generation of DVH curves and dose overlays on the patients anatomy. The latter step represents an important development that advances the clinical relevance of complex treatment QA.

A method to correct for stray light in telecentric optical-CT imaging of radiochromic dosimeters

Radiochromic plastic and gel materials have recently emerged which can yield 3D dose information over clinical volumes in high resolution. These dosimeters can provide a much more comprehensive verification of complex radiation therapy treatments than can be achieved by conventional planar and point dosimeters. To achieve full clinical potential, these dosimeters require a fast and accurate read-out technology. Broad-beam optical-computed tomography (optical-CT) systems have shown promise, but can be sensitive to stray light artifacts originating in the imaging chain. In this work we present and evaluate a method to correct for stray light artifacts by deconvolving a measured, spatially invariant, point spread function (PSF). The correction was developed for the DLOS (Duke large field-of-view optical-CT scanner) in conjunction with radiochromic PRESAGE® dosimeters. The PSF was constructed from a series of acquisitions of projection images of various sized apertures placed in the optical imaging chain. Images were acquired with a range of exposure times, and for a range of aperture sizes (0.2-11 mm). The PSF is investigated under a variety of conditions, and found to be robust and spatially invariant, key factors enabling the viability of the deconvolution approach. The spatial invariance and robustness of the PSF are facilitated by telecentric imaging, which produces a collimated light beam and removes stray light originating upstream of the imaging lens. The telecentric capability of the DLOS therefore represents a significant advantage, both in keeping stray light levels to a minimum and enabling viability of an accurate PSF deconvolution method to correct for the residual. The performance of the correction method was evaluated on projection images containing known optical-density variations, and also on known 3D dose distributions. The method is shown to accurately account for stray light on small field dosimetry with corrections up to 3% in magnitude shown here although corrections of >10% have been observed in extreme cases. The dominant source of stray light was found to be within the imaging lens. Correcting for stray light extended the dynamic range of the system from ∼30 to ∼60 dB. The correction should be used when measurements need to be accurate within 3%.

A comprehensive investigation of the accuracy and reproducibility of a multitarget single isocenter VMAT radiosurgery technique

PURPOSE Recent trends in stereotactic radiosurgery use multifocal volumetric modulated arc therapy (VMAT) plans to simultaneously treat several distinct targets. Conventional verification often involves low resolution measurements in a single plane, a cylinder, or intersecting planes of diodes or ion chambers. This work presents an investigation into the consistency and reproducibility of this new treatment technique using a comprehensive commissioned high-resolution 3D dosimetry system (PRESAGE(®)∕Optical-CT). METHODS A complex VMAT plan consisting of a single isocenter but five separate targets was created in Eclipse for a head phantom containing a cylindrical PRESAGE(®) dosimetry insert of 11 cm diameter and height. The plan contained five VMAT arcs delivering target doses from 12 to 20 Gy. The treatment was delivered to four dosimeters positioned in the head phantom and repeated four times, yielding four separate 3D dosimetry verifications. Each delivery was completely independent and was given after image guided radiation therapy (IGRT) positioning using Brainlab ExacTrac and cone beam computed tomography. A final delivery was given to a modified insert containing a pin-point ion chamber enabling calibration of PRESAGE(®) 3D data to dose. Dosimetric data were read out in an optical-CT scanner. Consistency and reproducibility of the treatment technique (including IGRT setup) was investigated by comparing the dose distributions in the four inserts, and with the predicted treatment planning system distribution. RESULTS Dose distributions from the four dosimeters were registered and analyzed to determine the mean and standard deviation at all points throughout the dosimeters. A dose standard deviation of <3% was found from dosimeter to dosimeter. Global 3D gamma maps show that the predicted and measured dose matched well [3D gamma passing rate was 98.0% (3%, 2 mm)]. CONCLUSIONS The deliveries of the irradiation were found to be consistent and matched the treatment plan, demonstrating high accuracy and reproducibility of both the treatment machine and the IGRT procedure. The complexity of the treatment (multiple arcs) and dosimetry (multiple strong gradients) pose a substantial challenge for comprehensive verification. 3D dosimetry can be uniquely effective in this scenario.

Fast, large field-of-view, telecentric optical-CT scanning system for 3D radiochromic dosimetry

We describe initial experiences with an in-house, fast, large field-of-view optical-CT telecentric scanner (the Duke Large field of view Optical-CT Scanner (DLOS)). The DLOS system is designed to enable telecentric optical-CT imaging of dosimeters up to 24 cm in diameter with a spatial resolution of 1 mm(3), in approximately 10 minutes. These capabilities render the DLOS system a unique device at present. The system is a scaled up version of early prototypes in our lab. This scaling introduces several challenges, including the accurate measurement of a greatly increased range of light attenuation within the dosimeter, and the need to reduce even minor reflections and scattered light within the imaging chain. We present several corrections and techniques that enable accurate, low noise, 3D dosimetery with the DLOS system.

Preliminary commissioning investigations with the DMOS-RPC optical-CT Scanner

A midsized broad beam Optical-CT scanner is being developed for collaborative research between Duke and the Radiological Physics Center (RPC). The Duke Midsized Optical-CT Scanner (DMOS-RPC) is designed to be compatible with several of the RPC phantoms, including the head and neck, stereotactic SRS, and lung phantoms. Preliminary data investigating the basic performance of the scanner is described. Two 10 cm PRESAGE cylinders were irradiated with simple test plans. Projections of ~80 μm resolution of each dosimeter were collected at 1 degree intervals over a full 360 degrees both before and after irradiation. 3 dimensional reconstructions of attenuation coefficients throughout the dosimeter were computed with 1 mm(3) resolution. Scans were normalized to the calculated dose distribution and a 3D comparison was made with a commissioned treatment planning system. Initial results indicate DMOS-RPC can produce accurate relative dose distributions with high spatial resolution (up to 1 mm(3) in 3D) in less than 30 minutes (acquisition and reconstruction). A maximum dose of ~3.6Gy was delivered in these tests, and observed noise was ~2% for 1 mm(3) reconstructions. Good agreement is observed with the planning system in these simple distributions, indicating promising potential for this scanner.

A comprehensive method for optical-emission computed tomography

Optical-computed tomography (CT) and optical-emission computed tomography (ECT) are recent techniques with potential for high-resolution multi-faceted 3D imaging of the structure and function in unsectioned tissue samples up to 1-4 cc. Quantitative imaging of 3D fluorophore distribution (e.g. GFP) using optical-ECT is challenging due to attenuation present within the sample. Uncorrected reconstructed images appear hotter near the edges than at the center. A similar effect is seen in SPECT/PET imaging, although an important difference is attenuation occurs for both emission and excitation photons. This work presents a way to implement not only the emission attenuation correction utilized in SPECT, but also excitation attenuation correction and source strength modeling which are unique to optical-ECT. The performance of the correction methods was investigated by the use of a cylindrical gelatin phantom whose central region was filled with a known distribution of attenuation and fluorophores. Uncorrected and corrected reconstructions were compared to a sectioned slice of the phantom imaged using a fluorescent dissecting microscope. Significant attenuation artifacts were observed in uncorrected images and appeared up to 80% less intense in the central regions due to attenuation and an assumed uniform light source. The corrected reconstruction showed agreement throughout the verification image with only slight variations ( approximately 5%). Final experiments demonstrate the correction in tissue as applied to a tumor with constitutive RFP.

A method to correct for spectral artifacts in optical-CT dosimetry

The recent emergence of radiochromic dosimeters with low inherent light-scattering presents the possibility of fast 3D dosimetry using broad-beam optical computed tomography (optical-CT). Current broad beam scanners typically employ either a single or a planar array of light-emitting diodes (LED) for the light source. The spectrum of light from LED sources is polychromatic and this, in combination with the non-uniform spectral absorption of the dosimeter, can introduce spectral artifacts arising from preferential absorption of photons at the peak absorption wavelengths in the dosimeter. Spectral artifacts can lead to large errors in the reconstructed attenuation coefficients, and hence dose measurement. This work presents an analytic method for correcting for spectral artifacts which can be applied if the spectral characteristics of the light source, absorbing dosimeter, and imaging detector are known or can be measured. The method is implemented here for a PRESAGE® dosimeter scanned with the DLOS telecentric scanner (Duke Large field-of-view Optical-CT Scanner). Emission and absorption profiles were measured with a commercial spectrometer and spectrophotometer, respectively. Simulations are presented that show spectral changes can introduce errors of 8% for moderately attenuating samples where spectral artifacts are less pronounced. The correction is evaluated by application to a 16 cm diameter PRESAGE® cylindrical dosimeter irradiated along the axis with two partially overlapping 6 × 6 cm fields of different doses. The resulting stepped dose distribution facilitates evaluation of the correction as each step had different spectral contributions. The spectral artifact correction was found to accurately correct the reconstructed coefficients to within ∼1.5%, improved from ∼7.5%, for normalized dose distributions. In conclusion, for situations where spectral artifacts cannot be removed by physical filters, the method shown here is an effective correction. Physical filters may be less viable if they introduce strong sensitivity to Schlieren bands in the dosimeters.