B Barraclough

A novel convolution-based approach to address ionization chamber volume averaging effect in model-based treatment planning systems.

The ionization chamber volume averaging effect is a well-known issue without an elegant solution. The purpose of this study is to propose a novel convolution-based approach to address the volume averaging effect in model-based treatment planning systems (TPSs). Ionization chamber-measured beam profiles can be regarded as the convolution between the detector response function and the implicit real profiles. Existing approaches address the issue by trying to remove the volume averaging effect from the measurement. In contrast, our proposed method imports the measured profiles directly into the TPS and addresses the problem by reoptimizing pertinent parameters of the TPS beam model. In the iterative beam modeling process, the TPS-calculated beam profiles are convolved with the same detector response function. Beam model parameters responsible for the penumbra are optimized to drive the convolved profiles to match the measured profiles. Since the convolved and the measured profiles are subject to identical volume averaging effect, the calculated profiles match the real profiles when the optimization converges. The method was applied to reoptimize a CC13 beam model commissioned with profiles measured with a standard ionization chamber (Scanditronix Wellhofer, Bartlett, TN). The reoptimized beam model was validated by comparing the TPS-calculated profiles with diode-measured profiles. Its performance in intensity-modulated radiation therapy (IMRT) quality assurance (QA) for ten head-and-neck patients was compared with the CC13 beam model and a clinical beam model (manually optimized, clinically proven) using standard Gamma comparisons. The beam profiles calculated with the reoptimized beam model showed excellent agreement with diode measurement at all measured geometries. Performance of the reoptimized beam model was comparable with that of the clinical beam model in IMRT QA. The average passing rates using the reoptimized beam model increased substantially from 92.1% to 99.3% with 3%/3 mm and from 79.2% to 95.2% with 2%/2 mm when compared with the CC13 beam model. These results show the effectiveness of the proposed method. Less inter-user variability can be expected of the final beam model. It is also found that the method can be easily integrated into model-based TPS.

Comparison between proton boron fusion therapy (PBFT) and boron neutron capture therapy (BNCT): a monte carlo study

The aim of this study is to compare between proton boron fusion therapy (PBFT) and boron neutron capture therapy (BNCT) and to analyze dose escalation using a Monte Carlo simulation. We simulated a proton beam passing through the water with a boron uptake region (BUR) in MCNPX. To estimate the interaction between neutrons/protons and borons by the alpha particle, the simulation yielded with a variation of the center of the BUR location and proton energies. The variation and influence about the alpha particle were observed from the percent depth dose (PDD) and cross-plane dose profile of both the neutron and proton beams. The peak value of the maximum dose level when the boron particle was accurately labeled at the region was 192.4% among the energies. In all, we confirmed that prompt gamma rays of 478 keV and 719 keV were generated by the nuclear reactions in PBFT and BNCT, respectively. We validated the dramatic effectiveness of the alpha particle, especially in PBFT. The utility of PBFT was verified using the simulation and it has a potential for application in radiotherapy.

SU‐E‐T‐584: Optical Tracking Guided Patient‐Specific VMAT QA with ArcCHECK

Purpose: To investigate the novel use of an in-house optical tracking system (OTS) to improve the efficacy of VMAT QA with a cylindrical dosimeter (ArcCHECK™). Methods: The translational and rotational setup errors of ArcCHECK are convoluted which makes it challenging to position the device efficiently and accurately. We first aligned the ArcCHECK to the machine cross-hair at three cardinal angles (0°, 90°, and 270°) to establish a reference position. Four infrared reflective markers were attached to the back of the device. An OTS with 0.2mm/0.2° accuracy was used to control its setup uncertainty. Translational uncertainties of 1 mm and 2 mm in three directions (in, right, and up) were applied on the device. Four open beams of various field sizes and six clinical VMAT arcs were delivered and measured for all simulated setup errors. The measurements were compared with Pinnacle™ calculations using Gamma analysis to evaluate the impact of setup uncertainty. This study also evaluated the improvement in setup reproducibility and efficiency with the aid of the OTS. Results: For open beams, with 3%/3mm, the mean passing rates dropped by less than 5% for all shifts; with 2%/2mm, two significant drops(>5%) were observed: 15.38±6.75% for 2 mm lateral shift and 9.35±4.88% for 2 mm longitudinal shift. For VMAT arcs, the mean passing rates using 2%/2mm dropped by 10.47±7.46% and 22.02±11.39% for 1 and 2 mm shift, respectively. With 3%/3mm, significant drop only occurred with 2 mm longitudinal shift (13.73±8.30%). Setup time could be reduced by >15 min with the aid of the OTS. Conclusion: OTS is an effective tool for separating translational and rotational uncertainties. The current VMAT QA solution was not strongly sensitive to translation errors of 2mm with widely accepted criterion (3%/3mm). This finding raises concerns regarding the efficacy of such QA system in detecting errors in the dynamic VMAT delivery.

Radiation treatment planning and delivery strategies for a pregnant brain tumor patient

Abstract The management of a pregnant patient in radiation oncology is an infrequent event requiring careful consideration by both the physician and physicist. The aim of this manuscript was to highlight treatment planning techniques and detail measurements of fetal dose for a pregnant patient recently requiring treatment for a brain cancer. A 27‐year‐old woman was treated during gestational weeks 19–25 for a resected grade 3 astrocytoma to 50.4 Gy in 28 fractions, followed by an additional 9 Gy boost in five fractions. Four potential plans were developed for the patient: a 6 MV 3D‐conformal treatment plan with enhanced dynamic wedges, a 6 MV step‐and‐shoot (SnS) intensity‐modulated radiation therapy (IMRT) plan, an unflattened 6 MV SnS IMRT plan, and an Accuray TomoTherapy HDA helical IMRT treatment plan. All treatment plans used strategies to reduce peripheral dose. Fetal dose was estimated for each treatment plan using available literature references, and measurements were made using thermoluminescent dosimeters (TLDs) and an ionization chamber with an anthropomorphic phantom. TLD measurements from a full‐course radiation delivery ranged from 1.0 to 1.6 cGy for the 3D‐conformal treatment plan, from 1.0 to 1.5 cGy for the 6 MV SnS IMRT plan, from 0.6 to 1.0 cGy for the unflattened 6 MV SnS IMRT plan, and from 1.9 to 2.6 cGy for the TomoTherapy treatment plan. The unflattened 6 MV SnS IMRT treatment plan was selected for treatment for this particular patient, though the fetal doses from all treatment plans were deemed acceptable. The cumulative dose to the patients unshielded fetus is estimated to be 1.0 cGy at most. The planning technique and distance between the treatment target and fetus both contributed to this relatively low fetal dose. Relevant treatment planning strategies and treatment delivery considerations are discussed to aid radiation oncologists and medical physicists in the management of pregnant patients.

Efficient independent planar dose calculation for FFF IMRT QA with a bivariate Gaussian source model

&NA; The aim of this study is to perform a direct comparison of the source model for photon beams with and without flattening filter (FF) and to develop an efficient independent algorithm for planar dose calculation for FF‐free (FFF) intensity‐modulated radiotherapy (IMRT) quality assurance (QA). The source model consisted of a point source modeling the primary photons and extrafocal bivariate Gaussian functions modeling the head scatter, monitor chamber backscatter, and collimator exchange effect. The model parameters were obtained by minimizing the difference between the calculated and measured in‐air output factors (Sc). The fluence of IMRT beams was calculated from the source model using a backprojection and integration method. The off‐axis ratio in FFF beams were modeled with a fourth degree polynomial. An analytical kernel consisting of the sum of three Gaussian functions was used to describe the dose deposition process. A convolution‐based method was used to account for the ionization chamber volume averaging effect when commissioning the algorithm. The algorithm was validated by comparing the calculated planar dose distributions of FFF head‐and‐neck IMRT plans with measurements performed with a 2D diode array. Good agreement between the measured and calculated Sc was achieved for both FF beams (<0.25%) and FFF beams (<0.10%). The relative contribution of the head‐scattered photons reduced by 34.7% for 6 MV and 49.3% for 10 MV due to the removal of the FF. Superior agreement between the calculated and measured dose distribution was also achieved for FFF IMRT. In the gamma comparison with a 2%/2 mm criterion, the average passing rate was 96.2 ± 1.9% for 6 MV FFF and 95.5 ± 2.6% for 10 MV FFF. The efficient independent planar dose calculation algorithm is easy to implement and can be valuable in FFF IMRT QA.

SU-F-T-518: Development and Characterization of a Gated Treatment System Implemented with An In-House Optical Tracking System and the Elekta Response Interface

PURPOSE To report the development and characterization of the first in-house gating system implemented with an optical tracking system (OTS) and the Elekta Response™ interface. METHODS The Response™ connects a patient tracking system with a linac, enabling the tracking system to control radiation delivery. The developed system uses an in-house OTS to monitor patient breathing. The OTS consists of two infrared-based cameras, tracking markers affixed on patient. It achieves gated or breath-held (BH) treatment by calling beam ON/OFF functions in the Response™ dynamic-link library (DLL). A 4D motion phantom was used to evaluate its dosimetric and time delay characteristics. Two FF- and two FFF-IMRT beams were delivered in non-gated, BH and gated mode. The sinusoidal gating signal had a 6 sec period and 15 mm amplitude. The duty cycle included 10%, 20%, 30% and 50%. The BH signal was adapted from the sinusoidal wave by inserting 15 sec BHs. Each delivery was measured with a 2D diode array (MapCHECK™) and compared with the non-gated delivery using gamma analysis (3%). The beam ON/OFF time was captured using the service graphing utility of the linac. RESULTS The gated treatments were successfully delivered except the 10% duty cycle. The BH delivery had perfect agreement (100%) with non-gated delivery; the agreement of gated delivery decreased from 99% to 88% as duty cycle reduced from 50% to 20%. The beam on/off delay was on average 0.25/0.06 sec. The delivery time for the 50%, 30% and 20% duty cycle increased by 29%, 71% and 139%, respectively. No dosimetric or time delay difference was noticed between FF- and FFF-IMRT beams. CONCLUSION The in-house gating system was successfully developed with dosimetric and time delay characteristics in line with published results for commercial systems. It will be an important platform for further research and clinical development of gated treatment.

SU-C-BRC-04: Efficient Dose Calculation Algorithm for FFF IMRT with a Simplified Bivariate Gaussian Source Model

PURPOSE To develop an efficient and accurate independent dose calculation algorithm with a simplified analytical source model for the quality assurance and safe delivery of Flattening Filter Free (FFF)-IMRT on an Elekta Versa HD. METHODS The source model consisted of a point source and a 2D bivariate Gaussian source, respectively modeling the primary photons and the combined effect of head scatter, monitor chamber backscatter and collimator exchange effect. The in-air fluence was firstly calculated by back-projecting the edges of beam defining devices onto the source plane and integrating the visible source distribution. The effect of the rounded MLC leaf end, tongue-and-groove and interleaf transmission was taken into account in the back-projection. The in-air fluence was then modified with a fourth degree polynomial modeling the cone-shaped dose distribution of FFF beams. Planar dose distribution was obtained by convolving the in-air fluence with a dose deposition kernel (DDK) consisting of the sum of three 2D Gaussian functions. The parameters of the source model and the DDK were commissioned using measured in-air output factors (Sc) and cross beam profiles, respectively. A novel method was used to eliminate the volume averaging effect of ion chambers in determining the DDK. Planar dose distributions of five head-and-neck FFF-IMRT plans were calculated and compared against measurements performed with a 2D diode array (MapCHECK™) to validate the accuracy of the algorithm. RESULTS The proposed source model predicted Sc for both 6MV and 10MV with an accuracy better than 0.1%. With a stringent gamma criterion (2%/2mm/local difference), the passing rate of the FFF-IMRT dose calculation was 97.2±2.6%. CONCLUSION The removal of the flattening filter represents a simplification of the head structure which allows the use of a simpler source model for very accurate dose calculation. The proposed algorithm offers an effective way to ensure the safe delivery of FFF-IMRT.

WE-G-BRD-03: Development of a Real-Time Optical Tracking Goggle System (OTGS) for Intracranial Stereotactic Radiotherapy

PURPOSE Optical tracking systems (OTS) are an acceptable alternative to frame-based stereotactic radiotherapy (SRT). However, current surface-based OTS lack the ability to target exclusively rigid/bony anatomical features. We propose a novel marker-based optical tracking goggle system (OTGS) that provides real-time guidance based on the nose/facial bony anatomy. This ongoing study involves the development and characterization of the OTGS for clinical implementation in intracranial stereotactic radiotherapy. METHODS The OTGS consists of eye goggles, a custom thermoplastic nosepiece, and 6 infrared markers pre-attached to the goggles. A phantom and four healthy volunteers were used to evaluate the calibration/registration accuracy, intrafraction accuracy, interfraction reproducibility, and end-to-end accuracy of the OTGS. The performance of the OTGS was compared with that of the frameless SonArray system and cone-beam computed tomography (CBCT) for volunteer and phantom cases, respectively. The performance of the OTGS with commercial immobilization devices and under treatment conditions (i.e., couch rotation and translation range) was also evaluated. RESULTS The difference in the calibration/registration accuracy of 24 translations or rotation combinations between CBCT and in-house OTS software was within 0.5 mm/0.4°. The mean intrafraction and interfraction accuracy among the volunteers was 0.004+/-0.4mm with -0.09+/-0.5° (n=6,170) and -0.26+/-0.8mm with 0.15+/0.8° (n=11), respectively. The difference in end-to-end accuracy between the OTGS and CBCT was within 1.3 mm/1.1°. The predetermined marker pattern (1) minimized marker occlusions, (2) allowed for continuous tracking for couch angles +/- 90°, (3) and eliminated individual marker misplacement. The device was feasible with open and half masks for immobilization. CONCLUSION Bony anatomical localization eliminated potential errors due to facial hair changes and/or soft tissue deformation. The OTGS offers a workflow-friendly, patient-friendly solution for intracranial SRT, while being comparable to other real-time options. The minimum rotation uncertainty of the OTGS can be combined with CBCT to ensure maximum accuracy for high-precision SRT.

TH-E-BRE-03: A Novel Method to Account for Ion Chamber Volume Averaging Effect in a Commercial Treatment Planning System Through Convolution

PURPOSE Fourier-based deconvolution approaches used to eliminate ion chamber volume averaging effect (VAE) suffer from measurement noise. This work aims to investigate a novel method to account for ion chamber VAE through convolution in a commercial treatment planning system (TPS). METHODS Beam profiles of various field sizes and depths of an Elekta Synergy were collected with a finite size ion chamber (CC13) to derive a clinically acceptable beam model for a commercial TPS (Pinnacle3 ), following the vendor-recommended modeling process. The TPS-calculated profiles were then externally convolved with a Gaussian function representing the chamber (σ = chamber radius). The agreement between the convolved profiles and measured profiles was evaluated with a one dimensional Gamma analysis (1%/1mm) as an objective function for optimization. TPS beam model parameters for focal and extra-focal sources were optimized and loaded back into the TPS for new calculation. This process was repeated until the objective function converged using a Simplex optimization method. Planar dose of 30 IMRT beams were calculated with both the clinical and the re-optimized beam models and compared with MapCHEC™ measurements to evaluate the new beam model. RESULTS After re-optimization, the two orthogonal source sizes for the focal source reduced from 0.20/0.16 cm to 0.01/0.01 cm, which were the minimal allowed values in Pinnacle. No significant change in the parameters for the extra-focal source was observed. With the re-optimized beam model, average Gamma passing rate for the 30 IMRT beams increased from 92.1% to 99.5% with a 3%/3mm criterion and from 82.6% to 97.2% with a 2%/2mm criterion. CONCLUSION We proposed a novel method to account for ion chamber VAE in a commercial TPS through convolution. The reoptimized beam model, with VAE accounted for through a reliable and easy-to-implement convolution and optimization approach, outperforms the original beam model in standard IMRT QA verification.