Christof Baltes

Time dependent pre-treatment EPID dosimetry for standard and FFF VMAT

Methods to calibrate Megavoltage electronic portal imaging devices (EPIDs) for dosimetry have been previously documented for dynamic treatments such as intensity modulated radiotherapy (IMRT) using flattened beams and typically using integrated fields. While these methods verify the accumulated field shape and dose, the dose rate and differential fields remain unverified. The aim of this work is to provide an accurate calibration model for time dependent pre-treatment dose verification using amorphous silicon (a-Si) EPIDs in volumetric modulated arc therapy (VMAT) for both flattened and flattening filter free (FFF) beams. A general calibration model was created using a Varian TrueBeam accelerator, equipped with an aS1000 EPID, for each photon spectrum 6 MV, 10 MV, 6 MV-FFF, 10 MV-FFF. As planned VMAT treatments use control points (CPs) for optimization, measured images are separated into corresponding time intervals for direct comparison with predictions. The accuracy of the calibration model was determined for a range of treatment conditions. Measured and predicted CP dose images were compared using a time dependent gamma evaluation using criteria (3%, 3 mm, 0.5 sec). Time dependent pre-treatment dose verification is possible without an additional measurement device or phantom, using the on-board EPID. Sufficient data is present in trajectory log files and EPID frame headers to reliably synchronize and resample portal images. For the VMAT plans tested, significantly more deviation is observed when analysed in a time dependent manner for FFF and non-FFF plans than when analysed using only the integrated field. We show EPID-based pre-treatment dose verification can be performed on a CP basis for VMAT plans. This model can measure pre-treatment doses for both flattened and unflattened beams in a time dependent manner which highlights deviations that are missed in integrated field verifications.

Optimized Varian aSi portal dosimetry: development of datasets for collective use

Although much literature has been devoted to portal dosimetry with the Varian amorphous silicon (aSi) portal imager, the majority of the described methods are not routinely adopted because implementation procedures are cumbersome and not within easy reach of most radiotherapy centers. To make improved portal dosimetry solutions more generally available, we have investigated the possibility of converting optimized configurations into ready‐to‐use standardized datasets. Firstly, for all commonly used photon energies (6, 10, 15, 18, and 20 MV), basic beam data acquired on 20 aSi panels were used to assess the interpanel reproducibility. Secondly, a standardized portal dose image prediction (PDIP) algorithm configuration was created for every energy, using a three‐step process to optimize the aSi dose response function and profile correction files for the dosimetric calibration of the imager panel. An approximate correction of the backscatter of the Exact arm was also incorporated. Thirdly, a set of validation fields was assembled to assess the accuracy of the standardized configuration. Variations in the basic beam data measured on different aSi panels very rarely exceeded 2% (2 mm) and are of the same order of magnitude as variations between different Clinacs when measuring in reference conditions in water. All studied aSi panels can hence be regarded as nearly identical. Standardized datasets were successfully created and implemented. The test package proved useful in highlighting possible problems and illustrating remaining limitations, but also in demonstrating the good overall results (95% pass rate for 3%,3 mm) that can be obtained. The dosimetric behavior of all tested aSi panels was found to be nearly identical for all tested energies. The approach of using standardized datasets was then successfully tested through the creation and evaluation of PDIP preconfigured datasets that can be used within the Varian portal dosimetry solution. PACS number: 87.55.km, 87.55.Qr, 87.56.N_

Evaluation of the Machine Performance Check application for TrueBeam Linac.

BackgroundMachine Performance Check (MPC) is an application to verify geometry and beam performances of TrueBeam Linacs, through automated checks based on their kV-MV imaging systems. In this study, preliminary tests with MPC were analyzed using all photon beam energies of our TrueBeam, comparing whenever possible with external independent checks.MethodsData acquisition comprises a series of 39 images (12 with kV and 27 with MV detector) acquired at predefined positions without and with the IsoCal phantom in the beam, and with particular MLC pattern settings. MPC performs geometric and dosimetric checks. The geometric checks intend to test the treatment isocenter size and its coincidence with imaging devices, the positioning accuracy of the imaging systems, the collimator, the gantry, the jaws, the MLC leaves and the couch position. The dosimetric checks: refer to a reference MV image and give the beam output, uniformity and center change relative to the reference. MPC data were acquired during 10 repetitions on different consecutive days.Alternative independent checks were performed. Geometric: routine mechanical tests, Winston-Lutz test for treatment isocenter radius. Dosimetric: the 2D array StarCheck (PTW) was used just after the MPC data acquisition.ResultsResults were analyzed for 6, 10, 15 MV flattened, and 6, 10 MV FFF beams. Geometric checks: treatment isocenter was between 0.31 ± 0.01 mm and 0.42 ± 0.02 mm with MPC, compared to 0.27 ± 0.01 mm averaged on all energies with the Winston-Lutz test. Coincidence of kV and MV imaging isocenters was within 0.36 ± 0.0 and 0.43 ± 0.06 mm, respectively (0.4 ± 0.1 mm with external tests). Positioning accuracy of MLC was within 0.5 mm; accuracy of jaws was 0.04 ± 0.02, 0.10 ± 0.05, −1.01 ± 0.03, 0.92 ± 0.04 mm for X1, X2, Y1, Y2 jaws, respectively, with MPC. Dosimetric tests: the output stability relative to the baseline was in average 0.15 ± 0.07% for MPC to compare with 0.3 ± 0.2% with the independent measurement.ConclusionsMPC proved to be a reliable, fast and easy to use method for checking the machine performances on both geometric and dosimetric aspects.

Detection of anatomical changes in lung cancer patients with 2D time-integrated, 2D time-resolved and 3D time-integrated portal dosimetry: a simulation study

The aim of this work is to assess the performance of 2D time-integrated (2D-TI), 2D time-resolved (2D-TR) and 3D time-integrated (3D-TI) portal dosimetry in detecting dose discrepancies between the planned and (simulated) delivered dose caused by simulated changes in the anatomy of lung cancer patients. For six lung cancer patients, tumor shift, tumor regression and pleural effusion are simulated by modifying their CT images. Based on the modified CT images, time-integrated (TI) and time-resolved (TR) portal dose images (PDIs) are simulated and 3D-TI doses are calculated. The modified and original PDIs and 3D doses are compared by a gamma analysis with various gamma criteria. Furthermore, the difference in the D 95% (ΔD 95%) of the GTV is calculated and used as a gold standard. The correlation between the gamma fail rate and the ΔD 95% is investigated, as well the sensitivity and specificity of all combinations of portal dosimetry method, gamma criteria and gamma fail rate threshold. On the individual patient level, there is a correlation between the gamma fail rate and the ΔD 95%, which cannot be found at the group level. The sensitivity and specificity analysis showed that there is not one combination of portal dosimetry method, gamma criteria and gamma fail rate threshold that can detect all simulated anatomical changes. This work shows that it will be more beneficial to relate portal dosimetry and DVH analysis on the patient level, rather than trying to quantify a relationship for a group of patients. With regards to optimizing sensitivity and specificity, different combinations of portal dosimetry method, gamma criteria and gamma fail rate should be used to optimally detect certain types of anatomical changes.