Christopher L. Williams

Independent brachytherapy plan verification software: Improving efficacy and efficiency

BACKGROUND AND PURPOSE To compare the pre-treatment brachytherapy plan verification by a physicist assisted by custom plan verification software (SAV) with those performed manually (MV). MATERIALS AND METHODS All HDR brachytherapy plans used for treatment in 2013, verified using either SAV or MV, were retrospectively reviewed. Error rate (number of errors/number of plans) was measured and verification time calculated. All HDR brachytherapy safety events recorded between 2010 and 2013 were identified. The rate of patient-related safety events (number of events/number of fractions treated) and the impact of SAV on the underlying errors were assessed. RESULTS Three/106 errors (2.8%) were found in the SAV group and 24/273 (8.8%) in the MV group (p=0.046). The mean ±1 standard deviation plan verification time was 8.4±4.0min for SAV and 11.6±5.3 for MV (p=0.006). Seven safety events out of 4729 fractions delivered (0.15%) were identified. Four events (57%) were associated with plan verification and could have been detected by SAV. CONCLUSIONS We found a safety event rate in HDR brachytherapy of 0.15%. SAV significantly reduced the number of undetected errors in HDR treatment plans compared to MV, and reduced the time required for plan verification.

An initial study on the estimation of time-varying volumetric treatment images and 3D tumor localization from single MV cine EPID images

PURPOSE In this work the authors develop and investigate the feasibility of a method to estimate time-varying volumetric images from individual MV cine electronic portal image device (EPID) images. METHODS The authors adopt a two-step approach to time-varying volumetric image estimation from a single cine EPID image. In the first step, a patient-specific motion model is constructed from 4DCT. In the second step, parameters in the motion model are tuned according to the information in the EPID image. The patient-specific motion model is based on a compact representation of lung motion represented in displacement vector fields (DVFs). DVFs are calculated through deformable image registration (DIR) of a reference 4DCT phase image (typically peak-exhale) to a set of 4DCT images corresponding to different phases of a breathing cycle. The salient characteristics in the DVFs are captured in a compact representation through principal component analysis (PCA). PCA decouples the spatial and temporal components of the DVFs. Spatial information is represented in eigenvectors and the temporal information is represented by eigen-coefficients. To generate a new volumetric image, the eigen-coefficients are updated via cost function optimization based on digitally reconstructed radiographs and projection images. The updated eigen-coefficients are then multiplied with the eigenvectors to obtain updated DVFs that, in turn, give the volumetric image corresponding to the cine EPID image. RESULTS The algorithm was tested on (1) Eight digital eXtended CArdiac-Torso phantom datasets based on different irregular patient breathing patterns and (2) patient cine EPID images acquired during SBRT treatments. The root-mean-squared tumor localization error is (0.73 ± 0.63 mm) for the XCAT data and (0.90 ± 0.65 mm) for the patient data. CONCLUSIONS The authors introduced a novel method of estimating volumetric time-varying images from single cine EPID images and a PCA-based lung motion model. This is the first method to estimate volumetric time-varying images from single MV cine EPID images, and has the potential to provide volumetric information with no additional imaging dose to the patient.

A mass-conserving 4D XCAT phantom for dose calculation and accumulation

PURPOSE The XCAT phantom is a realistic 4D digital torso phantom that is widely used in imaging and therapy research. However, lung mass is not conserved between respiratory phases of the phantom, making detailed dosimetric simulations and dose accumulation unphysical. A framework is developed to correct this issue by enforcing local mass conservation in the XCAT lung. Dose calculations are performed to assess the implications of neglecting mass conservation, and to demonstrate an application of the phantom to calculate the accumulated delivered dose in an irregularly breathing patient. METHODS A displacement vector field (DVF) between each respiratory state and a reference image is generated from the XCAT motion model and its divergence is calculated and used to correct the lung density. A series of phantoms with regular and irregular breathing (based on patient data) are generated and modified to conserve mass. Monte Carlo methods are used to simulate conventional and SBRT treatment delivery. The calculated dose is deformed and accumulated using the DVF. Results from the mass-conserving and original XCAT are compared. A 4DCT is simulated for the irregularly breathing patient, and a 4DCT-based dose estimate is compared with the accumulated delivered dose. RESULTS The presented framework successfully conserves mass in the XCAT lung. The spatial distribution of the lung dose was qualitatively changed by the use of a mass conservation in the XCAT; however, the corresponding DVH did not change significantly. The comparison of the delivered dose with the 4DCT-based prediction shows similar lung metric results, however dose differences of 10% can be seen in some spatial regions. CONCLUSIONS The XCAT phantom has been successfully modified so that it conserves lung mass during respiration, enabling it to be used as a tool to perform dose accumulation studies in the lung without relying on deformable image registration. Neglecting mass conservation can result in erroneous spatial distributions of the dose in the lung. Using this tool to simulate patient treatments reveals differences between the planned dose and the calculated delivered dose for the full treatment. The software is freely available from the authors.

SU-F-T-426: Measurement of Dose Enhancement Due to Backscatter From Modern Dental Materials

PURPOSE High-density materials used in dental restoration can cause significant localized dose enhancement due to electron backscatter in head-and-neck radiotherapy, increasing the risk of mucositis. The materials used in prosthetic dentistry have evolved in the last decades from metal alloys to ceramics. We aim to determine the dose enhancement caused by backscatter from currently-used dental materials. METHODS Measurements were performed for three different dental materials: lithium disilicate (Li2 Si2 O5 ), zirconium dioxide (ZrO2 ), and gold alloy. Small thin squares (2×2×0.15 cm3 ) of the material were fabricated, and placed into a phantom composed of tissue-equivalent material. The phantom was irradiated with a single 6 MV photon field. A thin-window parallel-plate ion chamber was used to measure the dose at varying distances from the proximal interface between the material and the plastic. RESULTS The dose enhancement at the interface between the high-density and tissue-equivalent materials, relative to a homogeneous phantom, was 54% for the gold alloy, 31% for ZrO2 , and 9% for Li2 Si2 O5 . This enhancement decreased rapidly with distance from the interface, falling to 11%, 5%, and 0.5%, respectively, 2 mm from the interface. Comparisons with the modeling of this effect in treatment planning systems are performed. CONCLUSION While dose enhancement due to dental restoration is smaller with ceramic materials than with metal alloys, it can still be significant. A spacer of about 2-3 mm would be effective in reducing this enhancement, even for metal alloys.