Evangelos Pappas

Dosimetric validation for an automatic brain metastases planning software using single-isocenter dynamic conformal arcsDosimetric validation for an automatic brain metastases planning software using single-isocenter dynamic conformal arcs.

An automatic brain‐metastases planning (ABMP) software has been installed in our institution. It is dedicated for treating multiple brain metastases with radiosurgery on linear accelerators (linacs) using a single‐setup isocenter with noncoplanar dynamic conformal arcs. This study is to validate the calculated absolute dose and dose distribution of ABMP. Three types of measurements were performed to validate the planning software: 1, dual micro ion chambers were used with an acrylic phantom to measure the absolute dose; 2, a 3D cylindrical phantom with dual diode array was used to evaluate 2D dose distribution and point dose for smaller targets; and 3, a 3D pseudo‐in vivo patient‐specific phantom filled with polymer gels was used to evaluate the accuracy of 3D dose distribution and radiation delivery. Micro chamber measurement of two targets (volumes of 1.2 cc and 0.9 cc, respectively) showed that the percentage differences of the absolute dose at both targets were less than 1%. Averaged GI passing rate of five different plans measured with the diode array phantom was above 98%, using criteria of 3% dose difference, 1 mm distance to agreement (DTA), and 10% low‐dose threshold. 3D gel phantom measurement results demonstrated a 3D displacement of nine targets of 0.7±0.4 mm (range 0.2 ~ 1.1 mm). The averaged two‐dimensional (2D) GI passing rate for several region of interests (ROI) on axial slices that encompass each one of the nine targets was above 98% (5% dose difference, 2 mm DTA, and 10% low‐dose threshold). Measured D95, the minimum dose that covers 95% of the target volume, of the nine targets was 0.7% less than the calculated D95. Three different types of dosimetric verification methods were used and proved the dose calculation of the new automatic brain metastases planning (ABMP) software was clinical acceptable. The 3D pseudo‐in vivo patient‐specific gel phantom test also served as an end‐to‐end test for validating not only the dose calculation, but the treatment delivery accuracy as well. PACS number(s): 87.53.Lv, 87.55.km, 87.55.Qr

The 5th International Conference on Radiotherapy Gel Dosimetry (DOSGEL 2008)

The International Conference on Radiotherapy Gel Dosimetry (DOSGEL) is held every two years. Its purpose is to bring together basic science and clinical researchers, medical physicists and clinicians from around the world to discuss the state-of-the-art of the gel dosimetry technique and to set the directions and trends for its future improvements. Gel dosimetry can be broadly defined as using a gel that can react to the absorption of ionizing radiation, and that can retain this information which can subsequently be retrieved by an external imaging modality. Examples of radiation-sensitive gels include, but are not limited to, polymer gel dosimeters, Fricke gel dosimeters and others. Imaging modalities that are of general use in this field are (in alphabetical order) magnetic resonance imaging (MRI), optical light computed tomography and x-ray computed tomography. This volume comprises the proceedings of the 5th International Conference on Radiotherapy Gel Dosimetry (DOSGEL 2008). The conference, organised by the University of Crete, Medical Physics Department, took place in Hersonissos, Crete, Greece from 29 September to 3 October 2008. The meeting aimed to continue the series of biannual DOSGEL conferences and focused on the promotion of gel dosimetry techniques by setting the trends for their future improvements. The main scientific session topics of DOSGEL 2008 were the following: Chemistry and fundamental properties of polymer gel dosimeters Gel dosimetry with Optical Computed Tomography Gel dosimetry with Magnetic Resonance Imaging Gel dosimetry with other than Optical CT and MR scan Techniques Other 3D dosimeters Gel dosimetry applications Local Organizing Committee Thomas G Maris (University of Crete, Greece, Chairman DOSGEL 2008) John Damilakis (University of Crete, Greece) Evangelos Pappas (University of Crete, Greece) Antonios Papadakis (University of Crete, Greece) Fotini Zacharopoulou (University of Crete, Greece) John Stratakis (University of Crete, Greece) Pantelis Karaiskos (University of Athens, Greece) Panos Papagiannis (University of Athens, Greece) Scientific Committee President: Yves De Deene (Ghent University, Belgium) Sven Back (Lund University, Sweden) Clive Baldock (University of Sydney, Australia) David Bonnett (Kent Oncology Center, UK) Simon Doran (University of Surrey, UK) Cheryl Duzenli (University of British Columbia, Canada) Geoffrey Ibbott (Colorado State University, USA) Andrew Jirasek (University of Victoria, Canada) Kevin Jordan (University of Western Ontario, Canada) Martin Lepage (Universite de Sherbrooke, Canada) Mark Oldham (Duke University, USA) L John Schreiner (Kingston Regional Cancer Centre, Canada) Acknowledgements The local organising committee wishes to express its gratitude to all participants for their activities at DOSGEL 2008 and for creating such a friendly and inspiring environment. Special thanks are due to all the speakers, for preparing and presenting their talks, and for many valuable discussions. We also give thanks to all members of the scientific committee who, acting as referees, improved significantly the scientific quality of this proceedings volume. We would also like to thank all chairmen for their efficient leading of sessions. On Behalf of the local organizing committee of DOSGEL 2008 Thomas G Maris and Evangelos Pappas Editors

Dosimetric and localization accuracy of Elekta high definition dynamic radiosurgery

BACKGROUND AND PURPOSE With the increasingly prominent role of stereotactic radiosurgery in radiation therapy, there is a clinical need for robust, efficient, and accurate solutions for targeting multiple sites with one patient setup. The end-to-end accuracy of high definition dynamic radiosurgery with Elekta treatment planning and delivery systems was investigated in this study. MATERIALS AND METHODS A patient-derived CT scan was used to create a radiosurgery plan to seven targets in the brain. Monaco was used for treatment planning using 5 VMAT non-coplanar arcs. Prior to delivery, 3D-printed phantoms from RTsafe were ordered including a gel phantom for 3D dosimetry, phantom with 2D film insert, and an ion chamber phantom for point dose measurement. Delivery was performed using the Elekta VersaHD, XVI cone-beam CT, and HexaPOD six degree of freedom tabletop. RESULTS Absolute dose accuracy was verified within 2%. 3D global gamma analysis in the film measurement revealed 3%/2 mm passing rates >95%. Gel dosimetry 3D global gamma analysis (3%/2 mm) were above 90% for all targets with the exception of one. Results were indicative of typical end-to-end accuracies (<1 mm spatial uncertainty, 2% dose accuracy) within 4 cm of isocenter. Beyond 4 cm, 2 mm accuracy was found. CONCLUSIONS High definition dynamic radiosurgery expands clinically acceptable stereotactic accuracy to a sphere around isocenter allowing for radiosurgery of several targets with one setup with a high degree of dosimetric precision. Gel dosimetry proved to be an essential tool for the validation of the 3D dose distributions in this technique.

MO-FG-CAMPUS-TeP1-04: Pseudo-In-Vivo Dose Verification of a New Mono-Isocentric Technique for the Treatment of Multiple Brain Metastases

PURPOSE To validate dose calculation and delivery accuracy of a recently introduced mono-isocentric technique for the treatment of multiple brain metastases in a realistic clinical case. METHODS Anonymized CT scans of a patient were used to model a hollow phantom that duplicates anatomy of the skull. A 3D printer was used to construct the phantom of a radiologically bone-equivalent material. The hollow phantom was subsequently filled with a polymer gel 3D dosimeter which also acted as a water-equivalent material. Irradiation plan consisted of 5 targets and was identical to the one delivered to the specific patient except for the prescription dose which was optimized to match the gel dose-response characteristics. Dose delivery was performed using a single setup isocenter dynamic conformal arcs technique. Gel dose read-out was carried out by a 1.5 T MRI scanner. All steps of the corresponding patients treatment protocol were strictly followed providing an end-to-end quality assurance test. Pseudo-in-vivo measured 3D dose distribution and calculated one were compared in terms of spatial agreement, dose profiles, 3D gamma indices (5%/2mm, 20% dose threshold), DVHs and DVH metrics. RESULTS MR-identified polymerized areas and calculated high dose regions were found to agree within 1.5 mm for all targets, taking into account all sources of spatial uncertainties involved (i.e., set-up errors, MR-related geometric distortions and registration inaccuracies). Good dosimetric agreement was observed in the vast majority of the examined profiles. 3D gamma index passing rate reached 91%. DVH and corresponding metrics comparison resulted in a satisfying agreement between measured and calculated datasets within targets and selected organs-at-risk. CONCLUSION A novel, pseudo-in-vivo QA test was implemented to validate spatial and dosimetric accuracy in treatment of multiple metastases. End-to-end testing demonstrated that our gel dosimetry phantom is suited for such QA procedures, allowing for 3D analysis of both targeting placement and dose.

SU‐F‐T‐585: A Novel Phantom for Dosimetric Validation of SBRT for Spinal Lesions

PURPOSE SBRT is proving to be a very efficacious treatment modality for an increasing number of indications, including spine lesions. We have developed a novel phantom to serve as an end-to-end QA tool for either patient specific QA or commissioning QA of SBRT for spine lesions. METHODS In this feasibility study, we have selected a patient with a single metastatic lesion in the L5 vertebral body. The patients CT simulation scan was used to develop a VMAT treatment plan delivering 18Gy to at least 90% of the target volume, following the guidelines of RTOG 0631. The treatment plan was developed with the Pinnacle planning system using the adaptive convolution superposition calculation mode. The approved plan was re-calculated using the Monaco planning system. We performed a pseudo-in-vivo study whereby we manufactured two copies of a phantom to the exact shape and anatomy of the patient. The phantom was made from the CT images of the patient using a 3D printer with sub-millimeter accuracy. One phantom was filled with a gel dosimeter and the other was made with two ion chamber inserts to allow us to obtain point dose measurements in the targets center and the spinal cord. RESULTS The prescribed dose of 18Gy was planned for the target while keeping the maximum spinal cord dose to less than 14Gy in 0.03cc of the cord. The VMAT plan was delivered to both the gel dosimeter filed phantom and the phantom with the ion chambers. The 3D gel dosimetry revealed a very good agreement between the monte carlo and measured point and volumetric dose. CONCLUSION A patient like phantom was developed and validated for use as an end-to-end tool of dose verification for SBRT of spine lesions. We found that gel dosimetry is ideally suited to assess positional and dosimetric accuracy in 3D. RTsafe provided the phantoms and the gel dosimeter used for this study.

Radiation Therapy Dosimetry With Optical Computed Tomography and MR Scanning

We present a study for three-dimensional dose distribution maps of radiation treatment schemes applied in modern radiotherapy, based on the use of Polymer N-Vinylpyrolidone-Argon (VIPAR) polymer gel-dosimeters along with a novel Optical Computed Tomography system.