J Driewer

Quantitative megavoltage radiation therapy dosimetry using the storage phosphor KCl: Eu2+.

This work, for the first time, reports the use of europium doped potassium chloride (KCl:Eu2+) storage phosphor for quantitative megavoltage radiation therapy dosimetry. In principle, KCl:Eu2+ functions using the same photostimulatated luminescence (PSL) mechanism as commercially available BaFBr0.85I0.15:Eu2+ material that is used for computed radiography (CR) but features a significantly smaller effective atomic number-18 versus 49-making it a potentially useful material for nearly tissue-equivalent radiation dosimetry. Cylindrical KCl:Eu2+ dosimeters, 7mm in diameter and 1mm thick, were fabricated in-house. Dosimetric properties, including radiation hardness, response linearity, signal fading, dose rate sensitivity, and energy dependence, were studied with a laboratory optical reader after irradiation by a linear accelerator. The overall experimental uncertainty was estimated to be within ±2.5%. The findings were (1) KCl:Eu2+ showed satisfactory radiation hardness. There was no significant change in the stimulation spectra after irradiation up to 200Gy when compared to a fresh dosimeter, indicating that this material could be reused at least 100 times if 2Gy per use was assumed, e.g., for patient-specific IMRT QA. (2) KCl:Eu2+ exhibited supralinear response to dose after irradiation from 0to800cGy. (3) After x ray irradiation, the PSL signal faded with time and eventually reached a fading rate of about 0.1%∕h after 12h. (4) The sensitivity of the dosimeter was independent of the dose rate ranging from 15to1000cGy∕min. (5) The sensitivity showed no beam energy dependence for either open x ray or megavoltage electron fields. (6) Over-response to low-energy scattered photons was comparable to radiographic film, e.g., Kodak EDR2 film. By sandwiching dosimeters between low-energy photon filters (0.3mm thick lead foils) during irradiation, the over-response was reduced. The authors have demonstrated that KCl:Eu2+ dosimeters have many desirable dosimetric characteristics that make the material conducive to radiation therapy dosimetry. In the future, a large-area KCl:Eu2+-based CR plate with a thickness of the order of a few microns, created using modern thin film techniques, could provide a reusable, quantitative, high-resolution two-dimensional dosimeter with minimal energy dependence.

Theoretical and empirical investigations of KCl:Eu2+ for nearly water-equivalent radiotherapy dosimetry

PURPOSE The low effective atomic number, reusability, and other computed radiography-related advantages make europium doped potassium chloride (KCl : Eu2+) a promising dosimetry material. The purpose of this study is to model KCl : Eu2+ point dosimeters with a Monte Carlo (MC) method and, using this model, to investigate the dose responses of two-dimensional (2D) KCl : Eu2+ storage phosphor films (SPFs). METHODS KCl : Eu2+ point dosimeters were irradiated using a 6 MV beam at four depths (5-20 cm) for each of five square field sizes (5 x 5-25 x 25 cm2). The dose measured by KCl : Eu2+ was compared to that measured by an ionization chamber to obtain the magnitude of energy dependent dose measurement artifact. The measurements were simulated using DOSXYZnrc with phase space files generated by BEAMnrcMP. Simulations were also performed for KCl : Eu2+ films with thicknesses ranging from 1 microm to 1 mm. The work function of the prototype KCl : Eu2+ material was determined by comparing the sensitivity of a 150 microm thick KCl : Eu2+ film to a commercial BaFBr0.85 I0.15 : Eu(2+)-based SPF with a known work function. The work function was then used to estimate the sensitivity of a 1 microm thick KCl : Eu2+ film. RESULTS The simulated dose responses of prototype KCl : Eu2+ point dosimeters agree well with measurement data acquired by irradiating the dosimeters in the 6 MV beam with varying field size and depth. Furthermore, simulations with films demonstrate that an ultrathin KCl : Eu2+ film with thickness of the order of 1 microm would have nearly water-equivalent dose response. The simulation results can be understood using classic cavity theories. Finally, preliminary experiments and theoretical calculations show that ultrathin KCl : Eu2+ film could provide excellent signal in a 1 cGy dose-to-water irradiation. CONCLUSIONS In conclusion, the authors demonstrate that KCl : Eu(2+)-based dosimeters can be accurately modeled by a MC method and that 2D KCl : Eu2+ films of the order of 1 microm thick would have minimal energy dependence. The data support the future research and development of a KCl : Eu2+ storage phosphor-based system for quantitative, high-resolution multidimensional radiation therapy dosimetry.

A new variable for SRS plan quality evaluation based on normal tissue sparing: the effect of prescription isodose levels

OBJECTIVE A new dosimetric variable, dose-dropping speed (DDS), was proposed and used to evaluate normal tissue sparing among stereotactic radiosurgery (SRS) plans with different prescription isodose lines. METHODS 40 plans were generated for 8 intracranial SRS cases, prescribing to isodose levels (IDLs) ranging from 50% to 90% in 10% increments. Whilst maintaining similar coverage and conformity, plans at different IDLs were evaluated in terms of normal tissue sparing using the proposed DDS. The DDS was defined as the greater decay coefficient in a double exponential decay fit of the dose drop-off outside the planning target volume (PTV), which models the steep portion of the drop-off. Provided that the prescription dose covers the whole PTV, a greater DDS indicates better normal tissue sparing. RESULTS Among all plans, the DDS was found to be the lowest for the prescription at 90% IDL and the highest for the prescription at 60% or 70%. The beam profile slope change in the penumbra and its field size dependence were explored and given as the physical basis of the findings. CONCLUSION A variable was proposed for SRS plan quality evaluation. Using this measure, prescriptions at 60% and 70% IDLs were found to provide best normal tissue sparing. ADVANCES IN KNOWLEDGE A new variable was proposed based on which normal tissue sparing was quantitatively evaluated, comparing different prescription IDLs in SRS.

Radiation hardness of the storage phosphor europium doped potassium chloride for radiation therapy dosimetry

PURPOSE An important property of a reusable dosimeter is its radiation hardness, that is, its ability to retain its dosimetric merits after irradiation. The radiation hardness of europium doped potassium chloride (KC1:Eu2+), a storage phosphor material recently proposed for radiation therapy dosimetry, is examined in this study. METHODS Pellet-style KCl:Eu2+ dosimeters, 6 mm in diameter, and 1 mm thick, were fabricated in-house for this study. The pellets were exposed by a 6 MV photon beam or in a high dose rate 137Cs irradiator. Macroscopic properties, such as radiation sensitivity, dose response linearity, and signal stability, were studied with a laboratory photostimulated luminescence (PSL) readout system. Since phosphor performance is related to the state of the storage centers and the activator, Eu2+, in the host lattice, spectroscopic and temporal measurements were carried out in order to explore radiation-induced changes at the microscopic level. RESULTS KCl:Eu2+ dosimeters retained approximately 90% of their initial signal strength after a 5000 Gy dose history. Dose response was initially supralinear over the dose range of 100-700 cGy but became linear after 60 Gy. Linearity did not change significantly in the 0-5000 Gy dose history spanned in this study. Annealing high dose history chips resulted in a return of supralinearity and a recovery of sensitivity. There were no significant changes in the PSL stimulation spectra, PSL emission spectra, photoluminescence spectra, or luminescence lifetime, indicating that the PSL signal process remains intact after irradiation but at a reduced efficiency due to reparable radiation-induced perturbations in the crystal lattice. CONCLUSIONS Systematic studies of KCl:Eu2+ material are important for understanding how the material can be optimized for radiation therapy dosimetry purposes. The data presented here indicate that KCl:Eu2+ exhibits strong radiation hardness and lends support for further investigations of this novel material.

Technical Note: Fabricating Cerrobend grids with 3D printing for spatially modulated radiation therapy: A feasibility study.

PURPOSE Grid therapy has promising applications in the radiation treatment of large tumors. However, research and applications of grid therapy are limited by the accessibility of the specialized blocks that produce the grid of pencil-like radiation beams. In this study, a Cerrobend grid block was fabricated using the 3D printing technique. METHODS A grid block mold was designed with flared tubes which follow the divergence of the beam. The mold was 3D printed using a resin with the working temperature below 230 °C. The melted Cerrobend liquid at 120 °C was cast into the resin mold to yield a block with a thickness of 7.4 cm. At the isocenter plane, the grid had a hexagonal pattern, with each pencil beam diameter of 1.4 cm; the distance between the beam centers was 2.1 cm. RESULTS The dosimetric properties of the grid block were studied using small field dosimeters: a pinpoint ionization chamber and a stereotactic diode. For a 6 MV photon beam, its valley-to-peak ratio was 20% at dmax and 30% at 10 cm depth; the output factor was 84.9% at dmax and 65.1% at 10 cm depth. CONCLUSIONS This study demonstrates that it is feasible to implement 3D printing technique in applying grid therapy in clinic.

Accuracy evaluation of a six‐degree‐of‐freedom couch using cone beam CT and IsoCal phantom with an in‐house algorithm

Purpose: The accuracy of a six degree of freedom (6DoF) couch was evaluated using a novel method. Methods: Cone beam CT (CBCT) images of a 3D phantom (IsoCal) were acquired with different, known combinations of couch pitch and roll angles. Pitch and roll angles between the maximum allowable values of 357 and 3 degrees were tested in one degree increments. A total of 49 combinations were tested at 0 degrees of yaw (couch rotation angle). The 3D positions of 16 tungsten carbide ball bearings (BBs), each 4 mm in diameter and arranged in a known geometry within the IsoCal phantom, were determined in the 49 image sets with in‐house software. The BB positions at different rotation angles were determined using a rotation matrix from the original BB positions at zero pitch and roll angles. A linear least squares fit method estimated the rotation angles and differences between detected and nominal rotation angles were calculated. This study was conducted for the case with and without extra weight on the couch. Couch walk shifts for the system were investigated using eight combinations of rotation, roll and pitch. Results: A total of 49 CBCT images with voxel sizes 0.5 × 0.5 × 1.0 mm3 were taken for the case without extra weight on the couch. The 16 BBs were determined to evaluate the isocenter translation and rotation differences between the calculated and nominal couch values. Among all 49 calculations, the maximum rotation angle differences were 0.10 degrees for pitch, 0.15 degrees for roll and 0.09 degrees for yaw. The corresponding mean and standard deviation values were 0.028 ± 0.032, −0.043 ± 0.058, and −0.009 ± 0.033 degrees. The maximum translation differences were 0.3 mm in the left–right direction, 0.5 mm in the anterior–posterior direction and 0.4 mm in the superior–inferior direction. The mean values and corresponding standard deviations were 0.07 ± 0.12, −0.05 ± 0.25, and −0.12±0.14 mm for the planes described above. With an 80 kg phantom on the couch, the maximum translation shift was 0.69 mm. The couch walk translation shifts were less than 0.1 mm and rotation shifts were less than 0.1 degree. Conclusions: Errors of a new 6DoF couch were tested using CBCT images of a 3D phantom. The rotation errors were less than 0.3 degree and the translation errors were less than or equal to 0.8 mm in each direction. This level of accuracy is warranted for clinical radiotherapy utilization including stereotactic radiosurgery.

SU-E-T-440: Gain Calibration Stability Study of a MV Flat-Panel-Detector (FPD) On Siemens ARTISTE Linac

Purpose: To study gain calibration variation over time for an MV flat-panel-detector (FPD). Methods: Gain calibration images (1024×1024 pixels) of a FPD (PerkinElmer AN-9 on a Siemens ARTISTE) acquired in 40 consecutive months were studied. Using Python programming language, the images were processed to analyze the central 900×900 pixels with a threshold applied to exclude dead pixels. Month1 was set as the base image, then the difference images between it and the following months were calculated. The pixel intensity mean and standard deviation of the difference images were used to study the gain variation over time. Two other months’ images were also randomly selected as the base image and the above analyses were repeated. Finally, to investigate the equivalence of monthly calibration and quarterly calibration, the results from comparing neighboring months’ images, such as (month2-month1), (month3 -month2) et al, were compared with those from comparing images taken in 3-month intervals, such as (month4-month1), (month7-month4) et al, using Welch’s t-test. Results: For most months’ gain calibration images, the differences (mean and standard deviation) from base images were constant. In three months, the differences were relatively larger compared to other months but seemed instantaneous without any worsening trend. In those 3 months no clinical portal image quality degradation was observed. The difference between monthly and quarterly calibration tested by Welch’s t-test were insignificant for both means (p=0.9) and standard deviations (p=0.8). Conclusion: Long term stability of the FPD gain calibration images was observed. Therefore, the vendor-recommended calibration frequency of 2–4 weeks is unnecessary. Less frequent, such as quarterly, calibration is sufficient.

SU‐E‐J‐180: Imaging‐Based ITV May Provide Insufficient Internal Margin for Lung SBRT Patients with Tumor Misalignments Between 3D and 4D Planning CTs

Purpose: To evaluate the target positional differences between 3D/4D planning CTs (pCTs) and daily CBCTs, and assess ITV coverage of daily GTVs, for lung SBRT patients with misaligned tumor positions between the 3D and 4D pCTs. Methods: Simulation 3D and 4D pCTs, both under free breathing, were acquired on a Sensation Open (Siemens) with RPM (Varian). ITV_All is the union of the GTVs delineated on the 3D pCT (GTV_3D) and on all phases of the 4D pCT (ITV_4D). While for most patients GTV_3D is included in ITV_4D, for some patients GTV_3D shows a substantial misalignment in the axial plane from ITV_4D with spine-based rigid registration. Under IRB approval, pCTs of 51 patients were retrospectively reviewed to assess the frequency of such misalignments. For one patient with daily kV CBCTs available, all planning and treatment CTs were rigidly registered. GTV_3D, ITV_4D, GTV_F1 through GTV_F5 (on daily CBCTs of Fractions 1–5) were delineated. ITV_All and ITV_5mm (5mm uniform expansion of GTV_3D) were generated. Volumes and centers-of-mass (COMs) of all structures were analyzed. The inclusion relations (percentage of Structure-A included in Structure-B) were studied between GTV_F1 to GTV_F5 (Structure-As) and GTV_3D, ITV_4D, ITV_All, ITV_5mm (Structure-Bs). Results: Three patients showed substantial target misalignments between the 3D and 4D pCTs. For the analyzed patient, daily GTV positions agreed better with GTV_3D than with ITV_4D, with a median (range) COM vector difference of 2.45mm (1.00–4.58) and 16.06mm (15.39–17.44), respectively. The average inclusion of daily GTVs was 99.47% and 69.53% in ITV_5mm and ITV_All, respectively; although ITV_5mm was ∼35% larger than ITV_All for the ∼2cc tumor (GTV_3D). Conclusion: Substantial lung tumor misalignments were observed between 3D and 4D pCTs for some patients. For one such patient, daily tumor positions agreed better with the 3D pCT. Using spinebased localization for SBRT, ITV_All may provide insufficient internal margin.

MO-DE-BRA-01: Enhancing Radiation Physics Instruction Through Gamification and E-Learning

Purpose: This project sought to “gamify” the instruction of radiation interaction physics concepts for technology students. Gamification applies game mechanics and user interactions in active learning contexts. In one part of this project, a self-guided eModule was developed for conceptual radiation interaction instruction. In a second part, a web-based game, Particle Launch (http://particle-launcher.ist.unomaha.edu), was created to challenge students to quickly apply radiation interaction concepts in a way that is stimulating and motivating. Methods: The eModule, focused on conceptual interaction physics, was designed in Adobe Captivate and incorporates animation, web videos, and assessment questions in order to generate student interest. Navigating the whole module takes 40 minutes for beginners. Assessments after three main sections are comprised of 3–4 questions randomly selected from a question pool. In collaboration with the University of Nebraska at Omaha’s College of Information Science and Technology, the Particle Launch game was created with the Unity gaming engine and designed with a game-play look and feel. The object of the game is to utilize different particles, energies, and directions to destroy a target given a limited number of resources and time to complete the task. A rewards system encourages accurate shots. Results: The eModule part of the project encourages a flipped classroom model in which class time is devoted to application of concepts rather than information-based lectures. Currently, eModule assessments are not tracked but this feature could be incorporated to encourage participation. Furthermore, in a class of five technology students, the game was found to be fun and engaging and had the effect of reinforcing basic concepts from the eModule. Conclusion: Gamification has significant potential to alter medical physics instruction. Game-play feedback is an important part of the learning process. Students found Particle Launch inviting and challenging and further research could help game design. This project was generously supported by the Office of the Vice-Chancellor for Academic Affairs and the University of Nebraska Medical Center.

SU-E-T-460: Impact of the LINAC Repetition Rate On a High-Resolution Liquid Ionization Chamber Array for Patient-Specific QA

Purpose: The purpose of this study is to investigate the LINAC repetition-rate (dose-rate) dependence of OCTAVIUS 1000SRS liquid ionization chamber (LIC) array for patient specific QA of SRT plans delivered with flattening-filter-free (FFF) beams. Methods: 1) The repetition-rate dependence of 1000SRS was measured in a phantom constructed with 5-cm solid water above and below the array for build-up and backscatter. A 0.3cc calibrated ion chamber was also placed along the central axis 2.3cm below the center chamber of the array for normalizing LINAC output fluctuation. The signals from the center chamber of the array under different repetition rates in the range of 400–2400 MU/min for 6xFFF and 10xFFF beams on a Varian TrueBeamSTx LINAC, normalized by the independent chamber readings, were analyzed for the array response dependence on repetition rates. 2) Twelve Step-and-shoot IMRS QA plans (6xFFF and 10xFFF) were delivered to the array under different repetition rates for analysis and comparison. 3) The absolute doses measured by the center chamber were compared to measurements using an independent ionization chamber with the identical setup, taken as the gold standard. 4) The correction factors based on the actual delivery repetition rate were applied to the measurements, and the results were compared again to the gold standard. Results: 1) The 1000SRS array exhibited repetition-rate dependence for FFF beams, up to 5% for 6xFFF and 10% for 10xFFF; 2) The array showed clinically-acceptable repetition-rate dependence for regular flattened beams; 3) This repetition-rate dependence significantly affected the measurement accuracy, thereby affecting IMRS QA results; 4) By applying an empirical repetition-rate correction, the corrected measurements agreed better with the gold standard ion chamber measurements. Conclusion: OCTAVIUS 1000SRS LIC array exhibited considerable repetition-rate dependence for FFF beams, which will affect the accuracy of the absolute QA measurements, especially for IMRS plans with the step-and-shoot technique.