Lixin Zhan

Beam coordinate transformations from DICOM to DOSXYZnrc

Digital imaging and communications in medicine (DICOM) format is the de facto standard for communications between therapeutic and diagnostic modalities. A plan generated by a treatment planning system (TPS) is often exported in DICOM format. BEAMnrc/DOSXYZnrc is a widely used Monte Carlo (MC) package for modelling the Linac head and simulating dose delivery in radiotherapy. It has its own definition of beam orientation, which is not in compliance with the one defined in the DICOM standard. MC dose calculations using information from TPS generated plans require transformation of beam orientations to the DOSXYZnrc coordinate system (c.s.) and the transformation is non-trivial. There have been two studies on the coordinate transformations. The transformation equation sets derived have been helpful to BEAMnrc/DOSXYZnrc users. However, the transformation equation sets are complex mathematically and not easy to program. In this study, we derive a new set of transformation equations, which are more compact, easily understandable, and easier for computational implementation. The derivation of the polar angle θ and the azimuthal angle φ used by DOSXYZnrc is similar to the existing studies by applying a series of rotations to a vector in DICOM patient c.s. The derivation of the beam rotation ϕ(col) for DOSXYZnrc, however, is different. It is obtained by a direct combination of the actual collimator rotation with the projection of the couch rotation to the collimator rotating plane. Verification of the transformation has been performed using clinical plans. The comparisons between TPS and MC results show very good geometrical agreement for field placements, together with good agreement in dose distributions.

Poster - 33: Dosimetry Comparison of Prone Breast Forward and Inverse Treatment planning considering daily setup variations

Introduction: The purpose of this study is to investigate the effects of daily setup variations on prone breast forward field-in-field (FinF) and inverse IMRT treatment planning. Methods: Rando Phantom (Left breast) and Pixy phantom (Right breast) were built and CT scanned in prone position. The treatment planning (TP) is performed in Eclipse TP system. Forward FinF plan and inverse IMRT plan were created to satisfy the CTV coverage and OARs criteria. The daily setup variations were assumed to be 5 mm at left-right, superior-inferior, and anterior-posterior directions. The DVHs of CTV coverage and OARs were compared for both forward FinF plan and inverse IMRT plans due to 5mm setup variation. Results and Discussions: DVHs of CTV coverage had fewer variations for 5m setup variation for forward FinF and inverse IMRT plan for both phantoms. However, for the setup variations in the left-right direction, the DVH of CTV coverage of IMRT plan showed the worst variation due to lateral setup variation for both phantoms. For anterior-posterior variation, the CTV could not get full coverage when the breast chest wall is shallow; however, with the guidance of MV imaging, breast chest wall will be checked during the MV imaging setup. So the setup variations have more effects on inverse IMRT plan, compared to forward FinF plan, especially in the left-right direction. Conclusions: The Forward FinF plan was recommended clinically considering daily setup variation.

Poster - 19: Investigation of Electron Reference Dosimetry Based on Optimal Chamber Shift

An addendum/revision to AAPM TG-51 electron reference dosimetry is highly expected to meet the clinical requirement with the increasing usage of new ion chambers not covered in TG-51. A recent study, Med. Phys. 41, 111701, proposed a new fitting equation for the beam quality conversion factor k’Q to a wide spectrum of chambers. In the study, an optimal Effective Point of Measurement (EPOM) from Monte Carlo calculations was recommended and the fitting parameters to k’Q was based on it. We investigated the absolute dose obtained based on the optimal EPOM method and the original TG-51 method with k’R50 determined differently. The results showed that using the Markus curve is a better choice than the well-guarded chamber fitting for an IBA PPC-05 parallel plate chamber if we need to strictly follow the AAPM TG-51 protocol. We also examined the usage of the new fitting equation with measurement performed at the physical EPOM, instead of the optimal EPOM. The former is more readily determined and more practical in clinics. Our study indicated that the k’Q fitting based on the optimal EPOM can be used to measurement at the physical EPOM with no significant clinical impact. The inclusion of Farmer chamber gradient correction Pgr in k’Q, as in the mentioned study, asks for the precise positioning of chamber center at dref. It is not recommended in clinics to avoid over-correction for low electron energies, especially for an institute having matching Linacs implemented.

Poster — Thur Eve — 31: Dosimetric Effect of Respiratory Motion on RapidArc Lung SBRT Treatment Delivered by TrueBeam Linear Accelerator

Volumetric modulated arc therapy (VMAT) allows fast delivery of stereotactic radiotherapy. However, the discrepancies between the calculated and delivered dose distributions due to respiratory motion and dynamic multileaf collimators (MLCs) interplay are not avoidable. The purpose of this study is to investigate RapidArc lung SBRT treatment delivered by the flattening filter-free (FFF) beam and flattened beam with Varian TrueBeam machine. CIRS Dynamic Thorax Phantom with in-house made lung tumor insertion was CT scanned both in free breathing and 4DCT. 4DCT was used to determine the internal target volume. The free breathing CT scan was used for treatment planning. A 5 mm margin was given to ITV to generate a planning target volume. Varian Eclipse treatment planning was used to generate RapidArc plans based on the 6 MV flattened beam and 6MV FFF beam. The prescription dose was 48 Gy in 4 fractions. At least 95% of PTV was covered by the prescribed dose. The RapidArc plans with 6 MV flattened beam and 6MV FFF beam were delivered with Varian TrueBeam machine. The dosimetric measurements were performed with Gafchromic XR-RV3 film, which was placed in the lung tumor insertion. The interplay between the dynamic MLC-based delivery of VMAT and the respiratory motion of the tumor degraded target coverage and created undesired hot or cold dose spots inside the lung tumor. Lung SBRT RapidArc treatments delivered by the FFF beam of TrueBeam linear accelerator is superior to the flattened beam. Further investigation will be performed by Monte Carlo simulation.

Poster — Thur Eve — 43: Monte Carlo Modeling of Flattening Filter Free Beams and Studies of Relative Output Factors

Flattening filter free (FFF) beams have been adopted by many clinics and used for patient treatment. However, compared to the traditional flattened beams, we have limited knowledge of FFF beams. In this study, we successfully modeled the 6 MV FFF beam for Varian TrueBeam accelerator with the Monte Carlo (MC) method. Both the percentage depth dose and profiles match well to the Golden Beam Data (GBD) from Varian. MC simulations were then performed to predict the relative output factors. The in-water output ratio, Scp, was simulated in water phantom and data obtained agrees well with GBD. The in-air output ratio, Sc, was obtained by analyzing the phase space placed at isocenter, in air, and computing the ratio of water Kerma rates for different field sizes. The phantom scattering factor, Sp, can then be obtained from the traditional way of taking the ratio of Scp and Sc. We also simulated Sp using a recently proposed method based on only the primary beam dose delivery in water phantom. Because there is no concern of lateral electronic disequilibrium, this method is more suitable for small fields. The results from both methods agree well with each other. The flattened 6 MV beam was simulated and compared to 6 MV FFF. The comparison confirms that 6 MV FFF has less scattering from the Linac head and less phantom scattering contribution to the central axis dose, which will be helpful for improving accuracy in beam modeling and dose calculation in treatment planning systems.

Poster — Thur Eve — 66: A planning comparison between RapidArc and intensity modulated radiotherapy for head and neck cancer

Volumetric modulated arc therapy (VMAT) has recently been used to improve the dose distribution and efficiency of treatment delivery over the standard intensity-modulated radiotherapy (IMRT) technique. This study compares the dosimetry between RapidArc plan and standard IMRT plan for head and neck cancer. Three head and neck patients treated clinically with sliding window intensity-modulated radiotherapy (IMRT) technique at Grand River Regional Cancer Center were selected randomly and re-planned using RapidArc technique with 6 MV photon beams generated by a Varian 21EX linac with 120-leaf multileaf collimator. Three dose prescriptions were used to deliver 70 Gy, 63 Gy and 58.1 Gy to the regions of the primary tumors, intermediate-risk nodes and low-risk nodal level, respectively, in 35 fractions. Dosimetric comparison based on the dose-volume histogram, target coverage, organ at risk (OAR) dose sparing were studied between the RapidArc plan and IMRT plan. RapidArc technique from Varian Medical Systems showed superior target coverage, better OAR sparing, fewer monitor units per fraction with less treatment time over IMRT technique for head and neck cancers. The average homogeneity index, defined as the difference between the percentage dose covering 5% and 95% of the PTV, is 9.5 for RapidArc plan and 10.5 for IMRT plan. All RapidArc plans met the dose objectives for the primary OAR: spinal cord, brainstem, brain etc. Both parotid mean dose and D50% are lower for RapidArc plan than those of the IMRT plan. The technique is currently being used clinically at our cancer center.

Sci—Thur AM: Planning ‐ 12: Comparative study of SBRT lung dose calculation using Eclipse and Monte Carlo

Stereotactic Body Radiation Therapy (SBRT) is an option for early stage non-small cell lung cancer treatment. In SBRT treatment, high biological effective dose is delivered to the patient within a small number of fractions. High level of confidence in accuracy is required in the entire treatment procedure, from patient setup, tumour delineation, treatment simulation and planning, to the final dose delivery. SBRT lung treatment utilizes small fields that are incident on large tissue inhomogeneities within the patient. It is difficult for commercially available treatment planning systems (TPS) to model the lack of charged particle equilibrium and the dose near tissue-lung interfaces accurately. The Monte Carlo (MC) technique calculates the dose distribution from the first principles thereby providing a feasible tool for verifying the dose distribution computed from TPS. In this study, we compared the SBRT dose distribution between Eclipse 8.9 and BEAMnrc/DOSXYZnrc for both conformal and RapidArc plans. Calculation results for five clinical SBRT conformal lung plans were compared. Eclipse and MC results for each plan showed good agreement in dose received by organs at risk. MC simulation predicted uniformly hotter or similar PTV coverage for three cases with tumor either small or attached to the chest wall. When tumor is inside lung and at relatively medium to larger size for SBRT, MC predicted lower PTV coverage. The variation in dose coverage may depend on the tumour size and its position within the lung. Dose comparison for RapidArc plans shows similar dependence.

Poster — Thur Eve — 77: Coordinate transformation from DICOM to DOSXYZnrc

DICOM format is the de facto standard for communications between therapeutic and diagnostic modalities. A plan generated by a treatment planning system (TPS) is often exported to DICOM format. BEAMnrc/DOSXYZnrc is a widely used Monte Carlo (MC) package for beam and dose simulations in radiotherapy. It has its own definition for beam orientation, which is not in compliance with the one defined in DICOM standard. Dose simulations using TPS generated plans require transformation of beam orientations to DOSXYZnrc coordinate system (c.s.) after extracting the necessary parameters from DICOM RP files. The transformation is nontrivial. There have been two studies for the coordinate transformations. The transformation equation sets derived have been helpful to BEAMnrc/DOSXYZnrc users. However, both the transformation equation sets are complex mathematically and not easy to program. In this study, we derive a new set of transformation equations, which are more compact, better understandable, and easier for computational implementation. The derivation of polar angle θ and azimuthal angle φ is similar to the existing studies by applying a series of rotations to a vector in DICOM patient c.s. The derivation of beam rotation Φcol for DOSXYZnrc, however, is different. It is obtained by a direct combination of the actual collimator rotation with the projection of the couch rotation to the collimator rotating plane. Verification of the transformation has been performed using clinical plans created with Eclipse. The comparison between Eclipse and MC results show exact geometrical agreement for field placements, together with good agreement in dose distributions.

Poster — Thur Eve — 67: Clinical results of deep inspiration breath hold radiation treatment for the left breast patients

Adjuvant radiotherapy for left breast cancers increases local tumor control, but also increases the risk of radiation-induced cardiac disease. Deep Inspiration Breath Hold (DIBH) can minimize dose to the heart for left breast patients where the heart is within the tangential field. In this study, we evaluated the dosimetric benefit of DIBH technique comparing to free breathing (FB) radiotherapy for left breast cancer patients. Five patients with left breast cancer treated with DIBH technique were selected randomly. The CT scans of breath hold (BH) and FB were taken for every DIBH patient. Standard clinical DIBH intensity-modulated radiotherapy (IMRT) plans were generated with BH scan dataset using the Varian Eclipse TP system. The prescription dose is 4250 cGy in 16 fractions. The BH plan was copied to the FB scan dataset and shifted accordingly to have the same coverage for the breast tissue, and the dose was re-calculated. Dose-volume histograms (DVH) of the heart and lung; mean dose and maximum dose of the heart were calculated and compared from the BH and FB plans for every patient. The lung volume is increased during BH and hence the heart is moved out of the field, resulting in the lower heart maximum dose. The mean dose is almost less than 1 Gy for all BH plans. The average mean heart dose is 0.8 Gy for BH plan compared to 1.6 Gy for FB plan. Patients benefit significantly from DIBH technique due to the very low heart dose.

SU‐E‐T‐729: A Superficial Information Management and Calculation System

Purpose: Superficial low energy X‐ray treatments are widely available in many cancer centers for skintumours. In comparison with the low energy electron treatmentsdelivered by modern Linacs, it has the advantage of easy setup, less resource intensive, and cost effective, but still achieves the same purpose of tumour control or cure. For some tumour sites, it is a better choice than Linac. To our knowledge, however, there is no suitable software package for superficial treatment management. Dose calculations are mostly based on home made calculators and independent check is not always available. For treatment safety and treatment management, we developed a superficial calculation and information management system. Methods: This program is a web based application in a server‐client infrastructure. The server provides web and database services for client access and data storage. Any network device with a modern web browser can launch the application through a webpage. Results: Application access is restricted to authorized users only. At the front end (client side), physics group has the permission to perform system commission. Physicians and therapists can perform patient information management, dose prescription and treatment calculation. At the back end (server side), the application is database driven. All measurement, patient and treatment information are stored in a relational database. Users can calculate doses for all biological tissues provided in AAPM TG61 with field diameter <20cm. Dose calculation is based on the in‐air method (40–300kV tube potential) of AAPM TG61. Because of the lower calculation intensity requirement, all computations are on the server side. This makes the applications availability for even handheld devices. Conclusions: A web based superficial dose calculation and management system has been developed. This system can be used either as the primary system or as a QA tool for independent check of the calculating results.