M. Craus

In Vivo Portal Dosimetry by an Ionization Chamber

As all methods for in-vivo dosimetry require special efforts many physicists are often discouraged in verifying the middle dose in a patient along the beam central axis. This work reports a practical method for the determination of the middle dose value, D(m), on the central beam axis, using a signal S(t), obtained by a small thimble ion-chamber positioned at the center of the electronic portal imaging device, and irradiated by the X-ray beam transmitted through the patient. The use of a stable ion-chamber reduces many of the disadvantages associated to the use of diodes as their periodic recalibration and time consuming positioning. The method makes use of a set of correlation functions obtained by the S(t) and D(m) ratios, determined by irradiating a water-equivalent phantom with 6 MV, 10 MV and 5 MV X-ray beams. Several tests were carried out in phantoms with asymmetric inhomogeneities. The method here proposed is based on the determination of the water-equivalent thickness of the patient, along the beam central axis, by the treatment planning system that makes use of the electron densities obtained by a computer tomography scanner, that works with calibrated Hounsfield numbers. This way, it is therefore possible to compare the dose, D(m, TPS), obtained by a treatment planning system, with the in-vivo dose D(m) value, both defined at density middle point (identified along the beam central axis, where the thick material, in terms of g cm(-2), above and below, is the same). The method has been applied for the in-vivo dosimetry of 30 patients, treated with conformed beams for pelvic tumor, checking: anterior-posterior or posterior-anterior irradiations and lateral-lateral irradiations. For every checked field at least five measurements were carried out. Applying a correct quality assurance program based on the tests of the patient set-up, machine settings and calculations, results showed that the method is able to verify agreements between the dose D(m,TPS) and the in-vivo dose value D(m), within 4% for 95% of the 240 measurements carried out in-vivo.

Comparison of measured and computed portal dose for IMRT treatment.

A new 2D array Seven 29™ model (PTW, Freiburg), equipped with 729 vented plane‐parallel ion chambers, projected for pretreatment verification of radiotherapy plans, was used as a detector for the transmitted or portal dose measurements below a Rando phantom. The dosimetric qualities of the 2D array make it attractive for measuring transmitted dose maps from step‐and‐shoot intensity‐modulated radiotherapy (IMRT). It is well known that for step‐and‐shoot IMRT beams that use a small number of monitor units (MUs) per sequence, the early and recent electronic portal imaging devices (EPIDs) present a different response at X‐ray start‐up that affects the accuracy of the measured transmitted dose. The comparison of portal doses measured to those calculated by a commercial treatment‐planning system (TPS) can verify correct dose delivery during treatment. This direct validation was tested by irradiating a simulated head tumor in a Rando anthropomorphic phantom by step‐and‐shoot IMRT beams. The absolute transmitted doses on a plane orthogonal to the beam central axis below the phantom were measured by the 2D array calibrated in terms of dose to water and compared with the computed portal dose extracted by custom software. In a previous paper, the comparison between the IMRT portal doses, computed by a commercial TPS and measured by a linear array that supplied a 1 mm spatial dose resolution, was carried out. The γ‐index analysis supplied an agreement of more than 95% of the dose point with acceptance criteria, in terms of dose difference, ΔDmax, and distance agreement, Δdmax, equal to 4% and 4 mm, respectively. In this paper, we verify the possible use of the PTW 2D array for measurements of the transmitted doses during several fractions of head and neck tumor radiotherapy. There are two advantages in the use of this 2D array as a portal dose device for the IMRT quality assurance program: first is the ability to perform absolute dose comparisons for hundreds of measurement positions to verify the correct dose delivery in several fractions of the therapy; second is the efficiency in time to detect these kinds of dose distributions within the field of view area of the CT scanner. PACS number: 87.53.Xd

Real time transit dosimetry for the breath-hold radiotherapy technique: An initial experience

Introduction. The breath-hold is one of the techniques to obtain the dose escalation for lung tumors. However, the change of the patients breath pattern can influence the stability of the inhaled air volume, IAV, used in this work as a surrogate parameter to assure the tumor position reproducibility during dose delivery.Materials. and methodIn this paper, an Elekta active breathing coordinator has been used for lung tumor irradiation. This device is not an absolute spirometer and the feasibility study here presented developed (i) the possibility to select a specific range ε of IAV values comfortable for the patient and (ii) the ability of a transit signal rate , obtained by a small ion-chamber positioned on the portal image device, to supply in real time the in vivo isocenter dose reproducibility. Indeed, while the selection of the IAV range depends on the patients ability to follow instructions for breath-hold, the monitoring can supply to the radiation therapist a surrogate of the tumor irradiation reproducibility.Results. The detection of the in real time during breath-hold was used to determine the interfraction isocenter dose variations due to the reproducibility of the patients breathing pattern. The agreement between the reconstructed and planned isocenter dose in breath-hold at the interfraction level was well within 1.5%, while in free breathing a disagreement up to 8% was observed. The standard deviation of the in breath-hold observed at the intrafraction level is a bit higher than the one obtained without the patient and this can be justified by the presence of a small residual tumor motion as heartbeat.Conclusion. The technique is simple and can be implemented for routine use in a busy clinic.

Linac-based extracranial radiosurgery with Elekta volumetric modulated arc therapy and an anatomy-based treatment planning system: Feasibility and initial experience.

We reported our initial experience in using Elekta volumetric modulated arc therapy (VMAT) and an anatomy-based treatment planning system (TPS) for single high-dose radiosurgery (SRS-VMAT) of liver metastases. This study included a cohort of 12 patients treated with a 26-Gy single fraction. Single-arc VMAT plans were generated with Ergo++ TPS. The prescription isodose surface (IDS) was selected to fulfill the 2 following criteria: 95% of planning target volume (PTV) reached 100% of the prescription dose and 99% of PTV reached a minimum of 90% of prescription dose. A 1-mm multileaf collimator (MLC) block margin was added around the PTV. For a comparison of dose distributions with literature data, several conformity indexes (conformity index [CI], conformation number [CN], and gradient index [GI]) were calculated. Treatment efficiency and pretreatment dosimetric verification were assessed. Early clinical data were also reported. Our results reported that target and organ-at-risk objectives were met for all patients. Mean and maximum doses to PTVs were on average 112.9% and 121.5% of prescribed dose, respectively. A very high degree of dose conformity was obtained, with CI, CN, and GI average values equal to 1.29, 0.80, and 3.63, respectively. The beam-on-time was on average 9.3 minutes, i.e., 0.36min/Gy. The mean number of monitor units was 3162, i.e., 121.6MU/Gy. Pretreatment verification (3%-3mm) showed an optimal agreement with calculated values; mean γ value was 0.27 and 98.2% of measured points resulted with γ < 1. With a median follow-up of 16 months complete response was observed in 12/14 (86%) lesions; partial response was observed in 2/14 (14%) lesions. No radiation-induced liver disease (RILD) was observed in any patients as well no duodenal ulceration or esophagitis or gastric hemorrhage. In conclusion, this analysis demonstrated the feasibility and the appropriateness of high-dose single-fraction SRS-VMAT in liver metastases performed with Elekta VMAT and Ergo++ TPS. Preliminary clinical outcomes showed a high rate of local control and minimum incidence of acute toxicity.