N Sperling

Correction factor measurements for multiple detectors used in small field dosimetry on the Varian Edge radiosurgery system.

PURPOSE Accurate dosimetry of small fields remains a challenge to the clinical physicist. Choosing the appropriate detector and determination of kQclin,Qmsr (fclin,fmsr) factors continue to be an area of active research. The purpose of this study is to evaluate the output factors for a dedicated stereotactic accelerator using multiple dosimeters designed for use in small fields and evaluate published kQclin,Qmsr (fclin,fmsr) factors relative to measured values using a commercial scintillating fiber. METHODS Four microionization chambers, a commercial plastic scintillation detector, and a semiconducting diode were used to measure output factors for a linear accelerator. Field sizes ranging from 6 × 6 to 0.6 × 0.6 cm(2) were measured in a water phantom at 10 cm depth for 100 cm SSD. All microionization chambers were mounted in both vertical and horizontal configurations. Fields were normalized to the output at 5 × 5 cm(2). Output correction factors, kQclin,Qmsr (fclin,fmsr), were calculated as the ratio of a detector response relative to the scintillating fiber response for a given clinical field size, fclin. RESULTS Ionization chambers consistently under-responded for small fields relative to the scintillating fiber. Variations in response between horizontal and vertical mounting were most notable for the microchambers, with the vertical mounting which reduced the magnitude of the necessary correction factor, kQclin,Qmsr (fclin,fmsr), for the microionization chambers ranging from 1.1 to 1.2 for the smallest field size at all energies. The semiconducting diode over-responded by 7% for the smallest field size across all energies, resulting in a kQclin,Qmsr (fclin,fmsr) of ∼ 0.93. CONCLUSIONS The commercial scintillating fiber, which produces accurate and consistent ratios of dose to water for nonstandard fields, can be used to measure correction factors for various detectors used in a clinical setting. This can allow for comparison of measured correction factors to previously published values.

SU-F-T-504: Non-Divergent Planning Method for Craniospinal Irradiation

PURPOSE Traditional Craniospinal Irradiation (CSI) planning techniques require careful field placement to allow optimal divergence and field overlap at depth, and measurement of skin gap. The result of this is a necessary field overlap resulting in dose heterogeneity in the spinal canal. A novel, nondivergent field matching method has been developed to allow simple treatment planning and delivery without the need to measure skin gap. METHODS The CSI patient was simulated in the prone, and a plan was developed. Bilateral cranial fields were designed with couch and collimator rotation to eliminate divergence with the upper spine field and minimize anterior divergence into the lenses. Spinal posterior-to-anterior fields were designed with the couch rotated to 90 degrees to allow gantry rotation to eliminate divergence at the match line, and the collimator rotated to 90 degrees to allow appropriate field blocking with the MLCs. A match line for the two spinal fields was placed and the gantry rotated to equal angles in opposite directions about the match line. Jaw positions were then defined to allow 1mm overlap at the match line to avoid cold spots. A traditional CSI plan was generated using diverging spinal fields, and a comparison between the two techniques was generated. RESULTS The non-divergent treatment plan was able to deliver a highly uniform dose to the spinal cord with a cold spot of only 95% and maximum point dose of 115.8%, as compared to traditional plan cold spots of 87% and hot spots of 132% of the prescription dose. CONCLUSION A non-divergent method for planning CSI patients has been developed and clinically implemented. Planning requires some geometric manipulation in order to achieve an adequate dose distribution, however, it can help to manage cold spots and simplify the shifts needed between spinal fields.

Technical Note: Influence of Compton currents on profile measurements in small‐volume ion chambers

PURPOSE This work is to evaluate the effects of Compton current generation in three small-volume ionization chambers on measured beam characteristics for electron fields. METHODS Beam scans were performed using Exradin A16, A26, and PTW 31014 microchambers. Scans with varying chamber components shielded were performed. Static point measurements, output factors, and cable only irradiations were performed to determine the contribution of Compton currents to various components of the chamber. Monte Carlo simulations were performed to evaluate why one microchamber showed a significant reduction in Compton current generation. RESULTS Beam profiles demonstrated significant distortion for two of the three chambers when scanned parallel to the chamber axis, produced by electron deposition within the wire. Measurements of ionization produced within the cable identified Compton current generation as the cause of these distortions. The size of the central collecting wire was found to have the greatest influence on the magnitude of Compton current generation. CONCLUSIONS Microchambers can demonstrate significant (>5%) deviations from properties as measured with larger volume chambers (0.125 cm(3) and above). These deviations can be substantially reduced by averaging measurements conducted at opposite polarities.

SU-G-BRB-12: Polarity Effects in Small Volume Ionization Chambers in Small Fields

PURPOSE Dosimetric quantities such as the polarity correction factor (Ppol) are important parameters for determining the absorbed dose and can influence the choice of dosimeter. Ppol has been shown to depend on beam energy, chamber design, and field size. This study is to investigate the field size and detector orientation dependence of Ppol in small fields for several commercially available micro-chambers. METHODS We evaluate the Exradin A26, Exradin A16, PTW 31014, PTW 31016, and two prototype IBA CC-01 micro-chambers in both horizontal and vertical orientations. Measurements were taken at 10cm depth and 100cm SSD in a Wellhofer BluePhantom2. Measurements were made at square fields of 0.6, 0.8, 1.0, 1.2, 1.4, 2.0, 2.4, 3.0, and 5.0 cm on each side using 6MV with both ± 300VDC biases. PPol was evaluated as described in TG-51, reported using -300VDC bias for Mraw. Ratios of PPol measured in the clinical field to the reference field are presented. RESULTS A field size dependence of Ppol was observed for all chambers, with increased variations when mounted vertically. The maximum variation observed in PPol over all chambers mounted horizontally was <1%, and occurred at different field sizes for different chambers. Vertically mounted chambers demonstrated variations as large as 3.2%, always at the smallest field sizes. CONCLUSION Large variations in Ppol were observed for vertically mounted chambers compared to horizontal mountings. Horizontal mountings demonstrated a complicated relationship between polarity variation and field size, probably relating to differing details in each chambers construction. Vertically mounted chambers consistently demonstrated the largest PPol variations for the smallest field sizes. Measurements obtained with a horizontal mounting appear to not need significant polarity corrections for relative measurements, while those obtained using a vertical mounting should be corrected for variations in PPol.

SU-D-206-05: A Critical Look at CBCT-Based Dose Calculation Accuracy as It Is Applied to Adaptive Radiotherapy

PURPOSE Cone-beam CTs (CBCT) obtained from On-Board Imaging Devices (OBI) are increasingly being used for dose calculation purposes in adaptive radiotherapy. Patient and target morphology are monitored and the treatment plan is updated using CBCT. Due to the difference in image acquisition parameters, dose calculated in a CBCT can differ from planned dose. We evaluate the difference between dose calculation in kV CBCT and simulation CT, and the effect of HU-density tables in dose discrepancies METHODS: HU values for various materials were obtained using a Catphan 504 phantom for a simulator CT (CTSIM) and two different OBI systems using three imaging protocols: Head, Thorax and Pelvis. HU-density tables were created in the TPS for each OBI image protocol. Treatment plans were made on each Catphan 504 dataset and on the head, thorax and pelvis sections of an anthropomorphic phantom, with and without the respective HU-density table. DVH information was compared among OBI systems and planning CT. RESULTS Dose calculations carried on the Catphan 504 CBCTs, with and without the respective CT-density table, had a maximum difference of -0.65% from the values on the planning CT. The use of the respective HU-density table decreased the percent differences from planned values by half in most of the protocols. For the anthropomorphic phantom datasets, the use of the correct HU-density table reduced differences by 0.89% on OBI1 and 0.59% on OBI2 for the head, 0.49% on OBI1 for the thorax, and 0.25% on OBI2 for the pelvis. Differences from planned values without HU-density correction ranged from 3.13% (OBI1, thorax) to 0.30% (OBI2, thorax). CONCLUSION CT-density tables in the TPS yield acceptable differences when used in partly homogeneous medium. Further corrections are needed when the medium contains pronounced density differences for accurate CBCT calculation. Current difference range (1-3%) can be clinically acceptable.

SU-F-T-557: Evaluation of Detector Response in Rectangular Small Field Dosimetry

PURPOSE As stereotactic treatment modalities grow towards becoming the standard of care, the need for accurate dose computation in small fields is becoming increasingly essential. The purpose of this study is to evaluate the response of different detectors, intended for small field dosimetry, in jaw defined small rectangular fields by analyzing output factors from a stereotactic clinical accelerator. METHODS Two Dosimeters, the Exradin A26 Microionization Chamber (Standard Imaging) and Edge Diode Detector (Sun Nuclear) were used to measure output factors taken on the Varian Edge Stereotactic Linear accelerator. Measurements were taken at 6MV and 6FFF at 10cm depth, 100cm SSD in a 48×48×40cm3 Welhoffer BluePhantom2 (IBA) with X and Y jaws set from 0.6 to 2.0cm. Output factors were normalized to a 5×5cm2 machine-specific reference field. Measurements were made in the vertical orientation for the A26 and horizontal orientation for both the A26 and Edge. Output factors were measured as: OFFS = MFS /Mref where MFS and Mref are the measured signals for the clinical field and the reference field, respectively. Measured output factors were then analyzed to establish relative responses of the detectors in small fields. RESULTS At 6MV the Edge detector exhibited a variation in output factors dependent on jaw positioning (X-by-Y vs Y-by-X) of 5.7% of the 5×5cm reference output and a variation of 3.33% at 6FFF. The A26 exhibited variation of output factor dependent on jaw positioning of upto 7.7% of the 5×5cm reference field at 6MV and upto 5.33% at 6FFF. CONCLUSION Both the Edge detector and A26 responded as expected at small fields however a dependence on the jaw positioning was noted. At 6MV and 6FFF the detector response showed an increased dependence on the positioning of the X jaws as compared to the positioning of the Y jaws.

SU-E-T-361: Energy Dependent Radiation/light-Field Misalignment On Truebeam Linear Accelerator

Purpose: Verifying the co-incidence of the radiation and light field is recommended by TG-142 for monthly and annual checks. On a digital accelerator, it is simple to verify that beam steering settings are consistent with accepted and commissioned values. This fact should allow for physicists to verify radiation-light-field co-incidence for a single energy and accept that Result for all energies. We present a case where the radiation isocenter deviated for a single energy without any apparent modification to the beam steering parameters. Methods: The radiation isocenter was determined using multiple Methods: Gafchromic film, a BB test, and radiation profiles measured with a diode. Light-field borders were marked on Gafchromic film and then irradiated for all photon energies. Images of acceptance films were compared with films taken four months later. A phantom with a radio-opaque BB was aligned to isocenter using the light-field and imaged using the EPID for all photon energies. An unshielded diode was aligned using the crosshairs and then beam profiles of multiple field sizes were obtained. Field centers were determined using Omni-Pro v7.4 software, and compared to similar scans taken during commissioning. Beam steering parameter files were checked against backups to determine that the steering parameters were unchanged. Results: There were no differences between the configuration files from acceptance. All three tests demonstrated that a single energy had deviated from accepted values by 0.8 mm in the inline direction. The other two energies remained consistent with previous measurements. The deviated energy was re-steered to be within our clinical tolerance. Conclusions: Our study demonstrates that radiation-light-field coincidence is an energy dependent effect for modern linacs. We recommend that radiation-light-field coincidence be verified for all energies on a monthly basis, particularly for modes used to treat small fields, as these may drift without influencing results from other tests.

SU-E-T-465: Implementation of An Automated Collision Detection Program Using Open Source Software for the Pinnacle Treatment Planning System

Purpose: Potential collisions between the gantry head and the patient or table assembly are difficult to detect in most treatment planning systems. We have developed and implemented a novel software package for the representation of potential gantry collisions with the couch assembly at the time of treatment planning. Methods: Physical dimensions of the Varian Edge linear accelerator treatment head were measured and reproduced using the Visual Python display package. A script was developed for the Pinnacle treatment planning system to generate a file with the relevant couch, gantry, and isocenter positions for each beam in a planning trial. A python program was developed to parse the information from the TPS and produce a representative model of the couch/gantry system. Using the model and the Visual Python libraries, a rendering window is generated for each beam that allows the planner to evaluate the possibility of a collision. Results: Comparison against heuristic methods and direct verification on the machine validated the collision model generated by the software. Encounters of <1 cm between the gantry treatment head and table were visualized as collisions in our virtual model. Visual windows were created depicting the angle of collision for each beam, including the anticipated table coordinates. Visual rendering of a 6 arc trial with multiple couch positions was completed in under 1 minute, with network bandwidth being the primary bottleneck. Conclusion: The developed software allows for quick examination of possible collisions during the treatment planning process and helps to prevent major collisions prior to plan approval. The software can easily be implemented on future planning systems due to the versatility and platform independence of the Python programming language. Further integration of the software with the treatment planning system will allow the possibility of patient-gantry collision detection for a range of treatment machines.

SU-E-J-269: Assessing the Precision of Dose Delivery in CBCT-Guided Stereotactic Body Radiation Therapy for Lung and Soft Tissue Metastatic Lesions

PURPOSE Ensuring reproducibility of target localization is critical to accurate stereotactic body radiation treatment (SBRT) for lung and soft tissue metastatic lesions. To characterize interfraction variability in set-up and evaluate PTV margins utilized for SBRT, daily CBCTs were used to calculate delivered target and OAR doses compared to those expected from planning. METHODS CBCT images obtained prior to each fraction of SBRT for a lung and thyroid metastatic lesion were evaluated. The target CTV/ITV and OARs on each of 8 CBCT data sets were contoured. Using MIM fusion software and Pinnacle3 RTP system, delivered dose distribution was reconstructed on each CBCT, utilizing translational shifts performed prior to treatment. Actual delivered vs. expected doses received by target CTV/ITV and adjacent critical structures were compared to characterize accuracy of pre-treatment translational shifts and PTV margins. RESULTS The planned CTV/ITV D95% and V100% were 4595cGy and 91.47% for the lung lesion, and 3010cGy and 96.34% for the thyroid lesion. Based on CBCT analysis, actual mean D95% and V100% for lung ITV were 4542±344.4cGy and 91.54±3.45%; actual mean D95% and V100% for thyroid metastasis CTV were 3005±25.98cGy and 95.20±2.522%. For the lung lesion, ipsilateral lung V20, heart V32 (cc) and spinal cord (.03 cc) max were 110.15cc, 3.33cc, and 1680cGy vs. 110.27±14.79cc, 6.74±3.76cc, and 1711±46.56cGy for planned vs. delivered doses, respectively. For the thyroid metastatic lesion, esophagus V18, trachea (.03 cc) max, and spinal cord (.03 cc) max were 0.35cc, 2555cGy, and 850cGy vs. 0.16±0.13cc, 2147±367cGy, and 838±45cGy for planned vs. delivered treatments, respectively. CONCLUSION Minimal variability in SBRT target lesion dose delivered based on pre-treatment CBCT-based translational shifts suggests tighter PTV margins may be considered to further decrease dose to surrounding critical structures. Guidelines for optimal target alignment during CBCT-guidance for lung and soft tissue metastatic lesions treated with SBRT are being established.

SU‐E‐T‐195; An Algorithm for the Reconstruction of An Entrance Beam Fluence Using a Simulated Exit Phantom Fluence

PURPOSE To design and test an algorithm for reconstructing entrance fluence from an exit fluence through a cylindrical phantom using fluence kernels generated in the BEAMnrc monte carlo code. This work may be extended to replace the simulated fluence with direct measurements on an EPID where dosimetry data from treatment can be acquired and compared with direct measures of fluence from devices used commonly for IMRT verification. METHOD AND MATERIALS A parameter space array of monte carlo fluence kernels is calculated for each voxel in a 256x256 pixel grid measuring across 16.384cm2 at 60cm SPD, which corresponds to a 40.96cm2 imager at 150cm SPD. An array of coefficients of parameter space elements is then used to calculate a fluence at 150cm SPD, and an iterative minimization solver is configured to minimize the sum of the square of the differences between the calculated fluence and the measured fluence. RESULTS Comparison between two IMRT beam sequences simulated using the same BEAMnrc model used to generate the parameter space array were performed. The iterative solver was allowed to run for 15 minutes on a 128 core cluster on each phase space generated. A comparison of directly simulated entrance fluence and entrance fluence calculated by the proposed algorithm was performed, with a comparison criterion of the percentage of points in the fluence array with a threshold of 10% of maximum intensity, within 1% of the simulated fluence intensity; passing rates of 94.5% and 97.9% were achieved. CONCLUSION These results demonstrate that the algorithm is capable of reconstructing entrance fluence from simulated exit fluence within a reasonable tolerance for verification of delivery. Additionally, patient and beam specific parameter space arrays may be generated, allowing live measurements during treatment to be used for the reconstruction of entrance fluence with a high degree of accuracy.