Pejman Rowshanfarzad

A comparison of the gamma index analysis in various commercial IMRT/VMAT QA systems.

PURPOSE To investigate the variability of the global gamma index (γ) analysis in various commercial IMRT/VMAT QA systems and to assess the impact of measurement with low resolution detector arrays on γ. MATERIALS Five commercial QA systems (PTW 2D-Array, Scandidos Delta4, SunNuclear ArcCHECK, Varian EPID, and Gafchromic EBT2 film) were investigated. The response of γ analysis to deliberately introduced errors in pelvis and head & neck IMRT and RapidArc™ plans was evaluated in each system. A theoretical γ was calculated in each commercial QA system software (PTW Verisoft, Delta4 software, SNC Patient, Varian Portal Dosimetry and IBA OmniPro, respectively), using treatment planning system resolution virtual measurements and compared to an independent calculation. Error-induced plans were measured on a linear accelerator and were evaluated against the error-free dose distribution calculated using Varian Eclipse™ in the relevant phantom CT scan. In all cases, global γ was used with a 20% threshold relative to a point selected in a high dose and low gradient region. The γ based on measurement was compared against the theoretical to evaluate the response of each system. RESULTS There was statistically good agreement between the predicted γ based on the virtual measurements from each software (concordance correlation coefficient, ρc>0.92) relative to the independent prediction in all cases. For the actual measured data, the agreement with the predicted γ reduces with tightening passing criteria and the variability between the different systems increases. This indicates that the detector array configuration and resolution have greater impact on the experimental calculation of γ due to under-sampling of the dose distribution, blurring effects, noise, or a combination. CONCLUSIONS It is important to understand the response and limitations of the gamma index analysis combined with the equipment in use. For the same pass-rate criteria, different devices and software combinations exhibit varying levels of agreement with the predicted γ analysis.

Measurement and modeling of the effect of support arm backscatter on dosimetry with a varian EPID.

PURPOSE Amorphous silicon EPIDs have been used for planar dose verification in IMRT treatments for many years. The support arm used to attach some types of EPIDs to linear accelerators can introduce inaccuracies to dosimetry measurements due to the presence of metallic parts in their structures. It is demonstrated that this uncertainty may be as large as approximately 6% of maximum image signal for large fields. In this study, a method has been described to quantify, model and correct for the effect of backscattered radiation from the EPID support arm (E-Arm type, Varian Medical Systems). METHODS Measurements of a support arm backscatter kernel were made using several 1 x 1 cm2 6 MV pencil beam irradiations at a sample of positions over the sensitive area of the EPID in standard clinical setup and repeated with the EPID removed from the support arm but at the same positions. A curve-fit to the subtraction of EPID response obtained on and off the arm was used to define the backscatter kernel. The measured kernel was compared with a backscatter kernel obtained by Monte Carlo simulations with EGS/BEAM code. A backscatter dose prediction using the measured backscatter kernel was added to an existing EPID dose prediction model. The improvement in the agreement of the modified model predictions with EPID measurements for a number of open fields and IMRT beams were investigated by comparison to the original model results. RESULTS Considering all functions tested to find the best functional fit to the data points, a broad Gaussian curve proved to be the optimum fit to the backscatter data. The best fit through the Monte Carlo simulated backscatter kernel was also found to be a Gaussian curve. The maximum decrease in normalized root mean squared deviation of the measured and modeled EPID image profiles for open fields was 13.7% for a 15 x 15 cm2 field with no decrease observed for a 3 x 3 cm2 (the smallest) field as it was not affected by the arm backscatter. Gamma evaluation (2%, 2 mm criteria) showed the improvement in agreement between the model and measurement results when the backscatter was incorporated. The average increase in Gamma pass rate was 2% for head and neck and 1.3% for prostate IMRT fields investigated in this study. CONCLUSIONS The application of the backscatter kernel determined in this study improved the accuracy of dosimetry using a Varian EPID with E-arm for open fields of different sizes: Eight head and neck and seven prostate IMRT fields. Further improvement in the agreement between the model predictions and EPID measurements requires more sophisticated modeling of the backscatter.

Detection and correction for EPID and gantry sag during arc delivery using cine EPID imaging

PURPOSE Electronic portal imaging devices (EPIDs) have been studied and used for pretreatment and in-vivo dosimetry applications for many years. The application of EPIDs for dosimetry in arc treatments requires accurate characterization of the mechanical sag of the EPID and gantry during rotation. Several studies have investigated the effects of gravity on the sag of these systems but each have limitations. In this study, an easy experiment setup and accurate algorithm have been introduced to characterize and correct for the effect of EPID and gantry sag during arc delivery. METHODS Three metallic ball bearings were used as markers in the beam: two of them fixed to the gantry head and the third positioned at the isocenter. EPID images were acquired during a 360° gantry rotation in cine imaging mode. The markers were tracked in EPID images and a robust in-house developed MATLAB code was used to analyse the images and find the EPID sag in three directions as well as the EPID + gantry sag by comparison to the reference gantry zero image. The algorithm results were then tested against independent methods. The method was applied to compare the effect in clockwise and counter clockwise gantry rotations and different source-to-detector distances (SDDs). The results were monitored for one linear accelerator over a course of 15 months and six other linear-accelerators from two treatment centers were also investigated using this method. The generalized shift patterns were derived from the data and used in an image registration algorithm to correct for the effect of the mechanical sag in the system. The Gamma evaluation (3%, 3 mm) technique was used to investigate the improvement in alignment of cine EPID images of a fixed field, by comparing both individual images and the sum of images in a series with the reference gantry zero image. RESULTS The mechanical sag during gantry rotation was dependent on the gantry angle and was larger in the in-plane direction, although the patterns were not identical for various linear-accelerators. The reproducibility of measurements was within 0.2 mm over a period of 15 months. The direction of gantry rotation and SDD did not affect the results by more than 0.3 mm. Results of independent tests agreed with the algorithm within the accuracy of the measurement tools. When comparing summed images, the percentage of points with Gamma index <1 increased from 85.4% to 94.1% after correcting for the EPID sag, and to 99.3% after correction for gantry + EPID sag. CONCLUSIONS The measurement method and algorithms introduced in this study use cine-images, are highly accurate, simple, fast, and reproducible. It tests all gantry angles and provides a suitable automatic analysis and correction tool to improve EPID dosimetry and perform comprehensive linac QA for arc treatments.

Gantry-angle resolved VMAT pretreatment verification using EPID image prediction

PURPOSE Pretreatment verification of volumetric modulated arc therapy (VMAT) dose delivery with electronic portal imaging device (EPID) uses images integrated over the entire delivery or over large subarcs. This work aims to develop a new method for gantry-angle-resolved verification of VMAT dose delivery using EPID. METHODS An EPID dose prediction model was used to calculate EPID images as a function of gantry angle for eight prostate patient deliveries. EPID image frames at 7.5 frames per second were acquired during delivery via a frame-grabber system. The gantry angle for each image was encoded in kV frames which were synchronized to the MV frames. Gamma analysis results as a function of gantry angle were assessed by integrating the frames over 2° subarcs with an angle-to-agreement tolerance of 0.5° about the measured image angle. RESULTS The model agreed with EPID images integrated over the entire delivery with average Gamma pass-rates at 2%, 2 mm of 99.7% (10% threshold). The accuracy of the kV derived gantry angle for each image was found to be 0.1° (1 SD) using a phantom test. For the gantry-resolved analysis all Gamma pass-rates were greater than 90% at 3%, 3 mm criteria (with only two exceptions), and more than 90% had a 95% pass-rate, with an average of 97.3%. The measured gantry angle lagged behind the predicted angle by a mean of 0.3°±0.3°, with a maximum lag of 1.3°. CONCLUSIONS The method provides a comprehensive and highly efficient pretreatment verification of VMAT delivery using EPID. Dose delivery accuracy is assessed as a function of gantry angle to ensure accurate treatment.

EPID‐based verification of the MLC performance for dynamic IMRT and VMAT

PURPOSE In advanced radiotherapy treatments such as intensity modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT), verification of the performance of the multileaf collimator (MLC) is an essential part of the linac QA program. The purpose of this study is to use the existing measurement methods for geometric QA of the MLCs and extend them to more comprehensive evaluation techniques, and to develop dedicated robust algorithms to quantitatively investigate the MLC performance in a fast, accurate, and efficient manner. METHODS The behavior of leaves was investigated in the step-and-shoot mode by the analysis of integrated electronic portal imaging device (EPID) images acquired during picket fence tests at fixed gantry angles and arc delivery. The MLC was also studied in dynamic mode by the analysis of cine EPID images of a sliding gap pattern delivered in a variety of conditions including different leaf speeds, deliveries at fixed gantry angles or in arc mode, and changing the direction of leaf motion. The accuracy of the method was tested by detection of the intentionally inserted errors in the delivery patterns. RESULTS The algorithm developed for the picket fence analysis was able to find each individual leaf position, gap width, and leaf bank skewness in addition to the deviations from expected leaf positions with respect to the beam central axis with sub-pixel accuracy. For the three tested linacs over a period of 5 months, the maximum change in the gap width was 0.5 mm, the maximum deviation from the expected leaf positions was 0.1 mm and the MLC skewness was up to 0.2°. The algorithm developed for the sliding gap analysis could determine the velocity and acceleration∕deceleration of each individual leaf as well as the gap width. There was a slight decrease in the accuracy of leaf performance with increasing leaf speeds. The analysis results were presented through several graphs. The accuracy of the method was assessed as 0.01 mm for both the gap size and peak position determination. CONCLUSIONS This study provides fast, easy, and accurate test methods for routine QA of the MLC performance and helps in faster troubleshooting of MLC problems in both IMRT and VMAT treatments.

Isocenter verification for linac-based stereotactic radiation therapy: review of principles and techniques

There have been several manual, semi‐automatic and fully‐automatic methods proposed for verification of the position of mechanical isocenter as part of comprehensive quality assurance programs required for linear accelerator‐based stereotactic radiosurgery/radiotherapy (SRS/SRT) treatments. In this paper, a systematic review has been carried out to discuss the present methods for isocenter verification and compare their characteristics, to help physicists in making a decision on selection of their quality assurance routine. PACS numbers: 87.53.Ly, 87.56.Fc, 87.56.‐v

Verification of the linac isocenter for stereotactic radiosurgery using cine‐EPID imaging and arc delivery

PURPOSE Verification of the mechanical isocenter position is required as part of comprehensive quality assurance programs for stereotactic radiosurgery/radiotherapy (SRS/SRT) treatments. Several techniques have been proposed for this purpose but each of them has certain drawbacks. In this paper, a new efficient and more comprehensive method using cine-EPID images has been introduced for automatic verification of the isocenter with sufficient accuracy for stereotactic applications. METHODS Using a circular collimator fixed to the gantry head to define the field, EPID images of a Winston-Lutz phantom were acquired in cine-imaging mode during 3600 gantry rotations. A robust MATLAB code was developed to analyze the data by finding the center of the field and the center of the ball bearing shadow in each image with sub-pixel accuracy. The distance between these two centers was determined for every image. The method was evaluated by comparison to results of a mechanical pointer and also by detection of a manual shift applied to the phantom position. The repeatability and reproducibility of the method were tested and it was also applied to detect couch and collimator wobble during rotation. RESULTS The accuracy of the algorithm was 0.03 +/- 0.02 mm. The repeatability was less than 3 pm and the reproducibility was less than 86 microm. The time elapsed for the analysis of more than 100 cine images of Varian aS1000 and aS500 EPIDs were approximately 65 and 20 s, respectively. Processing of images taken in integrated mode took 0.1 s. The output of the analysis software is printable and shows the isocenter shifts as a function of angle in both in-plane and cross-plane directions. It gives warning messages where the shifts exceed the criteria for SRS/SRT and provides useful data for the necessary adjustments in the system including bearing system and/or room lasers. CONCLUSIONS The comprehensive method introduced in this study uses cine-images, is highly accurate, fast, and independent of the observer. It tests all gantry angles and is suitable for pretreatment QA of the isocenter for stereotactic treatments.

Gantry angle determination during arc IMRT: evaluation of a simple EPID‐based technique and two commercial inclinometers

The increasing popularity of intensity‐modulated arc therapy (IMAT) treatments requires specifically designed linac quality assurance (QA) programs. Gantry angle is one of the parameters that has a major effect on the outcome of IMAT treatments since dose reconstruction for patient‐specific QA relies on the gantry angle; therefore, it is essential to ensure its accuracy for correct delivery of the prescribed dose. In this study, a simple measurement method and algorithm are presented for QA of gantry angle measurements based on integrated EPID images acquired at distinct gantry angles and cine EPID images during an entire 360° arc. A comprehensive study was carried out to evaluate this method, as well as to evaluate two commercially available inclinometers (NG360 and IBA GAS supplied in conjunction with popular array dosimeters Delta4 and MatriXXEvolution, respectively) by comparing their simultaneous angle measurement results with the linac potentiometer readouts at five gantry speeds. In all tested measurement systems, the average differences with the reference angle data were less than 0.3° in static mode. In arc mode, at all tested gantry speeds the average difference was less than 0.1° for the IBA GAS and the proposed EPID‐based method, and 0.6° for the NG360 after correction for the inherent systematic time delay of the inclinometer. The gantry rotation speed measured by the three independent systems had an average deviation of about 0.01°/s from the nominal gantry speed. PACS numbers: 06.30.Bp; 87.56.Fc; 87.56.‐v

An investigation of gantry angle data accuracy for cine-mode EPID images acquired during arc IMRT

EPID images acquired in cine mode during arc therapy have inaccurate gantry angles recorded in their image headers. In this work, methods were developed to assess the accuracy of the gantry potentiometer for linear accelerators. As well, assessments of the accuracy of other, more accessible, sources of gantry angle information (i.e., treatment log files, analysis of EPID image headers) were investigated. The methods used in this study are generally applicable to any linear accelerator unit, and have been demonstrated here with Clinac/Trilogy systems. Gantry angle data were simultaneously acquired using three methods: i) a direct gantry potentiometer measurement, ii) an incremental rotary encoder, and iii) a custom‐made radiographic gantry‐angle phantom which produced unique wire intersections as a function of gantry angle. All methods were compared to gantry angle data from the EPID image header and the linac MLC DynaLog file. The encoder and gantry‐angle phantom were used to validate the accuracy of the linacs potentiometer. The EPID image header gantry angles and the DynaLog file gantry angles were compared to the potentiometer. The encoder and gantry‐angle phantom mean angle differences with the potentiometer were 0.13∘±0.14∘ and 0.10∘±0.30∘, respectively. The EPID image header angles analyzed in this study were within ±1∘ of the potentiometer angles only 35% of the time. In some cases, EPID image header gantry angles disagreed by as much as 3° with the potentiometer. A time delay in frame acquisition was determined using the continuous acquisition mode of the EPID. After correcting for this time delay, 75% of the header angles, on average, were within ±1∘ of the true gantry angle, compared to an average of only 35% without the correction. Applying a boxcar smoothing filter to the corrected gantry angles further improved the accuracy of the header‐derived gantry angles to within ±1∘ for almost all images (99.4%). An angle accuracy of 0.11∘±0.04∘ was determined using a point‐by‐point comparison of the gantry angle data in the MLC DynaLog file and the potentiometer data. These simple correction methods can be easily applied to individual treatment EPID images in order to more accurately define the gantry angle. PACS numbers: 87.53.Kn, 87.55.T‐, 87.56.bd, 87.59.‐e

Preclinical studies of [61Cu]ATSM as a PET radiopharmaceutical for fibrosarcoma imaging.

Preclinical studies of [61Cu]ATSM as a PET radiopharmaceutical for fibrosarcoma imaging [61Cu]diacetyl-bis(N4-methylthiosemicarbazone) ([61Cu] ATSM) was prepared using in house-made diacetyl-bis(N4-methylthiosemicarbazone) (ATSM) ligand and [61Cu]CuCl2 produced via the natZn(p, x)61Cu (180 μA proton irradiation, 22 MeV, 3.2 h) and purified by a ion chromatography method. [61Cu]ATSM radiochemical purity was >98 %, as shown by HPLC and RTLC methods. [61Cu]ATSM was administered into normal and tumor bearing rodents for up to 210 minutes, followed by biodistribution and co-incidence imaging studies. Significant tumor/non-tumor accumulation was observed either by animal sacrification or imaging. [61Cu]ATSM is a positron emission tomography (PET) radiotracer for tumor hypoxia imaging. Predkliničke studije [61Cu]ATSM kao PET radiofarmaka za snimanje fibrosarkoma [61Cu]diacetil-bis(N4-metiltiosemikarbazon) ([61Cu]ATSM) dobiven je iz liganda diacetil-bis(N4-metiltiosemikarbazona) (ATSM) pripravljenog u vlastitom laboratoriju i [61Cu]CuCl2 dobivenog iz natZn(p, x)61Cu (180 μA protonskim zračenjem, 22 MeV, 3,2 h). [61Cu]ATSM je čišćen ionskom kromatografijom. Prema HPLC i RTLC radiokemijska čistoć a bila je > 98 %. [61Cu]ATSM je davan zdravim glodavcima i glodavcima s tumorom tijekom 210 minuta te je praćena biodistribucija. Žrtvovanjem testiranih životinja te snimanjem primijećena je značajna razlika u akumulaciji [61Cu]ATSM u tumorskom tkivu u odnosu na zdravo tkivo. [61Cu]ATSM je pogodan za dijagnostiku hipoksije tumora pozitron emisijskom tomografijom (PET).