S Rathee

Dosimetric IMRT verification with a flat-panel EPID

A convolution-based calibration procedure has been developed to use an amorphous silicon flat-panel electronic portal imaging device (EPID) for accurate dosimetric verification of intensity-modulated radiotherapy (IMRT) treatments. Raw EPID images were deconvolved to accurate, high-resolution 2-D distributions of primary fluence using a scatter kernel composed of two elements: a Monte Carlo generated kernel describing dose deposition in the EPID phosphor, and an empirically derived kernel describing optical photon spreading. Relative fluence profiles measured with the EPID are in very good agreement with those measured with a diamond detector, and exhibit excellent spatial resolution required for IMRT verification. For dosimetric verification, the EPID-measured primary fluences are convolved with a Monte Carlo kernel describing dose deposition in a solid water phantom, and cross-calibrated with ion chamber measurements. Dose distributions measured using the EPID agree to within 2.1% with those measured with film for open fields of 2 x 2 cm2 and 10 x 10 cm2. Predictions of the EPID phantom scattering factors (SPE) based on our scatter kernels are within 1% of the SPE measured for open field sizes of up to 16 x 16 cm2. Pretreatment verifications of step-and-shoot IMRT treatments using the EPID are in good agreement with those performed with film, with a mean percent difference of 0.2 +/- 1.0% for three IMRT treatments (24 fields).

Patient dosimetry for hybrid MRI-radiotherapy systems

A novel geometry has been proposed for a hybrid magnetic resonance imaging (MRI)-linac system in which a 6 MV linac is mounted on the open end of a biplanar, low field (0.2 T) MRI magnet on a single gantry that is free to rotate around the patient. This geometry creates a scenario in which the magnetic field vector remains fixed with respect to the incident photon beam, but moves with respect to the patient as the gantry rotates. Other proposed geometries are characterized by a radiation source rotating about a fixed cylindrical magnet where the magnetic field vector remains fixed with respect to the patient. In this investigation we simulate the inherent dose distribution patterns within the two MRI-radiation source geometries using PENELOPE and EGSnrc Monte Carlo radiation transport codes with algorithms implemented to account for the magnetic field deflection of charged particles. Simulations are performed in phantoms and for clinically realistic situations. The novel geometry results in a net Lorentz force that remains fixed with respect to the patient (in the cranial-caudal direction) and results in a cumulative influence on dose distribution for a multiple beam treatment scenario. For a case where patient anatomy is reasonably homogeneous (brain plan), differences in dose compared to a conventional (no magnetic field) case are minimal for the novel geometry. In the case of a lung plan where the inhomogeneous patient anatomy allows for the magnetic field to have significant influence on charged particle transport, larger differences occur in a predictable manner. For a system using a fixed cylindrical geometry and higher magnetic field (1.5 T), differences from the case without a magnetic field are significantly greater.

Three‐dimensional IMRT verification with a flat‐panel EPID

A three-dimensional (3D) intensity-modulated radiotherapy (IMRT) pretreatment verification procedure has been developed based on the measurement of two-dimensional (2D) primary fluence profiles using an amorphous silicon flat-panel electronic portal imaging device (EPID). As described in our previous work, fluence profiles are extracted from EPID images by deconvolution with kernels that represent signal spread in the EPID due to radiation and optical scattering. The deconvolution kernels are derived using Monte Carlo simulations of dose deposition in the EPID and empirical fitting methods, for both 6 and 15 MV photon energies. In our new 3D verification technique, 2D fluence modulation profiles for each IMRT field in a treatment are used as input to a treatment planning system (TPS), which then generates 3D doses. Verification is accomplished by comparing this new EPID-based 3D dose distribution to the planned dose distribution calculated by the TPS. Thermoluminescent dosimeter (TLD) point dose measurements for an IMRT treatment of an anthropomorphic phantom were in good agreement with the EPID-based 3D doses; in contrast, the planned dose under-predicts the TLD measurement in a high-gradient region by approximately 16%. Similarly, large discrepancies between EPID-based and TPS doses were also evident in dose profiles of small fields incident on a water phantom. These results suggest that our 3D EPID-based method is effective in quantifying relevant uncertainties in the dose calculations of our TPS for IMRT treatments. For three clinical head and neck cancer IMRT treatment plans, our TPS was found to underestimate the mean EPID-based doses in the critical structures of the spinal cord and the parotids by approximately 4 Gy (11%-14%). According to radiobiological modeling calculations that were performed, such underestimates can potentially lead to clinically significant underpredictions of normal tissue complication rates.

Novel methods of measuring single scan dose profiles and cumulative dose in CT.

Computed tomography dose index (CTDI) is a conventional indicator of the patient dose in CT studies. It is measured as the integration of the longitudinal single scan dose profile (SSDP) by using a 100-mm-long pencil ionization chamber and a single axial scan. However, the assumption that most of the SSDP is contained within the chamber length may not be valid even for thin slices. We have measured the SSDPs for several slice widths on two CT scanners using a PTW diamond detector placed in a 300 mm x 200 mm x 300 mm water-equivalent plastic phantom. One SSDP was also measured using lithium fluoride (LiF) TLDs and an IC-10 small volume ion chamber, verifying the general shape of the SSDP measured using the diamond detector. Standard cylindrical PMMA CT phantoms (140 mm length) were also used to qualitatively study the effects of phantom shape, length, and composition on the measured SSDP. The SSDPs measured with the diamond detector in the water-equivalent phantom were numerically integrated to calculate the relative accumulated dose D(L)(0)calc at the center of various scan lengths L. D(L)(0)calc reached an equilibrium value for L > 300 mm, suggesting the need for phantoms longer than standard CT dose phantoms. We have also measured the absolute accumulated dose using an IC-10 small volume ion chamber, D(L)(0)SV, at three points in the phantom cross section for several beamwidths and scan lengths. For one CT system, these measurements were made in both axial and helical scanning modes. The absolute CTDI100, measured with a 102 mm active length pencil chamber, were within 4% of D(L)(0)SV measured with the small volume ion chamber for L approximately 100 mm suggesting that nonpencil chambers can be successfully used for CT dosimetry. For nominal beam widths ranging from 3 to 20 mm and for L approximately 250 mm, D(L)(0)SV values at the center of the water-equivalent phantoms elliptic cross section were approximately 25%-30% higher than the measured CTDI100. For small beamwidths, the difference in D(L)(0)SV for L approximately 250 mm and L approximately 14 x beamwidth (CTDI14nT) reached up to 50%. Peripheral point doses at 70 mm depth along the major axis of the phantom for L approximately 250 mm were up to 22% higher than for L approximately 100 mm. The differences between CTDI100 and D(L)(0)SV for L approximately 250 mm were in good agreement with the predictions made from the numerical integration of the measured SSDPs. Due to the considerable dose measured beyond the length of standard CT phantoms, CT dosimetry for longer body scan series should be performed in longer phantoms. Measurements could be made as we have shown, using a small volume chamber translating through the beam using multiple scans.

Lung dosimetry in a linac-MRI radiotherapy unit with a longitudinal magnetic field.

PURPOSE There is interest in developing linac-MR systems for MRI-guided radiation therapy. To date, the designs for such linac-MR devices have been restricted to a transverse geometry where the static magnetic field is oriented perpendicular to the direction of the incident photon beam. This work extends possibilities in this field by proposing and examining by Monte Carlo simulations, a probable longitudinal configuration where the magnetic field is oriented in the same direction as the photon beam. METHODS The EGSnrc Monte Carlo (MC) radiation transport codes with algorithms implemented to account for the magnetic field deflection of charged particles were used to compare dose distributions for linac-MR systems in transverse and longitudinal geometries. Specifically, the responses to a 6 MV pencil photon beam incident on water and lung slabs were investigated for 1.5 and 3.0 T magnetic fields. Further a five field lung plan was simulated in the longitudinal and transverse geometries across a range of magnetic field strengths from 0.2 through 3.0 T. RESULTS In a longitudinal geometry, the magnetic field is shown to restrict the radial spread of secondary electrons to a small degree in water, but significantly in low density tissues such as lung in contrast to the lateral shift in dose distribution seen in the transverse geometry. These effects extend to the patient case, where the longitudinal configuration demonstrated dose distributions more tightly confined to the primary photon fields, which increased dose to the planning target volume (PTV), bettered dose homogeneity within a heterogeneous (in density) PTV, and reduced the tissue interface effects associated with the transverse geometry. CONCLUSIONS Dosimetry issues observed in a transverse linac-MR geometry such as changes to the depth dose distribution and tissue interface effects were significantly reduced or eliminated in a longitudinal geometry on a representative lung plan. Further, an increase in dose to the PTV, resulting from the magnetic field confining electrons to the forward direction, shows potential for a reduction in dose to the surrounding tissues.

Experimental Validation of the Eclipse AAA Algorithm

The present study evaluates the performance of a newly released photon‐beam dose calculation algorithm that is incorporated into an established treatment planning system (TPS). We compared the analytical anisotropic algorithm (AAA) factory‐commissioned with “golden beam data” for Varian linear accelerators with measurements performed at two institutions using 6‐MV and 15‐MV beams. The TG‐53 evaluation regions and criteria were used to evaluate profiles measured in a water phantom for a wide variety of clinically relevant beam geometries. The total scatter factor (TSF) for each of these geometries was also measured and compared against the results from the AAA. At one institute, TLD measurements were performed at several points in the neck and thoracic regions of a Rando phantom; at the other institution, ion chamber measurements were performed in a CIRS inhomogeneous phantom. The phantoms were both imaged using computed tomography (CT), and the dose was calculated using the AAA at corresponding detector locations. Evaluation of measured relative dose profiles revealed that 97%, 99%, 97%, and 100% of points at one institute and 96%, 88%, 89%, and 100% of points at the other institution passed TG‐53 evaluation criteria in the outer beam, penumbra, inner beam, and buildup regions respectively. Poorer results in the inner beam regions at one institute are attributed to the mismatch of the measured profiles at shallow depths with the “golden beam data.” For validation of monitor unit (MU) calculations, the mean difference between measured and calculated TSFs was less than 0.5%; test cases involving physical wedges had, in general, differences of more than 1%. The mean difference between point measurements performed in inhomogeneous phantoms and Eclipse was 2.1% (5.3% maximum) and all differences were within TG‐53 guidelines of 7%. By intent, the methods and evaluation techniques were similar to those in a previous investigation involving another convolution–superposition photon‐beam dose calculation algorithm in another TPS, so that the current work permitted an independent comparison between the two algorithms for which results have been provided. PACS number: 87.53.Dq

Dose response of selected ion chambers in applied homogeneous transverse and longitudinal magnetic fields

PURPOSE The magnetic fields of an integrated MR-Linac system will alter the paths of electrons that produce ions in the ionization chambers. The dose response of selected ion chambers is evaluated in the presence of varying transverse and longitudinal magnetic fields. The investigation is useful in calibration of therapeutic x-ray beams associated with MR-Linac systems. METHODS The Monte Carlo code PENELOPE was used to model the irradiation of NE2571, and PR06C ionization chambers in the presence of a transverse and longitudinal (with respect to the photon beam) magnetic fields of varying magnitude. The long axis of each chamber was simulated both parallel and perpendicular to the incident photon beam for each magnetic field case. The dose deposited in each chamber for each case was compared to the case with zero magnetic field by means of a ratio. The PR06C chambers response was measured in the presence of a transverse magnetic field with field strengths ranging from 0.0 to 0.2 T to compare to simulated results. RESULTS The simulations and measured data show that in the presence of a transverse magnetic field there is a considerable dose response (maximum of 11% near 1.0 T in the ion chambers investigated, which depends on the magnitude of magnetic field, and relative orientation of the magnetic field, radiation beam, and ion chamber. Measurements made with the PR06C chamber verify these results in the region of measurement. In contrast, a longitudinal magnetic field produces only a slight increase in dose response (2% at 1.5 T) that rises slowly with increasing magnetic field and is seemingly independent of chamber orientation. Response trends were similar for the two ion chambers and relative orientations considered, but slight variations are present from chamber to chamber. CONCLUSIONS Care must be taken when making ion chamber measurements in a transverse magnetic field. Ion chamber responses vary not only with transverse field strength, but with chamber orientation and type, and can be considerable. Longitudinal magnetic fields influence ion chamber responses relatively little (2% at 1.5 T), and only at field strengths in excess of 1.0 T.

TU‐C‐M100F‐01: Development of a Linac‐MRI System for Real‐Time ART

Purpose: To describe the novel design of the coupling an of MRI to a medical linac to provide real‐time tracking of the tumor and healthy tissues during irradiation by the treatment beam Method and Materials: Various embodiments are defined in our patents (Fallone, Carlone, Murray) to avoid mutual interference between the MR and the linac. Our method allows rotation of a linac with respect to the subject to allow irradiation of the subject from any angle without disturbing the magnet homogeneity. Magnetic shielding of the linac prevents disturbance from the MRI. RF signal shielding, modifications the RF‐signal triggering and pulse shaping are used to minimize linac interference of MRI RF read sequences. Various Monte Carlo calculations (EGS4 NRC and Penelope) and finite‐element analyses (Comsol) are performed in all design stages. Results: The initial design for the human system involves a bi‐planar MRI with 65 cm opening to allow rotation of the shoulders within the bore. A short 6 MV waveguide is coupled to one open end of the MR, and a beam‐stop and a projection imaging device (eg, flatpanel) is coupled to the other end. Rotation is provide by two concentric rings, and the permanent‐magnet design is preferred in the initial stage to provide stability and lack of electric wiring in the rotation process. Low fields allows very small fringe fields to minimize linac interference yet with adequate image quality of soft tissue for lungs, prostate, GBM, etc. Mutual interference issues and other issues arising externally are calculated and resolved. Conclusion: We have shown the design to be a practical, viable and realizable within a reasonable time frame. Our other presentations detail resolutions to mutual MRI‐linac interferences.

Breast radiotherapy with inclusion of internal mammary nodes: a comparison of techniques with three-dimensional planning.

PURPOSE To compare the partially wide tangent (PWT) technique of breast and internal mammary chain irradiation with photon/electron (P/E) and standard tangent (ST) techniques in terms of dose homogeneity within breast and the dose to critical structures such as the heart and lung. METHODS AND MATERIALS Sixteen left breast cancer patients underwent CT simulation. The breasts, lungs, heart, and internal mammary chain were contoured and treatment plans generated on a three-dimensional planning system (Helax-TMS). RESULTS The mean dose to the left breast volume with the ST, P/E, and PWT techniques was 94.7%, 98.4%, and 96.5%, respectively (p = 0.029). The left lung received the lowest mean dose with the ST technique (13.9%) compared with PWT (22.8%) and P/E (24.3%). The internal mammary chain volume was most consistently treated with the PWT (mean dose 99%) vs. P/E (86%) and ST (38.4%) techniques. The heart received the least dose with ST (mean dose 6.7%) vs. PWT (10.3%) and P/E (19%). The PWT treated the greatest amount of contralateral breast (mean dose 5.8%) vs. ST (3.2%) vs. P/E (2.8%). CONCLUSION The PWT technique treats the internal mammary chain with acceptable toxicity to major organs, especially the heart, and with reasonable dose homogeneity in patients with mastectomy or intact breasts.

Skin dose in longitudinal and transverse linac‐MRIs using Monte Carlo and realistic 3D MRI field models

PURPOSE The magnetic fields of linac-MR systems modify the path of contaminant electrons in photon beams, which alters patient skin dose. To accurately quantify the magnitude of changes in skin dose, the authors use Monte Carlo calculations that incorporate realistic 3D magnetic field models of longitudinal and transverse linac-MR systems. METHODS Finite element method (FEM) is used to generate complete 3D magnetic field maps for 0.56 T longitudinal and transverse linac-MR magnet assemblies, as well as for representative 0.5 and 1.0 T Helmholtz MRI systems. EGSnrc simulations implementing these 3D magnetic fields are performed. The geometry for the BEAMnrc simulations incorporates the Varian 600C 6 MV linac, magnet poles, the yoke, and the magnetic shields of the linac-MRIs. Resulting phase-space files are used to calculate the central axis percent depth-doses in a water phantom and 2D skin dose distributions for 70 μm entrance and exit layers using DOSXYZnrc. For comparison, skin doses are also calculated in the absence of magnetic field, and using a 1D magnetic field with an unrealistically large fringe field. The effects of photon field size, air gap (longitudinal configuration), and angle of obliquity (transverse configuration) are also investigated. RESULTS Realistic modeling of the 3D magnetic fields shows that fringe fields decay rapidly and have a very small magnitude at the linac head. As a result, longitudinal linac-MR systems mostly confine contaminant electrons that are generated in the air gap and have an insignificant effect on electrons produced further upstream. The increase in the skin dose for the longitudinal configuration compared to the zero B-field case varies from ∼1% to ∼14% for air gaps of 5-31 cm, respectively. (All dose changes are reported as a % of D(max).) The increase is also field-size dependent, ranging from ∼3% at 20 × 20 cm(2) to ∼11% at 5 × 5 cm(2). The small changes in skin dose are in contrast to significant increases that are calculated for the unrealistic 1D magnetic field. For the transverse configuration, the entrance skin dose is equal or smaller than that of the zero B-field case for perpendicular beams. For a 10 × 10 cm(2) oblique beam the transverse magnetic field decreases the entry skin dose for oblique angles less than ±20° and increases it by no more than 10% for larger angles up to ±45°. The exit skin dose is increased by 42% for a 10 × 10 cm(2) perpendicular beam, but appreciably drops and approaches the zero B-field case for large oblique angles of incidence. CONCLUSIONS For longitudinal linac-MR systems only a small increase in the entrance skin dose is predicted, due to the rapid decay of the realistic magnetic fringe fields. For transverse linac-MR systems, changes to the entrance skin dose are small for most scenarios. For the same geometry, on the exit side a fairly large increase is observed for perpendicular beams, but significantly drops for large oblique angles of incidence. The observed effects on skin dose are not expected to limit the application of linac-MR systems in either the longitudinal or transverse configuration.