Sheridan Meltsner

A round-robin gamma stereotactic radiosurgery dosimetry interinstitution comparison of calibration protocols.

PURPOSE Absorbed dose calibration for gamma stereotactic radiosurgery is challenging due to the unique geometric conditions, dosimetry characteristics, and nonstandard field size of these devices. Members of the American Association of Physicists in Medicine (AAPM) Task Group 178 on Gamma Stereotactic Radiosurgery Dosimetry and Quality Assurance have participated in a round-robin exchange of calibrated measurement instrumentation and phantoms exploring two approved and two proposed calibration protocols or formalisms on ten gamma radiosurgery units. The objectives of this study were to benchmark and compare new formalisms to existing calibration methods, while maintaining traceability to U.S. primary dosimetry calibration laboratory standards. METHODS Nine institutions made measurements using ten gamma stereotactic radiosurgery units in three different 160 mm diameter spherical phantoms [acrylonitrile butadiene styrene (ABS) plastic, Solid Water, and liquid water] and in air using a positioning jig. Two calibrated miniature ionization chambers and one calibrated electrometer were circulated for all measurements. Reference dose-rates at the phantom center were determined using the well-established AAPM TG-21 or TG-51 dose calibration protocols and using two proposed dose calibration protocols/formalisms: an in-air protocol and a formalism proposed by the International Atomic Energy Agency (IAEA) working group for small and nonstandard radiation fields. Each institutions results were normalized to the dose-rate determined at that institution using the TG-21 protocol in the ABS phantom. RESULTS Percentages of dose-rates within 1.5% of the reference dose-rate (TG-21+ABS phantom) for the eight chamber-protocol-phantom combinations were the following: 88% for TG-21, 70% for TG-51, 93% for the new IAEA nonstandard-field formalism, and 65% for the new in-air protocol. Averages and standard deviations for dose-rates over all measurements relative to the TG-21+ABS dose-rate were 0.999±0.009 (TG-21), 0.991±0.013 (TG-51), 1.000±0.009 (IAEA), and 1.009±0.012 (in-air). There were no statistically significant differences (i.e., p>0.05) between the two ionization chambers for the TG-21 protocol applied to all dosimetry phantoms. The mean results using the TG-51 protocol were notably lower than those for the other dosimetry protocols, with a standard deviation 2-3 times larger. The in-air protocol was not statistically different from TG-21 for the A16 chamber in the liquid water or ABS phantoms (p=0.300 and p=0.135) but was statistically different from TG-21 for the PTW chamber in all phantoms (p=0.006 for Solid Water, 0.014 for liquid water, and 0.020 for ABS). Results of IAEA formalism were statistically different from TG-21 results only for the combination of the A16 chamber with the liquid water phantom (p=0.017). In the latter case, dose-rates measured with the two protocols differed by only 0.4%. For other phantom-ionization-chamber combinations, the new IAEA formalism was not statistically different from TG-21. CONCLUSIONS Although further investigation is needed to validate the new protocols for other ionization chambers, these results can serve as a reference to quantitatively compare different calibration protocols and ionization chambers if a particular method is chosen by a professional society to serve as a standardized calibration protocol.

SU-G-201-13: Investigation of Dose Variation Induced by HDR Ir-192 Source Global Shift Within the Varian Ring Applicator Using Monte Carlo Methods

PURPOSE The Varian tandem and ring applicators are used to deliver HDR Ir-192 brachytherapy for cervical cancer. The source path within the ring is hard to predict due to the larger interior ring lumen. Some studies showed the source could be several millimeters different from planned positions, while other studies demonstrated minimal dosimetric impact. A global shift can be applied to limit the effect of positioning offsets. The purpose of this study was to assess the necessities of implementing a global source shift using Monte Carlo (MC) simulations. METHODS The MCNP5 radiation transport code was used for all MC simulations. To accommodate TG-186 guidelines and eliminate inter-source attenuation, a BrachyVision plan with 10 dwell positions (0.5cm step sizes) was simulated as the summation of 10 individual sources with equal dwell times for simplification. To simplify the study, the tandem was also excluded from the MC model. Global shifts of ±0.1, ±0.3, ±0.5 cm were then simulated as distal and proximal from the reference positions. Dose was scored in water for all MC simulations and was normalized to 100% at the normalization point 0.5 cm from the cap in the ring plane. For dose comparison, Point A was 2 cm caudal from the buildup cap and 2 cm lateral on either side of the ring axis. With seventy simulations, 108 photon histories gave a statistical uncertainties (k=1) <2% for (0.1 cm)3 voxels. RESULTS Compared to no global shift, average Point A doses were 0.0%, 0.4%, and 2.2% higher for distal global shifts, and 0.4%, 2.8%, and 5.1% higher for proximal global shifts, respectively. The MC Point A doses differed by < 1% when compared to BrachyVision. CONCLUSION Dose variations were not substantial for ±0.3 cm global shifts, which is common in clinical practice.

TU‐G‐BRD‐04: A Round Robin Dosimetry Intercomparison of Gamma Stereotactic Radiosurgery Calibration Protocols

Purpose: The purpose of this multi-institutional study was to compare two new gamma stereotactic radiosurgery (GSRS) dosimetry protocols to existing calibration methods. The ultimate goal was to guide AAPM Task Group 178 in recommending a standard GSRS dosimetry protocol. Methods: Nine centers (ten GSRS units) participated in the study. Each institution made eight sets of dose rate measurements: six with two different ionization chambers in three different 160mm-diameter spherical phantoms (ABS plastic, Solid Water and liquid water), and two using the same ionization chambers with a custom in-air positioning jig. Absolute dose rates were calculated using a newly proposed formalism by the IAEA working group for small and non-standard radiation fields and with a new air-kerma based protocol. The new IAEA protocol requires an in-water ionization chamber calibration and uses previously reported Monte-Carlo generated factors to account for the material composition of the phantom, the type of ionization chamber, and the unique GSRS beam configuration. Results obtained with the new dose calibration protocols were compared to dose rates determined by the AAPM TG-21 and TG-51 protocols, with TG-21 considered as the standard. Results: Averaged over all institutions, ionization chambers and phantoms, the mean dose rate determined with the new IAEA protocol relative to that determined with TG-21 in the ABS phantom was 1.000 with a standard deviation of 0.008. For TG-51, the average ratio was 0.991 with a standard deviation of 0.013, and for the new in-air formalism it was 1.008 with a standard deviation of 0.012. Conclusion: Average results with both of the new protocols agreed with TG-21 to within one standard deviation. TG-51, which does not take into account the unique GSRS beam configuration or phantom material, was not expected to perform as well as the new protocols. The new IAEA protocol showed remarkably good agreement with TG-21. Conflict of Interests: Paula Petti, Josef Novotny, Gennady Neyman and Steve Goetsch are consultants for Elekta Instrument A/B; Elekta Instrument AB, PTW Freiburg GmbH, Standard Imaging, Inc., and The Phantom Laboratory, Inc. loaned equipment for use in these experiments; The University of Wisconsin Accredited Dosimetry Calibration Laboratory provided calibration services.

SU‐E‐J‐88: Dose Summation Between Multimodality Treatments for Cervical Cancer

Purpose: 1) To explore the feasibility of volumetric dose summation between external beam radiation (EBRT) and high dose rate (HDR) brachytherapy treatments for cervical cancer, and 2) to investigate the differences between two deformable registration platforms: MIM Software (M) and VelocityAI (V). Methods: Five patients treated with combined EBRT (45 Gy) and HDR (5 x 5.5 Gy/FX, T&R) were selected in this study. The doses were converted to EQD2 (α/β of 10 for early and 3 for late effects). The HDR CT sets were registered using rigid (r), based on applicator, and deformable (d) registration. To quantify geometrical similarities between the deformed secondary and the original primary structures, the Dice Similarity Coefficient (DSC) was calculated for HRCTV (for HDR sums only), bladder, and rectum. Each HDR fractional dose was resampled to a primary set. The registration between EBRT and HDR was performed using the HDR primary CT. The metrics HRCTV D90, and bladder/rectum D2cc were extracted from total dose DVHs and compared to the current clinical point dose summation protocol. Results: The average DSC for HRCTV, bladder and rectum was 0.72, 0.71, and 0.56 for MIM and 0.71, 0.70, and 0.51 for Velocity. Volumetric dose summation between the two modalities lead to differences from the point summation of 2.1±1.6% (r, M), 3.2±2.0% (r, V), 2.6±1.9% (d, M), and 3.9±1.5% (d, V) for HRCTV D90, 8.9±6.7% (r, M), 9.9±6.5% (r, V), 10.2± 6.2 (d, M), and 9.4± 4.5% (d, V) for bladder, and 5.2±3.4% (r, M), 5.0± 1.1%(r, V), 5.2± 3.3% (d, M), and 5.3± 3.8% (d, V) for rectum. Conclusion: The two algorithms produced similar results, with expected better DSC for HRCTV and bladder than for rectum. With understanding of the limitations of current deformable registration algorithms, 3D dose summation can be accomplished and composite dose estimates can be improved.

SU-D-108-03: Evaluation of the Feasibility of a Novel Radiochromic Dosimetry System for In-Vivo Dose Verification in Organs at Risk in HDR Intracavitary Gynecological Brachytherapy

PURPOSE To evaluate the feasibility of a novel radiochromic dosimetry system for in-vivo dose verification in organs at risk in HDR intracavitary gynecological brachytherapy. METHODS Novel, small cylindrical PRESAGE dosimeters (4mm in diameter by 20mm in height) were attached to intracavitary HDR brachytherapy applicators near the rectum and bladder of three patients undergoing Ir-192 HDR brachytherapy treatments. Two methods of dose-readout were investigated (i) a volume averaged readout by spectrophotometer, and (ii) 2D projection imaging in a high-resolution (50 micron) telecentric optical system. Both readout techniques were benchmarked against a gold standard. The gold standard consisted of spectrophotometer readout of precision 1×1×4cm optical cuvettes filled with PRESAGE, and irradiated to known doses in a 6 MV photon beam. Temperature corrections were required to account for increased PRESAGE sensitivity at body temperature. Estimated doses were compared with measured dose distributions in Eclipse. RESULTS Examination of the change in optical density between dosimeters and cuvettes shows a linear relationship in sensitivity between 1-15 Gy with a 95% confidence interval in the slope (0.8703 +/- 0.0192). Patient data showed a 0 % and 2.8% difference in estimated doses vs. Eclipse measurements in the bladder and rectum, respectively. CONCLUSION This work presents the spectrophotometer/optical scanning system as a viable dosimetry system, which can provide in-vivo dose verification in intracavitary HDR brachytherapy. Further work needs to be done in regard to dosimeter positioning in patient treatments. NIH Grant RO1CA100835.