Silvia Pella

Mean-field approximations for the electronic states in disordered alloys

Mean-field approximations are used to find approximate solutions to the one-electron equations for the electronic states in disordered alloys because ordinary band-theory approaches are not applicable. The first mean-field approximation, the coherent potential approximation, does not treat Coulomb effects correctly. This has been improved by changing the way the mean-field approximation is implemented. It may be that this experience with mean-field approximations will be useful to the combination of many-body theory and mean-field theory that has produced the dynamical coherent potential approximation and dynamical mean field theory for treating strongly correlated electron systems.

SU-F-T-26: A Study of the Consistency of Brachytherapy Treatments for Vaginal Cuff

PURPOSE To evaluate to treatment consistency over the total number of fractions when treatment what HDR brachytherapy using the ML cylinders. At the same time the dosimetric impact on the critical organs is monitored over the total number of fractions. METHODS A retrospective analysis of 10 patients treated with Cylinder applicators, from 2015-2016 were considered for this study. The CT scans of these patients, taken before each treatment were separately imported in to the treatment planning system and paired with the initial CT scan after completing the contouring. Two sets of CT images were fused together with respective to the applicator, using landmark registration. The doses of each plan were imported as well and a cumulative dosimetric analysis was made for bladder, bowels, and rectum and PTV. RESULTS No contour of any of the OAR was exactly similar when CT images were fused on each other. The PTV volumes vary from fraction to fraction. There was always a difference between the doses received by the OARs between treatments. The maximum dose varied between 5% and 30% in rectum and bladder. The minimum dose varied between 5% and 8% in rectum and bladder. The average dose varied between 15% and 20% in rectum and bladder. Deviation in placement were noticed between fractions. CONCLUSION The variation in volumes of OARs and isodoses near the OARs, indicate that the estimated doses to OARs on the planning system may not be the same dose delivered to the patient in all the fractions. There are no major differences between the prescribed dose and the delivered dose over the total number of fractions. In some cases the critical organs will benefit if the consecutive plans will made after the CT scans will be registered with the initial scan and then planned.

SU‐F‐J‐87: Impact Of The Dosimetric Consequences From Minimal Displacements Throughout The Treatment Time In APBI With SAVI Applicators

PURPOSE To assess the variation in dose received by the organs at risk (OARs) due to inter-fractional motion by SAVI to determine the importance of providing proper immobilization METHODS: An analysis of 15 patients treated with SAVI applicators were considered for this study. Treatment planning teams did not see significant changes in their CT scans through scout images and initial treatment plan was used for the entire treatment. These scans, taken before each treatment were imported in to the treatment planning system and were fused together with respective to the applicator, using landmark registration. Dosimetric evaluations were performed. Dose received by skin, ribs and PTV(Planning target volume) respect to the initial treatment plan were measured. RESULTS Contours of the OARs were not similar with the initial image. Deduction in volumes of PTV and cavity, small deviations in displacements from the applicator to the OARs, difference in doses received by the OARs between treatments were noticed. The maximum, minimum, average doses varied between 10% to 20% 5% to 8% and 15% to 20% in ribs and skin. The 0.1cc doses to OARs showed an average change of 10% of the prescribed dose. PTV was receiving a different dose than the estimated dose CONCLUSION: The variation in volumes and isodoses related to the OARs, PTV receiving a lesser dose than the prescribed dose indicate that the estimated doses are different from the received dose. This study reveals the urgent need of improving the immobilization methods. Taking a CT scan before each treatment and replanning is helpful to minimize the risk of delivering undesired high doses to the OARs. Patient positioning, motion, respiration, observer differences and time lap between the planning and treating can arise more complications. VacLock, Positioning cushions, Image guided brachytherapy and adjustable registration should be used for further improvements.

SU-F-T-19: The Consistency Dosimetric Analysis of the Accelerated Breast Brachytherapy

PURPOSE To assess the best approach in accept a treatment plan for APBI Savi patients. Should we run a treatment verification test prior to delivering it to the patient? Should we check each CT scan in regards to the initial one in dosimetrical terms? Do we need deformable registration and adaptive planning for each fraction? These are the questions we want to answer running a dosimetric analysis of the dose variances for APBI treatments who receive 10 fractions and no re-planning has been done being considered unnecessary with todays means of assessment. METHODS A retrospective analysis of 30 patients treated with SAVI applicators were considered for this study. The CT scans taken before each treatment were imported in the treatment planning system and registered with the initial CT scan. The images were fused together with respective to the applicator, using landmark registration. Dosimetric evaluations were performed. Dose received by skin, ribs and PTV on CT images with respect to the initial treatment plan were recorded including maximum, average and minimum dose RESULTS: All the structures displayed changes in volume over the 10 fractions of treatment. The cavities reduction in volume was considerable with a maximum reduction of over 10%. The PTV-eval is covered better due to this fact while the critical organs manifest an increase in the total and maximum dose delivered. Ribs and skin surface that are required by B39 protocol to be monitored can acquire maximum doses of 20% to 30% respectively. CONCLUSION A dosimetric evaluation prior to the initial treatment and prior to each of the 10 fractions is proven to be necessary. Deformable registration and adaptive planning have to be studied more and eventually implemented for every patient who received more than one fraction of any type of brachytherapy treatment. Immobilization ad localization methods must be improved and studied further.

SU-F-T-18: The Importance of Immobilization Devices in Brachytherapy Treatments of Vaginal Cuff

PURPOSE High dose rate brachytherapy is a highly localized radiation therapy that has a very high dose gradient. Thus one of the most important parts of the treatment is the immobilization. The smallest movement of the patient or applicator can result in dose variation to the surrounding tissues as well as to the tumor to be treated. We will revise the ML Cylinder treatments and their localization challenges. METHODS A retrospective study of 25 patients with 5 treatments each looking into the applicators placement in regard to the organs at risk. Motion possibilities for each applicator intra and inter fractionation with their dosimetric implications were covered and measured in regard with their dose variance. The localization immobilization devices used were assessed for the capability to prevent motion before and during the treatment delivery. RESULTS We focused on the 100% isodose on central axis and a 15 degree displacement due to possible rotation analyzing the dose variations to the bladder and rectum walls. The average dose variation for bladder was 15% of the accepted tolerance, with a minimum variance of 11.1% and a maximum one of 23.14% on the central axis. For the off axis measurements we found an average variation of 16.84% of the accepted tolerance, with a minimum variance of 11.47% and a maximum one of 27.69%. For the rectum we focused on the rectum wall closest to the 120% isodose line. The average dose variation was 19.4%, minimum 11.3% and a maximum of 34.02% from the accepted tolerance values CONCLUSION: Improved immobilization devices are recommended. For inter-fractionation, localization devices are recommended in place with consistent planning in regards with the initial fraction. Many of the present immobilization devices produced for external radiotherapy can be used to improve the localization of HDR applicators during transportation of the patient and during treatment.

SU‐E‐T‐358: Empirical Beam Angle Optimization for Lung Cancer Intensity Modulated Radiation Therapy

Purpose: Creating an improved BAO can decrease the amount of time a dosimetrist spends on making a treatment plan, improve the treatment quality and enhance the tools an inexperienced dosimetrist can use to develop planning techniques. Methods: Using empirical data created by experienced dosimetrists from 69 patients treated for lung cancer, the most frequently used gantry angles were applied to four different regions in each lung to gather an optimal set of fields that could be used to treat future lung cancer patients. This method, given the moniker FAU BAO, is compared in 7 plans created with the Eclipse BAO choosing 5 fields and 9 fields. Results: The results show that the conformality index improved by 30% or 3% when using the 5 and 9 fields. The conformation number was better by 12% from the 5 fields and 9% from the 9 fields. The organs at risk (OAR) were overall more protected to produce fewer nonstochastic effects from the radiation treatment with the FAU BAO. Conclusion: Empirical methods for beam angle optimization is a viable method for IMRT treatment planning techniques.

SU-E-T-630: Commissioning for SRS Planning Systems

PURPOSE This study will try to find optimal procedures to collect small fields beam data for commissioning in treatment planning systems (TPS), and to provide a protocol to collect output factors for very small field sizes: 0.5 cm × 0.5 cm to 4.0 cm × 4.0 cm. This will help in determining the correct beam configuration methods in TPS planning intensity modulated radiation therapy (IMRT), and stereotactic radiosurgery SRS using mini multileaf collimation (mMLC). METHODS Data has been collected for a mMLC linear accelerator (linac) Novalis from 0.5 cm × 0.5 cm to 10 cm × 10 cm (its maximum field size). The TPS chosen is BrainLab, Eclipse & Cyberknife. The beam data collected was modeled and imported in the TPS. Verification plans were generated in solid water to confirm the goodness of the data. 3D and IMRT plans on regular CT scans were generated and verified using Mapcheck. All 3D plans with field sizes above 4 cm × 4 cm verified excellent using a distance to agreement of 2 mm and a 2% tolerance. IMRT plans gave an error of -8%. New scans with new detectors have been taken, new field sizes were introduced, and focus has been applied on determining the dosimetric leaf gap. RESULTS Although this is still a work in progress, this study brings several issues to light: the importance of the correct technique in beam data collection from the correct watertank to the correct detectors. Readings for rectangular fields have to be taken especially for fields which one side is under 4 cm. CONCLUSION The use of equivalent square fields will not provide correct readings for the fields with large differences between the length and the width.

SU-E-T-636: Investigation of Dose Variation in High Dose Radiation Brachytherapy

PURPOSE The purpose of this study is to revise most of the HDR types of treatments with their applicators and their localization challenges. Since every millimeter of misplacement counts the study will look into the necessity of increasing the immobilization for several types of applicators METHODS: The study took over 136 plans generated by the treatment planning system (TPS) looking into the applicators placement in regard to the organs at risk (OR) and simulated the three possible displacements at the hottest dose point on the critical organ for several accessories to evaluate the variation of the delivered dose at the point due to the displacement. RESULTS Significant dose variation was obtained for the Contura, Savi, MLM and Prostate applicators. CONCLUSION This study data indicates that an improvement of the immobilization devices for HDR is absolutely necessary. Better applicator fixation devices are required too. Developing new immobilization devices for all the applicators is recommended. Florida Atlantic University may provide Travel reimbursements.

SU-E-T-244: Motion Control Challenges in High Dose Rate Brachytherapy.

PURPOSE High dose rate (HDR) brachytherapy dose distribution is highly localized and has a very sharp fall-off. Thus the one of the most important part of the treatment is the localization and immobilization of the applicator from the implantation to the setup verification to the treatment delivery. The smallest motions of the patient can induce a small rotation, tilt, or translational movement of the applicator that can convert into miss of a significant part of the tumor or to over irradiating a nearby critical organ. The purpose of this study is to revise most of the HDR types of treatments with their applicators and their localization challenges. Since every millimeter of misplacement counts the study will look into the necessity of increasing the immobilization for several types of applicators. METHODS The study took over 136 plans generated by the treatment planning system (TPS) looking into the applicator placement in regard to the organs at risk (OR) and simulated the three possible displacements at the hottest dose point on the critical organ for several accessories to evaluate the variation of the delivered dose at the point due to the displacement. RESULTS Many of the present immobilization devices produced for external radiotherapy can be used to improve the localization of HDR applicators during transportation of the patient and during treatment. CONCLUSION This study data indicates that an improvement of the immobilization devices for HDR is absolutely necessary. Better applicator fixation devices are required too. Developing new immobilization devices for all the applicators is recommended.