6FFF Beams Research Articles

Comprehensive characterisation of the IBA myQA SRS for SRS and SBRT patient specific quality assurance.

The myQA SRS (IBA) is a new to market 2D complementary metal oxide semiconductor detector array with an active area 140 × 120mm2 and 0.4mm resolution, making it a potential real-time dosimetry alternative to radiochromic film for stereotactic plan verification. Characterisation of the device was completed to assess performance. The dosimetric properties of the device were assessed for 6FF and 6FFF beams from a Varian TrueBeam STx with high definition multileaf collimator. Clinical suitability of the device for Patient Specific Quality Assurance was verified using ten SRS/SBRT plans, compared against other detectors, as well as multi leaf collimator (MLC) tests including picket fence and chair. Gamma analysis was performed using myQA software with criteria of 4%/1mm. The device demonstrated compliance with recommended specifications for basic tests. After the required warm-up period, the maximum deviation in detector signal from initial readings was 0.2%. Short-term and long-term reproducibility was 0.1% (6FF) and 1.0% (6FFF), respectively. Dose linearity was within 0.3% (6FF) and 0.7% (6FFF) and dose-rate dependence within 1.7% (6FF) and 2.9% (6FFF) and were verified with a Farmer type ionization chamber (PTW 30013). Angular dependence was quantified for coplanar and non-coplanar situations. Output factors and beam profiles measured on the device showed agreement within 1% of baseline RAZOR diode (IBA) and CC04 ionisation chamber (IBA) measurements for field sizes 1 × 1 to 10 × 10cm2. The minimum gamma (4%/1mm) pass rates for MLC-pattern tests were 96.5% and 98.1% for the myQA SRS and film, respectively. The average gamma (4%/1mm) pass rates for SBRT and SRS plans were 98.8% and 99.8% respectively. This work represents one of the first studies performed on the commissioning and performance characterisation of this novel device, demonstrating its accuracy and reliability, making it highly useful as a film alternative in stereotactic treatment plan verification.

Extending the EclipseTM AcurosXB output factor table for small field radiosurgery.

To investigate the necessity of extending the output factor table (OF Table) of the Varian EclipseTM Treatment Planning System for small field stereotactic radiosurgery (SRS) and stereotactic body radiosurgery (SBRT) treatments. A new AcurosXB 15.6 beam model was created in the Eclipse Beam Configuration, which is identical to the one that has been used in the clinic with a default 3×3cm to 40×40cm OF Table, except the OF Table in the new model was extended to cover the range from 1×1cm to 40×40cm. 80 small square and rectangular output factors were measured on a Varian TrueBeam utilizing a Standard Imaging Exradin W2-1×1 scintillator detector, inside a PTW BeamScan water tank with 95cm SSD at 5cm depth. Cerenkov contamination was corrected using a rectangular field method (2cm×15cm field). Nine Radiosurgery plans with primary jaw setting ranging from 0.7cm to 2.0cm were evaluated by both beam models. The monitor unit (MU) differences between the two beam models were calculated for identical 3-dimensional (3D) absolute dose distributions. Output factors, measured versus Eclipse calculated, were compared down to 0.5×0.5cm primary jaw setting. For the 6FFF beam, the difference between the two beam models was ∼ 6% for 1×1cm jaw settings and 4% at 1.5×1.5cm, with the extended OF Table requiring higher MUs for the same dose prescription and same 3-dimensional isodose distribution. For the 6MV beam, the corresponding difference is ∼7.5% for 1×1cm, 5% for 1.5×1.5cm, and 3% for 2×2cm jaw settings, with the extended OF Table requiring higher MUs. For jaw settings smaller than 1×1cm, measured dose can be considerably smaller than Eclipse predicted dose, even with the OF Table extension. This is reflected by the fact that the output factor for 0.5×0.5cm, calculated via Eclipse external beam, was more than 30% greater than that measured for both 6FFF and 6MV beams. Eclipse does a satisfactory job for primary jaw sizes down to 2cm. For jaw settings smaller than 1.5cm, the OF Table in Eclipse should be extended to improve the dose calculation accuracy.

Determination of correction factors in small MLC-defined fields for the Razor and microSilicon diode detectors and evaluation of the suitability of the IAEA TRS-483 protocol for multiple detectors.

Small field output factors for Multileaf collimator (MLC)‐defined field sizes between 0.5 × 0.5 cm2 and 3 × 3 cm2 were measured with six different detectors for a Varian TrueBeam in 6‐MV, 6‐FFF, 10‐MV, and 10‐FFF photon beams. Correction factors kQclin,Qreffclin,fref from the IAEA publication TRS‐483 were used to correct the measured output factors. The corrected output factors from the six detectors were used to calculate correction factors for the PTW microSilicon T60023 (PTW, Freiburg, Germany) and IBA Razor (IBA Dosimetry, Schwarzenbruck, Germany) detectors. The uncertainty of the output and correction factors in this study was calculated and the calculations presented in detail. The application of the TRS‐483 correction factors significantly reduced the variation in output factors between the various detectors, with the exception of the PTW 60016 diode in 6‐MV and 6‐FFF beams, and the IBA PFD in 10‐MV and 10‐FFF beams. Correction factors calculated for the Razor agreed within 2.9% of existing literature for all energies, while the microSilicon correction factors agreed within 1.6% to the literature for 6‐MV beams. The uncertainty in the microSilicon and Razor correction factors was calculated to be less than 0.9% (k = 1). This study shows that TRS‐483 correction factors reduce the variation in output factors between the detectors used in this study and presents a suitable method for determining correction factors for detectors with unpublished values.

Technical Note: An alternative approach to verify 6FFF beam dosimetry for Ethos and MR Linac without using a 3D water tank.

The current approach to Linac beam dosimetry verification is typically performed utilizing a three-dimensional (3D) water tank system. The 3D beam scanning process is cumbersome, labor intensive, error-prone, and costly. This is especially challenging for the new Ethos system and MR Linacs with a ring gantry. This work proposes an alternative approach to verify 6FFF beam dosimetry for Ethos, ViewRay MRIdian® Linac, and other Linacs with 6FFF beam quality using two-dimensional (2D) ion chamber arrays. Percentage depth dose (PDD) and profiles of an Ethos, an MRIdian® Linac, and several Linacs with 6FFF beams were measured at the nominal beam current. The beam energy was detuned by changing the bending magnet current on one TrueBeam. PDDs and profiles were measured for detuned beam energies. The peak shape of the 6FFF profile was defined by a "slope" parameter and unflatness. Correlations between peak slope and unflatness metrics vs PDDs were used to evaluate the sensitivity of beam energy to beam profile changes at different field sizes and depths. Strong correlations were found between peak slope and PDDs for all Linacs with 6FFF beam. The R-squared values in the linear regression fitting between PDD and peak slope and unflatness were 0.99 and 0.84, respectively. Both profile slope and unflatness were proportional to PDD at the 10cm depth and the peak slope was 4.3 times more sensitive than PDD. We have identified that measurements with a shallow depth are preferred to quantify the beam energy consistency. Our work shows the feasibility of verifying 6FFF beam quality of Ethos, MR Linac, and other Linacs by defining a profile slope measured from 2D ionization chambers array devices. This new approach provides a simplified method for performing a routine beam quality check without using a 3D water tank system while maximizing cost effectiveness and efficiency.

Identification of a potential source of error for 6FFF beams delivered on an AgilityTM multileaf collimator.

PurposeThe performance of the AgilityTM multileaf collimator was investigated with a focus on dynamic, small fields for flattening filter free (FFF) beams.MethodsIn this study we have developed a simple tool to test the robustness of the control mechanisms during dynamic beam delivery for Elekta’s VersaHD linear accelerator with Integrity 4.0.4 control software. We have programed the planning system to calculate dose for delivery of sweeping gaps. These sweeping gaps have a constant speed, constant size, and are delivered at a constant dose rate. Therefore they specifically identify delivery problems in dynamic mode.ResultsThe Elekta AgilityTM control mechanism fails to maintain accurate delivery for small, dynamic sweeping gaps. For small gap sizes, the AgilityTM control mechanism delivers a field that is more than four times the size of the planned field width without generating an interlock. This has dosimetric implications: The discrepancy between calculated and measured doses increases with decreasing gap size and exceeds 10% and 60% at isocenter for a 3.5 mm and 1 mm gap size, respectively.ConclusionA deficiency of the AgilityTM control system was identified in this study. This deficiency is a potential source of error for volumetric modulated arc therapy fields and could therefore contribute to relatively high failure rates in quality assurance measurements, especially for FFF beams.

EP-1843: Pre-verification of SBRT plans using VMAT with 6FFF beams - quantitative and qualitative analysis

EP-1843: Pre-verification of SBRT plans using VMAT with 6FFF beams - quantitative and qualitative analysis

SU‐C‐304‐07: Are Small Field Detector Correction Factors Strongly Dependent On Machine‐Specific Characteristics?

Purpose:The current small field dosimetry formalism utilizes quality correction factors to compensate for the difference in detector response relative to dose deposited in water. The correction factors are defined on a machine‐specific basis for each beam quality and detector combination. Some research has suggested that the correction factors may only be weakly dependent on machine‐to‐machine variations, allowing for determinations of class‐specific correction factors for various accelerator models. This research examines the differences in small field correction factors for three detectors across two Varian Truebeam accelerators to determine the correction factor dependence on machine‐specific characteristics.Methods:Output factors were measured on two Varian Truebeam accelerators for equivalently tuned 6 MV and 6 FFF beams. Measurements were obtained using a commercial plastic scintillation detector (PSD), two ion chambers, and a diode detector. Measurements were made at a depth of 10 cm with an SSD of 100 cm for jaw‐defined field sizes ranging from 3×3 cm2 to 0.6×0.6 cm2, normalized to values at 5×5cm2. Correction factors for each field on each machine were calculated as the ratio of the detector response to the PSD response. Percent change of correction factors for the chambers are presented relative to the primary machine.Results:The Exradin A26 demonstrates a difference of 9% for 6×6mm2 fields in both the 6FFF and 6MV beams. The A16 chamber demonstrates a 5%, and 3% difference in 6FFF and 6MV fields at the same field size respectively. The Edge diode exhibits less than 1.5% difference across both evaluated energies. Field sizes larger than 1.4×1.4cm2 demonstrated less than 1% difference for all detectors.Conclusion:Preliminary results suggest that class‐specific correction may not be appropriate for micro‐ionization chamber. For diode systems, the correction factor was substantially similar and may be useful for class‐specific reference conditions.

SU‐E‐T‐216: Comparison of Volumetrically Modulated Arc Therapy Treatment Using Flattening Filter Free Beams Vs. Flattened Beams for Partial Brain Irradiation

Purpose:Flattening Filter Free (FFF) beams offer the potential for higher dose rates, short treatment time, and lower out of field dose. Therefore, the aim of this study was to investigate the dosimetric effects and out of field dose of Volumetric Modulated Arc Therapy (VMAT) plans using FFF vs Flattening Filtering (FF) beams for partial brain irradiation.Methods:Ten brain patients treated with a 6FF beam from a Truebeam STX were analyzed retrospectively for this study. These plans (46Gy at 2 Gy per fraction) were re‐optimized for 6FFF beams using the same dose constraints as the original plans. PTV coverage, PTV Dmax, total MUs, and mean dose to organs‐at‐risk (OAR) were evaluated. In addition, the out‐of‐field dose for 6FF and 6FFF plans for one patient was measured on an anthropomorphic phantom. TLDs were placed inside (central axis) and outside (surface) the phantom at distances ranging from 0.5 cm to 17 cm from the field edge. Paired T‐test was used for statistical analysis.Results:PTV coverage and PTV Dmax were comparable for the FF and FFF plans with 95.9% versus 95.6% and 111.2% versus 111.9%, respectively. Mean dose to the OARs were 3.7% less for FFF than FF plans (p<0.0001). Total MUs were, on average, 12.5% greater for FFF than FF plans with 481±55 MU (FFF) versus 429±50 MU (FF), p=0.0003. On average, the measured out of field dose was 24% less for FFF compared to FF, p<0.0001. A similar beam‐on time was observed for the FFF and FF treatment.Conclusion:It is beneficial to use 6FFF beams for regular fractionated brain VMAT treatments. VMAT treatment plans using FFF beams can achieve comparable PTV coverage but with more OAR sparing. The out of field dose is significant less with mean reduction of 24%.