Calculated Output Factors Research Articles

Clinical Experience with Commissioning a GRID Collimator for Spatially Fractionated Radiation Therapy

In this study, we report our physics commissioning experience for clinically implementing a GRID collimator based Spatially Fractionated Radiation Therapy (SFRT). For SFRT commissioning, we utilized a commercially available brass GRID collimator (DotDecimal, Sanford, FL) that is mounted on a blocking tray for positioning into the accessory mount of the Linac. The brass GRID is 7.62 cm thick and weighs 15.8 kg. The GRID has a total of 149 divergent holes arranged in a hexagonal pattern (1.43 cm in diameter and hole-centers spaced at 2.11 cm when projected at the isocenter distance). The GRID encompasses a maximum field size of 25 × 25 cm at the isocenter. A commercial 48 × 48 × 48 cm water phantom scanning system was used to collect GRID output factors (GRID field to open field ratio), depth dose and beam profile data. Output measurements were performed using a 0.13 cm3 active volume ion-chamber and beam scans were obtained with a diode detector. Data was collected for both flattening and flattening-free beams of nominal energies 6 MV and 10 MV photons. The measurement depths were at dmax (1.5 cm for 6 MV and 2.5 cm for 10 MV), 5-cm and 10-cm respectively. For each energy and depth of measurement, collimator settings were varied from 5 × 5 cm to 28 × 28 cm. From scan profiles at different depths, the valley (lowest) to peak (highest) dose ratios (VPDR) were calculated. A commercial treatment planning system (TPS) was used to test the accuracy of dose calculations with GRID. This was accomplished by importing vendor generated DICOM RT file into the TPS. A block transmission factor of 7% for 6 MV and 10.2% for 10 MV energy beams were applied. All measured data were compared with corresponding TPS calculated data. Test patient treatment plans with GRID were created in TPS and planned distributions were verified using a commercial detector array with 2.5 mm detector spacing. The VPDR, expressed as %, are presented in Table 1. Measured and TPS calculated output factors agreed within 2% for 6 MV and within 3% for 10 MV photon beams. Percent depth doses were lower in magnitude for GRID field compared to open field for all energies studied (for e.g., 6 MV depth dose at 10 cm depth for 10 cm x10cm field 62% for GRID field vs. 66% for open field). Measured and calculated GRID beam profiles agreed within 5% dose difference and 1 mm distance-to agreement. For all test cases, the planned vs. measured dose distributions passed at an average gamma passing rate of 96.5% using a 3% dose difference/ 3 mm distance to agreement and 10% threshold criteria. The Dot Decimal GRID collimator provides a simple way of achieving SFRT in the clinic, albeit heavy to use and has an irradiation field size limitation of 25 cm × 25 cm.

Commissioning and validation of a Monte Carlo algorithm for spine stereotactic radiosurgery.

A 6FFF Monte Carlo (MC) dose calculation algorithm was commissioned for spine stereotactic radiosurgery (SRS). Model generation, validation, and ensuing model tuning are presented. The model was generated using in-air and in-water commissioning measurements of field sizes between 10 and 400 mm2 . Commissioning measurements were compared to simulated water tank MC calculations to validate output factors, percent depth doses (PDDs), profile sizes and penumbras. Previously treated Spine SRS patients were re-optimized with the MC model to achieve clinically acceptable plans. Resulting plans were calculated on the StereoPHAN phantom and subsequently delivered to the microDiamond and SRSMapcheck to verify calculated dose accuracy. Model tuning was performed by adjusting the model's light field offset (LO) distance between physical and radiological positions of the MLCs, to improve field size and StereoPHAN calculation accuracy. Following tuning, plans were generated and delivered to an anthropomorphic 3D-printed spine phantom featuring realistic bone anatomy, to validate heterogeneity corrections. Finally, plans were validated using polymer gel (VIPAR based formulation) measurements. Compared to open field measurements, MC calculated output factors and PDDs were within 2%, profile penumbra widths were within 1mm, and field sizes were within 0.5mm. Calculated point dose measurements in the StereoPHAN were within 0.26%±0.93% and -0.10%±1.37% for targets and spinal canals, respectively. Average SRSMapcheck per-plan pass rates using a 2%/2mm/10% threshold relative gamma analysis was 99.1%±0.89%. Adjusting LOs improved open field and patient-specific dosimetric agreement. Anthropomorphic phantom measurements were within -1.29%±1.00% and 0.27%±1.36% of MC calculated for the vertebral body (target) and spinal canal, respectively. VIPAR gel measurements confirmed good dosimetric agreement near the target-spine junction. Validation of a MC algorithm for simple fields and complex SRS spine deliveries in homogeneous and heterogeneous phantoms has been performed. The MC algorithm has been released for clinical use.

Preliminary evaluation of a novel secondary check tool for intensity modulated radiotherapy treatment planning

PurposeTo evaluate the dosimetric accuracy of the Delta4 Insight (DI) secondary-check dosimetry system. MethodsAbsolute dosimetry in reference conditions, output factors, percent depth doses normalized and off-axis dose profiles for different field sizes calculated by DI were compared with measurements. Dose calculations for 20 clinical IMRT/VMAT plans generated in the TPS using both AAA or AcurosXB algorithms were compared with measurements. The average difference between calculated and measured point dose in high-dose region was calculated for all cases. 3D dose measurements were performed in Delta4 Phantom+ and a comparison between calculated and measured dose distributions was performed by means of the gamma analysis with 3 %/2 mm criteria. The dose distributions calculated by DI for 20 IMRT/VMAT plans were compared with those calculated by the TPS. ResultsThe absolute dosimetry computed by DI showed dose value in agreement with the measured one within 0.3 %. The average differences between measured and calculated output factors were less than 2.5 %. The average PDD differences were less than 0.6 %. An excellent agreement between calculations and off-axis measurements is found. The point doses calculated for the 20 recalculated plan showed good agreement with measurements with average differences less than 0.5 %. The average gamma pass rate values for the Delta4 Phantom + 3D dose analysis was greater than 97.%. The comparison of DI with theTPS showed good agreement for the used metrics. ConclusionsDelta4 Insight may provide a useful independent secondary dose verification system for IMRT/VMAT plans, complementing the traditional global QA protocols.

The Effect of Mouse Size on Dose from an X-Rad320 Irradiator.

Irradiation protocols for murine experiments often use standardized dose rate estimates for calculating dose delivered, regardless of physical variations between mouse subjects. This work sought to determine the significance of mouse size on absorbed dose. Five mouse-like phantoms of various sizes based on the mouse whole-body (MOBY) model were 3D printed. The phantoms were placed in an X-Rad320 biological irradiator and a standard irradiation protocol was used to deliver dose. Dose was measured using thermoluminescent dosimeter (TLD) microcubes inside each phantom, and the relative readings were used to calculate output factors (OFs), normalized to the phantom of median volume. Additionally, the OF for each mouse was simulated in Monte Carlo N-Particle (MCNP) code. For both the TLD measurements and MCNP simulations, the OF for each mouse was determined by both experiments and calculations to be unity within the relative standard uncertainties (k = 1). This work supports comparing results across various studies using the X-Rad320 irradiator without need for corrections based on mouse size.

Monte Carlo study of small-field dosimetry for an ELEKTA Unity MR-Linac system

This study aims to investigate the magnetic field effect in small-field dosimetry for an ELEKTA Unity MR-Linac system using Monte Carlo (MC) simulations. The EGSnrc/BEAMnrc code was used to simulate the MR-Linac treatment head. The percentage depth-doses (PDDs) and off-axis dose profiles were calculated for field sizes of 2 cm × 2 cm and 10 cm × 10 cm using the DOSXYZnrc code, while the output factors were calculated with the egs_chamber code. The dose profiles and output factors were calculated at a depth of 10 cm in water with a 143.5 cm source-axis-distance. The output factors for the detectors with different sensitive volumes were compared with previously measured values. The kQ,B was also calculated. The accuracy of the simulated beam was validated by comparing the MC-calculated PDDs and dose profiles with previously measured values, which agreed within 2% except the penumbra region. The output factors of the ion chambers decreased rapidly depending on the sensitive volumes of small fields. The output factors of the PTW-31022 agreed within 2% with those in a water slab down to a 1 cm × 1 cm field. The output factors of PTW-31021 and PTW-31022 chambers and PTW-60018 diode agreed within 2% with previously measured values. The kQ,B values for PTW-30013, PTW-31010, PTW-31021, and PTW-31022 chambers were 0.974 ± 0.14%, 0.976 ± 0.26%, 0.977 ± 0.21%, and 0.995 ± 0.36%, respectively. The calculated output factors for the detectors showed good agreement with previously measured values. The magnetic field effect was small in ionization chambers with the small cavity radius.

Optimizing the effective spot size and the dosimetric leaf gap of the AcurosXB algorithm for VMAT treatment planning.

PurposeThe aim of this study is to provide and test a new methodology to adjust the AcurosXB beam model for VMAT treatment plans.MethodThe effective target spot size of the AcurosXB v15 algorithm was adjusted in order to minimize the difference between calculated and measured penumbras. The dosimetric leaf gap (DLG) was adjusted using the asynchronous oscillating sweeping gap tests defined in the literature and the MLC transmission was measured. The impact of the four parameters on the small field output factors was assessed using a design of experiment methodology. Patient quality controls were performed for the three beam models investigated including two energies and two MLC models.ResultsEffective target spot sizes differed from the manufacturer recommendations and strongly depended on the MLC model considered. DLG values ranged from 0.7 to 2.3 mm and were found to be larger than the ones based on the sweeping gap tests. All parameters were found to significantly influence the calculated output factors, especially for the 0.5 cm × 0.5 cm field size. Interactions were also identified for fields smaller than 2 cm × 2 cm, suggesting that adjusting the parameters on the small field output factors should be done with caution. All patient quality controls passed the universal action limit of 90%.ConclusionThe methodology provided is simple to implement in clinical practice. It was validated for three beam models covering a large variety of treatment types and localizations.

PENELOPE simulations and experiment for 6 MV clinac iX accelerator for standard and small static fields

The goal of this work was to produce accurate data for use as a ‘gold standard’ and a valid tool for measurements in reference dosimetry for standard/small static field sizes from 0.5 × 0.5 to 10 × 10 cm2. It is based on the accuracy of the phase space files (PSFs) as a key quantity. Because the IAEA general public database provides few PSFs for the Varian iX, we simulated the head through Monte Carlo (MC) simulations and calculated validated PSFs for 12 square field sizes including seven for small static fields. The resulting dosimetric calculations allowed us to reach a good level of agreement in comparison to our relative and absolute dose measurements performed on a Varian iX in water phantom. Measured and MC calculated output factors were investigated for different detectors. Based on the TRS 483 formalism and MC (PENELOPE/penEasy), we calculated output correction factors for the unshielded Diode-E (T60017) and the PinPoint-3D (T31016) micro-chamber according to manufacturers' blueprints. Our MC results were in agreement with the recommended data; they compete with recent measurements and MC simulations and in particular the TRS 483 MC data obtained from similar simulations. Moreover, our MC results provide supplemental data in comparison to TRS 483 data in particular for the PinPoint-3D (T31016). We suggest our MC output correction factors as new datasets for future TRS compilations. The work was substantial, used different robust MC strategies depending on the scoring regions, and led in most cases to uncertainties of less than 1%.

Experimental Validation of Monte Carlo Simulation for the Leksell Gamma Knife Perfexion Using Gafchromic EBT3 Dosimetry Film and Diamond Detector T60019 PTW

This work presents experimental measurements performed using GAFChromic EBT3 dosimetry film and diamond detector T60019 to validate penEasy Monte Carlo based model developed previously for the Leksell Gamma Knife Perfexion. The relative dose profiles along X and Z coordinate axes, for each collimator size 4, 8, and 16 mm, and the relative output factors have been investigated. The penEasy model has been validated comparing the calculated output factors and dose profiles with the corresponding experimental results. The differences between the calculated output factors and the corresponding data measured with diamond detector were found to be 1.8 and 2.1% for the 8 and 4 mm collimator, respectively. Excellent agreement was found between penEasy and EBT3 results. The differences in the output factors were found to be 0.4% and −0.7% for the 8 and 4 mm collimators, respectively. The relative dose profiles were found to be in good agreement for both detectors and penEasy data. The gamma index test returns values (3%, 1 mm) < 1 for all profiles comparison calculated between penEasy and EBT3 film.

Evaluation of the IAEA-TRS483 protocol for the dosimetry of small fields (square and stereotactic cones) using multiple detectors.

The IAEA TRS 483 protocol1 for the dosimetry of small static fields in radiotherapy was used to calculate output factors for the Elekta Synergy linac at the Australian Radiation Protection and Nuclear Safety Agency (ARPANSA). Small field output factors for both square and circular fields were measured using nine different detectors. The “corrected” output factors (ratio of detector readings multiplied by the appropriate correction factor from the protocol) showed better consistency compared to the “uncorrected” output factors (ratio of detector readings only), with the relative standard deviation decreasing by approximately 1% after the application of the relevant correction factors. Comparisons relative to an arbitrarily chosen PTW 60019 microDiamond detector showed a reduction of maximal variation for the corrected values of approximately 3%. A full uncertainty budget was prepared to analyze the consistency of the output factors. Agreement within uncertainties between all detectors and field sizes was found, except for the 15 mm circular field. The results of this study show that the application of IAEA TRS 4831 when measuring small fields will improve the consistency of small field measurements when using multiple detectors contained within the protocol.

Output and () correction factors measured and calculated in very small circular fields for microDiamond and EFD-3G detectors

The purpose of this work was to obtain factors for microDiamond and EFD-3G detectors in very small (less than 5 mm) circular fields. We also investigated the impact of possible variations in microDiamond detector design schematics on the calculated factors. Output factors (OF’s) of 6 MV beams from TrueBeam linac collimated with 1.27–40 mm diameter cones were measured with EBT3 films, microDiamond and EFD-3G detectors as well as calculated (in water) using Monte Carlo (MC) methods. Based on EBT3 measurements and MC calculations factors were derived for these detectors. MC calculations were performed for microDiamond detector in parallel and perpendicular orientations relative to the beam axis. Furthermore, factors were calculated for two microDiamond detector models, differing by the presence or absence of metallic pins. The measured OFs agreed within 2.4% for fields ⩾10 mm. For the cones of 1.27, 2.46, and 3.77 mm maximum differences were 17.9%, 1.8% and 9.0%, respectively. MC calculated output factors in water agreed with those obtained using EBT3 film within 2.2% for all fields. MC calculated factors for microDiamond detector in fields ⩾10 mm ranged within 0.975–1.020 for perpendicular and parallel orientations. MicroDiamond detector factors calculated for the 1.27, 2.46 and 3.77 mm fields were 1.974, 1.139 and 0.982 with detector in parallel orientation, and these factors were 1.150, 0.925 and 0.914 in perpendicular orientation. Including metallic pins in the microDiamond model had little effect on calculated factors. EBT3 and MC obtained factors agreed within 3.7% for fields of ⩾3.77 mm and within 5.9% for smaller cones. Including metallic pins in the detector model had no effect on calculated factors. Our results show that microDiamond and EFD-3G detectors can be used in very small (1.27–3.77 mm) fields once corrections determined in this work are applied. Expected uncertainty of such measurements will be in the range of 8%–2.5%.

Performance of a multi leaf collimator system for MR-guided radiation therapy.

The purpose of this study was to investigate and characterize the performance of a Multi Leaf Collimator (MLC) designed for Cobalt-60 based MR-guided radiation therapy system in a 0.35 T magnetic field. The MLC design and unique assembly features in the ViewRay MRIdian system were first reviewed. The RF cage shielding of MLC motor and cables were evaluated using ACR phantoms with real-time imaging and quantified by signal-to-noise ratio. The dosimetric characterizations, including the leaf transmission, leaf penumbra, tongue-and-groove effect, were investigated using radiosensitive films. The output factor of MLC-defined fields was measured with ionization chambers for both symmetric fields from 2.1 × 2.1 cm2 to 27.3 × 27.3 cm2 and asymmetric fields from 10.5 × 10.5 cm2 to 10.5 × 2.0 cm2 . Multi leaf collimator (MLC) positional accuracy was assessed by delivering either a picket fence (PF) style pattern on radiochromic films with wire-jig phantom or double and triple-rectangular patterns on ArcCheck-MR (Sun Nuclear, Melbourne, FL, USA) with gamma analysis as the pass/fail indicator. Leaf speed tests were performed to assess the capability of full range leaf travel within manufacture's specifications. Multi leaf collimator plan delivery reproducibility was tested by repeatedly delivering both open fields and fields with irregular shaped segments over 1-month period. Comparable SNRs within 4% were observed for MLC moving and stationary plans on vendor-reconstructed images, and the direct k-space reconstructed images showed that the three SNRs are within 1%. The maximum leaf transmission for all three MLCs was less than 0.35% and the average leakage was 0.153 ± 0.006%, 0.151 ± 0.008%, and 0.159 ± 0.015% for head 1, 2, and 3, respectively. Both the leaf edge and leaf end penumbra showed comparable values within 0.05 cm, and the measured values are within 0.1 cm with TPS values. The leaf edge TG effect indicated 10% underdose and the leaf end TG showed a shifted dose distribution with 0.3 cm offset. The leaf positioning test showed a 0.2 cm accuracy in the PF style test, and a gamma passing rate above 96% was observed with a 3%/2 mm criteria when comparing the measured double/triple-rectangular pattern fluence with TPS calculated fluence. The average leaf speed when executing the test plan fell in a range from 1.86 to 1.95 cm/s. The measured and TPS calculated output factors were within 2% for squared fields and within 3% for rectangular fields. The reproducibility test showed the deviation of output factors were well within 2% for square fields and the gamma passing rate within 1.5% for fields with irregular segments. The Monte Carlo predicted output factors were within 2% compared to TPS values. 15 out of the 16 IMRT plans have gamma passing rate more than 98% compared to the TPS fluence with an average passing rate of 99.1 ± 0.6%. The MRIdian MLC has a good RF noise shielding design, low radiation leakage, good positioning accuracy, comparable TG effect, and can be modeled by an independent Monte Carlo calculation platform.

Analysis of Accuracy of Interpolation Methods in Estimating the Output Factors for Square Fields in Medical Linear Accelerator

Introduction: To estimate the accuracy levels of Lagrange, Newton backward interpolation, and linear interpolation methods in estimating the output factors for square fields used in linear accelerator for 6 MV photons at various depths. Materials and Methods: Ionization measurements were carried out in radiation field analyzer in linear accelerator for 6 MV beams at the depths of 5 and 10 cm by 0.6 cc Farmer-type ionisation chamber. Dosimetry was performed by ion collection method with 0.5 cm2 interval for square fields from 4 × 4 cm2 to 40 × 40 cm2 field sizes. The measured output factor values for 10 square field sizes with equal interval were taken for interpolating the intermediate square field size values. The Lagrange and Newton backward methods were used for predicting the intermediate output factors. Results: The percentage of deviation from the measured value was estimated for all the three methods. The calculated output factor values of the two proposed methods were compared with the standard linear interpolation method used in routine clinical practice. It was observed that the Lagrange and Newton backward methods were not significantly different from the measured value (P=0.77). The linear interpolation values were significantly different from the measured value (p <0.01). Conclusion: It is recommended to use the Lagrange and Newton backward interpolation methods to estimate the intermediate output factors to increase accuracy in treatment delivery. The routine linear interpolation method can be applied only for small intervals. This proposed interpolation method is highly associated with the measured values in all the interval levels.

Development of a Monte Carlo model for treatment planning dose verification of the Leksell Gamma Knife Perfexion radiosurgery system.

Detailed Monte Carlo (MC) modeling of the Leksell Gamma Knife (GK) Perfexion (PFX) collimator system is the only accurate ab initio approach appearing in the literature. As a different approach, in this work, we present a MC model based on film measurement. By adjusting the model parameters and fine‐tuning the derived fluence map for each individual source to match the manufacturer's ring output factors, we created a reasonable virtual source model for MC simulations to verify treatment planning dose for the GK PFX radiosurgery system. The MC simulation model was commissioned by simple single shots. Dose profiles and both ring and collimator output factors were compared with the treatment planning system (TPS). Good agreement was achieved for dose profiles especially for the region of plateau (<2%), while larger difference (<5%) came from the penumbra region. The maximum difference of the calculated output factor was within 0.7%. The model was further validated by a clinical test case. Good agreement was obtained. The DVHs for brainstem and the skull were almost identical and, for the target, the volume covered by the prescription (12.5 Gy to 50% isodose line) was 95.6% from MC calculation versus 100% from the TPS.PACS number(s): 87.55.dk

Monte Carlo validation of the TrueBeam 10XFFF phase-space files for applications in lung SABR.

To establish the clinical acceptability of universal Monte Carlo phase-space data for the 10XFFF (flattening filter free) photon beam on the Varian TrueBeam Linac, including previously unreported data for small fields, output factors, and inhomogeneous media. The study was particularly aimed at confirming the suitability for use in simulations of lung stereotactic ablative radiotherapy treatment plans. Monte Carlo calculated percent depth doses (PDDs), transverse profiles, and output factors for the TrueBeam 10 MV FFF beam using generic phase-space data that have been released by the Varian MC research team were compared with in-house measurements and published data from multiple institutions (ten Linacs from eight different institutions). BEAMnrc was used to create field size specific phase-spaces located underneath the jaws. Doses were calculated with DOSXYZnrc in a water phantom for fields ranging from 1 × 1 to 40 × 40 cm(2). Particular attention was paid to small fields (down to 1 × 1 cm(2)) and dose per pulse effects on dosimeter response for high dose rate 10XFFF beams. Ion chamber measurements were corrected for changes in ion collection efficiency (P(ion)) with increasing dose per pulse. MC and ECLIPSE ANISOTROPIC ANALYTICAL ALGORITHM (AAA) calculated PDDs were compared to Gafchromic film measurement in inhomogeneous media (water, bone, lung). Measured data from all machines agreed with Monte Carlo simulations within 1.0% and 1.5% for PDDs and in-field transverse profiles, respectively, for field sizes >1 × 1 cm(2) in a homogeneous water phantom. Agreements in the 80%-20% penumbra widths were better than 2 mm for all the fields that were compared. For all the field sizes considered, the agreement between their measured and calculated output factors was within 1.1%. Monte Carlo results for dose to water at water/bone, bone/lung, and lung/water interfaces as well as within lung agree with film measurements to within 2.8% for 10 × 10 and 3 × 3 cm(2) field sizes. This represents a significant improvement over the performance of the ECLIPSE AAA. The 10XFFF phase-space data offered by the Varian Monte Carlo research team have been validated for clinical use using measured, interinstitutional beam data in water and with film dosimetry in inhomogeneous media.

SU‐E‐T‐248: Determining Output Factor of Irregular Electron Cutouts at Extended SSD

Purpose:To calculate the output factor (OPF) of any irregularly shaped electron beam at extended SSDMethods:Using Cerrobend block, circular cutouts with diameter ranging from 2.0cm to the maximum possible size for 15×15 applicator of Varian 2100C and 14×14 applicator of ELEKTA Synergy LINACs were prepared. In addition, two irregular cutouts were made. For each cutout, percentage depth dose (PDD) at standard SSD and point doses at different SSD were measured in water using Scanditronix diodes and PTW 0.125 cm3 ion‐chambers, respectively. In addition, the distance at which electron fluence along the central axis becomes independent of cutout size was determined using EDR2 films. On each LINAC, electron beam energies of 6, 9, 12, and 15/20 MeV were used.Results:Using the open applicator as the reference field, the lateral buildup ratio (LBR) for each circular cutout as a function of depth was calculated. From the LBR value and radius of the cutout, the corresponding lateral spread parameter (σR(z)) was determined. Taking the cutout side dependence of σR(z)) into account, PDD of the irregular cutouts at the standard SSD were calculated. From the point dose measurement at different SSDs, the effective SSD of each cutout was calculated. Taking the calculated PDD of the irregular cutout and effective SSD (SSDeff) of the circular cutout into account, OPFs of the irregular cutout at extended SSD values were calculated. Finally, the calculated output factors were compared with the measured values.Conclusion:In this research, the improved LBR method has been generalized to calculate output factor of irregular cutouts at extended SSD. In a clinically useful region, the percentage difference between the measured and the calculated output factors of the irregular cutouts was within 2%. Similar results were obtained for all available electron energies of both Varian 2100C and ELEKTA Synergy machines.

SU‐E‐T‐467: Implementation of Monte Carlo Dose Calculation for a Multileaf Collimator Equipped Robotic Radiotherapy System

Purpose:To improve the treatment efficiency and capabilities for full‐body treatment, a robotic radiosurgery system has equipped with a multileaf collimator (MLC) to extend its accuracy and precision to radiation therapy. To model the MLC and include it in the Monte Carlo patient dose calculation is the goal of this work.Methods:The radiation source and the MLC were carefully modeled to consider the effects of the source size, collimator scattering, leaf transmission and leaf end shape. A source model was built based on the output factors, percentage depth dose curves and lateral dose profiles measured in a water phantom. MLC leaf shape, leaf end design and leaf tilt for minimizing the interleaf leakage and their effects on beam fluence and energy spectrum were all considered in the calculation. Transmission/leakage was added to the fluence based on the transmission factors of the leaf and the leaf end. The transmitted photon energy was tuned to consider the beam hardening effects. The calculated results with the Monte Carlo implementation was compared with measurements in homogeneous water phantom and inhomogeneous phantoms with slab lung or bone material for 4 square fields and 9 irregularly shaped fields.Results:The calculated output factors are compared with the measured ones and the difference is within 1% for different field sizes. The calculated dose distributions in the phantoms show good agreement with measurements using diode detector and films. The dose difference is within 2% inside the field and the distance to agreement is within 2mm in the penumbra region. The gamma passing rate is more than 95% with 2%/2mm criteria for all the test cases.Conclusion:Implementation of Monte Carlo dose calculation for a MLC equipped robotic radiosurgery system is completed successfully. The accuracy of Monte Carlo dose calculation with MLC is clinically acceptable.This work was supported by Accuray Inc.

Development and application of a dose verification tool using a small field model for TomoTherapy

Helical TomoTherapy® is a radiation delivery technique that uses the superposition of many small fields to precisely deliver the prescribed dose to the patient. This work presents a dose verification tool that can be used as part of a quality assurance program for a tomotherapy system. This tool is based on a small field model that takes into account the two main effects that influence the dose distribution in small fields: the extended shape of the radiation source and the loss of lateral charged particle equilibrium (CPE) within the field. The dose verification tool was implemented for simple beam configurations and used to study the influence of temporal beam parameter variations on the delivered dose. After comparing measured and calculated output factors (OFs) and dose profiles for different field configurations, it was found that they agree well to within the globally-defined gamma acceptance criteria of 2%/2mm. The study demonstrated that none of the studied systematic and random variations applied resulted in failed gamma scores using gamma acceptance criteria of 3%/3mm. The developed model implemented in the verification tool allows to evaluate the performance of devices applying narrow photon beams in the treatment delivery and, in particular, to evaluate the delivery performance of a tomotherapy unit.

SU-E-T-601: Output Factor Calculation of Irregular Shape Electron Cutout at Extended SSD

Purpose: To calculate the output factor of irregular shape electron beam at extended SSD using modified lateral build-up-ratio method. Methods: Circular cutouts from 2.0cm diameter to maximum possible sizes were prepared for applicator cone size of 15×15cm. In addition, different irregular cutouts were prepared. Percentage depth dose (PDD) curves were measured for each cutout using 6, 9, 12 and 16-MeV at the standard SSD of 100cm. The scanning was done using Multidata system and Scanditronix diodes on 2100SC Varian LINAC. In addition, for each cutout and electron beam energy doses were measured at SSD values of 100, 105, 110, 115cm using EDR2 films and diodes. Results: The measured PDD were normalized to the depth of 1.0mm. The lateral build-up-ratio (LBR) and the lateral scatter parameter (sigma) were calculated for each circular cutout using the open 15×15-cm2 field as the reference field. Taking the linear increase of sigma with cutout size into account, PDD of the irregular cutouts were calculated at 100 cm SSD. Furthermore, using the dose measured at different SSDs, the effective SSD value for each circular cutout and electron beam energy was determined. Employing the LBR and the effective-SSD values of the circular cutouts along with the calculated PDD of the irregular cutouts, the output factors of the irregular cutout at different extended SSD values were calculated. Finally, the calculated output factors were compared with the measured values. Conclusion: In this research, it is shown that output factor of irregular shape electron beam at extended SSD can be determined by using the LBR and the effective SSD values of circular cutouts. The percentage difference of the calculated output factor from the measured output factor for irregular cutouts at extended SSD were within 3.0%.

Analysis of electron beam output factors by Monte Carlo method

Objective To investigate the application of the Monte Carlo dose calculation of output factors for electron beams in radiotherapy.Methods The code EGS4/MCTP was used to simulate the head of a medical linear accelerator (Varian 23EX) to calculate the output factors for 6 MeV,9 MeV and 18 MeV electron beams.The source-to-surface distance used was 100 cm.The field sizes ranged from 2 cm × 2 cm to 25 cm × 25 cm.The calculated output factors agreed with the corresponding measured factors which were measured by the IBA Phantom system to within 2％.Then,the output factors of direct articles and indirect articles which were under different energy and various cone-insert combinations were calculated by the code EGS4/MCTP.Results The calculated output factors agreement with the measurements is found to be mostly under the 1％ level.The variation of output factors depends on the characteristics of the beams and the modifications that the various cone-insert combinations introduce to these characteristics.Conclusions Monte Carlo dose calculations for electron beams in homogeneous water phantoms have been demonstrated to be accurate under the 1％ level in comparison with measurements.The output factors were influenced by energy and cone-insert combinations in complex ways. Key words: Electronbeam irradiation; Output factor; Monte Carlo method

SU‐E‐T‐411: Monte Carlo Simulations for Quality Assurance of Varian TrueBeam 10XFFF VMAT SABR Treatments

Purpose: To establish feasibility of performing quality assurance on 10X Flattening Filter Free (FFF) VMAT stereotactic ablative radiotherapy (SABR) treatments on the TrueBeam LINAC with Monte Carlo simulations using vendor‐supplied phase space data. Methods: Monte Carlo simulations were performed with BEAMnrc and DOSXYZnrc using the TrueBeam 10XFFF photon beam phase space data that were made available by the Varian Monte Carlo research team. To establish validity of the phase space, dose calculations in a water phantom for fields ranging from 2×2 cm2 to 40×40 cm2 were performed using DOSXYZnrc. Percent depth doses (PDDs), transverse profiles and output factors were calculated and compared with measurements for all the fields simulated. Monte Carlo simulations of 10XFFF SABR VMAT plans were performed on a homogeneous cylindrical phantom and on the Quasar™ phantom with a lung‐equivalent insert. Simulations were compared with both ion chamber measurement and Eclipse Treatment Planning System (TPS) dose calculations. 3D gamma analysis comparing Monte Carlo and TPS results was performed. Results: Monte Carlo simulations and measured values agreed within 1% and 2% for PDDs and profiles respectively. The agreement between measured and calculated output factors was within 1% including for highly asymmetric fields. These results indicate that the 10XFFF phase space data is sufficiently accurate for use in simulations for quality assurance purposes in radiation therapy. For the VMAT plans the point dose agreement between MC and both measured and TPS calculations was within 1.2%. The 3%, 3mm Gamma test pass rates were 95% and 92% for plans calculated on the homogeneous phantom and on the Quasar phantom respectively. Conclusion: We have demonstrated the feasibility of performing patient specific quality assurance on 10XFFF SABR treatment plans using Monte Carlo simulations of the TrueBeam LINAC. This is the first independent validation on the 10XFFF Varian phase space data presented to date. The work of Tony Teke, Cheryl Duzenli and Ermais Gete has been supported by Varian under a Master Research Agreement.