Collapsed Cone Convolution Superposition Algorithm Research Articles

Dosimetric Comparison of Single-Isocenter and Multiple-Isocenter Techniques for Two-Lesion Lung SBRT Using the RefleXion High-Speed Ring-Gantry System

Due to the technical challenges that accompany stereotactic body radiotherapy (SBRT) to multiple lesions, a single-isocenter treatment plan technique for multi-target scenarios may optimize the final, aggregate dose distribution. The RefleXion™ X1 is a new ring-gantry based system with several features that may optimize dosimetry in a multi-target SBRT scenario, including high speed rotation (60 revolutions per minute), a high-speed multi-leaf collimator (100 Hz), and a variable pitch couch. A comprehensive dosimetric comparison for multiple targets that contrasts multiple isocenters versus a single-isocenter technique has not been performed. Therefore, this investigation performed such a comparison in two-lesion lung SBRT cases.Three patients with two synchronous lung lesions with maximum dimension of 5 cm underwent single-isocenter and two-isocenter planning with the RefleXion treatment planning system using a Collapsed Cone Convolution Superposition algorithm. Treatment doses were in accordance with AAPM TG101 criteria (50Gy in 5 fractions) and planned such that 95% of the planning target volume (PTV) would receive at least 95% of the prescription dose. In the single-isocenter plans, the isocenter was placed between the two-lesions, whereas the two-isocenter plans localized the isocenters on each target with a limitation on the IEC-X direction to avoid couch-bore collisions. Conformity index (CI), homogenous index (HI), R50%, and D2cm were calculated. The volume of the normal lung receiving 5 Gy (V5), V10, V15, V20, mean lung dose, and dose to other OARs were evaluated. In addition, the treatment time to deliver each plan was recorded.The mean isocenter to the tumor distance in XYZ-space was 8.53 cm (range: 7.66-10.62 cm). The mean combined PTV was 42.47cc (range: 9.7- 97.8 cc). There was no significant difference in target coverage, maximum target dose, CI, HI, R50%, V20, V15, and V10 between single-isocenter and two-isocenters for lung SBRT plans. On average, single-isocenter plans contributed an increase in OAR dose, especially to the carina and esophagus, by 5.17% (range: 2.91-6.52%) and 15.62% (range: 6.44-22.97%), respectively. With the RefleXion X1 set at 850MU/min, the average difference in total beam-on time was approximately 33 seconds between the two approaches. However, set-up time for the second isocenter in the two-isocenter plan would likely prolong the total treatment delivery time.This study shows that a single-isocenter technique for the scenario of two lung lesions is dosimetrically feasible and clinically efficient with the RefleXion X1 in SBRT mode. Single-isocenter treatment delivery techniques may be a desirable option for efficient radio-ablative therapies directed at multiple metastatic targets.

A preliminary study of a photon dose calculation algorithm using a convolutional neural network

The aim of dose calculation algorithm research is to improve the calculation accuracy while maximizing the calculation efficiency. In this study, the three-dimensional distribution of total energy release per unit mass (TERMA) and the electron density (ED) distribution are considered inputs in a method for calculating the three-dimensional dose distribution based on a convolutional neural network (CNN). Attempts are made to improve the efficiency of the collapsed cone convolution/superposition (CCCS) algorithm while providing an approach to improve the efficiency of other traditional dose calculation algorithms. Twelve sets of computed tomography (CT) images were employed for training. Data sets were generated by the CCCS algorithm with a random beam configuration. For each monoenergetic photon model, 7500 samples were generated for the training set, and 1500 samples were generated for the validation set. Training occurred for 0.5 MeV, 1 MeV, 2 MeV, 3 MeV, 4 MeV, 5 MeV, and 6 MeV monoenergetic photon models. To evaluate the usability under linac conditions, a comparison between CCCS and CNN-Dose was performed for the Mohan 6-MV spectrum for 12 additional new sets of CT images with different anatomies. A total of 1512 test samples were generated. For all anatomies, the mean value, 95% lower confidence limit (LCL) and 95% upper confidence limit (UCL) were 99.56%, 99.51% and 99.61%, respectively, at the 3%/2 mm criteria. The mean value, 95% LCL and 95% UCL were 98.57%, 98.46% and 98.67%, respectively, at the 2%/2 mm criteria. The results meet the relevant clinical requirements. In the proposed methods, the dose distribution of clinical energy can be obtained by TERMA, and the electronic density can be obtained with a CNN. This method can also be used for other traditional dose algorithms and displays potential in treatment planning, adaptive radiation therapy, and in vivo verification.

Trajectory-based VMAT for cranial targets with delivery at shortened SAD.

Trajectory-based volumetric modulated arc therapy (tr-VMAT) treatment plans enable the option for noncoplanar delivery yielding steeper dose gradients and increased sparing of critical structures compared to conventional treatment plans. The addition of translational couch motion to shorten the effective source-to-axis distance (SAD) may result in improved delivery precision and an increased effective dose rate. In this work, tr-VMAT treatment plans using a noncoplanar "baseball stitch" trajectory were implemented, applied to patients presented with cranial targets, and compared to the clinical treatment plans. A treatment planning workflow was implemented: (a) beamlet doses were calculated for control points defined along a baseball stitch trajectory using a collapsed-cone convolution-superposition algorithm; (b) VMAT treatment plans were optimized using the column generation approach; (c) a final dose distribution was calculated in Varian Eclipse using the analytical anisotropic algorithm by importing the optimized treatment plan parameters. Tr-VMAT plans were optimized for ten patients presented with cranial targets at both standard and shortened SAD, and compared to the clinical treatment plans through isodose distributions, dose-volume histograms, and dosimetric indices. The control point specifications of the optimized tr-VMAT plans were used to estimate the delivery time. The optimized tr-VMAT plans with both shortened and standard SAD delivery yielded a comparable plan quality to the clinical treatment plans. A statistically significant benefit was observed for dose gradient index and monitor unit efficiency for shortened SAD tr-VMAT plans, while improved target volume conformity was observed for the clinical treatment plan (P≤0.05). A clear dosimetric benefit was not demonstrated between tr-VMAT delivery at shortened SAD compared to standard SAD, but shortened SAD delivery yielded a fraction size-dependent reduction in the estimated delivery time. The implementation of "baseball stitch" tr-VMAT treatment plans to patients presented with cranial targets demonstrated comparable plan quality to clinical treatment plans. The delivery at shortened SAD produced a fraction size-dependent decrease in estimated delivery time.

Dosimetric Analysis of a Longitudinal Clinical Experience Using Robotic Radiosurgery and LINAC-based SBRT with VMAT for Early-Stage Non-Small Cell Lung Cancer (ES-NSCLC)

SBRT is standard of care for medically inoperable patients with ES-NSCLC and can be delivered using robotic radiosurgery or standard linear accelerator (LINAC) platforms. CK uses hundreds of anterior oblique non-coplanar beams while LINAC SBRT commonly uses volumetric modulated arc therapy (VMAT) with multiple coplanar full or partial arc fields. SBRT plans are designed to cover the PTV in prescription dose while achieving steep dose fall-off in adjacent tissue which causes increased dose heterogeneity “i.e., hotspots” in the target volume. We aimed to compare the dosimetric characteristics of lung SBRT plans delivered at one institution based on CK vs LINAC VMAT technique. Patients were included who received CK-based (2012-16) or LINAC-based SBRT from (2016-17) for T1-2N0M0 NSCLC. SBRT plans of 198 patients who met inclusion criteria were analyzed (CK, n=149 and LINAC, n=59). CK plans were computed using Monte Carlo algorithm, while the LINAC-based VMAT plans were computed in collapsed cone convolution-superposition algorithm. All clinically delivered plans were reviewed to extract dosimetric parameters including target volume coverage and OARs dose distribution. Differences in mean dosimetric values by technique were estimated via Wilcoxon Rank-Sum Test. Multivariate analyses were run using logistical regression to test for confounding variables. LINAC SBRT was prescribed to a higher mean isodose line (IDL) (89% vs 80%, p<.001) yet had increased mean ratios of GTVmax (131% vs 125%, p<.001), GTVmean (120% vs 116%, p<.001), PTVmax (132% vs 126%, p<.001), and D90GTV (114% vs 111%, p<.001) doses to prescription dose compared to CK. LINAC-based SBRT had lower mean conformality index (1.10 vs. 1.21, p <.001) than CK, but there was no difference in mean R50 values (5.06 vs. 4.88, p=.67). Mean ratio of PTV to total lung volume did not differ significantly for LINAC SBRT vs. CK (1.17% vs. 1.54%, p=.08), but LINAC SBRT was associated with lower average lung V5 (18% vs. 25%, p<.001), V10 (11% vs. 14%, p=.02), mean lung dose (3.7 Gy vs. 5.1 Gy, p<.001) and lung volume (cc) receiving <12.5 Gy (3980 cc vs. 3300 cc, p=.002) than CK. LINAC SBRT was also associated with lower heart mean doses compared to CK (1.8 Gy vs. 2.5 Gy, p=.004) and heart V5 (12.7% vs. 19.5%, p=.009). There was no difference in max dose to the proximal bronchial tree. On multivariate analysis controlling for total dose, lung volume, PTV size, and target lobe the differences in lung V5 (p <.001) and mean lung dose (p <.001) by technique persisted but differences in lung cc receiving <12.5 Gy, lung V10, heart V5 and heart mean dose were no longer statistically significant. Despite being prescribed to higher mean IDLs, LINAC SBRT with VMAT technique delivered higher doses to the GTV and PTV as compared to CK and was associated with lower lung V5 and mean lung dose but not lower lung V10 or V20.

121. Automated planning for Hodgkin lymphoma radiotherapy

PurposePurpose of the present study was to report on the evaluation of Pinnacle3Auto-Planning (AP) algorithm for Hodgkin lymphoma (HL) radiation therapy (RT). MethodsPlanning CT-scans of 10 female patients with supradiaphragmatic HL were considered. Involved site clinical target volume (CTV) included the upper mediastinal and supraclavear nodes. Planning Target Volume (PTV) was obtained by CTV uniform 10-mm expansion. A total dose of 30 Gy was prescribed in 20 fractions.A “butterfly” (BF) volumetric modulated arc therapy was planned with Pinnacle3 v. 9.10 using SmartArc module and Collapsed Cone Convolution Superposition algorithm dose calculation. Human-driven (Manual-BF) and AP-BF optimization plans were generated using published priority and constraints on the OARs. In addition to BF technique, the AP engine was applied to a 2 coplanar disjointed arches (AP-ARC) technique. A single AP optimization list of PTV/OAR clinical goals was created for each patient. For plan comparison, DVHs of PTVs and OARs were extracted; homogeneity and conformity indices (HI and CI) computed and OARs dose-volume constraints and NTCP models for RP, HT, and CD evaluated. Non-parametric Friedman and Dunn tests were used to identify significant differences between groups. ResultsAP (AP-BF or AP-ARC) offers comparable coverage of the PTV as the manual plan and a consistently better sparing of OARs. In particular, the heart and thyroid mean doses and lung V20 were significantly reduced using AP engine. Accordingly, AP provides similar, if not lower, complication risks. The median number of monitor units was slightly reduced by AP (3.5%). Hands-on planning time decreased on average by a factor of 3 by AP. ConclusionsThe AP module was able to limit heart and thyroid complication risks, producing clinically acceptable HL plans with stable quality without additional user input. Overall AP-ARC provided better results in terms of OAR sparing when compared with AP-BF.

Treatment planning dose accuracy improvement in the presence of dental implants

Streaking artifacts in computed tomography (CT) scans caused by metallic dental implants (MDIs) can lead to inaccuracies in dose calculations. This study quantifies and compares the effect of MDIs on dose distributions using the collapsed cone convolution superposition (CCCS) and Monte Carlo (MC) algorithms, with and without correcting for the density of the MDIs. Ion chamber measurements were taken to test the ability of the algorithms in Pinnacle3 and Monaco to calculate dose near high-Z materials. Nine previously treated patients with head and neck cancer were included in this study. The MDI and the streaking artifacts on the CT images were carefully contoured. For each patient, a plan was optimized and calculated using the Pinnacle3 treatment planning system (TPS). Two dose calculations were performed for each patient: one with overridden densities of the MDI and CT artifacts and one without overridden densities of the MDI and CT artifacts. The plans were then exported to the Monaco TPS and recalculated for the same number of monitor units (MUs) using its MC dose calculation algorithm. The changes in dose to the planning target volume (PTV) and surrounding healthy tissues were examined between all the plans using VelocityAI. For the ion chamber measurements, when correct density information was used, Monaco was within 3% of the measured values, whereas the doses calculated in Pinnacle3 varied up to 7%. The CCCS algorithm in Pinnacle3 calculated only a significant decrease in PTV coverage for 1 patient when the densities were overridden. The MC algorithm in Monaco was able to calculate a significant change in PTV coverage for five of the patients when the density was overridden. Additionally, when healthy tissues affected by streaking artifacts were assigned the correct density, cumulative (from all the fractions) point doses increased up to 46.2 Gy. Not properly accounting for MDIs can impact both the high-dose regions (PTVs) and surrounding healthy tissues. This study demonstrates that if MDIs and the artifacts are not appropriately accounted for by contouring and assigning to them the correct density, there is a potential risk of compromising the quality of the plan regarding PTV coverage and dose to healthy tissues.

Auto- versus human-driven plan in mediastinal Hodgkin lymphoma radiation treatment

BackgroundTechnological advances in Hodgkin lymphoma (HL) radiation therapy (RT) by high conformal treatments potentially increase control over organs-at-risk (OARs) dose distribution. However, plan optimization remains a time-consuming task with great operator dependent variability. Purpose of the present study was to devise a fully automated pipeline based on the Pinnacle3 Auto-Planning (AP) algorithm for treating female supradiaphragmatic HL (SHL) patients.MethodsCT-scans of 10 female patients with SHL were considered. A “butterfly” (BF) volumetric modulated arc therapy was optimized using SmartArc module integrated in Pinnacle3 v. 9.10 using Collapsed Cone Convolution Superposition algorithm (30 Gy in 20 fractions). Human-driven (Manual-BF) and AP-BF optimization plans were generated. For AP, an optimization objective list of Planning Target Volume (PTV)/OAR clinical goals was first implemented, starting from a subset of 5 patients used for algorithm training. This list was then tested on the remaining 5 patients (validation set). In addition to the BF technique, the AP engine was applied to a 2 coplanar disjointed arc (AP-ARC) technique using the same objective list. For plan evaluation, dose-volume-histograms of PTVs and OARs were extracted; homogeneity and conformity indices (HI and CI), OARs dose-volume metrics and odds for different toxicity endpoints were computed. Non-parametric Friedman and Dunn tests were used to identify significant differences between groups.ResultsA single AP objective list for SHL was obtained. Compared to the manual plan, both AP-plans offer comparable CIs while AP-ARC also achieved comparable HIs. All plans fulfilled the clinical dose criteria set for OARs: both AP solutions performed at least as good as Manual-BF plan. In particular, AP-ARC outperformed AP-BF in terms of heart sparing involving a lower risk of coronary events and radiation-induced lung fibrosis. Hands-on planning time decreased by a factor of 10 using AP on average.ConclusionsDespite the high interpatient PTV (size and position) variability, it was possible to set a standard SHL AP optimization list with a high level of generalizability. Using the implemented list, the AP module was able to limit OAR doses, producing clinically acceptable plans with stable quality without additional user input. Overall, the AP engine associated to the arc technique represents the best option for SHL.

P249] Influence of gamma index comparison on differences in dose calculation algorithm deposition method

Purpose Phantomless patient specific QA saves time and is able to detect errors by comparing the TPS dose distribution with a secondary independent dose calculation. TG 218 recommends that gamma analysis should be performed on metrics such as, mean gamma, γ > 1 and γ > 1.5, per structure. The aim of this study is to investigate how gamma index comparison is affected by differences on dose calculation algorithms when treating bone metastases. Methods 10 patients treated for bone metastases in different sites were chosen and 3D and VMAT plans were created using Elekta Monaco TPS in a Versa linac and 10 MV photons. Both 3D and VMAT dose distributions were calculated with Monaco XVMC Monte Carlo (MC) calculation algorithm using dose to medium in medium MC(Dm,m) and dose to water in medium MC(Dw,m) dose deposition modes. All plans were also calculated and evaluated using IBA Compass incorporating a Collapsed Cone convolution superposition algorithm calculating dose to water in medium CC(Dw,m). 3D dose distribution evaluation was performed in terms of gamma metrics such as mean gamma values and % PTV with γ > 1 and γ > 1.5 using 3%, 3 mm criteria for the following combinations: (a) MC(Dw,m) vs CC(Dw,m) and (b) MC(Dm,m) vs CC(Dw,m). Results For the 3D plans, average mean gamma values for MC(Dw,m) vs CC(Dw,m) and MC(Dm,m) vs CC(Dw,m) were found 0.37 ± 0.1 and 0.52 ± 0.12 respectively. The average % PTV points with γ > 1 were found 6.34 ± 5.7% and 12.6 ± 7.5% and the average % PTV points with γ > 1.5 1.45 ± 1.87% and 2.21 ± 2.28%, respectively. Corresponding values for the VMAT plans were 0.46 ± 0.12 and 0.68 ± 0.09 (mean gamma values), 9.48 ± 7.26% and 21.5 ± 7.3% (% PTV points with γ > 1) and 2.37 ± 2.8% and 7.95 ± 7.4% (% PTV points with γ > 1.5). Conclusions Gamma index comparison revealed that both MC and CC calculation algorithms are in fair agreement in dose calculation determination providing that the same dose deposition mode (i.e. Dw,m or Dm,m) is used. The use of different dose deposition mode, results in increased differences in dose calculation determination in structures/areas where materials different than water, such as bone, is included. The observed differences are also increased as the complexity of the plan increases (e.g. VMAT vs 3D).

Refinement of MLC modeling improves commercial QA dosimetry system for SRS and SBRT patient-specific QA.

Mobius 3D (M3D) provides a volumetric dose verification of the treatment planning system's calculated dose using an independent beam model and a collapsed cone convolution superposition algorithm. However, there is a lack of investigation into M3D's accuracy and effectiveness for stereotactic radiosurgery (SRS) and stereotactic body radiotherapy (SBRT) quality assurance (QA). Here, we collaborated with the vendor to develop a revised M3D beam model for SRS/SBRT cases treated with a 6X flattening filter-free (FFF) beam and high-definition multiple leaf collimator (HDMLC) on an Edge linear accelerator. Eighty SRS/SBRT cases, planned with AAA dose algorithm and validated with Gafchromic film, were compared to M3D dose calculations using 3D gamma analysis with 2%/2 mm gamma criteria and a 10% threshold. A revised beam model was developed by refining the HD-MLC model in M3D to improve small field dose calculation accuracy and beam profile agreement. All cases were reanalyzed using the revised beam model. The impact of heterogeneity corrections for lung cases was investigated by applying lung density overrides to five cases. For the standard and revised beam models, respectively, the mean gamma passing rates were 94.6% [standard deviation (SD): 6.1%] and 98.0% [SD: 1.7%] (for the overall patient), 88.2% [SD: 17.3%] and 93.8% [SD: 6.8%] (for the brain PTV), 71.4% [SD: 18.4%] and 81.5% [SD: 14.3%] (for the lung PTV), 83.3% [SD: 16.7%] and 67.9% [SD: 23.0%] (for the spine PTV), and 78.6% [SD: 14.0%] and 86.8% [SD: 12.5%] (for the PTV of all other sites). The lung PTV mean gamma passing rates improved from 74.1% [SD: 7.5%] to 89.3% [SD: 7.2%] with the lung density overridden. The revised beam model achieved an output factor within 3% of plastic scintillator measurements for 2 × 2 cm2 MLC field size, but larger discrepancies are still seen for smaller field sizes which necessitate further improvement of the beam model. Special attention needs to be paid to small field dosimetry, MLC modeling, and inhomogeneity corrections in the beam model for SRS/SBRT QA. The improvements noted in this study, and further collaborations between clinical physicists and the vendor to refine the M3D beam model could enable M3D to become a premier SRS/SBRT QA tool.

Single fraction computed tomography-guided high-dose-rate brachytherapy or stereotactic body radiotherapy for primary and metastatic lung tumors?

PurposeTo provide a pilot dosimetric study of computed tomography (CT)-guided high-dose-rate (HDR) brachytherapy (BRT) and stereotactic body radiotherapy (SBRT) for primary and metastatic lung lesions.Material and methodsFor nine lung primary and metastasis patients, 3D image-based BRT plan using a single virtual catheter was planned for 34 Gy in single fraction to the gross tumor volume (GTV) + 3 mm margin to account for tumor deformation. These plans were compared to margin-based (MB-) and robustness optimized (RO-) SBRT, assuming the same tumor deformation under real-time tumor tracking. Consistent dose calculation was ensured for both BRT and SBRT plans using the same class of collapsed cone convolution superposition algorithm. Plan quality metrics were compared by Friedman tests and Wilcoxon t-tests.Results and ConclusionsBrachytherapy plans showed significant higher GTV mean dose compared to MB- and RO-SBRT (122.2 Gy vs. 50.4 and 44.7 Gy, p < 0.05), and better dose gradient index (R50) = 2.9 vs. 4.3 and 8.4 for MB- and RO-SBRT, respectively. Dose constraints per the RTOG 0915 protocol were achieved for all critical organs except chest wall in BRT. All other dose-volume histograms (DVH) metrics are comparable between BRT and SBRT. Treatment delivery time of BRT and SBRT plans significantly increased and decreased with increasing GTV size, respectively. SBRT using advanced MLC tracking technique and non-coplanar VMAT can achieve comparable dosimetric quality to HDR BRT. Whether or not, the significantly higher GTV dose can increase killing of radioresistant tumor cells and offset the effect of tumor reoxygenation in single fraction BRT, requires further clinical investigation.

Assessment of Imprecise Small Photon Beam Modeling by Two Treatment Planning System Algorithms

Dosimetric accuracy in intensity-modulated radiation therapy (IMRT) is the main part of quality assurance program. Improper beam modeling of small fields by treatment planning system (TPS) can lead to inaccuracy in treatment delivery. This study aimed to evaluate of the dose delivery accuracy at small segments of IMRT technique using two-dimensional (2D) array as well as evaluate the capability of two TPSs algorithm in modeling of small fields. Irradiation were performed using 6 MV photon beam of Siemens Artiste linear accelerator. Dosimetric behaviors of two dose calculation algorithms, namely, collapsed cone convolution/superposition (CCCS) and full scatter convolution (FSC) in small segments of IMRT plans were analyzed using a 2D diode array and gamma evaluation. Comparisons of measurements against TPSs calculations showed that percentage difference of output factors of small fields were 2% and 15% for CCCS and FSC algorithm, respectively. Gamma analysis of calculated dose distributions by TPSs against those measured by 2D array showed that in passing criteria of 3 mm/3%, the mean pass rate for all segment sizes is higher than 95% except for segment sizes below 3 cm × 3 cm optimized by TiGRT TPS. High pass rate of gamma index (95%) achieved in planned small segments by Prowess relative to results obtained with TiGRT. This study showed that the accuracy of small field modeling differs between two dose calculation algorithms.

Abstract ID: 220 Evaluating the effect of dental implants in the treatment of head and neck cancer using Monte Carlo dose calculation

Purpose To quantify and compare the effect of metallic dental implants (MDI) on dose distributions calculated using Collapsed Cone Convolution Superposition (CCCS) algorithm or a Monte Carlo algorithm (with and without correcting for the density of the MDI). Methods Seven previously treated patients to the head and neck region were included in this study. The MDI and the streaking artifacts on the CT images were carefully contoured. For each patient a plan was optimized and calculated using the Pinnacle treatment planning system (TPS). For each patient two dose calculations were performed, a) with the densities of the MDI and CT artifacts overridden (12 g/cc and 1 g/cc respectively) and b) without density overrides. The plans were then exported to the Monaco TPS and recalculated using Monte Carlo dose calculation algorithm. The changes in dose to PTVs and surrounding Regions of Interest (ROIs) were examined between all plans. Results The Monte Carlo dose calculation indicated that PTVs received 6% lower dose than the CCCS algorithm predicted. In some cases, the Monte Carlo algorithm indicated that surrounding ROIs received higher dose (up to a factor of 2). Conclusion Not properly accounting for dental implants can impact both the high dose regions (PTV) and the low dose regions (OAR). This study implies that if MDI and the artifacts are not appropriately contoured and given the correct density, there is potential significant impact on PTV coverage and OAR maximum doses.

Independent 3D dose calculation for IMRT based on simplification of beam model and collapsed-cone convolution/superposition algorithm

Objective To realize independent 3D dose calculation for intensity-modulated radiotherapy (IMRT) by building a two-source beam model of medical linear accelerator combined with a collapsed-cone convolution/superposition (CCCS) algorithm. Methods Two-source beam models of medical linear accelerators (Varian and Elekta) were built to calculate the 3D dose distributions using the CCCS algorithm. Scp, percent depth dose, and off-axis dose distribution were compared with the scanning data of ion chamber to confirm the calculation model. Twelve intensity-modulated treatment plans from each accelerator (a total of 24 plans) were selected for comparison. The calculation results of treatment planning system (TPS) were independently validated, and further compared with the measurement results of detector matrix. Results The dose deviations at the center of rectangle fields were lower than 1%, the deviation between doses at the same position in the field was not higher than 1%, and the positional deviation in the penumbra region was not higher than 1 mm. Gamma analysis based on 3%/3 mm standard was used to compare the results calculated by detectors and TPS.The pass rates were higher than 90%. Conclusions The independent 3D dose calculation for IMRT based on two-source beam model combined with CCCS algorithm has been successfully set up. The comparison between regular field and IMRT plan indicates that this method and calculation model can be used for independent 3D dose calculation of clinical plan. Key words: Clinical linear accelerators beam model; Independent dose calculation; Quality assurance

Assessment the accuracy of dose calculation in build-up region for two radiotherapy treatment planning systems.

Our objective is to quantify dose calculation accuracy in the build-up region using TiGRT and Prowess Panther treatment planning systems (TPSs). Thermoluminescent dosimeter-100 chips were used in a phantom for dose measurement. TiGRT Version 1.2 (LinaTech, Sunnyvale, CA, USA) and Prowess Panther version 5.1 (Prowess Inc., Concord, CA, USA) TPSs were also used for dose calculations. Finally, the confidence limit values obtained to quantify dose calculation accuracy of the TPSs at build-up region for different field sizes and various gantry angles. For 8 cm × 10 cm, 10 cm × 10 cm, and 15 cm × 10 cm field sizes, the confidence limit values for TiGRT TPS were 16.64, 16.56, and 25.85; for Prowess TPS with fast photon effective (FPE) algorithm were 15.17, 14.22, and 9.73; and for Prowess TPS with collapsed cone convolution superposition (CCCS) algorithm were 10.53, 9.97, and 9.76, respectively. For wedged field with gantry angles of 15°, 30°, and 60°, the confidence limit values for TiGRT TPS were 12.11, 12.96, and 22.69 and for Prowess TPS with FPE algorithm were 24.50, 22.07, and 7.82, respectively. It is concluded that for open field sizes without gantry angulation, dose calculation accuracy in Prowess TPS with CCCS algorithm is better than TiGRT and Prowess TPSs with FPE algorithm. Furthermore, it is concluded that for wedged field with large gantry angle, dose calculation accuracy of Prowess TPS with FPE algorithm is better than TiGRT TPS while, for medium and small gantry angles, dose calculation accuracy of TiGRT TPS is better than Prowess TPS with FPE algorithm.

SU‐F‐T‐444: Quality Improvement Review of Radiation Therapy Treatment Planning in the Presence of Dental Implants

Purpose:To quantify and compare the effect of metallic dental implants (MDI) on dose distributions calculated using Collapsed Cone Convolution Superposition (CCCS) algorithm or a Monte Carlo algorithm (with and without correcting for the density of the MDI).Methods:Seven previously treated patients to the head and neck region were included in this study. The MDI and the streaking artifacts on the CT images were carefully contoured. For each patient a plan was optimized and calculated using the Pinnacle3 treatment planning system (TPS). For each patient two dose calculations were performed, a) with the densities of the MDI and CT artifacts overridden (12 g/cc and 1 g/cc respectively) and b) without density overrides. The plans were then exported to the Monaco TPS and recalculated using Monte Carlo dose calculation algorithm. The changes in dose to PTVs and surrounding Regions of Interest (ROIs) were examined between all plans.Results:The Monte Carlo dose calculation indicated that PTVs received 6% lower dose than the CCCS algorithm predicted. In some cases, the Monte Carlo algorithm indicated that surrounding ROIs received higher dose (up to a factor of 2).Conclusion:Not properly accounting for dental implants can impact both the high dose regions (PTV) and the low dose regions (OAR). This study implies that if MDI and the artifacts are not appropriately contoured and given the correct density, there is potential significant impact on PTV coverage and OAR maximum doses.

Dosimetric comparison of Acuros XB with collapsed cone convolution/superposition and anisotropic analytic algorithm for stereotactic ablative radiotherapy of thoracic spinal metastases.

The aim of this study is to compare the recent Eclipse Acuros XB (AXB) dose calculation engine with the Pinnacle collapsed cone convolution/superposition (CCC) dose calculation algorithm and the Eclipse anisotropic analytic algorithm (AAA) for stereotactic ablative radiotherapy (SAbR) treatment planning of thoracic spinal (T‐spine) metastases using IMRT and VMAT delivery techniques. The three commissioned dose engines (CCC, AAA, and AXB) were validated with ion chamber and EBT2 film measurements utilizing a heterogeneous slab‐geometry water phantom and an anthropomorphic phantom. Step‐and‐shoot IMRT and VMAT treatment plans were developed and optimized for eight patients in Pinnacle, following our institutional SAbR protocol for spinal metastases. The CCC algorithm, with heterogeneity corrections, was used for dose calculations. These plans were then exported to Eclipse and recalculated using the AAA and AXB dose calculation algorithms. Various dosimetric parameters calculated with CCC and AAA were compared to that of the AXB calculations. In regions receiving above 50% of prescription dose, the calculated CCC mean dose is 3.1%–4.1% higher than that of AXB calculations for IMRT plans and 2.8%–3.5% higher for VMAT plans, while the calculated AAA mean dose is 1.5%–2.4% lower for IMRT and 1.2%–1.6% lower for VMAT. Statistically significant differences (p<0.05) were observed for most GTV and PTV indices between the CCC and AXB calculations for IMRT and VMAT, while differences between the AAA and AXB calculations were not statistically significant. For T‐spine SAbR treatment planning, the CCC calculations give a statistically significant overestimation of target dose compared to AXB. AAA underestimates target dose with no statistical significance compared to AXB. Further study is needed to determine the clinical impact of these findings.PACS number: 87.55.D‐, 87.53.Ly

SU‐E‐T‐117: Analysis of the ArcCHECK Dosimetry Gamma Failure Using the 3DVH System

Purpose:To evaluate gamma analysis failure for the VMAT patient specific QA using ArcCHECK cylindrical phantom. The 3DVH system(Sun Nuclear, FL) was used to analyze the dose difference statistic between measured dose and treatment planning system calculated dose.Methods:Four case of gamma analysis failure were selected retrospectively. Our institution gamma analysis indexes were absolute dose, 3%/3mm and 90%pass rate in the ArcCHECK dosimetry. The collapsed cone convolution superposition (CCCS) dose calculation algorithm for VMAT was used. Dose delivery was performed with Elekta Agility. The A1SL(standard imaging, WI) and cavity plug were used for point dose measurement. Delivery QA plans and images were used for 3DVH Reference data instead of patient plan and image. The measured data of ‘.txt’ file was used for comparison at diodes to acquire a global dose level. The,.acml’ file was used for AC‐PDP and to calculated point dose.Results:The global dose of 3DVH was calculated as 1.10 Gy, 1.13, 1.01 and 0.2 Gy respectively. The global dose of 0.2 Gy case was induced by distance discrepancy. The TPS calculated point dose of was 2.33 Gy to 2.77 Gy and 3DVH calculated dose was 2.33 Gy to 2.68 Gy. The maximum dose differences were −2.83% and −3.1% for TPS vs. measured dose and TPS vs. 3DVH calculated respectively in the same case. The difference between measured and 3DVH was 0.1% in that case. The 3DVH gamma pass rate was 98% to 99.7%.Conclusion:We found the TPS calculation error by 3DVH calculation using ArcCHECK measured dose. It seemed that our CCCS algorithm RTP system over estimated at the central region and underestimated scattering at the peripheral diode detector point. The relative gamma analysis and point dose measurement would be recommended for VMAT DQA in the gamma failure case of ArcCHECK dosimetry.

Fast 3D dosimetric verifications based on an electronic portal imaging device using a GPU calculation engine.

PurposeTo use a graphic processing unit (GPU) calculation engine to implement a fast 3D pre-treatment dosimetric verification procedure based on an electronic portal imaging device (EPID).MethodsThe GPU algorithm includes the deconvolution and convolution method for the fluence-map calculations, the collapsed-cone convolution/superposition (CCCS) algorithm for the 3D dose calculations and the 3D gamma evaluation calculations. The results of the GPU-based CCCS algorithm were compared to those of Monte Carlo simulations. The planned and EPID-based reconstructed dose distributions in overridden-to-water phantoms and the original patients were compared for 6 MV and 10 MV photon beams in intensity-modulated radiation therapy (IMRT) treatment plans based on dose differences and gamma analysis.ResultsThe total single-field dose computation time was less than 8 s, and the gamma evaluation for a 0.1-cm grid resolution was completed in approximately 1 s. The results of the GPU-based CCCS algorithm exhibited good agreement with those of the Monte Carlo simulations. The gamma analysis indicated good agreement between the planned and reconstructed dose distributions for the treatment plans. For the target volume, the differences in the mean dose were less than 1.8%, and the differences in the maximum dose were less than 2.5%. For the critical organs, minor differences were observed between the reconstructed and planned doses.ConclusionsThe GPU calculation engine was used to boost the speed of 3D dose and gamma evaluation calculations, thus offering the possibility of true real-time 3D dosimetric verification.

Evaluation collapsed cone convolution/superposition (CCCS) algorithms in prowess treatment planning system for calculating symmetric and asymmetric field size

Purpose: This work investigated the accuracy of prowess treatment planning system (TPS) in dose calculation in a homogenous phantom for symmetric and asymmetric field sizes using collapse cone convolution / superposition algorithm (CCCS). Methods: The measurements were carried out at source-to-surface distance (SSD) set to 100 cm for 6 and 10 MV photon beams. Data for a full set of measurements for symmetric fields and asymmetric fields, including inplane and crossplane profiles at various depths and percentage depth doses (PDDs) were obtained during measurements on the linear accelerator. Results: The results showed that the asymmetric collimation dose lead to significant errors (up to approximately 7%) in dose calculations if changes in primary beam intensity and beam quality. It is obvious that the most difference in the isodose curves was found in buildup and the penumbra regions. Conclusion: The results showed that the dose calculation using Prowess TPS based on CCCS algorithm is generally in excellent agreement with measurements.

Poster - Thur Eve - 76: Dosimetric Comparison of Pinnacle and iPlan Algorithms with an Anthropomorphic Lung Phantom

Our goal is to compare the dosimetric accuracy of the Pinnacle-3 9.2 Collapsed Cone Convolution Superposition (CCCS) and the iPlan 4.1 Monte Carlo (MC) and Pencil Beam (PB) algorithms in an anthropomorphic lung phantom using measurement as the gold standard. Ion chamber measurements were taken for 6, 10, and 18 MV beams in a CIRS E2E SBRT Anthropomorphic Lung Phantom, which mimics lung, spine, ribs, and tissue. The plan implemented six beams with a 5×5 cm2 field size, delivering a total dose of 48 Gy. Data from the planning systems were computed at the treatment isocenter in the left lung, and two off-axis points, the spinal cord and the right lung. The measurements were taken using a pinpoint chamber. The best results between data from the algorithms and our measurements occur at the treatment isocenter. For the 6, 10, and 18 MV beams, iPlan 4.1 MC software performs the best with 0.3%, 0.2%, and 4.2% absolute percent difference from measurement, respectively. Differences between our measurements and algorithm data are much greater for the off-axis points. The best agreement seen for the right lung and spinal cord is 11.4% absolute percent difference with 6 MV iPlan 4.1 PB and 18 MV iPlan 4.1 MC, respectively. As energy increases absolute percent difference from measured data increases up to 54.8% for the 18 MV CCCS algorithm. This study suggests that iPlan 4.1 MC computes peripheral dose and target dose in the lung more accurately than the iPlan 4.1 PB and Pinnicale CCCS algorithms.