Collimator Aperture Research Articles

Potential improvements of lung and prostate MLC tracking investigated by treatment simulations.

Intrafraction tumor motion during external radiotherapy is a challenge for the treatment accuracy. A novel technique to mitigate the impact of tumor motion is real-time adaptation of the multileaf collimator (MLC) aperture to the motion, also known as MLC tracking. Although MLC tracking improves the dosimetric accuracy, there are still residual errors. Here, we investigate and rank the performance of five prediction algorithms and seven improvements of an MLC tracking system by extensive tracking treatment simulations. An in-house-developed MLC tracking simulator that has been experimentally validated against an electromagnetic-guided MLC tracking system was used to test the prediction algorithms and tracking system improvements. The simulator requires a Dicom treatment plan and a motion trajectory as input and outputs all motion of the accelerator during MLC tracking treatment delivery. For lung tumors, MLC tracking treatments were simulated with a low and a high modulation VMAT plan using 99 patient-measured lung tumor trajectories. For prostate, tracking was also simulated with a low and a high modulation VMAT plan, but with 695 prostate trajectories. For each simulated treatment, the tracking error was quantified as the mean MLC exposure error, which is the sum of the overexposed area (irradiated area that should have been shielded according to the treatment plan) and the underexposed area (shielded area that should have been irradiated). First, MLC tracking was simulated with the current MLC tracking system without prediction, with perfect prediction (Perfect), and with the following five prediction algorithms: linear Kalman filter (Kalman), kernel density estimation (KDE), linear adaptive filtering (LAF), wavelet-based multiscale autoregression (wLMS), and time variant seasonal autoregression (TVSAR). Next, MLC tracking was simulated using the best prediction algorithm and seven different tracking system improvements: no localization signal latency (a), doubled maximum MLC leaf speed (b), halved MLC leaf width (c), use of Y backup jaws to track motion perpendicular to the MLC leaves (d), dynamic collimator rotation for alignment of the MLC leaves with the dominant target motion direction (e), improvements 4 and 5 combined (f), and all improvements combined (g). All results are presented as the mean residual MLC exposure error compared to no tracking. In the prediction study, the residual MLC exposure error was 47.0% (no prediction), 45.1% (Kalman), 43.8% (KDE), 43.7% (LAF), 42.1% (wLMS), 40.1% (TVSAR), and 36.5% (Perfect) for lung MLC tracking. For prostate MLC tracking, it was 66.0% (no prediction), 66.9% (Kalman), and 63.4% (Perfect). For lung with TVSAR prediction, the residual MLC exposure error for the seven tracking system improvements was 37.2%(1), 38.3%(2), 37.4%(3), 34.2%(4), 30.6%(5), 27.7%(6), and 20.7%(7). For prostate with no prediction, the residual MLC exposure error was 61.7%(1), 61.4%(2), 55.4%(3), 57.2%(4), 47.5%(5), 43.7%(6), and 38.7%(7). For prostate, MLC tracking was slightly better without prediction than with linear Kalman filter prediction. For lung, the TVSAR prediction algorithm performed best. Dynamic alignment of the collimator with the dominant motion axis was the most efficient MLC tracking improvement except for lung tracking with the low modulation VMAT plan, where jaw tracking was slightly better.

PO-0926: Comparison of CyberKnife multileaf collimator and variable aperture collimator in renal SBRT

PO-0926: Comparison of CyberKnife multileaf collimator and variable aperture collimator in renal SBRT

Beam Commissioning Data Acquisition for the Iris Variable Aperture Collimator of CyberKnife VSI

Objective: To minimize the risk inherent to the use of medical radiation and robotic radiosurgery, this research introduced the basis and method of beam commissioning data acquisition for the Iris variable aperture collimator of CyberKnife VSI. Methods: In this study, clinical dosimetry measurements of the Iris collimator such as tissue-phantom ratios (TPRs), off-center ratios (OCRs), and secondary collimator output factors (OFs) were conducted, and the data was contrasted with that of the Fixed collimator. Results: The Iris data and the Fixed data were not quite different in TPRs in the same radiation field size. Since the difference of the hardware structure,the OCRs and OFs were quite different, especially in small aperture (5, 7.5 and 10 mm) under the same condition of SAD. For example, the maximum discrepancy of the OFs was 26.67% (5mm aperture, 650mm SAD). Conclusion: When Iris aperture makes some change, tungsten segments move fast and form an aperture smaller than that we need, and then recover to the right size, which may affect the results of the measurement, and also the dodecagonal design of Iris results in a problem of leakage radiation on the edge. Keywords: Beam commissioning, Iris Variable Aperture Collimator, tissue phantom ratio, off center ratio, output factor, CyberKnife VSI™.

Comparison and Assessment of Profile and Output Factor Measurement for a Frameless Robotic Radiosurgery System Using Different Detectors

To compare and assess different detectors for the profile and output factor (OF) measurement for a Cyberknife system, and provide reference and suggestions for selecting and using the correct detectors. Profiles were acquired using the detectors of PTW-60017, PTW-60018, PTW-60019 and IBA-SFD, at different depths for different collimator sizes, with the detectors stem oriented both perpendicular and parallel to the central beam axis. The differences of profiles among different detectors and orientation of detectors were analyzed. Output factors were measured using PTW ionization chamber 30013, 31010, diode detector PTW 60017, PTW60018 and diamond detector 60019 for different fixed aperture collimators from 5 mm to 60 mm at SAD 800 mm and depth of water 50 mm. EBT3 film measured OF at 5 cm depth in a water phantom with a SAD of 800mm was used as reference for comparison. All full width at half maximum (FWHM) of field measured by four detectors in parallel orientation were larger than actual field size. The deviation increased with the size of collimator and measurement depth, with the maximal deviation of 0.6mm. The deviation of FWHM among four detectors increased with the increase of measurement depth, with the maximum deviation of 0.2mm. The penumbra was the smallest for IBA-SFD, and largest for PTW-60019. The maximal deviation of penumbra was 0.3mm. The IBA-SFD agreed with other detectors but tended to over-respond in the out-of-field region when the collimator size was larger than 30mm. Both FWHM and penumbra in perpendicular orientation were smaller than in parallel orientation for PTW-60017, PTW-60018 and PTW-60019, especially for the 5mm collimator. However, the trend was opposite for IBA-SFD. With the increase of collimator aperture, the difference between the right and left penumbra acquired by four detectors increased, with more obvious stem effects observed. A good agreement among the output factors obtained from these five detectors was found for the collimator size more than 30mm, with the deviations less than 1%. When the collimator size was less than 30mm, the deviations of the OF became large and obviously increased with the decrease of the collimator size. The measured OFs of PTW60019 were basically consistent with EBT3 film, with the deviation less than 2%. The OFs were higher for diodes detectors, and much smaller for Ionization chambers than EBT3 film. Similar profiles were acquired by PTW-60017, PTW-60018, PTW-60019 and IBA-SFD, but the detectors’ characteristics and effects of detector orientations should be considered. PTW 30013, 31010, PTW 60017, PTW60018 and 60019 could be directly used for the OFs measurement, when field was greater than 30mm. But if the field was less than 30mm, the measurement results obtained by these detectors need to be corrected. Sensitive volume, the effective measure length and material density of detector affected the measurement of OFs, especially for small filed.

Implementation of a Coded Aperture Imaging System for Gamma Measurement and Experimental Feasibility Tests

Radioactive materials are used in medicine, non-destructive testing, and nuclear plants. Source localization is especially important during nuclear decommissioning and decontamination because the actual location of the radioactive source within nuclear waste is often unknown. The coded-aperture imaging technique started with space exploration and moved into X-ray and gamma ray imaging, which have imaging process characteristics similar to each other. In this study, we simulated 21x21 and 37x37 coded aperture collimators based on a modified uniformly redundant array (MURA) pattern to make a gamma imaging system that can localize a gamma-ray source. We designed a 21x21 coded aperture collimator that matches our gamma imaging detector and did feasibility experiments with the coded aperture imaging system. We evaluated the performance of each collimator, from 2 mm to 10 mm thicknesses (at 2 mm intervals) using root mean square error (RMSE) and sensitivity in a simulation. . In experimental results, the full width half maximum (FWHM) of the point source was 5.09° at the center and 4.82° at the location of the source was 9°. We will continue to improve the decoding algorithm and optimize the collimator for high-energy gamma rays emitted from a nuclear power plant.

Reaching record-low [formula omitted] at the CERN Large Hadron Collider using a novel scheme of collimator settings and optics

The Large Hadron Collider (LHC) at CERN is built to collide intense proton beams with an unprecedented energy of 7TeV. The design stored energy per beam of 362MJ makes the LHC beams highly destructive, so that any beam losses risk to cause quenches of superconducting magnets or damage to accelerator components. Collimators are installed to protect the machine and they define a minimum normalized aperture, below which no other element is allowed. This imposes a limit on the achievable luminosity, since when squeezing β* (the β-function at the collision point) to smaller values for increased luminosity, the β-function in the final focusing system increases. This leads to a smaller normalized aperture that risks to go below the allowed collimation aperture. In the first run of the LHC, this was the main limitation on β*, which was constrained to values above the design specification. In this article, we show through theoretical and experimental studies how tighter collimator openings and a new optics with specific phase-advance constraints allows a β* as small as 40cm, a factor 2 smaller than β*=80cm used in 2015 and significantly below the design value β*=55cm, in spite of a lower beam energy. The proposed configuration with β*=40cm has been successfully put into operation and has been used throughout 2016 as the LHC baseline. The decrease in β* compared to 2015 has been an essential contribution to reaching and surpassing, in 2016, the LHC design luminosity for the first time, and to accumulating a record-high integrated luminosity of around 40 fb−1 in one year, in spite of using less bunches than in the design.

40. Evaluation of the Incise2™ multileaf collimator for stereotactic radiotherapy on Cyberknife®

Introduction The CyberKnife® (Accuray) is a stereotactic robotic system using historically circular collimators to define the beam apertures. A new multileaf collimator (MLC) is now available on the Cyberknife® M6 version. The purpose of this study was to evaluate the quality of treatment plans using MLC compared to treatment plans using a variable circular aperture collimator IRIS™ for radiosurgery (SRS) and stereotactic body radiotherapy (SBRT). Methods The study was performed on a Cyberknife® M6™ v10.6. A total of 17 cases including cranial, liver, spinal and prostatic cases were investigated. For each case, two treatment plans were generated with Multiplan® v5.3 treatment planning system: one plan using the Incise2™ MLC associated with the Finite Size Pencil Beam (FSPB) dose calculation algorithm and one using the IRIS™ collimator associated with Ray Tracing or Monte Carlo dose calculation algorithm. The dose was prescribed near the 80% isodose level relative to max dose. Plans were normalized to have the same target coverage at ±0.5%. The quality of the MLC and IRIS™ treatment plans was assessed using two criteria: - Dose distribution by reporting the conformal index (COIN), Homogeneity Index (HI) and dose gradient index (GI). - Efficiency by reporting the number of delivered monitor units (MUs) and the treatment time. To evaluate the accuracy of dose calculation algorithm within heterogeneity, a typical lung treatment plan for each collimator was created on a QUASAR™ Respiratory phantom (Modus Medical Inc) with a lung target insert. Calculated planar dose was compared with measurements by radiochromic EBT3 films (Ashland). The analysis was done using gamma analysis 3% (local) / 2 mm (threshold: 30% of the max dose) Results Results are summarized in Table 1. Dose conformality and homogeneity were equivalent for both collimator systems (mean differences less than 3%) except for targets with volumes smaller than 2 cm3 for which dose conformality was better of 14% on average with the IRIS collimator. The dose gradient index was improved by 10.5% on average with the MLC and up to 26% on average for volume larger than 100 cm3. The number of MUs decreased by 25% on average (up to 70%) and the treatment times were systematically reduced with a mean reduction of 28% (max 54%) with the MLC. The comparison between calculated and measured dose in lung phantom showed a gamma passing rate of 51.6 %, 45.5 % and 98.7% for FSPB, Ray Tracing and Monte Carlo respectively. Conclusion The MLC Incise2™ on Cyberknife® allows a significant reduction of MUs and treatment time compared to circular collimators while maintaining a high degree of conformality and a steep dose gradient. For treatment of target volumes smaller than 2 cm3, circular collimators should be still used. The use of MLC for SBRT of lung targets should not be recommended currently due to the absence of type B dose calculation algorithm.

CTDI versus New AAPM Metrics to assess Doses in CT: a case study

In modern CT, CTDI 100 measurements would underestimate accumulated dose at the gantry center. AAPM TG 111 report proposed improved metrics for CT dosimetry, mainly for helical and wide beam width scanning. In this study, a methodology to assess CT dose, inspired on TG 111, was applied. Dosimeters were firstly calibrated in lab in beams like those utilized clinically. Using a reference 0.6cc Farmer chamber, two CT “pencil” chambers were calibrated in P KL by substitution method. Results showed differences ≤ 2% in the calibration coefficients, for three collimation apertures. A small 0.6cc chamber was calibrated in air kerma with this setup, without any collimator. After this, in a private Brazilian hospital, the small chamber was applied in dosimetry tests of a CT scanner, according to TG 111, determining Dose profiles and Equilibrium dose free-in-air (D eq,air ) for some protocols and pitch values. Results showed that D eq,air increased when reducing pitch and Equilibrium dose-pitch product free-in-air (p.D eq,air ) remain constant. In measurements with a 450mm CT phantom, differences between Planar Average Equilibrium Dose (D eq,p ) and CTDI vol ranged between 30-37%. This occurs because CTDI vol cannot include dose profile tail contribution, caused by scattering in phantom, especially for wide beam widths.

GEANT4 models for the secondary radiation flux in the collimation system of a 300 MeV proton microbeam

In Harbin, we are developing a 300MeV proton microbeam for many applications in space science including upset studies in microelectronic devices, radiation hardness of materials for satellites and radiation effects in human tissues. There are also applications of this facility proposed for proton therapy. The microbeam system will employ a purpose-built proton synchrotron to provide the beam. However there are many challenges to be addressed in the design, construction and operation of this facility. Here we address two important design aspects for which we apply GEANT4 modeling. First, the high energy proton beam interacts strongly with beam line materials, especially the collimation slits, to produce showers of secondary particles which could introduce significant background signals and degrade the resolution of the proton microbeam. Second, the beam transport within the residual vacuum of the beam line may also introduce undesirable background radiation. In both cases mitigation strategies need to be incorporated during the design phase of the new system. We study the use of a dipole magnet following the aperture collimator to reduce the flux of secondary particles incident on the analysis chamber. Monte Carlo simulations are performed using GEANT4 and SRIM. By inserting the dipole magnet, we find as expected a significant reduction in the scattering of protons and other particles, such as neutrons and gamma rays, at the collimation system exit position. Secondary radiation from the residual gas pressure within the beam line vacuum system are also modelled and found to be negligible under the standard operating conditions.

Clinical commissioning of the INCISE™ multileaf collimator for cyberknife M6™ system

Introduction The National Center for Cancer Care and Research (NCCCR) at Hamad Medical Corporation in Qatar is amongst the first institutions in Asia and Europe to have the CyberKnife® M6 FIM system (Accuray, Inc., Sunnyvale, CA, USA) including Fixed Collimators, Iris Variable Aperture Collimator and InCise™ Multileaf Collimator. Purpose To report our commissioning experiences of the CyberKnife M6 InCise™ Multileaf Collimator system. Materials and methods Accuray guidelines were used to conduct measurements. A detailed description of the equipment used, the mechanical alignment, the verification procedures, and the alignment of the detector motion with the radiation beam is described. Incise MLC testing was conducted as per Accuray procedure. Further MLC tests were developed to verify its feasibility under certain clinical settings. Results Our results were within the manufacturer specifications. Results for both the Sun Nuclear Edge detector and PTW SRS diode 60018 were found to be comparable. Measurement conditions specified by Accuray were sufficient; however the use of a reference chamber introduced additional noise for the continuous profile acquisitions. As compared to fixed and IRIS collimators, the incise MLC produced acceptable results with an average of 20% decrease in treatment delivery time. Conclusions Our results are amongst the first set of data reported on the InCise™ MLC and were within the manufacturer specifications. These results will be used to develop a benchmark reference for periodic Quality Control (QC). Disclosure Authors have nothing to disclose.

Interior tomographic imaging of mouse heart in a carbon nanotube micro-CT.

The relatively high radiation dose from micro-CT is a cause for concern in preclinical research involving animal subjects. Interior region-of-interest (ROI) imaging was proposed for dose reduction, but has not been experimentally applied in micro-CT. Our aim is to implement interior ROI imaging in a carbon nanotube (CNT) x-ray source based micro-CT, and present the ROI image quality and radiation dose reduction for interior cardiac micro-CT imaging of a mouse heart in situ. An aperture collimator was mounted at the source-side to induce a small-sized cone beam (10 mm width) at the isocenter. Interior in situ micro-CT scans were conducted on a mouse carcass and several micro-CT phantoms. A GPU-accelerated hybrid iterative reconstruction algorithm was employed for volumetric image reconstruction. Radiation dose was measured for the same system operated at the interior and global micro-CT modes. Visual inspection demonstrated comparable image quality between two scan modes. Quantitative evaluation demonstrated high structural similarity index (up to 0.9614) with improved contrast-noise-ratio (CNR) on interior micro-CT mode. Interior micro-CT mode yielded significant reduction (up to 83.9%) for dose length product (DLP). This work demonstrates the applicability of using CNT x-ray source based interior micro-CT for preclinical imaging with significantly reduced radiation dose.

WE‐DE‐BRA‐10: Development of a Novel Scanning Beam Low‐Energy Intraoperative Radiation Therapy (SBIORT) System for Pancreatic Cancer

Purpose:Developing a compact collimator system and validating a 3D surface imaging module for a scanning beam low‐energy x‐ray radiation therapy (SBIORT) system that enables delivery of non‐uniform radiation dose to targets with irregular shapes intraoperatively.Methods:SBIORT consists of a low energy x‐ray source, a custom compact collimator module, a robotic arm, and a 3D surface imaging module. The 3D surface imaging system (structure sensor) is utilized for treatment planning and motion monitoring of the surgical cavity. SBIORT can deliver non‐uniform dose distributions by dynamically moving the x‐ray source assembly along optimal paths with various collimator apertures. The compact collimator utilizes a dynamic shutter mechanism to form a variable square aperture. The accuracy and reproducibility of the collimator were evaluated using a high accuracy encoder and a high resolution camera platform. The dosimetrical characteristics of the collimator prototype were evaluated using EBT3 films with a Pantak Therapax unit. The accuracy and clinical feasibility of the 3D imaging system were evaluated using a phantom and a cadaver cavity.Results:The SBIORT collimator has a compact size: 66 mm diameter and 10 mm thickness with the maximum aperture of 20 mm. The mechanical experiment indicated the average accuracy of leaf position was 0.08 mm with a reproducibility of 0.25 mm at 95% confidence level. The dosimetry study indicated the collimator had a penumbra of 0.35 mm with a leaf transmission of 0.5%. 3D surface scans can be acquired in 5 seconds. The average difference between the acquired 3D surface and the ground truth is 1 mm with a standard deviation of 0.6 mm.Conclusion:This work demonstrates the feasibility of the compact collimator and 3D scanning system for the SBIORT. SBIORT is a way of delivering IORT with a compact system that requires minimum shielding of the procedure room.This research is supported by the University of Iowa Internal Funding Initiatives

TH-CD-201-02: A Monte Carlo Investigation of a Novel Detector Arrangement for the Energy Spectrum Measurement of a 6MV Linear Accelerator

Purpose: Direct measurement of the energy spectrum of a 6MV linear accelerator has not been successful due to the high fluence rate, high energy nature of these photon beams. Previous work used a Compton Scattering (CS) spectrometry setup with a shielded spectrometer for spectrum measurements. Despite substantial lead shielding, excessive pulse pile-up was seen. MCNP6 transport code was used to investigate the feasibility and effectiveness of performing measurements using a novel detector setup. Methods: Simulations were performed with a shielded high-purity germanium (HPGe) semiconductor detector placed in the accelerator vault's maze, with a 2 cm diameter collimator through a 92 cm thick concrete wall. The detector was positioned 660 cm from a scattering rod (placed at isocenter) at an angle of 45° relative to the central axis. This setup was compared with the shielded detector positioned in the room, 200 cm from the scattering rod at the same CS angle. Simulations were used to determine fluence contributions from three sources: (1) CS photons traveling through the collimator aperture, the intended signal, (2) CS scatter photons penetrating the detector shield, and (3) room-scattered photons penetrating the detector shield. Variance reduction techniques including weight windows, DXTRAN spheres, forced collisions, and energy cutoffs were used. Results: Simulations showed that the number of pulses per starting particle from an F8 detector tally for the intended signal decreased by a factor of 102 when moving the detector out of the vault. This reduction in signal was amplified for the unwanted scatter signal which decreased by up to a factor of 109. Conclusion: This work used MCNP6 to show that using a vault wall to shield unwanted scatter and increasing isocenter-to-detector distance reduces unwanted fluence to the detector. This study aimed to provide motivation for future experimental work using the proposed setup.

TU‐H‐BRC‐05: Stereotactic Radiosurgery Optimized with Orthovoltage Beams

Purpose:To achieve improved stereotactic radiosurgery (SRS) dose distributions using orthovoltage energy fluence modulation with inverse planning optimization techniques.Methods:A pencil beam model was used to calculate dose distributions from the institution's orthovoltage unit at 250 kVp. Kernels for the model were derived using Monte Carlo methods as well as measurements with radiochromic film. The orthovoltage photon spectra, modulated by varying thicknesses of attenuating material, were approximated using open‐source software. A genetic algorithm search heuristic routine was used to optimize added tungsten filtration thicknesses to approach rectangular function dose distributions at depth. Optimizations were performed for depths of 2.5, 5.0, and 7.5 cm, with cone sizes of 8, 10, and 12 mm.Results:Circularly‐symmetric tungsten filters were designed based on the results of the optimization, to modulate the orthovoltage beam across the aperture of an SRS cone collimator. For each depth and cone size combination examined, the beam flatness and 80–20% and 90–10% penumbrae were calculated for both standard, open cone‐collimated beams as well as for the optimized, filtered beams. For all configurations tested, the modulated beams were able to achieve improved penumbra widths and flatness statistics at depth, with flatness improving between 33 and 52%, and penumbrae improving between 18 and 25% for the modulated beams compared to the unmodulated beams.Conclusion:A methodology has been described that may be used to optimize the spatial distribution of added filtration material in an orthovoltage SRS beam to result in dose distributions at depth with improved flatness and penumbrae compared to standard open cones. This work provides the mathematical foundation for a novel, orthovoltage energy fluence‐modulated SRS system.

TH-C-BRC-02: A Review of Emerging Technologies in Robotic SRS/SBRT Delivery

The delivery techniques for SRS/SBRT have been under rapid developments in recent years, which pose new challenges to medical physicists ranging from planning and quality assurance to imaging and motion management. This educational course will provide a general overview of the latest delivery techniques in SRS/SBRT, and discuss the clinical processes to address the challenges of each technique with special emphasis on dedicated gamma-ray based device, robotic x-band linac-based system and conventional C-arm s-band linac-based SRS systems. (1). Gamma-ray based SRS/SRT: This is the gold standard of intracranial SRS. With the advent of precision imaging guidance and frameless patient positioning capabilities, novel stereoscopic CBCT and automatic dose adaption solution are introduced to the Gamma-ray based SRS for the first time. The first North American system has been approved by the US regulatory for patient treatments in the spring of 2016. (2). Robotic SRS/SBRT system: A number of technological milestones have been developed in the past few years, including variable aperture collimator, sequential optimization technique, and the time reduction technique. Recently, a new robotic model allows the option of a multi-leaf collimator. These technological advances have reduced the treatment time and improved dose conformity significantly and could potentially expand the application of radiosurgery for the treatment of targets not previously suitable for robotic SRS/SBRT or fractionated stereotactic radiotherapy. These technological advances have created new demanding mandates on hardware and patient quality assurance (QA) tasks, as well as the need for updating/educating the physicists in the community on these requirements. (3). Conventional Linac based treatments: Modulated arc therapy (MAT) has gained wide popularities in Linac-based treatments in recent years due to its high delivery efficiency and excellent dose conformities. Recently, MAT has been introduced to deliver highly conformal radiosurgery treatments to multiple targets simultaneously via a single isocenter to replace the conventional multi-iso multi-plan treatments. It becomes important to understand the advantages and limitations of this technique, and the pitfalls for implementing this technique in clinical practice. The planning process of single-iso multi-target MAT will be described, and its plan quality and delivery efficiency will be compared with multi-iso plans. The QA process for verifying such complex plans will be illustrated, and pitfalls in imaging and patient set up will be discussed. Overall, this session will focus on the following areas: 1) Update on the emerging technology in current SRS/SBRT delivery. 2) New developments in treatment planning and Quality Assurance program. 3) Imaging guidance and motion management. Learning Objectives: 1.To understand the SRS/SBRT principles and its clinical applications, and gain knowledge on the emerging technologies in SRS/SBRT. 2.To review planning concepts and useful tips in treatment planning. 3.To learn about the imaging guidance procedures and the quality assurance program in SRS/SBRT. National Institutes of Health, Varian Medical System; L. Ren, The presenter is funded by National Institutes of Health and Varian Medical System.

TH-C-BRC-03: Emerging Linac Based SRS/SBRT Technologies with Modulated Arc Delivery

The delivery techniques for SRS/SBRT have been under rapid developments in recent years, which pose new challenges to medical physicists ranging from planning and quality assurance to imaging and motion management. This educational course will provide a general overview of the latest delivery techniques in SRS/SBRT, and discuss the clinical processes to address the challenges of each technique with special emphasis on dedicated gamma-ray based device, robotic x-band linac-based system and conventional C-arm s-band linac-based SRS systems. (1). Gamma-ray based SRS/SRT: This is the gold standard of intracranial SRS. With the advent of precision imaging guidance and frameless patient positioning capabilities, novel stereoscopic CBCT and automatic dose adaption solution are introduced to the Gamma-ray based SRS for the first time. The first North American system has been approved by the US regulatory for patient treatments in the spring of 2016. (2). Robotic SRS/SBRT system: A number of technological milestones have been developed in the past few years, including variable aperture collimator, sequential optimization technique, and the time reduction technique. Recently, a new robotic model allows the option of a multi-leaf collimator. These technological advances have reduced the treatment time and improved dose conformity significantly and could potentially expand the application of radiosurgery for the treatment of targets not previously suitable for robotic SRS/SBRT or fractionated stereotactic radiotherapy. These technological advances have created new demanding mandates on hardware and patient quality assurance (QA) tasks, as well as the need for updating/educating the physicists in the community on these requirements. (3). Conventional Linac based treatments: Modulated arc therapy (MAT) has gained wide popularities in Linac-based treatments in recent years due to its high delivery efficiency and excellent dose conformities. Recently, MAT has been introduced to deliver highly conformal radiosurgery treatments to multiple targets simultaneously via a single isocenter to replace the conventional multi-iso multi-plan treatments. It becomes important to understand the advantages and limitations of this technique, and the pitfalls for implementing this technique in clinical practice. The planning process of single-iso multi-target MAT will be described, and its plan quality and delivery efficiency will be compared with multi-iso plans. The QA process for verifying such complex plans will be illustrated, and pitfalls in imaging and patient set up will be discussed. Overall, this session will focus on the following areas: 1) Update on the emerging technology in current SRS/SBRT delivery. 2) New developments in treatment planning and Quality Assurance program. 3) Imaging guidance and motion management. Learning Objectives: 1. To understand the SRS/SBRT principles and its clinical applications, and gain knowledge on the emerging technologies in SRS/SBRT. 2. To review planning concepts and useful tips in treatment planning. 3. To learn about the imaging guidance procedures and the quality assurance program in SRS/SBRT. National Institutes of Health, Varian Medical System; L. Ren, The presenter is funded by National Institutes of Health and Varian Medical System.

TH-C-BRC-01: An Overview of Emerging Technologies in SRS/SBRT Delivery

The delivery techniques for SRS/SBRT have been under rapid developments in recent years, which pose new challenges to medical physicists ranging from planning and quality assurance to imaging and motion management. This educational course will provide a general overview of the latest delivery techniques in SRS/SBRT, and discuss the clinical processes to address the challenges of each technique with special emphasis on dedicated gamma-ray based device, robotic x-band linac-based system and conventional C-arm s-band linac-based SRS systems. (1). Gamma-ray based SRS/SRT: This is the gold standard of intracranial SRS. With the advent of precision imaging guidance and frameless patient positioning capabilities, novel stereoscopic CBCT and automatic dose adaption solution are introduced to the Gamma-ray based SRS for the first time. The first North American system has been approved by the US regulatory for patient treatments in the spring of 2016. (2). Robotic SRS/SBRT system: A number of technological milestones have been developed in the past few years, including variable aperture collimator, sequential optimization technique, and the time reduction technique. Recently, a new robotic model allows the option of a multi-leaf collimator. These technological advances have reduced the treatment time and improved dose conformity significantly and could potentially expand the application of radiosurgery for the treatment of targets not previously suitable for robotic SRS/SBRT or fractionated stereotactic radiotherapy. These technological advances have created new demanding mandates on hardware and patient quality assurance (QA) tasks, as well as the need for updating/educating the physicists in the community on these requirements. (3). Conventional Linac based treatments: Modulated arc therapy (MAT) has gained wide popularities in Linac-based treatments in recent years due to its high delivery efficiency and excellent dose conformities. Recently, MAT has been introduced to deliver highly conformal radiosurgery treatments to multiple targets simultaneously via a single isocenter to replace the conventional multi-iso multi-plan treatments. It becomes important to understand the advantages and limitations of this technique, and the pitfalls for implementing this technique in clinical practice. The planning process of single-iso multi-target MAT will be described, and its plan quality and delivery efficiency will be compared with multi-iso plans. The QA process for verifying such complex plans will be illustrated, and pitfalls in imaging and patient set up will be discussed. Overall, this session will focus on the following areas: 1) Update on the emerging technology in current SRS/SBRT delivery. 2) New developments in treatment planning and Quality Assurance program. 3) Imaging guidance and motion management. Learning Objectives: 1. To understand the SRS/SBRT principles and its clinical applications, and gain knowledge on the emerging technologies in SRS/SBRT. 2. To review planning concepts and useful tips in treatment planning. 3. To learn about the imaging guidance procedures and the quality assurance program in SRS/SBRT. National Institutes of Health, Varian Medical System; L. Ren, The presenter is funded by National Institutes of Health and Varian Medical System.

TH-C-BRC-00: Emerging Technologies in SRS/SBRT Delivery

The delivery techniques for SRS/SBRT have been under rapid developments in recent years, which pose new challenges to medical physicists ranging from planning and quality assurance to imaging and motion management. This educational course will provide a general overview of the latest delivery techniques in SRS/SBRT, and discuss the clinical processes to address the challenges of each technique with special emphasis on dedicated gamma-ray based device, robotic x-band linac-based system and conventional C-arm s-band linac-based SRS systems. (1). Gamma-ray based SRS/SRT: This is the gold standard of intracranial SRS. With the advent of precision imaging guidance and frameless patient positioning capabilities, novel stereoscopic CBCT and automatic dose adaption solution are introduced to the Gamma-ray based SRS for the first time. The first North American system has been approved by the US regulatory for patient treatments in the spring of 2016. (2). Robotic SRS/SBRT system: A number of technological milestones have been developed in the past few years, including variable aperture collimator, sequential optimization technique, and the time reduction technique. Recently, a new robotic model allows the option of a multi-leaf collimator. These technological advances have reduced the treatment time and improved dose conformity significantly and could potentially expand the application of radiosurgery for the treatment of targets not previously suitable for robotic SRS/SBRT or fractionated stereotactic radiotherapy. These technological advances have created new demanding mandates on hardware and patient quality assurance (QA) tasks, as well as the need for updating/educating the physicists in the community on these requirements. (3). Conventional Linac based treatments: Modulated arc therapy (MAT) has gained wide popularities in Linac-based treatments in recent years due to its high delivery efficiency and excellent dose conformities. Recently, MAT has been introduced to deliver highly conformal radiosurgery treatments to multiple targets simultaneously via a single isocenter to replace the conventional multi-iso multi-plan treatments. It becomes important to understand the advantages and limitations of this technique, and the pitfalls for implementing this technique in clinical practice. The planning process of single-iso multi-target MAT will be described, and its plan quality and delivery efficiency will be compared with multi-iso plans. The QA process for verifying such complex plans will be illustrated, and pitfalls in imaging and patient set up will be discussed. Overall, this session will focus on the following areas: 1) Update on the emerging technology in current SRS/SBRT delivery. 2) New developments in treatment planning and Quality Assurance program. 3) Imaging guidance and motion management. Learning Objectives: 1.To understand the SRS/SBRT principles and its clinical applications, and gain knowledge on the emerging technologies in SRS/SBRT. 2.To review planning concepts and useful tips in treatment planning. 3.To learn about the imaging guidance procedures and the quality assurance program in SRS/SBRT. National Institutes of Health, Varian Medical System; L. Ren, The presenter is funded by National Institutes of Health and Varian Medical System.

A Novel Method for Quality Assurance of the Cyberknife Iris Variable Aperture Collimator.

Objective: To characterize a novel method for field-size quality assurance of a variable approximately circular aperture collimator by means of dose-area product measurements and to validate its practical use over two years of clinical application.Methods: To assess methodical limitations, we analyze measurement errors due to change in linac output, beam tuning, uncertainty in MU delivery, daily factors, inherent uncertainty of the large-area parallel-plate ionisation chamber, and misalignment of the large-area parallel-plate ionisation chamber relative to the primary beam axis. To establish a baseline for quality assurance, the dose-area product is measured with the large-area parallel-plate ionisation chamber for all 12 clinical iris apertures in relation to the 60 mm fixed reference aperture. To evaluate the long-term stability of the Iris collimation system, deviation from baseline data is assessed monthly and compared to a priori derived tolerance levels.Results: Only chamber misalignment, variation in output, and uncertainty in MU delivery contribute to a combined error that is estimated at 0.2 % of the nominal field size. This is equivalent to a resolution of 0.005 mm for the 5 mm, and 0.012 mm for the 60 mm field. The method offers ease of use, small measurement time commitment, and is independent of most error sources. Over the observed period, the Iris accuray is within the tolerance levels.Conclusions: The method is an advantageous alternative to film quality assurance with a high reliability, short measurement time, and superior accuracy in field-size determination.

Influence of beam incidence and irradiation parameters on stray neutron doses to healthy organs of pediatric patients treated for an intracranial tumor with passive scattering proton therapy

PurposeIn scattering proton therapy, the beam incidence, i.e. the patient’s orientation with respect to the beam axis, can significantly influence stray neutron doses although it is almost not documented in the literature. MethodsMCNPX calculations were carried out to estimate stray neutron doses to 25 healthy organs of a 10-year-old female phantom treated for an intracranial tumor. Two beam incidences were considered in this article, namely a superior (SUP) field and a right lateral (RLAT) field. For both fields, a parametric study was performed varying proton beam energy, modulation width, collimator aperture and thickness, compensator thickness and air gap size. ResultsUsing a standard beam line configuration for a craniopharyngioma treatment, neutron absorbed doses per therapeutic dose of 63μGyGy−1 and 149μGyGy−1 were found at the heart for the SUP and the RLAT fields, respectively. This dose discrepancy was explained by the different patient’s orientations leading to changes in the distance between organs and the final collimator where external neutrons are mainly produced. Moreover, investigations on neutron spectral fluence at the heart showed that the number of neutrons was 2.5times higher for the RLAT field compared against the SUP field. Finally, the influence of some irradiation parameters on neutron doses was found to be different according to the beam incidence. ConclusionBeam incidence was thus found to induce large variations in stray neutron doses, proving that this parameter could be optimized to enhance the radiation protection of the patient.