Distance To Agreement Research Articles

Impact of dose rate on accuracy of intensity modulated radiation therapy plan delivery using the pretreatment portal dosimetry quality assurance and setting up the workflow at hospital levels.

The aim of this study was to examine the impact of dose rate on accuracy of intensity modulated radiation therapy (IMRT) plan delivery by comparing the gamma agreement between the calculated and measured portal doses by pretreatment quality assurance (QA) using electronic portal imaging device dosimetry and creating a workflow for the pretreatment IMRT QA at hospital levels. As the improvement in gamma agreement leads to increase in the quality of IMRT treatment delivery, gamma evaluation was carried out for the calculated and the measured portal images for the criteria of 3% dose difference and 3 mm distance-to-agreement (DTA). Three gamma parameters: Maximum gamma, average gamma, and percentage of the field area with a gamma value>1.0 were analyzed. Three gamma index parameters were evaluated for 40 IMRT plans (315 IMRT fields) which were calculated for 400 monitor units (MU)/min dose rate and maximum multileaf collimator (MLC) speed of 2.5 cm/s. Gamma parameters for all 315 fields are within acceptable limits set at our center. Further, to improve the gamma results, we set an action level for this study using the mean and standard deviation (SD) values from the 315 fields studied. Forty out of 315 IMRT fields showed low gamma agreement (gamma parameters>2 SD as per action level of the study). The parameters were recalculated and reanalyzed for the dose rates of 300, 400 and 500 MU/min. Lowering the dose rate helped in getting an enhanced gamma agreement between the calculated and measured portal doses of complicated fields. This may be attributed to the less complex motion of MLC over time and the MU of the field/segment. An IMRT QA work flow was prepared which will help in improving the quality of IMRT delivery.

Consistency analysis for the performance of planar detector systems used in advanced radiotherapy

Purpose: To evaluate the performance linked to the consistency of a-Si EPID and ion-chamber array detectors for dose verification in advanced radiotherapy. Methods: Planar measurements were made for 250 patients using an array of ion chamber and a-Si EPID. For pre-treatment verification, the plans were generated on the phantom for re-calculation of doses. The γ-evaluation method with the criteria: dose-difference (DD) ≤ 3% and distance-to-agreement (DTA) ≤ 3 mm was used for the comparison of measurements. Also, the central axis (CAX) doses were measured using 0.125cc ion chamber and were compared with the central chamber of array and central pixel correlated dose value from EPID image. Two types of statistical approaches were applied for the analysis. Conventional statistics used analysis of variance (ANOVA) and unpaired t-test to evaluate the performance of the detectors. And statistical process control (SPC) was utilized to study the statistical variation for the measured data. Control charts (CC) based on an average , standard deviation ( ) and exponentially weighted moving averages (EWMA) were prepared. The capability index (C pm ) was determined as an indicator for the performance consistency of the two systems. Results: Array and EPID measurements had the average gamma pass rates as 99.9% ± 0.15% and 98.9% ± 1.06% respectively. For the point doses, the 0.125cc chamber results were within 2.1% ± 0.5% of the central chamber of the array. Similarly, CAX doses from EPID and chamber matched within 1.5% ± 0.3%. The control charts showed that both the detectors were performing optimally and all the data points were within ± 5%. EWMA charts revealed that both the detectors had a slow drift along the mean of the processes but was found well within ± 3%. Further, higher C pm values for EPID demonstrate its higher efficiency for radiotherapy techniques. Conclusion: The performances of both the detectors were seen to be of high quality irrespective of the radiotherapy technique. Higher C pm values for EPID indicate its higher efficiency than array.

A new approach for dose calculation in targeted radionuclide therapy (TRT) based on collapsed cone superposition: validation with 90Y

To speed-up the absorbed dose (AD) computation while accounting for tissue heterogeneities, a Collapsed Cone (CC) superposition algorithm was developed and validated for 90Y. The superposition was implemented with an Energy Deposition Kernel scaled with the radiological distance, along with CC acceleration. The validation relative to Monte Carlo simulations was performed on 6 phantoms involving soft tissue, lung and bone, a radioembolisation treatment and a simulated bone metastasis treatment. As a figure of merit, the relative AD difference (ΔAD) in low gradient regions (LGR), distance to agreement (DTA) in high gradient regions and the γ(1%,1 mm) criterion were used for the phantoms. Mean organ doses and γ(3%,3 mm) were used for the patient data. For the semi-infinite sources, ΔAD in LGR was below 1%. DTA was below 0.6 mm. All profiles verified the γ(1%,1 mm) criterion. For both clinical cases, mean doses differed by less than 1% for the considered organs and all profiles verified the γ(3%,3 mm). The calculation time was below 4 min on a single processor for CC superposition and 40 h on a 40 nodes cluster for MCNP (108 histories). Our results show that the CC superposition is a very promising alternative to MC for 90Y dosimetry, while significantly reducing computation time.

Intra- and intervariability in beam data commissioning among water phantom scanning systems.

Accurate beam data acquisition during commissioning is essential for modeling the treatment planning system and dose calculation in radiotherapy. Although currently several commercial scanning systems are available, there is no report that compared the differences among the systems because most institutions do not acquire several scanning systems due to the high cost, storage space, and infrequent usage. In this report, we demonstrate the intra‐ and intervariability of beam profiles measured with four commercial scanning systems. During a recent educational and training workshop, four different vendors of beam scanning water phantoms were invited to demonstrate the operation and data collection of their systems. Systems were set up utilizing vendor‐recommended protocols and were operated with a senior physicist, who was assigned as an instructor along with vendor. During the training sessions, each group was asked to measure beam parameters, and the intravariability in percent depth dose (PDD). At the end of the day, the profile of one linear accelerator was measured with each system to evaluate intervariability. Relatively very small (SD < 0.12%) intervariability in PDD was observed among four systems at a region deeper than peak (1.5 cm). All systems showed almost identical profiles. At the area within 80% of radiation field, the average, and maximum differences were within ± 0.35% and 0.80%, respectively, compared to arbitrarily chosen IBA system as reference. In the penumbrae region, the distance to agreement (DTA) of the region where dose difference exceed ± 1% was less than 1 mm. Repeated PDD measurement showed small intravariability with SD < 0.5%, although large SD was observed in the buildup region. All four water phantom scanning systems demonstrated adequate accuracy for beam data collection (i.e., within 1% of dose difference or 1 mm of DTA among each other). It is concluded that every system is capable of acquiring accurate beam. Thus the selection of a water scanning system should be based on institutional comfort, personal preference of software and hardware, and financial consideration.PACS number: 87.53.Bn

SU-E-T-356: Accuracy of Eclipse Electron Macro Monte Carlo Dose Algorithm for Use in Bolus Electron Conformal Therapy

Purpose: To evaluate the accuracy of electron dose distribution calculated by the Varian Eclipse electron Monte Carlo (eMC) algorithm for use with recent commercially available bolus electron conformal therapy (ECT). Methods: eMC-calculated electron dose distributions for bolus ECT have been compared to those previously measured for cylindrical phantoms (retromolar trigone and nose), whose axial cross sections were based on the mid-PTV CT anatomy for each site. The phantoms consisted of SR4 muscle substitute, SR4 bone substitute, and air. The bolus ECT treatment plans were imported into the Eclipse treatment planning system and calculated using the maximum allowable histories (2×10^9), resulting in a statistical error of <0.2%. Smoothing was not used for these calculations. Differences between eMC-calculated and measured dose distributions were evaluated in terms of absolute dose difference as well as distance to agreement (DTA). Results: Results from the eMC for the retromolar trigone phantom showed 89% (41/46) of dose points within 3% dose difference or 3 mm DTA. There was an average dose difference of −0.12% with a standard deviation of 2.56%. Results for the nose phantom showed 95% (54/57) of dose points within 3% dose difference or 3 mm DTA. There was an average dose difference of 1.12% with a standard deviation of 3.03%. Dose calculation times for the retromolar trigone and nose treatment plans were 15 min and 22 min, respectively, using 16 processors (Intel Xeon E5-2690, 2.9 GHz) on a Varian Eclipse framework agent server (FAS). Results of this study were consistent with those previously reported for accuracy of the eMC electron dose algorithm and for the .decimal, Inc. pencil beam redefinition algorithm used to plan the bolus. Conclusion: These results show that the accuracy of the Eclipse eMC algorithm is suitable for clinical implementation of bolus ECT.

SU-E-T-535: Preliminary 2D and 3D Gamma Calculation Comparison Using PRESAGE

Purpose: To compare gamma calculations from 2D and 3D dosimetry measurements for phantom quality assurance. Methods: An IROC Houston (RPC) head and neck phantom was irradiated with a 9 beam IMRT plan using two inserts: a TLD and film insert and a PRESAGE insert. Both inserts were irradiated 3 times. The film and PRESAGE doses were scaled to the TLD dose and 2D gamma calculations were made in the axial and sagittal planes bisecting the primary target. 3D gamma measurements were taken within the PRESAGE dosimeter volume. Gamma constraints of 3%/3mm distance to agreement (DTA), 5%/3mm DTA and 7%/4mm DTA were used in the study. The 3 irradiations for each insert were averaged together for comparison. Results: Film measurements for the 2D gamma showed 85% pixels passing at 3%/3mm in both planes. The 5%/3 mm constraint had 93% and 90% passing in the two planes. The 7%/4mm restraint resulted in 99% passing in both planes. The PRESAGE 2D gamma passed 66% and 61% of pixels in the both planes at 3%/3mm. At 5%/3mm 86% and 82% passed. For 7%/4mm, 94% of pixels passed in both planes. The 3D gamma resulted in a pass rate of 90% at 3%/3mm, 95% atmore » 5%/3mm, and 99% at 7%/4mm. Conclusion: 2D gamma pass rates using film showed a higher pass rate than PRESAGE using the same criteria in the same planes. This may be due to poor 3D registration with the treatment plan compared to the 2D film registration system. The 3D gamma results had a higher pass rate (> 90% pass rate) possibly because it sampled many more pixels in noncritical volumes thus diluting the percent of pixels passing. 3D restraints should be more restrictive to be comparable to 2D results. Funding from NIH grant 5R01CA100835.« less

SU-E-T-639: A Study On the Response of 2D Array Detector for VMAT Delivery for a Period of Two Years

Purpose: To evaluate the 2D array for radiation response for a period of 2 years. Methods: 45 VMAT plans already treated and quality assured before 2 years, 1.5 years and 1 year were selected for the study. Quality assurances of the plans were done using 2D array combined with Octavius phantom. Verification plans were recalculated without changing any parameters in Eclipse 10.0 TPS using the AAA algorithm. Response of 2D array to the plans treated before 2 years, 1.5 years and 1 year where evaluated. The results were analyzed using the Gamma analysis method with the standard gamma passing criteria of 3mm distance to agreement (DTA) and 3% dose difference (DD). Results: All the plans evaluated passed the gamma analysis with a percentage greater than 95, except for three cases. Higher gamma passing criteria where observed for all the analyzed plans, when analysis done before 2 years, 1.5 years and 1 year. The standard deviation of ± 1.38, ± 1.40,± 0.97 where observed between the plans when verification plans did before 2 years, 1.5 years and 1 year respectively. Same set of plans shows a standard deviation of ± 0.70, ± 1.36, and ± 1.18, when analysis done recently. A significance difference in response of the array when analysis done recently for the verification plans treated and quality assured before 2 years.This indicates a slightly reduced response of 2D array towards radiation response as the array gets older. Conclusion: It is found that 2D array shows a reduced response against radiation detection over a period of years. An onsite calibration of the instrument is recommended before the measurements. A dose correction factor can be applied if necessary to the results if the radiation response and efficiency of the array is very poor.

SU-E-T-138: Dosimetric Verification For Volumetric Modulated Arc Therapy Cranio-Spinal Irradiation Technique

Purpose: Dosimetric feasibility of cranio-spinal irradiation with volumetric modulated arc therapy (VMAT-CSI) technique in terms of dose distribution accuracy was investigated using a humanlike phantom. Methods: The OARs and PTV volumes for the Rando phantom were generated on supine CT images. Eclipse (version 8.6) TPS with AAA algorithm was used to create the treatment plan with VMAT-CSI technique. RapidArc plan consisted of cranial, upper spinal (US) and lower spinal (LS) regions that were optimized in the same plan. US field was overlapped by 3cm with cranial and LS fields. Three partial arcs for cranium and 1 full arc for each US and LS region were used. The VMAT-CSI dose distribution inside the Rando phantom was measured with thermoluminescent detectors (TLD) and film dosimetry, and was compared to the calculated doses of field junctions, target and OARs. TLDs were placed at 24 positions throughout the phantom. The measured TLD doses were compared to the calculated point doses. Planar doses for field junctions were verified with Gafchromic films. Films were analyzed in PTW Verisoft application software using gamma analysis method with the 4 mm distance to agreement (DTA) and 4% dose agreement criteria. Results: TLD readings demonstrated accurate dose delivery, with amore » median dose difference of -0.3% (range: -8% and 12%) when compared with calculated doses for the areas inside the treatment portal. The maximum dose difference was 12% higher in testicals that are outside the treatment region and 8% lower in lungs where the heterogeinity was higher. All planar dose verifications for field junctions passed the gamma analysis and measured planar dose distributions demonstrated average 97% agreement with calculated doses. Conclusion: The dosimetric data verified with TLD and film dosimetry shows that VMAT-CSI technique provides accurate dose distribution and can be delivered safely.« less

SU‐E‐T‐316: The Design of a Risk Index Method for 3D Patient Specific QA

Purpose:To suggest a new guidance for the evaluation of 3D patient specific QA, a structure‐specific risk‐index (RI) method was designed and implemented.Methods:A new algorithm was designed to assign the score of Pass, Fail or Pass with Risk to all 3D voxels in each structure by improving a conventional Gamma Index (GI) algorithm, which implied the degree of the risk of under‐dose to the treatment target or over‐dose to the organ at risks (OAR). Structure‐specific distance to agreement (DTOA), dose difference and minimum checkable dose were applied to the GI algorithm, and additional parameters such as dose gradient factor and dose limit of structures were used to the RI method. Maximum passing rate (PR) and minimum PR were designed and calculated for each structure with the RI method. 3D doses were acquired from a spine SBRT plan by simulating the shift of beam iso‐center, and tested to show the feasibility of the suggested method.Results:When the iso‐center was shifted by 1 mm, 2 mm, and 3 mm, the PR of conventional GI method between shifted and non‐shifted 3D doses were 99.9%, 97.4%, and 89.7% for PTV, 99.8%, 84.8%, and 63.2% for spinal cord, and 100%, 99.5%, 91.7% for right lung. The minimum PRs from the RI method were 98.9%, 96.9%, and 89.5% for PTV, and 96.1%, 79.3%, 57.5% for spinal cord, and 92.5%, 92.0%, 84.4% for right lung, respectively. The maximum PRs from the RI method were equal or less than the PRs from the conventional GI evaluation.Conclusion:Designed 3D RI method showed more strict acceptance level than the conventional GI method, especially for OARs. The RI method is expected to give the degrees of risks in the delivered doses, as well as the degrees of agreements between calculated 3D doses and measured (or simulated) 3D doses.

SU-E-T-199: How Number of Control Points Influences the Dynamic IMRT Plan Quality and Deliverability

Purpose: To study the influence of number of control points on plan quality and deliverability. Methods: Five previously treated patients of carcinoma of rectum were selected. Planning target volume (PTV) and organs at risk (OARs) i.e. bladder and bowel were contoured. Dynamic IMRT plans (6MV, 7-fields, 45Gy/25 fractions and prescribed at 95% isodose) were created in Eclipse (Varian medical system, Palo Alto, CA) treatment planning system (TPS) for Varian CL2300C/D linear-accelerator. Base plan was calculated with 166 control points, variable mode (Eclipse Default). For generating other plans, all parameters were kept constant, only number of control points (Fixed mode) was varied as follows: 100, 166 and 200. Then, plan quality was analyzed in terms of maximum and mean dose received by the PTV and OARs. For plan deliverability, TPS calculated fluence was verified with I’matriXX (IBA Dosimetry, Germany) array and compared with TPS dose-plane using gamma index criteria of 3% dose difference and 3mm distance to agreement (DTA). Total number of monitor units (MU) required to deliver a plan was also noted. Results: The maximum variation for the PTV maximum with respect to eclipse default control point (166) was 0.28% (0.14Gy). Similarly, PTV mean varied only up to 0.22 %(0.11Gy). Bladder maximum and bladder mean varied up to 0.51% (0.24Gy) and 0.16% (0.06Gy). The variation for the bowel maximum and bowel mean was also only 0.39% (0.19Gy) and 0.33% (0.04Gy). Total MU was within 0.32 % (4MU). Average gamma pass rate using different control points for five patients are 98.75±0.33%, 99.37±0.09%, 99.29±0.12%, 98.14±0.13% and 99.25±0.14% respectively. Conclusion: Slight variation (<1%) in PTV and OARs maximum and mean doses was observed with varying number of control points. Monitor unit was also not varied much. Reducing number of control points did not showed any comprise in plan deliverability in terms of gamma index pass rate.

SU‐E‐T‐32: An Application of GafChromic RTQA2 Film to the Patient Specified Quality Assurance

Purpose:GafChromic RTQA2 film is known as a quality assurance (QA) tool for light field and radiation field verification. This study is attempted to apply the RTQA2 film to the patient specified quality assurance.Methods:Pre‐irradiated and post‐irradiated RTQA2 films were scanned in a reflection mode using a flatbed scanner. A plan‐based dose calibration method utilized the mapping information of calculated dose image and measured film image to create a dose vs. pixel value calibration model. This model was used to calibrate the measured film image from the pixel value (gray value) image to the dose image. The dose agreement between calculated and measured dose images were analyzed using the gamma analysis. To evaluate the feasibility of this method, three clinical approved RapidArc cases (one abdomen cancer and two head‐and‐neck cancer patients) were tested. The tolerance of 3% dose difference and 3 mm distance to agreement (DTA) and gamma index ≤ 1 were set for the analysis.Results:The calibrated film dose image from measurement was successfully compared to the predicted dose image from the commercial treatment planning. The gamma analysis results showed good consistency. Gamma passing rates were 99.02%, 94.84%, and 98.33% for the three patients, respectively.Conclusion:The plan based calibration method has the feasibility for dose verification without shortages of film batch and development time variation.

Dose verification of intensity modulated radiotherapy in head and neck tumors

Purpose: To evaluate the agreement between measured and calculated doses for head and neck tumors using different gamma criteria and to establish quality assurance protocol for the delivery of IMRT in The National Cancer Institute in Cairo. Methods : The dose is calculated for 30 patients using CMS Treatment Planning System. The ionization chamber (0.6 cm 3 Farmer type) is used for point dose measurements. The 2D-array (PTW 729) and GafChromic films (EBT2) are used for 2D graphical dose distribution. Four different gamma criteria of dose difference (DD) and distance to agreement (DTA) (3%/3 mm, 3%/5 mm, 4%/4 mm and 5%/5 mm DD / DTA) are selected. These criteria are evaluated while suppressing the dose of 10%, 20% or 30% from dose distribution. Results: Point dose evaluations using the ion chamber ranged from -2.6% to 3.7% (mean and standard deviation of 0.46 ± 1.7) . Significant differences are observed between the films and 2D-array for all criteria except the 3%/5 mm criteria (96.89 ± 2.2% vs. 94.81 ± 4.2% (p < 0.01)). Conclusion : Differences may exceed about 3% when the ionization chamber is present in steep dose gradient regions. The present results suggest the gamma criteria of 3%/5 mm as the most suitable criteria for IMRT quality assurance. This gamma criterion of 3%/5 mm favorably exceeds 95% in case of maximum dose while suppressing the dose of 20%.The use of 2D-array can reduce the IMRT QA workload. ------------------------------ Cite this article as: Elawady RA, Attalla EM, Elshemey WM, Shouman T, Alsayed AA. Dose verification of intensity modulated radiotherapy in head and neck tumors. Int J Cancer Ther Oncol 2014; 2 (3):02037. DOI : 10.14319/ijcto.0203.7

Compact two-electron wave function for bond dissociation and Van der Waals interactions: a natural amplitude assessment.

Electron correlations in molecules can be divided in short range dynamical correlations, long range Van der Waals type interactions, and near degeneracy static correlations. In this work, we analyze for a one-dimensional model of a two-electron system how these three types of correlations can be incorporated in a simple wave function of restricted functional form consisting of an orbital product multiplied by a single correlation function f (r12) depending on the interelectronic distance r12. Since the three types of correlations mentioned lead to different signatures in terms of the natural orbital (NO) amplitudes in two-electron systems, we make an analysis of the wave function in terms of the NO amplitudes for a model system of a diatomic molecule. In our numerical implementation, we fully optimize the orbitals and the correlation function on a spatial grid without restrictions on their functional form. Due to this particular form of the wave function, we can prove that none of the amplitudes vanishes and moreover that it displays a distinct sign pattern and a series of avoided crossings as a function of the bond distance in agreement with the exact solution. This shows that the wave function ansatz correctly incorporates the long range Van der Waals interactions. We further show that the approximate wave function gives an excellent binding curve and is able to describe static correlations. We show that in order to do this the correlation function f (r12) needs to diverge for large r12 at large internuclear distances while for shorter bond distances it increases as a function of r12 to a maximum value after which it decays exponentially. We further give a physical interpretation of this behavior.

Evaluation of a software system for estimating planned dose error in patients, based on planar IMRT QA measurements

BackgroundIntensity modulated radiation therapy (IMRT) dosimetry verification is routinely conducted via integrated or individual field dosimetry using film or a matrix of detectors. Techniques and software systems are commercially available which use individual field dosimetry measurements as input into algorithms that estimate 3D patient dose distributions on CT scan derived target volumes and organs at risk (OARs), thus allowing direct dose-volume histogram (DVH) analysis vs. treatment planning system (TPS) DVH. The purpose of this work is to present a systematic benchmarking technique to evaluate the accuracy and consistency of such a software system.MethodsA MapCheck2 diode array and 3DVH™ software from Sun Nuclear were used for this study. Delivered planar dose was measured with the diode array as an input to 3DVH™ software that was used to estimate the 3D dose matrix. Accuracy of the output of 3DVH™ is tested by comparing measured planar doses over a range of depths to the same planes reconstructed by 3DVH™. Different fields from complex IMRT cases were selected and examined in this study. The sensitivity to depth of measurement was evaluated.ResultsThe Gamma Index analysis, comparing calculated 3D dose with measured 3D dose with 2% and 2mm distance-to-agreement (DTA) criteria returned a pass rate of > 90% for all patient cases calculated by the treatment planning system and it returned a pass rate of > 96% in 9 out of 10 cases calculated by 3DVH™. Extracted computed dose planes with 3DVH™ software at different depths in the flat phantom passed all gamma evaluation analyses when compared to measured planes at different depths using MapCheck2.ConclusionsStudying complex head and neck IMRT fields, it was shown that the 3D dose distribution predicted by the planned dose perturbation (PDP) algorithm is both accurate and consistent.

Monte Carlo based beam model using a photon MLC for modulated electron radiotherapy

Modulated electron radiotherapy (MERT) promises sparing of organs at risk for certain tumor sites. Any implementation of MERT treatment planning requires an accurate beam model. The aim of this work is the development of a beam model which reconstructs electron fields shaped using the Millennium photon multileaf collimator (MLC) (Varian Medical Systems, Inc., Palo Alto, CA) for a Varian linear accelerator (linac). This beam model is divided into an analytical part (two photon and two electron sources) and a Monte Carlo (MC) transport through the MLC. For dose calculation purposes the beam model has been coupled with a macro MC dose calculation algorithm. The commissioning process requires a set of measurements and precalculated MC input. The beam model has been commissioned at a source to surface distance of 70 cm for a Clinac 23EX (Varian Medical Systems, Inc., Palo Alto, CA) and a TrueBeam linac (Varian Medical Systems, Inc., Palo Alto, CA). For validation purposes, measured and calculated depth dose curves and dose profiles are compared for four different MLC shaped electron fields and all available energies. Furthermore, a measured two-dimensional dose distribution for patched segments consisting of three 18 MeV segments, three 12 MeV segments, and a 9 MeV segment is compared with corresponding dose calculations. Finally, measured and calculated two-dimensional dose distributions are compared for a circular segment encompassed with a C-shaped segment. For 15 × 34, 5 × 5, and 2 × 2 cm(2) fields differences between water phantom measurements and calculations using the beam model coupled with the macro MC dose calculation algorithm are generally within 2% of the maximal dose value or 2 mm distance to agreement (DTA) for all electron beam energies. For a more complex MLC pattern, differences between measurements and calculations are generally within 3% of the maximal dose value or 3 mm DTA for all electron beam energies. For the two-dimensional dose comparisons, the differences between calculations and measurements are generally within 2% of the maximal dose value or 2 mm DTA. The results of the dose comparisons suggest that the developed beam model is suitable to accurately reconstruct photon MLC shaped electron beams for a Clinac 23EX and a TrueBeam linac. Hence, in future work the beam model will be utilized to investigate the possibilities of MERT using the photon MLC to shape electron beams.

Pre-Treatment Dose Verification of Imrt Using Gafchromic Ebt3 Film and 2DArray

Purpose: The present work deals with pre-treatment dosimetric verification of 10 prostate intensity-modulated radiotherapy (IMRT) plans obtained by Gafchromic EBT3 film and 2D-Array seven29 to establish quality control protocol for the delivery of prostate IMRT in our clinic. Methods: 10 prostate patients were irradiated according to IMRT techniques with 6 MV photon beams produced by a Varian DHX linear accelerator. Dose plans were computed using Eclipse 8.9 (version8.9, Varian, Palo Alto, CA, United States) treatment planning system (TPS). Pre-treatment dosimetric verification was carried out on field-perfield and total IMRT plan basis measuring 2D dose distributions in RW3 solid water phantom (PTW-Freiburg, Germany). For 10 patient plans, the dose distribution was re-calculated with the phantom CT scan and delivered to the phantom with the original and 0 degrees gantry, collimator and table angles. Thus IMRT quality control (QC) plans were generated. Dose distribution measurements were measured with Gafchromic EBT3 film and 2D-Array seven29 (PTW-Freiburg, Germany) two dimensional ionization chamber system. Verification measurements of total IMRT plans and each individual beams were compared with expected dose maps, and differences were evaluated by Verisoft program (PTW-Freiburg, Germany). To provide comparisons of multidimensional dose distributions, dose comparison tools such as gamma dose distribution, distance- to- agreement (DTA) and dose difference (DD) have been developed. The gamma dose distribution tool was used in our study. Three different gamma criteria of dose difference (DD) and distance to agreement (DTA) (3%/3 mm, 4%/4 mm and 5%/5 mm DD / DTA) are selected. These criteria are evaluated while suppressing the dose of 5% from dose distribution. Criterion validity accepted as section with gamma value less than or equal to 1 (γ ≤ 1) to be 90%. Results: In the comparison of dose distributions obtained from TPS and the results of PTW 2D-Array seven29 and Gafchromic EBT3 film dosimetry systems, it was showed that the compatibility of both methods were above 90% with respect to 3% DD and 3mm DTA criteria. PTW 2D-Array seven29 results compared to the results of the film was closer to the TPS data and this difference was statistically meaningful (p 0.05). Conclusions: The measurements performed with PTW 2D-Array seven29 were closer to the TPS data than film measurements and it takes less time during clinical use, so it could be preferred for routine use. The present results suggest the gamma criteria of 3%/3 mm as the most suitable criteria for prostate IMRT quality assurance.

A comprehensive comparison study of three different planar IMRT QA techniques using MapCHECK 2

The purpose of this study is to determine comparability of three different planar IMRT QA techniques: patient gantry angle composite (PGAC), single gantry angle composite (SGAC), and field by field (FBF), using MapCHECK 2 device and the γ test as performance metrics; and to assess the dependency of these techniques on intensity modulation, couch attenuation, and detector position (angular dependency). Ten highly modulated head and neck (H&N) and ten moderately modulated prostate IMRT validation plans were delivered using different techniques and were intercompared using the Student's t‐test. The IMRT QA measurements were evaluated by percentage of points passing the γ test for three different criteria: 1% (dose difference)/1 mm (distance to agreement (DTA)) (C1), 2%/2 mm (C2), and 3%/3 mm (C3). To investigate dependency of the IMRT validation on treatment couch, ionization chamber measurements, as well as the conventional MapCHECK 2 QAs, were performed with PGAC and PGAC‐WOC (without couch; using an extended tennis racket‐type insert with negligible attenuation assumed). To determine angular dependency of the MapCHECK 2, patient gantry field‐by‐field (PG‐FBF) technique was delivered and evaluated separately for each field. The differences of γ passing rates between SGAC and FBF were statistically insignificant, while these were statistically significant when compared to PGAC. SGAC and FBF techniques showed statistically insignificant differences between different levels of intensity modulation (H&N vs. Prostate) at C2 and C3 criteria, while PGAC could not for any criteria. The treatment couch has a significant impact on γ passing rates (PGAC vs. PGAC‐WOC), but an ionization chamber‐based IMRT validations showed clinically insignificant dose errors (< 2%) in all cases. This study showed that the MapCHECK 2 device has large angular dependency, especially at gantry angles of 90° and 270°, which dramatically affected the γ passing rates of PGAC. With proper consideration of couch attenuation and beam arrangement, the MapCHECK 2 will produce clinically comparable QA results using the three different planar IMRT QA techniques.PACS numbers: 87.55.km, 87.55.Qr, 87.56.Fc

Design and implementation of a film dosimetry audit tool for comparison of planned and delivered dose distributions in high dose rate (HDR) brachytherapy

A novel phantom is presented for ‘full system’ dosimetric audit comparing planned and delivered dose distributions in HDR gynaecological brachytherapy, using clinical treatment applicators. The brachytherapy applicator dosimetry test object consists of a near full-scatter water tank with applicator and film supports constructed of Solid Water, accommodating any typical cervix applicator. Film dosimeters are precisely held in four orthogonal planes bisecting the intrauterine tube, sampling dose distributions in the high risk clinical target volume, points A and B, bladder, rectum and sigmoid. The applicator position is fixed prior to CT scanning and through treatment planning and irradiation. The CT data is acquired with the applicator in a near clinical orientation to include applicator reconstruction in the system test. Gamma analysis is used to compare treatment planning system exported RTDose grid with measured multi-channel film dose maps. Results from two pilot audits are presented, using Ir-192 and Co-60 HDR sources, with a mean gamma passing rate of 98.6% using criteria of 3% local normalization and 3 mm distance to agreement (DTA). The mean DTA between prescribed dose and measured film dose at point A was 1.2 mm. The phantom was funded by IPEM and will be used for a UK national brachytherapy dosimetry audit.

Does the γ dose distribution comparison technique default to the distance to agreement test in clinical dose distributions?

To determine the validity of the assumption that the γ dose distribution comparison tool defaults to the distance to agreement test under conditions of clinically relevant steep dose gradients and γ test criteria. The assumption was tested by computing the angle θ between the dose axis and γ vector for clinical treatment plans. θ was a function of the evaluated dose distribution dose gradient and the ratio (α) of the dose difference to distance to agreement (DTA) criteria. Dose distributions from prostate, head and neck, and lung clinical treatment plans were examined: 50 treatment plans were selected for each of the prostate and head neck sites and 27 treatment plans were selected for lung. Dose-gradient histograms were prepared for each of the treatment plans using α = 1%/mm (e.g., 3%, 3 mm dose difference and DTA criteria, respectively). To determine how frequently different values of α were used in publications, papers that referenced the original γ paper were examined to identify the dose difference and DTA criteria used in those publications. In order to compare θ calculated using α = 1%/mm to θ for other values of α, the relationship between θ and α was determined. For most of the targets and critical structures, the maximum value of θ approached 90°, so the assumption that the γ tool defaulted to the DTA test in steep dose gradients was correct. Most of the published papers using the γ tool employed the 3%, 3 mm dose difference and DTA criteria, respectively. Most of the other evaluations used criteria such that α ≥ 1%/mm, so the conclusions relating to the examined dose distributions applied. There were a few papers employing very small values of α (including one where α = 0.17%/mm), breaking the assumption that the γ dose comparison tool defaulted to the DTA tool in steep dose gradients. Most published cases utilized values of α ≥ 1%/mm, and for those the implicit assumption that the γ dose comparison tool defaults to the DTA test in steep dose gradient regions was true. There were a few cases for which α was small enough to potentially invalidate this assumption. Care should be taken by investigators when selecting the γ test criteria to assure that the γ test will appropriately default to the DTA test in the steepest dose gradients being evaluated.

A comprehensive procedure for characterizing arbitrary azimuthally symmetric photon beams

PurposeA new Monte Carlo (MC) source model (SM) has been developed for azimuthally symmetric photon beams. MethodsThe MC simulation tallied phase space file (PSF) is divided into two categories depending on the relationship of the particle track line to the beam central axis: multiple point source (MPS) and spatial mesh based surface source (SMBSS). To validate this SM, MCNPX2.6 was used to generate two PSFs for a 6 MV photon beam from a Varian 2100C/D linear accelerator. ResultsPDDs and profiles were calculated using the SM and original PSF for different field sizes from 5 × 5 to 40 × 40 cm2. Agreement was within 2% of the maximum dose at 100 cm SSD and 2.5% of the maximum dose at 200 cm SSD for beam profiles at depths of 3.5 cm and 15 cm with respect to the original PSF. Differences between the source model and the PSF in the out-of-field regions were less than 0.5% of the profile maximum value at 100 cm SSD. Differences between measured and calculated points were less than 2% of the maximum dose or 2 mm distance to agreement (DTA) at 100 cm SSD. ConclusionsThis SM is unique in that it accounts for a higher level of energy dependence on the particle's direction and it is independent from accelerator components, unlike other published SMs. The model can be applied to any arbitrary azimuthally symmetric beam and has source biasing capabilities that significantly increase the simulation speed up to 3300 for certain field sizes.