EDR2 Film Research Articles

Planar dose calculation of electron therapy

Purpose. The aim of this study is to determine the planar dose distribution of irregularly-shaped electron beams at their maximum dose depth (z max) using the modied lateral build-up ratio (LBR) and curve-fitting methods. Methods. Circular and irregular cutouts were created using Cerrobend alloy for a 14 × 14 cm2 applicator. Percentage depth dose (PDD) at the standard source-surface-distance (SSD = 100 cm) and point dose at different SSD were measured for each cutout. Orthogonal profiles of the cutouts were measured at z max. Data were collected for 6, 9, 12, and 15 MeV electron beam energies on a VERSA HDTM LINAC using the IBA Blue Phantom2 3D water phantom system. The planar dose distributions of the cutouts were also measured at z max in solid water using EDR2 films. Results. The measured PDD curves were normalized to a normalization depth (d 0) of 1 mm. The lateral-buildup-ratio (LBR), lateral spread parameter (σ R (z)), and effective SSD (SSD eff ) for each cutout were calculated using the PDD of the open applicator as the reference field. The modified LBR method was then employed to calculate the planar dose distribution of the irregular cutouts within the field at least 5 mm from the edge. A simple curve-fitting model was developed based on the profile shapes of the circular cutouts around the field edge. This model was used to calculate the planar dose distribution of the irregular cutouts in the region from 3 mm outside to 5 mm inside the field edge. Finally, the calculated planar dose distribution was compared with the film measurement. Conclusions. The planar dose distribution of electron therapy for irregular cutouts at z max was calculated using the improved LBR method and a simple curve-fitting model. The calculated profiles were within 3% of the measured values. The gamma passing rate with a 3%/3 mm and 10% dose threshold was more than 96%.

Experimental dosimetry of EDR2 films in scanning carbon-ion irradiation.

PurposeTo investigate the dose‐sensitometric response of extended dose range (EDR2) films to scanning carbon‐ion beams and to evaluate the applications of the obtained response curves to carbon‐ion dose distributions.MethodsEDR2 films were irradiated by mono‐energetic scanning carbon‐ion beams with different doses to obtain sensitometric curves at different integrated depth doses (DDDs). Six different DDDs were generated by using a proper buildup for each mono‐energetic beam and were used to investigate the energy dependence. The sensitometric curves were obtained by fitting the net optical density (netOD) to dose at different DDDs. The dose difference between the value converted from the netOD and that calculated in the treatment planning system (TPS) was investigated to evaluate the application scope of the sensitometric curve.ResultsDigitizing the EDR2 film with a resolution of 0.36 (72 dpi) provided a good signal‐to‐noise ratio, and the sensitometric curve was linear at all DDDs of clinically relevant incident kinetic energies in the netOD range of 0.02–1.70 for carbon‐ion film dosimetry. The factors used to convert the netOD to absorbed dose were expressed as a linear function of DDDs, with which the depth dose difference between converted and TPS was less than 3% in the proximal area for incident kinetic energies lower than 307.5 MeV/u.ConclusionThe EDR2 film is a feasible tool for scanning carbon‐ion beam profile measurements by directly evaluating the netOD distribution with proper digitizing resolution and netOD range. By applying the conversion factors, the EDR2 film can also be employed to perform the percentage depth dose consistency checking and linear energy transfer comparison of carbon‐ion lower than 307.5 MeV/u.

Feasibility Study of Using XRV-124 Scintillation Detector for Collinearity Measurement in Uniform Scanning Proton Therapy

PurposeThe purpose of this work is to study the feasibility of using an XRV-124 scintillation detector in measuring the collinearity of the x-ray system and uniform scanning proton beam.MethodsA brass aperture for Snout 10 was manufactured. The center of the aperture had an opening of 1 cm in diameter (4 cm for the film measurements). The 2D kV x-ray images of the XRV-124 were acquired such that the marker inside the detector is aligned to the imaging isocenter. After obtaining the optimal camera settings, a uniform scanning proton beam was delivered for various ranges (12 g/cm2 to 28 g/cm2 in step size of 2 g/cm2). For each range, 10 monitor units (MU) of the first layer were delivered to the XRV-124 detector. Collinearity tests were repeated by using EDR2 and EBT3 films following our current quality assurance protocol in practice. The results from the XRV-124 measurements were compared against the collinearity results from EDR2 and EBT3 films.Results and DiscussionThe collinearity results were evaluated in the horizontal (x) and vertical (y) directions. The average deviation in collinearity in the x-direction was −0.24 ± 0.30 mm, 0.57 ± 0.39 mm, and −0.27 ± 0.14 mm for EDR2, EBT3, and XRV-124, respectively. In the y-direction, the average deviation was 0.39 ± 0.07 mm, 0.29 ± 0.14 mm, and 0.39 ± 0.03 mm for EDR2, EBT3, and XRV-124, respectively.ConclusionThe measurement results from the XRV-124 and films are in good agreement. Compared to film, the use of the XRV-124 detector for collinearity measurements in uniform scanning protons is more efficient and provides results in real time.

Monte Carlo Dose Calculation - A QA Method for SRT and SBRT Plans in Treating Multiple and Small Metastatic Lesions.

To provide accurate and fast 3-D dose verification for hypofractionated stereotactic radiotherapy (SRT/SBRT) of small and multi targets calculated with a Varian Eclipse treatment planning system (TPS) delivered on a Varian accelerator. Ten brain and lung hypofractionated SRT/SBRT linac-based and CyberKnife plans were generated by the Eclipse system for delivery on the accelerator with the Millenium-120 leaf multileaf collimator (MLC) and Multiplan for the CyberKnife machine. These clinical SRT/SBRT plans required accurate quality assurance measurements to obtain absolute point dose and 3-D dose distributions due to the low number of fractions and high fraction doses. For small-field and multi-target plans, the EGS4/MCSIM code was used to calculate the dose distribution. A 0.125 cc ion chamber, a 0.016 cc pin-point chamber and Kodak EDR2 film were used for the measurements and the results were compared with Monte Carlo (MC) calculations. The dosimetry for small-field and multi-target treatment plans is challenging due to the comparable range of secondary electrons and the field sizes defined by SRT/SBRT MLC segments. Our MC simulations can accurately reproduce the linac dose distributions (within 1%/1 mm) three dimensionally. For the clinical SRT/SBRT plans investigated in this work, the MC doses agreed within 3% with ion chamber measurements and within 2%/2 mm with film measurements. The doses calculated by the Eclipse AAA algorithm and Multiplan differed by no more than 5% from MC calculations for small (4–40 cc) Planning Target Volumes (PTVs). MC dose calculation provides accurate and fast 3-D dose verification for hypofractionated SRT for small and multi-target treatment plans generated by a Varian Eclipse TPS on a Varian accelerator and Multiplan treatment planning on the CyberKnife System.

Characterization of penumbra sharpening and scattering by adaptive aperture for a compact pencil beam scanning proton therapy system.

To quantitatively access penumbra sharpening and scattering by adaptive aperture (AA) under various beam conditions and clinical cases for a Mevion S250i compact pencil beam scanning proton therapy system. First, in-air measurements were performed using a scintillation detector for single spot profile and lateral penumbra for five square field sizes (3×3 to 18×18cm2 ), three energies (33.04, 147.36, and 227.16MeV), and three snout positions (5, 15, and 33.6cm) with Open and AA field. Second, treatment plans were generated in RayStation treatment planning system (TPS) for various combination of target size (3- and 10-cm cube), target depth (5, 10, and 15cm) and air gap (5-20cm) for both Open and AA field. These plans were delivered to EDR2 films in the solid water and penumbra reduction by AA was quantified. Third, the effect of the AA scattered protons on the surface dose was studied at 5mm depth by EDR2 film and the RayStation TPS computation. Finally, dosimetric advantage of AA over Open field was studied for five brain and five prostate cases using the TPS simulation. The spot size changed dramatically from 3.8mm at proton beam energy of 227.15MeV to 29.4mm at energy 33.04MeV. In-air measurements showed that AA substantially reduced the lateral penumbra by 30% to 60%. The EDR2 film measurements in solid water presented the maximum penumbra reduction of 10 to 14mm depending on the target size. The maximum increase of 25% in field edge dose at 5mm depth as compared to central axis was observed. The substantial penumbra reduction by AA produced less dose to critical structures for all the prostate and brain cases. Adaptive aperture sharpens the penumbra by factor of two to three depending upon the beam condition. The absolute penumbra reduction with AA was more noticeable for shallower target, smaller target, and larger air gap. The AA-scattered protons contributed to increase in surface dose. Clinically, AA reduced the doses to critical structures.

Dosimetric Effect of Biozorb Markers for Accelerated Partial Breast Irradiation in Proton Therapy.

PurposeTo investigate dosimetric implications of biodegradable Biozorb (BZ) markers for proton accelerated partial breast irradiation (APBI) plans.Materials and MethodsSix different BZs were placed within in-house breast phantoms to acquire computed tomography (CT) images. A contour correction method with proper mass density overriding for BZ titanium clip and surrounding tissue was applied to minimize inaccuracies found in the CT images in the RayStation planning system. Each breast phantom was irradiated by a monoenergetic proton beam (103.23 MeV and 8×8 cm2) using a pencil-beam scanning proton therapy system. For a range perturbation study, doses were measured at 5 depths below the breast phantoms by using an ionization chamber and compared to the RayStation calculations with 3 scenarios for the clip density: the density correction method (S1: 1.6 g/cm3), raw CT (S2), and titanium density (S3: 4.54 g/cm3). For the local dose perturbation study, the radiographic EDR2 film was placed at 0 and 2 cm below the phantoms and compared to the RayStation calculations. Clinical effects of the perturbations were retrospectively examined with 10 APBI plans for the 3 scenarios (approved by our institutional review board).ResultsIn the range perturbation study, the S1 simulation showed a good agreement with the chamber measurements, while excess pullbacks of 1∼2 mm were found in the S2 and S3 simulations. The film study showed local dose shadowing and perturbation by the clips that RayStation could not predict. In the plan study, no significant differences in the plan quality were found among the 3 scenarios. However, substantial range pullbacks were observed for S3.ConclusionThe density correction method could minimize the dose and range difference between measurement and RayStation prediction. It should be avoided to simply override the known physical density of the BZ clips for treatment planning owing to overestimation of the range pullback.

Clinical Evaluation of a Two-dimensional Liquid-Filled Ion chamber Detector Array for Verification of High Modulation Small Fields in Radiotherapy.

Introduction:Clinical evaluation of a two-dimensional (2D) liquid-filled ion chamber detector array used in the verification of highly modulated small beams of stereotactic body radiation therapy (SBRT) has been conducted.Materials and Methods:Measurements with the Octavius 1000 SRS (PTW, Freiburg, Germany) detector with 977 liquid-filled ion chambers were compared against EDR2 film and PTW Octavius Seven29. The performance of detector array has been evaluated on ten SBRT patient plans. Dose profiles of individual and composite fields' calculated using Pinnacle3 treatment planning system were compared against measurements with Octavius 1000 SRS detector array, EDR2 film, and Octavius Seven29 detector. Gamma index and profile comparison were used in the evaluation and assessment of the detector's performance.Results:The Gamma index measurements show agreement between Pinnacle3 computations and Octavius 1000 SRS array, PTW Octavius Seven29, and EDR2 film for >90% of the points using 2%, 2 mm tolerance criteria. Profiles obtained with the Octavius 1000 SRS were in agreement with the EDR2 film profiles, demonstrating the detector's superior sampling rate.Conclusions:The Octavius 1000 SRS is a dosimetrically accurate device to perform quality assurance checks in SBRT treatments. The broad range of measurements performed in this study quantified the dosimetric accuracy of Octavius 1000 SRS detector in the clinical setup of the small fields in radiotherapy.

An Experimental Slope Method for a More Accurate Measurement of Relative Radiation Doses using Radiographic and Radiochromic Films and Its Application to Megavoltage Small-Field Dosimetry.

Purpose:An experimental method using the linear portion of the relative film dose–response curve for radiographic and radiochromic films is presented, which can be used to determine the relative depth doses in a variety of very small, medium, and large radiation fields and relative output factors (ROFs) for small fields.Materials and Methods:The film slope (FS) method was successfully applied to obtain the percentage depth doses (PDDs) for external beams of photon and electrons from a Synergy linear accelerator (Elekta AB, Stockholm, Sweden) under reference conditions of 10 cm × 10 cm for photon beam and nominal 10 cm × 10 cm size applicator for electron beam. For small-field dosimetry, the FS method was applied to EDR2 films (Carestream Health, Rochester, NY) for 6 MV photon beam from a linac (Elekta AB, Stockholm, Sweden) and small, circular radiosurgery cones (Elekta AB, Stockholm, Sweden) with diameters of 5, 7.5, 10, 12.5, and 15 mm. The ROFs for all these cones and central axis PDDs for 5, 10, and 15 mm diameter cones were determined at source-to-surface distance of 100 cm. The ROFs for small fields of CyberKnife system were determined using this technique with Gafchromic EBT3 film (Ashland, NJ, USA). The PDDs and ROFs were compared with ion chamber (IC) and Monte Carlo (MC) simulated values.Results:The maximum percentage deviation of PDDFS with PDDIC for 4, 6, and 15 MV photon beams was within 1.9%, 2.5%, and 1.4%, respectively, up to 20-cm depth. The maximum percentage deviation of PDDFS with PDDIC for electron beams was within 3% for energy range studied of 8–15 MeV. The gamma passing rates of PDDFS with PDDIC were above 96.5% with maximum gamma value of >2, occurring at the zero depths for 4, 6, and 15 MV photons. For electron beams, the gamma passing rates between PDDFS with PDDIC were above 97.7% with a maximum gamma value of 0.9, 1.3, and 0.7 occurring at the zero depth for 8, 12, and 15 MeV. For small field of 5-mm cone, the ROFFS was 0.665 ± 0.021 as compared to 0.674 by MC method. The maximum percentage deviation between PDDFS and PDDMC was 3% for 5 mm and 10 mm and 2% for 15 mm cones with 1D gamma passing rates, respectively, of 95.5%, 96%, and 98%. For CyberKnife system, the ROFFS using EBT3 film and MC published values agrees within 0.2% for for 5 mm cone.Conclusions:The authors have developed a novel and more accurate method for the relative dosimetry of photon and electron beams. This offers a unique method to determine PDD and ROF with a high spatial resolution in fields of steep dose gradient, especially in small fields.

Commissioning and validation of fluence-based 3D VMAT dose reconstruction system using new transmission detector.

In this study, we evaluated the basic performance of the three-dimensional dose verification system COMPASS (IBA Dosimetry). This system is capable of reconstructing 3D dose distributions on the patient anatomy based on the fluence measured using a new transmission detector (Dolphin, IBA Dosimetry) during treatment. The stability of the absolute dose and geometric calibrations of the COMPASS system with the Dolphin detector were investigated for fundamental validation. Furthermore, multileaf collimator (MLC) test patterns and a complicated volumetric modulated arc therapy (VMAT) plan were used to evaluate the accuracy of the reconstructed dose distributions determined by the COMPASS. The results from the COMPASS were compared with those of a Monte Carlo simulation (MC), EDR2 film measurement, and a treatment planning system (TPS). The maximum errors for the absolute dose and geometrical position were -0.28% and 1.0mm for 3months, respectively. The Dolphin detector, which consists of ionization chamber detectors, was firmly mounted on the linear accelerator and was very stable. For the MLC test patterns, the TPS showed a > 5% difference at small fields, while the COMPASS showed good agreement with the MC simulation at small fields. However, the COMPASS produced a large error for complex small fields. For a clinical VMAT plan, COMPASS was more accurate than TPS. COMPASS showed real delivered-dose distributions because it uses the measured fluence, a high-resolution detector, and accurate beam modeling. We confirm here that the accuracy and detectability of the delivered dose of the COMPASS system are sufficient for clinical practice.

Evaluation of targeted image-guided radiation therapy treatment planning system by use of american association of physicists in medicine task group-119 test cases

This study aimed to evaluate the overall accuracy of the beam commissioning criteria of targeted image-guided radiation therapy (TiGRT) treatment planning system (TPS) based on the American Association of Physicists in Medicine (AAPM) Task Group Report 119 (TG-119). The work was performed using 6 MV energy LINAC with a variable dose rate of 200 MU/min which equipped with the high-quality external TiGRT dynamic multileaf collimator model H. The AAPM TG-119 intensity-modulated radiation therapy (IMRT) commissioning tests are composed of two preliminary tests and four clinical test cases. The clinical tests consisted of mock prostate, mock head and neck, C-shaped target, and multitarget. EDR2 film was used for evaluating the IMRT plans and point dose measured by a Pinpoint chamber positioned in slab phantom. The film analysis was done with the Sun Nuclear Corporation patient software. The dose prescription for each fraction was 200 cGy in mock prostate, mock head and neck, C-shaped target, and multitarget. Dose distributions were analyzed using gamma criteria of 3% and 2% dose difference (DD) and 3 and 2 mm distance to agreement. In all test cases, the gamma criteria for 2%/2 and 3%/3 were found to be 94% and 98%, respectively. Results showed that the average gamma criteria result was in the range of 99.1% to 93% (3%/3, 2%/2) overall test cases. Findings were favorable and in some tests were comparable with the other studies. The dose point values were within the mean values of the range reported by TG-119. Overall, the TiGRT TPS is needed to apply IMRT technique in radiation therapy centers.

Validation of a method for invivo 3D dose reconstruction in SBRT using a new transmission detector.

Stereotactic body radiation therapy (SBRT) involves the delivery of substantially larger doses over fewer fractions than conventional therapy. Therefore, SBRT treatments will strongly benefit patients using vivo patient dose verification, because the impact of the fraction is large. For in vivo measurements, a commercially available quality assurance (QA) system is the COMPASS system (IBA Dosimetry, Germany). For measurements, the system uses a new transmission detector (Dolphin, IBA Dosimetry). In this study, we evaluated the method for in vivo 3D dose reconstruction for SBRT using this new transmission detector. We confirmed the accuracy of COMPASS with Dolphin for SBRT using multi leaf collimator (MLC) test patterns and clinical SBRT cases. We compared the results between the COMPASS, the treatment planning system, the Kodak EDR2 film, and the Monte Carlo (MC) calculations. MLC test patterns were set up to investigate various aspects of dose reconstruction for SBRT: (a) simple open fields (2 × 2–10 × 10 cm2), (b) a square wave chart pattern, and (c) the MLC position detectability test in which the MLCs were changed slightly. In clinical cases, we carried out 6 and 8 static IMRT beams for SBRT in the lung and liver. For MLC test patterns, the differences between COMPASS and MC were around 3%. The COMPASS with the dolphin system showed sufficient resolution in SBRT. For clinical cases, COMPASS can detect small changes for the dose profile and dose–volume histogram. COMPASS also showed good agreement with MC. We can confirm the feasibility of SBRT QA using the COMPASS system with Dolphin. This method was successfully operated using the new transmission detector and verified by measurements and MC.

Evaluating the performance of TG-43 protocol in esophageal HDR brachytherapy viewpoint to trachea inhomogeneity.

The aim of this study is to evaluate the effect of air within trachea on dose calculations of esophageal HDR brachytherapy treatment planning. Dose calculations in esophageal HDR brachytherapy treatment planning systems are greatly based on TG-43 protocol which in all materials are considered to be water equivalent. A cylindrical PMMA phantom with a tube in the center (neck equivalent phantom) accompanied by Flexitron HDR brachytherapy system was used in this study. Brachytherapy applicators with various diameters were placed inside the esophageal tube and EDR2 film was used for dosimetry. The absorbed dose by reference point of esophageal HDR brachytherapy and anterior wall of trachea were measured and compared with those calculated by Flexiplan treatment planning system. Based on the performed statistical analysis (t-test) with 95% confidence level (t-value >1.96), there was a meaningful difference between the results of film dosimetry and treatment planning at all of the points understudy. The meaningful difference between the results of film dosimetry and treatment planning indicates that the trachea inhomogeneity has a considerable effect on dose calculations of Flexiplan treatment planning software featuring the TG-43 dose calculation algorithm. This mismatch can affect the accuracy of performed treatment plan and irradiation.

Feasibility Study on Applying Radiophotoluminescent Glass Dosimeters for CyberKnife SRS Dose Verification.

CyberKnife is one of multiple modalities for stereotactic radiosurgery (SRS). Due to the nature of CyberKnife and the characteristics of SRS, dose evaluation of the CyberKnife procedure is critical. A radiophotoluminescent glass dosimeter was used to verify the dose accuracy for the CyberKnife procedure and validate a viable dose verification system for CyberKnife treatment. A radiophotoluminescent glass dosimeter, thermoluminescent dosimeter, and Kodak EDR2 film were used to measure the lateral dose profile and percent depth dose of CyberKnife. A Monte Carlo simulation for dose verification was performed using BEAMnrc to verify the measured results. This study also used a radiophotoluminescent glass dosimeter coupled with an anthropomorphic phantom to evaluate the accuracy of the dose given by CyberKnife. Measurements from the radiophotoluminescent glass dosimeter were compared with the results of a thermoluminescent dosimeter and EDR2 film, and the differences found were less than 5%. The radiophotoluminescent glass dosimeter has some advantages in terms of dose measurements over CyberKnife, such as repeatability, stability, and small effective size. These advantages make radiophotoluminescent glass dosimeters a potential candidate dosimeter for the CyberKnife procedure. This study concludes that radiophotoluminescent glass dosimeters are a promising and reliable dosimeter for CyberKnife dose verification with clinically acceptable accuracy within 5%.

Dosimetric characteristic of physical wedge versus enhanced dynamic wedge based on Monte Carlo simulations.

Physical wedges (PWs) are widely used in radiotherapy to obtain tilted isodose curves, but they alter beam quality. Dynamic wedges (DWs) using moving collimator overcome this problem, but measuring their beam data is not simple. The main aim of this study is to obtain all dosimetric parameters of DWs produced by Varian 2100CD with Monte Carlo simulation and compare them to those from PWs. To simulate 6 MV photon beams equipped with PW and DW, BEAMnrc code was used. All dosimetric data were obtained with EDR2 films and two-dimensional diode array detector. Good agreement between simulated and measured dosimetric data for PW and DW fields was obtained. Our results showed that percentage depth dose and beam profiles at nonwedged direction for DWs are the same as open fields and can be used to each other. From Monte Carlo simulations, it can be concluded that DWs in spite of PW do not have effect on beam quality and are good options for treatment planning system which cannot consider hardening effect produced by PWs. Furthermore, BEAMnrc is a powerful code to acquire all date required by DWs.

Rounded leaf end modeling in Pinnacle VMAT treatment planning for fixed jaw linacs.

During volume‐modulated arc therapies (VMAT), dosimetric errors are introduced by multiple open dynamic leaf gaps that are present in fixed diaphragm linear accelerators. The purpose of this work was to develop a methodology for adjusting the rounded leaf end modeling parameters to improve out‐of‐field dose agreement in SmartArc VMAT treatment plans delivered by fixed jaw linacs where leaf gap dose is not negligible. Leaf gap doses were measured for an Elekta beam modulator linac with 0.4 cm micro‐multileaf collimators (MLC) using an A16 micro‐ionization chamber, a MatriXX ion chamber detector array, and Kodak EDR2 film dosimetry in a solid water phantom. The MLC offset and rounded end tip radius were adjusted in the Pinnacle treatment planning system (TPS) to iteratively arrive at the optimal configuration for 6 MV and 10 MV photon energies. Improvements in gamma index with a 3%/3 mm acceptance criteria and an inclusion threshold of 5% of maximum dose were measured, analyzed, and validated using an ArcCHECK diode detector array for field sizes ranging from 1.6 to 14 cm square field arcs and Task Group (TG) 119 VMAT test cases. The best results were achieved for a rounded leaf tip radius of 13 cm with a 0.1 cm MLC offset. With the optimized MLC model, measured gamma indices ranged between 99.9% and 91.7% for square field arcs with sizes between 3.6 cm and 1.6 cm, with a maximum improvement of 42.7% for the 1.6 cm square field size. Gamma indices improved up to 2.8% in TG‐119 VMAT treatment plans. Imaging and Radiation Oncology Core (IROC) credentialing of a VMAT plan with the head and neck phantom passed with a gamma index of 100%. Fine‐tune adjustments to MLC rounded leaf ends may improve patient‐specific QA pass rates and provide more accurate predictions of dose deposition to avoidance structures.PACS number(s): 87.55.D‐, 87.55.kd, 87.55.kh

SU-F-T-610: Comparison of Output Factors for Small Radiation Fields Used in SBRT Treatment

Purpose: In order to fundamentally understand our previous dose verification results between measurements and calculations from treatment planning system (TPS) for SBRT plans for different sized targets, the goal of the present work was to compare output factors for small fields measured using EDR2 films with TPS and Monet Carlo (MC) simulations. Methods: 6MV beam was delivered to EDR2 films for each of the following field sizes; 1×1 cm2, 1.5×1.5 cm2, 2×2 cm2, 3×3 cm2, 4×4 cm2, 5×5 cm2 and 10×10 cm2. The films were developed in a film processer, then scanned with a Vidar VXR-16 scanner and analyzed using RIT113 version 6.1. A standard calibration curve was obtained with the 6MV beam and was used to get absolute dose for measured field sizes. Similar plans for all fields sizes mentioned above were generated using Eclipse with the Analytical Anisotropic Algorithm. Similarly, MC simulations were carried out using the MCSIM, an in-house MC code for different field sizes. Output factors normalized to 10×10 cm2 reference field were calculated for different field sizes in all the three cases and compared. Results: For field sizes ranging from 1×1 cm2 to 2×2 cm2, the differences in output factors between measurements (films), TPS and MC simulations were within 0.22%. For field sizes ranging from 3×3cm2 to 5×5cm2, differences in output factors were within 0.10%. Conclusion: No clinically significant difference was obtained in output factors for different field sizes acquired from films, TPS and MC simulations. Our results showed that the output factors are predicted accurately from TPS when compared to the actual measurements and superior dose calculation Monte Carlo method. This study would help us in understanding our previously obtained dose verification results for small fields used in the SBRT treatment.

SU‐F‐T‐180: Evaluation of a Scintillating Screen Detector for Proton Beam QA and Acceptance Testing

Purpose:To test the performance of a commercial scintillating screen detector for acceptance testing and Quality Assurance of a proton pencil beam scanning system.Method:The detector (Lexitek DRD 400) has 40cm × 40cm field, uses a thin scintillator imaged onto a 16‐bit scientific CCD with ∼0.5mm resolution. A grid target and LED illuminators are provided for spatial calibration and relative gain correction. The detector mounts to the nozzle with micron precision. Tools are provided for image processing and analysis of single or multiple Gaussian spots.Results:The bias and gain of the detector were studied to measure repeatability and accuracy. Gain measurements were taken with the LED illuminators to measure repeatability and variation of the lens‐CCD pair as a function with f‐stop. Overall system gain was measured with a passive scattering (broad) beam whose shape is calibrated with EDR film placed in front of the scintillator. To create a large uniform field, overlapping small fields were recorded with the detector translated laterally and stitched together to cover the full field. Due to the long exposures required to obtain multiple spills of the synchrotron and very high detector sensitivity, borated polyethylene shielding was added to reduce direct radiation events hitting the CCD. Measurements with a micro ion chamber were compared to the detector's spot profile. Software was developed to process arrays of Gaussian spots and to correct for radiation events.Conclusion:The detector background has a fixed bias, a small component linear in time, and is easily corrected. The gain correction method was validated with 2% accuracy. The detector spot profile matches the micro ion chamber data over 4 orders of magnitude. The multiple spot analyses can be easily used with plan data for measuring pencil beam uniformity and for regular QA comparison.

SU-G-TeP1-13: Reclined Total Skin Electron Treatment Technique

Purpose: The purpose is to describe a new reclined technique for treatment of weakened patients that require total skin electron irradiation. Methods: This technique is a modification of a previously published reclined technique differing in that all six patient positions are treated with the gantry angled 60° from vertically down. The patient is located at a treatment distance of 330 cm SSD along the CA of the beam. The 3/8′ thick Lexan beam spoiler is placed 25 cm from the most proximal surface of the patient for all patient treatment positions. To produce a flat, uniform field of ∼190 cm length, the patient was moved longitudinally by an experimentally determined distance. Kodak EDR2 and EBT3 Radiochromic film were placed around the periphery of the phantom, and OSLs were placed every 30° around the phantom periphery to determine output and surface dose uniformity. A piece of Kodak EDR2 was sandwiched between the two slabs of the 30 cm diameter phantom to determine beam penetration. Results: Field uniformity shifting the patient ±75 cm was ±5% over a treatment span of 190 cm. The dose variation around the periphery of the 30 cm diameter phantom varied by <±5% with the maximum values observed at the 0°-300°, 60° locations with the minimum values at the 30°-330°, 60° locations. Results obtained using Kodak EDR2, EBT3 Radiochromic film, and OSLs agreed to within ±5%. Conclusion: This technique provides a very efficient and convenient means by which to treat the entire skin surface of patients incapable of standing for treatment. It provides a treatment field that is both large and uniform enough for adults along with a convenient way to treat four of the six patient treatment positions. The beam spoiler lies to the side of the patient allowing easy access for patient positioning.

SU‐F‐T‐549: Validation of a Method for in Vivo 3D Dose Reconstruction for SBRT Using a New Transmission Detector

Purpose:Recently, there has been increased clinical use of stereotactic body radiation therapy (SBRT). SBRT treatments will strongly benefit from in vivo patient dose verification, as any errors in delivery can be more detrimental to the radiobiology of the patient as compared to conventional therapy. In vivo dose measurements, a commercially available quality assurance platform which is able to correlate the delivered dose to the patient's anatomy and take into account tissue inhomogeneity, is the COMPASS system (IBA Dosimetry, Germany) using a new transmission detector (Dolphin, IBA Dosimetry). In this work, we evaluate a method for in vivo 3D dose reconstruction for SBRT using a new transmission detector, which was developed for in vivo dose verification for intensity‐modulated radiation therapy (IMRT).Methods:We evaluated the accuracy of measurement for SBRT using simple small fields (2×2−10×10 cm2), a multileaf collimator (MLC) test pattern, and clinical cases. The dose distributions from the COMPASS were compared with those of EDR2 films (Kodak, USA) and the Monte Carlo simulations (MC). For clinical cases, we compared MC using dose‐volume‐histograms (DVHs) and dose profiles.Results:The dose profiles from the COMPASS for small fields and the complicated MLC test pattern agreed with those of EDR2 films, and MC within 3%. This showed the COMPASS with Dolphin system showed good spatial resolution and can measure small fields which are required for SBRT. Those results also suggest that COMPASS with Dolphin is able to detect MLC leaf position errors for SBRT. In clinical cases, the COMPASS with Dolphin agreed well with MC. The Dolphin detector, which consists of ionization chambers, provided stable measurement.Conclusion:COMPASS with Dolphin detector showed a useful in vivo 3D dose reconstruction for SBRT. The accuracy of the results indicates that this approach is suitable for clinical implementation.

SU‐F‐T‐449: Dosimetric Comparison of Acuros XB, Adaptive Convolve in Intensity Modulated Radiotherapy for Head and Neck Cancer

Purpose:There have been several publications focusing on dose calculation in lung for a new dose calculation algorithm of Acuros XB (AXB). AXB could contribute to dose calculation for high‐density media for bone and dental prosthesis rather than in lung. We compared the dosimetric performance of AXB, Adaptive Convolve (AC) in head and neck IMRT plans.Methods:In a phantom study, the difference in depth profile between AXB and AC was evaluated using Kodak EDR2 film sandwiched with tough water phantoms. 6 MV x‐ray using the TrueBeam was irradiated. In a patient study, 20 head and neck IMRT plans had been clinically approved in Pinnacle3 and were transferred to Eclipse. Dose distribution was recalculated using AXB in Eclipse while maintaining AC‐calculated monitor units and MLC sequence planned in Pinnacle. Subsequently, both the dose‐volumetric data obtained using the two different calculation algorithms were compared.Results:The results in the phantom evaluation for the shallow area ahead of the build‐up region shows over‐dose for AXB and under‐dose for AC, respectively. In the patient plans, AXB shows more hot spots especially around the high‐density media than AC in terms of PTV (Max difference: 4.0%) and OAR (Max. difference: 1.9%). Compared to AC, there were larger dose deviations in steep dose gradient region and higher skin‐dose.Conclusion:In head and neck IMRT plans, AXB and AC show different dosimetric performance for the regions inside the target volume around high‐density media, steep dose gradient regions and skin‐surface. There are limitations in skin‐dose and complex anatomic condition using even inhomogeneous anthropomorphic phantom Thus, there is the potential for an increase of hot‐spot in AXB, and an underestimation of dose in substance boundaries and skin regions in AC.