Flattening Filter Research Articles

Evaluation of patient-specific quality assurance for fractionated stereotactic treatment plans with 6 and 10MV photon beams in beam-matched linacs.

Beam-matched linear accelerators (LA's) require accurate and precise dosimetry for fractionated stereotactic treatment. In this study, the beam data were validated by comparing the three-beam-matched LA's measured data and the vendor reference data. Upon its validation, the accuracy of the volumetric dose delivery for eighty patient-specific fractionated stereotactic treatment plans was evaluated. Measurements of the percentage depth dose (PDD), beam profiles, output factors (OFs), absolute output, and dynamic multi-leaf collimator (MLC) transmission factors for 6MV and 10MV flattening filter (FF) and flattening filter-free (FFF) photon beams were obtained from three-beam-matched LA's. The patient-specific quality assurance evaluation for all eighty plans was performed using PTW Octavius 1000 SRS™ array detectors for two-dimensional (2D) fluence measurement. The following 2D gamma passing criteria were used: 1%/1mm, 2%/1mm, 1%/2mm, 2%/2mm and 3%/2mm. In all three LA's, gamma analysis for PDD and profile were above 97% with gamma criteria of 1%/1mm. The differences OFs, absolute output, and dynamic MLC transmission factors were less than ± 1% of base value. For all eighty cases, the median passing rates on the three LA's were above 76%, 88%, 92%, 96%, and 98% for the above-mentioned gamma criteria of the three LA's. The beam-matched LA's showed good agreement between the measured and treatment planning system (TPS) calculated values for fractionated stereotactic VMAT plans with 6MV and 10MV (FF and FFF) photon beams. Patients can be shifted and treated on any beam-matched linac without the need of re-planning.

Stereotactic body radiation therapy for prostate cancer: a dosimetric comparison of IMRT and VMAT using flattening filter and flattening filter-free beams.

This retrospective study was performed to evaluate plan quality and treatment delivery parameters of stereotactic body radiation therapy (SBRT) for prostate cancer. The study utilized different isocentric modulated techniques: intensity modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT) using 6 MV flattening filter (FF) and 10 MV flattening filter-free beams (FFF). Fifteen retrospective prostate cancer patients were selected for this study. Sixty plans were created with an SBRT-prescribed dose of 36.25Gy delivered in five fractions. Planning target volume (PTV) coverage, plan quality indices, doses delivered to organs at risk (OARs), and treatment delivery parameters were compared for all plans. It turned out that VMAT plans, particularly those using the FFF beam, provided superior target conformality and a steeper dose gradient as compared to IMRT plans. Additionally, VMAT plans showed better OARs sparing compared to IMRT plans. However, IMRT plans delivered a lower maximum dose to the target than VMAT plans. Importantly, the VMAT plans resulted in reduced treatment delivery parameters, including beam on time (BOT), monitor unit (MU), and modulation factor (MF), compared to IMRT plans. Furthermore, a statistically significant difference was observed in BOT and mean body dose between FF and FFF beams, with FFF beams showing superior performance. Considering all results, VMAT using 10 MV (FFF) is suggested for treating prostate cancer patients with SBRT. This offers the fastest delivery in addition to maintaining the highest plan quality.

A Study on Radiation Level at the Treatment Plane Due to Induced Activity in Linear Accelerator Head.

The induced activity is produced in the target, monitor chamber, flattening filter (FF), collimating jaws, etc., when a high-energy photon beam is utilized for radiation therapy. This may result in add-on exposure to radiation professionals. This study aims to measure the radiation level (RL) at the treatment plane due to induced activity in the linear accelerator head. In this study, RLs were measured close to the isocenter (I), LINAC head (H), and 0.5 m lateral to the isocenter (L) inside the radiation bunker. The RLs were measured for field sizes (FS) 5 cm × 5 cm, 10 cm × 10 cm, 20 cm × 20 cm, 30 cm × 30 cm, and 40 cm × 40 cm, using 50, 100, 200, 300, 400, 500, and 1000 monitor units (MUs) at above said locations inside the bunker using 10 mega-voltage (MV), 10 MV FF free, and 15 MV radiation beam. RL increases with an increase in FS and MUs at all mentioned locations inside the bunker, except for 40 cm × 40 cm FS. The present study shows that RL increases with an increase in radiation beam energy, and there was significant RL inside the bunker at the mentioned location, even after the 1 min of high-energy radiation exposure. Therefore, treatment with a high-energy beam should be scheduled in the later evening of the working day and the jaw should be closed to a minimum before entering the bunker and a sufficient time gap should be followed to minimize the additional exposure due to induced activation in high-energy treatment.

APSSF: Adaptive CNN Pruning Based on Structural Similarity of Filters

Convolutional neural network (CNN) pruning is a technique used to remove redundant parameters from the network. By doing so, it aims to greatly reduce the computational complexity and scale of the network while still preserving its accuracy. In the CNN, the majority of parameters are weights that form filters. When it comes to pruning, it is more effective to focus on removing redundant filters rather than insignificant weights within filters. The essence of filter pruning lies in determining the significance or contribution of each filter. Filters that have a significant contribution are kept, while others are pruned. Current methods for calculating contribution in pruning often rely on weight magnitude or filter similarity. However, approaches based solely on assume that small weights are unimportant and ignore correlation between filters, which leads to a significant loss of network accuracy. Those based on filter similarity flatten filter tensors into a vector when calculating filter similarity, and lose the important structural information of filters, or the superposition information of the weight convolution in the corresponding space position. These limitations can compromise the accuracy and effectiveness of the pruning process. This paper proposes an adaptive CNN pruning method based on the structural similarity of filters (APSSF) by taking both the structural characteristics of and the correlation between filters into the consideration for pruning filters. APSSF efficiently calculates the distance between the filters by factoring in information from all the dimensions of filters, and clusters the filters according to the distance threshold determined adaptively according to the compression rate, and deletes a certain number of filters from each category. On the CIFAR10 and ImageNet datasets, APSSF outperforms several state-of-the-art methods. On the CIFAR100, APSSF reduces parameters of networks by 91.71% and 74.80% on VGG-16 and ResNet-34, respectively. The accuracy was decreased only by 0.03 on VGG-16, while on ResNet-34, it was increased by 0.04.

Impact of flattening filter-free beams on remaining volume at risk in lung cancer treatment.

Modern radiotherapy machines offer a new modality, like flattening filter-free beam (FFF), which is used especially in stereotactic body radiation therapy (SBRT) to reduce treatment time. The remaining volume at risk (RVR) is known as undefined normal tissue, and assists in evaluating late effects such as carcinogenesis. This study aimed to compare the effects of flattening and un-flattened beams on RVR in lung cancer treated by conventional doses using volumetric modulated arc therapy (VMAT) and intensity modulated radiation therapy (IMRT). Twenty-three lung cancer patients with a prescribed dose of 60Gy delivered in 30 fractions were selected retrospectively. Four treatment plans were generated for each case (VMAT FF, VMAT FFF, IMRT FF and IMRT FFF). Mean doses to RVR and volumes that received low doses (V15Gy, V10Gy and V5Gy) were introduced as RVR evaluation parameters. Variance percentage comparison between flattening filter (FF) and FFF for the RVR evaluation parameters gave 2.38, 1.10, 1.80 and 2.22 for VMAT, and 1.73, 1.18, 1.62 and 1.81 for IMRT. In contrast, VMAT and IMRT RVR evaluation parameters resulted in variance percentage differences of 10.29, 5.02, -8.84 and -4.82 for FF, and 11.18, 4.96, -8.59 and -4.48for FFF. It is concluded that in terms of RVR evaluation parameters, FFF is clinically beneficial compared to FF for RVR, due to the decrease in mean RVR dose and low-dose irradiated RVR volume. Furthermore, VMAT is preferred in the mean RVR dose and V15Gy, while IMRT is better in V10Gy and V5Gy for RVR.

Dosimetric Validation of Treatment Planning System for Volumetric Modulated Arc Therapy Using AAPM Medical Physics Practice Guideline 5.b.

To assess the precision of dose calculations for Volumetric Modulated Arc Therapy (VMAT) using megavoltage (MV) photon beams, we validated the accuracy of two algorithms: AUROS XB and Analytical Anisotropic Algorithm (AAA). This validation will encompass both flattening filter (FF) and flattening filter-free beam (FFF) modes, using AAPM Medical Physics Practice Guideline (MPPG 5b). VMAT validation tests were generated for 6 MV FF and 6 MV FFF beams using the AAA and AXB algorithms in the Eclipse V.15.1 treatment planning system (TPS). Corresponding measurements were performed on a linear accelerator using a diode detector and a radiation field analyzer. Point dose (PD) and in-vivo measurements were conducted using an A1SL ion chamber and (TLD) from Thermofisher, respectively. The Rando Phantom was employed for end-to-end (E2E) tests. The mean difference (MD) between the TPS-calculated values and the measured values for the PDD and output factors were within 1% and 0.5%, respectively, for both 6 MV FF and 6 MV FFF. In the TG 119 sets, the MD for PD with both AAA and AXB was <0.9%. For the TG 244 sets, the minimum, maximum, and mean deviations in PD for both 6 MV FF and 6 MV FFF beams were 0.3%, 1.4% and 0.8% respectively. In the E2E test, using the Rando Phantom, the MD between the TLD dose and the TPS dose was within 0.08% for both 6 MV FF (p=1.0) and 6 MV FFF (0.018) beams. The accuracy of the TPS and its algorithms (AAA and AXB) has been successfully validated. The recommended tests included in the VMAT/IMRT validation section proved invaluable for verifying the PDD, output factors, and the feasibility of complex clinical cases. E2E tests were instrumental in validating the entire workflow from CT simulation to treatment delivery.

Characterization of a commercial PIN diode for radiotherapy photon beam dosimetry

The dosimetric characterization of a commercial diode (BPW-34) was performed using a True Beam accelerator (Varian), with flattening filter (FF) photon beams of 6 and 15 MV and flattening filter free (FFF) of 6 MVFFF. The main performance characteristics, namely dose response, energy and dose rate dependence, field output factor, and percentage depth dose profile (PDD), were compared with those available in the literature and, whenever possible, benchmarked against the Varian Eclipse treatment planning system (TPS) predictions. Regardless of the energy, the results showed that the dose response curves are linear (R2 = 1) with nonlinearity parameters less than 0.1% and 0.3% of repeatability. Furthermore, the average dose rate effect (0.7%) is almost negligible within the range of 20–600 MU/min (6 MV, 15 MV) and 400–1400 MU/min (6 MVFFF). Despite these good results, the charge sensitivity measurements evidenced that the diode response depends slightly on the energy, being within 5% for 6 MV–15 MV. It is important to underline that all these results adhere to the standard radiotherapy dosimetry protocols. Moreover, the general output field factor measurements and the percentage depth dose profiles, which are in excellent agreement with the Eclipse TPS calculations, also demonstrated that the diode BPW-34 is a low-budget alternative radiotherapy photon beam dosimeter.

Monte Carlo study on nanogold dose enhancement for breast radiotherapy using an ICRP female computational phantom

Due to distinct photoelectric absorption properties and physiochemical features, high-atomic-element nanomaterials are frequently used as radiosensitizer for radiotherapy, such as gold nanoparticles. which in-turn can increase radiation dose to tumours while minimizing exposure to normal tissues. The aim of this study is to investigate the dose enhancement due to the presence of nanogold particles mixed with breast tissue using a real radiotherapy plan with two photon energies, with and without flattening filter. A fully validated linac head was used to model a complete field-in-field (FIF) radiotherapy breast plan using 4 and 6 MV with a flattening filter (FF) and flattening filter-free (FFF) using BEAMnrc/EGSnrc MC code. The dose distributions were simulated in a female ICRP voxel computational phantom. The dose enhancement ratio (DER) and flattening filter-free enhancement ratio (FFFER) were calculated for a range of nanogold concentrations. The results showed that the DER increased with increasing nanogold concentration. The maximum DER was achieved when FFF was used and the increase was higher for 4 MV than 6 MV. The FFFER was higher for the 4 MV beam than 6 MV when 40 mg/ml nanogold was used. The combination of higher nanogold concentrations, lower photon energies, and FFF resulted in a higher dose enhancement. The implementation of nanogold particles in breast tissue enhanced the dose deposition, especially with FFF, as presented in this study. The results would improve nanogold-enhanced breast radiotherapy and dose delivery with an increase in patient throughput.

Histopathological evaluation of the effects of Flattening Filter (FF) and Flattening Filter Free (FFF) X-ray: In vivo malignant melanoma cancer models

The objective of this study was to investigate the radiobiological effects of Flattening Filter (FF) and Flattening Filter Free (FFF) beams on Malignant Melanoma cancer (MMe Ca) modeled NOD-Prkdc IL2rg tm1 (NSG) mice in vivo, with a specific focus on necrotic and immunofluorescent changes.Thirty-five adult NSG mice models were randomly divided into four groups; MMe Ca, FF with a low dose rate of 400 MU/min (FF-400) and FFF with a high dose rate of 1400 MU/min (FFF-1400), and Control. The NSG mice in FF-400 and FFF-1400 groups (MMe Ca plus RT groups) were irradiated with a single dose of 20 Gy at 400 MU/min and 1400 MU/min. Radiotherapy was administered to NSG mice 20 days after tumor transplantation. The mice were then sacrificed 2 days after radiotherapy for assessment of the necrotic area, cell proliferation and apoptosis.The Ki-67 proliferation index showed a significant increase (p < 0.05) in the MMe Ca group (G1) compared to the FF-400 and FFF-1400 radiotherapy groups (G2 and G3) and the control group (G4), whereas a significant decrease was observed in the radiotherapy groups due to single-dose 20Gy irradiation (p < 0.05). The apoptotic index increased with irradiation in the FF-400 and FFF-1400 radiotherapy groups (p < 0.05). The necrotic area values of FF-400 and FFF-1400 at different dose rates (G2 and G3) increased statistically significantly (p < 0.05) compared to the MMe Ca group (G1). In addition, the Ki-67 cell proliferation, apoptotic index, and necrotic area parameters exhibited statistically significant differences between the FF-400 and FFF-1400 beams (p < 0.05). The FFF-high dose rate beams were found to be more effective on MMe Ca compared to the FF conventional beams (p < 0.05).It was concluded that FF and FFF beams caused significant radiobiological changes in cell proliferation (Ki-67), apoptosis (TUNEL) and necrosis histopathological parameters and the FFF beam was more effective on MMe Ca.

Dosimetric parameters calculation for 18 MV photon beam in flattening filter (FF) and flattening filter free (FFF) linear accelerators with and without magnetic deflector and lead filter

Dosimetric characteristics of the flattening filter (FF) and flattening filter free (FFF) modes of 18 MV therapeutic photon beam were investigated with and without the magnetic deflector (MD) and lead filter. MCNP version 6.1.0 Monte Carlo (MC) code was used to simulate the 18 MV photon beam of 2100 C/D-Varian linear accelerator (LINAC) for the FF and FFF modes. The MD (uniform magnetic flux density of 1 Tesla) and lead filter (thickness of 1 mm) were modeled to remove contaminant electrons. The dosimetric parameters for different scenarios of LINAC’s head were calculated. Removing the flattening filter in the FFF mode increased the dose rate, electron contamination, skin dose, out-of-field dose, and un-flatness compared to the FF mode. While the lead filter decreased the contaminant electrons significantly, using the MD removed all secondary electrons from the beam line. The surface dose was decreased by 8.3% and 11.2% for the magnetic deflector (MD) and lead filter in the FF mode, respectively. The surface dose was decreased by 16.8% and 20.3% for the MD and lead filter scenarios in the FFF mode, respectively. The MD and lead filter decreased surface penumbra by 15.5% and 11.5% compared to the FFF mode. Removing the flattening filter from the LINAC’s head improves most of the dosimetric characteristics of the 18MV therapeutic beam. The use of a lead filter and magnetic deflector preserves the skin-sparing property of megavoltage beams that deteriorate in FFF mode. However, using a magnetic deflector does not reduce photon fluence and dose rate.

Radiobiological analysis of VMAT treatment plan with flattened and flattening filter free photon beam: an EUD and TCP based comparative study.

This study aimed to evaluate the dosimetric and radiobiological differences between 6MV flattened filter (FF) and flattening filter free (FFF) using volumetric modulated arc (VMAT) technique for head and neck (H&N) cancer patients. Fifteen patients with H&N carcinoma were selected and treated with VMAT with FF (VMATFF) treatment plan. Retrospectively, additional VMAT treatment plans were developed using FFF beams (VMATFFF). Radiobiological parameters, such as equivalent uniform dose (EUD), tumor cure probability (TCP), and normal tissue complication probability (NTCP), were calculated using Niemierko's model for both VMATFF and VMATFFF. Correlation between dosimetric and radiobiological data were analyzed and compared. The conformity index (CI) was 0.975 ± 0.014 (VMATFF) and 0.964 ± 0. 019 (VMATFFF) with p ≥ 0.05. Statistically, there was an insignificant difference in the planning target volume (PTV) results for TCP (%) values, with values of 81.20 ± 0.88% (VMATFF) and 81.01 ± 0.92 (%) (VMATFF). Similarly, there was an insignificant difference in the EUD (Gy) values, which were 71.53 ± 0.33 Gy (VMATFF) and 71.46 ± 0.34 Gy (VMATFFF). The NTCP values for the spinal cord, left parotid, and right parotid were 6.54 × 10-07%, 8.04%, and 7.69%, respectively, in the case of VMATFF. For VMATFFF, the corresponding NTCP values for the spinal cord, parotids left, and parotid right were 3.09 × 10-07%, 6.57%, and 6.73%, respectively. The EUD and Mean Dose to PTV were strongly correlated for VMATFFF. An increased mean dose to the PTV and greater TCP were reported for the VMATFF, which can enhance the delivery of the therapeutic dose to the target.

Comparison of skin dose in IMRT and VMAT with TrueBeam and Halcyon linear accelerator for whole breast irradiation

With the increasing use of flattening filter free (FFF) beams, it is important to evaluate the impact on the skin dose and target coverage of breast cancer treatments. This study aimed to compare skin doses of treatments using FFF and flattening filter (FF) beams for breast cancer. The study established treatment plans for left breast of an anthropomorphic phantom using Halcyon’s 6-MV FFF beam and TrueBeam’s 6-MV FF beam. Volumetric modulated arc therapy (VMAT) with varying numbers of arcs and intensity modulated radiation therapy (IMRT) were employed, and skin doses were measured at five points using Gafchromic EBT3 film. Each measurement was repeated three times, and averaged to reduce uncertainty. All plans were compared in terms of plan quality to ensure homogeneous target coverage. The study found that when using VMAT with two, four, and six arcs, in-field doses were 19%, 15%, and 6% higher, respectively, when using Halcyon compared to TrueBeam. Additionally, when using two arcs for VMAT, in-field doses were 10% and 15% higher compared to four and six arcs when using Halcyon. Finally, in-field dose from Halcyon using IMRT was about 1% higher than when using TrueBeam. Our research confirmed that when treating breast cancer with FFF beams, skin dose is higher than with traditional FF beams. Moreover, number of arcs used in VMAT treatment with FFF beams affects skin dose to the patient. To maintain a skin dose similar to that of FF beams when using Halcyon, it may be worth considering increasing the number of arcs.

Comparative Evaluation of Dosimetric Quality and Treatment Efficiency for Halcyon, TrueBeam, and TomoTherapy in Cervical-Thoracic Esophageal Cancer Radiotherapy.

This study primarily aims to investigate the suitability of Halcyon in the context of cervical-thoracic esophageal cancer by exploring the dosimetric quality and delivery efficiency of Halcyon plans with different arc configurations. Additionally, it compares these findings with the dosimetric indices and delivery efficiency of TrueBeam and TomoTherapy accelerators, focusing on their capability to optimize protection for organs at risk (OARs) while maintaining efficient treatment delivery strategies. This retrospective study involved 26 patients diagnosed with cervical-thoracic esophageal cancer, and new radiotherapy plans were created using Halcyon, TrueBeam, and TomoTherapy. Dose volume histogram (DVH) metrics and delivery efficiency for plans involving different arc numbers on Halcyon (2, 3, and 4 arcs) were compared with those from TrueBeam and TomoTherapy. T-tests were employed to evaluate differences in organ protection among the accelerators. The Halcyon plans, especially those with 4 arcs, provided superior protection for organs at risk, including the heart, lungs, and spinal cord, while maintaining excellent delivery efficiency. Compared to TrueBeam 2arc plans and TomoTherapy helical plans, Halcyon plans with 3 arcs also showed slight advantages. Although TomoTherapy offered better uniformity in dose distribution, it did not demonstrate a clear advantage over the other accelerators in terms of OAR protection or treatment efficiency. Furthermore, despite the lack of clear advantages in TrueBeam 2arc plans with flattening filter (FF), TrueBeam with flattening filter free (FFF) plans may hold potential in the treatment. Halcyon, particularly with 4 arcs, offers an optimal balance between reducing toxicity to organs at risk and maintaining treatment efficiency, making it a preferred choice in cervical thoracic esophageal cancer radiotherapy. The findings highlight the need for careful selection of radiotherapy accelerators based on specific clinical goals, with Halcyon showing potential advantages in scenarios where both treatment efficiency and OAR protection are paramount.

Comparison of the dose distribution of the VMAT radiotherapy technique depending on the beam used: FFF-X10MV and FFF-X15MV.

The aim of the study was to answer the question of whether flattening filter (FF) and flattening filter-free (FFF) beams can be used alternately in the volumetric modulated arc therapy (VMAT) treatment technique, regardless of the size of the irradiated volume [small (S) or large (L) planning target volume (PTV)]. Two groups of patients were examined: a group with a S-PTV-laryngeal cancer and a group with a L-PTV - gynecological volume. For each patient, two treatment plans were made for beams (energies): FFF-X10MV and FF-X15MV. Then, a statistical analysis, nonparametric test, and independent groups were performed, comparing the beams' impact on the analyzed treatment plans. In the case of laryngeal irradiation (S-PTV), there are no statistically significant differences between the energy used and the assessed parameters of the plan. In the case of gynecological volume (L-PTV), only statistically significant differences were noted for the number of monitor units depending on the energy used. For a large irradiated volume (gynecological case), the use of FFF beams increases the number of monitor units by 39,4% in relation to the FF beam. In the case of gynecological neoplasms, statistically significant differences were found in the number of monitor units. Therefore, in the case of irradiation of L-PTV, it is recommended that flattening-filtering beams are used due to the smaller number of monitors. In the case of S-PTV, no statistically significant differences were found between the types of beams used (FF or FFF) and the treatment plan parameters analyzed in the study.

Evaluation of Flattening-Filter-Free and Flattening Filter Dosimetric and Radiobiological Criteria for Lung SBRT: A Volume-Based Analysis

The use of volumetric modulated arc therapy (VMAT) with flattening-filter-free (FFF) beams is becoming more prevalent in lung cancer stereotactic body radiotherapy (SBRT). The aim in this study was to assess the impact of dosimetric and radiobiological differences between FFF and flattening filter (FF) beams for lung SBRT based on the target volume. A total of 198 lung stereotactic body radiation therapy treatment plans with FFF beams and FF beams were retrospectively selected for this study. For all plans, the prescribed dose was 50 Gy/5 fractions, and the dose volume histogram (DVH) for the target and organs at risk (OAR) and the normal tissue complication probability (NTCP) of the lung were recorded and compared. Moreover, monitor units (MUs), the beam on-time and the treatment time were evaluated. The study was performed following the Radiation Therapy Oncology Group (RTOG) 0813 and 0915 protocols. No significant differences in D90, coverage rate (CR) or conformity index (CI) of the target were observed between FFF beams and FF beams (p>0.05). The D2, R50% and gradient index (GI) for the target improved with FFF beams compared with FF beams (p<0.05). FFF beams also significantly reduced the dose for the lung, heart, spinal cord, esophagus and NTCP of the lung (p<0.05), compared with FF beams. However, there was no significant difference in sparing of the trachea (p>0.05). The mean MUs, beam on-time and treatment time were 1871±278 MUs, 3.2 ±0.2 min and 3.9 ±0.3 min for FFF beams, and 1890±260 MUs, 4.2±0.3 min and 4.8 ±0.4 min for FF beams, respectively. The FFF beam technique for lung SBRT with VMAT results in a better dose fall-off, better dose-sparing of OAR, lower NTCP of the lung and a shorter beam on-time compared with the FF beam technique. Additionally, the improvement in target and OAR-sparing for FFF beams was increased with increasing target volume.

Dosimetric evaluation of accelerated partial breast irradiation (APBI) using volumetric modulated arc therapy (VMAT) technique

Purpose: Five-fraction radiation therapy treatment regimens for accelerated partial breast irradiation (APBI) using intensity modulated radiotherapy (IMRT) have become increasingly used after several phase three trials demonstrated similar or reduced toxicity compared with whole breast irradiation. Improving the treatment efficiency of this technique could significantly improve delivery accuracy and tolerability, especially for treatment plans utilizing deep inspiration breath hold (DIBH) technique. The aim of this study was to determine the optimal technique for APBI, with a focus on volumetric modulated arc therapy technique (VMAT) and flattening-filter free (FFF) delivery. Methods: Ten APBI cases, five cases each left and right breast, were randomly selected. Each case was contoured following guidelines included in the APBI-IMRT-Florence Trial and planned to use both non-coplanar static-field IMRT with standard flattened-filter (FF) beam and VMAT techniques with both FF and FFF beam. For each VMAT plan, two partial arcs were used with patient-specific start and stop angles. Arc extents emulated opposed tangential fields and were chosen based on target and organ at risk (OAR) locations. Evaluated OARs included the heart, ipsilateral and contralateral lung, and normal breast. All plans were generated using the Eclipse treatment planning system (Version 15.6). A prescription dose of 30Gy delivered in 5 fractions was used for all cases. Plans were compared and evaluated using several dose metrics as well as treatment time. Results: For targets, VMAT exhibited similar coverage (V95%) but higher Dmax compared to IMRT (105% (IMRT) v.s .111% (VMAT), p=0.002. VMAT provided similar OAR avoidance compared to IMRT for the heart (Dmean, V3Gy, V0.5Gy), ipsilateral lung (V10Gy), contralateral lung (V5Gy) and contralateral breast Dmax within 10cGy/2% (p~0.005). VMAT contributed slightly lower dose outside the target in the ipsilateral breast, with an average difference in V15Gy of approximately 8% (37% (IMRT) v.s. 29% (VMAT)). Finally, because IMRT delivery is non-coplanar, and typically requires at least 5 treatment fields, co-planar VMAT reduced the total treatment significantly. VMAT with FF beam energies also used fewer monitor unites compared to IMRT with FF beam energies. The utilization of FFF beam energies for VMAT further improved delivery time compared to IMRT. Overall, VMAT with FFF beam energies reduced treatment time by approximately 20% compared to IMRT with FF beam. Conclusions: Co-planar partial-arc FFF VMAT technique produced equivalent target coverage, improved efficiency, better normal tissue sparing, and shorter delivery time compared to non-coplanar IMRT technique. Shorter delivery time also assists in the reduction of patient motion associated with breath hold. VMAT technique with FFF delivery is a suitable replacement for IMRT in APBI.

The effects of flattening filter-free beams and aperture shape controller on the complexity of conventional large-field treatment plans.

The purpose of this study was to investigate the impact of using flattening filter-free (FFF) beams and the aperture shape controller (ASC) on the complexity of conventional large-field treatment plans. A total of 24 head and neck (H&N) and 24 prostate with pelvic nodes treatment plans were used in this study. Each plan was reoptimized using the original clinical objectives with both flattened and FFF beams, as well as six different ASC settings. The dosimetric qualities of each plan cohort were evaluated using commonly used dose-volume histogram values, and plan complexities were assessed through metrics including monitor unit (MU)/Dose, change in gantry speed, multileaf collimator (MLC) speed, the edge area ratio metric (EM), and the equivalent square length. No significant differences in dosimetric qualities were found between plans with flattened and FFF beams. The ASC settings did not have significant effects on dosimetric qualities in the H&N plan cohort, but the "very high" ASC setting resulted in poorer dosimetric results for the prostate plans. Plans with FFF beams had significantly higher MU/Dose compared to plans with flattened beams. The use of flattening filter (FF) had significant effects on the change in gantry speed, with flattened beams producing plans that required higher change in gantry speed. However, the FF did not have significant effects on MLC speed, EM, or equivalent square length. In contrast, ASC settings had significant effects on these three metrics; increasing the ASC level resulted in plans with decreasing MLC speed, lower edge area ratio, and higher equivalent square length. This study demonstrated that using FFF beams with various ASC settings, except for the "very high" level, can produce plans with reduced complexities without compromising dosimetric qualities in conventional large-field treatment plans.

Determination of small-field output factors for beam-matched linear accelerators using various detectors and comparison of detector-specific output correction factors using IAEA Technical Report Series 483 protocol.

Beam matching is widely used to ensure that linear accelerators used in radiotherapy have equal dosimetry characteristics. Small-field output factors (OF) were measured using different detectors infour beam-matched linear accelerators and the measured OFs were compared with existing treatment planning system (TPS) Monte Carlo algorithm calculated OFs. Three Elekta Versa HDTM and one Elekta InfinityTMlinear accelerators with photon energies of 6 MV flattening filter (FF), 10 MVFF, 6 MV flattening filter free (FFF) and 10 MVFFF were used in this study. All the Linac'swere beam-matched, Dosimetry beam data were ± 1% compare with Reference Linac. Ten different type of detectors (four ionizationchambers and six diode detectors) were used for small-field OF measurements. The OFs were measured for field sizes of 1 × 1 to 10 × 10 cm2, and normalized to 10 × 10 cm2 field size. The uncorrected and corrected OFs were calculated from these measurements. The corrected OF was compare with existing treatment planning system (TPS) Monte Carlo algorithm calculated OFs. The small-field corrected and Uncorrected OF variations among the linear accelerators was within 1% for all energies and detectors. An increase in field size led to a reduction in the difference between OFs among the detectors, which was the case for all energies. The RSD values decreased with increasing field size. The TRS 483 provided Detector-specificoutput-correction factor (OCF) reduced uncertainty in small-field measurements. It is necessary to implement the OF-correction of small fields in a TPS. Special care must be taken to incorporate the corrected small-field OF in a TPS.

Mathematic modeling of the dose in water for calculating collimator scatter factor of flattening filter and flattening filter free megavoltage photon beams

This study presents an empirical method to model the percent depth dose (PDD) curves of flattening filter (FF) and FF-free (FFF) high-energy photon beams using a home-generated buildup function and tail function (buildup-tail function) in radiation therapy. The modeling parameters n and &amp;mu; of the buildup-tail function were used to characterize the collimator scatter factor (Sc). The buildup function was a quadratic function in the form of d/ &amp;radic;(d2 + n) with main parameters of d (depth in water) and n, while the tail function was in the form of e&amp;minus;&amp;mu;d and was composed of an exponential function with d and &amp;mu;. PDD was the product of buildup-tail function and characterized by the buildup-tail function by adjusting the parameters n and &amp;mu;. The Sc of 6 and 10 MV in FF and FFF beams can be expressed simply by the modeling parameters n and &amp;mu;. The main parameter n increases when photon energy increases. Its physical meaning expresses the beam hardening of photon energy in PDD. The parameter &amp;mu; can be treated as an attenuation coefficient in the tail function, decreasing when photon energy increases. The values of n and &amp;mu; obtained from the fitted buildup-tail function were applied into an analytical formula of Sc,FF = nE(S)0.63 &amp;mu; E, Sc,FFF = nE(S)4.45 &amp;mu; E to get the Sc of 6 and 10 MV in FF and FFF photon beams, with nE, &amp;mu; E, S denoting n and &amp;mu; at photon energy E of field size S. The calculated Sc was compared with the measured data and showed agreement, finding that the field difference was size within &amp;plusmn;1%. This model can be used to parameterize the Sc for some clinical requirements. The modeling parameters n and &amp;mu; can be used to predict the Sc in either FF or FFF beams for the treatment monitor unit in double-check dose calculation. The technique developed in this study can also be used for systematic or random errors in the quality assurance program, thus improving the clinical dose computation accuracy for patient treatment.

High resolution 2D plastic scintillator detectors for radiotherapy departments

Abstract Introduction Plastic scintillation detectors (PSD) have been developed for over four decades and are widely used in a variety of fields, but one can find relatively few reports of their clinical use compared to other dosimetric solutions. Material and methods The inexpensive detector setup made of a Saint-Gobain BC-400 plastic scintillator and commercially available on the market CMOS-based DSLR Pentax camera was investigated. Build PSD detectors were irradiated with 6, 10 and 15 MV flattening filtered (FF) and 6 and 10 MV flattening filter free (FFF) photon beams using a clinical linear accelerator. Data were processed using Matlab software to remove background and artefacts. A comparison of the spatial resolution parameters to the Gafchromic EBT3 films was performed. Results Average dose difference between TPS and PSD was 1.1%. The measured spatial resolution was 0.29 mm, and it differed from the film by 1.1%. MTF50 for PSD was 0.57 mm higher than the Gafchromic film. Signal to dose fit function with an R-square equal to 0.999 was established. The standard deviation of mean pixels value for a series of measurements was below 0.1%, for variable dose rate dependence was below 0.6% and for different energies 1.1%. It was demonstrated that such a setup allows a satisfactory signal-to-dose dependence and provides high spatial resolution at an affordable price compared to a 2D ion chamber or a diode detector array. Moreover, PSDs are reusable and provide a simple readout compared to Gafchromic films commonly used in radiotherapy departments. Conclusions Variable parameters of the camera allow to select signal values at the optimal level. The system presented excellent signal stability, high image resolution and a simple signal-to-dose relationship which encourages further work to investigate PSDs for use in radiation therapy departments.