Beam Gantry Research Articles

Emulating the Delivery of Sawtooth Proton Arc Therapy Plans on a Cyclotron-Based Proton Beam Therapy System

Purpose: To evaluate and compare the deliverability of ‘sawtooth’ proton arc therapy (PAT) plans relative to static intensity modulated proton therapy (IMPT) at a cyclotron-based clinical facility. Methods: The delivery of single and dual arc Sawtooth PAT plans for an abdominal CT phantom and multiple clinical cases of brain, head and neck (H&N) and base of skull (BoS) targets was emulated under the step-and-shoot and continuous PAT delivery regimes and compared to that of a corresponding static IMPT plan. Results: Continuous PAT delivery increased the time associated with beam delivery and gantry movement in single/dual PAT plans by 4.86/7.34 min (brain), 7.51/12.40 min (BoS) and 6.59/10.57 min (H&N) on average relative to static IMPT. Step-and-shoot PAT increased this delivery time further by 4.79 min on average as the delivery was limited by gantry motion. Conclusions: The emulator can approximately model clinical sawtooth PAT delivery but requires experimental validation. No clear benefit was observed regarding beam-on time for sawtooth PAT relative to static IMPT.

Rotatorlike gantry optics

Rotating gantries are commonly used in ion-therapy facilities to assist and support optimizing the dose distribution delivered to the patient. They are installed at the end of the beamlines and rotated mechanically in the treatment room. In synchrotron-based facilities, the gantries must be able to transport slowly extracted beams with essentially different emittance patterns in the two transverse planes. Such beams will be referred to as the asymmetric beams. A special device called rotator has been proposed as a possible solution. The worldwide first beamline with the rotator has been recently commissioned. The original rotator concept uses an “external” rotator that is a part (a module) of the beamline the gantry is connected to. In this paper, a novel gantry ion-optical concept integrating the rotator optics into the gantry optics is introduced. The first-order gantry transfer matrix satisfies the so-called sigma-matching ion-optical constraints, and—at the same time—it possesses the format of a rotator transfer matrix. The rotator-matching and the sigma-matching principles are combined in the gantry transfer matrix, which means that the sigma-matching gantry acts simultaneously as a rotator without the need for an extra rotator device. In addition, scattering in the gantry nozzle is used to balance the asymmetric beam emittances in the two transverse planes without an additional scattering foil. In this way, the presented ion-optical concept combines all three known matching techniques—the sigma matching, the rotator matching, and the scattering-foil matching—within the gantry beam transport system. Such a beam transport system provides the best matching result and full angular independence of the beam parameters at the gantry isocenter. It also makes it possible to optimize the beam parameters not only at the gantry isocenter but also at the beam monitors located in the gantry nozzle without increasing the number of gantry quadrupoles. There are two possible versions of such gantry optics: the point-to-point and the parallel-to-point optics. They both are presented in this paper. Theoretical calculations are supported by beam transport simulations performed with the in code. Feasibility of the newly proposed ion-optical concept is demonstrated on the MedAustron proton gantry. However, it can be applied to any rotating gantry at any ion-therapy facility. The presented design is the first rotatorlike gantry ion-optical concept worldwide. Published by the American Physical Society 2024

1124: Feasibility of AI chosen automated couch and gantry beam angles for brain tumors treated with IMPT

1124: Feasibility of AI chosen automated couch and gantry beam angles for brain tumors treated with IMPT

Commissioning and first operation of East Japan Heavy Ion Center at Yamagata University

A world smallest carbon ion radiotherapy facility, East Japan Heavy Ion Center, Yamagata University, started treatment operations in February 2021. The treatment system consists of an ECR ion source, an RFQ and IH-type drift tube linac, a 430 MeV/u synchrotron and a spot-scanning irradiation system. It has two treatment rooms, one is a fixed horizontal beam port and the other is a rotating gantry beam port with superconducting magnets. The ECR ion source is the Kei2-type permanent magnet 10 GHz ECR ion source with a maximum field of 0.8 T. All the improvements of the previous facilities are applied to the ion source, such as helium gas-assisted operation and changes in the shape of an anode electrode and an extraction electrode to reduce the discharge. Owing to these improvements, the ion source has been operated stably during the commissioning and clinical operation. The irradiation system of Yamagata University eliminated the plastic block range shifter to realize a compact gantry, and has 600 energy levels to control the beam range in step of 0.5 mm. In order to optimize the beam transport parameters quickly, automation tools for orbit correction were developed. Machine commissioning and clinical commissioning were carried out in parallel to allow treatment to begin earlier. First, the horizontal fixed beam port was commissioned by verifying the dose distribution of the treatment planning system. Then, the gantry beam port was commissioned by full beam distribution measurement for representing beam angle of 90 degree, and other angles were sequentially released after the compatibility measurement of beam position, beam size, and two-dimensional uniformity. In September 2022, we were able to accept all treatment sites. By August 2023, 1151 cancer patients had been treated. Further improvements to increase available gantry angle and to increase beam efficiency are ongoing.

Structural Optimization and Process Scheme of Large-span Gantry Crossbeam based on Response Surface

A comprehensive design method for large-span gantry beams, combining process techniques and structural optimization, is proposed to address significant deflection deformation issues caused by their own gravity and the gravity of front attachments. Selecting the beam section type, finite element static analysis is performed using ANSYS Workbench for both cast and welded gantry beams. The maximum static deformation values of the beams for both process schemes are compared to determine the process scheme for the large-span beam. Subsequently, multiple structural dimensions of the welded gantry beam are parameterized, and sensitivity analysis is conducted to determine the degree of influence of each parameter on the optimization objective. Parameters with relatively small effects on the corresponding objectives are eliminated. A response surface multi-objective genetic algorithm optimization based on Box-Behnken design experimental design method is employed to minimize deflection deformation and reduce weight. The response surface model is fitted with expressions, and variance and significance analyses are conducted to validate the model's reliability. The optimal Pareto solutions are determined based on the response surface model using a multi-objective genetic algorithm. A comparison between the beams before and after optimization shows a reduction of 0.052 in maximum static deformation of the welded beam, representing an 8.3% decrease. Additionally, the mass decreases by 1710 kg, indicating a 14.63% reduction, demonstrating significant optimization effects.

Commissioning of a gantry beamline with rotator at a synchrotron-based ion therapy center

This paper provides an overview of the worldwide first commissioning of a gantry beamline with a rotator at the MedAustron synchrotron-based proton/ion cancer therapy facility in Wiener Neustadt, Austria. The gantry beamline consists of the high energy beam transfer (HEBT) line and the gantry beam transport system. It transports the beam from the synchrotron to the gantry-room isocenter. The HEBT transports the beam from the synchrotron to the gantry entrance, which is the coupling point between the HEBT and the gantry. The rotator is one of the HEBT modules, thus it is an integral part of the gantry beamline. The MedAustron rotator is the worldwide first rotator system used to match slowly extracted asymmetric beams from the synchrotron to the rotating gantry. In this paper, main attention is paid to ion-optical and beam-alignment aspects of the beamline commissioning. A novel orbit-correction and beam-alignment technique has been developed specifically for the beamline with the rotator. While the theoretical concept of the rotator has existed for almost two decades, the MedAustron rotator is the first hardware implementation of this concept all over the world. The presented overview of the beamline commissioning includes a description of the principal technical solutions and main results of the first beam-transport measurements. Since the measured beam size and beam position agree well with theoretical predictions, one can conclude that the proof-of-concept of the rotator-matching has been successfully accomplished. Published by the American Physical Society 2024

Evaluating the Impact of Bowel Gas Variations for Wilms’ Tumor in Pediatric Proton Therapy

(1) Background: Proton therapy, a precise form of radiation treatment, can be significantly affected by variations in bowel content. The purpose was to identify the most beneficial gantry angles that minimize deviations from the treatment plan quality, thus enhancing the safety and efficacy of proton therapy for Wilms’ tumor patients. (2) Methods: Thirteen patients with Wilms’ tumor, enrolled in the SJWT21 clinical trial, underwent proton therapy. The variations in bowel gas were systematically monitored using daily Cone Beam Computed Tomography (CBCT) imaging. Air cavities identified in daily CBCT images were analyzed to construct daily verification plans and measure water equivalent path length (WEPL) changes. A worst-case scenario simulation was conducted to identify the safest beam angles. (3) Results: The study revealed a maximum decrease in target dose (ΔD100%) of 8.0%, which corresponded to a WEPL variation (ΔWEPL) of 11.3 mm. The average reduction in target dose, denoted as mean ΔD100%, was found to be 2.8%, with a standard deviation (SD) of 3.2%. The mean ΔWEPL was observed as 3.3 mm, with an SD of 2.7 mm. The worst-case scenario analysis suggested that gantry beam angles oriented toward the patient’s right and posterior aspects from 110° to 310° were associated with minimized WEPL discrepancies. (4) Conclusions: This study comprehensively evaluated the influence of bowel gas variability on treatment plan accuracy and proton range uncertainties in pediatric proton therapy for Wilms’ tumor.

A quantitative framework for patient-specific collision detection in proton therapy.

Beam modifying accessories for proton therapy often need to be placed in close proximity of the patient for optimal dosimetry. However, proton treatment units are larger in size and as a result the planned treatment geometry may not be achievable due to collisions with the patient. A framework that can accurately simulate proton treatment geometry is desired. A quantitative framework was developed to model patient-specific proton treatment geometry, minimize air gap, and avoid collisions. The patient's external contour is converted into the International Electrotechnique Commission (IEC) gantry coordinates following the patient's orientation and each beam's gantry and table angles. All snout components are modeled by three-dimensional (3D) geometric shapes such as columns, cuboids, and frustums. Beam-specific parameters such as isocenter coordinates, snout type and extension are used to determine if any point on the external contour protrudes into the various snout components. A 3D graphical user interface is also provided to the planner to visualize the treatment geometry. In case of a collision, the framework's analytic algorithm quantifies the maximum protrusion of the external contour into the snout components. Without a collision, the framework quantifies the minimum distance of the external contour from the snout components and renders a warning if such distance is less than 5cm. Three different snout designs are modeled. Examples of potential collision and its aversion by snout retraction are demonstrated. Different patient orientations, including a sitting treatment position, as well as treatment plans with multiple isocenters, are successfully modeled in the framework. Finally, the dosimetric advantage of reduced air gap enabled by this framework is demonstrated by comparing plans with standard and reduced air gaps. Implementation of this framework reduces incidence of collisions in the treatment room. In addition, it enables the planners to minimize the air gap and achieve better plan dosimetry.

Novel Monthly Quality Assurance Regimen and 5-Year Analysis Using a Proton Metrology System

PurposeTo develop a novel, monthly quality assurance (QA) regimen for a proton therapy system that uses 2 custom phantoms, each housing a commercial scintillator detector and a charge-coupled device camera. The novel metrology system assessed QA trends at a pediatric proton therapy center from 2018 to 2022. Materials and MethodsThe measurement system was designed to accommodate horizontal and vertical positioning of the commercial device and to enable gantry and couch isocentricity measurements (using a star shot procedure), proton spot profile verification, and imaging and radiation congruence tests to be performed simultaneously in the dual-phantom setup. Gantry angles and proton beam energies were varied and alternated each month, using gantry angles of 0°, 30°, 60°, 90°, 120°, 150°, and 180° and discrete beam energies of 69.4, 84.5, 100, 139.1, 180.4, 200.4, and 221.3 MeV after radiographic verification. A total of 1176 individual monthly QA measurements of gantry and couch isocentricity, spot size, and congruence were analyzed. ResultsGantry and couch star shot measurements showed beam isocentricities of 0.3 ± 0.2 mm and 0.2 ± 0.2 mm, respectively, which were within the threshold of 1.0 mm. Spot sizes for each discrete energy were within the threshold of ± 10% of the baseline values for all 3 proton rooms. The imaging and radiation coincidence test results for the 1176 individual monthly QA measurements were 0.5 mm for the 50th percentile and 1.2 mm (the clinical threshold) for the 97.6th percentile. ConclusionsIntegrating a commercial device with custom phantoms improved the quality of proton system checks compared with previous methods using radiochromic films, loose ball bearings, and foam. The scheme of alternating beam angles with discrete energies in the monthly QA-enabled, clinically meaningful verification of beam energy and gantry angle combinations while the machine performance and accuracy were being checked.

AI Beam Angle Prediction in Proton Therapy for Brain Patients.

Patients receiving brain Intensity-modulated Proton Therapy (IMPT) are treated with 1-3 fields. Typically, beam angles must be selected manually, requiring substantial planner time and experience. The choice of beam angles has a major impact on the treatment plan quality. An AI model was developed to automate this process aiming to improve efficiency and potentially plan quality. AI performance was tested by comparing predicted beam angles to the human ground truth angles and evaluating plans resulting from each set of beam angles. Previously treated IMPT brain patients were divided into a training (n = 40) and validation set (n = 10) for the AI. Beam-angle selection in the AI was cast as a multi-label classification problem, training the convolution neural network with a Circular Earth Mover's Distance based regularization and multi-label circular-smooth label technique. An analytical post-processing algorithm is employed to minimize distance to the target and avoid organs-at-risk. Finalized gantry angle predictions are discretized in steps of 5°. For an independent test set of n = 10 patients beam angles were predicted by the AI and compared to those chosen by human planners. Both sets of angles were used to create treatment plans with an automated knowledge-based planning (KBP) tool for brain IMPT utilizing single-field optimization and robust optimization. Plan differences are therefore solely due to the choice of beam angles as automated KBP removes human optimization variability. Resulting plan quality was compared by standard clinical dosimetric parameters to the CTV, brain, brainstem, cochlea, cord, eye, lens, optic chiasm, optic nerves, pituitary, and temporal lobes. All Human and AI selected beam angles are shown in the table. For cases 1-6, AI and Human selected beam angles were within ±15° and resulting plans showed minimal dosimetric differences. In cases 7-9 AI beam angles reduced max dose while keeping organ-at-risk dose within ±2 Gy. In case 10 the AI chosen beam angles reduced cord Dmax by 9.1 Gy but increased left eye Dmax by 4.9 Gy, other organs-at-risk showed minimal differences. Gantry beam angle selection was automated by a newly developed AI model and tested on 10 brain IMPT patients. The comparison showed that the AI often chooses similar beam angles to the human planners. When there are differences, dosimetric analysis demonstrated that plans created from AI beam angles have at least the same quality as the human ones. Results motivate further research into this approach showing the AI being a promising tool to fill a current gap in the strive for automating proton treatment planning, increasing planning efficiency and potentially quality.

Comparative dosimetric, setup margin, and treatment time analysis between ring gantry and C-Arm linear accelerators for VMAT-based craniospinal irradiation plans.

The purpose of this study is to evaluate the dosimetric and treatment delivery characteristics of volumetric modulated arc therapy technique (VMAT)-based craniospinal axis irradiation (CSI) between ring gantry Halcyon (HAL) and C-arm based Novalis Tx (NTx) linear accelerator. Set-up margin and treatment delivery time for both machines were also taken into account. Fifteen patients, 4 females and 11 males treated between March 2019 and February 2022 within the age group 4-56 years simulated in the supine position and were planned for multiple isocentre VMAT technique in ring gantry Halcyon and C-Arm Novalis linear accelerator for 6FFF and 6 MV flatten beam energy. The number of isocenters was the same in both the machines, usually three for adult adolescent age group patients and two for pediatric patients. Total on-couch time and the patient positional shift were captured for each isocenter during each session of treatment. Margins were calculated using Herk's formula of margin = 2.5Σ +0.7σ. Dosimetry, on-couch time, and set-up margin were compared between two competing arms. Ninety-five percent of PTV coverage (P = 0.333), volume receiving 107% (P = 0.676), total MU (P = 0.818) in both the arms were comparable and statically insignificant. Low-dose spillage such as D20% (P = 0.212) and D50% (P = 0.008) was lesser in HAL comparable to NTx. CI and HI were statically insignificant. Out of 26 organs at risk (OAR), only 3 organs showed a statically significant dose difference. The mean and maximum setup margin in any linear direction was 0.45 and 0.53 cm for HAL and 0.37 and 0.56 cm for NTx and, variation was statistically insignificant (0.23 < P < 0.47). On-couch time was 4.0 ± 5.5 min lesser for HAL and the difference in on-couch time between the two arms was statistically different. Even though the majority of the delivery parameters such as gantry speed, dose rate, beam characteristic (flatten or unflatten), MLC width, and speed between the ring gantry HAL and C-arm NTx linear accelerators were distinctly different, they offered no or minimal difference in the dose distribution and in the setup margin. HAL gives a faster treatment time delivery, which could be crucial for some selective cases such as patients receiving treatment under general anesthesia.

Accelerators, Gantries, Magnets and Imaging Systems for Particle Beam Therapy: Recent Status and Prospects for Improvement.

The paper begins by emphasizing the clinical and commercial importance of proton or other charged particle such as carbon ion therapy, refers to the manufacturers of such systems of which more than 120 are installed or under construction worldwide by April 2021. A general review of charged particle therapy systems refers to six manufacturers and provides in tabular form some details of systems installed in the US, Europe, Asia, and elsewhere. In a description of the principles of particle beam therapy a comparison is made of the properties of photons (x-rays) versus protons and protons versus carbon ions. A brief discussion of accelerators in general is followed by descriptions of cyclotrons (including the isosynchronous cyclotron and the synchrocyclotron) and synchrotrons. An interesting case study describes the evolution of a normal-conducting 220 ton cyclotron into an iron-free synchrocyclotron weighing only 5 tons. The general principles of beam handling and gantry design are described. Subsequent sections describe gantry magnets in detail - normal conducting gantry magnets, superconducting gantry magnets for proton- and carbon therapy. Mention is made of a novel CERN-designed superconducting toroidal gantry for hadron therapy, GaToroid. This device, operating under steady state current and magnetic field, is able to deliver a beam at discrete angles over a range of treatment energies. Also considered are low temperature superconducting (LTS) and high temperature superconducting (HTS) magnet windings, and the choice of REBCO conductors for cryogen-free carbon-ion gantries. Finally, the paper mentions an important “Prospect for Improvement”, viz: the introduction of MRI image guidance. A well-known property of the particle beam as it passes through tissue is its energy dependent absorption that rises to a pronounced peak (the Bragg peak) at the end of its range. In order to take advantage of this effect the exact targeting of the tumor and positioning of the patient should be guided by imaging visualization using X-ray, CT, and hopefully advanced MRI. Unlike MRI-guided photon therapy the direct interaction of the magnetic field with the charged particle beam presents a huge challenge such that MRI image-guided proton/particle therapy has not yet been available in clinical practice. Modeling studies have been undertaken on the general topic of beam-line/magnetic field interaction using, for example, the software GEANT4 (GEometry And Tracking) a platform for simulating the passage of charged particles through matter using a Monte Carlo method.

Increase of the transmission and emittance acceptance through a cyclotron-based proton therapy gantry.

PurposeIn proton therapy, the gantry, as the final part of the beamline, has a major effect on beam intensity and beam size at the isocenter. Most of the conventional beam optics of cyclotron‐based proton gantries have been designed with an imaging factor between 1 and 2 from the coupling point (CP) at the gantry entrance to the isocenter (patient location) meaning that to achieve a clinically desirable (small) beam size at isocenter, a small beam size is also required at the CP. Here we will show that such imaging factors are limiting the emittance which can be transported through the gantry. We, therefore, propose the use of large beam size and low divergence beam at the CP along with an imaging factor of 0.5 (2:1) in a new design of gantry beam optics to achieve substantial improvements in transmission and thus increase beam intensity at the isocenter.MethodsThe beam optics of our gantry have been re‐designed to transport higher emittance without the need of any mechanical modifications to the gantry beamline. The beam optics has been designed using TRANSPORT, with the resulting transmissions being calculated using Monte Carlo simulations (BDSIM code). Finally, the new beam optics have been tested with measurements performed on our Gantry 2 at PSI.ResultsWith the new beam optics, we could maximize transmission through the gantry for a fixed emittance value. Additionally, we could transport almost four times higher emittance through the gantry compared to conventional optics, whilst achieving good transmissions through the gantry (>50%) with no increased losses in the gantry. As such, the overall transmission (cyclotron to isocenter) can be increased by almost a factor of 6 for low energies. Additionally, the point‐to‐point imaging inherent to the optics allows adjustment of the beam size at the isocenter by simply changing the beam size at the CP.ConclusionWe have developed a new gantry beam optics which, by selecting a large beam size and low divergence at the gantry entrance and using an imaging factor of 0.5 (2:1), increases the emittance acceptance of the gantry, leading to a substantial increase in beam intensity at low energies. We expect that this approach could easily be adapted for most types of existing gantries.

Analysis of target doses on various tissues in treatment of lung cancer: a simulation study

The success indicator of radiotherapy planning is that it can deliver a precise and maximum dose to the tumor, and at the same time, health tissues receive a minimum dose. The success can be achieved by understanding the density of the organs that go into the treatment beams because the dose distribution was directly affected by tissue inhomogeneity. Therefore, the study aimed to evaluate the tissue density of DICOM images and the homogeneity of the distribution of dose from treatment planning in lung cancer using 3D Slicer-SlicerRT. The method used in the study was used 3 data of CT and RT – Structures data from The Cancer Imaging Archive (TCIA), NSCLC-Radiomics with a diagnosis of stage IIIB squamous cell carcinoma, the location of right cancer, and only one nodule. The calculation of tissue density values using segment statistics in 3D Slicer was based on CT-DICOM information. While the treatment planning was built using 3D Slicer-SlicerRT with a prescription of 60 Gy/30 fractions. Treatment design used six fields, and optimization was done by combining a gantry angle and beam weight. The results represented that the calculation of tissue density was following the reference standard and relative electron density for each organ. Besides, the study had successfully designed a treatment planning system using 3D Slicer-SlicerRT that fulfilled the total dose standard, was excellent for OAR sparing, and had a homogeneity index for patient data ID 1 until 4 with values of 0.252, 0.009, 0.007, and 0.007, respectively.

Actual delivered dose calculation on intra-irradiation cone-beam computed tomography images: a phantom study

Cone-beam computed tomography (CBCT) images acquired during volumetric modulated arc therapy (VMAT; ii-CBCT) can be used to calculate actual delivered doses (ADDs). However, such ii-CBCT images are degraded by scattered megavoltage x-rays (MV-scatters). We aimed to evaluate the dose calculation accuracy of the MV-scatter uncorrected or corrected ii-CBCT images acquired during VMAT deliveries. For MV-scatter correction on concurrent kilovoltage projections (P MVkV), projections consisting only of MV-scatters (P MVS) were acquired under the same MV beam parameters and gantry angles and subtracted from P MVkV (P MVScorr). In addition, the projections by kilovoltage beams were acquired for reference (P kV). The corresponding CBCT images were reconstructed using the Feldkamp–Davis–Kress algorithm (CBCTMVkV, CBCTMVScorr, and CBCTkV as reference). A multi-energy phantom with rods of various relative electron densities (REDs) was used to generate a CBCT-number-to-RED conversion table. First, CBCTkV was reconstructed. Then, the mean CBCT-numbers within each rod were extracted, and a reference table was generated. Concurrent kilovoltage imaging with various field sizes was also demonstrated, and CBCTMVkV and CBCTMVScorr were reconstructed. The extracted CBCT-numbers of each ii-CBCT image were converted into REDs using the reference table. Next, the absolute differences of RED between the ii-CBCT image and CBCTkV were calculated. Ten VMAT plans using a 10 MV flattening-filter-free beam were used for concurrent imaging of an anthropomorphic torso phantom. Moreover, an iterative reconstruction algorithm (IRA) was used for CBCTMVScorr. The plans were recalculated for the corresponding CBCTMVkV, CBCTMVScorr, CBCTMVScorr+IRA, and CBCTkV with the reference table. Finally, the doses were evaluated using 3D gamma analysis (1%/1 mm). The median difference ranges between CBCTMVkV/CBCTMVScorr and the reference values were −0.58 to −0.10/−0.03 to 0.00. The median gamma pass rates of the doses on CBCTMVkV, CBCTMVScorr, and CBCTMVScorr+IRA to the rate on CBCTkV were 70.4, 99.5, and 98.2%, respectively. CBCTMVScorr were comparable with CBCTkV for calculating the ADD from VMAT.

Implementation of carbon fibre treatment couches in the XiO® and Monaco® Treatment Planning Systems

Abstract Purpose: Carbon fibre treatment couches on linear accelerators provide a strong, rigid framework for patient support. Patient safety is a priority, therefore the dosimetric properties of treatment couches need to be accurately incorporated in treatment plans, to minimize differences between planned and delivered dose. This study aims to determine the attenuation effect of treatment couches for 3-D Conformal Radiotherapy (3-D CRT) and to validate the implementation thereof in the XiO and Monaco treatment planning systems (TPS). Material and methods: Attenuation measurements were performed on the ELEKTA Connexion couches of the ELEKTA Precise and Synergy-Agility linear accelerators. Measurements were made at 10° intervals in RMI-457 Solid water (30 cm x 30 cm x 30 cm) using a PTW Farmer-type ionization chamber (TW30013) positioned at the accelerator’s isocentre. The percentage attenuation was calculated as the ratio of the electrometer readings for parallel-opposed fields. The Computed Tomography (CT) data sets of the set-ups were obtained on a Philips Big Bore 16-slice CT scanner and exported to the TPS. The individual couch structures were delineated and electron density (ED) values were assigned using the commissioned CT-to-ED curve. Test treatment plans were generated with 100MU per field at 10° gantry intervals. Results: The percentage attenuation was determined to be within 2% and 3% for beams perpendicular to the couch surface for XiO and Monaco, respectively. The maximum attenuation was observed for oblique fields which was significantly higher than the manufacturer specified values. TPS validation showed an agreement to 1% for XiO and Monaco. At extreme oblique angles, both planning systems overestimated this effect up to a maximum of 4%. Conclusions: Couch attenuation differs significantly with gantry angle and beam energy. As a result, the treatment couch models should be included in all treatment planning calculations.

Variation of radiation dose with distance from radiotherapy linac bunker maze entrances

Instantaneous dose rate (IDR) measurements were made at the entrances of a number of linac bunkers for a range of beam energies and gantry angles in a large radiotherapy department. The results demonstrate that the IDR does not decrease with distance from the maze entrances according to the inverse square law (ISL), which is commonly used in the design of such bunkers. No simple relationship exists, but a useful guiding principle was found that the IDR at 1 m back from the maze entrance is approximately 50% of that at the entrance itself. This was found to hold with a standard error within 5% across the full extent of the maze entrance by measuring in a grid pattern. The ISL should therefore be used with caution in the design of radiotherapy bunker mazes as it may not provide accurate estimates of the dose in surrounding areas. The results of the grid pattern measurements also indicate that the centre of the maze entrance is the best position to affix passive dosemeters for the purpose of environmental monitoring. This may not always be practical (e.g. if the bunker does not have a door), but factors have been found to correct readings taken elsewhere to the central reading. For instance, if the dosemeter is placed on the wall, the measured dose rate will be equal to 94% ± 8% of the value at the centre of the bunker.

Quality assurance of IMRT treatment plans for a 1.5 T MR-linac using a 2D ionization chamber array and a static solid phantom

MR-guided radiotherapy requires novel quality assurance (QA) methods for intensity-modulated radiotherapy treatment plans (TPs). Here, an optimized method for TPs for a 1.5 T MR-linac was developed and implemented clinically.A static solid phantom and an MR-compatible 2D ionization chamber array were used. The array’s response with respect to the incident beam gantry angles was characterized for four different orientations of the array relative to the beam. A lookup table was created identifying the optimum orientation for each gantry angle. For the QA of clinical MR-linac TPs, beams were grouped according to their gantry angles and measured with up to four setups. The method was applied to n = 106 clinical TPs of 54 patients for different tumour entities. Reference plans and plans created in the online adaptive workflow were analysed, using a local 3%/3 mm gamma criterion for dose values larger than 30% of the maximum. Pass rates were averaged over all beam groups.The array’s response strongly depends on the beam incidence angle. Optimum angles typically range from −10° to 80° around the phantom setup angle. Consequently, plan verification required up to four setups. For clinical MR-linac TPs, the overall median pass rate was 98.5% (range 88.6%–100%). Pass rates depended on the tumour entity. Median pass rates were for liver metastases stereotactic body radiotherapy 99.2%, prostate cancer 99%, pancreatic cancer 98.9%, lymph node metastases 98.7%, partial breast irradiation (PBI) 98%, head-and-neck cancer 97.7%, rectal cancer 94% and others 96.6%. 85% of plans were accepted straightaway, with pass rates above 95%. A single plan with a pass rate below 90% was subsequently verified with a modified method. Off-axis target volumes, e.g. PBI, were verified successfully using a lateral shift of the phantom.The method is suitable to verify reference and online adapted TPs for a 1.5 T MR-linac, including plans for off-axis target volumes.

Proton Therapy in a Pandemic: An Operational Response to the COVID-19 Crisis.

Proton Therapy in a Pandemic: An Operational Response to the COVID-19 Crisis.

Abstract P4-12-10: Clinical implementation of the machine learning-based automated treatment planning tool for whole breast radiotherapy

Abstract Objectives: The machine learning (ML)-based automated treatment planning tool has been developed and evaluated for whole breast radiotherapy. This study implemented the tool in clinic and compared plan quality and planning efficiency with the manual treatment process for whole breast radiotherapy using irregular surface compensator technique. Methods: This study involved two phases. The 1st phase was to evaluate and the 2nd phase was to implement in the clinic. In the 1st phase, thirty whole breast or chest wall cases were planned by using the irregular surface compensator technique with fluence maps manually and iteratively edited to achieve uniform dose distribution to the target by planners. Patients were treated with these manual plans after physician’s approval. The evaluation phase thus compared our in-house ML-based automated treatment planning tool implemented in Eclipse Scripting Application Programming Interface (ESAPI) to these manual plans. The ML-based planning tool generated the fluence maps with the same beam parameters such as beam energy, gantry angle, collimator angle, and aperture shape as manual plans. Breast or chest wall clinical target volume (CTV) coverage based on the percentage CTV volume receiving 95% of the prescribed dose (V95%) and high-dose volume based on V105% were compared to evaluate the plan quality as well as the planning efficiency. Two-tailed Wilcoxon Signed-Rank test was performed to test the null hypothesis that the two planning schemes yield equivalent plan quality. In the 2nd phase, the planners used the automated planning tool for fourteen plans (twelve patients) followed by manual fluence modification as needed. Physicians reviewed and approved the plans, and patients were treated. Results: For the 1st phase, the mean planning time was 110.2 min with standard deviation (SD) of 62.8 min for the manual planning with the range from 25 to 270 min, and 6.4 min with SD of 2.1 min for the automated planning with the range from 4 to 12 min (p&amp;lt;0.01). CTV mean V95% was 96.7% (SD: 5.0%) for the manual planning and 96.7% (SD: 4.8%) for the automated planning (p=0.89). CTV mean V105% was 21.6% (SD: 29.8%) for the manual planning and 20.4% (SD: 30.5%) for the automated planning (p=0.22). Differences in doses to heart and lungs were negligible between the paired plans as the two planning schemes used the same beam parameters. For the 2nd phase, the mean planning time was 16.4 min (SD: 9.1 min) and the mean time for additional manual editing was 12.7 min (SD: 12.5 min). The mean total treatment planning time was 29.1 min (SD: 14.8 min).). CTV mean V95% was 97.2% (SD: 4.2%) and mean V105% was 8.2 % (SD: 3.6%). The manual post modifications were added by the planners with intention to improve the target coverage or to reduce high doses, yet, the difference between the plans without and without the manual post modification was negligible. Conclusion: The ML-based automated treatment planning tool through Varian ESAPI has been successfully implemented for clinical use going through two phases of study. Abiding to the same plan quality as manual process, the automated tool significantly reduced the planning time as the ML-based tool automate the iterative fluence editing process. Citation Format: Sua Yoo, Yang Sheng, Rachel Blitzblau, Suzanne Catalano, Jay Morrison, Leigh O'Neill, Fangfang Yin, Q. Jackie Wu. Clinical implementation of the machine learning-based automated treatment planning tool for whole breast radiotherapy [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P4-12-10.