HD120 MLC Research Articles

SU‐E‐T‐133: Assessing IMRT Treatment Delivery Accuracy and Consistency On a Varian TrueBeam Using the SunNuclear PerFraction EPID Dosimetry Software

Purpose:To assess if the TrueBeam HD120 collimator is delivering small IMRT fields accurately and consistently throughout the course of treatment using the SunNuclear PerFraction software.Methods:7‐field IMRT plans for 8 canine patients who passed IMRT QA using SunNuclear Mapcheck DQA were selected for this study. The animals were setup using CBCT image guidance. The EPID fluence maps were captured for each treatment field and each treatment fraction, with the first fraction EPID data serving as the baseline for comparison. The Sun Nuclear PerFraction Software was used to compare the EPID data for subsequent fractions using a Gamma (3%/3mm) pass rate of 90%. To simulate requirements for SRS, the data was reanalyzed using a Gamma (3%/1mm) pass rate of 90%. Low‐dose, low‐ and high gradient thresholds were used to focus the analysis on clinically relevant parts of the dose distribution.Results:Not all fractions could be analyzed, because during some of the treatment courses the DICOM tags in the EPID images intermittently change from CU to US (unspecified), which would indicate a temporary loss of EPID calibration. This technical issue is still being investigated. For the remaining fractions, the vast majority (7/8 of patients, 95% of fractions, and 96.6% of fields) are passing the less stringent Gamma criteria. The more stringent Gamma criteria caused a drop in pass rate (90 % of fractions, 84% of fields). For the patient with the lowest pass rate, wet towel bolus was used. Another patient with low pass rates experienced masseter muscle wasting.Conclusion:EPID dosimetry using the PerFraction software demonstrated that the majority of fields passed a Gamma (3%/3mm) for IMRT treatments delivered with a TrueBeam HD120 MLC. Pass rates dropped for a DTA of 1mm to model SRS tolerances. PerFraction pass rates can flag missing bolus or internal shields.Sanjeev Saini is an employee of Sun Nuclear Corporation. For this study, a pre‐release version of PerFRACTION 1.1 software from Sun Nuclear Corporation was used.

TU‐CD‐304‐08: Feasibility of a VMAT‐Based Spatially Fractionated Grid Therapy Technique

Purpose:Grid therapy (GT) uses spatially modulated radiation doses to treat large tumors without significant toxicities. Incorporating 3D conformal‐RT or IMRT improved single‐field GT by reducing dose to normal tissues spatially through the use of multiple fields. The feasibility of a MLC‐based, inverse‐planned multi‐field GT technique has been demonstrated. Volumetric modulated arc therapy (VMAT) provides conformal dose distributions with the additional potential advantage of reduced treatment times. In this study, we characterize a new VMAT‐based GT (VMAT‐GT) technique with respect to its deliverability and dosimetric accuracy.Methods:A lattice of 5mm‐diameter spheres was created as the boost volume within a large treatment target. A simultaneous boost VMAT (RapidArc) plan with 8Gy to the target and 20Gy to the boost volume was generated using the Eclipse treatment planning system (AAA‐v11). The linac utilized HD120 MLC and 6MV flattening‐filter free beam. Four non‐coplanar arcs, with couch angles at 0, 45, 90 and 317° were used. Collimator angles were at 45 and 315°. The plan was mapped to a phantom. Calibrated Gafchromic EBT3 films were used to measure the delivered dose.Results:The VMAT plan generated a highly spatially modulated dose distribution in the target. D95%, D50%, D5% for the spheres and the targets in Gy were 18.9, 20.6, 23 and 8.0, 9.6, 14.8, respectively. D50% for a 1cm ring 1cm outside the target was 3.0Gy. The peak‐to‐valley ratio of this technique is comparable to previously proposed techniques, but the MUs were reduced by almost 50%. Film dosimetry showed good agreement between calculated and delivered dose, with an overall gamma passing rate of >98% (3% and 1mm). The point dose differences at sphere centers varied from 2–8%.Conclusion:The deliverability and dose calculation accuracy of the proposed VMAT‐GT technique demonstrates that ablative radiation doses are deliverable to large tumors safely and efficiently.

SU-D-BRB-05: Gamma Knife and Volumetric Modulated Arc Therapy Stereotactic Radiosurgery Have Equivalent Plan Quality and OAR Sparing for Pituitary Adenomas and Vestibular Schwannomas

Purpose: To compare the plan quality and organs at risk (OAR) sparing of volumetric modulated art therapy (VMAT) and Gamma Knife for stereotactic radiosurgery (SRS) of pituitary adenomas and vestibular schwannomas (VS). Methods: VMAT radiosurgery plans (SmartArc) were made using Pinnacle’s (version 9.10, Phillips) new Auto-Plan tool for eight vestibular schwannoma (VS) and eight pituitary adenoma patients previously treated with Gamma Knife Perfexion (GK) system. VMAT plans were made with three non-coplanar arcs using 3 angles, 6MV, FFF mode at 1400 MU per min dose rate and millennium HD MLC. All plans were normalized to deliver prescription dose (Rx) to at least 99.5 percent of the target volume. Results: For pituitary cases (1.07 – 20.71cc), respectively for GK and VMAT plans, mean conformity index (CI) was 1.62 ± 0.23 Gy and 1.51 ± 0.21 Gy (p = 0.05); mean gradient index (GI) was 2.76 ± 0.14 and 3.15 ± 0.43 Gy (p < 0.05); mean brainstem maximum dose was 9.13 ± 3.50 Gy and 7.31 ± 2.01 Gy (p < 0.05); mean optic nerve maximum dose was 9.66 ± 1.0 Gy and 7.67 ± 2.58 Gy (p < 0.05); and mean treatment time of 68 min and 4 min. For VS (0.47 – 5.26cc), respectively for GK and VMAT plans, CI was 1.39 ± 0.23 Gy and 1.57 ± 0.28 Gy (p < 0.05); GI was 3.71 ± 1.83 and 3.60 ± 0.84 Gy (p = 0.82); brainstem maximum dose was 11.67 ± 4.56 Gy and 12.22 ± 4.56 Gy (p = 0.12), cochlea mean dose was 7.31 ± 2.7 Gy and 6.75 ± 3.88 Gy (p = 0.52); and mean treatment time of 40 min and 4 min. Conclusion: VMAT plan quality and OAR sparing were comparable to GK plans with a shorter treatment time. Samuel Chao is a member of Varian Speakers Bureau, Gennady Neyman is a consultant for Elekta Instrument A/B

Feasibility of using Geant4 Monte Carlo simulation for IMRT dose calculations for the Novalis Tx with a HD-120 multi-leaf collimator

The aim of this study was to develop an independent dose verification system by using a Monte Carlo (MC) calculation method for intensity modulated radiation therapy (IMRT) conducted by using a Varian Novalis Tx (Varian Medical Systems, Palo Alto, CA, USA) equipped with a highdefinition multi-leaf collimator (HD-120 MLC). The Geant4 framework was used to implement a dose calculation system that accurately predicted the delivered dose. For this purpose, the Novalis Tx Linac head was modeled according to the specifications acquired from the manufacturer. Subsequently, MC simulations were performed by varying the mean energy, energy spread, and electron spot radius to determine optimum values of irradiation with 6-MV X-ray beams by using the Novalis Tx system. Computed percentage depth dose curves (PDDs) and lateral profiles were compared to the measurements obtained by using an ionization chamber (CC13). To validate the IMRT simulation by using the MC model we developed, we calculated a simple IMRT field and compared the result with the EBT3 film measurements in a water-equivalent solid phantom. Clinical cases, such as prostate cancer treatment plans, were then selected, and MC simulations were performed. The accuracy of the simulation was assessed against the EBT3 film measurements by using a gamma-index criterion. The optimal MC model parameters to specify the beam characteristics were a 6.8-MeV mean energy, a 0.5-MeV energy spread, and a 3-mm electron radius. The accuracy of these parameters was determined by comparison of MC simulations with measurements. The PDDs and the lateral profiles of the MC simulation deviated from the measurements by 1% and 2%, respectively, on average. The computed simple MLC fields agreed with the EBT3 measurements with a 95% passing rate with 3%/3-mm gamma-index criterion. Additionally, in applying our model to clinical IMRT plans, we found that the MC calculations and the EBT3 measurements agreed well with a passing rate of greater than 95% on average with a 3%/3-mm gamma-index criterion. In summary, the Novalis Tx Linac head equipped with a HD-120 MLC was successfully modeled by using a Geant4 platform, and the accuracy of the Geant4 platform was successfully validated by comparisons with measurements. The MC model we have developed can be a useful tool for pretreatment quality assurance of IMRT plans and for commissioning of radiotherapy treatment planning.

Assessment for the Utility of Treatment Plan QA System according to Dosimetric Leaf Gap in Multileaf Collimator

For evaluating the treatment planning accurately, the quality assurance for treatment planning is recommended when patients were treated with IMRT which is complex and delicate. To realize this purpose, treatment plan quality assurance software can be used to verify the delivered dose accurately before and after of treatment. The purpose of this study is to evaluate the accuracy of treatment plan quality assurance software for each IMRT plan according to MLC DLG (dosimetric leaf gap). Novalis Tx with a built-in HD120 MLC was used in this study to acquire the MLC dynalog file be imported in MobiusFx. To establish IMRT plan, Eclipse RTP system was used and target and organ structures (multi-target, mock prostate, mock head/neck, C-shape case) were contoured in I'm RT phantom. To verify the difference of dose distribution according to DLG, MLC dynalog files were imported to MobiusFx software and changed the DLG (0.5, 0.7, 1.0, 1.3, 1.6 mm) values in MobiusFx. For evaluation dose, dose distribution was evaluated by using 3D gamma index for the gamma criteria 3% and distance to agreement 3 mm, and the point dose was acquired by using the CC13 ionization chamber in isocenter of I'mRT phantom. In the result for point dose, the mock head/neck and multi-target had difference about 4% and 3% in DLG 0.5 and 0.7 mm respectively, and the other DLGs had difference less than 3%. The gamma index passing-rate of mock head/neck were below 81% for PTV and cord, and multi-target were below 30% for center and superior target in DLGs 0.5, 0.7 mm, however, inferior target of multi-target case and parotid of mock head/neck case had 100.0% passing rate in all DLGs. The point dose of mock prostate showed difference below 3.0% in all DLGs, however, the passing rate of PTV were below 95% in 0.5, 0.7 mm DLGs, and the other DLGs were above 98%. The rectum and bladder had 100.0% passing rate in all DLGs. As the difference of point dose in C-shape were 3∼9% except for 1.3 mm DLG, the passing rate of PTV in 1.0 1.3 mm were 96.7, 93.0% respectively. However, passing rate of the other DLGs were below 86% and core was 100.0% passing rate in all DLGs. In this study, we verified that the accuracy of treatment planning QA system can be affected by DLG values. For precise quality assurance for treatment technique using the MLC motion like IMRT and VMAT, we should use appropriate DLG value in linear accelerator and RTP system.

SU-E-T-569: Evaluation of VMAT Plans Generated with HD120 and Millennium 120 MLC Between Two Matched Linacs

Purpose: To evaluate VMAT treatment plans generated with HD120 MLC and Millennium 120 MLC between two matched linacs and to determine if one can back up the other. Methods: The 6x photon beams are matched for our Varian TrueBeam STx and Trilogy linacs, which are equipped with HD120 MLC and Millennium 120 MLC, respectively. Three prostate and three brain VMAT plans were used for the evaluation. Five plans (three prostate and two brain plans) were originally generated with the TrueBeam STx and re-computed with the Trilogy. One brain plan was evaluated the other way around. For each plan, the PTV coverage of V95 was made the same between two linacs. The dosimetric differences associated with the plans were compared using: 1) Percentage mean dose differences to the PTV, 2) Homogeneity index, HI = (Dmax − Dmin)/Dmean for the PTV. For prostate plans, the mean dose differences to the rectum were evaluated. While for brain plans, the percentage max dose differences to the lenses (left and right lens) were evaluated. Results: For three prostate plans, the average of the percentage mean dose differences to the PTV was 0.5 ± 0.1% and the HI was 0.1 ± 0.0%. The average of themore » percentage mean dose difference to the rectum was 3.5 ± 0.5%. For three brain plans, the average of the percentage mean dose differences to the PTV was 0.2 ± 1.1% and the HI was 0.2 ± 0.1%. The average of the percentage max dose differences to the lenses was 22.9 ± 4.0%. Conclusion: For prostate VMAT plans, changing the treatment from the TrueBeam STx to the Trilogy does not necessarily need re-optimization. But for brain plans, in order to minimize dose to the lenses, it is recommended to re-optimize the plan if changing the treatment between these two linacs.« less

SU-E-T-175: Evaluation of the Relative Output Ratio for Collimator Jaw and MLC Defined Small Static 6MV Photon Fields

Purpose: To evaluate relative output ratio of collimator jaw and MLC defined small photon fields. Methods: Relative output ratios were measured using Gafchromic EBT3 film for a 6 MV photon beam on a Novalis Tx with HD120 MLC. Beam collimation was achieved by the jaws for 1.0 cm and 3.0 cm and MLC defined square field sizes between 0.5 cm and 1.0 cm with varying jaw settings between 2.0 and 4.0 cm. Film pieces were exposed to 4 Gy. Experiments were repeated with each session consisting of five consecutive exposures for the given MLC and/or jaw collimation and with the MLC and the jaws reset for each exposure. Films were scanned using EPSON 10000XL flatbed scanner approximately 24 hours after exposure in 48 bit RGB format at 150 dpi. Film calibration data were corrected for daily linac output variations. Doses were evaluated using the green channel with square ROI sizes of 0.1 – 0.6 cm. Converted doses were normalised for output ratio calculation using the 3.0 cm field as a machine specific reference field size. Mean output ratio and coefficient of variation (CV) were calculated for each experimental session. Results: For the Novalis 6 MV photon beam the output ratiosmore » between 0.719 and 0.872 have been measured for the jaw/MLC combinations tested. For a jaw setting of 4.0 cm field, the mean CV of the output ratios increased from 0.77% to 1.48% with decreasing MLC field size from 1.0 cm to 0.5 cm. For a nominal MLC 1.0 cm field, the CV increased to 1.00% from 0.77% with reducing jaw field size from 4.0 cm to 2.0 cm. Conclusion: The relative output ratio and the associated CV were dependent on the collimator jaw and MLC settings. The field size dependent CV showed similar trends to those reported in the literature.« less

TH‐C‐12A‐06: Feasibility of a MLC‐Based Inversely Optimized Multi‐Field Grid Therapy Technique

Purpose:Grid therapy (GT), which generates highly spatially modulated dose distributions, can deliver single‐ or hypo‐fractionated radiotherapy for large tumors without causing significant toxicities. GT may be applied in combination with immunotherapy, in light of recent preclinical data of synergetic interaction between radiotherapy and immunotherapy. However, conventional GT uses only one field, which does not have the advantage of multi‐fields in 3D conformal‐RT or IMRT. We have proposed a novel MLC‐based, inverse‐planned multi‐field 3D GT technique. This study aims to test its deliverability and dosimetric accuracy.Methods:A lattice of small spheres was created as the boost volume within a large target. A simultaneous boost IMRT plan with 8‐Gy to the target and 20‐Gy to the boost volume was generated in the Eclipse treatment planning system (AAA v10) with a HD120 MLC. Nine beams were used, and the gantry and couch angles were selected so that the spheres were perfectly aligned in every beams eye view. The plan was mapped to a phantom with dose scaled. EBT3 films were calibrated and used to measure the delivered dose.Results:The IMRT plan generated a highly spatially modulated dose distribution in the target. D95%, D50%, D5% for the spheres and the targets in Gy were 18.5, 20.0, 21.4 and 7.9, 9.8, 16.1, respectively. D50% for a 1cm ring 1cm outside the target was 2.9‐Gy. Film dosimetry showed good agreement between calculated and delivered dose, with an overall gamma passing rate of 99.6% (3%/1mm). The point dose differences for different spheres varied from 1–6%.Conclusion:We have demonstrated the deliverability and dose calculation accuracy of the MLC‐based inversely optimized multi‐field GT technique, which achieved a brachytherapy‐like dose distribution. Single‐fraction high dose can be delivered to the spheres in a large target with minimal dose to the surrounding normal tissue.

SU‐E‐T‐19: A New End‐To‐End Test Method for ExacTrac for Radiation and Plan Isocenter Congruence

Purpose:To combine and integrate quality assurance (QA) of target localization and radiation isocenter End to End (E2E) test of BrainLAB ExacTrac system, a new QA approach was devised using anthropomorphic head and neck phantom. This test insures the target localization as well as radiation isocenter congruence which is one step ahead the current ExacTrac QA procedures.Methods:The head and neck phantom typically used for CyberKnife E2E test was irradiated to the sphere target that was visible in CT‐sim images. The CT‐sim was performed using 1 mm thickness slice with helical scanning technique. The size of the sphere was 3‐cm diameter and contoured as a target volume using iPlan V.4.5.2. A conformal arc plan was generated using MLC‐based with 7 fields, and five of them were include couch rotations. The prescription dose was 5 Gy and 95% coverage to the target volume. For the irradiation, two Gafchromic films were perpendicularly inserted into the cube that hold sphere inside. The linac used for the irradiation was TrueBeam STx equipped with HD120 MLC. In order to use ExacTrac, infra‐red head–array was used to correlate orthogonal X‐ray images.Results:Using orthogonal X‐rays of ExacTrac the phantom was positioned. For each field, phantom was check again with X‐rays and re‐positioned if necessary. After each setup using ExacTrac, the target was irradiated. The films were analyzed to determine the deviation of the radiation isocenter in all three dimensions: superior‐inferior, left‐right and anterior‐posterior. The total combining error was found to be 0.76 mm ± 0.05 mm which was within sub‐millimeter accuracy.Conclusion:Until now, E2E test for ExacTrac was separately implemented to test image localization and radiation isocenter. This new method can be used for periodic QA procedures.

SU-E-T-628: Effect of Dose Rate and Leakage Correction for Dosimetric Leaf Gap Measurement

Purpose: To study the dose rate response of Mapcheck and quantify/correct dose rate/leakage effect on IMRT QA. Evaluate the dose rate/leakage effect on dosimetric leaf gap (DLG) measurement. Methods: Varian Truebeam Linac with HD120 MLC was used for all measurement, it is capable to adjust dose rate from 600MU/min to 5MU/min. Fluke Advanced Therapy Doisemter and PTW 30013 Farmer chamber for chamber measurement; SunNuclear Mapcheck2 with 5cm total buildup for diode measurement. DLG was measured with both chamber and diode.Diode response was measured by varies dose rate, while fixed mapcheck setup and total MU. MLC Leakage was measured with both chamber and diode. Mapcheck measurement was saved as movie file (mcm file), which include measurement updated every 50mSec. The difference between intervals can be converted to dose and dose rate and leakage response correction can be applied to them. Results: DLG measurement results with chamber and diode were showed as follows, the DLG value is 0.36 vs. 0.24mm respectively. Diode dose rate response drops from 100% at 600MU/min to 95.5% at 5MU/min as follows. MLC Leakage measured with diode is 1.021%, which is 9% smaller than 1.112% from chamber measurement. By apply the dose rate and leakage correction, the residue error reduced 2/3. Conclusions: Diode has lower response at lower dose rate, as low as 4.5% for 5MU/min; diode has lower energy response for low energy too, 5% lower for Co-60 than 6MV. It partially explains the leakage difference of 9% between chamber and diode. Lower DLG with diode is because of the lower response at narrower gap, in Eclipse however DLG need to increase to makeup lower response, which is over correction for chamber though. Correction can reduce error by 2/3, the rest 1/3 can be corrected by scatter effect, which is under study.

SU-E-T-57: Brain SRS Dose Variations Due to TrueBeam STx Isocenter Uncertainty

Purpose: Stereotactic Radiosurgery (SRS) is a valuable option for treatment of cranial melignancies. Well defined isocenter position (uncertainty <1 mm) of Varian TrueBeam STx, HD MLC, linac allows for tighter PTV margins(1mm). We report the effect of daily isocenter fluctuations established by Winston-Lutz test on target and cranial organ at risk (OAR) dosimetric parameters. Methods: 10 patient treatments were prepared using BrainLab iPlan softare. GTV and critical structures were contoured by neurosurgeon. A uniform margin of 1mm was used to expand GTV to PTV. Dose of 18 to 20Gy was prescribed to cover 99% of PTV volume using 3 or 4 dynamic arcs. Winston-Lutz test was performed daily to monitor linac isocenter stability, with 8 images (4 for various gantry angles, 4 for couch angles) analyzed by Standard Imaging PIPSpro software. Singular Value Decomposition method is used to determine the values for isocenter x, y and z coordinate offset, subsequently fed into treatment planning software to evaluate changes in dose coverage. Results: The average displacement (distance from lightfield center) of linac isocenter during 3 months of daily observations was 0.42±0.12mm (max observed displacement 0.656mm), with the average displacement of 0.27mm ptsuperior, 0.22mm pt-right, 0.04mm pt-posterior direction. With all plans normalized (PTV V100=99%) the daily isocenter walk resulted in average loss of V100PTV volume coverage of 4.2%. PTV Dmin dropped 8.9%, while GTV Dmin was 3.1% lower (108.1% planned) on average. Changes for PTV and GTV Dmean and Dmax parameters were less than 1%. Most of the cases showed insignificant changes in OAR dose coverage, with exception of vermis lesion where brainstem Dmax changed 2.4%. Conclusion: Daily monitoring of TrueBeam STx linac isocenter showed that GTV V100 remained at 100% of target volume in all cases. The effect of isocenter uncertainty could be further reduced by Brainlab ExacTrac Xray imaging.

Monte Carlo modeling of HD120 multileaf collimator on Varian TrueBeam linear accelerator for verification of 6X and 6X FFF VMAT SABR treatment plans.

A Monte Carlo (MC) validation of the vendor‐supplied Varian TrueBeam 6 MV flattened (6X) phase‐space file and the first implementation of the Siebers‐Keall MC MLC model as applied to the HD120 MLC (for 6X flat and 6X flattening filterfree (6X FFF) beams) are described. The MC model is validated in the context of VMAT patient‐specific quality assurance. The Monte Carlo commissioning process involves: 1) validating the calculated open‐field percentage depth doses (PDDs), profiles, and output factors (OF), 2) adapting the Siebers‐Keall MLC model to match the new HD120‐MLC geometry and material composition, 3) determining the absolute dose conversion factor for the MC calculation, and 4) validating this entire linac/MLC in the context of dose calculation verification for clinical VMAT plans. MC PDDs for the 6X beams agree with the measured data to within 2.0% for field sizes ranging from 2 × 2 to 40 × 40 cm2. Measured and MC profiles show agreement in the 50% field width and the 80%‐20% penumbra region to within 1.3 mm for all square field sizes. MC OFs for the 2 to 40 cm2 square fields agree with measurement to within 1.6%. Verification of VMAT SABR lung, liver, and vertebra plans demonstrate that measured and MC ion chamber doses agree within 0.6% for the 6X beam and within 2.0% for the 6X FFF beam. A 3D gamma factor analysis demonstrates that for the 6X beam, > 99% of voxels meet the pass criteria (3%/3 mm). For the 6X FFF beam, > 94% of voxels meet this criteria. The TrueBeam accelerator delivering 6X and 6X FFF beams with the HD120 MLC can be modeled in Monte Carlo to provide an independent 3D dose calculation for clinical VMAT plans. This quality assurance tool has been used clinically to verify over 140 6X and 16 6X FFF TrueBeam treatment plans.PACS number: 87.55.K‐

SU-E-T-172: Portal Dosimetry of Gated VMAT; with and Without Gating

Purpose: To study duty cycle and respiratory period influence on VMAT delivery using portal dosimetry. Methods: For this study, we selected 12 ARC fields from four different gated VMAT plans with Varian, TrueBeam 6 MV photon beam and HD120 MLC. For Planning and portal dose prediction we used Varian, Eclipse (Version 10.0) AAA and PDIP algorithms respectively. We acquired integrated portal images with and without gated arc fields delivered to EPID at SID 140cm. We simulated respiratory periods with Quasar, Motion Phantom. For gated delivery, we used planned duty cycle for patient respiratory trace, and 6 sec per breath (SPB) and duty cycles 40%, 30%, 20% and 10% with 3SPB. Eclipse, Portal dosimetry software was used for Gamma analyses of measured and predicted portal dose images. In addition, we compared with and without gated portal dose images of same arc. MLC log file analyses of delivered arcs were done with Mobius, Dose lab software. Gamma passing criteria is to have gamma<1 for greater than 90% data points. Results: For all arcs, predicted vs. measured dose distributions passed with criteria ΔD = 3% & DTA = 3mm, excluding few 10% duty cycle measurements. For these, pass criteria is ΔD = 5% & DTA = 4mm. Similarly, with and without gated portal dose image comparison passed the criteria of ΔD = 1% & DTA = 1mm excluding few 10% duty cycle measurements. For these pass criteria is ΔD = 2% & DTA = 2mm. For all delivered arcs, Leaf error 95 percentile is < 0. 1mm and error RMS is below 0.05mmConclusion: Except 10 % duty cycle, the gating influence on VMAT delivery is minimal. Therefore, gated VMAT QA can be done without gating. Duty cycles larger than 20% are recommended to minimize delivery errors.

SU-E-T-507: Dose Calculation Quality of AcurosXB Involving a HD120 MLC Compared with Monte Carlo Methods.

Advanced radiation therapy requires highly sophisticated dose calculation algorithms such as finite element based Boltzmann solvers or Monte Carlo (MC) methods. MC is commonly accepted as the golden standard method for dose calculation in high energy treatments and thus it is used for benchmarking other algorithms. In this work the quality of dose distribution calculated using the Boltzmann solver based AcurosXB algorithm within Eclipse (Varian Medical Systems) is investigated for volumetric modulated arc treatment (VMAT) plans involving the high definition MLC (HD120 MLC) by comparing doses with the validated Swiss Monte Carlo Plan (SMCP). Within SMCP and Eclipse using AcurosXB, 10 VMAT H&N patient plans and corresponding verification plans were recalculated using fixed MUs. In SMCP, radiation transport and dose calculation were performed using VMC++ with a statistical uncertainty of 1%. The voxel size was 2.5 mm for SMCP and AcurosXB and the same material composition data was used for CT conversion. Dose volume histograms (DVH) were used in order to quantify the difference between the dose distributions of the patient plans. In addition, calculated verification plans were compared with measurements carried out with the Delta4 system (Scandidos) by using the gamma evaluation with 3%/3 mm criteria of points having a dose larger than 20% of isocenter dose. DVHs for the patient plans showed good agreement between SMCP and AcurosXB calculations. Overall AcurosXB lead to an underestimation of the median dose values by about 1%. For measured total dose distributions of the verification plans on average 98.6% and 99.0% of the points fullfil the gamma criteria for the dose calculated using AcurosXB and SMCP, respectively. Resulting AcurosXB dose distributions for VMAT H&N plans involving a HD120 MLC are in good agreement with calculated SMCP dose distributions. This work was supported by Varian Medical Systems.

Clinical commissioning and use of the Novalis Tx linear accelerator for SRS and SBRT

The purpose of this study was to perform comprehensive measurements and testing of a Novalis Tx linear accelerator, and to develop technical guidelines for commissioning from the time of acceptance testing to the first clinical treatment. The Novalis Tx (NTX) linear accelerator is equipped with, among other features, a high‐definition MLC (HD120 MLC) with 2.5 mm central leaves, a 6D robotic couch, an optical guidance positioning system, as well as X‐ray‐based image guidance tools to provide high accuracy radiation delivery for stereotactic radiosurgery and stereotactic body radiation therapy procedures. We have performed extensive tests for each of the components, and analyzed the clinical data collected in our clinic. We present technical guidelines in this report focusing on methods for: (1) efficient and accurate beam data collection for commissioning treatment planning systems, including small field output measurements conducted using a wide range of detectors; (2) commissioning tests for the HD120 MLC; (3) data collection for the baseline characteristics of the on‐board imager (OBI) and ExacTrac X‐ray (ETX) image guidance systems in conjunction with the 6D robotic couch; and (4) end‐to‐end testing of the entire clinical process. Established from our clinical experience thus far, recommendations are provided for accurate and efficient use of the OBI and ETX localization systems for intra‐ and extracranial treatment sites. Four results are presented. (1) Basic beam data measurements: Our measurements confirmed the necessity of using small detectors for small fields. Total scatter factors varied significantly (30% to approximately 62%) for small field measurements among detectors. Unshielded stereotactic field diode (SFD) overestimated dose by ~ 2% for large field sizes. Ion chambers with active diameters of 6 mm suffered from significant volume averaging. The sharpest profile penumbra was observed for the SFD because of its small active diameter (0.6 mm). (2) MLC commissioning: Winston Lutz test, light/radiation field congruence, and Picket Fence tests were performed and were within criteria established by the relevant task group reports. The measured mean MLC transmission and dynamic leaf gap of 6 MV SRS beam were 1.17% and 0.36 mm, respectively. (3) Baseline characteristics of OBI and ETX: The isocenter localization errors in the left/right, posterior/anterior, and superior/inferior directions were, respectively, −0.2±0.2 mm, −0.8±0.2 mm, and −0.8±0.4 mm for ETX, and 0.5±0.7 mm, 0.6±0.5 mm, and 0.0±0.5 mm for OBI cone‐beam computed tomography. The registration angular discrepancy was 0.1±0.2°, and the maximum robotic couch error was 0.2°. (4) End‐to‐end tests: The measured isocenter dose differences from the planned values were 0.8% and 0.4%, measured respectively by an ion chamber and film. The gamma pass rate, measured by EBT2 film, was 95% (3% DD and 1 mm DTA). Through a systematic series of quantitative commissioning experiments and end‐to‐end tests and our initial clinical experience, described in this report, we demonstrate that the NTX is a robust system, with the image guidance and MLC requirements to treat a wide variety of sites — in particular for highly accurate delivery of SRS and SBRT‐based treatments.PACS numbers: 87.55.Qr, 87.53.Ly, 87.59.‐e

3D Dose Reconstruction of Pretreatment Verification Plans Using Multiple 2D Planes from the OCTAVIUS/Seven29 Phantom Array

The purpose of this study is to evaluate 3D dose reconstruction of pretreatment verification plans using multiple 2D planes acquired from the OCTAVIUS phantom and the Seven29 detector array. Eight VMAT patient treatment plans of different sites were delivered onto the OCTAVIUS phantom. The plans span a variety of tumor site locations from low to high plan complexity. A patient specific quality assurance (QA) plan was created and delivered for each of the 8 patients using the OCTAVIUS phantom in which the Seven29 detector array was placed. Each plan was delivered four times by rotating the phantom in 45° increments along its longitudinal axis. The treatment plans were delivered using a Novalis Tx with the HD120 MLC. Each of the four corresponding planar doses was exported as a text file for further analysis. An in-house MATLAB code was used to process the planar dose information. A cylindrical geometry-based, linear interpolation method was utilized to generate the measured 3D dose reconstruction. The TPS calculated volumetric dose was exported and compared against the measured reconstructed volumetric dose. Dose difference, dose area histograms (DAH), isodose lines, profiles, 2D and 3D gamma were used for evaluation. The interpolation method shows good agreement (<2%) between the planned dose distributions in the high dose region but shows discrepancies in the low dose region. Horizontal profiles, dose area histograms and isodose lines show good agreement for the sagittal and coronal planes but demonstrate slight discrepancies in the transverse plane. The 3D gamma index average was 92.4% for all patients when a 5%/5 mm gamma passing rate criteria was employed but dropped to <80.1% on average when parameters were reduced to 2%/2 mm. A simple cylindrical geometry-based, linear interpolation method is able to predict good agreement in the high dose region between the reconstructed volumetric dose and the planned volumetric dose. It is important to mention that the interpolation algorithm introduces dose discrepancies in small regions within the high dose gradients due to the interpolation itself. However, the work presented serves as a good starting point to establish a benchmark for the level of manipulation necessary to obtain 3D dose delivery quality assurance using current technology.

Evaluation of volumetric modulated arc therapy for cranial radiosurgery using multiple noncoplanar arcs

To evaluate a commercial volumetric modulated arc therapy (VMAT), using multiple noncoplanar arcs, for linac-based cranial radiosurgery, as well as evaluate the combined accuracy of the VMAT dose calculations and delivery. Twelve patients with cranial lesions of variable size (0.1-29 cc) and two multiple metastases patients were planned (Eclipse RapidArc AAA algorithm, v8.6.15) using VMAT (1-6 noncoplanar arcs), dynamic conformal arc (DCA, ∼4 arcs), and IMRT (nine static fields). All plans were evaluated according to a conformity index (CI), healthy brain tissue doses and volumes, and the dose to organs at risk. A 2D dose distribution was measured (Varian Novalis Tx, HD120 MLC, 1000 MU/min, 6 MV beam) for the ∼4 arc VMAT treatment plans using calibrated film dosimetry. The CI (0-1 best) average for all plans was best for ∼4 noncoplanar arc VMAT at 0.86 compared with ∼0.78 for IMRT and a single arc VMAT and 0.68 for DCA. The volumes of healthy brain receiving 50% of the prescribed target coverage dose or more (V(50%)) were lowest for the four arc VMAT [RA(4)] and DCA plans. The average ratio of the V(50%) for the other plans to the RA(4) V(50%) were 1.9 for a single noncoplanar arc VMAT [RA(1nc)], 1.4 for single full coplanar arc VMAT [RA(1f)] and 1.3 for IMRT. The V(50%) improved significantly for single isocenter multiple metastases plan when two noncoplanar VMAT arcs were added to a full single coplanar one. The maximum dose to 5 cc of the outer 1 cm rim of healthy brain which one may want to keep below nonconsequential doses of 300-400 cGy, was 2-3 times greater for IMRT, RA(1nc) and RA(1f) plans compared with the multiple noncoplanar arc DCA and RA(4) techniques. Organs at risk near (0-4 mm) to targets were best spared by (i) single noncoplanar arcs when the targets are lateral to the organ at risk and (ii) by skewed nonvertical planes of IMRT fields when the targets are not lateral to the organ at risk. The highest dose gradient observed between an organ at risk and a target at the edge of a VMAT arc plane or plane of IMRT fields was 17%/mm. The average absolute percent difference between the measured and calculated central axis dose for all the VMAT plans was 3.6 ± 2.2%. The measured perpendicular profile widths and shifts were on average within 0.5 mm of planned values. The average total MUs for VMAT plans was double the DCA average and similar to the IMRT average. For the aforementioned planning and delivery system and cranial lesions greater than 7 mm in diameter, multiple noncoplanar arc VMAT consistently provides accurate and high quality cranial radiosurgery dose distributions with low doses to healthy brain tissue and high dose conformity to the target. These qualities may make multiple noncoplanar arc VMAT suitable for a greater range of prescription doses or larger and more irregular lesions. For smaller and/or rounder lesions there are other clinically acceptable treatment techniques that may involve fewer couch angles or arcs and reduce treatment times.

SU-E-T-897: SRS Treatment Plan Quality for Large Brain Tumor Using Cyberknife and RapidArc

Purpose: This work will evaluate the quality of the treatment plan for large brain tumors using Cyberknife from Accuray and RapidArc from Varian. Cyberknife is a cone based non-isocentric stereotactic radiosurgery (SRS) system; RapidArc is a MLC based volumetric modulated arc therapy system. The Cyberknife system can generate arbitrary dose shape with high conformality and rapid dose fall off. RapidArc with 2.5mm HD MLC can potentially deliver dose shape typically required for brain radiosurgery. This study compares treatment plans using RapidArc with clinical treatment plans for large brain tumors from Cyberknife. Methods: Clinical Cyberknife treatment plans for large brain tumors with volume up to 50 cubic centimeters are selected to be re-planned using RapidArc. Prescriptions are 24 or 27 Gy in 3 fractions covering at least 95% of the target volume while minimizing the dose to critical organs with CI (Conformity Index: ratio of target volume receiving prescription dose to total volume at prescription) 1.5 or less. RapidArc plans are generated with one 358 degree arc to have the same target coverage and similar dose constraints. CI, CI50% (ratio of volume getting 50% prescription dose to total volume at prescription) and maximum dose 2cm from the targets are compared between the 2 modalities.Results: The RapidArc plans have same to 10% higher CI, 10%– 150% higher CI50% and same to 50% higher maximum dose 2cm from targets than Cyberknife plans with same target coverage and similar target minimum Conclusions: RapidArc can generate plans with similar conformality with Cyberknife but with lower dose fall off than Cyberknife. RapidArc results come closest to Cyberknife results for larger tumor volumes.

SU-GG-T-250: 3D Dose Reconstruction for Delivery Quality Assurance (DQA) from Multiple 2D Planes Using the OCTAVIOUS Phantom

Purpose: To perform a 3D dose reconstruction for delivery quality assurance (DQA) from multiple 2D planes using the OCTAVIOUS phantom. Method and Materials: Ten RapidArc patient treatment plans of different sites were delivered on two phantoms. Two different DQA plans were delivered for each of the 10 patients: 1) OCTAVIOUS phantom and 2) 30×30×30 cube solid water phantom in which the detector array (Seven29) was placed. The corresponding 3D dose of each of the DQA plans was exported. All DQA plans were delivered by means of a NovalisTX with the HD120 MLC. For the solid water phantom, the same plan was delivered six times with the array varying in the coronal plane in increments of 0.5cm. For the OCTAVIOUS, the same plan was delivered four times by rotating the phantom in 45° increments along its longitudinal axis. An in‐house MATLAB code was used to read the planar dose information. A linear reconstruction was performed for the cube phantom while a circular reconstruction was used for the OCTAVIOUS. Dose statistics per plane were obtained to validate the reconstruction method. Results: Both interpolation methods showed good agreement to the planned dose distribution in the high dose region (<1.0%) but showed discrepancies in the low dose region. A DAH comparison shows good agreement for the sagittal and coronal planes but demonstrates some discrepancies in the transversal plane. Conclusion: A simple linear interpolation method is able to predict good matching in the high dose region between the reconstructed dose and the planned dose. This technique is a good starting point to establish a benchmark in the level of manipulation necessary to obtain good 3D dose delivery quality assurance using current technology. Conflict of Interest: Research Sponsored by PTW Company

SU‐GG‐T‐208: 3‐D Dosimetric Comparison of IMRT with 2.5 Mm HD120 MLC Using Optical CT Based Polymer Gel and PRESAGE Dosimeters

Purpose: To evaluate and compare the 3‐D dose distributions for IMRT with 2.5 mm HD120 MLC using optical CT based polymer gel and PRESAGE dosimeters. Method and Materials: In this study, a polymer BANG gel dosimeter and a PRESAGE phantom, together with an optical CT scanner, were employed to implement 3‐D dose distribution measurements. Both dosimeters, with 15 cm diameter and 14 cm height, were modified to optimal and linear dose‐response characteristics. A slice thickness of 2.5 mm without spacing was used for CT simulation on both the patient and cylindrical phantoms. The Varian Eclipse treatment planning system was used to design the IMRT radiosurgery plan for a patient with a 2.5 cc small brain tumor treated with 6 MV photon beams. To correlate the optical density response with radiation dose, the same batch of gel and PRESAGE phantoms were irradiated with a 16 MeV electron beam to a known dose at the depth of dmax. The optical density at a specific depth and the PDD table of the electron beam can be used to obtain the optical density dose response of the dosimeters. Both phantoms were scanned with 1 mm pixel resolution using a commercial optical CT scanner, OCTOPUS™ (MGS Research Inc., Madison, CT). Results: Both measured dose distributions from gel and PRESAGE and calculated results are in reasonable agreement. However, the isodose lines from the measurements show more variation than those from the calculation, and this trend is more significant for the 2.5 mm MLC. These discrepancies may be partly attributed to the fact that the calculation grid for the planning system is 2.5 mm yet the resolution of gel measurements is 1 mm, as well as the Trilogy TX having a smaller leaf width. Issues and difficulties on 3‐D dosimetric comparison will be presented.