High Definition MLC Research Articles

Monte Carlo evaluation of tissue heterogeneities corrections in the treatment of head and neck cancer patients using stereotactic radiotherapy.

The purpose of this study was to generate Monte Carlo computed dose distributions with the X‐ray voxel Monte Carlo (XVMC) algorithm in the treatment of head and neck cancer patients using stereotactic radiotherapy (SRT) and compare to heterogeneity corrected pencil‐beam (PB‐hete) algorithm. This study includes 10 head and neck cancer patients who underwent SRT re‐irradiation using heterogeneity corrected pencil‐beam (PB‐hete) algorithm for dose calculation. Prescription dose was 24‐40 Gy in 3‐5 fractions (treated 3‐5 fractions per week) with at least 95% of the PTV volume receiving 100% of the prescription dose. A stereotactic head and neck localization box was attached to the base of the thermoplastic mask fixation for target localization. The gross tumor volume (GTV) and organs‐at‐risk (OARs) were contoured on the 3D CT images. The planning target volume (PTV) was generated from the GTV with 0 to 5 mm uniform expansion; PTV ranged from 10.2 to 64.3 cc (average=35.0±17.5 cc). OARs were contoured on the 3D planning CT and consisted of spinal cord, brainstem, optic structures, parotids, and skin. In the BrainLab treatment planning system (TPS), clinically optimal SRT plans were generated using hybrid planning technique (combination of 3D conformal noncoplanar arcs and nonopposing static beams) for the Novalis‐Tx linear accelerator consisting of high‐definition multileaf collimators (HD‐MLCs: 2.5 mm leaf width at isocenter) and 6 MV‐SRS (1000 MU/min) beam. For the purposes of this study, treatment plans were recomputed using XVMC algorithm utilizing identical beam geometry, multileaf positions, and monitor units and compared to the corresponding clinical PB‐hete plans. The Monte Carlo calculated dose distributions show small decreases (<1.5%) in calculated dose for D99,Dmean, and Dmax of the PTV coverage between the two algorithms. However, the average target volume encompassed by the prescribed percent dose (Vp) was about 2.5% less with XVMC vs. PB‐hete and ranged between ‐0.1 and 7.8%. The averages for D100 and D10 of the GTV were lower by about 2% and ranged between ‐0.8 and 3.1%. For the spinal cord, both the maximal dose difference and the dose to 0.35 cc of the structure were higher by an average of 4.2% (ranged 1.2 to −13.6%) and 1.4% (ranged 7.5 to −11.3%), respectively, with XVMC calculation. For the brainstem, the maximal dose differences and the dose to 0.5 cc of the structure were, on average, higher by 2.4% (ranged 6.4 to −8.0%) and 3.6% (ranged 6.4 to −9.0%), respectively. For the parotids, both the mean dose and the dose to 20 cc of parotids were higher by an average of 3% (ranged ‐0.2 to −5.9%) and 4% (ranged ‐0.2 to ‐8%), respectively, with XVMC calculation. For the optic apparatus, results from both algorithms were similar. However, the mean dose to skin was 3% higher (ranged 0 to ‐6%), on average, with XVMC compared to PB‐hete, although the maximum dose to skin was 2% lower (ranged −5% to 15.5%). The results from our XVMC dose calculations for head and neck SRT patients indicate small to moderate underdosing of the tumor volume when compared to PB‐hete calculation. However, Vp was up to 7.8% less for the lower‐neck patient with XVMC. Critical structures, such as spinal cord, brainstem, or parotids, could potentially receive higher doses when using XVMC algorithm. Given the proximity to critical structures and the smaller volumes treated with SRT in the region of the head and neck, the differences between XVMC and PB‐hete calculation methods may be of clinical interest.PACS number(s): 87.55.K‐

Comparison of Dosimetric Performance among Commercial Quality Assurance Systems for Verifying Pretreatment Plans of Stereotactic Body Radiotherapy Using Flattening-Filter-Free Beams

The purpose of this study was to compare the performance of different commercial quality assurance (QA) systems for the pretreatment verification plan of stereotactic body radiotherapy (SBRT) with volumetric arc therapy (VMAT) technique using a flattening-filter-free beam. The verification for 20 pretreatment cancer patients (seven lung, six spine, and seven prostate cancers) were tested using three QA systems (EBT3 film, I’mRT MatriXX array, and MapCHECK). All the SBRT-VMAT plans were optimized in the Eclipse (version 11.0.34) treatment planning system (TPS) using the Acuros XB dose calculation algorithm and were delivered to the Varian TrueBeam® accelerator equipped with a high-definition multileaf collimator. Gamma agreement evaluation was analyzed with the criteria of 2% dose difference and 2 mm distance to agreement (2%/2 mm) or 3%/3 mm. The highest passing rate (99.1% for 3%/3 mm) was observed on the MapCHECK system while the lowest passing rate was obtained on the film. The pretreatment verification results depend on the QA systems, treatment sites, and delivery beam energies. However, the delivery QA results for all QA systems based on the TPS calculation showed a good agreement of more than 90% for both the criteria. It is concluded that the three 2D QA systems have sufficient potential for pretreatment verification of the SBRT-VMAT plan.

Treatment planning strategy for whole-brain radiotherapy with hippocampal sparing and simultaneous integrated boost for multiple brain metastases using intensity-modulated arc therapy

PurposeTo retrospectively evaluate the accuracy, plan quality and efficiency of intensity-modulated arc therapy (IMAT) for hippocampal sparing whole-brain radiotherapy (HS-WBRT) with simultaneous integrated boost (SIB) in patients with multiple brain metastases (m-BM). Materials and methodsA total of 5 patients with m-BM were retrospectively replanned for HS-WBRT with SIB using IMAT treatment planning. The hippocampus was contoured on diagnostic T1-weighted magnetic resonance imaging (MRI) which had been fused with the planning CT image set. The hippocampal avoidance zone (HAZ) was generated using a 5-mm uniform margin around the paired hippocampi. The m-BM planning target volumes (PTVs) were contoured on T1/T2-weighted MRI registered with the 3D planning computed tomography (CT). The whole-brain planning target volume (WB-PTV) was defined as the whole-brain tissue volume minus HAZ and m-BM PTVs. Highly conformal IMAT plans were generated in the Eclipse treatment planning system for Novalis-TX linear accelerator consisting of high-definition multileaf collimators (HD-MLCs: 2.5-mm leaf width at isocenter) and 6-MV beam. Prescription dose was 30Gy for WB-PTV and 45Gy for each m-BM in 10 fractions. Three full coplanar arcs with orbit avoidance sectors were used. Treatment plans were evaluated using homogeneity (HI) and conformity indices (CI) for target coverage and dose to organs at risk (OAR). Dose delivery efficiency and accuracy of each IMAT plan was assessed via quality assurance (QA) with a MapCHECK device. Actual beam-on time was recorded and a gamma index was used to compare dose agreement between the planned and measured doses. ResultsAll 5 HS-WBRT with SIB plans met WB-PTV D2%, D98%, and V30Gy NRG-CC001 requirements. The plans demonstrated highly conformal and homogenous coverage of the WB-PTV with mean HI and CI values of 0.33 ± 0.04 (range: 0.27 to 0.36), and 0.96 ± 0.01 (range: 0.95 to 0.97), respectively. All 5 hippocampal sparing patients met protocol guidelines with maximum dose and dose to 100% of hippocampus (D100%) less than 16 and 9Gy, respectively. The dose to the optic apparatus was kept below protocol guidelines for all 5 patients. Highly conformal and homogenous radiosurgical dose distributions were achieved for all 5 patients with a total of 33 brain metastases. The m-BM PTVs had a mean HI = 0.09 ± 0.02 (range: 0.07 to 0.19) and a mean CI = 1.02 ± 0.06 (range: 0.93 to 1.2). The total number of monitor units (MU) was, on average, 1677 ± 166. The average beam-on time was 4.1 ± 0.4 minute . The IMAT plans demonstrated accurate dose delivery of 95.2 ± 0.6%, on average, for clinical gamma passing rate with 2%/2-mm criteria and 98.5 ± 0.9%, on average, with 3%/3-mm criteria. ConclusionsAll hippocampal sparing plans were considered clinically acceptable per NRG-CC001 dosimetric compliance criteria. IMAT planning provided highly conformal and homogenous dose distributions for the WB-PTV and m-BM PTVs with lower doses to OAR such as the hippocampus. These results suggest that HS-WBRT with SIB is a clinically feasible, fast, and effective treatment option for patients with a relatively large numbers of m-BM lesions.

Dosimetric comparison of a 6-MV flattening-filter and a flattening-filter-free beam for lung stereotactic ablative radiotherapy treatment

The purpose of this study was to test the feasibility of clinical usage of a flattening-filter-free (FFF) beam for treatment with lung stereotactic ablative radiotherapy (SABR). Ten patients were treated with SABR and a 6-MV FFF beam for this study. All plans using volumetric modulated arc therapy (VMAT) were optimized in the Eclipse treatment planning system (TPS) by using the Acuros XB (AXB) dose calculation algorithm and were delivered by using a Varian TrueBeam™ linear accelerator equipped with a high-definition (HD) multi-leaf collimator. The prescription dose used was 48 Gy in 4 fractions. In order to compare the plan using a conventional 6-MV flattening-filter (FF) beam, the SABR plan was recalculated under the condition of the same beam settings used in the plan employing the 6-MV FFF beam. All dose distributions were calculated by using Acuros XB (AXB, version 11) and a 2.5-mm isotropic dose grid. The cumulative dosevolume histograms (DVH) for the planning target volume (PTV) and all organs at risk (OARs) were analyzed. Technical parameters, such as total monitor units (MUs) and the delivery time, were also recorded and assessed. All plans for target volumes met the planning objectives for the PTV (i.e., V95% > 95%) and the maximum dose (i.e., Dmax < 110%) revealing adequate target coverage for the 6-MV FF and FFF beams. Differences in DVH for target volumes (PTV and clinical target volume (CTV)) and OARs on the lung SABR plans from the interchange of the treatment beams were small, but showed a marked reduction (52.97%) in the treatment delivery time. The SABR plan with a FFF beam required a larger number of MUs than the plan with the FF beam, and the mean difference in MUs was 4.65%. This study demonstrated that the use of the FFF beam for lung SABR plan provided better treatment efficiency relative to 6-MV FF beam. This strategy should be particularly beneficial for high dose conformity to the lung and decreased intra-fraction movements because of the shorter treatment delivery time. Future studies are necessary to assess the clinical outcome and the toxicity.

A Monte Carlo model for independent dose verification in IMRT and VMAT for the Varian Novalis TX with high definition MLC

Purpose: With intensity modulated radiation therapy (IMRT), the physician can prescribe, design and deliver optimized treatment plans that target the tumor and spare adjacent critical structures. The increased conformity of such plans often comes at the expenses of adding significant complexity to the delivery of the treatment. With volumetrically modulated arc therapy (VMAT), in addition to the modulation of the intensity of the radiation beam, other mechanical parameters such as gantry speed and dose rate are varied during treatment delivery. It is therefore imperative that we develop comprehensive and accurate methods to validate such complex delivery techniques prior to the commencement of the patient’s treatment. Methods : In this study, a Monte Carlo simulation was performed for the high definition multileaf collimator (HD-MLC) of a Varian Novalis TX linac. Our simulation is based on the MCSIM code and provides a comprehensive model of the linac head. After validating the model in reference geometries, treatment plans for different anatomical sites were simulated and compared against the treatment planning system (TPS) dose calculations. All simulations were performed in a cylindrical water phantom as opposed to the patient anatomy, to remove any complexities associated with density effects. Finally, a comparison through gamma analysis of dose plane between the simulation, the TPS and the measurements from the Matrixx array (IBA) was conducted to verify the accuracy of our model against both the measurements and the TPS. Results : Gamma analysis of ten IMRT and ten VMAT cases for different anatomical sites was performed, using a 3%/3 mm passing criterion. The average passing rates were 97.5% and 94.3% for the IMRT and the VMAT plans respectively when comparing the MCSIM and TPS dose calculations. Conclusion : In the present work a Monte Carlo model of a Novalis TX linac which has been tested and benchmarked to produce phase-space files for the treatment head of the linac was used to produce a input phase-space to calculated dose deposition phenomena in different geometries for IMRT and VMAT treatment modalities. The control points defined for the MLC were replaced by blocks with the same characteristics and materials of the linac MLC to speed up the simulation time. With this technique a simulation of a typical IMRT case can be performed with a 10 computer cluster in about 1.02 hours in average. If the number of computer used is increased the computing time can be reduced even more which make our model suitable for clinical use as a second check method to compare the TPS dose calculated. Our results showed that for IMRT and VMAT deliveries with a HD-MLC, there is an average of 95.9% of the points have a gamma index less than 1 with our chosen criterion between our Monte Carlo simulations and the corresponding measurements and TPS calculations in a cylindrical water equivalent phantom. This Monte Carlo code can be used as pre-treatment, independent dose calculation verification for IMRT and VMAT deliveries.

Characteristics of a novel treatment system for linear accelerator-based stereotactic radiosurgery.

The purpose of this study is to characterize the dosimetric properties and accuracy of a novel treatment platform (Edge radiosurgery system) for localizing and treating patients with frameless, image‐guided stereotactic radiosurgery (SRS) and stereotactic body radiotherapy (SBRT). Initial measurements of various components of the system, such as a comprehensive assessment of the dosimetric properties of the flattening filter‐free (FFF) beams for both high definition (HD120) MLC and conical cone‐based treatment, positioning accuracy and beam attenuation of a six degree of freedom (6DoF) couch, treatment head leakage test, and integrated end‐to‐end accuracy tests, have been performed. The end‐to‐end test of the system was performed by CT imaging a phantom and registering hidden targets on the treatment couch to determine the localization accuracy of the optical surface monitoring system (OSMS), cone‐beam CT (CBCT), and MV imaging systems, as well as the radiation isocenter targeting accuracy. The deviations between the percent depth‐dose curves acquired on the new linac‐based system (Edge), and the previously published machine with FFF beams (TrueBeam) beyond Dmax were within 1.0% for both energies. The maximum deviation of output factors between the Edge and TrueBeam was 1.6%. The optimized dosimetric leaf gap values, which were fitted using Eclipse dose calculations and measurements based on representative spine radiosurgery plans, were 0.700 mm and 1.000 mm, respectively. For the conical cones, 6X FFF has sharper penumbra ranging from 1.2−1.8 mm (80%‐20%) and 1.9−3.8 mm (90%‐10%) relative to 10X FFF, which has 1.2−2.2 mm and 2.3−5.1 mm, respectively. The relative attenuation measurements of the couch for PA, PA (rails‐in), oblique, oblique (rails‐out), oblique (rails‐in) were: −2.0%, −2.5%, −15.6%, −2.5%, −5.0% for 6X FFF and −1.4%, −1.5%, −12.2%, −2.5%, −5.0% for 10X FFF, respectively, with a slight decrease in attenuation versus field size. The systematic deviation between the OSMS and CBCT was −0.4±0.2 mm, 0.1±0.3 mm, and 0.0±0.1 mm in the vertical, longitudinal, and lateral directions. The mean values and standard deviations of the average deviation and maximum deviation of the daily Winston‐Lutz tests over three months are 0.20±0.03 mm and 0.66±0.18 mm, respectively. Initial testing of this novel system demonstrates the technology to be highly accurate and suitable for frameless, linac‐based SRS and SBRT treatment.PACS number: 87.56.J‐

SU‐E‐T‐331: Dosimetric Impact of Multileaf Collimator Leaf Width On Stereotactic Radiosurgery (SRS) RapidArc Treatment Plans for Single and Multiple Brain Metastases

Purpose:To determine the effects of multileaf collimator (MLC) leaf width on normal‐brain‐tissue doses and dose conformity of SRS RapidArc treatment plans for brain tumors.Methods:Ten patients with 24 intracranial tumors (seven with 1–2 and three with 4–6 lesions) were planned using RapidArc for both Varian Millennium 120 MLC (5 mm leaf width) and high definition (HD) MLC (2.5 mm leaf width). Between 2 and 8 arcs were used with two full coplanar arcs and the rest non‐coplanar half arcs. 6 MV beams were used and plans were optimized with a high priority to the Normal Tissue Objective (to achieve dose conformity and sharp dose fall‐off) and normal brain tissue. Calculation was done using AAA on a 1 mm grid size. The prescription dose ranged from 14–22 Gy. Plans were normalized such that 99% of the target received the prescription dose. Identical beam geometries, optimizations, calculations, and normalizations were used for both plans. Paddick Conformity Index (PCI), V4, V8 and V12 Gy for normal brain tissue and Integral Dose were used for analysis.Results:In all cases, HD MLC plans performed better in sparing normal brain tissue, achieving a higher PCI with a lower Integral Dose. The average PCI for all 24 targets was 0.75±0.23 and 0.70±0.23 (p ≤0.0015) for HD MLC and Millennium MLC plans, respectively. The average ratio of normal brain doses for Millennium MLC to HD MLC plans was 1.30±0.16, 1.27±0.15, and 1.31±0.18 for the V4, V8, and V12, respectively. The differences in normal brain dose for all criteria were statistically significant with p‐value &lt; 0.02. On average Millennium MLC plans had a 16% higher integral dose than HD MLC plans.Conclusion:Significantly better dose conformity with reduced volume of normal brain tissue and integral dose was achieved with HD MLC plans compared to Millennium MLC plans.

SU‐E‐T‐111: An Iterative Approach to Modelling Dosimetric Properties of a Varian MLC

Purpose:In effort to efficiently and accurately model MLC parameters for use in Varian Eclipse treatment planning system (TPS), an iterative technique for characterizing the dosimetric properties of MLCs has been developed.Methods:The initial characterization of the dosimetric leaf gap (DLG) and MLC transmission was performed using varied sizes of moving gaps and transmission measurements through central axis of the radiation beam. These values were determined during the initial data collection. After the initial values were determined and entered into the TPS, two plans were calculated to test the veracity of DLG and transmission independently. The plan used to determine the DLG has openings of varied sizes which are affected differently by the DLG. A large field uniform fluence that required a MLC carriage shift was used to determine the transmission value independent of DLG. After characterizing the dosimetric properties of the MLC independently, clinical IMRT plans were tested and used to tweak the final values.Results:This approach to modelling MLC dosimetric properties was employed for: standard 120 leaf MLC (SDMLC) and 120 leaf high definition MLC (HDMLC). Both types were successfully commissioned, tested, and approved for clinical use on 4 SDMLC machines and 2 HDMLC machines. The pass rate of clinical IMRT plans was 96.9% for 6MV and 98.3% for 10MV for SDMLC and 96.3% for 6MV, 96.5% for 6FFF, and 97.5% for 10FFF for HDMLCs using MapCheck2 with gamma analysis of 2%/2mm and 10% threshold. The final DLG and transmission parameters for 6X were 0.5mm and 0.01, and 1.35mm and 0.02 for HD and SD MLCs respectively.Conclusion:This iterative approach of determining dosimetric properties of MLCs is viable for both SDMLC and HDMLC and multiple energies. This approach accurately and efficiently determines the values needed for commissioning MLCs when they are employed for modulated therapies.

SU‐E‐T‐410: Evaluation of Treatment Modalities for Stereotactic Lung Radiation Therapy: A Phantom Study

Purpose:To evaluate and verify the accuracy of alternative treatment modalities for stereotactic lung therapy with end‐to‐end testing. We compared three dimensional conformal therapy (3DCRT), dynamic conformal arc therapy (DCAT), intensity modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) treatment using 6 MV, 6 MV flattening filter free (FFF) and 10 MV FFF photons.Methods:A QUASAR respiratory motion phantom was utilized with custom ion chamber and gafchromatic EBT2 film inserts. The phantom contained a low density lung medium with a cylindrical polystyrene tumor (35 cc). Pseudo representative structures for various organs at risk (OAR) were created. All treatment plans were created using Eclipse ver. 11 using the same image and structure sets, and delivered via Varian TrueBeam STx linear accelerator equipped with high definition MLC. Evaluation of plan quality followed ROTG 0813 criterion for conformity index (CI100%), high dose spillage, D2cm, and R50%.Results:All treatment plans met the OAR dose constraints per protocol and could be delivered without any beam hold offs or other interlocks and hence were deemed clinically safe. For equivalent beam energies, target conformity was improved for all modalities when switching to FFF mode. Treatment efficiency increased for VMAT FFF by a factor of 3–4 over IMRT, and up to factor of 7 when compared to 3DCRT. Pass rates were &gt; 97% for all treatment using gamma criteria of 3%, 3mm. Absolute dose at iso‐center was verified with ion chamber, and found to be within 2% of the treatment planning system.Conclusion:The higher dose rate associated with FFF not only reduces delivery times, but in most cases enhances plan quality. The one modality with succeeding best results for all RTOG criterions was VMAT 6 MV FFF. This end‐to‐end testing provides necessary confidence in the entire dose delivery chain for lung SBRT patients.

TH-CD-304-10: A Method for Correcting Ion Recombination Effects in OCTAVIUS 1000 SRS Measurements

Purpose: PTW's Octavius 1000 SRS array performs IMRT QA measurements with liquid filled ionization chambers to allow closer detector spacing and higher resolution. Increased density of liquid relative to air, leads to increased ion recombination effects, which are proportional to dose/pulse experienced at the detectors. During IMRT QA, dose/per pulse will vary across the array, leading to varying collection efficiencies. Magnitudes of recombination effects were investigated and a method was developed to correct them in QA measurements. Methods: The OCTAVIUS 1000 SRS was used to measure different IMRT plans using varying dose/pulse and results were normalized to air filled chamber measurements to obtain collection efficiencies. Regression analysis was performed to relate collection efficiency to dose/pulse. Matlab software was developed to correct IMRT QA measurements using these correlations. Measurements were performed on a Truebeam equipped with high-definition MLC, using 6MV and 10FFF RapidArc plans. Plans were measured in the OCTAVIUS 4D system, which measures dose in time intervals. Dose/time was converted to dose/pulse using pulse repetition information. Collection efficiency to dose/pulse correlations were used to correct measured dose. 3D gamma analysis was performed on plans with and without corrections. Results: Liquid filled ionization chamber collection efficiency correlated linearly to dose/pulse with slopes of 2.15%/(mGy/pulse) for 6MV and 5.74%/(mGy/pulse) for 10FFF. After corrections, average gamma pass rates improved by [0.02%,0.06%,0.24%] for 6MV and [0.19%,0.54%,2.01%] for 10FFF using [3%/3mm,2%/2mm,1%/1mm] criteria. Maximum changes in gamma pass rates were [0.1%,0.3%,0.5%] for 6MV and [0.4%,0.8%,5.1%] for 10FFF using [3%/3mm,2%/2mm,1%/1mm] criteria. Conclusion: OCTAVIUS 1000 SRS ion recombination effects have little effect on 6MV measurements. However, the effect is larger for higher dose/pulse unflattened beams when using tighter gamma tolerances, as is common for SRS/SBRT. This researched was supported by PTW.

SU‐E‐T‐613: Physics Considerations for Single‐Isocenter Volumetric Modulated Arc Radiosurgery for Treatment of Multiple Intracranial Targets

Purpose:To address physics challenges associated with single isocenter radiosurgery for multiple intracranial metastases (SIRMIT). Because the Varian High Definition MLC has thicker leaves &gt;4cm from the isocenter, we predict inferior dose falloff and plan quality for small targets located &gt;4cm from isocenter. To address this concern, we evaluate various isocenter placement strategies including one that places the isocenter closer to smaller targets. We also evaluate the significance of arc geometry avoidance angles to limit lens dose.Methods:11 SIRMIT plans with isocenter at centroid were retrospectively analyzed to determine the relationship between relevant dosimetric indices and distance from isocenter (e.g. relative tumor volume). We investigated three isocenter placements for four SIRMIT patients whose lesions had larger variations in target volume; placements included: centroid, Eclipse's built‐in method, and an “inverse center of mass” (ICM) method that weights the isocenter towards smaller lesions. Three VMAT SIRMIT plans were prepared according to institutional and Clark et al.'s guidelines to investigate the effect of arc geometry on lens dose.Results:Dose conformity and gradient fall‐off tended to be better for larger tumors (&gt;1cc) close to isocenter. For the four largest tumors (per plan), centroid CI, GI, and HI values were 9±9%, 12±4%, and 3.8±4.9% better than the next best isocenter placement strategy. None of the methods yielded significantly higher conformity for small tumors, however ICM GI and HI values were better for three of the small tumors by 6±12% and 1.8±2.2% respectively. Lens dose range decreased from [3.3%, 11.4%] to [0.1%, 0.5%] by avoiding arc geometries that enter/exit through the eyes.Conclusion:CI and GI values were poorer for small distal targets, especially &gt;6cm. Large tumors benefited from centroid placement more than small tumors did from ICM. It is necessary to consider arc geometry avoidance angles to adequately reduce lens dose.

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.

Technical Note: Dosimetric evaluation of Monte Carlo algorithm in iPlan for stereotactic ablative body radiotherapy (SABR) for lung cancer patients using RTOG 0813 parameters.

For stereotactic ablative body radiotherapy (SABR) in lung cancer patients, Radiation Therapy Oncology Group (RTOG) protocols currently require radiation dose to be calculated using tissue heterogeneity corrections. Dosimetric criteria of RTOG 0813 were established based on the results obtained from non‐Monte Carlo (MC) algorithms, such as superposition/convolutions. Clinically, MC‐based algorithms are now routinely used for lung SABR dose calculations. It is essential to confirm that MC calculations in lung SABR meet RTOG guidelines. This report evaluates iPlan MC plans for SABR in lung cancer patients using dose‐volume histogram normalization per current RTOG 0813 compliance criteria. Eighteen Stage I‐II non‐small cell lung cancer (NSCLC) patients with centrally located tumors, who underwent MC‐based lung SABR with heterogeneity correction using X‐ray Voxel Monte Carlo (XVMC) algorithm (BrainLAB iPlan version 4.1.2), were analyzed. Total dose of 60 Gy in 5 fractions was delivered to planning target volume (PTV) with at least V100%=95%. Internal target volumes (ITVs) were delineated on maximum intensity projection (MIP) images of 4D CT scans. PTV (ITV+5 mm margin) volumes ranged from 10.0 to 99.9 cc (mean=36.8±20.7 cc). Organs at risk (OARs) were delineated on average images of 4D CT scans. Optimal clinical MC SABR plans were generated using a combination of non‐coplanar conformal arcs and beams for the Novalis‐TX consisting of high definition multileaf collimators (MLCs) and 6 MV‐SRS (1000MU/min) mode. All plans were evaluated using the RTOG 0813 high and intermediate dose spillage criteria: conformity index (R100%), ratio of 50% isodose volume to the PTV (R50%), maximum dose 2 cm away from PTV in any direction (D2cm), and percent of normal lung receiving 20 Gy (V20) or more. Other organs‐at‐risk (OARs) doses were tabulated, including the volume of normal lung receiving 5 Gy (V5), maximum cord dose, dose to <15 cc of heart, and dose to <5 cc of esophagus. Only six out of 18 patients met all RTOG 0813 compliance criteria. Eight of 18 patients had minor deviations in R100%, four in R50%, and nine in D2cm. However, only one patient had minor deviation in V20. All other OARs doses, such as maximum cord dose, dose to <15 cc of heart, and dose to <5 cc of esophagus, were satisfactory for RTOG criteria, except for one patient, for whom the dose to <15 cc of heart was higher than RTOG guidelines. The preliminary results for our limited iPlan XVMC dose calculations indicate that the majority (i.e., 2/3) of our patients had minor deviations in the dosimetric guidelines set by RTOG 0813 protocol in one way or another. When using an exclusive highly sophisticated XVMC algorithm, the RTOG 0813 dosimetric compliance criteria such as R100% and D2cm may need to be revisited. Based on our limited number of patient datasets, in general, about 6% for R100% and 9% for D2cm corrections could be applied to pass the RTOG 0813 compliance criteria in most of those patients. More patient plans need to be evaluated to make recommendation for R50%. No adjustment is necessary for OAR dose tolerances, including normal lung V20. In order to establish new MC specific dose parameters, further investigation with a large cohort of patients including central, as well as peripheral lung tumors, is anticipated and strongly recommended.PACS number: 8087

Study on the Sensitivity of Gamma-Index Evaluation Methods to Positioning Errors of High-Definition MLC of True Beam STx in VMAT Quality Assurance for SBRT

Study on the Sensitivity of Gamma-Index Evaluation Methods to Positioning Errors of High-Definition MLC of True Beam STx in VMAT Quality Assurance for SBRT

The sensitivity of gamma-index method to the positioning errors of high-definition MLC in patient-specific VMAT QA for SBRT.

BackgroundTo investigate the sensitivity of various gamma criteria used in the gamma-index method for patient-specific volumetric modulated arc therapy (VMAT) quality assurance (QA) for stereotactic body radiation therapy (SBRT) using a flattening filter free (FFF) photon beam.MethodsThree types of intentional misalignments were introduced to original high-definition multi-leaf collimator (HD-MLC) plans. The first type, referred to Class Out, involved the opening of each bank of leaves. The second type, Class In, involved the closing of each bank of leaves. The third type, Class Shift, involved the shifting of each bank of leaves towards the ground. Patient-specific QAs for the original and the modified plans were performed with MapCHECK2 and EBT2 films. The sensitivity of the gamma-index method using criteria of 1%/1 mm, 1.5%/1.5 mm, 1%/2 mm, 2%/1 mm and 2%/2 mm was investigated with absolute passing rates according to the magnitudes of MLCs misalignments. In addition, the changes in dose-volumetric indicators due to the magnitudes of MLC misalignments were investigated. The correlations between passing rates and the changes in dose-volumetric indicators were also investigated using Spearman’s rank correlation coefficient (γ).ResultsThe criterion of 2%/1 mm was able to detect Class Out and Class In MLC misalignments of 0.5 mm and Class Shift misalignments of 1 mm. The widely adopted clinical criterion of 2%/2 mm was not able to detect 0.5 mm MLC errors of the Class Out or Class In types, and also unable to detect 3 mm Class Shift errors. No correlations were observed between dose-volumetric changes and gamma passing rates (γ < 0.8).ConclusionsGamma criterion of 2%/1 mm was found to be suitable as a tolerance level with passing rates of 90% and 80% for patient-specific VMAT QA for SBRT when using MapCHECK2 and EBT2 film, respectively.

SU-E-T-533: Evaluation of Dose Calculation Accuracy for Small Elongated Targets On the Edge Linac

Purpose: To evaluate output factors and dose calculation accuracy on a novel SRS linear accelerator, the Edge (Varian), for treatments of small, elongated targets using flattening filter free (FFF) beam. Methods: Total scatter/output factors (OF’s) for 24 elongated, small, high definition multi-leaf collimator (HDMLC)-defined fields were measured on the Edge machine using 6X FFF beam. 3 detectors were used in water tank: CC01 ion chamber (active volume 10cc), stereotactic photon diode (SFD) (active diameter 0.6mm, active thickness 0.06mm), Edge detector (active volume 0.0019cc). The 24 MLC apertures have widths ranging from 5 to 20mm and length/width ratio from 0.25 to 5. Readings were cross calibrated with CC04 at field size 3×3 cm. A beam model was developed using commissioning measurements for treatment planning in Eclipse (AAA, version 11). One representative patient case (IMRT, target volume 0.2cc, 4×4×14mm) was calculated using AAA 11 and delivered on the Edge. Results: Due to volume averaging effects, CC01 readings were 11.2±0.9% lower than SFD readings for 5mm field sizes. The Edge diode showed a uniform over-response of 2.6±0.7% compared to SFD. Calculation using AAA v11 showed the best agreement with SFD measurements (2.4±1.7% lower than SFD). The largest difference between AAA v11 and SFD occurs at 5mm field sizes. For the patient plan, dose delivered on Edge was measured to be 2.2% higher than AAA v11 calculation. Conclusion: Cross-calibrated SFD output measurements presented the best agreement with commissioned AAA v11 beam model. Field sizes smaller than 1cm posed challenges to both the detectors and the calculation algorithm. For the representative patient with small elongated target, AAA v11 and measurements agreed within ~2% on the Edge linac. Although encouraging, a more comprehensive study is required to validate the overall algorithmic accuracy.

SU-E-T-576: Evaluation of Patient Specific VMAT QA Using Dynalog Files and Treatment Planning System

Purpose: This research investigates the use of Mult-ileaf Collimator (MLC) dynalog files to modify a Volumetric Arc Therapy (VMAT) DICOM Radiotherapy Treatment file from the Treatment Planning System (TPS) for quality assurance and treatment plan verification. Methods: Actual MLC positions and gantry angles where retrieved from the MLC Dynalog files of an approved and treated VMAT plan. The treatment machine used was a Novalis TX linac equipped with high definition MLC. The DICOM RT file of the plan was exported from the TPS (Eclipse, Varian Medical Systems) and the actual MLC leaf positions and gantry angles were inserted in place of the planned positions for each control point. The modified DICOM RT file was then imported back into the TPS where dose calculations were performed. The resulting dose distributions were then exported to VeriSoft (PTW) where a 3D gamma was calculated using 3mm-3% and 2mm-2% criteria. A 2D gamma was also calculated using dose measurements on the Delta4 (Sandidose) phantom. Results: A 3D gamma was calculated in Verisoft at 3mm-3% of 99.5% and at 2mm-2% of 99.2%. The pretreatment verification on the Delta4 yielded a 2D gamma at 3mm-3% of 97.9% and at 2mm-2% of 88.5%. The dose volume histogramsmore » of the approved plan and the dynalog plan are virtually identical. Conclusion: Initial results show good agreement of the dynalog dose distribution with the approved plan. Future work on this research will aim to increase the number of patients and replace the planned fractionated dose per control point with the actual fractionated dose.« less

SU‐E‐T‐252: On the Evaluation of Patient Specific IMRT QA Using EPID, Dynalog Files and Patient Anatomy

Purpose:This research, investigates the viability of using the Electronic portal imaging device (EPID) coupled with the treatment planning system (TPS), to calculate the doses delivered and verify agreement with the treatment plan. The results of QA analysis using the EPID, Delta4 and fluence calculations using the multi‐leaf collimator (MLC) dynalog files on 10 IMRT patients are presented in this study.Methods:EPID Fluence Images in integrated mode and Dynalog files for each field were acquired for 10 IMRT (6MV) patients and processed through an in house MatLab program to create an opening density matrix (ODM) which was used as the input fluence for dose calculation with the TPS (Pinnacle3, Philips). The EPID used in this study was the aSi1000 Varian on a Novalis TX linac equipped with high definition MLC. The resulting dose distributions were then exported to VeriSoft (PTW) where a 3D gamma was calculated using 3mm‐3% criteria. The Scandidos Delta4 phantom was also used to measure a 2D dose distribution for all 10 patients and a 2D gamma was calculated for each patient using the Delta4 software.Results:The average 3D gamma for all 10 patients using the EPID images was 98.2% ± 2.6%. The average 3D gamma using the dynalog files was 94.6% ± 4.9%. The average 2D gamma from the Delta4 was 98.1% ± 2.5%. The minimum 3D gamma for the EPID and dynalog reconstructed dose distributions was found on the same patient which had a very large PTV, requiring the jaws to open to the maximum field size.Conclusion:Use of the EPID, combined with a TPS is a viable method for QA of IMRT plans. A larger ODM size can be implemented to accommodate larger field sizes. An adaptation of this process to Volumetric Arc Therapy (VMAT) is currently under way.

SU-E-T-109: Development of An End-To-End Test for the Varian TrueBeamtm with a Novel Multiple-Dosimetric Modality H&amp;N Phantom

Purpose: To develop a comprehensive end-to-end test for Varian's TrueBeam linear accelerator for head and neck IMRT using a custom phantom designed to utilize multiple dosimetry devices. Methods: The initial end-to-end test and custom H&N phantom were designed to yield maximum information in anatomical regions significant to H&N plans with respect to: i) geometric accuracy, ii) dosimetric accuracy, and iii) treatment reproducibility. The phantom was designed in collaboration with Integrated Medical Technologies. A CT image was taken with a 1mm slice thickness. The CT was imported into Varian's Eclipse treatment planning system, where OARs and the PTV were contoured. A clinical template was used to create an eight field static gantry angle IMRT plan. After optimization, dose was calculated using the Analytic Anisotropic Algorithm with inhomogeneity correction. Plans were delivered with a TrueBeam equipped with a high definition MLC. Preliminary end-to-end results were measured using film and ion chambers. Ion chamber dose measurements were compared to the TPS. Films were analyzed with FilmQAPro using composite gamma index. Results: Film analysis for the initial end-to-end plan with a geometrically simple PTV showed average gamma pass rates >99% with a passing criterion of 3% / 3mm. Film analysis of a plan with a more realistic, ie. complex, PTV yielded pass rates >99% in clinically important regions containing the PTV, spinal cord and parotid glands. Ion chamber measurements were on average within 1.21% of calculated dose for both plans. Conclusion: trials have demonstrated that our end-to-end testing methods provide baseline values for the dosimetric and geometric accuracy of Varian's TrueBeam system.

On the evaluation of patient specific IMRT QA using EPID, dynalog files and patient anatomy

Purpose: This research, investigates the viability of using the Electronic portal imaging device (EPID) coupled with the treatment planning system (TPS), to calculate the doses delivered and verify agreement with the treatment plan. The results of QA analysis using the EPID, Delta 4 and fluence calculations using the multi-leaf collimator (MLC) dynalog files on 10 IMRT patients are presented in this study. Methods : EPID Fluence Images in integrated mode and Dynalog files for each field were acquired for 10 IMRT (6MV) patients and processed through an in house MatLab program to create an opening density matrix (ODM) which was used as the input fluence for dose calculation with the TPS (Pinnacle 3 , Philips). The EPID used in this study was the aSi1000 Varian on a Novalis TX linac equipped with high definition MLC. The resulting dose distributions were then exported to VeriSoft (PTW) where a 3D gamma was calculated using 3 mm-3% criteria. The Scandidos Delta 4 phantom was also used to measure a 2D dose distribution for all 10 patients and a 2D gamma was calculated for each patient using the Delta 4 software. Results: The average 3D gamma for all 10 patients using the EPID images was 98.2% ± 2.6%. The average 3D gamma using the dynalog files was 94.6% ± 4.9%. The average 2D gamma from the Delta 4 was 98.1% ± 2.5%. The minimum 3D gamma for the EPID and dynalog reconstructed dose distributions was found on the same patient which had a very large PTV, requiring the jaws to open to the maximum field size. Conclusion : Use of the EPID, combined with a TPS is a viable method for QA of IMRT plans. A larger ODM size can be implemented to accommodate larger field sizes. An adaptation of this process to Volumetric Arc Therapy (VMAT) is currently under way. ----------------------------- Cite this article as: Defoor D, Mavroidis P, Quino L, Gutierrez A, Papanikolaou N, Stathakis S. On the evaluation of patient specific IMRT QA using EPID, dynalog files and patient anatomy. Int J Cancer Ther Oncol 2014; 2(2):020219. DOI: 10.14319/ijcto.0202.19