High Gradient Regions Research Articles

Modification and validation of an analytical source model for external beam radiotherapy Monte Carlo dose calculations.

A dose calculation tool, which combines the accuracy of the dose planning method (DPM) Monte Carlo code and the versatility of a practical analytical multisource model, which was previously reported has been improved and validated for the Varian 6 and 10 MV linear accelerators (linacs). The calculation tool can be used to calculate doses in advanced clinical application studies. One shortcoming of current clinical trials that report dose from patient plans is the lack of a standardized dose calculation methodology. Because commercial treatment planning systems (TPSs) have their own dose calculation algorithms and the clinical trial participant who uses these systems is responsible for commissioning the beam model, variation exists in the reported calculated dose distributions. Today's modern linac is manufactured to tight specifications so that variability within a linac model is quite low. The expectation is that a single dose calculation tool for a specific linac model can be used to accurately recalculate dose from patient plans that have been submitted to the clinical trial community from any institution. The calculation tool would provide for a more meaningful outcome analysis. The analytical source model was described by a primary point source, a secondary extra-focal source, and a contaminant electron source. Off-axis energy softening and fluence effects were also included. The additions of hyperbolic functions have been incorporated into the model to correct for the changes in output and in electron contamination with field size. A multileaf collimator (MLC) model is included to facilitate phantom and patient dose calculations. An offset to the MLC leaf positions was used to correct for the rudimentary assumed primary point source. Dose calculations of the depth dose and profiles for field sizes 4 × 4 to 40 × 40 cm agree with measurement within 2% of the maximum dose or 2 mm distance to agreement (DTA) for 95% of the data points tested. The model was capable of predicting the depth of the maximum dose within 1 mm. Anthropomorphic phantom benchmark testing of modulated and patterned MLCs treatment plans showed agreement to measurement within 3% in target regions using thermoluminescent dosimeters (TLD). Using radiochromic film normalized to TLD, a gamma criteria of 3% of maximum dose and 2 mm DTA was applied with a pass rate of least 85% in the high dose, high gradient, and low dose regions. Finally, recalculations of patient plans using DPM showed good agreement relative to a commercial TPS when comparing dose volume histograms and 2D dose distributions. A unique analytical source model coupled to the dose planning method Monte Carlo dose calculation code has been modified and validated using basic beam data and anthropomorphic phantom measurement. While this tool can be applied in general use for a particular linac model, specifically it was developed to provide a singular methodology to independently assess treatment plan dose distributions from those clinical institutions participating in National Cancer Institute trials.

SU-F-T-328: Real-Time in Vivo Dosimetry of Prostate SBRT Boost Treatments Using MOSkin Detectors

Purpose: To provide in vivo measurements of dose to the anterior rectal wall during prostate SBRT boost treatments using MOSFET detectors. Methods: Dual MOSkin detectors were attached to a Rectafix rectal sparing device and inserted into patients during SBRT boost treatments. Patients received two boost fractions, each of 9.5–10 Gy and delivered using 2 VMAT arcs. Measurements were acquired for 12 patients. MOSFET voltages were read out at 1 Hz during delivery and converted to dose. MV images were acquired at known frequency during treatment so that the position of the gantry at each point in time was known. The cumulative dose at the MOSFET location was extracted from the treatment planning system at in 5.2° increments (FF beams) or at 5 points during each delivered arc (FFF beams). The MOSFET dose and planning system dose throughout the entirety of each arc were then compared using root mean square error normalised to the final planned dose for each arc. Results: The average difference between MOSFET measured and planning system doses determined over the entire course of treatment was 9.7% with a standard deviation of 3.6%. MOSFETs measured below the planned dose in 66% of arcs measured. Uncertainty in the position of the MOSFET detector and verification point are major sources of discrepancy, as the detector is placed in a high dose gradient region during treatment. Conclusion: MOSkin detectors were able to provide real time in vivo measurements of anterior rectal wall dose during prostate SBRT boost treatments. This method could be used to verify Rectafix positioning and treatment delivery. Further developments could enable this method to be used during high dose treatments to monitor dose to the rectal wall to ensure it remains at safe levels. Funding has been provided by the University of Newcastle. Kimberley Legge is the recipient of an Australian Postgraduate Award.

MO-FG-202-07: Real-Time EPID-Based Detection Metric For VMAT Delivery Errors

Purpose: To create and test an accurate EPID-frame-based VMAT QA metric to detect gross dose errors in real-time and to provide information about the source of error. Methods: A Swiss cheese model was created for an EPID-based real-time QA process. The system compares a treatmentplan- based reference set of EPID images with images acquired over each 2° gantry angle interval. The metric utilizes a sequence of independent consecutively executed error detection Methods: a masking technique that verifies infield radiation delivery and ensures no out-of-field radiation; output normalization checks at two different stages; global image alignment to quantify rotation, scaling and translation; standard gamma evaluation (3%, 3 mm) and pixel intensity deviation checks including and excluding high dose gradient regions. Tolerances for each test were determined. For algorithm testing, twelve different types of errors were selected to modify the original plan. Corresponding predictions for each test case were generated, which included measurement-based noise. Each test case was run multiple times (with different noise per run) to assess the ability to detect introduced errors. Results: Averaged over five test runs, 99.1% of all plan variations that resulted in patient dose errors were detected within 2° and 100% within 4° (∼1% of patient dose delivery). Including cases that led to slightly modified but clinically equivalent plans, 91.5% were detected by the system within 2°. Based on the type of method that detected the error, determination of error sources was achieved. Conclusion: An EPID-based during-treatment error detection system for VMAT deliveries was successfully designed and tested. The system utilizes a sequence of methods to identify and prevent gross treatment delivery errors. The system was inspected for robustness with realistic noise variations, demonstrating that it has the potential to detect a large majority of errors in real-time and indicate the error source. J. V. Siebers receives funding support from Varian Medical Systems.

Inversion of stress field evolution consisting of static and dynamic stresses by microseismic velocity tomography

In order to reveal the stress precursors of the “3.15” rockburst disaster that occurred in the No. 1 working face of Junde coal mine, the combined stress field inversion including static and dynamic stresses was conducted by using P-wave velocity tomography, and the static high-stress concentration regions were further designated. Simultaneously, the evolution of dynamic stress generated by seven periodical caving events of primary roof was analyzed, and the fracturing characteristics were described in detail. Ultimately, the stress precursors of the “3.15” rockburst for early warning were clearly revealed. The main conclusions are as follows: (1) the micro-fissures inside coal and rock mass produce the significant reflection and refraction on the propagation of microseismic (MS) waves, and thus P-wave overall characterizes with lower velocity and higher velocity gradient; (2) after the slightly fracturing of primary roof on March 9, 2013, the maximum stress concentration factor suddenly rises to 20. This sign can be viewed as an early warning precursor of rockburst; (3) until March 12, 2013, the large-scale micro-fractures begin to form inside primary roof, and thus the corresponding high velocity gradient regions are generated. This phenomenon can be regarded as an effective precursor of macroscopic fracturing of primary roof; and (4) before the “3.15″ rockburst, the scope of P-wave velocity gradient in the No. 1 working face does not change significantly. The above findings may put forward a certain reference for accurately warning the stress precursors of rockburst by P-wave velocity tomography.

Evaluation of the Eclipse eMC algorithm for bolus electron conformal therapy using a standard verification dataset

The purpose of this study was to evaluate the accuracy and calculation speed of electron dose distributions calculated by the Eclipse electron Monte Carlo (eMC) algorithm for use with bolus electron conformal therapy (ECT). The recent commercial availability of bolus ECT technology requires further validation of the eMC dose calculation algorithm. eMC‐calculated electron dose distributions for bolus ECT have been compared to previously measured TLD‐dose points throughout patient‐based cylindrical phantoms (retromolar trigone and nose), whose axial cross sections were based on the mid‐PTV (planning treatment volume) CT anatomy. The phantoms consisted of SR4 muscle substitute, SR4 bone substitute, and air. The treatment plans were imported into the Eclipse treatment planning system, and electron dose distributions calculated using 1% and <0.2% statistical uncertainties. The accuracy of the dose calculations using moderate smoothing and no smoothing were evaluated. Dose differences (eMC‐calculated less measured dose) were evaluated in terms of absolute dose difference, where 100% equals the given dose, as well as distance to agreement (DTA). Dose calculations were also evaluated for calculation speed. Results from the eMC for the retromolar trigone phantom using 1% statistical uncertainty without smoothing showed calculated dose at 89% (41/46) of the measured TLD‐dose points was within 3% dose difference or 3 mm DTA of the measured value. The average dose difference was −0.21%, and the net standard deviation was 2.32%. Differences as large as 3.7% occurred immediately distal to the mandible bone. Results for the nose phantom, using 1% statistical uncertainty without smoothing, showed calculated dose at 93% (53/57) of the measured TLD‐dose points within 3% dose difference or 3 mm DTA. The average dose difference was 1.08%, and the net standard deviation was 3.17%. Differences as large as 10% occurred lateral to the nasal air cavities. Including smoothing had insignificant effects on the accuracy of the retromolar trigone phantom calculations, but reduced the accuracy of the nose phantom calculations in the high‐gradient dose areas. Dose calculation times with 1% statistical uncertainty for the retromolar trigone and nose treatment plans were 30 s and 24 s, respectively, using 16 processors (Intel Xeon E5‐2690, 2.9 GHz) on a framework agent server (FAS). In comparison, the eMC was significantly more accurate than the pencil beam algorithm (PBA). The eMC has comparable accuracy to the pencil beam redefinition algorithm (PBRA) used for bolus ECT planning and has acceptably low dose calculation times. The eMC accuracy decreased when smoothing was used in high‐gradient dose regions. The eMC accuracy was consistent with that previously reported for accuracy of the eMC electron dose algorithm and shows that the algorithm is suitable for clinical implementation of bolus ECT.PACS number(s): 87.55.kd

Adaptive Optimization-Based Improvement of Tetrahedral Meshes

A tetrahedral mesh improvement method is presented that uses an optimization-based node perturbation technique to minimize a cost function. The cost function for each tetrahedron is based on the element condition number. This condition number incorporates a weight matrix that transforms the element from physical space to a reference space. The condition number is a measure of the conformity of the physical element with respect to the reference element. Feature-based adaptation is incorporated into the element weight matrix to influence the node perturbation scheme to favor nonunit aspect ratio elements. The mesh improvement scheme produces meshes that cluster grid nodes in high-gradient regions of the selected adaptation function. Results for several inviscid, three-dimensional cases are included.

Determination of boundaries between ranges of high and low gradient of beam profile

AimThis work addresses the problem of treatment planning system commissioning by introducing a new method of determination of boundaries between high and low gradient in beam profile. BackgroundThe commissioning of a treatment planning system is a very important task in the radiation therapy. One of the main goals of this task is to compare two field profiles: measured and calculated. Applying points of 80% and 120% of nominal field size can lead to the incorrect determination of boundaries, especially for small field sizes. Materials and methodsThe method that is based on the beam profile gradient allows for proper assignment of boundaries between high and low gradient regions even for small fields. TRS 430 recommendations for commissioning were used. ResultsThe described method allows a separation between high and low gradient, because it directly uses the value of the gradient of a profile. For small fields, the boundaries determined by the new method allow a commissioning of a treatment planning system according to the TRS 430, while the point of 80% of nominal field size is already in the high gradient region. ConclusionsThe method of determining the boundaries by using the beam profile gradient can be extremely helpful during the commissioning of the treatment planning system for Intensity Modulated Radiation Therapy or for other techniques which require very small field sizes.

Parameterization of photon beam dosimetry for a linear accelerator.

In radiation therapy, accurate data acquisition of photon beam dosimetric quantities is important for (1) beam modeling data input into a treatment planning system (TPS), (2) comparing measured and TPS modeled data, (3) the quality assurance process of a linear accelerator's (Linac) beam characteristics, (4) the establishment of a standard data set for comparison with other data, etcetera. Parameterization of the photon beam dosimetry creates a data set that is portable and easy to implement for different applications such as those previously mentioned. The aim of this study is to develop methods to parameterize photon beam dosimetric quantities, including percentage depth doses (PDDs), profiles, and total scatter output factors (S(cp)). S(cp), PDDs, and profiles for different field sizes, depths, and energies were measured for a Linac using a cylindrical 3D water scanning system. All data were smoothed for the analysis and profile data were also centered, symmetrized, and geometrically scaled. The S(cp) data were analyzed using an exponential function. The inverse square factor was removed from the PDD data before modeling and the data were subsequently analyzed using exponential functions. For profile modeling, one halfside of the profile was divided into three regions described by exponential, sigmoid, and Gaussian equations. All of the analytical functions are field size, energy, depth, and, in the case of profiles, scan direction specific. The model's parameters were determined using the minimal amount of measured data necessary. The model's accuracy was evaluated via the calculation of absolute differences between the measured (processed) and calculated data in low gradient regions and distance-to-agreement analysis in high gradient regions. Finally, the results of dosimetric quantities obtained by the fitted models for a different machine were also assessed. All of the differences in the PDDs' buildup and the profiles' penumbra regions were less than 2 and 0.5 mm, respectively. The differences in the low gradient regions were 0.20% ± 0.20% (<1% for all) and 0.50% ± 0.35% (<1% for all) for PDDs and profiles, respectively. For S(cp) data, all of the absolute differences were less than 0.5%. This novel analytical model with minimum measurement requirements was proved to accurately calculate PDDs, profiles, and S(cp) for different field sizes, depths, and energies.

Modeling of an ice storage buried in the ground for solar heating applications. Validations with one year of monitored data from a pilot plant

A mathematical model for an ice storage buried in the ground is presented and validated with experimental results of one full operation year of a pilot plant with a 75m3 ice storage. The ice storage was designed with heat exchangers that can be de-iced and it was developed for heating applications using a combined solar thermal and heat pump system. Because of the inherent coupling between the ice storage and the ground, a ground model was developed and coupled with the ice storage for the validation.The ice storage model is based on a transient one dimensional energy equation derived along the height of the storage with equally distributed control volumes. The ground is solved with a transient heat conduction equation with a heat source term from the ice storage. The physical ground domain is discretized in an axial-symmetrical mesh concentrated in high density gradient regions close to the ice storage. The models are solved in sequence until global convergence is achieved.The model was found to be in good agreement in terms of ice storage temperature and energy exchanged by the heat exchangers. Extracted energy from the storage was very well predicted. However, differences were found in the energy delivered by the wall heat exchangers. Ground temperatures were found to be well predicted below and above the storage, but not at the sides of the storage were over-predicted values, partially due to the simplifications assumed in this region, were observed.

Высокопроизводительное численное моделирование стратифицированных течений около клина в OpenFOAM

Results of numerical simulation of a continuously stratified fluid are presented. They are characterized by a wide range of values of internal scales that are not in a homogeneous liquid. Mathematical model is based on the fundamental set of differential equations of inhomogeneous multicomponent fluid mechanics. The problem is solved using the finite volume method in an open source package OpenFOAM. To take into account the stratification and diffusion effects a new own solver was developed and tested using the standard and extended libraries of the package. A particular attention is focused at construction of a high quality computational grid which satisfies basic requirements for resolution of all the microscales of the problem in high-gradient regions of the flow. Testing of the proposed numerical model Testing was conducted for continuously stratified fluid flows around a motionless and a moving wedge-shaped body with straight and curved edges. The calculations performed in parallel regime on computational facilities of the web-laboratory UniHUB (www.unihub.ru) demonstrated complex structure of flows. High-gradient layers near the sharp edges of the obstacles have been identified. Formation of an intensive zone of pressure depression in front of the leading vertex of the wedge is responsible for generation of propulsive mechanism that results in a self-motion of the obstacle along its neutral buoyancy horizon in a stably stratified environment.

A numerical method of the ship structures analysis based on meshless local Petrov-Galerkin method

The paper presents a numerical simulation method for ship structures based on meshless local Petrov-Galerkin method. The proposal method is a suitable for adaptive computation method while processing the displacement and stress fields of the ship structures in high-gradient regions. Above all, based on the theory of Mindlin-Reissner plate, the field approximation function of the displacement is obtained by employing Moving-least Square method, and then the governing equation and the stiffness matrix of the structures are established. Numerical demonstrations show the solutions of the presented method are good agreement between FEM-ANSYS and the proposed approach, which verifies the validity of the presented method for the ship structures analysis.

An analytic linear accelerator source model for GPU-based Monte Carlo dose calculations

Recently, there has been a lot of research interest in developing fast Monte Carlo (MC) dose calculation methods on graphics processing unit (GPU) platforms. A good linear accelerator (linac) source model is critical for both accuracy and efficiency considerations. In principle, an analytical source model should be more preferred for GPU-based MC dose engines than a phase-space file-based model, in that data loading and CPU-GPU data transfer can be avoided. In this paper, we presented an analytical field-independent source model specifically developed for GPU-based MC dose calculations, associated with a GPU-friendly sampling scheme. A key concept called phase-space-ring (PSR) was proposed. Each PSR contained a group of particles that were of the same type, close in energy and reside in a narrow ring on the phase-space plane located just above the upper jaws. The model parameterized the probability densities of particle location, direction and energy for each primary photon PSR, scattered photon PSR and electron PSR. Models of one 2D Gaussian distribution or multiple Gaussian components were employed to represent the particle direction distributions of these PSRs. A method was developed to analyze a reference phase-space file and derive corresponding model parameters. To efficiently use our model in MC dose calculations on GPU, we proposed a GPU-friendly sampling strategy, which ensured that the particles sampled and transported simultaneously are of the same type and close in energy to alleviate GPU thread divergences. To test the accuracy of our model, dose distributions of a set of open fields in a water phantom were calculated using our source model and compared to those calculated using the reference phase-space files. For the high dose gradient regions, the average distance-to-agreement (DTA) was within 1 mm and the maximum DTA within 2 mm. For relatively low dose gradient regions, the root-mean-square (RMS) dose difference was within 1.1% and the maximum dose difference within 1.7%. The maximum relative difference of output factors was within 0.5%. Over 98.5% passing rate was achieved in 3D gamma-index tests with 2%/2 mm criteria in both an IMRT prostate patient case and a head-and-neck case. These results demonstrated the efficacy of our model in terms of accurately representing a reference phase-space file. We have also tested the efficiency gain of our source model over our previously developed phase-space-let file source model. The overall efficiency of dose calculation was found to be improved by ~1.3–2.2 times in water and patient cases using our analytical model.

A 3-D implicit finite-volume model of shallow water flows

A three-dimensional (3-D) model has been developed to simulate shallow water flows in large water bodies, such as coastal and estuarine waters. The eddy viscosity is determined using a newly modified mixing length model that uses different mixing length functions for the horizontal and vertical shear strain rates. The 3-D shallow water flow equations with the hydrostatic pressure assumption are solved using an implicit finite-volume method based on a quadtree (telescoping) rectangular mesh on the horizontal plane and the sigma coordinate in the vertical direction. The quadtree technique can locally refine the mesh around structures or in high-gradient regions by splitting a coarse cell into four child cells. The grid nodes are numbered with a one-dimensional index system that has unstructured grid feature for better grid flexibility. All the primary variables are arranged in a non-staggered grid system. Fluxes at cell faces are determined using a Rhie and Chow-type momentum interpolation, to avoid the possible spurious checkerboard oscillations caused by linear interpolation. Each of the discretized governing equations is solved iteratively using the flexible GMRES method with ILUT preconditioning, and coupling of water level and velocity among these equations is achieved by using the SIMPLEC algorithm with under-relaxation. The model has been tested in four cases, including steady flow near a spur-dyke, tidal flows in San Francisco Bay and Gironde Estuary, and wind-induced current in a flume. The calculated water levels and velocities are in good agreement with the measured values.

Case study of seismic hazard assessment in underground coal mining using passive tomography

The relation between applied stress and wave velocity is examined firstly at the laboratory-scale by using ultrasonic technique. Subsequently, an island longwall face under hard-thick strata, suffering from the threat of seismic hazards, e.g. rock burst, strong tremor, was chosen for a case study of passive velocity tomography. Based on continuous seismic monitoring during mining operation, passive tomographic imaging has been used to locate high seismic activity zones and assess seismic hazard around the face. The results show that the high velocity and velocity gradient regions correlated well with the high seismic activities occurred in future mining period. In addition, the high velocity or velocity gradient regions redistributed with the retreat of coalface and large-scale movement of key strata. Passive velocity tomography can be a promising tool to continuously monitor the relatively high stress zone or evaluate seismic hazard in underground coal mining.

SU‐E‐T‐597: Parameterization of the Photon Beam Dosimetry for a Commercial Linear Accelerator

Purpose:In radiation therapy, accurate data acquisition of photon beam dosimetric quantities is important for (1) beam modeling data input into a treatment planning system (TPS), (2) comparing measured and TPS modelled data, (3) a linear accelerator's (linac) beam characteristics quality assurance process, and (4) establishing a standard data set for data comparison, etcetera. Parameterization of the photon beam dosimetry creates a portable data set that is easy to implement for different applications such as those previously mentioned. The aim of this study is to develop methods to parameterize photon percentage depth doses(PDD), profiles, and total scatter output factors(Scp).Methods:Scp, PDDs and profiles for different field sizes (from 2×2 to 40×40cm2), depths and energies were measured in a linac using a three‐dimensional water tank. All data were smoothed and profile data were also centered, symmetrized and geometrically scaled. The Scp and PDD data were analyzed using exponential functions. For modelling of open and wedge field profiles, each side was divided into three regions described by exponential, sigmoid and Gaussian equations. The model's equations were chosen based on the physical principles described by these dosimetric quantities. The equations’ parameters were determined using a least square optimization method with the minimal amount of measured data necessary. The model's accuracy was then evaluated via the calculation of absolute differences and distance–to–agreement analysis in low gradient and high gradient regions, respectively.Results:All differences in the PDDs’ buildup and the profiles’ penumbra regions were less than 2 mm and 0.5 mm, respectively. Differences in the low gradient regions were 0.20 ± 0.20% and 0.50 ± 0.35% for PDDs and profiles, respectively. For Scp data, all differences were less than 0.5%.Conclusion:This novel analytical model with minimum measurement requirements proved to accurately calculate PDDs, profiles, and Scp for different field sizes, depths and energies.

WE-D-BRA-05: Pseudo In Vivo Patient Dosimetry Using a 3D-Printed Patient-Specific Phantom

Purpose: To test the feasibility of using 3D-printed patient-specific phantoms for intensity-modulated radiation therapy (IMRT) quality assurance (QA). Methods: We created a patient-specific whole-head phantom using a 3D printer. The printer data file was created from high-resolution DICOM computed tomography (CT) images of 3-year old child treated at our institution for medulloblastoma. A custom-modified extruder system was used to create tissue-equivalent materials. For the printing process, the Hounsfield Units from the CT images were converted to proportional volumetric densities. A 5-field IMRT plan was created from the patient CT and delivered to the 3D- phantom. Dose was measured by an ion chamber placed through the eye. The ion chamber was placed at the posterior edge of the planning target volume in a high dose gradient region. CT scans of the patient and 3D-phantom were fused by using commercial treatment planning software (TPS). The patient's plan was calculated on the phantom CT images. The ion chamber's active volume was delineated in the TPS; dose per field and total dose were obtained. Measured and calculated doses were compared. Results: The 3D-phantom dimensions and tissue densities were in good agreement with the patient. However, because of a printing error, there was a large discrepancy in the density in the frontal cortex. The calculated and measured treatment plan doses were 1.74 Gy and 1.72 Gy, respectively. For individual fields, the absolute dose difference between measured and calculated values was on average 3.50%. Conclusion: This study demonstrated the feasibility of using 3D-printed patient-specific phantoms for IMRT QA. Such phantoms would be particularly advantageous for complex IMRT treatment plans featuring high dose gradients and/or for anatomical sites with high variation in tissue densities. Our preliminary findings are promising. We anticipate that, once the printing process is further refined, the agreement between measured and calculated doses will improve.

Error Approximation in Mesoscale Material Property Field Representations

AbstractLocally averaged random fields can be used to represent composite material properties at an intermediate scale. These types of fields provide the basis for stochastic simulation to generate nominally identical realizations of random composite microstructures to be used in reliability analysis. One challenge in choosing an appropriate local averaging technique and mesoscale length parameter is the difficulty of quantifying the accuracy of the locally averaged model. Although mesoscale models may offer advantages over the use of a representative volume element (RVE), particularly in regions of high stress gradients, mesoscale approximations do not converge to an effective medium, so the accuracy of the mesoscale representation cannot be quantified. In this paper, a matrix norm error is developed to test locally averaged material property approximations where loading is not specified a priori. This norm-based approach illustrates the advantage of local averaging over global averaging when small-scale...

Breaking bad IMRT QA practice.

Agreement between planned and delivered dose distributions for patient‐specific quality assurance in routine clinical practice is predominantly assessed utilizing the gamma index method. Several reports, however, fundamentally question current IMRT QA practice due to poor sensitivity and specificity of the standard gamma index implementation. An alternative is to employ dose volume histogram (DVH)‐based metrics. An analysis based on the AAPM TG 53 and ESTRO booklet No.7 recommendations for QA of treatment planning systems reveals deficiencies in the current “state of the art” IMRT QA, no matter which metric is selected. The set of IMRT benchmark plans were planned, delivered, and analyzed by following guidance of the AAPM TG 119 report. The recommended point dose and planar dose measurements were obtained using a PinPoint ionization chamber, EDR2 radiographic film, and a 2D ionization chamber array. Gamma index criteria {3%(global),3 mm} and {3%(global),3 mm} were used to assess the agreement between calculated and delivered planar dose distributions. Next, the AAPM TG 53 and ESTRO booklet No.7 recommendations were followed by dividing dose distributions into four distinct regions: the high‐dose (HD) or umbra region, the high‐gradient (HG) or penumbra region, the medium‐dose (MD) region, and the low‐dose (LD) region. A different gamma passing criteria was defined for each region, i.e., a “divide and conquer” (D&C) gamma method was utilized. The D&C gamma analysis was subsequently tested on 50 datasets of previously treated patients. Measured point dose and planar dose distributions compared favorably with TG 119 benchmark data. For all complex tests, the percentage of points passing the conventional {3%(global),3 mm} gamma criteria was 97.2%±3.2% and 95.7%±1.2% for film and 2D ionization chamber array, respectively. By dividing 2D ionization chamber array dose measurements into regions and applying 3 mm isodose point distance and variable local point dose difference criteria of 7%, 15%, 25%, and 40% for HD, HG, MD, and LD regions, respectively, a 93.4%±2.3% gamma passing rate was obtained. Identical criteria applied using the D&C gamma technique on 50 clinical treatment plans resulted in a 97.9%±2.3% gamma passing score. Based on the TG 119 standard, meeting or exceeding the benchmark results would indicate an exemplary IMRT QA program. In contrast to TG 119 analysis, a different scrutiny on the same set of data, which follows the AAPM TG 53 and ESTRO booklet No.7 guidelines, reveals a much poorer agreement between calculated and measured dose distributions with large local point dose differences within different dose regions. This observation may challenge the conventional wisdom that an IMRT QA program is producing acceptable results.PACS number: 87.55.Qr

Toward adaptive radiotherapy for head and neck patients: Uncertainties in dose warping due to the choice of deformable registration algorithm.

The aims of this work were to evaluate the performance of several deformable image registration (DIR) algorithms implemented in our in-house software (NiftyReg) and the uncertainties inherent to using different algorithms for dose warping. The authors describe a DIR based adaptive radiotherapy workflow, using CT and cone-beam CT (CBCT) imaging. The transformations that mapped the anatomy between the two time points were obtained using four different DIR approaches available in NiftyReg. These included a standard unidirectional algorithm and more sophisticated bidirectional ones that encourage or ensure inverse consistency. The forward (CT-to-CBCT) deformation vector fields (DVFs) were used to propagate the CT Hounsfield units and structures to the daily geometry for "dose of the day" calculations, while the backward (CBCT-to-CT) DVFs were used to remap the dose of the day onto the planning CT (pCT). Data from five head and neck patients were used to evaluate the performance of each implementation based on geometrical matching, physical properties of the DVFs, and similarity between warped dose distributions. Geometrical matching was verified in terms of dice similarity coefficient (DSC), distance transform, false positives, and false negatives. The physical properties of the DVFs were assessed calculating the harmonic energy, determinant of the Jacobian, and inverse consistency error of the transformations. Dose distributions were displayed on the pCT dose space and compared using dose difference (DD), distance to dose difference, and dose volume histograms. All the DIR algorithms gave similar results in terms of geometrical matching, with an average DSC of 0.85 ± 0.08, but the underlying properties of the DVFs varied in terms of smoothness and inverse consistency. When comparing the doses warped by different algorithms, we found a root mean square DD of 1.9% ± 0.8% of the prescribed dose (pD) and that an average of 9% ± 4% of voxels within the treated volume failed a 2%pD DD-test (DD2%-pp). Larger DD2%-pp was found within the high dose gradient (21% ± 6%) and regions where the CBCT quality was poorer (28% ± 9%). The differences when estimating the mean and maximum dose delivered to organs-at-risk were up to 2.0%pD and 2.8%pD, respectively. The authors evaluated several DIR algorithms for CT-to-CBCT registrations. In spite of all methods resulting in comparable geometrical matching, the choice of DIR implementation leads to uncertainties in dose warped, particularly in regions of high gradient and/or poor imaging quality.

Clinical applications of 3-D dosimeters

Both 3-D gels and radiochromic plastic dosimeters, in conjunction with dose image readout systems (MRI or optical-CT), have been employed to measure 3-D dose distributions in many clinical applications. The 3-D dose maps obtained from these systems can provide a useful tool for clinical dose verification for complex treatment techniques such as IMRT, SRS/SBRT, brachytherapy, and proton beam therapy. These complex treatments present high dose gradient regions in the boundaries between the target and surrounding critical organs. Dose accuracy in these areas can be critical, and may affect treatment outcome. In this review, applications of 3-D gels and PRESAGE dosimeter are reviewed and evaluated in terms of their performance in providing information on clinical dose verification as well as commissioning of various treatment modalities. Future interests and clinical needs on studies of 3-D dosimetry are also discussed.