Ion Chamber Array Research Articles

The use of a mini-ridge filter with cyclotron-based pencil beam scanning proton therapy.

Pencil beam scanning (PBS) proton therapy allows for far superior dose conformality compared with passive scattering techniques. However, one drawback of PBS is that the beam delivery time can be long, particularly when treating superficial disease. Minimizing beam delivery time is important for patient comfort and precision of treatment delivery. Mini-ridge filters (MRF) have been shown to reduce beam delivery time for synchrotron-based PBS. Given that cyclotron systems are widely used in proton therapy it is necessary to investigate the potential clinical benefit of mini-ridge filters in such systems. To demonstrate the clinical benefit of using a MRF to reduce beam delivery time for patients with large target volumes and superficial disease in cyclotron-based PBS proton therapy. A MRF beam model was generated by simulating the effect of a MRF on our clinical beam data assuming a fixed snout position relative to the isocenter. The beam model was validated with a series of measurements. The model was used to optimize treatment plans in a water phantom and on six patient DICOM datasets to further study the effect of the MRF and for comparison with physician-approved clinical treatment plans. Beam delivery time was measured for six plans with and without the MRF to demonstrate the reduction achievable. Plans with and without MRF were reviewed to confirm clinical acceptability by a radiation oncologist. Patient-specific QA measurements were carried out with a two-dimensional ionization chamber array detector for one representative patient's plan optimized with the MRF beam model. Results show good agreement between the simulated beam model and measurements with mean and maximum deviations of 0.06mm (0.45%) and 0.61mm (4.9%). The increase in Bragg peak width (FWHM) ranged from 2.7mm at 226MeV to 6.1mm at 70 MeV. The mean and maximum reduction in beam delivery time observed per field was 29.1s (32.2%) and 79.7s (55.3%). MRFs can be used to reduce treatment time in cyclotron-based PBS proton therapy without sacrificing plan quality. This is particularly beneficial for patients with large targets and superficial disease such as in breast cancer where treatment times are generally long, as well as patients treated with deep inspiration breath hold (DIBH).

Validation of an EGSnrc-based Monte Carlo model for a complex 2D-array for technical QA measurements of a linear accelerator.

Multi-axis ionization chamber arrays can be used for quality assurance (QA) and measurement of linear accelerator (linac) specific data. In this work, the ability of the IC Profiler (Sun Nuclear Corp., Melbourne, Florida) detector array to measure the photon beam quality specifier %dd(10) and TPR20, 10 was investigated. To investigate the method for beam energy QA using a two-dimensional detector array, a Monte Carlo-based model of the detector array was developed and validated. A Monte Carlo-based model of the IC Profiler detector array with Quad Wedge accessories was developed in detail from drawings provided by the manufacturer using the egs++ class library from the EGSnrc code system. Monte Carlo simulations were used to calculate the absorbed dose in the 251 ionization chambers of the IC profiler in the 6 MV Elekta Precise radiation field. To validate the results from the Monte Caro simulations, measurements were performed on clinical 6 MV linacs. To vary the photon beam quality of the Elekta 6 MV linac, the current of the bending magnet was varied. Furthermore, the area ratio was calculated from IC Profiler measurements with the Quad Wedgeaccessories. Measurements as well as Monte Carlo simulations confirmed the linear relationship between the area ratio and the investigated photon beam quality specifier %dd(10) and TPR20, 10 for the investigated radiation source. Furthermore, the Monte Carlo-simulated data were within the 95% confidence interval of the linear fit to the measured data. This enabled the Monte Carlo-based IC Profiler model to be used for further investigations. The values were calculated for various electron beam sizes and the angle of incidence on the target of thelinac. A Monte-Carlo-based model of the detector array was developed, which could successfully reproduce measurements, demonstrating that even very complex geometries can be modeled in EGSnrc. Moreover, the study showed that the validated Monte Carlo model has the potential to investigate variations in beam parameters and their effects on AR ratios and %dd(10) that may not be investigated experimentally. While these findings may help users gain a deeper understanding of the QA method, the Monte Carlo model enables other complex investigations, such as the simulation of measurements in the presence of magnetic fields, or the simulation of measurements on novel treatment delivery techniques anddevices.

An evaluation of the use of DirectSPR images for proton planning in the RayStation treatment planning software.

An important source of uncertainty in proton therapy treatment planning is the assignment of stopping-power ratio (SPR) from CT data. A commercial product is now available that creates an SPR map directly from dual-energy CT (DECT). This paper investigates the use of this new product in proton treatment planning and compares the results to the current method of assigning SPR based on a single-energy CT (SECT). Two tissue surrogate phantoms were CT scanned using both techniques. The SPRs derived from single-energy CT and by DirectSPR™ were compared to measured values. SECT-based values agreed with measurements within 4% except for low density lung and high density bone, which differed by 13% and 8%, respectively. DirectSPR™ values were within 2% of measured values for all tissues studied. Both methods were also applied to scanned containers of three types of animal tissue, and the expected range of protons of two different energies was calculated in the treatment planning system and compared to the range measured using a multi-layer ion chamber. The average difference between range measurements and calculations based on SPR maps from dual- and single-energy CT, respectively, was 0.1mm (0.07%) versus 2.2mm (1.5%). Finally, a phantom was created using a layer of various tissue surrogate plugs on top of a 2D ion chamber array. Dose measurements on this array were compared to predictions using both single- and dual-energy CTs and SPR maps. While standard gamma pass rates for predictions based on DECT-derived SPR maps were slightly higher than those based on single-energy CT, the differences were generally modest for this measurement setup. This study showed that SPR maps created by the commercial product from dual-energy CT can successfully be used in RayStation to generate proton dose distributions and that these predictions agree well with measurements.

Decomposing a Beam Profile Constancy into Energy and Symmetry Components and Its Evaluation Using an Ionization Chamber Array

We have proposed a new formulation that can decompose the profile constancy defined in the AAPM TG 142 into energy and symmetry constancies by measuring beam profiles using an IC profiler (ICP). Measured profiles were laterally inverted to calculate averaged profiles in the lateral direction, thereby cancelling asymmetric components. Validation tests were performed by comparing the proposed calculation and measured results under various experimental conditions. Calculated profile constancies were further compared to decomposed energy and symmetry constancies. The energy constancy calculated from the averaged beam profile by lateral inversion and the measured PDD(10) constancy agreed within 0.1% when only symmetries were varied. The calculated energy and symmetry constancies, and the measured results agreed within 0.2% when both energies and symmetries were varied. The linac beam profile constancy has been decomposed into energy and symmetry terms. The proposed formulation has been validated by comparing the calculations and the direct measurements using the ICP. We have shown that QA/QC for profile constancy tests can be efficiently performed using the proposed formulation.

Commissioning of a synchrotron-based proton beam therapy system for use with a Monte Carlo treatment planning system

This work tackles the commissioning and validation of a novel combination of a synchrotron-based proton beam therapy system (Hitachi, Ltd.) for use with a Monte Carlo treatment planning system (TPS). Four crucial aspects in this configuration have been investigated: (1) Monte Carlo-based correction performed by the TPS to the measured integrated depth-dose curves (IDD), (2) circular spot modelling with a single Gaussian function to characterize the synchrotron physical spot, which is elliptical, (3) the modelling of the range shifter that enables using only one set of measurements in open beams, and (4) the Monte Carlo dose calculation model in small fields.Integrated depth-dose curves were measured with a PTW Bragg peak chamber and corrected, with a Monte Carlo model, to account for energy absorbed outside the detector. The elliptical spot was measured by IBA Lynx scintillator, EBT3 films and PTW microDiamond. The accuracy of the TPS (RayStation, RaySearch Laboratories) at spot modelling with a circular Gaussian function was assessed.The beam model was validated using spread-out Bragg peak (SOBP) fields. We took single-point doses at several depths through the central axis using a PTW Farmer chamber, for fields between 2 × 2cm and 30 × 30cm. We checked the range-shifter modelling from open-beam data. We tested clinical cases with film and an ionization chamber array (IBA Matrix).Sigma differences for spots fitted using 2D images and 1D profiles to elliptical and circular Gaussian models were below 0.22 mm. Differences between SOBP measurements at single points and TPS calculations for all fields between 5 × 5 and 30 × 30cm were below 2.3%. Smaller fields had larger differences: up to 3.8% in the 2 × 2cm field. Mean differences at several depths along the central axis were generally below 1%. Differences in range-shifter doses were below 2.4%. Gamma test (3%, 3 mm) results for clinical cases were generally above 95% for Matrix and film.Approaches for modelling synchrotron proton beams have been validated. Dose values for open and range-shifter fields demonstrate accurate Monte Carlo correction for IDDs. Elliptical spots can be successfully modelled using a circular Gaussian, which is accurate for patient calculations and can be used for small fields. A double-Gaussian spot can improve small-field calculations. The range-shifter modelling approach, which reduces clinical commissioning time, is adequate.

Experimental Validation of a Real-Time Adaptive 4D-Optimized Particle Radiotherapy Approach to Treat Irregularly Moving Tumors

Treatment of locally advanced lung cancer is limited by toxicity and insufficient local control. Particle therapy could enable more conformal treatment than intensity modulated photon therapy but is challenged by irregular tumor motion, associated range changes, and tumor deformations. We propose a new strategy for robust, online adaptive particle therapy, synergizing 4-dimensional optimization with real-time adaptive beam tracking. The strategy was tested and the required motion monitoring precision was determined. In multiphase 4-dimensional dose delivery (MP4D), a dedicated quasistatic treatment plan is delivered to each motion phase of periodic 4-dimensional computed tomography (4DCT). In the new extension, "MP4D with residual tracking" (MP4DRT), lateral beam tracking compensates for the displacement of the tumor center-of-mass relative to the current phase in the planning 4DCT. We implemented this method in the dose delivery system of a clinical carbon facility and tested it experimentally for a lung cancer plan based on a periodic subset of a virtual lung 4DCT (planned motion amplitude 20mm). Treatments were delivered in a quality assurance-like setting to a moving ionization chamber array. We considered variable motion amplitudes and baseline drifts. The required motion monitoring precision was evaluated by adding noise to the motion signal. Log-file-based dose reconstructions were performed in silico on the entire 4DCT phantom data set capable of simulating nonperiodic motion. MP4DRT was compared with MP4D, rescanned beam tracking, and internal target volume plans. Treatment quality was assessed in terms of target coverage (D95), dose homogeneity (D5-D95), conformity number, and dose to heart and lung. For all considered motion scenarios and metrics, MP4DRT produced the most favorable metrics among the tested motion mitigation strategies and delivered high-quality treatments. The conformity was similar to static treatments. The motion monitoring precision required for D95 >95% was 1.9mm. With clinically feasible motion monitoring, MP4DRT can deliver highly conformal dose distributions to irregularly moving targets.

Quality assurance of scanned proton beams at different gantry angles using an ionization chamber array in a rotational phantom

PurposeTo implement a single set-up monthly QA procedure for 9 different beam parameters at different gantry angles and evaluate its clinical implementation over a 12 month period. MethodsWe developed a QA procedure using an array detector (PTW Octavius 1500XDR) embedded in a rotational unit (PTW Octavius 4D) at our proton facility. With a single set-up we can monitor field central axis position, field symmetry, field size, flatness, penumbrae, output, spot size, spot position and range at different gantry angles (AAPM TG 224). The set-up is irradiated with homogenous 2D fields with dynamic aperture and spot patterns at five gantry angles. A modular top is used to check the range consistency. Absolute γ analysis were performed to compare measured dose distributions to calculated dose. All other parameters are directly extracted from the measurements. Additionally, the sensitivity of the set-up to small changes in beam parameters were compared to the Lynx detector (IBA). ResultsOver a 12 month period, output, symmetry, and flatness were within ± 2 %; FWHM, spot positions, penumbra widths, and central axis fields were within ± 1 mm. Range differences were all within 1/2 of the energy spacing (±0.6 MeV) relative to baseline. Most (2 %, 2 mm) γ-analysis showed agreement scores higher than 90 %. The sensitivity is comparable to the Lynx detector and measurement time is reduced by 40 %. ConclusionThe time-efficient monthly QA procedure that we developed can accurately be used to measure a large range of beam parameters at different gantry angles, within the TG 224 AAPM recommendations.

Overall Accuracy of Single-Isocenter Multiple Metastases SRS Treatments over Time: Comparison of Two Commercially Available Methods

<h3>Purpose/Objective(s)</h3> Single isocenter stereotactic radiosurgery (SI-SRS) is an efficient approach for dose delivery to multiple brain metastases since the treatment duration is considerably reduced, compared to the standard method of the isocenter placement at each tumor center. However, the complexity of this technique results in increased sensitivity to geometric and dosimetric uncertainties during plan delivery, thus patient-specific quality assurance procedures of high accuracy are mandatory. This study presents the investigation into the consistency of this technique, using the a 4D dose verification system and 3D printed head phantoms. <h3>Materials/Methods</h3> A treatment plan with two brain metastases was delivered four times in the period of one month on a Linac, to evaluate the reproducibility of the SI-SRS technique. The targets had a concave (2.4 cc) and a spherical (1.5 cc) shape, placed at a distance of 5 cm. Dose prescription was set to 8 Gy for both targets and a treatment plan of a single fraction using four Hyperarc beams, one full coplanar arc and three half noncoplanar arcs, arranged with a single isocenter automatically located on the center of the distance between the two targets was created. Before plan delivery, Winston-Lutz (WL) tests were performed to determine the diameter of the sphere containing the radiation isocenter for various positions of the collimator, gantry and couch. The dose distribution was recalculated on 4D geometry and measured with the 1000 SRS ion chamber array. The head phantom accommodated a film insert and the irradiation procedure consisted of positioning, imaging and plan delivery as if it was the real patient. Gamma analysis was performed for 3%/1mm acceptance criteria using a dose threshold of 1 Gy for films and 10% of maximum dose for 4D. <h3>Results</h3> The Root Mean Square (RMS) variation of the isocenter was 0.71±0.15 mm for gantry, 0.66±0.14 mm for collimator and 0.87±0.22 mm for couch, validating that the isocenter diameter was within the tolerance of 1 mm before each measurement. Gamma analysis revealed a mean passing rate (GPR) of 93.2%±0.07% for 4D measurements, compared to 91.2%±1.8% for the film ones. The reduced GPR in the case of the head phantom is expected, since it is an End-to-End QA procedure, incorporating not only the plan delivery uncertainties, but also the ones related to image registration and couch rotation. <h3>Conclusion</h3> Both QA methods showed a good agreement with each other and the calculated dose distribution having GPRs above 90% for the 3%/1mm criteria, rendering them suitable for verification of SRS plans' dosimetric and spatial accuracy. The standard deviation of the GPRs revealed that the plan delivery was consistent between the measurements, demonstrating high reproducibility and accuracy of the SI-SRS technique.

Testing of an enhanced leaf model for improved dose calculation in a commercial treatment planning system.

With the ever-increasing complexity of dynamic radiotherapy treatments, dose calculation algorithms are challenged to accurately calculate the dose resulting from small, on- and off-axis multileaf collimator (MLC) aperture movements. Although the currently available Eclipse (Varian Medical Systems, Palo Alto) dose calculation algorithms still use a simplified, binary MLC model, a more advanced and detailed modeling of the MLC could be beneficial for the dose calculation precision of high-end treatments. To improve the modeling of the MLC in the dose calculation algorithms of the Eclipse treatment planning system, an enhanced MLC attenuation model was constructed through ray tracing through the actual leaf designs for the most commonly used Varian MLC types. The enhanced leaf model (ELM) thus includes the rounded leaf tip shape, the drive screw cutout, and the leaf body thickness. The purpose of this work is to test out this new model and explore possible improvements compared to the previous model. Dose calculations were performed in a research Eclipse environment equipped with the original and enhanced MLC model. Measurements were performed on TrueBeam and on Halcyon dual MLC treatment units. Dedicated static and dynamic MLC test plans were designed to challenge the dose calculation and highlight differences between both models while keeping the experimental setup simple in order to minimize measurement uncertainties. Measurements were performed with single ion chambers, 2D ion chamber arrays and film. The improved MLC model considerably improves the accuracy of the dose calculation for the test fields used in this study. For the TrueBeam MLC, improvements are most prominent for off-axis dose delivery through narrow (static or dynamic) MLC gaps. For 3mm narrow sweeping gap deliveries at 12cm off-axis, the advanced model agrees within 2% with the measurement, in contrast to the 12% deviation observed with the original MLC model. For the Halcyon MLC, improvements are especially prominent when the leaves of both MLC stacks are aligned, regardless of their position in the field. Sweeping gap measurements improve from a 7%-10% deviation with the original model to within 2% with the new model. Although test fields designed in this study emphasize the flaws in the original MLC dose calculation model, the enhanced MLC model resolves all of the observed discrepancies, showing excellent on- and off-axis agreements with all of the performed measurements.

Validation of a digital method for patient-specific verification of VMAT treatment using a 2D ionisation detector array

VMAT treatment involves the delivery of complex beam parameters including the dynamic multi-leaf collimators (MLC) from a linac. The use of a detector array has become a standard method to verify the treatment accuracy before the treatment planned is delivered to the patient with some limitations. This study aims to evaluate the accuracy of a high-resolution, digital method using linac log data for VMAT treatment verification. The log data was obtained from a Versa HD (Elekta ltd., Crawley, UK) linac during VMAT treatment. All the dynamic treatment parameters including MLC position, and MLC speed, were recorded at the rate of 4 Hz in the log data. The treatment delivery was also measured simultaneously using an Octavius 1500 2D ionisation chamber array (PTW, Freiburg, Germany) during the log data measurements. The parameters were extracted and analysed using algorithms written in MATLAB (MathWorks, Natick, MA). The results demonstrated that the log data can track MLC leaves with an accuracy of 1 mm at speeds ranging from 3.04 to 3.40 cm/s. Evaluation of the fluence generated for the VMAT delivery using log data was shown to agree well with the planned dose distribution measured in the 2D detector array, with an average gamma pass rate of 97.5% at 3%/3 mm. Log data obtained a higher gamma pass rate of 98.5% compared to the 2D detector array of 97.5%. The digital linac log data provides the basis for an essential high-resolution real-time verification tool that may be used for routine VMAT verification.

Comparison of pencil beam and Monte Carlo calculations with ion chamber array measurements for patient-specific quality assurance

ObjectiveTo determine under what conditions and criteria comparisons between calculations made with the current clinical treatment planning system (Syngo) and an in-house built TPS (TIMPS) would allow skipping of in-beam portal-specific measurements. MethodsMeasurements were made with an array of 24 ion chambers in a water phantom for 227 proton and 313 carbon ion portals with and without a range shifter (RS). These measurements were compared with calculations performed with Syngo and TIMPS using metrics of average dose difference and Gamma index. ResultsFor proton portals without RS, if a Gamma comparison between TIMPS and Syngo passed using criteria of 90% of tested points being within 3% and 3 ​mm, then 74% of measurements would agree with both TIMPS and Syngo. For proton portals with RS, more than 80% of measurements would agree with both calculations using the same criteria. For carbon ion portals without RS, if a Gamma evaluation between TIMPS and Syngo passed with criteria of 90% of tested points being within 2% and 2 ​mm, 85% of measurements would agree with both calculations. For carbon ion portals with RS, if a Gamma evaluation between TIMPS and Syngo passed with criteria of 90% of tested points being within 3% and 3 ​mm, 60% of measurements would agree with both calculations. ConclusionsBoth the pencil beam algorithm in Syngo and the FDC algorithm in TIMPS can provide accurate dose calculations in water for most clinical portals. For about 75% of portals, physicists can perform comparisons of calculations instead of phantom measurements to verify Syngo calculations thereby saving a large amount of beam time. There are some portals, however, such as for low-energy protons without RS and high-energy carbon ions, where agreement between the two calculations and measurements are not yet satisfactory to allow the elimination of all measurements.

A 2D strip ionization chamber array with high spatiotemporal resolution for proton pencil beam scanning FLASH radiotherapy.

Experimental measurements of two-dimensional (2D) dose rate distributions in proton pencil beam scanning (PBS) FLASH radiation therapy (RT) are currently lacking. In this study, we characterize a newly designed 2D strip-segmented ionization chamber array (SICA) with high spatial and temporal resolution and demonstrate its applications in a modern proton PBS delivery system at both conventional and ultrahigh dose rates. A dedicated research beamline of the Varian ProBeam system was employed to deliver a 250-MeV proton PBS beam with nozzle currents up to 215nA. In the research and clinical beamlines, the spatial, temporal, and dosimetric performances of the SICA were characterized and compared with measurements using parallel-plate ion chambers (IBA PPC05 and PTW Advanced Markus chamber), a 2D scintillator camera (IBA Lynx), Gafchromic films (EBT-XD), and a Faraday cup. A novel reconstruction approach was proposed to enable the measurement of 2D dose and dose rate distributions using such a strip-type detector. The SICA demonstrated a position accuracy of 0.12±0.02mm at a 20-kHz sampling rate (50μs per event) and a linearity of R2 >0.99 for both dose and dose rate with nozzle beam currents ranging from 1 to 215nA. The 2D dose comparison to the film measurement resulted in a gamma passing rate of 99.8% (2mm/2%). A measurement-based proton PBS 2D FLASH dose rate distribution was compared to simulation results and showed a gamma passing rate of 97.3% (2mm/2%). The newly designed SICA demonstrated excellent spatial, temporal, and dosimetric performances and is well suited for commissioning, quality assurance, and a wide range of clinical applications in proton PBS clinical and FLASH-RT.

Potential of a Second-Generation Dual-Layer Spectral CT for Dose Calculation in Particle Therapy Treatment Planning.

In particle therapy treatment planning, dose calculation is conducted using patient-specific maps of tissue ion stopping power ratio (SPR) to predict beam ranges. Improving patient-specific SPR prediction is therefore essential for accurate dose calculation. In this study, we investigated the use of the Spectral CT 7500, a second-generation dual-layer spectral computed tomography (DLCT) system, as an alternative to conventional single-energy CT (SECT) for patient-specific SPR prediction. This dual-energy CT (DECT)-based method allows for the direct prediction of SPR from quantitative measurements of relative electron density and effective atomic number using the Bethe equation, whereas the conventional SECT-based method consists of indirect image data-based prediction through the conversion of calibrated CT numbers to SPR. The performance of the Spectral CT 7500 in particle therapy treatment planning was characterized by conducting a thorough analysis of its SPR prediction accuracy for both tissue-equivalent materials and common non-tissue implant materials. In both instances, DLCT was found to reduce uncertainty in SPR predictions compared to SECT. Mean deviations of 0.7% and 1.6% from measured SPR values were found for DLCT- and SECT-based predictions, respectively, in tissue-equivalent materials. Furthermore, end-to-end analyses of DLCT-based treatment planning were performed for proton, helium, and carbon ion therapies with anthropomorphic head and pelvic phantoms. 3D gamma analysis was performed with ionization chamber array measurements as the reference. DLCT-predicted dose distributions revealed higher passing rates compared to SECT-predicted dose distributions. In the DLCT-based treatment plans, measured distal-edge evaluation layers were within 1 mm of their predicted positions, demonstrating the accuracy of DLCT-based particle range prediction. This study demonstrated that the use of the Spectral CT 7500 in particle therapy treatment planning may lead to better agreement between planned and delivered dose compared to current clinical SECT systems.

On the potential of 2D ion chamber arrays for high-dose rate remote afterloading brachytherapy quality assurance

Objective. To investigate the potential of 2D ion chamber arrays to serve as a standalone tool for the verification of source strength, positioning and dwell time, within the framework of 192Ir high-dose rate brachytherapy device quality assurance (QA). Approach. A commercially available ion chamber array was used. Fitting of a 2D Lorentzian peak function to experimental data from a multiple source dwell position irradiation on a frame-by-frame basis, facilitated tracking of the source center orthogonal projection on the array plane. For source air kerma strength verification, Monte Carlo simulation was employed to obtain a chamber array- and source-specific correction factor of calibration with a 6 MV photon beam. This factor converted the signal measured by each ion chamber element to air kerma in free space. A source positioning correction was also applied to lift potential geometry mismatch between experiment and Monte Carlo simulation. Main results. Spatial and temporal accuracy of source movement was verified within 0.5 mm and 0.02 s, respectively, in compliance with the test endpoints recommended by international professional societies. The source air kerma strength was verified experimentally within method uncertainties estimated as 1.44% (k = 1). The source positioning correction method employed did not introduce bias to experimental results of irradiations where source positioning was accurate. Development of a custom jig attachable to the chamber array for accurate and reproducible experimental set up would improve testing accuracy and obviate the need for source positioning correction in air kerma strength verification. Significance. Delivery of a single irradiation plan, optimized based on results of this work, to a 2D ion chamber array can be used for concurrent testing of source position, dwell time and air kerma strength, and the procedure can be expedited through automation. Chamber arrays merit further study in treatment planning QA and real time, in vivo dose verification.

Evaluating Proton Dose and Associated Range Uncertainty Using Daily Cone-Beam CT.

PurposeThis study aimed to quantitatively evaluate the range uncertainties that arise from daily cone-beam CT (CBCT) images for proton dose calculation compared to CT using a measurement-based technique.MethodsFor head and thorax phantoms, wedge-shaped intensity-modulated proton therapy (IMPT) treatment plans were created such that the gradient of the wedge intersected and was measured with a 2D ion chamber array. The measured 2D dose distributions were compared with 2D dose planes extracted from the dose distributions using the IMPT plan calculated on CT and CBCT. Treatment plans of a thymoma cancer patient treated with breath-hold (BH) IMPT were recalculated on 28 CBCTs and 9 CTs, and the resulting dose distributions were compared.ResultsThe range uncertainties for the head phantom were determined to be 1.2% with CBCT, compared to 0.5% for CT, whereas the range uncertainties for the thorax phantom were 2.1% with CBCT, compared to 0.8% for CT. The doses calculated on CBCT and CT were similar with similar anatomy changes. For the thymoma patient, the primary source of anatomy change was the BH uncertainty, which could be up to 8 mm in the superior–inferior (SI) direction.ConclusionWe developed a measurement-based range uncertainty evaluation method with high sensitivity and used it to validate the accuracy of CBCT-based range and dose calculation. Our study demonstrated that the CBCT-based dose calculation could be used for daily dose validation in selected proton patients.

A multi-institutional comparison of dosimetric data for a 0.35 T MR-linac

Objective. A comparison of percent depth dose (PDD) curves, lateral beam profiles, output factors (OFs), multileaf collimator (MLC) leakage, and couch transmission factors was performed between ten institutes for a commercial 0.35 T MR-linac. Approach. The measured data was collected during acceptance testing of the MR-linac. The PDD curves were measured for the 3.32 × 3.32 cm2, 9.96 × 9.96 cm2, and 27.20 × 24.07 cm2 field sizes. The lateral beam profiles were acquired for a 27.20 × 24.07 cm2 field size using an ion chamber array and penumbra was defined as the distance between 80% of the maximum dose and 20% of the maximum dose after normalizing the profiles to the dose at the inflection points. The OFs were measured using solid-state dosimeters, whereas radiochromic films were utilized to measure radiation leakage through the MLC stacks. The relative couch transmission factors were measured for various gantry angles. The variation in the multi-institutional data was quantified using the percent standard deviation metric. Main results. Minimal variations (<1%) were found between the PDD data, except for the build-up region and the deeper regions of the PDD curve. The in-field region of the lateral beam profiles varied <1.5% between different institutions and a small variation (<0.7 mm) in penumbra was observed. A variation of <1% was observed in the OF data for field sizes above 1.66 × 1.66 cm2, whereas large variations were shown for small-field sizes. The average and maximum MLC leakage was calculated to be <0.3% and <0.6%, which was well below the international electrotechnical commission (IEC) leakage thresholds. The couch transmission was smallest for oblique beams and ranged from 0.83 to 0.87. Significance. The variation in the data was found to be relatively small and the different 0.35 T MR-linacs were concluded to have similar dosimetric characteristics.

A High-Throughput In Vitro Radiobiology Platform for Megavoltage Photon Linear Accelerator Studies

We designed and developed a multiwell tissue culture plate irradiation setup, and intensity modulated radiotherapy plans were generated for 96-, 24-, and 6-well tissue culture plates. We demonstrated concordance between planned and measured/imaged radiation dose profiles using radiochromic film, a 2D ion chamber array, and an electronic portal-imaging device. Cell viability, clonogenic potential, and γ-H2AX foci analyses showed no significant differences between intensity-modulated radiotherapy and open-field, homogeneous irradiations. This novel platform may help to expedite radiobiology experiments within a clinical environment and may be used for wide-ranging ex vivo radiobiology applications.

Evaluation of Patient-Specific Quality Assurance for Carbon Ion Radiotherapy Using Full Energy Scanning Method at QST Hospital

Purpose: Patient-specific QA (PSQA) measurements for carbon ion radiotherapy (CIRT) are critical components of processes designed to identify discrepancies between calculated and delivered doses. We report the results of PSQA conducted at the QST Hospital during the period from September 2017 to March 2018. Methods: We analyzed PSQA results for 1448 fields for 10 disease sites with various target volumes, target depths and number of energy layers. For the PSQA, all the planned beams were recalculated on a water phantom with treatment planning software. The recalculated dose distributions were compared with the measured distributions using a 2D ionization chamber array at three depths, including 95% of the area of the prescription dose. These recalculated dose distributions were evaluated using the 3%/3mm gamma index with a passing threshold of 90%. Results: The passing rates for prostate, head and neck, and bone and soft tissue were 96.8%, 99.3%, and 91.7%, respectively. Additionally, 94.7% of lung plans with low energy beams passed. Overall, the CIRT in the QST Hospital reached a high passing rate of more than 95%. Although the remaining 5% failed to pass, there was no dependence between measurement depth and disease sites in these failures. Conclusion: Using PSQA measurements, we confirmed consistency between the planned and delivered doses for CIRT using the full energy scanning method.

P71 - Use of an ion chamber array for the quality control of low-energy x-ray systems

P71 - Use of an ion chamber array for the quality control of low-energy x-ray systems

Extension of RBE-weighted 4D particle dose calculation for non-periodic motion.

Highly conformal scanned Carbon Ion Radiotherapy (CIRT) might permit dose escalation and improved local control in advanced stage thoracic tumors, but is challenged by target motion. Dose calculation algorithms typically assume a periodically repeating, regular motion. To assess the effect of realistic, irregular motion, new algorithms of validated accuracy are needed. We extended an in-house treatment planning system to calculate RBE-weighted dose distributions in CIRT on non-periodic CT image sequences. Dosimetric accuracy was validated experimentally on a moving, time-resolved ionization chamber array. Log-file based dose reconstructions were compared by gamma analysis and correlation to measurements at every intermediate detector frame during delivery. The impact of irregular motion on treatment quality was simulated on a virtual 4DCT thorax phantom. Periodic motion was compared to motion with varying amplitude and period ± baseline drift. Rescanning as a mitigation strategy was assessed on all scenarios. In experimental validation, average gamma pass rates were 99.89+-0.30% for 3%/3mm and 88.2+-2.2% for 2%/2mm criteria. Average correlation for integral dose distributions was 0.990±0.002. Median correlation for single 200ms frames was 0.947±0.006. In the simulations, irregular motion deteriorated V95 target coverage to 81.2%, 76.6% and 79.0% for regular, irregular motion and irregular motion with base-line drift, respectively. Rescanning restored V95 to >98% for both scenarios without baseline drift, but not with additional baseline drift at 83.7%. The validated algorithm permits to study the effects of irregular motion and to develop and adapt appropriate motion mitigation techniques.