kV Dose Research Articles

Planar and volumetric imaging dosimetry for longitudinal projection extended cone beam CT based adaptive radiotherapy

BackgroundThe objective of this study is to provide a detailed insight into the broad beam dosimetric characteristics of two commercial cone beam computed tomography (CBCT) imaging systems to complement the longitudinal projection extended CBCT based image guided adaptive radiotherapy (IGART). Methods and materialsThe absolute dose calibration, planar and volumetric dosimetric characteristics of two CBCT imaging systems viz., the Clinac 2100 C/D On-Board Imager (OBI) and the TrueBeam X-ray Imaging system (XI) (Varian Medical Systems, Palo Alto, CA) were investigated. Reference dosimetry specific to volumetric CBCT imaging mode was performed as per American Association of Physicists in Medicine (AAPM) task group (TG) 61 protocol using calibrated 0.6 cc Farmer ionization chamber (30010, PTW Dosimetry Company, Germany). The rotational planar and volumetric dosimetry was performed after calibrating the OCTAVIUS 1500 detector array as a mere photon detector, with and without the detachable hemisphere of 4D Modular phantom. ResultsThe absolute dose of half-fan XI CBCT was found to be 1.2 times lower when compared to OBI CBCT. The abutting kV cone beam dosimetry specific to dual-scan CBCT fusion technique showed a wider in-plane profile for the OBI system when compared to the XI system, due to an additional field opening of 3.4 cm used for half-fan mode in the former. The reconstructed volumetric imaging dose distribution specific to half-fan geometry and dynamic movement of gantry, brought to light valuable details about the kV dose distribution. ConclusionThe planar and 3D imaging dosimetry reported in this study paves the way for the integration of volumetric imaging dose reconstruction capabilities during high precision radiotherapy to demonstrate a complete picture of the total dose delivered to the patient during the planned course of IGART.

A novel multichannel deep learning model for fast denoising of Monte Carlo dose calculations: preclinical applications

Objective. In preclinical radiotherapy with kilovolt (kV) x-ray beams, accurate treatment planning is needed to improve the translation potential to clinical trials. Monte Carlo based radiation transport simulations are the gold standard to calculate the absorbed dose distribution in external beam radiotherapy. However, these simulations are notorious for their long computation time, causing a bottleneck in the workflow. Previous studies have used deep learning models to speed up these simulations for clinical megavolt (MV) beams. For kV beams, dose distributions are more affected by tissue type than for MV beams, leading to steep dose gradients. This study aims to speed up preclinical kV dose simulations by proposing a novel deep learning pipeline. Approach. A deep learning model is proposed that denoises low precision (∼106 simulated particles) dose distributions to produce high precision (109 simulated particles) dose distributions. To effectively denoise the steep dose gradients in preclinical kV dose distributions, the model uses the novel approach to use the low precision Monte Carlo dose calculation as well as the Monte Carlo uncertainty (MCU) map and the mass density map as additional input channels. The model was trained on a large synthetic dataset and tested on a real dataset with a different data distribution. To keep model inference time to a minimum, a novel method for inference optimization was developed as well. Main results. The proposed model provides dose distributions which achieve a median gamma pass rate (3%/0.3 mm) of 98% with a lower bound of 95% when compared to the high precision Monte Carlo dose distributions from the test set, which represents a different dataset distribution than the training set. Using the proposed model together with the novel inference optimization method, the total computation time was reduced from approximately 45 min to less than six seconds on average. Significance. This study presents the first model that can denoise preclinical kV instead of clinical MV Monte Carlo dose distributions. This was achieved by using the MCU and mass density maps as additional model inputs. Additionally, this study shows that training such a model on a synthetic dataset is not only a viable option, but even increases the generalization of the model compared to training on real data due to the sheer size and variety of the synthetic dataset. The application of this model will enable speeding up treatment plan optimization in the preclinical workflow.

Treatment of keloids with a single dose of low-energy superficial X-ray radiation to prevent recurrence after surgical excision: An in vitro and in vivo study

Although keloids have been empirically treated with steroids and radiation, evidence-based radiation parameters for keloid therapy are lacking. To determine evidence-based radiation parameters for blocking keloid fibroblast proliferation invitro and apply them to patients. The effects of various radiation parameters and steroids on cell proliferation, cell death, and collagen production in keloid explants and fibroblasts were evaluated with standard assays. Effective radiation parameters were then tested on patients. No differences were observed between the effects of 50 and 320 kV radiation or between single and fractionated radiation doses on keloid fibroblasts. A 3 Gy, 50 kV dose inhibited keloid fibroblast proliferation in culture, whereas 9Gy completely blocked their outgrowth from explants by inducing multiple cell death pathways and reducing collagen levels. Thirteen of 14 keloids treated with a single 8 Gy, 50 kV dose of radiation did not recur, although 4 patients with 6 keloids were lost to follow-up. Seventy-five percent of patients received steroids for pruritus, whereas approximately 25% of patients were lost to follow-up. A single 8 Gy dose of superficial 50 kV radiation delivered an average of 34days after keloid excision maybe sufficient to minimize recurrence, including in individuals resistant to steroids. Higher radiation energies, doses, or fractions may be unnecessary for keloid therapy.

Dose optimization in computed tomography of brain using CARE kV and CARE Dose 4D

Background: Computed Tomography (CT) scan of brain is the most widely used CT examination. Latest CT scanners have the potential to deliver very low radiation dose by utilizing tube potential and tube current modulation techniques. We aim to determine the application of CARE kV (tube potential modulation) and CARE Dose4D (tube current modulation) in CT scan of brain. Both CARE kV and CARE Dose4D are well-established innovative technology of Siemens Medical Solutions.
 Methodology: A prospective hospital-based study was conducted during four months at Tribhuvan University Teaching Hospital (TUTH). The data were collected on a Siemens Somatom Definition Edge 128 slices CT scanner. Non-random purposive sampling technique was employed. Ethical approval and consent to participate were taken for every participant. Non-contrast (NC) CT images were acquired without using CARE kV and CARE Dose4D, whereas during contrast-enhanced (CE) investigation, both were turned on keeping other scanning parameters constant for each individual.
 Results: A total of 72 patients, 42 males and 28 females - mean age 41y (range 16-87y) participated in this study. The Body Mass Index (BMI) was 22.0, range 20.1-25.0. The mean value of Computed Tomography Dose Index (CTDI), Dose Length Product (DLP) and Effective Dose (ED) before and after switching on both CARE kV and CARE Dose4D were 58.19±0.35 and 39.67±3.59 milli-Gray (mGy), 946.67 and 652.58 mGy-cm, and 1.98 and 1.36 milli-Sievert (mSv) respectively.
 Conclusion: CARE kV and CARE Dose4D can reduce radiation dose in CT scan of brain without loss of image quality.

Use of a laser‐guided collimation system to perform direct kilovoltage x‐ray spectra measurements on a linear accelerator onboard imager

The increased use of image-guided radiation therapy (IGRT) has led to increased use of kV on board imaging (OBI) devices. At present, directly measured OBI beam quality data have only been reported in terms of half-value layers (HVL). However, the HVL metric alone does not give the full OBI energy spectra as needed for accurate beam modeling. Although direct kV spectrometer devices exist they typically suffer from detector pile-up when used with OBI sources. We therefore present, for the first time, a novel laser-guided collimation system that allows direct measurement of the full energy spectrum for clinical OBI systems. Several clinically relevant spectra (80, 100, and 125 kVp), with and without the half bow-tie filter, were measured using a thermoelectric cooled cadmium telluride (CdTe) detector paired with a multichannel analyzer. To prevent detector saturation, the photon flux at the detector was reduced by use of an in-house designed laser-guided collimation system. After applying energy bin corrections, direct spectroscopic measurements were compared to Monte Carlo (MC) simulated spectra in order to verify accuracy of collected data. Both percent depth dose (PDD) curves and digitally reconstructed radiographs (DRR) were compared using the measured vs MC spectra. Measured and MC spectra agree with RMSD between 1.96% and 3.29%. PDD curves generated from the measured and MC spectra were found to match except for in the small buildup region, with an overall match for the six beams ranging between 0.3% and 2.7% RMSD. DRRs matched well with a maximum difference in contrast of 1.1% and RMSD of 0.46% contrast for various materials in DRRs. The use of a laser-guided collimation system provided a method for quickly obtaining highly accurate kV spectrum data from OBI sources. For kV dose or DRR calculation, it was found that both spectra produced similar results.

Kilovoltage transit and exit dosimetry for a small animal image-guided radiotherapy system using built-in EPID.

We investigated the potential use of the built-in electronic portal imaging device (EPID) in the small animal radiation research platform (SARRP) as a dosimeter in the kV energy range. To this end, we developed a method for converting portal images to a two-dimensional (2D) dose maps at the detector plane and object's exit surface and validated them against empirical dose measurements. We calibrated the SARRP's EPID to measure transit dose. The transit dose map was back-projected to calculate 2D dose distribution at the object's exit surface. The accuracy of transit and exit dose distributions was independently validated with a PinPoint ion chamber (IC) and Gafchromic EBT3 film measurements for a range of radiation dose rates (0.43-2.78 cGy/s), cone sizes (5-40 mm), in a homogeneous phantom of varying thickness (0-50 mm) and in an inhomogeneous phantom containing graphite, cork, air, and aluminum. In-air central axis (CAX) transit dose values measured with the EPID showed close agreement with film and IC measurements. The maximum differences in EPID in-air transit measurements with film or IC measurements were 1%. The EPID was capable of accurately measuring phantom transit dose independently of the attenuating phantom thickness, with average discrepancies of 0.5% and 2.9% with IC and film, respectively, where the maximum difference between the EPID and the IC was 1.8%. The results were slightly worse for film, with maximum differences in 4.9%. Output factor measurements using EPID were within 2.9% of both IC and film measurements. In addition, calculated exit doses agreed with film values within ≤3.1%, for attenuating phantom thicknesses ≥15 mm. The agreement became worse with decreasing phantom thickness; for thicknesses of 10 and 5 mm, agreements were ≤5.7% and ≤6.9%, respectively. Compared to film, transit and exit profiles measured with the EPID showed average differences <2% for both homogeneous and inhomogeneous materials. We developed and validated a novel 2D transit/exit dosimetry for a kV SA-IGRT system using an EPID. We verified the accuracy of our method to measure EPID transit and exit dose distributions for a range of dose rates, beam attenuation, and collimation. Our results indicate that the EPID can be used as a simple, convenient device for kV dose delivery verification in small animal radiotherapy.

Comparison of 2D and 3D modeled tumor motion estimation/prediction for dynamic tumor tracking during arc radiotherapy

Many real-time imaging techniques have been developed to localize a target in 3D space or in a 2D beam’s eye view (BEV) plane for intrafraction motion tracking in radiation therapy. With tracking system latency, the 3D-modeled method is expected to be more accurate even in terms of 2D BEV tracking error. No quantitative analysis, however, has been reported. In this study, we simulated co-planar arc deliveries using respiratory motion data acquired from 42 patients to quantitatively compare the accuracy between 2D BEV and 3D-modeled tracking in arc therapy and to determine whether 3D information is needed for motion tracking.We used our previously developed low kV dose adaptive MV–kV imaging and motion compensation framework as a representative of 3D-modeled methods. It optimizes the balance between additional kV imaging dose and 3D tracking accuracy and solves the MLC blockage issue.With simulated Gaussian marker detection errors (zero mean and 0.39 mm standard deviation) and ~155/310/460 ms tracking system latencies, the mean percentage of time that the target moved >2 mm from the predicted 2D BEV position are 1.1%/4.0%/7.8% and 1.3%/5.8%/11.6% for the 3D-modeled and 2D-only tracking, respectively. The corresponding average BEV RMS errors are 0.67/0.90/1.13 mm and 0.79/1.10/1.37 mm. Compared to the 2D method, the 3D method reduced the average RMS unresolved motion along the beam direction from ~3 mm to ~1 mm, resulting in on average only <1% dosimetric advantage in the depth direction. Only for a small fraction of the patients, when tracking latency is long, the 3D-modeled method showed significant improvement of BEV tracking accuracy, indicating potential dosimetric advantage. However, if the tracking latency is short (~150 ms or less), those improvements are limited. Therefore, 2D BEV tracking has sufficient targeting accuracy for most clinical cases. The 3D technique is, however, still important in solving the MLC blockage problem during 2D BEV tracking.

Experimental validation of a kV source model and dose computation method for CBCT imaging in an anthropomorphic phantom.

We present an experimental validation of a kilovoltage (kV) X‐ray source characterization model in an anthropomorphic phantom to estimate patient‐specific absorbed dose from kV cone‐beam computed tomography (CBCT) imaging procedures and compare these doses to nominal weighted CT‐dose index (CTDIw) dose estimates. We simulated the default Varian on‐board imager 1.4 (OBI) default CBCT imaging protocols (i.e., standard‐dose head, low‐dose thorax, pelvis, and pelvis spotlight) using our previously developed and easy to implement X‐ray point‐source model and source characterization approach. We used this characterized source model to compute absorbed dose in homogeneous and anthropomorphic phantoms using our previously validated in‐house kV dose computation software (kVDoseCalc). We compared these computed absorbed doses to doses derived from ionization chamber measurements acquired at several points in a homogeneous cylindrical phantom and from thermoluminescent detectors (TLDs) placed in the anthropomorphic phantom. In the homogeneous cylindrical phantom, computed values of absorbed dose relative to the center of the phantom agreed with measured values within ≤2% of local dose, except in regions of high‐dose gradient where the distance to agreement (DTA) was 2 mm. The computed absorbed dose in the anthropomorphic phantom generally agreed with TLD measurements, with an average percent dose difference ranging from 2.4%±6.0% to 5.7%±10.3%, depending on the characterized CBCT imaging protocol. The low‐dose thorax and the standard dose scans showed the best and worst agreement, respectively. Our results also broadly agree with published values, which are approximately twice as high as the nominal CTDIw would suggest. The results demonstrate that our previously developed method for modeling and characterizing a kV X‐ray source could be used to accurately assess patient‐specific absorbed dose from kV CBCT procedures within reasonable accuracy, and serve as further evidence that existing CTDIw assessments underestimate absorbed dose delivered to patients.PACS number(s): 87.57.Q‐, 87.57.uq, 87.10.Rt

TH-AB-202-09: Direct-Aperture Optimization for Combined MV+kV Dose Planning in Fluoroscopic Real-Time Tumor-Tracking Radiation Therapy

Purpose: Real-time kV fluoroscopic tumor tracking has the benefit of direct tumor position monitoring. However, there is clinical concern over the excess kV imaging dose cost to the patient when imaging in continuous fluoroscopic mode. This work addresses this specific issue by proposing a combined MV+kV direct-aperture optimization (DAO) approach to integrate the kV imaging beam into a treatment planning such that the kV radiation is considered as a contributor to the overall dose delivery. Methods: The combined MV+kV DAO approach includes three algorithms. First, a projected Quasi-Newton algorithm (L-BFGS) is used to find optimized fluence with MV+kV dose for the best possible dose distribution. Then, Engel's algorithm is applied to optimize the total number of monitor units and heuristically optimize the number of apertures. Finally, an aperture shape optimization (ASO) algorithm is applied to locally optimize the leaf positions of MLC. Results: Compared to conventional DAO MV plans with continuous kV fluoroscopic tracking, combined MV+kV DAO plan leads to a reduction in the total number of MV monitor units due to inclusion of kV dose as part of the PTV, and was also found to reduce the mean and maximum doses on the organs at risk (OAR). Compared to conventional DAO MV plan without kV tracking, the OAR dose in the combined MV+kV DAO plan was only slightly higher. DVH curves show that combined MV+kV DAO plan provided about the same PTV coverage as that in the conventional DAO plans without kV imaging. Conclusion: We report a combined MV+kV DAO approach that allows real time kV imager tumor tracking with only a trivial increasing on the OAR doses while providing the same coverage to PTV. The approach is suitable for clinic implementation.

SU‐C‐204‐06: Monte Carlo Dose Calculation for Kilovoltage X‐Ray‐Psoralen Activated Cancer Therapy (X‐PACT): Preliminary Results

Purpose:X‐PACT is an experimental cancer therapy where kV x‐rays are used to photo‐activate anti‐cancer therapeutics through phosphor intermediaries (phosphors that absorb x‐rays and re‐radiate as UV light). Clinical trials in pet dogs are currently underway (NC State College of Veterinary Medicine) and an essential component is the ability to model the kV dose in these dogs. Here we report the commissioning and characterization of a Monte Carlo (MC) treatment planning simulation tool to calculate X‐PACT radiation doses in canine trials.Methods:FLUKA multi‐particle MC simulation package was used to simulate a standard X‐PACT radiation treatment beam of 80kVp with the Varian OBI x‐ray source geometry. The beam quality was verified by comparing measured and simulated attenuation of the beam by various thicknesses of aluminum (2–4.6 mm) under narrow beam conditions (HVL). The beam parameters at commissioning were then corroborated using MC, characterized and verified with empirically collected commissioning data, including: percent depth dose curves (PDD), back‐scatter factors (BSF), collimator scatter factor(s), and heel effect, etc. All simulations were conducted for N=30M histories at M=100 iterations.Results:HVL and PDD simulation data agreed with an average percent error of 2.42%±0.33 and 6.03%±1.58, respectively. The mean square error (MSE) values for HVL and PDD (0.07% and 0.50%) were low, as expected; however, longer simulations are required to validate convergence to the expected values. Qualitatively, pre‐ and post‐filtration source spectra matched well with 80kVp references generated via SPEKTR software. Further validation of commissioning data simulation is underway in preparation for first‐time 3D dose calculations with canine CBCT data.Conclusion:We have prepared a Monte Carlo simulation capable of accurate dose calculation for use with ongoing X‐PACT canine clinical trials. Preliminary results show good agreement with measured data and hold promise for accurate quantification of dose for this novel psoralen X‐ray therapy.Funding Support, Disclosures, &amp; Conflict of Interest: The Monte Carlo simulation work was not funded; Drs. Adamson &amp; Oldham have received funding from Immunolight LLC for X‐PACT research.

SU‐E‐T‐93: Activation of Psoralen at Depth Using Kilovoltage X‐Rays: Physics Considerations in Implementing a New Teletherapy Paradigm

Purpose:Psoralen is a UV‐light activated anti‐cancer biotherapeutic used for treating skin lesions (PUVA) and advanced cutaneous T‐cell lymphoma (ECP). To date psoralen has not been used to treat deep seated tumors due to difficulty in generating UV‐light at depth. We recently demonstrated psoralen activation at depth by introducing energy converting particles that absorb kV x‐ray radiation and re‐emit UV‐light. Our in‐vitro work found that 0.2–1Gy using 40–100kVp x‐rays combined with psoralen and particles can induce a substantial apoptotic response beyond that expected from the sum of individual components. In preparation for a phase I clinical trial of canine companion animals, we address the physics and dosimetry considerations for applying this new teletherapy paradigm to an in‐vivo setting.Methods:The kV on‐board imaging (OBI) system mounted on a medical linear accelerator (Varian) was commissioned to deliver the prescribed dose (0.6Gy) using 80 and 100kVp. Dosimetric measurements included kVp, HVL, depth dose, backscatter factors, collimator and phantom scatter factors, field size factors, and blade leakage. Absolute dosimetry was performed following AAPM TG61 recommendations and verified with an independent kV dose meter. We also investigated collimated rotational delivery to minimize skin dose using simple dose calculations on homogeneous cylindrical phantoms.Results:Single beam delivery is feasible for shallow targets (&lt;5cm) without exceeding skin tolerance, while a rotational delivery may be utilized for deeper targets; skin dose is ∼75% of target dose for 80kVp collimated rotational delivery to a 3cm target within a 20cm phantom. Heat loading was tolerable; 0.6Gy to 5cm can be delivered before the anode reaches 75% capacity.Conclusion:KV teletherapy for Psoralen activation in deep seated tissue was successfully commissioned for a Varian OBI machine for use in a phase I clinical trial in canines. Future work will use Monte Carlo dosimetry to investigate dose in presence of bone.Research funded by Immunolight LLC. H. Walder, Z. Fathi, &amp; W. Beyer are employees of Immunolight LLC which holds a patent on the technology. Drs. Adamson and Oldham are consultants to Immunolight LLC.

Sci—Thur AM: YIS ‐ 09: Validation of a General Empirically‐Based Beam Model for kV X‐ray Sources

Purpose:To present an empirically‐based beam model for computing dose deposited by kilovoltage (kV) x‐rays and validate it for radiographic, CT, CBCT, superficial, and orthovoltage kV sources.Method and Materials:We modeled a wide variety of imaging (radiographic, CT, CBCT) and therapeutic (superficial, orthovoltage) kV x‐ray sources. The model characterizes spatial variations of the fluence and spectrum independently. The spectrum is derived by matching measured values of the half value layer (HVL) and nominal peak potential (kVp) to computationally‐derived spectra while the fluence is derived from in‐air relative dose measurements. This model relies only on empirical values and requires no knowledge of proprietary source specifications or other theoretical aspects of the kV x‐ray source.To validate the model, we compared measured doses to values computed using our previously validated in‐house kV dose computation software, kVDoseCalc. The dose was measured in homogeneous and anthropomorphic phantoms using ionization chambers and LiF thermoluminescent detectors (TLDs), respectively.Results:The maximum difference between measured and computed dose measurements was within 2.6%, 3.6%, 2.0%, 4.8%, and 4.0% for the modeled radiographic, CT, CBCT, superficial, and the orthovoltage sources, respectively. In the anthropomorphic phantom, the computed CBCT dose generally agreed with TLD measurements, with an average difference and standard deviation ranging from 2.4 ± 6.0% to 5.7 ± 10.3% depending on the imaging technique. Most (42/62) measured TLD doses were within 10% of computed values.Conclusions:The proposed model can be used to accurately characterize a wide variety of kV x‐ray sources using only empirical values.

Assessing the deviation from the inverse square law for orthovoltage beams with closed‐ended applicators

In this report, we quantify the divergence from the inverse square law (ISL) of the beam output as a function of distance (standoff) from closed‐ended applicators for a modern clinical orthovoltage unit. The divergence is clinically significant exceeding 3% at a 1.2 cm distance for 4 × 4 and 10×10cm2 closed‐ended applicators. For all investigated cases, the measured dose falloff is more rapid than that predicted by the ISL and, therefore, causes a systematic underdose when using the ISL for dose calculations at extended SSD. The observed divergence from the ISL in closed‐ended applicators can be explained by the end‐plate scattering contribution not accounted for in the ISL calculation. The standoff measurements were also compared to the predictions from a home‐built kV dose computation algorithm, kVDoseCalc. The kVDoseCalc computation predicted a more rapid falloff with distance than observed experimentally. The computation and measurements agree to within 1.1% for standoff distances of 3 cm or less for 4×4cm2 and 10×10cm2 field sizes. The overall agreement is within 2.3% for all field sizes and standoff distances measured. No significant deviation from the ISL was observed for open‐ended applicators for standoff distances up to 10 cm.PACS numbers: 87.55.‐x, 87.55.kh

Experimental validation of a kilovoltage x‐ray source model for computing imaging dose

To introduce and validate a kilovoltage (kV) x-ray source model and characterization method to compute absorbed dose accrued from kV x-rays. The authors propose a simplified virtual point source model and characterization method for a kV x-ray source. The source is modeled by: (1) characterizing the spatial spectral and fluence distributions of the photons at a plane at the isocenter, and (2) creating a virtual point source from which photons are generated to yield the derived spatial spectral and fluence distribution at isocenter of an imaging system. The spatial photon distribution is determined by in-air relative dose measurements along the transverse (x) and radial (y) directions. The spectrum is characterized using transverse axis half-value layer measurements and the nominal peak potential (kVp). This source modeling approach is used to characterize a Varian(®) on-board-imager (OBI(®)) for four default cone-beam CT beam qualities: beams using a half bowtie filter (HBT) with 110 and 125 kVp, and a full bowtie filter (FBT) with 100 and 125 kVp. The source model and characterization method was validated by comparing dose computed by the authors' inhouse software (kVDoseCalc) to relative dose measurements in a homogeneous and a heterogeneous block phantom comprised of tissue, bone, and lung-equivalent materials. The characterized beam qualities and spatial photon distributions are comparable to reported values in the literature. Agreement between computed and measured percent depth-dose curves is ⩽ 2% in the homogeneous block phantom and ⩽ 2.5% in the heterogeneous block phantom. Transverse axis profiles taken at depths of 2 and 6 cm in the homogeneous block phantom show an agreement within 4%. All transverse axis dose profiles in water, in bone, and lung-equivalent materials for beams using a HBT, have an agreement within 5%. Measured profiles of FBT beams in bone and lung-equivalent materials were higher than their computed counterparts resulting in an agreement within 2.5%, 5%, and 8% within solid water, bone, and lung, respectively. The proposed virtual point source model and characterization method can be used to compute absorbed dose in both the homogeneous and heterogeneous block phantoms within of 2%-8% of measured values, depending on the phantom and the beam quality. The authors' results also provide experimental validation for their kV dose computation software, kVDoseCalc.

Combined MV + kV inverse treatment planning for optimal kV dose incorporation in IGRT

Despite the existence of real-time kV intra-fractional tumor tracking strategies for many years, clinical adoption has been held back by concern over the excess kV imaging dose cost to the patient when imaging in continuous fluoroscopic mode. This work aims to solve this problem by investigating, for the first time, the use of convex optimization tools to optimally integrate this excess kV imaging dose into the MV therapeutic dose in order to make real-time kV tracking clinically feasible. Phase space files modeling both a 6 MV treatment beam and a kV on-board-imaging beam of a commercial LINAC were generated with BEAMnrc, and used to generate dose influence matrices in DOSXYZnrc for ten previously treated lung cancer patients. The dose optimization problem for IMRT, formulated as a quadratic problem, was modified to include additional constraints as required for real-time kV intra-fractional tracking. An interior point optimizer was used to solve the modified optimization problem. It was found that when using large kV imaging apertures during fluoroscopic tracking, combined MV + kV optimization lead to a 0.5%–5.17% reduction in the total number of monitor units assigned to the MV beam due to inclusion of the kV dose over the ten patients. This was accompanied by a reduction of up to 42% of the excess kV dose compared to standard MV IMRT with kV tracking. For all kV field sizes considered, combined MV + kV optimization provided prescription dose to the treatment volume coverage equal to the no-imaging case, yet superior to standard MV IMRT with non-optimized kV fluoroscopic tracking. With combined MV + kV optimization, it is possible to quantify in a patient specific way the dosimetric effect of real-time imaging on the patient. Such information is necessary when substantial kV imaging is performed.

WE‐A‐134‐02: Combined MV+kV Beam Optimization for Enabling Real‐Time KV Tumor Tracking

Purpose: Despite the existence of real‐time kV intrafractional tumor tracking strategies for many years, clinical adoption has been held back by concern over excess kV imaging dose cost to the patient when imaging in continuous fluoroscopic mode. This work aims to solve this specific problem by performing a first time investigation into the use of convex optimization tools to best integrate this excess kV imaging dose into the MV therapeutic dose as to make real‐time kV tracking clinically feasible. Methods: Phase space files for both a 125 kVp kV beam and a 6 MV treatment beam were generated with BEAMNRC, and used to make dose influence matrices in DOSXYZNRC for a lung cancer patient. The dose optimization problem for IMRT, formulated as a quadratic problem, was modified to include additional kV imaging constraints as required for real‐time kV fluorescent tracking. The MOSEK optimization toolkit was used to solve the modified optimization problem. Results: Compared to conventional IMRT optimization, combined MV+kV optimization leads to a 2.4–5.2% reduction in the total number of monitor units assigned to the MV beam due to inclusion of the kV dose. When using an open kV aperture, combined MV+kV optimization allows for a reduction of up to 50% of the excess kV dose compared to standard IMRT with kV fluoro tracking. For all kV field sizes considered, combined MV+kV optimization provided PTV coverage equal to standard IMRT without kV imaging and superior to standard IMRT plus kV fluoro tracking. Skin dose with combined MV+kV imaging was only slightly higher than the no‐imaging case. Conclusion: The use of MV+kV optimization allows for greatly reduced imaging dose to the skin, especially in cases of large kV aperture imaging. Combined MV+kV optimization demonstrates potential for real‐time tumor tracking without excessive imaging dose, paving the way for clinical implementation.

Evaluation of a dedicated MDCT protocol using iterative image reconstruction after cervical spine trauma

To evaluate radiation exposure for 64-row computed tomography (CT) of the cervical spine comparing two optimized protocols using filtered back projection (FBP) and adaptive statistical iterative reconstruction (ASIR), respectively. Sixty-seven studies using FBP (scanner 1) were retrospectively compared with 80 studies using ASIR (scanner 2). The key scanning parameters were identical (120 kV dose modulation, 64 × 0.625 mm collimation, pitch 0.531:1). In protocol 2, the noise index (NI) was increased from 5 to 25, and ASIR and the high-definition (HD) mode were used. The scan length, CT dose index (CTDI), and dose-length product (DLP) were recorded. The image quality was analysed subjectively by using a three-point scale (0; 1; 2), and objectively by using a region of interest (ROI) analysis. Mann-Whitney U and Wilcoxon's test were used. In the FBP group, the mean CTDI was 21.43 mGy, mean scan length 186.3 mm, and mean DLP 441.15 mGy cm. In the ASIR group, the mean CTDI was 9.57 mGy, mean scan length 195.21 mm, and mean DLP 204.23 mGy cm. The differences were significant for CTDI and DLP (p < 0.001) and scan length (p = 0.01). There was no significant difference in the subjective image quality (p > 0.05). The estimated mean effective dose decreased from 2.38 mSv (FBP) to 1.10 mSv (ASIR). The radiation dose of 64-row MDCT can be reduced to a level comparable to plain radiography without loss of subjective image quality by implementation of ASIR in a dedicated cervical spine trauma protocol. These results might contribute to an improved relative risk-to-benefit ratio and support the justification of CT as a first-line imaging tool to evaluate cervical spine trauma.

PO-0803: Validation of a kV dose computation method for CBCT imaging procedures

PO-0803: Validation of a kV dose computation method for CBCT imaging procedures

Sci-Fri PM: Delivery - 08: Characterizing the spatially varying fluence and spectra of a kV imaging source for dose calculations.

Kilovoltage (kV) daily image-guided radiotherapy (IGRT) procedures accumulate radiation dose within the patient that is currently not routinely incorporated in the treatment plan. As part of the process of developing a patient-specific kV dose computation tool, the kV x-ray source must be characterized. We propose a simple, clinically feasible experimental characterization method using in-air dose measurements along the transverse axis. We determine half-value layer (HVL) along the transverse axis, from which we derive the HVL-specific mass-absorption coefficient, which is used to determine beam fluence. These values are interpolated over the entire field. The spectrum at each interpolation point in the field is found from HVL and accelerating potential (kVp) using third-party software Spektr. We use this method to characterize the spatially varying fluence and spectra of a Varian® On-Board Imaging® source for energies 80, 100 and 125 kVp. This characterization is used to compute dose within a heterogeneous phantom, using our previously validated in-house dose computation software, which we compare with relative dose measurements. We show that for a 10×10 cm2 field size using no added filtration, the agreement for all three energies is within 2% for the central depth-dose profile and within 2.6% for the transverse profiles. This clinically feasible experimental characterization method for kV imaging sources represents a crucial step in the development of a patient-specific dose computation tool.

A simplified approach to characterizing a kilovoltage source spectrum for accurate dose computation

To investigate and validate the clinical feasibility of using half-value layer (HVL) and peak tube potential (kVp) for characterizing a kilovoltage (kV) source spectrum for the purpose of computing kV x-ray dose accrued from imaging procedures. To use this approach to characterize a Varian® On-Board Imager® (OBI) source and perform experimental validation of a novel in-house hybrid dose computation algorithm for kV x-rays. We characterized the spectrum of an imaging kV x-ray source using the HVL and the kVp as the sole beam quality identifiers using third-party freeware Spektr to generate the spectra. We studied the sensitivity of our dose computation algorithm to uncertainties in the beam's HVL and kVp by systematically varying these spectral parameters. To validate our approach experimentally, we characterized the spectrum of a Varian® OBI system by measuring the HVL using a Farmer-type Capintec ion chamber (0.06 cc) in air and compared dose calculations using our computationally validated in-house kV dose calculation code to measured percent depth-dose and transverse dose profiles for 80, 100, and 125 kVp open beams in a homogeneous phantom and a heterogeneous phantom comprising tissue, lung, and bone equivalent materials. The sensitivity analysis of the beam quality parameters (i.e., HVL, kVp, and field size) on dose computation accuracy shows that typical measurement uncertainties in the HVL and kVp (±0.2 mm Al and ±2 kVp, respectively) source characterization parameters lead to dose computation errors of less than 2%. Furthermore, for an open beam with no added filtration, HVL variations affect dose computation accuracy by less than 1% for a 125 kVp beam when field size is varied from 5 × 5 cm(2) to 40 × 40 cm(2). The central axis depth dose calculations and experimental measurements for the 80, 100, and 125 kVp energies agreed within 2% for the homogeneous and heterogeneous block phantoms, and agreement for the transverse dose profiles was within 6%. The HVL and kVp are sufficient for characterizing a kV x-ray source spectrum for accurate dose computation. As these parameters can be easily and accurately measured, they provide for a clinically feasible approach to characterizing a kV energy spectrum to be used for patient specific x-ray dose computations. Furthermore, these results provide experimental validation of our novel hybrid dose computation algorithm.