Linac Beam Research Articles

In vivo dosimetry of total body irradiation patients: A 10 year retrospective analysis

Myeloablative Total Body Irradiation (TBI) used in our Institution, as part of the conditioning scheme for haematopoietic stem cell transplantation, is an extended-distance supine technique that has been implemented using a 15 MV LINAC beam, lead lung compensators, PMMA, and water bolus to improve homogeneity. This study reviews in-vivo dosimetry (IVD) over 10 years of treatments, assessing the technique’s robustness, accuracy, and efficiency.A 2-lateral opposite fields plan was calculated from planning CT with validated Oncentra TPS (Elekta AB, Sweden). Monitor units (MUs), lung compensators shape and thickness were calculated to deliver the prescription dose (12 Gy in 6 bi-daily fractions or 9.9 Gy in 3 daily fractions) to the patient’s abdomen midline at the umbilical level, maintaining lung dose within ±5 % range of prescription. Data from 103 patients, of which more than 87 % were pediatric, were retrieved and analyzed for a total of 537 treatment fractions. The impact of IVD omission was evaluated, supposing doing it only once or in the first two fractions, if necessary.Median ΔMU from planned was −1.2 %. Median percentage dose deviation from prescription in 6 anatomical regions was below 2 %. IVD omission could have resulted in an increase of 7 patients registering at least one anatomical region outside the ±5 % dose range at the end of treatment.It is possible to confirm the implemented technique’s robustness and accuracy in delivering the prescribed dose under IVD monitoring. Nevertheless, this technique and associated IVD are time-consuming and IVD omission could be assessed with limited drawbacks.

Dosimetric impact of calibration coefficients determined using linear accelerator photon and electron beams for ionization chamber in an on-site dosimetry audit.

This study aimed to clarify the dosimetric impact of calibration beam quality for calibration coefficients of the absorbed dose to water for an ionization chamber in an on-site dosimetry audit. Institution-measured doses of 200 photon and 184 electron beams were compared with the measured dose using one year data before and after the calibration of the ionization chamber used. For photon and electron reference dosimetry, the agreements of the institution-measured dose against two measured doses in this audit were evaluated using the calibration coefficients determined using 60Co (${N}_{D,\mathrm{w},{}^{60}\mathrm{Co}}$) and linear accelerator (linac) (${N}_{D,\mathrm{w},Q}$) beams. For electron reference dosimetry, the agreement of two institution-measured doses against the measured dose was evaluated using${N}_{D,\mathrm{w},Q}$. Institution-measured doses were evaluated using direct- and cross-calibration coefficients. For photon reference dosimetry, the mean differences and standard deviation (SD) of institution-measured dose against the measured dose using ${N}_{D,\mathrm{w},{}^{60}\mathrm{Co}}$ and ${N}_{D,\mathrm{w},Q}$ were -0.1% ± 0.4% and -0.3% ± 0.4%, respectively. For electron reference dosimetry, the mean differences and SD of institution-measured dose using the direct-calibration coefficient against the measured dose using ${N}_{D,\mathrm{w},{}^{60}\mathrm{Co}}$ and ${N}_{D,\mathrm{w},Q}$ were 1.3% ± 0.8% and 0.8% ± 0.8%, respectively. Further, the mean differences and SD of institution-measured dose using the cross-calibration coefficient against the measured dose using ${N}_{D,\mathrm{w},Q}$ were -0.1% ± 0.6%. For photon beams, the dosimetric impact of introducing calibration coefficients determined using linac beams was small. For electron beams, it was larger, and the measured dose using ${N}_{D,\mathrm{w},Q}$ was most consistent with the institution-measured dose, which was evaluated using a cross-calibration coefficient.

Cerenkov free micro-dosimetry in small-field radiation therapy technique

Objective. Optical fiber-based scintillating dosimetry is a recent promising technique owing to the miniature size dosimeter and quality measurement in modern radiation therapy treatment. Despite several advantages, the major issue of using scintillating dosimeters is the Cerenkov effect and predominantly requires extra measurement corrections. Therefore, this work highlighted a novel micro-dosimetry technique to ensure Cerenkov-free measurement in radiation therapy treatment protocol by investigating several dosimetric characteristics. Approach. A micro-dosimetry technique was proposed with the performance evaluation of a novel infrared inorganic scintillator detector (IR-ISD). The detector essentially consists of a micro-scintillating head based on IR-emitting micro-clusters with a sensitive volume of 1.5 × 10−6 mm3. The proposed system was evaluated under the 6 MV LINAC beam used in patient treatment. Overall measurements were performed using IBATM water tank phantoms by following TRS-398 protocol for radiotherapy. Cerenkov measurements were performed for different small fields from 0.5 × 0.5 cm2 to 10 × 10 cm2 under LINAC. In addition, several dosimetric parameters such as percentage depth dose (PDD), high lateral resolution beam profiling, dose linearity, dose rate linearity, repeatability, reproducibility, and field output factor were investigated to realize the performance of the novel detector. Main results. This study highlighted a complete removal of the Cerenkov effect using a point-like miniature detector, especially for small field radiation therapy treatment. Measurements demonstrated that IR-ISD has acceptable behavior with dose rate variability (maximum standard deviation ∼0.18%) for the dose rate of 20–1000 cGy s−1. An entire linear response (R 2 = 1) was obtained for the dose delivered within the range of 4–1000 cGy, using a selected field size of 1 × 1 cm2. Perfect repeatability (max 0.06% variation from average) with day-to-day reproducibility (0.10% average variation) was observed. PDD profiles obtained in the water tank present almost identical behavior to the reference dosimeter with a build-up maximum depth dose at 1.5 cm. The small field of 0.5 × 0.5 cm2 profiles have been characterized with a high lateral resolution of 100 µm. Significance. Unlike recent plastic scintillation detector systems, the proposed micro-dosimetry system in this study requires no Cerenkov corrections and showed efficient performance for several dosimetric parameters. Therefore, it is expected that considering the detector correction factors, the IR-ISD system can be a suitable dose measurement tool, such as in small-field dose measurements, high and low gradient dose verification, and, by extension, in microbeam radiation and FLASH radiation therapy.

Operational Status and Future Plan of Proton Linear Accelerator at KOMAC

Since the second half of 2013, Korea Multi-purpose Accelerator Complex (KOMAC) has been supporting user beam service by using a 100-MeV proton linac and several beam line facilities. Proton beam service fields include various applications and research programs, such as material science, bio-medical science, semiconductor applications as well as nuclear physics and basic science. The 100-MeV linac is composed of an injector based on a 50-keV microwave ion source and two-solenoid LEBT (low energy beam transport), a 3-MeV RFQ with four-vane structure and conventional drift tube linac (DTL), where proton beam is accelerated from 3 MeV to 100 MeV. As the operation period of the proton accelerator exceeds 10 years and the cumulative operating time surpasses 30,000 hours, we judge that it is an opportune time to establish a long-term plan to prepare for the aging of the accelerator. To replace the currently operating RFQ, which shows degradation in performance (especially the beam transmission), we design a new RFQ with some modifications. For DTL, we are supposed to change the quadrupole magnet inside each drift tube from electromagnet type to permanent magnet type because the electromagnet has shown some trouble in view of long term stability. To leap forward in device and utilization technologies, we complete the construction of new facility of a Beam Test Stand (BTS) with a structure similar to the beam injection system (ion source, LEBT, RFQ) of the 100 MeV linear accelerator. We plan to actively conduct beam physics and accelerator research using this facility. Moreover, we are supposed to upgrade the proton linac to 1 GeV for spallation neutron source applications, which will be a long-term plan. In short term, we take phased approach with focusing the first phase at 200 MeV energy upgrade.

Three-row MRI receive array with remote circuitry to preserve radiation transparency

Objective. Up to this point, 1.5 T linac-compatible coil array layouts have been restricted to one or two rows of coils because of the desire to place radiation-opaque circuitry adjacent to the coils and outside the window through which the linac beam travels. Such layouts can limit parallel imaging performance. The purpose of this work was to design and build a three-row array in which remotely located circuits permitted a central row of coils while preserving the radiolucent window. Approach. The remote circuits consisted of a phase shifter to cancel the phase introduced by the coaxial link between the circuit and coil, followed by standard components for tuning, matching, detuning, and preamplifier decoupling. Tests were performed to compare prototype single-channel coils with remote or local circuits, which were followed by tests comparing two and three-row arrays . Main results. The single-channel coil with the remote circuit maintained 85% SNR at depths of 30 mm or more as compared to a coil with local circuit. The three-row array provided similar SNR as the two-row array, along with geometry factor advantages for parallel imaging acceleration in the head–foot direction. Significance. The remote circuit strategy could potentially support future MR-linac arrays by allowing greater flexibility in array layout compared to those confined by local circuits, which can be leveraged for parallel imaging acceleration.

Improving Cathode Testing with a High-Gradient Cryogenic Normal Conducting RF Photogun

Future electron accelerator applications such as X-ray free electron lasers and colliders are dependent on significantly increasing beam brightness. With the observation that linac beam manipulation’s best preservation of max brightness is at the cathode, we are incentivized to create an environment where we can study how to achieve the highest possible photogun brightness. In order to do so, we intend to extract beams from high-brightness photocathodes with the highest achievable accelerating gradients we can manage in a klystron-powered radiofrequency (RF) photogun. We utilize here cryogenic normal conducting cavities to achieve ultra-high gradients via limitation of breakdown rates (BDR). The low temperatures should also reduce cathode emittance by reducing the mean transverse energy (MTE) of electrons near the photoemission threshold. To this end, we have designed and produced a new CrYogenic Brightness-Optimized Radiofrequency Gun (CYBORG) for use in a new beamline at UCLA. We will introduce the enabling RF and photoemission physics as a primer for the new regime of high field low temperature cathodes we intend to enter. We further report the current status of the beamline commissioning, including the cooling of the photogun to 100 K, and producing 0.5 MW of RF feed power, which corresponds to cathode accelerating fields in the range of 80–90 MV/m. We further plan iterative improvements to both to 77 K and 1 MW corresponding to our ultimate goal >120 MV/m. Our discussion will include future beamline tests and the consideration of the initial realization of an ultra-high-gradient photoinjector concept.

Using KMeans Clustering to Evaluate and Alert for Deviations of Linac Photon Beam Parameters.

To analyse the daily measured Dosimetric Quality Assurance (QA) parameters of linear accelerator (linac) using Unsupervised Machine Learning (ML) Algorithm thereby evaluating the current machine status and to highlight the probable cause of the 'out-of-range' measured parameter. Five Parameters measured using PTW QuickCheckwebline device in a linac is subjected to KMeans clustering technique. The measured parameters comprise of Central Axis Dose (CAX), Beam Flatness, SymmetryLR, SymmetryGT and Beam Quality (BQF). Data from Varian with 55- and 107-day's measurements and from Elekta with 75 days measurements from 2 beam matched linacs were used in this clustering technique. This evaluation is used to review the current linac status and obtain 1) Upper and lower limits of each parameter (CAX, Flatness, Symmetry, Beam Quality), 2) Frequency of the days when the linac parameters are closer to the target value and when they deviate from the target value. 3) The date when these parameters deviate from the estimated limits. 4) The probable reason for the deviation and 5) Finally if the machine requires maintenance. This methodology ensures that the machine is always closest to the target value, thus providing quality radiation treatment for the cancer patients. Moreover, the performance of the linac is studied meticulously and the need for maintenance is alerted before the linac beam shows marked deviation from the base value. KMeans clustering is a very simple and easy to use ML tool. With quick computation time and with lesser data it can arrive at the actual limits of the linac parameters and help to determine if the linac needs maintenance well in advance.

Dose-rate dependence and IMRT QA suitability of EBT3 radiochromic films for pulse reduced dose-rate radiotherapy (PRDR) dosimetry.

Pulsed reduced dose rate (PRDR) is an emerging radiotherapy technique for recurrent diseases. It is pertinent that the linac beam characteristics are evaluated for PRDR dose rates and a suitable dosimeter is employed for IMRT QA. This study sought to investigate the pulse characteristics of a 6 MV photon beam during PRDR irradiations on a commercial linac. The feasibility of using EBT3 radiochromic film for use in IMRT QA was also investigated by comparing its response to a commercial diode array phantom. A plastic scintillator detector was employed to measure the photon pulse characteristics across nominal repetition rates (NRRs) in the 5-600 MU/min range. Film was irradiated with dose rates in the 0.033-4Gy/min range to study the dose rate dependence. Five clinical PRDR treatment plans were selected for IMRT QA with the Delta4 phantom and EBT3 film sheets. The planned and measured dose were compared using gamma analysis with a criterion of 3%/3mm. EBT3 film QA was performed using a cumulative technique and a weighting factor technique. Negligible differences were observed in the pulse width and height data between the investigated NRRs. The pulse width was measured to be 3.15±0.01 and the PRF was calculated to be 3-357Hz for the 5-600 MU/min NRRs. The EBT3 film was found to be dose rate independent within 3%. The gamma pass rates (GPRs) were above 99% and 90% for the Delta4 phantom and the EBT3 film using the cumulative QA method, respectively. GPRs as low as 80% were noted for the weighting factor EBT3 QA method. Altering the NRRs changes the mean dose rate while the instantaneous dose rate remains constant. The EBT3 film was found to be suitable for PRDR dosimetry and IMRT QA with minimal dose rate dependence.

Regression fitting megavoltage depth dose curves to determine material relative electron density in radiotherapy.

The relative electron density (RED) parameter is ubiquitous throughout radiotherapy for clinical dosimetry and treatment planning purposes as it provides a more accurate description of the relevant radiological properties over mass density alone. RED is in practice determined indirectly from calibrated CT Hounsfield Units (HU). While CT images provide useful 3D information, the spectral differences between CT and clinical LINAC beams may impact the validity of the CT-ED calibration, especially in the context of novel tissue-mimicking materials where deviations from biologically typical atomic number to atomic weight ratios 〈Z/A〉 occur and/or high-Z materials are present. A theoretical basis for determining material properties directly in a clinical beam spectrum via an electron-density equivalent pathlength (eEPL) method has been previously established. An experimental implementation of this approach is introduced whereby material-specific measured percentage depth dose curves (PDDs) are regressed to a PDD measured in a reference material (water), providing an inference of 〈Z/A〉, which when combined with the physical density provides a determination of RED. This method is validated over a range of tissue-mimicking materials and compared against the standard CT output, as well as compositional information obtained from the manufacturer's specifications. The measured PDD regression method shows consistent results against both manufacturer-provided and CT-derived values between 0.9 and 1.15 RED. Outside of this soft-tissue range a trend was observed whereby the 〈Z/A〉 determined becomes unrealistic indicating the method is no longer reporting RED alone and the assumptions around the eEPL model are constrained. Within the soft-tissue RED range of validity, the regression method provides a practical and robust characterisation for unknown materials in the clinical setting and may be used to improve on the CT derived RED where high Z material components are suspected.

Investigation of cyanine-based infrared dyes as calibrants in radiochromic films.

Radiochromic material such as lithium pentacosa-10,12-diynoate (LiPCDA) has been suggested as the radiation-sensitive material for real-time in vivo fiber-optic dosimetry. In this configuration, micron-thick radiochromic coating would measure the absorbed dose, where a major challenge is the uncertainty in the active material thickness, necessitating calibration. A homogeneously incorporated inert infrared (IR) dye, which must also be stable in ambient conditions and against radiolysis, can be added to the radiochromic film to enable optical calibration. This study investigates four commercial cyanine-based dyes (IR-783, IR-806, IR-868, and IR-880) for use as an optical calibrant in fiber-optic radiochromic dosimeters. All dyes were dissolved in water to confirm solubility. IR-783 and IR-806 were dissolved in 10% w/w gelatin solution and coated onto a polyester substrate, which were then sandwiched between two layers of adhesives forming IR-783 and IR-806 films. A second batch of IR dyes in gelatin incorporated the LiPCDA, and was coated onto substrate and sandwiched between adhesive to form IR dye+LiPCDA films. The absorbance spectra of the films were measured periodically (176 and 102 days for IR-dye films, and IR dye+LiPCDA, respectively). The average percentage absorbance, normalized to day 1, was fit to either a single or a double exponential decay model to calculate the spectral stability lifetime (τ1 , τ2 ). Films were irradiated using a 6 MV LINAC beam with a standard setup of 100 source to axis distance (SAD), 10cm×10cm field size and 1.5cm depth. The change in absorbance of the IR-dye+LiPCDA films were measured after they were irradiated to 1, 2, 5, 10, and 20Gy at 3Gy/min. Only IR-783 and IR-806 were sufficiently water soluble. In gelatin matrix, these dyes demonstrated a decrease in absorbance with time for IR-783 and IR-806 dyes, with IR-783 films having an average τ1 =73±7 days and IR-806 films τ1 =7±3 days. When combined with LiPCDA, IR-806 degraded, losing its original peak at ∼820nm. Similarly, IR-783, combined with LiPCDA, showed signs of degradation; however, its original absorbance peak was still observed at ∼800nm. In the IR-783+LiPCDA films, the IR-783 dye had a τ=4±1 days, an order of magnitude faster than the IR-783 with no LiPCDA films. When exposed to x-ray irradiation, the IR-783 dye in the IR-783+LiPCDA films showed no change in absorbance with increasing absorbed dose. In contrast, the LiPCDA in the films responded as expected, increasing in optical density with increased absorbed dose. IR-783 and IR-806 dyes were observed to degrade over time following exponential decay curves. IR-806 could not be combined with the LiPCDA without degrading. The combination of IR-783 with LiPCDA demonstrated single exponential decay behavior at a comparatively faster rate than films that did not have LiPCDA. IR-783 was insensitive to ionizing radiation and thus may be suitable for thickness correction, but an alternative manufacturing procedure may need to be developed.

An 8 GeV linac as the Booster replacement in the Fermilab Power Upgrade

Increasing the Main Injector beam power above ∼ 1.2 MW requires replacement of the 8 GeV Booster by a higher intensity alternative. In this paper, we consider an 8 GeV linac Booster replacement that produces 8 GeV H- beam for injection into the Recycler Ring or Main Injector. This upgrade will maximize the beam available for neutrino production for the long baseline DUNE experiment to greater than 2.5 MW and enable a next generation of intensity frontier experiments. The 8 GeV linac takes ∼ 1 GeV beam from the PIP-II Linac and accelerates it to ∼ 2 GeV in a 650 MHz superconducting RF linac, followed by a ∼ 2 to 8 GeV pulsed linac using 1300 MHz cryomodules. The linac components incorporate recent improvements in superconducting RF technology. The linac configuration and beam dynamics requirements are presented. Injection options are discussed, including use of an 8 GeV Accumulator Ring. Foil-based injection is the present standard but R&D toward implementing laser-assisted injection could enable a significant improvement. Research needed to implement the Booster replacement is described.

A method for selecting reference beam model of VMAT plans with three 6MV beam-matched linear accelerators during radiation oncology

Our objective was to provide a method for selecting reference beam model and evaluating the dosimetric accuracy of volumetric modulated arc therapy (VMAT) plans delivered on three Elekta beam-matched linacs during radiation oncology. Beam data was measured on three beam-matched linacs including Synergy1, Synergy2 and VersaHD. For eighteen lung and esophagus cases, fifty-four plans were generated using VMAT technique with three linac beam models respectively for point dose measurement and three-dimensional dose measurement. Each VMAT plan was executed sequentially on three linacs respectively. Measurement results were compared with treatment planning system (TPS) calculation results for all VMAT plans. Among three beam-matched linacs, discrepancy in beam output factor, percentage depth dose at 5 cm, 10 cm, 20 cm depth and MLC leaf offset are all within 1% except 20 × 20 cm2 and 30 × 30 cm2 field sizes, and discrepancy in beam profile is all within 2%. With comparison between measurement result and TPS calculation result, the absolute dose deviations are within the range of ± 3%, and the gamma passing rates are all over 95% for all VMAT plans, which are within the tolerance of clinical acceptability. Compared with all plans delivered on Synegy1 and VersaHD, the point dose discrepancy between measured results and TPS calculated results for plans delivered on Synergy2 is smallest, and the gamma passing rate between measured results and TPS calculated results for plans delivered on Synergy2 is highest. The beam-matched linacs demonstrate good agreement between measurement result and TPS calculation result for VMAT plans. The method can be used for selecting reference beam model for VMAT plans.

Shielding design aspects of SR in 3 GeV ILSF

Iranian Light Source Facility (ILSF) is an under-construction synchrotron radiation accelerator consisting of a 150 MeV linac, a booster synchrotron operating from 150 MeV to 3 GeV, and a 3 GeV storage ring that stores a maximum of 400 mA current of electrons. As the stored beam circulates, a fraction of the beam is lost due to interactions with gas molecules, interactions among beam particles, and orbital bending, which produce radiation. The bulk shielding calculation for the ILSF and the input parameters used for this analysis are discussed in this paper. The potential of skyshine neutrons to cause radiation hazards is investigated as well. Moreover, the design and shielding simulation using the FLUKA Monte Carlo code is presented for the linac beam stop and primary and scattered gas bremsstrahlung for the first optics enclosure of the ILSF spectro microscopy beamline. Our designed radiation shielding system guarantees that the annual dose in all areas around the ILSF machine does not exceed the dose limit of 1 mSv.

Implementation and validation of a beam-current transformer on a medical pulsed electron beam LINAC for FLASH-RT beam monitoring

Implementation and validation of a beam-current transformer on a medical pulsed electron beam LINAC for FLASH-RT beam monitoring

Beam dynamics for beam commissioning of RAON linac and KoBRA beam line

Beam dynamics for beam commissioning of RAON linac and KoBRA beam line

Assessment of feasibility of cochlear sparing optimized radiotherapy in nasopharyngeal squamous cell carcinoma using high conformal radiation technique

Background: One of the most prevalent head-and-neck tumors in Southeast Asia is nasopharyngeal carcinoma (NPC). Each year, NPC causes 84,400 new cases and 51,600 fatalities worldwide. Intensity-modulated radiation therapy (IMRT), which has good local control and few side effects on healthy tissue, is being used to treat NPC. Aims and Objectives: Our study aims to assess the feasibility of cochlear sparing using volumetric-modulated arc therapy/IMRT technique. Materials and Methods: Radiotherapy plans of 20 patients diagnosed with NPC who received curative concurrent chemoradiation (Weekly Cisplatin dose of 40 mg/m2) with RT dose of 66 −70 Gy at 1.8–2 Gy/# to a total of 33–35# delivered using True beam LINAC between the year 2020 and 2022 were analyzed retrospectively. Results: Cochlea sparing reoptimization led to a considerable reduction in radiation dose for both cochleae as compared to the original treatment plans. The median D mean and D max for the left and right cochlea was found to be decreased. The difference in planning target volume (PTV)-D mean between the original and reoptimized plans was negligible. After reoptimization, the median PTV CI remained unchanged. The sparing of the left and right parotids and brain stem was not improved by reoptimization. A similar event was noted for the spinal cord, where the change from the median D max was not statistically significant. Conclusion: Our investigation showed that a much-increased cochlea sparing is possible in the majority of patients while maintaining PTV dosage coverage and the other organs at risk. Clinical trials in the future, both retrospective and prospective, should examine the effects of this optimization.

Modeling linear accelerator (Linac) beam data by implicit neural representation learning for commissioning and quality assurance applications.

Linear accelerator (Linac) beam data commissioning and quality assurance (QA) play a vital role in accurate radiation treatment delivery and entail a large number of measurements using a variety of field sizes. How to optimize the effort in data acquisition while maintaining high quality of medical physics practice has been sought after. We propose to model Linac beam data through implicit neural representation (NeRP) learning. The potential of the beam model in predicting beam data from sparse measurements and detecting data collection errors was evaluated, with the goal of using the beam model to verify beam data collection accuracy and simplify the commissioning and QA process. NeRP models with continuous and differentiable functions parameterized by multilayer perceptrons (MLPs) were used to represent various beam data including percentage depth dose (PDD) and profiles of 6 MV beams with and without flattening filter. Prior knowledge of the beam data was embedded into the MLP network by learning the NeRP of a vendor-provided "golden" beam dataset. The prior-embedded network was then trained to fit clinical beam data collected at one field size and used to predict beam data at other field sizes. We evaluated the prediction accuracy by comparing network-predicted beam data to water tank measurements collected from 14 clinical Linacs. Beam datasets with intentionally introduced errors were used to investigate the potential use of the NeRP model for beam data verification, by evaluating the model performance when trained with erroneous beam data samples. Linac beam data predicted by the model agreed well with water tank measurements, with averaged Gamma passing rates (1%/1mm passing criteria) higher than 95% and averaged mean absolute errors less than 0.6%. Beam data samples with measurement errors were revealed by inconsistent beam predictions between networks trained with correct versus erroneous data samples, characterized by a Gamma passing rate lower than 90%. A NeRP beam data modeling technique has been established for predicting beam characteristics from sparse measurements. The model provides a valuable tool to verify beam data collection accuracy and promises to simplify commissioning/QA processes by reducing the number of measurements without compromising the quality of medical physics service.

A carbon minibeam irradiation facility concept

In minibeam therapy, the sparing of deep-seated normal tissue is limited by transverse beam spread caused by small-angle scattering. Contrary to proton minibeams, helium or carbon minibeams experience less deflection, which potentially reduces side effects. To verify this potential, an irradiation facility for preclinical and clinical studies is needed. This manuscript presents a concept for a carbon minibeam irradiation facility based on a LINAC design for conventional carbon therapy. A quadrupole triplet focuses the LINAC beam to submillimeter minibeams. A scanning and a dosimetry unit are provided to move the minibeam over the target and monitor the applied dose. The beamline was optimized by TRAVEL simulations. The interaction between beam and these components and the resulting beam parameters at the focal plane is evaluated by TOPAS simulations. A transverse beamwidth of < 100 μm (sigma) and a peak-to-valley (energy) dose ratio of > 1000 results for carbon energies of 100 MeV/u and 430 MeV/u (∼ 3 cm and 30 cm range in water) whereby the average beam current is ∼ 30 nA. Therefore, the presented irradiation facility exceeds the requirements for hadron minibeam therapy.

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.

Predicted Inferior Outcomes for Lung SBRT With Treatment Planning Systems That Fail Independent Phantom-Based Audits

More than 15% of radiotherapy clinics fail external audits with anthropomorphic phantoms conducted by Imaging and Radiation Oncology Core-Houston (IROC-H) while passing other industry-standard quality assurance (QA) tests. We seek to evaluate the predicted impact of such failed plans on outcomes for patients treated with stereotactic body radiation therapy (SBRT) for lung tumors. We conducted a retrospective study of 55 patients treated with SBRT for lung tumors with prescription BED10 ≥100Gy using a treatment planning system (TPS) that passed IROC-H phantom audits. Sample linac beam models with introduced errors were commissioned by varying the multi-leaf collimator leaf tip offset parameter (i.e., 'dosimetric leaf gap') over the range +/-1.0 mm relative to the validated model. These models mimic TPS that pass internal QA measures but fail IROC-H tests. Patient plans were recalculated on sample beam models. Predicted tumor control probability (TCP) and normal tissue complication probability (NTCP) were calculated based on published dose-response models. A leaf tip offset value of -1.0 mm decreased the fraction of plans receiving a PTV BED10 ≥100 Gy from 95% to 27%. This translated to a significant decrease in 2-yr TCP of 4.8% (95% CI: 2.0-5.5%) with a decrease in TCP up to 21%. Conversely, leaf tip offset of +1.0 mm resulted in 36% of patients exceeding previously met OAR constraints, including two instances of spinal cord and brachial plexus overdoses and a small increase in chest wall NTCP by 0.7%, (95% CI 0.5%-0.8%). Simulated treatment plans with modest MLC leaf offsets result in lung SBRT plans that significantly under-dose tumor or exceed OAR constraints. These dosimetric endpoints translate to significant detriments in TCP. These simulated plans mimic planning systems that pass internal QA measures but fail independent phantom-based tests, underscoring the need for enhanced quality assurance including external audits of TPS.