Off-axis Dose Research Articles

An Integrated 2-dimensional Dosimeter and Electronic Portal Imaging Device for In Vivo Dosimetry: A Feasibility Study

Purpose/Objective(s): As radiation therapy becomes more conformal and the delivery technology becomes more complex, in-vivo dosimetry is becoming more necessary but at the same time more technically challenging. This work investigates the feasibility of a novel integrated in-vivo imaging and dosimetry device to meet the current and future requirements of radiation therapy treatment verification whereby imaging and dosimetry could be achieved concurrently. Materials/Methods: The dose response of a commercial 2-D ion-chamber array, in two configurations was investigated; (1) the experimental configuration with the ion-chamber array positioned directly under an electronic portal imaging device (EPID), (2) the standard dosimetry configuration with the ion-chamber array and 5cm solid water build-up. All measurements were conducted with the ion chamber array at isocentric distance and no additional objects in the beam. The measured dose was compared with the calculated dose from a treatment planning system (TPS). For the experimental configuration (1) the ion chamber array was positioned on the treatment couch with the EPID sitting directly on top of it. An additional 3.2 cm solid water was added to fill the air gap between the array and EPID. All the experiments were conducted at zero gantry angle. The central axis dose per Monitor unit and dose profiles for a 10x10 cm open field was measured in both configurations. The water equivalent depth of the experimental configuration (1) was determined by comparison with the TPS calculated dose. This depth was subsequently used for TPS dose calculations for further open beams, IMRT test patterns, and clinical IMRT beams. The field size factor and off-axis dose response measured with configuration (1) for open fields was compared with TPS data. The gamma analysis was performed with 2% and 3 mm criteria. Agreement between ion-chamber array and TPS was compared for both configurations. Results: The water equivalent depth of the ion chamber array in configuration (1) was 8.2 cm. The maximum dose difference between measured dose profiles with configuration (1) and TPS was 3.5% for 20x20 cm field size. The field size output factor with configuration (1) agreed within 2% with TPS. For a given set of gamma criteria the percentage of gamma pass agreed to with 0.5% for all the measurements. Conclusion: An ion chamber array integrated with an EPID maintains accurate water equivalent dose response. This configuration has the potential to provide a new technique of accurate 2D in vivo dosimetry. Further work is underway to assess the impact of the ion chamber array on imaging, and the performance of the device with an object in the beam to more closely simulate the clinical setting. Author Disclosure: S. Deshpande: None. L. Holloway: None. P. Metcalfe: None. P. Vial: None.

Poster - Thur Eve - 74: A set of tests designed for electron dose calculation algorithm verification during a treatment planning system upgrade.

A set of tests were designed to verify an electron algorithm effectively and quickly during a treatment planning system upgrade. Based on TG-53 report's suggestion and the assumption that the algorithm is well commissioned before the upgrade, the tests spot-check the output factors, depth doses, off-axis doses and treatment field sizes. The field sizes of 4×4, 6×6, 10×10, 15×15, 20×20 and 25×25 are to be tested. Four test plans are created for each field size, i.e., for open field, for extended SSD, for shaped field, and for bolus field. Fixed MU setting is recommended to avoid a possible plan normalization issue. The parameters to be recorded and compared include doses at dmax , R50 and Rp along central axis, which contain output and depth dose information, doses at four off-axis points in dmax plane, which contain off-axis dose and beam symmetry information, and FWHMs at dmax . For the plans other than open field only doses at dmax are checked. The tests were performed successfully during a planning system upgrade. The whole test can be completed in approximately 12 hours if the workload is distributed into multiple task carriers. It was found that most of the data agree very well between the old and the new version of the algorithm while some of the Rp or R50 doses deviated more than other data, which prompted a depth dose check. PDD comparisons were performed for the involved fields and it was found there were less than 0.5 mm PDD shifts occurred.

SU-E-T-73: Off-Axis Dose and Dose Equivalent Due to Secondary Neutrons from Uniform Scanning Proton Beams

Purpose: The production of secondary neutrons is an undesirable byproduct of proton therapy and it is important to quantify the contribution from secondary neutrons to patient dose received outside the treatment volume. The purpose of the study is to investigate the off‐axis dose and dose equivalent from secondary neutrons experimentally using CR‐39 Plastic Nuclear Track Detectors (PNTD) at Procure Proton Therapy Center,Oklahoma City. Methods: CR‐39 PNTD is generally insensitive to therapeuticprotons, but has a sensitivity to the secondary neutrons similar to that of tissue. In this experiment, we placed several CR‐39 PNTDs laterallyinside a 60×20×35 cm3 phantom and in free air respectively at various depths and angles with respect to the primary beam axis. Three differentproton energies (78 MeV, 162 MeV and 226 MeV), 4 cm modulation width, 5cm diameter brass aperture, 38 cm snout to isocenter distance and 10 cm isocenter point in the phantom were used for the entire experiment andsimulation. Monte Carlo simulations were also performed based on the experimental setup using a simplified snout configuration and FLUKA. Results: The dose and dose equivalent is observed to be higher in air than in the phantom. Preliminary results show that the measured ratio of secondary neutron dose equivalent to primary proton dose (H/D) in CR‐39 PNTDranges from 1.04 ±0.13 mSv/Gy inside the phantom to 43.5 ± 3 mSv/Gy in free air for 78 MeV proton. The experiment and simulation results follow a similar decreasing trend with distance but the magnitude varies with a factor of about 2 to 10 depending on measurement location. Conclusions: We are currently investigating the contribution from external neutrons produced in the nozzle and from the internal neutrons produced inside the phantom to total patient dose outside the treatment volume as a function of location.

SU-E-T-385: Accelerated Beam Delivery with MLC Gaps in IMRT Fields.

By default, the 4-mm wide leaf-pairs of the Elekta Beam Modulator MLC not used for field shaping are moved to under the primary collimator to minimize the leakage dose. The trade-off is the increased beam delivery time in the case of IMRT. This study examines the dosimetric impact and improved delivery efficiency by allowing the unused leaf-pair as 2mm gap to stay within the PTV aperture during beam-on. The capability of the treatment planning system (Pinnacle) in modeling the central and off-axis dose through 2mm MLC gaps, respectively, was investigated. EBT film measurement performed in a solid water phantom was compared with the computed dose. For two representative IMRT cases, the dosimetric features of treatment plans generated with and without MLC gaps in the field were compared. Similarly, the delivery times for 13 IMRT cases with and without MLC gaps were compared. The peak dose of the leaf gap computed with Pinnacle was dependent on dose grid resolution. The difference between a 0.5mm and 2mm dose grid was about 16.5% for 6MV and 15MV beam respectively. Using a 0.5mm dose grid, the maximum difference between measured and calculated dose was < 1% for a central axis gap, and < 3% for an off-axis gap. The maximum dose through a 2mm×4mm leaf gap was estimated < 10cGy for a typical IMRT plan. DVH comparison showed an increase of target dose up to 2% for the IMRT plans with gap, with minimal dose change to all critical structures. For the 13 IMRT cases, the beam delivery times were reduced by 27+/-9.7%, from 8.7+/-4.5 minutes to 6.5+/-4.0 minutes. The beam delivery is accelerated by utilizing minimal gaps in the IMRT fields. The increased dose to the target is acceptable and is minimal to all critical structures.

SU-E-T-289: On the Use of a Diode Array for the Commissioning of Dynamically-Wedged Asymmetric Fields Generated by Varian EDW's in the Pinnacle Treatment Planning System.

To present a validation study of enhanced dynamic wedges (EDWs) implemented into Pinnacle3 treatment planning system (TPS) using a diode array, Monte Carlo (MC) simulation, and measurements. Modeling of EDW dose distribution in the Pinnacle3 TPS is based on a combination of open-field beam data and the Varian 'Golden Segmented Treatment Table' (GSTT) unique to each photon beam. To validate the EDW models, dose profiles of 6- and 10-MV photon beams from a Clinac 2100C/D were measured in virtual water at depths from near- surface to 30 cm for a wide range of asymmetric field sizes and wedge angles using the Profiler-2 diode array system. The EDW output factors for asymmetric fields were measured in solid water using a small-volume cylindrical ionization chamber placed at a depth of 10 cm on the central axis. In addition, absolute doses on central axis at depths of 5, 10, 15 and 20 cm were measured in virtual water using a small-volume cylindrical chamber for comparison with the collapsed-cone convolution (CCC) calculations. The 6- and 10-MV photon beams emerging from the treatment head of the Clinac 2100C/D were fully simulated using the Monte Carlo code BEAMnrc and DOSXYZnrc. This code was used to calculate the central-axis percentage depth doses and dose profiles for the open and dynamically-wedged fields in a water phantom. The off-axis dose profiles of various EDWs computed with the CCC dose model and MC simulations agreed with measured EDW dose distributions to an accuracy of better than 2%/2 mm. Measured EDW output factors used for MU calculations in Pinnacle3 TPS agreed with MC predictions within 1-2%. The utility of Profiler-2 diode array system to measure dose profiles for commissioning of EDWs into the Pinnacle3 TPS has been demonstrated to have acceptable accuracy for clinical implementation.

SU-E-T-391: Modelling Peripheral Photon Dose in TomoTherapy Treatments.

The delivery of the therapeutic radiation dose to the tumour in photon radiotherapy, also implies dose deposition in distant organs (peripheral dose) related to secondary cancers induction (Hall and Wuu, Int J Radiat Oncol Biol Phys 56:83-88, 2003). Therefore, peripheral dose estimation in MU-demanding techniques, such as Helical TomoTherapy (HT), becomes relevant. TLD measurements and Monte Carlo modelling were compared by D'Agostino (Strahlenther Onkol 187:693, 2011). The purpose of this work was to find out experimental models predicting the equivalent photon dose as a function of the distance to the isocenter for different treatment types. The prostate case is presented here. A HT prostate plan was delivered to an anthropomorphic phantom mimicking a male adult. The phantom was made of polyethylene blocks whereas light wood was used for lungs. 16 points distributed along the phantom, covering different depths, were selected (Sánchez-Doblado IFMBE, World Congress Med Phys & Biomed Eng, 259-261, 2009). Additionally, a polyethylene sheet was inserted in the phantom to measure the off-axis dose profile at midplane depth. Measurements were carried out with standard TLD-100 pairs of dosimeters (calibrated in a 137Cs source). Two-exponential-terms curve fitting was carried out to model separately the scatter and leakage contribution (f=a*exp(-b*x)+c*exp(-d*x)). The former resulted predominant in the proximal region (10=x=14cm) and the latter in the distal re gion (x=14cm). Both components equate at 18cm. Scatter contribution becomes negligible for x=23cm. Points at 5cm were not used for the model as they are too close to the isocenter to be considered as peripheral dose. Model fits well experimental data (13% mean deviation). Only depths behind the build-up region could be properly modelled. Peripheral photon dose profiles in HT treatments have been modelled by a two-exponential-terms curve modelling separately scatter and leakage.

Monte Carlo modeling and simulations of the High Definition (HD120) micro MLC and validation against measurements for a 6 MV beam

The most recent Varian(®) micro multileaf collimator (MLC), the High Definition (HD120) MLC, was modeled using the BEAMNRC Monte Carlo code. This model was incorporated into a Varian medical linear accelerator, for a 6 MV beam, in static and dynamic mode. The model was validated by comparing simulated profiles with measurements. The Varian(®) Trilogy(®) (2300C/D) accelerator model was accurately implemented using the state-of-the-art Monte Carlo simulation program BEAMNRC and validated against off-axis and depth dose profiles measured using ionization chambers, by adjusting the energy and the full width at half maximum (FWHM) of the initial electron beam. The HD120 MLC was modeled by developing a new BEAMNRC component module (CM), designated HDMLC, adapting the available DYNVMLC CM and incorporating the specific characteristics of this new micro MLC. The leaf dimensions were provided by the manufacturer. The geometry was visualized by tracing particles through the CM and recording their position when a leaf boundary is crossed. The leaf material density and abutting air gap between leaves were adjusted in order to obtain a good agreement between the simulated leakage profiles and EBT2 film measurements performed in a solid water phantom. To validate the HDMLC implementation, additional MLC static patterns were also simulated and compared to additional measurements. Furthermore, the ability to simulate dynamic MLC fields was implemented in the HDMLC CM. The simulation results of these fields were compared with EBT2 film measurements performed in a solid water phantom. Overall, the discrepancies, with and without MLC, between the opened field simulations and the measurements using ionization chambers in a water phantom, for the off-axis profiles are below 2% and in depth-dose profiles are below 2% after the maximum dose depth and below 4% in the build-up region. On the conditions of these simulations, this tungsten-based MLC has a density of 18.7 g cm(- 3) and an overall leakage of about 1.1 ± 0.03%. The discrepancies between the film measured and simulated closed and blocked fields are below 2% and 8%, respectively. Other measurements were performed for alternated leaf patterns and the agreement is satisfactory (to within 4%). The dynamic mode for this MLC was implemented and the discrepancies between film measurements and simulations are within 4%. The Varian(®) Trilogy(®) (2300 C/D) linear accelerator including the HD120 MLC was successfully modeled and simulated using the Monte Carlo BEAMNRC code by developing an independent CM, the HDMLC CM, either in static and dynamic modes.

A Monte Carlo evaluation of carbon and lithium ions dose distributions in water

Purpose: To compare dose distributions on the central- and off-axis for 12C and 7Li ion beams simulated by the codes SHIELD-HIT (Heavy Ion Transport) and FLUKA (FLUKtuierende KAskade), and compare with experimental data for 300 MeV/u 12C and 185 MeV/u 7Li ion beams.Materials and methods: The general purpose Monte Carlo codes, SHIELD-HIT10 and FLUKA 2008.3d.1 were used for the ion dose distribution calculations. SHIELD-HIT transports hadrons and atomic nuclei of arbitrary charge and mass number in an energy range from 1 keV/u up to 1 GeV/u. Similarly, FLUKA transports charged hadrons in an energy range from 100 keV up to 20 TeV. Neutrons are transported down to thermal energies in both codes. Inelastic nuclear interactions are modelled in SHIELD-HIT by the Many Stage Dynamical Model (MSDM), whereas in FLUKA the Pre-Equilibrium Approach to Nuclear Thermalisation (PEANUT) package which includes a Generalized Intra-Nuclear Cascade model was used.Results: The dose distributions in water irradiated with 300 MeV/u 12C and 185 MeV/u 7Li ion beams were simulated with the two codes. Studies were performed of the energy deposition both on the central axis and at lateral distances up to 10 cm off-axis. The dose distributions calculated by SHIELD-HIT and FLUKA were compared with published experimental data. The dose mean lineal energy , frequency mean lineal energy , dose mean specific energy , and frequency mean specific energy were calculated with the ion track-structure code PITS99 (Positive Ion Track Structure 99), coupled with the electron code KURBUC for the primary and secondary ions average energies at 1 mm before the Bragg peak.Conclusion: The Monte Carlo codes show good agreement with experimental results for off-axis dose distributions. The disagreements in the Bragg peak region for the central-axis dose distributions imply that further improvements especially in the nuclear interaction models are required to increase the accuracy of the codes.

A novel cerrobend block in the radiation therapy

This study was carried out to look for the substitute products of lead cerrobend block and determine whether the products can give more radiation dose to the tumor in the skin and superficial tumors in radiotherapy treatment. Five kinds of PbO/Er2O3/Epoxy(E-51) samples used as the cerrobend block in the electron beam radiotherapy treatment were prepared successfully by a solidified forming approach. The central axis depth dose and off-axis dose profiles in the water phantom were calculated using BEAMnrc/DOSEXYZnrc user codes. The results revealed that there were more energy deposition events induced by low energy electron beams in the surface of the water phantom. These electron beams were attributed to Compton scattering and photoemission between photons and erbium, plumbum elements. The maximum dose (Dm) and the depth at the maximum dose (Rm) were linearly dependent on the mass fraction of erbium and plumbum element in the sample. The max dose and its depth varied depending on the combined actions of new electrons and transmission electrons.

Study of the response of plastic scintillation detectors in small‐field 6 MV photon beams by Monte Carlo simulations

To investigate the response of plastic scintillation detectors (PSDs) in a 6 MV photon beam of various field sizes using Monte Carlo simulations. Three PSDs were simulated: A BC-400 and a BCF-12, each attached to a plastic-core optical fiber, and a BC-400 attached to an air-core optical fiber. PSD response was calculated as the detector dose per unit water dose for field sizes ranging from 10 x 10 down to 0.5 x 0.5 cm2 for both perpendicular and parallel orientations of the detectors to an incident beam. Similar calculations were performed for a CC01 compact chamber. The off-axis dose profiles were calculated in the 0.5 x 0.5 cm2 photon beam and were compared to the dose profile calculated for the CC01 chamber and that calculated in water without any detector. The angular dependence of the PSDs' responses in a small photon beam was studied. In the perpendicular orientation, the response of the BCF-12 PSD varied by only 0.5% as the field size decreased from 10 x 10 to 0.5 x 0.5 cm2, while the response of BC-400 PSD attached to a plastic-core fiber varied by more than 3% at the smallest field size because of its longer sensitive region. In the parallel orientation, the response of both PSDs attached to a plastic-core fiber varied by less than 0.4% for the same range of field sizes. For the PSD attached to an air-core fiber, the response varied, at most, by 2% for both orientations. The responses of all the PSDs investigated in this work can have a variation of only 1%-2% irrespective of field size and orientation of the detector if the length of the sensitive region is not more than 2 mm long and the optical fiber stems are prevented from pointing directly to the incident source.

Oblique incidence for broad monoenergetic proton beams

The depth dose of a monoenergetic broad parallel proton beam has been modeled in a number of ways, but evidently not yet for oblique incidence. The purpose of this investigation is to find an accurate analytic formula for this case, which can then be used to model the depth dose of a broad beam with an initial Gaussian angular distribution. The Bortfeld model of depth dose in a broad normally incident proton beam has been extended to the case of oblique incidence. This extension uses an empirically determined Gaussian parameter sigma(x) which (roughly) characterizes the off-axis dose of a proton pencil beam. As with Bortfeld's work, the modeling is done in terms of parabolic cylinder functions. To obtain the depth dose for an initial angular distribution, the result is integrated over the angle of incidence, weighted by a Gaussian probability function. The predictions of the theory have been compared to MCNPX Monte Carlo calculations for four phantom materials (water, bone, aluminum, and copper) and for initial proton energies of 50, 100, 150, 200, and 250 MeV. Comparisons of the depth dose predicted by this theory with Monte Carlo calculations have established that with very good accuracy, sigma(x) can be taken to be independent both of the depth and of the angle of incidence. As a function of initial proton range or of initial proton energy, sigma(x) has been found to obey a power law to very high accuracy. Good fits to Monte Carlo calculations have also been found for an initial Gaussian angular distribution. This investigation is the first step in the accurate modeling of a proton pencil beam with initial Gaussian angular distribution. It provides the longitudinal factor, with its Bragg peak buildup and sharp distal falloff. A transverse factor must still be incorporated into this theory and this will give the lateral penumbra of a collimated proton beam. Also, it will be necessary to model the dose of product particles from nuclear interactions of the proton beam. With the accurate modeling of a pencil beam, it will be possible to accurately take into account the effect of localized tissue inhomogeneities.

Poster - Thur Eve - 73: Dosimetric Performance of Radionics Mini-MLC on Elekta Synergy S Linear Accelerator: A Monte Carlo Evaluation

This work contributed new information of dosimetric evaluation of Radionics mini-multileaf collimator (MMLC) attached on the head of an Elekta Synergy S linear accelerator using Monte Carlo simulations. The penumbrae, depth and lateral dose profiles of the Radionics MMLC for the 6 MV photon beams, were determined first time using the EGSnrc-based Monte Carlo codes (BEAMnrc) verified by measurements. The Monte Carlo modelled MMLC has a maximum field size of 9.6 × 12 cm2 and 3.8 mm leaf thickness at the isocenter. Monte Carlo verification was carried out using CC13 Wellhofer ionization chamber (cavity volume = 0.13 cm3) and a Wellhofer water tank for measurements. Dosimetric parameters such as the penumbrae, percentage depth doses, the in-plane and cross-plane off-axis dose profiles were measured and calculated for different field sizes and depths. Penumbra widths (80%−20%) for the reference field of 9.6 × 10.4 cm2 at the isocenter with a depth of 10 cm were 4.8 and 5.1 mm for the leaf-sides and leaf-ends, respectively. The corresponding values of penumbrae at depths of 1.5 and 5 cm were 3.6 and 4.2 mm for the leaf-sides and 3.8 and 4.5 mm for the leaf-ends. Dosimetric results based on our Monte Carlo model demonstrated excellent agreement to within 1% or 1 mm when compared to measurements. Our Monte Carlo model for the MMLC is expected to benefit the commissioning of the stereotactic radiosurgery planning for the small intracranial and extracranial lesions.

Verification of Varian enhanced dynamic wedge implementation in MasterPlan treatment planning system

This paper investigates the accuracy of the two available calculation algorithms of the Oncentra MasterPlan three‐dimensional treatment planning system (TPS) – the pencil beam method and collapsed‐cone convolution – in modeling the Varian enhanced dynamic wedge (EDW). Measurements were carried out for a dual high energy (6–15 MV) Varian DHX‐S linear accelerator using ionization chambers for beam axis measurements (wedge factors and depth doses), film dosimetry for off‐axis dose profiles measurements, and a diode matrix detector for two dimensional absolute dose distributions. Using both calculation algorithms, different configuration of symmetric and asymmetric fields varying the wedge's angle were tested. Accuracy of the treatment planning system was evaluated in terms of percentage differences between measured and calculated values for wedge factors, depth doses, and profiles. As far as the absolute dose distribution was concerned, the gamma index method (Low et al. (13) ) was used with 3% and 3 mm as acceptance criteria for dose difference and distance‐to‐agreement, respectively. Wedge factors and percentage depth doses were within 1% deviation between calculated and measured values. The comparison of measured and calculated dose profiles shows that the Van Dyk's acceptance criteria (Van Dyk et al. (14) ) are generally met; a disagreement can be noted for large wedge angles and field size limited to the low dose‐low gradient region only. The 2D absolute dose distribution analysis confirms the good accuracy of the two calculation algorithms in modeling the enhanced dynamic wedge.PACS number: 87.53.Bn, 87.55.kn, 87.56.ng

Independent calculation of dose from a helical TomoTherapy unit

A new calculation algorithm has been developed for independently verifying doses calculated by the TomoTherapy® Hi·Art® treatment planning system (TPS). The algorithm is designed to confi rm the dose to a point in a high dose, low dose‐gradient region. Patient data used by the algorithm include the radiological depth to the point for each projection angle and the treatment sinogram file controlling the leaf opening time for each projection. The algorithm uses common dosimetric functions [tissue phantom ratio (TPR) and output factor (Scp)] for the central axis combined with lateral and longitudinal beam profile data to quantify the off‐axis dose dependence. Machine data for the dosimetric functions were measured on the Hi·Art machine and simulated using the TPS. Point dose calculations were made for several test phantoms and for 97 patient treatment plans using the simulated machine data. Comparisons with TPS‐predicted point doses for the phantom treatment plans demonstrated agreement within 2% for both on‐axis and off‐axis planning target volumes (PTVs). Comparisons with TPS‐predicted point doses for the patient treatment plans also showed good agreement. For calculations at sites other than lung and superficial PTVs, agreement between the calculations was within 2% for 94% of the patient calculations (64 of 68). Calculations within lung and superficial PTVs overestimated the dose by an average of 3.1% (σ=2.4%) and 3.2% (σ=2.2%), respectively. Systematic errors within lung are probably due to the weakness of the algorithm in correcting for missing tissue and/or tissue density heterogeneities. Errors encountered within superficial PTVs probably result from the algorithm overestimating the scatter dose within the patient. Our results demonstrate that for the majority of cases, the algorithm could be used without further refinement to independently verify patient treatment plans.PACS number(s): 87.53.Bn, 87.53.Dq, 87.53.Xd

Clinical implementation of enhanced dynamic wedges into the Pinnacle treatment planning system: Monte Carlo validation and patient-specific QA

The goal of this work is to present a systematic Monte Carlo validation study on the clinical implementation of the enhanced dynamic wedges (EDWs) into the Pinnacle3 (Philips Medical Systems, Fitchburg, WI) treatment planning system (TPS) and QA procedures for patient plan verification treated with EDWs. Modeling of EDW beams in the Pinnacle3 TPS, which employs a collapsed-cone convolution superposition (CCCS) dose model, was based on a combination of measured open-beam data and the ‘Golden Segmented Treatment Table’ (GSTT) provided by Varian for each photon beam energy. To validate EDW models, dose profiles of 6 and 10 MV photon beams from a Clinac 2100 C/D were measured in virtual water at depths from near-surface to 30 cm for a wide range of field sizes and wedge angles using the Profiler 2 (Sun Nuclear Corporation, Melbourne, FL) diode array system. The EDW output factors (EDWOFs) for square fields from 4 to 20 cm wide were measured in virtual water using a small-volume Farmer-type ionization chamber placed at a depth of 10 cm on the central axis. Furthermore, the 6 and 10 MV photon beams emerging from the treatment head of Clinac 2100 C/D were fully modeled and the central-axis depth doses, the off-axis dose profiles and the output factors in water for open and dynamically wedged fields were calculated using the Monte Carlo (MC) package EGS4. Our results have shown that (1) both the central-axis depth doses and the off-axis dose profiles of various EDWs computed with the CCCS dose model and MC simulations showed good agreement with the measurements to within 2%/2 mm; (2) measured EDWOFs used for monitor-unit calculation in Pinnacle3 TPS agreed well with the CCCS and MC predictions within 2%; (3) all the EDW fields satisfied our validation criteria of 1% relative dose difference and 2 mm distance-to-agreement (DTA) with 99–100% passing rate in routine patient treatment plan verification using MapCheck 2D diode array.

Off-axis dose distribution for rectangle proton beam

This paper modifies an analytical algorithm originally developed for electron dose calculations to evaluate the off-axis dose distribution of rectangle proton beam. This spatial distribution could be described by Fermi–Eyges theory since a proton undergoes small-angle scattering when it passes through medium. Predictions of the algorithm for relative off-axis dose distribution by a 6 cm * 6 cm initial monoenergetic proton beam are compared with the results from the published Monte Carlo simulations. The excellent level of agreement between the results of these two methods of dose calculation (< 2%) demonstrates that the off-axis dose distribution from rectangle proton beam may be computed with high accuracy using this algorithm. The results also prompts the necessity to consider the off-axis distribution when the proton is applied to clinical radiotherapy since the penumbra is significant at the distal of its range (about 0.6 cm at the Bragg-peak depth).

Optical imaging analysis of microscopic radiation dose gradients in Gafchromic EBT film using a digital microscope

By providing superior localization and immobilization, stereotactic radiosurgery (SRS) is capable of delivering millimeter spheres of dose to intracranial targets with submillimeter precision. Several authors have proposed new SRS solutions to dramatically reduce beam penumbra to hundreds of microns. These solutions require new quality assurance methods capable of penumbra measurement at the micron scale. This article examines the capability of a digital microscope, with translation stage and associated software, to resolve dose gradients in Gafchromic EBT film at this level. To produce very steep penumbra, films were irradiated in phantom beneath pinhole collimators using lower energy x rays (100 kVp, 300 kVp, and Iridium-192) and minimal geometric penumbra contribution. For film analysis, a method was developed which improved the signal to noise ratio by finding the center of the irradiation spot, generating several radial dose profiles and averaging these to obtain the final off-axis dose profile. Optical density was converted to dose using a calibration curve. The experimentally determined off-axis dose profiles were compared with MCNP Monte Carlo simulations which replicated the irradiation geometry and served to validate our measured data. The measured 80%-20% penumbral widths were 46 microm +/- 26 microm (100 kVp, 2 mm field size), 69 microm +/- m 27 microm (300 kVp, 2 mm field size), and 241 microm +/-31 microm (Ir-192, 1 mm field size). These penumbral widths agreed with Monte Carlo simulations within experimental uncertainty. Our findings suggest that reading Gafchromic EBT films using a digital microscope with translation stage is suitable for the quality assurance of very sharp penumbra able to resolve gradients to within at least 30 microm.

Sci-Thurs PM: Delivery-03: Optical imaging of microscopic radiation dose gradients using a digital microscope.

Using superior localization and immobilization methods, stereotactic radiosurgery is capable of delivering spheres of dose as small as a few millimetres in diameter to intracranial targets. For targets abutting critical structures, the most conformal treatments minimize adverse radiation side effects and it is important, therefore, to ensure proper quality assurance prior to delivering high doses of radiation to eloquent brain locations in a single fraction. This work examines the capability of a digital microscope, with translation stage and associated software, to resolve dose gradients in Gafchromic EBT™ film at the micron level. In order to validate the microscope-film system from a radiation physics approach, films were irradiated to produce very steep penumbrae by using very small fields, lower photon energies and minimal geometric penumbra contribution. Orthovoltage film irradiations were done by placing films in phantom beneath pinhole collimators. The experimentally determined off-axis dose profiles were compared with Monte Carlo computer simulations which replicated the irradiation geometry and served to validate our measured data. The measured 80% - 20% penumbral widths were 46 μm ± 26 μm (100 kVp, 2 mm field size) and 69 μm ± 27 μm (300 kVp, 2 mm field size). In the energy range covered, the measured penumbral widths agreed with Monte Carlo computer simulations within experimental uncertainty. The effects of noise originating from both the film and the microscope system are discussed and improvements to this system suggested.

The development and investigation of a prototype three-dimensional compensator for whole brain radiation therapy

Whole brain radiation therapy (WBRT) is the standard treatment for patients with brain metastases, and is often used in conjunction with stereotactic radiotherapy for patients with a limited number of brain metastases, as well as prophylactic cranial irradiation. The use of open fields (conventionally used for WBRT) leads to higher doses to the brain periphery if dose is prescribed to the brain center at the largest lateral radius. These dose variations potentially compromise treatment efficacy and translate to increased side effects. The goal of this research was to design and construct a 3D ‘brain wedge’ to compensate dose heterogeneities in WBRT. Radiation transport theory was invoked to calculate the desired shape of a wedge to achieve a uniform dose distribution at the sagittal plane for an ellipsoid irradiated medium. The calculations yielded a smooth 3D wedge design to account for the missing tissue at the peripheral areas of the brain. A wedge was machined based on the calculation results. Three ellipsoid phantoms, spanning the mean and ± two standard deviations from the mean cranial dimensions were constructed, representing 95% of the adult population. Film was placed at the sagittal plane for each of the three phantoms and irradiated with 6 MV photons, with the wedge in place. Sagittal plane isodose plots for the three phantoms demonstrated the feasibility of this wedge to create a homogeneous distribution with similar results observed for the three phantom sizes, indicating that a single wedge may be sufficient to cover 95% of the adult population. The sagittal dose is a reasonable estimate of the off-axis dose for whole brain radiation therapy. Comparing the dose with and without the wedge the average minimum dose was higher (90% versus 86%), the maximum dose was lower (107% versus 113%) and the dose variation was lower (one standard deviation 2.7% versus 4.6%). In summary, a simple and effective 3D wedge for whole brain radiotherapy has been developed. The wedge gives a more uniform dose distribution than commonly used techniques. Further development and shape optimization may be necessary prior to clinical implementation.

Experimental verification and clinical implementation of a commercial Monte Carlo electron beam dose calculation algorithm

This study describes the modeling and the experimental verification and clinical implementation of the alpha release of Pinnacle3 Monte Carlo (MC) electron beam dose calculation algorithm for patient-specific treatment planning. The MC electron beam modeling was performed for beam energies ranging from 6 to 18 MeV from a Siemens (Primus) linear accelerator using standard-shaped electron applicators and 100 cm source-to-surface distance (SSD). The agreement between MC calculations and measurements was, on average, within 2% and 2 mm for all applicator sizes. However, differences of the order of 3%-4% were noted in the off-axis dose profiles for the largest applicator modeled and for all energies. Output factors were calculated for standard electron cones and square cutouts inserted in the 10 x 10 cm2 applicator for different SSDs and were found to be within 4% of measured data. Experimental verification of the MC electron beam model was carried out using an ionization chamber and film in solid-water slab and anthropomorphic phantoms containing bone and lung materials. Agreement between calculated and measured dose distributions was within +/-3%. Clinical comparison was performed in four patient treatment plans with lesions in highly irregular anatomies, such as the ear, face, and breast, where custom-designed bolus and field shaping blocks were used in the patient treatments. For comparison purposes, treatment planning was also performed using the conventional pencil beam (PB) algorithm with the Pinnacle3 treatment planning system. Differences between MC and PB dose calculations for the patient treatment plans were significant, particularly in anatomies where the target was in close proximity to low density tissues, such as lung and air cavities. Concerning monitor unit calculations, the largest differences obtained between MC and PB algorithms were between 4.0% and 5.0% for two patients treated with oblique beams and involving highly irregular surfaces, i.e., breast and cheek. Clinical results are reported for overall uncertainty values (averaged over voxels with doses >50% dosemax) ranging from 2% to 0.3% and calculations were performed using cubic voxels with side 0.3 cm. Timing values ranged from 2 min to 24.5 h, depending on the field size, beam energy, number, and thickness of computed tomography slices used to define the patient's anatomy for the overall uncertainty values mentioned above.