Pretreatment Dose Verification Research Articles

Magnetron Sputtered CsPbCl3 Perovskite Detectors as Real-Time Dosimeters for Clinical Radiotherapy

The aim of this study is to investigate the feasibility of manufacturing thin real-time relative dosimeters for clinical radiotherapy (RT) with potential applications for transmission monitoring in vivo dosimetry and pre-treatment dose verifications. Thin (≈1μm) layers of a high sensitivity, wide bandgap semiconductor, the inorganic perovskite CsPbCl3, have been grown for the first time by magnetron sputtering on plastic substrates equipped with electrode arrays. Prototype devices have been tested in real-time configuration to evaluate the dose delivered by a 6MV photon beam from a linear accelerator. Linearity of the charge with the dose has been verified over three order of magnitudes, linearity of the current signal with the dose rate has been also successfully tested in the range 0.5-4.3Gy/min. The combination of high sensitivity per unit volume and wide bandgap provides high signal-to-noise ratios, up to 70, even at moderate applied voltages. The Schottky diode configuration allows the detector to operate without bias voltage (null bias).The blocking-barrier structure allows to confine the active volume within sub-millimetric sizes, a quite attractive feature in view to increase granularity and achieve the high spatial resolutions required in modern RT techniques. All the above-mentioned features indeed pave the way to a novel generation of flexible, transmission, real time dosimeters for clinical radiotherapy.

Automated hybrid volumetric modulated arc therapy (HVMAT) for whole-breast irradiation with simultaneous integrated boost to lumpectomy area : Atreatment planning study.

To develop anautomated treatment planning approach for whole breast irradiation with simultaneous integrated boost using an automated hybrid VMAT class solution (HVMAT). Twenty-five consecutive patients with left breast cancer received 50 Gy (2 Gy/fraction) to the whole breast and an additional simultaneous 10 Gy (2.4 Gy/fraction) to the tumor cavity. Ipsilateral lung, heart, and contralateral breast were contoured as main organs-at-risk. HVMAT plans were inversely optimized by combining two open fields with aVMAT semi-arc beam. Open fields were setup to include the whole breast with a2 cm flash region and to carry 80% of beams weight. HVMAT plans were compared with three tangential techniques: conventional wedged-field tangential plans (SWF), field-in-field forward planned tangential plans (FiF), and hybrid-IMRT plans (HMRT). Dosimetric differences among the plans were evaluated using Kruskal-Wallis one-way analysis of variance. Dose accuracy was validated using the PTW Octavius-4D phantom together with the 15002D-array. No significant differences were found among the four techniques for both targets coverage. HVMAT plans showed consistently better PTVs dose contrast, conformity, and homogeneity (p < 0.001 for all metrics) and statistically significant reduction of high-dose breast irradiation. V55 and V60 decreased by 30.4, 26.1, and 20.8% (p < 0.05) and 12.3, 9.9, and 6.0% (p < 0.05) for SWF, FIF, and HMRT, respectively. Pretreatment dose verification reported agamma pass-rate greater than the acceptance threshold of 95% for all HVMAT plans. In addition, HVMAT reduced the time for full planning optimization to about 20 min. HVMAT plans resulted in superior target dose conformity and homogeneity compared to other tangential techniques. Due to fast planning time HVMAT can be applied for all patients, minimizing the impact on human or departmental resources.

Automation and integration of a novel restricted single-isocenter stereotactic body radiotherapy (a-RESIST) method for synchronous two lung lesions.

Synchronous treatment of two lung lesions using a single‐isocenter volumetric modulated arc therapy (VMAT) stereotactic body radiation therapy (SBRT) plan can decrease treatment time and reduce the impact of intrafraction motion. However, alignment of both lesions on a single cone beam CT (CBCT) can prove difficult and may lead to setup errors and unacceptable target coverage loss. A Restricted Single‐Isocenter Stereotactic Body Radiotherapy (RESIST) method was created to minimize setup uncertainties and provide treatment delivery flexibility. RESIST utilizes a single‐isocenter placed at patient’s midline and allows both lesions to be planned separately but treated in the same session. Herein is described a process of automation of this novel RESIST method. Automation of RESIST significantly reduced treatment planning time while maintaining the benefits of RESIST. To demonstrate feasibility, ten patients with two lung lesions previously treated with a single‐isocenter clinical VMAT plan were replanned manually with RESIST (m‐RESIST) and with automated RESIST (a‐RESIST). a‐RESIST method automatically sets isocenter, creates beam geometry, chooses appropriate dose calculation algorithms, and performs VMAT optimization using an in‐house trained knowledge‐based planning model for lung SBRT. Both m‐RESIST and a‐RESIST showed lower dose to normal tissues compared to manually planned clinical VMAT although a‐RESIST provided slightly inferior, but still clinically acceptable, dose conformity and gradient indices. However, a‐RESIST significantly reduced the treatment planning time to less than 20 min and provided a higher dose to the lung tumors. The a‐RESIST method provides guidance for inexperienced planners by standardizing beam geometry and plan optimization using DVH estimates. It produces clinically acceptable two lesions VMAT lung SBRT plans efficiently. We have further validated a‐RESIST on phantom measurement and independent pretreatment dose verification of another four selected 2‐lesions lung SBRT patients and implemented clinically. Further development of a‐RESIST for more than two lung lesions and refining this approach for extracranial oligometastastic abdominal/pelvic SBRT, including development of automated simulated collision detection algorithm, merits future investigation.

A Beam Projection-Based Modified Gamma Analysis Scheme for Clinically Interpretable Pre-Treatment Dose Verification.

Purpose:To investigate a novel gamma analysis system for dose verification results in terms of clinical significance.Methods and Materials:The modified scheme redefined the computational domain of the conventional gamma analysis with the projections of beams and the regions of interest (ROI). We retrospectively studied 6 patients with the conventional and the modified gamma analysis schemes while compared their performances. The cold spots ratio of the planning target volume (PTV) and the hot spots ratio of the organs at risk (OAR) were also computed by the modified scheme to assess the clinical significance.Results:The result of the gamma passing rate in the modified method was conformable to that in the conventional method with a cut-off threshold of 5%. The cold spots ratio of PTV and hot spots ratio of OAR were able to be evaluated by the modified scheme. For an introduced 7.1% dose error, the discrimination ratio in gamma passing rate of the conventional method was lower than 2%, while it was improved to 5% by the modified method.Conclusions:The modified gamma analysis scheme had a comparable quality as the conventional scheme in terms of dose inspection. Besides, it could improve the clinical significance of the QA result and provide the assessment for ROI-specific discrepancy. The modified scheme could also be conveniently integrated into the conventional dose verification process, benefiting the less developed regions where high-end 3D dose verification devices are not affordable.

Toward real-time verification for MLC tracking treatments using time-resolved EPID imaging.

In multileaf collimator (MLC) tracking, the MLC positions from the original treatment plan are continuously modified to account for intrafraction tumor motion. As the treatment is adapted in real time, there is additional risk of delivery errors which cannot be detected using traditional pretreatment dose verification. The purpose of this work is to develop a system for real-time geometric verification of MLC tracking treatments using an electronic portal imaging device (EPID). MLC tracking was utilized during volumetric modulated arc therapy (VMAT). During these deliveries, treatment beam images were taken at 9.57 frames per second using an EPID and frame grabber computer. MLC positions were extracted from each image frame and used to assess delivery accuracy using three geometric measures: the location, size, and shape of the radiation field. The EPID-measured field location was compared to the tumor motion measured by implanted electromagnetic markers. The size and shape of the beam were compared to the size and shape from the original treatment plan, respectively. This technique was validated by simulating errors in phantom test deliveries and by comparison between EPID measurements and treatment log files. The method was applied offline to images acquired during the LIGHT Stereotactic Ablative Body Radiotherapy (SABR) clinical trial, where MLC tracking was performed for 17 lung cancer patients. The EPID-based verification results were subsequently compared to post-treatment dose reconstruction. Simulated field location errors were detected during phantom validation tests with an uncertainty of 0.28mm (parallel to MLC motion) and 0.38mm (perpendicular), expressed as a root-mean-square error (RMSError ). For simulated field size errors, the RMSError was 0.47 cm2 and field shape changes were detected for random errors with standard deviation≥2.5mm. For clinical lung SABR deliveries, field location errors of 1.6mm (parallel MLC motion) and 4.9mm (perpendicular) were measured (expressed as a full-width-half-maximum). The mean and standard deviation of the errors in field size and shape were 0.0±0.3 cm2 and 0.3±0.1 (expressed as a translation-invariant normalized RMS). No correlation was observed between geometric errors during each treatment fraction and dosimetric errors in the reconstructed dose to the target volume for this cohort of patients. A system for real-time delivery verification has been developed for MLC tracking using time-resolved EPID imaging. The technique has been tested offline in phantom-based deliveries and clinical patient deliveries and was used to independently verify the geometric accuracy of the MLC during MLC tracking radiotherapy.

Portal dosimetry in radiotherapy repeatability evaluation.

The accuracy of radiotherapy is the subject of continuous discussion, and dosimetry methods, particularly in dynamic techniques, are being developed. At the same time, many oncology centers develop quality procedures, including pretreatment and online dose verification and proper patient tracking methods. This work aims to present the possibility of using portal dosimetry in the assessment of radiotherapy repeatability. The analysis was conducted on 74 cases treated with dynamic techniques. Transit dosimetry was made for each collision‐free radiation beam. It allowed the comparison of summary fluence maps, obtained for fractions with the corresponding summary maps from all other treatment fractions. For evaluation of the compatibility in the fluence map pairs (6798), the gamma coefficient was calculated. The results were considered in four groups, depending on the used radiotherapy technique: stereotactic fractionated radiotherapy, breath‐hold, free‐breathing, and conventionally fractionated other cases. The chi2 or Fisher's exact test was made depending on the size of the analyzed set and also Mann–Whitney U‐test was used to compare treatment repeatability of different techniques. The aim was to test whether the null hypothesis of error‐free therapy was met. The patient is treated repeatedly if the P‐value in all the fluence maps sets is higher than the level of 0.01. The best compatibility between treatment fractions was obtained for the stereotactic technique. The technique with breath‐holding gave the lowest percentage of compliance of the analyzed fluence pairs. The results indicate that the repeatability of the treatment is associated with the radiotherapy technique. Treated volume location is also an essential factor found in the evaluation of treatment accuracy. The EPID device is a useful tool in assessing the repeatability of radiotherapy. The proposed method of fluence maps comparison also allows us to assess in which therapeutic session the patient was treated differently from the other fractions.

17 Portal dosimetry prediction using collapsed-cone convolution model for clinical quality assurance applications

Introduction.Quality assurance (QA) of a volumetric modulated arc therapy (VMAT) plan can be performed using an amorphous silicon electronical portal imaging devices (EPIDs) to improve the QA efficiency. In our clinical routine, dosimetric plannifications are calculated with clinical treatment planning system (TPS) Pinnacle (Philips Medical Systems, Madison, WI) and transferred to Eclipse (Varian Medical Systems, Palo Alto, CA). Then a 3D recalculation is required in order to use the portal dose image prediction (PDIP) algorithm, which extends the files preparation time. The aim of this work is to use Pinnacle to create a model dedicated to portal pre-treatment dose verification.

Preclinical dose verification using a 3D printed mouse phantom for radiobiology experiments.

Dose verification in preclinical radiotherapy is often challenged by a lack of standardization in the techniques and technologies commonly employed along with the inherent difficulty of dosimetry associated with small-field kilovoltage sources. As a consequence, the accuracy of dosimetry in radiobiological research has been called into question. Fortunately, the development and characterization of realistic small-animal phantoms has emerged as an effective and accessible means of improving dosimetric accuracy and precision in this context. The application of three-dimensional (3D) printing, in particular, has enabled substantial improvements in the conformity of representative phantoms with respect to the small animals they are modeled after. In this study, our goal was to evaluate a fully 3D printed mouse phantom for use in preclinical treatment verification of sophisticated therapies for various anatomical targets of therapeutic interest. An anatomically realistic mouse phantom was 3D printed based on segmented microCT data of a tumor-bearing mouse. The phantom was modified to accommodate both laser-cut EBT3 radiochromic film within the mouse thorax and a plastic scintillator dosimeter (PSD), which may be placed within the brain, abdomen, or 1-cm flank subcutaneous tumor. Various treatments were delivered on an image-guided small-animal irradiator in order to determine the doses to isocenter using a PSD and validate lateral- and depth-dose distributions using film dosimeters. On-board cone-beam CT imaging was used to localize isocenter to the film plane or PSD active element prior to irradiation. The PSD irradiations comprised a 3×3mm2 brain arc, 5×5mm2 parallel-opposed pair (POP), and 5-beam 10×10mm2 abdominal coplanar arrangement while two-dimensional (2D) film dose distributions were acquired using a 3×3mm2 arc and both 5×5 and 10×10mm2 3-beam coplanar plans. A validated Monte Carlo (MC) model of the source was used as to verify the accuracy of the film and PSD dose measurements. computer-aided design (CAD) geometries for the mouse phantom and dosimeters were imported directly into the MC code to allow for highly accurate reproduction of the physical experiment conditions. Experimental and MC-derived film data were co-registered and film dose profiles were compared for points above 90% of the dose maximum. Point dose measurements obtained with the PSD were similarly compared for each of the candidate (brain, abdomen, and tumor) treatment sites. For each treatment configuration and anatomical target, the MC-calculated and measured doses met the proposed 5% agreement goal for dose accuracy in radiobiology experiments. The 2D film and MC dose distributions were successfully registered and mean doses for lateral profiles were found to agree to within 2.3% in all cases. Isocentric point-dose measurements taken with the PSD were similarly consistent, with a maximum percentage deviation of 3.2%. Our study confirms the utility of 3D printed phantom design in providing accurate dose estimates for a variety of preclinical treatment paradigms. As a tool for pretreatment dose verification, the phantom may be of particular interest to researchers for its ability to facilitate precise dosimetry while fostering a reduction in cost for radiobiology experiments.

Use of artificial neural network for pretreatment verification of intensity modulation radiation therapy fields.

The accuracy of dose delivery for intensity modulated radiotherapy (IMRT) treatments should be determined by an accurate quality assurance procedure. In this work, we used artificial neural networks (ANNs) as an application for the pre-treatment dose verification of IMRT fields based two-dimensional-fluence maps acquired by an electronic portal imaging device (EPID). The ANN must be trained and validated before use for the pretreatment dose verification. Hence, 60 EPID fluence maps of the anteroposterior prostate and nasopharynx IMRT fields were used as an input for the ANN (feed forward type), and a dose map of those fluence maps that were acquired by two-dimensional Array Seven29TM as an output for the ANN. After the training and validation of the neural network, the analysis of 20 IMRT anteroposterior fields showed excellent agreement between the ANN output and the dose map predicted by the treatment planning system. The average overall global and local γ field pass rate was greater than 90% for the prostate and nasopharynx fields, with the 2 mm/3% criteria. The results indicated that the ANN can be used as a fast and powerful tool for pretreatment dose verification, based on an EPID fluence map. In this study, ANN is proposed for EPID based dose validation of IMRT fields. The proposed method has good accuracy and high speed in response to problems. Neural network show to be low price and precise method for IMRT fields verification.

Pretreatment Dose Verification in Volumetric Modulated Arc Therapy Using Liquid Ionization Chamber.

Purpose:The purpose of the present study was to evaluate the practicability of liquid ionization chamber (LIC) for pretreatment dose verification of the advanced radiotherapy techniques such as volumetric modulated arc therapy (VMAT).Materials and Methods:The dosimetric characteristics of LIC such as repeatability, sensitivity, monitor unit linearity, dose rate dependence, angular dependence, voltage-current response, and output factors were investigated in 6 MV therapeutic X-ray beams. The LIC was cross-calibrated against 0.125-cc air-filled thimble ionization chamber. A dedicated dosimetry insert made up of Perspex to incorporate the LIC at proper location in the intensity-modulated radiation therapy thorax phantom was locally fabricated. The collection efficiency and ion recombination correction factor was determined using the two-dose rate method. Pretreatment dose verification measurement of VMAT treatment plans were carried out using the liquid ionization chamber as well as small volume (0.125 cc) air-filled thimble ionization chamber. The measured dose values by the two dosimeters and TPS calculated dose at a given point were compared.Results:The relative percentage differences between the TPS calculated and measured doses were within ± 1.57% for LIC and ± 2.21% for 0.125 cc ionization chamber, respectively.Conclusions:The measured dose values by the two dosimeters and TPS calculated dose at a given point were found comparable suggesting that the LIC could be a good choice of dosimeter for pretreatment dose verification in VMAT.

Electronic Portal Imaging Device-Based Three-Dimensional Volumetric Dosimetry for Intensity-modulated Radiotherapy Pretreatment Quality Assurance.

Aim:This study aimed at evaluating the efficacy of treatment planning system (TPS)-based heterogeneity correction for two- and three-dimensional (2D and 3D) electronic portal imaging device (EPID)-based pretreatment dose verification. An experiment was conducted on the EPID back-projection technique and intensity-modulated radiotherapy (IMRT).Materials and Methods:Treatment plans were delivered in EPID without a patient to obtain the fluence pattern (FEPID). A heterogeneity correction plane (Fhet) for an open beam of 30 cm × 30 cm was extracted from the TPS. The heterogeneity-corrected measured fluence is developed by matrix element multiplication (FResultant = FEPID × Fhet). Further planes were summed to develop a 3D dose distribution and exported to the TPS. Dose verifications for 2D and 3D were carried out with the corresponding TPS values using 2D gamma analysis (ɣ) and dose volume histogram (DVH) comparison, respectively. Totally, 33 patients (17 head–neck and 16 thorax cases) were evaluated in this study.Results:The head–neck and thorax plans show a 3-mm-distance to agreement (DTA) 3% DD gamma passing of 96.3% ± 2.0% and 95.4% ± 1.8% points, respectively, between FTPS and FResultant. The comparison of the uncorrected measured fluence (FEPID) with FTPS reveals a gamma passing of 82.2% ± 7.3% and 80.4% ± 8.6% for head–neck and thorax cases, respectively. A total of 87 out of the 102 head–neck and thorax beams exhibit a planner gamma passing of 97.6% ± 2.1%. In the 3D-DVH comparison of thorax and head–neck cases, D5% for planning target volume were −0.5% ± 2.2% and −2.1% ± 3.5%, respectively; D95% varies as 1.0% ± 2.7% and 1.4% ± 1.1% between TPS calculated and heterogeneity-corrected-EPID-based dose reconstruction.Conclusion:The novel TPS-based heterogeneity correction can improve the 2D and 3D EPID-based back projection technique. Structures with large heterogeneities can also be handled using the proposed technique.

Assessment of a 2D EPID-based Dosimetry Algorithm for Pre-treatment and In-vivo Midplane Dose Verification

Introduction: The use of electronic portal imaging devices (EPIDs) is a method for the dosimetric verification of radiotherapy plans both pretreatment and in-vivo. The aim of this study was to test a 2D EPID-based dosimetry algorithm for dose verification of some plans inside a homogenous and anthropomorphic phantom and in-vivo, as well. Materials and Methods: Dose distributions were reconstructed from EPID images using a 2D EPID dosimetry algorithm inside a homogenous slab phantom for a simple 10×10 cm2 box technique, the 3D conformal (prostate, head-and-neck and lung) and an IMRT prostate plans inside an anthropomorphic (Alderson) phantom and the patients (one fraction in-vivo) for the 3D conformal plans (prostate, head-and-neck and lung). Results: The Planned and EPID dose difference at isocenter, on average, was 1.7% for the pretreatment verification and was less than 3% for all in vivo plans except a head-and-neck which was 3.6%. The mean γ values for a 7-field prostate IMRT plan delivered to the Alderson phantom varied from 0.28 to 0.65. For 3D conformal plans applied for the Alderson phantom, all γ1% values were within the tolerance level for all plans and in both AP-PA beams. Conclusion: The 2D EPID-based dosimetry algorithm provides an accurate method to verify the dose of a simple 10×10 cm2 fields in two dimensions inside a homogenous slab phantom as well as for IMRT prostate plan and 3D conformal plans (prostate, head-and-neck and lung plans) applied using an anthropomorphic phantom and in-vivo.

158. Retrospective analysys of volumetric modulated arc therapy treatments: Correlation between plans complexity and dosimetric accuracy

Purpose A retrospective analysis of VMAT treatments delivered in our center since 2015 has been performed by studying the correlation between the results of pretreatment dosimetric evaluation and different parameters related to the complexity of the treatment plans. Districts considered for this study included Head & Neck, Pelvis and Prostate. Methods 3D pretreatment dose verification has been performed by OCTAVIUS 4D (PTW) with matrix 729 on a Linac Elekta Synergy Agility. Analysis of volumetric 3D gamma has been done by using thresholds of 3%, 3mm and 10%. The treatment plans have been created with the TPS Pinnacle 9.10; since 2016, the autoplanning module was also considered. The complexity of each plan has been evaluated by a complexity index [1] and the number of MU. Within- and across- districts analysis has been performed by Receiver operating characteristic (ROC) curves. Results For both complexity index and number of MU, our analysis identified a set of district-specific threshold values able to predict the success of pretreatment dosimetric evaluation (3D gamma > 90%). Conclusions Our analysis (for our configuration: Elekta Agility, Pinnacle 9.10 with autoplanning module, OCTAVIUS 4D with 729 matrix) suggests that, especially for Head&Neck and Pelvi, it’s possible to predict the quality of a treatment plan on the basis of the corresponding complexity index and the number of MU. If validated prospectively, this analysis suggests the possibility to evaluate the quality of the plan before performing its 3D dose verification.

Camera based EPID dosimetric verification of radiation treatments

Introduction: Tumor control and treatment quality depend on accuracy of delivered dose. Various methods have been studied for treatment dosimetry verification. Among these methods, the use of electronic portal imaging device (EPID) is highly considered. Many efforts are underway to improve the results of this context. Materials and Methods: In this study, a new method for pretreatment dose verification is reported using the transmitted signal of a camera based EPID. Lateral scatter within imager has been considered as field size dependent additive operation. Lateral scatter description within the imager were obtained from measurements with a 2D array ionization chambers for a set of different field sizes. The water-equivalent thickness of phantom material was defined for dose reconstruction, by means of the treatment planning system, according to the patient's data in CT scans along the beam central axis. Results: The method was tested for pretreatment verification of 3D conformal prostate cancer treatment plans. There are no significant differences between the EPID and ionization chamber responses (P value = 0.37). Conclusion: This study proposes a practical method with easier and less calculations in comparison to the deconvolution approaches that can be applied for overall dosimetric assessments of treatments in every fraction.

2D Dose Reconstruction by Artificial Neural Network for Pretreatment Verification of IMRT Fields

The use of intensity-modulated radiation therapy (IMRT) is developing rapidly in clinical routines. Because of the high complexity and uniqueness of IMRT treatment plans, patient-specific pretreatment quality assurance is generally considered a necessary prerequisite for patient treatment. In this work, we proposed a modified methodology of electronic portal imaging device (EPID)–based dose validation for pretreatment verification of IMRT fields by applying artificial neural networks (ANNs). The ANN must be trained and validated before use for pretreatment dose verification. For this purpose, 20 EPID fluence maps of IMRT prostate anterior-posterior fields were used as an input for ANN (feed forward type) and a dose map of those fluence maps that were predicted by treatment planning system as an output for ANN. After the training and validation of the neural network, the analysis of 10 IMRT prostate anterior-posterior fields showed excellent agreement between ANN output and dose map predicted by the treatment planning system. The average overall fields pass rate was 96.0% ± 0.1% with 3 mm/3% criteria. The results indicated that the ANN can be used as a low-cost, fast, and powerful tool for pretreatment dose verification, based on an EPID fluence map.

Spatially fractionated (GRID) radiation therapy using proton pencil beam scanning (PBS): Feasibility study and clinical implementation.

GRID therapy is an effective treatment for bulky tumors. Linear accelerator (Linac)-produced photon beams collimated through blocks or multileaf collimators (MLCs) are the most common methods used to deliver this therapy. Utilizing the newest proton delivery method of pencil beam scanning (PBS) can further improve the efficacy of GRID therapy. In this study, we developed a method of delivering GRID therapy using proton PBS, evaluated the dosimetry of this novel technique and applied this method in two clinical cases. In the feasibility study phase, a single PBS proton beam was optimized to heterogeneously irradiate a shallow 20×20×12cm3 target volume centered at a 6cm depth in a water phantom. The beam was constrained to have an identical spot pattern in all layers, creating a "beamlet" at each spot position. Another GRID treatment using PBS was also performed on a deep 15×15×8cm3 target volume centered at a 14cm depth in a water phantom. Dosimetric parameters of both PBS dose distributions were compared with typical photon GRID dose distributions. In the next phase, four patients have been treated at our center with this proton GRID technique. The planning, dosimetry, and measurements for two representative patients are reported. For the shallow phantom target, the depth-dose curve of the PBS plan was uniform within the target (variation <5%) and dropped quickly beyond the target (50% at 12.9cm and 0.5% at 14cm). The lateral profiles of the PBS plan were comparable to those of photon GRID in terms of valley-to-peak ratios. For the deep phantom target, the PBS plan provided smaller valley-to-peak ratios than the photon GRID technique. Pretreatment dose verification QA showed close agreement between the measurements and the plan (pass rate >95% with a gamma index criterion of 3%/3mm). Patients tolerated the treatment well without significant skin toxicity (radiation dermatitis grade ≤1). Proton GRID therapy using a PBS delivery method was successfully developed and implemented clinically. Proton GRID therapy offers many advantages over photon GRID techniques. The use of protons provides a more uniform beamlet dose within the tumor and spares normal tissues located beyond the tumor. This new PBS method will also reduce the dose to proximal organs when treating a deep-seated tumor.

Preliminary study of clinical application on IMRT three-dimensional dose verification-based EPID system.

The three‐dimensional dose (3D) distribution of intensity‐modulated radiation therapy (IMRT) was verified based on electronic portal imaging devices (EPIDs), and the results were analyzed. Thirty IMRT plans of different lesions were selected for 3D EPID‐based dose verification. The gamma passing rates of the 3D dose verification‐based EPID system (Edose, Version 3.01, Raydose, Guangdong, China) and Delta4 measurements were then compared with treatment planning system (TPS) calculations using global gamma criteria of 5%/3 mm, 3%/3 mm, and 2%/2 mm. Furthermore, the dose–volume histograms (DVHs) for planning target volumes (PTVs) as well as organs at risk (OARs) were analyzed using Edose. For dose verification of the 30 treatment plans, the average gamma passing rates of Edose reconstructions under the gamma criteria of 5%/3 mm, 3%/3 mm, and 2%/2 mm were (98.58 ± 0.93)%, (95.67 ± 1.97)%, and (83.13 ± 4.53)%, respectively, whereas the Delta4 measurement results were (99.14% ± 1.16)%, (95.81% ± 2.88)%, and (84.74% ± 7.00)%, respectively. The dose differences between Edose reconstructions and TPS calculations were within 3% for D95%, D98%, and Dmean in each PTV, with the exception that the D98% of the PTV‐clinical target volume (CTV) in esophageal carcinoma cases was (3.21 ± 2.33)%. However, the larger dose deviations in OARs (such as lens, parotid gland, optic nerve, and spinal cord) can be determined based on DVHs. The difference was particularly obvious for OARs with small volumes; for example, the maximum dose deviation for the lens reached (−6.12 ± 5.28)%. A comparison of the results obtained with Edose and Delta4 indicated that the Edose system could be applied for 3D pretreatment dose verification of IMRT. This system could also be utilized to evaluate the gamma passing rate of each treatment plan. Furthermore, the detailed dose distributions of PTVs and OARs could be indicated based on DVHs, providing additional reliable data for quality assurance in a clinic setting.

Reconstruction of high resolution MLC leaf positions using a low resolution detector for accurate 3D dose reconstruction in IMRT

In pre-treatment dose verification, low resolution detector systems are unable to identify shifts of individual leafs of high resolution multi leaf collimator (MLC) systems from detected changes in the dose deposition. The goal of this study was to introduce an alternative approach (the shutter technique) combined with a previous described iterative reconstruction method to accurately reconstruct high resolution MLC leaf positions based on low resolution measurements. For the shutter technique, two additional radiotherapy treatment plans (RT-plans) were generated in addition to the original RT-plan; one with even MLC leafs closed for reconstructing uneven leaf positions and one with uneven MLC leafs closed for reconstructing even leaf positions. Reconstructed leaf positions were then implemented in the original RT-plan for 3D dose reconstruction. The shutter technique was evaluated for a 6 MV Elekta SLi linac with 5 mm MLC leafs (Agility™) in combination with the MatriXX Evolution detector with detector spacing of 7.62 mm. Dose reconstruction was performed with the COMPASS system (v2.0). The measurement setup allowed one row of ionization chambers to be affected by two adjacent leaf pairs. Measurements were obtained for various field sizes with MLC leaf position errors ranging from 1.0 mm to 10.0 mm. Furthermore, one clinical head and neck IMRT treatment beam with MLC introduced leaf position errors of 5.0 mm was evaluated to illustrate the impact of the shutter technique on 3D dose reconstruction. Without the shutter technique, MLC leaf position reconstruction showed reconstruction errors up to 6.0 mm. Introduction of the shutter technique allowed MLC leaf position reconstruction for the majority of leafs with sub-millimeter accuracy resulting in a reduction of dose reconstruction errors. The shutter technique in combination with the iterative reconstruction method allows high resolution MLC leaf position reconstruction using low resolution measurements with sub-millimeter accuracy.

Quality assurance of carbon ion and proton beams: A feasibility study for using the 2D MatriXX detector

PurposeThe quality assurance (QA) procedures in particle therapy centers with active beam scanning make extensive use of films, which do not provide immediate results. The purpose of this work is to verify whether the 2D MatriXX detector by IBA Dosimetry has enough sensitivity to replace films in some of the measurements. MethodsMatriXX is a commercial detector composed of 32×32 parallel plate ionization chambers designed for pre-treatment dose verification in conventional radiation therapy. The detector and GAFCHROMIC® films were exposed simultaneously to a 131.44MeV proton and a 221.45MeV/u carbon-ion therapeutic beam at the CNAO therapy center of Pavia – Italy, and the results were analyzed and compared. ResultsThe sensitivity MatriXX on the beam position, beam width and field flatness was investigated. For the first two quantities, a method for correcting systematic uncertainties, dependent on the beam size, was developed allowing to achieve a position resolution equal to 230μm for carbon ions and less than 100μm for protons. The beam size and the field flatness measured using MatriXX were compared with the same quantities measured with the irradiated film, showing a good agreement. ConclusionsThe results indicate that a 2D detector such as MatriXX can be used to measure several parameters of a scanned ion beam quickly and precisely and suggest that the QA would benefit from a new protocol where the MatriXX detector is added to the existing systems.

Diamond detector in absorbed dose measurements in high-energy linear accelerator photon and electron beams.

Diamond detectors (DD) are preferred in small field dosimetry of radiation beams because of small dose profile penumbras, better spatial resolution, and tissue‐equivalent properties. We investigated a commercially available ‘microdiamond’ detector in realizing absorbed dose from first principles. A microdiamond detector, type TM 60019 with tandem electrometer is used to measure absorbed doses in water, nylon, and PMMA phantoms. With sensitive volume 0.004 mm3, radius 1.1 mm, thickness 1×10−3mm, the nominal response is 1 nC/Gy. It is assumed that the diamond detector could collect total electric charge (nC) developed during irradiation at 0 V bias. We found that dose rate effect is less than 0.7% for changing dose rate by 500 MU/min. The reproducibility in obtaining readings with diamond detector is found to be ±0.17% (1 SD) (n=11). The measured absorbed doses for 6 MV and 15 MV photons arrived at using mass energy absorption coefficients and stopping power ratios compared well with Nd, water calibrated ion chamber measured absorbed doses within 3% in water, PMMA, and nylon media. The calibration factor obtained for diamond detector confirmed response variation is due to sensitivity due to difference in manufacturing process. For electron beams, we had to apply ratio of electron densities of water to carbon. Our results qualify diamond dosimeter as a transfer standard, based on long‐term stability and reproducibility. Based on micro‐dimensions, we recommend these detectors for pretreatment dose verifications in small field irradiations like stereotactic treatments with image guidance.PACS number(s): 87.56.Da