Linac System Research Articles

Development and validation of an MR-driven dose-of-the-day procedure for online adaptive radiotherapy in upper gastrointestinal cancer patients

Objective. To develop and validate a dose-of-the-day (DOTD) treatment plan verification procedure for liver and pancreas cancer patients treated with an magnetic resonance (MR)-Linac system. Approach. DOTD was implemented as an automated process that uses 3D datasets collected during treatment delivery. Particularly, the DOTD pipeline’s input included the adapt-to-shape (ATS) plan—i.e. 3D-MR dataset acquired at beginning of online session, anatomical contours, dose distribution—and 3D-MR dataset acquired during beam-on (BON). The DOTD automated analysis included (a) ATS-to-BON image intensity-based deformable image registration (DIR), (b) ATS-to-BON contours mapping via DIR, (c) BON-to-ATS contours copying through rigid registration, (d) determining ATS-to-BON dosimetric differences, and (e) PDF report generation. The DIR process was validated by two expert reviewers. ATS-plans were recomputed on BON datasets to assess dose differences. DOTD analysis was performed retrospectively for 75 treatment fractions (12-liver and 5-pancreas patients). Main results. The accuracy of DOTD process relied on DIR and mapped contours quality. Most DIR-generated contours (99.6%) were clinically acceptable. DICE correlated with depreciation of DIR-based region of interest mapping process. The ATS-BON plan difference was found negligible (<1%). The duodenum and large bowel exhibited highest variations, 24% and 39% from fractional values, for 5-fraction liver and pancreas. For liver 1-fraction, a 62% variation was observed for duodenum. Significance. The DOTD methodology provides an automated approach to quantify 3D dosimetric differences between online plans and their delivery. This analysis offers promise as a valuable tool for plan quality assessment and decision-making in the verification stage of the online workflow.

Quality assurance of an established online adaptive radiotherapy program: patch and software upgrade.

The ability to dynamically adjust target contours, derived Boolean structures, and ultimately, the optimized fluence is the end goal of online adaptive radiotherapy (ART). The purpose of this work is to describe the necessary tests to perform after a software patch installation and/or upgrade for an established online ART program. A patch upgrade on a low-field MR Linac system was evaluated for post-software upgrade quality assurance (QA) with current infrastructure of ART workflow on (1) the treatment planning system (TPS) during the initial planning stage and (2) the treatment delivery system (TDS), which is a TPS integrated into the delivery console for online ART planning. Online ART QA procedures recommended for post-software upgrade include: (1) user interface (UI) configuration; (2) TPS beam model consistency; (3) segmentation consistency; (4) dose calculation consistency; (5) optimizer robustness consistency; (6) CT density table consistency; and (7) end-to-end absolute ART dose and predicted dose measured including interruption testing. Differences of calculated doses were evaluated through DVH and/or 3D gamma comparisons. The measured dose was assessed using an MR-compatible A26 ionization chamber in a motion phantom. Segmentation differences were assessed through absolute volume and visual inspection. (1) No UI configuration discrepancies were observed. (2) Dose differences on TPS pre-/post-software upgrade were within 1% for DVH metrics. (3) Differences in segmentation when observed were small in general, with the largest change noted for small-volume regions of interest (ROIs) due to partial volume impact. (4) Agreement between TPS and TDS calculated doses was 99.9% using a 2%/2-mm gamma criteria. (5) Comparison between TPS and online ART plans for a given patient plan showed agreement within 2% for targets and 0.6 cc for organs at risk. (6) Relative electron densities demonstrated comparable agreement between TPS and TDS. (7) ART absolute and predicted measured end-to-end doses were within 1% of calculated TDS. An online ART QA program for post-software upgrade has been developed and implemented on an MR Linac system. Testing mechanics and their respective baselines may vary across institutions, but all necessary components for a post-software upgrade QA have been outlined and detailed. These outlined tests were demonstrated feasible for a low-field MR Linac system; however, the scope of this work may be applied and adapted more broadly to other online ART platforms.

Numerical modelling of the cool-down of the helium transfer-lines for FRIB LINAC and experimental systems

The cryogenic distribution system at FRIB is extensive, encompassing three Linac segments, fourteen experimental system superconducting magnets, cross-connect between FRIB and the reconfigured NSCL legacy system, and the A1900 magnets, as well as many other user experimental loads. The cool-down or warm-up of these transfer-lines is an inherently transient process and must be conducted at a gradual enough rate to keep local temperature gradients and corresponding thermal stress on the piping system within acceptable limits. To this end, estimation of this transient process is very helpful in operational planning. A two temperature (fluid and pipe wall) model was developed to capture the transient characteristics of the cool-down or warm-up process with real fluid properties, and considering the effects of heat in-leak, momentum, flow resistance, and piping components. It was employed to estimate the cool-down of different FRIB transfer line sections, and the results were compared against data obtained during actual cool-down of the transfer line.

Evaluation of Comparison of Noise Power Spectrum according to the Time of Using Electronic Portal Imaging Device (EPID) for LINAC System

Evaluation of Comparison of Noise Power Spectrum according to the Time of Using Electronic Portal Imaging Device (EPID) for LINAC System

Comparison between Volumetric Modulated arc Therapy based Coplanar and Noncoplanar Planning for Stereotactic Body Radiation Therapy of Liver

The study aims to investigate potential dosimetric benefits between non-coplanar and coplanar beam arrangements of Volumetric-Modulated Arc Therapy (VMAT) plans for liver stereotactic body radiotherapy (SBRT). Thirteen patients who had undergone liver SBRT treatment in our department were chosen retrospectively for the study. Two sets of SBRT-VMAT plans namely, non-coplanar (NC-VMAT) and Coplanar (C-VMAT) were generated in Monaco(v5.11) planning system for Elekta Versa HD Linac using unflatten 6MV photon. The NC-VMAT plans were created by two/three non-coplanar partial arcs with couch rotation of ±150 and had an arc span of 1300 to 1600 whereas the C-VMAT plans consisted of a full arc. Both plans were compared by statistically analyzing various dosimetric and technical parameters. There is no statistically significant difference observed between the C-VMAT and NC-VMAT plans for planning target volume (PTV) coverage. However, the spine dose (D1cc) was much less in the NC-VMAT plan compared to the C-VMAT plan, with mean values of 6.127 ± 3.08Gy and 9.058 ± 4.76Gy, respectively (p-value=0.002). The low dose spillage to the healthy tissue was compared by the volume receiving 5Gy (V5Gy) and 10Gy (V10Gy). V5Gy of the NC-VMAT plan was 2399.23±1870.76cc while that of C-VMAT plans was 2835.36±1930.20cc with the p-value <0.001. Moreover, the monitor units(MU) were less with NC-VMAT than with C-VMAT SBRT plans (p=0.015). The plan quality of NC-VMAT plans was favorable compared to C-VMAT plans for liver SBRT especially in reducing spine dose, low dose spillage to healthy tissue, and MU.

Initial validation of a diaphragm tracking system for multiple breath-hold volumetric modulated arc therapy of abdominal tumors: A phantom study.

The breath-hold radiotherapy has been increasingly used to mitigate interfractional and intrafractional breathing impact on treatment planning and beam delivery. Previous techniques include body surface measurements or radiopaque metal markers, each having known disadvantages. We recently proposed a new markerless technique without the disadvantages, where diaphragm was registered between DRR and fluoroscopic x-ray projection images every 180ms during VMAT delivery. An initial validation of the proposed diaphragm tracking system (DiaTrak) was performed using a chest phantom to evaluate its characteristics. Diaphragm registration was performed between DRR and projection streaming kV x-ray images of a chest phantom during VMAT delivery. Streaming data including the projection images and the beam angles were transferred from a linac system to an external PC, where the diaphragm registration accuracy and beam-off latency were measured based on image cross correlation between the DRR and the projection images every 180ms. It was shown that the average of the beam-off latency was 249.5ms and the average of the diaphragm registration error was 0.84mm CONCLUSIONS: Initial validation of the proposed DiaTrak system for multiple breath-hold VMAT of abdominal tumors has been successfully completed with a chest phantom. The resulting beam-off latency and the diaphragm registration error were regarded clinically acceptable.

Receive coil quality assurance procedure and automated analysis for ViewRay MRIdian MR-Linac.

Regular receiving coil quality assurance (QA) is required to ensure image quality of an MRIdian Linac system. The manufacturer provides a spherical phantom and positioning tube for single-slice signal-to-noise ratio (SNR) and uniformity assessments. We aimed to improve imaging setup and coverage and eliminate inter-scan variability by employing multi-slice imaging of a stable phantom. Additionally, we strived to expedite analysis by developing objective, automated analysis software. A 5300mL cylindrical plastic bottle placed in plastic bins was scanned at isocenter using a spin-echo sequence with NEMA-recommended parameters and 18 axial slices, avoiding phantom repositioning. Acquisition was repeated with and without prescan normalization filtering and by saving uncombined element images. Obtained data were analyzed using custom open-source MATLAB code. Signal and noise images were automatically assigned, and ROIs for SNR and uniformity calculations were defined using image thresholding. SNR and uniformity pass/fail decisions were made using baseline comparisons. The proposed method was successfully implemented as monthly coil QA for 3.5 years. Setup and scanning took 41 min on average for a coil set. Automated image analysis was completed in a few minutes. Signal intensity peaked around +90 or -90mm for Torso or Head/Neck coil unfiltered images. Noise peaked and minimized SNR inside±30mm from isocenter, while maximizing it around±130mm. Prescan normalization smoothed signal response, reduced SNR and increased uniformity. Individual coil element image analysis identified their position, signal or noise response and SNR. SNR and uniformity pass/fail thresholds were set for already tested and new coils. Conspicuous and subtle Torso coil malfunctions were detected considering baseline deviations of combined and individual element results. Our QA method eliminated observer bias and provided insights into coil function, image filtering performance and coil element location. It provided SNR and uniformity thresholds and identified faulty coil elements.

Students training on virtual medical linear accelerator

At the Czech Technical University in Prague, we have installed virtual software environment simulating a radiotherapy treatment room with a medical linear accelerator (software VERT and VERT Physics by Vertual Ltd., United Kingdom). It is possible to simulate patient treatment and physics QA (quality assurance) measurements in virtual reality. This is beneficial for our students and teachers because there is no radiation present while doing the exercises and it is accessible at any time, unlike medical linear accelerators at hospitals. For our department, we have chosen the TrueBeam model by Varian Medical Systems, USA. The linear accelerator can be operated by the user in the same way as at the hospital, including the hardware pendant. There is a selection of patient treatment plans, CT images and RT structures, all of which can be visualised inside the treatment room, also during beam on, simulating the situation inside the patient while irradiating the tumour. Any DICOM files, even from another manufacturer’s linac (linear accelerator) or treatment planning system, can be imported into VERT. Apart from this, there is also an imaging interface and cone-beam CT interface showing options for patient setup. Another part of the software is a physics module with various phantoms and detectors for dosimetry as well as geometry tests. For example, a large water tank can be used for relative dosimetry of photon beams (percent depth doses and profiles), a smaller water phantom can be used for reference dosimetry or chamber cross calibration according to the TRS 398 (1) or IPEM (2) protocol. The results of measurements are based on look-up tables coming from real beam data, so dependence on the depth of measurement, field size, temperature and pressure and other parameters can be demonstrated. Moreover, it is possible to introduce many types of errors into the linac, such as jaw position, laser, or collimator miscalibration, and show how these errors propagate to patient irradiation and how they can be detected by QA tools. This paper is a short report on how this system has been used at our university and how it might be used in modern learning, pointing out its advantages and drawbacks. At the 16th Workshop on European Collaboration in Higher Education on Radiological and Nuclear Engineering and Radiation Protection (CHERNE) it was proposed that this virtual system could be used for an international student training course on medical physics in radiotherapy within the CHERNE network. This course might contain theoretical lectures with demonstrations on the virtual linac, practical exercises on the virtual linac and visits to hospitals (a photon radiotherapy centre, the Thomayer University Hospital in particular, and a proton therapy centre).

New digital low-level RF controls based on the Red Pitaya STEMlab for the TLS Linac system

The Linac system at Taiwan Light Source (TLS) has been in operation for almost a quarter of a century and requires upgrades to improve its reliability. To achieve this, some components of the control system have been replaced with new digital low-level RF control units that use emerging technologies. A new unit is based on the open-source hardware platform which is named “Red Pitaya STEMlab” and offers a compact size and low power consumption. The unit features DAC (Digital-to-Analog Converter) blocks for downloading arbitrary waveforms with external trigger play and ADC (Analog-to-Digital Converter) blocks for waveform acquisition, enabling the development of real-time diagnostic toolkits. The new low-level RF control interface has been fully integrated into the existing EPICS software framework for system integration. The new digital low-level RF control system supports I/Q (in-phase/quadra-ture-phase) data with online amplitude and phase set-tings, and a waveform digitizer for inspecting low-level RF signals from the klystron modulator. Specific graphical applications have been designed and integrated into the existing operation interfaces. The system has been successfully achieved during routine operations. This paper describes the details of these efforts.

Optimization study for RF cavity and beam dynamics simulation in the electron linear accelerator using the multi-objective genetic algorithm

This work presents an optimization study on the RF cavity geometry design and beam dynamics of an electron injector linac for the Korea Fourth-Generation Storage Ring (Korea-4GSR). It is challenging to achieve an optimal design for a linac system due to the nonlinear nature of accelerator system and the associated beam dynamics with numerous knobs to control. To address this challenge, we employed the Multi-Objective Genetic Algorithm (MOGA) for efficient optimization. Through the utilization of MOGA, we effectively optimized the electron linac for the Korea-4GSR. The optimized design yielded a horizontal normalized rms emittance of approximately 3.79 mm-mrad and an energy spread of about 307.37 keV, which met design requirements of the Korea-4GSR. This approach facilitated the design of an electron linac tailored for the Korea-4GSR with enhanced efficiency and effectiveness.

A Feasibility Study of GPU-Accelerated Image Reconstruction with Distance-Driven Method in Digital Tomosynthesis Utilizing Rectilinear Geometry in the LINAC System

A Feasibility Study of GPU-Accelerated Image Reconstruction with Distance-Driven Method in Digital Tomosynthesis Utilizing Rectilinear Geometry in the LINAC System

Optimization of target system for the production of 99Mo via 100Mo(γ,n)99Mo reaction

With an increase of stopping operation of nuclear reactors worldwide, the supply of medical 99Mo becomes difficult and thus many efforts have been made to find an alternative. A process based on an electron linear accelerator (linac) system and a100Mo target via the 100Mo (γ,n)99Mo reaction receives a lot of attention due to the relatively low level of co-produced impurities. This process has been recently developed at the Institute of Modern Physics (IMP) and the Monte Carlo simulation was used to optimize the target system before operating pilot irradiation experiments. First, tungsten and tantalum, as mostly used converter materials, were tested. The yield of 99Mo was evaluated with respect to the converter thickness and the electron beam energy by means of Geant4 simulations. Besides, the specific activity of 99Mo produced from one-stage approach (100Mo target without a converter) and two-stage approach (100Mo target with a converter) was compared when varying the testing conditions. The two-stage approach was selected for the experiment due to the higher specific activity of produced 99Mo at all tested conditions. A target consisting of a 10 mm thickness of the 100Mo tablets and a 2.4 mm thick Ta converter was irradiated for 40 h (50 MeV with 0.2 μA). The Geant4-calculated specific activity of generated 99Mo at the end of bombardment agreed well with the experimental value, which proved high level of accuracy of the Geant4 simulation. In future studies, the Geant4 simulation will be used to optimize the production process when using high power linac system.

Knowledge Based Planning for Lung SBRT: Model Transferability between Treatment Systems and Calculation Algorithms

Knowledge based planning (KBP) is known to be effective and clinically feasible in achieving high quality treatment plans with less variability between planners and reduced planning time. A KBP model is highly dependent on characteristics of the training data. Our institution developed and validated a lung SBRT KBP model from plans treated with a C-arm linear accelerator (Linac). This study aims to evaluate the quality of lung SBRT plans with a KBP model when this model is used for an O-ring Linac with different MLC design, beam quality, and calculation algorithm. Two academic hospitals in the same healthcare network were included in this study. One hospital trained a KBP model for five-fraction lung SBRT using 43 plans calculated using the Eclipse AcurosXB v15.6 algorithm for a C-arm Linac. The model was developed to prioritize dose gradient outside the PTV while satisfying institutional critical organ limits and validated using an additional set of 12 plans. A cohort of 10 patients (11 plans) previously treated with lung SBRT using the O-ring Linac at the second hospital was selected. These plans were calculated using the Eclipse AAA v15.6 algorithm with prescription doses of 30-50 Gy in five fractions. Each plan was re-optimized using the KBP model, without manual adjustment of the optimization objectives, using the same beam geometry as in the clinical plans. KBP plans were normalized to achieve the same PTV coverage as the clinical plans. Clinical and KBP plans were evaluated for ITV D98%, PTV conformity index (CI), R50 and maximum dose at 2 cm from the PTV (D2cm). All clinical and KBP plans met critical organ dose constraints. The range of CI was 1-1.13 vs. 0.96-1.05 for clinical plans and KBP plans, respectively. R50 and D2cm were lower with KBP plans (p = 0.007 and p = 0.05, respectively). ITV D98% range was 105-120% vs. 117-122% of the PTV prescription dose for clinical plans and KBP plans, respectively, and higher with KBP plans (p<0.001). For plans where the PTV overlaps the chest wall (n = 7), the maximum chest wall doses (D0.03cc) from KBP plans were higher than the clinical plans (p = 0.16), with an absolute chest wall D0.03cc difference of 9 Gy (54 Gy vs 63 Gy). The KBP model includes an ITV SIB of 120% of the PTV prescription, whereas the clinical plans reduced the ITV SIB when the PTV overlapped the chest wall, highlighting a difference in clinical practice between the two hospitals in this study. This study supports that a lung SBRT KBP model trained using plans for one Linac system and the AcurosXB algorithm can be used to generate clinically acceptable plans without manual planner intervention for a different Linac system and the AAA calculation algorithm, indicating the potential of a KBP model use for centralized planning process across different Linac systems and calculation algorithms.

Data Driven Approach to Exactrac Setup Parameters after CBCT for Cranial Radiotherapy

The purpose of this study is to 1) Determine the congruence of shifts derived from Cone-Beam CT (CBCT) and from Exactrac dynamic KV X-rays 2) To setup action levels for Exactrac imaging to determine if patient potentially moved between CBCT and Exactrac acquisition and 3) To analyze if Exactrac alone can be reliably used for cranial setup forgoing the CBCT step MATERIALS/METHODS: Exactrac dynamic, uses in-room KV X-ray imaging that is mounted on the floor to monitor patient positioning during treatment. The congruence of imaging and radiation isocenter for the LINAC and Exactrac system was verified using the Winston-Lutz (WL) test over a period of one year. The WL pointer was set up and its coincidence with imaging and radiation isocenter was confirmed. Exactrac images were then acquired at various couch angles and the pointer deviation from Exactrac imaging isocenter is noted. Secondly, translation and rotation shifts for 175 consecutive cranial cases were examined to determine the deviation between shifts as denoted by CBCT and Exactrac. These patients were initially set up using CBCT and then once in treatment position, Exactrac KV images were acquired to check for any deviation. The deviation between the two systems was collected and a Kolomogorov-Smirnov (KS) test was performed on the data to check for the normality of the distribution. Statistical Process Control (SPC) was performed to derive action levels for Exactrac based shifts after CBCT. Based on repeated Winston-Lutz tests over a period of one year, the maximum deviation between radiation and imaging isocenters and Exactrac isocenter was 0.3mm and 0.3 deg over all couch angles. This number remained stable over the entire time period without necessitating any recalibration of Exactrac isocenter. Based on patient data for cranial cases, the mean and standard deviations for the largest shifts were (0.45 mm, 0.40 mm) for translations (range 0 - 2.03mm) and (0.44 deg and 0.32 deg) for rotations (range 0 - 2.21 degree). Using SPC, it was decided that the action level for translations and rotations could be set to 0.8mm and 0.5 deg respectively. Any deviation beyond this action level necessitates re-imaging to verify that the patient did not move in between the CBCT and Exactrac imaging acquisitions CONCLUSION: Exactrac system derived shifts show excellent agreement with CBCT. The isocentricity of the systems is maintained over a long period of time and shows no drift. Either system can be reliably used to set up cranial patients. With the added advantage of speed of acquisition, matching and shifts, the Exactrac system could replace CBCT for daily setup of patients undergoing cranial radiotherapy.

Carbon Footprint of Photon Therapy

Rising carbon dioxide levels have hazardous impact on human health and climate change. This study estimates the energy utilization of radiation therapy and estimates corresponding carbon footprint. Patients treated between 07/2020 and 06/2021 using a Varian LINAC system were evaluated. Power draw was directly measured in 1 second increments, from the LINAC machine and the radiation department facility. Patients treated were reviewed for number of fractions and beam duration during each fraction. kWh power consumption was calculated per fraction and per treatment course. Patient commute distance was evaluated using Google Maps. EPA calculator was used to calculate CO2 equivalent (CO2e) footprint. There were 176 patients treated for 191 treatment courses. Total of 4,517 fractions were delivered (avg 23.6, range 1 to 48). Average BeamOn time was 141 seconds per fraction (22 to 310 sec); electron plans (n = 8) 29 sec, 2D/3D (n = 63) 77 sec, and IMRT (n = 120) 182 sec. BeamOn power draw was ∼36.3 kW. Power consumption per fraction was 1.4 kWh (0.2 to 3.0 kWh), and per course 37.5 kWh (0.9 to 109.1 kWh). LINAC was otherwise in standby mode 71% of time (∼7.3 kW) and ON/ready mode 25% (∼12.5 kW). Patient BeamOn time accounted for 2% of total its time and 8% of its power use during the year. Incremental standby/ready energy contribution per treatment course was 410 kWh (78,332/191). The building power draw was 12.5 kW, for incremental contribution of 576 kWh per course. Average patient travel distance was 9.6 miles (0.7 miles to 73.5 miles), resulting in 711-mile round trip per course (6 miles to 5620 miles). Corresponding carbon footprint for BeamOn time was 0.6 kg CO2e per fraction (electrons 0.1 kg, 2D/3D 0.3 kg, and IMRT 1.1 kg per fx). The treatment course footprint was 16.2 kg CO2e (0.4 kg to 47.2 kg). The attributed standby/ready LINAC footprint was 177.8 kg CO2e per course. The attributed facility footprint was further 250.0 kg CO2e per course. The attributed commute footprint was further 286.3 kg CO23 per course (2.4 kg to 2264.0 kg). The entire treatment course was 730.4 kg CO2e. As such, single fraction was 0.1% of the total CO2e course (0.01% to 0.27%), BeamOn was 2.3% (0.1% to 7.1%), LINAC standby/ready was 28.0% (6.5% to 41.3%), building was 39.4% (9.2% to 58%), and commute was 30.3% (0.6% to 82.9%). The entire program generated 139.5 metric tons of CO2e during the year. Linear accelerator BeamOn carbon footprint varied as a function of technique but was only 2% of the overall patient treatment footprint. The LINAC standby electricity contributed 28%, building electricity 39%, and commute 30%, though this varied significantly per patient, as a function of number of fractions and treatment distance. Fixed CO2e contribution from the standby LINAC and the building draw accounted for ∼67% of the footprint. However, radiation oncologists can potentially impact the overall carbon footprint by prescribing fewer fractions to lower total commute, as clinically indicated.

Characterization of mechanical and radiation isocenter on an MR-guided radiotherapy (MRgRT) Linac.

In the emerging paradigm of stereotactic radiosurgery being proposed for MR-guided radiotherapy (MRgRT), assessment of mechanical geometric accuracy is critical for the implementation of stereotactic delivery. We benchmarked the mechanical accuracy of an MR Linac system that lacks an onboard detector/array. Our mechanical tests utilize a half beam block (HBB) geometry that takes advantage of the sensitivity of a partially occluded detector. Mechanical tests benchmarked the couch, MLC, and gantry geometric accuracy for an MR-Linac system. An HBB technique was used to irradiate an ionization chamber profiler (ICP) array with partial occlusion of individual detectors for characterization of MLC skew, beam divergence displacement, and RT isocenter localization. The sensitivity of the partially occluded detector's ICP-X (detector width) and ICP-Y (detector length) was characterized by displacing the detector relative to radiation isocenter by 0.2mm increments, introduced through couch motion. The accuracy of the HBB ICP technique was verified with a starshot using radiochromic film, and the reproducibility was verified on a conventional C-arm Linac and compared to Winston-Lutz. The sensitivity of the HBB technique as quantified through the dose difference normalized to open field as a function of displacement from RT isocenter was 6.4%/mm and 13.0%/mm for the ICP-X and ICP-Y orientation, respectively, due to the oblong detector orientation. Couch positional accuracy and sag was within ±0.1mm. Maximum MLC positional displacement was 0.7mm with mean MLC skew at 0.07°. The maximum beam divergence displacement was 0.03mm. The gantry angle was within 0.1°. Independent verification of the RT isocenter localization procedure produced repeatable results. This work serves for characterizing the mechanical and geometric radiation accuracy for the foundation of an MR-guided stereotactic radiosurgery program, as demonstrated with high sensitivity and independent validation.

DYNAMION—A Powerful Beam Dynamics Software Package for the Development of Ion Linear Accelerators and Decelerators

Numerous ambitious particle accelerator facilities, based on proton and ion linear accelerators, have recently been in development for fundamental research, as well as for industrial applications. The advanced design of such new machines, as well as the upgrade and optimization of existing linacs, requires adequate, precise and reliable tools to simulate beam dynamics. The software package DYNAMION, created about 30 years ago, is undergoing systematic improvement and further development in order to characterize modern ion linacs and to provide solutions for its intrinsic complex problems. The DYNAMION code features Front to End beam dynamics simulations under space charge conditions in a linac system, comprising an arbitrary sequence of accelerating-focusing structures and beam transport lines. The evolution of a macroparticle ensemble could be analyzed at a high level of specification. A 3D distribution of the external electrical field (RFQ, DTL) is modeled using integrated internal solvers. Optionally, a 3D electromagnetic field mapping, supplied by specialized external codes, could be used. The recent status of the DYNAMION software package is presented in this paper. Furthermore, the performance of the code is demonstrated on the basis of its application for various linear accelerator/decelerator projects.

Deep learning-based fast volumetric imaging using kV and MV projection images for lung cancer radiotherapy: A feasibility study.

The long acquisition time of CBCT discourages repeat verification imaging, therefore increasing treatment uncertainty. In this study, we present a fast volumetric imaging method for lung cancer radiation therapy using an orthogonal 2D kV/MV image pair. The proposed model is a combination of 2D and 3D networks. The proposed model consists of five major parts: (1) kV and MV feature extractors are used to extract deep features from the perpendicular kV and MV projections. (2) The feature-matching step is used to re-align the feature maps to their projection angle in a Cartesian coordinate system. By using a residual module, the feature map can focus more on the difference between the estimated and ground truth images. (3) In addition, the feature map is downsized to include more global semantic information for the 3D estimation, which is useful to reduce inhomogeneity. By using convolution-based reweighting, the model is able to further increase the uniformity of image. (4) To reduce the blurry noise of generated 3D volume, the Laplacian latent space loss calculated via the feature map that is extracted via specifically-learned Gaussian kernel is used to supervise the network. (5) Finally, the 3D volume is derived from the trained model. We conducted a proof-of-concept study using 50 patients with lung cancer. An orthogonal kV/MV pair was generated by ray tracing through CT of each phase in a 4D CT scan. Orthogonal kV/MV pairs from nine respiratory phases were used to train this patient-specific model while the kV/MV pair of the remaining phase was held for model testing. The results are based on simulation data and phantom results from a real Linac system. The mean absolute error (MAE) values achieved by our method were 57.5 HU and 77.4 HU within body and tumor region-of-interest (ROI), respectively. The mean achieved peak-signal-to-noise ratios (PSNR) were 27.6dB and 19.2dB within the body and tumor ROI, respectively. The achieved mean normalized cross correlation (NCC) values were 0.97 and 0.94 within the body and tumor ROI, respectively. A phantom study demonstrated that the proposed method can accurately re-position the phantom after shift. It is also shown that the proposed method using both kV and MV is superior to current method using kV or MV only in image quality. These results demonstrate the feasibility and accuracy of our proposed fast volumetric imaging method from an orthogonal kV/MV pair, which provides a potential solution for daily treatment setup and verification of patients receiving radiation therapy for lung cancer.

First-in-human technique translation of oxygen-enhanced MRI to an MR Linac system in patients with head and neck cancer

Background and purposeTumour hypoxia is prognostic in head and neck cancer (HNC), associated with poor loco-regional control, poor survival and treatment resistance. The advent of hybrid MRI – radiotherapy linear accelerator or ‘MR Linac’ systems – could permit imaging for treatment adaptation based on hypoxic status. We sought to develop oxygen-enhanced MRI (OE-MRI) in HNC and translate the technique onto an MR Linac system. Materials and methodsMRI sequences were developed in phantoms and 15 healthy participants. Next, 14 HNC patients (with 21 primary or local nodal tumours) were evaluated. Baseline tissue longitudinal relaxation time (T1) was measured alongside the change in 1/T1 (termed ΔR1) between air and oxygen gas breathing phases. We compared results from 1.5 T diagnostic MR and MR Linac systems. ResultsBaseline T1 had excellent repeatability in phantoms, healthy participants and patients on both systems. Cohort nasal concha oxygen-induced ΔR1 significantly increased (p < 0.0001) in healthy participants demonstrating OE-MRI feasibility. ΔR1 repeatability coefficients (RC) were 0.023–0.040 s−1 across both MR systems. The tumour ΔR1 RC was 0.013 s−1 and the within-subject coefficient of variation (wCV) was 25% on the diagnostic MR. Tumour ΔR1 RC was 0.020 s−1 and wCV was 33% on the MR Linac. ΔR1 magnitude and time-course trends were similar on both systems. ConclusionWe demonstrate first-in-human translation of volumetric, dynamic OE-MRI onto an MR Linac system, yielding repeatable hypoxia biomarkers. Data were equivalent on the diagnostic MR and MR Linac systems. OE-MRI has potential to guide future clinical trials of biology guided adaptive radiotherapy.

ACPSEM position paper: dosimetry for magnetic resonance imaging linear accelerators

Consistency and clear guidelines on dosimetry are essential for accurate and precise dosimetry, to ensure the best patient outcomes and to allow direct dose comparison across different centres. Magnetic Resonance Imaging Linac (MRI-linac) systems have recently been introduced to Australasian clinics. This report provides recommendations on reference dosimetry measurements for MRI-linacs on behalf of the Australiasian College of Physical Scientists and Engineers in Medicine (ACPSEM) MRI-linac working group. There are two configurations considered for MRI-linacs, perpendicular and parallel, referring to the relative direction of the magnetic field and radiation beam, with different impacts on dose deposition in a medium. These recommendations focus on ion chambers which are most commonly used in the clinic for reference dosimetry. Water phantoms must be MR safe or conditional and practical limitations on phantom set-up must be considered. Solid phantoms are not advised for reference dosimetry. For reference dosimetry, IAEA TRS-398 recommendations cannot be followed completely due to physical differences between conventional linac and MRI-linac systems. Manufacturers’ advice on reference conditions should be followed. Beam quality specification of TPR20,10 is recommended. The configuration of the central axis of the ion chamber relative to the magnetic field and radiation beam impacts the chamber response and must be considered carefully. Recommended corrections to delivered dose are {k}_{{Q}_{msr}{Q}_{0}}^{{f}_{msr}{f}_{ref}}, a correction for beam quality and {k}_{overrightarrow{B},{Q}_{msr}}^{{f}_{msr}}, for the impact of the magnetic field on dosimeter response in the magnetic field. Literature based values for {k}_{overrightarrow{B},{Q}_{msr}}^{{f}_{msr}} are given. It is important to note that this is a developing field and these recommendations should be used together with a review of current literature.