Treatment Planning System Algorithms Research Articles

Evaluation of Dose Calculation Algorithms Accuracy for ISOgray Treatment Planning System in Motorized Wedged Treatment Fields.

Different dose calculation methods vary in accuracy and speed. While most methods sacrifice precision for efficiency Monte Carlo (MC) simulation offers high accuracy but slower calculation. ISOgray treatment planning system (TPS) uses Clarkson, collapsed cone convolution (CCC), and fast Fourier transform (FFT) algorithms for dose distribution. This study's primary goal is to evaluate the dose calculation accuracy for ISOgray TPS algorithms in the presence of a wedge. This study evaluates the dose calculation algorithms using the ISOgray TPS in the context of radiation therapy. The authors compare ISOgray TPS algorithms on an Elekta Compact LINAC through MC simulations. The study compares MC simulations for open and wedge fields with ISOgray algorithms by using gamma index analysis for validation. The percentage depth dose results for all open and wedge fields showed a more than 98% pass rate for points. However, there were differences in the dose profile gamma index results. Open fields passed the gamma index analysis in the in-plane direction, but not all points passed in the cross-plane direction. Wedge fields passed in the cross-plane direction, but not all in the in-plane direction, except for the Clarkson algorithms. In all investigated algorithms, error increases in the penumbra areas, outside the field, and at cross-plane of open fields and in-plane direction of wedged fields. By increasing the wedge angle, the discrepancy between the TPS algorithms and MC simulations becomes more pronounced. This discrepancy is attributed to the increased presence of scattered photons and the variation in the delivered dose within the wedge field, consequently impacts the beam quality. While the CCC and FFT algorithms had better accuracy, the Clarkson algorithm, particularly at larger effective wedge angles, exhibited greater effectiveness than the two mentioned algorithms.

Which failures do patient-specific quality assurance systems need to catch?

The Joint AAPM-ESTRO TG-360 is developing a quantitative framework to evaluate treatment verification systems used for patient-specific quality assurance (PSQA). A subgroup was commissioned to determine which potential failure modes had the greatest risk to treatment quality and safety, and therefore should be evaluated as part of the PSQA verification. To create an extensive database of potential radiotherapy failure modes that should be detected by PSQA and to determine their relative importance for maximizing treatment quality. The subgroup consisted of eight physicists from seven countries, including representatives from three international quality assurance groups. We collected error reports from RO-ILS, SAFRON, AAPM TG publications, and other literature, including international audits. We focused on the subset of failure modes that impact whether the planned dose matches the dose received by the patient. We performed a failure-mode-and-effects analysis (FMEA), estimating the severity (S), occurrence (O), and detectability (D) of each failure mode. Detectability was scored assuming that PSQA was not done but other routine clinical QA was performed, which allowed us to see the importance of PSQA for detecting each specific failure mode. We analyzed the risk priority number (RPN=O*S*D), O*S, and severity rankings to determine the priority of each failure mode. We collected 394 error reports, which we categorized into 33 failure modes that underwent FMEA. Five failure modes were in the top ranks for both RPN and O*S analysis: four involving treatment planning system (TPS) commissioning and one regarding patient model errors. The highest-ranking RPN failure modes were: TPS algorithm limitations, TPS commissioning errors [multileaf collimator (MLC) modeling, output factor, percent-depth-dose/tissue-maximum-ratio (PDD/TMR), off-axis factor], and patient weight variation. The highest O*S failure modes were similar, with the addition of external patient position variation and incorrect linear accelerator isocenter and cGy/monitor units calibration. RPN and O*S analyses prioritized failure modes that impacted multiple patients with high occurrence and detectability scores, while severity analysis gave higher priority to single-patient modes with high severity scores. The highest-ranking severity modes were MLC sequence deletion, collision, and TPS isocenter incorrect. We have developed a list of failure modes critical to be detected during PSQA and ranked them in order of importance. The top failure modes emphasize the importance of utilizing a variety of treatment verification systems for PSQA, from secondary dose calculation through in-vivo dosimetry, in order to detect all possible errors. For failure modes in the top quartile, PSQA is critical. Without adequate PSQA, these errors may go undetected unless caught by an external audit. This analysis can be useful for optimizing PSQA workflows and for designing evaluations of treatment verification systems, and will be used by the Joint AAPM-ESTRO TG-360 to determine an appropriate validation strategy.

Clinical Viability of an Active Spot Scanning Beam Delivery System With a Newly Developed Carbon-Ion Treatment Planning System

PurposeAlthough active spot scanning irradiation technique is theoretically superior to passive-scattered broad beam irradiation with respect to normal tissue sparing, corroborations of the clinical benefit of carbon-ion spot scanning have remained scarce. This study aims to investigate the feasibility and clinical implementation of an active spot scanning beam calculation algorithm in a homemade carbon-ion treatment planning system (TPS) by comparing it with a conventional passive uniform scanning technique. Materials and methodsCarbon-ion plans were initially formulated using spot/uniform scanning methods in 22 participants enrolled in a prospective observational clinical trial. Subsequently, two additional plans were designed, resulting in three carbon-ion plans for each participant: uniform and spot scanning with mini-ridge filters (MRFs) of 2mm and 4mm, respectively. ResultsThe findings revealed no significant differences in dose homogeneity; however, significant differences in dose conformity were found between the active and passive scanning plans. For dose drop-off outside the target volume, the average gradient index (GI) values were 1.94 (95% confidence interval (CI): 1.79%-2.09%), 1.87 (95% CI: 1.73%-2.01%), and 3.20 (95% CI: 2.80%-3.61%) for the MRF4, MRF2, and uniform scanning plans, respectively. The pre-treatment tumor volume was 124.7 cm3 (range, 54.2-234 cm3), and the average shrinkage observed was 38.4% (95% CI: 17.6%-59.4%). Seven participants experienced grade 1 acute toxicity, and four experienced grade 2 acute toxicity. However, none of the patients developed grade 3 acute toxicity. ConclusionsIncreasing evidence suggests that potential clinical advantages of spot scanning delivery underlie its technical characteristics. As one among the few institutions currently utilizing carbon-ion radiotherapy, the investigation also provides promising safety and efficacy outcomes from the initial groups of treated participants, thereby contributing to the established clinical evidence supporting the effectiveness and superiority of carbon-ion therapy.

Commissioning and initial validation of Eclipse eMC algorithm for the electron FLASH research extension (FLEX) system for pre-clinical studies.

To investigate the feasibility of commissioning the 16 MeV electron FLASH Extension (FLEX) in the commercial treatment planning system (TPS) for biomedical research with cell and mouse models, and in silico treatment planning studies. To commission the FLEX system with the electron Monte Carlo (eMC) algorithm in the commercial TPS, radiochromic film was used to measure the vendor-recommended beam data. Once the beam model was generated for the eMC algorithm, supplemental measurements were collected for validation purposes and compared against the TPS-calculated results. Additionally, the newly commissioned 16 MeV FLASH beam was compared to the corresponding 16 MeV conventional electron beam. The eMC algorithm effectively modeled the FLEX system. The eMC-calculated PDDs and profiles for the 16 MeV electron FLASH beam agreed with measured values within 1%, on average, for 6×6 cm2 and 10×10cm2 applicators. Flatness and symmetry deviated by less than 1%, while FWHM and penumbra agreed within 1mm for both eMC-calculated and measured profiles. Additionally, the small field (i.e., 2-cm diameter cutout) that was measured for validation purposes agreed with TPS-calculated results within 1%, on average, for both the PDD and profiles. The FLASH and conventional dose rate 16 MeV electron beam were in agreement in regard to energy, but the profiles for larger field sizes began to deviate(>10×10cm2) due to the forward-peaked nature of the FLASH beam. For cell irradiation experiments, the measured and eMC-calculated in-plane and cross-plane absolute dose profiles agreed within 1%, on average. The FLEX system was successfully commissioned in the commercial TPS using the eMC algorithm, which accurately modeled the forward-peaked nature of the FLASH beam. A commissioned TPS for FLASH will be useful for pre-clinical cell and animal studies, as well as in silico FLASH treatment planning studies for future clinical implementation.

Dosimetric verification of radiotherapy treatment planning system at TMSS Cancer Center, Bogura, Bangladesh

Authentication of TPS is the component of the QA program for RTPS and planning process. So, verification of dose calculation algorithm is essential to measure the efficiency of the dose calculations. The goal is to assess how far the dosage measured deviates from the dose predicted by the treatment planning system (TPS) algorithm using a CIRS Thorax phantom. It has been done to measure the dosimetric variations of 6MV, 10MV and 15MV photon beams. The phantom was initially scanned using a CT-simulator, and the raw data from the gated scans were then exported to TPS to perform the planning. Using this planning, the phantom was irradiated for four different cases. The computed dose was then compared with the measured dose to ensure TPS validity. The findings demonstrate that the variation between the measured doses in altered holes of the CIRS thorax phantom and the calculated doses by TPS was within the allowed limit except few points of four cases. Max. and Min. deviations for 6MV were 3.87% and 0.05% respectively. On the other hand, Max. and Min. deviations for 10MV were 7.87% and 0.12% respectively and that for 15MV are 4.44% and 0.02% respectively. Satisfactory results were obtained for lung and bone substitute. The results demonstrate the accuracy of the doses determined by the treatment planning system algorithm using a thorax phantom, and they also demonstrate the competency of using the phantom for regular verification. In case of external beam radiation therapy with AAA algorithm, the CIRS Thorax Phantom is suitable for dose computation in heterogeneous medium. However it is more compatible for 6MV than 10MV and 15MV.

Optimal values of the Electron Monte Carlo dose engine parameters.

The aim of this study was to indicate the most favorable - in terms of to the time of calculation and the uncertainty of determining the dose distribution - values of the parameters for the Electron Monte Carlo (eMC) algorithm in the Eclipse treatment planning system. Using the eMC algorithm and the variability of the values of its individual parameters, calculations of the electron dose distribution in the full-scattering virtual water phantom were performed, obtaining percentage depth doses, beam profiles, absolute dose values in points and calculation times. The reference data included water tank measurements such as relative dose distributions and absolute point doses. For 63 sets of calculation data created from selected values of the parameters for the eMC algorithm, calculation times were analyzed and the absolute calculated and measured doses were compared. Performing a statistical analysis made it possible to determine whether the differences in the values of deviations between the actual dose and the calculated dose in individual regions of the percentage depth dose curve and the beam profile are statistically significant between the analyzed sets of parameters. Taking into account obtained results from the analysis of the discrepancy between the distribution of the calculated and measured dose, the correspondence of the absolute value of the calculated and measured dose and the duration of the calculation of the dose distribution, the optimal set of parameters was indicated for the eMC algorithm which allows obtaining the dose distribution and the number of monitor units in an acceptable time.

Analysis of Performance and Failure Modes of the IROC Proton Liver Phantom.

To analyze trends in institutional performance and failure modes for the Imaging and Radiation Oncology Core's (IROC's) proton liver phantom. Results of 66 phantom irradiations from 28 institutions between 2015 and 2020 were retrospectively analyzed. Univariate analysis and random forest models were used to associate irradiation conditions with phantom results. Phantom results included pass/fail classification, average thermoluminescent dosimeter (TLD) ratio of both targets, and percentage of pixels passing gamma of both targets. The following categories were evaluated in terms of how they predicted these outcomes: irradiation year, treatment planning system (TPS), TPS algorithm, treatment machine, number of irradiations, treatment technique, motion management technique, number of isocenters, and superior-inferior extent (in cm) of the 90% TPS isodose line for primary target 1 (PTV1) and primary target 2 (PTV2). In addition, failures were categorized by failure mode. Average pass rate was approximately 52% and average TLD ratio for both targets had slightly improved. As the treatment field increased to cover the target, the pass rate statistically significantly fell. Lower pass rates were observed for Mevion machines, scattered irradiation techniques, and gating and internal target volume (ITV) motion management techniques. Overall, the accuracy of the random forest modeling of the phantom results was approximately 73% ± 14%. The most important predictor was the superior-inferior extent for both targets and irradiation year. Three failure modes dominated the failures of the phantom: (1) systematic underdosing, (2) poor localization in the superior-inferior direction, and (3) range error. Only 44% of failures have similar failure modes between the 2 targets. Improvement of the proton liver phantom has been observed; however, the pass rate remains the lowest among all IROC phantoms. Through various analysis techniques, range uncertainty, motion management, and underdosing are the main culprits of failures of the proton liver phantom. Clinically, careful consideration of the influences of liver proton therapy is needed to improve phantom performance and patient outcome.

Dosimetric accuracy of Acuros® XB and AAA algorithms for stereotactic body radiotherapy (SBRT) lung treatments: evaluation with PRIMO Monte Carlo code

Abstract Purpose: The study aimed to compare the dosimetric performance of Acuros® XB (AXB) and anisotropic analytical algorithm (AAA) for lung SBRT plans using Monte Carlo (MC) simulations. Methods: We compared the dose calculation algorithms AAA and either of the dose reporting modes of AXB (dose to medium (AXB-Dm) or dose to water (AXB-Dw)) algorithms implemented in Eclipse® (Varian Medical Systems, Palo Alto, CA) Treatment planning system (TPS) with MC. PRIMO code was used for the MC simulations. The TPS-calculated dose profiles obtained with a multi-slab heterogeneity phantom were compared to MC. A lung phantom with a tumour was used to validate TPS algorithms using different beam delivery techniques. 2D gamma values obtained from Gafchromic film measurements in the tumour isocentre plane were compared with TPS algorithms and MC. Ten VMAT SBRT plans generated in TPS with each algorithm were recalculated with a PRIMO MC system for identical beam parameters for the clinical plan validation. A dose–volume histogram (DVH) based plan comparison and a 3D global gamma analysis were performed. Results: AXB demonstrated better agreement with MC and film measurements in the lung phantom validation, with good agreement in PDD, profiles and gamma analysis. AAA showed an overestimated PDD, a significant difference in dose profiles and a lower gamma pass rate near the field borders. With AAA, there was a dose overestimation at the periphery of the tumour. For clinical plan validation, AXB demonstrated higher agreement with MC than AAA. Conclusions: AXB provided better agreement with MC than AAA in the phantom and clinical plan evaluations.

Dosimetric evaluation of a treatment planning system using the AAPM Medical Physics Practice Guideline 5.a (MPPG 5.a) validation tests.

Verifying the accuracy of the dose calculation algorithm is considered one of the most critical steps in radiotherapy treatment for delivering an accurate dose to the patient. This work aimed to evaluate the dosimetric performance of the treatment planning system (TPS) algorithms; the AAA (v. 15.6), AXB (v. 15.6) and eMC (v. 15.6) following the AAPM medical physics practice guideline 5.a (MPPG 5.a) validation tests package in a Varian iX Linear Accelerator (Linac). A series of tests were developed based on the MPPG 5.a. on a Varian's Eclipse TPS (v. 15.6) (Varian Medical Systems). First, the basic photon and electron tests were validated by comparing the TPS calculated dose with the measurements. Next, for heterogeneity tests, we verified the Computed Tomography number to electron density (CT-to-ED) curve by comparing it with the baseline values, and TPS calculated point doses beyond heterogeneous media were compared to the measurements. Finally, for IMRT/VMAT dose validation tests, clinical reference plans were re-calculated on ArcCheck's virtual phantom (Sun Nuclear Corporation, Melbourne, FL, USA) and exported to the Linac for delivery using the ArcCheck dosimetry system. All validation tests were evaluated following the MPPG 5.a recommended tolerances. In basic dose validation tests, the TPS calculated depth dose profiles agreed well with the measurements, with a minimum gamma passing rate of 95% at 2%/2mm criteria. However, disagreements are seen in the build-up and penumbra region. Results for most point doses in homogeneous water phantoms were within the MPPG 5.a tolerance. For the heterogeneity tests, the CT-to-ED curve was established, and calculated point doses were all within 3% of the measurements for heterogeneous media for both photon algorithms at three energies. These results are within the MPPG5.a the recommended tolerance of 3%. Moreover, for electron beams, the differences between the calculated and measured point doses averaged 5% and 7%, but were just within the MPPG 5.a tolerance of 7%. For IMRT and VMAT validation tests using a gamma criteria of a 2%/2mm, IMRT plans showed maximum and minimum passing rates of 98.2% and 97.4%, respectively. Whereas VMAT plans showed maximum and minimum passing rates of 100% and 94.3%, respectively. We conclude that the dosimetric accuracy of the Eclipse TPS (v15.6) algorithm is adequate for clinical use. The MPPG 5.a tests are valuable for evaluating dose calculation accuracy and are very useful for TPS upgrade checks, commissioning tests, and routine TPS QA.

PO33 Presentation Time: 10:30 AM: Testing the Usability of the Vaginal Speculum Tongue Made of Polyetheretherketone Material in Brachytherapy by Dosimetry Method

<h3>Purpose</h3> In the tandem + ovoid brachytherapy application, during the metallic speculum removing process after the vaginal packaging process, the positions of the sponges may change due to the spoon-shaped structure of the speculum, and this situation may cause not desired efficiency from the packaging process. In this project, we aimed to 3D printing of vaginal speculum tongues from polyetheretherketone (PEEK) material and make the dosimetric evaluation to assess usability during packing in gynecologic brachytherapy. <h3>Materials and Methods</h3> In this study, we designed a modular structure in which the upper and lower tongue can be easily separated from the handle similarly to the metallic vaginal speculum we use in our routine practice with no requirement to remove the speculum tongues from the patient after packaging. The tongues of the designed speculum were produced with PEEK material with a layer thickness of 200 microns using a 3D printer (Intamsys Technology Co. Ltd., Shanghai, China). To evaluate the radiation permeability of the produced speculum tongues, a phantom containing water was designed to perform dosimetric studies and 2 different dosimetric methods were used such as the treatment planning system (TPS) and Radiochromic Film Dosimeter system (Gafchromic: EBT3). TG43 and ACUROS BV algorithms are used as TPS. Prescribed dose (3 Gy) at the surface of phantom (side with the speculum) was calculated for a single source Dwell position in TPS using with ACUROS BV algorithm. The irradiation time was 631.1 seconds for both algorithms. The activity of the radioactive source was 11,086 Ci. The measured values that were obtained from the same points with different techniques were recorded and relations with each other were evaluated by using the Pearson Correlation test. In each measurement method, dose values were recorded in 4 different directions such as right (with no speculum), left (with speculum), up, and down. Dose-distance graphs were created for each direction from these values, and no break in the curve was detected on the side of the speculum tongue in phantom. This work was supported by Eskisehir Osmangazi University Scientific Research Projects Unit as project number TSA-2021-2143. <h3>Results</h3> The measurement values obtained from two different TPS algorithms and the film dosimetry method are given in Figure 1, and no significant difference was found in the statistical evaluation. The values obtained by using different methods show parallelism with each other, and no breakage was detected due to the speculum tongue. <h3>Conclusions</h3> In conclusion, all values obtained from TPS and radiochromic film dosimetry were parallel to each other. When the dose values at the same points and dose-distributions were evaluated, we concluded the speculum tongues we produced from PEEK did not have any negative effect on the dose distribution. However, this proposition needs to be supported by making more measurements with different dosimetry methods.

Testing of an enhanced leaf model for improved dose calculation in a commercial treatment planning system.

With the ever-increasing complexity of dynamic radiotherapy treatments, dose calculation algorithms are challenged to accurately calculate the dose resulting from small, on- and off-axis multileaf collimator (MLC) aperture movements. Although the currently available Eclipse (Varian Medical Systems, Palo Alto) dose calculation algorithms still use a simplified, binary MLC model, a more advanced and detailed modeling of the MLC could be beneficial for the dose calculation precision of high-end treatments. To improve the modeling of the MLC in the dose calculation algorithms of the Eclipse treatment planning system, an enhanced MLC attenuation model was constructed through ray tracing through the actual leaf designs for the most commonly used Varian MLC types. The enhanced leaf model (ELM) thus includes the rounded leaf tip shape, the drive screw cutout, and the leaf body thickness. The purpose of this work is to test out this new model and explore possible improvements compared to the previous model. Dose calculations were performed in a research Eclipse environment equipped with the original and enhanced MLC model. Measurements were performed on TrueBeam and on Halcyon dual MLC treatment units. Dedicated static and dynamic MLC test plans were designed to challenge the dose calculation and highlight differences between both models while keeping the experimental setup simple in order to minimize measurement uncertainties. Measurements were performed with single ion chambers, 2D ion chamber arrays and film. The improved MLC model considerably improves the accuracy of the dose calculation for the test fields used in this study. For the TrueBeam MLC, improvements are most prominent for off-axis dose delivery through narrow (static or dynamic) MLC gaps. For 3mm narrow sweeping gap deliveries at 12cm off-axis, the advanced model agrees within 2% with the measurement, in contrast to the 12% deviation observed with the original MLC model. For the Halcyon MLC, improvements are especially prominent when the leaves of both MLC stacks are aligned, regardless of their position in the field. Sweeping gap measurements improve from a 7%-10% deviation with the original model to within 2% with the new model. Although test fields designed in this study emphasize the flaws in the original MLC dose calculation model, the enhanced MLC model resolves all of the observed discrepancies, showing excellent on- and off-axis agreements with all of the performed measurements.

Treatment planning of total marrow irradiation with intensity-modulated spot-scanning proton therapy.

PurposeThe goal of this study is to investigate treatment planning of total marrow irradiation (TMI) using intensity-modulated spot-scanning proton therapy (IMPT). The dosimetric parameters of the intensity-modulated proton plans were evaluated and compared with the corresponding TMI plans generated with volumetric modulated arc therapy (VMAT) using photon beams.MethodsIntensity-modulated proton plans for TMI were created using the Monte Carlo dose-calculation algorithm in the Raystation 11A treatment planning system with spot-scanning proton beams from the MEVION S250i Hyperscan system. Treatment plans were generated with four isocenters placed along the longitudinal direction, each with a set of five beams for a total of 20 beams. VMAT-TMI plans were generated with the Eclipse-V15 analytical anisotropic algorithm (AAA) using a Varian Trilogy machine. Three planning target volumes (PTVs) for the bones, ribs, and spleen were covered by 12 Gy. The dose conformity index, D80, D50, and D10, for PTVs and organs at risk (OARs) for the IMPT plans were quantified and compared with the corresponding VMAT plans.ResultsThe mean dose for most of the OARs was reduced substantially (5% and more) in the IMPT plans for TMI in comparison with VMAT plans except for the esophagus and thyroid, which experienced an increase in dose. This dose reduction is due to the fast dose falloff of the distal Bragg peak in the proton plans. The conformity index was found to be similar (0.78 vs 0.75) for the photon and proton plans. IMPT plans provided superior superficial dose coverage for the skull and ribs in comparison with VMAT because of increased entrance dose deposition by the proton beams.ConclusionTreatment plans for TMI generated with IMPT were superior to VMAT plans mainly due to a large reduction in the OAR dose. Although the current IMPT-TMI technique is not clinically practical due to the long overall treatment time, this study presents an enticing alternative to conventional TMI with photons by providing superior dose coverage of the targets, increased sparing of the OARs, and enhanced radiobiological effects associated with proton therapy.

Evaluation of a New Inverse, Globally Convex Treatment Planning System Algorithm for Gamma Knife Radiation Surgery Within a Prospective Trial: Advantages and Disadvantages in Practical Application

PurposeA new inverse planning software called IntuitivePlan (IP) based on a global convex optimization algorithm was adopted for the Gamma Knife radiation surgery. We investigated IP's suitability for daily clinical use and its applicability for different cerebral entities. Methods and MaterialsFor 230 target volumes, IP was tested in a prospective trial. The computed treatment plans were compared with conventional expert preplans, which included forward planning by the expert and local internal optimization. Based on the same dose constraints, we used the default settings for the inverse calculation of the treatment plans. Plan quality metrics such as the Paddick conformity index were compared for both planning techniques with additional subdivisions into the 3 selectable IP planning strategies and different entity groups. ResultsIP calculated treatment plans of quality similar to that of preplans created by expert planners. Some plan quality metrics, especially those related to conformity and dose gradient, attained statistically significantly higher scores combined with high coverage for the inversely generated plans except for the selectivity optimizing strategy. Normal brain volume receiving 10 Gy or 12 Gy or higher (V10Gy or V12Gy) did not show significant differences for the coverage optimizing strategies. The IP software demonstrated significantly shorter planning times versus manual planning as well as greater numbers of isocenters, often associated with longer treatment times. In terms of total time, these differences almost balanced out again. ConclusionsOur results suggest that IP is advantageous for complex tumors. We observed general clinical significance for conformity and superiority for the selectivity optimizing strategy. In addition, the high-quality calculation from IP enables novices in the profession to achieve pre-treatment plans of a quality similar to that of expert planners. IP allows for optimizing the sparing of surrounding tissue and conformity for benign tumors within a short time. Thus, IP forms a solid basis for further planning on the treatment day.

Comparison of pre-treatment and in-vivo dosimetry for advanced radiotherapy of prostate cancer.

BackgroundThe usage of advanced radiotherapy techniques requires validation of a previously calculated dose with the precise delivery with a linear accelerator. This study aimed to review and evaluate new verification methods of dose distribution. Moreover, our purpose was to define an internal protocol of acceptance for in-vivo measurements of dose distribution.Materials and methodsThis study included 43 treatment plans of prostate cancer calculated using the Monte Carlo algorithm. All plans were delivered using the Volumetric Modulated Arc Therapy (VMAT) technique of advanced radiotherapy by the linear accelerator Elekta VersaHD. The dose distribution was verified using: MatriXX, iViewDose, and in-vivo measurements. The verification also included recalculation of fluence maps of quality assurance plans in another independent algorithm.ResultsThe acceptance criterion of 95% points of dose in agreement was found for pre-treatment verification using MatriXX; the average γ value was 99.09 ± 0.93 (SD) and 99.64 ± 0.35 (SD) for recalculation in the Collapse Cone algorithm. Moreover, using the second algorithm in the verification process showed a positive correlation ρ = 0.58, p < 0.001. However, verification using iViewDose in a phantom and in-vivo did not meet this γ-pass rate.ConclusionsEvaluation of gamma values for in-vivo measurements utilizing iViewDose software was helpful to establish an internal dosimetry protocol for prostate cancer treatments. We assumed value at a minimum of 50% points of the dose in agreement with the 3%/3 mm criterion as an acceptable compliance level. The recalculated dose distribution of QA plans in regard to the Collapse Cone algorithm in the other treatment planning system can be used as a pre-treatment verification method used by a medical physicist in their daily work. The effectiveness of use in iViewDose software, as a pre-treatment tool, is still debatable, unlike the MatriXX device.

Evaluating impact of medium variation on dose calculated through planning system in a low cost in-house phantom

Purpose: In radiotherapy, accuracy in dose estimation of dose calculation methods is critical. The influence of deformity on radiation dose calculations derived by planning system is evaluated in present study. The goal of study was to create a low-cost inhomogeneous phantom for measuring absorbed dose using an Ionisation chamber and Gafchromic film, which was validated using treatment planning system (TPS) dose outcome. Methods:and Materials: The central axis dose calculations were computed using Pencil Beam Convolution algorithm (PBC), Collapsed Cone Convolution (CCC) and Monte Carlo (MC) algorithm in the Monaco treatment planning system using an In-house phantom (20 × 20 × 20cm3) made up of acrylic sheet containing water and inhomogeneous material wooden powder equivalent to lung. Phantom was scanned in Computed Tomography (CT) scanner and image set was sent to the planning workstation. The depth dose evaluations were performed using ionization chamber and Gafchromic film with same beam settings and monitor units in every setup. Following that, the calculated doses obtained from TPS and measured depth doses were compared. Results: The results was reported for photon energies 6MV, 10MV, 15MV, 6FFF and 10FFF at varying field sizes of 4 × 4 cm2, 5 × 5 cm2, 10 × 10 cm2, and 15 × 15 cm2. MC maximum dose variation predicted was 2.06% in 15MV of measured chamber dose and −2.06% of measured gafchromic film dose in 6MVFFF. CCC maximum dose variation predicted was 2.68% of measured chamber dose in 6MV and 3.31% of measured gafchromic film dose in 6MV whereas PB maximum dose variation predicted was −5.94% in 15MV of measured chamber dose and −11.6% of measured gafchromic film dose in 6MVFFF. Conclusion: Low-cost in-house phantoms can be utilised to assess point and planar doses during patient-specific quality assurance in centres that don’t have accessibility to phantoms due to the high cost of commercially available tools.

Implementation and Validation of Anisotropic Analytical Algorithm in Eclipse Treatment Planning System for Indigenous Telecobalt Machine (Bhabhatron II)

Background:The photon dose calculation model anisotropic analytical algorithm (AAA) available with eclipse integrated treatment planning system (TPS) (Varian) supports telecobalt dose calculation from Version 13.6 onward. Formerly, pencil beam convolution (PBC) was used for modeling telecobalt machines. Eclipse TPS no longer supports PBC dose calculation algorithm in v13.6 and above. The AAA dose calculation model is a three-dimensional PBC/superposition algorithm. Its configuration is based on Monte-Carlo-determined basic physical parameters that are tailored to measured clinical beam data.Aim:The study investigated the feasibility of clinical implementation of AAA in Eclipse TPS for Bhabhatron II.Materials and Methods:The indigenous telecobalt machine, Bhabhatron II, was configured as a generic machine because an inbuilt machine model for the same was not available in Varian Eclipse TPS algorithm library. In such a scenario, it was necessary to evaluate and validate dosimetric parameters of the TPS because improper tailoring would cause errors in dose calculations. Beam data measurements of the machine were carried out which were used for configuration of the algorithm.Result:After successful configuration, a variety of plans created in TPS were executed on the machine and subsequently evaluated.Conclusion:From this study, we concluded that AAA-based dose calculation in TPS is very well suited for accurate dose calculations for telecobalt machine and can be implemented for clinical use.

Impact of the dose quantity used in MV photon optimization on dose distribution, robustness, and complexity

Convolution/superposition algorithms used in megavoltage (MV) photon radiotherapy model radiation transport in water, yielding dose to water-in-water (Dw,w ). Advanced algorithms constitute a step forward, but their dose distributions in terms of dose to medium-in-medium (Dm,m ) or dose to water-in-medium (Dw,m ) can be problematic when used in plan optimization due to their different dose responses to some atomic composition heterogeneities. Failure to take this into account can lead to undesired overcorrections and thus to unnoticed suboptimal and unrobust plans. Dose to reference-like medium (Dref,m* ) was recently introduced to overcome these limitations while ensuring accurate transport. This work evaluates and compares the performance of these four dose quantities in planning target volume (PTV)-based optimization. We considered three cases with heterogeneities inside the PTV: virtual phantom with water surrounded by bone; head and neck; and lung. These cases were planned with volumetric modulated arc therapy (VMAT) technique, optimizing with the same setup and objectives for each dose quantity. We used different algorithms of the Varian Eclipse treatment planning system (TPS): Acuros XB (AXB) for Dm,m and Dw,m , and Analytical Anisotropic Algorithm (AAA) for Dw,w . Dref,m* was obtained from Dm,m distributions using an in-house software considering water as the reference medium (Dw,m* ). The optimization process consisted of: (1) common first optimization, (2) dose distribution computed for each quantity, (3) re-optimization, and (4) final calculation for each dose quantity. The dose distribution, robustness to patient setup errors, and complexity of the plans were analyzed and compared. The quantities showed similar dose distributions after the optimization but differed in terms of plan robustness. The cases with soft tissue and high-density heterogeneities followed the same pattern. For AXB Dm,m , cold regions appeared in the heterogeneities after the first optimization. They were compensated in the second optimization through local fluence increases, but any positional mismatch impacted robustness, with clinical target volume (CTV) variations from the nominal scenario around +3% for bone and up to +7% for metal. For AXB Dw,m the pattern was inverse (hot regions compensated by fluence decreases) and more pronounced, with CTV dose variations around -7% for bone and up to -17% for metal. Neither AXB Dw,m* nor AAA Dw,w presented these dose inhomogeneities, which resulted in more robust plans. However, Dw,w differed markedly from the other quantities in the lung case because of its lower radiation transport accuracy. AXB Dm,m was the most complex of the four dose quantities and AXB Dw,m* the least complex, though we observed no major differences in this regard. The dose quantity used in MV photon optimization can affect plan robustness. Dw,w distributions from convolution/superposition algorithms are robust but may not provide sufficient radiation transport accuracy in some cases. Dm,m and Dw,m from advanced algorithms can compromise robustness because their different responses to some composition heterogeneities introduce additional fluence compensations. Dref,m* offers advantages in plan optimization and evaluation, producing accurate and robust plans without increasing complexity. Dref,m* can be easily implemented as a built-in feature of the TPS and can facilitate and simplify the treatment planning process when using advanced algorithms. Final reporting can be kept in Dm,m or Dw,m for clinical correlations.

Quantitative evaluation of dosimetric uncertainties in electron therapy by measurement and calculation using the electron Monte Carlo dose algorithm in the Eclipse treatment planning system.

In the electron beam radiation therapy, customized blocks are mostly used to shape treatment fields to generate conformal doses. The goal of this study is to investigate quantitatively dosimetric uncertainties associated with heterogeneities, detectors used in the measurement of the beam data commissioning, and modeling of the interactions of high energy electrons with tissue. These uncertainties were investigated both by measurements with different detectors and calculations using electron Monte Carlo algorithm (eMC) in the Eclipse treatment planning system. Dose distributions for different field sizes were calculated using eMC and measured with a multiple‐diode‐array detector (MapCheck2) for cone sizes ranging from 6 to 25 cm. The dose distributions were calculated using the CT images of the MapCheck2 and water‐equivalent phantoms. In the umbra region (<20% isodose line), the eMC underestimated dose by a factor of 3 for high energy electron beams due to lack of consideration of bremsstrahlung emitted laterally that was not accounted by eMC in the low dose region outside the field. In the penumbra (20%–80% isodose line), the eMC overestimated dose (40%) for high energy 20 MeV electrons compared to the measured dose with small diodes in the high gradient dose region. This was mainly due to lack of consideration of volume averaging of the ion chamber used in beam data commissioning which was input to the eMC dose calculation algorithm. Large uncertainties in the CT numbers (25%) resulted from the image artifacts in the CT images of the MapCheck2 phantom due to metal artifacts. The eMC algorithm used the electron and material densities extracted from the CT numbers which resulted large dosimetric uncertainties (10%) in the material densities and corresponding stopping power ratios. The dose calculations with eMC are associated with large uncertainties particularly in penumbra and umbra regions and around heterogeneities which affect the low dose level that cover nearby normal tissue or critical structures.

Dosimetric validation of Acuros® XB algorithm for RapidArc™ treatment technique: A post software upgrade analysis.

To validate the Acuros® XB (AXB) algorithm in Eclipse treatment planning system (TPS) for RapidArc™ (RA) technique following the software upgrades. A Clinac-iX (2300CD) linear accelerator and Eclipse TPS (Varian Medical System, Inc., Palo Alto, USA) was used for commissioning of AXB algorithm using a 6 megavolts photon beam. Percentage depth dose (PDD) and profiles for field size 2 cm × 2 cm, 4 cm × 4 cm, 6 cm × 6 cm, 10 cm × 10 cm, 20 cm × 20 cm, 30 cm × 30 cm to 40 cm × 40 cm were taken. AXB calculated PDDs and profiles were evaluated against the measured and analytical anisotropic algorithm (AAA)-calculated PDDs and profiles. Test sites recommended by American Association of Physicists in Medicine task group (AAPM TG)-119 recommendation were used for RA planning and delivery verification using AXB algorithm. AXB shows excellent agreement with measurements and AAA calculated data. The CLs were consistent with the baseline values published by TG-119. AXB algorithm has the potential to perform photon dose calculation with comparable fast calculation speed without negotiating the accuracy. AAPM TG-119 was successfully implemented to access the proper configuration of AXB algorithm following the TPS upgrade.

Dose calculation accuracy in particle therapy: Comparing carbon ions with protons.

PurposeThis work presents the validation of an analytical pencil beam dose calculation algorithm in a commercial treatment planning system (TPS) for carbon ions by measurements of dose distributions in heterogeneous phantom geometries. Additionally, a comparison study of carbon ions versus protons is performed considering current best solutions in commercial TPS.MethodsAll treatment plans were optimized and calculated using the RayStation TPS (RaySearch, Sweden). The dose distributions calculated with the TPS were compared with measurements using a 24‐pinpoint ionization chamber array (T31015, PTW, Germany). Tissue‐like inhomogeneities (bone, lung, and soft tissue) were embedded in water, while a target volume of 4 x 4 x 4 cm3 was defined at two different depths behind the heterogeneities. In total, 10 different test cases, with and without range shifter as well as different air gaps, were investigated. Dose distributions inside as well as behind the target volume were evaluated.ResultsInside the target volume, the mean dose difference between calculations and measurements, averaged over all test cases, was 1.6% for carbon ions. This compares well to the final agreement of 1.5% obtained in water at the commissioning stage of the TPS for carbon ions and is also within the clinically acceptable interval of 3%. The mean dose difference and maximal dose difference obtained outside the target area were 1.8% and 13.4%, respectively. The agreement of dose distributions for carbon ions in the target volumes was comparable or better to that between Monte Carlo (MC) dose calculations and measurements for protons. Percentage dose differences of more than 10% were present outside the target area behind bone–lung structures, where the carbon ion calculations systematically over predicted the dose. MC dose calculations for protons were superior to carbon ion beams outside the target volumes.ConclusionThe pencil beam dose calculations for carbon ions in RayStation were found to be in good agreement with dosimetric measurements in heterogeneous geometries for points of interest located within the target. Large local discrepancies behind the target may contribute to incorrect dose predictions for organs at risk.