Water-equivalent Plastic Research Articles

Toward a multi-layer micro-structured detector for high-energy electron radiotherapy.

The use of electron beams has been rekindled by the advent of ultra-high-dose rate radiotherapy (FLASH) and very high energy electrons (VHEE). The need for development of novel technology for beam monitoring and dosimetry of such beams is of paramount importance prior to their clinical translation. In this work we explore the potential of a multi-layer nanoporous aerogel High-Energy-Current (HEC) detector as a dosimeter for electron beam. The detector does not suffer from radiation damage or signal saturation, making it suitable for very-high-dose-rate applications. Standard dose rates and energies are used to establish reference for FLASH and VHEE. We explore detector response to electron energy and residual range both experimentally and computationally. Multilayer HEC detectors were constructed using 1×-10× basic modules of Aluminum(Al)_aerogel(A)_Tantalum(Ta) with 10-70 µm layer thicknesses. Signals are collected from all electrodes (3-21, depending on module multiplicity) with zero external voltage bias. Measurements are acquired as a function of depth(z) in water equivalent plastic using Varian TrueBeam for energies E=6,9,12,15 MeV (SAD=105cm, 6×6 cone, 1000 MU/min). Computational simulations of identical detector geometries are performed using the 1D deterministic code CEPXS/ONEDANT. Additionally, percent-depth-doses PDD(z), measured with diode in water, are used to explore the response of HEC for various energies and residual ranges. The current measured from Ta electrodes resembles the shape of deposited charges in water and it is proportional to the derivative of the clinical PDD corrected for contribution from photon contamination. The signal is positive on the surface, and it decreases with depth reaching a negative local minimum at z=R50, before increasing again, reaching zero at about the practical range z=Rp. In contrast, the signal from Al electrodes is shaped like the electron PDD(z) shape but with lower signal at the surface and higher bremsstrahlung tail. By subtracting the signal from Ta and Al electrodes we obtained a curve resembling PDD(z,E) after Bremsstrahlung contamination correction. Multi-layer HEC sensors exhibit characteristic responses to electron beams that are unlike responses of ion chambers or diodes. Since the sensor structures are sensitive to electronic disequilibrium, high-Z electrodes give a signal proportional to the charge deposition pattern and can be modeled using the derivative of PDD(z).

Low-cost dual-energy CBCT by spectral filtration of a dual focal spot X-ray source

Dual-energy cone beam computed tomography (DE-CBCT) has been shown to provide more information and improve performance compared to a conventional single energy spectrum CBCT. Here we report a low-cost DE-CBCT by spectral filtration of a carbon nanotube x-ray source array. The x-ray photons from two focal spots were filtered respectively by a low and a high energy filter. Projection images were collected by alternatively activating the two beams while the source array and detector rotated around the object, and were processed by a one-step materials decomposition and reconstruction method. The performance of the DE-CBCT scanner was evaluated by imaging a water-equivalent plastic phantom with inserts containing known densities of calcium or iodine and an anthropomorphic head phantom with dental implants. A mean energy separation of 15.5 keV was achieved at acceptable dose rates and imaging time. Accurate materials quantification was obtained by materials decomposition. Metal artifacts were reduced in the virtual monoenergetic images synthesized at high energies. The results demonstrated the feasibility of high quality DE-CBCT imaging by spectral filtration without using either an energy sensitive detector or rapid high voltage switching.

Characterization of a flexible a-Si:H detector for in vivo dosimetry in therapeutic x-ray beams.

The increasing use of complex and high dose-rate treatments in radiation therapy necessitates advanced detectors to provide accurate dosimetry. Rather than relying on pre-treatment quality assurance (QA) measurements alone, many countries are now mandating the use of in vivo dosimetry, whereby a dosimeter is placed on the surface of the patient during treatment. Ideally, in vivo detectors should be flexible to conform to a patient's irregular surfaces. This study aims to characterize a novel hydrogenated amorphous silicon (a-Si:H) radiation detector for the dosimetry of therapeutic x-ray beams. The detectors are flexible as they are fabricated directly on a flexible polyimide (Kapton) substrate. The potential of this technology for application as a real-time flexible detector is investigated through a combined dosimetric and flexibility study. Measurements of fundamental dosimetric quantities were obtained including output factor (OF), dose rate dependence (DPP), energy dependence, percentage depth dose (PDD), and angular dependence. The response of the a-Si:H detectors investigated in this study are benchmarked directly against commercially available ionization chambers and solid-state diodes currently employed for QA practices. The a-Si:H detectors exhibit remarkable dose linearities in the direct detection of kV and MV therapeutic x-rays, with calibrated sensitivities ranging from (0.580±0.002) pC/cGy to (19.36±0.10) pC/cGy as a function of detector thickness, area, and applied bias. Regarding dosimetry, the a-Si:H detectors accurately obtained OF measurements that parallel commercially available detector solutions. The PDD response closely matched the expected profile as predicted via Geant4 simulations, a PTW Farmer ionization chamber and a PTW ROOS chamber. The most significant variation in the PDD performance was 5.67%, observed at a depth of 3mm for detectors operated unbiased. With an external bias, the discrepancy in PDD response from reference data was confined to±2.92% for all depths (surface to 250mm) in water-equivalent plastic. Very little angular dependence is displayed between irradiations at angles of 0° and 180°, with the most significant variation being a 7.71% decrease in collected charge at a 110° relative angle of incidence. Energy dependence and dose per pulse dependence are also reported, with results in agreement with the literature. Most notably, the flexibility of a-Si:H detectors was quantified for sample bending up to a radius of curvature of 7.98mm, where the recorded photosensitivity degraded by (-4.9±0.6)% of the initial device response when flat. It is essential to mention that this small bending radius is unlikely during in vivo patient dosimetry. In a more realistic scenario, with a bending radius of 15-20mm, the variation in detector response remained within±4%. After substantial bending, the detector's photosensitivity when returned to a flat condition was (99.1±0.5)% of the original response. This work successfully characterizes a flexible detector based on thin-film a-Si:H deposited on a Kapton substrate for applications in therapeutic x-ray dosimetry. The detectors exhibit dosimetric performances that parallel commercially available dosimeters, while also demonstrating excellent flexibility results.

Metal Artifact Reduction in Photon-Counting Detector CT: Quantitative Evaluation of Artifact Reduction Techniques.

With the introduction of clinical photon-counting detector computed tomography (PCD-CT) and its novel reconstruction techniques, a quantitative investigation of different acquisition and reconstruction settings is necessary to optimize clinical acquisition protocols for metal artifact reduction. A multienergy phantom was scanned on a clinical dual-source PCD-CT (NAEOTOM Alpha; Siemens Healthcare GmbH) with 4 different central inserts: water-equivalent plastic, aluminum, steel, and titanium. Acquisitions were performed at 120 kVp and 140 kVp (CTDI vol 10 mGy) and reconstructed as virtual monoenergetic images (VMIs; 110-150 keV), as T3D, and with the standard reconstruction "none" (70 keV VMI) using different reconstruction kernels (Br36, Br56) and with as well as without iterative metal artifact reduction (iMAR). Metal artifacts were quantified, calculating relative percentages of metal artifacts. Mean CT numbers of an adjacent water-equivalent insert and different tissue-equivalent inserts were evaluated, and eccentricity of metal rods was measured. Repeated-measures analysis of variance was performed for statistical analysis. Metal artifacts were most prevalent for the steel insert (12.6% average artifacts), followed by titanium (4.2%) and aluminum (1.0%). The strongest metal artifact reduction was noted for iMAR (with iMAR: 1.4%, without iMAR: 10.5%; P < 0.001) or VMI (VMI: 110 keV 2.6% to 150 keV 3.3%, T3D: 11.0%, and none: 16.0%; P < 0.001) individually, with best results when combining iMAR and VMI at 110 keV (1.2%). Changing acquisition tube potential (120 kV: 6.6%, 140 kV: 5.2%; P = 0.33) or reconstruction kernel (Br36: 5.5%, Br56: 6.4%; P = 0.17) was less effective. Mean CT numbers and standard deviations were significantly affected by iMAR (with iMAR: -3.0 ± 21.5 HU, without iMAR: -8.5 ± 24.3 HU; P < 0.001), VMI (VMI: 110 keV -3.6 ± 21.6 HU to 150 keV -1.4 ± 21.2 HU, T3D: -11.7 ± 23.8 HU, and none: -16.9 ± 29.8 HU; P < 0.001), tube potential (120 kV: -4.7 ± 22.8 HU, 140 kV: -6.8 ± 23.0 HU; P = 0.03), and reconstruction kernel (Br36: -5.5 ± 14.2 HU, Br56: -6.8 ± 23.0 HU; P < 0.001). Both iMAR and VMI improved quantitative CT number accuracy and metal rod eccentricity for the steel rod, but iMAR was of limited effectiveness for the aluminum rod. For metal artifact reduction in PCD-CT, a combination of iMAR and VMI at 110 keV demonstrated the strongest artifact reduction of the evaluated options, whereas the impact of reconstruction kernel and tube potential was limited.

On the measurement of scaling factors in the RW3 plastic phantom during high energy electron beam dosimetry.

Ionometric electron dosimetry inside water-equivalent plastic phantoms demands special considerations including determination of depth scaling and fluence scaling factors (cpl and hpl) to shift from in-phantom measurements to those relevant to water. This study evaluates these scaling factors for RW3 slab phantom and also introduces a new coefficient, k(RW3), for direct conversion from RW3 measurements to water without involving scaling factors. The RW3 solid phantom developed by the PTW Company was used and the corresponding scaling factors including cpl, hpl, and k(RW3) were measured for conventional electron energies of 4, 6, 9, 12, and 16MeV. Separate measurements were performed in water and the RW3 slab phantom using the Advanced Markus chamber. The validity of the reported scaling factors was confirmed by comparing the direct and indirect percentage depth dose (PDD) measurements in water and in the RW3 phantom. The cpl values for the RW3 phantom were respectively equal to 0.915, 0.927, 0.934, 0.937, and 0.937 for 4, 6, 9, 12, and 16MeV electron energies. The hpl and k(RW3) values were dependent on the depth of investigation and electron energy. Application of the cpl-hpl factors and k(RW3) coefficients to measured data inside the RW3 can reliably reproduce the measured PDD curves in water. The mean difference between the PDDs measured directly and indirectly in water and in the RW3 phantom was less than 1.2% in both approaches for PDD conversion (cpl-hpl coupling and the use of k(RW3)). The measured scaling factors and k(RW3) coefficients are sufficiently relevant to mimic water-based dosimetry results through indirect measurements inside the RW3 slab phantom. Nevertheless, employing k(RW3) is more straightforward than the cpl-hpl approach because it does not involve scaling and it is also less time-consuming.

Evaluation of a complementary metal oxide semiconductor detector as a tool for stereotactic body radiotherapy plan quality assurance.

A sub-mm resolution Complementary Metal Oxide Semiconductor sensor has been developed for stereotactic radiotherapy quality assurance. Herein we evaluate its basic dosimetric performance and its application for linac C-arm stereotactic body radiotherapy (SBRT) plan quality assurance. The detector was integrated into its accompanying phantom or in Water Equivalent Plastic (WEP). The measurement reproducibility, stability, dose linearity and dependence on angularity, dose rate and field size were investigated. Clinical plan measurements were compared to our radiotherapy treatment planning system and radiochromic film. Sensitivity to introduced Multi Leaf Collimator (MLC) offsets was evaluated by simulating single MLC offsets in SBRT plans and comparing measurements to expected doses. Signal reproducibility was within±0.1% and output calibration was stable over a 6month period. Detector showed good linearity with dose (r2=1). Signal decreased by 5% when dose rate was decreased from 1300 MU/min to 300 MU/min. Output factors agreed within 0.5% of chamber measurements for 1x1 cm field sizes or greater. Angularity measurements showed good agreement with reference. For measurement of planned clinical doses, gamma pass-rates were 98.5%±2.3% (treatment planning system reference, 2%/2mm) and 99.2%±1.0% (film reference, 2%,2mm). The detector also showed sensitivity to errors of 1mm offsets in MLC positioning. The detector performed well when used for pre-treatment SBRT plan quality assurance, offering a good alternative to radiochromic film.

Longitudinal assessment of quality assurance measurements in a 1.5T MR-linac: Part I-Linear accelerator.

PurposeTo describe and report longitudinal quality assurance (QA) measurements for the mechanical and dosimetric performance of an Elekta Unity MR‐linac during the first year of clinical use in our institution.Materials and methodsThe mechanical and dosimetric performance of the MR‐linac was evaluated with daily, weekly, monthly, and annual QA testing. The measurements monitor the size of the radiation isocenter, the MR‐to‐MV isocenter concordance, MLC and jaw position, the accuracy and reproducibility of step‐and‐shoot delivery, radiation output and beam profile constancy, and patient‐specific QA for the first 50 treatments in our institution. Results from end‐to‐end QA using anthropomorphic phantoms are also included as a reference for baseline comparisons. Measurements were performed in water or water‐equivalent plastic using ion chambers of various sizes, an ion chamber array, MR‐compatible 2D/3D diode array, portal imager, MRI, and radiochromic film.ResultsThe diameter of the radiation isocenter and the distance between the MR/MV isocenters was (μ ± σ) 0.39 ± 0.01 mm and 0.89 ± 0.05 mm, respectively. Trend analysis shows both measurements to be well within the tolerance of 1.0 mm. MLC and jaw positional accuracy was within 1.0 mm while the dosimetric performance of step‐and‐shoot delivery was within 2.0%, irrespective of gantry angle. Radiation output and beam profile constancy were within 2.0% and 1.0%, respectively. End‐to‐end testing performed with ion‐chamber and radiochromic film showed excellent agreement with treatment plan. Patient‐specific QA using a 3D diode array identified gantry angles with low‐pass rates allowing for improvements in plan quality after necessary adjustments.ConclusionThe MR‐linac operates within the guidelines of current recommendations for linear accelerator performance, stability, and safety. The analysis of the data supports the recently published guidance in establishing clinically acceptable tolerance levels for relative and absolute measurements.

Simultaneous Measurements of Dose and Microdosimetric Spectra in a Clinical Proton Beam Using a scCVD Diamond Membrane Microdosimeter.

A single crystal chemical vapor deposition (scCVD) diamond membrane-based microdosimetric system was used to perform simultaneous measurements of dose profile and microdosimetric spectra with the Y1 proton passive scattering beamline of the Center of Proton Therapy, Institute Curie in Orsay, France. To qualify the performance of the set-up in clinical conditions of hadrontherapy, the dose, dose rate and energy loss pulse-height spectra in a diamond microdosimeter were recorded at multiple points along depth of a water-equivalent plastic phantom. The dose-mean lineal energy () values were computed from experimental data and compared to silicon on insulator (SOI) microdosimeter literature results. In addition, the measured dose profile, pulse height spectra and values were benchmarked with a numerical simulation using TOPAS and Geant4 toolkits. These first clinical tests of a novel system confirm that diamond is a promising candidate for a tissue equivalent, radiation hard, high spatial resolution microdosimeter in beam quality assurance of proton therapy.

Use of a plastic scintillator detector for patient-specific quality assurance of VMAT SRS.

PurposeTo evaluate a scintillator detector for patient‐specific quality assurance of VMAT radiosurgery plans.MethodsThe detector was comprised of a 1 mm diameter, 1 mm high scintillator coupled to an acrylic optical fiber. Sixty VMAT SRS plans for treatment of single targets having sizes ranging from 3 mm to 30.2 mm equivalent diameter (median 16.3 mm) were selected. The plans were delivered to a 20 cm × 20 cm x 15 cm water equivalent plastic phantom having either the scintillator detector or radiochromic film at the center. Calibration films were obtained for each measurement session. The films were scanned and converted to dose using a 3‐channel technique.ResultsThe mean difference between scintillator and film was ‒0.45% (95% confidence interval ‒0.1% to 0.8%). For target equivalent diameter smaller than the median, the mean difference was 1.1% (95% confidence interval 0.5% to 1.7%). For targets larger than the median, the mean difference was ‒0.2% (95% confidence interval ‒0.7% to 0.1%). ConclusionsThe scintillator detector response is independent of target size for targets as small as 3 mm and is well‐suited for patient‐specific quality assurance of VMAT SRS plans. Further work is needed to evaluate the accuracy for VMAT plans that treat multiple targets using a single isocenter.

Evaluation of OARtrac Real-Time In Vivo Dosimetry for High Dose Rate Prostate Brachytherapy

Patient dose verification is an important part of radiation oncology; it gives the physician and physicist confidence that the treatment planning system is accurately calculating the dose the patient is receiving. There are several options available for external beam patient dosimetry, but due to high dose gradients around the source, there are few options for verifying dose in brachytherapy. OARtrac (AngioDynamics, Latham NY), a real-time in vivo dosimetry system that uses water equivalent micro plastic scintillating detectors (PSD), could be the solution to patient dose verification for brachytherapy. The goals of this project are to better understand the OARtrac in vivo dosimetry system and evaluate the feasibility of using the system for real-time in vivo dosimetry for high dose rate (HDR) brachytherapy.

Water-equivalence of ZrO2 doped polystyrene by Monte Carlo simulation

Objective To design water-equivalent plastic scintillator detector for the measurement of absorbed dose in tumor radiotherapy. Methods The concentration of ZrO2 to be doped in polystyrene was estimated according to the empirical formula, and then the Monte Carlo program Geant4 (GEometry And Tracking 4) was used to simulate the energy deposition and transport process of X-rays with different energies in water, solid water RW34 (composed of 2.1 wt% TiO2 doping polystyrene) and different concentrations of ZrO2 particles doped in polystyrene. The dose and attenuation coefficients were compared among different materials at different depths of water. Results The doses at different depths and the attenuation coefficient of polystyrene (doped with about 0.4 wt% ZrO2 nanoparticles) were much more consistent with those of water and even exhibit much better water-equivalence than RW34. Conclusions The simulation results provide the basis for the development of water-equivalent scintillator. Key words: Geant4; Water-equivalent; ZrO2nanoparticle; Polystyrene

A simple model for transit dosimetry based on a water equivalent EPID.

The aim of this study was to demonstrate a new model for implementing a transit dosimetry system as a means of invivo dose verification with a water equivalent electronic portal imaging device (WE-EPID) and a conventional treatment planning system (TPS). A standard amorphous silicon (a-Si) EPID was modified to a WE-EPID configuration by replacing the metal-plate/phosphor screen situated above the photodiode detector with a 3cm thick water equivalent plastic x ray converter material. A clinical TPS was used to calculate dose to the WE-EPID in its conventional EPID position behind the phantom/patient. The "extended phantom" concept was used to facilitate dose calculation at the EPID position, which is outside the CT field of view (FOV). The CT images were manipulated from 512×512 into 1024×1024 and padded pixels were assigned the density of air before importing to the TPS. The virtual WE-EPID was added as an RT structure of water density at the EPID plane. The accuracy of TPS dose calculations at the EPID plane in transit geometry was first evaluated for different field sizes and thickness of object in the beam by comparison with the dose measured using a 2D ion chamber array (ICA) and the WE-EPID. Following basic dose response tests, clinical fields including direct single fields (open and wedged) and modulated fields (integrated or control point by control point doses for VMAT) were measured for 6 MV photons with varying of solid water thickness or an anthropomorphic phantom present in beam. The EPID images were corrected for dark signal and pixel sensitivity and converted to dose using a single dose calibration factor. The 2D dose evaluation was conducted using 3%/3 and 2%/2mm gamma-index criteria. The measured dose-response with the ICA and WE-EPID for all basic dose-response tests agreed with TPS dose calculations to within 1.5%. The maximum difference in dose profiles for the largest measured field size of 25×25cm2 was 2.5%. Gamma evaluation showed at least 94% (3%/3mm criteria) and 90% (2%/2mm) agreement in both integrated and control-point doses for all clinical fields acquired by the WE-EPID and ICA when compared with TPS-calculated portal dose images. A new approach to transit dose verification has been demonstrated utilizing a water equivalent EPID and a commercial TPS. The accuracy of dose calculations at the EPID plane using a commercial TPS beam model was experimentally confirmed. The model proposed in this study provides an accurate method to directly verify doses delivered during treatment without the additional uncertainties inherent in modelling the complex dose-response of standard EPIDs.

A multicentre audit of HDR/PDR brachytherapy absolute dosimetry in association with the INTERLACE trial (NCT015662405)

A UK multicentre audit to evaluate HDR and PDR brachytherapy has been performed using alanine absolute dosimetry. This is the first national UK audit performing an absolute dose measurement at a clinically relevant distance (20 mm) from the source. It was performed in both INTERLACE (a phase III multicentre trial in cervical cancer) and non-INTERLACE brachytherapy centres treating gynaecological tumours. Forty-seven UK centres (including the National Physical Laboratory) were visited. A simulated line source was generated within each centre’s treatment planning system and dwell times calculated to deliver 10 Gy at 20 mm from the midpoint of the central dwell (representative of Point A of the Manchester system). The line source was delivered in a water-equivalent plastic phantom (Barts Solid Water) encased in blocks of PMMA (polymethyl methacrylate) and charge measured with an ion chamber at 3 positions (120° apart, 20 mm from the source). Absorbed dose was then measured with alanine at the same positions and averaged to reduce source positional uncertainties. Charge was also measured at 50 mm from the source (representative of Point B of the Manchester system). Source types included 46 HDR and PDR 192Ir sources, (7 Flexisource, 24 mHDR-v2, 12 GammaMed HDR Plus, 2 GammaMed PDR Plus, 1 VS2000) and 1 HDR 60Co source, (Co0.A86). Alanine measurements when compared to the centres’ calculated dose showed a mean difference (±SD) of +1.1% (±1.4%) at 20 mm. Differences were also observed between source types and dose calculation algorithm. Ion chamber measurements demonstrated significant discrepancies between the three holes mainly due to positional variation of the source within the catheter (0.4%–4.9% maximum difference between two holes). This comprehensive audit of absolute dose to water from a simulated line source showed all centres could deliver the prescribed dose to within 5% maximum difference between measurement and calculation.

Poster ‐ 16: Time‐resolved diode dosimetry for in vivo proton therapy range verification: calibration through numerical modeling

Purpose:A method to refine the implementation of an in vivo, adaptive proton therapy range verification methodology was investigated. Simulation experiments and in‐phantom measurements were compared to validate the calibration procedure of a time‐resolved diode dosimetry technique.Methods:A silicon diode array system has been developed and experimentally tested in phantom for passively scattered proton beam range verification by correlating properties of the detector signal to the water equivalent path length (WEPL). The implementation of this system requires a set of calibration measurements to establish a beam‐specific diode response to WEPL fit for the selected ‘scout’ beam in a solid water phantom. This process is both tedious, as it necessitates a separate set of measurements for every ‘scout’ beam that may be appropriate to the clinical case, as well as inconvenient due to limited access to the clinical beamline. The diode response to WEPL relationship for a given ‘scout’ beam may be determined within a simulation environment, facilitating the applicability of this dosimetry technique. Measurements for three ‘scout’ beams were compared against simulated detector response with Monte Carlo methods using the Tool for Particle Simulation (TOPAS).Results:Detector response in water equivalent plastic was successfully validated against simulation for spread out Bragg peaks of range 10 cm, 15 cm, and 21 cm (168 MeV, 177 MeV, and 210 MeV) with adjusted R2 of 0.998.Conclusion:Feasibility has been shown for performing calibration of detector response for a given ‘scout’ beam through simulation for the time resolved diode dosimetry technique.

SU-F-T-569: Implementation of a Patient Specific QA Method Using EBT-XD for CyberKnife SRS/SBRT Plans

Purpose: To implement the new EBT-XD Gafchromic films for accurate dosimetric and geometric validation of stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT) CyberKnife (CK) patient specific QA. Methods: Film calibration was performed using a triplechannel film analysis on an Epson 10000XL scanner. Calibration films were irradiated using a Varian Clinac 21EX flattened beam (0 to 20 Gy), to ensure sufficient dose homogeneity. Films were scanned to a resolution of 0.3 mm, 24 hours post irradiation following a well-defined protocol. A set of 12 QA was performed for several types of CK plans: trigeminal neuralgia, brain metastasis, prostate and lung tumors. A custom made insert for the CK head phantom has been manufactured to yield an accurate measured to calculated dose registration. When the high dose region was large enough, absolute dose was also measured with an ionization chamber. Dose calculation is performed using MultiPlan Ray-tracing algorithm for all cases since the phantom is mostly made from near water-equivalent plastic. Results: Good agreement (<2%) was found between the dose to the chamber and the film, when a chamber measurement was possible The average dose difference and standard deviations between film measurements and TPS calculations were respectively 1.75% and 3%. The geometric accuracy has been estimated to be <1 mm, combining robot positioning uncertainty and film registration to calculated dose. Conclusion: Patient specific QA measurements using EBT-XD films yielded a full 2D dose plane with high spatial resolution and acceptable dose accuracy. This method is particularly promising for trigeminal neuralgia plan QA, where the positioning of the spatial dose distribution is equally or more important than the absolute delivered dose to achieve clinical goals.

TH-CD-201-11: Optimizing the Response and Cost of a DNA Double-Strand Break Dosimeter

Purpose: A DNA double-strand break (DSB) dosimeter was developed to measure the biological effect of radiation. The goal here is to refine the fabrication method of this dosimeter to reproducibly create a low coefficient of variation (CoV) and reduce the cost for the dosimeter. Methods: Our dosimeter consists of 4 kilo-base pair DNA strands (labeled on one end with biotin and on the other with fluorescein) attached to streptavidin magnetic beads. The final step of the DNA dosimeter fabrication is to suspend these attached beads in phosphate-buffered saline (PBS). The amount of PBS used to suspend the attached beads and the relative volume of the DNA strands to the beads both affect the CoV and dosimeter cost. We diluted the beads attached with DNA in different volumes of PBS (100, 200, and 400 µL) to create different concentrations of the DNA dosimeter. Then we irradiated these dosimeters (50 µL samples) in a water-equivalent plastic phantom at 25 and 50 Gy (three samples per dose) and calculated the CoV for each dosimeter concentration. Also, we used different masses of DNA strands (1, 2, 8, 16, 24, and 32 µg) to attach to the same volume of magnetic beads (100 µL) to explore how this affects the cost of the dosimeter. Results: The lowest CoV was produced for the highest concentration of dosimeter (100 µL of PBS), which created CoV of 2.0 and 1.0% for 25 and 50 Gy, respectively. We found that the lowest production cost for the dosimeter occurs by attaching 16 µg of DNA strands with 100 µL of beads. Conclusion: : We optimized the fabrication of the DNA dosimeter to produce low CoV and cost, but we still need to explore ways to further improve the dosimeter for use at lower doses. This work was supported in part by Yarmouk University (Irbid, Jordan) and CPRIT (RP140105)

Use of electronic portal imaging devices for electron treatment verification

This study aims to help broaden the use of electronic portal imaging devices (EPIDs) for pre-treatment patient positioning verification, from photon-beam radiotherapy to photon- and electron-beam radiotherapy, by proposing and testing a method for acquiring clinically-useful EPID images of patient anatomy using electron beams, with a view to enabling and encouraging further research in this area. EPID images used in this study were acquired using all available beams from a linac configured to deliver electron beams with nominal energies of 6, 9, 12, 16 and 20 MeV, as well as photon beams with nominal energies of 6 and 10 MV. A widely-available heterogeneous, approximately-humanoid, thorax phantom was used, to provide an indication of the contrast and noise produced when imaging different types of tissue with comparatively realistic thicknesses. The acquired images were automatically calibrated, corrected for the effects of variations in the sensitivity of individual photodiodes, using a flood field image. For electron beam imaging, flood field EPID calibration images were acquired with and without the placement of blocks of water-equivalent plastic (with thicknesses approximately equal to the practical range of electrons in the plastic) placed upstream of the EPID, to filter out the primary electron beam, leaving only the bremsstrahlung photon signal. While the electron beam images acquired using a standard (unfiltered) flood field calibration were observed to be noisy and difficult to interpret, the electron beam images acquired using the filtered flood field calibration showed tissues and bony anatomy with levels of contrast and noise that were similar to the contrast and noise levels seen in the clinically acceptable photon beam EPID images. The best electron beam imaging results (highest contrast, signal-to-noise and contrast-to-noise ratios) were achieved when the images were acquired using the higher energy electron beams (16 and 20 MeV) when the EPID was calibrated using an intermediate (12 MeV) electron beam energy. These results demonstrate the feasibility of acquiring clinically-useful EPID images of patient anatomy using electron beams and suggest important avenues for future investigation, thus enabling and encouraging further research in this area. There is manifest potential for the EPID imaging method proposed in this work to lead to the clinical use of electron beam imaging for geometric verification of electron treatments in the future.

Daily QA of linear accelerators using only EPID and OBI.

As treatment delivery becomes more complex, there is a pressing need for robust quality assurance (QA) tools to improve efficiency and comprehensiveness while simultaneously maintaining high accuracy and sensitivity. This work aims to present the hardware and software tools developed for comprehensive QA of linear accelerator (LINAC) using only electronic portal imaging devices (EPIDs) and kV flat panel detectors. A daily QA phantom, which includes two orthogonally positioned phantoms for QA of MV-beams and kV onboard imaging (OBI) is suspended from the gantry accessory holder to test both geometric and dosimetric components of a LINAC and an OBI. The MV component consists of a 0.5 cm water-equivalent plastic sheet incorporating 11 circular steel plugs for transmission measurements through multiple thicknesses and one resolution plug for MV-image quality testing. The kV-phantom consists of a Leeds phantom (TOR-18 FG phantom supplied by Varian) for testing low and high contrast resolutions. In the developed process, the existing LINAC tools were used to automate daily acquisition of MV and kV images and software tools were developed for simultaneous analysis of these images. A method was developed to derive and evaluate traditional QA parameters from these images [output, flatness, symmetry, uniformity, TPR20/10, and positional accuracy of the jaws and multileaf collimators (MLCs)]. The EPID-based daily QA tools were validated by performing measurements on a detuned 6 MV beam to test its effectiveness in detecting errors in output, symmetry, energy, and MLC positions. The developed QA process was clinically commissioned, implemented, and evaluated on a Varian TrueBeam LINAC (Varian Medical System, Palo Alto, CA) over a period of three months. Machine output constancy measured with an EPID (as compared against a calibrated ion-chamber) is shown to be within ±0.5%. Beam symmetry and flatness deviations measured using an EPID and a 2D ion-chamber array agree within ±0.5% and ±1.2% for crossline and inline profiles, respectively. MLC position errors of 0.5 mm can be detected using a picket fence test. The field size and phantom positioning accuracy can be determined within 0.5 mm. The entire daily QA process takes ∼15 min to perform tests for 5 photon beams, MLC tests, and imaging checks. The exclusive use of EPID-based QA tools, including a QA phantom and simultaneous analysis software tools, has been demonstrated as a viable, efficient, and comprehensive process for daily evaluation of LINAC performance.

Acceptance, commissioning and clinical use of the WOmed T-200 kilovoltage X-ray therapy unit.

The objective of this work was to characterize the performance of the WOmed T-200-kilovoltage (kV) therapy machine. Mechanical functionality, radiation leakage, alignment and interlocks were investigated. Half-value layers (HVLs) (first and second HVLs) from X-ray beams generated from tube potentials between 30 and 200 kV were measured. Reference dose was determined in water. Beam start-up characteristics, dose linearity and reproducibility, beam flatness, and uniformity as well as deviations from inverse square law were assessed. Relative depth doses (RDDs) were determined in water and water-equivalent plastic. The quality assurance program included a dosimetry audit with thermoluminescent dosemeters. All checks on machine performance were satisfactory. HVLs ranged between 0.45-4.52 mmAl and 0.69-1.78 mmCu. Dose rates varied between 0.2 and 3 Gy min(-1) with negligible time-end errors. There were differences in measured RDDs from published data. Beam outputs were confirmed with the dosimetry audit. The use of published backscatter factors was implemented to account for changes in phantom scatter for treatments with irregularly shaped fields. Guidance on the determination of HVL and RDD in kV beams can be contradictory. RDDs were determined through measurement and curve fitting. These differed from published RDD data, and the differences observed were larger in the low-kV energy range. This article reports on the comprehensive and novel approach to the acceptance, commissioning and clinical use of a modern kV therapy machine. The challenges in the dosimetry of kV beams faced by the medical physicist in the clinic are highlighted.

TH-CD-304-08: Small Air-Gaps Affect the Response of Ionization Chambers in the Presence of a 1.5 T Magnetic Field

Purpose: Small air-gaps surrounding ionization chambers (ICs) are unavoidable if ICs are used in plastic phantoms. Here we show that air-gaps affect the response of ICs in a 1.5 T magnetic (B-)field from a MR-linac. Methods: We used NE2571 and PTW30013 Farmer chambers with and without a 1.5 T B-field for measurements and Monte Carlo simulations. For measurements, the chambers were exposed in water-equivalent plastic and water phantoms at the University Medical Center Utrecht in a 1.5 T MR-linac and an Elekta Precise linac. The NE2571 Farmer chamber was modeled with Geant4 at a 10 cm depth in a water phantom with a 1.5 T B-field with a beam modeled from a 10×10 cm2 Elekta SL25 6 MV energy spectrum. The detector model was positioned on the central-axis with a cylindrical air block surrounding it (symmetric) or beside it (asymmetric). The chamber cavity dose was calculated for a range of air-gap thicknesses. Chamber, beam and B-field were all orthogonal. Results: To experimentally change the distribution of air-gaps surrounding the chamber in the plastic phantom we rotated the chamber about its cylindrical axis. Variations of 1.8% and 1.3% were observed in the response of the NE2571 and PTW30013 ICs, respectively, in the presence of a B-field. No effect was observed when it was exposed in water instead of plastic or in plastic but without the B-field. The symmetric simulations show that the chamber cavity dose decreases as the air-gap thickness increases. The effect is >1% for thicknesses >1 mm. For a 0.25 mm asymmetric air-gap the dose-response varied by up to 2.2% depending on air-gap orientation. These effects disappear when no B-field is modeled. Conclusion: Small air-gaps surrounding a Farmer chamber may affect its response by over 1% when the chamber is exposed in the presence of a 1.5 T B-field. Funding provided by Elekta Limited.