bluuebunny/crossref_metadata_2025 huggingface dataset:
Dosimetric evaluation of the Acuros XB algorithm for a 4 MV photon beam in head and neck intensity‐modulated radiation therapy
Authors: Hirata Kimiko , Nakamura Mitsuhiro , Yoshimura Michio , Mukumoto Nobutaka , Nakata Manabu , Ito Hitoshi , Inokuchi Haruo , Matsuo Yukinori , Mizowaki Takashi , Hiraoka Masahiro
Published: February 2017

In this study, we assessed the differences in the dose distribution of a 4 MV photon beam among different calculation algorithms: the Acuros XB (AXB) algorithm, the analytic anisotropic algorithm (AAA), and the pencil beam convolution (PBC) algorithm (ver. 11.0.31), in phantoms and in clinical intensity‐modulated radiation therapy (IMRT) plans. Homogeneous and heterogeneous, including middle‐, low‐, and high‐density, phantoms were combined to assess the percentage depth dose and lateral dose profiles among AXB, AAA, and PBC. For the phantom containing the low‐density area, AXB was in agreement with measurement within 0.5%, while the greatest differences between the AAA and PBC calculations and measurement were 2.7% and 3.6%, respectively. AXB showed agreement with measurement within 2.5% at the high‐density area, while AAA and PBC overestimated the dose by more than 4.5% and 4.0%, respectively. Furthermore, 15 IMRT plans, calculated using AXB, for oropharyngeal, hypopharyngeal, and laryngeal carcinomas were analyzed. The dose prescription was 70 Gy to 50% of the planning target volume (). Subsequently, each plan was recalculated using AAA and PBC while maintaining the AXB‐calculated monitor units, leaf motion, and beam arrangement. Additionally, nine hypopharyngeal and laryngeal cancer patients were analyzed in terms of for cartilaginous structures (). The doses covering 50% to calculated by AAA and PBC were and significantly higher than those using AXB, respectively (). The increases in doses to calculated by AAA and PBC relative to AXB were 3.9% and 5.3% on average, respectively, and were relatively greater than those in the entire . AXB was found to be in better agreement with measurement in phantoms in heterogeneous areas for the 4 MV photon beam. Considering AXB as the standard, AAA and PBC overestimated the IMRT dose for head and neck cancer. The dosimetric differences should not be ignored, particularly with cartilaginous structures in PTV.

PACS number: 87.55.‐x, 87.55.dk, 87.55.kd
Robotic radiosurgery system patient‐specific QA for extracranial treatments using the planar ion chamber array and the cylindrical diode array
Authors: Lin Mu‐Han , Veltchev Iavor , Koren Sion , Ma Charlie , Li Jinsgeng
Published: February 2017

Robotic radiosurgery system has been increasingly employed for extracranial treatments. This work is aimed to study the feasibility of a cylindrical diode array and a planar ion chamber array for patient‐specific QA with this robotic radiosurgery system and compare their performance. Fiducial markers were implanted in both systems to enable image‐based setup. An in‐house program was developed to postprocess the movie file of the measurements and apply the beam‐by‐beam angular corrections for both systems. The impact of noncoplanar delivery was then assessed by evaluating the angles created by the incident beams with respect to the two detector arrangements and cross‐comparing the planned dose distribution to the measured ones with/without the angular corrections. The sensitivity of detecting the translational (1–3 mm) and the rotational (1°–3°) delivery errors were also evaluated for both systems. Six extracranial patient plans (PTV 7–137 cm3) were measured with these two systems and compared with the calculated doses. The plan dose distributions were calculated with ray‐tracing and the Monte Carlo (MC) method, respectively. With 0.8 by 0.8 mm2 diodes, the output factors measured with the cylindrical diode array agree better with the commissioning data. The maximum angular correction for a given beam is 8.2% for the planar ion chamber array and 2.4% for the cylindrical diode array. The two systems demonstrate a comparable sensitivity of detecting the translational targeting errors, while the cylindrical diode array is more sensitive to the rotational targeting error. The MC method is necessary for dose calculations in the cylindrical diode array phantom because the ray‐tracing algorithm fails to handle the high‐Z diodes and the acrylic phantom. For all the patient plans, the cylindrical diode array/ planar ion chamber array demonstrate passing rates. The feasibility of using both systems for robotic radiosurgery system patient‐specific QA has been demonstrated. For gamma evaluation, criteria for cylindrical diode array and criteria for planar ion chamber array are suggested. The customized angular correction is necessary as proven by the improved passing rate, especially with the planar ion chamber array system.

PACS number: 29.40.‐n
Utilization of optical tracking to assess efficacy of intracranial immobilization techniques in proton therapy
Authors: His Wen C. , Schreuder Andries N. , Zeidan Omar
Published: February 2017

We present a quantitative methodology to measure head interfraction movements within intracranial masks of commercial immobilization devices used for proton radiotherapy. A three‐points tracking (3PtTrack) method was developed to measure the mask location for each treatment field over an average of 10 fractions for seven patients. Five patients were treated in supine with the Qfix Base‐of‐Skull (BoS) headframe, and two patients were treated in prone with the CIVCO Uni‐frame baseplate. Patients were first localized by an in‐room, image‐guidance (IG) system, and then the mask location was measured using the 3PtTrack method. Measured mask displacements from initial location at the first fraction are considered equivalent to the head interfraction movement within the mask. The trends of head movements and couch displacements and rotation were analyzed in three major directions. The accuracy of 3PtTrack method was shown to be within 1.0 mm based on daily measurements of a QA device after localization by the IG system for a period of three months. For seven patients, mean values of standard deviation (SD) in anterior–posterior, lateral, and superior–inferior directions were 1.1 mm, 1.4 mm, and 1.6 mm for head movements, and were 1.4 mm, 1.8 mm, and 3.4 mm for couch displacements. The mean SD values of couch rotations were 1.1°, 0.9°, and 1.1° for yaw, pitch, and roll, respectively. The overall patterns of head movements and couch displacements were similar for patients treated in either supine or prone, with larger deviations in the superior–inferior (SI) direction. A suboptimal mask fixation to the frame of the mask to the H&N frame is likely the cause for the observed larger head movements and couch displacements in the SI direction compared to other directions. The optical‐tracking methodology provided a quantitative assessment of the magnitude of head motion.

PACS number: 87.55.km
Optimum radiation source for radiation therapy of skin cancer
Authors: Safigholi Habib , Song William Y. , Meigooni Ali S.
Published: February 2017

Several different applicators have been designed for treatment of skin cancers, such as scalp, hand, and legs using Ir‐192 HDR brachytherapy sources (IR‐HDRS), miniature electronic brachytherapy sources (eBT), and external electron beam radiation therapy (EEBRT). Although, all of these methodologies may deliver the desired radiation dose to the skin, but the dose to the underlying bone may become the limiting factor for selection of the optimum treatment technique. In this project, dose to the underlying bone has been evaluated as a function of the radiation type, thickness of the bone, and thickness of the soft tissue on top of bone, assuming the same radiation dose delivery to the skin. These evaluations are performed using Monte Carlo (MC) simulation technique with MCNP5 code. The results of these investigations indicate that, for delivery of the same skin dose with a 50 keV eBT, 4 MeV or 6 MeV EEBRT techniques, the average doses received by the underlying bones are 5.31, 2, or 1.75 times the dose received from IR‐HDRS technique, respectively. These investigations indicate that, for the treatment of skin cancer condition with bone immediately beneath skin, the eBT technique may not be the most suitable technique, as it may lead to excessive bone dose relative to IR‐HDRS and 6 MeV or 4 MeV electron beams.

PACS number: 87.53.Jw, 87.55.K‐
AAPM Medical Physics Practice Guideline 5.a.: Commissioning and QA of Treatment Planning Dose Calculations — Megavoltage Photon and Electron Beams
Authors: Smilowitz Jennifer B. , Das Indra J. , Feygelman Vladimir , Fraass Benedick A. , Kry Stephen F. , Marshall Ingrid R. , Mihailidis Dimitris N. , Ouhib Zoubir , Ritter Timothy , Snyder Michael G. , Fairobent Lynne
Published: February 2017

The American Association of Physicists in Medicine (AAPM) is a nonprofit professional society whose primary purposes are to advance the science, education and professional practice of medical physics. The AAPM has more than 8,000 members and is the principal organization of medical physicists in the United States.

The AAPM will periodically define new practice guidelines for medical physics practice to help advance the science of medical physics and to improve the quality of service to patients throughout the United States. Existing medical physics practice guidelines will be reviewed for the purpose of revision or renewal, as appropriate, on their fifth anniversary or sooner.

Each medical physics practice guideline represents a policy statement by the AAPM, has undergone a thorough consensus process in which it has been subjected to extensive review, and requires the approval of the Professional Council. The medical physics practice guidelines recognize that the safe and effective use of diagnostic and therapeutic radiology requires specific training, skills, and techniques, as described in each document. Reproduction or modification of the published practice guidelines and technical standards by those entities not providing these services is not authorized.

The following terms are used in the AAPM practice guidelines:

Must and Must Not: Used to indicate that adherence to the recommendation is considered necessary to conform to this practice guideline.

Should and Should Not: Used to indicate a prudent practice to which exceptions may occasionally be made in appropriate circumstances.
Evaluation of the dosimetric properties of a diode detector for small field proton radiosurgery
Authors: McAuley Grant A. , Teran Anthony V. , Slater Jerry D. , Slater James M. , Wroe Andrew J.
Published: February 2017

The small fields and sharp gradients typically encountered in proton radiosurgery require high spatial resolution dosimetric measurements, especially below 1–2 cm diameters. Radiochromic film provides high resolution, but requires postprocessing and special handling. Promising alternatives are diode detectors with small sensitive volumes (SV) that are capable of high resolution and real‐time dose acquisition. In this study we evaluated the PTW PR60020 proton dosimetry diode using radiation fields and beam energies relevant to radiosurgery applications. Energies of 127 and 157 MeV (9.7 to 15 cm range) and initial diameters of 8, 10, 12, and 20 mm were delivered using single‐stage scattering and four modulations (0, 15, 30, and 60 mm) to a water tank in our treatment room. Depth dose and beam profile data were compared with PTW Markus N23343 ionization chamber, EBT2 Gafchromic film, and Monte Carlo simulations. Transverse dose profiles were measured using the diode in "edge‐on" orientation or EBT2 film. Diode response was linear with respect to dose, uniform with dose rate, and showed an orientation‐dependent (i.e., beam parallel to, or perpendicular to, detector axis) response of less than 1%. Diode vs. Markus depth‐dose profiles, as well as Markus relative dose ratio vs. simulated dose‐weighted average lineal energy plots, suggest that any LET‐dependent diode response is negligible from particle entrance up to the very distal portion of the SOBP for the energies tested. Finally, while not possible with the ionization chamber due to partial volume effects, accurate diode depth‐dose measurements of 8, 10, and 12 mm diameter beams were obtained compared to Monte Carlo simulations. Because of the small SV that allows measurements without partial volume effects and the capability of submillimeter resolution (in edge‐on orientation) that is crucial for small fields and high‐dose gradients (e.g., penumbra, distal edge), as well as negligible LET dependence over nearly the full the SOBP, the PTW proton diode proved to be a useful high‐resolution, real‐time metrology device for small proton field radiation measurements such as would be encountered in radiosurgery applications.

PACS numbers: 87.56.‐v, 87.56.jf, 87.56.Fc
Quantification of dose differences between two versions of Acuros XB algorithm compared to Monte Carlo simulations — the effect on clinical patient treatment planning
Authors: Ojala Jarkko , Kapanen Mika
Published: February 2017

A commercialized implementation of linear Boltzmann transport equation solver, the Acuros XB algorithm (AXB), represents a class of most advanced type ‘c’ photon radiotherapy dose calculation algorithms. The purpose of the study was to quantify the effects of the modifications implemented in the more recent version 11 of the AXB (AXB11) compared to the first commercial implementation, version 10 of the AXB (AXB10), in various anatomical regions in clinical treatment planning. Both versions of the AXB were part of Varian's Eclipse clinical treatment planning system and treatment plans for 10 patients were created using intensity‐modulated radiotherapy (IMRT) and volumetric‐modulated arc radiotherapy (VMAT). The plans were first created with the AXB10 and then recalculated with the AXB11 and full Monte Carlo (MC) simulations. Considering the full MC simulations as reference, a DVH analysis for gross tumor and planning target volumes (GTV and PTV) and organs at risk was performed, and also 3D gamma agreement index (GAI) values within a 15% isodose region and for the PTV were determined. Although differences up to 12% in DVH analysis were seen between the MC simulations and the AXB, based on the results of this study no general conclusion can be drawn that the modifications made in the AXB11 compared to the AXB10 would imply that the dose calculation accuracy of the AXB10 would be inferior to the AXB11 in the clinical patient treatment planning. The only clear improvement with the AXB11 over the AXB10 is the dose calculation accuracy in air cavities. In general, no large deviations are present in the DVH analysis results between the two versions of the algorithm, and the results of 3D gamma analysis do not favor one or the other. Thus it may be concluded that the results of the comprehensive studies assessing the accuracy of the AXB10 may be extended to the AXB11.

PACS numbers: 87.55.‐x, 87.55.D‐, 87.55.K‐, 87.55.kd, 87.55.Qr
Feasibility of portal dosimetry for flattening filter‐free radiotherapy
Authors: Chuter Robert W. , Rixham Philip A. , Weston Steve J. , Cosgrove Vivian P.
Published: February 2017

The feasibility of using portal dosimetry (PD) to verify 6 MV flattening filter‐free (FFF) IMRT treatments was investigated. An Elekta Synergy linear accelerator with an Agility collimator capable of delivering FFF beams and a standard iViewGT amorphous silicon (aSi) EPID panel (RID 1640 AL5P) at a fixed SSD of 160 cm were used. Dose rates for FFF beams are up to four times higher than for conventional flattened beams, meaning images taken at maximum FFF dose rate can saturate the EPID. A dose rate of 800 MU/min was found not to saturate the EPID for open fields. This dose rate was subsequently used to characterize the EPID for FFF portal dosimetry. A range of open and phantom fields were measured with both an ion chamber and the EPID, to allow comparison between the two. The measured data were then used to create a model within The Nederlands Kanker Instituut's (NKI's) portal dosimetry software. The model was verified using simple square fields with a range of field sizes and phantom thicknesses. These were compared to calculations performed with the Monaco treatment planning system (TPS) and isocentric ion chamber measurements. It was found that the results for the FFF verification were similar to those for flattened beams with testing on square fields, indicating a difference in dose between the TPS and portal dosimetry of approximately 1%. Two FFF IMRT plans (prostate and lung SABR) were delivered to a homogeneous phantom and showed an overall dose difference at isocenter of and good agreement between the TPS and PD dose distributions. The feasibility of using the NKI software without any modifications for high‐dose‐rate FFF beams and using a standard EPID detector has been investigated and some initial limitations highlighted.

PACS number: 87.55.Qr
Percentage depth dose calculation accuracy of model based algorithms in high energy photon small fields through heterogeneous media and comparison with plastic scintillator dosimetry
Authors: Alagar Ananda Giri Babu , Mani Ganesh Kadirampatti , Karunakaran Kaviarasu
Published: February 2017

Small fields smaller than are used in stereotactic and conformal treatments where heterogeneity is normally present. Since dose calculation accuracy in both small fields and heterogeneity often involves more discrepancy, algorithms used by treatment planning systems (TPS) should be evaluated for achieving better treatment results. This report aims at evaluating accuracy of four model‐based algorithms, X‐ray Voxel Monte Carlo (XVMC) from Monaco, Superposition (SP) from CMS‐Xio, AcurosXB (AXB) and analytical anisotropic algorithm (AAA) from Eclipse are tested against the measurement. Measurements are done using Exradin W1 plastic scintillator in Solid Water phantom with heterogeneities like air, lung, bone, and aluminum, irradiated with 6 and 15 MV photons of square field size ranging from 1 to 4 cm2. Each heterogeneity is introduced individually at two different depths from depth‐of‐dose maximum (Dmax), one setup being nearer and another farther from the Dmax. The central axis percentage depth‐dose (CADD) curve for each setup is measured separately and compared with the TPS algorithm calculated for the same setup. The percentage normalized root mean squared deviation (%NRMSD) is calculated, which represents the whole CADD curve's deviation against the measured. It is found that for air and lung heterogeneity, for both 6 and 15 MV, all algorithms show maximum deviation for field size and gradually reduce when field size increases, except for AAA. For aluminum and bone, all algorithms' deviations are less for 15 MV irrespective of setup. In all heterogeneity setups, field showed maximum deviation, except in 6 MV bone setup. All algorithms in the study, irrespective of energy and field size, when any heterogeneity is nearer to Dmax, the dose deviation is higher compared to the same heterogeneity far from the Dmax. Also, all algorithms show maximum deviation in lower‐density materials compared to high‐density materials.

PACS numbers: 87.53.Bn, 87.53.kn, 87.56.bd, 87.55.Kd, 87.56.jf
Investigation of optimal display size for viewing T1‐weighted MR images of the brain using a digital contrast‐detail phantom
Authors: Fujita Hideki , Kuwahata Nao , Hattori Hiroyuki , Kinoshita Hiroshi , Fukuda Haruyuki
Published: February 2017

We clarified the relationship between the display size of MRI images and observer performance using a digital contrast‐detail (d‐CD) phantom. The d‐CD phantom was developed using Microsoft Visual Basic 2010 Express. It had a matrix in size and a total of 100 holes, whose diameter increased stepwise from 4 to 40 pixels with a 4‐pixel interval in the vertical direction; the contrast varied stepwise in the horizontal direction. The digital driving level (DDL) of the background, the width of the DDL, and the contrast were adjustable. These parameters were determined on the basis of the actual T1‐weighted magnetic resonance (MR) images of the brain. In this study, the DDL, width, and contrast were set to 85, 20, and 1, respectively. The observer performance study was performed for three different display sizes ( as the enlarged size, as the original size, and as the reduced size) using a 2‐megapixel color liquid crystal display monitor, and it was analyzed using Friedman and Wilcoxon statistical tests. The observer performances for the original display and the reduced display sizes were superior to that observed for the enlarged size, whereas there was no significant difference between the original display and reduced display sizes . Evaluation with the digital phantom simulating MR imaging also revealed that the original and reduced display sizes were superior to the enlarged display size in observer performance. The d‐CD phantom enables a short‐term evaluation of observer performance and is useful in analyzing relationship between display size and observer performance.

PACS number: 87.57.‐s
Spatially fractionated radiotherapy (GRID) using helical tomotherapy
Authors: Zhang Xin , Penagaricano Jose , Yan Yulong , Liang Xiaoying , Morrill Steven , Griffin Robert J. , Corry Peter , Ratanatharathorn Vaneerat
Published: February 2017

Spatially fractionated radiotherapy (GRID) was designed to treat large tumors while sparing skin, and it is usually delivered with a linear accelerator using a commercially available block or multileaf collimator (LINAC‐GRID). For deep‐seated (skin to tumor distance ) tumors, it is always a challenge to achieve adequate tumor dose coverage. A novel method to perform GRID treatment using helical tomotherapy (HT‐GRID) was developed at our institution. Our approach allows treating patients by generating a patient‐specific virtual GRID block (software‐generated) and using IMRT technique to optimize the treatment plan. Here, we report our initial clinical experience using HT‐GRID, and dosimetric comparison results between HT‐GRID and LINAC‐GRID. This study evaluates 10 previously treated patients who had deep‐seated bulky tumors with complex geometries. Five of these patients were treated with HT‐GRID and replanned with LINAC‐GRID for comparison. Similarly, five other patients were treated with LINAC‐GRID and replanned with HT‐GRID for comparison. The prescription was set such that the maximum dose to the GTV is 20 Gy in a single fraction. Dosimetric parameters compared included: mean GTV dose (), GTV dose inhomogeneity (valley‐to‐peak dose ratio (VPR)), normal tissue doses (), and other organs‐at‐risk (OARs) doses. In addition, equivalent uniform doses (EUD) for both GTV and normal tissue were evaluated. In summary, HT‐GRID technique is patient‐specific, and allows adjustment of the GRID pattern to match different tumor sizes and shapes when they are deep‐seated and cannot be adequately treated with LINAC‐GRID. HT‐GRID delivers a higher , EUD, and VPR compared to LINAC‐GRID. HT‐GRID delivers a higher and lower EUD for normal tissue compared to LINAC‐GRID. HT‐GRID plans also have more options for tumors with complex anatomical relationships between the GTV and the avoidance OARs (abutment or close proximity).

PACS numbers: 87.55.D, 87.55.de, 87.55.ne, 87.55.tg
Dose calculation for hypofractionated volumetric‐modulated arc therapy: approximating continuous arc delivery and tongue‐and‐groove modeling*
Authors: Yang Jie , Tang Grace , Zhang Pengpeng , Hunt Margie , Lim Seng B. , LoSasso Thomas , Mageras Gig
Published: February 2017

Hypofractionated treatments generally increase the complexity of a treatment plan due to the more stringent constraints of normal tissues and target coverage. As a result, treatment plans contain more modulated MLC motions that may require extra efforts for accurate dose calculation. This study explores methods to minimize the differences between in‐house dose calculation and actual delivery of hypofractionated volumetric‐modulated arc therapy (VMAT), by focusing on arc approximation and tongue‐and‐groove (TG) modeling. For dose calculation, the continuous delivery arc is typically approximated by a series of static beams with an angular spacing of 2°. This causes significant error when there is large MLC movement from one beam to the next. While increasing the number of beams will minimize the dose error, calculation time will increase significantly. We propose a solution by inserting two additional apertures at each of the beam angle for dose calculation. These additional apertures were interpolated at two‐thirds’ degree before and after each beam. Effectively, there were a total of three MLC apertures at each beam angle, and the weighted average fluence from the three apertures was used for calculation. Because the number of beams was kept the same, calculation time was only increased by about 6%‐8%. For a lung plan, areas of high local dose differences () between film measurement and calculation with one aperture were significantly reduced in calculation with three apertures. Ion chamber measurement also showed similar results, where improvements were seen with calculations using additional apertures. Dose calculation accuracy was further improved for TG modeling by developing a sampling method for beam fluence matrix. Single element point sampling for fluence transmitted through MLC was used for our fluence matrix with 1 mm resolution. For Varian HDMLC, grid alignment can cause fluence sampling error. To correct this, transmission volume averaging was applied. For three paraspinal HDMLC cases, the average dose difference was greatly reduced in film and calculation comparisons with our new approach. The gamma (3%, 3 mm) pass rates have improved significantly from 74.1%, 90.0%, and 90.4% to 99.2%, 97.9%, and 97.3% for three cases, for calculation without volume averaging and calculation with volume averaging, respectively. Our results indicate that more accurate MLC leaf position and transmission sampling can improve accuracy and agreement between calculation and measurement, and are particularly important for hypofractionated VMAT that consists of large MLC movement.

PACS number(s): 87.55.kd
Going the distance: validation of Acuros and AAA at an extended SSD of 400 cm
Authors: Lamichhane Narottam , Patel Vivek N. , Studenski Matthew T.
Published: February 2017

Accurate dose calculation and treatment delivery is essential for total body irradiation (TBI). In an effort to verify the accuracy of TBI dose calculation at our institution, we evaluated both the Varian Eclipse AAA and Acuros algorithms to predict dose distributions at an extended source‐to‐surface distance (SSD) of 400 cm. Measurements were compared to calculated values for a 6 MV beam in physical and virtual phantoms at 400 cm SSD using open beams for both and field sizes. Inline and crossline profiles were acquired at equivalent depths of 5 cm, 10 cm, and 20 cm. Depth‐dose curves were acquired using EBT2 film and an ion chamber for both field sizes. Finally, a RANDO phantom was used to simulate an actual TBI treatment. At this extended SSD, care must be taken using the planning system as there is good relative agreement between measured and calculated profiles for both algorithms, but there are deviations in terms of the absolute dose. Acuros has better agreement than AAA in the penumbra region.

PACS number(s): 87.55.kd
A software tool of digital tomosynthesis application for patient positioning in radiotherapy
Authors: Yan Hui , Dai Jian‐Rong
Published: February 2017

Digital Tomosynthesis (DTS) is an image modality in reconstructing tomographic images from two‐dimensional kV projections covering a narrow scan angles. Comparing with conventional cone‐beam CT (CBCT), it requires less time and radiation dose in data acquisition. It is feasible to apply this technique in patient positioning in radiotherapy. To facilitate its clinical application, a software tool was developed and the reconstruction processes were accelerated by graphic processing unit (GPU). Two reconstruction and two registration processes are required for DTS application which is different from conventional CBCT application which requires one image reconstruction process and one image registration process. The reconstruction stage consists of productions of two types of DTS. One type of DTS is reconstructed from cone‐beam (CB) projections covering a narrow scan angle and is named onboard DTS (ODTS), which represents the real patient position in treatment room. Another type of DTS is reconstructed from digitally reconstructed radiography (DRR) and is named reference DTS (RDTS), which represents the ideal patient position in treatment room. Prior to the reconstruction of RDTS, The DRRs are reconstructed from planning CT using the same acquisition setting of CB projections. The registration stage consists of two matching processes between ODTS and RDTS. The target shift in lateral and longitudinal axes are obtained from the matching between ODTS and RDTS in coronal view, while the target shift in longitudinal and vertical axes are obtained from the matching between ODTS and RDTS in sagittal view. In this software, both DRR and DTS reconstruction algorithms were implemented on GPU environments for acceleration purpose. The comprehensive evaluation of this software tool was performed including geometric accuracy, image quality, registration accuracy, and reconstruction efficiency. The average correlation coefficient between DRR/DTS generated by GPU‐based algorithm and CPU‐based algorithm is 0.99. Based on the measurements of cube phantom on DTS, the geometric errors are within 0.5 mm in three axes. For both cube phantom and pelvic phantom, the registration errors are within 0.5 mm in three axes. Compared with reconstruction performance of CPU‐based algorithms, the performances of DRR and DTS reconstructions are improved by a factor of 15 to 20. A GPU‐based software tool was developed for DTS application for patient positioning of radiotherapy. The geometric and registration accuracy met the clinical requirement in patient setup of radiotherapy. The high performance of DRR and DTS reconstruction algorithms was achieved by the GPU‐based computation environments. It is a useful software tool for researcher and clinician in evaluating DTS application in patient positioning of radiotherapy.

PACS number(s): 87.57.nf
Time‐resolved beam symmetry measurement for VMAT commissioning and quality assurance
Authors: Barnes Michael P. , Greer Peter B.
Published: February 2017

In volumetric‐modulated arc therapy (VMAT) treatment delivery perfect beam symmetry is assumed by the planning system. This study aims to test this assumption and present a method of measuring time‐resolved beam symmetry measurement during a VMAT delivery that includes extreme variations of dose rate and gantry speed. The Sun Nuclear IC Profiler in gantry mount was used to measure time‐resolved in‐plane and cross‐plane profiles during plan delivery from which symmetry could be determined. Time‐resolved symmetry measurements were performed throughout static field exposures at cardinal gantry angles, conformal arcs with constant dose rate and gantry speed, and during a VMAT test plan with gantry speed and dose rate modulation. Measurements were performed for both clockwise and counterclockwise gantry rotation and across four Varian 21iX linacs. The symmetry was found to be generally constant throughout the static field exposures to within 0.3% with an exception on one linac of up to 0.7%. Agreement in symmetry between cardinal angles was always within 1.0% and typically within 0.6%. During conformal arcs the results for clockwise and counterclockwise rotation were in agreement to within 0.3%. Both clockwise and counterclockwise tended to vary in similar manner by up to 0.5% during arc consistent with the cardinal gantry angle static field results. During the VMAT test plan the symmetry generally was in agreement with the conformal arc results. Greater variation in symmetry was observed in the low‐dose‐rate regions by up to 1.75%. All results were within clinically acceptable levels using the tolerances of NCS Report 24 (2015).

PACS number(s): 87.55.Qr
Electron beam energy QA — a note on measurement tolerances
Authors: Meyer Juergen , Nyflot Matthew J. , Smith Wade P. , Wootton Landon S. , Young Lori , Yang Fei , Kim Minsun , Hendrickson Kristi R. G. , Ford Eric , Kalet Alan M. , Cao Ning , Dempsey Claire , Sandison George A.
Published: February 2017

Monthly QA is recommended to verify the constancy of high‐energy electron beams generated for clinical use by linear accelerators. The tolerances are defined as in beam penetration according to AAPM task group report 142. The practical implementation is typically achieved by measuring the ratio of readings at two different depths, preferably near the depth of maximum dose and at the depth corresponding to half the dose maximum. Based on beam commissioning data, we show that the relationship between the ranges of energy ratios for different electron energies is highly nonlinear. We provide a formalism that translates measurement deviations in the reference ratios into change in beam penetration for electron energies for six Elekta (6‐18 MeV) and eight Varian (6‐22 MeV) electron beams. Experimental checks were conducted for each Elekta energy to compare calculated values with measurements, and it was shown that they are in agreement. For example, for a 6 MeV beam a deviation in the measured ionization ratio of might still be acceptable (i.e., be within ), whereas for an 18 MeV beam the corresponding tolerance might be . These values strongly depend on the initial ratio chosen. In summary, the relationship between differences of the ionization ratio and the corresponding beam energy are derived. The findings can be translated into acceptable tolerance values for monthly QA of electron beam energies.

PACS number(s): 87.55, 87.56
Quantitative evaluation of patient setup uncertainty of stereotactic radiotherapy with the frameless 6D ExacTrac system using statistical modeling
Authors: Keeling Vance , Hossain Sabbir , Jin Hosang , Algan Ozer , Ahmad Salahuddin , Ali Imad
Published: February 2017

The purpose of this study is to evaluate patient setup accuracy and quantify individual and cumulative positioning uncertainties associated with different hardware and software components of the stereotactic radiotherapy (SRS/SRT) with the frameless 6D ExacTrac system. A statistical model is used to evaluate positioning uncertainties of the different components of SRS/SRT treatment with the Brainlab 6D ExacTrac system using the positioning shifts of 35 patients having cranial lesions. All these patients are immobilized with rigid head‐and‐neck masks, simulated with Brainlab localizer and planned with iPlan treatment planning system. Stereoscopic X‐ray images (XC) are acquired and registered to corresponding digitally reconstructed radiographs using bony‐anatomy matching to calculate 6D translational and rotational shifts. When the shifts are within tolerance (0.7 mm and 1°), treatment is initiated. Otherwise corrections are applied and additional X‐rays (XV) are acquired to verify that patient position is within tolerance. The uncertainties from the mask, localizer, IR ‐frame, X‐ray imaging, MV, and kV isocentricity are quantified individually. Mask uncertainty (translational: lateral, longitudinal, vertical; rotational: pitch, roll, yaw) is the largest and varies with patients in the range obtained from mean of XC shifts for each patient. Setup uncertainty in IR positioning (0.88, 2.12, 1.40 mm, and 0.64°, 0.83°, 0.96°) is extracted from standard deviation of XC. Systematic uncertainties of the frame (0.18, 0.25, , , 0.18°, and 0.47°) and localizer (, , 0.03 mm, and , 0.00°, ) are extracted from means of all XV setups and mean of all XC distributions, respectively. Uncertainties in isocentricity of the MV radiotherapy machine are (0.27, 0.24, 0.34 mm) and kV imager (0.15, , 0.21 mm). A statistical model is developed to evaluate the individual and cumulative systematic and random positioning uncertainties induced by the different hardware and software components of the 6D ExacTrac system. The uncertainties from the mask, localizer, IR frame, X‐ray imaging, couch, MV linac, and kV imager isocentricity are quantified using statistical modeling.

PACS number(s): 87.56.B‐, 87.59.B‐
Small field detector correction factors: effects of the flattening filter for Elekta and Varian linear accelerators
Authors: Tyler Madelaine K. , Liu Paul Z.Y. , Lee Christopher , McKenzie David R. , Suchowerska Natalka
Published: February 2017

Flattening filter‐free (FFF) beams are becoming the preferred beam type for stereotactic radiosurgery (SRS) and stereotactic ablative radiation therapy (SABR), as they enable an increase in dose rate and a decrease in treatment time. This work assesses the effects of the flattening filter on small field output factors for 6 MV beams generated by both Elekta and Varian linear accelerators, and determines differences between detector response in flattened (FF) and FFF beams. Relative output factors were measured with a range of detectors (diodes, ionization chambers, radiochromic film, and microDiamond) and referenced to the relative output factors measured with an air core fiber optic dosimeter (FOD), a scintillation dosimeter developed at Chris O'Brien Lifehouse, Sydney. Small field correction factors were generated for both FF and FFF beams. Diode measured detector response was compared with a recently published mathematical relation to predict diode response corrections in small fields. The effect of flattening filter removal on detector response was quantified using a ratio of relative detector responses in FFF and FF fields for the same field size. The removal of the flattening filter was found to have a small but measurable effect on ionization chamber response with maximum deviations of less than across all field sizes measured. Solid‐state detectors showed an increased dependence on the flattening filter of up to . Measured diode response was within of the published mathematical relation for all fields up to 30 mm, independent of linac type and presence or absence of a flattening filter. For 6 MV beams, detector correction factors between FFF and FF beams are interchangeable for a linac between FF and FFF modes, providing that an additional uncertainty of up to is accepted.

PACS number(s): 87.55.km, 87.56.bd, 87.56.Da
The feasibility of atlas‐based automatic segmentation of MRI for H&N radiotherapy planning
Authors: Wardman Kieran , Prestwich Robin J.D. , Gooding Mark J. , Speight Richard J.
Published: February 2017

Atlas‐based autosegmentation is an established tool for segmenting structures for CT‐planned head and neck radiotherapy. MRI is being increasingly integrated into the planning process. The aim of this study is to assess the feasibility of MRI‐based, atlas‐based autosegmentation for organs at risk (OAR) and lymph node levels, and to compare the segmentation accuracy with CT‐based autosegmentation. Fourteen patients with locally advanced head and neck cancer in a prospective imaging study underwent a T1‐weighted MRI and a PET‐CT (with dedicated contrast‐enhanced CT) in an immobilization mask. Organs at risk (orbits, parotids, brainstem, and spinal cord) and the left level II lymph node region were manually delineated on the CT and MRI separately. A ‘leave one out’ approach was used to automatically segment structures onto the remaining images separately for CT and MRI. Contour comparison was performed using multiple positional metrics: Dice index, mean distance to conformity (MDC), sensitivity index (Se Idx), and inclusion index (Incl Idx). Automatic segmentation using MRI of orbits, parotids, brainstem, and lymph node level was acceptable with a DICE coefficient of , MDC , Se Idx , Incl Idx Segmentation of the spinal cord was poor (Dice coefficient 0.37). The process of automatic segmentation was significantly better on MRI compared to CT for orbits, parotid glands, brainstem, and left lymph node level II by multiple positional metrics; spinal cord segmentation based on MRI was inferior compared with CT. Accurate atlas‐based automatic segmentation of OAR and lymph node levels is feasible using T1‐MRI; segmentation of the spinal cord was found to be poor. Comparison with CT‐based automatic segmentation suggests that the process is equally as, or more accurate, using MRI. These results support further translation of MRI‐based segmentation methodology into clinical practice.

PACS number(s): 87.55.de
Treatment accuracy without rotational setup corrections in intracranial SRT
Authors: Boman Eeva , Kapanen Mika , Laaksomaa Marko , Mäenpää Hanna , Hyödynmaa Simo , Kellokumpu‐Lehtinen Pirkko‐Liisa
Published: February 2017

The aim of this study was to evaluate the impact of actual rotational setup errors on dose distributions in intracranial stereotactic radiotherapy (SRT) with different alternatives for treatment position selection. A total of 38 SRT fractions from 18 patients were retrospectively evaluated with rotational setup errors obtained from actual treatments. The planning computed tomography (CT) images were rotated according to online cone‐beam CT (CBCT) images and the dose distribution was recalculated to the rotated CT images using three different patient positionings derived from: 1) an automatic 6D match neglecting rotation correction ; 2) an automatic 3D match ; and 3) a manual 3D match from actual treatment . The mean conformity index (CI) was 0.92 for the original plans and 0.91 for the plans. The mean CI decreased significantly to 0.78 and 0.80 for the and the plans, respectively. The mean minimum dose of the planning target volume (PTVmin) was 91.9% of the prescribed dose for the original plans and 92.1% for the plans, while for the and the plans PTVmin decreased significantly to 78.9% and 80.2%, respectively. No significant differences were seen between the and the original treatment plans in terms of the dose parameters. However, the and the plans were statistically significantly inferior to the and the original plans. In addition, a significant negative correlation was found in the and the cases between the rotation error and CI, PTVmin or minimum dose of gross tumour volume. In SRT, a treatment plan of comparable quality to 6D rotation correction can be achieved by using 6D registration without a rotational correction in the selection of patient positioning. This was demonstrated for typical rotation errors seen in clinical practice.

PACS number(s): 87.55, 87.57
Measurement of image rotation angle in CT for radiotherapy treatment planning
Authors: Skrzynski Witold , Ślusarczyk‐Kacprzyk Wioletta
Published: February 2017

The geometric accuracy of CT images is essential when they are used for planning radiation therapy. In this study, a method of quantitative testing of image rotation in CT is presented, based on the automated analysis of an image of a phantom half‐filled with water. A plug‐in was written for ImageJ software for automated detection of a water surface in an image and measurement of its angle relative to a horizontal line. A water phantom can be used for the evaluation of image rotation for axial mode. In helical mode the movement of the table would cause movement of the water. The difference between image rotation for axial and helical scans can be evaluated by measuring and comparing the angles of the tabletop surface for both modes. Preliminary results of measurements for three CT scanners show that image rotation does not exceed 0.5°, and is less than 0.1° for the dedicated CT simulator. It was observed that, for one CT scanner image, the rotation angle depended on tube rotation time.

PACS number(s): 87.57.Q‐, 87.55.Qr, 06.30.Bp
Predicting deliverability of volumetric‐modulated arc therapy (VMAT) plans using aperture complexity analysis
Authors: Younge Kelly C. , Roberts Don , Janes Lindsay A. , Anderson Carlos , Moran Jean M. , Matuszak Martha M.
Published: February 2017

The purpose of this study was to evaluate the ability of an aperture complexity metric for volumetric‐modulated arc therapy (VMAT) plans to predict plan delivery accuracy. We developed a complexity analysis tool as a plug‐in script to Varian's Eclipse treatment planning system. This script reports the modulation of plans, arcs, and individual control points for VMAT plans using a previously developed complexity metric. The calculated complexities are compared to that of 649 VMAT plans previously treated at our institution from 2013 to mid‐2015. We used the VMAT quality assurance (QA) results from the 649 treated plans, plus 62 plans that failed pretreatment QA, to validate the ability of the complexity metric to predict plan deliverability. We used a receiver operating characteristic (ROC) analysis to determine an appropriate complexity threshold value above which a plan should be considered for reoptimization before it moves further through our planning workflow. The average complexity metric for the 649 treated plans analyzed with the script was with a standard deviation of . We found that when using a threshold complexity value of , the true positive rate for correctly identifying plans that failed QA was 44%, and the false‐positive rate was 7%. Used clinically with this threshold, the script can identify overly modulated plans and thus prevent a significant portion of QA failures. Reducing VMAT plan complexity has a number of important clinical benefits, including improving plan deliverability and reducing treatment time. Use of the complexity metric during both the planning and QA processes can reduce the number of QA failures and improve the quality of VMAT plans used for treatment.

PACS number(s): 87.55.de, 87.55.Qr, 87.56.jk