bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison between an in‐house 1D profile correction method and a 2D correction provided in Varian's PDPC Package for improving the accuracy of portal dosimetry images
Authors: Hobson Maritza A. , Davis Stephen D.
Published: February 2017

While commissioning Varian's Portal Dose Image Prediction (PDIP) algorithm for portal dosimetry, an asymmetric radial response in the portal imager due to backscatter from the support arm was observed. This asymmetric response led to differences on the order of 2%–3% for simple square fields () when comparing the measured to predicted portal fluences. A separate problem was that discrepancies of up to 10% were seen in measured to predicted portal fluences at increasing off‐axis distance (). We have modified suggested methods from the literature to provide a 1D correction for the off‐axis response problem which adjusts the diagonal profile used in the portal imager calibration. This inherently cannot fix the 2D problem since the PDIP algorithm assumes a radially symmetric response and will lead to some uncertainty in portal dosimetry results. Varian has recently released generic “2D correction” files with their Portal Dosimetry Pre‐configuration (PDPC) package, but no independent testing has been published. We present the comparison between QA results using the Varian correction method to results using our 1D profile correction method using the gamma passing rates with a 3%, 3 mm criterion. The average, minimum, and maximum gamma pass rates for nine fixed‐field IMRT fields at gantry 0° using our profile correction method were 98.1%, 93.7%, and 99.8%, respectively, while the results using the PDPC correction method were 98.4%, 93.1%, and 99.8%. For four RapidArc fields, the average, minimum, and maximum gamma pass rates using our correction method were 99.6%, 99.4%, and 99.9%, respectively, while the results using the PDPC correction method were 99.8%, 99.5%, and 99.9%. The average gamma pass rates for both correction methods are quite similar, but both show improvement over the uncorrected results.

PACS numbers: 87.55.Qr, 87.55.N‐
Comparing the dosimetric characteristics of the electron beam from dedicated intraoperative and conventional radiotherapy accelerators
Authors: Baghani Hamid Reza , Aghamiri Seyed Mahmoud Reza , Mahdavi Seyed Rabi , Akbari Mohammad Esmail , Mirzaei Hamid Reza
Published: February 2017

The specific design of the mobile dedicated intraoperative radiotherapy (IORT) accelerators and different electron beam collimation system can change the dosimetric characteristics of electron beam with respect to the conventional accelerators. The aim of this study is to measure and compare the dosimetric characteristics of electron beam produced by intraoperative and conventional radiotherapy accelerators. To this end, percentage depth dose along clinical axis (PDD), transverse dose profile (TDP), and output factor of LIAC IORT and Varian 2100C/D conventional radiotherapy accelerators were measured and compared. TDPs were recorded at depth of maximum dose. The results of this work showed that depths of maximum dose, , and for LIAC beam are lower than those of Varian beam. Furthermore, for all energies, surface doses related to the LIAC beam are substantially higher than those of Varian beam. The symmetry and flatness of LIAC beam profiles are more desirable compared to the Varian ones. Contrary to Varian accelerator, output factor of LIAC beam substantially increases with a decrease in the size of the applicator. Dosimetric characteristics of beveled IORT applicators along clinical axis were different from those of the flat ones. From these results, it can be concluded that dosimetric characteristics of intraoperative electron beam are substantially different from those of conventional clinical electron beam. The dosimetric characteristics of the LIAC electron beam make it a useful tool for intraoperative radiotherapy purposes.

PACS number: 87.56.‐v, 87.56.bd
Interfraction positional variation in pancreatic tumors using daily breath‐hold cone‐beam computed tomography with visual feedback
Authors: Nakamura Mitsuhiro , Akimoto Mami , Ono Tomohiro , Nakamura Akira , Kishi Takahiro , Yano Shinsuke , Nakata Manabu , Itasaka Satoshi , Mizowaki Takashi , Shibuya Keiko , Hiraoka Masahiro
Published: February 2017

We assessed interfraction positional variation in pancreatic tumors using daily breath‐hold cone‐beam computed tomography at end‐exhalation (EE) with visual feedback (BH‐CBCT). Eleven consecutive patients with pancreatic cancer who underwent BH intensity‐modulated radiation therapy with visual feedback were enrolled. All participating patients stopped oral intake, with the exception of drugs and water, for before treatment planning and daily treatment. Each patient was fixed in the supine position on an individualized vacuum pillow. An isotropic margin of 5 mm was added to the clinical target volume to create the planning target volume (PTV). The prescription dose was 42 to 51 Gy in 15 fractions. After correcting initial setup errors based on bony anatomy, the first BH‐CBCT scans were performed before beam delivery in every fraction. BH‐CBCT acquisition was obtained in three or four times breath holds by interrupting the acquisition two or three times, depending on the patient's BH ability. The image acquisition time for a 360° gantry rotation was approximately 90 s, including the interruption time due to BH. The initial setup errors were corrected based on bony structure, and the residual errors in the target position were then recorded. The magnitude of the interruptions variation in target position was assessed for 165 fractions. The systematic and random errors were 1.2 and 1.8 mm, 1.1 and 1.8 mm, and 1.7 and 2.9 mm in the left–right (LR), anterior–posterior (AP), and superior–inferior (SI) directions, respectively. Absolute interfraction variations of were observed in 18 fractions (11.0%) from seven patients because of EE‐BH failure. In conclusion, target matching is required to correct interfraction variation even with visual feedback, especially to ensure safe delivery of escalated doses to patients with pancreatic cancer.

PACS number: 87.57.Q‐, 87.57.‐s, 87.55.Qr
Quantifying isocenter measurements to establish clinically meaningful thresholds
Authors: Denton Travis R. , Shields Lisa B.E. , Howe Jonathan N. , Spalding Aaron C.
Published: February 2017

A dataset range of isocenter congruency verification tests have been examined from a statistical perspective for the purpose of establishing tolerance levels that are meaningful, based on the fundamental limitation of linear accelerator isocentricity and the demands of a high‐precision stereotactic radiosurgery program. Using a laser‐defined isocenter, a total of 149 individual isocenter congruency tests were examined with recorded values for ideal spatial corrections to the isocenter test tool. These spatial corrections were determined from radiation exposures recorded on an electronic portal imaging device (EPID) at various gantry, collimator, and treatment couch combinations. The limitations of establishing an ideal isocenter were quantified from each variable which contributed to uncertainty in isocenter definition. Individual contributors to uncertainty, specifically, daily positioning setup errors, gantry sag, multileaf collimator (MLC) offset, and couch walkout, were isolated from isocenter congruency measurements to determine a clinically meaningful isocenter measurement. Variations in positioning of the test tool constituted, on average, 0.38 mm magnitude of correction. Gantry sag and MLC offset contributed 0.4 and 0.16 mm, respectively. Couch walkout had an average degrading effect to isocenter of 0.72 mm. Considering the magnitude of uncertainty contributed by each uncertainty variable and the nature of their combination, an appropriate schedule action and immediate action level were determined for use in analyzing daily isocenter congruency test results in a stereotactic radiosurgery (SRS) program. The recommendations of this study for this linear accelerator include a schedule action level of 1.25 mm and an immediate action level of 1.50 mm, requiring prompt correction response from clinical medical physicists before SRS or stereotactic body radiosurgery (SBRT) is administered. These absolute values were derived from considering relative data from a specific linear accelerator and, therefore, represent a means by which a numerical quantity can be used as a test threshold with relative specificity to a particular linear accelerator.

PACS number: 87.53Ly, 29.20.Ej, 87.56.Fc
Quantitative comparison of automatic and manual IMRT optimization for prostate cancer: the benefits of DVH prediction
Authors: Yang Yun , Li Taoran , Yuan Lulin , Ge Yaorong , Yin Fang‐Fang , Lee W. Robert , Wu Q. Jackie
Published: February 2017

A recent publication indicated that the patient anatomical feature (PAF) model was capable of predicting optimal objectives based on past experience. In this study, the benefits of IMRT optimization using PAF‐predicted objectives as guidance for prostate were evaluated. Three different optimization methods were compared. 1) Expert Plan: Ten prostate cases (16 plans) were planned by an expert planner using conventional trial‐and‐error approach started with institutional modified OAR and PTV constraints. Optimization was stopped at 150 iterations and that plan was saved as Expert Plan. 2) Clinical Plan: The planner would keep working on the Expert Plan till he was satisfied with the dosimetric quality and the final plan was referred to as Clinical Plan. 3) PAF Plan: A third sets of plans for the same ten patients were generated fully automatically using predicted DVHs as guidance. The optimization was based on PAF‐based predicted objectives, and was continued to 150 iterations without human interaction. and for PTV, for femoral heads, , D10cc, , and for bladder/rectum were compared. Clinical Plans are further optimized with more iterations and adjustments, but in general provided limited dosimetric benefits over Expert Plans. PTV agreed within 2.31% among Expert, Clinical, and PAF plans. Between Clinical and PAF Plans, differences for of PTV, bladder, and rectum were within 2.65%, 2.46%, and 2.20%, respectively. Bladder D10cc was higher for PAF but in general. Bladder and were lower for PAF, by up to 7.71% and 6.81%, respectively. Rectum D10cc, , and were 2.11%, 2.72%, and 0.27% lower for PAF, respectively. for femoral heads were comparable ( on average). Compared to Clinical Plan (), the average optimization time for PAF plan was reduced by 5.2 min on average, with a maximum reduction of 7.1 min. Total numbers of MUs per plan for PAF Plans were lower than Clinical Plans, indicating better delivery efficiency. The PAF‐guided planning process is capable of generating clinical‐quality prostate IMRT plans with no human intervention. Compared to manual optimization, this automatic optimization increases planning and delivery efficiency, while maintaining plan quality.

PACS numbers: 87.55.D‐, 87.55.de, 87.53.Jw
Evaluation of image lag in a flat‐panel, detector‐equipped cardiovascular X‐ray machine using a newly developed dynamic phantom
Authors: Sato Hisaya , Kondo Keisuke , Kato Kyoichi , Nakazawa Yasuo
Published: February 2017

We developed a dynamic phantom for use in routine checks. This phantom can be used to physically evaluate image lag that occurs in dynamic images. It has a unique measurement method. ROIs on the target are chosen, and, with the position of ROIs fixed on the image, changes in pixel value are detected physically when the target passes through the ROIs over time and perceived as image lag. Thus, it was possible to physically detect different intensities of image lag lasting less than one second while maintaining the same intensity trends. The checking technique we propose with the dynamic phantom that we developed could be effective for routine checking of fluoroscopy X‐ray machines, and could become an established method.

PACS number: 87.59.C‐, 87.59.Dj
Clinical experience using a video‐guided spirometry system for deep inhalation breath‐hold radiotherapy of left‐sided breast cancer
Authors: Yang Wensha , McKenzie Elizabeth M. , Burnison Michele , Shiao Stephen , Mirhadi Amin , Hakimian Behrooz , Reznik Robert , Tuli Richard , Sandler Howard , Fraass Benedick A.
Published: February 2017

The purpose was to report clinical experience of a video‐guided spirometry system in applying deep inhalation breath‐hold (DIBH) radiotherapy for left‐sided breast cancer, and to study the systematic and random uncertainties, intra‐ and interfraction motion and impact on cardiac dose associated with DIBH. The data from 28 left‐sided breast cancer patients treated with spirometer‐guided DIBH radiation were studied. Dosimetric comparisons between free‐breathing (FB) and DIBH plans were performed. The distance between the heart and chest wall measured on the digitally reconstructed radiographs (DRR) and MV portal images, dDRR(DIBH) and dport(DIBH), respectively, was compared as a measure of DIBH setup uncertainty. The difference () between dDRR(DIBH) and dport(DIBH) was defined as the systematic uncertainty. The standard deviation of for each patient was defined as the random uncertainty. MV cine images during radiation were acquired. Affine registrations of the cine images acquired during one fraction and multiple fractions were performed to study the intra‐ and interfraction motion of the chest wall. The median chest wall motion was used as the metric for intra‐ and interfraction analysis. Breast motions in superior–inferior (SI) direction and “AP” (defined on the DRR or MV portal image as the direction perpendicular to the SI direction) are reported. Systematic and random uncertainties of 3.8 mm and 2 mm, respectively, were found for this spirometer‐guided DIBH treatment. MV cine analysis showed that intrafraction chest wall motions during DIBH were 0.3 mm in “AP” and 0.6 mm in SI. The interfraction chest wall motions were 3.6 mm in “AP” and 3.4 mm in SI. Utilization of DIBH with this spirometry system led to a statistically significant reduction of cardiac dose relative to FB treatment. The DIBH using video‐guided spirometry provided reproducible cardiac sparing with minimal intra‐ and interfraction chest wall motion, and thus is a valuable adjunct to modern breast treatment techniques.

PACS number: 87.55.kh, 87.55.ne, 87.55.tg
Evaluation of a single‐scan protocol for radiochromic film dosimetry
Authors: Shimohigashi Yoshinobu , Araki Fujio , Maruyama Masato , Nakaguchi Yuji , Kuwahara Satoshi , Nagasue Nozomu , Kai Yudai
Published: February 2017

The purpose of this study was to evaluate a single‐scan protocol using Gafchromic EBT3 film (EBT3) by comparing it with the commonly used 24‐hr measurement protocol for radiochromic film dosimetry. Radiochromic film is generally scanned 24 hr after film exposure (24‐hr protocol). The single‐scan protocol enables measurement results within a short time using only the verification film, one calibration film, and unirradiated film. The single‐scan protocol was scanned 30 min after film irradiation. The EBT3 calibration curves were obtained with the multichannel film dosimetry method. The dose verifications for each protocol were performed with the step pattern, pyramid pattern, and clinical treatment plans for intensity‐modulated radiation therapy (IMRT). The absolute dose distributions for each protocol were compared with those calculated by the treatment planning system (TPS) using gamma evaluation at 3% and 3 mm. The dose distribution for the single‐scan protocol was within 2% of the 24‐hr protocol dose distribution. For the step pattern, the absolute dose discrepancies between the TPS for the single‐scan and 24‐hr protocols were and at the dose plateau, respectively. The pass rates were 96.0% for the single‐scan protocol and 95.9% for the 24‐hr protocol. Similarly, the dose discrepancies for the pyramid pattern were and , respectively, while the pass rates for the pyramid pattern were 95.3% and 96.4%, respectively. The average pass rates for the four IMRT plans were for the single‐scan protocol and for the 24‐hr protocol. Thus, the single‐scan protocol measurement is useful for dose verification of IMRT, based on its accuracy and efficiency.

PACS number: 87.55.Qr
Optimization of a general‐purpose, actively scanned proton beamline for ocular treatments: Geant4 simulations
Authors: Piersimoni Pierluigi , Rimoldi Adele , Riccardi Cristina , Pirola Michele , Molinelli Silvia , Ciocca Mario
Published: February 2017

The Italian National Center for Hadrontherapy (CNAO, Centro Nazionale di Adroterapia Oncologica), a synchrotron‐based hospital facility, started the treatment of patients within selected clinical trials in late 2011 and 2012 with actively scanned proton and carbon ion beams, respectively. The activation of a new clinical protocol for the irradiation of uveal melanoma using the existing general‐purpose proton beamline is foreseen for late 2014. Beam characteristics and patient treatment setup need to be tuned to meet the specific requirements for such a type of treatment technique. The aim of this study is to optimize the CNAO transport beamline by adding passive components and minimizing air gap to achieve the optimal conditions for ocular tumor irradiation. The CNAO setup with the active and passive components along the transport beamline, as well as a human eye‐modeled detector also including a realistic target volume, were simulated using the Monte Carlo Geant4 toolkit. The strong reduction of the air gap between the nozzle and patient skin, as well as the insertion of a range shifter plus a patient‐specific brass collimator at a short distance from the eye, were found to be effective tools to be implemented. In perspective, this simulation toolkit could also be used as a benchmark for future developments and testing purposes on commercial treatment planning systems.

PACS numbers: 21.30Fe, 24.10.Lx, 29.20.dk, 29.27.Eg, 29.85.Fj
Technical evaluation of TomoTherapy automatic roll correction
Authors: Laub Steve , Snyder Michael , Burmeister Jay
Published: February 2017

The TomoTherapy Hi·Art System allows the application of rotational corrections as a part of the pretreatment image guidance process. This study outlines a custom method to perform an end‐to‐end evaluation of the TomoTherapy Hi·Art roll correction feature. A roll‐sensitive plan was designed and delivered to a cylindrical solid water phantom to test the accuracy of roll corrections, as well as the ability of the automatic registration feature to detect induced roll. Cylindrical target structures containing coaxial inner avoidance structures were placed adjacent to the plane bisecting the phantom and 7 cm laterally off central axis. The phantom was positioned at isocenter with the target‐plane parallel to the couch surface. Varying degrees of phantom roll were induced and dose to the targets and inner avoidance structures was measured using Kodak EDR2 films placed in the target‐plane. Normalized point doses were compared with baseline (no roll) data to determine the sensitivity of the test and the effectiveness of the roll correction feature. Gamma analysis comparing baseline, roll‐corrected, and uncorrected films was performed using film analysis software. MVCT images were acquired prior to plan delivery. Measured roll was compared with induced roll to evaluate the automatic registration feature's ability to detect rotational misalignment. Rotations beyond 0.3° result in statistically significant deviation from baseline point measurements. Gamma pass rates begin to drop below 90% at approximately 0.5° induced rotation at and between 0.2° and 0.3° for 2%/2 mm. With roll correction applied, point dose measurements for all rotations are indistinguishable from baseline, and gamma pass rates exceed 96% when using 3% and 3 mm as evaluation criteria. Measured roll via the automatic registration algorithm agrees with induced rotation to within the test sensitivity for nearly all imaging settings. The TomoTherapy automatic registration system accurately detects induced rotations, and the method presented here for evaluation of the roll correction feature is easily implemented by any clinic with a TomoTherapy Hi·Art unit. This method is sensitive to well within half a degree and demonstrates that the TomoTherapy Hi·Art roll correction feature accurately corrects for induced rotational misalignments to within this level of uncertainty.

PACS numbers: 87.53.Jw, 87.53.Kn, 87.55.Qr, 87.57.nj
Increased dose near the skin due to electromagnetic surface beacon transponder
Authors: Ahn Kang‐Hyun , Manger Ryan , Halpern Howard J. , Aydogan Bulent
Published: February 2017

The purpose of this study was to evaluate the increased dose near the skin from an electromagnetic surface beacon transponder, which is used for localization and tracking organ motion. The bolus effect due to the copper coil surface beacon was evaluated with radiographic film measurements and Monte Carlo simulations. Various beam incidence angles were evaluated for both 6 MV and 18 MV experimentally. We performed simulations using a general‐purpose Monte Carlo code MCNPX (Monte Carlo N‐Particle) to supplement the experimental data. We modeled the surface beacon geometry using the actual mass of the glass vial and copper coil placed in its L‐shaped polyethylene terephthalate tubing casing. Film dosimetry measured factors of 2.2 and 3.0 enhancement in the surface dose for normally incident 6 MV and 18 MV beams, respectively. Although surface dose further increased with incidence angle, the relative contribution from the bolus effect was reduced at the oblique incidence. The enhancement factors were 1.5 and 1.8 for 6 MV and 18 MV, respectively, at an incidence angle of 60°. Monte Carlo simulation confirmed the experimental results and indicated that the epidermal skin dose can reach approximately 50% of the dose at at normal incidence. The overall effect could be acceptable considering the skin dose enhancement is confined to a small area (), and can be further reduced by using an opposite beam technique. Further clinical studies are justified in order to study the dosimetric benefit versus possible cosmetic effects of the surface beacon. One such clinical situation would be intact breast radiation therapy, especially large‐breasted women.

PACS number: 87.53
Helical 4D CT pitch management for the Brilliance CT Big Bore in clinical practice
Authors: Hilgers Guido , Nuver Tonnis , Minken André
Published: February 2017

In external beam radiotherapy treatment planning for patients with thoracic malignancies, respiratory‐correlated CT (4D CT) is used to obtain high quality studies in the presence of respiratory motion. When helical 4D CT scans are acquired with a Brilliance CT Big Bore, the pitch must meet two conditions. It must be low enough to avoid motion artifacts, and high enough to cover the entire scan length within 120 s to prevent overheating of the X‐ray tube. We developed a nomogram that can be used to obtain a suitable pitch satisfying both requirements. We also assessed the effects on the image quality of a pitch that exceeds the maximum pitch, and of a field of view (FOV) reduction. It was shown that, for AV G and MIP reconstructions, the manufacturer's maximum pitch equation yields an underestimation due to its FOV term.

PACS number: 87.57.Q‐, 87.57.cp
Simulation of a medical linear accelerator for teaching purposes
Authors: Anderson Rhys , Lamey Mike , MacPherson Miller , Carlone Marco
Published: February 2017

Simulation software for medical linear accelerators that can be used in a teaching environment was developed. The components of linear accelerators were modeled to first order accuracy using analytical expressions taken from the literature. The expressions used constants that were empirically set such that realistic response could be expected. These expressions were programmed in a MATLAB environment with a graphical user interface in order to produce an environment similar to that of linear accelerator service mode. The program was evaluated in a systematic fashion, where parameters affecting the clinical properties of medical linear accelerator beams were adjusted independently, and the effects on beam energy and dose rate recorded. These results confirmed that beam tuning adjustments could be simulated in a simple environment. Further, adjustment of service parameters over a large range was possible, and this allows the demonstration of linear accelerator physics in an environment accessible to both medical physicists and linear accelerator service engineers. In conclusion, a software tool, named SIMAC, was developed to improve the teaching of linear accelerator physics in a simulated environment. SIMAC performed in a similar manner to medical linear accelerators. The authors hope that this tool will be valuable as a teaching tool for medical physicists and linear accelerator service engineers.

PACS number: 87.55Gh, 87.56bd
Comparison between two different algorithms used for pretreatment QA via aSi portal images
Authors: Merheb Charbel , Chevillard Clément , Ksouri Wassim , Fawzi Maher , Bollet Marc , Toledano Alain
Published: February 2017

Several algorithms exist to perform quality assurance for volumetric‐modulated arc therapy (VMAT) treatments based on electronic portal imaging devices (EPID). These algorithms are used to compare doses (convert into water, GLAaS) and fluences (in amorphous silicon (aSi), Varian portal dosimetry). The aim of this study is to compare the two methods using clinical data. In this study, Varian portal dosimetry (VPD) and Epiqa solutions were compared. We used a same set of patient images data treated with 6 MV and 20 MV photon energies and different locations. The response of the portal imaging device was also investigated with different field sizes, monitor units, dose rates, sag effect, and linac daily output. All images were acquired on an electronic portal imaging device (EPID) positioned at source detector distance (SDD) of 100 cm. A virtual water phantom was used for Epiqa to calculate the dose matrices at the maximum depth doses . The 2D gamma evaluation index (GAI) was performed to quantitatively compare the results given by the two solutions. The response of the EPID gave a good agreement with Epiqa (deviation less than 1%) for MU greater than 20 for both 6 MV and 20 MV photon energies. For VPD, the upward sloping trend showed a good agreement for MU higher than 50. Dose rate evaluations for both methods gave a deviation of, respectively, 0.4 and 0.5 % for 6 MV and 20 MV. The gamma criteria of 3 mm for distance to agreement and 3 % for dose difference was, as mean , and for VPD and Epiqa, respectively, for 6 MV photon energy. The mean values of the gamma criteria for the collected data using 20 MV photon energy were, respectively, and for VPD and Epiqa. The output constancy deviation correction (a reference field plan to obtain absorbed dose despite the linac monitor daily variations) showed a mean deviation of, respectively, and for 6 MV and 20 MV photon energies. For sag effect, a slight improvement was noticed for realignment of the integrated image and was for 6 MV and for 20 MV. The clinical data were used for pretreatment QA with the two systems, both VPD and Epiqa software, showed acceptable and similar results for low and high energies. Furthermore, Epiqa shows better linearity response for low MU.

PACS number: 87.53.Bn, 87.55.km, 87.57.uq
Evaluation of patient DVH‐based QA metrics for prostate VMAT: correlation between accuracy of estimated 3D patient dose and magnitude of MLC misalignment
Authors: Kadoya Noriyuki , Saito Masahide , Ogasawara Makoto , Fujita Yukio , Ito Kengo , Sato Kiyokazu , Kishi Kazuma , Dobashi Suguru , Takeda Ken , Jingu Keiichi
Published: February 2017

The purpose of this study was to evaluate the accuracy of commercially available software, using patient DVH‐based QA metrics, by investigating the correlation between estimated 3D patient dose and magnitude of MLC misalignments. We tested 3DVH software with an ArcCHECK. Two different calculating modes of ArcCHECK Planned Dose Perturbation (ACPDP) were used: “Normal Sensitivity” and “High Sensitivity”. Ten prostate cancer patients treated with hypofractionated VMAT (67.6 Gy/26 Fr) in our hospital were studied. For the baseline plan, we induced MLC errors (, and 0.75 mm for each single bank). We calculated the dose differences between the ACPDP dose with error and TPS dose with error using gamma passing rates and using DVH‐based QA metrics. The correlations between dose estimation error and MLC position error varied with each structure and metric. A comparison using gamma index showed that the larger was the MLC error‐induced, the worse were the gamma passing rates. Slopes of linear fit to dose estimation error versus MLC position error for mean dose and D95 to the PTV were 1.76 and , respectively, for “Normal Sensitivity”, and −0.53 and , respectively, for “High Sensitivity”, showing better accuracy for “High Sensitivity” than “Normal Sensitivity”. On the other hand, the slopes for mean dose to the rectum and bladder, V35 to the rectum and bladder and V55 to the rectum and bladder, were , and , respectively, for “Normal Sensitivity”, and , and , respectively, for “High Sensitivity”, showing significant better accuracy for “Normal Sensitivity” than “High Sensitivity”. Our results showed that 3DVH had some residual error for both sensitivities. Furthermore, we found that “Normal Sensitivity” might have better accuracy for the DVH metric for the PTV and that “High Sensitivity” might have better accuracy for DVH metrics for the rectum and bladder. We must be willing to tolerate this residual error in clinical care.

PACS number: 87.55Qr
Potential systematic uncertainties in IGRT when FBCT reference images are used for pancreatic tumors
Authors: Amoush Ahmad , Abdel‐Wahab May , Abazeed Mohamed , Xia Ping
Published: February 2017

The purpose of this study was to quantify the systematic uncertainties resulting from using free breathing computed tomography (FBCT) as a reference image for image‐guided radiation therapy (IGRT) for patients with pancreatic tumors, and to quantify the associated dosimetric impact that resulted from using FBCT as reference for IGRT. Fifteen patients with implanted fiducial markers were selected for this study. For each patient, a FBCT and an average intensity projection computed tomography (AIP) created from four‐dimensional computed tomography (4D CT) were acquired at the simulation. The treatment plan was created based on the FBCT. Seventy‐five weekly kilovoltage (kV) cone‐beam computed tomography (CBCT) images (five for each patient) were selected for this study. Bony alignment without rotation correction was performed 1) between the FBCT and CBCT, 2) between the AIP and CBCT, and 3) between the AIP and FBCT. The contours of the fiducials from the FBCT and AIP were transferred to the corresponding CBCT and were compared. Among the 75 CBCTs, 20 that had differences in centers of mass (COMs) in any directions between the FBCT and AIP were chosen for further dosimetric analysis. These COM discrepancies were converted into isocenter shifts in the corresponding planning FBCT, and dose was recalculated and compared to the initial FBCT plans. For the 75 CBCTs studied, the mean absolute differences in the COMs of the fiducial markers between the FBCT and CBCTs were , and in the right–left (RL), anterior–posterior (AP), and superior–inferior (SI) directions, respectively. Between the AIP and CBCTs, the mean absolute differences were , and . The absolute mean discrepancies in these COMs shifts between FBCT/CBCT and AIP/CBCT were , and in RL, AP, and SI, respectively. This represented a potential systematic error. For the 20 CBCTs that had COM discrepancies in any direction, the average reduction in planning target volume (PTV) coverage (PTV volume receiving 100% of prescription dose) was (range: ). Using FBCT as a reference for IGRT may introduce potential interfractional systematic COM shifts if the FBCT is acquired at a different breathing phase than the average breathing phase. The potential systematic error could be significant in the SI direction and varied among patients for the other directions. AIP is a better choice of reference image set for IGRT in order to correct interfractional variations due to respiratory motion and nonrespiratory organ displacement.

PACS numbers: 87.55.D, 87.55.dk, 87.55.km
Is there a preferred IMRT technique for left‐breast irradiation?
Authors: Jeulink Marloes , Dahele Max , Meijnen Philip , Slotman Ben J. , Verbakel Wilko F.A.R.
Published: February 2017

Not all clinics have breath‐hold radiotherapy available for left‐breast irradiation. However intensity‐modulated radiotherapy (IMRT) has also been advocated as a means of lowering heart doses. There is currently no large‐scale, long‐term follow‐up data after breast IMRT and, since dose distributions may differ from classic tangent‐based radiotherapy, caution is needed to avoid unexpected worsening of the late toxicity profile. We compared four IMRT techniques for free‐breathing left‐breast irradiation. Consistent with the aforementioned concerns, our goal in planning was to prioritize organ at risk (OAR) sparing in a way that mimicked tangent‐based radiotherapy. Ten simultaneous integrated boost treatment plans were created using 1) hybrid‐IMRT (H‐IMRT), 2) full IMRT (F‐IMRT), and 3) volumetric‐modulated arc therapy with two partial arcs (2ARC) and 4) six partial arcs (6ARC). Reduction in OAR mean and low dose was prioritized. End‐points included OAR sparing (e.g., heart, left anterior descending artery [], lungs, and contralateral breast) and PTV coverage/dose homogeneity. Under these conditions we found the following: 1) H‐IMRT provided the best mean and low dose OAR sparing, coverage , and PTV homogeneity. However, it delivered most intermediate–high dose to the heart, and ipsilateral lung; 2) 6ARC had the best intermediate–high dose sparing, followed by F‐IMRT, but this was at the expense of more dose in the contralateral lung and breast and worse PTV coverage ( and for 6ARC/F‐IMRT). When trying to spare mean and low dose to OARs, the preferred IMRT technique for left‐breast irradiation without breath‐hold was H‐IMRT. This is currently the standard solution in our institution for left‐breast radiotherapy under free‐breathing and breath‐hold conditions.

PACS numbers: 87.53kn, 87.53Jw, 87.55.D‐, 87.55.de, 87.55.dk
Portal dosimetry in wedged beams
Authors: Spreeuw Hanno , Rozendaal Roel , Camargo Priscilla , Mans Anton , Wendling Markus , Olaciregui‐Ruiz Igor , Sonke Jan‐Jakob , Van Herk Marcel , Mijnheer Ben
Published: February 2017

Portal dosimetry using electronic portal imaging devices (EPIDs) is often applied to verify high‐energy photon beam treatments. Due to the change in photon energy spectrum, the resulting dose values are, however, not very accurate in the case of wedged beams if the pixel‐to‐dose conversion for the situation without wedge is used. A possible solution would be to consider a wedged beam as another photon beam quality requiring separate beam modeling of the dose calculation algorithm. The aim of this study was to investigate a more practical solution: to make aSi EPID‐based dosimetry models also applicable for wedged beams without an extra commissioning effort of the parameters of the model. For this purpose two energy‐dependent wedge multiplication factors have been introduced to be applied for portal images taken with and without a patient/phantom in the beam. These wedge multiplication factors were derived from EPID and ionization chamber measurements at the EPID level for wedged and nonwedged beams, both with and without a polystyrene slab phantom in the beam. This method was verified for an EPID dosimetry model used for wedged beams at three photon beam energies (6, 10, and 18 MV) by comparing dose values reconstructed in a phantom with data provided by a treatment planning system (TPS), as a function of field size, depth, and off‐axis distance. Generally good agreement, within 2%, was observed for depths between dose maximum and 15 cm. Applying the new model to EPID dose measurements performed during ten breast cancer patient treatments with wedged 6 MV photon beams showed that the average isocenter underdosage of 5.3% was reduced to 0.4%. Gamma‐evaluation (global ) of these in vivo data showed an increase in percentage of points with from 60.2% to 87.4%, while reduced from 1.01 to 0.55. It can be concluded that, for wedged beams, the multiplication of EPID pixel values with an energy‐dependent correction factor provides good agreement between dose values determined by an EPID and a TPS, indicating the usefulness of such a practical solution.

PACS numbers: 87.55.km, 87.55.kd, 87.55.Qr, 87.56a.ng
AutoLock: a semiautomated system for radiotherapy treatment plan quality control
Authors: Dewhurst Joseph M. , Lowe Matthew , Hardy Mark J. , Boylan Christopher J. , Whitehurst Philip , Rowbottom Carl G.
Published: February 2017

A semiautomated system for radiotherapy treatment plan quality control (QC), named AutoLock, is presented. AutoLock is designed to augment treatment plan QC by automatically checking aspects of treatment plans that are well suited to computational evaluation, whilst summarizing more subjective aspects in the form of a checklist. The treatment plan must pass all automated checks and all checklist items must be acknowledged by the planner as correct before the plan is finalized. Thus AutoLock uniquely integrates automated treatment plan QC, an electronic checklist, and plan finalization. In addition to reducing the potential for the propagation of errors, the integration of AutoLock into the plan finalization workflow has improved efficiency at our center. Detailed audit data are presented, demonstrating that the treatment plan QC rejection rate fell by around a third following the clinical introduction of AutoLock.

PACS number: 87.55.Qr
Volumetric‐modulated arc therapy planning using multicriteria optimization for localized prostate cancer
Authors: Ghandour Sarah , Matzinger Oscar , Pachoud Marc
Published: February 2017

The purpose of this work is to evaluate the volumetric‐modulated arc therapy (VMAT) multicriteria optimization (MCO) algorithm clinically available in the RayStation treatment planning system (TPS) and its ability to reduce treatment planning time while providing high dosimetric plan quality. Nine patients with localized prostate cancer who were previously treated with 78 Gy in 39 fractions using VMAT plans and rayArc system based on the direct machine parameter optimization (DMPO) algorithm were selected and replanned using the VMAT‐MCO system. First, the dosimetric quality of the plans was evaluated using multiple conformity metrics that account for target coverage and sparing of healthy tissue, used in our departmental clinical protocols. The conformity and homogeneity index, number of monitor units, and treatment planning time for both modalities were assessed. Next, the effects of the technical plan parameters, such as constraint leaf motion CLM and maximum arc delivery time T (s), on the accuracy of delivered dose were evaluated using quality assurance passing rates (QAs) measured using the Delta4 phantom from ScandiDos. For the dosimetric plan's quality analysis, the results show that the VMAT‐MCO system provides plans comparable to the rayArc system with no statistical difference for V95% (), D1% (), CI (), and HI () of the PTV, bladder (), and rectum () constraints, except for the femoral heads and healthy tissues, for which a dose reduction was observed using MCO compared with rayArc (). The technical parameter study showed that a combination of CLM equal to and a maximum delivery time of 72 s allowed the accurate delivery of the VMAT‐MCO plan on the Elekta Versa HD linear accelerator. Planning evaluation and dosimetric measurements showed that VMAT‐MCO can be used clinically with the advantage of enhanced planning process efficiency by reducing the treatment planning time without impairing dosimetric quality.

PACS numbers: 87.55.D, 87.55.de, 87.55.Qr
First experiences in using a dose control system on a TomoTherapy Hi·Art II
Authors: Moutrie Zoë R. , Lancaster Craig M. , Yu Litang
Published: February 2017

The purpose of this study was to investigate the impact of a dose control system (DCS) servo installed on two fully commissioned TomoTherapy Hi·Art II treatment units. This servo is designed to actively adjust machine parameters to control the output variation of a tomotherapy unit to within of the nominal dose rate. Machine output, dose rate, and patient‐specific quality assurance data were retrospectively analyzed for periods prior to and following the installation of the servo system. Quality assurance tests indicate a reduction in the rotational variation of the output during a procedure, where the peak‐to‐peak amplitude of the variation was to DCS and equal to DCS. Comparing two tomotherapy unit static outputs over four years the percentage error was and and, once DCS was installed, was reduced to and . The results of the quality assurance tests indicate that the dose control system reduced the output variation of each machine for both static and rotational delivery, leading to an improvement in the overall performance of the machine and providing greater certainty in treatment delivery.

PACS number: 87.56.‐v, 87.56.bd, 87.55.Qr, 87.56.Fc
Mechanical and dose delivery accuracy evaluation in radiosurgery using polymer gels
Authors: Sandilos Panagiotis , Tatsis Elias , Vlachos Lampros , Dardoufas Constantinos , Karaiskos Pantelis , Georgiou Evangelos , Baras Panagiotis , Kipouros Panagiotis , Torrens Michael , Angelopoulos Angelos
Published: February 2017

The polymer gel–magnetic resonance imaging (MRI) dosimetry technique was used to evaluate the mechanical and dose delivery accuracy in Leksell gamma‐knife stereotactic radiosurgery for the treatment of multiple targets. Two different polymer gel dosimeter formulations reported in the literature were prepared in‐house. A plan for the treatment of four brain metastases (targets) was generated. It involved the delivery of four 8‐mm collimator shots using different prescription isodose lines and different prescription doses for each target, keeping the maximum dose constant for all targets. A sample of each gel formulation was irradiated using a custom‐made phantom with an experimental procedure capable of testing the increased nominal mechanical accuracy of stereotactic radiosurgery. The irradiated dosimeters were evaluated using a clinical 1.5 T MR imager. Result manipulation in 3D allowed for the determination of the mechanical accuracy in the delivery of each shot through the comparison of measured versus planned shot center coordinates. Dose delivery accuracy was also evaluated by comparison of maximum dose values measured at the center of each shot as well as dose distribution measurements, with corresponding treatment‐planning calculations. Polymer gel dosimetry was found capable of verifying the complete chain of radiosurgery treatment in gamma‐knife applications involving the irradiation of multiple targets.

PACS numbers: 87.53.Dq, 87.53.Ly, 87.53.Xd
Initial evaluation of a four‐dimensional computed tomography system, using a programmable motor
Authors: Simon Luc , Giraud Philippe , Servois Vincent , Rosenwald Jean‐Claude
Published: February 2017

A dynamic lung tumor phantom was used to investigate the geometric reconstruction accuracy of a commercial four‐dimensional computed tomography (4D‐CT) system. A ball filled with resin, embedded in a cork cube, was placed on a moving platform. Various realistic antero‐posterior (AP) motions were programmed to reproduce the respiratory motion of a lung tumor. Several three‐dimensional (3D) CT and 4D‐CT images of this moving object were acquired and compared using different acquisition parameters. Apparent volume and diameter of the ball were measured and compared to the real values. The position of two points (the AP limits of the ball) during the motion in the coordinate system of the CT scanner were also compared with the expected values. Volume error was shown to increase with object speed. However, although the volume error was associated with intraslice artifacts, it did not reflect large interslice inconstancies in object position and should not be used as an indicator of image accuracy. The 3D‐CT gave a random position of the tumor along the phantom excursion; accuracy in the assessment of position by 4D‐CT ranged from 0.4 mm to 2.6 mm during extreme phases of breathing. We used average projection (AVE) and maximum intensity projection (MIP) algorithms available on the commercial software to create internal target volumes (ITVs) by merging gross tumor volume (GTV) images at various respiratory phases. The ITVs were compared to a theoretical value computed from the programmed ball excursion. The ITVs created from the MIP algorithm were closer to the theoretical value (within 12%) than were those created from the AVE algorithm (within 40%).

PACS numbers: 87.53.Xd, 87.56.Mp, 87.57.Ce, 87.59.Fm
Comparison of three image segmentation techniques for target volume delineation in positron emission tomography
Authors: Drever Laura , Roa Wilson , McEwan Alexander , Robinson Don
Published: February 2017

Incorporation of positron emission tomography (PET) data into radiotherapy planning is currently under investigation for numerous sites including lung, brain, head and neck, breast, and prostate. Accurate tumor‐volume quantification is essential to the proper utilization of the unique information provided by PET. Unfortunately, target delineation within PET currently remains a largely unaddressed problem. We therefore examined the ability of three segmentation methods—thresholding, Sobel edge detection, and the watershed approach—to yield accurate delineation of PET target cross‐sections. A phantom study employing well‐defined cylindrical and spherical volumes and activity distributions provided an opportunity to assess the relative efficacy with which the three approaches could yield accurate target delineation in PET. Results revealed that threshold segmentation can accurately delineate target cross‐sections, but that the Sobel and watershed techniques both consistently fail to correctly identify the size of experimental volumes. The usefulness of threshold‐based segmentation is limited, however, by the dependence of the correct threshold (that which returns the correct area at each image slice) on target size.

PACS numbers: 87.58.Fg, 87.57.Nk