Comparison of dosimetric characteristics of physical and enhanced dynamic wedges

BackgroundWedge filters can be used as missing tissue compensators or wedge pairs to alter the shape of isodose curves so that two beams can be angled with a small hinge angle at a target volume without creating a hotspot.AimIn this study the dosimetric properties of Varian Enhanced Dynamic Wedge (EDW) and physical wedges (PW) were analyzed and compared.Materials and methodsIonometric measurements of open field output factor, physical wedge output factor, physical wedge factor and EDW factor for photon beams were carried out. A 3D scanning water phantom was used to scan depth dose and profiles for open and PW fields. The 2D ionization matrix was used to measure profiles of physical and EDW wedges. The isodose curves of physical and EDW angles were obtained using a therapy verification film.Results and discussionThe PW output factors of photons were compared with the open field output factors. The physical and EDW factors were compared. The difference in percentage depth dose for open and PW fields was observed for both photon beams. The measured isodose plots for physical and EDW were compared.ConclusionThe wedge field output factor increases with field size and wedge angle compared to that of the open field output factor. The number of MU to deliver a particular dose with the EDW field is less than that of the PW field due to a change in wedge factor. The dosimetric characteristics, like profile and isodose of EDW, closely match with that of the PW.     

Design,implementation and validation of a motorized wedge filter for a telecobalt machine (Bhabhatron-II)

A universal wedge filter of 15W × 20 cm² and 60° nominal wedge angle is designed and placed between the collimating jaws and penumbra trimmers inside the treatment head. A pneumatically driven actuating mechanism toggles the wedge between the wedge IN position and wedge OUT position. The effective wedge angles were determined using an analytical formula. An accumulated wedge profile at a depth of 10 cm which was measured using a 2D profiler and dose values at depths of 10 cm and 20 cm for the same experimental setup were used as input parameters in the formula used for determining effective wedge angles. The relationship between the wedge beam weight and effective wedge angle was established. The planned wedge angles were compared with the measured wedge angles and the differences are found to be less than 2° throughout the range of field sizes. Planned doses for various field sizes and wedge angles were measured for verification and the differences were found to be less than 1.8%. This study established that the relationship between the beam weights and effective wedge angles implemented for the motorized wedge filter of medical linacs is not directly applicable for the motorized wedge filter of Telecobalt.     

Determination of field output correction factors of radiophotoluminescence glass dosimeter and CC01 ionization chamber and validation against IAEA-AAPM TRS-483 code of practice

PurposeTo determine the field output correction factors of the radiophotoluminescence glass dosimeter (RPLGD) in parallel and perpendicular orientations with reference to CC01, the ionization chamber.MethodsThe dose to a small water volume and the sensitive volume of the RPLGD and the IBA-CC01 were determined for 6-MV, 100-cm SAD, 10-cm depth using egs_chamber user-code. The RPLGD in perpendicular and parallel orientations to the beam axis were studied. The field output correction factors of each detector for 0.5 × 0.5 to 10 × 10 cm² field sizes were determined. These field output correction factors were validated by comparing field output factors against data determined from IAEA-AAPM TRS-483 code of practice.ResultsThe field output correction factors of all detectors were within 5% for field sizes down to 0.8 × 0.8 cm². For 0.5 × 0.5 cm², the field output correction factors of CC01, RPLGD in perpendicular and parallel orientations differed from unity by 14%, 19%, and 5%, respectively. The percentage difference between field output factors determined using RPLGD and CC01 data, corrected using the field output correction factors determined in this work and measurements with CC01 data corrected using TRS-483, was less than 3% for all field sizes, except for the smallest field size of RPLGD in perpendicular orientation and the CC01.ConclusionsThe field output correction factors of RPLGD and CC01 are reported. The validation proves that RPLGD in parallel orientation combined with the field output correction factors is the most suitable for determining the field output factors for the smallest field used in this study.     

Study of 2D ion chamber array for angular response and QA of dynamic MLC and pretreatment IMRT plans

AimTo study of 2 Dimensional ion chamber array for angular response and its utility for quality assurance of dynamic multileaf collimator and pretreatment intensity modulated radiotherapy plans.Materials and MethodsThe MLC QA test patterns and IMRT plans were executed on 2D ion chamber array having 1020 vented pixel ionization chambers. The dynamic MLC QA test patterns were chair test, x–wedge, pyramid, open swipe field, garden fence and picket fence. Performance of Dynamic wedges was compared with physical wedges. For IMRT verification, five patients with localized prostate carcinoma were planned using dynamic IMRT technique. Angular response of MatriXX was measured by exposing the system from different gantry angles.ResultsDynamic MLC QA tests such as chair, x-wedge, pyramid, and open swipe field were successfully verified. MatriXX was not able to recognize the bar pattern of picket test and garden fence test. The response of MatriXX gradually decreases from 0° to 180° angles and it was 7.7% less at 180° angle. The dynamic wedge profiles were matching with corresponding physical wedge profiles. For pretreatment IMRT QA, the average dose difference between planned and measured dose was 1.26% with standard deviation of 1.06.ConclusionI'mRT MatriXX can be used for routine dynamic MLC and IMRT pretreatment QA but care should be taken while taking measurements in penumbra region because of its limited spatial resolution.     

On the interplay effect for moving targets treated with the CyberKnife static tracking system

PurposeTo assess the interplay effect amplitude between different planned MU distributions and respiratory patterns in the CyberKnife system when treating moving targets with static tracking technique.MethodsSmall- and Large-Respiratory Motions (SRM and LRM) differing in amplitude and frequency were simulated in a semi-anthropomorphic dynamic thorax phantom. The interplay effect was evaluated for both respiration motions in terms of GTV coverage and conformity for three plans designed with an increasing range of MU per beam (small, medium and large). Each plan was delivered three times changing the initial beam-on phase to assess the inter-fraction variation. Dose distributions were measured using radiochromic films placed in the GTV axial and sagittal planes.ResultsGenerally, SRM plans gave higher GTV coverage and were less dependent on beam-on phases than LRM plans. For SRM (LRM) plans, the GTV coverage ranged from 95.2% to 99.7% (85.9% to 99.8%). Maximum GTV coverage was found for large MU plans in SRM and for small MU plans in LRM. Minimum GTV coverage was found for medium MU plans for both SRM and LRM. For SRM plans, dose conformity decreased with increasing MU range while the variation was reduced for LRM plans. Large MU plans reduced the inter-fraction variation for SRM and LRM.ConclusionsWe confirmed the interplay effect between target motion and beam irradiation time for CyberKnife static tracking. Plans with large MU per beam improved the GTV coverage for small motion amplitude and the inter-fraction dose variation for large motion amplitude.     

Multienergetic verification of dynamic wedge angles in medical accelerators using multichannel linear array

Background

The aim of the modern radiotherapy is to get a homogenous dose distribution in PTV, which is obtained by using for example physical or dynamic wedges. The using of a physical wedge has provided such isodose distributions but their use resulted in detrimental dosimetric consequences, for example beam hardening effects and practical consequences of filter handling or possible misalignment. Linear accelerators are now equipped with collimator jaws systems and controlled by modern computers and it is possible to generate wedge shaped isodose distributions dynamically. Because of a more comfortable use of a dynamic wedge, there are alternatives to the standard physical wedge. During the treatment, different segments of the treatment field can be exposed to the primary beam at different intervals of time. This process of shrinking the field while modulating the collimator jaw velocity and dose rate creates the desired wedge-shaped isodose gradient across the treatment field. Dynamic wedges can replace physical wedges but they need more precise dosimetry and quality control procedures.

Aim

The aim of this study was to perform a multienergetic verification of dynamic wedge angles using the multichannel detector PTW LA48 linear array.

Material and methods

The measurements of angle value of dynamic wedges were performed for Clinac 2300 C/D accelerators (Varian). The accelerator was equipped with the EDW option for 6 MV and 15 MV photon beams. In this case, 7 wedge angle values were used: 10°, 15°, 20°, 25°, 30°, 45° and 60°. The dynamic wedges are realized by continuous movement of one collimator jaw. The field size is gradually reduced until the collimator is almost completely closed or the field increases, while the beam is on. The measurements were divided in two steps: in the first step, the dynamic wedges were verified with the recommended values and in the second step there the planned and measured angles of dynamic wedges were compared. Measurements were made by means of LA48 linear array of ionization chambers (PTW). The results of the measurements were compared with the reference profile produced by the treatment planning system ECLIPSE 8.5 (Varian).

Results

The results showed differences between measured and calculated angle of dynamic wedges. The differences were observed for both energies in the case of a small angle value. For energies 6 MV and 15 MV, almost all percentage difference between the measured and calculated profile was lower than 5%. The biggest difference was observed in the first step of measurements when the angle of Dynamic Wedge was verified. The comparison between the planned and measured angle value of Dynamic Wedge showed the difference between 0.1% and 4.5%.The difference for 6 MV for the angle value of 10° in orientation IN was 1.1% and for energy 15 MV in the same case the difference was 3.8%. Thinner wedges exhibit less difference.

Conclusion

It is necessary to provide comprehensive quality control procedure for enhanced dynamic wedges. Verification measurements should be an obligatory procedure in the recommendation for the testing of medical accelerators. These results are the preliminary results to provide measurements in other Polish Cancer Centres.     

In vitro analysis of kinematics and elastostatics of the human rib cage during thoracic spinal movement for the validation of numerical models

Neither kinematic nor stiffness properties of the rib cage during thoracic spinal motion were investigated in previous studies, while being essential for the accurate validation of numerical models of the whole thorax. The aim of this in vitro study therefore was to quantify the kinematics and elastostatics of the human rib cage under defined boundary conditions. Eight fresh frozen human thoracic spine specimens (C7-L1, median age 55 years, ranging from 40 to 60 years) including entire rib cages were loaded quasi-statically in flexion/extension, lateral bending, and axial rotation using pure moments of 5 Nm. Relative motions of ribs, thoracic vertebrae, and sternal structures as well as strains on the ribs were measured using optical motion tracking of 150 reflective markers per specimen, while specimens were loaded displacement-controlled with a constant rate of 1°/s for 3.5 cycles. The third full cycle was used to determine relative angles and strains at full loading of the spine for all motion directions. Largest relative angles were found in the main loading directions with only small motions at the mid-thoracic levels. Highest strains of the intercostal spaces were detected in the anterior section of the lowest fourth of the rib cage, showing compressions and elongations of more than 10% in all spinal motion planes. Elastostatic rib deformation was generally less than 1%. Rib-sternum relative motions exhibited complex motion patterns, overall showing relative angles below 2°. The results indicate that rib cage structures are not macroscopically deformed during spinal motion, but exhibit characteristic reproducible kinematics patterns.     

Effect of patient positioning on carbon-ion therapy planned dose distribution to pancreatic tumors and organs at risk

PurposePancreatic tumor treatment dose distribution variations associated with supine and prone patient positioning were evaluated.MethodsA total of 33 patients with pancreatic tumors who underwent CT in the supine and prone positions were analyzed retrospectively. Gross tumor volume (GTV), planning target volume (PTV), and organs at risk (OARs) (duodenum and stomach) were contoured. The prescribed dose of 55.2 Gy (RBE) was planned from four beam angles (0°, 90°, 180°, and 270°). Patient collimator and compensating boli were designed for each field. Dose distributions were calculated for each field in the supine and prone positions. To improve dose distribution, patient positioning was selected from supine or prone for each beam field.ResultsCompared with conventional beam angle and patient positioning, D2cc of 1st-2nd portion of duodenum (D1-D2), 3rd-4th portion of duodenum (D3-D4), and stomach could be reduced to a maximum of 6.4 Gy (RBE), 3.5 Gy (RBE), and 4.5 Gy (RBE) by selection of patient positioning. V10 of D1-D2, D3-D4, and stomach could be reduced to a maximum of 7.2 cc, 11.3 cc, and 11.5 cc, respectively. D95 of GTV and PTV were improved to a maximum of 6.9% and 3.7% of the prescribed dose, respectively.ConclusionsOptimization of patient positioning for each beam angle in treatment planning has the potential to reduce OARs dose maintaining tumor dose in pancreatic treatment.     

Comparison of dosimetric characteristics of physical wedge and enhanced dynamic wedge in inhomogeneous medium using Monte Carlo simulations

BackgroundWidely used physical wedges in clinical radiotherapy lead to beam intensity attenuation as well as the beam hardening effect, which must be considered. Dynamic wedges devised to overcome the physical wedges (PWs) problems result in dosimetry complications due to jaw movement while the beam is on. This study was aimed to investigate the usability of physical wedge data instead of enhanced dynamic wedge due to the enhanced dynamic wedge (EDW) dosimetry measurement hardships of Varian 2100CD in inhomogeneous phantom by Monte Carlo code as a reliable method in radiation dosimetry.Materials and methodsA PW and EDW-equipped-linac head was simulated using BEAMnrc code. DOSXYZnrc was used for three-dimensional dosimetry calculation in the CIRS phantom.ResultsBased on the isodose curves, EDW generated a less scattered as well as lower penumbra width compared to the PW. The depth dose variations of PWs and EDWs were more in soft tissue than the lung tissue. Beam profiles of PW and EDW indicated good coincidence in all points, except for the heel area.ConclusionResults demonstrated that it is possible to apply PW data instead of EDW due to the dosimetry and commissioning hardships caused by EDW in inhomogeneous media.     

Dosimetric effect of intrafraction motion and different localization strategies in prostate SBRT

The aim of this study was to evaluate the dosimetric effect of continuous motion monitoring based localization (Calypso, Varian Medical Systems), gating and intrafraction motion correction in prostate SBRT. Delivered doses were modelled by reconstructing motion inclusive dose distributions for different localization strategies. Actually delivered dose (strategy A) utilized initial Calypso localization, CBCT and additional pre-treatment motion correction by kV-imaging and Calypso, and gating during the irradiation. The effect of gating was investigated by simulating non-gated treatments (strategy B). Additionally, non-gated and single image-guided (CBCT) localization was simulated (strategy C). A total of 308 fractions from 22 patients were reconstructed. The dosimetric effect was evaluated by comparing motion inclusive target and risk organ dose-volume parameters to planned values. Motion induced dose deficits were seen mainly in PTV and CTV to PTV margin regions, whereas CTV dose deficits were small in all strategies: mean ± SD difference in CTVD99% was –0.3 ± 0.4%, −0.4 ± 0.6% and –0.7 ± 1.2% in strategies A, B and C, respectively. Largest dose deficits were seen in individual fractions for strategy C (maximum dose reductions were −29.0% and –7.1% for PTVD95% and CTVD99%, respectively). The benefit of gating was minor, if additional motion correction was applied immediately prior to irradiation. Continuous motion monitoring based localization and motion correction ensured the target coverage and minimized the OAR exposure for every fraction and is recommended to use in prostate SBRT. The study is part of clinical trial NCT02319239.     

Conceptual design of integrated microfluidic system for magnetic cell separation,electroporation, and transfection

For the purposes of a successful ex vivo gene therapy we have proposed and analyzed a new concept of an integrated microfluidic system for combined magnetic cell separation, electroporation, and magnetofection. For the analysis of magnetic and electric field distribution (given by Maxwell equations) as well as dynamics of magnetically labeled cell and transfection complex, we have used finite element method directly interfaced to the Matlab routine solving Newton dynamical equations of motion. Microfluidic chamber has been modeled as a channel with height and length 1 mm and 1 cm, respectively. Bottom electrode consisted of 100 parallel ferromagnetic straps and the upper electrode was plate of diamagnetic copper. From the dynamics of magnetic particle motion we have found that the characteristic time-scales for the motion of cells (mean capture time ～ 4 s) and gene complexes (mean capture time ～ 3 min), when permanent magnets are used, are in the range suitable for efficient cell separation and gene delivery. The largest electric field intensity (～10 kV/m) was observed at the edges of the microelectrodes, in the close proximity of magnetically separated cells, which is optimal for subsequent cell electroporation.     

Accuracy checks of physical beam modifier factors algorithm used in computerized treatment planning system for a 15 MV photon beam

In order to optimize the tumour dose by using wedge filters, systematic studies were carried out to investigate the accuracy of the beam modifier algorithm in a computerized treatment planning system (Theraplan plus, version 3.8). The effect of different parameters such as beam hardening and softening coefficients on the wedge factor was also studied. A 15 MV photon beam obtained from a linear accelerator was used throughout the experiments. Normalized wedge factors were determined experimentally as well as with the Theraplan plus system as a function of field size and depth in a water phantom for 15°, 30°, 45°, and 60° wedge filters. The attenuation coefficients, beam hardening coefficient, and beam softening coefficients were also determined experimentally using the 15 MV photon beam for each wedge angle. The measured normalized wedge factor was found to increase with increasing depth and field size for the 15 MV beam. The Theraplan plus calculated normalized wedge factor was found to be in good agreement with the experimental values. This study indicated that ignoring the dependence of the wedge factor on depth and field size will result in underexposure of the tumour.     

Gated carbon-ion scanning treatment for pancreatic tumour with field specific target volume and organs at risk

ObjectiveTo assess the feasibility of treatment planning for pancreatic tumours subject to respiratory motion using field-specific target volumes (FTV) and field-specific organs at risk (FOAR) using four-dimensional computed tomography (4DCT).MethodsFourteen pancreatic cancer patients underwent 4DCT. Radiation oncologists contoured the gross tumour volume (GTV), clinical target volume (CTV), spinal cord, duodenum, kidneys, and stomach. The gating duty cycle was set to 30 % around exhalation. FTV and FOAR were calculated using the 4DCT dataset. Planning target volumes (PTV) and planning organs at risk volumes (PRV) were defined as equal to FTV and FOAR, respectively. A dose of 55.2 Gy relative biological effectiveness (RBE) was planned to target the PTV from four beam angles. A single field uniform dose (SFUD) plan was selected. The dose distribution, including intrafractional motion changes, was generated.ResultsThe mean volume of target receiving 95 % of the planned doses was 96.4 ± 4.1 % to the GTV and 94.7 ± 0.9 % to the CTV. The highest dose to 2 cc of duodenal volume was 27.5 Gy (RBE). The volume of the stomach receiving ⩾30 Gy (RBE) was <7.0 cc in all patients. All metrics for OARs satisfied dose constraints.ConclusionDose to the CTV was covered sufficiently by the 4DCT-generated FTV, and dose to OARs was reduced by 4DCT-generated FOAR. This methodology may prevent adverse reactions while preserving local tumour control.     

Dobutamine stress echocardiography assessment of myocardial contusion due to blunt impact in dogs

We sought to investigate the role of two-dimensional stress echocardiography in the early assessment of myocardial contusion. For this purpose, 12 dogs, weighing 11.36 ± 1.50 kg, were selected and the myocardial contusion was experimentally induced. Two-dimensional dobutamine stress echocardiography (DSE) was used to detect abnormal myocardial motions segments at time phases of baseline and 0.5, 2, 4, and 8 h post-wounding. Finally, the above results were compared with pathological findings. The data show that after the dogs were induced to have severe myocardial contusion, 122 segments were found with abnormal myocardial wall motions at 0.5 h post-wounding, 133 segments at 2 h post-wounding, and 142 segments, each, at 4 h and 8 h post-wounding. The wall motion score (WMS) and wall motion score index (WMSI) increased (P < 0.001) as compared with the pre-impaction values. Considering the left ventricular axis view as the standard section, in the 60 segments examined by echocardiography, 54 segments were found to have wall motion abnormalities. Comparing with the results of pathological TTC staining, the sensitivity and specificity were found to be 100 and 66.6%, respectively. It was, therefore, concluded that two-dimensional DSE was a valuable technique in the early diagnosis of myocardial contusion due to its better sensitivity and specificity.     

Towards MR-guided electron therapy: Measurement and simulation of clinical electron beams in magnetic fields

PurposeIn the current era of MRI-linac radiotherapy, dose optimization with arbitrary dose distributions is a reality. For the first time, we present new and targeted experiments and modeling to aid in evaluating the potential dose improvements offered with an electron beam mode during MRI-linac radiotherapy.MethodsSmall collimated (1 cm diameter and 1.5 × 1.5 cm² square) electron beams (6, 12 and 20 MeV) from a clinical linear accelerator (Varian Clinac 2100C) are incident perpendicular and parallel to the strong and localized magnetic fields (0–0.7 T) generated by a permanent magnet device. Gafchromic EBT3 film is placed inside a slab phantom to measure two-dimensional dose distributions. A benchmarked and comprehensive Monte Carlo model (Geant4) is established to directly compare with experiments.ResultsWith perpendicular fields a 5% narrowing of the beam FWHM and a 10 mm reduction in the 15% isodose penetration is seen for the 20 MeV beam. In the inline setup the penumbral width is reduced by up to 20%, and a local central dose enhancement of 100% is observed. Monte Carlo simulations are in agreement with the measured dose distributions (2% or 2 mm).ConclusionA new range of experiments have been performed to offer insight into how an electron beam mode could offer additional choices in MRI-linac radiotherapy. The work extends on historic studies to bring a successful unified experimental and Monte Carlo modeling approach for studying small field electron beam dosimetry inside magnetic fields. The results suggest further work, particularly on the inline magnetic field scenario.     

Use of dual Euler angles to quantify the three-dimensional joint motion and its application to the ankle joint complex

This paper presents a modified Euler angles method, dual Euler angles approach, to describe general spatial human joint motions. In dual Euler angles approach, the three-dimensional joint motion is considered as three successive screw motions with respect to the axes of the moving segment coordinate system; accordingly, the screw motion displacements are represented by dual Euler angles. The algorithm for calculating dual Euler angles from coordinates of markers on the moving segment is also provided in this study. As an example, the proposed method is applied to describe motions of ankle joint complex during dorsiflexion–plantarflexion. A Flock of Birds electromagnetic tracking device (FOB) was used to measure joint motion in vivo. Preliminary accuracy tests on a gimbal structure demonstrate that the mean errors of dual Euler angles evaluated by using source data from FOB are less than 1° for rotations and 1 mm for translations, respectively. Based on the pilot study, FOB is feasible for quantifying human joint motions using dual Euler angles approach.     

Validation of 4D Monte Carlo dose calculations using a programmable deformable lung phantom

PurposeTo validate the accuracy of 4D Monte Carlo (4DMC) simulations to calculate dose deliveries to a deforming anatomy in the presence of realistic respiratory motion traces. A previously developed deformable lung phantom comprising an elastic tumor was modified to enable programming of arbitrary motion profiles. 4D simulations of the dose delivered to the phantom were compared with the measurements.MethodsThe deformable lung phantom moving with irregular breathing patterns was irradiated using static and VMAT beam deliveries. Using the RADPOS 4D dosimetry system, point doses were measured inside and outside the tumor. Dose profiles were acquired using films along the motion path of the tumor (S-I). In addition to dose measurements, RADPOS was used to record the motion of the tumor during dose deliveries. Dose measurements were then compared against 4DMC simulations with EGSnrc/4DdefDOSXYZnrc using the recorded tumor motion.ResultsThe agreements between dose profiles from measurements and simulations were determined to be within 2%/2 mm. Point dose agreements were within 2σ of experimental and/or positional/dose reading uncertainties. 4DMC simulations were shown to accurately predict the sensitivity of delivered dose to the starting phase of breathing motions. We have demonstrated that our 4DMC method, combined with RADPOS, can accurately simulate realistic dose deliveries to a deforming anatomy moving with realistic breathing traces. This 4DMC tool has the potential to be used as a quality assurance tool to verify treatments involving respiratory motion. Adaptive treatment delivery is another area that may benefit from the potential of this 4DMC tool.     

Dose delivery accuracy on helical tomotherapy for 4-dimensional tumor motion — a phantom study

BackgroundThe advances in image guidance and capability of highly conformal dose deliveries made possible the use of helical tomotherapy (HT) for lung cancer treatment. To determine the effect of respiratory motion on the delivered dose in HT, film dosimetry using a dynamic phantom was performed. This was a phantom study to determine the effect of motion on the delivered dose in HT.Materials and methods4D computed tomography (4DCT) was acquired for various target motions of CIRS dynamic phantom (CIRS Inc., Norfolk, USA) with 2.5cm diameter spherical target of volume 8.2 cc moving in the COS⁴ motion pattern. AveIP images and treatment plans were generated in the HT planning system. Target excursions during treatment delivery were changed in the superior-inferior, anteroposterior and lateral directions. The breathing cycle time was varied from 4 to 5 sec. and also the delivery interruptions were introduced. A film was exposed for each delivery and gamma analysis was performed.ResultsThe gamma pass rate (GPR) with 3%, 2 mm criteria for the target motion in the S-I direction showed a significant reduction from 97.5% to 54.4% as the motion increased from 3 mm to 8 mm (p = 0.03). For the target motion in S-I = 8 mm, L-R = A-P = 3 mm, the percentage decrease in the GPR was 74% (p = 0.001) for three interruptions.ConclusionThe ITV based approach in HT is ideal for a shallow breathing situation when the tumor excursions were confined to 5 mm in the S-I and 3 mm in L-R and A-P directions.     

Credentialing of vertebral stereotactic ablative body radiotherapy in a multi-centre trial

Purpose/objectiveStereotactic ablative body radiotherapy (SABR) in multi-centre trials requires rigorous quality assurance to ensure safe and consistent treatment for all trial participants. We report results of vertebral SABR dosimetry credentialing for the ALTG/TROG NIVORAD trial.Material/methodsCentres with a previous SABR site visit performed axial film measurement of the benchmarking vertebral plan in a local phantom and submitted radiochromic film images for analysis. Remaining centres had on-site review of SABR processes and axial film measurement of the vertebral benchmarking plan. Films were analysed for dosimetric and positional accuracy: gamma analysis (>90% passing 2%/2mm/10% threshold) and ≤ 1 mm positional accuracy at target-cord interface was required.Results19 centres were credentialed; 11 had on-site measurement. Delivery devices included linear accelerator, TomoTherapy and CyberKnife systems. Five centres did not achieve 90% gamma passing rate. Of these, three were out of tolerance (OOT) in low (<5Gy) dose regions and > 80% passing rate and deemed acceptable. Two were OOT over the full dose range: one elected not to remeasure; the other also had positional discrepancy greater than 1 mm and repeat measurement with a new plan was in tolerance. The original OOT was attributed to inappropriate MLC constraints. All centres delivered planned target-cord dose gradient within 1 mm.ConclusionCredentialing measurements for vertebral SABR in a multi-centre trial showed although the majority of centres delivered accurate vertebral SABR, there is high value in independent audit measurements. One centre with inappropriate MLC settings was detected, which may have resulted in delivery of clinically unacceptable vertebral SABR plans.     

Evaluation of Acuros® XB accuracy for static small fields dose calculations based on the IAEA/AAPM TRS-483 recommendation

Purpose: Evaluate Acuros® XB dose calculation accuracy following TRS-483 recommendations in small static fields for flattened and un-flattened 6 MV X-ray beams.Methods: Field output factors were measured following TRS-483 recommendations using four radiation detectors. Two sets of field output factors were measured. One set was used to configure the beam model into Acuros® XB down to a jaw-defined field size of 1.0 cm × 1.0 cm. The second set was used to evaluate the differences between calculated and measured field output factors for MLC-fields down to a field size of 0.5 cm × 0.5 cm.Results: Acuros® XB showed an accuracy within 1.5% down to an MLC-field of 1.0 cm × 1.0 cm, for a focal spot size of 1.0 and 0.0 mm in the cross and in-plane directions. For an MLC-field of 0.5 cm × 0.5 cm, an agreement was found within 3% between calculated and measured field output factors. These results were addressed by optimizing the focal spot size to minimize the differences between calculated and measured dose profiles.Conclusions: By optimizing the focal spot size, Acuros® XB showed an acceptable agreement within 3% down to an MLC-field of 0.5 cm × 0.5 cm. The results of this work suggest that if static and modulated delivery of very small targets is planned, then a field output factor table down to a field size of 1.0 cm is required in the beam configuration model.