Accelerator beam data commissioning equipment and procedures: Report of the TG-106 of the Therapy Physics Committee of the AAPM

Commissioning of a Versa HDTM linear accelerator for three commercial treatment planning systems

In a mixed-vendor radiation oncology environment, it is advantageous if the department's treatment planning system (TPS) supports the linear accelerators of different vendors. In this publication beam data collection and modeling for the Versa HD linear accelerator in Monaco, Pinnacle, and Eclipse are discussed. In each TPS static field, Intensity-Modulated Radiation Therapy (IMRT) step and shoot, and Volumetric-Modulated Arc Therapy (VMAT) plans for flattened and flattening-filter free photon beams of all available energies were evaluated for field sizes >3 × 3. To compare passing rates, identical beam model validation plans were calculated in each TPS. Eclipse, Monaco, and Pinnacle beam models passed validation measurements in homogeneous materials for a variety of treatment fields, including static, IMRT, and VMAT. In the case of Eclipse, the "dosimetric leaf gap" parameter was found to be critical for passing rates of VMAT plans. The source size parameter plays an important role as well for small fields. In the case of Pinnacle the multileaf collimator offset table needed to be optimized for better VMAT QA results. Each of the investigated treatment planning systems met the criteria to be used clinically in conjunction with Elekta Versa HD linear accelerators. It can be of great advantage to have the option to operate a TPS and linear accelerator from different vendors, as decisions surrounding linear accelerator or TPS purchases are very complicated and not just limited to technical considerations.

Recommended procedures and responsibilities for radiosurgery (SRS) and extracranial stereotactic body radiotherapy (SBRT): report of the SEOR in collaboration with the SEFM

Today, patient management generally requires a multidisciplinary approach. However, due to the growing knowledge base and increasing complexity of Medicine, clinical practice has become even more specialised. Radiation oncology is not immune to this trend towards subspecialisation, which is particularly evident in ablative radiotherapy techniques that require high dose fractions, such as stereotactic radiosurgery (SRS), and stereotactic body radiotherapy (SBRT). The aim of the present report is to establish the position of the Spanish Society of Radiation Oncology (SEOR), in collaboration with the Spanish Society of Medical Physics (SEFM), with regard to the roles and responsibilities of healthcare professionals involved in performing SRS and SBRT. The need for this white paper is motivated due to the recent changes in Spanish Legislation (Royal Decree [RD] 601/2019, October 18, 2019) governing the use and optimization of radiotherapy and radiological protection for medical exposure to ionizing radiation (article 11, points 4 and 5) [1 ], which states: "In radiotherapy treatment units, the specialist in Radiation Oncology will be responsible for determining the correct treatment indication, selecting target volumes, determining the clinical radiation parameters for each volume, directing and supervising treatment, preparing the final clinical report, reporting treatment outcomes, and monitoring the patient's clinical course." Consequently, the SEOR and SEFM have jointly prepared the present document to establish the roles and responsibilities for the specialists-radiation oncologists (RO), medical physicists (MP), and related staff -involved in treatments with ionizing radiation. We believe that it is important to clearly establish the responsibilities of each professional group and to clearly establish the professional competencies at each stage of the radiotherapy process.

Simplified sigmoidal curve fitting for a 6 MV FFF photon beam of the Halcyon to determine the field size for beam commissioning and quality assurance

Background

An O-ring gantry-type linear accelerator (LINAC) with a 6-MV flattening filter-free (FFF) photon beam, Halcyon, includes a reference beam that contains representative information such as the percent depth dose, profile and output factor for commissioning and quality assurance. However, because it does not provide information about the field size, we proposed a method to determine all field sizes according to all depths for radiation therapy using simplified sigmoidal curve fitting (SCF).

Methods

After mathematical definition of the SCF using four coefficients, the defined curves were fitted to both the reference data (RD) and the measured data (MD). For good agreement between the fitting curve and the profiles in each data set, the field sizes were determined by identifying the maximum point along the third derivative of the fitting curve. The curve fitting included the field sizes for beam profiles of 2 × 2, 4 × 4, 6 × 6, 8 × 8, 10 × 10, 20 × 20 and 28 × 28 cm² as a function of depth (at 1.3, 5, 10 and 20 cm). The field size results from the RD were compared with the results from the MD using the same condition.

Results

All fitting curves show goodness of fit, R², values that are greater than 0.99. The differences in field size between the RD and the MD were within the range of 0 to 0.2 cm. The smallest difference in the field sizes at a depth of 10 cm, which is a surface-to-axis distance, was reported.

Conclusion

Application of the SCF method has been proven to accurately capture the field size of the preconfigured RD and the measured FFF photon beam data for the Halcyon system. The current work can be useful for beam commissioning as a countercheck methodology to determine the field size from RD in the treatment planning system of a newly installed Halcyon system and for routine quality assurance to ascertain the correctness of field sizes for clinical use of the Halcyon system.

Effect of an integral quality monitor on 4-, 6-, 10-MV, and 6-MV flattening filter-free photon beams

Purpose

To investigate the effect of an integral quality monitor (IQM; iRT Systems GmbH, Koblenz, Germany) on 4, 6, 10, and 6‐MV flattening filter‐free (FFF) photon beams.

Methods

We assessed surface dose, PDD_20,10, TPR_20,10, PDD curves, inline and crossline profiles, transmission factor, and output factor with and without the IQM. PDD, transmission factor, and output factor were measured for square fields of 3, 5, 10, 15, 20, 25, and 30 cm and profiles were performed for square fields of 3, 5, 10, 20, and 30 cm at 5‐, 10‐, and 30‐cm depth.

Results

The differences in surface dose of all energies for square fields of 3, 5, 10, 15, 20, and 25 cm were within 3.7% whereas for a square field of 30 cm, they were 4.6%, 6.8%, 6.7%, and 8.7% for 4‐MV, 6‐MV, 6‐MV‐FFF, and 10‐MV, respectively. Differences in PDD_20,10, TPR_20,10, PDD, profiles, and output factors were within ±1%. Local and global gamma values (2%/2 mm) were below 1 for PDD beyond d_max and inline/crossline profiles in the central beam region, respectively. The gamma passing rates (10% threshold) for PDD curves and profiles were above 95% at 2%/2 mm. The transmission factors for 4‐MV, 6‐MV, 6‐MV‐FFF, and 10‐MV for field sizes from 3 × 3 to 30 × 30 cm² were 0.926–0.933, 0.937–0.941, 0.937–0.939, and 0.949–0.953, respectively.

Conclusions

The influence of the IQM on the beam quality (in particular 4‐MV X‐ray has not verified before) was tested and introduced a slight beam perturbation at the surface and build‐up region and the edge of the crossline/inline profiles. To use IQM in pre‐ and intra‐treatment quality assurance, a tray factor should be put into treatment planning systems for the dose calculation for the 4‐, 6‐, 10‐, and 6‐MV flattening filter‐free photon beams to compensate the beam attenuation of the IQM detector.

An inter-comparison between accuracy of EGSnrc and MCNPX Monte Carlo codes in dosimetric characterization of intraoperative electron beam

BACKGROUND

Ionometric dosimetry in IOERT is a complicated process, due to the sophisticated beam setup and the necessity for dedicated protocols for ion chamber response correction. On the other hand, the Monte Carlo (MC) technique can easily overcome such limitations and be considered as an alternative dosimetry approach. This paper presents a comparative analysis of two widely used MC codes, EGSnrc and MCNPX, for intraoperative electron beam dosimetry.

METHOD

The head of LIAC12, a dedicated IOERT accelerator, was modeled by both mentioned MC codes. Then, the percentage depth dose (PDD) curves, transverse dose profiles (TDPs), and output factor (OF) values were accordingly calculated within the water phantom. To realize the accuracy of MC codes in dosimetric characterization of intraoperative electron beam, their results were finally compared with those measured by corresponding ionometric dosimetry for all forms of electron energy/applicator size.

RESULTS

A good agreement was observed between the simulated and measured PDDs/TDPs for both considered MC codes, such that the calculated gamma index values were always lower than unity for both considered MC codes. Nevertheless, the lower gamma index values were found in the case of the EGSnrc code. The maximum difference between the measured and calculated OF was obtained as 2.3% and 3.1% for EGSnrc and MCNPX code, respectively.

CONCLUSIONS

Although both studied MC codes showed compatible results with the measured ones, EGSnrc code has superior accuracy in this regard and can be considered as a more reliable toolkit in Monte Carlo-based commissioning of dedicated IOERT accelerators.

Artificial intelligence-based radiotherapy machine parameter optimization using reinforcement learning

PURPOSE

To develop and evaluate a volumetric modulated arc therapy (VMAT) machine parameter optimization (MPO) approach based on deep-Q reinforcement learning (RL) capable of finding an optimal machine control policy using previous prostate cancer patient CT scans and contours, and applying the policy to new cases to rapidly produce deliverable VMAT plans in a simplified beam model.

METHODS

A convolutional deep-Q network was employed to control the dose rate and multileaf collimator of a C-arm linear accelerator model using the current dose distribution and machine parameter state as input. A Q-value was defined as the discounted cumulative cost based on dose objectives, and experience-replay RL was performed to determine a policy to minimize the Q-value. A two-dimensional network design was employed which optimized each opposing leaf pair independently while monitoring the corresponding dose plane blocked by those leaves. This RL approach was applied to CT and contours from 40 retrospective prostate cancer patients. The dataset was split into training (15 patients) and validation (5 patients) groups to optimize the network, and its performance was tested in an independent cohort of 20 patients by comparing RL-based dose distributions to conformal arcs and clinical intensity modulated radiotherapy (IMRT) delivering a prescription dose of 78 Gy in 40 fractions.

RESULTS

Mean ± SD execution time of the RL VMAT optimization was 1.5 ± 0.2 s per slice. In the test cohort, mean ± SD (P-value) planning target volume (PTV), bladder, and rectum dose were 80.5 ± 2.0 Gy (P < 0.001), 44.2 ± 14.6 Gy (P < 0.001), and 43.7 ± 11.1 Gy (P < 0.001) for RL VMAT compared to 81.6 ± 1.1 Gy, 51.6 ± 12.9 Gy, and 36.0 ± 12.3 Gy for clinical IMRT.

CONCLUSIONS

RL was applied to VMAT MPO using clinical patient contours without independently optimized treatment plans for training and achieved comparable target and normal tissue dose to clinical plans despite the application of a relatively simple network design originally developed for video-game control. These results suggest that extending a RL approach to a full three-dimensional beam model could enable rapid artificial intelligence-based optimization of deliverable treatment plans, reducing the time required for radiotherapy planning without requiring previous plans for training.

Assessing the out-of-field dose calculation accuracy by eclipse treatment planning system in sliding window IMRT of prostate cancer patients

AIM

The objective of this study was to evaluate out-of-field dose distribution calculation accuracy by the Anisotropic Analytical Algorithm (AAA), version 13.0.26, in Eclipse TPS, (Varian Medical Systems, Palo Alto, Ca, USA) for sliding window IMRT delivery technique in prostate cancer patients.

MATERIALS AND METHODS

Prostate IMRT plans with nine coplanar were calculated with the AAA Eclipse treatment planning system. To assess the accuracy of dose calculation predicted by the Eclipse in normal tissue and OARs located out of radiation field areas, including the rectum, bladder, right and left head of the femur, absolute organ dose value, and dose distribution were measured using the Delta⁴⁺ IMRT phantom.

RESULTS

In the out-of-field areas, underestimation of -0.66% in organs near the field edge to -39.63% in organs far from the field edge (2.5 and 7.3 cm respectively) occurred in the TPS calculations. The percentage of dose deviation for the femoral heads was 95.7 on average while for the organ closer to the target (rectum) it was 79.81.

CONCLUSIONS

AAA dosimetry algorithm (used in Eclipse TPS) showed poor dose calculation in areas beyond the treatment fields border where underestimation varies with the distance from the field edges. A significant underestimation was found for the AAA algorithm in the sliding window IMRT technique (P-value > 0.05).

Evaluation of differences and dosimetric influences of beam models using golden and multi-institutional measured beam datasets in radiation treatment planning systems

PURPOSE

The beam model in radiation treatment planning systems (RTPSs) plays a crucial role in determining the accuracy of calculated dose distributions. The purpose of this study was to ascertain differences in beam models and their dosimetric influences when a golden beam dataset (GBD) and multi-institution measured beam datasets (MBDs) are used for beam modeling in RTPSs.

METHODS

The MBDs collected from 15 institutions, and the MBDs' beam models, were compared with a GBD, and the GBD's beam model, for Varian TrueBeam linear accelerator. The calculated dose distributions of the MBDs' beam models were compared with those of the GBD's beam model for simple geometries in a water phantom. Calculated dose distributions were similarly evaluated in volumetric modulated arc therapy (VMAT) plans for TG-119 C-shape and TG-244 head and neck, at several dose constraints of the planning target volumes (PTVs), and organs at risk.

RESULTS

The agreements of the MBDs with the GBD were almost all within ±1%. The calculated dose distributions for simple geometries in a water phantom also closely corresponded between the beam models of GBD and MBDs. Nevertheless, there were considerable differences between the beam models. The maximum differences between the mean energy of the energy spectra of GBD and MBDs were -0.12 MeV (-10.5%) in AcurosXB (AXB, Eclipse) and 0.11 MeV (7.7%) in collapsed cone convolution (CCC, RayStation). The differences in the VMAT calculated dose distributions varied for each dose region, plan, X-ray energy, and dose calculation algorithm. The ranges of the differences in the dose constraints were -5.6% to 3.0% for AXB and -24.1% to 2.8% for CCC. In several VMAT plans, the calculated dose distributions of GBD's beam model tended to be lower in high-dose regions and higher in low-dose regions than those of the MBDs' beam models.

CONCLUSIONS

We found that small differences in beam data have large impacts on the beam models, and on calculated dose distributions in clinical VMAT plan, even if beam data correspond within ±1%. GBD's beam model was not a representative beam model. The beam models of GBD and MBDs and their calculated dose distributions under clinical conditions were significantly different. These differences are most likely due to the extensive variation in the beam models, reflecting the characteristics of beam data. The energy spectrum and radial energy in the beam model varied in a wide range, even if the differences in the beam data were <±1%. To minimize the uncertainty of the calculated dose distributions in clinical plans, it was best to use the institutional MBD for beam modeling, or the beam model that ensures the accuracy of calculated dose distributions.

Beam data modeling of linear accelerators (linacs) through machine learning and its potential applications in fast and robust linac commissioning and quality assurance

BACKGROUND AND PURPOSE

To propose a novel machine learning-based method for reliable and accurate modeling of linac beam data applicable to the processes of linac commissioning and QA.

MATERIALS AND METHODS

We hypothesize that the beam data is a function of inherent linac features and percentage depth doses (PDDs) and profiles of different field sizes are correlated with each other. The correlation is formulated as a multivariable regression problem using a machine learning framework. Varian TrueBeam beam data sets (n = 43) acquired from multiple institutions were used to evaluate the framework. The data sets included PDDs and profiles across different energies and field sizes. A multivariate regression model was trained for prediction of beam specific PDDs and profiles of different field sizes using a 10 × 10 cm² field as input.

RESULTS

Predictions of PDDs were achieved with a mean absolute percent relative error (%RE) of 0.19-0.35% across the different beam energies investigated. The maximum mean absolute %RE was 0.93%. For profile prediction, the mean absolute %RE was 0.66-0.93% with a maximum absolute %RE of 3.76%. The largest uncertainties in the PDD and profile predictions were found at the build-up region and at the field penumbra, respectively. The prediction accuracy increased with the number of training sets up to around 20 training sets.

CONCLUSIONS

Through this novel machine learning-based method we have shown accurate and reproducible generation of beam data for linac commissioning for routine radiation therapy. This method has the potential to simplify the linac commissioning procedure, save time and manpower while increasing the accuracy of the commissioning process.

Characterization of novel polydiacetylene gel dosimeter for radiotherapy

Polymer gel dosimeters are instrumental for clinical and research applications in radiotherapy. These dosimeters possess the unique ability to record dose distribution in three dimensions. A Polymer gel dosimeter is composed of organic molecules in a gel matrix, which upon irradiation polymerize to form a conjugated polymer with optical absorbance proportional to the irradiated dose. Other required characteristics of a radiotherapy clinical dosimeter are soft-tissue equivalency, linear dose-response in a range of clinical treatments, and long term stability for the duration of the analysis. The dosimeter presented in this paper is based on diacetylene bearing fatty acid aggregates embedded in a soft-tissue equivalent gel matrix, Phytagel™, which upon irradiation polymerize to form a blue phase polydiacetylene with a strong optical absorption. Initial characterization showed that PDA-gel irradiated with 160 kV x-ray responded linearly to the irradiated dose, and the calculated diffusion coefficient is [Formula: see text] what is very low. It was also found that the percentage depth dose (PDD) curve of the PDA-gel in a 4 × 4 cm² field, irradiated with 6 MV x-rays, was with good agreement with the literature. PDA-gel has the potential to detect absorbed dose in a range of clinical radiological irradiation regimes.

Estimation of the cable effect in megavoltage photon beam by measurement and Monte Carlo simulation

PURPOSE

Ionization chambers are widely used for dosimetry with megavoltage photon beams. Several properties of ionization chambers, including the cable effect, polarity effect, and ion recombination loss, are described in standard dosimetry protocols. The cable effect is categorized as the leakage current and Compton current, and careful consideration of these factors has been described not only in reference dosimetry but also in large fields. However, the mechanism of Compton current in the cable has not been investigated thoroughly. The cable effect of ionization chambers in 6 MV X-ray beam was evaluated by measurement, and the mechanism of Compton current was investigated by Monte Carlo simulation.

MATERIALS AND METHODS

Four PTW ionization chambers (TM30013, TM31010, TM31014, and TM31016) with the same type of mounted cable, but different ionization volumes, were used to measure output factor (OPF) and cable effect measurement. The OPF was measured to observe any variation resulting from the cable effect. The cable effect was evaluated separately for the leakage current and Compton current, and its charge per absorbed dose to water per cable length was estimated by a newly proposed method. The behavior of electrons and positrons in the core wire was analyzed and the Compton current for the photon beam was estimated by Monte Carlo simulation.

RESULTS

In OPF measurement, the difference in the electrometer readings by polarity became obvious for the mini- or microchamber and its difference tended to be larger for a chamber with a smaller ionization volume. For the cable effect measurement, it was determined that the contribution of the leakage current to the cable effect was ignorable, while the Compton current was dominant. The charge due to the Compton current per absorbed dose to water per cable length was estimated to be 0.36 ± 0.03 pC Gy^-1  cm^-1 for PTW ionization chambers. As a result, the contribution of the Compton current to the electrometer readings was estimated to be 0.002% cm^-1 for the Farmer-type, 0.011% cm^-1 for the scanning, and 0.088% cm^-1 for microchambers, respectively. By the simulation, it was determined that the Compton current for MV x-ray could be explained by not only recoil electrons due to Compton scattering but also positron due to pair production. The Compton current estimated by the difference in outflowing and inflowing charge was 0.45 pC Gy^-1  cm^-1 and was comparable with the measured value.

CONCLUSION

The cable effect, which includes the leakage current and Compton current, was quantitatively estimated for several chambers from measurements, and the mechanism of Compton current was investigated by Monte Carlo simulation. It was determined that the Compton current is a dominant component of the cable effect and its charge is consistently positive and nearly the same, irrespective of the ionization chamber volume. The contribution of Compton current to the electrometer readings was estimated for chambers. The mechanism of Compton current was analyzed and it was confirmed that the Compton current can be estimated from the difference in outflowing and inflowing charge to and from the core wire.

Improvement of prediction and classification performance for gamma passing rate by using plan complexity and dosiomics features

PURPOSE

The purpose of this study was to predict and classify the gamma passing rate (GPR) value by using new features (3D dosiomics features and combined with plan and dosiomics features) together with a machine learning technique for volumetric modulated arc therapy (VMAT) treatment plans.

METHODS AND MATERIALS

A total of 888 patients who underwent VMAT were enrolled comprising 1255 treatment plans. Further, 24 plan complexity features and 851 dosiomics features were extracted from the treatment plans. The dataset was randomly split into a training/validation (80%) and test (20%) dataset. The three models for prediction and classification using XGBoost were as follows: (i) plan complexity features-based prediction method (plan model); (ii) 3D dosiomics feature-based prediction model (dosiomics model); (iii) a combination of both the previous models (hybrid model). The prediction performance was evaluated by calculating the mean absolute error (MAE) and the correlation coefficient (CC) between the predicted and measured GPRs. The classification performance was evaluated by calculating the area under curve (AUC) and sensitivity.

RESULTS

MAE and CC at γ2%/2 mm in the test dataset were 4.6% and 0.58, 4.3% and 0.61, and 4.2% and 0.63 for the plan model, dosiomics model, and hybrid model, respectively. AUC and sensitivity at γ2%/2 mm in test dataset were 0.73 and 0.70, 0.81 and 0.90, and 0.83 and 0.90 for the plan model, dosiomics model, and hybrid model, respectively.

CONCLUSIONS

A combination of both plan and dosiomics features with machine learning technique can improve the prediction and classification performance for GPR.

Characterization and Performance Evaluation of the First-Proton Therapy Facility in India

Purpose:

The purpose of this study is to evaluate the performance characteristic of volumetric image-guided dedicated-nozzle pencil beam-scanning proton therapy (PT) system.

Materials and Methods:

PT system was characterized for electromechanical, image quality, and registration accuracy. Proton beam of 70.2–226.2 MeV was characterized for short- and long-term reproducibility in integrated depth dose; spot profile characteristics at different air gap and gantry angle; positioning accuracy of single and pattern of spot; dose linearity, reproducibility and consistency. All measurements were carried out using various X-ray and proton-beam specific detectors following standard protocols.

Results:

All electro-mechanical, imaging, and safety parameters performed well within the specified tolerance limit. The image registration errors along three translation and three rotational axes were ≤0.5 mm and ≤0.2° for both point-based and intensity-based auto-registration. Distal range (R₉₀) and distal dose fall-off (DDF) of 70.2–226.2 MeV proton beams were within 1 mm of calculated values based on the international commission on radiation units and measurements 49 and 0.0156× R₉₀, respectively. The R₉₀ and DDF were reproducible within a standard deviation of 0.05 g/cm² during the first 8 months. Dose were linear from 18.5 (0.011 MU/spot) to 8405 (5 MU/spot) MU, reproducible within 0.5% in 5 consecutive days and consistent within 0.8% for full rotation. The cGy/MU for 70.2–226.2MeV was consistent within 0.5%. In-air X(Y) spot-sigma at isocenter varies from 2.96 (3.00) mm to 6.68 (6.52) mm for 70.2–226.2 MeV. Maximum variation of spot-sigma with air-gap of ±20 cm was ±0.36 mm (5.28%) and ±0.82 mm (±12.5%) along X- and Y-direction and 3.56% for full rotation. Relative spot positions were accurate within ±0.6 mm. The planned and delivered spot pattern of known complex geometry agreed with (γ%≤1) for 1% @ 1 mm >98% for representative five-proton energies at four gantry angle.

Conclusion:

The PT-system performed well within the expected accuracy level and consistent over a period of 8 months. The methodology and data presented here may help upcoming modern PT center during their crucial phase of commissioning.

Automated and robust beam data validation of a preconfigured ring gantry linear accelerator using a 1D tank with synchronized beam delivery and couch motions

PURPOSE

To develop an efficient and automated methodology for beam data validation for a preconfigured ring gantry linear accelerator using scripting and a one-dimensional (1D) tank with automated couch motions.

MATERIALS AND METHODS

Using an application programming interface, a program was developed to allow the user to choose a set of beam data to validate with measurement. Once selected the program generates a set of instructions for radiation delivery with synchronized couch motions for the linear accelerator in the form of an extensible markup language (XML) file to be delivered on the ring gantry linear accelerator. The user then delivers these beams while measuring with the 1D tank and data logging electrometer. The program also automatically calculates this set of beams on the measurement geometry within the treatment planning system (TPS) and extracts the corresponding calculated dosimetric data for comparison to measurement. Once completed the program then returns a comparison of the measurement to the predicted result from the TPS to the user and prints a report. In this work lateral, longitudinal, and diagonal profiles were taken for fields sizes of 6 × 6, 8 × 8, 10 × 10, 20 × 20, and 28 × 28 cm² at depths of 1.3, 5, 10, 20, and 30 cm. Depth dose profiles were taken for all field sizes.

RESULTS

Using this methodology, the TPS was validated to agree with measurement. All compared points yielded a gamma value less than 1 for a 1.5%/1.5 mm criteria (100% passing rate). Off axis profiles had >98.5% of data points producing a gamma value <1 with a 1%/1 mm criteria. All depth profiles produced 100% of data points with a gamma value <1 with a 1%/1 mm criteria. All data points measured were within 1.5% or 2 mm distance to agreement.

CONCLUSIONS

This methodology allows for an increase in automation in the beam data validation process. Leveraging the application program interface allows the user to use a single system to create the measurement files, predict the result, and then compare to actual measurement increasing efficiency and reducing the chance for user input errors.

New algorithm using L1 regularization for measuring electron energy spectra

Retrieving the spectrum of physical radiation from experimental measurements typically involves using a mathematical algorithm to deconvolve the instrument response function from the measured signal. However, in the field of signal processing known as "Source Separation" (SS), which refers to the process of computationally retrieving the separate source components that generate an overlapping signal on the detector, the deconvolution process can become an ill-posed problem and crosstalk complicates the separation of the individual sources. To overcome this problem, we have designed a magnetic spectrometer for inline electron energy spectrum diagnosis and developed an analysis algorithm using techniques applicable to the problem of SS. An unknown polychromatic electron spectrum is calculated by sparse coding using a Gaussian basis function and an L1 regularization algorithm with a sparsity constraint. This technique is verified by using a specially designed magnetic field electron spectrometer. We use Monte Carlo simulations of the detector response to Maxwellian input energy distributions with electron temperatures of 5.0 MeV, 10.0 MeV, and 15.0 MeV to show that the calculated sparse spectrum can reproduce the input spectrum with an optimum energy bin width automatically selected by the L1 regularization. The spectra are reproduced with a high accuracy of less than 4.0% error, without an initial value. The technique is then applied to experimental measurements of intense laser accelerated electron beams from solid targets. Our analysis concept of spectral retrieval and automatic optimization of energy bin width by sparse coding could form the basis of a novel diagnostic method for spectroscopy.

Collection and analysis of photon beam data for Varian C-series linear accelerators: a potential reference beam data set

This study aimed to collect and analyze photon beam data for the Varian C-series linear accelerators (Varian Medical Systems, Palo Alto, CA, USA). We evaluated the potential of the average data to be used as reference beam data for the radiotherapy treatment planning system commissioning verification. We collected 20 data sets for 4 and 6 MV photon beams, and 40 data sets for a 10 MV photon beam generated by the Varian C-series machines, which contained the percent depth dose (PDD), off-center ratio (OCR), and output factor (OPF) from 20 institutions. The average for each of the data types was calculated across the 20 machines. Dose differences from the average for PDD at the dose fall-off region were less than 1.0%. Relative differences from the average for the OPF data were almost within 1.0% for all energies and field sizes. For OCR data in the flat regions, the standard deviation of the dose differences from the average was within 1.0%, excluding that of the 30 × 30 mm² field size being approximately 1.5%. For all energies and field sizes, the distance to agreement from the average in the OCR penumbra regions was less than 1.0 mm. The average data except for the small field size found in this study can be used as reference beam data for verifying users' commissioning results.

Evaluation of a neural network‐based photon beam profile deconvolution method

Purpose

The authors have previously shown the feasibility of using an artificial neural network (ANN) to eliminate the volume average effect (VAE) of scanning ionization chambers (ICs). The purpose of this work was to evaluate the method when applied to beams of different energies (6 and 10 MV) and modalities [flattened (FF) vs unflattened (FFF)], measured with ICs of various sizes.

Methods

The three‐layer ANN extracted data from transverse photon beam profiles using a sliding window, and output deconvolved value corresponding to the location at the center of the window. Beam profiles of seven fields ranging from 2 × 2 to 10 × 10 cm² at four depths (1.5, 5, 10 and 20 cm) were measured with three ICs (CC04, CC13, and FC65‐P) and an EDGE diode detector for 6 MV FF and FFF. Similar data for the 10 MV FF beam was also collected with CC13 and EDGE. The EDGE‐measured profiles were used as reference data to train and test the ANNs. Separate ANNs were trained by using the data of each beam energy and modality. Combined ANNs were also trained by combining data of different beam energies and/or modalities. The ANN's performance was quantified and compared by evaluating the penumbra width difference (PWD) between the deconvolved and reference profiles.

Results

Excellent agreement between the deconvolved and reference profiles was achieved with both separate and combined ANNs for all studied ICs, beam energies, beam modalities, and geometries. After deconvolution, the average PWD decreased from 1–3 mm to under 0.15 mm with separate ANNs and to under 0.20 mm with combined ANN.

Conclusions

The ANN‐based deconvolution method can be effectively applied to beams of different energies and modalities measured with ICs of various sizes. Separate ANNs yielded marginally better results than combined ANNs. An IC‐specific, combined ANN can provide clinically acceptable results as long as the training data includes data of each beam energy and modality.

Migration of treatment planning system using existing commissioned planning system

Introduction:

Commissioning of a new planning system involves extensive data acquisition which can be onerous involving significant clinic downtime. This could be circumvented by extracting data from existing treatment planning system (TPS) to speed up the process.

Material and methods:

In this study, commissioning beam data was obtained from a clinically commissioned TPS (Pinnacle™) using Matlab™ generated Pinnacle™ executable scripts to commission an independent 3D dose verification TPS (Eclipse™). Profiles and output factors for commissioning as required by Eclipse™ were computed on a 50 × 50 × 50 cm3 water phantom at a dose grid resolution of 2 mm3. Verification doses were computed and compared to clinical TPS dose profiles based on TG-106 guidelines. Standard patient plans from Pinnacle™ including intensity modulated radiation therapy and volumetric modulated arc therapy were re-computed on Eclipse™ TPS while maintaining the same monitor units. Computed dose was exported back to Pinnacle for comparison with the original plans. This methodology enabled us to alleviate all ambiguities that arise in such studies.

Results:

Profile analysis using in-house software showed that for all field sizes including small multi-leaf collimator-generated fields, >95% of infield and penumbra data points of Eclipse™ match Pinnacle™ generated and measured profiles with 2%/2 mm gamma criteria. Excellent agreement was observed in the penumbra regions, with >95% of the data points passing distance to agreement criteria for complex C-shaped and S-shaped profiles. Dose volume histograms and isodose lines of patient plans agreed well to within a 0·5% for target coverage.

Findings:

Migration of TPS is possible without compromising accuracy or enduring the cumbersome measurement of commissioning data. Economising time for commissioning such a verification system or for migration of TPS can add great QA value and minimise downtime.

The impact of corrected field output factors based on IAEA/AAPM code of practice on small-field dosimetry to the calculated monitor unit in eclipse™ treatment planning system

The objective of this study was to investigate the effect of field output factors (FOFs) according to the current protocol for small-field dosimetry in conjunction to treatment planning system (TPS) commissioning. The calculated monitor unit (MU) for intensity-modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) plans in Eclipse™ TPS were observed. Micro ion chamber (0.01 CC) (CC01), photon field diode (shielded diode) (PFD), and electron field diode (unshielded diode) (EFD) were used to measure percentage depth doses, beam profiles, and FOFs from 1 × 1 cm2 to 10 × 10 cm2 field sizes of 6 MV photon beams. CC01 illustrated the highest percentage depth doses at 10 cm depth while EFD exhibited the lowest with the difference of 1.6% at 1 × 1 cm2 . CC01 also produced slightly broader penumbra, the difference with other detectors was within 1 mm. For uncorrected FOF of three detectors, the maximum percent standard deviation (%SD) was 5.4% at 1 × 1 cm2 field size. When the correction factors were applied, this value dropped to 2.7%. For the calculated MU in symmetric field sizes, beam commissioning group from uncorrected FOF demonstrated maximum %SD of 6.0% at 1 × 1 cm2 field size. This value decreased to 2.2% when the corrected FOF was integrated. For the calculated MU in IMRT-SRS plans, the impact of corrected FOF reduced the maximum %SD from 6.0% to 2.5% in planning target volume (PTV) less than 0.5 cm3 . Beam commissioning using corrected FOF also decreased %SD for VMAT-SRS plans, although it was less pronounced in comparison to other treatment planning techniques, since the %SD remained less than 2%. The use of FOFs based on IAEA/AAPM TRS 483 has been proven in this research to reduce the discrepancy of calculated MU among three beam commissioning datasets in Eclipse™ TPS. The dose measurement of both symmetric field and clinical cases comparing to the calculation illustrated the dependence of the types of detector commissioning and the algorithm of the treatment planning for small field size.

Evaluation of dosimetric parameters of small fields of 6 MV flattening filter free photon beam measured using various detectors against Monte Carlo simulation

Purpose:

This study aims to evaluate dosimetric parameters like percentage depth dose, dosimetric field size, depth of maximum dose surface dose, penumbra and output factors measured using IBA CC01 pinpoint chamber, IBA stereotactic field diode (SFD), PTW microDiamond against Monte Carlo (MC) simulation for 6 MV flattening filter-free small fields.

Materials and Methods:

The linear accelerator used in the study was a Varian TrueBeam® STx. All field sizes were defined by jaws. The required shift to effective point of measurement was given for CC01, SFD and microdiamond for depth dose measurements. The output factor of a given field size was taken as the ratio of meter readings normalised to 10 × 10 cm2 reference field size without applying any correction to account for changes in detector response. MC simulation was performed using PRIMO (PENELOPE-based program). The phase space files for MC simulation were adopted from the MyVarian Website.

Results and Discussion:

Variations were seen between the detectors and MC, especially for fields smaller than 2 × 2 cm2 where the lateral charge particle equilibrium was not satisfied. Diamond detector was seen as most suitable for all measurements above 1 × 1 cm2. SFD was seen very close to MC results except for under-response in output factor measurements. CC01 was observed to be suitable for field sizes above 2 × 2 cm2. Volume averaging effect for penumbra measurements in CC01 was observed. No detector was found suitable for surface dose measurement as surface ionisation was different from surface dose due to the effect of perturbation of fluence. Some discrepancies in measurements and MC values were observed which may suggest effects of source occlusion, shift in focal point or mismatch between real accelerator geometry and simulation geometry.

Conclusion:

For output factor measurement, TRS483 suggested correction factor needs to be applied to account for the difference in detector response. CC01 can be used for field sizes above 2 × 2 cm2 and microdiamond detector is suitable for above 1 × 1 cm2. Below these field sizes, perturbation corrections and volume averaging corrections need to be applied.

Detector response in the buildup region of small MV fields

PURPOSE

The model used to calculate dose distributions in a radiotherapy treatment plan relies on the data entered during beam commissioning. The quality of these data heavily depends on the detector choice made, especially in small fields and in the buildup region. Therefore, it is necessary to identify suitable detectors for measurements in the buildup region of small fields. To aid the understanding of a detector's limitations, several factors that influence the detector signal are to be analyzed, for example, the volume effect due to the detector size, the response to electron contamination, the signal dependence on the polarity used, and the effective point of measurement chosen.

METHODS

We tested the suitability of different small field detectors for measurements of depth dose curves with a special focus on the surface-near area of dose buildup for fields sized between 10 × 10 and 0.6 × 0.6 cm² . Depth dose curves were measured with 14 different detectors including plane-parallel chambers, thimble chambers of different types and sizes, shielded and unshielded diodes as well as a diamond detector. Those curves were compared with depth dose curves acquired on Gafchromic film. Additionally, the magnitude of geometric volume corrections was estimated from film profiles in different depths. Furthermore, a lead foil was inserted into the beam to reduce contaminating electrons and to study the resulting changes of the detector response. The role of the effective point of measurement was investigated by quantifying the changes occurring when shifting depth dose curves. Last, measurements for the small ionization chambers taken at opposing biasing voltages were compared to study polarity effects.

RESULTS

Depth-dependent correction factors for relative depth dose curves with different detectors were derived. Film, the Farmer chamber FC23, a 0.13 cm³ scanning chamber CC13 and a plane-parallel chamber PPC05 agree very well in fields sized 4 × 4 and 10 × 10 cm² . For most detectors and in smaller fields, depth dose curves differ from the film. In general, shielded diodes require larger corrections than unshielded diodes. Neither the geometric volume effect nor the electron contamination can account for the detector differences. The biggest uncertainty arises from the positioning of a detector with respect to the water surface and from the choice of the detector's effective point of measurement. Depth dose curves acquired with small ionization chambers differ by over 15% in the buildup region depending on sign of the biasing voltage used.

CONCLUSIONS

A scanning chamber or a PPC40 chamber is suitable for fields larger than 4 × 4 cm² . Below that field size, the microDiamond or small ionization chambers perform best requiring the smallest corrections at depth as well as in the buildup region. Diode response changes considerably between the different types of detectors. The position of the effective point of measurement has a huge effect on the resulting curves, therefore detector specific rather than general shifts of half the inner radius of cylindrical ionization chambers for the effective point of measurement should be used. For small ionization chambers, averaging between both polarities is necessary for data obtained near the surface.

Dosimetric Optimization and Commissioning of a High Field Inline MRI-Linac

Purpose: Unique characteristics of MRI-linac systems and mutual interactions between their components pose specific challenges for their commissioning and quality assurance. The Australian MRI-linac is a prototype system which explores the inline orientation, with radiation beam parallel to the main magnetic field. The aim of this work was to commission the radiation-related aspects of this system for its application in clinical treatments.

Methods: Physical alignment of the radiation beam to the magnetic field was fine-tuned and magnetic shielding of the radiation head was designed to achieve optimal beam characteristics. These steps were guided by investigative measurements of the beam properties. Subsequently, machine performance was benchmarked against the requirements of the IEC60976/77 standards. Finally, the geometric and dosimetric data was acquired, following the AAPM Task Group 106 recommendations, to characterize the beam for modeling in the treatment planning system and with Monte Carlo simulations. The magnetic field effects on the dose deposition and on the detector response have been taken into account and issues specific to the inline design have been highlighted.

Results: Alignment of the radiation beam axis and the imaging isocentre within 2 mm tolerance was obtained. The system was commissioned at two source-to-isocentre distances (SIDs): 2.4 and 1.8 m. Reproducibility and proportionality of the dose monitoring system met IEC criteria at the larger SID but slightly exceeded it at the shorter SID. Profile symmetry remained under 103% for the fields up to ~34 × 34 and 21 × 21 cm² at the larger and shorter SID, respectively. No penumbra asymmetry, characteristic for transverse systems, was observed. The electron focusing effect, which results in high entrance doses on central axis, was quantified and methods to minimize it have been investigated.

Conclusion: Methods were developed and employed to investigate and quantify the dosimetric properties of an inline MRI-Linac system. The Australian MRI-linac system has been fine-tuned in terms of beam properties and commissioned, constituting a key step toward the application of inline MRI-linacs for patient treatments.

Monte Carlo simulation using PRIMO code as a tool for checking the credibility of commissioning and quality assurance of 6 MV TrueBeam STx varian LINAC

Aim

To validate and implement Monte Carlo simulation using PRIMO code as a tool for checking the credibility of measurements in LINAC initial commissioning and routine Quality Assurance (QA). Relative and absolute doses of 6 MV photon beam from TrueBeam STx Varian Linear Accelerator (LINAC) were simulated and validated with experimental measurement, Analytical Anisotropic Algorithm (AAA) calculation, and golden beam.

Methods and Materials

Varian phase-space files were imported to the PRIMO code and four blocks of jaws were simulated to determine the field size of the photon beam. Water phantom was modeled in the PRIMO code with water equivalent density. Golden beam data, experimental measurement, and AAA calculation results were imported to PRIMO code for gamma comparison.

Results

PRIMO simulations of Percentage Depth Dose (PDD) and in-plane beam profiles had good agreement with experimental measurements, AAA calculations and golden beam. However, PRIMO simulations of cross-plane beam profiles have a better agreement with AAA calculation and golden beam than the experimental measurement. Furthermore, PRIMO simulations of absolute dose agreed well with experimental results with ±0.8% uncertainty.

Conclusion

The PRIMO code has good accuracy and is appropriate for use as a tool to check the credibility of beam scanning and output measurement in initial commissioning and routine QA.

The use of 0.5rcav as an effective point of measurement for cylindrical chambers may result in a systematic shift of electron percentage depth doses

Electron dosimetry can be performed using cylindrical chambers, plane‐parallel chambers, and diode detectors. The finite volume of these detectors results in a displacement effect which is taken into account using an effective point of measurement (EPOM). Dosimetry protocols have recommended a shift of 0.5 r_cav for cylindrical chambers; however, various studies have shown that the optimal shift may deviate from this recommended value. This study investigated the effect that the selection of EPOM shift for cylindrical chamber has on percentage depth dose (PDD) curves. Depth dose curves were measured in a water phantom for electron beams with energies ranging from 6 to 18 MeV. The detectors investigated were of three different types: diodes (Diode‐E PTW 60017 and SFD IBA), cylindrical (Semiflex PTW 31010, PinPoint PTW 31015, and A12 Exradin), and parallel plate ionization chambers (Advanced Markus PTW 34045 and Markus PTW 23343). Depth dose curves measured with Diode‐E and Advanced Markus agreed within 0.2 mm at R₅₀ except for 18 MeV and extremely large field size. The PDDs measured with the Semiflex chamber and Exradin A12 were about 1.1 mm (with respect to the Advanced Markus chamber) shallower than those measured with the other detectors using a 0.5 r_cav shift. The difference between the PDDs decreased when a Pinpoint chamber, with a smaller cavity radius, was used. Agreement improved at lower energies, with the use of previously published EPOM corrections (0.3 r_cav). Therefore, the use of 0.5 r_cav as an EPOM may result in a systematic shift of the therapeutic portion of the PDD (distances < R₉₀). Our results suggest that a 0.1 r_cav shift is more appropriate for one chamber model (Semiflex PTW 31010).

Sensitivity analysis of Monte Carlo model of a gantry-mounted passively scattered proton system

Purpose

This study aimed to present guidance on the correlation between treatment nozzle and proton source parameters, and dose distribution of a passive double scattering compact proton therapy unit, known as Mevion S250.

Methods

All 24 beam options were modeled using the MCNPX MC code. The calculated physical dose for pristine peak, profiles, and spread out Bragg peak (SOBP) were benchmarked with the measured data. Track‐averaged LET (LET_t) and dose‐averaged LET (LET_d) distributions were also calculated. For the sensitivity investigations, proton beam line parameters including Average Energy (AE), Energy Spread (ES), Spot Size (SS), Beam Angle (BA), Beam Offset (OA), and Second scatter Offset (SO) from central Axis, and also First Scatter (FS) thickness were simulated in different stages to obtain the uncertainty of the derived results on the physical dose and LET distribution in a water phantom.

Results

For the physical dose distribution, the MCNPX MC model matched measurements data for all the options to within 2 mm and 2% criterion. The Mevion S250 was found to have a LET_t between 0.46 and 8.76 keV.μm^–1 and a corresponding LET_d between 0.84 and 15.91 keV.μm^–1. For all the options, the AE and ES had the greatest effect on the resulting depth of pristine peak and peak‐to‐plateau ratio respectively. BA, OA, and SO significantly decreased the flatness and symmetry of the profiles. The LETs were found to be sensitive to the AE, ES, and SS, especially in the peak region.

Conclusions

This study revealed the importance of considering detailed beam parameters, and identifying those that resulted in large effects on the physical dose distribution and LETs for a compact proton therapy machine.

Technical Note: Investigation of the dosimetric impact of stray radiation on the Common Control Unit of the IBA Blue Phantom2

PURPOSE

This technical note aims to investigate the dosimetric impact of stray radiation on the Common Control Unit (CCU) of the IBA Blue Phantom2 and the measured beam data.

METHODS

Three CCUs of the same model were used for the study. The primary test CCU was placed at five distances from the radiation beam central axis. At each distance, a set of depth dose and beam profiles for two open and two wedge fields were measured. The field sizes were 10 × 10 cm2 and 30 × 30 cm2 for the open fields, and 30 × 30 cm2 and 15 × 15 cm2 for the 30° and 60° wedges, respectively. The other two CCUs were used to cross check the data of the primary CCU. Assuming the effect of stray radiation on the data measured at the farthest reachable distance 4.5 m is negligible, the dosimetric impact of stray radiation on the CCU and consequently on the measured data can be extracted for analysis by comparing it with those measured at shorter distances.

RESULTS

The results of three CCUs were consistent. The dosimetric impact of stray radiation was greater for lower energies at larger field sizes. For open fields, the data variation was up to 4.5% for depth dose curves and 7.1% for beam profiles. For wedge fields, the data variation was up to 9.3% for depth dose curves and 10.6% for beam profiles. Moreover, for wedge field profiles in the wedge direction, they became flatter as the CCU was placed closer to the primary radiation beam, manifesting smaller wedge angles.

CONCLUSION

The stray radiation added a uniform background noise on all measured data. The magnitude of the noise is inversely proportional to the square of the distance of the CCU to the primary radiation beam, approximately following the inverse square law.

[Dose Distribution Combinations of Different Electron Beam Energy for Treatment Region Expansion in High-energy Electron Beam Radiation Therapy: A Feasibility Study]

INTRODUCTION

External electron beams have excellent distributions in treatment for superficial tumors while suppressing influence deeper normal tissue. However, the skin surface cannot be given a sufficient dose due to the build-up effect. In this study, we have investigated the combination of electron beams to expand the treatment region by keeping the dose gradient beyond d_max.

MATERIALS AND METHODS

The percentage depth doses of different electron beams were superimposed on a spreadsheet to determine the combinations of electron beams so that the treatment range was maximized. Based on the obtained weight for electron beams, dose distributions were calculated using a treatment planning system and examined for potential clinical application.

RESULTS

With the combination of 4 MeV and 9 MeV electron beams, the 90% treatment range in the depth direction increased by 8.0 mm, and with 4 MeV and 12 MeV beams, it increased by 4.0 mm, with the same maximum dose depth and halfdose depth of the absorbed dose. The dose calculations were performed using the treatment planning system yielded similar results with a matching degree of ±1.5%.

CONCLUSIONS

Although the influences of low monitor unit values and daily output differences remain to be considered, the results suggest that the proposed approach can be clinically applied to expand treatment regions easily.

[Quantitative Evaluation of Coincidence between Quantified Light Field Width and X-ray Field Width as Mechanical Quality Assurance]

AIM

The aim of this work was to evaluate the coincidence between light and X-ray field width in air.

BACKGROUND

Light fields are often used for confirmation of irradiation position to superficial tumors and final confirmation of the patient's irradiation position. To guarantee collation by the light field, the light and X-ray fields must coincide. Currently, the light field width is determined mainly by visual evaluation using manual methods, such as use of graph paper and rulers. The light field width is difficult to visually recognize a definite position at the edge of the light field.

MATERIALS AND METHODS

We quantified the width of light fields emitted from a linear accelerator using a light probe detector and compared the results with those of X-ray fields. In-air measurements were conducted at the same position in the light field with the light probe detector and X-ray field using an ionization chamber installed in an emptied three-dimensional water phantom.

RESULTS

The radiation field in air was approximately 2 mm larger than the light field, and we found some influence of transmission and scattered rays on the penumbra region. Before and after exchanging crosshair sheets, the fields also exhibited differences in uniformity.

CONCLUSIONS

The proposed method quantifies the light field using a photodetector and can be used to compare the light field with the X-ray field, conforming a useful tool for evaluating the accuracy of treatment devices in an objective and systematic manner.

Reference dataset of users' photon beam modeling parameters for the Eclipse, Pinnacle, and RayStation treatment planning systems

PURPOSE

The aim of this work was to provide a novel description of how the radiotherapy community configures treatment planning system (TPS) radiation beam models for clinically used treatment machines. Here we describe the results of a survey of self-reported TPS beam modeling parameter values across different C-arm linear accelerators, beam energies, and multileaf collimator (MLC) configurations.

ACQUISITION AND VALIDATION METHODS

Beam modeling data were acquired via electronic survey implemented through the Imaging and Radiation Oncology Core (IROC) Houston Quality Assurance Center's online facility questionnaire. The survey was open to participation from January 2018 through January 2019 for all institutions monitored by IROC. After quality control, 2818 beam models were collected from 642 institutions. This survey, designed for Eclipse, Pinnacle, and RayStation, instructed physicists to report parameter values used to model the radiation source and MLC for each treatment machine and beam energy used clinically for intensity-modulated radiation therapy. Parameters collected included the effective source/spot size, MLC transmission, dosimetric leaf gap, tongue and groove effect, and other nondosimetric parameters specific to each TPS. To facilitate survey participation, instructions were provided on how to identify requested beam modeling parameters within each TPS environment.

DATA FORMAT AND USAGE NOTES

Numeric values of the beam modeling parameters are compiled and tabulated according to TPS and calculation algorithm, linear accelerator model class, beam energy, and MLC configuration. Values are also presented as distributions, ranging from the 2.5th to the 97.5th percentile.

POTENTIAL APPLICATIONS

These data provide an independent guide describing how the radiotherapy community mathematically represents its clinical radiation beams. These distributions may be used by the community for comparison during the commissioning or verification of their TPS beam models. Ultimately, we hope that the current work will allow institutions to spot potentially suspicious parameter values and help ensure more accurate radiotherapy delivery.

Surface dose and acute skin reactions in external beam breast radiotherapy

The biologically relevant depth for acute skin reactions in radiotherapy is 70 µm. The dose at this depth is difficult to measure or calculate and can be quite different than the dose at a depth of as little as 1 mm. For breast radiotherapy with medial and lateral tangential beams, the skin dose depends on both the contribution from the entrance beam and the exit beam. The skin dose has been estimated in a breast model hemi-ellipse accounting for field size, beam energy, obliquity, lack of backscatter, fractionation, size and shape of the hemi-ellipse. The dose has been held constant along the axis of symmetry of the hemi-ellipse by introducing modulation as in clinical IMRT practice. Dose distributions have been computed as a function of the polar angle from the center of the hemi-ellipse. The exit dose always dominates the entrance dose for all realistic parameters. As a result, the surface dose is higher for 18 MV than 6 MV over the entire surface for all reasonable sizes and shapes of the hemi-ellipse. The results of these calculations suggest that substituting an 18 MV beam for a 6 MV beam to achieve greater skin sparing may have just the opposite effect. The ratio of the surface dose to the mid-depth dose ranges from about 35% at polar angle 0^o to up to 70% at polar angle 80^o. The dose rises sharply at angles above 30^o. The surface dose rises moderately at all angles as the size of the hemi-ellipse increases. The effect of shape is somewhat complex: as the breast becomes flatter, doses at intermediate angles increase, but doses at small and large angles decrease. The biologically effective dose for erythema and moist desquamation is about 2 to 3 Gy higher at all polar angles for conventional fractionation (2.00 Gy × 25 fractions) than for hypofractionation (2.66 Gy × 16).

Characterization of Extrafocal Dose Influence on the Out-of-Field Dose Distribution by Monte Carlo Simulations and Dose Measurements

Out-of-field scattered and transmitted extrafocal radiation may induce secondary cancer in long-term survivors of external radiotherapy. Pediatric patients have higher life expectancy and tend to receive higher secondary radiation damage due to geometric and biological factors. The goal of this study is to characterize the location and the magnitude of extrafocal dose regions in the case of three-dimensional conformal radiotherapy and volumetric arc therapy, to apply this information to clinical treatment cases, and to provide mitigation strategies. Extrafocal dose has been investigated in a Varian TrueBeam linac equipped with a high-definition 120 multileaf collimator using different physical and virtual phantoms, dose calculation (including Monte Carlo techniques), and dose measurement methods. All Monte Carlo calculations showed excellent agreement with measurements. Treatment planning system calculations failed to provide reliable results out of the treatment field. Both Monte Carlo calculations and dose measurements showed regions with higher dose (extrafocal dose areas) when compared to the background. These areas start to be noticeable beyond 11 cm from the isocenter in the direction perpendicular to the multileaf collimator leaves' travel direction. Out-of-field extrafocal doses up to 160% of the mean dose transmitted through the closed multileaf collimator were registered. Two overlapping components were observed in the extrafocal distribution: the first is an almost elliptical blurred dose distribution, and the second is a well-defined rectangular dose distribution. Extra precautions should be taken into consideration when treating pediatric patients with a high-definition 120 multileaf collimator to avoid directing the extrafocal radiation into a radiosensitive organ during external beam therapy.

Early clinical experience with varian halcyon V2 linear accelerator: Dual-isocenter IMRT planning and delivery with portal dosimetry for gynecological cancer treatments

PURPOSE

Varian Halcyon linear accelerator version 2 (The Halcyon 2.0) was recently released with new upgraded features. The aim of this study was to report our clinical experience with Halcyon 2.0 for a dual-isocenter intensity-modulated radiation therapy (IMRT) planning and delivery for gynecological cancer patients and examine the feasibility of in vivo portal dosimetry.

METHODS

Twelve gynecological cancer patients were treated with extended-field IMRT technique using two isocenters on Halcyon 2.0 to treat pelvis and pelvic/or para-aortic nodes region. The prescription dose was 45 Gy in 25 fractions (fxs) with simultaneous integrated boost (SIB) dose of 55 or 57.5 Gy in 25 fxs to involved nodes. All treatment plans, pretreatment patient-specific QA and treatment delivery records including daily in vivo portal dosimetry were retrospectively reviewed. For in vivo daily portal dosimetry analysis, each fraction was compared to the reference baseline (1st fraction) using gamma analysis criteria of 4 %/4 mm with 90% of total pixels in the portal image planar dose.

RESULTS

All 12 extended-field IMRT plans met the planning criteria and delivered as planned (a total of 300 fractions). Conformity Index (CI) for the primary target was achieved with the range of 0.99-1.14. For organs at risks, most were well within the dose volume criteria. Treatment delivery time was from 5.0 to 6.5 min. Interfractional in vivo dose variation exceeded gamma analysis threshold for 8 fractions out of total 300 (2.7%). These eight fractions were found to have a relatively large difference in small bowel filling and SSD change at the isocenter compared to the baseline.

CONCLUSION

Halcyon 2.0 is effective to create complex extended-field IMRT plans using two isocenters with efficient delivery. Also Halcyon in vivo dosimetry is feasible for daily treatment monitoring for organ motion, internal or external anatomy, and body weight which could further lead to adaptive radiation therapy.

Modeling Elekta VersaHD using the Varian Eclipse treatment planning system for photon beams: A single-institution experience

The aim of this study was to report a single‐institution experience and commissioning data for Elekta VersaHD linear accelerators (LINACs) for photon beams in the Eclipse treatment planning system (TPS). Two VersaHD LINACs equipped with 160‐leaf collimators were commissioned. For each energy, the percent‐depth‐dose (PDD) curves, beam profiles, output factors, leaf transmission factors and dosimetric leaf gaps (DLGs) were acquired in accordance with the AAPM task group reports No. 45 and No. 106 and the vendor‐supplied documents. The measured data were imported into Eclipse TPS to build a VersaHD beam model. The model was validated by creating treatment plans spanning over the full‐spectrum of treatment sites and techniques used in our clinic. The quality assurance measurements were performed using MatriXX, ionization chamber, and radiochromic film. The DLG values were iteratively adjusted to optimize the agreement between planned and measured doses. Mobius, an independent LINAC logfile‐based quality assurance tool, was also commissioned both for routine intensity‐modulated radiation therapy (IMRT) QA and as a secondary check for the Eclipse VersaHD model. The Eclipse‐generated VersaHD model was in excellent agreement with the measured PDD curves and beam profiles. The measured leaf transmission factors were less than 0.5% for all energies. The model validation study yielded absolute point dose agreement between ionization chamber measurements and Eclipse within ±4% for all cases. The comparison between Mobius and Eclipse, and between Mobius and ionization chamber measurements lead to absolute point dose agreement within ±5%. The corresponding 3D dose distributions evaluated with 3%global/2mm gamma criteria resulted in larger than 90% passing rates for all plans. The Eclipse TPS can model VersaHD LINACs with clinically acceptable accuracy. The model validation study and comparisons with Mobius demonstrated that the modeling of VersaHD in Eclipse necessitates further improvement to provide dosimetric accuracy on par with Varian LINACs.

Experience in commissioning the halcyon linac

PURPOSE

This manuscript describes the experience of two institutions in commissioning the new Halcyon^TM platform. Its purpose is to: (a) validate the pre-defined beam data, (b) compare relevant commissioning data acquired independently by two separate institutions, and (c) report on any significant differences in commissioning between the Halcyon linear accelerator and other medical linear accelerators.

METHODS

Extensive beam measurements, testing of mechanical and imaging systems, including the multi-leaf collimator (MLC), were performed at the two institutions independently. The results were compared with published recommendations as well. When changes in standard practice were necessitated by the design of the new system, the efficacy of such changes was evaluated as compared to published approaches (guidelines or vendor documentation).

RESULTS

Given the proper choice of detectors, good agreement was found between the respective experimental data and the treatment planning system calculations, and between independent measurements by the two institutions. MLC testing, MV imaging, and mechanical system showed unique characteristics that are different from the traditional C-arm linacs. Although the same methodologies and physics equipment can generally be used for commissioning the Halcyon, some adaptation of previous practices and development of new methods were also necessary.

CONCLUSIONS

We have shown that the vendor pre-loaded data agree well with the independent measured ones during the commission process. This verifies that a data validation instead of a full-data commissioning process may be a more efficient approach for the Halcyon. Measurement results could be used as a reference for future Halcyon users.

[Efficient Commissioning of the Radiotherapy Treatment Planning System with the Golden Beam Data]

Commissioning of a linear accelerator (Linac) and treatment planning systems (RTPs) for clinical use is complex and time-consuming, typically 3-4 months in total. However, based on clinical needs and economics, hospitals desire early clinical starts for patients, and various studies have been conducted for shortening the preparation period. One of the methods to shorten the period is using golden beam data (GBD). The purpose of this study was to shorten the commissioning period without reducing accuracy and to simplify commissioning works while improving safety. We conducted commissioning of the RTPs before installing the Linac using GBD, and carried out verification immediately after the acceptance test. We used TrueBeam STx (Varian Medical Systems) and Eclipse (ver. 13.7, Varian Medical Systems) for RTPs and anisotropic analysis algorithm (AAA) and AcurosXB (AXB) for calculation algorithms. The difference between GBD and the measured beam data was 0.0 ± 0.2% [percentage depth dose (PDDs) ] and -0.1 ± 0.2% (Profiles) with X-ray, and -1.2 ± 1.3% (PDDs) with electrons. The difference between the calculated dose and the measured dose was 0.1 ± 0.3% (AAA) and 0.0 ± 0.3% (AXB) under homogeneous conditions, and 0.7 ± 1.4% (AAA) and 0.6 ± 1.1% (AXB) under heterogeneous conditions. We took 43 days from the end of the acceptance test to the start of clinical use. We found that the preparation period for clinical use can be shortened without reducing the accuracy, by thinning out the number of measurement items using GBD.

Out-of-Field Dose Calculation by a Commercial Treatment Planning System and Comparison by Monte Carlo Simulation for Varian TrueBeam®

PURPOSE

The calculation accuracy of treatment planning systems (TPSs) drops drastically when the points outside the field edges are considered. The real accuracy of a TPS and linear accelerator (linac) combination for regions outside the field edge is a subject which demands more study. In this study, the accuracy of out-of-field dose calculated by a TPS, used with a TrueBeam® (TB) linac, is quantified.

MATERIALS AND METHODS

For dose calculation, Eclipse™ version 13.7 commissioned for TB machine was used. For comparison, Monte Carlo (MC) methods, as well as the measurements, were used. The VirtuaLinac, a Geant 4-based MC program which is offered as a cloud solution, is used for the generation of input phase-space (PS) files. This PS file was imported into PRIMO (PENELOPE based MC program) for the simulation of out-of-field dose.

RESULTS

In this study, the accuracy of the out-of-field dose calculated by a TPS for a TB linac was estimated. As per the results in comparison with MC simulations, the TPS underestimated the dose by around 45% on an average for the off-axis-distance range considered in this study. As the off-axis distance increased, the underestimation of the dose also increased.

CONCLUSION

In this work, it was observed that the TPS underestimates doses beyond the edges of treatment fields for a clinical treatment executed on a TB machine. This indicates that the out-of-field dose from TPSs should only be used with a clear understanding of the inaccuracy of dose calculations beyond the edge of the field.

Technical Note: Consistency of PTW30013 and FC65-G ion chamber magnetic field correction factors

Purpose

Reference dosimetry in a strong magnetic field is made more complex due to (a) the change in dose deposition and (b) the change in sensitivity of the detector. Potentially it is also influenced by thin air layers, interfaces between media, relative orientations of field, chamber and radiation, and minor variations in ion chamber stem or electrode construction. The PTW30013 and IBA FC65‐G detectors are waterproof Farmer‐type ion chambers that are suitable for reference dosimetry. The magnetic field correction factors have previously been determined for these chamber types. The aim of this study was to assess the chamber‐to‐chamber variation and determine whether generic chamber type‐specific magnetic field correction factors can be applied for each of the PTW30013 and FC65‐G type ion chambers when they are oriented anti‐parallel (ǁ) to, or perpendicular (⊥) to, the magnetic field.

Methods

The experiment was conducted with 12 PTW30013 and 13 FC65‐G chambers. The magnetic field correction factors were measured using a practical method. In this study each chamber was cross‐calibrated against the local standard chamber twice; with and without magnetic field. Measurements with 1.5 T magnetic field were performed with the 7 MV FFF beam of the MRI‐linac. Measurements without magnetic field (0 T) were performed with the 6 MV conventional beam of an Elekta Agility linac. A prototype MR‐compatible PTW MP1 phantom was used along with a prototype holder that facilitated measurements with the chamber aligned 90° counter‐clockwise (⊥) and 180° (ǁ) to the direction of the magnetic field. A monitor chamber was also mounted on the holder and all measurements were normalized so that the effect of variations in the output of each linac was minimized. Measurements with the local standard chamber were repeated during the experiment to quantify the experimental uncertainty. Recombination was measured in the 6 MV beam. Beam quality correction factors were applied. Differences in recombination and beam quality between beams are constant within each chamber type. By comparing the results for the two cross calibrations the magnetic field correction factors can be determined for each chamber, and the variation within the chamber‐type determined.

Results

The magnetic field correction factors within both PTW30013 and FC65‐G chamber‐types were found to be very consistent, with observed standard deviations for the PTW30013 of 0.19% (ǁ) and 0.13% (⊥), and for the FC65‐G of 0.15% (ǁ) and 0.17% (⊥). These variations are comparable with the standard uncertainty (k = 1) of 0.24%.

Conclusion

The consistency of the results for the PTW30013 and FC65‐G chambers implies that it is not necessary to derive a new factor for every new PTW30013 or FC65‐G chamber. Values for each chamber‐type (with careful attention to beam energy, magnetic field strength and beam‐field‐chamber orientations) can be applied from the literature.

Characterisation of out-of-field dose at shallow depths for external beam radiotherapy: implications for eye lens dose

Re-evaluation of the eye lens radio-sensitivity by the ICRP in 2011 resulted in a significant reduction of the threshold for lens opacities from 8 Gy to 0.5 Gy. This has led to an increase in concern for eye lens doses from treatment sites further from the eye than previously considered. The aim of this study was to examine the out-of-field dose far from the field edge and develop an effective method to accurately characterise the constituent components of this dose at varying depths. Dose profile scans using a 0.6 cm³ cylindrical ionisation chamber in a motorised water tank were compared with previous studies and displayed good agreement. At points more than 20 cm from the field edge patient scatter becomes insignificant, and the dose is dominated by head leakage and collimator scatter. Point depth-dose measurements made with a Roos parallel plate chamber in solid water at distances of 52 cm and 76 cm from central axis showed that the highest dose is at the surface. Since the sensitive region of the eye can be as shallow as 3 mm, in vivo measurements carried out with a detector with buildup more than 3 mm water equivalent thickness may be underestimating the dose to the lens. It is therefore recommended that for in vivo measurements for the eye lens further than 20 cm from the field edge the detector should have only 3 mm build-up material over the effective point of measurement.

Monte Carlo-based determination of radiation leakage dose around a dedicated IOERT accelerator

Evaluating the stray radiation around medical electron accelerators is a mandatory issue. Surveying the radiation leakage dose is important for patients, technicians, and health physicists, due to radiation protection aspects. Consequently, radiation leakage dose around the head of a mobile-dedicated intraoperative radiotherapy accelerator (LIAC), at different electron energies and field sizes have been evaluated in this study. More specifically, the MCNPX Monte Carlo code was used to model the LIAC head, connected applicator, and employed water phantom. Radiation leakage dose around the LIAC head was calculated for different energy and field sizes through tuning the Monte Carlo results to the practically measured doses. These measurements were performed using an Advance Markus ionization chamber inside an automated MP3-XS water phantom. The good agreement between the calculated dose distributions within the water tank and corresponding dose measurements show that the simulation model of the LIAC head is appropriate for radiation leakage assessment. The obtained radiation leakage dose distribution highly depends on the electron energy and applicator diameter. With increasing the electron energy, the leakage dose decreased, while increasing the field size increased the leakage dose. It is concluded that the rate of stray radiation and leakage dose around the LIAC head in both vertical and horizontal planes were acceptable according to the recommended radiation protection criteria. To meet the recommended dose limit (100 µSv/week for controlled areas), the maximum number of patients should be kept to four patients per week inside a standard and unshielded operating room.