Correlation Between Detector Array Measurements and a Computer Algorithm for Enhanced Dynamic Wedge Profiles

AAPM Task Group 198 Report: An implementation guide for TG 142 quality assurance of medical accelerators

The charges on this task group (TG) were as follows: (a) provide specific procedural guidelines for performing the tests recommended in TG 142; (b) provide estimate of the range of time, appropriate personnel, and qualifications necessary to complete the tests in TG 142; and (c) provide sample daily, weekly, monthly, or annual quality assurance (QA) forms. Many of the guidelines in this report are drawn from the literature and are included in the references. When literature was not available, specific test methods reflect the experiences of the TG members (e.g., a test method for door interlock is self-evident with no literature necessary). In other cases, the technology is so new that no literature for test methods was available. Given broad clinical adaptation of volumetric modulated arc therapy (VMAT), which is not a specific topic of TG 142, several tests and criteria specific to VMAT were added.

Analysis of measurement deviations for the patient-specific quality assurance using intensity-modulated spot-scanning particle beams

To analyze measurement deviations of patient-specific quality assurance (QA) using intensity-modulated spot-scanning particle beams, a commercial radiation dosimeter using 24 pinpoint ionization chambers was utilized. Before the clinical trial, validations of the radiation dosimeter and treatment planning system were conducted. During the clinical trial 165 measurements were performed on 36 enrolled patients. Two or three fields of particle beam were used for each patient. Measurements were typically performed with the dosimeter placed at special regions of dose distribution along depth and lateral profiles. In order to investigate the dosimeter accuracy, repeated measurements with uniform dose irradiations were also carried out. A two-step approach was proposed to analyze 24 sampling points over a 3D treatment volume. The mean value and the standard deviation of each measurement did not exceed 5% for all measurements performed on patients with various diseases. According to the defined intervention thresholds of mean deviation and the distance-to-agreement concept with a Gamma index analysis using criteria of 3.0% and 2 mm, a decision could be made regarding whether the dose distribution was acceptable for the patient. Based measurement results, deviation analysis was carried out. In this study, the dosimeter was used for dose verification and provided a safety guard to assure precise dose delivery of highly modulated particle therapy. Patient-specific QA will be investigated in future clinical operations.

Quantitative Verification of Dynamic Wedge Dose Distribution Using a 2D Ionization Chamber Array

The accuracy of two calculation algorithms of the Eclipse 8.9 treatment planning system (TPS)--the anisotropic analytic algorithm (AAA) and pencil-beam convolution (PBC)--in modeling the enhanced dynamic wedge (EDW) was investigated. Measurements were carried out for 6 and 18 MV photon beams using a 2D ionization chamber array. Accuracy of the TPS was evaluated using a gamma index analysis with the following acceptance criteria for dose differences (DD) and distance to agreement (DTA): 3%/3 mm and 2%/2 mm. The TPS models the dose distribution accurately except for 20×20 cm(2) field size, 60 (°) and 45 (°) wedge angles using PBC at 6 MV photon energy. For these latter fields, the pass rate and the mean value of gamma were less than 90% and more than 0.5, respectively at the (3%/3 mm) acceptance criteria. In addition, an accuracy level of (2%/2 mm) was achieved using AAA with better agreement for 18 MV photon energy.

Linear array measurements of enhanced dynamic wedge and treatment planning system (TPS) calculation for 15 MV photon beam and comparison with electronic portal imaging device (EPID) measurements

INTRODUCTION

Enhanced dynamic wedges (EDW) are known to increase drastically the radiation therapy treatment efficiency. This paper has the aim to compare linear array measurements of EDW with the calculations of treatment planning system (TPS) and the electronic portal imaging device (EPID) for 15 MV photon energy.

MATERIALS AND METHODS

The range of different field sizes and wedge angles (for 15 MV photon beam) were measured by the linear chamber array CA 24 in Blue water phantom. The measurement conditions were applied to the calculations of the commercial treatment planning system XIO CMS v.4.2.0 using convolution algorithm. EPID measurements were done on EPID-focus distance of 100 cm, and beam parameters being the same as for CA24 measurements.

RESULTS

Both depth doses and profiles were measured. EDW linear array measurements of profiles to XIO CMS TPS calculation differ around 0.5%. Profiles in non-wedged direction and open field profiles practically do not differ. Percentage depth doses (PDDs) for all EDW measurements show the difference of not more than 0.2%, while the open field PDD is almost the same as EDW PDD. Wedge factors for 60 deg wedge angle were also examined, and the difference is up to 4%. EPID to linear array differs up to 5%.

CONCLUSIONS

The implementation of EDW in radiation therapy treatments provides clinicians with an effective tool for the conformal radiotherapy treatment planning. If modelling of EDW beam in TPS is done correctly, a very good agreement between measurements and calculation is obtained, but EPID cannot be used for reference measurements.

Analytical correction of an extension of the "MU Fraction Approximation" for Varian enhanced dynamic wedges

The most common method to determine enhanced dynamic wedge factors begins with the use of segmented treatment tables. These segmental dose delivery values set as a function of upper jaw position are the backbone of a calculation process coined the "MU Fraction Approximation." Analytical and theoretical attempts have been made to extend and alter the mathematics for this approximation for greater accuracy. A set of linear equations in the form of a matrix are introduced here which correct one published extension of the MU Fraction Approximation as it applies to both symmetric and asymmetric photon fields. The matrix results are compared to data collected from a commissioned Varian Eclipse Treatment Planning System and previously published research for Varian linear accelerators. A total enhanced dynamic wedge factor with excellent accuracy was achieved in comparison to the most accurate previous research found. The deviation seen here is only 0.4% and 1.0% for symmetric and asymmetric fields respectively, for both 6MV and 18MV photon beams.