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Purpose: To investigate the impact of strong magnetic fields on the stem‐effect in plastic scintillation detectors (PSDs) using Monte Carlo methods. Methods: Prior to building the light guide model, the properties of the Čerenkov process in GEANT4 were investigated by simulating depth‐dose and depth‐Čerenkov emission profiles in water as functions of Čerenkov process input parameters. In addition, profile simulations were performed for magnetic field strengths ranging from 0 T to 1.5 T. A PMMA light guide was constructed in GEANT4 using data from the manufacturer and literature. Simulations were performed with the model as functions of depth and fiber‐beam angle where the simulated stem‐effect spectrum and the Čerenkov light ratio (CLR) were scored and compared to measured data in the literature. The light guide optical properties were iteratively adjusted until agreement between the simulated and measured data was achieved. Simulations were performed with the validated model as functions of depth and magnetic field strength and the simulated data were compared to measured data in the literature. The model was also used to evaluate the sensitivity of the CLR to the various optical properties of the light guide in different irradiation conditions. Results: No significant changes in the depth‐dose or depth‐Čerenkov emission profiles were observed with step‐size restrictions imposed by the Čerenkov process input parameters, which was attributed to the condensed history algorithm and transport parameters used in this work. Similar changes in the depth‐dose and depth‐Čerenkov emission profiles were observed with increasing magnetic field strength, which indicates the Čerenkov process is not adversely impacted by the presence of the magnetic field. Following optimization of the light guide optical properties, agreement within two standard deviations was observed between the simulated and measured optical data for all validation geometries considered. Agreement within one standard deviation was observed between the simulated and measured data for all depths and field strengths ≥0 T whereas discrepancies were observed for magnetic field strengths <−0.35 T. These significant differences were attributed to insufficient measurement data for this irradiation configuration during model validation. Of the light guide optical properties investigated, the fluorescence signal had the greatest impact on the CLR sensitivity to the magnetic field. Conclusions: No significant change in the Čerenkov emission per dose in water was observed for magnetic field strengths up to 1.5 T. The nominal fiber fluorescence signal was found to have a significant impact on the CLR sensitivity to varying irradiation conditions where changes up to 11.7% were observed whereas the mirror reflectivity and fiber attenuation had a modest impact with maximum CLR changes of 2.6% and 1.2% relative to 0 T, respectively. The results of this work suggest light guides with low fiber fluorescence should be used with PSDs for dosimetry measurements in magnetic fields to minimize the impact of the magnetic field on the CLR correction. [ABSTRACT FROM AUTHOR]

The purpose of this work was to characterize the stem-effect signal and the Cerenkov light ratio (CLR) in various light guides as functions of measurement geometry and magnetic field strength. Two PMMA-, two silica-, and one polystyrene-based light guides were considered in this work. Spectra measurements were performed as functions of depth, fiber-beam angle, and magnetic field strength using an optical spectrometer. All measurements were performed using a clinical linear accelerator at a nominal photon beam energy of 6 MV. Depths ranging from 1 cm to 10 cm, fiber-beam angles ranging from 90 degrees to 30 degrees, and magnetic field strengths ranging from 0 T to ± 1.40 T were investigated. The CLR was calculated from each spectrum by taking the ratio of the integral signal between 400 nm and 500 nm to the integral signal between 500 nm and 600 nm. A maximum increase of 80.5% in the stem-effect signal was observed in the magnetic field. Variations in spectral shape and, consequently, the CLR were observed for all of the fibers as functions of magnetic field strength and measurement geometry, particularly for wavelengths less than 400 nm. The plastic fibers exhibited decreases in the CLR as a function of magnetic field strength at all depths investigated, whereas the silica fibers exhibited increases in the CLR with decreasing magnetic field strength. A maximum variation of 11.1% in the CLR was observed for the polystyrene fiber due to the magnetic field. The sensitivity of the CLR to the magnetic field decreased as the fiber-beam angle decreased. The measured spectral response, shape, and CLR were found to be sensitive to the applied magnetic field strength and polarity where the variations in response were unique to each fiber. [ABSTRACT FROM AUTHOR]

Purpose/objective(s): Compared to conventional TBI techniques, VMAT TBI has been shown to provide superior lung sparing while maintaining target coverage. However, one of the significant barriers preventing widespread VMAT TBI implementation is the time-consuming treatment planning process. To overcome this issue, we developed an in-house automated treatment planning process for VMAT TBI and evaluated the resulting dosimetric plan quality against manually generated treatment plans.Materials/methods: Application Programming Interface (API) scripting was utilized to interface with a commercial treatment planning system. Two scripts were built to facilitate autoplanning: the first generates optimization structures, creates the plan, places the beams, and sets the optimization constraints using user-defined input. The second uses the output from the first script to run successive VMAT optimizations, where the plan quality is evaluated after each iteration and the optimization objectives are adjusted according to dosimetric deviation of each constraint from its objective. The optimization loop proceeds until either all plan objectives are met, or the number of iterations reaches a user-defined maximum. Nine patients previously treated in our clinic with VMAT TBI were used to evaluate the efficacy of the proposed autoplanning process. The plan quality of the produced auto plans was evaluated by comparing against the manually generated clinical plans. The clinically relevant metrics, including global Dmax, PTV V110%, lungs and lungs-1cm Dmean, kidneys Dmean, and bowel Dmax, were analyzed. All plans were normalized to deliver 100% of the prescription dose to 90% of the PTV. All dosimetric comparisons between the auto and manual plans were made with the dose expressed as a percentage of the prescription dose. Paired t-test was used to compare the dosimetric indices between auto and manual plans.Results: No significant differences were observed between the manual and autoplan global Dmax (P < 0.893), PTV V110% (P < 0.734), kidneys Dmean (P = 0.351), and bowel Dmax (P < 0.473). Statistically significant decreases in the Dmean to the lungs and lungs-1cm volumes of 5.4% ± 6.4% (P < 0.024) and 6.8% ± 7.4% (P < 0.017), respectively, were obtained with the autoplans as compared to the manual plans. The required time for treatment planning (i.e., contouring and planning) ranged from approximately 2-3 days for the manual plans as compared to approximately 3-5 hours for the autoplans.Conclusion: Superior lung sparing with the same target coverage and similar global Dmax were observed with the autoplans as compared to the manual treatment plans. Large reductions in planning time were obtained using the developed autoplanning scripts as compared to manual planning, thus reducing the required effort of the treatment planning team and making VMAT TBI a more accessible treatment technique. The developed scripts will be made open-source and freely available to the public in the near future. [ABSTRACT FROM AUTHOR]

Purpose/objective(s): The first clinical biology-guided radiation therapy (BgRT) system - RefleXion X1 - is installed and is being commissioned for clinical use at our institution. The system delivers 6MV-FFF beam via 50 firing positions at 850 cGy/min dose rate on 60 rpm rotating gantry with the couch advancing in 2.1 mm increments. Collimation is achieved through a binary multi-leaf collimator system composed of 64 (6.25 mm width at 850 cm SAD) leaves and 10mm or 20mm jaws. The purpose of this study was to compare the treatment plan quality and delivery efficiency for SBRT cases without PET-guidance.Materials/methods: Five lung cancer patients (50 Gy/4fx) with motion-inclusive PTV previously treated with VMAT SBRT were selected for this retrospective study. For each VMAT plan a corresponding plan was generated on the RefleXion treatment planning system (TPS) using our institutional planning constraints. VMAT SBRT plans used 1-2 partial arcs with 10MV-FFF energy and 2400 MU/min dose rate. RefleXion SBRT plans used all 50 firing positions and 1 cm jaw collimation. As plan normalization option does not yet exist in the RefleXion TPS, the plans were optimized to achieve PTV D95% coverage with 100% of prescription dose to the best of planner's ability. All clinically relevant metrics in this study, including plan PTV D95%, PTV D1%, 50% isodose volume (I50%), Conformity Index (CI), organs at risk constraints, and treatment time were analyzed and compared between VMAT and RefleXion plans using paired t-tests.Results: Clinically acceptable plans were obtained with both techniques. The average PTV volume was 14.1 ± 6.4cc. For VMAT and RefleXion plans, no statistically significant difference was observed in PTV D95%, PTV D1%, CI or I50%. Ipsilateral lung volume spared at 12.4 Gy (VS12.4) was slightly greater (31.6cc increase, P < 0.035) and skin Dmax was slightly lower (1.4 Gy decrease, P < 0.038) for RefleXion plans. Treatment beam-on time was significantly longer for RefleXion plans (23.4min increase, P < 0.0002).Conclusion: RefleXion TPS provided comparable plan quality to lung SBRT VMAT plans. Treatment beam-on time is significantly longer for the RefleXion system. [ABSTRACT FROM AUTHOR]

Purpose/objective(s): A biologically guided radiotherapy (BgRT) system was developed and equipped with a novel O-ring gantry Linac, positron emission tomography (PET) and computed tomography technologies. This architectural design is to support real-time PET-guided treatment, termed biology-guided radiotherapy. To reduce latency between PET data acquisition and radiation delivery, the BgRT system incorporates a fast-transitioning binary multi-leaf collimator (MLC) leaves sandwiched between a split-jaw. This study reports the dosimetric commissioning of the first clinical BgRT machines at our institution, and compared with the reference data provided by the manufacturer.Materials/methods: The dosimetric commissioning of the 6 MV flattening filter-free (FFF) photon beam was characterized using a 3D water phantom and diode detectors at a source to surface distance of 85 cm. In-air profiles of 40cm x 2cm field, 40cm x 1cm field, and various leaf combinations plus in water PDD data of 12 field sizes (1.25, 2.5, 5, 10, 20 and 40 cm MLC opened leaves with 1 and 2cm jaw settings) were acquired first for beam modeling. Additional longitudinal and transverse profile scans were performed for these 12 field sizes at the depth of 1.5, 5, 10, 15 and 20 cm to verify the beam model accuracy. The relative outputs factors were measured with the W2 1mmx1mm scintillator at the depth of 10cm for the field sizes from the smallest 0.6cm x 1cm to the maximum 40cm x 2cm.Results: For the PDDs of reference field size of 10cm x 2cm measured at Stanford, the maximum doses (dmax) were 12.5mm within the manufacturer's reference range of 13 ± 0.75 mm. The percentage doses at 10cm depth (d10) at reference field size were 56.9% and 57.6% for Stanford and RefleXion measurements, respectively. The longitudinal field sizes for all tested fields were agreed within 0.5mm and the transverse off-axis ratio is within 1% in the beam core (80% of nominal field size). The output factors measured at our institute were ranging from 0.706 to 1.012 relative to the reference 10cm x 2cm field.Conclusion: This evaluation represents the first commissioning evaluation of the dosimetric characteristics of the BgRT system with architecture designed to accommodate both PET detector and LINAC subsystems. This data will serve as a clinical reference for the BgRT treatment planning system's beam model and can act as a standard for comparison and beam model improvement for units installed at future clinical sites. [ABSTRACT FROM AUTHOR]