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Background: Protoacoustic (PA) imaging has the potential to provide real‐time 3D dose verification of proton therapy. However, PA images are susceptible to severe distortion due to limited angle acquisition. Our previous studies showed the potential of using deep learning to enhance PA images. As the model was trained using a limited number of patients' data, its efficacy was limited when applied to individual patients. Purpose: In this study, we developed a patient‐specific deep learning method for protoacoustic imaging to improve the reconstruction quality of protoacoustic imaging and the accuracy of dose verification for individual patients. Methods: Our method consists of two stages: in the first stage, a group model is trained from a diverse training set containing all patients, where a novel deep learning network is employed to directly reconstruct the initial pressure maps from the radiofrequency (RF) signals; in the second stage, we apply transfer learning on the pre‐trained group model using patient‐specific dataset derived from a novel data augmentation method to tune it into a patient‐specific model. Raw PA signals were simulated based on computed tomography (CT) images and the pressure map derived from the planned dose. The reconstructed PA images were evaluated against the ground truth by using the root mean squared errors (RMSE), structural similarity index measure (SSIM) and gamma index on 10 specific prostate cancer patients. The significance level was evaluated by t‐test with the p‐value threshold of 0.05 compared with the results from the group model. Results: The patient‐specific model achieved an average RMSE of 0.014 (p<0.05${{{p}}}<{0.05}$), and an average SSIM of 0.981 (p<0.05${{{p}}}<{0.05}$), out‐performing the group model. Qualitative results also demonstrated that our patient‐specific approach acquired better imaging quality with more details reconstructed when comparing with the group model. Dose verification achieved an average RMSE of 0.011 (p<0.05${{{p}}}<{0.05}$), and an average SSIM of 0.995 (p<0.05${{{p}}}<{0.05}$). Gamma index evaluation demonstrated a high agreement (97.4% [p<0.05${{{p}}}<{0.05}$] and 97.9% [p<0.05${{{p}}}<{0.05}$] for 1%/3 and 1%/5 mm) between the predicted and the ground truth dose maps. Our approach approximately took 6 s to reconstruct PA images for each patient, demonstrating its feasibility for online 3D dose verification for prostate proton therapy. Conclusions: Our method demonstrated the feasibility of achieving 3D high‐precision PA‐based dose verification using patient‐specific deep‐learning approaches, which can potentially be used to guide the treatment to mitigate the impact of range uncertainty and improve the precision. Further studies are needed to validate the clinical impact of the technique. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the dose rate dependence of MapCHECK3 and its influence on measurement accuracy, as well as the effect of dose rate correction. Materials and methods: The average and instantaneous dose rate dependence of MapCHECK2 and MapCHECK3 were studied. The accuracy of measurements was investigated where the dose rate differed significantly between dose calibration of the MapCHECK and the measurement. Measurements investigated include: the central axis dose for different fields at different depths, off‐axis doses outside the field, and off‐axis doses along the wedge direction. Measurements using an ion chamber were taken as the reference. Exponential functions were fit to account for average and instantaneous dose rate dependence for MapCHECK3 and used for dose rate correction. The effect of the dose rate correction was studied by comparing the differences between the measurements for MapCHECK (with and without the correction) and the reference. Results: The maximum dose rate dependence of MapCHECK3 is greater than 2.5%. If the dose calibration factor derived from a 10 × 10 cm2 open field at 10 cm depth was used for measurements, the average differences in central diode dose were 0.8% ± 1.0% and 1.0% ± 0.8% for the studied field sizes and measurement depths, respectively. The introduction of wedge would not only induce −1.8% ± 1.3% difference in central diode dose, but also overestimate the effective wedge angle. After the instantaneous dose rate correction, above differences can be changed to 1.9% ± 8.1%, 0.2% ± 0.1%, and 0.0% ± 0.9%. The pass rate can be improved from 98.4% to 98.8%, 98.3%–100.0%, and 96.3%–100.0%, respectively. Conclusion: Compared with MapCHECK2 (SunPoint1 diodes), the more pronounced dose rate dependence of MapCHECK3 (SunPoint2 diodes) should be carefully considered. To ensure highly accurate measurement, it is suggested to perform the dose calibration at the same condition where measurement will be performed. Otherwise, the dose rate correction should be applied. [ABSTRACT FROM AUTHOR]

Objective. To develop and benchmark a novel 3D dose verification technique consisting of polymer gel dosimetry (PGD) with cone-beam-CT (CBCT) readout through a two-institution study. The technique has potential for wide and robust applicability through reliance on CBCT readout. Approach. Three treatment plans (3-field, TG119-C-shape spine, 4-target SRS) were created by two independent institutions (Institutions A and B). A Varian Truebeam linear accelerator was used to deliver the plans to NIPAM polymer gel dosimeters produced at both institutions using an identical approach. For readout, a slow CBCT scan mode was used to acquire pre- and post-irradiation images of the gel (1 mm slice thickness). Independent gel analysis tools were used to process the PGD images (A: VistaAce software, B: in-house MATLAB code). Comparing planned and measured doses, the analysis involved a combination of 1D line profiles, 2D contour plots, and 3D global gamma maps (criteria ranging between 2%1 mm and 5%2 mm, with a 10% dose threshold). Main results. For all gamma criteria tested, the 3D gamma pass rates were all above 90% for 3-field and 88% for the SRS plan. For the C-shape spine plan, we benchmarked our 2% 2 mm result against previously published work using film analysis (93.4%). For 2%2 mm, 99.4% (Institution A data), and 89.7% (Institution B data) were obtained based on VistaAce software analysis, 83.7% (Institution A data), and 82.9% (Institution B data) based on MATLAB. Significance. The benchmark data demonstrate that when two institutions follow the same rigorous procedures gamma passing rates up to 99%, for 2%2 mm criteria can be achieved for substantively different treatment plans. The use of different software and calibration techniques may have contributed to the variation in the 3D gamma results. By sharing the data across institutions, we observe the gamma passing rate is more consistent within each pipeline, indicating the need for standardized analysis methods. [ABSTRACT FROM AUTHOR]

Copyright of Chinese Medical Equipment Journal is the property of Chinese Medical Equipment Journal Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective. Protoacoustic imaging showed great promise in providing real-time 3D dose verification of proton therapy. However, the limited acquisition angle in protoacoustic imaging induces severe artifacts, which impairs its accuracy for dose verification. In this study, we developed a hybrid-supervised deep learning method for protoacoustic imaging to address the limited view issue. Approach. We proposed a Recon-Enhance two-stage deep learning method. In the Recon-stage, a transformer-based network was developed to reconstruct initial pressure maps from raw acoustic signals. The network is trained in a hybrid-supervised approach, where it is first trained using supervision by the iteratively reconstructed pressure map and then fine-tuned using transfer learning and self-supervision based on the data fidelity constraint. In the enhance-stage, a 3D U-net is applied to further enhance the image quality with supervision from the ground truth pressure map. The final protoacoustic images are then converted to dose for proton verification. Main results. The results evaluated on a dataset of 126 prostate cancer patients achieved an average root mean squared errors (RMSE) of 0.0292, and an average structural similarity index measure (SSIM) of 0.9618, out-performing related start-of-the-art methods. Qualitative results also demonstrated that our approach addressed the limit-view issue with more details reconstructed. Dose verification achieved an average RMSE of 0.018, and an average SSIM of 0.9891. Gamma index evaluation demonstrated a high agreement (94.7% and 95.7% for 1%/3 mm and 1%/5 mm) between the predicted and the ground truth dose maps. Notably, the processing time was reduced to 6 s, demonstrating its feasibility for online 3D dose verification for prostate proton therapy. Significance. Our study achieved start-of-the-art performance in the challenging task of direct reconstruction from radiofrequency signals, demonstrating the great promise of PA imaging as a highly efficient and accurate tool for in vivo 3D proton dose verification to minimize the range uncertainties of proton therapy to improve its precision and outcomes. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to develop a data-collecting package ExpressMLC and investigate the applicability of MapCHECK2 for multileaf collimator (MLC) modeling and commissioning for complex radiation treatment plans. Materials and methods: The MLC model incorporates realistic parameters to account for sophisticated MLC features. A set of 8 single-beam plans, denoted by ExpressMLC, is created for the determination of parameters. For the commissioning of the MLC model, 4 intensity modulated radiation therapy (IMRT) plans specified by the AAPM TG 119 report were transferred to a computed tomography study of MapCHECK2, recalculated, and compared to measurements on a Varian accelerator. Both per-beam and composite-beam dose verification were conducted. Results: Through sufficient characterization of the MLC model, under 3%/2 mm and 2%/2 mm criteria, MapCHECK2 can be used to accurately verify per beam dose with gamma passing rate better than 90.9% and 89.3%, respectively, while the Gafchromic EBT3 films can achieve gamma passing rate better than 89.3% and 85.7%, respectively. Under the same criteria, MapCHECK2 can achieve composite beam dose verification with a gamma passing rate better than 95.9% and 90.3%, while the Gafchromic EBT3 films can achieve a gamma passing rate better than 96.1% and 91.8%; the p -value from the Mann Whitney test between gamma passing rates of the per beam dose verification using full MapCHECK2 package calibrated MLC model and film calibrated MLC model is.44 and.47, respectively; the p -value between those of the true composite beam dose verification is.62 and.36, respectively. Conclusion: It is confirmed that the 2-dimensional (2D) diode array MapCHECK2 can be used for data collection for MLC modeling with the combination of the ExpressMLC package of plans, whose doses are sufficient for the determination of MLC parameters. It could be a fitting alternative to films to boost the efficiency of MLC modeling and commissioning without sacrificing accuracy. [ABSTRACT FROM AUTHOR]

Background: Volumetric-modulated arc therapy (VMAT) is an efficient method of administering intensity-modulated radiotherapy beams. The Delta4 device was employed to examine patient data. Aims and Objectives: The utility of the Delta4 device in identifying errors for patient-specific quality assurance of VMAT plans was studied in this research. Materials and Methods: Intentional errors were purposely created in the collimator rotation, gantry rotation, multileaf collimator (MLC) position displacement, and increase in the number of monitor units (MU). Results: The results show that when the characteristics of the treatment plans were changed, the gamma passing rate (GPR) decreased. The largest percentage of erroneous detection was seen in the increasing number of MU, with a GPR ranging from 41 to 92. Gamma analysis was used to compare the dose distributions of the original and intentional error designs using the 2%/2 mm criteria. The percentage of dose errors (DEs) in the dose-volume histogram (DVH) was also analyzed, and the statistical association was assessed using logistic regression. A modest association (Pearson's R-values: 0.12-0.67) was seen between the DE and GPR in all intentional plans. The findings indicated a moderate association between DVH and GPR. The data reveal that Delta4 is effective in detecting mistakes in treatment regimens for head-and-neck cancer as well as lung cancer. Conclusion: The study results also imply that Delta4 can detect errors in VMAT plans, depending on the details of the defects and the treatment plans employed. [ABSTRACT FROM AUTHOR]

Background: This paper makes use of Monte Carlo (MC) simulation to verify the dosimetric accuracy lung SBRT treatment plans delivered with an Elekta beam modulator multileaf collimator (MLC) system. Materials and Methods: Treatment plans of twenty early stage non-small cell lung carcinoma (NSCLC) patients were retrospectively re-calculated using the collapsed cone convolution (CCC) algorithm of the Pinnacle treatment planning system (TPS). Dose distributions were also calculated using the BEAMnrc and DOSXYZnrc MC user codes. A comparative analysis of target volume and organ at risk (OAR) dosimetry was performed between the TPS and MC dose calculation. A statistical analysis of the two dose distributions and parameters generated by the TPS and MC was performed to examine the significance of any differences. Results: The results showed that the TPS matched within 6% of the MC calculations for the planning treatment volume (PTV) coverage, mean and maximum PTV doses, and conformity index. The differences over all plans for the PTV were not statistically significant. For the organ at risk, the TPS overestimated the mean dose parameters over all patients but was only statistically significant for some organ at risks including the mean lung dose (MLD), V20Gy to the lung and V30Gy to the chest wall. Conclusion: The TPS dose calculation of lung SBRT using CCC Pinnacle³ algorithms is relatively closer to the MC calculation, however there may be inaccuracies in the TPS dose calculation for some patients, manifesting in some of the key dosimetric parameters that are used as correlates for irradiation related complications. [ABSTRACT FROM AUTHOR]

Objective: To develop a novel ionization chamber array dosimetry system, study its dosimetry characteristics, and perform preliminary tests for plan dose verification. Methods: The dosimetry characteristics of this new array were tested, including short‐term and long‐term reproducibility, dose linearity, dose rate dependence, field size dependence, and angular dependence. The open field and MLC field plans were designed for dose testing. Randomly select 30 patient treatment plans (10 intensity‐modulated radiation therapy [IMRT] plans and 20 volumetric modulated arc therapy [VMAT] plans) that have undergone dose verification using Portal Dosimetry to perform verification measurement and evaluate dose verification test results. Results: The dosimetry characteristics of the arrays all performed well. The gamma passing rates (3%/2 mm) were more than 96% for the combined open field and MLC field plans. The average gamma pass rates were (99.54 ± 0.58)% and (96.70 ± 3.41)% for the 10 IMRT plans and (99.32 ± 0.89)% and (94.91 ± 6.01)% for the 20 VMAT plans at the 3%/2 mm and 2%/2 mm criteria, respectively, which is similar to the Portal Dosimetry's measurement results. Conclusions: This novel ionization chamber array demonstrates good dosimetry characteristics and is suitable for clinical IMRT and VMAT plan verifications. [ABSTRACT FROM AUTHOR]

Purpose: To quantify the dose distribution effect of insufficient scattering conditions in keloid HDR brachytherapy with Freiburg fFlap (FF) applicator. Materials and Methods: A phantom composed of FF applicator, MatriXX and solid water slices was designed and scanned for treatment planning. Bolus with different thicknesses were covered to offer different scatter conditions. Planar dose distributions were measured by MatriXX. The maximum value (Max), average value (Avg) and γ passing rate (3 mm/3%) were evaluated by the software MyQA Platform. Results: The maximum and average doses measured by MatriXX were lower than the calculated values. The difference increased as field size decreased. The Max value, found at 0.86 cm level in the two tube case, was ‐20.0%, and the avg value was ‐11.9%. All the γ values were less than 95%. This difference gradually decreased with increasing bolus thickness and the γ values were significantly improved. Conclusion: MatriXX could be used for dose verification of HDR brachytherapy with an FF applicator. When the FF applicator was applied for keloid, insufficient scattering conditions would cause an insufficient target dose. This difference could be reduced by covering the bolus with different thicknesses on the applicator. The smaller the field, the thicker the bolus required. [ABSTRACT FROM AUTHOR]

Copyright of Atomic Energy Science & Technology is the property of Editorial Board of Atomic Energy Science & Technology and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: To investigate the use of statistical process control (SPC) for quality assurance of an integrated web‐based autoplanning tool, Radiation Planning Assistant (RPA). Methods: Automatically generated plans were downloaded and imported into two treatment planning systems (TPSs), RayStation and Eclipse, in which they were recalculated using fixed monitor units. The recalculated plans were then uploaded back to the RPA, and the mean dose differences for each contour between the original RPA and the TPSs plans were calculated. SPC was used to characterize the RPA plans in terms of two comparisons: RayStation TPS versus RPA and Eclipse TPS versus RPA for three anatomical sites, and variations in the machine parameters dosimetric leaf gap (DLG) and multileaf collimator transmission factor (MLC‐TF) for two algorithms (Analytical Anisotropic Algorithm [AAA]) and Acuros in the Eclipse TPS. Overall, SPC was used to monitor the process of the RPA, while clinics would still perform their routine patient‐specific QA. Results: For RayStation, the average mean percent dose differences across all contours were 0.65% ± 1.05%, −2.09% ± 0.56%, and 0.28% ± 0.98% and average control limit ranges were 1.89% ± 1.32%, 2.16% ± 1.31%, and 2.65% ± 1.89% for the head and neck, cervix, and chest wall, respectively. In contrast, Eclipse's average mean percent dose differences across all contours were −0.62% ± 0.34%, 0.32% ± 0.23%, and −0.91% ± 0.98%, while average control limit ranges were 1.09% ± 0.77%, 3.69% ± 2.67%, 2.73% ± 1.86%, respectively. Averaging all contours and removing outliers, a 0% dose difference corresponded with a DLG value of 0.202 ± 0.019 cm and MLC‐TF value of 0.020 ± 0.001 for Acuros and a DLG value of 0.135 ± 0.031 cm and MLC‐TF value of 0.015 ± 0.001 for AAA. Conclusions: Differences in mean dose and control limits between RPA and two separately commissioned TPSs were determined. With varying control limits and means, SPC provides a flexible and useful process quality assurance tool for monitoring a complex automated system such as the RPA. [ABSTRACT FROM AUTHOR]

Purpose: Online dose verification based on proton‐induced positron emitters requires high accuracy in the assignment of elemental composition (e.g., C and O). We developed a machine learning framework for deriving oxygen and carbon concentration based on dual‐energy CT (DECT). Methods: Digital phantoms at the head site were constructed based on single‐energy CT (SECT) and stoichiometric calibration. DECT images (80 and 140 kVp) were synthesized using two methods: (1) theoretical CT numbers with Gaussian noise (method 1) and (2) forward/backward image reconstruction with poly‐energetic energy spectrum and Poisson noise modeled (method 2). Two architectures of convolutional neural networks, UNet and ResNet, were investigated to map from DECT images to C/O weights. Four cases (UNet‐1: Method 1+UNet, ResNet‐1: Method 1+ResNet, UNet‐2: Method 2+UNet, and ResNet‐2: Method 2 +ResNet) were tested for different tissue types and different noise levels. Monte‐Carlo simulation was employed to identify the impact of fluctuation in oxygen and carbon concentration on activity/dose distribution. Results: When no noise is present, all four cases are able to obtain <2% mean absolute errors and <4% root mean square error (RMSE). For the worst image quality (e.g., lowest image SNR), the RMSE for O among all tissue types is 3.02% (UNet‐1), 4.46% (ResNet‐1), 4.38% (UNet‐2), and 6.31% (ResNet‐2), respectively. For UNet‐1 and ResNet‐1, the model performed slightly better in terms of RMSE for skeletal tissue than soft tissues. Such a trend is not observed for UNet‐2 and ResNet‐2. With regard to the comparison between UNet and ResNet, different accuracy and noise immunity are observed. The activity profiles exhibit 3%–5% difference in terms of mean relative error between the ground truth and machine learning outcome. Conclusion: We explored the feasibility of a machine learning framework to derive elemental concentration of oxygen and carbon based on DECT images. Two machine learning models, UNet and ResNet, are able to utilize spatial correlation and obtain accurate carbon and oxygen concentration. This study lays a foundation for us to apply the proposed approach to clinical DECT images. [ABSTRACT FROM AUTHOR]

Background: Electronic brachytherapy (eBT) is considered a safe treatment with good outcomes. However, eBT lacks standardized and independent dose verification, which could impede future use. Purpose: To validate the 3D dose‐to‐water distribution of an electronic brachytherapy (eBT) source using a small‐volume plastic scintillation detector (PSD). Methods: The relative dose distribution of a Papillon 50 (P50) (Ariane Medical Systems, UK) eBT source was measured in water with a PSD consisting of a cylindrical scintillating BCF‐12 fiber (length: 0.5 mm, Ø: 1 mm) coupled to a photodetector via an optical fiber. The measurements were performed with the PSD mounted on a motorized stage in a water phantom (MP3) (PTW, Germany). This allowed the sensitive volume of the PSD to be moved to predetermined positions relative to the P50 applicator, which pointed vertically downward while just breaching the water surface. The percentage depth‐dose (PDD) was measured from 0 to 50 mm source‐to‐detector distance (SDD) in 1–3 mm steps. Dose profiles were measured along two perpendicular axes at five different SDDs with step sizes down to 0.5 mm. Characterization of the PSD consisted of determining the energy correction through Monte Carlo (MC) simulation and by measuring the stability and dose rate linearity using a well‐type ionization chamber as a reference. The measured PDD and profiles were validated with corresponding MC simulations. Results: The measured and simulated PDD curves agreed within 2% (except at 0 mm and 43 mm depth) after the PSD measurements were corrected for energy dependency. The absorbed dose decreased by a factor of 2 at 7 mm depth and by a factor of 10 at 26 mm depth. The measured dose profiles showed dose gradients at the profile edges of more than 50%/mm at 5 mm depth and 15%/mm at 50 mm depth. The measured profile widths increased 0.66 mm per 1 mm depth, while the simulated profile widths increased 0.74 mm per 1 mm depth. An azimuthal dependency of > 10% was observed in the dose at 10 mm distance from the beam center. The total uncertainty of the measured relative dose is < 2.5% with a positional uncertainty of 0.4 mm. The measurements for a full 3D dose characterization (PDD and profiles) can be carried out within 8 h, the limiting factor being cooling of the P50. Conclusion: The PSD and MP3 water phantoms provided a method to independently verify the relative 3D dose distribution in water of an eBT source. [ABSTRACT FROM AUTHOR]

Purpose: MR‐Linac integrates an MRI scanner and a linear accelerator to provide adaptive radiation treatment. Superior tissue contrast and real‐time imaging can give the clinicians confidence to reduce the margins of the planning target volume (PTV). The purpose of this study was to verify the dosimetric accuracy of an MR‐Linac system in treating a moving target and assess the error with different motion patterns and adaptation methods. Methods: We performed an end‐to‐end test for Elekta Unity (Elekta) using the 4D Dynamic Thorax Phantom (CIRS MRgRT 008Z), comparing the measured and planned dose. The moving phantom had four measurement locations in the tumor, liver, kidney, and spinal cord regions with a PTW30013 ion chamber. For seven different motion patterns, we first acquired simulation CT using a slow‐scanning protocol, based on which we generated reference plans. The treatment technique was the standard intensity‐modulated radiation therapy (IMRT). We tested both adaptation workflows: the Adapt‐to‐Position (ATP) and the Adapt‐to‐Shape (ATS). The three‐dimensional (3D) distribution was measured using a diode array phantom (Sun Nuclear Inc.) to check the dose distribution accuracy as part of the routine QA process. We also performed end‐to‐end tests on a conventional Linac. Finally, we used SPSS Statistics 22.0 (Inc., Chicago, IL, USA) for data analysis. Results: All pretreatment reference plans and delivered plans had excellent QA results with a better than 95% passing rate of relative gamma analysis (2%/2 mm criteria). The adaptive planning for MR‐Linac produced quality plans. The measured dose in the target agreed with the calculated dose. Conclusions: The adaptive treatment on the MR‐Linac system investigated met the expected performance with tumor motions. The outline of the target could be visualized and accurately contoured on the 3D MR for online planning. Under different motion patterns, the difference between the measured and calculated dose was acceptable clinically. [ABSTRACT FROM AUTHOR]

Proton therapy represents a technologically advanced method for delivery of radiation treatments to tumors. The determination of the biological effectiveness is one of the objectives of the MoVe IT (Modeling and Verification for Ion Beam Treatment Planning) project of the National Institute for Nuclear Physics (INFN) CSN5. The aim of the present work, which is part of the project, was to evaluate the performance of the thermoluminescent dosimeters (TLDs-100) for dose verification in the proton beam line. Four irradiation experiments were performed in the experimental room at the Trento Proton Therapy Center, where a 150 MeV monoenergetic proton beam is available. A total of 80 TLDs were used. The TLDs were arranged in one or two rows and accommodated in a specially designed water-equivalent phantom. In the experimental setup, the beam enters orthogonally to the dosimeters and is distributed along the proton beam profile, while the irradiation delivers doses of 0.8 Gy or 1.5 Gy in the Bragg peak. For each irradiation stage, the depth–dose curve was determined by the TLD readings. The results showed the good performance of the TLDs-100, proving their reliability for dose recordings in future radiobiological experiments planned within the MoVe IT context. [ABSTRACT FROM AUTHOR]

Copyright of Chinese Medical Equipment Journal is the property of Chinese Medical Equipment Journal Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: In vivo range and dose verification based on proton‐induced acoustics (protoacoustics) is potentially a useful tool for proton therapy. Built upon our previous study with two‐dimensional reconstruction, the time reversal (TR) method was extended to three‐dimensional (3D) and evaluated at two treatment sites (head and liver) through simulation, with the emphasis on a number of aspects such as increased spatial coverage, computational workload, and signal interference among slices. Methods: Two mono‐energetic pencil beams were modeled in each site. The k‐Wave toolbox was used to investigate the propagation and TR reconstruction of acoustic waves. The performance was quantitatively assessed based on mean square error (MSE) for dose verification and Bragg peak localization error (ΔBP) for range verification, with regard to five parameters: number of sensors, sampling duration, sampling timestep, spill time, and noise level. Results: The respective impacts of five parameters are examined. Under the optimum setting, the achievable ΔBP can be limited within 1 voxel (voxel size: 3 × 3 × 3 mm3) and the achievable MSE can be limited below 0.02, for the head case (56 sensors) and the liver case (204 sensors), respectively. Conclusions: The feasibility of range and dose verification utilizing the 3D TR method is demonstrated, as the very first step. In spite of several challenges unique to the 3D case (spatial coverage, computational workload, and signal interference among slices, etc.), promising performance is found and can be further improved through optimizing the deployment of sensors. The proposed approach may find potential use in several applications: beam diagnostics, in vivo dosimetry, and treatment monitoring. [ABSTRACT FROM AUTHOR]

Purpose: To commission MCsquare (a multi-cores CPU-based dose calculation engine) for pencil beam scanning (PBS) proton therapy, integrate it into RayStation treatment plan system (TPS) to create a dedicated platform for fast independent dose verification. Method: A MCsquare-based independent dose verification platform (MC2InRS) was developed to realize automatic dose re-calculation for clinical use, including data preparation, dose calculation, 2D/3D gamma analysis. MCsquare was commissioned based on in-air lateral dose profiles, integrated depth dose, and the absolute dose of different beam energies for Proteus®ONE. MC2InRS was validated with measurement data using various targets and depths in a water phantom. This study also investigated 15 clinical cases to demonstrate the feasibility and effectiveness of MC2InRS platform in clinic practice. Results: Between simulation and measurement, the distal range differences at 80% (R80) and 20% (R20) dose levels for each energy were below 0.05 mm, and 0.1 mm, respectively, and the absolute dose differences were below 0.5%. 29 out of 36 QA planes reached a 100% gamma passing rate (GPR) for 2%/2mm criteria, and a minimum of 98.3% gamma was obtained in water phantom between simulation and measurement. For the 15 clinical cases investigated, the average 2D GPR (2%/2mm) was 95.4%, 99.3% for MCsquare vs. measurement, MCsquare vs. TPS, respectively. The average 3D GPR (2%/2mm) was 98.9%, 95.3% for MCsquare vs. TPS in water, and computed tomography (CT), respectively. Conclusion: MC2InRS, a fast, independent dose verification platform, has been developed to perform dose verification with high accuracy and efficiency for Pencil Bream Scanning (PBS). Its potential to be applied in routine clinical practice has also been discussed. [ABSTRACT FROM AUTHOR]

Background: Plastic scintillator detector (PSD) Exradin W1 has shown promising performance in small field dosimetry due to its water equivalence and small sensitive volume. However, few studies reported its capability in measuring fields of conventional sizes. Therefore, the purpose of this study is to assess the performance of W1 in measuring point dose of both conventional IMRT plans and VMAT SRS plans. Methods: Forty-seven clinical plans (including 29 IMRT plans and 18 VMAT SRS plans with PTV volume less than 8 cm3) from our hospital were included in this study. W1 and Farmer-Type ionization chamber Exradin A19 were used in measuring IMRT plans, and W1 and microchamber Exradin A16 were used in measuring SRS plans. The agreement between the results of different types of detectors and TPS was evaluated. Results: For IMRT plans, the average differences between measurements and TPS in high-dose regions were 0.27% ± 1.66% and 0.90% ± 1.78% (P = 0.056), and were −0.76% ± 1.47% and 0.37% ± 1.34% in low-dose regions (P = 0.000), for W1 and A19, respectively. For VMAT SRS plans, the average differences between measurements and TPS were −0.19% ± 0.96% and −0.59% ± 1.49% for W1 and A16 with no statistical difference (P = 0.231). Conclusion: W1 showed comparable performance with application-dedicated detectors in point dose measurements for both conventional IMRT and VMAT SRS techniques. It is a potential one-stop solution for general radiotherapy platforms that deliver both IMRT and SRS plans. [ABSTRACT FROM AUTHOR]

Objective: To investigate the usefulness of positron emission tomography (PET) images obtained after carbon-ion irradiation for dose verification in carbon-ion radiotherapy. Methods and Materials: An anthropomorphic head phantom was used in this study. Three cubes with volumes of 1, 4, and 10 ml were contoured as targets in the phantom CT through a treatment planning system. Treatment plans with six prescriptions from 2.5 to 10 Gy (2.5, 3, 5, 6, 8, and 10 Gy effective dose) were designed and delivered by 90° fixed carbon-ion beams, respectively. After irradiation of the phantom, a PET/CT scan was performed to fuse the treatment-planning CT image with the PET/CT image. The relationship between target volume and the standard uptake value (SUV) in PET/CT was evaluated for corresponding plan prescription. The MIM Maestro software was used for the image fusion and data analysis. Results: SUV in the target had an approximate linear relationship with the effective dose. The same effective dose could generate a roughly equal SUV for different target volumes (p < 0.05). Conclusions: It is feasible to verify the actual 3-D dose distribution of carbon-ion radiotherapy by the approach in this study. [ABSTRACT FROM AUTHOR]

In the preparation of intensity-modulated radiation therapy (IMRT), patient-specific verification is widely employed to optimize the treatment. To accurately estimate the accumulated dose and obtain the field-by-field or segment-by-segment verification, an original IMRT verification tool using scintillator light and an analysis workflow was developed in this study. The raw light distribution was calibrated with respect to the irradiated field size dependency and light diffusion in the water. The calibrated distribution was converted to dose quantity and subsequently compared with the results of the clinically employed plan. A criterion of 2-mm dose-to-agreement and 3% dose difference was specified in the gamma analysis with a 10% dose threshold. By applying the light diffusion calibration, the maximum dose difference was corrected from 7.7 cGy to 3.9 cGy around the field edge for a 60 cGy dose, 7 × 7 cm2 irradiation field, and 10 MV beam energy. Equivalent performance was confirmed in the chromodynamic film. The average dose difference and gamma pass rate of the accumulated dose distributions in six patients were 0.8 ± 4.5 cGy and 97.4%, respectively. In the field-by-field analysis, the average dose difference and gamma pass rate in seven fields of Patient 1 were 0.2 ± 1.2 cGy and 93.9%, respectively. In the segment-by-segment analysis, the average dose difference and gamma pass rate in nine segments of Patient 1 and a 305° gantry angle were − 0.03 ± 0.2 cGy and 93.9%, respectively. This system allowed the simultaneous and independent analysis of each field or segment in the accumulated dose analysis. [ABSTRACT FROM AUTHOR]

Copyright of Chinese Medical Equipment Journal is the property of Chinese Medical Equipment Journal Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

End‐to‐end testing of a new breast radiotherapy technique preferably requires realistic phantom geometries, which is challenging to achieve using currently commercially available solutions. We have developed a series of three‐dimensional (3D)‐printed breast phantoms, with ionization chamber and radiochromic film inserts, which can be attached to a commercial anthropomorphic thorax phantom. A contoured left breast from a patient's planning CT was mapped onto a CT of the CIRS E2E thorax phantom (CIRS Inc.) and cropped to fit the surface. Four versions of the breast were 3D printed, containing a cavity for an ionization chamber and slits for radiochromic film insertion in the three cardinal planes, respectively. The phantoms were fully compatible with surface scanning technology used for setup. The phantoms were validated using a whole‐breast volumetric modulated arc therapy protocol with a simultaneous integrated boost to the tumor bed (VMAT‐SIB). Six patient plans and one original plan on the breast phantom were verified with planar portal imaging, point dose, and film measurements in the MultiCube phantom and planar γ‐analysis using ArcCHECK diode array. Six patient plans were recalculated on the breast phantom (hybrid plans) and delivered with point dose and film measurements with 3% (local)/2 mm γ‐analysis. One complete end‐to‐end test on the breast phantom was performed. All plan quality verifications had point dose differences below 2.4% from the calculated dose and γ‐agreement scores (γAS) > 87.3% for film measurements in the MultiCube, portal dosimetry, and ArcCHECK. Point dose differences in the 3D‐printed phantoms were below 2.6% (median −1.4%, range −2.6%; 0.3%). Median γAS was 96.4% (range 80.1%–99.7%) for all film inserts. The proposed 3D‐printed attachable breast dosimetry phantoms have been shown to be a valuable tool for end‐to‐end testing of a new radiotherapy protocol. The workflow described in this report can aid users to create their own phantom‐specific breast 3D‐printed phantoms. [ABSTRACT FROM AUTHOR]

Purpose: To create a snapshot of common practices for 3D‐CRT and intensity‐modulated radiation therapy (IMRT) QA through a large‐scale survey and compare to TG‐218 recommendations. Methods: A survey of 3D‐CRT and IMRT QA was constructed at and distributed by the IROC‐Houston QA center to all institutions monitored by IROC (n = 2,861). The first part of the survey asked about methods to check dose delivery for 3D‐CRT. The bulk of the survey focused on IMRT QA, inquiring about treatment modalities, standard tools used to verify planned dose, how assessment of agreement is calculated and the comparison criteria used, and the strategies taken if QA fails. Results: The most common tools for dose verification were a 2D diode array (52.8%), point(s) measurement (39.0%), EPID (27.4%), and 2D ion chamber array (23.9%). When IMRT QA failed, the highest average rank strategy utilized was to remeasure with the same setup, which had an average position ranking of 1.1 with 90.4% of facilities employing this strategy. The second highest average ranked strategy was to move to a new calculation point and remeasure (54.9%); this had an average ranking of 2.1. Conclusion: The survey provided a snapshot of the current state of dose verification for IMRT radiotherapy. The results showed variability in approaches and that work is still needed to unify and tighten criteria in the medical physics community, especially in reference to TG‐218's recommendations. [ABSTRACT FROM AUTHOR]

Objective: This study compared the dose verification results between plans created based on computed tomography (CT) scan and digital virtual phantom. Methods: We retrospectively analyzed the treatment plan of 10 patients with head and neck cancer. CT scanned phantom and digital virtual phantom measured using Delta4 3‐D matrix were used to generate verification plans for each patient. The doses based on the effective measurement volume of the two phantoms were compared, and the verification results were analyzed using gamma index analysis. Results: For the body, the minimum dose, the maximum dose, the average dose, and the total dose were 0.72 ± 0.46 cGy, 251.86 ± 49.83 cGy, 58.10 ± 10.93 cGy, and 154.67 ± 20.28 cGy, respectively, in the CT‐scan group, and 0.62 ± 0.36 cGy, 248.34 ± 48.59 cGy, 57.20 ± 10.77 cGy, and 151.57 ± 19.73 cGy, respectively in the Uniform group. The difference between the groups was significant (P < 0.05). In the Delta4 analysis software, the dose deviation, distance to agreement, and gamma passing rates were 73.39 ± 10.75%, 95.25 ± 1.00%, and 96.67 ± 1.415%, respectively in the CT‐scan group, and 83.36 ± 10.15%, 98.61 ± 0.810%, and 99.38 ± 0.452%, respectively, in the Uniform group. The two plans were significantly different (P < 0.05), and there was a 3% difference in the gamma passing rate. Therefore, the conclusions relating to the examined dose applied, the groups were significantly higher than those of CT‐scan groups. (both P‐values were <0.05). As the parameter value increases, the difference decreases. In the 3 mm/3% standard, both groups met the clinical requirement of gamma passing rate of >95%, but the Uniform group had a higher passing rate than the CT‐scan group. Conclusions: Because the passing rate was higher in the Uniform group than in the CT‐scan group, it is recommended to use digital virtual phantom modules to generate verification plans in clinical practice. [ABSTRACT FROM AUTHOR]

Purpose: To accomplish novel radiation treatment techniques in preclinical radiation research, small animal image‐guided radiotherapy systems have been increasingly integrated into preclinical radiation research over the last decade. Although such systems have sophisticated tools (such as cone‐beam computed tomography–based image guidance, robotic couch, treatment planning system (TPS), and electronic portal imaging devices [EPIDs]). To our knowledge, no established technique can perform independent and online verification of the delivered dose during radiotherapy. In this study, we implement an online EPID dosimetry for each administered SA‐IGRT fraction in a rat orthotopic model of prostate cancer. Methods: To verify the accuracy of delivered dose to rat, we compared the two‐dimensional (2D) calculated dose distribution by TPS as the planned dose, with online dose distribution estimated using an EPID as the delivered dose. Since image acquisition software was not capable of acquiring integrated images over a long period of time, we used the EPID to estimate dose rate rather than dose. The central axis (CAX) dose rate values at the beam's exit surface were compared. In addition, 2D dose distributions were also compared under different gamma criteria. To verify the accuracy of our EPID dosimetry technique, we measured transit and exit doses with film during animal treatment. In this study, 20‐mm cone was used to collimate beam. We previously observed that the EPID response was independent of collimator size for collimator size ≥15‐mm, we did not apply for additional correction factor. Results: Comparison of exit CAX dose rate values of TPS‐calculated and EPID‐estimated showed that the average difference was 3.1%, with a maximum of 9.3%. Results of gamma analysis for 2D comparison indicated an average of 90% passing rate with global gamma criterion of 2 mm/5%. We observed that TPS could not calculate dose accurately in peripheral regions in which the penumbra effect was dominant. Dose rate values estimated by EPID were within 2.1% agreement with film at both the imager plane and the beam's exit surface for 4 randomly selected animals for which film measurement verification was performed. Conclusions: The small animal radiation research platform (SARRP) system's built‐in EPID was utilized to estimate dose delivered to rats at kilovoltage energy x‐rays. The results of this study suggest that the EPID is an invaluable tool for verifying delivered dose to small animal to help validate conclusions made from preclinical radiation research. [ABSTRACT FROM AUTHOR]

The Fe3+ diffusion in Fricke gel dosimeter, widely used for the measurement of accurate dose distributions in radiotherapy, results in a gradual blurring of the dose pattern with time after irradiation. In order to solve this issue, we embedded Fricke gel dosimeter with boron nitride nanosheets. The results show that the nanosheets-embedded gel dosimeter exhibited lower diffusion rate of Fe3+ ions (0.23 mm2 h−1) and a good response to γ irradiation in UV absorbance spectra. The hydrogen bond barriers between nanosheets and the gels were an important mechanism for the hindrance to Fe3+ diffusion besides the physical blocking of the Fe3+ motion by boron nitride nanosheets. This work will benefit understanding the mechanism for the limit on irons' diffusion and developing three dimensional Fricke gel dosimeter for the measurement of accurate dose distributions. [ABSTRACT FROM AUTHOR]

Purpose/objective(s): Online proton range/dose verification based on measurements of proton‐induced positron emitters is a promising strategy for quality assurance in proton therapy. Because of the nonlinear correlation between the dose distribution and the activity distribution of positron emitters in addition to the presence of noise, machine learning approaches were proposed to establish their relationship. Materials/methods: Simulations were carried out with a spot‐scanning proton system using GATE‐8.0 and Geant4‐10.3 toolkit with a computed tomography (CT)‐based patient phantom. The one‐dimensional (1D) distributions of positron emitters and radiation dose were obtained. A feedforward neural network classification model comprising two hidden layers, was developed to estimate whether the range is within a preset threshold. A recurrent neural network (RNN) regression model comprising three layers and ten neurons in each hidden layer was developed to estimate dose distribution. The performance was quantitatively studied in terms of mean squared error (MSE) and mean absolute error (MAE) under different signal‐to‐noise ratio (SNR) values. Results: The feasibility of proton range and dose verification using the proposed neural network framework was demonstrated. The feedforward NN model achieves high classification accuracy close to 100% for individual classes without bias. The RNN model is able to accurately predict the 1D dose distribution for different energies and irradiation positions. When the SNR of the input activity profiles is above 4, the framework is able to predict with an MAE of ~0.60 mm and an MSE of ~0.066. Moreover, the model demonstrates a good capability of generalization. Conclusions: The RNN model is found to be effective in identifying the relationship between the distributions of dose and positron emitters. The machine learning‐based framework and RNN models may be a useful tool to allow for accurate online range and dose verification based on proton‐induced positron emitters. [ABSTRACT FROM AUTHOR]

Purpose: At our institute, in vivo patient dose distributions are reconstructed for all treatments delivered using conventional linacs from electronic portal imaging device (EPID) transit images acquired during treatment using a simple back‐projection model. Currently, the clinical implementation of MRI‐guided radiotherapy systems, which aims for online and real‐time adaptation of the treatment plan, is progressing. In our department, the MR‐linac (Unity, Elekta AB, Stockholm, Sweden) is now in clinical use. The aim of this work is to demonstrate the feasibility of two‐dimensional (2D) EPID dosimetric verification for the magnetic resonance (MR)‐linac by comparing back‐projected EPID doses to ionization chamber (IC) array dose distributions. Materials and methods: Our conventional back‐projection algorithm was adapted for the MR‐linac. The most important changes involve modeling of the attenuation by and scatter from the cryostat. The commissioning process involved the acquisition of square field EPID measurements using various phantom setups (varying SSD, phantom thickness, and field size). Commissioning models were created for gantry 0°, 90°, and 180° and verified by comparing EPID‐reconstructed 2D dose distributions to measurements made with the OCTAVIUS 1500 IC array (PTW, Freiburg, Germany) for two prostate and one rectum IMRT plans (25 beams total). The average of the γ parameters (y‐mean and y‐pass rate) and the dose difference at a reference point were reported. Due to their construction, the attenuation of couch, bridge, and cryostat shows a much stronger dependence on gantry angle in the MR‐linac compared to conventional linacs. We present a method to correct for these effects. This method is validated by dose reconstruction of the 25 intensity‐modulated radiation therapy beams recorded at a certain gantry angle using the model of another gantry angle, combined with the correction method. Results: For dose verification performed at a gantry angle identical to the commissioned model, the average y‐mean and y‐pass rate values (3% global dose, 2 mm, 10% isodose) were 0.37 ± 0.07 and 98.1, 95% CI [98.1 ± 2.4], respectively. The average dose difference at the reference point was −0.5% ± 1.8%. Verification at gantry angles different from the commissioned model (i.e., using the gantry angle dependent correction) reported 0.39 ± 0.08 and 97.6, 95% CI [96.9, 98.3] average y‐mean and y‐pass rate values. The average dose difference at the reference point was −0.1% ± 1.8%. Conclusion: The EPID dosimetry back‐projection model was successfully adapted for the MR‐linac at gantry 0°, 90°, and 180°, accounting for the presence of the MRI housing between phantom (or patient) and the EPID. A method to account for the gantry angle dependence was also tested reporting similar results. [ABSTRACT FROM AUTHOR]

Aims: The main objective of this research work is to compare the dosimertic effect on lower and upper oesophagus cancer treatment using 3D conformal radiotherapy as well as to evaluate the doses administered to the organs at risk. Materials and methods: In this study, a cohort of 30 oesophageal cancer patients between the ages of 45 and 67 years registered during March 2017 to February 2018 was considered. These patients were treated through 3D conformal radiotherapy using four-field technique. Beam energy of 15 MV from Varian DHX linear accelerator was used. The given 30 patients were divided into two groups. The 1st group of 15 patients with upper oesophagus cancer was prescribed 5000 cGy doses, and the 2nd group of remaining 15 patients with lower oesophagus cancer was prescribed 4500 cGy. Computed tomography scans of every patient were obtained and then transmitted to Eclipse TPS for generating treatment plans. All radiotherapy plans were evaluated through various dosimetric indices. Statistical analysis software SPSS was utilised to get the values of means standard error and standard deviation of these indices for the treatment plan evaluation. Results: Uniformity index (UI) calculated for first group of patients showed difference of 7·4% from ideal value. A difference of 7% between ideal and calculated UI value was observed in 2nd group of patients. The values of other dosimetric indices like coverage, homogeneity, moderate dose homogeneity index (mDHI) and radical dose homogeneity index (rDHI) were found in limits specified by the Radiation Therapy and Oncology Group. The maximum difference of 6% was observed between the coverage mean values of 1st and 2nd group treatment plans. Conclusion: For oesophageal cancer, 3D conformal radiotherapy using four-field treatment plans shows homogeneous distribution of dose around the target and limits the dose to organ at risk. [ABSTRACT FROM AUTHOR]

Purpose: In vivo range verification in proton therapy is a critical step to help minimize range and dose uncertainty. We propose to employ a time reversal (TR)‐based approach using proton‐induced acoustics (protoacoustics) to reconstruct pressure/dose distribution in heterogeneous tissues. Methods: The dose distribution of mono‐energetic proton pencil beam in a CT‐based patient phantom was calculated by Monte Carlo simulation. K‐wave toolbox was used to investigate protoacoustic pressurization, propagation and reconstruction in 2D. To address the tissue heterogeneity effect, a number of physical parameters, including mass density (ρ), speed of sound (c), volumetric thermal expansion coefficient (αV), isobaric specific heat capacity (Cp) and attenuation power law prefactor (α0), were empirically converted from CT number. The performance was evaluated using two figures of merit: mean square error (MSE) of pressure profiles and Bragg peak localization error (ΔBP). The impact of six parameters of the TR inversion was examined, including number of sensors, sampling duration, sampling timestep, spill time, noise level and number of iterations. Results: The quantitative accuracy of TR reconstruction and its dependency on the selected parameters is presented. Under optimum conditions, the positioning accuracy of the Bragg peak can be controlled below 1 mm. For instance, MSE is 0.0123 and ΔBP is 0.59 mm under the following conditions (32 sensors, sampling duration: 600 µs, sampling timestep: 40 ns, spill time: 1 µs, no noise). Conclusions: The feasibility of TR‐based protoacoustic reconstruction in 2D for proton range verification was first demonstrated. The approach is not only applicable to pencil beam, but also has potential to be extended to passive scattering systems. [ABSTRACT FROM AUTHOR]

The Mobius3D (M3D) system (Mobius Medical Systems) is a second-check dosimetry system. We investigated the dose calculation accuracy of this system using heterogeneous phantoms with reference beam data provided by the manufacturer using simple and patient plans. We compared the dose distributions between M3D and the treatment planning system, as well as the measurements in solid water phantoms, heterogeneous phantoms, and patient plans for Varian and Elekta accelerators. The M3D results agreed well with the measurements in the solid water phantoms for the simple plans. However, the accuracy of M3D appeared to depend on the type of accelerator, as indicated by the slight differences in the dose measurements. Furthermore, the M3D dose measurements differed by 5-10% in the lung and bone regions. Regarding the patient plans, we confirmed that M3D is reasonably accurate as a second-check system, despite the slight accelerator type-dependent dose difference. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of the present study was to evaluate the practicability of liquid ionization chamber (LIC) for pretreatment dose verification of the advanced radiotherapy techniques such as volumetric modulated arc therapy (VMAT). Materials and Methods: The dosimetric characteristics of LIC such as repeatability, sensitivity, monitor unit linearity, dose rate dependence, angular dependence, voltage-current response, and output factors were investigated in 6 MV therapeutic X-ray beams. The LIC was cross-calibrated against 0.125-cc air-filled thimble ionization chamber. A dedicated dosimetry insert made up of Perspex to incorporate the LIC at proper location in the intensity-modulated radiation therapy thorax phantom was locally fabricated. The collection efficiency and ion recombination correction factor was determined using the two-dose rate method. Pretreatment dose verification measurement of VMAT treatment plans were carried out using the liquid ionization chamber as well as small volume (0.125 cc) air-filled thimble ionization chamber. The measured dose values by the two dosimeters and TPS calculated dose at a given point were compared. Results: The relative percentage differences between the TPS calculated and measured doses were within ± 1.57% for LIC and ± 2.21% for 0.125 cc ionization chamber, respectively. Conclusions: The measured dose values by the two dosimeters and TPS calculated dose at a given point were found comparable suggesting that the LIC could be a good choice of dosimeter for pretreatment dose verification in VMAT. [ABSTRACT FROM AUTHOR]

Background: Independent verification of the dose delivered by complex radiotherapy can be performed by electronic portal imaging device (EPID) dosimetry. This paper presents 5‐yr EPID in vivo dosimetry (IVD) data obtained using the Dosimetry Check (DC) software on a large cohort including breast, lung, prostate, and head and neck (H&N) cancer patients. Material and Methods: The difference between in vivo dose measurements obtained by DC and point doses calculated by the Eclipse treatment planning system was obtained on 3795 radiotherapy patients treated with volumetric modulated arc therapy (VMAT) (n = 842) and three‐dimensional conformal radiotherapy (3DCRT) (n = 2953) at 6, 10, and 15 MV. In cases where the dose difference exceeded ±10% further inspection and additional phantom measurements were performed. Results: The mean and standard deviation (μ±σ) of the percentage difference in dose obtained by DC and calculated by Eclipse in VMAT was: 0.19±3.89% in brain, 1.54±4.87% in H&N, and 1.23±4.61% in prostate cancer. In 3DCRT, this was 1.79±3.51% in brain, −2.95±5.67% in breast, −1.43±4.38% in bladder, 1.66±4.77% in H&N, 2.60 ± 5.35% in lung and −3.62±4.00% in prostate cancer. A total of 153 plans exceeded the ±10% alert criteria, which included: 88 breast plans accounting for 7.9% of all breast treatments; 28 H&N plans accounting for 4.4% of all H&N treatments; and 12 prostate plans accounting for 3.5% of all prostate treatments. All deviations were found to be as a result of patient‐related anatomical deviations and not from procedural errors. Conclusions: This preliminary data shows that EPID‐based IVD with DC may not only be useful in detecting errors but has the potential to be used to establish site‐specific dose action levels. The approach is straightforward and has been implemented as a radiographer‐led service with no disruption to the patient and no impact on treatment time. [ABSTRACT FROM AUTHOR]

Objective: Intensity‐modulated radiation therapy (IMRT) plays an increasingly important role in clinical applications, and dose verification is particularly crucial for each patient. In the present study, we retrospectively analyzed the results of dose verification in 924 actual IMRT plans, including the relationship between gamma pass rates and the location of lesions, and the total number of monitor units, and the maximum area of the collected dose. Methods: All the 924 IMRT plans implemented in a Varian Trilogy accelerator between 1 January 2014 and 31 March 2016 at Shandong Cancer Hospital were acquired. The Varian Eclipse planning system was used for all treatment planning and verification. Then, actual implemented plans were transplanted into a water phantom. Subsequently, the derived fluence was compared with the actual measured fluence by gamma analysis with the gamma criteria (3%/3 mm). Results: A total of 924 IMRT plans were categorized into six groups, including the brain, head and neck, chest, abdomen, pelvis, and breast. The gamma pass rate average was >98% for 902 IMRT plans, whereas 22 plans did not pass the first time. A correlation was observed between the treatment site and gamma pass rate (P = 0.017). Meanwhile, a negative correlation was observed between the gamma pass rate and the total number of monitor units (P < 0.001), and the largest area of the acquisition dose (P < 0.001), respectively. Varian Trilogy accelerator IMRT QA data has a stable pass rate with a 100 confidence limit (CL) value of 95.19. Conclusion: There was a correlation between the pass rate and the treatment site, the total number of monitor units, and the maximum area of collected dose. When using Mapcheck for patient plan dose verification, the gamma pass rate is very high, and only a few of them need to be analyzed. [ABSTRACT FROM AUTHOR]

Copyright of Chinese Medical Equipment Journal is the property of Chinese Medical Equipment Journal Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: To report an implementation method and the results of independent brachytherapy dose verification software (DVS). Material and methods: The DVS was developed based on Visual C++ and adopted a modular structure design. The DICOM RT files exported from a treatment planning system (TPS) were automatically loaded into the DVS. The DVS used the TG-43 formalism for dose calculation. A total of 15 cervical cancer patients who underwent brachytherapy were retrospectively selected to test the DVS. Dosimetric parameters and γ analysis (0.1 cm, 5%) were used to evaluate the dose differences between the DVS and the TPS. Results: Compared with the TPS dose, the γ pass rates of the dose calculated by the DVS were higher than 98%. For the clinical target volume (CTV), the dosimetric differences were less than 0.63% for D90% and D100%. For the bladder, rectum, and sigmoid, the agreement of D0.1cc, D1cc, and D2cc were within a 0.78% level. Conclusions: With minimal human-computer interactions, the DVS can verify the accuracy of doses calculated by the TPS. [ABSTRACT FROM AUTHOR]

Abstract: In this study, the optimum density scaling factors of phantom materials for a commercially available three‐dimensional (3D) dose verification system (Delta4) were investigated in order to improve the accuracy of the calculated dose distributions in the phantom materials. At field sizes of 10 × 10 and 5 × 5 cm2 with the same geometry, tissue‐phantom ratios (TPRs) in water, polymethyl methacrylate (PMMA), and Plastic Water Diagnostic Therapy (PWDT) were measured, and TPRs in various density scaling factors of water were calculated by Monte Carlo simulation, Adaptive Convolve (AdC, Pinnacle3), Collapsed Cone Convolution (CCC, RayStation), and AcurosXB (AXB, Eclipse). Effective linear attenuation coefficients (μeff) were obtained from the TPRs. The ratios of μeff in phantom and water ((μeff)pl,water) were compared between the measurements and calculations. For each phantom material, the density scaling factor proposed in this study (DSF) was set to be the value providing a match between the calculated and measured (μeff)pl,water. The optimum density scaling factor was verified through the comparison of the dose distributions measured by Delta4 and calculated with three different density scaling factors: the nominal physical density (PD), nominal relative electron density (ED), and DSF. Three plans were used for the verifications: a static field of 10 × 10 cm2 and two intensity modulated radiation therapy (IMRT) treatment plans. DSF were determined to be 1.13 for PMMA and 0.98 for PWDT. DSF for PMMA showed good agreement for AdC and CCC with 6 MV x ray, and AdC for 10 MV x ray. DSF for PWDT showed good agreement regardless of the dose calculation algorithms and x‐ray energy. DSF can be considered one of the references for the density scaling factor of Delta4 phantom materials and may help improve the accuracy of the IMRT dose verification using Delta4. [ABSTRACT FROM AUTHOR]

Purpose Full integration of EPID-based dosimetry in a global quality control workflow is still complicated. All the actual solutions are based on a relation between image gray-level signal and total linac-delivered dose. In this study, we propose a simple algorithm relying pixel gray-level of EPID image with average linac delivered dose per acquisition frame. Methods Calibration models are constructed for Varian and Elekta linacs including scattering conditions and EPID-arm backscatter-specific corrections. Only simple homogeneous fields are required to establish the EPID dose conversion model for each x-ray beam. Then, the model was evaluated by comparing calculated and converted dose distributions for homogeneous and modulated beams using gamma maps. Results To fit average dose per frame (Dfnorm) vs pixel gray value (Ngnorm) of each EPID image, a logarithmic curve [ABSTRACT FROM AUTHOR]

Stereotactic body radiation therapy (SBRT) to treat spinal metastases has shown excellent clinical outcomes for local control. High dose gradients wrapping around spinal cord make this treatment technically challenging. In this work, we present a spine SBRT case where a dosimetric error was identified during pre-treatment dosimetric quality assurance (QA). A patient with metastasis in T7 vertebral body consented to undergo SBRT. A dual arc volumetric modulated arc therapy plan was generated on the Pinnacle treatment planning system (TPS) with a 6 MV Elekta machine using gantry control point spacing of 4°. Standard pre-treatment QA measurements were performed, including ArcCHECK, ion chamber in CTV and spinal cord (SC) region and film measurements in multiple planes. While the dose measured at CTV region showed good agreement with TPS, the dose measured to the SC was significantly higher than reported by TPS in the original and repeat plans. Acceptable agreement was only achieved when the gantry control point spacing was reduced to 3°. A potentially harmful dose error was identified by pre-treatment QA. TPS parameter settings used safely in conventional treatments should be re-assessed for complex treatments. [ABSTRACT FROM AUTHOR]

In phase I of the survey a planning intercomparison of patient-related QA was performed at 12 institutions. The participating clinics created phantom based IMRT and VMAT plans which were measured utilizing the ArcCheck diode array. Mobius3D (M3D) was used in phase II. It acts as a secondary dose verification tool for patient-specific QA based on average linac beam data collected by Mobius Medical Systems. All Quasimodo linac plans will be analyzed for the continuation of the intercomparison. We aim to determine if Mobius3D is suited for use with diverse treatment techniques, if beam model customization is needed. Initially we computed first Mobius3D results by transferring all plans from phase I to our Mobius3D server. Because of some larger PTV mean dose differences we checked if output factor customization would be beneficial. We performed measurements and output factor correction to account for discrepancies in reference conditions. Compared to Mobius3D's preconfigured average beam data values, these corrected output factors differed by ±1.5% for field sizes between 7x7cm2 and 30x30cm2 and to −3.9% for 3x3cm2. Our method of correcting the output factors turns out good congruence to M3D's reference values for these medium field sizes. [ABSTRACT FROM AUTHOR]

Eye plaque brachytherapy has been developed and refined for the last 80 years, demonstrating effective results in the treatment of ocular malignancies. Current dosimetry techniques for eye plaque brachytherapy (such as TLD- and film-based techniques) are time consuming and cannot be used prior to treatment in a sterile environment. The measurement of the expected dose distribution within the eye, prior to insertion within the clinical setting, would be advantageous, as any errors in source loading will lead to an erroneous dose distribution and inferior treatment outcomes. This study investigated the use of spectroscopic dosimetry techniques for real-time quality assurance of I-125 based eye plaques, immediately prior to insertion. A silicon detector based probe, operating in spectroscopy mode was constructed, containing a small (1 mm) silicon detector, mounted within a ceramic holder, all encapsulated within a rubber sheath to prevent water infiltration of the electronics. Preliminary tests of the prototype demonstrated that the depth dose distribution through the central axis of an I-125 based eye plaque may be determined from AAPM Task Group 43 recommendations to a deviation of 6 % at 3 mm depth, 7 % at 5 mm depth, 1 % at 10 mm depth and 13 % at 20 mm depth, with the deviations attributed to the construction of the probe. A new probe design aims to reduce these discrepancies, however the concept of spectroscopic dosimetry shows great promise for use in eye plaque quality assurance in the clinical setting. [ABSTRACT FROM AUTHOR]

This study verified the dose calculation accuracy of the analytical anisotropic algorithm (AAA), Acuros XB version 10 (AXB10), and version 11 (AXB11) installed in an Eclipse treatment planning system, by comparing with Monte Carlo (MC) simulations. First, the algorithms were compared in terms of dose distributions using four types of virtual heterogeneous multi-layer phantom for 6 and 15 MV photons. Next, the clinical head and neck intensity-modulated radiation therapy (IMRT) dose distributions for 6 MV photons were evaluated using dose volume histograms (DVHs) and three-dimensional gamma analysis. In percentage depth doses (PDDs) for virtual heterogeneous phantoms, AAA overestimated absorbed doses in the air cavity, bone, and aluminum in comparison with MC, AXB10, and AXB11. The PDDs of AXB10 almost agreed with those of MC and AXB11, except for the air cavity. The dose in the air cavity was higher for AXB10 than for AXB11, because their electron cutoff energies are set at 500 and 200 keV, respectively. For head and neck IMRT dose distributions, the D in the clinical target volume (CTV) for AAA was almost the same as that for AXB10 and was approximately 7 % larger than that for MC. Comparing each approach with MC using a criterion of 3 %/3 mm, the pass rates for AXB10, AXB11, and AAA were 92.4, 94.7, and 90.4 % in the CTV, respectively. In conclusion, AAA produces dose errors in heterogeneous regions, while AXB11 provides calculation accuracy comparable to MC. AXB10 overestimates the dose in regions that include an air cavity. [ABSTRACT FROM AUTHOR]

Purpose: Radiation treatments have become increasingly more complex with the development of volumetric modulated arc therapy (VMAT) and the use of stereotactic body radiation therapy (SBRT). SBRT involves the delivery of substantially larger doses over fewer fractions than conventional therapy. SBRT-VMAT treatments will strongly benefit from in vivo patient dose verification, as any errors in delivery can be more detrimental to the radiobiology of the patient as compared to conventional therapy. Electronic portal imaging devices (EPIDs) are available on most commercial linear accelerators (Linacs) and their documented use for dosimetry makes them valuable tools for patient dose verification. In this work, the authors customize and validate a physics-based model which utilizes on-treatment EPID images to reconstruct the 3D dose delivered to the patient during SBRT-VMAT delivery. Methods: The SBRT Linac head, including jaws, multileaf collimators, and flattening filter, were modeled using Monte Carlo methods and verified with measured data. The simulation provides energy spectrum data that are used by their "forward" model to then accurately predict fluence generated by a SBRT beam at a plane above the patient. This fluence is then transported through the patient and then the dose to the phosphor layer in the EPID is calculated. Their "inverse" model back-projects the EPID measured focal fluence to a plane upstream of the patient and recombines it with the extra-focal fluence predicted by the forward model. This estimate of total delivered fluence is then forward projected onto the patient's density matrix and a collapsed cone convolution algorithm calculates the dose delivered to the patient. The model was tested by reconstructing the dose for two prostate, three lung, and two spine SBRT-VMAT treatment fractions delivered to an anthropomorphic phantom. It was further validated against actual patient data for a lung and spine SBRT-VMAT plan. The results were verified with the treatment planning system (TPS) (ECLIPSE AAA) dose calculation. Results: The SBRT-VMAT reconstruction model performed very well when compared to the TPS. A stringent 2%/2 mm -comparison calculation gave pass rates better than 91% for the prostate plans, 88% for the lung plans, and 86% for the spine plans for voxels containing 80% or more of the prescribed dose. Patient data were 86% for the lung and 95% for the spine. A 3%/3 mm -comparison was also performed and gave pass rates better than 93% for all plan types. Conclusions: The authors have customized and validated a robust, physics-based model that calculates the delivered dose to a patient for SBRT-VMAT delivery using on-treatment EPID images. The accuracy of the results indicates that this approach is suitable for clinical implementation. Future work will incorporate this model into both offline and real-time clinical adaptive radiotherapy. [ABSTRACT FROM AUTHOR]

Purpose: Radiation treatments are trending toward delivering higher doses per fraction under stereotactic radiosurgery and hypofractionated treatment regimens. There is a need for accurate 3D in vivo patient dose verification using electronic portal imaging device (EPID) measurements. This work presents a model-based technique to compute full three-dimensional patient dose reconstructed from on-treatment EPID portal images (i.e., transmission images). Methods: EPID dose is converted to incident fluence entering the patient using a series of steps which include converting measured EPID dose to fluence at the detector plane and then back-projecting the primary source component of the EPID fluence upstream of the patient. Incident fluence is then recombined with predicted extra-focal fluence and used to calculate 3D patient dose via a collapsed-cone convolution method. This method is implemented in an iterative manner, although in practice it provides accurate results in a single iteration. The robustness of the dose reconstruction technique is demonstrated with several simple slab phantom and nine anthropomorphic phantom cases. Prostate, head and neck, and lung treatments are all included as well as a range of delivery techniques including VMAT and dynamic intensity modulated radiation therapy (IMRT). Results: Results indicate that the patient dose reconstruction algorithm compares well with treatment planning system computed doses for controlled test situations. For simple phantom and square field tests, agreement was excellent with a 2%/2 mm 3D chi pass rate =98.9%. On anthropomorphic phantoms, the 2%/2 mm 3D chi pass rates ranged from 79.9% to 99.9% in the planning target volume (PTV) region and 96.5% to 100% in the low dose region (>20% of prescription, excluding PTV and skin build-up region). Conclusions: An algorithm to reconstruct delivered patient 3D doses from EPID exit dosimetry measurements was presented. The method was applied to phantom and patient data sets, as well as for dynamic IMRT and VMAT delivery techniques. Results indicate that the EPID dose reconstruction algorithm presented in this work is suitable for clinical implementation. [ABSTRACT FROM AUTHOR]

Purpose: Lung cancer treatment is susceptible to treatment errors caused by interfractional anatomical and respirational variations of the patient. On-board treatment dose verification is especially critical for the lung stereotactic body radiation therapy due to its high fractional dose. This study investigates the feasibility of using cone-beam (CB)CT images estimated by a motion modeling and free-form deformation (MM-FD) technique for on-board dose verification. Methods: Both digital and physical phantom studies were performed. Various interfractional variations featuring patient motion pattern change, tumor size change, and tumor average position change were simulated from planning CT to on-board images. The doses calculated on the planning CT (planned doses), the on-board CBCT estimated by MM-FD (MM-FD doses), and the on-board CBCT reconstructed by the conventional Feldkamp-Davis-Kress (FDK) algorithm (FDK doses) were compared to the on-board dose calculated on the "gold-standard" on-board images (gold-standard doses). The absolute deviations of minimum dose (?Dmin), maximum dose (?Dmax), and mean dose (?Dmean), and the absolute deviations of prescription dose coverage (?V100%) were evaluated for the planning target volume (PTV). In addition, 4D on-board treatment dose accumulations were performed using 4D-CBCT images estimated by MM-FD in the physical phantom study. The accumulated doses were compared to those measured using optically stimulated luminescence (OSL) detectors and radiochromic films. Results: Compared with the planned doses and the FDK doses, the MM-FD doses matched much better with the gold-standard doses. For the digital phantom study, the average (± standard deviation) ?Dmin, ?Dmax, ?Dmean, and ?V100% (values normalized by the prescription dose or the total PTV) between the planned and the gold-standard PTV doses were 32.9% (±28.6%), 3.0% (±2.9%), 3.8% (±4.0%), and 15.4% (±12.4%), respectively. The corresponding values of FDK PTV doses were 1.6% (±1.9%), 1.2% (±0.6%), 2.2% (±0.8%), and 17.4% (±15.3%), respectively. In contrast, the corresponding values of MM-FD PTV doses were 0.3% (±0.2%), 0.9% (±0.6%), 0.6% (±0.4%), and 1.0% (±0.8%), respectively. Similarly, for the physical phantom study, the average ?Dmin, ?Dmax, ?Dmean, and ?V100% of planned PTV doses were 38.1% (±30.8%), 3.5% (±5.1%), 3.0% (±2.6%), and 8.8% (±8.0%), respectively. The corresponding values of FDK PTV doses were 5.8% (±4.5%), 1.6% (±1.6%), 2.0% (±0.9%), and 9.3% (±10.5%), respectively. In contrast, the corresponding values of MM-FD PTV doses were 0.4% (±0.8%), 0.8% (±1.0%), 0.5% (±0.4%), and 0.8% (±0.8%), respectively. For the 4D dose accumulation study, the average (± standard deviation) absolute dose deviation (normalized by local doses) between the accumulated doses and the OSL measured doses was 3.3% (±2.7%). The average gamma index (3%/3 mm) between the accumulated doses and the radiochromic film measured doses was 94.5% (±2.5%). Conclusions: MM-FD estimated 4D-CBCT enables accurate on-board dose calculation and accumulation for lung radiation therapy. It can potentially be valuable for treatment quality assessment and adaptive radiation therapy. [ABSTRACT FROM AUTHOR]

The fi rst part of this study was about measurement of dosimetric parameters for small photon beams to be used as input data for treatment planning computer system (TPS) and to verify the dose calculated by TPS in Stereotactic Radiosurgery (SRS) procedure. The beam data required were percentage depth dose (PDD), off-axis ratio (OAR) and scattering factor. Small beams of 5 mm to 45 mm diameter from a circular cone collimator in SRS were used for beam data measurements. Measurements were made using pinpoint ionisation chamber (0.016cc). In the second part of this study, we reported the important of carrying out quality assurance (QA) procedures before SRS treatment which were found to influence the accuracy of dose delivery. These QA procedures consisted of measurements on the accuracy in target localization and treatment room laser alignment. The calculated TPS dose for treatment was verified using pinpoint ionisation chamber and thermoluminescent detector (TLD) 100H. The deviation mean between measured and calculated dose was -3.28%. The measured dose obtained from pinpoint ionisation chamber is in good agreement with the calculated dose from TPS with deviation mean of 2.17%. In conclusion, pinpoint ionisation chamber gives a better accuracy in dose calculation compared to TLD 100H. The results are acceptable as recommended by International Commission on Radiation Units and Measurements (ICRU) Report No. 50 (1994) that dose delivered to the target volume must be within ± 5% error. [ABSTRACT FROM AUTHOR]