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ObjectiveProtoacoustic 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 basedon 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. Qualitative results also demonstrated that our approach addressed the limit-view issue. 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. The processing time was reduced to 6 seconds, 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..

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]

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ObjectiveA quality control (QC) system based on the electronic portal imaging device (EPID) system was used to realize the Multi-Leaf Collimator (MLC) position verification and dose verification functions on Primus and VenusX accelerators. Methods The MLC positions were calculated by the maximum gradient method of gray values to evaluate the deviation. The dose of images acquired by EPID were reconstructed using the algorithm combining dose calibration and dose calculation. The dose data obtained by EPID and two-dimensional matrix (MapCheck/PTW) were compared with the dose calculated by Pinnacle/TiGRT TPS for \begin{document}$ \gamma $\end{document} passing rate analysis. ResultsThe position error of VenusX MLC was less than 1 mm. The position error of Primus MLC was significantly reduced after being recalibrated under the instructions of EPID. For the dose reconstructed by EPID, the average \begin{document}$ \gamma $\end{document} passing rates of Primus were 98.86% and 91.39% under the criteria of 3%/3 mm, 10% threshold and 2%/2 mm, 10% threshold, respectively. The average \begin{document}$ \gamma $\end{document} passing rates of VenusX were 98.49% and 91.11%, respectively.ConclusionThe EPID-based accelerator quality control system can improve the efficiency of accelerator quality control and reduce the workload of physicists.

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.)

In-beam PET imaging provides a noninvasive method to monitor the dose distribution in real-time for particle therapy such as carbon ion therapy and proton therapy. This work designed in-beam PET prototypes based on free PET including cylindrical, open-PET, C-shaped, dual-head plate and rectangular PET scanners and simulated in-beam PET imaging based on these scanners in GATE, a Monte Carlo simulation platform. The scanners were composed of 32 detector modules through free combination and had similar field of view, which could be used for dose monitoring in carbon therapy for the different part of human body and small animal. Each detector module was composed of LYSO array coupled with SiPM. The crystal array contained 20×20 crystals measuring 1.5 mm × 1.5 mm × 10 mm with 1.6 mm pitch. A PMMA phantom was irradiated by the periodic carbon ion pencil beam with an energy of 230 MeV/u and was monitored by the in-beam PET imaging using GATE macros. PET images of the generated positrons were reconstructed by using a MLEM algorithm. Results showed that the shift of image’s peak recreated the variation of positron activity, making it feasible for range verification in the carbon ion therapy by use of free PET scanners. This work compared the reconstructed images between the experimental measurement and simulation based on the dual-head plate scanner containing 8 detector modules. Both peak positions of experimental and simulated images were at 27 mm depth, which validated the feasibility of free PET prototypes for range verification and dose monitoring in carbon ion therapy.

The objective of the study is to verify the dose delivered on helical tomotherapy based on treatment plan with varying virtual bolus (VB) thickness. The target was localized on the ArcCHECK image by 3 mm margin from the phantom surface. The dimension of target, which includes the ArcCHECK's detectors, with the 4.0 cm width and length 12.0 cm along the phantom The 5 treatment plans were generated, 1 plan without VB application (NoVB) and the 4 plans with varying of VB thickness on the phantom surface by 0.5 cm (VB0.5), 1.0 cm (VB1.0), 1.5 cm (VB1.5), and 2.0 cm (VB2.0), in treatment planning but absent during irradiation. For measurement analysis, the ionization chamber and the ArcCHECK detectors were used for point dose and dose distribution by investigating the percentage of dose difference and the gamma passing rate. The VB thickness 0.5, 1.0 and 1.5 cm showed acceptable value with less than 2% for dose difference by 0.37% (VB0.5), -0.11% (VB1.0) and -0.37% (VB1.5) at the center of ArcCHECK. The accuracy of dose distribution showed an acceptable gamma passing rate of 99.8% (VB0.5), 100% (VB1.0), and 90.2% (VB1.5) for gamma criteria by 3%/3mm for absolute dose analysis. However, the gamma passing rate of VB2.0 down to 71.2% of absolute mode for gamma criteria by 3%/3mm. The treatment plans with VB thickness less than 15 mm deliver doses that are comparable to treatment plans without virtual bolus based on gamma analysis. However, the deviation showed a trend increasing when VB thickness increased. The VB2.0 was not acceptable for point dose and dose distribution verification by more than 2% dose difference and less than 90% of gamma passing rate. [ABSTRACT FROM AUTHOR]

To perform commissioning of the VMAT dose verification system 3DVH from a unique perspective and investigating its clinical applications in unreported cases with heterogeneous organs or long-target tumors. Initially, the standard ArcCheck calibration process was conducted. Then, the impact of absolute dose calibration values and ArcCheck CT density settings on the accuracy of the 3DVH reconstruction model was assessed. Subsequently, ten lung cancer cases with heterogeneous organ-encased targets and ten cervical cancer cases with large target volumes were selected to receive VMAT treatment with a TrueBeam Linac. Finally, the performance of the 3DVH method in such radiotherapy validations was assessed. Various calibration files had distinct impacts on ArcCheck 2D surface dosimetry and 3DVH dose reconstruction, thus requiring separate optimal calibrations files for these two purposes. The 3DVH dose reconstruction mode exhibited the highest accuracy when using the optimal ArcCheck density value of 1.1787 g/cm³ and an absolute dose calibration value of 249.96 cGy. In all test cases, deviations for target Dmean and D95% were within ±4.2% compared to the planned dose, with notable variations in critical organ doses. In structure-based 3D gamma evaluation, differences were observed compared to existing reports. It's crucial to account for the ArcCheck array calibration and the interplay between CT density settings and absolute dose calibration values to identify the best combination for an optimal 3DVH dose reconstruction model. The performance of 3DVH in verifying VMAT doses for tumors in heterogeneous or longer target areas may exhibit slight variations compared to other regions. • A unique perspective to perform commissioning of the VMAT dose verification system 3DVH. • Interplay of dose calibration and ArcCheck density setting impacts 3DVH model establishment and commissioning. • The 3DVH&ArcCheck system performs excellently for tumors in heterogeneous environments or with longer target areas. [ABSTRACT FROM AUTHOR]

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]

Background/Aim: The more complex the treatment plan, the higher the possibility of errors in dose verification. Recently, a treatment planning quality assurance (QA) software (PlanIQ) with a function to objectively evaluate the quality of volumetric-modulated arc therapy (VMAT) treatment plans by scoring and calculating the ideal dose-volume histogram has been marketed. This study aimed to assess the association between the scores of ideal treatment plans identified using PlanIQ and the results of dose verification and to investigate whether the results of dose verification can be predicted based on the complexity of treatment plans. Materials and methods: Dose verification was performed using an ionization chamber dosimeter, a radiochromic film, and a three-dimensional dose verification system, Delta4 PT. Correlations between the ideal treatment plan scores obtained by PlanIQ and the results of the absolute dose verification and dose distribution verification were obtained, and it was examined whether dose verifications could be predicted from the complexity of the treatment plans. Results: Even when the score from the ideal treatment plan was high, the results of absolute dose verification and dose distribution verification were sometimes poor. However, even when the score from the ideal treatment plan was low, the absolute volume verification and dose distribution verification sometimes yielded good results. Conclusions: Treatment plan complexity can be determined in advance from the ideal treatment plan score calculated by PlanIQ. However, it is difficult to predict the results of dose verification using an ideal treatment plan. [ABSTRACT FROM AUTHOR]

Background: Lung cancer poses a significant global health challenge. Adaptive radiotherapy (ART) addresses uncertainties due to lung tumor dynamics. We aimed to investigate a comprehensively and systematically validated offline ART regimen with high clinical feasibility for lung cancer., Methods: This study enrolled 102 lung cancer patients, who underwent kV iterative cone-beam computed tomography (iCBCT). Data collection included iCBCT and planning CT (pCT) scans. Among these, data from 70 patients were employed for training the UNet++ based deep learning model, while 15 patients were allocated for testing the model. The model transformed iCBCT into adaptive CT (aCT). Clinical radiotherapy feasibility was verified in 17 patients. The dosimetric evaluation encompassed GTV, organs at risk (OARs), and monitor units (MU), while delivery accuracy was validated using ArcCHECK and thermoluminescent dosimeter (TLD) detectors., Results: The UNet++ based deep learning model substantially improved image quality, reducing mean absolute error (MAE) by 70.05%, increasing peak signal-to-noise ratio (PSNR) by 17.97%, structural similarity (SSIM) by 7.41%, and the Hounsfield Units (HU) of aCT approaching a closer proximity to pCT compared to kV iCBCT. There were no significant differences observed in the dosimetric parameters of GTV and OARs between the aCT and pCT plans, confirming the accuracy of the dose maps in ART plans. Similarly, MU manifested no notable disparities, underscoring the consistency in treatment efficiency. Gamma passing rates for intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) plans derived from aCT and pCT exceeded 98%, while the deviations in TLD measurements (within 2% to 7%) also exhibited no significant differences, thus corroborating the precision of dose delivery., Conclusion: An offline ART regimen utilizing kV iCBCT and UNet++ based deep learning model is clinically feasible for lung cancer treatment. This approach provides enhanced image quality, comparable treatment plans to pCT, and precise dose delivery., (© 2024 The Author(s). Journal of Applied Clinical Medical Physics published by Wiley Periodicals LLC on behalf of American Association of Physicists in Medicine.)

Cancer prevention and treatment are currently the focus of most research. Dose verification is an important step for reducing the improper dose deposition during radiotherapy. To mend the traditional gel dosimeters for 3D dose verification, a novel rare-earth nanoparticle-based composite gel was prepared, which has good radioluminescence property and reusability. It is a promising phantom material for the new 3D gel dosimeter. TEM, DLS, FT-IR, TGA, and spectrofluorometer were used to determine the chemical structure, micromorphology, and optical performance. Compared to the traditional gel dosimeters, the composite gel has a good linear relationship between the light intensity excited by X-ray and the tube current. Furthermore, it may measure the dose distribution immediately in situ, which reduces errors and saves time. This work provides a new idea for the research of 3D gel dosimeters and promotes the safe and effective use of radiotherapy.

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]

• Verifying dose distribution during HDR brachytherapy treatment planning is vital. • Independent dose verification techniques can ensure the treatment efficacy. • Review of experimental and computational dose verification methods is presented. • Combination of dose verification techniques assures the optimum dose delivery. High dose rate (HDR) brachytherapy is a widely accepted cancer treatment method which provides high cure rates. In a HDR brachytherapy treatment, high radiation doses are delivered to the tumor area by placing the radioactive sources in the close proximity to the region of interest. The brachytherapy dose delivery follows the inverse square law with rapid dose fall of leading to minimal damage to the surrounding normal tissue. The safe direct delivery of the radiation dose to the tumour leads to good treatment outcomes comparable to other modalities of treatment. Hence, it is crucial to maintain a sharp drop in the radiation dose distribution within very short distances. Treatment planning system (TPS) which is controlled by a computer algorithm plays a significant role in calculating the optimum doses to the tumour area during a typical HDR brachytherapy treatment. However, the optimum dose calculated by the TPS must be verified by using an independent testing method in order to eliminate under/over irradiation of the tumor region and as quality assurance. In general, two types of independent dose verification methods(experimental and computational) are used to crosscheck the doses calculated by TPS. This systematic review aims to summarize the studies done in the past ten years on HDR brachytherapy treatment planning verification and to analyze the reliability and limitations. [ABSTRACT FROM AUTHOR]

Abstract 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 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.

Objective. To develop and validate a dose-of-the-day (DOTD) treatment plan verification procedure for liver and pancreas cancer patients treated with an magnetic resonance (MR)-Linac system. Approach. DOTD was implemented as an automated process that uses 3D datasets collected during treatment delivery. Particularly, the DOTD pipeline's input included the adapt-to-shape (ATS) plan-i.e. 3D-MR dataset acquired at beginning of online session, anatomical contours, dose distribution-and 3D-MR dataset acquired during beam-on (BON). The DOTD automated analysis included (a) ATS-to-BON image intensity-based deformable image registration (DIR), (b) ATS-to-BON contours mapping via DIR, (c) BON-to-ATS contours copying through rigid registration, (d) determining ATS-to-BON dosimetric differences, and (e) PDF report generation. The DIR process was validated by two expert reviewers. ATS-plans were recomputed on BON datasets to assess dose differences. DOTD analysis was performed retrospectively for 75 treatment fractions (12-liver and 5-pancreas patients). Main results. The accuracy of DOTD process relied on DIR and mapped contours quality. Most DIR-generated contours (99.6%) were clinically acceptable. DICE correlated with depreciation of DIR-based region of interest mapping process. The ATS-BON plan difference was found negligible (<1%). The duodenum and large bowel exhibited highest variations, 24% and 39% from fractional values, for 5-fraction liver and pancreas. For liver 1-fraction, a 62% variation was observed for duodenum. Significance. The DOTD methodology provides an automated approach to quantify 3D dosimetric differences between online plans and their delivery. This analysis offers promise as a valuable tool for plan quality assessment and decision-making in the verification stage of the online workflow., (© 2024 Institute of Physics and Engineering in Medicine.)

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]

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.)

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]

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]

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.

ObjectiveTo investigate the usefulness of positron emission tomography (PET) images obtained after carbon-ion irradiation for dose verification in carbon-ion radiotherapy.Methods and MaterialsAn 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.ResultsSUV 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).ConclusionsIt is feasible to verify the actual 3-D dose distribution of carbon-ion radiotherapy by the approach in this study.

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]

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 3D proton dose verification to minimize the range uncertainties of proton therapy to improve its precision and outcomes.vivo 3D proton dose verification to minimize the range uncertainties of proton therapy to improve its precision and outcomes., (© 2024 Institute of Physics and Engineering in Medicine.)

Highly precise dose delivery to the target (tumor or cancerous tissue) is a key point when brain diseases are treated applying recent stereotactic techniques: intensity-modulated, image-guided radiotherapy, volumetric modulated arc therapy, Gamma knife radiosurgery. The doses in one single shot may vary between tens and hundreds of Gy and cause significant cell/tissue/organ damages. This indicates the need for implementation of quality assurance (QA) measures which are realized performing treatment dose verification with more than one calibrated quality assurance method or tool, especially when functional radiosurgery with a high dose (up to 40 Gy in our case) shall be delivered to the target using small 4 mm collimator. Application of two dosimetry methods: radiochromic film dosimetry using RTQA2 and EBT3 films and dose gel dosimetry using modified nPAG polymer gels for quality assurance purposes in stereotactic radiosurgery treatments using Leksell Gamma Knife© Icon™ facility is discussed in this paper. It is shown that due to their polymerization ability upon irradiation nPAG gels might be potentially used as a quality assurance tool in Gamma knife radiosurgery: they indicate well pronounced linear dose response in hypo-fractionated (up to 10 Gy) dose range and are sensitive enough to irradiation dose changes with a high (at least 0.2 mm) spatial resolution. Dose assessment sensitivity of gels depends on parameters of a dose evaluation method (optical or magnetic resonance imaging), however, is similar to this estimated using film dosimetry, which is set as a standard dosimetry method for dose verification in radiotherapy.

Objective To explore the feasibility of COMPASS 3D dose verification system in volumetric modulated arc therapy of esophageal cancer. Methods We selected 37 patients newly diagnosed as esophageal neoplasm to make VMAT design based on the Oncentra planning system, and then transferred the treatment plan to the COMPASS validation system and the accelerator.We compared the calculated results in the planned system with the actual measurements in the COMPASS validation system.We obtained the Gamma passing rate, separately D95 and Dmean of the gross tumor volume(GTV) and the planning target volume(PTV), and compared the V20 and V30 dose values of the total lung. Results The calculated results and the measured results of the γ pass rate were higher than 92% respectively.The average dose difference for D95 was less than 3% for most treatment plans and the average difference for the target volumes(Dmean) was less than 1%.The average difference for V20 and V30 of the total lung were (9.86±2.18, 20.03±2.21)% and (12.35±2.61, 12.40±2.52)% in the calculated results and the measured results, respectively. Conclusion COMPASS 3D validation system could analyze the results accurately and quickly, ensure the safety of esophageal cancer treatment.

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]

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.

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.

Objective: A quality control (QC) system based on the electronic portal imaging device (EPID) system was used to realize the Multi-Leaf Collimator (MLC) position verification and dose verification functions on Primus and VenusX accelerators., Methods: The MLC positions were calculated by the maximum gradient method of gray values to evaluate the deviation. The dose of images acquired by EPID were reconstructed using the algorithm combining dose calibration and dose calculation. The dose data obtained by EPID and two-dimensional matrix (MapCheck/PTW) were compared with the dose calculated by Pinnacle/TiGRT TPS for γ passing rate analysis., Results: The position error of VenusX MLC was less than 1 mm. The position error of Primus MLC was significantly reduced after being recalibrated under the instructions of EPID. For the dose reconstructed by EPID, the average γ passing rates of Primus were 98.86% and 91.39% under the criteria of 3%/3 mm, 10% threshold and 2%/2 mm, 10% threshold, respectively. The average γ passing rates of VenusX were 98.49% and 91.11%, respectively., Conclusion: The EPID-based accelerator quality control system can improve the efficiency of accelerator quality control and reduce the workload of physicists.