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Title: SU-E-T-602: Patient-Specific Online Dose Verification Based On Transmission Detector Measurements

Abstract

Purpose: Intensity modulated radiotherapy requires a comprehensive quality assurance program in general and ideally independent verification of dose delivery. Since conventional 2D detector arrays allow only pre-treatment verification, there is a debate concerning the need of online dose verification. This study presents the clinical performance, including dosimetric plan verification in 2D as well as in 3D and the error detection abilities of a new transmission detector (TD) for online dose verification of 6MV photon beam. Methods: To validate the dosimetric performance of the new device, dose reconstruction based on TD measurements were compared to a conventional pre-treatment verification method (reference) and treatment planning system (TPS) for 18 IMRT and VMAT treatment plans. Furthermore, dose reconstruction inside the patient based on TD read-out was evaluated by comparing various dose volume indices and 3D gamma evaluations against independent dose computation and TPS. To investigate the sensitivity of the new device, different types of systematic and random errors for leaf positions and linac output were introduced in IMRT treatment sequences. Results: The 2D gamma index evaluation of transmission detector based dose reconstruction showed an excellent agreement for all IMRT and VMAT plans compared to reference measurements (99.3±1.2)% and TPS (99.1±0.7)%. Good agreement wasmore » also obtained for 3D dose reconstruction based on TD read-out compared to dose computation (mean gamma value of PTV = 0.27±0.04). Only a minimal dose underestimation within the target volume was observed when analyzing DVH indices (<1%). Positional errors in leaf banks larger than 1mm and errors in linac output larger than 2% could clearly identified with the TD. Conclusion: Since 2D and 3D evaluations for all IMRT and VMAT treatment plans were in excellent agreement with reference measurements and dose computation, the new TD is suitable to qualify for routine treatment plan verification. Funding Support, Disclosures, and Conflict of Interest: COIs: Frank Lohr: Elekta: research grant, travel grants, teaching honoraria IBA: research grant, travel grants, teaching honoraria, advisory board C-Rad: board honoraria, travel grants Frederik Wenz: Elekta: research grant, teaching honoraria, consultant, advisory board Zeiss: research grant, teaching honoraria, patent Hansjoerg Wertz: Elekta: research grant, teaching honoraria IBA: research grant.« less

Authors:
; ; ; ; ; ;  [1]
  1. University Medical Center Mannheim, University of Heidelberg, Mannheim, Baden-Wuerttemberg (Germany)
Publication Date:
OSTI Identifier:
22496315
Resource Type:
Journal Article
Resource Relation:
Journal Name: Medical Physics; Journal Volume: 42; Journal Issue: 6; Other Information: (c) 2015 American Association of Physicists in Medicine; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
61 RADIATION PROTECTION AND DOSIMETRY; 62 RADIOLOGY AND NUCLEAR MEDICINE; CALCULATION METHODS; EDUCATION; ERRORS; LINEAR ACCELERATORS; PHOTON BEAMS; QUALITY ASSURANCE; RADIATION DETECTORS; RADIATION DOSES; RADIOTHERAPY; READOUT SYSTEMS; VERIFICATION

Citation Formats

Thoelking, J, Yuvaraj, S, Jens, F, Lohr, F, Wenz, F, Wertz, H, and Wertz, H. SU-E-T-602: Patient-Specific Online Dose Verification Based On Transmission Detector Measurements. United States: N. p., 2015. Web. doi:10.1118/1.4924965.
Thoelking, J, Yuvaraj, S, Jens, F, Lohr, F, Wenz, F, Wertz, H, & Wertz, H. SU-E-T-602: Patient-Specific Online Dose Verification Based On Transmission Detector Measurements. United States. doi:10.1118/1.4924965.
Thoelking, J, Yuvaraj, S, Jens, F, Lohr, F, Wenz, F, Wertz, H, and Wertz, H. Mon . "SU-E-T-602: Patient-Specific Online Dose Verification Based On Transmission Detector Measurements". United States. doi:10.1118/1.4924965.
@article{osti_22496315,
title = {SU-E-T-602: Patient-Specific Online Dose Verification Based On Transmission Detector Measurements},
author = {Thoelking, J and Yuvaraj, S and Jens, F and Lohr, F and Wenz, F and Wertz, H and Wertz, H},
abstractNote = {Purpose: Intensity modulated radiotherapy requires a comprehensive quality assurance program in general and ideally independent verification of dose delivery. Since conventional 2D detector arrays allow only pre-treatment verification, there is a debate concerning the need of online dose verification. This study presents the clinical performance, including dosimetric plan verification in 2D as well as in 3D and the error detection abilities of a new transmission detector (TD) for online dose verification of 6MV photon beam. Methods: To validate the dosimetric performance of the new device, dose reconstruction based on TD measurements were compared to a conventional pre-treatment verification method (reference) and treatment planning system (TPS) for 18 IMRT and VMAT treatment plans. Furthermore, dose reconstruction inside the patient based on TD read-out was evaluated by comparing various dose volume indices and 3D gamma evaluations against independent dose computation and TPS. To investigate the sensitivity of the new device, different types of systematic and random errors for leaf positions and linac output were introduced in IMRT treatment sequences. Results: The 2D gamma index evaluation of transmission detector based dose reconstruction showed an excellent agreement for all IMRT and VMAT plans compared to reference measurements (99.3±1.2)% and TPS (99.1±0.7)%. Good agreement was also obtained for 3D dose reconstruction based on TD read-out compared to dose computation (mean gamma value of PTV = 0.27±0.04). Only a minimal dose underestimation within the target volume was observed when analyzing DVH indices (<1%). Positional errors in leaf banks larger than 1mm and errors in linac output larger than 2% could clearly identified with the TD. Conclusion: Since 2D and 3D evaluations for all IMRT and VMAT treatment plans were in excellent agreement with reference measurements and dose computation, the new TD is suitable to qualify for routine treatment plan verification. Funding Support, Disclosures, and Conflict of Interest: COIs: Frank Lohr: Elekta: research grant, travel grants, teaching honoraria IBA: research grant, travel grants, teaching honoraria, advisory board C-Rad: board honoraria, travel grants Frederik Wenz: Elekta: research grant, teaching honoraria, consultant, advisory board Zeiss: research grant, teaching honoraria, patent Hansjoerg Wertz: Elekta: research grant, teaching honoraria IBA: research grant.},
doi = {10.1118/1.4924965},
journal = {Medical Physics},
number = 6,
volume = 42,
place = {United States},
year = {Mon Jun 15 00:00:00 EDT 2015},
month = {Mon Jun 15 00:00:00 EDT 2015}
}
  • Purpose: To independently verify the QA dose of proton pencil beam scanning (PBS) plans using an analytic dose calculation model. Methods: An independent proton dose calculation engine is created using the same commissioning measurements as those employed to build our commercially available treatment planning system (TPS). Each proton PBS plan is exported from the TPS in DICOM format and calculated by this independent dose engine in a standard 40 x 40 x 40 cm water tank. This three-dimensional dose grid is then compared with the QA dose calculated by the commercial TPS, using standard Gamma criterion. A total of 18more » measured pristine Bragg peaks, ranging from 100 to 226 MeV, are used in the model. Intermediate proton energies are interpolated. Similarly, optical properties of the spots are measured in air over 15 cm upstream and downstream, and fitted to a second-order polynomial. Multiple Coulomb scattering in water is approximated analytically using Preston and Kohler formula for faster calculation. The effect of range shifters on spot size is modeled with generalized Highland formula. Note that the above formulation approximates multiple Coulomb scattering in water and we therefore chose not use the full Moliere/Hanson form. Results: Initial examination of 3 patient-specific prostate PBS plans shows that agreement exists between 3D dose distributions calculated by the TPS and the independent proton PBS dose calculation engine. Both calculated dose distributions are compared with actual measurements at three different depths per beam and good agreements are again observed. Conclusion: Results here showed that 3D dose distributions calculated by this independent proton PBS dose engine are in good agreement with both TPS calculations and actual measurements. This tool can potentially be used to reduce the amount of different measurement depths required for patient-specific proton PBS QA.« less
  • Purpose: In recent years patient-specific IMRT QA has transitioned from film and chamber measurements to beam-by-beam 2D array measurements. 3DVH takes this transition a step further by estimating the 3D dose distribution delivered using 2D per beam diode array measurements. In this study, the 3D dose distribution generated by 3DVH is compared to film and chamber measurements. In addition, the accuracy ROI volume and error detection is investigated. Methods: Composite film and ion chamber measurements in a solid water phantom were performed for 9 IMRT PINNACLE patient plans for 4 treatment sites. The film and chamber measurements were compared tomore » the dose distribution predicted by 3DVH using MAPCHECK2 per beam measurements. The absolute point dose measurement (CAX) was extracted from the predicted 3DVH and PINNACLE dose distribution and was compared by taking the ratio of measured to predicted doses. The dose distribution measured with film was compared to the distribution in the corresponding plane (AX, SAG, COR) extracted from predicted dose distribution by 3DVH and PINNACLE using a 2D gamma analysis. Gamma analysis was performed with 2% dose, 2 mm DTA, 20% threshold, and global normalization. In addition, the percent difference between 3DVH and PINNACLE ROI volumes was calculated. Results: The average ratio of the measured point dose vs the 3DVH predicted dose was 1.017 (σ=0.011). The average gamma passing rate for measured vs 3DVH dose distributions was 95.1% (σ=2.53%). The average percent difference of 3DVH vs PINNACLE ROI volume was 2.29% (σ=2.5%). Conclusion: The dose distributions predicted by 3DVH using MAPCHECK2 measurements are the same as the distributions that would have been obtained using film and chamber. The ROI volumes used in 3DVH are not an exact match to those in PINNACLE; the effect requires more investigation. The accuracy of error detection by 3DVH is currently being investigated.« less
  • Purpose: Raven QA (JPLC, MD) is a unified and comprehensive quality assurance system for QA of TG-142, which use a phosphor screen, a mirror system and a camera. It is to test if this device can be used for IMRT QA dosimetry. Methods: A lung IMRT case is used deliver dose to Raven QA. Accuracy of dose distribution of 5cm slab phantom using Eclipse planning system (Varian) has been confirmed both from a Monte Carlo Simulation and from a MapCheck (SunNuclear) measurement. Geometric distortion and variation of spatial dose response are corrected after background subtraction. A pin-hole grid plate ismore » designed and used to determine the light scatter in the Raven QA box and the spatial dose response. Optic scatter model was not applied in this preliminary study. Dose is normalized to the response of the 10×10 field and the TMR of 5cm depth was considered. Results: Time to setup the device for IMRT QA takes less than 5 minutes as other commercially available devices. It shows excellent dose linearity and dose rate independent, less than 1 %. Background signal, however, changes for different field sizes. It is believed to be due to inaccurate correction of optic scatter. Absolute gamma (5%, 5mm) passing rate was higher than 95%. Conclusion: This study proves that the Raven QA can be used for a patient specific IMRT verification. Part of this study is supported by the Maryland Industrial Partnership Grant.« less
  • Purpose: Two newly emerging transmission detectors positioned upstream from the patient have been evaluated for online quality assurance of external beam radiotherapy. The prototype for the Integral Quality Monitor (IQM), developed by iRT Systems GmbH (Koblenz, Germany) is a large-area ion chamber mounted on the linac accessory tray to monitor photon fluence, energy, beam shape, and gantry position during treatment. The ion chamber utilizes a thickness gradient which records variable response dependent on beam position. The prototype of Delta4 Discover™, developed by ScandiDos (Uppsala, Sweden) is a linac accessory tray mounted 4040 diode array that measures photon fluence during patientmore » treatment. Both systems are employable for patient specific QA prior to treatment delivery. Methods: Our institution evaluated the reproducibility of measurements using various beam types, including VMAT treatment plans with both the IQM ion chamber and the Delta4 Discover diode array. Additionally, the IQM’s effect on photon fluence, dose response, simulated beam error detection, and the accuracy of the integrated barometer, thermometer, and inclinometer were characterized. The evaluated photon beam errors are based on the annual tolerances specified in AAPM TG-142. Results: Repeated VMAT treatments were measured with 0.16% reproducibility by the IQM and 0.55% reproducibility by the Delta4 Discover. The IQM attenuated 6, 10, and 15 MV photon beams by 5.43±0.02%, 4.60±0.02%, and 4.21±0.03% respectively. Photon beam profiles were affected <1.5% in the non-penumbra regions. The IQM’s ion chamber’s dose response was linear and the thermometer, barometer, and inclinometer agreed with other calibrated devices. The device detected variations in monitor units delivered (1%), field position (3mm), single MLC leaf positions (13mm), and photon energy. Conclusion: We have characterized two new transmissions detector systems designed to provide in-vivo like measurements upstream from the patient. Both systems demonstrate substantial utility for online treatment verification and QA of photon external beam radiotherapy.« less
  • Purpose: The RavenQA system (LAP Laser, Germany) is a QA device with a phosphor screen detector for performing the QA tasks of TG-142. This study tested if it is feasible to use the system for the patient specific QA of the Volumetric Modulated Arc Therapy (VMAT). Methods: Water equivalent material (5cm) is attached to the front of the detector plate of the RavenQA for dosimetry purpose. Then the plate is attached to the gantry to synchronize the movement between the detector and the gantry. Since the detector moves together with gantry, The ’Reset gantry to 0’ function of the Eclipsemore » planning system (Varian, CA) is used to simulate the measurement situation when calculating dose of the detector plate. The same gantry setup is used when delivering the treatment beam for feasibility test purposes. Cumulative dose is acquired for each arc. The optical scatter component of each captured image from the CCD camera is corrected by deconvolving the 2D spatial invariant optical scatter kernel (OSK). We assume that the OSK is a 2D isotropic point spread function with inverse-squared decrease as a function of radius from the center. Results: Three cases of VMAT plans including head & neck, whole pelvis and abdomen-pelvis are tested. Setup time for measurements was less than 5 minutes. Passing rates of absolute gamma were 99.3, 98.2, 95.9 respectively for 3%/3mm criteria and 96.2, 97.1, 86.4 for 2%/2mm criteria. The abdomen-pelvis field has long treatment fields, 37cm, which are longer than the detector plate (25cm). This plan showed relatively lower passing rate than other plans. Conclusion: An algorithm for IMRT/VMAT verification using the RavenQA has been developed and tested. The model of spatially invariant OSK works well for deconvolution purpose. It is proved that the RavenQA can be used for the patient specific verification of VMAT. This work is funded in part by a Maryland Industrial Partnership Program grant to University of Maryland and to JPLC who owns the Raven technology. John Wong is a co-founder of JPLC.« less