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Title: SU-F-T-279: Impact of Beam Energy Drifts On IMRT Delivery Accuracy

Abstract

Purpose: According to TG-40 percent-depth-dose (PDD) tolerance is ±2% but TG-142 is ±1%. Now the question is, which one is relevant in IMRT era? The primary objective of this study is to evaluate dosimetric impact of beam-energy-drifts on IMRT-delivery. Methods: Beam-energy drifts were simulated by adjusting Linac’s bending-magnet-current (BMC) followed by tuning the pulse-forming network and adjusting gun-current. PDD change of −0.6% and +1.2% were tested. Planar-dosimetry measurements were performed using an ionization-chamber-array in solid-water phantoms. Study includes 10-head-and-neck and 3-breast cancer patients. en-face beam-deliveries were also tested at 1.3cm and 5.3cm depths. Composite and single-field dose-distributions were compared against the plans to determine %Gamma pass-rates (%GPRs). For plan dose comparisons, changes in %Gamma pass-rates (cPGPRs) were computed/reported to exclude the differences between dose-computation and delivery. Dose distributions of the drifted-energies were compared against their baseline measurements to determine the% GPRs. A Gamma criteria of 3%/3mm was considered for plan-dose comparisons while 3%/1mm used for measured dose intercomparisons. Results: For composite-dose delivery, average cPGPRs were 0.41%±2.48% and −2.54%±3.65% for low-energy (LE) and high-energy (HE) drifts, respectively. For measured dose inter-comparisons, the average%GPRs were 98.4%±2.2% (LE-drift) and 95.8%±4.0 (HE-drift). The average %GPR of 92.6%±4.3% was noted for the worst-case scenario comparingmore » LE-drift to HE-drift. All en-face beams at 5.3 cm depth have cPGPRs within ±4% of the baseline-energy measurements. However, greater variations were noted for 1.3cm depth. Average %GPRs for drifted energies were >99% at 5.3cm and >97% at 1.3cm depths. However, for the worst-case scenario (LE-drift to HE-drift) these numbers dropped to 95.2% at 5.3cm and 93.1% at 1.3cm depths. Conclusion: The dosimetric impact of beam-energy drifts was found to be within clinically acceptable tolerance. However, this study includes a single energy with limited range of PDD change. Further studies are on going and the results will be presented. Received funding from Varian Medical Systems, Palo Alto, CA.« less

Authors:
 [1]; ; ; ;  [2];  [3];  [4];  [5];  [6]
  1. Washington University, St. Louis, MO (United States)
  2. Washington University School of Medicine, St. Louis, MO (United States)
  3. Washington University in St. Louis, St. Louis, MO (United States)
  4. Baylor Scot & White, Temple, TX (United States)
  5. Baylor Scott & White Health, Temple, TX (United States)
  6. Washington University School of Medicine, Saint Louis, MO (United States)
Publication Date:
OSTI Identifier:
22648892
Resource Type:
Journal Article
Resource Relation:
Journal Name: Medical Physics; Journal Volume: 43; Journal Issue: 6; Other Information: (c) 2016 American Association of Physicists in Medicine; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
60 APPLIED LIFE SCIENCES; 61 RADIATION PROTECTION AND DOSIMETRY; BEAMS; CALCULATION METHODS; DELIVERY; RADIATION DOSES; RADIOTHERAPY

Citation Formats

Goddu, S, Kamal, G, Herman, A, Edwards, S, Cai, B, Yaddanapudi, S, Oddiraju, S, Rangaraj, D, and Mutic, S. SU-F-T-279: Impact of Beam Energy Drifts On IMRT Delivery Accuracy. United States: N. p., 2016. Web. doi:10.1118/1.4956419.
Goddu, S, Kamal, G, Herman, A, Edwards, S, Cai, B, Yaddanapudi, S, Oddiraju, S, Rangaraj, D, & Mutic, S. SU-F-T-279: Impact of Beam Energy Drifts On IMRT Delivery Accuracy. United States. doi:10.1118/1.4956419.
Goddu, S, Kamal, G, Herman, A, Edwards, S, Cai, B, Yaddanapudi, S, Oddiraju, S, Rangaraj, D, and Mutic, S. Wed . "SU-F-T-279: Impact of Beam Energy Drifts On IMRT Delivery Accuracy". United States. doi:10.1118/1.4956419.
@article{osti_22648892,
title = {SU-F-T-279: Impact of Beam Energy Drifts On IMRT Delivery Accuracy},
author = {Goddu, S and Kamal, G and Herman, A and Edwards, S and Cai, B and Yaddanapudi, S and Oddiraju, S and Rangaraj, D and Mutic, S},
abstractNote = {Purpose: According to TG-40 percent-depth-dose (PDD) tolerance is ±2% but TG-142 is ±1%. Now the question is, which one is relevant in IMRT era? The primary objective of this study is to evaluate dosimetric impact of beam-energy-drifts on IMRT-delivery. Methods: Beam-energy drifts were simulated by adjusting Linac’s bending-magnet-current (BMC) followed by tuning the pulse-forming network and adjusting gun-current. PDD change of −0.6% and +1.2% were tested. Planar-dosimetry measurements were performed using an ionization-chamber-array in solid-water phantoms. Study includes 10-head-and-neck and 3-breast cancer patients. en-face beam-deliveries were also tested at 1.3cm and 5.3cm depths. Composite and single-field dose-distributions were compared against the plans to determine %Gamma pass-rates (%GPRs). For plan dose comparisons, changes in %Gamma pass-rates (cPGPRs) were computed/reported to exclude the differences between dose-computation and delivery. Dose distributions of the drifted-energies were compared against their baseline measurements to determine the% GPRs. A Gamma criteria of 3%/3mm was considered for plan-dose comparisons while 3%/1mm used for measured dose intercomparisons. Results: For composite-dose delivery, average cPGPRs were 0.41%±2.48% and −2.54%±3.65% for low-energy (LE) and high-energy (HE) drifts, respectively. For measured dose inter-comparisons, the average%GPRs were 98.4%±2.2% (LE-drift) and 95.8%±4.0 (HE-drift). The average %GPR of 92.6%±4.3% was noted for the worst-case scenario comparing LE-drift to HE-drift. All en-face beams at 5.3 cm depth have cPGPRs within ±4% of the baseline-energy measurements. However, greater variations were noted for 1.3cm depth. Average %GPRs for drifted energies were >99% at 5.3cm and >97% at 1.3cm depths. However, for the worst-case scenario (LE-drift to HE-drift) these numbers dropped to 95.2% at 5.3cm and 93.1% at 1.3cm depths. Conclusion: The dosimetric impact of beam-energy drifts was found to be within clinically acceptable tolerance. However, this study includes a single energy with limited range of PDD change. Further studies are on going and the results will be presented. Received funding from Varian Medical Systems, Palo Alto, CA.},
doi = {10.1118/1.4956419},
journal = {Medical Physics},
number = 6,
volume = 43,
place = {United States},
year = {Wed Jun 15 00:00:00 EDT 2016},
month = {Wed Jun 15 00:00:00 EDT 2016}
}
  • Purpose: In this study, we evaluated the performance of an Elekta linac in the delivery of gated radiotherapy. We examined whether the use of either a short gating window or a long beam hold impacts the accuracy of the delivery Methods: The performance of an Elekta linac in the delivery of gated radiotherapy was assessed using a 20cmX 20cm open field with the radiation delivered using a range of beam-on and beam-off time periods. Two SBRT plans were used to examine the accuracy of gated beam delivery for clinical treatment plans. For the SBRT cases, tests were performed for bothmore » free-breathing based gating and for gated delivery with a simulated breath-hold. A MatriXX 2D ion chamber array was used for data collection, and the gating accuracy was evaluated using gamma score. Results: For the 20cmX20cm open field, the gated beam delivery agreed closely with the non-gated delivery results. Discrepancies in the agreement, however, began to appear with a 5-to-1 ratio of the beam-off to beam-on. For these tight gating windows, each beam-on segment delivered a small number of monitor units. This finding was confirmed with dose distribution analysis from the delivery of the two VMAT plans where the gamma score(±1%,2%/1mm) showed passing rates in the range of 95% to 100% for gating windows of 25%, 38%, 50%, 63%, 75%, and 83%. Using a simulated sinusoidal breathing signal with a 4 second period, the gamma score of freebreathing gating and breath-hold gating deliveries were measured in the range of 95.7% to 100%. Conclusion: The results demonstrate that Elekta linacs can be used to accurately deliver respiratory gated treatments for both free-breathing and breath-hold patients. The accuracy of beams delivered in a gated delivery mode at low small MU proved higher than similar deliveries performed in a non-gated (manually interrupted) fashion.« less
  • Purpose: To estimate the dose distributions delivered to the patient in each treatment fraction using deformable image registration (DIR) and assess the radiobiological impact of the inter-fraction variations due to patient deformation and setup. Methods: The work is based on the cone beam CT (CBCT) images and treatment plans of two lung cancer patients. Both patients were treated with intensity modulated radiation therapy (IMRT) to 66Gy in 2Gy/fraction. The treatment plans were exported from the treatment planning system (TPS) to the Velocity AI where DIR was performed and the same deformation matrix was used for the deformation of the plannedmore » dose distribution and organ contours to each CBCT dataset. A radiobiological analysis was performed based on the radiobiological parameters of the involved organs at risk (OARs) and planning target volume (PTV). Using the complication free tumor control probability (P+) index, differences in P+ were observed between each CBCT as well as between CBCT and planning dose distributions. Results: The optimal CBCT P? values ranged from 91.6 % to 94.8 % for patient #1 and from 88.8 % to 90.6 % for patient #2. At the dose level of the clinical prescription, the CBCT P+ values ranged from 80.3% to 80.7% for patient #1 and from 80.7% to 81.0% for the patient #2. The planning CT P+ values were 81.0% and 80.7% for the two patients, respectively. These differences emphasize the significance of using the radiobiological analysis when assessing changes in the dose distribution due to the tumor motion and lung deformations. Conclusion: Daily setup variations yield to differences in the actual dose delivered versus the planned one. The observed differences were rather small when only looking at the dosimetric comparison of the dose distributions, however the radiobiology analysis was able to detect clinically relevant differences among the studied dose distributions.« less
  • Purpose: A method is established to improve the accuracy of the IMRT dose delivery for the treatment of breast and chest wall tumors when the higher dose gradient is delivered at the end of the leaf sequence. Methods: Dynamic MLC deliveries on Varian Linacs are achieved through the motion of the leaves from X1 to X2 direction. If the higher dose gradient is at the end of the leaf motion sequence, this can Result in an increased error in the overall dose delivery. Such errors have been observed in Lateral beams for Left-sided and Medial beams for Right-sided treatments. Tomore » evaluate and resolve this issue we adopted an approach where the fluence for such beams was geometrically flipped (mirrored) to treat the higher end of the dose gradient first. Results: Using this method, it was possible to deliver the optimized dose map to the area of interest still using only the X1–X2 direction of the leaf motion. The accuracy of this method was tested on different beam as part of our pre-treatment QA program on both Varian delivery systems. With this approach we found that there was significant improvement in delivery accuracy on both 21EX and TrueBeam systems. Beams of initial Gamma index (3% and 3mm) 89–93% were increased to 98–99%. We also observed superior delivery accuracy with TB compared to the 21EX Conclusion: This work demonstrate the need for a delivery sequence option from X2–X1 in situations where the MLC sequence indicates higher dose gradient component is being delivered at the end of the sequence. Results from this work can be considered in the IMRT beam optimization in the treatment planning systems. Further work will be required to establish the application of this approach in clinical setting.« less
  • Purpose: To assess if the TrueBeam HD120 collimator is delivering small IMRT fields accurately and consistently throughout the course of treatment using the SunNuclear PerFraction software. Methods: 7-field IMRT plans for 8 canine patients who passed IMRT QA using SunNuclear Mapcheck DQA were selected for this study. The animals were setup using CBCT image guidance. The EPID fluence maps were captured for each treatment field and each treatment fraction, with the first fraction EPID data serving as the baseline for comparison. The Sun Nuclear PerFraction Software was used to compare the EPID data for subsequent fractions using a Gamma (3%/3mm)more » pass rate of 90%. To simulate requirements for SRS, the data was reanalyzed using a Gamma (3%/1mm) pass rate of 90%. Low-dose, low- and high gradient thresholds were used to focus the analysis on clinically relevant parts of the dose distribution. Results: Not all fractions could be analyzed, because during some of the treatment courses the DICOM tags in the EPID images intermittently change from CU to US (unspecified), which would indicate a temporary loss of EPID calibration. This technical issue is still being investigated. For the remaining fractions, the vast majority (7/8 of patients, 95% of fractions, and 96.6% of fields) are passing the less stringent Gamma criteria. The more stringent Gamma criteria caused a drop in pass rate (90 % of fractions, 84% of fields). For the patient with the lowest pass rate, wet towel bolus was used. Another patient with low pass rates experienced masseter muscle wasting. Conclusion: EPID dosimetry using the PerFraction software demonstrated that the majority of fields passed a Gamma (3%/3mm) for IMRT treatments delivered with a TrueBeam HD120 MLC. Pass rates dropped for a DTA of 1mm to model SRS tolerances. PerFraction pass rates can flag missing bolus or internal shields. Sanjeev Saini is an employee of Sun Nuclear Corporation. For this study, a pre-release version of PerFRACTION 1.1 software from Sun Nuclear Corporation was used.« less
  • Purpose: To identify the robustness of different treatment techniques in respect to simulated linac errors on the dose distribution to the target volume and organs at risk for step and shoot IMRT (ssIMRT), VMAT and Autoplan generated VMAT nasopharynx plans. Methods: A nasopharynx patient dataset was retrospectively replanned with three different techniques: 7 beam ssIMRT, one arc manual generated VMAT and one arc automatically generated VMAT. Treatment simulated uncertainties: gantry, collimator, MLC field size and MLC shifts, were introduced into these plans at increments of 5,2,1,−1,−2 and −5 (degrees or mm) and recalculated in Pinnacle. The mean and maximum dosesmore » were calculated for the high dose PTV, parotids, brainstem, and spinal cord and then compared to the original baseline plan. Results: Simulated gantry angle errors have <1% effect on the PTV, ssIMRT is most sensitive. The small collimator errors (±1 and ±2 degrees) impacted the mean PTV dose by <2% for all techniques, however for the ±5 degree errors mean target varied by up to 7% for the Autoplan VMAT and 10% for the max dose to the spinal cord and brain stem, seen in all techniques. The simulated MLC shifts introduced the largest errors for the Autoplan VMAT, with the larger MLC modulation presumably being the cause. The most critical error observed, was the MLC field size error, where even small errors of 1 mm, caused significant changes to both the PTV and the OAR. The ssIMRT is the least sensitive and the Autoplan the most sensitive, with target errors of up to 20% over and under dosages observed. Conclusion: For a nasopharynx patient the plan robustness observed is highest for the ssIMRT plan and lowest for the Autoplan generated VMAT plan. This could be caused by the more complex MLC modulation seen for the VMAT plans. This project is supported by a grant from NSW Cancer Council.« less