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Title: MO-FG-BRA-03: A Novel Method for Characterizing Gating Response Time in Radiation Therapy

Abstract

Purpose: Low temporal latency between a gating ON/OFF signal and the LINAC beam ON/OFF during respiratory gating is critical for patient safety. Current film based methods to assess gating response have poor temporal resolution and are highly qualitative. We describe a novel method to precisely measure gating lag times at high temporal resolutions and use it to characterize the temporal response of several gating systems. Methods: A respiratory gating simulator with an oscillating platform was modified to include a linear potentiometer for position measurement. A photon diode was placed at linear accelerator isocenter for beam output measurement. The output signals of the potentiometer and diode were recorded simultaneously at 2500 Hz (0.4 millisecond (ms) sampling interval) with an analogue-to-digital converter (ADC). The techniques was used on three commercial respiratory gating systems. The ON and OFF of the beam signal were located and compared to the expected gating window for both phase and position based gating and the temporal lag times extracted using a polynomial fit method. Results: A Varian RPM system with a monoscopic IR camera was measured to have mean beam ON and OFF lag times of 98.2 ms and 89.6 ms, respectively. A Varian RPM system with amore » stereoscopic IR camera was measured to have mean beam ON and OFF lag times of 86.0 ms and 44.0 ms, respectively. A Calypso magnetic fiducial tracking system was measured to have mean beam ON and OFF lag times of 209.0 ms and 60.0 ms, respectively. Conclusions: A novel method allowed for quantitative determination of gating timing accuracy for several clinically used gating systems. All gating systems met the 100 ms TG-142 criteria for mean beam OFF times. For beam ON response, the Calypso system exceeded the recommended response time.« less

Authors:
; ; ;  [1];  [2];  [1];  [3]
  1. The University of Chicago, Chicago, IL (United States)
  2. University Illinois at Chicago, Orland Park, IL (United States)
  3. (United States)
Publication Date:
OSTI Identifier:
22653866
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; LINEAR ACCELERATORS; RADIOTHERAPY; SIGNALS

Citation Formats

Wiersma, R, McCabe, B, Belcher, A, Jenson, P, Smith, B, Aydogan, B, and University Illinois at Chicago, Orland Park, IL. MO-FG-BRA-03: A Novel Method for Characterizing Gating Response Time in Radiation Therapy. United States: N. p., 2016. Web. doi:10.1118/1.4957296.
Wiersma, R, McCabe, B, Belcher, A, Jenson, P, Smith, B, Aydogan, B, & University Illinois at Chicago, Orland Park, IL. MO-FG-BRA-03: A Novel Method for Characterizing Gating Response Time in Radiation Therapy. United States. doi:10.1118/1.4957296.
Wiersma, R, McCabe, B, Belcher, A, Jenson, P, Smith, B, Aydogan, B, and University Illinois at Chicago, Orland Park, IL. Wed . "MO-FG-BRA-03: A Novel Method for Characterizing Gating Response Time in Radiation Therapy". United States. doi:10.1118/1.4957296.
@article{osti_22653866,
title = {MO-FG-BRA-03: A Novel Method for Characterizing Gating Response Time in Radiation Therapy},
author = {Wiersma, R and McCabe, B and Belcher, A and Jenson, P and Smith, B and Aydogan, B and University Illinois at Chicago, Orland Park, IL},
abstractNote = {Purpose: Low temporal latency between a gating ON/OFF signal and the LINAC beam ON/OFF during respiratory gating is critical for patient safety. Current film based methods to assess gating response have poor temporal resolution and are highly qualitative. We describe a novel method to precisely measure gating lag times at high temporal resolutions and use it to characterize the temporal response of several gating systems. Methods: A respiratory gating simulator with an oscillating platform was modified to include a linear potentiometer for position measurement. A photon diode was placed at linear accelerator isocenter for beam output measurement. The output signals of the potentiometer and diode were recorded simultaneously at 2500 Hz (0.4 millisecond (ms) sampling interval) with an analogue-to-digital converter (ADC). The techniques was used on three commercial respiratory gating systems. The ON and OFF of the beam signal were located and compared to the expected gating window for both phase and position based gating and the temporal lag times extracted using a polynomial fit method. Results: A Varian RPM system with a monoscopic IR camera was measured to have mean beam ON and OFF lag times of 98.2 ms and 89.6 ms, respectively. A Varian RPM system with a stereoscopic IR camera was measured to have mean beam ON and OFF lag times of 86.0 ms and 44.0 ms, respectively. A Calypso magnetic fiducial tracking system was measured to have mean beam ON and OFF lag times of 209.0 ms and 60.0 ms, respectively. Conclusions: A novel method allowed for quantitative determination of gating timing accuracy for several clinically used gating systems. All gating systems met the 100 ms TG-142 criteria for mean beam OFF times. For beam ON response, the Calypso system exceeded the recommended response time.},
doi = {10.1118/1.4957296},
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: to evaluate the dosimetric and radiobiological consequences from having different gating windows, dose rates, and breathing patterns in gated VMAT lung radiotherapy. Methods: A novel 3D-printed moving phantom with central high and peripheral low tracer uptake regions was 4D FDG-PET/CT-scanned using ideal, patient-specific regular, and irregular breathing patterns. A scan of the stationary phantom was obtained as a reference. Target volumes corresponding to different uptake regions were delineated. Simultaneous integrated boost (SIB) 6 MV VMAT plans were produced for conventional and hypofractionated radiotherapy, using 30–70 and 100% cycle gating scenarios. Prescribed doses were 200 cGy with SIB to 240more » cGy to high uptake volume for conventional, and 800 with SIB to 900 cGy for hypofractionated plans. Dose rates of 600 MU/min (conventional and hypofractionated) and flattening filter free 1400 MU/min (hypofractionated) were used. Ion chamber measurements were performed to verify delivered doses. Vials with A549 cells placed in locations matching ion chamber measurements were irradiated using the same plans to measure clonogenic survival. Differences in survival for the different doses, dose rates, gating windows, and breathing patterns were analyzed. Results: Ion chamber measurements agreed within 3% of the planned dose, for all locations, breathing patterns and gating windows. Cell survival depended on dose alone, and not on gating window, breathing pattern, MU rate, or delivery time. The surviving fraction varied from approximately 40% at 2Gy to 1% for 9 Gy and was within statistical uncertainty relative to that observed for the stationary phantom. Conclusions: Use of gated VMAT in PET-driven SIB radiotherapy was validated using ion chamber measurements and cell survival assays for conventional and hypofractionated radiotherapy.« less
  • Purpose: Conventional treatment plans for lung radiotherapy are created using either the free breathing (FB) scheme which represents the tumor at an arbitrary breathing phase of the patient’s respiratory cycle, or the average computed tomography (ACT) intensity projection over 10-binned phases. Neither method is entirely accurate because of the absence of time dependence of tumor movement. In the present “Hybrid” method, the HU of tumor in 3D space is determined by relative weighting of the HU of the tumor and lung in proportion to the time they spend at that location during the entire breathing cycle. Methods: A Quasar respiratorymore » motion phantom was employed to simulate lung tumor movement. Utilizing 4DCT image scans, volumetric modulated arc therapy (VMAT) plans were generated for three treatment planning scenarios which included conventional FB and ACT schemes, along with a third alternative Hybrid approach. Our internal target volume (ITV) hybrid structure was created using Boolean operation in Eclipse (ver. 11) treatment planning system, where independent sub-regions created by the gross tumor volume (GTV) overlap from the 10 motion phases were each assigned a time weighted CT value. The dose-volume-histograms (DVH) for each scheme were compared and analyzed. Results: Using our hybrid technique, we have demonstrated a reduction of 1.9% – 3.4% in total monitor units with respect to conventional treatment planning strategies, along with a 6 fold improvement in high dose spillage over the FB plan. The higher density ACT and Hybrid schemes also produced a slight enhancement in target conformity and reduction in low dose spillage. Conclusion: All treatment plans created in this study exceeded RTOG protocol criteria. Our results determine the free breathing approach yields an inaccurate account of the target treatment density. A significant decrease in unnecessary lung irradiation can be achieved by implementing Hybrid HU method with ACT method second best.« less
  • Purpose: AGuIX are gadolinium-based nanoparticles, initially developed for MRI, that have a potential role in radiation therapy as a radiosensitizer. Our goal is to demonstrate that these nanoparticles can both be used as an MRI contrast agent, as well as to obtain local dose enhancement in a pancreatic tumor when delivered in combination with an external beam irradiation. Methods: We performed in vitro cell uptake and radiosensitization studies of a pancreatic cancer cell line in a low energy (220kVp) beam, a standard clinical 6MV beam (STD) and a flattening filter free clinical 6MV beam (FFF). After injection of 40mM ofmore » nanoparticles, a biodistribution study was performed in vivo on mice with subcutaneous xenograft pancreatic tumors. In vivo radiation therapy studies were performed at the time point of maximum tumor uptake. Results: The concentration of AGuIX nanoparticles in Panc-1 pancreatic cancer cells, determined in vitro by MRI and ICPMS, peaks after 30 minutes with 0.3% of the initial concentration (5mg/g). Clonogenic assays show a significant effect (p<0.05) when the AGuIX are coupled with MV photon irradiation (DEF20%=1.31). Similar AGuIX tumor uptake is found in vivo by both MRI and ICPMS 30 minutes after intravenous injection. For long term survival studies, the choice of the radiation dose is determined with 5 control groups (3mice/group) irradiated with 0, 5, 10, 15, and 20Gy. Afterwards, 4 groups (8mice/group) are used to evaluate the effect of the nanoparticles. A Logrank test is performed as a statistical test to evaluate the effect of the nanoparticles. Conclusion: The combination of the MRI contrast and radiosensitization properties of gadolinium nanoparticles reveals a strong potential for usage with MRI-guided radiation therapy.« less
  • Purpose: High Dose Rate (HDR) brachytherapy treatments are employed worldwide to treat a wide variety of cancers. However, in vivo dose verification remains a challenge with no commercial dosimetry system available to verify the treatment dose delivered to the patient. We propose a novel dosimetry system that couples an independent Monte Carlo (MC) simulation platform and an amorphous silicon Electronic Portal Imaging Device (EPID) to provide real time treatment verification. Methods: MC calculations predict the EPID response to the photon fluence emitted by the HDR source by simulating the patient, the source dwell positions and times, and treatment complexities suchmore » as tissue compositions/densities and different applicators. Simulated results are then compared against EPID measurements acquired with ∼0.14s time resolution which allows dose measurements for each dwell position. The EPID has been calibrated using an Ir-192 HDR source and experiments were performed using different phantoms, including tissue equivalent materials (PMMA, lung and bone). A source positioning accuracy of 0.2 mm, without including the afterloader uncertainty, was ensured using a robotic arm moving the source. Results: An EPID can acquire 3D Cartesian source positions and its response varies significantly due to differences in the material composition/density of the irradiated object, allowing detection of changes in patient geometry. The panel time resolution allows dose rate and dwell time measurements. Moreover, predicted EPID images obtained from clinical treatment plans provide anatomical information that can be related to the patient anatomy, mostly bone and air cavities, localizing the source inside of the patient using its anatomy as reference. Conclusion: Results obtained show the feasibility of the proposed dose verification system that is capable to verify all the brachytherapy treatment steps in real time providing data about treatment delivery quality and also applicator/structure motion during or between treatments.« less
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