Radiation dosimetry

Dose uniformity in the Planning Target Volume (PTV) can induce a higher-than-expected dose distribution in the nearby critical organs. The goal of this study is to evaluate the influence of the Planning Target volume dose uniformity on the surrounding critical organs (OAR).
Ten cases of anonymized patients’ data were selected for our study including: Breast cancer, Brain cancer, Head and Neck cancer, Lung and Prostate calculations of Conformity indices, Biological Effective Doses (BED), Tumor Control Probability (TCP) and Normal Tissue Complication Probability (NTCP) were used to calculate the dose distribution in PTV as well as the dose delivered to the surrounding critical organs of each PTV. We assume that the tumors PTVs have homogeneous density as well as the surrounding normal tissue.
Conformity indices (CI) for Breast (PTV) are between 1.8 – 1.9, for Brain (PTV) are between 1.6 – 2.0, for Lungs are 1.5 – 1.6, for Prostate are between 0.4 – 0.5, for Head and Neck are 0.3 – 0.4. Dose uniformity in all the PTVs is 1.089 which is a good indication of the quality of treatment delivered to the tumor. TCP is averaging of value of 87.94 and NTCP is 3.4445.

The Monaco treatment planning system offers three different dose calculation algorithms for use in calculating 3D treatment plans. These include Monte Carlo (MC), Collapsed Cone (CC) and the pencil beam algorithms. The aim of this study is an in-depth analysis of Monte Carlo and Collapsed Cone dose calculation methods to find the optimal parameters for clinical use for both algorithms.
An end-to-end phantom with inhomogeneities was scanned and the DICOM images were imported into Monaco for contouring and planning. Treatment plans were then created in Monaco for both MC and CC using different permutations of variables for approximately 400 plans. These variables include CT Slice thickness, grid size, statistical uncertainty, and beam energy. Following planning the end-to-end phantom was then irradiated on an Elekta Linac and plans for each beam energy were created. Clinical beam data was then compared to the computed plans for each dose calculation method.

Dosimetric uncertainty in very small (< 2 x 2 cm2) photon fields is notably higher that has created research questions when using small-field virtual cone with variable multileaf collimator (MLC) fields. We evaluate the efficacy of the virtual cone with a fixed MLC field for stereotactic radiosurgery (SRS) of small targets such as trigeminal neuralgia.
We employed a virtual cone technique with a fixed field geometry, called fixed virtual cone (fVC), for small target radiosurgery using the EDGE (Varian Medical Systems, Palo Alto, CA) linac. The fVC is characterized by 0.5 cm x 0.5 cm high-definition MLC field of 10 MV flattening filter-free (FFF) beam defined at 100 cm SAD, while jaws are positioned at 1.5 cm x 1.5 cm. A spherical dose distribution equivalent to 5 mm cone was generated by using 10–14 non-coplanar partial arcs. The dosimetric accuracy of this technique was validated using the SRS MapCHECK (Sun Nuclear Corporation, FL) and the EBT3 (Ashland Inc., NJ) film based on absolute dose measurements. For the quality assurance (QA), 10 treatment plans for trigeminal neuralgia consisting of various arc fields at different collimator angles were analyzed retrospectively using 6 MV and 10 MV FFF beams, including the field-by-field study (n = 130 fields). Dose outputs were compared between the SRS MapCHECK measurements and Eclipse treatment planning system (TPS) with Acuros XB algorithm (version 16.1). In addition, important clinical parameters of 15 cases treated for trigeminal neuralgia were evaluated for the clinical performance. Moreover, dosimetric (field output factors, dose/MU) uncertainties considering a minute (± 0.5–1.0 mm) leaf shift in the field defining fVC, were examined from the TPS, SRS diode (PTW 60018) measurements, and Monte Carlo (MC) simulations.

In this work, we have developed a robust daily quality assurance (QA) system for pencil-beam scanning (PBS) dosimetry. A novel phantom and multi-PTV PBS plan were used in conjunction with the Sun Nuclear Daily QA3 multichamber detector array to verify output, range, and spot position. The sensitivity to detect change in these parameters with our designed tests was determined empirically. Associated tolerance levels were established based on these sensitivities and guidelines published in recent American Association of Physics in Medicine (AAPM) task group reports. The output has remained within the 3% tolerance and the range was within ±1mm. Spot position has remained within ±2mm. This daily QA procedure is quick and efficient with the time required for setup and delivery at less than 10 minutes.

Physical cones equipped on GammaKnife, Cyberknife, and C-arm linacs have been the standard practice in Stereotactic Ablative Radiotherapy (SART) for small intracranial lesions, such as treating trigeminal or glossopharyngeal neuralgia targets. The advancement of high-definition multi-leaf collimators (HDMLC), treatment planning systems, and small field dosimetry now allows for treatment without the need for an auxiliary mounted physical cone. This treatment type uses the “virtual cone”, a permanent high-definition MLC, arrangement to deliver “very small fields” with comparable spherical dose distributions to physical cones. The virtual cone therapy, on a Varian Edge™ linac using multiple non-coplanar arcs with static HDMLCs, is a comparable technique that can be used to treat small intracranial neuralgia or other small lesions.
In this investigation, two flattening filter free (FFF) photon beams, 6MV FFF and 10MV FFF, were tested for optimal delivery and safety conditions for treating intracranial lesions. The virtual cone method on a Varian Edge™ Linear accelerator using rapid arc stereotactic radiosurgery was used to treat cranial neuralgia for chronic pain for six patients. Absolute dose, relative dose measurements, and monitor units were the main characteristics that were examined to decide which energy was the best for treatment. Source-to-axis distances (SAD) of 100cm measurements were taken at depths of 10cm and 5cm, respectively.

Due to the difficulty of a complex commissioning technique for a multi energetic, multi-modality linear accelerator, I perform all the commissioning and acceptance testing for a TrueBeam linear accelerator with 4 megavoltage (MV) energies of which 2 are flattening filter-free (FFF) and 6 electron energies varying from 6 MeV to 20 MeV.
A 2 dimensional (2D) water tank was used for scanning all the required field sizes for all the energies. The one dimensional (1D) water tank was used to collect all the output factors for all the photon fields sizes small to medium electron field sizes. For the large electron fields sizes, we had to use the 2D water tank. All the collected data was converted into a file type accepted by the planning system (Eclipse) and subsequently imported there. Treatment plans were generated using multiple forms of planning to verify the viability and quality of the beam data commissioned.

Since the release of the Cyberknife Multileaf Collimator (CK-MLC), it has been a constant
concern on the realistic dose differences computed with its early-available Finite Size
Pencil Beam algorithm (FSPB) from those computed by using industry well-accepted
algorithms such as the Monte Carlo (MC) dose algorithm. In this study dose disparities
between FSPB and MC dose calculation algorithms for selected CK-MLC treatment plans
were quantified. The dosimetry for planning target volume (PTV) and major organs at risks
(OAR) was compared by calculating normalized percentage deviations (Ndev) between the
two algorithms. It is found that the FSPB algorithm overestimates D95 of PTV when
compared with the MC algorithm by averaging 24.0% in detached lung cases, and 15.0%
in non-detached lung cases which is attributed to the absence of heterogeneity correction
in the FSPB algorithm. Average dose differences are 0.3% in intracranial and 0.9% in
pancreas cases. Ndev for the D95 of PTV range from 8.8% to 14.1% for the CK-MLC lung
treatment plans with small field (SF ≤ 2x2cm2). Ndev is ranged from 0.5-7.0% for OARs.

MapCheck measurements for 50 retrospective patient’s treatment plans suggested that MapCheck could be effectively employed in routine patient specific quality assurance in M6 Cyberknife with beams delivered at different treatment angles. However, these measurements also suggested that for highly intensity modulated MLC plans, field segments of width < 8 mm should further be analyzed with a modified (-4%) correction factor. Results of MC simulations of the M6 Cyberknife using the EGSnrc program for 2-5 millions of incident particles in BEAMnrc and 10-20 millions in DOSXYZnrc have shown dose uncertainties within 2% for open fields from 7.6 x 7.7 mm2 to 100 x 100 mm2. Energy and corresponding FWHM were optimized by comparing with water phantom measurements at 800 mm SAD resulting to E = 7 MeV and FWHM = 2.2 mm. Good agreement of dose profiles (within 2%) and outputs (within 3%) were found between the MC simulations and water phantom measurements for the open fields.

Stereotactic Body Radiation Therapy (SBRT) is a modern precision radiation therapy to deliver the dose in 1 to 5 fractions with high target dose conformity, and steep dose gradient towards healthy tissues. The dose delivered is influenced by the leaf width of the MLC, especially in case of SBRT. Treatment plans with high definition (HD) MLC having leaf-width 2.5 mm and normal MLC having leaf-width 5 mm, were compared to quantify dosimetric and radiobiological parameters. Dosimetric parameters conformity indices (CI), gradient indices (GI) and heterogeneity indices (HI) were compared. The radiobiological parameters were evaluated by normal tissue complication probability (NTCP) and tumor control probability (TCP) based on the equivalent uniform dose (EUD). The results show that there is dosimetric and radiobiological merit of the HD MLC over the normal MLC. However, the improvement is not consistent with all the plans and thus further research is required prior to conclusion.

Patients receiving Intensity Modulated Radiation Therapy (IMRT) for late stage head and neck (HN) cancer often experience anatomical changes due to weight loss, tumor regression, and positional changes of normal anatomy (1). As a result, the actual dose delivered may vary from the original treatment plan. The purpose of this study was (a) to evaluate the dosimetric consequences of the parotid glands during the course of treatment, and (b) to determine if there would be an optimal timeframe for replanning. Nineteen locally advanced HN cancer patients underwent definitive IMRT. Each patient received an initial computerized tomography simulation (CT-SIM) scan and weekly cone beam computerized tomography (CBCT) scans. A Deformable Image Registration (DIR) was performed between the CT-SIM and CBCT of the parotid glands and Planning Target Volumes (PTVs) using the Eclipse treatment planning system (TPS) and the Velocity deformation software. A recalculation of the dose was performed on the weekly CBCTs using the original monitor units. The parameters for evaluation of our method were: the changes in volume of the PTVs and parotid glands, the dose coverage of the PTVs, the lateral displacement in the Center of Mass (COM), the mean dose, and Normal Tissue Complication Probability (NTCP) of the parotid glands. The studies showed a reduction of the volume in the PTVs and parotids, a medial displacement in COM, and alterations of the mean dose to the parotid glands as compared to the initial plans. Differences were observed for the dose volume coverage of the PTVs and NTCP of the parotid gland values between the initial plan and our proposed method utilizing deformable registration-based dose calculations.