Shang, Charles

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 proton therapy systems with pencil-beam scanning, output of Halo effect is not necessarily included in Treatment Planning System (TPS). Halo effect (low-intensity tail) can significantly affect a patient’s dose distribution. The output of this dose depends on the field size being irradiated. Although much research has been made to investigate such relation to the field size, the number of reports on dose calculations including the halo effect is small. In this work we have investigated the Halo effect, including field size factor, target depth factor, and air gaps with a range shifter for a Varian ProBeam.
Dose calculations created on the Eclipse Treatment Planning System (vs15.6 TPS) are compared with plane-parallel ionization chambers (PTW Octavius 1500) measurements using PCS and AcurosPT MC model in different isocenters: 5cm, 10cm, and 20cm. We find that in AcurosPT algorithm deviations range between -7.53% (for 2cm field in 25cm air gap with range shifter) up to +7.40% (for 20cm field in 15cm air gap with range shifter). Whereas, in PCS algorithm the deviations are -2.07% (for 20x20cm field in open conditions) to -6.29% (for 20x20cm field in 25cm air gap with range shifter).

A clinical commissioning of the first 360 rotational compact Varian ProBeam scanning proton pencil beam (Varian Medical, Palo Alto, CA) system was conducted at the South Florida Proton Therapy Institute (SFPTI). The beam dosimetry and characterizations were the vital section used to verify the consistency of the treatment planning system (TPS) outputs. The integrated depth dose curves were acquired with AP CAX in water phantom utilizing a large PTW Bragg peak chamber; the dose output factors measurements were performed by using IBA PCC05 chamber at 1.5 cm water depth applying a single layer 10×10 cm2 beams and 1.1 RBE offset as recommended in TRS 398 report. Widths of the Bragg peaks ranges (Rb80-Ra80) were from 4.07 cm to 30.51 cm for the energy range 70 MeV to 220 MeV. Beam optics such as spot sizes and spot profiles were acquired in-air by using Logos scintillators with a CCD camera and the result data were from 2.33 mm to for 77 MeV to 9.70 mm for 220 MeV. In different field sizes, a comparison between the dose measured using PTW Semiflex and the AcurosPT estimated dose were performed to study the halo effect. All the measured dosimetric parameters showed that the design specifications were well achieved, and the results are suitable for being used as a part of the clinical commissioning and quality assurance program for treating patients.

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.

Proton therapy with pencil beam scanning technique is a novel technique to treat cancer patients due to its unique biophysical properties. However, a small error in dose calculation may lead towards undesired greater uncertainties in planed doses. This project aims to create a simulation model of Varian ProBeam Compact using the GEANT4 Monte Carlo simulation tool kit.
Experimental data from the first clinical ProBeam Compact system at South Florida Proton Therapy Institute was used to validate the simulation model. A comparison was made between the experimental and simulated Integrated Depth-Dose curves using a 2%/2mm gamma index test with 100% of points passing. The beam spot standard deviation sizes (s!) were compared using percent deviation. All simulated s! matched the experimental s! within 2.5%, except 70 and 80 MeV. The model can be used to develop a more comprehensive model as an independent dose verification tool and further investigate dose distribution.

The accuracy of proton dose computation in the treatment planning system relies on the conversion from the Hounsfield units (HU) of each voxel in the patient CT scan to the proton stopping power ratio (SPR). The aim of this study is to investigate the potential improvement in determining proton SPR using single energy computed tomography (SECT) to reduce the uncertainty in predicting the proton range in patients. Factors which may cause CT number variations in the calibration curve have been examined. The HU-SPR calibration curve was determined based on HU of human body tissues using the stoichiometric method. The uncertainties in SPR were divided into two major categories: The inherent uncertainty, and the CT number uncertainty. The root mean square errors of the inherent uncertainties were estimated 0.02%, 0.61% and 0.26% for lung tissues, soft tissues (excluding Thyroid), and bone tissues, respectively. The total uncertainties due to the inherent uncertainty and CT imaging errors were estimated 1.50%. The average calibration curve of two sized phantoms (head and body) were used in the treatment planning system to mitigate beam hardening effect through the attenuating media. A higher accuracy of the SPR prediction using the stoichiometric method is suggested through comparison with the predicted SPRs that derived from the direct calibration approach.

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.

Quality Assurance (QA) for medical linear accelerators (linac) is the primary concern in
external beam radiation therapy. In this research, we have developed a MATLAB-based software
named Quality Assurance for Linacs (QALMA), which is unique, due to cost-effectiveness, user
friendly interface, and customizability. It includes five modules to perform different QA tests: Star
Shot analysis, Picket Fence test, Winston-Lutz test, MLC log file analysis, and verification of light
& radiation field coincidence. We also pay attention to quality assurance of 6DOF treatment couch
that plays a very important role in radiation therapy. We developed an Arduino based 3D printed
6DOF robotic phantom to check the accuracy of the treatment couch. This robotic phantom was
experimentally validated under clinical standards, and customizable upon requirements of the
quality assurance Task. The current features of this robotic phantom open development opportunities
beyond the specific couch application, such as organs motion simulation.

It is hypothesized that the uncertainty of the Synchrony® model from the rotation of a
geometrically asymmetrical single fiducial shall be non-zero during the motion tracking.
To validate this hypothesis, the uncertainty was measured for a Synchrony® model built
for a respiratory motion phantom oriented at different yaw angles on a Cyberknife®
treatment table.
A Mini-ball Cube with three cylindrical GoldMark™ (1mmx5mm Au) numbered
fiducials was placed inside a respiratory phantom and used for all tests. The fiducial with
the least artifact interference was selected for the motion tracking. A 2cm periodic,
longitudinal, linear motion of the Mini-ball cube was executed and tested for yaw
rotational angles, 0° – 90°. The test was repeated over 3 nonconsecutive days. The
uncertainty increased with the yaw angle with the most noticeable changes seen
between20° and 60° yaw, where uncertainty increased from 23.5% to 57.9%. A similar test was performed using a spherical Gold Anchor™ fiducial. The uncertainties found
when using the Gold Anchor™ were statistically lower than those found when using the
GoldMark™ fiducial for all angles of rotation.
For the first time, it is found that Synchrony® model uncertainty depends on fiducial
geometry. In addition, this research has shown that tracking target rotation using a single
fiducial can be accomplished with the Synchrony® model uncertainty as it is displayed on
the treatment console.
The results of this research could lead to decreased acute toxicity effects related to
multiple fiducials.