Breathing-Adapted Imaging Techniques for Rapid 4-Dimensional Lung Tomosynthesis.

Purpose: This article presents enhancements to a 4-dimensional (4D) lung digital tomosynthesis (DTS) model introduced in a 2018 paper. That model was proposed as an adjunct to 4D computed tomography (4DCT) to improve tumor localization through artifact reduction achieved by imaging the entire lung in all projections, reducing the projection collection time duration for each phase compared with 4DCT, and requiring only a single-breath cycle to capture all phases. This is applicable to SABR treatment planning. Enhancements comprise customized patient 4D-DTS x-ray scanning parameters. Methods and Materials: Imaging parameters derived with the 4D-DTS model were arc duration, frames per second, pulse duration, and tube current normalized to single-chest radiographic milliampere-seconds (mA/mAsAEC). Optimized phase-specific DTS projections imaging parameters were derived for volunteer respiration-tracking surrogate waveforms and for sinusoidal waveforms. These parameters are temporally matched to the respiratory surrogate waveform and presented as continuous data plots during a period of 20 seconds. Comparison is made between surrogate excursions during a single-phase CT and 4D-DTS reconstructions. Results: 4D-DTS imaging techniques were customized to volunteer respiratory waveforms and sinusoidal waveforms. Technique settings at the highest velocity portions of the volunteer waveforms were arc duration 0.066 seconds, frame rate 921 Hz, pulse duration 1.076 ms, and normalized tube current 76.2 s-1. Technique settings at the highest velocity portions of the sinusoidal waveforms were arc duration 0.029 seconds, frame rate 2074 Hz, pulse duration 0.472 ms, and normalized tube current 173.6 s-1. Sinusoidal surrogate excursion distance at the highest velocity portion of the waveform during a CT rotation of 0.5 seconds ranged from 2.68 to 21.09 mm, all greater than the limiting excursion distance chosen in the 4D-DTS model. Conclusions: 4D-DTS image technique settings can be customized to individual patient breathing patterns so that captured range of motion satisfies an operator-selected value.

Extrapolation Ionization Chamber Dosimetry of Fluorescent X-Ray Energies from 4.5 to 19.6 keV.

Characteristic X rays of energies less than approximately 20 keV are of interest in radiobiology and radiation oncology. There is evidence that these low-energy photons produce higher relative biological effectiveness (RBE) and lower oxygen enhancement ratio (OER) relative to higher energies. Lower energy X rays also offer the advantage of healthy tissue sparing beyond the target treatment depth. Electronic brachytherapy systems that can deliver characteristic and bremsstrahlung X rays of varying energy are in clinical use as well as under development. We performed low-energy extrapolation ionization chamber dosimetry using two methods: 1. the exposure-to-dose method; and 2. the Burlin theory method combined with the extrapolation chamber method of Klevenhagen. We investigated fluorescent X rays emitted from seven metals: titanium (Ti, Z = 22); chromium (Cr, Z = 24); iron (Fe, Z = 26); cobalt (Co, Z = 27); copper (Cu, Z = 29); zinc (Zn, Z = 30); and molybdenum (Mo, Z = 42). X rays were produced by irradiation of the metals with a 55 kVp, 45 mA silver anode spectrum. The data obtained were air kerma rate (cGy/min), and radiation dose rate (cGy/min) in phosphate-buffered saline (PBS) solution and water. Air kerma rates ranged from 3.55 ± 0.10 to 14.36 ± 0.39 cGy/min. Dose rates ranged from 3.85 ± 0.10 to 16.96 ± 0.46 cGy/min in PBS and 3.59 ± 0.10 to 16.06 ± 0.43 cGy/min in water. Dose-rate energy dependence of both models was examined by taking a ratio of measured to Monte Carlo calculated dose rates. Dosimetry method 1 exhibited a linear relationship across all energies with a slope of 0.0127 keV(-1) and R(2) of 0.9276. Method 2 exhibited a linear relationship across all energies with a slope of 0.0467 keV(-1) and R(2) of 0.9933. Method 1 or 2 may be used as a relative dosimetry system to derive dose rates to water by using a second reference ion chamber with a NIST-traceable calibration for the molybdenum spectrum.

Development and evaluation of an end-to-end test for head and neck IMRT with a novel multiple-dosimetric modality phantom.

A comprehensive end-to-end test for head and neck IMRT treatments was developed using a custom phantom designed to utilize multiple dosimetry devices. Initial end-to-end test and custom H&N phantom were designed to yield maximum information in anatomical regions significant to H&N plans with respect to: (i) geometric accuracy, (ii) dosimetric accuracy, and (iii) treatment reproducibility. The phantom was designed in collaboration with Integrated Medical Technologies. The phantom was imaged on a CT simulator and the CT was reconstructed with 1 mm slice thickness and imported into Varian's Eclipse treatment planning system. OARs and the PTV were contoured with the aid of Smart Segmentation. A clinical template was used to create an eight-field IMRT plan and dose was calculated with heterogeneity correction on. Plans were delivered with a TrueBeam equipped with a high definition MLC. Preliminary end-to-end results were measured using film, ion chambers, and optically stimulated luminescent dosimeters (OSLDs). Ion chamber dose measurements were compared to the treatment planning system. Films were analyzed with FilmQA Pro using composite gamma index. OSLDs were read with a MicroStar reader using a custom calibration curve. Final phantom design incorporated two axial and one coronal film planes with 18 OSLD locations adjacent to those planes as well as four locations for IMRT ionization chambers below inferior film plane. The end-to-end test was consistently reproducible, resulting in average gamma pass rate greater than 99% using 3%/3 mm analysis criteria, and average OSLD and ion chamber measurements within 1% of planned dose. After initial calibration of OSLD and film systems, the end-to-end test provides next-day results, allowing for integration in routine clinical QA. Preliminary trials have demonstrated that our end-to-end is a reproducible QA tool that enables the ongoing evaluation of dosimetric and geometric accuracy of clinical head and neck treatments.

AAPM Medical Physics Practice Guideline 5.a.: Commissioning and QA of Treatment Planning Dose Calculations - Megavoltage Photon and Electron Beams.

The American Association of Physicists in Medicine (AAPM) is a nonprofit professional society whose primary purposes are to advance the science, education and professional practice of medical physics. The AAPM has more than 8,000 members and is the principal organization of medical physicists in the United States. The AAPM will periodically define new practice guidelines for medical physics practice to help advance the science of medical physics and to improve the quality of service to patients throughout the United States. Existing medical physics practice guidelines will be reviewed for the purpose of revision or renewal, as appropriate, on their fifth anniversary or sooner. Each medical physics practice guideline represents a policy statement by the AAPM, has undergone a thorough consensus process in which it has been subjected to extensive review, and requires the approval of the Professional Council. The medical physics practice guidelines recognize that the safe and effective use of diagnostic and therapeutic radiology requires specific training, skills, and techniques, as described in each document. Reproduction or modification of the published practice guidelines and technical standards by those entities not providing these services is not authorized. The following terms are used in the AAPM practice guidelines:• Must and Must Not: Used to indicate that adherence to the recommendation is considered necessary to conform to this practice guideline.• Should and Should Not: Used to indicate a prudent practice to which exceptions may occasionally be made in appropriate circumstances.

Measurement of gold nanofilm dose enhancement using unlaminated radiochromic film.

PURPOSE: Bombarding high-Z material with x-ray radiation releases Auger electrons and Coster-Kronig electrons, along with deeper penetrating fluorescent x-rays and photoelectrons. The Auger and Coster-Kronig electron penetration distance is on the order of nanometers to micrometers in water or tissue, creating a large dose enhancement accompanied by a RBE greater than 1 at the cellular level. The authors' aim is to measure the gold nanofilm dose enhancement factor (DEF) at the cellular level with unlaminated radiochromic film via primary 50 kVp tungsten x-ray spectrum interaction, similar to an electronic brachytherapy spectrum. METHODS: Unlaminated Gafchromic(®) EBT2 film and Monte Carlo modeling were combined to derive DEF models. Gold film of thickness 23.1 ± 4.3 nm and surface roughness of 1.2 ± 0.2 nm was placed in contact with unlaminated radiochromic film in a downstream orientation and exposed to a 50 kVp tungsten bremsstrahlung, mean energy 19.2 keV. Film response correction factors were derived by Monte Carlo modeling of electron energy deposition in the film's active layer, and by measuring film energy dependence from 4.5 keV to 50 kVp. RESULTS: The measured DEF within a 13.6 µm thick water layer was 0.29 with a mean dose of 94 ± 9.4 cGy from Au emissions and 324 ± 32.4 cGy from the 50 kVp primary beam. Monte Carlo derived correction factors allowed determination of Au contributed dose in shallower depths at 0.25 µm intervals. Maximum DEF of 18.31 was found in the first 0.25 µm water depth. CONCLUSIONS: Dose enhancement from Au nanofilm can be measured at the cellular level using unlaminated radiochromic film. Complementing the measured dose value with Monte Carlo calculations allows estimation of dose enhancement at depth increments within the cellular range.