In search of a one plan solution for VMAT post-mastectomy chest wall irradiation.

PURPOSE: This study was designed to evaluate skin dose in both VMAT and tangent treatment deliveries for the purpose of identifying suitable bolus use protocols that should produce similar superficial doses. METHODS: Phantom measurements were used to investigate skin dose in chest wall radiotherapy with and without bolus for 3D and rotational treatment techniques. Optically stimulated luminescence dosimeters (OSLDs) with and without housing and EBT3 film were used. Superflab (3, 5, and 10 mm) and brass mesh were considered. Measured doses were compared with predictions by the Eclipse treatment planning system. Patient measurements were also performed and the bolusing effect of hospital gowns and blankets were highlighted. The effect of flash for VMAT plans was considered experimentally by using 2 mm couch shifts. RESULTS: For tangents, average skin doses without bolus were 0.64 (EBT3), 0.62 (bare OSLD), 0.77 (jacketed OSLD), and 0.68 (Eclipse) as a fraction of prescription. For VMAT, doses without bolus were 0.53 (EBT3), 0.53 (bare OSLD), 0.64 (jacketed OSLD), and 0.60 (Eclipse). For tangents, the average doses with different boluses as measured by EBT3 were 0.99 (brass mesh), 1.02 (3 mm), 1.03 (5 mm), and 1.07 (10 mm). For VMAT with bolus, average doses as measured by EBT3 were 0.83 (brass), 0.96 (3 mm), 1.03 (5 mm), and 1.04 (10 mm). Eclipse doses agreed with measurements to within 5% of measurements for all Superflab thicknesses and within 15% of measurements for no bolus. The presence of a hospital gown and blanket had a bolusing effect that increased the surface dose by approximately 10%. CONCLUSIONS: Results of this work allow for consideration of different bolus thicknesses, materials, and usage schedules based on desired skin dose and choice of either tangents or an arc beam techniques.

A customizable, open-source Winston-Lutz system for multi-target, single isocentre radiotherapy.

Objective. To present and share an open-source system (phantom and software) for verifying the targeting accuracy of linac-based, single-isocenter, multi-target radiotherapy. This quality assurance test extends the traditional Winston-Lutz test, which considers a single target located at isocentre.Approach. Plans for a 3D-printed phantom are provided, which can be customized to accommodate various target (BB) positions. Given BB positions and gantry/collimator/couch combinations, the software generates multi-leaf collimator positions to facilitate multi-target Winston-Lutz (MTWL) plan creation. The software determines deviations between detected and expected BB positions on MV images resulting from MTWL plan delivery. BBs are located using a Hough circle detection algorithm, which is modified to favour the detection of circles: (1) having a reasonable size, (2) that are contained within the radiation field, and (3) having reasonable pixel intensities. Validation was performed in two ways: (1) using synthetic data with zero targeting errors and (2) by measuring real linac targeting errors and comparing against results obtained using a commercial system.Main results. Validation using the synthetic data yielded a mean (maximum) absolute discrepancy of 0.11 mm (0.21 mm), which is comparable to the synthetic phantom resolution (0.2 mm). The mean (maximum) absolute discrepancy compared to the commercial system is 0.13 mm (0.43 mm). These values are similar to results obtained with repeated deliveries of the same MTWL plan with the same phantom setup. Both validation tests yield reasonable results and are therefore considered successful. The MTWL test was performed independently by three physicists on two linacs to investigate repeatability, resulting in a mean (maximum) absolute discrepancy of 0.14 mm (0.51 mm) among the various attempts.Significance. Successful completion of this quality assurance test, using our customizable and open-source system, provides confidence that multi-target, single isocentre radiotherapy treatments can be delivered with sufficient geometric accuracy according to the chosen tolerance level.

Skin dose in chest wall radiotherapy with bolus: a Monte Carlo study.

Monte Carlo simulations are used to investigate skin dose resulting from chest wall radiotherapy with bolus. A simple model of a female thorax is developed, which includes a 2 mm-thick skin layer. Two representative 6 MV source models are considered: a tangents source model consisting of a parallel opposed pair of medial and lateral fields and subfields, and an arc source model. Tissue equivalent (TE) boluses (thicknesses of 3, 5 and 10 mm) and brass mesh bolus are considered. Skin dose distributions depend on incident photon obliquity: for tangents, radiation is incident more obliquely, resulting in longer path lengths through the bolus and higher skin dose compared to the arc source model in most cases. However, for thicker TE boluses, attenuation of oblique photons becomes apparent. Brass bolus and 3 mm TE bolus result in similar mean skin dose. This relatively simple computational model allows for consideration of different bolus thicknesses, materials and usage schedules based on desired skin dose and choice of either tangents or an arc beam technique. For example, using a 5 mm TE bolus every second treatment would result in mean skin doses of 89% and 85% for tangents and the arc source model, respectively. The hot spot metric D[Formula: see text] would be 103% and 99%, respectively.

Investigating energy deposition within cell populations using Monte Carlo simulations.

In this work, we develop multicellular models of healthy and cancerous human soft tissues, which are used to investigate energy deposition in subcellular targets, quantify the microdosimetric spread in a population of cells, and determine how these results depend on model details. Monte Carlo (MC) tissue models combining varying levels of detail on different length scales are developed: microscopically-detailed regions of interest (>1500 explicitly-modelled cells) are embedded in bulk tissue phantoms irradiated by photons (20 keV-1.25 MeV). Specific energy (z; energy imparted per unit mass) is scored in nuclei and cytoplasm compartments using the EGSnrc user-code egs_chamber; specific energy mean, [Formula: see text], standard deviation, [Formula: see text], and distribution, [Formula: see text], are calculated for a variety of macroscopic doses, D. MC-calculated [Formula: see text] are compared with normal distributions having the same mean and standard deviation. For ∼mGy doses, there is considerable variation in energy deposition (microdosimetric spread) throughout a cell population: e.g. for 30 keV photons irradiating melanoma with 7.5 µm cell radius and 3 µm nuclear radius, [Formula: see text] for nuclear targets is [Formula: see text], and the fraction of nuclei receiving no energy deposition, f z=0, is 0.31 for a dose of 10 mGy. If cobalt-60 photons are considered instead, then [Formula: see text] decreases to [Formula: see text], and f z=0 decreases to 0.036. These results correspond to randomly arranged cells with cell/nucleus sizes randomly sampled from a normal distribution with a standard deviation of 1 µm. If cells are arranged in a hexagonal lattice and cell/nucleus sizes are uniform throughout the population, then [Formula: see text] decreases to [Formula: see text] and [Formula: see text] for 30 keV and cobalt-60, respectively; f z=0 decreases to 0.25 and 0.000 94 for 30 keV and cobalt-60, respectively. Thus, specific energy distributions are sensitive to cell/nucleus sizes and their distributions: variations in specific energy deposited over a cell population are underestimated if targets are assumed to be uniform in size compared with more realistic variation in target size. Bulk tissue dose differs from [Formula: see text] for nuclei (cytoplasms) by up to [Formula: see text] ([Formula: see text]) across all cell/nucleus sizes, bulk tissues, and incident photon energies, considering a 50 mGy dose level. Overall, results demonstrate the importance of microdosimetric considerations at low doses, and indicate the sensitivity of energy deposition within subcellular targets to incident photon energy, dose level, elemental compositions, and microscopic tissue model.

A Monte Carlo study of macroscopic and microscopic dose descriptors for kilovoltage cellular dosimetry.

This work investigates how doses to cellular targets depend on cell morphology, as well as relations between cellular doses and doses to bulk tissues and water. Multicellular models of five healthy and cancerous soft tissues are developed based on typical values of cell compartment sizes, elemental compositions and number densities found in the literature. Cells are modelled as two concentric spheres with nucleus and cytoplasm compartments. Monte Carlo simulations are used to calculate the absorbed dose to the nucleus and cytoplasm for incident photon energies of 20-370 keV, relevant for brachytherapy, diagnostic radiology, and out-of-field radiation in higher-energy external beam radiotherapy. Simulations involving cell clusters, single cells and single nuclear cavities are carried out for cell radii between 5 and [Formula: see text]m, and nuclear radii between 2 and [Formula: see text]m. Seven nucleus and cytoplasm elemental compositions representative of animal cells are considered. The presence of a cytoplasm, extracellular matrix and surrounding cells can affect the nuclear dose by up to [Formula: see text]. Differences in cell and nucleus size can affect dose to the nucleus (cytoplasm) of the central cell in a cluster of 13 cells by up to [Formula: see text] ([Formula: see text]). Furthermore, the results of this study demonstrate that neither water nor bulk tissue are reliable substitutes for subcellular targets for incident photon energies <50 keV: nuclear (cytoplasm) doses differ from dose-to-medium by up to [Formula: see text] ([Formula: see text]), and from dose-to-water by up to [Formula: see text] ([Formula: see text]). The largest differences between dose descriptors are seen for the lowest incident photon energies; differences are less than [Formula: see text] for energies [Formula: see text]90 keV. The sensitivity of results with regard to the parameters of the microscopic tissue structure model and cell model geometry, and the importance of the nucleus and cytoplasm as targets for radiation-induced cell death emphasize the importance of accurate models for cellular dosimetry studies.

Cavity theory applications for kilovoltage cellular dosimetry.

Relationships between macroscopic (bulk tissue) and microscopic (cellular) dose descriptors are investigated using cavity theory and Monte Carlo (MC) simulations. Small, large, and multiple intermediate cavity theory (SCT, LCT, and ICT, respectively) approaches are considered for 20 to 370 keV incident photons; ICT is a sum of SCT and LCT contributions weighted by parameter d. Considering µm-sized cavities of water in bulk tissue phantoms, different cavity theory approaches are evaluated via comparison of [Formula: see text] (where D w,m is dose-to-water-in-medium and D m,m is dose-to-medium-in-medium) with MC results. The best overall agreement is achieved with an ICT approach in which [Formula: see text], where L is the mean chord length of the cavity and ß is given by [Formula: see text] (R CSDA is the continuous slowing down approximation range of an electron of energy equal to that of incident photons). Cell nucleus doses, D nuc, computed with this ICT approach are compared with those from MC simulations involving multicellular soft tissue models considering a representative range of cell/nucleus sizes and elemental compositions. In [Formula: see text] of cases, ICT and MC predictions agree within [Formula: see text]; disagreement is at most 8.8%. These results suggest that cavity theory may be useful for linking doses from model-based dose calculation algorithms (MBDCAs) with energy deposition in cellular targets. Finally, based on the suggestion that clusters of water molecules associated with DNA are important radiobiological targets, two approaches for estimating dose-to-water by application of SCT to MC results for D m,m or D nuc are compared. Results for these two estimates differ by up to [Formula: see text], demonstrating the sensitivity of energy deposition within a small volume of water in nucleus to the geometry and composition of its surroundings. In terms of the debate over the dose specification medium for MBDCAs, these results do not support conversion of D m,m to D w,m using SCT.