[Study on the sensitivity of a volumetric modulated arc therapy plan verification equipment on multi-leaf collimator opening and closing errors and its gamma pass rate limit].

To investigate the γ pass rate limit of plan verification equipment for volumetric modulated arc therapy (VMAT) plan verification and its sensitivity on the opening and closing errors of multi-leaf collimator (MLC), 50 cases of nasopharyngeal carcinoma VMAT plan with clockwise and counterclockwise full arcs were randomly selected. Eight kinds of MLC opening and closing errors were introduced in 10 cases of them, and 80 plans with errors were generated. Firstly, the plan verification was conducted in the form of field-by-field measurement and true composite measurement. The γ analysis with the criteria of 3% dose difference, distance to agreement of 2 mm, 10% dose threshold, and absolute dose global normalized conditions were performed for these fields. Then gradient analysis was used to investigate the sensitivity of field-by-field measurement and true composite measurement on MLC opening and closing errors, and the receiver operating characteristic curve (ROC) was used to investigate the optimal threshold of γ pass rate for identifying errors. Tolerance limits and action limits for γ pass rates were calculated using statistical process control (SPC) method for another 40 cases. The error identification ability using the tolerance limit calculated by SPC method and the universal tolerance limit (95%) were compared with using the optimal threshold of ROC. The results show that for the true composite measurement, the clockwise arc and the counterclockwise arc, the descent gradients of the γ passing rate with per millimeter MLC opening error are 10.61%, 7.62% and 6.66%, respectively, and the descent gradients with per millimeter MLC closing error are 9.75%, 7.36% and 6.37%, respectively. The optimal thresholds obtained by the ROC method are 99.35%, 97.95% and 98.25%, respectively, and the tolerance limits obtained by the SPC method are 98.98%, 97.74% and 98.62%, respectively. The tolerance limit calculated by SPC method is close to the optimal threshold of ROC, both of which could identify all errors of ±2 mm, while the universal tolerance limit can only partially identify them, indicating that the universal tolerance limit is not sensitive on some large errors. Therefore, considering the factors such as ease of use and accuracy, it is suggested to use the true composite measurement in clinical practice, and to formulate tolerance limits and action limits suitable for the actual process of the institution based on the SPC method. In conclusion, it is expected that the results of this study can provide some references for institutions to optimize the radiotherapy plan verification process, set appropriate pass rate limit, and promote the standardization of plan verification.

Radiotherapy dose distribution prediction for breast cancer using deformable image registration.

BACKGROUND: Radiotherapy treatment planning dose prediction can be used to ensure plan quality and guide automatic plan. One of the dose prediction methods is incorporating historical treatment planning data into algorithms to estimate the dose-volume histogram (DVH) of organ for new patients. Although DVH is used extensively in treatment plan quality and radiotherapy prognosis evaluation, three-dimensional dose distribution can describe the radiation effects more explicitly. The purpose of this retrospective study was to predict the dose distribution of breast cancer radiotherapy by means of deformable registration into atlas images with historical treatment planning data that were considered to achieve expert level. The atlas cohort comprised 20 patients with left-sided breast cancer, previously treated by volumetric-modulated arc radiotherapy. The registration-based prediction technique was applied to 20 patients outside the atlas cohort. This study evaluated and compared three different approaches: registration to the most similar image from a dataset of individual atlas images (SIM), registration to all images from a database of individual atlas images with the average method (WEI_A), and the weighted method (WEI_F). The dose prediction performance of each strategy was quantified using nine metrics, including the region of interest dose error, 80% and 100% prescription area dice similarity coefficients (DSCs), and γ metrics. A Friedman test and a nonparametric exact Wilcoxon signed rank test were performed to compare the differences among groups. The clinical doses of all cases served as the gold standard. RESULTS: The WEI_F method could achieve superior dose prediction results to those of WEI_A. WEI_F outperformed SIM in the organ-at-risk mean absolute difference (MAD). When using the WEI_F method, the MAD values for the ipsilateral lung, heart, and whole lung were 197.9 ± 42.9, 166 ± 55.1, 122.3 ± 25.5, and 55.3 ± 42.2 cGy, respectively. Moreover, SIM exhibited superior prediction in the DSC and γ metrics. When using the SIM method, the means of the 80% and 100% prescription area DSCs, 33γ metric, and 55γ metric were 0.85 ± 0.05, 0.84 ± 0.05, 0.64 ± 0.13, and 0.84 ± 0.10, respectively. The plan target volume and spinal cord MAD when using SIM and WEI were 235.6 ± 158.4 cGy versus 227.4 ± 144.0 cGy ([Formula: see text]) and 61.4 ± 44.9 cGy versus 55.3 ± 42.2 cGy ([Formula: see text]), respectively. CONCLUSIONS: A predicted dose distribution that approximated the clinical plan could be generated using the methods presented in this study.

Dosimetric study of GZP6 60 Co high dose rate brachytherapy source.

The purpose of this study was to obtain dosimetric parameters of GZP6 60 Co brachytherapy source number 3. The Geant4 MC code has been used to obtain the dose rate distribution following the American Association of Physicists in Medicine (AAPM) TG-43U1 dosimetric formalism. In the simulation, the source was centered in a 50 cm radius water phantom. The cylindrical ring voxels were 0.1 mm thick for r ≤ 1 cm, 0.5 mm for 1 cm < r ≤ 5 cm, and 1 mm for r > 5 cm. The kerma-dose approximation was performed for r > 0.75 cm to increase the simulation efficiency. Based on the numerical results, the dosimetric datasets were obtained. These results were compared with the available data of the similar 60 Co high dose rate sources and the detailed dosimetric characterization was discussed.

[A fitted formula for calculating electron beams mean energy in the homogeneous water phantom].

The hybrid pencil beam model (HPBM) is an effective algorithm for calculating electron dose distribution in radiotherapy. The mean energy distribution of incident electron beam in phantom is one of the factors that affect the calculation accuracy of HPBM, especially in field edge areas near the end of the electron range. A new fitted formula based on Monte Carlo (MC) simulation data for electron beams with energy range of 6-20 MeV in the homogeneous water phantom is proposed in this paper. The precision of the fitted formula within the scope of the energy was evaluated by comparing the electron dose distribution of ECWG measured data with that obtained from HPBM which took the mean electron energy that calculated by the fitted formula and the existed empirical formula, respectively. The results showed that the accuracy of dose distribution that obtained by the mean electron energy calculated with the fitted formula increased about 1%.

Neutron Activation Analysis Based on AB-BNCT Treatment Room.

ABSTRACT: Boron neutron capture therapy (BNCT) is an ideal binary targeted radiotherapy for treating refractory tumors. An accelerator-based BNCT (AB-BNCT) neutron source has attracted more and more attention due to its advantages such as higher neutron yield in the keV energy region, less gamma radiation, and higher safety. In addition to 10B, neutrons also react with other elements in the treatment room during BNCT to produce many activation products. Due to the long half-life of some activation products, there will be residual radiation after the end of treatment and the shutdown of the accelerator, which has adverse effects on radiation workers. Therefore, the ambient dose equivalent rate in the treatment room needs to be evaluated. The AB-BNCT neutron source model proposed by Li is studied in this paper. Based on the Monte Carlo method, the Geant4 platform was used to simulate the dose induced by radionuclides near the Beam Shaping Assembly (BSA) of the source. It is concluded that the concrete wall contributed the most to the radiation dose. The dose rate of 2.45 µSv h-1 after 13 min of shutdown meets the dose rate limit of 2.5 µSv h-1, at which point it is safe for workers to enter the treatment room area.

[Fast gamma index calculation method in dose distribution comparison].

As a method of dosimetric verification in radiotherapy, gamma index has been widely used for evaluating dose distribution in research and clinical cases. However, for three-dimensional dose distributions, gamma index calculation is very time consuming for the computers. In this paper, based on a pre-sorting technique, we implement a parallel computing algorithm of gamma index on graphic processing unit (GPU). Dose comparisons are performed for seven cases to test our new implementation. It was shown that the GPU-based gamma index calculations achieved a speedup of ten-folds in comparison with corresponding CPU implementation without losing accuracy. The result showed that utilizing GPU parallel computing to speed up gamma index calculations could be reliable and efficient in the implementation.

Sensitivity of Three Patient-Specific Quality Assurance Systems to MLC Aperture Errors With Volumetric Modulated Arc Therapy.

Purpose: To compare the sensitivity of ArcCHECK (AC), portal dosimetry (PD), and an in-house logfile-based system (LF) to multileaf collimators (MLC) aperture errors and the ability to identify these errors. Methods and Materials: For 12 retrospective original head and neck volumetric modulated arc therapy (VMAT) plans, MLC aperture errors of ± 0.4mm, ± 1.2mm, ± 2mm, and ± 3mm were introduced for each plan, resulting in 96 plans with errors. AC, PD, and LF were used for the gamma evaluation at 3%/3mm, 3%/2mm, and 2%/2mm criteria. Gradient analysis was used to evaluate the sensitivity to MLC aperture errors. The area under the curve (AUC) obtained from the receiver operating characteristic (ROC) curve was used to evaluate the ability to identify MLC aperture errors and dose errors, and the optimal cut-off value to identify the error was obtained. Results: The gamma pass rate (%GP) of LF had the smallest descent gradient as the MLC error increases in any case. The descent gradient of PD was larger than AC, except for the case at the 2%/2mm criteria. For the 3%/3mm criteria, the MLC aperture errors that can be perfectly identified by AC, PD, and LF were ± 3mm, ± 2mm, and ± 1.2mm, respectively, and the average percent dose error (%DEs) of dose metrics in targets that can be perfectly identified were 4% to 5%, 3% to 4%, and 2% to 3%, respectively. For the 3%/2mm criteria, the errors that AC, PD, and LF can perfectly identify were the same as the 3%/3mm criteria. For the 2%/2mm criteria, AC can perfectly identify the MLC error of ± 2mm and the %DE of 3% to 4%. PD and LF can identify the MLC error of ± 1.2mm and the %DE of 2% to 3%. Conclusion: Different patient-specific quality assurance (PSQA) systems have different sensitivity and recognition abilities to MLC aperture errors. Institutions should formulate their own customized %GP limits based on their PSQA process through ROC or other methods.

[The specification of parameters driven by measurement data in the construction of virtual sources in Monte Carlo simulation].

Dose calculation algorithms based on the Monte Carlo (MC) method are widely regarded as the most accurate tool available in radiotherapy. The MC simulation in radiotherapy has been split into two parts, the radiation source simulation and patient simulation. In this research, a virtual source for simulating the linear accelerator head was constructed with measurement-driven models. The dependence between the calculation accuracy and the specification of various parameters was studied by comparison between the measurement data and calculation results. It has been shown that the dose profile obtained by MC simulation can be consistent with measurement data, suggesting that the compound effect of primary photons and secondary photons are considered with appropriate parameter specification. The requirement of modeling for MC simulation can be met in clinical conditions.

An Inverse Dose Optimization Algorithm for Three-Dimensional Brachytherapy.

PURPOSE: To investigate an implementation method and the results of an inverse dose optimization algorithm, Gradient Based Planning Optimization (GBPO), for three-dimensional brachytherapy. METHODS: The GBPO used a quadratic objective function, and a dwell time modulation item was added to the objective function to restrict the dwell time variance. We retrospectively studied 4 cervical cancer patients using different applicators and 15 cervical cancer patients using the Fletcher applicator. We assessed the plan quality of GBPO by isodose lines for the patients using different applicators. For the 15 patients using the Fletcher applicator, we utilized dose-volume histogram (DVH) parameters of HR-CTV (D100%, V150%) and organs at risk (OARs) (D0.1cc, D1cc, D2cc) to evaluate the difference between the GBPO plans and the IPSA (Inverse Planning Simulated Annealing) plans, as well as the GBPO plans and the Graphic plans. RESULTS: For the 4 patients using different applicators, the dose distributions are conformable. For the 15 patients using the Fletcher applicator, when the dwell time modulation factor (DTMF) is less than 20, the dwell time deviation reduces quickly; however, after the DTMF increased to 100, the dwell time deviation has no remarkable change. The difference in dosimetric parameters between the GBPO plans and the IPSA plans is not statistically significant (P>0.05). The GBPO plans have a higher D100% (3.57 ± 0.36, 3.38 ± 0.34; P<0.01) and a lower V150% (55.73 ± 4.06, 57.75 ± 3.79; P<0.01) than those of the Graphic plans. The differences in other DVH parameters are negligible between the GBPO plans and the Graphic plans. CONCLUSIONS: The GBPO plans have a comparable quality as the IPSA plans and the Graphic plans for the studied cervical cancer cases. The GBPO algorithm could be integrated into a three-dimensional brachytherapy treatment planning system after studying more sites.

COMPARISON OF BNCT DOSIMETRY CALCULATIONS USING DIFFERENT GEANT4 PHYSICS LISTS.

A comparison of Geant4 physics lists is conducted in the calculation of the total absorbed dose, boron dose, and non-boron dose in phantom, and the total depth-dose, boron depth-dose, and non-boron depth-dose along the beam axis for neutrons in a range of 0.0253 eV to 10 MeV. Physics processes are included for neutrons, photons, and charged particles, and calculations are conducted for neutrons and secondary particles. The results obtained from QBBC, QGSP_BERT, and neutron high precision physics lists with and without S(α, ß) data are compared with the FLUKA values. Neutron high precision physics lists with S(α, ß) data showed the best agreement with FLUKA in the studied energy range.

An automated dose verification software for brachytherapy.

PURPOSE: To report an implementation method and the results of independent brachytherapy dose verification software (DVS). MATERIAL AND METHODS: The DVS was developed based on Visual C++ and adopted a modular structure design. The DICOM RT files exported from a treatment planning system (TPS) were automatically loaded into the DVS. The DVS used the TG-43 formalism for dose calculation. A total of 15 cervical cancer patients who underwent brachytherapy were retrospectively selected to test the DVS. Dosimetric parameters and γ analysis (0.1 cm, 5%) were used to evaluate the dose differences between the DVS and the TPS. RESULTS: Compared with the TPS dose, the γ pass rates of the dose calculated by the DVS were higher than 98%. For the clinical target volume (CTV), the dosimetric differences were less than 0.63% for D90% and D100%. For the bladder, rectum, and sigmoid, the agreement of D0.1cc, D1cc, and D2cc were within a 0.78% level. CONCLUSIONS: With minimal human-computer interactions, the DVS can verify the accuracy of doses calculated by the TPS.

Monte Carlo dosimetric parameter study of a new (32)P brachytherapy source.

OBJECTIVE: Recently, a new catheter-based (32)P brachytherapy source has been developed (College of Chemistry, Sichuan University) for use in high-dose-rate afterloader. This study presents the results of the dosimetric data of the Geant4 Monte Carlo (MC) simulation toolkit for this new (32)P brachytherapy source. METHODS: The new (32)P source had dimensions of 0.50-cm length and 0.08-cm diameter and was encapsulated in teflon. In this study, we attempted to obtain dosimetric data for this new source, as required by the formalism proposed by the American Association of Physicists in Medicine reports TG60 and TG149. The source was located in a 30-cm radius theoretical sphere water phantom, and the absorbed dose of the source was calculated using MC code. RESULTS: The dosimetric data included the reference absorbed dose rate, the radial dose function in the range of 0.10-0.50 cm at a longitudinal axis, the polynomial function for the radial dose function and the anisotropy function with a θ value of 0-90° in 5° intervals and an r of 0.10-0.35 cm in 0.01-cm intervals. The radial and axial dose profiles and away-along quality assurance table are also calculated for the unsheathed (32)P source. The dose rate D(r0,θ0) at the reference point for the unsheathed (32)P source is determined to be equal to 1.2660 ± 0.0006 cGy s(-1) mCi. The radial dose function of the new (32)P source shows good agreement with the other (32)P source presented in this work with an average difference of 1.78%. CONCLUSION: Dosimetric data are provided for the new (32)P source. These data could be used in treatment-planning systems in clinical practice. ADVANCES IN KNOWLEDGE: Provided a new beta-emitting brachytherapy source that is intended for treatment of liver cancer. A dosimetric study of the unsheathed (32)P source for which no published dosimetric data existed was performed.

A semi-analytical model for calculating the penetration depth of a high energy electron beam in a water phantom with a magnetic field.

PURPOSE: As an electron beam is incident on a uniform water phantom in the presence of a lateral magnetic field, the depth-dose distribution of the electron beam changes significantly and forms the well-known 'Bragg peak', with a depth-dose distribution similar to that of heavy ions. This phenomenon has pioneered a new field in the clinical application of electron beams. For such clinical applications, evaluating the penetration depth of electron beams quickly and accurately is the critical problem. METHODS: This paper describes a model for calculating the penetration depth of an electron beam rapidly and correctly in a water phantom under the influence of a magnetic field. The model was used to calculate the penetration depths under different conditions: the energies of electron beams of 6, 8, 12 and 15 MeV and the magnetic induction intensities of 0.75, 1.0, 1.5, 2.0 and 3.0 T. In addition, the calculation results were compared with the results of a Monte Carlo simulation. RESULTS: The comparison results indicate that the difference between the two calculation methods was less than 0.5 cm. Moreover, the computing time of the calculation model was less than a second. CONCLUSIONS: The semi-analytical model proposed in the present study enables the penetration depth of the electron beam in the presence of a magnetic field to be obtained with a computational efficiency higher than that of the Monte Carlo approach; thus, the proposed model has high potential for application.