Investigation of Halcyon multi-leaf collimator model in Eclipse treatment planning system: A focus on the VMAT dose calculation with the Acuros XB algorithm.

PURPOSE: The dual-layer multi-leaf collimator (MLC) in Halcyon involves further complexities in the dose calculation process, because the leaf-tip transmission varies according to the leaf trailing pattern. For the volumetric modulated arc therapy (VMAT) treatment, the prescribed dose for the target volume can be sensitive to the leaf-tip transmission change. This report evaluates the dosimetric consequence due to the uncertainty of the dual-layer MLC model in Eclipse through the dose verifications for clinical VMAT. Additionally, the Halcyon leaf-tip model is empirically adjusted for the VMAT dose calculation with the Acuros XB. MATERIALS AND METHODS: For this evaluation, an in-house program that analyzes the leaf position in each layer was developed. Thirty-two clinical VMAT plans were edited into three leaf sequences: dual layer (original), proximal single layer, or distal single layer. All leaf sequences were verified using Delta4 according to the dose difference (DD) and the global gamma index (GI). To improve the VMAT dose calculation accuracy, the dosimetric leaf gap (DLG) was adjusted to minimize the DD in single-layer leaf sequences. RESULTS: The mean of DD were -1.35%, -1.20%, and -1.34% in the dual-layer, proximal single-layer, and distal single-layer leaf sequences, respectively. The changes in the mean of DD between leaf sequences were within 0.2%. However, the calculated doses differed from the measured doses by approximately 1% in all leaf sequences. The tuned DLG was increased by 0.8 mm from the original DLG in Eclipse. When the tuned DLG was used in the dose calculation, the mean of DD neared 0% and GI with a criterion of 2%/2 mm yielded a pass rate of more than 98%. CONCLUSION: No significant change was confirmed in the dose calculation accuracy between the leaf sequences. Therefore, it is suggested that the dosimetric consequence due to the leaf trailing was negligibly small in clinical VMAT plans. The DLG tuning for Halcyon can be useful for reducing the dose calculation uncertainties in Eclipse VMAT and required in the commissioning for Acuros XB.

Direct energy spectrum measurement of X-ray from a clinical linac.

A realistic X-ray energy spectrum is essential for accurate dose calculation using the Monte Carlo (MC) algorithm. An energy spectrum for dose calculation in the radiation treatment planning system is modeled using the MC algorithm and adjusted to obtain acceptable agreement with the measured percent depth dose (PDD) and off-axis ratio. The simulated energy spectrum may not consistently reproduce a realistic energy spectrum. Therefore, direct measurement of the X-ray energy spectrum from a linac is necessary to obtain a realistic spectrum. Previous studies have measured low photon fluence directly, but the measurement was performed with a nonclinical linac with a thick target and a long target-to-detector distance. In this study, an X-ray energy spectrum from a clinical linac was directly measured using a NaI(Tl) scintillator at an ultralow dose rate achieved by adjusting the gun grid voltage. The measured energy spectrum was unfolded by the Gold algorithm and compared with a simulated spectrum using statistical tests. Furthermore, the PDD was calculated using an unfolded energy spectrum and a simulated energy spectrum was compared with the measured PDD to evaluate the validity of the unfolded energy spectrum. Consequently, there was no significant difference between the unfolded and simulated energy spectra by nonparametric, Wilcoxon's rank-sum, chi-square, and two-sample Kolmogorov-Smirnov tests with a significance level of 0.05. However, the PDD calculated from the unfolded energy spectrum better agreed with the measured compared to the calculated PDD results from the simulated energy spectrum. The adjustment of the incident electron parameters using MC simulation is sensitive and takes time. Therefore, it is desirable to obtain the energy spectrum by direct measurement. Thus, a method to obtain the realistic energy spectrum by direct measurement was proposed in this study.

Evaluation of differences and dosimetric influences of beam models using golden and multi-institutional measured beam datasets in radiation treatment planning systems.

PURPOSE: The beam model in radiation treatment planning systems (RTPSs) plays a crucial role in determining the accuracy of calculated dose distributions. The purpose of this study was to ascertain differences in beam models and their dosimetric influences when a golden beam dataset (GBD) and multi-institution measured beam datasets (MBDs) are used for beam modeling in RTPSs. METHODS: The MBDs collected from 15 institutions, and the MBDs' beam models, were compared with a GBD, and the GBD's beam model, for Varian TrueBeam linear accelerator. The calculated dose distributions of the MBDs' beam models were compared with those of the GBD's beam model for simple geometries in a water phantom. Calculated dose distributions were similarly evaluated in volumetric modulated arc therapy (VMAT) plans for TG-119 C-shape and TG-244 head and neck, at several dose constraints of the planning target volumes (PTVs), and organs at risk. RESULTS: The agreements of the MBDs with the GBD were almost all within ±1%. The calculated dose distributions for simple geometries in a water phantom also closely corresponded between the beam models of GBD and MBDs. Nevertheless, there were considerable differences between the beam models. The maximum differences between the mean energy of the energy spectra of GBD and MBDs were -0.12 MeV (-10.5%) in AcurosXB (AXB, Eclipse) and 0.11 MeV (7.7%) in collapsed cone convolution (CCC, RayStation). The differences in the VMAT calculated dose distributions varied for each dose region, plan, X-ray energy, and dose calculation algorithm. The ranges of the differences in the dose constraints were -5.6% to 3.0% for AXB and -24.1% to 2.8% for CCC. In several VMAT plans, the calculated dose distributions of GBD's beam model tended to be lower in high-dose regions and higher in low-dose regions than those of the MBDs' beam models. CONCLUSIONS: We found that small differences in beam data have large impacts on the beam models, and on calculated dose distributions in clinical VMAT plan, even if beam data correspond within ±1%. GBD's beam model was not a representative beam model. The beam models of GBD and MBDs and their calculated dose distributions under clinical conditions were significantly different. These differences are most likely due to the extensive variation in the beam models, reflecting the characteristics of beam data. The energy spectrum and radial energy in the beam model varied in a wide range, even if the differences in the beam data were <±1%. To minimize the uncertainty of the calculated dose distributions in clinical plans, it was best to use the institutional MBD for beam modeling, or the beam model that ensures the accuracy of calculated dose distributions.

Estimation of the cable effect in megavoltage photon beam by measurement and Monte Carlo simulation.

PURPOSE: Ionization chambers are widely used for dosimetry with megavoltage photon beams. Several properties of ionization chambers, including the cable effect, polarity effect, and ion recombination loss, are described in standard dosimetry protocols. The cable effect is categorized as the leakage current and Compton current, and careful consideration of these factors has been described not only in reference dosimetry but also in large fields. However, the mechanism of Compton current in the cable has not been investigated thoroughly. The cable effect of ionization chambers in 6 MV X-ray beam was evaluated by measurement, and the mechanism of Compton current was investigated by Monte Carlo simulation. MATERIALS AND METHODS: Four PTW ionization chambers (TM30013, TM31010, TM31014, and TM31016) with the same type of mounted cable, but different ionization volumes, were used to measure output factor (OPF) and cable effect measurement. The OPF was measured to observe any variation resulting from the cable effect. The cable effect was evaluated separately for the leakage current and Compton current, and its charge per absorbed dose to water per cable length was estimated by a newly proposed method. The behavior of electrons and positrons in the core wire was analyzed and the Compton current for the photon beam was estimated by Monte Carlo simulation. RESULTS: In OPF measurement, the difference in the electrometer readings by polarity became obvious for the mini- or microchamber and its difference tended to be larger for a chamber with a smaller ionization volume. For the cable effect measurement, it was determined that the contribution of the leakage current to the cable effect was ignorable, while the Compton current was dominant. The charge due to the Compton current per absorbed dose to water per cable length was estimated to be 0.36 ± 0.03 pC Gy-1  cm-1 for PTW ionization chambers. As a result, the contribution of the Compton current to the electrometer readings was estimated to be 0.002% cm-1 for the Farmer-type, 0.011% cm-1 for the scanning, and 0.088% cm-1 for microchambers, respectively. By the simulation, it was determined that the Compton current for MV x-ray could be explained by not only recoil electrons due to Compton scattering but also positron due to pair production. The Compton current estimated by the difference in outflowing and inflowing charge was 0.45 pC Gy-1  cm-1 and was comparable with the measured value. CONCLUSION: The cable effect, which includes the leakage current and Compton current, was quantitatively estimated for several chambers from measurements, and the mechanism of Compton current was investigated by Monte Carlo simulation. It was determined that the Compton current is a dominant component of the cable effect and its charge is consistently positive and nearly the same, irrespective of the ionization chamber volume. The contribution of Compton current to the electrometer readings was estimated for chambers. The mechanism of Compton current was analyzed and it was confirmed that the Compton current can be estimated from the difference in outflowing and inflowing charge to and from the core wire.

Effect of ICRU report 90 recommendations on Monte Carlo calculated kQ for ionization chambers listed in the Addendum to AAPM's TG-51 protocol.

PURPOSE: The ICRU has published new recommendations for ionizing radiation dosimetry. In this work, the effect of recommendations on the water-to-air and graphite-to-air restricted mass electronic stopping power ratios (sw, air and sg, air ) and the individual perturbation correction factors Pi was calculated. The effect on the beam quality conversion factors kQ for reference dosimetry of high-energy photon beams was estimated for all ionization chambers listed in the Addendum to AAPM's TG-51 protocol. METHODS: The sw, air , sg, air , individual Pi, and kQ were calculated using EGSnrc Monte Carlo code system and key data of both ICRU report 37 and ICRU report 90. First, the Pi and kQ were calculated using precise models of eight ionization chambers: NE2571 (Nuclear Enterprise), 30013, 31010, 31021 (PTW), Exradin A12, A12S, A1SL (Standard imaging), and FC-65P (IBA). In this simulation, the radiation sources were one 60 Co beam and ten photon beams with nominal energy between 4 MV and 25 MV. Then, the change in kQ for ionization chambers listed in the Addendum to AAPM's TG-51 protocol was calculated by changing the specification of the simple-model of ionization chamber. The simple-models were made with only cylindrical component modules. In this simulation, the radiation sources of 60 Co beam and 24 MV photon beam were used. RESULTS: The significant changes (p < 0.05) were observed for sw, air , sg, air , the wall correction factor Pwall , and the waterproofing sleeve correction factor Psleeve . The decrease in sw, air varied from -0.57% for a 60 Co beam to -0.36% for the highest beam quality. The decrease in sg, air varied from -0.72% to -1.12% in the same range. The changes in Pwall and Psleeve were up to 0.41% and 0.14% and those maximum changes were observed for the 60 Co beam. All changes in the central electrode correction factor Pcel , the stem correction factor Pstem , and the replacement correction factor Prepl were from -0.02% to 0.12%. Those changes were statistically insignificant (p = 0.07 or more) and were independent of photon energy. The change in kQ was mainly characterized by the change in sw, air , Pwall , and Psleeve . The relationship between the change in kQ and the beam quality index was linear approximately. The changes in kQ of the simple-models were agreed with those of the precise-models within 0.08%. CONCLUSION: The effects of ICRU-90 recommendations on kQ for the ionization chambers listed in the Addendum to AAPM's TG-51 protocol were from -0.15% to 0.30%. To remove the known systematic effect on the clinical reference dosimetry, the kQ based on ICRU-37 should be updated to the kQ based on ICRU-90.

Evaluation of gantry angle during respiratory-gated VMAT using triggered kilovoltage x-ray image.

Respiratory-gated volumetric modulated arc therapy (gated VMAT) involves further complexities to the dose delivery process because the gantry rotation must repeatedly stop and restart according to the gating signals. In previous studies, the gantry rotation performances were evaluated by the difference between the plan and the machine log. However, several reports pointed out that log analysis does not sufficiently replicate the machine performance. In this report, a measurement-based quality assurance of the relation between the gantry angle and gate-on or gate-off using triggered kilovoltage imaging and a cylinder phantom with 16 ball bearings is proposed. For the analysis, an in-house program that estimates and corrects the phantom offset was developed. The gantry angle in static and gated arc delivery was compared between the machine log and the proposed method. The gantry was set every 5 deg through its full motion range in static delivery, and rotated at three speeds (2, 4 and 6 deg s-1 ) with different gating intervals (1.5 or 3.0 s) in gated arc delivery. The mean and standard deviation of the angular differences between the log and the proposed method was -0.05 deg ± 0.12 deg in static delivery. The mean of the angular difference was within ±0.10 deg and the largest difference was 0.41 deg in gated arc delivery. The log records the output of the encoder so that miscalibration and mechanical sagging will be disregarded. However, the proposed method will help the users to detect the mechanical issues due to the repeated gantry stops and restarts in gated VMAT.

Density scaling of phantom materials for a 3D dose verification system.

In this study, the optimum density scaling factors of phantom materials for a commercially available three-dimensional (3D) dose verification system (Delta4) were investigated in order to improve the accuracy of the calculated dose distributions in the phantom materials. At field sizes of 10 × 10 and 5 × 5 cm2 with the same geometry, tissue-phantom ratios (TPRs) in water, polymethyl methacrylate (PMMA), and Plastic Water Diagnostic Therapy (PWDT) were measured, and TPRs in various density scaling factors of water were calculated by Monte Carlo simulation, Adaptive Convolve (AdC, Pinnacle3 ), Collapsed Cone Convolution (CCC, RayStation), and AcurosXB (AXB, Eclipse). Effective linear attenuation coefficients (µeff ) were obtained from the TPRs. The ratios of µeff in phantom and water ((µeff )pl,water ) were compared between the measurements and calculations. For each phantom material, the density scaling factor proposed in this study (DSF) was set to be the value providing a match between the calculated and measured (µeff )pl,water . The optimum density scaling factor was verified through the comparison of the dose distributions measured by Delta4 and calculated with three different density scaling factors: the nominal physical density (PD), nominal relative electron density (ED), and DSF. Three plans were used for the verifications: a static field of 10 × 10 cm2 and two intensity modulated radiation therapy (IMRT) treatment plans. DSF were determined to be 1.13 for PMMA and 0.98 for PWDT. DSF for PMMA showed good agreement for AdC and CCC with 6 MV x ray, and AdC for 10 MV x ray. DSF for PWDT showed good agreement regardless of the dose calculation algorithms and x-ray energy. DSF can be considered one of the references for the density scaling factor of Delta4 phantom materials and may help improve the accuracy of the IMRT dose verification using Delta4.

A Proposal for the Absorbed Dose to Water Dosimetry for Flattening Filter-free Beams.

Flattening filter-free (FFF) beams generated by linear accelerators have been widely adopted in many hospitals recently for radiation therapy. FFF technology can provide higher dose rates so that shortening of the treatment time and less intra-fraction motion error are expected.In Japan, the current way of determining absorbed dose to water for FFF beams is to follow the Standard Dosimetry 12 protocol which was developed for flattened beams. Since it has been reported that the flattened beams and FFF beams have different beam properties, it is necessary to evaluate the usefulness of Standard Dosimetry 12 protocol for FFF beam dosimetry.This report reviews physical and dosimetric properties of FFF beams especially in terms of the effect on absorbed dose to water dosimetry using an ionization chamber. From the review, it became evident that the absorbed dose to water is underestimated by volume averaging effect of the ionization chamber. On the other hand, the absorbed dose to water is overestimated by using the beam-quality specifier TPR20,10 to predict the restricted mass collision stopping power ratio for FFF beams. Therefore, an alternative method was proposed for absorbed dose to water dosimetry of FFF beams based on Standard Dosimetry 12.