An overview of the comprehensive proton therapy machine quality assurance procedures implemented at The University of Texas M. D. Anderson Cancer Center Proton Therapy Center-Houston.

The number of proton and carbon ion therapy centers is increasing; however, since the publication of the International Commission on Radiation Units and Measurements report, there has been no dedicated report dealing with proton therapy quality assurance. The purpose of this article is to describe the quality assurance procedures performed on the passively scattered proton therapy beams at The University of Texas M. D. Anderson Cancer Center Proton Therapy Center in Houston. The majorities of these procedures are either adopted from procedures outlined in the American Association of Physicists in Medical Task Group (TG) 40 report or are a modified version of the TG 40 procedures. In addition, new procedures, which were designed specifically to be applicable to the synchrotron at the author's center, have been implemented. The authors' procedures were developed and customized to ensure patient safety and accurate operation of synchrotron to within explicit limits. This article describes these procedures and can be used by others as a guideline for developing QA procedures based on particle accelerator specific parameters and local regulations pertinent to any new facility.

Implication of CT table sag on geometrical accuracy during virtual simulation.

Computed tomography (CT) scanners are used in hospitals worldwide for radiation oncology treatment simulation. It is critical that the process very accurately represents the patient positioning to be used during the administration of radiation therapy to minimize the dose delivery to normal tissue. Unfortunately, this is not always the case. One problem is that some degree of vertical displacement, or sag, occurs when the table is extended from its base when under a clinical weight load, a problem resulting from mechanical limitations of the CT table. In an effort to determine the extent of the problem, we measured and compared the degree of table sag for various CT scanner tables at our institution. A clinically representative weight load was placed on each table, and the amount of table sag was measured for varying degrees of table extension from its base. Results indicated that the amount of table sag varied from approximately 0.7 to 6.6 mm and that the amount of table sag varied not only between tables from different manufacturers but also between tables of the same model from the same manufacturer. Failure to recognize and prevent this problem could lead to incorrectly derived isocenter localization and subsequent patient positioning errors. Treatment site-specific and scanner-based laser offset correction should be implemented for each patient's virtual simulation procedure. In addition, the amount of sag should be measured under a clinically representative weight load upon CT-simulator commissioning.

Linearity and uniformity response as an indicator of performance for Agfa ADC-MD10 computed radiography plates.

Computed radiography (CR) plates are currently used in radiation therapy clinics to acquire digital radiographic images for the purpose of verifying the treatment field size, shape, and location. Each CR plate may be used numerous times, and the use of these digital images allows for easy storage and retrieval of patient data. Over prolonged repeat exposures of the CR plates, however, the image quality begins to degrade, making it increasingly more difficult for the therapists and physicians to determine where one anatomical structure begins, and the other ends. The purpose of this project was to analyze and compare the linearity and uniformity responses of new CR plates, versus CR plates that have been used clinically for a period of 2 years, and determine whether linearity or uniformity response may be used as an indicator of image quality degradation. To determine this, 44 old Agfa MD10 CR plates and 56 new Agfa MD10 CR plates were tested. When comparing the results of the uniformity test, we found both the old and the new plates varied from approximately 0.5% to 3.2%. When comparing the results of the linearity test, we found that the correlation coefficient, R(2), for both the old and the new plates varied from approximately 0.996 to 0.998, with the mean values being 0.9972 and 0.9979, respectively. We concluded that linearity and uniformity response cannot be used as an effective method for the evaluation of CR plate performance. Additional research is currently underway to evaluate various other methods of assessing CR plate performance.

Measurement of neutron dose equivalent and its dependence on beam configuration for a passive scattering proton delivery system.

PURPOSE: To measure the neutron dose equivalent per therapeutic proton dose (H/D) in a passive scattering proton therapy system and study its dependence on the proton energy, aperture-to-isocenter distance, spread-out Bragg peak (SOBP) width, and field size. METHODS AND MATERIALS: We performed four experiments of varying proton energies, aperture-to-isocenter distances, SOBP widths, and field sizes. Etched track detectors were used to measure the neutron dose equivalent at both an in-field (isocenter, beyond the protons' range) and out-of-field (30 cm lateral to the isocenter) location in air. RESULTS: For a nonmodulated beam with all the protons stopping in the aperture and an aperture-to-isocenter distance of 30 cm, the H/D values measured at the isocenter were approximately 0.3 mSv/Gy for all snouts with a 100-MeV beam. The H/D values increased to 10.7, 14.5, and 15.1 mSv/Gy, respectively, for small, medium, and large snouts when the beam energy increased to 250 MeV. At the out-of-field location, H/D values increased from 0.1 to 2.7, 3.0, and 3.2 mSv/Gy, respectively, for small, medium, and large snouts. When the aperture-to-isocenter distance was changed from 10 to 40 cm, the H/D value at the isocenter dropped 70%. The H/D value doubled for the modulated beam relative to the nonmodulated beam. Open apertures reduced the neutrons produced in the nozzle, but increased those produced in the phantom. CONCLUSIONS: Our data showed that changes in the four factors studied affect the H/D value in predictable ways which permits an estimate of a patient's neutron exposure.

LiF TLD-100 as a dosimeter in high energy proton beam therapy--can it yield accurate results?

In the region of high-dose gradients at the end of the proton range, the stopping power ratio of the protons undergoes significant changes, allowing for a broad spectrum of proton energies to be deposited within a relatively small volume. Because of the potential linear energy transfer dependence of LiF TLD-100 (thermolumescent dosimeter), dose measurements made in the distal fall-off region of a proton beam may be less accurate than those made in regions of low-dose gradients. The purpose of this study is to determine the accuracy and precision of dose measured using TLD-100 for a pristine Bragg peak, particularly in the distal fall-off region. All measurements were made along the central axis of an unmodulated 200-MeV proton beam from a Probeat passive beam-scattering proton accelerator (Hitachi, Ltd., Tokyo, Japan) at varying depths along the Bragg peak. Measurements were made using TLD-100 powder flat packs, placed in a virtual water slab phantom. The measurements were repeated using a parallel plate ionization chamber. The dose measurements using TLD-100 in a proton beam were accurate to within +/-5.0% of the expected dose, previously seen in our past photon and electron measurements. The ionization chamber and the TLD relative dose measurements agreed well with each other. Absolute dose measurements using TLD agreed with ionization chamber measurements to within +/- 3.0 cGy, for an exposure of 100 cGy. In our study, the differences in the dose measured by the ionization chamber and those measured by TLD-100 were minimal, indicating that the accuracy and precision of measurements made in the distal fall-off region of a pristine Bragg peak is within the expected range. Thus, the rapid change in stopping power ratios at the end of the range should not affect such measurements, and TLD-100 may be used with confidence as an in vivo dosimeter for proton beam therapy.