A model-based 3D patient-specific pre-treatment QA method for VMAT using the EPID

This study reports the development and validation of a model-based, 3D patient dose reconstruction method for pre-treatment quality assurance using EPID images. The method is also investigated for sensitivity to potential MLC delivery errors. Each cine-mode EPID image acquired during plan delivery was processed using a previously developed back-projection dose reconstruction model providing a 3D dose estimate on the CT simulation data. Validation was carried out using 24 SBRT-VMAT patient plans by comparing: (1) ion chamber point dose measurements in a solid water phantom, (2) the treatment planning system (TPS) predicted 3D dose to the EPID reconstructed 3D dose in a solid water phantom, and (3) the TPS predicted 3D dose to the EPID and our forward predicted reconstructed 3D dose in the patient (CT data). AAA and AcurosXB were used for TPS predictions. Dose distributions were compared using 3%/3 mm (95% tolerance) and 2%/2 mm (90% tolerance) γ-tests in the planning target volume (PTV) and 20% dose volumes. The average percentage point dose differences between the ion chamber and the EPID, AcurosXB, and AAA were 0.73  ±  1.25%, 0.38  ±  0.96% and 1.06  ±  1.34% respectively. For the patient (CT) dose comparisons, seven (3%/3 mm) and nine (2%/2 mm) plans failed the EPID versus AAA. All plans passed the EPID versus Acuros XB and the EPID versus forward model γ-comparisons. Four types of MLC sensitive errors (opening, shifting, stuck, and retracting), of varying magnitude (0.2, 0.5, 1.0, 2.0 mm), were introduced into six different SBRT-VMAT plans. γ-comparisons of the erroneous EPID dose and original predicted dose were carried out using the same criteria as above. For all plans, the sensitivity testing using a 3%/3 mm γ-test in the PTV successfully determined MLC errors on the order of 1.0 mm, except for the single leaf retraction-type error. A 2%/2 mm criteria produced similar results with two more additional detected errors.

Frame average optimization of cine-mode EPID images used for routine clinical in vivo patient dose verification of VMAT deliveries

PURPOSE

The in vivo 3D dose delivered to a patient during volumetric modulated arc therapy (VMAT) delivery can be calculated using electronic portal imaging device (EPID) images. These images must be acquired in cine-mode (i.e., "movie" mode) in order to capture the time-dependent delivery information. The angle subtended by each cine-mode EPID image during an arc can be changed via the frame averaging number selected within the image acquisition software. A large frame average number will decrease the EPID's angular resolution and will result in a decrease in the accuracy of the dose information contained within each image. Alternatively, less EPID images acquired per delivery will decrease the overall 3D patient dose calculation time, which is appealing for large-scale clinical implementation. Therefore, the purpose of this study was to determine the optimal frame average value per EPID image, defined as the highest frame averaging that can be used without an appreciable loss in 3D dose reconstruction accuracy for VMAT treatments.

METHODS

Six different VMAT plans and six different SBRT-VMAT plans were delivered to an anthropomorphic phantom. Delivery was carried out on a Varian 2300ix model linear accelerator (Linac) equipped with an aS1000 EPID running at a frame acquisition rate of 7.5 Hz. An additional PC was set up at the Linac console area, equipped with specialized frame-grabber hardware and software packages allowing continuous acquisition of all EPID frames during delivery. Frames were averaged into "frame-averaged" EPID images using matlab. Each frame-averaged data set was used to calculate the in vivo dose to the patient and then compared to the single EPID frame in vivo dose calculation (the single frame calculation represents the highest possible angular resolution per EPID image). A mean percentage dose difference of low dose (<20% prescription dose) and high dose regions (>80% prescription dose) was calculated for each frame averaged scenario for each plan. The authors defined their unacceptable loss of accuracy as no more than a ±1% mean dose difference in the high dose region. Optimal frame average numbers were then determined as a function of the Linac's average gantry speed and the dose per fraction.

RESULTS

The authors found that 9 and 11 frame averages were suitable for all VMAT and SBRT-VMAT treatments, respectively. This resulted in no more than a 1% loss to any of the dose region's mean percentage difference when compared to the single frame reconstruction. The optimized number was dependent on the treatment's dose per fraction and was determined to be as high as 14 for 12 Gy/fraction (fx), 15 for 8 Gy/fx, 11 for 6 Gy/fx, and 9 for 2 Gy/fx.

CONCLUSIONS

The authors have determined an optimal EPID frame averaging number for multiple VMAT-type treatments. These are given as a function of the dose per fraction and average gantry speed. These optimized values are now used in the authors' clinical, 3D, in vivo patient dosimetry program. This provides a reduction in calculation time while maintaining the authors' required level of accuracy in the dose reconstruction.

Investigation of the spatial resolution of an online dose verification device

PURPOSE

The aim of this work is to characterize a new online dose verification device, COMPASS transmission detector array (IBA Dosimetry, Schwarzenbruck, Germany). The array is composed of 1600 cylindrical ionization chambers of 3.8 mm diameter, separated by 6.5 mm center-to-center spacing, in a 40 × 40 arrangement.

METHODS

The line spread function (LSF) of a single ion chamber in the detector was measured with a narrow slit collimator for a 6 MV photon beam. The 0.25 × 10 mm(2) slit was formed by two machined lead blocks. The LSF was obtained by laterally translating the detector in 0.25 mm steps underneath the slit over a range of 24 mm and taking a measurement at each step. This measurement was validated with Monte Carlo simulation using BEAMnrc and DOSXYZnrc. The presampling modulation transfer function (MTF), the Fourier transform of the line spread function, was determined and compared to calculated (Monte Carlo and analytical) MTFs. Two head-and-neck intensity modulated radiation therapy (IMRT) fields were measured using the device and were used to validate the LSF measurement. These fields were simulated with the BEAMnrc Monte Carlo model, and the Monte Carlo generated incident fluence was convolved with the 2D detector response function (derived from the measured LSF) to obtain calculated dose. The measured and calculated dose distributions were then quantitatively compared using χ-comparison criteria of 3% dose difference and 3 mm distance-to-agreement for in-field points (defined as those above the 10% maximum dose threshold).

RESULTS

The full width at half-maximum (FWHM) of the measured detector response for a single chamber is 4.3 mm, which is comparable to the chamber diameter of 3.8 mm. The pre-sampling MTF was calculated, and the resolution of one chamber was estimated as 0.25 lp∕mm from the first zero crossing. For both examined IMRT fields, the χ-comparison between measured and calculated data show good agreement with 95.1% and 96.3% of in-field points below χ of 1.0 for fields 1 and 2, respectively (with an average χ of 0.29 for IMRT field 1 and 0.24 for IMRT field 2).

CONCLUSIONS

The LSF for a new novel online detector has been measured at 6 MV using a narrow slit technique, and this measurement has been validated by Monte Carlo simulation. The detector response function derived from line spread function has been applied to recover measured IMRT fields. The results have shown that the device measures IMRT fields accurately within acceptable tolerance.

A Monte Carlo investigation of contaminant electrons due to a novel in vivo transmission detector

A novel transmission detector (IBA Dosimetry, Germany) developed as an IMRT quality assurance tool, intended for in vivo patient dose measurements, is studied here. The goal of this investigation is to use Monte Carlo techniques to characterize treatment beam parameters in the presence of the detector and to compare to those of a plastic block tray (a frequently used clinical device). Particular attention is paid to the impact of the detector on electron contamination model parameters of two commercial dose calculation algorithms. The linac head together with the COMPASS transmission detector (TRD) was modeled using BEAMnrc code. To understand the effect of the TRD on treatment beams, the contaminant electron fluence, energy spectra, and angular distributions at different SSDs were analyzed for open and non-open (i.e. TRD and block tray) fields. Contaminant electrons in the BEAMnrc simulations were separated according to where they were created. Calculation of surface dose and the evaluation of contributions from contaminant electrons were performed using the DOSXYZnrc user code. The effect of the TRD on contaminant electrons model parameters in Eclipse AAA and Pinnacle(3) dose calculation algorithms was investigated. Comparisons of the fluence of contaminant electrons produced in the non-open fields versus open field show that electrons created in the non-open fields increase at shorter SSD, but most of the electrons at shorter SSD are of low energy with large angular spread. These electrons are out-scattered or absorbed in air and contribute less to surface dose at larger SSD. Calculated surface doses with the block tray are higher than those with the TRD. Contribution of contaminant electrons to dose in the buildup region increases with increasing field size. The additional contribution of electrons to surface dose increases with field size for TRD and block tray. The introduction of the TRD results in a 12% and 15% increase in the Gaussian widths used in the contaminant electron source model of the Eclipse AAA dose algorithm. The off-axis coefficient in the Pinnacle(3) dose calculation algorithm decreases in the presence of TRD compared to without the device. The electron model parameters were modified to reflect the increase in electron contamination with the TRD, a necessary step for accurate beam modeling when using the device.

A comparison of medical physics training and education programs--Canada and Australia

An overview and comparison of medical physics clinical training, academic education, and national certification/accreditation of individual professionals in Canada and Australia is presented. Topics discussed include program organization, funding, fees, administration, time requirements, content, program accreditation, and levels of certification/accreditation of individual Medical Physicists. Differences in the training, education, and certification/accreditation approaches between the two countries are highlighted. The possibility of mutual recognition of certified/accredited Medical Physicists is examined.

Investigation of tilted dose kernels for portal dose prediction in a-Si electronic portal imagers

The effect of beam divergence on dose calculation via Monte Carlo generated dose kernels was investigated in an amorphous silicon electronic portal imaging device (EPID). The flat-panel detector was simulated in EGSnrc with an additional 3.0 cm water buildup. The model included details of the detector's imaging cassette and the front cover upstream of it. To approximate the effect of the EPID's rear housing, a 2.1 cm air gap and 1.0 cm water slab were introduced into the simulation as equivalent backscatter material. Dose kernels were generated with an incident pencil beam of monoenergetic photons of energy 0.1, 2, 6, and 18 MeV. The orientation of the incident pencil beam was varied from 0 degrees to 14 degrees in 2 degrees increments. Dose was scored in the phosphor layer of the detector in both cylindrical (at 0 degrees) and Cartesian (at 0 degrees - 14 micro) geometries. To reduce statistical fluctuations in the Cartesian geometry simulations at large radial distances from the incident pencil beam, the voxels were first averaged bilaterally about the pencil beam and then combined into concentric square rings of voxels. Profiles of the EPID dose kernels displayed increasing asymmetry with increasing angle and energy. A comparison of the superposition (tilted kernels) and convolution (parallel kernels) dose calculation methods via the chi-comparison test (a derivative of the gamma-evaluation) in worst-case-scenario geometries demonstrated an agreement between the two methods within 0.0784 cm (one pixel width) distance-to-agreement and up to a 1.8% dose difference. More clinically typical field sizes and source-to-detector distances were also tested, yielding at most a 1.0% dose difference and the same distance-to-agreement. Therefore, the assumption of parallel dose kernels has less than a 1.8% dosimetric effect in extreme cases and less than a 1.0% dosimetric effect in most clinically relevant situations and should be suitable for most clinical dosimetric applications. The resulting time difference for the parallel kernel assumption versus the tilted kernels was 10.5 s vs 18 h (a factor of approximately 6000), dependent on existing hardware and software details.