Faculty Bibliography

Modern radiation therapy requires reproducible patient positioning and limited intra-fraction motion. The patient immobilization equipment that enables this is the theme for the 2019 Exhibit Hall Guided Tours in Radiation Therapy. This year's Guided Tours will begin with an overview of current immobilization equipment from the tour leader. Following the tour leader's presentation, participants in the guided tours will split into groups led by a tour guide and visit participating vendors who will demonstrate their immobilization equipment. Each vendor will present educational materials about patient immobilization to the guided tour participants. Outline: The tour leader's introduction will cover the following aspects of immobilization equipment: 1. Site-specific options for patient immobilization 2. Dosimetric effects of immobilization equipment 3. Impact of intra-fraction motion monitoring on immobilization requirements

Purpose: Radiation induced interstitial pneumonitis and late renal dysfunction are major concerns for patients undergoing total body irradiation (TBI). The purpose of this work is to evaluate the dosimetry of VMAT-based TBI plans generated using Varian Eclipse scripting.
Method(s): Three full-body CT datasets (two patients, one anthropomorphic CIRS phantom) were used. An in-house Eclipse script was developed to generate optimized field arrangements using the body contour, user origin, and couch longitudinal travel. Plans consisted of a lower-body AP/PA portion and an upper-body VMAT portion (8 full arcs with 4-isocenters). Treatment plans to 1320 cGy (165 cGy x 8fx) were generated with dose directives: [PTV V100% >=90- 95%; Total lung Dmean <900 cGy; Kidneys Dmean <1100 cGy]. All plans used 6MV photons and were calculated using the AAA algorithm. Upperbody VMAT plan dosimetry was evaluated 'in-phantom' placing 12 OSLDs in different key locations (lung, kidneys, bone, and soft tissue). Additionally, dosimetric verification was performed for the three plans using Varian portal dosimetry, PerFraction(SNC) and ArcCheck(SNC) with a global gamma criterion of 2%/2 mm.
Result(s): Planning objectives were met for the three treatment plans with the following averages: PTV V100% = 94.02%, total lung Dmean = 872.9 cGy, and kidneys Dmean = 1075.8 cGy. The dose deviation between Eclipse and the OSLDs (relative to the prescribed dose) averaged 0.98%, with each individual dose deviation within +/-4%. Dose ranged between 52.5 cGy (lung) and 187.5 cGy (bone) for OSLD measurements. The average passing rate for all 24 fields (8 per plan) was 98.0%, 99.76% and 98.6% for portal dosimetry, PerFraction and ArcCheck respectively. The lowest passing rate of any individual field was 95.4%, 99.0% and 91.8% for portal dosimetry, PerFraction and ArcCheck respectively.
Conclusion(s): Eclipse scripting can assist in creating robust multi-isocentric VMATbased TBI treatment plans to block lungs and kidneys without compromising target coverage. Dosimetric accuracy and deliverability was confirmed using in-phantom OSLD dosimetry, Varian portal dosimetry, PerFraction and Arc-Check verification

Modern radiation therapy requires reproducible patient positioning and limited intra-fraction motion. The patient immobilization equipment that enables this is the theme for the 2019 Exhibit Hall Guided Tours in Radiation Therapy. This year's Guided Tours will begin with an overview of current immobilization equipment from the tour leader. Following the tour leader's presentation, participants in the guided tours will split into groups led by a tour guide and visit participating vendors who will demonstrate their immobilization equipment. Each vendor will present educational materials about patient immobilization to the guided tour participants. Outline: The tour leader's introduction will cover the following aspects of immobilization equipment: 1. Site-specific options for patient immobilization 2. Dosimetric effects of immobilization equipment 3. Impact of intra-fraction motion monitoring on immobilization requirements Learning Objectives: 1. Describe various options for patient immobilization 2. Understand the dosimetric effect of immobilization equipment on the patient 3. Describe immobilization requirements for different sites and procedures

PURPOSE/OBJECTIVE:We calculated setup margins for whole breast radiotherapy during voluntary deep-inspiration breath-hold (vDIBH) using real-time surface imaging (SI). METHODS AND MATERIALS/METHODS:Patients (n = 58) with a 27-to-31 split between right- and left-sided cancers were analyzed. Treatment beams were gated using AlignRT by registering the whole breast region-of-interest to the surface generated from the simulation CT scan. AlignRT recorded (three-dimensional) 3D displacements and the beam-on-state every 0.3 s. Means and standard deviations of the displacements during vDIBH for each fraction were used to calculate setup margins. Intra-DIBH stability and the intrafraction reproducibility were estimated from the medians of the 5th to 95th percentile range of the translations in each breath-hold and fraction, respectively. RESULTS:A total of 7269 breath-holds were detected over 1305 fractions in which a median dose of 200 cGy was delivered. Each fraction was monitored for 5.95 ± 2.44 min. Calculated setup margins were 4.8 mm (A/P), 4.9 mm (S/I), and 6.4 mm (L/R). The intra-DIBH stability and the intrafraction reproducibility were ≤0.7 mm and ≤2.2 mm, respectively. The isotropic margin according to SI (9.2 mm) was comparable to other institutions' calculations that relied on x-ray imaging and/or spirometry for patients with left-sided cancer (9.8-11.0 mm). Likewise, intra-DIBH variability and intrafraction reproducibility of breast surface measured with SI agreed with spirometry-based positioning to within 1.2 and 0.36 mm, respectively. CONCLUSIONS:We demonstrated that intra-DIBH variability, intrafraction reproducibility, and setup margins are similar to those reported by peer studies who utilized spirometry-based positioning.

Purpose/UNASSIGNED:Interstitial brachytherapy implemented for locally advanced gynecologic cancer can result in toxicity due to the proximity of organs at risk (OAR). We report our experience using superflab bolus as vaginal packing to displace OAR during interstitial brachytherapy. Material and methods/UNASSIGNED:including external beam radiation therapy (EBRT). 5-6 Gy per fraction was delivered biologically effective dose (BID) over 2-3 days in 1-2 implants. Toxicities were evaluated post-treatment, 1 month, and 3 months. Results/UNASSIGNED:= 0.4). Conclusions/UNASSIGNED:Our initial experience with superflab as vaginal packing demonstrates technical feasibility and dosimetric improvement for OAR.

The quantity of relevance for external beam radiotherapy is absorbed dose to water (ADW). An interferometer was built, characterized, and tested to measure ADW within the dose range of interest for external beam radiotherapy using the temperature dependence of the refractive index of water. The interferometer was used to measure radiation-induced phase shifts of a laser beam passing through a (10 × 10 × 10) cm³ water-filled glass phantom, irradiated with a 6 MV photon beam from a medical linear accelerator. The field size was (7 × 7) cm² and the dose was measured at a depth of 5 cm in the water phantom. The intensity of the interference pattern was measured with a photodiode and was used to calculate the time-dependent phase shift curve. The system was thermally insulated to achieve temperature drifts of less than 1.5 mK/min. Data were acquired 60 s before and after the irradiation. The radiation-induced phase shifts were calculated by taking the difference in the pre- and post-irradiation drifts extrapolated to the midpoint of the irradiation. For 200, 300, and 400 monitor units, the measured doses were 1.6 ± 0.3, 2.6 ± 0.3, and 3.1 ± 0.3 Gy, respectively. Measurements agreed within the uncertainty with dose calculations performed with a treatment planning system. The estimated type-A, k = 1 uncertainty in the measured doses was 0.3 Gy which is an order of magnitude lower than previously published interferometer-based ADW measurements.

PURPOSE/OBJECTIVE:Energy-based source strength metrics may find use with model-based dose calculation algorithms, but no instruments exist that can measure the energy emitted from low-dose rate (LDR) sources. This work developed a calorimetric technique for measuring the power emitted from encapsulated low-dose rate, photon-emitting brachytherapy sources. This quantity is called emitted power (EP). The measurement methodology, instrument design and performance, and EP measurements made with the calorimeter are presented in this work. METHODS:A calorimeter operating with a liquid helium thermal sink was developed to measure EP from LDR brachytherapy sources. The calorimeter employed an electrical substitution technique to determine the power emitted from the source. The calorimeter's performance and thermal system were characterized. EP measurements were made using four (125)I sources with air-kerma strengths ranging from 2.3 to 5.6 U and corresponding EPs of 0.39-0.79 μW, respectively. Three Best Medical 2301 sources and one Oncura 6711 source were measured. EP was also computed by converting measured air-kerma strengths to EPs through Monte Carlo-derived conversion factors. The measured EP and derived EPs were compared to determine the accuracy of the calorimeter measurement technique. RESULTS:The calorimeter had a noise floor of 1-3 nW and a repeatability of 30-60 nW. The calorimeter was stable to within 5 nW over a 12 h measurement window. All measured values agreed with derived EPs to within 10%, with three of the four sources agreeing to within 4%. Calorimeter measurements had uncertainties ranging from 2.6% to 4.5% at the k = 1 level. The values of the derived EPs had uncertainties ranging from 2.9% to 3.6% at the k = 1 level. CONCLUSIONS:A calorimeter capable of measuring the EP from LDR sources has been developed and validated for (125)I sources with EPs between 0.43 and 0.79 μW.