Feasibility of output quality assurance considering gantry angle using “Stealth Chamber”

Purpose: This study was conducted to demonstrate the feasibility of X-ray output constancy quality assurance (QA) of a linear accelerator for various gantry angles using the Stealth Chamber. Methods: The X-ray output constancy of a Varian TrueBeam STx was evaluated under various gantry angles and a 10 × 10 cm2 field size using a Stealth Chamber. Specifically, 10X and 10X-flattening-filter-free beams with dose rates of 600 and 2400 monitor units (MU)/min, respectively, were used. The Stealth Chamber was attached to the gantry head, and irradiation was performed every 45° for gantry angles of 0-315°. To evaluate the variations in the output constancy with respect to the gantry angle, the acquired values were normalized to the value corresponding to a 0° gantry angle. The obtained results were utilized to determine the correction factors for all gantry angles. To verify the correction factors, additional measurements were performed for five days. Results: The maximum variation in the output constancy measurement relative to the output constancy at a 0° gantry angle was found to be approximately 4.0% for both energy beams at a gantry angle of 180°. Furthermore, the measured values were dependent on the gantry angle. Upon applying the correction factor, the variation in the output constancy with respect to the gantry angle was less than 0.5%. Conclusions: Output constancy QA using the Stealth Chamber for various gantry angles was found to be feasible with the application of a correction factor.

Robust Angle Selection in Particle Therapy

The popularity of particle radiotherapy has grown exponentially over recent years owing to the marked advantage of the depth–dose curve and its unique biological property. However, particle therapy is sensitive to changes in anatomical structure, and the dose distribution may deteriorate. In particle therapy, robust beam angle selection plays a crucial role in mitigating inter- and intrafractional variation, including daily patient setup uncertainties and tumor motion. With the development of a rotating gantry, angle optimization has gained increasing attention. Currently, several studies use the variation in the water equivalent thickness to quantify anatomical changes during treatment. This method seems helpful in determining better beam angles and improving the robustness of planning. Therefore, this review will discuss and summarize the robust beam angles at different tumor sites in particle radiotherapy.

Commissioning Measurements On An Elekta Unity MR-Linac

MR-guided radiotherapy technology is relatively new and commissioning publications, QA protocols and commercial products are limited. This work provides guidance for implementation measurements that may be performed on the Elekta Unity MR-Linac (Elekta, Stockholm, Sweden). Adaptions of vendor supplied phantoms facilitated determination of gantry angle accuracy and MV isocentre, whereas in-house developed phantoms were used for End-to-End (E2E) testing and anterior coil attenuation measurements. Third-party devices were used for measuring beam quality, reference dosimetry and during IMRT commissioning; however, due to several challenges, variations on standard techniques were required. Gantry angle accuracy was within 0.1°, confirmed with pixel intensity profiles, and MV isocentre diameter was < 0.5 mm. Anterior coil attenuation was < 0.6 %. Beam quality as determined by TPR20,10 was 0.704 ± 0.002, in agreement with treatment planning system (TPS) calculations, and gamma comparison against the TPS for a 22.0 × 22.0 cm2 field was above 95.0 % (2.0 %, 2.0 mm). G90 output was 1.000 ± 0.002 Gy per 100 MU, depth 5.0 cm. During IMRT commissioning, sub-standard results indicated issues with machine behaviour. Once rectified, gamma comparisons were above 95.0 % (2.0 %, 2.0 mm). Centres which may not have access to specialized equipment can use in-house developed phantoms, or adapt those supplied by the vendor, to perform commissioning work and confirm operation of the MRL within published tolerances. The IMRT QA devices and techniques used in this work highlight issues with machine behaviour when appropriate gamma criteria are set.

Radiation dosimetry effect evaluation of a carbon fiber couch on novel uRT-linac 506c accelerator

Recently, a diagnostic helical CT is integrated into a linear accelerator, called uRT-linac 506c, whose CT scanning dataset can be directly used to do simulation. This novel structure provides a possibility for online adaptive radiotherapy. For adaptive radiotherapy, the carbon fiber couch is an essential external device for supporting and positioning patients. And the effect on dose attenuation and distribution caused by a couch is inevitable and vital for precise treatment. In this research, the couch equipped with uRT-linac 506c was evaluated on the radiation dosimetry effect. The treatment couch equipped on the uRT-linac 506c accelerator was evaluated, and its effect on the attenuation, surface dose and dose buildup were measured for different phantom positions (offset = 0 cm, offset = + 10 cm and offset = − 10 cm, respectively) and different gantry angles. Since uRT-linac 506c is exclusively capable to provide diagnostic CT scanning data with real relative electron density (RED), this CT scanning data of the couch can be used directly in uRT-TPS to design plans. This scanned couch dataset was designated as the model A. The model B was a dummy structure of a treatment couch inserted with artificially preset RED. The dose calculation accuracy of these two models was compared using PB, CC, and MC on uRT-TPS. With the effect of carbon fiber couch, the surface dose was increased at least 97.94% for 25 × 25 cm2 field and 188.83% for 10 × 10 cm2 field, compared with those without. At different phantom positions (offset = 0, + 10, − 10 cm), the attenuation for 6 MV photon beam at gantry angle 180° were 4.4%, 4.4%, and 4.3%, respectively, and varied with changes of gantry angle. There do exists dose deviation between measurement and TPS calculation with the involvement of treatment couch, among the three algorithms, MC presented the least deviation, and the model A made less and steadier deviation than the model B, showing promising superiority. The attenuation, surface dose, and buildup effects of the carbon fiber couch in this study were measured similarly to most counterparts. The dose deviation calculated based on the couch dataset scanned by the diagnostic helical CT was smaller than those based on a dummy couch. This result suggests that an accelerator equipped with a diagnostic CT, which can help reduce the dose deviation of the carbon fiber couch, is a promising platform for online adaptive radiotherapy.

Evaluation of MU2net as an Online Secondary Dose Check for MR Guided Radiation Therapy with the Elekta Unity MR Linac

During the adaptive workflow associated with MRgRT, a secondary dose calculation is required and MU2net (DOSIsoft, France) is one commercial option. The suitability of MU2net to be used in conjunction with the online Monaco treatment planning system of the Elekta Unity (Elekta AB, Stockholm, Sweden), is evaluated in this work. Monaco and MU2net point doses are compared for various fields on and off axis and at different SSDs. To investigate the comparative effects of attenuation due to the cryostat, couch and posterior coil, measured, MU2net and Monaco dose outputs at the isocentre, as a function of gantry angle, were compared. Point doses for the beams of nine step and shoot IMRT (SSIMRT) test plans (courtesy Elekta) were calculated with Monaco v5.4 and compared to corresponding doses computed with MU2net. In addition, Monaco v5.4 and MU2net point doses were compared for 1552 beams treated on the Unity at our facility. For the on-axis fields investigated the agreement between MU2net and measured data is acceptable. MU2net and Monaco point doses for the Elekta SSIMRT test plans were within ± 5.0 % and ± 6.4 % for beams delivered from gantry zero and at planned beam angles, respectively. For the 1552 beams delivered approximately 80.0 % of MU2net and Monaco point doses agree within ± 5.0 %, therefore it is recommended to correlate MU2net Dose Reference Points (DRPs )with pre and post treatment dosimetry verification. Computational accuracy of MU2net could be enhanced with improved modelling of attenuation due to the couch, cryostat and posterior MR imaging coil.

Dosimetric characteristics of VMAT plans with respect to a different increment of gantry angle size for Ca cervix

Aim: We have investigated the influence in volumetric-modulated arc therapy (VMAT) plans by a sequence of increment of gantry angle (IGA) in definitive radiotherapy treatment for cervical cancer. The plans are quantitatively analysed in terms of conformity index (CI), heterogeneity index (HI), dose–gradient index (DGI), target coverage (TC) by prescription dose, monitor unit (MU) usage, control points (CPs) and dose to organs. Materials and Methods: In this retrospective study, we selected 27 patients with cervical cancer having aged between 54 and 69. All the patients enrolled in this study were at T3N1M0 stage of cervical cancer. The prescription dose to planning target volume (PTV) was 50 Gy and was administered in 2 Gy/fraction through VMAT technique. VMAT plans were optimised by varying the parameter ‘IGA’ as 10, 20, 30 and 40°. Results: Homogenous dose distribution within PTV and TC by prescription dose was significantly enhanced (p < 0·05) with larger IGA. The difference between volume receiving 15 Gy (V15Gy) in bowel was up to 10% with larger IGA (30 and 40°) and V25Gy in femoral head was up to 3% with smaller IGA (10 and 20°). CPs were enhanced and MU usage was reduced with larger IGA (30 and 40°). IGA 40° had reduced the MU usage than IGA 30° but the CI and DGI were compromised due to large MLC field segments. Conclusion: This study recommends that the larger IGA could yield better results when the number of sectors is even, for a cervical cancer patient. However, more data from more patients need to be obtained and analysed to make this an evidence-based hypothesis.

Intelligent IoT-based large-scale inverse planning system considering postmodulation factors

The model and algorithm of intensity-modulated radiotherapy (IMRT) are updated increasingly quickly, but the hardware upgrade of primary hospitals often lags behind. The new generation of intelligent precise radiotherapy platforms provides users with intelligent medical consortium services using big data, artificial intelligence and industrial Internet of Things technology. This technology can ensure that under the real-time guidance of a professional medical consortium, primary hospitals can realize rapid large-scale reverse planning design and can more accurately consider many factors of postprocessing. Although large-scale healthcare systems, such as volumetric-modulated arc therapy and other accurate radiotherapy technologies, have developed rapidly, the development of step-and-shoot-mode IMRT technology is still very important for developing countries. For software, in addition to the conformity of the dose distribution, the modulation speed, convenience and stability of the later dose delivery should also be considered in inverse planning. Therefore, this paper analyzes the main problems in conventional IMRT inverse planning, including the smoothing of the fluence map, the selection of the gantry angle and the dose leakage of tongue–groove effects. To address these issues, a novel Intelligent IoT-based large-scale inverse planning strategy with the key factors of the postmodulation is developed, and a detailed flow chart is also provided. The scheme consists of two steps. The first step is to obtain a relatively optimal combination of gantry angles by considering the dose distribution requirements and constraints and the modulation requirements and constraints. The second step is to optimize the intensity map, to smooth the map based on prior knowledge according to the determined angles, and to obtain the final modulation scheme according to the relevant objectives and constraints of the map decomposition (leaf sequencing). In an experiment, we calculate and validate the clinical head and neck case. Because of the special gantry angle selection, the angle combination is optimized from the initial equivalent distribution to adapt to the target area and protect the nontarget area. The value of the objective function varies greatly after the optimization, especially in the target area, and the target value decreases by approximately 10%. On this basis, we smooth the fluence map by a partial differential equation with prior knowledge and a minimization of the total number of monitor units. It is also shown from the objective function value that the target value is essentially unchanged for the target area, while for the nontarget area, the value decreases by 16%, which is very impressive.