EP-1307: Innovative QA methodology for true patient-specific Dose Volume Histograms (DVHs) measurements

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Apparent diffusion coefficient measurements on a novel diffusion weighted MRI phantom utilizing EPI and HASTE sequences

Purpose: The aim of this study is to introduce a novel DWI-MRI phantom and to compare Apparent Diffusion Coefficient (ADC) measurements, utilizing EPI-DWI and HASTE-DWI sequences and two different fitting algorithms. Materials and Methods: 23 test tubes with different sucrose concentrations and polyacrylamide gels were used as a phantom for ADC measurements. The phantom was scanned on a clinical MRI system (1.5 T) over a two-month period utilizing an EPI-DWI and a HASTE-DWI sequence. ADC maps were calculated using a Weighted Linear (WL) and a Non Linear (NL) fitting algorithm. Measurements were performed with two sequences and two fitting algorithms. Geometric Distortions (GD), Ghosting Ratios (GR) and Signal to Structured Noise Ratios (SSNRs) were estimated using both sequences from the resultant ADC parametric maps. Results: Polyacrylamide gels reveal lower coefficient of variation (CV%) as compared to sucrose solutions. ADC measurements performed with WL and NL algorithms reveal identical results with both sequences. WL and NL algorithms require approx. 3 s and 7 min respectively, for a single slice. EPI-DWI reveals a mean percent ADC value difference of (+4.5%) as compared to HASTE-DWI, regardless the type of fitting algorithm. Conclusion: Polyacrylamide gels can serve as a better means for simulating ADC values, compared with sucrose solutions used in this study. WL can be proposed as the method for ADC measurements in daily clinical practice. WL is significantly faster than NL fitting method and equally precise. SSNR measured directly on ADC maps is an excellent means for testing the precision of ADC measurements. © 2020 Associazione Italiana di Fisica Medic

Dosimetric performance of the Elekta Unity MR-linac system: 2D and 3D dosimetry in anthropomorphic inhomogeneous geometry

Following the clinical introduction of the Elekta Unity MR-linac, there is an urgent need for development of dosimetry protocols and tools, not affected by the presence of a magnetic field. This work presents a benchmarking methodology comprising 2D/3D passive dosimetry and involving on-couch adaptive treatment planning, a unique step in MR-linac workflows. Two identical commercially available 3D-printed head phantoms (featuring realistic bone anatomy and MR/CT contrast) were employed. One phantom incorporated a film dosimetry insert, while the second was filled with polymer gel. Gel dose-response characteristics were evaluated under the Unity irradiation and read-out conditions, using vials and a cubic container filled with gel from the same batch. Treatment plan for the head phantoms involved a hypothetical large C-shape brain lesion, partly surrounding the brainstem. An IMRT step-and-shoot 7-beam plan was employed. Pre-treatment on-couch MR-images were acquired in order for the treatment planning system to calculate the virtual couch shifts and perform adaptive planning. Absolute 2D and relative 3D measurements were compared against calculations related to both adapted and original plans. Real-time dose accumulation monitoring in the gel-filled phantom was also performed. Results from the vials and cubic container suggest that gel dose-response is linear in the dose range investigated and signal integrity is mature at the read-out timings considered. Head phantom 2D and 3D measurements agreed well with calculations with 3D gamma index passing rates above 90% in all cases, even with the most stringent criteria used (2 mm/2%). By exploiting the 3D information provided by the gel, comparison also involved DVHs, dose-volume and plan quality metrics, which also reflected the agreement between adapted and delivered plans within ±4%. No considerable discrepancies were detected between adapted and original plans. A novel methodology was developed and implemented, suitable for QA procedures in Unity. TPS calculations were validated within the experimental uncertainties involved. © 2019 Institute of Physics and Engineering in Medicine

Validation of PTV margin for Gamma Knife Icon frameless treatment using a PseudoPatient® Prime anthropomorphic phantom

The Gamma Knife Icon allows the treatment of brain tumors mask-based single-fraction or fractionated treatment schemes. In clinic, uniform axial expansion of 1 mm around the gross tumor volume (GTV) and a 1.5 mm expansion in the superior and inferior directions are used to generate the planning target volume (PTV). The purpose of the study was to validate this margin scheme with two clinical scenarios: (a) the patient’s head remaining right below the high-definition motion management (HDMM) threshold, and (b) frequent treatment interruptions followed by plan adaptation induced by large pitch head motion. A remote-controlled head assembly was used to control the motion of a PseudoPatient® Prime head phantom; for dosimetric evaluations, an ionization chamber, EBT3 films, and polymer gels were used. These measurements were compared with those from the Gamma Knife plan. For the absolute dose measurements using an ionization chamber, the percentage differences for both targets were less than 3.0% for all scenarios, which was within the expected tolerance. For the film measurements, the two-dimensional (2D) gamma index with a 2%/2 mm criterion showed the passing rates of ≥87% in all scenarios except the scenario 1. The results of Gel measurements showed that GTV (D100) was covered by the prescription dose and PTV (D95) was well above the planned dose by up to 5.6% and the largest geometric PTV offset was 0.8 mm for all scenarios. In conclusion, the current margin scheme with HDMM setting is adequate for a typical patient’s intrafractional motion. © 2020 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals LLC on behalf of American Association of Physicists in Medicine