An EPID-based method for comprehensive verification of gantry, EPID and the MLC carriage positional accuracy in Varian linacs during arc treatments

BACKGROUND: In modern radiotherapy, it is crucial to monitor the performance of all linac components including gantry, collimation system and electronic portal imaging device (EPID) during arc deliveries. In this study, a simple EPID-based measurement method has been introduced in conjunction with an algorithm to investigate the stability of these systems during arc treatments with the aim of ensuring the accuracy of linac mechanical performance. METHODS: The Varian EPID sag, gantry sag, changes in source-to-detector distance (SDD), EPID and collimator skewness, EPID tilt, and the sag in MLC carriages as a result of linac rotation were separately investigated by acquisition of EPID images of a simple phantom comprised of 5 ball-bearings during arc delivery. A fast and robust software package was developed for automated analysis of image data. Twelve Varian linacs of different models were investigated. RESULTS: The average EPID sag was within 1 mm for all tested linacs. All machines showed less than 1 mm gantry sag. Changes in SDD values were within 1.7 mm except for three linacs of one centre which were within 9 mm. Values of EPID skewness and tilt were negligible in all tested linacs. The maximum sag in MLC leaf bank assemblies was around 1 mm. The EPID sag showed a considerable improvement in TrueBeam linacs. CONCLUSION: The methodology and software developed in this study provide a simple tool for effective investigation of the behaviour of linac components with gantry rotation. It is reproducible and accurate and can be easily performed as a routine test in clinics

Investigation of a modified electronic portal imaging device for improving dosimetry in radiotherapy

Research Doctorate - Doctor of Philosophy (PhD)In modern radiotherapy treatments such as Intensity Modulated Radiation Therapy (IMRT), megavoltage beams are delivered using plans that usually include sharp dose gradients. Therefore, high resolution dosimetry devices which provide accurate two-dimensional data are required to ensure the correct delivery of radiation fields. There has been growing interest on using Electronic portal imaging devices (EPIDs) for dosimetry applications. A major problem associated with amorphous silicon (a-Si) EPIDs for transit dosimetry is the presence of a phosphor layer, which can introduce large deviations from water-equivalent behaviour due to energy-dependent response and visible light scattering. In the present study, the phosphor scintillator screen and all other layers above it were removed from the structure of a research-dedicated a-Si EPID and were replaced by buildup layers. The modified EPID (to direct detection configuration) was evaluated for dosimetry applications by comparison to ionization chamber in water measurements for 6 and 18 MV treatment beams. The indirect (unmodified) EPID was similarly investigated in transit dosimetry conditions for comparison. The direct EPID with 3 cm solid water buildup showed water-equivalent response in all tested conditions except for very thick phantoms in 6 MV beams which could be easily corrected, while the indirect EPID was sensitive to changes in field size, phantom thickness and off-axis distance. Some of the EPID characteristics which could affect dosimetry measurements (such as dose rate dependence and image lag) were also investigated for both EPID configurations. The direct EPID was tested for absolute dosimetry measurements with slab and anthropomorphic phantoms in a number of clinical IMRT fields by comparison to a two dimensional array of ionization chambers used as reference and the Gamma evaluation (3%, 3 mm criteria) showed that on average 97.9% of points had a Gamma index less than 1. Monte Carlo method was used to simulate the head of a linear accelerator for 6 MV beams (using BEAMnrc) and the direct EPID (using DOSXYZnrc). The models were then used to simulate the same transit dosimetry conditions as used for the measurements. The agreement of the relative measured and simulated image profiles on the central axis were within 3% for square fields with slab phantoms in the beam. For a head and neck phantom in a dynamic IMRT beam, the Gamma evaluation of measured and simulated relative dose images showed 80.3% of points with Gamma index less than 1 (3%, 3 mm criteria). A simple measurement-based correction model was also developed to correct the EPID images and use them for water-equivalent transit dosimetry without the application of any kernels. The model was tested by comparison of the absolute dose images measured by the EPID and a reference two dimensional array of ionization chambers for clinical IMRT fields in transit conditions, and as a result on average 99.5% of points had a Gamma index less than 1 (3%, 3 mm criteria). The only drawback of using the EPID in direct configuration is the poor quality of images compared with the indirect EPID. If direct EPIDs are used as two-dimensional dosimeters mounted on linacs, on-board kilovoltage imaging devices could be used as an alternative for the EPID (as imager) to confirm patient positioning

Verification of the linac isocenter for stereotactic radiosurgery using cine-EPID imaging and arc delivery

Purpose:Verification of the mechanical isocenter position is required as part of comprehensive quality assurance programs for stereotactic radiosurgery/radiotherapy (SRS/SRT) treatments. Several techniques have been proposed for this purpose but each of them has certain drawbacks. In this paper, a new efficient and more comprehensive method using cine-EPID images has been introduced for automatic verification of the isocenter with sufficient accuracy for stereotactic applications.Methods: Using a circular collimator fixed to the gantry head to define the field, EPID images of a Winston–Lutz phantom were acquired in cine-imaging mode during 360° gantry rotations. A robust matlab code was developed to analyze the data by finding the center of the field and the center of the ball bearing shadow in each image with sub-pixel accuracy. The distance between these two centers was determined for every image. The method was evaluated by comparison to results of a mechanical pointer and also by detection of a manual shift applied to the phantom position. The repeatability and reproducibility of the method were tested and it was also applied to detect couch and collimator wobble during rotation.Results:The accuracy of the algorithm was 0.03 ± 0.02 mm. The repeatability was less than 3 μm and the reproducibility was less than 86 μm. The time elapsed for the analysis of more than 100 cine images of Varian aS1000 and aS500 EPIDs were ∼65 and 20 s, respectively. Processing of images taken in integrated mode took 0.1 s. The output of the analysis software is printable and shows the isocenter shifts as a function of angle in both in-plane and cross-plane directions. It gives warning messages where the shifts exceed the criteria for SRS/SRT and provides useful data for the necessary adjustments in the system including bearing system and/or room lasers.Conclusions: The comprehensive method introduced in this study uses cine-images, is highly accurate, fast, and independent of the observer. It tests all gantry angles and is suitable for pretreatment QA of the isocenter for stereotactic treatments

Transit dosimetry in dynamic IMRT with an a-Si EPID

Using an amorphous silicon (a-Si) EPID for transit dosimetry requires detailed characterization of its dosimetric response in a variety of conditions. In this study, a measurement-based model was developed to calibrate an a-Si EPID response to dose for transit dosimetry by comparison with a reference ionization chamber. The ionization chamber reference depth and the required additional buildup thickness for electronic portal imaging devices (EPID) transit dosimetry were determined. The combined effects of changes in radiation field size, phantom thickness, and the off-axis distance on EPID transit dosimetry were characterized. The effect of scattered radiation on out-of-field response was investigated for different field sizes and phantom thicknesses by evaluation of the differences in image profiles and in-water measured profiles. An algorithm was developed to automatically apply these corrections to EPID images based on the user-specified field size and phantom thickness. The average phantom thickness and an effective field size were used for IMRT fields, and images were acquired in cine mode in the presence of an anthropomorphic phantom. The effective field size was defined as the percentage of the jaw-defined field that was involved during the delivery. Nine head and neck dynamic IMRT fields were tested by comparison with a MatriXX two-dimensional array dosimeter using the Gamma (3 %, 3 mm) evaluation. A depth of 1.5 cm was selected as the ionization chamber reference depth. An additional 2.2 mm of copper buildup was added to the EPID. Comparison of EPID and MatriXX dose images for the tested fields showed that using a 10 % threshold, the average number of points with Gamma index <1 was 96.5 %. The agreement in the out-of field area was shown by selection of a 2 % threshold which on average resulted in 94.8 % of points with a Gamma index <1. The suggested method is less complicated than previously reported techniques and can be used for all a-Si EPIDs regardless of the manufacturer

Reduction of the effect of non-uniform backscatter from an E-type support arm of a Varian a-Si EPID used for dosimetry

Backscatter from the metallic components in the support arm is one of the sources of inaccuracy in dosimetry with Varian amorphous silicon electronic portal imaging devices (a-Si EPIDs). In this study, the non-uniform arm backscatter is blocked by adding lead sheets between the EPID and an E-type support arm. By comparing the EPID responses on and off the arm, with and without lead and considering the extra weight on the imager, 2 mm of lead was determined as the optimum thickness for both 6 and 18 MV beam energies. The arm backscatter at the central axis with the 2 mm lead in place decreased to 0.1% and 0.2% for the largest field size of 30 x 30 cm² using 6 and 18 MV beams, from 2.3% and 1.3% without lead. Changes in the source–to-detector distance (SDD) did not affect the backscatter component more than 1%. The symmetry of the in-plane profiles improved for all field sizes for both beam energies. The addition of lead decreased the contrast-to-noise ratio and resolution by 1.3% and 0.84% for images taken in 6 MV and by 0.5% and 0.38% for those in 18 MV beams. The displacement of the EPID central pixel was measured during a 360° gantry rotation with and without lead which was 1 pixel different. While the backscatter reduces with increasing lead thickness, a 2 mm lead sheet seems sufficient for acceptable dosimetry results without any major degradation to the routine performance of the imager. No increase in patient skin dose was detected

Improvement of Varian a-Si EPID dosimetry measurements using a lead-shielded support-arm

Dosimetry measurements with Varian amorphous silicon electronic portal imaging devices (a-Si EPIDs) are affected by the backscattered radiation from the EPID support arm. In this study, the nonuniform backscatter from an E-type support arm was reduced by fixing a thick (12.2 × 10.5 × 0.5 cm³) piece of lead on top of the arm, and the remaining backscatter was modeled and included in an existing dose prediction algorithm. The applied backscatter kernel was the average of kernels on different regions of the EPID over the arm. The lead-shielded arm reduced the nonuniform backscatter component by about 50% for field sizes ranging from 3 × 3 to 30 × 30 cm² and the field symmetry improved for medium to large fields up to 3%. Gamma evaluation of the measured and modeled doses (2%, 2-mm criteria) showed that using the lead-shielded arm in the model increased the number of points with Gamma index <1 by 5.7% and decreased the mean Gamma by 0.201. Even using the lead alone (no modeling) could increase the number of points with Gamma index <1 by 4.7% and decrease the mean Gamma by 0.153. This is a simple and easy method to decrease the nonuniform arm backscatter and improve the accuracy of dosimetry measurements with the existing EPIDs used for clinical applications

Isocenter verification for linac-based stereotactic radiation therapy: review of principles and techniques

There have been several manual, semi-automatic and fully-automatic methods proposed for verification of the position of mechanical isocenter as part of comprehensive quality assurance programs required for linear accelerator-based stereotactic radiosurgery/radiotherapy (SRS/SRT) treatments. In this paper, a systematic review has been carried out to discuss the present methods for isocenter verification and compare their characteristics, to help physicists in making a decision on selection of their quality assurance routine

EPID-based verification of the MLC performance for dynamic IMRT and VMAT

Purpose: In advanced radiotherapy treatments such as intensity modulated radiation therapy(IMRT) and volumetric modulated arc therapy (VMAT), verification of the performance of the multileaf collimator(MLC) is an essential part of the linac QA program. The purpose of this study is to use the existing measurement methods for geometric QA of the MLCs and extend them to more comprehensive evaluation techniques, and to develop dedicated robust algorithms to quantitatively investigate the MLC performance in a fast, accurate, and efficient manner. Methods: The behavior of leaves was investigated in the step-and-shoot mode by the analysis of integrated electronic portal imaging device(EPID)images acquired during picket fence tests at fixed gantry angles and arc delivery. The MLC was also studied in dynamic mode by the analysis of cine EPIDimages of a sliding gap pattern delivered in a variety of conditions including different leaf speeds, deliveries at fixed gantry angles or in arc mode, and changing the direction of leaf motion. The accuracy of the method was tested by detection of the intentionally inserted errors in the delivery patterns. Results: The algorithm developed for the picket fence analysis was able to find each individual leaf position, gap width, and leaf bank skewness in addition to the deviations from expected leaf positions with respect to the beam central axis with sub-pixel accuracy. For the three tested linacs over a period of 5 months, the maximum change in the gap width was 0.5 mm, the maximum deviation from the expected leaf positions was 0.1 mm and the MLC skewness was up to 0.2°. The algorithm developed for the sliding gap analysis could determine the velocity and acceleration/deceleration of each individual leaf as well as the gap width. There was a slight decrease in the accuracy of leaf performance with increasing leaf speeds. The analysis results were presented through several graphs. The accuracy of the method was assessed as 0.01 mm for both the gap size and peak position determination. Conclusions: This study provides fast, easy, and accurate test methods for routine QA of the MLC performance and helps in faster troubleshooting of MLC problems in both IMRT and VMAT treatments

Preparation and Biological Evaluation of a [55Co]-2-Acetylpyridine Thiosemicarbazone

Due to the anti-proliferative properties of cobalt-thiosemicarbazone complexes, the production of [55Co](III)-bis-(2-acetylpyridine thiosemicarbazone) ([55Co](III)[APTS]2) was investigated. Co-55 (T1/2=17.53 h) was produced by 150 μA irradiation of a natural nickel target by 15 MeV protons. The 55Co was separated from the irradiated target material using a two-step method with a radiochemical yield of &gt;95% followed by radionuclidic and chemical purity control. [55Co](III)chloride was mixed with 2-acetylpyridine thiosemicarbazone for 30 min at room temperature to yield [55Co](III)[APTS]2 (radiochemical purity &gt; 98% shown by RTLC/HPLC). A specific activity of about 10–20 Ci/mmol was obtained. The final solution was diluted in normal saline to 5% ethanolic solution for biological evaluation. The stability of the final product was checked in the absence and presence of human serum at 37°C to 24 h. The partition co-efficient of the final complex at the pH of 7 was 1.00±0.08. A significant tumor accumulation (%ID/g; 3.5%) was observed in tumoral tissue 21 h post injection in fibrosarcoma-bearing mice by biodistribution studies. Co-incidence imaging also demonstrated tumor uptake from 21–35 h however at 35 h tumor uptake is more specific and significant

Gantry angle determination during arc IMRT: evaluation of a simple EPID-based technique and two commercial inclinometers

The increasing popularity of intensity-modulated arc therapy (IMAT) treatments requires specifically designed linac quality assurance (QA) programs. Gantry angle is one of the parameters that has a major effect on the outcome of IMAT treatments since dose reconstruction for patient-specific QA relies on the gantry angle; therefore, it is essential to ensure its accuracy for correct delivery of the prescribed dose. In this study, a simple measurement method and algorithm are presented for QA of gantry angle measurements based on integrated EPID images acquired at distinct gantry angles and cine EPID images during an entire 360° arc. A comprehensive study was carried out to evaluate this method, as well as to evaluate two commercially available inclinometers (NG360 and IBA GAS supplied in conjunction with popular array dosimeters Delta4 and MatriXXEvolution, respectively) by comparing their simultaneous angle measurement results with the linac potentiometer readouts at five gantry speeds. In all tested measurement systems, the average differences with the reference angle data were less than 0.3° in static mode. In arc mode, at all tested gantry speeds the average difference was less than 0.1° for the IBA GAS and the proposed EPID-based method, and 0.6° for the NG360 after correction for the inherent systematic time delay of the inclinometer. The gantry rotation speed measured by the three independent systems had an average deviation of about 0.01°/s from the nominal gantry speed