Advanced Radiotherapy

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1 Advanced Radiotherapy IBA Concept for IMRT Verification Dr. Lutz Müller 1

2 IMRT Verification BIS BIS ADAS Fluence Model Delivered fluence Target Volume Constraints Inverse Backprojection Fluence Map Leaf Sequencer Leaf & Gantry sequence Desired 3-d dose distribution Film Body Phantom WBIS Delivered 3-d dose distribution

3 Film Integrated IMRT concept Input from TPS DICOM RT RTOG Proprietary formats Solid Phantoms (Body, H&N) Absolute Dosimetry OmniPro Software Platform In Vivo with R&V link BIS-G D-Amorphous Silicon 3

4 OmniPro - IMRT 4

5 Solid-State Phantoms Body Phantom Head and neck Phantom Devices: Film Absolute Probes Applications: Interface to all common TPS Verification of plan MU verification 5

6 BIS-G System 6

7 Scintillator Incident Radiation Reflected Light 1-bit CCD Camera Mirror Digital output to frame grabber 7

8 Key features Fast and simple set-up: less than 5 minutes. Positioning on table or in gantry accessory holder. Minimum acquisition time: 10 msec per D image. Typical acquisition time: 500 msec per D image. Intensity resolution: 1 bit. Acquisition of D-images in a sequence. Spatial resolution 0.4 x 0.4 mm. Field size up to 400 x 400 mm. Acquisition and analysis integrated in OmniPro software platform. 8

9 Key applications On-line D dose distribution (leave movement) D Fluence measurements Verification of complex fields: MLC, dynamic wedge Linac start-up behaviour Fast daily QA of accelerators (symm.,flatness etc.) Leakage of MLC Light vs radiation field congruence Adjustment of LINAC (on-line 1D inplane+crossplane) 9

10 Fluence Verification - Step and-shoot Elekta 16 MV ADAC Pinnacle Step-and-shoot BIS Film ADAS EPID (Elekta i-view) Planar dose from pinnacle 1 0

11 Pyramide Pyramide: 10 square Fields (x,4x4,...0x0 cm 10 MU each Used for film calibration 1 1

12 IMRT field Prostate plan 5 fields 0 : 7 segments 1

13 Startup behaviour Dose Rate [arb. units] Startup Elekta 16MV Startup Behaviour Time [ms] 1 3

14 BIS vs. Film Signal (arb. units) crossline (cm) SumResc-BIS Film 1 4

15 A-Si Detector Build-up (removable) Backscatter (removable) Aluminum Graphite Polyimide a-si PC-board 1 5

16 Wedge profile ADAS vs. WP blue 1000 Dose [arb. units] % Position [cm] 1 6

17 BIS vs. ADAS Signal (arb. units) crossline (cm) BIS ADAS 1 7

18 BIS vs. Pinnacle planar dose Signal (arb. units) crossline (cm) Plan BIS 1 8

19 We discovered a delivery error! What is that??? planned BIS Direct integral corrected 1 9

20 Measurements at Ulm Univ. Hospital Dynamic delivery Short delivery times (max. ca. 1 min) Moderate dose rate (300 MU/min) plans: 5-field prostate, field mamma Complete movies taken Fixed at accessory holder 300ms integration time 1 GB RAM 0

21 BIS vs. Cadplan 1

22 Fluence reconstruction more complex n m Φ x, y = β( x, y) S( x x', y y') T ( x x', y y') dx' dy' Open field w/o penumbra Double-Gaussian Kernel (from penumbra) L.Ma, P.Geis, A.L.Boyer, Med Phys 4(8), 1997 Transmission through MLC 1 or 0

23 I( x 0, Double-Gaussian Kernel: y 0 Fit of penumbra region ( x x0) ( y y0) ( x x0) ) I0( x, y) exp + ε exp x, y σ1 σ ( y y 0 ) rel. fluence square field 6cm position [cm] BIS kernel0.6-03/5 Fit to Penumbra region (square field): σ 1 =0.6mm σ =3 mm ε=0.3 3

24 Double-Gaussian Kernel BIS measured Cadplan / double gaussian kernel 4

25 Gamma Index Cadplan raw fluence Double Gaussian Kernel x = 3mm, D = 3%

26 MLC QA - Garden Fence MLC pairs form a narow slot moving across the field, stopping and reaccelerationg at predefined positions 6

27 MLC QA Pickett Fence Regular Pattern Error introduced 1.0 mm 0.9 mm 0.8 mm 0.7 mm 0.6 mm 0.5 mm 0.4 mm 0.3 mm 0. mm 0.1 mm 7

28 MLC QA Garden Fence 1.0 mm 0.9 mm 0.8 mm 0.7 mm 0.6 mm 0.5 mm 0.4 mm 0.3 mm 0. mm 0.1 mm 1.0 mm 0.5 mm 8

29 Gap Error Reihe1 Linear (Reihe1)

30 MLC QA Garden Fence 90 Gantry Orientation vs. 70 Gantry Orientation 3 0

31 Graphic railway schedule 3 1

32 Railroad diagram railroad diagram leaf position (mm) left leaf right leaf left leaf (error) right leaf (error) frame number 3

33 MLC QA - Leaf Speed Test Leaf pairs form gaps moving with different speed 3 3

34 MLC QA Leaf Speed test Delivery with beam interrupts 90 Gantry Orientation vs. 70 Gantry Orientation 3 4

35 Edge filter-fast fourier transform 3 5

36 Constant-fraction approach Original field -shifted, attenuated field Zero crossing 3 6

37 Right edge positions 3 7

38 3 8

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