• Progress in Medical Physics
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• v.23 no.4
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• pp.317-325
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• 2012

The Varian PORTALVISION (Varian Medical Systems, US) shows significant overresponses as the off-center distance increases compared to the predicted dose. In order to correct the dose discrepancy, the off-axis correction is applied to VARIAN iX linear accelerators. The portal dose for $38{\times}28cm^2$ open field is acquired for 6 MV, 15 MV photon beams and also are predicted by PDIP algorithm under the same condition of the portal dose acquisition. The off-axis correction is applied by modifying the $40{\times}40cm^2$ diagonal beam profile data which is used for the beam profile calibration. The ratios between predicted dose and measured dose is modeled as a function of off-axis distance with the $4^{th}$ polynomial and is applied to the $40{\times}40cm^2$ diagonal beam profile data as the weight to correct measured dose by EPID detector. The discrepancy between measured dose and predicted dose is reduced from $4.17{\pm}2.76$ CU to $0.18{\pm}0.8$ CU for 6 MV photon beam and from $3.23{\pm}2.59$ CU to $0.04{\pm}0.85$ CU for 15 MV photon beam. The passing rate of gamma analysis for the pyramid fluence patten with the 4%, 4 mm criteria is improved from 98.7% to 99.1% for 6 MV photon beam, from 99.8% to 99.9% for 15 MV photon beam. IMRT QA is also performed for randomly selected Head and Neck and Prostate IMRT plans after applying the off-axis correction. The gamma passing rare is improved by 3% on average, for Head and Neck cases: $94.7{\pm}3.2%$ to $98.2{\pm}1.4%$, for Prostate cases: $95.5{\pm}2.6%$, $98.4{\pm}1.8%$. The gamma analysis criteria is 3%, 3 mm with 10% threshold. It is considered that the off-axis correction might be an effective and easily adaptable means for correcting the discrepancy between measured dose and predicted dose for IMRT QA using EPID in clinic.

• Progress in Medical Physics
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• v.30 no.4
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• pp.128-138
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• 2019

Purpose: Segmental analysis of volumetric modulated arc therapy (VMAT) is not clinically used for compositional error source evaluation. Instead, dose verification is routinely used for plan-specific quality assurance (QA). While this approach identifies the resultant error, it does not specify which machine parameter was responsible for the error. In this research study, we adopted an approach for the segmental analysis of VMAT as a part of machine QA of linear accelerator (LINAC). Methods: Two portal dose QA plans were generated for VMAT QA: a) for full arc and b) for the arc, which was segmented in 12 subsegments. We investigated the multileaf collimator (MLC) position and dosimetric accuracy in the full and segmented arc delivery schemes. A MATLAB program was used to calculate the MLC position error from the data in the dynalog file. The Gamma passing rate (GPR) and the measured to planned dose difference (DD) in each pixel of the electronic portal imaging device was the measurement for dosimetric accuracy. The eclipse treatment planning system and a MATLAB program were used to calculate the dosimetric accuracy. Results: The maximum root-mean-square error of the MLC positions were <1 mm. The GPR was within the range of 98%-99.7% and was similar in both types of VMAT delivery. In general, the DD was <5 calibration units in both full arcs. A similar DD distribution was found for continuous arc and segmented arcs sums. Exceedingly high DD were not observed in any of the arc segment delivery schemes. The LINAC performance was acceptable regarding the execution of the VMAT QA plan. Conclusions: The segmental analysis proposed in this study is expected to be useful for the prediction of the delivery of the VMAT in relation to the gantry angle. We thus recommend the use of segmental analysis of VMAT as part of the regular QA.

• Progress in Medical Physics
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• v.25 no.1
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• pp.23-30
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• 2014

The purpose of this study is to evaluate the developed dose verification program for in vivo dosimetry based on transit dose in radiotherapy. Five intensity modulated radiotherapy (IMRT) plans of lung cancer patients were used in the irradiation of a homogeneous solid water phantom and anthropomorphic phantom. Transit dose distribution was measured using electronic portal imaging device (EPID) and used for the calculation of in vivo dose in patient. The average passing rate compared with treatment planning system based on a gamma index with a 3% dose and a 3 mm distance-to-dose agreement tolerance limit was 95% for the in vivo dose with the homogeneous phantom, but was reduced to 81.8% for the in vivo dose with the anthropomorphic phantom. This feasibility study suggested that transit dose-based in vivo dosimetry can provide information about the actual dose delivery to patients in the treatment room.

• Journal of radiological science and technology
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• v.39 no.4
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• pp.577-585
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• 2016

The purpose of this study is to evaluate the accuracy of beam delivery QA software using the MLC dynalog file, about the VMAT plan with AAPM TG-119 protocol. The Clinac iX with a built-in 120 MLC was used to acquire the MLC dynalog file be imported in MobiusFx(MFX). To establish VMAT plan, Oncentra RTP system was used target and organ structures were contoured in Im'RT phantom. For evaluation of dose distribution was evaluated by using gamma index, and the point dose was evaluated by using the CC13 ion chamber in Im'RT phantom. For the evaluation of point dose, the mean of relative error between measured and calculated value was $1.41{\pm}0.92%$(Target) and $0.89{\pm}0.86%$(OAR), the confidence limit were 3.21(96.79%, Target) and 2.58(97.42%, OAR). For the evaluation of dose distribution, in case of $Delta^{4PT}$, the average percentage of passing rate were $99.78{\pm}0.2%$(3%/3 mm), $96.86{\pm}1.76%$(2%/2 mm). In case of MFX, the average percentage of passing rate were $99.90{\pm}0.14%$(3%/3 mm), $97.98{\pm}1.97%$(2%/2 mm), the confidence limits(CL) were in case of $Delta^{4PT}$ 0.62(99.38%, 3%/3 mm), 6.6(93.4%, 2%/2 mm), in case of MFX, 0.38(99.62%, 3%/3 mm), 5.88(94.12%, 2%/2 mm). In this study, we performed VMAT QA method using dynamic MLC log file compare to binary diode array chamber. All analyzed results were satisfied with acceptance criteria based on TG-119 protocol.

• Progress in Medical Physics
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• v.22 no.4
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• pp.206-215
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• 2011

The purpose of this was to investigate the measurement of fluence dose map for the specific patient quality assurance. The measurement of fluence map was performed using 2D matrixx detector. The absorbed dose was measured by a glass detector, Gafchromic film and ion chamber in Hybrid Optimized VMAT Phantom (HOVP). For 2D Matrixx, the results of comparison were average passing rate $85.22%{\pm}1.7$ (RT_Target), $89.96%{\pm}2.15$ (LT_Target) and $95.14%{\pm}1.18$ (G4). The dose difference was $11.72%{\pm}0.531$, $-11.47%{\pm}0.991$, $7.81%{\pm}0.857$, $-4.14%{\pm}0.761$ at the G1, G2, G3, G4. In HOVP, the results of comparison for film were average passing rate (3%, 3 mm) $93.64%{\pm}3.87$, $90.82%{\pm}0.99$. We were measured an absolute dose in steep gradient area G1, G2, G3, G4 using the glass detector. The difference between the measurement and calculation are 8.3% (G1), -5.4% (G2), 6.1% (G3), 7.2% (G4). The using an Ion-chamber were an average relative dose error $-1.02%{\pm}0.222$ (Rt_target), $0.96%{\pm}0.294$ (Lt_target). Though we need a more study using a transmission detector. However, a measurement of real-time fluence map will be predicting a dose for real-time specific patient quality assurance in volume modulated arc therapy.

• Progress in Medical Physics
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• v.32 no.4
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• pp.99-106
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• 2021

Purpose: In this study, we aimed to manufacture a patient-specific gel phantom combining three-dimensional (3D) printing and polymer gel and evaluate the radiation dose and dose profile using gel dosimetry. Methods: The patient-specific head phantom was manufactured based on the patient's computed tomography (CT) scan data to create an anatomically replicated phantom; this was then produced using a ColorJet 3D printer. A 3D polymer gel dosimeter called RTgel-100 is contained inside the 3D printing head phantom, and irradiation was performed using a 6 MV LINAC (Varian Clinac) X-ray beam, a linear accelerator for treatment. The irradiated phantom was scanned using magnetic resonance imaging (Siemens) with a magnetic field of 3 Tesla (3T) of the Korea Institute of Nuclear Medicine, and then compared the irradiated head phantom with the dose calculated by the patient's treatment planning system (TPS). Results: The comparison between the Hounsfield unit (HU) values of the CT image of the patient and those of the phantom revealed that they were almost similar. The electron density value of the patient's bone and brain was 996±167 HU and 58±15 HU, respectively, and that of the head phantom bone and brain material was 986±25 HU and 45±17 HU, respectively. The comparison of the data of TPS and 3D gel revealed that the difference in gamma index was 2%/2 mm and the passing rate was within 95%. Conclusions: 3D printing allows us to manufacture variable density phantoms for patient-specific dosimetric quality assurance (DQA), develop a customized body phantom of the patient in the future, and perform a patient-specific dosimetry with film, ion chamber, gel, and so on.

• Progress in Medical Physics
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• v.26 no.3
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• pp.127-136
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• 2015

The purpose of this study is to perform a dosimetric evaluation of amplitude-based respiratory gating for the delivery of volumetric modulated arc therapy (VMAT). We selected two types of breathing patterns, subjectively among patients with respiratory-gated treatment log files. For patients that showed consistent breathing patterns (CBP) relative to the 4D CT respiration patterns, the variability of the breath-holding position during treatment was observed within the thresholds. However, patients with inconsistent breathing patterns (IBP) show differences relative to those with CBP. The relative isodose distribution was evaluated using an EBT3 film by comparing gated delivery to static delivery, and an absolute dose measurement was performed with a $0.6cm^3$ Farmer-type ion chamber. The passing rate percentages under the 3%/3 mm gamma analysis for Patients 1, 2 and 3 were respectively 93.18%, 91.16%, and 95.46% for CBP, and 66.77%, 48.79%, and 40.36% for IBP. Under the more stringent criteria of 2%/2 mm, passing rates for Patients 1, 2 and 3 were respectively 73.05%, 67.14%, and 86.85% for CBP, and 46.53%, 32.73%, and 36.51% for IBP. The ion chamber measurements were within 3.5%, on average, of those calculated by the TPS and within 2.0%, on average, when compared to the static-point dose measurements for all cases of CBP. Inconsistent breathing patterns between 4D CT simulation and treatment may cause considerable dosimetric differences. Therefore, patient training is important to maintain consistent breathing amplitude during CT scan acquisition and treatment delivery.

• The Journal of Korean Society for Radiation Therapy
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• v.31 no.1
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• pp.33-41
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• 2019

Purpose : To evaluate the effectiveness of Jaw-tracking(JT) technique in Intensity-modulated radiation therapy(IMRT) and Volumetric-modulated arc therapy(VMAT) for radiation therapy of esophageal cancer by analyzing volume dose of perimetrical normal organs along with the low-dose volume regions. Materials and Method: A total of 27 patients were selected who received radiation therapy for esophageal cancer with using $VitalBeam^{TM}$(Varian Medical System, U.S.A) in our hospital. Using Eclipse system(Ver. 13.6 Varian, U.S.A), radiation treatment planning was set up with Jaw-tracking technique(JT) and Non-Jaw-tracking technique(NJT), and was conducted for the patients with T-shaped Planning target volume(PTV), including Supraclavicular lymph nodes(SCL). PTV was classified into whether celiac area was included or not to identify the influence on the radiation field. To compare the treatment plans, Organ at risk(OAR) was defined to bilateral lung, heart, and spinal cord and evaluated for Conformity index(CI) and Homogeneity index(HI). Portal dosimetry was performed to verify a clinical application using Electronic portal imaging device(EPID) and Gamma analysis was performed with establishing thresholds of radiation field as a parameter, with various range of 0 %, 5 %, and 10 %. Results: All treatment plans were established on gamma pass rates of 95 % with 3 mm/3 % criteria. For a threshold of 10 %, both JT and NJT passed with rate of more than 95 % and both gamma passing rate decreased more than 1 % in IMRT as the low dose threshold decreased to 5 % and 0 %. For the case of JT in IMRT on PTV without celiac area, $V_5$ and $V_{10}$ of both lung showed a decrease by respectively 8.5 % and 5.3 % in average and up to 14.7 %. A $D_{mean}$ decreased by $72.3{\pm}51cGy$, while there was an increase in radiation dose reduction in PTV including celiac area. A $D_{mean}$ of heart decreased by $68.9{\pm}38.5cGy$ and that of spinal cord decreased by $39.7{\pm}30cGy$. For the case of JT in VMAT, $V_5$ decreased by 2.5 % in average in lungs, and also a little amount in heart and spinal cord. Radiation dose reduction of JT showed an increase when PTV includes celiac area in VMAT. Conclusion: In the radiation treatment planning for esophageal cancer, IMRT showed a significant decrease in $V_5$, and $V_{10}$ of both lungs when applying JT, and dose reduction was greater when the irradiated area in low-dose field is larger. Therefore, IMRT is more advantageous in applying JT than VMAT for radiation therapy of esophageal cancer and can protect the normal organs from MLC leakage and transmitted doses in low-dose field.

• Progress in Medical Physics
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• v.26 no.4
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• pp.193-200
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• 2015

The aim of this study is to present commissioning results of the ViewRay system. We verified safety functions of the ViewRay system. For imaging system, we acquired signal to noise ratio (SNR) and image uniformity. In addition, we checked spatial integrity of the image. Couch movement accuracy and coincidence of isocenters (radiation therapy system, imaging system and virtual isocneter) was verified. Accuracy of MLC positioing was checked. We performed reference dosimetry according to American Association of Physicists in Medicine (AAPM) Task Group 51 (TG-51) in water phantom for head 1 and 3. The deviations between measurements and calculation of percent depth dose (PDD) and output factor were evaluated. Finally, we performed gamma evaluations with a total of 8 IMRT plans as an end-to-end (E2E) test of the system. Every safety system of ViewRay operated properly. The values of SNR and Uniformity met the tolerance level. Every point within 10 cm and 17.5 cm radii about the isocenter showed deviations less than 1 mm and 2 mm, respectively. The average couch movement errors in transverse (x), longitudinal (y) and vertical (z) directions were 0.2 mm, 0.1 mm and 0.2 mm, respectively. The deviations between radiation isocenter and virtual isocenter in x, y and z directions were 0 mm, 0 mm and 0.3 mm, respectively. Those between virtual isocenter and imaging isocenter were 0.6 mm, 0.5 mm and 0.2 mm, respectively. The average MLC positioning errors were less than 0.6 mm. The deviations of output, PDDs between mesured vs. BJR supplement 25, PDDs between measured and calculated and output factors of each head were less than 0.5%, 1%, 1% and 2%, respectively. For E2E test, average gamma passing rate with 3%/3 mm criterion was $99.9%{\pm}0.1%$.

• The Journal of Korean Society for Radiation Therapy
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• v.32
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• pp.93-109
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• 2020

Purpose: The radiochromic film (Gafchromic EBT3, Ashland Advanced Materials, USA) and 3-dimensional analysis system dosimetry checkTM (DC, MathResolutions, USA) were evaluated for patient-specific quality assurance (QA) of helical tomotherapy. Materials and Methods: Depending on the tumors' positions, three types of targets, which are the abdominal tumor (130.6㎤), retroperitoneal tumor (849.0㎤), and the whole abdominal metastasis tumor (3131.0㎤) applied to the humanoid phantom (Anderson Rando Phantom, USA). We established a total of 12 comparative treatment plans by the four geometric conditions of the beam irradiation, which are the different field widths (FW) of 2.5-cm, 5.0-cm, and pitches of 0.287, 0.43. Ionization measurements (1D) with EBT3 by inserting the cheese phantom (2D) were compared to DC measurements of the 3D dose reconstruction on CT images from beam fluence log information. For the clinical feasibility evaluation of the DC, dose reconstruction has been performed using the same cheese phantom with the EBT3 method. Recalculated dose distributions revealed the dose error information during the actual irradiation on the same CT images quantitatively compared to the treatment plan. The Thread effect, which might appear in the Helical Tomotherapy, was analyzed by ripple amplitude (%). We also performed gamma index analysis (DD: 3mm/ DTA: 3%, pass threshold limit: 95%) for pattern check of the dose distribution. Results: Ripple amplitude measurement resulted in the highest average of 23.1% in the peritoneum tumor. In the radiochromic film analysis, the absolute dose was on average 0.9±0.4%, and gamma index analysis was on average 96.4±2.2% (Passing rate: >95%), which could be limited to the large target sizes such as the whole abdominal metastasis tumor. In the DC analysis with the humanoid phantom for FW of 5.0-cm, the three regions' average was 91.8±6.4% in the 2D and 3D plan. The three planes (axial, coronal, and sagittal) and dose profile could be analyzed with the entire peritoneum tumor and the whole abdominal metastasis target, with planned dose distributions. The dose errors based on the dose-volume histogram in the DC evaluations increased depending on FW and pitch. Conclusion: The DC method could implement a dose error analysis on the 3D patient image data by the measured beam fluence log information only without any dosimetry tools for patient-specific quality assurance. Also, there may be no limit to apply for the tumor location and size; therefore, the DC could be useful in patient-specific QAl during the treatment of Helical Tomotherapy of large and irregular tumors.