The use of EPID-measured leaf sequence files for IMRT dose reconstruction in adaptive radiation therapy

Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California 94305, USA.
Medical Physics (Impact Factor: 2.64). 12/2008; 35(11):5019-29. DOI: 10.1118/1.2990782
Source: PubMed


For intensity modulated radiation treatment (IMRT) dose reconstruction, multileaf collimator (MLC) log files have been shown applicable for deriving delivered fluence maps. However, MLC log files are dependent on the accuracy of leaf calibration and only available from one linear accelerator manufacturer. This paper presents a proof of feasibility and principles in (1) using an amorphous silicon electronic portal imaging device (aSi-EPID) to capture the MLC segments during an IMRT delivery and (2) reconstituting a leaf sequence (LS) file based on the leaf end positions calculated from the MLC segments and their associated fractional monitor units. These EPID-measured LS files are then used to derive delivered fluence maps for dose reconstruction. The developed approach was tested on a pelvic phantom treated with a typical prostate IMRT plan. The delivered fluence maps, which were derived from the EPID-measured LS files, showed slight differences in the intensity levels compared with the corresponding planned ones. The dose distribution calculated with the delivered fluence maps showed a discernible difference in the high dose region when compared to that calculated with the planned fluence maps. The maximum dose in the former distribution was also 2.5% less than that in the latter one. The EPID-measured LS file can serve the same purpose as a MLC log files does for the derivation of the delivered fluence map and yet is independent of the leaf calibration. The approach also allows users who do not have access to MLC log files to probe the actual IMRT delivery and translate the information gained for dose reconstruction in adaptive radiation therapy.

3 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: The fluence exiting a patient during beam delivery can be used as treatment delivery quality assurance, either by direct comparison with expected exit fluences or by backprojection to reconstruct the patient dose. Multiple possible sources of measured exit fluence deviations exist, including changes in the beam delivery and changes in the patient anatomy. The purpose of this work is to compare the deviations caused by these sources. Machine delivery-related variability is measured by acquiring multiple dosimetric portal images (DPIs) of several test fields without a patient/phantom in the field over a time period of 2 months. Patient anatomy-related sources of fluence variability are simulated by computing transmission DPIs for a prostate patient using the same incident fluence for 11 different computed tomography (CT) images of the patient anatomy. The standard deviation (SD) and maximum deviation of the exit fluence, averaged over 5 mm x 5 mm square areas, is calculated for each test set. Machine delivery fluence SDs as large as 1% are observed for a sample patient field and as large as 2.5% for a picket-fence dMLC test field. Simulations indicate that day-to-day patient anatomy variations induce exit fluence SDs as large as 3.5%. The largest observed machine delivery deviations are 4% for the sample patient field and 7% for the picket-fence field, while the largest difference for the patient anatomy-related source is 8.5%. Since daily changes in patient anatomy can result in substantial exit fluence deviations, care should be taken when applying fluence back-projection to ensure that such deviations are properly attributed to their source.
    Physics in Medicine and Biology 10/2009; 54(19):N451-8. DOI:10.1088/0031-9155/54/19/N03 · 2.76 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Volumetric modulated arc therapy (VMAT) is a system for intensity-modulated radiotherapy treatment delivery that achieves high dose conformality by optimizing the dose rate, gantry speed, and the leaf positions of the dynamic multileaf collimator (DMLC). The aim of this work is to present a practical approach for patient-specific volumetric reconstruction of the dose delivered of a VMAT treatment using the DMLC and treatment controller log (Dynalog) files. The accuracy of VMAT delivery was analyzed for five prostate patients. For each patient, a clinical treatment was delivered and values recorded in the log files for the gantry angle, dose rate, and leaf positions were converted to a new DICOM-compliant plan using a custom-developed software system. The plan was imported in a treatment planning system and the dose distribution was recreated on the original CT by simply recomputing the dose. Using the standard evaluation tools, it is straightforward to assess if reconstructed dose meets clinical endpoints, as well as to compare side-by-side reconstructed and original plans. The study showed that log files can be directly used for dose reconstruction without resorting to phantom measurements or setups. In all cases, analysis of the leaf positions showed a maximum error of -0.26 mm (mean of 0.15 mm). Gantry angle deviation was less than 1degree and the total MU was within 0.5 from the planned value. Differences between the reconstructed and the intended dose matrices were less than 1.46% for all cases. Measurements using the MATRIXX system in a phantom were used to validate the dosimetric accuracy of the proposed method, with an agreement of at least 96% in all pixels as measured using the gamma index. The methodology provides a volumetric evaluation of the dose reconstructed by VMAT plans which is easily achieved by automated analysis of Dynalog files without additional measurements or phantom setups. This process provides a valuable platform for adaptive therapy in the future.
    Medical Physics 10/2009; 36(10):4530-5. DOI:10.1118/1.3213085 · 2.64 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The authors have developed a novel technique using an electronic portal imaging device (EPID) to verify the geometrical accuracy of delivery of dose-rate-regulated tracking (DRRT). This technique, called verification of real-time tracking with EPID (VORTE), can potentially be used for both on-line and off-line quality assurance (QA) of MLC-based dynamic tumor tracking. The shape and position of target as a function of time, which is assumed to be known, is projected onto the EPID plane. This projected sequence of apertures as a function of time (target motion) is then used as the reference. The accuracy of dynamic MLC tracking can then be assessed by how well the delivered beam follows this projected target motion without the use of a physical moving phantom. The beam apertures controlled by DRRT (aperture motion) is detected by the EPID as a function of time. The aperture motion is compared to the target motion to evaluate tracking error introduced by DRRT. The accuracy of VORTE was measured using film measurements of ten static fields. The VORTE for dynamic tumor tracking was tested with several target motions, including (1) rigid-body two-dimensional (2-D) cyclic motion in the superior-inferior direction with various period and amplitude; (2) the above 2-D cyclic motion plus cyclic deformation; and (3) 2-D cyclic motion with both deformation and rotation. For each target motion, the controlled aperture motion resulting from DRRT was acquired at approximately 8 Hz using EPID in the continuous-acquisition mode. Leaf positions in all captured frames were measured from the EPID and compared to their expected positions. The passing rate of 2 mm criteria for all leaves from all frames was calculated for each of the four patterns of tumor motion. Additionally, the root-mean-square (RMS) deviations of the centroid of the apertures between the designed and delivered beams were calculated for all three cases. The accuracy of MLC-leaf position determination by VORTE is 0.5 mm (1 standard deviation) by comparison to film measurements. With DRRT, the passing rates using the 2 mm criteria for all acquired frames are 100% for the 2-D displacement, 99% for the 2-D displacement with deformation, and 88% for the 2-D displacement combined with both deformation and rotation. The RMS deviations are 0.6 mm for the 2-D displacement, 1.0 mm for the 2-D displacement with deformation, and 1.1 mm for the 2-D displacement combined with both deformation and rotation. The VORTE can measure the accuracy of MLC-based tumor tracking without the necessity of employing a moving phantom. Moreover, it can be used for complex target motion (i.e., 2-D displacement combined with deformation and rotation) that is difficult to create with physical moving phantoms. Therefore, the VORTE and the novel QA process illustrated by this study have a great potential for verifying real-time tumor tracking.
    Medical Physics 06/2010; 37(6):2435-40. DOI:10.1118/1.3425789 · 2.64 Impact Factor
Show more


3 Reads
Available from