Project 5 Photon Beams: Dose Modeling for External Beams

Spring 2010

Introduction In modern radiotherapy computer software is used to calculate the dose distribution in patients from the beams of radiation produced by the linear accelerators used to treat the patients. Using computers allows much more complicated types of treatments (e.g. IMRT) to be calculated than would be possible if one were doing every calculation by hand. At the Cleveland Clinic the treatment planning system currently in use for most linear accelerators is Pinnacle. The following will discuss the algorithms used by Pinnacle to calculate dose, the measured data required from a linac to commission Pinnacle for use on that machine and the tests used to determine planning system accuracy. These tests will then be applied to some example measured data from a linac to test the acceptability of Pinnacles model for that linac. Pinnacle Photon Beam Modeling Algorithms The algorithm that Pinnacle uses to determine dose to patients from external photon beams is called Collapsed Cone Convolution Superposition (CCCS). The CCCS algorithm computes dose distributions from first principles rather than relying on measured data to come up with a beam model for a machine. In other words the CCCS algorithm allows one to have a model for a generic linac. The measured data one takes from their own linac is then used to tweak this model to fit the linac being commissioned in Pinnacle. The CCCS dose model consists of four parts: 1. Modeling the energy fluence of the photon beam as it exits the accelerator head. 2. Projection of the energy fluence through a density representation of a patient (typically a CT data set) in order to calculate Total Energy Released per unit Mass (TERMA) for the volume. 3. A three-dimensional superposition of the TERMA with an energy deposition kernel using a ray-tracing technique to include the effects of heterogeneous densities on the lateral scatter of the photon beam in the patient. 4. Lastly, electron contamination is calculated with an exponential falloff which is added to the complete photon dose computation to attain a complete dose distribution. To model the initial energy fluence exiting the accelerator head CCCS starts with a uniform plane of fluence. The horns in the beam created by the flattening filter are modeled by removing an inverted cone from the distribution. A Gaussian distribution is used to model off-focus scatter produced in the accelerator head. The geometric penumbra of the beam is modeled by convolving the fluence plane with a focal spot blurring function. When blocks or MLCs are used in a beam, Pinnacle cuts out the blocked fluence shape out of the beam leaving behind the fluence that will actually pass through to treat the patient. The energy fluence also includes any attenuation due to the thickness of any wedges or compensators present in the field.

A CT scan is taken of the patient we would like to treat with external beam radiation therapy. This CT data set, which includes information about the density of patient, is then imported to Pinnacle. The computed energy fluence coming out of the machine head is then projected through the CT data of the patient. The fluence is attenuated by using mass attenuation coefficients. These coefficients are stored in a table and are a function of density, radiological depth, and off-axis angle. The density coefficients take into account patient heterogeneities, radiological depth dependence takes into account the beam hardening through the patient, and the off-axis angles take into account the off-axis softening of the energy spectrum of the beam. Pinnacle uses the concept of Total Energy Released per unit Mass (TERMA) volume to end up calculating the final dose distribution. The TERMA is computed by projecting the incident energy fluence through the patient density volume using a ray-tracing technique. Pinnacle ends up calculating the TERMA in each voxel of the patients CT data set by tracing a ray from the radiation source through the data set and using the aforementioned parameters of density, radiological depth, and off-axis angle. Finally, the three-dimensional dose is computed by taking the superposition of the TERMA at each voxel with an energy deposition kernel. This kernel describes what happens after the incident photon fluence has its primary interaction with the patient volume. The superposition is calculated using a ray-tracing technique as well and the rays in three dimensions are propagated throughout the patient data set so that the final dose distribution can be calculated by combining the TERMA at each voxel with the energy deposition kernel value for that voxel. Pinnacle also has a faster algorithm than CCCS called Adapative Convolution Superposition. This algorithm uses adaptive dose calculation grid sizes to achieve faster computation of the dose distribution in the desired region. It uses a coarse grid size for regions where the TERMA curvature is low and adaptively smaller grid sizes for high TERMA curvature regions. This allows Pinnacle to reduce computational times by about 23 times compared to the CCCS algorithm. Using the Adaptive Convolution Superposition algorithm can be useful when one desires to see a dose distribution quickly and then one can switch to CCCS to obtain a final dose distribution. Measured Data Required for TPS Commissioning The first thing to do when commissioning a machine in Pinnacle is to enter the physical machine characteristics. This allows Pinnacle to adapt its model to the specific linac. The physical description parameters that need to be entered are the following: Collimator jaw attributes, including whether the jaws can be independent and the minimum, maximum, and default jaw position settings Source to axis distance, source to jaw distance, and monitor unit limits Couch attributes, gantry attributes, and collimator Although Pinnacle uses a dose model based on first principles physics calculations, commissioning of Pinnacle requires one to acquire some measured data from the machine

that is to be modeled. The measured beam data is used to compare how well the computed dose for a given measurement geometry matches the measured data of [ones] machine (Pinnacle Physics Reference Guide). The Physics Reference Guide lists the following types of data that must be collected for the machine. These data must be collected for each beam energy: Percent depth dose curves from which the energy spectrum and electron contamination are determined Dose profiles for the determination of the incident fluence inside the field Dose profiles extending outside the field for the determination of scatter dose and jaw transmission from the machine head components Various profiles with the MLC aperture to verify dose accuracy for MLC fields The calibration output factor The tray transmission factor and block and tray transmission factor The Reference Guide also states that the following data must be measured for each wedge on each machine at each energy: depth doses and depth profiles measured with the wedge in place, and wedged field relative output factors. Acceptance Testing of the TPS The commissioning and acceptance of the treatment planning system used to treat patients is important to make sure that the system is accurate, stable, and safe. According to the IAEA acceptance testing is a process designed to verify that the TPS behaves according to specifications. (IAEA TRS 430) These specifications can come from the manufacturer. The user and manufacturer must agree upon what specifications are to be met and tested and this should be clearly stated in a document. In ones acceptance testing one of the first things that must be checked is the systems hardware. One must assess that the computer hardware and peripherals are operating correctly. Diagnostic systems should be run to check cpu, memory, and disk operation. Also one should check the input devices such as the keyboard and mouse and the output devices such as the storage and printer systems. Additionally the networking and data transfer functionality of the TPS should be tested. The TPS can be linked to a CT simulator, a record and verify system, and other systems. Furthermore, the software functionality should be tested as well to make sure the system is working as advertised. One should make sure that everything one purchased is actually installed as well. Additionally one should have extensive documentation about ones TPS including documentation on the overall design, theory of calculation, and limitations of the system. Arguably the most important part of acceptance testing of the TPS is verifying the calculation capabilities or algorithm checks. Van Dyk (1993) states that for photon and electron beams certain measurements should be checked versus the TPS calculations. Ones checks should include checking open fields, complex fields, and attenuation factors.

Van Dyk gives recommendations of criteria to determine whether or not the possible discrepancies between measurement and calculation are acceptable. These acceptability criteria are shown in the following table for photon and electron beams.

These criteria will be applied to some data taken from a linac at the Cleveland Clinic to check the acceptability of the model for the Artiste 2. The Artiste 2 machine was supposed to be matched to the Artiste 1 machine. This would allow the two machines to share the same model therefore making availability the option to move a patient from one machine to another without new calculations. However the 45 wedge measured data from the Artiste 2 does not agree very well with the Artiste 1 model. According to Van Dyk, in high dose regions with a low dose gradient we should see an agreement the measured and calculated data to within 3%. The percent error is defined as

the difference between the computed and measured doses divided by the measured central axis dose. One can see in the high dose region with a low dose gradient starting at around -14 we have very large percent errors for the Artiste 2 data and the Artiste 1 model. Additionally at the tale end around 14 which is a small dose gradient in a low dose region we still have errors over 3% which is unacceptable. In conclusion one must say that the model is not accurate enough for clinical use and a new model would be needed to use the 45 wedge clinically. References: Van Dyk, J., Barnett, R. Cygler, J., and Shragge, P., Commissioning and Quality Assurance of Treatment Planning Computers:, International Journal of Radiation Oncology, Biology, and Physics, 26, 261-273, 1993. IAEA, Commissioning and Quality Assurance of Treatment Planning Systems for Radiation Treatment of Cancer Technical Report Series Number 430, 2004. Pinnacle Physics Reference Guide Release 8.0, Philips Corporaton