[en] Computed radiography (CR) plates are currently used in radiation therapy clinics to acquire digital radiographic images for the purpose of verifying the treatment field size, shape, and location. Each CR plate may be used numerous times, and the use of these digital images allows for easy storage and retrieval of patient data. Over prolonged repeat exposures of the CR plates, however, the image quality begins to degrade, making it increasingly more difficult for the therapists and physicians to determine where one anatomical structure begins, and the other ends. The purpose of this project was to analyze and compare the linearity and uniformity responses of new CR plates, versus CR plates that have been used clinically for a period of 2 years, and determine whether linearity or uniformity response may be used as an indicator of image quality degradation. To determine this, 44 old Agfa MD10 CR plates and 56 new Agfa MD10 CR plates were tested. When comparing the results of the uniformity test, we found both the old and the new plates varied from approximately 0.5% to 3.2%. When comparing the results of the linearity test, we found that the correlation coefficient, R², for both the old and the new plates varied from approximately 0.996 to 0.998, with the mean values being 0.9972 and 0.9979, respectively. We concluded that linearity and uniformity response cannot be used as an effective method for the evaluation of CR plate performance. Additional research is currently underway to evaluate various other methods of assessing CR plate performance

[en] A comparison study of depth profiling by secondary ion mass spectrometry (SIMS) and neutron depth profiling (NDP) was recently conducted. The specimens were portions of 5 cm diameter single crystal <111> silicon slices in which B-10 had been implanted at various fluences and energies. NDP measurements were made on a 13 mm diameter area at the center of the wafers. SIMS measurements were taken from a 60 μm diameter area approximately 16 mm from the center of the wafer. One observation that emerged from this work was an apparent discrepancy between the profiles of B-10 measured by DNP and SIMS. The peaks of the SIMS profiles were typically deeper than those of NDP by as much as 30 nm, which is 10% of the projected range for a 70 keV implant. Moreover, the profiles could not be made to coincide by either a constant shift or a proportional change of one depth scale with respect to the other. The lateral inhomogeneity of boron that these experiments have demonstrated arises from the variable contribution of ion channeling during implantation

[en] Changes in secondary ion yields of matrix and dopant species have been correlated with changes in surface topography during O⁺₂ bombardment of Si and GaAs. In Si, profiles were measured in (100) wafers at 6- and 8-keV impact energy. At 6 keV, a yield increase of about 70% occurred for Si⁺ over a depth range of 2.5 to 3.5 μm, with changes in other species ranging from a decrease of ∼20% for Si⁺₃ to an increase of more than 25% for O⁺. The development of a rippled surface topography was observed in scanning electron micrographs over the same depth range. Similar effects occurred over a 3--5 μm depth range for 8-keV ions, and in (111) silicon at a depth of 3 to 4 μm for 6-keV ions. No differences were noted between p- and n-type silicon, or implanted and unimplanted silicon. In GaAs, profiles were measured in (100) wafers at 2.5-, 5.5-, and 8-keV impact energies. At 8 keV, a yield increase of about 70% was found for GaO⁺ in the range 0.6--1.0 μm, with smaller changes for other matrix species. At 5.5 keV, similar effects were observed, but over a depth interval of 0.3 to 0.7 μm. No yield changes were detected at 2.5-keV impact energy. The yield changes at the higher energies were again correlated with the onset of changes in topography. No change in ion yield or surface topography was noted for Cs⁺ bombardment of Si or GaAs. The topography and ion yield changes are affected by the angle of incidence and, for Si, the oxygen coverage. The results show that the practice of normalizing secondary ion mass spectrometry dopant profiles to a matrix signal must be modified for situations where matrix yield changes occur

[en] Bulk heterojunction solar cells were fabricated with flexible webs of aligned multiwalled carbon nanotubes (MWNTs). These webs were drawn from a forest of MWNTs and placed directly onto the device substrate to form the hole collecting electrode. Devices were fabricated on glass substrates with one or two MWNT web layers to study the trade-off between transparency and resistivity on device performance. Devices with two web layers performed better with a fill factor of 0.47 and a device power conversion efficiency of 1.66% due to their higher conductivity. Flexible devices on Mylar substrates were also demonstrated with an efficiency of 1.2% indicating the potential of MWNT webs as a flexible alternative to the more conventional indium tin oxide. - Highlights: ► Drawable carbon nanotube webs were used as an anode in bulk heterojunction cells. ► One and two layers of carbon nanotube webs were compared. ► A thick active layer of ∼ 530 nm was needed to avoid shunting through nanotubes. ► Two layers of web gave the better efficiency of 1.6%. ► Flexible devices on Mylar were demonstrated with 1.2% efficiency

[en] Purpose: Develop a matching VMAT field technique and investigate planning feasibility for treating the entire central nervous system (CNS) using Cranio-Spinal Irradiation (CSI) . Methods: Two patients diagnosed with acute myeloid leukemia (AML) presented with CNS involvement, received CSI, and were included in this study. The patients were treated with the traditional CSI technique: prone position, opposing lateral brain fields, two posterior fields (upper and lower spine), and 5mm junction shifts to improve dose uniformity. The patients were retrospectively re-planned using volumetric arc therapy (VMAT). The spine and brain were contoured to create the clinical target volume (CTV) as well as normal tissues including kidneys, lung and heart for optimization. Three isocenters were used for planning: brain, upper and lower spine. The beams were allowed to overlap by approximately 10cm. Entire 360 degree rotations were used for the brain fields and posterior 120 degree arcs were used for the spine fields. The dosimetric coverage of the target between the VMAT and traditional plans was compared, as well as the dose to normal tissues. Results: Both VMAT plans achieved improved dose uniformity in the CTV (standard deviation < 2%), and reduced hot spots (<110%). Dose to the heart was reduced, with the V10 being 12.7% and 28.2%, compared to 44.6% and 50.2%, respectively, for the traditional plan. Dose to the total lung V5 increased for the VMAT plans for both patients (21.6% and 27.8% compared to 12% and 13% respectively). The results for the kidneys were mixed with the mean dose increasing for one patient and decreasing for the other . Conclusion: The efficacy of planning CSI treatments using a matching VMAT technique was demonstrated. The developed technique has the potential to improve dose uniformity to the target while at the same time reduce the risk of under or over dosing the spine

[en] Purpose: To verify the accuracy of total body irradiation (TBI) measurement commissioning data using the treatment planning system (TPS) for a wide range of patient separations. Methods: Our institution conducts TBI treatments with an 18MV photon beam at 380cm extended SSD using an AP/PA technique. Currently, the monitor units (MU) per field for patient treatments are determined using a lookup table generated from TMR measurements in a water phantom (75 × 41 × 30.5 cm3). The dose prescribed to an umbilicus midline point at spine level is determined based on patient separation, dose/ field and dose rate/MU. One-dimensional heterogeneous dose calculations from Pinnacle TPS were validated with thermoluminescent dosimeters (TLD) placed in an average adult anthropomorphic phantom and also in-vivo on four patients with large separations. Subsequently, twelve patients with various separations (17–47cm) were retrospectively analyzed. Computed tomography (CT) scans were acquired in the left and right decubitus positions from vertex to knee. A treatment plan for each patient was generated. The ratio of the lookup table MU to the heterogeneous TPS MU was compared. Results: TLD Measurements in the anthropomorphic phantom and large TBI patients agreed with Pinnacle calculated dose within 2.8% and 2%, respectively. The heterogeneous calculation compared to the lookup table agreed within 8.1% (ratio range: 1.014–1.081). A trend of reduced accuracy was observed when patient separation increases. Conclusion: The TPS dose calculation accuracy was confirmed by TLD measurements, showing that Pinnacle can model the extended SSD dose without commissioning a special beam model for the extended SSD geometry. The difference between the lookup table and TPS calculation potentially comes from lack of scatter during commissioning when compared to extreme patient sizes. The observed trend suggests the need for development of a correction factor between the lookup table and TPS dose calculations.

[en] Purpose: The objective of this project was to report our initial IMRT QA results and experience with the SunNuclear ArcCHECK. Methods: Three thousand one-hundred and sixteen cases were treated with IMRT or VMAT at our institution between October 2013 and September 2014. All IMRT/VMAT treatment plans underwent Quality Assurance (QA) using ArcCHECK prior to therapy. For clinical evaluation, a Gamma analysis is performed following QA delivery using the SNC Patient software (Sun Nuclear Corp) at the 3%/3mm level. QA Gamma pass rates were analyzed based on categories of treatment site, technique, and type of MLCs. Our current clinical threshold for passing a QA (Tclin) is set at a Gamma pass rate greater than 90%. We recorded the percent of failures for each category, as well as the Gamma pass rate threshold that would Result in 95% of QAs to pass (T95). Results: Using Tclin a failure rate of 5.9% over all QAs was observed. The highest failure rate was observed for gynecological (22%) and the lowest for CNS (0.9%) treatments. T95 was 91% over all QAs and ranged from 73% (gynecological) to 96.5% (CNS) for individual treatments sites. T95 was lower for IMRT and non-HD (high definition) MLCs at 88.5% and 94.5%, respectively, compared to 92.4% and 97.1% for VMAT and HD MLC treatments, respectively. There was a statistically significant difference between the passing rates for IMRT vs. VMAT and for HD MLCs vs. non-HD MLCs (p-values << 0.01). Gynecological, IMRT, and HD MLC treatments typically include more plans with larger field sizes. Conclusion: On average, Tclin with ArcCHECK was consistent with T95, as well as the 90% action level reported in TG-119. However, significant variations between the examined categories suggest a link between field size and QA passing rates and may warrant field size-specific passing rate thresholds

[en] Purpose: A simple Field-in-Field technique for Total Body Irradiation (TBI) was developed for traditional AP/PA TBI treatments to improve dosimetric uniformity in patients with large separation. Methods: TBI at our institution currently utilizes an AP/PA technique at an extended source-to-surface distance (SSD) of 380cm with patients in left decubitus position during the AP beam and in right decubitus during the PA beam. Patients who have differences in thickness (separation) between the abdomen and head greater than 10cm undergo CT simulation in both left and right decubitus treatment positions. One plan for each CT is generated to evaluate dose to patient midline with both AP and PA fields, but only corresponding AP fields will be exported for treatment for patient left decubitus position and PA fields for patient right decubitus position. Subfields are added by collimating with the x-ray jaws according to separation changes at 5–7% steps to minimize hot regions to less than 10%. Finally, the monitor units (MUs) for the plans are verified with hand calculation and water phantom measurements. Results: Dose uniformity (+/−10%) is achieved with field-in-field using only asymmetric jaws. It is dosimetrically robust with respect to minor setup/patient variations inevitable due to patient conditions. MUs calculated with Pinnacle were verified in 3 clinical cases and only a 2% difference was found compared to homogeneous calculation. In-vivo dosimeters were also used to verify doses received by each patient with and confirmed dose variations less than 10%. Conclusion: We encountered several cases with separation differences that raised uniformity concerns — based on a 1% dose difference per cm separation difference assumption. This could Resultin an unintended hot spot, often in the head/neck, up to 25%. This method allows dose modulation without adding treatment complexity nor introducing radiobiological variations, providing a reasonable solution for this unique TBI situation

[en] Purpose: Treatment planning for Head and Neck(HN) re-irradiation is a challenge because of ablative doses to target volume and strict critical structure constraints. PlanIQ(Sun Nuclear Corporation) can assess the feasibility of clinical goals and quantitatively measure plan quality. Here, we assess whether incorporation of PlanIQ in our SBRT treatment planning process can improve plan quality and planning efficiency. Methods: From 2013–2015, 35 patients (29 retrospective, 6 prospective) with recurrent HN tumors were treated with SBRT using VMAT treatment plans. The median prescription dose was 45 Gy in 5 fractions. We retrospectively reviewed the treatment plans and physician directives of our first 29 patients and generated score functions of the dosimetric goals used in our practice and obtained a baseline histogram. We then re-optimized 12 plans that had potential to further reduce organs-at-risk (OAR) doses according to PlanIQ feasibility DVH and plan quality analysis and compared them to the original plans. We applied our new PlanIQ-assisted planning process for our 6 most recently treated patients and evaluated the plan quality and planning efficiency. Results: The mean plan quality metric(PQM) and feasibility adjusted PQM(APQM) scores of our initial 29 treatment plans were 77.1±13.1 and 88.7±11.9, respectively (0–100 scale). The PQM and APQM scores for the 12 optimized plans improved from 75.9±11.0 and 85.1±10.2 to 80.7±9.3 and 90.2±8.0, respectively (p<0.005). Using our newly developed PlanIQ-assisted planning process, the PQM and APQM scores for the 6 most recently treated patients were 93.6±6.5 and 99.1±0.6, respectively. The planning goals were more straightforward to minimize OAR doses during optimization, thus less planning and revision time were used than before. Conclusion: PlanIQ has the potential to provide achievable planning goals and also improve plan quality and planning efficiency.

[en] Purpose: A fixed horizontal-beam linac, where the patient is treated in a seated position, could lower the overall costs of the treatment unit and room shielding substantially. This design also allows the treatment room and control area to be contained within a reduced space, such as a shipping container. The main application is the introduction of low-cost, high-quality radiation therapy to low- and middle-income regions. Here we consider shielding for upright treatments with a fixed-6MV-beam linac in a shipping container and a conventional treatment vault. Methods: Shielding calculations were done for two treatment room layouts using calculation methods in NCRP Report 151: (1) a shipping container (6m × 2.4m with the remaining space occupied by the console area), and (2) the treatment vault in NCRP 151 (7.8m by 5.4m by 3.4m). The shipping container has a fixed gantry that points in one direction at all times. For the treatment vault, various beam directions were evaluated. Results: The shipping container requires a primary barrier of 168cm concrete (4.5 TVL), surrounded by a secondary barrier of 3.6 TVL. The other walls require between 2.8–3.3 TVL. Multiple shielding calculations were done along the side wall. The results show that patient scatter increases in the forward direction and decreases dramatically in the backward direction. Leakage scatter also varies along the wall, depending largely on the distance between the gantry and the wall. For the treatment room, fixed-beam requires a slightly thicker primary barrier than the conventional linac (0.6 TVL), although this barrier is only needed in the center of one wall. The secondary barrier is different only by 0–0.2 TVL. Conclusion: This work shows that (1) the shipping container option is achievable, using indigenous materials for shielding and (2) upright treatments can be performed in a conventional treatment room with minimal additional shielding. Varian Medical Systems