A Monte Carlo model of the Novalis Tx linear accelerator equipped with high‐definition multileaf collimator (HD‐120 HD‐MLC) was commissioned using ionization chamber measurements in water. All measurements in water were performed using a liquid filled ionization chamber. Film measurements were made using EDR2 film in solid water. Open rectangular fields defined by the jaws or the HD‐MLC were used for comparison against measurements. Furthermore, inter‐ and intraleaf leakage calculated by the Monte Carlo model was compared against film measurements. The statistical uncertainty of the Monte Carlo calculations was less than 1% for all simulations. Results for all regular field sizes show an excellent agreement with commissioning data (percent depth‐dose curves and profiles), well within 1% of difference in the relative dose and 1 mm distance to agreement. The computed leakage through HD‐MLCs shows good agreement with film measurements. The Monte Carlo model developed in this study accurately represents the new Novalis Tx Varian linac with HD‐MLC and can be used for reliable patient dose calculations.PACS number: 87.10.Rt

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Purpose: To evaluate the use of MobiusFX as a pre‐treatment verification IMRT QA tool and compare it with a commercial 4D detector array for VMAT plan QA. Methods: 15 VMAT plan QA of different treatment sites were delivered and measured by traditional means with the 4D detector array ArcCheck (Sun Nuclear corporation) and at the same time measurement in linac treatment logs (Varian Dynalogs files) were analyzed from the same delivery with MobiusFX software (Mobius Medical Systems). VMAT plan QAs created in Eclipse treatment planning system (Varian) in a TrueBeam linac machine (Varian) were delivered and analyzed with the gamma analysis routine from SNPA software (Sun Nuclear corporation). Results: Comparable results in terms of the gamma analysis with 99.06% average gamma passing with 3%,3mm passing rate is observed in the comparison among MobiusFX, ArcCheck measurements, and the Treatment Planning System dose calculated. When going to a stricter criterion (1%,1mm) larger discrepancies are observed in different regions of the measurements with an average gamma of 66.24% between MobiusFX and ArcCheck. Conclusion: This work indicates the potential for using MobiusFX as a routine pre‐treatment patient specific IMRT method for quality assurance purposes and its advantages as a phantom‐less method which reduce the time for IMRT QA measurement. MobiusFX is capable of produce similar results of those by traditional methods used for patient specific pre‐treatment verification VMAT QA. Even the gamma results comparing to the TPS are similar the analysis of both methods show that the errors being identified by each method are found in different regions. Traditional methods like ArcCheck are sensitive to setup errors and dose difference errors coming from the linac output. On the other hand linac log files analysis record different errors in the VMAT QA associated with the MLCs and gantry motion that by traditional methods cannot be detected.

Purpose: We aim to provide accurate proton dose calculations for ocular tumors and adjacent critical organs using intensity modulated proton therapy (IMPT) using a human anatomy‐based Monte Carlo model. Dose is simulated using Monte Carlo code MCNPX and compared to standard photon IMRT planning using Pinnacle3® TPS. Method and Materials: The human anatomy model was adapted from the Visible Human Project from the National Library in Medicine. Sectioned images were assigned physical properties. Two independent trials delivering 90% prescription dose to 100% tumor volume were developed using IMRT and IMPT, respectively. Dose profiles for each transverse, sagittal and coronal view of the model were provided for evaluation. Both treatment plans were optimized to deliver maximum dose to the tumor and minimize dose elsewhere. The dose volume histograms for the PTV (tumor), eye, lens, optic nerve, lacrimal gland, brain, chiasm, and pituitary gland were compared between IMRT and IMPT, respectively. Results: IMPT delivered superior isodose coverage to all tissues. Comparing IMRT and IMPT, the mean dose was 4499 cGy and 4750 cGy‐Eq (PTV), 2334 cGy and 1700 cGy‐Eq (eye), 2705 cGy and 1330 cGy‐Eq (lens), 156 cGy and 181 cGy‐Eq (optic nerve), 142 cGy and 23 cGy‐Eq (lacrimal gland), 21 cGy and 0.0 cGy‐Eq (brain), 31 cGy and 0.0 cGy‐Eq (chiasm), and 43 cGy and 0.00 cGy‐Eq (pituitary gland), respectively. The PTV was well covered by 90% isodose to 100% of the tumor volume with an average % prescription dose of 99.9% and 105.6 % for IMRT and IMPT, respectively. Conclusions: IMPT provided conformal dose to the ocular tumor and significantly spared dose to critical organs compared to IMRT. The human‐anatomy dose model performs very well in dose calculation; however, further validation using additional human anatomy‐based models and more specified proton source configuration is needed for optimization purposes.

Purpose: To implement Toyota Production System (TPS) lean tools and techniques in the Department of Radiation Oncology to maximize the individual productivity, process efficiency, deliver high level of quality and safe patient treatments. Methods: To continuously and relentlessly improve the performance of individuals and processes to an acceptable level of operation we have categorized the departmental operations into safety, quality, deliverability, cost and morale. We had issues with all aspects of the radiation therapy process that affect the quality and deliverability of treatment to our patients. To address these areas we adopted TPS lean principles and tools with existing resources such as gemba walk, visual controls and daily huddle where therapists, dosimeterists, physicists and physicians participate towards the lean management of the processes until the requested resources are available. These issues are addressed with clear communication through simple tools and with individuals in the department. To make this process and progress transparent, we have placed a huddle boards consisting of daily update of issues, actions needed to address the issues, and progress in safety, quality, deliverability, cost and morale, and effects of these progressions to the department. Results: With the implementation of simple, direct and effective TPS lean techniques in the department and hard stop policy of postponing IMRT patients not ready by the noon of the day before the first treatment, the work flow has become more streamlined and has helped in timely start of the patient treatments. With the availability of an assigned physicist to answer questions during the clinical hours, physicians, dosimeterists, and therapists concerns were also addressed in timely and orderly fashion and boosted the morale among the departmentConclusion: TPS lean techniques have been effective in decreasing the patient delays while increasing quality and safety to the patients with same cost and improved staff morale.