Purpose: To quantitatively compare and evaluate the dosimetry difference between breast brachytherapy protocols with different fractionation using deformable image registration. Methods: The accumulative dose distribution for multiple breast brachytherapy patients using four different applicators: Contura, Mammosite, Savi, and interstitial catheters, under two treatment protocols: 340cGy by 10 fractions in 5 days and 825cGy by 3 fractions in 2days has been reconstructed using a two stage deformable image registration approach. For all patients, daily CT was acquired with the same slice thickness (2.5mm). In the first stage, the daily CT images were rigidly registered to the initial planning CT using the registration module in Eclipse (Varian) to align the applicators. In the second stage, the tissues surrounding the applicator in the rigidly registered daily CT image were non‐rigidly registered to the initial CT using a combination of image force and the local constraint that enforce zero normal motion on the surface of the applicator, using a software developed in house. We calculated the dose distribution in the daily CTs and deformed them using the final registration to convert into the image domain of the initial planning CT. The accumulative dose distributions were evaluated by dosimetry parameters including D90, V150 and V200, as well as DVH. Results: Dose reconstruction results showed that the two day treatment has a significant dosimetry improvement over the five day protocols. An average daily drop of D90 at 1.3% of the prescription dose has been observed on multiple brachytherapy patients. There is no significant difference on V150 and V200 between those two protocols. Conclusion: Brachytherapy with higher fractional dose and less fractions has an improved performance on being conformal to the dose distribution in the initial plan. Elongated brachytherapy treatments need to consider the dose uncertainty caused by the temporal changes of the soft tissue.

Purpose: To develop an imaging angle optimization methodology for orthogonal 2D cine MRI based radiotherapy guidance using Principal Component Analysis (PCA) of target motion retrieved from 4DCT. Methods: We retrospectively analyzed 4DCT of 6 patients with lung tumor. A radiation oncologist manually contoured the target volume at the maximal inhalation phase of the respiratory cycle. An object constrained deformable image registration (DIR) method has been developed to track the target motion along the respiration at ten phases. The motion of the center of the target mass has been analyzed using the PCA to find out the principal motion components that were uncorrelated with each other. Two orthogonal image planes for cineMRI have been determined using this method to minimize the through plane motion during MRI based radiotherapy guidance. Results: 3D target respiratory motion for all 6 patients has been efficiently retrieved from 4DCT. In this process, the object constrained DIR demonstrated satisfactory accuracy and efficiency to enable the automatic motion tracking for clinical application. The average motion amplitude in the AP, lateral, and longitudinal directions were 3.6mm (min: 1.6mm, max: 5.6mm), 1.7mm (min: 0.6mm, max: 2.7mm), and 5.6mm (min: 1.8mm, max: 16.1mm), respectively. Based on PCA, the optimal orthogonal imaging planes were determined for cineMRI. The average angular difference between the PCA determined imaging planes and the traditional AP and lateral imaging planes were 47 and 31 degrees, respectively. After optimization, the average amplitude of through plane motion reduced from 3.6mm in AP images to 2.5mm (min:1.3mm, max:3.9mm); and from 1.7mm in lateral images to 0.6mm (min: 0.2mm, max:1.5mm), while the principal in plane motion amplitude increased from 5.6mm to 6.5mm (min: 2.8mm, max: 17mm). Conclusion: DIR and PCA can be used to optimize the orthogonal image planes of cineMRI to minimize the through plane motion during radiotherapy guidance.

Purpose:In lung radiation treatment, PTV is formed with a margin around GTV (or CTV/ITV). Although GTV is most likely of water equivalent density, the PTV margin may be formed with the surrounding low‐density tissues, which may lead to unreal dosimetric plan. This study is to evaluate whether the concern of dose calculation inside the PTV with only low density margin could be justified in lung treatment.Methods:Three SBRT cases were analyzed. The PTV from the original plan (Plan‐O) was created with a 5–10 mm margin outside the ITV to incorporate setup errors and all mobility from 10 respiratory phases. Test plans were generated with the GTV shifted to the PTV edge to simulate the extreme situations with maximum setup uncertainties. Two representative positions as the very posterior‐superior (Plan‐PS) and anterior‐inferior (Plan‐AI) edge were considered. The virtual GTV was assigned a density of 1.0 g.cm−3 and surrounding lung, including the PTV margin, was defined as 0.25 g.cm−3. Also, additional plan with a 1mm tissue‐margin instead of full lung‐margin was created to evaluate whether a composite‐margin (Plan‐Comp) has a better approximation for dose calculation. All plans were generated on the average CT using Analytical Anisotropic Algorithm with heterogeneity correction on and all planning parameters/monitor unites remained unchanged. DVH analyses were performed for comparisons.Results:Despite the non‐static dose distribution, the high‐dose region synchronized with tumor positions. This might due to scatter conditions as greater doses were absorbed in the solid‐tumor than in the surrounding low‐density lungtissue. However, it still showed missing target coverage in general. Certain level of composite‐margin might give better approximation for the dosecalculation.Conclusion:Our exploratory results suggest that with the lungmargin only, the planning dose of PTV might overestimate the coverage of the target during treatment. The significance of this overestimation might warrant further investigation.

Purpose: To investigate the incident angle dependence of the OnedosePlus MOSFET dosimeter and to evaluate the dosimeterˈs performance in vivo dosimetry for tangential fields treatments. Methods: Two types of external beam radiation plan were generated based on a solid water phantom: one with a group of oblique beams directed toward the anterior surface of the phantom and other with two opposing half blocked beams directed parallel to the anterior surface. The second plan represented an extreme case of tangential field treatments. In the deliveries of the plans, OnedosePlus dosimeters were placed at various locations on the phantom anterior surface. Calibrated Radiochromic EBT2 film dosimeters were placed at the same locations of the phantom anterior surface and at the corresponding locations 1cm away from the anterior surface. The measured doses from the OnedosePlus dosimeters were compared against the corresponding doses in the plans and the film measurements. Results: As the incident beam angle increased from 0 to 90 degree to the CAX, the OnedosePlus reading increased 15%. The doses measured using the OnedosePlus dosimeters in the extreme tangential field plan did not have a clear correspondence to either the surface dose or the doses at 1 cm depth. The film readings were in close agreement with the TPS calculated doses with an average dose difference less than 5%. The OnedosePlus measured doses were higher than the TPS calculated doses at the 1cm depth by a constant (average: 31.45+/− 2.71cGy), and much higher than the surface film measurements by an average of 246%. Conclusions: OnedosePlus dosimeter readings have a strong dependence on the incident beam angle, especially when the beam angle is larger than 45 degree. The point of measurement for OnedosePlus dosimeter is unclear for the treatments involving tangential beams and it overestimates doses for the assumed point of measurement (1cm depth).