Purpose: The isocenter of a medical linac system is a frequently used concept in clinical practice. However, so far not all the isocenters are rigorously defined. This work is intended as an attempt of deriving consistent and operable isocenter definitions. Methods: The isocenter definition is based on a fundamental concept, the axis of rotation of a rigid body. The axis of rotation is determined using the trajectory of any point on a plane that intersects the rigid body. A point on the axis of rotation is found through the minimal bounding sphere of the trajectory when the rigid body makes a full rotation. The essential mathematical tool of the isocenter definition system is three-dimensional coordinate transformation. Results: The axes of rotation of the linac collimator, gantry, and couch are established first. The linac mechanical isocenter (linac isocenter) is defined as the center of a circle that best fits the trajectory of a select linac X-ray source position. The axis of rotation and the minimal bounding sphere are cornerstones for the rotation isocenters of the collimator, gantry and couch. The definition of radiation isocenter incorporates a surrogate of the useful beam axis. Conclusions: A framework of isocenter definitions for medical linacs is presented in this manuscript. Consistent meanings of the mechanical and radiation isocenters can be achieved using this approach.

Purpose Stereotactic radiosurgery (SRS) has become an important modality in the treatment of brain metastases. The purpose of this study is to investigate the potential of radiomic features from planning magnetic resonance (MR) images and dose maps to predict local failure after SRS for brain metastases. Materials/Methods Twenty‐eight patients who received Gamma Knife (GK) radiosurgery for brain metastases were retrospectively reviewed in this IRB‐approved study. 179 irradiated tumors included 42 that locally failed within one‐year follow‐up. Using SRS tumor volumes, radiomic features were calculated on T1‐weighted contrast‐enhanced MR images acquired for treatment planning and planned dose maps. 125 radiomic features regarding tumor shape, dose distribution, MR intensities and textures were extracted for each tumor. Logistic regression with automatic feature selection was built to predict tumor progression from local control after SRS. Feature selection and model evaluation using receiver operating characteristic (ROC) curves were performed in a nested cross validation (CV) scheme. The associations between selected radiomic features and treatment outcomes were statistically assessed by univariate analysis. Results The logistic model with feature selection achieved ROC AUC of 0.82 ± 0.09 on 5‐fold CV, providing 83% sensitivity and 70% specificity for predicting local failure. A total of 10 radiomic features including 1 shape feature, 6 MR images and 3 dose distribution features were selected. These features were significantly associated with treatment outcomes (p < 0.05). The model was validated on independent holdout data with an AUC of 0.78. Conclusions Radiomic features from planning MR images and dose maps provided prognostic information in SRS for brain metastases. A model built on the radiomic features shows promise for early prediction of tumor local failure after treatment, potentially aiding in personalized care for brain metastases.

The effect of head phantom size on the 10B and 1H[n,gamma]2H dose distributions for a broad epithermal neutron radiation field generated by an accelerator-based epithermal neutron source for boron neutron capture therapy (BNCT) have been studied. Also two techniques for calculating the absorbed gamma dose from a measured gamma-ray source distribution are compared: a Monte Carlo technique, which is well accepted in the BNCT community, and a Point Kernel technique. The count-rate distribution in the central plane of three rectangular parallelopiped head water phantoms irradiated with an epithermal neutron field was measured with a boron trifluoride (BF3) detector. This epithermal neutron field was produced at the Ohio State University Van de Graaff Accelerator Facility. The 10B absorbed dose and the gamma-ray source have the same distribution in the head phantom as the BF3 count-rate distribution. The absorbed gamma dose from the measured source distribution was calculated using MCNP, a Monte Carlo code, and QAD-CGGP, a Point Kernel code. The most pronounced effect of phantom size on 10B absorbed dose was on the dose rate at the depth of maximum dose, dmax. An increase in dose rate at dmax was observed with a decrease in phantom size, the dose rate in the smallest phantom being larger by a factor of 1.4 than the dose rate in the largest phantom. Also, dmax for the phantoms shifted deeper with a decrease in phantom dimensions. The shift between the largest and the smallest phantoms was 6 mm. Finally, the smaller phantoms had lower entrance 10B dose as a percent of the dose at dmax, or better skin sparing. Our calculations for the gamma dose show that a Point Kernel technique can be used to calculate the dose distribution as accurately as a Monte Carlo technique, in much shorter computation times.

Purpose The purpose of this study is to quantify dosimetric changes throughout the delivery of oropharyngeal cancer treatment and to investigate the application of statistical process control (SPC) for the management of significant deviations during the course of radiotherapy. Methods Thirteen oropharyngeal cancer patients with daily cone beam computed tomography (CBCT) were retrospectively reviewed. Cone beam computed tomography images of every other fraction were imported to the Velocity software and registered to planning CT using the 6 DOF (degrees of freedom) couch shifts generated during patient setup. Using Velocity “Adaptive Monitoring” module, the setup‐corrected CBCT was matched to planning CT using a deformable registration. Volumes and dose metrics at each fraction were calculated and rated with plan values to evaluate interfractional dosimetric variations using a SPC framework. T‐tests between plan and fraction volumes were performed to find statistically insignificant fractions. Average upper and lower process capacity limits (UCL, LCL) of each dose metric were derived from these fractions using conventional SPC guidelines. Results Gross tumor volume (GTV) and organ at risk (OAR) volumes in the first 13 fractions had no significant changes from the pretreatment planning CT. The GTV and the parotid glands subsequently decreased by 10% at the completion of treatment. There were 3–4% increases in parotid mean doses, but no significant differences in dose metrics of GTV and other OARs. The changes were organ and patient dependent. Control charts for various dose metrics were generated to assess the metrics at each fraction for individual patient. Conclusions Daily CBCT could be used to monitor dosimetric variations of targets and OARs resulting from volume changes and tissue deformation in oropharyngeal cancer radiotherapy. Treatment review with the guidance of a SPC tool allows for an objective and consistent clinical decision to apply adaptive radiotherapy.

Purpose Detector arrays and profile‐scans have widely replaced film‐measurements for quality assurance (QA) on linear accelerators. Film is still used for relative output factor (ROF) measurements, positioning, and dose‐profile verification for annual Leksell Gamma Knife (LGK) QA. This study shows that small‐field active detector measurements can be performed in the easily accessed clinical mode and that they are an effective replacement to time‐consuming and exacting film measurements. Methods Beam profiles and positioning scans for 4‐mm, 8‐mm, and 16‐mm‐collimated fields were collected along the x‐, y‐, and z‐axes. The Exradin W2‐scintillator and the PTW microdiamond‐detector were placed in custom inserts centered in the Elekta solid‐water phantom for these scans. GafChromic EBT3‐film was irradiated with single uniformly collimated exposures as the clinical‐standard reference, using the same solid‐water phantom for profile tests and the Elekta film holder for radiation focal point (RFP)/patient‐positioning system (PPS) coincidence. All experimental data were compared to the tissue‐maximum‐ratio‐based (TMR10) dose calculation. Results The detector‐measured beam profiles and film‐based profiles showed excellent agreement with TMR10‐predicted full‐width, half‐maximum (FWHM) values. Absolute differences between the measured FWHM and FWHM from the treatment‐planning system were on average 0.13 mm, 0.08 mm, and 0.04 mm for film, microdiamond, and scintillator, respectively. The coincidence between the RFP and the PPS was measured to be ≤0.5 mm with microdiamond, ≤0.41 mm with the W2‐1 × 1 scintillator, and ≤0.22 mm using the film‐technique. Conclusions Small‐volume field detectors, used in conjunction with a clinically available phantom, an electrometer with data‐logging, and treatment plans created in clinical mode offer an efficient and viable alternative for film‐based profile tests. Position verification can be accurately performed when CBCT‐imaging is available to correct for residual detector‐position uncertainty. Scans are easily set up within the treatment‐planning‐system and, when coupled with an automated analysis, can provide accurate measurements within minutes.