林 直樹

This study aimed to evaluate the performance for answering the Japanese medical physicist examination and providing the benchmark of knowledge about medical physics in language-generative AI with large language model. We used questions from Japan's 2018, 2019, 2020, 2021 and 2022 medical physicist board examinations, which covered various question types, including multiple-choice questions, and mainly focused on general medicine and medical physics. ChatGPT-3.5 and ChatGPT-4.0 (OpenAI) were used. We compared the AI-based answers with the correct ones. The average accuracy rates were 42.2 ± 2.5% (ChatGPT-3.5) and 72.7 ± 2.6% (ChatGPT-4), showing that ChatGPT-4 was more accurate than ChatGPT-3.5 [all categories (except for radiation-related laws and recommendations/medical ethics): p value < 0.05]. Even with the ChatGPT model with higher accuracy, the accuracy rates were less than 60% in two categories; radiation metrology (55.6%), and radiation-related laws and recommendations/medical ethics (40.0%). These data provide the benchmark for knowledge about medical physics in ChatGPT and can be utilized as basic data for the development of various medical physics tools using ChatGPT (e.g., radiation therapy support tools with Japanese input).

The reference dose for clinical proton beam therapy is based on ionization chamber dosimetry. However, data on uncertainties in proton dosimetry are lacking, and multifaceted studies are required. Monte Carlo simulations are useful tools for calculating ionization chamber dosimetry in radiation fields and are sensitive to the transport algorithm parameters when particles are transported in a heterogeneous region. We aimed to evaluate the proton transport algorithm of the Particle and Heavy Ion Transport Code System (PHITS) using the Fano test. The response of the ionization chamber f Q and beam quality correction factors k Q were calculated using the same parameters as those in the Fano test and compared with those of other Monte Carlo codes for verification. The geometry of the Fano test consisted of a cylindrical gas-filled cavity sandwiched between two cylindrical walls. f Q was calculated as the ratio of the absorbed dose in water to the dose in the cavity in the chamber. We compared the f Q calculated using PHITS with that of a previous study, which was calculated using other Monte Carlo codes (Geant4, FULKA, and PENH) under similar conditions. The flight mesh, a parameter for charged particle transport, passed the Fano test within 0.15%. This was shown to be sufficiently accurate compared with that observed in previous studies. The f Q calculated using PHITS were 1.116 ± 0.002 and 1.124 ± 0.003 for NACP-02 and PTW-30013, respectively, and the k Q were 0.981 ± 0.008 and 1.027 ± 0.008, respectively, at 150 MeV. Our results indicate that PHITS can calculate the f Q and k Q with high precision.

INTRODUCTION: In this simulation study, we examined the effects of a de-escalation strategy with a reduced dose to subclinical nodal regions in patients with human papillomavirus (HPV)-associated oropharyngeal carcinoma (OPC). METHODS: We created two patterns of intensity-modulated radiotherapy for 16 patients with HPV-associated OPC. In the standard and de-escalation plans, the initial field including elective nodal regions received 46 and 30 Gy, followed by 20 and 36 Gy to the cutdown field, respectively. Comparison metrics were set for each organ at risk (OAR). We compared these metric values and the probability of adverse effects based on the normal tissue complication probability (NTCP) model between the two plans. RESULTS: Both plans generally met the dose constraints for the targets and all OAR. Among the comparison metrics, the mean doses to the brain, pharyngeal constrictor muscle, thyroid, and skin and the dose to a 1 % volume of the skin were higher in the standard plan than in the de-escalation plan (P = 0.031, 0.007, < 0.001, < 0.001, and 0.006, respectively). NTCP analyses revealed that the probability of adverse effects in the ipsilateral parotid gland and thyroid was higher in the standard plan than in the de-escalation plan (standard vs. de-escalation plans: ipsilateral parotid gland, 6.4 % vs. 5.0 %, P = 0.016; thyroid, 3.3 % vs. 0.5 %, P < 0.001). CONCLUSIONS: A de-escalation strategy with elective nodal regions is a promising treatment to prevent a decline in the quality of life in patients with HPV-associated OPC, particularly xerostomia, dysphagia, and hypothyroidism.

This study aimed to investigate the educational environment of radiotherapy technology and medical physics specialists (RTMP) in Japan. We conducted a nationwide questionnaire survey in radiotherapy institutions between June and August 2022. Participants were asked questions regarding the educational system, perspectives on updating RTMP's skills and qualifications, and perspectives on higher education for RTMP at radiotherapy institutions. The results were then analyzed in detail according to three factors: whether the hospital was designed for cancer care, whether it was a Japanese Society for Radiation Oncology (JASTRO)-accredited hospital, and whether it was an intensity-modulated radiation therapy charged hospital. Responses were obtained from 579 (69%) nationwide radiation therapy institutions. For non-qualified RTMP, 10% of the institutions had their own educational systems, only 17% of institutions provided on-the-job training, and 84% of institutions encouraged participation in educational lectures and workshops in academic societies. However, for qualified RTMP, 3.0% of institutions had their own educational systems, only 8.9% of the institutions provided on-the-job training, and 83% encouraged participation in academic conferences and workshops. Less than 1% of the facilities offered salary increases for certification, whereas 8.2% offered consideration for occupational promotion. Regarding the educational environment, JASTRO-accredited hospitals were better than general hospitals. Few institutions have their own educational systems for qualified and non-qualified RTMP, but they encourage them to attend educational seminars and conferences. It is desirable to provide systematic education and training by academic and professional organizations to maintain the skills of individuals.

Several staffing models are used to determine the required medical physics staffing, including radiotherapy technologists, of radiation oncology departments. However, since Japanese facilities tend to be smaller in scale than foreign ones, those models might not apply to Japan. Therefore, in this study, we surveyed workloads in Japan to estimate the optimal medical physics staffing in external beam radiotherapy. A total of 837 facilities were surveyed to collect information regarding radiotherapy techniques and medical physics specialists (RTMPs). The survey covered facility information, staffing, patient volume, equipment volume, workload and quality assurance (QA) status. Full-time equivalent (FTE) factors were estimated from the workload and compared with several models. Responses were received from 579 facilities (69.2%). The median annual patient volume was 369 at designated cancer care hospitals (DCCHs) and 252 across all facilities. In addition, the median FTE of RTMPs was 4.6 at DCCHs and 3.0 at all sites, and the average QA implementation rate for radiotherapy equipment was 69.4%. Furthermore, advanced treatment technologies have increased workloads, particularly in computed tomography simulations and treatment planning tasks. Compared to published models, larger facilities (over 500 annual patients) had a shortage of medical physics staff. In very small facilities (about 140 annual patients), the medical physics staffing requirement was estimated to be 0.5 FTE, implying that employing a full-time medical physicist would be inefficient. However, ensuring the quality of radiotherapy is an important issue, given the limited number of RTMPs. Our study provides insights into optimizing staffing and resource allocation in radiotherapy departments.

Deep learning-based CT image reconstruction (DLR) is a state-of-the-art method for obtaining CT images. This study aimed to evaluate the usefulness of DLR in radiotherapy. Data were acquired using a large-bore CT system and an electron density phantom for radiotherapy. We compared the CT values, image noise, and CT value-to-electron density conversion table of DLR and hybrid iterative reconstruction (H-IR) for various doses. Further, we evaluated three DLR reconstruction strength patterns (Mild, Standard, and Strong). The variations of CT values of DLR and H-IR were large at low doses, and the difference in average CT values was insignificant with less than 10 HU at doses of 100 mAs and above. DLR showed less change in CT values and smaller image noise relative to H-IR. The noise-reduction effect was particularly large in the low-dose region. The difference in image noise between DLR Mild and Standard/Strong was large, suggesting the usefulness of reconstruction intensities higher than Mild. DLR showed stable CT values and low image noise for various materials, even at low doses; particularly for Standard or Strong, the reduction in image noise was significant. These findings indicate the usefulness of DLR in treatment planning using large-bore CT systems.

A calibration phantom made of Derlin requires manual translational and rotational adjustments when calibrating a light-section-based optical surface monitoring system (VOXELAN) with a phantom material that insufficiently reflects the red-slit laser of the system. This study aimed to develop a new calibration phantom using different materials and to propose a procedure that minimizes setup errors. The new phantom, primarily made of PET100, which exhibits good reflectivity without scattering or attenuating the red-slit laser at the phantom surface, was shaped in a manner similar to that of previous designs. The detection accuracy and stability were evaluated using six different regions of interest (ROIs) and compared with previous phantom designs. The coordinate coincidence between the machine and VOXELAN was compared for both phantom designs. The detection accuracy and stability of the new phantom in the reference ROI setting were found to be better than those of previous phantoms. In the lateral, longitudinal, and vertical directions, the coordinate coincidences in translational directions for the previous phantom were obtained at 1.07 ± 0.66, 1.46 ± 0.47, and 0.26 ± 0.83 mm, whereas those for the new phantom were obtained at 0.28 ± 0.21, 0.18 ± 0.30, and - 0.30 ± 0.29 mm, respectively. The rotational errors of the two phantoms were identical. The new phantom exhibited improved detection stability because of its good reflectivity. Additionally, the new placement procedure was linked to the six-degrees-of-freedom couch. A combination of the new phantom and its new placement procedure is suitable for coordinate calibration of VOXELAN.

PURPOSE: The spot position is an important beam parameter in the quality assurance of scanning proton therapy. In this study, we investigated dosimetric impact of systematic 15 spot position errors (SSPE) in spot scanning proton therapy using three types of optimization methods of head and neck tumor. MATERIALS AND METHODS: The planning simulation was performed with ± 2 mm model SSPE in the X and Y directions. Treatment plans were created using intensity-modulated proton therapy (IMPT) and single-field uniform dose (SFUD). IMPT plans were created by two optimization methods: with worst-case optimization (WCO-IMPT) and without (IMPT). For clinical target volume (CTV), D95%, D50%, and D2cc were used for analysis. For organs at risk (OAR), Dmean was used to analyze the brain, cochlea, and parotid, and Dmax was used to analyze brainsetem, chiasm, optic nerve, and cord. RESULTS: For CTV, the variation (1 standard deviation) of D95% was ± 0.88%, 0.97% and 0.97% to WCO-IMPT, IMPT, and SFUD plan. The variation of D50% and D2cc of CTV showed <0.5% variation in all plans. The dose variation due to SSPE was larger in OAR, and worst-case optimization reduced the dose variation, especially in Dmax. The analysis results showed that SSPE has little impact on SFUD. CONCLUSIONS: We clarified the impact of SSPE on dose distribution for three optimization methods. SFUD was shown to be a robust treatment plan for OARs, and the WCO can be used to increase robustness to SSPE in IMPT.

In single-isocenter multiple-target stereotactic radiotherapy (SIMT-SRT), it is difficult to evaluate both the geometrical accuracy and absorbed dose measurement when irradiating off-isocenter targets. This study aimed to develop a simple quality assurance (QA) method to evaluate off-isocenter irradiation position accuracy in SIMT-SRT and compare its feasibility with that of a commercial device. First, we created two types of inserts and metallic balls with a diameter of 5 mm to be inserted into a commercially available phantom (SIMT phantom). Second, we developed a dedicated analysis software using Python for the Winston-Lutz test (WLT). Third, an image processing software, including the filtered back-projection algorithm, was developed to analyze the images obtained using an electronic portal imaging device (EPID). Fourth, the feasibility of our method was evaluated by comparing it with the results of WLT using two commercially available phantoms: WL-QA and MultiMet-WL cubes. Notably, 92% of the results in one-dimensional deviations were within 0.26 mm (EPID pixel width). The correlation coefficients were 0.52, 0.92, and 0.96 in the left-right, superior-inferior, and anterior-posterior directions, respectively. In the WLT, a maximum two-dimensional deviation of 0.70 mm was detected in our method, while the deviation in the other method was within 0.5 mm. The advantage of our method is that it can evaluate the geometrical accuracy at any gantry angle during dynamic rotation irradiation using a filtered back-projection algorithm, even if the target is located off the isocenter. Our method can perform WLT at arbitrary positions and is suitable for the QA of dynamic rotation irradiation using an EPID.

PURPOSE: Accurate calculation of the proton beam range inside a patient is an important topic in proton therapy. In recent times, a computed tomography (CT) image reconstruction algorithm was developed for treatment planning to reduce the impact of the variation of the CT number with changes in imaging conditions. In this study, we investigated the usefulness of this new reconstruction algorithm (DirectDensity™: DD) in proton therapy based on its comparison with filtered back projection (FBP). METHODS: We evaluated the effects of variations in the X-ray tube potential and target size on the FBP- and DD-image values and investigated the usefulness of the DD algorithm based on the range variations and dosimetric quantity variations. RESULTS: For X-ray tube potential variations, the range variation in the case of FBP was up to 12.5 mm (20.8%), whereas that of DD was up to 3.3 mm (5.6%). Meanwhile, for target size variations, the range variation in the case of FBP was up to 2.2 mm (2.5%), whereas that of DD was up to 0.9 mm (1.4%). Moreover, the variations observed in the case of DD were smaller than those of FBP for all dosimetric quantities. CONCLUSION: The dose distributions obtained using DD were more robust against variations in the CT imaging conditions (X-ray tube potential and target size) than those obtained using FBP, and the range variations were often less than the dose calculation grid (2 mm). Therefore, the DD algorithm is effective in a robust workflow and reduces uncertainty in range calculations.

The purpose of this study was to evaluate the effect of quality assurance (QA)-related setup errors in passive proton therapy for prostate cancer with and without a hydrogel spacer. We used 20 typical computed tomography (CT) images of prostate cancer: 10 patients with and 10 patients without spacers. The following 12 model errors were assumed: output error ± 2%, range error ± 1 mm, setup error ± 1 mm for three directions, and multileaf collimator (MLC) position error ± 1 mm. We created verification plans with model errors and compared the prostate-rectal (PR) distance and dose indices with and without the spacer. The mean PR distance at the isocenter was 1.1 ± 1.3 mm without the spacer and 12.9 ± 2.9 mm with the spacer (P < 0.001). The mean rectum V53.5 GyE, V50 GyE, and V34.5 GyE in the original plan were 2.3%, 4.1%, and 12.1% without the spacer and 0.1%, 0.4%, and 3.3% with the spacer (P = 0.0011, < 0.001, and < 0.001). The effects of the range and lateral setup errors were small; however, the effects of the vertical/long setup and MLC error were significant in the cases without the spacer. The means of the maximum absolute change from original plans across all scenarios in the rectum V53.5 GyE, V50 GyE, and V34.5 GyE were 1.3%, 1.5%, and 2.3% without the spacer, and 0.2%, 0.4%, and 1.3% with the spacer (P < 0.001, < 0.001, and = 0.0019). This study indicated that spacer injections were also effective in reducing the change in the rectal dose due to setup errors.

A radiophotoluminescent glass dosimeter (RGD) is used for a postal audit of a photon beam because of its various excellent characteristics. However, it has not been used for scanning proton beams because its response characteristics have not been verified. In this study, the response of RGD to scanning protons was investigated to develop a dosimetry protocol using the linear energy transfer (LET)-based correction factor. The responses of RGD to four maximum-range-energy-pattern proton beams were verified by comparing it with ionization chamber (IC) dosimetry. The LET at each measurement depth was calculated via Monte Carlo (MC) simulation. The LET correction factor ( k LET RGD ) was the ratio between the uncorrected RGD dose ( D raw RGD ) and the IC dose at each measurement depth. k LET RGD can be represented as a function of LET using the following equation: k LET RGD LET = - 0.035 LET + 1.090 . D raw RGD showed a linear under-response with increasing LET, and the maximum dose difference between the IC dose and D raw RGD was 15.2% at an LET of 6.07 keV/μm. The LET-based correction dose ( D LET RGD ) conformed within 3.6% of the IC dose. The mean dose difference (±SD) of D raw RGD and D LET RGD was -2.5 ± 6.9% and 0.0 ± 1.6%, respectively. To achieve accurate dose verification for scanning proton beams using RGD, we derived a linear regression equation based on LET. The results show that with appropriate LET correction, RGD can be used for dose verification of scanning proton beams.

A radiophotoluminescent glass dosimeter (RGD) is widely used in postal audit system for photon beams in Japan. However, proton dosimetry in RGDs is scarcely used owing to a lack of clarity in their response to beam quality. In this study, we investigated RGD response to beam quality for establishing a suitable linear energy transfer (LET)-corrected dosimetry protocol in a therapeutic proton beam. The RGD response was compared with ionization chamber measurement for a 100-225 MeV passive proton beam. LET of the measurement points was calculated by the Monte Carlo method. An LET-correction factor, defined as a ratio between the non-corrected RGD dose and ionization chamber dose, of 1.226×(LET)-0.171 was derived for the RGD response. The magnitude of the LET-dependence of RGD increased with LET; for an LET of 8.2 keV/μm, the RGD under-response was up to 16%. The coefficient of determination, mean difference ± SD of non-corrected RGD dose, residual range-corrected RGD dose, and LET-corrected RGD dose to the ionization chamber are 0.923, 3.7 ± 4.2%, -2.4 ± 7.5%, and 0.04 ± 2.1%, respectively. The LET-corrected RGD dose was within 5% of the corresponding ionization chamber dose at all energies until 200 MeV, where it was 5.3% lower than the ionization chamber dose. A corrected LET-dependence of RGD using a correction factor based on a power function of LET and precise dosimetric verification close to the maximum LET were realized here. We further confirmed establishment of an accurate postal audit under various irradiation conditions.

Background: The purpose of this study was to investigate the dosimetric characteristics of a new type of two-dimensional diode detector array used for quality assurance of stereotactic radiosurgery (SRS). Materials and Methods: The devices used in this study were the SRS MapCHECK detector and the StereoPHAN. The detector has 1013 diode detectors over an area of 77 x 77 mm2. The reproducibility, dose linearity, dose rate dependencies, output factors (OPFs) and angular dependencies were investigated as dosimetric characteristics. The OPFs were measured and compared between AP and PA direction ranging from 0.5 x 0.5 to 7 x 7 cm2. The angular dependencies were measured using 19 gantry angles. Results: The dose reproducibility and linearities showed sufficient performance of 6 MV and 10 MV. At 40 MU/min, there was a 1.3% difference from the ionization chamber measurements. For the flattening filter-free beam, there was no dose rate dependency from the 400 MU/minute to 2400 MU/minute, and the variation was within 0.5%. For small irradiation fields of 1 cm or less, the measured value of the SMC differed in AP and PA directions by up to 4.5%. The maximum gantry angle dependency of the detector was 5.3%. A maximum difference of -3.1% occurred between the measurements and TPS calculations. Conclusion: Results indicate that the new 2D diode detector is stable and useful for QA and end-to-end testing of SRS due to its excellent dose characteristics, high resolution and ease of handling when combined with the StereoPHAN.

PURPOSE: The beam model in radiation treatment planning systems (RTPSs) plays a crucial role in determining the accuracy of calculated dose distributions. The purpose of this study was to ascertain differences in beam models and their dosimetric influences when a golden beam dataset (GBD) and multi-institution measured beam datasets (MBDs) are used for beam modeling in RTPSs. METHODS: The MBDs collected from 15 institutions, and the MBDs' beam models, were compared with a GBD, and the GBD's beam model, for Varian TrueBeam linear accelerator. The calculated dose distributions of the MBDs' beam models were compared with those of the GBD's beam model for simple geometries in a water phantom. Calculated dose distributions were similarly evaluated in volumetric modulated arc therapy (VMAT) plans for TG-119 C-shape and TG-244 head and neck, at several dose constraints of the planning target volumes (PTVs), and organs at risk. RESULTS: The agreements of the MBDs with the GBD were almost all within ±1%. The calculated dose distributions for simple geometries in a water phantom also closely corresponded between the beam models of GBD and MBDs. Nevertheless, there were considerable differences between the beam models. The maximum differences between the mean energy of the energy spectra of GBD and MBDs were -0.12 MeV (-10.5%) in AcurosXB (AXB, Eclipse) and 0.11 MeV (7.7%) in collapsed cone convolution (CCC, RayStation). The differences in the VMAT calculated dose distributions varied for each dose region, plan, X-ray energy, and dose calculation algorithm. The ranges of the differences in the dose constraints were -5.6% to 3.0% for AXB and -24.1% to 2.8% for CCC. In several VMAT plans, the calculated dose distributions of GBD's beam model tended to be lower in high-dose regions and higher in low-dose regions than those of the MBDs' beam models. CONCLUSIONS: We found that small differences in beam data have large impacts on the beam models, and on calculated dose distributions in clinical VMAT plan, even if beam data correspond within ±1%. GBD's beam model was not a representative beam model. The beam models of GBD and MBDs and their calculated dose distributions under clinical conditions were significantly different. These differences are most likely due to the extensive variation in the beam models, reflecting the characteristics of beam data. The energy spectrum and radial energy in the beam model varied in a wide range, even if the differences in the beam data were <±1%. To minimize the uncertainty of the calculated dose distributions in clinical plans, it was best to use the institutional MBD for beam modeling, or the beam model that ensures the accuracy of calculated dose distributions.

OBJECTIVES: The efficacy of radiotherapy for breast cancer has greatly improved owing to better irradiation methods. Radiotherapy aims to deliver therapeutic doses to predetermined target volumes while sparing surrounding healthy tissues. However, there are few reports on radiation exposure to eye lenses, and the recommended exposure limits to ocular lens have been substantially reduced in recent years. This study aimed to investigate the amount of radiation exposure to eye lenses using optically stimulated luminescence dosimeters (OSLDs) and determine whether wearing special protective devices to protect the eyes, as an organ at risk, during whole breast irradiation, is necessary. METHODS: This experiment used OSLDs on water-equivalent phantom to measure the change in scattered radiation dose due to the difference of irradiation field while using 4- and 6-MV photons of TrueBeam linear accelerator. Using a total treatment dose of 50 Gy, a target was positioned to approximate the breast, and a plan was formulated to deliver 2 Gy per treatment by tangential irradiation. The mean (SD) irradiation dose at the lens position outside the irradiation field was reported. RESULTS: The scattered radiation dose outside the irradiation field was more affected by the irradiation field size than by the radiation energy. The out-of-field irradiation dose with a larger field of view was higher than that with a smaller field of view. The use of 0.07- and 0.83-mm-thick lead shield protective glasses reduced the radiation dose by 56.1% (P < .001) and 55.6% (P < .001), respectively. CONCLUSIONS: In this experimental model, the amount of radiation the eye was exposed to during whole breast irradiation was determined by the distance of the eye from the radiation field edge and by wearing protective glasses. In clinical practice, the protection offered by eyeglasses may reduce the risk of long-term side effects and allow the use of higher intensive radiotherapy.

© 2019 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, Inc. on behalf of American Association of Physicists in Medicine The purpose of this study was to propose a verification method and results of intensity-modulated proton therapy (IMPT), using a commercially available heterogeneous phantom. We used a simple simulated head and neck and prostate phantom. An ionization chamber and radiochromic film were used for measurements of absolute dose and relative dose distribution. The measured doses were compared with calculated doses using a treatment planning system. We defined the uncertainty of the measurement point of the ionization chamber due to the effective point of the chamber and mechanical setup error as 2 mm and estimated the dose variation base on a 2 mm error. We prepared a HU-relative stopping power conversion table and fluence correction factor that were specific to the heterogeneous phantom. The fluence correction factor was determined as a function of depth and was obtained from the ratio of the doses in water and in the phantom at the same effective depths. In the simulated prostate plan, composite doses of measurements and calculations agreed within ±1.3% and the maximum local dose differences of each field were 10.0%. Composite doses in the simulated head and neck plan agreed within 4.0% and the maximum local dose difference for each field was 12.0%. The dose difference for each field came within 2% when taking the measurement uncertainty into consideration. In the composite plan, the maximum dose uncertainty was estimated as 4.0% in the simulated prostate plan and 5.8% in the simulated head and neck plan. Film measurements showed good agreement, with more than 92.5% of points passing a gamma value (3%/3 mm). From these results, the heterogeneous phantom should be useful for verification of IMPT by using a phantom-specific HU-relative stopping power conversion, fluence correction factor, and dose error estimation due to the effective point of the chamber.

© 2018 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, Inc. on behalf of American Association of Physicists in Medicine. The purpose of this study was to provide periodic quality assurance (QA) methods for respiratory-gated proton beam with a range modulation wheel (RMW) and to clarify the characteristics and long-term stability of the respiratory-gated proton beam. A two-dimensional detector array and a solid water phantom were used to measure absolute dose, spread-out Bragg peak (SOBP) width and proton range for monthly QA. SOBP width and proton range were measured using an oblique incidence beam to the lateral side of a solid water phantom and compared between with and without a gating proton beam. To measure the delay time of beam-on/off for annual QA, we collected the beam-on/off signals and the dose monitor-detected pulse. We analyzed the results of monthly QA over a 15-month period and investigated the delay time by machine signal analysis. The dose deviations at proximal, SOBP center and distal points were −0.083 ± 0.25%, 0.026 ± 0.20%, and −0.083 ± 0.35%, respectively. The maximum dose deviation between with and without respiratory gating was −0.95% at the distal point and other deviations were within ±0.5%. Proximal and SOBP center doses showed the same trend over a 15-month period. Delay times of beam-on/off for 200 MeV/SOBP 16 cm were 140.5 ± 0.8 ms and 22.3 ± 13.0 ms, respectively. Delay times for 160 MeV/SOBP 10 cm were 167.5 ± 15.1 ms and 19.1 ± 9.8 ms. Our beam delivery system with the RMW showed sufficient stability for respiratory-gated proton therapy and the system did not show dependency on the energy and the respiratory wave form. The delay times of beam-on/off were within expectations. The proposed QA methods will be useful for managing the quality of respiratory-gated proton beams and other beam delivery systems.

We clarified the reconstructed 3D dose difference between two different commercial software programs (Mobius3D v2.0 and PerFRACTION v1.6.4). Five prostate cancer patients treated with IMRT (74 Gy/37 Fr) were studied. Log files and cine EPID images were acquired for each fraction. 3D patient dose was reconstructed using log files (Mobius3D) or log files with EPID imaging (PerFRACTION). The treatment planning dose was re-calculated on homogeneous and heterogeneous phantoms, and log files and cine EPID images were acquired. Measured doses were compared with the reconstructed point doses in the phantom. Next, we compared dosimetric metrics (mean dose for PTV, rectum, and bladder) calculated by Mobius3D and PerFRACTION for all fractions from five patients. Dose difference at isocenter between measurement and reconstructed dose for two software programs was within 3.0% in both homogeneous and heterogeneous phantoms. Moreover, the dose difference was larger using skip arc plan than that using full arc plan, especially for PerFRACTION (e.g., dose difference at isocenter for PerFRACTION: 0.34% for full arc plan vs. -4.50% for skip arc plan in patient 1). For patients, differences in dosimetric parameters were within 1% for almost all fractions. PerFRACTION had wider range of dose difference between first fraction and the other fractions than Mobius3D (e.g., maximum difference: 0.50% for Mobius3D vs. 1.85% for PerFRACTION), possibly because EPID may detect some types of MLC positioning errors such as miscalibration errors or mechanical backlash which cannot be detected by log files, or that EPID data might include image acquisition failure and image noise.

© 2018 American Association of Physicists in Medicine. In this study, we evaluate dosimetric advantages of using patient-specific aperture system with intensity-modulated proton therapy (IMPT) for head and neck tumors at the shallow depth. We used four types of patient-specific aperture system (PSAS) to irradiate shallow regions less than 4 g/cm2 with a sharp lateral penumbra. Ten head and neck IMPT plans with or without aperture were optimized separately with the same 95% prescription dose and same dose constraint for organs at risk (OARs). The plans were compared using dose volume histograms (DVHs), dose distributions, and some dose indexes such as volume receiving 50% of the prescribed dose (V50), mean or maximum dose (Dmean and Dmax) to the OARs. All examples verified in this study had decreased V50 and OAR doses. Average, maximum, and minimum relative reductions of V50 were 15.4%, 38.9%, and 1.0%, respectively. Dmax and Dmean of OARs were decreased by 0.3% to 25.7% and by 1.0% to 46.3%, respectively. The plans with the aperture over more than half of the field showed decreased V50 or OAR dose by more than 10%. The dosimetric advantage of patient-specific apertures with IMPT was clarified in many cases. The PSAS has some dosimetric advantages for clinical use, and in some cases, it enables to fulfill dose constraints.

The aim of this study is to investigate the dosimetric uncertainty of stochastic noise and the postirradiation density growth for reflective-type radiochromic film to obtain the appropriate dose from the exactly controlled film density. Film pieces were irradiated with 6-MV photon beams ranging from 0 to 400 cGy. The pixel values (PVs) of these films were obtained using a flatbed scanner at elapsed times of 1 min to 120 h between the end of irradiation and the film scan. The means and standard deviations (SDs) of the PVs were calculated. The SDs of the converted dose scale, u(sd), and the dose increases resulting from the PV increases per +/- 29 min at each elapsed time, u(time), were computed. The combined dose uncertainties from these two factors, u(c), were then calculated. A sharp increase in the PV occurred within the first 3 h after irradiation, and a slight increase continued from 3 h to 120 h. usd was independent of post-irradiation elapsed time. Sharp decreases in utime were obtained within 1 h after irradiation, and slight decreases in utime were observed from 1 to 24 h after irradiation. uc first decreased 1 h after irradiation and remained constant afterward. Assuming that the post-irradiation elapsed times of all of the related measurements are synchronized within +/- 29 min, the elapsed time should be at least 1 h in our system. It is important to optimize the scanning protocol for each institution with consideration of the required measurement uncertainty and acceptable latency time. (C) 2016 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

Several tools are used for the dosimetric verification of intensity-modulated arc therapy (IMAT) treatment delivery. However, limited information is available for composite on-line evaluation of these tools. The purpose of this study was to evaluate the dosimetric verification of IMAT treatment plans using a 2D diode array detector (2D array), radiochromic film (RCF) and radiosensitive polymer gel dosimeter (RPGD). The specific verification plans were created for IMAT for two prostate cancer patients by use of the clinical treatment plans. Accordingly, the IMAT deliveries were performed with the 2D array on a gantry-mounting device, RCF in a cylindrical acrylic phantom, and the RPGD in two cylindrical phantoms. After the irradiation, the planar dose distributions from the 2D array and the RCFs, and the 3D dose distributions from the RPGD measurements were compared with the calculated dose distributions using the gamma analysis method (3% dose difference and 3-mm distance-to-agreement criterion), dose-dependent dose difference diagrams, dose difference histograms, and isodose distributions. The gamma passing rates of 2D array, RCFs and RPGD for one patient were 99.5%, 96.5% and 93.7%, respectively; the corresponding values for the second patient were 97.5%, 92.6% and 92.9%. Mean percentage differences between the RPGD measured and calculated doses in 3D volumes containing PTVs were -0.29 +/- 7.1% and 0.97 +/- 7.6% for the two patients, respectively. In conclusion, IMAT prostate plans can be delivered with high accuracy, although the 3D measurements indicated less satisfactory agreement with the treatment plans, mainly due to the dosimetric inaccuracy in low-dose regions of the RPGD measurements.

In small-field irradiation, the back-scattered radiation (BSR) affects the counts measured with a beam monitor chamber (BMC). In general, the effect of the BSR depends on the opened-jaw size. The effect is significantly large in small-field irradiation. Our purpose in this study was to predict the effect of BSR on LINAC output accurately with an improved target-current-pulse (TCP) technique. The pulse signals were measured with a system consisting of a personal computer and a digitizer. The pulse signals were analyzed with in-house software. The measured parameters were the number of pulses, the change in the waveform and the integrated signal values of the TCPs. The TCPs were measured for various field sizes with four linear accelerators. For comparison, Yu's method in which a universal counter was used was re-examined. The results showed that the variance of the measurements by the new method was reduced to approximately 1/10 of the variance by the previous method. There was no significant variation in the number of pulses due to a change in the field size in the Varian Clinac series. However, a change in the integrated signal value was observed. This tendency was different from the result of other investigations in the past. Our prediction method is able to define the cutoff voltage for the TCP acquired by digitizer. This functionality provides the capability of clearly classifying TCPs into signals and noise. In conclusion, our TCP analysis method can predict the effect of BSR on the BMC even for small-field irradiations. © 2012 Japanese Society of Radiological Technology and Japan Society of Medical Physics.

Purpose: The purpose of this study is to develop the dedicated in‐house program for calculation of the monitor unit (MU) of proton therapy beam and to verify the feasibility of its clinical implementation in proton beam therapy with a combination of range modulation wheel (RMW).Materials and Methods: The MU calculation for the proton beam was suggested by Dr.Sahoo in 2008 and given by the formalism using the multiplication of several factors with regard to the structure of the proton beam system. Following his theory, we implemented eight factors into the formalism for MU calculation as follows: Relative output factor (ROF), Spread‐out Bragg peak factor (SOBPF), Range shifter factor (RSF), SOBP off‐center factor (SOBPOCF), Off‐center ratio (OCR), Field size factor (FSF), Inverse square factor (ISF), and Compensator and patient scatter factor (CPSF). Our program was built by Microsoft Visual Basic language. The MU could be calculated by division of the prescribed dose with (d/MU). After building the program, the calculated doses by the formalism were compared with the measured dose. Results: The (d/MU) was calculated by the multiplication using eight factors by use of our program. Once the energy and the settings were input to the program, these factors were estimated from the measurement data. Then MU calculation was done immediately. It was simply and satisfactory fast for the user to complete calculating (d/MU). As the results of the comparison between the measured and calculated doses, the discrepancies in all referential settings were within 2%. Conclusions: The in‐house program provides the fast MU calculation for proton beams. The accuracy of the dose calculation is good in the referential settings. However, further improvement is required for the complicated condition. © 2013, American Association of Physicists in Medicine. All rights reserved.

The energy spectra of high-energy electron beams used in radiotherapy are the most important data for evaluating absorbed doses and/or dose distributions in the body of a patient. However, it is impossible to measure the actual spectra of a high-energy electron beam. In this study, we suggest a method to presume the spectra of high-energy electron beams by use of the beta distribution model. The procedure of this method is as follows: (1) the spectrum of the high-energy electron beam was assumed to have a maximum energy E_max, and α, β parameters of the beta probability density function. (2) The percentage depth dose (PDD) based on the assumed spectrum was calculated by a Monte Carlo simulation. (3) The best matching energy spectrum was searched in comparison with the experimental PDD curves. Finally, the optimal energy spectrum of the electron beam was estimated after reiterating the process from (1) to (3). With our method, the measured PDD curves were optimally simulated following the experimental data. It appeared that the assumed spectra approximated well to the actual spectra. However, the error between the assumed and experimental data was observed in the region under the incident surface. We believe this was due to the influence of low-energy electrons scattered at installed collimators, etc. In order to simulate PDDs in this region accurately, a further correction process is required for a spectrum based on the beta distribution model.

In external radiotherapy, the absorbed doses are measured using an ionization process in a gas-filled ionization chamber and estimated by the extended cavity theory. The calculation requires both the W-value of cavity gas and the restricted mass collision stopping powers (L/ρ) for the gas and medium. ICRU Report 37 gives us the data regarding the mass collision stopping powers (S/ρ) for several elements and chemical compounds or mixtures. However, there are no detailed data for L/ρ. In this study, we developed an in-house program to calculate the L/ρ for arbitrary substances by the use of the equation described in ICRU Report 37. With this program, we can search the calculated L/ρ easily. When we calculated L/ρ for chemical compounds and mixtures with implementation of Bragg's additivity rule, a large error of density effect corrections was observed. Therefore, our program adopted both the mean excitation energy and density effect correction obtained by ESTAR, which was developed by Berger et al. With adoption of these values, the calculation accuracy of our program was improved. Our program is useful to search L/ρ for radiation dosimetry in radiotherapy.

The purpose of this study was to evaluate the triple channel correction acquisition (TCCA) method for radiochromic film dosimetry performed with a flatbed scanner. The study had two parts: a fundamental and a clinical examination. In the fundamental examination, we evaluated the accuracy of calibration curves for Gafchromic EBT2 (EBT2). The films were calibrated using a field-by-field method with 13 dose steps. Seven calibration curves obtained by TCCA were compared with those produced by a single channel acquisition (SCA) method. For the clinical examination, we compared relative dose distributions obtained by TCCA and SCA for four cases of intensity-modulated radiation therapy (IMRT) and intensity-modulated arc therapy (IMAT). The fundamental examination showed that the consistency of the calibration curves was better for TCCA than for SCA, particularly for the dose range between 0.25 Gy and 1.00 Gy. The clinical examination showed that the dose differences between the measured and calculated doses in high-gradient regions were smaller with TCCA than with SCA. The average pass rates in gamma analysis for the TCCA and SCA methods were 97.2 +/- 0.8% (n = 20) and 93.0 +/- 1.2% (n = 20), respectively. In conclusion, TCCA can acquire accurate average dose values when creating the calibration curve. The potential advantage of TCCA for EBT2 film dosimetry was seen in high-gradient regions in clinically relevant IMRT and IMAT cases. TCCA is useful to verify dose distribution.

Some dosimeters require a relationship between detector signal and delivered dose. The relationship (characteristic curve or calibration equation) usually depends on the environment under which the dosimeters are manufactured or stored. To compensate for the difference in radiation response among different batches of dosimeters, the measured dose can be scaled by normalizing the measured dose to a specific dose. Such a procedure, often called "relative dosimetry", allows us to skip the time-consuming production of a calibration curve for each irradiation. In this study, the magnitudes of errors due to the dose scaling procedure were evaluated by using the characteristic curves of BANG3 polymer gel dosimeter, radiographic EDR2 films, and GAFCHROMIC EBT2 films. Several sets of calibration data were obtained for each type of dosimeters, and a calibration equation of one set of data was used to estimate doses of the other dosimeters from different batches. The scaled doses were then compared with expected doses, which were obtained by using the true calibration equation specific to each batch. In general, the magnitude of errors increased with increasing deviation of the dose scaling factor from unity. Also, the errors strongly depended on the difference in the shape of the true and reference calibration curves. For example, for the BANG3 polymer gel, of which the characteristic curve can be approximated with a linear equation, the error for a batch requiring a dose scaling factor of 0.87 was larger than the errors for other batches requiring smaller magnitudes of dose scaling, or scaling factors of 0.93 or 1.02. The characteristic curves of EDR2 and EBT2 films required nonlinear equations. With those dosimeters, errors larger than 5% were commonly observed in the dose ranges of below 50% and above 150% of the normalization dose. In conclusion, the dose scaling for relative dosimetry introduces large errors in the measured doses when a large dose scaling is applied, and this procedure should be applied with special care.