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Marsh, R

Publications and source records attributed to Marsh, R.

14 records
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DOE OSTI2016

SU-F-I-37: How Fat Distribution and Table Height Affect Estimates of Patient Size in CT Scanning: A Phantom Study

Purpose: Localizer projection radiographs acquired prior to CT scans are used to estimate patient size, affecting the function of Automatic Tube Current Modulation (ATCM) and hence CTDIvol and SSDE. Due to geometric effects, the projected patient size varies with scanner table height and with the orientation of the localizer (AP versus PA). This study sought to determine if patient size estimates made from localizer scans is affected by variations in fat distribution, specifically when the widest part of the patient is not at the geometric center of the patient. Methods: Lipid gel bolus material was wrapped around an anthropomorphic phantom to simulate two different body mass distributions. The first represented a patient with fairly rigid fat and had a generally oval shape. The second was bell-shaped, representing corpulent patients more susceptible to gravity’s lustful tug. Each phantom configuration was imaged using an AP localizer and then a PA localizer. This was repeated at various scanner table heights. The width of the phantom was measured from the localizer and diagnostic images using in-house software. Results: 1) The projected phantom width varied up to 39% as table height changed.2) At some table heights, the width of the phantom, designed to represent larger patients, exceeded the localizer field of view, resulting in an underestimation of the phantom width.3) The oval-shaped phantom approached a normalized phantom width of 1 at a table height several centimeters lower (AP localizer) or higher (PA localizer) than did the bell-shaped phantom. Conclusion: Accurate estimation of patient size from localizer scans is dependent on patient positioning with respect to scanner isocenter and is limited in large patients. Further, patient size is more accurately measured on projection images if the widest part of the patient, rather than the geometric center of the patient, is positioned at scanner isocenter.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-G-206-11: The Effect of Table Height On CTDIvol and SSDE in CT Scanning: A Phantom Study

Purpose: Localizer projection radiographs acquired prior to CT scans are used to estimate patient size, affecting the function of Automatic Tube Current Modulation (ATCM) and calculation of the Size Specific Dose Estimate (SSDE). Due to geometric effects, the projected patient size varies with scanner table height and with the orientation of the localizer (AP versus PA). Consequently, variations in scanner table height may affect both CTDIvol and the calculated size-corrected dose index (SSDE). This study sought to characterize these effects. Methods: An anthropomorphic phantom was imaged using an AP localizer, followed by a diagnostic scan using ATCM and our institution’s routine abdomen protocol. This was repeated at various scanner table heights, recording the scanner-reported CTDIvol for each diagnostic scan. The width of the phantom was measured from the localizer and diagnostic images using in-house software. The measured phantom width and scanner-reported CTDIvol were used to calculate SSDE. This was repeated using PA localizers followed by diagnostic scans. Results: 1) The localizer-based phantom width varied by up to 54% of the nominal phantom width between minimum and maximum table heights. 2) Changing the table height caused a variation in scanner-reported CTDIvol of a factor greater than 4.6 when using a PA localizer and almost 2 when using an AP localizer. 3) SSDE, calculated from measured phantom size and scanner-reported CTDIvol, varied by a factor of more than 2.8 when using a PA localizer and almost 1.5 when using an AP localizer. Conclusion: Our study demonstrates that off-center patient positioning affects the efficacy of ATCM, more severely when localizers are acquired in the PA rather than AP projection. Further, patient positioning errors can cause a large variation in the calculated SSDE. This hinders interpretation of SSDE for individual patients and aggregate SSDE data when evaluating CT protocols and clinical practices.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-G-TeP4-14: Quality Control of Treatment Planning Using Knowledge-Based Planning Across a System of Radiation Oncology Practices

Purpose: There is potentially a wide variation in plan quality for a certain disease site, even for clinics located in the same system of hospitals. We have used a prostate-specific knowledge-based planning (KBP) model as a quality control tool to investigate the variation in prostate treatment planning across a network of affiliated radiation oncology departments. Methods: A previously created KBP model was applied to 10 patients each from 4 community-based clinics (Clinics A, B, C, and D). The KBP model was developed using RapidPlan (Eclipse v13.5, Varian Medical Systems) from 60 prostate/prostate bed IMRT plans that were originally planned using an in-house treatment planning system at the central institution of the community-based clinics. The dosimetric plan quality (target coverage and normal-tissue sparing) of each model-generated plan was compared to the respective clinically-used plan. Each community-based clinic utilized the same planning goals to develop the clinically-used plans that were used at the main institution. Results: Across all 4 clinics, the model-generated plans decreased the mean dose to the rectum by varying amounts (on average, 12.5, 2.6, 4.5, and 2.7 Gy for Clinics A, B, C, and D, respectively). The mean dose to the bladder also decreased with the model-generated plans (5.4, 2.3, 3.0, and 4.1 Gy, respectively). The KBP model also identified that target coverage (D95%) improvements were possible for for Clinics A, B, and D (0.12, 1.65, and 2.75%) while target coverage decreased by 0.72% for Clinic C, demonstrating potentially different trade-offs made in clinical plans at different institutions. Conclusion: Quality control of dosimetric plan quality across a system of radiation oncology practices is possible with knowledge-based planning. By using a quality KBP model, smaller community-based clinics can potentially identify the areas of their treatment plans that may be improved, whether it be in normal-tissue sparing or improved target coverage. M. Matuszak has research funding for KBP from Varian Medical Systems.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-97: An Analysis of Knowledge Based Planning for Stereotactic Body Radiation Therapy of the Spine

Purpose: Creating high quality SBRT treatment plans for the spine is often tedious and time consuming. In addition, the quality of treatment plans can vary greatly between treatment facilities due to inconsistencies in planning methods. This study investigates the performance of knowledge-based planning (KBP) for spine SBRT. Methods: Treatment plans were created for 28 spine SBRT patients. Each case was planned to meet strict dose objectives and guidelines. After physician and physicist approval, the plans were added to a custom model in a KBP system (RapidPlan, Varian Eclipse v13.5). The model was then trained to be able to predict estimated DVHs and provide starting objective functions for future patients based on both generated and manual objectives. To validate the model, ten additional spine SBRT cases were planned manually as well as using the model objectives. Plans were compared based on planning time and quality (ability to meet the plan objectives, including dose metrics and conformity). Results: The average dose to the spinal cord and the cord PRV differed between the validation and control plans by <0.25% demonstrating iso-toxicity. Six out of 10 validation plans met all dose objectives without the need for modifications, and overall, target dose coverage was increased by about 4.8%. If the validation plans did not meet the dose requirements initially, only 1–2 iterations of modifying the planning parameters were required before an acceptable plan was achieved. While manually created plans usually required 30 minutes to 3 hours to create, KBP can be used to create similar quality plans in 15–20 minutes. Conclusion: KBP for spinal tumors has shown to greatly decrease the amount of time required to achieve high quality treatment plans with minimal human intervention and could feasibly be used to standardize plan quality between institutions. Supported by Varian Medical Systems.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-C-12A-07: Effect of Vertical Position On Dose Reduction Using X-Care

Purpose: Reduction of absorbed dose to radiosensitive tissues is an important goal in diagnostic radiology. Siemens Medical has introduced a technique (X-CARE) to lower CT dose to anterior anatomy by reducing the tube current during 80° of rotation over radiosensitive tissues. Phantom studies have shown 30-40% dose reduction when phantoms are positioned at isocenter. However, for CT face and sinus exams, the center of the head is commonly positioned below isocenter. This work investigated the effects of vertical patient positioning on dose reduction using X-CARE. Methods: A 16cm Computed Tomography Dose Index phantom was scanned on a Siemens Definition Flash CT scanner using a routine head protocol, with the phantom positioned at scanner isocenter. Optically stimulated luminescent dosimeters were placed on the anterior and posterior sides of the phantom. The phantom was lowered in increments of 2cm and rescanned, up to 8cm below isocenter. The experiment was then repeated using the same scan parameters but adding the X-CARE technique. The mean dosimeter counts were determined for each phantom position, and the difference between XCARE and routine scans was plotted as a function of distance from isocenter. Results: With the phantom positioned at isocenter, using XCARE reduced dose to the anterior side of the phantom by 40%, compared to dose when X-CARE was not used. Positioned below isocenter, anterior dose was reduced by only 20-27%. Additionally, using X-CARE at isocenter reduced dose to the anterior portion of the phantom by 45.6% compared to scans performed without X-CARE 8cm below isocenter. Conclusion: While using X-CARE substantially reduced dose to the anterior side of the phantom, this effect was diminished when the phantom was positioned below isocenter, simulating common practice for face and sinus scans. This indicates that centering the head in the gantry will maximize the effect of X-CARE.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2014

SU-E-I-12: Characterization of Edge Effects in a Commercial Low-Dose Image Processing System

Purpose: Minimizing radiation dose while preserving image quality is critical in fluoroscopic imaging. One recent development is a noise reduction system (Allura Clarity) offered by Philips. Others have reported approximately 50% reduction in air kerma when using Clarity. These studies, however, provide only a cursory look at how the Clarity system affects image quality. The purpose of this work was to evaluate the effect of Clarity on the appearance of high-frequency image information. Methods: A lead attenuator with a smooth edge was imaged on two Philips Allura FD20 detectors: one with Clarity and one without. The edge was positioned in the center of the field of view and images were obtained under the following conditions: 40cm and 11cm fields of view, single shot and continuous fluoroscopy modes, and using abdomen and cardiac protocols, for a total of sixteen imaging conditions. Profiles were drawn perpendicular to the edge across 80% of its length, averaged to reduce noise, normalized to the maximum pixel value, and plotted as a function of distance. Results: For all single-shot acquisitions and most fluoroscopic images, overshoot of the edge was observed. This effect was more substantial for single-shot acquisitions (∼20%) than for fluoroscopic images (∼50%). For fluoroscopic acquisition, the overshoot decayed more quickly with the Clarity system. However, the system with Clarity introduced a ringing effect for both single-shot and fluoroscopic images that is not present on the non-Clarity system. Conclusion: Previous reports have demonstrated a substantial dose reduction when using Clarity but the impact this has on image appearance has not been characterized. One demonstrated difference is the change in appearance of high-frequency image information. It remains to be determined whether this effect may impact clinical images adversely.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗
DOE OSTI2011

Laser System for Livermore's Mono Energetic Gamma-Ray Source

A Mono-energetic Gamma-ray (MEGa-ray) source, based on Compton scattering of a high-intensity laser beam off a highly relativistic electron beam, requires highly specialized laser systems. To minimize the bandwidth of the {gamma}-ray beam, the scattering laser must have minimal bandwidth, but also match the electron beam depth of focus in length. This requires a {approx}1 J, 10 ps, fourier-transform-limited laser system. Also required is a high-brightness electron beam, best provided by a photoinjector. This electron source requires a second laser system with stringent requirements on the beam including flat transverse and longitudinal profiles and fast rise times. Furthermore, these systems must be synchronized to each other with ps-scale accuracy. Using a novel hyper-dispersion compressor configuration and advanced fiber amplifiers and diode-pumped Nd:YAG amplifiers, we have designed laser systems that meet these challenges for the X-band photoinjector and Compton-scattering source being built at Lawrence Livermore National Laboratory.

42 ENGINEERING↗