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All sourcesNASA NTRSDOE OSTI
DOE OSTI2014

SU-D-17A-01: Geometric and Dosimetric Evaluation of a 4D-CBCT Reconstruction Technique Using Prior Knowledge

Purpose: To evaluate a 4D-CBCT reconstruction technique both geometrically and dosimetrically Methods: A prior-knowledge guided 4DC-BCT reconstruction method named the motion-modeling and free-form deformation (MM-FD) has been developed. MM-FD views each phase of the 4D-CBCT as a deformation of a prior CT volume. The deformation field is first solved by principal component analysis based motion modeling, followed by constrained free-form deformation.The 4D digital extended-cardiac- torso (XCAT) phantom was used for comprehensive evaluation. Based on a simulated 4D planning CT of a lung patient, 8 different scenarios were simulated to cover the typical on-board anatomical and respiratory variations: (1) synchronized and (2) unsynchronized motion amplitude change for body and tumor; tumor (3) shrinkage and (4) expansion; tumor average position shift in (5) superior-inferior (SI) direction, (6) anterior-posterior (AP) direction and (7) SI, AP and lateral directions altogether; and (8) tumor phase shift relative to the respiratory cycle of the body. Orthogonal-view 30° projections were simulated based on the eight patient scenarios to reconstruct on-board 4D-CBCTs. For geometric evaluation, the volume-percentage-difference (VPD) was calculated to assess the volumetric differences between the reconstructed and the ground-truth tumor.For dosimetric evaluation, a gated treatment plan was designed for the prior 4D-CT. The dose distributions were calculated on the reconstructed 4D-CBCTs and the ground-truth images for comparison. The MM-FD technique was compared with MM-only and FD-only techniques. Results: The average (±s.d.) VPD values of reconstructed tumors for MM-only, FDonly and MM-FD methods were 59.16%(± 26.66%), 75.98%(± 27.21%) and 5.22%(± 2.12%), respectively. The average min/max/mean dose (normalized to prescription) of the reconstructed tumors by MM-only, FD-only, MM-FD methods and ground-truth tumors were 78.0%/122.2%/108.2%, 13%/117.7%/86%, 58.1%/120.8%/103.6% and 57.6%/118.6%/101.8%,respectively. Conclusion: The MM-FD method provides superior reconstruction accuracy both geometrically and dosimetrically, which can potentially be used for 4D target localization, dose tracking and adaptive radiation therapy. This research is supported by grant from Varian Medical Systems.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

Markerless tracking of small lung tumors for stereotactic radiotherapy

Purpose: (1) To validate retrospective markerless tracking software for small lung tumors by comparing tracked motion in 4-dimensional planning computed tomography (4DCT) derived kV projection images and known tumor motion in the same 4DCT. (2) To evaluate variability of tumor motion using kV projection images from cone-beam computed tomography (CBCT) scans acquired on different days. Methods: Nonclinical tumor tracking software (TTS) used a normalized cross correlation algorithm to track the tumor on enhanced kV projection images (e.g., from a CBCT scan). The reference dataset consisted of digitally reconstructed radiographs (DRRs) from one phase of a planning 4DCT. TTS matches two in-plane coordinates and obtains the out-of-plane coordinate by triangulating with match results from other projections. (1) To validate TTS, tracking results were compared with known 4DCT tumor motion for two patients (A and B). Projection images (1 image/1°) were digitally reconstructed for each 4DCT phase. From these, kV projection series were composed simulating full breathing cycles every 20° of gantry rotation [breathing period = 20°/(6°/s) = 3.33 s]. Reference templates were 360 “tumor enhanced” DRRs from the 4DCT expiration phase. TTS-derived tumor motion was compared to known tumor motion on 4DCT. (2) For five patients, TTS-assessed motion during clinical CBCT acquisition was compared with motion on the planning 4DCT, and the motion component in the Y (cranio–caudal)-direction was compared with the motion of an external marker box (RPM, real-time position management). Results: (1) Validation results: TTS for case A (tumor 6.2 cm{sup 3}, 32 mm axial diameter) over 360° showed mean motion X (medial–lateral) = 3.4, Y = 11.5, and Z (ventral–dorsal) = 4.9 mm (1 SD < 1.0 mm). Corresponding 4DCT motion was X = 3.1, Y = 11.3, and Z = 5.1 mm. Correlation coefficients between TTS tumor motion and displacement of the tumor’s center of mass (CoM) on 4DCT were 0.64, 0.96, and 0.82 (X, Y, and Z, respectively). For case B (4.1 cm{sup 3}, 20 mm diameter), due to temporarily decreased tumor visibility preventing TTS from resolving the tumor, robust tracking data were only available between angles 300°–40° and 120°–220°. Mean motion according to TTS was X = 2.0, Y = 7.7, and Z = 8.2 mm (1 SD < 0.9 mm). Tumor motion on 4DCT was X = 1.8, Y = 7.6, and Z = 9.5 mm and correlation coefficients between TTS motion and CoM displacement were 0.59, 0.95, and 0.93 (X, Y, and Z, respectively). (2) Clinical results: TTS revealed a mean intrafraction variation in tumor motion in Y-direction of >2.0 mm (1 SD) in four of five patients. In addition, clinical tumor motion amplitude differed from that seen on planning 4DCT. Internal and external structures that create abrupt density change (e.g., table-top edge, interface between lung/mediastinum and lung/heart) were observed to prevent 360° tracking of the tumor. Correlation coefficients between TTS motion in the Y-direction and the RPM signal (22 observations) ranged from 0.78 to 0.96. In 2D, 241 TTS matches at end-inspiration and end-expiration were visually validated: mean difference was 0.8 mm (SD = 0.7) for both. Conclusions: TTS can track small lung tumors if these are visible in kV projections. A 4DCT dataset can be used to validate kV tracking of moving targets. TTS and 4DCT displacement agreed to within 2 mm. TTS and RPM motion were closely associated but tumor motion during CBCT can vary from the planning 4DCT.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

A Closed-Loop Proportional-Integral (PI) Control Software for Fully Mechanically Controlled Automated Electron Microscopic Tomography

A closed-loop proportional-integral (PI) control software is provided for fully mechanically controlled automated electron microscopic tomography. The software is developed based on Gatan DigitalMicrograph, and is compatible with Zeiss LIBRA 120 transmission electron microscope. However, it can be expanded to other TEM instrument with modification. The software consists of a graphical user interface, a digital PI controller, an image analyzing unit, and other drive units (i.e.: image acquire unit and goniometer drive unit). During a tomography data collection process, the image analyzing unit analyzes both the accumulated shift and defocus value of the latest acquired image, and provides the results to the digital PI controller. The digital PI control compares the results with the preset values and determines the optimum adjustments of the goniometer. The goniometer drive unit adjusts the spatial position of the specimen according to the instructions given by the digital PI controller for the next tilt angle and image acquisition. The goniometer drive unit achieves high precision positioning by using a backlash elimination method. The major benefits of the software are: 1) the goniometer drive unit keeps pre-aligned/optimized beam conditions unchanged and achieves position tracking solely through mechanical control; 2) the image analyzing unit relies on only historical data and therefore does not require additional images/exposures; 3) the PI controller enables the system to dynamically track the imaging target with extremely low system error.

Ren, Gang↗
DOE OSTI2013

Analysis of Hepatitis C Virus Decline during Treatment with the Protease Inhibitor Danoprevir Using a Multiscale Model

The current paradigm for studying hepatitis C virus (HCV) dynamics in patients utilizes a standard viral dynamic model that keeps track of uninfected (target) cells, infected cells, and virus. The model does not account for the dynamics of intracellular viral replication, which is the major target of direct-acting antiviral agents (DAAs). In this paper, we describe and study a recently developed multiscale age-structured model that explicitly considers the potential effects of DAAs on intracellular viral RNA production, degradation, and secretion as virus into the circulation. We show that when therapy significantly blocks both intracellular viral RNA production and virus secretion, the serum viral load decline has three phases, with slopes reflecting the rate of serum viral clearance, the rate of loss of intracellular viral RNA, and the rate of loss of intracellular replication templates and infected cells, respectively. We also derive analytical approximations of the multiscale model and use one of them to analyze data from patients treated for 14 days with the HCV protease inhibitor danoprevir. Analysis suggests that danoprevir significantly blocks intracellular viral production (with mean effectiveness 99.2%), enhances intracellular viral RNA degradation about 5-fold, and moderately inhibits viral secretion (with mean effectiveness 56%). Finally, the multiscale model can be used to study viral dynamics in patients treated with other DAAs and explore their mechanisms of action in treatment of hepatitis C.

59 BASIC BIOLOGICAL SCIENCES↗
DOE OSTI2022

People who inject drugs in metropolitan Chicago: A meta-analysis of data from 1997-2017 to inform interventions and computational modeling toward hepatitis C microelimination

Progress toward hepatitis C virus (HCV) elimination in the United States is not on track to meet targets set by the World Health Organization, as the opioid crisis continues to drive both injection drug use and increasing HCV incidence. A pragmatic approach to achieving this is using a microelimination approach of focusing on high-risk populations such as people who inject drugs (PWID). Computational models are useful in understanding the complex interplay of individual, social, and structural level factors that might alter HCV incidence, prevalence, transmission, and treatment uptake to achieve HCV microelimination. However, these models need to be informed with realistic sociodemographic, risk behavior and network estimates on PWID. We conducted a meta-analysis of research studies spanning 20 years of research and interventions with PWID in metropolitan Chicago to produce parameters for a synthetic population for realistic computational models (e.g., agent-based models). We then fit an exponential random graph model (ERGM) using the network estimates from the meta-analysis in order to develop the network component of the synthetic population.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2013

Advanced Demonstration of Motion Correction for Ship-to-Ship Passive Inspections

Passive radiation detection is a key tool for detecting illicit nuclear materials. In maritime applications it is most effective against small vessels where attenuation is of less concern. Passive imaging provides: discrimination between localized (threat) and distributed (non-threat) sources, removal of background fluctuations due to nearby shorelines and structures, source localization to an individual craft in crowded waters, and background subtracted spectra. Unfortunately, imaging methods cannot be easily applied in ship-to-ship inspections because relative motion of the vessels blurs the results over many pixels, significantly reducing sensitivity. This is particularly true for the smaller water craft where passive inspections are most valuable. In this project we performed tests and improved the performance of an instrument (developed earlier under, “Motion Correction for Ship-to-Ship Passive Inspections”) that uses automated tracking of a target vessel in visible-light images to generate a 3D radiation map of the target vessel from data obtained using a gamma-ray imager.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗
DOE OSTI2015

Effects of Crab Cavities' Multipole Content in an Electron-Ion Collider

The impact on the beam dynamics of the Medium Energy Electron-Ion Colider (MEIC) due to the multipole content of the 750 MHz crab cavity was studied using thin multipole elements for 6D phase space particle tracking in ELEGANT. Target values of the sextupole component for the cavity’s field expansion were used to perform preliminary studies on the proton beam stability when compared to the case of pure dipole content of the rf kicks. Finally, important effects on the beam sizes due to non-linear components of the crab cavities’ fields were identified, and some criteria for their future study were proposed.

43 PARTICLE ACCELERATORS↗
DOE OSTI2019

Efficient track-before detect algorithm with minimal prior knowledge

Apparatus, system and method for tracking an image target in a system, wherein a system receives an image comprising a plurality of pixels. The received image is processed via a plurality of different recursive motion model kernels in parallel to provide a plurality of kernel outputs, wherein each of the motion model kernels may include a respective pixel mask. Per-pixel energy is estimated of at least some of the plurality of kernel outputs. Velocity of at least one of the image pixels may also be estimated by generating a directional energy vector for each motion model kernel. The per-pixel energy and velocity estimates are fused to produce a fused estimate representing at least some of the motion model kernels for the image.

42 ENGINEERING↗
DOE OSTI2015

Accuracy of Robotic Radiosurgical Liver Treatment Throughout the Respiratory Cycle

Purpose: To quantify random uncertainties in robotic radiosurgical treatment of liver lesions with real-time respiratory motion management. Methods and Materials: We conducted a retrospective analysis of 27 liver cancer patients treated with robotic radiosurgery over 118 fractions. The robotic radiosurgical system uses orthogonal x-ray images to determine internal target position and correlates this position with an external surrogate to provide robotic corrections of linear accelerator positioning. Verification and update of this internal–external correlation model was achieved using periodic x-ray images collected throughout treatment. To quantify random uncertainties in targeting, we analyzed logged tracking information and isolated x-ray images collected immediately before beam delivery. For translational correlation errors, we quantified the difference between correlation model–estimated target position and actual position determined by periodic x-ray imaging. To quantify prediction errors, we computed the mean absolute difference between the predicted coordinates and actual modeled position calculated 115 milliseconds later. We estimated overall random uncertainty by quadratically summing correlation, prediction, and end-to-end targeting errors. We also investigated relationships between tracking errors and motion amplitude using linear regression. Results: The 95th percentile absolute correlation errors in each direction were 2.1 mm left–right, 1.8 mm anterior–posterior, 3.3 mm cranio–caudal, and 3.9 mm 3-dimensional radial, whereas 95th percentile absolute radial prediction errors were 0.5 mm. Overall 95th percentile random uncertainty was 4 mm in the radial direction. Prediction errors were strongly correlated with modeled target amplitude (r=0.53-0.66, P<.001), whereas only weak correlations existed for correlation errors. Conclusions: Study results demonstrate that model correlation errors are the primary random source of uncertainty in Cyberknife liver treatment and, unlike prediction errors, are not strongly correlated with target motion amplitude. Aggregate 3-dimensional radial position errors presented here suggest the target will be within 4 mm of the target volume for 95% of the beam delivery.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2015

SU-E-J-44: A Novel Approach to Quantify Patient Setup and Target Motion for Real-Time Image-Guided Radiotherapy (IGRT)

Purpose Isocenter shifts and rotations to correct patient setup errors and organ motion cannot remedy some shape changes of large targets. We are investigating new methods in quantification of target deformation for realtime IGRT of breast and chest wall cancer. Methods Ninety-five patients of breast or chest wall cancer were accrued in an IRB-approved clinical trial of IGRT using 3D surface images acquired at daily setup and beam-on time via an in-room camera. Shifts and rotations relating to the planned reference surface were determined using iterative-closest-point alignment. Local surface displacements and target deformation are measured via a ray-surface intersection and principal component analysis (PCA) of external surface, respectively. Isocenter shift, upper-abdominal displacement, and vectors of the surface projected onto the two principal components, PC1 and PC2, were evaluated for sensitivity and accuracy in detection of target deformation. Setup errors for some deformed targets were estimated by superlatively registering target volume, inner surface, or external surface in weekly CBCT or these outlines on weekly EPI. Results Setup difference according to the inner-surface, external surface, or target volume could be 1.5 cm. Video surface-guided setup agreed with EPI results to within < 0.5 cm while CBCT results were sometimes (∼20%) different from that of EPI (>0.5 cm) due to target deformation for some large breasts and some chest walls undergoing deep-breath-hold irradiation. Square root of PC1 and PC2 is very sensitive to external surface deformation and irregular breathing. Conclusion PCA of external surfaces is quick and simple way to detect target deformation in IGRT of breast and chest wall cancer. Setup corrections based on the target volume, inner surface, and external surface could be significant different. Thus, checking of target shape changes is essential for accurate image-guided patient setup and motion tracking of large deformable targets. NIH grant for the first author as cionsultant and the last author as the PI.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2025

Searching for Neutrino Tridents in the NOvA Near Detector

This dissertation presents a search for neutrino trident production in the NOvA near detector through the coherent ``dimuon" channel: $\nu_\mu +\hspace{1pt}\text{X} \rightarrow \nu_\mu + \mu^- + \mu^+ +\hspace{1pt}\text{X}$. Trident production is a rare, purely electroweak process with sensitivity to physics beyond the Standard Model. The theoretical background, motivation for studying the process, and previous experimental measurements are reviewed. The analysis uses data collected by the NOvA near detector (ND) from Fermilab's Neutrinos at the Main Injector (NuMI) beam between November 2014 and February 2024, corresponding to an exposure of $25.5\times 10^{20}$ protons on target. The ND is a segmented tracking calorimeter located 800~m from the beam target, receiving neutrinos with a mean energy of 2~GeV. A multi-pass background reduction strategy is implemented, including the development of a novel dimuon-specific tracking technique. Trident candidates are identified using a boost ed decision tree classifier trained on simulated signal and background events. Limited background Monte Carlo statistics necessitate the use of functional fits to sideband data, which are extrapolated to estimate backgrounds in the signal region. The unblinded data contain 9 trident-like events, with an estimated background of 5.66 $\pm$ 5.15 events. This yields a best fit estimate of 3.34 tridents compared to the Standard Model prediction of 4.66. A profiled Feldman-Cousins method is used to determine a 90\% confidence interval of [0,9.1] on the number of signal events, corresponding to an upper limit of 1.95$\times$ the Standard Model prediction. This result represents the lowest energy search for trident events to date, and the first experimental contribution to the process in 27 years.

Bowles, Reed Scott [Indiana U.]↗
DOE OSTI2013

FINAL TECHNICAL REPORT: Underwater Active Acoustic Monitoring Network For Marine And Hydrokinetic Energy Projects

This project saw the completion of the design and development of a second generation, high frequency (90-120 kHz) Subsurface-Threat Detection Sonar Network (SDSN). The system was deployed, operated, and tested in Cobscook Bay, Maine near the site the Ocean Renewable Power Company TidGen™ power unit. This effort resulted in a very successful demonstration of the SDSN detection, tracking, localization, and classification capabilities in a high current, MHK environment as measured by results from the detection and tracking trials in Cobscook Bay. The new high frequency node, designed to operate outside the hearing range of a subset of marine mammals, was shown to detect and track objects of marine mammal-like target strength to ranges of approximately 500 meters. This performance range results in the SDSN system tracking objects for a significant duration - on the order of minutes - even in a tidal flow of 5-7 knots, potentially allowing time for MHK system or operator decision-making if marine mammals are present. Having demonstrated detection and tracking of synthetic targets with target strengths similar to some marine mammals, the primary hurdle to eventual automated monitoring is a dataset of actual marine mammal kinematic behavior and modifying the tracking algorithms and parameters which are currently tuned to human diver kinematics and classification.

16 TIDAL AND WAVE POWER↗
DOE OSTI2025

Status and prospects for inertial fusion energy via lasers

Fusion energy is the ultimate clean and limitless energy source, but its development requires overcoming many scientific and technological challenges. For the first time in the 60-year long history of fusion research, ignition and target gain above unity (G>1) were demonstrated in the laboratory at the National Ignition Facility at the Lawrence Livermore National Laboratory in 2022. Turning laser fusion into an energy source requires that the results from single shot experiments be replicated at much higher repetition rates of many shots per second to produce high average power at relatively low cost. Furthermore, this requires the development of new laser technologies, mass production of suitable targets, accurate injection and tracking systems and new materials for the reactor chamber components and final optics. Ultra broadband and deep UV light are laser advances that can dramatically improve the laser energy coupling to the target thereby reducing the laser energy and power requirements.

Fusion energy↗
DOE OSTI2016

TU-D-202-03: Gating Is the Best ITV Killer

Respiratory motion has long been recognized as an important factor affecting the precision of radiotherapy. After the introduction of the 4D CT to visualize the respiratory motion in 3D, the internal target volume (ITV) has been widely adopted as simple method to take the motion into account in treatment planning and delivery. The ITV is generated as the union of the CTVs as the patient goes through the respiratory cycle. Many issues have been identified with the ITV. In this session three alternatives for the ITV will be discussed: 1) An alternative motion-inclusive approach with better imaging and smaller margins, called mid-position CT. 2) The tracking approach and 3) The gating approach. The following topics will be addressed by Marcel van Herk (“Is ITV the correct motion encompassing strategy”): Magnitude of respiratory motion, effect of motion on radiotherapy, motion encompassing strategies, and software solutions to assist in motion encompassing strategies. Then Paul Keall (“Make margins simple: Use real-time target tracking”) will discuss tracking with: clinical drivers for tracking, current clinical status of tumor tracking, future tumor tracking technology, and margin margin challenges with and without tracking. Finally Daniel Low will discuss gating (“Gating is the best ITV killer”): why ITV in the first place, requirements for planning, requirements at the machine, benefits and costs. The session will end with a discussion and live demo of motion simulation software to illustrate the issues and explain the relative benefit and appropriate uses for the three methods. Learning Objectives: Explain the 4D imaging and treatment planning process. Summarize the various approaches to deal with respiratory motion during radiotherapy Discuss the tradeoffs involved when choosing one of the three discussed approaches. Explain in which situation each method is the best choice Research is partly funded by Elekta Oncology Systems and the Dutch Cancer Foundation; M. van Herk, Part of the research was funded by Elekta Oncology Systems and the Dutch Cancer Foundation.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2021

Data-driven delta-generalized labeled multi-bernoulli tracker

A system and method for tracking a plurality of objects. Unlabeled measurement data identifying a plurality of targets corresponding to the plurality of objects is received. A multi-target likelihood function is generated using a persistent target density, a birth target density, and a clutter density. The multi-target likelihood function is used to associate persistent targets with the unlabeled measurement data to update persistent tracks and to initiate a new track for each target in the plurality of targets in the measurement data that is not associated with a persistent target.

LeGrand, Keith Allen↗
DOE OSTI2025

Correcting beam space charge effects in Active-Target Time Projection Chamber

By providing a large gaseous volume for nuclear interactions while simultaneously recording the tracks of resulting reaction products, an active target serves as both a thick target and a detector. Once a reaction occurs, the emitted charged fragments strip electrons from the target gas along their path as they transverse the detector. Collection of these stripped electrons allow for detection of the product tracks. As beam intensity increases, the resulting ionization in the active target can significantly distort this collection of electrons. If left uncorrected, the resulting measurements could be wrong. In this paper, we investigate the impact of the space charge produced by heavy radioactive beams within the Active Target - Time Projection Chamber at Michigan State University. The beams are injected parallel to the electric field of the time projection chamber which is operated without a magnetic field for this experiment. Furthermore, we analyze the rate dependence of the space charge effects and demonstrate that they can be modeled and effectively corrected.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗
DOE OSTI2025

Using Eye Tracking to Elucidate the Mechanisms Underlying Stimulation-Enhanced Visual Target Detection

Transcranial direct current stimulation (tDCS) is a noninvasive form of brain stimulation that involves passing a weak electrical current between electrodes on the scalp to modulate underlying neural tissue. TDCS has been shown to modulate cognition in a variety of domains, including memory, attention, and visual processing. Prior work from our laboratory has shown positive effects of tDCS on learning to detect target objects hidden in complex naturalistic visual scenes and learn rules for categorizing images, though the mechanism for these benefits remains unknown. One possibility is that tDCS optimizes visual search by modulating visual attention or via the reduction in search errors. One method of quantifying visual attention is to use eye tracking to record search patterns to determine if and how visual search is adjusted under verum stimulation conditions. Eye tracking data allows classification of errors into error types, including sampling errors (failing to look in the relevant region), recognition errors (looking at the critical portion of a scene, but failing to recognize it as such as evidenced by visual fixation), and decision-making errors (fixating on the relevant portion of a scene, but making the wrong determination). Our results indicate that the benefit tDCS confers on visual search for targets stems from the reduction in decision-making errors when targets are present (Cohen’s d = 0.86). Also reported is a replication of previous findings showing a tDCS-dependent improvement in learning this task, learning score (Cohen’s d = 0.88); d’ (Cohen’s d = 1.00). This provides support for moving tDCS into the application space by pairing it with analysts who are concerned with the type of search error that is corrected via stimulation.

attention↗
DOE OSTI2015

SU-E-J-57: First Development of Adapting to Intrafraction Relative Motion Between Prostate and Pelvic Lymph Nodes Targets

Purpose Large intrafraction relative motion of multiple targets is common in advanced head and neck, lung, abdominal, gynaecological and urological cancer, jeopardizing the treatment outcomes. The objective of this study is to develop a real-time adaptation strategy, for the first time, to accurately correct for the relative motion of multiple targets by reshaping the treatment field using the multi-leaf collimator (MLC). Methods The principle of tracking the simultaneously treated but differentially moving tumor targets is to determine the new aperture shape that conforms to the shifted targets. Three dimensional volumes representing the individual targets are projected to the beam’s eye view. The leaf openings falling inside each 2D projection will be shifted according to the measured motion of each target to form the new aperture shape. Based on the updated beam shape, new leaf positions will be determined with optimized trade-off between the target underdose and healthy tissue overdose, and considerations of the physical constraints of the MLC. Taking a prostate cancer patient with pelvic lymph node involvement as an example, a preliminary dosimetric study was conducted to demonstrate the potential treatment improvement compared to the state-of- art adaptation technique which shifts the whole beam to track only one target. Results The world-first intrafraction adaptation system capable of reshaping the beam to correct for the relative motion of multiple targets has been developed. The dose in the static nodes and small bowel are closer to the planned distribution and the V45 of small bowel is decreased from 110cc to 75cc, corresponding to a 30% reduction by this technique compared to the state-of-art adaptation technique. Conclusion The developed adaptation system to correct for intrafraction relative motion of multiple targets will guarantee the tumour coverage and thus enable PTV margin reduction to minimize the high target dose to the adjacent organs-at-risk. The authors acknowledge funding support from the Australian NHMRC Australia Fellowship and NHMRC Project Grant No. APP1042375.

60 APPLIED LIFE SCIENCES↗