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All sourcesNASA NTRSDOE OSTI
DOE OSTI2014

SU-E-T-213: Initial Experience with VMAT Plan and Delivery Verification Using a DICOM-RT Framework and Linac Delivery Log Files

Purpose: Mobius3D/MobiusFX (M3D/MFX), a commercial DICOM-RT based plan and delivery verification system, was used to compare calculated and delivered volumetric modulated arc therapy (VMAT) dose distributions using TrueBeam delivery log files (TrajectoryLogs). Methods: M3D/MFX utilizes measured linac commissioning data to generate institution specific beam models for evaluating planned and delivered dose distributions. 30 RapidArc prostate plans and 30 head and neck SmartArc plans were used in this study. For every plan, CT images, contoured structure sets, RT-plan, and RT-dose files were exported to M3D, which recalculated the patients’ planning CT dose distributions using a collapsed-cone-convolutionsuperposition algorithm. MFX utilized the acquired TrajectoryLogs to compute patients’ delivered dose distributions based on actual treatment delivery parameters. The agreement between computed and delivered dose distributions was evaluated utilizing a (3%, 3mm) global 3D-gamma analysis and dose-volume histogram changes for targets and organs at risk. Results: Excellent 3D-gamma agreements were observed for all VMAT plans. On average, for computed and delivered RapidArc and SmartArc plans the gamma passing rates were (99.0%±1.4%) and (96.8%±1.8%), respectively. The average difference for primary target prescription dose percent-coverage between calculated and delivered plans was (− 0.09%±2.52%) for RapidArc and (−2.71%±4.62%) for SmartArc cases. Similarly, the planning target mean dose differences were (1.38%±0.96%) for RapidArc and (1.17%±0.72%) for SmartArc plans. For the prostate plans, the calculated and delivered variations of the maximum dose for a 2cc volume for bladder and rectum were (1.32%±1.26%) and (0.65%±1.44%), respectively. The spinal-cord 2cc maximum dose differences of (3.26%±1.68%) were observed for the SmartArc plans. Conclusions: Clinical quality assurance practice based on linac treatment log files for verification of delivered 3D dose distributions in the patients’ geometries represents a paradigm shift from dose measurements in a phantom. This approach captures treatment planning beam modeling differences as well as the linac uncertainties during treatment delivery of the plan.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-115: Analysis of Patient Specific QA for VMAT by Disease Site and Planning-Delivery System Using the ScandiDos Delta4 Phantom

Purpose: To evaluate patient specific quality assurance (PSQA) for the delivery of volumetric modulated arc therapy (VMAT) by disease site. To compare planning-delivery system (PDS) PSQA pass rates in a dual vendor institution. Methods: PSQA is performed for VMAT plans using a ScandiDos Delta4 phantom. Verification plans are calculated using Varian Eclipse and Elekta Monaco treatment planning systems (TPS) for patients treated using Varian Truebeam and Elekta linear accelerators respectively. Individual arcs are delivered to the Delta4 phantoms and assessed using the gamma index pass criterion(3% Dose Deviation(DD%), 3mm Distance to Agreement(DTA),10% dose threshold and 90% gamma index). Results: A total of 287 VMAT plans and 680 arcs were analyzed. The passing rates for VMAT QA plans were 95% and 98% for head/neck and pelvis/prostate plans respectively, and 100% for chest/abdomen, spine, lung Stereotactic Body Radiotherapy (SBRT) and Stereotactic Radiosurgery(SRS) plans. Average gamma indices were: (99 ± 2) % for pelvis/prostate, chest/abdomen and lung SBRT plans, (97 ± 4) % for head and neck plans and (98 ± 3) % for spine plans. The average DD% and DTA pass rates ranged from 82% to 90% and 98% to 99% respectively for plans in different disease sites. Paired t-test analysis (two tails) indicated no significant differences in the gamma indices between plans delivered using different PDS; the P values were: 0.08, 0.45, and 0.94 for lung SBRT, head/neck and pelvis/prostate plans respectively. The statistical power for comparing PDS in different disease sites with an alpha of 0.05 is 1. Conclusion: The Gamma indices based on 3% DD%, 3 mm DTA and 10% dose threshold for the VMAT QA plans in all disease sites were well above 90%, suggesting the possibility of using a more stringent PSQA criterion. No significant differences were observed in the QA of VMAT plans delivered using different PDS.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-T-520: Dosimetric Comparison of Radiation Treatment Plans for Whole Breast Irradiation Between 3D Conformal in Prone and Supine Positions Vs. VMAT and IMRT in Supine Positions

Purpose: The target volume for Whole Breast Irradiation (WBI) is dictated by location of tumor mass, breast tissue distribution, and involvement of lymph nodes. Dose coverage and Organs at Risk (OARs) sparing can be difficult to achieve in patients with unfavorable thoracic geometries. For these cases, inverse-planned and 3D-conformal prone treatments can be alternatives to traditional supine 3D-conformal plans. A dosimetric comparison can determine which of these techniques achieve optimal target coverage while sparing OARs. Methods: This study included simulation datasets for 8 patients, 5 of whom were simulated in both supine and prone positions. Positioning devices included breast boards and Vaclok bags for the supine position, and prone breast boards for the prone position. WBI 3-D conformal plans were created for patients simulated in both positions. Additional VMAT and IMRT WBI plans were made for all patients in the supine position. Results: Prone and supine 3D conformal plans had comparable PTV coverage. Prone 3D conformal plans received a significant 50% decrease to V20, V10, V5 and V30% for the ipsilateral lung in contrast to the supine plans. The heart also experienced a 10% decrease in maximum dose in the prone position, and V20, V10, V5 and V2 had significantly lower values than the supine plan. Supine IMRT and VMAT breast plans obtained comparable PTV coverage. The heart experienced a 10% decrease in maximum dose with inverse modulated plans when compared to the supine 3D conformal plan, while V20, V10, V5 and V2 showed higher values with inverse modulated plans than with supine 3D conformal plans. Conclusion: Prone 3D-conformal, and supine inverse planned treatments were generally superior in sparing OARs to supine plans with comparable PTV coverage. IMRT and VMAT plans offer sparing of OARs from high dose regions with an increase of irradiated volume in the low dose regions.

60 APPLIED LIFE SCIENCES↗
NASA NTRS2002

Lessons Learned In Developing Multiple Distributed Planning Systems for the International Space Station

The planning processes for the International Space Station (ISS) Program are quite complex. Detailed mission planning for ISS on-orbit operations is a distributed function. Pieces of the on-orbit plan are developed by multiple planning organizations, located around the world, based on their respective expertise and responsibilities. The "pieces" are then integrated to yield the final detailed plan that will be executed onboard the ISS. Previous space programs have not distributed the planning and scheduling functions to this extent. Major ISS planning organizations are currently located in the United States (at both the NASA Johnson Space Center (JSC) and NASA Marshall Space Flight Center (MSFC)), in Russia, in Europe, and in Japan. Software systems have been developed by each of these planning organizations to support their assigned planning and scheduling functions. Although there is some cooperative development and sharing of key software components, each planning system has been tailored to meet the unique requirements and operational environment of the facility in which it operates. However, all the systems must operate in a coordinated fashion in order to effectively and efficiently produce a single integrated plan of ISS operations, in accordance with the established planning processes. This paper addresses lessons learned during the development of these multiple distributed planning systems, from the perspective of the developer of one of the software systems. The lessons focus on the coordination required to allow the multiple systems to operate together, rather than on the problems associated with the development of any particular system. Included in the paper is a discussion of typical problems faced during the development and coordination process, such as incompatible development schedules, difficulties in defining system interfaces, technical coordination and funding for shared tools, continually evolving planning concepts/requirements, programmatic and budget issues, and external influences. Techniques that mitigated some of these problems will also be addressed, along with recommendations for any future programs involving the development of multiple planning and scheduling systems. Many of these lessons learned are not unique to the area of planning and scheduling systems, so may be applied to other distributed ground systems that must operate in concert to successfully support space mission operations.

Maxwell, Theresa G.↗
NASA NTRS2002

Lessons Learned in Developing Multiple Distributed Planning Systems for the International Space Station

The planning processes for the International Space Station (ISS) Program are quite complex. Detailed mission planning for ISS on-orbit operations is a distributed function. Pieces of the on-orbit plan are developed by multiple planning organizations, located around the world, based on their respective expertise and responsibilities. The pieces are then integrated to yield the final detailed plan that will be executed onboard the ISS. Previous space programs have not distributed the planning and scheduling functions to this extent. Major ISS planning organizations are currently located in the United States (at both the NASA Johnson Space Center (JSC) and NASA Marshall Space Flight Center (MSFC)), in Russia, in Europe, and in Japan. Software systems have been developed by each of these planning organizations to support their assigned planning and scheduling functions. Although there is some cooperative development and sharing of key software components, each planning system has been tailored to meet the unique requirements and operational environment of the facility in which it operates. However, all the systems must operate in a coordinated fashion in order to effectively and efficiently produce a single integrated plan of ISS operations, in accordance with the established planning processes. This paper addresses lessons learned during the development of these multiple distributed planning systems, from the perspective of the developer of one of the software systems. The lessons focus on the coordination required to allow the multiple systems to operate together, rather than on the problems associated with the development of any particular system. Included in the paper is a discussion of typical problems faced during the development and coordination process, such as incompatible development schedules, difficulties in defining system interfaces, technical coordination and funding for shared tools, continually evolving planning concepts/requirements, programmatic and budget issues, and external influences. Techniques that mitigated some of these problems will also be addressed, along with recommendations for any future programs involving the development of multiple planning and scheduling systems. Many of these lessons learned are not unique to the area of planning and scheduling systems, so may be applied to other distributed ground systems that must operate in concert to successfully support space mission operations.

Maxwell, Theresa G.↗
NASA NTRS2021

Concept of Operations for OSIRIS-REx Optical Navigation Image Planning

Optical navigation (OpNav) is a critical subsystem of the OSIRIS-REx asteroid sample return mission, which operated in the vicinity of near-Earth asteroid (101955) Bennu from August 2018 through April 2021. A substantial amount of mission resources across multiple subsystems and institutions is required to ensure that the OpNav data are successfully acquired. The KinetX OpNav team, part of the Flight Dynamics System (FDS), is responsible for performing required analysis to develop the OpNav operations plans; requesting, reviewing and verifying the plans; and ultimately using the image data for critical navigation operations. The FDS team, responsible for the mission navigation, is operated by KinetX Aerospace with management and operations support from NASA’s Goddard Space Flight Center. The Science Processing and Operations Center (SPOC), located at the University of Arizona’s Lunar and Planetary Laboratory, is responsible for generating the planning products for all science and most OpNav data. These plans are integrated into the spacecraft sequences, tested, and commanded by the Mission Support Area (MSA) at Lockheed Martin Space. To ensure mission-critical navigation image data are successfully acquired, the plan is developed through a waterfall of planning cycles over the course of 3 months prior to onboard plan execution. During the initial strategic planning for a mission phase, detailed analysis is performed by the OpNav team to conceptualize the concept of operations (ConOps) for image data collection. This phase OpNav Narrative is included along with other strategic planning documents for the key ground segment stakeholders to review and provide feedback. The detailed OpNav plans get defined in the tactical planning cycle, which spans 8 to 3 weeks before the week-long integrated sequence is executed on-board the spacecraft. During the tactical cycle, the initial OpNav Request is submitted along with the science requests, kicking off development of the science and OpNav plans. Once the initial plan is drafted, interfaces are exercised so that the plan can be reviewed and iterated, if necessary. A rigorous schedule is followed by the planning teams during the implementation cycle, spanning the last 18 days before uplink, to ensure all the necessary integration, testing, and reviewing can occur on time. The development of the OpNav planning ConOps, including responsibilities, interfaces, timelines, and procedures, took extensive collaboration across mission elements and institutions. The process was robust throughout the 137 weeks of continuous Optical Navigation Operations at Bennu, which concluded on April 9th, 2021.

Coralie D. Adam↗
DOE OSTI2015

Drilling, Completion, and Data Collection Plans An Assessment of Geological Carbon Sequestration Options in the Illinois Basin: Phase III

Executive Summary The Illinois Basin – Decatur Project (IBDP) is managed by the Midwest Geological Sequestration Consortium (MGSC) and is led by the Illinois State Geological Survey (ISGS) at the University of Illinois. The project site is located on the Archer Daniels Midland Company (ADM) property in Decatur, Illinois, and is a fully integrated carbon capture and storage (CCS) project that uses CO₂ captured from the ethanol-producing fermentation process at the ADM corn-processing plant (Finley et. al., 2013). IBDP has a goal of injecting one million tonnes of CO₂ into the basal sands of the Mt. Simon Sandstone over a three-year period. This is a multifaceted project, and this report details the planning and results of the drilling, completions, well testing, log data acquisition, and the Health, Safety, and Environment (HSE) aspects of the project. Three deep wells were planned for the IBDP: • The injection well: Injection Well #1 (CCS1); • The monitoring well (both in-zone and above seal): Verification Well #1 (VW1); and • The geophone monitoring well: Geophysical Monitoring Well #1 (GM1). The detailed plans for these wells are attached to the appendices of this document. The wells were drilled successfully with little deviation from the original plans. The biggest change from the plan to execution was the need to adjust for larger-than-expected loss of circulation in the Potosi section of the Knox Formation. The completions reports also attached to this document detail the well constructions as they were actually built. Injectivity testing was carried out, and the perforating plans were adjusted based on the results. Additional perforations and acidizing were performed as a result of the injectivity testing. The testing plans are detailed in this report along with the actual testing results. The injectivity testing results were used in the modeling and simulation efforts. Detailed HSE plans were developed and implemented during the planning and execution phases of the project. The implementation included an HSE Bridging Document, which served to unify the HSE policies of the project partners and key subcontractors. The HSE plan and actual HSE results are presented in this document. There were no recordable HSE incidents during the project. A detailed logging program was developed based on project needs. The log data were acquired in accordance with the plan, and both the plan and log results are presented in this report. Log data were heavily utilized by the research staff, modelers, reservoir engineers, and for technical and permitting efforts. 5 Several key lessons were learned during the project: • Safety in operations and execution is paramount and is only achieved through proper planning and behavior control. The certainty of this was reinforced through implementation of this lesson and the resultant flawless HSE performance during the project. • Losses of drilling fluid circulation were larger than anticipated within the Potosi Formation. Circulation was only recovered through cementing the loss zones. • When possible, minimizing complexity in permit requirements and well designs is preferable. • The size of the wells were outside of the standard experience and expertise typical within the basin, and therefore required substantial planning and ramp-up of contractors and partners to meet project objectives. • With multiple stakeholders and research partners, establishing objectives and requirements early and adhering to change request procedures throughout the project are critical to manage competing data and sampling objectives that may be detrimental to overall progress. The well construction and completion operations were successfully executed, with all wells built in a manner that achieved excellent wellbore integrity. Log planning involved a number of stakeholders and technical specialists. Data collection from logging, coring, and testing was excellent. Time and effort spent with the associated contractors and suppliers to develop a well plan beyond normal scope proved highly successful, resulting in a well-construction and completion project that surpassed expectations. The world-class HSE results also demonstrate the commitment of all stakeholders in the project. The details follow in the body of this document

01 COAL, LIGNITE, AND PEAT↗
DOE OSTI2014

Clinical Implementation of an Online Adaptive Plan-of-the-Day Protocol for Nonrigid Motion Management in Locally Advanced Cervical Cancer IMRT

Purpose: To evaluate the clinical implementation of an online adaptive plan-of-the-day protocol for nonrigid target motion management in locally advanced cervical cancer intensity modulated radiation therapy (IMRT). Methods and Materials: Each of the 64 patients had four markers implanted in the vaginal fornix to verify the position of the cervix during treatment. Full and empty bladder computed tomography (CT) scans were acquired prior to treatment to build a bladder volume-dependent cervix-uterus motion model for establishment of the plan library. In the first phase of clinical implementation, the library consisted of one IMRT plan based on a single model-predicted internal target volume (mpITV), covering the target for the whole pretreatment observed bladder volume range, and a 3D conformal radiation therapy (3DCRT) motion-robust backup plan based on the same mpITV. The planning target volume (PTV) combined the ITV and nodal clinical target volume (CTV), expanded with a 1-cm margin. In the second phase, for patients showing >2.5-cm bladder-induced cervix-uterus motion during planning, two IMRT plans were constructed, based on mpITVs for empty-to-half-full and half-full-to-full bladder. In both phases, a daily cone beam CT (CBCT) scan was acquired to first position the patient based on bony anatomy and nodal targets and then select the appropriate plan. Daily post-treatment CBCT was used to verify plan selection. Results: Twenty-four and 40 patients were included in the first and second phase, respectively. In the second phase, 11 patients had two IMRT plans. Overall, an IMRT plan was used in 82.4% of fractions. The main reasons for selecting the motion-robust backup plan were uterus outside the PTV (27.5%) and markers outside their margin (21.3%). In patients with two IMRT plans, the half-full-to-full bladder plan was selected on average in 45% of the first 12 fractions, which was reduced to 35% in the last treatment fractions. Conclusions: The implemented online adaptive plan-of-the-day protocol for locally advanced cervical cancer enables (almost) daily tissue-sparing IMRT.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2015

Quality of Intensity Modulated Radiation Therapy Treatment Plans Using a {sup 60}Co Magnetic Resonance Image Guidance Radiation Therapy System

Purpose: This work describes a commercial treatment planning system, its technical features, and its capabilities for creating {sup 60}Co intensity modulated radiation therapy (IMRT) treatment plans for a magnetic resonance image guidance radiation therapy (MR-IGRT) system. Methods and Materials: The ViewRay treatment planning system (Oakwood Village, OH) was used to create {sup 60}Co IMRT treatment plans for 33 cancer patients with disease in the abdominal, pelvic, thorax, and head and neck regions using physician-specified patient-specific target coverage and organ at risk (OAR) objectives. Backup plans using a third-party linear accelerator (linac)-based planning system were also created. Plans were evaluated by attending physicians and approved for treatment. The {sup 60}Co and linac plans were compared by evaluating conformity numbers (CN) with 100% and 95% of prescription reference doses and heterogeneity indices (HI) for planning target volumes (PTVs) and maximum, mean, and dose-volume histogram (DVH) values for OARs. Results: All {sup 60}Co IMRT plans achieved PTV coverage and OAR sparing that were similar to linac plans. PTV conformity for {sup 60}Co was within <1% and 3% of linac plans for 100% and 95% prescription reference isodoses, respectively, and heterogeneity was on average 4% greater. Comparisons of OAR mean dose showed generally better sparing with linac plans in the low-dose range <20 Gy, but comparable sparing for organs with mean doses >20 Gy. The mean doses for all {sup 60}Co plan OARs were within clinical tolerances. Conclusions: A commercial {sup 60}Co MR-IGRT device can produce highly conformal IMRT treatment plans similar in quality to linac IMRT for a variety of disease sites. Additional work is in progress to evaluate the clinical benefit of other novel features of this MR-IGRT system.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2013

Independent calculation-based verification of IMRT plans using a 3D dose-calculation engine

Independent monitor unit verification of intensity-modulated radiation therapy (IMRT) plans requires detailed 3-dimensional (3D) dose verification. The aim of this study was to investigate using a 3D dose engine in a second commercial treatment planning system (TPS) for this task, facilitated by in-house software. Our department has XiO and Pinnacle TPSs, both with IMRT planning capability and modeled for an Elekta-Synergy 6 MV photon beam. These systems allow the transfer of computed tomography (CT) data and RT structures between them but do not allow IMRT plans to be transferred. To provide this connectivity, an in-house computer programme was developed to convert radiation therapy prescription (RTP) files as generated by many planning systems into either XiO or Pinnacle IMRT file formats. Utilization of the technique and software was assessed by transferring 14 IMRT plans from XiO and Pinnacle onto the other system and performing 3D dose verification. The accuracy of the conversion process was checked by comparing the 3D dose matrices and dose volume histograms (DVHs) of structures for the recalculated plan on the same system. The developed software successfully transferred IMRT plans generated by 1 planning system into the other. Comparison of planning target volume (TV) DVHs for the original and recalculated plans showed good agreement; a maximum difference of 2% in mean dose, − 2.5% in D95, and 2.9% in V95 was observed. Similarly, a DVH comparison of organs at risk showed a maximum difference of +7.7% between the original and recalculated plans for structures in both high- and medium-dose regions. However, for structures in low-dose regions (less than 15% of prescription dose) a difference in mean dose up to +21.1% was observed between XiO and Pinnacle calculations. A dose matrix comparison of original and recalculated plans in XiO and Pinnacle TPSs was performed using gamma analysis with 3%/3 mm criteria. The mean and standard deviation of pixels passing gamma tolerance for XiO-generated IMRT plans was 96.1 ± 1.3, 96.6 ± 1.2, and 96.0 ± 1.5 in axial, coronal, and sagittal planes respectively. Corresponding results for Pinnacle-generated IMRT plans were 97.1 ± 1.5, 96.4 ± 1.2, and 96.5 ± 1.3 in axial, coronal, and sagittal planes respectively.

61 RADIATION PROTECTION AND DOSIMETRY↗
DOE OSTI2014

Multicriteria optimization informed VMAT planning

We developed a patient-specific volumetric-modulated arc therapy (VMAT) optimization procedure using dose-volume histogram (DVH) information from multicriteria optimization (MCO) of intensity-modulated radiotherapy (IMRT) plans. The study included 10 patients with prostate cancer undergoing standard fractionation treatment, 10 patients with prostate cancer undergoing hypofractionation treatment, and 5 patients with head/neck cancer. MCO-IMRT plans using 20 and 7 treatment fields were generated for each patient on the RayStation treatment planning system (clinical version 2.5, RaySearch Laboratories, Stockholm, Sweden). The resulting DVH of the 20-field MCO-IMRT plan for each patient was used as the reference DVH, and the extracted point values of the resulting DVH of the MCO-IMRT plan were used as objectives and constraints for VMAT optimization. Weights of objectives or constraints of VMAT optimization or both were further tuned to generate the best match with the reference DVH of the MCO-IMRT plan. The final optimal VMAT plan quality was evaluated by comparison with MCO-IMRT plans based on homogeneity index, conformity number of planning target volume, and organ at risk sparing. The influence of gantry spacing, arc number, and delivery time on VMAT plan quality for different tumor sites was also evaluated. The resulting VMAT plan quality essentially matched the 20-field MCO-IMRT plan but with a shorter delivery time and less monitor units. VMAT plan quality of head/neck cancer cases improved using dual arcs whereas prostate cases did not. VMAT plan quality was improved by fine gantry spacing of 2 for the head/neck cancer cases and the hypofractionation-treated prostate cancer cases but not for the standard fractionation–treated prostate cancer cases. MCO-informed VMAT optimization is a useful and valuable way to generate patient-specific optimal VMAT plans, though modification of the weights of objectives or constraints extracted from resulting DVH of MCO-IMRT or both is necessary.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2014

Advantages and limitations of navigation-based multicriteria optimization (MCO) for localized prostate cancer IMRT planning

Efficacy of inverse planning is becoming increasingly important for advanced radiotherapy techniques. This study’s aims were to validate multicriteria optimization (MCO) in RayStation (v2.4, RaySearch Laboratories, Sweden) against standard intensity-modulated radiation therapy (IMRT) optimization in Oncentra (v4.1, Nucletron BV, the Netherlands) and characterize dose differences due to conversion of navigated MCO plans into deliverable multileaf collimator apertures. Step-and-shoot IMRT plans were created for 10 patients with localized prostate cancer using both standard optimization and MCO. Acceptable standard IMRT plans with minimal average rectal dose were chosen for comparison with deliverable MCO plans. The trade-off was, for the MCO plans, managed through a user interface that permits continuous navigation between fluence-based plans. Navigated MCO plans were made deliverable at incremental steps along a trajectory between maximal target homogeneity and maximal rectal sparing. Dosimetric differences between navigated and deliverable MCO plans were also quantified. MCO plans, chosen as acceptable under navigated and deliverable conditions resulted in similar rectal sparing compared with standard optimization (33.7 ± 1.8 Gy vs 35.5 ± 4.2 Gy, p = 0.117). The dose differences between navigated and deliverable MCO plans increased as higher priority was placed on rectal avoidance. If the best possible deliverable MCO was chosen, a significant reduction in rectal dose was observed in comparison with standard optimization (30.6 ± 1.4 Gy vs 35.5 ± 4.2 Gy, p = 0.047). Improvements were, however, to some extent, at the expense of less conformal dose distributions, which resulted in significantly higher doses to the bladder for 2 of the 3 tolerance levels. In conclusion, similar IMRT plans can be created for patients with prostate cancer using MCO compared with standard optimization. Limitations exist within MCO regarding conversion of navigated plans to deliverable apertures, particularly for plans that emphasize avoidance of critical structures. Minimizing these differences would result in better quality treatments for patients with prostate cancer who were treated with radiotherapy using MCO plans.

61 RADIATION PROTECTION AND DOSIMETRY↗
DOE OSTI2017

Functional image-guided stereotactic body radiation therapy planning for patients with hepatocellular carcinoma

The aim of the current planning study is to evaluate the ability of gadoxetate disodium-enhanced magnetic resonance imaging (EOB-MRI)–guided stereotactic body radiation therapy (SBRT) planning by using intensity-modulated radiation therapy (IMRT) techniques in sparing the functional liver tissues during SBRT for hepatocellular carcinoma. In this study, 20 patients with hepatocellular carcinoma were enrolled. Functional liver tissues were defined according to quantitative liver-spleen contrast ratios ≥ 1.5 on a hepatobiliary phase scan. Functional images were fused with the planning computed tomography (CT) images; the following 2 SBRT plans were designed using a “step-and-shoot” static IMRT technique for each patient: (1) an anatomical SBRT plan optimization based on the total liver; and (2) a functional SBRT plan based on the functional liver. The total prescribed dose was 48 gray (Gy) in 4 fractions. Dosimetric parameters, including dose to 95% of the planning target volume (PTV D{sub 95%}), percentages of total and functional liver volumes, which received doses from 5 to 30 Gy (V5 to V30 and fV5 to fV30), and mean doses to total and functional liver (MLD and fMLD, respectively) of the 2 plans were compared. Compared with anatomical plans, functional image-guided SBRT plans reduced MLD (mean: plan A, 5.5 Gy; and plan F, 5.1 Gy; p < 0.0001) and fMLD (mean: plan A, 5.4 Gy; and plan F, 4.9 Gy; p < 0.0001), as well as V5 to V30 and fV5 to fV30. No differences were noted in PTV coverage and nonhepatic organs at risk (OARs) doses. In conclusion, EOB-MRI–guided SBRT planning using the IMRT technique may preserve functional liver tissues in patients with hepatocellular carcinoma (HCC).

61 RADIATION PROTECTION AND DOSIMETRY↗
DOE OSTI2014

Independent calculation of dose distributions for helical tomotherapy using a conventional treatment planning system

Purpose: The dosimetric verification of treatment plans in helical tomotherapy usually is carried out via verification measurements. In this study, a method for independent dose calculation of tomotherapy treatment plans is presented, that uses a conventional treatment planning system with a pencil kernel dose calculation algorithm for generation of verification dose distributions based on patient CT data. Methods: A pencil beam algorithm that directly uses measured beam data was configured for dose calculation for a tomotherapy machine. Tomotherapy treatment plans were converted into a format readable by an in-house treatment planning system by assigning each projection to one static treatment field and shifting the calculation isocenter for each field in order to account for the couch movement. The modulation of the fluence for each projection is read out of the delivery sinogram, and with the kernel-based dose calculation, this information can directly be used for dose calculation without the need for decomposition of the sinogram. The sinogram values are only corrected for leaf output and leaf latency. Using the converted treatment plans, dose was recalculated with the independent treatment planning system. Multiple treatment plans ranging from simple static fields to real patient treatment plans were calculated using the new approach and either compared to actual measurements or the 3D dose distribution calculated by the tomotherapy treatment planning system. In addition, dose–volume histograms were calculated for the patient plans. Results: Except for minor deviations at the maximum field size, the pencil beam dose calculation for static beams agreed with measurements in a water tank within 2%/2 mm. A mean deviation to point dose measurements in the cheese phantom of 0.89% ± 0.81% was found for unmodulated helical plans. A mean voxel-based deviation of −0.67% ± 1.11% for all voxels in the respective high dose region (dose values >80%), and a mean local voxel-based deviation of −2.41% ± 0.75% for all voxels with dose values >20% were found for 11 modulated plans in the cheese phantom. Averaged over nine patient plans, the deviations amounted to −0.14% ± 1.97% (voxels >80%) and −0.95% ± 2.27% (>20%, local deviations). For a lung case, mean voxel-based deviations of more than 4% were found, while for all other patient plans, all mean voxel-based deviations were within ±2.4%. Conclusions: The presented method is suitable for independent dose calculation for helical tomotherapy within the known limitations of the pencil beam algorithm. It can serve as verification of the primary dose calculation and thereby reduce the need for time-consuming measurements. By using the patient anatomy and generating full 3D dose data, and combined with measurements of additional machine parameters, it can substantially contribute to overall patient safety.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-J-239: IMRT Planning of Prostate Cancer for a MRI-Linac Based On MRI Only

Purpose: : To investigate dosimetric differences between MRI- and CT-based IMRT planning for prostate cancer, the impact of a magnetic field in a MRI-Linac, and to explore the feasibility of IMRT planning based on MRI alone. Methods: IMRT plans were generated based on CT and MRI images acquired on two representative prostate-cancer patients using clinical dose volume constraints. A research planning system (Monaco, Elekta), which employs a Monte Carlo dose engine and includes a perpendicular magnetic field of 1.5T from an MRI-Linac, was used. Bulk electron density assignments based on organ-specific values from ICRU 46 were used to convert MRI (T2) to pseudo CT. With the same beam configuration as in the original CT plan, 5 additional plans were generated based on CT or MRI, with or without optimization (i.e., just recalculation) and with or without the magnetic field. The plan quality in terms of commonly used dose volume (DV) parameters for all plans was compared. The statistical uncertainty on dose was < 1%. Results: For plans with the same contour set but without re-optimization, the DV parameters were different from those for the original CT plan, mostly less than 5% with a few exceptions. These differences were reduced to mostly less than 3% when the plans were re-optimized. For plans with contours from MRI, the differences in the DV parameters varied depending on the difference in the contours as compared to CT. For the optimized plans with contours from MR, the differences for PTV were less than 3%. Conclusion: The prostate IMRT plans based on MRI-only for a MR-Linac were practically similar as compared to the CT plan under the same beam and optimization configuration if the difference on the structure delineation is excluded, indicating the feasibility of using MRI-only for prostate IMRT.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-337: Treatment Planning Study of Craniospinal Irradiation with Spot Scanning Proton Therapy

Purpose: To develop a treatment planning technique that achieves optimal robustness against systematic position and range uncertainties, and interfield position errors for craniospinal irradiation (CSI) using spot scanning proton radiotherapy. Methods: Eighteen CSI patients who had previously been treated using photon radiation were used for this study. Eight patients were less than 10 years old. The prescription dose was 23.4Gy in 1.8Gy fractions. Two different field arrangement types were investigated: 1 posterior field per isocenter and 2 posterior oblique fields per isocenter. For each field type, two delivery configurations were used: 5cm bolus attached to the treatment table and a 4.5cm range shifter located inside the nozzle. The target for each plan was the whole brain and thecal sac. For children under the age of 10, all plan types were repeated with an additional dose of 21Gy prescribed to the vertebral bodies. Treatment fields were matched by stepping down the dose in 10% increments over 9cm. Robustness against 3% and 3mm uncertainties, as well as a 3mm inter-field error was analyzed. Dose coverage of the target and critical structure sparing for each plan type will be considered. Ease of planning and treatment delivery was also considered for each plan type. Results: The mean dose volume histograms show that the bolus plan with posterior beams gave the best overall plan, and all proton plans were comparable to or better than the photon plans. The plan type that was the most robust against the imposed uncertainties was also the bolus plan with posterior beams. This is also the plan configuration that is the easiest to deliver and plan. Conclusion: The bolus plan with posterior beams achieved optimal robustness against systematic position and range uncertainties, as well as inter-field position errors.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-353: Decoding the Beam Complexity in Intensity-Modulated Radiation Therapy Plans

Purpose: Modern IMRT relies on computers to generate treatment plans of varied complexity. A highly complex treatment plan may use a large number of small and irregular beam apertures in order to achieve high dose conformity. However, excessive beam complexity can increase dosimetric uncertainty, prolong treatment time, and increase susceptibility to target or organ motion. In this study we sought to develop metrics to assess the complexity of IMRT beams and plans. Methods: Based the information of leaf positions and MU for each beam segment, we calculated the following beam complexity metrics: aperture area, shape irregularity, and beam modulation. Then these beam complexity metrics were averaged to obtain the corresponding plan complexity metrics, using the beam MUs as weighting factors. We evaluated and compared the beam and plan complexity scores for 65 IMRT plans from 3 sites (prostate, head and neck, and spine). We also studied how the plan complexity scores were affected by adjusting inverse planning parameters. Results: For prostate IMRT, the lateral beams had large MUs and smaller shape irregularity, while the anterior or posterior beams had larger modulation values. On average, the prostate IMRT plans had the smallest shape irregularity and beam modulation; the HN IMRT plans had the largest aperture area, shape irregularity, and beam modulation; and the spine stereotactic IMRT plans often had small aperture area, which may be associated with relatively large discrepancies between calculated and measures doses. The plan complexity increased as the number of optimization iterations and the number of beam segments increased and as the minimum segment area decreased. Conclusion: Complexity of IMRT beams and plans were quantified in terms of aperture area, shape irregularity and beam modulation. The complexity metrics varied among IMRT plans for different disease sites and were affected when the planning parameters were adjusted.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

MO-C-17A-06: Online Adaptive Re-Planning to Account for Independent Motions Between Multiple Targets During Radiotherapy of Lung Cancer

Purpose: To quantify interfractional independent motions between multiple targets in radiotherapy (RT) of lung cancer, and to study the dosimetric benefits of an online adaptive replanning method to account for these variations. Methods: Ninety five diagnostic-quality daily CTs acquired for 9 lung cancer patients treated with IGRT using an in-room CT (CTVision, Siemens) were analyzed. On each daily CT set, contours of the targets (GTV, CTV, or involved nodes) and organs at risk were generated by populating the planning contours using an auto-segmentation tool (ABAS, Elekta) with manual editing. For each patient, an IMRT plan was generated based on the planning CT with a prescription dose of 60 Gy in 2Gy fractions. Three plans were generated and compared for each daily CT set: an IGRT (repositioning) plan by copying the original plan with the required shifts, an online adaptive plan by rapidly modifying the aperture shapes and segment weights of the original plan to conform to the daily anatomy, and a new fully re-optimized plan based on the daily CT using a planning system (Panther, Prowess). Results: The daily deviations of the distance between centers of masses of the targets from the plans varied daily from -10 to 8 mm with an average −0.9±4.1 mm (one standard deviation). The average CTV V100 are 99.0±0.7%, 97.9±2.8%, 99.0±0.6%, and 99.1±0.6%, and the lung V20 Gy 928±332 cc, 944±315 cc, 917±300 cc, and 891±295 cc for the original, repositioning, adaptive, and re-optimized plans, respectively. Wilcoxon signed-rank tests show that the adaptive plans are statistically significantly better than the repositioning plans and comparable with the reoptimized plans. Conclusion: There exist unpredictable, interfractional, relative volume changes and independent motions between multiple targets during lung cancer RT which cannot be accounted for by the current IGRT repositioning but can be corrected by the online adaptive replanning method.

60 APPLIED LIFE SCIENCES↗