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Validation of columnar CsI x-ray detector responses obtained with hybridMANTIS, a CPU-GPU Monte Carlo code for coupled x-ray, electron, and optical transport

Purpose: hybridMANTIS is a Monte Carlo package for modeling indirect x-ray imagers using columnar geometry based on a hybrid concept that maximizes the utilization of available CPU and graphics processing unit processors in a workstation. Methods: The authors compare hybridMANTIS x-ray response simulations to previously published MANTIS and experimental data for four cesium iodide scintillator screens. These screens have a variety of reflective and absorptive surfaces with different thicknesses. The authors analyze hybridMANTIS results in terms of modulation transfer function and calculate the root mean square difference and Swank factors from simulated and experimental results. Results: The comparison suggests that hybridMANTIS better matches the experimental data as compared to MANTIS, especially at high spatial frequencies and for the thicker screens. hybridMANTIS simulations are much faster than MANTIS with speed-ups up to 5260. Conclusions: hybridMANTIS is a useful tool for improved description and optimization of image acquisition stages in medical imaging systems and for modeling the forward problem in iterative reconstruction algorithms.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗

A tracking system to calculate patient skin dose in real-time during neurointerventional procedures using a biplane x-ray imaging system

Purpose: Neurovascular interventional procedures using biplane fluoroscopic imaging systems can lead to increased risk of radiation-induced skin injuries. The authors developed a biplane dose tracking system (Biplane-DTS) to calculate the cumulative skin dose distribution from the frontal and lateral x-ray tubes and display it in real-time as a color-coded map on a 3D graphic of the patient for immediate feedback to the physician. The agreement of the calculated values with the dose measured on phantoms was evaluated. Methods: The Biplane-DTS consists of multiple components including 3D graphic models of the imaging system and patient, an interactive graphical user interface, a data acquisition module to collect geometry and exposure parameters, the computer graphics processing unit, and functions for determining which parts of the patient graphic skin surface are within the beam and for calculating dose. The dose is calculated to individual points on the patient graphic using premeasured calibration files of entrance skin dose per mAs including backscatter; corrections are applied for field area, distance from the focal spot and patient table and pad attenuation when appropriate. The agreement of the calculated patient skin dose and its spatial distribution with measured values was evaluated in 2D and 3D for simulated procedure conditions using a PMMA block phantom and an SK-150 head phantom, respectively. Dose values calculated by the Biplane-DTS were compared to the measurements made on the phantom surface with radiochromic film and a calibrated ionization chamber, which was also used to calibrate the DTS. The agreement with measurements was specifically evaluated with variation in kVp, gantry angle, and field size. Results: The dose tracking system that was developed is able to acquire data from the two x-ray gantries on a biplane imaging system and calculate the skin dose for each exposure pulse to those vertices of a patient graphic that are determined to be in the beam. The calculations are done in real-time with a typical graphic update time of 30 ms and an average vertex separation of 3 mm. With appropriate corrections applied, the Biplane-DTS was able to determine the entrance dose within 6% and the spatial distribution of the dose within 4% compared to the measurements with the ionization chamber and film for the SK150 head phantom. The cumulative dose for overlapping fields from both gantries showed similar agreement. Conclusions: The Biplane-DTS can provide a good estimate of the peak skin dose and cumulative skin dose distribution during biplane neurointerventional procedures. Real-time display of this information should help the physician manage patient dose to reduce the risk of radiation-induced skin injuries.

60 APPLIED LIFE SCIENCES↗

MO-PIS-Exhibit Hall-01: Imaging: CT Dose Optimization Technologies I

Partners in Solutions is an exciting new program in which AAPM partners with our vendors to present practical “hands-on” information about the equipment and software systems that we use in our clinics. The imaging topic this year is CT scanner dose optimization capabilities. Note that the sessions are being held in a special purpose room built on the Exhibit Hall Floor, to encourage further interaction with the vendors. Dose Optimization Capabilities of GE Computed Tomography Scanners Presentation Time: 11:15 – 11:45 AM GE Healthcare is dedicated to the delivery of high quality clinical images through the development of technologies, which optimize the application of ionizing radiation. In computed tomography, dose management solutions fall into four categories: employs projection data and statistical modeling to decrease noise in the reconstructed image - creating an opportunity for mA reduction in the acquisition of diagnostic images. Veo represents true Model Based Iterative Reconstruction (MBiR). Using high-level algorithms in tandem with advanced computing power, Veo enables lower pixel noise standard deviation and improved spatial resolution within a single image. Advanced Adaptive Image Filters allow for maintenance of spatial resolution while reducing image noise. Examples of adaptive image space filters include Neuro 3-D filters and Cardiac Noise Reduction Filters. AutomA adjusts mA along the z-axis and is the CT equivalent of auto exposure control in conventional x-ray systems. Dynamic Z-axis Tracking offers an additional opportunity for dose reduction in helical acquisitions while SmartTrack Z-axis Tracking serves to ensure beam, collimator and detector alignment during tube rotation. SmartmA provides angular mA modulation. ECG Helical Modulation reduces mA during the systolic phase of the heart cycle. SmartBeam optimization uses bowtie beam-shaping hardware and software to filter off-axis x-rays - minimizing dose and reducing x-ray scatter. The DICOM Radiation Dose Structured Report (RDSR) generates a dose report at the conclusion of every examination. Dose Check preemptively notifies CT operators when scan parameters exceed user-defined dose thresholds. DoseWatch is an information technology application providing vendor-agnostic dose tracking and analysis for CT (and all other diagnostic x-ray modalities) SnapShot Pulse improves coronary CTA dose management. VolumeShuttle uses two acquisitions to increase coverage, decrease dose, and conserve on contrast administration. Color-Coding for Kids applies the Broselow-Luten Pediatric System to facilitate pediatric emergency care and reduce medical errors. FeatherLight achieves dose optimization through pediatric procedure-based protocols. Adventure Series scanners provide a child-friendly imaging environment promoting patient cooperation with resultant reduction in retakes and patient motion. Philips CT Dose Optimization Tools and Advanced Reconstruction Presentation Time: 11:45 ‘ 12:15 PM The first part of the talk will cover “Dose Reduction and Dose Optimization Technologies” present in Philips CT Scanners. The main Technologies to be presented include: DoseRight and tube current modulation (DoseRight, Z-DOM, 3D-DOM, DoseRight Cardiac) Special acquisition modes Beam filtration and beam shapers Eclipse collimator and ClearRay collimator NanoPanel detector DoseRight will cover automatic tube current selection that automatically adjusts the dose for the individual patient. The presentation will explore the modulation techniques currently employed in Philips CT scanners and will include the algorithmic concepts as well as illustrative examples. Modulation and current selection technologies to be covered include the Automatic Current Selection component of DoseRight, ZDOM longitudinal dose modulation, 3D-DOM (combination of longitudinal and rotational dose modulation), Cardiac Dose right (an ECG based dose modulation scheme), and the DoseRight Index (DRI) IQ index. The special acquisition modes covers acquisition techniques such as prospective gating that is designed to reduce exposure to the patient through the Cardiac Step and Shoot scan mode. This mode can substitute the much higher dose retrospective scan modes for certain types of cardiac imaging. The beam filtration and beam shaper portion will discuss the variety of filtration and beam shaping configurations available on Philips scanners. This topic includes the x-ray beam characteristics, tube filtration as well as dose compensator characteristics. The Eclipse collimator, ClearRay collimator and the NanoPanel detector portion will discuss additional technologies specific to wide coverage CT that address some of the unique challenges encountered and techniques employed to optimize image quality and optimize dose utilization. The Eclipse collimator reduces extraneous exposure by actively blocking the radiation tails at either end of helical scans that do not contribute to the image generation. The ClearRay collimator and the NanoPanel detector optimize the quality of the signal that reaches the detectors by addressing the increased scattered radiation present in wide coverage and the NanoPanel detector adds superior electronic noise characteristics valuable when imaging at a low dose level. The second part of the talk will present “Advanced Reconstruction Technologies” currently available on Philips CT Scanners. The talk will cover filtered back projection (FBP), iDose4 and Iterative Model Reconstruction (IMR). Each reconstruction method will include a discussion of the algorithm as well as similarities and differences between the algorithms. Examples illustrating the merits of each algorithm will be presented, and techniques and metrics to characterize the performance of each type of algorithm will be presented. The Filtered Back projection portion will discuss and provide a brief summary of relevant standard image reconstruction techniques in common use, and discuss the common tradeoffs when using the FBP algorithm. The iDose4 portion will present the algorithms used for iDose4 as well the different levels. The meaning of different levels of iDose4 available will be presented and quantified. Guidelines for selection iDose4 parameters based on the imaging need will be explained. The different image quality goals available with iDose4 and specifically how iDose4 enables noise reduction, spatial resolution improvement or both will be explained. The approaches to leveraging the benefits of iDose4 such as improved spatial resolution, decreased noise, and artifact prevention will be described and quantified; and measurements and metrics behind the improvements will be presented. The image quality benefits in specific imaging situations as well as how to best combine the technology with other dose reduction strategies to ensure the best image quality at a given dose level will be presented. Insight into the IMR algorithm as well as contrast to the iDose4 techniques and performance characteristics will be discussed. Metrics and techniques for characterizing this class of algorithm and IQ performance will be presented. The image quality benefits and the dose reduction capabilities of IMR will be explored. Illustrative examples of the noise reduction, spatial resolution improvement, and low contrast detectability improvements of the reconstruction method will be presented: clinical cases and phantom measurements demonstrating the benefits of IMR in the areas of low dose imaging, spatial resolution and low contrast resolution are discussed and the technical details behind the measurements will be presented compared to both iDose4 and traditional filtered back projection (FBP)

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗

Real-time X-ray phase-contrast imaging using SPINNet—a speckle-based phase-contrast imaging neural network

X-ray phase-contrast imaging has become indispensable for visualizing samples with low absorption contrast. In this regard, speckle-based techniques have shown significant advantages in spatial resolution, phase sensitivity, and implementation flexibility compared with traditional methods. However, the computational cost associated with data inversion has hindered their wider adoption. By exploiting the power of deep learning, we developed a speckle-based phase-contrast imaging neural network (SPINNet) that significantly improves the imaging quality and boosts the phase retrieval speed by at least 2 orders of magnitude compared to existing methods. To achieve this performance, we combined SPINNet with a coded-mask-based technique, an enhanced version of the speckle-based method. Using this scheme, we demonstrate the simultaneous reconstruction of absorption and phase images on the order of 100 ms, where a traditional correlation-based analysis would take several minutes even with a cluster. In addition to significant improvement in speed, our experimental results show that the imaging and phase retrieval quality of SPINNet outperform existing single-shot speckle-based methods. Furthermore, we successfully demonstrate SPINNet application in x-ray optics metrology and 3D x-ray phase-contrast tomography. Our result shows that SPINNet could enable many applications requiring high-resolution and fast data acquisition and processing, such as in situ and in operando 2D and 3D phase-contrast imaging and real-time at-wavelength metrology and wavefront sensing.

36 MATERIALS SCIENCE↗

SU-E-T-300: Spatial Variations of Multiple Off-Axial Targets for a Single Isocenter SRS Treatment Plan in ExacTrac 6D Robotic Couch System

Purpose: To evaluate the spatial variations of multiple off-axial targets for a single isocenter stereotactic radiosurgery (SRS) treatment plan in ExacTrac 6D robotic couch system (BrainLab AG). Methods: Five metallic ball bearing (BB) markers were placed sparsely in 3D off-axial locations (non-coplanar) inside a skull phantom as the representatives of multiple targets mimicking multiple brain metastases. The locations of the BB markers were carefully chosen to minimize overlapping of each other in a port imaging detector plane. The skull phantom was immobilized by a frameless mask and CT scanned with a BrainLab Head and Neck Localizer using a GE Optima MDCT scanner. The CT images were exported to iPlan software (BrainLab AG) and a multiple target PTV was drawn by combining all the contours of the BBs. The margin of the MLC opening was selected as 3 mm expansion outward. Two coplanar arc beams were placed to generate a single isocenter SRS plan to treat the PTV. The arc beams were delivered using Novalis Tx system with portal imaging acquisition mode per 10% temporal resolution. The locations of the BBs were visualized and analyzed with respect to the MLC aperture in the treatment plan similar to the Winston-Lutz test. Results: All the BBs were clearly identified inside the MLC openings. The positional errors for the BBs were overall less than 1 mm along the rotational path of the two arcs. Conclusion: This study verified that the spatial deviations of multiple off-axial targets for a single isocenter SRS treatment plan is within sub-millimeter range in ExacTrac 6D robotic couch system. Accompanied with the Winston-Lutz test, this test will quality-assure the spatial accuracies of the isocenter as well as the positions of multiple off-axial targets for the SRS treatment using a single isocenter multiple target treatment plan.

60 APPLIED LIFE SCIENCES↗

Remote Radiation Sensing Using Aerial and Ground Platforms

Remote sensing of ionizing radiation has a significant role in waste management, nuclear material management and nonproliferation, and radiation safety. Robotic platforms can surpass the number of tasks that are achieved by humans. With this technique, the operator's radiation exposure can be decreased. Remote sensing allows for the evaluation and monitoring of radiological contamination. Gamma-ray and neutron sensors were integrated onto the robotic platforms. This approach allows for the radiation sensor data to be dynamically tracked and mapped thus enabling further analysis of the radiation flux in temporal and spatial domains. The goal is to complete scheduled tasks while the robot is being irradiated. To achieve this, electronic components must be shielded and radiation hardened. CZT Detector: Cadmium Zinc Telluride (CZT) detector technology has been a promising solution for gamma-ray and x-ray measurements. Detector data is transferred to the Odroid minicomputer that controls and powers the module via the USB. Robot Operating System (ROS) was utilized for data acquisition and data fusion. The Mariscotti method was employed for the spectrum analysis. A function was programmed in ROS for the automatic identification of photopeaks. CLYC Detector: A Cs{sub 2}LiYCl{sub 6}:Ce{sup 3+} (CLYC) detector was used for simultaneous medium-resolution gamma-ray measurements and neutron counting. A 2.54 cm diameter photomultiplier tube (PMT) was equipped with a high voltage supply and a miniature digitizer. Gamma-ray excitation: fast core-to-valence luminescence (CVL) with 1 ns decay constant, and prompt Ce{sup 3+} emission with 50 ns decay constant. Neutron excitation: slow cerium self-trapped excitation (Ce{sup 3+} STE), 1000 ns decay constant. Radiation Source Localization: Maximum Likelihood Estimation (MLE) and gradient-based methods were used to locate the position of a radiation source based on measured radiation intensities. Multi-Particle Transport Code FLUKA: Estimation of radiation damage of the electronic components is important in order to optimize the robot's operational time while it is irradiated. Displacement per atom (DPA) represents the radiation damage in materials exposed to the ionizing radiation. Various shielding layers of different thickness t were analyzed (< 5% statistical error). The model of the controller of the UAS was designed in FLUKA. Conclusion: CZT and CLYC detectors were integrated onto the robotic platforms. Radiation source localization and contour mapping using robotic platforms were studied. Functions for data analysis and fusion were developed in ROS. FLUKA code was utilized to analyze DPA values. Layers of low-density and high-density materials were used to shield the UAS electronics.

12 MANAGEMENT OF RADIOACTIVE AND NON-RADIOACTIVE W↗

SU-E-I-51: Quantitative Assessment of X-Ray Imaging Detector Performance in a Clinical Setting - a Simple Approach Using a Commercial Instrument

Purpose: To measure and compare the performance of X-ray imaging detectors in a clinical setting using a dedicated instrument for the quantitative determination of detector performance. Methods: The DQEPro (DQE Instruments Inc., London, Ontario Canada) was used to determine the MTF, NPS and DQE using an IEC compliant methodology for three different imaging modalities: conventional radiography (CsI-based detector), general-purpose radioscopy (CsI-based detector), and mammography (a-Se based detector). The radiation qualities (IEC) RQA-5 and RQA-M-2 were used for the CsI-based and a-Se-based detectors, respectively. The DQEPro alleviates some of the difficulties associated with DQE measurements by automatically positioning test devices over the detector, guiding the user through the image acquisition process and providing software for calculations. Results: A comparison of the NPS showed that the image noise of the a-Se detector was less correlated than the CsI detectors. A consistently higher performance was observed for the a-Se detector at all spatial frequencies (MTF: 0.97@0.25 cy/mm, DQE: 0.72@0.25 cy/mm) and the DQE drops off slower than for the CsI detectors. The CsI detector used for conventional radiography displayed a higher performance at low spatial frequencies compared to the CsI detector used for radioscopy (DQE: 0.65 vs 0.60@0.25 cy/mm). However, at spatial frequencies above 1.3 cy/mm, the radioscopy detector displayed better performance than the conventional radiography detector (DQE: 0.35 vs 0.24@2.00 cy/mm). Conclusion: The difference in the MTF, NPS and DQE that was observed for the two different CsI detectors and the a-Se detector reflect the imaging tasks that the different detector types are intended for. The DQEPro has made the determination and calculation of quantitative metrics of X-ray imaging detector performance substantially more convenient and accessible to undertake in a clinical setting.

60 APPLIED LIFE SCIENCES↗

Compressive Classification for TEM-EELS

Acquiring atomic-resolution images of beam sensitive materials or under dynamic conditions (e.g. operando STEM) is very difficult and requires precise dose fractioning to minimize the dose delivered to the sample and acquire the data more rapidly than dynamics present. Typical methods of low-dose STEM imaging include adjusting the beam current, dwell-time, and probe Scanning transmission electron microscopy (STEM) is used routinely to obtain atomic-resolution images of a small selection of radiation tolerant materials under stable conditions.size. All three of these determine the dose over a spatial area in STEM. Recently, compressive sensing [1] has been applied to electron microscopy. The computational imaging method of inpainting [2] has been proposed as a method to reduce dose and increase acquisition speed for STEM. Inpainting is a technique to recover missing pixels in an image. By skipping pixels (randomly) during acquisition, a fourth dose-control mechanism is realized [3]. A few implementations of randomly-subsampled STEM exist (e.g., [4]). To make the concepts of compressive sensing accessible to the microscopy community we begin with an example using atomic resolution images of a GaAs crystal (see Figure 1). Because the crystal is periodic it has a sparse representation in reciprocal space. In fact, a sparse representation is a key component of compressive sensing. If an image is sub-sampled randomly we find that the Fourier transform remains sparse, but becomes increasing noisy as less and less data is acquired. Yet, by finding the peaks in the reciprocal image and removing the noise it is possible to recover atomic resolution images with only 1% of the pixels. Figure 1 shows the reconstruction process for GaAs sub-sampled at 50%, 10%, 5%, and 1%. Periodic images form a special class for which the optimal sampling approach (according to CS theory) is a random selection of pixels. For non-periodic images, such as those arising in in-situ STEM, methods such as dictionary learning are necessary [2,5]. The data can be compressed in time for TEM [5] or pixels can be skipped randomly for STEM. There are several issues that arise in developing a random scan for STEM [4] and a coded aperture for TEM. The remainder of the talk will address these issues. References: [1] E Candes and M Wakin. Signal Processing Magazine, IEEE. 2(25) (2008), pp. 21. [2] A Stevens, Pu Y, Sun Y, et al. Artificial Intelligence & Statistics (AISTATS), 2017. [3] A Stevens, H Yang, L Carin et al. Microscopy 63(1), (2014), pp. 41. [4] L Kovarik, A Stevens, A Liyu et al. Appl. Phys. Lett. 109, 164102 (2016). [5] A Stevens, L Kovarik, P Abellan et al. Adv. Structural and Chemical Imaging 1(10), (2015), pp. 1. [6] Supported by the Chemical Imaging, Signature Discovery, and Analytics in Motion Initiatives at PNNL. PNNL is operated by Battelle Memorial Inst. for the US DOE; contract DE-AC05-76RL01830.

Hao, Weituo↗

SU-C-201-07: Validation of a GATE Gamma Camera Model for the Siemens Symbia

Purpose: To develop a simulation model of a clinical gamma camera/SPECT system and to validate the model using experimental and published measurements from the clinical system. Methods: Geant4 Application for Tomographic Emission (GATE) was used to create a model of the Siemens Symbia gamma camera. A modular model was implemented that allows specifying combinations of crystal thickness (3/8”, 5/8”) and collimator (LEHR, MELP, HE). Shielding, energy resolution, intrinsic resolution, crystal thickness, and collimator properties were set based on manufacturer specifications. Validation of the model was performed by simulating NEMA 2007 gamma camera tests including spatial resolution and sensitivity for Tc99; these were compared with experimental and published data for the scanner. The simulated energy spectra of a Tc99 line source in acrylic blocks was visually compared with the corresponding experimental acquisition. For a 4 cm diameter sphere filled with Tc99, the attenuation maps were generated from simulation data, and the photopeak and scatter window were extracted from GATE output using ROOT to create DICOM files to use in the clinical reconstruction. Results: Simulated spatial resolutions for LEHR 3/8” crystal at 0, 10 cm, 10 cm (with scatter), and 30 cm were 4, 6.7, 7.9, and 14.5 mm FWHM; these were 9% less than published data. For 5/8” crystal the spatial resolutions were 4.5, 7.0, 8.5, and 14.7 mm FWHM; these were 4% to 10% less than published data. Simulated sensitivity was within 3.5% of published data for both LEHR 3/8” and 5/8”. The simulated energy spectra matched the photopeak and scatter window well, but did overestimate the counts below 90 keV. The simulated attenuation map and projection data were successfully reconstructed with the clinical software, and the passed visual inspection. Conclusions: Validation of a specific clinical scanner allows future studies of quantification accuracy for both planar and SPECT imaging. Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under Award Number R01CA138986. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

60 APPLIED LIFE SCIENCES↗

Evaluation and Testing of the ADVANTG Code on SNM Detection

Pacific Northwest National Laboratory (PNNL) has been tasked with evaluating the effectiveness of ORNL’s new hybrid transport code, ADVANTG, on scenarios of interest to our NA-22 sponsor, specifically of detection of diversion of special nuclear material (SNM). PNNL staff have determined that acquisition and installation of ADVANTG was relatively straightforward for a code in its phase of development, but probably not yet sufficient for mass distribution to the general user. PNNL staff also determined that with little effort, ADVANTG generated weight windows that typically worked for the problems and generated results consistent with MCNP. With slightly greater effort of choosing a finer mesh around detectors or sample reaction tally regions, the figure of merit (FOM) could be further improved in most cases. This does take some limited knowledge of deterministic transport methods. The FOM could also be increased by limiting the energy range for a tally to the energy region of greatest interest. It was then found that an MCNP run with the full energy range for the tally showed improved statistics in the region used for the ADVANTG run. The specific case of interest chosen by the sponsor is the CIPN project from Las Alamos National Laboratory (LANL), which is an active interrogation, non-destructive assay (NDA) technique to quantify the fissile content in a spent fuel assembly and is also sensitive to cases of material diversion. Unfortunately, weight windows for the CIPN problem cannot currently be properly generated with ADVANTG due to inadequate accommodations for source definition. ADVANTG requires that a fixed neutron source be defined within the problem and cannot account for neutron multiplication. As such, it is rendered useless in active interrogation scenarios. It is also interesting to note that this is a difficult problem to solve and that the automated weight windows generator in MCNP actually slowed down the problem. Therefore, PNNL had determined that there is not an effective tool available for speeding up MCNP for problems such as the CIPN scenario. With regard to the Benchmark scenarios, ADVANTG performed very well for most of the difficult, long-running, standard radiation detection scenarios. Specifically, run time speedups were observed for spatially large scenarios, or those having significant shielding or scattering geometries. ADVANTG performed on par with existing codes for moderate sized scenarios, or those with little to moderate shielding, or multiple paths to the detectors. ADVANTG ran slower than MCNP for very simply, spatially small cases with little to no shielding that run very quickly anyway. Lastly, ADVANTG could not solve problems that did not consist of fixed source to detector geometries. For example, it could not solve scenarios with multiple detectors or secondary particles, such as active interrogation, neutron induced gamma, or fission neutrons.

73 NUCLEAR PHYSICS AND RADIATION PHYSICS↗

A virtual source model for Kilo-voltage cone beam CT: Source characteristics and model validation

Purpose: The purpose of this investigation was to study the source characteristics of a clinical kilo-voltage cone beam CT unit and to develop and validate a virtual source model that could be used for treatment planning purposes. Methods: We used a previously commissioned full Monte Carlo model and new bespoke software to study the source characteristics of a clinical kilo-voltage cone beam CT (CBCT) unit. We identified the main particle sources, their spatial, energy and angular distribution for all the image acquisition presets currently used in our clinical practice. This includes a combination of two energies (100 and 120 kVp), two filters (neutral and bowtie), and eight different x-ray beam apertures. We subsequently built a virtual source model which we validated against full Monte Carlo calculations. Results: We found that the radiation output of the clinical kilo-voltage cone beam CT unit investigated in this study could be reproduced with a virtual model comprising of two sources (target and filtration cone) or three sources (target, filtration cone and bowtie filter) when additional filtration was used. With this model, we accounted for more than 97% of the photons exiting the unit. Each source in our model was characterised by a origin distribution in both X and Y directions, a fluence map, a single energy spectrum for unfiltered beams and a two dimensional energy spectrum for bowtie filtered beams. The percentage dose difference between full Monte Carlo and virtual source model based dose distributions was well within the statistical uncertainty associated with the calculations ( {+-} 2%, one standard deviation) in all cases studied. Conclusions: The virtual source that we developed is accurate in calculating the dose delivered from a commercial kilo-voltage cone beam CT unit operating with routine clinical image acquisition settings. Our data have also shown that target, filtration cone, and bowtie filter sources needed to be all included in the model in order to accurately replicate the dose distribution from the clinical radiation beam.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗

Frame average optimization of cine-mode EPID images used for routine clinical in vivo patient dose verification of VMAT deliveries

Purpose: The in vivo 3D dose delivered to a patient during volumetric modulated arc therapy (VMAT) delivery can be calculated using electronic portal imaging device (EPID) images. These images must be acquired in cine-mode (i.e., “movie” mode) in order to capture the time-dependent delivery information. The angle subtended by each cine-mode EPID image during an arc can be changed via the frame averaging number selected within the image acquisition software. A large frame average number will decrease the EPID’s angular resolution and will result in a decrease in the accuracy of the dose information contained within each image. Alternatively, less EPID images acquired per delivery will decrease the overall 3D patient dose calculation time, which is appealing for large-scale clinical implementation. Therefore, the purpose of this study was to determine the optimal frame average value per EPID image, defined as the highest frame averaging that can be used without an appreciable loss in 3D dose reconstruction accuracy for VMAT treatments. Methods: Six different VMAT plans and six different SBRT-VMAT plans were delivered to an anthropomorphic phantom. Delivery was carried out on a Varian 2300ix model linear accelerator (Linac) equipped with an aS1000 EPID running at a frame acquisition rate of 7.5 Hz. An additional PC was set up at the Linac console area, equipped with specialized frame-grabber hardware and software packages allowing continuous acquisition of all EPID frames during delivery. Frames were averaged into “frame-averaged” EPID images using MATLAB. Each frame-averaged data set was used to calculate the in vivo dose to the patient and then compared to the single EPID frame in vivo dose calculation (the single frame calculation represents the highest possible angular resolution per EPID image). A mean percentage dose difference of low dose (<20% prescription dose) and high dose regions (>80% prescription dose) was calculated for each frame averaged scenario for each plan. The authors defined their unacceptable loss of accuracy as no more than a ±1% mean dose difference in the high dose region. Optimal frame average numbers were then determined as a function of the Linac’s average gantry speed and the dose per fraction. Results: The authors found that 9 and 11 frame averages were suitable for all VMAT and SBRT-VMAT treatments, respectively. This resulted in no more than a 1% loss to any of the dose region’s mean percentage difference when compared to the single frame reconstruction. The optimized number was dependent on the treatment’s dose per fraction and was determined to be as high as 14 for 12 Gy/fraction (fx), 15 for 8 Gy/fx, 11 for 6 Gy/fx, and 9 for 2 Gy/fx. Conclusions: The authors have determined an optimal EPID frame averaging number for multiple VMAT-type treatments. These are given as a function of the dose per fraction and average gantry speed. These optimized values are now used in the authors’ clinical, 3D, in vivo patient dosimetry program. This provides a reduction in calculation time while maintaining the authors’ required level of accuracy in the dose reconstruction.

61 RADIATION PROTECTION AND DOSIMETRY↗

How does C-VIEW image quality compare with conventional 2D FFDM?

Purpose: The FDA approved the use of digital breast tomosynthesis (DBT) in 2011 as an adjunct to 2D full field digital mammography (FFDM) with the constraint that all DBT acquisitions must be paired with a 2D image to assure adequate interpretative information is provided. Recently manufacturers have developed methods to provide a synthesized 2D image generated from the DBT data with the hope of sparing patients the radiation exposure from the FFDM acquisition. While this much needed alternative effectively reduces the total radiation burden, differences in image quality must also be considered. The goal of this study was to compare the intrinsic image quality of synthesized 2D C-VIEW and 2D FFDM images in terms of resolution, contrast, and noise. Methods: Two phantoms were utilized in this study: the American College of Radiology mammography accreditation phantom (ACR phantom) and a novel 3D printed anthropomorphic breast phantom. Both phantoms were imaged using a Hologic Selenia Dimensions 3D system. Analysis of the ACR phantom includes both visual inspection and objective automated analysis using in-house software. Analysis of the 3D anthropomorphic phantom includes visual assessment of resolution and Fourier analysis of the noise. Results: Using ACR-defined scoring criteria for the ACR phantom, the FFDM images scored statistically higher than C-VIEW according to both the average observer and automated scores. In addition, between 50% and 70% of C-VIEW images failed to meet the nominal minimum ACR accreditation requirements—primarily due to fiber breaks. Software analysis demonstrated that C-VIEW provided enhanced visualization of medium and large microcalcification objects; however, the benefits diminished for smaller high contrast objects and all low contrast objects. Visual analysis of the anthropomorphic phantom showed a measureable loss of resolution in the C-VIEW image (11 lp/mm FFDM, 5 lp/mm C-VIEW) and loss in detection of small microcalcification objects. Spectral analysis of the anthropomorphic phantom showed higher total noise magnitude in the FFDM image compared with C-VIEW. Whereas the FFDM image contained approximately white noise texture, the C-VIEW image exhibited marked noise reduction at midfrequency and high frequency with far less noise suppression at low frequencies resulting in a mottled noise appearance. Conclusions: Their analysis demonstrates many instances where the C-VIEW image quality differs from FFDM. Compared to FFDM, C-VIEW offers a better depiction of objects of certain size and contrast, but provides poorer overall resolution and noise properties. Based on these findings, the utilization of C-VIEW images in the clinical setting requires careful consideration, especially if considering the discontinuation of FFDM imaging. Not explicitly explored in this study is how the combination of DBT + C-VIEW performs relative to DBT + FFDM or FFDM alone.

60 APPLIED LIFE SCIENCES↗