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At least 397 records · Page 22
All sourcesNASA NTRSDOE OSTI
DOE OSTI2016

SU-F-T-447: The Impact of Treatment Planning Methods On RapidPlan Modeling for Rectum Cancer

Purpose: To investigate the dose volume histogram (DVH) prediction varieties based on intensity modulate radiotherapy (IMRT) plan or volume arc modulate radiotherapy (VMAT) plan models on the RapidPlan. Methods: Two DVH prediction models were generated in this study, including an IMRT model trained from 83 IMRT rectum plans and a VMAT model trained from 60 VMAT rectum plans. In the internal validation, 20 plans from each training database were selected to verify the clinical feasibility of the model. Then, 10 IMRT plans (PIMRT-by-IMRT-model) generated from IMRT model and 10 IMRT plans generated from VMAT model (PIMRT-by-VMAT-model) were compared on the dose to organs at risk (OAR), which included bladder, left and right femoral heads. The similar comparison was also performed on the VMAT plans generated from IMRT model (PVMAT-by-IMRT-model) and VMAT plans generated from VMAT (PVMAT-by-VMAT-model) model. Results: For the internal validation, all plans from IMRT or VMAT model shows significantly improvement on OAR sparing compared with the corresponded clinical ones. Compared to the PIMRT-by-VMAT-model, the PIMRT-by-IMRT-model has a reduction of 6.90±3.87%(p<0.001) on V40 6.63±3.62%(p<0.001) on V45 and 4.74±2.26%(p<0.001) on V50 in bladder; and a mean dose reduction of 2.12±1.75Gy(p=0.004) and 2.84±1.53Gy(p<0.001) in right and left femoral head, respectively. There was no significant difference on OAR sparing between PVMAT-by-IMRT-model and PVMAT-by-VMAT-model. Conclusion: The IMRT model for the rectal cancer in the RapidPlan can be applied to for VMAT planning. However, the VMAT model is not suggested to use in the IMRT planning. Cautions should be taken that the planning model based on some technique may not feasible to other planning techniques.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-T-522: Dosimetric Study of Junction Dose in Double Isocenter Flatten and Flatten Filter Free IMRT and VMAT Plan Delivery

Purpose: To quantify the dosimetric accuracy of junction dose in double isocenter flattened and flatten filter free(FFF) intensity modulated radiation therapy(IMRT) and volumetric modulated arc therapy(VMAT) plan delivery using pelvis phantom. Methods: Five large field pelvis patients were selected for this study. Double isocenter IMRT and VMAT treatment plans were generated in Eclipse Treatment planning System (V.11.0) using 6MV FB and FFF beams. For all the plans same distance 17.0cm was kept between one isocenter to another isocenter. IMRT Plans were made with 7 coplanar fields and VMAT plans were made with full double arcs. Dose calculation was performed using AAA algorithms with dose grid size of 0.25 cm. Verification plans were calculated on Scanditronix Wellhofer pelvis slab phantom. Measurement point was selected and calculated, where two isocenter plan fields are overlapping, this measurement point was kept at distance 8.5cm from both isocenter. The plans were delivered using Varian TrueBeamTM machine on pelvis slab phantom. Point dose measurements was carried out using CC13 ion chamber volume of 0.13cm3. Results: The measured junction point dose are compared with TPS calculated dose. The mean difference observed was 4.5%, 6.0%, 4.0% and 7.0% for IMRT-FB,IMRT-FFF, VMAT-FB and VMAT-FFF respectively. The measured dose results shows closer agreement with calculated dose in Flatten beam planning in both IMRT and VMAT, whereas in FFF beam plan dose difference are more compared with flatten beam plan. Conclusion: Dosimetry accuracy of Large Field junction dose difference was found less in Flatten beam compared with FFF beam plan delivery. Even though more dosimetric studies are required to analyse junction dose for FFF beam planning using multiple point dose measurements and fluence map verification in field junction area.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-T-611: Critical Analysis and Efficacy of Linac Based (Beam Modulator) and Cyberknife Treatment Plans for Acoustic Neuroma/schwannoma

Purpose: To study the critical analysis and efficacy of Linac and Cyberknife (CK) treatment plans for acoustic neuroma/schwannoma. Methods: Twelve of acoustic neuroma/schwannoma patients were taken for these study that. Treatment plans were generated in Multiplan treatment planning system (TPS) for CK using 5,7.5 and 10mm diameter collimators. Target volumes were in the range of 0.280 cc to 9.256 cc. Prescription dose (Rx) ranges from 1150cGy to 1950cGy delivered over 1 to 3 Fractions. For same patients stereotactic Volumetric modulated arc plans were generated using Elekta Linac with MLC thickness of 4mm in Monaco TPS. Appropriate calculation algorithms and grid size were used with same Rx and organ at risk (OAR) constrains for both Linac and CK plans. Treatment plans were developed to achieve at least 95% of the target volume to receive the Rx. The dosimetric indices such as conformity index (CI), coverage, OAR dose and volume receiving 50% of Rx (V50%) were used to evaluate the plans. Results: Target volumes ranges from 0.280 cc to 3.5cc shows the CI of 1.16±0.109 and 1.53±0.360 for cyberknife and Linac plans respectively. For small volume targets, the OARs were well spared in CK plans. There are no significant differences in CI and OAR doses were observed between CK and Linac plans that have the target volume >3.5 cc. Perhaps the V50% were lesser in CK plans, and found to be 12.8± 8.4 and 22.8 ± 15.0 for CK and Linac respectively. Conclusion: The analysis shows the importance of collimator size for small volume targets. The target volumes >3.5 cc can be treated in Linac as comparable with CK. For targets <3.5cc CK plans showed superior plan quality with better CI and OAR sparing than the Linac based plans. Further studies may require evaluating the clinical advantage of CK robotic system.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

MO-G-201-04: Knowledge-Based Planning for Single-Isocenter Stereotactic Radiosurgery to Multiple Brain Metastases

Purpose: Single-isocenter, linac-based SRS for multiple brain metastases (multi-mets) can deliver highly conformal radiation doses and reduce overall patient treatment time compared to other therapy techniques. This study aims to quantify the dosimetric benefits of knowledge-based planning (KBP) for multi-met treatments. Methods: Using a previously-published KBP methodology (an artificial neural network (ANN) trained on single-target linac-based SRS plans), 3D dose distribution predictions for multi-met patients were obtained by treating each brain lesion as a solitary target and subsequently combining individual predictions into a single distribution using a dose-weighted geometric averaging to obtain the best results in the inter-target space. 17 previously-treated multi-met plans, with target numbers ranging from N=2–5, were used to validate the ANN predictions and subsequent KBP auto-planning routine. The fully-deliverable KBP plans were developed by converting dose distribution predictions into patient-specific optimization objectives while maintaining identical target normalizations (typically PTV V100%=D98%). Plan quality improvements were quantified by the difference between SRS quality metrics (QMs): δdQM=QM(clinical)-QM(KBP). QMs of interest were: gradient measure (GM), conformity index (CI), brain V10 and V5, brainstem D0.1cc and heterogeneity index (HI). Finally, overall plan quality was judged via blinded plan comparison by SRS-specializing physicians. Results: Two clinical plans were found to be significant outliers wherein plan quality was dramatically worse than KBP. Despite indicating KBP superiority, these were removed from the QM analysis to prevent skewing the results. In the remaining cases, clinical and KBP QMs were nearly identical with modest improvements in the KBP sample: δGM=0.12±0.56mm, δCI=−0.01±0.04, Brain δV10=0.8±2.6cc, brain δV5=6.3 ±10.7cc, brainstem δD0.1cc=0.06±1.19Gy and δHI= −0.04±0.05. Ultimately, 13/17 KBP plans were deemed superior to the manual plans in blinded physician review. Conclusion: The results demonstrate that KBP-driven automated planning in linac-based single-isocenter treatments for multiple brain metastases is indistinguishable from, or even better than, traditional manual planning. J. Hattangadi: Research Grant; Varian Medical Systems; K.L. Moore: Research Grant: Varian Medical Systems.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

TU-D-201-06: HDR Plan Prechecks Using Eclipse Scripting API

Purpose: Automate brachytherapy treatment plan quality check using Eclipse v13.6 scripting API based on pre-configured rules to minimize human error and maximize efficiency. Methods: The HDR Precheck system is developed based on a rules-driven approach using Eclipse scripting API. This system checks for critical plan parameters like channel length, first source position, source step size and channel mapping. The planned treatment time is verified independently based on analytical methods. For interstitial or SAVI APBI treatment plans, a Patterson-Parker system calculation is performed to verify the planned treatment time. For endobronchial treatments, an analytical formula from TG-59 is used. Acceptable tolerances were defined based on clinical experiences in our department. The system was designed to show PASS/FAIL status levels. Additional information, if necessary, is indicated appropriately in a separate comments field in the user interface. Results: The HDR Precheck system has been developed and tested to verify the treatment plan parameters that are routinely checked by the clinical physicist. The report also serves as a reminder or checklist for the planner to perform any additional critical checks such as applicator digitization or scenarios where the channel mapping was intentionally changed. It is expected to reduce the current manual plan check time from 15 minutes to <1 minute. Conclusion: Automating brachytherapy plan prechecks significantly reduces treatment plan precheck time and reduces human errors. When fully developed, this system will be able to perform TG-43 based second check of the treatment planning system’s dose calculation using random points in the target and critical structures. A histogram will be generated along with tabulated mean and standard deviation values for each structure. A knowledge database will also be developed for Brachyvision plans which will then be used for knowledge-based plan quality checks to further reduce treatment planning errors and increase confidence in the planned treatment.

61 RADIATION PROTECTION AND DOSIMETRY↗
DOE OSTI2016

WE-AB-209-02: A New Inverse Planning Framework with Principle-Based Modeling of Inter-Structural Dosimetric Tradeoffs

Purpose: Traditional radiotherapy inverse planning relies on the weighting factors to phenomenologically balance the conflicting criteria for different structures. The resulting manual trial-and-error determination of the weights has long been recognized as the most time-consuming part of treatment planning. The purpose of this work is to develop an inverse planning framework that parameterizes the inter-structural dosimetric tradeoff among with physically more meaningful quantities to simplify the search for a clinically sensible plan. Methods: A permissible dosimetric uncertainty is introduced for each of the structures to balance their conflicting dosimetric requirements. The inverse planning is then formulated as a convex feasibility problem, which aims to generate plans with acceptable dosimetric uncertainties. A sequential procedure (SP) is derived to decompose the model into three submodels to constrain the uncertainty in the planning target volume (PTV), the critical structures, and all other structures to spare, sequentially. The proposed technique is applied to plan a liver case and a head-and-neck case and compared with a conventional approach. Results: Our results show that the strategy is able to generate clinically sensible plans with little trial-and-error. In the case of liver IMRT, the fractional volumes to liver and heart above 20Gy are found to be 22% and 10%, respectively, which are 15.1% and 33.3% lower than that of the counterpart conventional plan while maintaining the same PTV coverage. The planning of the head and neck IMRT show the same level of success, with the DVHs for all organs at risk and PTV very competitive to a counterpart plan. Conclusion: A new inverse planning framework has been established. With physically more meaningful modeling of the inter-structural tradeoff, the technique enables us to substantially reduce the need for trial-and-error adjustment of the model parameters and opens new opportunities of incorporating prior knowledge to facilitate the treatment planning process.

60 APPLIED LIFE SCIENCES↗
NASA NTRS2018

Evaluation of Crew-Centric Onboard Mission Operations Planning and Execution Tool: Year 2

Currently, mission planning for the International Space Station (ISS) is largely affected by ground operators in mission control. The task of creating a week-long mission plan for ISS crew takes dozens of people multiple days to complete, and is often created far in advance of its execution. As such, re-planning or adapting to changing real-time constraints or emergent issues is similarly taxing. As we design for future mission operations concepts to other planets or areas with limited connectivity to Earth, more of these ground-based tasks will need to be handled autonomously by the crew onboard.There is a need for a highly usable (including low training time) tool that enables efficient self-scheduling and execution within a single package. The ISS Program has identified Playbook as a potential option. It already has high crew acceptance as a plan viewer from previous analogs and can now support a crew self-scheduling assessment on ISS or on another mission. The goals of this work, a collaboration between the Human Research Program and the ISS Program, are to inform the design of systems for more autonomous crew operations and provide a platform for research on crew autonomy for future deep space missions. Our second year of the research effort have included new insights on the crew self-scheduling sessions performed by the crew through use on the HERA (Human Exploration Research Analog) and NEEMO (NASA Extreme Environment Mission Operations) analogs. Use on the NEEMO analog involved two self-scheduling strategies where the crew planned and executed two days of EVAs (Extra-Vehicular Activities). On HERA year two represented the first HERA campaign where we were able to perform research tasks. This involved selected flexible activities that the crew could schedule, mock timelines where the crew completed more complex planning exercises, usability evaluation of the crew self-scheduling features, and more insights into the limit of plan complexity that the crew could effectively self-schedule. In parallel we have added in new features and functionality in the Playbook tool based off of our insights from crew self-scheduling in the NASA analogs. In particular this year we have added in the ability for the crew to add, edit, and remove their own activities in the Playbook tool, expanding the type of planning and re-planning possible in the tool and opening up the ability for more free form plan creation. The ability to group and manipulate groups of activities from the plan task list was also added, allowing crew members to add predefined sets of activities onto their mission timeline. In addition we also added a way for crew members to roll back changes in their plan, in order to allow an undo like capability. These features expand and complement the initial self-scheduling features added in year one with the goal of making crew autonomous planning more efficient. As part of this work we have also finished developing the first version of our Playbook Data Analysis Tool, a research tool built to interpret and analyze the unobtrusively collected data obtained during the NASA analog missions through Playbook. This data which includes user click interaction as well as plan change information, through the Playbook Data Analysis Tool, allows us to playback this information as if a video camera was mounted over the crewmember's tablet. While the primary purpose of this tool is to allow usability analysis of crew self-scheduling sessions used on the NASA analog, since the data collected is structured, the tool can automatically derive metrics that would be traditionally tedious to achieve without manual analysis of video playback. We will demonstrate and discuss the ability for future derived metrics to be added to the tool. In addition to the current data and results gathered in year two we will also discuss the preparation and goals of our International Space Station (ISS) onboard technology demonstration with Playbook. This technology demonstration will be preformed as part of the CAST payload starting in late 2016.

onboard planning↗
DOE OSTI2014

SU-E-T-569: Evaluation of VMAT Plans Generated with HD120 and Millennium 120 MLC Between Two Matched Linacs

Purpose: To evaluate VMAT treatment plans generated with HD120 MLC and Millennium 120 MLC between two matched linacs and to determine if one can back up the other. Methods: The 6x photon beams are matched for our Varian TrueBeam STx and Trilogy linacs, which are equipped with HD120 MLC and Millennium 120 MLC, respectively. Three prostate and three brain VMAT plans were used for the evaluation. Five plans (three prostate and two brain plans) were originally generated with the TrueBeam STx and re-computed with the Trilogy. One brain plan was evaluated the other way around. For each plan, the PTV coverage of V95 was made the same between two linacs. The dosimetric differences associated with the plans were compared using: 1) Percentage mean dose differences to the PTV, 2) Homogeneity index, HI = (Dmax − Dmin)/Dmean for the PTV. For prostate plans, the mean dose differences to the rectum were evaluated. While for brain plans, the percentage max dose differences to the lenses (left and right lens) were evaluated. Results: For three prostate plans, the average of the percentage mean dose differences to the PTV was 0.5 ± 0.1% and the HI was 0.1 ± 0.0%. The average of the percentage mean dose difference to the rectum was 3.5 ± 0.5%. For three brain plans, the average of the percentage mean dose differences to the PTV was 0.2 ± 1.1% and the HI was 0.2 ± 0.1%. The average of the percentage max dose differences to the lenses was 22.9 ± 4.0%. Conclusion: For prostate VMAT plans, changing the treatment from the TrueBeam STx to the Trilogy does not necessarily need re-optimization. But for brain plans, in order to minimize dose to the lenses, it is recommended to re-optimize the plan if changing the treatment between these two linacs.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-538: Lung SBRT Dosimetric Comparison of 3D Conformal and RapidArc Planning

Purpose: Dose distributions of RapidArc Plan can be quite different from standard 3D conformal radiation therapy. SBRT plans can be optimized with high conformity or mimic the 3D conformal treatment planning with very high dose in the center of the tumor. This study quantifies the dosimetric differences among 3D conformal plan; flattened beam and FFF beam RapidArc Plans for lung SBRT. Methods: Five lung cancer patients treated with 3D non-coplanar SBRT were randomly selected. All the patients were CT scanned with 4DCT to determine the internal target volume. Abdominal compression was applied to minimize respiratory motion for SBRT patients. The prescription dose was 48 Gy in 4 fractions. The PTV coverage was optimized by two groups of objective function: one with high conformity, another mimicking 3D conformal dose distribution with high dose in the center of PTV. Optimization constraints were set to meet the criteria of the RTOG-0915 protocol. All VMAT plans were optimized with the RapidArc technique using four full arcs in Eclipse treatment planning system. The RapidArc SBRT plans with flattened 6MV beam and 6MV FFF beam were generated and dosimetric results were compared with the previous treated 3D non-coplanar plans. Results: All the RapidArc plans with flattened beam and FFF beam had similar results for the PTV and OARs. For the high conformity optimization group, The DVH of PTV exhibited a steep dose fall-off outside the PTV compared to the 3D non-coplanar plan. However, for the group mimicking the 3D conformal target dose distribution, although the PTV is very similar to the 3D conformal plan, the ITV coverage is better than 3D conformal plan. Conclusion: Due to excellent clinical experiences of 3D conformal SBRT treatment, the Rapid Arc optimization mimicking 3D conformal planning may be suggested for clinical use.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
NASA NTRS1987

Maintaining consistency between planning hierarchies: Techniques and applications

In many planning and scheduling environments, it is desirable to be able to view and manipulate plans at different levels of abstraction, allowing the users the option of viewing and manipulating either a very detailed representation of the plan or a high-level more abstract version of the plan. Generating a detailed plan from a more abstract plan requires domain-specific planning/scheduling knowledge; the reverse process of generating a high-level plan from a detailed plan Reverse Plan Maintenance, or RPM) requires having the system remember the actions it took based on its domain-specific knowledge and its reasons for taking those actions. This reverse plan maintenance process is described as implemented in a specific planning and scheduling tool, The Mission Operations Planning Assistant (MOPA), as well as the applications of RPM to other planning and scheduling problems; emphasizing the knowledge that is needed to maintain the correspondence between the different hierarchical planning levels.

Zoch, David R.↗
NASA NTRS2002

Demonstration of a Spoken Dialogue Interface for Planning Activities of a Semi-autonomous Robot

Planning and scheduling in the face of uncertainty and change pushes the capabilities of both planning and dialogue technologies by requiring complex negotiation to arrive at a workable plan. Planning for use of semi-autonomous robots involves negotiation among multiple participants with competing scientific and engineering goals to co-construct a complex plan. In NASA applications this plan construction is done under severe time pressure so having a dialogue interface to the plan construction tools can aid rapid completion of the process. But, this will put significant demands on spoken dialogue technology, particularly in the areas of dialogue management and generation. The dialogue interface will need to be able to handle the complex dialogue strategies that occur in negotiation dialogues, including hypotheticals and revisions, and the generation component will require an ability to summarize complex plans. This demonstration will describe a work in progress towards building a spoken dialogue interface to the EUROPA planner for the purposes of planning and scheduling the activities of a semi-autonomous robot. A prototype interface has been built for planning the schedule of the Personal Satellite Assistant (PSA), a mobile robot designed for micro-gravity environments that is intended for use on the Space Shuttle and International Space Station. The spoken dialogue interface gives the user the capability to ask for a description of the plan, ask specific questions about the plan, and update or modify the plan. We anticipate that a spoken dialogue interface to the planner will provide a natural augmentation or alternative to the visualization interface, in situations in which the user needs very targeted information about the plan, in situations where natural language can express complex ideas more concisely than GUI actions, or in situations in which a graphical user interface is not appropriate.

Dowding, John↗
DOE OSTI2014

Fully Automated Volumetric Modulated Arc Therapy Plan Generation for Prostate Cancer Patients

Purpose: To develop and evaluate fully automated volumetric modulated arc therapy (VMAT) treatment planning for prostate cancer patients, avoiding manual trial-and-error tweaking of plan parameters by dosimetrists. Methods and Materials: A system was developed for fully automated generation of VMAT plans with our commercial clinical treatment planning system (TPS), linked to the in-house developed Erasmus-iCycle multicriterial optimizer for preoptimization. For 30 randomly selected patients, automatically generated VMAT plans (VMAT{sub auto}) were compared with VMAT plans generated manually by 1 expert dosimetrist in the absence of time pressure (VMAT{sub man}). For all treatment plans, planning target volume (PTV) coverage and sparing of organs-at-risk were quantified. Results: All generated plans were clinically acceptable and had similar PTV coverage (V{sub 95%} > 99%). For VMAT{sub auto} and VMAT{sub man} plans, the organ-at-risk sparing was similar as well, although only the former plans were generated without any planning workload. Conclusions: Fully automated generation of high-quality VMAT plans for prostate cancer patients is feasible and has recently been implemented in our clinic.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2011

A planning and delivery study of a rotational IMRT technique with burst delivery

Purpose: A novel rotational IMRT (rIMRT) technique using burst delivery (continuous gantry rotation with beam off during MLC repositioning) is investigated. The authors evaluate the plan quality and delivery efficiency and accuracy of this dynamic technique with a conventional flat 6 MV photon beam. Methods: Burst-delivery rIMRT was implemented in a planning system and delivered with a 160-MLC linac. Ten rIMRT plans were generated for five anonymized patient cases encompassing head and neck, brain, prostate, and prone breast. All plans were analyzed retrospectively and not used for treatment. Among the varied plan parameters were the number of optimization points, number of arcs, gantry speed, and gantry angle range (alpha) over which the beam is turned on at each optimization point. Combined rotational/step-and-shoot rIMRT plans were also created by superimposing multiple-segment static fields at several optimization points. The rIMRT trial plans were compared with each other and with plans generated using helical tomotherapy and VMAT. Burst-mode rotational IMRT plans were delivered and verified using a diode array, ionization chambers, thermoluminescent dosimeters, and film. Results: Burst-mode rIMRT can achieve plan quality comparable to helical tomotherapy, while the former may lead to slightly better OAR sparing for certain cases and the latter generally achieves slightly lower hot spots. Few instances were found in which increasing the number of optimization points above 36, or superimposing step-and-shoot IMRT segments, led to statistically significant improvements in OAR sparing. Using an additional rIMRT partial arc yielded substantial OAR dose improvements for the brain case. Measured doses from the rIMRT plan delivery were within 4% of the plan calculation in low dose gradient regions. Delivery time range was 228-375 s for single-arc rIMRT 200-cGy prescription with a 300 MU/min dose rate, comparable to tomotherapy and VMAT. Conclusions: Rotational IMRT with burst delivery, whether combined with static fields or not, yields clinically acceptable and deliverable treatment plans.

61 RADIATION PROTECTION AND DOSIMETRY↗
DOE OSTI2012

A hybrid electron and photon IMRT planning technique that lowers normal tissue integral patient dose using standard hardware

Purpose: To present a mixed electron and photon IMRT planning technique using electron beams with an energy range of 6-22 MeV and standard hardware that minimizes integral dose to patients for targets as deep as 7.5 cm. Methods: Ten brain cases, two lung, a thyroid, an abdominal, and a parotid case were planned using two planning techniques: a photon-only IMRT (IMRT) versus a mixed modality treatment (E + IMRT) that includes an enface electron beam and a photon IMRT portion that ensures a uniform target coverage. The electron beam is delivered using a regular cutout placed in an electron cone. The electron energy was chosen to provide a good trade-off between minimizing integral dose and generating a uniform, deliverable plan. The authors choose electron energies that cover the deepest part of PTV with the 65%-70% isodose line. The normal tissue integral dose, the dose for ring structures around the PTV, and the volumes of the 75%, 50%, and 25% isosurfaces were used to compare the dose distributions generated by the two planning techniques. Results: The normal tissue integral dose was lowered by about 20% by the E + IMRT plans compared to the photon-only IMRT ones for most studied cases. With the exception of lungs, the dose reduction associated to the E + IMRT plans was more pronounced further away from the target. The average dose ratio delivered to the 0-2 cm and the 2-4 cm ring structures for brain patients for the two planning techniques were 89.6% and 70.8%, respectively. The enhanced dose sparing away from the target for the brain patients can also be observed in the ratio of the 75%, 50%, and 25% isodose line volumes for the two techniques, which decreases from 85.5% to 72.6% and further to 65.1%, respectively. For lungs, the lateral electron beams used in the E + IMRT plans were perpendicular to the mostly anterior/posterior photon beams, generating much more conformal plans. Conclusions: The authors proved that even using the existing electron delivery hardware, a mixed electron/photon planning technique (E + IMRT) can decrease the normal tissue integral dose compared to a photon-only IMRT plan. Different planning approaches can be enabled by the use of an electron beam directed toward organs at risk distal to the target, which are still spared due the rapid dose fall-off of the electron beam. Examples of such cases are the lateral electron beams in the thoracic region that do not irradiate the heart and contralateral lung, electron beams pointed toward kidneys in the abdominal region, or beams treating brain lesions pointed toward the brainstem or optical apparatus. For brain, electron vertex beams can also be used without irradiating the whole body. Since radiation retreatments become more and more common, minimizing the normal tissue integral dose and the dose delivered to tissues surrounding the target, as enabled by E + IMRT type techniques, should receive more attention.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2014

SU-D-19A-06: The Effect of Beam Parameters On Very High-Energy Electron Radiotherapy: A Planning Study

Purpose: We evaluated the effect of very high-energy electron (VHEE) beam parameters on the planning of a lung cancer case by means of Monte Carlo simulations. Methods: We simulated VHEE radiotherapy plans using the EGSnrc/BEAMnrc-DOSXYZnrc code. We selected a lung cancer case that was treated with 6MV photon VMAT to be planned with VHEE. We studied the effect of beam energy (80 MeV, 100 MeV, and 120 MeV), number of equidistant beams (16 or 32), and beamlets sizes (3 mm, 5 mm or 7 mm) on PTV coverage, sparing of organs at risk (OARs) and dose conformity. Inverse-planning optimization was performed in a research version of RayStation (RaySearch Laboratories AB) using identical objective functions and constraints for all VHEE plans. Results: Similar PTV coverage and dose conformity was achieved by all the VHEE plans. The 100 MeV and 120 MeV VHEE plans were equivalent amongst them and were superior to the 80 MeV plan in terms of OARs sparing. The effect of using 16 or 32 equidistant beams was a mean difference in average dose of 2.4% (0%–7.7%) between the two plans. The use of 3 mm beamlet size systematically reduced the dose to all the OARs. Based on these results we selected the 100MeV-16beams-3mm-beamlet-size plan to compare it against VMAT. The selected VHEE plan was more conformal than VMAT and improved OAR sparing (heart and trachea received 125% and 177% lower dose, respectively) especially in the low-dose region. Conclusion: We determined the VHEE beam parameters that maximized the OAR dose sparing and dose conformity of the actually delivered VMAT plan of a lung cancer case. The selected parameters could be used for the planning of other treatment sites with similar size, shape, and location. For larger targets, a larger beamlet size might be used without significantly increasing the dose. B Palma: None. M Bazalova: None. B Hardemark: Employee, RaySearch Americas. E Hynning: Employee, RaySearch Americas. B Qu: None. B Loo Jr.: Research support, RaySearch, Varian. P Maxim: Research support, RaySearch, Varian.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-P-06: A Novel Hybrid Planning Approach to Allow More Patients Benefited by the Intensity Modulated Proton Therapy

Purpose: We report a hybrid scattering and scanning beam delivery approach, termed as (HimpsPT), which demonstrated that majority IMPT delivery can be potentially replaced with hybrid IMPT and PSPT delivery with similar or better plan quality. Methods: Three representative clinical cases, including head and neck (HN), skull base chordoma (CNS) and lung cancer, treated in MDACC Proton Therapy Center with IMPT were retrospectively redesigned using HimpsPT. The PSPT plans are designed with the same prescriptions as those of IMPT plans. The whole treatment can be delivered by either alternating or sequential PSPT and IMPT delivery. The dosimetric data and dose distributions of HimpsPT plans are compared with those of IMPT plans. We also performed a worst-case robust analysis for all plans. Results: The target coverages for all cases are comparable. For the HN case, the mean dose of esophagus larynx, left parotid and right submandibular, oral cavity V20, the max dose of cord is 18.0, 36.1, 23.6, 47.2, 0.1, 31.7 Gy in HimpsPT plan, and 25.5, 33.8, 24.9, 49.1, 0.2, 33.8 Gy in IMPT plan. For the lung case, the lung V5, V20, V30, mean lung dose, heart V40, esophagus V70, cord maximum dose are 50.5%, 37.0%, 31.7%, 21.3 Gy, 7.2%, 4.9%, 35.5 Gy in HimpsPT plan, and 55.4%, 36.7%, 30.1%, 21.3 Gy, 7.7%, 8.4%, 36.8Gy in IMPT plans. For the CNS case, brainstem maximum dose is 50.5 Gy in HimpsPT plan and 55.4 Gy in IMPT plan due to sharp penumbra offered by the aperture of the PSPT plan in HimpsPT technique. Conclusion: For majority disease sites, the dosimetric advantage of IMPT technique can be achieved by the hybrid PSPT and IMPT technique, which enables the centers equipped with both scattering and scanning beam facilities to treat more patients which can be benefited by the scanning beam.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-J-88: Margin Reduction of Level II/III Planning Target Volume for Image-Guided Simultaneous Integrated Boost Head-And-Neck Treatment

Purpose: To investigate the feasibility of improved normal tissue sparing for head-and-neck (H'N) image-guided radiotherapy (IGRT) by employing tighter CTV-to-PTV margins for target level II/III though a GPU-based deformable image registration and dose accumulation framework. Methods: Ten H'N simultaneous integrated boost cases treated on TomoTherapy were retrospectively analyzed. Weekly kVCT scans in addition to daily MVCT scans were acquired for each patient. Reduced margin plans were generated with 0- mm margin for level II and III PTV (while 3-5 mm margin for PTV1) and compared with the standard margin plan using 3-5mm margin to all CTV1-3 (reference plan). An in-house developed GPU-based 3D image deformation tool was used to register and deform the weekly KVCTs with the planning CT and determine the delivered mean/minimum/maximum dose, dose volume histograms (DVHs), etc. Results: Compared with the reference plans, the averaged cord maximum, the right and left parotid doses reduced by 22.7 %, 16.5 %, and 9 % respectively in the reduced margin plans. The V95 for PTV2 and PTV3 were found within 2 and 5% between the reference and tighter margin plans. For the reduced margin plans, the averaged cumulative mean doses were consistent with the planned dose for PTV1, PTV2 and PTV3 within 1.5%, 1.7% and 1.4%. Similar dose variations of the delivered dose were seen for the reference and tighter margin plans. The delivered maximum and mean doses for the cord were 3.55 % and 2.37% higher than the planned doses; a 5 % higher cumulative mean dose for the parotids was also observed for the delivered dose than the planned doses in both plans. Conclusion: By imposing tighter CTV-to-PTV margins for level II and III targets for H'N irradiation, acceptable cumulative doses were achievable when coupled with weekly kVCT guidance while improving normal structure sparing.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-J-268: Is It Necessary to Account for Organs at Risk Respiratory Induced Motion Effects in Radiotherapy Planning with Tumor Tracking?

Purpose: The objective of this study was to evaluate the necessity to account for the organs at risk (OARs) respiratory induced motion in addition to the tumor displacement when planning a radiotherapy treatment that accounts for tumor motion. Methods: For 18 lung cancer patients, conformational radiotherapy treatment plans were generated using 3 different CT volumes: the two extreme respiratory phases corresponding to either the full inspiration (plan 1) or expiration (plan 3), as well as a manually deformed phase consisting in full inspiration combined with the full expiration tumor location (plan 2) simulating a tumor tracking plan without addressing OARs motion. Treatment plans were initially created on plan 1 and then transferred to plan 2 and 3 which represent respectively the tumor displacement only and the whole anatomic variations due to breathing. The dose coverage and the dose delivered to the OARs were compared using conformational indexes and generalized equivalent uniform dose. Results: The worst conformational indexes were obtained for plans with all anatomic deformations (Table 1) with an underestimation of the 95% isodose spreading on healthy tissue compared to plans considering the tumor displacement only. Furthermore, mean doses to the OARs when accounting for all the anatomic changes were always higher than those associated with the tumor displacement only: the mean difference between these two plans was 1±1.37 Gy (maximum of 3.8 Gy) for the heart and 1.4±1.42 Gy (maximum of 4.1 Gy) for the lung in which the tumor was located (Figure 1). Conclusion: OARs deformations due to breathing motion should be included in the treatment planning in order to avoid unnecessary OARs dose and/or allow for a tumor dose escalation. This is even more important for treatments like stereotactic radiation therapy which necessitates a high precision ballistic and dose control.

60 APPLIED LIFE SCIENCES↗