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At least 433 records · Page 24
All sourcesNASA NTRSDOE OSTI
DOE OSTI2017

Importance of deformable image registration and biological dose summation in planning of radiotherapy retreatments

The purpose of this study is to evaluate the effect of nonrigid and fractionation-corrected dose summation on total doses in radiotherapy and to demonstrate the benefits of such dose summation on clinical decision-making for planning of retreatments. Dose summation of organs at risk (OARs) was investigated for 3 clinical cases with need of retreatment to the same site: head and neck, brain, and mediastinum. Three different summation methods over old and new radiotherapy treatment plans are presented and compared: (1) rigid raw sum with rigid registration of the planning images and direct dose summing; (2) deformable raw sum with deformable image registration and direct dose summing; and (3) deformable biological sum with deformable registration and takes into account the dose per fraction in biological manner in certain critical organs. In 2 cases, a user-defined dose downscaling is applied to take into account the time between the treatments and the healing from the radiation-induced effects. Of the 3 summation methods presented, the deformable biological sum was considered to offer the most biologically plausible account of the treatment. There were remarkable differences between near-maximum doses (D0.1cc) and dose-volume histogram (DVH) curves for OARs between different summation methods. The differences between deformable raw sum and rigid raw sum D0.1cc doses are in the range from −8 Gy to 2 Gy. Similarly, the deviation was from −14 Gy to 5 Gy for the deformable biological sum compared with the rigid raw sum. These differences come from incorrect summation of doses in the rigid raw sum case, and from the dose per fraction effect in biological summation. We conclude that computing the 3-dimensional deformable biological summation could be a valuable tool for treating patients with complex retreatments. It has the potential to assist the oncologist in refining plans for maximally curative doses while respecting appropriate tissue tolerances.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2013

Failure-probability driven dose painting

Purpose: To demonstrate a data-driven dose-painting strategy based on the spatial distribution of recurrences in previously treated patients. The result is a quantitative way to define a dose prescription function, optimizing the predicted local control at constant treatment intensity. A dose planning study using the optimized dose prescription in 20 patients is performed.Methods: Patients treated at our center have five tumor subvolumes from the center of the tumor (PET positive volume) and out delineated. The spatial distribution of 48 failures in patients with complete clinical response after (chemo)radiation is used to derive a model for tumor control probability (TCP). The total TCP is fixed to the clinically observed 70% actuarial TCP at five years. Additionally, the authors match the distribution of failures between the five subvolumes to the observed distribution. The steepness of the dose–response is extracted from the literature and the authors assume 30% and 20% risk of subclinical involvement in the elective volumes. The result is a five-compartment dose response model matching the observed distribution of failures. The model is used to optimize the distribution of dose in individual patients, while keeping the treatment intensity constant and the maximum prescribed dose below 85 Gy.Results: The vast majority of failures occur centrally despite the small volumes of the central regions. Thus, optimizing the dose prescription yields higher doses to the central target volumes and lower doses to the elective volumes. The dose planning study shows that the modified prescription is clinically feasible. The optimized TCP is 89% (range: 82%–91%) as compared to the observed TCP of 70%.Conclusions: The observed distribution of locoregional failures was used to derive an objective, data-driven dose prescription function. The optimized dose is predicted to result in a substantial increase in local control without increasing the predicted risk of toxicity.

61 RADIATION PROTECTION AND DOSIMETRY↗
DOE OSTI2014

SU-E-T-94: Daily Fraction Dose Recalculation Based On Rigid Registration Using Cone Beam CT

Purpose: To calculate the daily fraction dose for a CBCT recalculation based on rigid registration and compare it to the planned CT dose. Methods: For this study, 30 patients that were previously treated (10 SBRT lung, 10 prostate and 10 abdomen) were considered. The daily CBCT images were imported into the Pinnacle treatment planning system from Mosaic. The prescribing physician contoured the regions of interest (ROI) on each CBCT and then dose was computed on each CBCT. Each CBCT dose distribution was then compared against the plan. The evaluation was based on isodose line comparison and Dose Volume Histogram comparison. Results: In the case of lung patients the dose differences between daily dose and plan dose were considered small. The PTV coverage was not compromised and the dose to the organs at risk had negligible differences. Larger differences were observed for prostate and abdomen patients. In these cases, although the PTV doses did not change on a daily basis, the doses to the organs at risk had significant differences. For a prostate patient, the bladder dose at 35% volume was 2714.444 cGy for the CT plan and 2844.747, 2801.556, 3552.37, and 2970.968 cGy for subsequent CBCTs. For the PTV on a SBRT patient, however, the CT plan had a dose at 35% volume of 6917.71 cGy and 6815.385, 6892.5, 6896.25, and 6922.9 cGy for the CBCTs. Conclusion: Daily dose validation is feasible using CBCT and treatment planning system. It provides means to evaluate the course of treatment for the patient undergoing radiation therapy and can assist in the decision of the need of adaptation of the treatment plan.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-641: Development and Verification of Automatic Reading Dose of Interest From Eclipse's DVH

Purpose: According to clinical and research requirement, we develop a function of automatic reading dose of interest from dose volume histogram(DVH), to replace the traditional method with a mouse one by one point, and it's also verified. Methods: The DVH automatic reading function will be developed in an in-house developed radiotherapy information management system(RTIMS), which is based on Apache+PHP+MySQL. A DVH ASCII file is exported from Varian Eclipse V8.6, which includes the following contents: 1. basic information of patient; 2. dose information of plan; 3. dose information of structures, including basic information and dose volume data of target volume and organ at risk. And the default exported dose volume data also includes relative doses by 1% step and corresponding absolute doses and cumulative relative volumes, and the volumes are 4 decimal fraction. Clinically, we often need read the doses of some integer percent volumes, such as D50 and D30. So it couldn't be directly obtained from the above data, but we can use linear interpolation bye the near volumes and doses: Dx=D2−(V2−Vx)*(D2−D1)/(V2−V1), and program a function to search, read and calculate the corresponding data. And the doses of all preseted volume of interest of all structures can be automatically read one by one patient, and saved as a CSV file. To verify it, we select 24 IMRT plans for prostate cancer, and doses of interest are PTV D98/D95/D5/D2, bladder D30/D50, and rectum D25/D50. Two groups of data, using the automatic reading method(ARM) and pointed dose method(PDM), are analyzed with SPSS 16. The absolute difference=D-ARM-D-PDM, relative difference=absolute difference*100%/prescription dose(7600cGy). Results: The differences are as following: PTV D98/D95/D5/D2: −0.04%/− 0.04%/0.13%/0.19%, bladder D30/D50: −0.02%/0.01%, and rectum D25/D50: 0.03%/0.01%. Conclusion: Using this function, the error is very small, and can be neglected. It could greatly improve the efficiency of clinical work. Project supported by the National Natural Science Foundation of China (Grant No.81101694)

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

DMLC tracking and gating can improve dose coverage for prostate VMAT

Purpose: To assess and compare the dosimetric impact of dynamic multileaf collimator (DMLC) tracking and gating as motion correction strategies to account for intrafraction motion during conventionally fractionated prostate radiotherapy. Methods: A dose reconstruction method was used to retrospectively assess the dose distributions delivered without motion correction during volumetric modulated arc therapy fractions for 20 fractions of five prostate cancer patients who received conventionally fractionated radiotherapy. These delivered dose distributions were compared with the dose distributions which would have been delivered had DMLC tracking or gating motion correction strategies been implemented. The delivered dose distributions were constructed by incorporating the observed prostate motion with the patient's original treatment plan to simulate the treatment delivery. The DMLC tracking dose distributions were constructed using the same dose reconstruction method with the addition of MLC positions from Linac log files obtained during DMLC tracking simulations with the observed prostate motions input to the DMLC tracking software. The gating dose distributions were constructed by altering the prostate motion to simulate the application of a gating threshold of 3 mm for 5 s. Results: The delivered dose distributions showed that dosimetric effects of intrafraction prostate motion could be substantial for some fractions, with an estimated dose decrease of more than 19% and 34% from the planned CTVD{sub 99%} and PTV D{sub 95%} values, respectively, for one fraction. Evaluation of dose distributions for DMLC tracking and gating deliveries showed that both interventions were effective in improving the CTV D{sub 99%} for all of the selected fractions to within 4% of planned value for all fractions. For the delivered dose distributions the difference in rectum V{sub 65%} for the individual fractions from planned ranged from −44% to 101% and for the bladder V{sub 65%} the range was −61% to 26% from planned. The application of tracking decreased the maximum rectum and bladder V{sub 65%} difference to 6% and 4%, respectively. Conclusions: For the first time, the dosimetric impact of DMLC tracking and gating to account for intrafraction motion during prostate radiotherapy has been assessed and compared with no motion correction. Without motion correction intrafraction prostate motion can result in a significant decrease in target dose coverage for a small number of individual fractions. This is unlikely to effect the overall treatment for most patients undergoing conventionally fractionated treatments. Both DMLC tracking and gating demonstrate dose distributions for all assessed fractions that are robust to intrafraction motion.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

In vitro dose measurements in a human cadaver with abdomen/pelvis CT scans

Purpose: To present a study of radiation dose measurements with a human cadaver scanned on a clinical CT scanner. Methods: Multiple point dose measurements were obtained with high-accuracy Thimble ionization chambers placed inside the stomach, liver, paravertebral gutter, ascending colon, left kidney, and urinary bladder of a human cadaver (183 cm in height and 67.5 kg in weight) whose abdomen/pelvis region was scanned repeatedly with a multidetector row CT. The flat energy response and precision of the dosimeters were verified, and the slight differences in each dosimeter's response were evaluated and corrected to attain high accuracy. In addition, skin doses were measured for radiosensitive organs outside the scanned region with OSL dosimeters: the right eye, thyroid, both nipples, and the right testicle. Three scan protocols were used, which shared most scan parameters but had different kVp and mA settings: 120-kVp automA, 120-kVp 300 mA, and 100-kVp 300 mA. For each protocol three repeated scans were performed. Results: The tube starting angle (TSA) was found to randomly vary around two major conditions, which caused large fluctuations in the repeated point dose measurements: for the 120-kVp 300 mA protocol this angle changed from approximately 110° to 290°, and caused 8% − 25% difference in the point dose measured at the stomach, liver, colon, and urinary bladder. When the fluctuations of the TSA were small (within 5°), the maximum coefficient of variance was approximately 3.3%. The soft tissue absorbed doses averaged from four locations near the center of the scanned region were 27.2 ± 3.3 and 16.5 ± 2.7 mGy for the 120 and 100-kVp fixed-mA scans, respectively. These values were consistent with the corresponding size specific dose estimates within 4%. The comparison of the per-100-mAs tissue doses from the three protocols revealed that: (1) dose levels at nonsuperficial locations in the TCM scans could not be accurately deduced by simply scaling the fix-mA doses with local mA values; (2) the general power law relationship between dose and kVp varied from location to location, with the power index ranged between 2.7 and 3.5. The averaged dose measurements at both nipples, which were about 0.6 cm outside the prescribed scan region, ranged from 23 to 27 mGy at the left nipple, and varied from 3 to 20 mGy at the right nipple over the three scan protocols. Large fluctuations over repeated scans were also observed, as a combined result of helical scans of large pitch (1.375) and small active areas of the skin dosimeters. In addition, the averaged skin dose fell off drastically with the distance to the nearest boundary of the scanned region. Conclusions: This study revealed the complexity of CT dose fluctuation and variation with a human cadaver.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-J-07: IGRT Gently: Evaluating Imaging Dose in Phantoms of Different Sizes

Purpose: IGRT imaging procedures have emerged as a common method of patient position verification in radiotherapy, though imaging dose is generally neglected in the treatment plan. Consequently, evaluating and optimizing the dose from these procedures is worthwhile. This process is especially important for children, who are more radiosensitive than adults. The aim of this work was to gain some understanding of the relative doses involved with various XVI-preset parameters for an “adult” and “child” phantom set, with the hopes that imaging dose for a child can be reduced. Methods: 32 and 16cm CTDI-phantoms were used as surrogates for adult and child torsos, respectively. Dose was measured in the central and peripheral chamber positions of the phantoms. CBCT scans were made for both phantoms using Elekta’s Chest-preset to establish a dose baseline. The child-phantom was then scanned using the Elekta Head and Neck (HN) preset. A modified HN-preset (named Peds Abd-pelvis) was also created with a doubled mAs to maintain a reduction in dose to the child-phantom (relative to the baseline), while providing clinically-usable image quality. Results: The baseline dose to the child-phantom from the Chest-preset was 310% that of the adult-phantom for the center chamber position and 150% at the periphery. An average dose reduction of 97% was obtained in the childphantom by switching from the Chest-preset to the HN-preset, while the Peds Abd-pelvis-preset similarly reduced the dose by an average of 92%. Conclusion: XVI-preset parameters significantly affect dose, and should be optimized to reduce dose, while ensuring clinically-usable image quality. Using a modified imaging preset (Peds Abd-pelvis-preset) greatly reduced the dose to the child-phantom compared to the dose for the Chest-preset for both the child and adult-phantoms. This outcome provides support for the development of child-specific protocols for IGRT imaging in pediatric patients.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-J-105: Trusting Dose Deformation and Accumulation for GYN Brachytherapy

Purpose: In brachytherapy, structures surrounding the target have the potential to move between treatments and receive unknown dose. Deformable image registration could overcome challenges through dose accumulation. This study uses two possible deformable dose summation techniques and compares the results to point dose summation currently performed in clinic. Methods: Data for ten patients treated with a Syed template was imported into the MIM software (Cleveland, OH). The deformable registration was applied to structures by masking other image data to a single intensity. The registration flow consisted of the following steps: 1) mask CTs so that each of the structures-of-interest had one unique intensity; 2) perform applicator — based rigid registration; 3) Perform deformable registration; 4) Refine registration by changing local alignments manually; 5) Repeat steps 1 to 3 until desired structure adequately deformed; 5) Transfer each deformed contours to the first CT. The deformed structure accuracy was determined by a dice similarity coefficient (DSC) comparison with the first fraction. Two dose summation techniques were investigated: a deformation and recalculation on the structure; and a dose deformation and accumulation method. Point doses were used as a comparison value. Results: The Syed deformations have DSC ranging from 0.53 to 0.97 and 0.75 and 0.95 for the bladder and rectum, respectively. For the bladder, contour deformation addition ranged from −34.8% to 0.98% and dose deformation accumulation ranged from −35% to 29.3% difference from clinical calculations. For the rectum, contour deformation addition ranged from −5.2% to 16.9% and the dose deformation accumulation ranged from −29.1% to 15.3% change. Conclusion: Deforming dose for summation leads to different volumetric doses than when dose is recalculated on deformed structures, raising concerns about the accuracy of the deformed dose. DSC alone cannot be used to establish the accuracy of a deformation for brachy dose summation purpose.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-322: Dosimetric Evaluation of Rib Dose in Peripheral Lung Tumors Treated with X-Ray Voxel Monte Carlo (XVMC) Based Lung Stereotactic Body Radiotherapy (SBRT) Following RTOG 0915 Guidelines

Purpose: To evaluate XVMC computed rib doses for peripherally located non-small-cell-lung tumors treated with SBRT following RTOG-0915 guidelines. Methods: Twenty patients with solitary peripherally located non-small-cell-lung tumors were treated using XVMC-based SBRT to 50–54Gy in 5−3 fractions, respectively, for PTV(V100%)=95%. Based on 4D-CT, ITV was delineated on MaximumIP images and organs-at-risk(OARs) including ribs were contoured on MeanIP images. Mean PTV(ITV+5mm uniform margin) was 46.1±38.7cc (range, 11.1–163.0cc). XVMC SBRT treatment plans were generated with a combination of non-coplanar 3D-conformal arcs/beams, and were delivered by Novalis-TX consisting of HD-MLCs and a 6MV-SRS(1000MU/min) beam, following RTOG-0915 criteria. XVMC rib maximum dose and dose to <1cc, <5cc, <10cc were evaluated as a function of PTV, prescription dose and 3D-distance from tumor isocenter to the most proximal rib contour. Plans were re-computed using heterogeneity-corrected pencil-beam (PB-hete) algorithm utilizing identical beam geometry/MLC positions and MUs and subsequently compared to XVMC. Results: XVMC average maximum rib dose was 50.9±6.4Gy (range, 35.1–59.3Gy). XVMC mean rib dose to <1cc was 41.6±5.6Gy (range, 27.9–47.9Gy), <5cc was 31.2±7.3Gy (range, 10.6–43.1Gy), and <10cc was 21.2±8.7Gy (range, 1.1–36Gy), respectively. For the given prescription, correlation between PTV and rib doses to <5cc (p=0.005) and <10cc (p=0.018) was observed. 3D-distance from the tumor isocenter to the proximal rib contour strongly correlated with maximum rib dose (p=0.0001). PB-hete algorithm overestimated maximum rib dose and dose to <1cc, <5cc, and <10cc of ribs by 5%, 3%, 3%, and 3%, respectively. Conclusion: PB-hete overestimates ribs dose relative to XVMC. Since all the clinical XVMC plans were generated without compromising the target coverage (per RTOG-0915), almost all patient’s ribs doses were higher than the protocol guidelines. As expected, larger tumor size and proximity to ribs received higher absolute dose to ribs. Prospective observation is needed to determine if XVMC delivered rib doses correlates with patient symptoms including chest wall pain and/or rib fractures.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-373: Evaluation and Reduction of Contralateral Skin /subcutaneous Dose for Tangential Breast Irradiation

Purpose: Tangential breast irradiation is a standard treatment technique for breast cancer therapy. One aspect of dose delivery includes dose delivered to the skin caused by electron contamination. This effect is especially important for highly oblique beams used on the medical tangent where the electron contamination deposits dose on the contralateral breast side. This work aims to investigate and predict as well as define a method to reduce this dose during tangential breast radiotherapy. Methods: Analysis and calculation of breast skin and subcutaneous dose is performed using a Varian Eclipse planning system, AAA algorithm for 6MV x-ray treatments. Measurements were made using EBT3 Gafchromic film to verify the accuracy of planning data. Various materials were tested to assess their ability to remove electron contamination on the contralateral breast. Results: Results showed that the Varian Eclipse AAA algorithm could accurately estimate contralateral breast dose in the build-up region at depths of 2mm or deeper. Surface dose was underestimated by the AAA algorithm. Doses up to 12% of applied dose were seen on the contralateral breast surface and up to 9 % at 2mm depth. Due to the nature of this radiation, being mainly low energy electron contamination, a bolus material could be used to reduce this dose to less than 3%. This is accomplished by 10 mm of superflab bolus or by 1 mm of lead. Conclusion: Contralateral breast skin and subcutaneous dose is present for tangential breast treatment and has been measured to be up to 12% of applied dose from the medial tangent beam. This dose is deposited at shallow depths and is accurately calculated by the Eclipse AAA algorithm at depths of 2mm or greater. Bolus material placed over the contralateral can be used to effectively reduce this skin dose.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

MO-F-CAMPUS-I-04: Patient Eye-Lens Dose Reduction in Routine Brain CT Examinations Using Organ-Based Tube Current Modulation and In-Plane Bismuth Shielding

Purpose: The purpose of this study is to assess eye-lens dose for patients who underwent brain CT examinations using two dose reduction Methods: organ-based tube current modulation (OBTCM) and in-plane bismuth shielding method. Methods: This study received institutional review board approval; written informed consent to participate was obtained from all patients. Ninety patients who underwent the routine brain CT examination were randomly assigned to three groups, ie. routine, OBTCM, and bismuth shield. The OBTCM technique reduced the tube current when the X-ray tube rotates in front of patients’ eye-lens region. The patients in the bismuth shield group were covered one-ply bismuth shield in the eyes’ region. Eye-lens doses were measured using TLD-100H chips and the total effective doses were calculated using CT-Expo according to the CT scanning parameters. The surface doses for patients at off-center positions were assessed to evaluate the off-centering effect. Results: Phantom measurements indicates that OBTCM technique could reduced by 26% to 28% of the surface dose to the eye lens, and increased by 25% of the surface dose at the opposed incident direction at the angle of 180°. Patients’ eye-lens doses were reduced 16.9% and 30.5% dose of bismuth shield scan and OBTCM scan, respectively compared to the routine scan. The eye-lens doses were apparently increased when the table position was lower than isocenter. Conclusion: Reducing the dose to the radiosensitive organs, such as eye lens, during routine brain CT examinations could lower the radiation risks. The OBTCM technique and in-plane bismuth shielding could be used to reduce the eye-lens dose. The eye-lens dose could be effectively reduced using OBTCM scan without interfering the diagnostic image quality. Patient position relative the CT gantry also affects the dose level of the eye lens. This study was supported by the grants from the Ministry of Science and Technology of Taiwan (MOST103-2314-B-182-009-MY2), and Chang Gung Memorial Hospital (CMRPD1C0682)

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

Four-dimensional dose reconstruction through in vivo phase matching of cine images of electronic portal imaging device

Purpose: A method is proposed to reconstruct a four-dimensional (4D) dose distribution using phase matching of measured cine images to precalculated images of electronic portal imaging device (EPID). Methods: (1) A phantom, designed to simulate a tumor in lung (a polystyrene block with a 3 cm diameter embedded in cork), was placed on a sinusoidally moving platform with an amplitude of 1 cm and a period of 4 s. Ten-phase 4D computed tomography (CT) images of the phantom were acquired. A planning target volume (PTV) was created by adding a margin of 1 cm around the internal target volume of the tumor. (2) Three beams were designed, which included a static beam, a theoretical dynamic beam, and a planning-optimized dynamic beam (PODB). While the theoretical beam was made by manually programming a simplistic sliding leaf motion, the planning-optimized beam was obtained from treatment planning. From the three beams, three-dimensional (3D) doses on the phantom were calculated; 4D dose was calculated by means of the ten phase images (integrated over phases afterward); serving as “reference” images, phase-specific EPID dose images under the lung phantom were also calculated for each of the ten phases. (3) Cine EPID images were acquired while the beams were irradiated to the moving phantom. (4) Each cine image was phase-matched to a phase-specific CT image at which common irradiation occurred by intercomparing the cine image with the reference images. (5) Each cine image was used to reconstruct dose in the phase-matched CT image, and the reconstructed doses were summed over all phases. (6) The summation was compared with forwardly calculated 4D and 3D dose distributions. Accounting for realistic situations, intratreatment breathing irregularity was simulated by assuming an amplitude of 0.5 cm for the phantom during a portion of breathing trace in which the phase matching could not be performed. Intertreatment breathing irregularity between the time of treatment and the time of planning CT was considered by utilizing the same reduced amplitude when the phantom was irradiated. To examine the phase matching in a humanoid environment, the matching was also performed in a digital phantom (4D XCAT phantom). Results: For the static, the theoretical, and the planning-optimized dynamic beams, the 4D reconstructed doses showed agreement with the forwardly calculated 4D doses within the gamma pass rates of 92.7%, 100%, and 98.1%, respectively, at the isocenter plane given by 3%/3 mm criteria. Excellent agreement in dose volume histogram of PTV and lung-PTV was also found between the two 4D doses, while substantial differences were found between the 3D and the 4D doses. The significant breathing irregularities modeled in this study were found not to be noticeably affecting the reconstructed dose. The phase matching was performed equally well in a digital phantom. Conclusions: The method of retrospective phase determination of a moving object under irradiation provided successful 4D dose reconstruction. This method will provide accurate quality assurance and facilitate adaptive therapy when distinguishable objects such as well-defined tumors, diaphragm, and organs with markers (pancreas and liver) are covered by treatment beam apertures.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-I-40: Impact of Scan Length On Patient Dose in Abdomen/pelvis CT Diagnosis

Purpose: To analysis the impact of scan length on patient doses in abdomen/pelvis CT diagnosis of each hospital. Methods: Scan length of 7 hospitals from abdomen/pelvis CT diagnosis was surveyed in Korea. Surveyed scan lengths were additional distance above diaphragm and distance below pubic symphysis except for standard scan range between diaphragm and pubic symphysis. Patient dose was estimated for adult male and female according to scan length of each hospital. CT-Expo was used to estimate the patient dose under identical equipment settings (120 kVp, 100 mAs, 10 mm collimation width, etc.) except scan length. Effective dose was calculated by using tissue weighting factor of ICRP 103 recommendation. Increase rate of effective dose was calculated comparing with effective dose of standard scan range Results: Scan lengths of abdomen/pelvis CT diagnosis of each hospital were different. Also effective dose was increased with increasing the scan length. Generally increasing the distance above diaphragm caused increase of effective dose of male and female, but increasing the distance below pubic symphysis caused increase of effective dose of male. Conclusion: We estimated the patient dose according to scan length of each hospital in abdomen/pelvis CT diagnosis. Effective dose was increased by increasing the scan length because dose of organs with high tissue weighting factor such as lung, breast, testis were increased. Scan length is important factor on patient dose in CT diagnosis. If radiologic technologist interested in patient dose, decreasing the unnecessary scan length will decrease the risk of patients from radiation. This research was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HI13C0004).

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-T-191: 4D Dose Reconstruction of Intensity Modulated Proton Therapy (IMPT) Based On Breathing Probability Density Function (PDF) From 4D Cone Beam Projection Images: A Study for Lung Treatment

Purpose: With energy repainting in lung IMPT, the dose delivered is approximate to the convolution of dose in each phase with corresponding breathing PDF. This study is to compute breathing PDF weighted 4D dose in lung IMPT treatment and compare to its initial robust plan. Methods: Six lung patients were evaluated in this study. Amsterdam shroud image were generated from pre-treatment 4D cone-beam projections. Diaphragm motion curve was extract from the shroud image and the breathing PDF was generated. Each patient was planned to 60 Gy (12GyX5). In initial plans, ITV density on average CT was overridden with its maximum value for planning, using two IMPT beams with robust optimization (5mm uncertainty in patient position and 3.5% range uncertainty). The plan was applied to all 4D CT phases. The dose in each phase was deformed to a reference phase. 4D dose is reconstructed by summing all these doses based on corresponding weighting from the PDF. Plan parameters, including maximum dose (Dmax), ITV V100, homogeneity index (HI=D2/D98), R50 (50%IDL/ITV), and the lung-GTV’s V12.5 and V5 were compared between the reconstructed 4D dose to initial plans. Results: The Dmax is significantly less dose in the reconstructed 4D dose, 68.12±3.5Gy, vs. 70.1±4.3Gy in the initial plans (p=0.015). No significant difference is found for the ITV V100, HI, and R50, 92.2%±15.4% vs. 96.3%±2.5% (p=0.565), 1.033±0.016 vs. 1.038±0.017 (p=0.548), 19.2±12.1 vs. 18.1±11.6 (p=0.265), for the 4D dose and initial plans, respectively. The lung-GTV V12.5 and V5 are significantly high in the 4D dose, 13.9%±4.8% vs. 13.0%±4.6% (p=0.021) and 17.6%±5.4% vs. 16.9%±5.2% (p=0.011), respectively. Conclusion: 4D dose reconstruction based on phase PDF can be used to evaluate the dose received by the patient. A robust optimization based on the phase PDF may even further improve patient care.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-T-452: Influence of Dose Calculation Algorithm and Heterogeneity Correction On Risk Categorization of Patients with Cardiac Implanted Electronic Devices Undergoing Radiotherapy

Purpose: There is a lack of studies with significant cohort data about patients using pacemaker (PM), implanted cardioverter defibrillator (ICD) or cardiac resynchronization therapy (CRT) device undergoing radiotherapy. There is no literature comparing the cumulative doses delivered to those cardiac implanted electronic devices (CIED) calculated by different algorithms neither studies comparing doses with heterogeneity correction or not. The aim of this study was to evaluate the influence of the algorithms Pencil Beam Convolution (PBC), Analytical Anisotropic Algorithm (AAA) and Acuros XB (AXB) as well as heterogeneity correction on risk categorization of patients. Methods: A retrospective analysis of 19 3DCRT or IMRT plans of 17 patients was conducted, calculating the dose delivered to CIED using three different calculation algorithms. Doses were evaluated with and without heterogeneity correction for comparison. Risk categorization of the patients was based on their CIED dependency and cumulative dose in the devices. Results: Total estimated doses at CIED calculated by AAA or AXB were higher than those calculated by PBC in 56% of the cases. In average, the doses at CIED calculated by AAA and AXB were higher than those calculated by PBC (29% and 4% higher, respectively). The maximum difference of doses calculated by each algorithm was about 1 Gy, either using heterogeneity correction or not. Values of maximum dose calculated with heterogeneity correction showed that dose at CIED was at least equal or higher in 84% of the cases with PBC, 77% with AAA and 67% with AXB than dose obtained with no heterogeneity correction. Conclusion: The dose calculation algorithm and heterogeneity correction did not change the risk categorization. Since higher estimated doses delivered to CIED do not compromise treatment precautions to be taken, it’s recommend that the most sophisticated algorithm available should be used to predict dose at the CIED using heterogeneity correction.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-T-516: Effects of Inter-Fraction Organ Displacement/deformation On the Delivered Doses to the Heart, Esophagus, and Lungs in Patients Receiving Thoracic Radiotherapy

Purpose: To quantitatively assess the effects of inter-fraction changes in organ shape and location on the delivered dose distribution to the organs at risk (OAR) in lung cancer patients. Methods: This study analyzes treatment data of 10 patients, who were treated to 60Gy in 30 fractions. In each fraction a cone beam CT (CBCT) was acquired. Each CBCT was registered with the planning CT using deformable registration tools within MIM Software. The daily setup shifts were used to translate the planned dose distribution on the deformed planning CT. The structures of lungs, esophagus and heart were re-delineated by a physician on each CBCT. The doses delivered to each OAR, reflecting changes in the position and shape variations, were recomputed. Resultant daily dose volume histograms (DVHs) for OARs were computed and compared to those from the planning CT. Results: Based on the findings of two patients and 24 CBCTs analyzed so far, higher doses are delivered to the lungs and esophagus compared to the treatment plan. The dose differences per fraction between the delivered doses and those in the treatment plan are: for patient 1, lung mean dose = 5.3±1.3cGy and esophagus mean dose = 3.4±3.5cGy. For patient 2, lung mean dose = 12.0±3.9cGy and esophagus mean dose = 34.2±7.5cGy. Regarding the maximum dose to heart, the results varied (−18.9±22.0cGy for patient1 and 53.0±62.2cGy for patient2). Conclusion: The dosimetric effects of inter-fractional anatomical variations could be estimated using deformable image registration and manual organ segmentation for each CBCT. A considerable dose distribution variation between fractions was observed for the OARs. These changes are currently not taken into account while treating the patients and these may explain cases with severe side effects even when the treatment plan looks satisfactory. These results suggest the need for automated daily dose tracking and accumulation.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-T-563: Delivered Dose Reconstruction of Moving Targets for Gated Volumetric Modulated Arc Therapy (VMAT)

Purpose: Actual delivered dose of moving tumors treated with gated volumetric arc therapy (VMAT) may significantly differ from the planned dose assuming static target. In this study, we developed a method which reconstructs actual delivered dose distribution of moving target by taking into account both tumor motion and dynamic beam delivery of gated VMAT, and applied to abdominal tumors. Methods: Fifteen dual-arc VMAT plans (Eclipse, Varian Medical Systems) for 5 lung, 5 pancreatic, and 5 liver cancer patients treated with gated VMAT stereotactic body radiotherapy (SBRT) were studied. For reconstruction of the delivered dose distribution, we divided each original arc beam into control-point-wise sub-beams, and applied beam isocenter shifting to each sub-beam to reflect the tumor motion. The tumor positions as a function of beam delivery were estimated by synchronizing the beam delivery with the respiratory signal which acquired during treatment. For this purpose, an in-house program (MATLAB, Mathworks) was developed to convert the original DICOM plan data into motion-involved treatment plan. The motion-involved DICOM plan was imported into Eclipse for dose calculation. The reconstructed delivered dose was compared to the plan dose using the dose coverage of gross tumor volume (GTV) and dose distribution of organs at risk (OAR). Results: The mean GTV dose coverage difference between the reconstructed delivered dose and the plan dose was 0.2 % in lung and pancreas cases, and no difference in liver cases. Mean D1000cc of ipsilateral lungs was reduced (0.8 ± 1.4cGy). Conclusion: We successfully developed a method of delivered dose reconstruction taking into account both respiratory tumor motion and dynamic beam delivery, and applied it to abdominal tumors treated with gated VAMT. No significant deterioration of delivered dose distribution indicates that interplay effect would be minimal even in the case of gated SBRT. This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIP) (No. 2015038710)

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

MO-FG-202-08: Real-Time Monte Carlo-Based Treatment Dose Reconstruction and Monitoring for Radiotherapy

Purpose: This proof-of-concept study is to develop a real-time Monte Carlo (MC) based treatment-dose reconstruction and monitoring system for radiotherapy, especially for the treatments with complicated delivery, to catch treatment delivery errors at the earliest possible opportunity and interrupt the treatment only when an unacceptable dosimetric deviation from our expectation occurs. Methods: First an offline scheme is launched to pre-calculate the expected dose from the treatment plan, used as ground truth for real-time monitoring later. Then an online scheme with three concurrent threads is launched while treatment delivering, to reconstruct and monitor the patient dose in a temporally resolved fashion in real-time. Thread T1 acquires machine status every 20 ms to calculate and accumulate fluence map (FM). Once our accumulation threshold is reached, T1 transfers the FM to T2 for dose reconstruction ad starts to accumulate a new FM. A GPU-based MC dose calculation is performed on T2 when MC dose engine is ready and a new FM is available. The reconstructed instantaneous dose is directed to T3 for dose accumulation and real-time visualization. Multiple dose metrics (e.g. maximum and mean dose for targets and organs) are calculated from the current accumulated dose and compared with the pre-calculated expected values. Once the discrepancies go beyond our tolerance, an error message will be send to interrupt the treatment delivery. Results: A VMAT Head-and-neck patient case was used to test the performance of our system. Real-time machine status acquisition was simulated here. The differences between the actual dose metrics and the expected ones were 0.06%–0.36%, indicating an accurate delivery. ∼10Hz frequency of dose reconstruction and monitoring was achieved, with 287.94s online computation time compared to 287.84s treatment delivery time. Conclusion: Our study has demonstrated the feasibility of computing a dose distribution in a temporally resolved fashion in real-time and quantitatively and dosimetrically monitoring the treatment delivery.

60 APPLIED LIFE SCIENCES↗