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At least 451 records · Page 25
All sourcesNASA NTRSDOE OSTI
DOE OSTI2014

SU-E-J-43: Deformed Planning CT as An Electron Density Substitute for Cone-Beam CT

Purpose: To confirm that deforming the planning CT to the daily Cone-Beam CTs (CBCT) can provide suitable electron density for adaptive planning. We quantify the dosimetric difference between plans calculated on deformed planning CTs (DPCT) and daily CT-on-rails images (CTOR). CTOR is used as a test of the method as CTOR already contains accurate electron density to compare against. Methods: Five prostate only IMRT patients, each with five CTOR images, were selected and re-planned on Panther (Prowess Inc.) with a uniform 5 mm PTV expansion, prescribed 78 Gy. The planning CT was deformed to match each CTOR using ABAS (Elekta Inc.). Contours were drawn on the CTOR, and copied to the DPCT. The original treatment plan was copied to both the CTOR and DPCT, keeping the center of the prostate as the isocenter. The plans were then calculated using the collapsed cone heterogeneous dose engine of Prowess and typical DVH planning parameters used to compare them. Results: Each DPCT was visually compared to its CTOR with no differences observed. The agreement of the copied CTOR contours with the DPCT anatomy further demonstrated the deformation accuracy. The plans calculated using CTOR and DPCT were compared. Over the 25 plan pairs, the average difference between them for prostate D100, D98 and D95 were 0.5%, 0.2%, and 0.2%; PTV D98, D95 and mean dose: 0.3%, 0.2% and 0.3%; bladder V70, V60 and mean dose: 1.1%, 0.7%, and 0.2%; and rectum mean dose: 0.3%. (D100 is the dose covering 100% of the target; V70 is the volume of the organ receiving 70 Gy). Conclusion: We observe negligible difference between the dose calculated on the DPCT and the CTOR, implying that deformed planning CTs are a suitable substitute for electron density. The method can now be applied to CBCTs. Research version of Panther provided by Prowess Inc. Research version of ABAS provided by Elekta Inc.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-521: Feasibility Study of a Rotational Step-And-Shoot IMRT Treatment Planning Approach

Purpose: Rotational step-and-shot IMRT (r-IMRT) could improve delivery efficiency with good dose conformity, especially if it can leverage the burst mode of the accelerator where radiation is turned on/off momentarily while the gantry rotates continuously. The challenge for the r-IMRT planning is to minimize the number of beams to achieve a fast and smooth rotational delivery. Methods: Treatment plans for r-IMRT were created using an in-house treatment planning system. To generate the plan using a very few beams, gantry angle was optimized by weighting the beam monitoring unit (MU), and beam shape optimization was a combination of column search with k-means clustering. A prostate case and a head and neck case were planned using r-IMRT. The dosimetry is compared to s-IMRT planned with Varian Eclipse treatment planning system. Results: With the same PTV dose coverage D95=100%, the r-IMRT plans shows comparable sparing as the s-IMRT plans in the prostate for the rectum D10cc and the bladder Dmean, and in the head and neck for the spinal cord Dmax, the brain stem Dmax, the left/right parotid Dmean, the larynx Dmean, and the mandible Dmean. Both plans meet the established institutional clinical dosimetric criteria. The r-IMRT plan uses 19 beam/405 MU for the prostate, and 68 beam/880 MU for the head and neck, while the s-IMRT uses 7 beam/724 MU and 9 beam/1812 MU, respectively. Compared to the corresponding s-IMRT, r-IMRT has a reduction of MUs of 44% for the prostate case and 41% for the head and neck case. Conclusions: We have demonstrated the feasibility of a rotational step and shoot IMRT treatment planning approach that significantly shortens the conventional IMRT treatment beam-on time without degrading the dose comformity.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-F-BRD-10: Lung IMRT Planning Using Standardized Beam Bouquet Templates

Purpose: We investigate the feasibility of choosing from a small set of standardized templates of beam bouquets (i.e., entire beam configuration settings) for lung IMRT planning to improve planning efficiency and quality consistency, and also to facilitate automated planning. Methods: A set of beam bouquet templates is determined by learning from the beam angle settings in 60 clinical lung IMRT plans. A k-medoids cluster analysis method is used to classify the beam angle configuration into clusters. The value of the average silhouette width is used to determine the ideal number of clusters. The beam arrangements in each medoid of the resulting clusters are taken as the standardized beam bouquet for the cluster, with the corresponding case taken as the reference case. The resulting set of beam bouquet templates was used to re-plan 20 cases randomly selected from the database and the dosimetric quality of the plans was evaluated against the corresponding clinical plans by a paired t-test. The template for each test case was manually selected by a planner based on the match between the test and reference cases. Results: The dosimetric parameters (mean±S.D. in percentage of prescription dose) of the plans using 6 beam bouquet templates and those of the clinical plans, respectively, and the p-values (in parenthesis) are: lung Dmean: 18.8±7.0, 19.2±7.0 (0.28), esophagus Dmean: 32.0±16.3, 34.4±17.9 (0.01), heart Dmean: 19.2±16.5, 19.4±16.6 (0.74), spinal cord D2%: 47.7±18.8, 52.0±20.3 (0.01), PTV dose homogeneity (D2%-D99%): 17.1±15.4, 20.7±12.2 (0.03).The esophagus Dmean, cord D02 and PTV dose homogeneity are statistically better in the plans using the standardized templates, but the improvements (<5%) may not be clinically significant. The other dosimetric parameters are not statistically different. Conclusion: It's feasible to use a small number of standardized beam bouquet templates (e.g. 6) to generate plans with quality comparable to that of clinical plans. Partially supported by NIH/NCI under grant #R21CA161389 and a master research grant by Varian Medical System.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

Sci—Sat AM: Stereo — 06: Dosimetric Comparison of 3D Conformai, Flattened and Flattening Filter-Free TrueBeam RapidArc Planning for Lung SBRT

The major advantages of the VMAT SBRT plans compared to the conventional 3D conformai plan include faster delivery and improved target dose conformity. This study quantifies the dosimetric differences among 3D conformai plan; flattened beam and flattening filter-free (FFF) beam RapidArc Plans for lung SBRT. Five early stage lung cancer patients with various tumor positions and sizes previously treated with 3D non-coplanar SBRT were randomly selected. 4DCT was used for each patient to determine the internal target volume. Abdominal compression was applied to minimize respiratory motion for SBRT patients. For treatment planning, a 5 mm margin was given to the ITV to generate a planning target volume. The prescription dose was 48 Gy in 4 fractions and normalized to 95% of the PTV. Organs at risk (OAR) included spinal cord, esophagus, heart, trachea, bilateral lung, and great vessels. Optimization constraints were set to meet the criteria of the RTOG-0915 protocol. All VMAT plans were optimized with the RapidArc technique using two 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. RapidArc plans demonstrated better conformity to target, sharper dose fall-off in normal tissues and lower dose to normal lung and other OARs than the 3D conformai plans. RapidArc SBRT for FFF beam showed comparable target conformity, adequate tumor dose, and clinically acceptable DVHs of OARs to flattened beams and significantly reduced treatment delivery time.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

Feasibility and robustness of dose painting by numbers in proton therapy with contour-driven plan optimization

Purpose: To prove the ability of protons to reproduce a dose gradient that matches a dose painting by numbers (DPBN) prescription in the presence of setup and range errors, by using contours and structure-based optimization in a commercial treatment planning system. Methods: For two patients with head and neck cancer, voxel-by-voxel prescription to the target volume (GTV{sub PET}) was calculated from {sup 18}FDG-PET images and approximated with several discrete prescription subcontours. Treatments were planned with proton pencil beam scanning. In order to determine the optimal plan parameters to approach the DPBN prescription, the effects of the scanning pattern, number of fields, number of subcontours, and use of range shifter were separately tested on each patient. Different constant scanning grids (i.e., spot spacing = Δx = Δy = 3.5, 4, and 5 mm) and uniform energy layer separation [4 and 5 mm WED (water equivalent distance)] were analyzed versus a dynamic and automatic selection of the spots grid. The number of subcontours was increased from 3 to 11 while the number of beams was set to 3, 5, or 7. Conventional PTV-based and robust clinical target volumes (CTV)-based optimization strategies were considered and their robustness against range and setup errors assessed. Because of the nonuniform prescription, ensuring robustness for coverage of GTV{sub PET} inevitably leads to overdosing, which was compared for both optimization schemes. Results: The optimal number of subcontours ranged from 5 to 7 for both patients. All considered scanning grids achieved accurate dose painting (1% average difference between the prescribed and planned doses). PTV-based plans led to nonrobust target coverage while robust-optimized plans improved it considerably (differences between worst-case CTV dose and the clinical constraint was up to 3 Gy for PTV-based plans and did not exceed 1 Gy for robust CTV-based plans). Also, only 15% of the points in the GTV{sub PET} (worst case) were above 5% of DPBN prescription for robust-optimized plans, while they were more than 50% for PTV plans. Low dose to organs at risk (OARs) could be achieved for both PTV and robust-optimized plans. Conclusions: DPBN in proton therapy is feasible with the use of a sufficient number subcontours, automatically generated scanning patterns, and no more than three beams are needed. Robust optimization ensured the required target coverage and minimal overdosing, while PTV-approach led to nonrobust plans with excessive overdose. Low dose to OARs can be achieved even in the presence of a high-dose escalation as in DPBN.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-F-BRD-07: Fast Monte Carlo-Based Biological Optimization of Proton Therapy Treatment Plans for Thyroid Tumors

Purpose: To demonstrate the feasibility of fast Monte Carlo (MC) based biological planning for the treatment of thyroid tumors in spot-scanning proton therapy. Methods: Recently, we developed a fast and accurate GPU-based MC simulation of proton transport that was benchmarked against Geant4.9.6 and used as the dose calculation engine in a clinically-applicable GPU-accelerated IMPT optimizer. Besides dose, it can simultaneously score the dose-averaged LET (LETd), which makes fast biological dose (BD) estimates possible. To convert from LETd to BD, we used a linear relation based on cellular irradiation data. Given a thyroid patient with a 93cc tumor volume, we created a 2-field IMPT plan in Eclipse (Varian Medical Systems). This plan was re-calculated with our MC to obtain the BD distribution. A second 5-field plan was made with our in-house optimizer, using pre-generated MC dose and LETd maps. Constraints were placed to maintain the target dose to within 25% of the prescription, while maximizing the BD. The plan optimization and calculation of dose and LETd maps were performed on a GPU cluster. The conventional IMPT and biologically-optimized plans were compared. Results: The mean target physical and biological doses from our biologically-optimized plan were, respectively, 5% and 14% higher than those from the MC re-calculation of the IMPT plan. Dose sparing to critical structures in our plan was also improved. The biological optimization, including the initial dose and LETd map calculations, can be completed in a clinically viable time (∼30 minutes) on a cluster of 25 GPUs. Conclusion: Taking advantage of GPU acceleration, we created a MC-based, biologically optimized treatment plan for a thyroid patient. Compared to a standard IMPT plan, a 5% increase in the target’s physical dose resulted in ∼3 times as much increase in the BD. Biological planning was thus effective in escalating the target BD.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

A comprehensive formulation for volumetric modulated arc therapy planning

Purpose: Volumetric modulated arc therapy (VMAT) is a widely employed radiation therapy technique, showing comparable dosimetry to static beam intensity modulated radiation therapy (IMRT) with reduced monitor units and treatment time. However, the current VMAT optimization has various greedy heuristics employed for an empirical solution, which jeopardizes plan consistency and quality. The authors introduce a novel direct aperture optimization method for VMAT to overcome these limitations. Methods: The comprehensive VMAT (comVMAT) planning was formulated as an optimization problem with an L2-norm fidelity term to penalize the difference between the optimized dose and the prescribed dose, as well as an anisotropic total variation term to promote piecewise continuity in the fluence maps, preparing it for direct aperture optimization. A level set function was used to describe the aperture shapes and the difference between aperture shapes at adjacent angles was penalized to control MLC motion range. A proximal-class optimization solver was adopted to solve the large scale optimization problem, and an alternating optimization strategy was implemented to solve the fluence intensity and aperture shapes simultaneously. Single arc comVMAT plans, utilizing 180 beams with 2° angular resolution, were generated for a glioblastoma multiforme case, a lung (LNG) case, and two head and neck cases—one with three PTVs (H&N{sub 3PTV}) and one with foue PTVs (H&N{sub 4PTV})—to test the efficacy. The plans were optimized using an alternating optimization strategy. The plans were compared against the clinical VMAT (clnVMAT) plans utilizing two overlapping coplanar arcs for treatment. Results: The optimization of the comVMAT plans had converged within 600 iterations of the block minimization algorithm. comVMAT plans were able to consistently reduce the dose to all organs-at-risk (OARs) as compared to the clnVMAT plans. On average, comVMAT plans reduced the max and mean OAR dose by 6.59% and 7.45%, respectively, of the prescription dose. Reductions in max dose and mean dose were as high as 14.5 Gy in the LNG case and 15.3 Gy in the H&N{sub 3PTV} case. PTV coverages measured by D95, D98, and D99 were within 0.25% of the prescription dose. By comprehensively optimizing all beams, the comVMAT optimizer gained the freedom to allow some selected beams to deliver higher intensities, yielding a dose distribution that resembles a static beam IMRT plan with beam orientation optimization. Conclusions: The novel nongreedy VMAT approach simultaneously optimizes all beams in an arc and then directly generates deliverable apertures. The single arc VMAT approach thus fully utilizes the digital Linac’s capability in dose rate and gantry rotation speed modulation. In practice, the new single VMAT algorithm generates plans superior to existing VMAT algorithms utilizing two arcs.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-T-188: A Robust Treatment Planning Technique for Proton Pencil Beam Scanning Cranial Spinal Irradiation

Purpose: To propose a proton pencil beam scanning (PBS) cranial spinal irradiation (CSI) treatment planning technique robust against patient roll, isocenter offset and proton range uncertainty. Method: Proton PBS plans were created (Eclipse V11) for three previously treated CSI patients to 36 Gy (1.8 Gy/fractions). The target volume was separated into three regions: brain, upper spine and lower spine. One posterior-anterior (PA) beam was used for each spine region, and two posterior-oblique beams (15° apart from PA direction, denoted as 2PO-15) for the brain region. For comparison, another plan using one PA beam for the brain target (denoted as 1PA) was created. Using the same optimization objectives, 98% CTV was optimized to receive the prescription dose. To evaluate plan robustness against patient roll, the gantry angle was increased by 3° and dose was recalculated without changing the proton spot weights. On the re-calculated plan, doses were then calculated using 12 scenarios that are combinations of isocenter shift (±3mm in X, Y, and Z directions) and proton range variation (±3.5%). The worst-case-scenario (WCS) brain CTV dosimetric metrics were compared to the nominal plan. Results: For both beam arrangements, the brain field(s) and upper-spine field overlap in the T2–T5 region depending on patient anatomy. The maximum monitor unit per spot were 48.7%, 47.2%, and 40.0% higher for 1PA plans than 2PO-15 plans for the three patients. The 2PO-15 plans have better dose conformity. At the same level of CTV coverage, the 2PO-15 plans have lower maximum dose and higher minimum dose to the CTV. The 2PO-15 plans also showed lower WCS maximum dose to CTV, while the WCS minimum dose to CTV were comparable between the two techniques. Conclusion: Our method of using two posterior-oblique beams for brain target provides improved dose conformity and homogeneity, and plan robustness including patient roll.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-T-208: An Efficient Planning Approach to Posterior Fossa Tumor Bed Boosts Using Proton Pencil Beam Scanning in Fixed-Beam Room

Purpose: A fixed-beam room could be underutilized in a multi-room proton center. We investigated the use of proton pencil beam scanning (PBS) on a fixed-beam as an alternative for posterior fossa tumor bed (PF-TB) boost treatments which were usually treating on a gantry with uniform scanning. Methods: Five patients were treated with craniospinal irradiation (CSI, 23.4 or 36.0 Gy(RBE)) followed by a PF-TB boost to 54 Gy(RBE) with proton beams. Three PF-TB boost plans were generated for each patient: (1) a uniform scanning (US) gantry plan with 4–7 posterior fields shaped with apertures and compensators (2) a PBS plan using bi-lateral and vertex fields with a 3-mm planning organ-at-risk volume (PRV) expansion around the brainstem and (3) PBS fields using same beam arrangement but replacing the PRV with robust optimization considering a 3-mm setup uncertainty. Results: A concave 54-Gy(RBE) isodose line surrounding the brainstem could be achieved using all three techniques. The mean V95% of the PTV was 99.7% (range: 97.6% to 100%) while the V100% of the PTV ranged from 56.3% to 93.1% depending on the involvement of the brainstem with the PTV. The mean doses received by 0.05 cm{sup 3} of the brainstem were effectively identical: 54.0 Gy(RBE), 53.4 Gy(RBE) and 53.3 Gy(RBE) for US, PBS optimized with PRV, and PBS optimized with robustness plans respectively. The cochlea mean dose increased by 23% of the prescribed boost dose in average from the bi-lateral fields used in the PBS plan. Planning time for the PBS plan with PRV was 5–10 times less than the US plan and the robustly optimized PBS plan. Conclusion: We have demonstrated that a fixed-beam with PBS can deliver a dose distribution comparable to a gantry plan using uniform scanning. Planning time can be reduced substantially using a PRV around the brainstem instead of robust optimization.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-T-355: Evaluation of Knowledge-Based Planning Model for the Cervical Cancer Radiotherapy

Purpose: The Varian RapidPlan™ is a commercial knowledge-based optimization process which uses a set of clinically used treatment plans to train a model that can predict individualized dose-volume objectives. The purpose of this study is to evaluate the performance of RapidPlan to generate intensity modulated radiation therapy (IMRT) plans for cervical cancer. Methods: Totally 70 IMRT plans for cervical cancer with varying clinical and physiological indications were enrolled in this study. These patients were all previously treated in our institution. There were two prescription levels usually used in our institution: 45Gy/25 fractions and 50.4Gy/28 fractions. 50 of these plans were selected to train the RapidPlan model for predicting dose-volume constraints. After model training, this model was validated with 10 plans from training pool(internal validation) and additional other 20 new plans(external validation). All plans used for the validation were re-optimized with the original beam configuration and the generated priorities from RapidPlan were manually adjusted to ensure that re-optimized DVH located in the range of the model prediction. DVH quantitative analysis was performed to compare the RapidPlan generated and the original manual optimized plans. Results: For all the validation cases, RapidPlan based plans (RapidPlan) showed similar or superior results compared to the manual optimized ones. RapidPlan increased the result of D98% and homogeneity in both two validations. For organs at risk, the RapidPlan decreased mean doses of bladder by 1.25Gy/1.13Gy (internal/external validation) on average, with p=0.12/p<0.01. The mean dose of rectum and bowel were also decreased by an average of 2.64Gy/0.83Gy and 0.66Gy/1.05Gy,with p<0.01/ p<0.01and p=0.04/<0.01 for the internal/external validation, respectively. Conclusion: The RapidPlan model based cervical cancer plans shows ability to systematically improve the IMRT plan quality. It suggests that RapidPlan has great potential to make the treatment planning process more efficient.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-T-359: Incorporating Dose Volume Histogram Prediction Into Auto-Planning for Volumetric-Modulated Arc Therapy in Rectal Cancer

Purpose: To incorporate dose volume histogram (DVH) prediction into Auto-Planning for volumetric-modulated arc therapy (VMAT) treatment planning and investigate the benefit of this new technique for rectal cancer. Methods: Ninety clinically accepted VMAT plans for patients with rectal cancer were selected and trained in the RapidPlan for DVH prediction. Both internal and external validations were performed before implementing the prediction model. A new VMAT planning method (hybrid-VMAT) was created with combining the DVH prediction and Auto-Planning. For each new patient, the DVH will be predicted and individual DVH constrains will be obtained and were exported as the original optimization parameters to the Auto-Planning (Pinnacle3 treatment planning system, v9.10) for planning. A total of 20 rectal cancer patients previously treated with manual VMAT (manual-VMAT) plans were replanned using this new method. Dosimetric comparisons were performed between manual VMAT and new method plans. Results: Hybrid-VMAT shows similar PTV coverage to manual-VMAT in D2%, D98% and HI (p>0.05) and superior coverage in CI (p=0.000). For the bladder, the means of V40 and mean dose are 36.0% and 35.6Gy for hybrid-VMAT and 42% and 38.0Gy for the manual-VMAT. For the left (right) femur, the means of V30 and mean dose are 10.6% (11.6%) and 17.9Gy (19.2Gy) for the hybrid-VMAT and 25.6% (24.1%) and 27.3Gy (26.2Gy) for the manual-VMAT. The hybrid-VMAT has significantly improved the organs at risk sparing. Conclusion: The integration of DVH prediction and Auto-Planning significantly improve the VMAT plan quality in the rectal cancer radiotherapy. Our results show the benefit of the new method and will be further investigated in other tumor sites.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-T-416: Dosimetric Comparison of Coplanar and Non-Coplanar IMRT Plans for Peripheral Lung Lesion

Purpose: The purpose of this study was to compare dosimetric parameters of treatment plans between coplanar and non-coplanar techniques for treating peripheral lung lesions. Methods: The planning CT scans of 6 patients in supine positions were used in this study. The size of the PTV ranges from 163 c.c. to 782 c.c.. The locations of PTV are mostly at the peripheral of Lung, some spreading to the mediastinum. For each patient, we generated two IMRT plans, one with and the other without non-coplanar beams. The non-coplanar beams were carefully selected so that the beams would never exit patient bodies through the contralateral lung. The IMRT plans were generated with Pinnacle 9.8 treatment planning software. The IMRT optimization objectives were kept the same for the corresponding pairs of plans. All plans were normalized such that 95% of PTV receives the prescription dose (full dose). Results: The conformity index (mean±standard deviation of the mean) is 1.49±0.14 and 1.58±0.23 for the coplanar and noncoplanar plans, respectively. The heterogeneity index (mean±standard deviation of the mean) is 7.74 ±2.33 and 6.34±1.40 for the coplanar and non-coplanar plans, respectively. The maximum heart dose is 60.94±6.22 and 60.42±7.21 Gy, and mean heart dose is 10.22 ±7.57, 9.07 ±6.32 Gy, for the coplanar and non-coplanar plans, respectively. The ipsilateral lung V20 is 48.0%±2.4% and 47.5%±3.3%, and V5 is 68.2%±10.0% and 69.1%±7.3%, for the coplanar and noncoplanar plans, respectively. Furthermore, with the non-coplanar beam arrangement, the contralateral lung V20 was reduced from 3.3%±3.7% to 1.3%±0.8%, and the contralateral Lung V5 is reduced significantly from 65.6%±9.3% to 33.5%±20.9% (p value =0.008). Conclusion: The IMRT plans with non-coplanar beam arrangement could reduce the exit dose to the contralateral lung, and therefore reduce the contralateral lung V5 significantly. This method is especially helpful while the lung lesion doesn’t have a symmetric shape.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-T-600: Influence of Acuros XB and AAA Dose Calculation Algorithms On Plan Quality Metrics and Normal Lung Doses in Lung SBRT

Purpose: To study the influence of superposition-beam model (AAA) and determinant-photon transport-solver (Acuros XB) dose calculation algorithms on the treatment plan quality metrics and on normal lung dose in Lung SBRT. Methods: Treatment plans of 10 Lung SBRT patients were randomly selected. Patients were prescribed to a total dose of 50-54Gy in 3–5 fractions (10?5 or 18?3). Doses were optimized accomplished with 6-MV using 2-arcs (VMAT). Doses were calculated using AAA algorithm with heterogeneity correction. For each plan, plan quality metrics in the categories- coverage, homogeneity, conformity and gradient were quantified. Repeat dosimetry for these AAA treatment plans was performed using AXB algorithm with heterogeneity correction for same beam and MU parameters. Plan quality metrics were again evaluated and compared with AAA plan metrics. For normal lung dose, V{sub 20} and V{sub 5} to (Total lung- GTV) were evaluated. Results: The results are summarized in Supplemental Table 1. PTV volume was mean 11.4 (±3.3) cm{sup 3}. Comparing RTOG 0813 protocol criteria for conformality, AXB plans yielded on average, similar PITV ratio (individual PITV ratio differences varied from −9 to +15%), reduced target coverage (−1.6%) and increased R50% (+2.6%). Comparing normal lung doses, the lung V{sub 20} (+3.1%) and V{sub 5} (+1.5%) were slightly higher for AXB plans compared to AAA plans. High-dose spillage ((V105%PD - PTV)/ PTV) was slightly lower for AXB plans but the % low dose spillage (D2cm) was similar between the two calculation algorithms. Conclusion: AAA algorithm overestimates lung target dose. Routinely adapting to AXB for dose calculations in Lung SBRT planning may improve dose calculation accuracy, as AXB based calculations have been shown to be closer to Monte Carlo based dose predictions in accuracy and with relatively faster computational time. For clinical practice, revisiting dose-fractionation in Lung SBRT to correct for dose overestimates attributable to algorithm may very well be warranted.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-T-615: Comparison of Plan Quality for Linac-Based Stereotactic Radiosurgery (SRS) Using Single- and Multi-Isocenter Techniques

Purpose: To compare the plan quality of linear accelerator (linac)-based stereotactic radiosurgery (SRS) using single-isocenter volumetric arc therapy (SI-VMAT), restricted single-isocenter dynamic-arc (RSI-DARC), and multi-isocenter DARC (MI-DARC) techniques. Methods: Fifteen SRS cases were randomly selected and re-planned using the SI-VMAT (Pinnacle), RSI-DARC (iPlanNet) and MI-DARC (iPlanNet). The number of planning target volumes (PTVs) for each plan ranged from 1 to 6. For SI-VMAT, a single isocenter and 3-4 VMAT beams are used for all PTVs, while for MI-DARC, each PTV has its own isocetner with 3 DARC beams. RSI-DARC uses one isocnter with 3-6 DARC beams to irradiate all PTVs within 2.5-cm radius. Both SI-DARC and RSI-DARC plans were optimized manually. The prescription dose was 20 Gy to each PTV. The maximal dose was 25 Gy for RSI-DARC and MI-DARC, but could not be controlled for SI-VMAT due to the nature of VMAT planning. Plan quality indexes including PTV coverage, mean dose of PTV (PTVmean) and tissue (Tmean), V12Gy, conformity index (CI), and V10Gy/VPTV were calculated and compared. Results: Full PTV coverage was achieved for all three techniques. Using the MI-DARC plans as the gold standard, the PTVmean of the SI-VMAT plans was 12.5%±8.3% (mean±standard deviation) higher, in comparison to 0.7%±1.4% for the RSI-DARC plans. Similar trend was observed for other indexes including V12Gy (39.4%±27.3% vs. 9.3%±7.8%), Tmean (35.0%±26.8% vs. 2.8%±3.4%), and V10Gy/VPTV (42.2%±31.5% vs. 9.9%±8.2%). CI is comparable (6.2%±14.2% vs. 6.3%±7.2%). Assuming the treatment time is proportional to the number of isocenters, the reduction of the treatment time in comparison to MI-DARC was 70% for SI-VMAT and 42% for RSI-DARC. Conclusion: Although the SI-VMAT can save a considerable amount of treatment time, the plan indexes also significantly deviates from the gold standard, MI-DARC. RSI-DARC, on the other hand, provides a good compromise between the treatment time and plan quality.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-G-TeP1-07: Investigation of RapidPlan Based Plan Quality for Breast IMRTSimultaneously Integrated Boost

Purpose: The aim of this study is to investigate the feasibility of using RapidPlan for breast cancer radiotherapy and to evaluate its performance for planners with different planning experiences. Methods: A training database was collected with 80 expert plan datasets from patients previously received left breast conserving surgery and IMRT-simultaneously integrated boost radiotherapy. The models were created on the RapidPlan. Five patients from the training database and 5 external patients were used for internal and external validation, respectively. Three planners with different planning experiences (beginner, junior, senior) designed manual and RapidPlan based plans for additional ten patients. The plan qualities were compared with manual and RapidPlan based ones. Results: For the internal and external validations, there were no significant dose differences on target coverage for plans from RapidPlan and manual. Also, no difference was found in the mean doses to contralateral breast and lung. The RapidPlan improved the heart (V5, V10, V20, V30, and mead dose) and ipsilateral lung (V5, V10, V20, V30, and mean dose) sparing for the beginner and junior planners. Compare to the plans from senior planner, 6 out of 16 clinically checked parameters were improved in RapidPlan, and the left parameters were similar. Conclusion: It is feasible to generate clinical acceptable plans using RapidPlan for breast cancer radiotherapy. The RapidPlan helps to systematically improve the quality of IMRT plans against the benchmark of clinically accepted plans. The RapidPlan shows promise for homogenizing plan quality by transferring planning expertise from more experienced to less experienced planners.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-G-JeP2-01: A New Approach for MR-Only Treatment Planning: Tissue Segmentation-Based Pseudo-CT Generation Using T1-Weighted MRI

Purpose: To evaluate MR-only treatment planning for brain Stereotactic Ablative Radiotherapy (SABR) based on pseudo-CT (pCT) generation using one set of T1-weighted MRI. Methods: T1-weighted MR and CT images from 12 patients who were eligible for brain SABR were retrospectively acquired for this study. MR-based pCT was generated by using a newly in-house developed algorithm based on MR tissue segmentation and voxel-based electron density (ED) assignment (pCTv). pCTs using bulk density assignment (pCTb where bone and soft tissue were assigned 800HU and 0HU,respectively), and water density assignment (pCTw where all tissues were assigned 0HU) were generated for comparison of ED assignment techniques. The pCTs were registered with CTs and contours of radiation targets and Organs-at-Risk (OARs) from clinical CT-based plans were copied to co-registered pCTs. Volumetric-Modulated-Arc-Therapy(VMAT) plans were independently created for pCTv and CT using the same optimization settings and a prescription (50Gy/10 fractions) to planning-target-volume (PTV) mean dose. pCTv-based plans and CT-based plans were compared with dosimetry parameters and monitor units (MUs). Beam fluence maps of CT-based plans were transferred to co-registered pCTs, and dose was recalculated on pCTs. Dose distribution agreement between pCTs and CT plans were quantified using Gamma analysis (2%/2mm, 1%/1mm with a 10% cut-off threshold) in axial, coronal and sagittal planes across PTV. Results: The average differences of PTV mean and maximum doses, and monitor units between independently created pCTv-based and CT-based plans were 0.5%, 1.5% and 1.1%, respectively. Gamma analysis of dose distributions of the pCTs and the CT calculated using the same fluence map resulted in average agreements of 92.6%/79.1%/52.6% with 1%/1mm criterion, and 98.7%/97.4%/71.5% with 2%/2mm criterion, for pCTv/CT, pCTb/CT and pCTw/CT, respectively. Conclusion: Plans produced on Voxel-based pCT is dosimetrically more similar to CT plans than bulk assignment-based pCTs. MR-only treatment planning using voxel-based pCT generated from T1-wieghted MRI may be feasible.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

Sci-Thur PM - Colourful Interactions: Highlights 06: Patient-specific calibration of cone-beam computed tomographic (CBCT) image sets for on-line dose tracking and plan assessment

Purpose: To develop a radiotherapy dose tracking and plan evaluation technique using cone-beam computed tomography (CBCT) images. Methods: We developed a patient-specific method of calibrating CBCT image sets for dose calculation. The planning CT was first registered with the CBCT using deformable image registration (DIR). A scatter plot was generated between the CT numbers of the planning CT and CBCT for each slice. The CBCT calibration curve was obtained by least-square fitting of the data, and applied to each CBCT slice. The calibrated CBCT was then merged with original planning CT to extend the small field of view of CBCT. Finally, the treatment plan was copied to the merged CT for dose tracking and plan evaluation. The proposed patient-specific calibration method was also compared to two methods proposed in literature. To evaluate the accuracy of each technique, 15 head-and-neck patients requiring plan adaptation were arbitrarily selected from our institution. The original plan was calculated on each method’s data set, including a second planning CT acquired within 48 hours of the CBCT (serving as gold standard). Clinically relevant dose metrics and 3D gamma analysis of dose distributions were compared between the different techniques. Results: Compared to the gold standard of using planning CTs, the patient-specific CBCT calibration method was shown to provide promising results with gamma pass rates above 95% and average dose metric agreement within 2.5%. Conclusions: The patient-specific CBCT calibration method could potentially be used for on-line dose tracking and plan evaluation, without requiring a re-planning CT session.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2011

Natural Resource Management Plan for Brookhaven National Laboratory

This comprehensive Natural Resource Management Plan (NRMP) for Brookhaven National Laboratory (BNL) was built on the successful foundation of the Wildlife Management Plan for BNL, which it replaces. This update to the 2003 plan continues to build on successes and efforts to better understand the ecosystems and natural resources found on the BNL site. The plan establishes the basis for managing the varied natural resources located on the 5,265 acre BNL site, setting goals and actions to achieve those goals. The planning of this document is based on the knowledge and expertise gained over the past 10 years by the Natural Resources management staff at BNL in concert with local natural resource agencies including the New York State Department of Environmental Conservation, Long Island Pine Barrens Joint Planning and Policy Commission, The Nature Conservancy, and others. The development of this plan is an attempt at sound ecological management that not only benefits BNL's ecosystems but also benefits the greater Pine Barrens habitats in which BNL is situated. This plan applies equally to the Upton Ecological and Research Reserve (Upton Reserve). Any difference in management between the larger BNL area and the Upton Reserve are noted in the text. The purpose of the Natural Resource Management Plan (NRMP) is to provide management guidance, promote stewardship of the natural resources found at BNL, and to sustainably integrate their protection with pursuit of the Laboratory's mission. The philosophy or guiding principles of the NRMP are stewardship, sustainability, adaptive ecosystem management, compliance, integration with other plans and requirements, and the incorporation of community involvement, where applicable. The NRMP is periodically reviewed and updated, typically every five years. This review and update was delayed to develop documents associated with a new third party facility, the Long Island Solar Farm. This two hundred acre facility will result in significant changes to this plan warranting the delay. The body of this plan establishes the management goals and actions necessary for managing the natural resources at BNL in a sustainable manner. The appendices provide specific management requirements for threatened and endangered amphibians and fish (Appendices A and B, respectively), and lists of actions in tabular format - including completed items as well as ongoing and new action items (Appendices C and D, respectively).

54 ENVIRONMENTAL SCIENCES↗