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At least 487 records · Page 27
All sourcesNASA NTRSDOE OSTI
DOE OSTI2013

Evaluation of the Role of Cisplatin-conjugated-soluble Gelatin Sponge: Feasibility Study in a Swine Model

PurposeTo evaluate the safety and the delivery function of cisplatin-conjugated-soluble gelatin sponge in a swine model.MethodsFifteen healthy young swine were assigned into three groups: transarterial cisplatin infusion group, transarterial chemoembolization (TACE) with cisplatin-conjugated 120-min soluble gelatin sponge (TACE-120) group, and TACE with cisplatin-conjugated 360-min soluble gelatin sponge (TACE-360) group. A total volume of 0.8 mL/kg cisplatin in each group and 8 mg/kg soluble gelatin sponge in TACE-120 and TACE-360 groups were injected from the left hepatic artery in small increments for 10 min. Common hepatic angiography and whole-blood sampling via the left hepatic vein were conducted to explore recanalization immediately after the procedure and again at 10, 30, 60, 90, 120, 180, 240, 300, 360, and 420 min later. The area under the plasma concentration curve (AUC) of non-protein-bound platinum was compared among the three groups. Each liver was removed and cut into 10-cm-thick sections for calculating liver-damaged volume ratio.ResultsSequential angiography depicted gradual recanalization of the occluded hepatic artery and total recanalization at 120 and 360 min after embolization in the TACE-120 and TACE-360 groups, respectively. Of the three groups, AUC{sub 0-30}, AUC{sub 30-120}, and AUC{sub 120-420} were significantly highest in the transarterial cisplatin infusion group (p < 0.001), the TACE-120 group (p < 0.001), and the TACE-360 group (p < 0.001), respectively. The liver-damaged volume ratio in the TACE-360 group was small (8.20 %) but significantly higher than that in the TACE-120 group (2.67 %, p = 0.014).ConclusionCisplatin-conjugated soluble gelatin sponge functions as a cisplatin carrier and is associated with tolerable liver damage.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2016

SU-C-207B-05: Tissue Segmentation of Computed Tomography Images Using a Random Forest Algorithm: A Feasibility Study

Purpose: Develop an automated Random Forest algorithm for tissue segmentation of CT examinations. Methods: Seven materials were classified for segmentation: background, lung/internal gas, fat, muscle, solid organ parenchyma, blood/contrast, and bone using Matlab and the Trainable Weka Segmentation (TWS) plugin of FIJI. The following classifier feature filters of TWS were investigated: minimum, maximum, mean, and variance each evaluated over a pixel radius of 2n, (n = 0–4). Also noise reduction and edge preserving filters, Gaussian, bilateral, Kuwahara, and anisotropic diffusion, were evaluated. The algorithm used 200 trees with 2 features per node. A training data set was established using an anonymized patient’s (male, 20 yr, 72 kg) chest-abdomen-pelvis CT examination. To establish segmentation ground truth, the training data were manually segmented using Eclipse planning software, and an intra-observer reproducibility test was conducted. Six additional patient data sets were segmented based on classifier data generated from the training data. Accuracy of segmentation was determined by calculating the Dice similarity coefficient (DSC) between manual and auto segmented images. Results: The optimized autosegmentation algorithm resulted in 16 features calculated using maximum, mean, variance, and Gaussian blur filters with kernel radii of 1, 2, and 4 pixels, in addition to the original CT number, and Kuwahara filter (linear kernel of 19 pixels). Ground truth had a DSC of 0.94 (range: 0.90–0.99) for adult and 0.92 (range: 0.85–0.99) for pediatric data sets across all seven segmentation classes. The automated algorithm produced segmentation with an average DSC of 0.85 ± 0.04 (range: 0.81–1.00) for the adult patients, and 0.86 ± 0.03 (range: 0.80–0.99) for the pediatric patients. Conclusion: The TWS Random Forest auto-segmentation algorithm was optimized for CT environment, and able to segment seven material classes over a range of body habitus and CT protocol parameters with an average DSC of 0.86 ± 0.04 (range: 0.80–0.99).

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

TU-AB-303-01: A Feasibility Study for Dynamic Adaptive Therapy of Non-Small Cell Lung Cancer

Purpose: To compare plans for NSCLC optimized using Dynamic Adaptive Therapy (DAT) with conventional IMRT optimization. DAT adapts plans based on changes in the target volume by using dynamic programing techniques to consider expected changes into the optimization process. Information gathered during treatment, e.g. from CBCT, is incorporated into the optimization. Methods and materials: DAT is formulated using stochastic control formalism, which minimizes the total expected number of tumor cells at the end of a treatment course subject to uncertainty inherent in the tumor response and organs-at-risk (OAR) dose constraints. This formulation allows for non-stationary dose distribution as well as non-stationary fractional dose as needed to achieve a series of optimal plans that are conformal to tumor over time. Sixteen phantom cases with various sizes and locations of tumors, and OAR geometries were generated. Each case was planned with DAT and conventional IMRT (60Gy/30fx). Tumor volume change over time was obtained by using, daily MVCT-based, two-level cell population model. Monte Carlo simulations have been performed for each treatment course to account for uncertainty in tumor response. Same OAR dose constraints were applied for both methods. The frequency of plan modification was varied to 1, 2, 5 (weekly), and 29 (daily). The final average tumor dose and OAR doses have been compared to quantify the potential benefit of DAT. Results: The average tumor max, min, mean, and D95 resulted from DAT were 124.0–125.2%, 102.1–114.7%, 113.7–123.4%, and 102.0–115.9% (range dependent on the frequency of plan modification) of those from conventional IMRT. Cord max, esophagus max, lung mean, heart mean, and unspecified tissue D05 resulted from AT were 84–102.4%, 99.8–106.9%, 66.9–85.6%, 58.2–78.8%, and 85.2–94.0% of those from conventional IMRT. Conclusions: Significant tumor dose increase and OAR dose reduction, especially with parallel OAR with mean or dose-volume constraints, can be achieved using DAT.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

TH-AB-BRA-11: Using 3D Dosimeters for the Investigation of the Electron Return Effect (ERE) in MR-Guided Radiation Therapy: A Feasibility Study

Purpose: To demonstrate the capability of 3D radiochromic PRESAGE and Fricke-type dosimeters to measure the influence of magnetic fields on dose distribution, including the electron return effect (ERE), for MR-guided radiation therapy applications. Methods: Short cylindrical 3D dosimeters with PRESAGE and Fricke-type formulations were created in-house prior to irradiations in a 1.5T/7MV MR-linac. Each dosimeter was prepared with a concentric cylindrical air cavity with diameters of 1.5 cm and 2.5 cm, and the diameters of the dosimeters were 7.2 cm and 8.8 cm for PRESAGE and Fricke-type respectively. The dosimeters were irradiated within the bore of the MR-linac with the flat face of the dosimeters perpendicular to the magnetic field. Dosimeters were irradiated to approximately 9 Gy and 29 Gy to the center of dosimeters with a 15×15 cm{sup 2} field. The PRESAGE dosimeter was scanned using an optical-CT 2 hours post-irradiation; the Fricke-type dosimeter was immediately imaged with the MR component of the MR-linac post-irradiation. Results: Axial slices of the dose distributions show a clear demonstration of the dose enhancement due to the ERE above the cavity and the region of reduced dose below the cavity. The regions of increased and reduced dose are rotated with respect to the radiation beam axis due to the average directional change of the electrons. Measurements from line profiles show the dose enhanced up to ∼0.5 cm around the cavity by up to a factor of 1.3 and 1.4 for PRESAGE and Fricke-type dosimeters respectively. Conclusion: PRESAGE and Fricke-type dosimeters are able to qualitatively measure the ERE with good agreement with previously published simulation and 2D dosimetry demonstrations of the ERE. Further investigation of these 3D dosimeters as promising candidates for quality assurance of MR-guided radiation therapy systems is encouraged to assess changes in response and measurement accuracy due to the magnetic field.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-P-16: A Feasibility Study of Using Eclipse AAA for SRS Treatement

Purpose: To commission Varian Eclipse AAA for SRS treatment and compare the accuracy with Brainlab iPlan system for clinical cases measured with radiochromic film. Methods: A 6MV AAA clinical model for a Varian TrueBeam STx is used as baseline. The focal spot and field size of the baseline model(BASE) are (1.75,0.75) and 40×40cm{sup 2} respectively. Maximum field sizes, output factors(S{sub t}), FWHM focal spot and secondary source sizes are systematically adjusted to obtain an optimized model(OPT) by comparing the calculated PDD’s, profiles, and output factors with measurements taken with a stereotactic diode(SD) and, cc01 and cc04 ion chambers in Blue Phantom. In-phantom dose distributions of clinical SRS fields are calculated using the OPT and the clinical Brainlab iPlan pencil-beam. Within the 90% isodose-line(ROI), the average dose difference between the calculations and radiochromic film measurements are assessed. Results: The maximum field, focal spot and secondary source sizes for the OPT are 15×15cm{sup 2}, (0,0), and 32.3mm respectively. The OPT St input at 1.0 and 2.0cm fields are increased by 4.5% and 1.5% from BASE. The calculated output of the BASE and OPT underestimate by 16.1%–3.2% respectively at 0.5×0.5cm{sup 2} field and 3.1%−0.02% respectively at 1.0×1.0cm{sup 2} field. The depth doses at 10cm are within 3.5% and 0.4% of measurements for 0.5×0.5 and 1.0×1.0cm{sup 2}. The ROI dose of OPT and iPlan are within 1.6% and 0.6% of film measurements for 3.0cm clinical fields. For 1.0cm fields, the ROI dose of OPT underestimate 0.0–2.0% and iPlan overestimates 1.7–2.9% relative to measurements. Conclusion: The small field dose calculation of Eclipse AAA algorithm can be significantly improved by carefully adjusting the input parameters. The larger deviation of the OPT for 0.5×0.5cm{sup 2} field from measurements can be attributed to the lowest 1.0cm field size input limit of AAA. The OPT compares reasonably well with the iPlan pencil-beam and measurements.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-E-02: A Feasibility Study for Application of Metal Artifact Reduction Techniques in MR-Guided Brachytherapy Gynecological Cancer with Titanium Applicators

Purpose: Utilization of Titanium Tandem and Ring (T&R) applicators in MR-guided brachytherapy has become widespread for gynecological cancer treatment. However, Titanium causes magnetic field disturbance and susceptibility artifact, which complicate image interpretation. In this study, metal artifact reduction techniques were employed to improve the image quality and reduce the metal related artifacts. Methods: Several techniques were employed to reduce the metal artifact caused by titanium T&R applicator. These techniques include Metal Artifact Reduction Sequence (MARS), View Angle Tilting (VAT) to correct in-plane distortion, and Slice Encoding for Metal Artifact Correction (SEMAC) for through-plane artifact correction. Moreover, MARS can be combined with VAT to further reduce the in-plane artifact by reapplying the selection gradients during the readout (MARS+VAT). SEMAC uses a slice selective excitation but acquires additional z-encodings in order to resolve off-resonant signal and to reduce through-plane distortions. Results: Comparison between the clinical sequences revealed that increasing the bandwidth reduces the error in measured diameter of T&R. However, the error is larger than 4mm for the best case with highest bandwidth and spatial resolution. MARS+VAT with isotropic resolution of 1mm reduced the error to 1.9mm which is the least among the examined 2D sequences. The measured diameter of tandem from SEMAC+VAT has the closest value to the actual diameter of tandem (3.2mm) and the error was reduced to less than 1mm. In addition, SEMAC+VAT significantly reduces the blooming artifact in the ring compared to clinical sequences. Conclusion: A higher bandwidth and spatial resolution sequence reduces the artifact and diameter of applicator with a slight compromise in SNR. Metal artifact reduction sequences decrease the distortion associated with titanium applicator. SEMAC+VAT sequence in combination with VAT revealed promising results for titanium imaging and can be utilized for MR-guided brachytherapy in gynecological cancer. The author is employee with Philips Healthcare.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-187: Feasibility Study of Stereotactic Liver Radiation Therapy Using Multiple Divided Partial Arcs in Volumetric Modulated Arc Therapy

Purpose: To verify volumetric modulated arc therapy (VMAT) using flattening filter free (FFF) mode with jaw tracking (JT) feature for single breath hold as long as 15 s per arc in liver stereotactic body radiation therapy (SBRT) against intensity modulated radiation therapy (IMRT) FFF-JT. Methods: Ten hepatocellular carcinoma (HCC) cases were planned with 10 MV FFF using Pinnacle3 treatment planning system which delivered by TrueBeam to administer 48 Gy/ 4 fractions. Eight non-coplanar beams were assigned to IMRT using step-and-shoot technique. For VMAT, two or three non-coplanar partial arcs (up to 180 degrees) were further divided into subarcs with gantry rotation less than 80 degrees to limit delivery time within 15 s. Dose distributions were verified using OCTAVIUS II system and pass rates were evaluated using gamma analysis with criteria of 3%/3 mm at threshold of 5% to the maximum dose. The actual irradiation time was measured. Results: The VMAT-FFF-JT of partial-arcs with sub-divided arcs was able to produce a highly conformal plan as well as IMRT-FFF-JT. Isodose lines and DVH showed slight improvement in dosimetry when JT was employed for both IMRT and VMAT. Consequently, VMAT-FFF-JT was superior in reducing the dose to liver minus gross tumor volume. VMAT-FFF-JT has shorter total treatment time compared with 3D conformal radiation therapy (3D-CRT) FFF because the gantry was rotated simultaneously with the beam delivery in VMAT. Moreover, due to the small and regular shape of HCC, VMAT-FFF-JT offered less multileaf collimator motion, thus the interplay effect is expected to be reduced. The patient specific QA of IMRT and VMAT acquired the pass rates higher than 90%. Conclusion: VMAT-FFF-JT could be a promising technique for liver SBRT as the sub-divided arcs method was able to accommodate a single breath hold irradiation time of less than 15 s without deterioration of the dose distribution compared with IMRT-FFF-JT.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-J-271: A Feasibility Study to Utilize XR-QA2 Radiochromic Films as An Alternative Tool for Measuring Beam Parameters of Kilovoltage CBCT Systems

Purpose: The beam parameters of the x-ray beams used in image guidance are difficult to measure in water due to the low exposure. This study is to investigate if XR-QA2 radiochromic films can be used in obtaining beam parameters, such as beam profiles and outputs for kV-CBCT systems. Methods: The kV-CBCT beams were from a Varian OBI system. The films used were XR-QA2-GAFCHROMICTM films placed in the middle of two Plastic -Water slab phantoms at isocenter. The scanner used to analyze the films was an Epson Expression 1680 flat-bed scanner. Pre and 24 h-post-irradiated scans of films were obtained by using the reflective mode. The corresponding pixel-by-pixel dose in the films was obtained using a dose calibration equation as a function of net reflectance from the literature. Beam profiles of different scan protocols with and without bow-tie filters were measured. Monte Carlo simulations were used to compare the accuracy of the measured dose profiles. Results: The beam profiles measured from XR-QA2 films for different clinical default kV-CBCT scan protocols were benchmarked against Monte Carlo simulated profiles which have been validated by measurements performed in water phantom. We confirmed that a minimum post-irradiated time of 24 hours is necessary to pass to scan the films to account for light scatter stability. We found that the uncertainties of the results depend on the scan orientation of the film when analyzed in different directions. Conclusion: The XR-QA2 radiochromic films are sensitive to measure the x-ray beam profiles with irradiated dose ranging 1–5 cGy. The film measurements can be performed with an easy setup compared to ion chamber measurements in a water phantom. These films provide an alternative method to obtain the beam profiles for kV-CBCT beams.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-J-126: Influence of Six Dimensional Motions in Frameless Stereotactic Dosimetry Incorporating Rotational Shifts as Equivalent Translational Shifts: A Feasibility Study for Elekta-BrainLAB Stereotactic System

Purpose: Six dimensional positional shifts (translational and rotational) determined by a volumetric imaging system were mathematically combined and incorporated as simple translational shifts and the resultant impact on dose characteristics was studied. Methods: Thirty patients who underwent either single fraction (12 Gy) or five fractions (5 Gy per fraction) stereotactic treatments were included in this study. They were immobilized using a double layered thermoplastic mask from BrainLAB. Isocenter matching was done using infrared marker of ExacTrac. An initial cone beam CT (CBCT) gave positional shifts in 6-dimensions that were applied through 6-D motion enabled couch. A verification CBCT was done following corrections before treatment. These 6-D positional shifts determined at each imaging session from the first CBCT were mathematically combined to give three simple translational shifts. Doses were recalculated in the patient matrix with these positional errors present by moving the whole image dataset. Doses were also recalculated after second CBCT with only residual errors present. PTV dose statistics were compared. Results: For the approved plans V100%(PTV), V100%(GTV), D95%(PTV), D95%(GTV), D1%(PTV) and D1%(GTV) were 96.2±3.0%, 98.2±1.4%, 102%±1.7%, 103±1.2%, 107.9±8.9% and 109.3±7.5% of prescription dose respectively. With the positional errors present (after 1st CBCT) the corresponding values were 86.7±4.9%, 91.3±2.9%, 89.6±4.2%, 95.9±3.7%, 108.3±9.9% and 108.6±4.5%. Post-correction (after 2nd CBCT) with only residual errors present, values were 94.5±5.7%, 97.3±2.9%, 99.3%±3.2%, 102%±2.1%, 107.6±8.5% and 109.0±7.6% respectively. Significant and nominal OAR dose variation was observed between pre- and post-table corrections. Conclusion: Positional errors significantly affect PTV dose statistics. They need to be corrected before delivery of stereotactic treatments although the magnitude of dose changes can vary from patient-to-patient depending on the tumor location. As expected after the table corrections, residual errors result in insignificant dose deviations. For frameless stereotactic treatments having a six-dimensional motion enabled couch is highly recommended to reduce quantum of dose deviations.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2013

Superior liver sparing by combined coplanar/noncoplanar volumetric-modulated arc therapy for hepatocellular carcinoma: A planning and feasibility study

Compared with step-and-shoot intensity-modulated radiotherapy (sIMRT) and tomotherapy, volumetric-modulated arc therapy (VMAT) allows additional arc configurations in treatment planning and noncoplanar (NC) delivery. This study was first to compare VMAT planning with sIMRT planning, and the second to evaluate the toxicity of coplanar (C)/NC-VMAT treatment in patients with hepatocellular carcinoma (HCC). Fifteen patients with HCC (7 with left-lobe and 8 with right-lobe tumors) were planned with C-VMAT, C/NC-VMAT, and sIMRT. The median total dose was 49 Gy (range: 40 to 56 Gy), whereas the median fractional dose was 3.5 Gy (range: 3 to 8 Gy). Different doses/fractionations were converted to normalized doses of 2 Gy per fraction using an α/β ratio of 2.5. The mean liver dose, volume fraction receiving more than 10 Gy (V10), 20 Gy (V20), 30 Gy (V30), effective volume (V{sub eff}), and equivalent uniform dose (EUD) were compared. C/NC-VMAT in 6 patients was evaluated for delivery accuracy and treatment-related toxicity. Compared with sIMRT, both C-VMAT (p = 0.001) and C/NC-VMAT (p = 0.03) had significantly improved target conformity index. Compared with C-VMAT and sIMRT, C/NC-VMAT for treating left-lobe tumors provided significantly better liver sparing as evidenced by differences in mean liver dose (p = 0.03 and p = 0.007), V10 (p = 0.003 and p = 0.009), V20 (p = 0.006 and p = 0.01), V30 (p = 0.02 and p = 0.002), V{sub eff} (p = 0.006 and p = 0.001), and EUD (p = 0.04 and p = 0.003), respectively. For right-lobe tumors, there was no difference in liver sparing between C/NC-VMAT, C-VMAT, and sIMRT. In all patients, dose to more than 95% of target points met the 3%/3 mm criteria. All 6 patients tolerated C/NC-VMAT and none of them had treatment-related ≥ grade 2 toxicity. The C/NC-VMAT can be used clinically for HCC and provides significantly better liver sparing in patients with left-lobe tumors.

61 RADIATION PROTECTION AND DOSIMETRY↗
DOE OSTI2013

3D inpatient dose reconstruction from the PET-CT imaging of {sup 90}Y microspheres for metastatic cancer to the liver: Feasibility study

Purpose: The introduction of radioembolization with microspheres represents a significant step forward in the treatment of patients with metastatic disease to the liver. This technique uses semiempirical formulae based on body surface area or liver and target volumes to calculate the required total activity for a given patient. However, this treatment modality lacks extremely important information, which is the three-dimensional (3D) dose delivered by microspheres to different organs after their administration. The absence of this information dramatically limits the clinical efficacy of this modality, specifically the predictive power of the treatment. Therefore, the aim of this study is to develop a 3D dose calculation technique that is based on the PET imaging of the infused microspheres.Methods: The Fluka Monte Carlo code was used to calculate the voxel dose kernel for {sup 90}Y source with voxel size equal to that of the PET scan. The measured PET activity distribution was converted to total activity distribution for the subsequent convolution with the voxel dose kernel to obtain the 3D dose distribution. In addition, dose-volume histograms were generated to analyze the dose to the tumor and critical structures.Results: The 3D inpatient dose distribution can be reconstructed from the PET data of a patient scanned after the infusion of microspheres. A total of seven patients have been analyzed so far using the proposed reconstruction method. Four patients underwent treatment with SIR-Spheres for liver metastases from colorectal cancer and three patients were treated with Therasphere for hepatocellular cancer. A total of 14 target tumors were contoured on post-treatment PET-CT scans for dosimetric evaluation. Mean prescription activity was 1.7 GBq (range: 0.58–3.8 GBq). The resulting mean maximum measured dose to targets was 167 Gy (range: 71–311 Gy). Mean minimum dose to 70% of target (D70) was 68 Gy (range: 25–155 Gy). Mean minimum dose to 90% of target (D90) was 53 Gy (range: 13–125 Gy).Conclusions: A three-dimensional inpatient dose reconstruction method has been developed that is based on the PET/CT data of a patient treated with {sup 90}Y microspheres. It allows for a complete description of the absorbed dose by the tumor and critical structures. It represents the first step in building predictive models for treatment outcomes for patients receiving this therapeutic modality as well as it allows for better analysis of patients' dose response and will ultimately improve future treatment administration.

61 RADIATION PROTECTION AND DOSIMETRY↗
DOE OSTI2016

SU-F-T-519: Is Geometry Based Setup Sufficient for All of the Head and Neck Treatment Cases?: A Feasibility Study Towards the Dose Based Setup

Purpose: This study compares the geometric-based setup (GBS) which is currently used in the clinic to a novel concept of dose-based setup (DBS) of head and neck (H&N) patients using cone beam CT (CBCT) of the day; and evaluates the clinical advantages. Methods: Ten H&N patients who underwent re-simulation and re-plan due to noticeable anatomic changes during the course of the treatments were retrospectively reviewed on dosimetric changes in the assumption of no plan modification was performed. RayStation planning system (RaySearch Laboratories AB, Sweden) was used to match (ROI fusion module) between prescribed isodoseline (IDL) in the CBCT imported along with ROIs from re-planned CT and the IDL of original plan (Dose-based setup: DBS). Then, the CBCT plan based on daily setup using the GBS (previously used for a patient) and the DBS CBCT plan recalculated in RayStation compared against the original CT-sim plan. Results: Most of patients’ tumor coverage and OAR doses got generally worsen when the CBCT plans were compared with original CT-sim plan with GBS. However, when DBS intervened, the OAR dose and tumor coverage was better than the GBS. For example, one of patients’ daily average doses of right parotid and oral cavity increased to 26% and 36%, respectively from the original plan to the GBS planning. However, it only increased by 13% and 24%, respectively with DBS. GTV D95 coverage also decreased by 16% with GBS, but only 2% decreased with DBS. Conclusion: DBS method is superior to GBS to prevent any abrupt dose changes to OARs as well as PTV/CTV or GTV at least for some H&N cases. Since it is not known when the DBS is beneficial to the GBS, a system which enables the on-line DBS may be helpful for better treatment of H&N.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

WE-EF-303-07: Imaging of Prompt Gamma Rays Emitted During Delivery of Clinical Proton Beams with a Compton Camera: Feasibility Studies for Range Verification

Purpose: Evaluation of a prototype Compton camera (CC) for imaging prompt gamma rays (PG) emitted during clinical proton beam irradiation for in vivo beam range verification. Methods: We irradiated a water phantom with 114 MeV and 150 MeV proton pencil beams at clinical beam currents ranging from 1 nA up to 5 nA. The CC was placed 15 cm from the beam central axis and PGs from 0.2 MeV up to 6.5 MeV were measured during irradiation. From the measured data, 2-dimensional (2D) PG images were reconstructed. One-dimensional (1D) profiles from the PG images were compared to measured depth dose curves. Results: The CC was able to measure PG emission during delivery of both a single 150 MeV pencil beam and a 5 cm x 5 cm mono-energetic layer of 114 MeV pencil beams. From the 2D images, a strong correlation was seen between the depth of the distal falloff of PG emission and the Bragg peak (BP). 1D profiles extracted from the PG images show that the distal 60% falloff of the PG emission lined up well with the distal 90% of the BP. Shifts as small as 3 mm in the beam range could be detected on both the 2D PG images and 1D profiles with an uncertainty of 1.5 mm. With the current CC prototype, a minimum dose delivery of 400 cGy was required to produce usable PG images. Conclusions: It was possible to measure and image PG emission with our prototype CC during proton beam delivery and to detect shifts in the BP range in the images. Therefore prompt gamma imaging with a CC for the purpose of in vivo range verification is feasible. However, for the studied system improvements in detector efficiency and reconstruction algorithms are necessary to make it clinically viable.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-J-265: Feasibility Study of Texture Analysis for Prognosis of Local Tumor Recurrence Within 5-Years for Pharyngeal-Laryngeal Carcinoma Patients Received Radiotherapy Treatment

Purpose: Pharyngeal and laryngeal carcinomas (PLC) are among the top leading cancers in Asian populations. Typically the tumor may recur and progress in a short period of time if radiotherapy fails to deliver a successful treatment. Here we used image texture features extracted from images of computed tomography (CT) planning and conducted a retrospective study to evaluate whether texture analysis is a feasible approach to predict local tumor recurrence for PLC patients received radiotherapy treatment. Methods: CT planning images of 100 patients with PLC treated by radiotherapy at our facility between 2001 and 2010 are collected. These patients were received two separate CT scans, before and mid-course of the treatment delivery. Before the radiotherapy, a CT scanning was used for the first treatment planning. A total of 30 fractions were used in the treatment and patients were scanned with a second CT around the end of the fifteenth delivery for an adaptive treatment planning. Only patients who were treated with intensity modulated radiation therapy and RapidArc were selected. Treatment planning software of Eclipse was used. The changes of texture parameters between two CT acquisitions were computed to determine whether they were correlated to the local tumor recurrence. The following texture parameters were used in the preliminary assessment: mean, variance, standard deviation, skewness, kurtosis, energy, entropy, inverse difference moment, cluster shade, inertia, cluster prominence, gray-level co-occurrence matrix, and gray-level run-length matrix. The study was reviewed and approved by the committee of our institutional review board. Results: Our calculations suggested the following texture parameters were correlated with the local tumor recurrence: skewness, kurtosis, entropy, and inertia (p<0.0.05). Conclusion: The preliminary results were positive. However some works remain crucial to be completed, including addition of texture parameters for different image features, sensitivity of tumor segmentation variations, and effect of image filtering.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

Toward adaptive radiotherapy for head and neck patients: Feasibility study on using CT-to-CBCT deformable registration for “dose of the day” calculations

Purpose: The aim of this study was to evaluate the appropriateness of using computed tomography (CT) to cone-beam CT (CBCT) deformable image registration (DIR) for the application of calculating the “dose of the day” received by a head and neck patient. Methods: NiftyReg is an open-source registration package implemented in our institution. The affine registration uses a Block Matching-based approach, while the deformable registration is a GPU implementation of the popular B-spline Free Form Deformation algorithm. Two independent tests were performed to assess the suitability of our registrations methodology for “dose of the day” calculations in a deformed CT. A geometric evaluation was performed to assess the ability of the DIR method to map identical structures between the CT and CBCT datasets. Features delineated in the planning CT were warped and compared with features manually drawn on the CBCT. The authors computed the dice similarity coefficient (DSC), distance transformation, and centre of mass distance between features. A dosimetric evaluation was performed to evaluate the clinical significance of the registrations errors in the application proposed and to identify the limitations of the approximations used. Dose calculations for the same intensity-modulated radiation therapy plan on the deformed CT and replan CT were compared. Dose distributions were compared in terms of dose differences (DD), gamma analysis, target coverage, and dose volume histograms (DVHs). Doses calculated in a rigidly aligned CT and directly in an extended CBCT were also evaluated. Results: A mean value of 0.850 in DSC was achieved in overlap between manually delineated and warped features, with the distance between surfaces being less than 2 mm on over 90% of the pixels. Deformable registration was clearly superior to rigid registration in mapping identical structures between the two datasets. The dose recalculated in the deformed CT is a good match to the dose calculated on a replan CT. The DD is smaller than 2% of the prescribed dose on 90% of the body's voxels and it passes a 2% and 2 mm gamma-test on over 95% of the voxels. Target coverage similarity was assessed in terms of the 95%-isodose volumes. A mean value of 0.962 was obtained for the DSC, while the distance between surfaces is less than 2 mm in 95.4% of the pixels. The method proposed provided adequate dose estimation, closer to the gold standard than the other two approaches. Differences in DVH curves were mainly due to differences in the OARs definition (manual vs warped) and not due to differences in dose estimation (dose calculated in replan CT vs dose calculated in deformed CT). Conclusions: Deforming a planning CT to match a daily CBCT provides the tools needed for the calculation of the “dose of the day” without the need to acquire a new CT. The initial clinical application of our method will be weekly offline calculations of the “dose of the day,” and use this information to inform adaptive radiotherapy (ART). The work here presented is a first step into a full implementation of a “dose-driven” online ART.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2014

Focused ultrasound treatment of abscesses induced by methicillin resistant Staphylococcus aureus: Feasibility study in a mouse model

Purpose: To study the therapeutic effect of focused ultrasound on abscesses induced by methicillin-resistantStaphylococcus aureus (MRSA). MRSA is a major nosocomial pathogen where immunocompromised patients are prone to develop infections that are less and less responsive to regular treatments. Because of its capability to induce a rise of temperature at a very precise location, the use of focused ultrasound represents a considerable opportunity for therapy of localized MRSA-related infections. Methods: 50μl of MRSA strain USA400 bacteria suspension at a concentration of 1.32 ± 0.5 × 10{sup 5} colony forming units (cfu)/μl was injected subcutaneously in the left flank of BALB/c mice. An abscess of 6 ± 2 mm in diameter formed after 48 h. A transducer operating at 3 MHz with a focal length of 50 mm and diameter of 32 mm was used to treat the abscess. The focal point was positioned 2 mm under the skin at the abscess center. Forty-eight hours after injection four ultrasound exposures of 9 s each were applied to each abscess under magnetic resonance imaging guidance. Each exposure was followed by a 1 min pause. These parameters were based on preliminary experiments to ensure repetitive accurate heating of the abscess. Real-time estimation of change of temperature was done using water-proton resonance frequency and a communication toolbox (matMRI) developed inhouse. Three experimental groups of animals each were tested: control, moderate temperature (MT), and high temperature (HT). MT and HT groups reached, respectively, 52.3 ± 5.1 and 63.8 ± 7.5 °C at the end of exposure. Effectiveness of the treatment was assessed by evaluating the bacteria amount of the treated abscess 1 and 4 days after treatment. Myeloperoxidase (MPO) assay evaluating the neutrophil amount was performed to assess the local neutrophil recruitment and the white blood cell count was used to evaluate the systemic inflammatory response after focused ultrasound treatment. Results: Macroscopic evaluation of treated abscess indicated a diminution of external size of abscess 1 day after treatment. Treatment did not cause open wounds. The median (lower to upper quartile) bacterial count 1 day after treatment was 6.18 × 10{sup 3} (0.76 × 10{sup 3}–11.18 × 10{sup 3}), 2.86 × 10{sup 3} (1.22 × 10{sup 3}–7.07 × 10{sup 3}), and 3.52 × 10{sup 3} (1.18 × 10{sup 3}–6.72 × 10{sup 3}) cfu/100 μl for control, MT and HT groups, respectively; for the 4-day end point, the count was 1.37 × 10{sup 3} (0.67 × 10{sup 3}–2.89 × 10{sup 3}), 1.35 × 10{sup 3} (0.09 × 10{sup 3}–2.96 × 10{sup 3}), and 0.07 × 10{sup 3} (0.03 × 10{sup 3}–0.36 × 10{sup 3}) cfu/100 μl for control, MT and HT, showing a significant reduction (p = 0.002) on the bacterial load four days after focused ultrasound treatment when treating at high temperature (HT). The MPO amount remained unchanged between groups and days, indicating no change on local neutrophil recruitment in the abscess caused by the treatment. The white blood cell count remained unchanged between groups and days indicating that no systemic inflammatory response was caused by the treatment. Conclusions: Focused ultrasound induces a therapeutic effect in abscesses induced by MRSA. This effect is observed as a reduction of the number bacteria without significantly altering the amount of MPO at the site of a MRSA-induced abscess. These initial results suggest that focused ultrasound is a viable option for the treatment of localized MRSA-related infections.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
NASA NTRS1997

Dual-Mission Large Aircraft Feasibility Study and Aerodynamic Investigation

A Dual-Mission Large Aircraft, or DMLA, represents the possibility of a single aircraft capable of fulfilling both a Global Reach Aircraft (GRA) and Very Large Transport (VLT) roles. The DMLA, by combining the GRA and VLT into a single new aircraft, could possibly lower the aircraft manufacturer's production costs through the resulting increase in production quantity. This translates into lower aircraft acquisition costs, a primary concern for both the Air Force and commercial airlines. This report outlines the first steps taken in this study, namely the assessment of technical and economic feasibility of the DMLA concept. In the course of this project, specialized GRA and VLT aircraft were sized for their respective missions, using baseline conventional (i.e., lacking advanced enabling technologies) aircraft models from previous work for the Air Force's Wright Laboratory and NASA-Langley. DMLA baseline aircraft were then also developed, by first sizing the aircraft for the more critical of the two missions and then analyzing the aircraft's performance over the other mission. The resulting aircraft performance values were then compared to assess technical feasibility. Finally, the life-cycle costs of each aircraft (GRA, VLT, and DMLA) were analyzed to quantify economic feasibility. These steps were applied to both a two-engine aircraft set, and a four-engine aircraft set.

Mavris, Dimitri↗
NASA NTRS1978

Geosynchronous Microwave Atmospheric Sounding Radiometer (MASR) feasibility studies. Volume 1: Management summary

The mission of the microwave atmospheric sounding radiometer (MASR) is to collect data to aid in the observation and prediction of severe storms. The geosynchronous orbit allows the continuous atmospheric measurement needed to resolve mesoscale dynamics. The instrument may operate in conjunction with this document, Volume 1 - Management, which summarizes the highlights of final reports on both the radiometer instrument and antenna studies. The radiometer instrument summary includes a synopsis of Volume 2 - Radiometer Receiver Feasibility, including design, recommended configuration, performance estimates, and weight and power estimates. The summary of the antenna study includes a synopsis of Volume 3 - Antenna Feasibility, including preliminary design tradeoffs, performance of selected design, and details of the mechanical/thermal design.

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