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DOE OSTI2017

State Performance-Based Regulation Using Multiyear Rate Plans for U.S. Electric Utilities

Electric utilities today must contain costs at a time when many need to modernize aging systems and all face major changes in technologies, customer preferences and competitive pressures.Most U.S. electric utility facilities are investor-owned, subject to rate and service regulation by state public utility commissions. Regulatory systems under which these utilities operate affect their performance and ability to meet these challenges. In this business environment, multiyear rate plans have some advantages over traditional rate regulation.The report focuses on key design issues and provides case studies of the multiyear rate plan approach, applicable to both vertically integrated and restructured states. Mark Newton Lowry and Matt Makos of Pacific Energy Group Research and Jeff Deason of Berkeley Lab authored the report; Lisa Schwartz, Berkeley Lab, was project manager and technical editor.The report is aimed primarily at state utility regulators and stakeholders in the state regulatory process. The multiyear rate approach also provides ideas on how to streamline oversight of public power utilities and rural electric cooperatives for their governing boards.Two key provisions of multiyear rate plans strengthen cost containment incentives and streamline regulation: 1. Reducing frequency of rate cases, typically to every four or five years 2. Using an attrition relief mechanism to escalate rates or revenue between rate cases to address cost pressures such as inflation and growth in number of customers, independently of the utility’s own cost Better utility performance can be achieved under well-designed multiyear rate plans while achieving lower regulatory costs. Benefits can be shared between utilities and their customers. But plans can be complex and involve significant changes in the regulatory system. Designing plans that stimulate utility performance without undue risk and share benefits fairly can be challenging.This report discusses the rationale for multiyear rate plans and their usefulness under modern business conditions. It then explains critical plan design issues and challenges and presents results from numerical research that considers the extra incentive power achieved under different plan provisions. Next, the report presents several case studies of utilities that have operated under formal multiyear rate plans or, for various reasons, have stayed out of rate cases for more than a decade. These studies consider the effect of multiyear rate plans and rate case frequency on utility cost, reliability and other performance dimensions.

29 ENERGY PLANNING, POLICY, AND ECONOMY↗

DOE OSTI2018

National Plan for the Disposal of Existing and Future TRU Wastes - 18616

Now that the Waste Isolation Pilot Plant (WIPP) has re-opened, after being down for three years due to an accident the DOE National TRU Program has re-developed a plan for the disposal of existing and future TRU wastes. The National TRU Waste Management Plan (NTWMP) is an integrated plan to address the needs of DOE sites across the DOE Weapons Complex that create and store TRU waste, and is centered on the capability of WIPP to receive and dispose of TRU waste. The WIPP capability is planned as a weekly shipping rate and is defined by emplacement and receipt rate capabilities since WIPP is not permitted for long-term storage. And, shipping rates may be constrained by new WIPP Waste Acceptance Criteria (WAC) and future plans for repository configurations and disposal package capabilities over the next 30 years. Since WIPP is the only disposal system available to the DOE for TRU waste disposal, DOE has a newly projected life-cycle need for WIPP to remain open and available up to 2050. It is projected that the need for WIPP will continue up to the year 2050 for the disposition of the remaining legacy TRU inventories and for the disposal of TRU waste continuing to be generated at DOE's National Laboratories. In addition, there are several other potential new waste streams in which WIPP is being considered an alternative solution for their disposition. The NTWMP has been updated to reflect the short-term and long-term plans for TRU waste disposal at WIPP. The short-term plan is used by DOE for budget projection and integration purposes to facilitate and inform budget planning, both in DOE's Environmental Management (EM) and National Nuclear Security Administration (NNSA) organizations. Most legacy TRU waste (generated in the past and stored at DOE sites today) is owned and managed by EM. And, EM submits integrated budget requests for DOE sites, including the integration of resources for TRU waste management. NNSA and DOE's Office of Science (OS) funds TRU waste management as part of their mission funding and NNSA should eventually be the primary user of the WIPP resources as EM's legacy TRU waste is cleaned-up. Prior to the unexpected shutdown of WIPP in 2014, there was a small back-log of waste certified for WIPP disposal and shipments of TRU waste to WIPP were 'just-in-time' as waste was certified. After three years of WIPP being down, DOE sites have built significant back-logs of TRU waste to be certified for WIPP. That back-log built up to over 25,000 containers of TRU waste during that three-year period (Table 1). The backlog included both Contact-Handled (CH) TRU waste and Remote-Handled (RH) TRU waste, and even though WIPP re-opened in April of 2017, it is only open for TRU waste containers that can be stacked on disposal room floors. Plans for changing RH waste disposal packages and methods are in-the-works, but are not yet mature enough for significant planning. In addition, the WIPP underground facilities are now partially contaminated with radioactive particulate, which significantly reduces the WIPP operational efficiencies as compared to 2014. With a large back-log of waste ready for WIPP disposal and limited throughput for WIPP disposal rates, the focus of the NTWMP is to prioritize the selection of TRU wastes from the various sites based on WIPP waste emplacement rates and shipping rates to WIPP. Some TRU waste sites have a significant need to be top priority for shipments to WIPP, and that must be balanced with the need for all TRU waste sites to have some shipments to deplete their back-log of TRU wastes. Storage and management of TRU waste is very costly for DOE and many of those resources could be used to optimize the overall disposition of TRU waste and save DOE significant funding. In addition, the plan will show the possible transition of TRU Waste Management from primarily being an EM function to being an NNSA function in the coming years. As legacy TRU waste inventories are removed, and as NNSA mission-related TRU waste inventories are produced, DOE will be faced with deciding where the primary responsibility for TRU waste management should reside. (author)

12 MANAGEMENT OF RADIOACTIVE AND NON-RADIOACTIVE W↗

DOE OSTI2023

Integrating equity in transportation scenario planning: A systematic review

To address the growing uncertainties in the future transportation industry, planners and engineers have identified and implemented scenario planning, a multi-step and strategic approach, in long-range transportation planning. A comprehensive examination of how equity is envisioned, planned, and analyzed during this process remains absent, despite several key guidelines of scenario planning exercises. This paper conducts a systematic literature review focusing on how equity has been considered and evaluated in scenario planning. The resources include academic papers, agency reports, and materials from the recent scenario planning conference, the 2nd Conference on Scenario Planning in Transportation hosted by the Transportation Research Board. This paper examines equity in scenario planning in three important ways: 1) the ways equity has been integrated across steps; 2) how equity analysis has evolved; and 3) when it is necessary to consider equity. This work adds value to the existing body of knowledge by presenting the policy implications based on the review of the current scenario planning research and practices. Early policy recommendations include the need for more vertical equity evaluations, the construction of robustness and justice indicators, and the adoption of a flexible mindset of planning for rather than being fixated on a single scenario.

29 ENERGY PLANNING, POLICY, AND ECONOMY↗

DOE OSTI2024

U.S. Department of Energy-National Lab Equity Summit: Grid Planning and Operations (Workshop Report)

This report summarizes the U.S. DOE and national laboratories equity summit that was held on February 5, 2024, and focused on grid planning and operations. The objectives of the summit were to connect DOE and lab researchers working on grid-related equity issues, share information on current and planned grid-related equity projects and initiatives, and inspire and educate participants by hearing from our panelists about solutions and challenges to integrating equity in grid planning and operations. The summit included two panels of industry leaders. The first was a state and community perspectives panel that included representatives from a state public utility commission (Oregon Public Utility Commission), a state energy office (Washington Department of Commerce), a state utility consumer advocate (Connecticut Consumer Counsel), and industry consultants (Elevated Engagement and ArkSpring Consulting). Panelists shared successes they have seen, critical challenges related to equity and grid planning and operations, and other considerations. The second panel addressed utility perspectives and included representatives from two utilities (Commonwealth Edison and Tacoma Power), the National Rural Electric Cooperative (NRECA), and a former utility employee and legal consultant. Panelists discussed the role of the utility concerning equity, the most significant technical and data modeling needs and opportunities, and the role the labs could help advance equity in grid planning and operations. There was also a session on partner organization presentations. Argonne National Laboratory made a short presentation on the Grid Modernization Laboratory Consortium (GMLC) project they are leading on equity-informed power system planning. NARUC, NASEO, and the Clean Energy States Alliance, as partners of the GMLC project also shared updates on relevant activities and resources. During the summit, there were two rounds of lightning presentations by national labs and DOE highlighting research that addresses equity and grid planning and operations (Tables 5 and 6 and slides in the Appendix). The goal of the lightning rounds was to share information between participants to encourage collaboration and leverage ongoing research at labs and DOE. The summit included two interactive exercises where summit participants shared their perspectives on relevant equity projects and initiatives (Table 2), key challenges regarding equity and grid planning and operations (Table 3), and promising innovations or progress (Table 4). At the end of the session, participants were asked to share essential insights from the event (Table 7) and an action they plan to take as a result of the event. Participants agreed that the event was useful in helping them share and learn from each other. The project team plans to use the information from the summit as a starting point to help inform future research and technical assistance. In 2026, another Equity Summit will be held (virtually or in person) as part of the same project to help raise awareness and disseminate research and resources completed during the project's duration.

24 POWER TRANSMISSION AND DISTRIBUTION↗

DOE OSTI2011

Impact of [{sup 18}F]Fluorodeoxyglucose PET-CT Staging on Treatment Planning in Radiotherapy Incorporating Elective Nodal Irradiation for Non-Small-Cell Lung Cancer: A Prospective Study;Non-small-cell lung cancer; PET; Radiotherapy; Elective nodal irradiation

Purpose: To evaluate prospectively how positron emission tomography (PET) information changes treatment plans for non-small-cell lung cancer (NSCLC) patients receiving or not receiving elective nodal irradiation (ENI). Methods and Materials: One hundred consecutive patients referred for curative radiotherapy were included in the study. Treatment plans were carried out with CT data sets only. For stage III patients, mediastinal ENI was planned. Then, patients underwent PET-CT for diagnostic/planning purposes. PET/CT was fused with the CT data for final planning. New targets were delineated. For stage III patients with minimal N disease (N0-N1, single N2), the ENI was omitted in the new plans. Patients were treated according to the PET-based volumes and plans. The gross tumor volume (GTV)/planning tumor volume (PTV) and doses for critical structures were compared for both data sets. The doses for areas of potential geographical misses derived with the CT data set alone were compared in patients with and without initially planned ENI. Results: In the 75 patients for whom the decision about curative radiotherapy was maintained after PET/CT, there would have been 20 cases (27%) with potential geographical misses by using the CT data set alone. Among them, 13 patients would receive ENI; of those patients, only 2 patients had the PET-based PTV covered by 90% isodose by using the plans based on CT alone, and the mean of the minimum dose within the missed GTV was 55% of the prescribed dose, while for 7 patients without ENI, it was 10% (p = 0.006). The lung, heart, and esophageal doses were significantly lower for plans with ENI omission than for plans with ENI use based on CT alone. Conclusions: PET/CT should be incorporated in the planning of radiotherapy for NSCLC, even in the setting of ENI. However, if PET/CT is unavailable, ENI may to some extent compensate for an inadequate dose coverage resulting from diagnostic uncertainties.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

DOE OSTI2011

Experience-Based Quality Control of Clinical Intensity-Modulated Radiotherapy Planning

Purpose: To incorporate a quality control tool, according to previous planning experience and patient-specific anatomic information, into the intensity-modulated radiotherapy (IMRT) plan generation process and to determine whether the tool improved treatment plan quality. Methods and Materials: A retrospective study of 42 IMRT plans demonstrated a correlation between the fraction of organs at risk (OARs) overlapping the planning target volume and the mean dose. This yielded a model, predicted dose = prescription dose (0.2 + 0.8 [1 - exp(-3 overlapping planning target volume/volume of OAR)]), that predicted the achievable mean doses according to the planning target volume overlap/volume of OAR and the prescription dose. The model was incorporated into the planning process by way of a user-executable script that reported the predicted dose for any OAR. The script was introduced to clinicians engaged in IMRT planning and deployed thereafter. The script's effect was evaluated by tracking {delta} = (mean dose-predicted dose)/predicted dose, the fraction by which the mean dose exceeded the model. Results: All OARs under investigation (rectum and bladder in prostate cancer; parotid glands, esophagus, and larynx in head-and-neck cancer) exhibited both smaller {delta} and reduced variability after script implementation. These effects were substantial for the parotid glands, for which the previous {delta} = 0.28 {+-} 0.24 was reduced to {delta} = 0.13 {+-} 0.10. The clinical relevance was most evident in the subset of cases in which the parotid glands were potentially salvageable (predicted dose <30 Gy). Before script implementation, an average of 30.1 Gy was delivered to the salvageable cases, with an average predicted dose of 20.3 Gy. After implementation, an average of 18.7 Gy was delivered to salvageable cases, with an average predicted dose of 17.2 Gy. In the prostate cases, the rectum model excess was reduced from {delta} = 0.28 {+-} 0.20 to {delta} = 0.07 {+-} 0.15. On surveying dosimetrists at the end of the study, most reported that the script both improved their IMRT planning (8 of 10) and increased their efficiency (6 of 10). Conclusions: This tool proved successful in increasing normal tissue sparing and reducing interclinician variability, providing effective quality control of the IMRT plan development process.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

DOE OSTI2016

Effect of Dosimetric Outliers on the Performance of a Commercial Knowledge-Based Planning Solution

Purpose: RapidPlan, a commercial knowledge-based planning solution, uses a model library containing the geometry and associated dosimetry of existing plans. This model predicts achievable dosimetry for prospective patients that can be used to guide plan optimization. However, it is unknown how suboptimal model plans (outliers) influence the predictions or resulting plans. We investigated the effect of, first, removing outliers from the model (cleaning it) and subsequently adding deliberate dosimetric outliers. Methods and Materials: Clinical plans from 70 head and neck cancer patients comprised the uncleaned (UC) Model{sub UC}, from which outliers were cleaned (C) to create Model{sub C}. The last 5 to 40 patients of Model{sub C} were replanned with no attempt to spare the salivary glands. These substantial dosimetric outliers were reintroduced to the model in increments of 5, creating Model{sub 5} to Model{sub 40} (Model{sub 5-40}). These models were used to create plans for a 10-patient evaluation group. Plans from Model{sub UC} and Model{sub C}, and Model{sub C} and Model{sub 5-40} were compared on the basis of boost (B) and elective (E) target volume homogeneity indexes (HI{sub B}/HI{sub E}) and mean doses to oral cavity, composite salivary glands (comp{sub sal}) and swallowing (comp{sub swal}) structures. Results: On average, outlier removal (Model{sub C} vs Model{sub UC}) had minimal effects on HI{sub B}/HI{sub E} (0%-0.4%) and sparing of organs at risk (mean dose difference to oral cavity and comp{sub sal}/comp{sub swal} were ≤0.4 Gy). Model{sub 5-10} marginally improved comp{sub sal} sparing, whereas adding a larger number of outliers (Model{sub 20-40}) led to deteriorations in comp{sub sal} up to 3.9 Gy, on average. These increases are modest compared to the 14.9 Gy dose increases in the added outlier plans, due to the placement of optimization objectives below the inferior boundary of the dose-volume histogram-predicted range. Conclusions: Overall, dosimetric outlier removal from or addition of 5 to 10 outliers to a 70-patient model had marginal effects on resulting plan quality. Although the addition of >20 outliers deteriorated plan quality, the effect was modest. In this study, RapidPlan demonstrated robustness for moderate proportions of salivary gland dosimetric outliers.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

DOE OSTI2018

Oncentra brachytherapy planning system

In modern cancer management, treatment planning has progressed as a contemporary tool with all the advances in computing power in recent years. One of the advanced planning tools uses 3-dimensional (3D) data sets for accurate dose distributions in patient prescription. Among these planning processes, brachytherapy has been a very important part of a successful cancer management program, offering clinical benefits with specific or combined treatments with external beam therapy. In this chapter, we mainly discussed the Elekta Oncentra planning system, which is the main treatment planning tool for high-dose rate (HDR) modality in our facility and in many other facilities in the United States. HDR is a technically advanced form of brachytherapy; a high-intensity radiation source (3.6 mm in length) is delivered with step motor in submillimeter precision under computer guidance directly into the tumor areas while minimizing injury to surrounding normal healthy tissue. Oncentra planning is the key component to generate a deliverable brachytherapy procedure, which is executed on the microSelectron V3 remote afterloader treatment system. Creating a highly conformal plan can be a time-consuming task. The development of Oncentra software (version 4.5.3) offers a variety of useful tools that facilitate many of the clinical challenging tasks for planning, such as contouring and image reconstruction, as well as rapid planning calculations with dose and dose volume histogram analysis. Oncentra Brachy module creates workflow and optimizes the planning accuracy for wide varieties of clinical HDR treatments, such as skin, gynecologic (GYN), breast, prostate, and many other applications. The treatment file can also be transferred to the afterloader control station for speedy delivery. The design concept, calculation algorithms, and optimization modules presented some key characteristics to plan and treat the patients effectively and accurately. The dose distribution and accuracy of several clinical sample cases were discussed to illustrate the effectiveness and clinical efficacy. The American Association of Physicists in Medicine brachytherapy reports of TG-43 and TG-186 were also described and compared in evaluations of fundamental calculation methodologies.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

DOE OSTI2014

SU-D-BRD-06: Automated Population-Based Planning for Whole Brain Radiation Therapy

Purpose: Treatment planning for whole brain radiation treatment is technically a simple process but in practice it takes valuable clinical time of repetitive and tedious tasks. This report presents a method that automatically segments the relevant target and normal tissues and creates a treatment plan in only a few minutes after patient simulation. Methods: Segmentation is performed automatically through morphological operations on the soft tissue. The treatment plan is generated by searching a database of previous cases for patients with similar anatomy. In this search, each database case is ranked in terms of similarity using a customized metric designed for sensitivity by including only geometrical changes that affect the dose distribution. The database case with the best match is automatically modified to replace relevant patient info and isocenter position while maintaining original beam and MLC settings. Results: Fifteen patients were used to validate the method. In each of these cases the anatomy was accurately segmented to mean Dice coefficients of 0.970 ± 0.008 for the brain, 0.846 ± 0.009 for the eyes and 0.672 ± 0.111 for the lens as compared to clinical segmentations. Each case was then subsequently matched against a database of 70 validated treatment plans and the best matching plan (termed auto-planned), was compared retrospectively with the clinical plans in terms of brain coverage and maximum doses to critical structures. Maximum doses were reduced by a maximum of 20.809 Gy for the left eye (mean 3.533), by 13.352 (1.311) for the right eye, and by 27.471 (4.856), 25.218 (6.315) for the left and right lens. Time from simulation to auto-plan was 3-4 minutes. Conclusion: Automated database- based matching is an alternative to classical treatment planning that improves quality while providing a cost—effective solution to planning through modifying previous validated plans to match a current patient's anatomy.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2014

SU-E-T-581: A Comparative Study of Standard IMRT and VMAT Planning Techniques for Unilateral and Bilateral Head and Neck Irradiation

Purpose: To compare dosimetric properties and monitor units (MU) of IMRT plans with several VMAT head and neck (H and N) plans. Methods: Seventeen unilateral H and N (UHN) and five bilateral H and N (BHN) patients initially treated with IMRT were replanned with VMAT. Several arc arrangements were studied for each patient: 1)for UHN, two 360° arcs, two 260° arcs, two 210° arcs, two 360° arcs with contralateral avoidance sectors, and 2)for BHN, two 360° arcs, two 360° arcs with bilateral avoidance sectors, two 360° arcs with bilateral avoidance sectors and a third arc limited to the upper neck. Optimization constraints were adjusted for each patient and plan. All plans were normalized to achieve the same highest-dose PTV coverage. Percent differences (IMRT-VMAT)/VMAT in MU, dose homogeneity (HI=maximum point dose/prescription dose), and organ-at-risk (OAR) metrics are reported and statistical significance evaluated (p<0.05; paired Student t-test). Results: Average reduction in MU with VMAT was 28% for UHN (p<0.0001) and 63% for BHN (p<0.0001). Average HI for UHN IMRT and 360° arc VMAT plans was 1.08 and for plans with arcs <360° average HI=1.10. Average HI for BHN IMRT was 1.07, for three-arc VMAT 1.08, and for two-arc VMAT 1.11. For UHN, two 210° arcs achieved lower contralateral parotid max (−2.6 Gy, p<0.02) and mean (−1.2 Gy, p=0.06) dose. For BHN two-arc plans, contralateral parotid mean dose increased (3.3 Gy, p<0.04) and larynx max dose increased (2.9 Gy, p<0.02) with no change in larynx mean dose. Conclusion: For UHN, 360degree arc VMAT consistently produced plans dosimetrically comparable to IMRT with the benefit of lower MU. VMAT with arcs <360degrees produced plans inferior to IMRT in dose homogeneity and without significantly improved OAR sparing. For BHN, three-arc plans were dosimetrically comparable to IMRT with lower MU, while two-arc plans were inferior to IMRT in HI and OAR dose. Research supported in part by a Kaye Family Award.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2014

SU-C-19A-07: Influence of Immobilization On Plan Robustness in the Treatment of Head and Neck Cancer with IMPT

Purpose: We evaluated the effect of interposing immobilization devices into the beam's path on the robustness of a head and neck plan. Methods: An anthropomorphic head phantom was placed into a preliminary prototype of a specialized head and neck immobilization device for proton beam therapy. The device consists of a hard low density shell, a custom mold insert, and thermoplastic mask to immobilize the patient's head in the shell. This device was provided by CIVCO Medical Solutions for the purpose of evaluation of suitability for proton beam therapy. See Figure 1. Two pairs of treatment plans were generated. The first plan in each pair was a reference plan including only the anthropomorphic phantom, and the second plan in each pair included the immobilization device. In all other respects the plans within the pair were identical. Results: In the case of the simple plan the degradation of plan robustness was found to be clinically insignificant. In this case, target coverage in the worst case scenario was reduced from 95% of the target volume receiving 96.5% of prescription dose to 95% of the target volume receiving 96.3% of prescription dose by introducing the immobilization device. In the case of the complex plan, target coverage of the boost volume in the worst case scenario was reduced from 95% of the boost target volume receiving 97% of prescription dose to 95% of the boost target volume receiving 83% of prescription dose by introducing the immobilization device. See Figure 2. Conclusion: Immobilization devices may have a deleterious effect on plan robustness. Evaluation of the preliminary prototype revealed a variable impact on the plan robustness depending of the complexity of the case. Brian Morse is an employee of CIVCO Medical Solutions.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2014

Toward optimizing patient-specific IMRT QA techniques in the accurate detection of dosimetrically acceptable and unacceptable patient plans

Purpose: The authors investigated the performance of several patient-specific intensity-modulated radiation therapy (IMRT) quality assurance (QA) dosimeters in terms of their ability to correctly identify dosimetrically acceptable and unacceptable IMRT patient plans, as determined by an in-house-designed multiple ion chamber phantom used as the gold standard. A further goal was to examine optimal threshold criteria that were consistent and based on the same criteria among the various dosimeters. Methods: The authors used receiver operating characteristic (ROC) curves to determine the sensitivity and specificity of (1) a 2D diode array undergoing anterior irradiation with field-by-field evaluation, (2) a 2D diode array undergoing anterior irradiation with composite evaluation, (3) a 2D diode array using planned irradiation angles with composite evaluation, (4) a helical diode array, (5) radiographic film, and (6) an ion chamber. This was done with a variety of evaluation criteria for a set of 15 dosimetrically unacceptable and 9 acceptable clinical IMRT patient plans, where acceptability was defined on the basis of multiple ion chamber measurements using independent ion chambers and a phantom. The area under the curve (AUC) on the ROC curves was used to compare dosimeter performance across all thresholds. Optimal threshold values were obtained from the ROC curves while incorporating considerations for cost and prevalence of unacceptable plans. Results: Using common clinical acceptance thresholds, most devices performed very poorly in terms of identifying unacceptable plans. Grouping the detector performance based on AUC showed two significantly different groups. The ion chamber, radiographic film, helical diode array, and anterior-delivered composite 2D diode array were in the better-performing group, whereas the anterior-delivered field-by-field and planned gantry angle delivery using the 2D diode array performed less well. Additionally, based on the AUCs, there was no significant difference in the performance of any device between gamma criteria of 2%/2 mm, 3%/3 mm, and 5%/3 mm. Finally, optimal cutoffs (e.g., percent of pixels passing gamma) were determined for each device and while clinical practice commonly uses a threshold of 90% of pixels passing for most cases, these results showed variability in the optimal cutoff among devices. Conclusions: IMRT QA devices have differences in their ability to accurately detect dosimetrically acceptable and unacceptable plans. Field-by-field analysis with a MapCheck device and use of the MapCheck with a MapPhan phantom while delivering at planned rotational gantry angles resulted in a significantly poorer ability to accurately sort acceptable and unacceptable plans compared with the other techniques examined. Patient-specific IMRT QA techniques in general should be thoroughly evaluated for their ability to correctly differentiate acceptable and unacceptable plans. Additionally, optimal agreement thresholds should be identified and used as common clinical thresholds typically worked very poorly to identify unacceptable plans.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

SU-D-BRB-04: Plan Quality Comparison of Intracranial Stereotactic Radiosurgery (SRS) for Gamma Knife and VMAT Treatments

Purpose: To compare treatment plan quality of intracranial stereotactic radiosurgery (SRS) for VMAT (RapidArc) and Gamma Knife (GK) systems. Methods: Ten patients with 24 tumors (seven with 1–2 and three with 4–6 lesions), previously treated with GK 4C (prescription doses ranging from 14–23 Gy) were re-planned for RapidArc. Identical contour sets were kept on MRI images for both plans with tissues assigned a CT number of zero. RapidArc plans were performed using 6 MV flattening-filter-free (FFF) beams with dose rate of 1400 MU/minute using two to eight arcs with the following combinations: 2 full coplanar arcs and the rest non-coplanar half arcs. Beam selection was based on target depth. Areas that penetrated more than 10 cm of tissue were avoided by creating smaller arcs or using avoidance sectors in optimization. Plans were optimized with jaw tracking and a high weighting to the normal-brain-tissue and Normal-Tissue-Objective without compromising PTV coverage. Plans were calculated on a 1 mm grid size using AAA algorithm and then normalized so that 99% of each target volume received the prescription dose. Plan quality was assessed by target coverage using Paddick Conformity Index (PCI), sparing of normal-brain-tissue through analysis of V4, V8, and V12 Gy, and integral dose. Results: In all cases critical structure dose criteria were met. RapidArc had a higher PCI than GK plans for 23 out of 24 lesions. The average PCI was 0.76±0.21 for RapidArc and 0.46±0.20 for GK plans (p≤0.001), respectively. Integral dose and normal-brain-tissue doses for all criteria were lower for RapidArc in nearly all patients. The average ratio of GK to RapidArc plans was 1.28±0.27 (p=0.018), 1.31±0.25 (p=0.017), 1.81±0.43 (p=0.005), and 1.50±0.61 (p=0.006) for V4, V8, and V12 Gy, and integral dose, respectively. Conclusion: VMAT was capable of producing higher quality treatment plans than GK when using optimal beam geometries and proper optimization techniques.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

SU-E-J-125: A Novel IMRT Planning Technique to Spare Sacral Bone Marrow in Pelvic Cancer Patients

Purpose: Develop an IMRT planning technique that can preferentially spare sacral bone marrow for pelvic cancer patients. Methods: Six pelvic cancer patients (two each with anal, cervical, and rectal cancer) were enrolled in an IRB approved protocol to obtain FLT PET images at simulation, during, and post chemoradiation therapy. Initially, conventional IMRT plans were created to maintain target coverage and reduce dose to OARs such as bladder, bowel, rectum, and femoral heads. Simulation FLT PET images were used to create IMRT plans to spare bone marrow identified as regions with SUV of 2 or greater (IMRT-BMS) within the pelvic bones from top of L3 to 5mm below the greater trochanter without compromising PTV coverage or OAR sparing when compared to the initial IMRT plan. IMRT-BMS plans used 8–10 beam angles that surrounded the subject. These plans were used for treatment. Retrospectively, the same simulation FLT PET images were used to create IMRT plans that spared bone marrow located in the sacral pelvic bone region (IMRT-FAN) also without compromising PTV coverage or OAR sparing. IMRT-FAN plans used 16 beam angles every 12° anteriorly from 90° – 270°. Optimization objectives for the sacral bone marrow avoidance region were weighted to reduce ≥V10. Results: IMRT-FAN reduced dose to the sacral bone marrow for all six subjects. The average V5, V10, V20, and V30 differences from the IMRT-BMS plan were −2.2 ± 1.7%, −11.4 ± 3.6%, −17.6 ± 5.1%, and −19.1 ± 8.1% respectively. Average PTV coverage change was 0.5% ± 0.8% from the conventional IMRT plan. Conclusion: An IMRT planning technique that uses beams from the anterior and lateral directions reduced the volume of sacral bone marrow that receives ≤10Gy while maintaining PTV coverage and OAR sparing. Additionally, the volume of sacral bone marrow that received 20 or 30 Gy was also reduced.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

SU-E-T-76: A Software System to Monitor VMAT Plan Complexity in a Large Radiotherapy Centre

Purpose: To develop a system that analyses and reports the complexity of Volumetric Modulated Arc Therapy (VMAT) plans to aid in the decision making for streamlining patient specific dosimetric quality assurance (QA) tests. Methods: A software system, Delcheck, was developed in-house to calculate VMAT plan and delivery complexity using the treatment delivery file. Delcheck has the functionality to calculate multiple plan complexity metrics including the Li-Xing Modulation Index (LI-MI), multiplicative combination of Leaf Travel and Modulation Complexity Score (LTMCSv), Monitor Units per prescribed dose (MU/D) and the delivery complexity index (MIt) that incorporates the modulation of dose rate, leaf speed and gantry speed. Delcheck includes database functionality to store and compare plan metrics for a specified treatment site. The overall plan and delivery complexity is assessed based on the 95% conformance limit of the complexity metrics as Similar, More or Less complex. The functionality of the software was tested using 42 prostate conventional, 10 prostate SBRT and 15 prostate bed VMAT plans generated for an Elekta linear accelerator. Results: The mean(σ) of LI-MI for conventional, SBRT and prostate bed plans were 1690(486), 3215.4(1294) and 3258(982) respectively. The LTMCSv of the studied categories were 0.334(0.05), 0.325(0.07) and 0.3112(0.09). The MU/D of the studied categories were 2.4(0.4), 2.7(0.7) and 2.5(0.5). The MIt of the studied categories were 21.6(3.4), 18.2(3.0) and 35.9(6.6). The values of the complexity metrics show that LI-MI appeared to resolve the plan complexity better than LTMCSv and MU/D. The MIt value increased as the delivery complexity increased. Conclusion: The developed software was shown to be working as expected. In studied treatment categories Prostate bed plans are more complex in both plan and delivery and SBRT is more complex in plan and less complex in delivery as demonstrated by LI-MI and MIt. This project was funded through a Cancer Council NSW Project Grant (RG14-11)

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

SU-E-T-215: Comparison of VMAT-SABR Treatment Plans with Flattened Filter (FF) Beam and Flattening Filter-Free (FFF) Beam for Localized Prostate Cancer

Purpose: The purpose of this study is to access VMAT-SABR plan using flattening filter (FF) and flattening filter-free (FFF) beam, and compare the verification results for all pretreatment plans. Methods: SABR plans for 20 prostate patients were optimized in the Eclipse treatment planning system. A prescription dose was 42.7 Gy/7 fractions. Four SABR plans for each patient were calculated using Acuros XB algorithm with both FF and FFF beams of 6- and 10-MV. The dose-volume histograms (DVH) and technical parameters were recorded and compared. A pretreatment verification was performed and the gamma analysis was used to quantify the agreement between calculations and measurements. Results: For each patient, the DVHs are closely similar for plans of four different beams. There are small differences showed in dose distributions and corresponding DVHs when comparing the each plan related to the same patient. Sparing on bladder and rectum was slightly better on plans with 10-MV FF and FFF than with 6-MV FF and FFF, but this difference was negligible. However, there was no significance in the other OARs. The mean agreement of 3%/3mm criteria was higher than 97% in all plans. The mean MUs and deliver time employed was 1701±101 and 3.02±0.17 min for 6-MV FF, 1870±116 and 1.69±0.08 min for 6-MV FFF, 1471±86 and 2.68±0.14 min for 10-MV FF, and 1619±101 and 0.98±0.04 min for 10-MV FFF, respectively. Conclusion: Dose distributions on prostate SABR plans using FFF beams were similar to those generated by FF beams. However, the use of FFF beam offers a clear benefit in delivery time when compared to FF beam. Verification of pretreatment also represented the acceptable and comparable results in all plans using FF beam as well as FFF beam. Therefore, this study suggests that the use of FFF beam is feasible and efficient technique for prostate SABR.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

SU-E-T-471: Improvement of Gamma Knife Treatment Planning Through Tumor Control Probability for Metastatic Brain Tumors

Purpose: The dose–volume histogram (DVH) has been normally accepted as a tool for treatment plan evaluation. However, spatial information is lacking in DVH. As a supplement to the DVH in three-dimensional treatment planning, the differential DVH (DDVH) provides the spatial variation, the size and magnitude of the different dose regions within a region of interest, which can be incorporated into tumor control probability model. This study was to provide a method in evaluating and improving Gamma Knife treatment planning. Methods: 10 patients with brain metastases from different primary tumors including melanoma (#1,#4,#5, #10), breast cancer (#2), prostate cancer (#3) and lung cancer (#6–9) were analyzed. By using Leksell GammaPlan software, two plans were prepared for each patient. Special attention was given to the DDVHs that were different for different plans and were used for a comparison between two plans. Dose distribution inside target and tumor control probability (TCP) based on DDVH were calculated, where cell density and radiobiological parameters were adopted from literature. The plans were compared based on DVH, DDVH and TCP. Results: Using DVH, the coverage and selectivity were the same between plans for 10 patients. DDVH were different between two plans for each patient. The paired t-test showed no significant difference in TCP between the two plans. For brain metastases from melanoma (#1, #4–5), breast cancer (#2) and lung cancer (#6–8), the difference in TCP was less than 5%. But the difference in TCP was about 6.5% for patient #3 with the metastasis from prostate cancer, 10.1% and 178.7% for two patients (#9–10) with metastasis from lung cancer. Conclusion: Although DVH provides average dose–volume information, DDVH provides differential dose– volume information with respect to different regions inside the tumor. TCP provides radiobiological information and adds additional information on improving treatment planning as well as adaptive radiotherapy. Further clinical validation is necessary.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

SU-E-T-574: Novel Chance-Constrained Optimization in Intensity-Modulated Proton Therapy Planning to Account for Range and Patient Setup Uncertainties

Purpose: We propose to apply a probabilistic framework, namely chanceconstrained optimization, in the intensity-modulated proton therapy (IMPT) planning subject to range and patient setup uncertainties. The purpose is to hedge against the influence of uncertainties and improve robustness of treatment plans. Methods: IMPT plans were generated for a typical prostate patient. Nine dose distributions are computed — the nominal one and one each for ±5mm setup uncertainties along three cardinal axes and for ±3.5% range uncertainty. These nine dose distributions are supplied to the solver CPLEX as chance constraints to explicitly control plan robustness under these representative uncertainty scenarios with certain probability. This probability is determined by the tolerance level. We make the chance-constrained model tractable by converting it to a mixed integer optimization problem. The quality of plans derived from this method is evaluated using dose-volume histogram (DVH) indices such as tumor dose homogeneity (D5% – D95%) and coverage (D95%) and normal tissue sparing like V70 of rectum, V65, and V40 of bladder. We also compare the results from this novel method with the conventional PTV-based method to further demonstrate its effectiveness Results: Our model can yield clinically acceptable plans within 50 seconds. The chance-constrained optimization produces IMPT plans with comparable target coverage, better target dose homogeneity, and better normal tissue sparing compared to the PTV-based optimization [D95% CTV: 67.9 vs 68.7 (Gy), D5% – D95% CTV: 11.9 vs 18 (Gy), V70 rectum: 0.0 % vs 0.33%, V65 bladder: 2.17% vs 9.33%, V40 bladder: 8.83% vs 21.83%]. It also simultaneously makes the plan more robust [Width of DVH band at D50%: 2.0 vs 10.0 (Gy)]. The tolerance level may be varied to control the tradeoff between plan robustness and quality. Conclusion: The chance-constrained optimization generates superior IMPT plan compared to the PTV-based optimization with explicit control of plan robustness. NIH/NCI K25CA168984, Eagles Cancer Research Career Development, The Lawrence W. and Marilyn W. Matteson Fund for Cancer Research, Mayo ASU Seed Grant, and The Kemper Marley Foundation.

62 RADIOLOGY AND NUCLEAR MEDICINE↗