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At least 559 records · Page 31
All sourcesNASA NTRSDOE OSTI
DOE OSTI2014

SU-E-J-73: Generation of Volumetric Images with a Respiratory Motion Model Based On An External Surrogate Signal

Purpose: Respiratory motion during radiotherapy treatment can differ significantly from motion observed during imaging for treatment planning. Our goal is to use an initial 4DCT scan and the trace of an external surrogate marker to generate 3D images of patient anatomy during treatment. Methods: Deformable image registration is performed on images from an initial 4DCT scan. The deformation vectors are used to develop a patient-specific linear relationship between the motion of each voxel and the trajectory of an external surrogate signal. Correlations in motion are taken into account with principal component analysis, reducing the number of free parameters. This model is tested with digital phantoms reproducing the breathing patterns of ten measured patient tumor trajectories, using five seconds of data to develop the model and the subsequent thirty seconds to test its predictions. The model is also tested with a breathing physical anthropomorphic phantom programmed to reproduce a patient breathing pattern. Results: The error (mean absolute, 95th percentile) over 30 seconds in the predicted tumor centroid position ranged from (0.8, 1.3) mm to (2.2, 4.3) mm for the ten patient breathing patterns. The model reproduced changes in both phase and amplitude of the breathing pattern. Agreement between prediction and truth over the entire image was confirmed by assessing the global voxel intensity RMS error. In the physical phantom, the error in the tumor centroid position was less than 1 mm for all images. Conclusion: We are able to reconstruct 3D images of patient anatomy with a model correlating internal respiratory motion with motion of an external surrogate marker, reproducing the expected tumor centroid position with an average accuracy of 1.4 mm. The images generated by this model could be used to improve dose calculations for treatment planning and delivered dose estimates. This work was partially funded by a research grant from Varian Medical Systems.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-J-81: Interplay Effect in Non-Gated Dynamic Treatment Delivery of a Lung Phantom with Simulated Respiratory Motion

Purpose: To quantify the interplay effect in non-gated VMAT external beam delivery using realistic, clinically relevant 3D motion in an anthropomorphic lung phantom, and to determine if adding margins is sufficient to account for motion or if gating is required in all cases. Methods: A 4D motion stage was used to move a Virtual Water (VW) lung target containing a piece of radiochromic EBT3 film in an anthropomorphic chest phantom. A five-arc stereotactic body radiation therapy (SBRT) treatment was planned using a CT scan of the phantom in its stationary position, using planning parameters chosen to push the optimizer to achieve a highly-modulated plan. Two scenarios were delivered using a Varian TrueBeam: the first was delivered with the phantom and target both stationary and the second was delivered with the phantom stationary but the target moving in a realistic, irregular 3D elliptical pattern. A single piece of 4×4 cm{sup 2} film was used per fraction, located in the central coronal plane of the target. Film was calibrated on a 6 MV beam with dose values from 0.20 to 20 Gy. Results: Preliminary test films were analyzed in ImageJ and MatLab software. Dose maps were calculated on a central region of interest (ROI) delineated on both the motion-induced and stationary films. Both static and dynamic film dose maps agreed with planning values within acceptable uncertainty. Conclusion: Including a large number of arcs in a clinically realistic SBRT treatment could reduce the effect of motion interplay due to averaging. Because all clinics do not employ multiple arcs for SBRT lung treatments, it is still important to consider the effects of motion on treatment delivery. Further analysis on the treatment films, as well as a broader investigation other planning parameters, will be conducted.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-J-150: Impact of Intrafractional Prostate Motion On the Accuracy and Efficiency of Prostate SBRT Delivery: A Retrospective Analysis of Prostate Tracking Log Files

Purpose: To measure intrafractional prostate motion by time-based stereotactic x-ray imaging and investigate the impact on the accuracy and efficiency of prostate SBRT delivery. Methods: Prostate tracking log files with 1,892 x-ray image registrations from 18 SBRT fractions for 6 patients were retrospectively analyzed. Patient setup and beam delivery sessions were reviewed to identify extended periods of large prostate motion that caused delays in setup or interruptions in beam delivery. The 6D prostate motions were compared to the clinically used PTV margin of 3–5 mm (3 mm posterior, 5 mm all other directions), a hypothetical PTV margin of 2–3 mm (2 mm posterior, 3 mm all other directions), and the rotation correction limits (roll ±2°, pitch ±5° and yaw ±3°) of CyberKnife to quantify beam delivery accuracy. Results: Significant incidents of treatment start delay and beam delivery interruption were observed, mostly related to large pitch rotations of ≥±5°. Optimal setup time of 5–15 minutes was recorded in 61% of the fractions, and optimal beam delivery time of 30–40 minutes in 67% of the fractions. At a default imaging interval of 15 seconds, the percentage of prostate motion beyond PTV margin of 3–5 mm varied among patients, with a mean at 12.8% (range 0.0%–31.1%); and the percentage beyond PTV margin of 2–3 mm was at a mean of 36.0% (range 3.3%–83.1%). These timely detected offsets were all corrected real-time by the robotic manipulator or by operator intervention at the time of treatment interruptions. Conclusion: The durations of patient setup and beam delivery were directly affected by the occurrence of large prostate motion. Frequent imaging of down to 15 second interval is necessary for certain patients. Techniques for reducing prostate motion, such as using endorectal balloon, can be considered to assure consistently higher accuracy and efficiency of prostate SBRT delivery.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗
DOE OSTI2014

SU-E-J-156: Preclinical Inverstigation of Dynamic Tumor Tracking Using Vero SBRT Linear Accelerator: Motion Phantom Dosimetry Study

Purpose: Following the ‘end-to-end testing’ paradigm of Dynamic Target Tracking option in our Image-Guided dedicated SBRT VeroTM linac, we verify the capability of the system to deliver planned dose to moving targets in the heterogeneous thorax phantom (CIRSTM). The system includes gimbaled C-band linac head, robotic 6 degree of freedom couch and a tumor tracking method based on predictive modeling of target position using fluoroscopically tracked implanted markers and optically tracked infrared reflecting external markers. Methods: 4DCT scan of the motion phantom with the VisicoilTM implanted marker in the close vicinity of the target was acquired, the ‘exhale’=most prevalent phase was used for planning (iPlan by BrainLabTM). Typical 3D conformal SBRT treatment plans aimed to deliver 6-8Gy/fx to two types of targets: a)solid water-equivalent target 3cm in diameter; b)single VisicoilTM marker inserted within lung equivalent material. The planning GTV/CTV-to-PTV margins were 2mm, the block margins were 3 mm. The dose calculated by MonteCarlo algorithm with 1% variance using option Dose-to-water was compared to the ion chamber (CC01 by IBA Dosimetry) measurements in case (a) and GafchromicTM EBT3 film measurements in case (b). During delivery, the target 6 motion patterns available as a standard on CIRSTM motion phantom were investigated: in case (a), the target was moving along the designated sine or cosine4 3D trajectory; in case (b), the inserted marker was moving sinusoidally in 1D. Results: The ion chamber measurements have shown the agreement with the planned dose within 1% under all the studied motion conditions. The film measurements show 98.1% agreement with the planar calculated dose (gamma criteria: 3%/3mm). Conclusion: We successfully verified the capability of the SBRT VeroTM linac to perform real-time tumor tracking and accurate dose delivery to the target, based on predictive modeling of the correlation between implanted marker motion and external surrogate of breathing motion.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-J-225: Quantitative Evaluation of Rigid and Non-Rigid Motion of Liver Tumors Using Stereo Imaging During SBRT

Purpose: To quantitatively evaluate rigid and nonrigid motion of liver tumors based on fiducial tracking in 3D by stereo imaging during CyberKnife SBRT. Methods: Twenty-five liver patients previously treated with three-fractions of SBRT were retrospectively recruited in this study. During treatment, the 3D locations of fiducials were reported by the CyberKnife system after two orthogonal kV X-ray images were taken and further validated by geometry derivations. A total of 5004 pairs of X-ray images acquired during the course of treatment for all the patients, were analyzed. For rigid motion, the rotational angles and translational shifts by aligning 3D fiducial groups in different image pairs after least-square fitting were reported. For nonrigid motion, the relative interfractional tumor shape variations were reported and correlated to the sum of inter-fiducial distances. The individual fiducial displacements were also reported after rigid corrections and without angle corrections. Results: The relative tumor volume variation indicated by the inter-fiducial distances demonstrated an increasing trend in the second (101.6±3.4%) and third fraction (101.2±5.6%) among most patients. The cause could be possibly due to radiation-induced edema. For all the patients, the translational shift was 8.1±5.7 mm, with shifts in LR, AP and SI were 2.1±2.4 mm, 2.8±2.9 mm and 6.7±5.1 mm, respectively. The greatest translation shift occurred in SI, mainly due the breathing motion of diaphragm The rotational angles were 1.1±1.7°, 1.9±2.6° and 1.6±2.2°, in roll, pitch, and yaw, respectively. The 3D fiducial displacement with rigid corrections were 0.2±0.2 mm and increased to 0.6±0.3 mm without rotational corrections. Conclusion: The fiducial locations in 3D can be precisely reconstructed from CyberKnife stereo imaging system during treatment. The fiducials provide close estimation of both rigid and nonrigid motion of .liver tumors. The reported data could be further utilized for tumor margin design and motion management in in conventional linac-based treatments.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

WE-G-17A-03: MRIgRT: Quantification of Organ Motion

Purpose: To develop an MRI-based methodology and tools required for the quantification of organ motion on a dedicated MRI-guided radiotherapy system. A three-room facility, consisting of a TrueBeam 6X linac vault, a 1.5T MR suite and a brachytherapy interventional room, is currently under commissioning at our institution. The MR scanner can move and image in either room for diagnostic and treatment guidance purposes. Methods: A multi-imaging modality (MR, kV) phantom, featuring programmable 3D simple and complex motion trajectories, was used for the validation of several image sorting algorithms. The testing was performed on MRI (e.g. TrueFISP, TurboFLASH), 4D CT and 4D CBCT. The image sorting techniques were based on a) direct image pixel manipulation into columns or rows, b) single and aggregated pixel data tracking and c) using computer vision techniques for global pixel analysis. Subsequently, the motion phantom and sorting algorithms were utilized for commissioning of MR fast imaging techniques for 2D-cine and 4D data rendering. MR imaging protocols were optimized (e.g. readout gradient strength vs. SNR) to minimize the presence of susceptibility-induced distortions, which were reported through phantom experiments and numerical simulations. The system-related distortions were also quantified (dedicated field phantom) and treated as systematic shifts where relevant. Results: Image sorting algorithms were validated for specific MR-based applications such as quantification of organ motion, local data sampling, and 4D MRI for pre-RT delivery with accuracy better than the raw image pixel size (e.g. 1 mm). MR fast imaging sequences were commissioning and imaging strategies were developed to mitigate spatial artifacts with minimal penalty on the image spatial and temporal sampling. Workflows (e.g. liver) were optimized to include the new motion quantification tools for RT planning and daily patient setup verification. Conclusion: Comprehensive methods were developed and validated for the quantification of organ motion with applications in MRI-guided RT.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

TH-A-BRF-04: Intra-Fraction Motion Characterization for Early Stage Rectal Cancer Using Cine-MRI

Purpose: To investigate the intra-fraction motion in patients with early stage rectal cancer using cine-MRI. Methods: Sixteen patient diagnosed with early stage rectal cancer underwent 1.5 T MR imaging prior to each treatment fraction of their short course radiotherapy (n=76). During each scan session, three 2D sagittal cine-MRIs were performed: at the beginning (Start), after 9:30 minutes (Mid), and after 18 minutes (End). Each cine-MRI has a duration of one minute at 2Hz temporal resolution, resulting in a total of 3:48 hours of cine-MRI. Additionally, standard T2-weighted (T2w) imaging was performed. Clinical target volume (CTV) an tumor (GTV) were delineated on the T2w scan and transferred to the first time-point of each cine-MRI scan. Within each cine-MRI, the first frame was registered to the remaining frames of the scan, using a non-rigid B-spline registration. To investigate potential drifts, a similar registration was performed between the first frame of the Start and End scans.To evaluate the motion, the distances by which the edge pixels of the delineations move in anterior-posterior (AP) and cranial-caudal (CC) direction, were determined using the deformation field of the registrations. The distance which incorporated 95% of these edge pixels (dist95%) was determined within each cine-MRI, and between Start- End scans, respectively. Results: Within a cine-MRI, we observed an average dist95% for the CTV of 1.3mm/1.5mm (SD=0.7mm/0.6mm) and for the GTV of 1.2mm/1.5mm (SD=0.8mm/0.9mm), in respectively AP/CC. For the CTV motion between the Start and End scan, an average dist95% of 5.5mm/5.3mm (SD=3.1mm/2.5mm) was found, in respectively AP/CC. For the GTV motion, an average dist95% of 3.6mm/3.9mm (SD=2.2mm/2.5mm) was found in AP/CC, respectively. Conclusion: Although intra-fraction motion within a one minute cine-MRI is limited, substantial intra-fraction motion was observed within the 18 minute time period between the Start and End cine-MRI.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-C-BRF-05: Design and Geometric Validation of An Externally and Internally Deformable, Programmable Lung Motion Phantom

Purpose: Most clinically-deployed strategies for respiratory motion management in lung radiotherapy (e.g., gating, tracking) use external markers that serve as surrogates for tumor motion. However, typical lung phantoms used to validate these strategies are rigid-exterior+rigid-interior or rigid-exterior+deformable-interior. Neither class adequately represents the human anatomy, which is deformable internally as well as externally. We describe the construction and experimental validation of a more realistic, externally- and internally-deformable, programmable lung phantom. Methods: The outer shell of a commercially-available lung phantom (RS- 1500, RSD Inc.) was used. The shell consists of a chest cavity with a flexible anterior surface, and embedded vertebrae, rib-cage and sternum. A 3-axis platform was programmed with sinusoidal and six patient-recorded lung tumor trajectories. The platform was used to drive a rigid foam ‘diaphragm’ that compressed/decompressed the phantom interior. Experimental characterization comprised of mapping the superior-inferior (SI) and anterior-posterior (AP) trajectories of external and internal radioopaque markers with kV x-ray fluoroscopy and correlating these with optical surface monitoring using the in-room VisionRT system. Results: The phantom correctly reproduced the programmed motion as well as realistic effects such as hysteresis. The reproducibility of marker trajectories over multiple runs for sinusoidal as well as patient traces, as characterized by fluoroscopy, was within 0.4 mm RMS error for internal as well as external markers. The motion trajectories of internal and external markers as measured by fluoroscopy were found to be highly correlated (R=0.97). Furthermore, motion trajectories of arbitrary points on the deforming phantom surface, as recorded by the VisionRT system also showed a high correlation with respect to the fluoroscopically-measured trajectories of internal markers (R=0.92). Conclusion: We have developed a realistic externally- and internally-deformable lung phantom that will serve as a valuable tool for clinical QA and motion management research. This work was supported through funding from the NIH and VisionRT Ltd. Amit Sawant has research funding from Varian Medical Systems, VisionRT and Elekta.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

Assessing and accounting for the impact of respiratory motion on FDG uptake and viable volume for liver lesions in free-breathing PET using respiration-suspended PET images as reference

Purpose: To assess and account for the impact of respiratory motion on the variability of activity and volume determination of liver tumor in positron emission tomography (PET) through a comparison between free-breathing (FB) and respiration-suspended (RS) PET images. Methods: As part of a PET/computed tomography (CT) guided percutaneous liver ablation procedure performed on a PET/CT scanner, a patient's breathing is suspended on a ventilator, allowing the acquisition of a near-motionless PET and CT reference images of the liver. In this study, baseline RS and FB PET/CT images of 20 patients undergoing thermal ablation were acquired. The RS PET provides near-motionless reference in a human study, and thereby allows a quantitative evaluation of the effect of respiratory motion on PET images obtained under FB conditions. Two methods were applied to calculate tumor activity and volume: (1) threshold-based segmentation (TBS), estimating the total lesion glycolysis (TLG) and the segmented volume and (2) histogram-based estimation (HBE), yielding the background-subtracted lesion (BSL) activity and associated volume. The TBS method employs 50% of the maximum standardized uptake value (SUV{sub max}) as the threshold for tumors with SUV{sub max} ≥ 2× SUV{sub liver-bkg}, and tumor activity above this threshold yields TLG{sub 50%}. The HBE method determines local PET background based on a Gaussian fit of the low SUV peak in a SUV-volume histogram, which is generated within a user-defined and optimized volume of interest containing both local background and lesion uptakes. Voxels with PET intensity above the fitted background were considered to have originated from the tumor and used to calculate the BSL activity and its associated lesion volume. Results: Respiratory motion caused SUV{sub max} to decrease from RS to FB by −15% ± 11% (p = 0.01). Using TBS method, there was also a decrease in SUV{sub mean} (−18% ± 9%, p = 0.01), but an increase in TLG{sub 50%} (18% ± 36%) and in the segmented volume (47% ± 52%, p = 0.01) from RS to FB PET images. The background uptake in normal liver was stable, 1% ± 9%. In contrast, using the HBE method, the differences in both BSL activity and BSL volume from RS to FB were −8% ± 10% (p = 0.005) and 0% ± 16% (p = 0.94), respectively. Conclusions: This is the first time that almost motion-free PET images of the human liver were acquired and compared to free-breathing PET. The BSL method's results are more consistent, for the calculation of both tumor activity and volume in RS and FB PET images, than those using conventional TBS. This suggests that the BSL method might be less sensitive to motion blurring and provides an improved estimation of tumor activity and volume in the presence of respiratory motion.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

Effect of respiratory motion on internal radiation dosimetry

Purpose: Estimation of the radiation dose to internal organs is essential for the assessment of radiation risks and benefits to patients undergoing diagnostic and therapeutic nuclear medicine procedures including PET. Respiratory motion induces notable internal organ displacement, which influences the absorbed dose for external exposure to radiation. However, to their knowledge, the effect of respiratory motion on internal radiation dosimetry has never been reported before. Methods: Thirteen computational models representing the adult male at different respiratory phases corresponding to the normal respiratory cycle were generated from the 4D dynamic XCAT phantom. Monte Carlo calculations were performed using the MCNP transport code to estimate the specific absorbed fractions (SAFs) of monoenergetic photons/electrons, the S-values of common positron-emitting radionuclides (C-11, N-13, O-15, F-18, Cu-64, Ga-68, Rb-82, Y-86, and I-124), and the absorbed dose of {sup 18}F-fluorodeoxyglucose ({sup 18}F-FDG) in 28 target regions for both the static (average of dynamic frames) and dynamic phantoms. Results: The self-absorbed dose for most organs/tissues is only slightly influenced by respiratory motion. However, for the lung, the self-absorbed SAF is about 11.5% higher at the peak exhale phase than the peak inhale phase for photon energies above 50 keV. The cross-absorbed dose is obviously affected by respiratory motion for many combinations of source-target pairs. The cross-absorbed S-values for the heart contents irradiating the lung are about 7.5% higher in the peak exhale phase than the peak inhale phase for different positron-emitting radionuclides. For {sup 18}F-FDG, organ absorbed doses are less influenced by respiratory motion. Conclusions: Respiration-induced volume variations of the lungs and the repositioning of internal organs affect the self-absorbed dose of the lungs and cross-absorbed dose between organs in internal radiation dosimetry. The dynamic anatomical model provides more accurate internal radiation dosimetry estimates for the lungs and abdominal organs based on realistic modeling of respiratory motion. This work also contributes to a better understanding of model-induced uncertainties in internal radiation dosimetry.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2015

SU-E-J-26: A Novel Technique for Markerless Self-Sorted 4D-CBCT Using Patient Motion Modeling: A Feasibility Study

Purpose: To develop an automatic markerless 4D-CBCT projection sorting technique by using a patient respiratory motion model extracted from the planning 4D-CT images. Methods: Each phase of onboard 4D-CBCT is considered as a deformation of one phase of the prior planning 4D-CT. The deformation field map (DFM) is represented as a linear combination of three major deformation patterns extracted from the planning 4D-CT using principle component analysis (PCA). The coefficients of the PCA deformation patterns are solved by matching the digitally reconstructed radiograph (DRR) of the deformed volume to the onboard projection acquired. The PCA coefficients are solved for each single projection, and are used for phase sorting. Projections at the peaks of the Z direction coefficient are sorted as phase 1 and other projections are assigned into 10 phase bins by dividing phases equally between peaks. The 4D digital extended-cardiac-torso (XCAT) phantom was used to evaluate the proposed technique. Three scenarios were simulated, with different tumor motion amplitude (3cm to 2cm), tumor spatial shift (8mm SI), and tumor body motion phase shift (2 phases) from prior to on-board images. Projections were simulated over 180 degree scan-angle for the 4D-XCAT. The percentage of accurately binned projections across entire dataset was calculated to represent the phase sorting accuracy. Results: With a changed tumor motion amplitude from 3cm to 2cm, markerless phase sorting accuracy was 100%. With a tumor phase shift of 2 phases w.r.t. body motion, the phase sorting accuracy was 100%. With a tumor spatial shift of 8mm in SI direction, phase sorting accuracy was 86.1%. Conclusion: The XCAT phantom simulation results demonstrated that it is feasible to use prior knowledge and motion modeling technique to achieve markerless 4D-CBCT phase sorting. National Institutes of Health Grant No. R01-CA184173 Varian Medical System.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-J-31: Monitor Interfractional Variation of Tumor Respiratory Motion Using 4D KV Conebeam Computed Tomography for Stereotactic Body Radiation Therapy of Lung Cancer

Purpose: 4DCT has been widely used to generate internal tumor volume (ITV) for a lung tumor for treatment planning. However, lung tumors may show different respiratory motion on the treatment day. The purpose of this study is to evaluate 4D KV conebeam computed tomography (CBCT) for monitoring tumor interfractional motion variation between simulation and each fraction of stereotactic body radiation therapy (SBRT) for lung cancer. Methods: 4D KV CBCT was acquired with the Elekta XVI system. The accuracy of 4D KV CBCT for image-guided radiation therapy (IGRT) was tested with a dynamic thorax motion phantom (CIRS, Virginia) with a linear amplitude of 2 cm. In addition, an adult anthropomorphic phantom (Alderson, Rando) with optically stimulated luminescence (OSL) dosimeters embedded at the center and periphery of a slab of solid water was used to measure the dose of 4D KV CBCT and to compare it with the dose with 3D KV CBCT. The image registration was performed by aligning\ each phase images of 4D KV CBCT to the planning images and the final couch shifts were calculated as a mean of all these individual shifts along each direction.A workflow was established based on these quality assurance tests for lung cancer patients. Results: 4D KV CBCT does not increase imaging dose in comparison to 3D KV CBCT. Acquisition of 4D KV CBCT is 4 minutes as compared to 2 minutes for 3D KV CBCT. Most of patients showed a small daily variation of tumor respiratory motion about 2 mm. However, some patients may have more than 5 mm variations of tumor respiratory motion. Conclusion: The radiation dose does not increase with 4D KV CBCT. 4D KV CBCT is a useful tool for monitoring interfractional variations of tumor respiratory motion before SBRT of lung cancer patients.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-J-61: Monitoring Tumor Motion in Real-Time with EPID Imaging During Cervical Cancer Treatment

Purpose: Traditional external beam radiotherapy for cervical cancer requires setup by external skin marks. In order to improve treatment accuracy and reduce planning margin for more conformal therapy, it is essential to monitor tumor positions interfractionally and intrafractionally. We demonstrate feasibility of monitoring cervical tumor motion online using EPID imaging from Beam’s Eye View. Methods: Prior to treatment, 1∼2 cylindrical radio opaque markers were implanted into inferior aspect of cervix tumor. During external beam treatments on a Varian 2100C by 4-field 3D plans, treatment beam images were acquired continuously by an EPID. A Matlab program was developed to locate internal markers on MV images. Based on 2D marker positions obtained from different treatment fields, their 3D positions were estimated for every treatment fraction. Results: There were 398 images acquired during different treatment fractions of three cervical cancer patients. Markers were successfully located on every frame of image at an analysis speed of about 1 second per frame. Intrafraction motions were evaluated by comparing marker positions relative to the position on the first frame of image. The maximum intrafraction motion of the markers was 1.6 mm. Interfraction motions were evaluated by comparing 3D marker positions at different treatment fractions. The maximum interfraction motion was up to 10 mm. Careful comparison found that this is due to patient positioning since the bony structures shifted with the markers. Conclusion: This method provides a cost-free and simple solution for online tumor tracking for cervical cancer treatment since it is feasible to acquire and export EPID images with fast analysis in real time. This method does not need any extra equipment or deliver extra dose to patients. The online tumor motion information will be very useful to reduce planning margins and improve treatment accuracy, which is particularly important for SBRT treatment with long delivery time.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-J-194: Continuous Patient Surface Monitoring and Motion Analysis During Lung SBRT

Purpose: Continuous monitoring of the SBRT lung patient motion during delivery is critical for ensuring adequate target volume margins in stereotactic body radiotherapy (SBRT). This work assesses the deviation of the patient surface motion using a real-time surface tracking system throughout treatment delivery. Methods: Our SBRT protocol employs abdominal compression to reduce the diaphragm movement to within 1 cm, and this is confirmed daily with fluoroscopy. Most patients are prescribed 3–5 fractions, and on treatment day a repeat motion analysis with fluoroscopy is performed, followed by a kV CBCT is aligned with the original planning CT image for 3D setup confirmation. During this entire process a patient surface data restricted to whole chest or the sternum at the middle of the breathing cycle was captured using AlignRT optical surface tracking system and defined as a reference surface. For 10 patients, the deviation of the patient position from the reference surface was recorded during the SBRT delivery in the anterior-posterior (AP) direction at 3–6 measurements per second. Results: On average, the patient position deviated from the reference surface more than 4 mm, 3 mm and 2 mm in the AP direction for 0.95%, 3.7% and 11.1% of the total treatment time, respectively. Only one of the 10 patients showed that the maximum deviation of the patient surface during the SBRT delivery was greater than 1 cm. The average deviation of the patient surface from the reference surface during the SBRT delivery was not greater than 1.6 mm for any patient. Conclusion: This investigation indicates that AP motion can be significant even though the frequency is low. Continuous monitoring during SBRT has demonstrated value in monitoring patient motion ensuring that margins selected for SBRT are appropriate, and the use of non-ionizing and high-frequency imaging can provide useful indicators of motion during treatment.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-J-234: Application of a Breathing Motion Model to ViewRay Cine MR Images

Purpose: A respiratory motion model previously used to generate breathing-gated CT images was used with cine MR images. Accuracy and predictive ability of the in-plane models were evaluated. Methods: Sagittalplane cine MR images of a patient undergoing treatment on a ViewRay MRI/radiotherapy system were acquired before and during treatment. Images were acquired at 4 frames/second with 3.5 × 3.5 mm resolution and a slice thickness of 5 mm. The first cine frame was deformably registered to following frames. Superior/inferior component of the tumor centroid position was used as a breathing surrogate. Deformation vectors and surrogate measurements were used to determine motion model parameters. Model error was evaluated and subsequent treatment cines were predicted from breathing surrogate data. A simulated CT cine was created by generating breathing-gated volumetric images at 0.25 second intervals along the measured breathing trace, selecting a sagittal slice and downsampling to the resolution of the MR cines. A motion model was built using the first half of the simulated cine data. Model accuracy and error in predicting the remaining frames of the cine were evaluated. Results: Mean difference between model predicted and deformably registered lung tissue positions for the 28 second preview MR cine acquired before treatment was 0.81 +/− 0.30 mm. The model was used to predict two minutes of the subsequent treatment cine with a mean accuracy of 1.59 +/− 0.63 mm. Conclusion: Inplane motion models were built using MR cine images and evaluated for accuracy and ability to predict future respiratory motion from breathing surrogate measurements. Examination of long term predictive ability is ongoing. The technique was applied to simulated CT cines for further validation, and the authors are currently investigating use of in-plane models to update pre-existing volumetric motion models used for generation of breathing-gated CT planning images.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-428: Feasibility Study of 4D Image Reconstruction by Organ Motion Vector Extension Based On Portal Images

Purpose: To develop and to test a method to generate a new 4D CT images of the treatment day from the old 4D CT and the portal images of the day when the motion extent exceeded from that represented by plan CTs. Methods: A motion vector of a moving tumor in a patient may be extended to reconstruct the tumor position when the motion extent exceeded from that represented by plan CTs. To test this, 1. a phantom that consists of a polystyrene cylinder (tumor) embedded in cork (lung) was placed on a moving platform with 4 sec/cycle and amplitudes of 1 cm and 2 cm, and was 4D-scanned. 2. A 6MV photon beam was irradiated on the moving phantoms and cineEPID images were obtained. 3. A motion vector of the tumor was acquired from 4D CT images of the phantom with 1 cm amplitude. 4. From cine EPID images of the phantom with the 2 cm amplitude, various motion extents (0.3 cm, 0.5 cm, etc) were acquired and programmed into the motion vector, producing CT images at each position. 5. The reconstructed CT images were then compared with pre-acquired “reference” 4D CT images at each position (i.e. phase). Results: The CT image was reconstructed and compared with the reference image, showing a slight mismatch in the transition direction limited by voxel size (slice thickness) in CT image. Due to the rigid nature of the phantom studied, the modeling the displacement of the center of object was sufficient. When deformable tumors are to be modeled, more complex scheme is necessary, which utilize cine EPID and 4D CT images. Conclusion: The new idea of CT image reconstruction was demonstrated. Deformable tumor movements need to be considered in the future.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-510: Interplay Between Spots Sizes, Spot / Line Spacing and Motion in Spot Scanning Proton Therapy

Purpose In proton beam configuration for spot scanning proton therapy (SSPT), one can define the spacing between spots and lines of scanning as a ratio of given spot size. If the spacing increases, the number of spots decreases which can potentially decrease scan time, and so can whole treatment time, and vice versa. However, if the spacing is too large, the uniformity of scanned field decreases. Also, the field uniformity can be affected by motion during SSPT beam delivery. In the present study, the interplay between spot/ line spacing and motion is investigated. Methods We used four Gaussian-shape spot sizes with 0.5cm, 1.0cm, 1.5cm, and 2.0cm FWHM, three spot/line spacing that creates uniform field profile which are 1/3*FWHM, σ/3*FWHM and 2/3*FWHM, and three random motion amplitudes within, +/−0.3mm, +/−0.5mm, and +/−1.0mm. We planned with 2Gy uniform single layer of 10×10cm2 and 20×20cm2 fields. Then, mean dose within 80% area of given field size, contrubuting MU per each spot assuming 1cGy/MU calibration for all spot sizes, number of spots and uniformity were calculated. Results The plans with spot/line spacing equal to or smaller than 2/3*FWHM without motion create ∼100% uniformity. However, it was found that the uniformity decreases with increased spacing, and it is more pronounced with smaller spot sizes, but is not affected by scanned field sizes. Conclusion It was found that the motion during proton beam delivery can alter the dose uniformity and the amount of alteration changes with spot size which changes with energy and spot/line spacing. Currently, robust evaluation in TPS (e.g. Eclipse system) performs range uncertainty evaluation using isocenter shift and CT calibration error. Based on presented study, it is recommended to add interplay effect evaluation to robust evaluation process. For future study, the additional interplay between the energy layers and motion is expected to present volumetric effect.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-520: Investigation of the Impact of Respiratory Motion On Spine SAbR Dose Distributions

Purpose Spine SRS/SAbR treatment plans typically require very steep dose gradients to meet spinal cord constraints and it is crucial that the dose distribution be accurate. However, these plans are typically calculated on helical free-breathing CT scans, which often contain motion artifacts. While the spine itself doesn’t exhibit very much intra-fraction motion, tissues around the spine, particularly the liver, do move with respiration. We investigated the dosimetric effect of liver motion on dose distributions calculated on helical free-breathing CT scans for spine SAbR delivered to the T and L spine. Methods We took 5 spine SAbR plans and used density overrides to simulate an average reconstruction CT image set, which would more closely represent the patient anatomy during treatment. The value used for the density override was 0.66 g/cc. All patients were planned using our standard beam arrangement, which consists of 13 coplanar step and shoot IMRT beams. The original plan was recalculated with the same MU on the “average” scan and target coverage and spinal cord dose were compared to the original plan. Results The average changes in minimum PTV dose, PTV coverage, max cord dose and volume of cord receiving 10 Gy were 0.6%, 0.8%, 0.3% and 4.4% (0.012 cc), respectively. Conclusion SAbR spine plans are surprisingly robust relative to surrounding organ motion due to respiration. Motion artifacts in helical planning CT scans do not cause clinically significant differences when these plans are re-calculated on pseudo-average CT reconstructions. This is likely due to the beam arrangement used because only three beams pass through the liver and only one beam passes completely through the density override. The effect of the respiratory motion on VMAT plans for spine SAbR is being evaluated.

60 APPLIED LIFE SCIENCES↗