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At least 667 records · Page 37
All sourcesNASA NTRSDOE OSTI
DOE OSTI2012

Dedicated breast CT: Fibroglandular volume measurements in a diagnostic population

Purpose: To determine the mean and range of volumetric glandular fraction (VGF) of the breast in a diagnostic population using a high-resolution flat-panel cone-beam dedicated breast CT system. This information is important for Monte Carlo-based estimation of normalized glandular dose coefficients and for investigating the dependence of VGF on breast dimensions, race, and pathology. Methods: Image data from a clinical trial investigating the role of dedicated breast CT that enrolled 150 women were retrospectively analyzed to determine the VGF. The study was conducted in adherence to a protocol approved by the institutional human subjects review boards and written informed consent was obtained from all study participants. All participants in the study were assigned BI-RADS{sup Registered-Sign} 4 or 5 as per the American College of Radiology assessment categories after standard diagnostic work-up and underwent dedicated breast CT exam prior to biopsy. A Gaussian-kernel based fuzzy c-means algorithm was used to partition the breast CT images into adipose and fibroglandular tissue after segmenting the skin. Upon determination of the accuracy of the algorithm with a phantom, it was applied to 137 breast CT volumes from 136 women. VGF was determined for each breast and the mean and range were determined. Pathology results with classification as benign, malignant, and hyperplasia were available for 132 women, and were used to investigate if the distributions of VGF varied with pathology. Results: The algorithm was accurate to within {+-}1.9% in determining the volume of an irregular shaped phantom. The study mean ({+-} inter-breast SD) for the VGF was 0.172 {+-} 0.142 (range: 0.012-0.719). VGF was found to be negatively correlated with age, breast dimensions (chest-wall to nipple length, pectoralis to nipple length, and effective diameter at chest-wall), and total breast volume, and positively correlated with fibroglandular volume. Based on pathology, pairwise statistical analysis (Mann-Whitney test) indicated that at the 0.05 significance level, there was no significant difference in distributions of VGF without adjustment for age between malignant and nonmalignant breasts (p= 0.41). Pairwise comparisons of the distributions of VGF in increasing order of mammographic breast density indicated all comparisons were statistically significant (p < 0.002). Conclusions: This study used a different clinical prototype breast CT system than that in previous studies to image subjects from a different geographical region, and used a different algorithm for analysis of image data. The mean VGF estimated from this study is within the range reported in previous studies, indicating that the choice of 50% glandular weight fraction to represent an average breast for Monte Carlo-based estimation of normalized glandular dose coefficients in mammography needs revising. In the study, the distributions of VGF did not differ significantly with pathology.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-J-119: What Effect Have the Volume Defined in the Alignment Clipbox for Cervical Cancer Using Automatic Registration Methods for Cone- Beam CT Verification?

Purpose: To investigate the impact of different clipbox volumes with automated registration techniques using commercially available software with on board volumetric imaging(OBI) for treatment verification in cervical cancer patients. Methods: Fifty cervical cancer patients received daily CBCT scans(on-board imaging v1.5 system, Varian Medical Systems) during the first treatment week and weekly thereafter were included this analysis. A total of 450 CBCT scans were registered to the planning CTscan using pelvic clipbox(clipbox-Pelvic) and around PTV clip box(clipbox- PTV). The translations(anterior-posterior, left-right, superior-inferior) and the rotations(yaw, pitch and roll) errors for each matches were recorded. The setup errors and the systematic and random errors for both of the clip-boxes were calculated. Paired Samples t test was used to analysis the differences between clipbox-Pelvic and clipbox-PTV. Results: . The SD of systematic error(σ) was 1.0mm, 2.0mm,3.2mm and 1.9mm,2.3mm, 3.0mm in the AP, LR and SI directions for clipbox-Pelvic and clipbox-PTV, respectively. The average random error(Σ)was 1.7mm, 2.0mm,4.2mm and 1.7mm,3.4mm, 4.4mm in the AP, LR and SI directions for clipbox-Pelvic and clipbox-PTV, respectively. But, only the SI direction was acquired significantly differences between two image registration volumes(p=0.002,p=0.01 for mean and SD). For rotations, the yaw mean/SD and the pitch SD were acquired significantly differences between clipbox-Pelvic and clipbox-PTV. Conclusion: The defined volume for Image registration is important for cervical cancer when 3D/3D match was used. The alignment clipbox can effect the setup errors obtained. Further analysis is need to determine the optimal defined volume to use the image registration in cervical cancer. Conflict of interest: none.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-328: The Volume Effect Correction of Probe-Type Dosimetric Detectors Derived From the Convolution Model

Purpose: To derive and introduce a new correction factor kV, the “volume effect correction factor”, that accounts for not only the dose averaging over the detector's sensitive volume but also the secondary electron generation and transport inclusive of the disturbance of the field of secondary electrons within the detector. Materials and Methods: Mathematical convolutions and Fourier's convolution theorem have been used. Monte Carlo simulations of photon pencil beams were performed using EGSnrc. Detector constructions were adapted from manufacturers' information. Results: For the calculation of kV, the three basic convolution kernels have to be taken into account: the dose deposition kernel KD(x) (fluence to dose), the photon fluence response kernel KM(x) (photon fluence to detector signal) and the “dose response kernel” K(x) (dose to detector signal). K(x) is calculated from FT[K(x)] = [1/sqrt(2”)]FT[KM(x)]/FT[KD(x)], where the magnitude of kV(x) can be thereby calculated for arbitrary photon beam profiles and the areanormalized K(x). Conclusions: n order to take into account for the dimensions of dosimetric detectors in narrow photon beams, the “volume effect correction factor” kV has been introduced into the fundamental equation of probe-type dosimetry, and the convolution method has proven to be a method for the derivation of its numerical values. For narrow photon beams, whose width is comparable to the secondary electron ranges, kV can reach very high values, but it can be shown that the signals of small diamond detectors are well representing the absorbed dose to water averaged over the detector volume.

07 ISOTOPE AND RADIATION SOURCES↗
DOE OSTI2014

SU-E-T-382: Influence of Compton Currents On Profile Measurements in Small- Volume Ion Chambers

Purpose: Ionization chambers in electron radiation fields are known to exhibit polarity effects due to Compton currents. Previously we have presented a unique manifestation of this effect observed with a microionization chamber. We have expanded that investigation to include three micro-ionization chambers commonly used in radiation therapy. The purpose of this project is to determine what factors influence this polarity effect for micro-chambers and how it might be mitigated. Methods: Three chambers were utilized: a PTW 31016, an Exradin A-16, and an Exradin A- 26. Beam profile scans were obtained on a Varian TrueBeam linear accelerator in combination with a Wellhofer water phantom for 6, 9, and 12 MeV electrons. Profiles were obtained parallel and perpendicular to the chamber's long axis, with both positive and negative collecting bias. Profiles were obtained with various chamber components shielded by 5 mm of Pb at 6 MeV to determine their relative contributions to this polarity effect. Results: The polarity effect was observed for all three chambers, and the ratio of the polarity effect for the Exradin chambers is proportional to the ratio of chamber volumes. Shielding the stem of both Exradin chambers diminished, but did not remove the polarity effect. However, they demonstrated no out-of-field effect when the cable was shielded with Pb. The PTW chamber demonstrated a significantly reduced polarity effect without any shielding despite its comparable volume with the A-26. Conclusions: The sensitive volume of these micro-chambers is relatively insensitive to collecting polarity. However, charge deposition within the cable can dramatically alter measured ionization profiles. This is demonstrated by the removal of the out-of-field ionization when the cable is shielded for the Exradin chambers. We strongly recommend analyzing any polarity dependence for small-volume chambers used in characterization of electron fields.

07 ISOTOPE AND RADIATION SOURCES↗
DOE OSTI2014

SU-E-T-480: Radiobiological Dose Comparison of Single Fraction SRS, Multi-Fraction SRT and Multi-Stage SRS of Large Target Volumes Using the Linear-Quadratic Formula

Purpose: To compare the radiobiological effect on large tumors and surrounding normal tissues from single fraction SRS, multi-fractionated SRT, and multi-staged SRS treatment. Methods: An anthropomorphic head phantom with a centrally located large volume target (18.2 cm{sup 3}) was scanned using a 16 slice large bore CT simulator. Scans were imported to the Multiplan treatment planning system where a total prescription dose of 20Gy was used for a single, three staged and three fractionated treatment. Cyber Knife treatment plans were inversely optimized for the target volume to achieve at least 95% coverage of the prescription dose. For the multistage plan, the target was segmented into three subtargets having similar volume and shape. Staged plans for individual subtargets were generated based on a planning technique where the beam MUs of the original plan on the total target volume are changed by weighting the MUs based on projected beam lengths within each subtarget. Dose matrices for each plan were export in DICOM format and used to calculate equivalent dose distributions in 2Gy fractions using an alpha beta ratio of 10 for the target and 3 for normal tissue. Results: Singe fraction SRS, multi-stage plan and multi-fractionated SRT plans had an average 2Gy dose equivalent to the target of 62.89Gy, 37.91Gy and 33.68Gy, respectively. The normal tissue within 12Gy physical dose region had an average 2Gy dose equivalent of 29.55Gy, 16.08Gy and 13.93Gy, respectively. Conclusion: The single fraction SRS plan had the largest predicted biological effect for the target and the surrounding normal tissue. The multi-stage treatment provided for a more potent biologically effect on target compared to the multi-fraction SRT treatments with less biological normal tissue than single-fraction SRS treatment.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-498: Energy Minimization and Dose-Volume Inverse Optimization in Prostate Cancer

Purpose: To compare dose-volume (DVH) and energy minimization-based (EM) optimization for prostate cancer cases. Methods: A dozen of prostate plans were retrospectively studied. For each case two IMRT plans were generated, one with DVH and the other with EM objective cost function. Those different objective functions were used only for the organs at risk (OARs), while target objectives were achieved through DVH cost functions. The plans used the same beam angles, maximum number of segments per plan, minimum segment area and MUs per segment. Both plans were normalized such that 95% of the PTV was covered by the same prescription dose. After prescription was achieved, doses to the OARs were iteratively lowered until the standard deviation of the dose across the PTV was ~3.5%. Plan quality was evaluated by several dose indices (DIs). A DI represents the dose delivered to certain volume of a structure. Tallied DIs were for rectum and bladder 10%, 40%, 60% volumes, and 1% volumes of the femoral heads as surrogate for maximum doses. Statistical significance in the differences among DIs was quantified with two-tailed paired t-tests. Results: On average EM plans performed better than DVH plans. Statistically significant dose reduction in rectum DI10, DI40, and DI60, were 2.6%, 25.7%, and 35.9%, respectively. For bladder DI10, DI40, and DI60 the differences were 1.1%, 20.8%, and 29.7%. Left and right femoral head DI1s were better by 33.8% and 27.8% in EM plans. The quoted dose reduction is with respect to EM absolute doses for the DIs. Conclusion: The performance of EM optimization with respect to DVH optimization is patient and DI dependent. While in some cases specific DIs were better with DVH optimization, on average the energy minimization allows better (ranging from 1% to ~40%) OAR sparing than DVH optimization. NIH-NCI.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-546: Use of Implant Volume for Quality Assurance of Low Dose Rate Brachytherapy Treatment Plans

Purpose: To analyze the application of volume implant (V100) data as a method for a global check of low dose rate (LDR) brachytherapy plans. Methods: Treatment plans for 335 consecutive patients undergoing permanent seed implants for prostate cancer and for 113 patients treated with plaque therapy for ocular melanoma were analyzed. Plaques used were 54 COMS (10 to 20 mm, notched and regular) and 59 Eye Physics EP917s with variable loading. Plots of treatment time x implanted activity per unit dose versus v100 ^.667 were made. V100 values were obtained using dose volume histograms calculated by the treatment planning systems (Variseed 8.02 and Plaque Simulator 5.4). Four different physicists were involved in planning the prostate seed cases; two physicists for the eye plaques. Results: Since the time and dose for the prostate cases did not vary, a plot of implanted activity vs V100 ^.667 was made. A linear fit with no intercept had an r{sup 2} = 0.978; more than 94% of the actual activities fell within 5% of the activities calculated from the linear fit. The greatest deviations were in cases where the implant volumes were large (> 100 cc). Both COMS and EP917 plaque linear fits were good (r{sup 2} = .967 and .957); the largest deviations were seen for large volumes. Conclusions: The method outlined here is effective for checking planning consistency and quality assurance of two types of LDR brachytherapy treatment plans (temporary and permanent). A spreadsheet for the calculations enables a quick check of the plan in situations were time is short (e.g. OR-based prostate planning)

07 ISOTOPE AND RADIATION SOURCES↗
DOE OSTI2014

SU-E-T-562: Scanned Percent Depth Dose Curve Discrepancy for Photon Beams with Physical Wedge in Place (Varian IX) Using Different Sensitive Volume Ion Chambers

Purpose: To investigate and report the discrepancy of scanned percent depth dose (PDD) for photon beams with physical wedge in place when using ion chambers with different sensitive volumes. Methods/Materials: PDD curves of open fields and physical wedged fields (15, 30, 45, and 60 degree wedge) were scanned for photon beams (6MV and 10MV, Varian iX) with field size of 5x5 and 10x10 cm using three common scanning chambers with different sensitive volumes - PTW30013 (0.6cm3), PTW23323 (0.1cm3) and Exradin A16 (0.007cm3). The scanning system software used was OmniPro version 6.2, and the scanning water tank was the Scanditronix Wellhoffer RFA 300.The PDD curves from the three chambers were compared. Results: Scanned PDD curves of the same energy beams for open fields were almost identical between three chambers, but the wedged fields showed non-trivial differences. The largest differences were observed between chamber PTW30013 and Exradin A16. The differences increased as physical wedge angle increased. The differences also increased with depth, and were more pronounced for 6MV beam. Similar patterns were shown for both 5x5 and 10x10 cm field sizes. For open fields, all PDD values agreed with each other within 1% at 10cm depth and within 1.62% at 20 cm depth. For wedged fields, the difference of PDD values between PTW30013 and A16 reached 4.09% at 10cm depth, and 5.97% at 20 cm depth for 6MV with 60 degree physical wedge. Conclusion: We observed a significant difference in scanned PDD curves of photon beams with physical wedge in place obtained when using different sensitive volume ion chambers. The PDD curves scanned with the smallest sensitive volume ion chamber showed significant difference from larger chamber results, beyond 10cm depth. We believe this to be caused by varying response to beam hardening by the wedges.

07 ISOTOPE AND RADIATION SOURCES↗
DOE OSTI2014

SU-E-T-568: Improving Normal Brain Sparing with Increasing Number of Arc Beams for Volume Modulated Arc Beam Radiosurgery of Multiple Brain Metastases

Purpose: Intensity modulated arc beams have been newly reported for treating multiple brain metastases. The purpose of this study was to determine the variations in the normal brain doses with increasing number of arc beams for multiple brain metastases treatments via the TrueBeam Rapidarc system (Varian Oncology, Palo Alto, CA). Methods: A patient case with 12 metastatic brain lesions previously treated on the Leksell Gamma Knife Perfexion (GK) was used for the study. All lesions and organs at risk were contoured by a senior radiation oncologist and treatment plans for a subset of 3, 6, 9 and all 12 targets were developed for the TrueBeam Rapidarc system via 3 to 7 intensity modulated arc-beams with each target covered by at least 99% of the prescribed dose of 20 Gy. The peripheral normal brain isodose volumes as well as the total beam-on time were analyzed with increasing number of arc beams for these targets. Results: All intensisty modulated arc-beam plans produced efficient treatment delivery with the beam-on time averaging 0.6–1.5 min per lesion at an output of 1200 MU/min. With increasing number of arc beams, the peripheral normal brain isodose volumes such as the 12-Gy isodose line enclosed normal brain tissue volumes were on average decreased by 6%, 11%, 18%, and 28% for the 3-, 6-, 9-, 12-target treatment plans respectively. The lowest normal brain isodose volumes were consistently found for the 7-arc treatment plans for all the cases. Conclusion: With nearly identical beam-on times, the peripheral normal brain dose was notably decreased when the total number of intensity modulated arc beams was increased when treating multiple brain metastases. Dr Sahgal and Dr Ma are currently serving on the board of international society of stereotactic radiosurgery.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-611: Effective Treatment Volume of the Small Size IORT Applicators

Purpose Mobile electron linear accelerators are gaining more attention recently, providing a lower cost and simpler way to perform intraoperative treatment. However, the simplicity of the treatment process does not eliminate the need for proper attention to the technical aspects of the treatment. One of the potential pitfalls is incorrect selection of the appropriate applicator size to adequately cover the tumor bed to the prescription dose. When treating tumor beds in the pelvis, the largest applicator that fits into the pelvis is usually selected as there is concern about microscopic extension of the disease along the sidewalls of the pelvis. But when treating early stage breast tumors, there is a natural tendency to select an applicator as small as possible so as not to jeopardize cosmesis. Methods This investigation questions how much of the typical breast treatment volume gets adequate exposure and what is the correct strategy in selecting the proper applicator size. Actual data from isodose scans were analyzed. Results We found that typical treatment dose prescriptions can cover as much as 80% and as little as 20% of the nominal treatment volume depending on the applicator size and energy of the beam and whether the dose is prescribed to the 80 or 90% isodose level. Treatment volume is defined as a cylinder with diameter equal to applicator and height equal to the corresponding D80 or D90 depth. Conclusion If mobile linear accelerators are used, there can be significant amount of “cold volume” depending on the applicator size and this should be taken into account when selecting the applicator that is needed. Using too small of an applicator could result in significant under-dosing to the tissue at risk. Long-term clinical data demonstrates that selecting an adequate field size results in good ontological control as well as excellent cosmesis. Intraop Medical Corp was providing facilities and equipment for this research.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

WE-G-BRD-07: Investigation of Distal Lung Atelectasis Following Stereotactic Body Radiation Therapy Using Regional Lung Volume Changes Between Pre- and Post- Treatment CT Scans

Purpose: To propose a quantitative method using lung deformations to differentiate between radiation-induced fibrosis and potential airway stenosis with distal atelectasis in patients treated with stereotactic body radiation therapy (SBRT) for lung tumors. Methods: Twenty-four lung patients with large radiation-induced density increases outside the high dose region had their pre- and post-treatment CT scans manually registered. They received SBRT treatments at our institution between 2002 and 2009 in 3 or 5 fractions, to a median total dose of 54Gy (range, 30–60). At least 50 anatomical landmarks inside the lung (airway branches) were paired for the pre- and post-treatment scans to guide the deformable registration of the lung structure, which was then interpolated to the whole lung using splines. Local volume changes between the planning and follow-up scans were calculated using the deformation field Jacobian. Hyperdense regions were classified as atelectatic or fibrotic based on correlations between regional density increases and significant volume contractions compared to the surrounding tissues. Results: Out of 24 patients, only 7 demonstrated a volume contraction that was at least one σ larger than the remaining lung average. Because they did not receive high doses, these shrunk hyperdense regions were likely showing distal atelectasis resulting from radiation-induced airway stenosis rather than conventional fibrosis. On average, the hyperdense regions extended 9.2 cm farther than the GTV contours but not significantly more than 8.6 cm for the other patients (p>0.05), indicating that a large offset between the radiation and hyperdense region centers is not a good surrogate for atelectasis. Conclusion: A method based on the relative comparison of volume changes between different dates was developed to identify potential lung regions experiencing distal atelectasis. Such a tool is essential to study which lung structures need to be avoided to prevent atelectasis and limit lung function loss.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

Evaluation of potential internal target volume of liver tumors using cine-MRI

Purpose: Four-dimensional computed tomography (4DCT) is widely used for evaluating moving tumors, including lung and liver cancers. For patients with unstable respiration, however, the 4DCT may not visualize tumor motion properly. High-speed magnetic resonance imaging (MRI) sequences (cine-MRI) permit direct visualization of respiratory motion of liver tumors without considering radiation dose exposure to patients. Here, the authors demonstrated a technique for evaluating internal target volume (ITV) with consideration of respiratory variation using cine-MRI. Methods: The authors retrospectively evaluated six patients who received stereotactic body radiotherapy (SBRT) to hepatocellular carcinoma. Before acquiring planning CT, sagittal and coronal cine-MRI images were acquired for 30 s with a frame rate of 2 frames/s. The patient immobilization was conducted under the same condition as SBRT. Planning CT images were then acquired within 15 min from cine-MRI image acquisitions, followed by a 4DCT scan. To calculate tumor motion, the motion vectors between two continuous frames of cine-MRI images were calculated for each frame using the pyramidal Lucas–Kanade method. The target contour was delineated on one frame, and each vertex of the contour was shifted and copied onto the following frame using neighboring motion vectors. 3D trajectory data were generated with the centroid of the contours on sagittal and coronal images. To evaluate the accuracy of the tracking method, the motion of clearly visible blood vessel was analyzed with the motion tracking and manual detection techniques. The target volume delineated on the 50% (end-exhale) phase of 4DCT was translated with the trajectory data, and the distribution of the occupancy probability of target volume was calculated as potential ITV (ITV {sub Potential}). The concordance between ITV {sub Potential} and ITV estimated with 4DCT (ITV {sub 4DCT}) was evaluated using the Dice’s similarity coefficient (DSC). Results: The distance between blood vessel positions determined with motion tracking and manual detection was analyzed. The mean and SD of the distance were less than 0.80 and 0.52 mm, respectively. The maximum ranges of tumor motion on cine-MRI were 2.4 ± 1.4 mm (range, 1.0–5.0 mm), 4.4 ± 3.3 mm (range, 0.8–9.4 mm), and 14.7 ± 5.9 mm (range, 7.4–23.4 mm) in lateral, anterior–posterior, and superior–inferior directions, respectively. The ranges in the superior–inferior direction were larger than those estimated with 4DCT images for all patients. The volume of ITV {sub Potential} was 160.3% ± 13.5% (range, 142.0%–179.2%) of the ITV {sub 4DCT}. The maximum DSC values were observed when the cutoff value of 24.7% ± 4.0% (range, 20%–29%) was applied. Conclusions: The authors demonstrated a novel method of calculating 3D motion and ITV {sub Potential} of liver cancer using orthogonal cine-MRI. Their method achieved accurate calculation of the respiratory motion of moving structures. Individual evaluation of the ITV {sub Potential} will aid in improving respiration management and treatment planning.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-C-210-01: Are Clinically Relevant Dosimetric Endpoints Significantly Better with Gating of Lung SBRT Vs. ITV-Based Treatment?: Results of a Large Cohort Investigation Analyzing Predictive Dosimetric Indicators as a Function of Tumor Volume and Motion Amplitude

Purpose: To quantitatively compare patient internal target volume (ITV)-based plans with retrospectively generated gated plans to evaluate potential dosimetric improvements in lung toxicity from gated radiotherapy. Methods: Evaluation was conducted for 150 stereotactic body radiation therapy (SBRT) treatment plans for 128 early-stage (T1–T3, <5cm) NSCLC patients. PTV margins were: ITV+5 mm (ITV-plan) and GTV+5 mm (Gated-plan). ITV-based and gated treatment plans were compared on the same free-breathing CT. ITV-based plan constraints were used to re-optimize and recalculate new gated plans. Plans were generated for 3 fractionation regimens: 3×18Gy, 4×12Gy (original), and 5×10Gy. Physical dose was converted to equivalent dose in 2Gy fractions (EQD2), which was used to determine mean lung dose (MLD) and percent volume of lung receiving ≥20Gy (V20). MLD and V20 differences between gating and ITV-based plans were analyzed as a function of both three-dimensional (3D) motion and tumor volume. The low dose region, V5, was also evaluated. Results: MLD and V20 differences between gated and ITV-based plans were larger for lower (1.48±1.32Gy and 1.44±1.29%) than for upper lobe tumors (0.89±0.74Gy and 0.92±0.71%) due to smaller tumor motion (2.9±3.4mm) compared to lower lobe tumors (8.1±6.1mm). Average differences of <1–2% were noted in V5 between ITV and gated plans. Dosimetric differences between gating and ITV-based methods increased with increasing tumor motion and decreasing tumor volume. Overall, average MLD (8.04±3.92Gy) and V20 (8.29±4.33%) values for ITV-based plans were already well below clinical guidelines, even for the 3×18Gy dose scheme, for which largest differences were noted relative to gated plans. Similar results were obtained for 5×10Gy and 4×12Gy regimens. Conclusion: Clinically relevant improvement in pulmonary toxicity, based on predictors of radiation pneumonitis (MLD and V20) was not generally observed, though improvement for tumors with 3D motion >15 mm, mainly concentrated in peripheral lower lobe tumors, may be considered clinically relevant. Work supported in part by a grant from Varian Medical systems, Palo Alto, CA.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-J-35: Using CBCT as the Alternative Method of Assessing ITV Volume

Purpose To study the accuracy of Internal Target Volumes (ITVs) created on cone beam CT (CBCT) by comparing the visible target volume on CBCT to volumes (GTV, ITV, and PTV) outlined on free breathing (FB) CT and 4DCT. Methods A Quasar Cylindrical Motion Phantom with a 3cm diameter ball (14.14 cc) embedded within a cork insert was set up to simulate respiratory motion with a period of 4 seconds and amplitude of 2cm superioinferiorly and 1cm anterioposteriorly. FBCT and 4DCT images were acquired. A PTV-4D was created on the 4DCT by applying a uniform margin of 5mm to the ITV-CT. PTV-FB was created by applying a margin of the motion range plus 5mm, i.e. total of 1.5cm laterally and 2.5cm superioinferiorly to the GTV outlined on the FBCT. A dynamic conformal arc was planned to treat the PTV-FB with 1mm margin. A CBCT was acquired before the treatment, on which the target was delineated. During the treatment, the position of the target was monitored using the EPID in cine mode. Results ITV-CBCT and ITV-CT were measured to be 56.6 and 62.7cc, respectively, with a Dice Coefficient (DC) of 0.94 and disagreement in center of mass (COM) of 0.59 mm. On the other hand, GTV-FB was 11.47cc, 19% less than the known volume of the ball. PTV-FB and PTV-4D were 149 and 116 cc, with a DC of 0.71. Part of the ITV-CT was not enclosed by the PTV-FB despite the large margin. The cine EPID images have confirmed geometrical misses of the target. Similar under-coverage was observed in one clinical case and captured by the CBCT, where the implanted fiducials moved outside PTV-FB. Conclusion ITV-CBCT is in good agreement with ITV-CT. When 4DCT was not available, CBCT can be an effective alternative in determining and verifying the PTV margin.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-J-179: Assessment of Tumor Volume Change and Movement During Stereotactic Body Radiotherapy (SBRT) for Lung Cancer: Is Adaptive Radiation Therapy (ART) Necessary?

Purpose: Delineation of gross tumor volumes (GTVs) is important for stereotactic body radiotherapy (SBRT). However, tumor volume changes during treatment response. Here, we have investigated tumor volume changes and movement during SBRT for lung cancer, as a means of examining the need for adaptive radiation therapy (ART). Methods: Fifteen tumors in 15 patients with lung cancer were treated with SBRT (total dose: 60 Gy in 4 fractions). GTVs were obtained from cone-beam computed tomography scans (CBCT1–4) taken before each of the 4 fractions was administered. GTVs were delineated and measured by radiation oncologists using a treatment planning system. Variance in the tumor position was assessed between the planning CT and the CBCT images. To investigate the dosimetric effects of tumor volume changes, planning CT and CBCT4 treatment plans were compared using the conformity index (CI), homogeneity index (HI), and Paddick’s index (PCI). Results: The GTV on CBCT1 was employed as a baseline for comparisons. GTV had decreased by a mean of 20.4% (range: 0.7% to 47.2%) on CBCT4. Most patients had smaller GTVs on CBCT4 than on CBCT1. The interfractional shifts of the tumor position between the planning CT and CBCT1–4 were as follows: right-left, −0.4 to 1.3 mm; anterior-posterior, −0.8 to 0.5 mm; and superiorinferior, −0.9 to 1.1 mm. Indices for plans from the planning CT and CBCT4 were as follows: CI = 0.94±0.02 and 1.11±0.03; HI= 1.1±0.02 and 1.10±0.03; and PCI = 1.35±0.16 and 1.11±0.02, respectively. Conclusion: CI, HI, and PCI did not differ between the planning CT and CBCTs. However, daily CBCT revealed a significant decrease in the GTV during lung SBRT. Furthermore, there was an obvious interfractional shift in tumor position. Using ART could potentially lead to a reduced GTV margin and improved regional tumor control for lung cancer patients with significantly decreased GTV.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-24: A Dose Volume Comparison in Stereotactic Body Radiation Therapy Using Flattened and Un-Flattened Photon Beams

Purpose: Aim of this study is to compare the dose volume characteristics of 6X FFF (flattening Free Filter) Arc and 6X FB (flattened Beam) arc photon plans in SBRT technique. Methods: Eight patients who received linear Accelearator-based SBRT were retrospectively included in this study. A dose of 50 Gy was given to the target in five fractions. Same data set was used to generate plans for both FFF and FB. ITV was generated using maximum intensity projection and critical structures were derived using average intensity projection. PTV obtained by giving 0.5cm margin to ITV. Results: While both modalities can provide satisfactory target dose coverage, the dose to PTV was more heterogeneous in FFF than 6X FB plans in all cases. The doses in all plans were well below institutional constraints for both modalities. Comparing the results of Homogeneity Index(HI), Conformity Index(CI), PTV-D80% volume, D50% volume and D20% volume (Table-1 ) for both techniques, found all the indices are within limits of RTOG guidelines but the 6X FFF is superior in sparing normal tissues in compare with FB. In all cases studied, more treatment time was required for FB treatment delivery for a given prescription. The results indicate that for large dose delivery FFF is preferable as volumetric parameters like HI and CI are better and dose can be delivered in a short span of time. Conclusion: Both Flattened and Unflattened beam SBRT systems can provide adequate dose coverage for target tumor. While the unflattened beams deliver less normal tissue dose than Flattened beams in all cases. The magnitude of differences in normal tissue dose between both modalities was due to beam characterization of the beams. Flattened beam requires more Monitor Units to deliver similar target prescription to the tumor than unflattened beam SBRT systems. The results of this study may provide a general guideline for patient and treatment modality selection based on volumetric, tumor control and normal tissue sparing considerations.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-170: Characterization of the Location, Extent, and Proximity to Critical Structures of Target Volumes Provides Detail for Improved Outcome Predictions Among Pancreatic Cancer Patients

Purpose: In radiotherapy, size, location and proximity of the target to critical structures influence treatment decisions. It has been shown that proximity of the target predicts dosimetric sparing of critical structures. In addition to dosimetry, precise location of disease has further implications such as tumor invasion, or proximity to major arteries that inhibit surgery. Knowledge of which patients can be converted to surgical candidates by radiation may have high impact on future treat/no-treat decisions. We propose a method to improve our characterization of the location of pancreatic cancer and treatment volume extent with respect to nearby arteries with the goal of developing features to improve clinical predictions and decisions. Methods: Oncospace is a local learning health system that systematically captures clinical outcomes and all aspects of radiotherapy treatment plans, including overlap volume histograms (OVH) – a measure of spatial relationships between two structures. Minimum and maximum distances of PTV and OARs based on OVH, PTV volume, anatomic location by ICD-9 code, and surgical outcome were queried. Normalized distance to center from the left and right kidney was calculated to indicate tumor location and laterality. Distance to critical arteries (celiac, superior mesenteric, common hepatic) is validated by surgical status (borderline resectable, locally advanced converted to resectable). Results: There were 205 pancreas stereotactic body radiotherapy patients treated from 2009–2015 queried. Location/laterality of tumor based on kidney OVH show strong trends between location by OVH and by ICD-9. Compared to the locally advanced group, the borderline resectable group showed larger geometrical distance from critical arteries (p=0.03). Conclusion: Our platform enabled analysis of shape/size-location relationships. These data suggest that PTV volume and attention to distance between PTVs and surrounding OARs and major arteries may be promising for improving characterization of treatment anatomy that can refine our ability for outcome predictions and decision making. Elekta, Toshiba.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-294: Dosimetric Analysis of Planning Phase Using Overlap Volume Histogram for Respiratory Gated Radiotherapy

Purpose: End-of-exhale (EOE) phase is generally preferred for gating window because tumor position is more reproducible. However, other gating windows might be more appropriate for dose distribution perspective. In this pilot study, we proposed to utilize overlap volume histogram (OVH) to search optimized gating window and demonstrated its feasibility. Methods: We acquired 4DCT of 10 phases for 3 lung patients (2 with a target at right middle lobe and 1 at right upper lobe). After structures were defined in every phase, the OVH of each OAR was generated to quantify the three dimensional spatial relationship between the PTV and OARs (bronchus, esophagus, heart and cord etc.) at each phase. OVH tells the overlap volume of an OAR according to outward distance from the PTV. Relative overlap volume at 20 mm outward distance from the PTV (ROV-20) was also defined as a metric for measuring overlap volume and obtained. For dose calculation, 3D CRT plans were made for all phases under the same beam angles and objectives (e.g., 95% of the PTV coverage with at least 100% of the prescription dose of 50 Gy). The gating window phase was ranked according to ROV-20, and the relationship between the OVH and dose distribution at each phase was evaluated by comparing the maximum dose, mean dose, and equivalent uniform dose of OAR. Results: OVHs showed noticeable difference from phase to phase, implying it is possible to find optimal phases for gating window. For 2 out of 3 patients (both with a target at RML), maximum dose, mean dose, and EUD increased as ROV-20 increased. Conclusion: It is demonstrated that optimal phases (in dose distribution perspective) for gating window could exist and OVH can be a useful tool for determining such phases without performing dose optimization calculations in all phases. This work was supported by the Radiation Technology R&D program (No. 2013M2A2A7043498) and the Mid-career Researcher Program (2012-007883) through the National Research Foundation (NRF) funded by the Ministry of Science, ICT & Future Planning (MSIP) of Korea.

60 APPLIED LIFE SCIENCES↗