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DOE OSTI2015

TU-EF-BRA-00: MR Basics I

NMR, and Proton Density MRI of the 1D Patient - Anthony Wolbarst Net Voxel Magnetization, m(x,t). T1-MRI; The MRI Device - Lisa Lemen ‘Classical’ NMR; FID Imaging in 1D via k-Space - Nathan Yanasak Spin-Echo; S-E/Spin Warp in a 2D Slice - Ronald Price Magnetic resonance imaging not only reveals the structural, anatomic details of the body, as does CT, but also it can provide information on the physiological status and pathologies of its tissues, like nuclear medicine. It can display high-quality slice and 3D images of organs and vessels viewed from any perspective, with resolution better than 1 mm. MRI is perhaps most extraordinary and notable for the plethora of ways in which it can create unique forms of image contrast, reflective of fundamentally different biophysical phenomena. As with ultrasound, there is no risk from ionizing radiation to the patient or staff, since no X-rays or radioactive nuclei are involved. Instead, MRI harnesses magnetic fields and radio waves to probe the stable nuclei of the ordinary hydrogen atoms (isolated protons) occurring in water and lipid molecules within and around cells. MRI consists, in essence, of creating spatial maps of the electromagnetic environments around these hydrogen nuclei. Spatial variations in the proton milieus can be related to clinical differences in the biochemical and physiological properties and conditions of the associated tissues. Imaging of proton density (PD), and of the tissue proton spin relaxation times known as T1 and T2, all can reveal important clinical information, but they do so with approaches so dissimilar from one another that each is chosen for only certain clinical situations. T1 and T2 in a voxel are determined by different aspects of the rotations and other motions of the water and lipid molecules involved, as constrained by the local biophysical surroundings within and between its cells – and they, in turn, depend on the type of tissue and its state of health. Three other common applications of MRI exploit its capability to detect and image distinct movements of fluids: MR angiography (MRA), which rivals CT angiography but often requires no contrast medium, monitors the bulk flow of blood; functional MRI (f MRI), distinguishes the perfusion of oxygenated blood from that of de-oxygenated, and lights up parts of the brain that are activated by a stimulus, rather like PET; and diffusion tensor imaging (DTI) indicates the diffusion of free water along tracts of axons, thereby bringing nerve trunks into view. There are variants on all of these themes, and on others as well. Magnetic Resonance Spectroscopy (MRS), for example, can perform non-invasive ‘virtual biopsies’ that allow identification of certain cancers and other lesions. And an MRI-guided needle biopsy can sample brain tissue from a region only millimeters in dimensions. MRI, however, involves deeper and more complex aspects of physics, technology, and biology than do most other imaging modalities, and it is widely considered to be correspondingly more difficult to learn. We could probably cover all of this rather comprehensively if we had 50 hours available rather than 2 ̶ but, to paraphrase a former Secretary of Defense, you tell your story in the time you have allotted. The four presenters and another physicist, Kevin King from GE, have combined their efforts to co-author a single slide show that describes essentials of MRI as simply as possible. It is obviously far from thorough, but hopefully it will succeed in explaining some of the basics in a simplified but still valid fashion; in providing a taste of the numerous capabilities and complexities of the modality; and in whetting your appetite to learn more. Part I. NMR, and Proton Density MRI of the 1D Patient (Wolbarst), begins with an introductory case study that illustrates a half dozen ways in which MRI provides valuable clinical information. It then explores the nuclear magnetic resonance (NMR) phenomenon, which underlies MRI. NMR can be introduced with either of two approaches. In the first, one thinks (loosely) of the nuclei of hydrogen atoms as (rotating and charged and therefore) magnetic objects, whose spin-axes tend to align in a strong external magnetic field, much like a compass needle. As with the Bohr atom, this spin-up/spin-down picture is a highly abridged version of the full quantum mechanical treatment, but still it leads to some useful, legitimate pictures of the NMR process occurring within a voxel: When RF photons of the correct (Larmor) frequency elevate protons in a fixed magnetic field out of their lower-energy spin state into the upper, the NMR phenomenon is indicated by the detectable absorption of RF power. With the addition of a linear gradient field along a multi-voxel, one-dimensional patient/phantom, as well, we can determine the water content of each compartment – an example of a real MRI study, albeit in 1D. Part I concludes with a discussion of the net magnetization at position x, m0(x), under conditions of dynamic thermal equilibrium, which leads into: Part II. Net Voxel Magnetization, m(x,t); T1-MRI; The MRI Device (Lemen), investigates the biophysics of the form of proton spin relaxation process characterized by the time T1. It then moves on to the creation of an MR image that displays the spatial variation in the values of this clinically relevant parameter, again in 1D. Finally, the design and workings of a clinical MRI machine are sketched, in preparation for: Part III. ‘Classical’ NMR; FID Imaging in 1D via k-Space (Yanasak) presents the second standard approach to NMR and MRI, the classical model. It focuses on the time dependence of the net nuclear magnetization, m(x,t), the overall magnetic field generated by the cohort of protons in the voxel at position x. Quite remarkably, this nuclear net magnetization itself acts in a strong magnetic field like a gyroscope in a gravitational field. This tack is better for explaining Free Induction Decay (FID), which involves a brief introduction to the Fourier transform and k-space. This leads to conventional Spin-Echo (S-E) reconstruction techniques for creating clinical images from raw data, and sets the stage for: Part IV. Spin-Echo; S-E / Spin Warp in a 2D Slice (Price) discusses application of the S- E sequence of radiofrequency pulses and gradient magnetic fields to the 1D patient. T2 is introduced but not explained. This Part also considers how to manipulate the image acquisition parameters so as to generate clinical pictures with contrast dominated by spatial variations in PD, T1, or T2. We conclude by demonstrating the spin-warp approach to imaging in 2D with a simple 2×2, 4-voxel example. Much of this material is presented in more detail in the chapter “MRI of the One-dimensional Patient, Part I”, in Advances in Medical Physics, Vol 5 (2014). Copies are on display at the Medical Physics Publishing booth. Learning Objectives: The participant will learn about the processes of NMR and T1 spin relaxation in a tissue voxel in a uniform magnetic field. The participant will learn about combining spin-up/spin-down NMR and T1 processes with a linear gradient to effect frequency-encoding of voxel spatial position. This approach can be used to create proton density and T1 MRI maps, respectively, of the contents of multi-voxel 1D phantoms. The participant will learn about how the ‘classical’ model of NMR it can generate Free Induction Decay (FID) images of 1D phantoms, which involves the use of the Fourier transform in k-space. This can lead simply into standard Spin-Echo images. The participant will learn about extending Spin-Echo imaging into 2 and more dimensions.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

TU-EF-BRA-01: NMR and Proton Density MRI of the 1D Patient

NMR, and Proton Density MRI of the 1D Patient - Anthony Wolbarst Net Voxel Magnetization, m(x,t). T1-MRI; The MRI Device - Lisa Lemen ‘Classical’ NMR; FID Imaging in 1D via k-Space - Nathan Yanasak Spin-Echo; S-E/Spin Warp in a 2D Slice - Ronald Price Magnetic resonance imaging not only reveals the structural, anatomic details of the body, as does CT, but also it can provide information on the physiological status and pathologies of its tissues, like nuclear medicine. It can display high-quality slice and 3D images of organs and vessels viewed from any perspective, with resolution better than 1 mm. MRI is perhaps most extraordinary and notable for the plethora of ways in which it can create unique forms of image contrast, reflective of fundamentally different biophysical phenomena. As with ultrasound, there is no risk from ionizing radiation to the patient or staff, since no X-rays or radioactive nuclei are involved. Instead, MRI harnesses magnetic fields and radio waves to probe the stable nuclei of the ordinary hydrogen atoms (isolated protons) occurring in water and lipid molecules within and around cells. MRI consists, in essence, of creating spatial maps of the electromagnetic environments around these hydrogen nuclei. Spatial variations in the proton milieus can be related to clinical differences in the biochemical and physiological properties and conditions of the associated tissues. Imaging of proton density (PD), and of the tissue proton spin relaxation times known as T1 and T2, all can reveal important clinical information, but they do so with approaches so dissimilar from one another that each is chosen for only certain clinical situations. T1 and T2 in a voxel are determined by different aspects of the rotations and other motions of the water and lipid molecules involved, as constrained by the local biophysical surroundings within and between its cells – and they, in turn, depend on the type of tissue and its state of health. Three other common applications of MRI exploit its capability to detect and image distinct movements of fluids: MR angiography (MRA), which rivals CT angiography but often requires no contrast medium, monitors the bulk flow of blood; functional MRI ( f MRI), distinguishes the perfusion of oxygenated blood from that of de-oxygenated, and lights up parts of the brain that are activated by a stimulus, rather like PET; and diffusion tensor imaging (DTI) indicates the diffusion of free water along tracts of axons, thereby bringing nerve trunks into view. There are variants on all of these themes, and on others as well. Magnetic Resonance Spectroscopy (MRS), for example, can perform non-invasive ‘virtual biopsies’ that allow identification of certain cancers and other lesions. And an MRI-guided needle biopsy can sample brain tissue from a region only millimeters in dimensions. MRI, however, involves deeper and more complex aspects of physics, technology, and biology than do most other imaging modalities, and it is widely considered to be correspondingly more difficult to learn. We could probably cover all of this rather comprehensively if we had 50 hours available rather than 2 ̶ but, to paraphrase a former Secretary of Defense, you tell your story in the time you have allotted. The four presenters and another physicist, Kevin King from GE, have combined their efforts to co-author a single slide show that describes essentials of MRI as simply as possible. It is obviously far from thorough, but hopefully it will succeed in explaining some of the basics in a simplified but still valid fashion; in providing a taste of the numerous capabilities and complexities of the modality; and in whetting your appetite to learn more. Part I. NMR, and Proton Density MRI of the 1D Patient (Wolbarst), begins with an introductory case study that illustrates a half dozen ways in which MRI provides valuable clinical information. It then explores the nuclear magnetic resonance (NMR) phenomenon, which underlies MRI. NMR can be introduced with either of two approaches. In the first, one thinks (loosely) of the nuclei of hydrogen atoms as (rotating and charged and therefore) magnetic objects, whose spin-axes tend to align in a strong external magnetic field, much like a compass needle. As with the Bohr atom, this spin-up/spin-down picture is a highly abridged version of the full quantum mechanical treatment, but still it leads to some useful, legitimate pictures of the NMR process occurring within a voxel: When RF photons of the correct (Larmor) frequency elevate protons in a fixed magnetic field out of their lower-energy spin state into the upper, the NMR phenomenon is indicated by the detectable absorption of RF power. With the addition of a linear gradient field along a multi-voxel, one-dimensional patient/phantom, as well, we can determine the water content of each compartment – an example of a real MRI study, albeit in 1D. Part I concludes with a discussion of the net magnetization at position x, m0(x), under conditions of dynamic thermal equilibrium, which leads into: Part II. Net Voxel Magnetization, m(x,t); T1-MRI; The MRI Device (Lemen), investigates the biophysics of the form of proton spin relaxation process characterized by the time T1. It then moves on to the creation of an MR image that displays the spatial variation in the values of this clinically relevant parameter, again in 1D. Finally, the design and workings of a clinical MRI machine are sketched, in preparation for: Part III. ‘Classical’ NMR; FID Imaging in 1D via k-Space (Yanasak) presents the second standard approach to NMR and MRI, the classical model. It focuses on the time dependence of the net nuclear magnetization, m(x,t), the overall magnetic field generated by the cohort of protons in the voxel at position x. Quite remarkably, this nuclear net magnetization itself acts in a strong magnetic field like a gyroscope in a gravitational field. This tack is better for explaining Free Induction Decay (FID), which involves a brief introduction to the Fourier transform and k-space. This leads to conventional Spin-Echo (S-E) reconstruction techniques for creating clinical images from raw data, and sets the stage for: Part IV. Spin-Echo; S-E / Spin Warp in a 2D Slice (Price) discusses application of the S- E sequence of radiofrequency pulses and gradient magnetic fields to the 1D patient. T2 is introduced but not explained. This Part also considers how to manipulate the image acquisition parameters so as to generate clinical pictures with contrast dominated by spatial variations in PD, T1, or T2. We conclude by demonstrating the spin-warp approach to imaging in 2D with a simple 2×2, 4-voxel example. Much of this material is presented in more detail in the chapter “MRI of the One-dimensional Patient, Part I”, in Advances in Medical Physics, Vol 5 (2014). Copies are on display at the Medical Physics Publishing booth. Learning Objectives: The participant will learn about the processes of NMR and T1 spin relaxation in a tissue voxel in a uniform magnetic field. The participant will learn about combining spin-up/spin-down NMR and T1 processes with a linear gradient to effect frequency-encoding of voxel spatial position. This approach can be used to create proton density and T1 MRI maps, respectively, of the contents of multi-voxel 1D phantoms. The participant will learn about how the ‘classical’ model of NMR it can generate Free Induction Decay (FID) images of 1D phantoms, which involves the use of the Fourier transform in k-space. This can lead simply into standard Spin-Echo images. The participant will learn about extending Spin-Echo imaging into 2 and more dimensions.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

TU-EF-BRA-02: Longitudinal Proton Spin Relaxation and T1-Imaging

NMR, and Proton Density MRI of the 1D Patient - Anthony Wolbarst Net Voxel Magnetization, m(x,t). T1-MRI; The MRI Device - Lisa Lemen ‘Classical’ NMR; FID Imaging in 1D via k-Space - Nathan Yanasak Spin-Echo; S-E/Spin Warp in a 2D Slice - Ronald Price Magnetic resonance imaging not only reveals the structural, anatomic details of the body, as does CT, but also it can provide information on the physiological status and pathologies of its tissues, like nuclear medicine. It can display high-quality slice and 3D images of organs and vessels viewed from any perspective, with resolution better than 1 mm. MRI is perhaps most extraordinary and notable for the plethora of ways in which it can create unique forms of image contrast, reflective of fundamentally different biophysical phenomena. As with ultrasound, there is no risk from ionizing radiation to the patient or staff, since no X-rays or radioactive nuclei are involved. Instead, MRI harnesses magnetic fields and radio waves to probe the stable nuclei of the ordinary hydrogen atoms (isolated protons) occurring in water and lipid molecules within and around cells. MRI consists, in essence, of creating spatial maps of the electromagnetic environments around these hydrogen nuclei. Spatial variations in the proton milieus can be related to clinical differences in the biochemical and physiological properties and conditions of the associated tissues. Imaging of proton density (PD), and of the tissue proton spin relaxation times known as T1 and T2, all can reveal important clinical information, but they do so with approaches so dissimilar from one another that each is chosen for only certain clinical situations. T1 and T2 in a voxel are determined by different aspects of the rotations and other motions of the water and lipid molecules involved, as constrained by the local biophysical surroundings within and between its cells – and they, in turn, depend on the type of tissue and its state of health. Three other common applications of MRI exploit its capability to detect and image distinct movements of fluids: MR angiography (MRA), which rivals CT angiography but often requires no contrast medium, monitors the bulk flow of blood; functional MRI ( f MRI), distinguishes the perfusion of oxygenated blood from that of de-oxygenated, and lights up parts of the brain that are activated by a stimulus, rather like PET; and diffusion tensor imaging (DTI) indicates the diffusion of free water along tracts of axons, thereby bringing nerve trunks into view. There are variants on all of these themes, and on others as well. Magnetic Resonance Spectroscopy (MRS), for example, can perform non-invasive ‘virtual biopsies’ that allow identification of certain cancers and other lesions. And an MRI-guided needle biopsy can sample brain tissue from a region only millimeters in dimensions. MRI, however, involves deeper and more complex aspects of physics, technology, and biology than do most other imaging modalities, and it is widely considered to be correspondingly more difficult to learn. We could probably cover all of this rather comprehensively if we had 50 hours available rather than 2 ̶ but, to paraphrase a former Secretary of Defense, you tell your story in the time you have allotted. The four presenters and another physicist, Kevin King from GE, have combined their efforts to co-author a single slide show that describes essentials of MRI as simply as possible. It is obviously far from thorough, but hopefully it will succeed in explaining some of the basics in a simplified but still valid fashion; in providing a taste of the numerous capabilities and complexities of the modality; and in whetting your appetite to learn more. Part I. NMR, and Proton Density MRI of the 1D Patient (Wolbarst), begins with an introductory case study that illustrates a half dozen ways in which MRI provides valuable clinical information. It then explores the nuclear magnetic resonance (NMR) phenomenon, which underlies MRI. NMR can be introduced with either of two approaches. In the first, one thinks (loosely) of the nuclei of hydrogen atoms as (rotating and charged and therefore) magnetic objects, whose spin-axes tend to align in a strong external magnetic field, much like a compass needle. As with the Bohr atom, this spin-up/spin-down picture is a highly abridged version of the full quantum mechanical treatment, but still it leads to some useful, legitimate pictures of the NMR process occurring within a voxel: When RF photons of the correct (Larmor) frequency elevate protons in a fixed magnetic field out of their lower-energy spin state into the upper, the NMR phenomenon is indicated by the detectable absorption of RF power. With the addition of a linear gradient field along a multi-voxel, one-dimensional patient/phantom, as well, we can determine the water content of each compartment – an example of a real MRI study, albeit in 1D. Part I concludes with a discussion of the net magnetization at position x, m0(x), under conditions of dynamic thermal equilibrium, which leads into: Part II. Net Voxel Magnetization, m(x,t); T1-MRI; The MRI Device (Lemen), investigates the biophysics of the form of proton spin relaxation process characterized by the time T1. It then moves on to the creation of an MR image that displays the spatial variation in the values of this clinically relevant parameter, again in 1D. Finally, the design and workings of a clinical MRI machine are sketched, in preparation for: Part III. ‘Classical’ NMR; FID Imaging in 1D via k-Space (Yanasak) presents the second standard approach to NMR and MRI, the classical model. It focuses on the time dependence of the net nuclear magnetization, m(x,t), the overall magnetic field generated by the cohort of protons in the voxel at position x. Quite remarkably, this nuclear net magnetization itself acts in a strong magnetic field like a gyroscope in a gravitational field. This tack is better for explaining Free Induction Decay (FID), which involves a brief introduction to the Fourier transform and k-space. This leads to conventional Spin-Echo (S-E) reconstruction techniques for creating clinical images from raw data, and sets the stage for: Part IV. Spin-Echo; S-E / Spin Warp in a 2D Slice (Price) discusses application of the S- E sequence of radiofrequency pulses and gradient magnetic fields to the 1D patient. T2 is introduced but not explained. This Part also considers how to manipulate the image acquisition parameters so as to generate clinical pictures with contrast dominated by spatial variations in PD, T1, or T2. We conclude by demonstrating the spin-warp approach to imaging in 2D with a simple 2×2, 4-voxel example. Much of this material is presented in more detail in the chapter “MRI of the One-dimensional Patient, Part I”, in Advances in Medical Physics, Vol 5 (2014). Copies are on display at the Medical Physics Publishing booth. Learning Objectives: The participant will learn about the processes of NMR and T1 spin relaxation in a tissue voxel in a uniform magnetic field. The participant will learn about combining spin-up/spin-down NMR and T1 processes with a linear gradient to effect frequency-encoding of voxel spatial position. This approach can be used to create proton density and T1 MRI maps, respectively, of the contents of multi-voxel 1D phantoms. The participant will learn about how the ‘classical’ model of NMR it can generate Free Induction Decay (FID) images of 1D phantoms, which involves the use of the Fourier transform in k-space. This can lead simply into standard Spin-Echo images. The participant will learn about extending Spin-Echo imaging into 2 and more dimensions.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

TU-EF-BRA-03: Free Induction Decay (without the Decay) and Spin-Echo Imaging

NMR, and Proton Density MRI of the 1D Patient - Anthony Wolbarst Net Voxel Magnetization, m(x,t). T1-MRI; The MRI Device - Lisa Lemen ‘Classical’ NMR; FID Imaging in 1D via k-Space - Nathan Yanasak Spin-Echo; S-E/Spin Warp in a 2D Slice - Ronald Price Magnetic resonance imaging not only reveals the structural, anatomic details of the body, as does CT, but also it can provide information on the physiological status and pathologies of its tissues, like nuclear medicine. It can display high-quality slice and 3D images of organs and vessels viewed from any perspective, with resolution better than 1 mm. MRI is perhaps most extraordinary and notable for the plethora of ways in which it can create unique forms of image contrast, reflective of fundamentally different biophysical phenomena. As with ultrasound, there is no risk from ionizing radiation to the patient or staff, since no X-rays or radioactive nuclei are involved. Instead, MRI harnesses magnetic fields and radio waves to probe the stable nuclei of the ordinary hydrogen atoms (isolated protons) occurring in water and lipid molecules within and around cells. MRI consists, in essence, of creating spatial maps of the electromagnetic environments around these hydrogen nuclei. Spatial variations in the proton milieus can be related to clinical differences in the biochemical and physiological properties and conditions of the associated tissues. Imaging of proton density (PD), and of the tissue proton spin relaxation times known as T1 and T2, all can reveal important clinical information, but they do so with approaches so dissimilar from one another that each is chosen for only certain clinical situations. T1 and T2 in a voxel are determined by different aspects of the rotations and other motions of the water and lipid molecules involved, as constrained by the local biophysical surroundings within and between its cells – and they, in turn, depend on the type of tissue and its state of health. Three other common applications of MRI exploit its capability to detect and image distinct movements of fluids: MR angiography (MRA), which rivals CT angiography but often requires no contrast medium, monitors the bulk flow of blood; functional MRI ( f MRI), distinguishes the perfusion of oxygenated blood from that of de-oxygenated, and lights up parts of the brain that are activated by a stimulus, rather like PET; and diffusion tensor imaging (DTI) indicates the diffusion of free water along tracts of axons, thereby bringing nerve trunks into view. There are variants on all of these themes, and on others as well. Magnetic Resonance Spectroscopy (MRS), for example, can perform non-invasive ‘virtual biopsies’ that allow identification of certain cancers and other lesions. And an MRI-guided needle biopsy can sample brain tissue from a region only millimeters in dimensions. MRI, however, involves deeper and more complex aspects of physics, technology, and biology than do most other imaging modalities, and it is widely considered to be correspondingly more difficult to learn. We could probably cover all of this rather comprehensively if we had 50 hours available rather than 2 ̶ but, to paraphrase a former Secretary of Defense, you tell your story in the time you have allotted. The four presenters and another physicist, Kevin King from GE, have combined their efforts to co-author a single slide show that describes essentials of MRI as simply as possible. It is obviously far from thorough, but hopefully it will succeed in explaining some of the basics in a simplified but still valid fashion; in providing a taste of the numerous capabilities and complexities of the modality; and in whetting your appetite to learn more. Part I. NMR, and Proton Density MRI of the 1D Patient (Wolbarst), begins with an introductory case study that illustrates a half dozen ways in which MRI provides valuable clinical information. It then explores the nuclear magnetic resonance (NMR) phenomenon, which underlies MRI. NMR can be introduced with either of two approaches. In the first, one thinks (loosely) of the nuclei of hydrogen atoms as (rotating and charged and therefore) magnetic objects, whose spin-axes tend to align in a strong external magnetic field, much like a compass needle. As with the Bohr atom, this spin-up/spin-down picture is a highly abridged version of the full quantum mechanical treatment, but still it leads to some useful, legitimate pictures of the NMR process occurring within a voxel: When RF photons of the correct (Larmor) frequency elevate protons in a fixed magnetic field out of their lower-energy spin state into the upper, the NMR phenomenon is indicated by the detectable absorption of RF power. With the addition of a linear gradient field along a multi-voxel, one-dimensional patient/phantom, as well, we can determine the water content of each compartment – an example of a real MRI study, albeit in 1D. Part I concludes with a discussion of the net magnetization at position x, m0(x), under conditions of dynamic thermal equilibrium, which leads into: Part II. Net Voxel Magnetization, m(x,t); T1-MRI; The MRI Device (Lemen), investigates the biophysics of the form of proton spin relaxation process characterized by the time T1. It then moves on to the creation of an MR image that displays the spatial variation in the values of this clinically relevant parameter, again in 1D. Finally, the design and workings of a clinical MRI machine are sketched, in preparation for: Part III. ‘Classical’ NMR; FID Imaging in 1D via k-Space (Yanasak) presents the second standard approach to NMR and MRI, the classical model. It focuses on the time dependence of the net nuclear magnetization, m(x,t), the overall magnetic field generated by the cohort of protons in the voxel at position x. Quite remarkably, this nuclear net magnetization itself acts in a strong magnetic field like a gyroscope in a gravitational field. This tack is better for explaining Free Induction Decay (FID), which involves a brief introduction to the Fourier transform and k-space. This leads to conventional Spin-Echo (S-E) reconstruction techniques for creating clinical images from raw data, and sets the stage for: Part IV. Spin-Echo; S-E / Spin Warp in a 2D Slice (Price) discusses application of the S- E sequence of radiofrequency pulses and gradient magnetic fields to the 1D patient. T2 is introduced but not explained. This Part also considers how to manipulate the image acquisition parameters so as to generate clinical pictures with contrast dominated by spatial variations in PD, T1, or T2. We conclude by demonstrating the spin-warp approach to imaging in 2D with a simple 2×2, 4-voxel example. Much of this material is presented in more detail in the chapter “MRI of the One-dimensional Patient, Part I”, in Advances in Medical Physics, Vol 5 (2014). Copies are on display at the Medical Physics Publishing booth. Learning Objectives: The participant will learn about the processes of NMR and T1 spin relaxation in a tissue voxel in a uniform magnetic field. The participant will learn about combining spin-up/spin-down NMR and T1 processes with a linear gradient to effect frequency-encoding of voxel spatial position. This approach can be used to create proton density and T1 MRI maps, respectively, of the contents of multi-voxel 1D phantoms. The participant will learn about how the ‘classical’ model of NMR it can generate Free Induction Decay (FID) images of 1D phantoms, which involves the use of the Fourier transform in k-space. This can lead simply into standard Spin-Echo images. The participant will learn about extending Spin-Echo imaging into 2 and more dimensions.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

TU-EF-BRA-04: Into 2, 3, and 4 Dimensions

NMR, and Proton Density MRI of the 1D Patient - Anthony Wolbarst Net Voxel Magnetization, m(x,t). T1-MRI; The MRI Device - Lisa Lemen ‘Classical’ NMR; FID Imaging in 1D via k-Space - Nathan Yanasak Spin-Echo; S-E/Spin Warp in a 2D Slice - Ronald Price Magnetic resonance imaging not only reveals the structural, anatomic details of the body, as does CT, but also it can provide information on the physiological status and pathologies of its tissues, like nuclear medicine. It can display high-quality slice and 3D images of organs and vessels viewed from any perspective, with resolution better than 1 mm. MRI is perhaps most extraordinary and notable for the plethora of ways in which it can create unique forms of image contrast, reflective of fundamentally different biophysical phenomena. As with ultrasound, there is no risk from ionizing radiation to the patient or staff, since no X-rays or radioactive nuclei are involved. Instead, MRI harnesses magnetic fields and radio waves to probe the stable nuclei of the ordinary hydrogen atoms (isolated protons) occurring in water and lipid molecules within and around cells. MRI consists, in essence, of creating spatial maps of the electromagnetic environments around these hydrogen nuclei. Spatial variations in the proton milieus can be related to clinical differences in the biochemical and physiological properties and conditions of the associated tissues. Imaging of proton density (PD), and of the tissue proton spin relaxation times known as T1 and T2, all can reveal important clinical information, but they do so with approaches so dissimilar from one another that each is chosen for only certain clinical situations. T1 and T2 in a voxel are determined by different aspects of the rotations and other motions of the water and lipid molecules involved, as constrained by the local biophysical surroundings within and between its cells – and they, in turn, depend on the type of tissue and its state of health. Three other common applications of MRI exploit its capability to detect and image distinct movements of fluids: MR angiography (MRA), which rivals CT angiography but often requires no contrast medium, monitors the bulk flow of blood; functional MRI ( f MRI), distinguishes the perfusion of oxygenated blood from that of de-oxygenated, and lights up parts of the brain that are activated by a stimulus, rather like PET; and diffusion tensor imaging (DTI) indicates the diffusion of free water along tracts of axons, thereby bringing nerve trunks into view. There are variants on all of these themes, and on others as well. Magnetic Resonance Spectroscopy (MRS), for example, can perform non-invasive ‘virtual biopsies’ that allow identification of certain cancers and other lesions. And an MRI-guided needle biopsy can sample brain tissue from a region only millimeters in dimensions. MRI, however, involves deeper and more complex aspects of physics, technology, and biology than do most other imaging modalities, and it is widely considered to be correspondingly more difficult to learn. We could probably cover all of this rather comprehensively if we had 50 hours available rather than 2 ̶ but, to paraphrase a former Secretary of Defense, you tell your story in the time you have allotted. The four presenters and another physicist, Kevin King from GE, have combined their efforts to co-author a single slide show that describes essentials of MRI as simply as possible. It is obviously far from thorough, but hopefully it will succeed in explaining some of the basics in a simplified but still valid fashion; in providing a taste of the numerous capabilities and complexities of the modality; and in whetting your appetite to learn more. Part I. NMR, and Proton Density MRI of the 1D Patient (Wolbarst), begins with an introductory case study that illustrates a half dozen ways in which MRI provides valuable clinical information. It then explores the nuclear magnetic resonance (NMR) phenomenon, which underlies MRI. NMR can be introduced with either of two approaches. In the first, one thinks (loosely) of the nuclei of hydrogen atoms as (rotating and charged and therefore) magnetic objects, whose spin-axes tend to align in a strong external magnetic field, much like a compass needle. As with the Bohr atom, this spin-up/spin-down picture is a highly abridged version of the full quantum mechanical treatment, but still it leads to some useful, legitimate pictures of the NMR process occurring within a voxel: When RF photons of the correct (Larmor) frequency elevate protons in a fixed magnetic field out of their lower-energy spin state into the upper, the NMR phenomenon is indicated by the detectable absorption of RF power. With the addition of a linear gradient field along a multi-voxel, one-dimensional patient/phantom, as well, we can determine the water content of each compartment – an example of a real MRI study, albeit in 1D. Part I concludes with a discussion of the net magnetization at position x, m0(x), under conditions of dynamic thermal equilibrium, which leads into: Part II. Net Voxel Magnetization, m(x,t); T1-MRI; The MRI Device (Lemen), investigates the biophysics of the form of proton spin relaxation process characterized by the time T1. It then moves on to the creation of an MR image that displays the spatial variation in the values of this clinically relevant parameter, again in 1D. Finally, the design and workings of a clinical MRI machine are sketched, in preparation for: Part III. ‘Classical’ NMR; FID Imaging in 1D via k-Space (Yanasak) presents the second standard approach to NMR and MRI, the classical model. It focuses on the time dependence of the net nuclear magnetization, m(x,t), the overall magnetic field generated by the cohort of protons in the voxel at position x. Quite remarkably, this nuclear net magnetization itself acts in a strong magnetic field like a gyroscope in a gravitational field. This tack is better for explaining Free Induction Decay (FID), which involves a brief introduction to the Fourier transform and k-space. This leads to conventional Spin-Echo (S-E) reconstruction techniques for creating clinical images from raw data, and sets the stage for: Part IV. Spin-Echo; S-E / Spin Warp in a 2D Slice (Price) discusses application of the S- E sequence of radiofrequency pulses and gradient magnetic fields to the 1D patient. T2 is introduced but not explained. This Part also considers how to manipulate the image acquisition parameters so as to generate clinical pictures with contrast dominated by spatial variations in PD, T1, or T2. We conclude by demonstrating the spin-warp approach to imaging in 2D with a simple 2×2, 4-voxel example. Much of this material is presented in more detail in the chapter “MRI of the One-dimensional Patient, Part I”, in Advances in Medical Physics, Vol 5 (2014). Copies are on display at the Medical Physics Publishing booth. Learning Objectives: The participant will learn about the processes of NMR and T1 spin relaxation in a tissue voxel in a uniform magnetic field. The participant will learn about combining spin-up/spin-down NMR and T1 processes with a linear gradient to effect frequency-encoding of voxel spatial position. This approach can be used to create proton density and T1 MRI maps, respectively, of the contents of multi-voxel 1D phantoms. The participant will learn about how the ‘classical’ model of NMR it can generate Free Induction Decay (FID) images of 1D phantoms, which involves the use of the Fourier transform in k-space. This can lead simply into standard Spin-Echo images. The participant will learn about extending Spin-Echo imaging into 2 and more dimensions.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

TU-F-CAMPUS-T-04: Variations in Nominally Identical Small Fields From Photon Jaw Reproducibility and Associated Effects On Small Field Dosimetric Parameters

Purpose: To investigate uncertainties in small field output factors and detector specific correction factors from variations in field size for nominally identical fields using measurements and Monte Carlo simulations. Methods: Repeated measurements of small field output factors are made with the Exradin W1 (plastic scintillation detector) and the PTW microDiamond (synthetic diamond detector) in beams from the Elekta Precise linear accelerator. We investigate corrections for a 0.6x0.6 cm{sup 2} nominal field size shaped with secondary photon jaws at 100 cm source to surface distance (SSD). Measurements of small field profiles are made in a water phantom at 10 cm depth using both detectors and are subsequently used for accurate detector positioning. Supplementary Monte Carlo simulations with EGSnrc are used to calculate the absorbed dose to the detector and absorbed dose to water under the same conditions when varying field size. The jaws in the BEAMnrc model of the accelerator are varied by a reasonable amount to investigate the same situation without the influence of measurements uncertainties (such as detector positioning or variation in beam output). Results: For both detectors, small field output factor measurements differ by up to 11 % when repeated measurements are made in nominally identical 0.6x0.6 cm{sup 2} fields. Variations in the FWHM of measured profiles are consistent with field size variations reported by the accelerator. Monte Carlo simulations of the dose to detector vary by up to 16 % under worst case variations in field size. These variations are also present in calculations of absorbed dose to water. However, calculated detector specific correction factors are within 1 % when varying field size because of cancellation of effects. Conclusion: Clinical physicists should be aware of potentially significant uncertainties in measured output factors required for dosimetry of small fields due to field size variations for nominally identical fields.

07 ISOTOPE AND RADIATION SOURCES↗
DOE OSTI2015

WE-A-BRD-00: MR Basics II

Ever since its introduction as a diagnostic imaging modality over 30 years ago, the radiation therapy community has acknowledged the utility of MR imaging as a tool for not only improved visualization of the target volume but also for demarcation of adjacent organs at risk. However, the adaptation of MR imaging in radiation oncology has, until recently been slow due in large part to the inability to image radiation therapy patients in their treatment position. With the introduction of so-called wide bore high field MR scanners, multi element flexible receive only RF coils, high performance imaging gradients and a range of volumetric imaging sequences it is now possible to obtain both high resolution and high signal-to-noise ratio images of in-treatment radiation therapy patients within clinically feasible imaging times. As a Result, there is renewed interest in the use of MR imaging for radiation oncology treatment planning that is being translated into physical siting and integration of these systems into radiation oncology departments. As MR imaging expands into the radiation oncology domain there is a significant and unmet need for radiation therapy physicists to become educated regarding the strengths, limitations and technical challenges associated with MR imaging. The purpose of this presentation is to address this need by providing an educational overview of the techniques and challenges associated with MR imaging of patients for radiation therapy treatment planning. As such this presentation will: 1) describe the fundamental differences between imaging of patients for diagnostic and therapeutic purposes (i.e. radiation therapy planning), 2) describe most commonly used imaging sequences and contrasts for identification of disease for radiation planning, 3) identify the most common sources of image distortion and techniques to reduce their effect on spatial fidelity of the MR data, 4) describe the effects of motion and methods to quantify/correct it, and 5) identify emergent techniques for performing MR only treatment simulation. Upon completion attendees will have a working understanding of the basic methodologies associated with MR imaging in radiation oncology, the unique technical challenges imposed by MR imaging in the treatment position and techniques to address these. Learning Objectives: 1. Understand the differences between MR imaging for diagnostic imaging and for radiation therapy planning. 2. Identify the most common sources of distortion and artifacts and simple methods to correct them. 3. Understand the challenges with MR imaging in the therapy treatment position and appropriate techniques to address them.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

WE-AB-201-00: Treatment Planning System Commissioning and QA

Treatment planning systems (TPS) are a cornerstone of modern radiation therapy. Errors in their commissioning or use can have a devastating impact on many patients. To support safe and high quality care, medical physicists must conduct efficient and proper commissioning, good clinical integration, and ongoing quality assurance (QA) of the TPS. AAPM Task Group 53 and related publications have served as seminal benchmarks for TPS commissioning and QA over the past two decades. Over the same time, continuing innovations have made the TPS even more complex and more central to the clinical process. Medical goals are now expressed in terms of the dose and margins around organs and tissues that are delineated from multiple imaging modalities (CT, MR and PET); and even temporally resolved (i.e., 4D) imaging. This information is passed on to optimization algorithms to establish accelerator movements that are programmed directly for IMRT, VMAT and stereotactic treatments. These advances have made commissioning and QA of the TPS much more challenging. This education session reviews up-to-date experience and guidance on this subject; including the recently published AAPM Medical Physics Practice Guideline (MPPG) #5 “Commissioning and QA of Treatment Planning Dose Calculations: Megavoltage Photon and Electron Beams”. Treatment Planning System Commissioning and QA: Challenges and Opportunities (Greg Salomons) This session will provide some key background and review publications describing prominent incidents relating to TPS commissioning and QA. Traditional approaches have been hardware and feature oriented. They aim to establish a functional configuration and establish specifications for regular testing of features (like dose calculation) to assure stable operation and detect failures. With the advent of more complex systems, more patient-specific testing has also been adopted. A number of actual TPS defects will be presented along with heuristics for identifying similar defects in the future. Finally, the Gamma test has become a popular metric for reporting TPS Commissioning and QA results. It simplifies complex testing into a numerical index, but noisy data and casual application can make it misleading. A brief review of the issues around the use of the Gamma test will be presented. TPS commissioning and QA: A process orientation and application of control charts (Michael Sharpe) A framework for commissioning a treatment planning system will be presented, focusing on preparations, practical aspects of configuration, priorities, specifications, and establishing performance. The complexity of the modern TPS make modular testing of features inadequate, and modern QA tools can provide “too much information” about the performance of techniques like IMRT and VMAT. We have adopted a process orientation and quality tools, like control charts, for ongoing TPS QA and assessment of patient-specific tests. The trending nature of these tools reveals the overall performance of the TPS system, and quantifies the variations that arise from individual plans, discrete calculations, and experimentation based on discrete measurements. Examples demonstrating application of these tools to TPS QA will be presented. TPS commissioning and QA: Incorporating the entire planning process (Sasa Mutic) The TPS and its features do not perform in isolation. Instead, the features and modules are key components in a complex process that begins with CT Simulation and extends to treatment delivery, along with image guidance and verification. Most importantly, the TPS is used by people working in a multi-disciplinary environment. It is very difficult to predict the outcomes of human interactions with software. Therefore, an interdisciplinary approach to training, commissioning and QA will be presented, along with an approach to the physics chart check and end-to-end testing as a tool for TPS QA. The role of standardization and automation in QA will also be discussed. The recommendations of MPPG #5 and practical implementation strategies (Jennifer Smilowitz) The recently published recommendations from Task Group No. 244, Medical Physics Practice Guideline on Commissioning and QA of Treatment Planning Dose Calculations: Megavoltage Photon and Electron Beams will be presented. The recommendations focus on the validation of commissioning data and dose calculations. Tolerance values for non-IMRT beam configurations are summarized based on established criteria and data collected by the IROC. More stringent evaluation criteria for IMRT dose calculations are suggested to test the limitations of the TPS dose algorithms for advanced delivery conditions. The MPPG encourages users to create a suite of validation tests for dose calculation for various conditions for static photon beams, heterogeneities, IMRT/VMAT and electron beams. This test suite is intended to be used for subsequent testing, including TPS software upgrades. In the past, the recommendations of some reports have not been widely implemented due to practical limitations. Implementation strategies, tools and processes developed by multiple centers for efficient and “do-able” MPPG # 5 testing will be presented, as well as a discussion on the overall validation experience. Learning Objectives: Identify some of the key documents relevant for TPS commissioning and QA Understand strategies for testing TPS software Gain a practical knowledge of the Gamma test criteria Increase familiarity with the process of commissioning a TPS Learn about the use of Control Charts for TPS QA Review the role of the TPS in the overall planning process Increase awareness of the link between TPS QA and chart checking Gain an increased appreciation for the importance of interdisciplinary communication Understand the new recommendations from MPPG #5 on TPS Dose Algorithm Commissioning and QC/QA Learn practical implementation processes and tools for MPPG #5 validation recommendations.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

WE-AB-201-01: Treatment Planning System Commissioning and QA: Challenges and Opportunities

Treatment planning systems (TPS) are a cornerstone of modern radiation therapy. Errors in their commissioning or use can have a devastating impact on many patients. To support safe and high quality care, medical physicists must conduct efficient and proper commissioning, good clinical integration, and ongoing quality assurance (QA) of the TPS. AAPM Task Group 53 and related publications have served as seminal benchmarks for TPS commissioning and QA over the past two decades. Over the same time, continuing innovations have made the TPS even more complex and more central to the clinical process. Medical goals are now expressed in terms of the dose and margins around organs and tissues that are delineated from multiple imaging modalities (CT, MR and PET); and even temporally resolved (i.e., 4D) imaging. This information is passed on to optimization algorithms to establish accelerator movements that are programmed directly for IMRT, VMAT and stereotactic treatments. These advances have made commissioning and QA of the TPS much more challenging. This education session reviews up-to-date experience and guidance on this subject; including the recently published AAPM Medical Physics Practice Guideline (MPPG) #5 “Commissioning and QA of Treatment Planning Dose Calculations: Megavoltage Photon and Electron Beams”. Treatment Planning System Commissioning and QA: Challenges and Opportunities (Greg Salomons) This session will provide some key background and review publications describing prominent incidents relating to TPS commissioning and QA. Traditional approaches have been hardware and feature oriented. They aim to establish a functional configuration and establish specifications for regular testing of features (like dose calculation) to assure stable operation and detect failures. With the advent of more complex systems, more patient-specific testing has also been adopted. A number of actual TPS defects will be presented along with heuristics for identifying similar defects in the future. Finally, the Gamma test has become a popular metric for reporting TPS Commissioning and QA results. It simplifies complex testing into a numerical index, but noisy data and casual application can make it misleading. A brief review of the issues around the use of the Gamma test will be presented. TPS commissioning and QA: A process orientation and application of control charts (Michael Sharpe) A framework for commissioning a treatment planning system will be presented, focusing on preparations, practical aspects of configuration, priorities, specifications, and establishing performance. The complexity of the modern TPS make modular testing of features inadequate, and modern QA tools can provide “too much information” about the performance of techniques like IMRT and VMAT. We have adopted a process orientation and quality tools, like control charts, for ongoing TPS QA and assessment of patient-specific tests. The trending nature of these tools reveals the overall performance of the TPS system, and quantifies the variations that arise from individual plans, discrete calculations, and experimentation based on discrete measurements. Examples demonstrating application of these tools to TPS QA will be presented. TPS commissioning and QA: Incorporating the entire planning process (Sasa Mutic) The TPS and its features do not perform in isolation. Instead, the features and modules are key components in a complex process that begins with CT Simulation and extends to treatment delivery, along with image guidance and verification. Most importantly, the TPS is used by people working in a multi-disciplinary environment. It is very difficult to predict the outcomes of human interactions with software. Therefore, an interdisciplinary approach to training, commissioning and QA will be presented, along with an approach to the physics chart check and end-to-end testing as a tool for TPS QA. The role of standardization and automation in QA will also be discussed. The recommendations of MPPG #5 and practical implementation strategies (Jennifer Smilowitz) The recently published recommendations from Task Group No. 244, Medical Physics Practice Guideline on Commissioning and QA of Treatment Planning Dose Calculations: Megavoltage Photon and Electron Beams will be presented. The recommendations focus on the validation of commissioning data and dose calculations. Tolerance values for non-IMRT beam configurations are summarized based on established criteria and data collected by the IROC. More stringent evaluation criteria for IMRT dose calculations are suggested to test the limitations of the TPS dose algorithms for advanced delivery conditions. The MPPG encourages users to create a suite of validation tests for dose calculation for various conditions for static photon beams, heterogeneities, IMRT/VMAT and electron beams. This test suite is intended to be used for subsequent testing, including TPS software upgrades. In the past, the recommendations of some reports have not been widely implemented due to practical limitations. Implementation strategies, tools and processes developed by multiple centers for efficient and “do-able” MPPG #5 testing will be presented, as well as a discussion on the overall validation experience. Learning Objectives: Identify some of the key documents relevant for TPS commissioning and QA Understand strategies for testing TPS software Gain a practical knowledge of the Gamma test criteria Increase familiarity with the process of commissioning a TPS Learn about the use of Control Charts for TPS QA Review the role of the TPS in the overall planning process Increase awareness of the link between TPS QA and chart checking Gain an increased appreciation for the importance of interdisciplinary communication Understand the new recommendations from MPPG #5 on TPS Dose Algorithm Commissioning and QC/QA Learn practical implementation processes and tools for MPPG #5 validation recommendations.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

WE-AB-201-02: TPS Commissioning and QA: A Process Orientation and Application of Control Charts

Treatment planning systems (TPS) are a cornerstone of modern radiation therapy. Errors in their commissioning or use can have a devastating impact on many patients. To support safe and high quality care, medical physicists must conduct efficient and proper commissioning, good clinical integration, and ongoing quality assurance (QA) of the TPS. AAPM Task Group 53 and related publications have served as seminal benchmarks for TPS commissioning and QA over the past two decades. Over the same time, continuing innovations have made the TPS even more complex and more central to the clinical process. Medical goals are now expressed in terms of the dose and margins around organs and tissues that are delineated from multiple imaging modalities (CT, MR and PET); and even temporally resolved (i.e., 4D) imaging. This information is passed on to optimization algorithms to establish accelerator movements that are programmed directly for IMRT, VMAT and stereotactic treatments. These advances have made commissioning and QA of the TPS much more challenging. This education session reviews up-to-date experience and guidance on this subject; including the recently published AAPM Medical Physics Practice Guideline (MPPG) #5 “Commissioning and QA of Treatment Planning Dose Calculations: Megavoltage Photon and Electron Beams”. Treatment Planning System Commissioning and QA: Challenges and Opportunities (Greg Salomons) This session will provide some key background and review publications describing prominent incidents relating to TPS commissioning and QA. Traditional approaches have been hardware and feature oriented. They aim to establish a functional configuration and establish specifications for regular testing of features (like dose calculation) to assure stable operation and detect failures. With the advent of more complex systems, more patient-specific testing has also been adopted. A number of actual TPS defects will be presented along with heuristics for identifying similar defects in the future. Finally, the Gamma test has become a popular metric for reporting TPS Commissioning and QA results. It simplifies complex testing into a numerical index, but noisy data and casual application can make it misleading. A brief review of the issues around the use of the Gamma test will be presented. TPS commissioning and QA: A process orientation and application of control charts (Michael Sharpe) A framework for commissioning a treatment planning system will be presented, focusing on preparations, practical aspects of configuration, priorities, specifications, and establishing performance. The complexity of the modern TPS make modular testing of features inadequate, and modern QA tools can provide “too much information” about the performance of techniques like IMRT and VMAT. We have adopted a process orientation and quality tools, like control charts, for ongoing TPS QA and assessment of patient-specific tests. The trending nature of these tools reveals the overall performance of the TPS system, and quantifies the variations that arise from individual plans, discrete calculations, and experimentation based on discrete measurements. Examples demonstrating application of these tools to TPS QA will be presented. TPS commissioning and QA: Incorporating the entire planning process (Sasa Mutic) The TPS and its features do not perform in isolation. Instead, the features and modules are key components in a complex process that begins with CT Simulation and extends to treatment delivery, along with image guidance and verification. Most importantly, the TPS is used by people working in a multi-disciplinary environment. It is very difficult to predict the outcomes of human interactions with software. Therefore, an interdisciplinary approach to training, commissioning and QA will be presented, along with an approach to the physics chart check and end-to-end testing as a tool for TPS QA. The role of standardization and automation in QA will also be discussed. The recommendations of MPPG #5 and practical implementation strategies (Jennifer Smilowitz) The recently published recommendations from Task Group No. 244, Medical Physics Practice Guideline on Commissioning and QA of Treatment Planning Dose Calculations: Megavoltage Photon and Electron Beams will be presented. The recommendations focus on the validation of commissioning data and dose calculations. Tolerance values for non-IMRT beam configurations are summarized based on established criteria and data collected by the IROC. More stringent evaluation criteria for IMRT dose calculations are suggested to test the limitations of the TPS dose algorithms for advanced delivery conditions. The MPPG encourages users to create a suite of validation tests for dose calculation for various conditions for static photon beams, heterogeneities, IMRT/VMAT and electron beams. This test suite is intended to be used for subsequent testing, including TPS software upgrades. In the past, the recommendations of some reports have not been widely implemented due to practical limitations. Implementation strategies, tools and processes developed by multiple centers for efficient and “do-able” MPPG #5 testing will be presented, as well as a discussion on the overall validation experience. Learning Objectives: Identify some of the key documents relevant for TPS commissioning and QA Understand strategies for testing TPS software Gain a practical knowledge of the Gamma test criteria Increase familiarity with the process of commissioning a TPS Learn about the use of Control Charts for TPS QA Review the role of the TPS in the overall planning process Increase awareness of the link between TPS QA and chart checking Gain an increased appreciation for the importance of interdisciplinary communication Understand the new recommendations from MPPG #5 on TPS Dose Algorithm Commissioning and QC/QA Learn practical implementation processes and tools for MPPG #5 validation recommendations.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

WE-AB-201-03: TPS Commissioning and QA: Incorporating the Entire Planning Process

Treatment planning systems (TPS) are a cornerstone of modern radiation therapy. Errors in their commissioning or use can have a devastating impact on many patients. To support safe and high quality care, medical physicists must conduct efficient and proper commissioning, good clinical integration, and ongoing quality assurance (QA) of the TPS. AAPM Task Group 53 and related publications have served as seminal benchmarks for TPS commissioning and QA over the past two decades. Over the same time, continuing innovations have made the TPS even more complex and more central to the clinical process. Medical goals are now expressed in terms of the dose and margins around organs and tissues that are delineated from multiple imaging modalities (CT, MR and PET); and even temporally resolved (i.e., 4D) imaging. This information is passed on to optimization algorithms to establish accelerator movements that are programmed directly for IMRT, VMAT and stereotactic treatments. These advances have made commissioning and QA of the TPS much more challenging. This education session reviews up-to-date experience and guidance on this subject; including the recently published AAPM Medical Physics Practice Guideline (MPPG) #5 “Commissioning and QA of Treatment Planning Dose Calculations: Megavoltage Photon and Electron Beams”. Treatment Planning System Commissioning and QA: Challenges and Opportunities (Greg Salomons) This session will provide some key background and review publications describing prominent incidents relating to TPS commissioning and QA. Traditional approaches have been hardware and feature oriented. They aim to establish a functional configuration and establish specifications for regular testing of features (like dose calculation) to assure stable operation and detect failures. With the advent of more complex systems, more patient-specific testing has also been adopted. A number of actual TPS defects will be presented along with heuristics for identifying similar defects in the future. Finally, the Gamma test has become a popular metric for reporting TPS Commissioning and QA results. It simplifies complex testing into a numerical index, but noisy data and casual application can make it misleading. A brief review of the issues around the use of the Gamma test will be presented. TPS commissioning and QA: A process orientation and application of control charts (Michael Sharpe) A framework for commissioning a treatment planning system will be presented, focusing on preparations, practical aspects of configuration, priorities, specifications, and establishing performance. The complexity of the modern TPS make modular testing of features inadequate, and modern QA tools can provide “too much information” about the performance of techniques like IMRT and VMAT. We have adopted a process orientation and quality tools, like control charts, for ongoing TPS QA and assessment of patient-specific tests. The trending nature of these tools reveals the overall performance of the TPS system, and quantifies the variations that arise from individual plans, discrete calculations, and experimentation based on discrete measurements. Examples demonstrating application of these tools to TPS QA will be presented. TPS commissioning and QA: Incorporating the entire planning process (Sasa Mutic) The TPS and its features do not perform in isolation. Instead, the features and modules are key components in a complex process that begins with CT Simulation and extends to treatment delivery, along with image guidance and verification. Most importantly, the TPS is used by people working in a multi-disciplinary environment. It is very difficult to predict the outcomes of human interactions with software. Therefore, an interdisciplinary approach to training, commissioning and QA will be presented, along with an approach to the physics chart check and end-to-end testing as a tool for TPS QA. The role of standardization and automation in QA will also be discussed. The recommendations of MPPG #5 and practical implementation strategies (Jennifer Smilowitz) The recently published recommendations from Task Group No. 244, Medical Physics Practice Guideline on Commissioning and QA of Treatment Planning Dose Calculations: Megavoltage Photon and Electron Beams will be presented. The recommendations focus on the validation of commissioning data and dose calculations. Tolerance values for non-IMRT beam configurations are summarized based on established criteria and data collected by the IROC. More stringent evaluation criteria for IMRT dose calculations are suggested to test the limitations of the TPS dose algorithms for advanced delivery conditions. The MPPG encourages users to create a suite of validation tests for dose calculation for various conditions for static photon beams, heterogeneities, IMRT/VMAT and electron beams. This test suite is intended to be used for subsequent testing, including TPS software upgrades. In the past, the recommendations of some reports have not been widely implemented due to practical limitations. Implementation strategies, tools and processes developed by multiple centers for efficient and “do-able” MPPG #5 testing will be presented, as well as a discussion on the overall validation experience. Learning Objectives: Identify some of the key documents relevant for TPS commissioning and QA Understand strategies for testing TPS software Gain a practical knowledge of the Gamma test criteria Increase familiarity with the process of commissioning a TPS Learn about the use of Control Charts for TPS QA Review the role of the TPS in the overall planning process Increase awareness of the link between TPS QA and chart checking Gain an increased appreciation for the importance of interdisciplinary communication Understand the new recommendations from MPPG #5 on TPS Dose Algorithm Commissioning and QC/QA Learn practical implementation processes and tools for MPPG #5 validation recommendations.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

WE-AB-201-04: The Recommendations of MPPG #5 and Practical Implementation Strategies

Treatment planning systems (TPS) are a cornerstone of modern radiation therapy. Errors in their commissioning or use can have a devastating impact on many patients. To support safe and high quality care, medical physicists must conduct efficient and proper commissioning, good clinical integration, and ongoing quality assurance (QA) of the TPS. AAPM Task Group 53 and related publications have served as seminal benchmarks for TPS commissioning and QA over the past two decades. Over the same time, continuing innovations have made the TPS even more complex and more central to the clinical process. Medical goals are now expressed in terms of the dose and margins around organs and tissues that are delineated from multiple imaging modalities (CT, MR and PET); and even temporally resolved (i.e., 4D) imaging. This information is passed on to optimization algorithms to establish accelerator movements that are programmed directly for IMRT, VMAT and stereotactic treatments. These advances have made commissioning and QA of the TPS much more challenging. This education session reviews up-to-date experience and guidance on this subject; including the recently published AAPM Medical Physics Practice Guideline (MPPG) #5 “Commissioning and QA of Treatment Planning Dose Calculations: Megavoltage Photon and Electron Beams”. Treatment Planning System Commissioning and QA: Challenges and Opportunities (Greg Salomons) This session will provide some key background and review publications describing prominent incidents relating to TPS commissioning and QA. Traditional approaches have been hardware and feature oriented. They aim to establish a functional configuration and establish specifications for regular testing of features (like dose calculation) to assure stable operation and detect failures. With the advent of more complex systems, more patient-specific testing has also been adopted. A number of actual TPS defects will be presented along with heuristics for identifying similar defects in the future. Finally, the Gamma test has become a popular metric for reporting TPS Commissioning and QA results. It simplifies complex testing into a numerical index, but noisy data and casual application can make it misleading. A brief review of the issues around the use of the Gamma test will be presented. TPS commissioning and QA: A process orientation and application of control charts (Michael Sharpe) A framework for commissioning a treatment planning system will be presented, focusing on preparations, practical aspects of configuration, priorities, specifications, and establishing performance. The complexity of the modern TPS make modular testing of features inadequate, and modern QA tools can provide “too much information” about the performance of techniques like IMRT and VMAT. We have adopted a process orientation and quality tools, like control charts, for ongoing TPS QA and assessment of patient-specific tests. The trending nature of these tools reveals the overall performance of the TPS system, and quantifies the variations that arise from individual plans, discrete calculations, and experimentation based on discrete measurements. Examples demonstrating application of these tools to TPS QA will be presented. TPS commissioning and QA: Incorporating the entire planning process (Sasa Mutic) The TPS and its features do not perform in isolation. Instead, the features and modules are key components in a complex process that begins with CT Simulation and extends to treatment delivery, along with image guidance and verification. Most importantly, the TPS is used by people working in a multi-disciplinary environment. It is very difficult to predict the outcomes of human interactions with software. Therefore, an interdisciplinary approach to training, commissioning and QA will be presented, along with an approach to the physics chart check and end-to-end testing as a tool for TPS QA. The role of standardization and automation in QA will also be discussed. The recommendations of MPPG #5 and practical implementation strategies (Jennifer Smilowitz) The recently published recommendations from Task Group No. 244, Medical Physics Practice Guideline on Commissioning and QA of Treatment Planning Dose Calculations: Megavoltage Photon and Electron Beams will be presented. The recommendations focus on the validation of commissioning data and dose calculations. Tolerance values for non-IMRT beam configurations are summarized based on established criteria and data collected by the IROC. More stringent evaluation criteria for IMRT dose calculations are suggested to test the limitations of the TPS dose algorithms for advanced delivery conditions. The MPPG encourages users to create a suite of validation tests for dose calculation for various conditions for static photon beams, heterogeneities, IMRT/VMAT and electron beams. This test suite is intended to be used for subsequent testing, including TPS software upgrades. In the past, the recommendations of some reports have not been widely implemented due to practical limitations. Implementation strategies, tools and processes developed by multiple centers for efficient and “do-able” MPPG #5 testing will be presented, as well as a discussion on the overall validation experience. Learning Objectives: Identify some of the key documents relevant for TPS commissioning and QA Understand strategies for testing TPS software Gain a practical knowledge of the Gamma test criteria Increase familiarity with the process of commissioning a TPS Learn about the use of Control Charts for TPS QA Review the role of the TPS in the overall planning process Increase awareness of the link between TPS QA and chart checking Gain an increased appreciation for the importance of interdisciplinary communication Understand the new recommendations from MPPG #5 on TPS Dose Algorithm Commissioning and QC/QA Learn practical implementation processes and tools for MPPG #5 validation recommendations.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

WE-D-213-04: Preparing for Parts 2 & 3 of the ABR Nuclear Medicine Physics Exam

Adequate, efficient preparation for the ABR Diagnostic and Nuclear Medical Physics exams is key to successfully obtain ABR professional certification. Each part of the ABR exam presents its own challenges: Part I: Determine the scope of basic medical physics study material, efficiently review this material, and solve related written questions/problems. Part II: Understand imaging principles, modalities, and systems, including image acquisition, processing, and display. Understand the relationship between imaging techniques, image quality, patient dose and safety, and solve related written questions/problems. Part III: Gain crucial, practical, clinical medical physics experience. Effectively communicate and explain the practice, performance, and significance of all aspects of clinical medical physics. All three parts of the ABR exam require specific skill sets and preparation: mastery of basic physics and imaging principles; written problem solving often involving rapid calculation; responding clearly and succinctly to oral questions about the practice, methods, and significance of clinical medical physics. This symposium focuses on the preparation and skill sets necessary for each part of the ABR exam. Although there is some overlap, the nuclear exam covers a different body of knowledge than the diagnostic exam. A separate speaker will address those aspects that are unique to the nuclear exam. Medical physicists who have recently completed each of part of the ABR exam will share their experiences, insights, and preparation methods to help attendees best prepare for the challenges of each part of the ABR exam. In accordance with ABR exam security policy, no recalls or exam questions will be discussed. Learning Objectives: How to prepare for Part 1 of the ABR exam by determining the scope of basic medical physics study material and related problem solving/calculations How to Prepare for Part 2 of the ABR exam by understanding diagnostic and/or nuclear imaging physics, systems, dosimetry, safety and related problem solving/calculations How to Prepare for Part 3 of the ABR exam by effectively communicating the practice, methods, and significance of clinical diagnostic and/or nuclear medical physics.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

WE-D-213-00: Preparing for the ABR Diagnostic and Nuclear Medicine Physics Exams

Adequate, efficient preparation for the ABR Diagnostic and Nuclear Medical Physics exams is key to successfully obtain ABR professional certification. Each part of the ABR exam presents its own challenges: Part I: Determine the scope of basic medical physics study material, efficiently review this material, and solve related written questions/problems. Part II: Understand imaging principles, modalities, and systems, including image acquisition, processing, and display. Understand the relationship between imaging techniques, image quality, patient dose and safety, and solve related written questions/problems. Part III: Gain crucial, practical, clinical medical physics experience. Effectively communicate and explain the practice, performance, and significance of all aspects of clinical medical physics. All three parts of the ABR exam require specific skill sets and preparation: mastery of basic physics and imaging principles; written problem solving often involving rapid calculation; responding clearly and succinctly to oral questions about the practice, methods, and significance of clinical medical physics. This symposium focuses on the preparation and skill sets necessary for each part of the ABR exam. Although there is some overlap, the nuclear exam covers a different body of knowledge than the diagnostic exam. A separate speaker will address those aspects that are unique to the nuclear exam. Medical physicists who have recently completed each of part of the ABR exam will share their experiences, insights, and preparation methods to help attendees best prepare for the challenges of each part of the ABR exam. In accordance with ABR exam security policy, no recalls or exam questions will be discussed. Learning Objectives: How to prepare for Part 1 of the ABR exam by determining the scope of basic medical physics study material and related problem solving/calculations How to Prepare for Part 2 of the ABR exam by understanding diagnostic and/or nuclear imaging physics, systems, dosimetry, safety and related problem solving/calculations How to Prepare for Part 3 of the ABR exam by effectively communicating the practice, methods, and significance of clinical diagnostic and/or nuclear medical physics.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

WE-D-213-01: Preparing for Part 1 of the ABR Diagnostic Physics Exam

Adequate, efficient preparation for the ABR Diagnostic and Nuclear Medical Physics exams is key to successfully obtain ABR professional certification. Each part of the ABR exam presents its own challenges: Part I: Determine the scope of basic medical physics study material, efficiently review this material, and solve related written questions/problems. Part II: Understand imaging principles, modalities, and systems, including image acquisition, processing, and display. Understand the relationship between imaging techniques, image quality, patient dose and safety, and solve related written questions/problems. Part III: Gain crucial, practical, clinical medical physics experience. Effectively communicate and explain the practice, performance, and significance of all aspects of clinical medical physics. All three parts of the ABR exam require specific skill sets and preparation: mastery of basic physics and imaging principles; written problem solving often involving rapid calculation; responding clearly and succinctly to oral questions about the practice, methods, and significance of clinical medical physics. This symposium focuses on the preparation and skill sets necessary for each part of the ABR exam. Although there is some overlap, the nuclear exam covers a different body of knowledge than the diagnostic exam. A separate speaker will address those aspects that are unique to the nuclear exam. Medical physicists who have recently completed each of part of the ABR exam will share their experiences, insights, and preparation methods to help attendees best prepare for the challenges of each part of the ABR exam. In accordance with ABR exam security policy, no recalls or exam questions will be discussed. Learning Objectives: How to prepare for Part 1 of the ABR exam by determining the scope of basic medical physics study material and related problem solving/calculations How to Prepare for Part 2 of the ABR exam by understanding diagnostic and/or nuclear imaging physics, systems, dosimetry, safety and related problem solving/calculations How to Prepare for Part 3 of the ABR exam by effectively communicating the practice, methods, and significance of clinical diagnostic and/or nuclear medical physics.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

WE-D-213-02: Preparing for Part 2 of the ABR Diagnostic Physics Exam

Adequate, efficient preparation for the ABR Diagnostic and Nuclear Medical Physics exams is key to successfully obtain ABR professional certification. Each part of the ABR exam presents its own challenges: Part I: Determine the scope of basic medical physics study material, efficiently review this material, and solve related written questions/problems. Part II: Understand imaging principles, modalities, and systems, including image acquisition, processing, and display. Understand the relationship between imaging techniques, image quality, patient dose and safety, and solve related written questions/problems. Part III: Gain crucial, practical, clinical medical physics experience. Effectively communicate and explain the practice, performance, and significance of all aspects of clinical medical physics. All three parts of the ABR exam require specific skill sets and preparation: mastery of basic physics and imaging principles; written problem solving often involving rapid calculation; responding clearly and succinctly to oral questions about the practice, methods, and significance of clinical medical physics. This symposium focuses on the preparation and skill sets necessary for each part of the ABR exam. Although there is some overlap, the nuclear exam covers a different body of knowledge than the diagnostic exam. A separate speaker will address those aspects that are unique to the nuclear exam. Medical physicists who have recently completed each of part of the ABR exam will share their experiences, insights, and preparation methods to help attendees best prepare for the challenges of each part of the ABR exam. In accordance with ABR exam security policy, no recalls or exam questions will be discussed. Learning Objectives: How to prepare for Part 1 of the ABR exam by determining the scope of basic medical physics study material and related problem solving/calculations How to Prepare for Part 2 of the ABR exam by understanding diagnostic and/or nuclear imaging physics, systems, dosimetry, safety and related problem solving/calculations How to Prepare for Part 3 of the ABR exam by effectively communicating the practice, methods, and significance of clinical diagnostic and/or nuclear medical physics.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

WE-D-213-03: Preparing for Part 3 of the ABR Diagnostic Physics Exam

Adequate, efficient preparation for the ABR Diagnostic and Nuclear Medical Physics exams is key to successfully obtain ABR professional certification. Each part of the ABR exam presents its own challenges: Part I: Determine the scope of basic medical physics study material, efficiently review this material, and solve related written questions/problems. Part II: Understand imaging principles, modalities, and systems, including image acquisition, processing, and display. Understand the relationship between imaging techniques, image quality, patient dose and safety, and solve related written questions/problems. Part III: Gain crucial, practical, clinical medical physics experience. Effectively communicate and explain the practice, performance, and significance of all aspects of clinical medical physics. All three parts of the ABR exam require specific skill sets and preparation: mastery of basic physics and imaging principles; written problem solving often involving rapid calculation; responding clearly and succinctly to oral questions about the practice, methods, and significance of clinical medical physics. This symposium focuses on the preparation and skill sets necessary for each part of the ABR exam. Although there is some overlap, the nuclear exam covers a different body of knowledge than the diagnostic exam. A separate speaker will address those aspects that are unique to the nuclear exam. Medical physicists who have recently completed each of part of the ABR exam will share their experiences, insights, and preparation methods to help attendees best prepare for the challenges of each part of the ABR exam. In accordance with ABR exam security policy, no recalls or exam questions will be discussed. Learning Objectives: How to prepare for Part 1 of the ABR exam by determining the scope of basic medical physics study material and related problem solving/calculations How to Prepare for Part 2 of the ABR exam by understanding diagnostic and/or nuclear imaging physics, systems, dosimetry, safety and related problem solving/calculations How to Prepare for Part 3 of the ABR exam by effectively communicating the practice, methods, and significance of clinical diagnostic and/or nuclear medical physics.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

WE-G-BRA-04: Common Errors and Deficiencies in Radiation Oncology Practice

Purpose: Dosimetric errors in radiotherapy dose delivery lead to suboptimal treatments and outcomes. This work reviews the frequency and severity of dosimetric and programmatic errors identified by on-site audits performed by the IROC Houston QA center. Methods: IROC Houston on-site audits evaluate absolute beam calibration, relative dosimetry data compared to the treatment planning system data, and processes such as machine QA. Audits conducted from 2000-present were abstracted for recommendations, including type of recommendation and magnitude of error when applicable. Dosimetric recommendations corresponded to absolute dose errors >3% and relative dosimetry errors >2%. On-site audits of 1020 accelerators at 409 institutions were reviewed. Results: A total of 1280 recommendations were made (average 3.1/institution). The most common recommendation was for inadequate QA procedures per TG-40 and/or TG-142 (82% of institutions) with the most commonly noted deficiency being x-ray and electron off-axis constancy versus gantry angle. Dosimetrically, the most common errors in relative dosimetry were in small-field output factors (59% of institutions), wedge factors (33% of institutions), off-axis factors (21% of institutions), and photon PDD (18% of institutions). Errors in calibration were also problematic: 20% of institutions had an error in electron beam calibration, 8% had an error in photon beam calibration, and 7% had an error in brachytherapy source calibration. Almost all types of data reviewed included errors up to 7% although 20 institutions had errors in excess of 10%, and 5 had errors in excess of 20%. The frequency of electron calibration errors decreased significantly with time, but all other errors show non-significant changes. Conclusion: There are many common and often serious errors made during the establishment and maintenance of a radiotherapy program that can be identified through independent peer review. Physicists should be cautious, particularly in areas highlighted herein that show a tendency for errors.

60 APPLIED LIFE SCIENCES↗