Results for “computerized procedures” — Page 41

DOE OSTI2016

SU-F-T-242: A Method for Collision Avoidance in External Beam Radiation Therapy

Purpose: We proposed a method for collision avoidance (CA) in external beam radiation therapy (EBRT). The method encompasses the analysis of all positions of the moving components of the beam delivery system such as the treatment table and gantry, including patient specific information obtained from the CT images. This method eliminates the need for time-consuming dry-runs prior to the actual treatments. Methods: The QA procedure for EBRT requires that the collision should be checked prior to treatment. We developed a system capable of a rigorous computer simulation of all moving components including positions of the couch and gantry during the delivery, position of the patients, and imaging equipment. By running this treatment simulation it is possible to quantify and graphically represent all positions and corresponding trajectories of all points of the moving parts during the treatment delivery. The development of the workflow for implementation of the CA includes several steps: a) derivation of combined dynamic equation of motion of the EBRT delivery systems, b) developing the simulation model capable of drawing the motion trajectories of the specific points, c) developing the interface between the model and the treatment plan parameters such as couch and gantry parameters for each field. Results: The patient CT images were registered to the treatment couch so the patient dimensions were included into the simulation. The treatment field parameters were structured in the xml-file which was used as the input into the dynamic equations. The trajectories of the moving components were plotted on the same graph using the dynamic equations. If the trajectories intersect that was the signal that collision exists. Conclusion: This CA method was proved to be effective in the simulation of treatment delivery. The proper implementation of this system can potentially improve the QA program and increase the efficacy in the clinical setup.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

SU-E-I-21: Dosimetric Characterization and Image Quality Evaluation of the AIRO Mobile CT Scanner

Purpose: The AIRO Mobile CT system was recently introduced which overcomes the limitations from existing CT, CT fluoroscopy, and intraoperative O-arm. With an integrated table and a large diameter bore, the system is suitable for cranial, spine and trauma procedures, making it a highly versatile intraoperative imaging system. This study is to investigate radiation dose and image quality of the AIRO and compared with those from a routine CT scanner. Methods: Radiation dose was measured using a conventional 100mm pencil ionization chamber and CT polymethylmetacrylate (PMMA) body and head phantoms. Image quality was evaluated with a CATPHAN 500 phantom. Spatial resolution, low contrast resolution (CNR), Modulation Transfer Function (MTF), and Normalized Noise Power Spectrum (NNPS) were analyzed. Results: Under identical technique conditions, radiation dose (mGy/mAs) from the AIRO mobile CT system (AIRO) is higher than that from a 64 slice CT scanner. MTFs show that both Soft and Standard filters of the AIRO system lost resolution quickly compared to the Sensation 64 slice CT. With the Standard kernel, the spatial resolutions of the AIRO system are 3lp/cm and 4lp/cm for the body and head FOVs, respectively. NNPSs show low frequency noise due to ring-like artifacts. Due to a higher dose in terms of mGy/mAs at both head and body FOV, CNR of the AIRO system is higher than that of the Siemens scanner. However detectability of the low contrast objects is poorer in the AIRO due to the presence of ring artifacts in the location of the targets. Conclusion: For image guided surgery applications, the AIRO has some advantages over a routine CT scanner due to its versatility, large bore size, and acceptable image quality. Our evaluation of the physical performance helps its future improvements.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

SU-E-T-04: 3D Dose Based Patient Compensator QA Procedure for Proton Radiotherapy

Purpose: In proton double-scattering radiotherapy, compensators are the essential patient specific devices to contour the distal dose distribution to the tumor target. Traditional compensator QA is limited to checking the drilled surface profiles against the plan. In our work, a compensator QA process was established that assess the entire compensator including its internal structure for patient 3D dose verification. Methods: The fabricated patient compensators were CT scanned. Through mathematical image processing and geometric transformations, the CT images of the proton compensator were combined with the patient simulation CT images into a new series of CT images, in which the imaged compensator is placed at the planned location along the corresponding beam line. The new CT images were input into the Eclipse treatment planning system. The original plan was calculated to the combined CT image series without the plan compensator. The newly computed patient 3D dose from the combined patientcompensator images was verified against the original plan dose. Test plans include the compensators with defects intentionally created inside the fabricated compensators. Results: The calculated 3D dose with the combined compensator and patient CT images reflects the impact of the fabricated compensator to the patient. For the test cases in which no defects were created, the dose distributions were in agreement between our method and the corresponding original plans. For the compensator with the defects, the purposely changed material and a purposely created internal defect were successfully detected while not possible with just the traditional compensator profiles detection methods. Conclusion: We present here a 3D dose verification process to qualify the fabricated proton double-scattering compensator. Such compensator detection process assesses the patient 3D impact of the fabricated compensator surface profile as well as the compensator internal material and structure changes. This research receives funding support from CURA Medical Technologies.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2012

Numerical and Experimental Investigations of Polyurethane Foam for Use as Cask Impact Limiter in Accidental Drop Scenarios - 12099

Rigid, closed-cell polyurethane foams are frequently used as cask impact limiters in nuclear materials and hazardous waste transport due to their high energy-absorption potential. When assessing the cask integrity in accidental scenarios based on numerical simulations, a description of the foam damping properties is required for different strain rates and for a wide temperature range with respect to waste heat generation in conjunction with critical operating and environmental conditions. Implementation and adaption of a respective finite element material model strongly relies on an appropriate experimental data base. Even though extensive impact experiments were conducted e.g. in Sandia National Laboratories, Savannah River National Laboratory and by Rolls Royce plc, not all relevant factors were taken into account. Hence, BAM who is in charge of the mechanical evaluation of such packages within the approval procedure in Germany, incorporated systematic test series into a comprehensive research project aimed to develop numerical methods for a couple of damping materials. In a first step, displacement driven compression tests have been performed on confined, cubic specimens at five loading rates ranging from 0.02 mm/s to 3 m/s at temperatures between +90 deg. C and -40 deg. C. Materials include two different polyurethane foam types called FR3718 and FR3730 having densities of 280 kg/m{sup 3} and 488 kg/m{sup 3} from the product line-up of General Plastics Manufacturing Company. Their data was used to adapt an advanced plasticity model allowing for reliably simulating cellular materials under multi-axial compression states. Therefore, an automated parameter identification procedure had been established by combining an artificial neural network with local optimization techniques. Currently, the selected numerical material input values are validated and optimized by means of more complex loading configurations with the prospect of establishing methods applicable to impact limiters under severe accidental conditions. The reference data base is provided by experiments, where weights between 212 kg and 1200 kg have been dropped from heights between 1.25 m and 7 m on confined 10 cm cubic foam specimens. By presenting the deviations between experimental values and the corresponding output of finite element simulations, the potentials and restrictions of the resulting models are highlighted. Systematic compression tests on polyurethane foams had been performed at BAM test site within the framework of a research project on impact limiters for handling casks for radioactive waste. The experimental results had been used to adapt numerical models for simulating the behaviour of different foam types at different temperatures. The loading speed, however, turned out to have a major influence on their flow curves that can not be captured by simple strain-rate dependent multipliers. Especially for guided drop tests that come close to real accidental scenarios there is a significant gap between experimental and numerical results even when applying such advanced material models. Hence, the extensive data base is currently deployed for expanding the standard algorithms to include adequate dynamic hardening factors. (authors)

12 MANAGEMENT OF RADIOACTIVE AND NON-RADIOACTIVE W↗

DOE OSTI2016

Iterative metal artifact reduction for x-ray computed tomography using unmatched projector/backprojector pairs

Purpose: Metal artifact reduction (MAR) is a major problem and a challenging issue in x-ray computed tomography (CT) examinations. Iterative reconstruction from sinograms unaffected by metals shows promising potential in detail recovery. This reconstruction has been the subject of much research in recent years. However, conventional iterative reconstruction methods easily introduce new artifacts around metal implants because of incomplete data reconstruction and inconsistencies in practical data acquisition. Hence, this work aims at developing a method to suppress newly introduced artifacts and improve the image quality around metal implants for the iterative MAR scheme. Methods: The proposed method consists of two steps based on the general iterative MAR framework. An uncorrected image is initially reconstructed, and the corresponding metal trace is obtained. The iterative reconstruction method is then used to reconstruct images from the unaffected sinogram. In the reconstruction step of this work, an iterative strategy utilizing unmatched projector/backprojector pairs is used. A ramp filter is introduced into the back-projection procedure to restrain the inconsistency components in low frequencies and generate more reliable images of the regions around metals. Furthermore, a constrained total variation (TV) minimization model is also incorporated to enhance efficiency. The proposed strategy is implemented based on an iterative FBP and an alternating direction minimization (ADM) scheme, respectively. The developed algorithms are referred to as “iFBP-TV” and “TV-FADM,” respectively. Two projection-completion-based MAR methods and three iterative MAR methods are performed simultaneously for comparison. Results: The proposed method performs reasonably on both simulation and real CT-scanned datasets. This approach could reduce streak metal artifacts effectively and avoid the mentioned effects in the vicinity of the metals. The improvements are evaluated by inspecting regions of interest and by comparing the root-mean-square errors, normalized mean absolute distance, and universal quality index metrics of the images. Both iFBP-TV and TV-FADM methods outperform other counterparts in all cases. Unlike the conventional iterative methods, the proposed strategy utilizing unmatched projector/backprojector pairs shows excellent performance in detail preservation and prevention of the introduction of new artifacts. Conclusions: Qualitative and quantitative evaluations of experimental results indicate that the developed method outperforms classical MAR algorithms in suppressing streak artifacts and preserving the edge structural information of the object. In particular, structures lying close to metals can be gradually recovered because of the reduction of artifacts caused by inconsistency effects.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2017

Verification of severe accident management guideline (SAMG) entry condition for OPR1000 - 367

The current severe accident prevention and mitigation strategies for OPR 1000 have emergency operating procedures (EOPs) and severe accident management guidelines (SAMGs), respectively. The main objective of SAMG is to prevent a release of radioactive materials from releasing into environment and mitigate severe accident phenomena during severe accident. The current SAMG entry condition is met when the core exit temperature (CET) reaches 650 deg. C in OPR 1000. Peak cladding temperature (PCT), which represents core integrity more precisely than CET does, cannot be used since it is not measurable in the main control room (MCR). Current SAMG entry condition for every kind of accident scenarios is not reasonable, since entry condition is determined without considering operator action time. Therefore, SAMG entry condition need to be verified with consider operator action time. Thus, an analysis methodology for SAMG entry condition was developed to verify the SAMG entry condition. A severe accident DB were also developed in order to analyze the SAMG entry condition. The analysis results of DB show that available operator action time from the SAMG entrance to RV fail is shorter than the required time in most cases. As a result, the proper SAMG entry condition was suggested through the results of DB analysis. When the SAMG entry condition is changed from CET to suggested condition, the available action time is increased about 350 to 4300 sec. Also, the suggested entry condition was verified through the simulation which considered operation action time and reflecting the suggested entry condition. (authors)

21 SPECIFIC NUCLEAR REACTORS AND ASSOCIATED PLANTS↗

DOE OSTI2015

SU-E-T-639: Proton Dose Calculation for Irregular Motion Using a Sliding Interface

Purpose: While many techniques exist to evaluate dose to regularly moving lung targets, there are few available to calculate dose at tumor positions not present in the 4DCT. We have previously developed a method that extrapolates an existing dose to a new tumor location. In this abstract, we present a novel technique that accounts for relative anatomical shifts at the chest wall interface. We also utilize this procedure to simulate breathing motion functions on a cohort of eleven patients. Amplitudes exceeding the original range of motion were used to evaluate coverage using several aperture and smearing beam settings. Methods: The water-equivalent depth (WED) technique requires an initial dose and CT image at the corresponding tumor position. Each dose volume was converted from its Cartesian geometry into a beam-specific radiological depth space. The sliding chest wall interface was determined by converting the lung contour into this same space. Any dose proximal to the initial boundary of the warped lung contour was held fixed, while the remaining distal dose was moved in the direction of motion along the interface. Results: V95 coverage was computed for each patient using the updated algorithm. Incorporation of the sliding motion yielded large dose differences, with gamma pass rates as low as 69.7% (3mm, 3%) and V95 coverage differences up to 2.0%. Clinical coverage was maintained for most patients with 5 mm excess simulated breathing motion, and up to 10 mm of excess motion was tolerated for a subset of patients and beam settings. Conclusion: We have established a method to determine the maximum allowable excess breathing motion for a given plan on a patient-by-patient basis. By integrating a sliding chest wall interface into our dose calculation technique, we have analyzed the robustness of breathing patterns that differ during treatment from at the time of 4DCT acquisition.

61 RADIATION PROTECTION AND DOSIMETRY↗

DOE OSTI2016

MO-DE-204-00: International Symposium: Patient Dose Reduction in Diagnostic Radiology

The main topic of the session is to show how dose optimization is being implemented in various regions of the world, including Europe, Australia, North America and other regions. A multi-national study conducted under International Atomic Energy Agency (IAEA) across more than 50 less resourced countries gave insight into patient radiation doses and safety practices in CT, mammography, radiography and interventional procedures, both for children and adults. An important outcome was the capability development on dose assessment and management. An overview of recent European projects related to CT radiation dose and optimization both to adults and children will be presented. Existing data on DRLs together with a European methodology proposed on establishing and using DRLs for paediatric radiodiagnostic imaging and interventional radiology practices will be shown. Compared with much of Europe at least, many Australian imaging practices are relatively new to the task of diagnostic imaging dose optimisation. In 2008 the Australian Government prescribed a requirement to periodically compare patient radiation doses with diagnostic reference levels (DRLs), where DRLs have been established. Until recently, Australia had only established DRLs for computed tomography (CT). Regardless, both professional society and individual efforts to improved data collection and develop optimisation strategies across a range of modalities continues. Progress in this field, principally with respect to CT and interventional fluoroscopy will be presented. In the US, dose reduction and optimization efforts for computed tomography have been promoted and mandated by several organizations and accrediting entities. This presentation will cover the general motivation, implementation, and implications of such efforts. Learning Objectives: Understand importance of the dose optimization in Diagnostic Radiology. See how this goal is achieved in different regions of the World. Learn about the global trend in the dose optimization and future prospectives. M. Rehani, The work was a part of the work of IAEA where I was an employee and IAEA is a United Nations organization.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

TU-H-CAMPUS-IeP1-03: Comparison of Monte Carlo Simulation and Conversion Factor Based Method On Estimation of Effective Dose in Pediatric Patients Undergoing Interventional Cardiac Procedures

Purpose: Interventional cardiac procedures utilize frequent fluoroscopy and cineangiography, which impose considerable radiation risk to patients, especially pediatric patients. Accurate calculation of effective dose is important in order to estimate cancer risk over the rest of their lifetime. This study evaluates the difference in effective dose calculated by Monte Carlo simulation with those estimated by locally-derived conversion factors (CF-local) and by commonly quoted conversion factors from Karambatsakidou et al (CF-K). Methods: Effective dose (E),of 12 pediatric patients, age between 2.5–19 years old, who had undergone interventional cardiac procedures, were calculated using PCXMC-2.0 software. Tube spectrum, irradiation geometry, exposure parameters and dose-area product (DAP) of each projection were included in the software calculation. Effective doses for each patient were also estimated by two Methods: 1) CF-local: conversion factor derived locally by generalizing results of 12 patients, multiplied by DAP of each patient gives E-local. 2) CF-K: selected factor from above-mentioned literature, multiplied by DAP of each patient gives E-K. Results: Mean of E, E-local and E-K were 16.01 mSv, 16.80 mSv and 22.25 mSv respectively. A deviation of −29.35% to +34.85% between E and E-local, while a greater deviation of −28.96% to +60.86% between E and EK were observed. E-K overestimated the effective dose for patients at age 7.5–19. Conclusion: Effective dose obtained by conversion factors is simple and quick to estimate radiation risk of pediatric patients. This study showed that estimation by CF-local may bear an error of 35% when compared with Monte Carlo calculation. If using conversion factors derived by other studies may result in an even greater error, of up to 60%, due to factors that are not catered for in the estimation, including patient size, projection angles, exposure parameters, tube filtration, etc. Users must be aware of these potential inaccuracies when simple conversion method is employed.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2014

SU-E-T-615: Investigation of the Dosimetric Impact of Tandem Loading in the Treatment of Cervical Cancer for HDR Brachytherapy Procedures

Purpose: To quantify the dosimetric impact of the tandem loading in the treatment of cervical cancer for HDR brachytherapy procedures. Methods: Ten patients were evaluated, each of whom received 5 fractions of treatment. Tandem and ovoid sets were inserted into the uterine cavity based on institutional protocols and procedures. Following insertion and stabilization, CT image sets of 1.5mm slice thickness were acquired and sent to the Oncentra V4.3 Treatment Planning System. Critical structures such as the CTV, bladder, rectum, sigmoid, and bowel were contoured and a fractional dose of 5.5Gy was prescribed to Point A for each patient. Six different treatment plans were created for each fraction using varying tandem weightings; from 0.5 to 1.4 times that of the ovoids. Surface dose evaluation of various ovoid diameters, 2.0-3.5cm, at the vaginal fornices was also investigated. Results: Critical structures were evaluated based on varying dose and volume constraints, in particular the 2.0 cc volume recommendation cited by the gynecological GEC-ESTRO working group. Based on dose volume histogram evaluation, a reduction of dose to the critical structures was most often discovered when the tandem weighting was increased. CTV coverage showed little change as the tandem weighting was varied. Ovoid surface dose decreased by 50-65% as the tandem weighting increased. Conclusion: The advantage of 3D planning with HDR brachytherapy is the dose optimization for each individual treatment plan. This investigation shows that by utilizing large tandem weightings, 1.4 times greater than the ovoid, one can still achieve adequate coverage of the CTV and relatively low doses to the critical structures. In some cases, one would still have to optimize further per individual case. In addition, the ovoid surface dose was greatly decreased when large tandem weighting was utilized; especially for small ovoid diameters.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

MO-DE-204-02: Optimization of the Patient CT Dose in Europe

The main topic of the session is to show how dose optimization is being implemented in various regions of the world, including Europe, Australia, North America and other regions. A multi-national study conducted under International Atomic Energy Agency (IAEA) across more than 50 less resourced countries gave insight into patient radiation doses and safety practices in CT, mammography, radiography and interventional procedures, both for children and adults. An important outcome was the capability development on dose assessment and management. An overview of recent European projects related to CT radiation dose and optimization both to adults and children will be presented. Existing data on DRLs together with a European methodology proposed on establishing and using DRLs for paediatric radiodiagnostic imaging and interventional radiology practices will be shown. Compared with much of Europe at least, many Australian imaging practices are relatively new to the task of diagnostic imaging dose optimisation. In 2008 the Australian Government prescribed a requirement to periodically compare patient radiation doses with diagnostic reference levels (DRLs), where DRLs have been established. Until recently, Australia had only established DRLs for computed tomography (CT). Regardless, both professional society and individual efforts to improved data collection and develop optimisation strategies across a range of modalities continues. Progress in this field, principally with respect to CT and interventional fluoroscopy will be presented. In the US, dose reduction and optimization efforts for computed tomography have been promoted and mandated by several organizations and accrediting entities. This presentation will cover the general motivation, implementation, and implications of such efforts. Learning Objectives: Understand importance of the dose optimization in Diagnostic Radiology. See how this goal is achieved in different regions of the World. Learn about the global trend in the dose optimization and future prospectives. M. Rehani, The work was a part of the work of IAEA where I was an employee and IAEA is a United Nations organization.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

MO-DE-204-03: Radiology Dose Optimisation - An Australian Perspective

The main topic of the session is to show how dose optimization is being implemented in various regions of the world, including Europe, Australia, North America and other regions. A multi-national study conducted under International Atomic Energy Agency (IAEA) across more than 50 less resourced countries gave insight into patient radiation doses and safety practices in CT, mammography, radiography and interventional procedures, both for children and adults. An important outcome was the capability development on dose assessment and management. An overview of recent European projects related to CT radiation dose and optimization both to adults and children will be presented. Existing data on DRLs together with a European methodology proposed on establishing and using DRLs for paediatric radiodiagnostic imaging and interventional radiology practices will be shown. Compared with much of Europe at least, many Australian imaging practices are relatively new to the task of diagnostic imaging dose optimisation. In 2008 the Australian Government prescribed a requirement to periodically compare patient radiation doses with diagnostic reference levels (DRLs), where DRLs have been established. Until recently, Australia had only established DRLs for computed tomography (CT). Regardless, both professional society and individual efforts to improved data collection and develop optimisation strategies across a range of modalities continues. Progress in this field, principally with respect to CT and interventional fluoroscopy will be presented. In the US, dose reduction and optimization efforts for computed tomography have been promoted and mandated by several organizations and accrediting entities. This presentation will cover the general motivation, implementation, and implications of such efforts. Learning Objectives: Understand importance of the dose optimization in Diagnostic Radiology. See how this goal is achieved in different regions of the World. Learn about the global trend in the dose optimization and future prospectives. M. Rehani, The work was a part of the work of IAEA where I was an employee and IAEA is a United Nations organization.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

MO-DE-204-04: Dose Optimization in CT: Trends and Motivation in the US

The main topic of the session is to show how dose optimization is being implemented in various regions of the world, including Europe, Australia, North America and other regions. A multi-national study conducted under International Atomic Energy Agency (IAEA) across more than 50 less resourced countries gave insight into patient radiation doses and safety practices in CT, mammography, radiography and interventional procedures, both for children and adults. An important outcome was the capability development on dose assessment and management. An overview of recent European projects related to CT radiation dose and optimization both to adults and children will be presented. Existing data on DRLs together with a European methodology proposed on establishing and using DRLs for paediatric radiodiagnostic imaging and interventional radiology practices will be shown. Compared with much of Europe at least, many Australian imaging practices are relatively new to the task of diagnostic imaging dose optimisation. In 2008 the Australian Government prescribed a requirement to periodically compare patient radiation doses with diagnostic reference levels (DRLs), where DRLs have been established. Until recently, Australia had only established DRLs for computed tomography (CT). Regardless, both professional society and individual efforts to improved data collection and develop optimisation strategies across a range of modalities continues. Progress in this field, principally with respect to CT and interventional fluoroscopy will be presented. In the US, dose reduction and optimization efforts for computed tomography have been promoted and mandated by several organizations and accrediting entities. This presentation will cover the general motivation, implementation, and implications of such efforts. Learning Objectives: Understand importance of the dose optimization in Diagnostic Radiology. See how this goal is achieved in different regions of the World. Learn about the global trend in the dose optimization and future prospectives. M. Rehani, The work was a part of the work of IAEA where I was an employee and IAEA is a United Nations organization.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

MO-DE-204-01: Radiation Doses in Over 50 Developing Countries of Asia, Africa, Eastern European and Latin America

The main topic of the session is to show how dose optimization is being implemented in various regions of the world, including Europe, Australia, North America and other regions. A multi-national study conducted under International Atomic Energy Agency (IAEA) across more than 50 less resourced countries gave insight into patient radiation doses and safety practices in CT, mammography, radiography and interventional procedures, both for children and adults. An important outcome was the capability development on dose assessment and management. An overview of recent European projects related to CT radiation dose and optimization both to adults and children will be presented. Existing data on DRLs together with a European methodology proposed on establishing and using DRLs for paediatric radiodiagnostic imaging and interventional radiology practices will be shown. Compared with much of Europe at least, many Australian imaging practices are relatively new to the task of diagnostic imaging dose optimisation. In 2008 the Australian Government prescribed a requirement to periodically compare patient radiation doses with diagnostic reference levels (DRLs), where DRLs have been established. Until recently, Australia had only established DRLs for computed tomography (CT). Regardless, both professional society and individual efforts to improved data collection and develop optimisation strategies across a range of modalities continues. Progress in this field, principally with respect to CT and interventional fluoroscopy will be presented. In the US, dose reduction and optimization efforts for computed tomography have been promoted and mandated by several organizations and accrediting entities. This presentation will cover the general motivation, implementation, and implications of such efforts. Learning Objectives: Understand importance of the dose optimization in Diagnostic Radiology. See how this goal is achieved in different regions of the World. Learn about the global trend in the dose optimization and future prospectives. M. Rehani, The work was a part of the work of IAEA where I was an employee and IAEA is a United Nations organization.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

Patterns of Recurrence After Low-Dose-Rate Prostate Brachytherapy: A Population-Based Study of 2223 Consecutive Low- and Intermediate-Risk Patients

Objectives: This study examined patterns of recurrence after low–dose-rate prostate brachytherapy (LDR-PB), estimated local recurrence rate and compared that rate to the estimated local recurrence rate after radical prostatectomy (RP). Methods and Materials: A prospective database was maintained with clinical, dosimetric, and outcome data for all LDR-PB implantation procedures performed at our institution. From 1998 to 2008, 2223 patients with prostate cancer received LDR-PB without supplemental external beam radiation therapy. Patients who developed Phoenix-defined biochemical failure were reviewed for sites of relapse and investigations completed. Results: At a median follow-up of 5 years, 108 of 2223 patients (4.8%) developed biochemical relapse. In 1 additional patient, local relapse was found on transurethral prostate resection, but his prostate-specific antigen concentration was well short of triggering Phoenix-defined failure. Of the 109 patients with disease relapse, 18 of 2223 (0.8%) had a proven local recurrence, and 30 of 2223 (1.3%) had a proven distant recurrence. The remaining 61 of 2223 patients (2.7%) had unidentified sites of recurrence; of these, 57 patients (93%) had digital rectal examinations (DREs), 18 (30%) had post-treatment biopsies, 45 (74%) had bone scans, and 34 (56%) had computed tomography imaging of the abdomen and pelvis. If every biochemical failure were local, the local recurrence rate would be as high as 4.9%; however, by excluding those with proven distant failure and those with both a negative DRE and biopsy, we estimate that the local recurrence rate is 2.7% or less. Conclusions: In the context of limitations of the study design, our population-based analysis indicates that the local recurrence rate after LDR-PB is as low or lower than that after RP in our jurisdiction.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

DOE OSTI2017

Relation between quantitative coronary CTA and myocardial ischemia by adenosine stress myocardial CT perfusion

Background: Coronary-computed tomography angiography (CTA) has limited accuracy to predict myocardial ischemia. Besides luminal area stenosis, other coronary plaque morphology and composition parameters may help to assess ischemia. With the integration of coronary CTA and adenosine stress CT myocardial perfusion (CTP), reliable information regarding coronary anatomy and function can be derived in one procedure. This analysis aimed to investigate the association between coronary stenosis severity, plaque composition and morphology and the presence of ischemia measured with adenosine stress myocardial CTP. Methods and Results: 84 patients (age, 62 ± 10 years; 48% men) who underwent sequential coronary CTA and adenosine stress myocardial CT perfusion were analyzed. Automated quantification was performed in all coronary lesions (quantitative CTA). Downstream myocardial ischemia was assessed by visual analysis of the rest and stress CTP images and defined as a summed difference score of ≥1. One or more coronary plaques were present in 146 coronary arteries of which 31 (21%) were ischemia-related. Of the lesions with a stenosis percentage <50%, 50%-70%, and >70%, respectively, 9% (6/67), 18% (9/51), and 57% (16/28) demonstrated downstream ischemia. Furthermore, mean plaque burden, plaque volume, lesion length, maximal plaque thickness, and dense calcium volume were significantly higher in ischemia-related lesions, but only stenosis severity (%) (OR 1.06; 95% CI 1.02-1.10; P = .006) and lesion length (mm) (OR 1.26; 95% CI 1.02-1.55; P = .029) were independent correlates. Conclusions: Increasing stenosis percentage by quantitative CTA is positively correlated to myocardial ischemia measured with adenosine stress myocardial CTP. However, stenosis percentage remains a moderate determinant. Lumen area stenosis and lesion length were independently associated with ischemia, adjusted for coronary plaque volume, mean plaque burden, maximal lesion thickness, and dense calcium volume.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

DOE OSTI2013

QUANTIFYING OBSERVATIONAL PROJECTION EFFECTS USING MOLECULAR CLOUD SIMULATIONS

The physical properties of molecular clouds are often measured using spectral-line observations, which provide the only probes of the clouds' velocity structure. It is hard, though, to assess whether and to what extent intensity features in position-position-velocity (PPV) space correspond to 'real' density structures in position-position-position (PPP) space. In this paper, we create synthetic molecular cloud spectral-line maps of simulated molecular clouds, and present a new technique for measuring the reality of individual PPV structures. Using a dendrogram algorithm, we identify hierarchical structures in both PPP and PPV space. Our procedure projects density structures identified in PPP space into corresponding intensity structures in PPV space and then measures the geometric overlap of the projected structures with structures identified from the synthetic observation. The fractional overlap between a PPP and PPV structure quantifies how well the synthetic observation recovers information about the three-dimensional structure. Applying this machinery to a set of synthetic observations of CO isotopes, we measure how well spectral-line measurements recover mass, size, velocity dispersion, and virial parameter for a simulated star-forming region. By disabling various steps of our analysis, we investigate how much opacity, chemistry, and gravity affect measurements of physical properties extracted from PPV cubes. For the simulations used here, which offer a decent, but not perfect, match to the properties of a star-forming region like Perseus, our results suggest that superposition induces a ∼40% uncertainty in masses, sizes, and velocity dispersions derived from {sup 13}CO (J = 1-0). As would be expected, superposition and confusion is worst in regions where the filling factor of emitting material is large. The virial parameter is most affected by superposition, such that estimates of the virial parameter derived from PPV and PPP information typically disagree by a factor of ∼2. This uncertainty makes it particularly difficult to judge whether gravitational or kinetic energy dominate a given region, since the majority of virial parameter measurements fall within a factor of two of the equipartition level α ∼ 2.

79 ASTRONOMY AND ASTROPHYSICS↗

DOE OSTI2015

WE-AB-BRA-04: Evaluation of the Tumor Registration Error in Biopsy Procedures Performed Under Real Time PET/CT Guidance

Purpose: PET/CT guidance is used for biopsies of metabolically active lesions, which are not well seen on CT alone or to target the metabolically active tissue in tumor ablations. It has also been shown that PET/CT guided biopsies provide an opportunity to verify the location of the lesion border at the place of needle insertion. However the error in needle placement with respect to the metabolically active region may be affected by motion between the PET/CT scan performed at the start of the procedure and the CT scan performed with the needle in place and this error has not been previously quantified. Methods: Specimens from 31 PET/CT guided biopsies were investigated and correlated to the intraoperative PET scan under an IRB approved HIPAA compliant protocol. For 4 of the cases in which larger motion was suspected a second PET scan was obtained with the needle in place. The CT and the PET images obtained before and after the needle insertion were used to calculate the displacement of the voxels along the needle path. CTpost was registered to CTpre using a free form deformable registration and then fused with PETpre. The shifts between the PET image contours (42% of SUVmax) for PETpre and PETpost were obtained at the needle position. Results: For these extreme cases the displacement of the CT voxels along the needle path ranged from 2.9 to 8 mm with a mean of 5 mm. The shift of the PET image segmentation contours (42% of SUVmax) at the needle position ranged from 2.3 to 7 mm between the two scans. Conclusion: Evaluation of the mis-registration between the CT with the needle in place and the pre-biopsy PET can be obtained using deformable registration of the respective CT scans and can be used to indicate the need of a second PET in real-time. This work is supported in part by a grant from Biospace Lab, S.A.

60 APPLIED LIFE SCIENCES↗