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At least 793 records · Page 44

Stereotactic Radiosurgery and Fractionated Stereotactic Radiation Therapy for the Treatment of Uveal Melanoma

Purpose: To evaluate treatment results of stereotactic radiosurgery or fractionated stereotactic radiation therapy (SRS/FSRT) for uveal melanoma. Methods and Materials: We retrospectively evaluated 181 patients with 182 uveal melanomas receiving SRS/FSRT between 2007 and 2013. Treatment was administered with CyberKnife. Results: According to Collaborative Ocular Melanoma Study criteria, tumor size was small in 1%, medium in 49.5%, and large in 49.5% of the patients. Seventy-one tumors received <45 Gy, and 111 received ≥45 Gy. Median follow-up time was 24 months. Complete and partial response was observed in 8 and 104 eyes, respectively. The rate of 5-year overall survival was 98%, disease-free survival 57%, local recurrence-free survival 73%, distant metastasis-free survival 69%, and enucleation-free survival 73%. There was a significant correlation between tumor size and disease-free survival, SRS/FSRT dose and enucleation-free survival; and both were prognostic for local recurrence-free survival. Enucleation was performed in 41 eyes owing to progression in 26 and complications in 11. Conclusions: The radiation therapy dose is of great importance for local control and eye retention; the best treatment outcome was achieved using ≥45 Gy in 3 fractions.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

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

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

60 APPLIED LIFE SCIENCES↗

Sci—Fri PM: Topics — 07: Monte Carlo Simulation of Primary Dose and PET Isotope Production for the TRIUMF Proton Therapy Facility

Uveal melanoma is a rare and deadly tumour of the eye with primary metastases in the liver resulting in an 8% 2-year survival rate upon detection. Large growths, or those in close proximity to the optic nerve, pose a particular challenge to the commonly employed eye-sparing technique of eye-plaque brachytherapy. In these cases external beam charged particle therapy offers improved odds in avoiding catastrophic side effects such as neuropathy or blindness. Since 1995, the British Columbia Cancer Agency in partnership with the TRIUMF national laboratory have offered proton therapy in the treatment of difficult ocular tumors. Having seen 175 patients, yielding 80% globe preservation and 82% metastasis free survival as of 2010, this modality has proven to be highly effective. Despite this success, there have been few studies into the use of the world's largest cyclotron in patient care. Here we describe first efforts of modeling the TRIUMF dose delivery system using the FLUKA Monte Carlo package. Details on geometry, estimating beam parameters, measurement of primary dose and simulation of PET isotope production are discussed. Proton depth dose in both modulated and pristine beams is successfully simulated to sub-millimeter precision in range (within limits of measurement) and 2% agreement to measurement within in a treatment volume. With the goal of using PET signals for in vivo dosimetry (alignment), a first look at PET isotope depth distribution is presented — comparing favourably to a naive method of approximating simulated PET slice activity in a Lucite phantom.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

SU-F-P-26: Study of Radiation Dose Evaluation for Organs at Risk Using MRI in Intensity Modulated Radiation Therapy for Nasopharyngeal Carcinoma

Purpose: To study the contour and dosimetric feature of organs at risk (OARs) applying magnetic resonance imaging (MRI) images in intensity modulated radiation therapy (IMRT) of nasopharyngeal carcinoma (NPC) compared to computed tomography (CT) images. Methods: 35 NPC patients was selected into this trail. CT simulation with non-contrast and contrast enhanced scan, MRI simulation with non-contrast and contrast enhanced T1, T2 and diffusion weighted imaging were achieved sequentially. And the OARs were contoured on the CT and MRI images after rigid registration respectively. 9 beams IMRT plan with equal division angle were designed for every patients, and the prescription dose for tumor target was set as 72Gy (2.4Gy/ fration). The boundary display, volume and dose-volume indices of each organ were compared between on MRI and CT images. Results: Compared to CT, MRI showed clearer boundary of brainstem, spinal cord, the deep lobe of Parotid gland and the optical nerve in canal. MRI images increase the volume of lens, optical nerve, while reducing the volume of eye slightly, and the maximum dose of lens, the mean dose of eyes and optical raised in different percentage, while there was no statistical differences were found. The left and right parotid volume on MRI increased by 7.07%, 8.13%, and the mean dose raised by 14.95% (4.01Gy), 18.76% (4.95Gy) with statistical significant difference (p<0.05). The brainstem volume reduced by 9.33% (p<0.05), and the dose of 0.1cm3 volume (D0.1cm3) reduced by mean 8.46% (4.32Gy), and D0.1cm3 of spinal cord increased by 1.5Gy on MRI. Conclusion: It is credible to evaluate the radiation dose of lens, eye and the spinal cord, while it should be necessary to evaluate the dose of brainstem, parotid and the optical nerve applying MRI images sometime, it will be more meaningful for these organs with high risk of radiation injury.

60 APPLIED LIFE SCIENCES↗

SU-F-I-32: Organ Doses from Pediatric Head CT Scan

Purpose: To evaluate the organ doses of pediatric patients who undergoing head CT scan using Monte Carlo (MC) simulation and compare it with measurements in anthropomorphic child phantom.. Methods: A ten years old children voxel phantom was developed from CT images, the voxel size of the phantom was 2mm*2mm*2mm. Organ doses from head CT scan were simulated using MCNPX software, 180 detectors were placed in the voxel phantom to tally the doses of the represented tissues or organs. When performing the simulation, 120 kVp and 88 mA were selected as the scan parameters. The scan range covered from the top of the head to the end of the chain, this protocol was used at CT simulator for radiotherapy. To validate the simulated results, organ doses were measured with radiophotoluminescence (RPL) detectors, placed in the 28 organs of the 10 years old CIRS ATOM phantom. Results: The organ doses results matched well between MC simulation and phantom measurements. The eyes dose was showed to be as expected the highest organ dose: 28.11 mGy by simulation and 27.34 mGy by measurement respectively. Doses for organs not included in the scan volume were much lower than those included in the scan volume, thymus doses were observed more than 10 mGy due the CT protocol for radiotherapy covered more body part than routine head CT scan. Conclusion: As the eyes are superficial organs, they may receive the highest radiation dose during the CT scan. Considering the relatively high radio sensitivity, using shielding material or organ based tube current modulation technique should be encouraged to reduce the eye radiation risks. Scan range was one of the most important factors that affects the organ doses during the CT scan. Use as short as reasonably possible scan range should be helpful to reduce the patient radiation dose. This work was supported by the National Natural Science Foundation of China(11475047)

60 APPLIED LIFE SCIENCES↗

SU-F-T-176: Therapeutic Proton Beam Range Measurement Method with EBT3 Film

Purpose: Ocular proton therapy has the following advantages: i) sparing optic nerve, ii) the minimal dose is delivered to surrounding normal tissues. Since the proton therapy center was opened in 2007, 30 patients with ocular tumor have been treated at National Cancer Center using single scattering technique. To develop a solid eye phantom which can verify the output and the beam range with EBT3 film for independent patient QA in ocular proton therapy. Methods: The proton therapy is very effective to treat ocular tumor, because of the Bragg peak feature. In general, the beam shape of eye treatment is about 3 cm in diameter and the beam range is under 5 cm. However, proton therapy has uncertainty of beam range problem due to various stopping power of normal tissue, bone, air and so on, so that we should verify the beam range before treatment. For this purpose, a new PMMA phantom with wedge has been developed to use the film dosimetry and the ionization chamber. It is able to place a film on the slope of the phantom, which the spread out Bragg Peak by the water equivalent thickness value of PMMA can be made on the film. We considered to relation with quenching effect of proton energy and range for simple second check. In addition, the ionization chamber (Pin-point chamber, PTW 31014) can be inserted into a hole in the phantom to measure the absolute dose. Results: The output difference and beam range difference were less than 2% and 1.0 mm, respectively, between the measurement and the plan. Conclusion: An eye phantom was developed and its performance was evaluated successfully and it was useful to verify the output. Also with EBT3 film with the quenching effect for measurement depth-dose profile, range to patient QA.

60 APPLIED LIFE SCIENCES↗

TU-D-209-06: Head and Neck Tissue Dose From X-Ray Scatter to Physicians Performing Cardiovascular Procedures

Purpose: The purpose of this work was to characterize the spatial distribution of scatter radiation to the head and neck of a physician performing an x-ray interventional procedure and assess brain, eye lens, and carotid artery dose. Methods: Radiographic x-ray beams were tuned to match the peak energy (56 to 106 keV) and HVL (3.5 to 6.5 mm Al) of x-ray scatter originating from a patient during a fluoroscopic procedure. The radiographic beam was directed upon a Rando phantom from an inferior-left location to mimic a typical patient-operator geometric relationship. A lead-equivalent protective garment was secured to the phantom. Direct exposure Gafchromic film (XRQA2) was placed between the transverse plane layers of the head and neck region of the phantom and exposed with 4 scatter-equivalent radiographic beams. A 3×3 cm{sup 2} film placed at the left collar of the phantom was used to monitor incident dose in the position of a radiation monitoring badge. The films were converted to 2D dose distribution maps using FilmQA Pro software and an Epson 11000-XL scanner. The 2D dose distributions maps were normalized by the left collar dose and the percent of left collar dose (%LCD) was calculated for select tissues. Results: The dose maps had high dynamic range (10{sub 4}) and spatial detail. Considering all transverse planes and 4 scatter beam qualities, the median %LCD values were: whole brain 8.5%, left brain 13%, right brain 5.4%, left eye lens 67%, right eye lens 25%, left carotid artery 72%, and right carotid artery 28%. Conclusion: Scatter radiation dose to an operator can be simulated using a tuned radiographic beam and used to expose a phantom and Gafchromic film, thereby creating detailed 2D dose distribution maps. This work facilitates individualized estimation of dose to select head and neck tissues based on an operator’s radiation monitoring badge value.

60 APPLIED LIFE SCIENCES↗

Sci-Thur PM – Brachytherapy 01: Fast brachytherapy dose calculations: Characterization of egs-brachy features to enhance simulation efficiency

Purpose: egs-brachy is a fast, new EGSnrc user-code for brachytherapy applications. This study characterizes egs-brachy features that enhance simulation efficiency. Methods: Calculations are performed to characterize efficiency gains from various features. Simulations include radionuclide and miniature x-ray tube sources in water phantoms and idealized prostate, breast, and eye plaque treatments. Features characterized include voxel indexing of sources to reduce boundary checks during radiation transport, scoring collision kerma via tracklength estimator, recycling photons emitted from sources, and using phase space data to initiate simulations. Bremsstrahlung cross section enhancement (BCSE), uniform bremsstrahlung splitting (UBS), and Russian Roulette (RR) are considered for electronic brachytherapy. Results: Efficiency is enhanced by a factor of up to 300 using tracklength versus interaction scoring of collision kerma and by up to 2.7 and 2.6 using phase space sources and particle recycling respectively compared to simulations in which particles are initiated within sources. On a single 2.5 GHz Intel Xeon E5-2680 processor cor, simulations approximating prostate and breast permanent implant ((2 mm){sup 3} voxels) and eye plaque ((1 mm){sup 3}) treatments take as little as 9 s (prostate, eye) and up to 31 s (breast) to achieve 2% statistical uncertainty on doses within the PTV. For electronic brachytherapy, BCSE, UBS, and RR enhance efficiency by a factor >2000 compared to a factor of >10{sup 4} using a phase space source. Conclusion: egs-brachy features provide substantial efficiency gains, resulting in calculation times sufficiently fast for full Monte Carlo simulations for routine brachytherapy treatment planning.

60 APPLIED LIFE SCIENCES↗

Low-Dose Radiation Cataract and Genetic Determinants of Radiosensitivity

The lens of the eye is one of the most radiosensitive tissues in the body. Ocular ionizing radiation exposure results in characteristic, dose related, progressive lens changes leading to cataract formation. While initial, early stages of lens opacification may not cause visual disability, the severity of such changes progressively increases with dose until vision is impaired and cataract extraction surgery may be required. Because of the transparency of the eye, radiation induced lens changes can easily be followed non-invasively over time. Thus, the lens provides a unique model system in which to study the effects of low dose ionizing radiation exposure in a complex, highly organized tissue. Despite this observation, considerable uncertainties remain surrounding the relationship between dose and risk of developing radiation cataract. For example, a growing number of human epidemiological findings suggest significant risk among various groups of occupationally and accidentally exposed individuals and confidence intervals that include zero dose. Nevertheless, questions remain concerning the relationship between lens opacities, visual disability, clinical cataract, threshold dose and/or the role of genetics in determining radiosensitivity. Experimentally, the response of the rodent eye to radiation is quite similar to that in humans and thus animal studies are well suited to examine the relationship between radiation exposure, genetic determinants of radiosensitivity and cataractogenesis. The current work has expanded our knowledge of the low-dose effects of X-irradiation or high-LET heavy ion exposure on timing and progression of radiation cataract and has provided new information on the genetic, molecular, biochemical and cell biological features which contribute to this pathology. Furthermore, findings have indicated that single and/or multiple haploinsufficiency for various genes involved in DNA repair and cell cycle checkpoint control, such as Atm, Brca1 or Rad9, influence cataract development and thus radiosensitivity. These observations have direct applicability to various human populations including accidentally exposed individuals, interventional medical workers, astronauts and nuclear plant workers.

59 BASIC BIOLOGICAL SCIENCES↗

Report for 2.2.1 Task 2: Provide execution support for the human factors studies conducted for the LWRS Control Room Modernization project for PVNGS

INL contracted IFE to develop custom software functionality to support INL’s use of eye movement tracking in simulator studies. This includes the support of remote eye trackers, the support of dynamic Areas of Interest based on simulator events, and a general-purpose communication protocol between a simulator and the eye tracking software. The report summarises the task deliverables, which include a requirements identification workshop at INL, a software package, and instructional videos.

99 GENERAL AND MISCELLANEOUS↗

Deep Gaze Velocity Analysis During Mammographic Reading for Biometric Identification of Radiologists

Several studies have confirmed that the gaze velocity of the human eye can be utilized as a behavioral biometric or personalized biomarker. In this study, we leverage the local feature representation capacity of convolutional neural networks (CNNs) for eye gaze velocity analysis as the basis for biometric identification of radiologists performing breast cancer screening. Using gaze data collected from 10 radiologists reading 100 mammograms of various diagnoses, we compared the performance of a CNN-based classification algorithm with two deep learning classifiers, deep neural network and deep belief network, and a previously presented hidden Markov model classifier. The study showed that the CNN classifier is superior compared to alternative classification methods based on macro F1-scores derived from 10-fold cross-validation experiments. Our results further support the efficacy of eye gaze velocity as a biometric identifier of medical imaging experts.

59 BASIC BIOLOGICAL SCIENCES↗

Context-specific adaptation of saccade gain in parabolic flight

Previous studies established that vestibular reflexes can have two adapted states (e.g., gains) simultaneously, and that a context cue (e.g., vertical eye position) can switch between the two states. Our earlier work demonstrated this phenomenon of context-specific adaptation for saccadic eye movements: we asked for gain decrease in one context state and gain increase in another context state, and then determined if a change in the context state would invoke switching between the adapted states. Horizontal and vertical eye position and head orientation could serve, to varying degrees, as cues for switching between two different saccade gains. In the present study, we asked whether gravity magnitude could serve as a context cue: saccade adaptation was performed during parabolic flight, which provides alternating levels of gravitoinertial force (0 g and 1.8 g). Results were less robust than those from ground experiments, but established that different saccade magnitudes could be associated with different gravity levels.

Clinical Trial↗

Changes in gravitational state cause changes in ocular torsion

Gravity-responsive eye torsion was studied simultaneously in both eyes during parabolic flight to determine the effects of weightlessness. Observed effects were that torsional position of eyes in the 1G states between parabolas was offset from the baseline positions obtained prior to the onset of parabolas, responses to hyper- and hypogravity were seen in most subjects, and responses were consistent within subjects but varied between subjects.

NASA Discipline Neuroscience↗

Path perception during rotation: influence of instructions, depth range, and dot density

How do observers perceive their direction of self-motion when traveling on a straight path while their eyes are rotating? Our previous findings suggest that information from retinal flow and extra-retinal information about eye movements are each sufficient to solve this problem for both perception and active control of self-motion [Vision Res. 40 (2000) 3873; Psych. Sci. 13 (2002) 485]. In this paper, using displays depicting translation with simulated eye rotation, we investigated how task variables such as instructions, depth range, and dot density influenced the visual system's reliance on retinal vs. extra-retinal information for path perception during rotation. We found that path errors were small when observers expected to travel on a straight path or with neutral instructions, but errors increased markedly when observers expected to travel on a curved path. Increasing depth range or dot density did not improve path judgments. We conclude that the expectation of the shape of an upcoming path can influence the interpretation of the ambiguous retinal flow. A large depth range and dense motion parallax are not essential for accurate path perception during rotation, but reference objects and a large field of view appear to improve path judgments.

Space Perception/physiology↗

Smooth Pursuit of Flicker-Defined Motion

We examined the pursuit response to stimuli defined by space-variant flicker of a dense random dot carrier pattern. On each frame, every element of the pattern could change polarity, with a probability given by a two-dimensional Gaussian distribution. A normal distribution produces a circular region of twinkle, while inverting the distribution results in a spot of static texture in a twinkling surround. In this latter case, the carrier texture could be stationary, or could move with the twinkle modulator, thereby producing first-order motion in the region of the spot. While the twinkle-defined spot produces a strong sensation of motion, the complementary stimulus defined by the absence of twinkle does not, when viewed peripherally, it appears to move in steps even when the generating distribution moves smoothly. We examined pursuit responses to these stimuli using two techniques: 1) the eye movement correlogram, obtained by cross-correlating eye velocity with the velocity of a randomly-moving stimulus; and 2) delayed visual feedback, where transient stabilization of a target can produce spontaneous oscillations of the eye, with a period empirically observed to vary linearly with the applied delay. Both techniques provide an estimate of the internal processing time, which can be as short as 100 milliseconds for a first-order target. Assessed by the correlogram method, the response to flicker-defined motion is delayed by more than 100 milliseconds, and significantly weaker (especially in the vertical dimension). When initially presented in the delayed feedback condition, purely saccadic oscillation is observed. One subject eventually developed smooth oscillations (albeit with significant saccadic intrusions), showing a period-versus-delay slope similar to that observed for first-order targets. This result is somewhat surprising, given that we interpret the slope of the period-versus-delay-function as reflecting the balance between position- and velocity-sensitive inputs to pursuit.

eye movements↗

Smooth Pursuit of Flicker-Defined Motion

We examined the pursuit response to stimuli defined by space-variant flicker of a dense random dot carrier pattern. On each frame, every element of the pattern could change polarity, with a probability given by a two-dimensional Gaussian distribution. A normal distribution produces a circular region of twinkle, while inverting the distribution results in a spot of static texture in a twinkling surround. In this latter case, the carrier texture could be stationary, or could move with the twinkle modulator,thereby producing first-order motion in the region of the spot. While the twinkle-defined spot produces a strong sensation of motion, the complementary stimulus defined by the absence of twinkle does not;when viewed peripherally, it appears to move in steps even when the generating distribution moves smoothly. We examined pursuit responses to these stimuli using two techniques: 1) the eye movement correlogram, obtained by cross-correlating eye velocity with the velocity of a randomly-moving stimulus; and 2) delayed visual feedback, where transient stabilization of a target can produce spontaneous oscillations of the eye, with a period empirically observed to vary linearly with the applied delay. Both techniques provide an estimate of the internal processing time, which can be as short as100 milliseconds for a first-order target. Assessed by the correlogram method, the response to flicker defined motion is delayed by more than 100 milliseconds, and significantly weaker (especially in the vertical dimension). When initially presented in the delayed feedback condition, purely saccadic oscillation is observed. One subject eventually developed smooth oscillations (albeit with significant saccadic intrusions), showing a period-versus-delay slope similar to that observed for first-order targets. This result is somewhat surprising, given that we interpret the slope of the period-versus-delayfunction as reflecting the balance between position- and velocity-sensitive inputs to pursuit.

smooth pursuit↗

Oculometric Surveillance of Neuro-Ocular Function

Future missions to the moon or Mars will require the crew to monitor and assess their health and performance more autonomously, with approaches easily useable and interpretable by non-clinicians. If an autonomous oculometric diagnostic-support system proves to be a reliable predictor of impending impairment of visual function in the case of primary ocular pathology on Earth, then it could also be applied in the future to the surveillance of crew to detect the potential progression of sensorimotor and neuro-ocular compromises during extended spaceflight missions, e.g., SANS, and thus guide earlier and more effective countermeasure intervention. Towards that goal, we intend to determine if a set of largely independent eye-movement metrics, called oculometrics, measured using a simple voluntary eye-tracking task that can be completed in just 5 minutes per eye, could provide clinically valid biomarkers of functional visual deficits due to primary ocular pathology. The premise is that oculometrics could be used to monitor slowly evolving ocular pathologies, potentially detecting them even before structural evidence appears in ocular imaging or other current state-of-the-art clinical measures. This study investigates how NASA’s patented oculometric assessment of visual and visuomotor function, shown to correlate with performance in a manual control task, will correlate with standard ophthalmological tests to confirm clinical and thus operational, validity.

eye movements↗

Efficient Oculometric Assessment of Altered Neural Function

Eye movements have long been known to shed light on the locus and nature of serious brain injuries and pathologies. Recent scientific findings linking eye movements and higher-order psychometric performance and recent technical advances in eye-tracking precision have enabled the harnessing of an assortment of oculometrics as sensitive and reliable biomarkers of mild neural impairment across a wide range of stressors and brain regions. Oculometrics is, therefore, a promising new tool for the assessment of spaceflight effects on sensorimotor performance and on the effectiveness of candidate countermeasures, even with small sample populations

eye movements↗