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At least 811 records · Page 45
All sourcesNASA NTRSDOE OSTI
DOE OSTI2014

SU-E-I-08: An Inpaint-Based Interpolation Technique to Recover Blocked Information for Cone Beam CT with a Synchronized Moving Grid (SMOG)

Purpose: Synchronized moving grid (SMOG) is a promising technique to reduce scatter and ghost artifacts in cone beam computed tomography (CBCT). However, the grid blocks part of image information in each projection, and multiple projections at the same gantry angle have to been taken to obtain full information. Because of the continuity of a patient's anatomy in the projection, the blocked information may be estimated by interpolation. This study aims to evaluate an inpainting-based interpolation approach to recover the missing information for CBCT reconstruction. Method: We used a simple region-based inpainting approach to interpolate the missing information. For a pixel to be interpolated, we divided the nearby regions having image information into 6 sub-regions: up-left, up-middle, up-right, down-left, down-middle, and down-right, each with 9 pixels. The average pixel value of each sub-region was calculated. These average values, along with the pixel location, were used to determine the interpolated pixel value. We compared our approach with the Criminisi Exemplar (CE) and total variation (TV) based inpainting techniques. Projection images of Catphan and a head phantom were used for the comparison. The SMOG was simulated by erasing the information (filling with “0”) of the areas in each projection corresponding to the grid. Results: For the Catphan, the processing time was 178, 45 and 0.98 minutes for CE, TV and our approach, respectively. The signal to noise ratio (SNR) was 19.4, 18.5 and 26.4 db, correspondingly. For the head phantom, the processing time was 222, 45 and 0.93 minutes for CE, TV and our approach, respectively. The SNR was 24.6, 20.2 and 26.2db correspondingly. Conclusion: We have developed a simple inpainting based interpolation approach, which can recover some of the image information for the SMOG-based CBCT imaging. This study is supported by NIH/NCI grant 1R01CA166948-01.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2014

SU-E-J-10: A Moving-Blocker-Based Strategy for Simultaneous Megavoltage and Kilovoltage Scatter Correction in Cone-Beam Computed Tomography Image Acquired During Volumetric Modulated Arc Therapy

Purpose: To evaluate a moving-blocker-based approach in estimating and correcting megavoltage (MV) and kilovoltage (kV) scatter contamination in kV cone-beam computed tomography (CBCT) acquired during volumetric modulated arc therapy (VMAT). Methods: XML code was generated to enable concurrent CBCT acquisition and VMAT delivery in Varian TrueBeam developer mode. A physical attenuator (i.e., “blocker”) consisting of equal spaced lead strips (3.2mm strip width and 3.2mm gap in between) was mounted between the x-ray source and patient at a source to blocker distance of 232mm. The blocker was simulated to be moving back and forth along the gantry rotation axis during the CBCT acquisition. Both MV and kV scatter signal were estimated simultaneously from the blocked regions of the imaging panel, and interpolated into the un-blocked regions. Scatter corrected CBCT was then reconstructed from un-blocked projections after scatter subtraction using an iterative image reconstruction algorithm based on constraint optimization. Experimental studies were performed on a Catphan 600 phantom and an anthropomorphic pelvis phantom to demonstrate the feasibility of using moving blocker for MV-kV scatter correction. Results: MV scatter greatly degrades the CBCT image quality by increasing the CT number inaccuracy and decreasing the image contrast, in addition to the shading artifacts caused by kV scatter. The artifacts were substantially reduced in the moving blocker corrected CBCT images in both Catphan and pelvis phantoms. Quantitatively, CT number error in selected regions of interest reduced from 377 in the kV-MV contaminated CBCT image to 38 for the Catphan phantom. Conclusions: The moving-blockerbased strategy can successfully correct MV and kV scatter simultaneously in CBCT projection data acquired with concurrent VMAT delivery. This work was supported in part by a grant from the Cancer Prevention and Research Institute of Texas (RP130109) and a grant from the American Cancer Society (RSG-13-326-01-CCE)

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-J-39: Comparison of PTV Margins Determined by In-Room Stereoscopic Image Guidance and by On-Board Cone Beam Computed Tomography Technique for Brain Radiotherapy Patients

Purpose: Stereoscopic in room kV image guidance is a faster tool in daily monitoring of patient positioning. Our centre, for the first time in the world, has integrated such a solution from BrainLAB (ExacTrac) with Elekta's volumetric cone beam computed tomography (XVI). Using van Herk's formula, we compared the planning target volume (PTV) margins calculated by both these systems for patients treated with brain radiotherapy. Methods: For a total of 24 patients who received partial or whole brain radiotherapy, verification images were acquired for 524 treatment sessions by XVI and for 334 sessions by ExacTrac out of the total 547 sessions. Systematic and random errors were calculated in cranio-caudal, lateral and antero-posterior directions for both techniques. PTV margins were then determined using van Herk formula. Results: In the cranio-caudal direction, systematic error, random error and the calculated PTV margin were found to be 0.13 cm, 0.12 cm and 0.41 cm with XVI and 0.14 cm, 0.13 cm and 0.44 cm with ExacTrac. The corresponding values in lateral direction were 0.13 cm 0.1 cm and 0.4 cm with XVI and 0.13 cm, 0.12 cm and 0.42 cm with ExacTrac imaging. The same parameters for antero-posterior were for 0.1 cm, 0.11 cm and 0.34 cm with XVI and 0.13 cm, 0.16 cm and 0.43 cm with ExacTrac imaging. The margins estimated with the two imaging modalities were comparable within ± 1 mm limit. Conclusion: Verification of setup errors in the major axes by two independent imaging systems showed the results are comparable and within ± 1 mm. This implies that planar imaging based ExacTrac can yield equal accuracy in setup error determination as the time consuming volumetric imaging which is considered as the gold standard. Accordingly PTV margins estimated by this faster imaging technique can be confidently used in clinical setup.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-J-103: Setup Errors Analysis by Cone-Beam CT (CBCT)-Based Imaged-Guided Intensity Modulated Radiotherapy for Esophageal Cancer

Purpose: To quantify setup errors by pretreatment kilovolt cone-beam computed tomography(KV-CBCT) scans for middle or distal esophageal carcinoma patients. Methods: Fifty-two consecutive middle or distal esophageal carcinoma patients who underwent IMRT were included this study. A planning CT scan using a big-bore CT simulator was performed in the treatment position and was used as the reference scan for image registration with CBCT. CBCT scans(On-Board Imaging v1. 5 system, Varian Medical Systems) were acquired daily during the first treatment week. A total of 260 CBCT scans was assessed with a registration clip box defined around the PTV-thorax in the reference scan based on(nine CBCTs per patient) bony anatomy using Offline Review software v10.0(Varian Medical Systems). The anterior-posterior(AP), left-right(LR), superiorinferior( SI) corrections were recorded. The systematic and random errors were calculated. The CTV-to-PTV margins in each CBCT frequency was based on the Van Herk formula (2.5Σ+0.7σ). Results: The SD of systematic error (Σ) was 2.0mm, 2.3mm, 3.8mm in the AP, LR and SI directions, respectively. The average random error (σ) was 1.6mm, 2.4mm, 4.1mm in the AP, LR and SI directions, respectively. The CTV-to-PTV safety margin was 6.1mm, 7.5mm, 12.3mm in the AP, LR and SI directions based on van Herk formula. Conclusion: Our data recommend the use of 6 mm, 8mm, and 12 mm for esophageal carcinoma patient setup in AP, LR, SI directions, respectively.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2014

SU-E-J-179: Prediction of Pelvic Nodal Coverage Using Mutual Information Between Cone-Beam and Planning CTs

Purpose: To investigate if pelvic nodal coverage for prostate patients undergoing intensity modulated radiotherapy (IMRT) can be predicted using mutual image information computed between planning and cone-beam CTs (CBCTs). Methods: Four patients with high-risk prostate adenocarcinoma were treated with IMRT on a Varian TrueBeam. Plans were designed such that 95% of the nodal planning target volume (PTV) received the prescription dose of 45 Gy (N=1) or 50.4 Gy (N=3). Weekly CBCTs (N=25) were acquired and the nodal clinical target volumes and organs at risk were contoured by a physician. The percent nodal volume receiving prescription dose was recorded as a ground truth. Using the recorded shifts performed by the radiation therapists at the time of image acquisition, CBCTs were aligned with the planning kVCT. Mutual image information (MI) was calculated between the CBCT and the aligned planning CT within the contour of the nodal PTV. Due to variable CBCT fields-of-view, CBCT images covering less than 90% of the nodal volume were excluded from the analysis, resulting in the removal of eight CBCTs. Results: A correlation coefficient of 0.40 was observed between the MI metric and the percent of the nodal target volume receiving the prescription dose. One patient's CBCTs had clear outliers from the rest of the patients. Upon further investigation, we discovered image artifacts that were present only in that patient's images. When those four images were excluded, the correlation improved to 0.81. Conclusion: This pilot study shows the potential of predicting pelvic nodal dosimetry by computing the mutual image information between planning CTs and patient setup CBCTs. Importantly, this technique does not involve manual or automatic contouring of the CBCT images. Additional patients and more robust exclusion criteria will help validate our findings.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-J-214: Comparative Assessment On IGRT On Partial Bladder Cancer Treatment Between CT-On-Rails (CTOR) and KV Cone Beam CT (CBCT)

Purpose: Image-Guided radiation therapy(IGRT) depends on reliable online patient-specific anatomy information to address random and progressive anatomy changes. Large margins have been suggested to bladder cancer treatment due to large daily bladder anatomy variation. KV Cone beam CT(CBCT) has been used in IGRT localization prevalently; however, its lack of soft tissue contrast makes clinicians hesitate to perform daily soft tissue alignment with CBCT for partial bladder cancer treatment. This study compares the localization uncertainties of bladder cancer IGRT using CTon- Rails(CTOR) and CBCT. Methods: Three T2N0M0 bladder cancer patients (total of 66 Gy to partial bladder alone) were localized daily with either CTOR or CBCT for their entire treatment course. A total of 71 sets of CTOR and 22 sets of CBCT images were acquired and registered with original planning CT scans by radiation therapists and approved by radiation oncologists for the daily treatment. CTOR scanning entailed 2mm slice thickness, 0.98mm axial voxel size, 120kVp and 240mAs. CBCT used a half fan pelvis protocol from Varian OBI system with 2mm slice thickness, 0.98axial voxel size, 125kVp, and 680mAs. Daily localization distribution was compared. Accuracy of CTOR and CBCT on partial bladder alignment was also evaluated by comparing bladder PTV coverage. Results: 1cm all around PTV margins were used in every patient except target superior limit margin to 0mm due to bowel constraint. Daily shifts on CTOR averaged to 0.48, 0.24, 0.19 mms(SI,Lat,AP directions); CBCT averaged to 0.43, 0.09, 0.19 mms(SI,Lat,AP directions). The CTOR daily localization showed superior results of V100% of PTV(102% CTOR vs. 89% CBCT) and bowel(Dmax 69.5Gy vs. 78Gy CBCT). CTOR images showed much higher contrast on bladder PTV alignment. Conclusion: CTOR daily localization for IGRT is more dosimetrically beneficial for partial bladder cancer treatment than kV CBCT localization and provided better soft tissue PTV identification.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-J-243: Possibility of Exposure Dose Reduction of Cone-Beam Computed Tomography in An Image Guided Patient Positioning System by Using Various Noise Suppression Filters

Purpose: To investigate the possibility of exposure dose reduction of the cone-beam computed tomography (CBCT) in an image guided patient positioning system by using 6 noise suppression filters. Methods: First, a reference dose (RD) and low-dose (LD)-CBCT (X-ray volume imaging system, Elekta Co.) images were acquired with a reference dose of 86.2 mGy (weighted CT dose index: CTDIw) and various low doses of 1.4 to 43.1 mGy, respectively. Second, an automated rigid registration for three axes was performed for estimating setup errors between a planning CT image and the LD-CBCT images, which were processed by 6 noise suppression filters, i.e., averaging filter (AF), median filter (MF), Gaussian filter (GF), bilateral filter (BF), edge preserving smoothing filter (EPF) and adaptive partial median filter (AMF). Third, residual errors representing the patient positioning accuracy were calculated as an Euclidean distance between the setup error vectors estimated using the LD-CBCT image and RD-CBCT image. Finally, the relationships between the residual error and CTDIw were obtained for 6 noise suppression filters, and then the CTDIw for LD-CBCT images processed by the noise suppression filters were measured at the same residual error, which was obtained with the RD-CBCT. This approach was applied to an anthropomorphic pelvic phantom and two cancer patients. Results: For the phantom, the exposure dose could be reduced from 61% (GF) to 78% (AMF) by applying the noise suppression filters to the CBCT images. The exposure dose in a prostate cancer case could be reduced from 8% (AF) to 61% (AMF), and the exposure dose in a lung cancer case could be reduced from 9% (AF) to 37% (AMF). Conclusion: Using noise suppression filters, particularly an adaptive partial median filter, could be feasible to decrease the additional exposure dose to patients in image guided patient positioning systems.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-J-252: A Motion Algorithm to Extract Physical and Motion Parameters of a Mobile Target in Cone-Beam Computed Tomographic Imaging Retrospective to Image Reconstruction

Purpose: A motion algorithm was developed to extract actual length, CT-numbers and motion amplitude of a mobile target imaged with cone-beam-CT (CBCT) retrospective to image-reconstruction. Methods: The motion model considered a mobile target moving with a sinusoidal motion and employed three measurable parameters: apparent length, CT number level and gradient of a mobile target obtained from CBCT images to extract information about the actual length and CT number value of the stationary target and motion amplitude. The algorithm was verified experimentally with a mobile phantom setup that has three targets with different sizes manufactured from homogenous tissue-equivalent gel material embedded into a thorax phantom. The phantom moved sinusoidal in one-direction using eight amplitudes (0–20mm) and a frequency of 15-cycles-per-minute. The model required imaging parameters such as slice thickness, imaging time. Results: This motion algorithm extracted three unknown parameters: length of the target, CT-number-level, motion amplitude for a mobile target retrospective to CBCT image reconstruction. The algorithm relates three unknown parameters to measurable apparent length, CT-number-level and gradient for well-defined mobile targets obtained from CBCT images. The motion model agreed with measured apparent lengths which were dependent on actual length of the target and motion amplitude. The cumulative CT-number for a mobile target was dependent on CT-number-level of the stationary target and motion amplitude. The gradient of the CT-distribution of mobile target is dependent on the stationary CT-number-level, actual target length along the direction of motion, and motion amplitude. Motion frequency and phase did not affect the elongation and CT-number distributions of mobile targets when imaging time included several motion cycles. Conclusion: The motion algorithm developed in this study has potential applications in diagnostic CT imaging and radiotherapy to extract actual length, size and CT-numbers distorted by motion in CBCT imaging. The model provides further information about motion of the target.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-86: Comparison of Two Commercially Available Programs for the Evaluation of Delivered Daily Dose Using Cone Beam CT (CBCT)

Purpose: In this study, two commercially available programs were compared for the evaluation of delivered daily dose using cone beam CT (CBCT). Methods: Thirty (n=30) patients previously treated in our clinic (10 prostate, 10 SBRT lung and 10 abdomen) were used in this study. The patients' plans were optimized and calculated using the Pinnacle treatment planning system. The daily CBCT scans were imported into Velocity and RayStation along with the corresponding planning CTs, structure sets and 3D dose distributions for each patient. The organs at risk (OAR) were contoured on each CBCT by the prescribing physician and were included in the evaluation of the daily delivered dose. Each CBCT was registered to the planning CT, once with rigid registration and then again, separately, with deformable registration. After registering each CBCT, the dose distribution from the planning CT was overlaid and the dose volume histograms (DVH) for the OAR and the planning target volumes (PTV) were calculated. Results: For prostate patients, we observed daily volume changes for the OARs. The DVH analysis for those patients showed variation in the sparing of the OARs while PTV coverage remained virtually unchanged using both Velocity and RayStation systems. Similar results were observed for abdominal patients. In contrast, for SBRT lung patients, the DVH for the OARs and target were comparable to those from the initial treatment plan. Differences in organ volume and organ doses were also observed when comparing the daily fractions using deformable and rigid registrations. Conclusion: By using daily CBCT dose reconstruction, we proved PTV coverage for prostate and abdominal targets is adequate. However, there is significant dosimetric change for the OARs. For lung SBRT patients, the delivered daily dose for both PTV and OAR is comparable to the planned dose with no significant differences.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-161: Evaluation of Dose Calculation Based On Cone-Beam CT

Purpose: The purpose of this study is to convert pixel values in cone-beam CT (CBCT) using histograms of pixel values in the simulation CT (sim-CT) and the CBCT images and to evaluate the accuracy of dose calculation based on the CBCT. Methods: The sim-CT and CBCT images immediately before the treatment of 10 prostate cancer patients were acquired. Because of insufficient calibration of the pixel values in the CBCT, it is difficult to be directly used for dose calculation. The pixel values in the CBCT images were converted using an in-house program. A 7 fields treatment plans (original plan) created on the sim-CT images were applied to the CBCT images and the dose distributions were re-calculated with same monitor units (MUs). These prescription doses were compared with those of original plans. Results: In the results of the pixel values conversion in the CBCT images,the mean differences of pixel values for the prostate,subcutaneous adipose, muscle and right-femur were −10.78±34.60, 11.78±41.06, 29.49±36.99 and 0.14±31.15 respectively. In the results of the calculated doses, the mean differences of prescription doses for 7 fields were 4.13±0.95%, 0.34±0.86%, −0.05±0.55%, 1.35±0.98%, 1.77±0.56%, 0.89±0.69% and 1.69±0.71% respectively and as a whole, the difference of prescription dose was 1.54±0.4%. Conclusion: The dose calculation on the CBCT images achieve an accuracy of <2% by using this pixel values conversion program. This may enable implementation of efficient adaptive radiotherapy.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-306: Study of the Reduction Technique for the Secondary Cancer Risk Due to Cone Beam CT in Image Guided Radiotherapy

Purpose: This study evaluated the effectiveness of a thin lead sheet based simple shielding method for imaging doses from cone beam computed tomography (CBCT) in image-guided radiotherapy (IGRT). Methods: The entire body, except for the region scanned by CBCT, was shielded by wrapping in a 2 mm lead sheet. Reduction of secondary doses from CBCT was measured using a radio-photoluminescence glass dosimeter (RPLGD) placed inside an anthropomorphic phantom and changes in secondary cancer risk due to the shielding effect were estimated using BEIR VII model. Results: Doses to out-of-field organs for head-and-neck, chest, and pelvis scans were decreased 15∼100 %, 23∼90 %, and 23∼98 %, respectively, and the average reductions in lifetime secondary cancer risk due to the 2 mm lead shielding were 1.61, 10.4, and 12.8 persons per 100,000, respectively. Conclusion: This study suggests that a simple thin lead sheet based shielding method results in a non-negligible reduction of secondary doses to out-of-field regions for CBCT.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-416: VMAT Dose Calculations Using Cone Beam CT Images: A Preliminary Study

Purpose: Cone beam CT (CBCT) images have been used routinely for patient positioning throughout the treatment course. However, use of CBCT for dose calculation is still investigational. The purpose of this study is to assess the utility of CBCT images for Volumetric Modulated Arc Therapy (VMAT) plan dose calculation. Methods: A CATPHAN 504 phantom (The Phantom Laboratory, Salem, NY) was used to compare the dosimetric and geometric accuracy between conventional CT and CBCT (in both full and half fan modes). Hounsfield units (HU) profiles at different density areas were evaluated. A C shape target that surrounds a central avoidance structure was created and a VMAT plan was generated on the CT images and copied to the CBCT phantom images. Patient studies included three brain patients, and one head and neck (H'N) patient. VMAT plans generated on the patients treatment planning CT was applied to CBCT images obtained during the first treatment. Isodose distributions and dosevolume- histograms (DVHs) were compared. Results: For the phantom study, the HU difference between CT and CBCT is within 100 (maximum 96 HU for Teflon CBCT images in full fan mode). The impact of these differences on the calculated dose distributions was clinically insignificant. In both phantom and patient studies, target DVHs based on CBCT images were in excellent agreement with those based on planning CT images. Mean, Median, near minimum (D98%), and near maximum (D2%) doses agreed within 0-2.5%. A slightly larger discrepancy is observed in the patient studies compared to that seen in the phantom study, (0-1% vs. 0 - 2.5%). Conclusion: CBCT images can be used to accurately predict dosimetric results, without any HU correction. It is feasible to use CBCT to evaluate the actual dose delivered at each fraction. The dosimetric consequences resulting from tumor response and patient geometry changes could be monitored.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-QI-08: Fourier Properties of Cone Beam CT Projection

Purpose: To explore the Fourier properties of cone beam CT (CBCT) projections and apply the property to directly estimate noise level of CBCT projections without any prior information. Methods: By utilizing the property of Bessel function, we derivate the Fourier properties of the CBCT projections for an arbitrary point object. It is found that there exists a double-wedge shaped region in the Fourier space where the intensity is approximately zero. We further derivate the Fourier properties of independent noise added to CBCT projections. The expectation of the square of the module in any point of the Fourier space is constant and the value approximately equals to noise energy. We further validate the theory in numerical simulations for both a delta function object and a NCAT phantom with different levels of noise added. Results: Our simulation confirmed the existence of the double-wedge shaped region in Fourier domain for the x-ray projection image. The boundary locations of this region agree well with theoretical predictions. In the experiments of estimating noise level, the mean relative error between the theory estimation and the ground truth values is 2.697%. Conclusion: A novel theory on the Fourier properties of CBCT projections has been discovered. Accurate noise level estimation can be achieved by applying this theory directly to the measured CBCT projections. This work was supported in part by NIH(1R01CA154747-01), NSFC((No. 61172163), Research Fund for the Doctoral Program of Higher Education of China (No. 20110201110011) and China Scholarship Council.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2014

SU-E-CAMPUS-J-03: Commissioning of the On-Board Cone-Beam CT System Equipped On the Rotating Gantry of a Proton Therapy System

Purpose: Proton therapy requires highly-precise image guidance in patient setup to ensure accurate dose delivery. Cone-beam CT (CBCT) is expected to play an important role to reduce uncertainties in patient setup. Hokkaido University has developed a new proton therapy system dedicated to spot-scanning under a collaborative work with Hitachi Ltd. In our system, an orthogonal X-ray imaging system is mounted on a full-rotating gantry. On-board CBCT imaging is therefore available. We have conducted commissioning of the CBCT system for clinical use in proton therapy. Methods: The orthogonal X-ray imaging system, which consists of two sets of X-ray tubes and flat panel detectors (FPDs), are equipped on the rotating gantry. The FPDs are mounted on the proton beam nozzle and can be retracted when not in use. The distance between the X-ray source and the FPD is about 2.1 m. The maximum rotation speed of the gantry is 1 rpm, so CBCT images can be acquired in approximately 1 minute. The maximum reconstruction volume is nearly 40 cm in diameter and 20 cm in axial length. For commissioning of the CBCT system, mechanical accuracy of the rotating gantry first was evaluated. Imaging performance was examined via quantitative evaluation of image quality. Results: Through the mechanical test, the isocentricity of the gantry was confirmed to be less than 1 mm. Moreover, it was improved to 0.5 mm with an appropriate correction. The accurate rotation of the gantry contributes to the CBCT image quality. In the image quality test, objects with 7 line-pairs per cm, which corresponds to a line spacing of 0.071 cm, could be discerned. Spatial linearity and uniformity were also sufficient. Conclusion: Clinical commissioning of the on-board CBCT system for proton therapy was conducted, and CBCT images with sufficient quality were successfully obtained. This research was supported by the Cabinet Office, Government of Japan and the Japan Society for the Promotion of Science (JSPS) through the Funding Program for World-Leading Innovative R and D on Science and Technology (FIRST Program), initiated by the Council for Science and Technology Policy (CSTP)

07 ISOTOPE AND RADIATION SOURCES↗
DOE OSTI2014

TU-F-BRE-08: Significant Variations in Measured Small Cone Output Factor for FFF Beams

Purpose: To evaluate the measurement accuracy of several dosimeters for small cone output factors in two SRS/SBRT dedicated systems with Flattening Filter Free (FFF) beams: a Varian TrueBeam STx (TB) and an Accuray CyberKnife VSI (CK). Output factors (OFs) were measured for both machines and for CK, compared against a Monte Carlo model. Methods: Dose measurements were taken using three different FFF beams (TB 6XFFF, TB 10XFFF, and CK 6XFFF). Three commonly used types of dosimeters were examined in this work: a micro-ion chamber (Exradin A16), two shielded diodes (PTW TN60008 and PTW TN60017), and radiochromic film (Gafchromic EBT2). Measured OFs from these dosimeters were compared with each other and OFs measured with an Exradin W1 scintillator. Monte Carlo determined correction factors for the CK beam for the micro-ion chamber and diodes were applied to the respective OF measurements and compared against scintillator measured OFs corrected for volume averaging. Results: OFs measured for the smallest fields using the micro-ion chamber, diodes, scintillator, and film varied substantially (with up to a 16% difference between dosimeters). Micro-ion chamber and film OF measurements were up to 9% and 10%, respectively, lower than scintillator measurements for the smallest fields. OF measurements by diode were up to 6% greater than scintillator measurements for the smallest fields. With correction factors, the micro-ion chamber and diode measured OFs showed good agreement with scintillator measured OFs for the CK 6XFFF beam (within 3% and 1.5%, respectively). Conclusion: Uncorrected small field OFs vary significantly with dosimeter. The accuracy of scintillator measurements for small field OFs may be greater than the other dosimeters studied in this work (when uncorrected). Measurements involving EBT2 film may Result in lower accuracy for smaller fields (less than 10mm). Care should be taken in the choice of the dosimeter used for small field OF measurements.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

TU-F-17A-05: Calculating Tumor Trajectory and Dose-Of-The-Day for Highly Mobile Tumors Using Cone-Beam CT Projections

Purpose: Cone-beam CT (CBCT) projection images provide anatomical data in real-time over several respiratory cycles, forming a comprehensive picture of tumor movement. We developed a method using these projections to determine the trajectory and dose of highly mobile tumors during each fraction of treatment. Methods: CBCT images of a respiration phantom were acquired, where the trajectory mimicked a lung tumor with high amplitude (2.4 cm) and hysteresis. A template-matching algorithm was used to identify the location of a steel BB in each projection. A Gaussian probability density function for tumor position was calculated which best fit the observed trajectory of the BB in the imager geometry. Two methods to improve the accuracy of tumor track reconstruction were investigated: first, using respiratory phase information to refine the trajectory estimation, and second, using the Monte Carlo method to sample the estimated Gaussian tumor position distribution. 15 clinically-drawn abdominal/lung CTV volumes were used to evaluate the accuracy of the proposed methods by comparing the known and calculated BB trajectories. Results: With all methods, the mean position of the BB was determined with accuracy better than 0.1 mm, and root-mean-square (RMS) trajectory errors were lower than 5% of marker amplitude. Use of respiratory phase information decreased RMS errors by 30%, and decreased the fraction of large errors (>3 mm) by half. Mean dose to the clinical volumes was calculated with an average error of 0.1% and average absolute error of 0.3%. Dosimetric parameters D90/D95 were determined within 0.5% of maximum dose. Monte-Carlo sampling increased RMS trajectory and dosimetric errors slightly, but prevented over-estimation of dose in trajectories with high noise. Conclusions: Tumor trajectory and dose-of-the-day were accurately calculated using CBCT projections. This technique provides a widely-available method to evaluate highly-mobile tumors, and could facilitate better strategies to mitigate or compensate for motion during SBRT.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

TU-F-17A-09: Four-Dimensional Cone Beam CT Ventilation Imaging Can Detect Interfraction Lung Function Variations for Locally Advanced Lung Cancer Patients

Purpose: Four-dimensional cone beam CT ventilation imaging (4D-CBCT VI) is a novel functional lung imaging modality requiring validation. We hypothesize that 4D-CBCT VI satisfies a necessary condition for validity: that intrafraction variations (e.g. due to poor 4D-CBCT image quality) are substantially different to interfraction variations (e.g. due to changes in underlying function). We perform the first comparison of intrafraction (pre/post fraction) and interfraction (week-to-week) 4D-CBCT VIs for locally advanced non small cell lung cancer (LA NSCLC) patients undergoing radiation therapy. Methods: A total of 215 4D-CBCT scans were acquired for 19 LA NSCLC patients over 4-6 weeks of radiation therapy, including 75 pairs of pre-/post-fraction scans on the same day. 4D-CBCT VIs were obtained by applying state-of-the-art, B-spline deformable image registration to obtain the Jacobian determinant of deformation between the end-exhale and end-inhale phases. All VIs were deformably registered to the corresponding first day scan, normalized between the 10th and 90th percentile values and cropped to the ipsilateral lung only. Intrafraction variations were assessed by computing the mean and standard deviation of voxel-wise differences between all same-day pairs of pre-/post-fraction VIs. Interfraction differences were computed between first-day VIs and treatment weeks 2, 4 and 6 for all 19 patients. We tested the hypothesis by comparing cumulative distribution functions (CDFs) of intrafraction and interfraction ventilation differences using two-sided Kolmogorov-Smirnov goodness-of-fit tests. Results: The (mean ± std. dev.) of intrafraction differences was (−0.007 ± 0.079). Interfraction differences for weeks 2, 4 and 6 were (−0.035 ± 0.103), (−0.006 ± 0.094) and (−0.019 ± 0.127) respectively. For week 2, the changes in CDFs for intrafraction and interfraction differences approached statistical significance (p=0.099). Conclusion: We have shown that 4D-CBCT VI can satisfy a necessary condition for validity; intrafraction variations do not limit the ability to measure interfraction variations in LA NSCLC patients. This work is supported by a Cancer Institute NSW Early Career Fellowship, an NHMRC Australia Fellowship and NIH P01CA116602.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

WE-A-17A-08: Evaluation of the OncentraBrachy Collapsed Cone Convolution Algorithm for Ir-192 Source Using Phantom and Real-Patient Heterogeneous Geometries

Purpose: To evaluate the commercially released Collapsed Cone convolution-based(CCC) dose calculation module of the Elekta OncentraBrachy(OcB) treatment planning system(TPS). Methods: An allwater phantom was used to perform TG43 benchmarks with single source and seventeen sources, separately. Furthermore, four real-patient heterogeneous geometries (chestwall, lung, breast and prostate) were used. They were selected based on their clinical representativity of a class of clinical anatomies that pose clear challenges. The plans were used as is(no modification). For each case, TG43 and CCC calculations were performed in the OcB TPS, with TG186-recommended materials properly assigned to ROIs. For comparison, Monte Carlo simulation was run for each case with the same material scheme and grid mesh as TPS calculations. Both modes of CCC (standard and high quality) were tested. Results: For the benchmark case, the CCC dose, when divided by that of TG43, yields hot-n-cold spots in a radial pattern. The pattern of the high mode is denser than that of the standard mode and is representative of angular dicretization. The total deviation ((hot-cold)/TG43) is 18% for standard mode and 11% for high mode. Seventeen dwell positions help to reduce “ray-effect”, with the total deviation to 6% (standard) and 5% (high), respectively. For the four patient cases, CCC produces, as expected, more realistic dose distributions than TG43. A close agreement was observed between CCC and MC for all isodose lines, from 20% and up; the 10% isodose line of CCC appears shifted compared to that of MC. The DVH plots show dose deviations of CCC from MC in small volume, high dose regions (>100% isodose). For patient cases, the difference between standard and high modes is almost undiscernable. Conclusion: OncentraBrachy CCC algorithm marks a significant dosimetry improvement relative to TG43 in real-patient cases. Further researches are recommended regarding the clinical implications of the above observations. Support provided by a CIHR grant and CCC system provided by Elekta-Nucletron.

60 APPLIED LIFE SCIENCES↗