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At least 847 records · Page 47
All sourcesNASA NTRSDOE OSTI
DOE OSTI2015

Robust primary modulation-based scatter estimation for cone-beam CT

Purpose: Scattered radiation is one of the major problems facing image quality in flat detector cone-beam computed tomography (CBCT). Previously, a new scatter estimation and correction method using primary beam modulation has been proposed. The original image processing technique used a frequency-domain-based analysis, which proved to be sensitive to the accuracy of the modulator pattern both spatially and in amplitude as well as to the frequency of the modulation pattern. In addition, it cannot account for penumbra effects that occur, for example, due to the finite focal spot size and the scatter estimate can be degraded by high-frequency components of the primary image. Methods: In this paper, the authors present a new way to estimate the scatter using primary modulation. It is less sensitive to modulator nonidealities and most importantly can handle arbitrary modulator shapes and changes in modulator attenuation. The main idea is that the scatter estimation can be expressed as an optimization problem, which yields a separation of the scatter and the primary image. The method is evaluated using simulated and experimental CBCT data. The scattering properties of the modulator itself are analyzed using a Monte Carlo simulation. Results: All reconstructions show strong improvements of image quality. To quantify the results, all images are compared to reference images (ideal simulations and collimated scans). Conclusions: The proposed modulator-based scatter reduction algorithm may open the field of flat detector-based imaging to become a quantitative modality. This may have significant impact on C-arm imaging and on image-guided radiation therapy.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗
DOE OSTI2015

Validation of a deformable image registration technique for cone beam CT-based dose verification

Purpose: As radiation therapy evolves toward more adaptive techniques, image guidance plays an increasingly important role, not only in patient setup but also in monitoring the delivered dose and adapting the treatment to patient changes. This study aimed to validate a method for evaluation of delivered intensity modulated radiotherapy (IMRT) dose based on multimodal deformable image registration (DIR) for prostate treatments. Methods: A pelvic phantom was scanned with CT and cone-beam computed tomography (CBCT). Both images were digitally deformed using two realistic patient-based deformation fields. The original CT was then registered to the deformed CBCT resulting in a secondary deformed CT. The registration quality was assessed as the ability of the DIR method to recover the artificially induced deformations. The primary and secondary deformed CT images as well as vector fields were compared to evaluate the efficacy of the registration method and it’s suitability to be used for dose calculation. PLASTIMATCH, a free and open source software was used for deformable image registration. A B-spline algorithm with optimized parameters was used to achieve the best registration quality. Geometric image evaluation was performed through voxel-based Hounsfield unit (HU) and vector field comparison. For dosimetric evaluation, IMRT treatment plans were created and optimized on the original CT image and recomputed on the two warped images to be compared. The dose volume histograms were compared for the warped structures that were identical in both warped images. This procedure was repeated for the phantom with full, half full, and empty bladder. Results: The results indicated mean HU differences of up to 120 between registered and ground-truth deformed CT images. However, when the CBCT intensities were calibrated using a region of interest (ROI)-based calibration curve, these differences were reduced by up to 60%. Similarly, the mean differences in average vector field lengths decreased from 10.1 to 2.5 mm when CBCT was calibrated prior to registration. The results showed no dependence on the level of bladder filling. In comparison with the dose calculated on the primary deformed CT, differences in mean dose averaged over all organs were 0.2% and 3.9% for dose calculated on the secondary deformed CT with and without CBCT calibration, respectively, and 0.5% for dose calculated directly on the calibrated CBCT, for the full-bladder scenario. Gamma analysis for the distance to agreement of 2 mm and 2% of prescribed dose indicated a pass rate of 100% for both cases involving calibrated CBCT and on average 86% without CBCT calibration. Conclusions: Using deformable registration on the planning CT images to evaluate the IMRT dose based on daily CBCTs was found feasible. The proposed method will provide an accurate dose distribution using planning CT and pretreatment CBCT data, avoiding the additional uncertainties introduced by CBCT inhomogeneity and artifacts. This is a necessary initial step toward future image-guided adaptive radiotherapy of the prostate.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

Calculating tumor trajectory and dose-of-the-day 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. The authors developed and validated a method which uses these projections to determine the trajectory of and dose to highly mobile tumors during each fraction of treatment. Methods: CBCT images of a respiration phantom were acquired, the trajectory of which mimicked a lung tumor with high amplitude (up to 2.5 cm) and hysteresis. A template-matching algorithm was used to identify the location of a steel BB in each CBCT projection, and a Gaussian probability density function for the absolute BB position was calculated which best fit the observed trajectory of the BB in the imager geometry. Two modifications of the trajectory reconstruction were investigated: first, using respiratory phase information to refine the trajectory estimation (Phase), and second, using the Monte Carlo (MC) method to sample the estimated Gaussian tumor position distribution. The accuracies of the proposed methods were evaluated by comparing the known and calculated BB trajectories in phantom-simulated clinical scenarios using abdominal tumor volumes. Results: With all methods, the mean position of the BB was determined with accuracy better than 0.1 mm, and root-mean-square trajectory errors averaged 3.8% ± 1.1% of the marker amplitude. Dosimetric calculations using Phase methods were more accurate, with mean absolute error less than 0.5%, and with error less than 1% in the highest-noise trajectory. MC-based trajectories prevent the overestimation of dose, but when viewed in an absolute sense, add a small amount of dosimetric error (<0.1%). Conclusions: Marker trajectory and target dose-of-the-day were accurately calculated using CBCT projections. This technique provides a method to evaluate highly mobile tumors using ordinary CBCT data, and could facilitate better strategies to mitigate or compensate for motion during stereotactic body radiotherapy.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

Automated planning of breast radiotherapy using cone beam CT imaging

Purpose: Develop and clinically validate a methodology for using cone beam computed tomography (CBCT) imaging in an automated treatment planning framework for breast IMRT. Methods: A technique for intensity correction of CBCT images was developed and evaluated. The technique is based on histogram matching of CBCT image sets, using information from “similar” planning CT image sets from a database of paired CBCT and CT image sets (n = 38). Automated treatment plans were generated for a testing subset (n = 15) on the planning CT and the corrected CBCT. The plans generated on the corrected CBCT were compared to the CT-based plans in terms of beam parameters, dosimetric indices, and dose distributions. Results: The corrected CBCT images showed considerable similarity to their corresponding planning CTs (average mutual information 1.0±0.1, average sum of absolute differences 185 ± 38). The automated CBCT-based plans were clinically acceptable, as well as equivalent to the CT-based plans with average gantry angle difference of 0.99°±1.1°, target volume overlap index (Dice) of 0.89±0.04 although with slightly higher maximum target doses (4482±90 vs 4560±84, P < 0.05). Gamma index analysis (3%, 3 mm) showed that the CBCT-based plans had the same dose distribution as plans calculated with the same beams on the registered planning CTs (average gamma index 0.12±0.04, gamma <1 in 99.4%±0.3%). Conclusions: The proposed method demonstrates the potential for a clinically feasible and efficient online adaptive breast IMRT planning method based on CBCT imaging, integrating automation.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

Measuring interfraction and intrafraction lung function changes during radiation therapy using four-dimensional cone beam CT ventilation imaging

Purpose: Adaptive ventilation guided radiation therapy could minimize the irradiation of healthy lung based on repeat lung ventilation imaging (VI) during treatment. However the efficacy of adaptive ventilation guidance requires that interfraction (e.g., week-to-week), ventilation changes are not washed out by intrafraction (e.g., pre- and postfraction) changes, for example, due to patient breathing variability. The authors hypothesize that patients undergoing lung cancer radiation therapy exhibit larger interfraction ventilation changes compared to intrafraction function changes. To test this, the authors perform the first comparison of interfraction and intrafraction lung VI pairs using four-dimensional cone beam CT ventilation imaging (4D-CBCT VI), a novel technique for functional lung imaging. Methods: The authors analyzed a total of 215 4D-CBCT scans acquired for 19 locally advanced non-small cell lung cancer (LA-NSCLC) patients over 4–6 weeks of radiation therapy. This set of 215 scans was sorted into 56 interfraction pairs (including first day scans and each of treatment weeks 2, 4, and 6) and 78 intrafraction pairs (including pre/postfraction scans on the same-day), with some scans appearing in both sets. VIs were obtained from the Jacobian determinant of the transform between the 4D-CBCT end-exhale and end-inhale images after deformable image registration. All VIs were deformably registered to their corresponding planning CT and normalized to account for differences in breathing effort, thus facilitating image comparison in terms of (i) voxelwise Spearman correlations, (ii) mean image differences, and (iii) gamma pass rates for all interfraction and intrafraction VI pairs. For the side of the lung ipsilateral to the tumor, we applied two-sided t-tests to determine whether interfraction VI pairs were more different than intrafraction VI pairs. Results: The (mean ± standard deviation) Spearman correlation for interfraction VI pairs was r{sup -}{sub Inter}=0.52±0.25, which was significantly lower than for intrafraction pairs (r{sup -}{sub Intra}=0.67±0.20, p = 0.0002). Conversely, mean absolute ventilation differences were larger for interfraction pairs than for intrafraction pairs, with |ΔV{sup -}{sub Inter}|=0.42±0.65 and |ΔV{sup -}{sub Intra}|=0.32±0.53, respectively (p < 10{sup −15}). Applying a gamma analysis with ventilation/distance tolerance of 25%/10 mm, we observed mean pass rate of (69% ± 20%) for interfraction VIs, which was significantly lower compared to intrafraction pairs (80% ± 15%, with p ∼ 0.0003). Compared to the first day scans, all patients experienced at least one subsequent change in median ipsilateral ventilation ≥10%. Patients experienced both positive and negative ventilation changes throughout treatment, with the maximum change occurring at different weeks for different patients. Conclusions: The authors’ data support the hypothesis that interfraction ventilation changes are larger than intrafraction ventilation changes for LA-NSCLC patients over a course of conventional lung cancer radiation therapy. Longitudinal ventilation changes are observed to be highly patient-dependent, supporting a possible role for adaptive ventilation guidance based on repeat 4D-CBCT VIs. We anticipate that future improvement of 4D-CBCT image reconstruction algorithms will improve the capability of 4D-CBCT VI to resolve interfraction ventilation changes.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

Noninvasive differential diagnosis of dental periapical lesions in cone-beam CT scans

Purpose: This paper proposes a novel application of computer-aided diagnosis (CAD) to an everyday clinical dental challenge: the noninvasive differential diagnosis of periapical lesions between periapical cysts and granulomas. A histological biopsy is the most reliable method currently available for this differential diagnosis; however, this invasive procedure prevents the lesions from healing noninvasively despite a report that they may heal without surgical treatment. A CAD using cone-beam computed tomography (CBCT) offers an alternative noninvasive diagnostic tool which helps to avoid potentially unnecessary surgery and to investigate the unknown healing process and rate for the lesions. Methods: The proposed semiautomatic solution combines graph-based random walks segmentation with machine learning-based boosted classifiers and offers a robust clinical tool with minimal user interaction. As part of this CAD framework, the authors provide two novel technical contributions: (1) probabilistic extension of the random walks segmentation with likelihood ratio test and (2) LDA-AdaBoost: a new integration of weighted linear discriminant analysis to AdaBoost. Results: A dataset of 28 CBCT scans is used to validate the approach and compare it with other popular segmentation and classification methods. The results show the effectiveness of the proposed method with 94.1% correct classification rate and an improvement of the performance by comparison with the Simon’s state-of-the-art method by 17.6%. The authors also compare classification performances with two independent ground-truth sets from the histopathology and CBCT diagnoses provided by endodontic experts. Conclusions: Experimental results of the authors show that the proposed CAD system behaves in clearer agreement with the CBCT ground-truth than with histopathology, supporting the Simon’s conjecture that CBCT diagnosis can be as accurate as histopathology for differentiating the periapical lesions.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

Imaging a moving lung tumor with megavoltage cone beam computed tomography

Purpose: Respiratory motion may affect the accuracy of image guidance of radiation treatment of lung cancer. A cone beam computed tomography (CBCT) image spans several breathing cycles, resulting in a blurred object with a theoretical size equal to the sum of tumor size and breathing motion. However, several factors may affect this theoretical relationship. The objective of this study was to analyze the effect of tumor motion on megavoltage (MV)-CBCT images, by comparing target sizes on simulation and pretreatment images of a large cohort of lung cancer patients. Methods: Ninety-three MV-CBCT images from 17 patients were analyzed. Internal target volumes were contoured on each MV-CBCT dataset [internal target volume (ITV{sub CB})]. Their extent in each dimension was compared to that of two volumes contoured on simulation 4-dimensional computed tomography (4D-CT) images: the combination of the tumor contours of each phase of the 4D-CT (ITV{sub 4D}) and the volume contoured on the average CT calculated from the 4D-CT phases (ITV{sub ave}). Tumor size and breathing amplitude were assessed by contouring the tumor on each CBCT raw projection where it could be unambiguously identified. The effect of breathing amplitude on the quality of the MV-CBCT image reconstruction was analyzed. Results: The mean differences between the sizes of ITV{sub CB} and ITV{sub 4D} were −1.6 ± 3.3 mm (p < 0.001), −2.4 ± 3.1 mm (p < 0.001), and −7.2 ± 5.3 mm (p < 0.001) in the anterior/posterior (AP), left/right (LR), and superior/inferior (SI) directions, respectively, showing that MV-CBCT underestimates the full target size. The corresponding mean differences between ITV{sub CB} and ITV{sub ave} were 0.3 ± 2.6 mm (p = 0.307), 0.0 ± 2.4 mm (p = 0.86), and −4.0 ± 4.3 mm (p < 0.001), indicating that the average CT image is more representative of what is visible on MV-CBCT in the AP and LR directions. In the SI directions, differences between ITV{sub CB} and ITV{sub ave} could be separated into two groups based on tumor motion: −3.2 ± 3.2 mm for tumor motion less than 15 mm and −10.9 ± 6.3 mm for tumor motion greater than 15 mm. Deviations of measured target extents from their theoretical values derived from tumor size and motion were correlated with motion amplitude similarly for both MV-CBCT and average CT images, suggesting that the two images were subject to similar motion artifacts for motion less than 15 mm. Conclusions: MV-CBCT images are affected by tumor motion and tend to under-represent the full target volume. For tumor motion up to 15 mm, the volume contoured on average CT is comparable to that contoured on the MV-CBCT. Therefore, the average CT should be used in image registration for localization purposes, and the standard 5 mm PTV margin seems adequate. For tumor motion greater than 15 mm, an additional setup margin may need to be used to account for the increased uncertainty in tumor localization.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-D-BRA-07: A Phantom Study to Assess the Variability in Radiomics Features Extracted From Cone-Beam CT Images

Purpose: Several studies have demonstrated the prognostic potential for texture features extracted from CT images of non-small cell lung cancer (NSCLC) patients. The purpose of this study was to determine if these features could be extracted with high reproducibility from cone-beam CT (CBCT) images in order for features to be easily tracked throughout a patient’s treatment. Methods: Two materials in a radiomics phantom, designed to approximate NSCLC tumor texture, were used to assess the reproducibility of 26 features. This phantom was imaged on 9 CBCT scanners, including Elekta and Varian machines. Thoracic and head imaging protocols were acquired on each machine. CBCT images from 27 NSCLC patients imaged using the thoracic protocol on Varian machines were obtained for comparison. The variance for each texture measured from these patients was compared to the variance in phantom values for different manufacturer/protocol subsets. Levene’s test was used to identify features which had a significantly smaller variance in the phantom scans versus the patient data. Results: Approximately half of the features (13/26 for material1 and 15/26 for material2) had a significantly smaller variance (p<0.05) between Varian thoracic scans of the phantom compared to patient scans. Many of these same features remained significant for the head scans on Varian (12/26 and 8/26). However, when thoracic scans from Elekta and Varian were combined, only a few features were still significant (4/26 and 5/26). Three features (skewness, coarsely filtered mean and standard deviation) were significant in almost all manufacturer/protocol subsets. Conclusion: Texture features extracted from CBCT images of a radiomics phantom are reproducible and show significantly less variation than the same features measured from patient images when images from the same manufacturer or with similar parameters are used. Reproducibility between CBCT scanners may be high enough to allow the extraction of meaningful texture values for patients. This project was funded in part by the Cancer Prevention Research Institute of Texas (CPRIT). Xenia Fave is a recipient of the American Association of Physicists in Medicine Graduate Fellowship.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-D-207-04: GPU-Based 4D Cone-Beam CT Reconstruction Using Adaptive Meshing Method

Purpose: Due to the limited number of projections at each phase, the image quality of a four-dimensional cone-beam CT (4D-CBCT) is often degraded, which decreases the accuracy of subsequent motion modeling. One of the promising methods is the simultaneous motion estimation and image reconstruction (SMEIR) approach. The objective of this work is to enhance the computational speed of the SMEIR algorithm using adaptive feature-based tetrahedral meshing and GPU-based parallelization. Methods: The first step is to generate the tetrahedral mesh based on the features of a reference phase 4D-CBCT, so that the deformation can be well captured and accurately diffused from the mesh vertices to voxels of the image volume. After the mesh generation, the updated motion model and other phases of 4D-CBCT can be obtained by matching the 4D-CBCT projection images at each phase with the corresponding forward projections of the deformed reference phase of 4D-CBCT. The entire process of this 4D-CBCT reconstruction method is implemented on GPU, resulting in significantly increasing the computational efficiency due to its tremendous parallel computing ability. Results: A 4D XCAT digital phantom was used to test the proposed mesh-based image reconstruction algorithm. The image Result shows both bone structures and inside of the lung are well-preserved and the tumor position can be well captured. Compared to the previous voxel-based CPU implementation of SMEIR, the proposed method is about 157 times faster for reconstructing a 10 -phase 4D-CBCT with dimension 256×256×150. Conclusion: The GPU-based parallel 4D CBCT reconstruction method uses the feature-based mesh for estimating motion model and demonstrates equivalent image Result with previous voxel-based SMEIR approach, with significantly improved computational speed.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-D-207-06: Clinical Validations of Shading Correction for Cone-Beam CT Using Planning CT as a Prior

Purpose: Current cone-beam CT (CBCT) images contain severe shading artifacts mainly due to scatter, hindering their quantitative use in current radiation therapy. We have previously proposed an effective shading correction method for CBCT using planning CT (pCT) as prior knowledge. In this work, we investigate the method robustness via statistical analyses on studies of a large patient group and compare the performance with that of a state-of-the-art method implemented on the current commercial radiation therapy machine -- the Varian Truebeam system. Methods: Since radiotherapy patients routinely undergo multiple-detector CT (MDCT) scans in the planning procedure, we use the high-quality pCT as “free” prior knowledge for CBCT image improvement. The CBCT image with no correction is first spatially registered with the pCT. Primary CBCT projections are estimated via forward projections of the registered image. The low frequency errors in the projections, which stem from mainly scatter, are estimated by filtering the difference between original line integral and the estimated scatter projections. The corrected CBCT image is then reconstructed from the scatter corrected projections. The proposed method is evaluated on 40 cancer patients. Results: On all patient images, we compare errors on CT number, spatial non-uniformity (SNU) and image contrast, using pCT as the ground truth. T-tests show that our algorithm improves over the Varian method on CBCT accuracies of CT number and SNU with 90% confident. The average CT number error is reduced from 54.8 HU on the Varian method to 40.9 HU, and the SNU error is reduced from 7.7% to 3.8%. There is no obvious improvement on image contrast. Conclusion: Large-group patient studies show that the proposed pCT-based algorithm outperforms the Varian method of the Truebeam system on CBCT shading correction, by providing CBCT images with higher CT number accuracy and greater image uniformity.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-E-11: Novel Matching Module for Respiration-Gated Motion Tumor of Cone-Beam Computed Tomography (CBCT) to 4DCT

Purpose: Four dimensional computed tomography (4DCT) scans reliably record whole respiratory phase and generate internal target volumes (ITV) for radiotherapy planning. However, image guiding with cone-beam computed tomography (CBCT) cannot acquire all or specific respiratory phases. This study was designed to investigate the correlation between average CT and Maximum Intensity Projection (MIP) from 4DCT and CBCT. Methods: Retrospective respiratory gating were performed by GE Discovery CT590 RT. 4DCT and CBCT data from CRIS Dynamic Thorax Phantom with simulated breathing mode were analyzed. The lung tissue equivalent material encompassed 3 cm sphere tissue equivalent material. Simulated breathing cycle period was set as 4 seconds, 5 seconds and 6 seconds for representing variation of patient breathing cycle time, and the sphere material moved toward inferior and superior direction with 1 cm amplitude simulating lung tumor motion during respiration. Results: Under lung window, the volume ratio of CBCT scans to ITVs derived from 10 phases average scans was 1.00 ± 0.02, and 1.03 ± 0.03 for ratio of CBCT scans to MIP scans. Under abdomen window, the ratio of CBCT scans to ITVs derived from 10 phases average scans was 0.39 ± 0.06, and 0.06 ± 0.00 for ratio of CBCT scans to MIP scans. There was a significant difference between lung window Result and abdomen window Result. For reducing image guiding uncertainty, CBCT window was set with width 500 and level-250. The ratio of CBCT scans to ITVs derived from 4 phases average scans with abdomen window was 1.19 ± 0.02, and 1.06 ± 0.01 for ratio of CBCT to MIP scans. Conclusion: CBCT images with suitable window width and level can efficiently reduce image guiding uncertainty for patient with mobile tumor. By our setting, we can match motion tumor to gating tumor location on planning CT more accurately neglecting other motion artifacts during CBCT scans.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-P-54: Evaluation of the Accuracy and Precision of IGPS-O X-Ray Image-Guided Positioning System by Comparison with On-Board Imager Cone-Beam Computed Tomography

Purpose: The purpose of this study is to assess the positioning accuracy and precision of IGPS-O system which is a novel radiographic kilo-voltage x-ray image-guided positioning system developed for clinical IGRT applications. Methods: IGPS-O x-ray image-guided positioning system consists of two oblique sets of radiographic kilo-voltage x-ray projecting and imaging devices which were equiped on the ground and ceiling of treatment room. This system can determine the positioning error in the form of three translations and three rotations according to the registration of two X-ray images acquired online and the planning CT image. An anthropomorphic head phantom and an anthropomorphic thorax phantom were used for this study. The phantom was set up on the treatment table with correct position and various “planned” setup errors. Both IGPS-O x-ray image-guided positioning system and the commercial On-board Imager Cone-beam Computed Tomography (OBI CBCT) were used to obtain the setup errors of the phantom. Difference of the Result between the two image-guided positioning systems were computed and analyzed. Results: The setup errors measured by IGPS-O x-ray image-guided positioning system and the OBI CBCT system showed a general agreement, the means and standard errors of the discrepancies between the two systems in the left-right, anterior-posterior, superior-inferior directions were −0.13±0.09mm, 0.03±0.25mm, 0.04±0.31mm, respectively. The maximum difference was only 0.51mm in all the directions and the angular discrepancy was 0.3±0.5° between the two systems. Conclusion: The spatial and angular discrepancies between IGPS-O system and OBI CBCT for setup error correction was minimal. There is a general agreement between the two positioning system. IGPS-O x-ray image-guided positioning system can achieve as good accuracy as CBCT and can be used in the clinical IGRT applications.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-I-11: A New Cone-Beam CT System for Bedside Head Imaging

Purpose: To design and develop a new mobile cone-beam CT (CBCT) system for head imaging with good soft-tissue visibility, to be used bedside in ICU and neurosurgery department to monitor treatment and operation outcome in brain patients. Methods: The imaging chain consists of a 30cmx25cm amorphous silicon flat panel detector and a pulsed, stationary anode monoblock x-ray source of 100kVp at a maximal tube current of 10mA. The detector and source are supported on motorized mechanisms to provide detector lateral shift and source angular tilt, enabling a centered digital radiographic imaging mode and half-fan CBCT, while maximizing the use of the x-ray field and keep the source to detector distance short. A focused linear anti-scatter grid is mounted on the detector, and commercial software with scatter and other corrective algorithms is used for data processing and image reconstruction. The gantry rotates around a horizontal axis, and is able to adjust its height for different patient table positions. Cables are routed through a custom protective sleeve over a large bore with an in-plane twister band, facilitating single 360-degree rotation without a slip-ring at a speed up to 5 seconds per rotation. A UPS provides about 10 minutes of operation off the battery when unplugged. The gantry is on locked casters, whose brake is control by two push handles on both sides for easy reposition. The entire system is designed to have a light weight and a compact size for excellent maneuverability. Results: System design is complete and main imaging components are tested. Initial results will be presented and discussed later in the presentation. Conclusion: A new mobile CBCT system for head imaging is being developed. With its compact size, a large bore, and quality design, it is expected to be a useful imaging tool for bedside uses. The work is supported by a grant from Chinese Academy of Sciences.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-J-19: An Intra-Institutional Study of Cone-Beam CT Dose for Image-Guided Radiation Therapy

Purpose: To determine the variability of Cone-Beam CT Dose Index (CB-CTDI) across multiple on-board imaging (OBI) systems within a single institution, and compare this to manufacturer provided data. Methods: The CB-CTDI was measured on three Trilogy and three TrueBeam Varian OBI systems, for six different clinically used scan protocols. Measurements were taken using a 10 cm long CT ionization chamber in either a 16 cm (head-simulating) or 32 cm (body-simulating) diameter, acrylic, cylindrical, 15 cm long CTDI phantom. We assessed the variation in CB-CTDI between the OBI systems and compared our measured values to the data provided by the manufacturer. Results: The standard error in the CB-CTDI measured for all protocols was found to be within ±2% and ±5% of the mean for TrueBeam and Trilogy, respectively. For all head scan protocols, the measured TrueBeam values were lower than the manufacturer’s reported values, with a maximum difference of 13.9% and an average difference of 11%. For the body scan protocols, the TrueBeam measured values were 3% and 13% greater than the manufacturer’s reported values for two out of three protocols, and 38% lower than reported for the third protocol. In total, 7/18 CB-CTDI measurements fell within the manufacturers specified range (±10%). Across all scans the Truebeam machines were found to have a lower CB-CTDI than Trilogy, particularly the head scan protocols, which show decreases of up to 30% . Conclusion: The intra-institutional variation of CB-CTDI was found to be clinically acceptable at less than 5%. For the TrueBeam OBI system, over half of the measured scans failed to fall with in the manufactured quoted range of 10%, however, all measured values were within 15% of the manufacturer’s reported values. For accurate assessment and reporting of imaging dose to radiotherapy patients, our results indicate a need for standardization in CB-CTDI measurement technique.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-J-24: Can Fiducial Marker-Based Setup Using ExacTrac Be An Alternative to Soft Tissue-Based Setup Using Cone-Beam CT for Prostate IMRT?

Purpose: To assess an accuracy of fiducial maker-based setup using ExacTrac (ExT-based setup) as compared with soft tissue-based setup using Cone-beam CT (CBCT-based setup) for patients with prostate cancer receiving intensity-modulated radiation therapy (IMRT) for the purpose of investigating whether ExT-based setup can be an alternative to CBCT-based setup. Methods: The setup accuracy was analyzed prospectively for 7 prostate cancer patients with implanted three fiducial markers received IMRT. All patients were treated after CBCT-based setup was performed and corresponding shifts were recorded. ExacTrac images were obtained before and after CBCT-based setup. The fiducial marker-based shifts were calculated based on those two images and recorded on the assumption that the setup correction was carried out by fiducial marker-based auto correction. Mean and standard deviation of absolute differences and the correlation between CBCT and ExT shifts were estimated. Results: A total of 178 image dataset were analyzed. On the differences between CBCT and ExT shifts, 133 (75%) of 178 image dataset resulted in smaller differences than 3 mm in all dimensions. Mean differences in the anterior-posterior (AP), superior-inferior (SI), and left-right (LR) dimensions were 1.8 ± 1.9 mm, 0.7 ± 1.9 mm, and 0.6 ± 0.8 mm, respectively. The percentages of shift agreements within ±3 mm were 76% for AP, 90% for SI, and 100% for LR. The Pearson coefficient of correlation for CBCT and ExT shifts were 0.80 for AP, 0.80 for SI, and 0.65 for LR. Conclusion: This work showed that the accuracy of ExT-based setup was correlated with that of CBCT-based setup, implying that ExT-based setup has a potential ability to be an alternative to CBCT-based setup. The further work is to specify the conditions that ExT-based setup can provide the accuracy comparable to CBCT-based setup.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-J-32: Dosimetric Evaluation Based On Pre-Treatment Cone Beam CT for Spine Stereotactic Body Radiotherapy: Does Region of Interest Focus Matter?

Purpose: Spine stereotactic body radiotherapy requires very conformal dose distributions and precise delivery. Prior to treatment, a KV cone-beam CT (KV-CBCT) is registered to the planning CT to provide image-guided positional corrections, which depend on selection of the region of interest (ROI) because of imperfect patient positioning and anatomical deformation. Our objective is to determine the dosimetric impact of ROI selections. Methods: Twelve patients were selected for this study with the treatment regions varied from C-spine to T-spine. For each patient, the KV-CBCT was registered to the planning CT three times using distinct ROIs: one encompassing the entire patient, a large ROI containing large bony anatomy, and a small target-focused ROI. Each registered CBCT volume, saved as an aligned dataset, was then sent to the planning system. The treated plan was applied to each dataset and dose was recalculated. The tumor dose coverage (percentage of target volume receiving prescription dose), maximum point dose to 0.03 cc of the spinal cord, and dose to 10% of the spinal cord volume (V10) for each alignment were compared to the original plan. Results: The average magnitude of tumor coverage deviation was 3.9%±5.8% with external contour, 1.5%±1.1% with large ROI, 1.3%±1.1% with small ROI. Spinal cord V10 deviation from plan was 6.6%±6.6% with external contour, 3.5%±3.1% with large ROI, and 1.2%±1.0% with small ROI. Spinal cord max point dose deviation from plan was: 12.2%±13.3% with external contour, 8.5%±8.4% with large ROI, and 3.7%±2.8% with small ROI. Conclusion: A small ROI focused on the target results in the smallest deviation from planned dose to target and cord although rotations at large distances from the targets were observed. It is recommended that image fusion during CBCT focus narrowly on the target volume to minimize dosimetric error. Improvement in patient setups may further reduce residual errors.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-J-47: Comparison of Online Image Registrations of Varian TrueBeam Cone-Beam CT and BrainLab ExacTrac Imaging Systems

Purpose To compare online image registrations of TrueBeam cone-beam CT (CBCT) and BrainLab ExacTrac imaging systems. Methods Tests were performed on a Varian TrueBeam STx linear accelerator (Version 2.0), which is integrated with a BrainLab ExacTrac imaging system (Version 6.0.5). The study was focused on comparing the online image registrations for translational shifts. A Rando head phantom was placed on treatment couch and immobilized with a BrainLab mask. The phantom was shifted by moving the couch translationally for 8 mm with a step size of 1 mm, in vertical, longitudinal, and lateral directions, respectively. At each location, the phantom was imaged with CBCT and ExacTrac x-ray. CBCT images were registered with TrueBeam and ExacTrac online registration algorithms, respectively. And ExacTrac x-ray image registrations were performed. Shifts calculated from different registrations were compared with nominal couch shifts. Results The averages and ranges of absolute differences between couch shifts and calculated phantom shifts obtained from ExacTrac x-ray registration, ExacTrac CBCT registration with default window, ExaxTrac CBCT registration with adjusted window (bone), Truebeam CBCT registration with bone window, and Truebeam CBCT registration with soft tissue window, were: 0.07 (0.02–0.14), 0.14 (0.01–0.35), 0.12 (0.02–0.28), 0.09 (0–0.20), and 0.06 (0–0.10) mm, in vertical direction; 0.06 (0.01–0.12), 0.27 (0.07–0.57), 0.23 (0.02–0.48), 0.04 (0–0.10), and 0.08 (0– 0.20) mm, in longitudinal direction; 0.05 (0.01–0.21), 0.35 (0.14–0.80), 0.25 (0.01–0.56), 0.19 (0–0.40), and 0.20 (0–0.40) mm, in lateral direction. Conclusion The shifts calculated from ExacTrac x-ray and TrueBeam CBCT registrations were close to each other (the differences between were less than 0.40 mm in any direction), and had better agreements with couch shifts than those from ExacTrac CBCT registrations. There were no significant differences between TrueBeam CBCT registrations using different windows. In ExacTrac CBCT registrations, using bone window led to better agreements than using default window.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-J-72: Dosimetric Study of Cone-Beam CT-Based Radiation Treatment Planning Using a Patient-Specific Stepwise CT-Density Table

Purpose: To assess dose calculation accuracy of cone-beam CT (CBCT) based treatment plans using a patient-specific stepwise CT-density conversion table in comparison to conventional CT-based treatment plans. Methods: Unlike CT-based treatment planning which use fixed CT-density table, this study used patient-specific CT-density table to minimize the errors in reconstructed mass densities due to the effects of CBCT Hounsfield unit (HU) uncertainties. The patient-specific CT-density table was a stepwise function which maps HUs to only 6 classes of materials with different mass densities: air (0.00121g/cm3), lung (0.26g/cm3), adipose (0.95g/cm3), tissue (1.05 g/cm3), cartilage/bone (1.6g/cm3), and other (3g/cm3). HU thresholds to define different materials were adjusted for each CBCT via best match with the known tissue types in these images. Dose distributions were compared between CT-based plans and CBCT-based plans (IMRT/VMAT) for four types of treatment sites: head and neck (HN), lung, pancreas, and pelvis. For dosimetric comparison, PTV mean dose in both plans were compared. A gamma analysis was also performed to directly compare dosimetry in the two plans. Results: Compared to CT-based plans, the differences for PTV mean dose were 0.1% for pelvis, 1.1% for pancreas, 1.8% for lung, and −2.5% for HN in CBCT-based plans. The gamma passing rate was 99.8% for pelvis, 99.6% for pancreas, and 99.3% for lung with 3%/3mm criteria, and 80.5% for head and neck with 5%/3mm criteria. Different dosimetry accuracy level was observed: 1% for pelvis, 3% for lung and pancreas, and 5% for head and neck. Conclusion: By converting CBCT data to 6 classes of materials for dose calculation, 3% of dose calculation accuracy can be achieved for anatomical sites studied here, except HN which had a 5% accuracy. CBCT-based treatment planning using a patient-specific stepwise CT-density table can facilitate the evaluation of dosimetry changes resulting from variation in patient anatomy.

60 APPLIED LIFE SCIENCES↗