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At least 883 records · Page 49

Cone beam x-ray luminescence computed tomography: A feasibility study

Purpose: The appearance of x-ray luminescence computed tomography (XLCT) opens new possibilities to perform molecular imaging by x ray. In the previous XLCT system, the sample was irradiated by a sequence of narrow x-ray beams and the x-ray luminescence was measured by a highly sensitive charge coupled device (CCD) camera. This resulted in a relatively long sampling time and relatively low utilization of the x-ray beam. In this paper, a novel cone beam x-ray luminescence computed tomography strategy is proposed, which can fully utilize the x-ray dose and shorten the scanning time. The imaging model and reconstruction method are described. The validity of the imaging strategy has been studied in this paper. Methods: In the cone beam XLCT system, the cone beam x ray was adopted to illuminate the sample and a highly sensitive CCD camera was utilized to acquire luminescent photons emitted from the sample. Photons scattering in biological tissues makes it an ill-posed problem to reconstruct the 3D distribution of the x-ray luminescent sample in the cone beam XLCT. In order to overcome this issue, the authors used the diffusion approximation model to describe the photon propagation in tissues, and employed the sparse regularization method for reconstruction. An incomplete variables truncated conjugate gradient method and permissible region strategy were used for reconstruction. Meanwhile, traditional x-ray CT imaging could also be performed in this system. The x-ray attenuation effect has been considered in their imaging model, which is helpful in improving the reconstruction accuracy. Results: First, simulation experiments with cylinder phantoms were carried out to illustrate the validity of the proposed compensated method. The experimental results showed that the location error of the compensated algorithm was smaller than that of the uncompensated method. The permissible region strategy was applied and reduced the reconstruction error to less than 2 mm. The robustness and stability were then evaluated from different view numbers, different regularization parameters, different measurement noise levels, and optical parameters mismatch. The reconstruction results showed that the settings had a small effect on the reconstruction. The nonhomogeneous phantom simulation was also carried out to simulate a more complex experimental situation and evaluated their proposed method. Second, the physical cylinder phantom experiments further showed similar results in their prototype XLCT system. With the discussion of the above experiments, it was shown that the proposed method is feasible to the general case and actual experiments. Conclusions: Utilizing numerical simulation and physical experiments, the authors demonstrated the validity of the new cone beam XLCT method. Furthermore, compared with the previous narrow beam XLCT, the cone beam XLCT could more fully utilize the x-ray dose and the scanning time would be shortened greatly. The study of both simulation experiments and physical phantom experiments indicated that the proposed method was feasible to the general case and actual experiments.

60 APPLIED LIFE SCIENCES↗

Radiation dose reduction in medical x-ray CT via Fourier-based iterative reconstruction

Purpose: A Fourier-based iterative reconstruction technique, termed Equally Sloped Tomography (EST), is developed in conjunction with advanced mathematical regularization to investigate radiation dose reduction in x-ray CT. The method is experimentally implemented on fan-beam CT and evaluated as a function of imaging dose on a series of image quality phantoms and anonymous pediatric patient data sets. Numerical simulation experiments are also performed to explore the extension of EST to helical cone-beam geometry. Methods: EST is a Fourier based iterative algorithm, which iterates back and forth between real and Fourier space utilizing the algebraically exact pseudopolar fast Fourier transform (PPFFT). In each iteration, physical constraints and mathematical regularization are applied in real space, while the measured data are enforced in Fourier space. The algorithm is automatically terminated when a proposed termination criterion is met. Experimentally, fan-beam projections were acquired by the Siemens z-flying focal spot technology, and subsequently interleaved and rebinned to a pseudopolar grid. Image quality phantoms were scanned at systematically varied mAs settings, reconstructed by EST and conventional reconstruction methods such as filtered back projection (FBP), and quantified using metrics including resolution, signal-to-noise ratios (SNRs), and contrast-to-noise ratios (CNRs). Pediatric data sets were reconstructed at their original acquisition settings and additionally simulated to lower dose settings for comparison and evaluation of the potential for radiation dose reduction. Numerical experiments were conducted to quantify EST and other iterative methods in terms of image quality and computation time. The extension of EST to helical cone-beam CT was implemented by using the advanced single-slice rebinning (ASSR) method. Results: Based on the phantom and pediatric patient fan-beam CT data, it is demonstrated that EST reconstructions with the lowest scanner flux setting of 39 mAs produce comparable image quality, resolution, and contrast relative to FBP with the 140 mAs flux setting. Compared to the algebraic reconstruction technique and the expectation maximization statistical reconstruction algorithm, a significant reduction in computation time is achieved with EST. Finally, numerical experiments on helical cone-beam CT data suggest that the combination of EST and ASSR produces reconstructions with higher image quality and lower noise than the Feldkamp Davis and Kress (FDK) method and the conventional ASSR approach. Conclusions: A Fourier-based iterative method has been applied to the reconstruction of fan-bean CT data with reduced x-ray fluence. This method incorporates advantageous features in both real and Fourier space iterative schemes: using a fast and algebraically exact method to calculate forward projection, enforcing the measured data in Fourier space, and applying physical constraints and flexible regularization in real space. Our results suggest that EST can be utilized for radiation dose reduction in x-ray CT via the readily implementable technique of lowering mAs settings. Numerical experiments further indicate that EST requires less computation time than several other iterative algorithms and can, in principle, be extended to helical cone-beam geometry in combination with the ASSR method.

60 APPLIED LIFE SCIENCES↗

Development and clinical evaluation of automatic fiducial detection for tumor tracking in cine megavoltage images during volumetric modulated arc therapy

Purpose: Real-time tracking of implanted fiducials in cine megavoltage (MV) imaging during volumetric modulated arc therapy (VMAT) delivery is complicated due to the inherent low contrast of MV images and potential blockage of dynamic leaves configurations. The purpose of this work is to develop a clinically practical autodetection algorithm for motion management during VMAT. Methods: The expected field-specific segments and the planned fiducial position from the Eclipse (Varian Medical Systems, Palo Alto, CA) treatment planning system were projected onto the MV images. The fiducials were enhanced by applying a Laplacian of Gaussian filter in the spatial domain for each image, with a blob-shaped object as the impulse response. The search of implanted fiducials was then performed on a region of interest centered on the projection of the fiducial when it was within an open field including the case when it was close to the field edge or partially occluded by the leaves. A universal template formula was proposed for template matching and normalized cross correlation was employed for its simplicity and computational efficiency. The search region for every image was adaptively updated through a prediction model that employed the 3D position of the fiducial estimated from the localized positions in previous images. This prediction model allowed the actual fiducial position to be tracked dynamically and was used to initialize the search region. The artifacts caused by electronic interference during the acquisition were effectively removed. A score map was computed by combining both morphological information and image intensity. The pixel location with the highest score was selected as the detected fiducial position. The sets of cine MV images taken during treatment were analyzed with in-house developed software written in MATLAB (The Mathworks, Inc., Natick, MA). Five prostate patients were analyzed to assess the algorithm performance by measuring their positioning accuracy during treatment. Results: The algorithm was able to accurately localize the fiducial position on MV images with success rates of more than 90% per case. The percentage of images in which each fiducial was localized in the studied cases varied between 23% and 65%, with at least one fiducial having been localized between 40% and 95% of the images. This depended mainly on the modulation of the plan and fiducial blockage. The prostate movement in the presented cases varied between 0.8 and 3.5 mm (mean values). The maximum displacement detected among all patients was of 5.7 mm. Conclusions: An algorithm for automatic detection of fiducial markers in cine MV images has been developed and tested with five clinical cases. Despite the challenges posed by complex beam aperture shapes, fiducial localization close to the field edge, partial occlusion of fiducials, fast leaf and gantry movement, and inherently low MV image quality, good localization results were achieved in patient images. This work provides a technique for enabling real-time accurate fiducial detection and tumor tracking during VMAT treatments without the use of extra imaging dose.

60 APPLIED LIFE SCIENCES↗

Experimental verification of the Acuros XB and AAA dose calculation adjacent to heterogeneous media for IMRT and RapidArc of nasopharygeal carcinoma

Purpose: To compare the doses calculated by the Acuros XB (AXB) algorithm and analytical anisotropic algorithm (AAA) with experimentally measured data adjacent to and within heterogeneous medium using intensity modulated radiation therapy (IMRT) and RapidArc{sup Registered-Sign} (RA) volumetric arc therapy plans for nasopharygeal carcinoma (NPC). Methods: Two-dimensional dose distribution immediately adjacent to both air and bone inserts of a rectangular tissue equivalent phantom irradiated using IMRT and RA plans for NPC cases were measured with GafChromic{sup Registered-Sign} EBT3 films. Doses near and within the nasopharygeal (NP) region of an anthropomorphic phantom containing heterogeneous medium were also measured with thermoluminescent dosimeters (TLD) and EBT3 films. The measured data were then compared with the data calculated by AAA and AXB. For AXB, dose calculations were performed using both dose-to-medium (AXB{sub Dm}) and dose-to-water (AXB{sub Dw}) options. Furthermore, target dose differences between AAA and AXB were analyzed for the corresponding real patients. The comparison of real patient plans was performed by stratifying the targets into components of different densities, including tissue, bone, and air. Results: For the verification of planar dose distribution adjacent to air and bone using the rectangular phantom, the percentages of pixels that passed the gamma analysis with the {+-} 3%/3mm criteria were 98.7%, 99.5%, and 97.7% on the axial plane for AAA, AXB{sub Dm}, and AXB{sub Dw}, respectively, averaged over all IMRT and RA plans, while they were 97.6%, 98.2%, and 97.7%, respectively, on the coronal plane. For the verification of planar dose distribution within the NP region of the anthropomorphic phantom, the percentages of pixels that passed the gamma analysis with the {+-} 3%/3mm criteria were 95.1%, 91.3%, and 99.0% for AAA, AXB{sub Dm}, and AXB{sub Dw}, respectively, averaged over all IMRT and RA plans. Within the NP region where air and bone were present, the film measurements represented the dose close to unit density water in a heterogeneous medium, produced the best agreement with the AXB{sub Dw}. For the verification of point doses within the target using TLD in the anthropomorphic phantom, the absolute percentage deviations between the calculated and measured data when averaged over all IMRT and RA plans were 1.8%, 1.7%, and 1.8% for AAA, AXB{sub Dm} and AXB{sub Dw}, respectively. From all the verification results, no significant difference was found between the IMRT and RA plans. The target dose analysis of the real patient plans showed that the discrepancies in mean doses to the PTV component in tissue among the three dose calculation options were within 2%, but up to about 4% in the bone content, with AXB{sub Dm} giving the lowest values and AXB{sub Dw} giving the highest values. Conclusions: In general, the verification measurements demonstrated that both algorithms produced acceptable accuracy when compared to the measured data. GafChromic{sup Registered-Sign} film results indicated that AXB produced slightly better accuracy compared to AAA for dose calculation adjacent to and within the heterogeneous media. Users should be aware of the differences in calculated target doses between options AXB{sub Dm} and AXB{sub Dw}, especially in bone, for IMRT and RA in NPC cases.

60 APPLIED LIFE SCIENCES↗

Intervertebral anticollision constraints improve out-of-plane translation accuracy of a single-plane fluoroscopy-to-CT registration method for measuring spinal motion

Purpose: The study aimed to propose a new single-plane fluoroscopy-to-CT registration method integrated with intervertebral anticollision constraints for measuring three-dimensional (3D) intervertebral kinematics of the spine; and to evaluate the performance of the method without anticollision and with three variations of the anticollision constraints via an in vitro experiment. Methods: The proposed fluoroscopy-to-CT registration approach, called the weighted edge-matching with anticollision (WEMAC) method, was based on the integration of geometrical anticollision constraints for adjacent vertebrae and the weighted edge-matching score (WEMS) method that matched the digitally reconstructed radiographs of the CT models of the vertebrae and the measured single-plane fluoroscopy images. Three variations of the anticollision constraints, namely, T-DOF, R-DOF, and A-DOF methods, were proposed. An in vitro experiment using four porcine cervical spines in different postures was performed to evaluate the performance of the WEMS and the WEMAC methods. Results: The WEMS method gave high precision and small bias in all components for both vertebral pose and intervertebral pose measurements, except for relatively large errors for the out-of-plane translation component. The WEMAC method successfully reduced the out-of-plane translation errors for intervertebral kinematic measurements while keeping the measurement accuracies for the other five degrees of freedom (DOF) more or less unaltered. The means (standard deviations) of the out-of-plane translational errors were less than -0.5 (0.6) and -0.3 (0.8) mm for the T-DOF method and the R-DOF method, respectively. Conclusions: The proposed single-plane fluoroscopy-to-CT registration method reduced the out-of-plane translation errors for intervertebral kinematic measurements while keeping the measurement accuracies for the other five DOF more or less unaltered. With the submillimeter and subdegree accuracy, the WEMAC method was considered accurate for measuring 3D intervertebral kinematics during various functional activities for research and clinical applications.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Evaluation of the microangiographic fluoroscope (MAF) using generalized system performance metrics

Purpose: The performance of a newly developed, high resolution, microangiographic fluoroscope (MAF) (35 {mu}m pixel pitch and 300 {mu}m thick CsI phosphor) was evaluated using a generalized linear system analysis and compared with that of a standard amorphous Si thin film transistor flat panel detector (FPD) (194 {mu}m pixel pitch and 600 {mu}m thick CsI phosphor). The linear system metrics such as modulation transfer function (MTF), noise power spectrum, and detection quantum efficiency (DQE) are commonly used to gauge the intrinsic detector performance in the detector plane. However, these linear system metrics do not provide information about the image receptor performance in a real system since they do not include the effects of other parameters such as focal spot distribution, scatter radiation, and geometric unsharpness, which may compromise detector performance characteristics. Use of generalized linear system metrics [generalized modulation transfer function (GMTF), generalized normalized noise power spectrum (GNNPS), and generalized detection quantum efficiency (GDQE)] that include these effects gives a more meaningful, complete, and appropriate evaluation of detector performance as part of the imaging system. Methods: A uniform head equivalent phantom was used to simulate realistic clinical parameters and x-ray spectra. The detector MTFs were measured using the slanted edge method and the focal spot MTFs were measured using a pinhole assembly. The scatter MTF was simulated and the scatter fraction was measured for a head-equivalent phantom. The generalized system metrics were calculated for different combinations of three choices of focal spots and three different magnifications with two different air-gaps. The performance of the MAF was also illustrated using stent images obtained with different focal spots under similar conditions. Results: Results for the generalized metrics provide a quantitative description of the performance of the imaging system for both detectors. This generalized analysis demonstrated that both detectors have similar imaging capabilities at lower spatial frequencies, but that the MAF has superior performance over the FPD at higher frequencies even when considering focal spot blurring and scatter. Conclusions: This generalized performance analysis demonstrates the significance of focal spot size, magnification, and scatter on the system performance metrics (GMTF, GNNPS, and GDQE). Although the ideal detector performance characteristics of the MAF are not fully realized due to these other system factors, it still retains an advantage in DQE at high spatial frequencies over the FPD. Similar studies based on the generalized linear system metrics can serve as an efficient tool to evaluate total system capabilities under different realistic conditions to enable optimal design for specific imaging tasks.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗

A method to measure paddle and detector pressures and footprints in mammography

Purpose: Compression is necessary in mammography to improve image quality and reduce radiation burden. Maximizing the amount of breast in contact with the image receptor (IR) is important. To achieve this, for the craniocaudal projection, there is no consensus within the literature regarding how the IR should be positioned relative to the inframammary fold (IMF). No information exists within the literature to describe how pressure balancing between IR and paddle, and IR breast footprint, might be optimized. This paper describes a novel method for measuring the respective pressures applied to the breast from the IR and the paddle and a method to simultaneously measure the breast footprints on the IR and the paddle. Methods: Using a deformable breast phantom and electronic pressure-sensitive mat, area and pressure readings were gathered from two mammography machines and four paddles at 60, 80, and 100 N with the IR positioned at -2, -1, 0, +1, and +2 cm relative to the IMF (60 combinations in total). Results: Paddle and IR footprints were calculated along with a uniformity index (UI). For all four paddle/machine/pressure combinations the greatest IR footprint was achieved at IMF +2 cm. The UI indicates that the best pressure/footprint balance is achieved at IMF +1 cm. Conclusions: The authors' method appears to be suited to measuring breast footprints and pressures on IR and paddle and a human female study is planned.

60 APPLIED LIFE SCIENCES↗

Technical Note: Skin thickness measurements using high-resolution flat-panel cone-beam dedicated breast CT

Purpose: To determine the mean and range of location-averaged breast skin thickness using high-resolution dedicated breast CT for use in Monte Carlo-based estimation of normalized glandular dose coefficients. Methods: This study retrospectively analyzed image data from a clinical study investigating dedicated breast CT. An algorithm similar to that described by Huang et al.['The effect of skin thickness determined using breast CT on mammographic dosimetry,' Med. Phys. 35(4), 1199-1206 (2008)] was used to determine the skin thickness in 137 dedicated breast CT volumes from 136 women. The location-averaged mean breast skin thickness for each breast was estimated and the study population mean and range were determined. Pathology results were available for 132 women, and were used to investigate if the distribution of location-averaged mean breast skin thickness varied with pathology. The effect of surface fitting to account for breast curvature was also studied. Results: The study mean ({+-} interbreast SD) for breast skin thickness was 1.44 {+-} 0.25 mm (range: 0.87-2.34 mm), which was in excellent agreement with Huang et al. Based on pathology, pair-wise statistical analysis (Mann-Whitney test) indicated that at the 0.05 significance level, there were no significant difference in the location-averaged mean breast skin thickness distributions between the groups: benign vs malignant (p= 0.223), benign vs hyperplasia (p= 0.651), hyperplasia vs malignant (p= 0.229), and malignant vs nonmalignant (p= 0.172). Conclusions: Considering this study used a different clinical prototype system, and the study participants were from a different geographical location, the observed agreement between the two studies suggests that the choice of 1.45 mm thick skin layer comprising the epidermis and the dermis for breast dosimetry is appropriate. While some benign and malignant conditions could cause skin thickening, in this study cohort the location-averaged mean breast skin thickness distributions did not differ significantly with pathology. The study also underscored the importance of considering breast curvature in estimating breast skin thickness.

60 APPLIED LIFE SCIENCES↗

Combining multiple FDG-PET radiotherapy target segmentation methods to reduce the effect of variable performance of individual segmentation methods

Purpose: Many approaches have been proposed to segment high uptake objects in 18F-fluoro-deoxy-glucose positron emission tomography images but none provides consistent performance across the large variety of imaging situations. This study investigates the use of two methods of combining individual segmentation methods to reduce the impact of inconsistent performance of the individual methods: simple majority voting and probabilistic estimation. Methods: The National Electrical Manufacturers Association image quality phantom containing five glass spheres with diameters 13-37 mm and two irregularly shaped volumes (16 and 32 cc) formed by deforming high-density polyethylene bottles in a hot water bath were filled with 18-fluoro-deoxyglucose and iodine contrast agent. Repeated 5-min positron emission tomography (PET) images were acquired at 4:1 and 8:1 object-to-background contrasts for spherical objects and 4.5:1 and 9:1 for irregular objects. Five individual methods were used to segment each object: 40% thresholding, adaptive thresholding, k-means clustering, seeded region-growing, and a gradient based method. Volumes were combined using a majority vote (MJV) or Simultaneous Truth And Performance Level Estimate (STAPLE) method. Accuracy of segmentations relative to CT ground truth volumes were assessed using the Dice similarity coefficient (DSC) and the symmetric mean absolute surface distances (SMASDs). Results: MJV had median DSC values of 0.886 and 0.875; and SMASD of 0.52 and 0.71 mm for spheres and irregular shapes, respectively. STAPLE provided similar results with median DSC of 0.886 and 0.871; and median SMASD of 0.50 and 0.72 mm for spheres and irregular shapes, respectively. STAPLE had significantly higher DSC and lower SMASD values than MJV for spheres (DSC, p < 0.0001; SMASD, p= 0.0101) but MJV had significantly higher DSC and lower SMASD values compared to STAPLE for irregular shapes (DSC, p < 0.0001; SMASD, p= 0.0027). DSC was not significantly different between 128 Multiplication-Sign 128 and 256 Multiplication-Sign 256 grid sizes for either method (MJV, p= 0.0519; STAPLE, p= 0.5672) but was for SMASD values (MJV, p < 0.0001; STAPLE, p= 0.0164). The best individual method varied depending on object characteristics. However, both MJV and STAPLE provided essentially equivalent accuracy to using the best independent method in every situation, with mean differences in DSC of 0.01-0.03, and 0.05-0.12 mm for SMASD. Conclusions: Combining segmentations offers a robust approach to object segmentation in PET. Both MJV and STAPLE improved accuracy and were robust against the widely varying performance of individual segmentation methods. Differences between MJV and STAPLE are such that either offers good performance when combining volumes. Neither method requires a training dataset but MJV is simpler to interpret, easy to implement and fast.

60 APPLIED LIFE SCIENCES↗

Respiratory triggered 4D cone-beam computed tomography: A novel method to reduce imaging dose

Purpose: A novel method called respiratory triggered 4D cone-beam computed tomography (RT 4D CBCT) is described whereby imaging dose can be reduced without degrading image quality. RT 4D CBCT utilizes a respiratory signal to trigger projections such that only a single projection is assigned to a given respiratory bin for each breathing cycle. In contrast, commercial 4D CBCT does not actively use the respiratory signal to minimize image dose. Methods: To compare RT 4D CBCT with conventional 4D CBCT, 3600 CBCT projections of a thorax phantom were gathered and reconstructed to generate a ground truth CBCT dataset. Simulation pairs of conventional 4D CBCT acquisitions and RT 4D CBCT acquisitions were developed assuming a sinusoidal respiratory signal which governs the selection of projections from the pool of 3600 original projections. The RT 4D CBCT acquisition triggers a single projection when the respiratory signal enters a desired acquisition bin; the conventional acquisition does not use a respiratory trigger and projections are acquired at a constant frequency. Acquisition parameters studied were breathing period, acquisition time, and imager frequency. The performance of RT 4D CBCT using phase based and displacement based sorting was also studied. Image quality was quantified by calculating difference images of the test dataset from the ground truth dataset. Imaging dose was calculated by counting projections. Results: Using phase based sorting RT 4D CBCT results in 47% less imaging dose on average compared to conventional 4D CBCT. Image quality differences were less than 4% at worst. Using displacement based sorting RT 4D CBCT results in 57% less imaging dose on average, than conventional 4D CBCT methods; however, image quality was 26% worse with RT 4D CBCT. Conclusions: Simulation studies have shown that RT 4D CBCT reduces imaging dose while maintaining comparable image quality for phase based 4D CBCT; image quality is degraded for displacement based RT 4D CBCT in its current implementation.

60 APPLIED LIFE SCIENCES↗

Population of anatomically variable 4D XCAT adult phantoms for imaging research and optimization

Purpose: The authors previously developed the 4D extended cardiac-torso (XCAT) phantom for multimodality imaging research. The XCAT consisted of highly detailed whole-body models for the standard male and female adult, including the cardiac and respiratory motions. In this work, the authors extend the XCAT beyond these reference anatomies by developing a series of anatomically variable 4D XCAT adult phantoms for imaging research, the first library of 4D computational phantoms. Methods: The initial anatomy of each phantom was based on chest-abdomen-pelvis computed tomography data from normal patients obtained from the Duke University database. The major organs and structures for each phantom were segmented from the corresponding data and defined using nonuniform rational B-spline surfaces. To complete the body, the authors manually added on the head, arms, and legs using the original XCAT adult male and female anatomies. The structures were scaled to best match the age and anatomy of the patient. A multichannel large deformation diffeomorphic metric mapping algorithm was then used to calculate the transform from the template XCAT phantom (male or female) to the target patient model. The transform was applied to the template XCAT to fill in any unsegmented structures within the target phantom and to implement the 4D cardiac and respiratory models in the new anatomy. Each new phantom was refined by checking for anatomical accuracy via inspection of the models. Results: Using these methods, the authors created a series of computerized phantoms with thousands of anatomical structures and modeling cardiac and respiratory motions. The database consists of 58 (35 male and 23 female) anatomically variable phantoms in total. Like the original XCAT, these phantoms can be combined with existing simulation packages to simulate realistic imaging data. Each new phantom contains parameterized models for the anatomy and the cardiac and respiratory motions and can, therefore, serve as a jumping point from which to create an unlimited number of 3D and 4D variations for imaging research. Conclusions: A population of phantoms that includes a range of anatomical variations representative of the public at large is needed to more closely mimic a clinical study or trial. The series of anatomically variable phantoms developed in this work provide a valuable resource for investigating 3D and 4D imaging devices and the effects of anatomy and motion in imaging. Combined with Monte Carlo simulation programs, the phantoms also provide a valuable tool to investigate patient-specific dose and image quality, and optimization for adults undergoing imaging procedures.

60 APPLIED LIFE SCIENCES↗

Determination of gonad doses during robotic stereotactic radiosurgery for various tumor sites

Purpose: The authors evaluated the absorbed dose received by the gonads during robotic stereotactic radiosurgery (SRS) for the treatment of different tumor localizations. Methods: The authors measured the gonad doses during the treatment of head and neck, thoracic, abdominal, or pelvic tumors in both RANDO phantom and actual patients. The computerized tomography images were transferred to the treatment planning system. The contours of tumor and critical organs were delineated on each slice, and treatment plans were generated. Measurements for gonad doses were taken from the geometric projection of the ovary onto the skin for female patients, and from the scrotal skin for male patients by attaching films and Thermoluminescent dosimeters (TLDs). SRS was delivered with CyberKnife (Accuray Inc., Sunnyvale, CA). Results: The median gonadal doses with TLD and film dosimeter in actual patients were 0.19 Gy (range, 0.035-2.71 Gy) and 0.34 Gy (range, 0.066-3.18 Gy), respectively. In the RANDO phantom, the median ovarian doses with TLD and film dosimeter were 0.08 Gy (range, 0.03-0.159 Gy) and 0.05 Gy (range, 0.015-0.13 Gy), respectively. In the RANDO phantom, the median testicular doses with TLD and film dosimeter were 0.134 Gy (range 0.056-1.97 Gy) and 0.306 Gy (range, 0.065-2.25 Gy). Conclusions: Gonad doses are below sterility threshold in robotic SRS for different tumor localizations. However, particular attention should be given to gonads during robotic SRS for pelvic tumors.

60 APPLIED LIFE SCIENCES↗

The feasibility of head motion tracking in helical CT: A step toward motion correction

Purpose: To establish a practical and accurate motion tracking method for the development of rigid motion correction methods in helical x-ray computed tomography (CT). Methods: A commercially available optical motion tracking system provided 6 degrees of freedom pose measurements at 60 Hz. A 4 Multiplication-Sign 4 calibration matrix was determined to convert raw pose data acquired in tracker coordinates to a fixed CT coordinate system with origin at the isocenter of the scanner. Two calibration methods, absolute orientation (AO), and a new method based on image registration (IR), were compared by means of landmark analysis and correlation coefficient in phantom images coregistered using the derived motion transformations. Results: Transformations calculated using the IR-derived calibration matrix were found to be more accurate, with positional errors less than 0.5 mm (mean RMS), and highly correlated image voxel intensities. The AO-derived calibration matrix yielded larger mean RMS positional errors ( Asymptotically-Equal-To 1.0 mm), and poorer correlation coefficients. Conclusions: The authors have demonstrated the feasibility of accurate motion tracking for retrospective motion correction in helical CT. Their new IR-based calibration method based on image registration and function minimization was simpler to perform and delivered more accurate calibration matrices. This technique is a useful tool for future work on rigid motion correction in helical CT and potentially also other imaging modalities.

60 APPLIED LIFE SCIENCES↗

BrachyView: Proof-of-principle of a novel in-body gamma camera for low dose-rate prostate brachytherapy

Purpose: The conformity of the achieved dose distribution to the treatment plan strongly correlates with the accuracy of seed implantation in a prostate brachytherapy treatment procedure. Incorrect seed placement leads to both short and long term complications, including urethral and rectal toxicity. The authors present BrachyView, a novel concept of a fast intraoperative treatment planning system, to provide real-time seed placement information based on in-body gamma camera data. BrachyView combines the high spatial resolution of a pixellated silicon detector (Medipix2) with the volumetric information acquired by a transrectal ultrasound (TRUS). The two systems will be embedded in the same probe so as to provide anatomically correct seed positions for intraoperative planning and postimplant dosimetry. Dosimetric calculations are based on the TG-43 method using the real position of the seeds. The purpose of this paper is to demonstrate the feasibility of BrachyView using the Medipix2 pixel detector and a pinhole collimator to reconstruct the real-time 3D position of low dose-rate brachytherapy seeds in a phantom. Methods: BrachyView incorporates three Medipix2 detectors coupled to a multipinhole collimator. Three-dimensionally triangulated seed positions from multiple planar images are used to determine the seed placement in a PMMA prostate phantom in real time. MATLAB codes were used to test the reconstruction method and to optimize the device geometry. Results: The results presented in this paper show a 3D position reconstruction accuracy of the seed in the range of 0.5-3 mm for a 10-60 mm seed-to-detector distance interval (Z direction), respectively. The BrachyView system also demonstrates a spatial resolution of 0.25 mm in the XY plane for sources at 10 mm distance from Medipix2 detector plane, comparable to the theoretical value calculated for an equivalent gamma camera arrangement. The authors successfully demonstrated the capability of BrachyView for real-time imaging (using a 3 s data acquisition time) of different brachytherapy seed configurations (with an activity of 0.05 U) throughout a 60 Multiplication-Sign 60 Multiplication-Sign 60 mm{sup 3} Perspex prostate phantom. Conclusions: The newly developed miniature gamma camera component of BrachyView, with its high spatial resolution and real time capability, allows accurate 3D localization of seeds in a prostate phantom. Combination of the gamma camera with TRUS in a single probe will complete the BrachyView system.

60 APPLIED LIFE SCIENCES↗

Objected constrained registration and manifold learning: A new patient setup approach in image guided radiation therapy of thoracic cancer

Purpose: The management of thoracic malignancies with radiation therapy is complicated by continuous target motion. In this study, a real time motion analysis approach is proposed to improve the accuracy of patient setup. Methods: For 11 lung cancer patients a long training fluoroscopy was acquired before the first treatment, and multiple short testing fluoroscopies were acquired weekly at the pretreatment patient setup of image guided radiotherapy (IGRT). The data analysis consisted of three steps: first a 4D target motion model was constructed from 4DCT and projected to the training fluoroscopy through deformable registration. Then the manifold learning method was used to construct a 2D subspace based on the target motion (kinetic) and location (static) information in the training fluoroscopy. Thereafter the respiratory phase in the testing fluoroscopy was determined by finding its location in the subspace. Finally, the phase determined testing fluoroscopy was registered to the corresponding 4DCT to derive the pretreatment patient position adjustment for the IGRT. The method was tested on clinical image sets and numerical phantoms. Results: The registration successfully reconstructed the 4D motion model with over 98% volume similarity in 4DCT, and over 95% area similarity in the training fluoroscopy. The machine learning method derived the phase values in over 98% and 93% test images of the phantom and patient images, respectively, with less than 3% phase error. The setup approach achieved an average accumulated setup error less than 1.7 mm in the cranial-caudal direction and less than 1 mm in the transverse plane. All results were validated against the ground truth of manual delineations by an experienced radiation oncologist. The expected total time for the pretreatment setup analysis was less than 10 s. Conclusions: By combining the registration and machine learning, the proposed approach has the potential to improve the accuracy of pretreatment setup for patients with thoracic malignancy.

60 APPLIED LIFE SCIENCES↗

Prediction of human observer performance in a 2-alternative forced choice low-contrast detection task using channelized Hotelling observer: Impact of radiation dose and reconstruction algorithms

Purpose: Efficient optimization of CT protocols demands a quantitative approach to predicting human observer performance on specific tasks at various scan and reconstruction settings. The goal of this work was to investigate how well a channelized Hotelling observer (CHO) can predict human observer performance on 2-alternative forced choice (2AFC) lesion-detection tasks at various dose levels and two different reconstruction algorithms: a filtered-backprojection (FBP) and an iterative reconstruction (IR) method. Methods: A 35 Multiplication-Sign 26 cm{sup 2} torso-shaped phantom filled with water was used to simulate an average-sized patient. Three rods with different diameters (small: 3 mm; medium: 5 mm; large: 9 mm) were placed in the center region of the phantom to simulate small, medium, and large lesions. The contrast relative to background was -15 HU at 120 kV. The phantom was scanned 100 times using automatic exposure control each at 60, 120, 240, 360, and 480 quality reference mAs on a 128-slice scanner. After removing the three rods, the water phantom was again scanned 100 times to provide signal-absent background images at the exact same locations. By extracting regions of interest around the three rods and on the signal-absent images, the authors generated 21 2AFC studies. Each 2AFC study had 100 trials, with each trial consisting of a signal-present image and a signal-absent image side-by-side in randomized order. In total, 2100 trials were presented to both the model and human observers. Four medical physicists acted as human observers. For the model observer, the authors used a CHO with Gabor channels, which involves six channel passbands, five orientations, and two phases, leading to a total of 60 channels. The performance predicted by the CHO was compared with that obtained by four medical physicists at each 2AFC study. Results: The human and model observers were highly correlated at each dose level for each lesion size for both FBP and IR. The Pearson's product-moment correlation coefficients were 0.986 [95% confidence interval (CI): 0.958-0.996] for FBP and 0.985 (95% CI: 0.863-0.998) for IR. Bland-Altman plots showed excellent agreement for all dose levels and lesions sizes with a mean absolute difference of 1.0%{+-} 1.1% for FBP and 2.1%{+-} 3.3% for IR. Conclusions: Human observer performance on a 2AFC lesion detection task in CT with a uniform background can be accurately predicted by a CHO model observer at different radiation dose levels and for both FBP and IR methods.

60 APPLIED LIFE SCIENCES↗

Evaluation of multiple image-based modalities for image-guided radiation therapy (IGRT) of prostate carcinoma: A prospective study

Purpose: Setup errors and prostate intrafraction motion are main sources of localization uncertainty in prostate cancer radiation therapy. This study evaluates four different imaging modalities 3D ultrasound (US), kV planar images, cone-beam computed tomography (CBCT), and implanted electromagnetic transponders (Calypso/Varian) to assess inter- and intrafraction localization errors during intensity-modulated radiation therapy based treatment of prostate cancer. Methods: Twenty-seven prostate cancer patients were enrolled in a prospective IRB-approved study and treated to a total dose of 75.6 Gy (1.8 Gy/fraction). Overall, 1100 fractions were evaluated. For each fraction, treatment targets were localized using US, kV planar images, and CBCT in a sequence defined to determine setup offsets relative to the patient skin tattoos, intermodality differences, and residual errors for each patient and patient cohort. Planning margins, following van Herk's formalism, were estimated based on error distributions. Calypso-based localization was not available for the first eight patients, therefore centroid positions of implanted gold-seed markers imaged prior to and immediately following treatment were used as a motion surrogate during treatment. For the remaining 19 patients, Calypso transponders were used to assess prostate intrafraction motion. Results: The means ({mu}), and standard deviations (SD) of the systematic ({Sigma}) and random errors ({sigma}) of interfraction prostate shifts (relative to initial skin tattoo positioning), as evaluated using CBCT, kV, and US, averaged over all patients and fractions, were: [{mu}{sub CBCT}= (-1.2, 0.2, 1.1) mm, {Sigma}{sub CBCT}= (3.0, 1.4, 2.4) mm, {sigma}{sub CBCT}= (3.2, 2.2, 2.5) mm], [{mu}{sub kV}= (-2.9, -0.4, 0.5) mm, {Sigma}{sub kV}= (3.4, 3.1, 2.6) mm, {sigma}{sub kV}= (2.9, 2.0, 2.4) mm], and [{mu}{sub US}= (-3.6, -1.4, 0.0) mm, {Sigma}{sub US}= (3.3, 3.5, 2.8) mm, {sigma}{sub US}= (4.1, 3.8, 3.6) mm], in the anterior-posterior (A/P), superior-inferior (S/I), and the left-right (L/R) directions, respectively. In the treatment protocol, adjustment of couch was guided by US images. Residual setup errors as assessed by kV images were found to be: {mu}{sub residual}= (-0.4, 0.2, 0.2) mm, {Sigma}{sub residual}= (1.0, 1.0,0.7) mm, and {sigma}{sub residual}= (2.5, 2.3, 1.8) mm. Intrafraction prostate motion, evaluated using electromagnetic transponders, was: {mu}{sub intrafxn}= (0.0, 0.0, 0.0) mm, {Sigma}{sub intrafxn}= (1.3, 1.5, 0.6) mm, and {sigma}{sub intrafxn}= (2.6, 2.4, 1.4) mm. Shifts between pre- and post-treatment kV images were: {mu}{sub kV(post-pre)}= (-0.3, 0.8, -0.2), {Sigma}{sub kV(post-pre)}= (2.4, 2.7, 2.1) mm, and {sigma}{sub kV(post-pre)}= (2.7, 3.2, 3.1) mm. Relative to skin tattoos, planning margins for setup error were within 10-11 mm for all image-based modalities. The use of image guidance was shown to reduce these margins to less than 5 mm. Margins to compensate for both residual setup (interfraction) errors as well as intrafraction motion were 6.6, 6.8, and 3.9 mm in the A/P, S/I, and L/R directions, respectively. Conclusions: Analysis of interfraction setup errors, performed with US, CBCT, planar kV images, and electromagnetic transponders, from a large dataset revealed intermodality shifts were comparable (within 3-4 mm). Interfraction planning margins, relative to setup based on skin marks, were generally within the 10 mm prostate-to-planning target volume margin used in our clinic. With image guidance, interfraction residual planning margins were reduced to approximately less than 4 mm. These findings are potentially important for dose escalation studies using smaller margins to better protect normal tissues.

60 APPLIED LIFE SCIENCES↗

Experimental evaluations of the accuracy of 3D and 4D planning in robotic tracking stereotactic body radiotherapy for lung cancers

Purpose: Due to the complexity of 4D target tracking radiotherapy, the accuracy of this treatment strategy should be experimentally validated against established standard 3D technique. This work compared the accuracy of 3D and 4D dose calculations in respiration tracking stereotactic body radiotherapy (SBRT). Methods: Using the 4D planning module of the CyberKnife treatment planning system, treatment plans for a moving target and a static off-target cord structure were created on different four-dimensional computed tomography (4D-CT) datasets of a thorax phantom moving in different ranges. The 4D planning system used B-splines deformable image registrations (DIR) to accumulate dose distributions calculated on different breathing geometries, each corresponding to a static 3D-CT image of the 4D-CT dataset, onto a reference image to compose a 4D dose distribution. For each motion, 4D optimization was performed to generate a 4D treatment plan of the moving target. For comparison with standard 3D planning, each 4D plan was copied to the reference end-exhale images and a standard 3D dose calculation was followed. Treatment plans of the off-target structure were first obtained by standard 3D optimization on the end-exhale images. Subsequently, they were applied to recalculate the 4D dose distributions using DIRs. All dose distributions that were initially obtained using the ray-tracing algorithm with equivalent path-length heterogeneity correction (3D{sub EPL} and 4D{sub EPL}) were recalculated by a Monte Carlo algorithm (3D{sub MC} and 4D{sub MC}) to further investigate the effects of dose calculation algorithms. The calculated 3D{sub EPL}, 3D{sub MC}, 4D{sub EPL}, and 4D{sub MC} dose distributions were compared to measurements by Gafchromic EBT2 films in the axial and coronal planes of the moving target object, and the coronal plane for the static off-target object based on the {gamma} metric at 5%/3mm criteria ({gamma}{sub 5%/3mm}). Treatment plans were considered acceptable if the percentage of pixels passing {gamma}{sub 5%/3mm} (P{sub {gamma}<1}) {>=} 90%. Results: The averaged P{sub {gamma}<1} values of the 3D{sub EPL}, 3D{sub MC}, 4D{sub EPL}, and 4D{sub MC} dose calculation methods for the moving target plans are 95%, 95%, 94%, and 95% for reproducible motion, and 95%, 96%, 94%, and 93% for nonreproducible motion during actual treatment delivery. The overall measured target dose distributions are in better agreement with the 3D{sub MC} dose distributions than the 4D{sub MC} dose distributions. Conversely, measured dose distributions agree much better with the 4D{sub EPL/MC} than the 3D{sub EPL/MC} dose distributions in the static off-target structure, resulting in higher P{sub {gamma}<1} values with 4D{sub EPL/MC} (91%) vs 3D{sub EPL} (24%) and 3D{sub MC} (25%). Systematic changes of target motion reduced the averaged P{sub {gamma}<1} to 47% and 53% for 4D{sub EPL} and 4D{sub MC} dose calculations, and 22% for 3D{sub EPL/MC} dose calculations in the off-target films. Conclusions: In robotic tracking SBRT, 4D treatment planning was found to yield better prediction of the dose distributions in the off-target structure, but not necessarily in the moving target, compared to standard 3D treatment planning, for reproducible and nonreproducible target motion. It is important to ensure on a patient-by-patient basis that the cumulative uncertainty associated with the 4D-CT artifacts, deformable image registration, and motion variability is significantly smaller than the cumulative uncertainty occurred in standard 3D planning in order to make 4D planning a justified option.

60 APPLIED LIFE SCIENCES↗