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DOE OSTI2015

SU-E-J-28: Gantry Speed Significantly Affects Image Quality and Imaging Dose for 4D Cone-Beam Computed Tomography On the Varian Edge Platform

Purpose: 4D-CBCT facilitates assessment of tumor motion at treatment position. We investigated the effect of gantry speed on 4D-CBCT image quality and dose using the Varian Edge On-Board Imager (OBI). Methods: A thoracic protocol was designed using a 125 kVp spectrum. Image quality parameters were obtained via 4D acquisition using a Catphan phantom with a gating system. A sinusoidal waveform was executed with a five second period and superior-inferior motion. 4D-CBCT scans were sorted into 4 and 10 phases. Image quality metrics included spatial resolution, contrast-to-noise ratio (CNR), uniformity index (UI), Hounsfield unit (HU) sensitivity, and RMS error (RMSE) of motion amplitude. Dosimetry was accomplished using Gafchromic XR-QA2 films within a CIRS Thorax phantom. This was placed on the gating phantom using the same motion waveform. Results: High contrast resolution decreased linearly from 5.93 to 4.18 lp/cm, 6.54 to 4.18 lp/cm, and 5.19 to 3.91 lp/cm for averaged, 4 phase, and 10 phase 4DCBCT volumes respectively as gantry speed increased from 1.0 to 6.0 degs/sec. CNRs decreased linearly from 4.80 to 1.82 as the gantry speed increased from 1.0 to 6.0 degs/sec, respectively. No significant variations in UIs, HU sensitivities, or RMSEs were observed with variable gantry speed. Ion chamber measurements compared to film yielded small percent differences in plastic water regions (0.1–9.6%), larger percent differences in lung equivalent regions (7.5–34.8%), and significantly larger percent differences in bone equivalent regions (119.1–137.3%). Ion chamber measurements decreased from 17.29 to 2.89 cGy with increasing gantry speed from 1.0 to 6.0 degs/sec. Conclusion: Maintaining technique factors while changing gantry speed changes the number of projections used for reconstruction. Increasing the number of projections by decreasing gantry speed decreases noise, however, dose is increased. The future of 4DCBCT’s clinical utility relies on further investigation of image optimization.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-J-65: Motion Difference Between the Pancreas and Nearby Veins for Pancreas Motion Monitoring Using Ultrasound During Radiation Therapy

Purpose: As it is generally difficult to outline the pancreas on an ultrasound b-mode image, visualized structures such as the portal or the splenic veins are assumed to have the same motion as the pancreas. These structures can be used as a surrogate for monitoring pancreas motion during radiation therapy (RT) delivery using ultrasound. To verify this assumption, we studied the motion difference between the head of the pancreas, the portal vein, the tail of the pancreas, and splenic vein. Methods: 4DCT data acquired during RT simulation were analyzed for a total of 5 randomly selected patients with pancreatic cancer. The data was sorted into 10 respiratory phases from 0% to 90% (0%: end of the inspiration, 50%: end of expiration) . The head of the pancreas (HP), tail of the pancreas (TP), portal vein (PV), and splenic vein (SV) were contoured on all 10 phases. The volume change and motion were measured in the left-right (LR), anterior-superior (AP), and superior-inferior (SI) directions. Results: The volume change for all patients/phases were: 1.2 ± 3% for HP, 0.78 ± 1.6% for PV, 2.5 ± 2.9% for TP, and 0.53 ± 2.1% for SV. Motion for each structure was estimated from the centroid displacements due to the uniformity of the structures and the small volume change. The measured motion between HP and PV was: LR: 0.1 ± 0.17 mm, AP: 0.04 ± 0.1 mm, SI: 0.17 ± 0.16 mm and between TP and the PV was: LR: 0.05 ± 0.3 mm, AP: 0.1 ± 0.4 mm, SI: 0.01 ± 0.022 mm. Conclusion: There are small motion differences between the portal vein and the head of the pancreas, and the splenic vein and the tail of the pancreas. This suggests the feasibility of utilizing these features for monitoring the pancreas motion during radiation therapy.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-J-77: Dose Tracking On An MR-Linac for Online QA and Plan Adaptation in Abdominal Organs

Recent developments made MRI-guided radiotherapy feasible. Simultaneously performed imaging during dose delivery reveals the influence of changes in anatomy not yet known at the planning stage. When targeting highly motile abdominal organs, respiratory gating is commonly employed in MRI and investigated in external beam radiotherapy to mitigate malicious motion effects. The purpose of the presented work is to investigate anatomy-adaptive dose reconstruction in the treatment of abdominalorgans using concurrent (duplex) gating of an integrated MRlinac modality.Using navigators, 3D-MR images were sampled during exhale phase, requiring 3s per axial volume (360×260×100mm{sup 3}, waterselective T1w-FFE). Deformation vector fields (DVF) were calculated for all imaging dynamics with respect to initial anatomy, yielding an estimation of anatomy changes over the time of a fraction. A pseudo-CT was generated from the outline of a reference MR image, assuming a water-filled body. Consecutively, a treatment was planned on a fictional kidney lesion and optimized simulating a 6MV linac in a 1.5T magnetic field. After delivery, using the DVF, the pseudo-CT was deformed and dose accumulated for every individual gating interval yielding the true accumulated dose on the dynamic anatomy during beam-on.Dose-volume parameters on the PTV show only moderate changes when incorporating motion, i.e. ΔD{sub 99} (GTV)=0.3Gy with D{sub 99} (GTV)=20Gy constraints. However, local differences in the PTV region showed underdosages as high as 2.7Gy and overdosages up to 1.4Gy as compared to the optimized dose on static anatomy.A dose reconstruction toolchain was successfully implemented and proved its potential in the duplex gated treatment of abdominal organs by means of an MR-linac modality. While primary dose constraints were not violated on the fictional test data, large deviations could be found locally, which are left unaccounted for in conventional treatments. Dose-tracking of both target structures and organs at risk using 3D MRI during treatment enables truly adaptive hypofractionated radiotherapy. This work was funded by the SoRTS consortium, which includes the industry partners Elekta, Philips and Technolution.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-J-120: Comparing 4D CT Computed Ventilation to Lung Function Measured with Hyperpolarized Xenon-129 MRI

Purpose: To correlate ventilation parameters computed from 4D CT to ventilation, profusion, and gas exchange measured with hyperpolarized Xenon-129 MRI for a set of lung cancer patients. Methods: Hyperpolarized Xe-129 MRI lung scans were acquired for lung cancer patients, before and after radiation therapy, measuring ventilation, perfusion, and gas exchange. In the standard clinical workflow, these patients also received 4D CT scans before treatment. Ventilation was computed from 4D CT using deformable image registration (DIR). All phases of the 4D CT scan were registered using a B-spline deformable registration. Ventilation at the voxel level was then computed for each phase based on a Jacobian volume expansion metric, yielding phase sorted ventilation images. Ventilation based upon 4D CT and Xe-129 MRI were co-registered, allowing qualitative visual comparison and qualitative comparison via the Pearson correlation coefficient. Results: Analysis shows a weak correlation between hyperpolarized Xe-129 MRI and 4D CT DIR ventilation, with a Pearson correlation coefficient of 0.17 to 0.22. Further work will refine the DIR parameters to optimize the correlation. The weak correlation could be due to the limitations of 4D CT, registration algorithms, or the Xe-129 MRI imaging. Continued development will refine parameters to optimize correlation. Conclusion: Current analysis yields a minimal correlation between 4D CT DIR and Xe-129 MRI ventilation. Funding provided by the 2014 George Amorino Pilot Grant in Radiation Oncology at the University of Virginia.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-J-150: Four-Dimensional Cone-Beam CT Algorithm by Extraction of Physical and Motion Parameter of Mobile Targets Retrospective to Image Reconstruction with Motion Modeling

Purpose: To develop 4D-cone-beam CT (CBCT) algorithm by motion modeling that extracts actual length, CT numbers level and motion amplitude of a mobile target retrospective to image reconstruction by motion modeling. Methods: The algorithm used three measurable parameters: apparent length and blurred CT number distribution of a mobile target obtained from CBCT images to determine actual length, CT-number value of the stationary target, and motion amplitude. The predictions of this algorithm were tested with mobile targets that with different well-known sizes made from tissue-equivalent gel which was inserted into a thorax phantom. The phantom moved sinusoidally in one-direction to simulate respiratory motion using eight amplitudes ranging 0–20mm. Results: Using this 4D-CBCT algorithm, three unknown parameters were extracted that include: length of the target, CT number level, speed or motion amplitude for the mobile targets retrospective to image reconstruction. The motion algorithms solved for the three unknown parameters using measurable apparent length, CT number level and gradient for a well-defined mobile target obtained from CBCT images. The motion model agreed with measured apparent lengths which were dependent on the actual target length and motion amplitude. The gradient of the CT number distribution of the mobile target is dependent on the stationary CT number level, actual target length and motion amplitude. Motion frequency and phase did not affect the elongation and CT number distribution of the mobile target and could not be determined. Conclusion: A 4D-CBCT motion algorithm was developed to extract three parameters that include actual length, CT number level and motion amplitude or speed of mobile targets directly from reconstructed CBCT images without prior knowledge of the stationary target parameters. This algorithm provides alternative to 4D-CBCT without requirement to motion tracking and sorting of the images into different breathing phases which has potential applications in diagnostic CT imaging and radiotherapy.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-J-153: Reconstructing 4D Cone Beam CT Images for Clinical QA of Lung SABR Treatments

Purpose: To verify that the planned Primary Target Volume (PTV) and Internal Gross Tumor Volume (IGTV) fully enclose a moving lung tumor volume as visualized on a pre-SABR treatment verification 4D Cone Beam CT. Methods: Daily 3DCBCT image sets were acquired immediately prior to treatment for 10 SABR lung patients using the on-board imaging system integrated into a Varian TrueBeam (v1.6: no 4DCBCT module available). Respiratory information was acquired during the scan using the Varian RPM system. The CBCT projections were sorted into 8 bins offline, both by breathing phase and amplitude, using in-house software. An iterative algorithm based on total variation minimization, implemented in the open source reconstruction toolkit (RTK), was used to reconstruct the binned projections into 4DCBCT images. The relative tumor motion was quantified by tracking the centroid of the tumor volume from each 4DCBCT image. Following CT-CBCT registration, the planning CT volumes were compared to the location of the CBCT tumor volume as it moves along its breathing trajectory. An overlap metric quantified the ability of the planned PTV and IGTV to contain the tumor volume at treatment. Results: The 4DCBCT reconstructed images visibly show the tumor motion. The mean overlap between the planned PTV (IGTV) and the 4DCBCT tumor volumes was 100% (94%), with an uncertainty of 5% from the 4DCBCT tumor volume contours. Examination of the tumor motion and overlap metric verify that the IGTV drawn at the planning stage is a good representation of the tumor location at treatment. Conclusion: It is difficult to compare GTV volumes from a 4DCBCT and a planning CT due to image quality differences. However, it was possible to conclude the GTV remained within the PTV 100% of the time thus giving the treatment staff confidence that SABR lung treatements are being delivered accurately.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-J-237: Real-Time 3D Anatomy Estimation From Undersampled MR Acquisitions

Recent developments made MRI guided radiotherapy feasible. Performing simultaneous imaging during fractions can provide information about changing anatomy by means of deformable image registration for either immediate plan adaptations or accurate dose accumulation on the changing anatomy. In 3D MRI, however, acquisition time is considerable and scales with resolution. Furthermore, intra-scan motion degrades image quality.In this work, we investigate the sensitivity of registration quality on imageresolution: potentially, by employing spatial undersampling, the acquisition timeof MR images for the purpose of deformable image registration can be reducedsignificantly.On a volunteer, 3D-MR imaging data was sampled in a navigator-gated manner, acquiring one axial volume (360×260×100mm{sup 3}) per 3s during exhale phase. A T1-weighted FFE sequence was used with an acquired voxel size of (2.5mm{sup 3}) for a duration of 17min. Deformation vector fields were evaluated for 100 imaging cycles with respect to the initial anatomy using deformable image registration based on optical flow. Subsequently, the imaging data was downsampled by a factor of 2, simulating a fourfold acquisition speed. Displacements of the downsampled volumes were then calculated by the same process.In kidneyliver boundaries and the region around stomach/duodenum, prominent organ drifts could be observed in both the original and the downsampled imaging data. An increasing displacement of approximately 2mm was observed for the kidney, while an area around the stomach showed sudden displacements of 4mm. Comparison of the motile points over time showed high reproducibility between the displacements of high-resolution and downsampled volumes: over a 17min acquisition, the componentwise RMS error was not more than 0.38mm.Based on the synthetic experiments, 3D nonrigid image registration shows little sensitivity to image resolution and the displacement information is preserved even when halving the resolution. This can be employed to greatly reduce image acquisition times for interventional applications in real-time. This work was funded by the SoRTS consortium, which includes the industry partners Elekta, Philips and Technolution.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-235: Data Mining for Evaluating Treatment Performances Over a Large Quantity of Data to Monitor and Improve SBRT Workflow

Purpose: To quality assure a large quantity of retrospective treatment cases for treatment performances by randomly sampling is inefficient. Here we provide a method to efficiently monitor and investigate the QA of SBRT workflow over Mosaiq. Methods: The code developed with Microsoft SQL Server Management Studio 2008R2 and VBA was used for retrieving and sorting data from Mosaiq (version 2.3–2.6 during 2012–2015). SBRT patients were filtered by fractional dose over 350cGy and total fraction number less than 6, which SBRT prescriptions were defined. The quality assurance on the SBRT workflow was focused on the treatment deliveries such as patient positioning setup, CBCT indicated offsets and couch shifted corrections. The treatment delivery were done by Varian Truebeam systems and the record/verify by Mosaiq. Results: Total 82 SBRT patients corresponding to 103 courses and 854 CBCT images were found by the retrieval query. Most centers record daily pre-treatment (Pre-Tx: before treatment shift) image-guided shifts along treatment course for inter-fraction motion record, and it is useful to also verify it with post-treatment imaging (Post-Tx: after treatment CBCT verification) to verify intra-fraction motion. Analyzing the details of daily recorded shifts can reveals the information of patient-setup and staff’s record/verify behaviors. 3 examples were provided as solid evidences and on-going rectification for preventing future mistakes. Conclusions: The report gave feasible examples for inspector to verify a large amount of data during site investigation. This program can also be extended to a scheduled data mining with software to periodical analyze the timely records in Mosaiq, for example, a various control charts for different QA purposes. As the current trend of automation in radiation therapy field, the data mining would be a necessary tool in the future, just as the automatic plan quality evaluation has been under development in Eclipse.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-F-303-11: Implementation and Applications of Rapid, SIFT-Based Cine MR Image Binning and Region Tracking

Purpose: To develop a novel and rapid, SIFT-based algorithm for assessing feature motion on cine MR images acquired during MRI-guided radiotherapy treatments. In particular, we apply SIFT descriptors toward both partitioning cine images into respiratory states and tracking regions across frames. Methods: Among a training set of images acquired during a fraction, we densely assign SIFT descriptors to pixels within the images. We cluster these descriptors across all frames in order to produce a dictionary of trackable features. Associating the best-matching descriptors at every frame among the training images to these features, we construct motion traces for the features. We use these traces to define respiratory bins for sorting images in order to facilitate robust pixel-by-pixel tracking. Instead of applying conventional methods for identifying pixel correspondences across frames we utilize a recently-developed algorithm that derives correspondences via a matching objective for SIFT descriptors. Results: We apply these methods to a collection of lung, abdominal, and breast patients. We evaluate the procedure for respiratory binning using target sites exhibiting high-amplitude motion among 20 lung and abdominal patients. In particular, we investigate whether these methods yield minimal variation between images within a bin by perturbing the resulting image distributions among bins. Moreover, we compare the motion between averaged images across respiratory states to 4DCT data for these patients. We evaluate the algorithm for obtaining pixel correspondences between frames by tracking contours among a set of breast patients. As an initial case, we track easily-identifiable edges of lumpectomy cavities that show minimal motion over treatment. Conclusions: These SIFT-based methods reliably extract motion information from cine MR images acquired during patient treatments. While we performed our analysis retrospectively, the algorithm lends itself to prospective motion assessment. Applications of these methods include motion assessment, identifying treatment windows for gating, and determining optimal margins for treatment.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

TU-CD-207-01: Characterization of Breast Tissue Composition Using Spectral Mammography

Purpose: To investigate the feasibility of characterizing the chemical composition of breast tissue, in terms of water and lipid, by using spectral mammography in simulation and postmortem studies. Methods: Analytical simulations were performed to obtain low- and high-energy signals of breast tissue based on previously reported water, lipid, and protein contents. Dual-energy decomposition was used to characterize the simulated breast tissue into water and lipid basis materials and the measured water density was compared to the known value. In experimental studies, postmortem breasts were imaged with a spectral mammography system based on a scanning multi-slit Si strip photon-counting detector. Low- and high-energy images were acquired simultaneously from a single exposure by sorting the recorded photons into the corresponding energy bins. Dual-energy material decomposition of the low- and high-energy images yielded individual pixel measurements of breast tissue composition in terms of water and lipid thicknesses. After imaging, each postmortem breast was chemically decomposed into water, lipid and protein. The water density calculated from chemical analysis was used as the reference gold standard. Correlation of the water density measurements between spectral mammography and chemical analysis was analyzed using linear regression. Results: Both simulation and postmortem studies showed good linear correlation between the decomposed water thickness using spectral mammography and chemical analysis. The slope of the linear fitting function in the simulation and postmortem studies were 1.15 and 1.21, respectively. Conclusion: The results indicate that breast tissue composition, in terms of water and lipid, can be accurately measured using spectral mammography. Quantitative breast tissue composition can potentially be used to stratify patients according to their breast cancer risk.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

TU-EF-304-04: A Heart Motion Model for Proton Scanned Beam Chest Radiotherapy

Purpose: To model fast-moving heart surface motion as a function of cardiac-phase in order to compensate for the lack of cardiac-gating in evaluating accurate dose to coronary structures. Methods: Ten subjects were prospectively imaged with a breath-hold, cardiac-gated MRI protocol to determine heart surface motion. Radial and planar views of the heart were resampled into a 3-dimensional volume representing one heartbeat. A multi-resolution optical flow deformable image registration algorithm determined tissue displacement during the cardiac-cycle. The surface of the heart was modeled as a thin membrane comprised of voxels perpendicular to a pencil beam scanning (PBS) beam. The membrane’s out-of-plane spatial displacement was modeled as a harmonic function with Lame’s equations. Model accuracy was assessed with the root mean squared error (RMSE). The model was applied to a cohort of six chest wall irradiation patients with PBS plans generated on phase-sorted 4DCT. Respiratory motion was separated from the cardiac motion with a previously published technique. Volumetric dose painting was simulated and dose accumulated to validate plan robustness (target coverage variation accepted within 2%). Maximum and mean heart surface dose assessed the dosimetric impact of heart and coronary artery motion. Results: Average and maximum heart surface displacements were 2.54±0.35mm and 3.6mm from the end-diastole phase to the end-systole cardiac-phase respectively. An average RMSE of 0.11±0.04 showed the model to be accurate. Observed errors were greatest between the circumflex artery and mitral valve level of the heart anatomy. Heart surface displacements correspond to a 3.6±1.0% and 5.1±2.3% dosimetric impact on the maximum and mean heart surface DVH indicators respectively. Conclusion: Although heart surface motion parallel to beam’s direction was substantial, its maximum dosimetric impact was 5.1±2.3%. Since PBS delivers low doses to coronary structures relative to photon radiotherapy, it is unknown whether this variation would be clinically significant for late effects.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

TU-G-BRA-01: Assessing Radiation-Induced Reductions in Regional Lung Perfusion Following Stereotactic Radiotherapy for Lung Cancer

Purpose: The dose-dependent nature of radiation therapy (RT)-induced lung injury following hypo-fractionated stereotactic RT is unclear. We herein report preliminary results of a prospective study assessing the magnitude of RT-induced reductions in regional lung perfusion following hypo-fractionated stereotactic RT. Methods: Four patients undergoing hypo-fractionated stereotactic lung RT (SBRT: 12 Gy x 4 fractions or 10 Gy x 5 fractions) had a pre-treatment SPECT (single-photon emission computed tomography) perfusion scan providing a 3D map of regional lung perfusion. Scans were repeated 3–6 months post-treatment. Pre- and post SPECT scans were registered to the planning CT scan (and hence the 3D dose data). Changes in regional perfusion (counts per cc on the pre-post scans) were computed in regions of the lung exposed to different doses of radiation (in 5 Gy intervals), thus defining a dose-response function. SPECT scans were internally normalized to the regions receiving <5 Gy. Results: At 3 months post-RT, the changes in perfusion are highly variable. At 6 months, there is a consistent dose-dependent reduction in regional perfusion. The average percent decline in regional perfusion was 10% at 15–20 Gy, 20% at 20–25 Gy, and 30% at 25–30 Gy representing a relatively linear dose response with an approximate 2% reduction per Gray for doses in excess of 10 Gy. There was a subtle increase in perfusion in the lung receiving <10 Gy. Conclusion: Hypo-fractionated stereotactic RT appears to cause a dose-dependent reduction in regional lung perfusion. There appears to be a threshold effect with no apparent perfusion loss at doses <10 Gy, though this might be in part due to the normalization technique used. Additional data is needed from a larger number of patients to better assess this issue. This sort of data can be used to assist optimizing RT treatment plans that minimize the risk of lung injury. Partly supported by the NIH (CA69579) and the Lance Armstrong Foundation.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

TU-F-CAMPUS-J-03: Evaluation of a New GE Device-Less Cine 4D-CT

Purpose: Standard cine 4D-CT (S-4DCT) is the cine CT scan of the thorax followed by image sorting with the respiratory signal recorded by the RPM. Although the feasibility of cine 4D-CT without RPM or device-less 4DCT (DL-4DCT) has been reported in a laboratory setting, the only commercial implementation of DL-4DCT was made recently by GE based on the measurements of the lung, body and air area and density. We report the initial results of this new DL-4DCT on its determination of gross tumor volume (GTV). Methods: 30 stereotactic body radiation therapy (SBRT) patients with NSCLC were included in the study. All patients received the S-4DCT for their treatment planning. Their cine CT data without the respiratory signal from RPM were submitted to the DL-4DCT. The DL-4DCT image quality was assessed in reference to S-4DCT. Using maximum intensity projection (MIP) images, the GTVs of the S-4DCT and DL-4DCT were compared on a subset of 9 patients whose tumors in the low density lung regions could be contoured using a region growing algorithm in MIM without contouring bias from the user. A lower threshold of −424 HU was used for all patients and other algorithm parameters were held constant for each patient. Results: The DL-4DCT was able to produce the 4DCT images on 29 out of the 30 SBRT cases. One case failed due to the enhanced calcification surrounding both the breast implants. The GTVs determined on the 9 patients with DL-4DCT were 4.2 ± 4.8% smaller than the GTVs with S-4DCT. However, this was statistically insignificant (p=0.15). The Dice similarity coefficients were 95.1 ± 1.8%. The image quality of DL-4DCT and S-4DCT was similar on the 29 cases. Conclusion: The first commercial DL-4DCT was promising in generating 4D-CT images without a respiratory monitoring device in this preliminary study of 30 patients.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

WE-G-207-03: Mask Guided Image Reconstruction (MGIR): A Novel Method for Ultra-Low-Dose 3D and Enhanced 4D Cone-Beam Computer-Tomography

Purpose: Recently, compressed sensing (CS) based iterative reconstruction (IR) method is receiving attentions to reconstruct high quality cone beam computed tomography (CBCT) images using sparsely sampled or noisy projections. The aim of this study is to develop a novel baseline algorithm called Mask Guided Image Reconstruction (MGIR), which can provide superior image quality for both low-dose 3DCBCT and 4DCBCT under single mathematical framework. Methods: In MGIR, the unknown CBCT volume was mathematically modeled as a combination of two regions where anatomical structures are 1) within the priori-defined mask and 2) outside the mask. Then we update each part of images alternatively thorough solving minimization problems based on CS type IR. For low-dose 3DCBCT, the former region is defined as the anatomically complex region where it is focused to preserve edge information while latter region is defined as contrast uniform, and hence aggressively updated to remove noise/artifact. In 4DCBCT, the regions are separated as the common static part and moving part. Then, static volume and moving volumes were updated with global and phase sorted projection respectively, to optimize the image quality of both moving and static part simultaneously. Results: Examination of MGIR algorithm showed that high quality of both low-dose 3DCBCT and 4DCBCT images can be reconstructed without compromising the image resolution and imaging dose or scanning time respectively. For low-dose 3DCBCT, a clinical viable and high resolution head-and-neck image can be obtained while cutting the dose by 83%. In 4DCBCT, excellent quality 4DCBCT images could be reconstructed while requiring no more projection data and imaging dose than a typical clinical 3DCBCT scan. Conclusion: The results shown that the image quality of MGIR was superior compared to other published CS based IR algorithms for both 4DCBCT and low-dose 3DCBCT. This makes our MGIR algorithm potentially useful in various on-line clinical applications. Provisional Patent: UF#15476; WGS Ref. No. U1198.70067US00.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

Quantifying the accuracy of the tumor motion and area as a function of acceleration factor for the simulation of the dynamic keyhole magnetic resonance imaging method

Purpose: The dynamic keyhole is a new MR image reconstruction method for thoracic and abdominal MR imaging. To date, this method has not been investigated with cancer patient magnetic resonance imaging (MRI) data. The goal of this study was to assess the dynamic keyhole method for the task of lung tumor localization using cine-MR images reconstructed in the presence of respiratory motion. Methods: The dynamic keyhole method utilizes a previously acquired a library of peripheral k-space datasets at similar displacement and phase (where phase is simply used to determine whether the breathing is inhale to exhale or exhale to inhale) respiratory bins in conjunction with central k-space datasets (keyhole) acquired. External respiratory signals drive the process of sorting, matching, and combining the two k-space streams for each respiratory bin, thereby achieving faster image acquisition without substantial motion artifacts. This study was the first that investigates the impact of k-space undersampling on lung tumor motion and area assessment across clinically available techniques (zero-filling and conventional keyhole). In this study, the dynamic keyhole, conventional keyhole and zero-filling methods were compared to full k-space dataset acquisition by quantifying (1) the keyhole size required for central k-space datasets for constant image quality across sixty four cine-MRI datasets from nine lung cancer patients, (2) the intensity difference between the original and reconstructed images in a constant keyhole size, and (3) the accuracy of tumor motion and area directly measured by tumor autocontouring. Results: For constant image quality, the dynamic keyhole method, conventional keyhole, and zero-filling methods required 22%, 34%, and 49% of the keyhole size (P < 0.0001), respectively, compared to the full k-space image acquisition method. Compared to the conventional keyhole and zero-filling reconstructed images with the keyhole size utilized in the dynamic keyhole method, an average intensity difference of the dynamic keyhole reconstructed images (P < 0.0001) was minimal, and resulted in the accuracy of tumor motion within 99.6% (P < 0.0001) and the accuracy of tumor area within 98.0% (P < 0.0001) for lung tumor monitoring applications. Conclusions: This study demonstrates that the dynamic keyhole method is a promising technique for clinical applications such as image-guided radiation therapy requiring the MR monitoring of thoracic tumors. Based on the results from this study, the dynamic keyhole method could increase the imaging frequency by up to a factor of five compared with full k-space methods for real-time lung tumor MRI.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

4D-CT scans reveal reduced magnitude of respiratory liver motion achieved by different abdominal compression plate positions in patients with intrahepatic tumors undergoing helical tomotherapy

Purpose: While abdominal compression (AC) can be used to reduce respiratory liver motion in patients receiving helical tomotherapy for hepatocellular carcinoma, the nature and extent of this effect is not well described. The purpose of this study was to evaluate the changes in magnitude of three-dimensional liver motion with abdominal compression using four-dimensional (4D) computed tomography (CT) images of several plate positions. Methods: From January 2012 to October 2015, 72 patients with intrahepatic carcinoma and divided into four groups underwent 4D-CT scans to assess respiratory liver motion. Of the 72 patients, 19 underwent abdominal compression of the cephalic area between the subxiphoid and umbilicus (group A), 16 underwent abdominal compression of the caudal region between the subxiphoid area and the umbilicus (group B), 11 patients underwent abdominal compression of the caudal umbilicus (group C), and 26 patients remained free breathing (group D). 4D-CT images were sorted into ten-image series, according to the respiratory phase from the end inspiration to the end expiration, and then transferred to treatment planning software. All liver contours were drawn by a single physician and confirmed by a second physician. Liver relative coordinates were automatically generated to calculate the liver respiratory motion in different axial directions to compile the 10 ten contours into a single composite image. Differences in respiratory liver motion were assessed with a one-way analysis of variance test of significance. Results: The average respiratory liver motion in the Y axial direction was 4.53 ± 1.16, 7.56 ± 1.30, 9.95 ± 2.32, and 9.53 ± 2.62 mm in groups A, B, C, and D, respectively, with a significant change among the four groups (p < 0.001). Abdominal compression was most effective in group A (compression plate on the subxiphoid area), with liver displacement being 2.53 ± 0.93, 4.53 ± 1.16, and 2.14 ± 0.92 mm on the X-, Y-, and Z-axes, respectively. There was no significant difference in respiratory liver motion between group C (displacement: 3.23 ± 1.47, 9.95 ± 2.32, and 2.92 ± 1.10 mm on the X-, Y-, and Z-axes, respectively) and group D (displacement: 3.35 ± 1.55, 9.53 ± 2.62, and 3.35 ± 1.73 mm on the X-, Y-, and Z-axes, respectively). Abdominal compression was least effective in group C (compression on caudal umbilicus), with liver motion in this group similar to that of free-breathing patients (group D). Conclusions: 4D-CT scans revealed significant liver motion control via abdominal compression of the subxiphoid area; however, this control of liver motion was not observed with compression of the caudal umbilicus. The authors, therefore, recommend compression of the subxiphoid area in patients undergoing external radiotherapy for intrahepatic carcinoma.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-D-207A-07: The Effects of Inter-Cycle Respiratory Motion Variation On Dose Accumulation in Single Fraction MR-Guided SBRT Treatment of Renal Cell Carcinoma

Purpose: To assess the dose deposition in simulated single-fraction MR-Linac treatments of renal cell carcinoma, when inter-cycle respiratory motion variation is taken into account using online MRI. Methods: Three motion characterization methods, with increasing complexity, were compared to evaluate the effect of inter-cycle motion variation and drifts on the accumulated dose for an SBRT kidney MR-Linac treatment: 1) STATIC, in which static anatomy was assumed, 2) AVG-RESP, in which 4D-MRI phase-volumes were time-weighted, based on the respiratory phase and 3) PCA, in which 3D volumes were generated using a PCA-model, enabling the detection of inter-cycle variations and drifts. An experimental ITV-based kidney treatment was simulated in a 1.5T magnetic field on three volunteer datasets. For each volunteer a retrospectively sorted 4D-MRI (ten respiratory phases) and fast 2D cine-MR images (temporal resolution = 476ms) were acquired to simulate MR-imaging during radiation. For each method, the high spatio-temporal resolution 3D volumes were non-rigidly registered to obtain deformation vector fields (DVFs). Using the DVFs, pseudo-CTs (generated from the 4D-MRI) were deformed and the dose was accumulated for the entire treatment. The accuracies of all methods were independently determined using an additional, orthogonal 2D-MRI slice. Results: Motion was most accurately estimated using the PCA method, which correctly estimated drifts and inter-cycle variations (RMSE=3.2, 2.2, 1.1mm on average for STATIC, AVG-RESP and PCA, compared to the 2DMRI slice). Dose-volume parameters on the ITV showed moderate changes (D99=35.2, 32.5, 33.8Gy for STATIC, AVG-RESP and PCA). AVG-RESP showed distinct hot/cold spots outside the ITV margin, which were more distributed for the PCA scenario, since inter-cycle variations were not modeled by the AVG-RESP method. Conclusion: Dose differences were observed when inter-cycle variations were taken into account. The increased inter-cycle randomness in motion as captured by the PCA model mitigates the local (erroneous) hotspots estimated by the AVG-RESP method.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-P-32: A Phantom Study of Accuracy of Four-Dimensional Cone-Beam CT (4D-CBCT) Vs. Three-Dimensional Cone Beam CT (3D-CBCT) in Image Guided Radiotherapy

Purpose: SymmetryTM 4D IGRT system of Elekta has been installed at our institution, which offers the 4D CBCT registration option. This study is to evaluate the accuracy of 4D CBCT system by using the CIRS 4D motion phantom and to perform a feasibility study on the implementation of 4D-CBCT as image guidance for SBRT treatment. Methods: The 3D and 4D CT image data sets are acquired using the CIRS motion phantom on a Philips large bore CT simulator. The motion was set as 0.5 cm superior and inferior directions with 6 seconds recycle time. The 4D CT data were sorted as 10 phases. One identifiable part of the 4D CT QA insert from CIRS phantom was used as the target. The ITV MIP was drawn based on maximum intensity projection (MIP) and transferred as a planning structure into 4D CBCT system. Then the 3D CBCT and 4D CBCT images were taken and registered with the free breath (3D), MIP (4D) and average intensity projection (AIP)(4D) reference data sets. The couch shifts (X, Y, Z) are recorded and compared. Results: Table 1 listed the twelve couch shifts based on the registration of MIP, AIP and free breath CT data sets with 3D CBCT and 4D CBCT for both whole body and local registration. X, Y and Z represent couch shifts in the direction of the right-left, superior-inferior and anterior-posterior. The biggest differences of 0.73 cm and 0.57 cm are noted in the free breath CT data with 4D CBCT and 3D CBCT data registration. Fig. 1 and Fig. 2 are the shift analysis in diagram. Fig. 3 shows the registration. Conclusion: Significant differences exist in the shifts corresponding with the direction of target motion. Further investigations are ongoing.

60 APPLIED LIFE SCIENCES↗