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At least 919 records · Page 51
All sourcesNASA NTRSDOE OSTI
DOE OSTI2015

SU-E-T-152: Building An Ultrafast, Earthquake Proof Treatment Planning System

Purpose: Situated 20 miles from 5 major fault lines in California’s Bay Area, Stanford Universityhas a critical need for IT infrastructure planning to handle the high probability devastating earthquakes. Recently, a multi-million dollar project has been underway to overhaul Stanford’s radiation oncology information systems, maximizing planning system performance and providing true disaster recovery abilities. An overview of the project will be given with particular focus on lessons learned throughout the build. Methods: In this implementation, two isolated external datacenters provide geographical redundancy to Stanford’s main campus datacenter. Real-time mirroring is made of all data stored to our serial attached network (SAN) storage. In each datacenter, hardware/software virtualization was heavily implemented to maximize server efficiency and provide a robust mechanism to seamlessly migrate users in the event of an earthquake. System performance is routinely assessed through the use of virtualized data robots, able to log in to the system at scheduled times, perform routine planning tasks and report timing results to a performance dashboard. A substantial dose calculation framework (608 CPU cores) has been constructed as part of the implementation. Results: Migration to a virtualized server environment with a high performance SAN has resulted in up to a 45% speed up of common treatment planning tasks. Switching to a 608 core DCF has resulted in a 280% speed increase in dose calculations. Server tuning was found to further improved read/write performance by 20%. Disaster recovery tests are carried out quarterly and, although successful, remain time consuming to perform and verify functionality. Conclusion: Achieving true disaster recovery capabilities is possible through server virtualization, support from skilled IT staff and leadership. Substantial performance improvements are also achievable through careful tuning of server resources and disk read/write operations. Developing a streamlined method to comprehensively test failover is a key requirement to the system’s success.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-258: Development of a New Patient Set-Up Monitoring System Using Force Sensing Resistor (FSR) Sensor for the Radiation Therapy

Purpose: The purpose of this work is to develop a new patient set-up monitoring system using force sensing resistor (FSR) sensors that can confirm pressure of contact surface and evaluate its feasibility. Methods: In this study, we focused on develop the patient set-up monitoring system to compensate for the limitation of existing optical based monitoring system, so the developed system can inform motion in the radiation therapy. The set-up monitoring system was designed consisting of sensor units (FSR sensor), signal conditioning devices (USB cable/interface electronics), a control PC, and a developed analysis software. The sensor unit was made by attaching FSR sensor and dispersing pressure sponge to prevent error which is caused by concentrating specific point. Measured signal from the FSR sensor was sampled to arduino mega 2560 microcontroller, transferred to control PC by using serial communication. The measured data went through normalization process. The normalized data was displayed through the developed graphic user interface (GUI) software. The software was designed to display a single sensor unit intensity (maximum 16 sensors) and display 2D pressure distribution (using 16 sensors) according to the purpose. Results: Changes of pressure value according to motion was confirmed by the developed set-up monitoring system. Very small movement such as little physical change in appearance can be confirmed using a single unit and using 2D pressure distribution. Also, the set-up monitoring system can observe in real time. Conclusion: In this study, we developed the new set-up monitoring system using FSR sensor. Especially, we expect that the new set-up monitoring system is suitable for motion monitoring of blind area that is hard to confirm existing optical system and compensate existing optical based monitoring system. As a further study, an integrated system will be constructed through correlation of existing optical monitoring system. This work was supported by the Industrial R&D program of MOTIE/KEIT. [10048997, Development of the core technology for integrated therapy devices based on real-time MRI guided tumor tracking] and the Mid-career Researcher Program (2014R1A2A1A10050270) through the National Research Foundation of Korea funded by the Ministry of Science, ICT&Future Planning.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-564: Multi-Helix Rotating Shield Brachytherapy for Cervical Cancer

Purpose: To present a novel and practical brachytherapy technique, called multi-helix rotating shield brachytherapy (H-RSBT), for the precise positioning of a partial shield in a curved applicator. H-RSBT enables RSBT delivery using only translational motion of the radiation source/shield combination. H-RSBT overcomes the challenges associated with previously proposed RSBT approaches based on a serial (S-RSBT) step-and-shoot delivery technique, which required independent translational and rotational motion. Methods: A Fletcher-type applicator, compatible with the combination of a Xoft Axxent™ electronic brachytherapy source and a 0.5 mm thick tungsten shield, is proposed. The wall of the applicator contains six evenly-spaced helical keyways that rigidly define the emission direction of the shield as a function of depth. The shield contains three protruding keys and is attached to the source such that it rotates freely. S-RSBT and H-RSBT treatment plans with 180° and 45° azimuthal emission angles were generated for five cervical cancer patients representative of a wide range of high-risk clinical target volume (HR-CTV) shapes and applicator positions. The number of beamlets used in the treatment planning process was nearly constant for S-RSBT and H-RSBT by using dwell positions separated by 5 and 1.7 mm, respectively, and emission directions separated by 22.5° and 60°, respectively. For all the treatment plans the EQD2 of the HR-CTV was escalated until the EQD{sub 2cc} tolerance of either the bladder, rectum, or sigmoid colon was reached. Results: Treatment times for H-RSBT tended to be shorter than for S-RSBT, with changes of −38.47% to 1.12% with an average of −8.34%. The HR-CTV D{sub 90} changed by −8.81% to 2.08% with an average of −2.46%. Conclusion: H-RSBT is a mechanically feasible technique in the curved applicators needed for cervical cancer brachytherapy. S-RSBT and H-RSBT dose distributions were clinically equivalent for all patients considered, with the H-RSBT deliveries tending to be faster. Ryan Flynn has ownership interest in pxAlpha, LLC, which is a startup company developing a rotating shield brachytherapy system.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2015

MO-DE-BRA-05: Developing Effective Medical Physics Knowledge Structures: Models and Methods

Purpose: Develop a method and supporting online resources to be used by medical physics educators for teaching medical imaging professionals and trainees so they develop highly-effective physics knowledge structures that can contribute to improved diagnostic image quality on a global basis. Methods: The different types of mental knowledge structures were analyzed and modeled with respect to both the learning and teaching process for their development and the functions or tasks that can be performed with the knowledge. While symbolic verbal and mathematical knowledge structures are very important in medical physics for many purposes, the tasks of applying physics in clinical imaging--especially to optimize image quality and diagnostic accuracy--requires a sensory conceptual knowledge structure, specifically, an interconnected network of visually based concepts. This type of knowledge supports tasks such as analysis, evaluation, problem solving, interacting, and creating solutions. Traditional educational methods including lectures, online modules, and many texts are serial procedures and limited with respect to developing interconnected conceptual networks. A method consisting of the synergistic combination of on-site medical physics teachers and the online resource, CONET (Concept network developer), has been developed and made available for the topic Radiographic Image Quality. This was selected as the inaugural topic, others to follow, because it can be used by medical physicists teaching the large population of medical imaging professionals, such as radiology residents, who can apply the knowledge. Results: Tutorials for medical physics educators on developing effective knowledge structures are being presented and published and CONET is available with open access for all to use. Conclusion: An adjunct to traditional medical physics educational methods with the added focus on sensory concept development provides opportunities for medical physics teachers to share their knowledge and experience at a higher cognitive level and produce medical professionals with the enhanced ability to apply physics to clinical procedures.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

TU-CD-BRB-05: Radiation Damage Signature of White Matter Fiber Bundles Using Diffusion Tensor Imaging (DTI)

Purpose: To develop an automated and scalable approach and identify temporal, spatial and dosimetric patterns of radiation damage of white matter (WM) fibers following partial brain irradiation. Methods: An automated and scalable approach was developed to extract DTI features of 22 major WM fibers from 33 patients with low-grade/benign tumors treated by radiation therapy (RT). DTI scans of the patients were performed pre-RT, 3- and 6-week during RT, and 1, 6 and 18 months after RT. The automated tractography analysis was applied to 198 datasets as: (1) intra-subject registration of longitudinal DTI, (2) spatial normalization of individual-patient DTI to the Johns Hopkins WM Atlas, (3) automatic fiber tracking regulated by the WM Atlas, and (4) segmentation of WM into 22 major tract profiles. Longitudinal percentage changes in fractional anisotropy (FA), and mean, axial and radial diffusivity (MD/AD/RD) of each tract from pre-RT were quantified and correlated to 95%, 90% and 80% percentiles of doses and mean doses received by the tract. Heatmaps were used to identify clusters of significant correlation and reveal temporal, spatial and dosimetric signatures of WM damage. A multivariate linear regression was further carried out to determine influence of clinical factors. Results: Of 22 tracts, AD/MD changes in 12 tracts had significant correlation with doses, especially at 6 and 18 months post-RT, indicating progressive radiation damage after RT. Most interestingly, the DTI-index changes in the elongated tracts were associated with received maximum doses, suggesting a serial-structure behavior; while short association fibers were affected by mean doses, indicating a parallel-structure response. Conclusion: Using an automated DTI-tractography analysis of whole brain WM fibers, we reveal complex radiation damage patterns of WM fibers. Damage in WM fibers that play an important role in the neural network could be associated with late neurocognitive function declines after brain irradiation. NIH NS064973.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

TU-G-204-03: Dynamic CT Myocardial Perfusion Measurement Using First Pass Analysis and Maximum Slope Models

Purpose: To evaluate the accuracy of dynamic CT myocardial perfusion measurement using first pass analysis (FPA) and maximum slope models. Methods: A swine animal model was prepared by percutaneous advancement of an angioplasty balloon into the proximal left anterior descending (LAD) coronary artery to induce varying degrees of stenosis. Maximal hyperaemia was achieved in the LAD with an intracoronary adenosine drip (240 µg/min). Serial microsphere and contrast (370 mg/mL iodine, 30 mL, 5mL/s) injections were made over a range of induced stenoses, and dynamic imaging was performed using a 320-row CT scanner at 100 kVp and 200 mA. The FPA CT perfusion technique was used to make vessel-specific myocardial perfusion measurements. CT perfusion measurements using the FPA and maximum slope models were validated using colored microspheres as the reference gold standard. Results: Perfusion measurements using the FPA technique (P-FPA) showed good correlation with minimal offset when compared to perfusion measurements using microspheres (P- Micro) as the reference standard (P -FPA = 0.96 P-Micro + 0.05, R{sup 2} = 0.97, RMSE = 0.19 mL/min/g). In contrast, the maximum slope model technique (P-MS) was shown to underestimate perfusion when compared to microsphere perfusion measurements (P-MS = 0.42 P -Micro −0.48, R{sup 2} = 0.94, RMSE = 3.3 mL/min/g). Conclusion: The results indicate the potential for significant improvements in accuracy of dynamic CT myocardial perfusion measurement using the first pass analysis technique as compared with the standard maximum slope model.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

Liver 4DMRI: A retrospective image-based sorting method

Purpose: Four-dimensional magnetic resonance imaging (4DMRI) is an emerging technique in radiotherapy treatment planning for organ motion quantification. In this paper, the authors present a novel 4DMRI retrospective image-based sorting method, providing reduced motion artifacts than using a standard monodimensional external respiratory surrogate. Methods: Serial interleaved 2D multislice MRI data were acquired from 24 liver cases (6 volunteers + 18 patients) to test the proposed 4DMRI sorting. Image similarity based on mutual information was applied to automatically identify a stable reference phase and sort the image sequence retrospectively, without the use of additional image or surrogate data to describe breathing motion. Results: The image-based 4DMRI provided a smoother liver profile than that obtained from standard resorting based on an external surrogate. Reduced motion artifacts were observed in image-based 4DMRI datasets with a fitting error of the liver profile measuring 1.2 ± 0.9 mm (median ± interquartile range) vs 2.1 ± 1.7 mm of the standard method. Conclusions: The authors present a novel methodology to derive a patient-specific 4DMRI model to describe organ motion due to breathing, with improved image quality in 4D reconstruction.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

Determinants of the reliability of ultrasound tomography sound speed estimates as a surrogate for volumetric breast density

Purpose: High breast density, as measured by mammography, is associated with increased breast cancer risk, but standard methods of assessment have limitations including 2D representation of breast tissue, distortion due to breast compression, and use of ionizing radiation. Ultrasound tomography (UST) is a novel imaging method that averts these limitations and uses sound speed measures rather than x-ray imaging to estimate breast density. The authors evaluated the reproducibility of measures of speed of sound and changes in this parameter using UST. Methods: One experienced and five newly trained raters measured sound speed in serial UST scans for 22 women (two scans per person) to assess inter-rater reliability. Intrarater reliability was assessed for four raters. A random effects model was used to calculate the percent variation in sound speed and change in sound speed attributable to subject, scan, rater, and repeat reads. The authors estimated the intraclass correlation coefficients (ICCs) for these measures based on data from the authors’ experienced rater. Results: Median (range) time between baseline and follow-up UST scans was five (1–13) months. Contributions of factors to sound speed variance were differences between subjects (86.0%), baseline versus follow-up scans (7.5%), inter-rater evaluations (1.1%), and intrarater reproducibility (∼0%). When evaluating change in sound speed between scans, 2.7% and ∼0% of variation were attributed to inter- and intrarater variation, respectively. For the experienced rater’s repeat reads, agreement for sound speed was excellent (ICC = 93.4%) and for change in sound speed substantial (ICC = 70.4%), indicating very good reproducibility of these measures. Conclusions: UST provided highly reproducible sound speed measurements, which reflect breast density, suggesting that UST has utility in sensitively assessing change in density.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

Multihelix rotating shield brachytherapy for cervical cancer

Purpose: To present a novel brachytherapy technique, called multihelix rotating shield brachytherapy (H-RSBT), for the precise angular and linear positioning of a partial shield in a curved applicator. H-RSBT mechanically enables the dose delivery using only linear translational motion of the radiation source/shield combination. The previously proposed approach of serial rotating shield brachytherapy (S-RSBT), in which the partial shield is rotated to several angular positions at each source dwell position [W. Yang et al., “Rotating-shield brachytherapy for cervical cancer,” Phys. Med. Biol. 58, 3931–3941 (2013)], is mechanically challenging to implement in a curved applicator, and H-RSBT is proposed as a feasible solution. Methods: A Henschke-type applicator, designed for an electronic brachytherapy source (Xoft Axxent™) and a 0.5 mm thick tungsten partial shield with 180° or 45° azimuthal emission angles and 116° asymmetric zenith angle, is proposed. The interior wall of the applicator contains six evenly spaced helical keyways that rigidly define the emission direction of the partial radiation shield as a function of depth in the applicator. The shield contains three uniformly distributed protruding keys on its exterior wall and is attached to the source such that it rotates freely, thus longitudinal translational motion of the source is transferred to rotational motion of the shield. S-RSBT and H-RSBT treatment plans with 180° and 45° azimuthal emission angles were generated for five cervical cancer patients with a diverse range of high-risk target volume (HR-CTV) shapes and applicator positions. For each patient, the total number of emission angles was held nearly constant for S-RSBT and H-RSBT by using dwell positions separated by 5 and 1.7 mm, respectively, and emission directions separated by 22.5° and 60°, respectively. Treatment delivery time and tumor coverage (D{sub 90} of HR-CTV) were the two metrics used as the basis for evaluation and comparison. For all the generated treatment plans, the D{sub 90} of the HR-CTV in units of equivalent dose in 2 Gy fractions (EQD2) was escalated until the D{sub 2cc} (minimum dose to hottest 2 cm{sup 3}) tolerance of either the bladder (90 Gy{sub 3}), rectum (75 Gy{sub 3}), or sigmoid colon (75 Gy{sub 3}) was reached. Results: Treatment time changed for H-RSBT versus S-RSBT by −7.62% to 1.17% with an average change of −2.8%, thus H-RSBT treatments times tended to be shorter than for S-RSBT. The HR-CTV D{sub 90} also changed by −2.7% to 2.38% with an average of −0.65%. Conclusions: H-RSBT is a mechanically feasible delivery technique for use in the curved applicators needed for cervical cancer brachytherapy. S-RSBT and H-RSBT were clinically equivalent for all patients considered, with the H-RSBT technique tending to require less time for delivery.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-C-BRB-01: Automated Dose Deformation for Re-Irradiation

Purpose: An objective of retreatment planning is to minimize dose to previously irradiated tissues. Conventional retreatment planning is based largely on best-guess superposition of the previous treatment’s isodose lines. In this study, we report a rigorous, automated retreatment planning process to minimize dose to previously irradiated organs at risk (OAR). Methods: Data for representative patients previously treated using helical tomotherapy and later retreated in the vicinity of the original disease site were retrospectively analyzed in an automated fashion using a prototype treatment planning system equipped with a retreatment planning module (Accuray, Inc.). The initial plan’s CT, structures, and planned dose were input along with the retreatment CT and structure set. Using a deformable registration algorithm implemented in the module, the initially planned dose and structures were warped onto the retreatment CT. An integrated third-party sourced software (MIM, Inc.) was used to evaluate registration quality and to contour overlapping regions between isodose lines and OARs, providing additional constraints during retreatment planning. The resulting plan and the conventionally generated retreatment plan were compared. Results: Jacobian maps showed good quality registration between the initial plan and retreatment CTs. For a right orbit case, the dose deformation facilitated delineating the regions of the eyes and optic chiasm originally receiving 13 to 42 Gy. Using these regions as dose constraints, the new retreatment plan resulted in V50 reduction of 28% for the right eye and 8% for the optic chiasm, relative to the conventional plan. Meanwhile, differences in the PTV dose coverage were clinically insignificant. Conclusion: Automated retreatment planning with dose deformation and definition of previously-irradiated regions allowed for additional planning constraints to be defined to minimize re-irradiation of OARs. For serial organs that do not recover from radiation damage, this method provides a more precise and quantitative means to limit cumulative dose. This research is partially supported by Accuray, Inc.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-D-204-05: Fitting Four NTCP Models to Treatment Outcome Data of Salivary Glands Recorded Six Months After Radiation Therapy for Head and Neck Tumors

Purpose: To estimate the radiobiological parameters of four popular NTCP models that describe the dose-response relations of salivary glands to the severity of patient reported dry mouth 6 months post chemo-radiotherapy. To identify the glands, which best correlate with the manifestation of those clinical endpoints. Finally, to evaluate the goodness-of-fit of the NTCP models. Methods: Forty-three patients were treated on a prospective multiinstitutional phase II study for oropharyngeal squamous cell carcinoma. All the patients received 60 Gy IMRT and they reported symptoms using the novel patient reported outcome version of the CTCAE. We derived the individual patient dosimetric data of the parotid and submandibular glands (SMG) as separate structures as well as combinations. The Lyman-Kutcher-Burman (LKB), Relative Seriality (RS), Logit and Relative Logit (RL) NTCP models were used to fit the patients data. The fitting of the different models was assessed through the area under the receiver operating characteristic curve (AUC) and the Odds Ratio methods. Results: The AUC values were highest for the contralateral parotid for Grade ≥ 2 (0.762 for the LKB, RS, Logit and 0.753 for the RL). For the salivary glands the AUC values were: 0.725 for the LKB, RS, Logit and 0.721 for the RL. For the contralateral SMG the AUC values were: 0.721 for LKB, 0.714 for Logit and 0.712 for RS and RL. The Odds Ratio for the contralateral parotid was 5.8 (1.3–25.5) for all the four NTCP models for the radiobiological dose threshold of 21Gy. Conclusion: It was shown that all the examined NTCP models could fit the clinical data well with very similar accuracy. The contralateral parotid gland appears to correlated best with the clinical endpoints of severe/very severe dry mouth. An EQD2Gy dose of 21Gy appears to be a safe threshold to be used as a constraint in treatment planning.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-J-84: Comparison of Quantitative Deformable Image Registration Evaluation Tools: Application to Prostate IGART

Purpose: Errors in displacement vector fields (DVFs) generated by Deformable Image Registration (DIR) algorithms can give rise to significant uncertainties in contour propagation and dose accumulation in Image-Guided Adaptive Radiotherapy (IGART). The purpose of this work is to assess the accuracy of two DIR algorithms using a variety of quality metrics for prostate IGART. Methods: Pelvic CT images were selected from an anonymized database of nineteen prostate patients who underwent 8–12 serial scans during radiotherapy. Prostate, bladder, and rectum were contoured on 34 image-sets for three patients by the same physician. The planning CT was deformably-registered to daily CT using three variants of the Small deformation Inverse Consistent Linear Elastic (SICLE) algorithm: Grayscale-driven (G), Contour-driven (C, which utilizes segmented structures to drive DIR), combined (G+C); and also grayscale ITK demons (Gd). The accuracy of G, C, G+C SICLE and Gd registrations were evaluated using a new metric Edge Gradient Distance to Agreement (EGDTA) and other commonly-used metrics such as Pearson Correlation Coefficient (PCC), Dice Similarity Index (DSI) and Hausdorff Distance (HD). Results: C and G+C demonstrated much better performance at organ boundaries, revealing the lowest HD and highest DSI, in prostate, bladder and rectum. G+C demonstrated the lowest mean EGDTA (1.14 mm), which corresponds to highest registration quality, compared to G and C DVFs (1.16 and 2.34 mm). However, demons DIR showed the best overall performance, revealing lowest EGDTA (0.73 mm) and highest PCC (0.85). Conclusion: As expected, both C- and C+G SICLE more accurately reproduce manually-contoured target datasets than G-SICLE or Gd using HD and DSI metrics. In general, the Gd appears to have difficulty reproducing large daily position and shape changes in the rectum and bladder. However, Gd outperforms SICLE in terms of EGDTA and PCC metrics, possibly at the expense of topological quality of the estimated DVFs.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-T-43: Prediction of Dose Increments by Brain Metastases Resection Cavity Shrinkage Model with I-125 and Cs-131 LDR Seed Implantations

Purpose: This work aims to determine dose variability via a brain metastases resection cavity shrinkage model (RC-SM) with I-125 or Cs-131 LDR seed implantations. Methods: The RC-SM was developed to represent sequential volume changes of 95 consecutive brain metastases patients. All patients underwent serial surveillance MR and change in cavity volume was recorded for each patient. For the initial resection cavity, a prolate-ellipsoid cavity model was suggested and applied volume shrinkage rates to correspond to 1.7, 3.6, 5.9, 11.7, and 20.5 months after craniotomy. Extra-ring structure (6mm) was added on a surface of the resection volume and the same shrinkage rates were applied. Total 31 LDR seeds were evenly distributed on the surface of the resection cavity. The Amersham 6711 I-125 seed model (Oncura, Arlington Heights, IL) and the Model Cs-1 Rev2 Cs-131 seed model (IsoRay, Richland, WA) were used for TG-43U1 dose calculation and in-house-programed 3D-volumetric dose calculation system was used for resection cavity rigid model (RC-RM) and the RC-SM dose calculation. Results: The initial resection cavity volume shrunk to 25±6%, 35±6.8%, 42±7.7%, 47±9.5%, and 60±11.6%, with respect to sequential MR images post craniotomy, and the shrinkage rate (SR) was calculated as SR=56.41Xexp(−0.2024Xt)+33.99 and R-square value was 0.98. The normal brain dose as assessed via the dose to the ring structure with the RC-SM showed 29.34% and 27.95% higher than the RC-RM, I-125 and Cs-131, respectively. The dose differences between I-125 and Cs-131 seeds within the same models, I-125 cases were 9.17% and 10.35% higher than Cs-131 cases, the RC-RM and the RC-SM, respectively. Conclusion: A realistic RC-SM should be considered during LDR brain seed implementation and post-implement planning to prevent potential overdose. The RC-SM calculation shows that Cs-131 is more advantageous in sparing normal brain as the resection cavity volume changes with the LDR seeds implementation.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-T-94: Plan2pdf - a Software Tool for Automatic Plan Report for Philips Pinnacle TPS

Purpose: To implement an automatic electronic PDF plan reporting tool for Philips Pinnacle treatment planning system (TPS) Methods: An electronic treatment plan reporting software is developed by us to enable fully automatic PDF report from Pinnacle TPS to external EMR programs such as MOSAIQ. The tool is named “plan2pdf”. plan2pdf is implemented using Pinnacle scripts, Java and UNIX shell scripts, without any external program needed. plan2pdf supports full auto-mode and manual mode reporting. In full auto-mode, with a single mouse click, plan2pdf will generate a detailed Pinnacle plan report in PDF format, which includes customizable cover page, Pinnacle plan summary, orthogonal views through each plan POI and maximum dose point, DRR for each beam, serial transverse views captured throughout the dose grid at a user specified interval, DVH and scorecard windows. The final PDF report is also automatically bookmarked for each section above for convenient plan review. The final PDF report can either be saved on a user specified folder on Pinnacle, or it can be automatically exported to an EMR import folder via a user configured FTP service. In manual capture mode, plan2pdf allows users to capture any Pinnacle plan by full screen, individual window or rectangular ROI drawn on screen. Furthermore, to avoid possible patients’ plan mix-up during auto-mode reporting, a user conflict check feature is included in plan2pdf: it prompts user to wait if another patient is being exported by plan2pdf by another user. Results: plan2pdf is tested extensively and successfully at our institution consists of 5 centers, 15 dosimetrists and 10 physicists, running Pinnacle version 9.10 on Enterprise servers. Conclusion: plan2pdf provides a highly efficient, user friendly and clinical proven platform for all Philips Pinnacle users, to generate a detailed plan report in PDF format for external EMR systems.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-T-104: Determining the NTCP Parameters of Pharyngeal Constrictors and Proximal Esophagus for Radiation Induced Swallowing Problems Recorded Six Months After Radiation Therapy for Head and Neck Tumors

Purpose: To estimate the radiobiological parameters of four NTCP models that describe the dose-response relations of pharyngeal constrictors and proximal esophagus regarding the severity of patient reported swallowing problems 6 months post chemo-radiotherapy. To identify the section/structure that best correlates with the manifestation of the clinical endpoints. Finally, to compare the goodness-of-fit of those models. Methods: Forty-three patients were treated on a prospective multi-institutional phase II study for oropharyngeal squamous cell carcinoma. All the patients received 60 Gy IMRT and they reported symptoms using the novel patient reported outcome version of the CTCAE. We derived the individual patient dosimetric data of superior, medium and inferior sections of pharyngeal constrictors (SPC, MPC and IPC), superior and inferior sections of esophagus (SES and IES) as separate structures as well as combinations. The Lyman-Kutcher-Burman (LKB), Relative Seriality (RS), Logit and Relative Logit (RL) NTCP models were used to fit the patient data. The fitting of the different models was assessed through the area under the receiver operating characteristic curve (AUC) and the Odds Ratio methods. Results: The AUC values were highest for the SPC for Grade ≥ 2 (0.719 for the RS and RL models, and 0.716 for LKB and Logit). For Grade ≥ 1, the respective values were 0.699 for RS, LKB and Logit and 0.676 for RL. For MPC the AUC values varied between 0.463–0.477, for IPC between 0.396–0.458, for SES between 0.556–0.613 and for IES between 0.410–0.519. The Odds Ratio for the SPC was 15.6 (1.7–146.4) for RS, LKB and Logit for NTCP of 55%. Conclusion: All the examined NTCP models could fit the clinical data with similar accuracy. The SPC appear to correlate best with the clinical endpoints of swallowing problems. A prospective study could establish the use of NTCP values of SPC as a constraint in treatment planning.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-T-451: Doses to Organs-At-Risk in the Presence and Absence of a 1.5 T Magnetic Field for NSCLC Patients Undergoing SABR

Purpose: To determine whether the electron return effect (ERE) has deleterious effects on lung SABR plans optimized in the presence of an orthogonal 1.5 T magnetic field. Methods: Data from five NSCLC-SABR patients were used. The Dose was modeled with a 2.5 mm dose grid in the presence and absence of a magnetic field using the Monaco (Elekta) TPS with the Monte Carlo GPUMCD (v5.1) algorithm. For each patient, two plans were generated, one using our conventional Elekta Agility linac beam model and another using the Elekta MRI Linac (MRL) model. Both plans were generated on the average CT using similar dose constraints and a 5 mm PTV. The optimization was performed using our clinic’s planning criteria, with normalization of the targets such that their V99% was equal to 99%. The OAR DVHs were compared for each patient. Results: The DVH plots revealed that there were limited differences when optimizing plans in the presence or absence of the magnetic field. The mean of the absolute differences, between the two planning types, in the equivalent uniform doses (EUDs) for the OARs were: 0.3 Gy (range of 0.0 - 1.0 Gy) for the esophagus, 0.6 Gy (range of 0.1 – 1.9 Gy) for the heart, 0.5 Gy (range of 0.2 – 0.8 Gy) for the lungs, and 0.6 Gy (range of 0.2 – 1.5 Gy) for the spinal canal. Regarding the maximum doses to the serial organs, the mean of the differences were 3.0 Gy (esophagus) and 0.9 Gy (spinal canal). No trends in the differences were observed. Conclusion: This study has demonstrated that there were no major differences between plans optimized using a conventional linac and those optimized using an MRI linac with an orthogonal 1.5 T magnetic field. This is attributed to the consideration of the ERE in the optimization. This project was made possible with the financial support of Elekta.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-G-206-08: How Should Focal Spot Be Chosen for Optimized CT Imaging with Dose Modulation?

Purpose: To choose the preferred focal spot for achieving optimized CT image quality with balanced tube heating considerations. Methods: An anthropomorphic pelvic phantom was scanned using a GE Discovery CT750 HD at 120 and 140kVp, 0.8s rotation time, and pitch of 0.984. “Smart mA” was enabled to simulate a routine abdomen–pelvis CT scan. Permissible mA values at 120 and 140 kVp were obtained from the Serial Load Rating table (for mimicking a busy CT clinical operation) in the scanner Technical Reference Manual. At each kVp station and two Noise Index levels, the mA Upper Limit was set above/below the permissible mA values. Scanned mA values and focal spot (FS) used were obtained from the DICOM header of each image, and the FS-mA relationship was analyzed. For visual confirmation beyond recorded FS information, a CatPhan with a fat-ring attached for mimicking patient size/shape was scanned at 120kVp. A group of radiologists/physicists compared a pair of CatPhan images qualitatively. Lastly, a number of patient cases were evaluated to confirm the FS-mA relationship. Results: When preset Upper Limit values were above the permissible mA values, the Large FS (labeled 1.2) was used in scans, even if the maximum scanned mA values were much lower than the permissible values at both 120 and 140 kVp. Otherwise the Small FS (labeled 0.7) was used. Visual evaluation of the high contrast module of CatPhan and additional analysis of patient cases further confirmed that the preset Upper Limit determines which focal spot is to be used, not the actual maximum mA value to be scanned. Conclusion: Specific FS can be selected by setting up appropriate mA Upper Limit in a protocol. CT protocols could be optimized by selecting appropriate FS for improving patient image quality, especially benefiting the small size and pediatric patients.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

MO-FG-CAMPUS-TeP2-02: First Experiences and Perspectives in Using Direct Multicriteria Optimization (MCO) On Volumetric-Modulated Arc Therapy (VMAT) for Head and Neck Cancer

Purpose: To report the first experiences and perspectives in using direct multicriteria optimization (MCO) on volumetric-modulated arc therapy (VMAT) for head and neck (H&N) cancer. Methods: Ten prior patients with tumors in representative H&N regions were selected to evaluate direct MCO-VMAT in RayStation v5.0 beta. The patients were previously treated by intensity-modulated radiation therapy (IMRT) with MCO on an Elekta linear accelerator with Agility multileaf collimator. To avoid radiating eyes and shoulders, MCO-VMAT required one to three partial-arc groups, with each group consisting of single or dual arcs. All MCO-VMAT plans were approved by a radiation oncologist. The MCO-VMAT and MCO-IMRT plans were compared using V{sub 100}, D{sub 5}, homogeneity index (HI) and conformity index (CI) for planning target volume (PTV), D{sub mean} and D{sub 50} for six parallel organs and D{sub max} for five serial organs. Patient-specific quality assurance (QA) was performed using ArcCHECK for MCO-VMAT and Matrixx for MCO-IMRT with results analyzed using gamma criteria of 3%/3mm. Results: MCO-VMAT provided better V{sub 100} (+0.8%) lower D{sub 5}(− 0.3 Gy), lower HI (−0.27) and comparable CI (+0.05). MCO-VMAT decreased D{sub mean} and D{sub 50} for multiple parallel organs in seven of the ten patients. On average the reduction ranged from 2.1 (larynx) to 7.6 Gy (esophagus). For the nasal cavity and nasopharynx plans significant reduction in D{sub max} was observed for optics (up to 11 Gy) brainstem (6.4 Gy), cord (2.1 Gy) and mandible (6.7 Gy). All MCO-VMAT and -IMRT plans passed clinical QA. MCO-VMAT required slightly longer planning time due to the more complex VMAT optimization. The net beam-on time for the MCO-VMAT plans ranged from 80 to 242 seconds, up to 9 minutes shorter than MCO-IMRT. Conclusion: With similar target coverage, reduced organ dose, comparable planning time, and significantly faster treatment, MCO-VMAT is very likely to become the modality of choice in RayStation v5.0 for H&N cancer.

60 APPLIED LIFE SCIENCES↗