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DOE OSTI2014

SU-E-I-22: Dependence On Calibration Phantom and Field Area of the Conversion Factor Used to Calculate Skin Dose During Neuro-Interventional Fluoroscopic Procedures

Purpose: To determine the appropriate calibration factor to use when calculating skin dose with our real-time dose-tracking system (DTS) during neuro-interventional fluoroscopic procedures by evaluating the difference in backscatter from different phantoms and as a function of entrance-skin field area. Methods: We developed a dose-tracking system to calculate and graphically display the cumulative skin-dose distribution in real time. To calibrate the DTS for neuro-interventional procedures, a phantom is needed that closely approximates the scattering properties of the head. We compared the x-ray backscatter from eight phantoms: 20-cm-thick solid water, 16-cm diameter water-filled container, 16-cm CTDI phantom, modified-ANSI head phantom, 20-cm-thick PMMA, Kyoto-Kagaku PBU- 50 head, Phantom-Labs SK-150 head, and RSD RS-240T head. The phantoms were placed on the patient table with the entrance surface at 15 cm tube-side from the isocenter of a Toshiba Infinix C-arm, and the entrance-skin exposure was measured with a calibrated 6-cc PTW ionization chamber. The measurement included primary radiation, backscatter from the phantom and forward scatter from the table and pad. The variation in entrance-skin exposure was also measured as a function of the skin-entrance area for a 30x30 cm by 20-cm-thick PMMA phantom and the SK-150 head phantom using four different added beam filters. Results: The entranceskin exposure values measured for eight different phantoms differed by up to 12%, while the ratio of entrance exposure of all phantoms relative to solid water showed less than 3% variation with kVp. The change in entrance-skin exposure with entrance-skin area was found to differ for the SK-150 head compared to the 20-cm PMMA phantom and the variation with field area was dependent on the added beam filtration. Conclusion: To accurately calculate skin dose for neuro-interventional procedures with the DTS, the phantom for calibration should be carefully chosen since different phantoms can contribute different backscatter for identical exposure parameters. Research supported in part by Toshiba Medical Systems and NIH Grants R43FD0158401, R44FD0158402 and R01EB002873.

61 RADIATION PROTECTION AND DOSIMETRY↗

DOE OSTI2014

SU-E-I-42: Normalized Embryo/fetus Doses for Fluoroscopically Guided Pacemaker Implantation Procedures Calculated Using a Monte Carlo Technique

Purpose: It is well known that pacemaker implantation is sometimes needed in pregnant patients with symptomatic bradycardia. To our knowledge, there is no reported experience regarding radiation doses to the unborn child resulting from fluoroscopy during pacemaker implantation. The purpose of the current study was to develop a method for estimating embryo/fetus dose from fluoroscopically guided pacemaker implantation procedures performed on pregnant patients during all trimesters of gestation. Methods: The Monte Carlo N-Particle (MCNP) radiation transport code was employed in this study. Three mathematical anthropomorphic phantoms representing the average pregnant patient at the first, second and third trimesters of gestation were generated using Bodybuilder software (White Rock science, White Rock, NM). The normalized embryo/fetus dose from the posteroanterior (PA), the 30° left-anterior oblique (LAO) and the 30° right-anterior oblique (RAO) projections were calculated for a wide range of kVp (50–120 kVp) and total filtration values (2.5–9.0 mm Al). Results: The results consist of radiation doses normalized to a) entrance skin dose (ESD) and b) dose area product (DAP) so that the dose to the unborn child from any fluoroscopic technique and x-ray device used can be calculated. ESD normalized doses ranged from 0.008 (PA, first trimester) to 2.519 μGy/mGy (RAO, third trimester). DAP normalized doses ranged from 0.051 (PA, first trimester) to 12.852 μGy/Gycm2 (RAO, third trimester). Conclusion: Embryo/fetus doses from fluoroscopically guided pacemaker implantation procedures performed on pregnant patients during all stages of gestation can be estimated using the method developed in this study. This study was supported by the Greek Ministry of Education and Religious Affairs, General Secretariat for Research and Technology, Operational Program ‘Education and Lifelong Learning’, ARISTIA (Research project: CONCERT)

60 APPLIED LIFE SCIENCES↗

DOE OSTI2014

SU-E-I-57: Evaluation and Optimization of Effective-Dose Using Different Beam-Hardening Filters in Clinical Pediatric Shunt CT Protocol

Purpose: Study image optimization and radiation dose reduction in pediatric shunt CT scanning protocol through the use of different beam-hardening filters Methods: A 64-slice CT scanner at OU Childrens Hospital has been used to evaluate CT image contrast-to-noise ratio (CNR) and measure effective-doses based on the concept of CT dose index (CTDIvol) using the pediatric head shunt scanning protocol. The routine axial pediatric head shunt scanning protocol that has been optimized for the intrinsic x-ray tube filter has been used to evaluate CNR by acquiring images using the ACR approved CT-phantom and radiation dose CTphantom, which was used to measure CTDIvol. These results were set as reference points to study and evaluate the effects of adding different filtering materials (i.e. Tungsten, Tantalum, Titanium, Nickel and Copper filters) to the existing filter on image quality and radiation dose. To ensure optimal image quality, the scanner routine air calibration was run for each added filter. The image CNR was evaluated for different kVps and wide range of mAs values using above mentioned beam-hardening filters. These scanning protocols were run under axial as well as under helical techniques. The CTDIvol and the effective-dose were measured and calculated for all scanning protocols and added filtration, including the intrinsic x-ray tube filter. Results: Beam-hardening filter shapes energy spectrum, which reduces the dose by 27%. No noticeable changes in image low contrast detectability Conclusion: Effective-dose is very much dependent on the CTDIVol, which is further very much dependent on beam-hardening filters. Substantial reduction in effective-dose is realized using beam-hardening filters as compare to the intrinsic filter. This phantom study showed that significant radiation dose reduction could be achieved in CT pediatric shunt scanning protocols without compromising in diagnostic value of image quality.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗

DOE OSTI2014

SU-E-I-76: Matching Primary and Scattered X-Ray Spectra for Use in Calculating the Diagnostic Radiation Index of Protection

Purpose: Lightweight lead-free or lead-composite protective garments exploit k-edge interactions to attenuate scattered X-rays. Manufacturers specify the protective value of garments in terms of lead equivalence at a single kVp. This is inadequate, as the protection provided by such garments varies with radiation quality in different use conditions. We present a method for matching scattered X-ray spectra to primary X-ray spectra. The resulting primary spectra can be used to measure penetration through protective garments, and such measurements can be weighted and summed to determine a Diagnostic Radiation Index for Protection (DRIP). Methods: Scattered X-ray spectra from fluoroscopic procedures were modeled using Monte Carlo techniques in MCNP-X 2.7. Data on imaging geometry, operator position, patient size, and primary beam spectra were gathered from clinical fluoroscopy procedures. These data were used to generate scattered X-ray spectra resulting from procedural conditions. Technical factors, including kV and added filtration, that yielded primary X-ray spectra that optimally matched the generated scattered X-ray spectra were identified through numerical optimization using a sequential quadratic programming (SQP) algorithm. Results: The primary spectra generated with shape functions matched the relative flux in each bin of the scattered spectra within 5%, and half and quarter-value layers matched within 0.1%. The DRIP for protective garments can be determined by measuring the penetration through protective garments using the matched primary spectra, then calculating a weighted average according to the expected clinical use of the garment. The matched primary spectra are specified in terms of first and second half-value layers in aluminum and acrylic. Conclusion: Lead equivalence is inadequate for completely specifying the protective value of garments. Measuring penetration through a garment using full scatter conditions is very difficult. The primary spectra determined in this work allow for practical primary penetration measurements to be made with equipment readily available to clinical medical physicists.

61 RADIATION PROTECTION AND DOSIMETRY↗

DOE OSTI2014

SU-E-I-95: Personalized Radiography Technical Parameters for Each Patient and Exam

Purpose: To determine exact electrical parameters (kV, mAs) a radiological technologist shall use taking account the exam and patient's structure, with guarantee of minimum dose and adequate quality image. Methods: A patient's absorbed dose equation was developed by means of Entrance Skin Dose (ESD), irradiated area and patient width for specific anatomy. ESD is calculated from a developed equation, where entrance surface air-KERMA and backscatter factor are included, with air-to-skin coefficient conversion. We developed specific Lambert-Beer attenuation equations derived from mass energy-absorption coefficients data for skin, fat, and muscle and bone as one tissue. Anatomy tissue thickness distribution at central X-ray location in anteroposterior incidence for hand and chest, was estimate by discounting constant skin and bone thickness from patient measured width, assuming the result as muscle and fat. A clinical research at a big hospital were executed when real parameters (kV, mAs, filtration, ripple) used by technologists were combined with the image quality and patient's data: anatomy width, height and weight. A correlation among the best images acquired and electrical parameters used were confronted with patient's data and dose estimation. The best combinations were used as gold standards. Results: For each anatomy, two equations were developed to calculate voltage (kV) and exposure (mAs) to reproduce and interpolate the gold standards. Patient is measured and data are input into equations, giving radiological technologists the right set of electrical parameters for that specific exam. Conclusion: This work indicates that radiological technologist can personalize the exact electrical parameters for each patient exam, instead of using standard values. It also guarantee that patients under or over-sized measures will receive the right dose for the best image. It will stop wrong empiric adjusts technologists do when examining a non-standard patient and reduce probability of radiography retaken because of over or under exposition.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2014

SU-E-J-125: Classification of CBCT Noises in Terms of Their Contribution to Proton Range Uncertainty

Purpose: This study assesses the potential use of CBCT images in adaptive protontherapy by estimating the contribution of the main sources of noise and calibration errors to the proton range uncertainty. Methods: Measurements intended to highlight each particular source have been achieved by adapting either the testbench configuration, e.g. use of filtration, fan-beam collimation, beam stop arrays, phantoms and detector reset light, or the sequence of correction algorithms including water precorrection. Additional Monte-Carlo simulations have been performed to complement these measurements, especially for the beam hardening and the scatter cases. Simulations of proton beams penetration through the resulting images have then been carried out to quantify the range change due to these effects. The particular case of a brain irradiation is considered mainly because of the multiple effects that the skull bones have on the internal soft tissues. Results: On top of the range error sources is the undercorrection of scatter. Its influence has been analyzed from a comparison of fan-beam and full axial FOV acquisitions. In this case, large range errors of about 12 mm can be reached if the assumption is made that the scatter has only a constant contribution over the projection images. Even the detector lag, which a priori induces a much smaller effect, has been shown to contribute for up to 2 mm to the overall error if its correction only aims at reducing the skin artefact. This last result can partially be understood by the larger interface between tissues and bones inside the skull. Conclusion: This study has set the basis of a more systematical analysis of the effect CBCT noise on range uncertainties based on a combination of measurements, simulations and theoretical results. With our method, even more subtle effects such as the cone-beam artifact or the detector lag can be assessed. SBR and JOR are financed by iMagX, a public-private partnership between the region Wallone of Belgium and IBA under convention #1217662.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗

DOE OSTI2014

SU-E-T-301: Spectral Comparison of the Xoft and Zeiss 50 KVp X-Ray Systems

Purpose: To compare x-ray spectra of the 50 kVp Xoft Axxent™ and Zeiss INTRABEAM™ x-ray sources after filtration by saline-filled balloons applicators or spherical polymer applicators, respectively. Methods: Measurements were made for 3.5, 4.0 and 5.0 cm diameter applicators using an AmpTek model XR-100T-CdTe cadmium telluride spectrometer with 100 μm diameter collimating aperture and model PX4 digital pulse processor. Spectra were then corrected for escape processes using AmpTek XRF-FP Escape software. Both Axxent and INTRABEAM sources were operated at 50 kV and 40 μA to eliminate pulse saturation. The balloon or spherical applicator was placed in a centering fixture in contact with the collimator cap. The distance through the collimator housing from the applicator surface to the spectrometer's beryllium entrance window was nominally 52mm. Approximately 500,000 counts were collected for each spectrum. Results: Measured spectra in all cases had a broad Bremsstrahlung continuum with subtle differences in characteristic low energy x-rays lines from the different materials used for the anode thin films and substrates. After corrections for escape events average energies were calculated for spectra emerging from applicators. The average energies were 28.2 ±0.3 keV, 29.0±0.7 keV, and 31.7±0.9 keV for the 3.5, 4.0 and 5.0 cm diameter applicators, respectively. Differences in average energies ranged from 2.0 to 5.6% for these diameters. The mean energies of the spectra are more dependent on balloon size than on the delivery system used. Conclusion: Energy spectra at the surfaces of 3.5, 4.0 and 5.0 cm diameter applicators were measured for the Axxent and INTRABEAM x-ray systems were using a Cd-Te spectrometer. The average energies of the two x-ray systems for comparable applicator sizes were within 5.6%, and as little as 0.6 keV difference for the smaller applicator size. Research sponsored by Xoft, a subsidiary of ICAD.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗

DOE OSTI2014

TU-F-18A-05: An X-Ray Fluorescence Technique for Energy Calibration of Photon-Counting Detectors

Purpose: To investigate the feasibility of energy response calibration of a Si strip photon-counting detector by using the x-ray fluorescence technique. Methods: X-ray fluorescence was generated by using a pencil beam from a tungsten anode x-ray tube with 2 mm Al filtration. Spectra were acquired at 90° from the primary beam direction with an energy-resolved photon-counting detector based on Si strips. The distances from the source to target and the target to detector were approximately 19 and 11 cm, respectively. Four different materials, containing Ag, I, Ba, and Gd, were placed in small plastic aliquots with a diameter of approximately 0.7 cm for x-ray fluorescence measurements. Linear regression analysis was performed to derive the gain and offset values for the correlation between the measured fluorescence peak center and the known energies for materials. The energy resolution was derived from the full width at half maximum (FWHM) of the fluorescence peaks. In addition, the angular dependence of the recorded fluorescence spectra was studied at 30°, 60°, and 120°. Results: Strong fluorescence signals of all four target materials were recorded with the investigated geometry for the Si strip detector. The recorded pulse height was calibrated with respect to photon energy and the gain and offset values were calculated to be 7.0 mV/keV and −69.3 mV, respectively. Negligible variation in energy calibration was observed among the four energy thresholds. The variation among different pixels was estimated to be approximately 1 keV. The energy resolution of the detector was estimated to be 7.9% within the investigated energy range. Conclusion: The performance of a spectral imaging system using energy-resolved photon-counting detectors is very dependent on the energy calibration of the detector. The proposed x-ray fluorescence technique provides an accurate and efficient way to calibrate the energy response of a photon-counting detector.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗

DOE OSTI2014

WE-E-18A-02: Enhancement of Lung Tumor Visibility by Dual-Energy X-Ray Imaging in An Anthropomorphic Chest Phantom Study

Purpose: Intrafractional lung tumor motion during radiotherapy can be compensated for by tracking the tumor position using x-ray imaging and adapting the treatment in real-time. However, locating the tumor with an automated template-matching algorithm is often challenging if the tumor is obscured by ribs. This study investigates the feasibility of creating dual-energy (DE) images of the chest with increased tumor visibility on an Elekta XVI system. Methods: An anthropomorphic chest phantom was imaged at two different energies. Low-energy images were obtained at 80 kVp (0.8 mAs); high-energy images at 129 kVp (0.6 mAs, additional 1.26 mm tin filter). A Geant4 Monte-Carlo framework was developed allowing simulation of the x-ray tube, flat-panel detector and phantom in order to optimize the beam energies, filtration and the weighting factor used to subtract the individual images into a synthetic DE image. The weighting factor was selected to minimize the visibility of bones while maintaining a sufficient tumor visibility. We scored the bone visibility as the contrast of tumor (with bone) to tumor (without bone), and similarly of lung tissue (with bone) to lung tissue (without bone). Tumor visibility was quantified as the contrast between tumor and lung tissue (both without bone). Results: In the experimentally obtained DE image the bone visibility was reduced by 79.2% in tumor and by 96.8% in lung tissue while the overall tumor visibility only decreased by 69.5%. The Monte-Carlo simulation yielded similar results reducing the scores by 90.0%, 85.3% and only 71.9%, respectively. Conclusion: This work demonstrates the feasibility of DE imaging to enhance lung tumor detectability. In the future, we hope to further refine the Monte-Carlo simulation to more accurately predict the weighting factors which would aid real-time implementation. Furthermore, we plan to use the Monte-Carlo framework to simulate DE images of actual lung tumors. The authors would like to thank Paul-Scherrer-Institut and Centre Suisse d'Electronique et Microtechnique for lending us the anthropomorphic phantom. We acknowledge support from Elekta AB under a research agreement. Research at The Institute of Cancer Research is also supported by Cancer Research UK under Programme C46/A10588.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2014

WE-E-18A-05: Bremsstrahlung of Laser-Plasma Interaction at KeV Temperature: Forward Dose and Attenuation Factors

Purpose: To obtain an analytical empirical formula for the photon dose source term in forward direction from bremsstrahlung generated from laser-plasma accelerated electron beams in aluminum solid targets, with electron-plasma temperatures in the 10–100 keV energy range, and to calculate transmission factors for iron, aluminum, methacrylate, lead and concrete and air, materials most commonly found in vacuum chamber labs. Methods: Bremsstrahlung fluence is calculated from the convolution of thin-target bremsstrahlung spectrum for monoenergetic electrons and the relativistic Maxwell-Juettner energy distribution for the electron-plasma. Unattenuatted dose in tissue is calculated by integrating the photon spectrum with the mass-energy absorption coefficient. For the attenuated dose, energy dependent absorption coefficient, build-up factors and finite shielding correction factors were also taken into account. For the source term we use a modified formula from Hayashi et al., and we fitted the proportionality constant from experiments with the aid of the previously calculated transmission factors. Results: The forward dose has a quadratic dependence on electron-plasma temperature: 1 joule of effective laser energy transferred to the electrons at 1 m in vacuum yields 0,72 Sv per MeV squared of electron-plasma temperature. Air strongly filters the softer part of the photon spectrum and reduce the dose to one tenth in the first centimeter. Exponential higher energy tail of maxwellian spectrum contributes mainly to the transmitted dose. Conclusion: A simple formula for forward photon dose from keV range temperature plasma is obtained, similar to those found in kilovoltage x-rays but with higher dose per dissipated electron energy, due to thin target and absence of filtration.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗

DOE OSTI2014

WE-E-18A-06: To Remove Or Not to Remove: Comfort Pads From Beneath Neonates for Radiography

07 ISOTOPE AND RADIATION SOURCES↗

DOE OSTI2014

TH-A-18C-10: Dynamic Intensity Weighted Region of Interest Imaging

Purpose: For image guidance tasks full image quality is not required throughout the entire image. With dynamic filtration of the kV imaging beam the noise properties of the CT image can be locally controlled, providing a high quality image around the target volume with a lower quality surrounding region while providing substantial dose sparing to the patient as well as reduced scatter fluence on the detector. Methods: A dynamic collimation device with 3mm copper blades has been designed to mount in place of the bowtie filter on the On-Board Imager (Varian Medical Systems). The beam intensity is reduced by 95% behind the copper filters and the aperture is controlled dynamically to conformally illuminate a given ROI during a standard cone-beam CT scan. A data correction framework to account for the physical effects of the collimator prior to reconstruction was developed. Furthermore, to determine the dose savings and scatter reduction a monte carlo model was built in BEAMnrc with specifics from the Varian Monte Carlo Data Package. The MC model was validated with Gafchromic film. Results: The reconstructed image shows image quality comparable to a standard scan in the specified ROI, with higher noise and streaks in the outer region but still sufficient information for alignment to high contrast structures. The monte carlo modeling showed that the scatter-to-primary ratio was reduced from 1.26 for an unfiltered scan to 0.45 for an intensity weighted scan, suggesting that image quality may be improved in the inner ROI. Dose in the inner region was reduced 10–15% due to reduced scatter and by as much as 75% in the outer region. Conclusion: Dynamic intensity-weighted ROI imaging allows reduction of imaging dose to sensitive organs away from the target region while providing images that retain their utility for patient setup and procedure guidance. Funding was provided in part by Varian Medical Systems and NIH Grants 1RO1CA120540, T32EB002103, S10 RR021039 and P30 CA14599. The contents of this work are solely the responsibility of the authors and do not necessarily represent the official views of any of the supporting organizations.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗

DOE OSTI2014

Characterization of energy response for photon-counting detectors using x-ray fluorescence

Purpose: To investigate the feasibility of characterizing a Si strip photon-counting detector using x-ray fluorescence. Methods: X-ray fluorescence was generated by using a pencil beam from a tungsten anode x-ray tube with 2 mm Al filtration. Spectra were acquired at 90° from the primary beam direction with an energy-resolved photon-counting detector based on an edge illuminated Si strip detector. The distances from the source to target and the target to detector were approximately 19 and 11 cm, respectively. Four different materials, containing silver (Ag), iodine (I), barium (Ba), and gadolinium (Gd), were placed in small plastic containers with a diameter of approximately 0.7 cm for x-ray fluorescence measurements. Linear regression analysis was performed to derive the gain and offset values for the correlation between the measured fluorescence peak center and the known fluorescence energies. The energy resolutions and charge-sharing fractions were also obtained from analytical fittings of the recorded fluorescence spectra. An analytical model, which employed four parameters that can be determined from the fluorescence calibration, was used to estimate the detector response function. Results: Strong fluorescence signals of all four target materials were recorded with the investigated geometry for the Si strip detector. The average gain and offset of all pixels for detector energy calibration were determined to be 6.95 mV/keV and −66.33 mV, respectively. The detector’s energy resolution remained at approximately 2.7 keV for low energies, and increased slightly at 45 keV. The average charge-sharing fraction was estimated to be 36% within the investigated energy range of 20–45 keV. The simulated detector output based on the proposed response function agreed well with the experimental measurement. Conclusions: The performance of a spectral imaging system using energy-resolved photon-counting detectors is very dependent on the energy calibration of the detector. The proposed x-ray fluorescence technique offers an accurate and efficient way to calibrate the energy response of a photon-counting detector.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗

DOE OSTI2015

A rapid noninvasive characterization of CT x-ray sources

Purpose: The aim of this study is to generate spatially varying half value layers (HVLs) that can be used to construct virtual equivalent source models of computed tomography (CT) x-ray sources for use in Monte Carlo CT dose computations. Methods: To measure the spatially varying HVLs, the authors combined a cylindrical HVL measurement technique with the characterization of bowtie filter relative attenuation (COBRA) geometry. An apparatus given the name “HVL Jig” was fabricated to accurately position a real-time dosimeter off-isocenter while surrounded by concentric cylindrical aluminum filters (CAFs). In this geometry, each projection of the rotating x-ray tube is filtered by an identical amount of high-purity (type 1100 H-14) aluminum while the stationary radiation dose probe records an air kerma rate versus time waveform. The CAFs were progressively nested to acquire exposure data at increasing filtrations to calculate the HVL. Using this dose waveform and known setup geometry, each timestamp was related to its corresponding fan angle. Data were acquired using axial CT protocols (i.e., rotating tube and stationary patient table) at energies of 80, 100, and 120 kVp on a single CT scanner. These measurements were validated against the more laborious conventional step-and-shoot approach (stationary x-ray tube). Results: At each energy, HVL data points from the COBRA-cylinder technique were fit to a trendline and compared with the conventional approach. The average relative difference in HVL between the two techniques was 1.3%. There was a systematic overestimation in HVL due to scatter contamination. Conclusions: The described method is a novel, rapid, accurate, and noninvasive approach that allows one to acquire the spatially varying fluence and HVL data using a single experimental setup in a minimum of three scans. These measurements can be used to characterize the CT beam in terms of the angle-dependent fluence and energy spectra along the bowtie filter direction, which can serve as input for accurate CT dose computations.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗

DOE OSTI2015

Three dimensional dose distribution comparison of simple and complex acquisition trajectories in dedicated breast CT

Purpose: A novel breast CT system capable of arbitrary 3D trajectories has been developed to address cone beam sampling insufficiency as well as to image further into the patient’s chest wall. The purpose of this study was to characterize any trajectory-related differences in 3D x-ray dose distribution in a pendant target when imaged with different orbits. Methods: Two acquisition trajectories were evaluated: circular azimuthal (no-tilt) and sinusoidal (saddle) orbit with ±15° tilts around a pendant breast, using Monte Carlo simulations as well as physical measurements. Simulations were performed with tungsten (W) filtration of a W-anode source; the simulated source flux was normalized to the measured exposure of a W-anode source. A water-filled cylindrical phantom was divided into 1 cm{sup 3} voxels, and the cumulative energy deposited was tracked in each voxel. Energy deposited per voxel was converted to dose, yielding the 3D distributed dose volumes. Additionally, three cylindrical phantoms of different diameters (10, 12.5, and 15 cm) and an anthropomorphic breast phantom, initially filled with water (mimicking pure fibroglandular tissue) and then with a 75% methanol-25% water mixture (mimicking 50–50 fibroglandular-adipose tissues), were used to simulate the pendant breast geometry and scanned on the physical system. Ionization chamber calibrated radiochromic film was used to determine the dose delivered in a 2D plane through the center of the volume for a fully 3D CT scan using the different orbits. Results: Measured experimental results for the same exposure indicated that the mean dose measured throughout the central slice for different diameters ranged from 3.93 to 5.28 mGy, with the lowest average dose measured on the largest cylinder with water mimicking a homogeneously fibroglandular breast. These results align well with the cylinder phantom Monte Carlo studies which also showed a marginal difference in dose delivered by a saddle trajectory in the central slice. Regardless of phantom material or filled fluid density, dose delivered by the saddle scan was negligibly different than the simple circular, no-tilt scans. The average dose measured in the breast phantom was marginally higher for saddle than the circular no tilt scan at 3.82 and 3.87 mGy, respectively. Conclusions: Not only does nontraditional 3D-trajectory CT scanning yield more complete sampling of the breast volume but also has comparable dose deposition throughout the breast and anterior chest volume, as verified by Monte Carlo simulation and physical measurements.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

SU-E-I-53: Comparison of Kerma-Area-Product Between the Micro-Angiographic Fluoroscope (MAF) and a Flat Panel Detector (FPD) as Used in Neuro-Endovascular Procedures

Purpose: To determine the reduction of integral dose to the patient when using the micro-angiographic fluoroscope (MAF) compared to when using the standard flat-panel detector (FPD) for the techniques used during neurointerventional procedures. Methods: The MAF is a small field-of-view, high resolution x-ray detector which captures 1024 x 1024 pixels with an effective pixel size of 35μm and is capable of real-time imaging up to 30 frames per second. The MAF was used in neuro-interventions during those parts of the procedure when high resolution was needed and the FPD was used otherwise. The technique parameters were recorded when each detector was used and the kerma-area-product (KAP) per image frame was determined. KAP values were calculated for seven neuro interventions using premeasured calibration files of output as a function of kVp and beam filtration and included the attenuation of the patient table for the frontal projections to be more representative of integral patient dose. The air kerma at the patient entrance was multiplied by the beam area at that point to obtain the KAP values. The ranges of KAP values per frame were determined for the range of technique parameters used during the clinical procedures. To appreciate the benefit of the higher MAF resolution in the region of interventional activity, DA technique parameters were generally used with the MAF. Results: The lowest and highest values of KAP per frame for the MAF in DA mode were 4 and 50 times lower, respectively, compared to those of the FPD in pulsed fluoroscopy mode. Conclusion: The MAF was used in those parts of the clinical procedures when high resolution and image quality was essential. The integral patient dose as represented by the KAP value was substantially lower when using the MAF than when using the FPD due to the much smaller volume of tissue irradiated. This research was supported in part by Toshiba Medical Systems Corporation and NIH Grant R01EB002873.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

SU-E-I-85: Absorbed Dose Estimation for a Commercially Available MicroCT Scanner

Purpose: To quantify the simulated absorbed dose delivered for a typical scan from a commercially available microCT scanner in order to aid in the dose estimation. Methods: The simulations were conducted using the Geant4 Monte Carlo Toolkit (version 10) with the standard electromagnetic classes. The Quantum FX microCT scanner (PerkinElmer, Waltham, MA) was modeled incorporating the energy fluence and angular distributions of generated photons, spatial dimensions of nominal source-to-object and source-to-detector distances. The energy distribution was measured using a spectrometer (X-123CdTe, Amptek Inc., Bedford, USA) with a 300 angular spread from the source for the 90 kVp X-ray beams with no additional filtration. The nominal distances from the source to object consisted of three setups: 154.0 mm, 104.0 mm, and 51.96 mm. Our simulations recorded the dose absorbed in a cylindrical phantom of PMMA with a fixed length of 2 cm and varying radii (10, 20, 30 and 40 mm) using 100 million incident photons. The averaged absorbed dose in the object was then quantified for all setups. An exposure measurement of 417 mR was taken using a Radcal 9095 system utilizing 10×9–180 ion chamber with the given technique of 90 kVp, 63 μA, and 12 s. The exposure rate was also simulated with same setup to calculate the conversion factor of the beam current and the number of incident photons. Results: For a typical cone-beam scan with non-filtered 90kVp, the dose coefficients (the absorbed dose per mAs) were 2.614, 2.549 and 2.467 μGy/mAs under source to object distance of 104 mm for the object diameters of 10 mm, 20 mm and 30 mm, respectively. Conclusion: A look-up table was developed where an investigator can estimate the delivered dose using this particular microCT given the scanning protocol (kVp and mAs) as well as the size of the scanned object.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗

DOE OSTI2015

SU-E-J-185: A Systematic Review of Breathing Guidance in Radiation Oncology and Radiology

Purpose: The advent of image-guided radiation therapy (IGRT) has led to dramatic improvements in the accuracy of treatment delivery in radiotherapy. Such advancements have highlighted the deleterious impact tumor motion can have on both image quality and radiation treatment delivery. One approach to reducing tumor motion is the use of breathing guidance systems during imaging and treatment. A review of such research had not yet been performed, it was therefore our aim to perform a systematic review of breathing guidance interventions within the fields of radiation oncology and radiology. Methods: Results of online database searches were filtered in accordance to a set of eligibility criteria. The search, filtration, and analysis of articles were conducted in accordance with the PRISMAStatement reporting standard (Preferred Reporting Items for Systematic reviews and Meta-Analyses) utilizing the PICOS approach (Participants, Intervention, Comparison, Outcome, Study design). Participants: Cancer patients, healthy volunteers. Intervention: Biofeedback breathing guidance systems. Comparison: No breathing guidance of the same breathing type. Outcome: Regularity of breathing signal and anatomic/tumor motion, medical image quality, radiation treatment margins and coverage, medical imaging and radiation treatment times. Study design: Quantitative and controlled prospective or retrospective trials. Results: The systematic search yielded a total of 479 articles, which were filtered down to 27 relevant articles in accordance to the eligibility criteria. The vast majority of investigated outcomes were significantly positively impacted by the use of breathing guidance; however, this was dependent upon the nature of the breathing guidance system and study design. In 25/27 studies significant improvements from the use of breathing guidance were observed. Conclusion: The results found here indicate that further clinical studies are warranted which quantify more comprehensively the clinical impact of The results found here indicate that further clinical studies are warranted which quantify more comprehensively the clinical impact of breathing guidance interventions.

60 APPLIED LIFE SCIENCES↗