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DOE OSTI2014

SU-E-J-35: Clinical Performance Evaluation of a Phase II Proton CT Scanner

Purpose: To develop the methodology to evaluate the clinical performance of a Phase II Proton CT scanner Methods: Range errors on the order of 3%-5% constitute a major uncertainty in current charged particle treatment planning based on Hounsfield Unit (HU)-relative stopping power (RSP) calibration curves. Within our proton CT collaboration, we previously developed and built a Phase I proton CT scanner that provided a sensitive area of 9 cm (axial) × 18 cm (in-plane). This scanner served to get initial experience with this new treatment planning tool and to incorporate lessons learned into the next generation design. A Phase II scanner was recently completed and is now undergoing initial performance testing. It will increase the proton acquisition rate and provide a larger detection area of 9 cm x 36 cm. We are now designing a comprehensive evaluation program to test the image quality, imaging dose, and range uncertainty associated with this scanner. The testing will be performed along the lines of AAPM TG 66. Results: In our discussion of the evaluation protocol we identified the following priorities. The image quality of proton CT images, in particular spatial resolution and low-density contrast discrimination, will be evaluated with the Catphan600 phantom. Initial testing showed that the Catphan uniformity phantom did not provide sufficient uniformity; it was thus replaced by a cylindrical water phantom. The imaging dose will be tested with a Catphan dose module, and compared to a typical cone beam CT dose for comparable image quality. Lastly, we developed a dedicated dosimetry range phantom based on the CIRS pediatric head phantom HN715. Conclusion: A formal evaluation of proton CT as a new tool for proton treatment planning is an important task. The availability of the new Phase II proton CT scanner will allow us to perform this task. This research is supported by the National Institute of Biomedical Imaging and Bioengineering of the NIH under award number R01EB013118. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗

DOE OSTI2014

SU-E-J-74: Impact of Respiration-Correlated Image Quality On Tumor Motion Reconstruction in 4D-CBCT: A Phantom Study

Purpose: To investigate the effects of scanning parameters and respiratory patterns on the image quality for 4-dimensional cone-beam computed tomography(4D-CBCT) imaging, and assess the accuracy of computed tumor trajectory for lung imaging using registration of phased 4D-CBCT imaging with treatment planning-CT. Methods: We simulated a periodic and non-sinusoidal respirations with various breathing periods and amplitudes using a respiratory phantom(Quasar, Modus Medical Devices Inc) to acquire respiration-correlated 4D-CBCT images. 4D-CBCT scans(Elekta Oncology Systems Ltd) were performed with different scanning parameters for collimation size(e.g., small and medium field-of-views) and scanning speed(e.g., slow 50°·min{sup −1}, fast 100°·min{sup −1}). Using a standard CBCT-QA phantom(Catphan500, The Phantom Laboratory), the image qualities of all phases in 4D-CBCT were evaluated with contrast-to-noise ratio(CNR) for lung tissue and uniformity in each module. Using a respiratory phantom, the target imaging in 4D-CBCT was compared to 3D-CBCT target image. The target trajectory from 10-respiratory phases in 4D-CBCT was extracted using an automatic image registration and subsequently assessed the accuracy by comparing with actual motion of the target. Results: Image analysis indicated that a short respiration with a small amplitude resulted in superior CNR and uniformity. Smaller variation of CNR and uniformity was present amongst different respiratory phases. The small field-of-view with a partial scan using slow scan can improve CNR, but degraded uniformity. Large amplitude of respiration can degrade image quality. RMS of voxel densities in tumor area of 4D-CBCT images between sinusoidal and non-sinusoidal motion exhibited no significant difference. The maximum displacement errors of motion trajectories were less than 1.0 mm and 13.5 mm, for sinusoidal and non-sinusoidal breathings, respectively. The accuracy of motion reconstruction showed good overall agreement with the 4D-CBCT image quality results only using sinusoidal breathings. Conclusion: This information can be used to determine the appropriate acquisition parameters of 4D-CBCT imaging for registration accuracy and target trajectory measurements in a clinical setting.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2014

SU-E-J-185: Gated CBCT Imaging for Positioning Moving Lung Tumor in Lung SBRT Treatment

Purpose: Lung stereo-tactic body radiotherapy(SBRT) treatment requires high accuracy of lung tumor positioning during treatment, which is usually accomplished by free breathing Cone-Beam computerized tomography (CBCT) scan. However, respiratory motion induced image artifacts in free breathing CBCT may degrade such positioning accuracy. The purpose of this study is to investigate the feasibility of gated CBCT imaging for lung SBRT treatment. Methods: Six Lung SBRT patients were selected for this study. The respiratory motion of the tumors ranged from 1.2cm to 3.5cm, and the gating windows for all patients were set between 35% and 65% of the respiratory phases. Each Lung SBRT patient underwent free-breathing CBCT scan using half-fan scan technique. The acquired projection images were transferred out for off-line analyses. An In-house semi-automatic algorithm was developed to trace the diaphragm movement from those projection images to acquire a patient's specific respiratory motion curve, which was used to correlate respiratory phases with each projection image. Afterwards, a filtered back-projection algorithm was utilized to reconstruct the gated CBCT images based on the projection images only within the gating window. Results: Target volumes determined by free breathing CBCT images were 71.9%±72% bigger than the volume shown in gated CBCT image. On the contrary, the target volume differences between gated CBCT and planning CT images at exhale stage were 5.8%±2.4%. The center to center distance of the targets shown in free breathing CBCT and gated CBCT images were 9.2±8.1mm. For one particular case, the superior boundary of the target was shifted 15mm between free breathing CBCT and gated CBCT. Conclusion: Gated CBCT imaging provides better representation of the moving lung tumor with less motion artifacts, and has the potential to improve the positioning accuracy in lung SBRT treatment.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2014

SU-E-J-195: Quantification of Rotations and Deformations in Head and Heck Radiotherapy

Purpose: To quantify the magnitude of patient rotations and deformations over the course of head and neck radiotherapy. Methods: 45 CBCT images acquired weekly were selected retrospectively from 5 head and neck cancer patients. CBCT images were registered to the corresponding planning CT images using translation, rigid-body, and cubic B-spline deformable transformations. Elastix ( elastix.isi.uu.nl ), an open-source public domain registration algorithm, was used for all registrations with mutual information as similarity metric and gradient descent as optimization. Four-level multiresolution approach was employed with 2 cm B-spline grid spacing at the finest resolution. Registration qualities were visually verified. Rotational occurrences were quantified from the rigid-body registrations. The magnitude of deformations in planning target volumes (PTV) and organs were quantified from the deformation vector fields with rigid registrations as baseline. Results: The measured rotations (mean±std) were 1.0±1.0 deg, - 0.3±1.0 deg, and 0.1±0.8 deg in the sagittal, coronal, and axial plains respectively. The estimated magnitudes of deformations (mean±std) were 3.4±2.1 mm for PTVs, 2.9±1.2 mm for parotid glands, 2.8±1.2 mm for mandible, and 2.2±1.1 mm for spinal cord. The overall deformation in the body contour was 4.3±4.3 mm. The organ spatial deviation due to rotation was small and approximately 8.4% of that from deformations. Results varied among patients. Conclusion: Rotations occurred about 1.0 deg (1SD) in the H'N area. Daily geometric deviation of target volumes was considerable and mainly from tissue deformation than rotations. Proper safety margin is necessary for adequate target coverage. Online plan adaptation may mitigate the daily differences between the plan and actual patient poses. Partially supported by a grant from Varian Medical Systems, Palo Alto, CA.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2014

SU-E-J-203: Reconstruction of the Treatment Area by Use of Sinogram in Helical Tomotherapy

Purpose: TomoTherapy (Accuray Co.) has an image-guided radiotherapy system with megavoltage (MV) X-ray source and the on-board imaging device. With the MV computed tomography (MVCT), it became feasible to perform the efficient daily-3D registration of the patient position before each treatment delivery. This system also allows one to acquire the delivery sinogram during the actual treatment, which partly includes the information of the irradiated object. In this study, we try to develop the image reconstruction during treatment in helical Tomotherapy. Methods: Sinogram data were acquired during helical Tomotherapy delivery using an arc-shaped detector array that consists of 738 xenon-gas filled detector cells. In preprocessing, these were normalized by full air-scan data. A software program was developed that reconstructs 3D images during treatment with corrections as; (1) the regions outside the field were masked not to be added in the backprojection (a masking correction), and (2) each voxel of the reconstructed image was divided by the number of the X-ray passing through its voxel (a ray-passing correction). Results: Without masking and ray-passing corrections, the image reconstruction was failed. The masking correction made the image clear, however, the streak artifact was accompanied. The ray-passing correction reduced this artifact. Although the SNR (the ratio of mean to standard deviation in homogeneous region) and the contrast of the reconstructed image were slightly improved with the ray-passing correction, the masking correction only is enough for the visualization purpose. Conclusion: The visualization of the treatment area was feasible by use of the sinogram in helical Tomotherapy. This proposed method can be utilized in the treatment verification. This work was partly supported by JSPS KAKENHI 24234567. No COI, but the data in this paper were prepared by collaborators in Accuray.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗

DOE OSTI2014

SU-E-J-205: Monte Carlo Modeling of Ultrasound Probes for Real-Time Ultrasound Image-Guided Radiotherapy

Purpose: To quantify the effect of ultrasound (US) probe beam attenuation for radiation therapy delivered under real-time US image guidance by means of Monte Carlo (MC) simulations. Methods: MC models of two Philips US probes, an X6-1 matrix-array transducer and a C5-2 curved-array transducer, were built based on their CT images in the EGSnrc BEAMnrc and DOSXYZnrc codes. Due to the metal parts, the probes were scanned in a Tomotherapy machine with a 3.5 MV beam. Mass densities in the probes were assigned based on an electron density calibration phantom consisting of cylinders with mass densities between 0.2–8.0 g/cm{sup 3}. Beam attenuation due to the probes was measured in a solid water phantom for a 6 MV and 15 MV 15x15 cm{sup 2} beam delivered on a Varian Trilogy linear accelerator. The dose was measured with the PTW-729 ionization chamber array at two depths and compared to MC simulations. The extreme case beam attenuation expected in robotic US image guided radiotherapy for probes in upright position was quantified by means of MC simulations. Results: The 3.5 MV CT number to mass density calibration curve was found to be linear with R{sup 2} > 0.99. The maximum mass densities were 4.6 and 4.2 g/cm{sup 3} in the C5-2 and X6-1 probe, respectively. Gamma analysis of the simulated and measured doses revealed that over 98% of measurement points passed the 3%/3mm criteria for both probes and measurement depths. The extreme attenuation for probes in upright position was found to be 25% and 31% for the C5-2 and X6-1 probe, respectively, for both 6 and 15 MV beams at 10 cm depth. Conclusion: MC models of two US probes used for real-time image guidance during radiotherapy have been built. As a Result, radiotherapy treatment planning with the imaging probes in place can now be performed. J Schlosser is an employee of SoniTrack Systems, Inc. D Hristov has financial interest in SoniTrack Systems, Inc.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗

DOE OSTI2014

SU-E-J-214: Comparative Assessment On IGRT On Partial Bladder Cancer Treatment Between CT-On-Rails (CTOR) and KV Cone Beam CT (CBCT)

Purpose: Image-Guided radiation therapy(IGRT) depends on reliable online patient-specific anatomy information to address random and progressive anatomy changes. Large margins have been suggested to bladder cancer treatment due to large daily bladder anatomy variation. KV Cone beam CT(CBCT) has been used in IGRT localization prevalently; however, its lack of soft tissue contrast makes clinicians hesitate to perform daily soft tissue alignment with CBCT for partial bladder cancer treatment. This study compares the localization uncertainties of bladder cancer IGRT using CTon- Rails(CTOR) and CBCT. Methods: Three T2N0M0 bladder cancer patients (total of 66 Gy to partial bladder alone) were localized daily with either CTOR or CBCT for their entire treatment course. A total of 71 sets of CTOR and 22 sets of CBCT images were acquired and registered with original planning CT scans by radiation therapists and approved by radiation oncologists for the daily treatment. CTOR scanning entailed 2mm slice thickness, 0.98mm axial voxel size, 120kVp and 240mAs. CBCT used a half fan pelvis protocol from Varian OBI system with 2mm slice thickness, 0.98axial voxel size, 125kVp, and 680mAs. Daily localization distribution was compared. Accuracy of CTOR and CBCT on partial bladder alignment was also evaluated by comparing bladder PTV coverage. Results: 1cm all around PTV margins were used in every patient except target superior limit margin to 0mm due to bowel constraint. Daily shifts on CTOR averaged to 0.48, 0.24, 0.19 mms(SI,Lat,AP directions); CBCT averaged to 0.43, 0.09, 0.19 mms(SI,Lat,AP directions). The CTOR daily localization showed superior results of V100% of PTV(102% CTOR vs. 89% CBCT) and bowel(Dmax 69.5Gy vs. 78Gy CBCT). CTOR images showed much higher contrast on bladder PTV alignment. Conclusion: CTOR daily localization for IGRT is more dosimetrically beneficial for partial bladder cancer treatment than kV CBCT localization and provided better soft tissue PTV identification.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2014

SU-E-J-218: Evaluation of CT Images Created Using a New Metal Artifact Reduction Reconstruction Algorithm for Radiation Therapy Treatment Planning

Purpose: Metal in patients creates streak artifacts in CT images. When used for radiation treatment planning, these artifacts make it difficult to identify internal structures and affects radiation dose calculations, which depend on HU numbers for inhomogeneity correction. This work quantitatively evaluates a new metal artifact reduction (MAR) CT image reconstruction algorithm (GE Healthcare CT-0521-04.13-EN-US DOC1381483) when metal is present. Methods: A Gammex Model 467 Tissue Characterization phantom was used. CT images were taken of this phantom on a GE Optima580RT CT scanner with and without steel and titanium plugs using both the standard and MAR reconstruction algorithms. HU values were compared pixel by pixel to determine if the MAR algorithm altered the HUs of normal tissues when no metal is present, and to evaluate the effect of using the MAR algorithm when metal is present. Also, CT images of patients with internal metal objects using standard and MAR reconstruction algorithms were compared. Results: Comparing the standard and MAR reconstructed images of the phantom without metal, 95.0% of pixels were within ±35 HU and 98.0% of pixels were within ±85 HU. Also, the MAR reconstruction algorithm showed significant improvement in maintaining HUs of non-metallic regions in the images taken of the phantom with metal. HU Gamma analysis (2%, 2mm) of metal vs. non-metal phantom imaging using standard reconstruction resulted in an 84.8% pass rate compared to 96.6% for the MAR reconstructed images. CT images of patients with metal show significant artifact reduction when reconstructed with the MAR algorithm. Conclusion: CT imaging using the MAR reconstruction algorithm provides improved visualization of internal anatomy and more accurate HUs when metal is present compared to the standard reconstruction algorithm. MAR reconstructed CT images provide qualitative and quantitative improvements over current reconstruction algorithms, thus improving radiation treatment planning accuracy.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2014

SU-E-J-219: Quantitative Evaluation of Motion Effects On Accuracy of Image-Guided Radiotherapy with Fiducial Markers Using CT Imaging

Purpose: To investigate quantitatively patient motion effects on the localization accuracy of image-guided radiation with fiducial markers using axial CT (ACT), helical CT (HCT) and cone-beam CT (CBCT) using modeling and experimental phantom studies. Methods: Markers with different lengths (2.5 mm, 5 mm, 10 mm, and 20 mm) were inserted in a mobile thorax phantom which was imaged using ACT, HCT and CBCT. The phantom moved with sinusoidal motion with amplitudes ranging 0–20 mm and a frequency of 15 cycles-per-minute. Three parameters that include: apparent marker lengths, center position and distance between the centers of the markers were measured in the different CT images of the mobile phantom. A motion mathematical model was derived to predict the variations in the previous three parameters and their dependence on the motion in the different imaging modalities. Results: In CBCT, the measured marker lengths increased linearly with increase in motion amplitude. For example, the apparent length of the 10 mm marker was about 20 mm when phantom moved with amplitude of 5 mm. Although the markers have elongated, the center position and the distance between markers remained at the same position for different motion amplitudes in CBCT. These parameters were not affected by motion frequency and phase in CBCT. In HCT and ACT, the measured marker length, center and distance between markers varied irregularly with motion parameters. The apparent lengths of the markers varied with inverse of the phantom velocity which depends on motion frequency and phase. Similarly the center position and distance between markers varied inversely with phantom speed. Conclusion: Motion may lead to variations in maker length, center position and distance between markers using CT imaging. These effects should be considered in patient setup using image-guided radiation therapy based on fiducial markers matching using 2D-radiographs or volumetric CT imaging.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2014

SU-E-J-222: Evaluation of Deformable Registration of PET/CT Images for Cervical Cancer Brachytherapy

Purpose: PET/CT provides important functional information for radiotherapy targeting of cervical cancer. However, repeated PET/CT procedures for external beam and subsequent brachytherapy expose patients to additional radiation and are not cost effective. Our goal is to investigate the possibility of propagating PET-active volumes for brachytherapy procedures through deformable image registration (DIR) of earlier PET/CT and ultimately to minimize the number of PET/CT image sessions required. Methods: Nine cervical cancer patients each received their brachytherapy preplanning PET/CT at the end of EBRT with a Syed template in place. The planning PET/CT was acquired on the day of brachytherapy treatment with the actual applicator (Syed or Tandem and Ring) and rigidly registered. The PET/CT images were then deformably registered creating a third (deformed) image set for target prediction. Regions of interest with standardized uptake values (SUV) greater than 65% of maximum SUV were contoured as target volumes in all three sets of PET images. The predictive value of the registered images was evaluated by comparing the preplanning and deformed PET volumes with the planning PET volume using Dice's coefficient (DC) and center-of-mass (COM) displacement. Results: The average DCs were 0.12±0.14 and 0.19±0.16 for rigid and deformable predicted target volumes, respectively. The average COM displacements were 1.9±0.9 cm and 1.7±0.7 cm for rigid and deformable registration, respectively. The DCs were improved by deformable registration, however, both were lower than published data for DIR in other modalities and clinical sites. Anatomical changes caused by different brachytherapy applicators could have posed a challenge to the DIR algorithm. The physiological change from interstitial needle placement may also contribute to lower DC. Conclusion: The clinical use of DIR in PET/CT for cervical cancer brachytherapy appears to be limited by applicator choice and requires further investigation.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2014

SU-E-J-226: Propagation of Pancreas Target Contours On Respiratory Correlated CT Images Using Deformable Image Registration

Purpose: Respiratory Correlated CT (RCCT) scans to assess intra-fraction motion among pancreatic cancer patients undergoing radiotherapy allow for dose sparing of normal tissues, in particular for the duodenum. Contour propagation of the gross tumor volume (GTV) from one reference respiratory phase to 9 other phases is time consuming. Deformable image registration (DIR) has been successfully used for high contrast disease sites but lower contrast for pancreatic tumors may compromise accuracy. This study evaluates the accuracy of Fast Free Form (FFF) registration-based contour propagation of the GTV on RCCT scans of pancreas cancer patients. Methods: Twenty-four pancreatic cancer patients were retrospectively studied; 20 had tumors in the pancreatic head/neck, 4 in the body/tail. Patients were simulated with RCCT and images were sorted into 10 respiratory phases. A radiation oncologist manually delineated the GTV for 5 phases (0%, 30%, 50%, 70% and 90%). The FFF algorithm was used to map deformations between the EE (50%) phase and each of the other 4 phases. The resultant deformation fields served to propagate GTV contours from EE to the other phases. The Dice Similarity Coefficient (DSC), which measures agreement between the DIR-propagated and manually-delineated GTVs, was used to quantitatively examine DIR accuracy. Results: Average DSC over all scans and patients is 0.82 and standard deviation is 0.09 (DSC range 0.97–0.57). For GTV volumes above and below the median volume of 20.2 cc, a Wilcoxon rank-sum test shows significantly different DSC (p=0.0000002). For the GTVs above the median volume, average +/− SD is 0.85 +/− 0.07; and for the GTVs below, the average +/− SD is 0.75 +/−0.08. Conclusion: For pancreatic tumors, the FFF DIR algorithm accurately propagated the GTV between the images in different phases of RCCT, with improved performance for larger tumors.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2014

SU-E-J-237: Image Feature Based DRR and Portal Image Registration

Purpose: Two-dimensional (2D) matching of the kV X-ray and digitally reconstructed radiography (DRR) images is an important setup technique for image-guided radiotherapy (IGRT). In our clinics, mutual information based methods are used for this purpose on commercial linear accelerators, but with often needs for manual corrections. This work proved the feasibility that feature based image transform can be used to register kV and DRR images. Methods: The scale invariant feature transform (SIFT) method was implemented to detect the matching image details (or key points) between the kV and DRR images. These key points represent high image intensity gradients, and thus the scale invariant features. Due to the poor image contrast from our kV image, direct application of the SIFT method yielded many detection errors. To assist the finding of key points, the center coordinates of the kV and DRR images were read from the DICOM header, and the two groups of key points with similar relative positions to their corresponding centers were paired up. Using these points, a rigid transform (with scaling, horizontal and vertical shifts) was estimated. We also artificially introduced vertical and horizontal shifts to test the accuracy of our registration method on anterior-posterior (AP) and lateral pelvic images. Results: The results provided a satisfactory overlay of the transformed kV onto the DRR image. The introduced vs. detected shifts were fit into a linear regression. In the AP image experiments, linear regression analysis showed a slope of 1.15 and 0.98 with an R2 of 0.89 and 0.99 for the horizontal and vertical shifts, respectively. The results are 1.2 and 1.3 with R2 of 0.72 and 0.82 for the lateral image shifts. Conclusion: This work provided an alternative technique for kV to DRR alignment. Further improvements in the estimation accuracy and image contrast tolerance are underway.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

DOE OSTI2014

SU-E-J-248: Comparative Study of Two Image Registration for Image-Guided Radiation Therapy in Esophageal Cancer

Purpose: Image-guided radiation therapy (IGRT) is one of the major treatment of esophageal cancer. Gray value registration and bone registration are two kinds of image registration, the purpose of this work is to compare which one is more suitable for esophageal cancer patients. Methods: Twenty three esophageal patients were treated by Elekta Synergy, CBCT images were acquired and automatically registered to planning kilovoltage CT scans according to gray value or bone registration. The setup errors were measured in the X, Y and Z axis, respectively. Two kinds of setup errors were analysed by matching T test statistical method. Results: Four hundred and five groups of CBCT images were available and the systematic and random setup errors (cm) in X, Y, Z directions were 0.35, 0.63, 0.29 and 0.31, 0.53, 0.21 with gray value registration, while 0.37, 0.64, 0.26 and 0.32, 0.55, 0.20 with bone registration, respectively. Compared with bone registration and gray value registration, the setup errors in X and Z axis have significant differences. In Y axis, both measurement comparison results of T value is 0.256 (P value > 0.05); In X axis, the T value is 5.287(P value < 0.05); In Z axis, the T value is −5.138 (P value < 0.05). Conclusion: Gray value registration is recommended in image-guided radiotherapy for esophageal cancer and the other thoracic tumors. Manual registration could be applied when it is necessary. Bone registration is more suitable for the head tumor and pelvic tumor department where composed of redundant interconnected and immobile bone tissue.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2014

SU-E-J-249: Correlation of Mean Lung Ventilation Value with Ratio of Total Lung Volumes

Purpose: Lung ventilation function measured from 4D-CT and from breathing correlated CT images is a novel concept to incorporate the lung physiologic function into treatment planning of radiotherapy. The calculated ventilation functions may vary from different breathing patterns, affecting evaluation of the treatment plans. The purpose of this study is to correlate the mean lung ventilation value with the ratio of the total lung volumes obtained from the relevant CTs. Methods: A ventilation map was calculated from the variations of voxel-to-voxel CT densities from two breathing phases from either 4D-CT or breathing correlated CTs. An open source image registration tool of Plastimatch was used to deform the inhale phase images to the exhale phase images. To calculate the ventilation map inside lung, the whole lung was delineated and the tissue outside the lung was masked out. With a software tool developed in house, the 3D ventilation map was then converted in the DICOM format associated with the planning CT images. The ventilation map was analyzed on a clinical workstation. To correlate ventilation map thus calculated with lung volume change, the total lung volume change was compared the mean ventilation from our method. Results: Twenty two patients who underwent stereotactic body irradiation for lung cancer was selected for this retrospective study. For this group of patients, the ratio of lung volumes for the inhale (Vin ) and exhale phase (Vex ) was shown to be linearly related to the mean of the local ventilation (Vent), Vin/Vex=1.+0.49*Vent (R2=0.93, p<0.01). Conclusion: The total lung volume change is highly correlated with the mean of local ventilation. The mean of local ventilation may be useful to assess the patient's lung capacity.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2014

SU-E-J-251: Fast MR-Based DRR Generation Using Highly Undersampled 3D Radial Trajectories

Purpose: The construction of a digitally reconstructed radiograph (DRR) from a magnetic resonance image (MRI) is possible if the cortical bone signal can be acquired and separated from air and soft tissue. This may be accomplished by subtracting a long echo-time, in-phase, gradient echo (GRE) image volume from an ultra-short echo time free induction decay (FID) image to produce a bone-enhanced (BE) image that reveals cortical bone. One limitation of this approach is the length of time required for data acquisition, which can limit the quality of the DRRs due to patient and organ motion. This study aimed to significantly reduce the acquisition time without compromising DRR quality. Methods: Brain data were acquired from two volunteers using a 3T MR scanner (Ingenia, Philips Healthcare). The FID and GRE images were acquired in a single acquisition using a 3D radial readout sequence with the following parameters: TE1=0.142ms (ultra-short), TE2=2.197ms (nearly in-phase), 2*2*2mm3 isotropic voxels, 250*250*250mm3 FOV. To reduce the acquisition time, k-space was sampled at 75, 50 and 25% of a full 3D sphere . The TE2 image was subtracted from the TE1 image to generate the BE images. The BE images were used to generate DRRs using the Pinnacle treatment planning system (Philips-version 9.2). The quality of the DRRs was evaluated qualitatively by 5 board certified medical physicists for clinical usefulness. Results: The acquisition time for 75, 50 and 25% sampling schemes were 219s, 146s, and 73s, respectively, the latter of which was a four-fold reduction in scan time compared to a 300s fully-sampled acquisition. All DRRs obtained were of acceptable quality and were shown to have sufficient information for clinical 2D image matching. Conclusion: Undersampling k-space while maintaining the same range of frequency information results in significantly reduced scan time and clinically acceptable DRR image quality. Drs. B Traughber and R Muzic have research support from Philips Healthcare. Drs. M Traughber and L Hu are employees of Philips Healthcare.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2014

SU-E-J-252: A Motion Algorithm to Extract Physical and Motion Parameters of a Mobile Target in Cone-Beam Computed Tomographic Imaging Retrospective to Image Reconstruction

Purpose: A motion algorithm was developed to extract actual length, CT-numbers and motion amplitude of a mobile target imaged with cone-beam-CT (CBCT) retrospective to image-reconstruction. Methods: The motion model considered a mobile target moving with a sinusoidal motion and employed three measurable parameters: apparent length, CT number level and gradient of a mobile target obtained from CBCT images to extract information about the actual length and CT number value of the stationary target and motion amplitude. The algorithm was verified experimentally with a mobile phantom setup that has three targets with different sizes manufactured from homogenous tissue-equivalent gel material embedded into a thorax phantom. The phantom moved sinusoidal in one-direction using eight amplitudes (0–20mm) and a frequency of 15-cycles-per-minute. The model required imaging parameters such as slice thickness, imaging time. Results: This motion algorithm extracted three unknown parameters: length of the target, CT-number-level, motion amplitude for a mobile target retrospective to CBCT image reconstruction. The algorithm relates three unknown parameters to measurable apparent length, CT-number-level and gradient for well-defined mobile targets obtained from CBCT images. The motion model agreed with measured apparent lengths which were dependent on actual length of the target and motion amplitude. The cumulative CT-number for a mobile target was dependent on CT-number-level of the stationary target and motion amplitude. The gradient of the CT-distribution of mobile target is dependent on the stationary CT-number-level, actual target length along the direction of motion, and motion amplitude. Motion frequency and phase did not affect the elongation and CT-number distributions of mobile targets when imaging time included several motion cycles. Conclusion: The motion algorithm developed in this study has potential applications in diagnostic CT imaging and radiotherapy to extract actual length, size and CT-numbers distorted by motion in CBCT imaging. The model provides further information about motion of the target.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2014

SU-E-J-254: Utility of Pinnacle Dynamic Planning Module Utilizing Deformable Image Registration in Adaptive Radiotherapy

Purpose For certain highly conformal treatment techniques, changes in patient anatomy due to weight loss and/or tumor shrinkage can result in significant changes in dose distribution. Recently, the Pinnacle treatment planning system added a Dynamic Planning module utilizing Deformable Image Registration (DIR). The objective of this study was to evaluate the effectiveness of this software in adapting to altered anatomy and adjusting treatment plans to account for it. Methods We simulated significant tumor response by changing patient thickness and altered chin positions using a commercially-available head and neck (H and N) phantom. In addition, we studied 23 CT image sets of fifteen (15) patients with H and N tumors and eight (8) patients with prostate cancer. In each case, we applied deformable image registration through Dynamic Planning module of our Pinnacle Treatment Planning System. The dose distribution of the original CT image set was compared to the newly computed dose without altering any treatment parameter. Result was a dose if we did not adjust the plan to reflect anatomical changes. Results For the H and N phantom, a tumor response of up to 3.5 cm was correctly deformed by the Pinnacle Dynamic module. Recomputed isodose contours on new anatomies were within 1 mm of the expected distribution. The Pinnacle system configuration allowed dose computations resulting from original plans on new anatomies without leaving the planning system. Original and new doses were available side-by-side with both CT image sets. Based on DIR, about 75% of H and N patients (11/15) required a re-plan using new anatomy. Among prostate patients, the DIR predicted near-correct bladder volume in 62% of the patients (5/8). Conclusions The Dynamic Planning module of the Pinnacle system proved to be an accurate and useful tool in our ability to adapt to changes in patient anatomy during a course of radiotherapy.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2014

SU-E-J-257: Image Artifacts Caused by Implanted Calypso Beacons in MRI Studies

Purpose: The presence of Calypso Beacon-transponders in patients can cause artifacts during MRI imaging studies. This could be a problem for post-treatment follow up of cancer patients using MRI studies to evaluate metastasis and for functional imaging studies.This work assesses (1) the volume immediately surrounding the transponders that will not be visualized by the MRI due to the beacons, and (2) the dependence of the non-visualized volume on beacon orientation, and scanning techniques. Methods: Two phantoms were used in this study (1) water filled box, (2) and a 2300 cc block of pork meat. Calypso beacons were implanted in the phantoms both in parallel and perpendicular orientations with respect to the MR scanner magnetic field. MR image series of the phantom were obtained with on a 1.0T high field open MR-SIM with multiple pulse sequences, for example, T1-weighted fast field echo and T2-weighted turbo spin echo. Results: On average, a no-signal region with 2 cm radius and 3 cm length was measured. Image artifacts are more significant when beacons are placed parallel to scanner magnetic field; the no-signal area around the beacon was about 0.5 cm larger in orthogonal orientation. The no-signal region surrounding the beacons slightly varies in dimension for the different pulse sequences. Conclusion: The use of Calypso beacons can prohibit the use of MRI studies in post-treatment assessments, especially in the immediate region surrounding the implanted beacon. A characterization of the MR scanner by identifying the no-signal regions due to implanted beacons is essential. This may render the use of Calypso beacons useful for some cases and give the treating physician a chance to identify those patients prior to beacon implantation.

60 APPLIED LIFE SCIENCES↗