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At least 1,063 records · Page 59
All sourcesNASA NTRSDOE OSTI
DOE OSTI2015

Estimated dose rates to members of the public from external exposure to patients with {sup 131}I thyroid treatment

Purpose: Estimated dose rates that may result from exposure to patients who had been administered iodine-131 ({sup 131}I) as part of medical therapy were calculated. These effective dose rate estimates were compared with simplified assumptions under United States Nuclear Regulatory Commission Regulatory Guide 8.39, which does not consider body tissue attenuation nor time-dependent redistribution and excretion of the administered {sup 131}I. Methods: Dose rates were estimated for members of the public potentially exposed to external irradiation from patients recently treated with {sup 131}I. Tissue attenuation and iodine biokinetics were considered in the patient in a larger comprehensive effort to improve external dose rate estimates. The external dose rate estimates are based on Monte Carlo simulations using the Phantom with Movable Arms and Legs (PIMAL), previously developed by Oak Ridge National Laboratory and the United States Nuclear Regulatory Commission. PIMAL was employed to model the relative positions of the {sup 131}I patient and members of the public in three exposure scenarios: (1) traveling on a bus in a total of six seated or standing permutations, (2) two nursing home cases where a caregiver is seated at 30 cm from the patient’s bedside and a nursing home resident seated 250 cm away from the patient in an adjacent bed, and (3) two hotel cases where the patient and a guest are in adjacent rooms with beds on opposite sides of the common wall, with the patient and guest both in bed and either seated back-to-back or lying head to head. The biokinetic model predictions of the retention and distribution of {sup 131}I in the patient assumed a single voiding of urinary bladder contents that occurred during the trip at 2, 4, or 8 h after {sup 131}I administration for the public transportation cases, continuous first-order voiding for the nursing home cases, and regular periodic voiding at 4, 8, or 12 h after administration for the hotel room cases. Organ specific activities of {sup 131}I in the thyroid, bladder, and combined remaining tissues were calculated as a function of time after administration. Exposures to members of the public were considered for {sup 131}I patients with normal thyroid uptake (peak thyroid uptake of ∼27% of administered {sup 131}I), differentiated thyroid cancer (DTC, 5% uptake), and hyperthyroidism (80% uptake). Results: The scenario with the patient seated behind the member of the public yielded the highest dose rate estimate of seated public transportation exposure cases. The dose rate to the adjacent room guest was highest for the exposure scenario in which the hotel guest and patient are seated by a factor of ∼4 for the normal and differentiated thyroid cancer uptake cases and by a factor of ∼3 for the hyperthyroid case. Conclusions: It was determined that for all modeled cases, the DTC case yielded the lowest external dose rates, whereas the hyperthyroid case yielded the highest dose rates. In estimating external dose to members of the public from patients with {sup 131}I therapy, consideration must be given to (patient- and case-specific) administered {sup 131}I activities and duration of exposure for a more complete estimate. The method implemented here included a detailed calculation model, which provides a means to determine dose rate estimates for a range of scenarios. The method was demonstrated for variations of three scenarios, showing how dose rates are expected to vary with uptake, voiding pattern, and patient location.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

Gradient maintenance: A new algorithm for fast online replanning

Purpose: Clinical use of online adaptive replanning has been hampered by the unpractically long time required to delineate volumes based on the image of the day. The authors propose a new replanning algorithm, named gradient maintenance (GM), which does not require the delineation of organs at risk (OARs), and can enhance automation, drastically reducing planning time and improving consistency and throughput of online replanning. Methods: The proposed GM algorithm is based on the hypothesis that if the dose gradient toward each OAR in daily anatomy can be maintained the same as that in the original plan, the intended plan quality of the original plan would be preserved in the adaptive plan. The algorithm requires a series of partial concentric rings (PCRs) to be automatically generated around the target toward each OAR on the planning and the daily images. The PCRs are used in the daily optimization objective function. The PCR dose constraints are generated with dose–volume data extracted from the original plan. To demonstrate this idea, GM plans generated using daily images acquired using an in-room CT were compared to regular optimization and image guided radiation therapy repositioning plans for representative prostate and pancreatic cancer cases. Results: The adaptive replanning using the GM algorithm, requiring only the target contour from the CT of the day, can be completed within 5 min without using high-power hardware. The obtained adaptive plans were almost as good as the regular optimization plans and were better than the repositioning plans for the cases studied. Conclusions: The newly proposed GM replanning algorithm, requiring only target delineation, not full delineation of OARs, substantially increased planning speed for online adaptive replanning. The preliminary results indicate that the GM algorithm may be a solution to improve the ability for automation and may be especially suitable for sites with small-to-medium size targets surrounded by several critical structures.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

3D delivered dose assessment using a 4DCT-based motion model

Purpose: The purpose of this work is to develop a clinically feasible method of calculating actual delivered dose distributions for patients who have significant respiratory motion during the course of stereotactic body radiation therapy (SBRT). Methods: A novel approach was proposed to calculate the actual delivered dose distribution for SBRT lung treatment. This approach can be specified in three steps. (1) At the treatment planning stage, a patient-specific motion model is created from planning 4DCT data. This model assumes that the displacement vector field (DVF) of any respiratory motion deformation can be described as a linear combination of some basis DVFs. (2) During the treatment procedure, 2D time-varying projection images (either kV or MV projections) are acquired, from which time-varying “fluoroscopic” 3D images of the patient are reconstructed using the motion model. The DVF of each timepoint in the time-varying reconstruction is an optimized linear combination of basis DVFs such that the 2D projection of the 3D volume at this timepoint matches the projection image. (3) 3D dose distribution is computed for each timepoint in the set of 3D reconstructed fluoroscopic images, from which the total effective 3D delivered dose is calculated by accumulating deformed dose distributions. This approach was first validated using two modified digital extended cardio-torso (XCAT) phantoms with lung tumors and different respiratory motions. The estimated doses were compared to the dose that would be calculated for routine 4DCT-based planning and to the actual delivered dose that was calculated using “ground truth” XCAT phantoms at all timepoints. The approach was also tested using one set of patient data, which demonstrated the application of our method in a clinical scenario. Results: For the first XCAT phantom that has a mostly regular breathing pattern, the errors in 95% volume dose (D95) are 0.11% and 0.83%, respectively for 3D fluoroscopic images reconstructed from kV and MV projections compared to the ground truth, which is clinically comparable to 4DCT (0.093%). For the second XCAT phantom that has an irregular breathing pattern, the errors are 0.81% and 1.75% for kV and MV reconstructions, both of which are better than that of 4DCT (4.01%). In the case of real patient, although it is impossible to obtain the actual delivered dose, the dose estimation is clinically reasonable and demonstrates differences between 4DCT and MV reconstruction-based dose estimates. Conclusions: With the availability of kV or MV projection images, the proposed approach is able to assess delivered doses for all respiratory phases during treatment. Compared to the planning dose based on 4DCT, the dose estimation using reconstructed 3D fluoroscopic images was as good as 4DCT for regular respiratory pattern and was a better dose estimation for the irregular respiratory pattern.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-247: Determinations of the Optimal Phase for Respiratory Gated Radiotherapy From Statistical Analysis Using a Visible Guidance System

Purpose: Respiratory gated radiation therapy (RGRT) is used to minimize the radiation dose to normal tissue in lung cancer patients. Determination of the optimal point in the respiratory phase of a patient is important in RGRT but it is not easy. The goal of the present study was to see if a visible guidance system is helpful in determining the optimal phase in respiratory gated therapy. Methods: The breathing signals of 23 lung cancer patients were recorded with a Real-time Position Management (RPM) respiratory gating system (Varian, USA). The patients underwent breathing training with our visible guidance system, after which their breathing signals were recorded during 5 min of free breathing and 5 min of guided breathing. The breathing signals recorded between 3 and 5 min before and after training were compared. We performed statistical analysis of the breathing signals to find the optimal duty cycle in guided breathing for RGRT. Results: The breathing signals aided by the visible guidance system had more regular cycles over time and smaller variations in the positions of the marker block than the free breathing signals. Of the 23 lung cancer patients, 19 showed statistically significant differences by time when the values obtained before and after breathing were compared (p < 0.05); 30% and 40% of the duty cycle, respectively, was determined to be the most effective, and the corresponding phases were 30 60% (duty cycle, 30%; p < 0.05) and 30 70% (duty cycle, 40%; p < 0.05). Conclusion: Respiratory regularity was significantly improved with the use of the RPM with our visible guiding system; therefore, it would help improve the accuracy and efficiency of RGRT.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-272: Direct Verification of a Treatment Planning System Megavoltage Linac Beam Photon Spectra Models, and Analysis of the Effects On Patient Plans

Purpose: For the photon dose calculation Philips Pinnacle Treatment Planning System (TPS) uses collapsed cone convolution algorithm, which relies on energy spectrum of the beam in computing the scatter component. The spectrum is modeled based on Linac’s standard commissioning data and typically is not independently verified. We explored a methodology of using transmission measurements in combination with regularization data processing to unfold Linac spectra. The measured spectra were compared to those modeled by the TPS, and the effect on patient plans was evaluated. Methods: Transmission measurements were conducted in narrow-beam geometry using a standard Farmer ionization chamber. Two attenuating materials and two build -up caps, having different atomic numbers, served to enhance discrimination between absorption of low and high-energy portions of the spectra, thus improving the accuracy of the results. The data was analyzed using a regularization technique implemented through spreadsheet-based calculations. Results: The unfolded spectra were found to deviate from the TPS beam models. The effect of such deviations on treatment planning was evaluated for patient plans through dose distribution calculations with either TPS modeled or measured energy spectra. The differences were reviewed through comparison of isodose distributions, and quantified based on maximum dose values for critical structures. While in most cases no drastic differences in the calculated doses were observed, plans with deviations of 4 to 8% in the maximum dose values for critical structures were discovered. The anatomical sites with large scatter contributions are the most vulnerable to inaccuracies in the modeled spectrum. Conclusion: An independent check of the TPS model spectrum is highly desirable and should be included as part of commissioning of a new Linac. The effect is particularly important for dose calculations in high heterogeneity regions. The developed approach makes acquisition of megavoltage Linac beam spectra achievable in a typical radiation oncology clinic.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

TU-AB-303-03: CBCT-Based On-Site Simulation, Planning, and Delivery (OSPD) for Whole Brain Radiotherapy

Purpose: To demonstrate the feasibility of a CBCT-based on-site simulation, planning, and delivery (OSPD) for whole brain radiotherapy, in which all steps from imaging, planning to treatment delivery are performed at the treatment unit in one appointment time slot. This work serves as the proof of concept for future OSPD single fraction radiation therapy. Methods: An integrated on-site imaging, planning and delivery workflow was developed and tested for whole brain radiotherapy. An automated two-opposed-oblique-beam plan is created by utilizing the treatment planning system scripting and simple field-in-field IMRT. The IMRT plan is designed with maximum 8 control points to cover the target volume consisting of the brain to C1/C2 of the spinal cord, with dose homogeneity criteria from −5% to +7% of the prescription dose. Due to inaccuracy of reconstructed Hounsfield unit numbers in CBCT images, the dose distribution is calculated with non-heterogeneity correction introducing only clinically insignificant dose discrepancy. A coherent and synchronized workflow was designed for a team of attending physician, physicist, therapists, and dosimetrist to work closely with the ability to quickly modify, approve, and implement the treatment. Results: Thirty-one patients have been treated with this OSPD treatment, without compromising the plan quality compared to our regular clinically used parallel apposed 2D plans. The average time for these procedures are 48.02 ±11.55 minutes from the time patient entered the treatment room until s/he exited, and 35.09 ±10.35 minutes from starting CBCT until last beam delivered. This time duration is comparable to the net time when individual tasks are summed up during our regular CT- based whole brain planning and delivery. Conclusions: The OSPD whole brain treatment has been tested to be clinically feasible. The next step is to further improve the efficiency and to streamline the workflow. Other disease sites will be also tested with this new technology.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

TU-CD-207-03: Time Evolution of Texture Parameters of Subtracted Images Obtained by Contrast-Enhanced Digital Mammography (CEDM)

Purpose: To evaluate the time evolution of texture parameters, based on the gray level co-occurrence matrix (GLCM), in subtracted images of 17 patients (10 malignant and 7 benign) subjected to contrast-enhanced digital mammography (CEDM). The goal is to determine the sensitivity of texture to iodine uptake at the lesion, and its correlation (or lack of) with mean-pixel-value (MPV). Methods: Acquisition of clinical images followed a single-energy CEDM protocol using Rh/Rh/48 kV plus external 0.5 cm Al from a Senographe DS unit. Prior to the iodine-based contrast medium (CM) administration a mask image was acquired; four CM images were obtained 1, 2, 3, and 5 minutes after CM injection. Temporal series were obtained by logarithmic subtraction of registered CM minus mask images.Regions of interest (ROI) for the lesion were drawn by a radiologist and the texture was analyzed. GLCM was evaluated at a 3 pixel distance, 0° angle, and 64 gray-levels. Pixels identified as registration errors were excluded from the computation. 17 texture parameters were chosen, classified according to similarity into 7 groups, and analyzed. Results: In all cases the texture parameters within a group have similar dynamic behavior. Two texture groups (associated to cluster and sum mean) show a strong correlation with MPV; their average correlation coefficient (ACC) is r{sup 2}=0.90. Other two groups (contrast, homogeneity) remain constant with time, that is, a low-sensitivity to CM uptake. Three groups (regularity, lacunarity and diagonal moment) are sensitive to CM uptake but less correlated with MPV; their ACC is r{sup 2}=0.78. Conclusion: This analysis has shown that, at least groups associated to regularity, lacunarity and diagonal moment offer dynamical information additional to the mean pixel value due to the presence of CM at the lesion. The next step will be the analysis in terms of the lesion pathology. Authors thank PAPIIT-IN105813 for support. Consejo Nacional de Ciencia Y Tecnologia, PAPIIT-IN105813.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

Breathing guidance in radiation oncology and radiology: A systematic review of patient and healthy volunteer studies

Purpose: The advent of image-guided radiation therapy 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 irregularities is the use of breathing guidance systems during imaging and treatment. These systems aim to facilitate regular respiratory motion which in turn improves image quality and radiation treatment accuracy. A review of such research has yet to be performed; it was therefore their aim to perform a systematic review of breathing guidance interventions within the fields of radiation oncology and radiology. Methods: From August 1–14, 2014, the following online databases were searched: Medline, Embase, PubMed, and Web of Science. Results of these searches were filtered in accordance to a set of eligibility criteria. The search, filtration, and analysis of articles were conducted in accordance with preferred reporting items for systematic reviews and meta-analyses. Reference lists of included articles, and repeat authors of included articles, were hand-searched. Results: The systematic search yielded a total of 480 articles, which were filtered down to 27 relevant articles in accordance to the eligibility criteria. These 27 articles detailed the intervention of breathing guidance strategies in controlled studies assessing its impact on such outcomes as breathing regularity, image quality, target coverage, and treatment margins, recruiting either healthy adult volunteers or patients with thoracic or abdominal lesions. In 21/27 studies, significant (p < 0.05) improvements from the use of breathing guidance were observed. Conclusions: There is a trend toward the number of breathing guidance studies increasing with time, indicating a growing clinical interest. The results found here indicate that further clinical studies are warranted that quantify the clinical impact of breathing guidance, along with the health technology assessment to determine the advantages and disadvantages of breathing guidance.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

Spectrotemporal CT data acquisition and reconstruction at low dose

Purpose: X-ray computed tomography (CT) is widely used, both clinically and preclinically, for fast, high-resolution anatomic imaging; however, compelling opportunities exist to expand its use in functional imaging applications. For instance, spectral information combined with nanoparticle contrast agents enables quantification of tissue perfusion levels, while temporal information details cardiac and respiratory dynamics. The authors propose and demonstrate a projection acquisition and reconstruction strategy for 5D CT (3D + dual energy + time) which recovers spectral and temporal information without substantially increasing radiation dose or sampling time relative to anatomic imaging protocols. Methods: The authors approach the 5D reconstruction problem within the framework of low-rank and sparse matrix decomposition. Unlike previous work on rank-sparsity constrained CT reconstruction, the authors establish an explicit rank-sparse signal model to describe the spectral and temporal dimensions. The spectral dimension is represented as a well-sampled time and energy averaged image plus regularly undersampled principal components describing the spectral contrast. The temporal dimension is represented as the same time and energy averaged reconstruction plus contiguous, spatially sparse, and irregularly sampled temporal contrast images. Using a nonlinear, image domain filtration approach, the authors refer to as rank-sparse kernel regression, the authors transfer image structure from the well-sampled time and energy averaged reconstruction to the spectral and temporal contrast images. This regularization strategy strictly constrains the reconstruction problem while approximately separating the temporal and spectral dimensions. Separability results in a highly compressed representation for the 5D data in which projections are shared between the temporal and spectral reconstruction subproblems, enabling substantial undersampling. The authors solved the 5D reconstruction problem using the split Bregman method and GPU-based implementations of backprojection, reprojection, and kernel regression. Using a preclinical mouse model, the authors apply the proposed algorithm to study myocardial injury following radiation treatment of breast cancer. Results: Quantitative 5D simulations are performed using the MOBY mouse phantom. Twenty data sets (ten cardiac phases, two energies) are reconstructed with 88 μm, isotropic voxels from 450 total projections acquired over a single 360° rotation. In vivo 5D myocardial injury data sets acquired in two mice injected with gold and iodine nanoparticles are also reconstructed with 20 data sets per mouse using the same acquisition parameters (dose: ∼60 mGy). For both the simulations and the in vivo data, the reconstruction quality is sufficient to perform material decomposition into gold and iodine maps to localize the extent of myocardial injury (gold accumulation) and to measure cardiac functional metrics (vascular iodine). Their 5D CT imaging protocol represents a 95% reduction in radiation dose per cardiac phase and energy and a 40-fold decrease in projection sampling time relative to their standard imaging protocol. Conclusions: Their 5D CT data acquisition and reconstruction protocol efficiently exploits the rank-sparse nature of spectral and temporal CT data to provide high-fidelity reconstruction results without increased radiation dose or sampling time.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

Evaluation of MRI and cannabinoid type 1 receptor PET templates constructed using DARTEL for spatial normalization of rat brains

Purpose: Image registration is one prerequisite for the analysis of brain regions in magnetic-resonance-imaging (MRI) or positron-emission-tomography (PET) studies. Diffeomorphic anatomical registration through exponentiated Lie algebra (DARTEL) is a nonlinear, diffeomorphic algorithm for image registration and construction of image templates. The goal of this small animal study was (1) the evaluation of a MRI and calculation of several cannabinoid type 1 (CB1) receptor PET templates constructed using DARTEL and (2) the analysis of the image registration accuracy of MR and PET images to their DARTEL templates with reference to analytical and iterative PET reconstruction algorithms. Methods: Five male Sprague Dawley rats were investigated for template construction using MRI and [{sup 18}F]MK-9470 PET for CB1 receptor representation. PET images were reconstructed using the algorithms filtered back-projection, ordered subset expectation maximization in 2D, and maximum a posteriori in 3D. Landmarks were defined on each MR image, and templates were constructed under different settings, i.e., based on different tissue class images [gray matter (GM), white matter (WM), and GM + WM] and regularization forms (“linear elastic energy,” “membrane energy,” and “bending energy”). Registration accuracy for MRI and PET templates was evaluated by means of the distance between landmark coordinates. Results: The best MRI template was constructed based on gray and white matter images and the regularization form linear elastic energy. In this case, most distances between landmark coordinates were <1 mm. Accordingly, MRI-based spatial normalization was most accurate, but results of the PET-based spatial normalization were quite comparable. Conclusions: Image registration using DARTEL provides a standardized and automatic framework for small animal brain data analysis. The authors were able to show that this method works with high reliability and validity. Using DARTEL templates together with nonlinear registration algorithms allows for accurate spatial normalization of combined MRI/PET or PET-only studies.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

Technical Note: Improving the VMERGE treatment planning algorithm for rotational radiotherapy

Purpose: The authors revisit the VMERGE treatment planning algorithm by Craft et al. [“Multicriteria VMAT optimization,” Med. Phys. 39, 686–696 (2012)] for arc therapy planning and propose two changes to the method that are aimed at improving the achieved trade-off between treatment time and plan quality at little additional planning time cost, while retaining other desirable properties of the original algorithm. Methods: The original VMERGE algorithm first computes an “ideal,” high quality but also highly time consuming treatment plan that irradiates the patient from all possible angles in a fine angular grid with a highly modulated beam and then makes this plan deliverable within practical treatment time by an iterative fluence map merging and sequencing algorithm. We propose two changes to this method. First, we regularize the ideal plan obtained in the first step by adding an explicit constraint on treatment time. Second, we propose a different merging criterion that comprises of identifying and merging adjacent maps whose merging results in the least degradation of radiation dose. Results: The effect of both suggested modifications is evaluated individually and jointly on clinical prostate and paraspinal cases. Details of the two cases are reported. Conclusions: In the authors’ computational study they found that both proposed modifications, especially the regularization, yield noticeably improved treatment plans for the same treatment times than what can be obtained using the original VMERGE method. The resulting plans match the quality of 20-beam step-and-shoot IMRT plans with a delivery time of approximately 2 min.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-I-12: Region-Specific Dictionary Learning for Low-Dose X-Ray CT Reconstruction

Purpose: Dictionary learning based method has attracted more and more attentions in low-dose CT due to the superior performance on suppressing noise and preserving structural details. Considering the structures and noise vary from region to region in one imaging object, we propose a region-specific dictionary learning method to improve the low-dose CT reconstruction. Methods: A set of normal-dose images was used for dictionary learning. Segmentations were performed on these images, so that the training patch sets corresponding to different regions can be extracted out. After that, region-specific dictionaries were learned from these training sets. For the low-dose CT reconstruction, a conventional reconstruction, such as filtered back-projection (FBP), was performed firstly, and then segmentation was followed to segment the image into different regions. Sparsity constraints of each region based on its dictionary were used as regularization terms. The regularization parameters were selected adaptively according to different regions. A low-dose human thorax dataset was used to evaluate the proposed method. The single dictionary based method was performed for comparison. Results: Since the lung region is very different from the other part of thorax, two dictionaries corresponding to lung region and the rest part of thorax respectively were learned to better express the structural details and avoid artifacts. With only one dictionary some artifact appeared in the body region caused by the spot atoms corresponding to the structures in the lung region. And also some structure in the lung regions cannot be recovered well by only one dictionary. The quantitative indices of the result by the proposed method were also improved a little compared to the single dictionary based method. Conclusion: Region-specific dictionary can make the dictionary more adaptive to different region characteristics, which is much desirable for enhancing the performance of dictionary learning based method.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-T-403: Impact of Dose Reduction for Simulation CT On Radiation Therapy Treatment Planning

Purpose: To investigate the feasibility of applying ALARA principles to current treatment planning CT scans. The study aims to quantitatively verify lower dose scans does not alter treatment planning. Method: Gammex 467 tissue characterization phantom with inserts of 14 different materials was scanned at seven different mA levels (30∼300 mA). CT numbers of different inserts were measured. Auto contouring for bone and lung in treatment planning system (Pinnacle) was used to evaluate the effect of CT number accuracy from treatment planning aspect, on the 30 and 300 mA-scanned images. A head CT scan intended for a 3D whole brain radiation treatment was evaluated. Dose calculations were performed on normal scanned images using clinical protocol (120 kVP, Smart mA, maximum 291 mA), and the images with added simulating noise mimicking a 70 mA scan. Plan parameters including isocenter, beam arrangements, block shapes, dose grid size and resolution, and prescriptions were kept the same for these two plans. The calculated monitor units (MUs) for these two plans were compared. Results: No significant degradation of CT number accuracy was found at lower dose levels from both the phantom scans, and the patient images with added noise. The CT numbers kept consistent when mA is higher than 60 mA. The auto contoured volumes for lung and cortical bone show 0.3% and 0.12% of differences between 30 mA and 300 mA respectively. The two forward plans created on regular and low dose images gave the same calculated MU, and 98.3% of points having <1% of dose difference. Conclusion: Both phantom and patient studies quantitatively verified low dose CT provides similar quality for treatment planning at 20–25% of regular scan dose. Therefore, there is the potential to optimize simulation CT scan protocol to fulfil the ALARA principle and limit unnecessary radiation exposure to non-targeted tissues.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-T-479: Estimation of the Accuracy in Respiratory-Gated Radiotherapy

Purpose: Irregular respiratory patterns affects dose outputs in respiratorygated radiotherapy and there is no commercially available quality assurance (QA) system for it. We designed and developed a patient specific QA system for respiratory-gated radiotherapy to estimate irradiated output. Methods: Our in-house QA system for gating was composed of a personal computer with the USB-FSIO electronic circuit connecting to the linear accelerator (ONCOR-K, Toshiba Medical Systems). The linac implements a respiratory gating system (AZ-733V, Anzai Medical). During the beam was on, 4.2 V square-wave pulses were continually sent to the system. Our system can receive and count the pulses. At first, our system and an oscilloscope were compared to check the performance of our system. Next, basic estimation models were generated when ionization-chamber measurements were performed in gating using regular sinusoidal wave patterns (2.0, 2.5, 4.0, 8.0, 15 sec/cycle). During gated irradiation with the regular patterns, the number of the pulses per one gating window was measured using our system. Correlation between the number of the pulses per one gating and dose per the gating window were assessed to generate the estimation model. Finally, two irregular respiratory patterns were created and the accuracy of the estimation was evaluated. Results: Compared to the oscilloscope, our system worked similarly. The basic models were generated with the accuracy within 0.1%. The results of the gated irradiations with two irregular respiratory patterns show good agreement within 0.4% estimation accuracy. Conclusion: Our developed system shows good estimation for even irregular respiration patterns. The system would be a useful tool to verify the output for respiratory-gated radiotherapy.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-G-JeP1-10: Feasibility of CyberKnife Tracking Using the Previously-Implanted Permanent Brachytherapy Seed Cloud

Purpose: Robotic radiosurgery is a salvage treatment option for patients with recurrent prostate cancer. We explored the feasibility of tracking the bolus of permanent prostate implants (PPI) using image recognition software optimized to track spinal anatomy. Methods: Forty-five inert iodine seeds were implanted into a gelatin-based prostate phantom. Four superficial gold seeds were inserted to provide ground-truth alignment. A CT scan of the phantom (120 kVp, 1 mm slice thickness) was acquired and a single-energy iterative metal artifact reduction (MAR) algorithm was used to enhance the quality of the DRR used for tracking. CyberKnife treatment plans were generated from the MAR CT and regular CT (no-MAR) using spine tracking. The spine-tracking grid was centered on the bolus of seeds and resized to encompass the full seed cloud. A third plan was created from the regular CT scan, using fiducial tracking based on the 4 superficial gold seeds with identical align-center coordinates. The phantom was initially aligned using the fiducial-tracking plan. Then the MAR and no-MAR spine-tracking plans were loaded without moving the phantom. Differences in couch correction parameters were recorded in the case of perfect alignment and after the application of known rotations and translations (roll/pitch of 2 degrees; translations XYZ of 2 cm). Results: The spine tracking software was able to lock on to the bolus of seeds and provide couch corrections both in the MAR and no-MAR plans. In all cases, differences in the couch correction parameters from fiducial alignment were <0.5 mm in translations and <1 degree in rotations. Conclusion: We were able to successfully track the bolus of seeds with the spine-tracking grid in phantom experiments. For clinical applications, further investigation and developments to adapt the spine-tracking algorithm to optimize for PPI seed cloud tracking is needed to provide reliable tracking in patients. One of the authors (MD) has received research support and speaker honoraria from Accuray.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-G-TeP1-04: Deriving Spot Shape Criteria for Proton Pencil Beam Scanning

Purpose: The shape of a single beam in proton PBS influences the resulting dose distribution. Spot profiles are modelled as two-dimensional Gaussian (single/ double) distributions in treatment planning systems (TPS). Impact of slight deviations from an ideal Gaussian on resulting dose distributions is typically assumed to be small due to alleviation by multiple Coulomb scattering (MCS) in tissue and superposition of many spots. Quantitative limits are however not clear per se. Methods: A set of 1250 deliberately deformed profiles with sigma=4 mm for a Gaussian fit were constructed. Profiles and fit were normalized to the same area, resembling output calibration in the TPS. Depth-dependent MCS was considered. The deviation between deformed and ideal profiles was characterized by root-mean-squared deviation (RMSD), skewness/ kurtosis (SK) and full-width at different percentage of maximum (FWxM). The profiles were convolved with different fluence patterns (regular/ random) resulting in hypothetical dose distributions. The resulting deviations were analyzed by applying a gamma-test. Results were compared to measured spot profiles. Results: A clear correlation between pass-rate and profile metrics could be determined. The largest impact occurred for a regular fluence-pattern with increasing distance between single spots, followed by a random distribution of spot weights. The results are strongly dependent on gamma-analysis dose and distance levels. Pass-rates of >95% at 2%/2 mm and 40 mm depth (=70 MeV) could only be achieved for RMSD<10%, deviation in FWxM at 20% and root of quadratic sum of SK <0.8. As expected the results improve for larger depths. The trends were well resembled for measured spot profiles. Conclusion: All measured profiles from ProBeam sites passed the criteria. Given the fact, that beam-line tuning can result shape distortions, the derived criteria represent a useful QA tool for commissioning and design of future beam-line optics.

07 ISOTOPE AND RADIATION SOURCES↗
DOE OSTI2016

SU-G-TeP1-12: Random Repainting as Mitigation for Scanned Ion Beam Interplay Effects

Purpose: Interference of dose application in scanned beam particle therapy and organ motion may lead to interplay effects with distorted dose to target volumes. Interplay effects depend on the speed and direction of the scanning beam, leading to fringed field edges (scanning parallel to organ motion direction) or over- and under-dosed regions (both directions are orthogonal). Current repainting methods can mitigate interplay effects, but are susceptible to artefacts when only a limited number of repaints are applied. In this study a random layered-repainting strategy was investigated. Methods: Mono-energetic proton beams were irradiated to a 10 ×10 cm{sup 2} scanned field at a Varian ProBeam facility. Applied dose was measured with a 2D amorphous silicon detector mounted on a motion platform (CIRS dynamic platform). Motion was considered with different cycles, directions and translations up to ±8 mm. Dose distributions were measured for a static case, regular repainting (repeated meander-like path) and random repainting. Latter was realized by randomly distributing single spot locations during irradiation for a given number of repaints. Efficiency of repainting was analyzed by comparison to the static case. A simulation tool based on treatment logs and motion information was developed to compare measurement results to expected dose distributions. Results: Regular repainting could reduce motion artefacts, but dose distortion was strongly dependent on motion direction. Random repainting with same number of repaints (N=4) showed superior results, independent of target movement direction, while introducing slight penalty on delivery times, caused by an increase of overall scanning travel distance. The simulation tool showed good agreement to measured results. Conclusion: The results demonstrate significant improvement in terms of dose conformity when layered repainting is applied in a randomized fashion. This allows for reduced target margins during treatment planning and limited number of repaints. A combination with e.g. respiratory gating is straight-forward. Authors are employees of Varian Medical Systems Particle Therapy GmbH.

43 PARTICLE ACCELERATORS↗
DOE OSTI2016

3D exemplar-based random walks for tooth segmentation from cone-beam computed tomography images

Purpose: Tooth segmentation is an essential step in acquiring patient-specific dental geometries from cone-beam computed tomography (CBCT) images. Tooth segmentation from CBCT images is still a challenging task considering the comparatively low image quality caused by the limited radiation dose, as well as structural ambiguities from intercuspation and nearby alveolar bones. The goal of this paper is to present and discuss the latest accomplishments in semisupervised tooth segmentation with adaptive 3D shape constraints. Methods: The authors propose a 3D exemplar-based random walk method of tooth segmentation from CBCT images. The proposed method integrates semisupervised label propagation and regularization by 3D exemplar registration. To begin with, the pure random walk method is to get an initial segmentation of the teeth, which tends to be erroneous because of the structural ambiguity of CBCT images. And then, as an iterative refinement, the authors conduct a regularization by using 3D exemplar registration, as well as label propagation by random walks with soft constraints, to improve the tooth segmentation. In the first stage of the iteration, 3D exemplars with well-defined topologies are adapted to fit the tooth contours, which are obtained from the random walks based segmentation. The soft constraints on voxel labeling are defined by shape-based foreground dentine probability acquired by the exemplar registration, as well as the appearance-based probability from a support vector machine (SVM) classifier. In the second stage, the labels of the volume-of-interest (VOI) are updated by the random walks with soft constraints. The two stages are optimized iteratively. Instead of the one-shot label propagation in the VOI, an iterative refinement process can achieve a reliable tooth segmentation by virtue of exemplar-based random walks with adaptive soft constraints. Results: The proposed method was applied for tooth segmentation of twenty clinically captured CBCT images. Three metrics, including the Dice similarity coefficient (DSC), the Jaccard similarity coefficient (JSC), and the mean surface deviation (MSD), were used to quantitatively analyze the segmentation of anterior teeth including incisors and canines, premolars, and molars. The segmentation of the anterior teeth achieved a DSC up to 98%, a JSC of 97%, and an MSD of 0.11 mm compared with manual segmentation. For the premolars, the average values of DSC, JSC, and MSD were 98%, 96%, and 0.12 mm, respectively. The proposed method yielded a DSC of 95%, a JSC of 89%, and an MSD of 0.26 mm for molars. Aside from the interactive definition of label priors by the user, automatic tooth segmentation can be achieved in an average of 1.18 min. Conclusions: The proposed technique enables an efficient and reliable tooth segmentation from CBCT images. This study makes it clinically practical to segment teeth from CBCT images, thus facilitating pre- and interoperative uses of dental morphologies in maxillofacial and orthodontic treatments.

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