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At least 109 records · Page 6
All sourcesNASA NTRSDOE OSTI
DOE OSTI2014

SU-F-18C-08: A Validation Study of a Commercially Available Software Package's Absorbed Dose Estimates in a Physical Phantom

Purpose: This study assesses the accuracy of the absorbed dose estimates from CT scans generated by Monte Carlo (MC) simulation using a commercially available radiation dose monitoring software program. Methods: Axial CT studies of an anthropomorphic abdomen phantom with dose bores at a central location and 4 peripheral locations were conducted using a fixed tube current at 120 kV. A 100 mm ion chamber and a 0.6 cc ion chamber calibrated at diagnostic energy levels were used to measure dose in the phantom at each of the 5 dose bore locations. Simulations using the software program's Monte Carlo engine were run using a mathematical model of the anthropomorphic phantom to determine conversion coefficients between the CTDIvol used for the study and the dose at the location of the dose bores. Simulations were conducted using both the software's generic CT beam model and a refined model generated using HVL and bow tie filter profile measurements made on the scanner used for the study. Results: Monte Carlo simulations completed using the generalized beam model differed from the measured conversion factors by an absolute value average of 13.0% and 13.8% for the 100 mm and 0.6 cc ion chamber studies, respectively. The MC simulations using the scanner specific beam model generated conversion coefficients that differed from the CTDIvol to measured dose conversion coefficients by an absolute value average of 7.3% and 7.8% for the 100 mm and 0.6 cc ion chamber cases, respectively. Conclusion: A scanner specific beam model used in MC simulations generates more accurate dose conversion coefficients in an anthropomorphic phantom than those generated with a generalized beam model. Agreement between measured conversion coefficients and simulated values were less than 20% for all positions using the universal beam model.

07 ISOTOPE AND RADIATION SOURCES↗
DOE OSTI2014

SU-F-18C-12: On the Relationship of the Weighted Dose to the Surface Dose In Abdominal CT - Patient Size Dependency

Purpose: It is possible to measure the patient surface dose non-invasively using radiolucent dosimeters. However, the patient size specific weighted dose remains unknown. We attempted to study the weighted dose to surface dose relationship as the patient size varies in abdominal CT. Methods: Seven abdomen phantoms (CIRS TE series) simulating patients from an infant to a large adult were used. Size specific doses were measured with a 100 mm CT chamber under axial scans using a Siemens Sensation 64 (mCT) and a GE 750 HD. The scanner settings were 120 kVp, 200 mAs with fully opened collimations. Additional kVps (80, 100, 140) were added depending on the phantom sizes. The ratios (r) of the weighted CT dose (Dw) to the surface dose (Ds) were related to the phantom size (L) defined as the diameter resulting the equivalent cross-sectional area. Results: The Dw versus Ds ratio (r) was fitted to a linear relationship: r = 1.083 − 0.007L (R square = 0.995), and r = 1.064 − 0.007L (R square = 0.953), for Siemens Sensation 64 and GE 750 HD, respectively. The relationship appears to be independent of the scanner specifics. Conclusion: The surface dose to the weighted dose ratio decreases linearly as the patient size increases. The result is independent of the scanner specifics. The result can be used to obtain in vivo CT dosimetry in abdominal CT.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

A 3D MR-acquisition scheme for nonrigid bulk motion correction in simultaneous PET-MR

Purpose: Positron emission tomography (PET) is a highly sensitive medical imaging technique commonly used to detect and assess tumor lesions. Magnetic resonance imaging (MRI) provides high resolution anatomical images with different contrasts and a range of additional information important for cancer diagnosis. Recently, simultaneous PET-MR systems have been released with the promise to provide complementary information from both modalities in a single examination. Due to long scan times, subject nonrigid bulk motion, i.e., changes of the patient's position on the scanner table leading to nonrigid changes of the patient's anatomy, during data acquisition can negatively impair image quality and tracer uptake quantification. A 3D MR-acquisition scheme is proposed to detect and correct for nonrigid bulk motion in simultaneously acquired PET-MR data. Methods: A respiratory navigated three dimensional (3D) MR-acquisition with Radial Phase Encoding (RPE) is used to obtain T1- and T2-weighted data with an isotropic resolution of 1.5 mm. Healthy volunteers are asked to move the abdomen two to three times during data acquisition resulting in overall 19 movements at arbitrary time points. The acquisition scheme is used to retrospectively reconstruct dynamic 3D MR images with different temporal resolutions. Nonrigid bulk motion is detected and corrected in this image data. A simultaneous PET acquisition is simulated and the effect of motion correction is assessed on image quality and standardized uptake values (SUV) for lesions with different diameters. Results: Six respiratory gated 3D data sets with T1- and T2-weighted contrast have been obtained in healthy volunteers. All bulk motion shifts have successfully been detected and motion fields describing the transformation between the different motion states could be obtained with an accuracy of 1.71 ± 0.29 mm. The PET simulation showed errors of up to 67% in measured SUV due to bulk motion which could be reduced to less than 10% with the proposed motion compensation approach. Conclusions: A MR acquisition scheme which yields both high resolution 3D anatomical data and highly accurate nonrigid motion information without an increase in scan time is presented. The proposed method leads to a strong improvement in both MR and PET image quality and ensures an accurate assessment of tracer uptake.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

Verification and compensation of respiratory motion using an ultrasound imaging system

Purpose: The purpose of this study was to determine if it is feasible to use ultrasound imaging as an aid for moving the treatment couch during diagnosis and treatment procedures associated with radiation therapy, in order to offset organ displacement caused by respiratory motion. A noninvasive ultrasound system was used to replace the C-arm device during diagnosis and treatment with the aims of reducing the x-ray radiation dose on the human body while simultaneously being able to monitor organ displacements. Methods: This study used a proposed respiratory compensating system combined with an ultrasound imaging system to monitor the compensation effect of respiratory motion. The accuracy of the compensation effect was verified by fluoroscopy, which means that fluoroscopy could be replaced so as to reduce unnecessary radiation dose on patients. A respiratory simulation system was used to simulate the respiratory motion of the human abdomen and a strain gauge (respiratory signal acquisition device) was used to capture the simulated respiratory signals. The target displacements could be detected by an ultrasound probe and used as a reference for adjusting the gain value of the respiratory signal used by the respiratory compensating system. This ensured that the amplitude of the respiratory compensation signal was a faithful representation of the target displacement. Results: The results show that performing respiratory compensation with the assistance of the ultrasound images reduced the compensation error of the respiratory compensating system to 0.81–2.92 mm, both for sine-wave input signals with amplitudes of 5, 10, and 15 mm, and human respiratory signals; this represented compensation of the respiratory motion by up to 92.48%. In addition, the respiratory signals of 10 patients were captured in clinical trials, while their diaphragm displacements were observed simultaneously using ultrasound. Using the respiratory compensating system to offset, the diaphragm displacement resulted in compensation rates of 60%–84.4%. Conclusions: This study has shown that a respiratory compensating system combined with noninvasive ultrasound can provide real-time compensation of the respiratory motion of patients.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

X-ray computed tomography using curvelet sparse regularization

Purpose: Reconstruction of x-ray computed tomography (CT) data remains a mathematically challenging problem in medical imaging. Complementing the standard analytical reconstruction methods, sparse regularization is growing in importance, as it allows inclusion of prior knowledge. The paper presents a method for sparse regularization based on the curvelet frame for the application to iterative reconstruction in x-ray computed tomography. Methods: In this work, the authors present an iterative reconstruction approach based on the alternating direction method of multipliers using curvelet sparse regularization. Results: Evaluation of the method is performed on a specifically crafted numerical phantom dataset to highlight the method’s strengths. Additional evaluation is performed on two real datasets from commercial scanners with different noise characteristics, a clinical bone sample acquired in a micro-CT and a human abdomen scanned in a diagnostic CT. The results clearly illustrate that curvelet sparse regularization has characteristic strengths. In particular, it improves the restoration and resolution of highly directional, high contrast features with smooth contrast variations. The authors also compare this approach to the popular technique of total variation and to traditional filtered backprojection. Conclusions: The authors conclude that curvelet sparse regularization is able to improve reconstruction quality by reducing noise while preserving highly directional features.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗
DOE OSTI2015

A framework for the correction of slow physiological drifts during MR-guided HIFU therapies: Proof of concept

Purpose: While respiratory motion compensation for magnetic resonance (MR)-guided high intensity focused ultrasound (HIFU) interventions has been extensively studied, the influence of slow physiological motion due to, for example, peristaltic activity, has so far been largely neglected. During lengthy interventions, the magnitude of the latter can exceed acceptable therapeutic margins. The goal of the present study is to exploit the episodic workflow of these therapies to implement a motion correction strategy for slow varying drifts of the target area and organs at risk over the entire duration of the intervention. Methods: The therapeutic workflow of a MR-guided HIFU intervention is in practice often episodic: Bursts of energy delivery are interleaved with periods of inactivity, allowing the effects of the beam on healthy tissues to recede and/or during which the plan of the intervention is reoptimized. These periods usually last for at least several minutes. It is at this time scale that organ drifts due to slow physiological motion become significant. In order to capture these drifts, the authors propose the integration of 3D MR scans in the therapy workflow during the inactivity intervals. Displacements were estimated using an optical flow algorithm applied on the 3D acquired images. A preliminary study was conducted on ten healthy volunteers. For each volunteer, 3D MR images of the abdomen were acquired at regular intervals of 10 min over a total duration of 80 min. Motion analysis was restricted to the liver and kidneys. For validating the compatibility of the proposed motion correction strategy with the workflow of a MR-guided HIFU therapy, an in vivo experiment on a porcine liver was conducted. A volumetric HIFU ablation was completed over a time span of 2 h. A 3D image was acquired before the first sonication, as well as after each sonication. Results: Following the volunteer study, drifts larger than 8 mm for the liver and 5 mm for the kidneys prove that slow physiological motion can exceed acceptable therapeutic margins. In the animal experiment, motion tracking revealed an initial shift of up to 4 mm during the first 10 min and a subsequent continuous shift of ∼2 mm/h until the end of the intervention. This leads to a continuously increasing mismatch of the initial shot planning, the thermal dose measurements, and the true underlying anatomy. The estimated displacements allowed correcting the planned sonication cell cluster positions to the true target position, as well as the thermal dose estimates during the entire intervention and to correct the nonperfused volume measurement. A spatial coherence of all three is particularly important to assure a confluent ablation volume and to prevent remaining islets of viable malignant tissue. Conclusions: This study proposes a motion correction strategy for displacements resulting from slowly varying physiological motion that might occur during a MR-guided HIFU intervention. The authors have shown that such drifts can lead to a misalignment between interventional planning, energy delivery, and therapeutic validation. The presented volunteer study and in vivo experiment demonstrate both the relevance of the problem for HIFU therapies and the compatibility of the proposed motion compensation framework with the workflow of a HIFU intervention under clinical conditions.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-P-15: Technique Factor Modulation and Reference Plane Air Kerma Rates in Response to Simulated Patient Thickness Variations for a Sample of Current Generation Fluoroscopes

Purpose: To evaluate and compare approaches to technique factor modulation and air kerma rates in response to simulated patient thickness variations for four state-of-the-art and one previous-generation interventional fluoroscopes. Methods: A polymethyl methacrylate (PMMA) phantom was used as a tissue surrogate for the purposes of determining fluoroscopic reference plane air kerma rates, kVp, mA, and spectral filtration over a wide range of simulated tissue thicknesses. Data were acquired for each fluoroscopic and acquisition dose curve within a default abdomen or body imaging protocol. Results: The data obtained indicated vendor- and model-specific variations in the approach to technique factor modulation and reference plane air kerma rates across a range of tissue thicknesses. Some vendors have made hardware advances increasing the radiation output capabilities of their fluoroscopes; this was evident in the acquisition air kerma rates. However, in the imaging protocol evaluated, all of the state-of-the-art systems had relatively low air kerma rates in the fluoroscopic low-dose imaging mode as compared to the previous-generation unit. Each of the newest-generation systems also employ copper filtration in the selected protocol in the acquisition mode of imaging; this is a substantial benefit, reducing the skin entrance dose to the patient in the highest dose-rate mode of fluoroscope operation. Conclusion: Understanding how fluoroscopic technique factors are modulated provides insight into the vendor-specific image acquisition approach and provides opportunities to optimize the imaging protocols for clinical practice. The enhanced radiation output capabilities of some of the fluoroscopes may, under specific conditions, may be beneficial; however, these higher output capabilities also have the potential to lead to unnecessarily high dose rates. Therefore, all parties involved in imaging, including the clinical team, medical physicists, and imaging vendors, must work together to ensure that adequate but not excessive radiation doses are used.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-I-23: A General KV Constrained Optimization of CNR for CT Abdominal Imaging

Purpose: While Tube current modulation has been well accepted for CT dose reduction, kV adjusting in clinical settings is still at its early stage. This is mainly due to the limited kV options of most current CT scanners. kV adjusting can potentially reduce radiation dose and optimize image quality. This study is to optimize CT abdomen imaging acquisition based on the assumption of a continuous kV, with the goal to provide the best contrast to noise ratio (CNR). Methods: For a given dose (CTDIvol) level, the CNRs at different kV and pitches were measured with an ACR GAMMEX phantom. The phantom was scanned in a Siemens Sensation 64 scanner and a GE VCT 64 scanner. A constrained mathematical optimization was used to find the kV which led to the highest CNR for the anatomy and pitch setting. Parametric equations were obtained from polynomial fitting of plots of kVs vs CNRs. A suitable constraint region for optimization was chosen. Subsequent optimization yielded a peak CNR at a particular kV for different collimations and pitch setting. Results: The constrained mathematical optimization approach yields kV of 114.83 and 113.46, with CNRs of 1.27 and 1.11 at the pitch of 1.2 and 1.4, respectively, for the Siemens Sensation 64 scanner with the collimation of 32 x 0.625mm. An optimized kV of 134.25 and 1.51 CNR is obtained for a GE VCT 64 slice scanner with a collimation of 32 x 0.625mm and a pitch of 0.969. At 0.516 pitch and 32 x 0.625 mm an optimized kV of 133.75 and a CNR of 1.14 was found for the GE VCT 64 slice scanner. Conclusion: CNR in CT image acquisition can be further optimized with a continuous kV option instead of current discrete or fixed kV settings. A continuous kV option is a key for individualized CT protocols.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-J-06: Additional Imaging Guidance Dose to Patient Organs Resulting From X-Ray Tubes Used in CyberKnife Image Guidance System

Purpose: The use of image-guided radiation therapy (IGRT) has become increasingly common, but the additional radiation exposure resulting from repeated image guidance procedures raises concerns. Although there are many studies reporting imaging dose from different image guidance devices, imaging dose for the CyberKnife Robotic Radiosurgery System is not available. This study provides estimated organ doses resulting from image guidance procedures on the CyberKnife system. Methods: Commercially available Monte Carlo software, PCXMC, was used to calculate average organ doses resulting from x-ray tubes used in the CyberKnife system. There are seven imaging protocols with kVp ranging from 60 – 120 kV and 15 mAs for treatment sites in the Cranium, Head and Neck, Thorax, and Abdomen. The output of each image protocol was measured at treatment isocenter. For each site and protocol, Adult body sizes ranging from anorexic to extremely obese were simulated since organ dose depends on patient size. Doses for all organs within the imaging field-of-view of each site were calculated for a single image acquisition from both of the orthogonal x-ray tubes. Results: Average organ doses were <1.0 mGy for every treatment site and imaging protocol. For a given organ, dose increases as kV increases or body size decreases. Higher doses are typically reported for skeletal components, such as the skull, ribs, or clavicles, than for softtissue organs. Typical organ doses due to a single exposure are estimated as 0.23 mGy to the brain, 0.29 mGy to the heart, 0.08 mGy to the kidneys, etc., depending on the imaging protocol and site. Conclusion: The organ doses vary with treatment site, imaging protocol and patient size. Although the organ dose from a single image acquisition resulting from two orthogonal beams is generally insignificant, the sum of repeated image acquisitions (>100) could reach 10–20 cGy for a typical treatment fraction.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-J-08: Comparison of Unintended Radiation Doses to Organs at Risk Resulting From the Out-Of-Field Therapeutic Beams and From Image-Guidance X-Ray Procedures

Purpose: The unintended radiation dose to organs at risk (OAR) can be contributed from imaging guidance procedures as well as from leakage and scatter of therapeutic beams. This study compares the imaging dose with the unintended out-of-field therapeutic dose to patient sensitive organs. Methods: The Monte Carlo EGSnrc user codes, BEAMnrc and DOSXYZnrc, were used to simulate kV X-ray sources from imaging devices as well as the therapeutic IMRT/VMAT beams and to calculate doses to target and OARs on patient treatment planning CT images. The accuracy of the Monte Carlo simulations was benchmarked against measurements in phantoms. The dose-volume histogram was utilized in analyzing the patient organ doses. Results: The dose resulting from Standard Head kV-CBCT scans to bone and soft tissues ranges from 0.7 to 1.1 cGy and from 0.03 to 0.3 cGy, respectively. The dose resulting from Thorax scans on the chest to bone and soft tissues ranges from 1.1 to 1.8 cGy and from 0.3 to 0.6 cGy, respectively. The dose resulting from Pelvis scans on the abdomen to bone and soft tissues range from 3.2 to 4.2 cGy and from 1.2 to 2.2 cGy, respectively. The out-of-field doses to OAR are sensitive to the distance between the treated target and the OAR. For a typical Head-and-Neck IMRT/VMAT treatment the out-of-field doses to eyes are 1–3% of the target dose, or 2–6 cGy per fraction. Conclusion: The imaging doses to OAR are predictable based on the imaging protocols used when OARs are within the imaged volume and can be estimated and accounted for by using tabulated values. The unintended out-of-field doses are proportional to the target dose, strongly depend on the distance between the treated target and OAR, and are generally higher comparing to the imaging dose. This work was partially supported by Varian research grant VUMC40590.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-J-23: Characteristics of X-Rays From ExacTrac and Patient Dose From Imaging Procedures

Purpose: The purpose of this investigation is 1) provide the beam characteristics of x-rays produced by a Novalis TX ExacTrac system; 2) present a method to commission such beams, 3) present radiation dose to patients resulting from the imaging procedures. Methods: The Monte Carlo simulations were used to obtain the characteristics of kV beams and validated by measurements. The calculated beam HVLs, profiles and depth-dose curves were benchmarked against measurements. Twelve different image acquisition protocols were studied. The x-ray tube voltage ranges from 70 - 145 kV and milliampere-second (mAs) ranges from 8 - 80 mAs depending on the selection of Cranium, Head & Neck, Thorax or Abdomen imaging protocols. The beam output of each image acquisition protocol was determined by using an ionization chamber. The air kerma calibration factors of the ion chamber were obtained from an Accredited Dosimetry Calibration Laboratory for specified HVLs. Results: The agreements between measured and simulated results were within the uncertainties for HVLs, dose profiles and depth-dose curves. When %dd was normalized at 1 cm depth, its values at depth of 5 cm ranged from 45% to 66% of in water for kV beams range from 70 kVp to 145 kVp respectively. For head images, a typical dose to eye resulting from single projection ranged from 0.008 cGy to 0.025 cGy depending on the cranial image protocols selected. For a single pelvic image the skin dose could reach up to 0.1 cGy from an abdominal protocol. Conclusion: Although multiple pairs of x-ray images are commonly acquired during a daily patient treatment, the imaging doses to patients resulting from the sum of these projected x-rays are generally much less than 0.5 cGy. The knowledge obtained from this investigation can be used to estimate the image dose and optimize the used of the system.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-J-78: Adaptive Planning Workflow in a Pencil Beam Scanning Proton Therapy Center

Purpose: The susceptibility of proton therapy to changes in patient setup and anatomy necessitates an adaptive planning process. With the right planning tools and clinical workflow, an adaptive plan can be created in a timely manner without adding significant workload to the treatment planning staff. Methods: In our center, a weekly QA CT is performed on most patients to assess setup, anatomy change, and tumor response. The QA CT is fused to the treatment planning CT, the contours are transferred via deformable registration, and the plan dose is recalculated on the QA CT. A physicist assesses the dose distribution, and an adaptive plan is requested based on tumor coverage or OAR dose changes. After the physician confirms or alters the deformed contours, a dosimetrist develops an adaptive plan using our TPS adaptation module. The plan is assessed for robustness and is then reviewed by the physician. Patient QA is performed within three days following the first adapted treatment. Results: Of the patients who received QA CTs, 19% required at least one adaptive plan (18.5% H&N, 18.5% brain, 11.1% breast, 14.8% chestwall, 14.8% lung, 18.5% pelvis and 3.8% abdomen). Of these patients, 14% went on a break, while the remainder was treated with the previous plan during the re-planning process. Adaptive plans were performed based on tumor shrinkage, anatomy change or positioning uncertainties for 37.9%, 44.8%, and 17.3% of the patients, respectively. On average, 3 full days are required between the QA CT and the first adapted plan treatment. Conclusion: Adaptive planning is a crucial component of proton therapy and should be applied to any site when the QA CT shows significant deviation from the plan. With an efficient workflow, an adaptive plan can be applied without delaying patient treatment or burdening the dosimetry and medical physics team.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-J-130: Automating Liver Segmentation Via Combined Global and Local Optimization

Purpose: The aim of this work is to develop a robust algorithm for accurate segmentation of liver with special attention paid to the problems with fuzzy edges and tumor. Methods: 200 CT images were collected from radiotherapy treatment planning system. 150 datasets are selected as the panel data for shape dictionary and parameters estimation. The remaining 50 datasets were used as test images. In our study liver segmentation was formulated as optimization process of implicit function. The liver region was optimized via local and global optimization during iterations. Our method consists five steps: 1)The livers from the panel data were segmented manually by physicians, and then We estimated the parameters of GMM (Gaussian mixture model) and MRF (Markov random field). Shape dictionary was built by utilizing the 3D liver shapes. 2)The outlines of chest and abdomen were located according to rib structure in the input images, and the liver region was initialized based on GMM. 3)The liver shape for each 2D slice was adjusted using MRF within the neighborhood of liver edge for local optimization. 4)The 3D liver shape was corrected by employing SSR (sparse shape representation) based on liver shape dictionary for global optimization. Furthermore, H-PSO(Hybrid Particle Swarm Optimization) was employed to solve the SSR equation. 5)The corrected 3D liver was divided into 2D slices as input data of the third step. The iteration was repeated within the local optimization and global optimization until it satisfied the suspension conditions (maximum iterations and changing rate). Results: The experiments indicated that our method performed well even for the CT images with fuzzy edge and tumors. Comparing with physician delineated results, the segmentation accuracy with the 50 test datasets (VOE, volume overlap percentage) was on average 91%–95%. Conclusion: The proposed automatic segmentation method provides a sensible technique for segmentation of CT images. This work is supported by NIH/NIBIB (1R01-EB016777), National Natural Science Foundation of China (No.61471226 and No.61201441), Research funding from Shandong Province (No.BS2012DX038 and No.J12LN23), and Research funding from Jinan City (No.201401221 and No.20120109)

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-J-190: Development of Abdominal Compression & Respiratory Guiding System Using Gas Pressure Sensor

Purpose: Abdominal compression is known to be effective but, often makes external-marker-based monitoring of breathing motion not feasible. In this study, we developed and evaluated a system that enables both abdominal compression and monitoring of residual abdominal motion simultaneously. The system can also provide visual-biofeedback capability. Methods: The system developed consists of a compression belt, an abdominal motion monitoring sensor (gas pressure sensor) and a visual biofeedback device. The compression belt was designed to be able to compress the frontal side of the abdomen. The pressure level of the belt is controlled by air volume and monitored in real time using the gas pressure sensor. The system displays not only the real-time monitoring curve but also a guiding respiration model (e.g., a breath hold or shallow breathing curve) simultaneously on the head mounted display to help patients keep their breathing pattern as consistent as possible. Three healthy volunteers were enrolled in this pilot study and respiratory signals (pressure variations) were obtained both with and without effective abdominal compression to investigate the feasibility of the developed system. Two guidance patterns, breath hold and shallow breathing, were tested. Results: All volunteers showed smaller abdominal motion with compression (about 40% amplitude reduction compared to without compression). However, the system was able to monitor residual abdominal motion for all volunteers. Even under abdominal compression, in addition, it was possible to make the subjects successfully follow the guide patterns using the visual biofeedback system. Conclusion: The developed abdominal compression & respiratory guiding system was feasible for residual abdominal motion management. It is considered that the system can be used for a respiratory motion involved radiation therapy while maintaining the merit of abdominal compression. This work was supported by the Radiation Technology R&D program (No. 2013M2A2A7043498) and the Mid-career Researcher Program (2014R1A2A1A10050270) through the National Research Foundation of Korea funded by the Ministry of Science, ICT&Future Planning.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-J-192: Comparative Effect of Different Respiratory Motion Management Systems

Purpose: Irregular breathing can influence the outcome of four-dimensional computed tomography imaging for causing artifacts. Audio-visual biofeedback systems associated with patient-specific guiding waveform are known to reduce respiratory irregularities. In Japan, abdomen and chest motion self-control devices (Abches), representing simpler visual coaching techniques without guiding waveform are used instead; however, no studies have compared these two systems to date. Here, we evaluate the effectiveness of respiratory coaching to reduce respiratory irregularities by comparing two respiratory management systems. Methods: We collected data from eleven healthy volunteers. Bar and wave models were used as audio-visual biofeedback systems. Abches consisted of a respiratory indicator indicating the end of each expiration and inspiration motion. Respiratory variations were quantified as root mean squared error (RMSE) of displacement and period of breathing cycles. Results: All coaching techniques improved respiratory variation, compared to free breathing. Displacement RMSEs were 1.43 ± 0.84, 1.22 ± 1.13, 1.21 ± 0.86, and 0.98 ± 0.47 mm for free breathing, Abches, bar model, and wave model, respectively. Free breathing and wave model differed significantly (p < 0.05). Period RMSEs were 0.48 ± 0.42, 0.33 ± 0.31, 0.23 ± 0.18, and 0.17 ± 0.05 s for free breathing, Abches, bar model, and wave model, respectively. Free breathing and all coaching techniques differed significantly (p < 0.05). For variation in both displacement and period, wave model was superior to free breathing, bar model, and Abches. The average reduction in displacement and period RMSE compared with wave model were 27% and 47%, respectively. Conclusion: The efficacy of audio-visual biofeedback to reduce respiratory irregularity compared with Abches. Our results showed that audio-visual biofeedback combined with a wave model can potentially provide clinical benefits in respiratory management, although all techniques could reduce respiratory irregularities.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-60: A Plan Quality Index in IMRT QA That Is Independent of the Acceptance Criteria

Purpose: In IMRT QA, plan quality evaluation is made based on pass rate under preset acceptance criteria, mostly using gamma-values. This method is convenient but, its Result highly depends on what the acceptance criteria are and suffers from the lack of sensitivity in judging how good the plan is. In this study, we introduced a simple but effective plan quality index of IMRT QA based on dose difference only to supplement such shortcomings, and investigated its validity. Methods: The proposed index is a single value which is calculated mainly based on point-by-point comparison between planned and measured dose distributions, and it becomes “1” in an ideal case. A systematic evaluation was performed with one-dimensional test dose distributions. For 3 hypothetical dose profiles, various displacements (in both dose and space) were introduced, the proposed index was calculated for each case, and the behavior of obtained indices was analyzed and compared with that of gamma evaluation. In addition, the feasibility of the index was assessed with clinical IMRT/VMAT/SBRT QA cases for different sites (prostate, head & neck, liver, lung, spine, and abdomen). Results: The proposed index showed more robust correlation with the amount of induced displacement compared to the gamma evaluation method. No matter what the acceptance criteria are (e.g., whether 3%/3mm or 2%/2mm), it was possible to clearly rank every case with the proposed index while it was difficult to do with the gamma evaluation method. Conclusion: IMRT plan quality can be evaluated quantitatively by the proposed index. It is considered that the proposed index would provide useful information for better judging the level of goodness of each plan and its Result is independent of the acceptance criteria. This work was supported by the Radiation Technology R&D program (No. 2013M2A2A7043498) and the Mid-career Researcher Program (2014R1A2A1A10050270) through the National Research Foundation of Korea funded by the Ministry of Science, ICT&Future Planning.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-106: An Institutional Review of Using Commercially Available Software to Evaluate Treatment Plan Quality for Various Treatment Sites and Beam Deliveries

Purpose: Use Sun Nuclear Quality Reports™ with PlanIQ™ to evaluate different treatment delivery techniques for various treatment sites. Methods: Fifteen random patients with different treatment sites were evaluated. These include the Head/Neck, prostate, pelvis, lung, esophagus, axilla, bladder and abdomen. Initially, these sites were planned on the Pinnacle {sup 3} V9.6 treatment planning system and utilized nine 6MV step-n-shoot IMRT fields. The RT plan, dose and structure sets were sent to Quality Reports™ where a DVH was recreated and the plans were compared to a unique Plan Algorithm for each treatment site. Each algorithm has its own plan quality metrics and objectives, which include the PTV coverage, PTV maximum dose, the prescription dose outside the target, doses to the critical structures, and the global maximum dose and its location. Each plan was scored base on meeting each objective. Plans may have been reoptimized and reevaluated with Quality Reports™ based on the initial score. PlanIQ™ was used to evaluate if any objective not met was achievable or difficult to obtain. A second plan using VMAT delivery was created for each patient and scored with Quality Reports™. Results: There were a wide range of scores for the different treatment sites with some scoring better for IMRT plans and some better for the VMAT deliveries. The variation in the scores could be attributed to the treatment site, location, and shape of the target. Most deliveries were chosen for the VMAT due to the short treatment times and quick patient throughput with acceptable plan scores. Conclusion: The tools are provided for both physician and dosimetrist to objectively evaluate the use of VMAT delivery versus the step-n-shoot IMRT delivery for various sites. PlanIQ validates if objectives can be met. For the physicist, a concise pass/fail report is created for plan evaluation.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-277: Dose Calculation Comparisons Between Monaco, Pinnacle and Eclipse Treatment Planning Systems

Purpose: Monaco treatment planning system (TPS) version 5.0 uses a Monte-Carlo based dose calculation engine. The aim of this study is to verify and compare the Monaco based dose calculations with both Pinnacle{sup 3} collapsed cone convolution superposition (CCC) and Eclipse analytical anisotropic algorithm (AAA) calculations. Methods: For this study, previously treated SBRT lung, head and neck and abdomen patients were chosen to compare dose calculations between Pinnacle, Monaco and Eclipse. Plans were chosen from those that had been treated using the Elekta VersaHD or a NovalisTX linac. The plans included 3D conventional and IMRT beams using 6MV and 6MV Flattening filter free (FFF) photon beams. The original plans calculated with CCCS or AAA along with the recalculated ones using MC from the three TPS were exported into Velocity software for inter-comparison. Results: To compare the dose calculations, Mean Lung Dose (MLD), lung V5 and V20 values, and PTV Heterogeneity indexes (HI) and Conformity indexes (CI) were all calculated and recorded from the dose volume histograms (DVH). For each patient, the CI values were identical but there were differences in all other parameters. The HI was computed higher by 5 and 4% for calculated plans AAA and CCCS respectively, compared to the MC ones. The DVH graphs showed large differences between the CCCS and AAA and Monaco for 3D FFF, VMAT and IMRT plans. Better DVH agreement between was observed for 3D conventional plans. Conclusion: Better agreement was observed between CCCS and MC calculations than AAA and MC calculations. Those differences were more profound as the field size was decreasing and in the presence of inhomogeneities.

60 APPLIED LIFE SCIENCES↗