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At least 1,117 records · Page 62

Intrusion Detection for Cybersecurity of Power Electronics Dominated Grids: Inverters PQ Set-Points Manipulation

This work provides cybersecurity analytics for a high photovoltaic (PV) penetrated distribution network, representing future power electronics dominated grid (PEDG). Firstly, the impact of active and reactive power (PQ) set-points manipulation on the network is studied. Then, an intrusion detection system (IDS) is developed for identifying the potentially compromised PV inverters in the network. The proposed IDS is based on defining the normal, safe, and abnormal operation regions of the PV inverters from point of view of the steady state voltage stability of the network. These three-operation regions are identified by utilizing active power, reactive power, and voltage (PQV) limits of each specific grid-following inverter in the network. Each grid-following inverter's PQV contour includes the information of network topology, inverter ratings, and inverter controller. The developed PQ limits are integrated into the centralized secondary control layer for realization of the proposed IDS. Furthermore, the proposed secondary control layer is capable of providing remedial actions during an anomaly event to enhance the grid resiliency. The theoretical analyses are verified by several attack scenarios for a network of grid-following inverters.

41 EE - Solar Energy Technologies Office (EE-4S)↗

Analyzing large data sets from XGC1 magnetic fusion simulations using apache spark

Apache Spark is explored as a tool for analyzing large data sets from the magnetic fusion simulation code XGCI. Implementation details of Apache Spark on the NERSC Edison supercomputer are discussed, including binary file reading, and parameter setup. Here, an unsupervised machine learning algorithm, k-means clustering, is applied to XGCI particle distribution function data, showing that highly turbulent spatial regions do not have common coherent structures, but rather broad, ring-like structures in velocity space.

70 PLASMA PHYSICS AND FUSION TECHNOLOGY↗

Modeling of Protection in Dynamic Simulation Using Generic Relay Models and Settings

This paper shows how generic protection relay models available in planning tools can be augmented with settings that are based on NERC standards or best engineering practice. Selected generic relay models in Siemens PSS®E have been used in dynamic simulations in the proposed approach. Undervoltage, overvoltage, underfrequency, and overfrequency relays have been modeled for each generating unit. Distance-relay protection was modeled for transmission system protection. Two types of load-shedding schemes were modeled: underfrequency (frequency-responsive non-firm load shedding) and underfrequency and undervoltage firm load shedding. Several case studies are given to show the impact of protection devices on dynamic simulations. This is useful for simulating cascading outages.

cascading failures↗

Optimal Droop Setting for Congestion Reduction in a 100% Grid-Forming Inverter-based Power System

he high penetration of inverter-based resources (IBRs) introduces new challenges to power systems due to the complex inverter control. However, IBRs can be configured to maximize their benefits to improve system resilience and reliability. This paper proposes a steady-state optimization model that aims to mitigate transmission congestion in a 100% grid- forming (GFM) IBR-based power system. This goal is achieved by determining the optimal droop settings for the GFM IBRs under different congestion conditions due to renewable energy and load variations. The numerical solution is rigorously verified by a high-fidelity model of the IEEE 39-bus test system with detailed GFM IBR control in the time-domain electromagnetic transient (EMT) simulation tool PSCAD. The numerical solution and simulation results show a significant congestion reduction while meeting all other operating requirements. It is also observed that the numerical solving time is substantially less compared to the EMT simulation time.

Nguyen, Quan H.↗

A Proton Pump Inhibitor in the Reformulation Setting: Bioequivalence and Potential Implications for Long-Term Safety: Reformulation and the Long-Term Safety of PPIs

Proton pump inhibitors (PPIs) have become known for both their therapeutic effect and good safety profile. An application was submitted to the US Food and Drug Administration for approval of a reformulated PPI product that failed bioequivalence testing, but was submitted on the basis of the long history of PPI use as a “surrogate” for equivalence. This review evaluates the safety data for PPIs, discuss variability of pharmacokinetic parameters of PPIs in the reformulation setting, and potential implications of those changes for long-term safety.

60 APPLIED LIFE SCIENCES↗

Multiple signaling systems target a core set of transition metal homeostasis genes using similar binding motifs

Bacterial response to metals can require complex regulation. We report an overlapping regulation for copper and zinc resistance genes in the denitrifying bacterium, Pseudomonas stutzeri RCH2, by three two-component regulatory proteins CopR1, CopR2 and CzcR. We conducted genome-wide evaluations to identify gene targets of two paralogous regulators, CopR1 and CopR2, annotated for copper signaling, and compared the results with the gene targets for CzcR, implicated in zinc signaling. We discovered that the CopRs and CzcR have largely common targets, and crossregulate a core set of P. stutzeri copper and zinc responsive genes. We established that this crossregulation is enabled by a conserved binding motif in the upstream regulatory regions of the target genes. The crossregulation is physiologically relevant as these regulators synergistically and antagonistically target multicopper oxidases, metal efflux and sequestration systems. CopR1 and CopR2 upregulate two cop operons encoding copper tolerance genes, while all three regulators downregulate a putative copper chaperone, Psest_1595. CzcR also upregulated the oprD gene and the CzcIABC Zn 2+ efflux system, while CopR1 and CopR2 downregulated these genes. Lastly, our study suggests that crossregulation of copper and zinc homeostasis can be advantageous, and in P. stutzeri this is enabled by shared binding motifs for multiple response regulators.

59 BASIC BIOLOGICAL SCIENCES↗

Coalescence Prevention Algorithm for Level Set Method

An algorithm to prevent or delay bubble coalescence for the level set (LS) method is presented. This novel algorithm uses the LS method field to detect when bubbles are in close proximity, indicating a potential coalescence event, and applies a repellent force to simulate the unresolved liquid drainage force. The model is introduced by locally modifying the surface tension force near the liquid film drainage area. The algorithm can also simulate the liquid drainage time of the thin film by controlling the length of time the increased surface tension has been applied. Thus, a new method of modeling bubble coalescence has been developed. Several test cases were designed to demonstrate the capabilities of the algorithm. The simulations, including a mesh study, confirmed the abilities to identify and prevent coalescence as well as implement the time tracking portion, with an additional 10–25% computational cost. Ongoing tests aim to verify the algorithm's functionality for simulations with different flow conditions, a ranging number of bubbles, and both structured and unstructured computational mesh types. Specifically, a bubble rising toward a free surface provides a test of performance and demonstrates the ability to consistently prevent coalescence. In addition, a two bubble case and a seven bubble case provide a more complex demonstration of how the algorithm performs for larger simulations. These cases are compared to much more expensive simulations capable of resolving the liquid film drainage (through very high local mesh resolution) to investigate how the algorithm replicates the liquid film drainage process.

Engineering↗

Patient radiation doses in interventional cardiology in the U.S.: Advisory data sets and possible initial values for U.S. reference levels

Purpose: To determine patient radiation doses from interventional cardiology procedures in the U.S and to suggest possible initial values for U.S. benchmarks for patient radiation dose from selected interventional cardiology procedures [fluoroscopically guided diagnostic cardiac catheterization and percutaneous coronary intervention (PCI)]. Methods: Patient radiation dose metrics were derived from analysis of data from the 2008 to 2009 Nationwide Evaluation of X-ray Trends (NEXT) survey of cardiac catheterization. This analysis used deidentified data and did not require review by an IRB. Data from 171 facilities in 30 states were analyzed. The distributions (percentiles) of radiation dose metrics were determined for diagnostic cardiac catheterizations, PCI, and combined diagnostic and PCI procedures. Confidence intervals for these dose distributions were determined using bootstrap resampling. Results: Percentile distributions (advisory data sets) and possible preliminary U.S. reference levels (based on the 75th percentile of the dose distributions) are provided for cumulative air kerma at the reference point (K{sub a,r}), cumulative air kerma-area product (P{sub KA}), fluoroscopy time, and number of cine runs. Dose distributions are sufficiently detailed to permit dose audits as described in National Council on Radiation Protection and Measurements Report No. 168. Fluoroscopy times are consistent with those observed in European studies, but P{sub KA} is higher in the U.S. Conclusions: Sufficient data exist to suggest possible initial benchmarks for patient radiation dose for certain interventional cardiology procedures in the U.S. Our data suggest that patient radiation dose in these procedures is not optimized in U.S. practice.

07 ISOTOPE AND RADIATION SOURCES↗

Generation of a suite of 3D computer-generated breast phantoms from a limited set of human subject data

Purpose: The authors previously reported on a three-dimensional computer-generated breast phantom, based on empirical human image data, including a realistic finite-element based compression model that was capable of simulating multimodality imaging data. The computerized breast phantoms are a hybrid of two phantom generation techniques, combining empirical breast CT (bCT) data with flexible computer graphics techniques. However, to date, these phantoms have been based on single human subjects. In this paper, the authors report on a new method to generate multiple phantoms, simulating additional subjects from the limited set of original dedicated breast CT data. The authors developed an image morphing technique to construct new phantoms by gradually transitioning between two human subject datasets, with the potential to generate hundreds of additional pseudoindependent phantoms from the limited bCT cases. The authors conducted a preliminary subjective assessment with a limited number of observers (n= 4) to illustrate how realistic the simulated images generated with the pseudoindependent phantoms appeared. Methods: Several mesh-based geometric transformations were developed to generate distorted breast datasets from the original human subject data. Segmented bCT data from two different human subjects were used as the 'base' and 'target' for morphing. Several combinations of transformations were applied to morph between the 'base' and 'target' datasets such as changing the breast shape, rotating the glandular data, and changing the distribution of the glandular tissue. Following the morphing, regions of skin and fat were assigned to the morphed dataset in order to appropriately assign mechanical properties during the compression simulation. The resulting morphed breast was compressed using a finite element algorithm and simulated mammograms were generated using techniques described previously. Sixty-two simulated mammograms, generated from morphing three human subject datasets, were used in a preliminary observer evaluation where four board certified breast radiologists with varying amounts of experience ranked the level of realism (from 1 ='fake' to 10 ='real') of the simulated images. Results: The morphing technique was able to successfully generate new and unique morphed datasets from the original human subject data. The radiologists evaluated the realism of simulated mammograms generated from the morphed and unmorphed human subject datasets and scored the realism with an average ranking of 5.87 {+-} 1.99, confirming that overall the phantom image datasets appeared more 'real' than 'fake.' Moreover, there was not a significant difference (p > 0.1) between the realism of the unmorphed datasets (6.0 {+-} 1.95) compared to the morphed datasets (5.86 {+-} 1.99). Three of the four observers had overall average rankings of 6.89 {+-} 0.89, 6.9 {+-} 1.24, 6.76 {+-} 1.22, whereas the fourth observer ranked them noticeably lower at 2.94 {+-} 0.7. Conclusions: This work presents a technique that can be used to generate a suite of realistic computerized breast phantoms from a limited number of human subjects. This suite of flexible breast phantoms can be used for multimodality imaging research to provide a known truth while concurrently producing realistic simulated imaging data.

60 APPLIED LIFE SCIENCES↗

Radial differential interior tomography and its image reconstruction with differentiated backprojection and projection onto convex sets

Purpose: Interior tomography has been recognized as one of the most effective approaches in computed tomography (CT) to reduce radiation dose rendered to patients. In this work, the authors propose and evaluate an imaging method of radial differential interior tomography.Methods: In interior tomography, an x-ray beam is collimated to only irradiate the region of interest (ROI) with suspected lesions while the surrounding area/volume of normal tissues/organs is spared. In the proposed imaging method of radial differential interior tomography, the outcome is a ROI image that has gone through a radial differential filtering. The image reconstruction algorithm for the radial differential interior tomography is kept in the fashion of differentiated backprojection and projection onto convex sets, but the required a priori knowledge in a small round area becomes zero and may be more readily available in practice.Results: Using the projection data simulated by computer and acquired by CT scanner, the authors evaluate and verify the performance of the proposed radial differential interior tomography method and its associated image reconstruction algorithm. The preliminary results show that the proposed imaging method can generate an image that is the radial differentiation of a conventional tomographic image and is robust over noise that inevitably exist in practice.Conclusions: It is believed that the proposed imaging method may find its utility in advanced clinical applications wherein a ROI-based image processing and analysis is required for lesion visualization, characterization, and diagnosis.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Sci—Thur AM: YIS - 11: Estimation of Bladder-Wall Cumulative Dose in Multi-Fraction Image-Based Gynaecological Brachytherapy Using Deformable Point Set Registration

Dosimetric parameters based on dose-volume histograms (DVH) of contoured structures are routinely used to evaluate dose delivered to target structures and organs at risk. However, the DVH provides no information on the spatial distribution of the dose in situations of repeated fractions with changes in organ shape or size. The aim of this research was to develop methods to more accurately determine geometrically localized, cumulative dose to the bladder wall in intracavitary brachytherapy for cervical cancer. The CT scans and treatment plans of 20 cervical cancer patients were used. Each patient was treated with five high-dose-rate (HDR) brachytherapy fractions of 600cGy prescribed dose. The bladder inner and outer surfaces were delineated using MIM Maestro software (MIM Software Inc.) and were imported into MATLAB (MathWorks) as 3-dimensional point clouds constituting the “bladder wall”. A point-set registration toolbox for MATLAB, Coherent Point Drift (CPD), was used to non-rigidly transform the bladder-wall points from four of the fractions to the coordinate system of the remaining (reference) fraction, which was chosen to be the emptiest bladder for each patient. The doses were accumulated on the reference fraction and new cumulative dosimetric parameters were calculated. The LENT-SOMA toxicity scores of these patients were studied against the cumulative dose parameters. Based on this study, there was no significant correlation between the toxicity scores and the determined cumulative dose parameters.

60 APPLIED LIFE SCIENCES↗

Super-resolution reconstruction for 4D computed tomography of the lung via the projections onto convex sets approach

Purpose: The use of 4D computed tomography (4D-CT) of the lung is important in lung cancer radiotherapy for tumor localization and treatment planning. Sometimes, dense sampling is not acquired along the superior–inferior direction. This disadvantage results in an interslice thickness that is much greater than in-plane voxel resolutions. Isotropic resolution is necessary for multiplanar display, but the commonly used interpolation operation blurs images. This paper presents a super-resolution (SR) reconstruction method to enhance 4D-CT resolution. Methods: The authors assume that the low-resolution images of different phases at the same position can be regarded as input “frames” to reconstruct high-resolution images. The SR technique is used to recover high-resolution images. Specifically, the Demons deformable registration algorithm is used to estimate the motion field between different “frames.” Then, the projection onto convex sets approach is implemented to reconstruct high-resolution lung images. Results: The performance of the SR algorithm is evaluated using both simulated and real datasets. Their method can generate clearer lung images and enhance image structure compared with cubic spline interpolation and back projection (BP) method. Quantitative analysis shows that the proposed algorithm decreases the root mean square error by 40.8% relative to cubic spline interpolation and 10.2% versus BP. Conclusions: A new algorithm has been developed to improve the resolution of 4D-CT. The algorithm outperforms the cubic spline interpolation and BP approaches by producing images with markedly improved structural clarity and greatly reduced artifacts.

60 APPLIED LIFE SCIENCES↗

SU-E-J-172: Bio-Physical Effects of Patients Set-Up Errors According to Whole Breast Irradiation Techniques

Purpose: The dose-related effects of patient setup errors on biophysical indices were evaluated for conventional wedge (CW) and field-in-field (FIF) whole breast irradiation techniques. Methods: The treatment plans for 10 patients receiving whole left breast irradiation were retrospectively selected. Radiobiological and physical effects caused by dose variations were evaluated by shifting the isocenters and gantry angles of the treatment plans. Dose-volume histograms of the planning target volume (PTV), heart, and lungs were generated, and conformity index (CI), homogeneity index (HI), tumor control probability (TCP), and normal tissue complication probability (NTCP) were determined. Results: For “isocenter shift plan” with posterior direction, the D95 of the PTV decreased by approximately 15% and the TCP of the PTV decreased by approximately 50% for the FIF technique and by 40% for the CW; however, the NTCPs of the lungs and heart increased by about 13% and 1%, respectively, for both techniques. Increasing the gantry angle decreased the TCPs of the PTV by 24.4% (CW) and by 34% (FIF). The NTCPs for the two techniques differed by only 3%. In case of CW, the CIs and HIs were much higher than that of the FIF in all cases. It had a significant difference between two techniques (p<0.01). According to our results, however, the FIF had more sensitive response by set up errors rather than CW in bio-physical aspects. Conclusions: The radiobiological-based analysis can detect significant dosimetric errors then, can provide a practical patient quality assurance method to guide the radiobiological and physical effects.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

SU-E-T-345: Effect of DLG and MLC Transmission Value Set in the Treatment Planning System (TPS) On Dosimetric Accuracy of True Beam Hypofractionated SRT/SBRT and 2Gy/fx Prostate Rapid Arc Plans

Purpose: Due to limited commissioning time, we previously only released our True beam non-FFF mode for prostate treatment. Clinical demand now pushes us to release the non-FFF mode for SRT/SBRT treatment. When re-planning on True beam previously treated SRT/SBRT cases on iX machine we found the patient specific QA pass rate was worse than iX’s, though the 2Gy/fx prostate Result had been as good. We hypothesize that in TPS the True beam DLG and MLC transmission values, of those measured during commissioning could not yet provide accurate SRS/SBRT dosimetry. Hence this work is to investigate how the TPS DLG and transmission value affects Rapid Arc plans’ dosimetric accuracy. Methods: We increased DLG and transmission value of True beam in TPS such that their percentage differences against the measured matched those of iX’s. We re-calculated 2 SRT, 1 SBRT and 2 prostate plans, performed patient specific QA on these new plans and compared the results to the previous. Results: With DLG and transmission value set respectively 40 and 8% higher than the measured, the patient specific QA pass rate (at 3%/3mm) improved from 95.0 to 97.6% vs previous iX’s 97.8% in the case of SRT. In the case of SBRT, the pass rate improved from 75.2 to 93.9% vs previous iX’s 92.5%. In the case of prostate, the pass rate improved from 99.3 to 100%. The maximum dose difference in plans before and after adjusting DLG and transmission was approximately 1% of the prescription dose among all plans. Conclusion: The impact of adjusting DLG and transmission value on dosimetry might be the same among all Rapid Arc plans regardless hypofractionated or not. The large variation observed in patient specific QA pass rate might be due to the data analysis method in the QA software being more sensitive to hypofractionated plans.

60 APPLIED LIFE SCIENCES↗

TU-EF-204-11: Impact of Using Multi-Slice Training Sets On the Performance of a Channelized Hotelling Observer in a Low-Contrast Detection Task in CT

Purpose: To investigate using multiple CT image slices from a single acquisition as independent training images for a channelized Hotelling observer (CHO) model to reduce the number of repeated scans for CHO-based CT image quality assessment. Methods: We applied a previously validated CHO model to detect low contrast disk objects formed from cross-sectional images of three epoxy-resin-based rods (diameters: 3, 5, and 9 mm; length: ∼5cm). The rods were submerged in a 35x 25 cm2 iodine-doped water filled phantom, yielding-15 HU object contrast. The phantom was scanned 100 times with and without the rods present. Scan and reconstruction parameters include: 5 mm slice thickness at 0.5 mm intervals, 120 kV, 480 Quality Reference mAs, and a 128-slice scanner. The CHO’s detectability index was evaluated as a function of factors related to incorporating multi-slice image data: object misalignment along the z-axis, inter-slice pixel correlation, and number of unique slice locations. In each case, the CHO training set was fixed to 100 images. Results: Artificially shifting the object’s center position by as much as 3 pixels in any direction relative to the Gabor channel filters had insignificant impact on object detectability. An inter-slice pixel correlation of >∼0.2 yielded positive bias in the model’s performance. Incorporating multi-slice image data yielded slight negative bias in detectability with increasing number of slices, likely due to physical variations in the objects. However, inclusion of image data from up to 5 slice locations yielded detectability indices within measurement error of the single slice value. Conclusion: For the investigated model and task, incorporating image data from 5 different slice locations of at least 5 mm intervals into the CHO model yielded detectability indices within measurement error of the single slice value. Consequently, this methodology would Result in a 5-fold reduction in number of image acquisitions. This project was supported by National Institutes of Health grants R01 EB017095 and U01 EB017185 from the National Institute of Biomedical Imaging and Bioengineering.

60 APPLIED LIFE SCIENCES↗

WE-F-BRB-02: Setting the Stage for Incorporation of Toxicity Measures in Treatment Plan Assessments

Advancements in informatics in radiotherapy are opening up opportunities to improve our ability to assess treatment plans. Models on individualizing patient dose constraints from prior patient data and shape relationships have been extensively researched and are now making their way into commercial products. New developments in knowledge based treatment planning involve understanding the impact of the radiation dosimetry on the patient. Akin to radiobiology models that have driven intensity modulated radiotherapy optimization, toxicity and outcome predictions based on treatment plans and prior patient experiences may be the next step in knowledge based planning. In order to realize these predictions, it is necessary to understand how the clinical information can be captured, structured and organized with ontologies and databases designed for recall. Large databases containing radiation dosimetry and outcomes present the opportunity to evaluate treatment plans against predictions of toxicity and disease response. Such evaluations can be based on dose volume histogram or even the full 3-dimensional dose distribution and its relation to the critical anatomy. This session will provide an understanding of ontologies and standard terminologies used to capture clinical knowledge into structured databases; How data can be organized and accessed to utilize the knowledge in planning; and examples of research and clinical efforts to incorporate that clinical knowledge into planning for improved care for our patients. Learning Objectives: Understand the role of standard terminologies, ontologies and data organization in oncology Understand methods to capture clinical toxicity and outcomes in a clinical setting Understand opportunities to learn from clinical data and its application to treatment planning Todd McNutt receives funding from Philips, Elekta and Toshiba for some of the work presented.

60 APPLIED LIFE SCIENCES↗

SU-F-P-33: Combining Research and Professional Practice in the Clinical Setting: A Medical Physicist Personal Experience

Purpose: To initiate a discussion on the current and evolving role of Medical Physicists based on author’s professional and research experience in patient safety and quality control. Methods: Several professionals of the departments of Medical Physics and Radiation Oncology, chiefly devoted to clinical tasks, began a research program on patient safety and quality control in a framework provided by the implementation of intraoperative radiotherapy (IORT). We performed studies on virtual simulation for IORT, in vivo dosimetry, failure mode and effect analysis (FMEA), statistical process control (SPC), and receiver operating characteristics of dosimetric equipment. This was done with the support of our research foundation and different grants while continuing with our departmental clinical routine involving about 1600 annual treatments with two linacs and different brachytherapy techniques. Results: We published 5 papers in international journals in the last two years. This author conducted a doctoral research which resulted in a dissertation in 2015. The extra time spent after treatments was essential to succeed. Funding and support achieved via our foundation played a crucial role; but this would have not been possible without punctual external mentoring and partnership. FMEA conclusions were able to be implemented only with staff commitment; however, conclusions concerning equipment cannot be easily communicated to manufacturers. These tasks required extra training in the appropriated methods. Conclusion: Research needed the support of a dedicated foundation, which would have been very difficult to obtain with the sole participation of our departments. FMEA and SPC results may need engagement of staff and manufacturers, respectively, hard to achieve without strong recommendations or even a regulatory framework. All these fields need evolution of Medical Physicists’ roles and additional training. Devotion to both clinical tasks and research could be unfeasible for Medical Physicists in the clinical setting without the appropriate rearrangement of their schedules and tasks. Supported by grants IPT-300000-2010-3 and PI11/01659. ERDF funds and Spanish Government.

60 APPLIED LIFE SCIENCES↗

SU-F-J-32: Do We Need KV Imaging During CBCT Based Patient Set-Up for Lung Radiation Therapy?

Purpose: To evaluate the role of 2D kilovoltage (kV) imaging to complement cone beam CT (CBCT) imaging in a shift threshold based image guided radiation therapy (IGRT) strategy for conventional lung radiotherapy. Methods: A retrospective study was conducted by analyzing IGRT couch shift trends for 15 patients that received lung radiation therapy to evaluate the benefit of performing orthogonal kV imaging prior to CBCT imaging. Herein, a shift threshold based IGRT protocol was applied, which would mandate additional CBCT verification if the applied patient shifts exceeded 3 mm to avoid intraobserver variability in CBCT registration and to confirm table shifts. For each patient, two IGRT strategies: kV + CBCT and CBCT alone, were compared and the recorded patient shifts were categorized into whether additional CBCT acquisition would have been mandated or not. The effectiveness of either strategy was gauged by the likelihood of needing additional CBCT imaging for accurate patient set-up. Results: The use of CBCT alone was 6 times more likely to require an additional CBCT than KV+CBCT, for a 3 mm shift threshold (88% vs 14%). The likelihood of additional CBCT verification generally increased with lower shift thresholds, and was significantly lower when kV+CBCT was used (7% with 5 mm shift threshold, 36% with 2 mm threshold), than with CBCT alone (61% with 5 mm shift threshold, 97% with 2 mm threshold). With CBCT alone, treatment time increased by 2.2 min and dose increased by 1.9 cGy per fraction on average due to additional CBCT with a 3mm shift threshold. Conclusion: The benefit of kV imaging to screen for gross misalignments led to more accurate CBCT based patient localization compared with using CBCT alone. The subsequently reduced need for additional CBCT verification will minimize treatment time and result in less overall patient imaging dose.

60 APPLIED LIFE SCIENCES↗