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All sourcesNASA NTRSDOE OSTI
DOE OSTI2018

Dynamics of the vaginal wall dose in HDR interstitial brachytherapy for gynecological cancer: Systematic analysis of phantom vs patient case

This study aimed to investigate the dynamics of the vaginal wall dose for interstitial brachytherapy (ISBT). A patient undergoing ISBT was selected as the patient case. The phantom case was generated to simulate the patient case in all regards with the exception of parallel needle positions. The vaginal wall was contoured as a 0.5-cm expansion around the vaginal surface of the obturator. The prescribed ISBT dose was 20 Gy in 4 fractions. Six treatment plans were generated by modifying relative dwell times and needle positions (DTNP). The volume of the vaginal wall receiving > 150% of prescription dose (V{sub > 150%}) and D{sub 2cc} of the vaginal wall were compared among plans. The V{sub > 150%} was much larger in the patient case (49.3%) due to unparallel needles compared with the phantom case (14.3%) without modification (plan 1). Among the 6 plans, reduced dwell time (plan 3) and no dwell time (plans 5 and 6) on the vaginal surface needles had the lowest vaginal wall doses with the use of a central obturator needle in both cases. In comparison of patient case plans 1, 3, 5, and 6, V{sub 150%} was 49.2%, 19.0%, 21.3%, and 28.7%, respectively, and D{sub 2cc} was 41.15 Gy, 33.10 Gy, 36.51 Gy, and 34.37 Gy, respectively, which was limited around each loaded needle. Modification of DTNP is able to reduce the vaginal wall volume exceeding 150% of the prescription dose in the patient case. Understanding these dynamics of the vaginal wall dose will improve dose optimization of ISBT and may reduce vaginal morbidities.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2013

Plasma and liver acetaminophen-protein adduct levels in mice after acetaminophen treatment: Dose–response, mechanisms, and clinical implications

At therapeutic doses, acetaminophen (APAP) is a safe and effective analgesic. However, overdose of APAP is the principal cause of acute liver failure in the West. Binding of the reactive metabolite of APAP (NAPQI) to proteins is thought to be the initiating event in the mechanism of hepatotoxicity. Early work suggested that APAP-protein binding could not occur without glutathione (GSH) depletion, and likely only at toxic doses. Moreover, it was found that protein-derived APAP-cysteine could only be detected in serum after the onset of liver injury. On this basis, it was recently proposed that serum APAP-cysteine could be used as diagnostic marker of APAP overdose. However, comprehensive dose–response and time course studies have not yet been done. Furthermore, the effects of co-morbidities on this parameter have not been investigated. We treated groups of mice with APAP at multiple doses and measured liver GSH and both liver and plasma APAP-protein adducts at various timepoints. Our results show that protein binding can occur without much loss of GSH. Importantly, the data confirm earlier work that showed that protein-derived APAP-cysteine can appear in plasma without liver injury. Experiments performed in vitro suggest that this may involve multiple mechanisms, including secretion of adducted proteins and diffusion of NAPQI directly into plasma. Induction of liver necrosis through ischemia–reperfusion significantly increased the plasma concentration of protein-derived APAP-cysteine after a subtoxic dose of APAP. While our data generally support the measurement of serum APAP-protein adducts in the clinic, caution is suggested in the interpretation of this parameter. - Highlights: • Extensive GSH depletion is not required for APAP-protein binding in the liver. • APAP-protein adducts appear in plasma at subtoxic doses. • Proteins are adducted in the cell and secreted out. • Coincidental liver injury increases plasma APAP-protein adducts at subtoxic doses. • Plasma APAP-protein adducts are diagnostically useful, but interpret with care.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

High Dose Hyperfractionated Radiotherapy for Adults with Glioblastomas

From 1989 to 1991, 27 patients with glioblastoma multiforme or anaplastic astrocytoma of the brain were treated with radiotherapy. Fifteen of twenty-seven patients were treated through limited volume fields, with a thrice-a-day (1.1 Gy/f) or twice-a-day (1.4 Gy/f) hyperfractionated regimen to a total physical dose of 62–92 Gy (median dose 76 Gy). The remaining 12 were treated with whole brain irradiation (40 Gy of total conventionally fractionated dose) and a localised boost to a total dose of 60 Gy. The hyperfractionated regimen was well tolerated and there was no sign of increased brain oedema to indicate the insertion of a split. Of six patients who received a NTD10 (normalised total dose for α/β =10) higher than 71 Gy, five showed CR (83% CR rate) versus three of 21 patients who received a lower NTD10 (14% CR rate). For 13 patients who received a NTD10 higher than 66 Gy, the 18-months survival was 61% (8/13) versus 28% (4/14) for 14 patients who received a NTD10 less than 66 Gy. As far as the late morbidity is concerned, of six patients treated with 76-92 Gy of physical dose, none died because of radiation-induced brain necrosis within 18-42 months of follow-up, and three of them are without evidence of disease 18-31 months after the end of radiation treatment. None of our 15 patients who received less than whole brain irradiation relapsed outside the radiation portals. The present study strongly suggests the use of limited volume hyperfractionated radiotherapy schemes, so as to increase the local tumor dose (NTD10) to values higher than 79 Gy, at the same time keeping the NTD2 (NTD for α/β = 2) below 68 Gy.

61 RADIATION PROTECTION AND DOSIMETRY↗
DOE OSTI2015

Modelling and mitigating dose to firefighters from inhalation of radionuclides in wildland fire smoke

Firefighters responding to wildland fires where surface litter and vegetation contain radiological contamination will receive a radiological dose by inhaling resuspended radioactive material in the smoke. This may increase their lifetime risk of contracting certain types of cancer. Using published data, we modelled hypothetical radionuclide emissions, dispersion and dose for 70th and 97th percentile environmental conditions and for average and high fuel loads at the Savannah River Site. We predicted downwind concentration and potential dose to firefighters for radionuclides of interest ( 137 Cs, 238 Pu, 90 Sr and 210 Po). Predicted concentrations exceeded dose guidelines in the base case scenario emissions of 1.0 × 10 7 Bq ha –1 for 238 Pu at 70th percentile environmental conditions and average fuel load levels for both 4- and 14-h shifts. Under 97th percentile environmental conditions and high fuel loads, dose guidelines were exceeded for several reported cases for 90 Sr, 238 Pu and 210 Po. Potential for exceeding dose guidelines was mitigated by including plume rise (>2 m s –1 ) or moving a small distance from the fire owing to large concentration gradients near the edge of the fire. As a result, our approach can quickly estimate potential dose from airborne radionuclides in wildland fire and assist decision-making to reduce firefighter exposure.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2025

First multi-institutional systematic comparison of the neutron ambient dose equivalent produced by proton therapy systems

Objective. Isochronous cyclotrons, synchrocyclotrons, and synchrotrons are used to accelerate protons for proton therapy. An accurate measurement of neutron doses generated by these accelerators and associated delivery systems and its clinical relevance requires systematic protocols and proper neutron dosimetry for a meaningful assessment. We present the first comprehensive comparison of neutron ambient dose equivalent (H*(10)) produced by clinically operational proton therapy systems. Approach. Treatment plans with 10 cm modulation-depth and ranges of 10 cm (R10M10) and 25 cm (R25M10) were created to cover a 10 × 10 × 10 cm 3 water target. The pencil beam scanning proton therapy machines studied were: two gantry-mounted synchrocyclotrons (Hyperscan, Mevion, half-gantry), two isochronous cyclotrons (ProBeam, Varian, full-gantry), one isochronous cyclotron (Proteus, IBA, full-gantry), and two synchrotrons (PROBEAT, Hitachi, full- and half-gantry). Proton beams were delivered to 30 × 30 × 40 cm 3 plastic water phantoms. WENDI-II and LUPIN-BF3-NP neutron rem-meters were positioned at three angles (0°, 45°, 90°) relative to the beam direction to measure the neutron H*(10) at distances between 50–300 cm from the isocenter. Main results. H*(10) showed dependence on beam energy, machine type, and measurement location. The highest reading was for the gantry-mounted synchrocyclotron, whereas other systems produced approximately comparable neutron doses. In all cases, the H*(10) reduced with distance from the isocenter. The H*(10) drop at 2 m distance compared to that at 0.5 m was a factor of ∼5 for the gantry-mounted synchrocyclotron whereas in other systems the decrease was a factor of 10. The WENDI-II device suffered from dead-time-associated under-estimation of the dose by a factor of ∼2–3 under the synchrocyclotron beam due to its high dose-per-pulse. However, WENDI-II and LUPIN-BF3-NP results were within reasonable agreement in isochronous cyclotron and synchrotron beams, indicating that both devices are suitable for those systems. Significance. Neutron H*(10) is dependent on various parameters including beam energy, measurement location, as well as machine design. Caution must be exercised in choosing the appropriate neutron-dose-measurement device to be used for low-duty-factor, particularly in high-instantaneous-rate proton delivery systems. By delivering the same volumetric proton dose across different machines, this work provides a benchmark for inter-system comparisons and serves as a foundation for future studies.

LUPIN↗
DOE OSTI2013

Cancer risk at low doses of ionizing radiation: artificial neural networks inference from atomic bomb survivors

Cancer risk at low doses of ionizing radiation remains poorly defined because of ambiguity in the quantitative link to doses below 0.2 Sv in atomic bomb survivors in Hiroshima and Nagasaki arising from limitations in the statistical power and information available on overall radiation dose. To deal with these difficulties, a novel nonparametric statistics based on the ‘integrate-and-fire’ algorithm of artificial neural networks was developed and tested in cancer databases established by the Radiation Effects Research Foundation. The analysis revealed unique features at low doses that could not be accounted for by nominal exposure dose, including (i) the presence of a threshold that varied with organ, gender and age at exposure, and (ii) a small but significant bumping increase in cancer risk at low doses in Nagasaki that probably reflects internal exposure to 239 Pu. The threshold was distinct from the canonical definition of zero effect in that it was manifested as negative excess relative risk, or suppression of background cancer rates. Such a unique tissue response at low doses of radiation exposure has been implicated in the context of the molecular basis of radiation–environment interplay in favor of recently emerging experimental evidence on DNA double-strand break repair pathway choice and its epigenetic memory by histone marking.

59 BASIC BIOLOGICAL SCIENCES↗
DOE OSTI2015

Polybutadiene and Styrene-Butadiene rubbers for high-dose dosimetry

Polybutadiene and Styrene-Butadiene are synthetical rubbers used widely for pneumatic tires manufacturing. In this research, the dosimeter characteristics of those rubbers were studied for application in high-dose dosimetry. The rubber samples were irradiated with doses of 10 Gy up to 10 kGy, using a {sup 60}Co Gamma Cell-220 system (dose rate of 1.089 kGy/h) and their readings were taken on a Fourier Transform Infrared Spectroscopy-FTIR system (model Frontier/Perkin Elmer). The ratios of two absorbance peaks were taken for each kind of rubber spectrum, Polybutadiene (1306/1130 cm{sup -1}) and Styrene-Butadiene (1449/1306 cm{sup -1}). The ratio calculated was used as the response to the irradiation, and is not uniform across the sample. From the results, it can be concluded for both rubbers: a) the dose-response curves may be useful for high-dose dosimetry (greater than 250 Gy); b) their response for reproducibility presented standard deviations lower than 2.5%; c) the relative sensitivity was higher for Styrene-Butadiene (1.86 kGy{sup -1}) than for Polybutadiene (1.81 kGy{sup -1}), d) for doses of 10 kGy to 200 kGy, there was no variation in the dosimetric response. Both types of rubber samples showed usefulness as high-dose dosimeters. (authors)

36 MATERIALS SCIENCE↗
DOE OSTI2013

Determination of gonad doses during robotic stereotactic radiosurgery for various tumor sites

Purpose: The authors evaluated the absorbed dose received by the gonads during robotic stereotactic radiosurgery (SRS) for the treatment of different tumor localizations. Methods: The authors measured the gonad doses during the treatment of head and neck, thoracic, abdominal, or pelvic tumors in both RANDO phantom and actual patients. The computerized tomography images were transferred to the treatment planning system. The contours of tumor and critical organs were delineated on each slice, and treatment plans were generated. Measurements for gonad doses were taken from the geometric projection of the ovary onto the skin for female patients, and from the scrotal skin for male patients by attaching films and Thermoluminescent dosimeters (TLDs). SRS was delivered with CyberKnife (Accuray Inc., Sunnyvale, CA). Results: The median gonadal doses with TLD and film dosimeter in actual patients were 0.19 Gy (range, 0.035-2.71 Gy) and 0.34 Gy (range, 0.066-3.18 Gy), respectively. In the RANDO phantom, the median ovarian doses with TLD and film dosimeter were 0.08 Gy (range, 0.03-0.159 Gy) and 0.05 Gy (range, 0.015-0.13 Gy), respectively. In the RANDO phantom, the median testicular doses with TLD and film dosimeter were 0.134 Gy (range 0.056-1.97 Gy) and 0.306 Gy (range, 0.065-2.25 Gy). Conclusions: Gonad doses are below sterility threshold in robotic SRS for different tumor localizations. However, particular attention should be given to gonads during robotic SRS for pelvic tumors.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2013

A real-time regional adaptive exposure method for saving dose-area product in x-ray fluoroscopy

Purpose: Reduction of radiation dose in x-ray imaging has been recognized as a high priority in the medical community. Here the authors show that a regional adaptive exposure method can reduce dose-area product (DAP) in x-ray fluoroscopy. The authors' method is particularly geared toward providing dose savings for the pediatric population. Methods: The scanning beam digital x-ray system uses a large-area x-ray source with 8000 focal spots in combination with a small photon-counting detector. An imaging frame is obtained by acquiring and reconstructing up to 8000 detector images, each viewing only a small portion of the patient. Regional adaptive exposure was implemented by varying the exposure of the detector images depending on the local opacity of the object. A family of phantoms ranging in size from infant to obese adult was imaged in anteroposterior view with and without adaptive exposure. The DAP delivered to each phantom was measured in each case, and noise performance was compared by generating noise arrays to represent regional noise in the images. These noise arrays were generated by dividing the image into regions of about 6 mm{sup 2}, calculating the relative noise in each region, and placing the relative noise value of each region in a one-dimensional array (noise array) sorted from highest to lowest. Dose-area product savings were calculated as the difference between the ratio of DAP with adaptive exposure to DAP without adaptive exposure. The authors modified this value by a correction factor that matches the noise arrays where relative noise is the highest to report a final dose-area product savings. Results: The average dose-area product saving across the phantom family was (42 {+-} 8)% with the highest dose-area product saving in the child-sized phantom (50%) and the lowest in the phantom mimicking an obese adult (23%). Conclusions: Phantom measurements indicate that a regional adaptive exposure method can produce large DAP savings without compromising the noise performance in the image regions with highest noise.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗
DOE OSTI2013

Effects of sparse sampling schemes on image quality in low-dose CT

Purpose: Various scanning methods and image reconstruction algorithms are actively investigated for low-dose computed tomography (CT) that can potentially reduce a health-risk related to radiation dose. Particularly, compressive-sensing (CS) based algorithms have been successfully developed for reconstructing images from sparsely sampled data. Although these algorithms have shown promises in low-dose CT, it has not been studied how sparse sampling schemes affect image quality in CS-based image reconstruction. In this work, the authors present several sparse-sampling schemes for low-dose CT, quantitatively analyze their data property, and compare effects of the sampling schemes on the image quality.Methods: Data properties of several sampling schemes are analyzed with respect to the CS-based image reconstruction using two measures: sampling density and data incoherence. The authors present five different sparse sampling schemes, and simulated those schemes to achieve a targeted dose reduction. Dose reduction factors of about 75% and 87.5%, compared to a conventional scan, were tested. A fully sampled circular cone-beam CT data set was used as a reference, and sparse sampling has been realized numerically based on the CBCT data.Results: It is found that both sampling density and data incoherence affect the image quality in the CS-based reconstruction. Among the sampling schemes the authors investigated, the sparse-view, many-view undersampling (MVUS)-fine, and MVUS-moving cases have shown promising results. These sampling schemes produced images with similar image quality compared to the reference image and their structure similarity index values were higher than 0.92 in the mouse head scan with 75% dose reduction.Conclusions: The authors found that in CS-based image reconstructions both sampling density and data incoherence affect the image quality, and suggest that a sampling scheme should be devised and optimized by use of these indicators. With this strategic approach, one can acquire optimally sampled sparse data so that the CS-based algorithms can best perform in terms of image quality.

61 RADIATION PROTECTION AND DOSIMETRY↗
DOE OSTI2014

Dose reduction using a dynamic, piecewise-linear attenuator

Purpose: The authors recently proposed a dynamic, prepatient x-ray attenuator capable of producing a piecewise-linear attenuation profile customized to each patient and viewing angle. This attenuator was intended to reduce scatter-to-primary ratio (SPR), dynamic range, and dose by redistributing flux. In this work the authors tested the ability of the attenuator to reduce dose and SPR in simulations. Methods: The authors selected four clinical applications, including routine full field-of-view scans of the thorax and abdomen, and targeted reconstruction tasks for an abdominal aortic aneurysm and the pancreas. Raw data were estimated by forward projection of the image volume datasets. The dynamic attenuator was controlled to reduce dose while maintaining peak variance by solving a convex optimization problem, assuminga priori knowledge of the patient anatomy. In targeted reconstruction tasks, the noise in specific regions was given increased weighting. A system with a standard attenuator (or “bowtie filter”) was used as a reference, and used either convex optimized tube current modulation (TCM) or a standard TCM heuristic. The noise of the scan was determined analytically while the dose was estimated using Monte Carlo simulations. Scatter was also estimated using Monte Carlo simulations. The sensitivity of the dynamic attenuator to patient centering was also examined by shifting the abdomen in 2 cm intervals. Results: Compared to a reference system with optimized TCM, use of the dynamic attenuator reduced dose by about 30% in routine scans and 50% in targeted scans. Compared to the TCM heuristics which are typically used withouta priori knowledge, the dose reduction is about 50% for routine scans. The dynamic attenuator gives the ability to redistribute noise and variance and produces more uniform noise profiles than systems with a conventional bowtie filter. The SPR was also modestly reduced by 10% in the thorax and 24% in the abdomen. Imaging with the dynamic attenuator was relatively insensitive to patient centering, showing a 17% increase in peak variance for a 6 cm shift of the abdomen, instead of an 82% increase in peak variance for a fixed bowtie filter. Conclusions: A dynamic prepatient x-ray attenuator consisting of multiple wedges is capable of achieving substantial dose reductions and modest SPR reductions.

61 RADIATION PROTECTION AND DOSIMETRY↗
DOE OSTI2014

Correction for FDG PET dose extravasations: Monte Carlo validation and quantitative evaluation of patient studies

Purpose: Current procedure guidelines for whole body [18F]fluoro-2-deoxy-D-glucose (FDG)-positron emission tomography (PET) state that studies with visible dose extravasations should be rejected for quantification protocols. Our work is focused on the development and validation of methods for estimating extravasated doses in order to correct standard uptake value (SUV) values for this effect in clinical routine. Methods: One thousand three hundred sixty-seven consecutive whole body FDG-PET studies were visually inspected looking for extravasation cases. Two methods for estimating the extravasated dose were proposed and validated in different scenarios using Monte Carlo simulations. All visible extravasations were retrospectively evaluated using a manual ROI based method. In addition, the 50 patients with higher extravasated doses were also evaluated using a threshold-based method. Results: Simulation studies showed that the proposed methods for estimating extravasated doses allow us to compensate the impact of extravasations on SUV values with an error below 5%. The quantitative evaluation of patient studies revealed that paravenous injection is a relatively frequent effect (18%) with a small fraction of patients presenting considerable extravasations ranging from 1% to a maximum of 22% of the injected dose. A criterion based on the extravasated volume and maximum concentration was established in order to identify this fraction of patients that might be corrected for paravenous injection effect. Conclusions: The authors propose the use of a manual ROI based method for estimating the effectively administered FDG dose and then correct SUV quantification in those patients fulfilling the proposed criterion.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2014

Objective assessment of image quality and dose reduction in CT iterative reconstruction

Purpose: Iterative reconstruction (IR) algorithms have the potential to reduce radiation dose in CT diagnostic imaging. As these algorithms become available on the market, a standardizable method of quantifying the dose reduction that a particular IR method can achieve would be valuable. Such a method would assist manufacturers in making promotional claims about dose reduction, buyers in comparing different devices, physicists in independently validating the claims, and the United States Food and Drug Administration in regulating the labeling of CT devices. However, the nonlinear nature of commercially available IR algorithms poses challenges to objectively assessing image quality, a necessary step in establishing the amount of dose reduction that a given IR algorithm can achieve without compromising that image quality. This review paper seeks to consolidate information relevant to objectively assessing the quality of CT IR images, and thereby measuring the level of dose reduction that a given IR algorithm can achieve. Methods: The authors discuss task-based methods for assessing the quality of CT IR images and evaluating dose reduction. Results: The authors explain and review recent literature on signal detection and localization tasks in CT IR image quality assessment, the design of an appropriate phantom for these tasks, possible choices of observers (including human and model observers), and methods of evaluating observer performance. Conclusions: Standardizing the measurement of dose reduction is a problem of broad interest to the CT community and to public health. A necessary step in the process is the objective assessment of CT image quality, for which various task-based methods may be suitable. This paper attempts to consolidate recent literature that is relevant to the development and implementation of task-based methods for the assessment of CT IR image quality.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-D-12A-06: A Comprehensive Parameter Analysis for Low Dose Cone-Beam CT Reconstruction

Purpose: There is always a parameter in compressive sensing based iterative reconstruction (IR) methods low dose cone-beam CT (CBCT), which controls the weight of regularization relative to data fidelity. A clear understanding of the relationship between image quality and parameter values is important. The purpose of this study is to investigate this subject based on experimental data and a representative advanced IR algorithm using Tight-frame (TF) regularization. Methods: Three data sets of a Catphan phantom acquired at low, regular and high dose levels are used. For each tests, 90 projections covering a 200-degree scan range are used for reconstruction. Three different regions-of-interest (ROIs) of different contrasts are used to calculate contrast-to-noise ratios (CNR) for contrast evaluation. A single point structure is used to measure modulation transfer function (MTF) for spatial-resolution evaluation. Finally, we analyze CNRs and MTFs to study the relationship between image quality and parameter selections. Results: It was found that: 1) there is no universal optimal parameter. The optimal parameter value depends on specific task and dose level. 2) There is a clear trade-off between CNR and resolution. The parameter for the best CNR is always smaller than that for the best resolution. 3) Optimal parameters are also dose-specific. Data acquired under a high dose protocol require less regularization, yielding smaller optimal parameter values. 4) Comparing with conventional FDK images, TF-based CBCT images are better under a certain optimally selected parameters. The advantages are more obvious for low dose data. Conclusion: We have investigated the relationship between image quality and parameter values in the TF-based IR algorithm. Preliminary results indicate optimal parameters are specific to both the task types and dose levels, providing guidance for selecting parameters in advanced IR algorithms. This work is supported in part by NIH (1R01CA154747-01)

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗
DOE OSTI2014

SU-E-J-69: Evaluation of the Lens Dose On the Cone Beam IGRT Procedures

Purpose: With the establishment of the IGRT as a standard technique, the extra dose that is given to the patients should be taken into account. Furthermore, it has been a recent decrease of the dose threshold in the lens, reduced to 0.5 Gy (ICRP ref 4825-3093-1464 on 21st April, 2011).The purpose of this work was to evaluate the extra dose that the lens is receive due to the Cone-Beam (CBCT) location systems in Head-and-Neck treatments. Methods: The On-Board Imaging (OBI) v 1.5 of the two Varian accelerators, one Clinac iX and one True Beam, were used to obtain the dose that this OBI version give to the lens in the Head-and-Neck location treatments. All CBCT scans were acquired with the Standard Dose Head protocol (100 kVp, 80 mA, 8 ms and 200 degree of rotation).The measurements were taken with thermoluminescence (TLD) EXTRAD (Harshaw) dosimeters placed in an anthropomorphic phantom over the eye and under 3 mm of bolus material to mimic the lens position. The center of the head was placed at the isocenter. To reduce TLD energy dependence, they were calibrated at the used beam quality. Results: The average lens dose at the lens in the OBI v 1.5 systems of the Clinac iX and the True Beam is 0.071 and 0.076 cGy/CBCT, respectively. Conclusions: The extra absorbed doses that receive the eye lenses due to one CBCT acquisition with the studied protocol is far below the new ICRP recommended threshold for the lens. However, the addition effect of several CBCT acquisition during the whole treatment should be taken into account.

61 RADIATION PROTECTION AND DOSIMETRY↗
DOE OSTI2014

SU-E-J-113: The Influence of Optimizing Pediatric CT Simulator Protocols On the Treatment Dose Calculation in Radiotherapy

Purpose: To investigate the possibility of applying optimized scanning protocols for pediatric CT simulation by quantifying the dosimetric inaccuracy introduced by using a fixed HU to density conversion. Methods: The images of a CIRS electron density reference phantom (Model 062) were acquired by a Siemens CT simulator (Sensation Open) using the following settings of tube voltage and beam current: 120 kV/190mA (the reference protocol used to calibrate CT for our treatment planning system (TPS)); Fixed 190mA combined with all available kV: 80, 100, and 140; fixed 120 kV and various current from 37 to 444 mA (scanner extremes) with interval of 30 mA. To avoid the HU uncertainty of point sampling in the various inserts of known electron densities, the mean CT numbers of the central cylindrical volume were calculated using DICOMan software. The doses per 100 MU to the reference point (SAD=100cm, Depth=10cm, Field=10X10cm, 6MV photon beam) in a virtual cubic phantom (30X30X30cm) were calculated using Eclipse TPS (calculation model: AcurosXB-11031) by assigning the CT numbers to HU of typical materials acquired by various protocols. Results: For the inserts of densities less than muscle, CT number fluctuations of all protocols were within the tolerance of 10 HU as accepted by AAPM-TG66. For more condensed materials, fixed kV yielded stable HU with any mA combination where largest disparities were found in 1750mg/cc insert: HU{sub reference}=1801(106.6cGy), HU{sub minimum}=1799 (106.6cGy, error{sub dose}=0.00%), HU{sub maximum}=1815 (106.8cGy, error{sub dose}=0.19%). Yet greater disagreements were observed with increasing density when kV was modified: HU{sub minimum}=1646 (104.5cGy, error{sub dose}=- 1.97%), HU{sub maximum}=2487 (116.4cGy, error{sub dose}=9.19%) in 1750mg/cc insert. Conclusion: Without affecting treatment dose calculation, personalized mA optimization of CT simulator can be conducted by fixing kV for a better cost-effectiveness of imaging dose and quality especially for children. Unless recalibrated, kV should be constant for all anatomical sites if diagnostic CT scanner is used as a simulator. This work was partially supported by Capital Medical Development Scientific Research Fund of China.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗
DOE OSTI2014

SU-E-J-229: Quantitative Assessment for Timely Adaptive Re-Planning Using Weekly Dose Monitoring for Head and Neck Cancer

Purpose: For patients with head and neck (HN) cancer, mid-course adaptive radiation therapy (ART) is a common practice in our institution to accommodate anatomic changes. The aim of the study is to evaluate whether dose re-calculation on weekly verification images can provide quantitative assessment for timely adaptive re-planning with daily image-guided intensity modulated radiotherapy (IMRT). Methods: We retrospectively selected sixty daily verification images acquired on CT-on-rail/CBCT from ten HN patients. These image sets were typically a week apart. Among these patients, six patients received a mid-course ART. Contours of the tumors and organ-at-risks (OARs) were manually delineated by a physician on each verification CT. After placing the treatment iso-center on the verification CTs according to the recorded clinical shifts, daily dose was re-calculated with the same beam configuration as the original plan. For the purpose of this study, electron densities for both verification CTs and planning CTs were set to 1.0 g/cm3. Results: Two patients had D99 of the CTV < 97% of the planned dose for more than three fractions due to remarkable tumor volume shrinkages. D-max of the spinal cord exceeded a tolerance of 45 Gy for four fractions in additional two patients. D-mean of the parotid increased within 25% of the planned value. D-max of the brainstem and D-mean of the oral cavity did not show significant variation. If the re-planning criteria included D99 of the CTV < 97% of the planned dose and D-max of the spinal cord > 45 Gy, two out ten patients required ART at week 2 and two patients required ART at week 3, respectively. Conclusion: Weekly dose monitoring with re-calculation on verification images can provide quantitative dose guidance for timely adaptive re-planning. Future work will include accumulative dose analysis for the decision of adaptive re-planning. The study is supported in part by Siemens Medical Solutions.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-J-275: Impact of the Intra and Inter Observer Variability in the Delineation of Parotid Glands On the Dose Calculation During Head and Neck Helical Tomotherapy

Purpose: The intra- and inter-observer variability in delineation of the parotids on the kilo-voltage computed tomography (kVCT) and mega-voltage computed tomography (MVCT) were examined to establish their impact on the dose calculation during adaptive head and neck helical tomotherapy (HT). Methods: Three observers delineated left and right parotids for ten randomly selected patients with oropharynx cancer treated on HT. The pre-treatment kVCT and the MVCT from the first fraction of irradiation were selected to delineation. The delineation procedure was repeated three times by each observer. The parotids were delineated according to the institutional protocol. The analyses included intra-observer reproducibility and inter-structure, -observer and -modality variability of the volume and dose. Results: The differences between the left and right parotid outlines were not statistically significant (p>0.3). The reproducibility of the delineation was confirmed for each observer on the kVCT (p>0.2) and on the MVCT (p>0.1). The inter-observer variability of the outlines was significant (p<0.001) as well as the inter-modality variability (p<0.006). The parotids delineated on the MVCT were 10% smaller than on the kVCT. The inter-observer variability of the parotids delineation did not affect the average dose (p=0.096 on the kVCT and p=0.176 on the MVCT). The dose calculated on the MVCT was higher by 3.3% than dose from the kVCT (p=0.009). Conclusion: Usage of the institutional protocols for the parotids delineation reduces intra-observer variability and increases reproducibility of the outlines. These protocols do not eliminate delineation differences between the observers, but these differences are not clinically significant and do not affect average doses in the parotids. The volumes of the parotids delineated on the MVCT are smaller than on the kVCT, which affects the differences in the calculated doses.

60 APPLIED LIFE SCIENCES↗