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At least 1,243 records · Page 69
All sourcesNASA NTRSDOE OSTI
DOE OSTI2012

Coupled motion of asymmetrical tilt grain boundaries: Molecular dynamics and phase field crystal simulations

Previous simulation and experimental studies have shown that some grain boundaries (GBs) can couple to applied shear stresses and be moved by them, producing shear deformation of the lattice traversed by their motion. While this coupling effect has been well confirmed for symmetrical tilt GBs, little is known about the coupling ability of asymmetrical boundaries. In this work we apply a combination of molecular dynamics and phase field crystal simulations to investigate stress-driven motion of asymmetrical GBs between cubic crystals over the entire range of inclination angles. Our main findings are that the coupling effect exists for most of the asymmetrical GBs and that the coupling factor exhibits a non-trivial dependence on both the misorientation and inclination angles. This dependence is characterized by a discontinuous change of sign of the coupling factor, which reflects a transition between two different coupling modes over a narrow range of angles. Importantly, the magnitude of the coupling factor becomes large or divergent within this transition region, thereby giving rise to a sliding-like behavior. Our results are interpreted in terms of a diagram presenting the domains of existence of the two coupling modes and the transition region between them in the plane of misorientation and inclination angles. The simulations reveal some of the dislocation mechanisms responsible for the motion of asymmetrical tilt GBs. Furthermore, the results of this study compare favorably with existing experimental measurements and provide a theoretical ground for the design of future experiments.

36 MATERIALS SCIENCE↗
DOE OSTI2015

Spontaneous excitation of a detector in circular motion coupled to massless Rarita–Schwinger fields in vacuum

We study the spontaneous excitation of a detector (modeled by a two-level atom) in circular motion coupled nonlinearly to vacuum massless Rarita–Schwinger fields in the ultrarelativistic limit and demonstrate that the spontaneous excitation occurs for ground-state atoms in circular motion in vacuum but the excitation rate is not of a pure thermal form as that of the atoms in linear uniform acceleration. An interesting feature is that terms of odd powers in acceleration appear in the excitation rate whereas in the linear acceleration case there are only terms of even powers present. On the other hand, what makes the present case unique in comparison to the atom’s coupling to other fields that are previously studied is the appearance of the terms proportional to the seventh and ninth powers of acceleration in the mean rate of change of atomic energy which are absent in the scalar, electromagnetic and Dirac field cases. -- Highlights: •Circular Unruh effect for detector coupled to Rarita–Schwinger field. •Nonlinear coupling between the detector and the fields. •Detector in circular motion does not feel pure thermal bath. •Excitation rate contains terms of odd powers in acceleration.

71 CLASSICAL AND QUANTUM MECHANICS, GENERAL PHYSIC↗
DOE OSTI2023

CIEL ∗ Ch color map for visualization and analysis of sea ice motion

The International Commission on Illumination (CIE) designed its color space to be perceptually uniform so that a given numerical change in the color code corresponds to perceived change in color. This color encoding is demon- strated to be advantageous in scientific visualization and analysis of vector fields. The specific application is analysis of ice motion in the Arctic where patterns in smooth monthly-averaged ice motion are seen. Furthermore, fractures occurring in the ice cover result in discontinuities in the ice motion. This vector jump in displacement can also be visualized. We then analyze modeled and observed fractures through the use of a metric on the color space, and image amplitude and phase metrics. Amplitude and phase met- rics arise from image registration that is accomplished by sampling images using space filling curves, thus reducing the image registration problem to the more reliable functional alignment problem. We demonstrate this through an exploration of the metrics to compare model runs to an observed ice crack.

97 MATHEMATICS AND COMPUTING↗
DOE OSTI2016

Computational design of microscopic swimmers and capsules: From directed motion to collective behavior

Systems of motile microscopic particles can exhibit behaviors that resemble those of living microorganisms, including cooperative motion, self-organization, and adaptability to changing environments. Using mesoscale computational modeling, we design synthetic microswimmers and microcapsules that undergo controllable, self-propelled motion in solution. Stimuli-responsive hydrogels are used to actuate the microswimmers and to enable their navigation and chemotaxing behavior. The self-propelled motion of microcapsules on solid surfaces is achieved by the release of encapsulated solutes that alter the surface adhesiveness. These signaling solutes also enable interactions among multiple microcapsules that lead to complex, cooperative behavior. Our findings provide guidelines for creating microscopic devices and machines able to autonomously move and mimic the communication and chemotaxis of biological microorganisms.

42 ENGINEERING↗
DOE OSTI2016

String flash-boiling in gasoline direct injection simulations with transient needle motion

A computational study was performed to investigate the influence of transient needle motion on gasoline direct injection (GDI) internal nozzle flow and near-field sprays. Simulations were conducted with a compressible Eulerian flow solver modeling liquid, vapor, and non-condensable gas phases with a diffuse interface. Variable rate generation and condensation of fuel vapor were captured using the homogeneous relaxation model (HRM). The non-flashing (spray G) and flashing (spray G2) conditions specified by the Engine Combustion Network were modeled using the nominal spray G nozzle geometry and transient needle lift and wobble were based upon ensemble averaged x-ray imaging preformed at Argonne National Lab. The minimum needle lift simulated was 5 μm and dynamic mesh motion was achieved with Laplacian smoothing. The results were qualitatively validated against experimental imaging and the experimental rate of injection profile was captured accurately using pressure boundary conditions and needle motion to actu- ate the injection. Needle wobble was found to have no measurable effect on the flow. Low needle lift is shown to result in vapor generation as fuel rushes past the needle. In conclusion, the internal injector flow is shown to contain many transient and interacting vortices which cause perturbations in the spray angle, fluctuations in the mass flux, and frequently result in string flash-boiling.

33 ADVANCED PROPULSION SYSTEMS↗
DOE OSTI2011

Effect of Immobilization and Performance Status on Intrafraction Motion for Stereotactic Lung Radiotherapy: Analysis of 133 Patients

Purpose: To assess intrafractional geometric accuracy of lung stereotactic body radiation therapy (SBRT) patients treated with volumetric image guidance. Methods and Materials: Treatment setup accuracy was analyzed in 133 SBRT patients treated via research ethics board-approved protocols. For each fraction, a localization cone-beam computed tomography (CBCT) scan was acquired for soft-tissue registration to the internal target volume, followed by a couch adjustment for positional discrepancies greater than 3 mm, verified with a second CBCT scan. CBCT scans were also performed at intrafraction and end fraction. Patient positioning data from 2047 CBCT scans were recorded to determine systematic ({Sigma}) and random ({sigma}) uncertainties, as well as planning target volume margins. Data were further stratified and analyzed by immobilization method (evacuated cushion [n = 75], evacuated cushion plus abdominal compression [n = 33], or chest board [n = 25]) and by patients' Eastern Cooperative Oncology Group performance status (PS): 0 (n = 31), 1 (n = 70), or 2 (n = 32). Results: Using CBCT internal target volume was matched within {+-}3 mm in 16% of all fractions at localization, 89% at verification, 72% during treatment, and 69% after treatment. Planning target volume margins required to encompass residual setup errors after couch corrections (verification CBCT scans) were 4 mm, and they increased to 5 mm with target intrafraction motion (post-treatment CBCT scans). Small differences (<1 mm) in the cranial-caudal direction of target position were observed between the immobilization cohorts in the localization, verification, intrafraction, and post-treatment CBCT scans (p < 0.01). Positional drift varied according to patient PS, with the PS 1 and 2 cohorts drifting out of position by mid treatment more than the PS 0 cohort in the cranial-caudal direction (p = 0.04). Conclusions: Image guidance ensures high geometric accuracy for lung SBRT irrespective of immobilization method or PS. A 5-mm setup margin suffices to address intrafraction motion. This setup margin may be further reduced by strategies such as frequent image guidance or volumetric arc therapy to correct or limit intrafraction motion.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2012

Cardiac Motion During Deep-Inspiration Breath-Hold: Implications for Breast Cancer Radiotherapy

Purpose: Many patients with left-sided breast cancer receive adjuvant radiotherapy during deep-inspiration breath hold (DIBH) to minimize radiation exposure to the heart. We measured the displacement of the left anterior descending artery (LAD) and heart owing to cardiac motion during DIBH, relative to the standard tangential fields for left breast cancer radiotherapy. Methods and Materials: A total of 20 patients who had undergone computed tomography-based coronary angiography with retrospective electrocardiographic gating were randomly selected for the present study. The patients underwent scanning during DIBH to control the influence of respiration on cardiac motion. Standard medial and lateral tangential fields were placed, and the LADs were contoured on the systolic- and diastolic-phase computed tomography data sets by the clinicians. Displacement of the LAD during cardiac contractions was calculated in three directions: toward the posterior edge of the treatment fields, left-right, and anteroposterior. Displacement of the entire heart was measured on the maximal and minimal intensity projection computed tomography images. Results: The mean displacement of the LAD from cardiac contraction without the influence of respiration for 20 patients was 2.3 mm (range, 0.7-3.8) toward the posterior edge of the treatment fields, 2.6 mm (range, 1.0-6.8) in the left-right direction, and 2.3 mm (range, 0.6-6.5) in the anteroposterior direction. At least 30% of the LAD volume was displaced >5 mm in any direction in 2 patients (10%), and <10% of the LAD volume was displaced >5 mm in 10 patients (50%). The extent of displacement of the heart periphery during cardiac motion was negligible near the treatment fields. Conclusions: Displacement of the heart periphery near the treatment fields was negligible during DIBH; however, displacement of the LAD from cardiac contraction varied substantially between and within patients. We recommend maintaining {>=}5 mm of distance between the LAD and the field edge for patients undergoing breast cancer radiotherapy during DIBH.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2012

Respiration Induced Heart Motion and Indications of Gated Delivery for Left-Sided Breast Irradiation

Purpose: To investigate respiration-induced heart motion for left-sided breast irradiation using a four-dimensional computed tomography (4DCT) technique and to determine novel indications to assess heart motion and identify breast patients who may benefit from a gated treatment. Methods and Materials: Images of 4DCT acquired during free breathing for 20 left-sided breast cancer patients, who underwent whole breast irradiation with or without regional nodal irradiation, were analyzed retrospectively. Dose distributions were reconstructed in the phases of 0%, 20%, and 50%. The intrafractional heart displacement was measured in three selected transverse CT slices using D{sub LAD} (the distance from left ascending aorta to a fixed line [connecting middle point of sternum and the body] drawn on each slice) and maximum heart depth (MHD, the distance of the forefront of the heart to the line). Linear regression analysis was used to correlate these indices with mean heart dose and heart dose volume at different breathing phases. Results: Respiration-induced heart displacement resulted in observable variations in dose delivered to the heart. During a normal free-breathing cycle, heart-induced motion D{sub LAD} and MHD changed up to 9 and 11 mm respectively, resulting in up to 38% and 39% increases of mean doses and V{sub 25.2} for the heart. MHD and D{sub LAD} were positively correlated with mean heart dose and heart dose volume. Respiratory-adapted gated treatment may better spare heart and ipsilateral-lung compared with the conventional non-gated plan in a subset of patients with large D{sub LAD} or MHD variations. Conclusion: Proposed indices offer novel assessment of heart displacement based on 4DCT images. MHD and D{sub LAD} can be used independently or jointly as selection criteria for respiratory gating procedure before treatment planning. Patients with great intrafractional MHD variations or tumor(s) close to the diaphragm may particularly benefit from the gated treatment.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2012

Incidence of Changes in Respiration-Induced Tumor Motion and Its Relationship With Respiratory Surrogates During Individual Treatment Fractions

Purpose: To determine how frequently (1) tumor motion and (2) the spatial relationship between tumor and respiratory surrogate markers change during a treatment fraction in lung and pancreas cancer patients. Methods and Materials: A Cyberknife Synchrony system radiographically localized the tumor and simultaneously tracked three respiratory surrogate markers fixed to a form-fitting vest. Data in 55 lung and 29 pancreas fractions were divided into successive 10-min blocks. Mean tumor positions and tumor position distributions were compared across 10-min blocks of data. Treatment margins were calculated from both 10 and 30 min of data. Partial least squares (PLS) regression models of tumor positions as a function of external surrogate marker positions were created from the first 10 min of data in each fraction; the incidence of significant PLS model degradation was used to assess changes in the spatial relationship between tumors and surrogate markers. Results: The absolute change in mean tumor position from first to third 10-min blocks was >5 mm in 13% and 7% of lung and pancreas cases, respectively. Superior-inferior and medial-lateral differences in mean tumor position were significantly associated with the lobe of lung. In 61% and 54% of lung and pancreas fractions, respectively, margins calculated from 30 min of data were larger than margins calculated from 10 min of data. The change in treatment margin magnitude for superior-inferior motion was >1 mm in 42% of lung and 45% of pancreas fractions. Significantly increasing tumor position prediction model error (mean {+-} standard deviation rates of change of 1.6 {+-} 2.5 mm per 10 min) over 30 min indicated tumor-surrogate relationship changes in 63% of fractions. Conclusions: Both tumor motion and the relationship between tumor and respiratory surrogate displacements change in most treatment fractions for patient in-room time of 30 min.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2012

Spine Stereotactic Body Radiotherapy Utilizing Cone-Beam CT Image-Guidance With a Robotic Couch: Intrafraction Motion Analysis Accounting for all Six Degrees of Freedom

Purpose: To evaluate the residual setup error and intrafraction motion following kilovoltage cone-beam CT (CBCT) image guidance, for immobilized spine stereotactic body radiotherapy (SBRT) patients, with positioning corrected for in all six degrees of freedom. Methods and Materials: Analysis is based on 42 consecutive patients (48 thoracic and/or lumbar metastases) treated with a total of 106 fractions and 307 image registrations. Following initial setup, a CBCT was acquired for patient alignment and a pretreatment CBCT taken to verify shifts and determine the residual setup error, followed by a midtreatment and posttreatment CBCT image. For 13 single-fraction SBRT patients, two midtreatment CBCT images were obtained. Initially, a 1.5-mm and 1 Degree-Sign tolerance was used to reposition the patient following couch shifts which was subsequently reduced to 1 mm and 1 Degree-Sign degree after the first 10 patients. Results: Small positioning errors after the initial CBCT setup were observed, with 90% occurring within 1 mm and 97% within 1 Degree-Sign . In analyzing the impact of the time interval for verification imaging (10 {+-} 3 min) and subsequent image acquisitions (17 {+-} 4 min), the residual setup error was not significantly different (p > 0.05). A significant difference (p = 0.04) in the average three-dimensional intrafraction positional deviations favoring a more strict tolerance in translation (1 mm vs. 1.5 mm) was observed. The absolute intrafraction motion averaged over all patients and all directions along x, y, and z axis ({+-} SD) were 0.7 {+-} 0.5 mm and 0.5 {+-} 0.4 mm for the 1.5 mm and 1 mm tolerance, respectively. Based on a 1-mm and 1 Degree-Sign correction threshold, the target was localized to within 1.2 mm and 0.9 Degree-Sign with 95% confidence. Conclusion: Near-rigid body immobilization, intrafraction CBCT imaging approximately every 15-20 min, and strict repositioning thresholds in six degrees of freedom yields minimal intrafraction motion allowing for safe spine SBRT delivery.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2012

Prostate Bed Motion During Intensity-Modulated Radiotherapy Treatment

Purpose: Conformal radiation therapy in the postprostatectomy setting requires accurate setup and localization of the prostatic fossa. In this series, we report prostate bed localization and motion characteristics, using data collected from implanted radiofrequency transponders. Methods and Materials: The Calypso four-dimensional localization system uses three implanted radiofrequency transponders for daily target localization and real-time tracking throughout a course of radiation therapy. We reviewed the localization and tracking reports for 20 patients who received ultrasonography-guided placement of Calypso transponders within the prostate bed prior to a course of intensity-modulated radiation therapy at Fox Chase Cancer Center. Results: At localization, prostate bed displacement relative to bony anatomy exceeded 5 mm in 9% of fractions in the anterior-posterior (A-P) direction and 21% of fractions in the superior-inferior (S-I) direction. The three-dimensional vector length from skin marks to Calypso alignment exceeded 1 cm in 24% of all 652 fractions with available setup data. During treatment, the target exceeded the 5-mm tracking limit for at least 30 sec in 11% of all fractions, generally in the A-P or S-I direction. In the A-P direction, target motion was twice as likely to move posteriorly, toward the rectum, than anteriorly. Fifteen percent of all treatments were interrupted for repositioning, and 70% of patients were repositioned at least once during their treatment course. Conclusion: Set-up errors and motion of the prostatic fossa during radiotherapy are nontrivial, leading to potential undertreatment of target and excess normal tissue toxicity if not taken into account during treatment planning. Localization and real-time tracking of the prostate bed via implanted Calypso transponders can be used to improve the accuracy of plan delivery.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2012

Dosimetric Impact of Breathing Motion in Lung Stereotactic Body Radiotherapy Treatment Using Image-Modulated Radiotherapy and Volumetric Modulated Arc Therapy

Purpose: The objective of this study was to investigate the influence of tumor motion on dose delivery in stereotactic body radiotherapy (SBRT) for lung cancer, using fixed field intensity- modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT). Methods and Materials: For each of 10 patients with stage I/II non-small-cell pulmonary tumors, a respiration-correlated four-dimensional computed tomography (4DCT) study was carried out. The internal target volume was delineated on the maximum intensity projection CT, which was reconstructed from the 4DCT dataset. A 5-mm margin was used for generation of the planning target volume. VMAT and five-field IMRT plans were generated using Pinnacle{sup 3} SmartArc and direct machine parameter optimization, respectively. All plans were generated for an Elekta Synergy linear accelerator using 6-MV photons. Simulation was performed to study the interplay between multileaf collimator (MLC) sequences and target movement during the delivery of VMAT and IMRT. For each plan, 4D dose was calculated using deformable image registration of the 4DCT images. Target volume coverage and doses to critical structures calculated using 4D methodology were compared with those calculated using 3D methodology. Results: For all patients included in this study, the interplay effect was found to present limited impact (less than 1% of prescription) on the target dose distribution, especially for SBRT, in which fewer fractions (three fractions) are delivered. Dose to the gross tumor volume (GTV) was, on average, slightly decreased (1% of prescription) in the 4D calculation compared with the 3D calculation. The motion impact on target dose homogeneity was patient-dependent and relatively small. Conclusions: Both VMAT and IMRT plans experienced negligible interplay effects between MLC sequence and tumor motion. For the most part, the 3D doses to the GTV and critical structures provided good approximations of the 4D dose calculations.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2013

Prostate and Patient Intrafraction Motion: Impact on Treatment Time-Dependent Planning Margins for Patients With Endorectal Balloon

Purpose: To investigate intrafraction prostate and patient motion during different radiation therapy treatments as a function of treatment time; included were prostate patients with an endorectal balloon (ERB). Margins accounting for setup uncertainties and intrafraction motion were determined. Methods and Materials: The study included 17 patients undergoing prostate cancer radiation therapy. All patients received 3 fiducial gold markers implanted in the prostate and were then immobilized in the supine position with a knee support and treated with an ERB. Twelve patients with intermediate risk for pelvic lymph node metastases received intensity modulated radiation therapy (IMRT), and 5 patients at low risk received a 4-field box treatment. After setup based on skin marks, patients were imaged with a stereoscopic imaging system. If the marker displacement exceeded a 3-mm tolerance relative to planning computed tomography, patients were shifted and verification images were taken. All patients underwent additional imaging after treatment; IMRT patients also received additional imaging at halftime of treatment. Prostate and bone drifts were evaluated as a function of treatment time for more than 600 fractions, and margins were extracted. Results: Patient motion evaluated by bone match was strongly patient dependent but in general was smallest in the superior-inferior (SI) direction. Prostate drifts were less patient dependent, showing an increase with treatment time in the SI and anterior-posterior (AP) directions. In the lateral (LAT) direction, the prostate stayed rather stable. Mean treatment times were 5.5 minutes for 4-field box, 10 minutes for 5-field boost IMRT, and 15 minutes or more for 9-field boost and 9-field pelvic IMRT treatments. Margins resulted in 2.2 mm, 3.9 mm, and 4.3 mm for 4-field box; 3.7 mm, 2.6 mm, and 3.6 mm for 5-field boost IMRT; 2.3 mm, 3.9 mm, and 6.2 mm for 9-field boost IMRT; and 4.2 mm, 5.1 mm, and 6.6 mm for 9-field pelvic IMRT in the LAT, SI, and AP directions, respectively. Conclusion: Intrafraction prostate and patient displacement increased with treatment time, showing different behaviors for the single directions of movement. Repositioning of the patients during long treatments or shorter treatment times will be necessary to further reduce the treatment margin.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2015

Six Degrees-of-Freedom Prostate and Lung Tumor Motion Measurements Using Kilovoltage Intrafraction Monitoring

Purpose: Tumor positional uncertainty has been identified as a major issue that deteriorates the efficacy of radiation therapy. Tumor rotational movement, which is not well understood, can result in significant geometric and dosimetric inaccuracies. The objective of this study was to measure 6 degrees-of-freedom (6 DoF) prostate and lung tumor motion, focusing on the more novel rotation, using kilovoltage intrafraction monitoring (KIM). Methods and Materials: Continuous kilovoltage (kV) projections of tumors with gold fiducial markers were acquired during radiation therapy for 267 fractions from 10 prostate cancer patients and immediately before or after radiation therapy for 50 fractions from 3 lung cancer patients. The 6 DoF motion measurements were determined from the individual 3-dimensional (3D) marker positions, after using methods to reject spurious and smooth noisy data, using an iterative closest point algorithm. Results: There were large variations in the magnitude of the tumor rotation among different fractions and patients. Various rotational patterns were observed. The average prostate rotation angles around the left-right (LR), superior-inferior (SI), and anterior-posterior (AP) axes were 1.0 ± 5.0°, 0.6 ± 3.3°, and 0.3 ± 2.0°, respectively. For 35% of the time, the prostate rotated more than 5° about the LR axis, indicating the need for intrafractional adaptation during radiation delivery. For lung patients, the average LR, SI, and AP rotation angles were 0.8 ± 4.2°, −0.8 ± 4.5°, and 1.7 ± 3.1°, respectively. For about 30% of the time, the lung tumors rotated more than 5° around the SI axis. Respiration-induced rotation was detected in 2 of the 3 lung patients. Conclusions: The prostate and lung tumors were found to undergo rotations of more than 5° for about a third of the time. The lung tumor data represent the first 6 DoF tumor motion measured by kV images. The 6 DoF KIM method can enable rotational and translational adaptive radiation therapy and potentially reduce treatment margins.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2015

Continuous Positive Airway Pressure for Motion Management in Stereotactic Body Radiation Therapy to the Lung: A Controlled Pilot Study

Objective: To determine the effect of continuous positive airway pressure (CPAP) on tumor motion, lung volume, and dose to critical organs in patients receiving stereotactic body radiation therapy (SBRT) for lung tumors. Methods and Materials: After institutional review board approval in December 2013, patients with primary or secondary lung tumors referred for SBRT underwent 4-dimensional computed tomographic simulation twice: with free breathing and with CPAP. Tumor excursion was calculated by subtracting the vector of the greatest dimension of the gross tumor volume (GTV) from the internal target volume (ITV). Volumetric and dosimetric determinations were compared with the Wilcoxon signed-rank test. CPAP was used during treatment if judged beneficial. Results: CPAP was tolerated well in 10 of the 11 patients enrolled. Ten patients with 18 lesions were evaluated. The use of CPAP decreased tumor excursion by 0.5 ± 0.8 cm, 0.4 ± 0.7 cm, and 0.6 ± 0.8 cm in the superior–inferior, right–left, and anterior–posterior planes, respectively (P≤.02). Relative to free breathing, the mean ITV reduction was 27% (95% confidence interval [CI] 16%-39%, P<.001). CPAP significantly augmented lung volume, with a mean absolute increase of 915 ± 432 cm{sup 3} and a relative increase of 32% (95% CI 21%-42%, P=.003), contributing to a 22% relative reduction (95% CI 13%-32%, P=.001) in mean lung dose. The use of CPAP was also associated with a relative reduction in mean heart dose by 29% (95% CI 23%-36%, P=.001). Conclusion: In this pilot study, CPAP significantly reduced lung tumor motion compared with free breathing. The smaller ITV, the planning target volume (PTV), and the increase in total lung volume associated with CPAP contributed to a reduction in lung and heart dose. CPAP was well tolerated, reproducible, and simple to implement in the treatment room and should be evaluated further as a novel strategy for motion management in radiation therapy.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2016

Kilovoltage Imaging of Implanted Fiducials to Monitor Intrafraction Motion With Abdominal Compression During Stereotactic Body Radiation Therapy for Gastrointestinal Tumors

Purpose: To assess intrafraction respiratory motion using a commercial kilovoltage imaging system for abdominal tumor patients with implanted fiducials and breathing constrained by pneumatic compression during stereotactic body radiation therapy (SBRT). Methods and Materials: A pneumatic compression belt limited respiratory motion in 19 patients with radiopaque fiducials in or near their tumor during SBRT for abdominal tumors. Kilovoltage images were acquired at 5- to 6-second intervals during treatment using a commercial system. Intrafractional fiducial displacements were measured using in-house software. The dosimetric effect of the observed displacements was calculated for 3 sessions for each patient. Results: Intrafraction displacement patterns varied between patients and between individual treatment sessions. Averaged over 19 patients, 73 sessions, 7.6% of craniocaudal displacements exceeded 0.5 cm, and 1.2% exceeded 0.75 cm. The calculated single-session dose to 95% of gross tumor volume differed from planned by an average of −1.2% (range, −11.1% to 4.8%) but only for 4 patients was the total 3-session calculated dose to 95% of gross tumor volume more than 3% different from planned. Conclusions: Our pneumatic compression limited intrafractional abdominal target motion, maintained target position established at setup, and was moderately effective in preserving coverage. Commercially available intrafractional imaging is useful for surveillance but can be made more effective and reliable.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2016

Intrafraction Motion in Stereotactic Body Radiation Therapy for Non-Small Cell Lung Cancer: Intensity Modulated Radiation Therapy Versus Volumetric Modulated Arc Therapy

Purpose: Stereotactic body radiation therapy (SBRT) for early-stage inoperable non-small cell lung cancer (NSCLC) patients delivers high doses that require high-precision treatment. Typically, image guidance is used to minimize day-to-day target displacement, but intrafraction position variability is often not corrected. Currently, volumetric modulated arc therapy (VMAT) is replacing intensity modulated radiation therapy (IMRT) in many departments because of its shorter delivery time. This study aimed to evaluate whether intrafraction variation in VMAT patients is reduced in comparison with patients treated with IMRT. Methods and Materials: NSCLC patients (197 IMRT and 112 VMAT) treated with a frameless SBRT technique to a prescribed dose of 3 × 18 Gy were evaluated. Image guidance for both techniques was identical: pretreatment cone beam computed tomography (CBCT) (CBCT{sub precorr}) for setup correction followed immediately before treatment by postcorrection CBCT (CBCT{sub postcorr}) for verification. Then, after either a noncoplanar IMRT technique or a VMAT technique, a posttreatment (CBCT{sub postRT}) scan was acquired. The CBCT{sub postRT} and CBCT{sub postcorr} scans were then used to evaluate intrafraction motion. Treatment delivery times, systematic (Σ) and random (σ) intrafraction variations, and associated planning target volume (PTV) margins were calculated. Results: The median treatment delivery time was significantly reduced by 20 minutes (range, 32-12 minutes) using VMAT compared with noncoplanar IMRT. Intrafraction tumor motion was significantly larger for IMRT in all directions up to 0.5 mm systematic (Σ) and 0.7 mm random (σ). The required PTV margins for IMRT and VMAT differed by less than 0.3 mm. Conclusion: VMAT-based SBRT for NSCLC was associated with significantly shorter delivery times and correspondingly smaller intrafraction motion compared with noncoplanar IMRT. However, the impact on the required PTV margin was small.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2016

Assessment of Intrafraction Breathing Motion on Left Anterior Descending Artery Dose During Left-Sided Breast Radiation Therapy

Purpose: To use 4-dimensional computed tomography (4D-CT) imaging to predict the level of uncertainty in cardiac dose estimates of the left anterior descending artery that arises due to breathing motion during radiation therapy for left-sided breast cancer. Methods and Materials: The fast helical CT (FH-CT) and 4D-CT of 30 left-sided breast cancer patients were retrospectively analyzed. Treatment plans were created on the FH-CT. The original treatment plan was then superimposed onto all 10 phases of the 4D-CT to quantify the dosimetric impact of respiratory motion through 4D dose accumulation (4D-dose). Dose-volume histograms for the heart, left ventricle (LV), and left anterior descending (LAD) artery obtained from the FH-CT were compared with those obtained from the 4D-dose. Results: The 95% confidence interval of 4D-dose and FH-CT differences in mean dose estimates for the heart, LV, and LAD were ±0.5 Gy, ±1.0 Gy, and ±8.7 Gy, respectively. Conclusion: Fast helical CT is a good approximation for doses to the heart and LV; however, dose estimates for the LAD are susceptible to uncertainties that arise due to intrafraction breathing motion that cannot be ascertained without the additional information obtained from 4D-CT and dose accumulation. For future clinical studies, we suggest the use of 4D-CT–derived dose-volume histograms for estimating the dose to the LAD.

62 RADIOLOGY AND NUCLEAR MEDICINE↗