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Acquisition, preprocessing, and reconstruction of ultralow dose volumetric CT scout for organ-based CT scan planning

Purpose: Traditionally, 2D radiographic preparatory scan images (scout scans) are used to plan diagnostic CT scans. However, a 3D CT volume with a full 3D organ segmentation map could provide superior information for customized scan planning and other purposes. A practical challenge is to design the volumetric scout acquisition and processing steps to provide good image quality (at least good enough to enable 3D organ segmentation) while delivering a radiation dose similar to that of the conventional 2D scout. Methods: The authors explored various acquisition methods, scan parameters, postprocessing methods, and reconstruction methods through simulation and cadaver data studies to achieve an ultralow dose 3D scout while simultaneously reducing the noise and maintaining the edge strength around the target organ. Results: In a simulation study, the 3D scout with the proposed acquisition, preprocessing, and reconstruction strategy provided a similar level of organ segmentation capability as a traditional 240 mAs diagnostic scan, based on noise and normalized edge strength metrics. At the same time, the proposed approach delivers only 1.25% of the dose of a traditional scan. In a cadaver study, the authors’ pictorial-structures based organ localization algorithm successfully located the major abdominal-thoracic organs from the ultralow dose 3D scout obtained with the proposed strategy. Conclusions: The authors demonstrated that images with a similar degree of segmentation capability (interpretability) as conventional dose CT scans can be achieved with an ultralow dose 3D scout acquisition and suitable postprocessing. Furthermore, the authors applied these techniques to real cadaver CT scans with a CTDI dose level of less than 0.1 mGy and successfully generated a 3D organ localization map.

60 APPLIED LIFE SCIENCES↗

Assessment of radiation dose in nuclear cardiovascular imaging using realistic computational models

Purpose: Nuclear cardiology plays an important role in clinical assessment and has enormous impact on the management of a variety of cardiovascular diseases. Pediatric patients at different age groups are exposed to a spectrum of radiation dose levels and associated cancer risks different from those of adults in diagnostic nuclear medicine procedures. Therefore, comprehensive radiation dosimetry evaluations for commonly used myocardial perfusion imaging (MPI) and viability radiotracers in target population (children and adults) at different age groups are highly desired. Methods: Using Monte Carlo calculations and biological effects of ionizing radiation VII model, we calculate the S-values for a number of radionuclides (Tl-201, Tc-99m, I-123, C-11, N-13, O-15, F-18, and Rb-82) and estimate the absorbed dose and effective dose for 12 MPI radiotracers in computational models including the newborn, 1-, 5-, 10-, 15-yr-old, and adult male and female computational phantoms. Results: For most organs, {sup 201}Tl produces the highest absorbed dose whereas {sup 82}Rb and {sup 15}O-water produce the lowest absorbed dose. For the newborn baby and adult patient, the effective dose of {sup 82}Rb is 48% and 77% lower than that of {sup 99m}Tc-tetrofosmin (rest), respectively. Conclusions: {sup 82}Rb results in lower effective dose in adults compared to {sup 99m}Tc-labeled tracers. However, this advantage is less apparent in children. The produced dosimetric databases for various radiotracers used in cardiovascular imaging, using new generation of computational models, can be used for risk-benefit assessment of a spectrum of patient population in clinical nuclear cardiology practice.

60 APPLIED LIFE SCIENCES↗

Experimental depth dose curves of a 67.5 MeV proton beam for benchmarking and validation of Monte Carlo simulation

Purpose: To measure depth dose curves for a 67.5 ± 0.1 MeV proton beam for benchmarking and validation of Monte Carlo simulation. Methods: Depth dose curves were measured in 2 beam lines. Protons in the raw beam line traversed a Ta scattering foil, 0.1016 or 0.381 mm thick, a secondary emission monitor comprised of thin Al foils, and a thin Kapton exit window. The beam energy and peak width and the composition and density of material traversed by the beam were known with sufficient accuracy to permit benchmark quality measurements. Diodes for charged particle dosimetry from two different manufacturers were used to scan the depth dose curves with 0.003 mm depth reproducibility in a water tank placed 300 mm from the exit window. Depth in water was determined with an uncertainty of 0.15 mm, including the uncertainty in the water equivalent depth of the sensitive volume of the detector. Parallel-plate chambers were used to verify the accuracy of the shape of the Bragg peak and the peak-to-plateau ratio measured with the diodes. The uncertainty in the measured peak-to-plateau ratio was 4%. Depth dose curves were also measured with a diode for a Bragg curve and treatment beam spread out Bragg peak (SOBP) on the beam line used for eye treatment. The measurements were compared to Monte Carlo simulation done with GEANT4 using TOPAS. Results: The 80% dose at the distal side of the Bragg peak for the thinner foil was at 37.47 ± 0.11 mm (average of measurement with diodes from two different manufacturers), compared to the simulated value of 37.20 mm. The 80% dose for the thicker foil was at 35.08 ± 0.15 mm, compared to the simulated value of 34.90 mm. The measured peak-to-plateau ratio was within one standard deviation experimental uncertainty of the simulated result for the thinnest foil and two standard deviations for the thickest foil. It was necessary to include the collimation in the simulation, which had a more pronounced effect on the peak-to-plateau ratio for the thicker foil. The treatment beam, being unfocussed, had a broader Bragg peak than the raw beam. A 1.3 ± 0.1 MeV FWHM peak width in the energy distribution was used in the simulation to match the Bragg peak width. An additional 1.3–2.24 mm of water in the water column was required over the nominal values to match the measured depth penetration. Conclusions: The proton Bragg curve measured for the 0.1016 mm thick Ta foil provided the most accurate benchmark, having a low contribution of proton scatter from upstream of the water tank. The accuracy was 0.15% in measured beam energy and 0.3% in measured depth penetration at the Bragg peak. The depth of the distal edge of the Bragg peak in the simulation fell short of measurement, suggesting that the mean ionization potential of water is 2–5 eV higher than the 78 eV used in the stopping power calculation for the simulation. The eye treatment beam line depth dose curves provide validation of Monte Carlo simulation of a Bragg curve and SOBP with 4%/2 mm accuracy.

60 APPLIED LIFE SCIENCES↗

SU-D-201-02: Prediction of Delivered Dose Based On a Joint Histogram of CT and FDG PET Images

Purpose: To investigate whether pre-treatment images can be used in predicting microsphere distribution in tumors. When intra-arterial radioembolization using Y90 microspheres was performed, the microspheres were often delivered non-uniformly within the tumor, which could lead to an inefficient therapy. Therefore, it is important to estimate the distribution of microspheres. Methods: Early arterial phase CT and FDG PET images were acquired for patients with primary liver cancer prior to radioembolization (RE) using Y90 microspheres. Tumor volume was delineated on CT images and fused with FDG PET images. From each voxel (3.9×3.9×3.3 mm3) in the tumor, the Hounsfield unit (HU) from the CT and SUV values from the FDG PET were harvested. We binned both HU and SUV into 11 bins and then calculated a normalized joint-histogram in an 11×11 array.Patients also underwent a post-treatment Y90 PET imaging. Radiation dose for the tumor was estimated using convolution of the Y90 distribution with a dose-point kernel. We also calculated a fraction of the tumor volume that received a radiation dose great than 100Gy. Results: Averaged over 40 patients, 55% of tumor volume received a dose greater than 100Gy (range : 1.1 – 100%). The width of the joint histogram was narrower for patients with a high dose. For patients with a low dose, the width was wider and a larger fraction of tumor volume had low HU. Conclusion: We have shown the pattern of joint histogram of the HU and SUV depends on delivered dose. The patterns can predict the efficacy of uniform intra-arterial delivery of Y90 microspheres.

60 APPLIED LIFE SCIENCES↗

SU-E-P-11: Comparison of Image Quality and Radiation Dose Between Different Scanner System in Routine Abdomen CT

Purpose To evaluate image quality and radiation dose of routine abdomen computed tomography exam with the automatic current modulation technique (ATCM) performed in two different brand 64-slice CT scanners in our site. Materials and Methods A retrospective review of routine abdomen CT exam performed with two scanners; scanner A and scanner B in our site. To calculate standard deviation of the portal hepatic level with a region of interest of 12.5 mm x 12.5mm represented to the image noise. The radiation dose was obtained from CT DICOM image information. Using Computed tomography dose index volume (CTDIv) to represented CT radiation dose. The patient data in this study were with normal weight (about 65–75 Kg). Results The standard deviation of Scanner A was smaller than scanner B, the scanner A might with better image quality than scanner B. On the other hand, the radiation dose of scanner A was higher than scanner B(about higher 50–60%) with ATCM. Both of them, the radiation dose was under diagnostic reference level. Conclusion The ATCM systems in modern CT scanners can contribute a significant reduction in radiation dose to the patient. But the reduction by ATCM systems from different CT scanner manufacturers has slightly variation. Whatever CT scanner we use, it is necessary to find the acceptable threshold of image quality with the minimum possible radiation exposure to the patient in agreement with the ALARA principle.

60 APPLIED LIFE SCIENCES↗

SU-E-I-34: Evaluating Use of AEC to Lower Dose for Lung Cancer Screening CT Protocols

Purpose: The National Lung Screening Trial mandated manual low dose CT technique factors, where up to a doubling of radiation output could be used over a regular to large patient size range. Recent guidance from the AAPM and ACR for lung cancer CT screening recommends radiation output adjustment for patient size either through AEC or a manual technique chart. This study evaluated the use of AEC for output control and dose reduction. Methods: The study was performed on a multidetector helical CT scanner (Aquillion ONE, Toshiba Medical) equipped with iterative reconstruction (ADIR-3D), AEC was adjusted with a standard deviation (SD) image quality noise index. The protocol SD parameter was incrementally increased to reduce patient population dose while image quality was evaluated by radiologist readers scoring the clinical utility of images on a Likert scale. Results: Plots of effective dose vs. body size (water cylinder diameter reported by the scanner) demonstrate monotonic increase in patient dose with increasing patient size. At the initial SD setting of 19 the average CTDIvol for a standard size patient was ∼ 2.0 mGy (1.2 mSv effective dose). This was reduced to ∼1.0 mGy (0.5 mSv) at an SD of 25 with no noticeable reduction in clinical utility of images as demonstrated by Likert scoring. Plots of effective patient diameter and BMI vs body size indicate that these metrics could also be used for manual technique charts. Conclusion: AEC offered consistent and reliable control of radiation output in this study. Dose for a standard size patient was reduced to one-third of the 3 mGy CTDIvol limit required for ACR accreditation of lung cancer CT screening. Gary Arbique: Research Grant, Toshiba America Medical Systems; Cecelia Brewington: Research Grant, Toshiba America Medical Systems; Di Zhang: Employee, Toshiba America Medical Systems.

60 APPLIED LIFE SCIENCES↗

SU-E-I-37: Eye Lens Dose Reduction From CT Scan Using Organ Based Tube Current Modulation

Purpose: To investigate the eye lens dose reduction by CT scan with organ based tube current modulation (OBTCM) using GPU Monte Carlo code ARCHER-CT. Methods: 36 X-ray sources and bowtie filters were placed around the patient head with the projection angle interval of 10° for one rotation of CT scan, each projection was simulated respectively. The voxel eye models with high resolution(0.1mm*0.1mm*0.1mm) were used in the simulation and different tube voltage including 80kVp, 100kVp, 120kVp and 140kVp were taken into consideration. Results: The radiation doses to the eye lens increased with the tube voltage raised from 80kVp to 140kVp, and the dose results from 0° (AP) direction are much higher than those from 180° (PA) direction for all the 4 different tube voltage investigated. This 360° projection dose characteristic enables organ based TCM, which can reduce the eye lens dose by more than 55%. Conclusion: As the eye lens belongs to superficial tissues, its radiation dose to external exposure like CT is direction sensitive, and this characteristic feature makes organ based TCM to be an effective way to reduce the eye lens dose, so more clinical use of this technique were recommended. National Nature Science Foundation of China(No.11475047)

60 APPLIED LIFE SCIENCES↗

SU-E-I-85: Absorbed Dose Estimation for a Commercially Available MicroCT Scanner

Purpose: To quantify the simulated absorbed dose delivered for a typical scan from a commercially available microCT scanner in order to aid in the dose estimation. Methods: The simulations were conducted using the Geant4 Monte Carlo Toolkit (version 10) with the standard electromagnetic classes. The Quantum FX microCT scanner (PerkinElmer, Waltham, MA) was modeled incorporating the energy fluence and angular distributions of generated photons, spatial dimensions of nominal source-to-object and source-to-detector distances. The energy distribution was measured using a spectrometer (X-123CdTe, Amptek Inc., Bedford, USA) with a 300 angular spread from the source for the 90 kVp X-ray beams with no additional filtration. The nominal distances from the source to object consisted of three setups: 154.0 mm, 104.0 mm, and 51.96 mm. Our simulations recorded the dose absorbed in a cylindrical phantom of PMMA with a fixed length of 2 cm and varying radii (10, 20, 30 and 40 mm) using 100 million incident photons. The averaged absorbed dose in the object was then quantified for all setups. An exposure measurement of 417 mR was taken using a Radcal 9095 system utilizing 10×9–180 ion chamber with the given technique of 90 kVp, 63 μA, and 12 s. The exposure rate was also simulated with same setup to calculate the conversion factor of the beam current and the number of incident photons. Results: For a typical cone-beam scan with non-filtered 90kVp, the dose coefficients (the absorbed dose per mAs) were 2.614, 2.549 and 2.467 μGy/mAs under source to object distance of 104 mm for the object diameters of 10 mm, 20 mm and 30 mm, respectively. Conclusion: A look-up table was developed where an investigator can estimate the delivered dose using this particular microCT given the scanning protocol (kVp and mAs) as well as the size of the scanned object.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗

SU-E-J-10: Imaging Dose and Cancer Risk in Image-Guided Radiotherapy of Cancers

Purpose: To systematically evaluate imaging doses and cancer risks to organs-at-risk as a Result of cumulative doses from various radiological imaging procedures in image-guided radiotherapy (IGRT) in a large cohort of cancer patients. Methods: With IRB approval, imaging procedures (computed tomography, kilo-voltage portal imaging, megavoltage portal imaging and kilo-voltage cone-beam computed tomography) of 4832 cancer patients treated during 4.5 years were collected with their gender, age and circumference. Correlations between patient’s circumference and Monte Carlo simulated-organ dose were applied to estimate organ doses while the cancer risks were reported as 1+ERR using BEIR VII models. Results: 80 cGy or more doses were deposited to brain, lungs and RBM in 273 patients (maximum 136, 278 and 267 cGy, respectively), due largely to repetitive imaging procedures and non-personalized imaging settings. Regardless of gender, relative cancer risk estimates for brain, lungs, and RBM were 3.4 (n = 55), 2.6 (n = 49), 1.8 (n = 25) for age group of 0–19; 1.2 (n = 87), 1.4 (n = 98), 1.3 (n = 51) for age group of 20–39; 1.0 (n = 457), 1.1 (n = 880), 1.8 (n=360) for age group of 40–59; 1.0 (n = 646), 1.1 (n = 1400), 2.3 (n = 716) for age group of 60–79 and 1.0 (n = 108),1.1 (n = 305),1.6 (n = 147) for age group of 80–99. Conclusion: The cumulative imaging doses and associated cancer risks from multi-imaging procedures were patient-specific and site-dependent, with up to 2.7 Gy imaging dose deposited to critical structures in some pediatric patients. The associated cancer risks in brain and lungs for children of age 0 to 19 were 2–3 times larger than those for adults. This study indicated a pressing need for personalized imaging protocol to maximize its clinical benefits while reducing associated cancer risks. Sichuan University Scholarship.

60 APPLIED LIFE SCIENCES↗

SU-E-J-83: CBCT Based Rectum and Bladder Dose Tracking in the Prostate Radiotherapy

Purpose: The aim of this study is to monitor the volume changes of bladder and rectum and evaluate the dosimetric changes of bladder and rectum using daily cone-beam CT for prostate radiotherapy. Methods: The data of this study were obtained from 12 patients, totally 222 CBCTs. All the volume of the bladder and the rectum on the CBCT were normalized to the bladder and the rectum on their own original CT to monitory the volume changes. To evaluate dose delivered to the OARs, volumes that receive 70Gy (V70Gy), 60Gy, 50Gy, 40Gy and 30Gy are calculated for the bladder and the rectum, V20Gy and V10Gy for rectum additionally. And the deviation of the mean dose to the bladder and the rectum are also chosen as the evaluation parameter. Linear regression analysis was performed to identify the mean dose change of the volume change using SPSS 19. Results: The results show that the variances of the normalize volume of the bladder and the rectum are 0.15–0.58 and 0.13–0.50. The variances of V70Gy, V60Gy, V50Gy, V40Gy and V30Gy of bladder are bigger than rectum for 11 patients. The linear regression analysis indicated a negative correlation between the volume and the mean dose of the bladder (p < 0.05). A 10% increase in bladder volume will cause 5.1% (±4.3%) reduction in mean dose. Conclusion: The bladder volume change is more significant than that for rectum for the prostate cancer patient. The volume changes of rectum are not significant except air gap in the rectum. Bladder volume varies will cause significant dose change. The bladder volume monitoring before fractional treatment delivery would be crucial for accuracy dose delivery.

60 APPLIED LIFE SCIENCES↗

SU-E-T-49: A Multi-Institutional Study of Independent Dose Verification for IMRT

Purpose: AAPM TG114 does not cover the independent verification for IMRT. We conducted a study of independent dose verification for IMRT in seven institutes to show the feasibility. Methods: 384 IMRT plans in the sites of prostate and head and neck (HN) were collected from the institutes, where the planning was performed using Eclipse and Pinnacle3 with the two techniques of step and shoot (S&S) and sliding window (SW). All of the institutes used a same independent dose verification software program (Simple MU Analysis: SMU, Triangle Product, Ishikawa, JP), which is Clarkson-based and CT images were used to compute radiological path length. An ion-chamber measurement in a water-equivalent slab phantom was performed to compare the doses computed using the TPS and an independent dose verification program. Additionally, the agreement in dose computed in patient CT images between using the TPS and using the SMU was assessed. The dose of the composite beams in the plan was evaluated. Results: The agreement between the measurement and the SMU were −2.3±1.9 % and −5.6±3.6 % for prostate and HN sites, respectively. The agreement between the TPSs and the SMU were −2.1±1.9 % and −3.0±3.7 for prostate and HN sites, respectively. There was a negative systematic difference with similar standard deviation and the difference was larger in the HN site. The S&S technique showed a statistically significant difference between the SW. Because the Clarkson-based method in the independent program underestimated (cannot consider) the dose under the MLC. Conclusion: The accuracy would be improved when the Clarkson-based algorithm should be modified for IMRT and the tolerance level would be within 5%.

60 APPLIED LIFE SCIENCES↗

SU-E-T-62: A Preliminary Experience of Using EPID Transit Dosimetry for Monitoring Daily Dose Variations in Radiation Treatment Delivery

Purpose: To investigate the use of EPID transit dosimetry for monitoring daily dose variations in radiation treatment delivery. Methods: A patient with head and neck cancer treated using nine field IMRT beams was used in this study. The prescription was 45 Gy in 25 fractions. A KV CBCT was acquired before each treatment on a Varian NTX linear accelerator. Integrated images using MV EPID were acquired for each treatment beam. Planning CT images, treatment plan, and daily integrated images were imported into a commercial QA software Dosimetry Check (v4r4 Math Resolutions, LLC, Columbia, MD) to calculate 3D dose of the day assuming 25 fractions treatment. Planning CT images were deformed and registered to each daily CBCT using Varian SmartAdapt (v11.MR2). ROIs were then propagated from planning CT to daily CBCT. The correlation between maximum, average dose of ROIs and ROI volume, center of mass shift, Dice Similarity Coefficient (DSC) were investigated. Results: Not all parameters investigated showed strong correlations. For PTV and CTV, the average dose has inverse correlation with their volume change (correlation coefficient −0.52, −0.50, respectively) and DSC (−0.59, −0.59, respectively). The average dose of right parotid has correlation with its volume change (0.56). The maximum dose of spinal cord has correlation with the center of mass superior-inferior shift (0.52) and inverse correlation with the center of mass anterior-posterior shift (−0.73). Conclusion: Transit dosimetry using EPID images collected during treatment delivery offers great potential to monitor daily dose variations due to patient anatomy change, motion, and setup errors in radiation treatment delivery. It can provide a patient-specific QA tool valuable for adaptive radiation therapy. Further work is needed to validate the technique.

60 APPLIED LIFE SCIENCES↗

SU-E-T-223: Computed Radiography Dose Measurements of External Radiotherapy Beams

Purpose: To obtain quantitative, two-dimensional dose measurements of external radiotherapy beams with a computed radiography (CR) system and to derive volume correction factors for ionization chambers in small fields. Methods: A commercial Kodak ACR2000i CR system with Kodak Flexible Phosphor Screen HR storage foils was used. Suitable measurement conditions and procedures were established. Several corrections were derived, including image fading, length-scale corrections and long-term stability corrections. Dose calibration curves were obtained for cobalt, 4 MV, 8 MV and 25 MV photons, and for 10 MeV, 15 MeV and 18 MeV electrons in a water phantom. Inherent measurement inhomogeneities were studied as well as directional dependence of the response. Finally, 2D scans with ionization chambers were directly compared to CR measurements, and volume correction factors were derived. Results: Dose calibration curves (0.01 Gy to 7 Gy) were obtained for multiple photon and electron beam qualities. For each beam quality, the calibration curves can be described by a single fit equation over the whole dose range. The energy dependence of the dose response was determined. The length scale on the images was adjusted scan-by-scan, typically by 2 percent horizontally and by 3 percent vertically. The remaining inhomogeneities after the system’s standard calibration procedure were corrected for. After correction, the homogeneity is on the order of a few percent. The storage foils can be rotated by up to 30 degrees without a significant effect on the measured signal. First results on the determination of volume correction factors were obtained. Conclusion: With CR, quantitative, two-dimensional dose measurements with a high spatial resolution (sub-mm) can be obtained over a large dose range. In order to make use of these advantages, several calibrations, corrections and supporting measurements are needed. This work was funded by the European Metrology Research Programme (EMRP) project HLT09 MetrExtRT Metrology for Radiotherapy using Complex Radiation Fields.

60 APPLIED LIFE SCIENCES↗

SU-E-T-265: Development of Dose-To-Water Conversion Models for Pre-Treatment Verification with the New AS1200 Imager

Purpose: To develop and evaluate models for dose verification of flattened (FF) and flattening filter free (FFF) beams for the new Varian aS1200 backscatter-shielded electronic portal imaging device (EPID). Methods: The model converts EPID images to incident energy fluence using deconvolution of EPID scatter kernels and fluence to dose in water using convolution with dose-to-water kernels. Model parameters were optimized using non-transmission EPID images of varying jaw defined field sizes for energies of 6 and 10 MV FF and FFF beams. Energy fluence was obtained from the Acuros planning system and reference dose profiles and output factors were measured at depths of 5, 10, 15 and 20 cm in a water phantom. Images for 34 IMRT fields acquired at 6 and 10 MV FF energy were converted to dose at 10 cm depth in water and compared to treatment planning system dose plane calculations using gamma criteria. Results: Gamma evaluations for the IMRT fields had mean (1 standard deviation) pass rates of 99.4% (0.8%) and mean gamma scores of 0.32 (0.06) with 2%, 2 mm criteria and 10% of maximum dose threshold. Conclusion: The developed model has been shown to be highly accurate for pre-treatment verification with the new aS1200 imager which does not display support-arm backscatter artefact and has improved dosimetric properties. Further investigation of FFF modes is in progress. The model is currently being evaluated at sites for potential clinical release.

60 APPLIED LIFE SCIENCES↗

SU-E-T-339: Dosimetric Verification of Acuros XB Dose Calculation Algorithm On An Air Cavity for 6-MV Flattening Filter-Free Beam

Purpose: This study was to verify the accuracy of Acuros XB (AXB) dose calculation algorithm on an air cavity for a single radiation field using 6-MV flattening filter-free (FFF) beam. Methods: A rectangular slab phantom containing an air cavity was made for this study. The CT images of the phantom for dose calculation were scanned with and without film at measurement depths (4.5, 5.5, 6.5 and 7.5 cm). The central axis doses (CADs) and the off-axis doses (OADs) were measured by film and calculated with Analytical Anisotropic Algorithm (AAA) and AXB for field sizes ranging from 2 Χ 2 to 5 Χ 5 cm{sup 2} of 6-MV FFF beams. Both algorithms were divided into AXB-w and AAA -w when included the film in phantom for dose calculation, and AXB-w/o and AAA-w/o in calculation without film. The calculated OADs for both algorithms were compared with the measured OADs and difference values were determined using root means squares error (RMSE) and gamma evaluation. Results: The percentage differences (%Diffs) between the measured and calculated CAD for AXB-w was most agreement than others. Compared to the %Diff with and without film, the %Diffs with film were decreased than without within both algorithms. The %Diffs for both algorithms were reduced with increasing field size and increased relative to the depth increment. RMSEs of CAD for AXB-w were within 10.32% for both inner-profile and penumbra, while the corresponding values of AAA-w appeared to 96.50%. Conclusion: This study demonstrated that the dose calculation with AXB within air cavity shows more accurate than with AAA compared to the measured dose. Furthermore, we found that the AXB-w was superior to AXB-w/o in this region when compared against the measurements.

60 APPLIED LIFE SCIENCES↗

SU-E-T-355: Efficient Scatter Correction for Direct Ray-Tracing Based Dose Calculation

Purpose: To propose a scatter correction method with linear computational complexity for direct-ray-tracing (DRT) based dose calculation. Due to its speed and simplicity, DRT is widely used as a dose engine in the treatment planning system (TPS) and monitor unit (MU) verification software, where heterogeneity correction is applied by radiological distance scaling. However, such correction only accounts for attenuation but not scatter difference, causing the DRT algorithm less accurate than the model-based algorithms for small field size in heterogeneous media. Methods: Inspired by the convolution formula derived from an exponential kernel as is typically done in the collapsed-cone-convolution-superposition (CCCS) method, we redesigned the ray tracing component as the sum of TERMA scaled by a local deposition factor, which is linear with respect to density, and dose of the previous voxel scaled by a remote deposition factor, D(i)=aρ(i)T(i)+(b+c(ρ(i)-1))D(i-1),where T(i)=e(-αr(i)+β(r(i))2) and r(i)=Σ-(j=1,..,i)ρ(j).The two factors together with TERMA can be expressed in terms of 5 parameters, which are subsequently optimized by curve fitting using digital phantoms for each field size and each beam energy. Results: The proposed algorithm was implemented for the Fluence-Convolution-Broad-Beam (FCBB) dose engine and evaluated using digital slab phantoms and clinical CT data. Compared with the gold standard calculation, dose deviations were improved from 20% to 2% in the low density regions of the slab phantoms for the 1-cm field size, and within 2% for over 95% of the volume with the largest discrepancy at the interface for the clinical lung case. Conclusion: We developed a simple recursive formula for scatter correction for the DRT-based dose calculation with much improved accuracy, especially for small field size, while still keeping calculation to linear complexity. The proposed calculator is fast, yet accurate, which is crucial for dose updating in IMRT optimization.

60 APPLIED LIFE SCIENCES↗

SU-E-T-491: Influence of Applicator Dimensions On Doses to Bladder, Rectum and Sigmoid in HDR Brachytherapy for Cervical Cancer

Purpose: To study the influence of dimensions of the tandem and ring applicator on bladder D2cc, rectum D2cc and sigmoid D2cc in HDR treatment planning for cervical cancer. Methods: 53 plans from 13 patients treated at our institution with the tandem and ring applicator were retrospectively reviewed. Prescription doses were one of the following: 8 Gy x 3, 7 Gy x 4 and 5.5 Gy x 5. Doses to the D2ccs of the bladder, rectum and the sigmoid were recorded. These doses were normalized to their relative prescriptions doses. Correlations between the normalized bladder D2cc, rectum D2cc and sigmoid D2cc were investigated and linear regression models were developed to study the dependence of these doses on the ring diameter and the applicator angle. Results: Normalized doses to the D2cc of the bladder, rectum and sigmoid showed statistically significant correlation (P < 0.05) to the applicator angle. Significant correlation was also noted for the normalized D2cc of the rectum and the sigmoid with the ring diameter. The normalized bladder D2cc was found to decrease with applicator angle on an average by 22.65% ± 4.43% while the same for the rectum and sigmoid were found to increase on an average by 14.43% ± 1.65% and 14.01% ± 1.42% respectively. Both the rectum and sigmoid D2cc reduced with increasing ring diameter by 12.93% ± 1.95% and 11.27% ± 1.79%. No correlation was observed between the normalized bladder D2cc and the ring diameter. Conclusion: Preliminary regression models developed in this study can potentially aid in the choice of the appropriate applicator angle and ring diameter for tandem and ring implant so as to optimize doses to the bladder, rectum and sigmoid.

60 APPLIED LIFE SCIENCES↗

MO-F-CAMPUS-T-03: Continuous Dose Delivery with Gamma Knife Perfexion

Purpose: We propose continuous dose delivery techniques for stereotactic treatments delivered by Gamma Knife Perfexion using inverse treatment planning system that can be applied to various tumour sites in the brain. We test the accuracy of the plans on Perfexion’s planning system (GammaPlan) to ensure the obtained plans are viable. This approach introduces continuous dose delivery for Perefxion, as opposed to the currently employed step-and-shoot approaches, for different tumour sites. Additionally, this is the first realization of automated inverse planning on GammaPlan. Methods: The inverse planning approach is divided into two steps of identifying a quality path inside the target, and finding the best collimator composition for the path. To find a path, we select strategic regions inside the target volume and find a path that visits each region exactly once. This path is then passed to a mathematical model which finds the best combination of collimators and their durations. The mathematical model minimizes the dose spillage to the surrounding tissues while ensuring the prescribed dose is delivered to the target(s). Organs-at-risk and their corresponding allowable doses can also be added to the model to protect adjacent organs. Results: We test this approach on various tumour sizes and sites. The quality of the obtained treatment plans are comparable or better than forward plans and inverse plans that use step- and-shoot technique. The conformity indices in the obtained continuous dose delivery plans are similar to those of forward plans while the beam-on time is improved on average (see Table 1 in supporting document). Conclusion: We employ inverse planning for continuous dose delivery in Perfexion for brain tumours. The quality of the obtained plans is similar to forward and inverse plans that use conventional step-and-shoot technique. We tested the inverse plans on GammaPlan to verify clinical relevance. This research was partially supported by Elekta, Sweden (vendor of Gamma Knife Perfexion)

60 APPLIED LIFE SCIENCES↗