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DOE OSTI2014

TU-C-17A-03: An Integrated Contour Evaluation Software Tool Using Supervised Pattern Recognition for Radiotherapy

Purpose: Radiotherapy (RT) contours delineated either manually or semiautomatically require verification before clinical usage. Manual evaluation is very time consuming. A new integrated software tool using supervised pattern contour recognition was thus developed to facilitate this process. Methods: The contouring tool was developed using an object-oriented programming language C# and application programming interfaces, e.g. visualization toolkit (VTK). The C# language served as the tool design basis. The Accord.Net scientific computing libraries were utilized for the required statistical data processing and pattern recognition, while the VTK was used to build and render 3-D mesh models from critical RT structures in real-time and 360° visualization. Principal component analysis (PCA) was used for system self-updating geometry variations of normal structures based on physician-approved RT contours as a training dataset. The inhouse design of supervised PCA-based contour recognition method was used for automatically evaluating contour normality/abnormality. The function for reporting the contour evaluation results was implemented by using C# and Windows Form Designer. Results: The software input was RT simulation images and RT structures from commercial clinical treatment planning systems. Several abilities were demonstrated: automatic assessment of RT contours, file loading/saving of various modality medical images and RT contours, and generation/visualization of 3-D images and anatomical models. Moreover, it supported the 360° rendering of the RT structures in a multi-slice view, which allows physicians to visually check and edit abnormally contoured structures. Conclusion: This new software integrates the supervised learning framework with image processing and graphical visualization modules for RT contour verification. This tool has great potential for facilitating treatment planning with the assistance of an automatic contour evaluation module in avoiding unnecessary manual verification for physicians/dosimetrists. In addition, its nature as a compact and stand-alone tool allows for future extensibility to include additional functions for physicians’ clinical needs.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2014

TH-A-19A-02: Expanding TOPAS Towards Biological Modeling

Purpose: To expand Monte Carlo simulations of TOPAS to directly calculate radiobiological effects using various biological models. Methods: We use the TOPAS toolkit version beta9 and expand the provided scoring system to directly include scorers for relative biological effect (RBE) modeling. A scorer is a class to record a given physical property in the Monte Carlo simulations. We developed a scorer for the dose averaged linear energy transfer (LETd). This scorer was used to compare RBE weighted dose distributions assuming a constant RBE of 1.1 with the RBE weighted dose using a variable RBE based on a model using LETd and dose as input. Additionally, the local effect model (LEM) was implemented in TOPAS to estimate RBE weighted dose distributions. Survival curves for the LEM were simulated for a monoenergetic proton beams impinging on phantoms and for full patient treatment plans. Results: We have implemented radiobiological effect models in TOPAS, providing users with the possibility to directly obtain parameters related to radiobiological dose and use those as additional information to assess the quality of treatment plans. We applied the scorers to clinical patient treatments and phantom simulations. We find that for the proton therapy plans investigated the regions with the highest LETd are generally outside of the target volume, coinciding with the distal edge of treatment fields. LETd-based variable RBE weighted dose models predict higher doses at the distal edge of over 10% of the prescribed dose than when assuming a constant RBE. Conclusion: By implementing radiobiological effect models into a Monte Carlo simulation package we combine accurate dose calculation with biological modeling. TOPAS thereby provides distributions of multiple physical quantities such as the dose and LETd, and estimates of biological parameters (RBE, survival) thus allowing direct comparison of biological effective dose predictions between different models.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

TH-A-19A-03: Impact of Proton Dose Calculation Method On Delivered Dose to Lung Tumors: Experiments in Thorax Phantom and Planning Study in Patient Cohort

Purpose: Evaluate Monte Carlo (MC) dose calculation and the prediction of the treatment planning system (TPS) in a lung phantom and compare them in a cohort of 20 lung patients treated with protons. Methods: A 2-dimensional array of ionization chambers was used to evaluate the dose across the target in a lung phantom. 20 lung cancer patients on clinical trials were re-simulated using a validated Monte Carlo toolkit (TOPAS) and compared to the TPS. Results: MC increases dose calculation accuracy in lung compared to the clinical TPS significantly and predicts the dose to the target in the phantom within ±2%: the average difference between measured and predicted dose in a plane through the center of the target is 5.6% for the TPS and 1.6% for MC. MC recalculations in patients show a mean dose to the clinical target volume on average 3.4% lower than the TPS, exceeding 5% for small fields. The lower dose correlates significantly with aperture size and the distance of the tumor to the chest wall (Spearman's p=0.0002/0.004). For large tumors MC also predicts consistently higher V{sub 5} and V{sub 10} to the normal lung, due to a wider lateral penumbra, which was also observed experimentally. Critical structures located distal to the target can show large deviations, though this effect is very patient-specific. Conclusion: Advanced dose calculation techniques, such as MC, would improve treatment quality in proton therapy for lung cancer by avoiding systematic overestimation of target dose and underestimation of dose to normal lung. This would increase the accuracy of the relationships between dose and effect, concerning tumor control as well as normal tissue toxicity. As the role of proton therapy in the treatment of lung cancer continues to be evaluated in clinical trials, this is of ever-increasing importance. This work was supported by National Cancer Institute Grant R01CA111590.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-C-16A-07: Sculpting Isodose Lines: Design of An Internally Shielded Tandem for Cervical Cancer Brachytherapy

Purpose: With the prescription method moving from point A to 3D volume based in cervical cancer HDR brachytherapy, the traditional pear-shaped isodose lines are desired to be sculptured to conform to the irregular shaped target. The standard single channel tandem cannot generate asymmetric isodose lines. Most of the directionally shielded sources proposed in literature are challenging to manufacture and operate. In this study, we proposed a novel internally shielded tandem applicator design which gave users more freedom to manipulate isodose lines while planning. Methods: The proposed tandem design has one centrally located lead cylindrical rod of 8 mm in diameter serving as the internal shield. Multiple source channels with the diameter of 2 mm are evenly spaced and engraved on the central cylindrical rod. The overall diameter of the tandem with polymer encapsulation was kept to be 10 mm. Various number of channels and engraving depths have been tested in the design process. Geant4 Monte Carlo toolkit was used for dose calculation assuming a Varian VS2000 source was placed inside the applicator. A Monte Carlo based planning system has been developed in-house to generate brachytherapy plans. Test plans by using this internally shielded tandem were generated for 3 clinical cases. Results: Water phantom results shown the dose distribution from a VS2000 source in the tandem was strongly distorted towards one direction due to the presence of shielding material. Conformal plans with asymmetric isodose distributions around the tandem can be generated by optimizing dwell times in different channels. Conclusion: An effective and easy-to-use internally shielded tandem was developed. It gave user the freedom to sculpt isodose lines to generate conformal plans for cervical cancer brachytherapy.

07 ISOTOPE AND RADIATION SOURCES↗
DOE OSTI2014

Poster — Thur Eve — 46: Monte Carlo model of the Novalis Classic 6MV stereotactic linear accelerator using the GATE simulation platform

Monte Carlo (MC) simulation is accepted as the most accurate method to predict dose deposition when compared to other methods in radiation treatment planning. Current dose calculation algorithms used for treatment planning can become inaccurate when small radiation fields and tissue inhomogeneities are present. At our centre the Novalis Classic linear accelerator (linac) is used for Stereotactic Radiosurgery (SRS). The first MC model to date of the Novalis Classic linac was developed at our centre using the Geant4 Application for Tomographic Emission (GATE) simulation platform. GATE is relatively new, open source MC software built from CERN's Geometry and Tracking 4 (Geant4) toolkit. The linac geometry was modeled using manufacturer specifications, as well as in-house measurements of the micro MLC's. Among multiple model parameters, the initial electron beam was adjusted so that calculated depth dose curves agreed with measured values. Simulations were run on the European Grid Infrastructure through GateLab. Simulation time is approximately 8 hours on GateLab for a complete head model simulation to acquire a phase space file. Current results have a majority of points within 3% of the measured dose values for square field sizes ranging from 6×6 mm{sup 2} to 98×98 mm{sup 2} (maximum field size on the Novalis Classic linac) at 100 cm SSD. The x-ray spectrum was determined from the MC data as well. The model provides an investigation into GATE'S capabilities and has the potential to be used as a research tool and an independent dose calculation engine for clinical treatment plans.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

Model-based versus specific dosimetry in diagnostic context: Comparison of three dosimetric approaches

Purpose: The dosimetric assessment of novel radiotracers represents a legal requirement in most countries. While the techniques for the computation of internal absorbed dose in a therapeutic context have made huge progresses in recent years, in a diagnostic scenario the absorbed dose is usually extracted from model-based lookup tables, most often derived from International Commission on Radiological Protection (ICRP) or Medical Internal Radiation Dose (MIRD) Committee models. The level of approximation introduced by these models may impact the resulting dosimetry. The aim of this work is to establish whether a more refined approach to dosimetry can be implemented in nuclear medicine diagnostics, by analyzing a specific case. Methods: The authors calculated absorbed doses to various organs in six healthy volunteers administered with flutemetamol ({sup 18}F) injection. Each patient underwent from 8 to 10 whole body 3D PET/CT scans. This dataset was analyzed using a Monte Carlo (MC) application developed in-house using the toolkit GATE that is capable to take into account patient-specific anatomy and radiotracer distribution at the voxel level. They compared the absorbed doses obtained with GATE to those calculated with two commercially available software: OLINDA/EXM and STRATOS implementing a dose voxel kernel convolution approach. Results: Absorbed doses calculated with GATE were higher than those calculated with OLINDA. The average ratio between GATE absorbed doses and OLINDA’s was 1.38 ± 0.34 σ (from 0.93 to 2.23). The discrepancy was particularly high for the thyroid, with an average GATE/OLINDA ratio of 1.97 ± 0.83 σ for the six patients. Differences between STRATOS and GATE were found to be higher. The average ratio between GATE and STRATOS absorbed doses was 2.51 ± 1.21 σ (from 1.09 to 6.06). Conclusions: This study demonstrates how the choice of the absorbed dose calculation algorithm may introduce a bias when gamma radiations are of importance, as is the case in nuclear medicine diagnostics.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

Technical Note: Improvements in GEANT4 energy-loss model and the effect on low-energy electron transport in liquid water

Purpose: The GEANT4-DNA physics models are upgraded by a more accurate set of electron cross sections for ionization and excitation in liquid water. The impact of the new developments on low-energy electron transport simulations by the GEANT4 Monte Carlo toolkit is examined for improving its performance in dosimetry applications at the subcellular and nanometer level. Methods: The authors provide an algorithm for an improved implementation of the Emfietzoglou model dielectric response function of liquid water used in the GEANT4-DNA existing model. The algorithm redistributes the imaginary part of the dielectric function to ensure a physically motivated behavior at the binding energies, while retaining all the advantages of the original formulation, e.g., the analytic properties and the fulfillment of the f-sum-rule. In addition, refinements in the exchange and perturbation corrections to the Born approximation used in the GEANT4-DNA existing model are also made. Results: The new ionization and excitation cross sections are significantly different from those of the GEANT4-DNA existing model. In particular, excitations are strongly enhanced relative to ionizations, resulting in higher W-values and less diffusive dose-point-kernels at sub-keV electron energies. Conclusions: An improved energy-loss model for the excitation and ionization of liquid water by low-energy electrons has been implemented in GEANT4-DNA. The suspiciously low W-values and the unphysical long tail in the dose-point-kernel have been corrected owing to a different partitioning of the dielectric function.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗
DOE OSTI2015

Proton dose calculation on scatter-corrected CBCT image: Feasibility study for adaptive proton therapy

Purpose: To demonstrate the feasibility of proton dose calculation on scatter-corrected cone-beam computed tomographic (CBCT) images for the purpose of adaptive proton therapy. Methods: CBCT projection images were acquired from anthropomorphic phantoms and a prostate patient using an on-board imaging system of an Elekta infinity linear accelerator. Two previously introduced techniques were used to correct the scattered x-rays in the raw projection images: uniform scatter correction (CBCT{sub us}) and a priori CT-based scatter correction (CBCT{sub ap}). CBCT images were reconstructed using a standard FDK algorithm and GPU-based reconstruction toolkit. Soft tissue ROI-based HU shifting was used to improve HU accuracy of the uncorrected CBCT images and CBCT{sub us}, while no HU change was applied to the CBCT{sub ap}. The degree of equivalence of the corrected CBCT images with respect to the reference CT image (CT{sub ref}) was evaluated by using angular profiles of water equivalent path length (WEPL) and passively scattered proton treatment plans. The CBCT{sub ap} was further evaluated in more realistic scenarios such as rectal filling and weight loss to assess the effect of mismatched prior information on the corrected images. Results: The uncorrected CBCT and CBCT{sub us} images demonstrated substantial WEPL discrepancies (7.3 ± 5.3 mm and 11.1 ± 6.6 mm, respectively) with respect to the CT{sub ref}, while the CBCT{sub ap} images showed substantially reduced WEPL errors (2.4 ± 2.0 mm). Similarly, the CBCT{sub ap}-based treatment plans demonstrated a high pass rate (96.0% ± 2.5% in 2 mm/2% criteria) in a 3D gamma analysis. Conclusions: A priori CT-based scatter correction technique was shown to be promising for adaptive proton therapy, as it achieved equivalent proton dose distributions and water equivalent path lengths compared to those of a reference CT in a selection of anthropomorphic phantoms.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-C-201-06: Utility of Quantitative 3D SPECT/CT Imaging in Patient Specific Internal Dosimetry of 153-Samarium with GATE Monte Carlo Package

Purpose: Patient-specific 3-dimensional (3D) internal dosimetry in targeted radionuclide therapy is essential for efficient treatment. Two major steps to achieve reliable results are: 1) generating quantitative 3D images of radionuclide distribution and attenuation coefficients and 2) using a reliable method for dose calculation based on activity and attenuation map. In this research, internal dosimetry for 153-Samarium (153-Sm) was done by SPECT-CT images coupled GATE Monte Carlo package for internal dosimetry. Methods: A 50 years old woman with bone metastases from breast cancer was prescribed 153-Sm treatment (Gamma: 103keV and beta: 0.81MeV). A SPECT/CT scan was performed with the Siemens Simbia-T scanner. SPECT and CT images were registered using default registration software. SPECT quantification was achieved by compensating for all image degrading factors including body attenuation, Compton scattering and collimator-detector response (CDR). Triple energy window method was used to estimate and eliminate the scattered photons. Iterative ordered-subsets expectation maximization (OSEM) with correction for attenuation and distance-dependent CDR was used for image reconstruction. Bilinear energy mapping is used to convert Hounsfield units in CT image to attenuation map. Organ borders were defined by the itk-SNAP toolkit segmentation on CT image. GATE was then used for internal dose calculation. The Specific Absorbed Fractions (SAFs) and S-values were reported as MIRD schema. Results: The results showed that the largest SAFs and S-values are in osseous organs as expected. S-value for lung is the highest after spine that can be important in 153-Sm therapy. Conclusion: We presented the utility of SPECT-CT images and Monte Carlo for patient-specific dosimetry as a reliable and accurate method. It has several advantages over template-based methods or simplified dose estimation methods. With advent of high speed computers, Monte Carlo can be used for treatment planning on a day to day basis.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-I-80: Quantification of Respiratory and Cardiac Motion Effect in SPECT Acquisitions Using Anthropomorphic Models: A Monte Carlo Simulation Study

Purpose: The purpose of the present study was to quantify, evaluate the impact of cardiac and respiratory motion on clinical nuclear imaging protocols. Common SPECT and scintigraphic scans are studied using Monte Carlo (MC) simulations, comparing the resulted images with and without motion. Methods: Realistic simulations were executed using the GATE toolkit and the XCAT anthropomorphic phantom as a reference model for human anatomy. Three different radiopharmaceuticals based on 99mTc were studied, namely 99mTc-MDP, 99mTc—N—DBODC and 99mTc—DTPA-aerosol for bone, myocardium and lung scanning respectively. The resolution of the phantom was set to 3.5 mm{sup 3}. The impact of the motion on spatial resolution was quantified using a sphere with 3.5 mm diameter and 10 separate time frames, in the ECAM modeled SPECT scanner. Finally, respiratory motion impact on resolution and imaging of lung lesions was investigated. The MLEM algorithm was used for data reconstruction, while the literature derived biodistributions of the pharmaceuticals were used as activity maps in the simulations. Results: FWHM was extracted for a static and a moving sphere which was ∼23 cm away from the entrance of the SPECT head. The difference in the FWHM was 20% between the two simulations. Profiles in thorax were compared in the case of bone scintigraphy, showing displacement and blurring of the bones when respiratory motion was inserted in the simulation. Large discrepancies were noticed in the case of myocardium imaging when cardiac motion was incorporated during the SPECT acquisition. Finally the borders of the lungs are blurred when respiratory motion is included resulting to a dislocation of ∼2.5 cm. Conclusion: As we move to individualized imaging and therapy procedures, quantitative and qualitative imaging is of high importance in nuclear diagnosis. MC simulations combined with anthropomorphic digital phantoms can provide an accurate tool for applications like motion correction techniques’ optimization. This research has been co-funded by the European Union (European Social Fund) and Greek national resources under the framework of the ‘Archimedes III: Funding of Research Groups in TEI of Athens’ project of the ‘Education & Lifelong Learning’ Operational Programme.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

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 ↗
DOE OSTI2015

SU-E-I-87: Calibrating Cherenkov Emission to Match Superficial Dose in Tissue

Purpose: Through Monte Carlo simulations and phantom studies, the dominant factors affecting the calibration of superficial Cherenkov intensity to absolute surface dose was investigated, including tissue optical properties, curvatures, beam properties and imaging angle. Methods: The phasespace files for the TrueBeam system from Varian were used in GAMOS (a GEANT4 based Monte Carlo simulation toolkit) to simulate surface emission Cherenkov signals and the correlated deposited dose. The parameters examined were: i) different tissue optical properties (skin color from light to dark), ii) beam types (X-ray and electron beam), iii) beam energies, iv) thickness of tissues (2.5 cm to 20 cm), v) SSD (80 cm to 120 cm), vi) field sizes (0.5×0.5 cm2 to 20×20 cm2), vii) entrance/exit sides, viii) curvatures (cylinders with diameters from 2.5 cm to 20cm) and ix) imaging angles (0 to 90 degrees). In a specific case, for any Cherenkov photon emitted from the surface, the original position and direction, final position and direction and energy were recorded. Similar experimental measurements were taken in a range of the most pertinent parameters using tissue phantoms. Results: Combining the dose distribution and sampling sensitivity of Cherenkov emission, quantitatively accurate calibration factors (the amount of radiation dose represented by a single Cherenkov photon) were calculated. The data showed relatively large dependence upon different optical properties, curvature, entrance/exit and beam types. For a diffusive surface, the calibration factor was insensitive to imaging angles smaller than 60 degrees. Normalization with the reflectance image was experimentally validated as a simple and accurate method for calibrations of different optical properties. Conclusion: This study sheds light on how and to what extent different conditions affect the calibration from Cherenkov intensity to absolute superficial dose and provides practical solutions to allow quantitative Cherenkov imaging to be used as a dose surrogate for imaging.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-J-141: Activity-Equivalent Path Length Approach for the 3D PET-Based Dose Reconstruction in Proton Therapy

Purpose: Ion beam therapy is sensitive to uncertainties from treatment planning and dose delivery. PET imaging of induced positron emitter distributions is a practical approach for in vivo, in situ verification of ion beam treatments. Treatment verification is usually done by comparing measured activity distributions with reference distributions, evaluated in nominal conditions. Although such comparisons give valuable information on treatment quality, a proper clinical evaluation of the treatment ultimately relies on the knowledge of the actual delivered dose. Analytical deconvolution methods relating activity and dose have been studied in this context, but were not clinically applied. In this work we present a feasibility study of an alternative approach for dose reconstruction from activity data, which is based on relating variations in accumulated activity to tissue density variations. Methods: First, reference distributions of dose and activity were calculated from the treatment plan and CT data. Then, the actual measured activity data were cumulatively matched with the reference activity distributions to obtain a set of activity-equivalent path lengths (AEPLs) along the rays of the pencil beams. Finally, these AEPLs were used to deform the original dose distribution, yielding the actual delivered dose. The method was tested by simulating a proton therapy treatment plan delivering 2 Gy on a homogeneous water phantom (the reference), which was compared with the same plan delivered on a phantom containing inhomogeneities. Activity and dose distributions were were calculated by means of the FLUKA Monte Carlo toolkit. Results: The main features of the observed dose distribution in the inhomogeneous situation were reproduced using the AEPL approach. Variations in particle range were reproduced and the positions, where these deviations originated, were properly identified. Conclusions: For a simple inhomogeneous phantom the 3D dose reconstruction from PET-activity induced by proton beams was shown to be feasible.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-J-148: Tools for Development of 4D Proton CT

Purpose: To develop tools for performing 4D proton computed tomography (CT). Methods: A suitable patient with a tumor in the right lower lobe was selected from a set of 4D CT scans. The volumetric CT images formed the basis for calculating the parameters of a breathing model that allows reconstruction of a static reference CT and CT images in each breathing phase. The images were imported into the TOPAS Monte Carlo simulation platform for simulating an experimental proton CT scan with 45 projections spaced by 4 degree intervals. Each projection acquired data for 2 seconds followed by a gantry rotation for 2 seconds without acquisition. The scan covered 180 degrees with individual protons passing through a 9-cm slab of the patient’s lung covering the moving tumor. An initial proton energy sufficient for penetrating the patient from all directions was determined. Performing the proton CT simulation, TOPAS provided output of the proton energy and coordinates registered in two planes before and after the patient, respectively. The set of projection data was then used with an iterative reconstruction algorithm to generate a volumetric proton CT image set of the static reference image and the image obtained under breathing motion, respectively. Results: An initial proton energy of 230 MeV was found to be sufficient, while for an initial energy of 200 MeV a substantial number of protons did not penetrate the patient. The reconstruction of the static reference image set provided sufficient detail for treatment planning. Conclusion: We have developed tools to perform studies of proton CT in the presence of lung motion based on the TOPAS simulation toolkit. This will allow to optimize 4D reconstruction algorithms by synchronizing the acquired proton CT data with a breathing signal and utilizing a breathing model obtained prior to the proton CT scan. This research has been supported by the National Institute Of Biomedical Imaging And Bioengineering of the National Institutes of Health under Award Number R01EB013118.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-J-153: Reconstructing 4D Cone Beam CT Images for Clinical QA of Lung SABR Treatments

Purpose: To verify that the planned Primary Target Volume (PTV) and Internal Gross Tumor Volume (IGTV) fully enclose a moving lung tumor volume as visualized on a pre-SABR treatment verification 4D Cone Beam CT. Methods: Daily 3DCBCT image sets were acquired immediately prior to treatment for 10 SABR lung patients using the on-board imaging system integrated into a Varian TrueBeam (v1.6: no 4DCBCT module available). Respiratory information was acquired during the scan using the Varian RPM system. The CBCT projections were sorted into 8 bins offline, both by breathing phase and amplitude, using in-house software. An iterative algorithm based on total variation minimization, implemented in the open source reconstruction toolkit (RTK), was used to reconstruct the binned projections into 4DCBCT images. The relative tumor motion was quantified by tracking the centroid of the tumor volume from each 4DCBCT image. Following CT-CBCT registration, the planning CT volumes were compared to the location of the CBCT tumor volume as it moves along its breathing trajectory. An overlap metric quantified the ability of the planned PTV and IGTV to contain the tumor volume at treatment. Results: The 4DCBCT reconstructed images visibly show the tumor motion. The mean overlap between the planned PTV (IGTV) and the 4DCBCT tumor volumes was 100% (94%), with an uncertainty of 5% from the 4DCBCT tumor volume contours. Examination of the tumor motion and overlap metric verify that the IGTV drawn at the planning stage is a good representation of the tumor location at treatment. Conclusion: It is difficult to compare GTV volumes from a 4DCBCT and a planning CT due to image quality differences. However, it was possible to conclude the GTV remained within the PTV 100% of the time thus giving the treatment staff confidence that SABR lung treatements are being delivered accurately.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-203: Comparison of a Commercial MRI-Linear Accelerator Based Monte Carlo Dose Calculation Algorithm and Geant4

Purpose: An MRI-linear accelerator is currently being developed by the vendor Elekta™. The treatment planning system that will be used to model dose for this unit uses a Monte Carlo dose calculation algorithm, GPUMCD, that allows for the application of a magnetic field. We tested this radiation transport code against an independent Monte-Carlo toolkit Geant4 (v.4.10.01) both with and without the magnetic field applied. Methods: The setup comprised a 6 MeV mono-energetic photon beam emerging from a point source impinging on a homogeneous water phantom at 100 cm SSD. The comparisons were drawn from the percentage depth doses (PDD) for three different field sizes (1.5 x 1.5 cm{sup 2}, 5 x 5 cm{sup 2}, 10 x 10 cm{sup 2}) and dose profiles at various depths. A 1.5 T magnetic field was applied perpendicular to the direction of the beam. The transport thresholds were kept the same for both codes. Results: All of the normalized PDDs and profiles agreed within ± 1 %. In the presence of the magnetic field, PDDs rise more quickly reducing the depth of maximum dose. Near the beam exit point in the phantom a hot spot is created due to the electron return effect. This effect is more pronounced for the larger field sizes. Profiles selected parallel to the external field show no effect, however, the ones selected perpendicular to the direction of the applied magnetic field are shifted towards the direction of the Lorentz force applied by the magnetic field on the secondary electrons. It is observed that these profiles are not symmetric which indicates a lateral build up of the dose. Conclusion: There is a good general agreement between the PDDs/profiles calculated by both algorithms thus far. We are proceeding towards clinically relevant comparisons in a heterogeneous phantom for polyenergetic beams. Funding for this work has been provided by Elekta.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-427: Feasibility Study for Evaluation of IMRT Dose Distribution Using Geant4-Based Automated Algorithms

Purpose: For intensity-modulated radiation therapy (IMRT) treatment planning validation using Monte Carlo (MC) simulations, a precise and automated procedure is necessary to evaluate the patient dose distribution. The aim of this study is to develop an automated algorithm for IMRT simulations using DICOM files and to evaluate the patient dose based on 4D simulation using the Geant4 MC toolkit. Methods: The head of a clinical linac (Varian Clinac 2300 IX) was modeled in Geant4 along with particular components such as the flattening filter and the multi-leaf collimator (MLC). Patient information and the position of the MLC were imported from the DICOM-RT interface. For each position of the MLC, a step- and-shoot technique was adopted. PDDs and lateral profiles were simulated in a water phantom (50×50×40 cm{sup 3}) and compared to measurement data. We used a lung phantom and MC-dose calculations were compared to the clinical treatment planning used at the Seoul National University Hospital. Results: In order to reproduce the measurement data, we tuned three free parameters: mean and standard deviation of the primary electron beam energy and the beam spot size. These parameters for 6 MV were found to be 5.6 MeV, 0.2378 MeV and 1 mm FWHM respectively. The average dose difference between measurements and simulations was less than 2% for PDDs and radial profiles. The lung phantom study showed fairly good agreement between MC and planning dose despite some unavoidable statistical fluctuation. Conclusion: The current feasibility study using the lung phantom shows the potential for IMRT dose validation using 4D MC simulations using Geant4 tool kits. This research was supported by Korea Institute of Nuclear safety and Development of Measurement Standards for Medical Radiation funded by Korea research Institute of Standards and Science. (KRISS-2015-15011032)

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-461: Impact of the Radiation Sensitivity of Tumor and Geometric Design of the GRID Block On the Clinical Response of Grid Therapy

Purpose: The spatially fractionated radiation therapy (Grid therapy) is a novel technique that has been recently introduced for treatments of the patients with advanced bulky tumors. The purpose of this study is to investigate the effect of the radiation sensitivity of tumor and Grid block design on the clinical response of the Grid therapy. Methods: The Geant4 toolkit is used to simulate a Varian2100C linear accelerator with the block-based Grid. The dose profile has been utilized to calculate the Therapeutic Ratio (TR) and Equivalent Uniform Dose (EUD) for different types of tumors. These calculations were performed with respect to their radiation sensitivities using Linear Quadratic model (LQ). Clinical responses of few hundred patients from different publications that were treated with Grid therapy, have been used to validate correlation between tumor radiation sensitivity and clinical response of Grid therapy. Moreover, the influence of Grid design on clinical response of this radiation technique was investigated with using Monte Carlo simulation of a Grid block with different hole-diameters of 0.5 cm, 0.75 cm, 1.25 cm, and 1.5 cm. The Geometrical Sparing Factor (GSF) was considered to compare the results from different Grid designs. Results: The higher clinical response of Grid therapy for more radio-resistant tumors was confirmed in both theoretical assumptions and clinical outcomes. In addition, the results indicate that the Grid hole diameter have more effect on increasing the TR in comparison with the hole center-to-center distance effect. From this Monte Carlo study, a Grid design with the hole diameter between 1.25 cm and 1.5 cm with GSF value of 0.90 is recommended. Conclusion: Grid Therapy is more effective for more radio-resistant tumors.The optimum results of the Grid therapy depend on selection of the appropriate Grid design.This study is a first step toward clarifying some important aspects in a clinical response of spatially fractionated radiation therapy.

60 APPLIED LIFE SCIENCES↗