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TH-E-18A-01: Developments in Monte Carlo Methods for Medical Imaging

Monte Carlo simulation methods are widely used in medical physics research and are starting to be implemented in clinical applications such as radiation therapy planning systems. Monte Carlo simulations offer the capability to accurately estimate quantities of interest that are challenging to measure experimentally while taking into account the realistic anatomy of an individual patient. Traditionally, practical application of Monte Carlo simulation codes in diagnostic imaging was limited by the need for large computational resources or long execution times. However, recent advancements in high-performance computing hardware, combined with a new generation of Monte Carlo simulation algorithms and novel postprocessing methods, are allowing for the computation of relevant imaging parameters of interest such as patient organ doses and scatter-to-primaryratios in radiographic projections in just a few seconds using affordable computational resources. Programmable Graphics Processing Units (GPUs), for example, provide a convenient, affordable platform for parallelized Monte Carlo executions that yield simulation times on the order of 10{sup 7} xray/ s. Even with GPU acceleration, however, Monte Carlo simulation times can be prohibitive for routine clinical practice. To reduce simulation times further, variance reduction techniques can be used to alter the probabilistic models underlying the x-ray tracking process, resulting in lower variance in the results without biasing the estimates. Other complementary strategies for further reductions in computation time are denoising of the Monte Carlo estimates and estimating (scoring) the quantity of interest at a sparse set of sampling locations (e.g. at a small number of detector pixels in a scatter simulation) followed by interpolation. Beyond reduction of the computational resources required for performing Monte Carlo simulations in medical imaging, the use of accurate representations of patient anatomy is crucial to the virtual generation of medical images and accurate estimation of radiation dose and other imaging parameters. For this, detailed computational phantoms of the patient anatomy must be utilized and implemented within the radiation transport code. Computational phantoms presently come in one of three format types, and in one of four morphometric categories. Format types include stylized (mathematical equation-based), voxel (segmented CT/MR images), and hybrid (NURBS and polygon mesh surfaces). Morphometric categories include reference (small library of phantoms by age at 50th height/weight percentile), patient-dependent (larger library of phantoms at various combinations of height/weight percentiles), patient-sculpted (phantoms altered to match the patient's unique outer body contour), and finally, patient-specific (an exact representation of the patient with respect to both body contour and internal anatomy). The existence and availability of these phantoms represents a very important advance for the simulation of realistic medical imaging applications using Monte Carlo methods. New Monte Carlo simulation codes need to be thoroughly validated before they can be used to perform novel research. Ideally, the validation process would involve comparison of results with those of an experimental measurement, but accurate replication of experimental conditions can be very challenging. It is very common to validate new Monte Carlo simulations by replicating previously published simulation results of similar experiments. This process, however, is commonly problematic due to the lack of sufficient information in the published reports of previous work so as to be able to replicate the simulation in detail. To aid in this process, the AAPM Task Group 195 prepared a report in which six different imaging research experiments commonly performed using Monte Carlo simulations are described and their results provided. The simulation conditions of all six cases are provided in full detail, with all necessary data on material composition, source, geometry, scoring and other parameters provided. The results of these simulations when performed with the four most common publicly available Monte Carlo packages are also provided in tabular form. The Task Group 195 Report will be useful for researchers needing to validate their Monte Carlo work, and for trainees needing to learn Monte Carlo simulation methods. In this symposium we will review the recent advancements in highperformance computing hardware enabling the reduction in computational resources needed for Monte Carlo simulations in medical imaging. We will review variance reduction techniques commonly applied in Monte Carlo simulations of medical imaging systems and present implementation strategies for efficient combination of these techniques with GPU acceleration. Trade-offs involved in Monte Carlo acceleration by means of denoising and “sparse sampling” will be discussed. A method for rapid scatter correction in cone-beam CT (<5 min/scan) will be presented as an illustration of the simulation speeds achievable with optimized Monte Carlo simulations. We will also discuss the development, availability, and capability of the various combinations of computational phantoms for Monte Carlo simulation of medical imaging systems. Finally, we will review some examples of experimental validation of Monte Carlo simulations and will present the AAPM Task Group 195 Report. Learning Objectives: Describe the advances in hardware available for performing Monte Carlo simulations in high performance computing environments. Explain variance reduction, denoising and sparse sampling techniques available for reduction of computational time needed for Monte Carlo simulations of medical imaging. List and compare the computational anthropomorphic phantoms currently available for more accurate assessment of medical imaging parameters in Monte Carlo simulations. Describe experimental methods used for validation of Monte Carlo simulations in medical imaging. Describe the AAPM Task Group 195 Report and its use for validation and teaching of Monte Carlo simulations in medical imaging.

60 APPLIED LIFE SCIENCES↗

SU-E-T-107: Development of a GPU-Based Dose Delivery System for Adaptive Pencil Beam Scanning

Purpose: A description of a GPU-based dose delivery system (G-DDS) to integrate a fast forward planning implementing in real-time the prescribed sequence of pencil beams. The system, which is under development, is designed to evaluate the dose distribution deviations due to range variations and interplay effects affecting mobile tumors treatments. Methods: The Dose Delivery System (DDS) in use at the Italian Centro Nazionale di Adroterapia Oncologica (CNAO), is the starting point for the presented system. A fast and partial forward planning (FP) tool has been developed to evaluate in few seconds the delivered dose distributions using the DDS data (on-line measurements of spot properties, i.e. number of particles and positions). The computation is performed during the intervals between synchrotron spills and, made available at the end of each spill. In the interval between two spills, the G-DDS will evaluate the delivered dose distributions taking into account the real-time target positions measured by a tracking system. The sequence of prescribed pencil beams for the following spill will be adapted taking into account the variations with respect to the original plan due to the target motion. In order to speed up the computation required to modify pencil beams distribution (up to 400 times has been reached), the Graphics Processing Units (GPUs) and advanced Field Programmable Gate Arrays (FPGAs) are used. Results: An existing offline forward planning is going to be optimized for the CUDA architecture: the gain in time will be presented. The preliminary performances of the developed GPU-based FP algorithms will be shown. Conclusion: A prototype of a GPU-based dose delivery system is under development and will be presented. The system workflow will be illustrated together with the approach adopted to integrate the three main systems, i.e. CNAO dose delivery system, fast forward planning, and tumor tracking system.

60 APPLIED LIFE SCIENCES↗

Measurement of time delays in gated radiotherapy for realistic respiratory motions

Purpose: Gated radiotherapy is used to reduce internal motion margins, escalate target dose, and limit normal tissue dose; however, its temporal accuracy is limited. Beam-on and beam-off time delays can lead to treatment inefficiencies and/or geographic misses; therefore, AAPM Task Group 142 recommends verifying the temporal accuracy of gating systems. Many groups use sinusoidal phantom motion for this, under the tacit assumption that use of sinusoidal motion for determining time delays produces negligible error. The authors test this assumption by measuring gating time delays for several realistic motion shapes with increasing degrees of irregularity. Methods: Time delays were measured on a linear accelerator with a real-time position management system (Varian TrueBeam with RPM system version 1.7.5) for seven motion shapes: regular sinusoidal; regular realistic-shape; large (40%) and small (10%) variations in amplitude; large (40%) variations in period; small (10%) variations in both amplitude and period; and baseline drift (30%). Film streaks of radiation exposure were generated for each motion shape using a programmable motion phantom. Beam-on and beam-off time delays were determined from the difference between the expected and observed streak length. Results: For the system investigated, all sine, regular realistic-shape, and slightly irregular amplitude variation motions had beam-off and beam-on time delays within the AAPM recommended limit of less than 100 ms. In phase-based gating, even small variations in period resulted in some time delays greater than 100 ms. Considerable time delays over 1 s were observed with highly irregular motion. Conclusions: Sinusoidal motion shapes can be considered a reasonable approximation to the more complex and slightly irregular shapes of realistic motion. When using phase-based gating with predictive filters even small variations in period can result in time delays over 100 ms. Clinical use of these systems for patients with highly irregular patterns of motion is not advised due to large beam-on and beam-off time delays.

60 APPLIED LIFE SCIENCES↗

Quality assurance for the clinical implementation of kilovoltage intrafraction monitoring for prostate cancer VMAT

Purpose: Kilovoltage intrafraction monitoring (KIM) is a real-time 3D tumor monitoring system for cancer radiotherapy. KIM uses the commonly available gantry-mounted x-ray imager as input, making this method potentially more widely available than dedicated real-time 3D tumor monitoring systems. KIM is being piloted in a clinical trial for prostate cancer patients treated with VMAT (NCT01742403). The purpose of this work was to develop clinical process and quality assurance (QA) practices for the clinical implementation of KIM. Methods: Informed by and adapting existing guideline documents from other real-time monitoring systems, KIM-specific QA practices were developed. The following five KIM-specific QA tests were included: (1) static localization accuracy, (2) dynamic localization accuracy, (3) treatment interruption accuracy, (4) latency measurement, and (5) clinical conditions accuracy. Tests (1)–(4) were performed using KIM to measure static and representative patient-derived prostate motion trajectories using a 3D programmable motion stage supporting an anthropomorphic phantom with implanted gold markers to represent the clinical treatment scenario. The threshold for system tolerable latency is <1 s. The tolerances for all other tests are that both the mean and standard deviation of the difference between the programmed trajectory and the measured data are <1 mm. The (5) clinical conditions accuracy test compared the KIM measured positions with those measured by kV/megavoltage (MV) triangulation from five treatment fractions acquired in a previous pilot study. Results: For the (1) static localization, (2) dynamic localization, and (3) treatment interruption accuracy tests, the mean and standard deviation of the difference are <1.0 mm. (4) The measured latency is 350 ms. (5) For the tests with previously acquired patient data, the mean and standard deviation of the difference between KIM and kV/MV triangulation are <1.0 mm. Conclusions: Clinical process and QA practices for the safe clinical implementation of KIM, a novel real-time monitoring system using commonly available equipment, have been developed and implemented for prostate cancer VMAT.

07 ISOTOPE AND RADIATION SOURCES↗

Impact of CT attenuation correction method on quantitative respiratory-correlated (4D) PET/CT imaging

Purpose: Respiratory-correlated positron emission tomography (PET/CT) 4D PET/CT is used to mitigate errors from respiratory motion; however, the optimal CT attenuation correction (CTAC) method for 4D PET/CT is unknown. The authors performed a phantom study to evaluate the quantitative performance of CTAC methods for 4D PET/CT in the ground truth setting. Methods: A programmable respiratory motion phantom with a custom movable insert designed to emulate a lung lesion and lung tissue was used for this study. The insert was driven by one of five waveforms: two sinusoidal waveforms or three patient-specific respiratory waveforms. 3DPET and 4DPET images of the phantom under motion were acquired and reconstructed with six CTAC methods: helical breath-hold (3DHEL), helical free-breathing (3DMOT), 4D phase-averaged (4DAVG), 4D maximum intensity projection (4DMIP), 4D phase-matched (4DMATCH), and 4D end-exhale (4DEXH) CTAC. Recovery of SUV{sub max}, SUV{sub mean}, SUV{sub peak}, and segmented tumor volume was evaluated as RC{sub max}, RC{sub mean}, RC{sub peak}, and RC{sub vol}, representing percent difference relative to the static ground truth case. Paired Wilcoxon tests and Kruskal–Wallis ANOVA were used to test for significant differences. Results: For 4DPET imaging, the maximum intensity projection CTAC produced significantly more accurate recovery coefficients than all other CTAC methods (p < 0.0001 over all metrics). Over all motion waveforms, ratios of 4DMIP CTAC recovery were 0.2 ± 5.4, −1.8 ± 6.5, −3.2 ± 5.0, and 3.0 ± 5.9 for RC{sub max}, RC{sub peak}, RC{sub mean}, and RC{sub vol}. In comparison, recovery coefficients for phase-matched CTAC were −8.4 ± 5.3, −10.5 ± 6.2, −7.6 ± 5.0, and −13.0 ± 7.7 for RC{sub max}, RC{sub peak}, RC{sub mean}, and RC{sub vol}. When testing differences between phases over all CTAC methods and waveforms, end-exhale phases were significantly more accurate (p = 0.005). However, these differences were driven by the patient-specific respiratory waveforms; when testing patient and sinusoidal waveforms separately, patient waveforms were significantly different between phases (p < 0.0001) while the sinusoidal waveforms were not significantly different (p = 0.98). When considering only the subset of 4DMATCH images that corresponded to the end-exhale image phase, 4DEXH, mean and interquartile range were similar to 4DMATCH but variability was considerably reduced. Conclusions: Comparative advantages in accuracy and precision of SUV metrics and segmented volumes were demonstrated with the use of the maximum intensity projection and end-exhale CT attenuation correction. While respiratory phase-matched CTAC should in theory provide optimal corrections, image artifacts and differences in implementation of 4DCT and 4DPET sorting can degrade the benefit of this approach. These results may be useful to guide the implementation, analysis, and development of respiratory-correlated thoracic PET/CT in the radiation oncology and diagnostic settings.

60 APPLIED LIFE SCIENCES↗

Development of PET/MRI with insertable PET for simultaneous PET and MR imaging of human brain

Purpose: The purpose of this study was to develop a dual-modality positron emission tomography (PET)/magnetic resonance imaging (MRI) with insertable PET for simultaneous PET and MR imaging of the human brain. Methods: The PET detector block was composed of a 4 × 4 matrix of detector modules, each consisting of a 4 × 4 array LYSO coupled to a 4 × 4 Geiger-mode avalanche photodiode (GAPD) array. The PET insert consisted of 18 detector blocks, circularly mounted on a custom-made plastic base to form a ring with an inner diameter of 390 mm and axial length of 60 mm. The PET gantry was shielded with gold-plated conductive fabric tapes with a thickness of 0.1 mm. The charge signals of PET detector transferred via 4 m long flat cables were fed into the position decoder circuit. The flat cables were shielded with a mesh-type aluminum sheet with a thickness of 0.24 mm. The position decoder circuit and field programmable gate array-embedded DAQ modules were enclosed in an aluminum box with a thickness of 10 mm and located at the rear of the MR bore inside the MRI room. A 3-T human MRI system with a Larmor frequency of 123.7 MHz and inner bore diameter of 60 cm was used as the PET/MRI hybrid system. A custom-made radio frequency (RF) coil with an inner diameter of 25 cm was fabricated. The PET was positioned between gradient and the RF coils. PET performance was measured outside and inside the MRI scanner using echo planar imaging, spin echo, turbo spin echo, and gradient echo sequences. MRI performance was also evaluated with and without the PET insert. The stability of the newly developed PET insert was evaluated and simultaneous PET and MR images of a brain phantom were acquired. Results: No significant degradation of the PET performance caused by MR was observed when the PET was operated using various MR imaging sequences. The signal-to-noise ratio of MR images was slightly degraded due to the PET insert installed inside the MR bore while the homogeneity was maintained. The change of gain of the 256 GAPD/scintillator elements of a detector block was <3% for 60 min, and simultaneous PET and MR images of a brain phantom were successfully acquired. Conclusions: Experimental results indicate that a compact and lightweight PET insert for hybrid PET/MRI can be developed using GAPD arrays and charge signal transmission method proposed in this study without significant interference.

60 APPLIED LIFE SCIENCES↗

SU-D-207-05: Real-Time Intrafractional Motion Tracking During VMAT Delivery Using a Conventional Elekta CBCT System

Purpose: Real-time kV projection streaming capability has become recently available for Elekta XVI version 5.0. This study aims to investigate the feasibility and accuracy of real-time fiducial marker tracking during CBCT acquisition with or without simultaneous VMAT delivery using a conventional Elekta linear accelerator. Methods: A client computer was connected to an on-board kV imaging system computer, and receives and processes projection images immediately after image acquisition. In-house marker tracking software based on FFT normalized cross-correlation was developed and installed in the client computer. Three gold fiducial markers with 3 mm length were implanted in a pelvis-shaped phantom with 36 cm width. The phantom was placed on a programmable motion platform oscillating in anterior-posterior and superior-inferior directions simultaneously. The marker motion was tracked in real-time for (1) a kV-only CBCT scan with treatment beam off and (2) a kV CBCT scan during a 6-MV VMAT delivery. The exposure parameters per projection were 120 kVp and 1.6 mAs. Tracking accuracy was assessed by comparing superior-inferior positions between the programmed and tracked trajectories. Results: The projection images were successfully transferred to the client computer at a frequency of about 5 Hz. In the kV-only scan, highly accurate marker tracking was achieved over the entire range of cone-beam projection angles (detection rate / tracking error were 100.0% / 0.6±0.5 mm). In the kV-VMAT scan, MV-scatter degraded image quality, particularly for lateral projections passing through the thickest part of the phantom (kV source angle ranging 70°-110° and 250°-290°), resulting in a reduced detection rate (90.5%). If the lateral projections are excluded, tracking performance was comparable to the kV-only case (detection rate / tracking error were 100.0% / 0.8±0.5 mm). Conclusion: Our phantom study demonstrated a promising Result for real-time motion tracking using a conventional Elekta linear accelerator. MV-scatter suppression is needed to improve tracking accuracy during MV delivery. This research is funded by Motion Management Research Grant from Elekta.

60 APPLIED LIFE SCIENCES↗

SU-D-210-05: The Accuracy of Raw and B-Mode Image Data for Ultrasound Speckle Tracking in Radiation Therapy

Purpose: For ultrasound speckle tracking there is some evidence that the envelope-detected signal (the main step in B-mode image formation) may be more accurate than raw ultrasound data for tracking larger inter-frame tissue motion. This study investigates the accuracy of raw radio-frequency (RF) versus non-logarithmic compressed envelope-detected (B-mode) data for ultrasound speckle tracking in the context of image-guided radiation therapy. Methods: Transperineal ultrasound RF data was acquired (with a 7.5 MHz linear transducer operating at a 12 Hz frame rate) from a speckle phantom moving with realistic intra-fraction prostate motion derived from a commercial tracking system. A normalised cross-correlation template matching algorithm was used to track speckle motion at the focus using (i) the RF signal and (ii) the B-mode signal. A range of imaging rates (0.5 to 12 Hz) were simulated by decimating the imaging sequences, therefore simulating larger to smaller inter-frame displacements. Motion estimation accuracy was quantified by comparison with known phantom motion. Results: The differences between RF and B-mode motion estimation accuracy (2D mean and 95% errors relative to ground truth displacements) were less than 0.01 mm for stable and persistent motion types and 0.2 mm for transient motion for imaging rates of 0.5 to 12 Hz. The mean correlation for all motion types and imaging rates was 0.851 and 0.845 for RF and B-mode data, respectively. Data type is expected to have most impact on axial (Superior-Inferior) motion estimation. Axial differences were <0.004 mm for stable and persistent motion and <0.3 mm for transient motion (axial mean errors were lowest for B-mode in all cases). Conclusions: Using the RF or B-mode signal for speckle motion estimation is comparable for translational prostate motion. B-mode image formation may involve other signal-processing steps which also influence motion estimation accuracy. A similar study for respiratory-induced motion would also be prudent. This work is support by Cancer Research UK Programme Grant C33589/A19727.

60 APPLIED LIFE SCIENCES↗

SU-E-P-13: Quantifying the Geometric Error Due to Irregular Motion in Four-Dimensional Computed Tomography (4DCT)

Purpose: Respiratory correlated 4DCT images are generated under the assumption of a regular breathing cycle. This study evaluates the error in 4DCT-based target position estimation in the presence of irregular respiratory motion. Methods: A custom-made programmable externally-and internally-deformable lung motion phantom was placed inside the CT bore. An abdominal pressure belt was placed around the phantom to mimic clinical 4DCT acquisitio and the motion platform was programmed with a sinusoidal (±10mm, 10 cycles per minute) motion trace and 7 motion traces recorded from lung cancer patients. The same setup and motion trajectories were repeated in the linac room and kV fluoroscopic images were acquired using the on-board imager. Positions of 4 internal markers segmented from the 4DCT volumes were overlaid upon the motion trajectories derived from the fluoroscopic time series to calculate the difference between estimated (4DCT) and “actual” (kV fluoro) positions. Results: With a sinusoidal trace, absolute errors of the 4DCT estimated markers positions vary between 0.78mm and 5.4mm and RMS errors are between 0.38mm to 1.7mm. With irregular patient traces, absolute errors of the 4DCT estimated markers positions increased significantly by 100 to 200 percent, while the corresponding RMS error values have much smaller changes. Significant mismatches were frequently found at peak-inhale or peak-exhale phase. Conclusion: As expected, under conditions of well-behaved, periodic sinusoidal motion, the 4DCT yielded much better estimation of marker positions. When an actual patient trace is used 4DCT-derived positions showed significant mismatches with the fluoroscopic trajectories, indicating the potential for geometric and therefore dosimetric errors in the presence of cycle-to-cycle respiratory variations.

60 APPLIED LIFE SCIENCES↗

SU-E-P-30: Clinical Applications of Spatially Fractionated Radiation Therapy (GRID) Using Helical Tomotherapy

Purpose: To present the first clinical applications of Helical Tomotherapy-based spatially fractionated radiotherapy (HT-GRID) for deep seated tumors and associated dosimetric study. Methods: Ten previously treated GRID patients were selected (5 HT-GRID and 5 LINAC-GRID using a commercially available GRID block). Each case was re-planned either in HT-GRID or LINAC-GRID for a total of 10 plans for both techniques using same prescribed dose of 20 Gy to maximum point dose of GRID GTV. For TOMO-GRID, a programmable virtual TOMOGRID template mimicking a GRID pattern was generated. Dosimetric parameters compared included: GRID GTV mean dose (Dmean) and equivalent uniform dose (EUD), GRID GTV dose inhomogeneity (Ratio(valley/peak)), normal tissue Dmean and EUD, and other organs-at-risk(OARs) doses. Results: The median tumor volume was 634 cc, ranging from 182 to 4646 cc. Median distance from skin to the deepest part of tumor was 22cm, ranging from 8.9 to 38cm. The median GRID GTV Dmean and EUD was 10.65Gy (9.8–12.5Gy) and 7.62Gy (4.31–11.06Gy) for HT-GRID and was 6.73Gy (4.44–8.44Gy) and 3.95Gy (0.14–4.2Gy) for LINAC-GRID. The median Ratio(valley/peak) was 0.144(0.05–0.29) for HT-GRID and was 0.055(0.0001–0.14) for LINAC-GRID. For normal tissue in HT-GRID, the median Dmean and EUD was 1.24Gy (0.34–2.54Gy) and 5.45 Gy(3.45–6.89Gy) and was 0.61 Gy(0.11–1.52Gy) and 6Gy(4.45–6.82Gy) for LINAC-GRID. The OAR doses were comparable between the HT-GRID and LINAC-GRID. However, in some cases it was not possible to avoid a critical structure in LINAC-GRID; while HT-GRID can spare more tissue doses for certain critical structures. Conclusion: HT-GRID delivers higher GRID GTV Dmean, EUD and Ratio(valley/peak) compared to LINAC-GRID. HT-GRID delivers higher Dmean and lower EUD for normal tissue compared to LINAC-GRID. TOMOGRID template can be highly patient-specific and allows adjustment of the GRID pattern to different tumor sizes and shapes when they are deeply-seated and cannot be safely treated with LINAC-GRID.

60 APPLIED LIFE SCIENCES↗

SU-E-U-02: The Development of a Practical Ultrasonic System for Cross-Sectional Imaging of Small Animals

Purpose: To test the feasibility of developing a practical medium frequency ultrasound tomography method for small animal imaging. The ability to produce cross-sectional or full body images of a live small animal using a low-cost tabletop ultrasound scanner without any special license would be very beneficial to long term biological studies, where repeated scanning is often required over an extended period of time. Methods: The cross sectional images were produced by compounding multiple B-scans of a laboratory phantom or an animal acquired at different projection angles. Two imaging systems were used to test the concept. The first system included a programmable 64-channel phased array controller driving a 128-channel, 5–10 MHz linear probe to produce 143 B-Mode projections of the spinning object. The second system designed and manufactured in house, produced 64 or 128 B-Mode projections with a single unfocused 8 MHz transducer scanning with a 0.116 mm step size. Results: The phased array system provided good penetration through the phantoms/mice (with the exception of the lungs) and allowed to acquire data in a very short time. The cross-sectional images have enough resolution and dynamic range to detect both high- and low-contrast organs. The single transducer system takes longer to scan, and the data require more sophisticated processing. To date, our images allow seeing details as small as 1–2 mm in the phantoms and in small animals, with the contrast mostly due to highly reflecting bones and air inclusions. Conclusion: The work indicates that very detailed and anatomically correct images can be created by relatively simple and inexpensive means. With more advanced algorithms and improved system design, scan time can be reduced considerably, enabling high-resolution full 3D imaging. This will allow for quick and easy scans that can help monitor tumor growth and/or regression without contributing any dose to the animal. The authors would like to acknowledge the financial and engineering support from Tessonics.

60 APPLIED LIFE SCIENCES↗

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↗

SU-E-J-123: Assessing Segmentation Accuracy of Internal Volumes and Sub-Volumes in 4D PET/CT of Lung Tumors Using a Novel 3D Printed Phantom

Purpose: To assess the accuracy of internal target volume (ITV) segmentation of lung tumors for treatment planning of simultaneous integrated boost (SIB) radiotherapy as seen in 4D PET/CT images, using a novel 3D-printed phantom. Methods: The insert mimics high PET tracer uptake in the core and 50% uptake in the periphery, by using a porous design at the periphery. A lung phantom with the insert was placed on a programmable moving platform. Seven breathing waveforms of ideal and patient-specific respiratory motion patterns were fed to the platform, and 4D PET/CT scans were acquired of each of them. CT images were binned into 10 phases, and PET images were binned into 5 phases following the clinical protocol. Two scenarios were investigated for segmentation: a gate 30–70 window, and no gating. The radiation oncologist contoured the outer ITV of the porous insert with on CT images, while the internal void volume with 100% uptake was contoured on PET images for being indistinguishable from the outer volume in CT images. Segmented ITVs were compared to the expected volumes based on known target size and motion. Results: 3 ideal breathing patterns, 2 regular-breathing patient waveforms, and 2 irregular-breathing patient waveforms were used for this study. 18F-FDG was used as the PET tracer. The segmented ITVs from CT closely matched the expected motion for both no gating and gate 30–70 window, with disagreement of contoured ITV with respect to the expected volume not exceeding 13%. PET contours were seen to overestimate volumes in all the cases, up to more than 40%. Conclusion: 4DPET images of a novel 3D printed phantom designed to mimic different uptake values were obtained. 4DPET contours overestimated ITV volumes in all cases, while 4DCT contours matched expected ITV volume values. Investigation of the cause and effects of the discrepancies is undergoing.

60 APPLIED LIFE SCIENCES↗

SU-E-J-219: A Dixon Based Pseudo-CT Generation Method for MR-Only Radiotherapy Treatment Planning of the Pelvis and Head and Neck

Purpose: To develop an image processing method for MRI-based generation of electron density maps, known as pseudo-CT (pCT), without usage of model- or atlas-based segmentation, and to evaluate the method in the pelvic and head-neck region against CT. Methods: CT and MRI scans were obtained from the pelvic region of four patients in supine position using a flat table top only for CT. Stratified CT maps were generated by classifying each voxel based on HU ranges into one of four classes: air, adipose tissue, soft tissue or bone.A hierarchical region-selective algorithm, based on automatic thresholding and clustering, was used to classify tissues from MR Dixon reconstructed fat, In-Phase (IP) and Opposed-Phase (OP) images. First, a body mask was obtained by thresholding the IP image. Subsequently, an automatic threshold on the Dixon fat image differentiated soft and adipose tissue. K-means clustering on IP and OP images resulted in a mask that, via a connected neighborhood analysis, allowing the user to select the components corresponding to bone structures.The pCT was estimated through assignment of bulk HU to the tissue classes. Bone-only Digital Reconstructed Radiographs (DRR) were generated as well. The pCT images were rigidly registered to the stratified CT to allow a volumetric and voxelwise comparison. Moreover, pCTs were also calculated within the head-neck region in two volunteers using the same pipeline. Results: The volumetric comparison resulted in differences <1% for each tissue class. A voxelwise comparison showed a good classification, ranging from 64% to 98%. The primary misclassified classes were adipose/soft tissue and bone/soft tissue. As the patients have been imaged on different table tops, part of the misclassification error can be explained by misregistration. Conclusion: The proposed approach does not rely on an anatomy model providing the flexibility to successfully generate the pCT in two different body sites. This research is founded by ZonMw IMDI Programme, project name: “RASOR sharp: MRI based radiotherapy planning using a single MRI sequence”, project number: 10-104003010.

60 APPLIED LIFE SCIENCES↗

SU-E-T-163: Characterization of a Novel High Resolution 1D Silicon Monolithic Array for Small Field Commissioning and Quality Assurance

Purpose: To study the suitability of a novel 1D silicon monolithic array for dosimetry of small radiation fields and for QA of high dose gradient treatment modalities (IMRT and SBRT). Methods: A 1D array composed of 4 monolithic silicon modules of 64 mm length and 1 mm pixel pitch was developed by IBA Dosimetry. Measurements were carried out for 6MV and 15MV photons on two commercial different linacs (TrueBeam and Clinac iX, Varian Medical Systems, Palo Alto, CA) and for a CyberKnife G4 (Accuray Inc., Sunnyvale, CA). The 1D array was used to measure output factors (OF), profiles and off axis correction factors (OACF) for the Iris CyberKnife variable collimator (5–60 mm). In addition, dose profiles (at the isocenter plane) were measured for multiple IMRT and SBRT treatment plans and compared with those obtained using EDR2radiographic film (Carestream Health, Rochester NY), a commercial 2D diode array and with the dose distribution calculated using a commercial TPS (Eclipse, Varian Medical Systems, Palo Alto, CA). Results: Due to the small pixel pitch of the detector, IMRT and SBRT plan profiles deviate from film measurements by less than 2%. Similarly, the 1D array exhibits better performance than the 2D diode array due to the larger (7 mm) pitch of that device. Iris collimator OFs measured using the 1D silicon array are in good agreement with the commissioning values obtained using a commercial stereotactic diode as well as with published data. Maximum deviations are < 3% for the smallest field (5 and 7.5mm) and below 1% for all other dimensions. Conclusion: We have demonstrated good performances of the array for commissioning of small photon fields and in patient QA, compared with diodes and film typically used in these clinical applications. The technology compares favorably with existing commercial solutions The presenting author is founded by a Marie Curie Early Initial Training Network Fellowship of the European Communitys Seventh Framework Programme under contract number (PITN-GA-2011-289198-ARDENT). The research activity is hosted by IBA Dosimetry, Gmbh.

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-421: Failure Mode and Effects Analysis (FMEA) of Xoft Electronic Brachytherapy for the Treatment of Superficial Skin Cancers

Purpose: To perform a failure mode and effects analysis (FMEA) of the process for treating superficial skin cancers with the Xoft Axxent electronic brachytherapy (eBx) system, given the recent introduction of expanded quality control (QC) initiatives at our institution. Methods: A process map was developed listing all steps in superficial treatments with Xoft eBx, from the initial patient consult to the completion of the treatment course. The process map guided the FMEA to identify the failure modes for each step in the treatment workflow and assign Risk Priority Numbers (RPN), calculated as the product of the failure mode’s probability of occurrence (O), severity (S) and lack of detectability (D). FMEA was done with and without the inclusion of recent QC initiatives such as increased staffing, physics oversight, standardized source calibration, treatment planning and documentation. The failure modes with the highest RPNs were identified and contrasted before and after introduction of the QC initiatives. Results: Based on the FMEA, the failure modes with the highest RPN were related to source calibration, treatment planning, and patient setup/treatment delivery (Fig. 1). The introduction of additional physics oversight, standardized planning and safety initiatives such as checklists and time-outs reduced the RPNs of these failure modes. High-risk failure modes that could be mitigated with improved hardware and software interlocks were identified. Conclusion: The FMEA analysis identified the steps in the treatment process presenting the highest risk. The introduction of enhanced QC initiatives mitigated the risk of some of these failure modes by decreasing their probability of occurrence and increasing their detectability. This analysis demonstrates the importance of well-designed QC policies, procedures and oversight in a Xoft eBx programme for treatment of superficial skin cancers. Unresolved high risk failure modes highlight the need for non-procedural quality initiatives such as improved planning software and more robust hardware interlock systems.

60 APPLIED LIFE SCIENCES↗

SU-E-T-594: Out-Of-Field Neutron and Gamma Dose Estimated Using TLD-600/700 Pairs in the Wobbling Proton Therapy System

Purpose: Secondary fast neutrons and gamma rays are mainly produced due to the interaction of the primary proton beam with the beam delivery nozzle. These secondary radiation dose to patients and radiation workers are unwanted. The purpose of this study is to estimate the neutron and gamma dose equivalent out of the treatment volume during the wobbling proton therapy system. Methods: Two types of thermoluminescent (TL) dosimeters, TLD-600 ({sup 6}LiF: Mg, Ti) and TLD-700 ({sup 7}LiF: Mg, Ti) were used in this study. They were calibrated in the standard neutron and gamma sources at National Standards Laboratory. Annealing procedure is 400°C for 1 hour, 100°C for 2 hours and spontaneously cooling down to the room temperature in a programmable oven. Two-peak method (a kind of glow curve analysis technique) was used to evaluate the TL response corresponding to the neutron and gamma dose. The TLD pairs were placed outside the treatment field at the neutron-gamma mixed field with 190-MeV proton beam produced by the wobbling system through the polyethylene plate phantom. The results of TLD measurement were compared to the Monte Carlo simulation. Results: The initial experiment results of calculated dose equivalents are 0.63, 0.38, 0.21 and 0.13 mSv per Gy outside the field at the distance of 50, 100, 150 and 200 cm. Conclusion: The TLD-600 and TLD-700 pairs are convenient to estimate neutron and gamma dosimetry during proton therapy. However, an accurate and suitable glow curve analysis technique is necessary. During the wobbling system proton therapy, our results showed that the neutron and gamma doses outside the treatment field are noticeable. This study was supported by the grants from the Chang Gung Memorial Hospital (CMRPD1C0682)

61 RADIATION PROTECTION AND DOSIMETRY↗