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DOE OSTI2015

Quantification and comparison of visibility and image artifacts of a new liquid fiducial marker in a lung phantom for image-guided radiation therapy

Purpose: A new biodegradable liquid fiducial marker was devised to allow for easy insertion in lung tumors using thin needles. The purpose of this study was to evaluate the visibility of the liquid fiducial markers for image-guided radiation therapy and compare to existing solid fiducial markers and to one existing liquid fiducial marker currently commercially available. Methods: Fiducial marker visibility was quantified in terms of contrast to noise ratio (CNR) on planar kilovoltage x-ray images in a thorax phantom for different concentrations of the radio-opaque component of the new liquid fiducial marker, four solid fiducial markers, and one existing liquid fiducial marker. Additionally, the image artifacts produced on computer tomography (CT) and cone-beam CT (CBCT) of all fiducial markers were quantified. Results: The authors found that the new liquid fiducial marker with the highest concentration of the radio-opaque component had a CNR > 2.05 for 62/63 exposures, which compared favorably to the existing solid fiducial markers and to the existing liquid fiducial marker evaluated. On CT and CBCT, the new liquid fiducial marker with the highest concentration produced lower streaking index artifact (30 and 14, respectively) than the solid gold markers (113 and 20, respectively) and the existing liquid fiducial marker (39 and 20, respectively). The size of the image artifact was larger for all of the liquid fiducial markers compared to the solid fiducial markers because of their larger physical size. Conclusions: The visibility and the image artifacts produced by the new liquid fiducial markers were comparable to existing solid fiducial markers and the existing liquid fiducial marker. The authors conclude that the new liquid fiducial marker represents an alternative to the fiducial markers tested.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

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↗

DOE OSTI2015

SU-E-J-205: Dose Distribution Differences Caused by System Related Geometric Distortion in MRI-Guided Radiation Treatment System

Purpose: MRI has superb soft tissue contrast but is also known for geometric distortions. The concerns and uncertainty about MRI’s geometric distortion have contributed to the hesitation of using only MRI for simulation in radiation therapy. There are two major categories of geometric distortion in MRI; system related and patient related. In this presentation, we studied the impact of system-related geometric distortion on dose distribution in a digital body phantom under an MR-Linac environment. Methods: Residual geometric distortion (after built-in geometric correction) was modeled based on phantom measurements of the system-related geometric distortions of a MRI scanner of a combined MR guided Radiation Therapy (MRgRT) system. A digital oval shaped phantom (40×25 cm) as well as one ellipsoid shaped tumor volume was created to simulate a simplified human body. The simulated tumor volume was positioned at several locations between the isocenter and the body surface. CT numbers in HUs that approximate soft tissue and tumor were assigned to the respective regions in the digital phantom. To study the effect of geometric distortion caused by system imperfections, an IMRT plan was optimized with the distorted image set with the B field. Dose distributions were re-calculated on the undistorted image set with the B field (as in MR-Linac). Results: The maximum discrepancies in both body contour and tumor boundary was less than 2 mm, which leads to small dose distribution change. For the target in the center, coverage was reduced from 98.8% (with distortion) to 98.2%; for the other peripheral target coverage was reduced from 98.4% to 95.9%. Conclusion: System related geometric distortions over the 40×25 area were within 2mm and the resulted dosimetric effects were minor for the two tumor locations in the phantom. Patient study will be needed for further investigation. The authors received a corporate research grant from Elekta.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

SU-E-J-210: Characterizing Tissue Equivalent Materials for the Development of a Dual MRI-CT Heterogeneous Anthropomorphic Phantom Designed Specifically for MRI Guided Radiotherapy Systems

Purpose: MRI guided radiotherapy (MRIgRT) is an emerging technology which will eventually require a proficient quality auditing system. Due to different principles in which MR and CT acquire images, there is a need for a multi-imaging-modality, end-to-end QA phantom for MRIgRT. The purpose of this study is to identify lung, soft tissue, and tumor equivalent substitutes that share similar human-like CT and MR properties (i.e. Hounsfield units and relaxation times). Methods: Materials of interested such as common CT QA phantom materials, and other proprietary gels/silicones from Polytek, SmoothOn, and CompositeOne were first scanned on a GE 1.5T Signa HDxT MR. Materials that could be seen on both T1-weighted and T2-weighted images were then scanned on a GE Lightspeed RT16 CT simulator and a GE Discovery 750HD CT scanner and their HU values were then measured. The materials with matching HU values of lung (−500 to −700HU), muscle (+40HU) and soft tissue (+100 to +300HU) were further scanned on GE 1.5T Signa HDx to measure their T1 and T2 relaxation times from varying parameters of TI and TE. Results: Materials that could be visualized on T1-weighted and T2-weighted images from a 1.5T MR unit and had an appropriate average CT number, −650, −685, 46,169, and 168 HUs were: compressed cork saturated with water, Polytek Platsil™ Gel-00 combined with mini styrofoam balls, radiotherapy bolus material, SmoothOn Dragon-Skin™ and SmoothOn Ecoflex™, respectively. Conclusion: Post processing analysis is currently being performed to accurately map T1 and T2 values for each material tested. From previous MR visualization and CT examinations it is expected that Dragon-Skin™, Ecoflex™ and bolus will have values consistent with tissue and tumor substitutes. We also expect compressed cork statured with water, and Polytek™-styrofoam combination to have approximate T1 and T2 values suitable for lung-equivalent materials.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

SU-E-T-335: Dosimetric Investigation of An Advanced Rotating Gamma Ray System for Imaged Guided Radiation Therapy

Purpose: Co-60 beams have unique dosimetric properties for cranial treatments and thoracic cancers. The conventional concern about the high surface dose is overcome by modern system designs with rotational treatment techniques. This work investigates a novel rotational Gamma ray system for image-guided, external beam radiotherapy. Methods: The CybeRT system (Cyber Medical Corp., China) consists of a ring gantry with either one or two treatment heads containing a Gamma source and a multileaf collimator (MLC). The MLC has 60 paired leaves, and the maximum field size is either 40cmx40cm (40 pairs of 0.5cm central leaves, 20 pairs of 1cm outer leaves), or 22cmx40cm (32 pairs of 0.25cm central leaves, 28 pairs of 0.5cm outer leaves). The treatment head(s) can swing 35° superiorly and 8° inferiorly, allowing a total of 43° non-coplanar beam incident. The treatment couch provides 6-degrees-of-freedom motion compensation and the kV cone-beam CT system has a spatial resolution of 0.4mm. Monte Carlo simulations were used to compute dose distributions and compare with measurements. A retrospective study of 98 previously treated patients was performed to compare CybeRT with existing RT systems. Results: Monte Carlo results confirmed the CybeRT design parameters including output factors and 3D dose distributions. Its beam penumbra/dose gradient was similar to or better than that of 6MV photon beams and its isocenter accuracy is 0.3mm. Co-60 beams produce lower-energy secondary electrons that exhibit better dose properties in low-density lung tissues. Because of their rapid depth dose falloff, Co-60 beams are favorable for peripheral lung tumors with half-arc arrangements to spare the opposite lung and critical structures. Superior dose distributions were obtained for head and neck, breast, spine and lung tumors. Conclusion: Because of its accurate dose delivery and unique dosimetric properties of C-60 sources, CybeRT is ideally suited for advanced SBRT as well as conventional RT. This work was partially supported by Cyber Medical Corp.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

SU-E-T-786: Utility of Gold Wires to Optimize Intensity Modulation Capacity of a Novel Directional Modulated Brachytherapy Tandem Applicator for Image Guided Cervical Cancer Brachytherapy

Purpose: To evaluate the impact of using gold wires to differentially fill various channels on plan quality compared with conventional T&R applicator, inside a novel directional modulated brachytherapy (DMBT) tandem applicator for cervical cancer brachytherapy. Materials and Methods: The novel DMBT tandem applicator has a 5.4-mm diameter MR-compatible tungsten alloy enclosed in a 0.3-mm thick plastic tubing that wraps around the tandem. To modulate the radiation intensity, 6 symmetric peripheral holes of 1.3-mm diameter are grooved along the tungsten alloy rod. These grooved holes are differentially filled with gold wires to generate various degrees of directional beams. For example, three different fill patterns of 1) all void, 2) all filled except the hole containing the 192-Ir source, and 3) two adjacent holes to the 192-Ir source filled were Monte Carlo simulated. The resulting 3D dose distributions were imported into an in-house-coded inverse optimization planning system to generate HDR brachytherapy clinical plans for 19 patient cases. All plans generated were normalized to the same D90 as the clinical plans and D2cc doses of OARs were evaluated. Prescription ranged between 15 and 17.5Gy. Results: In general, the plans in case 1) resulted in the highest D2cc doses for the OARs with 11.65±2.30Gy, 7.47±3.05Gy, and 9.84±2.48Gy for bladder, rectum, and sigmoid, respectively, although the differences were small. For the case 2), D2cc doses were 11.61±2.29Gy, 7.41±3.07Gy, and 9.75±2.45Gy, respectively. And, for the case 3), D2cc doses were 11.60±2.28Gy, 7.41±3.05Gy, and 9.74±2.45Gy, respectively. Difference between 1) and 2) cases were small with the average D2cc difference of <0.64%. Difference between 1) and 3) cases were even smaller with the average D2cc difference of <0.1%. Conclusions: There is a minimal clinical benefit by differentially filling grooved holes in the novel DMBT tandem applicator for image guided cervical cancer brachytherapy.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

SU-F-303-17: Real Time Dose Calculation of MRI Guided Co-60 Radiotherapy Treatments On Free Breathing Patients, Using a Motion Model and Fast Monte Carlo Dose Calculation

Purpose: To demonstrate real-time dose calculation of free-breathing MRI guided Co−60 treatments, using a motion model and Monte-Carlo dose calculation to accurately account for the interplay between irregular breathing motion and an IMRT delivery. Methods: ViewRay Co-60 dose distributions were optimized on ITVs contoured from free-breathing CT images of lung cancer patients. Each treatment plan was separated into 0.25s segments, accounting for the MLC positions and beam angles at each time point. A voxel-specific motion model derived from multiple fast-helical free-breathing CTs and deformable registration was calculated for each patient. 3D images for every 0.25s of a simulated treatment were generated in real time, here using a bellows signal as a surrogate to accurately account for breathing irregularities. Monte-Carlo dose calculation was performed every 0.25s of the treatment, with the number of histories in each calculation scaled to give an overall 1% statistical uncertainty. Each dose calculation was deformed back to the reference image using the motion model and accumulated. The static and real-time dose calculations were compared. Results: Image generation was performed in real time at 4 frames per second (GPU). Monte-Carlo dose calculation was performed at approximately 1frame per second (CPU), giving a total calculation time of approximately 30 minutes per treatment. Results show both cold- and hot-spots in and around the ITV, and increased dose to contralateral lung as the tumor moves in and out of the beam during treatment. Conclusion: An accurate motion model combined with a fast Monte-Carlo dose calculation allows almost real-time dose calculation of a free-breathing treatment. When combined with sagittal 2D-cine-mode MRI during treatment to update the motion model in real time, this will allow the true delivered dose of a treatment to be calculated, providing a useful tool for adaptive planning and assessing the effectiveness of gated treatments.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

MO-DE-210-03: Ultrasound imaging is an attractive method for image guided radiation treatment (IGRT), by itself or to complement other imaging modalities

Ultrasound imaging is an attractive method for image guided radiation treatment (IGRT), by itself or to complement other imaging modalities. It is inexpensive, portable and provides good soft tissue contrast. For challenging soft tissue targets such as pancreatic cancer, ultrasound imaging can be used in combination with pre-treatment MRI and/or CT to transfer important anatomical features for target localization at time of treatment. The non-invasive and non-ionizing nature of ultrasound imaging is particularly powerful for intra-fraction localization and monitoring. Recognizing these advantages, efforts are being made to incorporate novel robotic approaches to position and manipulate the ultrasound probe during irradiation. These recent enabling developments hold potential to bring ultrasound imaging to a new level of IGRT applications. However, many challenges, not limited to image registration, robotic deployment, probe interference and image acquisition rate, need to be addressed to realize the full potential of IGRT with ultrasound imaging. Learning Objectives: Understand the benefits and limitations in using ultrasound to augment MRI and/or CT for motion monitoring during radiation therapy delivery. Understanding passive and active robotic approaches to implement ultrasound imaging for intra-fraction monitoring. Understand issues of probe interference with radiotherapy treatment. Understand the critical clinical workflow for effective and reproducible IGRT using ultrasound guidance. The work of X.L. is supported in part by Elekta; J.W. and K.D. is supported in part by a NIH grant R01 CA161613 and by Elekta; D.H. is support in part by a NIH grant R41 CA174089.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

MO-FG-BRA-01: Development of An Image-Guided Dosimetric Planning System for Injectable Brachytherapy Using ELP Nanoparticles

Purpose: To develop, validate, and evaluate a methodology for determining dosimetry for intratumoral injections of elastin-like-polypeptide (ELP) brachytherapy nanoparticles. These organic-polymer-based nanoparticles are injectable, biodegradable, and genetically tunable. We present a genetically encoded polymer-solution, composed of novel radiolabeled-ELP nanoparticles that are custom-designed to self-assemble into a local source upon intratumoral injection. Our preliminary results of a small animal study demonstrate 100% tumor response, effective radionuclide retention-rates, strong in vivo stability, and no polymer-induced toxicities. While our approach is therefore highly promising for improved brachytherapy, the current workflow lacks a dosimetry framework. Methods: We are developing a robust software framework that provides image-guided dosimetric-planning capabilities for ELP brachytherapy. The user graphically places ELP injection sites within a µCT-planning-image, and independently defines each injection volume, concentration, and radioisotope to be used. The resulting internal dosimetry is then pre-determined by first modeling post-injection ELP advection-diffusion, and then calculating the resulting dose distribution based on a point- dose-kernel-convolution algorithm. We have experimentally measured ELP steady-state concentrations via µSPECT acquisition, and validated our dose calculation algorithm against Monte Carlo simulations of several radioactivity distributions. Finally, we have investigated potential advantages and limitations of various ELP injection parameters. Results: The µSPECT results demonstrated inhomogeneous steady-state distributions of ELP in tissue, and Monte Carlo radioactivity distributions were designed accordingly. Our algorithm yielded a root-mean-square-error of less than 2% for each distribution tested (average root-mean-square-error was 0.73%). Dose-Volume-Histogram analysis of five different plans showed how strategic injection placement, and an injection volume-tapering technique, could be used to achieve D95% target coverage. Conclusion: We have preliminarily developed a novel planning framework for ELP brachytherapy. Its dosimetry accuracy has been validated against Monte Carlo, and we have started to investigate the potential advantages of injection-based planning. This system, once fully developed, will serve as the technical foundation for our novel approach.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

MO-FG-BRA-07: Theranostic Gadolinium-Based AGuIX Nanoparticles for MRI-Guided Radiation Therapy

Purpose: AGuIX are gadolinium-based nanoparticles, initially developed for MRI, that have a potential role in radiation therapy as a radiosensitizer. Our goal is to demonstrate that these nanoparticles can both be used as an MRI contrast agent, as well as to obtain local dose enhancement in a pancreatic tumor when delivered in combination with an external beam irradiation. Methods: We performed in vitro cell uptake and radiosensitization studies of a pancreatic cancer cell line in a low energy (220kVp) beam, a standard clinical 6MV beam (STD) and a flattening filter free clinical 6MV beam (FFF). After injection of 40mM of nanoparticles, a biodistribution study was performed in vivo on mice with subcutaneous xenograft pancreatic tumors. In vivo radiation therapy studies were performed at the time point of maximum tumor uptake. Results: The concentration of AGuIX nanoparticles in Panc-1 pancreatic cancer cells, determined in vitro by MRI and ICPMS, peaks after 30 minutes with 0.3% of the initial concentration (5mg/g). Clonogenic assays show a significant effect (p<0.05) when the AGuIX are coupled with MV photon irradiation (DEF20%=1.31). Similar AGuIX tumor uptake is found in vivo by both MRI and ICPMS 30 minutes after intravenous injection. For long term survival studies, the choice of the radiation dose is determined with 5 control groups (3mice/group) irradiated with 0, 5, 10, 15, and 20Gy. Afterwards, 4 groups (8mice/group) are used to evaluate the effect of the nanoparticles. A Logrank test is performed as a statistical test to evaluate the effect of the nanoparticles. Conclusion: The combination of the MRI contrast and radiosensitization properties of gadolinium nanoparticles reveals a strong potential for usage with MRI-guided radiation therapy.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

MO-FG-210-00: US Guided Systems for Brachytherapy

Ultrasound (US) is one of the most widely used imaging modalities in medical practice. Since US imaging offers real-time imaging capability, it has becomes an excellent option to provide image guidance for brachytherapy (IGBT). (1) The physics and the fundamental principles of US imaging are presented, and the typical steps required to commission an US system for IGBT is provided for illustration. (2) Application of US for prostate HDR brachytherapy, including partial prostate treatments using MR-ultrasound co-registration to enable a focused treatment on the disease within the prostate is also presented. Prostate HDR with US image guidance planning can benefit from real time visualization of the needles, and fusion of the ultrasound images with T2 weighted MR allows the focusing of the treatment to the specific areas of disease within the prostate, so that the entire gland need not be treated. Finally, (3) ultrasound guidance for an eye plaque program is presented. US can be a key component of placement and QA for episcleral plaque brachytherapy for ocular cancer, and the UCLA eye plaque program with US for image guidance is presented to demonstrate the utility of US verification of plaque placement in improving the methods and QA in episcleral plaque brachytherapy. Learning Objectives: To understand the physics of an US system and the necessary aspects of commissioning US for image guided brachytherapy (IGBT). To understand real time planning of prostate HDR using ultrasound, and its application in partial prostate treatments using MR-ultrasound fusion to focus treatment on disease within the prostate. To understand the methods and QA in applying US for localizing the target and the implant during a episcleral plaque brachytherapy procedures.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

MO-FG-210-02: Implementation of Image-Guided Prostate HDR Brachytherapy Using MR-Ultrasound Fusion

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

MO-FG-210-03: Intraoperative Ultrasonography-Guided Positioning of Plaque Brachytherapy in the Treatment of Choroidal Melanoma

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

MO-F-CAMPUS-I-01: A System for Automatically Calculating Organ and Effective Dose for Fluoroscopically-Guided Procedures

Purpose: A system was developed that automatically calculates the organ and effective dose for individual fluoroscopically-guided procedures using a log of the clinical exposure parameters. Methods: We have previously developed a dose tracking system (DTS) to provide a real-time color-coded 3D- mapping of skin dose. This software produces a log file of all geometry and exposure parameters for every x-ray pulse during a procedure. The data in the log files is input into PCXMC, a Monte Carlo program that calculates organ and effective dose for projections and exposure parameters set by the user. We developed a MATLAB program to read data from the log files produced by the DTS and to automatically generate the definition files in the format used by PCXMC. The processing is done at the end of a procedure after all exposures are completed. Since there are thousands of exposure pulses with various parameters for fluoroscopy, DA and DSA and at various projections, the data for exposures with similar parameters is grouped prior to entry into PCXMC to reduce the number of Monte Carlo calculations that need to be performed. Results: The software developed automatically transfers data from the DTS log file to PCXMC and runs the program for each grouping of exposure pulses. When the dose from all exposure events are calculated, the doses for each organ and all effective doses are summed to obtain procedure totals. For a complicated interventional procedure, the calculations can be completed on a PC without manual intervention in less than 30 minutes depending on the level of data grouping. Conclusion: This system allows organ dose to be calculated for individual procedures for every patient without tedious calculations or data entry so that estimates of stochastic risk can be obtained in addition to the deterministic risk estimate provided by the DTS. Partial support from NIH grant R01EB002873 and Toshiba Medical Systems Corp.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

TU-AB-303-09: Investigation of Simple Method to Guide Adaptive Radiotherapy of Head-And-Neck Treatment Using Portal Imager

Purpose: Planned dose distribution for IMRT or VMAT could be altered by tissue changes during treatment course as in head and neck patients. Thus the aim of our study is to investigate a simple method that guides decision for re-planning. We will correlate changes in exit fluence tracked through entire treatment course with the anatomical changes. Methods: Fifteen patients were planned for IMRT; weekly CT scan was registered to original CT. Volume changes of different structures were assessed for each week. Frequently integrated images were acquired for all fields twice weekly via portal imager. The delivered fluences were compared with reference images. Gamma analysis (3% and 3 mm) including maximum γ, and percentage of points with γ≥ 1, were calculated for all fields. Results: Continuous reduction in GTV, CTV1 and parotids volumes during treatment was found [median value of 5.3 (1.3–20.8), 23.8 (3.0–128.7) and 1.7 (0.5–6.3) cm3 respectively] with significant change on week 2 (p= < 0.005). Also the value of gamma area >1 parameter continued to increase, significantly (P < 0.005), starting from second week (1.8 ± 1.9%) reaching 4.1 ± 1.6% by the end of treatment. Most of these changes in the exit fluences are significantly correlated to patient anatomy variations. Pearson correlation coefficient was −0.984 (P = 0.002) and −0.984 (P = 0.014) for the maximum gamma value and the value of gamma area >1, respectively. Conclusion: The changes in exit fluences are reflecting the corresponding anatomical changes. We proposed a method to track the changes in the averaged maximum gamma value and the gamma area > 1 value for the exit fluences during treatment. Maximum gamma value of 2.6% and Maximum gamma area > 1 value of 1.8% would be useful boarder lines that if exceeded a re-planning would be recommended.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

TU-AB-201-01: A Comprehensive Planning Comparison Study Between a Novel Direction Modulated Brachytherapy Tandem Applicator and Conventional T&R Applicator for Image Guided Cervical Cancer Brachytherapy

Purpose: To demonstrate that utilization of a novel, intensity modulation capable, direction modulated brachytherapy (DMBT) tandem applicator can improve plan quality compared with conventional T&R applicator during an image guided cervical cancer brachytherapy. Methods: 45 cervical cancer patients treated with PDR brachytherapy were reviewed. Of them, a) 27 were treated using T&R only, b) 9 were treated using T&R with needles attached to the ring, and c) the remaining 9 were treated using T&R with needles attached to the ring (AN) as well as additional free-hand-loaded needles (FN). The DMBT tandem design has 6 peripheral holes of 1.3-mm diameter, grooved along a nonmagnetic tungsten alloy rod, enclosed in a plastic sheath with total 6.0-mm diameter. An in-house-coded inverse planning system was used for planning DMBT and T&R cases. All typical clinical constraints including OAR dose limits, dwell times, and loading patterns were respected. For the DMBT and T&R applicators, the plans were optimized with the same conventional ring in place, but repeatedly planned with and without AN/FN needles. All generated plans were normalized to the same D90 of the clinically treated plans. Results: For the plans in category a), DMBT generally outperformed T&R with average reduction in D2cc of −2.39%, −5.21%, and −2.69% for bladder, rectum, and sigmoid, respectively. For the plans in category b) and c), DMBT generally outperformed T&R if the same needles in AN/FN were utilized in both cases with average reduction in D2cc of −1.82%, −3.40%, and −6.04%, respectively. For the cases where the needles were not utilized for both applicators, an average D2cc reduction of −7.45%, −7.61%, and 17.47% were observed, respectively. Conclusions: Under the same clinical conditions, with/without needles, the DMBT applicator tends to generate more favorable plans compared with the conventional T&R applicator, and hence, is a promising technology.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

WE-AB-BRA-07: Quantitative Evaluation of 2D-2D and 2D-3D Image Guided Radiation Therapy for Clinical Trial Credentialing, NRG Oncology/RTOG

Purpose: 2D-2D kV image guided radiation therapy (IGRT) credentialing evaluation for clinical trial qualification was historically qualitative through submitting screen captures of the fusion process. However, as quantitative DICOM 2D-2D and 2D-3D image registration tools are implemented in clinical practice for better precision, especially in centers that treat patients with protons, better IGRT credentialing techniques are needed. The aim of this work is to establish methodologies for quantitatively reviewing IGRT submissions based on DICOM 2D-2D and 2D-3D image registration and to test the methodologies in reviewing 2D-2D and 2D-3D IGRT submissions for RTOG/NRG Oncology clinical trials qualifications. Methods: DICOM 2D-2D and 2D-3D automated and manual image registration have been tested using the Harmony tool in MIM software. 2D kV orthogonal portal images are fused with the reference digital reconstructed radiographs (DRR) in the 2D-2D registration while the 2D portal images are fused with DICOM planning CT image in the 2D-3D registration. The Harmony tool allows alignment of the two images used in the registration process and also calculates the required shifts. Shifts calculated using MIM are compared with those submitted by institutions for IGRT credentialing. Reported shifts are considered to be acceptable if differences are less than 3mm. Results: Several tests have been performed on the 2D-2D and 2D-3D registration. The results indicated good agreement between submitted and calculated shifts. A workflow for reviewing these IGRT submissions has been developed and will eventually be used to review IGRT submissions. Conclusion: The IROC Philadelphia RTQA center has developed and tested a new workflow for reviewing DICOM 2D-2D and 2D-3D IGRT credentialing submissions made by different cancer clinical centers, especially proton centers. NRG Center for Innovation in Radiation Oncology (CIRO) and IROC RTQA center continue their collaborative efforts to enhance quality assurance services and to be consistently adaptive to the new advances in radiation therapy. This project was supported by NCI grants U10CA180868, U10CA180822, U24CA180803, U24CA12014 and PA CURE Grant.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

WE-D-BRD-01: New Linac Designs for MR-Guided Therapy Systems

The advantages that make MR highly desirable for in-room treatment guidance, i.e. soft-tissue visualization and physiological assessment of healthy/tumor tissues, are largely recognized in the research community. However, the MR absorption in practical clinical workflows is still hindered by lack of sufficient technological infrastructure. Recent advances have been made towards filling that gap such as the development of integrated therapy systems relying on an MR scanner and a radiation source (linac, Co-60) and/or brachytherapy. The session is intended to present new efforts and methods aimed at facilitating the adoption of MR guidance for treatment delivery. Specifically, the discussion will focus on a) linac designs for reduced footprint and seamless integration with MR/linac systems, b) tracking coils for brachytherapy applications, and c) procedures for the commissioning and monitoring of MR and MR/linac performance. Learning Objectives: Understand limitations and proposed solutions for linac designs and associated integration with MR/linac systems; Understand current issues with MR-guided brachytherapy procedures Understand the issues and needs for new MR commissioning and QC. License agreement with Modus Medical Devices to develop a phantom for the quantification of MR image distortions.

60 APPLIED LIFE SCIENCES↗