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All sourcesNASA NTRSDOE OSTI
DOE OSTI2021

Functional Adaptation of LPS-affected Dentoalveolar Fibrous Joints in Rats

We report the functional interplay between cementum of the root and alveolar bone of the socket is tuned by a uniquely positioned 70–80 µm wide fibrous and lubricious ligament in a dentoalveolar joint (DAJ). In this study, structural and biomechanical properties of the DAJ, periodontal ligament space (PDL-space also known as the joint space), alveolar bone of the socket, and cementum of the tooth root that govern the biomechanics of a lipopolysaccharide (LPS)-affected DAJ were mapped both in space and time. The hemi-maxillae from 20 rats (4 control at 6 weeks of age, 4 control and 4 LPS-affected at 12 weeks of age, 4 control and 4 LPS-affected at 16 weeks of age) were investigated using a hybrid technique; micro-X-ray computed tomography (5 µm resolution) in combination with biomechanical testing in situ. Temporal variations in bone and cementum volume fractions were evaluated. Trends in mineral apposition rates (MAR) in additional six Sprague Dawley rats (3 controls, 3 LPS-affected) were revealed by transforming spatial fluorochrome signals to functional growth rates (linearity factor - RW) of bone, dentin, and cementum using a fast Fourier transform on fluorochrome signals from 100-µm hemi-maxillae sections. An overall change in LPS-affected DAJ biomechanics (a 2.5–4.5X increase in tooth displacement and 2X tooth rotation at 6 weeks, no increase in displacement and a 7X increase in rotation at 12 weeks; 27% increase in bone effective strain at 6 weeks and 11% at 12 weeks relative to control) was associated with structural changes in the coronal regions of the DAJ (15% increase in PDL-space from 0 to 6 weeks but only 5% from 6 to 12 weeks compared to control). A significant increase (p < 0.05) in PDL-space between ligated and age-matched control was observed. The bone fraction of ligated at 12 weeks was significantly lower than its age-matched control, and no significant differences (p > 0.05) between groups were observed at 6 weeks. Cementum in the apical regions grew faster but nonlinearly (11% and 20% increase in cementum fraction (CF) at 6 and 12 weeks) compared to control. Alveolar bone revealed site-specific nonlinear growth with an overall increase in MAR (108.5 µm/week to 126.7 µm/week after LPS treatment) compared to dentin (28.3 µm/week in control vs. 26.1 µm/week in LPS-affected) and cementum (126.5 µm/week in control vs. 119.9 µm/week in LPS-affected). A significant increase in CF (p < 0.05) in ligated specimens was observed at 6 weeks of age. Anatomy-specific responses of cementum and bone to the mechano-chemo stimuli, and their collective temporal contribution to observed changes in PDL-space were perpetuated by altered tooth movement. Data highlight the “resilience” of DAJ function through the predominance of nonlinear growth response of cementum, changes in PDL-space, and bone architecture. Despite the significant differences in bone and cementum architectures, data provided insights into the reactionary effects of cementum as a built-in compensatory mechanism to reestablish functional competence of the DAJ. The spatial shifts in architectures of alveolar bone and cementum, and consequently ligament space, highlight adaptations farther away from the site of insult, which also is another novel insight from this study. These adaptations when correlated within the context of joint function (biomechanics) illustrate that they are indeed necessary to sustain DAJ function albeit being pathological.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2018

Acclimation and adaptation components of the temperature dependence of plant photosynthesis at the global scale

The temperature response of photosynthesis is one of the key factors determining predicted responses to warming in global vegetation models (GVMs). The response may vary geographically, due to genetic adaptation to climate, and temporally, due to acclimation to changes in ambient temperature. Our goal was to develop a robust quantitative global model representing acclimation and adaptation of photosynthetic temperature responses.

54 ENVIRONMENTAL SCIENCES↗
DOE OSTI2021

Data-Driven Forgetting and Discount Factors for Vehicle Speed Forecasting in Ecological Adaptive Cruise Control

Abstract This paper investigates temporal correlations in human driving behavior using real-world driving to improve speed forecasting accuracy. These correlations can point to a measurement weighting function with two parameters: a forgetting factor for past speed measurements that the vehicle itself drove with, and a discount factor for the speeds of vehicles ahead based on information from vehicle-to-vehicle communication. The developed weighting approach is applied to a vehicle speed predictor using polynomial regression, a prediction method well-known in the literature. The performance of the developed approach is then assessed in both real-world and simulated traffic scenarios for accuracy and robustness. The new weighting method is applied to an ecological adaptive cruise control system, and its influence is analyzed on the prediction accuracy and the performance of the ecological adaptive cruise control in an electric vehicle powertrain model. The results show that the new prediction method improves energy saving from the eco-driving by up to 4.7% compared to a baseline least-square-based polynomial regression. This is a 10% improvement over the constant speed/acceleration model, a conventional speed predictor.

Automation & Control Systems↗
DOE OSTI2025

Machine learning-driven design and self-sensing capabilities of automotive bumper lattices for adaptive impact response

We present a novel approach to design an automotive bumper energy absorber using carbon fiber reinforced polymer composites, optimized to meet conflicting performance requirements for two distinct impact scenarios. The design must satisfy both a low-speed (2.5 mph) pendulum intrusion test, simulating vehicle-to-vehicle collisions, and a high-speed (25 mph) leg flexion test, replicating pedestrian impacts. These tests demand opposing deformation characteristics: high flexibility (deformation < 85 mm) for the former and high stiffness (deformation < 22 mm) for the latter. To address these contradictory requirements, we developed a machine learning (ML) framework for inverse optimization of lattice designs and material selection. Unlike traditional iterative design processes, our ML model directly outputs optimal design parameters and material choices based on target performance inputs. The energy absorber was fabricated using advanced additive manufacturing techniques, including extrusion deposition and digital light processing. The integration of carbon fibers provides multifunctionality to the bumper structure, enabling self-sensing capabilities through changes in electrical resistivity under compression. This electrical response demonstrates high repeatability under multiple cycles at 2% compression and exhibits distinct signatures during crack formation under high deformation. This research offers adaptive performance through innovative design methodologies and smart material integration. The approach has potential applications in various fields requiring adaptive energy absorption and real-time structural health monitoring.

Chawla, Komal [ORNL] (ORCID:0000000190327565)↗
DOE OSTI2015

Adaptive beamlet-based finite-size pencil beam dose calculation for independent verification of IMRT and VMAT

Purpose: The use of sophisticated dose calculation procedure in modern radiation therapy treatment planning is inevitable in order to account for complex treatment fields created by multileaf collimators (MLCs). As a consequence, independent volumetric dose verification is time consuming, which affects the efficiency of clinical workflow. In this study, the authors present an efficient adaptive beamlet-based finite-size pencil beam (AB-FSPB) dose calculation algorithm that minimizes the computational procedure while preserving the accuracy. Methods: The computational time of finite-size pencil beam (FSPB) algorithm is proportional to the number of infinitesimal and identical beamlets that constitute an arbitrary field shape. In AB-FSPB, dose distribution from each beamlet is mathematically modeled such that the sizes of beamlets to represent an arbitrary field shape no longer need to be infinitesimal nor identical. As a result, it is possible to represent an arbitrary field shape with combinations of different sized and minimal number of beamlets. In addition, the authors included the model parameters to consider MLC for its rounded edge and transmission. Results: Root mean square error (RMSE) between treatment planning system and conventional FSPB on a 10 × 10 cm{sup 2} square field using 10 × 10, 2.5 × 2.5, and 0.5 × 0.5 cm{sup 2} beamlet sizes were 4.90%, 3.19%, and 2.87%, respectively, compared with RMSE of 1.10%, 1.11%, and 1.14% for AB-FSPB. This finding holds true for a larger square field size of 25 × 25 cm{sup 2}, where RMSE for 25 × 25, 2.5 × 2.5, and 0.5 × 0.5 cm{sup 2} beamlet sizes were 5.41%, 4.76%, and 3.54% in FSPB, respectively, compared with RMSE of 0.86%, 0.83%, and 0.88% for AB-FSPB. It was found that AB-FSPB could successfully account for the MLC transmissions without major discrepancy. The algorithm was also graphical processing unit (GPU) compatible to maximize its computational speed. For an intensity modulated radiation therapy (∼12 segments) and a volumetric modulated arc therapy fields (∼90 control points) with a 3D grid size of 2.0 × 2.0 × 2.0 mm{sup 3}, dose was computed within 3–5 and 10–15 s timeframe, respectively. Conclusions: The authors have developed an efficient adaptive beamlet-based pencil beam dose calculation algorithm. The fast computation nature along with GPU compatibility has shown better performance than conventional FSPB. This enables the implementation of AB-FSPB in the clinical environment for independent volumetric dose verification.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

An adaptive filtered back-projection for photoacoustic image reconstruction

Purpose: The purpose of this study is to develop an improved filtered-back-projection (FBP) algorithm for photoacoustic tomography (PAT), which allows image reconstruction with higher quality compared to images reconstructed through traditional algorithms. Methods: A rigorous expression of a weighting function has been derived directly from a photoacoustic wave equation and used as a ramp filter in Fourier domain. The authors’ new algorithm utilizes this weighting function to precisely calculate each photoacoustic signal’s contribution and then reconstructs the image based on the retarded potential generated from the photoacoustic sources. In addition, an adaptive criterion has been derived for selecting the cutoff frequency of a low pass filter. Two computational phantoms were created to test the algorithm. The first phantom contained five spheres with each sphere having different absorbances. The phantom was used to test the capability for correctly representing both the geometry and the relative absorbed energy in a planar measurement system. The authors also used another phantom containing absorbers of different sizes with overlapping geometry to evaluate the performance of the new method for complicated geometry. In addition, random noise background was added to the simulated data, which were obtained by using an arc-shaped array of 50 evenly distributed transducers that spanned 160° over a circle with a radius of 65 mm. A normalized factor between the neighbored transducers was applied for correcting measurement signals in PAT simulations. The authors assumed that the scanned object was mounted on a holder that rotated over the full 360° and the scans were set to a sampling rate of 20.48 MHz. Results: The authors have obtained reconstructed images of the computerized phantoms by utilizing the new FBP algorithm. From the reconstructed image of the first phantom, one can see that this new approach allows not only obtaining a sharp image but also showing the correct signal strength of the absorbers. The reconstructed image of the second phantom further demonstrates the capability to form clear images of the spheres with sharp borders in the overlapping geometry. The smallest sphere is clearly visible and distinguishable, even though it is surrounded by two big spheres. In addition, image reconstructions were conducted with randomized noise added to the observed signals to mimic realistic experimental conditions. Conclusions: The authors have developed a new FBP algorithm that is capable for reconstructing high quality images with correct relative intensities and sharp borders for PAT. The results demonstrate that the weighting function serves as a precise ramp filter for processing the observed signals in the Fourier domain. In addition, this algorithm allows an adaptive determination of the cutoff frequency for the applied low pass filter.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗
DOE OSTI2015

Semiautomated head-and-neck IMRT planning using dose warping and scaling to robustly adapt plans in a knowledge database containing potentially suboptimal plans

Purpose: Prior work by the authors and other groups has studied the creation of automated intensity modulated radiotherapy (IMRT) plans of equivalent quality to those in a patient database of manually created clinical plans; those database plans provided guidance on the achievable sparing to organs-at-risk (OARs). However, in certain sites, such as head-and-neck, the clinical plans may not be sufficiently optimized because of anatomical complexity and clinical time constraints. This could lead to automated plans that suboptimally exploit OAR sparing. This work investigates a novel dose warping and scaling scheme that attempts to reduce effects of suboptimal sparing in clinical database plans, thus improving the quality of semiautomated head-and-neck cancer (HNC) plans. Methods: Knowledge-based radiotherapy (KBRT) plans for each of ten “query” patients were semiautomatically generated by identifying the most similar “match” patient in a database of 103 clinical manually created patient plans. The match patient’s plans were adapted to the query case by: (1) deforming the match beam fluences to suit the query target volume and (2) warping the match primary/boost dose distribution to suit the query geometry and using the warped distribution to generate query primary/boost optimization dose-volume constraints. Item (2) included a distance scaling factor to improve query OAR dose sparing with respect to the possibly suboptimal clinical match plan. To further compensate for a component plan of the match case (primary/boost) not optimally sparing OARs, the query dose volume constraints were reduced using a dose scaling factor to be the minimum from either (a) the warped component plan (primary or boost) dose distribution or (b) the warped total plan dose distribution (primary + boost) scaled in proportion to the ratio of component prescription dose to total prescription dose. The dose-volume constraints were used to plan the query case with no human intervention to adjust constraints during plan optimization. Results: KBRT and original clinical plans were dosimetrically equivalent for parotid glands (mean/median doses), spinal cord, and brainstem (maximum doses). KBRT plans significantly reduced larynx median doses (21.5 ± 6.6 Gy to 17.9 ± 3.9 Gy), and oral cavity mean (32.3 ± 6.2 Gy to 28.9 ± 5.4 Gy) and median (28.7 ± 5.7 Gy to 23.2 ± 5.3 Gy) doses. Doses to ipsilateral parotid gland, larynx, oral cavity, and brainstem were lower or equivalent in the KBRT plans for the majority of cases. By contrast, KBRT plans generated without the dose warping and dose scaling steps were not significantly different from the clinical plans. Conclusions: Fast, semiautomatically generated HNC IMRT plans adapted from existing plans in a clinical database can be of equivalent or better quality than manually created plans. The reductions in OAR doses in the semiautomated plans, compared to the clinical plans, indicate that the proposed dose warping and scaling method shows promise in mitigating the impact of suboptimal clinical plans.

60 APPLIED LIFE SCIENCES↗
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-E-P-32: Adapting An MMLC to a Conventional Linac to Perform Stereotactic Applications

Purpose: Micro-MLCs minimizes beam scalloping effects caused by conventional-MLCs and facilitates conformal dynamic treatment delivery. But their effect on dosimetric parameters require careful investigations. Physical and dosimetric parameters and Linac mechanical stability with mMLC (net weight 30 Kg) attached to the gantry are to be investigated. Moreover, output study along with recommended jaws offsets are studied. Adaptation of an mMLC to our 16-years old conventional Linac is investigated in this work Methods: BrainLab mMLC (m3) mounted in a detachable chassis to the Philips SL-15 Linac (30kg). Gantry and collimator spoke shots measurements are made using a calibrated film in a solid phantom and compared with pin-point measurements. Leaf penumbra, transmission, leakage between the leaves, percentage depth dose (PDD) are measured using IBA pin-point ion chamber at 6 and 10 MV. For output measurements (using brass build-up cap), jaws are modified continuously regarding to m3-fields while output factor are compared with fixed jaws situation, while the mMLC leaf configuration is modified for different m3-fields Results: Mean transmission through leaves is 1.9±0.1% and mean leakage between leaves is 2.8±0.15%. Between opposing leaves abutting along the central beam-axis mean transmission is 15±3%, but it is reduced to 4.5±0.6% by moving the abutment position 4.5cm off-axis. The penumbra was sharper for m3 -fields than jaws-fields (maximum difference is 1.51±0.2%). m3-fields PDD show ∼3% variation from those of jaws-fields. m3-fields output factors show large variations (<4%) from Jaws defined fields. Output for m3-rectangular fields show slight variation in case of leaf-end&leaf-side as well as X-jaw&Y-jaw exchange. Circular m3-fields output factors shows close agreement with their corresponding square jaws-defined fields using 2mm Jaws offsets, If jaws are retracted to m3 limits, differences become <5%. Conclusion: BrainLab m3 is successfully adapted to our 16 old Philips-SL-15 Linac. Dosimetric properties should be taken into account for treatment planning considerations.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-J-58: Comparison of Conformal Tracking Methods Using Initial, Adaptive and Preceding Image Frames for Image Registration

Purpose: Accounting for tumor motion during radiation therapy is important to ensure that the tumor receives the prescribed dose. Increasing the field size to account for this motion exposes the surrounding healthy tissues to unnecessary radiation. In contrast to using motion-encompassing techniques to treat moving tumors, conformal radiation therapy (RT) uses a smaller field to track the tumor and adapts the beam aperture according to the motion detected. This work investigates and compares the performance of three markerless, EPID based, optical flow methods to track tumor motion with conformal RT. Methods: Three techniques were used to track the motions of a 3D printed lung tumor programmed to move according to the tumor of seven lung cancer patients. These techniques utilized a multi-resolution optical flow algorithm as the core computation for image registration. The first method (DIR) registers the incoming images with an initial reference frame, while the second method (RFSF) uses an adaptive reference frame and the third method (CU) uses preceding image frames for registration. The patient traces and errors were evaluated for the seven patients. Results: The average position errors for all patient traces were 0.12 ± 0.33 mm, −0.05 ± 0.04 mm and −0.28 ± 0.44 mm for CU, DIR and RFSF method respectively. The position errors distributed within 1 standard deviation are 0.74 mm, 0.37 mm and 0.96 mm respectively. The CU and RFSF algorithms are sensitive to the characteristics of the patient trace and produce a wider distribution of errors amongst patients. Although the mean error for the DIR method is negatively biased (−0.05 mm) for all patients, it has the narrowest distribution of position error, which can be corrected using an offset calibration. Conclusion: Three techniques of image registration and position update were studied. Using direct comparison with an initial frame yields the best performance. The authors would like to thank Dr.YeLin Suh for making the Cyberknife dataset available to us. Scholarship funding from the Natural Sciences and Engineering Research Council of Canada (NSERC) and CancerCare Manitoba Foundation is acknowledged.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-J-77: Dose Tracking On An MR-Linac for Online QA and Plan Adaptation in Abdominal Organs

Recent developments made MRI-guided radiotherapy feasible. Simultaneously performed imaging during dose delivery reveals the influence of changes in anatomy not yet known at the planning stage. When targeting highly motile abdominal organs, respiratory gating is commonly employed in MRI and investigated in external beam radiotherapy to mitigate malicious motion effects. The purpose of the presented work is to investigate anatomy-adaptive dose reconstruction in the treatment of abdominalorgans using concurrent (duplex) gating of an integrated MRlinac modality.Using navigators, 3D-MR images were sampled during exhale phase, requiring 3s per axial volume (360×260×100mm{sup 3}, waterselective T1w-FFE). Deformation vector fields (DVF) were calculated for all imaging dynamics with respect to initial anatomy, yielding an estimation of anatomy changes over the time of a fraction. A pseudo-CT was generated from the outline of a reference MR image, assuming a water-filled body. Consecutively, a treatment was planned on a fictional kidney lesion and optimized simulating a 6MV linac in a 1.5T magnetic field. After delivery, using the DVF, the pseudo-CT was deformed and dose accumulated for every individual gating interval yielding the true accumulated dose on the dynamic anatomy during beam-on.Dose-volume parameters on the PTV show only moderate changes when incorporating motion, i.e. ΔD{sub 99} (GTV)=0.3Gy with D{sub 99} (GTV)=20Gy constraints. However, local differences in the PTV region showed underdosages as high as 2.7Gy and overdosages up to 1.4Gy as compared to the optimized dose on static anatomy.A dose reconstruction toolchain was successfully implemented and proved its potential in the duplex gated treatment of abdominal organs by means of an MR-linac modality. While primary dose constraints were not violated on the fictional test data, large deviations could be found locally, which are left unaccounted for in conventional treatments. Dose-tracking of both target structures and organs at risk using 3D MRI during treatment enables truly adaptive hypofractionated radiotherapy. This work was funded by the SoRTS consortium, which includes the industry partners Elekta, Philips and Technolution.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-J-81: Adaptive Radiotherapy for IMRT Head & Neck Patient in AKUH

Purpose: In this study we proposed Adaptive radiotherapy for IMRT patients which will brought an additional dimension to the management of patients with H&N cancer in Aga Khan University Hospital. Methods: In this study 5 Head and Neck (H&N) patients plan where selected, who’s Re-CT were done during the course of their treatment, they were simulated with IMRT technique to learn the consequence of anatomical changes that may occur during the treatment, as they are more dramatic changes can occur as compare to conventional treatment. All the organ at risk were drawn according RTOG guidelines and doses were checked as per NCCN guidelines. Results: The reduction in size of Planning target volume (PTV) is more than 20% in all the cases which leads to 3 to 5 % overdose to normal tissues and Organ at Risk. Conclusion: Through this study we would like to emphasis the importance of Adaptive Radiotherapy practice in all IMRT (H&N) patients, although prospective studies are required with larger sample sizes to address the safety and the clinical effect of such approaches on patient outcome, also one need to develop protocols before implementation of this technique in practice.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-J-102: Performance Variations Among Clinically Available Deformable Image Registration Tools in Adaptive Radiotherapy: How Should We Evaluate and Interpret the Result?

Purpose: To evaluate the performance variations in commercial deformable image registration (DIR) tools for adaptive radiation therapy. Methods: Representative plans from three different anatomical sites, prostate, head-and-neck (HN) and cranial spinal irradiation (CSI) with L-spine boost, were included. Computerized deformed CT images were first generated using virtual DIR QA software (ImSimQA) for each case. The corresponding transformations served as the “reference”. Three commercial software packages MIMVista v5.5 and MIMMaestro v6.0, VelocityAI v2.6.2, and OnQ rts v2.1.15 were tested. The warped contours and doses were compared with the “reference” and among each other. Results: The performance in transferring contours was comparable among all three tools with an average DICE coefficient of 0.81 for all the organs. However, the performance of dose warping accuracy appeared to rely on the evaluation end points. Volume based DVH comparisons were not sensitive enough to illustrate all the detailed variations while isodose assessment on a slice-by-slice basis could be tedious. Point-based evaluation was over-sensitive by having up to 30% hot/cold-spot differences. If adapting the 3mm/3% gamma analysis into the evaluation of dose warping, all three algorithms presented a reasonable level of equivalency. One algorithm had over 10% of the voxels not meeting this criterion for the HN case while another showed disagreement for the CSI case. Conclusion: Overall, our results demonstrated that evaluation based only on the performance of contour transformation could not guarantee the accuracy in dose warping. However, the performance of dose warping accuracy relied on the evaluation methodologies. Nevertheless, as more DIR tools are available for clinical use, the performance could vary at certain degrees. A standard quality assurance criterion with clinical meaning should be established for DIR QA, similar to the gamma index concept, in the near future.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-434: Fixed Margin Or Online Adaptation for Intermediate-Risk Prostate Stereotactic Body Radiation Therapy? A Dosimetric Study

Purpose: To investigate the choice of fixed margin or online adaptation when treating intermediate-risk prostate cancer including seminal vesicles (SV) using stereotactic body radiation therapy (SBRT). Methods: 9 prostate SBRT patients were retrospectively studied. All patients were implanted with fiducial markers in the prostate for daily localization and verification. Each patient had 5 pairs of pre-treatment and post-treatment cone-beam CT (CBCT) per protocol. SVs were contoured on planning CT and all CBCTs by one attending physician. Simultaneous integral boost (SIB) IMRT plans were developed to deliver 25Gy/5fx to the SV while delivering 37Gy/5fx to the prostate. A 3mm isotropic margin was added to the prostate while a 5 mm isotropic margin was used for the SV. The planning CT was registered to daily pre-treatment and post-treatment CBCT based on fiducial markers in the prostate to mimic online prostate localization; and the SV on daily CBCT was transferred to the CT structure set after the prostates were aligned. Daily pre-treatment and post-treatment SV dose coverage and the organ-at-risk (OAR) sparing were evaluated for the SIB regimen. At least 95% of the SV need to receive the prescription dose (5Gy per fraction). Results: For the total of 90 daily SVs analyzed (ten CBCTs for each of nine patients), only 45 daily SVs (50%) were able to meet the coverage that 95% of the SV received 25Gy. The OAR sparing performance was acceptable for most of the dosimetric constraints in low-risk prostate SBRT protocol with only two exceptions in bladder V100 (cc). Conclusion: A fixed 5mm margin for SV is not sufficient to provide consistent daily dose coverage due to SV’s substantial inter- and intra-fractional motion relative to the prostate. This finding calls for innovative strategies in margin design as well as online treatment adaptation. This work is partially supported a master research grant from Varian Medical Systems.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

TU-AB-303-01: A Feasibility Study for Dynamic Adaptive Therapy of Non-Small Cell Lung Cancer

Purpose: To compare plans for NSCLC optimized using Dynamic Adaptive Therapy (DAT) with conventional IMRT optimization. DAT adapts plans based on changes in the target volume by using dynamic programing techniques to consider expected changes into the optimization process. Information gathered during treatment, e.g. from CBCT, is incorporated into the optimization. Methods and materials: DAT is formulated using stochastic control formalism, which minimizes the total expected number of tumor cells at the end of a treatment course subject to uncertainty inherent in the tumor response and organs-at-risk (OAR) dose constraints. This formulation allows for non-stationary dose distribution as well as non-stationary fractional dose as needed to achieve a series of optimal plans that are conformal to tumor over time. Sixteen phantom cases with various sizes and locations of tumors, and OAR geometries were generated. Each case was planned with DAT and conventional IMRT (60Gy/30fx). Tumor volume change over time was obtained by using, daily MVCT-based, two-level cell population model. Monte Carlo simulations have been performed for each treatment course to account for uncertainty in tumor response. Same OAR dose constraints were applied for both methods. The frequency of plan modification was varied to 1, 2, 5 (weekly), and 29 (daily). The final average tumor dose and OAR doses have been compared to quantify the potential benefit of DAT. Results: The average tumor max, min, mean, and D95 resulted from DAT were 124.0–125.2%, 102.1–114.7%, 113.7–123.4%, and 102.0–115.9% (range dependent on the frequency of plan modification) of those from conventional IMRT. Cord max, esophagus max, lung mean, heart mean, and unspecified tissue D05 resulted from AT were 84–102.4%, 99.8–106.9%, 66.9–85.6%, 58.2–78.8%, and 85.2–94.0% of those from conventional IMRT. Conclusions: Significant tumor dose increase and OAR dose reduction, especially with parallel OAR with mean or dose-volume constraints, can be achieved using DAT.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

TU-AB-303-11: Predict Parotids Deformation Applying SIS Epidemiological Model in H&N Adaptive RT

Purpose: The aim is to investigate the use of epidemiological models to predict morphological variations in patients undergoing radiation therapy (RT). The susceptible-infected-susceptible (SIS) deterministic model was applied to simulate warping within a focused region of interest (ROI). Hypothesis is to consider each voxel like a single subject of the whole sample and to treat displacement vector fields like an infection. Methods: Using Raystation hybrid deformation algorithms and automatic re-contouring based on mesh grid, we post-processed 360 MVCT images of 12 H&N patients treated with Tomotherapy. Study focused on parotid glands, identified by literature and previous analysis, as ROI more susceptible to warping in H&N region. Susceptible (S) and infectious (I) cases were identified in voxels with inter-fraction movement respectively under and over a set threshold. IronPython scripting allowed to export positions and displacement data of surface voxels for every fraction. A MATLAB homemade toolbox was developed to model the SIS. Results: SIS model was validated simulating organ motion on QUASAR phantom. Applying model in patients, within a [0–1cm] range, a single voxel movement of 0.4cm was selected as displacement threshold. SIS indexes were evaluated by MATLAB simulations. Dynamic time warping algorithm was used to assess matching between model and parotids behavior days of treatments. The best fit of the model was obtained with contact rate of 7.89±0.94 and recovery rate of 2.36±0.21. Conclusion: SIS model can follow daily structures evolutions, making possible to compare warping conditions and highlighting challenges due to abnormal variation and set-up errors. By epidemiology approach, organ motion could be assessed and predicted not in terms of average of the whole ROI, but in a voxel-by-voxel deterministic trend. Identifying anatomical region subjected to variations, would be possible to focus clinic controls within a cohort of pre-selected patients eligible for adaptive RT. The research is partially co-funded by the Italian Research Grant: Dose warping methods for IGRT and Adaptive RT: dose accumulation based on organ motion and anatomical variations of the patients during radiation therapy treatments,MoH (GR-2010-2318757) and Tecnologie Avanzate S.r.l.(Italy)

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

WE-AB-BRA-09: Sensitivity of Plan Re-Optimization to Errors in Deformable Image Registration in Online Adaptive Image-Guided Radiation Therapy

Purpose: Online adaptive therapy (ART) relies on auto-contouring using deformable image registration (DIR). DIR’s inherent uncertainties require user intervention and manual edits while the patient is on the table. We investigated the dosimetric impact of DIR errors on the quality of re-optimized plans, and used the findings to establish regions for focusing manual edits to where DIR errors can Result in clinically relevant dose differences. Methods: Our clinical implementation of online adaptive MR-IGRT involves using DIR to transfer contours from CT to daily MR, followed by a physicians’ edits. The plan is then re-optimized to meet the organs at risk (OARs) constraints. Re-optimized abdomen and pelvis plans generated based on physician edited OARs were selected as the baseline for evaluation. Plans were then re-optimized on auto-deformed contours with manual edits limited to pre-defined uniform rings (0 to 5cm) around the PTV. A 0cm ring indicates that the auto-deformed OARs were used without editing. The magnitude of the variations caused by the non-deterministic optimizer was quantified by repeat re-optimizations on the same geometry to determine the mean and standard deviation (STD). For each re-optimized plan, various volumetric parameters for the PTV, the OARs were extracted along with DVH and isodose evaluation. A plan was deemed acceptable if the variation from the baseline plan was within one STD. Results: Initial results show that for abdomen and pancreas cases, a minimum of 5cm margin around the PTV is required for contour corrections, while for pelvic and liver cases a 2–3 cm margin is sufficient. Conclusion: Focusing manual contour edits to regions of dosimetric relevance can reduce contouring time in the online ART process while maintaining a clinically comparable plan. Future work will further refine the contouring region by evaluating the path along the beams, dose gradients near the target and OAR dose metrics.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

WE-AB-303-07: Computational Monitoring Framework of Four-Dimensional Dose Distributions During Treatment Time Based On a 2D/3D Registration with Adaptive Transformation Parameters in Lung Stereotactic Body Radiotherapy

Purpose: The aim of this study was to develop a computational framework for monitoring four-dimensional (4D) dose distributions during treatment time based on a 2D/3D registration with adaptive transformation parameters (ATPs) in lung stereotactic body radiotherapy (SBRT). Methods: The 4D dose distributions during the SBRT were calculated by applying a pencil beam convolution (PBC) algorithm to simulated 4D-computed tomography (CT) images during treatment time (hereinafter referred to as “treatment” 4D-CT images). The “treatment” 4D-CT images were derived by deforming 3D planning CT images by using transformation parameters so that 2D planning portal dose images (PDIs) can resemble 2D dynamic clinical PDIs in each frame, which were derived from electronic portal imaging device (EPID) images. The transformation parameters were optimized by the Levenberg- Marquardt (LM) algorithm. The optimized transformation parameters in a certain frame were adaptively employed as initial transformation parameters for optimization of the parameters in the consecutive frame. Gamma pass rates (3mm/3%) between dynamic clinical PDIs and dynamic “treatment” PDIs derived from the “treatment” 4D-CT images were measured for comparing the proposed frameworks without and with the ATPs. These proposed frameworks were applied to the EPID dynamic images (40 frames) of two patients with lung cancer, who underwent the SBRT. Results: Gamma pass rates without and with the ATPs were 83.01±4.42% and 89.31±3.18% on average, respectively (p<0.05). Moreover, percentage errors between prescribed doses and estimated doses at an isocenter by the proposed frameworks without and with the ATPs were 10.67±5.66% and 6.34±0.47% on average, respectively (p<0.05). Conclusion: The proposed framework with ATPs could be useful to ensure the quality of the SBRT by monitoring 4D dose distributions during treatment time.

60 APPLIED LIFE SCIENCES↗