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DOE OSTI2014

A complete software application for automatic registration of x-ray mammography and magnetic resonance images

Purpose: This work presents a complete and automatic software application to aid radiologists in breast cancer diagnosis. The application is a fully automated method that performs a complete registration of magnetic resonance (MR) images and x-ray (XR) images in both directions (from MR to XR and from XR to MR) and for both x-ray mammograms, craniocaudal (CC), and mediolateral oblique (MLO). This new approximation allows radiologists to mark points in the MR images and, without any manual intervention, it provides their corresponding points in both types of XR mammograms and vice versa. Methods: The application automatically segments magnetic resonance images and x-ray images using the C-Means method and the Otsu method, respectively. It compresses the magnetic resonance images in both directions, CC and MLO, using a biomechanical model of the breast that distinguishes the specific biomechanical behavior of each one of its three tissues (skin, fat, and glandular tissue) separately. It makes a projection of both compressions and registers them with the original XR images using affine transformations and nonrigid registration methods. Results: The application has been validated by two expert radiologists. This was carried out through a quantitative validation on 14 data sets in which the Euclidean distance between points marked by the radiologists and the corresponding points obtained by the application were measured. The results showed a mean error of 4.2 ± 1.9 mm for the MRI to CC registration, 4.8 ± 1.3 mm for the MRI to MLO registration, and 4.1 ± 1.3 mm for the CC and MLO to MRI registration. Conclusions: A complete software application that automatically registers XR and MR images of the breast has been implemented. The application permits radiologists to estimate the position of a lesion that is suspected of being a tumor in an imaging modality based on its position in another different modality with a clinically acceptable error. The results show that the application can accelerate the mammographic screening process for high risk populations or for dense breasts.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-I-59: Image Quality and Dose Measurement for Partial Cone-Beam CT

Purpose: To characterize performance of cone beam CT (CBCT) used in dentistry investigating quantitatively the image quality and radiation dose during dental CBCT over different settings for partial rotation of the x-ray tube. Methods: Image quality and dose measurements were done on a variable field of view (FOV) dental CBCT (Carestream 9300). X-ray parameters for clinical settings were adjustable for 2–10 mA, 60–90 kVp, and two optional voxel size values, but time was fixed for each FOV. Image quality was assessed by scanning cylindrical poly-methyl methacrylate (PMMA) image quality phantom (SEDENTEXCT IQ), and then the images were analyzed using ImageJ to calculate image quality parameters such as noise, uniformity, and contrast to noise ratio (CNR). A protocol proposed by SEDENTEXCT, dose index 1 (DI1), was applied to dose measurements obtained using a thimble ionization chamber and cylindrical PMMA dose index phantom (SEDENTEXCT DI). Dose distributions were obtained using Gafchromic film. The phantoms were positioned in the FOV to imitate a clinical positioning. Results: The image noise was 6–12.5% which, when normalized to the difference of mean voxel value of PMMA and air, was comparable between different FOVs. Uniformity was 93.5ß 99.7% across the images. CNR was 1.7–4.2 and 6.3–14.3 for LDPE and Aluminum, respectively. Dose distributions were symmetric about the rotation angle's bisector. For large and medium FOVs at 4 mA and 80–90 kVp, DI1 values were in the range of 1.26–3.23 mGy. DI1 values were between 1.01–1.93 mGy for small FOV (5×5 cm{sup 2}) at 4–5 mA and 75–84 kVp. Conclusion: Noise decreased by increasing kVp, and the CNR increased for each FOV. When FOV size increased, image noise increased and CNR decreased. DI1 values were increased by increasing tube current (mA), tube voltage (kVp), and/or FOV. Funding for this project from NSERC Discovery grant, UBC Faculty of Dentistry Research Equipment Grant and UBC Faculty of Dentistry S. Wah Leung Endowment Fund.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗
DOE OSTI2014

SU-E-J-08: A Hybrid Three Dimensional Registration Framework for Image-Guided Accurate Radiotherapy System ARTS-IGRT

Purpose: The purpose of this work was to develop a registration framework and method based on the software platform of ARTS-IGRT and implement in C++ based on ITK libraries to register CT images and CBCT images. ARTS-IGRT was a part of our self-developed accurate radiation planning system ARTS. Methods: Mutual information (MI) registration treated each voxel equally. Actually, different voxels even having same intensity should be treated differently in the registration procedure. According to their importance values calculated from self-information, a similarity measure was proposed which combined the spatial importance of a voxel with MI (S-MI). For lung registration, Firstly, a global alignment method was adopted to minimize the margin error and achieve the alignment of these two images on the whole. The result obtained at the low resolution level was then interpolated to become the initial conditions for the higher resolution computation. Secondly, a new similarity measurement S-MI was established to quantify how close the two input image volumes were to each other. Finally, Demons model was applied to compute the deformable map. Results: Registration tools were tested for head-neck and lung images and the average region was 128*128*49. The rigid registration took approximately 2 min and converged 10% faster than traditional MI algorithm, the accuracy reached 1mm for head-neck images. For lung images, the improved symmetric Demons registration process was completed in an average of 5 min using a 2.4GHz dual core CPU. Conclusion: A registration framework was developed to correct patient's setup according to register the planning CT volume data and the daily reconstructed 3D CBCT data. The experiments showed that the spatial MI algorithm can be adopted for head-neck images. The improved Demons deformable registration was more suitable to lung images, and rigid alignment should be applied before deformable registration to get more accurate result. Supported by National Natural Science Foundation of China (NO.81101132) and Natural Science Foundation of Anhui Province (NO.11040606Q55)

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-J-39: Comparison of PTV Margins Determined by In-Room Stereoscopic Image Guidance and by On-Board Cone Beam Computed Tomography Technique for Brain Radiotherapy Patients

Purpose: Stereoscopic in room kV image guidance is a faster tool in daily monitoring of patient positioning. Our centre, for the first time in the world, has integrated such a solution from BrainLAB (ExacTrac) with Elekta's volumetric cone beam computed tomography (XVI). Using van Herk's formula, we compared the planning target volume (PTV) margins calculated by both these systems for patients treated with brain radiotherapy. Methods: For a total of 24 patients who received partial or whole brain radiotherapy, verification images were acquired for 524 treatment sessions by XVI and for 334 sessions by ExacTrac out of the total 547 sessions. Systematic and random errors were calculated in cranio-caudal, lateral and antero-posterior directions for both techniques. PTV margins were then determined using van Herk formula. Results: In the cranio-caudal direction, systematic error, random error and the calculated PTV margin were found to be 0.13 cm, 0.12 cm and 0.41 cm with XVI and 0.14 cm, 0.13 cm and 0.44 cm with ExacTrac. The corresponding values in lateral direction were 0.13 cm 0.1 cm and 0.4 cm with XVI and 0.13 cm, 0.12 cm and 0.42 cm with ExacTrac imaging. The same parameters for antero-posterior were for 0.1 cm, 0.11 cm and 0.34 cm with XVI and 0.13 cm, 0.16 cm and 0.43 cm with ExacTrac imaging. The margins estimated with the two imaging modalities were comparable within ± 1 mm limit. Conclusion: Verification of setup errors in the major axes by two independent imaging systems showed the results are comparable and within ± 1 mm. This implies that planar imaging based ExacTrac can yield equal accuracy in setup error determination as the time consuming volumetric imaging which is considered as the gold standard. Accordingly PTV margins estimated by this faster imaging technique can be confidently used in clinical setup.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-J-86: Lobar Lung Function Quantification by PET Galligas and CT Ventilation Imaging in Lung Cancer Patients

Purpose: The purpose of this study was to quantify the lobar lung function using the novel PET Galligas ([68Ga]-carbon nanoparticle) ventilation imaging and the investigational CT ventilation imaging in lung cancer patients pre-treatment. Methods: We present results on our first three lung cancer patients (2 male, mean age 78 years) as part of an ongoing ethics approved study. For each patient a PET Galligas ventilation (PET-V) image and a pair of breath hold CT images (end-exhale and end-inhale tidal volumes) were acquired using a Siemens Biograph PET CT. CT-ventilation (CT-V) images were created from the pair of CT images using deformable image registration (DIR) algorithms and the Hounsfield Unit (HU) ventilation metric. A comparison of ventilation quantification from each modality was done on the lobar level and the voxel level. A Bland-Altman plot was used to assess the difference in mean percentage contribution of each lobe to the total lung function between the two modalities. For each patient, a voxel-wise Spearmans correlation was calculated for the whole lungs between the two modalities. Results: The Bland-Altman plot demonstrated strong agreement between PET-V and CT-V for assessment of lobar function (r=0.99, p<0.001; range mean difference: −5.5 to 3.0). The correlation between PET-V and CT-V at the voxel level was moderate(r=0.60, p<0.001). Conclusion: This preliminary study on the three patients data sets demonstrated strong agreement between PET and CT ventilation imaging for the assessment of pre-treatment lung function at the lobar level. Agreement was only moderate at the level of voxel correlations. These results indicate that CT ventilation imaging has potential for assessing pre-treatment lobar lung function in lung cancer patients.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-J-236: Feasibility of Using Infrared Imaging to Verify the Accuracy of the Radiotherapy Delivery

Purpose: To assess whether infrared imaging can be used to verify the accuracy of the radiation treatment delivery. Methods: Radiation treatment induced skin reactions include acute changes (erythema and pigmentation) and chronic changes (telangiectasia and ulceration). Thermal imaging can detect these reactions before they become visible. A thermal camera with infrared spectral band 7.5 μm to 14 μm, and temperature measurement range from −20 °C to +150 °C and accuracy of ±2 °C was used. Beams-eye-view images were taken by the end of each treatment for a head and neck patient. The temperature changes of three points were monitored throughout the treatment course, including two points in the field (canthus and vessel) and one point outside of the field. The thermal images were warped and registered to the corresponding planning CT skin rendering. Dose map was exported from the treatment planning system and warped and registered to the planning CT skin rendering as well. The correlation between these two warped and registered images was calculated. The time spent to take the images was recorded. Results: The temperatures of the two points inside the field were always higher than the temperature of the point outside of the field. The temperature inside the field tended to increase as more fractions delivered to the patient. A correlation of 0.90 was found between the registered thermal image and the 3D dose map. On average, half minute was needed to take the images after each treatment. Conclusion: Thermal imaging can monitor the temperature variations of the skin, and the temperatures were proportional to the dose map. It can therefore potentially be an inexpensive and non-ionization tool to verify the accuracy of the radiation treatment delivery.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-416: VMAT Dose Calculations Using Cone Beam CT Images: A Preliminary Study

Purpose: Cone beam CT (CBCT) images have been used routinely for patient positioning throughout the treatment course. However, use of CBCT for dose calculation is still investigational. The purpose of this study is to assess the utility of CBCT images for Volumetric Modulated Arc Therapy (VMAT) plan dose calculation. Methods: A CATPHAN 504 phantom (The Phantom Laboratory, Salem, NY) was used to compare the dosimetric and geometric accuracy between conventional CT and CBCT (in both full and half fan modes). Hounsfield units (HU) profiles at different density areas were evaluated. A C shape target that surrounds a central avoidance structure was created and a VMAT plan was generated on the CT images and copied to the CBCT phantom images. Patient studies included three brain patients, and one head and neck (H'N) patient. VMAT plans generated on the patients treatment planning CT was applied to CBCT images obtained during the first treatment. Isodose distributions and dosevolume- histograms (DVHs) were compared. Results: For the phantom study, the HU difference between CT and CBCT is within 100 (maximum 96 HU for Teflon CBCT images in full fan mode). The impact of these differences on the calculated dose distributions was clinically insignificant. In both phantom and patient studies, target DVHs based on CBCT images were in excellent agreement with those based on planning CT images. Mean, Median, near minimum (D98%), and near maximum (D2%) doses agreed within 0-2.5%. A slightly larger discrepancy is observed in the patient studies compared to that seen in the phantom study, (0-1% vs. 0 - 2.5%). Conclusion: CBCT images can be used to accurately predict dosimetric results, without any HU correction. It is feasible to use CBCT to evaluate the actual dose delivered at each fraction. The dosimetric consequences resulting from tumor response and patient geometry changes could be monitored.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

TU-C-12A-07: Characterization of Longitudinal Reproducibility of Quantitative Diffusion Imaging Data Acquired with Four Different Protocols Using a Phantom

Purpose: To characterize and compare the longitudinal reproducibility of diffusion imaging data acquired with four different protocols using a phantom. Methods: The Diffusive Quantitative Imaging Phantom (DQIP) was constructed using fifteen cylindrical compartments within a larger compartment, filled with deionized water doped with CuSO4 and NaCl. The smaller compartments contained arrays of hexagonal or cylindrical glass capillaries of varying inner diameters, for differing restraint of water diffusion. The sensitivity of diffusion imaging metrics to signal-to-noise ratio (SNR) was probed by doping compartments with differing ratios of deuterium oxide to H2O. A cork phantom enclosure was constructed to increase thermal stability during scanning and a cork holder was made to reproduce scanner positioning. Four different protocols of DWI (diffusion weighted imaging) and DTI (Diffusion tensor imaging) imaging were assembled on a GE Excite HDx 3.0T MRI scanner to collect imaging data over 9-10 days. Data was processed with in-house software created in Matlab to obtain fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values. Results: All DTI and DWI sequences showed good longitudinal stability of mean FA and ADC values per compartment, exhibiting low standard deviation ∼9%. A t-test was performed to compare mean FA values from the DTI clinical protocol to those of the DTI special protocol, indicating significantly different values in the majority of compartments. ANOVA performed on ADC values for all DTI and DWI sequences also showed significantly different values in a majority of compartments. Conclusion: This work has the potential for quantifying systemic variations between diffusion imaging sequences from different platforms. Characterization of DWI and DTI performance were done over four sequences with predictable results. This data suggests that the DQIP phantom may be a reliable method of monitoring day-to-day and scan-to-scan variation in diffusion imaging sequences from different platforms. Schott Glass North America and The Phantom Laboratory have donated materials and personnel time to this project.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

WE-G-BRF-09: Force- and Image-Adaptive Strategies for Robotised Placement of 4D Ultrasound Probes

Purpose: To allow continuous acquisition of high quality 4D ultrasound images for non-invasive live tracking of tumours for IGRT, image- and force-adaptive strategies for robotised placement of 4D ultrasound probes are developed and evaluated. Methods: The developed robotised ultrasound system is based on a 6-axes industrial robot (adept Viper s850) carrying a 4D ultrasound transducer with a mounted force-torque sensor. The force-adaptive placement strategies include probe position control using artificial potential fields and contact pressure regulation by a PD controller strategy. The basis for live target tracking is a continuous minimum contact pressure to ensure good image quality and high patient comfort. This contact pressure can be significantly disturbed by respiratory movements and has to be compensated. All measurements were performed on human subjects under realistic conditions. When performing cardiac ultrasound, rib- and lung shadows are a common source of interference and can disrupt the tracking. To ensure continuous tracking, these artefacts had to be detected to automatically realign the probe. The detection is realised by multiple algorithms based on entropy calculations as well as a determination of the image quality. Results: Through active contact pressure regulation it was possible to reduce the variance of the contact pressure by 89.79% despite respiratory motion of the chest. The results regarding the image processing clearly demonstrate the feasibility to detect image artefacts like rib shadows in real-time. Conclusion: In all cases, it was possible to stabilise the image quality by active contact pressure control and automatically detected image artefacts. This fact enables the possibility to compensate for such interferences by realigning the probe and thus continuously optimising the ultrasound images. This is a huge step towards fully automated transducer positioning and opens the possibility for stable target tracking in ultrasoundguided radiation therapy requiring contact pressure of 5–10 N. This work was supported by the Graduate School for Computing in Medicine and Life Sciences funded by Germany's Excellence Initiative [DFG GSC 235/1].

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

TH-E-17A-02: High-Pitch and Sparse-View Helical 4D CT Via Iterative Image Reconstruction Method Based On Tensor Framelet

Purpose: 4D CT is routinely performed during radiation therapy treatment planning of thoracic and abdominal cancers. Compared with the cine mode, the helical mode is advantageous in temporal resolution. However, a low pitch (∼0.1) for 4D CT imaging is often required instead of the standard pitch (∼1) for static imaging, since standard image reconstruction based on analytic method requires the low-pitch scanning in order to satisfy the data sufficient condition when reconstructing each temporal frame individually. In comparison, the flexible iterative method enables the reconstruction of all temporal frames simultaneously, so that the image similarity among frames can be utilized to possibly perform high-pitch and sparse-view helical 4D CT imaging. The purpose of this work is to investigate such an exciting possibility for faster imaging with lower dose. Methods: A key for highpitch and sparse-view helical 4D CT imaging is the simultaneous reconstruction of all temporal frames using the prior that temporal frames are continuous along the temporal direction. In this work, such a prior is regularized through the sparsity transform based on spatiotemporal tensor framelet (TF) as a multilevel and high-order extension of total variation transform. Moreover, GPU-based fast parallel computing of X-ray transform and its adjoint together with split Bregman method is utilized for solving the 4D image reconstruction problem efficiently and accurately. Results: The simulation studies based on 4D NCAT phantoms were performed with various pitches (i.e., 0.1, 0.2, 0.5, and 1) and sparse views (i.e., 400 views per rotation instead of standard >2000 views per rotation), using 3D iterative individual reconstruction method based on 3D TF and 4D iterative simultaneous reconstruction method based on 4D TF respectively. Conclusion: The proposed TF-based simultaneous 4D image reconstruction method enables high-pitch and sparse-view helical 4D CT with lower dose and faster speed.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

Investigating the limits of PET/CT imaging at very low true count rates and high random fractions in ion-beam therapy monitoring

Purpose: External beam radiotherapy with protons and heavier ions enables a tighter conformation of the applied dose to arbitrarily shaped tumor volumes with respect to photons, but is more sensitive to uncertainties in the radiotherapeutic treatment chain. Consequently, an independent verification of the applied treatment is highly desirable. For this purpose, the irradiation-induced β{sup +}-emitter distribution within the patient is detected shortly after irradiation by a commercial full-ring positron emission tomography/x-ray computed tomography (PET/CT) scanner installed next to the treatment rooms at the Heidelberg Ion-Beam Therapy Center (HIT). A major challenge to this approach is posed by the small number of detected coincidences. This contribution aims at characterizing the performance of the used PET/CT device and identifying the best-performing reconstruction algorithm under the particular statistical conditions of PET-based treatment monitoring. Moreover, this study addresses the impact of radiation background from the intrinsically radioactive lutetium-oxyorthosilicate (LSO)-based detectors at low counts. Methods: The authors have acquired 30 subsequent PET scans of a cylindrical phantom emulating a patientlike activity pattern and spanning the entire patient counting regime in terms of true coincidences and random fractions (RFs). Accuracy and precision of activity quantification, image noise, and geometrical fidelity of the scanner have been investigated for various reconstruction algorithms and settings in order to identify a practical, well-suited reconstruction scheme for PET-based treatment verification. Truncated listmode data have been utilized for separating the effects of small true count numbers and high RFs on the reconstructed images. A corresponding simulation study enabled extending the results to an even wider range of counting statistics and to additionally investigate the impact of scatter coincidences. Eventually, the recommended reconstruction scheme has been applied to exemplary postirradiation patient data-sets. Results: Among the investigated reconstruction options, the overall best results in terms of image noise, activity quantification, and accurate geometrical recovery were achieved using the ordered subset expectation maximization reconstruction algorithm with time-of-flight (TOF) and point-spread function (PSF) information. For this algorithm, reasonably accurate (better than 5%) and precise (uncertainty of the mean activity below 10%) imaging can be provided down to 80 000 true coincidences at 96% RF. Image noise and geometrical fidelity are generally improved for fewer iterations. The main limitation for PET-based treatment monitoring has been identified in the small number of true coincidences, rather than the high intrinsic random background. Application of the optimized reconstruction scheme to patient data-sets results in a 25% − 50% reduced image noise at a comparable activity quantification accuracy and an improved geometrical performance with respect to the formerly used reconstruction scheme at HIT, adopted from nuclear medicine applications. Conclusions: Under the poor statistical conditions in PET-based treatment monitoring, improved results can be achieved by considering PSF and TOF information during image reconstruction and by applying less iterations than in conventional nuclear medicine imaging. Geometrical fidelity and image noise are mainly limited by the low number of true coincidences, not the high LSO-related random background. The retrieved results might also impact other emerging PET applications at low counting statistics.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-D-BRA-07: A Phantom Study to Assess the Variability in Radiomics Features Extracted From Cone-Beam CT Images

Purpose: Several studies have demonstrated the prognostic potential for texture features extracted from CT images of non-small cell lung cancer (NSCLC) patients. The purpose of this study was to determine if these features could be extracted with high reproducibility from cone-beam CT (CBCT) images in order for features to be easily tracked throughout a patient’s treatment. Methods: Two materials in a radiomics phantom, designed to approximate NSCLC tumor texture, were used to assess the reproducibility of 26 features. This phantom was imaged on 9 CBCT scanners, including Elekta and Varian machines. Thoracic and head imaging protocols were acquired on each machine. CBCT images from 27 NSCLC patients imaged using the thoracic protocol on Varian machines were obtained for comparison. The variance for each texture measured from these patients was compared to the variance in phantom values for different manufacturer/protocol subsets. Levene’s test was used to identify features which had a significantly smaller variance in the phantom scans versus the patient data. Results: Approximately half of the features (13/26 for material1 and 15/26 for material2) had a significantly smaller variance (p<0.05) between Varian thoracic scans of the phantom compared to patient scans. Many of these same features remained significant for the head scans on Varian (12/26 and 8/26). However, when thoracic scans from Elekta and Varian were combined, only a few features were still significant (4/26 and 5/26). Three features (skewness, coarsely filtered mean and standard deviation) were significant in almost all manufacturer/protocol subsets. Conclusion: Texture features extracted from CBCT images of a radiomics phantom are reproducible and show significantly less variation than the same features measured from patient images when images from the same manufacturer or with similar parameters are used. Reproducibility between CBCT scanners may be high enough to allow the extraction of meaningful texture values for patients. This project was funded in part by the Cancer Prevention Research Institute of Texas (CPRIT). Xenia Fave is a recipient of the American Association of Physicists in Medicine Graduate Fellowship.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-I-91: Quantitative Assessment of Early Hepatocellular Carcinoma and Cavernous Hemangioma of Live Using In-Line Phase-Contrast X-Ray Imaging

Purpose: To investigate the potential utility of in-line phase-contrast imaging (ILPCI) technique with synchrotron radiation in detecting early hepatocellular carcinoma and cavernous hemangioma of live using in vitro model system. Methods: Without contrast agents, three typical early hepatocellular carcinoma specimens and three typical cavernous hemangioma of live specimens were imaged using ILPCI. To quantitatively discriminate early hepatocellular carcinoma tissues and cavernous hemangioma tissues, the projection images texture feature based on gray level co-occurrence matrix (GLCM) were extracted. The texture parameters of energy, inertia, entropy, correlation, sum average, sum entropy, difference average, difference entropy and inverse difference moment, were obtained respectively. Results: In the ILPCI planar images of early hepatocellular carcinoma specimens, vessel trees were clearly visualized on the micrometer scale. Obvious distortion deformation was presented, and the vessel mostly appeared as a ‘dry stick’. Liver textures appeared not regularly. In the ILPCI planar images of cavernous hemangioma of live specimens, typical vessels had not been found compared with the early hepatocellular carcinoma planar images. The planar images of cavernous hemangioma of live specimens clearly displayed the dilated hepatic sinusoids with the diameter of less than 100 microns, but all of them were overlapped with each other. The texture parameters of energy, inertia, entropy, correlation, sum average, sum entropy, and difference average, showed a statistically significant between the two types specimens image (P<0.01), except the texture parameters of difference entropy and inverse difference moment(P>0.01). Conclusion: The results indicate that there are obvious changes in morphological levels including vessel structures and liver textures. The study proves that this imaging technique has a potential value in evaluating early hepatocellular carcinoma and cavernous hemangioma of live.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-J-52: Decreasing Frequency of Performing TG-142 Imaging QA – 5 Year Experience

Purpose This study is an update to check if the frequency of imaging QA suggested by AAPM Task Group Report 142 (TG142) is necessary with our 5 year experience. TG142 presents recommendations for QA criteria of IGRT treatment. ACR has adopted it to be the requirements for any radiatiotherapy practices; however, we propose to reduce the frequency on image quality QA according to this 5 year study.Method and Materials: This study uses VarianIX2100 and Siemens Artiste Linacs to perform QAs on KV, MV, CBCT modalities. The QA was designed following under the recommendations of TG142. This study reports the daily imaging positioning/repositioning and imaging and treatment coordinate coincidence. QA results on kV, MV and CBCT from 4/7/2010∼3/11/15 are analyzed. KV, MV, CBCT images are taken with the Varian isocube localized at the isocenter. Digital graticule is used in the software to verify the isocenter position. CBCT images are taken with the cube placed at 1cm superior, lateral and anterior of the isocenter. In-line fusion software is used to verify the contrived shift. Digital ruler provided at the on-board-imaging software or adaptive-targeting software was used to measure the position differences. The position differences were recorded at AP,LR,SI directions. Results 5 year records on kV, MV, CBCT show the shifts in all three directions are within the tolerance of 1mm suggested in TG142 for stereotactic radiation treatment(SRS/SRT). There is no occasion where shifts are outside 1mm tolerance. Conclusions The daily imaging QA suggested in TG142 is useful in ensuring the accuracy needed for SRS/SRT in IGRT. 5 year measurements presented suggest that decreasing the frequency of imaging QA may be acceptable, in particular for institutions reporting no violation of tolerance over periods of few years.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

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

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

WE-EF-303-10: Single- Detector Proton Radiography as a Portal Imaging Equivalent for Proton Therapy

Purpose: In proton therapy, patient alignment is of critical importance due to the sensitivity of the proton range to tissue heterogeneities. Traditionally proton radiography is used for verification of the water-equivalent path length (WEPL), which dictates the depth protons reach. In this work we propose its use for alignment. Additionally, many new proton centers have cone-beam computed tomography in place of beamline X-ray imaging and so proton radiography offers a unique patient alignment verification similar to portal imaging in photon therapy. Method: Proton radiographs of a CIRS head phantom were acquired using the Beam Imaging System (BIS) (IBA, Louvain-la-Neuve) in a horizontal beamline. A scattered beam was produced using a small, dedicated, range modulator (RM) wheel fabricated out of aluminum. The RM wheel was rotated slowly (20 sec/rev) using a stepper motor to compensate for the frame rate of the BIS (120 ms). Dose rate functions (DRFs) over two RM wheel rotations were acquired. Calibration was made with known thicknesses of homogeneous solid water. For each pixel the time width, skewness and kurtosis of the DRFs were computed. The time width was used to compute the object WEPL. In the heterogeneous phantom, the excess skewness and excess kurtosis (i.e. difference from homogeneous cases) were computed and assessed for suitability for patient set up. Results: The technique allowed for the simultaneous production of images that can be used for WEPL verification, showing few internal details, and excess skewness and kurtosis images that can be used for soft tissue alignment. These latter images highlight areas where range mixing has occurred, correlating with phantom heterogeneities. Conclusion: The excess skewness and kurtosis images contain details that are not visible in the WET images. These images, unique to the time-resolved proton radiographic method, could be used for patient set up according to soft tissues.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

A minimum spanning forest based classification method for dedicated breast CT images

Purpose: To develop and test an automated algorithm to classify different types of tissue in dedicated breast CT images. Methods: Images of a single breast of five different patients were acquired with a dedicated breast CT clinical prototype. The breast CT images were processed by a multiscale bilateral filter to reduce noise while keeping edge information and were corrected to overcome cupping artifacts. As skin and glandular tissue have similar CT values on breast CT images, morphologic processing is used to identify the skin based on its position information. A support vector machine (SVM) is trained and the resulting model used to create a pixelwise classification map of fat and glandular tissue. By combining the results of the skin mask with the SVM results, the breast tissue is classified as skin, fat, and glandular tissue. This map is then used to identify markers for a minimum spanning forest that is grown to segment the image using spatial and intensity information. To evaluate the authors’ classification method, they use DICE overlap ratios to compare the results of the automated classification to those obtained by manual segmentation on five patient images. Results: Comparison between the automatic and the manual segmentation shows that the minimum spanning forest based classification method was able to successfully classify dedicated breast CT image with average DICE ratios of 96.9%, 89.8%, and 89.5% for fat, glandular, and skin tissue, respectively. Conclusions: A 2D minimum spanning forest based classification method was proposed and evaluated for classifying the fat, skin, and glandular tissue in dedicated breast CT images. The classification method can be used for dense breast tissue quantification, radiation dose assessment, and other applications in breast imaging.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

Luminescence imaging of water during carbon-ion irradiation for range estimation

Purpose: The authors previously reported successful luminescence imaging of water during proton irradiation and its application to range estimation. However, since the feasibility of this approach for carbon-ion irradiation remained unclear, the authors conducted luminescence imaging during carbon-ion irradiation and estimated the ranges. Methods: The authors placed a pure-water phantom on the patient couch of a carbon-ion therapy system and measured the luminescence images with a high-sensitivity, cooled charge-coupled device camera during carbon-ion irradiation. The authors also carried out imaging of three types of phantoms (tap-water, an acrylic block, and a plastic scintillator) and compared their intensities and distributions with those of a phantom containing pure-water. Results: The luminescence images of pure-water phantoms during carbon-ion irradiation showed clear Bragg peaks, and the measured carbon-ion ranges from the images were almost the same as those obtained by simulation. The image of the tap-water phantom showed almost the same distribution as that of the pure-water phantom. The acrylic block phantom’s luminescence image produced seven times higher luminescence and had a 13% shorter range than that of the water phantoms; the range with the acrylic phantom generally matched the calculated value. The plastic scintillator showed ∼15 000 times higher light than that of water. Conclusions: Luminescence imaging during carbon-ion irradiation of water is not only possible but also a promising method for range estimation in carbon-ion therapy.

60 APPLIED LIFE SCIENCES↗