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TU-F-17A-07: Real-Time Personalized Margins

Purpose: To maximize normal tissue sparing for treatments requiring motion encompassing margins. Motion mitigation techniques including DMLC or couch tracking can freeze tumor motion within the treatment aperture potentially allowing for smaller treatment margins and thus better sparing of normal tissue. To enable for a safe application of this concept in the clinic we propose adapting margins dynamically in real-time during radiotherapy delivery based on personalized tumor localization confidence. To demonstrate technical feasibility we present a phantom study. Methods: We utilize a realistic anthropomorphic dynamic thorax phantom with a lung tumor model embedded close to the spine. The tumor, a 3D-printout of a patient's GTV, is moved 15mm peak-to-peak by diaphragm compression and monitored by continuous EPID imaging in real-time. Two treatment apertures are created for each beam, one representing ITV -based and the other GTV-based margin expansion. A soft tissue localization (STiL) algorithm utilizing the continuous EPID images is employed to freeze tumor motion within the treatment aperture by means of DMLC tracking. Depending on a tracking confidence measure (TCM), the treatment aperture is adjusted between the ITV and the GTV leaf. Results: We successfully demonstrate real-time personalized margin adjustment in a phantom study. We measured a system latency of about 250 ms which we compensated by utilizing a respiratory motion prediction algorithm (ridge regression). With prediction in place we observe tracking accuracies better than 1mm. For TCM=0 (as during startup) an ITV-based treatment aperture is chosen, for TCM=1 a GTV-based aperture and for 0<TCM<1 a linear interpolation between the two apertures is chosen. Conclusions: We have proposed and demonstrated a concept to safely shrink treatment margins during radiotherapy and adapt to tracking confidence in real-time. Normal tissue sparing is maximized. The worst case scenario results in delivering a plan with standard margins used in the clinic today.

60 APPLIED LIFE SCIENCES↗

WE-G-BRD-07: Investigation of Distal Lung Atelectasis Following Stereotactic Body Radiation Therapy Using Regional Lung Volume Changes Between Pre- and Post- Treatment CT Scans

Purpose: To propose a quantitative method using lung deformations to differentiate between radiation-induced fibrosis and potential airway stenosis with distal atelectasis in patients treated with stereotactic body radiation therapy (SBRT) for lung tumors. Methods: Twenty-four lung patients with large radiation-induced density increases outside the high dose region had their pre- and post-treatment CT scans manually registered. They received SBRT treatments at our institution between 2002 and 2009 in 3 or 5 fractions, to a median total dose of 54Gy (range, 30–60). At least 50 anatomical landmarks inside the lung (airway branches) were paired for the pre- and post-treatment scans to guide the deformable registration of the lung structure, which was then interpolated to the whole lung using splines. Local volume changes between the planning and follow-up scans were calculated using the deformation field Jacobian. Hyperdense regions were classified as atelectatic or fibrotic based on correlations between regional density increases and significant volume contractions compared to the surrounding tissues. Results: Out of 24 patients, only 7 demonstrated a volume contraction that was at least one σ larger than the remaining lung average. Because they did not receive high doses, these shrunk hyperdense regions were likely showing distal atelectasis resulting from radiation-induced airway stenosis rather than conventional fibrosis. On average, the hyperdense regions extended 9.2 cm farther than the GTV contours but not significantly more than 8.6 cm for the other patients (p>0.05), indicating that a large offset between the radiation and hyperdense region centers is not a good surrogate for atelectasis. Conclusion: A method based on the relative comparison of volume changes between different dates was developed to identify potential lung regions experiencing distal atelectasis. Such a tool is essential to study which lung structures need to be avoided to prevent atelectasis and limit lung function loss.

60 APPLIED LIFE SCIENCES↗

TH-A-BRF-10: Quantification of Subject-Specific Susceptibility-Related Geometric Distortion in Clinical Liver MRI for Radiation Therapy

Purpose: Subject-specific susceptibility-induced B0 inhomogeneity affects the geometric accuracy of MRI images, with potential impact on the accuracy of treatment planning and image guidance. This study quantifies individual distortions for patients with intrahepatic tumors. Methods: Liver MRI scans of 13 patients who were enrolled in an IRB approved study were acquired on a 3T scanner (Skyra, Siemens). Clinical contrast-enhanced images were acquired by a 3D Volume Interpolated Breath-Hold Examination (VIBE) sequence with TE/TR =1.65/4.3ms, voxel size = 2.5×2.5×3mm (axial sets) or 3.5×3.5×5mm (coronal sets), and frequency-encoding (FE) bandwidth of 440Hz/pixel. B0 inhomogeneity was evaluated by acquisition of dual gradient echoes (GRE) with TE1/TE2/TR =4.92/7.38/106ms, a voxel size of 3.5×3.5×3.75mm, a FE bandwidth of 290Hz/pixel and breath-hold. The phase difference maps from the two echoes were unwrapped using a quantitative MRI analysis software package (FSL, FMRIB, Oxford, UK). The resulting calculated B0 inhomogeneity maps (ΔB0 in Hz) were converted to voxel distortion maps in the FE direction (ΔX in mm) corresponding to the VIBE images. Results: Maximum susceptibility-induced distortions were observed in the liver dome near the diaphragm. Using results from coronal VIBE images in this study as examples, we observed clusters of voxels displaced close to or greater than ΔX=3.5mm (440 Hz in ΔB0) in the VIBE images of the liver in 3 patients, and greater than 2 mm but less than 3.5 mm in 12 patients. On average, approximately 14% of imaged liver voxels had distortions ΔX>±1mm (ΔB0>±125Hz) and 1% of the voxels had ΔX>±2mm (ΔB0>±250Hz). Conclusion: Although advanced MRI techniques, like VIBE, permit faster acquisitions allowing for breath-held examinations with limited motion-induced artifacts, this study suggests that localized distortions due to subject-specific susceptibility variations can occur and require additional advanced corrections based on measuring patient-specific B0 inhomogeneity maps. The authors would like to acknowledge funding support from NIH R01EB016079 and NIH/NCI RO1 CA132834.

60 APPLIED LIFE SCIENCES↗

TH-A-18C-04: Ultrafast Cone-Beam CT Scatter Correction with GPU-Based Monte Carlo Simulation

Purpose: Scatter artifacts severely degrade image quality of cone-beam CT (CBCT). We present an ultrafast scatter correction framework by using GPU-based Monte Carlo (MC) simulation and prior patient CT image, aiming at automatically finish the whole process including both scatter correction and reconstructions within 30 seconds. Methods: The method consists of six steps: 1) FDK reconstruction using raw projection data; 2) Rigid Registration of planning CT to the FDK results; 3) MC scatter calculation at sparse view angles using the planning CT; 4) Interpolation of the calculated scatter signals to other angles; 5) Removal of scatter from the raw projections; 6) FDK reconstruction using the scatter-corrected projections. In addition to using GPU to accelerate MC photon simulations, we also use a small number of photons and a down-sampled CT image in simulation to further reduce computation time. A novel denoising algorithm is used to eliminate MC scatter noise caused by low photon numbers. The method is validated on head-and-neck cases with simulated and clinical data. Results: We have studied impacts of photo histories, volume down sampling factors on the accuracy of scatter estimation. The Fourier analysis was conducted to show that scatter images calculated at 31 angles are sufficient to restore those at all angles with <0.1% error. For the simulated case with a resolution of 512×512×100, we simulated 10M photons per angle. The total computation time is 23.77 seconds on a Nvidia GTX Titan GPU. The scatter-induced shading/cupping artifacts are substantially reduced, and the average HU error of a region-of-interest is reduced from 75.9 to 19.0 HU. Similar results were found for a real patient case. Conclusion: A practical ultrafast MC-based CBCT scatter correction scheme is developed. The whole process of scatter correction and reconstruction is accomplished within 30 seconds. This study is supported in part by NIH (1R01CA154747-01), The Core Technology Research in Strategic Emerging Industry, Guangdong, China (2011A081402003)

60 APPLIED LIFE SCIENCES↗

TH-C-BRD-01: Analytical Computation of Prompt Gamma Ray Emission and Detection for Proton Range Verification

Purpose: A prompt gamma (PG) slit camera prototype demonstrated that on-line range monitoring within 1–2 mm could be performed by comparing expected and measured PG detection profiles. Monte Carlo (MC) can simulate the expected PG profile but this would result in prohibitive computation time for a complete pencil beam treatment plan. We implemented a much faster method that is based on analytical processing of pre-computed MC data. Methods: The formation of the PG detection signal can be separated into: 1) production of PGs and 2) detection by the camera detectors after PG transport in geometry. For proton energies from 40 to 230 MeV, PG productions in depth were pre-computed by MC (PENH) for 12C, 14N, 16O, 31P and 40Ca. The PG production was then modeled analytically by adding the PG production for each element according to local proton energy and tissue composition.PG transport in the patient/camera geometries and the detector response were modeled by convolving the PG production profile with a transfer function. The latter is interpolated from a database of transfer functions fitted to pre-computed MC data (PENELOPE). The database was generated for a photon source in a cylindrical phantom with various radiuses and a camera placed at various positions.As a benchmark, the analytical model was compared to PENH for a water phantom, a phantom with different slabs (adipose, muscle, lung) and a thoracic CT. Results: Good agreement (within 5%) was observed between the analytical model and PENH for the PG production. Similar accuracy for detecting range shifts was also observed. Speed of around 250 ms per profile was achieved (single CPU) using a non-optimized MatLab implementation. Conclusion: We devised a fast analytical model for generating PG detection profiles. In the test cases considered in this study, similar accuracy than MC was achieved for detecting range shifts. This research is supported by IBA.

60 APPLIED LIFE SCIENCES↗

TH-C-BRD-04: Beam Modeling and Validation with Triple and Double Gaussian Dose Kernel for Spot Scanning Proton Beams

Purpose: To present the validity of our beam modeling with double and triple Gaussian dose kernels for spot scanning proton beams in Nagoya Proton Therapy Center. This study investigates the conformance between the measurements and calculation results in absolute dose with two types of beam kernel. Methods: A dose kernel is one of the important input data required for the treatment planning software. The dose kernel is the 3D dose distribution of an infinitesimal pencil beam of protons in water and consists of integral depth doses and lateral distributions. We have adopted double and triple Gaussian model as lateral distribution in order to take account of the large angle scattering due to nuclear reaction by fitting simulated inwater lateral dose profile for needle proton beam at various depths. The fitted parameters were interpolated as a function of depth in water and were stored as a separate look-up table for the each beam energy. The process of beam modeling is based on the method of MDACC [X.R.Zhu 2013]. Results: From the comparison results between the absolute doses calculated by double Gaussian model and those measured at the center of SOBP, the difference is increased up to 3.5% in the high-energy region because the large angle scattering due to nuclear reaction is not sufficiently considered at intermediate depths in the double Gaussian model. In case of employing triple Gaussian dose kernels, the measured absolute dose at the center of SOBP agrees with calculation within ±1% regardless of the SOBP width and maximum range. Conclusion: We have demonstrated the beam modeling results of dose distribution employing double and triple Gaussian dose kernel. Treatment planning system with the triple Gaussian dose kernel has been successfully verified and applied to the patient treatment with a spot scanning technique in Nagoya Proton Therapy Center.

07 ISOTOPE AND RADIATION SOURCES↗

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

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

60 APPLIED LIFE SCIENCES↗

Oxygen distribution in tumors: A qualitative analysis and modeling study providing a novel Monte Carlo approach

Purpose: To construct a Monte Carlo (MC)-based simulation model for analyzing the dependence of tumor oxygen distribution on different variables related to tumor vasculature [blood velocity, vessel-to-vessel proximity (vessel proximity), and inflowing oxygen partial pressure (pO{sub 2})]. Methods: A voxel-based tissue model containing parallel capillaries with square cross-sections (sides of 10 μm) was constructed. Green's function was used for diffusion calculations and Michaelis-Menten's kinetics to manage oxygen consumption. The model was tuned to approximately reproduce the oxygenational status of a renal carcinoma; the depth oxygenation curves (DOC) were fitted with an analytical expression to facilitate rapid MC simulations of tumor oxygen distribution. DOCs were simulated with three variables at three settings each (blood velocity, vessel proximity, and inflowing pO{sub 2}), which resulted in 27 combinations of conditions. To create a model that simulated variable oxygen distributions, the oxygen tension at a specific point was randomly sampled with trilinear interpolation in the dataset from the first simulation. Six correlations between blood velocity, vessel proximity, and inflowing pO{sub 2} were hypothesized. Variable models with correlated parameters were compared to each other and to a nonvariable, DOC-based model to evaluate the differences in simulated oxygen distributions and tumor radiosensitivities for different tumor sizes. Results: For tumors with radii ranging from 5 to 30 mm, the nonvariable DOC model tended to generate normal or log-normal oxygen distributions, with a cut-off at zero. The pO{sub 2} distributions simulated with the six-variable DOC models were quite different from the distributions generated with the nonvariable DOC model; in the former case the variable models simulated oxygen distributions that were more similar to in vivo results found in the literature. For larger tumors, the oxygen distributions became truncated in the lower end, due to anoxia, but smaller tumors showed undisturbed oxygen distributions. The six different models with correlated parameters generated three classes of oxygen distributions. The first was a hypothetical, negative covariance between vessel proximity and pO{sub 2} (VPO-C scenario); the second was a hypothetical positive covariance between vessel proximity and pO{sub 2} (VPO+C scenario); and the third was the hypothesis of no correlation between vessel proximity and pO{sub 2} (UP scenario). The VPO-C scenario produced a distinctly different oxygen distribution than the two other scenarios. The shape of the VPO-C scenario was similar to that of the nonvariable DOC model, and the larger the tumor, the greater the similarity between the two models. For all simulations, the mean oxygen tension decreased and the hypoxic fraction increased with tumor size. The absorbed dose required for definitive tumor control was highest for the VPO+C scenario, followed by the UP and VPO-C scenarios. Conclusions: A novel MC algorithm was presented which simulated oxygen distributions and radiation response for various biological parameter values. The analysis showed that the VPO-C scenario generated a clearly different oxygen distribution from the VPO+C scenario; the former exhibited a lower hypoxic fraction and higher radiosensitivity. In future studies, this modeling approach might be valuable for qualitative analyses of factors that affect oxygen distribution as well as analyses of specific experimental and clinical situations.

60 APPLIED LIFE SCIENCES↗

Moving metal artifact reduction in cone-beam CT scans with implanted cylindrical gold markers

Purpose: Implanted gold markers for image-guided radiotherapy lead to streaking artifacts in cone-beam CT (CBCT) scans. Several methods for metal artifact reduction (MAR) have been published, but they all fail in scans with large motion. Here the authors propose and investigate a method for automatic moving metal artifact reduction (MMAR) in CBCT scans with cylindrical gold markers. Methods: The MMAR CBCT reconstruction method has six steps. (1) Automatic segmentation of the cylindrical markers in the CBCT projections. (2) Removal of each marker in the projections by replacing the pixels within a masked area with interpolated values. (3) Reconstruction of a marker-free CBCT volume from the manipulated CBCT projections. (4) Reconstruction of a standard CBCT volume with metal artifacts from the original CBCT projections. (5) Estimation of the three-dimensional (3D) trajectory during CBCT acquisition for each marker based on the segmentation in Step 1, and identification of the smallest ellipsoidal volume that encompasses 95% of the visited 3D positions. (6) Generation of the final MMAR CBCT reconstruction from the marker-free CBCT volume of Step 3 by replacing the voxels in the 95% ellipsoid with the corresponding voxels of the standard CBCT volume of Step 4. The MMAR reconstruction was performed retrospectively using a half-fan CBCT scan for 29 consecutive stereotactic body radiation therapy patients with 2–3 gold markers implanted in the liver. The metal artifacts of the MMAR reconstructions were scored and compared with a standard MAR reconstruction by counting the streaks and by calculating the standard deviation of the Hounsfield units in a region around each marker. Results: The markers were found with the same autosegmentation settings in 27 CBCT scans, while two scans needed slightly changed settings to find all markers automatically in Step 1 of the MMAR method. MMAR resulted in 15 scans with no streaking artifacts, 11 scans with 1–4 streaks, and 3 scans with severe streaking artifacts. The corresponding numbers for MAR were 8 (no streaks), 1 (1–4 streaks), and 20 (severe streaking artifacts). The MMAR method was superior to MAR in scans with more than 8 mm 3D marker motion and comparable to MAR for scans with less than 8 mm motion. In addition, the MMAR method was tested on a 4D CBCT reconstruction for which it worked equally well as for the 3D case. The markers in the 4D case had very low motion blur. Conclusions: An automatic method for MMAR in CBCT scans was proposed and shown to effectively remove almost all streaking artifacts in a large set of clinical CBCT scans with implanted gold markers in the liver. Residual streaking artifacts observed in three CBCT scans may be removed with better marker segmentation.

60 APPLIED LIFE SCIENCES↗

Efficient scatter distribution estimation and correction in CBCT using concurrent Monte Carlo fitting

Purpose: X-ray scatter is a significant impediment to image quality improvements in cone-beam CT (CBCT). The authors present and demonstrate a novel scatter correction algorithm using a scatter estimation method that simultaneously combines multiple Monte Carlo (MC) CBCT simulations through the use of a concurrently evaluated fitting function, referred to as concurrent MC fitting (CMCF). Methods: The CMCF method uses concurrently run MC CBCT scatter projection simulations that are a subset of the projection angles used in the projection set, P, to be corrected. The scattered photons reaching the detector in each MC simulation are simultaneously aggregated by an algorithm which computes the scatter detector response, S{sub MC}. S{sub MC} is fit to a function, S{sub F}, and if the fit of S{sub F} is within a specified goodness of fit (GOF), the simulations are terminated. The fit, S{sub F}, is then used to interpolate the scatter distribution over all pixel locations for every projection angle in the set P. The CMCF algorithm was tested using a frequency limited sum of sines and cosines as the fitting function on both simulated and measured data. The simulated data consisted of an anthropomorphic head and a pelvis phantom created from CT data, simulated with and without the use of a compensator. The measured data were a pelvis scan of a phantom and patient taken on an Elekta Synergy platform. The simulated data were used to evaluate various GOF metrics as well as determine a suitable fitness value. The simulated data were also used to quantitatively evaluate the image quality improvements provided by the CMCF method. A qualitative analysis was performed on the measured data by comparing the CMCF scatter corrected reconstruction to the original uncorrected and corrected by a constant scatter correction reconstruction, as well as a reconstruction created using a set of projections taken with a small cone angle. Results: Pearson’s correlation, r, proved to be a suitable GOF metric with strong correlation with the actual error of the scatter fit, S{sub F}. Fitting the scatter distribution to a limited sum of sine and cosine functions using a low-pass filtered fast Fourier transform provided a computationally efficient and accurate fit. The CMCF algorithm reduces the number of photon histories required by over four orders of magnitude. The simulated experiments showed that using a compensator reduced the computational time by a factor between 1.5 and 1.75. The scatter estimates for the simulated and measured data were computed between 35–93 s and 114–122 s, respectively, using 16 Intel Xeon cores (3.0 GHz). The CMCF scatter correction improved the contrast-to-noise ratio by 10%–50% and reduced the reconstruction error to under 3% for the simulated phantoms. Conclusions: The novel CMCF algorithm significantly reduces the computation time required to estimate the scatter distribution by reducing the statistical noise in the MC scatter estimate and limiting the number of projection angles that must be simulated. Using the scatter estimate provided by the CMCF algorithm to correct both simulated and real projection data showed improved reconstruction image quality.

60 APPLIED LIFE SCIENCES↗

Correcting lateral response artifacts from flatbed scanners for radiochromic film dosimetry

Purpose: A known factor affecting the accuracy of radiochromic film dosimetry is the lateral response artifact (LRA) induced by nonuniform response of a flatbed scanner in the direction perpendicular to the scan direction. This work reports a practical solution to eliminate such artifacts for all forms of dose QA. Methods: EBT3 films from a single production lot (02181401) cut into rectangular 4 × 5 cm{sup 2} pieces, with the long dimension parallel to the long dimension of the original 20.3 × 25.4 cm{sup 2} sheets, were exposed at a depth of 5 cm on a Varian Trilogy at the center of a 20 × 20 cm{sup 2} open field at seven doses between 50 and 1600 cGy using 6 MV photons. These films together with an unexposed film from the same production lot were lined one next to the other on an Epson 10000XL or 11000XL scanner in portrait orientation with their long dimension parallel to the scan direction. Scanned images were then obtained with the line of films positioned at seven discrete lateral locations perpendicular to the scan direction. The process was repeated in landscape orientation and on three other Epson scanners. Data were also collected for three additional production lots of EBT3 film (11051302, 03031401, and 03171403). From measurements at the various lateral positions, the scanner response was determined as a function of the lateral position of the scanned film. For a given color channel X, the response at any lateral position L is related to the response at the center, C, of the scanner by Response(C, D, X) = A{sub L,X} + B{sub L,X}⋅Response(L, D, X), where D is dose and the coefficients A{sub L,X} and B{sub L,X} are determined from the film measurements at the center of the scanner and six other discrete lateral positions. The values at intermediate lateral positions were obtained by linear interpolation. The coefficients were determined for the red, green, and blue color channels, preserving the ability to apply triple-channel dosimetry once corrections were applied to compensate for the lateral position response artifact. To validate this method, corrections were applied to several films that were exposed to 15 × 15cm{sup 2} open fields and large IMRT and VMAT fields and scanned at the extreme edges of the scan window in addition to the central location. Calibration and response data were used to generate dose maps and perform gamma analysis using single- or triple-channel dosimetry with FilmQAPro 2014 software. Results: The authors’ study found that calibration curves at the different lateral positions could be correlated by a simple two-point rescaling using the response for unexposed film as well as the response of film exposed at high doses between 800 and 1600 cGy. The coefficients A{sub L,X} and B{sub L,X} for each color channel X were found to be independent of dose at each lateral location L. This made it possible to apply the relationship Response(C, D, X) = A{sub L,X} + B{sub L,X}⋅Response(L, D, X), to the raw film responses, permitting correction of the response values at any lateral position to an equivalent response, as if that part of the film was located at the center of the scanner. This correction method was validated for several films exposed to open as well as large IMRT and VMAT fields. Conclusions: The work reported elaborates on the process using the correction procedures to eliminate the lateral response artifact and demonstrates improvements in the accuracy of radiochromic film dosimetry for the radiation therapy quality assurance applications.

07 ISOTOPE AND RADIATION SOURCES↗

SU-E-E-12: Validation of the Implementation of Different CT Scanners in Proton Treatment Planning

Purpose: To quantify the impact of the relationship of CT number and Relative Stopping Power (RSP) among different CT-scanners in the evaluation of dose distribution, for different tumor sites and proton therapy modalities like Pencil Beam and Uniform Scanning. Methods: The same tissue characterization phantom was used to analyze the difference in the X-rays energy spectra of 2 CT scanners of the same vendor. One CT is for planning and the other for treatment verification. The Hounsfield unit (HU) variations and associated dosimetric uncertainty were investigated in uniform scanning and pencil beam treatment plans of different sites. At the same time comparisons of the CT calibration curve were done using the same acquisition protocols. The phantom was imaged on a 16 multi-row CT scanner, with energies of 120 and 140 kVp,currents of 263 and 245 mA and slice thickness of 2 and 3mm respectively. The dosimetric uncertainty of the plans was evaluated in a homogeneus phantom comparing DVHs, gamma index criteria 3% 3mm, and range between them. Results: The variation of HU was within the standard deviation of the average for each tissue substitute. The curves fitted with a bilinear interpolation show a maximum deviation in high density materials like cortical bone and solid water, where the HU values deviated more than 0,6% for the 120kVp protocol. For the others curves the deviation was more than 2% for low densities materials. The gamma index uncertainty criteria passed in all the cases. Conclusion: The HU variations for the different scanners were ≤3%. Lower than the 3,5% uncertainties considered in our treatment planning system. The dosimetric analysis shows that the X-ray spectrum has a small effect on the HU-RSP curve, allowing the use of a single tissue characterization curve in our proton treatment planning system for plans verifications.

60 APPLIED LIFE SCIENCES↗

SU-E-J-257: A PCA Model to Predict Adaptive Changes for Head&neck Patients Based On Extraction of Geometric Features From Daily CBCT Datasets

Purpose: Using daily cone beam CTs (CBCTs) to develop principal component analysis (PCA) models of anatomical changes in head and neck (H&N) patients and to assess the possibility of using these prospectively in adaptive radiation therapy (ART). Methods: Planning CT (pCT) images of 4 H&N patients were deformed to model several different systematic changes in patient anatomy during the course of the radiation therapy (RT). A Pinnacle plugin was used to linearly interpolate the systematic change in patient for the 35 fraction RT course and to generate a set of 35 synthetic CBCTs. Each synthetic CBCT represents the systematic change in patient anatomy for each fraction. Deformation vector fields (DVFs) were acquired between the pCT and synthetic CBCTs with random fraction-to-fraction changes were superimposed on the DVFs. A patient-specific PCA model was built using these DVFs containing systematic plus random changes. It was hypothesized that resulting eigenDVFs (EDVFs) with largest eigenvalues represent the major anatomical deformations during the course of treatment. Results: For all 4 patients, the PCA model provided different results depending on the type and size of systematic change in patient’s body. PCA was more successful in capturing the systematic changes early in the treatment course when these were of a larger scale with respect to the random fraction-to-fraction changes in patient’s anatomy. For smaller scale systematic changes, random changes in patient could completely “hide” the systematic change. Conclusion: The leading EDVF from the patientspecific PCA models could tentatively be identified as a major systematic change during treatment if the systematic change is large enough with respect to random fraction-to-fraction changes. Otherwise, leading EDVF could not represent systematic changes reliably. This work is expected to facilitate development of population-based PCA models that can be used to prospectively identify significant anatomical changes early in treatment. This work is supported in part by a grant from Varian Medical Systems, Palo Alto, CA.

60 APPLIED LIFE SCIENCES↗

SU-E-T-31: A Fast Finite Size Pencil Beam (FSPB) Convolution Algorithm for a New Co-60 Arc Therapy Machine

Purpose: Present a fast Finite Size Pencil Beam (FSPB) convolution algorithm for a new Co-60 arc therapy machine. The FSPB algorithm accounts for (i) strong angular divergence (short SAD), (ii) heterogeneity effect for primary attenuation, and (iii) source energy spectrum. Methods: The FSPB algorithm is based on a 0.5×0.5-cm2 dose kernel calculated using the GEPTS (Gamma Electron and Positron Transport System) Monte Carlo code. The dose kernel is tabulated using a thin XYZ mesh (0.1 mm steps in lateral directions) for radius less than 1 cm and using an RZ mesh (with varying steps) for larger radial distance. To account for SSD effect, 11 dose kernels with SSDs varying between 30 cm to 80 cm are calculated. Maynord factor and “lateral stretching” are applied to account for differences between closest and actual SSD. Appropriate rotations and second order interpolation are used to calculate the dose from a given beamlet to a point. Results: Accuracy: Dose distributions in water with 80 cm SSD are calculated using the new FSPB convolution algorithm and full Monte Carlo simulation (gold standard). Figs 1–4 show excellent agreements between FSPB and Monte Carlo calculations for different field sizes and at different depths. The dose distribution for a prostate case is calculated using FSPB (Fig.5). Sixty conformal beams with rectum blocking are assumed. Figs 6–8 show the comparison with Monte Carlo simulation based on the same beam apertures. The excellent agreement demonstrates the accuracy of the new algorithm in handling SSD variation, oblique incidence, and scatter contribution.Speed: The FSPB convolution algorithm calculates 28 million dose points per second using a single 2.2-GHz CPU. The present algorithm is seven times faster than a similar algorithm from Gu et al. (Phys. Med. Biol. 54, 2009, 6287–6297). Conclusion: A fast and accurate FSPB convolution algorithm was developed and benchmarked.

60 APPLIED LIFE SCIENCES↗

SU-E-T-120: Analytic Dose Verification for Patient-Specific Proton Pencil Beam Scanning Plans

Purpose: To independently verify the QA dose of proton pencil beam scanning (PBS) plans using an analytic dose calculation model. Methods: An independent proton dose calculation engine is created using the same commissioning measurements as those employed to build our commercially available treatment planning system (TPS). Each proton PBS plan is exported from the TPS in DICOM format and calculated by this independent dose engine in a standard 40 x 40 x 40 cm water tank. This three-dimensional dose grid is then compared with the QA dose calculated by the commercial TPS, using standard Gamma criterion. A total of 18 measured pristine Bragg peaks, ranging from 100 to 226 MeV, are used in the model. Intermediate proton energies are interpolated. Similarly, optical properties of the spots are measured in air over 15 cm upstream and downstream, and fitted to a second-order polynomial. Multiple Coulomb scattering in water is approximated analytically using Preston and Kohler formula for faster calculation. The effect of range shifters on spot size is modeled with generalized Highland formula. Note that the above formulation approximates multiple Coulomb scattering in water and we therefore chose not use the full Moliere/Hanson form. Results: Initial examination of 3 patient-specific prostate PBS plans shows that agreement exists between 3D dose distributions calculated by the TPS and the independent proton PBS dose calculation engine. Both calculated dose distributions are compared with actual measurements at three different depths per beam and good agreements are again observed. Conclusion: Results here showed that 3D dose distributions calculated by this independent proton PBS dose engine are in good agreement with both TPS calculations and actual measurements. This tool can potentially be used to reduce the amount of different measurement depths required for patient-specific proton PBS QA.

60 APPLIED LIFE SCIENCES↗

SU-E-T-150: Brachytherapy QA Employing a High Resolution Liquid Filled Ionisation Chamber Array: Initial Experience and Limitations

Purpose: Verifying a complex 3D brachytherapy dose distribution by measurement is non-trivial. Ideally a photon detector array should be independent of energy and angle, have high spatial resolution and be robust for routine clinical use. Methods: An iridium-192 source was used. A PMMA jig was constructed comprising an outer slab and a central insert with eight milled channels for 1.33mm (outer diameter) steel needles, see figure. All calculations were performed using an empty CT study reconstructing eight virtual needles (QA-CT), using the v2 source model (Elekta AG, Sweden). A high resolution liquid filled ionisation chamber array SRS1000, together with Verisoft software v6.0 (PTW Freiburg, Germany), was used to perform measurements of plans of increasing complexity to evaluate its suitability for device- and patient-specific QA. The dimension of backscatter material was investigated. The patient plan dwell time distribution was entered manually into the QA-CT and the dose distribution was calculated. Results: Our measurements indicate that the array is independent of energy and angle. The resulting measured dose values are linearly interpolated to 2025 values. Shifts of 1mm of the entire needle are readily detectable. Individual dwell position shifts (2.5mm) are also readily measurable. Moreover a dwell time increase of 1 second both in the edge and central region are detectable. Conclusion: The high resolution SRS1000 array is a powerful instrument for brachytherapy QA enabling 977 simultaneous measurements to be performed. Our measurements suggest 60mm of RW3 backscatter material upstream and downstream are sufficient. Local percentage difference analysis is useful for device based QA, normalized relative percentage difference is arguably better for patient specific QA. Automated transfer of patient plan dwell time distribution to the QA plan is required to enable a comprehensive patient QA study to be performed. Moreover the described measurement technique can be used for commissioning new brachytherapy applicators.

60 APPLIED LIFE SCIENCES↗

SU-E-T-157: CARMEN: A MatLab-Based Research Platform for Monte Carlo Treatment Planning (MCTP) and Customized System for Planning Evaluation

Purpose: Although there exist several radiotherapy research platforms, such as: CERR, the most widely used and referenced; SlicerRT, which allows treatment plan comparison from various sources; and MMCTP, a full MCTP system; it is still needed a full MCTP toolset that provides users complete control of calculation grids, interpolation methods and filters in order to “fairly” compare results from different TPSs, supporting verification with experimental measurements. Methods: This work presents CARMEN, a MatLab-based platform including multicore and GPGPU accelerated functions for loading RT data; designing treatment plans; and evaluating dose matrices and experimental data.CARMEN supports anatomic and functional imaging in DICOM format, as well as RTSTRUCT, RTPLAN and RTDOSE. Besides, it contains numerous tools to accomplish the MCTP process, managing egs4phant and phase space files.CARMEN planning mode assist in designing IMRT, VMAT and MERT treatments via both inverse and direct optimization. The evaluation mode contains a comprehensive toolset (e.g. 2D/3D gamma evaluation, difference matrices, profiles, DVH, etc.) to compare datasets from commercial TPS, MC simulations (i.e. 3ddose) and radiochromic film in a user-controlled manner. Results: CARMEN has been validated against commercial RTPs and well-established evaluation tools, showing coherent behavior of its multiple algorithms. Furthermore, CARMEN platform has been used to generate competitive complex treatment that has been published in comparative studies. Conclusion: A new research oriented MCTP platform with a customized validation toolset has been presented. Despite of being coded with a high-level programming language, CARMEN is agile due to the use of parallel algorithms. The wide-spread use of MatLab provides straightforward access to CARMEN’s algorithms to most researchers. Similarly, our platform can benefit from the MatLab community scientific developments as filters, registration algorithms etc. Finally, CARMEN arises the importance of grid and filtering control in treatment plan comparison.

60 APPLIED LIFE SCIENCES↗

SU-E-T-263: Development of Dose Monitor Unit Calculation Using Clarkson Integration for Proton Beam Therapy Using Beam-Wobbling System

Purpose: The purpose of the present study is to develop a calculation method of dose-calibration-factor using Clarkson integration for proton therapy employing the wobbling system and to evaluate accuracy of the calculation by comparison between calculations and measurements. Methods: CF and CALF stand for a dose-calibration-factor and a dose per monitor unit (MU), respectively. A measured dose-calibration-factor CFmeas is defined as a ratio of the measured dose per monitor unit in a patient-specific condition CALFpat to the measured dose per MU in a reference beam condition CALFref. The CFcalc is a product of three factors: CF1, CF2 and CF3. The CF1 and CF2 are a factor reflecting the effect of common beam delivery devices and that of patient specific devices and parameter (an aperture collimator, a range compensator and an air gap), respectively. The CF1 was obtained by interpolation using measured data. The CF2 was calculated using the Simplified Monte Carlo (SMC) method. The SMC method calculates a dose distribution by tracing individual protons and by using a measured Bragg curve in water. The CF3 representing the correction factor of field size effect was obtained by using the Clarkson integration. We compared the calculated and measured CF values for 20 prostate cases. Results: Field size correction was found to be important. The calculations reproduce the measurement results within an error of ±2.0%, except for a few cases. The error was about –3.1% for the small field area of less than19 square centimeters. Conclusion: We have developed a calculation method of dose-calibration-factor. Calculations agreed with measurements within ±2.0% for 90% of 20 prostate cases. Except for a small field size cases, the calculation method can be applied to determine the dose-calibration–factor for majority cases of prostate cancer.

60 APPLIED LIFE SCIENCES↗