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Improving anatomical mapping of complexly deformed anatomy for external beam radiotherapy and brachytherapy dose accumulation in cervical cancer

Purpose: In the treatment of cervical cancer, large anatomical deformations, caused by, e.g., tumor shrinkage, bladder and rectum filling changes, organ sliding, and the presence of the brachytherapy (BT) applicator, prohibit the accumulation of external beam radiotherapy (EBRT) and BT dose distributions. This work proposes a structure-wise registration with vector field integration (SW+VF) to map the largely deformed anatomies between EBRT and BT, paving the way for 3D dose accumulation between EBRT and BT. Methods: T2w-MRIs acquired before EBRT and as a part of the MRI-guided BT procedure for 12 cervical cancer patients, along with the manual delineations of the bladder, cervix-uterus, and rectum-sigmoid, were used for this study. A rigid transformation was used to align the bony anatomy in the MRIs. The proposed SW+VF method starts by automatically segmenting features in the area surrounding the delineated organs. Then, each organ and feature pair is registered independently using a feature-based nonrigid registration algorithm developed in-house. Additionally, a background transformation is calculated to account for areas far from all organs and features. In order to obtain one transformation that can be used for dose accumulation, the organ-based, feature-based, and the background transformations are combined into one vector field using a weighted sum, where the contribution of each transformation can be directly controlled by its extent of influence (scope size). The optimal scope sizes for organ-based and feature-based transformations were found by an exhaustive analysis. The anatomical correctness of the mapping was independently validated by measuring the residual distances after transformation for delineated structures inside the cervix-uterus (inner anatomical correctness), and for anatomical landmarks outside the organs in the surrounding region (outer anatomical correctness). The results of the proposed method were compared with the results of the rigid transformation and nonrigid registration of all structures together (AST). Results: The rigid transformation achieved a good global alignment (mean outer anatomical correctness of 4.3 mm) but failed to align the deformed organs (mean inner anatomical correctness of 22.4 mm). Conversely, the AST registration produced a reasonable alignment for the organs (6.3 mm) but not for the surrounding region (16.9 mm). SW+VF registration achieved the best results for both regions (3.5 and 3.4 mm for the inner and outer anatomical correctness, respectively). All differences were significant (p < 0.02, Wilcoxon rank sum test). Additionally, optimization of the scope sizes determined that the method was robust for a large range of scope size values. Conclusions: The novel SW+VF method improved the mapping of large and complex deformations observed between EBRT and BT for cervical cancer patients. Future studies that quantify the mapping error in terms of dose errors are required to test the clinical applicability of dose accumulation by the SW+VF method.

60 APPLIED LIFE SCIENCES↗

FEM design and simulation of a short, 10 MV, S-band Linac with Monte Carlo dose simulations

Purpose: Current commercial 10 MV Linac waveguides are 1.5 m. The authors’ current 6 MV linear accelerator–magnetic resonance imager (Linac–MR) system fits in typical radiotherapy vaults. To allow 10 MV treatments with the Linac–MR and still fit within typical vaults, the authors design a 10 MV Linac with an accelerator waveguide of the same length (27.5 cm) as current 6 MV Linacs. Methods: The first design stage is to design a cavity such that a specific experimental measurement for breakdown is applicable to the cavity. This is accomplished through the use of finite element method (FEM) simulations to match published shunt impedance, Q factor, and ratio of peak to mean-axial electric field strength from an electric breakdown study. A full waveguide is then designed and tuned in FEM simulations based on this cavity design. Electron trajectories are computed through the resulting radio frequency fields, and the waveguide geometry is modified by shifting the first coupling cavity in order to optimize the electron beam properties until the energy spread and mean energy closely match values published for an emulated 10 MV Linac. Finally, Monte Carlo dose simulations are used to compare the resulting photon beam depth dose profile and penumbra with that produced by the emulated 10 MV Linac. Results: The shunt impedance, Q factor, and ratio of peak to mean-axial electric field strength are all matched to within 0.1%. A first coupling cavity shift of 1.45 mm produces an energy spectrum width of 0.347 MeV, very close to the published value for the emulated 10 MV of 0.315 MeV, and a mean energy of 10.53 MeV, nearly identical to the published 10.5 MeV for the emulated 10 MV Linac. The depth dose profile produced by their new Linac is within 1% of that produced by the emulated 10 MV spectrum for all depths greater than 1.5 cm. The penumbra produced is 11% narrower, as measured from 80% to 20% of the central axis dose. Conclusions: The authors have successfully designed and simulated an S-band waveguide of length of 27.5 cm capable of producing a 10 MV photon beam. This waveguide operates well within the breakdown threshold determined for the cavity geometry used. The designed Linac produces depth dose profiles similar to those of the emulated 10 MV Linac (waveguide-length of 1.5 m) but yields a narrower penumbra.

07 ISOTOPE AND RADIATION SOURCES↗

Estimating pediatric entrance skin dose from digital radiography examination using DICOM metadata: A quality assurance tool

Purpose: To develop an automated methodology to estimate patient examination dose in digital radiography (DR) imaging using DICOM metadata as a quality assurance (QA) tool. Methods: Patient examination and demographical information were gathered from metadata analysis of DICOM header data. The x-ray system radiation output (i.e., air KERMA) was characterized for all filter combinations used for patient examinations. Average patient thicknesses were measured for head, chest, abdomen, knees, and hands using volumetric images from CT. Backscatter factors (BSFs) were calculated from examination kVp. Patient entrance skin air KERMA (ESAK) was calculated by (1) looking up examination technique factors taken from DICOM header metadata (i.e., kVp and mA s) to derive an air KERMA (k{sub air}) value based on an x-ray characteristic radiation output curve; (2) scaling k{sub air} with a BSF value; and (3) correcting k{sub air} for patient thickness. Finally, patient entrance skin dose (ESD) was calculated by multiplying a mass–energy attenuation coefficient ratio by ESAK. Patient ESD calculations were computed for common DR examinations at our institution: dual view chest, anteroposterior (AP) abdomen, lateral (LAT) skull, dual view knee, and bone age (left hand only) examinations. Results: ESD was calculated for a total of 3794 patients; mean age was 11 ± 8 yr (range: 2 months to 55 yr). The mean ESD range was 0.19–0.42 mGy for dual view chest, 0.28–1.2 mGy for AP abdomen, 0.18–0.65 mGy for LAT view skull, 0.15–0.63 mGy for dual view knee, and 0.10–0.12 mGy for bone age (left hand) examinations. Conclusions: A methodology combining DICOM header metadata and basic x-ray tube characterization curves was demonstrated. In a regulatory era where patient dose reporting has become increasingly in demand, this methodology will allow a knowledgeable user the means to establish an automatable dose reporting program for DR and perform patient dose related QA testing for digital x-ray imaging.

60 APPLIED LIFE SCIENCES↗

SU-E-I-31: Differences Observed in Radiation Doses Across 2 Similar CT Scanners From Adult Brain-Neck CT Angiography

Purpose: The aim of this study is to evaluate the difference in radiation doses from adult Brain-Neck CT angiography (CTA) between two CT scanners. Methods: We collected CT dose index data (CTDIvol, DLP) from adult Brain-Neck CTA performed with two CT scanners (Sensation 64 (S64) and Definition AS (AS), Siemens Healthcare) performed at two of our facilities from Jan 1st to Dec 31th, 2014. X-ray dose management software (Radmetrics, Bayer Healthcare) was used to mine these data. All exams were performed with Tube Current Modulation (Care Dose 4D), tube voltage of 120 kVp, quality reference mAs of 300, beam collimation of 64*0.6 mm. The rotation time was set to 0.5 sec for S64 and 1.0 sec for AS. We also scanned an anthropomorphic skull and chest phantom under routine Brain-Neck CTA protocol with the two scanners and extracted the tube current values from the raw projection data. Results: The mean CTDIvol and DLP in Brain-Neck CTA was 72 mGy and 2554 mGy*cm for AS, which was substantially larger than the mean values of 46 mGy and 1699 mGy*cm for S64. The maximum tube current was 583 mA for most cases on the S64 while the maximum was 666 mA for AS even though the rotation time set for AS was 1.0 sec. Measurements obtained with the anthropomorphic phantom showed that the tube current reached 583 mA at the shoulder region for S64 while it reached to 666 mA for AS. Conclusion: The results of this study showed that substantially different CT doses can Result from Brain-Neck CTA protocols even when similar scanners and similar settings are used. Though both scanners have a similar maximum mA rating, differences in mA were observed through the shoulders, resulting in substantially different CTDIvol values.

60 APPLIED LIFE SCIENCES↗

SU-E-I-55: The Contribution to Skin Dose Due to Scatter From the Patient Table and the Head Holder During Fluoroscopy

Purpose: To determine contributions to skin dose due to scatter from the table and head holder used during fluoroscopy, and also to explore alternative design material to reduce the scatter dose. Methods: Measurements were made of the primary and scatter components of the xray beam exiting the patient table and a cylindrical head holder used on a Toshiba Infinix c-arm unit as a function of kVp for the various beam filters on the machine and for various field sizes. The primary component of the beam was measured in air with the object placed close to the x-ray tube with an air gap between it and a 6 cc parallel-plate ionization chamber and with the beam collimated to a size just larger than the chamber. The primary plus scatter radiation components were measured with the object moved to a position in the beam next to the chamber for larger field sizes. Both sets of measurements were preformed while keeping the source-to-chamber distance fixed. The scatter fraction was estimated by taking the ratio of the difference between the two measurements and the reading that included both primary and scatter. Similar measurements were also made for a 2.3 cm thick Styrofoam block which could substitute for the patient support. Results: The measured scatter fractions indicate that the patient table as well as the head holder contributes an additional 10–16% to the patient entrance dose depending on field size. Forward scatter was reduced with the Styrofoam block so that the scatter fraction was about 4–5%. Conclusion: The results of this investigation demonstrated that scatter from the table and head holder used in clinical fluoroscopy contribute substantially to the skin dose. The lower contribution of scatter from Styrofoam suggests that there is an opportunity to redesign patient support accessories to reduce the skin dose. Partial support from NIH grant R01EB002873 and Toshiba Medical Systems Corporation Equipment Grant.

60 APPLIED LIFE SCIENCES↗

SU-E-J-176: Characterization of Inter-Fraction Breast Variability and the Implications On Delivered Dose

Purpose: To systematically characterize inter-fraction breast variability and determine implications on delivered dose. Methods: Weekly port films were used to characterize breast setup variability. Five evenly spaced representative positions across the contour of each breast were chosen on the electronic port film in reference to graticule, and window and level was set such that the skin surface of the breast was visible. Measurements from the skin surface to treatment field edge were taken on each port film at each position and compared to the planning DRR, quantifying the variability. The systematic measurement technique was repeated for all port films for 20 recently treated breast cancer patients. Measured setup variability for each patient was modeled as a normal distribution. The distribution was randomly sampled from the model and applied as isocentric shifts in the treatment planning computer, representing setup variability for each fraction. Dose was calculated for each shifted fraction and summed to obtain DVHs and BEDs that modeled the dose with daily setup variability. Patients were categorized in to relevant groupings that were chosen to investigate the rigorousness of immobilization types, treatment techniques, and inherent anatomical difficulties. Mean position differences and dosimetric differences were evaluated between planned and delivered doses. Results: The setup variability was found to follow a normal distribution with mean position differences between the DRR and port film between − 8.6–3.5 mm with sigma range of 5.3–9.8 mm. Setup position was not found to be significantly different than zero. The mean seroma or whole breast PTV dosimetric difference, calculated as BED, ranged from a −0.23 to +1.13Gy. Conclusion: A systematic technique to quantify and model setup variability was used to calculate the dose in 20 breast cancer patients including variable setup. No statistically significant PTV or OAR BED differences were found between immobilization, treatment or anatomical differences investigated.

60 APPLIED LIFE SCIENCES↗

SU-E-T-36: A GPU-Accelerated Monte-Carlo Dose Calculation Platform and Its Application Toward Validating a ViewRay Beam Model

Purpose: To build a fast, accurate and easily-deployable research platform for Monte-Carlo dose calculations. We port the dose calculation engine PENELOPE to C++, and accelerate calculations using GPU acceleration. Simulations of a Co-60 beam model provided by ViewRay demonstrate the capabilities of the platform. Methods: We built software that incorporates a beam model interface, CT-phantom model, GPU-accelerated PENELOPE engine, and GUI front-end. We rewrote the PENELOPE kernel in C++ (from Fortran) and accelerated the code on a GPU. We seamlessly integrated a Co-60 beam model (obtained from ViewRay) into our platform. Simulations of various field sizes and SSDs using a homogeneous water phantom generated PDDs, dose profiles, and output factors that were compared to experiment data. Results: With GPU acceleration using a dated graphics card (Nvidia Tesla C2050), a highly accurate simulation – including 100*100*100 grid, 3×3×3 mm3 voxels, <1% uncertainty, and 4.2×4.2 cm2 field size – runs 24 times faster (20 minutes versus 8 hours) than when parallelizing on 8 threads across a new CPU (Intel i7-4770). Simulated PDDs, profiles and output ratios for the commercial system agree well with experiment data measured using radiographic film or ionization chamber. Based on our analysis, this beam model is precise enough for general applications. Conclusions: Using a beam model for a Co-60 system provided by ViewRay, we evaluate a dose calculation platform that we developed. Comparison to measurements demonstrates the promise of our software for use as a research platform for dose calculations, with applications including quality assurance and treatment plan verification.

60 APPLIED LIFE SCIENCES↗

SU-E-T-104: An Examination of Dose in the Buildup and Build-Down Regions

Purpose: To examine dose in the buildup and build-down regions and compare measurements made with various models and dosimeters Methods: Dose was examined in a 30×30cm {sup 2} phantom of water-equivalent plastic with 10cm of backscatter for various field sizes. Examination was performed with radiochromic film and optically-stimulated-luminescent-dosimeter (OSLD) chips, and compared against a plane-parallel chamber with a correction factor applied to approximate the response of an extrapolation chamber. For the build-down region, a correction factor to account for table absorption and chamber orientation in the posterior-anterior direction was applied. The measurement depths used for the film were halfway through their sensitive volumes, and a polynomial best fit curve was used to determine the dose to their surfaces. This chamber was also compared with the dose expected in a clinical kernel-based computer model, and a clinical Boltzmann-transport-equation-based (BTE) computer model. The two models were also compared against each other for cases with air gaps in the buildup region. Results: Within 3mm, all dosimeters and models agreed with the chamber within 10% for all field sizes. At the entrance surface, film differed in comparison with the chamber from +90% to +15%, the BTE-model by +140 to +3%, and the kernel-based model by +20% to −25%, decreasing with increasing field size. At the exit surface, film differed in comparison with the chamber from −10% to −15%, the BTE-model by −53% to −50%, the kernel-based model by −55% to −57%, mostly independent of field size. Conclusion: The largest differences compared with the chamber were found at the surface for all field sizes. Differences decreased with increasing field size and increasing depth in phantom. Air gaps in the buildup region cause dose buildup to occur again post-gap, but the effect decreases with increasing phantom thickness prior to the gap.

60 APPLIED LIFE SCIENCES↗

SU-E-T-183: Clinical Quality Assurance Workflow for Dynamic Tumor Tracking Radiation Dose Delivery

Purpose: One of the most important aspects of implementation of new treatment modalities is an ‘end-to-end’ verification of the treatment process. Radiation treatment based on dynamic tracking of a tumor is highly patient-specific, therefore, special attention should be paid to quality assurance of the treatment delivery. Our goal was to design the clinical workflow that ensures accurate delivery of the planned dose using the Dynamic Target Tracking option of VeroTM (BrainLab,MHI) linac. Methods: A patient simulation is designed to include a pre-treatment session to verify whether the system can reliably track the motion of the implanted marker and build the 4D model of the target motion. The external surrogate and target motion patterns are recorded in the ExactracTM log files. In this work, a spectrum of custom marker and external surrogate motion trajectories closely resembling the patient specific motion patterns was used. 1mm thick/11mm long VisicoilTM marker was placed 15 and 20mm from the center of the spherical tissue equivalent target (centroid to centroid distance) in the 4D motion phantom (CIRSTM). 3D conformal (3 mm block margin) SBRT plans were delivered to 2 moving targets in the phantom: 1) 20mm diameter target that allows ion chamber dose measurement and 2) 25mm target that allows using film to measure CAX dose (GafchromicTM EBT3 used). The measured dose was compared to the iPlanTM TPS results using MonteCarlo algorithm (1% variance, Dose-to-water). Results: On average, film shows 98.9% pass using gamma criterion for 2% and 2mm DTA, 94.3% match for 2% and 1 mm DTA, 98% pass for 1% and 2 mm DTA however only 88% points passing for 1% and 1 mm DTA. Ion chamber measurements agreed with the calculation within 1.5%. Conclusion: The clinical QA workflow was designed for SBRT delivery using real-time tumor tracking on VeroTM linac.

60 APPLIED LIFE SCIENCES↗

SU-E-T-202: Comparison of 4D-Measurement-Guided Dose Reconstructions (MGDR) with COMPASS and OCTAVIUS 4D System

Purpose: To cross-validate the MGDR of COMPASS (IBA dosimetry, GmbH, Germany) and OCTAVIUS 4D system (PTW, Freiburg, Germany). Methods: Volumetric-modulated arc plans (5 head-and-neck and 3 prostate) collapsed to 40° gantry on the OCTAVIUS 4D phantom in QA mode on Monaco v5.0 (Elekta, CMS, Maryland Heights, MO) were delivered on a Elekta Agility linac. This study was divided into two parts: (1) error-free measurements by gantry-mounted EvolutionXX 2D array were reconstructed in COMPASS (IBA dosimetry, GmbH, Germany), and by OCTAVIUS 1500 array in Versoft v6.1 (PTW, Freiburg, Germany) to obtain the 3D doses (COM4D and OCTA4D). COM4D and OCTA4D were compared to the raw measurement (OCTA3D) at the same detector plane for which OCTAVIUS 1500 was perpendicular to 0° gantry axis while the plans were delivered at gantry 40°; (2) beam steering errors of energy (Hump=-2%) and symmetry (2T=+2%) were introduced during the delivery of 5 plans to compare the MGDR doses COM4D-Hump (COM4D-2T), OCTA4D-Hump (OCTA4D-2T), with raw doses OCTA3D-Hump (OCTA3D-2T) and with OCTA3D to assess the error reconstruction and detection ability of MGDR tools. All comparisons used Υ-criteria of 2%(local dose)/2mm and 3%/3mm. Results: Averaged Υ passing rates were 85% and 96% for COM4D,and 94% and 99% for OCTA4D at 2%/2mm and 3%/3mm criteria respectively. For error reconstruction, COM4D-Hump (COM4D-2T) showed 81% (93%) at 2%/2mm and 94% (98%) at 3%/3mm, while OCTA4D-Hump (OCTA4D-2T) showed 96% (96%) at 2%/2mm and 99% (99%) at 3%/3mm. For error detection, OCTA3D doses were compared to COM4D-Hump (COM4D-2T) showing Υ passing rates of 93% (93%) at 2%/2mm and 98% (98%), and to OCTA4D-Hump (OCTA4D -2T) showing 94% (99%) at 2%/2mm and 81% (96%) at 3%/3mm, respectively. Conclusion: OCTAVIUS MGDR showed better agreement to raw measurements in both error- and error-free comparisons. COMPASS MGDR deviated from the raw measurements possibly owing to beam modeling uncertainty.

60 APPLIED LIFE SCIENCES↗

SU-E-T-281: Dose Measurements of Modulated Spot-Scanning Particle Beams with Beam-Gating of Respiratory-Phase

Purpose: To present dosimetric variations due to target movements with beam-gating windows of various respiratory-phase in homogeneous phantom irradiated by modulated spot-scanning carbon-ions and protons in Siemens IONTRIS system. Methods: For the safety and efficacy of proton therapy to treat three patients with lung cancer during our clinical trial, residual motion was required within 5mm. To study dosimetric variations due to respiratory movement, a target of 4.0cmx4.0cm with 2cm thick was moved with distances of 3.5mm, 4.4mm, 6.0mm, 8.3mm, and 11.0mm with beam-gating windows between various phases of inhalation or exhalation at a sin-wave breathing pattern. The target was irritated at 110mm depth by modulated carbon-ions with focus sizes of 4.1mm to 4.6mm, and a grid size of 1mm between spots. And, by modulated protons with focus sizes of 11.4mm to 13.6mm, and a grid size of 1.9mm between spots. A 4.0cmx4.0cm field size was used for both beams. EBT3 films was placed at the center of target for measurements. Delivery dose was 5.0 Gy with >1.0% uniformity over target. The uniformity and field size of each measured 2D lateral profiles were extracted. Results: By irradiating films to a doses at linear region of dose response, the uniformity and field size were extracted by measured optical density. The measured deviations from calculated field width and dose increase with increased motion amplitude. Larger non-uniformity was observed for carbonion with smaller focus size in comparing with protons. For movements of 4.4mm and 6.0mm, Optical Density uniformity of 3.80% and 5.66%were observed for carbon beam. But, is 3.46% for protons with 11.4mm movement. Conclusion: Our investigations showed that 5% optical density uniformity for carbon-ions and protons might be acceptable for treatments with 8.3mm movements in homogeneous phantoms. Dose variation introduced in complex anatomy of real patients need further investigation.

60 APPLIED LIFE SCIENCES↗

SU-E-T-282: Dose Measurements with An End-To-End Audit Phantom for Stereotactic Radiotherapy

Purpose: Report on dose measurements as part of an end-to-end test for stereotactic radiotherapy, using a new audit tool, which allows audits to be performed efficiently either by an onsite team or as a postal audit. Methods: Film measurements have been performed with a new Stereotactic Cube Phantom. The phantom has been designed to perform Winston Lutz type position verification measurements and dose measurements in one setup. It comprises a plastic cube with a high density ball in its centre (used for MV imaging with film or EPID) and low density markers in the periphery (used for Cone Beam Computed Tomography, CBCT imaging). It also features strategically placed gold markers near the posterior and right surfaces, which can be used to calculate phantom rotations on MV images. Slit-like openings allow insertion of film or other detectors.The phantom was scanned and small field treatment plans were created. The fields do not traverse any inhomogeneities of the phantom on their paths to the measurement location. The phantom was setup at the delivery system using CBCT imaging. The calculated treatment fields were delivered, each with a piece of radiochromic film (EBT3) placed in the anterior film holder of the phantom. MU had been selected in planning to achieve similar exposures on all films. Calibration films were exposed in solid water for dose levels around the expected doses. Films were scanned and analysed following established procedures. Results: Setup of the cube showed excellent suitability for CBCT 3D alignment. MV imaging with EPID allowed for clear identification of all markers. Film based dose measurements showed good agreement for MLC created fields down to 0.5 mm × 0.5 mm. Conclusion: An end-to-end audit phantom for stereotactic radiotherapy has been developed and tested.

60 APPLIED LIFE SCIENCES↗

SU-E-T-508: Internal Organ Motion Effect On Radiation Dose to a Point Under Half-Beam Block Match Line

Purpose Half-beam block is a field matching technique frequently used in radiotherapy. With no setup error, a well calibrated linac, and no internal organ motion, two photon fields can be matched seamlessly dosimetry-wise with their central axes passing the match line. However, in actual clinical situations, internal organ motion is often inevitable. This study was conducted to investigate its influence on radiation dose to patient internal points directly under the matching line. Methods A clinical setting is modeled as two half-space (x<0 and x<0) radiation fields that are turned on sequentially with a time gap of integer times of the patient internal organ motion period (T{sub 0}). Our point of interest moves with patient internal organs periodically and evenly in and out of the radiation fields, resulting in an average location at x=0. When the fields are delivered without any motion management, the initial phase of the point’s movement is unknown. Statistical methods are used to compute the expected value ( ) and variance (σ) of the point dose given the uncertainty. Results Analytical solutions are obtained for and s of dose received by a point directly under the match line. is proportional to the total beam-on time (T1), and σ demonstrates previously unknown periodic behavior. /<Dσ has local maximums (minimums) when T{sub 1} is 2n*T{sub 0} ((2n+1)*T{sub 0}) (n is an integer) with an upper envelope scales as 1/T{sub 1}. Worst case scenario the point dose can be zero or double of the expected value. Conclusion We have analytically analyzed the internal organ motion effect on radiation dose received by a patient internal point directly under a half-beam block match line. Our results help us to better understand this phenomenon and facilitate the reduction of point dosimetric uncertainties in our clinical practice.

60 APPLIED LIFE SCIENCES↗

SU-E-T-578: On Definition of Minimum and Maximum Dose for Target Volume

Purpose: This study aims to investigate the impact of different minimum and maximum dose definitions in radiotherapy treatment plan quality evaluation criteria by using tumor control probability (TCP) models. Methods: Dosimetric criteria used in RTOG 1308 protocol are used in the investigation. RTOG 1308 is a phase III randomized trial comparing overall survival after photon versus proton chemoradiotherapy for inoperable stage II-IIIB NSCLC. The prescription dose for planning target volume (PTV) is 70Gy. Maximum dose (Dmax) should not exceed 84Gy and minimum dose (Dmin) should not go below 59.5Gy in order for the plan to be “per protocol” (satisfactory).A mathematical model that simulates the characteristics of PTV dose volume histogram (DVH) curve with normalized volume is built. The Dmax and Dmin are noted as percentage volumes Dη% and D(100-δ)%, with η and d ranging from 0 to 3.5. The model includes three straight line sections and goes through four points: D95%= 70Gy, Dη%= 84Gy, D(100-δ)%= 59.5 Gy, and D100%= 0Gy. For each set of η and δ, the TCP value is calculated using the inhomogeneously irradiated tumor logistic model with D50= 74.5Gy and γ50=3.52. Results: TCP varies within 0.9% with η; and δ values between 0 and 1. With η and η varies between 0 and 2, TCP change was up to 2.4%. With η and δ variations from 0 to 3.5, maximum of 8.3% TCP difference is seen. Conclusion: When defined maximum and minimum volume varied more than 2%, significant TCP variations were seen. It is recommended less than 2% volume used in definition of Dmax or Dmin for target dosimetric evaluation criteria. This project was supported by NIH grants U10CA180868, U10CA180822, U24CA180803, U24CA12014 and PA CURE Grant.

61 RADIATION PROTECTION AND DOSIMETRY↗

SU-E-T-750: Three Dimensional in Silico Study of Brachytherapy Application with In-Situ Dose-Painting Administered Via Gold-Nanoparticle Eluters

Purpose: Brachytherapy Application with in-situ Dose-painting Administered via Gold-Nanoparticle Eluters (BANDAGE) has been proposed as a new therapeutic strategy for radiation boosting of high-risk prostate tumor subvolume while minimizing dose to neighboring organs-at-risk. In a previous study the one-dimensional dose-painting with gold nanoparticles (GNP) released from GNP-loaded brachytherapy spacers was investigated. The current study investigates BANDAGE in three-dimensions. Methods: To simulate GNPs transport in prostrate tumors, a three dimensional, cylindrically symmetric transport model was generated using a finite element method (FEM). A mathematical model of Gold nanoparticle (GNPs) transport provides a useful strategy to optimize potential treatment planning for BANDAGE. Here, treatment of tumors with a radius of 2.5 cm was simulated in 3-D. This simulation phase considered one gold based cylindrical spacer (GBS of size 5mm × 0.8 mm) introduced at the center of the spherical tumor with initial concentration of 100 mg/g or 508 mol/m3 of GNP. Finite element mesh is used to stimulate the GNP transport. Gold concentrations within the tumor were obtained using a 3-D FEM solution implemented by COMSOL. Results: The analysis shows the spread of the GNPs through-out the tumor with the increase of concentration towards the periphery with time. The analysis also shows the concentration profiles and corresponding dose enhancement factors (dose boost factor) as a function of GNP size. Conclusion: This study demonstrates the use of computational modeling and optimal parameter estimation to predict local GNPs from central implant as a function of x, y and z axis . Such a study provides a useful reference for ongoing translational studies for the BANDAGE approach.

60 APPLIED LIFE SCIENCES↗

SU-E-T-801: Verification of Dose Information Passed Through 3D-Printed Products

Purpose: When quality assurance (QA) of patient treatment beam is performed, homogeneous water equivalent phantom which has different structure from patient’s internal structure is normally used. In these days, it is possible to make structures which have same shapes of human organs with commercialization of 3D-printer. As a Result, structures with same shape of human organs made by 3D-printer could be used to test qualification of treatment beam with greater accuracy than homogeneous water phantom. In this study, we estimated the dose response of 3D-printer materials to test the probability as a humanoid phantom or new generation of compensator tool. Methods: The rectangular products with variety densities (50%, 75% and 100%) were made to verify their characteristics. The products for experiment group and solid water phantom and air for control group with 125 cubic centimeters were put on solid water phantom with enough thickness. CT image of two products were acquired to know their HU values and to know about their radiologic characteristics. 6MV beams with 500MU were exposed for each experiment. Doses were measured behind the 3D-printed products. These measured doses were compared to the results taken by TPS. Results: Absorbed dose penetrated from empty air is normalized to 100%. Doses measured from 6MV photon beams penetrated from 50%, 75% and 100% products were 99%, 96% and 84%, respectively. HU values of 50%, 75% and 100% products are about −910, −860 and −10. Conclusion: 3D-printer can produce structures which have similar characteristics with human organ. These results would be used to make similar phantoms with patient information. This work was supported by the Nuclear Safety Research Program (Grant No. 1305033 and 1403019) of the Korea Radiation Safety Foundation and the Nuclear Safety and Security Commission and Radiation Technology Development Program (2013M2A2A4027117) of the Republic of Korea.

60 APPLIED LIFE SCIENCES↗

MO-G-304-02: Knowledge Based DVH Prediction Using a Geometric Dose Transform

Purpose: To demonstrate a novel method for predicting patient dose-volume histograms (DVHs) using a prior database of optimized radiotherapy treatment plans. Such predicted DVHs could be useful for automating treatment planning. Methods: Our initial demonstration utilized a database of 100 prostate intensity-modulated radiotherapy (IMRT) data-sets. Each data-set contained a CT image with contours of the planning target volume (PTV), rectum, and bladder, the parameters of a clinically approved IMRT plan, and a corresponding simulated dose distribution. We applied a novel geometric transformation to remove the influence of the PTV size, shape, and location on the dose distribution. We termed the transformed distribution the geometrically normalized dose distribution (GNDD). This normalization transform was applied to 80 data-sets randomly selected from the database, and a population GNDD was computed as the average. Next, the population GNDD was mapped onto each of the remaining 20 patient datasets using the reverse of the geometric normalization transform, and predicted DVHs were calculated from the reverse transformed dose distributions (GNDD-DVHs). In addition, a state of the art machine learning based method from the literature was tested for comparison. Results: DVH prediction accuracy was quantified by calculating the relative root mean squared error (rRMSE) on predicted DVHs for the 20 test patients using their known DVHs. For bladder, rectum, and PTV average rRMSEs for the GNDD method were 9.7 ± 4.2%, 13.9 ± 6.0%, and 2.3 ± 0.5% respectively. Prediction results using GNDD were roughly equivalent to that from the machine learning method. Conclusion: We developed a new method for predicting DVH curves from a database of prior patient plans. We demonstrated that our simple approach achieves accuracy comparable to a method using a complicated machine learning based approach.

60 APPLIED LIFE SCIENCES↗

TU-EF-304-05: Anterior Proton Beams for Prostate Treatments Lead to Substantial Elevations in Modeled RBE-Weighted Rectal Dose

Purpose: If a constant RBE of 1.1 is assumed, range-verified anterior oblique (AO) proton beams appear to offer the potential to reduce the mean dose delivered to the rectum, anterior rectal wall and penile bulb by a factor of ∼2 relative to standard bilateral (SB) proton beam arrangements. Additionally, AO proton beams targeted at the prostate avoid the femoral heads and so form a particularly appealing option for patients with hip prostheses. This study investigates LET enhancement at the distal edge of AO SOBPs, applying RBE models to consider the extent to which AO beams lead to hotspots in rectum biological dose. Methods: Eight patients were selected, all treated with passively scattered, SB proton beams to 79.2Gy(E) within the prostate and 50.4Gy(E) within the proximal 5–15mm of seminal vesicles. Additional plans utilizing AO beams (±35°) were created in XiO (Elekta) assuming a fixed RBE of 1.1. Voxelised dose and LET distributions were calculated using Monte Carlo (TOPAS). Three different LET/RBE models were applied (Carabe 2012, Wedenberg 2013, McNamara 2015). Results: Across the eight patients, the mean LET within the rectal wall was found to be 3.5(3.2–4.0)keV/µm for the SB plans compared to 10.5(8.6–13.0)keV/µm for the AO plans. Application of the median LET/RBE model to the AO plans, rather than a fixed RBE of 1.1, resulted in an increase of 13.6(11.9–14.7)GyRBE in maximum rectal wall (1cc) RBEw dose, leading to values of 90.4(90.0–91.3)GyRBE. Conclusion: relative to SB proton beams, AO proton beams exhibit substantially increased mean LET values within the rectal wall. For the passively scattered AO beams, modeling indicates that this enhancement is likely to translate into unacceptable RBEw dose hotspots. Whilst no RBE- LET model has yet been fully validated in-vivo, caution must be applied if AO beams are to be considered for prostate patients.

60 APPLIED LIFE SCIENCES↗