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Search indexed NASA NTRS and DOE OSTI research on propulsion, heat transfer, battery materials and energy systems. Follow report and document links to the original sources.

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At least 19 records
All sourcesNASA NTRSDOE OSTI
DOE OSTI2015

SU-E-J-65: Motion Difference Between the Pancreas and Nearby Veins for Pancreas Motion Monitoring Using Ultrasound During Radiation Therapy

Purpose: As it is generally difficult to outline the pancreas on an ultrasound b-mode image, visualized structures such as the portal or the splenic veins are assumed to have the same motion as the pancreas. These structures can be used as a surrogate for monitoring pancreas motion during radiation therapy (RT) delivery using ultrasound. To verify this assumption, we studied the motion difference between the head of the pancreas, the portal vein, the tail of the pancreas, and splenic vein. Methods: 4DCT data acquired during RT simulation were analyzed for a total of 5 randomly selected patients with pancreatic cancer. The data was sorted into 10 respiratory phases from 0% to 90% (0%: end of the inspiration, 50%: end of expiration) . The head of the pancreas (HP), tail of the pancreas (TP), portal vein (PV), and splenic vein (SV) were contoured on all 10 phases. The volume change and motion were measured in the left-right (LR), anterior-superior (AP), and superior-inferior (SI) directions. Results: The volume change for all patients/phases were: 1.2 ± 3% for HP, 0.78 ± 1.6% for PV, 2.5 ± 2.9% for TP, and 0.53 ± 2.1% for SV. Motion for each structure was estimated from the centroid displacements due to the uniformity of the structures and the small volume change. The measured motion between HP and PV was: LR: 0.1 ± 0.17 mm, AP: 0.04 ± 0.1 mm, SI: 0.17 ± 0.16 mm and between TP and the PV was: LR: 0.05 ± 0.3 mm, AP: 0.1 ± 0.4 mm, SI: 0.01 ± 0.022 mm. Conclusion: There are small motion differences between the portal vein and the head of the pancreas, and the splenic vein and the tail of the pancreas. This suggests the feasibility of utilizing these features for monitoring the pancreas motion during radiation therapy.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2019

CT and MRI features of undifferentiated carcinomas with osteoclast-like giant cells of the pancreas: a case series

Purpose: The purpose of this case series was to describe computed tomography (CT) and magnetic resonance imaging (MRI) features of undifferentiated carcinoma with osteoclast-like giant cells of the pancreas. Methods: Institutional ethics review board approval was obtained, and informed consent was waived for this case series. We reviewed CT and MRI of patients with pathologically confirmed undifferentiated carcinoma with osteoclast-like giant cells of the pancreas found in the medical records of our hospital between 2006 and 2016. Results: Seven patients (3 males and 4 females; age, 59–82 years (mean, 71)) with confirmation by surgical resection (n = 3) or biopsy (n = 4) were identified. They underwent CT (n = 7) and MRI (n = 6). The tumors 26–83 mm in diameter (mean, 44 mm) were located in the head (n = 4) or body (n = 3) of the pancreas. They were demonstrated as lower attenuation areas relative to the adjacent pancreas on CT images obtained in both pancreatic and portal vein phases (n = 7) with a well-defined smooth margin (n = 5). They were demonstrated as hypointense areas relative to the pancreas on T2-weighted images (n = 4) and T2*-weighted images (n = 4) and diffusion-weighted images (n = 3). They contained hemosiderin deposits on histology (n = 7). Conclusions: Undifferentiated carcinoma with osteoclast-like giant cells of the pancreas might be present as low attenuation areas with a well-defined smooth margin on CT images obtained in pancreatic and portal vein phases, and hypointense areas on T2-, T2*-, and diffusion-weighted images caused by hemosiderin deposits.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2016

Non-invasive glucagon-like peptide-1 receptor imaging in pancreas with {sup 18}F-Al labeled Cys{sup 39}-exendin-4

Purpose: Glucagon-like peptide-1 receptor (GLP-1R) is abundantly expressed on beta cells and may be an ideal target for the pancreas imaging. Monitoring the GLP-1R of pancreas could be benefit for understanding the pathophysiology of diabetes. In the present study, {sup 18}F-Al labeled exendin-4 analog, {sup 18}F-Al-NOTA-MAL-Cys{sup 39}-exendin-4, was evaluated for PET imaging GLP-1R in the pancreas. Methods: The targeting of {sup 18}F-Al labeled exendin-4 analog was examined in healthy and streptozotocin induced diabetic rats. Rats were injected with {sup 18}F-Al-NOTA-MAL-Cys{sup 39}-exendin-4 and microPET imaging was performed at 1 h postinjection, followed by ex vivo biodistribution. GLP-1R expression in pancreas was determined through post mortern examinations. Results: The pancreas of healthy rats was readily visualized after administration of {sup 18}F-Al-NOTA-MAL-Cys{sup 39}-exendin-4, whereas the pancreas of diabetic rats, as well as those from rats co-injected with excess of unlabeled peptides, was barely visible by microPET. At 60 min postinjection, the pancreatic uptakes were 1.02 ± 0.15%ID/g and 0.23 ± 0.05%ID/g in healthy and diabetic rats respectively. Under block, the pancreatic uptakes of non-diabetic rats reduced to 0.21 ± 0.07%ID/g at the same time point. Biodistribution data and IHC staining confirmed the findings of the microPET imaging. Conclusion: The favorable preclinical data indicated that {sup 18}F-Al-NOTA-MAL-Cys{sup 39}-exendin-4may be suitable for non-invasive monitoring functional pancreatic beta cells.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-D-210-06: Feasibility for Monitoring the Head of the Pancreas Motion Through a Surrogate Using Ultrasound During Radiation Therapy Delivery

Purpose: Substantial target motion during the delivery of radiation therapy (RT) for pancreatic cancer is well recognized as a major limiting factor on RT effectiveness. The aim of this work is to monitor intra-fractional motion of the pancreas using ultrasound during RT delivery. Methods: Transabdominal Ultrasound B-mode images were collected from 5 volunteers using a research version of the Clarity Autoscan System (Elekta). The autoscan transducer with center frequency of 5 MHz was utilized for the scans. Imaging parameters were adjusted to acquire images at the desired depth with good contrast and a wide sweep angle. Since well-defined boundaries of the pancreas can be difficult to find on ultrasound B-mode images, the portal vein was selected as a surrogate for motion estimation of the head of the pancreas. The selection was due to its anatomical location posterior to the neck of the pancreas and close proximity to the pancreas head. The portal vein was contoured on the ultrasound images acquired during simulation using the Clarity Research AFC Workstation software. Volunteers were set up in a similar manner to the simulation for their monitoring session and the ultrasound transducer was mounted on an arm fixed to the couch. A video segment of the portal vein motion was captured. Results: The portal vein was visualized and segmented. Successful monitoring sessions of the portal vein were observed. In addition, our results showed that the ultrasound transducer itself reduces breathing related motion. This is analogous to the use of a compression plate to suppress respiration motion during thorax or abdominal irradiation. Conclusion: We demonstrate the feasibility of tracking the pancreas through the localization of the portal vein using abdominal ultrasound. This will allow for real-time tracking of the intra-fractional motion to justify PTV-margin and to account for unusual motions, thus, improving normal tissue sparing. This research was funding in part by Elekta Inc.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

Pancreas volume and fat fraction in children with Type 1 diabetes

Abstract Aims People with Type 1 diabetes have smaller pancreases than healthy individuals. Several diseases causing pancreatic atrophy are associated with pancreatic steatosis, but pancreatic fat in Type 1 diabetes has not been measured. This cross‐sectional study aimed to compare pancreas size and fat fraction in children with Type 1 diabetes and controls. Methods The volume and fat fraction of the pancreases of 22 children with Type 1 diabetes and 29 controls were determined using magnetic resonance imaging. Results Pancreas volume was 27% smaller in children with diabetes (median 34.9 cm 3 ) than in controls (47.8 cm 3 ; P < 0.001). Pancreas volume correlated positively with age in controls ( P = 0.033), but not in children with diabetes ( P = 0.649). Pancreas volume did not correlate with diabetes duration, but it did correlate positively with units of insulin/kg body weight/day ( P = 0.048). A linear model of pancreas volume as influenced by age, body surface area and insulin units/kg body weight/day found that insulin dosage correlated with pancreas volume after controlling for both age and body surface area ( P = 0.009). Pancreatic fat fraction was not significantly different between the two groups (1.34% vs. 1.57%; P = 0.891). Conclusions Our findings do not indicate that pancreatic atrophy in Type 1 diabetes is associated with an increased pancreatic fat fraction, unlike some other diseases featuring reduced pancreatic volume. We speculate that our results may support the hypotheses that much of pancreatic atrophy in Type 1 diabetes occurs before the clinical onset of the disease and that exogenous insulin administration decelerates pancreatic atrophy after diabetes onset.

Regnell, S. E.↗
DOE OSTI2014

SU-E-J-168: Automated Pancreas Segmentation Based On Dynamic MRI

Purpose: MRI guided radiotherapy is particularly attractive for abdominal targets with low CT contrast. To fully utilize this modality for pancreas tracking, automated segmentation tools are needed. A hybrid gradient, region growth and shape constraint (hGReS) method to segment 2D upper abdominal dynamic MRI is developed for this purpose. Methods: 2D coronal dynamic MR images of 2 healthy volunteers were acquired with a frame rate of 5 f/second. The regions of interest (ROIs) included the liver, pancreas and stomach. The first frame was used as the source where the centers of the ROIs were annotated. These center locations were propagated to the next dynamic MRI frame. 4-neighborhood region transfer growth was performed from these initial seeds for rough segmentation. To improve the results, gradient, edge and shape constraints were applied to the ROIs before final refinement using morphological operations. Results from hGReS and 3 other automated segmentation methods using edge detection, region growth and level set were compared to manual contouring. Results: For the first patient, hGReS resulted in the organ segmentation accuracy as measure by the Dices index (0.77) for the pancreas. The accuracy was slightly superior to the level set method (0.72), and both are significantly more accurate than the edge detection (0.53) and region growth methods (0.42). For the second healthy volunteer, hGReS reliably segmented the pancreatic region, achieving a Dices index of 0.82, 0.92 and 0.93 for the pancreas, stomach and liver, respectively, comparing to manual segmentation. Motion trajectories derived from the hGReS, level set and manual segmentation methods showed high correlation to respiratory motion calculated using a lung blood vessel as the reference while the other two methods showed substantial motion tracking errors. hGReS was 10 times faster than level set. Conclusion: We have shown the feasibility of automated segmentation of the pancreas anatomy based on dynamic MRI.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

TU-F-BRF-06: 3D Pancreas MRI Segmentation Using Dictionary Learning and Manifold Clustering

Purpose: The recent advent of MRI guided radiotherapy machines has lent an exciting platform for soft tissue target localization during treatment. However, tools to efficiently utilize MRI images for such purpose have not been developed. Specifically, to efficiently quantify the organ motion, we develop an automated segmentation method using dictionary learning and manifold clustering (DLMC). Methods: Fast 3D HASTE and VIBE MR images of 2 healthy volunteers and 3 patients were acquired. A bounding box was defined to include pancreas and surrounding normal organs including the liver, duodenum and stomach. The first slice of the MRI was used for dictionary learning based on mean-shift clustering and K-SVD sparse representation. Subsequent images were iteratively reconstructed until the error is less than a preset threshold. The preliminarily segmentation was subject to the constraints of manifold clustering. The segmentation results were compared with the mean shift merging (MSM), level set (LS) and manual segmentation methods. Results: DLMC resulted in consistently higher accuracy and robustness than comparing methods. Using manual contours as the ground truth, the mean Dices indices for all subjects are 0.54, 0.56 and 0.67 for MSM, LS and DLMC, respectively based on the HASTE image. The mean Dices indices are 0.70, 0.77 and 0.79 for the three methods based on VIBE images. DLMC is clearly more robust on the patients with the diseased pancreas while LS and MSM tend to over-segment the pancreas. DLMC also achieved higher sensitivity (0.80) and specificity (0.99) combining both imaging techniques. LS achieved equivalent sensitivity on VIBE images but was more computationally inefficient. Conclusion: We showed that pancreas and surrounding normal organs can be reliably segmented based on fast MRI using DLMC. This method will facilitate both planning volume definition and imaging guidance during treatment.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

Exocrine pancreas ER stress is differentially induced by different fatty acids

Exocrine pancreas acinar cells have a highly developed endoplasmic reticulum (ER), accommodating their high protein production rate. Overload of dietary fat (typical to obesity) is a recognized risk factor in pancreatitis and pancreatic cancer. Dietary fat, especially saturated fat, has been suggested by others and us to induce an acinar lipotoxic effect. The effect of different dietary fatty acids on the ER stress response is unknown. We studied the effect of acute (24 h) challenge with different fatty acids (saturated, mono and poly-unsaturated) at different concentrations (between 200 and 500 µM, typical to normal and obese states, respectively), testing fat accumulation, ER stress indicators, X-box binding protein 1 (Xbp1) splicing and nuclear translocation, as well as unfolded protein response (UPR) transcripts and protein levels using exocrine pancreas acinar AR42J and primary cells. Acute exposure of AR42J cells to different fatty acids caused increased accumulation of triglycerides, dependent on the type of fat. Different FAs had different effects on ER stress: most notably, saturated palmitic acid significantly affected the UPR response, as demonstrated by altered Xbp1 splicing, elevation in transcript levels of UPR (Xbp, CHOP, Bip) and immune factors (Tnfα, Tgfβ), and enhanced Xbp1 protein levels and Xbp1 time-dependent nuclear translocation. Poly-unsaturated FAs caused milder elevation of ER stress markers, while mono-unsaturated oleic acid attenuated the ER stress response. Thus, various fatty acids differentially affect acinar cell fat accumulation and, apart from oleic acid, induce ER stress. The differential effect of the various fatty acids could have potential nutritional and therapeutic implications. - Highlights: • Exocrine pancreas acinar cells have a highly developed endoplasmic reticulum (ER) and thus highly susceptible to ER stress. • We studied the effect of acute challenge with different fatty acids and doses typical to normal and obese states on ER stress. • Saturated palmitic acid significantly affected the ER UPR response demonstrated by; altered Xbp1 splicing, elevation in UPR transcripts levels and immune factors, Xbp1 protein level and Xbp1 time-depended nucleus translocation. • Poly and monounsaturated fatty acids demonstrated varying effects on ER stress markers. • Oleic acid demonstrate protective effect on pancreatic ER stress.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-J-42: Evaluation of Fiducial Markers for Ultrasound and X-Ray Images Used for Motion Tracking in Pancreas SBRT

Purpose Ultrasound tracking of target motion relies on visibility of vascular and/or anatomical landmark. However this is challenging when the target is located far from vascular structures or in organs that lack ultrasound landmark structure, such as in the case of pancreas cancer. The purpose of this study is to evaluate visibility, artifacts and distortions of fusion coils and solid gold markers in ultrasound, CT, CBCT and kV images to identify markers suitable for real-time ultrasound tracking of tumor motion in SBRT pancreas treatment. Methods Two fusion coils (1mm × 5mm and 1mm × 10 mm) and a solid gold marker (0.8mm × 10mm) were embedded in a tissue–like ultrasound phantom. The phantom (5cm × 12cm × 20cm) was prepared using water, gelatin and psyllium-hydrophilic-mucilloid fiber. Psylliumhydrophilic mucilloid acts as scattering medium to produce echo texture that simulates sonographic appearance of human tissue in ultrasound images while maintaining electron density close to that of water in CT images. Ultrasound images were acquired using 3D-ultrasound system with markers embedded at 5, 10 and 15mm depth from phantom surface. CT images were acquired using Philips Big Bore CT while CBCT and kV images were acquired with XVI-system (Elexta). Visual analysis was performed to compare visibility of the markers and visibility score (1 to 3) were assigned. Results All markers embedded at various depths are clearly visible (score of 3) in ultrasound images. Good visibility of all markers is observed in CT, CBCT and kV images. The degree of artifact produced by the markers in CT and CBCT images are indistinguishable. No distortion is observed in images from any modalities. Conclusion All markers are visible in images across all modalities in this homogenous tissue-like phantom. Human subject data is necessary to confirm the marker type suitable for real-time ultrasound tracking of tumor motion in SBRT pancreas treatment.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

Endoluminal ultrasound applicators for MR-guided thermal ablation of pancreatic tumors: Preliminary design and evaluation in a porcine pancreas model

Purpose: Endoluminal ultrasound may serve as a minimally invasive option for delivering thermal ablation to pancreatic tumors adjacent to the stomach or duodenum. The objective of this study was to explore the basic feasibility of this treatment strategy through the design, characterization, and evaluation of proof-of-concept endoluminal ultrasound applicators capable of placement in the gastrointestinal (GI) lumen for volumetric pancreas ablation under MR guidance. Methods: Two variants of the endoluminal applicator, each containing a distinct array of two independently powered transducers (10 × 10 mm 3.2 MHz planar; or 8 × 10 × 20 mm radius of curvature 3.3 MHz curvilinear geometries) at the distal end of a meter long flexible catheter assembly, were designed and fabricated. Transducers and circulatory water flow for acoustic coupling and luminal cooling were contained by a low-profile polyester balloon covering the transducer assembly fixture. Each applicator incorporated miniature spiral MR coils and mechanical features (guiding tips and hinges) to facilitate tracking and insertion through the GI tract under MRI guidance. Acoustic characterization of each device was performed using radiation force balance and hydrophone measurements. Device delivery into the upper GI tract, adjacent to the pancreas, and heating characteristics for treatment of pancreatic tissue were evaluated in MR-guided ex vivo and in vivo porcine experiments. MR guidance was utilized for anatomical target identification, tracking/positioning of the applicator, and MR temperature imaging (MRTI) for PRF-based multislice thermometry, implemented in the real-time RTHawk software environment. Results: Force balance and hydrophone measurements indicated efficiencies of 48.8% and 47.8% and −3 dB intensity beam-widths of 3.2 and 1.2 mm for the planar and curvilinear transducers, respectively. Ex vivo studies on whole-porcine carcasses revealed capabilities of producing ablative temperature rise (ΔT > 15 °C) contours in pancreatic tissue 4–40 mm long and 4–28 mm wide for the planar transducer applicator (1–13 min sonication duration, ∼4 W/cm{sup 2} applied acoustic intensity). Curvilinear transducers produced more selective heating, with a narrower ΔT > 15 °C contour length and width of up to 1–24 mm and 2–7 mm, respectively (1–7 min sonication duration, ∼4 W/cm{sup 2} applied acoustic intensity). Active tracking of the miniature spiral coils was achieved using a Hadamard encoding tracking sequence, enabling real-time determination of each coil’s coordinates and automated prescription of imaging planes for thermometry. In vivo MRTI-guided heating trials in three pigs demonstrated capability of ∼20 °C temperature elevation in pancreatic tissue at 2 cm depths from the applicator, with 5–7 W/cm{sup 2} applied intensity and 6–16 min sonication duration. Dimensions of thermal lesions in the pancreas ranged from 12 to 28 mm, 3 to 10 mm, and 5 to 10 mm in length, width, and depth, respectively, as verified through histological analysis of tissue sections. Multiple-baseline reconstruction and respiratory-gated acquisition were demonstrated to be effective strategies in suppressing motion artifacts for clear evolution of temperature profiles during MRTI in the in vivo studies. Conclusions: This study demonstrates the technical feasibility of generating volumetric ablation in pancreatic tissue using endoluminal ultrasound applicators positioned in the stomach lumen. MR guidance facilitates target identification, device tracking/positioning, and treatment monitoring through real-time multislice PRF-based thermometry.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-C-BRB-02: Automatic Planning as a Potential Strategy for Dose Escalation for Pancreas SBRT?

Purpose: Stereotactic body radiation therapy (SBRT) has been suggested to provide high rates of local control for locally advanced pancreatic cancer. However, the close proximity of highly radiosensitive normal tissues usually causes the labor-intensive planning process, and may impede further escalation of the prescription dose. The present study evaluates the potential of an automatic planning system as a dose escalation strategy. Methods: Ten pancreatic cancer patients treated with SBRT were studied retrospectively. SBRT was delivered over 5 consecutive fractions with 6 ∼ 8Gy/fraction. Two plans were generated by Pinnacle Auto-Planning with the original prescription and escalated prescription, respectively. Escalated prescription adds 1 Gy/fraction to the original prescription. Manually-created planning volumes were excluded in the optimization goals in order to assess the planning efficiency and quality simultaneously. Critical organs with closest proximity were used to determine the plan normalization to ensure the OAR sparing. Dosimetric parameters including D100, and conformity index (CI) were assessed. Results: Auto-plans directly generate acceptable plans for 70% of the cases without necessity of further improvement, and two more iterations at most are necessary for the rest of the cases. For the pancreas SBRT plans with the original prescription, autoplans resulted in favorable target coverage and PTV conformity (D100 = 96.3% ± 1.48%; CI = 0.88 ± 0.06). For the plans with the escalated prescriptions, no significant target under-dosage was observed, and PTV conformity remains reasonable (D100 = 93.3% ± 3.8%, and CI = 0.84 ± 0.05). Conclusion: Automatic planning, without substantial human-intervention process, results in reasonable PTV coverage and PTV conformity on the premise of adequate OAR sparing for the pancreas SBRT plans with escalated prescription. The results highlight the potential of autoplanning as a dose escalation strategy for pancreas SBRT treatment planning. Further investigations with a larger number of patients are necessary. The project is partially supported by Philips Medical Systems.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-T-636: Comprehensive Approach to Motion Assessment for Liver and Pancreas SBRT Patients

Purpose: Our past practice for liver and pancreas SBRT consisted of free breathing (FB) with gated treatment delivery using a 30-70% phase window. We have recently adopted an assessment method leading to individualized motion management to minimize target motion. We present our results from 47 patients treated with this new approach. Methods: We perform an initial patient coaching and assessment session in our conventional simulator suite to observe the motion of the implanted fiducials with FB anterior and lateral 20-second cine acquisitions. The physician decides whether to attempt inhale or exhale breath-hold (BH). The patient is coached while observing with cine to ascertain their ability to achieve the desired BH mode for long periods as needed for treatment delivery. If the patient cannot comply, a FB approach is adopted using gating or simple ITV method (for patients without fiducials). After achieving a patient-specific motion management mode, we perform CT-simulation using the Varian RPM system to reproduce the chosen mode and record a reference session for treatment delivery. For pre-treatment imaging, the fiducials are observed under fluoro while coaching the patient. Results: Of 47 SBRT cases analyzed, 32 were liver and 15 were pancreas. The chosen techniques were: 32 exhale BH (12 with abdominal compression), 7 FB gated, 4 inhale BH, and 4 FB ITV. Maximum fiducial motion amplitude was 5 mm for the FB gated patients, and less than 5 mm for all BH patients with most able to achieve a maximum amplitude of 3 mm. Conclusion: This study showed that an individualized motion management approach can reduce the target volume and, therefore, the volume of irradiated healthy tissue from liver or pancreas SBRT. Effective coaching is essential in achieving consistent BH with 3 mm amplitude. The fluoro/cine session is helpful in establishing the right coaching approach for each patient.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2018

Dual-Energy Imaging of the Pancreas

Purpose of Review: Dual-energy CT (DECT) is a recently introduced computed tomography (CT) technique with the ability to acquire data in multiple energies allowing energy-based material separation based on energy-dependent attenuation profiles of specific materials. Recent Findings: There are several clinical applications of DECT that are relevant in pancreatic imaging which will be reviewed in this article. Pathologies of the pancreas can vary widely in their clinical significance and can be subtle and difficult to detect. In this article, we review the current literature on DECT in pancreatic imaging, specifically in the evaluation of benign and malignant pathologic conditions of the pancreas, including inflammatory, neoplastic, and vascular disorders, as well as in the assessment of traumatic injuries. Summary: This paper will review the clinical implementation and application of DECT in pancreatic imaging, thereby allowing for improved detection and characterization of various pancreatic pathologies.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2014

SU-E-J-133: Evaluation of Inter- and Intra-Fractional Pancreas Tumor Residual Motions with Abdominal Compression

Purpose: Abdominal compression (AC) has been widely used to reduce pancreas motion due to respiration for pancreatic cancer patients undergoing stereotactic body radiotherapy (SBRT). However, the inter-fractional and intra-fractional patient motions may degrade the treatment. The purpose of this work is to study daily CBCT projections and 4DCT to evaluate the inter-fractional and intra-fractional pancreatic motions. Methods: As a standard of care at our institution, 4D CT scan was performed for treatment planning. At least two CBCT scans were performed for daily treatment. Retrospective studies were performed on patients with implanted internal fiducial markers or surgical clips. The initial motion pattern was obtained by extracting marker positions on every phase of 4D CT images. Daily motions were presented by marker positions on CBCT scan projection images. An adaptive threshold segmentation algorithm was used to extract maker positions. Both marker average positions and motion ranges were compared among three sets of scans, 4D CT, positioning CBCT, and conformal CBCT, for inter-fractional and intra-fractional motion variations. Results: Data from four pancreatic cancer patients were analyzed. These patients had three fiducial markers implanted. All patients were treated by an Elekta Synergy with single fraction SBRT. CBCT projections were acquired by XVI. Markers were successfully detected on most of the projection images. The inter-fractional changes were determined by 4D CT and the first CBCT while the intra-fractional changes were determined by multiple CBCT scans. It is found that the average motion range variations are within 2 mm, however, the average marker positions may drift by 6.5 mm. Conclusion: The patients respiratory motion variation for pancreas SBRT with AC was evaluated by detecting markers from CBCT projections and 4DCT, both the inter-fraction and intra-fraction motion range change is small but the drift of marker positions may be comparable to motion ranges.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-P-25: Evaluation of Motion in Pancreas SBRT Treatment Deliveries

Purpose: Stereotactic Body Radiation Therapy (SBRT) procedures for pancreatic cancer present a challenge in motion management because the target is directly adjacent to critical structures and the target is subject to significant respiratory motion. Gated treatment is usually planned with a tight (few mm) PTV margin. The positioning and setup relies on on-board-imaging (OBI) of internal fiducials. This study evaluates the corrections for inter- and intra-fractional target motion as evidenced by the OBI. Methods: 20 patients with gated pancreas SBRT treatment were setup with KV imaging guidance before and during each treatment. The couch position was fine-tuned to align with the internal fiducials for each patient. The data for 148 intra- and 111 inter-fractional couch movements were captured and analyzed. Results: The mean ± standard deviation of couch shifts for the initial daily setup is 4.9±4.1 mm for couch vertical, 5.3±4.6 mm for couch longitudinal, and 3.7±4.0 mm for couch lateral. The mean ± standard deviation of intra-treatment adjustments are 1.1±1.6, 2.5±3.8, and 1.1±1.8 mm for couch vertical, longitudinal and lateral. The probability of intra-fractional motion in the three orthogonal directions with magnitude no more than 2 mm, 3 mm and 5 mm is 55%, 68% and 84% respectively. Conclusion: The intra-treatment target motion for pancreas SBRT patients indicates that a PTV margin of 5mm may be necessary.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2019

Differentiation of pancreatic neuroendocrine tumors from pancreas renal cell carcinoma metastases on CT using qualitative and quantitative features

Purpose: To assess qualitative and quantitative imaging features on enhanced CT that may differentiate pancreatic neuroendocrine tumors (PNETs) from pancreatic renal cell carcinoma (RCC) metastases. Methods: This IRB-approved multi-center retrospective case–control study compared 43 resected PNETs and 28 resected RCC metastases with pre-operative enhanced CT identified consecutively between 2003 and 2017. Two blinded radiologists (R1/R2) independently assessed tumor location, attenuation (relative to pancreas), composition (solid/cystic/mixed), homogeneity (homogeneous/heterogeneous), calcification, multiplicity, and for main pancreatic duct (MPD) dilation. Tumors were segmented for quantitative texture analysis. Data were analyzed with Chi square, logistic regression, and receiver operating characteristic (ROC). Inter-observer agreement was assessed (Cohen’s kappa). Results: There was no difference in age, gender, location, attenuation, or composition (P > 0.05) between groups. PNETs were larger than RCC metastases (37 ± 23 mm vs. 26 ± 21 mm, P = 0.038), more frequently solitary (P < 0.001), subjectively more heterogeneous (P = 0.033/0.144, R1/R2), and associated with calcification (P = 0.002/0.004) and MPD dilation (P = 0.025/0.006). Agreement for subjective features was moderate-to-almost perfect (K = 0.4879–0.9481). Quantitative texture analysis showed higher entropy in PNETs (6.32 ± 0.49 versus 5.96 ± 0.53; P = 0.004) with no difference in other features studied (P > 0.05). Entropy had ROC area under the curve for diagnosis of PNET of 0.77 ± 0.06, with optimal sensitivity/specificity of 71.4/79.1%. Conclusions: Compared to pancreatic RCC metastases, PNETs are larger, more frequently solitary, contain calcification, show MPD dilation, and are subjectively and quantitatively more heterogeneous tumors.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2019

110 Patients with adenosquamous carcinomas of the pancreas (PASC): imaging differentiation of small (≤ 3 cm) versus large (> 3 cm) tumors

Objective: This study examined radiological imaging features of small (≤ 3 cm) and large (> 3 cm) adenosquamous carcinomas of the pancreas (PASC) lesions to better understand the morphology of these lesions. Methods: Images from 110 patients with pathologically proven PASC (80 males and 30 females, mean age: 62.6 years) were retrospectively reviewed. Two radiologists analyzed images and reached a consensus regarding the following features: location, shape, margins, presence of solid and necrotic components, rim enhancement, density/intensity during the portal venous phase, invasion of surrounding organs, vascular invasion, venous tumor thrombus formation, and enlarged lymph nodes. Differences in the imaging features between the two groups were evaluated with the Chi-square test or Fisher’s exact test. Results: There were 41 small PASC lesions (mean age: 60.59 years) and 69 large PASC lesions (63.74 years). Statistical analysis demonstrated significant differences in the location, shape, adjacent organ and vessel invasion, and venous tumor thrombus formation (P < 0.05). Small PASC lesions were more frequently detected in the pancreatic head and had an ovoid shape. There was no significant difference in the presence of solid and necrotic components (P = 0.090), including approximately 3/4 of the lesions with necrosis and 1/4 purely solid lesions, enlarged lymph nodes (P = 0.068) and other features. Conclusion: Regardless of the tumor size, 75% of PASC lesions present with central necrosis while 25% are purely solid. Small PASC lesions can be associated with lymph node metastasis at a relatively early stage. Large PASC lesions are likely to invade adjacent tissues and be associated with venous tumor thrombus formation.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2013

Management of Respiration-Induced Motion With 4-Dimensional Computed Tomography (4DCT) for Pancreas Irradiation

Purpose: The purposes of this study were to quantify respiration-induced organ motions for pancreatic cancer patients and to explore strategies to account for these motions. Methods and Materials: Both 3-dimensional computed tomography (3DCT) and 4-dimensional computed tomography (4DCT) scans were acquired sequentially for 15 pancreatic cancer patients, including 10 randomly selected patients and 5 patients selected from a subgroup of patients with large tumor respiratory motions. 3DCTs were fused with 2 sets of 4DCT data at the end of exhale phase (50%) and the end of inhale phase (0%). The target was delineated on the 50% and 0% phase CT sets, and the organs at risk were drawn on the 3DCT. These contours were populated to the CT sets at other respiratory phases based on deformable image registration. Internal target volumes (ITV) were generated by tracing the target contours of all phases (ITV{sub 10}), 3 phases of 0%, 20% and 50% (ITV{sub 3}), and 2 phases of 0% and 50% (ITV{sub 2}). ITVs generated from phase images were compared using percentage of volume overlap, Dice coefficient, geometric centers, and average surface distance. Results: Volume variations of pancreas, kidneys, and liver as a function of respiratory phases were small (<5%) during respiration. For the 10 randomly selected patients, peak-to-peak amplitudes of liver, left kidney, right kidney, and the target along the superior-inferior (SI) direction were 7.9 ± 3.2 mm, 7.1 ± 3.1 mm, 5.7 ± 3.2 mm, and 5.9 ± 2.8 mm, respectively. The percentage of volume overlap and Dice coefficient were 92% ± 1% and 96% ± 1% between ITV{sub 10} and ITV{sub 2} and 96% ± 1% and 98% ± 1% between ITV{sub 10} and ITV{sub 3}, respectively. The percentage of volume overlap between ITV{sub 10} and ITV{sub 3} was 93.6 ± 1.1 for patients with tumor motion >8 mm. Conclusions: Appropriate motion management strategies are proposed for radiation treatment planning of pancreatic tumors based on magnitudes of tumor respiratory motions.

62 RADIOLOGY AND NUCLEAR MEDICINE↗