Engineering topics

Booth, J

Publications and source records attributed to Booth, J.

8 records

DOE OSTI2016

SU-G-JeP1-05: Clinical Impact of MLC Tracking for Lung SABR

Purpose: The objective of this study was to investigate the dosimetric benefits of multi-leaf collimator (MLC) tracking for lung SABR treatments in end-to-end clinically realistic planning and delivery scenarios. Methods: The clinical benefits of MLC tracking were assessed using previously delivered treatment plans and physical experiments. The 10 most recent single lesion lung SABR patients were re-planned following a 4D-GTV-based real-time adaptive protocol (PTV defined as the end-of-exhalation GTV plus 5.0 mm margins). The plans were delivered on a Trilogy Varian linac. Electromagnetic transponders (Calypso, Varian Medical Systems, USA) were embedded into a programmable moving phantom (HexaMotion platform) tracked with the Varian Calypso system. For each physical experiment, the MLC positions were collected and used as input for dose reconstruction. For both planned and physical experiments, the OAR dose metrics from the conventional and real-time adaptive SABR plans (Mean Lung Dose (MLD), V20 for lung, and near-maximum dose (D2%) for spine and heart) were statistically compared. The Wilcoxon test was used to compare plan and physical experiment dose metrics. Results: While maintaining target coverage, percentage reductions in dose metrics to the OARs were observed for both planned and physical experiments. Comparing the two plans showed MLD percentage reduction (MLDr) of 25.4% (absolute differences of 1.41 Gy) and 28.9% (1.29%) for the V20r. D2% percentage reduction for spine and heart were respectively 27.9% (0.3 Gy) and 20.2% (0.3 Gy). For the physical experiments, MLDr was 23.9% (1.3 Gy), and V20r 37.4% (1.6%). D2% reduction for spine and heart were respectively 27.3% (0.3 Gy) and 19.6% (0.3 Gy). For both plans and physical experiments, significant OAR dose differences (p<0.05) were found between the conventional SABR and real-time adaptive plans. Conclusion: Application of MLC tracking for lung SABR patients has the potential to reduce the dose to OARs during radiation therapy.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

SU-G-JeP1-12: Head-To-Head Performance Characterization of Two Multileaf Collimator Tracking Algorithms for Radiotherapy

Purpose: Multi-leaf collimator (MLC) tracking is being clinically pioneered to continuously compensate for thoracic and abdominal motion during radiotherapy. The purpose of this work is to characterize the performance of two MLC tracking algorithms for cancer radiotherapy, based on a direct optimization and a piecewise leaf fitting approach respectively. Methods: To test the algorithms, both physical and in silico experiments were performed. Previously published high and low modulation VMAT plans for lung and prostate cancer cases were used along with eight patient-measured organ-specific trajectories. For both MLC tracking algorithm, the plans were run with their corresponding patient trajectories. The physical experiments were performed on a Trilogy Varian linac and a programmable phantom (HexaMotion platform). For each MLC tracking algorithm, plan and patient trajectory, the tracking accuracy was quantified as the difference in aperture area between ideal and fitted MLC. To compare algorithms, the average cumulative tracking error area for each experiment was calculated. The two-sample Kolmogorov-Smirnov (KS) test was used to evaluate the cumulative tracking errors between algorithms. Results: Comparison of tracking errors for the physical and in silico experiments showed minor differences between the two algorithms. The KS D-statistics for the physical experiments were below 0.05 denoting no significant differences between the two distributions pattern and the average error area (direct optimization/piecewise leaf-fitting) were comparable (66.64 cm2/65.65 cm2). For the in silico experiments, the KS D-statistics were below 0.05 and the average errors area were also equivalent (49.38 cm2/48.98 cm2). Conclusion: The comparison between the two leaf fittings algorithms demonstrated no significant differences in tracking errors, neither in a clinically realistic environment nor in silico. The similarities in the two independent algorithms give confidence in the use of either algorithm for clinical implementation.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

SU-G-JeP4-10: Measurement of Prostate Motion Trajectories During Prostate SBRT Boost Treatments with a Rectafix

Purpose: To determine prostate motion during SBRT boost treatments with a Rectafix rectal sparing device in place using kV imaging during treatment. Methods: Patients each had three gold fiducial markers inserted into the prostate and received two VMAT boost fractions of 9.5–10 Gy under the PROMETHEUS clinical trial protocol with a Rectafix rectal retractor in place. Two-dimensional kilovoltage images of fiducial markers were acquired continuously during delivery. Three patients were treated on a Varian Clinac iX linear accelerator (6X, 600 MU/min), where kV images were acquired at 5 Hz during treatment. Seven patients were treated on a Varian Truebeam linear accelerator (10XFFF, 2400 MU/min) where kV images were acquired every 3 seconds. Images were processed off-line using the Kilovoltage Intrafraction Monitoring (KIM) software after treatment. KIM determines prostate position in three dimensions from 2D kV projections using a probability density model and a pre-treatment kV arc. The 3D displacement of the prostate was quantified as a function of time throughout each fraction. Results: From all fractions analyzed, it was found that the prostate had moved less than 1 mm in any direction from its initial position 84.6% of the time. The prostate was between 1 and 2 mm from its initial position 14.2% of the time, between 2 and 3 mm of its initial position 0.8% of the time and was greater than 3 mm from its initial position only 0.4% of the time. Conclusion: The amount of prostate motion observed during prostate SBRT boost treatments with a Rectafix device in place was minimal and lower than that observed in non-Rectafix studies. The Rectafix device reduces rectal dose as well as immobilizing the prostate. Kimberley Legge is the recipient of an Australian Postgraduate Award.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

MO-FG-BRA-06: Electromagnetic Beacon Insertion in Lung Cancer Patients and Resultant Surrogacy Errors for Dynamic MLC Tumour Tracking

Purpose: To assess endo-bronchial electromagnetic beacon insertion and to quantify the geometric accuracy of using beacons as a surrogate for tumour motion in real-time multileaf collimator (MLC) tracking of lung tumours. Methods: The LIGHT SABR trial is a world-first clinical trial in which the MLC leaves move with lung tumours in real time on a standard linear accelerator. Tracking is performed based on implanted electromagnetic beacons (CalypsoTM, Varian Medical Systems, USA) as a surrogate for tumour motion. Five patients have been treated and have each had three beacons implanted endo-bronchially under fluoroscopic guidance. The centre of mass (C.O.M) has been used to adapt the MLC in real-time. The geometric error in using the beacon C.O.M as a surrogate for tumour motion was measured by measuring the tumour and beacon C.O.M in all phases of the respiratory cycle of a 4DCT. The surrogacy error was defined as the difference in beacon and tumour C.O.M relative to the reference phase (maximum exhale). Results: All five patients have had three beacons successfully implanted with no migration between simulation and end of treatment. Beacon placement relative to tumour C.O.M varied from 14 to 74 mm and in one patient spanned two lobes. Surrogacy error was measured in each patient on the simulation 4DCT and ranged from 0 to 3 mm. Surrogacy error as measured on 4DCT was subject to artefacts in mid-ventilation phases. Surrogacy error was a function of breathing phase and was typically larger at maximum inhale. Conclusion: Beacon placement and thus surrogacy error is a major component of geometric uncertainty in MLC tracking of lung tumours. Surrogacy error must be measured on each patient and incorporated into margin calculation. Reduction of surrogacy error is limited by airway anatomy, however should be taken into consideration when performing beacon insertion and planning. This research is funded by Varian Medical Systems via a collaborative research agreement.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

TU-FG-201-09: Predicting Accelerator Dysfunction

Purpose: To develop an integrated statistical process control (SPC) framework using digital performance and component data accumulated within the accelerator system that can detect dysfunction prior to unscheduled downtime. Methods: Seven digital accelerators were monitored for twelve to 18 months. The accelerators were operated in a ‘run to failure mode’ with the individual institutions determining when service would be initiated. Institutions were required to submit detailed service reports. Trajectory and text log files resulting from a robust daily VMAT QA delivery were decoded and evaluated using Individual and Moving Range (I/MR) control charts. The SPC evaluation was presented in a customized dashboard interface that allows the user to review 525 monitored parameters (480 MLC parameters). Chart limits were calculated using a hybrid technique that includes the standard SPC 3σ limits and an empirical factor based on the parameter/system specification. The individual (I) grand mean values and control limit ranges of the I/MR charts of all accelerators were compared using statistical (ranked analysis of variance (ANOVA)) and graphical analyses to determine consistency of operating parameters. Results: When an alarm or warning was directly connected to field service, process control charts predicted dysfunction consistently on beam generation related parameters (BGP)– RF Driver Voltage, Gun Grid Voltage, and Forward Power (W); beam uniformity parameters – angle and position steering coil currents; and Gantry position accuracy parameter: cross correlation max-value. Control charts for individual MLC – cross correlation max-value/position detected 50% to 60% of MLCs serviced prior to dysfunction or failure. In general, non-random changes were detected 5 to 80 days prior to a service intervention. The ANOVA comparison of BGP determined that each accelerator parameter operated at a distinct value. Conclusion: The SPC framework shows promise. Long term monitoring coordinated with service will be required to definitively determine the effectiveness of the model. Varian Medical System, Inc. provided funding in support of the research presented.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗

DOE OSTI2016

TH-AB-202-02: Real-Time Verification and Error Detection for MLC Tracking Deliveries Using An Electronic Portal Imaging Device

Purpose: The added complexity of the real-time adaptive multi-leaf collimator (MLC) tracking increases the likelihood of undetected MLC delivery errors. In this work we develop and test a system for real-time delivery verification and error detection for MLC tracking radiotherapy using an electronic portal imaging device (EPID). Methods: The delivery verification system relies on acquisition and real-time analysis of transit EPID image frames acquired at 8.41 fps. In-house software was developed to extract the MLC positions from each image frame. Three comparison metrics were used to verify the MLC positions in real-time: (1) field size, (2) field location and, (3) field shape. The delivery verification system was tested for 8 VMAT MLC tracking deliveries (4 prostate and 4 lung) where real patient target motion was reproduced using a Hexamotion motion stage and a Calypso system. Sensitivity and detection delay was quantified for various types of MLC and system errors. Results: For both the prostate and lung test deliveries the MLC-defined field size was measured with an accuracy of 1.25 cm{sup 2} (1 SD). The field location was measured with an accuracy of 0.6 mm and 0.8 mm (1 SD) for lung and prostate respectively. Field location errors (i.e. tracking in wrong direction) with a magnitude of 3 mm were detected within 0.4 s of occurrence in the X direction and 0.8 s in the Y direction. Systematic MLC gap errors were detected as small as 3 mm. The method was not found to be sensitive to random MLC errors and individual MLC calibration errors up to 5 mm. Conclusion: EPID imaging may be used for independent real-time verification of MLC trajectories during MLC tracking deliveries. Thresholds have been determined for error detection and the system has been shown to be sensitive to a range of delivery errors.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

TH-AB-202-10: Quantifying the Accuracy and Precision of Six Degree-Of-Freedom Motion Estimation for Use in Real-Time Tumor Motion Monitoring During Radiotherapy

Purpose: Kilovoltage intrafraction monitoring (KIM) scheme has been successfully used to simultaneously monitor 3D tumor motion during radiotherapy. Recently, an iterative closest point (ICP) algorithm was implemented in KIM to also measure rotations about three axes, enabling real-time tracking of tumor motion in six degrees-of-freedom (DoF). This study aims to evaluate the accuracy of the six DoF motion estimates of KIM by comparing it with the corresponding motion (i) measured by the Calypso; and (ii) derived from kV/MV triangulation. Methods: (i) Various motions (static and dynamic) were applied to a CIRS phantom with three embedded electromagnetic transponders (Calypso Medical) using a 5D motion platform (HexaMotion) and a rotating treatment couch while both KIM and Calypso were used to concurrently track the phantom motion in six DoF. (ii) KIM was also used to retrospectively estimate six DoF motion from continuous sets of kV projections of a prostate, implanted with three gold fiducial markers (2 patients with 80 fractions in total), acquired during the treatment. Corresponding motion was obtained from kV/MV triangulation using a closed form least squares method based on three markers’ positions. Only the frames where all three markers were present were used in the analysis. The mean differences between the corresponding motion estimates were calculated for each DoF. Results: Experimental results showed that the mean of absolute differences in six DoF phantom motion measured by Calypso and KIM were within 1.1° and 0.7 mm. kV/MV triangulation derived six DoF prostate tumor better agreed with KIM estimated motion with the mean (s.d.) difference of up to 0.2° (1.36°) and 0.2 (0.25) mm for rotation and translation, respectively. Conclusion: These results suggest that KIM can provide an accurate six DoF intrafraction tumor during radiotherapy.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

TH-AB-202-12: The First Clinical Implementation of a Real-Time Six Degree of Freedom Tracking System During Radiation Therapy

Purpose: In current practice, imaging is typically performed prior to treatment; the cancer target motion during treatment is unknown. We present the first clinical implementation of real time Kilovoltage Intrafraction Monitoring (KIM) system which tracks the cancer target translational and rotational motions during treatment. Methods: KIM technology: KIM estimates the 3D position of the target tumour based on segmented 2D positions of the three implanted fiducials in each of the kV images (125 kV, 10 mA at 11 fps) taken continuously during the treatment arc. The 2D-3D target estimation is based on a probability distribution function, obtained during pre-treatment CBCT. Rotations about each axis with the centroid of the markers as the pivot were calculated using the iterative closest point algorithm in real time. Patient: A patient with prostate adenocarcinoma undergoing stereotactic body radiotherapy (SBRT) with 36.25 Gy delivered in 5 fractions (Varian TrueBeam, 6X, VMAT) was enrolled in the study. The trial complies with Australian ethical and regulatory standards. Results: Of the 5 fractions of treatment the patient received, KIM was utilised successfully in 4 fractions with 3 couch shifts due to large persistent prostate movements (>2mm for more than 5 seconds). KIM translational accuracy and precision in comparison with post treatment kV-MV triangulation are 0.28±0.59 mm, −0.19±0.25 mm and 0.23±0.69 mm in the Left-Right, Superior-Inferior and Anterior-Posterior directions, respectively. KIM rotational accuracy as compared with triangulation is: 0.429°±2.22°, −0.44°±4.7° and 0.06°±1.08° in the roll, pitch and yaw direction, respectively. Conclusion: The first six degree of freedom KIM system was successfully implemented clinically. The presented KIM system has sub-millimeters accuracy and precision in all three translational axes, and less than 1° of mean error in all three rotational axes. Acknowledgement: This work is supported by Cancer Australia grants APPXXX, APPYYY.

60 APPLIED LIFE SCIENCES↗