Engineering topics

Gu, X

Publications and source records attributed to Gu, X.

At least 19 records

DOE OSTI2016

SU-C-BRA-06: Automatic Brain Tumor Segmentation for Stereotactic Radiosurgery Applications

Purpose: Stereotactic radiosurgery (SRS), which delivers a potent dose of highly conformal radiation to the target in a single fraction, requires accurate tumor delineation for treatment planning. We present an automatic segmentation strategy, that synergizes intensity histogram thresholding, super-voxel clustering, and level-set based contour evolving methods to efficiently and accurately delineate SRS brain tumors on contrast-enhance T1-weighted (T1c) Magnetic Resonance Images (MRI). Methods: The developed auto-segmentation strategy consists of three major steps. Firstly, tumor sites are localized through 2D slice intensity histogram scanning. Then, super voxels are obtained through clustering the corresponding voxels in 3D with reference to the similarity metrics composited from spatial distance and intensity difference. The combination of the above two could generate the initial contour surface. Finally, a localized region active contour model is utilized to evolve the surface to achieve the accurate delineation of the tumors. The developed method was evaluated on numerical phantom data, synthetic BRATS (Multimodal Brain Tumor Image Segmentation challenge) data, and clinical patients’ data. The auto-segmentation results were quantitatively evaluated by comparing to ground truths with both volume and surface similarity metrics. Results: DICE coefficient (DC) was performed as a quantitative metric to evaluate the auto-segmentation in the numerical phantom with 8 tumors. DCs are 0.999±0.001 without noise, 0.969±0.065 with Rician noise and 0.976±0.038 with Gaussian noise. DC, NMI (Normalized Mutual Information), SSIM (Structural Similarity) and Hausdorff distance (HD) were calculated as the metrics for the BRATS and patients’ data. Assessment of BRATS data across 25 tumor segmentation yield DC 0.886±0.078, NMI 0.817±0.108, SSIM 0.997±0.002, and HD 6.483±4.079mm. Evaluation on 8 patients with total 14 tumor sites yield DC 0.872±0.070, NMI 0.824±0.078, SSIM 0.999±0.001, and HD 5.926±6.141mm. Conclusion: The developed automatic segmentation strategy, which yields accurate brain tumor delineation in evaluation cases, is promising for its application in SRS treatment planning.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

SU-C-202-05: Pilot Study of Online Treatment Evaluation and Adaptive Re-Planning for Laryngeal SBRT

Purpose: We have instigated a phase I trial of 5-fraction stereotactic body radiotherapy (SBRT) for advanced-stage laryngeal cancer. We conducted this pilot dosimetric study to confirm the potential utility of online adaptive re-planning to preserve treatment quality. Methods: Ten cases of larynx cancer were evaluated. Baseline and daily SBRT treatment plans were generated per trial protocol. Daily volumetric images were acquired prior to every fraction of treatment. Reference simulation CT images were deformably registered to daily volumetric images using Eclipse. Planning contours were then deformably propagated to daily images. Reference SBRT plans were directly copied to calculate delivered dose distributions on deformed reference CT images. In-house software platform has been developed to calculate cumulative dose over a course of treatment in four steps: 1) deforming delivered dose grid to reference CT images using deformation information exported from Eclipse; 2) generating tetrahedrons using deformed dose grid as vertices; 3) resampling dose to a high resolution within every tetrahedron; 4) calculating dose-volume histograms. Our inhouse software was benchmarked with a commercial software, Mirada. Results: In all ten cases including 49 fractions of treatments, delivered daily doses were completely evaluated and treatment could be re-planned within 10 minutes. Prescription dose coverage of PTV was less than intended in 53% of fractions of treatment (mean: 94%, range: 84%–98%) while minimum coverage of CTV and GTV was 94% and 97%, respectively. Maximum bystander point dose limits to arytenoids, parotids, and spinal cord remained respected in all cases, although variances in carotid artery doses were observed in a minority of cases. Conclusion: Although GTV and CTV coverage is preserved by in-room 3D image guidance of larynx SBRT, PTV coverage can vary significantly from intended plans. Online adaptive treatment evaluation and re-planning is potentially necessary and our procedure is clinically applicable to fully preserve treatment quality. This project is supported by CPRIT Individual Investigator Research Award RP150386.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

SU-F-J-111: A Novel Distance-Dose Weighting Method for Label Fusion in Multi- Atlas Segmentation for Prostate Radiation Therapy

Purpose: A novel distance-dose weighting method for label fusion was developed to increase segmentation accuracy in dosimetrically important regions for prostate radiation therapy. Methods: Label fusion as implemented in the original SIMPLE (OS) for multi-atlas segmentation relies iteratively on the majority vote to generate an estimated ground truth and DICE similarity measure to screen candidates. The proposed distance-dose weighting puts more values on dosimetrically important regions when calculating similarity measure. Specifically, we introduced distance-to-dose error (DDE), which converts distance to dosimetric importance, in performance evaluation. The DDE calculates an estimated DE error derived from surface distance differences between the candidate and estimated ground truth label by multiplying a regression coefficient. To determine the coefficient at each simulation point on the rectum, we fitted DE error with respect to simulated voxel shift. The DEs were calculated by the multi-OAR geometry-dosimetry training model previously developed in our research group. Results: For both the OS and the distance-dose weighted SIMPLE (WS) results, the evaluation metrics for twenty patients were calculated using the ground truth segmentation. The mean difference of DICE, Hausdorff distance, and mean absolute distance (MAD) between OS and WS have shown 0, 0.10, and 0.11, respectively. In partial MAD of WS which calculates MAD within a certain PTV expansion voxel distance, the lower MADs were observed at the closer distances from 1 to 8 than those of OS. The DE results showed that the segmentation from WS produced more accurate results than OS. The mean DE error of V75, V70, V65, and V60 were decreased by 1.16%, 1.17%, 1.14%, and 1.12%, respectively. Conclusion: We have demonstrated that the method can increase the segmentation accuracy in rectum regions adjacent to PTV. As a result, segmentation using WS have shown improved dosimetric accuracy than OS. The WS will provide dosimetrically important label selection strategy in multi-atlas segmentation. CPRIT grant RP150485.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

SU-F-J-217: Accurate Dose Volume Parameters Calculation for Revealing Rectum Dose-Toxicity Effect Using Deformable Registration in Cervical Cancer Brachytherapy: A Pilot Study

Purpose: To study the feasibility of employing deformable registration methods for accurate rectum dose volume parameters calculation and their potentials in revealing rectum dose-toxicity between complication and non-complication cervical cancer patients with brachytherapy treatment. Method and Materials: Data from 60 patients treated with BT including planning images, treatment plans, and follow-up clinical exam were retrospectively collected. Among them, 12 patients complained about hematochezia were further examined with colonoscopy and scored as Grade 1–3 complication (CP). Meanwhile, another 12 non-complication (NCP) patients were selected as a reference group. To seek for potential gains in rectum toxicity prediction when fractional anatomical deformations are account for, the rectum dose volume parameters D0.1/1/2cc of the selected patients were retrospectively computed by three different approaches: the simple “worstcase scenario” (WS) addition method, an intensity-based deformable image registration (DIR) algorithm-Demons, and a more accurate, recent developed local topology preserved non-rigid point matching algorithm (TOP). Statistical significance of the differences between rectum doses of the CP group and the NCP group were tested by a two-tailed t-test and results were considered to be statistically significant if p < 0.05. Results: For the D0.1cc, no statistical differences are found between the CP and NCP group in all three methods. For the D1cc, dose difference is not detected by the WS method, however, statistical differences between the two groups are observed by both Demons and TOP, and more evident in TOP. For the D2cc, the CP and NCP cases are statistically significance of the difference for all three methods but more pronounced with TOP. Conclusion: In this study, we calculated the rectum D0.1/1/2cc by simple WS addition and two DIR methods and seek for gains in rectum toxicity prediction. The results favor the claim that accurate dose deformation and summation tend to be more sensitive in unveiling the dose-toxicity relationship. This work is supported in part by grant from VARIAN MEDICAL SYSTEMS INC, the National Natural Science Foundation of China (no 81428019 and no 81301940), the Guangdong Natural Science Foundation (2015A030313302)and the 2015 Pearl River S&T Nova Program of Guangzhou (201506010096).

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

SU-F-T-428: An Optimization-Based Commissioning Tool for Finite Size Pencil Beam Dose Calculations

Purpose: Finite size pencil beam (FSPB) algorithms are commonly used to pre-calculate the beamlet dose distribution for IMRT treatment planning. FSPB commissioning, which usually requires fine tuning of the FSPB kernel parameters, is crucial to the dose calculation accuracy and hence the plan quality. Yet due to the large number of beamlets, FSPB commissioning could be very tedious. This abstract reports an optimization-based FSPB commissioning tool we have developed in MatLab to facilitate the commissioning. Methods: A FSPB dose kernel generally contains two types of parameters: the profile parameters determining the dose kernel shape, and a 2D scaling factors accounting for the longitudinal and off-axis corrections. The former were fitted using the penumbra of a reference broad beam’s dose profile with Levenberg-Marquardt algorithm. Since the dose distribution of a broad beam is simply a linear superposition of the dose kernel of each beamlet calculated with the fitted profile parameters and scaled using the scaling factors, these factors could be determined by solving an optimization problem which minimizes the discrepancies between the calculated dose of broad beams and the reference dose. Results: We have commissioned a FSPB algorithm for three linac photon beams (6MV, 15MV and 6MVFFF). Dose of four field sizes (6*6cm2, 10*10cm2, 15*15cm2 and 20*20cm2) were calculated and compared with the reference dose exported from Eclipse TPS system. For depth dose curves, the differences are less than 1% of maximum dose after maximum dose depth for most cases. For lateral dose profiles, the differences are less than 2% of central dose at inner-beam regions. The differences of the output factors are within 1% for all the three beams. Conclusion: We have developed an optimization-based commissioning tool for FSPB algorithms to facilitate the commissioning, providing sufficient accuracy of beamlet dose calculation for IMRT optimization.

07 ISOTOPE AND RADIATION SOURCES↗

DOE OSTI2016

SU-F-T-598: Robotic Radiosurgery System Versus Pencil Beam Scanning Proton Therapy for Definitive Intracranial Treatments

Purpose: To characterize the dose distributions of Cyberknife and intensity-modulated-proton-therapy (IMPT). Methods: A total of 20 patients previously treated with Cyberknife were selected. The original planning-target-volume (PTV) was used in the ‘IMPT-ideal’ plan assuming a comparable image-guidance with Cyberknife. A 3mm expansion was made to create the proton-PTV for the ‘IMPT-3mm’ plan representing the current proton-therapy where a margin of 3mm is used to account for the inferior image-guidance. The proton range uncertainty was taken-care in beam-design by adding the proximal- and distal-margins (3%water-equivalent-depth+1mm) for both proton plans. The IMPT plans were generated to meet the same target coverage as the Cyberknife-plans. The plan quality of IMPT-ideal and IMPT-3mm were compared to the Cyberknife-plan. To characterize plan quality, we defined the ratio(R) of volumes encompassed by the selected isodose surfaces for Cyberknife and IMPT plans (VCK/VIMPT). Comparisons were made for both Cyberknife versus IMPT-ideal and Cyberknife versusIMPT-3mm to further discuss the impact of setup error margins used in proton therapy and the correlation with target size and location. Results: IMPT-ideal plans yield comparable plan quality as CK plans and slightly better OAR sparing while the IMPT-3mm plan results in a higher dose to the OARs, especially for centralized tumors. Comparing to the IMPT-ideal plans, a slightly larger 80% (Ravg=1.05) dose cloud and significantly larger 50% (Ravg=1.3) and 20% (Ravg=1.60) dose clouds are seen in CK plans. However, the 3mm expansion results in a larger high and medium dose clouds in IMPT-3mm plans (Ravg=0.65 for 80%-isodose; Ravg=0.93 for 50%-isodose). The trend increases with the size of the target and the distance from the brainstem to the center of target. Conclusion: Cyberknife is more preferable for treating centralized targets and proton therapy is advantageous for the large and peripheral targets. Advanced image guidance would improve the efficacy of proton therapy for intracranial treatments.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

SU-G-TeP1-09: Modality-Specific Dose Gradient Modeling for Prostate IMRT Using Spherical Distance Maps of PTV and Isodose Contours

Purpose: Overlapping volume histogram (OVH) and distance-to-target histogram (DTH) calculations rely on the assumption that dose gradients are symmetric with respect to primary target volume (PTV) expansion and minimum distance to PTV surface, respectively. It is desirable to lift this assumption and instead account for achievable modality-specific dose gradients (MSDG) for a given PTV shape. Methods: From a library of 96 prostate 7-beam IMRT plans, we computed spherical distance maps (SDMs) for PTVs and 3 iso-dose contours. Each SDM contains the minimum distances between plan isocenter and the object’s surface for a fixed set of azimuthal and polar angles. We performed principal component analysis (PCA)-based missing data recovery with PTV SDM as input and a single iso-dose contour SDM as output. Repeating this process for the set of iso-dose contours sparsely reconstructed the MSDG for a given PTV. DVH points were computed from the MSDG for bladder and rectum (OARs) as a natural way of casting patient-specific geometric information into modality-specific dose space (vs. OVH and DTH where data is purely geometric). For comparison, we implemented a cumulative (c)DTH-based prediction algorithm, and produced DVH for both OARs separately. We then computed linear regressions between each method and the DVH of the original patient plan for three different OAR DVH points. Results: R-squared for MSD-Gcomputed DVH vs. original plan DVH at V90%, V80% and V60% of max dose were 0.86, 0.83, and 0.78, for bladder and 0.36, 0.52, and 0.55 for rectum, respectively; R-squared for cDTH-based predicted DVH vs. original plan DVH were 0.67, 0.81, and 0.83, for bladder and 0.44, 0.50, and 0.51, for rectum, respectively. Conclusion: By simply modeling the MSDG about a given PTV, we are able to reproduce DVHs consistent with a validated cDTH-based DVH prediction. Regression analysis suggests MSDG could further improve predictions.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

MO-FG-BRA-08: Swarm Intelligence-Based Personalized Respiratory Gating in Lung SAbR

Purpose: Respiratory gating is widely deployed as a clinical motion-management strategy in lung radiotherapy. In conventional gating, the beam is turned on during a pre-determined phase window; typically, around end-exhalation. In this work, we challenge the notion that end-exhalation is always the optimal gating phase. Specifically, we use a swarm-intelligence-based, inverse planning approach to determine the optimal respiratory phase and MU for each beam with respect to (i) the state of the anatomy at each phase and (ii) the time spent in that state, estimated from long-term monitoring of the patient’s breathing motion. Methods: In a retrospective study of five lung cancer patients, we compared the dosimetric performance of our proposed personalized gating (PG) with that of conventional end-of-exhale gating (CEG) and a previously-developed, fully 4D-optimized plan (combined with MLC tracking delivery). For each patient, respiratory phase probabilities (indicative of the time duration of the phase) were estimated over 2 minutes from lung tumor motion traces recorded previously using the Synchrony system (Accuray Inc.). Based on this information, inverse planning optimization was performed to calculate the optimal respiratory gating phase and MU for each beam. To ensure practical deliverability, each PG beam was constrained to deliver the assigned MU over a time duration comparable to that of CEG delivery. Results: Maximum OAR sparing for the five patients achieved by the PG and the 4D plans compared to CEG plans was: Esophagus Dmax [PG:57%, 4D:37%], Heart Dmax [PG:71%, 4D:87%], Spinal cord Dmax [PG:18%, 4D:68%] and Lung V13 [PG:16%, 4D:31%]. While patients spent the most time in exhalation, the PG-optimization chose end-exhale only for 28% of beams. Conclusion: Our novel gating strategy achieved significant dosimetric improvements over conventional gating, and approached the upper limit represented by fully 4D optimized planning while being significantly simpler and more clinically translatable. This work was partially supported through research funding from National Institutes of Health (R01CA169102) and Varian Medical Systems, Palo Alto, CA, USA.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

MO-FG-202-08: Real-Time Monte Carlo-Based Treatment Dose Reconstruction and Monitoring for Radiotherapy

Purpose: This proof-of-concept study is to develop a real-time Monte Carlo (MC) based treatment-dose reconstruction and monitoring system for radiotherapy, especially for the treatments with complicated delivery, to catch treatment delivery errors at the earliest possible opportunity and interrupt the treatment only when an unacceptable dosimetric deviation from our expectation occurs. Methods: First an offline scheme is launched to pre-calculate the expected dose from the treatment plan, used as ground truth for real-time monitoring later. Then an online scheme with three concurrent threads is launched while treatment delivering, to reconstruct and monitor the patient dose in a temporally resolved fashion in real-time. Thread T1 acquires machine status every 20 ms to calculate and accumulate fluence map (FM). Once our accumulation threshold is reached, T1 transfers the FM to T2 for dose reconstruction ad starts to accumulate a new FM. A GPU-based MC dose calculation is performed on T2 when MC dose engine is ready and a new FM is available. The reconstructed instantaneous dose is directed to T3 for dose accumulation and real-time visualization. Multiple dose metrics (e.g. maximum and mean dose for targets and organs) are calculated from the current accumulated dose and compared with the pre-calculated expected values. Once the discrepancies go beyond our tolerance, an error message will be send to interrupt the treatment delivery. Results: A VMAT Head-and-neck patient case was used to test the performance of our system. Real-time machine status acquisition was simulated here. The differences between the actual dose metrics and the expected ones were 0.06%–0.36%, indicating an accurate delivery. ∼10Hz frequency of dose reconstruction and monitoring was achieved, with 287.94s online computation time compared to 287.84s treatment delivery time. Conclusion: Our study has demonstrated the feasibility of computing a dose distribution in a temporally resolved fashion in real-time and quantitatively and dosimetrically monitoring the treatment delivery.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

TU-AB-202-05: GPU-Based 4D Deformable Image Registration Using Adaptive Tetrahedral Mesh Modeling

Purpose: Deformable image registration (DIR) has been employed today as an automated and effective segmentation method to transfer tumor or organ contours from the planning image to daily images, instead of manual segmentation. However, the computational time and accuracy of current DIR approaches are still insufficient for online adaptive radiation therapy (ART), which requires real-time and high-quality image segmentation, especially in a large datasets of 4D-CT images. The objective of this work is to propose a new DIR algorithm, with fast computational speed and high accuracy, by using adaptive feature-based tetrahedral meshing and GPU-based parallelization. Methods: The first step is to generate the adaptive tetrahedral mesh based on the image features of a reference phase of 4D-CT, so that the deformation can be well captured and accurately diffused from the mesh vertices to voxels of the image volume. Subsequently, the deformation vector fields (DVF) and other phases of 4D-CT can be obtained by matching each phase of the target 4D-CT images with the corresponding deformed reference phase. The proposed 4D DIR method is implemented on GPU, resulting in significantly increasing the computational efficiency due to its parallel computing ability. Results: A 4D NCAT digital phantom was used to test the efficiency and accuracy of our method. Both the image and DVF results show that the fine structures and shapes of lung are well preserved, and the tumor position is well captured, i.e., 3D distance error is 1.14 mm. Compared to the previous voxel-based CPU implementation of DIR, such as demons, the proposed method is about 160x faster for registering a 10-phase 4D-CT with a phase dimension of 256×256×150. Conclusion: The proposed 4D DIR method uses feature-based mesh and GPU-based parallelism, which demonstrates the capability to compute both high-quality image and motion results, with significant improvement on the computational speed.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

TU-H-CAMPUS-TeP1-05: Fast Processed 3D Printing-Aided Urethane Resin (PUR) Bolus in Radiation Therapy

Purpose: 3D printed custom bolus is regularly used in radiation therapy clinic as a compensator. However, usual method of bolus printing with 100% filling is very time-consuming. The purpose of this study is to evaluate the feasibility and benefit of 3D printed bolus filled with UR. Methods: Two boluses were designed on nose (9e electrons) and ear (6× photons) for a head phantom in treatment planning system (TPS) to achieve dose coverage to the skin. The bolus structures (56–167cc) were converted to STereoLithographic (STL) model using an in-house developed algorithm and sent to a commercial fused deposition modeling (FDM) printer. Only shells were printed with polylactic acid (PLA) material. Liquid UR was then placed in a vacuum pump and slowly poured into the hollow bolus from its top opening. Liquid UR hardened in around half an hour. The phantom was rescanned with custom boluses attached and the dosimetry was compared with original design in TPS. Basic CT and dose properties were investigated. GaF films were irradiated to measure dose profile and output of several open photon and electron beams under solid water and UR slabs of same thicknesses. Results: CT number was 11.2±7.3 and 65.4±7.8, respectively for solid water(∼1.04g/cc) and UR(∼1.08g/cc). The output measurement at dmax for 6× was within 2% for the two materials. The relative dose profiles of the two materials above dmax show 94–99% Gamma analysis passing rates for both photons and electrons. Dose distributions with 3D PUR boluses maintained great coverage on the intended skin regions and resembled that with computer generated boluses. Manufacturing 3D PUR boluses was 3–4 times faster than 100% printed boluses. The efficiency significantly improves for larger boluses. Conclusion: The study suggests UR has similar dose responses as solid water. Making custom bolus with UR greatly increases clinical workflow efficiency.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

TH-CD-207A-03: A Surface Deformation Driven Respiratory Model for Organ Motion Tracking in Lung Cancer Radiotherapy

Purpose: To propose and validate a novel real-time surface-mesh-based internal organ-external surface motion and deformation tracking method for lung cancer radiotherapy. Methods: Deformation vector fields (DVFs) which characterizes the internal and external motion are obtained by registering the internal organ and tumor contours and external surface meshes to a reference phase in the 4D CT images using a recent developed local topology preserved non-rigid point matching algorithm (TOP). A composite matrix is constructed by combing the estimated internal and external DVFs. Principle component analysis (PCA) is then applied on the composite matrix to extract principal motion characteristics and finally yield the respiratory motion model parameters which correlates the internal and external motion and deformation. The accuracy of the respiratory motion model is evaluated using a 4D NURBS-based cardiac-torso (NCAT) synthetic phantom and three lung cancer cases. The center of mass (COM) difference is used to measure the tumor motion tracking accuracy, and the Dice’s coefficient (DC), percent error (PE) and Housdourf’s distance (HD) are used to measure the agreement between the predicted and ground truth tumor shape. Results: The mean COM is 0.84±0.49mm and 0.50±0.47mm for the phantom and patient data respectively. The mean DC, PE and HD are 0.93±0.01, 0.13±0.03 and 1.24±0.34 voxels for the phantom, and 0.91±0.04, 0.17±0.07 and 3.93±2.12 voxels for the three lung cancer patients, respectively. Conclusions: We have proposed and validate a real-time surface-mesh-based organ motion and deformation tracking method with an internal-external motion modeling. The preliminary results conducted on a synthetic 4D NCAT phantom and 4D CT images from three lung cancer cases show that the proposed method is reliable and accurate in tracking both the tumor motion trajectory and deformation, which can serve as a potential tool for real-time organ motion and deformation monitoring in lung cancer radiotherapy. This work is supported in part by grant from VARIAN MEDICAL SYSTEMS INC, the National Natural Science Foundation of China (no 81428019 and no 81301940), the Guangdong Natural Science Foundation (2015A030313302)and the 2015 Pearl River S&T Nova Program of Guangzhou (201506010096).

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

TH-CD-206-08: An Anthropopathic Deformable Phantom for Geometric and Dose Accumulation Accuracy Validation of Deformable Image Registration

Purpose: To design and construct a three-dimensional (3D) anthropopathic abdominal phantom for evaluating deformable image registration (DIR) accuracy on images and dose deformation in adaptive radiation therapy (ART). Method: Organ moulds, including liver, kidney, spleen, stomach, vertebra and two metastasis tumors, are 3D printed using the contours from an ovarian cancer patient. The organ moulds are molded with deformable gels that made of different mixtures of polyvinyl chloride (PVC) and the softener dioctyl terephthalate. Gels with different densities are obtained by a polynomial fitting curve which describes the relation between the CT number and PVC-softener blending ratio. The rigid vertebras are constructed by moulding with white cement. The final abdominal phantom is assembled by arranging all the fabricated organs inside a hollow dummy according to their anatomies and sealed with deformable gel with averaged CT number of muscle and fat. Geometric and dosimetric landmarks are embedded inside the phantom for spatial accuracy and dose accumulation accuracy studies. Three DIR algorithms available in the open source DIR toolkit-DIRART, including the Demons, the Horn-Schunck and Lucas-Kanade method and the Level-Set Motion method, are tested using the constructed phantom. Results: Viscoelastic behavior is observed in the constructed deformable gel, which serves as an ideal material for the deformable phantom. The constructed abdominal phantom consists of highly realistic anatomy and the fabricated organs inside have close CT number to its reference patient. DIR accuracy studies conducted on the constructed phantom using three DIR approaches indicate that geometric accuracy of a DIR algorithm has achieved does not guarantee accuracy in dose accumulation. Conclusions: We have designed and constructed an anthropopathic abdominal deformable phantom with satisfactory elastic property, realistic organ density and anatomy. This physical phantom is recyclable and can be used for routine validations of DIR geometric accuracy and dose accumulation accuracy in ART. This work is supported in part by grant from VARIAN MEDICAL SYSTEMS INC, the National Natural Science Foundation of China (no 81428019 and no 81301940), the Guangdong Natural Science Foundation (2015A030313302) and the 2015 Pearl River S&T Nova Program of Guangzhou (201506010096).

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

TH-EF-BRB-04: 4π Dynamic Conformal Arc Therapy Dynamic Conformal Arc Therapy (DCAT) for SBRT

Purpose: To develop an efficient and effective trajectory optimization methodology for 4π dynamic conformal arc treatment (4π DCAT) with synchronized gantry and couch motion; and to investigate potential clinical benefits for stereotactic body radiation therapy (SBRT) to breast, lung, liver and spine tumors. Methods: The entire optimization framework for 4π DCAT inverse planning consists of two parts: 1) integer programming algorithm and 2) particle swarm optimization (PSO) algorithm. The integer programming is designed to find an optimal solution for arc delivery trajectory with both couch and gantry rotation, while PSO minimize a non-convex objective function based on the selected trajectory and dose-volume constraints. In this study, control point interaction is explicitly taken into account. Beam trajectory was modeled as a series of control points connected together to form a deliverable path. With linear treatment planning objectives, a mixed-integer program (MIP) was formulated. Under mild assumptions, the MIP is tractable. Assigning monitor units to control points along the path can be integrated into the model and done by PSO. The developed 4π DCAT inverse planning strategy is evaluated on SBRT cases and compared to clinically treated plans. Results: The resultant dose distribution of this technique was evaluated between 3D conformal treatment plan generated by Pinnacle treatment planning system and 4π DCAT on a lung SBRT patient case. Both plans share the same scale of MU, 3038 and 2822 correspondingly to 3D conformal plan and 4π DCAT. The mean doses for most of OARs were greatly reduced at 32% (cord), 70% (esophagus), 2.8% (lung) and 42.4% (stomach). Conclusion: Initial results in this study show the proposed 4π DCAT treatment technique can achieve better OAR sparing and lower MUs, which indicates that the developed technique is promising for high dose SBRT to reduce the risk of secondary cancer.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

TH-EF-BRB-11: Volumetric Modulated Arc Therapy for Total Body Irradiation

Purpose: To develop a modern, patient-comfortable total body irradiation (TBI) technique suitable for standard-sized linac vaults. Methods: An indexed rotatable immobilization system (IRIS) was developed to make possible total-body CT imaging and radiation delivery on conventional couches. Treatment consists of multi-isocentric volumetric modulated arc therapy (VMAT) to the upper body and parallel-opposed fields to the lower body. Each isocenter is indexed to the couch and includes a 180° IRIS rotation between the upper and lower body fields. VMAT fields are optimized to satisfy lung dose objectives while achieving a uniform therapeutic dose to the torso. End-to-end tests with a rando phantom were used to verify dosimetric characteristics. Treatment plan robustness regarding setup uncertainty was assessed by simulating global and regional isocenter setup shifts on patient data sets. Dosimetric comparisons were made with conventional extended distance, standing TBI (cTBI) plans using a Monte Carlo-based calculation. Treatment efficiency was assessed for eight courses of patient treatment. Results: The IRIS system is level and orthogonal to the scanned CT image plane, with lateral shifts <2mm following rotation. End-to-end tests showed surface doses within ±10% of the prescription dose, field junction doses within ±15% of prescription dose. Plan robustness tests showed <15% changes in dose with global setup errors up to 5mm in each direction. Local 5mm relative setup errors in the chest resulted in < 5% dose changes. Local 5mm shift errors in the pelvic and upper leg junction resulted in <10% dose changes while a 10mm shift error causes dose changes up to 25%. Dosimetric comparison with cTBI showed VMAT-TBI has advantages in preserving chest wall dose with flexibility in leveraging the PTV-body and PTV-lung dose. Conclusion: VMAT-TBI with the IRIS system was shown clinically feasible as a cost-effective approach to TBI for standard-sized linac vaults.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

SU-D-BRD-02: Auto Weekly - An Automated Online Weekly Chart Check System for Medical Physics

Purpose: Radiation therapy has evolved to become not only more precise and potent, but also more complicated to monitor and deliver. More rigorous and comprehensive quality assurance is needed to safeguard ever advancing radiation therapy. ICRU standards dictate that an ever growing set of treatment parameters are manually checked weekly by medical physicists. This “weekly chart check” procedure is laborious and subject to human errors or other factors. A computer-assisted chart checking process will enable more complete and accurate human review of critical parameters, reduce the risk of medical errors, and improve the efficiency. Methods: We developed a web-based software system that enables a thorough weekly quality assurance checks. In the backend, the software retrieves all machine parameters from a Treatment Management System (TMS) and compares them against the corresponding ones from the treatment planning system. They are also checked for validity against preset rules. The results are displayed as a web page in the front-end for physicists to review. Then a summary report is generated and uploaded automatically to the TMS as a record for weekly chart checking. Results: The software system has been deployed on a web server in our department’s intranet, and has been tested thoroughly by our clinical physicists. A plan parameter would be highlighted when it is off the preset limit. The developed system has changed the way of checking charts with significantly improved accuracy, efficiency, and completeness. It has been shown to be robust, fast, and easy to use. Conclusion: A computer-assisted system has been developed for efficient, accurate, and comprehensive weekly chart checking. The system has been extensively validated and is being implemented for routine clinical use.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

SU-D-BRB-02: Patient-Specific Rectal Toxicity Predictor Based Plan Quality Control for Prostate Stereotactic Body Radiation Therapy (SBRT)

Purpose: To develop a patient-specific rectal toxicity predictor guided plan quality control tool for prostate SBRT plans. Methods: For prostate SBRT cases, four segments of rectal walls including peri-prostatic anterior rectal wall, peri-prostatic lateral rectal walls, peri-prostatic posterior rectal wall and rectum superior to prostate are identified as organs at risk and the circumference of rectal wall receiving more than 39 Gy (CRW39) and 24 Gy (CRW24) are rectal toxicity predictors. In this new geometry-dosimetry model, a patient geometry descriptor, differential circumference of rectal wall (dCRW) is used as model input geometry parameters and plan dosimetric endpoints CRW39 and CRW24 are output dosimetric parameters. Linear models are built to correlate dCRW to both CRW39 and CRW24 and established with both a linear regression method and a modified bagging ensemble machine learning method. 27 SBRT prostate cases are retrospectively studied from a dose-escalated clinical trial research. 20 prescribed 50 Gy SBRT cases are recruited to train the model and the other rescaled 7 cases are used to evaluated model feasibility and accuracy. Results: Each solved linear coefficient sequence related to CRW39 or CRW24 is a one-dimensional decreasing function of the distance from the PTV boundary, indicating that the different locations of each rectal circumference have different contributions to each particular dosimetric endpoint. The fitting errors for those trained 20 prostate SBRT cases are small with mean values of 2.39%, 2.45% relative to the endpoint values for SBRT rectal toxicity predictor CRW39 and CRW24 respectively. 1 out of 7 evaluation plans is identified as poor quality plan. After re-planning, the CRW39 and CRW24 can be reduced by 3.34% and 3%, without sacrificing PTV coverage. Conclusion: The proposed patient geometry-plan toxicity predictor model for SBRT plans can be successfully applied to plan quality control for prostate SBRT cases.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

SU-D-207-04: GPU-Based 4D Cone-Beam CT Reconstruction Using Adaptive Meshing Method

Purpose: Due to the limited number of projections at each phase, the image quality of a four-dimensional cone-beam CT (4D-CBCT) is often degraded, which decreases the accuracy of subsequent motion modeling. One of the promising methods is the simultaneous motion estimation and image reconstruction (SMEIR) approach. The objective of this work is to enhance the computational speed of the SMEIR algorithm using adaptive feature-based tetrahedral meshing and GPU-based parallelization. Methods: The first step is to generate the tetrahedral mesh based on the features of a reference phase 4D-CBCT, so that the deformation can be well captured and accurately diffused from the mesh vertices to voxels of the image volume. After the mesh generation, the updated motion model and other phases of 4D-CBCT can be obtained by matching the 4D-CBCT projection images at each phase with the corresponding forward projections of the deformed reference phase of 4D-CBCT. The entire process of this 4D-CBCT reconstruction method is implemented on GPU, resulting in significantly increasing the computational efficiency due to its tremendous parallel computing ability. Results: A 4D XCAT digital phantom was used to test the proposed mesh-based image reconstruction algorithm. The image Result shows both bone structures and inside of the lung are well-preserved and the tumor position can be well captured. Compared to the previous voxel-based CPU implementation of SMEIR, the proposed method is about 157 times faster for reconstructing a 10 -phase 4D-CBCT with dimension 256×256×150. Conclusion: The GPU-based parallel 4D CBCT reconstruction method uses the feature-based mesh for estimating motion model and demonstrates equivalent image Result with previous voxel-based SMEIR approach, with significantly improved computational speed.

60 APPLIED LIFE SCIENCES↗