Engineering topics

Kirby, N

Publications and source records attributed to Kirby, N.

At least 19 records

DOE OSTI2016

SU-F-J-20: Commissioning and Acceptance Testing of the C-Rad CatalystHD Surface Imaging System

Introduction: With the increasing use of surface-based, nonionizing image-guided radiotherapy (IGRT) systems, a comprehensive set of clinical acceptance and commissioning procedures are needed to ensure correct functionality and proper clinical integration. Although TG-147 provides a specific set of parameters, measurement methodologies have yet to be described. The aim of this study was to provide a comprehensive overview of the commissioning and acceptance analysis performed for the C-Rad CatalystHD imaging system. Methods and Materials: Methodology for the commissioning and acceptance of the C-Rad CatalystHD imaging system was developed using commercially available clinical equipment. Following TG-147 guidelines, the following tests were performed: integration of peripheral equipment, system drift, static spatial reproducibility and localization accuracy, static end-to-end analysis, static rotational accuracy, dynamic spatial accuracy, dynamic temporal accuracy, dynamic radiation delivery and a comprehensive end-to-end analysis. Results: The field of view (FOV) of the CatalystHD was 105×109×83 cm3 in the lateral, longitudinal and vertical directions. For thermal equilibrium and system drift, a thermal drift of 1.0mm was noted. A 45 min warmup time is recommended if the system has been shut off an extended period of time (>24 hours) before the QA procedure to eliminate any thermal drift. Spatial reproducibility was found to be 0.05±0.03 mm using a rigid phantom. For the static localization accuracy, system agreement with couch shifts was within 0.1±0.1 mm and positioning agreement with kV-CBCT was 0.16±0.10 mm. For static rotational accuracy, system agreement with a high precision rotational stage (0.01 deg precision) was within 0.10±0.07 deg. Dynamic spatial and temporal localization accuracy was found to be within 0.2±0.1 mm. Conclusion: A comprehensive commissioning and acceptance study was performed using commercially available phantoms and in-house methodologies to provide a performance evaluation of the CatalystHD imaging system.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

SU-F-T-99: Data Visualization From a Treatment Planning Tracking System for Radiation Oncology

Purpose: A treatment planning process tracker database with input forms and a TV-viewable display webpage was developed and implemented in our clinic to collect time data points throughout the process. Tracking plan times is important because it directly affects the patient quality of care. Simply, the longer a patient waits after their initial simulation CT for treatment to begin, the more time the cancer has to progress. The tracker helps to drive workflow through the clinic, while the data collected can be used to understand and manage the process to find and eliminate inefficiencies. Methods: The overall process steps tracked are CT-simulation, mark patient, draw normal contours, draw target volumes, create plan, and review/approve plan. Time stamps for task completion were extracted and used to generate a set of clinic metrics, among which include average time for each step in the process split apart by type of treatment, average time to completion for plans started in a given week, and individual overall completion time per plan. Results: Trends have been tracked for fourteen weeks of clinical data (196 plans). On average, drawing normal contours and target volumes is taking 2–5 times as long as creating the plan itself. This is potentially an issue because it could mean the process is taking too long initially, and it could be forcing the planning step to be done in a short amount of time. We also saw from our graphs that there appears to be no clear trend on the average amount of time per plan week-to-week. Conclusion: A tracker of this type has the potential to provide insight into how time is utilized in our clinic. By equipping our dosimetrists, radiation oncologists, and physicists with individualized metric sets, the tracker can help provide visibility and drive workflow. Funded in part by CPRIT (RP140105).

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

SU-F-T-458: Tracking Trends of TG-142 Parameters Via Analysis of Data Recorded by 2D Chamber Array

Purpose: With increasing QA demands of medical physicists in clinical radiation oncology, the need for an effective method of tracking clinical data has become paramount. A tool was produced which scans through data automatically recorded by a 2D chamber array and extracts relevant information recommended by TG-142. Using this extracted information a timely and comprehensive analysis of QA parameters can be easily performed enabling efficient monthly checks on multiple linear accelerators simultaneously. Methods: A PTW STARCHECK chamber array was used to record several months of beam outputs from two Varian 2100 series linear accelerators and a Varian NovalisTx−. In conjunction with the chamber array, a beam quality phantom was used to simultaneously to determine beam quality. A minimalist GUI was created in MatLab that allows a user to set the file path of the data for each modality to be analyzed. These file paths are recorded to a MatLab structure and then subsequently accessed by a script written in Python (version 3.5.1) which then extracts values required to perform monthly checks as outlined by recommendations from TG-142. The script incorporates calculations to determine if the values recorded by the chamber array fall within an acceptable threshold. Results: Values obtained by the script are written to a spreadsheet where results can be easily viewed and annotated with a “pass” or “fail” and saved for further analysis. In addition to creating a new scheme for reviewing monthly checks, this application allows for able to succinctly store data for follow up analysis. Conclusion: By utilizing this tool, parameters recommended by TG-142 for multiple linear accelerators can be rapidly obtained and analyzed which can be used for evaluation of monthly checks.

61 RADIATION PROTECTION AND DOSIMETRY↗

DOE OSTI2016

SU-F-T-513: Dosimetric Validation of Spatially Fractionated Radiotherapy Using Gel Dosimetry

Purpose: Spatially fractionated radiation therapy, also known as GRID therapy, is used to treat large solid tumors by irradiating the target to a single dose of 10–20Gy through spatially distributed beamlets. We have investigated the use of a 3D gel for dosimetric characterization of GRID therapy. Methods: GRID therapy is an external beam analog of volumetric brachytherapy, whereby we produce a distribution of hot and cold dose columns inside the tumor volume. Such distribution can be produced with a block or by using a checker-like pattern with MLC. We have studied both types of GRID delivery. A cube shaped acrylic phantom was filled with polymer gel and served as a 3D dosimeter. The phantom was scanned and the CT images were used to produce two plans in Pinnacle, one with the grid block and one with the MLC defined grid. A 6MV beam was used for the plan with a prescription of 1500cGy at dmax. The irradiated phantom was scanned in a 3T MRI scanner. Results: 3D dose maps were derived from the MR scans of the gel dosimeter and were found to be in good agreement with the predicted dose distribution from the RTP system. Gamma analysis showed a passing rate of 93% for 5% dose and 2mm DTA scoring criteria. Both relative and absolute dose profiles are in good agreement, except in the peripheral beamlets where the gel measured slightly higher dose, possibly because of the changing head scatter conditions that the RTP is not fully accounting for. Our results have also been benchmarked against ionization chamber measurements. Conclusion: We have investigated the use of a polymer gel for the 3D dosimetric characterization and evaluation of GRID therapy. Our results demonstrated that the planning system can predict fairly accurately the dose distribution for GRID type therapy.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

SU-F-T-585: A Novel Phantom for Dosimetric Validation of SBRT for Spinal Lesions

Purpose: SBRT is proving to be a very efficacious treatment modality for an increasing number of indications, including spine lesions. We have developed a novel phantom to serve as an end-to-end QA tool for either patient specific QA or commissioning QA of SBRT for spine lesions. Methods: In this feasibility study, we have selected a patient with a single metastatic lesion in the L5 vertebral body. The patient’s CT simulation scan was used to develop a VMAT treatment plan delivering 18Gy to at least 90% of the target volume, following the guidelines of RTOG 0631. The treatment plan was developed with the Pinnacle planning system using the adaptive convolution superposition calculation mode. The approved plan was re-calculated using the Monaco planning system. We performed a pseudo-in-vivo study whereby we manufactured two copies of a phantom to the exact shape and anatomy of the patient. The phantom was made from the CT images of the patient using a 3D printer with sub-millimeter accuracy. One phantom was filled with a gel dosimeter and the other was made with two ion chamber inserts to allow us to obtain point dose measurements in the target’s center and the spinal cord. Results: The prescribed dose of 18Gy was planned for the target while keeping the maximum spinal cord dose to less than 14Gy in 0.03cc of the cord. The VMAT plan was delivered to both the gel dosimeter filed phantom and the phantom with the ion chambers. The 3D gel dosimetry revealed a very good agreement between the monte carlo and measured point and volumetric dose. Conclusion: A patient like phantom was developed and validated for use as an end-to-end tool of dose verification for SBRT of spine lesions. We found that gel dosimetry is ideally suited to assess positional and dosimetric accuracy in 3D. RTsafe provided the phantoms and the gel dosimeter used for this study.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

SU-G-201-07: Dosimetric Verification of a 3D Printed HDR Skin Brachytherapy Applicator

Purpose: The use of radiation as a treatment modality for skin cancer has increased significantly over the last decade with standardized applicators. Utilizing 3D printing, the ability to make applicators specifically designed for each patient’s anatomy has become economically feasible. With this in mind it was the aim of this study to determine the dosimetric accuracy of a 3-D printed HDR brachytherapy applicator for the skin. Methods: A CT reference image was used to generate a custom applicator based on an anthropomorphic head and neck phantom. To create the applicator a 1cm expansion anteriorly with 0.5cmX0.5cm trenches on the outer surface that were spaced 1cm sup-inf to accommodate standard 6F flexible catheters. The applicator was printed using PLA material using a printrbot simple printer. A treatment plan optimized to deliver a clinically representative volume was created in Oncentra and delivered with a nucletron afterloader. Measurements were made using TLDs and EBT3 gafchromic film that were placed between the applicator and the phantom’s forehead. An additional piece of film was also used to qualitatively asses the dose distribution in the transverse plane. Using a standard vaginal cylinder and bolus, a standardized curve correlating TLD and film exposure-to-radiation dose was established by irradiating film to known doses (200,500,700 cGy) at a 3.5 cm radius distance. Results: Evaluated TLDs showed the absolute dose delivered to the skin surface using the 3-D printed bolus was 615cGy±6%, with a mean predicted TPS value in the measured area of 617.5±7%. Additionally, planar dose distributions had good qualitative agreement with calculated TPS isodoses. Conclusion: This work demonstrates patient specific 3-D printed HDR brachytherapy applicators for skin cancer treatments are practical and accurate in TPS calculations but additional measurements are needed to verify additional sites and dose at depth.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

SU-G-TeP1-14: SRS Dose Calculation Accuracy Comparison Between Pencil Beam and Monte Carlo Algorithms

Purpose: Stereotactic radiosurgery (SRS) outcomes are related to the delivered dose to the target and to surrounding tissue. We have commissioned a Monte Carlo based dose calculation algorithm to recalculated the delivered dose planned using pencil beam calculation dose engine. Methods: Twenty consecutive previously treated patients have been selected for this study. All plans were generated using the iPlan treatment planning system (TPS) and calculated using the pencil beam algorithm. Each patient plan consisted of 1 to 3 targets and treated using dynamically conformal arcs or intensity modulated beams. Multi-target treatments were delivered using multiple isocenters, one for each target. These plans were recalculated for the purpose of this study using a single isocenter. The CT image sets along with the plan, doses and structures were DICOM exported to Monaco TPS and the dose was recalculated using the same voxel resolution and monitor units. Benchmark data was also generated prior to patient calculations to assess the accuracy of the two TPS against measurements using a micro ionization chamber in solid water. Results: Good agreement, within −0.4% for Monaco and +2.2% for iPlan were observed for measurements in water phantom. Doses in patient geometry revealed up to 9.6% differences for single target plans and 9.3% for multiple-target-multiple-isocenter plans. The average dose differences for multi-target-single-isocenter plans were approximately 1.4%. Similar differences were observed for the OARs and integral dose. Conclusion: Accuracy of the beam is crucial for the dose calculation especially in the case of small fields such as those used in SRS treatments. A superior dose calculation algorithm such as Monte Carlo, with properly commissioned beam models, which is unaffected by the lack of electronic equilibrium should be preferred for the calculation of small fields to improve accuracy.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

MO-AB-BRA-04: Radiation Measurements with a DNA Double-Strand-Break Dosimeter

Purpose: Many types of dosimeters are used to measure radiation, but none of them directly measures the biological effect of this dose. The purpose here is to create a dosimeter that can measure the probability of double-strand breaks (DSB) for DNA, which is directly related to the biological effect of radiation. Methods: The dosimeter has DNA strands, which are labeled on one end with biotin and on the other with fluorescein. The biotin attaches these strands to magnetic beads. We suspended the DNA dosimeter in phosphate-buffered saline (PBS) as it matches the internal environment of the body. We placed small volumes (50µL) of the DNA dosimeter into tubes and irradiated these samples in a water-equivalent plastic phantom with several doses (three samples per dose). After irradiating the samples, a magnet was placed against the tubes. The fluorescein attached to broken DNA strands was extracted (called the supernatant) and placed into a different tube. The fluorescein on the unbroken strands remained attached to the beads in the tube and was re-suspended with 50µL of PBS. A fluorescence reader was used to measure the fluorescence for both the re-suspended beads and supernatant. To prove that we are measuring DSB, we tested dosimeter response with two different lengths of attached DNA strands (1 and 4 kilo-base pair). Results: The probability of DSB at the dose levels of 5, 10, 25, and 50 Gy were 0.05, 0.08, 0.12, and 0.19, respectively, while the coefficients of variation were 0.14, 0.07, 0.02, and 0.01, respectively. The 4 kilo-base-pair dosimeter produced 5.3 times the response of the 1 kilo-base-pair dosimeter. Conclusion: The DNA dosimeter yields a measurable response to dose that scales with the DNA strand length. The goal now is to refine the dosimeter fabrication to reproducibly create a low coefficient of variation for the lower doses. This work was supported in part by Yarmouk University (Irbid, Jordan) and CPRIT (RP140105)

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

TU-AB-202-03: Prediction of PET Transfer Uncertainty by DIR Error Estimating Software, AUTODIRECT

Purpose: Deformable image registration (DIR) is a powerful tool, but DIR errors can adversely affect its clinical applications. To estimate voxel-specific DIR uncertainty, a software tool, called AUTODIRECT (automated DIR evaluation of confidence tool), has been developed and validated. This work tests the ability of this software to predict uncertainty for the transfer of standard uptake values (SUV) from positron-emission tomography (PET) with DIR. Methods: Virtual phantoms are used for this study. Each phantom has a planning computed tomography (CT) image and a diagnostic PET-CT image set. A deformation was digitally applied to the diagnostic CT to create the planning CT image and establish a known deformation between the images. One lung and three rectum patient datasets were employed to create the virtual phantoms. Both of these sites have difficult deformation scenarios associated with them, which can affect DIR accuracy (lung tissue sliding and changes in rectal filling). The virtual phantoms were created to simulate these scenarios by introducing discontinuities in the deformation field at the lung rectum border. The DIR algorithm from Plastimatch software was applied to these phantoms. The SUV mapping errors from the DIR were then compared to that predicted by AUTODIRECT. Results: The SUV error distributions closely followed the AUTODIRECT predicted error distribution for the 4 test cases. The minimum and maximum PET SUVs were produced from AUTODIRECT at 95% confidence interval before applying gradient-based SUV segmentation for each of these volumes. Notably, 93.5% of the target volume warped by the true deformation was included within the AUTODIRECT-predicted maximum SUV volume after the segmentation, while 78.9% of the target volume was within the target volume warped by Plastimatch. Conclusion: The AUTODIRECT framework is able to predict PET transfer uncertainty caused by DIR, which enables an understanding of the associated target volume uncertainty.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

TU-H-CAMPUS-TeP2-04: Measurement of Stereotactic Output Factors with DNA Double-Strand Breaks

Purpose: Radiotherapy treatment is specified by radiation dose prescriptions, but biological DNA damage actually controls treatment effectiveness. It is impractical to directly measure dose in the clinic, so we measure quantities, such as collected charge, and calculate the relationship to dose. At small fields, such as those in stereotactic radiosurgery (SRS), charged-particle equilibrium (CPE) breaks down and the accuracy of the measurement for delivered dose decreases. By measuring DNA double-strand breaks (DSB) directly, we believe treatment accuracy could improve by providing a more meaningful measurement. Methods: A DNA dosimeter, consisting of magnetic streptavidin beads attached to 4 kilobase pair DNA strands labeled with biotin and fluorescein amidite (FAM) on opposing ends, was suspended in phosphate-buffered saline (PBS). Twenty µL samples were placed in plastic micro-capillary tubes inside a water tank setup and irradiated with 10 cm, 3 cm, 1.25 cm, 0.75 cm, and 0.5 cm radiation field sizes, where the three smallest sizes were cones. After irradiation, the dosimeters were mechanically separated into beads (intact DNA) and supernatant (broken DNA/FAM) using a magnet. The fluorescence was read and the probability of DSB was calculated. This was used to calculate the output factor for an SRS beam and compared to that measured using a diode detector. Results: The output factors relative to a 10 cm field were 0.89±0.07, 0.76±0.08, 0.59±0.04, and 0.78±0.12 for the field sizes of 3 cm, 1.25 cm, 0.75 cm, and 0.5 cm, respectively. Some of the diode measurements do not fall within these uncertainties. Conclusion: This was the first attempt to measure output factors in a water tank with the DNA dosimeter. Although differences compared to the diode were observed, the uncertainty analysis ignored systematic errors. For future work, we will repeat this experiment to quantify and correct systematic errors, such as those caused by positional alignment and sample contamination. This work was funded in part by CPRIT (RP140105).

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

TH-CD-201-11: Optimizing the Response and Cost of a DNA Double-Strand Break Dosimeter

Purpose: A DNA double-strand break (DSB) dosimeter was developed to measure the biological effect of radiation. The goal here is to refine the fabrication method of this dosimeter to reproducibly create a low coefficient of variation (CoV) and reduce the cost for the dosimeter. Methods: Our dosimeter consists of 4 kilo-base pair DNA strands (labeled on one end with biotin and on the other with fluorescein) attached to streptavidin magnetic beads. The final step of the DNA dosimeter fabrication is to suspend these attached beads in phosphate-buffered saline (PBS). The amount of PBS used to suspend the attached beads and the relative volume of the DNA strands to the beads both affect the CoV and dosimeter cost. We diluted the beads attached with DNA in different volumes of PBS (100, 200, and 400 µL) to create different concentrations of the DNA dosimeter. Then we irradiated these dosimeters (50 µL samples) in a water-equivalent plastic phantom at 25 and 50 Gy (three samples per dose) and calculated the CoV for each dosimeter concentration. Also, we used different masses of DNA strands (1, 2, 8, 16, 24, and 32 µg) to attach to the same volume of magnetic beads (100 µL) to explore how this affects the cost of the dosimeter. Results: The lowest CoV was produced for the highest concentration of dosimeter (100 µL of PBS), which created CoV of 2.0 and 1.0% for 25 and 50 Gy, respectively. We found that the lowest production cost for the dosimeter occurs by attaching 16 µg of DNA strands with 100 µL of beads. Conclusion: : We optimized the fabrication of the DNA dosimeter to produce low CoV and cost, but we still need to explore ways to further improve the dosimeter for use at lower doses. This work was supported in part by Yarmouk University (Irbid, Jordan) and CPRIT (RP140105)

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

SU-E-E-02: An Excel-Based Study Tool for ABR-Style Exams

Purpose: As the landscape of learning and testing shifts toward a computer-based environment, a replacement for paper-based methods of studying is desirable. Using Microsoft Excel, a study tool was developed that allows the user to populate multiple-choice questions and then generate an interactive quiz session to answer them. Methods: The code for the tool was written using Microsoft Excel Visual Basic for Applications with the intent that this tool could be implemented by any institution with Excel. The base tool is a template with a setup macro, which builds out the structure based on user’s input. Once the framework is built, the user can input sets of multiple-choice questions, answer choices, and even add figures. The tool can be run in random-question or sequential-question mode for single or multiple courses of study. The interactive session allows the user to select answer choices and immediate feedback is provided. Once the user is finished studying, the tool records the day’s progress by reporting progress statistics useful for trending. Results: Six doctoral students at UTHSCSA have used this tool for the past two months to study for their qualifying exam, which is similar in format and content to the American Board of Radiology (ABR) Therapeutic Part II exam. The students collaborated to create a repository of questions, met weekly to go over these questions, and then used the tool to prepare for their exam. Conclusion: The study tool has provided an effective and efficient way for students to collaborate and be held accountable for exam preparation. The ease of use and familiarity of Excel are important factors for the tool’s use. There are software packages to create similar question banks, but this study tool has no additional cost for those that already have Excel. The study tool will be made openly available.

97 MATHEMATICS AND COMPUTING↗

DOE OSTI2015

SU-E-J-89: Comparative Analysis of MIM and Velocity’s Image Deformation Algorithm Using Simulated KV-CBCT Images for Quality Assurance

Purpose: Deformable image registration (DIR) is used routinely in the clinic without a formalized quality assurance (QA) process. Using simulated deformations to digitally deform images in a known way and comparing to DIR algorithm predictions is a powerful technique for DIR QA. This technique must also simulate realistic image noise and artifacts, especially between modalities. This study developed an algorithm to create simulated daily kV cone-beam computed-tomography (CBCT) images from CT images for DIR QA between these modalities. Methods: A Catphan and physical head-and-neck phantom, with known deformations, were used. CT and kV-CBCT images of the Catphan were utilized to characterize the changes in Hounsfield units, noise, and image cupping that occur between these imaging modalities. The algorithm then imprinted these changes onto a CT image of the deformed head-and-neck phantom, thereby creating a simulated-CBCT image. CT and kV-CBCT images of the undeformed and deformed head-and-neck phantom were also acquired. The Velocity and MIM DIR algorithms were applied between the undeformed CT image and each of the deformed CT, CBCT, and simulated-CBCT images to obtain predicted deformations. The error between the known and predicted deformations was used as a metric to evaluate the quality of the simulated-CBCT image. Ideally, the simulated-CBCT image registration would produce the same accuracy as the deformed CBCT image registration. Results: For Velocity, the mean error was 1.4 mm for the CT-CT registration, 1.7 mm for the CT-CBCT registration, and 1.4 mm for the CT-simulated-CBCT registration. These same numbers were 1.5, 4.5, and 5.9 mm, respectively, for MIM. Conclusion: All cases produced similar accuracy for Velocity. MIM produced similar values of accuracy for CT-CT registration, but was not as accurate for CT-CBCT registrations. The MIM simulated-CBCT registration followed this same trend, but overestimated MIM DIR errors relative to the CT-CBCT registration.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

SU-E-J-92: Validating Dose Uncertainty Estimates Produced by AUTODIRECT, An Automated Program to Evaluate Deformable Image Registration Accuracy

Purpose: Deformable image registration (DIR) is a powerful tool with the potential to deformably map dose from one computed-tomography (CT) image to another. Errors in the DIR, however, will produce errors in the transferred dose distribution. We have proposed a software tool, called AUTODIRECT (automated DIR evaluation of confidence tool), which predicts voxel-specific dose mapping errors on a patient-by-patient basis. This work validates the effectiveness of AUTODIRECT to predict dose mapping errors with virtual and physical phantom datasets. Methods: AUTODIRECT requires 4 inputs: moving and fixed CT images and two noise scans of a water phantom (for noise characterization). Then, AUTODIRECT uses algorithms to generate test deformations and applies them to the moving and fixed images (along with processing) to digitally create sets of test images, with known ground-truth deformations that are similar to the actual one. The clinical DIR algorithm is then applied to these test image sets (currently 4) . From these tests, AUTODIRECT generates spatial and dose uncertainty estimates for each image voxel based on a Student’s t distribution. This work compares these uncertainty estimates to the actual errors made by the Velocity Deformable Multi Pass algorithm on 11 virtual and 1 physical phantom datasets. Results: For 11 of the 12 tests, the predicted dose error distributions from AUTODIRECT are well matched to the actual error distributions within 1–6% for 10 virtual phantoms, and 9% for the physical phantom. For one of the cases though, the predictions underestimated the errors in the tail of the distribution. Conclusion: Overall, the AUTODIRECT algorithm performed well on the 12 phantom cases for Velocity and was shown to generate accurate estimates of dose warping uncertainty. AUTODIRECT is able to automatically generate patient-, organ- , and voxel-specific DIR uncertainty estimates. This ability would be useful for patient-specific DIR quality assurance.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

SU-E-J-97: Quality Assurance of Deformable Image Registration Algorithms: How Realistic Should Phantoms Be?

Purpose: Deformable image registration (DIR) has widespread uses in radiotherapy for applications such as dose accumulation studies, multi-modality image fusion, and organ segmentation. The quality assurance (QA) of such algorithms, however, remains largely unimplemented. This work aims to determine how detailed a physical phantom needs to be to accurately perform QA of a DIR algorithm. Methods: Virtual prostate and head-and-neck phantoms, made from patient images, were used for this study. Both sets consist of an undeformed and deformed image pair. The images were processed to create additional image pairs with one through five homogeneous tissue levels using Otsu’s method. Realistic noise was then added to each image. The DIR algorithms from MIM and Velocity (Deformable Multipass) were applied to the original phantom images and the processed ones. The resulting deformations were then compared to the known warping. A higher number of tissue levels creates more contrast in an image and enables DIR algorithms to produce more accurate results. For this reason, error (distance between predicted and known deformation) is utilized as a metric to evaluate how many levels are required for a phantom to be a realistic patient proxy. Results: For the prostate image pairs, the mean error decreased from 1–2 tissue levels and remained constant for 3+ levels. The mean error reduction was 39% and 26% for Velocity and MIM respectively. For head and neck, mean error fell similarly through 2 levels and flattened with total reduction of 16% and 49% for Velocity and MIM. For Velocity, 3+ levels produced comparable accuracy as the actual patient images, whereas MIM showed further accuracy improvement. Conclusion: The number of tissue levels needed to produce an accurate patient proxy depends on the algorithm. For Velocity, three levels were enough, whereas five was still insufficient for MIM.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

SU-E-J-116: Uncertainties Associated with Dose Summation of High-Dose Rate Brachytherapy and Intensity Modulated Radiotherapy for Gynecological Cases

Purpose: Determining the cumulative dose distribution (CDD) for gynecological patients treated with both high-dose rate (HDR) brachytherapy and intensity-modulated radiotherapy (IMRT) is challenging. The purpose of this work is to study the uncertainty of performing this with a structure-guided deformable (SGD) approach in Velocity. Methods: For SGD, the Hounsfield units inside specified contours are overridden to set uniform values. Deformable image registration (DIR) is the run on these process images, which forces the DIR to focus on these contour boundaries. 18 gynecological cancer patients were used in this study. The original bladder and rectum planning contours for these patients were used to drive the SGD. A second set of contours were made of the bladder by the same person with the intent of carefully making them completely consistent with each other. This second set was utilized to evaluate the spatial accuracy of the SGD. The determined spatial accuracy was then multiplied by the local dose gradient to determine a dose uncertainty associated with the SGD dose warping. The normal tissue complication probability (NTCP) was then calculated for each dose volume histogram (DVH) that included four different probabilistic uncertainties associated with the spatial errors (e.g., 68.3% and 95.4%). Results: The NTCPs for each DVH (e.g., NTCP-−95.4%, NTCP-−68.3%, NTCP-68.3%, NTCP-95.4%) differed amongst patients. All patients had an NTCP-−95.4% close to 0%, while NTCP-95.4% ranged from 0.67% to 100%. Nine patients had an NTCP-−95.4% less than 50% while the remaining nine patients had NTCP-95.4% greater than 50%. Conclusion: The uncertainty associated with this CDD technique renders a large NTCP uncertainty. Thus, it is currently not practical for clinical use. The two ways to improve this would be to use more precise contours to drive the SGD and to use a more accurate DIR algorithm.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

SU-E-T-277: Dose Calculation Comparisons Between Monaco, Pinnacle and Eclipse Treatment Planning Systems

Purpose: Monaco treatment planning system (TPS) version 5.0 uses a Monte-Carlo based dose calculation engine. The aim of this study is to verify and compare the Monaco based dose calculations with both Pinnacle{sup 3} collapsed cone convolution superposition (CCC) and Eclipse analytical anisotropic algorithm (AAA) calculations. Methods: For this study, previously treated SBRT lung, head and neck and abdomen patients were chosen to compare dose calculations between Pinnacle, Monaco and Eclipse. Plans were chosen from those that had been treated using the Elekta VersaHD or a NovalisTX linac. The plans included 3D conventional and IMRT beams using 6MV and 6MV Flattening filter free (FFF) photon beams. The original plans calculated with CCCS or AAA along with the recalculated ones using MC from the three TPS were exported into Velocity software for inter-comparison. Results: To compare the dose calculations, Mean Lung Dose (MLD), lung V5 and V20 values, and PTV Heterogeneity indexes (HI) and Conformity indexes (CI) were all calculated and recorded from the dose volume histograms (DVH). For each patient, the CI values were identical but there were differences in all other parameters. The HI was computed higher by 5 and 4% for calculated plans AAA and CCCS respectively, compared to the MC ones. The DVH graphs showed large differences between the CCCS and AAA and Monaco for 3D FFF, VMAT and IMRT plans. Better DVH agreement between was observed for 3D conventional plans. Conclusion: Better agreement was observed between CCCS and MC calculations than AAA and MC calculations. Those differences were more profound as the field size was decreasing and in the presence of inhomogeneities.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

SU-E-T-363: Error Detection Comparison of EPID and MLC Log File Based IMRT QA Systems

Purpose: In this study we will compare the ability of three QA methods (Delta4, MU-EPID, Dynalog QA) to detect specific errors. Methods: A Varian Novalis Tx with a HD120 MLC and aS1000 Electronic Portal Imaging Device (EPID) was used in our study. Multi-leaf collimator (MLC) errors, gantry angle and dose errors were introduced into 5 volumetric arc therapy (VMAT) plans. 3D dose distributions calculated with data from the EPID and Dynalog QA methods were compared with the planned dose distribution. The gamma passing percentages as well as percentage error of planning target volume (PTV) dose were used for passing determination. Baselines for gamma passing percentages and PTV dose were established by measuring the original plan 5 times consecutively. Standard passing thresholds as well as thresholds derived from receiver operator characteristic (ROC) analysis and 2 standard deviation (SD) criteria were used. Results: When applying the standard 95% pass rate at 3%/3mm gamma analysis 14, 21 and 8 of 30 errors were detected by the Delta4, MU-EPID and Dynalog QA methods respectively. Thresholds set at 2 SD from our base line measurements resulted in the detection of 18, 9 and 14 of 30 errors for the Delta4, MU-EPID and Dynalog QA methods respectively. When using D2 of the PTV as a metric the Dynalog QA detected 20 of 30 errors while the EPID method detected 14 of 30 errors. Using D98 of the PTV, Dynalog QA detected 13 of 30 while the EPID detected 3 of 30 errors. Conclusion: Although MU-EPID detected the most errors at the standard 95% cutoff it also produced the most false detections in the baseline data. The Dynalog QA was the most effective when the ROC adjusted passing threshold was used. D2 was more effective as a metric for detecting errors than D98.

60 APPLIED LIFE SCIENCES↗