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Myronakis, M

Publications and source records attributed to Myronakis, M.

SU-F-J-41: Experimental Validation of a Cascaded Linear System Model for MVCBCT with a Multi-Layer EPID

Purpose: The purpose of this study was to validate the use of a cascaded linear system model for MV cone-beam CT (CBCT) using a multi-layer (MLI) electronic portal imaging device (EPID) and provide experimental insight into image formation. A validated 3D model provides insight into salient factors affecting reconstructed image quality, allowing potential for optimizing detector design for CBCT applications. Methods: A cascaded linear system model was developed to investigate the potential improvement in reconstructed image quality for MV CBCT using an MLI EPID. Inputs to the three-dimensional (3D) model include projection space MTF and NPS. Experimental validation was performed on a prototype MLI detector installed on the portal imaging arm of a Varian TrueBeam radiotherapy system. CBCT scans of up to 898 projections over 360 degrees were acquired at exposures of 16 and 64 MU. Image volumes were reconstructed using a Feldkamp-type (FDK) filtered backprojection (FBP) algorithm. Flat field images and scans of a Catphan model 604 phantom were acquired. The effect of 2×2 and 4×4 detector binning was also examined. Results: Using projection flat fields as an input, examination of the modeled and measured NPS in the axial plane exhibits good agreement. Binning projection images was shown to improve axial slice SDNR by a factor of approximately 1.4. This improvement is largely driven by a decrease in image noise of roughly 20%. However, this effect is accompanied by a subsequent loss in image resolution. Conclusion: The measured axial NPS shows good agreement with the theoretical calculation using a linear system model. Binning of projection images improves SNR of large objects on the Catphan phantom by decreasing noise. Specific imaging tasks will dictate the implementation image binning to two-dimensional projection images. The project was partially supported by a grant from Varian Medical Systems, Inc. and grant No. R01CA188446-01 from the National Cancer Institute.

60 APPLIED LIFE SCIENCES↗

SU-G-BRA-06: Quantification of Tracking Performance of a Multi-Layer Electronic Portal Imaging Device

Purpose: The purpose of this study was to quantify the improvement in tumor tracking, with and without fiducial markers, afforded by employing a multi-layer (MLI) electronic portal imaging device (EPID) over the current state-of-the-art, single-layer, digital megavolt imager (DMI) architecture. Methods: An ideal observer signal-to-noise ratio (d’) approach was used to quantify the ability of an MLI EPID and a current, state-of-the-art DMI EPID to track lung tumors from the treatment beam’s-eye-view. Using each detector modulation transfer function (MTF) and noise power spectrum (NPS) as inputs, a detection task was employed with object functions describing simple three-dimensional Cartesian shapes (spheres and cylinders). Marker-less tumor tracking algorithms often use texture discrimination to differentiate benign and malignant tissue. The performance of such algorithms is simulated by employing a discrimination task for the ideal observer, which measures the ability of a system to differentiate two image quantities. These were defined as the measured textures for benign and malignant lung tissue. Results: The NNPS of the MLI ∼25% of that of the DMI at the expense of decreased MTF at intermediate frequencies (0.25≤<f≤<0.5 cycles/mm). Lung tissue textures were found to follow a power-law trend in the frequency domain. It was found that for both fiducial marker tracking and lung tissue texture differentiation, the signal power of each task is retained at low frequencies. Thus, little difference may be observed in signal power when DMI and MLI are compared. In all cases, improvements in tracking were greater than a factor of 2. Conclusion: MLI performance in tumor tracking is greatly improved by the additional imager layers. This implies that further improvements in tracking may be gained through increasing the thickness of each MLI layer. For tracking, the MLI performance is limited by noise response. Losses in MTF result in negligible differences in d’. The project was partially supported by a grant from Varian Medical Systems, Inc. and grant No. R01CA188446-01 from the National Cancer Institute.

60 APPLIED LIFE SCIENCES↗

WE-DE-BRA-04: A Cost-Effective Pixelated EPID Scintillator for Enhanced Contrast and DQE

Purpose: Beams-eye-view imaging applications such as real-time soft-tissue motion estimation and MV-CBCT are hindered by the inherently low image contrast of electronic portal imaging devices (EPID) currently in clinical use. We investigate a cost effective scintillating glass that provides substantially increased detective quantum efficiency (DQE) and contrast to noise ratio (CNR). Methods: A pixelated scintillator prototype was built from LKH-5 glass. The array is 12mm thick; 42.4×42.4cm2 wide and features 1.51mm pixel pitch with 20µm separation (glue+septa). The LKH-5 array was mounted on the active matrix flat panel imager (AMPFI) of an AS-1200 (Varian) with the GdO2S2:Tb removed. A second AS-1200 was utilized as reference detector. The prototype EPID was characterized in terms of CNR, modulation transfer function (MTF) and DQE. Additionally, the visibility of various fiducial markers typically used in the clinic as well as a realistic 3D-printed lung tumor model was assessed. All items were placed in a 12cm thick solid water phantom. CNR is estimated using a Las Vegas contrast phantom, presampled MTF is estimated using a slanted slit technique and the DQE is calculated from measured normalized noise power spectra (NPS) and the MTF. Results: DQE(0) for the LKH-5 prototype increased by a factor of 8× to about 10%, compared to the AS-1200 equipped with its standard GdO2S2:Tb scintillator. CNR increased by a factor of 5.3×. Due to the pixel size the MTF50 decreased by about 55% to 0.23lp/mm. The visibility of all fiducial markers as well as the tumor model were however markedly improved in comparison to an acquisition with the same parameters using the GdO2S2:Tb scintillator. Conclusion: LKH-5 scintillating glasses allow the cost effective construction of thick pixelated scintillators for portal imaging which can yield a substantial increase in DQE and CNR. Soft tissue and fiducial marker visibility was found to be markedly improved. The project was supported in part by NIH grant R01CA188446-01 and a grant from Varian Medical Systems.

60 APPLIED LIFE SCIENCES↗

WE-DE-BRA-05: Monte Carlo Simulation of a Novel Multi-Layer MV Imager

Purpose: To develop and validate a Monte Carlo (MC) model of a novel multi-layer imager (MLI) for megavolt (MV) energy beams. The MC model will enable performance optimization of the MLI design for clinical applications including patient setup verification, tumor tracking and MVCBCT. Methods: The MLI is composed of four layers of converter, scintillator and light detector, each layer similar to the current clinical AS1200 detector (Varian Medical Systems, Inc). The MLI model was constructed using the Geant4 Application for Tomographic Emission (GATE v7.1) and includes interactions for x-ray photons, charged particles and optical photons. Computational experiments were performed to assess Modulation Transfer Function (MTF), Detective Quantum Efficiency (DQE) and Noise Power Spectrum normalized by photon fluence and average detector signal (qNNPS). Results were compared with experimental measurements. The current work incorporates, in one model, the complete chain of events occurring in the imager; i.e. starting from x-ray interaction to charged particle transport and energy deposition to subsequent generation, interactions and detection of optical photons. Results: There is good agreement between measured and simulated MTF, qNNPS and DQE values. Normalized root mean squared error (NRMSE) between measured and simulated values over all four layers was 2.18%, 2.43% and 6.05% for MTF, qNNPS and DQE respectively. The relative difference between simulated and measured values for qNNPS(0) was 1.68% and 1.57% for DQE(0). Current results were obtained using a 6MV Varian Truebeam™ spectrum. Conclusion: A comprehensive Monte Carlo model of the MLI prototype was developed to allow optimization of detector components. The model was assessed in terms of imaging performance using standard metrics (i.e. MTF, qNNPS, DQE). Good agreement was found between simulated and measured values. The model will be used to assess alternative detector constructions to facilitate advanced clinical imaging applications including MV-CBCT and tumor tracking. The project was supported, partially, by a grant from Varian Medical Systems, Inc., and Award No. R01CA188446-01 from the National Cancer Institute. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute or the National Institutes of Health.

60 APPLIED LIFE SCIENCES↗

WE-DE-BRA-07: Megavoltage Spectral Imaging with a Layered Detector

Purpose: The aim of the current work is to investigate the feasibility of megavoltage spectral imaging using a multiple layered detector for enhancement of low contrast detectability through material segmentation and discrimination (such as bone, markers and metal implants). Potentially the technique can be applied to improve detection and reduce dose in Megavoltage Cone Beam Computed Tomography (MV-CBCT). Methods: Experiments were performed with a prototype multi-layer imager (MLI) which has higher detective efficiency and lower noise characteristics than conventional Electronic Portal Imaging Devices (EPIDs). Images of a solid water phantom were acquired at 2.5 MV, 6MV and 6MV without flattening filter (FFF). The following materials were placed within a stack of solid water: aluminum, copper and gold. Material separation was assessed based on Contrast-to-Noise Ratio (CNR) of the weighted image, formed by a weighted subtraction of the images from two layers of the MLI. A range of weighting factors were investigated for material separation. Results: CNR can be minimized for each material by appropriate selection of the subtraction weighting factor. This is equivalent to a selective subtraction of specific materials from the image. Using multiple layers simultaneously also decreases the dose requirement and removes any registration errors. The minimum CNR for aluminum, copper and gold at the weighted image formed with 2.5MV was obtained at weighting factors equal to 0.92, 0.76 and 0.64 respectively. The corresponding values at 6MVFFF were 0.99, 0.92 and 0.78 respectively. Conclusion: In the current work, an MV spectral imaging feasibility study was attempted using a novel multi-layer prototype EPID imager. Initial results suggest that material separation based on spectral differences between different layers is possible. This spectral imaging technique has potential advantages in MV-CBCT for real-time target tracking, patient set-up imaging and adaptive radiotherapy. The project was supported, partially, by a grant from Varian Medical Systems, Inc., and Award No. R01CA188446-01 from the National Cancer Institute. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute or the National Institutes of Health.

60 APPLIED LIFE SCIENCES↗

SU-E-P-59: A Graphical Interface for XCAT Phantom Configuration, Generation and Processing

Purpose: To design a comprehensive open-source, publicly available, graphical user interface (GUI) to facilitate the configuration, generation, processing and use of the 4D Extended Cardiac-Torso (XCAT) phantom. Methods: The XCAT phantom includes over 9000 anatomical objects as well as respiratory, cardiac and tumor motion. It is widely used for research studies in medical imaging and radiotherapy. The phantom generation process involves the configuration of a text script to parameterize the geometry, motion, and composition of the whole body and objects within it, and to generate simulated PET or CT images. To avoid the need for manual editing or script writing, our MATLAB-based GUI uses slider controls, drop-down lists, buttons and graphical text input to parameterize and process the phantom. Results: Our GUI can be used to: a) generate parameter files; b) generate the voxelized phantom; c) combine the phantom with a lesion; d) display the phantom; e) produce average and maximum intensity images from the phantom output files; f) incorporate irregular patient breathing patterns; and f) generate DICOM files containing phantom images. The GUI provides local help information using tool-tip strings on the currently selected phantom, minimizing the need for external documentation. The DICOM generation feature is intended to simplify the process of importing the phantom images into radiotherapy treatment planning systems or other clinical software. Conclusion: The GUI simplifies and automates the use of the XCAT phantom for imaging-based research projects in medical imaging or radiotherapy. This has the potential to accelerate research conducted with the XCAT phantom, or to ease the learning curve for new users. This tool does not include the XCAT phantom software itself. We would like to acknowledge funding from MRA, Varian Medical Systems Inc.

60 APPLIED LIFE SCIENCES↗

SU-E-J-151: Day-To-Day Variations in Fraction-Specific Motion Modeling Using Patient 4DCBCT Images

Purpose: The goal of this study is to quantify the interfraction reproducibility of patient-specific motion models derived from 4DCBCT acquired on the day of treatment of lung cancer stereotactic body radiotherapy (SBRT) patients. Methods: Motion models are derived from patient 4DCBCT images acquired daily over 3–5 fractions of treatment by 1) applying deformable image registration between each 4DCBCT image and a reference phase from that day, resulting in a set of displacement vector fields (DVFs), and 2) performing principal component analysis (PCA) on the DVFs to derive a motion model. The motion model from the first day of treatment is compared to motion models from each successive day of treatment to quantify variability in motion models generated from different days. Four SBRT patient datasets have been acquired thus far in this IRB approved study. Results: Fraction-specific motion models for each fraction and patient were derived and PCA eigenvectors and their associated eigenvalues are compared for each fraction. For the first patient dataset, the average root mean square error between the first two eigenvectors associated with the highest two eigenvalues, in four fractions was 0.1, while it was 0.25 between the last three PCA eigenvectors associated with the lowest three eigenvalues. It was found that the eigenvectors and eigenvalues of PCA motion models for each treatment fraction have variations and the first few eigenvectors are shown to be more stable across treatment fractions than others. Conclusion: Analysis of this dataset showed that the first two eigenvectors of the PCA patient-specific motion models derived from 4DCBCT were stable over the course of several treatment fractions. The third, fourth, and fifth eigenvectors had larger variations.

60 APPLIED LIFE SCIENCES↗

SU-E-J-186: Using 4DCT-Based Motion Modeling to Predict Motion and Duty Cycle On Successive Days of Gated Radiotherapy

Purpose: To determine if 4DCT-based motion modeling and external surrogate motion measured during treatment simulation can enhance prediction of residual tumor motion and duty cycle during treatment delivery. Methods: This experiment was conducted using simultaneously recorded tumor and external surrogate motion acquired over multiple fractions of lung cancer radiotherapy. These breathing traces were combined with the XCAT phantom to simulate CT images. Data from the first day was used to estimate the residual tumor motion and duty cycle both directly from the 4DCT (the current clinical standard), and from external-surrogate based motion modeling. The accuracy of these estimated residual tumor motions and duty cycles are evaluated by comparing to the measured internal/external motions from other treatment days. Results: All calculations were done for 25% and 50% duty cycles. The results indicated that duty cycle derived from 4DCT information alone is not enough to accurately predict duty cycles during treatment. Residual tumor motion was determined from the recorded data and compared with the estimated residual tumor motion from 4DCT. Relative differences in residual tumor motion varied from −30% to 55%, suggesting that more information is required to properly predict residual tumor motion. Compared to estimations made from 4DCT, in three out of four patients examined, the 30 seconds of motion modeling data was able to predict the duty cycle with better accuracy than 4DCT. No improvement was observed in prediction of residual tumor motion for this dataset. Conclusion: Motion modeling during simulation has the potential to enhance 4DCT and provide more information about target motion, duty cycles, and delivered dose. Based on these four patients, 30 seconds of motion modeling data produced improve duty cycle estimations but showed no measurable improvement in residual tumor motion prediction. More patient data is needed to verify this Result. I would like to acknowledge funding from MRA, VARIAN Medical Systems, Inc.

60 APPLIED LIFE SCIENCES↗

WE-G-207-06: 3D Fluoroscopic Image Generation From Patient-Specific 4DCBCT-Based Motion Models Derived From Physical Phantom and Clinical Patient Images

Purpose: Respiratory-correlated cone-beam CT (4DCBCT) images acquired immediately prior to treatment have the potential to represent patient motion patterns and anatomy during treatment, including both intra- and inter-fractional changes. We develop a method to generate patient-specific motion models based on 4DCBCT images acquired with existing clinical equipment and used to generate time varying volumetric images (3D fluoroscopic images) representing motion during treatment delivery. Methods: Motion models are derived by deformably registering each 4DCBCT phase to a reference phase, and performing principal component analysis (PCA) on the resulting displacement vector fields. 3D fluoroscopic images are estimated by optimizing the resulting PCA coefficients iteratively through comparison of the cone-beam projections simulating kV treatment imaging and digitally reconstructed radiographs generated from the motion model. Patient and physical phantom datasets are used to evaluate the method in terms of tumor localization error compared to manually defined ground truth positions. Results: 4DCBCT-based motion models were derived and used to generate 3D fluoroscopic images at treatment time. For the patient datasets, the average tumor localization error and the 95th percentile were 1.57 and 3.13 respectively in subsets of four patient datasets. For the physical phantom datasets, the average tumor localization error and the 95th percentile were 1.14 and 2.78 respectively in two datasets. 4DCBCT motion models are shown to perform well in the context of generating 3D fluoroscopic images due to their ability to reproduce anatomical changes at treatment time. Conclusion: This study showed the feasibility of deriving 4DCBCT-based motion models and using them to generate 3D fluoroscopic images at treatment time in real clinical settings. 4DCBCT-based motion models were found to account for the 3D non-rigid motion of the patient anatomy during treatment and have the potential to localize tumor and other patient anatomical structures at treatment time even when inter-fractional changes occur. This project was supported, in part, through a Master Research Agreement with Varian Medical Systems, Inc., Palo Alto, CA. The project was also supported, in part, by Award Number R21CA156068 from the National Cancer Institute.

60 APPLIED LIFE SCIENCES↗