Engineering topics

Pouliot, J

Publications and source records attributed to Pouliot, J.

16 records

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-102: Performance Variations Among Clinically Available Deformable Image Registration Tools in Adaptive Radiotherapy: How Should We Evaluate and Interpret the Result?

Purpose: To evaluate the performance variations in commercial deformable image registration (DIR) tools for adaptive radiation therapy. Methods: Representative plans from three different anatomical sites, prostate, head-and-neck (HN) and cranial spinal irradiation (CSI) with L-spine boost, were included. Computerized deformed CT images were first generated using virtual DIR QA software (ImSimQA) for each case. The corresponding transformations served as the “reference”. Three commercial software packages MIMVista v5.5 and MIMMaestro v6.0, VelocityAI v2.6.2, and OnQ rts v2.1.15 were tested. The warped contours and doses were compared with the “reference” and among each other. Results: The performance in transferring contours was comparable among all three tools with an average DICE coefficient of 0.81 for all the organs. However, the performance of dose warping accuracy appeared to rely on the evaluation end points. Volume based DVH comparisons were not sensitive enough to illustrate all the detailed variations while isodose assessment on a slice-by-slice basis could be tedious. Point-based evaluation was over-sensitive by having up to 30% hot/cold-spot differences. If adapting the 3mm/3% gamma analysis into the evaluation of dose warping, all three algorithms presented a reasonable level of equivalency. One algorithm had over 10% of the voxels not meeting this criterion for the HN case while another showed disagreement for the CSI case. Conclusion: Overall, our results demonstrated that evaluation based only on the performance of contour transformation could not guarantee the accuracy in dose warping. However, the performance of dose warping accuracy relied on the evaluation methodologies. Nevertheless, as more DIR tools are available for clinical use, the performance could vary at certain degrees. A standard quality assurance criterion with clinical meaning should be established for DIR QA, similar to the gamma index concept, in the near future.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

SU-F-207-09: Evaluating the Dosimetric Accuracy of Extended Field-Of-View CT Reconstructions Using Clinical Data with Real Patient Geometries

Purpose: To determine the accuracy of dose calculations performed with CT images reconstructed using extended field of view (FOV) algorithms. Methods: In this study we selected 6 radiotherapy patients (3 head and neck & 3 chest/pelvis) whose body circumferences extended past the 50 cm scan FOV in the treatment planning CT. Images acquired on a Siemens Sensation Open scanner, were reconstructed using the standard FOV (sFOV) and two different extended FOV algorithms, eFOV and HDFOV. A physician and dosimetrist identified the radiation target, critical organs, and external patient contour. A benchmark CT was created for each patient, consisting of an average of the 3 CT reconstructions with a density override applied to regions containing truncation artifacts, and was used to create an optimal radiation treatment plan. The plan was copied onto each reconstruction without density override and dose was recalculated. Results: The native sFOV dose calculations had the largest deviation from the benchmark (0.4 – 6.0%). Both the HDFOV and eFOV calculations showed improvement over the sFOV. For patients with a smooth patient contour, the HDFOV calculation had the least deviation from the benchmark (0.1–0.5%) compared to eFOV (0.4–1.8%). In cases with large amounts of tissue and irregular skin folds, the eFOV deviated the least from the benchmark (0.2–0.6%) compared to HDFOV (1.3–1.8%). It was observed that the eFOV scan has large image artifact in air with an average HU of −600 compared to the ideal of −1000. In these cases, the artifact in air appears to attenuate the dose and compensate for the missing tissue density. The HDFOV demonstrated minimal artifact in air. Conclusion: Both eFOV and HDFOV provide improved dose calculation accuracy. The HDFOV reconstruction provides a clearer patient border than the eFOV allowing for well-defined density overrides to be applied with minimal air artifact. This research was supported by Siemens Medical Solutions.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

TU-AB-303-10: KVCBCT, MVCBCT and MVCT On-Board Imaging Suitability for An Urgent Radiotherapy Treatment Workflow

Purpose: A comparison of image quality and dose calculation accuracy to study the suitability of available on-board imaging systems for a new treatment workflow in emergency radiotherapy situations. Methods: Water and anthropomorphic phantom images were acquired on four different Linac on-board imaging systems, including kVCBCT (Varian TrueBeam and Elekta VersaHD), MVCBCT (Siemens Artiste) and MVCT (Accuray Tomotherapy). Simple treatments of single or opposed beams were planned on the respective kVCT images and copied to all CT images. Image suitability for dose planning was based on the overall mean dose differences and 3D gamma index with 3%/3mm criteria for a prescription of 100 monitor units (MU) and differences in calculated MUs per plan for dose prescriptions to mid-plane. Results: TrueBeam kVCBCT and Tomotherapy MVCT images produced most accurate dose calculation for all tested cases (γ-index >95%). MVCBCT and VersaHD kVCBCT images resulted in minimum γ-passing rates of 94% and 87%, respectively. MUs calculated from treatment plans prescribed to mid-plane were within differences of 5% relative to kVCT-based plans in all cases. However, VersaHD images showed considerable local image artifacts in the pelvis water and anthropomorphic neck phantom that complicated accurate Hounsfield unit (HU) to electron density conversion, thus causing local dose differences of more than 10% relative to kVCT-based dose distributions. Conclusion: TrueBeam kVCBCT, MVCBCT and MVCT systems provide image quality that allows for accurate simple treatment plan calculation. Prescription points should be placed away from areas found to cause local dose discrepancies, such as air cavities. Improved image filter settings and HU-to-electron density calibration adjustments may be required for the VersaHD system to obtain an overall accurate dose distribution. To evaluate a system’s overall suitability, its clinical features also require consideration, such as imaging field of view, acquisition time and the ability to instantly export images for treatment planning.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

WE-G-207-04: Non-Local Total-Variation (NLTV) Combined with Reweighted L1-Norm for Compressed Sensing Based CT Reconstruction

Purpose: Compressed sensing (CS) has been used for CT (4DCT/CBCT) reconstruction with few projections to reduce dose of radiation. Total-variation (TV) in L1-minimization (min.) with local information is the prevalent technique in CS, while it can be prone to noise. To address the problem, this work proposes to apply a new image processing technique, called non-local TV (NLTV), to CS based CT reconstruction, and incorporate reweighted L1-norm into it for more precise reconstruction. Methods: TV minimizes intensity variations by considering two local neighboring voxels, which can be prone to noise, possibly damaging the reconstructed CT image. NLTV, contrarily, utilizes more global information by computing a weight function of current voxel relative to surrounding search area. In fact, it might be challenging to obtain an optimal solution due to difficulty in defining the weight function with appropriate parameters. Introducing reweighted L1-min., designed for approximation to ideal L0-min., can reduce the dependence on defining the weight function, therefore improving accuracy of the solution. This work implemented the NLTV combined with reweighted L1-min. by Split Bregman Iterative method. For evaluation, a noisy digital phantom and a pelvic CT images are employed to compare the quality of images reconstructed by TV, NLTV and reweighted NLTV. Results: In both cases, conventional and reweighted NLTV outperform TV min. in signal-to-noise ratio (SNR) and root-mean squared errors of the reconstructed images. Relative to conventional NLTV, NLTV with reweighted L1-norm was able to slightly improve SNR, while greatly increasing the contrast between tissues due to additional iterative reweighting process. Conclusion: NLTV min. can provide more precise compressed sensing based CT image reconstruction by incorporating the reweighted L1-norm, while maintaining greater robustness to the noise effect than TV min.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2014

MO-C-17A-05: A Three-Dimensional Head-And-Neck Phantom for Validation of Kilovoltage- and Megavoltage-Based Deformable Image Registration

Purpose: To develop a three-dimensional (3D) deformable head-and-neck (H and N) phantom with realistic tissue contrast for both kilovoltage and megavoltage computed tomography and use it to objectively evaluate deformable image registration (DIR) algorithms. Methods: The phantom represents H and N patient anatomy. It is constructed from thermoplastic, which becomes pliable in boiling water, and hardened epoxy resin. Using a system of additives, the Hounsfield unit (HU) values of these materials were tuned to mimic anatomy for both kilovoltage (kV) and megavoltage (MV) imaging. The phantom opened along a sagittal midsection to reveal nonradiopaque markers, which were used to characterize the phantom deformation. The deformed and undeformed phantom was scanned with kV and MV computed tomography. Additionally, a calibration curve was created to change the HUs of the MV scans to be similar to kV HUs, (MC). The extracted ground-truth deformation was then compared to the results of two commercially available DIR algorithms, from Velocity Medical Solutions and MIM Software. Results: The phantom produced a 3D deformation, representing neck flexion, with a magnitude of up to 8 mm and was able represent tissue HUs for both kV and MV imaging modalities. The two tested deformation algorithms yielded vastly different results. For kV-kV registration, MIM made the lowest mean error, and Velocity made the lowest maximum error. For MV-MV, kV-MV, and kV-MC Velocity produced both the lowest mean and lowest maximum errors. Conclusion: The application of DIR across different imaging modalities is particularly difficult, due to differences in tissue HUs and the presence of imaging artifacts. For this reason, DIR algorithms must be validated specifically for this purpose. The developed H and N phantom is an effective tool for this purpose.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

DOE OSTI2014

MO-E-BRD-01: Adapt-A-Thon - Texas Hold’em Invitational

Software tools for image-based adaptive radiotherapy such as deformable image registration, contour propagation and dose mapping have progressed beyond the research setting and are now commercial products available as part of both treatment planning systems and stand-alone applications. These software tools are used together to create clinical workflows to detect, track and evaluate changes in the patient and to accumulate dose. Deviations uncovered in this process are used to guide decisions about replanning/adaptation with the goal of keeping the delivery of prescribed dose “on target” throughout the entire course of radiotherapy. Since the output from one step of the adaptive process is used as an input for another, it is essential to understand and document the uncertainty associated with each of the step and how these uncertainties are propagated. This in turn requires an understanding how the underlying tools work. Unfortunately, important details about the algorithms used to implement these tools are scarce or incomplete, too often for competitive reasons. This is in contrast to the situation involving other basic treatment planning algorithms such as dose calculations, where the medical physics community essentially requires vendors to provide physically important details about their underlying theory and clinical implementation. Vendors should adopt this same level of information sharing when it comes to the tools and techniques for image guided adaptive radiotherapy. The goal of this session is to start this process by inviting vendors and medical physicists to discuss and demonstrate the available tools and describe how they are intended to be used in clinical practice. The format of the session will involve a combination of formal presentations, interactive demonstrations, audience participation and some friendly “Texas style” competition. Learning Objectives: Understand the components of the image-based adaptive radiotherapy process. Understand the how these components are implemented in various commercial systems. Understand the different use cases and workflows currently supported these tools.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2014

WE-F-16A-01: Commissioning and Clinical Use of PC-ISO for Customized, 3D Printed, Gynecological Brachytherapy Applicators

Purpose: (1) Evaluate the safety and radiation attenuation properties of PCISO, a bio-compatible, sterilizable 3D printing material by Stratasys, (2) establish a method for commissioning customized multi- and single-use 3D printed applicators, (3) report on use of customized vaginal cylinders used to treat a series of serous endometrial cancer patient. Methods: A custom film dosimetry apparatus was designed to hold a Gafchromic radio film segment between two blocks of PC-ISO and 3D-printed using a Fortus 400mc (StrataSys). A dose plan was computed using 13 dwell positions at 2.5 mm spacing and normalized to 1500 cGy at 1 cm. Film exposure was compared to control tests in only air and only water. The average Hounsfield Unit (HU) was computed and used to verify water equivalency. For the clinical use cases, the physician specifies the dimensions and geometry of a custom applicator from which a CAD model is designed and printed. Results: The doses measured from the PC-ISO Gafchromic film test were within 1% of the dose measured in only water between 1cm and 6cm from the channel. Doses increased 7–4% measured in only air. HU range was 11–43. The applicators were sterilized using the Sterrad system multiple times without damage. As of submission 3 unique cylinders have been designed, printed, and used in the clinic. A standardizable workflow for commissioning custom 3D printed applicators was codified and will be reported. Conclusions: Quality assurance (QA) evaluation of the PC-ISO 3D-printing material showed that PC-ISO is a suitable material for a gynecological brachytherapy vaginal cylinder in a clinical setting. With the material commissioning completed, if the physician determines that a better treatment would Result, a customized design is fabricated with limited additional QA necessary. Although this study was specific to PC-ISO, the same setup can be used to evaluate other 3D-printing materials.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2014

TH-C-BRF-01: The Promise and Potential Pitfalls of Deformable Image Registration in Clinical Practice

Accurate and robust deformable image registration (DIR) is a key enabling technique in the clinical realization of two approaches for advancing radiation therapy treatment efficacy: adaptive radiation therapy and treatment response assessment. Currently there are a wide variety of DIR methods including the categories of splines, optical/diffusion, free-form, and biomechanical algorithms. All methods aim to translate information between image sets (including multi-modal data) in the presence of spatial deformation of tissues. However, recent research has shown that different DIR algorithms can yield substantially different results for the same reference deformation, and that DIR performance can be site and application dependent. As a result, errors can occur, and subsequent patient treatment can be compromised. There is a clear need for greater understanding of appropriate use of DIR techniques, as well as effective methods of validation, evaluation, and improvement. In this session, we will review the state-of-the-art concerning DIR development, clinical application, and performance evaluation. Novel DIR methods and evaluating technologies will be reviewed. Learning Objectives: To understand the underlying principles and physics of current DIR techniques To explore potential clinical applications and areas of high impact for DIR To investigate sources of uncertainty, appropriate usage, and methods for validating and evaluating DIR performance.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2014

SU-C-16A-05: OAR Dose Tolerance Recommendations for Prostate and Cervical HDR Brachytherapy: Dose Versus Volume Metrics

Purpose: HDR brachytherapy consensus dose tolerance recommendations for organs at risk (OARs) remain widely debated. Prospective trials reporting metrics must be sufficiently data-dense to assess adverse affects and identify optimally predictive tolerances. We explore the tradeoffs between reporting dose-metrics versus volume-metrics and the potential impact on trial outcome analysis and tolerance recommendations. Methods: We analyzed 26 prostate patients receiving 15 Gy HDR single-fraction brachytherapy boost to 45 Gy external beam radiation therapy and 28 cervical patients receiving 28 Gy HDR brachytherapy monotherapy in 4 fractions using 2 implants. For each OAR structure, a robust linear regression fit was performed for the dose-metrics as a function of the volume-metrics. The plan quality information provided by recommended dose-metric and volume-metric values were compared. Results: For prostate rectal dose, D2cc and V75 lie close to the regression line, indicating they are similarly informative. Two outliers for prostate urethral dose are substantially different from the remaining cohort in terms of D0.1cc and V75, but not D1cc, suggesting the choice of reporting dose metric is essential. For prostate bladder and cervical bladder, rectum, and bowel, dose outliers are more apparent via V75 than recommended dose-metrics. This suggests that for prostate bladder dose and all cervical OAR doses, the recommended volume-metrics may be better predictors of clinical outcome than dose-metrics. Conclusion: For plan acceptance criteria, dose and volume-metrics are reciprocally equivalent. However, reporting dosemetrics or volume-metrics alone provides substantially different information. Our results suggest that volume-metrics may be more sensitive to differences in planned dose, and if one metric must be chosen, volumemetrics are preferable. However, reporting discrete DVH points severely limits the ability to identify planning tolerances most predictive of adverse effects. Thus, we recommend that full OAR DVH reporting be required for future prospective trials.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2014

SU-C-18A-05: Registration Accuracy of MR-Based Images to On-Board Megavoltage Cone-Beam CT for Brain Patient Setup

Purpose: To quantify the difference in isocenter shifts when co-registering MR and MR-based pseudo CTs (pCT) with on-board megavoltage conebeam CT (CBCT) images. Methods: Fast Spoiled Gradient Echo MRs were used to generate pCTs (research version of Advantage Sim MD™, GE Healthcare) for ten patients who had prior brain radiotherapy. The planning CT (rCT) for each was co-registered with the MR, and the plan isocenter and two other reference points were transferred to the MR and pCT. CBCT images (with the machine isocenter) from a single treatment day were coregistered with the 3 test images (MR, pCT and rCT), by two observers and by an automated registration algorithm. The reference points were used to calculate patient shifts and rotations from the registrations. The shifts calculated from the test image registrations were compared to each other and to the shifts performed by the therapists who treated the patients on that day. Results: The average difference in absolute value between the isocenter shifts from the MR-, pCT- and rCT-CBCT registrations, and the therapist shifts, were 2.02, 3.01 and 0.89 mm (craniocaudal), 1.14, 1.34 and 0.46 mm (lateral), and 1.37, 3.43 and 1.43 mm (vertical), respectively. The MR- and pCT-CBCT registrations differed by 1.99, and 2.53 mm (craniocaudal), 1.36, and 1.37 mm (lateral), and 0.74 and 2.34 mm (vertical), respectively, from the average rCT-CBCT shifts. On average, differences of 2.39 (craniocaudal), 1.28 (lateral) and 2.84 mm (vertical) were seen between the MR and pCT shifts. Rotations relative to the CBCT coordinate system were on average <2° for the MR and rCT, and <6° for the pCT. Conclusion: In this study, FSPGR MR-CBCT registrations were more precise compared to the pCT-CBCT registrations. For improved accuracy, MR sequences that are optimal for bony anatomy visualization are necessary. GE healthcare has provided a research version of Advantage Sim MD to UCSF. No financial support was provided.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2014

SU-E-J-42: Customized Deformable Image Registration Using Open-Source Software SlicerRT

Purpose: SlicerRT is a flexible platform that allows the user to incorporate the necessary images registration and processing tools to improve clinical workflow. This work validates the accuracy and the versatility of the deformable image registration algorithm of the free open-source software SlicerRT using a deformable physical pelvic phantom versus available commercial image fusion algorithms. Methods: Optical camera images of nonradiopaque markers implanted in an anatomical pelvic phantom were used to measure the ground-truth deformation and evaluate the theoretical deformations for several DIR algorithms. To perform the registration, full and empty bladder computed tomography (CT) images of the phantom were obtained and used as fixed and moving images, respectively. The DIR module, found in SlicerRT, used a B-spline deformable image registration with multiple optimization parameters that allowed customization of the registration including a regularization term that controlled the amount of local voxel displacement. The virtual deformation field at the center of the phantom was obtained and compared to the experimental ground-truth values. The parameters of SlicerRT were then varied to improve spatial accuracy. To quantify image similarity, the mean absolute difference (MAD) parameter using Hounsfield units was calculated. In addition, the Dice coefficient of the contoured rectum was evaluated to validate the strength of the algorithm to transfer anatomical contours. Results: Overall, SlicerRT achieved one of the lowest MAD values across the algorithm spectrum, but slightly smaller mean spatial errors in comparison to MIM software (MIM). On the other hand, SlicerRT created higher mean spatial errors than Velocity Medical Solutions (VEL), although obtaining an improvement on the DICE to 0.91. The large spatial errors were attributed to the poor contrast in the prostate bladder interface of the phantom. Conclusion: Based phantom validation, SlicerRT is capable of achieving comparable DIR accuracy to commercial programs such as MIM and VEL.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2014

SU-E-J-78: Internal Target Volume Delineation for Lung Tumors in Patients Treated with Robotic Radiosurgery

Purpose: To compare different approaches for Internal Target Volume (ITV) delineation for patients treated with fiducial-free robotic radiosurgery for primary and metastatic lung tumors. Methods: Ten patients undergoing Lung-Optimized Treatment (LOT) for robotic radiosurgery were imaged with inhale and exhale breath-hold CT scans and 8-phase 4DCT scan. We evaluated the differences in internal target volume (ITV) delineated using three approaches: 1) maximum intensity projection (MIP) images reconstructed from 4DCT scan (ITV-MIP); 2) linear interpolation of Gross Tumor Volumes (GTV) segmented on inhale and exhale breath-hold scans (ITV-BH); 3) linear interpolation of GTV segmented on inhale and exhale phases of 4DCT scan (ITV-2Phase). All contours were independently generated by the same radiation oncologist using lung window settings. Patients had ITV-MIP volumes ranging from 1.5 to 146.9 cc (mean 36.8 cc) located in various parts of the lung. Volume overlap and matching index (MI) were calculated and compared. The MI between two volumes was defined as the ratio of their intersection to their union. MI of 1 indicates the volumes are identical; MI of 0 indicates that there is no overlap. Results: The three approaches generated very different results. The average (SD) MI for ITV-MIP and ITV-BH was 0.52 (0.24); for ITV-MIP and ITV-2Phase it was 0.69 (0.13); and for ITV-BH and ITV-2Phase was 0.57 (0.21), (ANOVA, p=0.16). Relative to the ITV-MIP, the percentage of volume overlap was 72% (26%) and 90% (7%) for ITV-BH and ITV-2Phase, respectively (t-test, p=0.05). Conclusion: Differences between ITV-BH and ITV-MIP are due to inconsistent lung filling at breath-hold and nonlinear tumor motion. Therefore, methods to check breath-hold scanning against regular patient breathing patterns should be developed. Whenever possible, ITV-BH generated by the LOT workflow should be verified by 4DCT data.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2014

SU-E-J-92: On-Line Cone Beam CT Based Planning for Emergency and Palliative Radiation Therapy

Purpose: To evaluate and develop the feasibility of on-line cone beam CT based planning for emergency and palliative radiotherapy treatments. Methods: Subsequent to phantom studies, a case library of 28 clinical megavoltage cone beam CT (MVCBCT) was built to assess dose-planning accuracies on MVCBCT for all anatomical sites. A simple emergency treatment plan was created on the MVCBCT and copied to its reference CT. The agreement between the dose distributions of each image pair was evaluated by the mean dose difference of the dose volume and the gamma index of the central 2D axial plane. An array of popular urgent and palliative cases was also evaluated for imaging component clearance and field-of-view. Results: The treatment cases were categorized into four groups (head and neck, thorax/spine, pelvis and extremities). Dose distributions for head and neck treatments were predicted accurately in all cases with a gamma index of >95% for 2% and 2 mm criteria. Thoracic spine treatments had a gamma index as low as 60% indicating a need for better uniformity correction and tissue density calibration. Small anatomy changes between CT and MVCBCT could contribute to local errors. Pelvis and sacral spine treatment cases had a gamma index between 90% and 98% for 3%/3 mm criteria. The limited FOV became an issue for large pelvis patients. Imaging clearance was difficult for cases where the tumor was positioned far off midline. Conclusion: The MVCBCT based dose planning and delivery approach is feasible in many treatment cases. Dose distributions for head and neck patients are unrestrictedly predictable. Some FOV restrictions apply to other treatment sites. Lung tissue is most challenging for accurate dose calculations given the current imaging filters and corrections. Additional clinical cases for extremities need to be included in the study to assess the full range of site-specific planning accuracies. This work is supported by Siemens.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2014

SU-E-T-48: Automated Quality Assurance for XML Controlled Linacs

Purpose: To automate routine imaging QA procedures so that complying with TG 142 and TG 179 can be efficient and reliable. Methods: Two QA tests for a True Beam Linac were automatized. A Winston Lutz test as described by Lutz et al{sup 1} using the Winston Lutz test kit from BrainLab, Germany and a CBCT Image Quality test as described in TG 179 using the EMMA phantom, Siemens Medical Physics, Germany were performed in our True Beam. For each QA procedure tested, a 3 step paradigm was used. First, the data was automatically acquired using True Beam Developer Mode and XML scripting. Second, the data acquired in the first step was automatically processed using in-home grown Matlab GUIs. Third, Machine Learning algorithms were used to automatically classify the processed data and reports generated. Results: The Winston Luzt test could be performed by an experienced medical physicist in 29.0 ± 8.0 min. The same test, if automated using our paradigm, could be performed in 3.0 ± 0.1 min. In the same lieu, time could be substantially saved for image quality tests. In this case, the amount of time saved will depend on the phantoms used and the initial localization method. Additionally, machine learning algorithms could automatically identify the roots of the problems if any and possibly help reduce machine down time. Conclusion: Modern linear accelerators are equipped with advanced 2D and 3D imaging that are used for patient alignment substantially improving IGRT protocols. However, this extra complexity exponentially increases the number of QA tests needed. Using the new paradigm described above, not only bare minimum but best practice QA programs could be implemented with the same manpower. This work is supported by Varian, Palo Alto, CA.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2014

SU-E-T-438: Commissioning of An In-Vivo Quality Assurance Method Using the Electronic Portal Imaging Device

Purpose: Patient specific pre-treatment quality assurance (QA) using arrays of detectors or film have been the standard approach to assure the correct treatment is delivered to the patient. This QA approach is expensive, labor intensive and does not guarantee or document that all remaining fractions were treated properly. The purpose of this abstract is to commission and evaluate the performance of a commercially available in-vivo QA software using the electronic portal imaging device (EPID) to record the daily treatments. Methods: The platform EPIgray V2.0.2 (Dosisoft), which machine model compares ratios of TMR with EPID signal to predict dose was commissioned for an Artiste (Siemens Oncology Care Systems) and a Truebeam (Varian medical systems) linear accelerator following the given instructions. The systems were then tested on three different phantoms (homogeneous stack of solid water, anthropomorphic head and pelvis) and on a library of patient cases. Simple and complex fields were delivered at different exposures and for different gantry angles. The effects of the table attenuation and the EPID sagging were evaluated. Gamma analysis of the measured dose was compared to the predicted dose for complex clinical IMRT cases. Results: Commissioning of the EPIgray system for two photon energies took 8 hours. The difference between the dose planned and the dose measured with EPIgray was better than 3% for all phantom scenarios tested. Preliminary results on patients demonstrate an accuracy of 5% is achievable in high dose regions for both 3DCRT and IMRT. Large discrepancies (>5%) were observed due to metallic structures or air cavities and in low dose areas. Flat panel sagging was visible and accounted for in the EPIgray model. Conclusion: The accuracy achieved by EPIgray is sufficient to document the safe delivery of complex IMRT treatments. Future work will evaluate EPIgray for VMAT and high dose rate deliveries. This work is supported by Dosisoft, Cachan, France.

60 APPLIED LIFE SCIENCES↗