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At least 235 records · Page 13

SU-D-BRD-02: A Web-Based Image Processing and Plan Evaluation Platform (WIPPEP) for Future Cloud-Based Radiotherapy

Purpose: Visualization and processing of medical images and radiation treatment plan evaluation have traditionally been constrained to local workstations with limited computation power and ability of data sharing and software update. We present a web-based image processing and planning evaluation platform (WIPPEP) for radiotherapy applications with high efficiency, ubiquitous web access, and real-time data sharing. Methods: This software platform consists of three parts: web server, image server and computation server. Each independent server communicates with each other through HTTP requests. The web server is the key component that provides visualizations and user interface through front-end web browsers and relay information to the backend to process user requests. The image server serves as a PACS system. The computation server performs the actual image processing and dose calculation. The web server backend is developed using Java Servlets and the frontend is developed using HTML5, Javascript, and jQuery. The image server is based on open source DCME4CHEE PACS system. The computation server can be written in any programming language as long as it can send/receive HTTP requests. Our computation server was implemented in Delphi, Python and PHP, which can process data directly or via a C++ program DLL. Results: This software platform is running on a 32-core CPU server virtually hosting the web server, image server, and computation servers separately. Users can visit our internal website with Chrome browser, select a specific patient, visualize image and RT structures belonging to this patient and perform image segmentation running Delphi computation server and Monte Carlo dose calculation on Python or PHP computation server. Conclusion: We have developed a webbased image processing and plan evaluation platform prototype for radiotherapy. This system has clearly demonstrated the feasibility of performing image processing and plan evaluation platform through a web browser and exhibited potential for future cloud based radiotherapy.

60 APPLIED LIFE SCIENCES↗

Toward the development of intrafraction tumor deformation tracking using a dynamic multi-leaf collimator

Purpose: Intrafraction deformation limits targeting accuracy in radiotherapy. Studies show tumor deformation of over 10 mm for both single tumor deformation and system deformation (due to differential motion between primary tumors and involved lymph nodes). Such deformation cannot be adapted to with current radiotherapy methods. The objective of this study was to develop and experimentally investigate the ability of a dynamic multi-leaf collimator (DMLC) tracking system to account for tumor deformation. Methods: To compensate for tumor deformation, the DMLC tracking strategy is to warp the planned beam aperture directly to conform to the new tumor shape based on real time tumor deformation input. Two deformable phantoms that correspond to a single tumor and a tumor system were developed. The planar deformations derived from the phantom images in beam's eye view were used to guide the aperture warping. An in-house deformable image registration software was developed to automatically trigger the registration once new target image was acquired and send the computed deformation to the DMLC tracking software. Because the registration speed is not fast enough to implement the experiment in real-time manner, the phantom deformation only proceeded to the next position until registration of the current deformation position was completed. The deformation tracking accuracy was evaluated by a geometric target coverage metric defined as the sum of the area incorrectly outside and inside the ideal aperture. The individual contributions from the deformable registration algorithm and the finite leaf width to the tracking uncertainty were analyzed. Clinical proof-of-principle experiment of deformation tracking using previously acquired MR images of a lung cancer patient was implemented to represent the MRI-Linac environment. Intensity-modulated radiation therapy (IMRT) treatment delivered with enabled deformation tracking was simulated and demonstrated. Results: The first experimental investigation of adapting to tumor deformation has been performed using simple deformable phantoms. For the single tumor deformation, the A{sub u}+A{sub o} was reduced over 56% when deformation was larger than 2 mm. Overall, the total improvement was 82%. For the tumor system deformation, the A{sub u}+A{sub o} reductions were all above 75% and the total A{sub u}+A{sub o} improvement was 86%. Similar coverage improvement was also found in simulating deformation tracking during IMRT delivery. The deformable image registration algorithm was identified as the dominant contributor to the tracking error rather than the finite leaf width. The discrepancy between the warped beam shape and the ideal beam shape due to the deformable registration was observed to be partially compensated during leaf fitting due to the finite leaf width. The clinical proof-of-principle experiment demonstrated the feasibility of intrafraction deformable tracking for clinical scenarios. Conclusions: For the first time, we developed and demonstrated an experimental system that is capable of adapting the MLC aperture to account for tumor deformation. This work provides a potentially widely available management method to effectively account for intrafractional tumor deformation. This proof-of-principle study is the first experimental step toward the development of an image-guided radiotherapy system to treat deforming tumors in real-time.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

SU-E-J-148: Evaluating Tumor Response with a Commercially Available Deformable Registration System

Purpose: The purpose of this study is to present a method for evaluating the response to treatment using a commercially available deformable image registration software package (Velocity Medical Systems) and repeat PET/CT imaging. This technique can be used to identify volumes that are risk for tumor recurrence. Methods: Response to treatment was evaluated using PET/CT images acquired prior-to and post-treatment for radiation therapy patients treated with concurrent chemotherapy. Velocity (Version 3.0.1) was used to deform the initial PET/CT to the post treatment PET/CT. The post-treatment PET images were then subtracted from the pre-treatment PET images. The resulting re-sampled image is a three-dimensional SUV difference map that shows pixels with increasing SUV values. SUV values increases greater than 2.5 in the post treatment images were identified for additional follow-up. Results: A total of 5 Lung patients were analyzed as part of this study. One lung patient in the cohort had an SUV increase of +3.28 that was identified using the SUV difference map. This volume of increased uptake was located outside the treatment field and adjacent to the 35 Gy isodose line. The remaining four patients all had SUV decreases inside the planning target volume, and no unexpected areas of increase outside the irradiated volumes. All five patients were analyzed using standard tools inside the Velocity application. Conclusion: The response to treatment can easily be measured using serial PET/CT images and a commercially available deformable image registration. This provides both the radiation oncologists and medical oncologists with a quantitative assessment of their treatment to use in patient follow-up.

60 APPLIED LIFE SCIENCES↗

TH-CD-207A-02: Implementation of Live EPID-Based Inspiration Level Assessment (LEILA) for Deepinspiration Breath-Hold (DIBH) Monitoring Using MV Fluoroscopy

Purpose: As prior work has shown that current DIBH monitoring approaches using surrogate measures (marker block on chest) do not always correspond with the clinical quantity of interest (lung depth, LD), a software tool and workflow are introduced to use MV fluoroscopy during treatment for real-time / Live EPID-based Inspiration Level Assessment (LEILA). Methods: A prototype software tool calculates and displays the LD during the treatment of left sided breast cancer. Calculations are based on MV cine images which are acquired with the treatment beam thereby not incurring any additional imaging dose. Image capture and processing are implemented using a dedicated frame grabber computer. The calculation engine automatically detects image orientation and includes provisions for large treatment fields that exceed the size of the EPID panel. LD is measured along a line profile in the middle of the field. LEILA’s interface displays the current MV image, a reference image (DRR), the current LD, as well as a trace of LD over treatment time. The display includes patient specific LD tolerances. Tolerances are specified for each field and loaded before the treatment. A visual warning is generated when the tolerance is exceeded. LEILA is initially run in parallel with current DIBH techniques. When later run by itself DIBH setup will be done using skin marks and room laser. Results: Offline tests of LEILA confirmed accurate automatic LD measurement for a variety of patient geometries. Deployment of the EPID during all left sided breast treatments was well tolerated by patients and staff during a multi-month pilot. The frame grabber provides 11 frames-per-second; the MATLAB based LEILA prototype software can analyze five frames-per-second standalone on standard desktop hardware. Conclusion: LEILA provides an automated approach to quantitatively monitor LD on MV images during DIBH treatment. Future improvements include a database and further speed optimization.

60 APPLIED LIFE SCIENCES↗

TU-AB-204-00: CDRH/FDA Regulatory Processes and Device Science Activities

The responsibilities of the Food and Drug Administration (FDA) have increased since the inception of the Food and Drugs Act in 1906. Medical devices first came under comprehensive regulation with the passage of the 1938 Food, Drug, and Cosmetic Act. In 1971 FDA also took on the responsibility for consumer protection against unnecessary exposure to radiation-emitting devices for home and occupational use. However it was not until 1976, under the Medical Device Regulation Act, that the FDA was responsible for the safety and effectiveness of medical devices. This session will be presented by the Division of Radiological Health (DRH) and the Division of Imaging, Diagnostics, and Software Reliability (DIDSR) from the Center for Devices and Radiological Health (CDRH) at the FDA. The symposium will discuss on how we protect and promote public health with a focus on medical physics applications organized into four areas: pre-market device review, post-market surveillance, device compliance, current regulatory research efforts and partnerships with other organizations. The pre-market session will summarize the pathways FDA uses to regulate the investigational use and commercialization of diagnostic imaging and radiation therapy medical devices in the US, highlighting resources available to assist investigators and manufacturers. The post-market session will explain the post-market surveillance and compliance activities FDA performs to monitor the safety and effectiveness of devices on the market. The third session will describe research efforts that support the regulatory mission of the Agency. An overview of our regulatory research portfolio to advance our understanding of medical physics and imaging technologies and approaches to their evaluation will be discussed. Lastly, mechanisms that FDA uses to seek public input and promote collaborations with professional, government, and international organizations, such as AAPM, International Electrotechnical Commission (IEC), Image Gently, and the Quantitative Imaging Biomarkers Alliance (QIBA) among others, to fulfill FDA’s mission will be discussed. Learning Objectives: Understand FDA’s pre-market and post-market review processes for medical devices Understand FDA’s current regulatory research activities in the areas of medical physics and imaging products Understand how being involved with AAPM and other organizations can also help to promote innovative, safe and effective medical devices J. Delfino, nothing to disclose.

60 APPLIED LIFE SCIENCES↗

SU-C-BRD-06: Sensitivity Study of An Automated System to Acquire and Analyze EPID Exit Dose Images

Purpose: The dosimetric consequences of errors in patient setup or beam delivery and anatomical changes are not readily known. A new product, PerFRACTION (Sun Nuclear Corporation), is designed to detect these errors by comparing the EPID exit dose image from each field of each fraction to those from baseline fraction images. This work investigates the sensitivity of PerFRACTION to detect the deviation of induced errors in a variety of realistic scenarios. Methods: Eight plans were created mimicking potential delivery or setup errors. The plans consisted of a nominal field and the field with an induced error. These were used to irradiate the EPID simulating multiple fractions with and without the error. Integrated EPID images were acquired in clinical mode and saved in ARIA. PerFRACTION automatically pulls the images into its database and performs the user defined comparison. In some cases, images were manually pushed to PerFRACTION. We varied the distance-to-agreement or dose tolerance until PerFRACTION showed failing pixels in the affected region and recorded the values. We induced errors of 1mm and greater in jaw, MLC, and couch position, 2 degree collimation rotation (patient yaw), and 0.5% to 1.5% in machine output. Both static and arc fields with the rails in or out were also acquired and compared. Results: PerFRACTION detected position errors of the jaws, MLC, and couch with an accuracy of better than 0.5 mm, and 0.2 degrees for collimator and gantry error. PerFRACTION detected a machine output error within 0.2% and detected the change in rail position. Conclusion: A new automated system for monitoring daily treatments for machine or patient variations from the first fraction using integrated EPID images was found to be sensitive enough to detect small positional, angular, and dosimetric errors within 0.5mm, 0.2 degrees, and 0.2%, respectively. Sun Nuclear Corporation has provided a software license for the product described.

60 APPLIED LIFE SCIENCES↗

First evaluation of the feasibility of MLC tracking using ultrasound motion estimation

Purpose: To quantify the performance of the Clarity ultrasound (US) imaging system (Elekta AB, Stockholm, Sweden) for real-time dynamic multileaf collimator (MLC) tracking. Methods: The Clarity calibration and quality assurance phantom was mounted on a motion platform moving with a periodic sine wave trajectory. The detected position of a 30 mm hypoechogenic sphere within the phantom was continuously reported via Clarity’s real-time streaming interface to an in-house tracking and delivery software and subsequently used to adapt the MLC aperture. A portal imager measured MV treatment field/MLC apertures and motion platform positions throughout each experiment to independently quantify system latency and geometric error. Based on the measured range of latency values, a prostate stereotactic body radiation therapy (SBRT) delivery was performed with three realistic motion trajectories. The dosimetric impact of system latency on MLC tracking was directly measured using a 3D dosimeter mounted on the motion platform. Results: For 2D US imaging, the overall system latency, including all delay times from the imaging and delivery chain, ranged from 392 to 424 ms depending on the lateral sector size. For 3D US imaging, the latency ranged from 566 to 1031 ms depending on the elevational sweep. The latency-corrected geometric root-mean squared error was below 0.75 mm (2D US) and below 1.75 mm (3D US). For the prostate SBRT delivery, the impact of a range of system latencies (400–1000 ms) on the MLC tracking performance was minimal in terms of gamma failure rate. Conclusions: Real-time MLC tracking based on a noninvasive US input is technologically feasible. Current system latencies are higher than those for x-ray imaging systems, but US can provide full volumetric image data and the impact of system latency was measured to be small for a prostate SBRT case when using a US-like motion input.

60 APPLIED LIFE SCIENCES↗

SU-F-T-262: Commissioning Varian Portal Dosimetry for EPID-Based Patient Specific QA in a Non-Aria Environment

Purpose: Development of an in-house program facilitates a workflow that allows Electronic Portal Imaging Device (EPID) patient specific quality assurance (QA) measurements to be acquired and analyzed in the Portal Dosimetry Application (Varian Medical Systems, Palo Alto, CA) using a non-Aria Record and Verify (R&V) system (MOSAIQ, Elekta, Crawley, UK) to deliver beams in standard clinical treatment mode. Methods: Initial calibration of an in-house software tool includes characterization of EPID dosimetry parameters by importing DICOM images of varying delivered MUs to determine linear mapping factors in order to convert image pixel values to Varian-defined Calibrated Units (CU). Using this information, the Portal Dose Image Prediction (PDIP) algorithm was commissioned by converting images of various field sizes to output factors using the Eclipse Scripting Application Programming Interface (ESAPI) and converting a delivered configuration fluence to absolute dose units. To verify the algorithm configuration, an integrated image was acquired, exported directly from the R&V client, automatically converted to a compatible, calibrated dosimetric image, and compared to a PDIP calculated image using Varian’s Portal Dosimetry Application. Results: For two C-Series and one TrueBeam Varian linear accelerators, gamma comparisons (global 3% / 3mm) of PDIP algorithm predicted dosimetric images and images converted via the inhouse system demonstrated agreement for ≥99% of all pixels, exceeding vendor-recommended commissioning guidelines. Conclusion: Combinations of a programmatic image conversion tool and ESAPI allow for an efficient and accurate method of patient IMRT QA incorporating a 3rd party R&V system.

60 APPLIED LIFE SCIENCES↗

SU-E-J-134: An Augmented-Reality Optical Imaging System for Accurate Breast Positioning During Radiotherapy

Purpose: Breast radiotherapy, particularly electronic compensation, may involve large dose gradients and difficult patient positioning problems. We have developed a simple self-calibrating augmented-reality system, which assists in accurately and reproducibly positioning the patient, by displaying her live image from a single camera superimposed on the correct perspective projection of her 3D CT data. Our method requires only a standard digital camera capable of live-view mode, installed in the treatment suite at an approximately-known orientation and position (rotation R; translation T). Methods: A 10-sphere calibration jig was constructed and CT imaged to provide a 3D model. The (R,T) relating the camera to the CT coordinate system were determined by acquiring a photograph of the jig and optimizing an objective function, which compares the true image points to points calculated with a given candidate R and T geometry. Using this geometric information, 3D CT patient data, viewed from the camera's perspective, is plotted using a Matlab routine. This image data is superimposed onto the real-time patient image, acquired by the camera, and displayed using standard live-view software. This enables the therapists to view both the patient's current and desired positions, and guide the patient into assuming the correct position. The method was evaluated using an in-house developed bolus-like breast phantom, mounted on a supporting platform, which could be tilted at various angles to simulate treatment-like geometries. Results: Our system allowed breast phantom alignment, with an accuracy of about 0.5 cm and 1 ± 0.5 degree. Better resolution could be possible using a camera with higher-zoom capabilities. Conclusion: We have developed an augmented-reality system, which combines a perspective projection of a CT image with a patient's real-time optical image. This system has the potential to improve patient setup accuracy during breast radiotherapy, and could possibly be used for other disease sites as well.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Radiation shielding properties of barite coated fabric by computer programme

With the development of technology radiation started to be used in variety of different fields. As the radiation is hazardous for human health, it is important to keep radiation dose as low as possible. This is done mainly using shielding materials. Barite is one of the important materials in this purpose. As the barite is not used directly it can be used in some other materials such as fabric. For this purposes barite has been coated on fabric in order to improve radiation shielding properties of fabric. Determination of radiation shielding properties of coated fabric has been done by using computer program written C# language. With this program the images obtained from digital Rontgen films is used to determine radiation shielding properties in terms of image processing numerical values. Those values define radiation shielding and in this way the coated barite effect on radiation shielding properties of fabric has been obtained.

07 ISOTOPE AND RADIATION SOURCES↗

SU-E-I-94: Automated Image Quality Assessment of Radiographic Systems Using An Anthropomorphic Phantom

Purpose: In a large, academic medical center, consistent radiographic imaging performance is difficult to routinely monitor and maintain, especially for a fleet consisting of multiple vendors, models, software versions, and numerous imaging protocols. Thus, an automated image quality control methodology has been implemented using routine image quality assessment with a physical, stylized anthropomorphic chest phantom. Methods: The “Duke” Phantom (Digital Phantom 07-646, Supertech, Elkhart, IN) was imaged twice on each of 13 radiographic units from a variety of vendors at 13 primary care clinics. The first acquisition used the clinical PA chest protocol to acquire the post-processed “FOR PRESENTATION” image. The second image was acquired without an antiscatter grid followed by collection of the “FOR PROCESSING” image. Manual CNR measurements were made from the largest and thickest contrast-detail inserts in the lung, heart, and abdominal regions of the phantom in each image. An automated image registration algorithm was used to estimate the CNR of the same insert using similar ROIs. Automated measurements were then compared to the manual measurements. Results: Automatic and manual CNR measurements obtained from “FOR PRESENTATION” images had average percent differences of 0.42%±5.18%, −3.44%±4.85%, and 1.04%±3.15% in the lung, heart, and abdominal regions, respectively; measurements obtained from “FOR PROCESSING” images had average percent differences of -0.63%±6.66%, −0.97%±3.92%, and −0.53%±4.18%, respectively. The maximum absolute difference in CNR was 15.78%, 10.89%, and 8.73% in the respective regions. In addition to CNR assessment of the largest and thickest contrast-detail inserts, the automated method also provided CNR estimates for all 75 contrast-detail inserts in each phantom image. Conclusion: Automated analysis of a radiographic phantom has been shown to be a fast, robust, and objective means for assessing radiographic image quality. The method reduces the burden of manual measurements and provides a means by which to monitor and compare radiographic system performance.

60 APPLIED LIFE SCIENCES↗

Comparison of Polarized Radiative Transfer Codes Used by the EHT Collaboration

Interpretation of resolved polarized images of black holes by the Event Horizon Telescope (EHT) requires predictions of the polarized emission observable by an Earth-based instrument for a particular model of the black hole accretion system. Such predictions are generated by general relativistic radiative transfer (GRRT) codes, which integrate the equations of polarized radiative transfer in curved spacetime. A selection of ray-tracing GRRT codes used within the EHT Collaboration is evaluated for accuracy and consistency in producing a selection of test images, demonstrating that the various methods and implementations of radiative transfer calculations are highly consistent. When imaging an analytic accretion model, we find that all codes produce images similar within a pixel-wise normalized mean squared error (NMSE) of 0.012 in the worst case. When imaging a snapshot from a cell-based magnetohydrodynamic simulation, we find all test images to be similar within NMSEs of 0.02, 0.04, 0.04, and 0.12 in Stokes I , Q , U , and V , respectively. We additionally find the values of several image metrics relevant to published EHT results to be in agreement to much better precision than measurement uncertainties.

79 ASTRONOMY AND ASTROPHYSICS↗

TU-AB-BRA-06: BEST IN PHYSICS (JOINT IMAGING-THERAPY): An MRI Compatible Externally and Internally Deformable Lung Motion Phantom for Multi-Modality IGRT

Purpose: MRI has become an attractive tool for tumor motion management. Current MR-compatible phantoms are only capable of reproducing translational motion. This study describes the construction and validation of a more realistic, MRI-compatible lung phantom that is deformable internally as well as externally. We demonstrate a radiotherapy application of this phantom by validating the geometric accuracy of the open-source deformable image registration software NiftyReg (UCL, UK). Methods: The outer shell of a commercially-available dynamic breathing torso phantom was filled with natural latex foam with eleven water tubes. A rigid foam cut-out served as the diaphragm. A high-precision programmable, in-house, MRI-compatible motion platform was used to drive the diaphragm. The phantom was imaged on a 3T scanner (Philips, Ingenia). Twenty seven tumor traces previously recorded from lung cancer patients were programmed into the phantom and 2D+t image sequences were acquired using a sparse-sampling sequence k-t BLAST (accn=3, resolution=0.66×0.66×5mm3; acquisition-time=110ms/slice). The geometric fidelity of the MRI-derived trajectories was validated against those obtained via fluoroscopy using the on board kV imager on a Truebeam linac. NiftyReg was used to perform frame by frame deformable image registration. The location of each marker predicted by using NiftyReg was compared with the values calculated by intensity-based segmentation on each frame. Results: In all cases, MR trajectories were within 1 mm of corresponding fluoroscopy trajectories. RMSE between centroid positions obtained from segmentation with those obtained by NiftyReg varies from 0.1 to 0.21 mm in the SI direction and 0.08 to 0.13 mm in the LR direction showing the high accuracy of deformable registration. Conclusion: We have successfully designed and demonstrated a phantom that can accurately reproduce deformable motion under a variety of imaging modalities including MRI, CT and x-ray fluodoscopy, making it an invaluable research tool for validating novel motion management strategies. This work was partially supported through research funding from National Institutes of Health (R01CA169102).

60 APPLIED LIFE SCIENCES↗

WE-G-BRD-07: Automated MR Image Standardization and Auto-Contouring Strategy for MRI-Based Adaptive Brachytherapy for Cervix Cancer

Purpose: MRI-based adaptive brachytherapy (ABT) is an emerging treatment modality for patients with gynecological tumors. However, MR image intensity non-uniformities (IINU) can vary from fraction to fraction, complicating image interpretation and auto-contouring accuracy. We demonstrate here an automated MR image standardization and auto-contouring strategy for MRI-based ABT of cervix cancer. Methods: MR image standardization consisted of: 1) IINU correction using the MNI N3 algorithm, 2) noise filtering using anisotropic diffusion, and 3) signal intensity normalization using the volumetric median. This post-processing chain was implemented as a series of custom Matlab and Java extensions in MIM (v6.4.5, MIM Software) and was applied to 3D T2 SPACE images of six patients undergoing MRI-based ABT at 3T. Coefficients of variation (CV=σ/µ) were calculated for both original and standardized images and compared using Mann-Whitney tests. Patient-specific cumulative MR atlases of bladder, rectum, and sigmoid contours were constructed throughout ABT, using original and standardized MR images from all previous ABT fractions. Auto-contouring was performed in MIM two ways: 1) best-match of one atlas image to the daily MR image, 2) multi-match of all previous fraction atlas images to the daily MR image. Dice’s Similarity Coefficients (DSCs) were calculated for auto-generated contours relative to reference contours for both original and standardized MR images and compared using Mann-Whitney tests. Results: Significant improvements in CV were detected following MR image standardization (p=0.0043), demonstrating an improvement in MR image uniformity. DSCs consistently increased for auto-contoured bladder, rectum, and sigmoid following MR image standardization, with the highest DSCs detected when the combination of MR image standardization and multi-match cumulative atlas-based auto-contouring was utilized. Conclusion: MR image standardization significantly improves MR image uniformity. The combination of MR image standardization and multi-match cumulative atlas-based auto-contouring produced the highest DSCs and is a promising strategy for MRI-based ABT for cervix cancer.

60 APPLIED LIFE SCIENCES↗

SU-E-T-624: Portal Dosimetry Commissioning of Multiple (6) Varian TrueBeam Linacs Equipped with PortalVision DMI MV Imager

Purpose: To show that a single model for Portal Domisetry (PD) can be established for beam-matched TrueBeam™ linacs that are equipped with the DMI imager (43×43cm effective area). Methods: Our department acquired 6 new TrueBeam™s, 4 “Slim” and 2 “Edge” models. The Slims were equipped with 6 and 10MV photons, and the Edges with 6MV. MLCs differed between the Slims and Edges (Millennium 120 vs HD-MLC respectively). PD model was created from data acquired using a single linac (Slim). This includes maximum field size profile, as well as output factors and acquired measured fluence using the DMI imager. All identical linacs were beam-matched, profiles were within 1% at maximum field size at a variety of depths. The profile correction file was generated from 40×40 profile acquired at 5cm depth, 95cm SSD, and was adjusted for deviation at the field edges and corners. The PD model and profile correction was applied to all six TrueBeam™s and imagers. A variety of jaw only and sliding window (SW) MLC test fields, as well as TG-119 and clinical SW and VMAT plans were run on each linac to validate the model. Results: For 6X and 10X, field by field comparison using 3mm/3% absolute gamma criteria passed 90% or better for all cases. This was also true for composite comparisons of TG-199 and clinical plans, matching our current department criteria. Conclusion: Using a single model per photon energy for PD for the TrueBeam™ equipped with a DMI imager can produce clinically acceptable results across multiple identical and matched linacs. It is also possible to use the same PD model despite different MLCs. This can save time during commissioning and software updates.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗

MO-FG-202-01: A Fast Yet Sensitive EPID-Based Real-Time Treatment Verification System

Purpose: To create a real-time EPID-based treatment verification system which robustly detects treatment delivery and patient attenuation variations. Methods: Treatment plan DICOM files sent to the record-and-verify system are captured and utilized to predict EPID images for each planned control point using a modified GPU-based digitally reconstructed radiograph algorithm which accounts for the patient attenuation, source energy fluence, source size effects, and MLC attenuation. The DICOM and predicted images are utilized by our C++ treatment verification software which compares EPID acquired 1024×768 resolution frames acquired at ∼8.5hz from Varian Truebeam™ system. To maximize detection sensitivity, image comparisons determine (1) if radiation exists outside of the desired treatment field; (2) if radiation is lacking inside the treatment field; (3) if translations, rotations, and magnifications of the image are within tolerance. Acquisition was tested with known test fields and prior patient fields. Error detection was tested in real-time and utilizing images acquired during treatment with another system. Results: The computational time of the prediction algorithms, for a patient plan with 350 control points and 60×60×42cm^3 CT volume, is 2–3minutes on CPU and <27 seconds on GPU for 1024×768 images. The verification software requires a maximum of ∼9ms and ∼19ms for 512×384 and 1024×768 resolution images, respectively, to perform image analysis and dosimetric validations. Typical variations in geometric parameters between reference and the measured images are 0.32°for gantry rotation, 1.006 for scaling factor, and 0.67mm for translation. For excess out-of-field/missing in-field fluence, with masks extending 1mm (at isocenter) from the detected aperture edge, the average total in-field area missing EPID fluence was 1.5mm2 the out-of-field excess EPID fluence was 8mm^2, both below error tolerances. Conclusion: A real-time verification software, with EPID images prediction algorithm, was developed. The system is capable of performing verifications between frames acquisitions and identifying source(s) of any out-of-tolerance variations. This work was supported in part by Varian Medical Systems.

60 APPLIED LIFE SCIENCES↗

Development of a video image-based QA system for the positional accuracy of dynamic tumor tracking irradiation in the Vero4DRT system

Purpose: To develop and evaluate a new video image-based QA system, including in-house software, that can display a tracking state visually and quantify the positional accuracy of dynamic tumor tracking irradiation in the Vero4DRT system. Methods: Sixteen trajectories in six patients with pulmonary cancer were obtained with the ExacTrac in the Vero4DRT system. Motion data in the cranio–caudal direction (Y direction) were used as the input for a programmable motion table (Quasar). A target phantom was placed on the motion table, which was placed on the 2D ionization chamber array (MatriXX). Then, the 4D modeling procedure was performed on the target phantom during a reproduction of the patient’s tumor motion. A substitute target with the patient’s tumor motion was irradiated with 6-MV x-rays under the surrogate infrared system. The 2D dose images obtained from the MatriXX (33 frames/s; 40 s) were exported to in-house video-image analyzing software. The absolute differences in the Y direction between the center of the exposed target and the center of the exposed field were calculated. Positional errors were observed. The authors’ QA results were compared to 4D modeling function errors and gimbal motion errors obtained from log analyses in the ExacTrac to verify the accuracy of their QA system. The patients’ tumor motions were evaluated in the wave forms, and the peak-to-peak distances were also measured to verify their reproducibility. Results: Thirteen of sixteen trajectories (81.3%) were successfully reproduced with Quasar. The peak-to-peak distances ranged from 2.7 to 29.0 mm. Three trajectories (18.7%) were not successfully reproduced due to the limited motions of the Quasar. Thus, 13 of 16 trajectories were summarized. The mean number of video images used for analysis was 1156. The positional errors (absolute mean difference + 2 standard deviation) ranged from 0.54 to 1.55 mm. The error values differed by less than 1 mm from 4D modeling function errors and gimbal motion errors in the ExacTrac log analyses (n = 13). Conclusions: The newly developed video image-based QA system, including in-house software, can analyze more than a thousand images (33 frames/s). Positional errors are approximately equivalent to those in ExacTrac log analyses. This system is useful for the visual illustration of the progress of the tracking state and for the quantification of positional accuracy during dynamic tumor tracking irradiation in the Vero4DRT system.

60 APPLIED LIFE SCIENCES↗

MIRC-X: A Highly Sensitive Six-telescope Interferometric Imager at the CHARA Array

Michigan InfraRed Combiner-eXeter (MIRC-X) is a new highly sensitive six-telescope interferometric imager installed at the CHARA Array that provides an angular resolution equivalent of up to a 330 m diameter baseline telescope in J- and H-band wavelengths ((λ/(2B))∼0.6 mas). We upgraded the original Michigan InfraRed Combiner (MIRC) instrument to improve sensitivity and wavelength coverage in two phases. First, a revolutionary sub-electron noise and fast-frame-rate C-RED ONE camera based on an SAPHIRA detector was installed. Second, a new-generation beam combiner was designed and commissioned to (i) maximize sensitivity, (ii) extend the wavelength coverage to J band, and (iii) enable polarization observations. A low-latency and fast-frame-rate control software enables high-efficiency observations and fringe tracking for the forthcoming instruments of the CHARA Array. Since mid-2017, MIRC-X has been offered to the community and has demonstrated best-case H-band sensitivity down to 8.2 correlated magnitude. MIRC-X uses single-mode fibers to coherently combine the light from six telescopes simultaneously with an image-plane combination scheme and delivers a visibility precision better than 1%, and closure phase precision better than 1°. MIRC-X aims at (i) imaging protoplanetary disks, (ii) detecting exoplanets with precise astrometry, and (iii) imaging stellar surfaces and starspots at an unprecedented angular resolution in the near-infrared. In this paper, we present the instrument design, installation, operation, and on-sky results, and demonstrate the imaging capability of MIRC-X on the binary system ι Peg. The purpose of this paper is to provide a solid reference for studies based on MIRC-X data and to inspire future instruments in optical interferometry.

79 ASTRONOMY AND ASTROPHYSICS↗