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At least 433 records · Page 24

WE-FG-202-12: Investigation of Longitudinal Salivary Gland DCE-MRI Changes

Purpose: To determine the correlation between dose and changes through treatment in dynamic contrast enhanced (DCE) MRI voxel parameters (Ktrans, kep, Ve, and Vp) within salivary glands of head and neck oropharyngeal squamous cell carcinoma (HNSCC) patients. Methods: 17 HNSCC patients treated with definitive radiation therapy completed DCE-MRI scans on a 3T scanner at pre-treatment, mid-treatment, and post-treatment time points. Mid-treatment and post-treatment DCE images were deformably registered to pre-treatment DCE images (Velocity software package). Pharmacokinetic analysis of the DCE images used a modified Tofts model to produce parameter maps with an arterial input function selected from each patient’s perivertebral space on the image (NordicICE software package). In-house software was developed for voxel-by-voxel longitudinal analysis of the salivary glands within the registered images. The planning CT was rigidly registered to the pre-treatment DCE image to obtain dose values in each voxel. Voxels within the lower and upper dose quartiles for each gland were averaged for each patient, then an average of the patients’ means for the two quartiles were compared. Dose-relationships were also assessed by Spearman correlations between dose and voxel parameter changes for each patient’s gland. Results: Changes in parameters’ means between time points were observed, but inter-patient variability was high. Ve of the parotid was the only parameter that had a consistently significant longitudinal difference between dose quartiles. The highest Spearman correlation was Vp of the sublingual gland for the change in the pre-treatment to mid-treatment values with only a ρ=0.29. Conclusion: In this preliminary study, there was large inter-patient variability in the changes of DCE voxel parameters with no clear relationship with dose. Additional patients may reduce the uncertainties and allow for the determination of the existence of parameter and dose relationships.

60 APPLIED LIFE SCIENCES↗

SU-E-T-455: Impact of Different Independent Dose Verification Software Programs for Secondary Check

Purpose: There have been many reports for different dose calculation algorithms for treatment planning system (TPS). Independent dose verification program (IndpPro) is essential to verify clinical plans from the TPS. However, the accuracy of different independent dose verification programs was not evident. We conducted a multi-institutional study to reveal the impact of different IndpPros using different TPSs. Methods: Three institutes participated in this study. They used two different IndpPros (RADCALC and Simple MU Analysis (SMU), which implemented the Clarkson algorithm. RADCALC needed the input of radiological path length (RPL) computed by the TPSs (Eclipse or Pinnacle3). SMU used CT images to compute the RPL independently from TPS). An ion-chamber measurement in water-equivalent phantom was performed to evaluate the accuracy of two IndpPros and the TPS in each institute. Next, the accuracy of dose calculation using the two IndpPros compared to TPS was assessed in clinical plan. Results: The accuracy of IndpPros and the TPSs in the homogenous phantom was +/−1% variation to the measurement. 1543 treatment fields were collected from the patients treated in the institutes. The RADCALC showed better accuracy (0.9 ± 2.2 %) than the SMU (1.7 ± 2.1 %). However, the accuracy was dependent on the TPS (Eclipse: 0.5%, Pinnacle3: 1.0%). The accuracy of RADCALC with Eclipse was similar to that of SMU in one of the institute. Conclusion: Depending on independent dose verification program, the accuracy shows systematic dose accuracy variation even though the measurement comparison showed a similar variation. The variation was affected by radiological path length calculation. IndpPro with Pinnacle3 has different variation because Pinnacle3 computed the RPL using physical density. Eclipse and SMU uses electron density, though.

60 APPLIED LIFE SCIENCES↗

SU-F-T-169: A Periodic Quality Assurance Program for a Spot-Scanning Proton Treatment Facility

Purpose: To develop daily and monthly quality assurance (QA) programs in support of a new spot-scanning proton treatment facility using a combination of commercial and custom equipment and software. Emphasis was placed on efficiency and evaluation of key quality parameters. Methods: The daily QA program was developed to test output, spot size and position, proton beam energy, and image guidance using the Sun Nuclear Corporation rf-DQA™3 device and Atlas QA software. The program utilizes standard Atlas linear accelerator tests repurposed for proton measurements and a custom jig for indexing the device to the treatment couch. The monthly QA program was designed to test mechanical performance, image quality, radiation quality, isocenter coincidence, and safety features. Many of these tests are similar to linear accelerator QA counterparts, but many require customized test design and equipment. Coincidence of imaging, laser marker, mechanical, and radiation isocenters, for instance, is verified using a custom film-based device devised and manufactured at our facility. Proton spot size and position as a function of energy are verified using a custom spot pattern incident on film and analysis software developed in-house. More details concerning the equipment and software developed for monthly QA are included in the supporting document. Thresholds for daily and monthly tests were established via perturbation analysis, early experience, and/or proton system specifications and associated acceptance test results. Results: The periodic QA program described here has been in effect for approximately 9 months and has proven efficient and sensitive to sub-clinical variations in treatment delivery characteristics. Conclusion: Tools and professional guidelines for periodic proton system QA are not as well developed as their photon and electron counterparts. The program described here efficiently evaluates key quality parameters and, while specific to the needs of our facility, could be readily adapted to other proton centers.

60 APPLIED LIFE SCIENCES↗

SU-E-J-232: Feasibility of MRI-Based Preplan On Low Dose Rate Prostate Brachytherapy

Purpose: To investigate the feasibility of using MRI-based preplan for low dose rate prostate brachytherapy. Methods: 12 patients who received transrectal ultrasound (TRUS) guided prostate brachytherapy with Pd-103 were retrospectively studied. Our care-standard of the TRUS-based preplan served as the control. One or more prostate T2-weighted wide and/or narrow-field of view MRIs obtained within the 3 months prior to the implant were imported into the MIM Symphony software v6.3 (MIM Software Inc., Cleveland, OH) for each patient. In total, 37 MRI preplans (10 different image sequences with average thickness of 4.8mm) were generated. The contoured prostate volume and the seed counts required to achieve adequate dosimetric coverage from TRUS and MRI preplans were compared for each patient. The effects of different MRI sequences and image thicknesses were also investigated statistically using Student’s t-test. Lastly, the nomogram from the MRI preplan and TRUS preplan from our historical treatment data were compared. Results: The average prostate volume contoured on the TRUS and MRI were 26.6cc (range: 12.6∼41.3cc), and 27.4 cc (range: 14.3∼50.0cc), respectively. Axial MRI thicknesses (range: 3.5∼8.1mm) did not significantly affect the contoured volume or the number of seeds required on the preplan (R2 = 0.0002 and 0.0012, respectively). Four of the MRI sequences (AX-T2, AX-T2-Whole-Pelvis, AX-T2-FSE, and AXIALT2- Hi-Res) showed statistically significant better prostate volume agreement with TRUS than the other seven sequences (P <0.01). Nomogram overlay between the MRI and TRUS preplans showed good agreement; indicating volumes contoured on MRI preplan scan reliably predict how many seeds are needed for implant. Conclusion: Although MRI does not allow for determination of the actual implant geometry, it can give reliable volumes for seed ordering purposes. Our future work will investigate if MRI is sufficient to reliably replace TRUS preplanning in patients where preplan TRUS may be technically challenging.

60 APPLIED LIFE SCIENCES↗

SU-E-J-107: The Impact of the Tumor Location to Deformable Image Registration

Purpose: For four-dimensional planning and adaptive radiotherapy, the accuracy of deformable image registration (DIR) is essential. We evaluated the accuracy of an in-house program with the free-downloadable DIR software library package (NiftyReg) and two commercially available DIR software programs (MIM Maestro and Velocity AI) in lung SBRT cancer patients. In addition to it, the relationship between the tumor location and the accuracy of the DIRs was investigated. Methods: The free-form deformation was implemented in the in-house program and the MIM. The Velocity was based on the B-spline algorithm. The accuracy of the three programs was evaluated in comparison for the structures on 4DCT image datasets between at the peak-inhale and at the peak-exhale. The dice similarity coefficient (DSC) and normalized DSC (NDSC) were measured for the gross tumor volumes from 19 lung SBRT patients. Results: The DSC measurement showed the median values of the DSC were 0.885, 0.872 and 0.798 for the In-house program, the MIM and the Velocity, respectively. The Velocity showed significant difference compared to the others. The median NDSC values were 1.027, 1.005 and 0.946 for the In-house, the MIM and the Velocity, respectively. This indicated that the spatial overlap agreement between the reference and the deformed structure for the in-house and MIM was comparable with the accuracy within 1mm uncertainty. There was larger discrepancy within 1–2mm uncertainty for the Velocity. The In-house and the MIM showed the higher NDSC values than the median values when the GTV was not attached to the chest wall and diaphragm(p < 0.05). However, there is no relationship between the accuracy and the tumor location in the Velocity. Conclusion: The difference of the DIR program would affect different accuracy and the accuracy may be reduced when the tumor is located or attached to chest wall or diaphragm.

60 APPLIED LIFE SCIENCES↗

SU-F-J-110: MRI-Guided Single-Session Simulation, Online Adaptation, and Treatment

Purpose: To develop a combined simulation and treatment workflow for MRI-guided radiation therapy using the ViewRay treatment planning and delivery system. Methods: Several features of the ViewRay MRIdian planning and treatment workflows are used to simulate and treat patients that require emergent radiotherapy. A simple “pre-plan” is created on diagnostic imaging retrieved from radiology PACS, where conformal fields are created to target a volume defined by a physician based on review of the diagnostic images and chart notes. After initial consult in radiation oncology, the patient is brought to the treatment room, immobilized, and imaged in treatment position with a volumetric MR. While the patient rests on the table, the pre-plan is applied to the treatment planning MR and dose is calculated in the treatment geometry. After physician review, modification of the plan may include updating the target definition, redefining fields, or re-balancing beam weights. Once an acceptable treatment plan is finalized and approved, the patient is treated. Results: Careful preparation and judicious choices in the online planning process allow conformal treatment plans to be created and delivered in a single, thirty-minute session. Several advantages have been identified using this process as compared to conventional urgent CT simulation and delivery. Efficiency gains are notable, as physicians appreciate the predictable time commitment and patient waiting time for treatment is decreased. MR guidance in a treatment position offers both enhanced contrast for target delineation and reduction of setup uncertainties. The MRIdian system tools designed for adaptive radiotherapy are particularly useful, enabling plan changes to be made in minutes. Finally, the resulting plans, typically 6 conformal beams, are delivered as quickly as more conventional AP/PA beam arrangements with comparatively superior dose distributions. Conclusion: The ViewRay treatment planning software and delivery system can accommodate a fast simulation and treatment workflow.

60 APPLIED LIFE SCIENCES↗

Source strength verification and quality assurance of preloaded brachytherapy needles using a CMOS flat panel detector

Purpose: Current methods of low dose rate brachytherapy source strength verification for sources preloaded into needles consist of either assaying a small number of seeds from a separate sample belonging to the same lot used to load the needles or performing batch assays of a subset of the preloaded seed trains. Both of these methods are cumbersome and have the limitations inherent to sampling. The purpose of this work was to investigate an alternative approach that uses an image-based, autoradiographic system capable of the rapid and complete assay of all sources without compromising sterility. Methods: The system consists of a flat panel image detector, an autoclavable needle holder, and software to analyze the detected signals. The needle holder was designed to maintain a fixed vertical spacing between the needles and the image detector, and to collimate the emissions from each seed. It also provides a sterile barrier between the needles and the imager. The image detector has a sufficiently large image capture area to allow several needles to be analyzed simultaneously.Several tests were performed to assess the accuracy and reproducibility of source strengths obtained using this system. Three different seed models (Oncura 6711 and 9011 {sup 125}I seeds, and IsoAid Advantage {sup 103}Pd seeds) were used in the evaluations. Seeds were loaded into trains with at least 1 cm spacing. Results: Using our system, it was possible to obtain linear calibration curves with coverage factor k = 1 prediction intervals of less than ±2% near the centre of their range for the three source models. The uncertainty budget calculated from a combination of type A and type B estimates of potential sources of error was somewhat larger, yielding (k = 1) combined uncertainties for individual seed readings of 6.2% for {sup 125}I 6711 seeds, 4.7% for {sup 125}I 9011 seeds, and 11.0% for Advantage {sup 103}Pd seeds. Conclusions: This study showed that a flat panel detector dosimetry system is a viable option for source strength verification in preloaded needles, as it is capable of measuring all of the sources intended for implantation. Such a system has the potential to directly and efficiently estimate individual source strengths, the overall mean source strength, and the positions within the seed-spacer train.

60 APPLIED LIFE SCIENCES↗

Reduced dose measurement of absolute myocardial blood flow using dynamic SPECT imaging in a porcine model

Purpose: Absolute myocardial blood flow (MBF) and myocardial flow reserve (MFR) measurements provide important additional information over traditional relative perfusion imaging. Recent advances in camera technology have made this possible with single-photon emission tomography (SPECT). Low dose protocols are desirable to reduce the patient radiation risk; however, increased noise may reduce the accuracy of MBF measurements. The authors studied the effect of reducing dose on the accuracy of dynamic SPECT MBF measurements. Methods: Nineteen 30–40 kg pigs were injected with 370 + 1110 MBq of Tc-99m sestamibi or tetrofosmin or 37 + 111 MBq of Tl-201 at rest + stress. Microspheres were injected simultaneously to measure MBF. The pigs were imaged in list-mode for 11 min starting at the time of injection using a Discovery NM 530c camera (GE Healthcare). Each list file was modified so that 3/4, 1/2, 1/4, 1/8, 1/16, and 1/32 of the original counts were included in the projections. Modified projections were reconstructed with CT-based attenuation correction and an energy window-based scatter correction and analyzed with FlowQuant kinetic modeling software using a 1-compartment model. A modified Renkin-Crone extraction function was used to convert the tracer uptake rate K1 to MBF values. The SPECT results were compared to those from microspheres. Results: Correlation between SPECT and microsphere MBF values for the full injected activity was r ≥ 0.75 for all 3 tracers and did not significantly degrade over all count levels. The mean MBF and MFR and the standard errors in the estimates were not significantly worse than the full-count data at 1/4-counts (Tc99m-tracers) and 1/2-counts (Tl-201). Conclusions: Dynamic SPECT measurement of MBF and MFR in pigs can be performed with 1/4 (Tc99m-tracers) or 1/2 (Tl-201) of the standard injected activity without significantly reducing accuracy and precision.

60 APPLIED LIFE SCIENCES↗

SU-F-J-166: Volumetric Spatial Distortions Comparison for 1.5 Tesla Versus 3 Tesla MRI for Gamma Knife Radiosurgery Scans Using Frame Marker Fusion and Co-Registration Modes

Purpose: To compare typical volumetric spatial distortions for 1.5 Tesla versus 3 Tesla MRI Gamma Knife radiosurgery scans in the frame marker fusion and co-registration frame-less modes. Methods: Quasar phantom by Modus Medical Devices Inc. with GRID image distortion software was used for measurements of volumetric distortions. 3D volumetric T1 weighted scans of the phantom were produced on 1.5 T Avanto and 3 T Skyra MRI Siemens scanners. The analysis was done two ways: for scans with localizer markers from the Leksell frame and relatively to the phantom only (simulated co-registration technique). The phantom grid contained a total of 2002 vertices or control points that were used in the assessment of volumetric geometric distortion for all scans. Results: Volumetric mean absolute spatial deviations relatively to the frame localizer markers for 1.5 and 3 Tesla machine were: 1.39 ± 0.15 and 1.63 ± 0.28 mm with max errors of 1.86 and 2.65 mm correspondingly. Mean 2D errors from the Gamma Plan were 0.3 and 1.0 mm. For simulated co-registration technique the volumetric mean absolute spatial deviations relatively to the phantom for 1.5 and 3 Tesla machine were: 0.36 ± 0.08 and 0.62 ± 0.13 mm with max errors of 0.57 and 1.22 mm correspondingly. Conclusion: Volumetric spatial distortions are lower for 1.5 Tesla versus 3 Tesla MRI machines localized with markers on frames and significantly lower for co-registration techniques with no frame localization. The results show the advantage of using co-registration technique for minimizing MRI volumetric spatial distortions which can be especially important for steep dose gradient fields typically used in Gamma Knife radiosurgery. Consultant for Elekta AB.

60 APPLIED LIFE SCIENCES↗

SU-E-J-173: Evaluation of Deformable Registration for Correcting Respiratory Motion in 4DCT Lung Images

Purpose: Deformable Image Registration (DIR) is gaining wider clinical acceptance in radiation oncology. The aim of this work is to characterise a DIR algorithm on publically available 4DCT lung images, such that comparison can be performed against other algorithms. We propose an evaluation method of registration accuracy that takes into account the initial misregistration of the datasets. Methods: The “DIR Validation dataset” ( http://www.creatis.insa-lyon.fr/rio/dir{sub v}alidation{sub d}ata ) provides benchmark data for evaluating 3D CT registration algorithms. It consists of six 4DCT lung datasets (1x1x2mm resolution) with 100 landmarks identified on the end-exhalation and end-inhalation phases. Images were registered to end-inhalation using proprietary form of optical flow in commercial software (Mirada RTx, Mirada Medical, UK). Target registration error was measured before and after DIR, referred to as Initial Registration Error (IRE) and Final Registration Error (FRE). Results: The mean FRE over all landmarks was 1.37±1.81mm. FRE increased with IRE. Mean FRE of 0.86, 0.86, 1.53, 3.38, 4.45, 7.58mm was observed for IRE in the ranges 0–5, 5–10, 10–15, 15–20, 20–25, >25 mm. Higher FRE was observed at the inferior lung, where IRE was greater. Out-of-plane motion contributed more to IRE, and therefore to FRE. Maximum FRE of 20.6mm was observed for IRE of 32.1mm, located at the posterior of the middle lobe for dataset 2. Sub-voxel registration accuracy was achieved for up to 10mm IRE, and increased linearly at 0.3mm FRE/mm IRE thereafter. Conclusion: Publicly available clinical datasets enable algorithms to be compared objectively between publications. However, only reporting average TRE after registration can be misleading as the ability of an algorithm to correct for displacements varies with the IRE or position within the patient. Consequently, algorithms should be characterized using the entire range of initial displacements. For the algorithm assessed, clinically acceptable error within one voxel was achieved for IRE of up to 15mm. TK, AL, and MG are employees of Mirada Medical.

60 APPLIED LIFE SCIENCES↗

MO-F-CAMPUS-I-01: Accuracy of Radiologists Interpretation of Mammographic Breast Density

Purpose: Several commercial and non-commercial software and techniques are available for determining breast density from mammograms. However, where mandated by law the breast density information communicated to the subject/patient is based on radiologist’s interpretation of breast density from mammograms. Several studies have reported on the concordance among radiologists in interpreting mammographic breast density. In this work, we investigated the accuracy of radiologist’s interpretation of breast density. Methods: Volumetric breast density (VBD) determined from 134 unilateral dedicated breast CT scans from 134 subjects was considered the truth. An MQSA-qualified study radiologist with more than 20 years of breast imaging experience reviewed the DICOM “for presentation” standard 2-view mammograms of the corresponding breasts and assigned BIRADS breast density categories. For statistical analysis, the breast density categories were dichotomized in two ways; fatty vs. dense breasts where “fatty” corresponds to BIRADS breast density categories A/B, and “dense” corresponds to BIRADS breast density categories C/D, and extremely dense vs. fatty to heterogeneously dense breasts, where extremely dense corresponds to BIRADS breast density category D and BIRADS breast density categories A through C were grouped as fatty to heterogeneously dense breasts. Logistic regression models (SAS 9.3) were used to determine the association between radiologist’s interpretation of breast density and VBD from breast CT, from which the area under the ROC (AUC) was determined. Results: Both logistic regression models were statistically significant (Likelihood Ratio test, p<0.0001). The accuracy (AUC) of the study radiologist for classification of fatty vs. dense breasts was 88.4% (95% CI: 83–94%) and for classification of extremely dense breast was 94.3% (95% CI: 90–98%). Conclusion: The accuracy of the radiologist in classifying dense and extremely dense breasts is high. Considering the variability in VBD estimates from commercial software, the breast density information communicated to the patient should be based on radiologist’s interpretation. This work was supported in part by NIH R21 CA176470 and R21 CA134128. The contents are solely the responsibility of the authors and do not reflect the official views of the NIH or NCI.

60 APPLIED LIFE SCIENCES↗

SU-E-T-164: Characterization of Breast Deformation During Accuboost TM Treatment

Purpose: During treatment using AccuboostTM (Advanced Radiation Therapy, Tyngsboro, MA) applicators the breast is compressed between two paddles in order to immobilize it. This causes the breast tissue to expand. The purpose of this study was to analyze the nature of this deformation. Methods: CT scans of a breast phantom (Computerized Imaging Reference Systems, Norfolk, VA) were acquired at different compressions in the cranial-caudal (CC) direction. These were performed by placing the phantom between two plates whose position is controlled by a manual crank. The phantom masses were contoured in order to simulate the clips placed after surgery. For all scans the mean distance between the masses was computed. Additionally, deformable registration was performed between two scans using the Velocity software (Varian Medical Systems, Palo Alto, CA) to assess the shifts of each of these masses. Results: As the compression increases so does the average distance between the masses. The relationship between deformation and compression is not linear. Additionally, the largest displacements are in the direction of compression. The mean shift is 1.8mm. The shifts in the RT-LT direction and ANT-POST direction are 1.1 mm and 0.7 mm respectively Conclusion: When treating patients the clips shift their position as a Result of the plate compression. For CC compressions this is not a problem if they shift their position primarily in the superior-inferior direction. The problem of not being able to cover all clips (target area) can arise when they shift position on a plane perpendicular to the patient. For clips which are already near the chest wall, care should be exercised not to compress the breast in such a way as to move those clips out of the treatable area.These preliminary results show a larger shift in the RT-LT direction than the ANT-POST one. Further research will seek to either confirm or infirm this.

60 APPLIED LIFE SCIENCES↗

SU-E-J-86: Functional Conformal Planning for Stereotactic Body Radiation Therapy with CT-Pulmonary Ventilation Imaging

Purpose: To evaluate the functional planning using CT-pulmonary ventilation imaging for conformal SBRT. Methods: The CT-pulmonary ventilation image was generated using the Jacobian metric in the in-house program with the NiftyReg software package. Using the ventilation image, the normal lung was split into three lung regions for functionality (high, moderate and low). The anatomical plan (AP) and functional plan (FP) were made for ten lung SBRT patients. For the AP, the beam angles were optimized with the dose-volume constraints for the normal lung sparing and the PTV coverage. For the FP, the gantry angles were also optimized with the additional constraint for high functional lung. The MLC aperture shapes were adjusted to the PTV with the additional 5 mm margin. The dosimetric parameters for PTV, the functional volumes, spinal cord and so on were compared in both plans. Results: Compared to the AP, the FP showed better dose sparing for high- and moderate-functional lungs with similar PTV coverage while not taking care of the low functional lung (High:−12.9±9.26% Moderate: −2.0±7.09%, Low: +4.1±12.2%). For the other normal organs, the FP and AP showed similar dose sparing in the eight patients. However, the FP showed that the maximum doses for spinal cord were increased with the significant increment of 16.4Gy and 21.0Gy in other two patients, respectively. Because the beam direction optimizer chose the unexpected directions passing through the spinal cord. Conclusion: Even the functional conformal SBRT can selectively reduce high- and moderatefunctional lung while keeping the PTV coverage. However, it would be careful that the optimizer would choose unexpected beam angles and the dose sparing for the other normal organs can be worse. Therefore, the planner needs to control the dose-volume constraints and also limit the beam angles in order to achieve the expected dose sparing and coverage.

60 APPLIED LIFE SCIENCES↗

WE-AB-BRA-08: Results of a Multi-Institutional Study for the Evaluation of Deformable Image Registration Algorithms for Structure Delineation Via Computational Phantoms

Purpose: To investigate the accuracy of various algorithms for deformable image registration (DIR), to propagate regions of interest (ROIs) in computational phantoms based on patient images using different commercial systems. This work is part of an Italian multi-institutional study to test on common datasets the accuracy, reproducibility and safety of DIR applications in Adaptive Radiotherapy. Methods: Eleven institutions with three available commercial solutions provided data to assess the agreement of DIR-propagated ROIs with automatically drown ROIs considered as ground-truth for the comparison. The DIR algorithms were tested on real patient data from three different anatomical districts: head and neck, thorax and pelvis. For every dataset two specific Deformation Vector Fields (DVFs) provided by ImSimQA software were applied to the reference data set. Three different commercial software were used in this study: RayStation, Velocity and Mirada. The DIR-mapped ROIs were then compared with the reference ROIs using the Jaccard Conformity Index (JCI). Results: More than 600 DIR-mapped ROIs were analyzed. Putting together all JCI data of all institutions for the first DVF, the mean JCI was 0.87 ± 0.7 (1 SD) while for the second DVF JCI was 0.8 ± 0.13 (1 SD). Several considerations on different structures are available from collected data: the standard deviation among different institutions on specific structure raise as the larger is the applied DVF. The higher value is 10% for bladder. Conclusion: Although the complexity of deformation of human body is very difficult to model, this work illustrates some clinical scenarios with well-known DVFs provided by specific software. CI parameter gives the inter-user variability and may put in evidence the need of improving the working protocol in order to reduce the inter-institution JCI variability.

60 APPLIED LIFE SCIENCES↗

Self-assessed performance improves statistical fusion of image labels

Purpose: Expert manual labeling is the gold standard for image segmentation, but this process is difficult, time-consuming, and prone to inter-individual differences. While fully automated methods have successfully targeted many anatomies, automated methods have not yet been developed for numerous essential structures (e.g., the internal structure of the spinal cord as seen on magnetic resonance imaging). Collaborative labeling is a new paradigm that offers a robust alternative that may realize both the throughput of automation and the guidance of experts. Yet, distributing manual labeling expertise across individuals and sites introduces potential human factors concerns (e.g., training, software usability) and statistical considerations (e.g., fusion of information, assessment of confidence, bias) that must be further explored. During the labeling process, it is simple to ask raters to self-assess the confidence of their labels, but this is rarely done and has not been previously quantitatively studied. Herein, the authors explore the utility of self-assessment in relation to automated assessment of rater performance in the context of statistical fusion. Methods: The authors conducted a study of 66 volumes manually labeled by 75 minimally trained human raters recruited from the university undergraduate population. Raters were given 15 min of training during which they were shown examples of correct segmentation, and the online segmentation tool was demonstrated. The volumes were labeled 2D slice-wise, and the slices were unordered. A self-assessed quality metric was produced by raters for each slice by marking a confidence bar superimposed on the slice. Volumes produced by both voting and statistical fusion algorithms were compared against a set of expert segmentations of the same volumes. Results: Labels for 8825 distinct slices were obtained. Simple majority voting resulted in statistically poorer performance than voting weighted by self-assessed performance. Statistical fusion resulted in statistically indistinguishable performance from self-assessed weighted voting. The authors developed a new theoretical basis for using self-assessed performance in the framework of statistical fusion and demonstrated that the combined sources of information (both statistical assessment and self-assessment) yielded statistically significant improvement over the methods considered separately. Conclusions: The authors present the first systematic characterization of self-assessed performance in manual labeling. The authors demonstrate that self-assessment and statistical fusion yield similar, but complementary, benefits for label fusion. Finally, the authors present a new theoretical basis for combining self-assessments with statistical label fusion.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Reconstruction and analysis of exploding wire particle trajectories via automatic calibration of stereo images

Quantitative understanding of the physics of dust or granular matter transport significantly impacts several aspects of burning plasma science and technology. Here, this work takes machine vision techniques popular in robotics and self-driving cars and applies them to identification and analysis of microparticles generated from exploding wires. Using only the image frames and knowledge of the intrinsic properties of the cameras, a Python code was written to identify the particles, automatically calibrate the relative image positions, and extract trajectory data. After identifying approximately 50 particles based on the timing of secondary particle explosions, the eight point and random sample consensus algorithms were used to determine the geometric correlation between the cameras. Over 100 particle matches were found between the two camera views. These correlated trajectories were used in subsequent 3D track reconstruction and analysis of the physics behind the particle motion. The 3D reconstruction resulted in accurate positioning of the particles with respect to the experimental setup. The particle motion was consistent with the effects of a 1 g gravitational field modified by drag forces. Lastly, the methods and analyses presented here can be used in many facets of high temperature plasma diagnostics.

70 PLASMA PHYSICS AND FUSION TECHNOLOGY↗

Electron-Beam Dynamics for an Advanced Flash-Radiography Accelerator

Beam dynamics issues were assessed for a new linear induction electron accelerator being designed for multipulse flash radiography of large explosively driven hydrodynamic experiments. Special attention was paid to equilibrium beam transport, possible emittance growth, and beam stability. Especially problematic would be high-frequency beam instabilities that could blur individual radiographic source spots, low-frequency beam motion that could cause pulse-to-pulse spot displacement, and emittance growth that could enlarge the source spots. Furthermore, beam physics issues were examined through theoretical analysis and computer simulations, including particle-in-cell codes. Beam instabilities investigated included beam breakup, image displacement, diocotron, parametric envelope, ion hose, and the resistive wall instability. The beam corkscrew motion and emittance growth from beam mismatch were also studied. It was concluded that a beam with radiographic quality equivalent to the present accelerators at Los Alamos National Laboratory will result if the same engineering standards and construction details are upheld.

43 PARTICLE ACCELERATORS↗

The 2-Year Cosmetic Outcome of a Randomized Trial Comparing Prone and Supine Whole-Breast Irradiation in Large-Breasted Women

Purpose: To report the 2-year cosmetic outcome of a randomized trial comparing prone and supine whole-breast irradiation in large-breasted patients. Methods and Materials: One hundred patients with a (European) cup size ≥C were included. Before and 2 years after radiation therapy, clinical endpoints were scored and digital photographs were taken with the arms alongside the body and with the arms elevated 180°. Three observers rated the photographs using the 4-point Harvard cosmesis scale. Cosmesis was also evaluated with the commercially available Breast Cancer Conservation Treatment.cosmetic results (BCCT.core) software. Results: Two-year follow-up data and photographs were available for 94 patients (47 supine treated and 47 prone treated). Patient and treatment characteristics were not significantly different between the 2 cohorts. A worsening of color change occurred more frequently in the supine than in the prone cohort (19/46 vs 10/46 patients, respectively, P=.04). Five patients in the prone group (11%) and 12 patients in the supine group (26%) presented with a worse scoring of edema at 2-year follow-up (P=.06). For retraction and fibrosis, no significant differences were found between the 2 cohorts, although scores were generally worse in the supine cohort. The cosmetic scoring by 3 observers did not reveal differences between the prone and supine groups. On the photographs with the hands up, 7 patients in the supine group versus none in the prone group had a worsening of cosmesis of 2 categories using the (BCCT.org) software (P=.02). Conclusion: With a limited follow-up of 2 years, better cosmetic outcome was observed in prone-treated than in supine-treated patients.

62 RADIOLOGY AND NUCLEAR MEDICINE↗