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Search indexed NASA NTRS and DOE OSTI research on propulsion, heat transfer, battery materials and energy systems. Follow report and document links to the original sources.

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DOE OSTI2014

SU-D-BRD-07: Automatic Patient Data Audit and Plan Quality Check to Support ARIA and Eclipse

Purpose: To ensure patient safety and treatment quality in RT departments that use Varian ARIA and Eclipse, we developed a computer software system and interface functions that allow previously developed electron chart checking (EcCk) methodologies to support these Varian systems. Methods: ARIA and Eclipse store most patient information in its MSSQL database. We studied the contents in the hundreds database tables and identified the data elements used for patient treatment management and treatment planning. Interface functions were developed in both c-sharp and MATLAB to support data access from ARIA and Eclipse servers using SQL queries. These functions and additional data processing functions allowed the existing rules and logics from EcCk to support ARIA and Eclipse. Dose and structure information are important for plan quality check, however they are not stored in the MSSQL database but as files in Varian private formats, and cannot be processed by external programs. We have therefore implemented a service program, which uses the DB Daemon and File Daemon services on ARIA server to automatically and seamlessly retrieve dose and structure data as DICOM files. This service was designed to 1) consistently monitor the data access requests from EcCk programs, 2) translate the requests for ARIA daemon services to obtain dose and structure DICOM files, and 3) monitor the process and return the obtained DICOM files back to EcCk programs for plan quality check purposes. Results: EcCk, which was previously designed to only support MOSAIQ TMS and Pinnacle TPS, can now support Varian ARIA and Eclipse. The new EcCk software has been tested and worked well in physics new start plan check, IMRT plan integrity and plan quality checks. Conclusion: Methods and computer programs have been implemented to allow EcCk to support Varian ARIA and Eclipse systems. This project was supported by a research grant from Varian Medical System.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-D-18A-02: Towards Real-Time On-Board Volumetric Image Reconstruction for Intrafraction Target Verification in Radiation Therapy

Purpose: To expedite on-board volumetric image reconstruction from limited-angle kV—MV projections for intrafraction verification. Methods: A limited-angle intrafraction verification (LIVE) system has recently been developed for real-time volumetric verification of moving targets, using limited-angle kV—MV projections. Currently, it is challenged by the intensive computational load of the prior-knowledge-based reconstruction method. To accelerate LIVE, we restructure the software pipeline to make it adaptable to model and algorithm parameter changes, while enabling efficient utilization of rapidly advancing, modern computer architectures. In particular, an innovative two-level parallelization scheme has been designed: At the macroscopic level, data and operations are adaptively partitioned, taking into account algorithmic parameters and the processing capacity or constraints of underlying hardware. The control and data flows of the pipeline are scheduled in such a way as to maximize operation concurrency and minimize total processing time. At the microscopic level, the partitioned functions act as independent modules, operating on data partitions in parallel. Each module is pre-parallelized and optimized for multi-core processors (CPUs) and graphics processing units (GPUs). Results: We present results from a parallel prototype, where most of the controls and module parallelization are carried out via Matlab and its Parallel Computing Toolbox. The reconstruction is 5 times faster on a data-set of twice the size, compared to recently reported results, without compromising on algorithmic optimization control. Conclusion: The prototype implementation and its results have served to assess the efficacy of our system concept. While a production implementation will yield much higher processing rates by approaching full-capacity utilization of CPUs and GPUs, some mutual constraints between algorithmic flow and architecture specifics remain. Based on a careful analysis of the prototype performance, it will be feasible to resolve such issues through appropriate algorithmic modifications or special-purpose hardware, thus enabling target verification in seconds with the LIVE system. This work was partially supported by a research grant from Varian Medical Systems.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗
DOE OSTI2014

SU-E-P-07: Evaluation of Productivity Systems for Radiation Therapy

Purpose: Health systems throughout the United States are under increased financial pressure to reduce operating cost. As a result, productivity models developed by third-party consultants are being used to optimize staff to treatment volumes. The purpose of this study was to critically evaluate productivity systems for radiation oncology. Methods: Staffing efficiency was evaluated using multiple productivity models. The first model evaluated staffing levels using equal weighting of procedure codes and hours worked. A second productivity model was developed using hours worked by job class and relative value units for each procedure code. A third model was developed using the measured procedure times extracted from the electronic medical record, which tracks the wait and treatment times for each patient for each treatment fraction. A MatLab program was developed to query and analyze the daily treatment data. A model was then created to determine any theoretical gains in treatment productivity. Results: Productivity was evaluated for six radiation therapy departments operating nine linear accelerators delivering over 40,000 treatment fractions per year. Third party productivity models that do not take into consideration the unique nature of radiation therapy can be counterproductive. For example, other outpatient departments can compress their daily schedule to decrease the worked hours. This approach was tested using the treatment schedule evaluation tool developed as part of this study. It was determined that the maximum possible savings for treatment schedule compression was $32,000 per year per linac. All annual cost savings would be lost if only two patients per year choose to be treated elsewhere because of limited or restricted appointment times. Conclusion: The use of productivity models in radiation therapy can easily result in a loss of treatment revenue that is greater than any potential cost savings in reduced hours worked by staff.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-I-02: A Framework to Perform Batch Simulations of Computational Voxel Phantoms to Study Organ Doses in Computed Tomography Using a Commercial Monte Carlo Software Package

Purpose: ImpactMC (CT Imaging, Erlangen, Germany) is a Monte Carlo (MC) software package that offers a GPU enabled, user definable and validated method for 3D dose distribution calculations for radiography and Computed Tomography (CT). ImpactMC, in and of itself, offers limited capabilities to perform batch simulations. The aim of this work was to develop a framework for the batch simulation of absorbed organ dose distributions from CT scans of computational voxel phantoms. Methods: The ICRP 110 adult Reference Male and Reference Female computational voxel phantoms were formatted into compatible input volumes for MC simulations. A Matlab (The MathWorks Inc., Natick, MA) script was written to loop through a user defined set of simulation parameters and 1) generate input files required for the simulation, 2) start the MC simulation, 3) segment the absorbed dose for organs in the simulated dose volume and 4) transfer the organ doses to a database. A demonstration of the framework is made where the glandular breast dose to the adult Reference Female phantom, for a typical Chest CT examination, is investigated. Results: A batch of 48 contiguous simulations was performed with variations in the total collimation and spiral pitch. The demonstration of the framework showed that the glandular dose to the right and left breast will vary depending on the start angle of rotation, total collimation and spiral pitch. Conclusion: The developed framework provides a robust and efficient approach to performing a large number of user defined MC simulations with computational voxel phantoms in CT (minimal user interaction). The resulting organ doses from each simulation can be accessed through a database which greatly increases the ease of analyzing the resulting organ doses. The framework developed in this work provides a valuable resource when investigating different dose optimization strategies in CT.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2014

SU-E-I-62: Assessing Radiation Dose Reduction and CT Image Optimization Through the Measurement and Analysis of the Detector Quantum Efficiency (DQE) of CT Images Using Different Beam Hardening Filters

Purpose: Reducing patient dose while maintaining (or even improving) image quality is one of the foremost goals in CT imaging. To this end, we consider the feasibility of optimizing CT scan protocols in conjunction with the application of different beam-hardening filtrations and assess this augmentation through noise-power spectrum (NPS) and detector quantum efficiency (DQE) analysis. Methods: American College of Radiology (ACR) and Catphan phantoms (The Phantom Laboratory) were scanned with a 64 slice CT scanner when additional filtration of thickness and composition (e.g., copper, nickel, tantalum, titanium, and tungsten) had been applied. A MATLAB-based code was employed to calculate the image of noise NPS. The Catphan Image Owl software suite was then used to compute the modulated transfer function (MTF) responses of the scanner. The DQE for each additional filter, including the inherent filtration, was then computed from these values. Finally, CT dose index (CTDIvol) values were obtained for each applied filtration through the use of a 100 mm pencil ionization chamber and CT dose phantom. Results: NPS, MTF, and DQE values were computed for each applied filtration and compared to the reference case of inherent beam-hardening filtration only. Results showed that the NPS values were reduced between 5 and 12% compared to inherent filtration case. Additionally, CTDIvol values were reduced between 15 and 27% depending on the composition of filtration applied. However, no noticeable changes in image contrast-to-noise ratios were noted. Conclusion: The reduction in the quanta noise section of the NPS profile found in this phantom-based study is encouraging. The reduction in both noise and dose through the application of beam-hardening filters is reflected in our phantom image quality. However, further investigation is needed to ascertain the applicability of this approach to reducing patient dose while maintaining diagnostically acceptable image qualities in a clinical setting.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗
DOE OSTI2014

SU-E-I-100: Heterogeneity Studying for Primary and Lymphoma Tumors by Using Multi-Scale Image Texture Analysis with PET-CT Images

Purpose: The purpose of this research is studying tumor heterogeneity of the primary and lymphoma by using multi-scale texture analysis with PET-CT images, where the tumor heterogeneity is expressed by texture features. Methods: Datasets were collected from 12 lung cancer patients, and both of primary and lymphoma tumors were detected with all these patients. All patients underwent whole-body 18F-FDG PET/CT scan before treatment.The regions of interest (ROI) of primary and lymphoma tumor were contoured by experienced clinical doctors. Then the ROI of primary and lymphoma tumor is extracted automatically by using Matlab software. According to the geometry size of contour structure, the images of tumor are decomposed by multi-scale method.Wavelet transform was performed on ROI structures within images by L layers sampling, and then wavelet sub-bands which have the same size of the original image are obtained. The number of sub-bands is 3L+1.The gray level co-occurrence matrix (GLCM) is calculated within different sub-bands, thenenergy, inertia, correlation and gray in-homogeneity were extracted from GLCM.Finally, heterogeneity statistical analysis was studied for primary and lymphoma tumor using the texture features. Results: Energy, inertia, correlation and gray in-homogeneity are calculated with our experiments for heterogeneity statistical analysis.Energy for primary and lymphomatumor is equal with the same patient, while gray in-homogeneity and inertia of primaryare 2.59595±0.00855, 0.6439±0.0007 respectively. Gray in-homogeneity and inertia of lymphoma are 2.60115±0.00635, 0.64435±0.00055 respectively. The experiments showed that the volume of lymphoma is smaller than primary tumor, but thegray in-homogeneity and inertia were higher than primary tumor with the same patient, and the correlation with lymphoma tumors is zero, while the correlation with primary tumor isslightly strong. Conclusion: This studying showed that there were effective heterogeneity differences between primary and lymphoma tumor by multi-scale image texture analysis. This work is supported by National Natural Science Foundation of China (No. 61201441), Research Fund for Excellent Young and Middle-aged Scientists of Shandong Province (No. BS2012DX038), Project of Shandong Province Higher Educational Science and Technology Program (No. J12LN23), Jinan youth science and technology star (No.20120109)

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2014

SU-E-J-14: A Novel Approach to Evaluate the Dosimetric Effect of Rectal Variation During Image Guided Prostate Radiotherapy

Purpose: Deformable registration establishes the spatial correspondence back to the reference image in order to accumulate dose. However, in prostate radiotherapy the changing shape and volume of the rectum present a challenge to accurate deformable registration and consequently calculation of delivered dose. We explored an alternative approach to calculating accumulated dose to the rectum, independent of deformable registration. Methods: This study was performed on three patients who received online image-guided radiotherapy (IGRT) with daily CBCT (XVI-system,Elekta) and target localization using intraprostatic fiducials. On each CBCT, the rectum was manually contoured and bulk density assignments were made allowing dose to be calculated for each fraction. Dose-surface maps (DSM) were generated (MATLAB,Mathworks,Natick,MA) by considering the rectum as a cylinder and sampling the dose at 21-equispaced points on each CT slice. The cylinder was “cut” at the posterior-most position on each CT and unfolded to generate a DSM. These were normalised in the longitudinal direction by interpolation creating maps of 21×21 pixels. A DSM was produced for each CBCT and the dose was accumulated. Results: The mean accumulated delivered rectal surface dose was on average 7.5(+/−3.5)% lower than the planned dose. The dose difference maps consistently show that the greatest variation in dose between planned and delivered dose is away from where the rectal surface is adjacent to the prostate. Conclusion: Estimation of dose accumulation using DSM provides an alternative method for determining actual delivered dose to the rectum. The dose difference is greatest in areas away from the region where the rectal surface abuts the prostate, the region where set-up is verified. The change in size and shape of the rectum was shown to resultin a change in the accumulated dose compared to the planned dose and this will have an impact on determining the relationships between dose delivered and toxicity. We acknowledge funding from CRUK and acknowledge NHS funding to the NIHR Biomedical Research Centre for Cancer. Patients were treated within the CHHiP IGRT sub-study (CRUK/06/016, ISRCTN:97182923) funded by CRUK. RayStation was used under an evaluation agreement with RaySearch Laboratories AB.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-J-44: Design a Platform and Phantom Model for Photoacoustic Imaging in Combination with CT

Purpose: Our (long-term) objective is to develop a US manipulator that will provide in situ radiation response and image-guided therapy for bladder cancer based on photoacoustic molecular imaging. Methods: A platform was devised to provide a reproducible positional frame of reference for targeting anatomic structure between MDCT and US scans, in lieu of CBCT, and to fuse photoacoustic molecular imaging. US and photoacoustic scans are taken of a patient while in the CT scanner and IRMT. Through co-registration, based on anatomical positions, we identified a common coordinate system to be used in Eclipse. A bladder phantom was constructed to validate anatomical tracking via US and photoacoustic imaging. We tested the platform using phantom model to demonstrate validity once moved from the CT couch to the linear accelerator couch. Results: This platform interlocks with Varian exact couch index points for reproducibility of positioning. Construction from low Z material and sized appropriately to fit in CT/IMRT gantry. Error in conversion from cylindrical coordinates of the manipulator to X, Y, Z coordinates of the treatment couch was less than 1mm. We measured the bladder size in 3 different directions in both Eclipse from the CT and Acuson from US. The error was less than 2mm in all directions. CT and US images were co-registered in MATLAB. Co-registration of photoacoustic images is still being developed. Conclusion: For Linear Accelerators without on board imaging, MV portal images are not a viable option for the localization of soft tissue anatomy. We believe our manipulator provides an alternative using US imaging, which will be examined in an upcoming clinical trial. We plan to examine the value of hypoxia guided treatment through photoacoustic imaging during this trial.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-J-81: Interplay Effect in Non-Gated Dynamic Treatment Delivery of a Lung Phantom with Simulated Respiratory Motion

Purpose: To quantify the interplay effect in non-gated VMAT external beam delivery using realistic, clinically relevant 3D motion in an anthropomorphic lung phantom, and to determine if adding margins is sufficient to account for motion or if gating is required in all cases. Methods: A 4D motion stage was used to move a Virtual Water (VW) lung target containing a piece of radiochromic EBT3 film in an anthropomorphic chest phantom. A five-arc stereotactic body radiation therapy (SBRT) treatment was planned using a CT scan of the phantom in its stationary position, using planning parameters chosen to push the optimizer to achieve a highly-modulated plan. Two scenarios were delivered using a Varian TrueBeam: the first was delivered with the phantom and target both stationary and the second was delivered with the phantom stationary but the target moving in a realistic, irregular 3D elliptical pattern. A single piece of 4×4 cm{sup 2} film was used per fraction, located in the central coronal plane of the target. Film was calibrated on a 6 MV beam with dose values from 0.20 to 20 Gy. Results: Preliminary test films were analyzed in ImageJ and MatLab software. Dose maps were calculated on a central region of interest (ROI) delineated on both the motion-induced and stationary films. Both static and dynamic film dose maps agreed with planning values within acceptable uncertainty. Conclusion: Including a large number of arcs in a clinically realistic SBRT treatment could reduce the effect of motion interplay due to averaging. Because all clinics do not employ multiple arcs for SBRT lung treatments, it is still important to consider the effects of motion on treatment delivery. Further analysis on the treatment films, as well as a broader investigation other planning parameters, will be conducted.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-J-102: Separation of Metabolic Supply and Demand: From Power Grid Economics to Cancer Metabolism

Purpose: To study a new model of glucose metabolism which is primarily governed by the timescale of the energetic demand and not by the oxygen level, and its implication on cancer metabolism (Warburg effect) Methods: 1) Metabolic profiling of membrane transporters activity in several cell lines, which represent the spectrum from normal breast epithelium to aggressive, metastatic cancer, using Seahorse XF reader.2) Spatial localization of oxidative and non-oxidative metabolic components using immunocytochemical imaging of the glycolytic ATP-producing enzyme, pyruvate kinase and mitochondria. 3) Finite element simulations of coupled partial differential equations using COMSOL and MATLAB. Results: Inhibition or activation of pumps on the cell membrane led to reduction or increase in aerobic glycolysis, respectively, while oxidative phosphorylation remained unchanged. These results were consistent with computational simulations of changes in short-timescale demand for energy by cell membrane processes. A specific model prediction was that the spatial distribution of ATP-producing enzymes in the glycolytic pathway must be primarily localized adjacent to the cell membrane, while mitochondria should be predominantly peri-nuclear. These predictions were confirmed experimentally. Conclusion: The results in this work support a new model for glucose metabolism in which glycolysis and oxidative phosphorylation supply different types of energy demand. Similar to power grid economics, optimal metabolic control requires the two pathways, even in normoxic conditions, to match two different types of energy demands. Cells use aerobic metabolism to meet baseline, steady energy demand and glycolytic metabolism to meet short-timescale energy demands, mainly from membrane transport activities, even in the presence of oxygen. This model provides a mechanism for the origin of the Warburg effect in cancer cells. Here, the Warburg effect emerges during carcinogenesis is a physiological response to an increase in energy demands from membrane transporters, required for cell division, growth, and migration. This work is supported by the NIH Physical Sciences in Oncology Center grant 1U54CA143970-03 and NIH R01 CA077575-10.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-J-117: Verification Method for the Detection Accuracy of Automatic Winston Lutz Test

Purpose: Winston Lutz test (WLT) has been a standard QA procedure performed prior to SRS treatment, to verify the mechanical iso-center setup accuracy upon different Gantry/Couch movements. Several detection algorithms exist,for analyzing the ball-radiation field alignment automatically. However, the accuracy of these algorithms have not been fully addressed. Here, we reveal the possible errors arise from each step in WLT, and verify the software detection accuracy with the Rectilinear Phantom Pointer (RLPP), a tool commonly used for aligning treatment plan coordinate with mechanical iso-center. Methods: WLT was performed with the radio-opaque ball mounted on a MIS and irradiated onto EDR2 films. The films were scanned and processed with an in-house Matlab program for automatic iso-center detection. Tests were also performed to identify the errors arise from setup, film development and scanning process. The radioopaque ball was then mounted onto the RLPP, and offset laterally and longitudinally in 7 known positions ( 0, ±0.2, ±0.5, ±0.8 mm) manually for irradiations. The gantry and couch was set to zero degree for all irradiation. The same scanned images were processed repeatedly to check the repeatability of the software. Results: Miminal discrepancies (mean=0.05mm) were detected with 2 films overlapped and irradiated but developed separately. This reveals the error arise from film processor and scanner alone. Maximum setup errors were found to be around 0.2mm, by analyzing data collected from 10 irradiations over 2 months. For the known shift introduced using the RLPP, the results agree with the manual offset, and fit linearly (R{sup 2}>0.99) when plotted relative to the first ball with zero shift. Conclusion: We systematically reveal the possible errors arise from each step in WLT, and introduce a simple method to verify the detection accuracy of our in-house software using a clinically available tool.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-J-126: Respiratory Gating Quality Assurance: A Simple Method to Achieve Millisecond Temporal Resolution

Purpose: Low temporal latency between a gating on/off signal and a linac beam on/off during respiratory gating is critical for patient safety. Although, a measurement of temporal lag is recommended by AAPM Task Group 142 for commissioning and annual quality assurance, there currently exists no published method. Here we describe a simple, inexpensive, and reliable method to precisely measure gating lag at millisecond resolutions. Methods: A Varian Real-time Position Management™ (RPM) gating simulator with rotating disk was modified with a resistive flex sensor (Spectra Symbol) attached to the gating box platform. A photon diode was placed at machine isocenter. Output signals of the flex sensor and diode were monitored with a multichannel oscilloscope (Tektronix™ DPO3014). Qualitative inspection of the gating window/beam on synchronicity were made by setting the linac to beam on/off at end-expiration, and the oscilloscope's temporal window to 100 ms to visually examine if the on/off timing was within the recommended 100-ms tolerance. Quantitative measurements were made by saving the signal traces and analyzing in MatLab™. The on and off of the beam signal were located and compared to the expected gating window (e.g. 40% to 60%). Four gating cycles were measured and compared. Results: On a Varian TrueBeam™ STx linac with RPM gating software, the average difference in synchronicity at beam on and off for four cycles was 14 ms (3 to 30 ms) and 11 ms (2 to 32 ms), respectively. For a Varian Clinac™ 21EX the average difference at beam on and off was 127 ms (122 to 133 ms) and 46 ms (42 to 49 ms), respectively. The uncertainty in the synchrony difference was estimated at ±6 ms. Conclusion: This new gating QA method is easy to implement and allows for fast qualitative inspection and quantitative measurements for commissioning and TG-142 annual QA measurements.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗
DOE OSTI2014

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↗
DOE OSTI2014

SU-E-J-155: Utilizing Varian TrueBeam Developer Mode for the Quantification of Mechanical Limits and the Simulation of 4D Respiratory Motion

Purpose: Use Varian TrueBeam Developer mode to quantify the mechanical limits of the couch and to simulate 4D respiratory motion. Methods: An in-house MATLAB based GUI was created to make the BEAM XML files. The couch was moved in a triangular wave in the S/I direction with varying amplitudes (1mm, 5mm, 10mm, and 50mm) and periods (3s, 6s, and 9s). The periods were determined by specifying the speed. The theoretical positions were compared to the values recorded by the machine at 50 Hz. HD videos were taken for certain tests as external validation. 4D Respiratory motion was simulated by an A/P MV beam being delivered while the couch moved in an elliptical manner. The ellipse had a major axis of 2 cm (S/I) and a minor axis of 1 cm (A/P). Results: The path planned by the TrueBeam deviated from the theoretical triangular form as the speed increased. Deviations were noticed starting at a speed of 3.33 cm/s (50mm amplitude, 6s period). The greatest deviation occurred in the 50mm- 3s sequence with a correlation value of −0.13 and a 27% time increase; the plan essentially became out of phase. Excluding these two, the plans had correlation values of 0.99. The elliptical sequence effectively simulated a respiratory pattern with a period of 6s. The period could be controlled by changing the speeds or the dose rate. Conclusion: The work first shows the quantification of the mechanical limits of the couch and the speeds at which the proposed plans begin to deviate. These limits must be kept in mind when programming other couch sequences. The methodology can be used to quantify the limits of other axes. Furthermore, the work shows the possibility of creating 4D respiratory simulations without using specialized phantoms or motion-platforms. This can be further developed to program patient-specific breathing patterns.

61 RADIATION PROTECTION AND DOSIMETRY↗
DOE OSTI2014

SU-E-J-235: Varian Portal Dosimetry Accuracy at Detecting Simulated Delivery Errors

Purpose: To use receiver operating characteristic (ROC) analysis to quantify the Varian Portal Dosimetry (VPD) application's ability to detect delivery errors in IMRT fields. Methods: EPID and VPD were calibrated/commissioned using vendor-recommended procedures. Five clinical plans comprising 56 modulated fields were analyzed using VPD. Treatment sites were: pelvis, prostate, brain, orbit, and base of tongue. Delivery was on a Varian Trilogy linear accelerator at 6MV using a Millenium120 multi-leaf collimator. Image pairs (VPD-predicted and measured) were exported in dicom format. Each detection test imported an image pair into Matlab, optionally inserted a simulated error (rectangular region with intensity raised or lowered) into the measured image, performed 3%/3mm gamma analysis, and saved the gamma distribution. For a given error, 56 negative tests (without error) were performed, one per 56 image pairs. Also, 560 positive tests (with error) with randomly selected image pairs and randomly selected in-field error location. Images were classified as errored (or error-free) if percent pixels with γ<κ was < (or ≥) τ. (Conventionally, κ=1 and τ=90%.) A ROC curve was generated from the 616 tests by varying τ. For a range of κ and τ, true/false positive/negative rates were calculated. This procedure was repeated for inserted errors of different sizes. VPD was considered to reliably detect an error if images were correctly classified as errored or error-free at least 95% of the time, for some κ+τ combination. Results: 20mm{sup 2} errors with intensity altered by ≥20% could be reliably detected, as could 10mm{sup 2} errors with intensity was altered by ≥50%. Errors with smaller size or intensity change could not be reliably detected. Conclusion: Varian Portal Dosimetry using 3%/3mm gamma analysis is capable of reliably detecting only those fluence errors that exceed the stated sizes. Images containing smaller errors can pass mathematical analysis, though may be detected by visual inspection. This work was not funded by Varian Oncology Systems. Some authors have other work partly funded by Varian Oncology Systems.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-J-240: The Impact On Clinical Dose-Distributions When Using MR-Images Registered with Stereotactic CT-Images in Gamma Knife Radiosurgery

Purpose: Most Gamma knife treatments are based solely on MR-images. However, for fractionated treatments and to implement TPS dose calculations that require electron densities, CT image data is essential. The purpose of this work is to assess the dosimetric effects of using MR-images registered with stereotactic CT-images in Gamma knife treatments. Methods: Twelve patients treated for vestibular schwannoma with Gamma Knife Perfexion (Elekta Instruments, Sweden) were selected for this study. The prescribed doses (12 Gy to periphery) were delivered based on the conventional approach of using stereotactic MR-images only. These plans were imported into stereotactic CT-images (by registering MR-images with stereotactic CT-images using the Leksell gamma plan registration software). The dose plans, for each patient, are identical in both cases except for potential rotations and translations resulting from the registration. The impact of the registrations was assessed by an algorithm written in Matlab. The algorithm compares the dose-distributions voxel-by-voxel between the two plans, calculates the full dose coverage of the target (treated in the conventional approach) achieved by the CT-based plan, and calculates the minimum dose delivered to the target (treated in the conventional approach) achieved by the CT-based plan. Results: The mean dose difference between the plans was 0.2 Gy to 0.4 Gy (max 4.5 Gy) whereas between 89% and 97% of the target (treated in the conventional approach) received the prescribed dose, by the CT-plan. The minimum dose to the target (treated in the conventional approach) given by the CT-based plan was between 7.9 Gy and 10.7 Gy (compared to 12 Gy in the conventional treatment). Conclusion: The impact of using MR-images registered with stereotactic CT-images has successfully been compared to conventionally delivered dose plans showing significant differences between the two. Although CTimages have been implemented clinically; the effect of the registration has not been fully investigated.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-J-241: Creation of Ventilation CT From Daily 4D CTs Or 4D Conebeam CTs Acquired During IGRT for Thoracic Cancers

Purpose: To develop a method to create ventilation CTs from daily 4D CTs or 4D KV conebeam CTs (4DCBCT) acquired during image-guided radiation therapy (IGRT) for thoracic tumors, and to explore the potential for using the ventilation CTs as a means for early detection of lung injury during radiation treatment. Methods: 4DCT acquired using an in-room CT (CTVision, Siemens) and 4DCBCT acquired using the X-ray Volume Imaging (XVI) system (Infinity, Elekta) for representative lung cancer patients were analyzed. These 4D data sets were sorted into 10 phase images. A newly-available deformable image registration tool (ADMIRE, Elekta) is used to deform the phase images at the end of exhale (EE) to the phase images at the end of inhale (EI). The lung volumes at EI and EE were carefully contoured using an intensity-based auto-contour tool and then manually edited. The ventilation images were calculated from the variations of CT numbers of those voxels masked by the lung contour at EI between the registered phase images. The deformable image registration is also performed between the daily 4D images and planning 4DCT, and the resulting deformable field vector (DFV) is used to deform the planning doses to the daily images by an in-house Matlab program. Results: The ventilation images were successfully created. The tide volumes calculated using the ventilation images agree with those measured through volume difference of contours at EE and EI, indicating the accuracy of ventilation images. The association between the delivered doses and the change of lung ventilation from the daily ventilation CTs is identified. Conclusions: A method to create the ventilation CT using daily 4DCTs or 4D KV conebeam CTs was developed and demonstrated.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-J-253: Evaluation of 4DCT Images with Correlation of RPM Signals to Tumor Motion for Respiratory-Gated Radiotherapy

Purpose: The amplitudes of lung tumor target motion and RPM signals are different from each other. Also, RPM system does not have in-depth RPM signal analysis tool. We have developed an algorithm that analyzes RPM signals for its stability as well as correlativity to the tumor motion. Methods: We used a Philips Big Bore CT scanner with a Varian Real-Time Position Management™ (RPM) system attached. 4DCT images were reviewed and tumor motion amplitudes of full breathing in superior-inferior, anterior-posterior, and left-right directions were measured. RPM signals were analyzed with the algorithm developed with Matlab. Average signal period, amplitude and statistical stability of the full breathing pattern as well as the pattern around full expiration were calculated. RPM signal amplitudes were normalized to measured tumor motion amplitudes so that selected gating phases (30%–70% or 40%–60%) allow tumor motion under 5.0mm. Results: Twelve patient cases were analyzed in this study with GTV sizes ranged from 1.0cm to 3.0cm diameter. The periods and amplitudes of RPM signal ranged from 3.1seconds to 6.5seconds and from 0.2cm to 1.7cm, respectively. RPM signals were most stable at full expiration. The standard deviation of the RPM signal peaks at full expiration was <0.11cm, and that of gated amplitudes was <0.25cm. Tumor motion amplitudes were primary in superior-inferior direction and minor (<=0.2cm) in other directions on all analyzed cases, ranged from 0.2cm to 2.5cm. The amplitudes increases with the tumor located toward the diaphragm. The gated phases were selected so that the average gated tumor motion amplitude as well as that plus deviation became under 0.5cm in superior-inferior direction. Conclusion: We were able to determine the respiratory-gated phases in RPM signals employing measured tumor motion amplitudes as well as developed RPM signal analyzer through correlation process. The RPM signal amplitudes do not represent tumor motion because of its location.

60 APPLIED LIFE SCIENCES↗