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SU-E-QI-11: Measurement of Renal Pyruvate-To-Lactate Exchange with Hyperpolarized 13C MRI

Purpose: Previous work [1] modeling the metabolic flux between hyperpolarized [1-13C]pyruvate and [1-13C]lactate in magnetic resonance spectroscopic imaging (MRSI) experiments failed to account for vascular signal artifacts. Here, we investigate a method to minimize the vascular signal and its impact on the fidelity of metabolic modeling. Methods: MRSI was simulated for renal metabolism in MATLAB both with and without bipolar gradients. The resulting data were fit to a two-site exchange model [1], and the effects of vascular partial volume artifacts on kinetic modeling were assessed. Bipolar gradients were then incorporated into a gradient echo sequence to validate the simulations experimentally. The degree of diffusion weighting (b = 32 s/mm{sup 2}) was determined empirically from 1H imaging of murine renal vascular signal. The method was then tested in vivo using MRSI with bipolar gradients following injection of hyperpolarized [1-{sup 13}C]pyruvate (∼80 mM at 20% polarization). Results: In simulations, vascular signal contaminated the renal metabolic signal at resolutions as high as 2 × 2 mm{sup 2} due to partial volume effects. The apparent exchange rate from pyruvate to lactate (k{sub p}) was underestimated in the presence of these artifacts due to contaminating pyruvate signal. Incorporation of bipolar gradients suppressed vascular signal and improved the accuracy of kp estimation. Experimentally, the in vivo results supported the ability of bipolar gradients to suppress vascular signal. The in vivo exchange rate increased, as predicted in simulations, from k{sub p} = 0.012 s-{sup 1} to k{sub p} = 0.020-{sup 1} after vascular signal suppression. Conclusion: We have demonstrated the limited accuracy of the two-site exchange model in the presence of vascular partial volume artifacts. The addition of bipolar gradients suppressed vascular signal and improved model accuracy in simulations. Bipolar gradients largely affected kp estimation in vivo. Currently, slow-flowing spins in small vessels and capillaries are only partially suppressed, so further improvement is possible. Funding support: Seed Grant from the Radiological Society of North America, GE Healthcare, University of Wisconsin Graduate School.

60 APPLIED LIFE SCIENCES↗

SU-F-BRE-03: Consideration of a Track-Interaction Model for Radiochromic Film Response

Purpose: Conventional methods for characterizing the energy response of radiochromic film (RCF) typically involve assessing changes in response when exposed to various beam qualities and use Monte Carlo to determine absorbed dose. These methods represent RCF as a dose integrator of a homogeneous energy deposition volume. Apparent film saturation, nonlinearity, and intrinsic energy dependence are unpredicted with conventional methods. Recent work has shown significant RCF intrinsic energy dependence, which limits its use in absolute dosimetry. This work introduces a track-interaction model (TIM) for RCF and assesses its ability to predict total energy response. Methods: A TIM based on Katz single-hit theory was developed to accumulate energy flux along particle tracks within active crystals, represented as (1×1×20)um{sup 3} prisms about the Gafchromic™ EBT3 active volume using MCNP5 and Matlab. Energy flux contributed to film response only if near the threshold energy for polymerization in polydiacetylenes (2.5eV/monomer). Energy deposition in excess of maximum efficiency represented crystal saturation and did not contribute to film response. The TIM was applied to RCF exposed in air to various monoenergetic photon beams and Co-60. Geometric distribution of energy flux was found for each beam quality in a (1×1)mm{sup 2} RCF area. RCF response relative to Co-60 absorbed dose-to-water (S-TIM) was determined and compared to published values (S-PUB). Results: TIM successfully predicted that lower energy radiation is less effective at inducing polymerization, though the magnitude of the phenomenon was overpredicted. S-TIM was −29% and +20% for 20 and 40 keV, respectively. This agreed qualitatively with S-PUB of −27% and +16%. TIM-generated sensitometric curves contained the non-linearity and saturation apparent in RCF. Conclusion: This work indicates the possibility for TIMs to predict changes in RCF response to various energies. Future work will refine TIM by considering size distributions of active elements, other RCF formulations, and response in complex treatment fields. Acknowledgements: The authors wish to thank Dr. Christopher Soares at NIST (Gaithersburg, MD) for performing film measurements and Dr. David Lewis of Ashland, Inc. (Wayne, NJ) for making the EBT3 film available to us.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗

SU-F-BRE-09: Linac Isocenter Quality Assurance: A Stereotactic Approach

Purpose: A quantitative method was designed to independently determine the couch/collimator/gantry isocenters, as well as the overall LINAC mechanical isocenter in 3D. Methods: Performed on both a Varian TrueBeam™ STx and Trilogy with the gold standard front pointer positioned at 100 cm SAD, and a Radionics XKnife™ (RX) attached to the couch. At gantry and couch 0°, the RX laser alignment attachment (RXLAA) was centered to the front pointer using the micrometers (0.1-mm precision) on the RX. The 3D coordinates of the micrometers were recorded. The collimator was rotated to 90° and 270°. At each collimator rotation, the RXLAA was re-centered to the front pointer and the micrometer coordinates recorded. At collimator and gantry 0°, the process was repeated for couch angles 0°/90°/270°. Finally, at collimator and couch 0°, the steps were repeated for gantry rotations 0°/90°/180°/270°. The centers/radii of the smallest bounding spheres for the collimator, couch and gantry walkout were calculated (using MatLab™). The smallest bounding sphere containing the collimator, couch and gantry walkout spheres was then calculated. The center of this all-encompassing sphere is the overall mechanical isocenter of the LINAC. This position was dialed in on the RX. LINAC mechanical and radiation isocenter coincidence was determined by performing Winston- Lutz test at four cardinal gantry angles. Results: TrueBeam and Trilogy mechanical isocenters had overall walkout radii of 0.8 mm and 1.5 mm, respectively. For the TrueBeam and Trilogy 6-MV beams, the radii of radiation isocenter were 0.3 mm and 0.4 mm, respectively, with distances between LINAC mechanical and radiation isocenters of 0.5 mm and 0.9 mm, respectively. Conclusion: This efficient and simple method allows for an independent and reliable quantitative assessment of LINAC isocenter in 3D with equipment typically available in a radiation oncology clinic. It can easily be performed for LINAC commissioning and annual QA.

07 ISOTOPE AND RADIATION SOURCES↗

MO-F-16A-01: Implementation of MPPG TPS Verification Tests On Various Accelerators

Purpose: To demonstrate the implementation of the Medical Physics Practice Guideline (MPPG) for dose calculation and beam parameters verification of treatment planning systems (TPS). Methods: We implemented the draft TPS MPPG for three linacs: Varian Trilogy, TomoHDA and Elekta Infinity. Static and modulated test plans were created. The static fields are different than used in commissioning. Data was collected using ion chambers and diodes in a scanning water tank, Delta4 phantom and a custom phantom. MatLab and Microsoft Excel were used to create analysis tools to compare reference DICOM dose with scan data. This custom code allowed for the interpolation, registration and gamma analysis of arbitrary dose profiles. It will be provided as open source code. IMRT fields were validated with Delta4 registration and comparison tools. The time for each task was recorded. Results: The tests confirmed the strengths, and revealed some limitations, of our TPS. The agreement between calculated and measured dose was reported for all beams. For static fields, percent depth dose and profiles were analyzed with criteria in the draft MPPG. The results reveal areas of slight mismatch with the model (MLC leaf penumbra, buildup region.) For TomoTherapy, the IMRT plan 2%/2 mm gamma analysis revealed poorest agreement in the low dose regions. For one static test plan for all 10MV Trilogy photon beams, the plan generation, scan queue creation, data collection, data analysis and report took 2 hours, excluding tank setup. Conclusions: We have demonstrated the implementation feasibility of the TPS MPPG. This exercise generated an open source tool for dose comparisons between scan data and DICOM dose data. An easily reproducible and efficient infrastructure with streamlined data collection was created for repeatable robust testing of the TPS. The tests revealed minor discrepancies in our models and areas for improvement that are being investigated.

07 ISOTOPE AND RADIATION SOURCES↗

MO-G-18C-07: Improving T2 Determination and Quantification of Lipid Methylene Protons in Proton Magnetic Resonance Spectroscopy at 3 T

Purpose: To improve proton magnetic resonance spectroscopy (MRS) transverse relaxation (T{sub 2}) determination and quantification of lipid methylene chain (1.3 ppm) protons by rewinding their J-coupling evolution. Methods: MRS experiments were performed on four lipid phantoms, namely, almond, corn, sunflower and oleic acid, using a 3 T Philips MRI scanner with a transmit/receive birdcage head coil. Two PRESS (Point RESolved Spectroscopy) pulse sequences were used. The first PRESS sequence employed standard bandwidth (BW) (∼550 Hz) RF (radiofrequency) refocussing pulses, while the second used refocussing pulses of narrow BW (∼50 Hz) designed to rewind J-coupling evolution of the methylene protons in the voxel of interest. Signal was acquired with each sequence from a 5×5×5 mm{sup 3} voxel, with a repetition time (TR) of 3000 ms, and with echo times (TE) of 100 to 200 ms in steps of 20 ms. 2048 sample points were measured with a 2000 Hz sampling bandwidth. Additionally, 30 mm outer volume suppression slabs were used to suppress signal outside the voxel of interest. The frequency of the RF pulses was set to that of the methylene resonance. Methylene peak areas were calculated and fitted in MATLAB to a monexponentially decaying function of the form M{sub 0}exp(-TE/T{sub 2}), where M{sub 0} is the extrapolated area when TE = 0 ms and yields a measure of concentration. Results: The determined values of M{sub 0} and T{sub 2} increased for all fatty acids when using the PRESS sequence with narrow BW refocussing pulses. M{sub 0} and T{sub 2} values increased by an average amount (over all the phantoms) of 31% and 14%, respectively. Conclusion: This investigation has demonstrated that J-coupling interactions of lipid methylene protons causes non-negligible signal losses which, if not accounted for, Result in underestimations of their levels and T{sub 2} values when performing MRS measurements. Funded by the Natural Sciences and Engineering Research Council of Canada and the Canadian Breast Cancer Foundation - Prairies.NWT.

60 APPLIED LIFE SCIENCES↗

MO-H-19A-01: FEATURED PRESENTATION - Treatment Planning Tool for Radiotherapy with Very High-Energy Electron Beams

Purpose: To develop a tool for treatment planning optimization for fast radiotherapy delivered with very high-energy electron beams (VHEE) and to compare VHEE plans to state-of-the-art plans for challenging pelvis and H'N cases. Methods: Treatment planning for radiotherapy delivered with VHEE scanning pencil beams was performed by integrating EGSnrc Monte Carlo (MC) dose calculations with spot scanning optimization run in a research version of RayStation. A Matlab GUI for MC beamlet generation was developed, in which treatment parameters such as the pencil beam size and spacing, energy and number of beams can be selected. Treatment planning study for H'N and pelvis cases was performed and the effect of treatment parameters on the delivered dose distributions was evaluated and compared to the clinical treatment plans. The pelvis case with a 691cm3 PTV was treated with 2-arc 15MV VMAT and the H'N case with four PTVs with total volume of 531cm3 was treated with 4-arc 6MV VMAT. Results: Most studied VHEE plans outperformed VMAT plans. The best pelvis 80MeV VHEE plan with 25 beams resulted in 12% body dose sparing and 8% sparing to the bowel and right femur compared to the VMAT plan. The 100MeV plan was superior to the 150MeV plan. Mixing 100 and 150MeV improved dose sparing to the bladder by 7% compared to either plan. Plans with 16 and 36 beams did not significantly affect the dose distributions compared to 25 beam plans. The best H'N 100MeV VHEE plan decreased mean doses to the brainstem, chiasm, and both globes by 10-42% compared to the VMAT plan. Conclusion: The pelvis and H'N cases suggested that sixteen 100MeV beams might be sufficient specifications of a novel VHEE treatment machine. However, optimum machine parameters will be determined with the presented VHEE treatment-planning tool for a large number of clinical cases. BW Loo and P Maxim received research support from RaySearch Laboratories. E Hynning and B Hardemark are employees of RaySearch Laboratories.

60 APPLIED LIFE SCIENCES↗

TU-C-17A-05: Dose Domain Optimization of MLC Leaf Patterns for Highly Complicated 4Ï€ IMRT Plans

Purpose: Highly conformal non-coplanar 4π radiotherapy plans typically require more than 20 intensity-modulated fields to deliver. A novel method to calculate multileaf collimator (MLC) leaf patterns is introduced to maximize delivery efficiency, accuracy and plan quality. Methods: 4 GBM patients, with a prescription dose of 59.4 Gy or 60 Gy, were evaluated using the 4π algorithm using 20 beams. The MLC calculation utilized a least square minimization of the dose distribution, with an anisotropic total variation regularization term to encourage piecewise continuity in the fluence maps. Transforming the fluence to the dose domain required multiplying the fluence with a sparse matrix. Exploiting this property made it feasible to solve the problem using CVX, a MATLAB-based convex modeling framework. The fluence was stratified into even step sizes, and the MLC segments, limited to 300, were calculated. The patients studied were replanned using Eclipse with the same beam angles. Results: Compared to the original 4π plan, the stratified 4π plan increased the maximum/mean dose for, in Gy, by 1.0/0.0 (brainstem), 0.5/0.2 (chiasm), 0.0/0.0 (spinal cord), 1.9/0.3 (L eye), 0.7/0.2 (R eye), 0.4/0.4 (L lens), 0.3/0.3 (R lens), 1.0/0.8 (L Optical Nerve), 0.5/0.3 (R Optical Nerve), 0.3/0.2 (L Cochlea), 0.1/0.1 (R Cochlea), 4.6/0.2 (brain), 2.4/0.1 (brain-PTV), 5.1/0.9 (PTV). Compared to Eclipse, which generated an average of 607 segments, the stratified plan reduced (−) or increased (+) the maximum/mean dose, in Gy, by −10.2/−4.1 (brainstem), −10.5/−8.9 (chiasm), +0.0/−0.1 (spinal cord), −4.9/−3.4 (L eye), −4.1/−2.5 (R eye), −2.8/−2.7 (L lens), −2.1/−1.9 (R lens), −7.6/−6.5 (L Optical Nerve), −8.9/−6.1 (R Optical Nerve), −1.3/−1.9 (L Cochlea), −1.8/−1.8 (R Cochlea), +1.7/−2.1 (brain), +3.2/−2.6 (brain-PTV), +1.8/+0.3 Gy (PTV. The stratified plan was also more homogeneous in the PTV. Conclusion: This novel solver can transform complicated fluence maps into significantly fewer deliverable MLC segments than the commercial system while achieving superior dosimetry. Funding support partially contributed by Varian.

60 APPLIED LIFE SCIENCES↗

TU-C-12A-07: Characterization of Longitudinal Reproducibility of Quantitative Diffusion Imaging Data Acquired with Four Different Protocols Using a Phantom

Purpose: To characterize and compare the longitudinal reproducibility of diffusion imaging data acquired with four different protocols using a phantom. Methods: The Diffusive Quantitative Imaging Phantom (DQIP) was constructed using fifteen cylindrical compartments within a larger compartment, filled with deionized water doped with CuSO4 and NaCl. The smaller compartments contained arrays of hexagonal or cylindrical glass capillaries of varying inner diameters, for differing restraint of water diffusion. The sensitivity of diffusion imaging metrics to signal-to-noise ratio (SNR) was probed by doping compartments with differing ratios of deuterium oxide to H2O. A cork phantom enclosure was constructed to increase thermal stability during scanning and a cork holder was made to reproduce scanner positioning. Four different protocols of DWI (diffusion weighted imaging) and DTI (Diffusion tensor imaging) imaging were assembled on a GE Excite HDx 3.0T MRI scanner to collect imaging data over 9-10 days. Data was processed with in-house software created in Matlab to obtain fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values. Results: All DTI and DWI sequences showed good longitudinal stability of mean FA and ADC values per compartment, exhibiting low standard deviation ∼9%. A t-test was performed to compare mean FA values from the DTI clinical protocol to those of the DTI special protocol, indicating significantly different values in the majority of compartments. ANOVA performed on ADC values for all DTI and DWI sequences also showed significantly different values in a majority of compartments. Conclusion: This work has the potential for quantifying systemic variations between diffusion imaging sequences from different platforms. Characterization of DWI and DTI performance were done over four sequences with predictable results. This data suggests that the DQIP phantom may be a reliable method of monitoring day-to-day and scan-to-scan variation in diffusion imaging sequences from different platforms. Schott Glass North America and The Phantom Laboratory have donated materials and personnel time to this project.

60 APPLIED LIFE SCIENCES↗

TU-F-17A-01: BEST IN PHYSICS (JOINT IMAGING-THERAPY) - An Automatic Toolkit for Efficient and Robust Analysis of 4D Respiratory Motion

Purpose: To provide an automatic image analysis toolkit to process thoracic 4-dimensional computed tomography (4DCT) and extract patient-specific motion information to facilitate investigational or clinical use of 4DCT. Methods: We developed an automatic toolkit in MATLAB to overcome the extra workload from the time dimension in 4DCT. This toolkit employs image/signal processing, computer vision, and machine learning methods to visualize, segment, register, and characterize lung 4DCT automatically or interactively. A fully-automated 3D lung segmentation algorithm was designed and 4D lung segmentation was achieved in batch mode. Voxel counting was used to calculate volume variations of the torso, lung and its air component, and local volume changes at the diaphragm and chest wall to characterize breathing pattern. Segmented lung volumes in 12 patients are compared with those from a treatment planning system (TPS). Voxel conversion was introduced from CT# to other physical parameters, such as gravity-induced pressure, to create a secondary 4D image. A demon algorithm was applied in deformable image registration and motion trajectories were extracted automatically. Calculated motion parameters were plotted with various templates. Machine learning algorithms, such as Naive Bayes and random forests, were implemented to study respiratory motion. This toolkit is complementary to and will be integrated with the Computational Environment for Radiotherapy Research (CERR). Results: The automatic 4D image/data processing toolkit provides a platform for analysis of 4D images and datasets. It processes 4D data automatically in batch mode and provides interactive visual verification for manual adjustments. The discrepancy in lung volume calculation between this and the TPS is <±2% and the time saving is by 1–2 orders of magnitude. Conclusion: A framework of 4D toolkit has been developed to analyze thoracic 4DCT automatically or interactively, facilitating both investigational and clinical use. More software tools are under development for automatic analysis of other 4D imaging modalities. This research is in part supported by NIH (U54CA137788/132378) and City Seed FY13(Grant No. 93348-14 01). AY would like to thank MSKCC summer medical student research program supported by National Cancer Institute and hosted by Department of Medical Physics at MSKCC.

60 APPLIED LIFE SCIENCES↗

WE-E-BRE-12: Tumor Microenvironment Dynamics Following Radiation

Purpose: This work aims to understand the radiation-induced interplay between tumor oxygenation and metabolic activity. These dynamics can potentially serve as biomarkers in assessing treatment response allowing for patient-specific adaptive radiotherapy. Methods: Using patient-derived xenografts of head and neck cancer we assessed tumor oxygenation via fiber-optic probe monitored hemoglobin saturation and Blood Oxygen Level Dependent (BOLD) MRI. Measurements were taken before and after a 10 Gy dose of radiation. Changes in metabolic activity were measured via Fluorescence Lifetime IMaging (FLIM) with the appropriate controls following a 10 Gy dose of radiation. FLIM can non-invasively monitor changes in fluorescence in response to the microenvironment including being able to detect free and bound states of the intrinsically fluorescent metabolite NADH (Nicotinamide Adenine Dinucleotide). With this information FLIM can accurately quantify the metabolic state of cells that have been radiated. To model the observed changes, a two-compartment, source-sink simulation relating hemoglobin saturation and metabolic activity was performed using MATLAB. Results: Hemoglobin saturation as measured by interstitial probe and BOLD-MRI decreased by 30% within 15 minutes following radiation. FLIM demonstrated a decrease in the mean fluorescence lifetime of NADH by 100 ps following 10 Gy indicating a shift towards glycolytic pathways. Simulation of radiation-induced alterations in tumor oxygenation demonstrated that these changes can be the result of changes in either vasculature or metabolic activity. Conclusion: Radiation induces significant changes in hemoglobin saturation and metabolic activity. These alterations occur on time scales approximately the duration of common radiation treatments. Further understanding these dynamics has important implications with regard to improvement of therapy and biomarkers of treatment response.

60 APPLIED LIFE SCIENCES↗

WE-G-17A-01: Improving Tracking Image Spatial Resolution for Onboard MR Image Guided Radiation Therapy Using the WHISKEE Technique

Purpose: To evaluate the feasibility of using the weighted hybrid iterative spiral k-space encoded estimation (WHISKEE) technique to improve spatial resolution of tracking images for onboard MR image guided radiation therapy (MR-IGRT). Methods: MR tracking images of abdomen and pelvis had been acquired from healthy volunteers using the ViewRay onboard MRIGRT system (ViewRay Inc. Oakwood Village, OH) at a spatial resolution of 2.0mm*2.0mm*5.0mm. The tracking MR images were acquired using the TrueFISP sequence. The temporal resolution had to be traded off to 2 frames per second (FPS) to achieve the 2.0mm in-plane spatial resolution. All MR images were imported into the MATLAB software. K-space data were synthesized through the Fourier Transform of the MR images. A mask was created to selected k-space points that corresponded to the under-sampled spiral k-space trajectory with an acceleration (or undersampling) factor of 3. The mask was applied to the fully sampled k-space data to synthesize the undersampled k-space data. The WHISKEE method was applied to the synthesized undersampled k-space data to reconstructed tracking MR images at 6 FPS. As a comparison, the undersampled k-space data were also reconstructed using the zero-padding technique. The reconstructed images were compared to the original image. The relatively reconstruction error was evaluated using the percentage of the norm of the differential image over the norm of the original image. Results: Compared to the zero-padding technique, the WHISKEE method was able to reconstruct MR images with better image quality. It significantly reduced the relative reconstruction error from 39.5% to 3.1% for the pelvis image and from 41.5% to 4.6% for the abdomen image at an acceleration factor of 3. Conclusion: We demonstrated that it was possible to use the WHISKEE method to expedite MR image acquisition for onboard MR-IGRT systems to achieve good spatial and temporal resolutions simultaneously. Y. Hu and O. green receive travel reimbursement from ViewRay. S. Mutic has consulting and research agreements with ViewRay. Q. Zeng, R. Nana, J.L. Patrick, S. Shvartsman and J.F. Dempsey are ViewRay employees.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

WE-G-18C-07: Accelerated Water/fat Separation in MRI for Radiotherapy Planning Using Multi-Band Imaging Techniques

Purpose: Dixon sequences are used to characterize disease processes, obtain good fat or water separation in cases where fat suppression fails and to obtain pseudo-CT datasets. Dixon's method uses at least two images acquired with different echo times and thus requires prolonged acquisition times. To overcome associated problems (e.g., for DCE/cine-MRI), we propose to use a method for water/fat separation based on spectrally selective RF pulses. Methods: Two alternating RF pulses were used, that imposes a fat selective phase cycling over the phase encoding lines, which results in a spatial shift for fat in the reconstructed image, identical to that in CAIPIRINHA. Associated aliasing artefacts were resolved using the encoding power of a multi-element receiver array, analogous to SENSE. In vivo measurements were performed on a 1.5T clinical MR-scanner in a healthy volunteer's legs, using a four channel receiver coil. Gradient echo images were acquired with TE/TR = 2.3/4.7ms, flip angle 20°, FOV 45×22.5cm{sup 2}, matrix 480×216, slice thickness 5mm. Dixon images were acquired with TE,1/TE,2/TR=2.2/4.6/7ms. All image reconstructions were done in Matlab using the ReconFrame toolbox (Gyrotools, Zurich, CH). Results: RF pulse alternation yields a fat image offset from the water image. Hence the water and fat images fold over, which is resolved using in-plane SENSE reconstruction. Using the proposed technique, we achieved excellent water/fat separation comparable to Dixon images, while acquiring images at only one echo time. Conclusion: The proposed technique yields both inphase water and fat images at arbitrary echo times and requires only one measurement, thereby shortening the acquisition time by a factor 2. In future work the technique may be extended to a multi-band water/fat separation sequence that is able to achieve single point water/fat separation in multiple slices at once and hence yields higher speed-up factors.

60 APPLIED LIFE SCIENCES↗

TH-A-18C-02: An Electrostatic Model for Assessment of Joint Space Morphology in Cone-Beam CT

Purpose: High-resolution cone-beam CT (CBCT) of the extremities presents a potentially valuable basis for image-based biomarkers of arthritis, trauma, and risk of injury. We present a new method for 3D joint space analysis that exploits the high isotropic spatial resolution of CBCT and is sensitive to small changes in disease-related morphology. Methods: The approach uses an “electrostatic” model in which joint surfaces (e.g., distal femur and proximal tibia) are labeled as charge densities between which the electric field is solved by approximation to the Laplace equation. The method yields a unique solution determined by the field lines across the “capacitor” and is hypothesized to be more sensitive than conventional (Sharp) scores and immune to degeneracies that limit simple distance-along-axis or closest-point analysis. The algorithm was validated in CBCT phantom images and applied in two clinical scenarios: osteoarthritis (OA, change in loadbearing tibiofemoral joint space); and assessment of injury risk (correlation of 3D joint space to tibial slope). Results: Joint space maps computed from the electrostatic model were accurate to within the voxel size (0.26 mm). The method highlighted subtle regions of morphological change that would likely be missed by conventional scalar metrics. Regions of subtle cartilage erosion were well quantified, and the method confidently discriminated OA and non-OA cohorts. 3D joint space maps correlated well with tibial slope and provide a new basis for principal component analysis of loadbearing injury risk. Runtime was less than 5 min (235×235×121 voxel subvolume in Matlab). Conclusion: A new method for joint space assessment was reported as a possible image-based biomarker of subtle articular change. The algorithm yields accurate quantitation of the joint in a manner that is robust against operator and patient setup variation. The method shows promising initial results in ongoing trials of CBCT in osteoarthritis, rheumatoid arthritis, and injury risk assessment. Research supported by R01 and R21 grants from the National Institutes of Health, academic-industry partnership with Carestream Health, and a grant from the US Army Natick Soldier Research, Development and Engineering Center.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗

TH-C-BRD-01: Analytical Computation of Prompt Gamma Ray Emission and Detection for Proton Range Verification

Purpose: A prompt gamma (PG) slit camera prototype demonstrated that on-line range monitoring within 1–2 mm could be performed by comparing expected and measured PG detection profiles. Monte Carlo (MC) can simulate the expected PG profile but this would result in prohibitive computation time for a complete pencil beam treatment plan. We implemented a much faster method that is based on analytical processing of pre-computed MC data. Methods: The formation of the PG detection signal can be separated into: 1) production of PGs and 2) detection by the camera detectors after PG transport in geometry. For proton energies from 40 to 230 MeV, PG productions in depth were pre-computed by MC (PENH) for 12C, 14N, 16O, 31P and 40Ca. The PG production was then modeled analytically by adding the PG production for each element according to local proton energy and tissue composition.PG transport in the patient/camera geometries and the detector response were modeled by convolving the PG production profile with a transfer function. The latter is interpolated from a database of transfer functions fitted to pre-computed MC data (PENELOPE). The database was generated for a photon source in a cylindrical phantom with various radiuses and a camera placed at various positions.As a benchmark, the analytical model was compared to PENH for a water phantom, a phantom with different slabs (adipose, muscle, lung) and a thoracic CT. Results: Good agreement (within 5%) was observed between the analytical model and PENH for the PG production. Similar accuracy for detecting range shifts was also observed. Speed of around 250 ms per profile was achieved (single CPU) using a non-optimized MatLab implementation. Conclusion: We devised a fast analytical model for generating PG detection profiles. In the test cases considered in this study, similar accuracy than MC was achieved for detecting range shifts. This research is supported by IBA.

60 APPLIED LIFE SCIENCES↗

TH-C-BRD-05: Reducing Proton Beam Range Uncertainty with Patient-Specific CT HU to RSP Calibrations Based On Single-Detector Proton Radiography

Purpose: Beam range uncertainty in proton treatment comes primarily from converting the patient's X-ray CT (xCT) dataset to relative stopping power (RSP). Current practices use a single curve for this conversion, produced by a stoichiometric calibration based on tissue composition data for average, healthy, adult humans, but not for the individual in question. Proton radiographs produce water-equivalent path length (WEPL) maps, dependent on the RSP of tissues within the specific patient. This work investigates the use of such WEPL maps to optimize patient-specific calibration curves for reducing beam range uncertainty. Methods: The optimization procedure works on the principle of minimizing the difference between the known WEPL map, obtained from a proton radiograph, and a digitally-reconstructed WEPL map (DRWM) through an RSP dataset, by altering the calibration curve that is used to convert the xCT into an RSP dataset. DRWMs were produced with Plastimatch, an in-house developed software, and an optimization procedure was implemented in Matlab. Tests were made on a range of systems including simulated datasets with computed WEPL maps and phantoms (anthropomorphic and real biological tissue) with WEPL maps measured by single detector proton radiography. Results: For the simulated datasets, the optimizer showed excellent results. It was able to either completely eradicate or significantly reduce the root-mean-square-error (RMSE) in the WEPL for the homogeneous phantoms (to zero for individual materials or from 1.5% to 0.2% for the simultaneous optimization of multiple materials). For the heterogeneous phantom the RMSE was reduced from 1.9% to 0.3%. Conclusion: An optimization procedure has been designed to produce patient-specific calibration curves. Test results on a range of systems with different complexities and sizes have been promising for accurate beam range control in patients. This project was funded equally by the Engineering and Physical Sciences Research Council (UK) and Ion Beam Applications (Louvain-La-Neuve, Belgium)

07 ISOTOPE AND RADIATION SOURCES↗

TH-C-18A-08: A Management Tool for CT Dose Monitoring, Analysis, and Protocol Review

Purpose: To develop a customizable tool for enterprise-wide managing of CT protocols and analyzing radiation dose information of CT exams for a variety of quality control applications Methods: All clinical CT protocols implemented on the 11 CT scanners at our institution were extracted in digital format. The original protocols had been preset by our CT management team. A commercial CT dose tracking software (DoseWatch,GE healthcare,WI) was used to collect exam information (exam date, patient age etc.), scanning parameters, and radiation doses for all CT exams. We developed a Matlab-based program (MathWorks,MA) with graphic user interface which allows to analyze the scanning protocols with the actual dose estimates, and compare the data to national (ACR,AAPM) and internal reference values for CT quality control. Results: The CT protocol review portion of our tool allows the user to look up the scanning and image reconstruction parameters of any protocol on any of the installed CT systems among about 120 protocols per scanner. In the dose analysis tool, dose information of all CT exams (from 05/2013 to 02/2014) was stratified on a protocol level, and within a protocol down to series level, i.e. each individual exposure event. This allows numerical and graphical review of dose information of any combination of scanner models, protocols and series. The key functions of the tool include: statistics of CTDI, DLP and SSDE, dose monitoring using user-set CTDI/DLP/SSDE thresholds, look-up of any CT exam dose data, and CT protocol review. Conclusion: our inhouse CT management tool provides radiologists, technologists and administration a first-hand near real-time enterprise-wide knowledge on CT dose levels of different exam types. Medical physicists use this tool to manage CT protocols, compare and optimize dose levels across different scanner models. It provides technologists feedback on CT scanning operation, and knowledge on important dose baselines and thresholds.

60 APPLIED LIFE SCIENCES↗

TH-C-12A-09: Planning and Delivery of the Fully Dynamic Trajectory Modulated Arc Therapy: Application to Accelerated Partial Breast Irradiation

Purpose: A novel trajectory modulated arc therapy (TMAT) system was developed that uses source motion trajectory involving synchronized gantry rotation with translational and rotational couch movement. MLC motion and dose rate were fully optimized for dynamic beam delivery. This work presents a platform for planning deliverable TMAT on a collision free coronal trajectory and evaluates its benefit for accelerated partial breast irradiation (APBI) in a prone position. Methods: The TMAT algorithm was built on VMAT with modifications (physical properties on couch movement were defined) and enhancements (pencil beam dose calculation engine to support extended SSDs) to make it feasible for TMAT delivery. A Matlab software environment for TMAT optimization and dose calculation was created to allow any user specified motion axis. TMAT delivery was implemented on Varian TrueBeamTM STx via XML scripts. 10 prone breast irradiation cases were evaluated in VMAT and compared with a 6- field non-coplanar IMRT plan. Patient selection/exclusion criteria and structure contouring followed the guidelines of NSABP B-39/RTOG 0413 protocol. Results: TMAT delivery time was ∼4.5 minutes. 251.5°±7.88° of non-isocentric couch arc was achieved by the optimized trajectory with 180– 210 control points at 1°–2° couch increments. The improved dose distribution by TMAT was most clearly observed by the marked reduction in the volume of irradiated normal breast tissue in the high dose region. The ratios of the normal breast tissue volume receiving more than 50%, 80% and 100% of the prescription dose for TMAT versus IMRT were: V50%(TMAT/IMRT) = 78.38%±13.03%, V80%(TMAT/IMRT) = 44.19%±9.04% and V100% (TMAT/IMRT) = 9.96%±7.55%, all p≤0.01. Conclusion: The study is the first demonstration of planning and delivery implementation of a fully dynamic APBI TMAT system with continuous couch motion. TMAT achieved significantly improved dosimetry over noncoplanar IMRT on dose volume parameters correlated with toxicity and cosmetic outcome of APBI. This project was supported by Varian Research Grant.

60 APPLIED LIFE SCIENCES↗

TH-E-BRE-07: Development of Dose Calculation Error Predictors for a Widely Implemented Clinical Algorithm

Purpose: Several shortcomings of the current implementation of the analytic anisotropic algorithm (AAA) may lead to dose calculation errors in highly modulated treatments delivered to highly heterogeneous geometries. Here we introduce a set of dosimetric error predictors that can be applied to a clinical treatment plan and patient geometry in order to identify high risk plans. Once a problematic plan is identified, the treatment can be recalculated with more accurate algorithm in order to better assess its viability. Methods: Here we focus on three distinct sources dosimetric error in the AAA algorithm. First, due to a combination of discrepancies in smallfield beam modeling as well as volume averaging effects, dose calculated through small MLC apertures can be underestimated, while that behind small MLC blocks can overestimated. Second, due the rectilinear scaling of the Monte Carlo generated pencil beam kernel, energy is not properly transported through heterogeneities near, but not impeding, the central axis of the beamlet. And third, AAA overestimates dose in regions very low density (< 0.2 g/cm{sup 3}). We have developed an algorithm to detect the location and magnitude of each scenario within the patient geometry, namely the field-size index (FSI), the heterogeneous scatter index (HSI), and the lowdensity index (LDI) respectively. Results: Error indices successfully identify deviations between AAA and Monte Carlo dose distributions in simple phantom geometries. Algorithms are currently implemented in the MATLAB computing environment and are able to run on a typical RapidArc head and neck geometry in less than an hour. Conclusion: Because these error indices successfully identify each type of error in contrived cases, with sufficient benchmarking, this method can be developed into a clinical tool that may be able to help estimate AAA dose calculation errors and when it might be advisable to use Monte Carlo calculations.

60 APPLIED LIFE SCIENCES↗