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All sourcesNASA NTRSDOE OSTI
DOE OSTI2018

Association of chronic fatigue syndrome with premature telomere attrition

Background: Chronic fatigue syndrome (CFS), also known as myalgic encephalomyelitis (ME), is a severely debilitating condition of unknown etiology. The symptoms and risk factors of ME/CFS share features of accelerated aging implicated in several diseases. Using telomere length as a marker, this study was performed to test the hypothesis that ME/CFS is associated with accelerated aging. Methods: Participant (n = 639) data came from the follow-up time point of the Georgia CFS surveillance study. Using the 1994 CFS Research Case Definition with questionnaire-based subscale thresholds for fatigue, function, and symptoms, participants were classified into four illness groups: CFS if all criteria were met (n = 64), CFS-X if CFS with exclusionary conditions (n = 77), ISF (insufficient symptoms/fatigue) if only some criteria were met regardless of exclusionary conditions (n = 302), and NF (non-fatigued) if no criteria and no exclusionary conditions (n = 196). Relative telomere length (T/S ratio) was measured using DNA from whole blood and real-time PCR. General linear models were used to estimate the association of illness groups or T/S ratio with demographics, biological measures and covariates with significance set at p < 0.05. Results: The mean T/S ratio differed significantly by illness group (p = 0.0017); the T/S ratios in CFS (0.90 ± 0.03) and ISF (0.94 ± 0.02) were each significantly lower than in NF (1.06 ± 0.04). Differences in T/S ratio by illness groups remained significant after adjustment for covariates of age, sex, body mass index, waist–hip ratio, post-exertional malaise and education attainment. Telomere length was shorter by 635, 254 and 424 base pairs in CFS, CFS-X and ISF, respectively, compared to NF. This shorter telomere length translates to roughly 10.1–20.5, 4.0–8.2 and 6.6–13.7 years of additional aging in CFS, CFS-X and ISF compared to NF respectively. Further, stratified analyses based on age and sex demonstrated that the association of ME/CFS with short telomeres is largely moderated by female subjects < 45 years old. Conclusions: This study found a significant association of ME/CFS with premature telomere attrition that is largely moderated by female subjects < 45 years old. Our results indicate that ME/CFS could be included in the list of conditions associated with accelerated aging. Further work is needed to evaluate the functional significance of accelerated aging in ME/CFS.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-T-514: Evaluation of the Accuracy of Free-Breathing and Deep Inspiration Breath-Hold Gated Beam Delivery Using An Elekta Linac

Purpose: In this study, we evaluated the performance of an Elekta linac in the delivery of gated radiotherapy. We examined whether the use of either a short gating window or a long beam hold impacts the accuracy of the delivery Methods: The performance of an Elekta linac in the delivery of gated radiotherapy was assessed using a 20cmX 20cm open field with the radiation delivered using a range of beam-on and beam-off time periods. Two SBRT plans were used to examine the accuracy of gated beam delivery for clinical treatment plans. For the SBRT cases, tests were performed for both free-breathing based gating and for gated delivery with a simulated breath-hold. A MatriXX 2D ion chamber array was used for data collection, and the gating accuracy was evaluated using gamma score. Results: For the 20cmX20cm open field, the gated beam delivery agreed closely with the non-gated delivery results. Discrepancies in the agreement, however, began to appear with a 5-to-1 ratio of the beam-off to beam-on. For these tight gating windows, each beam-on segment delivered a small number of monitor units. This finding was confirmed with dose distribution analysis from the delivery of the two VMAT plans where the gamma score(±1%,2%/1mm) showed passing rates in the range of 95% to 100% for gating windows of 25%, 38%, 50%, 63%, 75%, and 83%. Using a simulated sinusoidal breathing signal with a 4 second period, the gamma score of freebreathing gating and breath-hold gating deliveries were measured in the range of 95.7% to 100%. Conclusion: The results demonstrate that Elekta linacs can be used to accurately deliver respiratory gated treatments for both free-breathing and breath-hold patients. The accuracy of beams delivered in a gated delivery mode at low small MU proved higher than similar deliveries performed in a non-gated (manually interrupted) fashion.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-J-47: Comparison of Online Image Registrations of Varian TrueBeam Cone-Beam CT and BrainLab ExacTrac Imaging Systems

Purpose To compare online image registrations of TrueBeam cone-beam CT (CBCT) and BrainLab ExacTrac imaging systems. Methods Tests were performed on a Varian TrueBeam STx linear accelerator (Version 2.0), which is integrated with a BrainLab ExacTrac imaging system (Version 6.0.5). The study was focused on comparing the online image registrations for translational shifts. A Rando head phantom was placed on treatment couch and immobilized with a BrainLab mask. The phantom was shifted by moving the couch translationally for 8 mm with a step size of 1 mm, in vertical, longitudinal, and lateral directions, respectively. At each location, the phantom was imaged with CBCT and ExacTrac x-ray. CBCT images were registered with TrueBeam and ExacTrac online registration algorithms, respectively. And ExacTrac x-ray image registrations were performed. Shifts calculated from different registrations were compared with nominal couch shifts. Results The averages and ranges of absolute differences between couch shifts and calculated phantom shifts obtained from ExacTrac x-ray registration, ExacTrac CBCT registration with default window, ExaxTrac CBCT registration with adjusted window (bone), Truebeam CBCT registration with bone window, and Truebeam CBCT registration with soft tissue window, were: 0.07 (0.02–0.14), 0.14 (0.01–0.35), 0.12 (0.02–0.28), 0.09 (0–0.20), and 0.06 (0–0.10) mm, in vertical direction; 0.06 (0.01–0.12), 0.27 (0.07–0.57), 0.23 (0.02–0.48), 0.04 (0–0.10), and 0.08 (0– 0.20) mm, in longitudinal direction; 0.05 (0.01–0.21), 0.35 (0.14–0.80), 0.25 (0.01–0.56), 0.19 (0–0.40), and 0.20 (0–0.40) mm, in lateral direction. Conclusion The shifts calculated from ExacTrac x-ray and TrueBeam CBCT registrations were close to each other (the differences between were less than 0.40 mm in any direction), and had better agreements with couch shifts than those from ExacTrac CBCT registrations. There were no significant differences between TrueBeam CBCT registrations using different windows. In ExacTrac CBCT registrations, using bone window led to better agreements than using default window.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2025

Evaluating algorithmic bias on biomarker classification of breast cancer pathology reports

Objectives: This work evaluated algorithmic bias in biomarkers classification using electronic pathology reports from female breast cancer cases. Bias was assessed across 5 subgroups: cancer registry, race, Hispanic ethnicity, age at diagnosis, and socioeconomic status. Materials and Methods: We utilized 594 875 electronic pathology reports from 178 121 tumors diagnosed in Kentucky, Louisiana, New Jersey, New Mexico, Seattle, and Utah to train 2 deep-learning algorithms to classify breast cancer patients using their biomarkers test results. We used balanced error rate (BER), demographic parity (DP), equalized odds (EOD), and equal opportunity (EOP) to assess bias. Results: We found differences in predictive accuracy between registries, with the highest accuracy in the registry that contributed the most data (Seattle Registry, BER ratios for all registries >1.25). BER showed no significant algorithmic bias in extracting biomarkers (estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2) for race, Hispanic ethnicity, age at diagnosis, or socioeconomic subgroups (BER ratio <1.25). DP, EOD, and EOP all showed insignificant results. Discussion: We observed significant differences in BER by registry, but no significant bias using the DP, EOD, and EOP metrics for socio-demographic or racial categories. This highlights the importance of employing a diverse set of metrics for a comprehensive evaluation of model fairness. Conclusion: A thorough evaluation of algorithmic biases that may affect equality in clinical care is a critical step before deploying algorithms in the real world. We found little evidence of algorithmic bias in our biomarker classification tool. Artificial intelligence tools to expedite information extraction from clinical records could accelerate clinical trial matching and improve care.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

WE-G-18C-08: Real Time Tumor Imaging Using a Novel Dynamic Keyhole MRI Reconstruction Technique

Purpose: To test the hypothesis that the novel Dynamic Keyhole MRI reconstruction technique can accelerate image acquisition whilst maintaining high image quality for lung cancer patients. Methods: 18 MRI datasets from 5 lung cancer patients were acquired using a 3T MRI scanner. These datasets were retrospectively reconstructed using (A) The novel Dynamic Keyhole technique, (B) The conventional keyhole technique and (C) the conventional zero filling technique. The dynamic keyhole technique in MRI refers to techniques in which previously acquired k-space data is used to supplement under sampled data obtained in real time. The novel Dynamic Keyhole technique utilizes a previously acquired a library of kspace datasets in conjunction with central k-space datasets acquired in realtime. A simultaneously acquired respiratory signal is utilized to sort, match and combine the two k-space streams with respect to respiratory displacement. Reconstruction performance was quantified by (1) comparing the keyhole size (which corresponds to imaging speed) required to achieve the same image quality, and (2) maintaining a constant keyhole size across the three reconstruction methods to compare the resulting image quality to the ground truth image. Results: (1) The dynamic keyhole method required a mean keyhole size which was 48% smaller than the conventional keyhole technique and 60% smaller than the zero filling technique to achieve the same image quality. This directly corresponds to faster imaging. (2) When a constant keyhole size was utilized, the Dynamic Keyhole technique resulted in the smallest difference of the tumor region compared to the ground truth. Conclusion: The dynamic keyhole is a simple and adaptable technique for clinical applications requiring real-time imaging and tumor monitoring such as MRI guided radiotherapy. Based on the results from this study, the dynamic keyhole method could increase the imaging frequency by a factor of five compared with full k-space methods.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-T-213: Commissioning Results of the Prototype Active Scanning Irradiation System of Korea Heavy Ion Medical Accelerator

Purpose: A prototype actives scanning beam delivery system was designed, manufactured and installed as a part of the Korea Heavy Ion Medical Accelerator Project. The prototype system includes the most components for steering, modulating, detecting incident beam to patient. The system was installed in MC-50 cyclotron beam line and tested to extract the normal operation conditions. Methods: The commissioning process was completed by using 45 MeV of proton beam. To measure the beam position accuracy along the scanning magnet power supply current, 25 different spots were scanning and measured. The scanning results on GaF film were compared with the irradiation plan. Also, the beam size variation and the intensity reduction using range shifter were measured and analyzed. The results will be used for creating a conversion factors for asymmetric behavior of scanning magnets and a dose compensation factor for longitudinal direction. Results: The results show asymmetry operations on both scanning × and y magnet. In case of scanning magnet × operation, the current to position conversion factors were measured 1.69 mm/A for positive direction and 1.74 mm/A for negative direction. The scanning magnet y operation shows 1.38mm/A and 1.48 mm/A for both directions. The size of incoming beam which was 18 mm as sigma becomes larger up to 55 mm as sigma while using 10 mm of the range shifter plate. As the beam size becomes large, the maximum intensity of the was decreased. In case of using 10 mm of range shifter, the maximum intensity was only 52% compared with no range shifter insertion. Conclusion: For the appropriate operation of the prototype active scanning system, the commissioning process were performed to measure the beam characteristics variation. The obtained results would be applied on the irradiation planning software for more precise dose delivery using the active scanning system.

43 PARTICLE ACCELERATORS↗
DOE OSTI2014

SU-E-T-01: 2-D Characterization of DLG Among All MLC Leaf Pairs

Purpose: The aim of this study is to evaluate the variation of dosimetric leaf-gap (DLG) along the travel path of each MLC leaf pair. This study evaluates whether the spatial variations in DLG could cause dose differences between TPS-calculated and measured dose. Methods: The 6MV DLG values were measured for all leaf pairs in the direction of leaf motion using a 2-D diode array and 0.6cc ion chamber. These measurements were performed on two Varian Linacs, employing the Millennium 120-leaf MLC and a 2-D-DLG variation map was created via in-house software. Several test plans were created with sweeping MLC fields using constant gaps from 2mm to 10mm and corrected for 2-D variation utilizing in-house software. Measurements were performed utilizing the MapCHECK at 5.0cm depth for plans with and without the 2-D DLG correction and compared to the TPS calculated dose via gamma analysis (3%/3mm). Results: The measured DLGs for the middle 40 MLC leaf pairs (0.5cm width) were very similar along the central superior-inferior axis, with maximum variation of 0.2mm. The outer 20 MLC leaf pairs (1.0cm width) have DLG values from 0.32mm (mean) to 0.65mm (maximum) lower than the central leaf-pair, depending on off-axis distance. Gamma pass rates for the 2mm, 4mm, and 6mm sweep plans increased by 23.2%, 28.7%, and 26.0% respectively using the 2-D-DLG correction. The most improved dose points occur in areas modulated by the 1.0cm leaf-pairs. The gamma pass rate for the 10mm sweep plan increased by only 7.7%, indicating that the 2D variation becomes less significant for dynamic plans with larger MLC gaps. Conclusion: Fluences residing significantly off-axis with narrow sweeping gaps may exhibit significant variations from planned dose due to large differences between the true DLG exhibited by the 1.0cm leaf-pairs versus the constant DLG value utilized by the TPS for dose calculation.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-184: Clinical VMAT QA Practice Using LINAC Delivery Log Files

Purpose: To evaluate the accuracy of volumetric modulated arc therapy (VMAT) treatment delivery dose clouds by comparing linac log data to doses measured using an ionization chamber and film. Methods: A commercial IMRT quality assurance (QA) process utilizing a DICOM-RT framework was tested for clinical practice using 30 prostate and 30 head and neck VMAT plans. Delivered 3D VMAT dose distributions were independently checked using a PinPoint ionization chamber and radiographic film in a solid water phantom. DICOM RT coordinates were used to extract the corresponding point and planar doses from 3D log file dose distributions. Point doses were evaluated by computing the percent error between log file and chamber measured values. A planar dose evaluation was performed for each plan using a 2D gamma analysis with 3% global dose difference and 3 mm isodose point distance criteria. The same analysis was performed to compare treatment planning system (TPS) doses to measured values to establish a baseline assessment of agreement. Results: The mean percent error between log file and ionization chamber dose was 1.0%±2.1% for prostate VMAT plans and −0.2%±1.4% for head and neck plans. The corresponding TPS calculated and measured ionization chamber values agree within 1.7%±1.6%. The average 2D gamma passing rates for the log file comparison to film are 98.8%±1.0% and 96.2%±4.2% for the prostate and head and neck plans, respectively. The corresponding passing rates for the TPS comparison to film are 99.4%±0.5% and 93.9%±5.1%. Overall, the point dose and film data indicate that log file determined doses are in excellent agreement with measured values. Conclusion: Clinical VMAT QA practice using LINAC treatment log files is a fast and reliable method for patient-specific plan evaluation.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2011

Fibroblast Growth Factor-Peptide Improves Barrier Function and Proliferation in Human Keratinocytes After Radiation

Purpose: Epidermal keratinocytes, which can be severely damaged after ionizing radiation (IR), are rapid turnover cells that function as a barrier, protecting the host from pathogenic invasion and fluid loss. We tested fibroblast growth factor-peptide (FGF-P), a small peptide derived from the receptor-binding domain of FGF-2, as a potential mitigator of radiation effects via proliferation and the barrier function of keratinocytes. Methods and Materials: Keratinocytes isolated from neonatal foreskin were grown on transwells. After being exposed to 0, 5, or 10 Gy IR, the cells were treated with a vehicle or FGF-P. The permeability of IR cells was assessed by using transepithelial electrical resistance (TEER) and a paracellular tracer flux of fluorescein isothiocyanate-conjugated bovine serum albumin (FITC-BSA) with Ussing chambers. The cell proliferation was measured with yellow tetrazolium salt (MTT) and tritiated thymidine ([{sup 3}H]-TdR) assays. The phosphorylation of extracellular signal-regulated kinases (ERK) was measured in an enzyme-linked immunosorbent (ELISA)-like assay, and the proteins related to tight junctions (TJ) and adherens junctions (AJ) were examined with Western blotting. We used a mouse model to assess the ability of FGF-P to promote the healing of skin {beta} burns created with a strontium applicator. Results: We found (1) FGF-P reduced the permeability of irradiated keratinocytes, as evidenced by increased TEER and decreased diffusion of FITC-BSA, both associated with the regulation of different proteins and levels of TJ and AJ; and (2) FGF-P enhanced the proliferation of irradiated keratinocytes, as evidenced by increased MTT activity and [{sup 3}H]-TdR incorporation, which was associated with activation of the ERK pathway; and (3) FGF-P promoted the healing of skin {beta} burns. Conclusions: FGF-P enhances the barrier function, including up-regulation of TJ proteins, increases proliferation of human keratinocytes, and accelerates the healing of skin {beta} burns. FGF-P is a promising mitigator that improves the proliferation and barrier function of keratinocytes after IR.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

Characterizing spatiotemporal information loss in sparse-sampling-based dynamic MRI for monitoring respiration-induced tumor motion in radiotherapy

Purpose: Sparse-sampling and reconstruction techniques represent an attractive strategy to achieve faster image acquisition speeds, while maintaining adequate spatial resolution and signal-to-noise ratio in rapid magnetic resonance imaging (MRI). The authors investigate the use of one such sequence, broad-use linear acquisition speed-up technique (k-t BLAST) in monitoring tumor motion for thoracic and abdominal radiotherapy and examine the potential trade-off between increased sparsification (to increase imaging speed) and the potential loss of “true” information due to greater reliance on a priori information. Methods: Lung tumor motion trajectories in the superior–inferior direction, previously recorded from ten lung cancer patients, were replayed using a motion phantom module driven by an MRI-compatible motion platform. Eppendorf test tubes filled with water which serve as fiducial markers were placed in the phantom. The modeled rigid and deformable motions were collected in a coronal image slice using balanced fast field echo in conjunction with k-t BLAST. Root mean square (RMS) error was used as a metric of spatial accuracy as measured trajectories were compared to input data. The loss of spatial information was characterized for progressively increasing acceleration factor from 1 to 16; the resultant sampling frequency was increased approximately from 2.5 to 19 Hz when the principal direction of the motion was set along frequency encoding direction. In addition to the phantom study, respiration-induced tumor motions were captured from two patients (kidney tumor and lung tumor) at 13 Hz over 49 s to demonstrate the impact of high speed motion monitoring over multiple breathing cycles. For each subject, the authors compared the tumor centroid trajectory as well as the deformable motion during free breathing. Results: In the rigid and deformable phantom studies, the RMS error of target tracking at the acquisition speed of 19 Hz was approximately 0.3–0.4 mm, which was smaller than the reconstructed pixel resolution of 0.67 mm. In the patient study, the dynamic 2D MRI enabled the monitoring of cycle-to-cycle respiratory variability present in the tumor position. It was seen that the range of centroid motion as well as the area covered due to target motion during each individual respiratory cycle was underestimated compared to the entire motion range observed over multiple breathing cycles. Conclusions: The authors’ initial results demonstrate that sparse-sampling- and reconstruction-based dynamic MRI can be used to achieve adequate image acquisition speeds without significant information loss for the task of radiotherapy guidance. Such monitoring can yield spatial and temporal information superior to conventional offline and online motion capture methods used in thoracic and abdominal radiotherapy.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-J-21: Clinical Evaluation of Surface Scanning Systems in Different Treatment Locations

Purpose: To reduce imaging dose in fractionated IGRT, the ability of optical surface imaging systems (OSIS) to detect setup errors was tested. Therefore, clinical studies to evaluate for different treatment locations setup corrections derived by OSIS in comparison with x-ray image guidance in fractionated radiation therapy was performed. Methods: The setup correction accuracy of an OSIS system (AlignRT, VisionRT, London, UK) will be analysed for the 4 tumour locations Pelvis, Upper Abdomen, Thorax and Breast, 20 patients for each location in comparison to a different system (Sentinel, C-RAD, SE). For each patient, the setup corrections of the cone-beam computed tomography (CBCT) of an Elekta Versa HD linear accelerator (Elekta, Crawley, UK) is considered as gold-standard and then compared with those of the OSIS for the first ten fractions retrospectively. There were no clinical decisions made based on the surrogate system. For the OSIS, the reference surface is highly important as it represents the actual ground truth. It can be obtained either with the system itself or the surface structure delineated in the planning CT can be imported via DICOM interface. In this paper, the first results for the treatment region thorax are presented. The reference image modalities were compared. Results: Table 1 displays the difference between the setup corrections obtained with OSIS and CBCT in lateral (LAT), longitudinal (LNG) and vertical (VRT) direction for the DICOM reference image. While the median deviations are within a few millimeters, some outliers showed large deviations. Generally, the mean deviation as well as the spread was smallest in lateral and largest in vertical direction. Conclusion: Although the system allows fast, simple and non-invasive determination of setup corrections, it should be evaluated treatment region dependant. Therefore, the study is ongoing. The application of OSIS may help to reduce the imaging dose for the patient. We gratefully acknowledge the support by our colleagues from the Radiological University Clinic Heidelberg, where the study was performed. This work was funded by the Federal Ministry of Education and Research (BMBF) Germany, grant number 01IB13001B.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-T-226: QA Management for a Large Institution with Multiple Campuses for FMEA

Purpose: To redesign our radiation therapy QA program with the goal to improve quality, efficiency, and consistency among a growing number of campuses at a large institution. Methods: A QA committee was established with at least one physicist representing each of our six campuses (22 linacs). Weekly meetings were scheduled to advise on and update current procedures, to review end-to-end and other test results, and to prepare composite reports for internal and external audits. QA procedures for treatment and imaging equipment were derived from TG Reports 142 and 66, practice guidelines, and feedback from ACR evaluations. The committee focused on reaching a consensus on a single QA program among all campuses using the same type of equipment and reference data. Since the recommendations for tolerances referenced to baseline data were subject to interpretation in some instances, the committee reviewed the characteristics of all machines and quantified any variations before choosing between treatment planning system (i.e. treatment planning system commissioning data that is representative for all machines) or machine-specific values (i.e. commissioning data of the individual machines) as baseline data. Results: The configured QA program will be followed strictly by all campuses. Inventory of available equipment has been compiled, and additional equipment acquisitions for the QA program are made as needed. Dosimetric characteristics are evaluated for all machines using the same methods to ensure consistency of beam data where possible. In most cases, baseline data refer to treatment planning system commissioning data but machine-specific values are used as reference where it is deemed appropriate. Conclusion: With a uniform QA scheme, variations in QA procedures are kept to a minimum. With a centralized database, data collection and analysis are simplified. This program will facilitate uniformity in patient treatments and analysis of large amounts of QA data campus-wide, which will ultimately facilitate FMEA.

43 PARTICLE ACCELERATORS↗
DOE OSTI2016

SU-F-T-463: Light-Field Based Dynalog Verification

Purpose: To independently verify leaf positions in so-called dynalog files for a Varian iX linac with a Millennium 120 MLC. This verification provides a measure of confidence that the files can be used directly as part of a more extensive intensity modulated radiation therapy / volumetric modulated arc therapy QA program. Methods: Initial testing used white paper placed at the collimator plane and a standard hand-held digital camera to image the light and shadow of a static MLC field through the paper. Known markings on the paper allow for image calibration. Noise reduction was attempted with removal of ‘inherent noise’ from an open-field light image through the paper, but the method was found to be inconsequential. This is likely because the environment could not be controlled to the precision required for the sort of reproducible characterization of the quantum noise needed in order to meaningfully characterize and account for it. A multi-scale iterative edge detection algorithm was used for localizing the leaf ends. These were compared with the planned locations from the treatment console. Results: With a very basic setup, the image of the central bank A leaves 15–45, which are arguably the most important for beam modulation, differed from the planned location by [0.38±0.28] mm. Similarly, for bank B leaves 15–45 had a difference of [0.42±0.28] mm Conclusion: It should be possible to determine leaf position accurately with not much more than a modern hand-held camera and some software. This means we can have a periodic and independent verification of the dynalog file information. This is indicated by the precision already achieved using a basic setup and analysis methodology. Currently, work is being done to reduce imaging and setup errors, which will bring the leaf position error down further, and allow meaningful analysis over the full range of leaves.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-438: Frameless Cranial Stereotactic Radiosurgery Immobilization Effectiveness Evaluation

Purpose: To evaluate immobilization effectiveness of Brainlab frameless mask in cranial stereotactic radiosurgery (SRS). Methods: Two sets of setup images were collected pre-and post-treatment for 24 frameless SRS cases. The pre-treatment images were obtained after applying 2D-2D kV image-guided shifts with patients in treatment position and approved by physicians; the post-treatment images were taken immediately after treatment completion. All cases were treated on a Novalis linac with ExacTrac positioning system and Exact Couch. The two image sets were compared with the correctional shifts measured by ExacTrac 6D auto-fusion. The shift differences were considered patient motion within the frameless mask and were used to evaluate its effectiveness for immobilization. Two-tailed paired t-test was applied for significance comparison. Results: The correctional shifts (mean±STD, median) of pre-and post-treatment images were 0.33±0.27mm, 0.26mm and 0.34±0.27mm, 0.23mm (p=0.740) in lateral direction; 0.32±0.29mm, 0.22mm and 0.48±0.30mm, 0.50mm (p=0.012) in longitudinal direction; 0.31±0.22mm, 0.24mm and 0.33±0.21mm, 0.36mm (p=0.623) in vertical direction. The radial correctional shifts (mean±STD, median) of pre -and post-treatment images were 0.60±0.38mm, 0.45mm and 0.75±0.31mm, 0.66mm (p=0.033). The shift differences (mean±STD, median, maximum) were 0.35±0.28mm, 0.3mm, 1.05mm, 0.34±0.28mm, 0.3mm, 1.00mm, 0.24±0.15mm, 0.21mm, 0.60mm and 0.61±0.32mm, 0.57mm, 1.40mm in lateral, longitudinal, vertical and radial direction, respectively. Two shifts greater than 1 mm (1.06mm and 1.02mm) were acquired from post-treatment images. However, the shift differences were only 0.09 and 0.19mm for these two shifts. Two patients with shift differences greater than 1mm (1.05 and 1.04mm) were observed and didn’t coincide with those two who had post-correctional shifts greater than 1mm. Conclusion: Image-guided SRS allowed us to set up patients with sub-millimeter accuracy relative to simulation position. However, patient motion during treatment could affect treatment accuracy. Our Result shows that Brainlab frameless mask provides reasonable patient immobilization and maintains the mean post-treatment position within sub-millimeter accuracy with some borderline results observed.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2025

Impact of Testing Method on Safety Assessment of Aged Li-Ion Cells: Part II – Aged Cells Without Li Plating

Understanding the safety profile of aged Li-ion batteries is essential for developing effective battery management and hazard mitigation strategies. However, most safety assessments have focused on fresh batteries, with just a few calorimetry studies on aged batteries with metal oxide positive electrodes. This study provides a broad assessment of commercial 18650-type Li-ion batteries with NCA, NMC, and LFP positive electrodes, both uncycled and aged under conditions that promoted solid electrolyte interphase (SEI) growth as the dominant degradation mechanism. The cells underwent mechanical (nail penetration, crush), electrical (overcharge, overdischarge), and thermal (accelerating rate calorimetry) abuse tests. Safety was rated on general characteristics such as mass loss, maximum temperature, and EUCAR (European Council for Automotive R&D) hazard level, as well as characteristics specific to individual abuse tests. Generally, aged cells with SEI growth exhibited similar or improved safety compared to uncycled cells, contrasting with our previous findings on NCA cells with Li plating as the dominant aging mechanism (Part I of this series). Yet, some tests and characteristics indicated reduced aged cell safety, such as earlier triggering of mechanical failure. These results emphasize the need to examine aged battery safety across diverse empirical techniques, degradation modes, and chemistries.

Lithium-ion cells↗
DOE OSTI2014

SU-E-J-109: Testing the KV Imaging Center Congruence with Radiation Isocenter of Small MLC and SRS Cone Field On Two Machines

Purpose: Orthogonal kV image pairs are used for target localization when fiducial markers are implanted. CBCT is used to verify cone SRS setup. Therefore it is necessary to evaluate the isocenter congruence between radiation fields and kV imaging center. This study used a simple method to evaluate the isocenter congruence, and compared the results for MLC and cone fields on two different Linacs. Methods: Varian OBI block was attached on the couch. It has a central 1mm BB with markers on three surfaces to align with laser. KV and MV images were taken at four cardinal angles. A 3x3cm2 MLC field and a 20mm cone field were irradiated respectively. On each kV image, the distance from BB center to the kV graticule center were measured. On the MV image of MLC field, the center of radiation field was determined manually, while for cone field, the Varian AM maintenance software was used to analyze the distance between BB and radiation field. The subtraction of the two distances gives the discrepancy between kV and radiation centers. Each procedure was repeated on five days at Trilogy and TrueBeam respectively. Results: The maximum discrepancy was found in the longitudinal direction at 180° gantry angel. It was 1.5±0.1mm for Trilogy and 0.6±0.1mm for TrueBeam. For Trilogy, although radiation center wobbled only 0.7mm and image center wobbled 0.8mm, they wobbled to the opposite direction. KV Pair using gantry 180° should be avoided in this case. Cone vs. kV isocenter has less discrepancy than MLC for Trilogy. Conclusion: Radiation isocenter of MLC and cone field is different, so is between Trilogy and TrueBeam. The method is simple and reproducible to check kV and radiation isocenter congruence.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗
DOE OSTI2014

SU-E-T-638: Evaluation and Comparison of Landauer Microstar (OSLD) Readers

Purpose: To evaluate and compare characteristic performance of a new Landauer nanodot Reader with the previous model. Methods: In order to calibrate and test the reader, a set of nanodots were irradiated using a Varian Truebeam Linac. Solid water slabs and bolus were used in the process of irradiation. Calibration sets of nanodots were irradiated for radiation dose ranges: 0 to 10 and 20 to 1000 cGy, using 6MV photons. Additionally, three sets of nanodots were each irradiated using 6MV, 10MV and 15MV beams. For each beam energy, and selected dose in the range of 3 to 1000 cGy, a pair of nanodots was irradiated and three readings were obtained with both readers. Results: The analysis shows that for 3 photon beam energies and selected ranges of dose, the calculated absorbed dose agrees well with the expected value. The results illustrate that the new Microstar II reader is a highly consistent system and that the repeated readings provide results with a reasonably small standard deviation. For all practical purposes, the response of system is linear for all radiation beam energies. Conclusion: The Microstar II nanodot reader is consistent, accurate, and reliable. The new hardware design and corresponding software contain several advantages over the previous model. The automatic repeat reading mechanism, that helps improve reproducibility and reduce processing time, and the smaller unit size that renders ease of transport, are two of such features. Present study shows that for high dose ranges a polynomial calibration equation provides more consistent results. A 3rd order polynomial calibration curve was used to analyze the readings of dosimeters exposed to high dose range radiation. It was observed that the results show less error compared to those calculated by using linear calibration curves, as provided by Landauer system software for all dose ranges.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-T-629: Effect of Multi-Leaf Collimator (MLC) Width On Plan Quality of Single-Isocenter VMAT Intracranial Stereotactic Radiosurgery for Multiple Metastases

Purpose: Single-isocenter VMAT has been shown able to create high quality plans for complex intracranial multiple metastasis SRS cases. Linacs capable of the technique are typically outfitted with an MLC that consists of a combination of 5 mm and 10 mm leaves (standard) or 2.5 mm and 5 mm leaves (high-definition). In this study, we test the hypothesis that thinner collimator leaves are associated with improved plan quality. Methods: Ten multiple metastasis cases were identified and planned for VMAT SRS using a 10 MV flattening filter free beam. Plans were created for a standard (std) and a high-definition (HD) MLC. Published values for leaf transmission factor and dosimetric leaf gap were utilized. All other parameters were invariant. Conformity (plan and individual target), moderate isodose spill (V50%), and low isodose spill (mean brain dose) were selected for analysis. Results: Compared to standard MLC, HD-MLC improved overall plan conformity (median: Paddick CI-HD = 0.83, Paddick CI-std = 0.79; p = 0.004 and median: RTOG CI-HD =1.18, RTOG CI-std =1.24; p = 0.01 ), improved individual lesion conformity (median: Paddick CI-HD,i =0.77, Paddick CI-std,i =0.72; p < 0.001 and median: RTOG CI-HD,i = 1.28, RTOG CI-std,i =1.35; p < 0.001), improved moderate isodose spill (median: V50%-HD = 37.0 cc, V50%-std = 45.7 cc; p = 0.002), and improved low dose spill (median: dmean-HD = 2.90 Gy, dmean-std = 3.19 Gy; p = 0.002). Conclusion: For the single-isocenter VMAT SRS of multiple metastasis plans examined, use of HD-MLC modestly improved conformity, moderate isodose, and low isodose spill compared to standard MLC. However, in all cases we were able to generate clinically acceptable plans with the standard MLC. More work is need to further quantify the difference in cases with higher numbers of small targets and to better understand any potential clinical significance. This research was supported in part by Varian Medical Systems.

60 APPLIED LIFE SCIENCES↗