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At least 721 records · Page 40
All sourcesNASA NTRSDOE OSTI
DOE OSTI2013

Modeling the dosimetry of organ-at-risk in head and neck IMRT planning: An intertechnique and interinstitutional study

Purpose: To build a statistical model to quantitatively correlate the anatomic features of structures and the corresponding dose-volume histogram (DVH) of head and neck (HN) Tomotherapy (Tomo) plans. To study if the model built upon one intensity modulated radiation therapy (IMRT) technique (such as conventional Linac) can be used to predict anticipated organs-at-risk (OAR) DVH of patients treated with a different IMRT technique (such as Tomo). To study if the model built upon the clinical experience of one institution can be used to aid IMRT planning for another institution. Methods: Forty-four Tomotherapy intensity modulate radiotherapy plans of HN cases (Tomo-IMRT) from Institution A were included in the study. A different patient group of 53 HN fixed gantry IMRT (FG-IMRT) plans was selected from Institution B. The analyzed OARs included the parotid, larynx, spinal cord, brainstem, and submandibular gland. Two major groups of anatomical features were considered: the volumetric information and the spatial information. The volume information includes the volume of target, OAR, and overlapped volume between target and OAR. The spatial information of OARs relative to PTVs was represented by the distance-to-target histogram (DTH). Important anatomical and dosimetric features were extracted from DTH and DVH by principal component analysis. Two regression models, one for Tomotherapy plan and one for IMRT plan, were built independently. The accuracy of intratreatment-modality model prediction was validated by a leave one out cross-validation method. The intertechnique and interinstitution validations were performed by using the FG-IMRT model to predict the OAR dosimetry of Tomo-IMRT plans. The dosimetry of OARs, under the same and different institutional preferences, was analyzed to examine the correlation between the model prediction and planning protocol. Results: Significant patient anatomical factors contributing to OAR dose sparing in HN Tomotherapy plans have been analyzed and identified. For all the OARs, the discrepancies of dose indices between the model predicted values and the actual plan values were within 2.1%. Similar results were obtained from the modeling of FG-IMRT plans. The parotid gland was spared in a comparable fashion during the treatment planning of two institutions. The model based on FG-IMRT plans was found to predict the median dose of the parotid of Tomotherapy plans quite well, with a mean error of 2.6%. Predictions from the FG-IMRT model suggested the median dose of the larynx, median dose of the brainstem and D2 of the brainstem could be reduced by 10.5%, 12.8%, and 20.4%, respectively, in the Tomo-IMRT plans. This was found to be correlated to the institutional differences in OAR constraint settings. Re-planning of six Tomotherapy patients confirmed the potential of optimization improvement predicted by the FG-IMRT model was correct. Conclusions: The authors established a mathematical model to correlate the anatomical features and dosimetric indexes of OARs of HN patients in Tomotherapy plans. The model can be used for the setup of patient-specific OAR dose sparing goals and quality control of planning results. The institutional clinical experience was incorporated into the model which allows the model from one institution to generate a reference plan for another institution, or another IMRT technique.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2013

Predicting objective function weights from patient anatomy in prostate IMRT treatment planning

Purpose: Intensity-modulated radiation therapy (IMRT) treatment planning typically combines multiple criteria into a single objective function by taking a weighted sum. The authors propose a statistical model that predicts objective function weights from patient anatomy for prostate IMRT treatment planning. This study provides a proof of concept for geometry-driven weight determination. Methods: A previously developed inverse optimization method (IOM) was used to generate optimal objective function weights for 24 patients using their historical treatment plans (i.e., dose distributions). These IOM weights were around 1% for each of the femoral heads, while bladder and rectum weights varied greatly between patients. A regression model was developed to predict a patient's rectum weight using the ratio of the overlap volume of the rectum and bladder with the planning target volume at a 1 cm expansion as the independent variable. The femoral head weights were fixed to 1% each and the bladder weight was calculated as one minus the rectum and femoral head weights. The model was validated using leave-one-out cross validation. Objective values and dose distributions generated through inverse planning using the predicted weights were compared to those generated using the original IOM weights, as well as an average of the IOM weights across all patients. Results: The IOM weight vectors were on average six times closer to the predicted weight vectors than to the average weight vector, usingl{sub 2} distance. Likewise, the bladder and rectum objective values achieved by the predicted weights were more similar to the objective values achieved by the IOM weights. The difference in objective value performance between the predicted and average weights was statistically significant according to a one-sided sign test. For all patients, the difference in rectum V54.3 Gy, rectum V70.0 Gy, bladder V54.3 Gy, and bladder V70.0 Gy values between the dose distributions generated by the predicted weights and IOM weights was less than 5 percentage points. Similarly, the difference in femoral head V54.3 Gy values between the two dose distributions was less than 5 percentage points for all but one patient. Conclusions: This study demonstrates a proof of concept that patient anatomy can be used to predict appropriate objective function weights for treatment planning. In the long term, such geometry-driven weights may serve as a starting point for iterative treatment plan design or may provide information about the most clinically relevant region of the Pareto surface to explore.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2014

Direct leaf trajectory optimization for volumetric modulated arc therapy planning with sliding window delivery

Purpose: The authors propose a novel optimization model for volumetric modulated arc therapy (VMAT) planning that directly optimizes deliverable leaf trajectories in the treatment plan optimization problem, and eliminates the need for a separate arc-sequencing step. Methods: In this model, a 360° arc is divided into a given number of arc segments in which the leaves move unidirectionally. This facilitates an algorithm that determines the optimal piecewise linear leaf trajectories for each arc segment, which are deliverable in a given treatment time. Multileaf collimator constraints, including maximum leaf speed and interdigitation, are accounted for explicitly. The algorithm is customized to allow for VMAT delivery using constant gantry speed and dose rate, however, the algorithm generalizes to variable gantry speed if beneficial. Results: The authors demonstrate the method for three different tumor sites: a head-and-neck case, a prostate case, and a paraspinal case. The authors first obtain a reference plan for intensity modulated radiotherapy (IMRT) using fluence map optimization and 20 intensity-modulated fields in equally spaced beam directions, which is beyond the standard of care. Modeling the typical clinical setup for the treatment sites considered, IMRT plans using seven or nine beams are also computed. Subsequently, VMAT plans are optimized by dividing the 360° arc into 20 corresponding arc segments. Assuming typical machine parameters (a dose rate of 600 MU/min, and a maximum leaf speed of 3 cm/s), it is demonstrated that the optimized VMAT plans with 2–3 min delivery time are of noticeably better quality than the 7–9 beam IMRT plans. The VMAT plan quality approaches the quality of the 20-beam IMRT benchmark plan for delivery times between 3 and 4 min. Conclusions: The results indicate that high quality treatments can be delivered in a single arc with 20 arc segments if sufficient time is allowed for modulation in each segment.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2014

Parametrization of textural patterns in {sup 123}I-ioflupane imaging for the automatic detection of Parkinsonism

Purpose: A novel approach to a computer aided diagnosis system for the Parkinson's disease is proposed. This tool is intended as a supporting tool for physicians, based on fully automated methods that lead to the classification of{sup 123}I-ioflupane SPECT images. Methods: {sup 123}I-ioflupane images from three different databases are used to train the system. The images are intensity and spatially normalized, then subimages are extracted and a 3D gray-level co-occurrence matrix is computed over these subimages, allowing the characterization of the texture using Haralick texture features. Finally, different discrimination estimation methods are used to select a feature vector that can be used to train and test the classifier. Results: Using the leave-one-out cross-validation technique over these three databases, the system achieves results up to a 97.4% of accuracy, and 99.1% of sensitivity, with positive likelihood ratios over 27. Conclusions: The system presents a robust feature extraction method that helps physicians in the diagnosis task by providing objective, operator-independent textural information about{sup 123}I-ioflupane images, commonly used in the diagnosis of the Parkinson's disease. Textural features computation has been optimized by using a subimage selection algorithm, and the discrimination estimation methods used here makes the system feature-independent, allowing us to extend it to other databases and diseases.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2014

A novel electron gun for inline MRI-linac configurations

Purpose: This work introduces a new electron gun geometry capable of robust functioning in the presence of a high strength external magnetic field for axisymmetric magnetic resonance imaging (MRI)-linac configurations. This allows an inline MRI-linac to operate without the need to isolate the linear accelerator (linac) using a magnetic shield. This MRI-linac integration approach not only leaves the magnet homogeneity unchanged but also provides the linac flexibility to move along the magnet axis of symmetry if the source to target distance needs to be adjusted. Methods: Simple electron gun geometry modifications of a Varian 600C electron gun are considered and solved in the presence of an external magnetic field in order to determine a set of design principles for the new geometry. Based on these results, a new gun geometry is proposed and optimized in the fringe field of a 0.5 T open bore MRI magnet (GE Signa SP). A computer model for the 6 MeV Varian 600C linac is used to determine the capture efficiency of the new electron gun-linac system in the presence of the fringe field of the same MRI scanner. The behavior of the new electron gun plus the linac system is also studied in the fringe fields of two other magnets, a 1.0 T prototype open bore magnet and a 1.5 T GE Conquest scanner. Results: Simple geometrical modifications of the original electron gun geometry do not provide feasible solutions. However, these tests show that a smaller transverse cathode diameter with a flat surface and a slightly larger anode diameter could alleviate the current loss due to beam interactions with the anode in the presence of magnetic fields. Based on these findings, an initial geometry resembling a parallel plate capacitor with a hole in the anode is proposed. The optimization procedure finds a cathode-anode distance of 5 mm, a focusing electrode angle of 5°, and an anode drift tube length of 17.1 mm. Also, the linac can be displaced with ±15 cm along the axis of the 0.5 T magnet without capture efficiency reduction below the experimental value in zero field. In this range of linac displacements, the electron beam generated by the new gun geometry is more effectively injected into the linac in the presence of an external magnetic field, resulting in approximately 20% increase of the target current compared to the original gun geometry behavior at zero field. The new gun geometry can generate and accelerate electron beams in external magnetic fields without current loss for fields higher than 0.11 T. The new electron-gun geometry is robust enough to function in the fringe fields of the other two magnets with a target current loss of no more than 16% with respect to the current obtained with no external magnetic fields. Conclusions: In this work, a specially designed electron gun was presented which can operate in the presence of axisymmetric strong magnetic fringe fields of MRI magnets. Computer simulations show that the electron gun can produce high quality beams which can be injected into a straight through linac such as Varian 600C and accelerated with more efficiency in the presence of the external magnetic fields. Also, the new configuration allows linac displacements along the magnet axis in a range equal to the diameter of the imaging spherical volume of the magnet under consideration. The new electron gun-linac system can function in the fringe field of a MRI magnet if the field strength at the cathode position is higher than 0.11 T. The capture efficiency of the linac depends on the magnetic field strength and the field gradient. The higher the gradient the better the capture efficiency. The capture efficiency does not degrade more than 16%.

43 PARTICLE ACCELERATORS↗
DOE OSTI2014

A dosimetric characterization of a novel linear accelerator collimator

Purpose: The aim of this work is to characterize a new linear accelerator collimator which contains a single pair of sculpted diaphragms mounted orthogonally to a 160 leaf multileaf collimator (MLC). The diaphragms have “thick” regions providing full attenuation and “thin” regions where attenuation is provided by both the leaves and the diaphragm. The leaves are mounted on a dynamic leaf guide allowing rapid leaf motion and leaf travel over 350 mm. Methods: Dosimetric characterization, including assessment of leaf transmission, leaf tip transmission, penumbral width, was performed in a plotting tank. Head scatter factor was measured using a mini-phantom and the effect of leaf guide position on output was assessed using a water phantom. The tongue and groove effect was assessed using multiple exposures on radiochromic film. Leaf reproducibility was assessed from portal images of multiple abutting fields. Results: The maximum transmission through the multileaf collimator is 0.44% at 6 MV and 0.52% at 10 MV. This reduced to 0.22% and 0.27%, respectively, when the beam passes through the dynamic leaf guide in addition to the MLC. The maximum transmission through the thick part of the diaphragm is 0.32% and 0.36% at 6 and 10 MV. The combination of leaf and diaphragm transmission ranges from 0.08% to 0.010% at 6 MV and 0.10% to 0.14% depending on whether the shielding is through the thick or thin part of the diaphragm. The off-axis intertip transmission for a zero leaf gap is 2.2% at 6 and 10 MV. The leaf tip penumbra for a 100 × 100 mm field ranges from 5.4 to 4.3 mm at 6 and 10 MV across the full range of leaf motion when measured in the AB direction, which reduces to 4.0–3.4 mm at 6 MV and 4.5–3.8 mm at 10 MV when measured in the GT direction. For a 50 × 50 mm field, the diaphragm penumbra ranges from 4.3 to 3.7 mm at 6 MV and 4.5 to 4.1 mm at 10 MV in the AB direction and 3.7 to 3.2 mm at 6 MV and 4.2 to 3.7 mm when measured in the GT direction. The tongue and groove effect observed from exposure of a radiochromic film to two abutting fields is an underdose of 25%. The head scatter factor at both 6 and 10 MV is similar to that from the MLCi2 collimator to within 0.8%. The uncertainty in the leaf position reproducibility is 0.05 mm (2σ). Conclusions: The Agility collimator is a low leakage, high definition collimator where both the MLC and the sculpted diaphragm have been optimized for dynamic treatments.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2014

TU-C-BRE-02: A Novel, Highly Efficient and Automated Quality Assurance Tool for Modern Linear Accelerators

Purpose: Quality assurance (QA) of complex linear accelerators is critical and highly time consuming. Varian’s Machine Performance Check (MPC) uses IsoCal phantom to test geometric and dosimetric aspects of the TrueBeam systems in <5min. In this study we independently tested the accuracy and robustness of the MPC tools. Methods: MPC is automated for simultaneous image-acquisition, using kV-and-MV onboard-imagers (EPIDs), while delivering kV-and-MV beams in a set routine of varying gantry, collimator and couch angles. MPC software-tools analyze the images to test: i) beam-output and uniformity, ii) positional accuracy of isocenter, EPIDs, collimating jaws (CJs), MLC leaves and couch and iii) rotational accuracy of gantry, collimator and couch. 6MV-beam dose-output and uniformity were tested using ionization-chamber (IC) and ICarray. Winston-Lutz-Tests (WLT) were performed to measure isocenter-offsets caused by gantry, collimator and couch rotations. Positional accuracy of EPIDs was evaluated using radio-opaque markers of the IsoCal phantom. Furthermore, to test the robustness of the MPC tools we purposefully miscalibrated a non-clinical TrueBeam by introducing errors in beam-output, energy, symmetry, gantry angle, couch translations, CJs and MLC leaves positions. Results: 6MV-output and uniformity were within ±0.6% for most measurements with a maximum deviation of ±1.0%. Average isocenter-offset caused by gantry and collimator rotations was 0.316±0.011mm agreeing with IsoLock (0.274mm) and WLT (0.41mm). Average rotation-induced couch-shift from MPC was 0.378±0.032mm agreeing with WLT (0.35mm). MV-and-kV imager-offsets measured by MPC were within ±0.15mm. MPC predicted all machine miscalibrations within acceptable clinical tolerance. MPC detected the output miscalibrations within ±0.61% while the MLC and couch positions were within ±0.06mm and ±0.14mm, respectively. Gantry angle miscalibrations were detected within ±0.1°. Conclusions: MPC is a useful tool for QA of TrueBeam systems and its automation makes it highly efficient for testing both geometric and dosimetric aspects of the machine. This is very important for hypo-fractionated SBRT treatments. Received support from Varian Medical Systems, Palo Alto, CA 94304-1038.

07 ISOTOPE AND RADIATION SOURCES↗
DOE OSTI2014

WE-A-17A-02: BEST IN PHYSICS (THERAPY) - Development of a Calorimeter for the Measurement of the Power Emitted From LDR Brachytherapy Sources

Purpose: Model-based dose calculation algorithms for brachytherapy sources are designed to compute dose per particle or dose per unit energy leaving the encapsulation of a brachytherapy source. As such, the power leaving the encapsulation of a source, called emitted power (EP), would be a natural source strength metric for these new algorithms. However, no instrument is currently capable of an absolute measurement of EP. A calorimeter operating with a liquid helium thermal sink was designed and constructed to measure the EP of low-dose rate (LDR) I-125 and Pd-103 brachytherapy sources. Methods: Calorimeter design was optimized through thermal and Monte Carlo (MC) modeling. Thermal modeling showed that specific thermal conditions would be necessary for accurate calorimeter measurements. These conditions were experimentally verified. The EP of two LDR I-125 source models was measured. An air-kermastrength (AKS)-to-EP conversion coefficient was determined through MC simulations and applied to well-type ionization chamber measurements of AKS to enable comparison with EP measurements. Results: MCdetermined EP per unit AKS conversion coefficients were source model dependent and are on the order of 0.1 μW/U. The signal-to-noise ratio was a function of source strength, and was 294 for a 0.5 μW source. Measurements were repeatable to within 3.6% for a 0.5 μW source. Initial EP measurements were made with two I-125 source models, a 5.7 U Oncura 6711 and a 2.9 U Best Medical 2301. Model 2301 results agreed with the MC-converted AKS value to within the measurement uncertainty of 4.3% at k=1. The Model 6711 results were systematically high and are under investigation. Conclusion: A calorimeter was designed to provide an absolute measurement of the EP for LDR brachytherapy sources and preliminary EP measurements have been made. This new calorimeter design shows promise of providing a more fundamentally useful source strength standard.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗
DOE OSTI2015

Impact of the differential fluence distribution of brachytherapy sources on the spectroscopic dose-rate constant

Purpose: To investigate why dose-rate constants for {sup 125}I and {sup 103}Pd seeds computed using the spectroscopic technique, Λ{sub spec}, differ from those computed with standard Monte Carlo (MC) techniques. A potential cause of these discrepancies is the spectroscopic technique’s use of approximations of the true fluence distribution leaving the source, φ{sub full}. In particular, the fluence distribution used in the spectroscopic technique, φ{sub spec}, approximates the spatial, angular, and energy distributions of φ{sub full}. This work quantified the extent to which each of these approximations affects the accuracy of Λ{sub spec}. Additionally, this study investigated how the simplified water-only model used in the spectroscopic technique impacts the accuracy of Λ{sub spec}. Methods: Dose-rate constants as described in the AAPM TG-43U1 report, Λ{sub full}, were computed with MC simulations using the full source geometry for each of 14 different {sup 125}I and 6 different {sup 103}Pd source models. In addition, the spectrum emitted along the perpendicular bisector of each source was simulated in vacuum using the full source model and used to compute Λ{sub spec}. Λ{sub spec} was compared to Λ{sub full} to verify the discrepancy reported by Rodriguez and Rogers. Using MC simulations, a phase space of the fluence leaving the encapsulation of each full source model was created. The spatial and angular distributions of φ{sub full} were extracted from the phase spaces and were qualitatively compared to those used by φ{sub spec}. Additionally, each phase space was modified to reflect one of the approximated distributions (spatial, angular, or energy) used by φ{sub spec}. The dose-rate constant resulting from using approximated distribution i, Λ{sub approx,i}, was computed using the modified phase space and compared to Λ{sub full}. For each source, this process was repeated for each approximation in order to determine which approximations used in the spectroscopic technique affect the accuracy of Λ{sub spec}. Results: For all sources studied, the angular and spatial distributions of φ{sub full} were more complex than the distributions used in φ{sub spec}. Differences between Λ{sub spec} and Λ{sub full} ranged from −0.6% to +6.4%, confirming the discrepancies found by Rodriguez and Rogers. The largest contribution to the discrepancy was the assumption of isotropic emission in φ{sub spec}, which caused differences in Λ of up to +5.3% relative to Λ{sub full}. Use of the approximated spatial and energy distributions caused smaller average discrepancies in Λ of −0.4% and +0.1%, respectively. The water-only model introduced an average discrepancy in Λ of −0.4%. Conclusions: The approximations used in φ{sub spec} caused discrepancies between Λ{sub approx,i} and Λ{sub full} of up to 7.8%. With the exception of the energy distribution, the approximations used in φ{sub spec} contributed to this discrepancy for all source models studied. To improve the accuracy of Λ{sub spec}, the spatial and angular distributions of φ{sub full} could be measured, with the measurements replacing the approximated distributions. The methodology used in this work could be used to determine the resolution that such measurements would require by computing the dose-rate constants from phase spaces modified to reflect φ{sub full} binned at different spatial and angular resolutions.

07 ISOTOPE AND RADIATION SOURCES↗
DOE OSTI2015

Development and evaluation of aperture-based complexity metrics using film and EPID measurements of static MLC openings

Purpose: Complexity metrics have been suggested as a complement to measurement-based quality assurance for intensity modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT). However, these metrics have not yet been sufficiently validated. This study develops and evaluates new aperture-based complexity metrics in the context of static multileaf collimator (MLC) openings and compares them to previously published metrics. Methods: This study develops the converted aperture metric and the edge area metric. The converted aperture metric is based on small and irregular parts within the MLC opening that are quantified as measured distances between MLC leaves. The edge area metric is based on the relative size of the region around the edges defined by the MLC. Another metric suggested in this study is the circumference/area ratio. Earlier defined aperture-based complexity metrics—the modulation complexity score, the edge metric, the ratio monitor units (MU)/Gy, the aperture area, and the aperture irregularity—are compared to the newly proposed metrics. A set of small and irregular static MLC openings are created which simulate individual IMRT/VMAT control points of various complexities. These are measured with both an amorphous silicon electronic portal imaging device and EBT3 film. The differences between calculated and measured dose distributions are evaluated using a pixel-by-pixel comparison with two global dose difference criteria of 3% and 5%. The extent of the dose differences, expressed in terms of pass rate, is used as a measure of the complexity of the MLC openings and used for the evaluation of the metrics compared in this study. The different complexity scores are calculated for each created static MLC opening. The correlation between the calculated complexity scores and the extent of the dose differences (pass rate) are analyzed in scatter plots and using Pearson’s r-values. Results: The complexity scores calculated by the edge area metric, converted aperture metric, circumference/area ratio, edge metric, and MU/Gy ratio show good linear correlation to the complexity of the MLC openings, expressed as the 5% dose difference pass rate, with Pearson’s r-values of −0.94, −0.88, −0.84, −0.89, and −0.82, respectively. The overall trends for the 3% and 5% dose difference evaluations are similar. Conclusions: New complexity metrics are developed. The calculated scores correlate to the complexity of the created static MLC openings. The complexity of the MLC opening is dependent on the penumbra region relative to the area of the opening. The aperture-based complexity metrics that combined either the distances between the MLC leaves or the MLC opening circumference with the aperture area show the best correlation with the complexity of the static MLC openings.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-C-201-01: Investigation of the Effects of Scintillator Surface Treatment On Light Output Measurements with SiPM Detectors

Purpose: To examine the effect of different scintillator surface treatments (BGO crystals) on the fraction of scintillation photons that exit the crystal and reach the photodetector (SiPM). Methods: Positron Emission Tomography is based on the detection of light that exits scintillator crystals, after annihilation photons deposit energy inside these crystals. A considerable fraction of the scintillation light gets trapped or absorbed after going through multiple internal reflections on the interfaces surrounding the crystals. BGO scintillator crystals generate considerably less scintillation light than crystals made of LSO and its variants. Therefore, it is crucial that the small amount of light produced by BGO exits towards the light detector. The surface treatment of scintillator crystals is among the factors affecting the ability of scintillation light to reach the detectors. In this study, we analyze the effect of different crystal surface treatments on the fraction of scintillation light that is detected by the solid state photodetector (SiPM), once energy is deposited inside a BGO crystal. Simulations were performed by a Monte Carlo based software named GATE, and validated by measurements from individual BGO crystals coupled to Philips digital-SiPM sensor (DPC-3200). Results: The results showed an increment in light collection of about 4 percent when only the exit face of the BGO crystal, is unpolished; compared to when all the faces are polished. However, leaving several faces unpolished caused a reduction of at least 10 percent of light output when the interaction occurs as far from the exit face of the crystal as possible compared to when it occurs very close to the exit face. Conclusion: This work demonstrates the advantages on light collection from leaving unpolished the exit face of BGO crystals. The configuration with best light output will be used to obtain flood images from BGO crystal arrays coupled to SiPM sensors.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗
DOE OSTI2015

SU-E-T-88: Acceptance Testing and Commissioning Measurements of a Newly Released InCiseâ„¢ Multileaf Collimator for CyberKnife M6â„¢ System

Purpose: Accuray recently released a new collimator, the InCise™ Multileaf Collimator (MLC), for clinical use with the CyberKnife M6™ System. This work reports the results of acceptance testing and commissioning measurements for this collimator. Methods: The MLC consists of 41 pairs of 2.5 mm wide leaves projecting a clinical maximum field size of 110 mm x 97.5 mm at 800 mm SAD. The leaves are made of tungsten, 90 mm in height and tilted by 0.5 degree. The manufacturer stated leaf positioning accuracy and reproducibility are 0.5 mm and 0.4 mm respectively at 800 mm SAD. The leaf over-travel is 100% with full interdigitation capability. Acceptance testing included, but are not limited to, the verification of the specifications of various parameters described above, leakage measurements and end-to-end tests. Dosimetric measurements included, but not limited to, measurements of output factors, open beam profiles, tissue-phantom ratios, beam flatness and symmetry, and patient specific QA. Results: All measurements were well within the manufacturer specifications. The values of output factors ranged from 0.804 (smallest field size of 7.6 mm x 7.5 mm) to 1.018 (largest field size of 110.0 mm x 97.5 mm). End-to-end test results for the various tracking modes are: Skull (0.27mm), fiducial (0.16mm), Xsight Spine (0.4mm), Xsight Lung (0.93 mm) and Synchrony (0.43mm). Measured maximum and average leakage was 0.37% and 0.3%, respectively. Patient-specific QA measurements with chamber were all within 5% absolute dose agreement, and film measurements all passed 2%/2mm gamma evaluation for more than 95% of measurement points. Conclusion: The presented results are the first set of data reported on the InCise™ MLC. The MLC proved to be very reliable and is currently in clinical use.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-444: Gravity Effect On Maximum Leaf Speed in Dynamic IMRT Treatments

Purpose: A leaf sequencing algorithm has been recently developed in our department. Our purpose is to utilize this algorithm to reduce treatment time by studying the feasibility of using several maximum leaf speeds depending on gantry angle and leaf thickness (0.5 or 1 cm at isocenter). To do so, the gravity effect on MLC performance has been examined by means of analysing the dynalog files. Methods: Leaf position errors has been ascertained according to gantry angle and leaf speed in MLC Millenium120 (Varian). In order to do this, the following test has been designed: all leaves move in synchrony, with same speed and 1 cm gap between opposite leaves. This test is implemented for 18 different speeds: 0.25-0.5-0.75-1-1.25-1.5-1.75-2-2.1-2.2-2.3-2.4-2.5-2.6-2.7-2.8-2.9-3.0 cm/s and 8 gantry angles: 0-45-90-135-180-225-270-315. Collimator angle is 2 degrees in all cases since it is the most usual one in IMRT treatments in our department. Dynamic tolerance is 2 mm. Dynalogs files of 10 repetitions of the test are analysed with a Mathlab in-house developed software and RMS error and 95th percentiles are calculated. Varian recommends 2.5 cm/s as the maximum leaf speed for its segmentation algorithm. In our case, we accept this speed in the most restrictive situation: gantry angle 270 and 1 cm leaf thickness. Maximum speeds for the rest of the cases are calculated by keeping the difference between 95th percentile and dynamic tolerance. In this way, beam hold-off probability does not increase. Results: Maximum speeds every 45 degrees of gantry rotation have been calculated for both leaf thickness. These results are 2.9-2.9-2.9-2.9-2.7-2.6-2.6-2.7 cm/s for 0.5 cm leaf thickness and 2.7-2.7-2.7-2.7-2.6-2.5-2.5-2.6 cm/s for 1 cm leaf thickness. Conclusion: Gravity effect on MLC positioning has been studied. Maximum leaf speed according to leaf thickness and gantry angle have been calculated which reduces treatment time.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-F-BRB-12: A Novel Haar Wavelet Based Approach to Deliver Non-Coplanar Intensity Modulated Radiotherapy Using Sparse Orthogonal Collimators

Purpose: Existing efforts to replace complex multileaf collimator (MLC) by simple jaws for intensity modulated radiation therapy (IMRT) resulted in unacceptable compromise in plan quality and delivery efficiency. We introduce a novel fluence map segmentation method based on compressed sensing for plan delivery using a simplified sparse orthogonal collimator (SOC) on the 4π non-coplanar radiotherapy platform. Methods: 4π plans with varying prescription doses were first created by automatically selecting and optimizing 20 non-coplanar beams for 2 GBM, 2 head & neck, and 2 lung patients. To create deliverable 4π plans using SOC, which are two pairs of orthogonal collimators with 1 to 4 leaves in each collimator bank, a Haar Fluence Optimization (HFO) method was used to regulate the number of Haar wavelet coefficients while maximizing the dose fidelity to the ideal prescription. The plans were directly stratified utilizing the optimized Haar wavelet rectangular basis. A matching number of deliverable segments were stratified for the MLC-based plans. Results: Compared to the MLC-based 4π plans, the SOC-based 4π plans increased the average PTV dose homogeneity from 0.811 to 0.913. PTV D98 and D99 were improved by 3.53% and 5.60% of the corresponding prescription doses. The average mean and maximal OAR doses slightly increased by 0.57% and 2.57% of the prescription doses. The average number of segments ranged between 5 and 30 per beam. The collimator travel time to create the segments decreased with increasing leaf numbers in the SOC. The two and four leaf designs were 1.71 and 1.93 times more efficient, on average, than the single leaf design. Conclusion: The innovative dose domain optimization based on compressed sensing enables uncompromised 4π non-coplanar IMRT dose delivery using simple rectangular segments that are deliverable using a sparse orthogonal collimator, which only requires 8 to 16 leaves yet is unlimited in modulation resolution. This work is supported in part by Varian Medical Systems, Inc. and NIH R43 CA18339.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

Computer-aided diagnosis for classifying benign versus malignant thyroid nodules based on ultrasound images: A comparison with radiologist-based assessments

Purpose: To develop a semiautomated computer-aided diagnosis (CAD) system for thyroid cancer using two-dimensional ultrasound images that can be used to yield a second opinion in the clinic to differentiate malignant and benign lesions. Methods: A total of 118 ultrasound images that included axial and longitudinal images from patients with biopsy-confirmed malignant (n = 30) and benign (n = 29) nodules were collected. Thyroid CAD software was developed to extract quantitative features from these images based on thyroid nodule segmentation in which adaptive diffusion flow for active contours was used. Various features, including histogram, intensity differences, elliptical fit, gray-level co-occurrence matrixes, and gray-level run-length matrixes, were evaluated for each region imaged. Based on these imaging features, a support vector machine (SVM) classifier was used to differentiate benign and malignant nodules. Leave-one-out cross-validation with sequential forward feature selection was performed to evaluate the overall accuracy of this method. Additionally, analyses with contingency tables and receiver operating characteristic (ROC) curves were performed to compare the performance of CAD with visual inspection by expert radiologists based on established gold standards. Results: Most univariate features for this proposed CAD system attained accuracies that ranged from 78.0% to 83.1%. When optimal SVM parameters that were established using a grid search method with features that radiologists use for visual inspection were employed, the authors could attain rates of accuracy that ranged from 72.9% to 84.7%. Using leave-one-out cross-validation results in a multivariate analysis of various features, the highest accuracy achieved using the proposed CAD system was 98.3%, whereas visual inspection by radiologists reached 94.9% accuracy. To obtain the highest accuracies, “axial ratio” and “max probability” in axial images were most frequently included in the optimal feature sets for the authors’ proposed CAD system, while “shape” and “calcification” in longitudinal images were most frequently included in the optimal feature sets for visual inspection by radiologists. The computed areas under curves in the ROC analysis were 0.986 and 0.979 for the proposed CAD system and visual inspection by radiologists, respectively; no significant difference was detected between these groups. Conclusions: The use of thyroid CAD to differentiate malignant from benign lesions shows accuracy similar to that obtained via visual inspection by radiologists. Thyroid CAD might be considered a viable way to generate a second opinion for radiologists in clinical practice.

61 RADIATION PROTECTION AND DOSIMETRY↗
DOE OSTI2016

A novel software and conceptual design of the hardware platform for intensity modulated radiation therapy

Purpose: To deliver high quality intensity modulated radiotherapy (IMRT) using a novel generalized sparse orthogonal collimators (SOCs), the authors introduce a novel direct aperture optimization (DAO) approach based on discrete rectangular representation. Methods: A total of seven patients—two glioblastoma multiforme, three head & neck (including one with three prescription doses), and two lung—were included. 20 noncoplanar beams were selected using a column generation and pricing optimization method. The SOC is a generalized conventional orthogonal collimators with N leaves in each collimator bank, where N = 1, 2, or 4. SOC degenerates to conventional jaws when N = 1. For SOC-based IMRT, rectangular aperture optimization (RAO) was performed to optimize the fluence maps using rectangular representation, producing fluence maps that can be directly converted into a set of deliverable rectangular apertures. In order to optimize the dose distribution and minimize the number of apertures used, the overall objective was formulated to incorporate an L2 penalty reflecting the difference between the prescription and the projected doses, and an L1 sparsity regularization term to encourage a low number of nonzero rectangular basis coefficients. The optimization problem was solved using the Chambolle–Pock algorithm, a first-order primal–dual algorithm. Performance of RAO was compared to conventional two-step IMRT optimization including fluence map optimization and direct stratification for multileaf collimator (MLC) segmentation (DMS) using the same number of segments. For the RAO plans, segment travel time for SOC delivery was evaluated for the N = 1, N = 2, and N = 4 SOC designs to characterize the improvement in delivery efficiency as a function of N. Results: Comparable PTV dose homogeneity and coverage were observed between the RAO and the DMS plans. The RAO plans were slightly superior to the DMS plans in sparing critical structures. On average, the maximum and mean critical organ doses were reduced by 1.94% and 1.44% of the prescription dose. The average number of delivery segments was 12.68 segments per beam for both the RAO and DMS plans. The N = 2 and N = 4 SOC designs were, on average, 1.56 and 1.80 times more efficient than the N = 1 SOC design to deliver. The mean aperture size produced by the RAO plans was 3.9 times larger than that of the DMS plans. Conclusions: The DAO and dose domain optimization approach enabled high quality IMRT plans using a low-complexity collimator setup. The dosimetric quality is comparable or slightly superior to conventional MLC-based IMRT plans using the same number of delivery segments. The SOC IMRT delivery efficiency can be significantly improved by increasing the leaf numbers, but the number is still significantly lower than the number of leaves in a typical MLC.

61 RADIATION PROTECTION AND DOSIMETRY↗
DOE OSTI2016

SU-F-J-207: Non-Small Cell Lung Cancer Patient Survival Prediction with Quantitative Tumor Textures Analysis in Baseline CT

Purpose: Chemo-radiation therapy (CRT) is widely used in treating patients with locally advanced non-small cell lung cancer (NSCLC). Determination of the likelihood of patient response to treatment and optimization of treatment regime is of clinical significance. Up to date, no imaging biomarker has reliably correlated to NSCLC patient survival rate. This pilot study is to extract CT texture information from tumor regions for patient survival prediction. Methods: Thirteen patients with stage II-III NSCLC were treated using CRT with a median dose of 6210 cGy. Non-contrast-enhanced CT images were acquired for treatment planning and retrospectively collected for this study. Texture analysis was applied in segmented tumor regions using the Local Binary Pattern method (LBP). By comparing its HU with neighboring voxels, the LBPs of a voxel were measured in multiple scales with different group radiuses and numbers of neighbors. The LBP histograms formed a multi-dimensional texture vector for each patient, which was then used to establish and test a Support Vector Machine (SVM) model to predict patients’ one year survival. The leave-one-out cross validation strategy was used recursively to enlarge the training set and derive a reliable predictor. The predictions were compared with the true clinical outcomes. Results: A 10-dimensional LBP histogram was extracted from 3D segmented tumor region for each of the 13 patients. Using the SVM model with the leave-one-out strategy, only 1 out of 13 patients was misclassified. The experiments showed an accuracy of 93%, sensitivity of 100%, and specificity of 86%. Conclusion: Within the framework of a Support Vector Machine based model, the Local Binary Pattern method is able to extract a quantitative imaging biomarker in the prediction of NSCLC patient survival. More patients are to be included in the study.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-T-103: Analysis of Hepatitis B Virus Reactivation After Conformal Radiotherapy in Patients with Hepatocellular Carcinoma Using the Lyman NTCP Model

Purpose: The aim of this research was to investigate the feasibility of Lyman-Kutcher-Burman (LKB) normal tissue complication probability (NTCP) model in analyzing hepatitis B virus (HBV) reactivation in patients receiving conformal radiotherapy for patients with hepatocellular carcinoma (HCC). Methods: Between June 2009 and June 2012, 108 HBV-related HCC patients (90 were specifically selected and 18 patients were excluded) treated with conformal RT at three centers were enrolled in this retrospective study. They were all diagnosed as HCC by pathology or cytology. All 90 patients were followed up to September 2013 with a median follow-up time of 25.2 months. The parameters (TD50 (1), n, and m) of the modified LKB NTCP model were derived using maximum likelihood estimation. Bootstrap and leave-one-out were employed to test the generalizability of the results for use in a general population. Results: The incidences of complications in the study population were as follows: radiation-induced liver diseases (RILD) were 17.6%, HBV reactivation was 24.8%, and HBV reactivation-induced hepatitis was 22.7%, respectively. In multivariate analysis, the NTCP (p<0.001), and V20 were associated with HBV reactivation. TD50 (1), m and n were 42.9Gy (95% CI) (38.2–46.8), 0.14 (0.12–0.15) and 0.30 (0.2–0.33), respectively, for HBV reactivation. Bootstrap and leave-one-out results showed that the HBV parameter fits were extremely robust. Conclusion: A modified LKB NTCP model has been established to predict HBV reactivation for patients with HCC receiving conformal RT. The finding derives parameters set to predict potential endpoints of HBV reactivation.

60 APPLIED LIFE SCIENCES↗