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

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DOE OSTI2016

SU-F-I-06: Evaluation of Imaging Dose for Modulation Layer Based Dual Energy Cone-Beam CT

Purpose: Dual energy cone beam CT system is finding a variety of promising applications in diagnostic CT, both in imaging of endogenous materials and exogenous materials across a range of body sites. Dual energy cone beam CT system to suggest in this study acquire image by rotating 360 degree with half of the X-ray window covered using copper modulation layer. In the region that covered by modulation layer absorb the low energy X-ray by modulation layer. Relative high energy X-ray passes through the layer and contributes to image reconstruction. Dose evaluation should be carried out in order to utilize such an imaging acquirement technology for clinical use. Methods: For evaluating imaging dose of modulation layer based dual energy cone beam CT system, Prototype cone beam CT that configured X-ray tube (D054SB, Toshiba, Japan) and detector (PaxScan 2520V, Varian Medical Systems, Palo Alto, CA) is used. A range of 0.5–2.0 mm thickness of modulation layer is implemented in Monte Carlo simulation (MCNPX, ver. 2.6.0, Los Alamos National Laboratory, USA) with half of X-ray window covered. In-house phantom using in this study that has 3 cylindrical phantoms configured water, Teflon air with PMMA covered for verifying the comparability the various material in human body and is implemented in Monte Carlo simulation. The actual dose with 2.0 mm copper covered half of X-ray window is measured using Gafchromic EBT3 film with 5.0 mm bolus for compared with simulative dose. Results: Dose in phantom reduced 33% by copper modulation layer of 2.0 mm. Scattering dose occurred in modulation layer by Compton scattering effect is 0.04% of overall dose. Conclusion: Modulation layer of that based dual energy cone beam CT has not influence on unnecessary scatter dose. This study was supported by the Radiation Safety Research Programs (1305033) through the Nuclear Safety and Security Commission.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-I-08: CT Image Ring Artifact Reduction Based On Prior Image

Purpose: In computed tomography (CT) system, CT images with ring artifacts will be reconstructed when some adjacent bins of detector don’t work. The ring artifacts severely degrade CT image quality. We present a useful CT ring artifacts reduction based on projection data correction, aiming at estimating the missing data of projection data accurately, thus removing the ring artifacts of CT images. Methods: The method consists of ten steps: 1) Identification of abnormal pixel line in projection sinogram; 2) Linear interpolation within the pixel line of projection sinogram; 3) FBP reconstruction using interpolated projection data; 4) Filtering FBP image using mean filter; 5) Forwarding projection of filtered FBP image; 6) Subtraction forwarded projection from original projection; 7) Linear interpolation of abnormal pixel line area in the subtraction projection; 8) Adding the interpolated subtraction projection on the forwarded projection; 9) FBP reconstruction using corrected projection data; 10) Return to step 4 until the pre-set iteration number is reached. The method is validated on simulated and real data to restore missing projection data and reconstruct ring artifact-free CT images. Results: We have studied impact of amount of dead bins of CT detector on the accuracy of missing data estimation in projection sinogram. For the simulated case with a resolution of 256 by 256 Shepp-Logan phantom, three iterations are sufficient to restore projection data and reconstruct ring artifact-free images when the dead bins rating is under 30%. The dead-bin-induced artifacts are substantially reduced. More iteration number is needed to reconstruct satisfactory images while the rating of dead bins increases. Similar results were found for a real head phantom case. Conclusion: A practical CT image ring artifact correction scheme based on projection data is developed. This method can produce ring artifact-free CT images feasibly and effectively.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-I-11: Software Development for 4D-CBCT Research of Real-Time-Image Gated Spot Scanning Proton Therapy

Purpose: To acquire correct information for inside the body in patient positioning of Real-time-image Gated spot scanning Proton Therapy (RGPT), utilization of tomographic image at exhale phase of patient respiration obtained from 4-dimensional Cone beam CT (4D-CBCT) has been desired. We developed software named “Image Analysis Platform” for 4D-CBCT researches which has technique to segment projection-images based on 3D marker position in the body. The 3D marker position can be obtained by using two axes CBCT system at Hokkaido University Hospital Proton Therapy Center. Performance verification of the software was implemented. Methods: The software calculates 3D marker position retrospectively by using matching positions on pair projection-images obtained by two axes fluoroscopy mode of CBCT system. Log data of 3D marker tracking are outputted after the tracking. By linking the Log data and gantry-angle file of projection-image, all projection-images are equally segmented to spatial five-phases according to marker 3D position of SI direction and saved to specified phase folder. Segmented projection-images are used for CBCT reconstruction of each phase. As performance verification of the software, test of segmented projection-images was implemented for sample CT phantom (Catphan) image acquired by two axes fluoroscopy mode of CBCT. Dummy marker was added on the images. Motion of the marker was modeled to move in 3D space. Motion type of marker is sin4 wave function has amplitude 10.0 mm/5.0 mm/0 mm, cycle 4 s/4 s/0 s for SI/AP/RL direction. Results: The marker was tracked within 0.58 mm accuracy in 3D for all images, and it was confirmed that all projection-images were segmented and saved to each phase folder correctly. Conclusion: We developed software for 4D-CBCT research which can segment projection-image based on 3D marker position. It will be helpful to create high quality of 4D-CBCT reconstruction image for RGPT.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-I-14: 3D Breast Digital Phantom for XACT Imaging

Purpose: The X-ray induced acoustic computed tomography (XACT) is a new imaging modality which combines X-ray contrast and high ultrasonic resolution in a single modality. Using XACT in breast imaging, a 3D breast volume can be imaged by only one pulsed X-ray radiation, which could dramatically reduce the imaging dose for patients undergoing breast cancer screening and diagnosis. A 3D digital phantom that contains both X-ray properties and acoustic properties of different tissue types is indeed needed for developing and optimizing the XACT system. The purpose of this study is to offer a realistic breast digital phantom as a valuable tool for improving breast XACT imaging techniques and potentially leading to better diagnostic outcomes. Methods: A series of breast CT images along the coronal plane from a patient who has breast calcifications are used as the source images. A HU value based segmentation algorithm is employed to identify breast tissues in five categories, namely the skin tissue, fat tissue, glandular tissue, chest bone and calcifications. For each pixel, the dose related parameters, such as material components and density, and acoustic related parameters, such as frequency-dependent acoustic attenuation coefficient and bandwidth, are assigned based on tissue types. Meanwhile, other parameters which are used in sound propagation, including the sound speed, thermal expansion coefficient, and heat capacity are also assigned to each tissue. Results: A series of 2D tissue type image is acquired first and the 3D digital breast phantom is obtained by using commercial 3D reconstruction software. When giving specific settings including dose depositions and ultrasound center frequency, the X-ray induced initial pressure rise can be calculated accordingly. Conclusion: The proposed 3D breast digital phantom represents a realistic breast anatomic structure and provides a valuable tool for developing and evaluating the system performance for XACT.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-I-31: Reproducibility of An Automatic Exposure Control Technique in the Low-Dose CT Scan of Cardiac PET/CT Exams

Purpose: Two separate low-dose CT scans are usually performed for attenuation correction of rest and stress N-13 ammonia PET/CT myocardial perfusion imaging (PET/CT). We utilize an automatic exposure control (AEC) technique to reduce CT radiation dose while maintaining perfusion image quality. Our goal is to assess the reproducibility of displayed CT dose index (CTDI) on same-day repeat CT scans (CT1 and CT2). Methods: Retrospectively, we reviewed CT images of PET/CT studies performed on the same day. Low-dose CT utilized AEC technique based on tube current modulation called Smart-mA. The scan parameters were 64 × 0.625mm collimation, 5mm slice thickness, 0.984 pitch, 1-sec rotation time, 120 kVp, and noise index 50 with a range of 10–200 mA. The scan length matched with PET field of view (FOV) with the heart near the middle of axial FOV. We identified the reference slice number (RS) for an anatomical landmark (carina) and used it to estimate axial shift between two CTs. For patient size, we measured an effective diameter on the reference slice. The effect of patient positioning to CTDI was evaluated using the table height. We calculated the absolute percent difference of the CTDI (%diff) for estimation of the reproducibility. Results: The study included 168 adults with an average body-mass index of 31.72 ± 9.10 (kg/m{sup 2}) and effective diameter was 32.72 ± 4.60 cm. The average CTDI was 1.95 ± 1.40 mGy for CT1 and 1.97 ± 1.42mGy for CT2. The mean %diff was 7.8 ± 6.8%. Linear regression analysis showed a significant correlation between the table height and %diff CTDI. (r=0.82, p<0.001) Conclusion: We have shown for the first time in human subjects, using two same-day CT images, that the AEC technique in low-dose CT is reproducible within 10% and significantly depends on the patient centering.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-I-37: How Fat Distribution and Table Height Affect Estimates of Patient Size in CT Scanning: A Phantom Study

Purpose: Localizer projection radiographs acquired prior to CT scans are used to estimate patient size, affecting the function of Automatic Tube Current Modulation (ATCM) and hence CTDIvol and SSDE. Due to geometric effects, the projected patient size varies with scanner table height and with the orientation of the localizer (AP versus PA). This study sought to determine if patient size estimates made from localizer scans is affected by variations in fat distribution, specifically when the widest part of the patient is not at the geometric center of the patient. Methods: Lipid gel bolus material was wrapped around an anthropomorphic phantom to simulate two different body mass distributions. The first represented a patient with fairly rigid fat and had a generally oval shape. The second was bell-shaped, representing corpulent patients more susceptible to gravity’s lustful tug. Each phantom configuration was imaged using an AP localizer and then a PA localizer. This was repeated at various scanner table heights. The width of the phantom was measured from the localizer and diagnostic images using in-house software. Results: 1) The projected phantom width varied up to 39% as table height changed.2) At some table heights, the width of the phantom, designed to represent larger patients, exceeded the localizer field of view, resulting in an underestimation of the phantom width.3) The oval-shaped phantom approached a normalized phantom width of 1 at a table height several centimeters lower (AP localizer) or higher (PA localizer) than did the bell-shaped phantom. Conclusion: Accurate estimation of patient size from localizer scans is dependent on patient positioning with respect to scanner isocenter and is limited in large patients. Further, patient size is more accurately measured on projection images if the widest part of the patient, rather than the geometric center of the patient, is positioned at scanner isocenter.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-I-41: Calibration-Free Material Decomposition for Dual-Energy CT

Purpose: To eliminate tedious phantom calibration or manually region of interest (ROI) selection as required in dual-energy CT material decomposition, we establish a new projection-domain material decomposition framework with incorporation of energy spectrum. Methods: Similar to the case of dual-energy CT, the integral of the basis material image in our model is expressed as a linear combination of basis functions, which are the polynomials of high- and low-energy raw projection data. To yield the unknown coefficients of the linear combination, the proposed algorithm minimizes the quadratic error between the high- and low-energy raw projection data and the projection calculated using material images. We evaluate the algorithm with an iodine concentration numerical phantom at different dose and iodine concentration levels. The x-ray energy spectra of the high and low energy are estimated using an indirect transmission method. The derived monochromatic images are compared with the high- and low-energy CT images to demonstrate beam hardening artifacts reduction. Quantitative results were measured and compared to the true values. Results: The differences between the true density value used for simulation and that were obtained from the monochromatic images, are 1.8%, 1.3%, 2.3%, and 2.9% for the dose levels from standard dose to 1/8 dose, and are 0.4%, 0.7%, 1.5%, and 1.8% for the four iodine concentration levels from 6 mg/mL to 24 mg/mL. For all of the cases, beam hardening artifacts, especially streaks shown between dense inserts, are almost completely removed in the monochromatic images. Conclusion: The proposed algorithm provides an effective way to yield material images and artifacts-free monochromatic images at different dose levels without the need for phantom calibration or ROI selection. Furthermore, the approach also yields accurate results when the concentration of the iodine concentrate insert is very low, suggesting the algorithm is robust with respect to the low-contrast scenario.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-I-43: A Software-Based Statistical Method to Compute Low Contrast Detectability in Computed Tomography Images

Purpose: The low contrast detectability (LCD) of a CT scanner is its ability to detect and display faint lesions. The current approach to quantify LCD is achieved using vendor-specific methods and phantoms, typically by subjectively observing the smallest size object at a contrast level above phantom background. However, this approach does not yield clinically applicable values for LCD. The current study proposes a statistical LCD metric using software tools to not only to assess scanner performance, but also to quantify the key factors affecting LCD. This approach was developed using uniform QC phantoms, and its applicability was then extended under simulated clinical conditions. Methods: MATLAB software was developed to compute LCD using a uniform image of a QC phantom. For a given virtual object size, the software randomly samples the image within a selected area, and uses statistical analysis based on Student’s t-distribution to compute the LCD as the minimal Hounsfield Unit’s that can be distinguished from the background at the 95% confidence level. Its validity was assessed by comparison with the behavior of a known QC phantom under various scan protocols and a tissue-mimicking phantom. The contributions of beam quality and scattered radiation upon the computed LCD were quantified by using various external beam-hardening filters and phantom lengths. Results: As expected, the LCD was inversely related to object size under all scan conditions. The type of image reconstruction kernel filter and tissue/organ type strongly influenced the background noise characteristics and therefore, the computed LCD for the associated image. Conclusion: The proposed metric and its associated software tools are vendor-independent and can be used to analyze any LCD scanner performance. Furthermore, the method employed can be used in conjunction with the relationships established in this study between LCD and tissue type to extend these concepts to patients’ clinical CT images.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-I-46: Optimizing Dose Reduction in Adult Head CT Protocols While Maintaining Image Quality in Postmortem Head Scans

Purpose: To optimize adult head CT protocol by reducing dose to an appropriate level while providing CT images of diagnostic quality. Methods: Five cadavers were scanned from the skull base to the vertex using a routine adult head CT protocol (120 kVp, 270 mA, 0.75 s rotation, 0.5 mm × 32 detectors, 70.8 mGy CTDIvol) followed by seven reduced-dose protocols with varying combinations of reduced tube current, reduced rotation time, and increased detectors with CTDIvol ranging from 38.2 to 65.6 mGy. Organ doses were directly measured with 21 OSL dosimeters placed on the surface and implanted in the head by a neurosurgeon. Two neuroradiologists assessed grey-white matter differentiation, fluid space, ventricular size, midline shift, brain mass, edema, ischemia, and skull fractures on a three point scale: (1) Unacceptable, (2) Borderline Acceptable, and (3) Acceptable. Results: For the standard scan, doses to the skin, lens of the eye, salivary glands, thyroid, and brain were 37.55 mGy, 49.65 mGy, 40.67 mGy, 4.63 mGy, and 27.33 mGy, respectively. Two cadavers had cerebral edema due to changing dynamics of postmortem effects, causing the grey-white matter differentiation to appear less distinct. Two cadavers with preserved grey-white matter received acceptable scores for all image quality features for the protocol with a CTDIvol of 57.3 mGy, allowing organ dose savings ranging from 34% to 45%. One cadaver allowed for greater dose reduction for the protocol with a CTDIvol of 42 mGy. Conclusion: Efforts to optimize scan protocol should consider both dose and clinical image quality. This is made possible with postmortem subjects, whose brains are similar to patients, allowing for an investigation of ideal scan parameters. Radiologists at our institution accepted scan protocols acquired with lower scan parameters, with CTDIvol values closer to the American College of Radiology’s (ACR) Achievable Dose level of 57 mGy.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-I-47: Optimizing Protocols for Image Quality and Dose in Abdominal CT of Large Patients

Purpose: Newer CT scanners are able to use scout views to adjust mA throughout the scan in order to achieve a given noise level. However, given constraints of radiologist preferences for kVp and rotation time, it may not be possible to achieve an acceptable noise level for large patients. A study was initiated to determine for which patients kVp and/or rotation time should be changed in order to achieve acceptable image quality. Methods: Patient scans were reviewed on two new Emergency Department scanners (Philips iCT) to identify patients over a large range of sizes. These iCTs were set with a limit of 500 mA to safeguard against a failure that might cause a CT scan to be (incorrectly) obtained at too-high mA. Scout views of these scans were assessed for both AP and LAT patient width and AP and LAT standard deviation in an ROI over the liver. Effective diameter and product of the scout standard deviations over the liver were both studied as possible metrics for identifying patients who would need kVp and/or rotation time changed. The mA used for the liver in the CT was compared to these metrics for those patients whose CT scans showed acceptable image quality. Results: Both effective diameter and product of the scout standard deviations over the liver result in similar predictions for which patients will require the kVp and/or rotation time to be changed to achieve an optimal combination of image quality and dose. Conclusion: Two mechanisms for CT technologists to determine based on scout characteristics what kVp, mA limit, and rotation time to use when DoseRight with our physicians’ preferred kVp and rotation time will not yield adequate image quality are described.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-I-50: Finite Element-Based Deformable Image Registration of Lung and Heart

Purpose: Photodynamic therapy (PDT) is used after surgical resection to treat the microscopic disease for malignant pleural mesothelioma and to increase survival rates. Although accurate light delivery is imperative to PDT efficacy, the deformation of the pleural volume during the surgery impacts the delivered light dose. To facilitate treatment planning, we use a finite-element-based (FEM) deformable image registration to quantify the anatomical variation of lung and heart volumes between CT pre-(or post-) surgery and surface contours obtained during PDT using an infrared camera-based navigation system (NDI). Methods: NDI is used during PDT to obtain the information of the cumulative light fluence on every cavity surface point that is being treated. A wand, comprised of a modified endotrachial tube filled with Intralipid and an optical fiber inside the tube, is used to deliver the light during PDT. The position of the treatment is tracked using an attachment with nine reflective passive markers that are seen by the NDI system. Then, the position points are plotted as three-dimensional volume of the pleural cavity using Matlab and Meshlab. A series of computed tomography (CT) scans of the lungs and heart, in the same patient, are also acquired before and after the surgery. The NDI and CT contours are imported into COMSOL Multiphysics, where the FEM-based deformable image registration is obtained. The NDI and CT contours acquired during and post-PDT are considered as the reference, and the Pre-PDT CT contours are used as the target, which will be deformed. Results: Anatomical variation of the lung and heart volumes, taken at different times from different imaging devices, was determined by using our model. The resulting three-dimensional deformation map along x, y and z-axes was obtained. Conclusion: Our model fuses images acquired by different modalities and provides insights into the variation in anatomical structures over time.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-I-57: Evaluate and Optimize PET Acquisition Overlap in 18F-FDG Oncology Wholebody PET/CT: Can We Scan PET Faster?

Purpose: The longer patient has to remain on the table during PET imaging, the higher the likelihood of motion artifacts due to patient discomfort. This study was to investigate and optimize PET acquisition overlap in 18F-FDG oncology wholebody PET/CT to speed up PET acquisition and improve patient comfort. Methods: Wholebody 18F-FDG PET/CT of phantoms, 8 pre-clinical patients (beagles) and 5 clinical oncology patients were performed in 90s/bed on a time-of-flight Gemini TF 64 system. Imaging of phantoms and beagles was acquired with reduced PET overlaps (40%, 33%, 27%, 20%, 13% and no overlap) in addition to the system default (53%). In human studies, 1 or 2 reduced overlaps from the listed options were used to acquire PET/CT sweeps right after the default standard of care imaging. Image quality was blindly reviewed using visual scoring criteria and quantitative SUV assessment. NEMA PET sensitivity was performed under different overlaps. Results: All PET exams demonstrated no significant impact on the visual grades for overlaps >20%. Blinded reviews assigned the best visual scores to PET using overlaps 53%–27%. Reducing overlap to 27% for oncology patients (12-bed) saved an average of ∼40% acquisition time (11min) compared to using the default overlap (18min). No significant SUV variances were found when reducing overlap to half of default for cerebellum, lung, heart, aorta, liver, fat, muscle, bone marrow, thighs and target lesions (p>0.05), except expected variability in urinary system. Conclusion: This study demonstrated by combined phantom, pre-clinical and clinical PET/CT scans that PET acquisition overlap in axial of today’s systems can be reduced and optimized. It showed that a reduction of PET acquisition overlap to 27% (half of system default) can be implemented to reduce table time by ∼40% to improve patient comfort and minimize potential motion artifacts, without prominently degrading image quality or compromising PET quantification.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-I-59: Quality Assurance Phantom for PET/CT Alignment and Attenuation Correction

Purpose: This study utilizes a commercial PET/CT phantom to investigate two specific properties of a PET/CT system: the alignment accuracy of PET images with those from CT used for attenuation correction and the accuracy of this correction in PET images. Methods: A commercial PET/CT phantom consisting of three aluminum rods, two long central cylinders containing uniform activity, and attenuating materials such as air, water, bone and iodine contrast was scanned using a standard PET/CT protocol. Images reconstructed with 2 mm slice thickness and a 512 by 512 matrix were obtained. The center of each aluminum rod in the PET and CT images was compared to evaluate alignment accuracy. ROIs were drawn on transaxial images of the central rods at each section of attenuating material to determine the corrected activity (in BQML). BQML values were graphed as a function of slice number to provide a visual representation of the attenuation-correction throughout the whole phantom. Results: Alignment accuracy is high between the PET and CT images. The maximum deviation between the two in the axial plane is less than 1.5 mm, which is less than the width of a single pixel. BQML values measured along different sections of the large central rods are similar among the different attenuating materials except iodine contrast. Deviation of BQML values in the air and bone sections from the water section is less than 1%. Conclusion: Accurate alignment of PET and CT images is critical to ensure proper calculation and application of CT-based attenuation correction. This study presents a simple and quick method to evaluate the two with a single acquisition. As the phantom also includes spheres of increasing diameter, this could serve as a straightforward means to annually evaluate the status of a modern PET/CT system.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-J-14: Kilovoltage Cone-Beam CT Dose Estimation of Varian On-Board Imager Using GMctdospp Monte Carlo Framework

Purpose: Although cone-beam CT (CBCT) imaging became popular in radiation oncology, its imaging dose estimation is still challenging. The goal of this study is to assess the kilovoltage CBCT doses using GMctdospp - an EGSnrc based Monte Carlo (MC) framework. Methods: Two Varian OBI x-ray tube models were implemented in the GMctpdospp framework of EGSnrc MC System. The x-ray spectrum of 125 kVp CBCT beam was acquired from an EGSnrc/BEAMnrc simulation and validated with IPEM report 78. Then, the spectrum was utilized as an input spectrum in GMctdospp dose calculations. Both full and half bowtie pre-filters of the OBI system were created by using egs-prism module. The x-ray tube MC models were verified by comparing calculated dosimetric profiles (lateral and depth) to ion chamber measurements for a static x-ray beam irradiation to a cuboid water phantom. An abdominal CBCT imaging doses was simulated in GMctdospp framework using a 5-year-old anthropomorphic phantom. The organ doses and effective dose (ED) from the framework were assessed and compared to the MOSFET measurements and convolution/superposition dose calculations. Results: The lateral and depth dose profiles in the water cuboid phantom were well matched within 6% except a few areas - left shoulder of the half bowtie lateral profile and surface of water phantom. The organ doses and ED from the MC framework were found to be closer to MOSFET measurements and CS calculations within 2 cGy and 5 mSv respectively. Conclusion: This study implemented and validated the Varian OBI x-ray tube models in the GMctdospp MC framework using a cuboid water phantom and CBCT imaging doses were also evaluated in a 5-year-old anthropomorphic phantom. In future study, various CBCT imaging protocols will be implemented and validated and consequently patient CT images will be used to estimate the CBCT imaging doses in patients.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-J-18: Feasibility of Open Mask Immobilization with Optical Imaging Guidance (OIG) for H&N Radiotherapy

Purpose: Full face and neck thermoplastic masks provide standard-of-care immobilization for patients receiving H&N IMRT. However, these masks are uncomfortable and increase skin dose. The purpose of this pilot study was to investigate the feasibility and setup accuracy of open face and neck mask immobilization with OIG. Methods: Ten patients were consented and enrolled to this IRB-approved protocol. Patients were immobilized with open masks securing only forehead and chin. Standard IMRT to 60–70 Gy in 30 fractions were delivered in all cases. Patient simulation information, including isocenter location and CT skin contours, were imported to a commercial OIG system. On the first day of treatment, patients were initially set up to surface markings and then OIG referenced to face and neck skin regions of interest (ROI) localized on simulation CT images, followed by in-room CBCT. CBCTs were acquired at least weekly while planar OBI was acquired on the days without CBCT. Following 6D robotic couch correction with kV imaging, a new optical real-time surface image was acquired to track intrafraction motion and to serve as a reference surface for setup at the next treatment fraction. Therapists manually recorded total treatment time as well as couch shifts based on kV imaging. Intrafractional ROI motion tracking was automatically recorded. Results: Setup accuracy of OIG was compared with CBCT results. The setup error based on OIG was represented as a 6D shift (vertical/longitudinal/lateral/rotation/pitch/roll). Mean error values were −0.70±3.04mm, −0.69±2.77mm, 0.33±2.67 mm, −0.14±0.94 o, −0.15±1.10o and 0.12±0.82o, respectively for the cohort. Average treatment time was 24.1±9.2 minutes, comparable to standard immobilization. The amplitude of intrafractional ROI motion was 0.69±0.36 mm, driven primarily by respiratory neck motion. Conclusion: OGI can potentially provide accurate setup and treatment tracking for open face and neck immobilization. Study accrual and patient/provider satisfaction survey collection remain ongoing. This study is supported by VisionRT, Ltd.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-J-25: Position Monitoring for Intracranial SRS Using BrainLAB ExacTrac Snap Verification

Purpose: To determine the accuracy of position monitoring with BrainLAB ExacTrac snap verification following couch rotations during intracranial SRS. Methods: A CT scan of an anthropomorphic head phantom was acquired using 1.25mm slices. The isocenter was positioned near the centroid of the frontal lobe. The head phantom was initially aligned on the treatment couch using cone-beam CT, then repositioned using ExacTrac x-ray verification with residual errors less than 0.2mm and 0.2°. Snap verification was performed over the full range of couch angles in 15° increments with known positioning offsets of 0–3mm applied to the phantom along each axis. At each couch angle, the smallest tolerance was determined for which no positioning deviation was detected. Results: For couch angles 30°–60° from the center position, where the longitudinal axis of the phantom is approximately aligned with the beam axis of one x-ray tube, snap verification consistently detected positioning errors exceeding the maximum 8mm tolerance. Defining localization error as the difference between the known offset and the minimum tolerance for which no deviation was detected, the RMS error is mostly less than 1mm outside of couch angles 30°–60° from the central couch position. Given separate measurements of patient position from the two imagers, whether to proceed with treatment can be determined by the criterion of a reading within tolerance from just one (OR criterion) or both (AND criterion) imagers. Using a positioning tolerance of 1.5mm, snap verification has sensitivity and specificity of 94% and 75%, respectively, with the AND criterion, and 67% and 93%, respectively, with the OR criterion. If readings exceeding maximum tolerance are excluded, the sensitivity and specificity are 88% and 86%, respectively, with the AND criterion. Conclusion: With a positioning tolerance of 1.5mm, ExacTrac snap verification can be used during intracranial SRS with sensitivity and specificity between 85% and 90%.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-J-34: Automatic Target-Based Patient Positioning Framework for Image-Guided Radiotherapy in Prostate Cancer Treatment

Purpose: Current image-guided radiotherapy (IGRT) procedure is bonebased patient positioning, followed by subjective manual correction using cone beam computed tomography (CBCT). This procedure might cause the misalignment of the patient positioning. Automatic target-based patient positioning systems achieve the better reproducibility of patient setup. Our aim of this study was to develop an automatic target-based patient positioning framework for IGRT with CBCT images in prostate cancer treatment. Methods: Seventy-three CBCT images of 10 patients and 24 planning CT images with digital imaging and communications in medicine for radiotherapy (DICOM-RT) structures were used for this study. Our proposed framework started from the generation of probabilistic atlases of bone and prostate from 24 planning CT images and prostate contours, which were made in the treatment planning. Next, the gray-scale histograms of CBCT values within CTV regions in the planning CT images were obtained as the occurrence probability of the CBCT values. Then, CBCT images were registered to the atlases using a rigid registration with mutual information. Finally, prostate regions were estimated by applying the Bayesian inference to CBCT images with the probabilistic atlases and CBCT value occurrence probability. The proposed framework was evaluated by calculating the Euclidean distance of errors between two centroids of prostate regions determined by our method and ground truths of manual delineations by a radiation oncologist and a medical physicist on CBCT images for 10 patients. Results: The average Euclidean distance between the centroids of extracted prostate regions determined by our proposed method and ground truths was 4.4 mm. The average errors for each direction were 1.8 mm in anteroposterior direction, 0.6 mm in lateral direction and 2.1 mm in craniocaudal direction. Conclusion: Our proposed framework based on probabilistic atlases and Bayesian inference might be feasible to automatically determine prostate regions on CBCT images.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-J-39: Dose Reduction Strategy Using Attenuation-Based Tube Current Modulation Method in CBCT for IGRT

Purpose: To reduce radiation dose to the patients, tube current modulation (TCM) method has been actively used in diagnostic CT systems. However, TCM method has not yet been applied to a kV-CBCT system on a LINAC machine. The purpose of this study is to investigate whether the use of TCM method is desirable in kV-CBCT system for IGRT. We have developed an attenuation-based tube current modulation (a-TCM) method using the prior knowledge of treatment CT image of a patient. Methods: Patients go through a diagnostic CT scan for RT planning; therefore, using this prior information of CT images, one can estimate the total attenuation of an x-ray through the patient body in a CBCT setting for radiation therapy. We performed a numerical study incorporating major factors into account such as polychromatic x-ray, scatter, noise, and bow-tie filter to demonstrate that a-TCM method can produce equivalent quality of images at reduced imaging radiation doses. Using the CT projector program, 680 projection images of the pediatric XCAT phantom were obtained both in conventional scanning condition, i.e., without modulating the tube current, and in the proposed a-TCM scanning condition. FDK reconstruction algorithm was used for image reconstruction, and the organ dose due to imaging radiation has been calculated in both cases and compared using GATE/Geant4 simulation toolkit. Results: Reconstructed CT images in the a-TCM method showed similar SSIM values and noise properties to the reference images acquired by the conventional CBCT. In addition, reduction of organ doses ranged from 12% to 27%. Conclusion: We have successfully demonstrated the feasibility and dosimetric merit of the a-TCM method for kV-CBCT, and envision that it can be a useful option of CBCT scanning that provides patient dose reduction without degrading image quality.

60 APPLIED LIFE SCIENCES↗