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DOE OSTI2016

SU-F-J-194: Development of Dose-Based Image Guided Proton Therapy Workflow

Purpose: To implement image-guided proton therapy (IGPT) based on daily proton dose distribution. Methods: Unlike x-ray therapy, simple alignment based on anatomy cannot ensure proper dose coverage in proton therapy. Anatomy changes along the beam path may lead to underdosing the target, or overdosing the organ-at-risk (OAR). With an in-room mobile computed tomography (CT) system, we are developing a dose-based IGPT software tool that allows patient positioning and treatment adaption based on daily dose distributions. During an IGPT treatment, daily CT images are acquired in treatment position. After initial positioning based on rigid image registration, proton dose distribution is calculated on daily CT images. The target and OARs are automatically delineated via deformable image registration. Dose distributions are evaluated to decide if repositioning or plan adaptation is necessary in order to achieve proper coverage of the target and sparing of OARs. Besides online dose-based image guidance, the software tool can also map daily treatment doses to the treatment planning CT images for offline adaptive treatment. Results: An in-room helical CT system is commissioned for IGPT purposes. It produces accurate CT numbers that allow proton dose calculation. GPU-based deformable image registration algorithms are developed and evaluated for automatic ROI-delineation and dose mapping. The online and offline IGPT functionalities are evaluated with daily CT images of the proton patients. Conclusion: The online and offline IGPT software tool may improve the safety and quality of proton treatment by allowing dose-based IGPT and adaptive proton treatments. Research is partially supported by Mevion Medical Systems.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

SU-F-J-195: On the Performance of Four Dual Energy CT Formalisms for Extracting Proton Stopping Powers

Purpose: Dual energy CT can predict stopping power ratios (SPR) for ion therapy treatment planning. Several approaches have been proposed recently, however accuracy and practicability in a clinical workflow are unaddressed. The aim of this work is to provide a fair comparison of available approaches in a human-like phantom to find the optimal method for tissue characterization in a clinical situation. Methods: The SPR determination accuracy is investigated using simulated DECT images. A virtual human-like phantom is created containing 14 different standard human tissues. SECT (120 kV) and DECT images (100 kV and 140 kV Sn) are simulated using the software ImaSim. The single energy CT (SECT) stoichiometric calibration method and four recently published calibration-based DECT methods are implemented and used to predict the SPRs from simulated images. The difference between SPR predictions and theoretical SPR are compared pixelwize. Mean, standard deviation and skewness of the SPR difference distributions are used as measures for bias, dispersion and symmetry. Results: The average SPR differences and standard deviations are (0.22 ± 1.27)% for SECT, and A) (−0.26 ± 1.30)%, B) (0.08 ± 1.12)%, C) (0.06 ± 1.15)% and D) (−0.05 ± 1.05)% for the four DECT methods. While SPR prediction using SECT is showing a systematic error on SPR, the DECT methods B, C and D are unbiased. The skewness of the SECT distribution is 0.57%, and A) −0.19%, B) −0.56%, C) −0.29% and D) −0.07% for DECT methods respectively. Conclusion: The here presented DECT methods B, C and D outperform the commonly used SECT stoichiometric calibration. These methods predict SPR accurately without a bias and within ± 1.2% (68th percentile). This indicates that DECT potentially improves accuracy of range predictions in proton therapy. A validation of these findings using clinical CT images of real tissues is necessary.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

SU-F-J-211: Scatter Correction for Clinical Cone-Beam CT System Using An Optimized Stationary Beam Blocker with a Single Scan

Purpose: X-ray scatter photons result in significant image quality degradation of cone-beam CT (CBCT). Measurement based algorithms using beam blocker directly acquire the scatter samples and achieve significant improvement on the quality of CBCT image. Within existing algorithms, single-scan and stationary beam blocker proposed previously is promising due to its simplicity and practicability. Although demonstrated effectively on tabletop system, the blocker fails to estimate the scatter distribution on clinical CBCT system mainly due to the gantry wobble. In addition, the uniform distributed blocker strips in our previous design results in primary data loss in the CBCT system and leads to the image artifacts due to data insufficiency. Methods: We investigate the motion behavior of the beam blocker in each projection and design an optimized non-uniform blocker strip distribution which accounts for the data insufficiency issue. An accurate scatter estimation is then achieved from the wobble modeling. Blocker wobble curve is estimated using threshold-based segmentation algorithms in each projection. In the blocker design optimization, the quality of final image is quantified using the number of the primary data loss voxels and the mesh adaptive direct search algorithm is applied to minimize the objective function. Scatter-corrected CT images are obtained using the optimized blocker. Results: The proposed method is evaluated using Catphan@504 phantom and a head patient. On the Catphan©504, our approach reduces the average CT number error from 115 Hounsfield unit (HU) to 11 HU in the selected regions of interest, and improves the image contrast by a factor of 1.45 in the high-contrast regions. On the head patient, the CT number error is reduced from 97 HU to 6 HU in the soft tissue region and image spatial non-uniformity is decreased from 27% to 5% after correction. Conclusion: The proposed optimized blocker design is practical and attractive for CBCT guided radiation therapy. This work is supported by grants from Guangdong Innovative Research Team Program of China (Grant No. 2011S013), National 863 Programs of China (Grant Nos. 2012AA02A604 and 2015AA043203), the National High-tech R&D Program for Young Scientists by the Ministry of Science and Technology of China (Grant No. 2015AA020917)

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

SU-F-J-220: Micro-CT Based Quantification of Mouse Brain Vasculature: The Effects of Acquisition Technique and Contrast Material

Purpose: Cognitive impairment from radiation therapy to the brain may be linked to the loss of total blood volume in the brain. To account for brain injury, it is crucial to develop an understanding of blood volume loss as a result of radiation therapy. This study investigates µCT based quantification of mouse brain vasculature, focusing on the effect of acquisition technique and contrast material. Methods: Four mice were scanned on a µCT scanner (Siemens Inveon). The reconstructed voxel size was 18µm3 and all protocols were Hounsfield Unit (HU) calibrated. The mice were injected with 40mg of gold nanoparticles (MediLumine) or 100µl of Exitron 12000 (Miltenyi Biotec). Two acquisition techniques were also performed. A single kVp technique scanned the mouse once using an x-ray beam of 80kVp and segmentation was completed based on a threshold of HU values. The dual kVp technique scanned the mouse twice using 50kVp and 80kVp, this segmentation was based on the ratio of the HU value of the two kVps. After image reconstruction and segmentation, the brain blood volume was determined as a percentage of the total brain volume. Results: For the single kVp acquisition at 80kVp, the brain blood volume had an average of 3.5% for gold and 4.0% for Exitron 12000. Also at 80kVp, the contrast-noise ratio was significantly better for images acquired with the gold nanoparticles (2.0) than for those acquired with the Exitron 12000 (1.4). The dual kVp acquisition shows improved separation of skull from vasculature, but increased image noise. Conclusion: In summary, the effects of acquisition technique and contrast material for quantification of mouse brain vasculature showed that gold nanoparticles produced more consistent segmentation of brain vasculature than Exitron 12000. Also, dual kVp acquisition may improve the accuracy of brain vasculature quantification, although the effect of noise amplification warrants further study.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

SU-F-T-20: Novel Catheter Lumen Recognition Algorithm for Rapid Digitization

Purpose: Manual catheter recognition remains a time-consuming aspect of high-dose-rate brachytherapy (HDR) treatment planning. In this work, a novel catheter lumen recognition algorithm was created for accurate and rapid digitization. Methods: MatLab v8.5 was used to create the catheter recognition algorithm. Initially, the algorithm searches the patient CT dataset using an intensity based k-means filter designed to locate catheters. Once the catheters have been located, seed points are manually selected to initialize digitization of each catheter. From each seed point, the algorithm searches locally in order to automatically digitize the remaining catheter. This digitization is accomplished by finding pixels with similar image curvature and divergence parameters compared to the seed pixel. Newly digitized pixels are treated as new seed positions, and hessian image analysis is used to direct the algorithm toward neighboring catheter pixels, and to make the algorithm insensitive to adjacent catheters that are unresolvable on CT, air pockets, and high Z artifacts. The algorithm was tested using 11 HDR treatment plans, including the Syed template, tandem and ovoid applicator, and multi-catheter lung brachytherapy. Digitization error was calculated by comparing manually determined catheter positions to those determined by the algorithm. Results: he digitization error was 0.23 mm ± 0.14 mm axially and 0.62 mm ± 0.13 mm longitudinally at the tip. The time of digitization, following initial seed placement was less than 1 second per catheter. The maximum total time required to digitize all tested applicators was 4 minutes (Syed template with 15 needles). Conclusion: This algorithm successfully digitizes HDR catheters for a variety of applicators with or without CT markers. The minimal axial error demonstrates the accuracy of the algorithm, and its insensitivity to image artifacts and challenging catheter positioning. Future work to automatically place initial seed positions would improve the algorithm speed.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

SU-F-T-62: Three-Dimensional Dosimetric Gamma Analysis for Impacts of Tissue Inhomogeneity Using Monte Carlo Simulation in Intracavitary Brachytheray for Cervix Carcinoma

Purpose: The aim of this study was to investigate the impacts of tissue inhomogeneity on dose distributions using a three-dimensional (3D) gamma analysis in cervical intracavitary brachytherapy using Monte Carlo (MC) simulations. Methods: MC simulations for comparison of dose calculations were performed in a water phantom and a series of CT images of a cervical cancer patient (stage: Ib; age: 27) by employing a MC code, Particle and Heavy Ion Transport Code System (PHIT) version 2.73. The {sup 192}Ir source was set at fifteen dwell positions, according to clinical practice, in an applicator consisting of a tandem and two ovoids. Dosimetric comparisons were performed for the dose distributions in the water phantom and CT images by using gamma index image and gamma pass rate (%). The gamma index is the minimum Euclidean distance between two 3D spatial dose distributions of the water phantom and CT images in a same space. The gamma pass rates (%) indicate the percentage of agreement points, which mean that two dose distributions are similar, within an acceptance criteria (3 mm/3%). The volumes of physical and clinical interests for the gamma analysis were a whole calculated volume and a region larger than t% of a dose (close to a target), respectively. Results: The gamma pass rates were 77.1% for a whole calculated volume and 92.1% for a region within 1% dose region. The differences of 7.7% to 22.9 % between two dose distributions in the water phantom and CT images were found around the applicator region and near the target. Conclusion: This work revealed the large difference on the dose distributions near the target in the presence of the tissue inhomogeneity. Therefore, the tissue inhomogeneity should be corrected in the dose calculation for clinical treatment.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

SU-F-T-552: A One-Year Evaluation of the QABeamChecker+ for Use with the CyberKnife System

Purpose: By attaching an adapter plate with fiducial markers to the QA BeamChecker+ (Standard Imaging, Inc., Middleton, WI), the output of the CyberKnife can be accurately, efficiently, and consistently evaluated. The adapter plate, known as the Cutting Board, allows for automated alignment of the QABC+ using the CK’s stereoscopic kV image-based treatment localization system (TLS). Described herein is an evaluation of the system following a year of clinical utilization. Methods: Based on a CT scan of the QABC+ and CB, a treatment plan is generated which delivers a beam to each of the 5 plane-parallel ionization chambers. Following absolute calibration of the CK, the QA plan is delivered, and baseline measurements are acquired (and automatically corrected for temperature and pressure). This test was performed at the beginning of each treatment day for a year. A calibration evaluation (using a water-equivalent slab and short thimble chamber) is performed every four weeks, or whenever the QABC+ detects a deviation of more than 1.0%. Results: During baseline evaluation, repeat measurements (n=10) were performed, with an average output of 0.25% with an SD of 0.11%. As a test of the reposition of the QABC+ and CB, ten additional measurements were performed where between each acquisition, the entire system was removed and re-positioned using the TLS. The average output deviation was 0.30% with a SD of 0.13%. During the course of the year, 187 QABC+ measurements and 13 slab-based measurements were performed. The output measurements of the QABC+ correlated well with slab-based measurements (R2=0.909). Conclusion: By using the QABC+ and CB, daily output was evaluated accurately, efficiently, and consistently. From setup to break-down (including analysis), this test required 5 minutes instead of approximately 15 using traditional techniques (collimator-mounted ionization chambers). Additionally, by automatically saving resultant output deviation to a database, trend analysis was simplified. Spectrum Medical Physics, LLC of Greenville, SC has a consulting contract with Standard Imaging of Middleton, WI.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

SU-F-T-634: Feasibility Study of Respiratory Gated RapidArc SBRT Using a 6MV FFF Photon Beam

Purpose: To conduct a feasibility study on retrospective respiratory gating and marker tracking for lung stereotactic body radiotherapy (SBRT) with a gated RapidArc delivery using a 6MV flattened filter free photon mode. Methods: A CIRS dynamic thorax phantom Model 008A with different inserts was used for treatment planning and respiratory gating. 4D CT had a free breathing simulation followed by a respiration gated, ten phased CT using a Philips Brilliance CT with a Varian RPM respiratory gating system. The internal target volume was created from the ten phase gated CT images, followed by exporting to a Varian Eclipse TPS v11 for treatment planning on the free breath images. Both MIP and AIP were also generated for comparison of planning and target motion tracking. The planned dose was delivered with a 6MV FFF photon beam from a Varian TrueBeam accelerator. Gated target motion was also verified by tracking the implanted makers during delivery using continuous kV imaging in addition to CBCT, kV and MV localization and verification. Results: Gating was studied in three situations of lower, normal, and faster breathing at a respiratory cycle of 5, 15 and 25 breaths per minute, respectively. 4D treatment planning was performed at a normal breathing of 15 breaths per minute. The gated patterns obtained using the TrueBeam IR camera were compared with the planned ones while gating operation was added prior to delivery . Gating was realized only when the measured respiratory patterns matched to the planned ones. The gated target motion was verified within the tolerance by kV and MV imaging. Either free breathing CT or averaged CT images were studied to be good for image guidance to align the target. Conclusion: Gated RapidArc SBRT delivered with a 6MV FFF photon beam is realized using a dynamic lung phantom.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

SU-G-206-02: Impact of Focal Spot Sizes On CT Image Quality

Purpose: To quantify a radiology team’s assessment of image quality differences between two CT scanner models currently in clinical use, with emphasis on spatial resolution that could be impacted by focal spot size. Methods: Modulation Transfer Functions (MTF) measurements were performed by scanning the impulse source insert module of the Catphan 600 at 120/140 kVp with both large (LFS) and small (SFS) focal spots and reconstructed to 2.5mm and 5.0mm thicknesses on a GE Discovery CT750 HD and a LightSpeed VCT CT scanner. MTFs were calculated by summing the 2D PSF along one-dimension to obtain line-spread-function (LSF), and calculating the Fourier Transform of the zero-padded and background corrected LSF. Spatial resolution performance was evaluated by comparing MTF curves, 50% and 10% MTF cutoff, and total area under the MTF curve (AUC). In addition, images of the Catphan high-contrast module and a Kagaku anthropomorphic body phantom were acquired from the HD scanner for visual comparisons. Results: For each scanner model, SFS was superior to LFS spatial resolution with respect to 50%/10% MTF cutoff and AUC. For the HD, 50%/10% cutoff was 4.29/7.22cm-1 for the LFS and 4.43/7.45cm-1 for the SFS. VCT outperformed HD, with 50%/10% cutoff of 4.40/7.29 cm-1 for LFS and 4.62/7.47cm-1 for SFS. Scanner model performance in order of decreasing AUC performance was VCT SFS (7.43), HD SFS (7.20), VCT LFS (7.09) and HD LFS (6.93). Visual evaluations of Kagaku phantom images confirmed that VCT outperformed HD. Conclusion: VCT outperformed HD and small focal spot is desired for either model over large focal spot in term of spatial resolution – in agreement with radiologist feedback of overall image quality. In-depth evaluations of clinical impact and focal spot selection mechanisms is currently being assessed.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

SU-G-206-11: The Effect of Table Height On CTDIvol and SSDE 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 calculation of the Size Specific Dose Estimate (SSDE). Due to geometric effects, the projected patient size varies with scanner table height and with the orientation of the localizer (AP versus PA). Consequently, variations in scanner table height may affect both CTDIvol and the calculated size-corrected dose index (SSDE). This study sought to characterize these effects. Methods: An anthropomorphic phantom was imaged using an AP localizer, followed by a diagnostic scan using ATCM and our institution’s routine abdomen protocol. This was repeated at various scanner table heights, recording the scanner-reported CTDIvol for each diagnostic scan. The width of the phantom was measured from the localizer and diagnostic images using in-house software. The measured phantom width and scanner-reported CTDIvol were used to calculate SSDE. This was repeated using PA localizers followed by diagnostic scans. Results: 1) The localizer-based phantom width varied by up to 54% of the nominal phantom width between minimum and maximum table heights. 2) Changing the table height caused a variation in scanner-reported CTDIvol of a factor greater than 4.6 when using a PA localizer and almost 2 when using an AP localizer. 3) SSDE, calculated from measured phantom size and scanner-reported CTDIvol, varied by a factor of more than 2.8 when using a PA localizer and almost 1.5 when using an AP localizer. Conclusion: Our study demonstrates that off-center patient positioning affects the efficacy of ATCM, more severely when localizers are acquired in the PA rather than AP projection. Further, patient positioning errors can cause a large variation in the calculated SSDE. This hinders interpretation of SSDE for individual patients and aggregate SSDE data when evaluating CT protocols and clinical practices.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

SU-G-IeP1-08: MR Geometric Distortion Dependency On Imaging Sequence, Acquisition Orientation and Receiver Bandwidth of a Dedicated 1.5T MR-Simulator

Purpose: To investigate the 3D geometric distortion of four potential MR sequences for radiotheraptic applications, and its dependency on sequence-type, acquisition-orientation and receiver-bandwidth from a dedicated 1.5T 700mm-wide bore MR-simulator (Magnetom-Aera, Sienmens Healthcare, Erlangen, Germany), using a large customized geometric accuracy phantom. Methods: This work studied 3D gradient-echo (VIBE) and spin-echo (SPACE) sequences for anatomical imaging; a specific ultra-short-TE sequence (PETRA) potentially for bone imaging and MR-based dosimetry; and a motion-insensitive sequence (BLADE) for dynamic applications like 4D-MRI. Integrated geometric-correction was employed, three orthogonal acquisition-orientations and up to three receiver-bandwidths were used, yielding 27 acquisitions for testing (Table 1a).A customized geometric accuracy phantom (polyurethane, MR/CT invisible, W×L×H:55×55×32.5cm3) was constructed and filled with 3892 spherical markers (6mm diameter, MR/CT visible) arranged on a 25mm-interval 3D isotropic-grid (Fig.1). The marker positions in MR images were quantitatively calculated and compared against those in the CT-reference using customized MatLab scripts. Results: The average distortion within various diameter-of-spherical-volumes (DSVs) and the usable DSVs under various distortion limits were measured (Tables 1b-c). It was observed that distortions fluctuated when sequence-type, acquisition-orientation or receiver-bandwidth changed (e.g. within 300mm-DSV, the lowest/highest average distortions of VIBE were 0.40mm/0.59mm, a 47.5% difference). According to AAPM-TG66 (<1mm distortion, left-most column of Table 1c), PETRA (Largest-DSV:253.9mm) has the potential on brain treatment, while BLADE (Largest-DSV:207.2mm) may need improvement for thoracic/abdominal applications. The results of VIBE (Largest-DSVs:294.3mm, the best among tested acquisitions) and SPACE (Largest-DSVs:267.7mm) suggests their potentials on head and neck applications. These Largest-DSVs were attained on different acquisition-orientations and receiver-bandwidths. Conclusion: Geometric distortion was shown to be dependent on sequence-type, acquisition-orientation and receiver-bandwidth. In the experiment, no configuration in any one of these factors could consistently reduce distortion while the others were varying. The distortion analysis result is a valuable guideline for sequence selection and optimization for MR-aided radiotherapy applications.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

SU-G-JeP3-05: Geometry Based Transperineal Ultrasound Probe Positioning for Image Guided Radiotherapy

Purpose: The use of ultrasound (US) imaging in radiotherapy is not widespread, primarily due to the need for skilled operators performing the scans. Automation of probe positioning has the potential to remove this need and minimize operator dependence. We introduce an algorithm for obtaining a US probe position that allows good anatomical structure visualization based on clinical requirements. The first application is on 4D transperineal US images of prostate cancer patients. Methods: The algorithm calculates the probe position and orientation using anatomical information provided by a reference CT scan, always available in radiotherapy workflows. As initial test, we apply the algorithm on a CIRS pelvic US phantom to obtain a set of possible probe positions. Subsequently, five of these positions are randomly chosen and used to acquire actual US volumes of the phantom. Visual inspection of these volumes reveal if the whole prostate, and adjacent edges of bladder and rectum are fully visualized, as clinically required. In addition, structure positions on the acquired US volumes are compared to predictions of the algorithm. Results: All acquired volumes fulfill the clinical requirements as specified in the previous section. Preliminary quantitative evaluation was performed on thirty consecutive slices of two volumes, on which the structures are easily recognizable. The mean absolute distances (MAD) between actual anatomical structure positions and positions predicted by the algorithm were calculated. This resulted in MAD of 2.4±0.4 mm for prostate, 3.2±0.9 mm for bladder and 3.3±1.3 mm for rectum. Conclusion: Visual inspection and quantitative evaluation show that the algorithm is able to propose probe positions that fulfill all clinical requirements. The obtained MAD is on average 2.9 mm. However, during evaluation we assumed no errors in structure segmentation and probe positioning. In future steps, accurate estimation of these errors will allow for better evaluation of the achieved accuracy.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

SU-G-JeP3-06: Lower KV Image Dose Are Expected From a Limited-Angle Intra-Fractional Verification (LIVE) System for SBRT Treatments

Purpose: In order to track the tumor movement for patient positioning verification during arc treatment delivery or in between 3D/IMRT beams for stereotactic body radiation therapy (SBRT), the limited-angle kV projections acquisition simultaneously during arc treatment delivery or in-between static treatment beams as the gantry moves to the next beam angle was proposed. The purpose of this study is to estimate additional imaging dose resulting from multiple tomosynthesis acquisitions in-between static treatment beams and to compare with that of a conventional kV-CBCT acquisition. Methods: kV imaging system integrated into Varian TrueBeam accelerators was modeled using EGSnrc Monte Carlo user code, BEAMnrc and DOSXYZnrc code was used in dose calculations. The simulated realistic kV beams from the Varian TrueBeam OBI 1.5 system were used to calculate dose to patient based on CT images. Organ doses were analyzed using DVHs. The imaging dose to patient resulting from realistic multiple tomosynthesis acquisitions with each 25–30 degree kV source rotation between 6 treatment beam gantry angles was studied. Results: For a typical lung SBRT treatment delivery much lower (20–50%) kV imaging doses from the sum of realistic six tomosynthesis acquisitions with each 25–30 degree x-ray source rotation between six treatment beam gantry angles were observed compared to that from a single CBCT image acquisition. Conclusion: This work indicates that the kV imaging in this proposed Limited-angle Intra-fractional Verification (LIVE) System for SBRT Treatments has a negligible imaging dose increase. It is worth to note that the MV imaging dose caused by MV projection acquisition in-between static beams in LIVE can be minimized by restricting the imaging to the target region and reducing the number of projections acquired. For arc treatments, MV imaging acquisition in LIVE does not add additional imaging dose as the MV images are acquired from treatment beams directly during the treatment.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

SU-G-JeP4-03: Anomaly Detection of Respiratory Motion by Use of Singular Spectrum Analysis

Purpose: The implementation and realization of automatic anomaly detection of respiratory motion is a very important technique to prevent accidental damage during radiation therapy. Here, we propose an automatic anomaly detection method using singular value decomposition analysis. Methods: The anomaly detection procedure consists of four parts:1) measurement of normal respiratory motion data of a patient2) calculation of a trajectory matrix representing normal time-series feature3) real-time monitoring and calculation of a trajectory matrix of real-time data.4) calculation of an anomaly score from the similarity of the two feature matrices. Patient motion was observed by a marker-less tracking system using a depth camera. Results: Two types of motion e.g. cough and sudden stop of breathing were successfully detected in our real-time application. Conclusion: Automatic anomaly detection of respiratory motion using singular spectrum analysis was successful in the cough and sudden stop of breathing. The clinical use of this algorithm will be very hopeful. This work was supported by JSPS KAKENHI Grant Number 15K08703.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

SU-G-JeP4-14: Assessment of Inter- and Intra-Fractional Motion for Extremity Soft Tissue Sarcoma Patients by Using In-House Real-Time Optical Image-Based Monitoring System

Purpose: This study aimed to assess inter- and intra-fractional motion for extremity Soft Tissue Sarcoma (STS) patients, by using in-house real-time optical image-based monitoring system (ROIMS) with infra-red (IR) external markers. Methods: Inter- and intra-fractional motions for five extremity (1 upper, 4 lower) STS patients received postoperative 3D conformal radiotherapy (3D-CRT) were measured by registering the image acquired by ROIMS with the planning CT image (REG-ROIMS). To compare with the X-ray image-based monitoring, pre- and post-treatment cone beam computed tomography (CBCT) scans were performed once per week and registered with planning CT image as well (REG-CBCT). If the CBCT scan is not feasible due to the large couch shift, AP and LR on-board imager (OBI) images were acquired. The comparison was done by calculating mutual information (MI) of those registered images. Results: The standard deviation (SD) of the inter-fractional motion was 2.6 mm LR, 2.8 mm SI, and 2.0 mm AP, and the SD of the intra-fractional motion was 1.4 mm, 2.1 mm, and 1.3 mm in each axis, respectively. The SD of rotational inter-fractional motion was 0.6° pitch, 0.9° yaw, and 0.8° roll and the SD of rotational intra-fractional motion was 0.4° pitch, 0.9° yaw, and 0.7° roll. The derived averaged MI values were 0.83, 0.92 for REG-CBCT without rotation and REG-ROIMS with rotation, respectively. Conclusion: The in-house real-time optical image-based monitoring system was implemented clinically and confirmed the feasibility to assess inter- and intra-fractional motion for extremity STS patients while the daily basis and real-time CBCT scan is not feasible in clinic.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

MO-DE-207A-12: Toward Patient-Specific 4DCT Reconstruction Using Adaptive Velocity Binning

Purpose: While 4DCT provides organ/tumor motion information, it often samples data over 10–20 breathing cycles. For patients presenting with compromised pulmonary function, breathing patterns can change over the acquisition time, potentially leading to tumor delineation discrepancies. This work introduces a novel adaptive velocity-modulated binning (AVB) 4DCT algorithm that modulates the reconstruction based on the respiratory waveform, yielding a patient-specific 4DCT solution. Methods: AVB was implemented in a research reconstruction configuration. After filtering the respiratory waveform, the algorithm examines neighboring data to a phase reconstruction point and the temporal gate is widened until the difference between the reconstruction point and waveform exceeds a threshold value—defined as percent difference between maximum/minimum waveform amplitude. The algorithm only impacts reconstruction if the gate width exceeds a set minimum temporal width required for accurate reconstruction. A sensitivity experiment of threshold values (0.5, 1, 5, 10, and 12%) was conducted to examine the interplay between threshold, signal to noise ratio (SNR), and image sharpness for phantom and several patient 4DCT cases using ten-phase reconstructions. Individual phase reconstructions were examined. Subtraction images and regions of interest were compared to quantify changes in SNR. Results: AVB increased signal in reconstructed 4DCT slices for respiratory waveforms that met the prescribed criteria. For the end-exhale phases, where the respiratory velocity is low, patient data revealed a threshold of 0.5% demonstrated increased SNR in the AVB reconstructions. For intermediate breathing phases, threshold values were required to be >10% to notice appreciable changes in CT intensity with AVB. AVB reconstructions exhibited appreciably higher SNR and reduced noise in regions of interest that were photon deprived such as the liver. Conclusion: We demonstrated that patient-specific velocity-based 4DCT reconstruction is feasible. Image noise was reduced with AVB, suggesting potential applications for low-dose acquisitions and to improve 4DCT reconstruction for irregular breathing patients. The submitting institution holds research agreements with Philips Healthcare.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

TU-A-201-01: Introduction to In-Room Imaging System Characteristics

Recent years have seen a widespread proliferation of available in-room image guidance systems for radiation therapy target localization with many centers having multiple in-room options. In this session, available imaging systems for in-room IGRT will be reviewed highlighting the main differences in workflow efficiency, targeting accuracy and image quality as it relates to target visualization. Decision-making strategies for integrating these tools into clinical image guidance protocols that are tailored to specific disease sites like H&N, lung, pelvis, and spine SBRT will be discussed. Learning Objectives: Major system characteristics of a wide range of available in-room imaging systems for IGRT. Advantages / disadvantages of different systems for site-specific IGRT considerations. Concepts of targeting accuracy and time efficiency in designing clinical imaging protocols.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

TU-A-201-02: Treatment Site-Specific Considerations for Clinical IGRT

60 APPLIED LIFE SCIENCES↗