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Younger facial looks are associate with a lower likelihood of several age-related morbidities in the middle-aged to elderly

Abstract Background Looking older for one’s chronological age is associated with a higher mortality rate. Yet it remains unclear how perceived facial age relates to morbidity and the degree to which facial ageing reflects systemic ageing of the human body. Objectives To investigate the association between ΔPA and age-related morbidities of different organ systems, where ΔPA represents the difference between perceived age (PA) and chronological age. Methods We performed a cross-sectional analysis on data from the Rotterdam Study, a population-based cohort study in the Netherlands. High-resolution facial photographs of 2679 men and women aged 51.5–87.8 years of European descent were used to assess PA. PA was estimated and scored in 5-year categories using these photographs by a panel of men and women who were blinded for chronological age and medical history. A linear mixed model was used to generate the mean PAs. The difference between the mean PA and chronological age was calculated (ΔPA), where a higher (positive) ΔPA means that the person looks younger for their age and a lower (negative) ΔPA that the person looks older. ΔPA was tested as a continuous variable for association with ageing-related morbidities including cardiovascular, pulmonary, ophthalmological, neurocognitive, renal, skeletal and auditory morbidities in separate regression analyses, adjusted for age and sex (model 1) and additionally for body mass index, smoking and sun exposure (model 2). Results We observed 5-year higher ΔPA (i.e. looking younger by 5 years for one’s age) to be associated with less osteoporosis [odds ratio (OR) 0.76, 95% confidence interval (CI) 0.62–0.93], less chronic obstructive pulmonary disease (OR 0.85, 95% CI 0.77–0.95), less age-related hearing loss (model 2; B = −0.76, 95% CI −1.35 to −0.17) and fewer cataracts (OR 0.84, 95% CI 0.73–0.97), but with better global cognitive functioning (g-factor; model 2; B = 0.07, 95% CI 0.04–0.10). Conclusions PA is associated with multiple morbidities and better cognitive function, suggesting that systemic ageing and cognitive ageing are, to an extent, externally visible in the human face.

Mekić, Selma↗

Subsurface landfill leachate contamination affects microbial metabolic potential and gene expression in the Banisveld aquifer

Microbial communities in groundwater ecosystems can develop the capacity to degrade complex mixtures of chemicals resulting from pollution by landfill leachate. Monitoring this natural attenuation requires insight into the metabolic potential and activity of microbial communities. We contrasted the metagenomes and metatranscriptomes from a leachate-polluted aquifer downstream of the Banisveld (the Netherlands) landfill with uncontaminated groundwater, which revealed changes in microbial genomic content and activity. Banisveld landfill leachate contains mono-aromatic hydrocarbons and the assessment of natural attenuation of these compounds in the aquifer had been a focal point of research. In the contaminated groundwater, active microbial functions were the ones involved in degradation of complex carbon substrates and organic pollutants. We found that benzylsuccinate synthase genes-involved in the catabolism of toluene-were highly expressed close to the source of contamination, confirming the ongoing natural attenuation of organic mono-aromatic hydrocarbon pollution in this aquifer. Additionally, metatranscriptomes were indicative of phosphorus limitation that can constrain total microbial activity and agree with the low phosphate concentrations (<0.4 μmol/L) in this aquifer. Through the application of metagenomics and metatranscriptomics, we were able to determine functional potential and expression patterns to assess the natural attenuation processes and constraints on microbial communities.

59 BASIC BIOLOGICAL SCIENCES↗

Investigation of Gas Turbine Internal Cooling Using Supercritical CO 2 —Effect of Surface Roughness and Channel Aspect Ratio

In this paper, an experimental and numerical investigation of internal cooling channels with rib turbulators is presented with sCO 2 as the working fluid at process conditions (pressure-20.7 MPa and temperature up to 150 °C). The effect of channel aspect ratio up to 2:1 on thermal-hydraulic performance is explored in additively manufactured rectangular channels and square channels, both with and without 60 deg ribs on the top and bottom sides. The Wilson-plot method is employed to experimentally measure channel-averaged Nusselt number over a Reynolds number range up to 370,000. The friction factor is calculated from pressure drop and mass flow rate and additionally, the overall thermal performance factor (TPF) is reported. A companion computational fluid dynamics (CFD) simulation is performed for the rib turbulated cooling configurations reported in the experiments using the Reynolds average Navier–Stokes-based turbulence model. The objective of the numerical study is to gain insight into the local heat transfer augmentation in the ribbed channels as a result of varying the aspect ratio, channel configuration (square versus rectangular), operating conditions (Reynolds number) and the surface roughness, an inherent outcome of the additive manufacturing process. Surface roughness is simulated using sand grain roughness height (K S ) calculated from the experimental data, and a comparison is presented with the corresponding channel configuration with varying surface roughness heights starting from smooth surfaces (K S = 0). Experimental results indicate that the heat transfer augmentation is negligible in the rectangular channels with ribs on the long side compared to the square channel. However, it is enhanced by 60% in comparison to placing ribs on the shorter side. The TPF remains constant at around 1 for the entire range of Reynolds numbers consistent with prior work at the National Energy Technology Laboratory (NETL). Here, the simulation results highlight that increased surface roughness can have a favorable considerable influence on Nusselt number and overall thermal performance enhancement.

42 ENGINEERING↗

Comparison of Second-Order Loads on a Semisubmersible Floating Wind Turbine: Preprint

As offshore wind projects move to deeper waters, floating platforms become the most feasible solution for supporting the turbines. The oil and gas industry has gained experience with floating platforms that can be applied to offshore wind projects. This paper focuses on the analysis of second-order wave loading on semisubmersible platforms. Semisubmersibles, which are being chosen for different floating offshore wind concepts, are particularly prone to slow-drift motions. The slack catenary moorings usually result in large natural periods for surge and sway motions (more than 100 s), which are in the range of the second-order difference-frequency excitation force. Modeling these complex structures requires coupled design codes. Codes have been developed that include turbine aerodynamics, hydrodynamic forces on the platform, restoring forces from the mooring lines, flexibility of the turbine, and the influence of the turbine control system. In this paper two different codes are employed: FAST, which was developed by the National Renewable Energy Laboratory, and aNySIM, which was developed by the Maritime Research Institute Netherlands. The hydrodynamic loads are based on potential-flow theory, up to the second order. Hydrodynamic coefficients for wave excitation, radiation, and hydrostatic forces are obtained with two different panel codes, WAMIT (developed by the Massachusetts Institute of Technology) and DIFFRAC (developed by MARIN). The semisubmersible platform, developed for the International Energy Agency Wind Task 30 Offshore Code Comparison Collaboration Continuation project is used as a reference platform. Irregular waves are used to compare the behavior of this platform under slow-drift excitation loads. The results from this paper highlight the effects of these loads on semisubmersible-type platforms, which represent a promising solution for the commercial development of the offshore deepwater wind resource.

17 WIND ENERGY↗

1:52 Scale Testing of the First US Commercial Scale Floating Wind Turbine, VolturnUS: Testing Overview and the Evolution of Scale Model Testing Methods

Over the past 6 years, the University of Maine (UMaine) has been an active contributor in research and scale-model testing of floating offshore wind turbines (FOWTs). This paper serves to share the evolution of UMaine’s scale-model testing pedigree by exploring the various test campaigns at a high level, culminating with the design validation of the VolturnUS floating platform. These model test campaigns have each provided key insights into the behavior of FOWT platforms as well as improving the ability to perform model tests of FOWTs. In 2011, the UMaine-led DeepCwind Consortium carried out 1/50-scale model tests of a generic tension leg platform (TLP), a semi-submersible (semi), and a spar-buoy (spar) floating platform at the Maritime Research Institute Netherlands (MARIN) test facility. The designs were Froude-scaled and supported a scaled version of the 5-MW National Renewable Energy Laboratory (NREL) offshore research turbine. Data from these tests has been used extensively for numerical simulation validation efforts using NREL’s computer-aided engineering software FAST and laid the foundation for UMaine’s design efforts on VolturnUS. In 2013, UMaine conducted another test campaign at MARIN using the original semi-submersible from 2011 with an improved turbine as well as a 1:50-scale model of the VolturnUS concrete semi-submersible design. The improved DeepCwind semi-submersible data is currently being utilized in the validation of a large number of other analysis codes as part of the International Energy Agency’s OC5 project. In 2015, UMaine opened its own Wind/Wave test facility, the Alfond Wind/Wave Ocean Engineering Laboratory (W2). Utilizing this new facility, UMaine tested the 1:50-scale model DeepCwind semi-submersible, repeating the tests from MARIN, to validate the experimental equipment and procedures as well as demonstrate the capability of the W2. In 2016 UMaine carried out testing of a 1:52-scale model of the 100% design of the VolturnUS with a 6-MW topside as a final design validation to support the US Department of Energy-supported, full-scale Aqua Ventus demonstration project scheduled to be connected to the grid in 2019. A newly designed 6-MW scale model turbine was used in this test and the performance-matched turbine design methodology is described. Selected results from the test campaign and preliminary numerical comparisons are discussed as well as key lessons learned from the model test campaigns are presented.

17 WIND ENERGY↗

SU-D-19A-07: Dosimetric Comparison of HDR Plesiotherapy and Electron Beam Therapy for Superficial Lesions

Purpose: Large superficial (skin, soft tissue sarcoma) lesions located on curved areas are hard to treat with electrons. The Freiburg Flap (Nucletron, Netherlands) is a flexible mesh style surface which can be easily shaped to fit curved surfaces for reproducible HDR fraction delivery. To understand the fundamental dosimetric differences, a dosimetric comparison was made between HDR plesiotherapy (Freiburg applicator for lesions over 4cm) and external electron beam radiotherapy over cases with varying target curvature (both stylized and clinical cases). Methods: Four stylized cases with variable complexity were created using artificial DICOM axial CT slices and RT structures (a square and three curved structures on a 4.5cm radius cylinder). They were planned using Oncentra v4.3 and exported to Pinnacle v9.6 for electrons planning. The HDR source dwell positions were optimized for the best coverage of the targets using graphical optimization. Electron treatment plans were created in Pinnacle using the same CT and RT structures of three HDR cases with surface lesions previously treated with the Freiburg flap. The En face electron plans used 6-12 MeV electrons and 0.5–1 cm bolus was added to increase surface dose. The electron plans were prescribed to an isodose line to conform to the target. Results: For all lesions, the average target dose coverage was similar (D90ave of 100% for HDR vs 101% for electrons). For lesions with high curvature, the HDR coverage was better (D90 102% vs D90 97% for electron). For all cases, adjacent structures high dose region was lower for HDR than electrons (D1cc 100% for HDR vs D1cc 111% for electrons). Conclusion: HDR plesiotherapy offers excellent target conformity for superficial targets similar to electrons. However, for lesions with complex curved surfaces, HDR has the advantage to achieve better dose distributions using graphical optimization to spare adjacent normal tissue while maximizing target coverage.

60 APPLIED LIFE SCIENCES↗

SU-E-T-362: Automatic Catheter Reconstruction of Flap Applicators in HDR Surface Brachytherapy

Purpose: Catheter reconstruction is crucial for the accurate delivery of radiation dose in HDR brachytherapy. The process becomes complicated and time-consuming for large superficial clinical targets with a complex topology. A novel method for the automatic catheter reconstruction of flap applicators is proposed in this study. Methods: We have developed a program package capable of image manipulation, using C++class libraries of The-Visualization-Toolkit(VTK) software system. The workflow for automatic catheter reconstruction is: a)an anchor point is placed in 3D or in the axial view of the first slice at the tip of the first, last and middle points for the curved surface; b)similar points are placed on the last slice of the image set; c)the surface detection algorithm automatically registers the points to the images and applies the surface reconstruction filter; d)then a structured grid surface is generated through the center of the treatment catheters placed at a distance of 5mm from the patient's skin. As a result, a mesh-style plane is generated with the reconstructed catheters placed 10mm apart. To demonstrate automatic catheter reconstruction, we used CT images of patients diagnosed with cutaneous T-cell-lymphoma and imaged with Freiburg-Flap-Applicators (Nucletron™-Elekta, Netherlands). The coordinates for each catheter were generated and compared to the control points selected during the manual reconstruction for 16catheters and 368control point Results: The variation of the catheter tip positions between the automatically and manually reconstructed catheters was 0.17mm(SD=0.23mm). The position difference between the manually selected catheter control points and the corresponding points obtained automatically was 0.17mm in the x-direction (SD=0.23mm), 0.13mm in the y-direction (SD=0.22mm), and 0.14mm in the z-direction (SD=0.24mm). Conclusion: This study shows the feasibility of the automatic catheter reconstruction of flap applicators with a high level of positioning accuracy. Implementation of this technique has potential to decrease the planning time and may improve overall quality in superficial brachytherapy.

60 APPLIED LIFE SCIENCES↗

TH-A-BRF-03: Evaluation of Synthetic CTs Generated Using MR-SIM Data

Purpose: To describe and evaluate a novel algorithm for generating synthetic CT images from MR-SIM data for dose calculations in MR-only treatment planning. Methods: A voxel-based weighted summation method was implemented to generate synthetic CT (synCT) images. MR data were acquired using Philips 1.0T Panorama high-field open MR-SIM. Retrospective patient data from seven prostate patients and one brain patient (three lesions) enrolled in an IRB-approved study were used. 3D T1-weighted fast field echo and 3D T2-weighted turbo spin echo sequences were utilized for all patients. A 3D balanced turbo field echo sequence using spectral presaturation with inversion recovery was acquired for prostate patients, but 3D ultra-short echo time (UTE)-DIXON was instead acquired for the brain patient to amplify bone signal for semi-automatic bone segmentation. Weight optimization was performed using a training subset of patients. HU value differences between planning CT and synCTs were analyzed using mean absolute error (MAE). Original patient CT-based treatment plans were mapped onto synCTs, dose was recalculated using original leaf motion and MU values, and DRRs were generated. Dosevolume metrics and gamma analysis were used for dosimetric evaluation. Results: Average whole-body MAE of synCTs across all patients was 75+12 HU. In prostate cancer patients, average HU difference between planning and synCTs was 0.9±1.0% for soft tissue structures and 4.3±2.5% for bony structures. DRRs were generated from synCTs and qualitatively showed good geometric agreement with planning CT-generated DRRs. D99, mean dose, and maximum dose to CTV calculated using the synCT remained within 1.2% of planning CT-based dose calculations. All gamma analysis evaluated at 2%/2mm dose difference/distance to agreement) pass rates were greater than 95% with an average of 99.9±0.1% for prostate patients and 98.4±2.2% for three brain lesions. Conclusion: SynCTs were generated with clinically acceptable accuracy comparable to planning CTs, enabling dose computations for MR-only simulation. Research supported in part by a grant from Philips HealthCare (Best, Netherlands)

60 APPLIED LIFE SCIENCES↗

TH-A-BRF-12: Assessment of 4D-MRI for Robust Motion and Volume Characterization

Purpose: Precise radiation therapy for abdominal lesions is complicated by respiratory motion and poor soft tissue contrast from 4DCT whereas 4DMRI provides superior tissue discrimination. We evaluated a novel 4D-MRI algorithm for MR-SIM motion management. Methods: Respiratory-triggered, T2-weighted single-shot Turbo Spin Echo 4D-MRI was evaluated for open high-field 1.0T MR-SIM. A programmable platform pulled objects on a trolley ∼2 cm superior-inferior (S-I) for “regular” (sinusoidal, (1-cos{sup 2}), 3-5 second periods) and “irregular” breathing patterns (exaggerated (1-cos{sup 2}) and patient curves), while a respiratory waveform was generated via a pressure sensor device. Coronal 4D-MRIs (2–12;10 phases, TE/TR/α = 35−61/6100 ms/90°, voxel=1×1×4 mm{sup 3}) were acquired for 54 unique phantom cases. Abdominal 4D−MRIs were evaluated for 5 healthy volunteers and 1 liver cancer patient (6–10 phases, TE/TR/α = 30−96/4500−6100 ms/90°, voxel=1×1×5–10 mm{sup 3}) on an IRB-approved protocol. Duty cycle, scan time, and excursion were evaluated between phase acquisitions and compared to coronal cine-MRI (∼1 frame/sec). Maximum intensity projections (MIPs) were analyzed. Results: In phantom, average duty cycle was 42.6 ± 11.4% (range: 23.6–69.1%). Regular, periodic breathing (sinusoidal, (1-cos{sup 2})) yielded higher duty cycles than irregular (48.5% and 35.9%, respectively, p<0.001) and fast periods had higher duty cycles than slow (50.4% for 3s and 39.4% for 5s, p<0.001). ∼4-fold acquisition time increase was measured for 10-phase versus 2-phase. MIP renderings revealed that SI object extent was underestimated a maximum of 4% (3mm) and 8% (6mm) for cine and 2-phase 4D-MRI, respectively, with respect to 10-phases. However, this was waveform dependent. A highly irregular breathing volunteer yielded lowest duty cycle (23%) and longest 10-phase scan time (∼14 minutes), although 6-phase acquisition for a liver cancer patient was reasonable (50% and 7.4 minutes, respectively). Conclusion: 4D-MRI offers potential for excursion characterization, although results suggest the use of adequate phases is important. Further application and clinical validation are warranted. Research supported in part by a grant from Philips HealthCare (Best, Netherlands) and an Internal Mentored Grant from Henry Ford Health System.

60 APPLIED LIFE SCIENCES↗

SU-E-I-60: Quality Assurance Testing Methods and Customized Phantom for Magnetic Resonance Imaging and Spectroscopy

Purpose: The objectives of this study are to develop an magnetic resonance imaging and spectroscopy (MRI-MRS) fused phantom along with the inserts for metabolite quantification and to conduct quantitative analysis and evaluation of the layered vials of brain-mimicking solution for quality assurance (QA) performance, according to the localization sequence. Methods: The outer cylindrical phantom body is made of acrylic materials. The section other than where the inner vials are located was filled with copper sulfate and diluted with water so as to reduce the T1 relaxation time. Sodium chloride was included to provide conductivity similar to the human body. All measurements of MRI and MRS were made using a 3.0 T scanner (Achiva Tx 3.0 T; Philips Medical Systems, Netherlands). The MRI scan parameters were as follows: (1) spin echo (SE) T1-weighted image: repetition time (TR), 500ms; echo time (TE), 20ms; matrix, 256×256; field of view (FOV), 250mm; gap, 1mm; number of signal averages (NSA), 1; (2) SE T2-weighted image: TR, 2,500 ms; TE, 80 ms; matrix, 256×256; FOV, 250mm; gap, 1mm; NSA, 1; 23 slice images were obtained with slice thickness of 5mm. The water signal of each volume of interest was suppressed by variable pulse power and optimized relaxation delays (VAPOR) applied before the scan. By applying a point-resolved spectroscopy sequence, the MRS scan parameters were as follows: voxel size, 0.8×0.8×0.8 cm{sup 3}; TR, 2,000ms; TE, 35ms; NSA, 128. Results: Using the fused phantom, the results of measuring MRI factors were: geometric distortion, <2% and ±2 mm; image intensity uniformity, 83.09±1.33%; percent-signal ghosting, 0.025±0.004; low-contrast object detectability, 27.85±0.80. In addition, the signal-to-noise ratio of N-acetyl-aspartate was consistently high (42.00±5.66). Conclusion: The MRI-MRS QA factors obtained simultaneously using the phantom can facilitate evaluation of both images and spectra, and provide guidelines for obtaining MRI and MRS QA factors simultaneously. This study was supported by grant (2012-007883 and 2014R1A2A1A10050270) from the Mid-career Researcher Program through the NRF funded by Ministry of Science. In addition, this study was supported by the Industrial R&D of MOTIE/KEIT (10048997, Development of the core technology for integrated therapy devices based on real-time MRI-guided tumor tracking)

60 APPLIED LIFE SCIENCES↗

SU-E-J-114: A Practical Hybrid Method for Improving the Quality of CT-CBCT Deformable Image Registration for Head and Neck Radiotherapy

Purpose: Accurate deformable image registration (DIR) between CT and CBCT in H&N is challenging. In this study, we propose a practical hybrid method that uses not only the pixel intensities but also organ physical properties, structure volume of interest (VOI), and interactive local registrations. Methods: Five oropharyngeal cancer patients were selected retrospectively. For each patient, the planning CT was registered to the last fraction CBCT, where the anatomy difference was largest. A three step registration strategy was tested; Step1) DIR using pixel intensity only, Step2) DIR with additional use of structure VOI and rigidity penalty, and Step3) interactive local correction. For Step1, a public-domain open-source DIR algorithm was used (cubic B-spline, mutual information, steepest gradient optimization, and 4-level multi-resolution). For Step2, rigidity penalty was applied on bony anatomies and brain, and a structure VOI was used to handle the body truncation such as the shoulder cut-off on CBCT. Finally, in Step3, the registrations were reviewed on our in-house developed software and the erroneous areas were corrected via a local registration using level-set motion algorithm. Results: After Step1, there were considerable amount of registration errors in soft tissues and unrealistic stretching in the posterior to the neck and near the shoulder due to body truncation. The brain was also found deformed to a measurable extent near the superior border of CBCT. Such errors could be effectively removed by using a structure VOI and rigidity penalty. The rest of the local soft tissue error could be corrected using the interactive software tool. The estimated interactive correction time was approximately 5 minutes. Conclusion: The DIR using only the image pixel intensity was vulnerable to noise and body truncation. A corrective action was inevitable to achieve good quality of registrations. We found the proposed three-step hybrid method efficient and practical for CT/CBCT registrations in H&N. My department receives grant support from Industrial partners: (a) Varian Medical Systems, Palo Alto, CA, and (b) Philips HealthCare, Best, Netherlands.

60 APPLIED LIFE SCIENCES↗

SU-E-T-580: On the Significance of Model Based Dosimetry for Breast and Head and Neck 192Ir HDR Brachytherapy

Purpose: To assess the dosimetric and radiobiological differences between TG43-based and model-based dosimetry in the treatment planning of {sup 192}Ir HDR brachytherapy for breast and head and neck cancer. Methods: Two cohorts of 57 Accelerated Partial Breast Irradiation (APBI) and 22 head and neck (H&N) patients with oral cavity carcinoma were studied. Dosimetry for the treatment plans was performed using the TG43 algorithm of the Oncentra Brachy v4.4 treatment planning system (TPS). Corresponding Monte Carlo (MC) simulations were performed using MCNP6 with input files automatically prepared by the BrachyGuide software tool from DICOM RT plan data. TG43 and MC data were compared in terms of % dose differences, Dose Volume Histograms (DVHs) and related indices of clinical interest for the Planning Target Volume (PTV) and the Organs-At-Risk (OARs). A radiobiological analysis was also performed using the Equivalent Uniform Dose (EUD), mean survival fraction (S) and Tumor Control Probability (TCP) for the PTV, and the Normal Tissue Control Probability (N TCP) and the generalized EUD (gEUD) for the OARs. Significance testing of the observed differences performed using the Wilcoxon paired sample test. Results: Differences between TG43 and MC DVH indices, associated with the increased corresponding local % dose differences observed, were statistically significant. This is mainly attributed to their consistency however, since TG43 agrees closely with MC for the majority of DVH and radiobiological parameters in both patient cohorts. Differences varied considerably among patients only for the ipsilateral lung and ribs in the APBI cohort, with a strong correlation to target location. Conclusion: While the consistency and magnitude of differences in the majority of clinically relevant DVH indices imply that no change is needed in the treatment planning practice, individualized dosimetry improves accuracy and addresses instances of inter-patient variability observed. Research co-financed by the ESF and Greek funds through the Operational Program Education and Lifelong Learning Investing in Knowledge Society of the NSRF. Research Funding Program Aristeia. Nucletron, an Elekta company (Veenendaal, The Netherlands) is gratefully acknowledged for providing Oncentra Brachy v4.4 for research purposes.

61 RADIATION PROTECTION AND DOSIMETRY↗

SU-F-303-10: Impact of Visual Biofeedback On Respiratory Reproducibility in 4DMRI

Purpose: Precise radiation therapy (RT) for abdominal lesions is complicated by respiratory motion and suboptimal soft tissue contrast in 4DCT. 4DMRI offers improved contrast. However, long scan times and irregular breathing patterns can be limiting. To address this, we introduced visual biofeedback (VBF) into 4DMRI. Methods: Eight healthy volunteers were consented to an IRB-approved protocol. Prospective respiratory-triggered, T2-weighted coronal 4DMRIs were acquired on an open 1.0T MR- SIM. VBF was integrated using an MR-compatible interactive breath-hold control system. Subjects visually monitored their breathing patterns to stay within pre-determined tolerances. 4DMRIs were acquired with and without VBF for 2–8 phase acquisitions. Normalized respiratory waveforms were evaluated for scan time, duty cycle (programmed/acquisition time), breathing period, end-inhale (EI) amplitude, and breathing variability (coefficient of variation, EI-COV). B-spline-based deformable image registration propagated contours from end-exhale (EE) to EI phases. Respiration-induced liver motion was calculated via centroid analysis and compared. Results: Incorporating VBF reduced 2-phase acquisition time (4.7±0.6 and 5.6±1.4 minutes with and without VBF, respectively) while reducing the amplitude EI-COV by 53.0±8.1%. On average, incorporating VBF reduced 8-phase 4DMRI acquisition times by 1.7±1.2 minutes and EI-COVs by 46.0±15.8%. Using VBF yielded higher duty cycles than free breathing (34.7% versus 28.3%, respectively). 4DMRI acquisition time was reduced for the cohort with VBF despite breathing rate remaining similar (10.5±4.0 with vs. 10.6±3.3 BPM without). Respiratory waveforms showed higher EI amplitude with VBF (0.84±0.05 a.u.) as compared to 0.72±0.06 a.u. without. This translated to differences in liver excursions, where superior-inferior, anterior-posterior, and left-right EE-EI displacements were 14.3±3.6, 4.8±2.1, and 1.6±1.0 mm, respectively, with VBF compared to 13.0±6.2, 3.8±2.4, and 1.2±1.4 mm without. Conclusion: Incorporating VBF system into 4DMRI substantially reduced acquisition time and breathing variability. While VBF reduced liver motion variability, differences in excursion were observed, suggesting that implementation will be required throughout the RT workflow. Research supported in part by a grant from Philips HealthCare (Best, Netherlands) and an equipment evaluation agreement with MedSpira.

60 APPLIED LIFE SCIENCES↗

SU-F-303-12: Implementation of MR-Only Simulation for Brain Cancer: A Virtual Clinical Trial

Purpose: To perform a retrospective virtual clinical trial using an MR-only workflow for a variety of brain cancer cases by incorporating novel imaging sequences, tissue segmentation using phase images, and an innovative synthetic CT (synCT) solution. Methods: Ten patients (16 lesions) were evaluated using a 1.0T MR-SIM including UTE-DIXON imaging (TE = 0.144/3.4/6.9ms). Bone-enhanced images were generated from DIXON-water/fat and inverted UTE. Automated air segmentation was performed using unwrapped UTE phase maps. Segmentation accuracy was assessed by calculating intersection and Dice similarity coefficients (DSC) using CT-SIM as ground truth. SynCTs were generated using voxel-based weighted summation incorporating T2, FLAIR, UTE1, and bone-enhanced images. Mean absolute error (MAE) characterized HU differences between synCT and CT-SIM. Dose was recalculated on synCTs; differences were quantified using planar gamma analysis (2%/2 mm dose difference/distance to agreement) at isocenter. Digitally reconstructed radiographs (DRRs) were compared. Results: On average, air maps intersected 80.8 ±5.5% (range: 71.8–88.8%) between MR-SIM and CT-SIM yielding DSCs of 0.78 ± 0.04 (range: 0.70–0.83). Whole-brain MAE between synCT and CT-SIM was 160.7±8.8 HU, with the largest uncertainty arising from bone (MAE = 423.3±33.2 HU). Gamma analysis revealed pass rates of 99.4 ± 0.04% between synCT and CT-SIM for the cohort. Dose volume histogram analysis revealed that synCT tended to yield slightly higher doses. Organs at risk such as the chiasm and optic nerves were most sensitive due to their proximities to air/bone interfaces. DRRs generated via synCT and CT-SIM were within clinical tolerances. Conclusion: Our approach for MR-only simulation for brain cancer treatment planning yielded clinically acceptable results relative to the CT-based benchmark. While slight dose differences were observed, reoptimization of treatment plans and improved image registration can address this limitation. Future work will incorporate automated registration between setup images (cone-beam CT and kilovoltage images) for synCT and CT-SIM. Submitting institution holds research agreements with Philips HealthCare, Best, Netherlands and Varian Medical Systems, Palo Alto, CA. Research partially sponsored via an Internal Mentored Research Grant.

60 APPLIED LIFE SCIENCES↗

Comparison and uncertainty evaluation of different calibration protocols and ionization chambers for low-energy surface brachytherapy dosimetry

Purpose: A surface electronic brachytherapy (EBT) device is in fact an x-ray source collimated with specific applicators. Low-energy (<100 kVp) x-ray beam dosimetry faces several challenges that need to be addressed. A number of calibration protocols have been published for x-ray beam dosimetry. The media in which measurements are performed are the fundamental difference between them. The aim of this study was to evaluate the surface dose rate of a low-energy x-ray source with small field applicators using different calibration standards and different small-volume ionization chambers, comparing the values and uncertainties of each methodology. Methods: The surface dose rate of the EBT unit Esteya (Elekta Brachytherapy, The Netherlands), a 69.5 kVp x-ray source with applicators of 10, 15, 20, 25, and 30 mm diameter, was evaluated using the AAPM TG-61 (based on air kerma) and International Atomic Energy Agency (IAEA) TRS-398 (based on absorbed dose to water) dosimetry protocols for low-energy photon beams. A plane parallel T34013 ionization chamber (PTW Freiburg, Germany) calibrated in terms of both absorbed dose to water and air kerma was used to compare the two dosimetry protocols. Another PTW chamber of the same model was used to evaluate the reproducibility between these chambers. Measurements were also performed with two different Exradin A20 (Standard Imaging, Inc., Middleton, WI) chambers calibrated in terms of air kerma. Results: Differences between surface dose rates measured in air and in water using the T34013 chamber range from 1.6% to 3.3%. No field size dependence has been observed. Differences are below 3.7% when measurements with the A20 and the T34013 chambers calibrated in air are compared. Estimated uncertainty (with coverage factor k = 1) for the T34013 chamber calibrated in water is 2.2%–2.4%, whereas it increases to 2.5% and 2.7% for the A20 and T34013 chambers calibrated in air, respectively. The output factors, measured with the PTW chambers, differ by less than 1.1% for any applicator size when compared to the output factors that were measured with the A20 chamber. Conclusions: Measurements using both dosimetric protocols are consistent, once the overall uncertainties are considered. There is also consistency between measurements performed with both chambers calibrated in air. Both the T34013 and A20 chambers have negligible stem effect. Any x-ray surface brachytherapy system, including Esteya, can be characterized using either one of these calibration protocols and ionization chambers. Having less correction factors, lower uncertainty, and based on measurements, performed in closer to clinical conditions, the TRS-398 protocol seems to be the preferred option.

60 APPLIED LIFE SCIENCES↗

SU-F-T-63: Dosimetric Relevance of the Valencia and Leipzig HDR Applicators Plastic Cap

Purpose: Utilization of HDR brachytherapy treatment of skin lesions using collimated applicators, such as the Valencia or Leipzig is increasing. These applicators are made of cup-shaped tungsten material in order to focalize the radiation into the lesion and to protect nearby tissues. These applicators have an attachable plastic cap that removes secondary electrons generated in the applicator and flattens the treatment surface. The purpose of this study is to examine the dosimetric impact of this cap, and the effect if the cap is not placed during the HDR fraction delivery. Methods: Monte Carlo simulations have been done using the code Geant4 for the Valencia and Leipzig applicators. Dose rate distributions have been obtained for the applicators with and without the plastic cap. An experimental study using EBT3 radiochromic film has been realized in order to verify the Monte Carlo results. Results: The Monte Carlo simulations show that absorbed dose in the first millimeter of skin can increase up to 180% for the Valencia applicator if the plastic cap is absent and up to 1500% for the Leipzig applicators. At deeper distances the increase of dose is smaller being about 10–15%. Conclusion: Important differences have been found if the plastic cap of the applicators is absent in the treatment producing an overdosage in the skin. The user should have a checklist to remind him check always before HDR fraction delivery to insure the plastic cap is placed on the applicator. This work was supported in part by Generalitat Valenciana under Project PROMETEOII/2013/010, by the Spanish Government under Project No. FIS2013-42156, and by a research agreement with Elekta Brachytherapy, Veenendaal, The Netherlands.

07 ISOTOPE AND RADIATION SOURCES↗

SU-F-T-643: Feasibility of Performing Patient Specific VMAT QA On Single Linac for Plans Treated in Beam-Matched Elekta Agility Linacs

Purpose: The increasing application of VMAT demands a more efficient workflow and QA solution. This study aims to investigate the feasibility of performing VMAT QA measurements on one linac for plans treated on other beam-matched Elekta Agility linacs. Methods: A single model was used to create 24 clinically approved VMAT plans (12 head-and-neck and 12 prostate using 6MV and 10MV respectively) on Pinnacle v9.10 (Philips, Einhoven, Netherlands). All head-and-neck plans were delivered on three beam-matched machines while all prostate cases were delivered on two beam-matched 10MV Agility machines. All plans were delivered onto PTW Octavius 4D phantom with 1500 detector array (PTW, Freiburg, Germany). Reconstructed volume doses were then compared with the Pinnacle reference plans in Verisoft 6.1 under 3%/3mm gamma criteria at local dose. Plans were considered clinically acceptable if >90% of the voxels passing the gamma criteria. Results: All measurements were passed (3D gamma passing rate >90%) and the result shows that the mean difference of 3D gamma of 12 head-and-neck cases is 1.2% with standard deviation of 0.6%. While for prostate cases, the mean difference of 3D gamma is 0.9% with standard deviation of 0.7%. Maximum difference of 3D gamma of all measurements between beam-matched machines is less than 2.5%. The differences of passing rates between different machines were statistically insignificant (p>0.05). Conclusion. The result suggests that ther Conclusion: The result suggests that there exists a 3D gamma threshold, in our case 92.5%, above which the VMAT QA performed in any one of beam-matched machine will also pass in another one. Therefore, VMAT QA efficiency may be increased and phantom set up time can be saved by implementing such method. A constant performance across all beam matched machines must be maintained to make this QA approach feasible.

60 APPLIED LIFE SCIENCES↗