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DOE OSTI2014

TU-A-12A-07: CT-Based Biomarkers to Characterize Lung Lesion: Effects of CT Dose, Slice Thickness and Reconstruction Algorithm Based Upon a Phantom Study

Purpose: Radiogenomics promises the ability to study cancer tumor genotype from the phenotype obtained through radiographic imaging. However, little attention has been paid to the sensitivity of image features, the image-based biomarkers, to imaging acquisition techniques. This study explores the impact of CT dose, slice thickness and reconstruction algorithm on measuring image features using a thorax phantom. Methods: Twentyfour phantom lesions of known volume (1 and 2mm), shape (spherical, elliptical, lobular and spicular) and density (-630, -10 and +100 HU) were scanned on a GE VCT at four doses (25, 50, 100, and 200 mAs). For each scan, six image series were reconstructed at three slice thicknesses of 5, 2.5 and 1.25mm with continuous intervals, using the lung and standard reconstruction algorithms. The lesions were segmented with an in-house 3D algorithm. Fifty (50) image features representing lesion size, shape, edge, and density distribution/texture were computed. Regression method was employed to analyze the effect of CT dose, slice of thickness and reconstruction algorithm on these features adjusting 3 confounding factors (size, density and shape of phantom lesions). Results: The coefficients of CT dose, slice thickness and reconstruction algorithm are presented in Table 1 in the supplementary material. No significant difference was found between the image features calculated on low dose CT scans (25mAs and 50mAs). About 50% texture features were found statistically different between low doses and high doses (100 and 200mAs). Significant differences were found for almost all features when calculated on 1.25mm, 2.5mm, and 5mm slice thickness images. Reconstruction algorithms significantly affected all density-based image features, but not morphological features. Conclusions: There is a great need to standardize the CT imaging protocols for radiogenomics study because CT dose, slice thickness and reconstruction algorithm impact quantitative image features to various degrees as our study has shown.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

WE-E-18A-05: Bremsstrahlung of Laser-Plasma Interaction at KeV Temperature: Forward Dose and Attenuation Factors

Purpose: To obtain an analytical empirical formula for the photon dose source term in forward direction from bremsstrahlung generated from laser-plasma accelerated electron beams in aluminum solid targets, with electron-plasma temperatures in the 10–100 keV energy range, and to calculate transmission factors for iron, aluminum, methacrylate, lead and concrete and air, materials most commonly found in vacuum chamber labs. Methods: Bremsstrahlung fluence is calculated from the convolution of thin-target bremsstrahlung spectrum for monoenergetic electrons and the relativistic Maxwell-Juettner energy distribution for the electron-plasma. Unattenuatted dose in tissue is calculated by integrating the photon spectrum with the mass-energy absorption coefficient. For the attenuated dose, energy dependent absorption coefficient, build-up factors and finite shielding correction factors were also taken into account. For the source term we use a modified formula from Hayashi et al., and we fitted the proportionality constant from experiments with the aid of the previously calculated transmission factors. Results: The forward dose has a quadratic dependence on electron-plasma temperature: 1 joule of effective laser energy transferred to the electrons at 1 m in vacuum yields 0,72 Sv per MeV squared of electron-plasma temperature. Air strongly filters the softer part of the photon spectrum and reduce the dose to one tenth in the first centimeter. Exponential higher energy tail of maxwellian spectrum contributes mainly to the transmitted dose. Conclusion: A simple formula for forward photon dose from keV range temperature plasma is obtained, similar to those found in kilovoltage x-rays but with higher dose per dissipated electron energy, due to thin target and absence of filtration.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗
DOE OSTI2014

TH-C-BRD-02: Analytical Modeling and Dose Calculation Method for Asymmetric Proton Pencil Beams

Purpose: A dynamic collimation system (DCS), which consists of two pairs of orthogonal trimmer blades driven by linear motors has been proposed to decrease the lateral penumbra in pencil beam scanning proton therapy. The DCS reduces lateral penumbra by intercepting the proton pencil beam near the lateral boundary of the target in the beam's eye view. The resultant trimmed pencil beams are asymmetric and laterally shifted, and therefore existing pencil beam dose calculation algorithms are not capable of trimmed beam dose calculations. This work develops a method to model and compute dose from trimmed pencil beams when using the DCS. Methods: MCNPX simulations were used to determine the dose distributions expected from various trimmer configurations using the DCS. Using these data, the lateral distribution for individual beamlets was modeled with a 2D asymmetric Gaussian function. The integral depth dose (IDD) of each configuration was also modeled by combining the IDD of an untrimmed pencil beam with a linear correction factor. The convolution of these two terms, along with the Highland approximation to account for lateral growth of the beam along the depth direction, allows a trimmed pencil beam dose distribution to be analytically generated. The algorithm was validated by computing dose for a single energy layer 5×5 cm{sup 2} treatment field, defined by the trimmers, using both the proposed method and MCNPX beamlets. Results: The Gaussian modeled asymmetric lateral profiles along the principal axes match the MCNPX data very well (R{sup 2}≥0.95 at the depth of the Bragg peak). For the 5×5 cm{sup 2} treatment plan created with both the modeled and MCNPX pencil beams, the passing rate of the 3D gamma test was 98% using a standard threshold of 3%/3 mm. Conclusion: An analytical method capable of accurately computing asymmetric pencil beam dose when using the DCS has been developed.

07 ISOTOPE AND RADIATION SOURCES↗
DOE OSTI2014

The influence of patient positioning uncertainties in proton radiotherapy on proton range and dose distributions

Purpose: Proton radiotherapy allows radiation treatment delivery with high dose gradients. The nature of such dose distributions increases the influence of patient positioning uncertainties on their fidelity when compared to photon radiotherapy. The present work quantitatively analyzes the influence of setup uncertainties on proton range and dose distributions. Methods: Thirty-eight clinical passive scattering treatment fields for small lesions in the head were studied. Dose distributions for shifted and rotated patient positions were Monte Carlo-simulated. Proton range uncertainties at the 50%- and 90%-dose falloff position were calculated considering 18 arbitrary combinations of maximal patient position shifts and rotations for two patient positioning methods. Normal tissue complication probabilities (NTCPs), equivalent uniform doses (EUDs), and tumor control probabilities (TCPs) were studied for organs at risk (OARs) and target volumes of eight patients. Results: The authors identified a median 1σ proton range uncertainty at the 50%-dose falloff of 2.8 mm for anatomy-based patient positioning and 1.6 mm for fiducial-based patient positioning as well as 7.2 and 5.8 mm for the 90%-dose falloff position, respectively. These range uncertainties were correlated to heterogeneity indices (HIs) calculated for each treatment field (38% < R{sup 2} < 50%). A NTCP increase of more than 10% (absolute) was observed for less than 2.9% (anatomy-based positioning) and 1.2% (fiducial-based positioning) of the studied OARs and patient shifts. For target volumes TCP decreases by more than 10% (absolute) occurred in less than 2.2% of the considered treatment scenarios for anatomy-based patient positioning and were nonexistent for fiducial-based patient positioning. EUD changes for target volumes were up to 35% (anatomy-based positioning) and 16% (fiducial-based positioning). Conclusions: The influence of patient positioning uncertainties on proton range in therapy of small lesions in the human brain as well as target and OAR dosimetry were studied. Observed range uncertainties were correlated with HIs. The clinical practice of using multiple fields with smeared compensators while avoiding distal OAR sparing is considered to be safe.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

A study of the short- to long-phantom dose ratios for CT scanning without table translation

Purpose: For CT scanning in the stationary-table modes, AAPM Task Group 111 proposed to measure the midpoint dose on the central and peripheral axes of sufficiently long phantoms. Currently, a long cylindrical phantom is usually not available in many clinical facilities. The use of a long phantom is also challenging because of the heavy weight. In order to shed light on assessing the midpoint dose in CT scanning without table movement, the authors present a study of the short- to long-phantom dose ratios, and perform a cross-comparison of CT dose ratios on different scanner models. Methods: The authors performed Geant4-based Monte Carlo simulations with a clinical CT scanner (Somatom Definition dual source CT, Siemens Healthcare), and modeled dosimetry measurements using a 0.6 cm{sup 3} Farmer type chamber and a 10-cm long pencil ion chamber. The short (15 cm) to long (90 cm) phantom dose ratios were computed for two PMMA diameters (16 and 32 cm), two phantom axes (the center and the periphery), and a range of beam apertures (3–25 cm). The results were compared with the published data of previous studies with other multiple detector CT (MDCT) scanners and cone beam CT (CBCT) scanners. Results: The short- to long-phantom dose ratios changed with beam apertures but were insensitive to beam qualities (80–140 kV, the head and body bowtie filters) and MDCT and CBCT scanner models. Conclusions: The short- to long-phantom dose ratios enable medical physicists to make dosimetry measurements using the standard CT dosimetry phantoms and a Farmer chamber or a 10 cm long pencil chamber, and to assess the midpoint dose in long phantoms. This method provides an effective approach for the dosimetry of CBCT scanning in the stationary-table modes, and is useful for perfusion and interventional CT.

07 ISOTOPE AND RADIATION SOURCES↗
DOE OSTI2014

Poster — Thur Eve — 26: Evaluation of lens dose from anterior electron beams: comparison of Pinnacle and Gafchromic EBT3 film

The purpose of this work is twofold: 1) to measure dose profiles under lead shielding at the level of the lens for a range of clinical electron energies via film dosimetry; and, 2) to assess the validity of the Pinnacle treatment planning system (TPS) in calculating the penumbral doses under lead shielding with the heterogeneous electron algorithm. First, a film calibration curve that spanned the electron energies of interest, 6–18MeV, was created. Next, EBT3 film and lead shielding were incorporated into a solid water phantom with the film positioned 7mm below the lead and a variable thickness of bolus on top. This geometry was reproduced in the Pinnacle TPS and used to calculate dose profiles using the heterogeneous electron algorithm. The measured vs. calculated dose profiles were normalized to d{sub max} in a homogeneous phantom with no lead shielding and compared. Pinnacle consistently overestimated the dose distal to the lead shielding with significant discrepancies occurring near the edge of the lead shield reaching 25% at the edge and 35% in the open field region. The film measurements showed that a minimum lead margin of 5mm extending beyond the diameter of the lens is required to adequately shield the lens to ≤10% of the dose at d{sub max}. These measurements allow for a reasonable estimate of the dose to the lens from anterior electron beams. They also allow for clinicians to assess the extent of the lead margin required to reduce the lens dose to an acceptable amount prior to radiotherapy treatment.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

Assessment of the dose reduction potential of a model-based iterative reconstruction algorithm using a task-based performance metrology

Purpose: Different computed tomography (CT) reconstruction techniques offer different image quality attributes of resolution and noise, challenging the ability to compare their dose reduction potential against each other. The purpose of this study was to evaluate and compare the task-based imaging performance of CT systems to enable the assessment of the dose performance of a model-based iterative reconstruction (MBIR) to that of an adaptive statistical iterative reconstruction (ASIR) and a filtered back projection (FBP) technique. Methods: The ACR CT phantom (model 464) was imaged across a wide range of mA setting on a 64-slice CT scanner (GE Discovery CT750 HD, Waukesha, WI). Based on previous work, the resolution was evaluated in terms of a task-based modulation transfer function (MTF) using a circular-edge technique and images from the contrast inserts located in the ACR phantom. Noise performance was assessed in terms of the noise-power spectrum (NPS) measured from the uniform section of the phantom. The task-based MTF and NPS were combined with a task function to yield a task-based estimate of imaging performance, the detectability index (d′). The detectability index was computed as a function of dose for two imaging tasks corresponding to the detection of a relatively small and a relatively large feature (1.5 and 25 mm, respectively). The performance of MBIR in terms of the d′ was compared with that of ASIR and FBP to assess its dose reduction potential. Results: Results indicated that MBIR exhibits a variability spatial resolution with respect to object contrast and noise while significantly reducing image noise. The NPS measurements for MBIR indicated a noise texture with a low-pass quality compared to the typical midpass noise found in FBP-based CT images. At comparable dose, the d′ for MBIR was higher than those of FBP and ASIR by at least 61% and 19% for the small feature and the large feature tasks, respectively. Compared to FBP and ASIR, MBIR indicated a 46%–84% dose reduction potential, depending on task, without compromising the modeled detection performance. Conclusions: The presented methodology based on ACR phantom measurements extends current possibilities for the assessment of CT image quality under the complex resolution and noise characteristics exhibited with statistical and iterative reconstruction algorithms. The findings further suggest that MBIR can potentially make better use of the projections data to reduce CT dose by approximately a factor of 2. Alternatively, if the dose held unchanged, it can improve image quality by different levels for different tasks.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

Dose reduction of scattered photons from concrete walls lined with lead: Implications for improvement in design of megavoltage radiation therapy facility mazes

Purpose: This study explores the possibility of using lead to cover part of the radiation therapy facility maze walls in order to absorb low energy photons and reduce the total dose at the maze entrance of radiation therapy rooms. Methods: Experiments and Monte Carlo simulations were utilized to establish the possibility of using high-Z materials to cover the concrete walls of the maze in order to reduce the dose of the scattered photons at the maze entrance. The dose of the backscattered photons from a concrete wall was measured for various scattering angles. The dose was also calculated by the FLUKA and EGSnrc Monte Carlo codes. The FLUKA code was also used to simulate an existing radiotherapy room to study the effect of multiple scattering when adding lead to cover the concrete walls of the maze. Monoenergetic photons were used to represent the main components of the x ray spectrum up to 10 MV. Results: It was observed that when the concrete wall was covered with just 2 mm of lead, the measured dose rate at all backscattering angles was reduced by 20% for photons of energy comparable to Co-60 emissions and 70% for Cs-137 emissions. The simulations with FLUKA and EGS showed that the reduction in the dose was potentially even higher when lead was added. One explanation for the reduction is the increased absorption of backscattered photons due to the photoelectric interaction in lead. The results also showed that adding 2 mm lead to the concrete walls and floor of the maze reduced the dose at the maze entrance by up to 90%. Conclusions: This novel proposal of covering part or the entire maze walls with a few millimeters of lead would have a direct implication for the design of radiation therapy facilities and would assist in upgrading the design of some mazes, especially those in facilities with limited space where the maze length cannot be extended to sufficiently reduce the dose.

07 ISOTOPE AND RADIATION SOURCES↗
DOE OSTI2015

SU-E-I-54: Effective Dose and Radiation Cancer Risks for Scoliosis Patients Undergoing Full Spine Radiography

Purpose: Scoliotic patients underwent a lot of radiologic examinations during the control and treatment periods. This study used the PCXMC program to calculate the effective dose of the patients and assess the radiation cancer risks. Methods: Seventy five scoliotic patients were examined using CR or DR systems during the control and treatment periods in Chang Gung Memorial Hospital. The technical factors were recorded for each patient during his/her control and treatment period. The entrance surface dose was measured using thermoluminence dosimeters and derived from technical factors and irradiated geometry. The effective dose of patients and relative radiation cancer risks were calculated by the PCXMC program. All required information regarding patient age and sex, the x-ray spectra, and the tube voltage and current were registered. The radiation risk were estimated using the model developed by the BEIR VII committee (2006). Results: The effective doses of full spine radiography with anteroposterior and lateral projections were 0.626 mSv for patients using DR systems, and 0.483mSv for patients using CR systems, respectively. The dose using DR system was 29.6% higher than those using CR system. The maximum organ dose was observed in the breast for both projections in all the systems. The risk of exposure—induced cancer death (REID) of patients for DR and CR systems were 0.009% and 0.007%, respectively. Conclusion: The risk estimates were regarded with healthy skepticism, placed more emphasis on the magnitude of the risk. The effective doses estimated in this study could be served as a reference for radiologists and technologists and demonstrate the necessity to optimize patient protection for full spine radiography though the effective doses are not at the level to induce deterministic effects and not significant in the stochastic effect. This study was supported by the grants from the Chang Gung Memorial Hospital (CMRPD1D0421)

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-J-77: Dose Tracking On An MR-Linac for Online QA and Plan Adaptation in Abdominal Organs

Recent developments made MRI-guided radiotherapy feasible. Simultaneously performed imaging during dose delivery reveals the influence of changes in anatomy not yet known at the planning stage. When targeting highly motile abdominal organs, respiratory gating is commonly employed in MRI and investigated in external beam radiotherapy to mitigate malicious motion effects. The purpose of the presented work is to investigate anatomy-adaptive dose reconstruction in the treatment of abdominalorgans using concurrent (duplex) gating of an integrated MRlinac modality.Using navigators, 3D-MR images were sampled during exhale phase, requiring 3s per axial volume (360×260×100mm{sup 3}, waterselective T1w-FFE). Deformation vector fields (DVF) were calculated for all imaging dynamics with respect to initial anatomy, yielding an estimation of anatomy changes over the time of a fraction. A pseudo-CT was generated from the outline of a reference MR image, assuming a water-filled body. Consecutively, a treatment was planned on a fictional kidney lesion and optimized simulating a 6MV linac in a 1.5T magnetic field. After delivery, using the DVF, the pseudo-CT was deformed and dose accumulated for every individual gating interval yielding the true accumulated dose on the dynamic anatomy during beam-on.Dose-volume parameters on the PTV show only moderate changes when incorporating motion, i.e. ΔD{sub 99} (GTV)=0.3Gy with D{sub 99} (GTV)=20Gy constraints. However, local differences in the PTV region showed underdosages as high as 2.7Gy and overdosages up to 1.4Gy as compared to the optimized dose on static anatomy.A dose reconstruction toolchain was successfully implemented and proved its potential in the duplex gated treatment of abdominal organs by means of an MR-linac modality. While primary dose constraints were not violated on the fictional test data, large deviations could be found locally, which are left unaccounted for in conventional treatments. Dose-tracking of both target structures and organs at risk using 3D MRI during treatment enables truly adaptive hypofractionated radiotherapy. This work was funded by the SoRTS consortium, which includes the industry partners Elekta, Philips and Technolution.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-05: 4D Measurement-Guided Dose Reconstruction (4D-MGDR) in End-End Quality Assurance (E2E QA) for Assessing Safety Margin in Radiosurgery (SRS) From Clinical Perspectives

Purpose: To assess the plan robustness and safety margin in SRS from 4DMGDR in E2E QA based on clinical objectives. Methods: OCTAVIUS SRS 1000 detector array and 4D phantom (PTW, Freiburg, Germany) were used to measure 5 coplanar SRS plans with 1 and 2 mm planning target volume (PTV). 3 targets were clinical, and 2 were virtual simulated to be 1mm from the brainstem (BS), and between chiasm (CS) and optic nerve (ON). Planning was done on Monaco v5.0 (Elekta, Maryland Heights, MO) to achieve 95–99% PTV and 100% gross tumor volume (GTV) prescription dose coverage. CBCT setup of the 4D phantom by 6D robotic couch was performed as for real patient. 4D-MGDR in patient CT and dosimetric analysis were performed in PTW Verisoft v6.1. The safety margin that achieved 100% GTV coverage was determined, and doses to 2% (D2%) of BS, ON and CS were assessed from E2E QA. Results: 100% GTV coverage was achieved with 1mm margin for 2 plans and 2mm margin for all plans. 98.3% and 99.4% GTV coverage were found in E2E QA for 1mm PTVs that either had sharp changing contour, or was nearby CS and ON or BS, and had either low planned minimum GTV dose (∼101% of the prescribed dose vs.∼106%) or compromised PTV coverage (95% vs. 99%). D2% to CS obtained with 4D-MGDR for one virtual target were 18.8Gy for 1mm PTV and 19.2Gy for 2mm PTV, exceeding the planned tolerance of 18Gy/3 fractions for prescription dose of 24Gy. Conclusion: 1mm margin is generally sufficient for dose planning and machine delivery errors. Irregular GTV with just enough dose coverage to spare critical organs may need 2mm margin at the costs of possible higher organ doses. 4D MGDR in an E2E QA approach can put the treatment plan evaluation in clinical perspectives.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-72: A Retrospective Correlation Analysis On Dose-Volume Control Points and Treatment Outcomes

Purpose: To quantify correlation between dose-volume control points and treatment outcomes. Specifically, two outcomes are analyzed: occurrence of radiation induced dysphagia and target complications. The results inform the treatment planning process when competing dose-volume criteria requires relaxations. Methods: 32 patients, treated with whole-field sequential intensity modulated radiation therapy during 2009–2010 period, are considered for this study. Acute dysphagia that is categorized into 3 grades is observed on all patients. 3 patients are observed in grade 1, 17 patients in grade 2, and 12 patients in grade 3. Ordinal logistic regression is employed to establish correlations between grades of dysphagia and dose to cervico-thoracic esophagus. Particularly, minimum (Dmin), mean (Dmean), and maximum (Dmax) dose control points are analyzed. Additionally, target complication, which includes local-regional recurrence and/or distant metastasis, is observed on 4 patients. Binary logistic regression is used to quantify correlation between target complication and four dose control points. Namely, ICRU recommended dose control points, D2, D50, D95, and D98 are analyzed. Results: For correlation with dysphagia, Dmin on cervico-thoracic esophagus is statistically significant (p-value = 0.005). Additionally, Dmean on cervico-thoracic esophagus is also significant in association with dysphagia (p-value = 0.012). However, no correlation was observed between Dmax and dysphagia (p-value = 0.263). For target complications, D50 on the target is a statistically significant dose control point (p-value = 0.032). No correlations were observed between treatment complications and D2 (p-value = 0.866), D95 (p-value = 0.750), and D98 (p-value = 0.710) on the target. Conclusion: Significant correlations are observed between radiation induced dysphagia and Dmean (and Dmin) to cervico-thoracic esophagus. Additionally, correlation between target complications and median dose to target (D50) is observed. Quantification of these correlations can inform treatment planners when any competing objectives requires relaxation of target D50 or Dmean (or Dmin) to cervico-thoracic esophagus.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-112: An OpenCL-Based Cross-Platform Monte Carlo Dose Engine (oclMC) for Coupled Photon-Electron Transport

Purpose: Low computational efficiency of Monte Carlo (MC) dose calculation impedes its clinical applications. Although a number of MC dose packages have been developed over the past few years, enabling fast MC dose calculations, most of these packages were developed under NVidia’s CUDA environment. This limited their code portability to other platforms, hindering the introduction of GPU-based MC dose engines to clinical practice. To solve this problem, we developed a cross-platform fast MC dose engine named oclMC under OpenCL environment for external photon and electron radiotherapy. Methods: Coupled photon-electron simulation was implemented with standard analogue simulation scheme for photon transport and Class II condensed history scheme for electron transport. We tested the accuracy and efficiency of oclMC by comparing the doses calculated using oclMC and gDPM, a previously developed GPU-based MC code on NVidia GPU platform, for a 15MeV electron beam and a 6MV photon beam in a homogenous water phantom, a water-bone-lung-water slab phantom and a half-slab phantom. We also tested code portability of oclMC on different devices, including an NVidia GPU, two AMD GPUs and an Intel CPU. Results: Satisfactory agreements were observed in all photon and electron cases, with ∼0.48%–0.53% average dose differences at regions within 10% isodose line for electron beam cases and ∼0.15%–0.17% for photon beam cases. It took oclMC 3–4 sec to perform transport simulation for electron beam on NVidia Titan GPU and 35–51 sec for photon beam, both with ∼0.5% statistical uncertainty. The computation was 6%–17% slower than gDPM due to the differences in both physics model and development environment, which is considered not significant for clinical applications. In terms of code portability, gDPM only runs on NVidia GPUs, while oclMC successfully runs on all the tested devices. Conclusion: oclMC is an accurate and fast MC dose engine. Its high cross-platform portability makes it clinically attractive.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-284: Dose Plan Optimization When Using Hydrogel Prostate-Rectum Spacer: A Single Institution Experience

Purpose: To describe rectal dose reduction achieved and techniques used to take advantage of the increased peri-rectal spacing provided by injected polyethylene-glycol. Methods: Thirty prostate cancer patents were 2:1 randomized during a clinical trial to evaluate the effectiveness of injected poly-ethylene glycol hydrogel (SpaceOAR System) in creating space between the prostate and the anterior rectal wall. All patients received a baseline CT/MR scan and baseline IMRT treatment plan. Patients were randomized to receive hydrogel injection (n=20) or Control (n=10), followed by another CT/MR scan and treatment plan (single arc VMAT, 6 MV photons, 79.2 Gy, 44 fractions). Additional optimization structures were employed to constrain the dose to the rectum; specifically an avoidance structure to limit V75 <15%, and a control structure to limit the maximum relative dose <105% in the interface region of the anterior rectal wall and the prostate planning target volume. Dose volumetric data was analyzed for rectal volumes receiving 60 through 80 Gy. Results: Rectal dose reduction was observed in all patients who received the hydrogel. Volumetric analysis indicates a median rectal volume and (reduction from baseline plan) following spacer application of 4.9% (8.9%) at V60Gy, 3.8% (8.1%) at V65Gy, 2.5% (7.2%) at V70Gy, 1.6% (5.8%) at V75Gy, and 0.5% (2.5%) at V80Gy. Conclusion: Relative to planning without spacers, rectal dose constraints of 5%, 4%, 3%, 2%, 1% for V60, V65, V70, V75, and V80, should be obtainable when peri-rectal spacers are used. The combined effect of increased peri-rectal space provided by the hydrogel, with strict optimization objectives, resulted in reduced dose to the rectum. To maximize benefit, strict optimization objectives and reduced rectal dose constraints should be employed when creating plans for patients with perirectal spacers. Clinical Trial for SpaceOAR product conducted by Augmenix,Inc. The research site was paid to be a participating site.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-285: Dose Variation at Bone in Small-Animal Irradiation: A Monte Carlo Study Using Monoenergetic Photon Beams

Purpose: The aim of this study is to investigate the variation of bone dose on photon beam energy (keV – MeV) in small-animal irradiation. Dosimetry of homogeneous and inhomogeneous phantoms as per the same mouse computed tomography image set were calculated using the DOSCTP and DOSXYZnrc based on the EGSnrc Monte Carlo code. Methods: Monte Carlo simulations for the homogeneous and inhomogeneous mouse phantom irradiated by a 360 degree photon arc were carried out. Mean doses of the bone tissue in the irradiated volumes were calculated at various photon beam energies, ranging from 50 keV to 1.25 MeV. The effect of bone inhomogeneity was examined through the Inhomogeneous Correction Factor (ICF), a dose ratio of the inhomogeneous to the homogeneous medium. Results: From our Monte Carlo results, higher mean bone dose and ICF were found when using kilovoltage photon beams compared to megavoltage. In beam energies ranging from 50 keV to 200 keV, the bone dose was found maximum at 50 keV, and decreased significantly from 2.6 Gy to 0.55 Gy, when 2 Gy was delivered at the center of the phantom (isocenter). Similarly, the ICF were found decreasing from 4.5 to 1 when the photon beam energy was increased from 50 keV to 200 keV. Both mean bone dose and ICF remained at about 0.5 Gy and 1 from 200 keV to 1.25 MeV with insignificant variation, respectively. Conclusion: It is concluded that to avoid high bone dose in the small-animal irradiation, photon beam energy higher than 200 keV should be used with the ICF close to one, and bone dose comparable to the megavoltage beam where photoelectric effect is not dominant.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-513: Investigating Dose of Internal Target Volume After Correcting for Tissue Heterogeneity in SBRT Lung Plans with Homogeneity Calculation

Purpose It was recommended to use the prescription of 54 Gy/3 with heterogeneity corrections for previously established dose scheme of 60 Gy/3 with homogeneity calculation. This study is to investigate dose coverage for the internal target volume (ITV) with and without heterogeneity correction. Methods Thirty patients who received stereotactic body radiotherapy (SBRT) to a dose of 60 Gy in 3 fractions with homogeneous planning for early stage non-small-cell lung cancer (NSCLC) were selected. ITV was created either from 4DCT scans or a fusion of multi-phase respiratory scans. Planning target volume (PTV) was a 5 mm expansion of the ITV. For this study, we recalculated homogeneous clinical plans using heterogeneity corrections with monitor units set as clinically delivered. All plans were calculated with 3 mm dose grids and collapsed cone convolution algorithm. To account for uncertainties from tumor delineation and image-guided radiotherapy, a structure ITV2mm was created by expanding ITV with 2 mm margins. Dose coverage to the PTV, ITV and ITV2mm were compared with a student paired t-test. Results With heterogeneity corrections, the PTV V60Gy decreased by 10.1% ± 18.4% (p<0.01) while the maximum dose to the PTV increased by 3.7 ± 4.3% (p<0.01). With and without corrections, D99% was 65.8 ± 4.0 Gy and 66.7 ± 4.8 Gy (p=0.15) for the ITV, and 63.9 ± 3.4 Gy and 62.9 ± 4.6 Gy for the ITV2mm (p=0.22), respectively. The mean dose to the ITV and ITV2mm increased 3.6% ± 4.7% (p<0.01) and 2.3% ± 5.2% (p=0.01) with heterogeneity corrections. Conclusion After heterogeneity correction, the peripheral coverage of the PTV decreased to approximately 54 Gy, but D99% of the ITV and ITV2mm was unchanged and the mean dose to the ITV and ITV2mm was increased. Clinical implication of these results requires more investigation.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-541: Measurement of CT Density Model Variations and the Impact On the Accuracy of Monte Carlo (MC) Dose Calculation in Stereotactic Body Radiation Therapy for Lung Cancer

Purpose: To measure the CT density model variations between different CT scanners used for treatment planning and impact on the accuracy of MC dose calculation in lung SBRT. Methods: A Gammex electron density phantom (RMI 465) was scanned on two 64-slice CT scanners (GE LightSpeed VCT64) and a 16-slice CT (Philips Brilliance Big Bore CT). All three scanners had been used to acquire CT for CyberKnife lung SBRT treatment planning. To minimize the influences of beam hardening and scatter for improving reproducibility, three scans were acquired with the phantom rotated 120° between scans. The mean CT HU of each density insert, averaged over the three scans, was used to build the CT density models. For 14 patient plans, repeat MC dose calculations were performed by using the scanner-specific CT density models and compared to a baseline CT density model in the base plans. All dose re-calculations were done using the same plan beam configurations and MUs. Comparisons of dosimetric parameters included PTV volume covered by prescription dose, mean PTV dose, V5 and V20 for lungs, and the maximum dose to the closest critical organ. Results: Up to 50.7 HU variations in CT density models were observed over the baseline CT density model. For 14 patient plans examined, maximum differences in MC dose re-calculations were less than 2% in 71.4% of the cases, less than 5% in 85.7% of the cases, and 5–10% for 14.3% of the cases. As all the base plans well exceeded the clinical objectives of target coverage and OAR sparing, none of the observed differences led to clinically significant concerns. Conclusion: Marked variations of CT density models were observed for three different CT scanners. Though the differences can cause up to 5–10% differences in MC dose calculations, it was found that they caused no clinically significant concerns.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2015

SU-E-T-544: Microscopic Dose Enhancement of Gold Nanoparticles in Water for Proton Therapy: A Simulation Study

Purpose: To quantify the microscopic dose and linear energy transfer (LET) enhancement of gold nanoparticles (GNPs) in water for proton therapy. Methods: The GEANT4 toolkit (version 10) with low energy electromagnetic classes was used to create a series of simulations where three radii (r=5, 20, 100 nm) of gold nanoparticles (GNPs) were irradiated with 5 × 106 80 MeV protons. A cubic detector (10 × 10 × 10 um, divided in 25 × 25 × 25 voxels) were placed in a water phantom where the GNP rests in the center. The size of incident proton beam was set to be same as the GNPs and perpendicularly aiming to the target. Dose deposited to each voxel were recorded to calculate the overall deposited dose and the dose-averaged LET. The emitted secondary electron spectra were also collected in a spherical customized scorer (radius = 150 nm). Results: The average dose from a single GNP in a cubic water phantom was increased by 0.12 %, 1.12% and 2.3% and the mean dose-averaged LET was increased by 5.87% and 27.67% and 0.31% for GNP radius of 5 nm, 20 nm and 100 nm, respectively. Conclusion: The dose enhancement effect from the presence of a single GNP was qualified in a water phantom. A significant increase in the mean dose-averaged LET was found for 20 nm GNP.

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