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

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DOE OSTI2016

SU-F-J-135: Tumor Displacement-Based Binning for Respiratory-Gated Time-Independent 5DCT Treatment Planning

Purpose: A published 5DCT breathing motion model enables image reconstruction at any user-selected breathing phase, defined by the model as a specific amplitude (v) and rate (f). Generation of reconstructed phase-specific CT scans will be required for time-independent radiation dose distribution simulations. This work answers the question: how many amplitude and rate bins are required to describe the tumor motion with a specific spatial resolution? Methods: 19 lung-cancer patients with 21 tumors were scanned using a free-breathing 5DCT protocol, employing an abdominally positioned pneumatic-bellows breathing surrogate and yielding voxel-specific motion model parameters α and β corresponding to motion as a function of amplitude and rate, respectively. Tumor GTVs were contoured on the first (reference) of 25 successive free-breathing fast helical CT image sets. The tumor displacements were binned into widths of 1mm to 5mm in 1mm steps and the total required number of bins recorded. The simulation evaluated the number of bins needed to encompass 100% of the breathing-amplitude and between the 5th and 95th percentile amplitudes to exclude breathing outliers. Results: The mean respiration-induced tumor motion was 9.90mm ± 7.86mm with a maximum of 25mm. The number of bins required was a strong function of the spatial resolution and varied widely between patients. For example, for 2mm bins, between 1–13 amplitude bins and 1–9 rate bins were required to encompass 100% of the breathing amplitude, while 1–6 amplitude bins and 1–3 rate bins were required to encompass 90% of the breathing amplitude. Conclusion: The strong relationship between number of bins and spatial resolution as well as the large variation between patients implies that time-independent radiation dose distribution simulations should be conducted using patient-specific data and that the breathing conditions will have to be carefully considered. This work will lead to the assessment of the dosimetric impact of binning resolution. This study is supported by Siemens Healthcare.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-J-138: An Extension of PCA-Based Respiratory Deformation Modeling Via Multi-Linear Decomposition

Purpose: To address and lift the limited degree of freedom (DoF) of globally bilinear motion components such as those based on principal components analysis (PCA), for encoding and modeling volumetric deformation motion. Methods: We provide a systematic approach to obtaining a multi-linear decomposition (MLD) and associated motion model from deformation vector field (DVF) data. We had previously introduced MLD for capturing multi-way relationships between DVF variables, without being restricted by the bilinear component format of PCA-based models. PCA-based modeling is commonly used for encoding patient-specific deformation as per planning 4D-CT images, and aiding on-board motion estimation during radiotherapy. However, the bilinear space-time decomposition inherently limits the DoF of such models by the small number of respiratory phases. While this limit is not reached in model studies using analytical or digital phantoms with low-rank motion, it compromises modeling power in the presence of relative motion, asymmetries and hysteresis, etc, which are often observed in patient data. Specifically, a low-DoF model will spuriously couple incoherent motion components, compromising its adaptability to on-board deformation changes. By the multi-linear format of extracted motion components, MLD-based models can encode higher-DoF deformation structure. Results: We conduct mathematical and experimental comparisons between PCA- and MLD-based models. A set of temporally-sampled analytical trajectories provides a synthetic, high-rank DVF; trajectories correspond to respiratory and cardiac motion factors, including different relative frequencies and spatial variations. Additionally, a digital XCAT phantom is used to simulate a lung lesion deforming incoherently with respect to the body, which adheres to a simple respiratory trend. In both cases, coupling of incoherent motion components due to a low model DoF is clearly demonstrated. Conclusion: Multi-linear decomposition can enable decoupling of distinct motion factors in high-rank DVF measurements. This may improve motion model expressiveness and adaptability to on-board deformation, aiding model-based image reconstruction for target verification. NIH Grant No. R01-184173.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-J-153: ACR MRI Phantom Test On a 1.5T MR-Simulator with Flexible Coils Setting and Performance Comparison to Volumetric Head Coil Setting

Purpose: To accommodate head-and-neck (HN) RT simulation scan with immobilization, sub-optimized flexible radiofrequency coils have to be used on an MR-sim rather than a volumetric head coil for diagnostic radiological (DR) applications. In this study, we present and compare ACR MRI phantom test with flexible coils setting (RT-setting) and volumetric head coil setting (DR-setting). Methods: Two 8-channel array coils were wrapped close to an ACR MRI phantom placed on a flat couch-top in RT-setting for acquisition. ACR MRI phantom tests were conducted 10 times for each setting on a 1.5T MR-sim. Sagittal localizer (TE/TR=20/200ms), axial T1 (TE/TR=20/500ms) and T2 scans (2TEs/TR=20,80/2000ms) were acquired (NEX=1). Acqusition and image analysis were conducted following ACR guidelines. Extra 10 RT-setting acquisitions were obtained by enabling prescan normalization. Results: For RT-setting without prescan normalization, all tests passed the ACR recommended criteria but image intensity uniformity. Geometric accuracy was 147.8±0.3mm and 191.0±0.4mm. Spatial resolution was 0.9mm. Slice thickness was 5.2mm±0.1mm (T1) and 5.1±0.1mm (T2). Slice position accuracy was 1.4±0.6mm, −2.2±0.3mm (T1), and 1.5±0.2mm, −2.2±0.2mm (T2). Image uniformity was 80.6%±2.6% (T1) and 80.2%±3.1% (T2) (criteria: ≥87.5% for 1.5T). Ghosting ratio was 0.0006±0.0004. Low contrast detectability was 30.7±1.7 (T1) and 22.6±3.0 (T2). Image uniformity (91.4%±4.2% and 91.8%±4.3%) and low contrast detectability (36.5±1.4 and 31.6±2.2) of DR-setting were better than RT-setting. Prescan normalization substantially improved image uniformity to 93.4%±0.2% and 93.4%±0.3%, but slightly compromised ghosting (0.0033±0.0004) and spatial resolution (0.9mm or 1.0mm) for RT-setting. Conclusion: Flexible coils setting for HN-RT simulation scan could successfully pass ACR criteria (prescan normalization enabled) and generally achieve comparable performance to volumetric coil setting, although compromise on low contrast detectability was observed probably due to the lower signal-to-noise ratio of the flexible coils. Our results could also serve as a reference baseline of high-field MR-sim QA performance under ACR guideline.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-J-156: The Feasibility of MR-Only IMRT Planning for Prostate Anatomy

Purpose: For prostate anatomy, previous investigations have shown that simulated CT (sCT) generated from MR images can be used for accurate dose computation. In this study, we demonstrate the feasibility of MR-only IMRT planning for prostate case. Methods: Regular CT (rCT) and MR images of the same patient were acquired for prostate anatomy. Regions-of-interest (ROIs) i.e. target and risk structures are delineated on the rCT. A simulated CT (sCT) is generated from the MR image using the method described by Schadewaldt N et al. Their work establishes the clinical acceptability of dose calculation results on the sCT when compared to rCT. rCT and sCT are rigidly registered to ensure proper alignment between the two images. rCT and sCT are overlaid on each other and slice-wise visual inspection confirms excellent agreement between the two images. ROIs on the rCT are copied over to sCT. Philips AutoPlanning solution is used for generating treatment plans. The same treatment technique protocol (plan parameters and clinical goals) is used to generate AutoPlan-rCT and AutoPlan-sCT respectively for rCT and and sCT. DVH comparison on ROIs and slice-wise evaluation of dose is performed between AutoPlan-rCT and AutoPlan-sCT. Delivery parameters i.e. beam and corresponding segments from the AutoPlan-sCT are copied over to rCT and dose is computed to get AutoPlan-sCT-on-rCT. Results: Plan evaluation is done based on Dose Volume Histogram (DVH) of ROIs and manual slice-wise inspection of dose distribution. Both AutoPlan-rCT and AutoPlan-sCT provide a clinically acceptable plan. Also, AutoPlan-sCT-on-rCT shows excellent agreement with AutoPlan-sCT. Conclusion: The study demonstrates that it is feasible to do IMRT planning on the simulated CT image obtained from MR image for prostate anatomy. The research is supported by Philips India Ltd.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-J-161: Prostate Contouring in Patients with Bilateral Hip Prostheses: Impact of Using Artifact-Reduced CT Images and MRI

Purpose: To investigate the usefulness of metal artifact reduction in CT images of patients with bilateral hip prostheses (BHP) for contouring the prostate and determine if the inclusion of MR images provides additional benefits. Methods: Five patients with BHP were CT scanned using our clinical protocol (140kV, 300mAs, 3mm slices, 1.5mm increment, Philips Medical Systems, OH). Images were reconstructed with the orthopaedic metal artifact reduction (O-MAR) algorithm. MRI scanning was then performed (1.5T, GE Healthcare, WI) with a flat table-top (T{sub 2}-weighted, inherent body coil, FRFSE, 3mm slices with 0mm gap). All images were transferred to Pinnacle (Version 9.2, Philips Medical Systems). For each patient, two data sets were produced: one containing the O-MAR-corrected CT images and another containing fused MRI and O-MAR-corrected CT images. Four genito-urinary radiation oncologists contoured the prostate of each patient on the O-MAR-corrected CT data. Two weeks later, they contoured the prostate on the fused data set, blinded to all other contours. During each contouring session, the oncologists reported their confidence in the contours (1=very confident, 3=not confident) and the contouring difficulty that they experienced (1=really easy, 4=very challenging). Prostate volumes were computed from the contours and the conformity index was used to evaluate inter-observer variability. Results: Larger prostate volumes were found on the O-MAR-corrected CT set than on the fused set (p< 0.05, median=36.9cm{sup 3} vs. 26.63 cm{sup 3}). No significant differences were noted in the inter-observer variability between the two data sets (p=0.3). Contouring difficulty decreased with the addition of MRI (p<0.05) while the radiation oncologists reported more confidence in their contours when MRI was fused with the O-MAR-corrected CT data (p<0.05). Conclusion: This preliminary work demonstrated that, while O-MAR correction to CT images improves visualization of anatomy, the addition of MRI enhanced the oncologists’ confidence in contouring the prostate in patients with BHP.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-J-175: Evaluation of Metal Artifact Reduction Algorithms in Computed Tomography and Their Application to Radiation Therapy Treatment Planning

Purpose: High-Z (metal) implants in CT scans cause significant streak-like artifacts in the reconstructed dataset. This results in both inaccurate CT Hounsfield units for the tissue as well as obscuration of the target and organs at risk (OARs) for radiation therapy planning. Herein we analyze two metal artifact reduction algorithms: GE’s Smart MAR and a Metal Deletion Technique (MDT) for geometric and Hounsfield Unit (HU) accuracy. Methods: A CT-to-electron density phantom, with multiple inserts of various densities and a custom Cerrobend insert (Zeff=76.8), is utilized in this continuing study. The phantom is scanned without metal (baseline) and again with the metal insert. Using one set of projection data, reconstructed CT volumes are created with filtered-back-projection (FBP) and the MAR and the MDT algorithms. Regions-of-Interest (ROIs) are evaluated for each insert for HU accuracy; the metal insert’s Full-Width-Half-Maximum (FWHM) is used to evaluate the geometric accuracy. Streak severity is quantified with an HU error metric over the phantom volume. Results: The original FBP reconstruction has a Root-Mean-Square-Error (RMSE) of 57.55 HU (STD=29.19, range=−145.8 to +79.2) compared to baseline. The MAR reconstruction has a RMSE of 20.98 HU (STD=13.92, range=−18.3 to +61.7). The MDT reconstruction has a RMSE of 10.05 HU (STD=10.5, range=−14.8 to +18.6). FWHM for baseline=162.05; FBP=161.84 (−0.13%); MAR=162.36 (+0.19%); MDT=162.99 (+0.58%). Streak severity metric for FBP=19.73 (22.659% bad pixels); MAR=8.743 (9.538% bad); MDT=4.899 (5.303% bad). Conclusion: Image quality, in terms of HU accuracy, in the presence of high-Z metal objects in CT scans is improved by metal artifact reduction reconstruction algorithms. The MDT algorithm had the highest HU value accuracy (RMSE=10.05 HU) and best streak severity metric, but scored the worst in terms of geometric accuracy. Qualitatively, the MAR and MDT algorithms increased detectability of inserts, although there is a loss of in-plane resolution near the metallic insert.

60 APPLIED LIFE SCIENCES↗
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↗