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At least 145 records · Page 8
All sourcesNASA NTRSDOE OSTI
DOE OSTI2014

SU-E-J-156: Preclinical Inverstigation of Dynamic Tumor Tracking Using Vero SBRT Linear Accelerator: Motion Phantom Dosimetry Study

Purpose: Following the ‘end-to-end testing’ paradigm of Dynamic Target Tracking option in our Image-Guided dedicated SBRT VeroTM linac, we verify the capability of the system to deliver planned dose to moving targets in the heterogeneous thorax phantom (CIRSTM). The system includes gimbaled C-band linac head, robotic 6 degree of freedom couch and a tumor tracking method based on predictive modeling of target position using fluoroscopically tracked implanted markers and optically tracked infrared reflecting external markers. Methods: 4DCT scan of the motion phantom with the VisicoilTM implanted marker in the close vicinity of the target was acquired, the ‘exhale’=most prevalent phase was used for planning (iPlan by BrainLabTM). Typical 3D conformal SBRT treatment plans aimed to deliver 6-8Gy/fx to two types of targets: a)solid water-equivalent target 3cm in diameter; b)single VisicoilTM marker inserted within lung equivalent material. The planning GTV/CTV-to-PTV margins were 2mm, the block margins were 3 mm. The dose calculated by MonteCarlo algorithm with 1% variance using option Dose-to-water was compared to the ion chamber (CC01 by IBA Dosimetry) measurements in case (a) and GafchromicTM EBT3 film measurements in case (b). During delivery, the target 6 motion patterns available as a standard on CIRSTM motion phantom were investigated: in case (a), the target was moving along the designated sine or cosine4 3D trajectory; in case (b), the inserted marker was moving sinusoidally in 1D. Results: The ion chamber measurements have shown the agreement with the planned dose within 1% under all the studied motion conditions. The film measurements show 98.1% agreement with the planar calculated dose (gamma criteria: 3%/3mm). Conclusion: We successfully verified the capability of the SBRT VeroTM linac to perform real-time tumor tracking and accurate dose delivery to the target, based on predictive modeling of the correlation between implanted marker motion and external surrogate of breathing motion.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-J-170: Beyond Single-Cycle 4DCT: Maximum a Posteriori (MAP) Reconstruction-Based Binning-Free Multicycle 4DCT for Lung Radiotherapy

Purpose: Thoracic motion changes from cycle-to-cycle and day-to-day. Conventional 4DCT does not capture these cycle to cycle variations. We present initial results of a novel 4DCT reconstruction technique based on maximum a posteriori (MAP) reconstruction. The technique uses the same acquisition process (and therefore dose) as a conventional 4DCT in order to create a high spatiotemporal resolution cine CT that captures several breathing cycles. Methods: Raw 4DCT data were acquired from a lung cancer patient. The continuous 4DCT was reconstructed using MAP algorithm which uses the raw, time-stamped CT data to reconstruct images while simultaneously estimating deformation in the subject's anatomy. This framework incorporates physical effects such as hysteresis and is robust to detector noise and irregular breathing patterns. The 4D image is described in terms of a 3D reference image defined at one end of the hysteresis loop, and two deformation vector fields (DVFs) corresponding to inhale motion and exhale motion respectively. The MAP method uses all of the CT projection data and maximizes the log posterior in order to iteratively estimate a timevariant deformation vector field that describes the entire moving and deforming volume. Results: The MAP 4DCT yielded CT-quality images for multiple cycles corresponding to the entire duration of CT acquisition, unlike the conventional 4DCT, which only yielded a single cycle. Variations such as amplitude and frequency changes and baseline shifts were clearly captured by the MAP 4DC Conclusion: We have developed a novel, binning-free, parameterized 4DCT reconstruction technique that can capture cycle-to-cycle variations of respiratory motion. This technique provides an invaluable tool for respiratory motion management research. This work was supported by funding from the National Institutes of Health and VisionRT Ltd. Amit Sawant receives research funding from Varian Medical Systems, Vision RT and Elekta.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-J-173: Evaluation of Deformable Registration for Correcting Respiratory Motion in 4DCT Lung Images

Purpose: Deformable Image Registration (DIR) is gaining wider clinical acceptance in radiation oncology. The aim of this work is to characterise a DIR algorithm on publically available 4DCT lung images, such that comparison can be performed against other algorithms. We propose an evaluation method of registration accuracy that takes into account the initial misregistration of the datasets. Methods: The “DIR Validation dataset” ( http://www.creatis.insa-lyon.fr/rio/dir{sub v}alidation{sub d}ata ) provides benchmark data for evaluating 3D CT registration algorithms. It consists of six 4DCT lung datasets (1x1x2mm resolution) with 100 landmarks identified on the end-exhalation and end-inhalation phases. Images were registered to end-inhalation using proprietary form of optical flow in commercial software (Mirada RTx, Mirada Medical, UK). Target registration error was measured before and after DIR, referred to as Initial Registration Error (IRE) and Final Registration Error (FRE). Results: The mean FRE over all landmarks was 1.37±1.81mm. FRE increased with IRE. Mean FRE of 0.86, 0.86, 1.53, 3.38, 4.45, 7.58mm was observed for IRE in the ranges 0–5, 5–10, 10–15, 15–20, 20–25, >25 mm. Higher FRE was observed at the inferior lung, where IRE was greater. Out-of-plane motion contributed more to IRE, and therefore to FRE. Maximum FRE of 20.6mm was observed for IRE of 32.1mm, located at the posterior of the middle lobe for dataset 2. Sub-voxel registration accuracy was achieved for up to 10mm IRE, and increased linearly at 0.3mm FRE/mm IRE thereafter. Conclusion: Publicly available clinical datasets enable algorithms to be compared objectively between publications. However, only reporting average TRE after registration can be misleading as the ability of an algorithm to correct for displacements varies with the IRE or position within the patient. Consequently, algorithms should be characterized using the entire range of initial displacements. For the algorithm assessed, clinically acceptable error within one voxel was achieved for IRE of up to 15mm. TK, AL, and MG are employees of Mirada Medical.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-J-185: Gated CBCT Imaging for Positioning Moving Lung Tumor in Lung SBRT Treatment

Purpose: Lung stereo-tactic body radiotherapy(SBRT) treatment requires high accuracy of lung tumor positioning during treatment, which is usually accomplished by free breathing Cone-Beam computerized tomography (CBCT) scan. However, respiratory motion induced image artifacts in free breathing CBCT may degrade such positioning accuracy. The purpose of this study is to investigate the feasibility of gated CBCT imaging for lung SBRT treatment. Methods: Six Lung SBRT patients were selected for this study. The respiratory motion of the tumors ranged from 1.2cm to 3.5cm, and the gating windows for all patients were set between 35% and 65% of the respiratory phases. Each Lung SBRT patient underwent free-breathing CBCT scan using half-fan scan technique. The acquired projection images were transferred out for off-line analyses. An In-house semi-automatic algorithm was developed to trace the diaphragm movement from those projection images to acquire a patient's specific respiratory motion curve, which was used to correlate respiratory phases with each projection image. Afterwards, a filtered back-projection algorithm was utilized to reconstruct the gated CBCT images based on the projection images only within the gating window. Results: Target volumes determined by free breathing CBCT images were 71.9%±72% bigger than the volume shown in gated CBCT image. On the contrary, the target volume differences between gated CBCT and planning CT images at exhale stage were 5.8%±2.4%. The center to center distance of the targets shown in free breathing CBCT and gated CBCT images were 9.2±8.1mm. For one particular case, the superior boundary of the target was shifted 15mm between free breathing CBCT and gated CBCT. Conclusion: Gated CBCT imaging provides better representation of the moving lung tumor with less motion artifacts, and has the potential to improve the positioning accuracy in lung SBRT treatment.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-J-200: A Dosimetric Analysis of 3D Versus 4D Image-Based Dose Calculation for Stereotactic Body Radiation Therapy in Lung Tumors

Purpose: To evaluate the dosimetric difference between 3D and 4Dweighted dose calculation using patient specific respiratory trace and deformable image registration for stereotactic body radiation therapy in lung tumors. Methods: Two dose calculation techniques, 3D and 4D-weighed dose calculation, were used for dosimetric comparison for 9 lung cancer patients. The magnitude of the tumor motion varied from 3 mm to 23 mm. Breath-hold exhale CT was used for 3D dose calculation with ITV generated from the motion observed from 4D-CT. For 4D-weighted calculation, dose of each binned CT image from the ten breathing amplitudes was first recomputed using the same planning parameters as those used in the 3D calculation. The dose distribution of each binned CT was mapped to the breath-hold CT using deformable image registration. The 4D-weighted dose was computed by summing the deformed doses with the temporal probabilities calculated from their corresponding respiratory traces. Dosimetric evaluation criteria includes lung V20, mean lung dose, and mean tumor dose. Results: Comparing with 3D calculation, lung V20, mean lung dose, and mean tumor dose using 4D-weighted dose calculation were changed by −0.67% ± 2.13%, −4.11% ± 6.94% (−0.36 Gy ± 0.87 Gy), −1.16% ± 1.36%(−0.73 Gy ± 0.85 Gy) accordingly. Conclusion: This work demonstrates that conventional 3D dose calculation method may overestimate the lung V20, MLD, and MTD. The absolute difference between 3D and 4D-weighted dose calculation in lung tumor may not be clinically significant. This research is supported by Siemens Medical Solutions USA, Inc and Iowa Center for Research By Undergraduates.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-J-227: Breathing Pattern Consistency and Reproducibility: Comparative Analysis for Supine and Prone Body Positioning

Purpose: Evaluate and compare the cycle-to-cycle consistency of breathing patterns and their reproducibility over the course of treatment, for supine and prone positioning. Methods: Respiratory traces from 25 patients were recorded for sequential supine/prone 4DCT scans acquired prior to treatment, and during the course of the treatment (weekly or bi-weekly). For each breathing cycle, the average(AVE), end-of-exhale(EoE) and end-of-inhale( EoI) locations were identified using in-house developed software. In addition, the mean values and variations for the above quantities were computed for each breathing trace. F-tests were used to compare the cycle-to-cycle consistency of all pairs of sequential supine and prone scans. Analysis of variances was also performed using population means for AVE, EoE and EoI to quantify differences between the reproducibility of prone and supine respiration traces over the treatment course. Results: Consistency: Cycle-to-cycle variations are less in prone than supine in the pre-treatment and during-treatment scans for AVE, EoE and EoI points, for the majority of patients (differences significant at p<0.05). The few cases where the respiratory pattern had more variability in prone appeared to be random events. Reproducibility: The reproducibility of breathing patterns (supine and prone) improved as treatment progressed, perhaps due to patients becoming more comfortable with the procedure. However, variability in supine position continued to remain significantly larger than in prone (p<0.05), as indicated by the variance analysis of population means for the pretreatment and subsequent during-treatment scans. Conclusions: Prone positioning stabilizes breathing patterns in most subjects investigated in this study. Importantly, a parallel analysis of the same group of patients revealed a tendency towards increasing motion amplitude of tumor targets in prone position regardless of their size or location; thus, the choice for body positioning during radiation therapy will have to consider the clinical relevance of the two opposing trends - breathing consistency and motion amplitude.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-J-241: Creation of Ventilation CT From Daily 4D CTs Or 4D Conebeam CTs Acquired During IGRT for Thoracic Cancers

Purpose: To develop a method to create ventilation CTs from daily 4D CTs or 4D KV conebeam CTs (4DCBCT) acquired during image-guided radiation therapy (IGRT) for thoracic tumors, and to explore the potential for using the ventilation CTs as a means for early detection of lung injury during radiation treatment. Methods: 4DCT acquired using an in-room CT (CTVision, Siemens) and 4DCBCT acquired using the X-ray Volume Imaging (XVI) system (Infinity, Elekta) for representative lung cancer patients were analyzed. These 4D data sets were sorted into 10 phase images. A newly-available deformable image registration tool (ADMIRE, Elekta) is used to deform the phase images at the end of exhale (EE) to the phase images at the end of inhale (EI). The lung volumes at EI and EE were carefully contoured using an intensity-based auto-contour tool and then manually edited. The ventilation images were calculated from the variations of CT numbers of those voxels masked by the lung contour at EI between the registered phase images. The deformable image registration is also performed between the daily 4D images and planning 4DCT, and the resulting deformable field vector (DFV) is used to deform the planning doses to the daily images by an in-house Matlab program. Results: The ventilation images were successfully created. The tide volumes calculated using the ventilation images agree with those measured through volume difference of contours at EE and EI, indicating the accuracy of ventilation images. The association between the delivered doses and the change of lung ventilation from the daily ventilation CTs is identified. Conclusions: A method to create the ventilation CT using daily 4DCTs or 4D KV conebeam CTs was developed and demonstrated.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-113: Dose Distribution Using Respiratory Signals and Machine Parameters During Treatment

Purpose: Volumetric modulated arc therapy (VMAT) is a rotational intensity-modulated radiotherapy (IMRT) technique capable of acquiring projection images during treatment. Treatment plans for lung tumors using stereotactic body radiotherapy (SBRT) are calculated with planning computed tomography (CT) images only exhale phase. Purpose of this study is to evaluate dose distribution by reconstructing from only the data such as respiratory signals and machine parameters acquired during treatment. Methods: Phantom and three patients with lung tumor underwent CT scans for treatment planning. They were treated by VMAT while acquiring projection images to derive their respiratory signals and machine parameters including positions of multi leaf collimators, dose rates and integrated monitor units. The respiratory signals were divided into 4 and 10 phases and machine parameters were correlated with the divided respiratory signals based on the gantry angle. Dose distributions of each respiratory phase were calculated from plans which were reconstructed from the respiratory signals and the machine parameters during treatment. The doses at isocenter, maximum point and the centroid of target were evaluated. Results and Discussion: Dose distributions during treatment were calculated using the machine parameters and the respiratory signals detected from projection images. Maximum dose difference between plan and in treatment distribution was −1.8±0.4% at centroid of target and dose differences of evaluated points between 4 and 10 phases were no significant. Conclusion: The present method successfully evaluated dose distribution using respiratory signals and machine parameters during treatment. This method is feasible to verify the actual dose for moving target.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-609: Evaluation of Transit Dosimetry Software Using Heterogeneous Phantom

Purpose: The purpose of this work was to evaluate limits and capabilities in the transit dosimetry software for use with the TomoTherapy system by irradiating a heterogeneous phantom. Methods: Helical TomoTherapy plan was created using CIRS phantom (model 062M) with nine various tissue equivalent inserts (lung inhale 0.2 g/cm{sup 3}, lung exhale 0.5 g/cm{sup 3}, adipose 0.96 g/cm{sup 3}, breast 0.99 g/cm{sup 3}, water 1.01 g/cm{sup 3}, muscle 1.06 g/cm{sup 3}, liver 1.07 g/cm{sup 3}, trabecular bone 1.16 g/cm{sup 3}, and dense bone 1.53 g/cm{sup 3}). Targets were contoured within every insert. The phantom was scanned with a 50 cm field of view and 3 mm slice width. Images were imported into the TomoTherapy TPS. A plan was generated to deliver 20 Gy to every insert (2 Gy per fraction) with a jaw width of 2.5 cm, a pitch of 0.430 and an actual modulation factor of 2.621. After the radiation delivery the planning CT, the RT structure, the RT plan, and the RT dose (DICOM format) as well as the exit detector sinogram were imported into the Dosimetry Check software (Math Resolutions, LLC). The 3D delivered doses were reconstructed from the exit detector data by correcting for phantom and couch attenuation. The resulting dose distribution were compared with the TPS planned dose using gamma index. Results: Using the clinical gamma criteria, 3% and 3 mm, all tissue equivalent inserts had a passing percentage of 100% except for 0.2 g/cm{sup 3} and 0.5 g/cm{sup 3} density inserts (gamma value of 81.67% and 99.18% respectively). Conclusion: The evaluated transit dosimetry software provides an independent verification of helical TomoTherapy plans giving additional confidence in the treatment delivery, however, an overestimation of the reconstructed dose in low density materials has been revealed. Implementation of Monte Carlo algorithm for exit dose reconstruction should improve dosimetric accuracy in heterogeneous patient tissues. Agreement with Math Resolutions.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

MO-A-BRD-05: Evaluation of Composed Lung Ventilation with 4DCT and Image Registration

Purpose: Regional pulmonary function can be derived using fourdimensional computed tomography (4DCT) combined with deformable image registration. However, only peak inhale and exhale phases have been used thus far while the lung ventilation during intermediate phases is not considered. In our previous work, we have investigated the spatiotemporal heterogeneity of lung ventilation and its dependence on respiration effort. In this study, composed ventilation is introduced using all inspiration phases and compared to direct ventilation. Both methods are evaluated against Xe-CT derived ventilation. Methods: Using an in-house tissue volume preserving deformable image registration, unlike the direct ventilation method, which computes from end expiration to end inspiration, Jacobian ventilation maps were computed from one inhale phase to the next and then composed from all inspiration steps. The two methods were compared in both patients prior to RT and mechanically ventilated sheep subjects. In addition, they wereassessed for the correlation with Xe-CT derived ventilation in sheep subjects. Annotated lung landmarks were used to evaluate the accuracy of original and composed deformation field. Results: After registration, the landmark distance for composed deformation field was always higher than that for direct deformation field (0IN to 100IN average in human: 1.03 vs 1.53, p=0.001, and in sheep: 0.80 vs0.94, p=0.009), and both increased with longer phase interval. Direct and composed ventilation maps were similar in both sheep (gamma pass rate 87.6) and human subjects (gamma pass rate 71.9),and showed consistent pattern from ventral to dorsal when compared to Xe-CT derived ventilation. Correlation coefficient between Xe-CT and composed ventilation was slightly better than the direct method but not significant (average 0.89 vs 0.85, p=0.135). Conclusion: More strict breathing control in sheep subjects may explain higher similarity between direct and composed ventilation. When compared to Xe-CT ventilation, no significant difference was found for the composed method. NIH Grant: R01 CA166703.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

MO-C-17A-08: Evaluation of Lung Deformation Using Three Dimensional Strain Maps

Purpose: To develop a systematic approach to generate three dimensional (3D) strain maps of lung using the displacement vector field (DVF) during the respiratory deformation, and to demonstrate its application in evaluating deformable image registration (DIR). Methods: A DVF based strain tensor at each voxel of interest (VOI) was calculated from the relative displacements between the VOI and each of the six nearest neighbors. The maximum and minimum stretches of a VOI can be determined by the principal strains (E{sub 1}, E{sub 2} and E{sub 3}), which are the eigenvalues and the corresponding strain tensors. Two healthy volunteers enrolled in this study under IRB-approved protocol, each was scanned using 3D Hyperpolarized He-3 tagging-MRI and 3D proton-MRI with TrueFISP sequence at the endof- inhalation (EOI) and the end-of-exhalation (EOE) phases. 3D DVFs of tagging- and proton-MRI were obtained by the direct measurements of the tagging grid trajectory and by the DIR method implemented in commercial software. Results: 3D strain maps were successfully generated for all DVFs. The principal strain E1s were calculated as 0.43±0.05 and 0.17±0.25 for tagging-MRI and proton-MRI, respectively. The large values of E{sub 1} indicate the predominant lung motion in the superior-inferior (SI) direction. Given that the DVFs from the tagging images are considered as the ground truth, the discrepancies in the DIR-based strain maps suggest the inaccuracy of the DIR algorithm. In the E{sub 1} maps of tagging-MRI for subject 1, the fissures were distinguishable by the larger values (0.49±0.02) from the adjacent tissues (0.41±0.03) due to the larger relative displacement between the lung lobes. Conclusion: We have successfully developed a methodology to generate DVF-based 3D strain maps of lung. It can potentially enable us to better understand the pulmonary biomechanics and to evaluate and improve the DIR algorithms for the lung deformation. We are currently studying more subjects to evaluate this tool.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

TU-F-17A-09: Four-Dimensional Cone Beam CT Ventilation Imaging Can Detect Interfraction Lung Function Variations for Locally Advanced Lung Cancer Patients

Purpose: Four-dimensional cone beam CT ventilation imaging (4D-CBCT VI) is a novel functional lung imaging modality requiring validation. We hypothesize that 4D-CBCT VI satisfies a necessary condition for validity: that intrafraction variations (e.g. due to poor 4D-CBCT image quality) are substantially different to interfraction variations (e.g. due to changes in underlying function). We perform the first comparison of intrafraction (pre/post fraction) and interfraction (week-to-week) 4D-CBCT VIs for locally advanced non small cell lung cancer (LA NSCLC) patients undergoing radiation therapy. Methods: A total of 215 4D-CBCT scans were acquired for 19 LA NSCLC patients over 4-6 weeks of radiation therapy, including 75 pairs of pre-/post-fraction scans on the same day. 4D-CBCT VIs were obtained by applying state-of-the-art, B-spline deformable image registration to obtain the Jacobian determinant of deformation between the end-exhale and end-inhale phases. All VIs were deformably registered to the corresponding first day scan, normalized between the 10th and 90th percentile values and cropped to the ipsilateral lung only. Intrafraction variations were assessed by computing the mean and standard deviation of voxel-wise differences between all same-day pairs of pre-/post-fraction VIs. Interfraction differences were computed between first-day VIs and treatment weeks 2, 4 and 6 for all 19 patients. We tested the hypothesis by comparing cumulative distribution functions (CDFs) of intrafraction and interfraction ventilation differences using two-sided Kolmogorov-Smirnov goodness-of-fit tests. Results: The (mean ± std. dev.) of intrafraction differences was (−0.007 ± 0.079). Interfraction differences for weeks 2, 4 and 6 were (−0.035 ± 0.103), (−0.006 ± 0.094) and (−0.019 ± 0.127) respectively. For week 2, the changes in CDFs for intrafraction and interfraction differences approached statistical significance (p=0.099). Conclusion: We have shown that 4D-CBCT VI can satisfy a necessary condition for validity; intrafraction variations do not limit the ability to measure interfraction variations in LA NSCLC patients. This work is supported by a Cancer Institute NSW Early Career Fellowship, an NHMRC Australia Fellowship and NIH P01CA116602.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

TU-F-12A-04: Differential Radiation Avoidance of Functional Liver Regions Defined by 99mTc-Sulfur Colloid SPECT/CT with Proton Therapy

Purpose: Radiotherapy for hepatocellular carcinoma patients is conventionally planned without consideration of spatial heterogeneity in hepatic function, which may increase risk of radiation-induced liver disease. Pencil beam scanning (PBS) proton radiotherapy (pRT) plans were generated to differentially decrease dose to functional liver volumes (FLV) defined on [{sup 99m}Tc]sulfur colloid (SC) SPECT/CT images (functional avoidance plans) and compared against conventional pRT plans. Methods: Three HCC patients underwent SC SPECT/CT scans for pRT planning acquired 15 min post injection over 24 min. Images were reconstructed with OSEM following scatter, collimator, and exhale CT attenuation correction. Functional liver volumes (FLV) were defined by liver:spleen uptake ratio thresholds (43% to 90% maximum). Planning objectives to FLV were based on mean SC SPECT uptake ratio relative to GTV-subtracted liver and inversely scaled to mean liver dose of 20 Gy. PTV target coverage (V{sub 95}) was matched between conventional and functional avoidance plans. PBS pRT plans were optimized in RayStation for single field uniform dose (SFUD) and systematically perturbed to verify robustness to uncertainty in range, setup, and motion. Relative differences in FLV DVH and target dose heterogeneity (D{sub 2}-D{sub 98})/D50 were assessed. Results: For similar liver dose between functional avoidance and conventional PBS pRT plans (D{sub mean}≤5% difference, V{sub 18Gy}≤1% difference), dose to functional liver volumes were lower in avoidance plans but varied in magnitude across patients (FLV{sub 70%max} D{sub mean}≤26% difference, V{sub 18Gy}≤8% difference). Higher PTV dose heterogeneity in avoidance plans was associated with lower functional liver dose, particularly for the largest lesion [(D{sub 2}-D{sub 98})/D{sub 50}=13%, FLV{sub 90%max}=50% difference]. Conclusion: Differential avoidance of functional liver regions defined on sulfur colloid SPECT/CT is feasible with proton therapy. The magnitude of benefit appears to be patient specific and dependent on tumor location, size, and proximity to functional volumes. Further investigation in a larger cohort of patients may validate the clinical utility of functional avoidance planning of HCC radiotherapy.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

WE-G-BRD-01: Diffusion Weighted MRI for Response Assessment of Inoperable Lung Tumors for Patients Undergoing SBRT Treatment

Purpose: To investigate early changes in tumor Apparent Diffusion Coefficients derived from diffusion weighted (DW)-MRI of lung cancer patients undergoing SBRT, as a possible early predictor of treatment response. Methods: DW-MRI scans were performed in this prospective phase I IRB-approved study of inoperable lung tumors at various time-points during the course of SBRT treatments. Axial DW scan using multi b-values ranging from 0–1000 s/mm{sup 2} were acquired in treatment position on a 3T Philips MR scanner during simulation, one hour after the first fraction (8 Gy), after a total of 5 fractions (40 Gy) and 4 weeks after SBRT delivery. A monoexponential model based on a least square fit from all b values was performed on a pixel-by-pixel basis and ADC was calculated. GTVs drawn on 4DCT for planning were mapped on the T2w MRI (acquired at exhale) after deformable registration. These volumes were then mapped on DWI scan for ADC calculation after rigid registration between the anatomical scan and diffusion scan. T2w scan on followup time points were deformably registered to the pretreatment T2 scan. Results: The first two patients in this study were analyzed. Median ADC values were 1.48, 1.48, 1.62 and 1.83 (10{sup −3}×) mm{sup 2}/s at pretreatment, after 8 Gy, after 40 Gy and 4 weeks posttreatment for the first patient and 1.57, 1.53, 1.66 and 1.72 (10{sup −3}×) mm{sup 2}/s for the second patient. ADC increased more significantly after 4 weeks of treatment rather than immediately post treatment, implying that late ADC value may be a better predictor of tumor response for SBRT treatment. The fraction of tumor pixels at high ADC values increased at 4 weeks post treatment. Conclusion: The observed increase in ADC values before the end of radiotherapy may be a surrogate for tumor response, but further patient accrual will be necessary to determine its value.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

TH-C-BRD-08: Reducing the Effect of Respiratory Motion On the Delivered Dose in Proton Therapy Through Proper Field Angle Selection

Purpose: This work investigated a novel planning strategy of selecting radiotherapy beam angles that minimizes the change in water equivalent thickness (dWET) during respiration in order to reduce the effects of respiratory motion in passively scattered proton therapy (PSPT). Methods: In a clinical trial treating locally-advanced lung cancer with proton therapy, 2–4 co-planar beams were previously selected by dosimetrists in the design of physician-approved PSPT treatment plans. The authors identified a cohort of patients in which respiratory motion affected the planned PSPT dose delivery. For this cohort, this work analyzed dWET during respiration over a 360 degree arc of potential treatment angles around the patient: the dWET was defined as the difference in WET between the full-exhale (T50) and full-inhale (T0) phases of the simulation 4DCT. New PSPT plans were redesigned by selecting new beam angles that demonstrated significant reduction in the value of dWET. Between the T50 and T0 phases, the root-mean-square deviation of dose and the change in dose-volume histogram curves (dAUC) for anatomical structures were calculated to compare the original to dWET reduction plans. Results: To date, three plans were retrospectively redesigned based on dWET analysis. In the dWET reduction plan, the root mean square dose (T50-T0) was reduced by 15–35% and the DVH dAUC values were reduced by more than 60%.The PSPT plans redesigned by selecting appropriate field angles to minimize dWET demonstrated less dosimetric variation due to respiration. Conclusion: We have introduced the use of a new metric to quantify respiratory motion in proton therapy: dWET. The use of dWET allows us to minimize the impact of respiratory motion of the entire anatomy in the beam path. This work is a proof of principle that dWET could suggest field angles in proton therapy that are more robust to the effects of respiratory motion.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

An initial study on the estimation of time-varying volumetric treatment images and 3D tumor localization from single MV cine EPID images

Purpose: In this work the authors develop and investigate the feasibility of a method to estimate time-varying volumetric images from individual MV cine electronic portal image device (EPID) images. Methods: The authors adopt a two-step approach to time-varying volumetric image estimation from a single cine EPID image. In the first step, a patient-specific motion model is constructed from 4DCT. In the second step, parameters in the motion model are tuned according to the information in the EPID image. The patient-specific motion model is based on a compact representation of lung motion represented in displacement vector fields (DVFs). DVFs are calculated through deformable image registration (DIR) of a reference 4DCT phase image (typically peak-exhale) to a set of 4DCT images corresponding to different phases of a breathing cycle. The salient characteristics in the DVFs are captured in a compact representation through principal component analysis (PCA). PCA decouples the spatial and temporal components of the DVFs. Spatial information is represented in eigenvectors and the temporal information is represented by eigen-coefficients. To generate a new volumetric image, the eigen-coefficients are updated via cost function optimization based on digitally reconstructed radiographs and projection images. The updated eigen-coefficients are then multiplied with the eigenvectors to obtain updated DVFs that, in turn, give the volumetric image corresponding to the cine EPID image. Results: The algorithm was tested on (1) Eight digital eXtended CArdiac-Torso phantom datasets based on different irregular patient breathing patterns and (2) patient cine EPID images acquired during SBRT treatments. The root-mean-squared tumor localization error is (0.73 ± 0.63 mm) for the XCAT data and (0.90 ± 0.65 mm) for the patient data. Conclusions: The authors introduced a novel method of estimating volumetric time-varying images from single cine EPID images and a PCA-based lung motion model. This is the first method to estimate volumetric time-varying images from single MV cine EPID images, and has the potential to provide volumetric information with no additional imaging dose to the patient.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

Poster — Thur Eve — 30: 4D VMAT dose calculation methodology to investigate the interplay effect: experimental validation using TrueBeam Developer Mode and Gafchromic film

The interplay effect between the tumor motion and the radiation beam modulation during a VMAT treatment delivery alters the delivered dose distribution from the planned one. This work present and validate a method to accurately calculate the dose distribution in 4D taking into account the tumor motion, the field modulation and the treatment starting phase. A QUASAR™ respiratory motion phantom was 4D scanned with motion amplitude of 3 cm and with a 3 second period. A static scan was also acquired with the lung insert and the tumor contained in it centered. A VMAT plan with a 6XFFF beam was created on the averaged CT and delivered on a Varian TrueBeam and the trajectory log file was saved. From the trajectory log file 10 VMAT plans (one for each breathing phase) and a developer mode XML file were created. For the 10 VMAT plans, the tumor motion was modeled by moving the isocentre on the static scan, the plans were re-calculated and summed in the treatment planning system. In the developer mode, the tumor motion was simulated by moving the couch dynamically during the treatment. Gafchromic films were placed in the QUASAR phantom static and irradiated using the developer mode. Different treatment starting phase were investigated (no phase shift, maximum inhalation and maximum exhalation). Calculated and measured isodose lines and profiles are in very good agreement. For each starting phase, the dose distribution exhibit significant differences but are accurately calculated with the methodology presented in this work.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

Poster — Thur Eve — 66: Robustness Assessment of a Novel IMRT Planning Method for Lung Radiotherapy

Conventional radiotherapy treatment planning for lung cancer accounts for tumour motion by increasing the beam apertures. We recently developed an IMRT planning strategy which uses reduced beam apertures in combination with an edge enhancing boost of 110% of the prescription dose to the volume that corresponds to the portion of the CTV that moves outside of the reduced beam. Previous results showed that this approach ensures target coverage while reducing lung dose. In the current study, we evaluate the robustness of this boost volume approach to changes in respiratory motion, including amplitude and phase weight variations. ITV and boost volume plans were generated for 5 NSCLC patients with respiratory motion amplitudes ranging from 1 to 2 cm. A standard 5mm PTV margin was used for all plans. The ORBIT treatment planning tool was used to plan and accumulate dose over 10 respiratory phases defined by the 4DCT datasets. For the phase weight variation study, dose was accumulated for three scenarios: equally-weighted-phases, higher weight assigned to exhale phases and higher weight assigned to inhale phases. For the amplitude variation study, a numerical phantom was used to generate 4DCT datasets corresponding to 7 mm, 10 mm and 14 mm motion amplitudes. Preliminary results found that delivered plans for all phase weight scenarios were clinically acceptable. When normalized to mean lung dose, the boost volume plan delivered 5% more dose to the CTV which indicates the potential for dose escalation using this approach.

60 APPLIED LIFE SCIENCES↗