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At least 163 records · Page 9
All sourcesNASA NTRSDOE OSTI
DOE OSTI2014

Sci—Sat AM: Stereo — 04: Evaluation of VMAT interplay effect for lung SABR using TrueBeam 10XFFF beam

During a VMAT treatment delivery, the interplay effect between the moving target and varying machine parameters result in dose distributions that are different from those initially planned. In this work, we investigate this effect for lung SABR by using 4D dose calculation derived from the Varian TrueBeam trajectory log file. The impact of treatment start phase is also evaluated. A QUASAR™ respiratory motion phantom was scanned with motion amplitudes of 0.4, 1, 2 and 3 cm with a 4 second period. MIP and the average dataset were generated from the 4DCT. A static CT was also acquired with the tumor in its centre position. Plans were optimized with 10X FFF beam until PTV and fictitious critical structures met the dose constraints. Ten temporally interleaved plans were constructed with the temporal machine parameter information from the trajectory log file. Ten plans were calculated with isocentre shifts to simulate respiratory motion and then summed. For each motion amplitude, three separate sum plans were created with various phase shifts (no phase shift, maximum inhalation and maximum exhalation) to assess the impact of treatment start phase. For all the phase shifts investigated, the DVH for PTV demonstrated good dose coverage. However, a careful review of slice by slice plan comparison indicates dose “holes” are observed within PTV. The PTV dose difference between various treatment start phases can be as high as 19%. This assumes all treatment fractions have identical treatment start phase. Our future work includes evaluation of interplay effect for various breathing periods.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

Evaluation of potential internal target volume of liver tumors using cine-MRI

Purpose: Four-dimensional computed tomography (4DCT) is widely used for evaluating moving tumors, including lung and liver cancers. For patients with unstable respiration, however, the 4DCT may not visualize tumor motion properly. High-speed magnetic resonance imaging (MRI) sequences (cine-MRI) permit direct visualization of respiratory motion of liver tumors without considering radiation dose exposure to patients. Here, the authors demonstrated a technique for evaluating internal target volume (ITV) with consideration of respiratory variation using cine-MRI. Methods: The authors retrospectively evaluated six patients who received stereotactic body radiotherapy (SBRT) to hepatocellular carcinoma. Before acquiring planning CT, sagittal and coronal cine-MRI images were acquired for 30 s with a frame rate of 2 frames/s. The patient immobilization was conducted under the same condition as SBRT. Planning CT images were then acquired within 15 min from cine-MRI image acquisitions, followed by a 4DCT scan. To calculate tumor motion, the motion vectors between two continuous frames of cine-MRI images were calculated for each frame using the pyramidal Lucas–Kanade method. The target contour was delineated on one frame, and each vertex of the contour was shifted and copied onto the following frame using neighboring motion vectors. 3D trajectory data were generated with the centroid of the contours on sagittal and coronal images. To evaluate the accuracy of the tracking method, the motion of clearly visible blood vessel was analyzed with the motion tracking and manual detection techniques. The target volume delineated on the 50% (end-exhale) phase of 4DCT was translated with the trajectory data, and the distribution of the occupancy probability of target volume was calculated as potential ITV (ITV {sub Potential}). The concordance between ITV {sub Potential} and ITV estimated with 4DCT (ITV {sub 4DCT}) was evaluated using the Dice’s similarity coefficient (DSC). Results: The distance between blood vessel positions determined with motion tracking and manual detection was analyzed. The mean and SD of the distance were less than 0.80 and 0.52 mm, respectively. The maximum ranges of tumor motion on cine-MRI were 2.4 ± 1.4 mm (range, 1.0–5.0 mm), 4.4 ± 3.3 mm (range, 0.8–9.4 mm), and 14.7 ± 5.9 mm (range, 7.4–23.4 mm) in lateral, anterior–posterior, and superior–inferior directions, respectively. The ranges in the superior–inferior direction were larger than those estimated with 4DCT images for all patients. The volume of ITV {sub Potential} was 160.3% ± 13.5% (range, 142.0%–179.2%) of the ITV {sub 4DCT}. The maximum DSC values were observed when the cutoff value of 24.7% ± 4.0% (range, 20%–29%) was applied. Conclusions: The authors demonstrated a novel method of calculating 3D motion and ITV {sub Potential} of liver cancer using orthogonal cine-MRI. Their method achieved accurate calculation of the respiratory motion of moving structures. Individual evaluation of the ITV {sub Potential} will aid in improving respiration management and treatment planning.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

Registration of clinical volumes to beams-eye-view images for real-time tracking

Purpose: The authors combine the registration of 2D beam’s eye view (BEV) images and 3D planning computed tomography (CT) images, with relative, markerless tumor tracking to provide automatic absolute tracking of physician defined volumes such as the gross tumor volume (GTV). Methods: During treatment of lung SBRT cases, BEV images were continuously acquired with an electronic portal imaging device (EPID) operating in cine mode. For absolute registration of physician-defined volumes, an intensity based 2D/3D registration to the planning CT was performed using the end-of-exhale (EoE) phase of the four dimensional computed tomography (4DCT). The volume was converted from Hounsfield units into electron density by a calibration curve and digitally reconstructed radiographs (DRRs) were generated for each beam geometry. Using normalized cross correlation between the DRR and an EoE BEV image, the best in-plane rigid transformation was found. The transformation was applied to physician-defined contours in the planning CT, mapping them into the EPID image domain. A robust multiregion method of relative markerless lung tumor tracking quantified deviations from the EoE position. Results: The success of 2D/3D registration was demonstrated at the EoE breathing phase. By registering at this phase and then employing a separate technique for relative tracking, the authors are able to successfully track target volumes in the BEV images throughout the entire treatment delivery. Conclusions: Through the combination of EPID/4DCT registration and relative tracking, a necessary step toward the clinical implementation of BEV tracking has been completed. The knowledge of tumor volumes relative to the treatment field is important for future applications like real-time motion management, adaptive radiotherapy, and delivered dose calculations.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

Measuring interfraction and intrafraction lung function changes during radiation therapy using four-dimensional cone beam CT ventilation imaging

Purpose: Adaptive ventilation guided radiation therapy could minimize the irradiation of healthy lung based on repeat lung ventilation imaging (VI) during treatment. However the efficacy of adaptive ventilation guidance requires that interfraction (e.g., week-to-week), ventilation changes are not washed out by intrafraction (e.g., pre- and postfraction) changes, for example, due to patient breathing variability. The authors hypothesize that patients undergoing lung cancer radiation therapy exhibit larger interfraction ventilation changes compared to intrafraction function changes. To test this, the authors perform the first comparison of interfraction and intrafraction lung VI pairs using four-dimensional cone beam CT ventilation imaging (4D-CBCT VI), a novel technique for functional lung imaging. Methods: The authors analyzed a total of 215 4D-CBCT scans acquired for 19 locally advanced non-small cell lung cancer (LA-NSCLC) patients over 4–6 weeks of radiation therapy. This set of 215 scans was sorted into 56 interfraction pairs (including first day scans and each of treatment weeks 2, 4, and 6) and 78 intrafraction pairs (including pre/postfraction scans on the same-day), with some scans appearing in both sets. VIs were obtained from the Jacobian determinant of the transform between the 4D-CBCT end-exhale and end-inhale images after deformable image registration. All VIs were deformably registered to their corresponding planning CT and normalized to account for differences in breathing effort, thus facilitating image comparison in terms of (i) voxelwise Spearman correlations, (ii) mean image differences, and (iii) gamma pass rates for all interfraction and intrafraction VI pairs. For the side of the lung ipsilateral to the tumor, we applied two-sided t-tests to determine whether interfraction VI pairs were more different than intrafraction VI pairs. Results: The (mean ± standard deviation) Spearman correlation for interfraction VI pairs was r{sup -}{sub Inter}=0.52±0.25, which was significantly lower than for intrafraction pairs (r{sup -}{sub Intra}=0.67±0.20, p = 0.0002). Conversely, mean absolute ventilation differences were larger for interfraction pairs than for intrafraction pairs, with |ΔV{sup -}{sub Inter}|=0.42±0.65 and |ΔV{sup -}{sub Intra}|=0.32±0.53, respectively (p < 10{sup −15}). Applying a gamma analysis with ventilation/distance tolerance of 25%/10 mm, we observed mean pass rate of (69% ± 20%) for interfraction VIs, which was significantly lower compared to intrafraction pairs (80% ± 15%, with p ∼ 0.0003). Compared to the first day scans, all patients experienced at least one subsequent change in median ipsilateral ventilation ≥10%. Patients experienced both positive and negative ventilation changes throughout treatment, with the maximum change occurring at different weeks for different patients. Conclusions: The authors’ data support the hypothesis that interfraction ventilation changes are larger than intrafraction ventilation changes for LA-NSCLC patients over a course of conventional lung cancer radiation therapy. Longitudinal ventilation changes are observed to be highly patient-dependent, supporting a possible role for adaptive ventilation guidance based on repeat 4D-CBCT VIs. We anticipate that future improvement of 4D-CBCT image reconstruction algorithms will improve the capability of 4D-CBCT VI to resolve interfraction ventilation changes.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

Novel spirometry based on optical surface imaging

Purpose: To evaluate the feasibility of using optical surface imaging (OSI) to measure the dynamic tidal volume (TV) of the human torso during free breathing. Methods: We performed experiments to measure volume or volume change in geometric and deformable phantoms as well as human subjects using OSI. To assess the accuracy of OSI in volume determination, we performed experiments using five geometric phantoms and two deformable body phantoms and compared the values with those derived from geometric calculations and computed tomography (CT) measurements, respectively. To apply this technique to human subjects, an institutional review board protocol was established and three healthy volunteers were studied. In the human experiment, a high-speed image capture mode of OSI was applied to acquire torso images at 4–5 frames per second, which was synchronized with conventional spirometric measurements at 5 Hz. An in-house MATLAB program was developed to interactively define the volume of interest (VOI), separate the thorax and abdomen, and automatically calculate the thoracic and abdominal volumes within the VOIs. The torso volume change (TV C = ΔV{sub torso} = ΔV{sub thorax} + ΔV{sub abdomen}) was automatically calculated using full-exhalation phase as the reference. The volumetric breathing pattern (BP{sub v} = ΔV{sub thorax}/ΔV{sub torso}) quantifying thoracic and abdominal volume variations was also calculated. Under quiet breathing, TVC should equal the tidal volume measured concurrently by a spirometer with a conversion factor (1.08) accounting for internal and external differences of temperature and moisture. Another MATLAB program was implemented to control the conventional spirometer that was used as the standard. Results: The volumes measured from the OSI imaging of geometric phantoms agreed with the calculated volumes with a discrepancy of 0.0% ± 1.6% (range −1.9% to 2.5%). In measurements from the deformable torso/thorax phantoms, the volume differences measured using OSI imaging and CT imaging were 1.2% ± 2.1% (range −0.5% to 3.6%), with a linear regression fitting (slope = 1.02 and R{sup 2} = 0.999). In volunteers, the relative error in OSI tidal volume measurement was −2.2% ± 4.9% (range −9.2% to 4.8%) and a correlation of r = 0.98 was found with spirometric measurement. The breathing pattern values of the three volunteers were substantially different from each other (BP{sub v} = 0.15, 0.45, and 0.32). Conclusions: This study demonstrates the feasibility of using OSI to measure breathing tidal volumes and breathing patterns with adequate accuracy. This is the first time that dynamic breathing tidal volume as well as breathing patterns is measured using optical surface imaging. The OSI-observed movement of the entire torso could serve as a new respiratory surrogate in the treatment room during radiation therapy.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-C-303-06: Treatment Planning Study for Non-Invasive Cardiac Arrhythmia Ablation with Scanned Carbon Ions in An Animal Model

Purpose: Scanned carbon ion beams might offer a non-invasive alternative treatment for cardiac arrhythmia, which are a major health-burden. We studied the feasibility of this procedure in an animal model. The underlying treatment planning and motion mitigation strategies will be presented. Methods: The study was carried out in 15 pigs, randomly distributed to 3 target groups: atrioventricular node (AVN, 8 animals with 25, 40, and 55 Gy target dose), left ventricular free-wall (LV, 4 animals with 40 Gy) and superior pulmonary vein (SPV, 3 animals with 40 Gy). Breathing motion was suppressed by repeated enforced breathholds at end exhale. Cardiac motion was mitigated by an inhomogeneous rescanning scheme with up to 15 rescans. The treatment planning was performed using the GSI in-house software TRiP4D on cardiac-gated 4DCTs, applying a range-considering ITV based on an extended CTV. For AVN and SPV isotropic 5 mm margins were applied to the CTV, while for the LV 2mm+2% range margins were used. The opposing fields for AVN and LV targets were optimized independently (SFUD), while SPV treatments were optimized as IMPT deliveries, including dose restrictions to the radiosensitive AVN. Results: Median value of D{sub 95} over all rescanning simulations was 99.1% (AVN), 98.0% (SPV) and 98.3% (LV) for the CTV and 94.7% (AVN) and 92.7% (SPV) for the PTV, respectively. The median D{sub 5}-D{sub 95} was improved with rescanning compared to unmitigated delivery from 13.3 to 6.5% (CTV) and from 23.4 to 11.6% (PTV). ICRP dose limits for aorta, trachea, esophagus and skin were respected. The maximal dose in the coronary arteries was limited to 30 Gy. Conclusion: We demonstrated the feasibility of a homogeneous dose delivery to different cardiac structures in a porcine model using a time-optimized inhomogeneous rescanning scheme. The presented treatment planning strategies were applied in a pig study with the analysis ongoing. Funding: This work was supported in part by the Helmholtz Association, the American Heart Association Midwest Affiliate Postdoctoral Fellowship Grant, the Mayo Clinic Foundation, and the Goldsmith Foundation.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-C-210-03: Impact of Breathing Irregularities On Gated Treatments

Purpose: To evaluate the effect of breathing irregularities on target location in gated treatments using amplitude and phase gating. Methods: 111 breathing patterns acquired using RPM system were categorized based on period and amplitude STD as regular (STD period ≤ 0.5 s, STD amplitude ≤ 1.5 mm), medium (0.5 s < STD period ≤ 1 s, 1.5 mm < STD amplitude ≤ 3 mm) and irregular (STD period > 1 s, STD amplitude > 3 mm). One pattern representative of the average defined population was selected per category and corresponding target motion reproduced using Quasar Respiratory Motion Phantom. Phantom in motion underwent 4D-CT scan with phase reconstruction. Gated window was defined at end of exhale and DRRs reconstructed in treatment planning at 40% (beam on) and 60% phase (beam off). Target location uncertainty was assessed by comparing gated kV triggered images continuously acquired at beam on/off on a True Beam 2.0 with corresponding DRRs. Results: Average target uncertainty with amplitude gating was in [0.4 – 1.9] mm range for the different scenarios with maximum STD of 1.2 mm for the irregular pattern. Average target uncertainty with phase gating was [1.1 – 2.2] mm for regular and medium patterns, while it increased to [3.6 – 9.6] mm for the irregular pattern. Live gated motion was stable with amplitude gating, while increasing with phase gating for the irregular pattern. Treatment duration range was [68 – 160] s with amplitude and [70 – 74] s with phase gating. Conclusion: Breathing irregularities were found to affect gated treatments only when using phase gating. For regular and medium patterns no significant difference was found between the two gating strategies. Amplitude gating ensured stable gated motion within the different patterns, thus reducing intra-fraction target location variability for the irregular pattern and resulting in longer treatment duration.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-P-13: Quantifying the Geometric Error Due to Irregular Motion in Four-Dimensional Computed Tomography (4DCT)

Purpose: Respiratory correlated 4DCT images are generated under the assumption of a regular breathing cycle. This study evaluates the error in 4DCT-based target position estimation in the presence of irregular respiratory motion. Methods: A custom-made programmable externally-and internally-deformable lung motion phantom was placed inside the CT bore. An abdominal pressure belt was placed around the phantom to mimic clinical 4DCT acquisitio and the motion platform was programmed with a sinusoidal (±10mm, 10 cycles per minute) motion trace and 7 motion traces recorded from lung cancer patients. The same setup and motion trajectories were repeated in the linac room and kV fluoroscopic images were acquired using the on-board imager. Positions of 4 internal markers segmented from the 4DCT volumes were overlaid upon the motion trajectories derived from the fluoroscopic time series to calculate the difference between estimated (4DCT) and “actual” (kV fluoro) positions. Results: With a sinusoidal trace, absolute errors of the 4DCT estimated markers positions vary between 0.78mm and 5.4mm and RMS errors are between 0.38mm to 1.7mm. With irregular patient traces, absolute errors of the 4DCT estimated markers positions increased significantly by 100 to 200 percent, while the corresponding RMS error values have much smaller changes. Significant mismatches were frequently found at peak-inhale or peak-exhale phase. Conclusion: As expected, under conditions of well-behaved, periodic sinusoidal motion, the 4DCT yielded much better estimation of marker positions. When an actual patient trace is used 4DCT-derived positions showed significant mismatches with the fluoroscopic trajectories, indicating the potential for geometric and therefore dosimetric errors in the presence of cycle-to-cycle respiratory variations.

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-J-87: Ventilation Weighting Effect On Mean Doses of Both Side Lungs for Patients with Advanced Stage Lung Cancer

Purpose: To study ventilation weighting effect on radiation doses to both side lungs for patients with advanced stage lung cancer. Methods: Fourteen patients with advanced stage lung cancer were included in this retrospective study. Proprietary software was developed to calculate the lung ventilation map based on 4DCT images acquired for radiation therapy. Two phases of inhale (0%) and exhale (50%) were used for the lung ventilation calculations. For each patient, the CT images were resampled to the same dose calculation resolution of 3mmx3mmx3mm. The ventilation distribution was then normalized by the mean value of the ventilation. The ventilation weighted dose was calculated by applying linearly weighted ventilation to the dose of each pixel. The lung contours were automatically delineated from patient CT image with lung window, excluding the tumor and high density tissues. For contralateral and ipsilateral lungs, the mean lung doses from the original plan and ventilation weighted mean lung doses were compared using two tail t-Test. Results: The average of mean dose was 6.1 ±3.8Gy for the contralateral lungs, and 26.2 ± 14.0Gy for the ipsilateral lungs. The average of ventilation weighted dose was 6.3± 3.8Gy for the contralateral lungs and 24.6 ± 13.1Gy for the ipsilateral lungs. The statistics analysis shows the significance of the mean dose increase (p<0.015) for the contralateral lungs and decrease (p<0.005) for the ipsilateral lungs. Conclusion: Ventilation weighted doses were greater than the un-weighted doses for contralateral lungs and smaller for ipsilateral lungs. This Result may be helpful to understand the radiation dosimetric effect on the lung function and provide planning guidance for patients with advance stage lung cancer.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-J-90: Lobar-Level Lung Ventilation Analysis Using 4DCT and Deformable Image Registration

Purpose: To assess regional changes in human lung ventilation and mechanics using four-dimensional computed tomography (4DCT) and deformable image registration. This work extends our prior analysis of the entire lung to a lobe-based analysis. Methods: 4DCT images acquired from 20 patients prior to radiation therapy (RT) were used for this analysis. Jacobian ventilation and motion maps were computed from the displacement field after deformable image registration between the end of expiration breathing phase and the end of inspiration breathing phase. The lobes were manually segmented on the reference phase by a medical physicist expert. The voxel-by-voxel ventilation and motion magnitude for all subjects were grouped by lobes and plotted into cumulative voxel frequency curves respectively. In addition, to eliminate the effect of different breathing efforts across subjects, we applied the inter-subject equivalent lung volume (ELV) method on a subset of the cohort and reevaluated the lobar ventilation. Results: 95% of voxels in the lung are expanding during inspiration. However, some local regions of lung tissue show far more expansion than others. The greatest expansion with respiration occurs within the lower lobes; between exhale and inhale the median expansion in lower lobes is approximately 15%, while the median expansion in upper lobes is 10%. This appears to be driven by a subset of lung tissues within the lobe that have greater expansion; twice the number of voxels in the lower lobes (20%) expand by > 30% when compared to the upper lobes (10%). Conclusion: Lung ventilation and motion show significant difference on the lobar level. There are different lobar fractions of driving voxels that contribute to the major expansion of the lung. This work was supported by NIH grant CA166703.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-J-91: Biomechanical Deformable Image Registration of Longitudinal Lung CT Images

Purpose: Spatial correlation of lung tissue across longitudinal images, as the patient responds to treatment, is a critical step in adaptive radiotherapy. The goal of this work is to expand a biomechanical model-based deformable registration algorithm (Morfeus) to achieve accurate registration in the presence of significant anatomical changes. Methods: Four lung cancer patients previously treated with conventionally fractionated radiotherapy that exhibited notable tumor shrinkage during treatment were retrospectively evaluated. Exhale breathhold CT scans were obtained at treatment planning (PCT) and following three weeks (W3CT) of treatment. For each patient, the PCT was registered to the W3CT using Morfeus, a biomechanical model-based deformable registration algorithm, consisting of boundary conditions on the lungs and incorporating a sliding interface between the lung and chest wall. To model the complex response of the lung, an extension to Morfeus has been developed: (i) The vessel tree was segmented by thresholding a vesselness image based on the Hessian matrix’s eigenvalues and the centerline was extracted; (ii) A 3D shape context method was used to find correspondences between the trees of the two images; (ii) Correspondences were used as additional boundary conditions (Morfeus+vBC). An expert independently identified corresponding landmarks well distributed in the lung to compute Target Registration Errors (TRE). Results: The TRE within 15mm of the tumor boundaries (on average 11 landmarks) is: 6.1±1.8, 4.6±1.1 and 3.8±2.3 mm after rigid registration, Morfeus and Morfeus+vBC, respectively. The TRE in the rest of the lung (on average 13 landmarks) is: 6.4±3.9, 4.7±2.2 and 3.6±1.9 mm, which is on the order of the 2mm isotropic dose grid vector (3.5mm). Conclusion: The addition of boundary conditions on the vessels improved the accuracy in modeling the response of the lung and tumor over the course of radiotherapy. Minimizing and modeling these geometrical uncertainties will enable future plan adaptation strategies. This work was funded in part by NIH 2P01CA059827-16.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-J-107: The Impact of the Tumor Location to Deformable Image Registration

Purpose: For four-dimensional planning and adaptive radiotherapy, the accuracy of deformable image registration (DIR) is essential. We evaluated the accuracy of an in-house program with the free-downloadable DIR software library package (NiftyReg) and two commercially available DIR software programs (MIM Maestro and Velocity AI) in lung SBRT cancer patients. In addition to it, the relationship between the tumor location and the accuracy of the DIRs was investigated. Methods: The free-form deformation was implemented in the in-house program and the MIM. The Velocity was based on the B-spline algorithm. The accuracy of the three programs was evaluated in comparison for the structures on 4DCT image datasets between at the peak-inhale and at the peak-exhale. The dice similarity coefficient (DSC) and normalized DSC (NDSC) were measured for the gross tumor volumes from 19 lung SBRT patients. Results: The DSC measurement showed the median values of the DSC were 0.885, 0.872 and 0.798 for the In-house program, the MIM and the Velocity, respectively. The Velocity showed significant difference compared to the others. The median NDSC values were 1.027, 1.005 and 0.946 for the In-house, the MIM and the Velocity, respectively. This indicated that the spatial overlap agreement between the reference and the deformed structure for the in-house and MIM was comparable with the accuracy within 1mm uncertainty. There was larger discrepancy within 1–2mm uncertainty for the Velocity. The In-house and the MIM showed the higher NDSC values than the median values when the GTV was not attached to the chest wall and diaphragm(p < 0.05). However, there is no relationship between the accuracy and the tumor location in the Velocity. Conclusion: The difference of the DIR program would affect different accuracy and the accuracy may be reduced when the tumor is located or attached to chest wall or diaphragm.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-J-237: Real-Time 3D Anatomy Estimation From Undersampled MR Acquisitions

Recent developments made MRI guided radiotherapy feasible. Performing simultaneous imaging during fractions can provide information about changing anatomy by means of deformable image registration for either immediate plan adaptations or accurate dose accumulation on the changing anatomy. In 3D MRI, however, acquisition time is considerable and scales with resolution. Furthermore, intra-scan motion degrades image quality.In this work, we investigate the sensitivity of registration quality on imageresolution: potentially, by employing spatial undersampling, the acquisition timeof MR images for the purpose of deformable image registration can be reducedsignificantly.On a volunteer, 3D-MR imaging data was sampled in a navigator-gated manner, acquiring one axial volume (360×260×100mm{sup 3}) per 3s during exhale phase. A T1-weighted FFE sequence was used with an acquired voxel size of (2.5mm{sup 3}) for a duration of 17min. Deformation vector fields were evaluated for 100 imaging cycles with respect to the initial anatomy using deformable image registration based on optical flow. Subsequently, the imaging data was downsampled by a factor of 2, simulating a fourfold acquisition speed. Displacements of the downsampled volumes were then calculated by the same process.In kidneyliver boundaries and the region around stomach/duodenum, prominent organ drifts could be observed in both the original and the downsampled imaging data. An increasing displacement of approximately 2mm was observed for the kidney, while an area around the stomach showed sudden displacements of 4mm. Comparison of the motile points over time showed high reproducibility between the displacements of high-resolution and downsampled volumes: over a 17min acquisition, the componentwise RMS error was not more than 0.38mm.Based on the synthetic experiments, 3D nonrigid image registration shows little sensitivity to image resolution and the displacement information is preserved even when halving the resolution. This can be employed to greatly reduce image acquisition times for interventional applications in real-time. 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-294: Dosimetric Analysis of Planning Phase Using Overlap Volume Histogram for Respiratory Gated Radiotherapy

Purpose: End-of-exhale (EOE) phase is generally preferred for gating window because tumor position is more reproducible. However, other gating windows might be more appropriate for dose distribution perspective. In this pilot study, we proposed to utilize overlap volume histogram (OVH) to search optimized gating window and demonstrated its feasibility. Methods: We acquired 4DCT of 10 phases for 3 lung patients (2 with a target at right middle lobe and 1 at right upper lobe). After structures were defined in every phase, the OVH of each OAR was generated to quantify the three dimensional spatial relationship between the PTV and OARs (bronchus, esophagus, heart and cord etc.) at each phase. OVH tells the overlap volume of an OAR according to outward distance from the PTV. Relative overlap volume at 20 mm outward distance from the PTV (ROV-20) was also defined as a metric for measuring overlap volume and obtained. For dose calculation, 3D CRT plans were made for all phases under the same beam angles and objectives (e.g., 95% of the PTV coverage with at least 100% of the prescription dose of 50 Gy). The gating window phase was ranked according to ROV-20, and the relationship between the OVH and dose distribution at each phase was evaluated by comparing the maximum dose, mean dose, and equivalent uniform dose of OAR. Results: OVHs showed noticeable difference from phase to phase, implying it is possible to find optimal phases for gating window. For 2 out of 3 patients (both with a target at RML), maximum dose, mean dose, and EUD increased as ROV-20 increased. Conclusion: It is demonstrated that optimal phases (in dose distribution perspective) for gating window could exist and OVH can be a useful tool for determining such phases without performing dose optimization calculations in all phases. This work was supported by the Radiation Technology R&D program (No. 2013M2A2A7043498) and the Mid-career Researcher Program (2012-007883) through the National Research Foundation (NRF) funded by the Ministry of Science, ICT & Future Planning (MSIP) of Korea.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-430: Feasibility Study On Using Overlap Volume Histogram to Predict the Dose Difference by Respiratory Motion

Purpose: The dose difference between three-dimensional dose (3D dose) and 4D dose which considers motion due to respiratory can be varied according to geometrical relationship between planning target volume (PTV) and organ at risk (OAR). The purpose of the study is to investigate the dose difference between 3D and 4D dose using overlap volume histogram (OVH) which is an indicator that quantify geometrical relationship between a PTV and an OAR. Methods: Five liver cancer patients who previously treated stereotactic body radiotherapy (SBRT) were investigated. Four-dimensional computed tomography (4DCT) images were acquired for all patients. ITV-based treatment planning was performed. 3D dose was calculated on the end-exhale phase image as a reference phase image. 4D dose accumulation was implemented from all phase images using dose warping technique used deformable image registration (DIR) algorithm (Horn and Schunck optical flow) in DIRART. In this study OVH was used to quantify geometrical relationship between a PTV and an OAR. OVH between a PTV and a selected OAR was generated for each patient case and compared for all cases. The dose difference between 3D and 4D dose for normal organ was calculated and compared for all cases according to OVH. Results: The 3D and 4D dose difference for OAR was analyzed using dose-volume histogram (DVH). On the basis of a specific point which corresponds to 10% of OAR volume overlapped with expanded PTV, mean dose difference was 34.56% in minimum OVH distance case and 13.36% in maximum OVH distance case. As the OVH distance increased, mean dose difference between 4D and 3D dose was decreased. Conclusion: The tendency of dose difference variation was verified according to OVH. OVH is seems to be indicator that has a potential to predict the dose difference between 4D and 3D dose. This work was supported by the Radiation Technology R&D program (No. 2013M2A2A7043498) and the Mid-career Researcher Program (2014R1A2A1A10050270) through the National Research Foundation of Korea funded by the Ministry of Science, ICT&Future Planning.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-464: Implementation and Validation of 4D Acuros XB Dose Calculations

Purpose: In this abstract we implement and validate a 4D VMAT Acuros XB dose calculation using Gafchromic film. Special attention is paid to the physical material assignment in the CT dataset and to reported dose to water and dose to medium. Methods: A QUASAR phantom with a 3 cm sinusoidal tumor motion and 5 second period was scanned using 4D computed tomography. A CT was also obtained of the static QUASAR phantom with the tumor at the central position. A VMAT plan was created on the average CT dataset and was delivered on a Varian TrueBeam linear accelerator. The trajectory log file from this treatment was acquired and used to create 10 VMAT subplans (one for each portion of the breathing cycle). Motion for each subplan was simulated by moving the beam isocentre in the superior/inferior direction in the Treatment Planning System on the static CT scan. The 10 plans were calculated (both dose to medium and dose to water) and summed for 1) the original HU values from the static CT scan and 2) the correct physical material assignment in the CT dataset. To acquire a breathing phase synchronized film measurements the trajectory log was used to create a VMAT delivery plan which includes dynamic couch motion using the Developer Mode. Three different treatment start phases were investigated (mid inhalation, full inhalation and full exhalation). Results: For each scenario the coronal dose distributions were measured using Gafchromic film and compared to the corresponding calculation with Film QA Pro Software using a Gamma test with a 3%/3mm distance to agreement criteria. Good agreement was found between calculation and measurement. No statistically significant difference in agreement was found between calculations to original HU values vs calculations to over-written (material-assigned) HU values. Conclusion: The investigated 4D dose calculation method agrees well with measurement.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-527: Is CTV-Based Robust Optimized IMPT in Non-Small-Cell Lung Cancer Robust Against Respiratory Motion?

Purpose: To determine which proton planning technique on average-CT is more vulnerable to respiratory motion induced density changes and interplay effect among (a) IMPT of CTV-based minimax robust optimization with 5mm set-up error considered, (b, c) IMPT/SFUD of 5mm-expanded PTV optimization. Methods: Three planning techniques were optimized in Raystation with a prescription of 60/25 (Gy/fractions) and almost the same OAR constraints/objectives for each of 10 NSCLC patients. 4D dose without/with interplay effect was recalculated on eight 4D-CT phases and accumulated after deforming the dose of each phase to a reference (exhalation phase). The change of D98% of each CTV caused by density changes and interplay was determined. In addition, evaluation of the DVH information vector (D99%, D98%, D95%, Dave, D50%, D2%, D1%) which compares the whole DVH by η score = (cosine similarity × Pearson correlation coefficient − 0.9) × 1000 quantified the degree of DVH change: score below 100 indicates changed DVH. Results: Three 3D plans of each technique satisfied our clinical goals. D98% shift mean±SD (Gy) due to density changes was largest in (c): −0.78±1.1 while (a): −0.11±0.65 and (b): − 0.59±0.93. Also the shift due to interplay effect most was (c): −.54±0.70 whereas (a): −0.25±0.93 and (b): −0.12±0.13. Moreover lowest η score caused by density change was also (c): 69, while (a) and (b) kept around 90. η score also indicated less effect of interplay than density changes. Note that generally the changed DVH were still acceptable clinically. Paired T-tests showed a significantly smaller density change effect in (a) (p<0.05) than in (b) or (c) and no significant difference in interplay effect. Conclusion: CTV-based robust optimized IMPT was more robust against respiratory motion induced density changes than PTV-based IMPT and SFUD. The interplay effect was smaller than the effect of density changes and similar among the three techniques. The JSPS Core-to-Core Program (No. 23003), Japan Society for the Promotion of Science Grant-in-Aid for Scientific Research (No. 23390300), Grant-in-Aid for Young Scientists (B) (No. 21791194) and Grant-in-Aid for Cancer Research (H22-3rd Term Cancer Control-General-043)

60 APPLIED LIFE SCIENCES↗