Results for “computerized procedures” — Page 9

DOE OSTI2014

{sup 32}P Brachytherapy Conformal Source Model RIC-100 for High-Dose-Rate Treatment of Superficial Disease: Monte Carlo Calculations, Diode Measurements, and Clinical Implementation

Purpose: A novel {sup 32}P brachytherapy source has been in use at our institution intraoperatively for temporary radiation therapy of the spinal dura and other localized tumors. We describe the dosimetry and clinical implementation of the source. Methods and Materials: Dosimetric evaluation for the source was done with a complete set of MCNP5 Monte Carlo calculations preceding clinical implementation. In addition, the depth dose curve and dose rate were measured by use of an electron field diode to verify the Monte Carlo calculations. Calibration procedures using the diode in a custom-designed phantom to provide an absolute dose calibration and to check dose uniformity across the source area for each source before treatment were established. Results: Good agreement was established between the Monte Carlo calculations and diode measurements. Quality assurance measurements results are provided for about 100 sources used to date. Clinical source calibrations were usually within 10% of manufacturer specifications. Procedures for safe handling of the source are described. Discussion: Clinical considerations for using the source are discussed.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

DOE OSTI2013

Evaluation of clinical IMRT treatment planning using the GATE Monte Carlo simulation platform for absolute and relative dose calculations

Purpose: The objective of this study was to evaluate and validate the use of the Geant4 application for emission tomography (GATE) Monte Carlo simulation platform for clinical intensity modulated radiotherapy (IMRT) dosimetry studies. Methods: The first step consisted of modeling a 6 MV photon beam linear accelerator (LINAC), with its corresponding validation carried out using percent depth dose evaluation, transverse profiles, tissue phantom ratio, and output factor on water phantom. The IMRT evaluation was performed by comparing simulation and measurements in terms of absolute and relative doses using IMRT dedicated quality assurance phantoms considering seven different patient datasets. Results: Concerning the LINAC simulated model validation tissue phantom ratios at 20 and 10 cm in water TPR{sub 10}{sup 20} obtained from GATE and measurements were 0.672 {+-} 0.063 and 0.675, respectively. In terms of percent depth dose and transverse profiles, error ranges were, respectively: 1.472%{+-} 0.285% and 4.827%{+-} 1.323% for field size of 4 Multiplication-Sign 4, 5 Multiplication-Sign 5, 10 Multiplication-Sign 10, 15 Multiplication-Sign 15, 20 Multiplication-Sign 20, 25 Multiplication-Sign 25, 30 Multiplication-Sign 30, and 40 Multiplication-Sign 40 cm{sup 2}. Most errors were observed at the edge of radiation fields because of higher dose gradient in these areas. Output factors showed good agreement between simulation and measurements with a maximum error of 1.22%. Finally, for IMRT simulations considering seven patient datasets, GATE provided good results with a relative error of 0.43%{+-} 0.25% on absolute dose between simulated and measured beams (measurements at the isocenter, volume 0.125 cm{sup 3}). Planar dose comparisons were also performed using gamma-index analysis. For the whole set of beams considered the mean gamma-index value was 0.497 {+-} 0.152 and 90.8%{+-} 3.6% of the evaluated dose points satisfied the 5%/ 4 mm criterion. Conclusions: These results show that GATE allows reliable simulation of complex beams in radiotherapy after an accurate LINAC modeling is validated. A simple cross-calibration procedure proposed in this work allows obtaining absolute dose values even in complex fields.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2014

Quasi real time in vivo dosimetry for VMAT

Purpose: Results about the feasibility of a method for quasi real timein vivo dosimetry (IVD) at the isocenter point for volumetric modulated arc therapy (VMAT) are here reported. The method is based on correlations between the EPID signal and the dose on the beam central axis. Moreover, the γ-analysis of EPID images was adopted to verify off-axis reproducibility of fractionated plan delivery. Methods: An algorithm to reconstructin vivo the isocenter dose, D{sub iso}, for RapidArc treatments has been developed. 20 VMAT plans, optimized with two opposite arcs, for prostate, pancreas, and head treatments have been delivered by a Varian linac both to a conic PMMA phantom with elliptical section and to patients. The ratios R between reconstructed D{sub iso} and the planned doses were determined for phantom and patient irradiations adopting an acceptance criterion of ±5%. In total, 40 phantom checks and 400 patient checks were analyzed. Moreover, 3% and 3 mm criteria were adopted for portal image γ-analysis to assess patient irradiation reproducibility. Results: The average ratio R, between reconstructed and planned doses for the PMMA phantom irradiations was equal to 1.007 ± 0.024. When the IVD method was applied to the 20 patients, the average R ratio was equal to 1.003 ± 0.017 and 96% of the tests were within the acceptance criteria. The portal image γ-analysis supplied 88% of the tests within the pass rates γ{sub mean} ≤ 0.4 and P{sub γ<1} ≥ 98%. All the warnings were understood comparing the CT and the cone beam CT images and in one case a patient's setup error was detected and corrected for the successive fractions. Conclusions: This preliminary experience suggests that the method is able to detect dosimetric errors in quasi real time at the end of the therapy session. The authors intend to extend this procedure to other pathologies with the integration of in-room imaging verification by cone beam CT.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

DOE OSTI2016

TH-C-BRC-00: Emerging Technologies in SRS/SBRT Delivery

The delivery techniques for SRS/SBRT have been under rapid developments in recent years, which pose new challenges to medical physicists ranging from planning and quality assurance to imaging and motion management. This educational course will provide a general overview of the latest delivery techniques in SRS/SBRT, and discuss the clinical processes to address the challenges of each technique with special emphasis on dedicated gamma-ray based device, robotic x-band linac-based system and conventional C-arm s-band linac-based SRS systems. (1). Gamma-ray based SRS/SRT: This is the gold standard of intracranial SRS. With the advent of precision imaging guidance and frameless patient positioning capabilities, novel stereoscopic CBCT and automatic dose adaption solution are introduced to the Gamma-ray based SRS for the first time. The first North American system has been approved by the US regulatory for patient treatments in the spring of 2016. (2). Robotic SRS/SBRT system: A number of technological milestones have been developed in the past few years, including variable aperture collimator, sequential optimization technique, and the time reduction technique. Recently, a new robotic model allows the option of a multi-leaf collimator. These technological advances have reduced the treatment time and improved dose conformity significantly and could potentially expand the application of radiosurgery for the treatment of targets not previously suitable for robotic SRS/SBRT or fractionated stereotactic radiotherapy. These technological advances have created new demanding mandates on hardware and patient quality assurance (QA) tasks, as well as the need for updating/educating the physicists in the community on these requirements. (3). Conventional Linac based treatments: Modulated arc therapy (MAT) has gained wide popularities in Linac-based treatments in recent years due to its high delivery efficiency and excellent dose conformities. Recently, MAT has been introduced to deliver highly conformal radiosurgery treatments to multiple targets simultaneously via a single isocenter to replace the conventional multi-iso multi-plan treatments. It becomes important to understand the advantages and limitations of this technique, and the pitfalls for implementing this technique in clinical practice. The planning process of single-iso multi-target MAT will be described, and its plan quality and delivery efficiency will be compared with multi-iso plans. The QA process for verifying such complex plans will be illustrated, and pitfalls in imaging and patient set up will be discussed. Overall, this session will focus on the following areas: 1) Update on the emerging technology in current SRS/SBRT delivery. 2) New developments in treatment planning and Quality Assurance program. 3) Imaging guidance and motion management. Learning Objectives: To understand the SRS/SBRT principles and its clinical applications, and gain knowledge on the emerging technologies in SRS/SBRT. To review planning concepts and useful tips in treatment planning. To learn about the imaging guidance procedures and the quality assurance program in SRS/SBRT. National Institutes of Health, Varian Medical System; L. Ren, The presenter is funded by National Institutes of Health and Varian Medical System.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2021

Nuclear Power Fault Diagnostics and Preventative Maintenance Optimization

The nuclear industry is beginning to see reactors shut down—even after their operating licenses have been extended—because they are not economically competitive with other energy sources. These early closures happen primarily due to economic reasons, despite excellent safety records. Therefore, it is imperative to reduce costs in order to prevent these early closures. One of the contributors to these economic reasons is the large operations and maintenance costs. This paper showcases recent research on advanced fault diagnostics techniques and preventative maintenance optimization (PMO) for reducing NPP maintenance costs. Specifically, it focuses on the feedwater and condensate system (FWCS) for both pressurized- and boiling-water reactor (BWR) systems. The computerized maintenance management system (CMMS), which contains the plant’s digital record of all corrective maintenance (CM) and preventative maintenance (PM) work orders, provided the ground truth for locating potential faults and labeling the process data as either healthy or faulted. Various feature extraction techniques were used to further differentiate the faulted data from the healthy data. Through a cross-validation procedure, support vectors machines were used to label other test sets of process data as either healthy or faulted. With relatively few faults identified in the BWR system, the potential for PMO opens up, since an unnecessary amount of PM leads to inflated maintenance costs. The steps for PMO are summarized, from component health determinations to recommendations for action. An example of PMO assessment is presented for condensate pumps, condensate booster pumps, and the respective motors that drive them.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗

DOE OSTI2021

Nuclear Power Fault Diagnostics and Preventative Maintenance Optimization NPIC presentation

The nuclear industry is beginning to see reactors shut down—even after their operating licenses have been extended—because they are not economically competitive with other energy sources. These early closures happen primarily due to economic reasons, despite excellent safety records. Therefore, it is imperative to reduce costs in order to prevent these early closures. One of the contributors to these economic reasons is the large operations and maintenance costs. This paper showcases recent research on advanced fault diagnostics techniques and preventative maintenance optimization (PMO) for reducing NPP maintenance costs. Specifically, it focuses on the feedwater and condensate system (FWCS) for both pressurized- and boiling-water reactor (BWR) systems. The computerized maintenance management system (CMMS), which contains the plant’s digital record of all corrective maintenance (CM) and preventative maintenance (PM) work orders, provided the ground truth for locating potential faults and labeling the process data as either healthy or faulted. Various feature extraction techniques were used to further differentiate the faulted data from the healthy data. Through a cross-validation procedure, support vectors machines were used to label other test sets of process data as either healthy or faulted. With relatively few faults identified in the BWR system, the potential for PMO opens up, since an unnecessary amount of PM leads to inflated maintenance costs. The steps for PMO are summarized, from component health determinations to recommendations for action. An example of PMO assessment is presented for condensate pumps, condensate booster pumps, and the respective motors that drive them.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗

DOE OSTI2012

SHORT-DURATION LENSING EVENTS. II. EXPECTATIONS AND PROTOCOLS

Ongoing microlensing observations by OGLE and MOA regularly identify lensing events with Einstein diameter crossing time, {tau}{sub E}, of 16 or fewer days. Events with estimated values of {tau}{sub E} of one to two days have been detected. Short-duration events tend to be generated by low-mass lenses or by lenses with high transverse velocities. We compute the expected rates, demonstrate the expected ranges of parameters for lenses of different mass, and develop a protocol for observing and modeling short-duration events. Relatively minor additions to the procedures presently used will increase the rate of planet discovery, and also discover or place limits on the population of high-speed dim stars and stellar remnants in the vicinity of the Sun.

79 ASTRONOMY AND ASTROPHYSICS↗

DOE OSTI2013

Design optimization of MR-compatible rotating anode x-ray tubes for stable operation

Purpose: Hybrid x-ray/MR systems can enhance the diagnosis and treatment of endovascular, cardiac, and neurologic disorders by using the complementary advantages of both modalities for image guidance during interventional procedures. Conventional rotating anode x-ray tubes fail near an MR imaging system, since MR fringe fields create eddy currents in the metal rotor which cause a reduction in the rotation speed of the x-ray tube motor. A new x-ray tube motor prototype has been designed and built to be operated close to a magnet. To ensure the stability and safety of the motor operation, dynamic characteristics must be analyzed to identify possible modes of mechanical failure. In this study a 3D finite element method (FEM) model was developed in order to explore possible modifications, and to optimize the motor design. The FEM provides a valuable tool that permits testing and evaluation using numerical simulation instead of building multiple prototypes.Methods: Two experimental approaches were used to measure resonance characteristics: the first obtained the angular speed curves of the x-ray tube motor employing an angle encoder; the second measured the power spectrum using a spectrum analyzer, in which the large amplitude of peaks indicates large vibrations. An estimate of the bearing stiffness is required to generate an accurate FEM model of motor operation. This stiffness depends on both the bearing geometry and adjacent structures (e.g., the number of balls, clearances, preload, etc.) in an assembly, and is therefore unknown. This parameter was set by matching the FEM results to measurements carried out with the anode attached to the motor, and verified by comparing FEM predictions and measurements with the anode removed. The validated FEM model was then used to sweep through design parameters [bearing stiffness (1×10{sup 5}–5×10{sup 7} N/m), shaft diameter (0.372–0.625 in.), rotor diameter (2.4–2.9 in.), and total length of motor (5.66–7.36 in.)] to increase the fundamental frequency past the operating range at 50 Hz.Results: The first large vibration during the prototype motor operation was obtained at 21.64±0.68 Hz in the power spectrum. An abrupt decrease in acceleration occurred at 21.5 Hz due to struggling against the resonance vibrations. A bearing stiffness of 1.2×10{sup 5} N/m in the FEM simulation was used to obtain a critical speed of 21.4 Hz providing 1.1% error. This bearing stiffness value and the 3D model were then confirmed by the experiments with the anode removed, demonstrating an agreement within 6.4% between simulation results and measurements. A calculated first critical frequency (fundamental frequency) of 68.5 Hz was obtained by increasing the bearing stiffness to 1×10{sup 7} N/m and increasing the shaft diameter by 68.0%. Reducing the number of bearings in the design permits decreasing the total length of the motor by 1.7 in., and results in a fundamental frequency of 68.3 Hz in concert with additional changes (shaft diameter of 0.625 in., rotor diameter of 2.4 in., and bearing stiffness of 1×10{sup 6} N/m).Conclusions: An FEM model of the x-ray tube motor has been implemented and experimentally validated. A fundamental frequency above the operational rotation speed can be achieved through modification of multiple design parameters, which allows the motor to operate stably and safely in the MR environment during the repeated acceleration/deceleration cycles required for an interventional procedure. The validated 3D FEM model can now be used to investigate trade-offs between generated torque, maximum speed, and motor inertia to further optimize motor design.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

DOE OSTI2014

SU-E-I-67: X-Ray Fluorescence for Energy Response Calibration of a Photon Counting Detector: A Simulation Study

Purpose: To investigate the feasibility of energy calibration and energy response characterization of a photon counting detector using x-ray fluorescence. Methods: A comprehensive Monte Carlo simulation study was done to investigate the influence of various geometric components on the x-ray fluorescence measurement. Different materials, sizes, and detection angles were simulated using Geant4 Application for Tomographic Emission (GATE) Monte Carlo package. Simulations were conducted using 100 kVp tungsten-anode spectra with 2 mm Al filter for a single pixel cadmium telluride (CdTe) detector with 3 × 3 mm2 in detection area. The fluorescence material was placed 300 mm away from both the x-ray source and the detector. For angular dependence measurement, the distance was decreased to 30 mm to reduce the simulation time. Compound materials, containing silver, barium, gadolinium, hafnium, and gold in cylindrical shape, were simulated. The object size varied from 5 to 100 mm in diameter. The angular dependence of fluorescence and scatter were simulated from 20° to 170° with an incremental step of 10° to optimize the fluorescence to scatter ratio. Furthermore, the angular dependence was also experimentally measured using a spectrometer (X-123CdTe, Amptek Inc., MA) to validate the simulation results. Results: The detection angle between 120° to 160° resulted in more optimal x-ray fluorescence to scatter ratio. At a detection angle of 120°, the object size did not have a significant effect on the fluorescence to scatter ratio. The experimental results of fluorescence angular dependence are in good agreement with the simulation results. The Kα and Kβ peaks of five materials could be identified. Conclusion: The simulation results show that the x-ray fluorescence procedure has the potential to be used for detector energy calibration and detector response characteristics by using the optimal system geometry.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗

DOE OSTI2015

SU-E-E-05: Improving Contouring Precision and Consistency for Physicians-In-Training with Simple Lab Experiments

Purpose: Target contouring for high-dose treatments such as radiosurgery of brain metastases is highly critical in eliminating marginal failure and reducing complications as shown by recent clinical studies. In order to improve contouring accuracy and practice consistency for the procedure, we introduced a self-assessed physics lab practice for the physicians-in-training. Methods: A set of commercially acquired high-precision PMMA plastic spheres were randomly embedded in a Styrofoam block and then scanned with the CT/MR via the clinical procedural imaging protocol. A group of first-year physicians-in-training (n=6) from either neurosurgery or radiation oncology department were asked to contour the scanned objects (diameter ranged from 0.4 cm to 3.8 cm). These user-defined contours were then compared with the ideal contour sets of object shape for self assessments to determine the maximum areas of the observed discrepancies and method of improvements. Results: The largest discrepancies from initial practice were consistently found to be located near the extreme longitudinal portions of the target for all the residents. Discrepancy was especially prominent when contouring small objects < 1.0 cm in diameters. For example, the mean volumes rendered from the initial contour data set differed from the ideal data set by 7.7%±6.6% for the participants (p> 0.23 suggesting agreement cannot be established). However, when incorporating a secondary imaging scan such as reconstructed coronal or sagittal images in a repeat practice, the agreement was dramatically improved yielding p<0.02 in agreement with the reference data set for all the participants. Conclusion: A simple physics lab revealed a common pitfall in contouring small metastatic brain tumors for radiosurgical procedures and provided a systematic tool for physicians-in-training in improving their clinical contouring skills. Dr Ma is current a board member of international stereotactic radiosurgical society.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

Evaluation of an active magnetic resonance tracking system for interstitial brachytherapy

Purpose: In gynecologic cancers, magnetic resonance (MR) imaging is the modality of choice for visualizing tumors and their surroundings because of superior soft-tissue contrast. Real-time MR guidance of catheter placement in interstitial brachytherapy facilitates target coverage, and would be further improved by providing intraprocedural estimates of dosimetric coverage. A major obstacle to intraprocedural dosimetry is the time needed for catheter trajectory reconstruction. Herein the authors evaluate an active MR tracking (MRTR) system which provides rapid catheter tip localization and trajectory reconstruction. The authors assess the reliability and spatial accuracy of the MRTR system in comparison to standard catheter digitization using magnetic resonance imaging (MRI) and CT. Methods: The MRTR system includes a stylet with microcoils mounted on its shaft, which can be inserted into brachytherapy catheters and tracked by a dedicated MRTR sequence. Catheter tip localization errors of the MRTR system and their dependence on catheter locations and orientation inside the MR scanner were quantified with a water phantom. The distances between the tracked tip positions of the MRTR stylet and the predefined ground-truth tip positions were calculated for measurements performed at seven locations and with nine orientations. To evaluate catheter trajectory reconstruction, fifteen brachytherapy catheters were placed into a gel phantom with an embedded catheter fixation framework, with parallel or crossed paths. The MRTR stylet was then inserted sequentially into each catheter. During the removal of the MRTR stylet from within each catheter, a MRTR measurement was performed at 40 Hz to acquire the instantaneous stylet tip position, resulting in a series of three-dimensional (3D) positions along the catheter’s trajectory. A 3D polynomial curve was fit to the tracked positions for each catheter, and equally spaced dwell points were then generated along the curve. High-resolution 3D MRI of the phantom was performed followed by catheter digitization based on the catheter’s imaging artifacts. The catheter trajectory error was characterized in terms of the mean distance between corresponding dwell points in MRTR-generated catheter trajectory and MRI-based catheter digitization. The MRTR-based catheter trajectory reconstruction process was also performed on three gynecologic cancer patients, and then compared with catheter digitization based on MRI and CT. Results: The catheter tip localization error increased as the MRTR stylet moved further off-center and as the stylet’s orientation deviated from the main magnetic field direction. Fifteen catheters’ trajectories were reconstructed by MRTR. Compared with MRI-based digitization, the mean 3D error of MRTR-generated trajectories was 1.5 ± 0.5 mm with an in-plane error of 0.7 ± 0.2 mm and a tip error of 1.7 ± 0.5 mm. MRTR resolved ambiguity in catheter assignment due to crossed catheter paths, which is a common problem in image-based catheter digitization. In the patient studies, the MRTR-generated catheter trajectory was consistent with digitization based on both MRI and CT. Conclusions: The MRTR system provides accurate catheter tip localization and trajectory reconstruction in the MR environment. Relative to the image-based methods, it improves the speed, safety, and reliability of the catheter trajectory reconstruction in interstitial brachytherapy. MRTR may enable in-procedural dosimetric evaluation of implant target coverage.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

Impact of 3D Rotational Angiography on Liver Embolization Procedures: Review of Technique and Applications

In the last years, the interest into interventional applications of C-arm cone-beam CT (CBCT) progressively raised, widening its clinical application from the original field of interventional neuroradiology to the field of peripheral procedures. Liver embolization procedures, due to their complexity and potential treatment-related life-threatening complications, represent one of the main clinical applications of this novel angiographic technique. CBCT has been demonstrated to render procedures safer and technically easier, and to predict outcome as well as to avoid major complications in different treatment scenarios (trans-arterial embolization, trans-arterial chemoembolization, selective internal radiation therapy, percutaneous portal vein embolization). This review summarizes all technical, dosimetric and procedural aspects of CBCT techniques, underlying all its potential clinical advantages in the field of liver embolization procedures. Moreover, the paper provides all the instructions to obtain the best diagnostic performance out of this novel angiographic technique.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

DOE OSTI2019

Usefulness of Direct Computed Tomography Venography in Predicting Inflow for Venous Reconstruction in Chronic Post-thrombotic Syndrome

Purpose: The purpose of this paper is to assess the applicability of direct computed tomography venography (DCTV) in assessing dominant inflow vein in the femoral confluence in extensive chronic iliofemoral venous obstruction, using venography as the gold standard. Methods: All DCTVs performed in symptomatic patients with previous iliofemoral deep vein thrombosis subsequently submitted to venography in the period from January 2014 to August 2018 were retrospectively reviewed. Two groups were defined depending on whether the femoral vein (FV) or the deep femoral vein (DFV) was the dominant inflow on venography in order to identify predictors of DFV as dominant inflow in DCTV. Statistical analysis was performed with SPSS V25. Results: A total of 30 DCTVs and subsequent venographies were reviewed. Venography identified the FV as the dominant inflow in 18 (60%) and the DFV in 12 (40%) patients. Predictors for DFV as dominant inflow were identified as follows: larger DFV diameter 50 mm and 250 mm below lesser trochanter (8.73 ± 4.34 mm vs. 11.9 ± 3.52 mm; p = 0.043 and 5.4 ± 3.90 mm vs. 8.90 ± 2.70 mm; p = 0.011); lower FV/DFV ratio 150 mm below lesser trochanter (11.39 ± 20.01 mm vs. 1.05 ± 0.47 mm; p = 0.043); and presence of FV scarring/synechiae, collaterals and abnormal wall thickness (p = 0.003, p = 0.003 and p < 0.0001). Conclusion: In cases of extensive chronic iliofemoral venous obstruction, especially when stent deployment into the DFV is entertained, the key to success is thorough pre-procedure planning focusing on choosing the access site. This study suggests DCTV is valuable in defining the dominant iliac vein inflow, but additional findings are necessary to validate these preliminary data.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

DOE OSTI2019

Efficacy of the Vertebral Body Stenting System for the Restoration of Vertebral Height in Acute Traumatic Compression Fractures in a Non-osteoporotic Population

Introduction: To evaluate the effectiveness of percutaneous image-guided vertebral body stenting (VBS) at restoring vertebral height in acute, stable, traumatic thoracolumbar fractures in a young, non-osteoporotic population. Materials and Methods: A single-centre retrospective review of all traumatic non-osteoporotic fractures treated with VBS between 2010 and 2017 was performed. Inclusion criteria included patients with recent (< 10 days), symptomatic and stable thoracolumbar compression fractures. Patients with low-energy fractures, osteoporosis and age > 60/50 years (male/female) were excluded. Primary outcomes included: correction of vertebral height, correction of kyphosis angle and Beck Index on reconstructed pre- and post-procedural CBCT images. Secondary outcomes included intra-procedural stent recoil, complications, cement leakage and factors predicting height restoration. Results: Thirty-nine patients (26 men, 13 women; mean age 33.6 years, range 15–57 years) underwent VBS 5 days post-trauma on average (range 1–10), for stable compression fractures located between T5 and L5. Mean vertebral height gain, vertebral kyphosis angle correction and Beck index improvement were 3.8 mm (95% CI 3.36–4.50; P(> 3 mm) = 99.9%), 4.3° (95% CI 3.50–5.20; P(> 3°) = 99.9%) and 0.07 [95% CI 0.053–0.11], respectively (all statistically significant). Technical success was 92%, with 3 “major” stent recoils resulting in loss of vertebral height correction. No symptomatic complications were observed. No predictive factors for procedural success were identified. Conclusion: VBS can significantly restore vertebral height in young patients with traumatic vertebral compression fractures.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

DOE OSTI2013

MODELING GALACTIC EXTINCTION WITH DUST AND 'REAL' POLYCYCLIC AROMATIC HYDROCARBONS

We investigate the remarkable apparent variety of galactic extinction curves by modeling extinction profiles with core-mantle grains and a collection of single polycyclic aromatic hydrocarbons. Our aim is to translate a synthetic description of dust into physically well-grounded building blocks through the analysis of a statistically relevant sample of different extinction curves. All different flavors of observed extinction curves, ranging from the average galactic extinction curve to virtually 'bumpless' profiles, can be described by the present model. We prove that a mixture of a relatively small number (54 species in 4 charge states each) of polycyclic aromatic hydrocarbons can reproduce the features of the extinction curve in the ultraviolet, dismissing an old objection to the contribution of polycyclic aromatic hydrocarbons to the interstellar extinction curve. Despite the large number of free parameters (at most the 54 Multiplication-Sign 4 column densities of each species in each ionization state included in the molecular ensemble plus the 9 parameters defining the physical properties of classical particles), we can strongly constrain some physically relevant properties such as the total number of C atoms in all species and the mean charge of the mixture. Such properties are found to be largely independent of the adopted dust model whose variation provides effects that are orthogonal to those brought about by the molecular component. Finally, the fitting procedure, together with some physical sense, suggests (but does not require) the presence of an additional component of chemically different very small carbonaceous grains.

79 ASTRONOMY AND ASTROPHYSICS↗

DOE OSTI2016

TH-C-BRC-01: An Overview of Emerging Technologies in SRS/SBRT Delivery

The delivery techniques for SRS/SBRT have been under rapid developments in recent years, which pose new challenges to medical physicists ranging from planning and quality assurance to imaging and motion management. This educational course will provide a general overview of the latest delivery techniques in SRS/SBRT, and discuss the clinical processes to address the challenges of each technique with special emphasis on dedicated gamma-ray based device, robotic x-band linac-based system and conventional C-arm s-band linac-based SRS systems. (1). Gamma-ray based SRS/SRT: This is the gold standard of intracranial SRS. With the advent of precision imaging guidance and frameless patient positioning capabilities, novel stereoscopic CBCT and automatic dose adaption solution are introduced to the Gamma-ray based SRS for the first time. The first North American system has been approved by the US regulatory for patient treatments in the spring of 2016. (2). Robotic SRS/SBRT system: A number of technological milestones have been developed in the past few years, including variable aperture collimator, sequential optimization technique, and the time reduction technique. Recently, a new robotic model allows the option of a multi-leaf collimator. These technological advances have reduced the treatment time and improved dose conformity significantly and could potentially expand the application of radiosurgery for the treatment of targets not previously suitable for robotic SRS/SBRT or fractionated stereotactic radiotherapy. These technological advances have created new demanding mandates on hardware and patient quality assurance (QA) tasks, as well as the need for updating/educating the physicists in the community on these requirements. (3). Conventional Linac based treatments: Modulated arc therapy (MAT) has gained wide popularities in Linac-based treatments in recent years due to its high delivery efficiency and excellent dose conformities. Recently, MAT has been introduced to deliver highly conformal radiosurgery treatments to multiple targets simultaneously via a single isocenter to replace the conventional multi-iso multi-plan treatments. It becomes important to understand the advantages and limitations of this technique, and the pitfalls for implementing this technique in clinical practice. The planning process of single-iso multi-target MAT will be described, and its plan quality and delivery efficiency will be compared with multi-iso plans. The QA process for verifying such complex plans will be illustrated, and pitfalls in imaging and patient set up will be discussed. Overall, this session will focus on the following areas: 1) Update on the emerging technology in current SRS/SBRT delivery. 2) New developments in treatment planning and Quality Assurance program. 3) Imaging guidance and motion management. Learning Objectives: To understand the SRS/SBRT principles and its clinical applications, and gain knowledge on the emerging technologies in SRS/SBRT. To review planning concepts and useful tips in treatment planning. To learn about the imaging guidance procedures and the quality assurance program in SRS/SBRT. National Institutes of Health, Varian Medical System; L. Ren, The presenter is funded by National Institutes of Health and Varian Medical System.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

TH-C-BRC-02: A Review of Emerging Technologies in Robotic SRS/SBRT Delivery

The delivery techniques for SRS/SBRT have been under rapid developments in recent years, which pose new challenges to medical physicists ranging from planning and quality assurance to imaging and motion management. This educational course will provide a general overview of the latest delivery techniques in SRS/SBRT, and discuss the clinical processes to address the challenges of each technique with special emphasis on dedicated gamma-ray based device, robotic x-band linac-based system and conventional C-arm s-band linac-based SRS systems. (1). Gamma-ray based SRS/SRT: This is the gold standard of intracranial SRS. With the advent of precision imaging guidance and frameless patient positioning capabilities, novel stereoscopic CBCT and automatic dose adaption solution are introduced to the Gamma-ray based SRS for the first time. The first North American system has been approved by the US regulatory for patient treatments in the spring of 2016. (2). Robotic SRS/SBRT system: A number of technological milestones have been developed in the past few years, including variable aperture collimator, sequential optimization technique, and the time reduction technique. Recently, a new robotic model allows the option of a multi-leaf collimator. These technological advances have reduced the treatment time and improved dose conformity significantly and could potentially expand the application of radiosurgery for the treatment of targets not previously suitable for robotic SRS/SBRT or fractionated stereotactic radiotherapy. These technological advances have created new demanding mandates on hardware and patient quality assurance (QA) tasks, as well as the need for updating/educating the physicists in the community on these requirements. (3). Conventional Linac based treatments: Modulated arc therapy (MAT) has gained wide popularities in Linac-based treatments in recent years due to its high delivery efficiency and excellent dose conformities. Recently, MAT has been introduced to deliver highly conformal radiosurgery treatments to multiple targets simultaneously via a single isocenter to replace the conventional multi-iso multi-plan treatments. It becomes important to understand the advantages and limitations of this technique, and the pitfalls for implementing this technique in clinical practice. The planning process of single-iso multi-target MAT will be described, and its plan quality and delivery efficiency will be compared with multi-iso plans. The QA process for verifying such complex plans will be illustrated, and pitfalls in imaging and patient set up will be discussed. Overall, this session will focus on the following areas: 1) Update on the emerging technology in current SRS/SBRT delivery. 2) New developments in treatment planning and Quality Assurance program. 3) Imaging guidance and motion management. Learning Objectives: To understand the SRS/SBRT principles and its clinical applications, and gain knowledge on the emerging technologies in SRS/SBRT. To review planning concepts and useful tips in treatment planning. To learn about the imaging guidance procedures and the quality assurance program in SRS/SBRT. National Institutes of Health, Varian Medical System; L. Ren, The presenter is funded by National Institutes of Health and Varian Medical System.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

TH-C-BRC-03: Emerging Linac Based SRS/SBRT Technologies with Modulated Arc Delivery

The delivery techniques for SRS/SBRT have been under rapid developments in recent years, which pose new challenges to medical physicists ranging from planning and quality assurance to imaging and motion management. This educational course will provide a general overview of the latest delivery techniques in SRS/SBRT, and discuss the clinical processes to address the challenges of each technique with special emphasis on dedicated gamma-ray based device, robotic x-band linac-based system and conventional C-arm s-band linac-based SRS systems. (1). Gamma-ray based SRS/SRT: This is the gold standard of intracranial SRS. With the advent of precision imaging guidance and frameless patient positioning capabilities, novel stereoscopic CBCT and automatic dose adaption solution are introduced to the Gamma-ray based SRS for the first time. The first North American system has been approved by the US regulatory for patient treatments in the spring of 2016. (2). Robotic SRS/SBRT system: A number of technological milestones have been developed in the past few years, including variable aperture collimator, sequential optimization technique, and the time reduction technique. Recently, a new robotic model allows the option of a multi-leaf collimator. These technological advances have reduced the treatment time and improved dose conformity significantly and could potentially expand the application of radiosurgery for the treatment of targets not previously suitable for robotic SRS/SBRT or fractionated stereotactic radiotherapy. These technological advances have created new demanding mandates on hardware and patient quality assurance (QA) tasks, as well as the need for updating/educating the physicists in the community on these requirements. (3). Conventional Linac based treatments: Modulated arc therapy (MAT) has gained wide popularities in Linac-based treatments in recent years due to its high delivery efficiency and excellent dose conformities. Recently, MAT has been introduced to deliver highly conformal radiosurgery treatments to multiple targets simultaneously via a single isocenter to replace the conventional multi-iso multi-plan treatments. It becomes important to understand the advantages and limitations of this technique, and the pitfalls for implementing this technique in clinical practice. The planning process of single-iso multi-target MAT will be described, and its plan quality and delivery efficiency will be compared with multi-iso plans. The QA process for verifying such complex plans will be illustrated, and pitfalls in imaging and patient set up will be discussed. Overall, this session will focus on the following areas: 1) Update on the emerging technology in current SRS/SBRT delivery. 2) New developments in treatment planning and Quality Assurance program. 3) Imaging guidance and motion management. Learning Objectives: To understand the SRS/SBRT principles and its clinical applications, and gain knowledge on the emerging technologies in SRS/SBRT. To review planning concepts and useful tips in treatment planning. To learn about the imaging guidance procedures and the quality assurance program in SRS/SBRT. National Institutes of Health, Varian Medical System; L. Ren, The presenter is funded by National Institutes of Health and Varian Medical System.

60 APPLIED LIFE SCIENCES↗