S. Anai

Can a belly board reduce respiratory-induced prostate motion in the prone position? - Assessed by cine-magnetic resonance imaging

The purpose of this study is to evaluate the real-time respiratory motion of the prostate and surrounding tissues/organs in the supine and prone positions and to investigate, using cine-MRI, whether a belly board can reduce respiratory-induced motion in the prone position. Cine-MRI scans were made of 13 volunteers in the supine and prone positions on a flat board and in two different prone positions using a belly board. Images in cine mode were recorded for 20 seconds. For each session, the points of interest (POIs) were located at the apex, base, mid-anterior surface and mid-posterior surface of the prostate; the tip of the seminal vesicle; the pubic symphysis; and the sacrum. The maximum range and standard deviation (SD) of the displacement from the mean value were calculated. The SDs for each of the four different positions were compared using a paired t-test. Respiratory-induced prostate motion was significantly larger in the prone position than in the supine position. However, when a belly board was used in the prone position, motion in the prostate and surrounding tissues/organs was significantly reduced. There were no significant differences between the two different positions using a belly board in any of the POIs.

SU‐E‐J‐26: Automated Estimation Method of Patient Setup Errors Using Simulated Portal Images for Prostate Cancer Radiotherapy

PURPOSE We developed a novel automated estimation method for patient setup errors based on simulated and real portal images for prostate cancer radiotherapy. METHODS The estimation of patient setup errors in this study was based on a template matching technique with a cross-correlation coefficient and Sobel filter between the real portal image and localized pelvic template of reference image, which were DRR (digitally reconstructed radiography) images and simulated portal images. The simulated portal image was derived by projecting a CT image according to an inverse exponential power law of x-ray attenuation for a water-equivalent path length of each voxel of the CT image on each ray from a source to each pixel on the EPID (electric portal imaging device). A localized pelvic template of each patient in AP (anterior-posterior) or lateral view was automatically extracted from the DRR or simulated portal images by cropping a rectangular region, which was determined by using the mean pelvic template and four anatomical feature points. We applied the proposed method to three prostate cancer cases, and evaluated it using the residual error between the patient setup error obtained by proposed method and the gold standard setup error determined by two radiation oncologists. RESULTS The average residual errors of the patient setup error for the DRR and simulated portal images were 0.79 and 1.26 mm in the left-right (LR) direction, 3.17 and 2.05 mm in the superior-inferior (SI) direction, 1.69 and 5.82 mm in the anterior-posterior (AP) direction, 3.84 and 6.94 mm in Euclidean distance (ED), respectively. If we used the simulated portal image for LR and SI directions and the DRR image for AP direction, the Euclidean distance was 3.22 mm. CONCLUSIONS The proposed method has a potential to correctly estimate patient setup errors for prostate cancer radiotherapy.

SU‐GG‐J‐58: Stereotactic Body Radiotherapy: Computer‐Assisted Verification of a Lung Tumor Region Using EPID without Implanted Markers

Purpose: Our purpose of this study was to develop a computer‐assisted verification method for lungtumor regions using a Gaussian image enhancement based on second derivatives of Gaussian functions in cine images on an EPID without implanted markers during SBRT.Method and Materials: The localization for a lungtumor was based on a template matching technique between a “tumor template” image obtained from a first EPID cine image and the subsequent image. The irradiation field region was cropped from an original EPID cine image by analyzing the histogram of this image. The “tumor template” image was segmented from the first EPID cine image, i.e., reference portal image, by using a Gaussian image enhancement based on second derivatives of Gaussian functions and a region growing technique. The tumor region was determined within the irradiation field as the position where the tumor template image took the maximum cross‐correlation value within each subsequent cine image. For performance evaluation of the proposed method, we applied the proposed method to EPIDimages acquired from twelve cases (age: 51–83 years old, mean: 72) with a non‐small cell lungcancer, and calculated the following two values: (1) the location error, i.e., the Euclidean distance from “tumor” point to the candidate point and (2) the overlap measure between the target candidate regions obtained by the manual method and our automated segmentation method. Results: The average location deviation between tumor center points obtained by the proposed method and the manual method was 1.80 ± 0.73 mm. The average overlap measure was 66.0 ± 10.0% for 12 cases. Conclusion: The results of this study suggest that the proposed method based on the tumor template matching technique might be feasible for localization of a lungtumor without implanted markers in SBRT.

SU‐GG‐J‐44: Estimation of Lateral Scatter Kernels in EPID and Water Equivalent Phantom for Dose Verification in Stereotactic Lung Radiotherapy

Purpose: Lateral scatter kernels (LSKs) of an electronic portal imaging device(EPID) and a water equivalent phantom are essential data for estimating the three‐dimensional dose distributions in lungcancer patients who receive stereotactic body radiotherapy. The LSKs are used for converting portal images to portal doseimages. The purpose of this study was to investigate a method of estimating LSKs of the EPID and water equivalent phantom, and then compare the LSKs between experimental measurements and the Monte Carlo(MC) method. Method and Materials: The experimental LSKs were derived from the differentiation of the signal (mean pixel value or absorbed dose) as a function of equivalent circular radius of irradiation area. Mean pixel values in a region of interest of the EPID and absorbed doses in the water equivalent phantom were measured for estimating the LSKs of the EPID and water equivalent phantom, respectively, by changing the irradiation area of 3×3 to 20×20 cm2. For evaluation of the experimental method, the theoretical LSKs were obtained based on the Monte Carlo method by simulating the same geometry of the experimental set‐up including the EPID and water equivalent phantom. Two x‐ray energies of 6 and 10 MV were employed respectively, at a medicallinear accelerator in conjunction with an EPID.Results: The experimental method overestimated the LSKs of the EPID and water equivalent phantom compared with those of the Monte Carlo simulation method. The full width half maximum values at 6 and 10 MV of the theoretical LSKs were 0.166 and 0.193 cm for the EPID, respectively, and 0.177 and 0.211 cm for the water equivalent phantom, respectively. Conclusion: We should continue to investigate the experimental and theoretical methods for estimation of LSKs of the EPID and water equivalent phantom for dose verification in stereotactic lungradiotherapy.

SU‐GG‐T‐257: Modeling of Beam Profiles Based On Three Gaussian Functions in Lung Stereotactic Body Radiotherapy for Acceptance Test of Radiotherapy Planning System

Purpose: The purpose of this study was to estimate beam profiles in lung stereotactic body radiotherapy for acceptance test of radiotherapy planning system (RTP) system. The beam profiles measured by an ionization chamber were approximated by using three Gaussian functions, and compared with profile data calculated by two RTP systems. Method and Materials: X‐ray linear accelerator with 4,6,10MV (Varian 21EX) was used to deliver symmetric beam profile for a field size of 5×5cm2. A lung phantom consisted of a lung equivalent material (thickness : 170 mm) sandwiched by two Solid Waters, whose thickness were 30 mm and 50 mm for anterior and posterior sides, respectively. Measured beam profiles were approximated by manually determining three amplitudes and standard deviations of three Gaussian functions corresponding to three point spread functions of an x‐ray focus, x‐ray or electron scatter, and a detector,and by integrating the composed function. Finally, we evaluated our method by comparing the approximated beam profiles with those calculated by two algorithms in two RTP systems, i.e., Convolution/superposition (CS) (Philips Pinnacle) and analytical anisotropic algorithm (AAA) (Varian Eclipse).Results: Difference between the measured and approximated beam profiles were 4% at 20–80% doses, and 1.5% difference at the other doses. The fringe values (distance between the 50 and 90% levels) of beam profiles approximated by Gaussian functions and calculated by CS and AAA algorithms were 4.7, 6.1, 6.4 mm for 4MV x‐ray, 5.7, 6.9, 7.1 mm for 6MV x‐ray, and 6.8, 7.7, 8.2 mm for 10MV x‐ray, respectively. Conclusion: It was suggested the beam profile model based on the three Gaussian functions may be useful for acceptance test of a RTP system.