Proceedings of the 52nd Annual ASTRO Meeting

comparison with tracking results from several expert human examiners. Preliminary results show that the tracking accuracy of the
marker-less algorithm is better than 2mm, i.e. of the same order as the manual tracking.
Conclusions: To verify lung SBRT treatments at our institution, we have developed and tested a robust algorithm to track lung
tumors on portal image sequences without the use of fiducial markers or user intervention. The algorithm has the potential to
be implemented in real time and is not dependent on prior information of the exact tumor motion range during treatment (unlike
classification algorithms, which generally require this). Final results and clinical implications will be discussed.
Author Disclosure: J. Rottmann, None; M. Aristophanous, None; A. Chen, None; D. Sher, None; J. Killoran, None; F. Hacker,
None; R. Berbeco, Varian Medical Systems Inc., B. Research Grant.

95

GPU-based Fast Low Dose Cone Beam CT Reconstruction via Total Variation
1

X. Jia , Y. Lou2, R. Li1, J. Lewis1, C. Men1, X. Gu1, W. Y. Song1, S. B. Jiang1

1

University of California San Diego, La Jolla, CA, 2University of California Los Angeles, Los Angeles, CA

Purpose/Objective(s): Cone-beam CT (CBCT) has been widely used in image guided radiation therapy (IGRT) to acquire updated volumetric anatomical information before treatment fractions for accurate patient alignment purpose. However, the excessive
x-ray imaging doses (a few c Gy per scan) delivered to patients from serial CBCT scans raises a clinical concern in most IGRT
procedures. This fact has greatly limited exploitation of IGRTs maximal potential. The excessive imaging dose can be effectively
reduced by reducing the number of x-ray projections and/or lowering mAs levels in a CBCT scan. The image quality reconstructed
from conventional FDK-type algorithms, however, will be highly degraded. Recently, total variation (TV) method has demonstrated its ability to reconstruct CBCT images from a few number of noisy x-ray projections. Nonetheless, such a method cannot
be applied in real clinical environments due to its long computational time (a few hours). It is the goal of this work to develop a fast
GPU-based algorithm to reconstruct high quality CBCT images from undersampled and noisy projection data so as to lower the
imaging dose.
Materials/Methods: The CBCT is reconstructed by minimizing an energy functional consisting of a data fidelity term and a TV
regularization term. We developed a GPU-friendly version of the forward-backward splitting algorithm to solve this model. Multigrid technique is also employed. We tested our CBCT reconstruction algorithm on a digital NCAT phantom and a head-and-neck
patient case with simulated x-ray projections. Our algorithm has also been validated on a Catphan phantom and a head-and-neck
Rando phantom scanned under Varian OBI system under different mAs levels.
Results: It is found that 40 x-ray projections are sufficient to reconstruct CBCT images with satisfactory quality for IGRT patient
alignment purpose. Phantom studies indicate that CBCT images can be successfully reconstructed with our algorithm under as low
as 0.1 mAs/projection level. Comparing with currently widely used full-fan head-and-neck scanning protocol of about 360 projections with 0.4 mAs/projection, it is estimated that an overall 36 times dose reduction has been achieved with our algorithm.
Moreover, the reconstruction time is about 130 sec on an NVIDIA Tesla C1060 GPU card, which is estimated ?100 times faster
than similar iterative reconstruction approaches.
Conclusions: We have developed a fast GPU-based low-dose CBCT reconstruction algorithm. The high computational efficiency
makes this iterative CBCT reconstruction approach feasible in real clinical environments.
Author Disclosure: X. Jia, None; Y. Lou, None; R. Li, None; J. Lewis, None; C. Men, None; X. Gu, None; W.Y. Song, None; S.B.
Jiang, None.

96

Normal Tissue Complication Probability (NTCP) Modeling of Late Rectal Bleeding following External Beam
Radiotherapy for Prostate Cancer: A Test of the QUANTEC-favored Model

M. Liu1, V. Moiseenko2, A. Agranovich1, A. Karvat1, W. Kwan1, Z. H. Saleh3, A. A. Apte3, J. O. Deasy3

1

Fraser Valley Centre, British Columbia Cancer Centre, Surrey, BC, Canada, 2Vancouver Centre, British Columbia Cancer
Agency, Vancouver, BC, Canada, 3Mallinckrodt Institute of Radiology, Washington University, St. Louis, MO

Purpose/Objective(s): Identifying a reliably predictive model for late rectal bleeding would improve guidance for prostate cancer
treatment planning. Specifically, we test the NTCP model recommended by QUANTEC (quantitative analysis of normal tissue
effects in the clinic; Michalski et al., IJROBP, 2010 (76) S123-9) against an independent dataset.
Materials/Methods: 161 prostate cancer patients were treated with 3D conformal radiotherapy at the British Columbia Cancer
Agency. Total prescription dose was 74 Gy, delivered in 2 Gy/fraction doses. Treatment plans were exported to CERR (computational environment for radiotherapy research) for review and further analysis. Dose distributions were added together according
to clinical records and the final total dose distributions were used to produce corresponding dose-volume histograms using the
DREES (dose response explorer system) software tool. The NTCP model recommended in the QUANTEC review to predict .
= Grade 2 toxicity was a Lyman-Kutcher-Burman (LKB) model with parameters (95% confidence intervals) n = 0.09 (0.040.14); m = 0.13 (0.1-0.17); and TD50 = 76.9 (73.7-80.1) Gy. Model fitting used a grid search to identify the best-fit parameters;
refitting on bootstrap data resamples was used to calculate 95% confidence intervals. Spearmans rank correlation coefficient was
used to test predictive power.
Results: Out of the 161 patients, 12 (7.5%) had late rectal bleeding of Grade . = 2. Multivariate logistic regression showed
a poor correlation between dose-volume parameters (V60, V70, etc.) and late rectal bleeding. Bootstrap refit LKB model parameters had positively skewed distributions with peak values and 95% confidence intervals of: n = 0.08 (0-10); m = 0.08 (0.02,
+infinity); and TD50 = 76 (71, +infinity) Gy. The peak values fall within the parameter range recommended by the QUANTEC
review given above. However, on this dataset, both models poorly predicted late rectal bleeding: the best-fit LKB model had
a non-significant Spearman correlation coefficient of 0.098 (p = 0.11); and the QUANTEC model had a coefficient of 0.096
(p = 0.11).
Conclusions: The observed rectal bleeding dose-volume response is in a broad agreement with the QUANTEC recommendations.
However, both the QUANTEC-preferred LKB model parameters and the best-fit LKB model parameters yield poor predictive

S45

I. J. Radiation Oncology d Biology d Physics

S46

Volume 78, Number 3, Supplement, 2010

power in this dataset. This may be partly because maximum doses to the rectum, which may be important in determining risk, are
similar across this patient population. We conclude that the QUANTEC-preferred LKB model may not reliably correlate to the risk
of late rectal bleeding, at least for the types of treatments considered here.
This research was partially supported by NIH grant R01 CA85181.
Author Disclosure: M. Liu, None; V. Moiseenko, None; A. Agranovich, None; A. Karvat, None; W. Kwan, None; Z.H. Saleh,
None; A.A. Apte, None; J.O. Deasy, Varian Corp., B. Research Grant; Tomotherapy, Inc., B. Research Grant.

97

Modeling Regional Sensitivity of Radiation Pneumonitis using Multi-institutional EUD Atlases from Phase I
Dose Escalation Protocols for Non-small Cell Lung Cancer

F. Liu1, E. D. Yorke1, J. S. A. Belderbos2, G. R. Borst2, K. E. Rosenzweig1, J. V. Lebesque2, A. Jackson1

1
Memorial Sloan-Kettering Cancer Center, New York, NY, 2The Netherlands Cancer Institute, Antoni Van Leeuwenhoek
Hospital, Amsterdam, Netherlands

Purpose/Objective(s): Studies indicate that radiation pneumonitis (RP) incidence depends on the region of lung irradiated. We
combined complication data and equivalent uniform doses (EUD) from independent prospective phase I dose escalation protocols
for treatment of Non-Small Cell Lung Cancer at Memorial Sloan-Kettering Cancer Center (MSKCC) and The Netherlands Cancer
Institute (NKI) to study regional radiation sensitivity. We used the increased statistical power of the combined 164 patient data set
to: 1) compare correlation of RP with EUDs in each lung region; 2) study consistency of results with the individual data sets; 3)
demonstrate utility of the atlas method for meta-analysis (Sem Rad Onc 16 260).
Materials/Methods: Doses ranged from 57.6 - 90 Gy in 1.8 - 2 Gy fractions (MSKCC) and 60.75 - 94.5 Gy in 2.25 Gy fractions
(NKI). RP was scored prospectively as requiring steroids or worse toxicity at 6 months. Seventy-eight and 86 patients met followup requirements, 10 and 14 with RP, respectively. EUD was calculated from DVHs normalized to 2 Gy fractions (linear quadratic
model with a/b = 3 Gy) for whole, contralateral (contra), ipsilateral (ipsi), superior (sup), and inferior (inf) lungs; the volume effect
parameter ranged from log10a = -1.0 to +1.0 in steps of 0.1. The atlas EUD grid was 0.5 Gy. All 78 MSKCC patients had dose
volume histograms (DVH) for all 5 lung regions; 86, 53, 53, 49, and 49 NKI patients had corresponding DVHs. Logistic regression
was used in each lung region to find significant (p # 0.05) EUD responses for RP. Consistency was checked between both individual and combined atlases, and atlas based and direct EUD analysis.
Results: EUD responses from the combined data from whole, ipsi, and inf lung regions gave the best models, and were significantly correlated with RP when log10a \ 0.2, 0.0, 0.6, respectively. Weak significant correlation with contra lung EUD occurred
for log10a \ -0.8. There was no significant correlation for sup lungs. Qualitative dependence of model p values on log10a was similar for individual and combined atlases, implying consistency of the individual data sets. Combining atlases decreased p values of
the whole lung, ipsi, and inf lungs. For contra lung, only combined data gave significant correlation. Atlas and direct EUD analysis
results were consistent, indicating minimal information loss from using atlases.
Conclusions: EUDs of the whole, ipsi, and inf lung are significantly correlated with RP. Sensitivity of the different lung regions is
similar in individual and combined data sets. Combining EUD atlases from two institutions improved modeling of the relationship
of EUD with RP. Calculations based on the atlas or directly on EUD data are consistent.
Supported in part by NIH R01CA129182-01A2.
Author Disclosure: F. Liu, None; E.D. Yorke, None; J.S.A. Belderbos, None; G.R. Borst, None; K.E. Rosenzweig, None; J.V.
Lebesque, None; A. Jackson, None.

98

Incorporating Gross Tumor Volume Location Information into the Modeling of Radiation Pneumonitis

Y. Vinogradskiy, S. Tucker, Z. Liao, M. Martel

MD Anderson Cancer Center, Houston, TX
Purpose/Objective(s): Current methods for prediction of severe lung toxicity after thoracic radiation therapy have used basic dosimetric indices derived from dose-volume data. However, studies have found that function may vary throughout lung and some
researchers have proposed that patients who have tumors located in the base of the lung are more susceptible to radiation pneumonitis. Our study will develop a novel method to incorporate gross tumor volume (GTV) location into a predictive model and test its
predictive power on a large clinical database of non-small cell lung cancer (NSCLC) patients.
Materials/Methods: The GTV centroids of 547 NSCLC patients were mapped onto one common coordinate system similar to the
manner described by Hope et al. (2006). The boundaries of the coordinate system were defined by the extreme points of each individual patient lung. The GTV centroid information was incorporated into the Lyman NTCP model by introducing a dose modification factor (DMF). The DMF was defined as eCL, where C was a model fitting parameter and L was the GTV centroid location
coordinates in various orientations. Six different orientations for L were investigated: superior-inferior (SI), anterior-posterior, leftright, medial-lateral, radial, and SI distance from the mean SI position of all tumors. Model parameters were fit to our 547 patient
cohorts with the end-point of severe radiation pneumonitis. The patient cohort consisted of stage III NSCLC patients that were
treated with either three-dimensional conformal radiotherapy or intensity modulated radiotherapy at M.D. Anderson Cancer Center
between 1999 and 2005. Using the ratio test, the accuracy of the model that combined dose-volume and GTV centroid information
was statistically compared against a conventional dose-volume model to determine whether adding a spatial component increased
the predictive power of the model.
Results: Out of the 547 patients, 111 (20.3%) experienced severe radiation pneumonitis. The pneumonitis rates were 16, 23, and
21%, for the superior, middle, and inferior thirds of the lung, respectively. The comparison of the GTV centroid model and the
conventional dose-volume model did not yield a statistically significant difference in model accuracy for the various orientations
that were investigated.
Conclusions: Consistent with the results from Hope et al. (2006) we found lower pneumonitis rates for tumors located in the superior third of the lung. However, we did not find an overall trend in increasing pneumonitis rates towards the inferior portion of the