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Early Detection of Breast Cancer Using Stationary Digital Breast Tomosynthesis with Quasimonochromatic X-ray Sources
S168
International Journal of Radiation Oncology Biology Physics
of Radiation Oncology, Columbus, OH, 2Pharos Scientific, LLC, Lilburn, GA, 3Department of Pathology, Wexner Medical Center at The Ohio State University, Columbus, OH, 4Department of Surgical Oncology, Wexner Medical Center at the Ohio State University, Columbus, OH, 521st Century Oncology, Fort Myers, FL
improve breast cancer early detection. However, the main reason for this technique has not been implemented for clinical uses are the lack of quasimonochromatic x-ray sources that can produce sufficient flux within acceptable scanning time. The stationary Digital Breast Tomosynthesis (s-DBT) can provide high quality images within short scanning time by using x-ray source array, which makes quasi-monochromatic technique feasible. The performance of s-DBT with quasi-monochromatic x-ray sources was evaluated using both simulated and physical phantoms. Materials/Methods: First, quasi-monochromatic x-ray using three different k-edge filtering approaches was simulated: 1) tungsten source with cerium filter at the 100th VL (W/Ce-100); 2) tungsten source with cerium filter at the 10th VL (W/Ce-10); 3) tungsten source with silver filter at the 1000th VL (W/Ag-1000). The conventional Mo/Mo combination was also included as a comparison. The normalized spectra were studied. Second, a CIRS phantom with low and high contrast objects embedded in a material resembles compressed breast was constructed. The contrast vs. noise standard deviation of the reconstructed objects using different x-ray source configurations was reported. Third, the W/Ce-10 approach was implemented for experimental study. The measured spectra using XR100TCdTe digital x-ray detector was compared to the simulated data. The reconstructed image quality of an ACR mammographic phantom with and without using W/Ce-10 combination was reported. Results: Normalized spectra in fraction of total photons vs. photon energy were generated. As expected, the sources have peaked energy from small to large in turn are Mo/Mo, W/Ag-1000, and W/Ce-10, W/Ce-100. For contrast vs. noise standard deviation on the simulated CIRS phantom, W/Ce-100 and W/Ce-10 have similar performance on both low and high contrast objects. For low contrast object, W/Ce-100 is barely noticeably better than W/Ce-10, and they are better than both W/Ag-1000 and Mo/Mo. For high contrast objects W/Ce-10 is slightly better than W/Ce-100. The spectra of the implemented W/Ce-10 x-ray source were measured, which matched the simulation well. The CNRs of reconstructed objects in ACR mammographic phantom with and without using W/Ce-10 combination are 7.1 and 5.4, respectively. Conclusion: The combination of s-DBT and quasi-monochromatic technique can compensate the loss of x-ray flux due to heavy K-edge filtering, and enable the s-DBT scanner to operate at acceptable scanning time with better low contrast lesion detectability. Author Disclosure: X. Qian: None. X. Tang: None.
Purpose/Objective(s): Develop a novel technique to (1) detect the early stage ductal pancreatic cancers and (2) treat them with high dose rate brachytherapy (HDR) by using the endoscopic 3-D high resolution Optical Coherence Tomography (OCT) imaging technique. The ultimate goal is to integrate the endoscopic OCT imaging device with a HDR machine to compose a portable and easy to operate system that has dual functions of diagnosis and OCT-guided HDR, which has the capabilities of detecting early stage pancreatic tumor and treating it from inside of the pancreas duct while greatly reducing the radiation toxicity to the neighboring organs. Materials/Methods: OCT is an imaging technique with ultra-high spatial resolution (w5 mm) to obtain real time images of biological tissue in vivo. Considering the fact that most pancreatic cancers arise from pancreatic ducts, the endoscopic OCT imaging technique is perfectly suitable for diagnosing pancreatic cancers in early stage, which is analogous to conventional ultrasound endoscopy but using near infrared (NIR) light instead of ultrasound. We built such an endoscopic OCT imaging system. It includes five components: (1) broad bandwidth NIR light source, (2) OCT probe that includes the OCT detector (diameter: 0.8 mm, length: 2 mm) attached to a fiber optic that transfers the illuminating light and signal between the source and the receiving optical spectrometer, (3) soft and transparent OCT catheter tube (inner-diameter: 1 mm; outer-diameter: 2 mm) that allows the OCT probe to travel through to the disease site for imaging, (4) linear in frequency optical spectrometer that acquires optical information with optimum imaging depth, (5) console computer that processes the signals, reconstructs raw data into images, displays live or offline OCT images, and controls the operations of the imaging system. To diagnose and treat the ductal pancreatic cancers, we first insert the HDR source catheter tube into the pancreatic duct, then connect the source catheter tube with the same size but different in length OCT catheter tube that connected to the OCT machine. The HDR source catheter tube is used as the common pathway for both endoscopic OCT imaging probe to detect and locate tumors and the HDR source be sent to irradiate the discovered lesion. Results: (1) We had built an endoscopic OCT machine and a special endoscopic OCT probe that connects the OCT device and HDR machine; (2) Using the machine we were able to imaging the cancerous pancreatic duct in a resected pancreas from a patient and compared the images of normal and cancerous ducts; (3) We had tested the integration of OCT and HDR with OCT-guided HDR experiments on a phantom, (4) the superiority of HDR over external beam radiotherapy on dosimetry was verified with simulation; (5) A patent had been filed in 2015 (U.S. provisional patent application. Serial No. 62/131,959). Conclusion: The feasibility of proposed endoscopic 3-D OCT-guided brachytherapy for early stage pancreatic cancer has been experimentally investigated and proved. Author Disclosure: L. Lu: Research Grant; Pelotonia. Patent/License Fees/ Copyright; The Ohio State University and Pharos Scientific, LLC. Z. Hu: Research Grant; Pelotonia. Patent/License Fees/Copyright; The Ohio State University and Pharos Scientific, LLC. W. Frankel: Research Grant; Pelotonia. M. Dillhoff: None. J.C. Grecula: None. M.P. Bloomston: Research Grant; Pelotonia.
1010 Early Detection of Breast Cancer Using Stationary Digital Breast Tomosynthesis with Quasimonochromatic X-ray Sources X. Qian1 and X. Tang2; 1Northwell Health System New Hyde Park, NY, 2 Memorial Sloan Kettering, West Harrison, NY Purpose/Objective(s): Early detection and treatment are considered the best hope for decreasing the mortality rate from breast cancer. Quasimonochromatic technique can enhance low contrast lesion detection by eliminating beam-hardening artifacts. This technique can potentially
1011 Real-Time Optical Image Guided Radiation Therapy (IGRT) of Breast/Chest Wall Cancer S. Li, C. Miyamoto, K. Reilly, A. Padmanabhan, and B. Micaily; Temple University, Philadelphia, PA Purpose/Objective(s): We are developing real-time 3D/4D video guidance to reduce breast and chest wall setup errors and track target motion during post-mastectomy chest wall/nodal irradiation, breast only irradiation, and breast nodal irradiation in a clinical trial. We have also compared the reliability, accuracy, and precision of camera-based IGRT with results of weekly portal image verification and weekly CBCT volumetric matching. Materials/Methods: One-hundred forty patients, 102 breast only, 23 breast + nodal, and 15 chest wall + nodal, were accrued in an IRB-approved clinical trial of IGRT using 3D/4D optical images at daily setup and beamon time. Breast board and vacuum bag were used for all patients. Eleven patients with left-side diseases were treated under deep inspiration breath hold using ABC device and twenty-two patient using IMRT. Target shifts and rotations relating to CT-based planned reference surface were determined with real-time optical surface images using modified iterativeclosest-point alignment. A selected light ray intersecting the middle-upper abdominal surface and the anterior surface of the target projected onto the principal components were used as the real-time point/marker-based and surface/volume-based motion tracking, respectively. The optical guidance and real-time respiratory motion tracking were completely performed by therapists and results were semi-automatically saved in the camera-control computer. The target displacements (shifts and rotations) were compared
International Journal of Radiation Oncology Biology Physics
of Radiation Oncology, Columbus, OH, 2Pharos Scientific, LLC, Lilburn, GA, 3Department of Pathology, Wexner Medical Center at The Ohio State University, Columbus, OH, 4Department of Surgical Oncology, Wexner Medical Center at the Ohio State University, Columbus, OH, 521st Century Oncology, Fort Myers, FL
improve breast cancer early detection. However, the main reason for this technique has not been implemented for clinical uses are the lack of quasimonochromatic x-ray sources that can produce sufficient flux within acceptable scanning time. The stationary Digital Breast Tomosynthesis (s-DBT) can provide high quality images within short scanning time by using x-ray source array, which makes quasi-monochromatic technique feasible. The performance of s-DBT with quasi-monochromatic x-ray sources was evaluated using both simulated and physical phantoms. Materials/Methods: First, quasi-monochromatic x-ray using three different k-edge filtering approaches was simulated: 1) tungsten source with cerium filter at the 100th VL (W/Ce-100); 2) tungsten source with cerium filter at the 10th VL (W/Ce-10); 3) tungsten source with silver filter at the 1000th VL (W/Ag-1000). The conventional Mo/Mo combination was also included as a comparison. The normalized spectra were studied. Second, a CIRS phantom with low and high contrast objects embedded in a material resembles compressed breast was constructed. The contrast vs. noise standard deviation of the reconstructed objects using different x-ray source configurations was reported. Third, the W/Ce-10 approach was implemented for experimental study. The measured spectra using XR100TCdTe digital x-ray detector was compared to the simulated data. The reconstructed image quality of an ACR mammographic phantom with and without using W/Ce-10 combination was reported. Results: Normalized spectra in fraction of total photons vs. photon energy were generated. As expected, the sources have peaked energy from small to large in turn are Mo/Mo, W/Ag-1000, and W/Ce-10, W/Ce-100. For contrast vs. noise standard deviation on the simulated CIRS phantom, W/Ce-100 and W/Ce-10 have similar performance on both low and high contrast objects. For low contrast object, W/Ce-100 is barely noticeably better than W/Ce-10, and they are better than both W/Ag-1000 and Mo/Mo. For high contrast objects W/Ce-10 is slightly better than W/Ce-100. The spectra of the implemented W/Ce-10 x-ray source were measured, which matched the simulation well. The CNRs of reconstructed objects in ACR mammographic phantom with and without using W/Ce-10 combination are 7.1 and 5.4, respectively. Conclusion: The combination of s-DBT and quasi-monochromatic technique can compensate the loss of x-ray flux due to heavy K-edge filtering, and enable the s-DBT scanner to operate at acceptable scanning time with better low contrast lesion detectability. Author Disclosure: X. Qian: None. X. Tang: None.
Purpose/Objective(s): Develop a novel technique to (1) detect the early stage ductal pancreatic cancers and (2) treat them with high dose rate brachytherapy (HDR) by using the endoscopic 3-D high resolution Optical Coherence Tomography (OCT) imaging technique. The ultimate goal is to integrate the endoscopic OCT imaging device with a HDR machine to compose a portable and easy to operate system that has dual functions of diagnosis and OCT-guided HDR, which has the capabilities of detecting early stage pancreatic tumor and treating it from inside of the pancreas duct while greatly reducing the radiation toxicity to the neighboring organs. Materials/Methods: OCT is an imaging technique with ultra-high spatial resolution (w5 mm) to obtain real time images of biological tissue in vivo. Considering the fact that most pancreatic cancers arise from pancreatic ducts, the endoscopic OCT imaging technique is perfectly suitable for diagnosing pancreatic cancers in early stage, which is analogous to conventional ultrasound endoscopy but using near infrared (NIR) light instead of ultrasound. We built such an endoscopic OCT imaging system. It includes five components: (1) broad bandwidth NIR light source, (2) OCT probe that includes the OCT detector (diameter: 0.8 mm, length: 2 mm) attached to a fiber optic that transfers the illuminating light and signal between the source and the receiving optical spectrometer, (3) soft and transparent OCT catheter tube (inner-diameter: 1 mm; outer-diameter: 2 mm) that allows the OCT probe to travel through to the disease site for imaging, (4) linear in frequency optical spectrometer that acquires optical information with optimum imaging depth, (5) console computer that processes the signals, reconstructs raw data into images, displays live or offline OCT images, and controls the operations of the imaging system. To diagnose and treat the ductal pancreatic cancers, we first insert the HDR source catheter tube into the pancreatic duct, then connect the source catheter tube with the same size but different in length OCT catheter tube that connected to the OCT machine. The HDR source catheter tube is used as the common pathway for both endoscopic OCT imaging probe to detect and locate tumors and the HDR source be sent to irradiate the discovered lesion. Results: (1) We had built an endoscopic OCT machine and a special endoscopic OCT probe that connects the OCT device and HDR machine; (2) Using the machine we were able to imaging the cancerous pancreatic duct in a resected pancreas from a patient and compared the images of normal and cancerous ducts; (3) We had tested the integration of OCT and HDR with OCT-guided HDR experiments on a phantom, (4) the superiority of HDR over external beam radiotherapy on dosimetry was verified with simulation; (5) A patent had been filed in 2015 (U.S. provisional patent application. Serial No. 62/131,959). Conclusion: The feasibility of proposed endoscopic 3-D OCT-guided brachytherapy for early stage pancreatic cancer has been experimentally investigated and proved. Author Disclosure: L. Lu: Research Grant; Pelotonia. Patent/License Fees/ Copyright; The Ohio State University and Pharos Scientific, LLC. Z. Hu: Research Grant; Pelotonia. Patent/License Fees/Copyright; The Ohio State University and Pharos Scientific, LLC. W. Frankel: Research Grant; Pelotonia. M. Dillhoff: None. J.C. Grecula: None. M.P. Bloomston: Research Grant; Pelotonia.
1010 Early Detection of Breast Cancer Using Stationary Digital Breast Tomosynthesis with Quasimonochromatic X-ray Sources X. Qian1 and X. Tang2; 1Northwell Health System New Hyde Park, NY, 2 Memorial Sloan Kettering, West Harrison, NY Purpose/Objective(s): Early detection and treatment are considered the best hope for decreasing the mortality rate from breast cancer. Quasimonochromatic technique can enhance low contrast lesion detection by eliminating beam-hardening artifacts. This technique can potentially
1011 Real-Time Optical Image Guided Radiation Therapy (IGRT) of Breast/Chest Wall Cancer S. Li, C. Miyamoto, K. Reilly, A. Padmanabhan, and B. Micaily; Temple University, Philadelphia, PA Purpose/Objective(s): We are developing real-time 3D/4D video guidance to reduce breast and chest wall setup errors and track target motion during post-mastectomy chest wall/nodal irradiation, breast only irradiation, and breast nodal irradiation in a clinical trial. We have also compared the reliability, accuracy, and precision of camera-based IGRT with results of weekly portal image verification and weekly CBCT volumetric matching. Materials/Methods: One-hundred forty patients, 102 breast only, 23 breast + nodal, and 15 chest wall + nodal, were accrued in an IRB-approved clinical trial of IGRT using 3D/4D optical images at daily setup and beamon time. Breast board and vacuum bag were used for all patients. Eleven patients with left-side diseases were treated under deep inspiration breath hold using ABC device and twenty-two patient using IMRT. Target shifts and rotations relating to CT-based planned reference surface were determined with real-time optical surface images using modified iterativeclosest-point alignment. A selected light ray intersecting the middle-upper abdominal surface and the anterior surface of the target projected onto the principal components were used as the real-time point/marker-based and surface/volume-based motion tracking, respectively. The optical guidance and real-time respiratory motion tracking were completely performed by therapists and results were semi-automatically saved in the camera-control computer. The target displacements (shifts and rotations) were compared