Gating Window Research Articles

Evaluation of the four-dimensional motion of lung tumors during end-exhalation breath-hold conditions using volumetric cine computed tomography images

Background and purposeThis study was performed to evaluate the four-dimensional motion of lung tumors during end-exhalation (EE) breath-holding (BH) using cine computed tomography (CT) and investigate the correlation between tumor and surrogate marker motions. Materials and methodsThis study included 28 patients who underwent stereotactic body radiation therapy at our institution and were capable of 15–20 s of EE BH within a ±1.5-mm gating window with external markers. During EE BH with cine CT, 21 s of continuous data were acquired using 320-row multislice CT. Displacements in the tumor position during EE BH were assessed in the left–right (LR), anterior–posterior (AP), and superior–inferior (SI) directions. Pearson’s correlation coefficient (r) between tumor motions during EE BH and diaphragm/external marker motions was also determined. ResultsThe mean absolute maximum displacements of the tumor position during EE BH were 1.3 (range: 0.2–4.0), 1.9 (range: 0.3–12.0), and 1.3 (range: 0.1–7.2) mm in the LR, AP, and SI directions, respectively. The displacement of the tumor position in the AP direction was weakly correlated (|r| < 0.4) with the external marker and diaphragm displacements in many cases (proportions of 50% and 46%, respectively). ConclusionWe found some cases showing substantial displacement in lung tumor positions during EE BH, especially in the AP direction. Because these tumor position displacements did not correlate with surrogate markers and were difficult to detect, we recommend pretreatment evaluation of the four-dimensional motions of tumors during BH using cine CT.

Patient-specific respiratory motion management using lung tumors vs fiducial markers for real-time tumor-tracking stereotactic body radiotherapy.

In real-time lung tumor-tracking stereotactic body radiotherapy (SBRT), tracking accuracy is related to radiotherapy efficacy. This study aimed to evaluate the respiratory movement relationship between a lung tumor and a fiducial marker position in each direction using four-dimensional (4D) computed tomography (CT) images. A series of 31 patients with a fiducial marker for lung SBRT was retrospectively analyzed using 4DCT. In the upper (UG) and middle and lower lobe groups (MLG), the cross-correlation coefficients of respiratory movement between the lung tumor and fiducial marker position in four directions (anterior-posterior, left-right, superior-inferior [SI], and three-dimensional [3D]) were calculated for each gating window (≤1, ≤2, and≤3mm). Subsequently, the proportions of phase numbers in unplanned irradiation (with lung tumors outside the gating window and fiducial markers inside the gating window) were calculated for each gating window. In the SI and 3D directions, the cross-correlation coefficients were significantly different between UG (mean r=0.59, 0.63, respectively) and MLG (mean r=0.95, 0.97, respectively). In both the groups, the proportions of phase numbers in unplanned irradiation were 11%, 28%, and 63% for the≤1-, ≤2-, and≤3-mm gating windows, respectively. Compared with MLG, fiducial markers for UG have low cross-correlation coefficients between the lung tumor and the fiducial marker position. Using 4DCT to assess the risk of unplanned irradiation in a gating window setting and selecting a high cross-correlation coefficient fiducial marker in advance are important for accurate treatment using lung SBRT.

3-D Raman Imaging Using Time-Resolving CMOS SPAD Line Sensor and 2-D Mapping

The capability of Raman imaging to produce 2D and 3D chemical presentations of samples has gained a lot of interest in different application fields. In this paper, we present a 3D chemical image reconstruction based on 2D scanning of a sample utilizing a time-resolved Raman spectrometer based on a CMOS single-photon avalanche diode (SPAD) line sensor. The 2D scanning data contains the lateral information (XY-plane) whereas the time-of-arrival data of the Raman photons measured by the sensor carries the axial information (i.e., depth information, Z-axis). The sensor is fabricated in 110-nm CMOS technology. It has 256-spectral channels and each channel has its own 7-bit on-chip time-to-digital converter (TDC) with an adjustable resolution from 25 ps to 65 ps. In addition to the 3D chemical reconstruction of the scanned sample, we have also shown the ability to retrieve depth profiling information of each scanned pixel such as the boundaries and middle points of any selected layer over the depth range of the scanned object by means of a single measurement for each scanned pixel. In addition, we have discussed the system components and the post-processing parameters that affect the depth profiling accuracy and the 3D reconstruction operation the most. Results showed that the instrument response function of the system and the time gate window width in a post-processing phase are playing the most important role in determining the axial (depth) accuracy. We believe that our system will enable a whole new class of Raman applications that will allow simultaneous 3D chemical geometric representation at the cm-level during Raman operations.

Design of a Patient-Specific Respiratory-Motion-Simulating Platform for In Vitro 4D Flow MRI.

Four-dimensional (4D) flow magnetic resonance imaging (MRI) is a leading-edge imaging technique and has numerous medicinal applications. In vitro 4D flow MRI can offer some advantages over in vivo ones, especially in accurately controlling flow rate (gold standard), removing patient and user-specific variations, and minimizing animal testing. Here, a complete testing method and a respiratory-motion-simulating platform are proposed for in vitro validation of 4D flow MRI. A silicon phantom based on the hepatic arteries of a living pig is made. Under the free-breathing, a human volunteer's liver motion (inferior-superior direction) is tracked using a pencil-beam MRI navigator and is extracted and converted into velocity-distance pairs to program the respiratory-motion-simulating platform. With the magnitude displacement of about 1.3cm, the difference between the motions obtained from the volunteer and our platform is ≤ 1mm which is within the positioning error of the MRI navigator. The influence of the platform on the MRI signal-to-noise ratio can be eliminated even if the actuator is placed in the MRI room. The 4D flow measurement errors are respectively 0.4% (stationary phantom), 9.4% (gating window = 3mm), 27.3% (gating window = 4mm) and 33.1% (gating window = 7mm). The vessel resolutions decreased with the increase of the gating window. The low-cost simulation system, assembled from commercially available components, is easy to be duplicated.

Nanosecond gating of superconducting nanowire single-photon detectors using cryogenic bias circuitry.

Superconducting nanowire single-photon detectors (SNSPDs) show near unity efficiency, low dark count rate, and short recovery time. Combining these characteristics with temporal control of SNSPDs broadens their applications as in active de-latching for higher dynamic range counting or temporal filtering for pump-probe spectroscopy or LiDAR. To that end, we demonstrate active gating of an SNSPD with a minimum off-to-on rise time of 2.4 ns and a total gate length of 5.0 ns. We show how the rise time depends on the inductance of the detector in combination with the control electronics. The gate window is demonstrated to be fully and freely, electrically tunable up to 500 ns at a repetition rate of 1.0 MHz, as well as ungated, free-running operation. Control electronics to generate the gating are mounted on the 2.3 K stage of a closed-cycle sorption cryostat, while the detector is operated on the cold stage at 0.8 K. We show that the efficiency and timing jitter of the detector is not altered during the on-time of the gating window. We exploit gated operation to demonstrate a method to increase in the photon counting dynamic range by a factor 11.2, as well as temporal filtering of a strong pump in an emulated pump-probe experiment.

Electrolyte-gate-driven carrier density modulation and metal–insulator transition in semiconducting epitaxial CdO films

CdO has drawn much recent interest as a high-room-temperature-mobility oxide semiconductor with exciting potential for mid-infrared photonics and plasmonics. Wide-range modulation of carrier density in CdO is of interest both for fundamental reasons (to explore transport mechanisms in single samples) and for applications (in tunable photonic devices). Here, we thus apply ion-gel-based electrolyte gating to ultrathin epitaxial CdO(001) films, using transport, x-ray diffraction, and atomic force microscopy to deduce a reversible electrostatic gate response from −4 to +2 V, followed by rapid film degradation at higher gate voltage. Further advancing the mechanistic understanding of electrolyte gating, these observations are explained in terms of low oxygen vacancy diffusivity and high acid etchability in CdO. Most importantly, the 6-V-wide reversible electrostatic gating window is shown to enable ten-fold modulation of the Hall electron density, a striking voltage-induced metal–insulator transition, and 15-fold variation of the electron mobility. Such modulations, which are limited only by unintentional doping levels in ultrathin films, are of exceptional interest for voltage-tunable devices.

Evaluation of the feasibility of cardiac gating for SBRT of ventricular tachycardia based on real-time ECG signal acquisition.

To investigate the feasibility of cardiac synchronized gating in stereotactic body radiation therapy (SBRT) of ventricular tachycardia (VT) using a real-time electrocardiogram (ECG) signal acquisition. Stability of beam characteristics during simulated ECG gating was examined by developing a microcontroller interface to a Varian Clinac iX linear accelerator allowing gating at frequencies and duty cycles relevant to cardiac rhythm. Delivery accuracy was evaluated by measuring dose linearity with an ionization chamber, and flatness and symmetry with a two-dimensional detector array, for different gating windows within typical human cardiac cycle periods. To establish a practical method of gating based on actual ECG signals, an AD8232 Heart Monitor board was used to acquire the ECG signal and synchronize the beam delivery. Real-time cardiac gated delivery measurements were performed for a single 10×10cm2 field and for a VT-SBRT plan using intensity-modulated radiation therapy (IMRT). Dose per monitor unit (MU) values were found to be linear within most gating windows investigated with maximum differences relative to non-gated delivery of <2% for gating windows ≥200ms and for >10MUs. Beam profiles for both gated and non-gated modes were also found to agree with maximum differences of 0.5% relative to central axis dose for all sets of beam-on/beam-off combinations. Comparison of dose distributions for intensity-modulated SBRT plans between non-gating and cardiac gating modes provided a gamma passing rate of 97.2% for a 2% 2mm tolerance. Beam output is stable with respect to linearity, flatness, and symmetry for gating windows within cardiac cycle periods. Agreement between dose distributions for VT-SBRT using IMRT in non-gated and cardiac cycle gated delivery modes shows that the proposed methodology is feasible. Technically, gating for delivery of SBRT for VT is possible with regard to beam stability.

Endobronchial Implanted Real-Time Radiofrequency (RF) Transponder Beacon Guided, Respiratory-Gated, Stereotactic Body Radiotherapy for Moving Lung Tumors: Interim Analysis of a Prospective Phase I/II Cohort Study

<h3>Purpose/Objective(s)</h3> Endobronchially implanted real-time tracking system (technology company) radiofrequency (RF) transponder beacons provide real-time, high precision, positional data of moving lung tumors. We report interim results of a Phase I/II prospective single arm prospective cohort study evaluating feasibility and dosimetric impact of real-time tracking system beacons for patients undergoing SBRT for moving lung tumors. <h3>Materials/Methods</h3> Eligible patients were adults, ECOG 0-2, with T1-T2N0 Non-small cell lung cancer (NSCLC) or pulmonary metastasis ≤4cm of the right middle/lower lobe, or lingula. Upper lobe tumors were eligible if they moved ≥5mm. Three real-time tracking system beacons were endobronchially implanted at prespecified peritumoral locations using SuperDimension™ navigational bronchoscopy (Medtronic, USA). Four-dimensional free-breathing CT simulation scans were obtained and end-exhalation phases were selected to define a gating window (GW). A 3mm expansion of the ITV_GW defined the PTV. Real-time tracking system-guided, respiratory phase-gated, SBRT (GW-SBRT) was delivered using 10MV VMAT photon arcs at 2400MU/min to total doses of 54Gy/3# or 48Gy/4#. For each GW-SBRT plan, a corresponding 10-phase plan was generated for comparison to standard image-guided (IG)SBRT. PTV, and OAR metrics were tabulated and differences between GW-SBRT and IG-SBRT plans analyzed using non-parametric Wilcoxon Signed-Rank pair test. Treatment related toxicity was graded using the Common Terminology Criteria for Adverse Events (CTCAE) version 4.0. <h3>Results</h3> From November 2017 to December 2021, 41 patients were screened and 17 patients consented to participate. Two patients did not undergo beacon implant: one had tumor progression; another withdrew consent. Of the 15 patients with beacon implants, median age was 73, with 7 females. 47% were T1 NSCLC, 40% were M1 and remaining 13% were T2 NSCLC. Median tumor dimension was 1.9cm. 73% of targets were located peripherally, and 27% centrally with a median respiratory tumor motion of 1.25 cm (range 0.53 cm to 4.04 cm). No beacon migration was observed between CT simulation scan and the completion of SBRT treatments. Of the N=12 tumor targets were treated with GW-SBRT, 47% of patients received 48Gy/4# and 53% received 54Gy/3#. GW-SBRT yielded an average relative reduction of PTV of 46.9% (p<0.005) compared with IG-SBRT. Lung V5, V10, V20 and D2 had mean relative reductions of 11.3%, 20.3%, 31.1% and 15.5% respectively (p<0.005). Dose to OARs was significantly reduced (p<0.05) except for spinal cord. At 6 months follow-up, mean radiographic tumor volume reduction was 53.5% (p<0.005); No treatment related grade 3 toxicity was observed. <h3>Conclusion</h3> Endobronchial RF beacons are safe and effective at reducing SBRT treatment volumes for patients with moving lung tumors and can be considered for tumors with large motion amplitude or those located in close proximity to organs at risk. This study has the ClinicalTrials.gov identifier NCT03322072.

Surface Imaging-Guided Adaptive Radiotherapy (ART): Imaging Protocol and Verification for Inter- and Intra-Fractional Motion Managements

<h3>Purpose/Objective(s)</h3> CBCT-guided adaptive radiotherapy (CT-ART) has proven to account for inter-fractional anatomic changes. However, no commercial solution for intra-fractional respiratory motion management existed in CT-ART. Therefore, we investigated intra-fractional motion-managed treatment strategies in CT-ART (or Image-guided RT: IGRT) using optical surface imaging combined with <i>in-situ</i> CBCTs. <h3>Materials/Methods</h3> Eight of ten cancer patients with mobile lower lung or upper abdominal malignancies have completed CT-ART (or IGRT) using Ethos radiotherapy in an IRB-approved clinical trial (phase I). Four of the eight patients underwent additional MR simulations, including cine MRIs, to estimate the tumor/abdominal skin motion correlation. In CT-ART, a pre-configured gating window (±2 mm in vertical position) on surface imaging was used for manually triggering intra-fractional CBCT and treatment beam irradiation in breath-hold (six patients for exhalation and two patients for inhalation). A donut-shaped imaging-surrogate on patient's abdomen was used to localize Region of Interest (ROI) of the abdomen on CBCTs. Two inter-fractional CBCTs at exhalation and inhalation in each fraction were acquired to verify the tumor/imaging-surrogate motions range. Intra-fractional CBCTs were used to quantify the residual motion of the tumor/imaging-surrogate within the pre-configured gating window. Tumor motion was measured by tracking the position of a tumor centroid. <h3>Results</h3> The pre-configured gating window on surface imaging was confirmed based on the correlation of the tumor and abdominal skin motions using cine MRIs. Thirty-six pairs of inter-fractional CBCTs and 100 intra-fractional CBCTs from 36 fractions were analyzed (13 fractions for IGRT and 23 for ART). In the motion range study from the inter-fractional CBCTs, the values of mean ± std were 17.3 ± 12.0 mm in the SI direction for the tumors and 16.6 ± 7.9 mm in the AP direction for the imaging-surrogate, respectively. The residual motion of the imaging-surrogate from intra-fractional CBCTs was 2.5 ± 2.1 mm for SI, 2.3 ± 2.0 mm for RL, and 2.1 ± 2.3 mm for AP directions. The residual motion of the tumors was 2.4 ± 3.1 mm for SI, 2.3 ± 2.3 mm for RL, and 2.2 ± 2.0 mm for AP directions. Trends in the residual motion during the course of treatment fractions and over time through delivery were stable. Inter-fractional residual motions of the tumors were 2.3 ± 0.8 mm for SI, 2.3 ± 0.6 mm for RL, and 2.2 ± 0.7 mm for AP directions. Intra-fractional residual motions of the tumors were 2.4 ± 0.9 mm for SI, 2.4 ± 0.7 mm for RL, and 3.2 ± 1.3 mm for AP. <h3>Conclusion</h3> We demonstrated the inter- and intra-fractional motion-managed treatment strategies in CBCT-guided ART using surface imaging. Since the residual motion of the tumors was comparable to that of the imaging-surrogate within clinical PTV margins (5 mm) but a bit larger than the pre-configured gating window, additional caution is needed with intra-fractional motion management in CT-ART using the optical surface imaging.

Surface-guided DIBH radiotherapy for left breast cancer: impact of different thresholds on intrafractional motion monitoring and DIBH stability.

To compare two left breast cancer patient cohorts (tangential vs. locoregional deep-inspiration breath-hold- DIBH treatment) with different predefined beam gating thresholds and to evaluate their impact on motion management and DIBH stability. AnSGRT-based clinical workflow was adopted for the DIBH treatment. Intrafractional monitoring was performed by tracking both the respiratory signal and the real-time displacement between the isocenter on the daily reference surface and on the live surface ("SGRT shift"). Beam gating tolerances were 5 mm/4 mm for the SGRT shifts and 5 mm/3 mm for the gating window amplitude for breast tangential and breast + lymph nodes locoregional treatments, respectively. Atotal of 24patients, 12treated with atangential technique and 12with alocoregional technique, were evaluated for atotal number of 684 fractions. Statistical distributions of SGRT shift and respiratory signal for each treatment fraction, for each patient treatment, and for the two population samples were generated. Lateral cumulative distributions of SGRT shifts for both locoregional and tangential samples were consistent with anull shift, whereas longitudinal and vertical ones were slightly negative (mean values < 1 mm). The distribution of the percentage of beam on time with SGRT shift > 3 mm, > 4 mm, or > 5 mm was extended toward higher values for the tangential sample than for the locoregional sample. The variability in the DIBH respiration signal was significantly greater for the tangential sample. Different beam gating thresholds for surface-guided DIBH treatment of left breast cancer can impact motion management and DIBH stability by reducing the frequency of the maximum SGRT shift and increasing respiration signal stability when tighter thresholds are adopted.

Statistical evaluation of the effectiveness of dual amplitude-gated stereotactic body radiotherapy using fiducial markers and lung volume.

The low tracking accuracy of lung stereotactic body radiotherapy (SBRT) risks reduced treatment efficacy. We used four-dimensional computed tomography (4DCT) images to determine the correlation between changes in fiducial marker positions and lung volume for lung tumors, and we evaluated the effectiveness of the combined use of these images in lung SBRT. Data of 30 patients who underwent fiducial marker placement were retrospectively analyzed. We calculated the motion amplitudes of the center of gravity coordinates of the lung tumor and fiducial markers in each phase and the ipsilateral, contralateral, and bilateral lung volumes using 4DCT. Moreover, we calculated the cross-correlation coefficient between the fiducial marker position and the lung volume changes waveform for the motion amplitude waveform of the lung tumor over three gating windows (all phases, ≤2 mm3, and ≤3mm3). Compared with the lung volume, approximately 30% of the fiducial markers demonstrated a low correlation with the lung tumor. In the ≤2mm3 and ≤3mm3 gating windows, the cross-correlation coefficients between the lung tumor and the optimal marker (r>0.9: 83% and 86%) were significantly different for all fiducial markers (r>0.9: 39%, 53%) and the ipsilateral (r>0.9: 35% and 40%), contralateral (r>0.9: 44% and 41%), and bilateral (r>0.9: 39% and 45%) lung volumes. Some of the fiducial markers showed a low correlation with the lung tumor. This study indicated that the combined use of lung volume monitoring can improve tracking accuracy.

Assessment of intrafractional prostate motion and its dosimetric impact in MRI-guided online adaptive radiotherapy with gating

PurposeThis study aimed to evaluate the intrafractional prostate motion captured during gated magnetic resonance imaging (MRI)-guided online adaptive radiotherapy for prostate cancer and analyze its impact on the delivered dose as well as the effect of gating.MethodsSagittal 2D cine-MRI scans were acquired at 4 Hz during treatment at a ViewRay MRIdian (ViewRay Inc., Oakwood Village, OH, USA) MR linac. Prostate shifts in anterior–posterior (AP) and superior–inferior (SI) directions were extracted separately. Using the static dose cloud approximation, the planned fractional dose was shifted according to the 2D gated motion (residual motion in gating window) to estimate the delivered dose by superimposing and averaging the shifted dose volumes. The dose of a hypothetical non-gated delivery was reconstructed similarly using the non-gated motion. For the clinical target volume (CTV), rectum, and bladder, dose–volume histogram parameters of the planned and reconstructed doses were compared.ResultsIn total, 174 fractions (15.7 h of cine-MRI) from 10 patients were evaluated. The average (±1 σ) non-gated prostate motion was 0.6 ± 1.0 mm in the AP and 0.0 ± 0.6 mm in the SI direction with respect to the centroid position of the gating boundary. 95% of the shifts were within [−3.5, 2.7] mm in the AP and [−2.9, 3.2] mm in the SI direction. For the gated treatment and averaged over all fractions, CTV D98% decreased by less than 2% for all patients. The rectum and the bladder D2% increased by less than 3% and 0.5%, respectively. Doses reconstructed for gated and non-gated delivery were similar for most fractions.ConclusionA pipeline for extraction of prostate motion during gated MRI-guided radiotherapy based on 2D cine-MRI was implemented. The 2D motion data enabled an approximate estimation of the delivered dose. For the majority of fractions, the benefit of gating was negligible, and clinical dosimetric constraints were met, indicating safety of the currently adopted gated MRI-guided treatment workflow.

Fast-Gated 16 × 16 SPAD Array With 16 on-Chip 6 ps Time-to-Digital Converters for Non-Line-of-Sight Imaging

We present the design and characterization of a fully-integrated array of <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$16 \times 16$ </tex-math></inline-formula> Single-Photon Avalanche Diodes (SPADs) with fast-gating capabilities and 16 on-chip 6 ps time-to-digital converters, which has been embedded in a compact imaging module. Such sensor has been developed for Non-Line-Of-Sight imaging applications, which require: i) a narrow instrument response function, for a centimeteraccurate single-shot precision; ii) fast-gated SPADs, for time-filtering of directly reflected photons; iii) high photon detection probability, for acquiring faint signals undergoing multiple scattering events. Thanks to a novel multiple differential SPAD-SPAD sensing approach, SPAD detectors can be swiftly activated in less than 500 ps and the full-width at half maximum of the instrument response function is always less than 75 ps (60 ps on average). Temporal responses are consistently uniform throughout the gate window, showing just few picoseconds of time dispersion when 30 ns gate pulses are applied, while the differential non-linearity is as low as 250 fs. With a photon detection probability peak of 70% at 490 nm, a fill-factor of 9.6% and up to <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$1.6 \cdot 10^{8}$ </tex-math></inline-formula> photon time-tagging measurements per second, such sensor fulfills the demand for fully-integrated imaging solutions optimized for non-line-of-sight imaging applications, enabling to cut exposure times while also optimizing size, weight, power and cost, thus paving the way for further scaled architectures.

MR-guided beam gating: Residual motion, gating efficiency and dose reconstruction for stereotactic treatments of the liver and lung

PurposeThis study aims to investigate the efficiency and the geometric as well as the dosimetric benefit of magnetic-resonance guided beam gating for stereotactic treatments in moving organs. MethodPatients treated with MR-guided (MRIdian system) SBRT for lung (n = 10) and liver (n = 10) targets were analyzed. Breath-hold gating was performed based on lesion tracking in sagittal cine MRI images. The target offset from the geometric center of the gating window with and without gating was evaluated. A dose reconstruction workflow based on convolution of these 2D position-probability maps and the daily 3D dose distribution was used to estimate the daily delivered dose including motion. The dose to the clinical target volume (CTV) and to a 2-cm ring structure around the planning target volume were evaluated. ResultsThe applied gating protocol resulted in a mean (±standard deviation) gating efficiency of 55%±16%. Over all patients, the mean target offset (2D-root-mean-square error) was 8.3 ± 4.3 mm, which reduced to 2.4 ± 0.6 mm during gating. The dose reconstruction showed a mean deviation in CTV coverage (D95) from the static plans of −1.7%±1.8% with gating and −12.0%±8.4% if no gating would have been used. The mean dose (Dmean) in the ring structure, with respect to the static plans, showed mean deviations of −0.1%±0.3% with gating and −1.6%±1.8% without gating. ConclusionThe MRIdian system enables gating based on the inner anatomy and the implemented dose reconstruction workflow demonstrated geometric robust delivery of the planned radiation doses.

A Multi-Time-Gated SPAD Array with Integrated Coarse TDCs

Time-gating of single-photon avalanche diodes (SPADs) was commonly used as a method to reduce dark noise in biomedical imaging applications where photon events are correlated with a reference clock. Time-gating was also used to obtain timing information of photon events by shifting the gate windows applied to a SPAD array. However, in this approach, fine timing resolution comes at the cost of a lengthened measurement time due to the large number of counts required for each shift. As a solution, we present a multi-time-gated SPAD array that simultaneously applies shifted gate windows to an array of SPADs, which has the potential to reduce the measurement time compared to a single time gate window. Compared to similar works, this design has fully integrated the multi-gate generation using shared circuitry which also functions as a coarse time-to-digital converter. The proposed array, fabricated in the TSMC 65 nm standard CMOS process, achieved a median dark count rate (DCR) of 37 kHz, 4.37 ns gate widths, 550 ps timing resolution, and a peak photon detection probability (PDP) of 42.9% at 420 nm, all at a 0.8 V excess bias.

Modeling and optimization of respiratory-gated partial breast irradiation with proton beams - A Monte Carlo study

The selection of a suitable duty factor (DF) remains a major challenge in respiratory-gated treatments. Therefore, this study aims at presenting a new methodology for fast optimizing the gating window width (duty factor (DF)) in respiratory-gated proton partial breast irradiation (PBI). To do so, GATE Monte Carlo simulations were performed for various target sizes and locations in supine and prone positions. Three different duty factors of 20, 25, and 33% were considered. Sparing factors (SF) for four organs-at-risk (OARs) were then assessed. The weighted-sum method was employed to search for an optimal DF. The results indicate that an SF higher than unity was obtained for all plans. The SF also depends on the target size/location and the patient positioning. By increasing the DF, SF monotonically decreases. Optimal DF was found to be 25% and 20% for shallow-/laterally- and medially-located targets, respectively. It can be concluded that for PBI using multiple passively scattered proton fields with large hinge angles, the respiratory-gated treatment addresses the intrafractional target motion and the extent of its impact remains patient specific.

Enhancement of voltage controlled magnetic anisotropy (VCMA) through electron depletion

Recent advancement in the switching of perpendicular magnetic tunnel junctions with an electric field has been a milestone for realizing ultra-low energy memory and computing devices. To integrate with current spin-transfer torque-magnetic tunnel junction and spin–orbit torque-magnetic tunnel junction devices, the typical linear fJ/V m range voltage controlled magnetic anisotropy (VCMA) needs to be significantly enhanced with approaches that include new materials or stack engineering. A possible bidirectional and 1.1 pJ/V m VCMA effect has been predicted by using heavily electron-depleted Fe/MgO interfaces. To improve upon existing VCMA technology, we have proposed inserting high work function materials underneath the magnetic layer. This will deplete electrons from the magnetic layer biasing the gating window into the electron-depleted regime, where the pJ/V m and bidirectional VCMA effect was predicted. We have demonstrated tunable control of the Ta/Pd(x)/Ta underlayer's work function. By varying the Pd thickness (x) from 0 to 10 nm, we have observed a tunable change in the Ta layer's work function from 4.32 to 4.90 eV. To investigate the extent of the electron depletion as a function of the Pd thickness in the underlayer, we have performed DFT calculations on supercells of Ta/Pd(x)/Ta/CoFe/MgO, which demonstrate that electron depletion will not be fully screened at the CoFe/MgO interface. Gated pillar devices with Hall cross geometries were fabricated and tested to extract the anisotropy change as a function of applied gate voltage for samples with various Pd thicknesses. The electron-depleted Pd samples show three to six times VCMA improvement compared to the electron accumulated Ta control sample.

Gating has a negligible impact on dose delivered in MRI-guided online adaptive radiotherapy of prostate cancer

Background and purposeMR-guided radiotherapy (MRgRT) allows real-time beam-gating to compensate for intra-fractional target position variations. This study investigates the dosimetric impact of beam-gating and the impact of PTV margin on prostate coverage for prostate cancer patients treated with online-adaptive MRgRT. Materials and methods20 consecutive prostate cancer patients were treated with online-adaptive MRgRT SBRT with 36.25 Gy in 5 fractions (PTV D95% ≥ 95% (N = 5) and PTV D95% ≥ 100% (N = 15)). Sagittal 2D cine MRIs were used for gating on the prostate with a 3 mm expansion as the gating window. We computed motion-compensated dose distributions for (i) all prostate positions during treatment (simulating non-gated treatments) and (ii) for prostate positions within the gating window (gated treatments). To evaluate the impact of PTV margin on prostate coverage, we simulated coverage with smaller margins than clinically applied both for gated and non-gated treatments. Motion-compensated fraction doses were accumulated and dose metrics were compared. ResultsWe found a negligible dosimetric impact of beam-gating on prostate coverage (median of 0.00 Gy for both D95% and Dmean). For 18/20 patients, prostate coverage (D95% ≥ 100%) would have been ensured with a prostate-to-PTV margin of 3 mm, even without gating. The same was true for all but one fraction. ConclusionBeam-gating has negligible dosimetric impact in online-adaptive MRgRT of prostate cancer. Accounting for motion, the clinically used prostate-to-PTV margin could potentially be reduced from 5 mm to 3 mm for 18/20 patients.

Time-resolved MRI for off-line treatment robustness evaluation in carbon-ion radiotherapy of pancreatic cancer.

PurposeIn this study, we investigate the use of magnetic resonance imaging (MRI) for the clinical evaluation of gating treatment robustness in carbon‐ion radiotherapy (CIRT) of pancreatic cancer. Indeed, MRI allows radiation‐free repeated scans and fast dynamic sequences for time‐resolved (TR) imaging (cine‐MRI), providing information on inter‐ and intra‐fraction cycle‐to‐cycle variations of respiratory motion. MRI can therefore support treatment planning and verification, overcoming the limitations of the current clinical standard, that is, four‐dimensional computed tomography (4DCT), which describes an “average” breathing cycle neglecting breathing motion variability.MethodsWe integrated a technique to generate a virtual CT (vCT) from 3D MRI with a method for 3D reconstruction from 2D cine‐MRI, to produce TR vCTs for dose recalculations. For eight patients, the method allowed evaluating inter‐fraction variations at end‐exhale and intra‐fraction cycle‐to‐cycle variability within the gating window in terms of tumor displacement and dose to the target and organs at risk.ResultsThe median inter‐fraction tumor motion was in the range 3.33–12.16 mm, but the target coverage was robust (‐0.4% median D 95% variation). Concerning cycle‐to‐cycle variations, the gating technique was effective in limiting tumor displacement (1.35 mm median gating motion) and corresponding dose variations (‐3.9% median D 95% variation). The larger exposure of organs at risk (duodenum and stomach) was caused by inter‐fraction motion, whereas intra‐fraction cycle‐to‐cycle dose variations were limited.ConclusionsThis study proposed a method for the generation of TR vCTs from MRI, which enabled an off‐line evaluation of gating treatment robustness and suggested its feasibility to support treatment planning of pancreatic tumors in CIRT.

A transit portal dosimetry method for respiratory gating quality assurance with a dynamic 3D printed tumor phantom.

BackgroundsRespiratory gating is one of the motion management techniques that is used to deliver radiation dose to a tumor at a specific position under free breathing. However, due to the dynamic feedback process of this approach, regular equipment quality assurance (QA) and patient‐specific QA checks need to be performed. This work proposes a new QA methodology using electronic portal imaging detector (EPID) to determine the target localization accuracy of phase gating.MethodsQA tools comprising 3D printed spherical tumor phantoms, programmable stages, and an EPID detector are characterized and assembled. Algorithms for predicting portal dose (PD) through moving phantoms are developed and verified using gamma analysis for two spherical tumor phantoms (2 cm and 4 cm), two different 6 MV volumetric modulated arc therapy plans, and two different gating windows (30%–70% and 40%–60%). Comparison between the two gating windows is then performed using the Wilcoxon signed‐rank test. An optimizer routine, which is used to determine the optimal window, based on maximal gamma passing rate (GPR), was applied to an actual breathing curve and breathing plan. This was done to ascertain if our method yielded a similar result with the actual gating window.ResultsHigh GPRs of more than 97% and 91% were observed when comparing the predicted PD with the measured PD in moving phantom at 2 mm/2% and 1 mm/1% levels, respectively. Analysis of gamma heatmaps shows an excellent agreement with the tumor phantom.The GPR of 40%–60% PD was significantly lower than that of the 30%–70% PD at the 1 mm/1% level (p = 0.0064). At the 2 mm/2% level, no significant differences were observed. The optimizer routine could accurately predict the center of the gating window to within a 10% range.ConclusionWe have successfully performed and verified a new method for QA with the use of a moving phantom with EPID for phase gating with real‐time position management.