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At least 721 records · Page 40
All sourcesNASA NTRSDOE OSTI
DOE OSTI2011

Experimental verification of a real-time compensation functionality for dose changes due to target motion in scanned particle therapy

Purpose: Implementation and experimental assessment of a real-time dose compensation system for beam tracking in scanned carbon beam therapy of intrafractionally moving targets. Methods: A real-time dose compensation functionality has been developed and implemented at the experimental branch of the beam tracking system at GSI Helmholtzzentrum fuer Schwerionenforschung (GSI). Treatment plans for different target geometries have been optimized. They have been delivered using scanned carbon ions with beam tracking (BT) and real-time dose compensation combined with beam tracking (RDBT), respectively. Target motion was introduced by a rotating table. Dose distributions were assessed by ionization chamber measurements and dose reconstructions. These distributions have been compared to stationary delivery for BT as well as RDBT. Additionally simulations have been performed to investigate the dependence of delivered dose distributions on varying motion starting phases for BT and RDBT, respectively. Results: Average measured dose differences between static delivery and motion influenced delivery could be reduced from 27-68 mGy when BT was used to 12-37 mGy when RDBT was used. Nominal dose was 1000 mGy. Simulated dose deliveries showed improvements in dose delivery and robustness against varying starting motion phases when RDBT was used. Conclusions: A real-time dose compensation functionality extending the existing beam tracking functionality has been implemented and verified by measurements. Measurements and simulated dose deliveries show that real-time dose compensation can substantially improve delivered dose distributions for large rotational target motion compared to beam tracking alone.

61 RADIATION PROTECTION AND DOSIMETRY↗
DOE OSTI2011

Prostate implant reconstruction from C-arm images with motion-compensated tomosynthesis

Purpose: Accurate localization of prostate implants from several C-arm images is necessary for ultrasound-fluoroscopy fusion and intraoperative dosimetry. The authors propose a computational motion compensation method for tomosynthesis-based reconstruction that enables 3D localization of prostate implants from C-arm images despite C-arm oscillation and sagging. Methods: Five C-arm images are captured by rotating the C-arm around its primary axis, while measuring its rotation angle using a protractor or the C-arm joint encoder. The C-arm images are processed to obtain binary seed-only images from which a volume of interest is reconstructed. The motion compensation algorithm, iteratively, compensates for 2D translational motion of the C-arm by maximizing the number of voxels that project on a seed projection in all of the images. This obviates the need for C-arm full pose tracking traditionally implemented using radio-opaque fiducials or external trackers. The proposed reconstruction method is tested in simulations, in a phantom study and on ten patient data sets. Results: In a phantom implanted with 136 dummy seeds, the seed detection rate was 100% with a localization error of 0.86 {+-} 0.44 mm (Mean {+-} STD) compared to CT. For patient data sets, a detection rate of 99.5% was achieved in approximately 1 min per patient. The reconstruction results for patient data sets were compared against an available matching-based reconstruction method and showed relative localization difference of 0.5 {+-} 0.4 mm. Conclusions: The motion compensation method can successfully compensate for large C-arm motion without using radio-opaque fiducial or external trackers. Considering the efficacy of the algorithm, its successful reconstruction rate and low computational burden, the algorithm is feasible for clinical use.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2013

Application of a spring-dashpot system to clinical lung tumor motion data

Purpose: The treatment efficacy of radiation therapy for lung tumors can be increased by compensating for breath-induced tumor motion. In this study, we quantitatively examine a mathematical model of pseudomechanical linkages between an external surrogate signal and lung tumor motion. Methods: A spring-dashpot system based on the Voigt model was developed to model the correlation between abdominal respiratory motion and tumor motion during lung radiotherapy. The model was applied to clinical data obtained from 52 treatments ('beams') from 10 patients, treated on the Mitsubishi Real-Time Radiation Therapy system, Sapporo, Japan. In Stage 1, model parameters were optimized for individual patients and beams to determine reference values and to investigate how well the model can describe the data. In Stage 2, for each patient the optimal parameters determined for a single beam were applied to data from other beams to investigate whether a beam-specific set of model parameters is sufficient to model tumor motion over a course of treatment. Results: In Stage 1, the baseline root mean square (RMS) residual error for all individually optimized beam data was 0.90 {+-} 0.40 mm (mean {+-} 1 standard deviation). In Stage 2, patient-specific model parameters based on a single beam were found to model the tumor position closely, even for irregular beam data, with a mean increase with respect to Stage 1 values in RMS error of 0.37 mm. On average, the obtained model output for the tumor position was 95% of the time within an absolute bound of 2.0 and 2.6 mm in Stages 1 and 2, respectively. The model was capable of dealing with baseline, amplitude and frequency variations of the input data, as well as phase shifts between the input abdominal and output tumor signals. Conclusions: These results indicate that it may be feasible to collect patient-specific model parameters during or prior to the first treatment, and then retain these for the rest of the treatment period. The model has potential for clinical application during radiotherapy treatment of lung tumors.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2013

Four-dimensional Monte Carlo simulations demonstrating how the extent of intensity-modulation impacts motion effects in proton therapy lung treatments

Purpose: To compare motion effects in intensity modulated proton therapy (IMPT) lung treatments with different levels of intensity modulation.Methods: Spot scanning IMPT treatment plans were generated for ten lung cancer patients for 2.5Gy(RBE) and 12Gy(RBE) fractions and two distinct energy-dependent spot sizes (σ∼8–17 mm and ∼2–4 mm). IMPT plans were generated with the target homogeneity of each individual field restricted to <20% (IMPT{sub 20%}). These plans were compared to full IMPT (IMPT{sub full}), which had no restriction on the single field homogeneity. 4D Monte Carlo simulations were performed upon the patient 4DCT geometry, including deformable image registration and incorporating the detailed timing structure of the proton delivery system. Motion effects were quantified via comparison of the results of the 4D simulations (4D-IMPT{sub 20%}, 4D-IMPT{sub full}) with those of a 3D Monte Carlo simulation (3D-IMPT{sub 20%}, 3D-IMPT{sub full}) upon the planning CT using the equivalent uniform dose (EUD), V{sub 95} and D{sub 1}-D{sub 99}. The effects in normal lung were quantified using mean lung dose (MLD) and V{sub 90%}.Results: For 2.5Gy(RBE), the mean EUD for the large spot size is 99.9%± 2.8% for 4D-IMPT{sub 20%} compared to 100.1%± 2.9% for 4D-IMPT{sub full}. The corresponding values are 88.6%± 8.7% (4D-IMPT{sub 20%}) and 91.0%± 9.3% (4D-IMPT{sub full}) for the smaller spot size. The EUD value is higher in 69.7% of the considered deliveries for 4D-IMPT{sub full}. The V{sub 95} is also higher in 74.7% of the plans for 4D-IMPT{sub full}, implying that IMPT{sub full} plans experience less underdose compared to IMPT{sub 20%}. However, the target dose homogeneity is improved in the majority (67.8%) of plans for 4D-IMPT{sub 20%}. The higher EUD and V{sub 95} suggests that the degraded homogeneity in IMPT{sub full} is actually due to the introduction of hot spots in the target volume, perhaps resulting from the sharper in-target dose gradients. The greatest variations between the IMPT{sub 20%} and IMPT{sub full} deliveries are observed for patients with the largest motion amplitudes. These patients would likely be treated using gating or another motion mitigation technique, which was not the focus of this study.Conclusions: For the treatment parameters considered in this study, the differences between IMPT{sub full} and IMPT{sub 20%} are only likely to be clinically significant for patients with large (>20 mm) motion amplitudes.

61 RADIATION PROTECTION AND DOSIMETRY↗
DOE OSTI2014

SU-E-J-142: Performance Study of Automatic Image-Segmentation Algorithms in Motion Tracking Via MR-IGRT

Purpose: Evaluate commonly used segmentation algorithms on a commercially available real-time MR image guided radiotherapy (MR-IGRT) system (ViewRay), compare the strengths and weaknesses of each method, with the purpose of improving motion tracking for more accurate radiotherapy. Methods: MR motion images of bladder, kidney, duodenum, and liver tumor were acquired for three patients using a commercial on-board MR imaging system and an imaging protocol used during MR-IGRT. A series of 40 frames were selected for each case to cover at least 3 respiratory cycles. Thresholding, Canny edge detection, fuzzy k-means (FKM), k-harmonic means (KHM), and reaction-diffusion level set evolution (RD-LSE), along with the ViewRay treatment planning and delivery system (TPDS) were included in the comparisons. To evaluate the segmentation results, an expert manual contouring of the organs or tumor from a physician was used as a ground-truth. Metrics value of sensitivity, specificity, Jaccard similarity, and Dice coefficient were computed for comparison. Results: In the segmentation of single image frame, all methods successfully segmented the bladder and kidney, but only FKM, KHM and TPDS were able to segment the liver tumor and the duodenum. For segmenting motion image series, the TPDS method had the highest sensitivity, Jarccard, and Dice coefficients in segmenting bladder and kidney, while FKM and KHM had a slightly higher specificity. A similar pattern was observed when segmenting the liver tumor and the duodenum. The Canny method is not suitable for consistently segmenting motion frames in an automated process, while thresholding and RD-LSE cannot consistently segment a liver tumor and the duodenum. Conclusion: The study compared six different segmentation methods and showed the effectiveness of the ViewRay TPDS algorithm in segmenting motion images during MR-IGRT. Future studies include a selection of conformal segmentation methods based on image/organ-specific information, different filtering methods and their influences on the segmentation results. Parag Parikh receives research grant from ViewRay. Sasa Mutic has consulting and research agreements with ViewRay. Yanle Hu receives travel reimbursement from ViewRay. Iwan Kawrakow and James Dempsey are ViewRay employees.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

MO-G-18C-03: Evaluation of Deformable Image Registration for Lung Motion Estimation Using Hyperpolarized Gas Tagging MRI

Purpose: Hyperpolarized gas (HP) tagging MRI is a novel imaging technique for direct measurement of lung motion during breathing. This study aims to quantitatively evaluate the accuracy of deformable image registration (DIR) in lung motion estimation using HP tagging MRI as references. Methods: Three healthy subjects were imaged using the HP MR tagging, as well as a high-resolution 3D proton MR sequence (TrueFISP) at the end-of-inhalation (EOI) and the end-of-exhalation (EOE). Ground truth of lung motion and corresponding displacement vector field (tDVF) was derived from HP tagging MRI by manually tracking the displacement of tagging grids between EOI and EOE. Seven different DIR methods were applied to the high-resolution TrueFISP MR images (EOI and EOE) to generate the DIR-based DVFs (dDVF). The DIR methods include Velocity (VEL), MIM, Mirada, multi-grid B-spline from Elastix (MGB) and 3 other algorithms from DIRART toolbox (Double Force Demons (DFD), Improved Lucas-Kanade (ILK), and Iterative Optical Flow (IOF)). All registrations were performed by independent experts. Target registration error (TRE) was calculated as tDVF – dDVF. Analysis was performed for the entire lungs, and separately for the upper and lower lungs. Results: Significant differences between tDVF and dDVF were observed. Besides the DFD and IOF algorithms, all other dDVFs showed similarity in deformation magnitude distribution but away from the ground truth. The average TRE for entire lung ranged 2.5−23.7mm (mean=8.8mm), depending on the DIR method and subject's breathing amplitude. Larger TRE (13.3–23.7mm) was found in subject with larger breathing amplitude of 45.6mm. TRE was greater in lower lung (2.5−33.9 mm, mean=12.4mm) than that in upper lung (2.5−11.9 mm, mean=5.8mm). Conclusion: Significant differences were observed in lung motion estimation between the HP gas tagging MRI method and the DIR methods, especially when lung motion is large. Large variation among different DIR methods was also observed.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

TH-C-BRD-08: Reducing the Effect of Respiratory Motion On the Delivered Dose in Proton Therapy Through Proper Field Angle Selection

Purpose: This work investigated a novel planning strategy of selecting radiotherapy beam angles that minimizes the change in water equivalent thickness (dWET) during respiration in order to reduce the effects of respiratory motion in passively scattered proton therapy (PSPT). Methods: In a clinical trial treating locally-advanced lung cancer with proton therapy, 2–4 co-planar beams were previously selected by dosimetrists in the design of physician-approved PSPT treatment plans. The authors identified a cohort of patients in which respiratory motion affected the planned PSPT dose delivery. For this cohort, this work analyzed dWET during respiration over a 360 degree arc of potential treatment angles around the patient: the dWET was defined as the difference in WET between the full-exhale (T50) and full-inhale (T0) phases of the simulation 4DCT. New PSPT plans were redesigned by selecting new beam angles that demonstrated significant reduction in the value of dWET. Between the T50 and T0 phases, the root-mean-square deviation of dose and the change in dose-volume histogram curves (dAUC) for anatomical structures were calculated to compare the original to dWET reduction plans. Results: To date, three plans were retrospectively redesigned based on dWET analysis. In the dWET reduction plan, the root mean square dose (T50-T0) was reduced by 15–35% and the DVH dAUC values were reduced by more than 60%.The PSPT plans redesigned by selecting appropriate field angles to minimize dWET demonstrated less dosimetric variation due to respiration. Conclusion: We have introduced the use of a new metric to quantify respiratory motion in proton therapy: dWET. The use of dWET allows us to minimize the impact of respiratory motion of the entire anatomy in the beam path. This work is a proof of principle that dWET could suggest field angles in proton therapy that are more robust to the effects of respiratory motion.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

TH-C-18A-11: Investigating the Minimum Scan Parameters Required to Generate Free-Breathing Fast-Helical CT Scans Without Motion-Artifacts

Purpose: A recently proposed 4D-CT protocol uses deformable registration of free-breathing fast-helical CT scans to generate a breathing motion model. In order to allow accurate registration, free-breathing images are required to be free of doubling-artifacts, which arise when tissue motion is greater than scan speed. This work identifies the minimum scanner parameters required to successfully generate free-breathing fast-helical scans without doubling-artifacts. Methods: 10 patients were imaged under free breathing conditions 25 times in alternating directions with a 64-slice CT scanner using a low dose fast helical protocol. A high temporal resolution (0.1s) 4D-CT was generated using a patient specific motion model and patient breathing waveforms, and used as the input for a scanner simulation. Forward projections were calculated using helical cone-beam geometry (800 projections per rotation) and a GPU accelerated reconstruction algorithm was implemented. Various CT scanner detector widths and rotation times were simulated, and verified using a motion phantom. Doubling-artifacts were quantified in patient images using structural similarity maps to determine the similarity between axial slices. Results: Increasing amounts of doubling-artifacts were observed with increasing rotation times > 0.2s for 16×1mm slice scan geometry. No significant increase in doubling artifacts was observed for 64×1mm slice scan geometry up to 1.0s rotation time although blurring artifacts were observed >0.6s. Using a 16×1mm slice scan geometry, a rotation time of less than 0.3s (53mm/s scan speed) would be required to produce images of similar quality to a 64×1mm slice scan geometry. Conclusion: The current generation of 16 slice CT scanners, which are present in most Radiation Oncology departments, are not capable of generating free-breathing sorting-artifact-free images in the majority of patients. The next generation of CT scanners should be capable of at least 53mm/s scan speed in order to use a fast-helical 4D-CT protocol to generate a motion-artifact free 4D-CT. NIH R01CA096679.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

A method of surface marker location optimization for tumor motion estimation in lung stereotactic body radiation therapy

Purpose: Accurately localizing lung tumor localization is essential for high-precision radiation therapy techniques such as stereotactic body radiation therapy (SBRT). Since direct monitoring of tumor motion is not always achievable due to the limitation of imaging modalities for treatment guidance, placement of fiducial markers on the patient’s body surface to act as a surrogate for tumor position prediction is a practical alternative for tracking lung tumor motion during SBRT treatments. In this work, the authors propose an innovative and robust model to solve the multimarker position optimization problem. The model is able to overcome the major drawbacks of the sparse optimization approach (SOA) model. Methods: The principle-component-analysis (PCA) method was employed as the framework to build the authors’ statistical prediction model. The method can be divided into two stages. The first stage is to build the surrogate tumor matrix and calculate its eigenvalues and associated eigenvectors. The second stage is to determine the “best represented” columns of the eigenvector matrix obtained from stage one and subsequently acquire the optimal marker positions as well as numbers. Using 4-dimensional CT (4DCT) and breath hold CT imaging data, the PCA method was compared to the SOA method with respect to calculation time, average prediction accuracy, prediction stability, noise resistance, marker position consistency, and marker distribution. Results: The PCA and SOA methods which were both tested were on all 11 patients for a total of 130 cases including 4DCT and breath-hold CT scenarios. The maximum calculation time for the PCA method was less than 1 s with 64 752 surface points, whereas the average calculation time for the SOA method was over 12 min with 400 surface points. Overall, the tumor center position prediction errors were comparable between the two methods, and all were less than 1.5 mm. However, for the extreme scenarios (breath hold), the prediction errors for the PCA method were not only smaller, but were also more stable than for the SOA method. Results obtained by imposing a series of random noises to the surrogates indicated that the PCA method was much more noise resistant than the SOA method. The marker position consistency tests using various combinations of 4DCT phases to construct the surrogates suggested that the marker position predictions of the PCA method were more consistent than those of the SOA method, in spite of surrogate construction. Marker distribution tests indicated that greater than 80% of the calculated marker positions fell into the high cross correlation and high motion magnitude regions for both of the algorithms. Conclusions: The PCA model is an accurate, efficient, robust, and practical model for solving the multimarker position optimization problem to predict lung tumor motion during SBRT treatments. Due to its generality, PCA model can also be applied to other imaging guidance system whichever using surface motion as the surrogates.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

Verification and compensation of respiratory motion using an ultrasound imaging system

Purpose: The purpose of this study was to determine if it is feasible to use ultrasound imaging as an aid for moving the treatment couch during diagnosis and treatment procedures associated with radiation therapy, in order to offset organ displacement caused by respiratory motion. A noninvasive ultrasound system was used to replace the C-arm device during diagnosis and treatment with the aims of reducing the x-ray radiation dose on the human body while simultaneously being able to monitor organ displacements. Methods: This study used a proposed respiratory compensating system combined with an ultrasound imaging system to monitor the compensation effect of respiratory motion. The accuracy of the compensation effect was verified by fluoroscopy, which means that fluoroscopy could be replaced so as to reduce unnecessary radiation dose on patients. A respiratory simulation system was used to simulate the respiratory motion of the human abdomen and a strain gauge (respiratory signal acquisition device) was used to capture the simulated respiratory signals. The target displacements could be detected by an ultrasound probe and used as a reference for adjusting the gain value of the respiratory signal used by the respiratory compensating system. This ensured that the amplitude of the respiratory compensation signal was a faithful representation of the target displacement. Results: The results show that performing respiratory compensation with the assistance of the ultrasound images reduced the compensation error of the respiratory compensating system to 0.81–2.92 mm, both for sine-wave input signals with amplitudes of 5, 10, and 15 mm, and human respiratory signals; this represented compensation of the respiratory motion by up to 92.48%. In addition, the respiratory signals of 10 patients were captured in clinical trials, while their diaphragm displacements were observed simultaneously using ultrasound. Using the respiratory compensating system to offset, the diaphragm displacement resulted in compensation rates of 60%–84.4%. Conclusions: This study has shown that a respiratory compensating system combined with noninvasive ultrasound can provide real-time compensation of the respiratory motion of patients.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-P-25: Evaluation of Motion in Pancreas SBRT Treatment Deliveries

Purpose: Stereotactic Body Radiation Therapy (SBRT) procedures for pancreatic cancer present a challenge in motion management because the target is directly adjacent to critical structures and the target is subject to significant respiratory motion. Gated treatment is usually planned with a tight (few mm) PTV margin. The positioning and setup relies on on-board-imaging (OBI) of internal fiducials. This study evaluates the corrections for inter- and intra-fractional target motion as evidenced by the OBI. Methods: 20 patients with gated pancreas SBRT treatment were setup with KV imaging guidance before and during each treatment. The couch position was fine-tuned to align with the internal fiducials for each patient. The data for 148 intra- and 111 inter-fractional couch movements were captured and analyzed. Results: The mean ± standard deviation of couch shifts for the initial daily setup is 4.9±4.1 mm for couch vertical, 5.3±4.6 mm for couch longitudinal, and 3.7±4.0 mm for couch lateral. The mean ± standard deviation of intra-treatment adjustments are 1.1±1.6, 2.5±3.8, and 1.1±1.8 mm for couch vertical, longitudinal and lateral. The probability of intra-fractional motion in the three orthogonal directions with magnitude no more than 2 mm, 3 mm and 5 mm is 55%, 68% and 84% respectively. Conclusion: The intra-treatment target motion for pancreas SBRT patients indicates that a PTV margin of 5mm may be necessary.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-J-57: First Development of Adapting to Intrafraction Relative Motion Between Prostate and Pelvic Lymph Nodes Targets

Purpose Large intrafraction relative motion of multiple targets is common in advanced head and neck, lung, abdominal, gynaecological and urological cancer, jeopardizing the treatment outcomes. The objective of this study is to develop a real-time adaptation strategy, for the first time, to accurately correct for the relative motion of multiple targets by reshaping the treatment field using the multi-leaf collimator (MLC). Methods The principle of tracking the simultaneously treated but differentially moving tumor targets is to determine the new aperture shape that conforms to the shifted targets. Three dimensional volumes representing the individual targets are projected to the beam’s eye view. The leaf openings falling inside each 2D projection will be shifted according to the measured motion of each target to form the new aperture shape. Based on the updated beam shape, new leaf positions will be determined with optimized trade-off between the target underdose and healthy tissue overdose, and considerations of the physical constraints of the MLC. Taking a prostate cancer patient with pelvic lymph node involvement as an example, a preliminary dosimetric study was conducted to demonstrate the potential treatment improvement compared to the state-of- art adaptation technique which shifts the whole beam to track only one target. Results The world-first intrafraction adaptation system capable of reshaping the beam to correct for the relative motion of multiple targets has been developed. The dose in the static nodes and small bowel are closer to the planned distribution and the V45 of small bowel is decreased from 110cc to 75cc, corresponding to a 30% reduction by this technique compared to the state-of-art adaptation technique. Conclusion The developed adaptation system to correct for intrafraction relative motion of multiple targets will guarantee the tumour coverage and thus enable PTV margin reduction to minimize the high target dose to the adjacent organs-at-risk. The authors acknowledge funding support from the Australian NHMRC Australia Fellowship and NHMRC Project Grant No. APP1042375.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-J-164: Estimation of DVH Variation for PTV Due to Interfraction Organ Motion in Prostate VMAT Using Gaussian Error Function

Purpose: We developed a method to predict the change of DVH for PTV due to interfraction organ motion in prostate VMAT without repeating the CT scan and treatment planning. The method is based on a pre-calculated patient database with DVH curves of PTV modelled by the Gaussian error function (GEF). Methods: For a group of 30 patients with different prostate sizes, their VMAT plans were recalculated by shifting their PTVs 1 cm with 10 increments in the anterior-posterior, left-right and superior-inferior directions. The DVH curve of PTV in each replan was then fitted by the GEF to determine parameters describing the shape of curve. Information of parameters, varying with the DVH change due to prostate motion for different prostate sizes, was analyzed and stored in a database of a program written by MATLAB. Results: To predict a new DVH for PTV due to prostate interfraction motion, prostate size and shift distance with direction were input to the program. Parameters modelling the DVH for PTV were determined based on the pre-calculated patient dataset. From the new parameters, DVH curves of PTVs with and without considering the prostate motion were plotted for comparison. The program was verified with different prostate cases involving interfraction prostate shifts and replans. Conclusion: Variation of DVH for PTV in prostate VMAT can be predicted using a pre-calculated patient database with DVH curve fitting. The computing time is fast because CT rescan and replan are not required. This quick DVH estimation can help radiation staff to determine if the changed PTV coverage due to prostate shift is tolerable in the treatment. However, it should be noted that the program can only consider prostate interfraction motions along three axes, and is restricted to prostate VMAT plan using the same plan script in the treatment planning system.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-J-175: Comparison of the Treatment Reproducibility of Tumors Affected by Breathing Motion

Purpose: The aim of the dose distribution simulations was to form a global idea of intensity-modulated radiation therapy (IMRT) realization, by its comparison to three-dimensional conformal radiation therapy (3DCRT) delivery for tumors affected by respiratory motion. Methods: In the group of 10patients both 3DCRT and IMRT plans were prepared.For each field the motion kernel was generated with the largest movement amplitude of 4;6 and 8mm.Additionally,the sets of reference measurements were made in no motion conditions(0 mm).The evaluation of plan delivery,using a diode array placed on moving platform,was based on the Gamma Index analysis with distance to agreement of 3mm and dose difference of 3%. Results: IMRT plans tended to spare doses delivered to lungs compared to 3DCRT.Nonetheless,analyzed volumes showed no significant difference between the static and dynamic techniques,except for the volumes of both lungs receiving 10 and 15Gy.After adding the components associated with the respiratory movement,all IMRT lung parameters evaluated for the ipsilateral,contralateral and both lungs together,revealed considerable differences between the 0vs.6, 0vs.8 and 4vs.8-mm amplitudes.Similar results were obtained for the 3DCRT lung measurements,but without significance between the 0vs.6-mm amplitude.Taking into account the CTV score parameter in 3DCRT and IMRT plans,there was no statistically significant difference between the motion patterns with the smallest amplitudes.The differences were found for the 8-mm amplitude when it was compared both with static conditions and 4-mm amplitude (for 3DCRT) and between 0vs.6, 0vs.8 and 4vs.8-mm amplitudes (for IMRT).All accepted and measured 3DCRT and IMRT doses to spinal cord,esophagus and heart were always below the QUANTEC limits. Conclusion: The application of IMRT technique in lung radiotherapy affords possibilities for reducing the lung doses.For maximal amplitudes of breathing trajectory below 4mm,the disagreement between CTV planned and delivered dose distribution can be neglected.Whereas respiratory motion with an amplitude above 5mm leads to significant changes in IMRT delivery.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-508: Internal Organ Motion Effect On Radiation Dose to a Point Under Half-Beam Block Match Line

Purpose Half-beam block is a field matching technique frequently used in radiotherapy. With no setup error, a well calibrated linac, and no internal organ motion, two photon fields can be matched seamlessly dosimetry-wise with their central axes passing the match line. However, in actual clinical situations, internal organ motion is often inevitable. This study was conducted to investigate its influence on radiation dose to patient internal points directly under the matching line. Methods A clinical setting is modeled as two half-space (x<0 and x<0) radiation fields that are turned on sequentially with a time gap of integer times of the patient internal organ motion period (T{sub 0}). Our point of interest moves with patient internal organs periodically and evenly in and out of the radiation fields, resulting in an average location at x=0. When the fields are delivered without any motion management, the initial phase of the point’s movement is unknown. Statistical methods are used to compute the expected value ( ) and variance (σ) of the point dose given the uncertainty. Results Analytical solutions are obtained for and s of dose received by a point directly under the match line. is proportional to the total beam-on time (T1), and σ demonstrates previously unknown periodic behavior. /<Dσ has local maximums (minimums) when T{sub 1} is 2n*T{sub 0} ((2n+1)*T{sub 0}) (n is an integer) with an upper envelope scales as 1/T{sub 1}. Worst case scenario the point dose can be zero or double of the expected value. Conclusion We have analytically analyzed the internal organ motion effect on radiation dose received by a patient internal point directly under a half-beam block match line. Our results help us to better understand this phenomenon and facilitate the reduction of point dosimetric uncertainties in our clinical practice.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-570: New Quality Assurance Method Using Motion Tracking for 6D Robotic Couches

Purpose: To accommodate geometrically accurate patient positioning, a robotic couch that is capable of 6-degrees of freedom has been introduced. However, conventional couch QA methods are not sufficient to enable the necessary accuracy of tests. Therefore, we have developed a camera based motion detection and geometry calibration system for couch QA. Methods: Employing a Visual-Tracking System (VTS, BonitaB10, Vicon, UK) which tracks infrared reflective(IR) markers, camera calibration was conducted using a 5.7 × 5.7 × 5.7 cm{sup 3} cube attached with IR markers at each corner. After positioning a robotic-couch at the origin with the cube on the table top, 3D coordinates of the cube’s eight corners were acquired by VTS in the VTS coordinate system. Next, positions in reference coordinates (roomcoordinates) were assigned using the known relation between each point. Finally, camera calibration was completed by finding a transformation matrix between VTS and reference coordinate systems and by applying a pseudo inverse matrix method. After the calibration, the accuracy of linear and rotational motions as well as couch sagging could be measured by analyzing the continuously acquired data of the cube while the couch moves to a designated position. Accuracy of the developed software was verified through comparison with measurement data when using a Laser tracker (FARO, Lake Mary, USA) for a robotic-couch installed for proton therapy. Results: VTS system could track couch motion accurately and measured position in room-coordinates. The VTS measurements and Laser tracker data agreed within 1% of difference for linear and rotational motions. Also because the program analyzes motion in 3-Dimension, it can compute couch sagging. Conclusion: Developed QA system provides submillimeter/ degree accuracy which fulfills the high-end couch QA. This work was supported by the National Research Foundation of Korea funded by Ministry of Science, ICT & Future Planning. (2013M2A2A7043507 and 2012M3A9B6055201)

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2015

TU-AB-303-06: Does Online Adaptive Radiation Therapy Mean Zero Margin for Intermediate-Risk Prostate Cancer? An Intra-Fractional Seminal Vesicles Motion Analysis

Purpose: To provide benchmark for seminal vesicles (SVs) margin selection to account for intra-fractional motion; and to investigate the effectiveness of two motion surrogates in predicting intra-fractional SV underdosage. Methods: 9 prostate SBRT patients were studied; each has five pairs of pre-treatment and post-treatment cone-beam CTs (CBCTs). Each pair of CBCTs was registered based on fiducial markers in the prostate. To provide “ground truth” for coverage evaluation, all pre-treatment SVs were expanded with isotropic margin of 1,2,3,5 and 8mm, and their overlap with post-treatment SVs were used to quantify intra-fractional coverage. Two commonly used motion surrogates, the center-of-mass (COM) and the border of contour (the most distal points in SI/AP/LR directions) were evaluated using Receiver-Operating Characteristic (ROC) analyses for predicting SV underdosage due to intra-fractional motion. Action threshold of determining underdosage for each surrogate was calculated by selecting the optimal balancing between sensitivity and specificity. For comparison, margin for each surrogate was also calculated based on traditional margin recipe. Results: 90% post-treatment SV coverage can be achieved in 47%, 82%, 91%, 98% and 98% fractions for 1,2,3,5 and 8mm margins. 3mm margin ensured the 90% intra-fractional SV coverage in 90% fractions when prostate was aligned. The ROC analysis indicated the AUC for COM and border were 0.88 and 0.72. The underdosage threshold was 2.9mm for COM and 4.1mm for border. The Van Herk’s margin recipe recommended 0.5, 0 and 1.8mm margin in LR, AP and SI direction based on COM and for border, the corresponding margin was 2.1, 4.5 and 3mm. Conclusion: 3mm isotropic margin is the minimum required to mitigate the intra-fractional SV motion when prostate is aligned. ROC analysis reveals that both COM and border are acceptable predictors for SV underdosage with 2.9mm and 4.1mm action threshold. Traditional margin calculation is less reliable for this application. This work is partially supported a master research grant from Varian Medical Systems.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

WE-AB-303-11: Verification of a Deformable 4DCT Motion Model for Lung Tumor Tracking Using Different Driving Surrogates

Purpose: Tumor tracking is an advanced technique to treat intra-fractionally moving tumors. The aim of this study is to validate a surrogate-driven model based on four-dimensional computed tomography (4DCT) that is able to predict CT volumes corresponding to arbitrary respiratory states. Further, the comparison of three different driving surrogates is evaluated. Methods: This study is based on multiple 4DCTs of two patients treated for bronchial carcinoma and metastasis. Analyses for 18 additional patients are currently ongoing. The motion model was estimated from the planning 4DCT through deformable image registration. To predict a certain phase of a follow-up 4DCT, the model considers for inter-fractional variations (baseline correction) and intra-fractional respiratory parameters (amplitude and phase) derived from surrogates. In this evaluation, three different approaches were used to extract the motion surrogate: for each 4DCT phase, the 3D thoraco-abdominal surface motion, the body volume and the anterior-posterior motion of a virtual single external marker defined on the sternum were investigated. The estimated volumes resulting from the model were compared to the ground-truth clinical 4DCTs using absolute HU differences in the lung volume and landmarks localized using the Scale Invariant Feature Transform (SIFT). Results: The results show absolute HU differences between estimated and ground-truth images with median values limited to 55 HU and inter-quartile ranges (IQR) lower than 100 HU. Median 3D distances between about 1500 matching landmarks are below 2 mm for 3D surface motion and body volume methods. The single marker surrogates Result in increased median distances up to 0.6 mm. Analyses for the extended database incl. 20 patients are currently in progress. Conclusion: The results depend mainly on the image quality of the initial 4DCTs and the deformable image registration. All investigated surrogates can be used to estimate follow-up 4DCT phases, however uncertainties decrease for three-dimensional approaches. This work was funded in parts by the German Research Council (DFG) - KFO 214/2.

60 APPLIED LIFE SCIENCES↗