Deformable image registration is an important tool for image-guided radiotherapy. Physics-modelbased deformable image registration using finite element analysis is one of the methods currently being investigated. The calculation accuracy of finite element analysis is dependent on given boundary conditions, which are usually based on the surface matching of the organ in two images. Such a surface matching, however, is hard to obtain from medical images. In this study, we developed a new boundary condition to circumvent the traditional difficulties. Finite element contact-impact analysis was employed to simulate the interaction between the organ of interest and the surrounding body. The displacement loading is not necessarily specified. The algorithm automatically deforms the organ model into the minimum internal energy state. The analysis was performed on CT images of the lung at two different breathing phases ͑exhalation and full inhalation͒. The result gave the displacement vector map inside the lung. Validation of the result showed satisfactory agreement in most parts of the lung. This approach is simple, operator independent and may provide improved accuracy of the prediction of organ deformation. © 2004 American Association of Physicists in Medicine.
(2006) Feasibility report of image guided stereotactic body radiotherapy (IG-SBRT) with tomotherapy for early stage medically inoperable lung cancer using extreme hypofractionation, Acta Oncologica, 45:7,[890][891][892][893][894][895][896]
It is becoming common clinical practice to shift prostate patients daily based on transabdominal ultrasound (US) or imaging of implanted fiducial markers. This paper investigates the dosimetric impact of these shifts by looking at five patients shifted using an optically guided 3D US localization system and treated with IMRT. Treatment plans were generated for each patient for the following 3 cases: (1) the initial preplan, which represents the ideal case in which no shifts are necessary; (2) a postplan incorporating each day's actual shifts; and (3) a postplan in which no shifts were made but the internal organs move by the amounts indicated by daily US imaging. Results show that when daily shifts are made, doses to the target, rectal wall, and bladder wall are nearly identical to those in the preplan. Equivalent uniform dose (EUD) and tumor control probability (TCP) for these plans were also the same as for the preplans. When no shifts were made, however, the dose distributions were degraded, and the computed target EUD and TCP were lower for all five patients. The magnitude of these differences varied: for three patients, the TCP was only 1%-2% lower than for the preplan. For the other two patients, however, the EUD was reduced by more than 10%, resulting in TCP reductions of 6% and 11%. These results indicate that for a symmetric beam arrangement and properly chosenmargins, shifting the patient each day and treating without recalculating the dose is unlikely toaffect local control or the sparing of normal tissues.
Recently, there has been proliferation of image-guided positioning systems for high-precision radiation therapy, with little attention given to quality assurance procedures for such systems. To ensure accurate treatment delivery, errors in the imaging, localization, and treatment delivery processes must be systematically analyzed. This paper details acceptance tests for an optically guided three-dimensional (3D) ultrasound system used for patient localization. While all tests were performed using the same commercial system, the general philosophy and procedures are applicable to all systems utilizing image guidance. Determination of absolute localization accuracy requires a consistent stereotactic, or three-dimensional, coordinate system in the treatment planning system and the treatment vault. We established such a coordinate system using optical guidance. The accuracy of this system for localization of spherical targets imbedded in a phantom at depths ranging from 3 to 13 cm was determined to be (average +/- standard deviation) AP = 0.2 +/- 0.7 mm, Lat = 0.9 +/- 0.6 mm, Ax = 0.6 +/- 1.0 mm. In order to test the ability of the optically guided 3D ultrasound localization system to determine the magnitude of an internal organ shift with respect to the treatment isocenter, a phantom that closely mimics the typical human male pelvic anatomy was used. A CT scan of the phantom was acquired, and the regions of interest were contoured. With the phantom on the treatment couch, optical guidance was used to determine the positions of each organ to within imaging uncertainty, and to align the phantom so the plan and treatment machine coordinates coincided. To simulate a clinical misalignment of the treatment target, the phantom was then shifted by different precise offsets, and an experimenter blind to the offsets used ultrasound guidance to determine the magnitude of the shifts. On average, the magnitude of the shifts could be determined to within 1.0 mm along each axis.
Stereotactic body radiotherapy (SBRT) can be used to treat small lesions in the chest. A vacuum-based immobilization system is used in our clinic for SBRT, and a motion envelope is used in treatment planning. The purpose of this study is to automatically derive motion envelopes using deformable image registration of 4D-CT images, and to assess the effect of abdominal pressure on the motion envelopes. 4D-CT scans at ten phases were acquired prior to treatment for both free and restricted breathing using a vacuum-based immobilization system that includes an abdominal pressure pillow. To study the stability of the motion envelope over the course of treatment, a mid-treatment 4D-CT scan was obtained after delivery of the third fraction for two patients. The planning target volume excluding breathing motion (PTV(ex)) was defined on the image set at full exhalation phase and transformed into all other phases using displacement maps from deformable image registration. The motion envelope was obtained as the union of PTV(ex) masks of all phases. The ratios of the motion envelope to PTV(ex) volume ranged from 1.3 to 2.5. When pressure was applied, the ratios were reduced by as much as 29% compared to free breathing for some patients, but increased by up to 9% for others. The abdominal pressure pillow has more motion restriction effects on the anterior/inferior region of the lung. For one of the two patients for whom the 4D-CT scan was repeated at mid-treatment, the motion envelope was reproducible. However, for the other patient the tumor location and lung motion pattern significantly changed due to changes in the anatomy surrounding the tumor during the course of treatment, indicating that an image-guided approach to SBRT may increase the efficacy of this treatment.
In this paper we report on the testing and verification of a system for IMRT delivery quality assurance that uses a cylindrical solid water phantom with a spiral trajectory for radiographic film placement. This spiral film technique provides more complete dosimetric verification of the entire IMRT treatment than perpendicular film methods, since it samples a three-dimensional dose subspace rather than using measurements at only one or two depths. As an example, the complete analysis of the predicted and measured spiral films is described for an intracranial IMRT treatment case. The results of this analysis are compared to those of a single field perpendicular film technique that is typically used for IMRT QA. The comparison demonstrates that both methods result in a dosimetric error within a clinical tolerance of 5%, however the spiral phantom QA technique provides a more complete dosimetric verification while being less time consuming. To independently verify the dosimetry obtained with the spiral film, the same IMRT treatment was delivered to a similar phantom in which LiF thermoluminescent dosimeters were arranged along the spiral trajectory. The maximum difference between the predicted and measured TLD data for the 1.8 Gy fraction was 0.06 Gy for a TLD located in a high dose gradient region. This further validates the ability of the spiral phantom QA process to accurately verify delivery of an IMRT plan.
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