Analysis of Interfraction Prostate Motion Using Megavoltage Cone Beam Computed Tomography

Bylund, Kevin; Bayouth, John E.; Smith, Mark C.; Hass, A. Curtis; Bhatia, Sudershan K.; Buatti, John M.

doi:10.1016/j.ijrobp.2008.07.002

Cited by 84 publications

(64 citation statements)

References 35 publications

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“…The previously reported range of inter-fractional motion of the prostate, as measured by a standard deviation from the initial setup, was 0.7 -5.2 mm for all directions [2] [3] [8]- [13]. Table 3 lists the previous studies of the daily inter-fractional motions of the prostate measured by various image guidance methods [5]- [7]. Bylund et al reported a total of 984 daily megavoltage CBCT images from 24 patients undergoing definitive IMRT for localized prostate cancer; the mean displacement of the inter-fractional motion was 4.8, 2.9, and 2.1 mm in the AP, LR, and SI directions, respectively [5].…”

Section: Discussionmentioning

confidence: 99%

“…Table 3 lists the previous studies of the daily inter-fractional motions of the prostate measured by various image guidance methods [5]- [7]. Bylund et al reported a total of 984 daily megavoltage CBCT images from 24 patients undergoing definitive IMRT for localized prostate cancer; the mean displacement of the inter-fractional motion was 4.8, 2.9, and 2.1 mm in the AP, LR, and SI directions, respectively [5]. Scarbrough et al investigated the inter-fractional motions of the prostate in 40 patients using ultrasound and fiducial seed markers; with ultrasound, the rates of <5 mm inter-fractional motion were 61.4%, 69.3%, and 59.6% in the AP, LR, SI directions respectively, and, with fiducial seed markers, were 64.5%, 78.4%, and 68.4% in the AP, LR, SI directions,…”

Section: Discussionmentioning

confidence: 99%

“…Many recent studies have focused on localizing and quantifying prostate displacement [2]- [4]. Various targeting modalities have been used, such as two-dimensional portal imaging, and fiducial marker matching to three-dimensional (3D) volumetric computed tomography (CT) and ultrasound information [5]- [7]. These findings may offer the potential for an increased dose to be safely delivered to the target with reduced acute and late toxicity rates.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy of Daily Cone-Beam Computed Tomography as Part of a Rescan Protocol for Large Offset to Reduce the Inter-Fractional Motion of the Prostate

Yamaguchi¹,

Ohguri²,

Imada³

et al. 2014

IJMPCERO

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Purpose: To prospectively analyze the inter-fractional motion of the prostate in patients with prostate cancer treated with intensity-modulated radiation therapy (IMRT) using image-guided radiotherapy (IGRT) with daily cone-beam computed tomography (CBCT) as part of a rescan protocol for large offset, and to evaluate the efficacy of our protocol. Materials and Methods: Eligible patients were treated with the following protocol: 1) magnesium oxide and dimethylpolysiloxane were administered to ensure that patients had regular bowel movements; 2) the patients were instructed to have an appropriately distended bladder during the planning CT and daily irradiation; 3) the daily CBCT image was fused with the planning CT image using the prostate outline; and 4) if large offset was recognized, a rescan CBCT image was obtained after appropriate countermeasures, such as the discharge of gas and defecation, and re-registration was performed. Three shifts for the inter-fractional motion of the prostate were analyzed, in the fractions which needed the CBCT rescan; the displacement data after the final rescan were used. Results: Sixty-one patients were eligible, and a total of 2302 fractions were available for the analysis. Rescans of the CBCT for large offset were performed in 113 (5%) of the 2302 fractions. After the first rescan, the large offset was resolved in 106 (94%) of the 113 fractions. Excessive rectal gas was the reason for the large offset in 94 (83%) of the 113 fractions. The total mean and standard deviation of the inter-fractional motion of the prostate in the AP, LR, and SI directions were 1.1 ± 2.4, −0.1 ± 2.3, and 0.7 ± 3.0 mm, respectively. Conclusion: Large offset was recognized in 5% of all fractions. Daily * Corresponding author. S. Yamaguchi et al. 194CBCT with our rescan protocol could resolve the large offset, which was mainly caused by excessive rectal gas, and it may therefore be promising to reduce the inter-fractional motion of the prostate.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Efficacy of Daily Cone-Beam Computed Tomography as Part of a Rescan Protocol for Large Offset to Reduce the Inter-Fractional Motion of the Prostate

Yamaguchi¹,

Ohguri²,

Imada³

et al. 2014

IJMPCERO

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“…In the study by Bylund et al 20 patients were given no direction regarding bladder or bowel emptying, diet or laxative use. They observed that the internal prostate motion was 3.8 mm when the setup was performed according to bony structures.…”

Section: Discussionmentioning

confidence: 99%

Determination of the Planning Target Volume Margin by the Use of kv Portal Imaging and kvCone Beam Computerized Tomography.

Yazıcı¹

2013

UHOD

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With portal imaging devices we can easily determine the position of bones in the patient, but we cannot visualize soft tissues. Kilo voltage cone beam computed tomography (CBCT) imaging integrated to treatment machine is relatively a new technique and provides higher resolution of soft tissues for imaging. In this study, our aim was to measure the differences between 2D-2D and 3D-3D registration based set-ups. We investigated whether using kV cone beam CT reduced setup errors compared to kV portal imaging. Four patients with the diagnosis of head and neck cancer (2 patients with cancer in the base of tongue, 2 with hypopharyngeal cancer) and 6 patients with prostate cancer were included in our study. The treatments were delivered with IMRT. kvCBCT-kv film comparisions were evaluated in 44 sets of data for head and neck cancer patients, and in 130 sets of data for prostate cancer patients. We analyzed the necessary planning target volume (PTV) margins for each group when only kv portal imaging is performed every day and found that a margin of 2.1 and 1.5 mm in all directions would be sufficient in case of pelvic tumors and head and neck cancers respectively if the kv portal images are performed every day. Compared to the literature the shifts were minimal when kvCBCT was performed after kv portal imaging. The immobilization procedures, followed strictly, may be reason for this observation.Keywords: Planning target volume margin, Set-up margin, kv portal imaging, Cone beam computed tomography ÖZET kv Portal Görüntüleme ve kvCone Beam Bilgisayarl› Tomografi ile Planlanan Hedef Hacim S›n›rlar›n›n BelirlenmesiPortal görüntüleme yöntemleri ile hastan›n kemik yap›lar›n› kolayca görüntüleyebiliriz, ancak yumuflak dokular bu yöntemle izlenemez. Kilo voltaj cone beam bilgisayarl› tomografi (CBCT) görüntüleme yöntemlerinin tedavi cihazlar›na entegre edilmesi nispeten yeni bir yöntemdir ve yumuflak dokular›n daha yüksek çözünürlükte görüntülemesini sa¤lar. Bu çal›flmada amac›m›z iki buyutlu görüntüleme ifllemleri ile yap›lan set-up ile üç boyutlu görüntüleme yöntemleri ile yap›lan set-up aras›ndaki fark› araflt›rmak ve set-up hatalar› aç›-s›ndan kvCBCT nin portal görüntülemeye göre set-up hatalar›n› ne kadar düzeltti¤ni incelemektir. Dört bafl ve boyun kanserli (2 hasta dil kökü, 2 hasta hipofarinks) ve dört prostat kanserli hasta çal›flmaya dahil edildi. Tedaviler yo¤unluk ayarl› radyoterapi (YART) yöntemi ile uyguland›. Bafl boyun kanserli hastalardan elde olunan 44 kvCBCT-kv portal film karfl›laflt›rmas› ve prostat kanserli hastalardan elde olunan 130 kvCBCT-kv portal film karfl›laflt›rmas› de¤erlendirildi. Analizler sonucunda her gün sadece kv portal görüntüleme yap›ld›¤›nda gerekli PTV emniyetinin bafl boyun kanserleri için 1.5mm ve prostat kanseri için 2.1 mm oldu¤u bulundu. Literatür ile k›yasland›¤›nda kv portal görüntüleme sonras› kvCBCT uyguland›¤›nda kaymalar›n minimal oldu¤u bulunmufltur. Bunun nedenlerinden biri immobilizasyon yöntemlerinin ve haz›rl›k aflamalar›n›n her hasta için özenle uygulanm›fl olm...

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“…[8][9] In the literature, the prostate motion has been well described while SV motion and dosimetric analysis have been relatively less well reported. [10][11][12][13][14][15][16][17][18] When the SV are included in the target volume, independent motion and the rotation of the SV and prostate may affect the dose distribution of the SV in prostate based image guidance. Stenmark et al showed that the displacement of the SV was different from the prostate and this movement was more in the distal part rather than the proximal part of SV.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Interfractional Movement of the Seminal Vesicle and Dose Variations with IGRT Throughout the Prostate Cancer Radiotherapy.

Ergen¹

2016

UHOD

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To validate the actual cumulative doses delivered to the seminal vesicle (SV) depending on the organ movement using kV-Cone Beam CT (kV-CBCT) datasets acquired during prostate image-guided radiation therapy. Ten patients with intermediate risk prostate cancer treated with IMRT were included in this study. Both the prostate and the first 2 cm of the SV were included in the CTV. PTV margin was 8 mm in all directions except posterior, where it was 5 mm. Sixteen kV-CBCT scans per patient were used for assessments. After each kV-CBCT was matched with the planning CT based on prostate, the SV were recontoured as proximal, distal SV and both of them together (the whole SV). Actual delivered doses to the SV were assessed by means of DVH. The variations in certain dosevolume parameters were analyzed using the Student's test. Systematic and random errors of the SV and margins were assessed using the van-Herk formula. We observed that the SV movement in the anterior-posterior direction was significantly more compared to superior-inferior and left-right direction. The dose volume variations for the whole SV (D98%, D50%, D2%) and the distal SV (D98%, D95%, D50%) were significantly different than the planned doses. However, both the whole SV and the distal SV received the prescribed dose. Although it seems that there is a need to give larger margin to the SV in posterior direction, the actual cumulative doses delivered to SV throughout the treatment were within the prescribed dose.Keywords: Image guided radiation therapy, Interfraction motions, kV-CBCT, Prostate cancer, Seminal vesicle ÖZET Prostat kanseri Radyoterapisi Sırasında Fraksiyonlar Arası Seminal Vezikül Hareketleri ve Doz Değişimlerinin IGRT ile DeğerlendirilmesiBu çalışmanın amacı, kV-Cone Beam CT (kV-CBCT) ile görüntü kılavuzluğunda prostat kanseri radyoterapisinde organ hareketine bağlı olarak seminal veziküllerin aldığı kümülatif dozların doğruluğunun değerlendirilmesidir. Çalışmamıza IMRT tekniği ile tedavi edilmiş orta risk prostat kanserli on hasta dahil edilmiştir. Prostat ve seminal vesiküllerin ilk 2 cm'lik bölümü CTV'ye dahil edilmiştir. Prostat ve SV'e posterior yönden 5 mm, diğer yönlerden 8 mm PTV marjı verilmiştir. Her hastadan 16 kV-CBCT alınmış ve SV'ye verilen marjın yeterli olup olmadığını saptamak için seçilen kV-CBCT görüntüleri ile planlama BT görüntüleri prostat referans alınarak offline eşleştirilmiştir. Seminal veziküller, proksimal-distal SV şeklinde ayrı ayrı ve her ikisi birlikte tüm SV olacak şekilde yeniden konturlanmıştır. Seminal veziküllerin aldığı doz DVH yardımı ile değerlendirilmiştir. Doz volüm histogramındaki değişiklikler Student test ile analiz edilmiştir. Sistematik ve random hatalar van-Herk formülü ile değerlendirilerek gerekli emniyet marjları bulunmuştur. Seminal vezikül hareketinin alt-üst ve sağ-sol yöne kıyasla ön-arka eksende daha fazla olduğu görülmüştür. Tüm SV için (D98% D50,% D2%) ve distal SV için doz volüm değişiklikleri (D98% D95,% D50%) planlanan dozlardan önemli ölçüde farklı bulunmuştur. Bununla bir...

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Analysis of Interfraction Prostate Motion Using Megavoltage Cone Beam Computed Tomography

Cited by 84 publications

References 35 publications

Efficacy of Daily Cone-Beam Computed Tomography as Part of a Rescan Protocol for Large Offset to Reduce the Inter-Fractional Motion of the Prostate

Efficacy of Daily Cone-Beam Computed Tomography as Part of a Rescan Protocol for Large Offset to Reduce the Inter-Fractional Motion of the Prostate

Determination of the Planning Target Volume Margin by the Use of kv Portal Imaging and kvCone Beam Computerized Tomography.

Evaluation of Interfractional Movement of the Seminal Vesicle and Dose Variations with IGRT Throughout the Prostate Cancer Radiotherapy.

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