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Title: An analysis of the treatment couch and control system dynamics for respiration-induced motion compensation

Abstract

Sophisticated methods for real-time motion compensation include using the linear accelerator, MLC, or treatment couch. To design such a couch, the required couch and control system dynamics need to be investigated. We used an existing treatment couch known as the Hexapod{sup TM} to gain insight into couch dynamics and an internal model controller to simulate feedback control of respiration-induced motion. The couch dynamics, described using time constants and dead times, were investigated using step inputs. The resulting data were modeled as first and second order systems with dead time. The couch was determined to have a linear response for step inputs {<=}1 cm. Motion data from 12 patients were obtained using a skin marker placed on the abdomen of the patient and the marker data were assumed to be an exact surrogate of tumor motion. The feedback system was modeled with the couch as a second-ordersystem and the controller as a first order system. The time constants of the couch and controller and the dead times were varied starting with parameters obtained from the Hexapod{sup TM} couch and the performance of the feedback system was evaluated. The resulting residual motion under feedback control was generally <0.3 cm when a fastmore » enough couch was simulated.« less

Authors:
;  [1];  [2]
  1. Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland 21201 (United States)
  2. (United States)
Publication Date:
OSTI Identifier:
20853836
Resource Type:
Journal Article
Resource Relation:
Journal Name: Medical Physics; Journal Volume: 33; Journal Issue: 12; Other Information: DOI: 10.1118/1.2372218; (c) 2006 American Association of Physicists in Medicine; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; ABDOMEN; COLLIMATORS; CONTROL SYSTEMS; DEAD TIME; LINEAR ACCELERATORS; NEOPLASMS; PATIENTS; PERFORMANCE; RADIOTHERAPY; RESPIRATION; SKIN

Citation Formats

D'Souza, Warren D., McAvoy, Thomas J., and Department of Chemical Engineering and Institute of Systems Research, University of Maryland, College Park, Maryland 20742. An analysis of the treatment couch and control system dynamics for respiration-induced motion compensation. United States: N. p., 2006. Web. doi:10.1118/1.2372218.
D'Souza, Warren D., McAvoy, Thomas J., & Department of Chemical Engineering and Institute of Systems Research, University of Maryland, College Park, Maryland 20742. An analysis of the treatment couch and control system dynamics for respiration-induced motion compensation. United States. doi:10.1118/1.2372218.
D'Souza, Warren D., McAvoy, Thomas J., and Department of Chemical Engineering and Institute of Systems Research, University of Maryland, College Park, Maryland 20742. Fri . "An analysis of the treatment couch and control system dynamics for respiration-induced motion compensation". United States. doi:10.1118/1.2372218.
@article{osti_20853836,
title = {An analysis of the treatment couch and control system dynamics for respiration-induced motion compensation},
author = {D'Souza, Warren D. and McAvoy, Thomas J. and Department of Chemical Engineering and Institute of Systems Research, University of Maryland, College Park, Maryland 20742},
abstractNote = {Sophisticated methods for real-time motion compensation include using the linear accelerator, MLC, or treatment couch. To design such a couch, the required couch and control system dynamics need to be investigated. We used an existing treatment couch known as the Hexapod{sup TM} to gain insight into couch dynamics and an internal model controller to simulate feedback control of respiration-induced motion. The couch dynamics, described using time constants and dead times, were investigated using step inputs. The resulting data were modeled as first and second order systems with dead time. The couch was determined to have a linear response for step inputs {<=}1 cm. Motion data from 12 patients were obtained using a skin marker placed on the abdomen of the patient and the marker data were assumed to be an exact surrogate of tumor motion. The feedback system was modeled with the couch as a second-ordersystem and the controller as a first order system. The time constants of the couch and controller and the dead times were varied starting with parameters obtained from the Hexapod{sup TM} couch and the performance of the feedback system was evaluated. The resulting residual motion under feedback control was generally <0.3 cm when a fast enough couch was simulated.},
doi = {10.1118/1.2372218},
journal = {Medical Physics},
number = 12,
volume = 33,
place = {United States},
year = {Fri Dec 15 00:00:00 EST 2006},
month = {Fri Dec 15 00:00:00 EST 2006}
}
  • In this study, the authors introduce and demonstrate quality control procedures for evaluating the geometric and dosimetric fidelity of dynamic treatment delivery techniques involving treatment couch motion synchronous with gantry and multileaf collimator (MLC). Tests were designed to evaluate positional accuracy, velocity constancy and accuracy for dynamic couch motion under a realistic weight load. A test evaluating the geometric accuracy of the system in delivering treatments over complex dynamic trajectories was also devised. Custom XML scripts that control the Varian TrueBeam™ STx (Serial #3) axes in Developer Mode were written to implement the delivery sequences for the tests. Delivered dosemore » patterns were captured with radiographic film or the electronic portal imaging device. The couch translational accuracy in dynamic treatment mode was 0.01 cm. Rotational accuracy was within 0.3°, with 0.04 cm displacement of the rotational axis. Dose intensity profiles capturing the velocity constancy and accuracy for translations and rotation exhibited standard deviation and maximum deviations below 3%. For complex delivery involving MLC and couch motions, the overall translational accuracy for reproducing programmed patterns was within 0.06 cm. The authors conclude that in Developer Mode, TrueBeam™ is capable of delivering dynamic treatment delivery techniques involving couch motion with good geometric and dosimetric fidelity.« less
  • Purpose: To determine how frequently (1) tumor motion and (2) the spatial relationship between tumor and respiratory surrogate markers change during a treatment fraction in lung and pancreas cancer patients. Methods and Materials: A Cyberknife Synchrony system radiographically localized the tumor and simultaneously tracked three respiratory surrogate markers fixed to a form-fitting vest. Data in 55 lung and 29 pancreas fractions were divided into successive 10-min blocks. Mean tumor positions and tumor position distributions were compared across 10-min blocks of data. Treatment margins were calculated from both 10 and 30 min of data. Partial least squares (PLS) regression models ofmore » tumor positions as a function of external surrogate marker positions were created from the first 10 min of data in each fraction; the incidence of significant PLS model degradation was used to assess changes in the spatial relationship between tumors and surrogate markers. Results: The absolute change in mean tumor position from first to third 10-min blocks was >5 mm in 13% and 7% of lung and pancreas cases, respectively. Superior-inferior and medial-lateral differences in mean tumor position were significantly associated with the lobe of lung. In 61% and 54% of lung and pancreas fractions, respectively, margins calculated from 30 min of data were larger than margins calculated from 10 min of data. The change in treatment margin magnitude for superior-inferior motion was >1 mm in 42% of lung and 45% of pancreas fractions. Significantly increasing tumor position prediction model error (mean {+-} standard deviation rates of change of 1.6 {+-} 2.5 mm per 10 min) over 30 min indicated tumor-surrogate relationship changes in 63% of fractions. Conclusions: Both tumor motion and the relationship between tumor and respiratory surrogate displacements change in most treatment fractions for patient in-room time of 30 min.« less
  • Radiation therapy to the cranial-spinal axis is typically targeted to the spinal cord and to the cerebrospinal fluid (CSF) in the subarachnoid space adjacent to the spinal cord and brain. Standard techniques employed in the treatment of the whole central nervous system do little to compensate for the varying depths of spinal cord along the length of the spinal field. Lateral simulation films, sagittal magnetic resonance imaging (MRI), or computerized tomography (CT) are used to estimate an average prescription depth for treatment along the spine field. However, due to the varying depth of the target along the spinal axis, evenmore » with the use of physical compensators, there can be considerable dose inhomogeneity along the spine field. With the advent of treatment machines that have full dynamic capabilities, a technique has been devised that will allow for more conformal dose distribution along the full length of the spinal field. This project simulates this technique utilizing computer-controlled couch motion to deliver multiple small electron beams of differing energies and intensities. CT planning determines target depth along the entire spine volume. The ability to conform dose along the complete length of the treatment field is investigated through the application of superpositioning of the fields as energies and intensities change. The positioning of each beam is registered with the treatment couch dynamic motion. This allows for 1 setup in the treatment room rather than multiple setups for each treatment position, which would have been previously required. Dose-volume histograms are utilized to evaluate the dose delivered to structures in the beam exit region. This technique will allow for precise localization and delivery of a homogeneous dose to the entire CSF space.« less
  • Purpose: To determine whether patients could tolerate the motion of a robotic couch that compensates for breathing-induced tumor motion. Methods and Materials: A total of 10 healthy subjects and 23 radio-oncology patients underwent simulated extracranial stereotactic radiotherapy (two 30-min sessions) on a robotic couch programmed to follow a fictitious tumor trajectory of 20x5x5 mm (cranio-caudal, left-right, and anterior-posterior directions, respectively) while rotating 2 deg. around a cranio-caudal axis at a frequency of 5 seconds per loop. Results: No session had to be interrupted and no nausea was induced. However, one patient refused the second session due to general deterioration andmore » not all patients could keep their arms elevated for the entire session. Conclusions: Our findings showed that most patients tolerated compensatory couch motion and that motion sickness should not pose a problem in the investigation of this tumor-tracking method.« less
  • Purpose: To evaluate the residual setup error and intrafraction motion following kilovoltage cone-beam CT (CBCT) image guidance, for immobilized spine stereotactic body radiotherapy (SBRT) patients, with positioning corrected for in all six degrees of freedom. Methods and Materials: Analysis is based on 42 consecutive patients (48 thoracic and/or lumbar metastases) treated with a total of 106 fractions and 307 image registrations. Following initial setup, a CBCT was acquired for patient alignment and a pretreatment CBCT taken to verify shifts and determine the residual setup error, followed by a midtreatment and posttreatment CBCT image. For 13 single-fraction SBRT patients, two midtreatmentmore » CBCT images were obtained. Initially, a 1.5-mm and 1 Degree-Sign tolerance was used to reposition the patient following couch shifts which was subsequently reduced to 1 mm and 1 Degree-Sign degree after the first 10 patients. Results: Small positioning errors after the initial CBCT setup were observed, with 90% occurring within 1 mm and 97% within 1 Degree-Sign . In analyzing the impact of the time interval for verification imaging (10 {+-} 3 min) and subsequent image acquisitions (17 {+-} 4 min), the residual setup error was not significantly different (p > 0.05). A significant difference (p = 0.04) in the average three-dimensional intrafraction positional deviations favoring a more strict tolerance in translation (1 mm vs. 1.5 mm) was observed. The absolute intrafraction motion averaged over all patients and all directions along x, y, and z axis ({+-} SD) were 0.7 {+-} 0.5 mm and 0.5 {+-} 0.4 mm for the 1.5 mm and 1 mm tolerance, respectively. Based on a 1-mm and 1 Degree-Sign correction threshold, the target was localized to within 1.2 mm and 0.9 Degree-Sign with 95% confidence. Conclusion: Near-rigid body immobilization, intrafraction CBCT imaging approximately every 15-20 min, and strict repositioning thresholds in six degrees of freedom yields minimal intrafraction motion allowing for safe spine SBRT delivery.« less