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Title: Sci—Fri AM: Mountain — 06: Optimizing planning target volume in lung radiotherapy using deformable registration

Abstract

A four dimensional computed tomography (4DCT) image is acquired for all radically treated, lung cancer patients to define the internal target volume (ITV), which encompasses tumour motion due to breathing and subclinical disease. Patient set-up error and anatomical motion that is not due to breathing is addressed through an additional 1 cm margin around the ITV to obtain the planning target volume (PTV). The objective of this retrospective study is to find the minimum PTV margin that provides an acceptable probability of delivering the prescribed dose to the ITV. Acquisition of a kV cone beam computed tomography (CBCT) image at each fraction was used to shift the treatment couch to accurately align the spinal cord and carina. Our method utilized deformable image registration to automatically position the planning ITV on each CBCT. We evaluated the percentage of the ITV surface that fell within various PTVs for 79 fractions across 18 patients. Treatment success was defined as a situation where at least 99% of the ITV is covered by the PTV. Overall, this is to be achieved in at least 90% of the treatment fractions. The current approach with a 1cm PTV margin was successful ∼96% of the time. This analysismore » revealed that the current margin can be reduced to 0.8cm isotropic or 0.6×0.6×1 cm{sup 3} non-isotropic, which were successful 92 and 91 percent of the time respectively. Moreover, we have shown that these margins maintain accuracy, despite intrafractional variation, and maximize CBCT image guidance capabilities.« less

Authors:
 [1];  [1];  [2]
  1. McMaster University, Medical Physics and Applied Radiation Sciences Department, Hamilton, Ontario (Canada)
  2. (Canada)
Publication Date:
OSTI Identifier:
22407703
Resource Type:
Journal Article
Resource Relation:
Journal Name: Medical Physics; Journal Volume: 41; Journal Issue: 8; Other Information: (c) 2014 American Association of Physicists in Medicine; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
60 APPLIED LIFE SCIENCES; ACCURACY; COMPUTERIZED TOMOGRAPHY; FOUR-DIMENSIONAL CALCULATIONS; LUNGS; NEOPLASMS; OPTIMIZATION; PATIENTS; PLANNING; RADIOTHERAPY; RESPIRATION; SPINAL CORD

Citation Formats

Hoang, P, Wierzbicki, M, and Juravinski Cancer Centre, Medical Physics Department, Hamilton, Ontario. Sci—Fri AM: Mountain — 06: Optimizing planning target volume in lung radiotherapy using deformable registration. United States: N. p., 2014. Web. doi:10.1118/1.4894946.
Hoang, P, Wierzbicki, M, & Juravinski Cancer Centre, Medical Physics Department, Hamilton, Ontario. Sci—Fri AM: Mountain — 06: Optimizing planning target volume in lung radiotherapy using deformable registration. United States. doi:10.1118/1.4894946.
Hoang, P, Wierzbicki, M, and Juravinski Cancer Centre, Medical Physics Department, Hamilton, Ontario. Fri . "Sci—Fri AM: Mountain — 06: Optimizing planning target volume in lung radiotherapy using deformable registration". United States. doi:10.1118/1.4894946.
@article{osti_22407703,
title = {Sci—Fri AM: Mountain — 06: Optimizing planning target volume in lung radiotherapy using deformable registration},
author = {Hoang, P and Wierzbicki, M and Juravinski Cancer Centre, Medical Physics Department, Hamilton, Ontario},
abstractNote = {A four dimensional computed tomography (4DCT) image is acquired for all radically treated, lung cancer patients to define the internal target volume (ITV), which encompasses tumour motion due to breathing and subclinical disease. Patient set-up error and anatomical motion that is not due to breathing is addressed through an additional 1 cm margin around the ITV to obtain the planning target volume (PTV). The objective of this retrospective study is to find the minimum PTV margin that provides an acceptable probability of delivering the prescribed dose to the ITV. Acquisition of a kV cone beam computed tomography (CBCT) image at each fraction was used to shift the treatment couch to accurately align the spinal cord and carina. Our method utilized deformable image registration to automatically position the planning ITV on each CBCT. We evaluated the percentage of the ITV surface that fell within various PTVs for 79 fractions across 18 patients. Treatment success was defined as a situation where at least 99% of the ITV is covered by the PTV. Overall, this is to be achieved in at least 90% of the treatment fractions. The current approach with a 1cm PTV margin was successful ∼96% of the time. This analysis revealed that the current margin can be reduced to 0.8cm isotropic or 0.6×0.6×1 cm{sup 3} non-isotropic, which were successful 92 and 91 percent of the time respectively. Moreover, we have shown that these margins maintain accuracy, despite intrafractional variation, and maximize CBCT image guidance capabilities.},
doi = {10.1118/1.4894946},
journal = {Medical Physics},
number = 8,
volume = 41,
place = {United States},
year = {Fri Aug 15 00:00:00 EDT 2014},
month = {Fri Aug 15 00:00:00 EDT 2014}
}
  • Purpose: To study the feasibility of a unified intensity-modulated arc therapy (UIMAT) that combines IMRT and VMAT optimization and delivery in order to produce efficient and superior radiation treatment plans. Methods: Inverse planning for UIMAT was prototyped on the Pinnacle treatment planning system (Philips Medical Systems). UIMAT integrates IMRT and VMAT delivery in the same arc where IMRT was delivered with gantry speed close to zero. Optimal gantry angles for the IMRT phases were selected automatically by the inverse optimization algorithm. Optimization of the VMAT phases and IMRT phases were done simultaneously using Pinnacle's direct machine parameter optimization algorithm. Fivemore » treatment plans each for prostate, head and neck, and lung were generated using our unified technique and compared with clinical VMAT or IMRT plans. Delivery verification was performed on an ArcCheck phantom (Sun Nuclear) and delivered in clinical mode on a Varian TrueBeam linear accelerator. Results: In this prototype implementation, compared to the VMAT or IMRT plans, with the plans normalized to the same dose coverage to the planning target volumes, the UIMAT plans produced improved OAR sparing for head and neck cases, while for lung and prostate cases, the dosimetric improvements for OARs were not as significant. In this proof-of-concept work, we demonstrated that a novel radiation therapy delivery technique combining VMAT and IMRT delivery in the same arc is feasible. Initial results showed UIMAT has the potential to be superior to either standard IMRT or VMAT.« less
  • Purpose: To evaluate the implications of differences between contours drawn manually and contours generated automatically by deformable image registration for four-dimensional (4D) treatment planning. Methods and Materials: In 12 lung cancer patients intensity-modulated radiotherapy (IMRT) planning was performed for both manual contours and automatically generated ('auto') contours in mid and peak expiration of 4D computed tomography scans, with the manual contours in peak inspiration serving as the reference for the displacement vector fields. Manual and auto plans were analyzed with respect to their coverage of the manual contours, which were assumed to represent the anatomically correct volumes. Results: Auto contoursmore » were on average larger than manual contours by up to 9%. Objective scores, D{sub 2%} and D{sub 98%} of the planning target volume, homogeneity and conformity indices, and coverage of normal tissue structures (lungs, heart, esophagus, spinal cord) at defined dose levels were not significantly different between plans (p = 0.22-0.94). Differences were statistically insignificant for the generalized equivalent uniform dose of the planning target volume (p = 0.19-0.94) and normal tissue complication probabilities for lung and esophagus (p = 0.13-0.47). Dosimetric differences >2% or >1 Gy were more frequent in patients with auto/manual volume differences {>=}10% (p = 0.04). Conclusions: The applied deformable image registration algorithm produces clinically plausible auto contours in the majority of structures. At this stage clinical supervision of the auto contouring process is required, and manual interventions may become necessary. Before routine use, further investigations are required, particularly to reduce imaging artifacts.« less
  • Purpose: lower lobe lung tumors move with amplitudes of up to 2 cm due to respiration. To reduce respiration imaging artifacts in planning CT scans, 4D imaging techniques are used. Currently, we use a single (midventilation) frame of the 4D data set for clinical delineation of structures and radiotherapy planning. A single frame, however, often contains artifacts due to breathing irregularities, and is noisier than a conventional CT scan since the exposure per frame is lower. Moreover, the tumor may be displaced from the mean tumor position due to hysteresis. The aim of this work is to develop a frameworkmore » for the acquisition of a good quality scan representing all scanned anatomy in the mean position by averaging transformed (deformed) CT frames, i.e., canceling out motion. A nonrigid registration method is necessary since motion varies over the lung. Methods and Materials: 4D and inspiration breath-hold (BH) CT scans were acquired for 13 patients. An iterative multiscale motion estimation technique was applied to the 4D CT scan, similar to optical flow but using image phase (gray-value transitions from bright to dark and vice versa) instead. From the (4D) deformation vector field (DVF) derived, the local mean position in the respiratory cycle was computed and the 4D DVF was modified to deform all structures of the original 4D CT scan to this mean position. A 3D midposition (MidP) CT scan was then obtained by (arithmetic or median) averaging of the deformed 4D CT scan. Image registration accuracy, tumor shape deviation with respect to the BH CT scan, and noise were determined to evaluate the image fidelity of the MidP CT scan and the performance of the technique. Results: Accuracy of the used deformable image registration method was comparable to established automated locally rigid registration and to manual landmark registration (average difference to both methods <0.5 mm for all directions) for the tumor region. From visual assessment, the registration was good for the clearly visible features (e.g., tumor and diaphragm). The shape of the tumor, with respect to that of the BH CT scan, was better represented by the MidP reconstructions than any of the 4D CT frames (including MidV; reduction of 'shape differences' was 66%). The MidP scans contained about one-third the noise of individual 4D CT scan frames. Conclusions: We implemented an accurate method to estimate the motion of structures in a 4D CT scan. Subsequently, a novel method to create a midposition CT scan (time-weighted average of the anatomy) for treatment planning with reduced noise and artifacts was introduced. Tumor shape and position in the MidP CT scan represents that of the BH CT scan better than MidV CT scan and, therefore, was found to be appropriate for treatment planning.« less
  • Dosimetric parameters based on dose-volume histograms (DVH) of contoured structures are routinely used to evaluate dose delivered to target structures and organs at risk. However, the DVH provides no information on the spatial distribution of the dose in situations of repeated fractions with changes in organ shape or size. The aim of this research was to develop methods to more accurately determine geometrically localized, cumulative dose to the bladder wall in intracavitary brachytherapy for cervical cancer. The CT scans and treatment plans of 20 cervical cancer patients were used. Each patient was treated with five high-dose-rate (HDR) brachytherapy fractions ofmore » 600cGy prescribed dose. The bladder inner and outer surfaces were delineated using MIM Maestro software (MIM Software Inc.) and were imported into MATLAB (MathWorks) as 3-dimensional point clouds constituting the “bladder wall”. A point-set registration toolbox for MATLAB, Coherent Point Drift (CPD), was used to non-rigidly transform the bladder-wall points from four of the fractions to the coordinate system of the remaining (reference) fraction, which was chosen to be the emptiest bladder for each patient. The doses were accumulated on the reference fraction and new cumulative dosimetric parameters were calculated. The LENT-SOMA toxicity scores of these patients were studied against the cumulative dose parameters. Based on this study, there was no significant correlation between the toxicity scores and the determined cumulative dose parameters.« less
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