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Title: SU-E-J-139: One Institution’s Experience with Surface Imaging in Proton Therapy

Abstract

Purpose: X-ray system is commonly used for IGRT in proton therapy, however image acquisition not only increases treatment time but also adds imaging dose. We studied a 3D surface camera system (AlignRT) performance for proton therapy. Methods: System accuracy was evaluated with rigid phantom under two different camera location configurations. For initial clinical applications, post mastectomy chest wall and partial breast treatments were studied. X-ray alignment was used as our ground truth. Our studies included: 1) comparison of daily patient setup shifts between X-ray alignment and SI calculation; 2) interfractional breast surface position variation when aligning to bony landmark on X-ray; 3) absolute positioning using planning CT DICOM data; 4) shifts for multi-isocenter treatment plan; 5) couch isocentric rotation accuracy. Results: Camera locations affected the system performance. After camera relocation, the accuracy of the system for the rigid phantom was within 1 mm (fixed couch), and 1.5 mm (isocentric rotation). For intrafractional patient positioning, X-ray and AlignRT shifts were highly correlated (r=0.99), with the largest difference (mean ± SD) in the longitudinal direction (2.14 ± 1.02 mm). For interfractional breast surface variation and absolute positioning, there were still larger disagreements between the two modalities due to different focus on anatomicalmore » landmarks, and 95% of the data lie within 5mm with some outliers at 7 mm–9 mm. For multi-isocenter shifts, the difference was 1 ± 0.56 mm over an 11 cm shift in longitudinal direction. For couch rotation study, the differences was 1.36 ± 1.0 mm in vertical direction, 3.04 ± 2.11 mm in longitudinal direction, and 2.10 ± 1.66 mm in lateral direction, with all rotation differences < 1.5 degree. Conclusion: Surface imaging is promising for intrafractional treatment application in proton therapy to reduce X-ray frequency. However the interfractional discrepancy between the X-ray and SI requires future validation.« less

Authors:
; ;  [1]
  1. ProCure Proton Therapy Center, Oklahoma City, OK (United States)
Publication Date:
OSTI Identifier:
22494151
Resource Type:
Journal Article
Resource Relation:
Journal Name: Medical Physics; Journal Volume: 42; Journal Issue: 6; Other Information: (c) 2015 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; BEAM POSITION; BIOMEDICAL RADIOGRAPHY; CAMERAS; COMPUTERIZED TOMOGRAPHY; MAMMARY GLANDS; POSITIONING; PROTON BEAMS; RADIOTHERAPY

Citation Formats

Zhao, L, Singh, H, and Zheng, Y. SU-E-J-139: One Institution’s Experience with Surface Imaging in Proton Therapy. United States: N. p., 2015. Web. doi:10.1118/1.4924225.
Zhao, L, Singh, H, & Zheng, Y. SU-E-J-139: One Institution’s Experience with Surface Imaging in Proton Therapy. United States. doi:10.1118/1.4924225.
Zhao, L, Singh, H, and Zheng, Y. Mon . "SU-E-J-139: One Institution’s Experience with Surface Imaging in Proton Therapy". United States. doi:10.1118/1.4924225.
@article{osti_22494151,
title = {SU-E-J-139: One Institution’s Experience with Surface Imaging in Proton Therapy},
author = {Zhao, L and Singh, H and Zheng, Y},
abstractNote = {Purpose: X-ray system is commonly used for IGRT in proton therapy, however image acquisition not only increases treatment time but also adds imaging dose. We studied a 3D surface camera system (AlignRT) performance for proton therapy. Methods: System accuracy was evaluated with rigid phantom under two different camera location configurations. For initial clinical applications, post mastectomy chest wall and partial breast treatments were studied. X-ray alignment was used as our ground truth. Our studies included: 1) comparison of daily patient setup shifts between X-ray alignment and SI calculation; 2) interfractional breast surface position variation when aligning to bony landmark on X-ray; 3) absolute positioning using planning CT DICOM data; 4) shifts for multi-isocenter treatment plan; 5) couch isocentric rotation accuracy. Results: Camera locations affected the system performance. After camera relocation, the accuracy of the system for the rigid phantom was within 1 mm (fixed couch), and 1.5 mm (isocentric rotation). For intrafractional patient positioning, X-ray and AlignRT shifts were highly correlated (r=0.99), with the largest difference (mean ± SD) in the longitudinal direction (2.14 ± 1.02 mm). For interfractional breast surface variation and absolute positioning, there were still larger disagreements between the two modalities due to different focus on anatomical landmarks, and 95% of the data lie within 5mm with some outliers at 7 mm–9 mm. For multi-isocenter shifts, the difference was 1 ± 0.56 mm over an 11 cm shift in longitudinal direction. For couch rotation study, the differences was 1.36 ± 1.0 mm in vertical direction, 3.04 ± 2.11 mm in longitudinal direction, and 2.10 ± 1.66 mm in lateral direction, with all rotation differences < 1.5 degree. Conclusion: Surface imaging is promising for intrafractional treatment application in proton therapy to reduce X-ray frequency. However the interfractional discrepancy between the X-ray and SI requires future validation.},
doi = {10.1118/1.4924225},
journal = {Medical Physics},
number = 6,
volume = 42,
place = {United States},
year = {Mon Jun 15 00:00:00 EDT 2015},
month = {Mon Jun 15 00:00:00 EDT 2015}
}
  • Purpose: The Mevion proton therapy machine is the first to feature a gantry mounted sychro-cyclotron. In addition, the system utilizes a 6D motion couch and kV imaging for precise proton therapy. To quantify coincidence between these systems, isocentricity tests were performed based on kV imaging alignment using radiochromic film. Methods: The 100 ton gantry and 6D robotic couch can rotate 190° around isocenter to provide necessary beam angles for treatment. The kV sources and detector panels are deployed as needed to acquire orthogonal portals. Gantry and couch mechanical isocenter were tested using star-shots and radiochromic-film (RCF). Using kV imaging, themore » star-shot phantom was aligned to an embedded fiducial and the isocenter was marked on RCF with a pinprick. The couch and gantry stars were performed by irradiating films at every 45° and 30°, respectively. A proton beam with a range and modulation-width of 18 cm was used. A Winston-Lutz test was also performed at the same gantry and couch rotations using a custom jig holding RCF and a tungsten ball placed at isocenter. A 2 cm diameter circular aperture was used for the irradiation. Results: The couch star-shot indicated a minimum tangent circle of 0.6 mm, with a 0.9 mm offset from the manually marked isocenter. The gantry star-shot showed a 0.6 mm minimum tangent circle with a 0.5 mm offset from the pinprick. The Winston Lutz test performed for gantry rotation showed a maximum deviation from center of 0.5 mm. Conclusion: Based on star-shots and Winston-Lutz tests, the proton gantry and 6D couch isocentricity are within 1 mm. In this study, we have shown that the methods commonly utilized for Linac characterization can be applied to proton therapy. This revolutionary proton therapy system possesses excellent agreement between the mechanical and radiation isocenter, providing highly precise treatment.« less
  • Purpose: Diffusion tensor imaging (DTI) can measure molecular mobility at the cellular level, quantified by the apparent diffusion coefficient (ADC). DTI may also reveal axonal fiber directional information in the white matter, quantified by the fractional anisotropy (FA). Juvenile pilocytic astrocytoma (JPA) is a rare brain tumor that occurs in children and young adults. Proton therapy (PT) is increasingly used in the treatment of pediatric brain tumors including JPA. However, the response of both tumors and normal tissues to PT is currently under investigation. We report tumor and normal brain tissue responses for a pediatric case of JPA treated withmore » PT assessed using DTI. Methods: A ten year old male with JPA of the left thalamus received passive scattered PT to a dose of 50.4 Gy (RBE) in 28 fractions. Post PT, the patient has been followed up in seven years. At each follow up, MRI imaging including DTI was performed to assess response. MR images were registered to the treatment planning CT and the GTV mapped onto each MRI. The GTV contour was then mirrored to the right side of brain through the patient’s middle line to represent normal brain tissue. ADC and FA were measured within the ROIs. Results: Proton therapy can completely spare contra lateral brain while the target volume received full prescribed dose. From a series of MRI ADC images before and after PT at different follow ups, the enhancement corresponding to GTV had nearly disappeared more than 2 years after PT. Both ADC and FA demonstrate that contralateral normal brain tissue were not affect by PT and the tumor volume reverted to normal ADC and FA values. Conclusion: DTI allowed quantitative evaluation of tumor and normal brain tissue responses to PT. Further study in a larger cohort is warranted.« less
  • Purpose: For proton beam therapy, small fiducial markers are preferred for patient alignment due to less interference with the proton beam. Visualizing small fiducial markers can be challenging in MRI. This study intends to investigate MRI imaging protocols for better visualization of small fiducial markers. Methods: Two carbon and two coil-shaped gold markers were placed into a gel phantom. Both carbon markers had a diameter of 1mm and a length of 3mm. Both gold markers had a length of 5mm. One gold marker had a diameter of 0.5mm and the other had a diameter of 0.75mm. T1 VIBE, T2 SPACE,more » TrueFISP and susceptibility weighted (SW) images were acquired. To improve marker contrast, high spatial resolution was used to reduce partial volume effect. Slice thickness was 1.5mm for all four sequences and in-plane resolution was 0.6mm for TrueFISP, 0.7mm for T1 VIBE, and 0.8mm for T2 SPACE and SW. For comparison purpose, a 3D T1 VIBE image set at 3mm slice thickness and 1.2mm in-plane resolution was also acquired. Results: All markers were visible in all high-resolution image sets. In each image set, marker-induced signal void was the smallest (in diameter) for carbon markers, followed by the 0.5mm gold marker and the largest for the 0.75mm gold marker. The SW images had the largest marker-induced signal void. However, those might be confused by susceptibility-gradient-induced signal voids. T1 VIBE had good visualization of markers with nicely defined edges. T2 SPACE had reasonable visualization of markers but edges were slightly blurred. TrueFISP had good visualization of markers only if they were not masked by banding artifacts. As a comparison, all markers were hardly visible in the standard resolution T1 VIBE images. Conclusion: 3D high-resolution T1 VIBE and SW have great potential in providing good visualization of small fiducial markers for proton beam therapy.« less
  • Purpose: The Mevion S250 proton therapy unit is equipped with a 6D-robotic couch and IGRT system (Verity). The patient alignment process allows corrections in six degrees of freedom: translation (x,y,z), pitch, roll, and yaw (θ,ϑ,ψ). Geometric accuracy of couch corrections and imaging vs. radiation isocenter coincidence were quantified before clinical implementation. Methods: A commercial phantom with sixteen 2mm tungsten BBs was rigidly couch-mounted and imaged with CT. Seventeen rigid translations/rotations of known magnitude were digitally applied to the original CT image using commercial software, validated with Varian OBI system. For each altered image, phantom was mounted on robotic couch inmore » original position, then Verity 2D:2D match (PA-LLAT) was performed using DRRs from altered images. Corrections were recorded and applied, phantom was imaged a second time and residual corrections recorded. Physical measurements verified that applied couch corrections coincided with both physical couch shifts/rotations and known CT image translations/rotations. Additionally, image vs. radiation isocenter coicidence was quantified over couch treatment angles (±90° from setup position) using radiochromic film and an image-guided couch star-shot. Posterior-anterior and left-lateral kV radiographs were taken before each beam was delivered to verify imaging/radiation isocentricity. Results: Verity suggested couch corrections and known CT shifts/rotations agreed within ±1mm (average: Δ lat=0.5mm; Δ vert=0.4mm; Δ long=0.3mm) and ± 0.4° (average: Δ pitch=0.24° Δ roll=0.01°; Δ yaw=0.10°). Physical couch measurements and Verity applied corrections agreed within ± 1mm (average: Δlat=0.5mm; Δvert=0.4mm; Δlong=0.2mm) and ±0.2° (average: Δpitch=0.03°; Δ roll=0.04°; Δ yaw=0.04°). The directionality of all translations and rotations were qualitatively verified. The image vs. radiation isocenter coincidence was <1mm and radiation-isocenter precision was <1mm over the 180° of couch motion, as indicated by film analysis. Conclusion: The Verity IGRT software and 6D-couch combination on the Mevion S250 was verified as accurate within 1mm and 0.5°. This complies with the TG-142 standards for a stereotactic radiotherapy IGRT system. Rob Cessac is employed as Product Manager for Mevion Medical Systems.« less
  • Purpose: To demonstrate feasibility of proton dose calculation on scattercorrected CBCT images for the purpose of adaptive proton therapy. Methods: Two CBCT image sets were acquired from a prostate cancer patient and a thorax phantom using an on-board imaging system of an Elekta infinity linear accelerator. 2-D scatter maps were estimated using a previously introduced CT-based technique, and were subtracted from each raw projection image. A CBCT image set was then reconstructed with an open source reconstruction toolkit (RTK). Conversion from the CBCT number to HU was performed by soft tissue-based shifting with reference to the plan CT. Passively scatteredmore » proton plans were simulated on the plan CT and corrected/uncorrected CBCT images using the XiO treatment planning system. For quantitative evaluation, water equivalent path length (WEPL) was compared in those treatment plans. Results: The scatter correction method significantly improved image quality and HU accuracy in the prostate case where large scatter artifacts were obvious. However, the correction technique showed limited effects on the thorax case that was associated with fewer scatter artifacts. Mean absolute WEPL errors from the plans with the uncorrected and corrected images were 1.3 mm and 5.1 mm in the thorax case and 13.5 mm and 3.1 mm in the prostate case. The prostate plan dose distribution of the corrected image demonstrated better agreement with the reference one than that of the uncorrected image. Conclusion: A priori CT-based CBCT scatter correction can reduce the proton dose calculation error when large scatter artifacts are involved. If scatter artifacts are low, an uncorrected CBCT image is also promising for proton dose calculation when it is calibrated with the soft-tissue based shifting.« less