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Title: SU-E-J-188: Theoretical Estimation of Margin Necessary for Markerless Motion Tracking

Abstract

Purpose: To estimate the margin necessary to adequately cover the target using markerless motion tracking (MMT) of lung lesions given the uncertainty in tracking and the size of the target. Methods: Simulations were developed in Matlab to determine the effect of tumor size and tracking uncertainty on the margin necessary to achieve adequate coverage of the target. For simplicity, the lung tumor was approximated by a circle on a 2D radiograph. The tumor was varied in size from a diameter of 0.1 − 30 mm in increments of 0.1 mm. From our previous studies using dual energy markerless motion tracking, we estimated tracking uncertainties in x and y to have a standard deviation of 2 mm. A Gaussian was used to simulate the deviation between the tracked location and true target location. For each size tumor, 100,000 deviations were randomly generated, the margin necessary to achieve at least 95% coverage 95% of the time was recorded. Additional simulations were run for varying uncertainties to demonstrate the effect of the tracking accuracy on the margin size. Results: The simulations showed an inverse relationship between tumor size and margin necessary to achieve 95% coverage 95% of the time using the MMT technique.more » The margin decreased exponentially with target size. An increase in tracking accuracy expectedly showed a decrease in margin size as well. Conclusion: In our clinic a 5 mm expansion of the internal target volume (ITV) is used to define the planning target volume (PTV). These simulations show that for tracking accuracies in x and y better than 2 mm, the margin required is less than 5 mm. This simple simulation can provide physicians with a guideline estimation for the margin necessary for use of MMT clinically based on the accuracy of their tracking and the size of the tumor.« less

Authors:
; ; ;  [1]
  1. Loyola Univ Medical Center, Maywood, IL (United States)
Publication Date:
OSTI Identifier:
22499293
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; IMAGES; LUNGS; NEOPLASMS; PLANNING; SIMULATION

Citation Formats

Patel, R, Block, A, Harkenrider, M, and Roeske, J. SU-E-J-188: Theoretical Estimation of Margin Necessary for Markerless Motion Tracking. United States: N. p., 2015. Web. doi:10.1118/1.4924274.
Patel, R, Block, A, Harkenrider, M, & Roeske, J. SU-E-J-188: Theoretical Estimation of Margin Necessary for Markerless Motion Tracking. United States. doi:10.1118/1.4924274.
Patel, R, Block, A, Harkenrider, M, and Roeske, J. Mon . "SU-E-J-188: Theoretical Estimation of Margin Necessary for Markerless Motion Tracking". United States. doi:10.1118/1.4924274.
@article{osti_22499293,
title = {SU-E-J-188: Theoretical Estimation of Margin Necessary for Markerless Motion Tracking},
author = {Patel, R and Block, A and Harkenrider, M and Roeske, J},
abstractNote = {Purpose: To estimate the margin necessary to adequately cover the target using markerless motion tracking (MMT) of lung lesions given the uncertainty in tracking and the size of the target. Methods: Simulations were developed in Matlab to determine the effect of tumor size and tracking uncertainty on the margin necessary to achieve adequate coverage of the target. For simplicity, the lung tumor was approximated by a circle on a 2D radiograph. The tumor was varied in size from a diameter of 0.1 − 30 mm in increments of 0.1 mm. From our previous studies using dual energy markerless motion tracking, we estimated tracking uncertainties in x and y to have a standard deviation of 2 mm. A Gaussian was used to simulate the deviation between the tracked location and true target location. For each size tumor, 100,000 deviations were randomly generated, the margin necessary to achieve at least 95% coverage 95% of the time was recorded. Additional simulations were run for varying uncertainties to demonstrate the effect of the tracking accuracy on the margin size. Results: The simulations showed an inverse relationship between tumor size and margin necessary to achieve 95% coverage 95% of the time using the MMT technique. The margin decreased exponentially with target size. An increase in tracking accuracy expectedly showed a decrease in margin size as well. Conclusion: In our clinic a 5 mm expansion of the internal target volume (ITV) is used to define the planning target volume (PTV). These simulations show that for tracking accuracies in x and y better than 2 mm, the margin required is less than 5 mm. This simple simulation can provide physicians with a guideline estimation for the margin necessary for use of MMT clinically based on the accuracy of their tracking and the size of the tumor.},
doi = {10.1118/1.4924274},
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 objective of this study was to evaluate the necessity to account for the organs at risk (OARs) respiratory induced motion in addition to the tumor displacement when planning a radiotherapy treatment that accounts for tumor motion. Methods: For 18 lung cancer patients, conformational radiotherapy treatment plans were generated using 3 different CT volumes: the two extreme respiratory phases corresponding to either the full inspiration (plan 1) or expiration (plan 3), as well as a manually deformed phase consisting in full inspiration combined with the full expiration tumor location (plan 2) simulating a tumor tracking plan without addressing OARsmore » motion. Treatment plans were initially created on plan 1 and then transferred to plan 2 and 3 which represent respectively the tumor displacement only and the whole anatomic variations due to breathing. The dose coverage and the dose delivered to the OARs were compared using conformational indexes and generalized equivalent uniform dose. Results: The worst conformational indexes were obtained for plans with all anatomic deformations (Table 1) with an underestimation of the 95% isodose spreading on healthy tissue compared to plans considering the tumor displacement only. Furthermore, mean doses to the OARs when accounting for all the anatomic changes were always higher than those associated with the tumor displacement only: the mean difference between these two plans was 1±1.37 Gy (maximum of 3.8 Gy) for the heart and 1.4±1.42 Gy (maximum of 4.1 Gy) for the lung in which the tumor was located (Figure 1). Conclusion: OARs deformations due to breathing motion should be included in the treatment planning in order to avoid unnecessary OARs dose and/or allow for a tumor dose escalation. This is even more important for treatments like stereotactic radiation therapy which necessitates a high precision ballistic and dose control.« less
  • Purpose: To evaluate the feasibility of markerless tumor tracking through the implementation of a novel dual-energy imaging approach into the clinical dynamic tracking (DT) workflow of the Vero SBRT system. Methods: Two sequential 20 s (11 Hz) fluoroscopy sequences were acquired at the start of one fraction for 7 patients treated for primary and metastatic lung cancer with DT on the Vero system. Sequences were acquired using 2 on-board kV imaging systems located at ±45° from the MV beam axis, at respectively 60 kVp (3.2 mAs) and 120 kVp (2.0 mAs). Offline, a normalized cross-correlation algorithm was applied to matchmore » the high (HE) and low energy (LE) images. Per breathing phase (inhale, exhale, maximum inhale and maximum exhale), the 5 best-matching HE and LE couples were extracted for DE subtraction. A contrast analysis according to gross tumor volume was conducted based on contrast-to-noise ratio (CNR). Improved tumor visibility was quantified using an improvement ratio. Results: Using the implanted fiducial as a benchmark, HE-LE sequence matching was effective for 13 out of 14 imaging angles. Overlying bony anatomy was removed on all DE images. With the exception of two imaging angles, the DE images showed no significantly improved tumor visibility compared to HE images, with an improvement ratio averaged over all patients of 1.46 ± 1.64. Qualitatively, it was observed that for those imaging angles that showed no significantly improved CNR, the tumor tissue could not be reliably visualized on neither HE nor DE images due to a total or partial overlap with other soft tissue. Conclusion: Dual-energy subtraction imaging by sequential orthogonal fluoroscopy was shown feasible by implementing an additional LE fluoroscopy sequence. However, for most imaging angles, DE images did not provide improved tumor visibility over single-energy images. Optimizing imaging angles is likely to improve tumor visibility and the efficacy of dual-energy imaging. This work was in part sponsored by corporate funding from BrainLAB AG.(BrainLAB AG, Feldkirchen, Germany)« less
  • Purpose: Although reduction of the cine EPID acquisition frame rate through multiple frame averaging may reduce hardware memory burden and decrease image noise, it can hinder the continuity of soft-tissue motion leading to poor auto-tracking results. The impact of motion blurring and image noise on the tracking performance was investigated. Methods: Phantom and patient images were acquired at a frame rate of 12.87Hz on an AS1000 portal imager. Low frame rate images were obtained by continuous frame averaging. A previously validated tracking algorithm was employed for auto-tracking. The difference between the programmed and auto-tracked positions of a Las Vegas phantommore » moving in the superior-inferior direction defined the tracking error (δ). Motion blurring was assessed by measuring the area change of the circle with the greatest depth. Additionally, lung tumors on 1747 frames acquired at eleven field angles from four radiotherapy patients are manually and automatically tracked with varying frame averaging. δ was defined by the position difference of the two tracking methods. Image noise was defined as the standard deviation of the background intensity. Motion blurring and image noise were correlated with δ using Pearson correlation coefficient (R). Results: For both phantom and patient studies, the auto-tracking errors increased at frame rates lower than 4.29Hz. Above 4.29Hz, changes in errors were negligible with δ<1.60mm. Motion blurring and image noise were observed to increase and decrease with frame averaging, respectively. Motion blurring and tracking errors were significantly correlated for the phantom (R=0.94) and patient studies (R=0.72). Moderate to poor correlation was found between image noise and tracking error with R -0.58 and -0.19 for both studies, respectively. Conclusion: An image acquisition frame rate of at least 4.29Hz is recommended for cine EPID tracking. Motion blurring in images with frame rates below 4.39Hz can substantially reduce the accuracy of auto-tracking. This work is supported in part by the Varian Medical Systems, Inc.« less
  • Purpose: To develop an automatic markerless 4D-CBCT projection sorting technique by using a patient respiratory motion model extracted from the planning 4D-CT images. Methods: Each phase of onboard 4D-CBCT is considered as a deformation of one phase of the prior planning 4D-CT. The deformation field map (DFM) is represented as a linear combination of three major deformation patterns extracted from the planning 4D-CT using principle component analysis (PCA). The coefficients of the PCA deformation patterns are solved by matching the digitally reconstructed radiograph (DRR) of the deformed volume to the onboard projection acquired. The PCA coefficients are solved for eachmore » single projection, and are used for phase sorting. Projections at the peaks of the Z direction coefficient are sorted as phase 1 and other projections are assigned into 10 phase bins by dividing phases equally between peaks. The 4D digital extended-cardiac-torso (XCAT) phantom was used to evaluate the proposed technique. Three scenarios were simulated, with different tumor motion amplitude (3cm to 2cm), tumor spatial shift (8mm SI), and tumor body motion phase shift (2 phases) from prior to on-board images. Projections were simulated over 180 degree scan-angle for the 4D-XCAT. The percentage of accurately binned projections across entire dataset was calculated to represent the phase sorting accuracy. Results: With a changed tumor motion amplitude from 3cm to 2cm, markerless phase sorting accuracy was 100%. With a tumor phase shift of 2 phases w.r.t. body motion, the phase sorting accuracy was 100%. With a tumor spatial shift of 8mm in SI direction, phase sorting accuracy was 86.1%. Conclusion: The XCAT phantom simulation results demonstrated that it is feasible to use prior knowledge and motion modeling technique to achieve markerless 4D-CBCT phase sorting. National Institutes of Health Grant No. R01-CA184173 Varian Medical System.« less
  • Purpose: To develop a novel technique to enhance the image contrast of clinical cone beam CT projections and extract respiratory signals based on anatomical motion using the modified Amsterdam Shroud (AS) method to benefit image guided radiation therapy. Methods: Thoracic cone beam CT projections acquired prior to treatment were preprocessed to increase their contrast for better respiratory signal extraction. Air intensity on raw images was firstly estimated and then applied to correct the projections to generate new attenuation images that were subsequently improved with deeper anatomy feature enhancement through taking logarithm operation, derivative along superior-inferior direction, respectively. All pixels onmore » individual post-processed two dimensional images were horizontally summed to one column and all projections were combined side by side to create an AS image from which patient’s respiratory signal was extracted. The impact of gantry rotation on the breathing signal rendering was also investigated. Ten projection image sets from five lung cancer patients acquired with the Varian Onboard Imager on 21iX Clinac (Varian Medical Systems, Palo Alto, CA) were employed to assess the proposed technique. Results: Application of the air correction on raw projections showed that more than an order of magnitude of contrast enhancement was achievable. The typical contrast on the raw projections is around 0.02 while that on attenuation images could greater than 0.5. Clear and stable breathing signal can be reliably extracted from the new images while the uncorrected projection sets failed to yield clear signals most of the time. Conclusion: Anatomy feature plays a key role in yielding breathing signal from the projection images using the AS technique. The air correction process facilitated the contrast enhancement significantly and attenuation images thus obtained provides a practical solution to obtaining markerless breathing motion tracking.« less