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Title: SU-E-J-229: Magnetic Resonance Imaging of Small Fiducial Markers for Proton Beam Therapy

Abstract

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, 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 andmore » 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

Authors:
; ; ; ; ; ; ; ; ; ; ; ;  [1]
  1. Mayo Clinic, Arizona, Scottsdale, AZ (United States)
Publication Date:
OSTI Identifier:
22499331
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; BIOMEDICAL RADIOGRAPHY; FIDUCIAL MARKERS; IMAGES; NMR IMAGING; PATIENTS; PHANTOMS; PROTON BEAMS; RADIOTHERAPY; SPATIAL RESOLUTION; THICKNESS

Citation Formats

Hu, Y, James, J, Panda, A, Vargas, C, Silva, A, Liu, W, Shen, J, Ding, X, Paden, R, Hanson, J, Wong, W, Schild, S, and Bues, M. SU-E-J-229: Magnetic Resonance Imaging of Small Fiducial Markers for Proton Beam Therapy. United States: N. p., 2015. Web. doi:10.1118/1.4924315.
Hu, Y, James, J, Panda, A, Vargas, C, Silva, A, Liu, W, Shen, J, Ding, X, Paden, R, Hanson, J, Wong, W, Schild, S, & Bues, M. SU-E-J-229: Magnetic Resonance Imaging of Small Fiducial Markers for Proton Beam Therapy. United States. doi:10.1118/1.4924315.
Hu, Y, James, J, Panda, A, Vargas, C, Silva, A, Liu, W, Shen, J, Ding, X, Paden, R, Hanson, J, Wong, W, Schild, S, and Bues, M. Mon . "SU-E-J-229: Magnetic Resonance Imaging of Small Fiducial Markers for Proton Beam Therapy". United States. doi:10.1118/1.4924315.
@article{osti_22499331,
title = {SU-E-J-229: Magnetic Resonance Imaging of Small Fiducial Markers for Proton Beam Therapy},
author = {Hu, Y and James, J and Panda, A and Vargas, C and Silva, A and Liu, W and Shen, J and Ding, X and Paden, R and Hanson, J and Wong, W and Schild, S and Bues, M},
abstractNote = {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, 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.},
doi = {10.1118/1.4924315},
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: To investigate quantitatively patient motion effects on the localization accuracy of image-guided radiation with fiducial markers using axial CT (ACT), helical CT (HCT) and cone-beam CT (CBCT) using modeling and experimental phantom studies. Methods: Markers with different lengths (2.5 mm, 5 mm, 10 mm, and 20 mm) were inserted in a mobile thorax phantom which was imaged using ACT, HCT and CBCT. The phantom moved with sinusoidal motion with amplitudes ranging 0–20 mm and a frequency of 15 cycles-per-minute. Three parameters that include: apparent marker lengths, center position and distance between the centers of the markers were measured inmore » the different CT images of the mobile phantom. A motion mathematical model was derived to predict the variations in the previous three parameters and their dependence on the motion in the different imaging modalities. Results: In CBCT, the measured marker lengths increased linearly with increase in motion amplitude. For example, the apparent length of the 10 mm marker was about 20 mm when phantom moved with amplitude of 5 mm. Although the markers have elongated, the center position and the distance between markers remained at the same position for different motion amplitudes in CBCT. These parameters were not affected by motion frequency and phase in CBCT. In HCT and ACT, the measured marker length, center and distance between markers varied irregularly with motion parameters. The apparent lengths of the markers varied with inverse of the phantom velocity which depends on motion frequency and phase. Similarly the center position and distance between markers varied inversely with phantom speed. Conclusion: Motion may lead to variations in maker length, center position and distance between markers using CT imaging. These effects should be considered in patient setup using image-guided radiation therapy based on fiducial markers matching using 2D-radiographs or volumetric CT imaging.« less
  • Purpose: In prostate proton radiotherapy, three fiducial markers are used for patient daily alignment. However fiducial alignment can change beamline heterogeneity in proton therapy. The purpose of this study is to determine the difference in fiducial and boney anatomy alignment for patient treatment. Methods and materials: Prostate cancer patients who received proton treatment were included in this study. 3 fiducial markers were implanted before the initial CT. All the patients were re-CT’d every 2 weeks to check the fiducial marker position reproducibility as well as dosimetric consistence of target coverage. In geometry study, re-CT were fused to the initial CTmore » base on the boney anatomy and the average fiducial marker displacement was measured the centers of the fiducials. Dosimetrically, the initial plan was recalculated directly to re-CT image set based on the boney alignment and fiducial alignment to determine the difference from daily treatment. Prostate coverage and hotspots were evaluated using the dose to 98% of the CTV (D98) and dose to 2% (D2), respectively. Results: The shift from the initial 6 patient CT image sets resulted in an average change in the fiducial location of 5.70 +/− 3 mm. Dosimetric comparison from a single patient revealed that differences from the planned dose resulted from both boney and fiducial alignment. Planned clinical treatment volume coverage resulted in a D98 of 70.44Gy and D2 of 70.84Gy compared to a D98 of 70.13Gy and D2 70.94Gy for boney alignment and a D98 of 70.08Gy and D2 71.18Gy for fiducial alignment respectively. Conclusion: This study demonstrates that with boney anatomy alignment there is little change to CTV coverage and only slightly worse CTV coverage and hotspot production with fiducial alignment. An increase patient cohort and further investigation is necessary to determine the whether boney alignment can help better control dose heterogeneity.« less
  • Purpose Ultrasound tracking of target motion relies on visibility of vascular and/or anatomical landmark. However this is challenging when the target is located far from vascular structures or in organs that lack ultrasound landmark structure, such as in the case of pancreas cancer. The purpose of this study is to evaluate visibility, artifacts and distortions of fusion coils and solid gold markers in ultrasound, CT, CBCT and kV images to identify markers suitable for real-time ultrasound tracking of tumor motion in SBRT pancreas treatment. Methods Two fusion coils (1mm × 5mm and 1mm × 10 mm) and a solid goldmore » marker (0.8mm × 10mm) were embedded in a tissue–like ultrasound phantom. The phantom (5cm × 12cm × 20cm) was prepared using water, gelatin and psyllium-hydrophilic-mucilloid fiber. Psylliumhydrophilic mucilloid acts as scattering medium to produce echo texture that simulates sonographic appearance of human tissue in ultrasound images while maintaining electron density close to that of water in CT images. Ultrasound images were acquired using 3D-ultrasound system with markers embedded at 5, 10 and 15mm depth from phantom surface. CT images were acquired using Philips Big Bore CT while CBCT and kV images were acquired with XVI-system (Elexta). Visual analysis was performed to compare visibility of the markers and visibility score (1 to 3) were assigned. Results All markers embedded at various depths are clearly visible (score of 3) in ultrasound images. Good visibility of all markers is observed in CT, CBCT and kV images. The degree of artifact produced by the markers in CT and CBCT images are indistinguishable. No distortion is observed in images from any modalities. Conclusion All markers are visible in images across all modalities in this homogenous tissue-like phantom. Human subject data is necessary to confirm the marker type suitable for real-time ultrasound tracking of tumor motion in SBRT pancreas treatment.« less
  • Purpose: To study breathing related tumor motion amplitudes by lung lobe location under controlled breathing conditions used in Stereotactic Body Radiation Therapy (SBRT) for NSCLC. Methods: Sixty-five NSCLC SBRT patients since 2009 were investigated. Patients were categorized based on tumor anatomic location (RUL-17, RML-7, RLL-18, LUL-14, LLL-9). A 16-slice CT scanner [GE RT16 Pro] along with Varian Realtime Position Management (RPM) software was used to acquire the 4DCT data set using 1.25 mm slice width. Images were binned in 10 phases, T00 being at maximum inspiration ' T50 at maximum expiration phase. Tumor volume was segmented in T50 using themore » CT-lung window and its displacement were measured from phase to phase in all three axes; superiorinferior, anterior-posterior ' medial-lateral at the centroid level of the tumor. Results: The median tumor movement in each lobe was as follows: RUL= 3.8±2.0 mm (mean ITV: 9.5 cm{sup 3}), RML= 4.7±2.8 mm (mean ITV: 9.2 cm{sup 3}), RLL=6.6±2.6 mm (mean ITV: 12.3 cm{sup 3}), LUL=3.8±2.4 mm (mean ITV: 18.5 cm{sup 3}), ' LLL=4.7±2.5 mm (mean ITV: 11.9 cm{sup 3}). The median respiratory cycle for all patients was found to be 3.81 ± 1.08 seconds [minimum 2.50 seconds, maximum 7.07 seconds]. The tumor mobility incorporating breathing cycle was RUL = 0.95±0.49 mm/s, RML = 1.35±0.62 mm/s, RLL = 1.83±0.71 mm/s, LUL = 0.98 ±0.50 mm/s, and LLL = 1.15 ±0.53 mm/s. Conclusion: Our results show that tumor displacement is location dependent. The range of motion and mobility increases as the location of the tumor nears the diaphragm. Under abdominal compression, the magnitude of tumor motion is reduced by as much as a factor of 2 in comparison to reported tumor magnitudes under conventional free breathing conditions. This study demonstrates the utility of abdominal compression in reducing the tumor motion leading to reduced ITV and planning tumor volumes (PTV)« less
  • Purpose: To describe prostate deformation during radiotherapy and determine the margins required to account for prostate deformation after setup to intraprostatic fiducial markers (FM). Methods and Materials: Twenty-five patients with T1c-T2c prostate cancer had three gold FMs implanted. The patients presented with a full bladder and empty rectum for two axial magnetic resonance imaging (MRI) scans using a gradient recalled echo (GRE) sequence capable of imaging the FMs. The MRIs were done at the time of radiotherapy (RT) planning and a randomly assigned fraction. A single observer contoured the prostate surfaces. They were entered into a finite element model andmore » aligned using the centroid of the three FMs. Results: During RT, the prostate volume decreased by 0.5%/fraction (p = 0.03) and the FMs in-migrated by 0.05 mm/fraction (p < 0.05). Prostate deformation was unrelated to differential bladder and bowel filling, but was related to a transurethral resection of the prostate (TURP) (p = 0.003). The standard deviation for systematic uncertainty of prostate surface contouring was 0.8 mm and for FM centroid localization was 0.4 mm. The standard deviation of random interfraction prostate deformation was 1.5 mm and for FM centroid variability was 1.1 mm. These uncertainties from prostate deformation can be incorporated into a margin recipe to determine the total margins required for RT. Conclusions: During RT, the prostate exhibited: volume decrease, deformation, and in-migration of FMs. Patients with TURPs were prone to prostate deformation.« less