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Title: SU-F-J-129: Verification of Geometric and Dosimetric Accuracy of Respiratory Management Systems Using Homemade Phantom

Abstract

Purpose: Different placements of Infrared Cameras (IRC) in CT and treatment rooms can cause gating window level (GWL) variations leading to differences between GWL used for planning and treatments. Although, Varian Clinac DHX-OBI sytem and CT are equipped with the same kind of IRC, Truebeam STx (TB) has a different type of IRC known as banana type. In this study; geometric and dosimetric accuracy of respiratory management system (RPM) for different machines were investigated with a special homemade phantom. Methods: Special phantom was placed on the respiratory simulator machine and a CT data set was obtained at the end of the expirium phase (EOE). Conformal and IMRT plans were generated on the EOE CT image series for both DHX-OBI and TB LINACs while a VMAT plan was generated only for TB.The acquired respiratory graphs in the CT were directly sent to DHX-OBI system, and they were converted with software before sending to TB. EBT3 films were placed inside the phantom and were irradiated using RPM system with two machines for different plans. Planar dose distributions were compared with gamma analysis (GA) method (3mm, %3) to evaluate planned-measured dose differences. In addition, radio-opac marker was placed in the center of themore » phantom to evaluate the geometric accuracy of treatment field with gated flouroscopy (GF). Results: There were no shifts detected between planning and treeatment GWL for both DHX-OBI and TB. Difference on the GF image between digital graticule and radio-opac marker was <1mm for TB and 1mm for DHX-OBI. Although, GA agreement was 97% for conformal and IMRT techniques in TB, it was 96% for VMAT technique. While GA agreement was 98% for conformal technique in DHX-OBI, IMRT was 95%.ConclusionThis study showed that RPM can be used accurately in spite of different IRC placements or different types of ICR used.« less

Authors:
; ;  [1];  [2]
  1. Acibadem Kozyatgi Hospital, Istanbul (Turkey)
  2. Acibadem University, Istanbul (Turkey)
Publication Date:
OSTI Identifier:
22634734
Resource Type:
Journal Article
Resource Relation:
Journal Name: Medical Physics; Journal Volume: 43; Journal Issue: 6; Other Information: (c) 2016 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; 61 RADIATION PROTECTION AND DOSIMETRY; ACCURACY; BIOMEDICAL RADIOGRAPHY; COMPUTER CODES; COMPUTERIZED TOMOGRAPHY; IMAGE PROCESSING; IMAGES; IRRADIATION; LINEAR ACCELERATORS; PHANTOMS; PLANNING; RADIATION DOSE DISTRIBUTIONS; RADIATION DOSES; RADIOTHERAPY; VERIFICATION

Citation Formats

Goksel, E, Kucucuk, H, Senkesen, O, and Tezcanli, E. SU-F-J-129: Verification of Geometric and Dosimetric Accuracy of Respiratory Management Systems Using Homemade Phantom. United States: N. p., 2016. Web. doi:10.1118/1.4956037.
Goksel, E, Kucucuk, H, Senkesen, O, & Tezcanli, E. SU-F-J-129: Verification of Geometric and Dosimetric Accuracy of Respiratory Management Systems Using Homemade Phantom. United States. doi:10.1118/1.4956037.
Goksel, E, Kucucuk, H, Senkesen, O, and Tezcanli, E. 2016. "SU-F-J-129: Verification of Geometric and Dosimetric Accuracy of Respiratory Management Systems Using Homemade Phantom". United States. doi:10.1118/1.4956037.
@article{osti_22634734,
title = {SU-F-J-129: Verification of Geometric and Dosimetric Accuracy of Respiratory Management Systems Using Homemade Phantom},
author = {Goksel, E and Kucucuk, H and Senkesen, O and Tezcanli, E},
abstractNote = {Purpose: Different placements of Infrared Cameras (IRC) in CT and treatment rooms can cause gating window level (GWL) variations leading to differences between GWL used for planning and treatments. Although, Varian Clinac DHX-OBI sytem and CT are equipped with the same kind of IRC, Truebeam STx (TB) has a different type of IRC known as banana type. In this study; geometric and dosimetric accuracy of respiratory management system (RPM) for different machines were investigated with a special homemade phantom. Methods: Special phantom was placed on the respiratory simulator machine and a CT data set was obtained at the end of the expirium phase (EOE). Conformal and IMRT plans were generated on the EOE CT image series for both DHX-OBI and TB LINACs while a VMAT plan was generated only for TB.The acquired respiratory graphs in the CT were directly sent to DHX-OBI system, and they were converted with software before sending to TB. EBT3 films were placed inside the phantom and were irradiated using RPM system with two machines for different plans. Planar dose distributions were compared with gamma analysis (GA) method (3mm, %3) to evaluate planned-measured dose differences. In addition, radio-opac marker was placed in the center of the phantom to evaluate the geometric accuracy of treatment field with gated flouroscopy (GF). Results: There were no shifts detected between planning and treeatment GWL for both DHX-OBI and TB. Difference on the GF image between digital graticule and radio-opac marker was <1mm for TB and 1mm for DHX-OBI. Although, GA agreement was 97% for conformal and IMRT techniques in TB, it was 96% for VMAT technique. While GA agreement was 98% for conformal technique in DHX-OBI, IMRT was 95%.ConclusionThis study showed that RPM can be used accurately in spite of different IRC placements or different types of ICR used.},
doi = {10.1118/1.4956037},
journal = {Medical Physics},
number = 6,
volume = 43,
place = {United States},
year = 2016,
month = 6
}
  • Purpose: 4D-CT is often limited by motion artifacts, low temporal resolution, and poor phase-based target definition. We recently developed a novel k-space self-gated 4D-MRI technique with high spatial and temporal resolution. The goal here is to geometrically validate 4D-MRI using a MRI-CT compatible respiratory motion phantom and comparison to 4D-CT. Methods: 4D-MRI was acquired using 3T spoiled gradient echo-based 3D projection sequences. Respiratory phases were resolved using self-gated k-space lines as the motion surrogate. Images were reconstructed into 10 temporal bins with 1.56×1.56×1.56mm3. A MRI-CT compatible phantom was designed with a 23mm diameter ball target filled with highconcentration gadolinium(Gd) gelmore » embedded in a 35×40×63mm3 plastic box stabilized with low-concentration Gd gel. The whole phantom was driven by an air pump. Human respiratory motion was mimicked using the controller from a commercial dynamic phantom (RSD). Four breathing settings (rates/depths: 10s/20mm, 6s/15mm, 4s/10mm, 3s/7mm) were scanned with 4D-MRI and 4D-CT (slice thickness 1.25mm). Motion ground-truth was obtained from input signals and real-time video recordings. Reconstructed images were imported into Eclipse(Varian) for target contouring. Volumes and target positions were compared with ground-truth. Initial human study was investigated on a liver patient. Results: 4D-MRI and 4D-CT scans for the different breathing cycles were reconstructed with 10 phases. Target volume in each phase was measured for both 4D-CT and 4D-MRI. Volume percentage difference for the 6.37ml target ranged from 6.67±5.33 to 11.63±5.57 for 4D-CT and from 1.47±0.52 to 2.12±1.60 for 4D-MRI. The Mann-Whitney U-test shows the 4D-MRI is significantly superior to 4D-CT (p=0.021) for phase-based target definition. Centroid motion error ranges were 1.35–1.25mm (4D-CT), and 0.31–0.12mm (4D-MRI). Conclusion: The k-space self-gated 4D-MRI we recently developed can accurately determine phase-based target volume while avoiding typical motion artifacts found in 4D-CT, and is being further studied for use in GI targeting and motion management. This work supported in part by grant 1R03CA173273-01.« less
  • Purpose: MRI is increasingly being used for radiotherapy planning, simulation, and in-treatment-room motion monitoring. To provide more detailed temporal and spatial MR data for these tasks, we have recently developed a novel self-gated (SG) MRI technique with advantage of k-space phase sorting, high isotropic spatial resolution, and high temporal resolution. The current work describes the validation of this 4D-MRI technique using a MRI- and CT-compatible respiratory motion phantom and comparison to 4D-CT. Methods: The 4D-MRI sequence is based on a spoiled gradient echo-based 3D projection reconstruction sequence with self-gating for 4D-MRI at 3 T. Respiratory phase is resolved by usingmore » SG k-space lines as the motion surrogate. 4D-MRI images are reconstructed into ten temporal bins with spatial resolution 1.56 × 1.56 × 1.56 mm{sup 3}. A MRI-CT compatible phantom was designed to validate the performance of the 4D-MRI sequence and 4D-CT imaging. A spherical target (diameter 23 mm, volume 6.37 ml) filled with high-concentration gadolinium (Gd) gel is embedded into a plastic box (35 × 40 × 63 mm{sup 3}) and stabilized with low-concentration Gd gel. The phantom, driven by an air pump, is able to produce human-type breathing patterns between 4 and 30 respiratory cycles/min. 4D-CT of the phantom has been acquired in cine mode, and reconstructed into ten phases with slice thickness 1.25 mm. The 4D images sets were imported into a treatment planning software for target contouring. The geometrical accuracy of the 4D MRI and CT images has been quantified using target volume, flattening, and eccentricity. The target motion was measured by tracking the centroids of the spheres in each individual phase. Motion ground-truth was obtained from input signals and real-time video recordings. Results: The dynamic phantom has been operated in four respiratory rate (RR) settings, 6, 10, 15, and 20/min, and was scanned with 4D-MRI and 4D-CT. 4D-CT images have target-stretching, partial-missing, and other motion artifacts in various phases, whereas the 4D-MRI images are visually free of those artifacts. Volume percentage difference for the 6.37 ml target ranged from 5.3% ± 4.3% to 10.3% ± 5.9% for 4D-CT, and 1.47 ± 0.52 to 2.12 ± 1.60 for 4D-MRI. With an increase of respiratory rate, the target volumetric and geometric deviations increase for 4D-CT images while remaining stable for the 4D-MRI images. Target motion amplitude errors at different RRs were measured with a range of 0.66–1.25 mm for 4D-CT and 0.2–0.42 mm for 4D-MRI. The results of Mann–Whitney tests indicated that 4D-MRI significantly outperforms 4D-CT in phase-based target volumetric (p = 0.027) and geometric (p < 0.001) measures. Both modalities achieve equivalent accuracy in measuring motion amplitude (p = 0.828). Conclusions: The k-space self-gated 4D-MRI technique provides a robust method for accurately imaging phase-based target motion and geometry. Compared to 4D-CT, the current 4D-MRI technique demonstrates superior spatiotemporal resolution, and robust resistance to motion artifacts caused by fast target motion and irregular breathing patterns. The technique can be used extensively in abdominal targeting, motion gating, and toward implementing MRI-based adaptive radiotherapy.« less
  • Purpose: Dynamic tumor tracking radiation therapy can potentially reduce internal margin without prolongation of irradiation time. However, dynamic tumor tracking technique requires an extra margin (tracking margin, TM) for the uncertainty of tumor localization, prediction, and beam repositioning. The purpose of this study was to evaluate a dosimetric impact caused by TM. Methods: We used 4D XCAT to create 9 digital phantom datasets of different tumor size and motion range: tumor diameter TD=(1, 3, 5) cm and motion range MR=(1, 2, 3) cm. For each dataset, respiratory gating (30%–70% phase) and tumor tracking treatment plans were created using 8-field 3D-CRTmore » by 4D dose calculation implemented in RayStation. The dose constraint was based on RTOG0618. For the tracking plan, TMs of (0, 2.5, 5) mm were considered by surrounding a normal setup margin: SM=5 mm. We calculated V20 of normal lung to evaluate the dosimetric impact for each case, and estimated an equivalent TM that affects the same impact on V20 obtained by the gated plan. Results: The equivalent TMs for (TD=1 cm, MR=2 cm), (TD=1 cm, MR=3 cm), (TD=5 cm, MR=2 cm), and (TD=5 cm, MR=3 cm) were estimated as 1.47 mm, 3.95 mm, 1.04 mm, and 2.13 mm, respectively. The larger the tumor size, the equivalent TM became smaller. On the other hand, the larger the motion range, the equivalent TM was found to be increased. Conclusion: Our results showed the equivalent TM changes depending on tumor size and motion range. The tracking plan with TM less than the equivalent TM achieves a dosimetric impact better than the gated plan in less treatment time. This study was partially supported by JSPS Kakenhi and Varian Medical Systems.« less
  • Purpose: Dynamic multileaf collimator tracking represents a promising method for high-precision radiotherapy to moving tumors. In the present study, we report on the integration of electromagnetic real-time tumor position monitoring into a multileaf collimator-based tracking system. Methods and Materials: The integrated system was characterized in terms of its geometric and radiologic accuracy. The former was assessed from portal images acquired during radiation delivery to a phantom in tracking mode. The tracking errors were calculated from the positions of the tracking field and of the phantom as extracted from the portal images. Radiologic accuracy was evaluated from film dosimetry performed formore » conformal and intensity-modulated radiotherapy applied to different phantoms moving on sinusoidal trajectories. A static radiation delivery to the nonmoving target served as a reference for the delivery to the moving phantom with and without tracking applied. Results: Submillimeter tracking accuracy was observed for two-dimensional target motion despite the relatively large system latency of 500 ms. Film dosimetry yielded almost complete recovery of a circular dose distribution with tracking in two dimensions applied: 2%/2 mm gamma-failure rates could be reduced from 59.7% to 3.3%. For single-beam intensity-modulated radiotherapy delivery, accuracy was limited by the finite leaf width. A 2%/2 mm gamma-failure rate of 15.6% remained with tracking applied. Conclusion: The integrated system we have presented marks a major step toward the clinical implementation of high-precision dynamic multileaf collimator tracking. However, several challenges such as irregular motion traces or a thorough quality assurance still need to be addressed.« less
  • Purpose: To investigate the clinical utility of on-line verification of respiratory gated VMAT dosimetry during treatment. Methods: Portal dose images were acquired during treatment in integrated mode on a Varian TrueBeam (v. 1.6) linear accelerator for gated lung and liver patients that used flattening filtered beams. The source to imager distance (SID) was set to 160 cm to ensure imager clearance in case the isocenter was off midline. Note that acquisition of integrated images resulted in no extra dose to the patient. Fraction 1 was taken as baseline and all portal dose images were compared to that of the baseline,more » where the gamma comparison and dose difference were used to measure day-to-day exit dose variation. All images were analyzed in the Portal Dosimetry module of Aria (v. 10). The portal imager on the TrueBeam was calibrated by following the instructions for dosimetry calibration in service mode, where we define 1 calibrated unit (CU) equal to 1 Gy for 10×10 cm field size at 100 cm SID. This reference condition was measured frequently to verify imager calibration. Results: The gamma value (3%, 3 mm, 5% threshold) ranged between 92% and 100% for the lung and liver cases studied. The exit dose can vary by as much as 10% of the maximum dose for an individual fraction. The integrated images combined with the information given by the corresponding on-line soft tissue matched cone-beam computed tomography (CBCT) images were useful in explaining dose variation. For gated lung treatment, dose variation was mainly due to the diaphragm position. For gated liver treatment, the dose variation was due to both diaphragm position and weight loss. Conclusion: Integrated images can be useful in verifying dose delivery consistency during respiratory gated VMAT, although the CBCT information is needed to explain dose differences due to anatomical changes.« less