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Title: SU-F-T-255: Accuracy and Precision of Dynamic Tracking Irradiation with VERO-4DRT System

Abstract

Purpose: The VERO-4DRT system is able to provide dynamic tracking irradiation (DTI) for the target with respiratory motion. This technique requires enough commissioning for clinical implementation. The purpose of this study is to make sure the accuracy and precision of DTI using VERO- 4DRT through commissioning from fundamental evaluation to end-to-end test. Method: We evaluated several contents for DTI commissioning: the accuracy of absorption dose at isocenter in DTI, the field size and penumbra of DTI, the accuracy of 4D modeling in DTI. All evaluations were performed by respiratory motion phantom (Quasar phantom). These contents were compared the results between static irradiation and DTI. The shape of radiation field was set to square from 3 cm × 3 cm to 10 cm × 10 cm. The micro 3D chamber and Gafchromic EBT3 film were used for absorbed dose and relative dose distribution measurement, respectively. The sine and irregular shaped waves were used for demonstrative respiratory motion. The visicoil was implanted into the phantom for guidance of respiratory motion. The respiration patterns of frequency and motion amount were set to 10–15 BPM and 1–2 cm, respectively. Results: As the result of absorbed dose of DTI in comparison with static irradiation, themore » average dose error at isocenter was 0.5% even though various respiratory patterns were set on. As the result of relative dose distribution, the field size (set it on 50% dose line) was not significantly changed in all respiratory patterns. However, the penumbra was larger in greater respiratory motion (up to 4.1 mm). The 4D modeling coincidence between actual and created waves was within 1%. Conclusion: The DTI using VERO-4DRT can provide sufficient accuracy and precision in absorbed dose and distribution. However, the patientspecific quantitative internal margin corresponding respiratory motion should be taken into consideration with image guidance.« less

Authors:
 [1]; ; ;  [2];  [3]
  1. Graduate school of Health Sciences, Fujita Health University, Tayoake, Aichi (Japan)
  2. Department of Radiology, Ogaki Tokushukai Hospital, Ogaki, Gifu (Japan)
  3. Department of Radiation Oncology, Nagoya City University, Nagoya, Aichi (Japan)
Publication Date:
OSTI Identifier:
22648871
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; ABSORBED RADIATION DOSES; ACCURACY; COMMISSIONING; IRRADIATION; PHANTOMS; RADIATION DOSE DISTRIBUTIONS; RADIOTHERAPY

Citation Formats

Hayashi, N, Takada, Y, Mizuno, T, Nakae, H, and Murai, T. SU-F-T-255: Accuracy and Precision of Dynamic Tracking Irradiation with VERO-4DRT System. United States: N. p., 2016. Web. doi:10.1118/1.4956395.
Hayashi, N, Takada, Y, Mizuno, T, Nakae, H, & Murai, T. SU-F-T-255: Accuracy and Precision of Dynamic Tracking Irradiation with VERO-4DRT System. United States. doi:10.1118/1.4956395.
Hayashi, N, Takada, Y, Mizuno, T, Nakae, H, and Murai, T. 2016. "SU-F-T-255: Accuracy and Precision of Dynamic Tracking Irradiation with VERO-4DRT System". United States. doi:10.1118/1.4956395.
@article{osti_22648871,
title = {SU-F-T-255: Accuracy and Precision of Dynamic Tracking Irradiation with VERO-4DRT System},
author = {Hayashi, N and Takada, Y and Mizuno, T and Nakae, H and Murai, T},
abstractNote = {Purpose: The VERO-4DRT system is able to provide dynamic tracking irradiation (DTI) for the target with respiratory motion. This technique requires enough commissioning for clinical implementation. The purpose of this study is to make sure the accuracy and precision of DTI using VERO- 4DRT through commissioning from fundamental evaluation to end-to-end test. Method: We evaluated several contents for DTI commissioning: the accuracy of absorption dose at isocenter in DTI, the field size and penumbra of DTI, the accuracy of 4D modeling in DTI. All evaluations were performed by respiratory motion phantom (Quasar phantom). These contents were compared the results between static irradiation and DTI. The shape of radiation field was set to square from 3 cm × 3 cm to 10 cm × 10 cm. The micro 3D chamber and Gafchromic EBT3 film were used for absorbed dose and relative dose distribution measurement, respectively. The sine and irregular shaped waves were used for demonstrative respiratory motion. The visicoil was implanted into the phantom for guidance of respiratory motion. The respiration patterns of frequency and motion amount were set to 10–15 BPM and 1–2 cm, respectively. Results: As the result of absorbed dose of DTI in comparison with static irradiation, the average dose error at isocenter was 0.5% even though various respiratory patterns were set on. As the result of relative dose distribution, the field size (set it on 50% dose line) was not significantly changed in all respiratory patterns. However, the penumbra was larger in greater respiratory motion (up to 4.1 mm). The 4D modeling coincidence between actual and created waves was within 1%. Conclusion: The DTI using VERO-4DRT can provide sufficient accuracy and precision in absorbed dose and distribution. However, the patientspecific quantitative internal margin corresponding respiratory motion should be taken into consideration with image guidance.},
doi = {10.1118/1.4956395},
journal = {Medical Physics},
number = 6,
volume = 43,
place = {United States},
year = 2016,
month = 6
}
  • Purpose: To develop and evaluate a new video image-based QA system, including in-house software, that can display a tracking state visually and quantify the positional accuracy of dynamic tumor tracking irradiation in the Vero4DRT system. Methods: Sixteen trajectories in six patients with pulmonary cancer were obtained with the ExacTrac in the Vero4DRT system. Motion data in the cranio–caudal direction (Y direction) were used as the input for a programmable motion table (Quasar). A target phantom was placed on the motion table, which was placed on the 2D ionization chamber array (MatriXX). Then, the 4D modeling procedure was performed on themore » target phantom during a reproduction of the patient’s tumor motion. A substitute target with the patient’s tumor motion was irradiated with 6-MV x-rays under the surrogate infrared system. The 2D dose images obtained from the MatriXX (33 frames/s; 40 s) were exported to in-house video-image analyzing software. The absolute differences in the Y direction between the center of the exposed target and the center of the exposed field were calculated. Positional errors were observed. The authors’ QA results were compared to 4D modeling function errors and gimbal motion errors obtained from log analyses in the ExacTrac to verify the accuracy of their QA system. The patients’ tumor motions were evaluated in the wave forms, and the peak-to-peak distances were also measured to verify their reproducibility. Results: Thirteen of sixteen trajectories (81.3%) were successfully reproduced with Quasar. The peak-to-peak distances ranged from 2.7 to 29.0 mm. Three trajectories (18.7%) were not successfully reproduced due to the limited motions of the Quasar. Thus, 13 of 16 trajectories were summarized. The mean number of video images used for analysis was 1156. The positional errors (absolute mean difference + 2 standard deviation) ranged from 0.54 to 1.55 mm. The error values differed by less than 1 mm from 4D modeling function errors and gimbal motion errors in the ExacTrac log analyses (n = 13). Conclusions: The newly developed video image-based QA system, including in-house software, can analyze more than a thousand images (33 frames/s). Positional errors are approximately equivalent to those in ExacTrac log analyses. This system is useful for the visual illustration of the progress of the tracking state and for the quantification of positional accuracy during dynamic tumor tracking irradiation in the Vero4DRT system.« less
  • Purpose: Dynamically compensating for target motion during radiotherapy will increase treatment accuracy. A laboratory system for real-time target tracking with a dynamic MLC has been developed. In this study, the geometric accuracy limits of this DMLC target tracking system were evaluated. Methods and Materials: A motion simulator was programmed to follow patient-derived tumor motion paths, parallel to the leaf motion direction. A target attached to the simulator was optically tracked, and the leaf positions adjusted to continually align the DMLC beam aperture to the target. Analysis of the tracking accuracy was based on video images of the target and beammore » alignment. The system response time was determined and the tracking error measured. Response time-corrected tracking accuracy was also calculated to investigate the accuracy limits of an improved system. Results: The response time of the system is 160 {+-} 2 ms. The geometric precision for tracking patient motion is 0.6 to 1.1 mm (1{sigma}) for the 3 patient datasets tested, with tracking errors relative to the original patient motion of 35, 40, and 100%. Conclusions: A DMLC target tracking system has been developed that can account for detected motion parallel to the leaf motion direction. The tracking error has a negligible systematic component. Reducing the response time will further increase the overall system accuracy.« less
  • Purpose: Following the ‘end-to-end testing’ paradigm of Dynamic Target Tracking option in our Image-Guided dedicated SBRT VeroTM linac, we verify the capability of the system to deliver planned dose to moving targets in the heterogeneous thorax phantom (CIRSTM). The system includes gimbaled C-band linac head, robotic 6 degree of freedom couch and a tumor tracking method based on predictive modeling of target position using fluoroscopically tracked implanted markers and optically tracked infrared reflecting external markers. Methods: 4DCT scan of the motion phantom with the VisicoilTM implanted marker in the close vicinity of the target was acquired, the ‘exhale’=most prevalent phasemore » was used for planning (iPlan by BrainLabTM). Typical 3D conformal SBRT treatment plans aimed to deliver 6-8Gy/fx to two types of targets: a)solid water-equivalent target 3cm in diameter; b)single VisicoilTM marker inserted within lung equivalent material. The planning GTV/CTV-to-PTV margins were 2mm, the block margins were 3 mm. The dose calculated by MonteCarlo algorithm with 1% variance using option Dose-to-water was compared to the ion chamber (CC01 by IBA Dosimetry) measurements in case (a) and GafchromicTM EBT3 film measurements in case (b). During delivery, the target 6 motion patterns available as a standard on CIRSTM motion phantom were investigated: in case (a), the target was moving along the designated sine or cosine4 3D trajectory; in case (b), the inserted marker was moving sinusoidally in 1D. Results: The ion chamber measurements have shown the agreement with the planned dose within 1% under all the studied motion conditions. The film measurements show 98.1% agreement with the planar calculated dose (gamma criteria: 3%/3mm). Conclusion: We successfully verified the capability of the SBRT VeroTM linac to perform real-time tumor tracking and accurate dose delivery to the target, based on predictive modeling of the correlation between implanted marker motion and external surrogate of breathing motion.« less
  • Purpose: The Vero4DRT system has the capability for dynamic tumor-tracking (DTT) stereotactic irradiation using a unique gimbaled x-ray head. The purposes of this study were to develop DTT conformal arc irradiation and to estimate its geometric and dosimetric accuracy. Methods: The gimbaled x-ray head, supported on an O-ring gantry, was moved in the pan and tilt directions during O-ring gantry rotation. To evaluate the mechanical accuracy, the gimbaled x-ray head was moved during the gantry rotating according to input command signals without a target tracking, and a machine log analysis was performed. The difference between a command and a measuredmore » position was calculated as mechanical error. To evaluate beam-positioning accuracy, a moving phantom, which had a steel ball fixed at the center, was driven based on a sinusoidal wave (amplitude [A]: 20 mm, time period [T]: 4 s), a patient breathing motion with a regular pattern (A: 16 mm, average T: 4.5 s), and an irregular pattern (A: 7.2–23.0 mm, T: 2.3–10.0 s), and irradiated with DTT during gantry rotation. The beam-positioning error was evaluated as the difference between the centroid position of the irradiated field and the steel ball on images from an electronic portal imaging device. For dosimetric accuracy, dose distributions in static and moving targets were evaluated with DTT conformal arc irradiation. Results: The root mean squares (RMSs) of the mechanical error were up to 0.11 mm for pan motion and up to 0.14 mm for tilt motion. The RMSs of the beam-positioning error were within 0.23 mm for each pattern. The dose distribution in a moving phantom with tracking arc irradiation was in good agreement with that in static conditions. Conclusions: The gimbal positional accuracy was not degraded by gantry motion. As in the case of a fixed port, the Vero4DRT system showed adequate accuracy of DTT conformal arc irradiation.« 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