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Title: SU-G-BRA-17: Tracking Multiple Targets with Independent Motion in Real-Time Using a Multi-Leaf Collimator

Abstract

Purpose: Multiple targets with large intrafraction independent motion are often involved in advanced prostate, lung, abdominal, and head and neck cancer radiotherapy. Current standard of care treats these with the originally planned fields, jeopardizing the treatment outcomes. A real-time multi-leaf collimator (MLC) tracking method has been developed to address this problem for the first time. This study evaluates the geometric uncertainty of the multi-target tracking method. Methods: Four treatment scenarios are simulated based on a prostate IMAT plan to treat a moving prostate target and static pelvic node target: 1) real-time multi-target MLC tracking; 2) real-time prostate-only MLC tracking; 3) correcting for prostate interfraction motion at setup only; and 4) no motion correction. The geometric uncertainty of the treatment is assessed by the sum of the erroneously underexposed target area and overexposed healthy tissue areas for each individual target. Two patient-measured prostate trajectories of average 2 and 5 mm motion magnitude are used for simulations. Results: Real-time multi-target tracking accumulates the least uncertainty overall. As expected, it covers the static nodes similarly well as no motion correction treatment and covers the moving prostate similarly well as the real-time prostate-only tracking. Multi-target tracking reduces >90% of uncertainty for the static nodalmore » target compared to the real-time prostate-only tracking or interfraction motion correction. For prostate target, depending on the motion trajectory which affects the uncertainty due to leaf-fitting, multi-target tracking may or may not perform better than correcting for interfraction prostate motion by shifting patient at setup, but it reduces ∼50% of uncertainty compared to no motion correction. Conclusion: The developed real-time multi-target MLC tracking can adapt for the independently moving targets better than other available treatment adaptations. This will enable PTV margin reduction to minimize health tissue toxicity while remain tumor coverage when treating advanced disease with independently moving targets involved. The authors acknowledge funding support from the Australian NHMRC Australia Fellowship and NHMRC Project Grant No. APP1042375.« less

Authors:
;  [1];  [2]
  1. University of Sydney, Sydney (Australia)
  2. Aarhus University Hospital, Aarhus (Denmark)
Publication Date:
OSTI Identifier:
22649305
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; COLLIMATORS; CORRECTIONS; PROSTATE; RADIATION DOSES

Citation Formats

Ge, Y, Keall, P, and Poulsen, P. SU-G-BRA-17: Tracking Multiple Targets with Independent Motion in Real-Time Using a Multi-Leaf Collimator. United States: N. p., 2016. Web. doi:10.1118/1.4956941.
Ge, Y, Keall, P, & Poulsen, P. SU-G-BRA-17: Tracking Multiple Targets with Independent Motion in Real-Time Using a Multi-Leaf Collimator. United States. doi:10.1118/1.4956941.
Ge, Y, Keall, P, and Poulsen, P. 2016. "SU-G-BRA-17: Tracking Multiple Targets with Independent Motion in Real-Time Using a Multi-Leaf Collimator". United States. doi:10.1118/1.4956941.
@article{osti_22649305,
title = {SU-G-BRA-17: Tracking Multiple Targets with Independent Motion in Real-Time Using a Multi-Leaf Collimator},
author = {Ge, Y and Keall, P and Poulsen, P},
abstractNote = {Purpose: Multiple targets with large intrafraction independent motion are often involved in advanced prostate, lung, abdominal, and head and neck cancer radiotherapy. Current standard of care treats these with the originally planned fields, jeopardizing the treatment outcomes. A real-time multi-leaf collimator (MLC) tracking method has been developed to address this problem for the first time. This study evaluates the geometric uncertainty of the multi-target tracking method. Methods: Four treatment scenarios are simulated based on a prostate IMAT plan to treat a moving prostate target and static pelvic node target: 1) real-time multi-target MLC tracking; 2) real-time prostate-only MLC tracking; 3) correcting for prostate interfraction motion at setup only; and 4) no motion correction. The geometric uncertainty of the treatment is assessed by the sum of the erroneously underexposed target area and overexposed healthy tissue areas for each individual target. Two patient-measured prostate trajectories of average 2 and 5 mm motion magnitude are used for simulations. Results: Real-time multi-target tracking accumulates the least uncertainty overall. As expected, it covers the static nodes similarly well as no motion correction treatment and covers the moving prostate similarly well as the real-time prostate-only tracking. Multi-target tracking reduces >90% of uncertainty for the static nodal target compared to the real-time prostate-only tracking or interfraction motion correction. For prostate target, depending on the motion trajectory which affects the uncertainty due to leaf-fitting, multi-target tracking may or may not perform better than correcting for interfraction prostate motion by shifting patient at setup, but it reduces ∼50% of uncertainty compared to no motion correction. Conclusion: The developed real-time multi-target MLC tracking can adapt for the independently moving targets better than other available treatment adaptations. This will enable PTV margin reduction to minimize health tissue toxicity while remain tumor coverage when treating advanced disease with independently moving targets involved. The authors acknowledge funding support from the Australian NHMRC Australia Fellowship and NHMRC Project Grant No. APP1042375.},
doi = {10.1118/1.4956941},
journal = {Medical Physics},
number = 6,
volume = 43,
place = {United States},
year = 2016,
month = 6
}
  • Purpose: Intrafraction deformation limits targeting accuracy in radiotherapy. Studies show tumor deformation of over 10 mm for both single tumor deformation and system deformation (due to differential motion between primary tumors and involved lymph nodes). Such deformation cannot be adapted to with current radiotherapy methods. The objective of this study was to develop and experimentally investigate the ability of a dynamic multi-leaf collimator (DMLC) tracking system to account for tumor deformation. Methods: To compensate for tumor deformation, the DMLC tracking strategy is to warp the planned beam aperture directly to conform to the new tumor shape based on real timemore » tumor deformation input. Two deformable phantoms that correspond to a single tumor and a tumor system were developed. The planar deformations derived from the phantom images in beam's eye view were used to guide the aperture warping. An in-house deformable image registration software was developed to automatically trigger the registration once new target image was acquired and send the computed deformation to the DMLC tracking software. Because the registration speed is not fast enough to implement the experiment in real-time manner, the phantom deformation only proceeded to the next position until registration of the current deformation position was completed. The deformation tracking accuracy was evaluated by a geometric target coverage metric defined as the sum of the area incorrectly outside and inside the ideal aperture. The individual contributions from the deformable registration algorithm and the finite leaf width to the tracking uncertainty were analyzed. Clinical proof-of-principle experiment of deformation tracking using previously acquired MR images of a lung cancer patient was implemented to represent the MRI-Linac environment. Intensity-modulated radiation therapy (IMRT) treatment delivered with enabled deformation tracking was simulated and demonstrated. Results: The first experimental investigation of adapting to tumor deformation has been performed using simple deformable phantoms. For the single tumor deformation, the A{sub u}+A{sub o} was reduced over 56% when deformation was larger than 2 mm. Overall, the total improvement was 82%. For the tumor system deformation, the A{sub u}+A{sub o} reductions were all above 75% and the total A{sub u}+A{sub o} improvement was 86%. Similar coverage improvement was also found in simulating deformation tracking during IMRT delivery. The deformable image registration algorithm was identified as the dominant contributor to the tracking error rather than the finite leaf width. The discrepancy between the warped beam shape and the ideal beam shape due to the deformable registration was observed to be partially compensated during leaf fitting due to the finite leaf width. The clinical proof-of-principle experiment demonstrated the feasibility of intrafraction deformable tracking for clinical scenarios. Conclusions: For the first time, we developed and demonstrated an experimental system that is capable of adapting the MLC aperture to account for tumor deformation. This work provides a potentially widely available management method to effectively account for intrafractional tumor deformation. This proof-of-principle study is the first experimental step toward the development of an image-guided radiotherapy system to treat deforming tumors in real-time.« less
  • Purpose: We report on an integrated system for real-time adaptive radiation delivery to moving tumors. The system combines two promising technologies-three-dimensional internal position monitoring using implanted electromagnetically excitable transponders and corresponding real-time beam adaptation using a dynamic multileaf collimator (DMLC). Methods and Materials: In a multi-institutional academic and industrial collaboration, a research version of the Calypso position monitoring system was integrated with a DMLC-based four-dimensional intensity-modulated radiotherapy delivery system using a Varian 120-leaf multileaf collimator (MLC). Two important determinants of system performance-latency (i.e., elapsed time between target motion and MLC response) and geometric accuracy-were investigated. Latency was quantified by acquiringmore » continuous megavoltage X-ray images of a moving phantom (with embedded transponders) that was tracked in real time by a circular MLC field. The latency value was input into a motion prediction algorithm within the DMLC tracking system. Geometric accuracy was calculated as the root-mean-square positional error between the target and the centroid of the MLC aperture for patient-derived three-dimensional motion trajectories comprising two lung tumor traces and one prostate trace. Results: System latency was determined to be approximately 220 milliseconds. Tracking accuracy was observed to be sub-2 mm for the respiratory motion traces and sub-1 mm for prostate motion. Conclusion: We have developed and characterized a research version of a novel four-dimensional delivery system that integrates nonionizing radiation-based internal position monitoring and accurate real-time DMLC-based beam adaptation. This system represents a significant step toward achieving the eventual goal of geometrically ideal dose delivery to moving tumors.« 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 develop a real-time target position estimation method using stereoscopic kilovoltage (kV)/megavoltage (MV) imaging and external respiratory monitoring, and to investigate the performance of a dynamic multileaf collimator tracking system using this method. Methods and Materials: The real-time three-dimensional internal target position estimation was established by creating a time-varying correlation model that connected the external respiratory signals with the internal target motion measured intermittently using kV/MV imaging. The method was integrated into a dynamic multileaf collimator tracking system. Tracking experiments were performed for 10 thoracic/abdominal traces. A three-dimensional motion platform carrying a gold marker and a separate one-dimensional motionmore » platform were used to reproduce the target and external respiratory motion, respectively. The target positions were detected by kV (1 Hz) and MV (5.2 Hz) imaging, and external respiratory motion was captured by an optical system (30 Hz). The beam-target alignment error was quantified as the positional difference between the target and circular beam center on the MV images acquired during tracking. The correlation model error was quantified by comparing a model estimate and measured target positions. Results: The root-mean-square errors in the beam-target alignment that had ranged from 3.1 to 7.6 mm without tracking were reduced to <1.5 mm with tracking, except during the model building period (6 s). The root-mean-square error in the correlation model was submillimeters in all directions. Conclusion: A novel real-time target position estimation method was developed and integrated into a dynamic multileaf collimator tracking system and demonstrated an average submillimeter geometric accuracy after initializing the internal/external correlation model. The method used hardware tools available on linear accelerators and therefore shows promise for clinical implementation.« 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