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Title: SU-G-JeP4-13: Continuous Intra-Fractional Monitoring of the Prostate Using Dynamic KV Collimation and Tube Current Modulation

Abstract

Purpose: The focus of this work is to improve the available kV image quality for continuous intra-fraction monitoring of the prostate. This is investigated using a novel blade collimation system enabling modulated volume-of-interest (VOI) imaging of prostate fiducial markers. Methods: A four-blade dynamic kV collimator was used to track a VOI during gantry rotation. Planar image quality was investigated as a function of collimator dimension, while maintaining the same dose to isocenter, for a 22.2 cm diameter cylindrical water phantom with a 9 mm diameter bone insert. A sample prostate anatomy was defined in the planning system, including three fiducial markers within the CTV. The VOI margin around each marker was set to be 2σ of the population covariance matrix characterizing prostate motion. DRRs were used to calculate the kV attenuation for each VOI as a function of angle. The optimal marker and tube current were determined using kV attenuation. Monte Carlo simulations were used to calculate the imaging dose to the phantom and MV scatter dose to the imaging panel. Results: Preliminary measurements show an increase in CNR by a factor of 1.3 with the VOI method, when decreasing from an 6×6 to 2×2 cm{sup 2} field. Attenuation calculationsmore » show a change in kV fluence at the detector by a factor of 21.6 with fiducial optimization; resultant tube current modulation increases maximum dose by a factor of 1.4 compared to no modulation. MV scatter contribution to the kV detector changes by approximately a factor of two over a complete gantry rotation. Conclusion: The dynamic collimation system allows single fiducial marker tracking at a very low dose, with reduction of scatter and improvement of image quality, compared to imaging the entire prostate. The approach is compatible with tube current modulation, which enables consistent image quality throughout the range of gantry rotation. This project was funded by Varian Medical Systems.« less

Authors:
 [1];  [1];  [2]
  1. Dalhousie Unviersity, Halifax, Nova Scotia (Canada)
  2. (Canada)
Publication Date:
OSTI Identifier:
22649462
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; ATTENUATION; BIOMEDICAL RADIOGRAPHY; COLLIMATORS; COMPUTERIZED SIMULATION; FIDUCIAL MARKERS; IMAGES; MODULATION; MONITORING; MONTE CARLO METHOD; PARTICLE TRACKS; PROSTATE; RADIATION DOSES

Citation Formats

Parsons, D, Robar, J, and Nova Scotia Health Authority, Halifax, NS. SU-G-JeP4-13: Continuous Intra-Fractional Monitoring of the Prostate Using Dynamic KV Collimation and Tube Current Modulation. United States: N. p., 2016. Web. doi:10.1118/1.4957123.
Parsons, D, Robar, J, & Nova Scotia Health Authority, Halifax, NS. SU-G-JeP4-13: Continuous Intra-Fractional Monitoring of the Prostate Using Dynamic KV Collimation and Tube Current Modulation. United States. doi:10.1118/1.4957123.
Parsons, D, Robar, J, and Nova Scotia Health Authority, Halifax, NS. 2016. "SU-G-JeP4-13: Continuous Intra-Fractional Monitoring of the Prostate Using Dynamic KV Collimation and Tube Current Modulation". United States. doi:10.1118/1.4957123.
@article{osti_22649462,
title = {SU-G-JeP4-13: Continuous Intra-Fractional Monitoring of the Prostate Using Dynamic KV Collimation and Tube Current Modulation},
author = {Parsons, D and Robar, J and Nova Scotia Health Authority, Halifax, NS},
abstractNote = {Purpose: The focus of this work is to improve the available kV image quality for continuous intra-fraction monitoring of the prostate. This is investigated using a novel blade collimation system enabling modulated volume-of-interest (VOI) imaging of prostate fiducial markers. Methods: A four-blade dynamic kV collimator was used to track a VOI during gantry rotation. Planar image quality was investigated as a function of collimator dimension, while maintaining the same dose to isocenter, for a 22.2 cm diameter cylindrical water phantom with a 9 mm diameter bone insert. A sample prostate anatomy was defined in the planning system, including three fiducial markers within the CTV. The VOI margin around each marker was set to be 2σ of the population covariance matrix characterizing prostate motion. DRRs were used to calculate the kV attenuation for each VOI as a function of angle. The optimal marker and tube current were determined using kV attenuation. Monte Carlo simulations were used to calculate the imaging dose to the phantom and MV scatter dose to the imaging panel. Results: Preliminary measurements show an increase in CNR by a factor of 1.3 with the VOI method, when decreasing from an 6×6 to 2×2 cm{sup 2} field. Attenuation calculations show a change in kV fluence at the detector by a factor of 21.6 with fiducial optimization; resultant tube current modulation increases maximum dose by a factor of 1.4 compared to no modulation. MV scatter contribution to the kV detector changes by approximately a factor of two over a complete gantry rotation. Conclusion: The dynamic collimation system allows single fiducial marker tracking at a very low dose, with reduction of scatter and improvement of image quality, compared to imaging the entire prostate. The approach is compatible with tube current modulation, which enables consistent image quality throughout the range of gantry rotation. This project was funded by Varian Medical Systems.},
doi = {10.1118/1.4957123},
journal = {Medical Physics},
number = 6,
volume = 43,
place = {United States},
year = 2016,
month = 6
}
  • Purpose: This study aimed to assess inter- and intra-fractional motion for extremity Soft Tissue Sarcoma (STS) patients, by using in-house real-time optical image-based monitoring system (ROIMS) with infra-red (IR) external markers. Methods: Inter- and intra-fractional motions for five extremity (1 upper, 4 lower) STS patients received postoperative 3D conformal radiotherapy (3D-CRT) were measured by registering the image acquired by ROIMS with the planning CT image (REG-ROIMS). To compare with the X-ray image-based monitoring, pre- and post-treatment cone beam computed tomography (CBCT) scans were performed once per week and registered with planning CT image as well (REG-CBCT). If the CBCT scanmore » is not feasible due to the large couch shift, AP and LR on-board imager (OBI) images were acquired. The comparison was done by calculating mutual information (MI) of those registered images. Results: The standard deviation (SD) of the inter-fractional motion was 2.6 mm LR, 2.8 mm SI, and 2.0 mm AP, and the SD of the intra-fractional motion was 1.4 mm, 2.1 mm, and 1.3 mm in each axis, respectively. The SD of rotational inter-fractional motion was 0.6° pitch, 0.9° yaw, and 0.8° roll and the SD of rotational intra-fractional motion was 0.4° pitch, 0.9° yaw, and 0.7° roll. The derived averaged MI values were 0.83, 0.92 for REG-CBCT without rotation and REG-ROIMS with rotation, respectively. Conclusion: The in-house real-time optical image-based monitoring system was implemented clinically and confirmed the feasibility to assess inter- and intra-fractional motion for extremity STS patients while the daily basis and real-time CBCT scan is not feasible in clinic.« less
  • Purpose: The focus of this work is the development of a novel blade collimation system enabling volume of interest (VOI) CBCT with tube current modulation using the kV image guidance source on a linear accelerator. Advantages of the system are assessed, particularly with regard to reduction and localization of dose and improvement of image quality. Methods: A four blade dynamic kV collimator was developed to track a VOI during a CBCT acquisition. The current prototype is capable of tracking an arbitrary volume defined by the treatment planner for subsequent CBCT guidance. During gantry rotation, the collimator tracks the VOI withmore » adjustment of position and dimension. CBCT image quality was investigated as a function of collimator dimension, while maintaining the same dose to the VOI, for a 22.2 cm diameter cylindrical water phantom with a 9 mm diameter bone insert centered on isocenter. Dose distributions were modeled using a dynamic BEAMnrc library and DOSXYZnrc. The resulting VOI dose distributions were compared to full-field CBCT distributions to quantify dose reduction and localization to the target volume. A novel method of optimizing x-ray tube current during CBCT acquisition was developed and assessed with regard to contrast-to-noise ratio (CNR) and imaging dose. Results: Measurements show that the VOI CBCT method using the dynamic blade system yields an increase in contrast-to-noise ratio by a factor of approximately 2.2. Depending upon the anatomical site, dose was reduced to 15%–80% of the full-field CBCT value along the central axis plane and down to less than 1% out of plane. The use of tube current modulation allowed for specification of a desired SNR within projection data. For approximately the same dose to the VOI, CNR was further increased by a factor of 1.2 for modulated VOI CBCT, giving a combined improvement of 2.6 compared to full-field CBCT. Conclusions: The present dynamic blade system provides significant improvements in CNR for the same imaging dose and localization of imaging dose to a predefined volume of interest. The approach is compatible with tube current modulation, allowing optimization of the imaging protocol.« less
  • Purpose: To evaluate the intra-fractional prostate movement range during the beam delivery and implement new IGRT method to correct the prostate movement during the hypofractionated prostate treatment delivery. Methods: To evaluate the prostate internal motion range during the beam delivery, 11 conventional treatments were utilized. Two-arc RapidArc plans were used for the treatment delivery. Orthogonal KV imaging is performed in the middle of the treatment to correct intra-fractional prostate movement. However, it takes gantry-mounted on-board imaging system relative long time to finish the orthogonal KV imaging because of gantry rotation. To avoid gantry movement and accelerate the IGRT processing time,more » orthogonal KV-MV image pair is tested using the OBI daily QA Cube phantom. Results: The average prostate movement between two orthogonal KV image pairs was 0.38cm (0.20cm ∼ 0.85cm). And the interval time between them was 6.71 min (4.64min ∼ 9.22 min). 2-arc beam delivery time is within 3 minutes for conventional RapidArc treatment delivery. Hypofractionated treatment or SBRT need 4 partial arc and possible non-coplanar technology, which need much longer beam delivery time. Therefore prostate movement might be larger. New orthogonal KV-MV image pair is a new method to correct the prostate movement in the middle of the beam delivery if real time tracking method is not available. Orthogonal KV-MV image pair doesn’t need gantry rotation. Images were acquired quickly which minimized possible new prostate movement. Therefore orthogonal KV-MV image pair is feasible for IGRT. Conclusion: Hypofractionated prostate treatment with less PTV margin always needs longer beam delivery time. Therefore prostate movement correction during the treatment delivery is critical. Orthogonal KV-MV imaging pair is efficient and accurate to correct the prostate movement during treatment beam delivery. Due to limited fraction number and high dose per fraction, the MV imaging dose is negligible.« less
  • Purpose: To provide benchmark for seminal vesicles (SVs) margin selection to account for intra-fractional motion; and to investigate the effectiveness of two motion surrogates in predicting intra-fractional SV underdosage. Methods: 9 prostate SBRT patients were studied; each has five pairs of pre-treatment and post-treatment cone-beam CTs (CBCTs). Each pair of CBCTs was registered based on fiducial markers in the prostate. To provide “ground truth” for coverage evaluation, all pre-treatment SVs were expanded with isotropic margin of 1,2,3,5 and 8mm, and their overlap with post-treatment SVs were used to quantify intra-fractional coverage. Two commonly used motion surrogates, the center-of-mass (COM) andmore » the border of contour (the most distal points in SI/AP/LR directions) were evaluated using Receiver-Operating Characteristic (ROC) analyses for predicting SV underdosage due to intra-fractional motion. Action threshold of determining underdosage for each surrogate was calculated by selecting the optimal balancing between sensitivity and specificity. For comparison, margin for each surrogate was also calculated based on traditional margin recipe. Results: 90% post-treatment SV coverage can be achieved in 47%, 82%, 91%, 98% and 98% fractions for 1,2,3,5 and 8mm margins. 3mm margin ensured the 90% intra-fractional SV coverage in 90% fractions when prostate was aligned. The ROC analysis indicated the AUC for COM and border were 0.88 and 0.72. The underdosage threshold was 2.9mm for COM and 4.1mm for border. The Van Herk’s margin recipe recommended 0.5, 0 and 1.8mm margin in LR, AP and SI direction based on COM and for border, the corresponding margin was 2.1, 4.5 and 3mm. Conclusion: 3mm isotropic margin is the minimum required to mitigate the intra-fractional SV motion when prostate is aligned. ROC analysis reveals that both COM and border are acceptable predictors for SV underdosage with 2.9mm and 4.1mm action threshold. Traditional margin calculation is less reliable for this application. This work is partially supported a master research grant from Varian Medical Systems.« less
  • Purpose: A clinical trial on stereotactic body radiation therapy (SBRT) for high-risk prostate cancer is undergoing at our institution. In addition to escalating dose to the prostate, we have increased dose to intra-prostatic lesions. Intra-fractional prostate motion deteriorates well planned radiation dose, especially for the small intra-prostatic lesions. To solve this problem, we have developed a motion tracking and 4D dose-reconstruction system to facilitate adaptive re-planning. Methods: Patients in the clinical trial were treated with VMAT using four arcs and 10 FFF beam. KV triggered x-ray projections were taken every 3 sec during delivery to acquire 2D projections of 3Dmore » anatomy at the direction orthogonal to the therapeutic beam. Each patient had three implanted prostate markers. Our developed system first determined 2D projection locations of these markers and then 3D prostate translation and rotation via 2D/3D registration of the markers. Using delivery log files, our GPU-based Monte Carlo tool (goMC) reconstructed dose corresponding to each triggered image. The calculated 4D dose distributions were further aggregated to yield the delivered dose. Results: We first tested each module in our system. MC dose engine were commissioned to our treatment planning system with dose difference of <0.5%. For motion tracking, 1789 kV projections from 7 patients were acquired. The 2D marker location error was <1 mm. For 3D motion tracking, root mean square (RMS) errors along LR, AP, and CC directions were 0.26mm, 0.36mm, and 0.01mm respectively in simulation studies and 1.99mm, 1.37mm, and 0.22mm in phantom studies. We also tested the entire system workflow. Our system was able to reconstruct delivered dose. Conclusion: We have developed a functional intra-fractional motion tracking and 4D dose re-construction system to support our clinical trial on adaptive high-risk prostate cancer SBRT. Comprehensive evaluations have shown the capability and accuracy of our system.« less