A. Isambert

An efficient locally affine framework for the smooth registration of anatomical structures.

Intra-subject and inter-subject nonlinear registration based on dense transformations requires the setting of many parameters, mainly for regularization. This task is a major issue, as the global quality of the registration will depend on it. Setting these parameters is, however, very hard, and they may have to be tuned for each patient when processing data acquired by different centers or using different protocols. Thus, we present in this article a method to introduce more coherence in the registration by using fewer degrees of freedom than with a dense registration. This is done by registering the images only on user-defined areas, using a set of affine transformations, which are optimized together in a very efficient manner. Our framework also ensures a smooth and coherent transformation thanks to a new regularization of the affine components. Finally, we ensure an invertible transformation thanks to the Log-Euclidean polyaffine framework. This allows us to get a more robust and very efficient registration method, while obtaining good results as explained below. We performed a qualitative and quantitative evaluation of the obtained results on two applications: first on atlas-based brain segmentation, comparing our results with a dense registration algorithm. Then the second application for which our framework is particularly well suited concerns bone registration in the lower-abdomen area. We obtain in this case a better positioning of the femoral heads than with a dense registration. For both applications, we show a significant improvement in computation time, which is crucial for clinical applications.

A pre-clinical assessment of an atlas-based automatic segmentation tool for the head and neck

BACKGROUND AND PURPOSE Accurate conformal radiotherapy treatment requires manual delineation of target volumes and organs at risk (OAR) that is both time-consuming and subject to large inter-user variability. One solution is atlas-based automatic segmentation (ABAS) where a priori information is used to delineate various organs of interest. The aim of the present study is to establish the accuracy of one such tool for the head and neck (H&N) using two different evaluation methods. MATERIALS AND METHODS Two radiotherapy centres were provided with an ABAS tool that was used to outline the brainstem, parotids and mandible on several patients. The results were compared to manual delineations for the first centre (EM1) and reviewed/edited for the second centre (EM2), both of which were deemed as equally valid gold standards. The contours were compared in terms of their volume, sensitivity and specificity with the results being interpreted using the Dice similarity coefficient and a receiver operator characteristic (ROC) curve. RESULTS Automatic segmentation took typically approximately 7min for each patient on a standard PC. The results indicated that the atlas contour volume was generally within +/-1SD of each gold standard apart from the parotids for EM1 and brainstem for EM2 that were over- and under-estimated, respectively (within +/-2SD). The similarity of the atlas contours with their respective gold standard was satisfactory with an average Dice coefficient for all OAR of 0.68+/-0.25 for EM1 and 0.82+/-0.13 for EM2. All data had satisfactory sensitivity and specificity resulting in a favourable position in ROC space. CONCLUSIONS These tests have shown that the ABAS tool exhibits satisfactory sensitivity and specificity for the OAR investigated. There is, however, a systematic over-segmentation of the parotids (EM1) and under-segmentation of the brainstem (EM2) that require careful review and editing in the majority of cases. Such issues have been discussed with the software manufacturer and a revised version is due for release.

Radiothérapie guidée par l’image

The IGRT is described in its various equipment and implementation. IGRT can be based either on ionizing radiation generating 2D imaging (MV or kV) or 3D imaging (CBCT or MV-CT) or on non-ionizing radiation (ultrasound, optical imaging, MRI or radiofrequency). Adaptive radiation therapy is then presented in its principles of implementation. The function of the technicians for IGRT is then presented and the possible dose delivered by the on-board imaging is discussed. The quality control of IGRT devices is finally described.

Multichannel dosemeter and Al2O3:C optically stimulated luminescence fibre sensors for use in radiation therapy: evaluation with electron beams

This article proposes an innovative multichannel optically stimulated luminescence (OSL) dosemeter for on-line in vivo dose verification in radiation therapy. OSL fibre sensors incorporating small Al(2)O(3):C fibre crystals (TLD(500)) have been tested with an X-ray generator. A reproducible readout procedure should reduce the fading-induced uncertainty ( approximately - 1% per decade). OSL readouts are temperature-dependent [ approximately 0.3% K(-1) when OSL stimulation is performed at the same temperature as irradiation; approximately 0.16% K(-1) after thermalisation (20 degrees C)]. Sensor calibration and depth-dose measurements with electron beams have been performed with a Saturne 43 linear accelerator in reference conditions at CEA-LNHB (ionising radiation reference laboratory in France). Predosed OSL sensors show a good repeatability in multichannel operation and independence versus electron energy in the range (9, 18 MeV). The difference between absorbed doses measured by OSL and an ionisation chamber were within +/-0.9% (for a dose of about 1 Gy) despite a sublinear calibration curve.

A phantom study of the accuracy of CT, MR and PET image registrations with a block matching-based algorithm

PURPOSE The aim of the present study was to quantitatively assess the performance of a block matching-based automatic registration algorithm integrated within the commercial treatment planning system designated ISOgray from Dosisoft. The accuracy of the process was evaluated by a phantom study on computed tomography (CT), magnetic resonance (MR) and positron emission tomography (PET) images. MATERIALS AND METHODS Two phantoms were used to carry out this study: the cylindrical Jaszczak phantom and the anthropomorphic Liqui-Phil Head Phantom (the Phantom Laboratory), containing fillable spheres. External fiducial markers were used to quantify the accuracy of 41 CT/CT, MR/CT and PET/CT automatic registrations with images of the rotated and tilted phantoms. RESULTS The study first showed that a cylindrical phantom was not adapted for the evaluation of the performance of a block matching-based registration software. Secondly, the Liqui-Phil Head Phantom study showed that the algorithm was able to perform automatic registrations of CT/CT and MR/CT images with differences of up to 40 degrees in phantom rotation and of up to 20-30 degrees for PET/CT with accuracy below the image voxel size. CONCLUSION The study showed that the block matching-based automatic registration software under investigation was robust, reliable and yielded very satisfactory results. This phantom-based test can be integrated into a periodical quality assurance process and used for any commissioning of image registration software for radiation therapy.

Determination of the optimal statistical uncertainty to perform electron-beam Monte Carlo absorbed dose estimation in the target volume

PURPOSE OF STUDY Monte Carlo based treatment planning system are known to be more accurate than analytical methods for performing absorbed dose estimation, particularly in and near heterogeneities. However, the required computation time can still be an issue. The present study focused on the determination of the optimum statistical uncertainty in order to minimise computation time while keeping the reliability of the absorbed dose estimation in treatments planned with electron-beams. MATERIALS AND METHODS Three radiotherapy plans (medulloblastoma, breast and gynaecological) were used to investigate the influence of the statistical uncertainty of the absorbed dose on the target volume dose-volume histograms (spinal cord, intramammary nodes and pelvic lymph nodes, respectively). RESULTS The study of the dose-volume histograms showed that for statistical uncertainty levels (1 S.D.) above 2 to 3%, the standard deviation of the mean dose in the target volume calculated from the dose-volume histograms increases by at least 6%, reflecting the gradual flattening of the dose-volume histograms. CONCLUSIONS This work suggests that, in clinical context, Monte Carlo based absorbed dose estimations should be performed with a maximum statistical uncertainty of 2 to 3%.

Multichannel Dosimeter and

A multichannel OSL fiber optic dosimeter based on optically stimulated luminescence (OSL) of alumina is proposed for online in vivo dosimetry (IVD) in radiation therapy (RT). Two types of dosimetric-grade Al2O3:C crystals are compared and show different behavior according to manufacturing process. Metrological validations have been performed with a Saturne 43 LINAC in reference conditions at CEA LIST LNHB (French Ionizing Radiation Reference Laboratory). The dose response of OSL integrals under photon beam irradiation (6, 12, and 20 MV) show sublinearity behavior modeled by second-order equations and exhibit a small energy dependence (between 0.7% and 1.4%), explained by a modified intermediate cavity model adapted to a LINAC photon spectrum. Preclinical tests at Institut Gustave Roussy (IGR) prove that a proper design for a PMMA build-up cap leads to a low dependence vs photon beam orientation (± 1.5% and ± 0.9%) and vs field size in view of surface measurements.

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A multichannel OSL Fibre Optic dosimeter based on Optically Stimulated Luminescence (OSL) of alumina is proposed for on-line In Vivo Dosimetry (IVD) in Radiation Therapy (RT). Two types of dosimetric-grade Al2O3:C crystals are compared and show different behavior according to manufacturing process. Metrological validations have been performed with a Saturne 43 LINAC in reference conditions at CEA LIST LNHB (French Ionizing Radiation Reference Laboratory). The dose response of OSL integrals under photon beam irradiation (6, 12 and 20 MV) show sublinearity behavior modeled by second-order equations and exhibit a small energy dependence (between 0.7% and 1.4%), explained by a modified intermediate cavity model adapted to a LINAC photon spectrum. Preclinical tests at Institut Gustave Roussy (IGR) prove that a proper design for a PMMA build-up cap leads to a low dependence vs photon beam orientation (± 1.5 % and ± 0.9 %) and vs field size in view of surface measurements.

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RésuméCes dernières années ont vu se développer des techniques d’irradiation performantes telles que la radiothérapie conformationnelle tridimensionnelle et la radiothérapie avec modulation d’intensité (RCMI), La précision avec laquelle ces techniques permettent de délivrer la dose a rehaussé l’importance d’une localisation et d’une définition les plus exactes possibles des volumes d’intérèt. Pour répondre à cette exigence, de nouvelles technologies regroupées sous l’appellation de la radiothérapie guidée par l’image (IGRT pour « image-guided radiation therapy») se sont développées et peuvent être utilisées dans deux principales phases d’un traitement par radiothérapie externe: 1) la préparation du traitement par la définition du volume cible; 2) la réalisation du traitement par le repositionnement du patient et la localisation du volume cible. Dans cet article, nous présenterons plus particulièrement différentes techniques d’IGRT pouvant étre utilisées lors de la deuxième phase: l’imagerie utilisant un faisceau de rayons X (kV ou MV) comme le système ExacTrac® ou le système associé au CyberKnife™, l’imagerie tomodensitométrique ou la tomographie conique, et l’imagerie non irradiante comme la détection des balises de radiofréquence ou le « tracking » de la surface du patient utilisant la vidéo.AbstractIn recent years, the new irradiation techniques as the conformal 3D radiation therapy and the intensity modulated radiation therapy (IMRT) have been strongly correlated with the technological developments. These techniques have heightened the necessity of a thorough localization and precise definition of the volumes of interest. In response to this challenge, new technologies known as image-guided radiation therapy (IGRT) have been developed and can be used in two of the main steps in external beam radiation therapy: 1) treatment preparation by determining target volume; and 2) treatment delivery by positioning the patient and localizing the target volume. Inthis paper, we focus on different IGRT techniques used in the second step: X-ray imaging (kV or MV), such as the ExacTrac® system and Cyberknife® imaging system, conventional in-room computed tomography (CT), cone beam computed tomography (CBCT), and non-ionizing imaging techniques, such as the detection of magnetic fiducials and tracking the surface of patients using video imaging.

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A multi-channel fibre optic OSL dosimeter system is developed by the CEA LIST for quality control in cancer radiation therapy, in the framework of the European Integrated Project MAESTRO.