Naoya Saotome

Evaluation of heterogeneity dose distributions for Stereotactic Radiotherapy (SRT): comparison of commercially available Monte Carlo dose calculation with other algorithms

BackgroundThe purpose of this study was to compare dose distributions from three different algorithms with the x-ray Voxel Monte Carlo (XVMC) calculations, in actual computed tomography (CT) scans for use in stereotactic radiotherapy (SRT) of small lung cancers.MethodsSlow CT scan of 20 patients was performed and the internal target volume (ITV) was delineated on Pinnacle3. All plans were first calculated with a scatter homogeneous mode (SHM) which is compatible with Clarkson algorithm using Pinnacle3 treatment planning system (TPS). The planned dose was 48 Gy in 4 fractions. In a second step, the CT images, structures and beam data were exported to other treatment planning systems (TPSs). Collapsed cone convolution (CCC) from Pinnacle3, superposition (SP) from XiO, and XVMC from Monaco were used for recalculating. The dose distributions and the Dose Volume Histograms (DVHs) were compared with each other.ResultsThe phantom test revealed that all algorithms could reproduce the measured data within 1% except for the SHM with inhomogeneous phantom. For the patient study, the SHM greatly overestimated the isocenter (IC) doses and the minimal dose received by 95% of the PTV (PTV95) compared to XVMC. The differences in mean doses were 2.96 Gy (6.17%) for IC and 5.02 Gy (11.18%) for PTV95. The DVHs and dose distributions with CCC and SP were in agreement with those obtained by XVMC. The average differences in IC doses between CCC and XVMC, and SP and XVMC were -1.14% (p = 0.17), and -2.67% (p = 0.0036), respectively.ConclusionsOur work clearly confirms that the actual practice of relying solely on a Clarkson algorithm may be inappropriate for SRT planning. Meanwhile, CCC and SP were close to XVMC simulations and actual dose distributions obtained in lung SRT.

4D registration and 4D verification of lung tumor position for stereotactic volumetric modulated arc therapy using respiratory-correlated cone-beam CT

We propose a clinical workflow of stereotactic volumetric modulated arc therapy (VMAT) for a lung tumor from planning to tumor position verification using 4D planning computed tomography (CT) and 4D cone-beam CT (CBCT). A 4D CT scanner, an Anzai belt and a BodyFix were employed to obtain 10-phase respiratory-correlated CT data for a lung patient under constrained breathing conditions. A planning target volume (PTV) was defined by adding a 5-mm margin to an internal target volume created from 10 clinical target volumes, each of which was delineated on each of the 10-phase planning CT data. A single-arc VMAT plan was created with a D95 prescription dose of 50 Gy in four fractions on the maximum exhalation phase CT images. The PTV contours were exported to a kilovoltage CBCT X-ray Volume Imaging (XVI) equipped with a linear accelerator (linac). Immediately before treatment, 10-phase 4D CBCT images were reconstructed leading to animated lung tumor imaging. Initial bone matching was performed between frame-averaged 4D planning CT and frame-averaged 4D CBCT datasets. Subsequently, the imported PTV contours and the animated moving tumor were simultaneously displayed on the XVI monitor, and a manual 4D registration was interactively performed on the monitor until the moving tumor was symmetrically positioned inside the PTV. A VMAT beam was delivered to the patient and during the delivery further 4D CBCT projection data were acquired to verify the tumor position. The entire process was repeated for each fraction. It was confirmed that the moving tumor was positioned inside the PTV during the VMAT delivery.

4D-CBCT reconstruction using MV portal imaging during volumetric modulated arc therapy

BACKGROUND Recording target motion during treatment is important for verifying the irradiated region. Recently, cone-beam computed tomography (CBCT) reconstruction from portal images acquired during volumetric modulated arc therapy (VMAT), known as VMAT-CBCT, has been investigated. In this study, we developed a four-dimensional (4D) version of the VMAT-CBCT. MATERIALS AND METHODS The MV portal images were sequentially acquired from an electronic portal imaging device. The flex, background, monitor unit, field size, and multi-leaf collimator masking corrections were considered during image reconstruction. A 4D VMAT-CBCT requires a respiratory signal during image acquisition. An image-based phase recognition (IBPR) method was performed using normalised cross correlation to extract a respiratory signal from the series of portal images. RESULTS Our original IBPR method enabled us to reconstruct 4D VMAT-CBCT with no external devices. We confirmed that 4D VMAT-CBCT was feasible for two patients and in good agreement with in-treatment 4D kV-CBCT. CONCLUSION The visibility of the anatomy in 4D VMAT-CBCT reconstruction for lung cancer patients has the potential of using 4D VMAT-CBCT as a tool for verifying relative positions of tumour for each respiratory phase.

In-treatment 4D cone-beam CT with image-based respiratory phase recognition

The use of respiration-correlated cone-beam computed tomography (4D-CBCT) appears to be crucial for implementing precise radiation therapy of lung cancer patients. The reconstruction of 4D-CBCT images requires a respiratory phase. In this paper, we propose a novel method based on an image-based phase recognition technique using normalized cross correlation (NCC). We constructed the respiratory phase by searching for a region in an adjacent projection that achieves the maximum correlation with a region in a reference projection along the cranio-caudal direction. The data on 12 lung cancer patients acquired just prior to treatment and on 3 lung cancer patients acquired during volumetric modulated arc therapy treatment were analyzed in the search for the effective area of cone-beam projection images for performing NCC with 12 combinations of registration area and segment size. The evaluation was done by a “recognition rate” defined as the ratio of the number of peak inhales detected with our method to that detected by eye (manual tracking). The average recognition rate of peak inhale with the most efficient area in the present method was 96.4%. The present method was feasible even when the diaphragm was outside the field of view. With the most efficient area, we reconstructed in-treatment 4D-CBCT by dividing the breathing signal into four phase bins; peak exhale, peak inhale, and two intermediate phases. With in-treatment 4D-CBCT images, it was possible to identify the tumor position and the tumor size in moments of inspiration and expiration, in contrast to in-treatment CBCT reconstructed with all projections.

Delivery verification using 3D dose reconstruction based on fluorescence measurement in a carbon beam scanning irradiation system

The authors have developed a method to reconstruct the 3D dose distribution in a particle beam scanning irradiation system. In this scheme, 3D dose distribution is reconstructed by using the measured images of fluence distribution, which are taken for each iso-energy slice (i.e., the unit of the depth scanning). A fluorescent screen with a CCD camera is used to measure the fluence distribution. This system was installed at the HIMAC experimental port and tested by using carbon ion beams. Since a maximum difference between the reconstructed dose and the ionization chamber measurement was around 5% in the target volume, this system can be useful for quick verification of 3D dose distribution.

Stereotactic Body Radiotherapy for Small Lung Tumors in the University of Tokyo Hospital

Our work on stereotactic body radiation therapy (SBRT) for primary and metastatic lung tumors will be described. The eligibility criteria for SBRT, our previous SBRT method, the definition of target volume, heterogeneity correction, the position adjustment using four-dimensional cone-beam computed tomography (4D CBCT) immediately before SBRT, volumetric modulated arc therapy (VMAT) method for SBRT, verifying of tumor position within internal target volume (ITV) using in-treatment 4D-CBCT during VMAT-SBRT, shortening of treatment time using flattening-filter-free (FFF) techniques, delivery of 4D dose calculation for lung-VMAT patients using in-treatment CBCT and LINAC log data with agility multileaf collimator, and SBRT method for centrally located lung tumors in our institution will be shown. In our institution, these efforts have been made with the goal of raising the local control rate and decreasing adverse effects after SBRT.

Experimental verification of gain drop due to general ion recombination for a carbon‐ion pencil beam

PURPOSE Accurate dose measurement in radiotherapy is critically dependent on correction for gain drop, which is the difference of the measured current from the ideal saturation current due to general ion recombination. Although a correction method based on the Boag theory has been employed, the theory assumes that ionized charge density in an ionization chamber (IC) is spatially uniform throughout the irradiation volume. For particle pencil beam scanning, however, the charge density is not uniform, because the fluence distribution of a pencil beam is not uniform. The aim of this study was to verify the effect of the nonuniformity of ionized charge density on the gain drop due to general ion recombination. METHODS The authors measured the saturation curve, namely, the applied voltage versus measured current, using a large plane-parallel IC and 24-channel parallel-plate IC with concentric electrodes. To verify the effect of the nonuniform ionized charge density on the measured saturation curve, the authors calculated the saturation curve using a method which takes into account the nonuniform ionized charge density and compared it with the measured saturation curves. RESULTS Measurement values of the different saturation curves in the different channels of the concentric electrodes differed and were consistent with the calculated values. The saturation curves measured by the large plane-parallel IC were also consistent with the calculation results, including the estimation error of beam size and of setup misalignment. Although the impact of the nonuniform ionized charge density on the gain drop was clinically negligible with the conventional beam intensity, it was expected that the impact would increase with higher ionized charge density. CONCLUSIONS For pencil beam scanning, the assumption of the conventional Boag theory is not valid. Furthermore, the nonuniform ionized charge density affects the prediction accuracy of gain drop when the ionized charge density is increased by a higher dose rate and/or lower beam size.

Others: Four-dimensional Cone-Beam CT During SBRT

The use of respiration-correlated cone-beam computed tomography (hereafter, referred to as four-dimensional cone-beam CT; 4D CBCT) appears to be crucial for implementing precise radiation therapy for lung cancer patients. With the 4D CBCT mounted on linear accelerator (LINAC), the mean position, trajectory, and shape of a moving tumor can be verified just prior to treatment. This reconstruction technique is also applicable for in-treatment imaging by accompanying a rotational treatment such as a volumetric modulated arc therapy (VMAT). In this chapter, we introduce the principle of 4D CBCT reconstruction and the planning strategy of the stereotactic body radiation therapy (SBRT) for lung cancer patients with VMAT. Combining 4D CBCT with VMAT delivery, we establish the novel clinical verification by use of in-treatment 4D CBCT.

SU-F-J-190: Time Resolved Range Measurement System Using Scintillator and CCD Camera for the Slow Beam Extraction

PURPOSE To investigate the time structure of the range, we have verified the rang shift due to the betatron tune shift with several synchrotron parameters. METHODS A cylindrical plastic scintillator block and a CCD camera were installed on the black box. Using image processing, the range was determined the 80 percent of distal dose of the depth light distribution. The root mean square error of the range measurement using the scintillator and CCD system is about 0.2 mm. Range measurement was performed at interval of 170 msec. The chromaticity of the synchrotron was changed in the range of plus or minus 1% from reference chromaticity in this study. All of the particle inside the synchrotron ring were extracted with the output beam intensity 1.8×108 and 5.0×107 particle per sec. RESULTS The time strictures of the range were changed by changing of the chromaticity. The reproducibility of the measurement was sufficient to observe the time structures of the range. The range shift was depending on the number of the residual particle inside the synchrotron ring. CONCLUSION In slow beam extraction for scanned carbon-ion therapy, the range shift is undesirable because it causes the dose uncertainty in the target. We introduced the time-resolved range measurement using scintillator and CCD system. The scintillator and CCD system have enabled to verify the range shift with sufficient spatial resolution and reproducibility.

[Evaluation of a Post-analysis Method for Cumulative Dose Distribution in Stereotactic Body Radiotherapy].

PURPOSE The purpose of this study was to evaluate a post-analysis method for cumulative dose distribution in stereotactic body radiotherapy (SBRT) using volumetric modulated arc therapy (VMAT) . METHOD VMAT is capable of acquiring respiratory signals derived from projection images and machine parameters based on machine logs during VMAT delivery. Dose distributions were reconstructed from the respiratory signals and machine parameters in the condition where respiratory signals were without division, divided into 4 and 10 phases. The dose distribution of each respiratory phase was calculated on the planned four-dimensional CT (4DCT). Summation of the dose distributions was carried out using deformable image registration (DIR), and cumulative dose distributions were compared with those of the corresponding plans. RESULTS AND DISCUSSION Without division, dose differences between cumulative distribution and plan were not significant. In the condition where respiratory signals were divided, dose differences were observed over dose in cranial region and under dose in caudal region of planning target volume (PTV). Differences between 4 and 10 phases were not significant. CONCLUSION The present method was feasible for evaluating cumulative dose distribution in VMAT-SBRT using 4DCT and DIR.