nach oben

Erschienen in:

10.02.2016 | Original Article

Towards clinical implementation of ultrafast combined kV-MV CBCT for IGRT of lung cancer

Evaluation of registration accuracy based on phantom study

verfasst von: Anna Arns, MSc., Manuel Blessing, PhD., Jens Fleckenstein, PhD., Dzmitry Stsepankou, MSc., Judit Boda-Heggemann, MD., Anna Simeonova-Chergou, MD., Jürgen Hesser, PhD., Frank Lohr, MD., Frederik Wenz, MD., Hansjörg Wertz, PhD.

Erschienen in: Strahlentherapie und Onkologie | Ausgabe 5/2016

Einloggen, um Zugang zu erhalten

Abstract

Purpose

Combined kV-MV cone-beam CT (CBCT) is a promising approach to accelerate imaging for patients with lung tumors treated with deep inspiration breath-hold. During a single breath-hold (15 s), a 3D kV-MV CBCT can be acquired, thus minimizing motion artifacts and increasing patient comfort. Prior to clinical implementation, positioning accuracy was evaluated and compared to clinically established imaging techniques.

Methods and materials

An inhomogeneous thorax phantom with four tumor-mimicking inlays was imaged in 10 predefined positions and registered to a planning CT. Novel kV-MV CBCT imaging (90° arc) was compared to clinically established kV-chest CBCT (360°) as well as nonclinical kV-CBCT and low-dose MV-CBCT (each 180°). Manual registration, automatic registration provided by the manufacturer and an additional in-house developed manufacturer-independent framework based on the MATLAB registration toolkit were applied.

Results

Systematic setup error was reduced to 0.05 mm by high-precision phantom positioning with optical tracking. Stochastic mean displacement errors were 0.5 ± 0.3 mm in right–left, 0.4 ± 0.4 mm in anteroposterior and 0.0 ± 0.4 mm in craniocaudal directions for kV-MV CBCT with manual registration (maximum errors of no more than 1.4 mm). Clinical kV-chest CBCT resulted in mean errors of 0.2 mm (other modalities: 0.4–0.8 mm). Similar results were achieved with both automatic registration methods.

Conclusion

The comparison study of repositioning accuracy between novel kV-MV CBCT and clinically established volume imaging demonstrated that registration accuracy is maintained below 1 mm. Since imaging time is reduced to one breath-hold, kV-MV CBCT is ideal for image guidance, e.g., in lung stereotactic ablative radiotherapy.

Goldsmith C, Gaya A (2012) Stereotactic ablative body radiotherapy (SABR) for primary and secondary lung tumours. Cancer Imaging 12:351–360. doi:10.1102/1470-7330.2012.9015 CrossRefPubMedPubMedCentral

Timmerman RD, Kavanagh BD, Cho LC et al (2007) Stereotactic body radiation therapy in multiple organ sites. J Clin Oncol 25:947–952. doi:10.1200/JCO.2006.09.7469 CrossRefPubMed

Boda-Heggemann J, Mai S, Fleckenstein J et al (2013) Flattening-filter-free intensity modulated breath-hold image-guided SABR (Stereotactic ABlative Radiotherapy) can be applied in a 15-min treatment slot. Radiother Oncol 109:505–509. doi:10.1016/j.radonc.2013.09.014 CrossRefPubMed

Georg D, Knöös T, McClean B (2011) Current status and future perspective of flattening filter free photon beams. Med Phys 38:1280. doi:10.1118/1.3554643 CrossRefPubMed

Navarria P, Ascolese AM, Mancosu P et al (2013) Volumetric modulated arc therapy with flattening filter free (FFF) beams for stereotactic body radiation therapy (SBRT) in patients with medically inoperable early stage non small cell lung cancer (NSCLC). Radiother Oncol 107:414–418. doi:10.1016/j.radonc.2013.04.016 CrossRefPubMed

Morin O, Gillis A, Chen J et al (2006) Megavoltage cone-beam CT: system description and clinical applications. Med Dosim 31:51–61. doi:10.1016/j.meddos.2005.12.009 CrossRefPubMed

Pouliot J, Bani-Hashemi A, Svatos M et al (2005) Low-dose megavoltage cone-beam CT for radiation therapy. Int J Radiat Oncol 61:552–560. doi:10.1016/j.ijrobp.2004.10.011 CrossRef

Boda-Heggemann J, Lohr F, Wenz F et al (2011) kV cone-beam CT-based IGRT: a clinical review. Strahlenther Onkol 187:284–291. doi:10.1007/s00066-011-2236-4 CrossRefPubMed

Jaffray D, Siewerdsen J (2002) Flat-panel cone-beam computed tomography for image-guided radiation therapy. Int J Radiat Oncol Biol Phys 53:1337–1349CrossRefPubMed

10.

Guckenberger M, Krieger T, Richter A et al (2009) Potential of image-guidance, gating and real-time tracking to improve accuracy in pulmonary stereotactic body radiotherapy. Radiother Oncol 91:288–295. doi:10.1016/j.radonc.2008.08.010 CrossRefPubMed

11.

Keall PJ, Mageras GS, Balter JM et al (2006) The management of respiratory motion in radiation oncology report of AAPM Task Group 76. Med Phys 33:3874–3900. doi:10.1118/1.2349696 CrossRefPubMed

12.

McClelland JR, Hawkes DJ, Schaeffter T, King AP (2013) Respiratory motion models: a review. Med Image Anal 17:19–42. doi:10.1016/j.media.2012.09.005 CrossRefPubMed

13.

Cho B, Poulsen PR, Sloutsky A et al (2009) First demonstration of combined kV/MV image-guided real-time dynamic multileaf-collimator target tracking. Int J Radiat Oncol Biol Phys 74:859–867. doi:10.1016/j.ijrobp.2009.02.012 CrossRefPubMedPubMedCentral

14.

Snider JW, Oermann EK, Chen V et al (2012) CyberKnife with tumor tracking: an effective treatment for high-risk surgical patients with single peripheral lung metastases. Front Oncol 2:1–5. doi:10.3389/fonc.2012.00063 CrossRef

15.

Guckenberger M, Wilbert J, Krieger T et al (2007) Four-dimensional treatment planning for stereotactic body radiotherapy. Int J Radiat Oncol Biol Phys 69:276–285. doi:10.1016/j.ijrobp.2007.04.074 CrossRefPubMed

16.

Li T, Xing L, Munro P et al (2006) Four-dimensional cone-beam computed tomography using an on-board imager. Med Phys 33:3825. doi:10.1118/1.2349692 CrossRefPubMed

17.

Sonke J-J, Zijp L, Remeijer P, van Herk M (2005) Respiratory correlated cone beam CT. Med Phys 32:1176. doi:10.1118/1.1869074 CrossRefPubMed

18.

Bissonnette J-P, Franks KN, Purdie TG et al (2009) Quantifying interfraction and intrafraction tumor motion in lung stereotactic body radiotherapy using respiration-correlated cone beam computed tomography. Int J Radiat Oncol Biol Phys 75:688–695. doi:10.1016/j.ijrobp.2008.11.066 CrossRefPubMed

19.

Boda-Heggemann J, Knopf A-C, Simeonova A et al. (in press) DBIH (Deep Inspiratory Breath Hold)- based radiotherapy—a clinical review. Int J Radiat Oncol Biol Phys (in press) 94:478-492. doi:10.1016/j.ijrobp.2015.11.049.

20.

Koshani R, Balter JM, Hayman JA et al (2006) Short-term and long-term reproducibility of lung tumor position using active breathing control (ABC). Int J Radiat Oncol Biol Phys 65:1553–1559. doi:10.1016/j.ijrobp.2006.04.027 CrossRefPubMed

21.

McNair HA, Brock J, Symonds-Tayler JRN et al (2009) Feasibility of the use of the Active Breathing Coordinator (ABC) in patients receiving radical radiotherapy for non-small cell lung cancer (NSCLC). Radiother Oncol 93:424–429. doi:10.1016/j.radonc.2009.09.012 CrossRefPubMed

22.

Wong JW, Sharpe MB, Jaffray DA et al (1999) The use of active breathing control (ABC) to reduce margin for breathing motion. Int J Radiat Oncol Biol Phys 44:911–919. doi:10.1016/S0360-3016(99)00056-5 CrossRefPubMed

23.

Boda-Heggemann J, Lohr F, Wertz H et al. (2010) Repeat ABC-breath Hold Imaging with Cone-beam CT. Int J Radiat Oncol 78:S736. doi:10.1016/j.ijrobp.2010.07.1705 CrossRef

24.

Boda-Heggemann J, Fleckenstein J, Lohr F et al (2011) Multiple breath-hold CBCT for online image guided radiotherapy of lung tumors: simulation with a dynamic phantom and first patient data. Radiother Oncol 98:309–316. doi:10.1016/j.radonc.2011.01.019 CrossRefPubMed

25.

Boda-Heggemann J, Jahnke A, Jahnke L et al. (2014) Breath-Hold Cone Beam CT (CBCT): improved image quality with “Stop-and-Go” Breath Hold-Only acquisition versus repetitive breath hold during continuous rotation. Int J Radiat Oncol 90:S826. doi:10.1016/j.ijrobp.2014.05.2378 CrossRef

26.

Simeonova AO, Jahnke A, Jahnke L et al (2014) Automatically gated cbct-controlled fast breath-hold sbrt is dosimetrically robust and facilitates precision treatments for patients with lung cancer. Int J Radiat Oncol 90:S891. doi:10.1016/j.ijrobp.2014.05.2537 CrossRef

27.

Blessing M, Stsepankou D, Wertz H et al (2010) Breath-hold target localization with simultaneous kilovoltage/megavoltage cone-beam computed tomography and fast reconstruction. Int J Radiat Oncol Biol Phys 78:1219–1226. doi:10.1016/j.ijrobp.2010.01.030 CrossRefPubMed

28.

Yin F-F, Guan H, Lu W (2005) A technique for on-board CT reconstruction using both kilovoltage and megavoltage beam projections for 3D treatment verification. Med Phys 32:2819–2826. doi:10.1118/1.1997307 CrossRefPubMed

29.

Wertz H, Stsepankou D, Blessing M et al (2010) Fast kilovoltage/megavoltage (kVMV) breathhold cone-beam CT for image-guided radiotherapy of lung cancer. Phys Med Biol 55:4203–4217. doi:10.1088/0031-9155/55/15/001 CrossRefPubMed

30.

Blessing M, Arns A, Wertz H et al. (2014) Image guided radiation therapy using ultrafast kV-MV CBCT: End-to-End test results of the finalized implementation. Int J Radiat Oncol 90:S828–S829. doi:10.1016/j.ijrobp.2014.05.2385 CrossRef

31.

Feldkamp LA, Davis LC, Kress JW (1984) Practical cone-beam algorithm. J Opt Soc Am A 1:612. doi:10.1364/JOSAA.1.000612 CrossRef

32.

Schulze R, Heil U, Groß D et al (2011) Artefacts in CBCT: a review. Dentomaxillofacial Radiol 40:265–273. doi:10.1259/dmfr/30642039 CrossRef

33.

Wiles AD, Thompson DG, Frantz DD (2004) Accuracy assessment and interpretation for optical tracking systems. Med Imaging 2004 Vis Image-guided Preced Display Proc SPIE 5367:421–432. doi:10.1117/12.536128

34.

Hristov DH, Fallone BG (1996) A grey-level image alignment algorithm for registration of portal images and digitally reconstructed radiographs. Med Phys 23:75–84. doi:10.1118/1.597780 CrossRefPubMed

35.

Mattes D, Haynor DR, Vesselle H, Lewellen T, Eubank W (2001) Non-rigid multimodality image registration. In: Med. Imaging 2001 Image Process. SPIE Publ. pp 1609–1620

36.

Yan H, Zhang L, Yin F-F (2008) A phantom study on target localization accuracy using cone-beam computed tomography. Clin Med Oncol 2:501–510PubMedPubMedCentral

37.

Ballhausen H, Hieber S, Li M et al (2015) Linearity of patient positioning detection. Strahlenther Onkol 191:442–447. doi:10.1007/s00066-015-0811-9 CrossRefPubMed

38.

Meyer J, Wilbert J, Baier K et al (2007) Positioning accuracy of cone-beam computed tomography in combination with a HexaPOD robot treatment table. Int J Radiat Oncol Biol Phys 67:1220–1228. doi:10.1016/j.ijrobp.2006.11.010 CrossRefPubMed

Titel: Towards clinical implementation of ultrafast combined kV-MV CBCT for IGRT of lung cancer
Evaluation of registration accuracy based on phantom study
verfasst von: Anna Arns, MSc.
Manuel Blessing, PhD.
Jens Fleckenstein, PhD.
Dzmitry Stsepankou, MSc.
Judit Boda-Heggemann, MD.
Anna Simeonova-Chergou, MD.
Jürgen Hesser, PhD.
Frank Lohr, MD.
Frederik Wenz, MD.
Hansjörg Wertz, PhD.
Publikationsdatum: 10.02.2016
Verlag: Springer Berlin Heidelberg
Erschienen in: Strahlentherapie und Onkologie / Ausgabe 5/2016
Print ISSN: 0179-7158
Elektronische ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-016-0947-2

Springer Medizin

Towards clinical implementation of ultrafast combined kV-MV CBCT for IGRT of lung cancer

Evaluation of registration accuracy based on phantom study