Triggered kV Imaging During Spine SBRT for Intrafraction Motion Management

Triggered kV Imaging During Spine SBRT for Intrafraction Motion Management

Purpose: To monitor intrafraction motion during spine stereotactic body radiotherapy(SBRT) treatment delivery with readily available technology, we implemented triggered kV imaging using the on-board imager(OBI) of a modern medical linear accelerator with an advanced imaging package. Methods: Trigge...

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Autores principales: Jihye Koo, Louis Nardella, Michael Degnan, Jacqueline Andreozzi, Hsiang-hsuan M. Yu, Jose Penagaricano, Peter A. S. Johnstone, Daniel Oliver, Kamran Ahmed, Stephen A. Rosenberg, Evan Wuthrick, Roberto Diaz, Vladimir Feygelman, Kujtim Latifi, Eduardo G. Moros, Gage Redler
Formato: article
Lenguaje:EN
Publicado: SAGE Publishing 2021
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Neoplasms. Tumors. Oncology. Including cancer and carcinogens
RC254-282
Acceso en línea:https://doaj.org/article/b67572372270419fab00b788561d35ad
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spelling oai:doaj.org-article:b67572372270419fab00b788561d35ad2021-12-03T00:03:24ZTriggered kV Imaging During Spine SBRT for Intrafraction Motion Management1533-033810.1177/15330338211063033https://doaj.org/article/b67572372270419fab00b788561d35ad2021-12-01T00:00:00Zhttps://doi.org/10.1177/15330338211063033https://doaj.org/toc/1533-0338Purpose: To monitor intrafraction motion during spine stereotactic body radiotherapy(SBRT) treatment delivery with readily available technology, we implemented triggered kV imaging using the on-board imager(OBI) of a modern medical linear accelerator with an advanced imaging package. Methods: Triggered kV imaging for intrafraction motion management was tested with an anthropomorphic phantom and simulated spine SBRT treatments to the thoracic and lumbar spine. The vertebral bodies and spinous processes were contoured as the image guided radiotherapy(IGRT) structures specific to this technique. Upon each triggered kV image acquisition, 2D projections of the IGRT structures were automatically calculated and updated at arbitrary angles for display on the kV images. Various shifts/rotations were introduced in x, y, z, pitch, and yaw. Gantry-angle-based triggering was set to acquire kV images every 45°. A group of physicists/physicians(n = 10) participated in a survey to evaluate clinical efficiency and accuracy of clinical decisions on images containing various phantom shifts. This method was implemented clinically for treatment of 42 patients(94 fractions) with 15 second time-based triggering. Result: Phantom images revealed that IGRT structure accuracy and therefore utility of projected contours during triggered imaging improved with smaller CT slice thickness. Contouring vertebra superior and inferior to the treatment site was necessary to detect clinically relevant phantom rotation. From the survey, detectability was proportional to the shift size in all shift directions and inversely related to the CT slice thickness. Clinical implementation helped evaluate robustness of patient immobilization. Based on visual inspection of projected IGRT contours on planar kV images, appreciable intrafraction motion was detected in eleven fractions(11.7%). Discussion: Feasibility of triggered imaging for spine SBRT intrafraction motion management has been demonstrated in phantom experiments and implementation for patient treatments. This technique allows efficient, non-invasive monitoring of patient position using the OBI and patient anatomy as a direct visual guide.Jihye KooLouis NardellaMichael DegnanJacqueline AndreozziHsiang-hsuan M. YuJose PenagaricanoPeter A. S. JohnstoneDaniel OliverKamran AhmedStephen A. RosenbergEvan WuthrickRoberto DiazVladimir FeygelmanKujtim LatifiEduardo G. MorosGage RedlerSAGE PublishingarticleNeoplasms. Tumors. Oncology. Including cancer and carcinogensRC254-282ENTechnology in Cancer Research & Treatment, Vol 20 (2021)
institution DOAJ
collection DOAJ
language EN
topic Neoplasms. Tumors. Oncology. Including cancer and carcinogens
RC254-282
spellingShingle Neoplasms. Tumors. Oncology. Including cancer and carcinogens
RC254-282
Jihye Koo
Louis Nardella
Michael Degnan
Jacqueline Andreozzi
Hsiang-hsuan M. Yu
Jose Penagaricano
Peter A. S. Johnstone
Daniel Oliver
Kamran Ahmed
Stephen A. Rosenberg
Evan Wuthrick
Roberto Diaz
Vladimir Feygelman
Kujtim Latifi
Eduardo G. Moros
Gage Redler
Triggered kV Imaging During Spine SBRT for Intrafraction Motion Management
description Purpose: To monitor intrafraction motion during spine stereotactic body radiotherapy(SBRT) treatment delivery with readily available technology, we implemented triggered kV imaging using the on-board imager(OBI) of a modern medical linear accelerator with an advanced imaging package. Methods: Triggered kV imaging for intrafraction motion management was tested with an anthropomorphic phantom and simulated spine SBRT treatments to the thoracic and lumbar spine. The vertebral bodies and spinous processes were contoured as the image guided radiotherapy(IGRT) structures specific to this technique. Upon each triggered kV image acquisition, 2D projections of the IGRT structures were automatically calculated and updated at arbitrary angles for display on the kV images. Various shifts/rotations were introduced in x, y, z, pitch, and yaw. Gantry-angle-based triggering was set to acquire kV images every 45°. A group of physicists/physicians(n = 10) participated in a survey to evaluate clinical efficiency and accuracy of clinical decisions on images containing various phantom shifts. This method was implemented clinically for treatment of 42 patients(94 fractions) with 15 second time-based triggering. Result: Phantom images revealed that IGRT structure accuracy and therefore utility of projected contours during triggered imaging improved with smaller CT slice thickness. Contouring vertebra superior and inferior to the treatment site was necessary to detect clinically relevant phantom rotation. From the survey, detectability was proportional to the shift size in all shift directions and inversely related to the CT slice thickness. Clinical implementation helped evaluate robustness of patient immobilization. Based on visual inspection of projected IGRT contours on planar kV images, appreciable intrafraction motion was detected in eleven fractions(11.7%). Discussion: Feasibility of triggered imaging for spine SBRT intrafraction motion management has been demonstrated in phantom experiments and implementation for patient treatments. This technique allows efficient, non-invasive monitoring of patient position using the OBI and patient anatomy as a direct visual guide.
format article
author Jihye Koo
Louis Nardella
Michael Degnan
Jacqueline Andreozzi
Hsiang-hsuan M. Yu
Jose Penagaricano
Peter A. S. Johnstone
Daniel Oliver
Kamran Ahmed
Stephen A. Rosenberg
Evan Wuthrick
Roberto Diaz
Vladimir Feygelman
Kujtim Latifi
Eduardo G. Moros
Gage Redler
author_facet Jihye Koo
Louis Nardella
Michael Degnan
Jacqueline Andreozzi
Hsiang-hsuan M. Yu
Jose Penagaricano
Peter A. S. Johnstone
Daniel Oliver
Kamran Ahmed
Stephen A. Rosenberg
Evan Wuthrick
Roberto Diaz
Vladimir Feygelman
Kujtim Latifi
Eduardo G. Moros
Gage Redler
author_sort Jihye Koo
title Triggered kV Imaging During Spine SBRT for Intrafraction Motion Management
title_short Triggered kV Imaging During Spine SBRT for Intrafraction Motion Management
title_full Triggered kV Imaging During Spine SBRT for Intrafraction Motion Management
title_fullStr Triggered kV Imaging During Spine SBRT for Intrafraction Motion Management
title_full_unstemmed Triggered kV Imaging During Spine SBRT for Intrafraction Motion Management
title_sort triggered kv imaging during spine sbrt for intrafraction motion management
publisher SAGE Publishing
publishDate 2021
url https://doaj.org/article/b67572372270419fab00b788561d35ad
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