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• W2746374337 abstract "Purpose/Objective(s)Intra-fraction organ motion existing in thorax and upper abdomen presents a challenge to not only treatment planning and delivery, but also verification of the dose delivery, especially when newly emerged time-resolved (4D) treatment techniques, such as gating and tumor tracking, are employed. The purpose of this work is to develop an on-board 4DCBCT-based independent dose verification for phase- or amplitude-based gated RT.Materials/MethodsThis study included the pre-treatment validation of a gated RT for (i) gating phase (to ensure that the beam delivery occur at the planned temporal point); (ii) geometric location of the tumor volume relative to the beams; and the after-treatment verification of the delivered dose distribution. The 4D CBCT scans in this study were acquired using slow-gantry-rotation and/or multiple-gantry rotation methods with a Varian Trilogy system. To obtain 4D images, the cone beam projection at each gantry angle was stamped by a phase tag through monitoring the motion of an external fiducial marker adhered to the patient skin or the motion of the reflective markers on a RPM block placed on the patient thoracic region. Six respiratory phases were obtained for all the cases. For the gating phase validation, an image registration software, which computed the correlations between the planning CT and each of the 4D CBCT phases, was developed. The 4D CBCT phase with the maximal correlation was identified and the consistency of this phase and the planned beam-on phase/amplitude was examined. To verify the anatomic location, the target and sensitive structures were mapped from the planning CT to the gating phase of 4D CBCT after the co-registration of the two images. The degree of overlapping of the mapped contours with that independently defined on the 4D CBCT was evaluated. The dose validation involved a forward dose calculation in which the incident beam parameters from the patient’s treatment plan were imported and used to compute the dose distribution on the 4D CBCT images. The above QA scheme was validated with phantom experiments with regular and irregular motions, and applied in a liver cancer patient study.Results4D CBCT effectively removed the motion artifacts commonly seen in 3D thoracic CBCT imaging, leading to significantly improved soft tissue contrast and making it possible to compute the dose more accurately. The correlation calculation between the 4D CBCT and planning CT images showed high sensitivity in detecting any deviation in the intended and actual beam-on phases/amplitudes. When motion irregularities were introduced intentionally for testing purpose, abnormality was readily observed in the correlation calculation. In the dosimetric study, errors greater than 7% were found when 3D CBCT images were used in the phantom measurements due to motion artifacts. With 4D CBCT, the planed and reconstructed doses agreed to within 2.6% for all tests with different motion periods and amplitudes. For the patient study, while the recomputed dose distributions and DVHs agreed reasonably with the planned ones, large discrepancies were found occasionally when the breathing pattern changed significantly.Conclusions4D CBCT affords an effective means for us to obtain time-resolved patient anatomical information prior to the treatment delivery and is valuable for patient geometric setup and dosimetric validation in 4D RT. Purpose/Objective(s)Intra-fraction organ motion existing in thorax and upper abdomen presents a challenge to not only treatment planning and delivery, but also verification of the dose delivery, especially when newly emerged time-resolved (4D) treatment techniques, such as gating and tumor tracking, are employed. The purpose of this work is to develop an on-board 4DCBCT-based independent dose verification for phase- or amplitude-based gated RT. Intra-fraction organ motion existing in thorax and upper abdomen presents a challenge to not only treatment planning and delivery, but also verification of the dose delivery, especially when newly emerged time-resolved (4D) treatment techniques, such as gating and tumor tracking, are employed. The purpose of this work is to develop an on-board 4DCBCT-based independent dose verification for phase- or amplitude-based gated RT. Materials/MethodsThis study included the pre-treatment validation of a gated RT for (i) gating phase (to ensure that the beam delivery occur at the planned temporal point); (ii) geometric location of the tumor volume relative to the beams; and the after-treatment verification of the delivered dose distribution. The 4D CBCT scans in this study were acquired using slow-gantry-rotation and/or multiple-gantry rotation methods with a Varian Trilogy system. To obtain 4D images, the cone beam projection at each gantry angle was stamped by a phase tag through monitoring the motion of an external fiducial marker adhered to the patient skin or the motion of the reflective markers on a RPM block placed on the patient thoracic region. Six respiratory phases were obtained for all the cases. For the gating phase validation, an image registration software, which computed the correlations between the planning CT and each of the 4D CBCT phases, was developed. The 4D CBCT phase with the maximal correlation was identified and the consistency of this phase and the planned beam-on phase/amplitude was examined. To verify the anatomic location, the target and sensitive structures were mapped from the planning CT to the gating phase of 4D CBCT after the co-registration of the two images. The degree of overlapping of the mapped contours with that independently defined on the 4D CBCT was evaluated. The dose validation involved a forward dose calculation in which the incident beam parameters from the patient’s treatment plan were imported and used to compute the dose distribution on the 4D CBCT images. The above QA scheme was validated with phantom experiments with regular and irregular motions, and applied in a liver cancer patient study. This study included the pre-treatment validation of a gated RT for (i) gating phase (to ensure that the beam delivery occur at the planned temporal point); (ii) geometric location of the tumor volume relative to the beams; and the after-treatment verification of the delivered dose distribution. The 4D CBCT scans in this study were acquired using slow-gantry-rotation and/or multiple-gantry rotation methods with a Varian Trilogy system. To obtain 4D images, the cone beam projection at each gantry angle was stamped by a phase tag through monitoring the motion of an external fiducial marker adhered to the patient skin or the motion of the reflective markers on a RPM block placed on the patient thoracic region. Six respiratory phases were obtained for all the cases. For the gating phase validation, an image registration software, which computed the correlations between the planning CT and each of the 4D CBCT phases, was developed. The 4D CBCT phase with the maximal correlation was identified and the consistency of this phase and the planned beam-on phase/amplitude was examined. To verify the anatomic location, the target and sensitive structures were mapped from the planning CT to the gating phase of 4D CBCT after the co-registration of the two images. The degree of overlapping of the mapped contours with that independently defined on the 4D CBCT was evaluated. The dose validation involved a forward dose calculation in which the incident beam parameters from the patient’s treatment plan were imported and used to compute the dose distribution on the 4D CBCT images. The above QA scheme was validated with phantom experiments with regular and irregular motions, and applied in a liver cancer patient study. Results4D CBCT effectively removed the motion artifacts commonly seen in 3D thoracic CBCT imaging, leading to significantly improved soft tissue contrast and making it possible to compute the dose more accurately. The correlation calculation between the 4D CBCT and planning CT images showed high sensitivity in detecting any deviation in the intended and actual beam-on phases/amplitudes. When motion irregularities were introduced intentionally for testing purpose, abnormality was readily observed in the correlation calculation. In the dosimetric study, errors greater than 7% were found when 3D CBCT images were used in the phantom measurements due to motion artifacts. With 4D CBCT, the planed and reconstructed doses agreed to within 2.6% for all tests with different motion periods and amplitudes. For the patient study, while the recomputed dose distributions and DVHs agreed reasonably with the planned ones, large discrepancies were found occasionally when the breathing pattern changed significantly. 4D CBCT effectively removed the motion artifacts commonly seen in 3D thoracic CBCT imaging, leading to significantly improved soft tissue contrast and making it possible to compute the dose more accurately. The correlation calculation between the 4D CBCT and planning CT images showed high sensitivity in detecting any deviation in the intended and actual beam-on phases/amplitudes. When motion irregularities were introduced intentionally for testing purpose, abnormality was readily observed in the correlation calculation. In the dosimetric study, errors greater than 7% were found when 3D CBCT images were used in the phantom measurements due to motion artifacts. With 4D CBCT, the planed and reconstructed doses agreed to within 2.6% for all tests with different motion periods and amplitudes. For the patient study, while the recomputed dose distributions and DVHs agreed reasonably with the planned ones, large discrepancies were found occasionally when the breathing pattern changed significantly. Conclusions4D CBCT affords an effective means for us to obtain time-resolved patient anatomical information prior to the treatment delivery and is valuable for patient geometric setup and dosimetric validation in 4D RT. 4D CBCT affords an effective means for us to obtain time-resolved patient anatomical information prior to the treatment delivery and is valuable for patient geometric setup and dosimetric validation in 4D RT." @default.
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• W2746374337 date "2006-11-01" @default.
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