Direction-dependent regularization for improved estimation of liver and lung motion in 4D image data

NASA Astrophysics Data System (ADS)

Schmidt-Richberg, Alexander; Ehrhardt, Jan; Werner, René; Handels, Heinz

2010-03-01

The estimation of respiratory motion is a fundamental requisite for many applications in the field of 4D medical imaging, for example for radiotherapy of thoracic and abdominal tumors. It is usually done using non-linear registration of time frames of the sequence without further modelling of physiological motion properties. In this context, the accurate calculation of liver und lung motion is especially challenging because the organs are slipping along the surrounding tissue (i.e. the rib cage) during the respiratory cycle, which leads to discontinuities in the motion field. Without incorporating this specific physiological characteristic, common smoothing mechanisms cause an incorrect estimation along the object borders. In this paper, we present an extended diffusion-based model for incorporating physiological knowledge in image registration. By decoupling normal- and tangential-directed smoothing, we are able to estimate slipping motion at the organ borders while preventing gaps and ensuring smooth motion fields inside. We evaluate our model for the estimation of lung and liver motion on the basis of publicly accessible 4D CT and 4D MRI data. The results show a considerable increase of registration accuracy with respect to the target registration error and a more plausible motion estimation.

Lung Motion Model Validation Experiments, Free-Breathing Tissue Densitometry, and Ventilation Mapping using Fast Helical CT Imaging

NASA Astrophysics Data System (ADS)

Dou, Hsiang-Tai

The uncertainties due to respiratory motion present significant challenges to accurate characterization of cancerous tissues both in terms of imaging and treatment. Currently available clinical lung imaging techniques are subject to inferior image quality and incorrect motion estimation, with consequences that can systematically impact the downstream treatment delivery and outcome. The main objective of this thesis is the development of the techniques of fast helical computed tomography (CT) imaging and deformable image registration for the radiotherapy applications in accurate breathing motion modeling, lung tissue density modeling and ventilation imaging. Fast helical CT scanning was performed on 64-slice CT scanner using the shortest available gantry rotation time and largest pitch value such that scanning of the thorax region amounts to just two seconds, which is less than typical breathing cycle in humans. The scanning was conducted under free breathing condition. Any portion of the lung anatomy undergoing such scanning protocol would be irradiated for only a quarter second, effectively removing any motion induced image artifacts. The resulting CT data were pristine volumetric images that record the lung tissue position and density in a fraction of the breathing cycle. Following our developed protocol, multiple fast helical CT scans were acquired to sample the tissue positions in different breathing states. To measure the tissue displacement, deformable image registration was performed that registers the non-reference images to the reference one. In modeling breathing motion, external breathing surrogate signal was recorded synchronously with the CT image slices. This allowed for the tissue-specific displacement to be modeled as parametrization of the recorded breathing signal using the 5D lung motion model. To assess the accuracy of the motion model in describing tissue position change, the model was used to simulate the original high-pitch helical CT scan geometries, employed as ground truth data. Image similarity between the simulated and ground truth scans was evaluated. The model validation experiments were conducted in a patient cohort of seventeen patients to assess the model robustness and inter-patient variation. The model error averaged over multiple tracked positions from several breathing cycles was found to be on the order of one millimeter. In modeling the density change under free breathing condition, the determinant of Jacobian matrix from the registration-derived deformation vector field yielded volume change information of the lung tissues. Correlation of the Jacobian values to the corresponding voxel Housfield units (HU) reveals that the density variation for the majority of lung tissues can be very well described by mass conservation relationship. Different tissue types were identified and separately modeled. Large trials of validation experiments were performed. The averaged deviation between the modeled and the reference lung density was 30 HU, which was estimated to be the background CT noise level. In characterizing the lung ventilation function, a novel method was developed to determine the extent of lung tissue volume change. Information on volume change was derived from the deformable image registration of the fast helical CT images in terms of Jacobian values with respect to a reference image. Assuming the multiple volume change measurements are independently and identically distributed, statistical formulation was derived to model ventilation distribution of each lung voxels and empirical minimum and maximum probability distribution of the Jacobian values was computed. Ventilation characteristic was evaluated as the difference of the expectation value from these extremal distributions. The resulting ventilation map was compared with an independently obtained ventilation image derived directly from the lung intensities and good correlation was found using statistical test. In addition, dynamic ventilation characterization was investigated by estimating the voxel-specific ventilation distribution. Ventilation maps were generated at different percentile levels using the tissue volume expansion metrics.

SU-E-J-163: A Biomechanical Lung Model for Respiratory Motion Study

DOE Office of Scientific and Technical Information (OSTI.GOV)

Liu, X; Belcher, AH; Grelewicz, Z

2015-06-15

Purpose: This work presents a biomechanical model to investigate the complex respiratory motion for the lung tumor tracking in radiosurgery by computer simulation. Methods: The models include networked massspring-dampers to describe the tumor motion, different types of surrogate signals, and the force generated by the diaphragm. Each mass-springdamper has the same mechanical structure and each model can have different numbers of mass-spring-dampers. Both linear and nonlinear stiffness parameters were considered, and the damping ratio was tuned in a range so that the tumor motion was over-damped (no natural tumor oscillation occurs without force from the diaphragm). The simulation was runmore » by using ODE45 (ordinary differential equations by Runge-Kutta method) in MATLAB, and all time courses of motions and inputs (force) were generated and compared. Results: The curvature of the motion time courses around their peaks was sensitive to the damping ratio. Therefore, the damping ratio can be determined based on the clinical data of a high sampling rate. The peak values of different signals and the time the peaks occurred were compared, and it was found that the diaphragm force had a time lead over the tumor motion, and the lead time (0.1–0.4 seconds) depended on the distance between the tumor and the diaphragm. Conclusion: We reported a model based analysis approach for the spatial and temporal relation between the motion of the lung tumor and the surrogate signals. Due to the phase lead of the diaphragm in comparing with the lung tumor motion, the measurement of diaphragm motion (or its electromyography signal) can be used as a beam gating signal in radiosurgery, and it can also be an additional surrogate signal for better tumor motion tracking. The research is funded by the American Cancer Society (ACS) grant. The grant name is: Frameless SRS Based on Robotic Head Motion Cancellation. The grant number is: RSG-13-313-01-CCE.« less

A hybrid patient-specific biomechanical model based image registration method for the motion estimation of lungs.

PubMed

Han, Lianghao; Dong, Hua; McClelland, Jamie R; Han, Liangxiu; Hawkes, David J; Barratt, Dean C

2017-07-01

This paper presents a new hybrid biomechanical model-based non-rigid image registration method for lung motion estimation. In the proposed method, a patient-specific biomechanical modelling process captures major physically realistic deformations with explicit physical modelling of sliding motion, whilst a subsequent non-rigid image registration process compensates for small residuals. The proposed algorithm was evaluated with 10 4D CT datasets of lung cancer patients. The target registration error (TRE), defined as the Euclidean distance of landmark pairs, was significantly lower with the proposed method (TRE = 1.37 mm) than with biomechanical modelling (TRE = 3.81 mm) and intensity-based image registration without specific considerations for sliding motion (TRE = 4.57 mm). The proposed method achieved a comparable accuracy as several recently developed intensity-based registration algorithms with sliding handling on the same datasets. A detailed comparison on the distributions of TREs with three non-rigid intensity-based algorithms showed that the proposed method performed especially well on estimating the displacement field of lung surface regions (mean TRE = 1.33 mm, maximum TRE = 5.3 mm). The effects of biomechanical model parameters (such as Poisson's ratio, friction and tissue heterogeneity) on displacement estimation were investigated. The potential of the algorithm in optimising biomechanical models of lungs through analysing the pattern of displacement compensation from the image registration process has also been demonstrated. Copyright © 2017 Elsevier B.V. All rights reserved.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Nasehi Tehrani, J; Wang, J; McEwan, A

Purpose: In this study, we developed and evaluated a method for predicting lung surface deformation vector fields (SDVFs) based on surrogate signals such as chest and abdomen motion at selected locations and spirometry measurements. Methods: A Patient-specific 3D triangular surface mesh of the lung region at end-expiration (EE) phase was obtained by threshold-based segmentation method. For each patient, a spirometer recorded the flow volume changes of the lungs; and 192 selected points at a regular spacing of 2cm X 2cm matrix points over a total area of 34cm X 24cm on the surface of chest and abdomen was used tomore » detect chest wall motions. Preprocessing techniques such as QR factorization with column pivoting (QRCP) were employed to remove redundant observations of the chest and abdominal area. To create a statistical model between the lung surface and the corresponding surrogate signals, we developed a predictive model based on canonical ridge regression (CRR). Two unique weighting vectors were selected for each vertex on the surface of the lung, and they were optimized during the training process using the all other phases of 4D-CT except the end-inspiration (EI) phase. These parameters were employed to predict the vertices locations of a testing data set, which was the EI phase of 4D-CT. Results: For ten lung cancer patients, the deformation vector field of each vertex of lung surface mesh was estimated from the external motion at selected positions on the chest wall surface plus spirometry measurements. The average estimation of 98th percentile of error was less than 1 mm (AP= 0.85, RL= 0.61, and SI= 0.82). Conclusion: The developed predictive model provides a non-invasive approach to derive lung boundary condition. Together with personalized biomechanical respiration modelling, the proposed model can be used to derive the lung tumor motion during radiation therapy accurately from non-invasive measurements.« less

TH-CD-207A-03: A Surface Deformation Driven Respiratory Model for Organ Motion Tracking in Lung Cancer Radiotherapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chen, H; Zhen, X; Zhou, L

Purpose: To propose and validate a novel real-time surface-mesh-based internal organ-external surface motion and deformation tracking method for lung cancer radiotherapy. Methods: Deformation vector fields (DVFs) which characterizes the internal and external motion are obtained by registering the internal organ and tumor contours and external surface meshes to a reference phase in the 4D CT images using a recent developed local topology preserved non-rigid point matching algorithm (TOP). A composite matrix is constructed by combing the estimated internal and external DVFs. Principle component analysis (PCA) is then applied on the composite matrix to extract principal motion characteristics and finally yieldmore » the respiratory motion model parameters which correlates the internal and external motion and deformation. The accuracy of the respiratory motion model is evaluated using a 4D NURBS-based cardiac-torso (NCAT) synthetic phantom and three lung cancer cases. The center of mass (COM) difference is used to measure the tumor motion tracking accuracy, and the Dice’s coefficient (DC), percent error (PE) and Housdourf’s distance (HD) are used to measure the agreement between the predicted and ground truth tumor shape. Results: The mean COM is 0.84±0.49mm and 0.50±0.47mm for the phantom and patient data respectively. The mean DC, PE and HD are 0.93±0.01, 0.13±0.03 and 1.24±0.34 voxels for the phantom, and 0.91±0.04, 0.17±0.07 and 3.93±2.12 voxels for the three lung cancer patients, respectively. Conclusions: We have proposed and validate a real-time surface-mesh-based organ motion and deformation tracking method with an internal-external motion modeling. The preliminary results conducted on a synthetic 4D NCAT phantom and 4D CT images from three lung cancer cases show that the proposed method is reliable and accurate in tracking both the tumor motion trajectory and deformation, which can serve as a potential tool for real-time organ motion and deformation monitoring in lung cancer radiotherapy. This work is supported in part by grant from VARIAN MEDICAL SYSTEMS INC, the National Natural Science Foundation of China (no 81428019 and no 81301940), the Guangdong Natural Science Foundation (2015A030313302)and the 2015 Pearl River S&T Nova Program of Guangzhou (201506010096).« less

Site-specific volumetric analysis of lung tumour motion

NASA Astrophysics Data System (ADS)

Pepin, Eric W.; Wu, Huanmei; Sandison, George A.; Langer, Mark; Shirato, Hiroki

2010-06-01

The treatment of lung cancer with radiation therapy is hindered by respiratory motion. Real-time adjustments to compensate for this motion are hampered by mechanical system latencies and imaging-rate restrictions. To better understand tumour motion behaviour for adaptive image-guided radiation therapy of lung cancer, the volume of a tumour's motion space was investigated. Motion data were collected by tracking an implanted fiducial using fluoroscopy at 30 Hz during treatment sessions. A total of 637 treatment fractions from 31 tumours were used in this study. For each fraction, data points collected from three consecutive breathing cycles were used to identify instantaneous tumour location. A convex hull was created over these data points, defining the tumour motion envelope. The study sought a correlation between the tumour location in the lung and the convex hull's volume and shape. It was found that tumours located in the upper apex had smaller motion envelopes (<50 mm3), whereas tumours located near the chest wall or diaphragm had larger envelopes (>70 mm3). Tumours attached to fixed anatomical structures had small motion spaces. Three general shapes described the tumour motion envelopes: 50% of motion envelopes enclosed largely 1D oscillation, 38% enclosed an ellipsoid path, 6% enclosed an arced path and 6% were of hybrid shape. This location-space correlation suggests it may be useful in developing a predictive model, but more work needs to be done to verify it.

Using an external surrogate for predictor model training in real-time motion management of lung tumors.

PubMed

Rottmann, Joerg; Berbeco, Ross

2014-12-01

Precise prediction of respiratory motion is a prerequisite for real-time motion compensation techniques such as beam, dynamic couch, or dynamic multileaf collimator tracking. Collection of tumor motion data to train the prediction model is required for most algorithms. To avoid exposure of patients to additional dose from imaging during this procedure, the feasibility of training a linear respiratory motion prediction model with an external surrogate signal is investigated and its performance benchmarked against training the model with tumor positions directly. The authors implement a lung tumor motion prediction algorithm based on linear ridge regression that is suitable to overcome system latencies up to about 300 ms. Its performance is investigated on a data set of 91 patient breathing trajectories recorded from fiducial marker tracking during radiotherapy delivery to the lung of ten patients. The expected 3D geometric error is quantified as a function of predictor lookahead time, signal sampling frequency and history vector length. Additionally, adaptive model retraining is evaluated, i.e., repeatedly updating the prediction model after initial training. Training length for this is gradually increased with incoming (internal) data availability. To assess practical feasibility model calculation times as well as various minimum data lengths for retraining are evaluated. Relative performance of model training with external surrogate motion data versus tumor motion data is evaluated. However, an internal-external motion correlation model is not utilized, i.e., prediction is solely driven by internal motion in both cases. Similar prediction performance was achieved for training the model with external surrogate data versus internal (tumor motion) data. Adaptive model retraining can substantially boost performance in the case of external surrogate training while it has little impact for training with internal motion data. A minimum adaptive retraining data length of 8 s and history vector length of 3 s achieve maximal performance. Sampling frequency appears to have little impact on performance confirming previously published work. By using the linear predictor, a relative geometric 3D error reduction of about 50% was achieved (using adaptive retraining, a history vector length of 3 s and with results averaged over all investigated lookahead times and signal sampling frequencies). The absolute mean error could be reduced from (2.0 ± 1.6) mm when using no prediction at all to (0.9 ± 0.8) mm and (1.0 ± 0.9) mm when using the predictor trained with internal tumor motion training data and external surrogate motion training data, respectively (for a typical lookahead time of 250 ms and sampling frequency of 15 Hz). A linear prediction model can reduce latency induced tracking errors by an average of about 50% in real-time image guided radiotherapy systems with system latencies of up to 300 ms. Training a linear model for lung tumor motion prediction with an external surrogate signal alone is feasible and results in similar performance as training with (internal) tumor motion. Particularly for scenarios where motion data are extracted from fluoroscopic imaging with ionizing radiation, this may alleviate the need for additional imaging dose during the collection of model training data.

Modeling respiratory mechanics in the MCAT and spline-based MCAT phantoms

NASA Astrophysics Data System (ADS)

Segars, W. P.; Lalush, D. S.; Tsui, B. M. W.

2001-02-01

Respiratory motion can cause artifacts in myocardial SPECT and computed tomography (CT). The authors incorporate models of respiratory mechanics into the current 4D MCAT and into the next generation spline-based MCAT phantoms. In order to simulate respiratory motion in the current MCAT phantom, the geometric solids for the diaphragm, heart, ribs, and lungs were altered through manipulation of parameters defining them. Affine transformations were applied to the control points defining the same respiratory structures in the spline-based MCAT phantom to simulate respiratory motion. The Non-Uniform Rational B-Spline (NURBS) surfaces for the lungs and body outline were constructed in such a way as to be linked to the surrounding ribs. Expansion and contraction of the thoracic cage then coincided with expansion and contraction of the lungs and body. The changes both phantoms underwent were spline-interpolated over time to create time continuous 4D respiratory models. The authors then used the geometry-based and spline-based MCAT phantoms in an initial simulation study of the effects of respiratory motion on myocardial SPECT. The simulated reconstructed images demonstrated distinct artifacts in the inferior region of the myocardium. It is concluded that both respiratory models can be effective tools for researching effects of respiratory motion.

Effect of respiratory motion on internal radiation dosimetry

DOE Office of Scientific and Technical Information (OSTI.GOV)

Xie, Tianwu; Zaidi, Habib, E-mail: habib.zaidi@hcuge.ch; Geneva Neuroscience Center, Geneva University, Geneva CH-1205

Purpose: Estimation of the radiation dose to internal organs is essential for the assessment of radiation risks and benefits to patients undergoing diagnostic and therapeutic nuclear medicine procedures including PET. Respiratory motion induces notable internal organ displacement, which influences the absorbed dose for external exposure to radiation. However, to their knowledge, the effect of respiratory motion on internal radiation dosimetry has never been reported before. Methods: Thirteen computational models representing the adult male at different respiratory phases corresponding to the normal respiratory cycle were generated from the 4D dynamic XCAT phantom. Monte Carlo calculations were performed using the MCNP transportmore » code to estimate the specific absorbed fractions (SAFs) of monoenergetic photons/electrons, the S-values of common positron-emitting radionuclides (C-11, N-13, O-15, F-18, Cu-64, Ga-68, Rb-82, Y-86, and I-124), and the absorbed dose of {sup 18}F-fluorodeoxyglucose ({sup 18}F-FDG) in 28 target regions for both the static (average of dynamic frames) and dynamic phantoms. Results: The self-absorbed dose for most organs/tissues is only slightly influenced by respiratory motion. However, for the lung, the self-absorbed SAF is about 11.5% higher at the peak exhale phase than the peak inhale phase for photon energies above 50 keV. The cross-absorbed dose is obviously affected by respiratory motion for many combinations of source-target pairs. The cross-absorbed S-values for the heart contents irradiating the lung are about 7.5% higher in the peak exhale phase than the peak inhale phase for different positron-emitting radionuclides. For {sup 18}F-FDG, organ absorbed doses are less influenced by respiratory motion. Conclusions: Respiration-induced volume variations of the lungs and the repositioning of internal organs affect the self-absorbed dose of the lungs and cross-absorbed dose between organs in internal radiation dosimetry. The dynamic anatomical model provides more accurate internal radiation dosimetry estimates for the lungs and abdominal organs based on realistic modeling of respiratory motion. This work also contributes to a better understanding of model-induced uncertainties in internal radiation dosimetry.« less

The application of the sinusoidal model to lung cancer patient respiratory motion

DOE Office of Scientific and Technical Information (OSTI.GOV)

George, R.; Vedam, S.S.; Chung, T.D.

2005-09-15

Accurate modeling of the respiratory cycle is important to account for the effect of organ motion on dose calculation for lung cancer patients. The aim of this study is to evaluate the accuracy of a respiratory model for lung cancer patients. Lujan et al. [Med. Phys. 26(5), 715-720 (1999)] proposed a model, which became widely used, to describe organ motion due to respiration. This model assumes that the parameters do not vary between and within breathing cycles. In this study, first, the correlation of respiratory motion traces with the model f(t) as a function of the parameter n(n=1,2,3) was undertakenmore » for each breathing cycle from 331 four-minute respiratory traces acquired from 24 lung cancer patients using three breathing types: free breathing, audio instruction, and audio-visual biofeedback. Because cos{sup 2} and cos{sup 4} had similar correlation coefficients, and cos{sup 2} and cos{sup 1} have a trigonometric relationship, for simplicity, the cos{sup 1} value was consequently used for further analysis in which the variations in mean position (z{sub 0}), amplitude of motion (b) and period ({tau}) with and without biofeedback or instructions were investigated. For all breathing types, the parameter values, mean position (z{sub 0}), amplitude of motion (b), and period ({tau}) exhibited significant cycle-to-cycle variations. Audio-visual biofeedback showed the least variations for all three parameters (z{sub 0}, b, and {tau}). It was found that mean position (z{sub 0}) could be approximated with a normal distribution, and the amplitude of motion (b) and period ({tau}) could be approximated with log normal distributions. The overall probability density function (pdf) of f(t) for each of the three breathing types was fitted with three models: normal, bimodal, and the pdf of a simple harmonic oscillator. It was found that the normal and the bimodal models represented the overall respiratory motion pdfs with correlation values from 0.95 to 0.99, whereas the range of the simple harmonic oscillator pdf correlation values was 0.71 to 0.81. This study demonstrates that the pdfs of mean position (z{sub 0}), amplitude of motion (b), and period ({tau}) can be used for sampling to obtain more realistic respiratory traces. The overall standard deviations of respiratory motion were 0.48, 0.57, and 0.55 cm for free breathing, audio instruction, and audio-visual biofeedback, respectively.« less

TU-F-17A-03: An Analytical Respiratory Perturbation Model for Lung Motion Prediction

DOE Office of Scientific and Technical Information (OSTI.GOV)

Li, G; Yuan, A; Wei, J

2014-06-15

Purpose: Breathing irregularity is common, causing unreliable prediction in tumor motion for correlation-based surrogates. Both tidal volume (TV) and breathing pattern (BP=ΔVthorax/TV, where TV=ΔVthorax+ΔVabdomen) affect lung motion in anterior-posterior and superior-inferior directions. We developed a novel respiratory motion perturbation (RMP) model in analytical form to account for changes in TV and BP in motion prediction from simulation to treatment. Methods: The RMP model is an analytical function of patient-specific anatomic and physiologic parameters. It contains a base-motion trajectory d(x,y,z) derived from a 4-dimensional computed tomography (4DCT) at simulation and a perturbation term Δd(ΔTV,ΔBP) accounting for deviation at treatment from simulation.more » The perturbation is dependent on tumor-specific location and patient-specific anatomy. Eleven patients with simulation and treatment 4DCT images were used to assess the RMP method in motion prediction from 4DCT1 to 4DCT2, and vice versa. For each patient, ten motion trajectories of corresponding points in the lower lobes were measured in both 4DCTs: one served as the base-motion trajectory and the other as the ground truth for comparison. In total, 220 motion trajectory predictions were assessed. The motion discrepancy between two 4DCTs for each patient served as a control. An established 5D motion model was used for comparison. Results: The average absolute error of RMP model prediction in superior-inferior direction is 1.6±1.8 mm, similar to 1.7±1.6 mm from the 5D model (p=0.98). Some uncertainty is associated with limited spatial resolution (2.5mm slice thickness) and temporal resolution (10-phases). Non-corrected motion discrepancy between two 4DCTs is 2.6±2.7mm, with the maximum of ±20mm, and correction is necessary (p=0.01). Conclusion: The analytical motion model predicts lung motion with accuracy similar to the 5D model. The analytical model is based on physical relationships, requires no training, and therefore is potentially more resilient to breathing irregularities. On-going investigation introduces airflow into the RMP model for improvement. This research is in part supported by NIH (U54CA137788/132378). AY would like to thank MSKCC summer medical student research program supported by National Cancer Institute and hosted by Department of Medical Physics at MSKCC.« less

A Fast Neural Network Approach to Predict Lung Tumor Motion during Respiration for Radiation Therapy Applications

PubMed Central

Slama, Matous; Benes, Peter M.; Bila, Jiri

2015-01-01

During radiotherapy treatment for thoracic and abdomen cancers, for example, lung cancers, respiratory motion moves the target tumor and thus badly affects the accuracy of radiation dose delivery into the target. A real-time image-guided technique can be used to monitor such lung tumor motion for accurate dose delivery, but the system latency up to several hundred milliseconds for repositioning the radiation beam also affects the accuracy. In order to compensate the latency, neural network prediction technique with real-time retraining can be used. We have investigated real-time prediction of 3D time series of lung tumor motion on a classical linear model, perceptron model, and on a class of higher-order neural network model that has more attractive attributes regarding its optimization convergence and computational efficiency. The implemented static feed-forward neural architectures are compared when using gradient descent adaptation and primarily the Levenberg-Marquardt batch algorithm as the ones of the most common and most comprehensible learning algorithms. The proposed technique resulted in fast real-time retraining, so the total computational time on a PC platform was equal to or even less than the real treatment time. For one-second prediction horizon, the proposed techniques achieved accuracy less than one millimeter of 3D mean absolute error in one hundred seconds of total treatment time. PMID:25893194

A fast neural network approach to predict lung tumor motion during respiration for radiation therapy applications.

PubMed

Bukovsky, Ivo; Homma, Noriyasu; Ichiji, Kei; Cejnek, Matous; Slama, Matous; Benes, Peter M; Bila, Jiri

2015-01-01

During radiotherapy treatment for thoracic and abdomen cancers, for example, lung cancers, respiratory motion moves the target tumor and thus badly affects the accuracy of radiation dose delivery into the target. A real-time image-guided technique can be used to monitor such lung tumor motion for accurate dose delivery, but the system latency up to several hundred milliseconds for repositioning the radiation beam also affects the accuracy. In order to compensate the latency, neural network prediction technique with real-time retraining can be used. We have investigated real-time prediction of 3D time series of lung tumor motion on a classical linear model, perceptron model, and on a class of higher-order neural network model that has more attractive attributes regarding its optimization convergence and computational efficiency. The implemented static feed-forward neural architectures are compared when using gradient descent adaptation and primarily the Levenberg-Marquardt batch algorithm as the ones of the most common and most comprehensible learning algorithms. The proposed technique resulted in fast real-time retraining, so the total computational time on a PC platform was equal to or even less than the real treatment time. For one-second prediction horizon, the proposed techniques achieved accuracy less than one millimeter of 3D mean absolute error in one hundred seconds of total treatment time.

Estimation of motion fields by non-linear registration for local lung motion analysis in 4D CT image data.

PubMed

Werner, René; Ehrhardt, Jan; Schmidt-Richberg, Alexander; Heiss, Anabell; Handels, Heinz

2010-11-01

Motivated by radiotherapy of lung cancer non- linear registration is applied to estimate 3D motion fields for local lung motion analysis in thoracic 4D CT images. Reliability of analysis results depends on the registration accuracy. Therefore, our study consists of two parts: optimization and evaluation of a non-linear registration scheme for motion field estimation, followed by a registration-based analysis of lung motion patterns. The study is based on 4D CT data of 17 patients. Different distance measures and force terms for thoracic CT registration are implemented and compared: sum of squared differences versus a force term related to Thirion's demons registration; masked versus unmasked force computation. The most accurate approach is applied to local lung motion analysis. Masked Thirion forces outperform the other force terms. The mean target registration error is 1.3 ± 0.2 mm, which is in the order of voxel size. Based on resulting motion fields and inter-patient normalization of inner lung coordinates and breathing depths a non-linear dependency between inner lung position and corresponding strength of motion is identified. The dependency is observed for all patients without or with only small tumors. Quantitative evaluation of the estimated motion fields indicates high spatial registration accuracy. It allows for reliable registration-based local lung motion analysis. The large amount of information encoded in the motion fields makes it possible to draw detailed conclusions, e.g., to identify the dependency of inner lung localization and motion. Our examinations illustrate the potential of registration-based motion analysis.

Investigating the impact of audio instruction and audio-visual biofeedback for lung cancer radiation therapy

NASA Astrophysics Data System (ADS)

George, Rohini

Lung cancer accounts for 13% of all cancers in the Unites States and is the leading cause of deaths among both men and women. The five-year survival for lung cancer patients is approximately 15%.(ACS facts & figures) Respiratory motion decreases accuracy of thoracic radiotherapy during imaging and delivery. To account for respiration, generally margins are added during radiation treatment planning, which may cause a substantial dose delivery to normal tissues and increase the normal tissue toxicity. To alleviate the above-mentioned effects of respiratory motion, several motion management techniques are available which can reduce the doses to normal tissues, thereby reducing treatment toxicity and allowing dose escalation to the tumor. This may increase the survival probability of patients who have lung cancer and are receiving radiation therapy. However the accuracy of these motion management techniques are inhibited by respiration irregularity. The rationale of this thesis was to study the improvement in regularity of respiratory motion by breathing coaching for lung cancer patients using audio instructions and audio-visual biofeedback. A total of 331 patient respiratory motion traces, each four minutes in length, were collected from 24 lung cancer patients enrolled in an IRB-approved breathing-training protocol. It was determined that audio-visual biofeedback significantly improved the regularity of respiratory motion compared to free breathing and audio instruction, thus improving the accuracy of respiratory gated radiotherapy. It was also observed that duty cycles below 30% showed insignificant reduction in residual motion while above 50% there was a sharp increase in residual motion. The reproducibility of exhale based gating was higher than that of inhale base gating. Modeling the respiratory cycles it was found that cosine and cosine 4 models had the best correlation with individual respiratory cycles. The overall respiratory motion probability distribution function could be approximated to a normal distribution function. A statistical analysis was also performed to investigate if a patient's physical, tumor or general characteristics played a role in identifying whether he/she responded positively to the coaching type---signified by a reduction in the variability of respiratory motion. The analysis demonstrated that, although there were some characteristics like disease type and dose per fraction that were significant with respect to time-independent analysis, there were no significant time trends observed for the inter-session or intra-session analysis. Based on patient feedback with the existing audio-visual biofeedback system used for the study and research performed on other feedback systems, an improved audio-visual biofeedback system was designed. It is hoped the widespread clinical implementation of audio-visual biofeedback for radiotherapy will improve the accuracy of lung cancer radiotherapy.

Evaluation of tumor localization in respiration motion-corrected cone-beam CT: Prospective study in lung

DOE Office of Scientific and Technical Information (OSTI.GOV)

Dzyubak, Oleksandr; Kincaid, Russell; Hertanto, Agung

Purpose: Target localization accuracy of cone-beam CT (CBCT) images used in radiation treatment of respiratory disease sites is affected by motion artifacts (blurring and streaking). The authors have previously reported on a method of respiratory motion correction in thoracic CBCT at end expiration (EE). The previous retrospective study was limited to examination of reducing motion artifacts in a small number of patient cases. They report here on a prospective study in a larger group of lung cancer patients to evaluate respiratory motion-corrected (RMC)-CBCT ability to improve lung tumor localization accuracy and reduce motion artifacts in Linac-mounted CBCT images. A secondmore » study goal examines whether the motion correction derived from a respiration-correlated CT (RCCT) at simulation yields similar tumor localization accuracy at treatment. Methods: In an IRB-approved study, 19 lung cancer patients (22 tumors) received a RCCT at simulation, and on one treatment day received a RCCT, a respiratory-gated CBCT at end expiration, and a 1-min CBCT. A respiration monitor of abdominal displacement was used during all scans. In addition to a CBCT reconstruction without motion correction, the motion correction method was applied to the same 1-min scan. Projection images were sorted into ten bins based on abdominal displacement, and each bin was reconstructed to produce ten intermediate CBCT images. Each intermediate CBCT was deformed to the end expiration state using a motion model derived from RCCT. The deformed intermediate CBCT images were then added to produce a final RMC-CBCT. In order to evaluate the second study goal, the CBCT was corrected in two ways, one using a model derived from the RCCT at simulation [RMC-CBCT(sim)], the other from the RCCT at treatment [RMC-CBCT(tx)]. Image evaluation compared uncorrected CBCT, RMC-CBCT(sim), and RMC-CBCT(tx). The gated CBCT at end expiration served as the criterion standard for comparison. Using automatic rigid image registration, each CBCT was registered twice to the gated CBCT, first aligned to spine, second to tumor in lung. Localization discrepancy was defined as the difference between tumor and spine registration. Agreement in tumor localization with the gated CBCT was further evaluated by calculating a normalized cross correlation (NCC) of pixel intensities within a volume-of-interest enclosing the tumor in lung. Results: Tumor localization discrepancy was reduced with RMC-CBCT(tx) in 17 out of 22 cases relative to no correction. If one considers cases in which tumor motion is 5 mm or more in the RCCT, tumor localization discrepancy is reduced with RMC-CBCT(tx) in 14 out of 17 cases (p = 0.04), and with RMC-CBCT(sim) in 13 out of 17 cases (p = 0.05). Differences in localization discrepancy between correction models [RMC-CBCT(sim) vs RMC-CBCT(tx)] were less than 2 mm. In 21 out of 22 cases, improvement in NCC was higher with RMC-CBCT(tx) relative to no correction (p < 0.0001). Differences in NCC between RMC-CBCT(sim) and RMC-CBCT(tx) were small. Conclusions: Motion-corrected CBCT improves lung tumor localization accuracy and reduces motion artifacts in nearly all cases. Motion correction at end expiration using RCCT acquired at simulation yields similar results to that using a RCCT on the treatment day (2–3 weeks after simulation)« less

Evaluation of tumor localization in respiration motion-corrected cone-beam CT: prospective study in lung.

PubMed

Dzyubak, Oleksandr; Kincaid, Russell; Hertanto, Agung; Hu, Yu-Chi; Pham, Hai; Rimner, Andreas; Yorke, Ellen; Zhang, Qinghui; Mageras, Gig S

2014-10-01

Target localization accuracy of cone-beam CT (CBCT) images used in radiation treatment of respiratory disease sites is affected by motion artifacts (blurring and streaking). The authors have previously reported on a method of respiratory motion correction in thoracic CBCT at end expiration (EE). The previous retrospective study was limited to examination of reducing motion artifacts in a small number of patient cases. They report here on a prospective study in a larger group of lung cancer patients to evaluate respiratory motion-corrected (RMC)-CBCT ability to improve lung tumor localization accuracy and reduce motion artifacts in Linac-mounted CBCT images. A second study goal examines whether the motion correction derived from a respiration-correlated CT (RCCT) at simulation yields similar tumor localization accuracy at treatment. In an IRB-approved study, 19 lung cancer patients (22 tumors) received a RCCT at simulation, and on one treatment day received a RCCT, a respiratory-gated CBCT at end expiration, and a 1-min CBCT. A respiration monitor of abdominal displacement was used during all scans. In addition to a CBCT reconstruction without motion correction, the motion correction method was applied to the same 1-min scan. Projection images were sorted into ten bins based on abdominal displacement, and each bin was reconstructed to produce ten intermediate CBCT images. Each intermediate CBCT was deformed to the end expiration state using a motion model derived from RCCT. The deformed intermediate CBCT images were then added to produce a final RMC-CBCT. In order to evaluate the second study goal, the CBCT was corrected in two ways, one using a model derived from the RCCT at simulation [RMC-CBCT(sim)], the other from the RCCT at treatment [RMC-CBCT(tx)]. Image evaluation compared uncorrected CBCT, RMC-CBCT(sim), and RMC-CBCT(tx). The gated CBCT at end expiration served as the criterion standard for comparison. Using automatic rigid image registration, each CBCT was registered twice to the gated CBCT, first aligned to spine, second to tumor in lung. Localization discrepancy was defined as the difference between tumor and spine registration. Agreement in tumor localization with the gated CBCT was further evaluated by calculating a normalized cross correlation (NCC) of pixel intensities within a volume-of-interest enclosing the tumor in lung. Tumor localization discrepancy was reduced with RMC-CBCT(tx) in 17 out of 22 cases relative to no correction. If one considers cases in which tumor motion is 5 mm or more in the RCCT, tumor localization discrepancy is reduced with RMC-CBCT(tx) in 14 out of 17 cases (p = 0.04), and with RMC-CBCT(sim) in 13 out of 17 cases (p = 0.05). Differences in localization discrepancy between correction models [RMC-CBCT(sim) vs RMC-CBCT(tx)] were less than 2 mm. In 21 out of 22 cases, improvement in NCC was higher with RMC-CBCT(tx) relative to no correction (p < 0.0001). Differences in NCC between RMC-CBCT(sim) and RMC-CBCT(tx) were small. Motion-corrected CBCT improves lung tumor localization accuracy and reduces motion artifacts in nearly all cases. Motion correction at end expiration using RCCT acquired at simulation yields similar results to that using a RCCT on the treatment day (2-3 weeks after simulation).

Tracking lung tissue motion and expansion/compression with inverse consistent image registration and spirometry

DOE Office of Scientific and Technical Information (OSTI.GOV)

Christensen, Gary E.; Song, Joo Hyun; Lu, Wei

2007-06-15

Breathing motion is one of the major limiting factors for reducing dose and irradiation of normal tissue for conventional conformal radiotherapy. This paper describes a relationship between tracking lung motion using spirometry data and image registration of consecutive CT image volumes collected from a multislice CT scanner over multiple breathing periods. Temporal CT sequences from 5 individuals were analyzed in this study. The couch was moved from 11 to 14 different positions to image the entire lung. At each couch position, 15 image volumes were collected over approximately 3 breathing periods. It is assumed that the expansion and contraction ofmore » lung tissue can be modeled as an elastic material. Furthermore, it is assumed that the deformation of the lung is small over one-fifth of a breathing period and therefore the motion of the lung can be adequately modeled using a small deformation linear elastic model. The small deformation inverse consistent linear elastic image registration algorithm is therefore well suited for this problem and was used to register consecutive image scans. The pointwise expansion and compression of lung tissue was measured by computing the Jacobian of the transformations used to register the images. The logarithm of the Jacobian was computed so that expansion and compression of the lung were scaled equally. The log-Jacobian was computed at each voxel in the volume to produce a map of the local expansion and compression of the lung during the breathing period. These log-Jacobian images demonstrate that the lung does not expand uniformly during the breathing period, but rather expands and contracts locally at different rates during inhalation and exhalation. The log-Jacobian numbers were averaged over a cross section of the lung to produce an estimate of the average expansion or compression from one time point to the next and compared to the air flow rate measured by spirometry. In four out of five individuals, the average log-Jacobian value and the air flow rate correlated well (R{sup 2}=0.858 on average for the entire lung). The correlation for the fifth individual was not as good (R{sup 2}=0.377 on average for the entire lung) and can be explained by the small variation in tidal volume for this individual. The correlation of the average log-Jacobian value and the air flow rate for images near the diaphragm correlated well in all five individuals (R{sup 2}=0.943 on average). These preliminary results indicate a strong correlation between the expansion/compression of the lung measured by image registration and the air flow rate measured by spirometry. Predicting the location, motion, and compression/expansion of the tumor and normal tissue using image registration and spirometry could have many important benefits for radiotherapy treatment. These benefits include reducing radiation dose to normal tissue, maximizing dose to the tumor, improving patient care, reducing treatment cost, and increasing patient throughput.« less

Tracking lung tissue motion and expansion/compression with inverse consistent image registration and spirometry.

PubMed

Christensen, Gary E; Song, Joo Hyun; Lu, Wei; El Naqa, Issam; Low, Daniel A

2007-06-01

Breathing motion is one of the major limiting factors for reducing dose and irradiation of normal tissue for conventional conformal radiotherapy. This paper describes a relationship between tracking lung motion using spirometry data and image registration of consecutive CT image volumes collected from a multislice CT scanner over multiple breathing periods. Temporal CT sequences from 5 individuals were analyzed in this study. The couch was moved from 11 to 14 different positions to image the entire lung. At each couch position, 15 image volumes were collected over approximately 3 breathing periods. It is assumed that the expansion and contraction of lung tissue can be modeled as an elastic material. Furthermore, it is assumed that the deformation of the lung is small over one-fifth of a breathing period and therefore the motion of the lung can be adequately modeled using a small deformation linear elastic model. The small deformation inverse consistent linear elastic image registration algorithm is therefore well suited for this problem and was used to register consecutive image scans. The pointwise expansion and compression of lung tissue was measured by computing the Jacobian of the transformations used to register the images. The logarithm of the Jacobian was computed so that expansion and compression of the lung were scaled equally. The log-Jacobian was computed at each voxel in the volume to produce a map of the local expansion and compression of the lung during the breathing period. These log-Jacobian images demonstrate that the lung does not expand uniformly during the breathing period, but rather expands and contracts locally at different rates during inhalation and exhalation. The log-Jacobian numbers were averaged over a cross section of the lung to produce an estimate of the average expansion or compression from one time point to the next and compared to the air flow rate measured by spirometry. In four out of five individuals, the average log-Jacobian value and the air flow rate correlated well (R2 = 0.858 on average for the entire lung). The correlation for the fifth individual was not as good (R2 = 0.377 on average for the entire lung) and can be explained by the small variation in tidal volume for this individual. The correlation of the average log-Jacobian value and the air flow rate for images near the diaphragm correlated well in all five individuals (R2 = 0.943 on average). These preliminary results indicate a strong correlation between the expansion/compression of the lung measured by image registration and the air flow rate measured by spirometry. Predicting the location, motion, and compression/expansion of the tumor and normal tissue using image registration and spirometry could have many important benefits for radiotherapy treatment. These benefits include reducing radiation dose to normal tissue, maximizing dose to the tumor, improving patient care, reducing treatment cost, and increasing patient throughput.

Estimation of slipping organ motion by registration with direction-dependent regularization.

PubMed

Schmidt-Richberg, Alexander; Werner, René; Handels, Heinz; Ehrhardt, Jan

2012-01-01

Accurate estimation of respiratory motion is essential for many applications in medical 4D imaging, for example for radiotherapy of thoracic and abdominal tumors. It is usually done by non-linear registration of image scans at different states of the breathing cycle but without further modeling of specific physiological motion properties. In this context, the accurate computation of respiration-driven lung motion is especially challenging because this organ is sliding along the surrounding tissue during the breathing cycle, leading to discontinuities in the motion field. Without considering this property in the registration model, common intensity-based algorithms cause incorrect estimation along the object boundaries. In this paper, we present a model for incorporating slipping motion in image registration. Extending the common diffusion registration by distinguishing between normal- and tangential-directed motion, we are able to estimate slipping motion at the organ boundaries while preventing gaps and ensuring smooth motion fields inside and outside. We further present an algorithm for a fully automatic detection of discontinuities in the motion field, which does not rely on a prior segmentation of the organ. We evaluate the approach for the estimation of lung motion based on 23 inspiration/expiration pairs of thoracic CT images. The results show a visually more plausible motion estimation. Moreover, the target registration error is quantified using manually defined landmarks and a significant improvement over the standard diffusion regularization is shown. Copyright © 2011 Elsevier B.V. All rights reserved.

A Novel Fast Helical 4D-CT Acquisition Technique to Generate Low-Noise Sorting Artifact–Free Images at User-Selected Breathing Phases

DOE Office of Scientific and Technical Information (OSTI.GOV)

Thomas, David, E-mail: dhthomas@mednet.ucla.edu; Lamb, James; White, Benjamin

2014-05-01

Purpose: To develop a novel 4-dimensional computed tomography (4D-CT) technique that exploits standard fast helical acquisition, a simultaneous breathing surrogate measurement, deformable image registration, and a breathing motion model to remove sorting artifacts. Methods and Materials: Ten patients were imaged under free-breathing conditions 25 successive times in alternating directions with a 64-slice CT scanner using a low-dose fast helical protocol. An abdominal bellows was used as a breathing surrogate. Deformable registration was used to register the first image (defined as the reference image) to the subsequent 24 segmented images. Voxel-specific motion model parameters were determined using a breathing motion model. Themore » tissue locations predicted by the motion model in the 25 images were compared against the deformably registered tissue locations, allowing a model prediction error to be evaluated. A low-noise image was created by averaging the 25 images deformed to the first image geometry, reducing statistical image noise by a factor of 5. The motion model was used to deform the low-noise reference image to any user-selected breathing phase. A voxel-specific correction was applied to correct the Hounsfield units for lung parenchyma density as a function of lung air filling. Results: Images produced using the model at user-selected breathing phases did not suffer from sorting artifacts common to conventional 4D-CT protocols. The mean prediction error across all patients between the breathing motion model predictions and the measured lung tissue positions was determined to be 1.19 ± 0.37 mm. Conclusions: The proposed technique can be used as a clinical 4D-CT technique. It is robust in the presence of irregular breathing and allows the entire imaging dose to contribute to the resulting image quality, providing sorting artifact–free images at a patient dose similar to or less than current 4D-CT techniques.« less

A novel fast helical 4D-CT acquisition technique to generate low-noise sorting artifact-free images at user-selected breathing phases.

PubMed

Thomas, David; Lamb, James; White, Benjamin; Jani, Shyam; Gaudio, Sergio; Lee, Percy; Ruan, Dan; McNitt-Gray, Michael; Low, Daniel

2014-05-01

To develop a novel 4-dimensional computed tomography (4D-CT) technique that exploits standard fast helical acquisition, a simultaneous breathing surrogate measurement, deformable image registration, and a breathing motion model to remove sorting artifacts. Ten patients were imaged under free-breathing conditions 25 successive times in alternating directions with a 64-slice CT scanner using a low-dose fast helical protocol. An abdominal bellows was used as a breathing surrogate. Deformable registration was used to register the first image (defined as the reference image) to the subsequent 24 segmented images. Voxel-specific motion model parameters were determined using a breathing motion model. The tissue locations predicted by the motion model in the 25 images were compared against the deformably registered tissue locations, allowing a model prediction error to be evaluated. A low-noise image was created by averaging the 25 images deformed to the first image geometry, reducing statistical image noise by a factor of 5. The motion model was used to deform the low-noise reference image to any user-selected breathing phase. A voxel-specific correction was applied to correct the Hounsfield units for lung parenchyma density as a function of lung air filling. Images produced using the model at user-selected breathing phases did not suffer from sorting artifacts common to conventional 4D-CT protocols. The mean prediction error across all patients between the breathing motion model predictions and the measured lung tissue positions was determined to be 1.19 ± 0.37 mm. The proposed technique can be used as a clinical 4D-CT technique. It is robust in the presence of irregular breathing and allows the entire imaging dose to contribute to the resulting image quality, providing sorting artifact-free images at a patient dose similar to or less than current 4D-CT techniques. Copyright © 2014 Elsevier Inc. All rights reserved.

Lung motion estimation using dynamic point shifting: An innovative model based on a robust point matching algorithm

DOE Office of Scientific and Technical Information (OSTI.GOV)

Yi, Jianbing, E-mail: yijianbing8@163.com; Yang, Xuan, E-mail: xyang0520@263.net; Li, Yan-Ran, E-mail: lyran@szu.edu.cn

2015-10-15

Purpose: Image-guided radiotherapy is an advanced 4D radiotherapy technique that has been developed in recent years. However, respiratory motion causes significant uncertainties in image-guided radiotherapy procedures. To address these issues, an innovative lung motion estimation model based on a robust point matching is proposed in this paper. Methods: An innovative robust point matching algorithm using dynamic point shifting is proposed to estimate patient-specific lung motion during free breathing from 4D computed tomography data. The correspondence of the landmark points is determined from the Euclidean distance between the landmark points and the similarity between the local images that are centered atmore » points at the same time. To ensure that the points in the source image correspond to the points in the target image during other phases, the virtual target points are first created and shifted based on the similarity between the local image centered at the source point and the local image centered at the virtual target point. Second, the target points are shifted by the constrained inverse function mapping the target points to the virtual target points. The source point set and shifted target point set are used to estimate the transformation function between the source image and target image. Results: The performances of the authors’ method are evaluated on two publicly available DIR-lab and POPI-model lung datasets. For computing target registration errors on 750 landmark points in six phases of the DIR-lab dataset and 37 landmark points in ten phases of the POPI-model dataset, the mean and standard deviation by the authors’ method are 1.11 and 1.11 mm, but they are 2.33 and 2.32 mm without considering image intensity, and 1.17 and 1.19 mm with sliding conditions. For the two phases of maximum inhalation and maximum exhalation in the DIR-lab dataset with 300 landmark points of each case, the mean and standard deviation of target registration errors on the 3000 landmark points of ten cases by the authors’ method are 1.21 and 1.04 mm. In the EMPIRE10 lung registration challenge, the authors’ method ranks 24 of 39. According to the index of the maximum shear stretch, the authors’ method is also efficient to describe the discontinuous motion at the lung boundaries. Conclusions: By establishing the correspondence of the landmark points in the source phase and the other target phases combining shape matching and image intensity matching together, the mismatching issue in the robust point matching algorithm is adequately addressed. The target registration errors are statistically reduced by shifting the virtual target points and target points. The authors’ method with consideration of sliding conditions can effectively estimate the discontinuous motion, and the estimated motion is natural. The primary limitation of the proposed method is that the temporal constraints of the trajectories of voxels are not introduced into the motion model. However, the proposed method provides satisfactory motion information, which results in precise tumor coverage by the radiation dose during radiotherapy.« less

Lung motion estimation using dynamic point shifting: An innovative model based on a robust point matching algorithm.

PubMed

Yi, Jianbing; Yang, Xuan; Chen, Guoliang; Li, Yan-Ran

2015-10-01

Image-guided radiotherapy is an advanced 4D radiotherapy technique that has been developed in recent years. However, respiratory motion causes significant uncertainties in image-guided radiotherapy procedures. To address these issues, an innovative lung motion estimation model based on a robust point matching is proposed in this paper. An innovative robust point matching algorithm using dynamic point shifting is proposed to estimate patient-specific lung motion during free breathing from 4D computed tomography data. The correspondence of the landmark points is determined from the Euclidean distance between the landmark points and the similarity between the local images that are centered at points at the same time. To ensure that the points in the source image correspond to the points in the target image during other phases, the virtual target points are first created and shifted based on the similarity between the local image centered at the source point and the local image centered at the virtual target point. Second, the target points are shifted by the constrained inverse function mapping the target points to the virtual target points. The source point set and shifted target point set are used to estimate the transformation function between the source image and target image. The performances of the authors' method are evaluated on two publicly available DIR-lab and POPI-model lung datasets. For computing target registration errors on 750 landmark points in six phases of the DIR-lab dataset and 37 landmark points in ten phases of the POPI-model dataset, the mean and standard deviation by the authors' method are 1.11 and 1.11 mm, but they are 2.33 and 2.32 mm without considering image intensity, and 1.17 and 1.19 mm with sliding conditions. For the two phases of maximum inhalation and maximum exhalation in the DIR-lab dataset with 300 landmark points of each case, the mean and standard deviation of target registration errors on the 3000 landmark points of ten cases by the authors' method are 1.21 and 1.04 mm. In the EMPIRE10 lung registration challenge, the authors' method ranks 24 of 39. According to the index of the maximum shear stretch, the authors' method is also efficient to describe the discontinuous motion at the lung boundaries. By establishing the correspondence of the landmark points in the source phase and the other target phases combining shape matching and image intensity matching together, the mismatching issue in the robust point matching algorithm is adequately addressed. The target registration errors are statistically reduced by shifting the virtual target points and target points. The authors' method with consideration of sliding conditions can effectively estimate the discontinuous motion, and the estimated motion is natural. The primary limitation of the proposed method is that the temporal constraints of the trajectories of voxels are not introduced into the motion model. However, the proposed method provides satisfactory motion information, which results in precise tumor coverage by the radiation dose during radiotherapy.

Incidence of Changes in Respiration-Induced Tumor Motion and Its Relationship With Respiratory Surrogates During Individual Treatment Fractions

DOE Office of Scientific and Technical Information (OSTI.GOV)

Malinowski, Kathleen; Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD; McAvoy, Thomas J.

2012-04-01

Purpose: To determine how frequently (1) tumor motion and (2) the spatial relationship between tumor and respiratory surrogate markers change during a treatment fraction in lung and pancreas cancer patients. Methods and Materials: A Cyberknife Synchrony system radiographically localized the tumor and simultaneously tracked three respiratory surrogate markers fixed to a form-fitting vest. Data in 55 lung and 29 pancreas fractions were divided into successive 10-min blocks. Mean tumor positions and tumor position distributions were compared across 10-min blocks of data. Treatment margins were calculated from both 10 and 30 min of data. Partial least squares (PLS) regression models ofmore » tumor positions as a function of external surrogate marker positions were created from the first 10 min of data in each fraction; the incidence of significant PLS model degradation was used to assess changes in the spatial relationship between tumors and surrogate markers. Results: The absolute change in mean tumor position from first to third 10-min blocks was >5 mm in 13% and 7% of lung and pancreas cases, respectively. Superior-inferior and medial-lateral differences in mean tumor position were significantly associated with the lobe of lung. In 61% and 54% of lung and pancreas fractions, respectively, margins calculated from 30 min of data were larger than margins calculated from 10 min of data. The change in treatment margin magnitude for superior-inferior motion was >1 mm in 42% of lung and 45% of pancreas fractions. Significantly increasing tumor position prediction model error (mean {+-} standard deviation rates of change of 1.6 {+-} 2.5 mm per 10 min) over 30 min indicated tumor-surrogate relationship changes in 63% of fractions. Conclusions: Both tumor motion and the relationship between tumor and respiratory surrogate displacements change in most treatment fractions for patient in-room time of 30 min.« less

Incidence of changes in respiration-induced tumor motion and its relationship with respiratory surrogates during individual treatment fractions.

PubMed

Malinowski, Kathleen; McAvoy, Thomas J; George, Rohini; Dietrich, Sonja; D'Souza, Warren D

2012-04-01

To determine how frequently (1) tumor motion and (2) the spatial relationship between tumor and respiratory surrogate markers change during a treatment fraction in lung and pancreas cancer patients. A Cyberknife Synchrony system radiographically localized the tumor and simultaneously tracked three respiratory surrogate markers fixed to a form-fitting vest. Data in 55 lung and 29 pancreas fractions were divided into successive 10-min blocks. Mean tumor positions and tumor position distributions were compared across 10-min blocks of data. Treatment margins were calculated from both 10 and 30 min of data. Partial least squares (PLS) regression models of tumor positions as a function of external surrogate marker positions were created from the first 10 min of data in each fraction; the incidence of significant PLS model degradation was used to assess changes in the spatial relationship between tumors and surrogate markers. The absolute change in mean tumor position from first to third 10-min blocks was >5 mm in 13% and 7% of lung and pancreas cases, respectively. Superior-inferior and medial-lateral differences in mean tumor position were significantly associated with the lobe of lung. In 61% and 54% of lung and pancreas fractions, respectively, margins calculated from 30 min of data were larger than margins calculated from 10 min of data. The change in treatment margin magnitude for superior-inferior motion was >1 mm in 42% of lung and 45% of pancreas fractions. Significantly increasing tumor position prediction model error (mean ± standard deviation rates of change of 1.6 ± 2.5 mm per 10 min) over 30 min indicated tumor-surrogate relationship changes in 63% of fractions. Both tumor motion and the relationship between tumor and respiratory surrogate displacements change in most treatment fractions for patient in-room time of 30 min. Copyright © 2012. Published by Elsevier Inc.

Design and analysis of a tendon-based computed tomography-compatible robot with remote center of motion for lung biopsy.

PubMed

Yang, Yunpeng; Jiang, Shan; Yang, Zhiyong; Yuan, Wei; Dou, Huaisu; Wang, Wei; Zhang, Daguang; Bian, Yuan

2017-04-01

Nowadays, biopsy is a decisive method of lung cancer diagnosis, whereas lung biopsy is time-consuming, complex and inaccurate. So a computed tomography-compatible robot for rapid and precise lung biopsy is developed in this article. According to the actual operation process, the robot is divided into two modules: 4-degree-of-freedom position module for location of puncture point is appropriate for patient's almost all positions and 3-degree-of-freedom tendon-based orientation module with remote center of motion is compact and computed tomography-compatible to orientate and insert needle automatically inside computed tomography bore. The workspace of the robot surrounds patient's thorax, and the needle tip forms a cone under patient's skin. A new error model of the robot based on screw theory is proposed in view of structure error and actuation error, which are regarded as screw motions. Simulation is carried out to verify the precision of the error model contrasted with compensation via inverse kinematics. The results of insertion experiment on specific phantom prove the feasibility of the robot with mean error of 1.373 mm in laboratory environment, which is accurate enough to replace manual operation.

Tumor control probability reduction in gated radiotherapy of non-small cell lung cancers: a feasibility study.

PubMed

Siochi, R Alfredo; Kim, Yusung; Bhatia, Sudershan

2014-10-16

We studied the feasibility of evaluating tumor control probability (TCP) reductions for tumor motion beyond planned gated radiotherapy margins. Tumor motion was determined from cone-beam CT projections acquired for patient setup, intrafraction respiratory traces, and 4D CTs for five non-small cell lung cancer (NSCLC) patients treated with gated radiotherapy. Tumors were subdivided into 1 mm sections whose positions and doses were determined for each beam-on time point. (The dose calculation model was verified with motion phantom measurements.) The calculated dose distributions were used to generate the treatment TCPs for each patient. The plan TCPs were calculated from the treatment planning dose distributions. The treatment TCPs were compared to the plan TCPs for various models and parameters. Calculated doses matched phantom measurements within 0.3% for up to 3 cm of motion. TCP reductions for excess motion greater than 5mm ranged from 1.7% to 11.9%, depending on model parameters, and were as high as 48.6% for model parameters that simulated an individual patient. Repeating the worst case motion for all fractions increased TCP reductions by a factor of 2 to 3, while hypofractionation decreased these reductions by as much as a factor of 3. Treatment motion exceeding gating margins by more than 5 mm can lead to considerable TCP reductions. Appropriate margins for excess motion are recommended, unless applying daily tumor motion verification and adjusting thegating window.

Quantification of heterogeneity in lung disease with image-based pulmonary function testing.

PubMed

Stahr, Charlene S; Samarage, Chaminda R; Donnelley, Martin; Farrow, Nigel; Morgan, Kaye S; Zosky, Graeme; Boucher, Richard C; Siu, Karen K W; Mall, Marcus A; Parsons, David W; Dubsky, Stephen; Fouras, Andreas

2016-07-27

Computed tomography (CT) and spirometry are the mainstays of clinical pulmonary assessment. Spirometry is effort dependent and only provides a single global measure that is insensitive for regional disease, and as such, poor for capturing the early onset of lung disease, especially patchy disease such as cystic fibrosis lung disease. CT sensitively measures change in structure associated with advanced lung disease. However, obstructions in the peripheral airways and early onset of lung stiffening are often difficult to detect. Furthermore, CT imaging poses a radiation risk, particularly for young children, and dose reduction tends to result in reduced resolution. Here, we apply a series of lung tissue motion analyses, to achieve regional pulmonary function assessment in β-ENaC-overexpressing mice, a well-established model of lung disease. The expiratory time constants of regional airflows in the segmented airway tree were quantified as a measure of regional lung function. Our results showed marked heterogeneous lung function in β-ENaC-Tg mice compared to wild-type littermate controls; identified locations of airway obstruction, and quantified regions of bimodal airway resistance demonstrating lung compensation. These results demonstrate the applicability of regional lung function derived from lung motion as an effective alternative respiratory diagnostic tool.

SU-C-BRA-07: Variability of Patient-Specific Motion Models Derived Using Different Deformable Image Registration Algorithms for Lung Cancer Stereotactic Body Radiotherapy (SBRT) Patients

DOE Office of Scientific and Technical Information (OSTI.GOV)

Dhou, S; Williams, C; Ionascu, D

2016-06-15

Purpose: To study the variability of patient-specific motion models derived from 4-dimensional CT (4DCT) images using different deformable image registration (DIR) algorithms for lung cancer stereotactic body radiotherapy (SBRT) patients. Methods: Motion models are derived by 1) applying DIR between each 4DCT image and a reference image, resulting in a set of displacement vector fields (DVFs), and 2) performing principal component analysis (PCA) on the DVFs, resulting in a motion model (a set of eigenvectors capturing the variations in the DVFs). Three DIR algorithms were used: 1) Demons, 2) Horn-Schunck, and 3) iterative optical flow. The motion models derived weremore » compared using patient 4DCT scans. Results: Motion models were derived and the variations were evaluated according to three criteria: 1) the average root mean square (RMS) difference which measures the absolute difference between the components of the eigenvectors, 2) the dot product between the eigenvectors which measures the angular difference between the eigenvectors in space, and 3) the Euclidean Model Norm (EMN), which is calculated by summing the dot products of an eigenvector with the first three eigenvectors from the reference motion model in quadrature. EMN measures how well an eigenvector can be reconstructed using another motion model derived using a different DIR algorithm. Results showed that comparing to a reference motion model (derived using the Demons algorithm), the eigenvectors of the motion model derived using the iterative optical flow algorithm has smaller RMS, larger dot product, and larger EMN values than those of the motion model derived using Horn-Schunck algorithm. Conclusion: The study showed that motion models vary depending on which DIR algorithms were used to derive them. The choice of a DIR algorithm may affect the accuracy of the resulting model, and it is important to assess the suitability of the algorithm chosen for a particular application. This project was supported, in part, through a Master Research Agreement with Varian Medical Systems, Inc, Palo Alto, CA.« less

Respiratory motion correction in emission tomography image reconstruction.

PubMed

Reyes, Mauricio; Malandain, Grégoire; Koulibaly, Pierre Malick; González Ballester, Miguel A; Darcourt, Jacques

2005-01-01

In Emission Tomography imaging, respiratory motion causes artifacts in lungs and cardiac reconstructed images, which lead to misinterpretations and imprecise diagnosis. Solutions like respiratory gating, correlated dynamic PET techniques, list-mode data based techniques and others have been tested with improvements over the spatial activity distribution in lungs lesions, but with the disadvantages of requiring additional instrumentation or discarding part of the projection data used for reconstruction. The objective of this study is to incorporate respiratory motion correction directly into the image reconstruction process, without any additional acquisition protocol consideration. To this end, we propose an extension to the Maximum Likelihood Expectation Maximization (MLEM) algorithm that includes a respiratory motion model, which takes into account the displacements and volume deformations produced by the respiratory motion during the data acquisition process. We present results from synthetic simulations incorporating real respiratory motion as well as from phantom and patient data.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Rottmann, Joerg; Berbeco, Ross

Purpose: Precise prediction of respiratory motion is a prerequisite for real-time motion compensation techniques such as beam, dynamic couch, or dynamic multileaf collimator tracking. Collection of tumor motion data to train the prediction model is required for most algorithms. To avoid exposure of patients to additional dose from imaging during this procedure, the feasibility of training a linear respiratory motion prediction model with an external surrogate signal is investigated and its performance benchmarked against training the model with tumor positions directly. Methods: The authors implement a lung tumor motion prediction algorithm based on linear ridge regression that is suitable tomore » overcome system latencies up to about 300 ms. Its performance is investigated on a data set of 91 patient breathing trajectories recorded from fiducial marker tracking during radiotherapy delivery to the lung of ten patients. The expected 3D geometric error is quantified as a function of predictor lookahead time, signal sampling frequency and history vector length. Additionally, adaptive model retraining is evaluated, i.e., repeatedly updating the prediction model after initial training. Training length for this is gradually increased with incoming (internal) data availability. To assess practical feasibility model calculation times as well as various minimum data lengths for retraining are evaluated. Relative performance of model training with external surrogate motion data versus tumor motion data is evaluated. However, an internal–external motion correlation model is not utilized, i.e., prediction is solely driven by internal motion in both cases. Results: Similar prediction performance was achieved for training the model with external surrogate data versus internal (tumor motion) data. Adaptive model retraining can substantially boost performance in the case of external surrogate training while it has little impact for training with internal motion data. A minimum adaptive retraining data length of 8 s and history vector length of 3 s achieve maximal performance. Sampling frequency appears to have little impact on performance confirming previously published work. By using the linear predictor, a relative geometric 3D error reduction of about 50% was achieved (using adaptive retraining, a history vector length of 3 s and with results averaged over all investigated lookahead times and signal sampling frequencies). The absolute mean error could be reduced from (2.0 ± 1.6) mm when using no prediction at all to (0.9 ± 0.8) mm and (1.0 ± 0.9) mm when using the predictor trained with internal tumor motion training data and external surrogate motion training data, respectively (for a typical lookahead time of 250 ms and sampling frequency of 15 Hz). Conclusions: A linear prediction model can reduce latency induced tracking errors by an average of about 50% in real-time image guided radiotherapy systems with system latencies of up to 300 ms. Training a linear model for lung tumor motion prediction with an external surrogate signal alone is feasible and results in similar performance as training with (internal) tumor motion. Particularly for scenarios where motion data are extracted from fluoroscopic imaging with ionizing radiation, this may alleviate the need for additional imaging dose during the collection of model training data.« less

4D cone-beam CT reconstruction using multi-organ meshes for sliding motion modeling

NASA Astrophysics Data System (ADS)

Zhong, Zichun; Gu, Xuejun; Mao, Weihua; Wang, Jing

2016-02-01

A simultaneous motion estimation and image reconstruction (SMEIR) strategy was proposed for 4D cone-beam CT (4D-CBCT) reconstruction and showed excellent results in both phantom and lung cancer patient studies. In the original SMEIR algorithm, the deformation vector field (DVF) was defined on voxel grid and estimated by enforcing a global smoothness regularization term on the motion fields. The objective of this work is to improve the computation efficiency and motion estimation accuracy of SMEIR for 4D-CBCT through developing a multi-organ meshing model. Feature-based adaptive meshes were generated to reduce the number of unknowns in the DVF estimation and accurately capture the organ shapes and motion. Additionally, the discontinuity in the motion fields between different organs during respiration was explicitly considered in the multi-organ mesh model. This will help with the accurate visualization and motion estimation of the tumor on the organ boundaries in 4D-CBCT. To further improve the computational efficiency, a GPU-based parallel implementation was designed. The performance of the proposed algorithm was evaluated on a synthetic sliding motion phantom, a 4D NCAT phantom, and four lung cancer patients. The proposed multi-organ mesh based strategy outperformed the conventional Feldkamp-Davis-Kress, iterative total variation minimization, original SMEIR and single meshing method based on both qualitative and quantitative evaluations.

4D cone-beam CT reconstruction using multi-organ meshes for sliding motion modeling.

PubMed

Zhong, Zichun; Gu, Xuejun; Mao, Weihua; Wang, Jing

2016-02-07

A simultaneous motion estimation and image reconstruction (SMEIR) strategy was proposed for 4D cone-beam CT (4D-CBCT) reconstruction and showed excellent results in both phantom and lung cancer patient studies. In the original SMEIR algorithm, the deformation vector field (DVF) was defined on voxel grid and estimated by enforcing a global smoothness regularization term on the motion fields. The objective of this work is to improve the computation efficiency and motion estimation accuracy of SMEIR for 4D-CBCT through developing a multi-organ meshing model. Feature-based adaptive meshes were generated to reduce the number of unknowns in the DVF estimation and accurately capture the organ shapes and motion. Additionally, the discontinuity in the motion fields between different organs during respiration was explicitly considered in the multi-organ mesh model. This will help with the accurate visualization and motion estimation of the tumor on the organ boundaries in 4D-CBCT. To further improve the computational efficiency, a GPU-based parallel implementation was designed. The performance of the proposed algorithm was evaluated on a synthetic sliding motion phantom, a 4D NCAT phantom, and four lung cancer patients. The proposed multi-organ mesh based strategy outperformed the conventional Feldkamp-Davis-Kress, iterative total variation minimization, original SMEIR and single meshing method based on both qualitative and quantitative evaluations.

4D cone-beam CT reconstruction using multi-organ meshes for sliding motion modeling

PubMed Central

Zhong, Zichun; Gu, Xuejun; Mao, Weihua; Wang, Jing

2016-01-01

A simultaneous motion estimation and image reconstruction (SMEIR) strategy was proposed for 4D cone-beam CT (4D-CBCT) reconstruction and showed excellent results in both phantom and lung cancer patient studies. In the original SMEIR algorithm, the deformation vector field (DVF) was defined on voxel grid and estimated by enforcing a global smoothness regularization term on the motion fields. The objective of this work is to improve the computation efficiency and motion estimation accuracy of SMEIR for 4D-CBCT through developing a multi-organ meshing model. Feature-based adaptive meshes were generated to reduce the number of unknowns in the DVF estimation and accurately capture the organ shapes and motion. Additionally, the discontinuity in the motion fields between different organs during respiration was explicitly considered in the multi-organ mesh model. This will help with the accurate visualization and motion estimation of the tumor on the organ boundaries in 4D-CBCT. To further improve the computational efficiency, a GPU-based parallel implementation was designed. The performance of the proposed algorithm was evaluated on a synthetic sliding motion phantom, a 4D NCAT phantom, and four lung cancer patients. The proposed multi-organ mesh based strategy outperformed the conventional Feldkamp–Davis–Kress, iterative total variation minimization, original SMEIR and single meshing method based on both qualitative and quantitative evaluations. PMID:26758496

Reproducible Simulation of Respiratory Motion in Porcine Lung Explants.

PubMed

Biederer, J; Plathow, C; Schoebinger, M; Tetzlaff, R; Puderbach, M; Bolte, H; Zaporozhan, J; Meinzer, H-P; Heller, M; Kauczor, H-U

2006-11-01

To develop a model for exactly reproducible respiration motion simulations of animal lung explants inside an MR-compatible chest phantom. The materials included a piston pump and a flexible silicone reconstruction of a porcine diaphragm and were used in combination with an established MR-compatible chest phantom for porcine heart-lung preparations. The rhythmic inflation and deflation of the diaphragm at the bottom of the artificial thorax with water (1 - 1.5 L) induced lung tissue displacement resembling diaphragmatic breathing. This system was tested on five porcine heart-lung preparations using 1.5T MRI with transverse and coronal 3D-GRE (TR/TE = 3.63/1.58, 256 x 256 matrix, 350 mm FOV, 4 mm slices) and half Fourier T2-FSE (TR/TE = 545/29, 256 x 192, 350 mm, 6 mm) as well as multiple row detector CT (16 x 1 mm collimation, pitch 1.5, FOV 400 mm, 120 mAs) acquired at five fixed inspiration levels. Dynamic CT scans and coronal MRI with dynamic 2D-GRE and 2D-SS-GRE sequences (image frequencies of 10/sec and 3/sec, respectively) were acquired during continuous "breathing" (7/minute). The position of the piston pump was visually correlated with the respiratory motion visible through the transparent wall of the phantom and with dynamic displays of CT and MR images. An elastic body splines analysis of the respiratory motion was performed using CT data. Visual evaluation of MRI and CT showed three-dimensional movement of the lung tissue throughout the respiration cycle. Local tissue displacement inside the lung explants was documented with motion maps calculated from CT. The maximum displacement at the top of the diaphragm (mean 26.26 [SD 1.9] mm on CT and 27.16 [SD 1.5] mm on MRI, respectively [p = 0.25; Wilcoxon test]) was in the range of tidal breathing in human patients. The chest phantom with a diaphragmatic pump is a promising platform for multi-modality imaging studies of the effects of respiratory lung motion.

Mapping cardiogenic oscillations using synchrotron-based phase contrast CT imaging

NASA Astrophysics Data System (ADS)

Thurgood, Jordan; Dubsky, Stephen; Siu, Karen K. W.; Wallace, Megan; Siew, Melissa; Hooper, Stuart; Fouras, Andreas

2012-10-01

In many animals, including humans, the lungs encase the majority of the heart thus the motion of each organ affects the other. The effects of the motion of the heart on the lungs potentially provides information with regards to both lung and heart health. We present a novel technique that is capable of measuring the effect of the heart on the surrounding lung tissue through the use of advanced synchrotron imaging techniques and recently developed X-ray velocimetry methods. This technique generates 2D frequency response maps of the lung tissue motion at multiple projection angles from projection X-ray images. These frequency response maps are subsequently used to generate 3D reconstructions of the lung tissue exhibiting motion at the frequency of ventilation and the lung tissue exhibiting motion at the frequency of the heart. This technique has a combined spatial and temporal resolution sufficient to observe the dynamic and complex 3D nature of lung-heart interactions.

A comprehensive computational model of sound transmission through the porcine lung

PubMed Central

Dai, Zoujun; Peng, Ying; Henry, Brian M.; Mansy, Hansen A.; Sandler, Richard H.; Royston, Thomas J.

2014-01-01

A comprehensive computational simulation model of sound transmission through the porcine lung is introduced and experimentally evaluated. This “subject-specific” model utilizes parenchymal and major airway geometry derived from x-ray CT images. The lung parenchyma is modeled as a poroviscoelastic material using Biot theory. A finite element (FE) mesh of the lung that includes airway detail is created and used in comsol FE software to simulate the vibroacoustic response of the lung to sound input at the trachea. The FE simulation model is validated by comparing simulation results to experimental measurements using scanning laser Doppler vibrometry on the surface of an excised, preserved lung. The FE model can also be used to calculate and visualize vibroacoustic pressure and motion inside the lung and its airways caused by the acoustic input. The effect of diffuse lung fibrosis and of a local tumor on the lung acoustic response is simulated and visualized using the FE model. In the future, this type of visualization can be compared and matched with experimentally obtained elastographic images to better quantify regional lung material properties to noninvasively diagnose and stage disease and response to treatment. PMID:25190415

A comprehensive computational model of sound transmission through the porcine lung.

PubMed

Dai, Zoujun; Peng, Ying; Henry, Brian M; Mansy, Hansen A; Sandler, Richard H; Royston, Thomas J

2014-09-01

A comprehensive computational simulation model of sound transmission through the porcine lung is introduced and experimentally evaluated. This "subject-specific" model utilizes parenchymal and major airway geometry derived from x-ray CT images. The lung parenchyma is modeled as a poroviscoelastic material using Biot theory. A finite element (FE) mesh of the lung that includes airway detail is created and used in comsol FE software to simulate the vibroacoustic response of the lung to sound input at the trachea. The FE simulation model is validated by comparing simulation results to experimental measurements using scanning laser Doppler vibrometry on the surface of an excised, preserved lung. The FE model can also be used to calculate and visualize vibroacoustic pressure and motion inside the lung and its airways caused by the acoustic input. The effect of diffuse lung fibrosis and of a local tumor on the lung acoustic response is simulated and visualized using the FE model. In the future, this type of visualization can be compared and matched with experimentally obtained elastographic images to better quantify regional lung material properties to noninvasively diagnose and stage disease and response to treatment.

SU-G-JeP1-06: Correlation of Lung Tumor Motion with Tumor Location Using Electromagnetic Tracking

DOE Office of Scientific and Technical Information (OSTI.GOV)

Muccigrosso, D; Maughan, N; Parikh, P

Purpose: It is well known that lung tumors move with respiration. However, most measurements of lung tumor motion have studied long treatment times with intermittent imaging; those populations may not necessarily represent conventional LINAC patients. We summarized the correlation between tumor motion and location in a multi-institutional trial with electromagnetic tracking, and identified the patient cohort that would most benefit from respiratory gating. Methods: Continuous electromagnetic transponder data (Varian Medical, Seattle, WA) of lung tumor motion was collected from 14 patients (214 total fractions) across 3 institutions during external beam radiation therapy in a prospective clinical trial (NCT01396551). External interventionmore » from the clinician, such as couch shifts, instructed breath-holds, and acquisition pauses, were manually removed from the 10 Hz tracking data according to recorded notes. The average three-dimensional displacement from the breathing cycle’s end-expiratory to end-inhalation phases (peak-to-peak distance) of the transponders’ isocenter was calculated for each patient’s treatment. A weighted average of each isocenter was used to assess the effects of location on motion. A total of 14 patients were included in this analysis, grouped by their transponders’ location in the lung: upper, medial, and lower. Results: 8 patients had transponders in the upper lung, and 3 patients each in the medial lobe and lower lung. The weighted average ± standard deviation of all peak-to-peak distances for each group was: 1.04 ± 0.39 cm in the lower lung, 0.56 ± 0.14 cm in the medial lung, and 0.30 ± 0.06 cm in the upper lung. Conclusion: Tumors in the lower lung are most susceptible to excessive motion and daily variation, and would benefit most from continuous motion tracking and gating. Those in the medial lobe might be at moderate risk. The upper lobes have limited motion. These results can guide different motion management strategies between lung tumor locations. This is part of an NIH-funded prospective clinical trial (NCT01396551), using an electromagnetic transponder tracking system and additional funding from Varian Medical (Seattle, WA).« less

Simulation of range imaging-based estimation of respiratory lung motion. Influence of noise, signal dimensionality and sampling patterns.

PubMed

Wilms, M; Werner, R; Blendowski, M; Ortmüller, J; Handels, H

2014-01-01

A major problem associated with the irradiation of thoracic and abdominal tumors is respiratory motion. In clinical practice, motion compensation approaches are frequently steered by low-dimensional breathing signals (e.g., spirometry) and patient-specific correspondence models, which are used to estimate the sought internal motion given a signal measurement. Recently, the use of multidimensional signals derived from range images of the moving skin surface has been proposed to better account for complex motion patterns. In this work, a simulation study is carried out to investigate the motion estimation accuracy of such multidimensional signals and the influence of noise, the signal dimensionality, and different sampling patterns (points, lines, regions). A diffeomorphic correspondence modeling framework is employed to relate multidimensional breathing signals derived from simulated range images to internal motion patterns represented by diffeomorphic non-linear transformations. Furthermore, an automatic approach for the selection of optimal signal combinations/patterns within this framework is presented. This simulation study focuses on lung motion estimation and is based on 28 4D CT data sets. The results show that the use of multidimensional signals instead of one-dimensional signals significantly improves the motion estimation accuracy, which is, however, highly affected by noise. Only small differences exist between different multidimensional sampling patterns (lines and regions). Automatically determined optimal combinations of points and lines do not lead to accuracy improvements compared to results obtained by using all points or lines. Our results show the potential of multidimensional breathing signals derived from range images for the model-based estimation of respiratory motion in radiation therapy.

A hybrid approach for fusing 4D-MRI temporal information with 3D-CT for the study of lung and lung tumor motion.

PubMed

Yang, Y X; Teo, S-K; Van Reeth, E; Tan, C H; Tham, I W K; Poh, C L

2015-08-01

Accurate visualization of lung motion is important in many clinical applications, such as radiotherapy of lung cancer. Advancement in imaging modalities [e.g., computed tomography (CT) and MRI] has allowed dynamic imaging of lung and lung tumor motion. However, each imaging modality has its advantages and disadvantages. The study presented in this paper aims at generating synthetic 4D-CT dataset for lung cancer patients by combining both continuous three-dimensional (3D) motion captured by 4D-MRI and the high spatial resolution captured by CT using the authors' proposed approach. A novel hybrid approach based on deformable image registration (DIR) and finite element method simulation was developed to fuse a static 3D-CT volume (acquired under breath-hold) and the 3D motion information extracted from 4D-MRI dataset, creating a synthetic 4D-CT dataset. The study focuses on imaging of lung and lung tumor. Comparing the synthetic 4D-CT dataset with the acquired 4D-CT dataset of six lung cancer patients based on 420 landmarks, accurate results (average error <2 mm) were achieved using the authors' proposed approach. Their hybrid approach achieved a 40% error reduction (based on landmarks assessment) over using only DIR techniques. The synthetic 4D-CT dataset generated has high spatial resolution, has excellent lung details, and is able to show movement of lung and lung tumor over multiple breathing cycles.

Effect of Audio Coaching on Correlation of Abdominal Displacement With Lung Tumor Motion

DOE Office of Scientific and Technical Information (OSTI.GOV)

Nakamura, Mitsuhiro; Narita, Yuichiro; Matsuo, Yukinori

2009-10-01

Purpose: To assess the effect of audio coaching on the time-dependent behavior of the correlation between abdominal motion and lung tumor motion and the corresponding lung tumor position mismatches. Methods and Materials: Six patients who had a lung tumor with a motion range >8 mm were enrolled in the present study. Breathing-synchronized fluoroscopy was performed initially without audio coaching, followed by fluoroscopy with recorded audio coaching for multiple days. Two different measurements, anteroposterior abdominal displacement using the real-time positioning management system and superoinferior (SI) lung tumor motion by X-ray fluoroscopy, were performed simultaneously. Their sequential images were recorded using onemore » display system. The lung tumor position was automatically detected with a template matching technique. The relationship between the abdominal and lung tumor motion was analyzed with and without audio coaching. Results: The mean SI tumor displacement was 10.4 mm without audio coaching and increased to 23.0 mm with audio coaching (p < .01). The correlation coefficients ranged from 0.89 to 0.97 with free breathing. Applying audio coaching, the correlation coefficients improved significantly (range, 0.93-0.99; p < .01), and the SI lung tumor position mismatches became larger in 75% of all sessions. Conclusion: Audio coaching served to increase the degree of correlation and make it more reproducible. In addition, the phase shifts between tumor motion and abdominal displacement were improved; however, all patients breathed more deeply, and the SI lung tumor position mismatches became slightly larger with audio coaching than without audio coaching.« less

SU-C-210-02: Impact of Intrafractional Motion On TomoTherapy Stereotactic Body Radiotherapy (SBRT) 4D Dosimetry

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lian, J; Matney, J; Chao, E

2015-06-15

Purpose: TomoTherapy treatment has unique challenges in handling intrafractional motion compared to conventional LINAC. This study is aimed to gain a realistic and quantitative understanding of motion impact on TomoTherapy SBRT treatment of lung and prostate cancer patients. Methods: A 4D dose engine utilizing GPUs and including motion during treatment was developed for the efficient simulation of TomoTherapy delivered dosimetry. Two clinical CyberKnife lung cases with respiratory motion tracking and two prostate cases with a slower non-periodical organ motion treated by LINAC plus Calypso tracking were used in the study. For each disease site, one selected case has an averagemore » motion (6mm); the other has a large motion (10mm for lung and 15mm for prostate). SBRT of lung and prostate cases were re-planned on TomoTherapy with 12 Gyx4 fractions and 7Gyx5 fractions, respectively, all with 95% PTV coverage. Each case was planned with 4 jaw settings: 1) conventional 1cm static, 2) 2.5cm static, 3) 2.5cm dynamic, and 4) 5cm dynamic. The intrafractional rigid motion of the target was applied in the dose calculation of individual fractions of each plan and total dose was accumulated from multiple fractions. Results: For 1cm static jaw plans with motions applied, PTV coverage is related to motion type and amplitude. For SBRT patients with average motion (6mm), the PTV coverage remains > 95% for lung case and 74% for prostate case. For cases with large motion, PTV coverage drops to 61% for lung SBRT and 49% for prostate SBRT. Plans with other jaws improve uniformity of moving target, but still suffer from poor PTV coverage (< 70%). Conclusion: TomoTherapy lung SBRT is less motion-impacted when average amplitude of respiratory-induced intrafractional motion is present (6mm). When motion is large and/or non-periodic (prostate), all studied plans lead to significantly decreased target coverage in actual delivered dosimetry.« less

Toward the modeling of mucus draining from human lung: role of airways deformation on air-mucus interaction

PubMed Central

Mauroy, Benjamin; Flaud, Patrice; Pelca, Dominique; Fausser, Christian; Merckx, Jacques; Mitchell, Barrett R.

2015-01-01

Chest physiotherapy is an empirical technique used to help secretions to get out of the lung whenever stagnation occurs. Although commonly used, little is known about the inner mechanisms of chest physiotherapy and controversies about its use are coming out regularly. Thus, a scientific validation of chest physiotherapy is needed to evaluate its effects on secretions. We setup a quasi-static numerical model of chest physiotherapy based on thorax and lung physiology and on their respective biophysics. We modeled the lung with an idealized deformable symmetric bifurcating tree. Bronchi and their inner fluids mechanics are assumed axisymmetric. Static data from the literature is used to build a model for the lung's mechanics. Secretions motion is the consequence of the shear constraints apply by the air flow. The input of the model is the pressure on the chest wall at each time, and the output is the bronchi geometry and air and secretions properties. In the limit of our model, we mimicked manual and mechanical chest physiotherapy techniques. We show that for secretions to move, air flow has to be high enough to overcome secretion resistance to motion. Moreover, the higher the pressure or the quicker it is applied, the higher is the air flow and thus the mobilization of secretions. However, pressures too high are efficient up to a point where airways compressions prevents air flow to increase any further. Generally, the first effects of manipulations is a decrease of the airway tree hydrodynamic resistance, thus improving ventilation even if secretions do not get out of the lungs. Also, some secretions might be pushed deeper into the lungs; this effect is stronger for high pressures and for mechanical chest physiotherapy. Finally, we propose and tested two a dimensional numbers that depend on lung properties and that allow to measure the efficiency and comfort of a manipulation. PMID:26300780

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lee, Danny; Greer, Peter B.; Department of Radiation Oncology, Calvary Mater Newcastle, Newcastle, NSW

Purpose: To assess the impact of an audiovisual (AV) biofeedback on intra- and interfraction tumor motion for lung cancer patients. Methods and Materials: Lung tumor motion was investigated in 9 lung cancer patients who underwent a breathing training session with AV biofeedback before 2 3T magnetic resonance imaging (MRI) sessions. The breathing training session was performed to allow patients to become familiar with AV biofeedback, which uses a guiding wave customized for each patient according to a reference breathing pattern. In the first MRI session (pretreatment), 2-dimensional cine-MR images with (1) free breathing (FB) and (2) AV biofeedback were obtained, andmore » the second MRI session was repeated within 3-6 weeks (mid-treatment). Lung tumors were directly measured from cine-MR images using an auto-segmentation technique; the centroid and outlier motions of the lung tumors were measured from the segmented tumors. Free breathing and AV biofeedback were compared using several metrics: intra- and interfraction tumor motion consistency in displacement and period, and the outlier motion ratio. Results: Compared with FB, AV biofeedback improved intrafraction tumor motion consistency by 34% in displacement (P=.019) and by 73% in period (P<.001). Compared with FB, AV biofeedback improved interfraction tumor motion consistency by 42% in displacement (P<.046) and by 74% in period (P=.005). Compared with FB, AV biofeedback reduced the outlier motion ratio by 21% (P<.001). Conclusions: These results demonstrated that AV biofeedback significantly improved intra- and interfraction lung tumor motion consistency for lung cancer patients. These results demonstrate that AV biofeedback can facilitate consistent tumor motion, which is advantageous toward achieving more accurate medical imaging and radiation therapy procedures.« less

Direct Measurement of Lung Motion Using Hyperpolarized Helium-3 MR Tagging

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cai Jing; Miller, G. Wilson; Altes, Talissa A.

2007-07-01

Purpose: To measure lung motion between end-inhalation and end-exhalation using a hyperpolarized helium-3 (HP {sup 3}He) magnetic resonance (MR) tagging technique. Methods and Materials: Three healthy volunteers underwent MR tagging studies after inhalation of 1 L HP {sup 3}He gas diluted with nitrogen. Multiple-slice two-dimensional and volumetric three-dimensional MR tagged images of the lungs were obtained at end-inhalation and end-exhalation, and displacement vector maps were computed. Results: The grids of tag lines in the HP {sup 3}He MR images were well defined at end-inhalation and remained evident at end-exhalation. Displacement vector maps clearly demonstrated the regional lung motion and deformationmore » that occurred during exhalation. Discontinuity and differences in motion pattern between two adjacent lung lobes were readily resolved. Conclusions: Hyperpolarized helium-3 MR tagging technique can be used for direct in vivo measurement of respiratory lung motion on a regional basis. This technique may lend new insights into the regional pulmonary biomechanics and thus provide valuable information for the deformable registration of lung.« less

In Vitro Experimental Model for the Long-Term Analysis of Cellular Dynamics During Bronchial Tree Development from Lung Epithelial Cells

PubMed Central

Maruta, Naomichi; Marumoto, Moegi

2017-01-01

Lung branching morphogenesis has been studied for decades, but the underlying developmental mechanisms are still not fully understood. Cellular movements dynamically change during the branching process, but it is difficult to observe long-term cellular dynamics by in vivo or tissue culture experiments. Therefore, developing an in vitro experimental model of bronchial tree would provide an essential tool for developmental biology, pathology, and systems biology. In this study, we succeeded in reconstructing a bronchial tree in vitro by using primary human bronchial epithelial cells. A high concentration gradient of bronchial epithelial cells was required for branching initiation, whereas homogeneously distributed endothelial cells induced the formation of successive branches. Subsequently, the branches grew in size to the order of millimeter. The developed model contains only two types of cells and it facilitates the analysis of lung branching morphogenesis. By taking advantage of our experimental model, we carried out long-term time-lapse observations, which revealed self-assembly, collective migration with leader cells, rotational motion, and spiral motion of epithelial cells in each developmental event. Mathematical simulation was also carried out to analyze the self-assembly process and it revealed simple rules that govern cellular dynamics. Our experimental model has provided many new insights into lung development and it has the potential to accelerate the study of developmental mechanisms, pattern formation, left–right asymmetry, and disease pathogenesis of the human lung. PMID:28471293

Motion Interplay as a Function of Patient Parameters and Spot Size in Spot Scanning Proton Therapy for Lung Cancer

PubMed Central

Grassberger, Clemens; Dowdell, Stephen; Lomax, Antony; Sharp, Greg; Shackleford, James; Choi, Noah; Willers, Henning; Paganetti, Harald

2013-01-01

Purpose Quantify the impact of respiratory motion on the treatment of lung tumors with spot scanning proton therapy. Methods and Materials 4D Monte Carlo simulations were used to assess the interplay effect, which results from relative motion of the tumor and the proton beam, on the dose distribution in the patient. Ten patients with varying tumor sizes (2.6-82.3cc) and motion amplitudes (3-30mm) were included in the study. We investigated the impact of the spot size, which varies between proton facilities, and studied single fractions and conventionally fractionated treatments. The following metrics were used in the analysis: minimum/maximum/mean dose, target dose homogeneity and 2-year local control rate (2y-LC). Results Respiratory motion reduces the target dose homogeneity, with the largest effects observed for the highest motion amplitudes. Smaller spot sizes (σ≈3mm) are inherently more sensitive to motion, decreasing target dose homogeneity on average by a factor ~2.8 compared to a larger spot size (σ≈13mm). Using a smaller spot size to treat a tumor with 30mm motion amplitude reduces the minimum dose to 44.7% of the prescribed dose, decreasing modeled 2y-LC from 87.0% to 2.7%, assuming a single fraction. Conventional fractionation partly mitigates this reduction, yielding a 2y-LC of 71.6%. For the large spot size, conventional fractionation increases target dose homogeneity and prevents a deterioration of 2y-LC for all patients. No correlation with tumor volume is observed. The effect on the normal lung dose distribution is minimal: observed changes in mean lung dose and lung V20 are <0.6Gy(RBE) and <1.7% respectively. Conclusions For the patients in this study, 2y-LC could be preserved in the presence of interplay using a large spot size and conventional fractionation. For treatments employing smaller spot sizes and/or in the delivery of single fractions, interplay effects can lead to significant deterioration of the dose distribution and lower 2y-LC. PMID:23462423

A hybrid approach for fusing 4D-MRI temporal information with 3D-CT for the study of lung and lung tumor motion

DOE Office of Scientific and Technical Information (OSTI.GOV)

Yang, Y. X.; Van Reeth, E.; Poh, C. L., E-mail: clpoh@ntu.edu.sg

2015-08-15

Purpose: Accurate visualization of lung motion is important in many clinical applications, such as radiotherapy of lung cancer. Advancement in imaging modalities [e.g., computed tomography (CT) and MRI] has allowed dynamic imaging of lung and lung tumor motion. However, each imaging modality has its advantages and disadvantages. The study presented in this paper aims at generating synthetic 4D-CT dataset for lung cancer patients by combining both continuous three-dimensional (3D) motion captured by 4D-MRI and the high spatial resolution captured by CT using the authors’ proposed approach. Methods: A novel hybrid approach based on deformable image registration (DIR) and finite elementmore » method simulation was developed to fuse a static 3D-CT volume (acquired under breath-hold) and the 3D motion information extracted from 4D-MRI dataset, creating a synthetic 4D-CT dataset. Results: The study focuses on imaging of lung and lung tumor. Comparing the synthetic 4D-CT dataset with the acquired 4D-CT dataset of six lung cancer patients based on 420 landmarks, accurate results (average error <2 mm) were achieved using the authors’ proposed approach. Their hybrid approach achieved a 40% error reduction (based on landmarks assessment) over using only DIR techniques. Conclusions: The synthetic 4D-CT dataset generated has high spatial resolution, has excellent lung details, and is able to show movement of lung and lung tumor over multiple breathing cycles.« less

A Method for Assessing Ground-Truth Accuracy of the 5DCT Technique

DOE Office of Scientific and Technical Information (OSTI.GOV)

Dou, Tai H., E-mail: tdou@mednet.ucla.edu; Thomas, David H.; O'Connell, Dylan P.

2015-11-15

Purpose: To develop a technique that assesses the accuracy of the breathing phase-specific volume image generation process by patient-specific breathing motion model using the original free-breathing computed tomographic (CT) scans as ground truths. Methods: Sixteen lung cancer patients underwent a previously published protocol in which 25 free-breathing fast helical CT scans were acquired with a simultaneous breathing surrogate. A patient-specific motion model was constructed based on the tissue displacements determined by a state-of-the-art deformable image registration. The first image was arbitrarily selected as the reference image. The motion model was used, along with the free-breathing phase information of the originalmore » 25 image datasets, to generate a set of deformation vector fields that mapped the reference image to the 24 nonreference images. The high-pitch helically acquired original scans served as ground truths because they captured the instantaneous tissue positions during free breathing. Image similarity between the simulated and the original scans was assessed using deformable registration that evaluated the pointwise discordance throughout the lungs. Results: Qualitative comparisons using image overlays showed excellent agreement between the simulated images and the original images. Even large 2-cm diaphragm displacements were very well modeled, as was sliding motion across the lung–chest wall boundary. The mean error across the patient cohort was 1.15 ± 0.37 mm, and the mean 95th percentile error was 2.47 ± 0.78 mm. Conclusion: The proposed ground truth–based technique provided voxel-by-voxel accuracy analysis that could identify organ-specific or tumor-specific motion modeling errors for treatment planning. Despite a large variety of breathing patterns and lung deformations during the free-breathing scanning session, the 5-dimensionl CT technique was able to accurately reproduce the original helical CT scans, suggesting its applicability to a wide range of patients.« less

Surrogate-driven deformable motion model for organ motion tracking in particle radiation therapy

NASA Astrophysics Data System (ADS)

Fassi, Aurora; Seregni, Matteo; Riboldi, Marco; Cerveri, Pietro; Sarrut, David; Battista Ivaldi, Giovanni; Tabarelli de Fatis, Paola; Liotta, Marco; Baroni, Guido

2015-02-01

The aim of this study is the development and experimental testing of a tumor tracking method for particle radiation therapy, providing the daily respiratory dynamics of the patient’s thoraco-abdominal anatomy as a function of an external surface surrogate combined with an a priori motion model. The proposed tracking approach is based on a patient-specific breathing motion model, estimated from the four-dimensional (4D) planning computed tomography (CT) through deformable image registration. The model is adapted to the interfraction baseline variations in the patient’s anatomical configuration. The driving amplitude and phase parameters are obtained intrafractionally from a respiratory surrogate signal derived from the external surface displacement. The developed technique was assessed on a dataset of seven lung cancer patients, who underwent two repeated 4D CT scans. The first 4D CT was used to build the respiratory motion model, which was tested on the second scan. The geometric accuracy in localizing lung lesions, mediated over all breathing phases, ranged between 0.6 and 1.7 mm across all patients. Errors in tracking the surrounding organs at risk, such as lungs, trachea and esophagus, were lower than 1.3 mm on average. The median absolute variation in water equivalent path length (WEL) within the target volume did not exceed 1.9 mm-WEL for simulated particle beams. A significant improvement was achieved compared with error compensation based on standard rigid alignment. The present work can be regarded as a feasibility study for the potential extension of tumor tracking techniques in particle treatments. Differently from current tracking methods applied in conventional radiotherapy, the proposed approach allows for the dynamic localization of all anatomical structures scanned in the planning CT, thus providing complete information on density and WEL variations required for particle beam range adaptation.

Conformal piezoelectric energy harvesting and storage from motions of the heart, lung, and diaphragm

PubMed Central

Dagdeviren, Canan; Yang, Byung Duk; Su, Yewang; Tran, Phat L.; Joe, Pauline; Anderson, Eric; Xia, Jing; Doraiswamy, Vijay; Dehdashti, Behrooz; Feng, Xue; Lu, Bingwei; Poston, Robert; Khalpey, Zain; Ghaffari, Roozbeh; Huang, Yonggang; Slepian, Marvin J.; Rogers, John A.

2014-01-01

Here, we report advanced materials and devices that enable high-efficiency mechanical-to-electrical energy conversion from the natural contractile and relaxation motions of the heart, lung, and diaphragm, demonstrated in several different animal models, each of which has organs with sizes that approach human scales. A cointegrated collection of such energy-harvesting elements with rectifiers and microbatteries provides an entire flexible system, capable of viable integration with the beating heart via medical sutures and operation with efficiencies of ∼2%. Additional experiments, computational models, and results in multilayer configurations capture the key behaviors, illuminate essential design aspects, and offer sufficient power outputs for operation of pacemakers, with or without battery assist. PMID:24449853

Motion and volumetric change as demonstrated by 4DCT: The effects of abdominal compression on the GTV, lungs, and heart in lung cancer patients.

PubMed

Rasheed, Abdullah; Jabbour, Salma K; Rosenberg, Stephen; Patel, Ajay; Goyal, Sharad; Haffty, Bruce G; Yue, Ning J; Khan, Alvin

2016-01-01

Lung tumors move during respiration, complicating radiation therapy. The abdominal compression plate (ACP) is thought to reduce respiratory motion. This study quantifies ACP efficacy on respiratory-induced motion by using 4-dimensional computed tomography to evaluate volume and displacement changes of the heart, lungs, and tumor with and without ACP. Lung cancer patients (n = 17) received 4-dimensional computed tomography simulations (10 computed tomography scans from 0% to 90% breathing phases) with and without ACP under maximally tolerated diaphragmatic pressure. Gross tumor volume (GTV), heart, and lungs were contoured in treatment planning software for each phase. Structures were exported for analysis. For each phase, with and without ACP, tumor and organ absolute centroid range of motion and volume were calculated. ACP did not significantly affect GTV, heart, or lung motion on the sample as a whole, but instead demonstrated patient-specific results. ACP reduced GTV motion in 3 (17.6%; 3 upper lobe tumors) by 2.9 mm (P < .01), increased motion in 5 (29.4%; 3 upper lobe tumors, 1 middle lobe, 1 lower lobe) by 1.9 mm (P < .03), and did not significantly change 9. Of the 3 patients exhibiting significantly decreased GTV motion, GTV, heart, and lung range of motion was 7.4 mm, 11.8 mm, and 11.9 mm, respectively, without compression and 4.5 mm, 8.4 mm, and 10.9 mm, respectively, with compression. Averaged across the sample, ACP did not exhibit any axis-specific effect. ACP efficacy was patient-specific, possibly because of pre-existing factors including chronic obstructive pulmonary disease severity, chest wall elasticity, tumor location, and patient comfort. Tumor lobe location does not predetermine compression efficacy; therefore, patients should be simulated with and without ACP, regardless of tumor location. GTV motion seems most important in determining suitability for compression. Alternative motion control should be considered in patients not benefited by compression. In patients who benefited, ACP may enhance tumor coverage while minimizing toxicity. Larger scale studies are necessary for definitive treatment recommendations. Copyright © 2016 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.

Extension of the NCAT phantom for the investigation of intra-fraction respiratory motion in IMRT using 4D Monte Carlo

NASA Astrophysics Data System (ADS)

McGurk, Ross; Seco, Joao; Riboldi, Marco; Wolfgang, John; Segars, Paul; Paganetti, Harald

2010-03-01

The purpose of this work was to create a computational platform for studying motion in intensity modulated radiotherapy (IMRT). Specifically, the non-uniform rational B-spline (NURB) cardiac and torso (NCAT) phantom was modified for use in a four-dimensional Monte Carlo (4D-MC) simulation system to investigate the effect of respiratory-induced intra-fraction organ motion on IMRT dose distributions as a function of diaphragm motion, lesion size and lung density. Treatment plans for four clinical scenarios were designed: diaphragm peak-to-peak amplitude of 1 cm and 3 cm, and two lesion sizes—2 cm and 4 cm diameter placed in the lower lobe of the right lung. Lung density was changed for each phase using a conservation of mass calculation. Further, a new heterogeneous lung model was implemented and tested. Each lesion had an internal target volume (ITV) subsequently expanded by 15 mm isotropically to give the planning target volume (PTV). The PTV was prescribed to receive 72 Gy in 40 fractions. The MLC leaf sequence defined by the planning system for each patient was exported and used as input into the MC system. MC simulations using the dose planning method (DPM) code together with deformable image registration based on the NCAT deformation field were used to find a composite dose distribution for each phantom. These composite distributions were subsequently analyzed using information from the dose volume histograms (DVH). Lesion motion amplitude has the largest effect on the dose distribution. Tumor size was found to have a smaller effect and can be mitigated by ensuring the planning constraints are optimized for the tumor size. The use of a dynamic or heterogeneous lung density model over a respiratory cycle does not appear to be an important factor with a <= 0.6% change in the mean dose received by the ITV, PTV and right lung. The heterogeneous model increases the realism of the NCAT phantom and may provide more accurate simulations in radiation therapy investigations that use the phantom. This work further evaluates the NCAT phantom for use as a tool in radiation therapy research in addition to its extensive use in diagnostic imaging and nuclear medicine research. Our results indicate that the NCAT phantom, combined with 4D-MC simulations, is a useful tool in radiation therapy investigations and may allow the study of relative effects in many clinically relevant situations.

Inter-fraction variations in respiratory motion models

NASA Astrophysics Data System (ADS)

McClelland, J. R.; Hughes, S.; Modat, M.; Qureshi, A.; Ahmad, S.; Landau, D. B.; Ourselin, S.; Hawkes, D. J.

2011-01-01

Respiratory motion can vary dramatically between the planning stage and the different fractions of radiotherapy treatment. Motion predictions used when constructing the radiotherapy plan may be unsuitable for later fractions of treatment. This paper presents a methodology for constructing patient-specific respiratory motion models and uses these models to evaluate and analyse the inter-fraction variations in the respiratory motion. The internal respiratory motion is determined from the deformable registration of Cine CT data and related to a respiratory surrogate signal derived from 3D skin surface data. Three different models for relating the internal motion to the surrogate signal have been investigated in this work. Data were acquired from six lung cancer patients. Two full datasets were acquired for each patient, one before the course of radiotherapy treatment and one at the end (approximately 6 weeks later). Separate models were built for each dataset. All models could accurately predict the respiratory motion in the same dataset, but had large errors when predicting the motion in the other dataset. Analysis of the inter-fraction variations revealed that most variations were spatially varying base-line shifts, but changes to the anatomy and the motion trajectories were also observed.

Analysis of Lung Tumor Motion in a Large Sample: Patterns and Factors Influencing Precise Delineation of Internal Target Volume

DOE Office of Scientific and Technical Information (OSTI.GOV)

Knybel, Lukas; VŠB-Technical University of Ostrava, Ostrava; Cvek, Jakub, E-mail: Jakub.cvek@fno.cz

Purpose/Objective: To evaluate lung tumor motion during respiration and to describe factors affecting the range and variability of motion in patients treated with stereotactic ablative radiation therapy. Methods and Materials: Log file analysis from online respiratory tumor tracking was performed in 145 patients. Geometric tumor location in the lungs, tumor volume and origin (primary or metastatic), sex, and tumor motion amplitudes in the superior-inferior (SI), latero-lateral (LL), and anterior-posterior (AP) directions were recorded. Tumor motion variability during treatment was described using intrafraction/interfraction amplitude variability and tumor motion baseline changes. Tumor movement dependent on the tumor volume, position and origin, andmore » sex were evaluated using statistical regression and correlation analysis. Results: After analysis of >500 hours of data, the highest rates of motion amplitudes, intrafraction/interfraction variation, and tumor baseline changes were in the SI direction (6.0 ± 2.2 mm, 2.2 ± 1.8 mm, 1.1 ± 0.9 mm, and −0.1 ± 2.6 mm). The mean motion amplitudes in the lower/upper geometric halves of the lungs were significantly different (P<.001). Motion amplitudes >15 mm were observed only in the lower geometric quarter of the lungs. Higher tumor motion amplitudes generated higher intrafraction variations (R=.86, P<.001). Interfraction variations and baseline changes >3 mm indicated tumors contacting mediastinal structures or parietal pleura. On univariate analysis, neither sex nor tumor origin (primary vs metastatic) was an independent predictive factor of different movement patterns. Metastatic lesions in women, but not men, showed significantly higher mean amplitudes (P=.03) and variability (primary, 2.7 mm; metastatic, 4.9 mm; P=.002) than primary tumors. Conclusion: Online tracking showed significant irregularities in lung tumor movement during respiration. Motion amplitude was significantly lower in upper lobe tumors; higher interfraction amplitude variability indicated tumors in contact with mediastinal structures, although adhesion to parietal pleura did not necessarily reduce tumor motion amplitudes. The most variable lung tumors were metastatic lesions in women.« less

Health Monitors for Chronic Disease by Gait Analysis with Mobile Phones

PubMed Central

Juen, Joshua; Cheng, Qian; Prieto-Centurion, Valentin; Krishnan, Jerry A.

2014-01-01

Abstract We have developed GaitTrack, a phone application to detect health status while the smartphone is carried normally. GaitTrack software monitors walking patterns, using only accelerometers embedded in phones to record spatiotemporal motion, without the need for sensors external to the phone. Our software transforms smartphones into health monitors, using eight parameters of phone motion transformed into body motion by the gait model. GaitTrack is designed to detect health status while the smartphone is carried during normal activities, namely, free-living walking. The current method for assessing free-living walking is medical accelerometers, so we present evidence that mobile phones running our software are more accurate. We then show our gait model is more accurate than medical pedometers for counting steps of patients with chronic disease. Our gait model was evaluated in a pilot study involving 30 patients with chronic lung disease. The six-minute walk test (6MWT) is a major assessment for chronic heart and lung disease, including congestive heart failure and especially chronic obstructive pulmonary disease (COPD), affecting millions of persons. The 6MWT consists of walking back and forth along a measured distance for 6 minutes. The gait model using linear regression performed with 94.13% accuracy in measuring walk distance, compared with the established standard of direct observation. We also evaluated a different statistical model using the same gait parameters to predict health status through lung function. This gait model has high accuracy when applied to demographic cohorts, for example, 89.22% accuracy testing the cohort of 12 female patients with ages 50–64 years. PMID:24694291

MO-E-BRB-00: PANEL DISCUSSION: SBRT/SRS Case Studies - Lung

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

2016-06-15

In this interactive session, lung SBRT patient cases will be presented to highlight real-world considerations for ensuring safe and accurate treatment delivery. An expert panel of speakers will discuss challenges specific to lung SBRT including patient selection, patient immobilization techniques, 4D CT simulation and respiratory motion management, target delineation for treatment planning, online treatment alignment, and established prescription regimens and OAR dose limits. Practical examples of cases, including the patient flow thought the clinical process are presented and audience participation will be encouraged. This panel session is designed to provide case demonstration and review for lung SBRT in terms ofmore » (1) clinical appropriateness in patient selection, (2) strategies for simulation, including 4D and respiratory motion management, and (3) applying multi imaging modality (4D CT imaging, MRI, PET) for tumor volume delineation and motion extent, and (4) image guidance in treatment delivery. Learning Objectives: Understand the established requirements for patient selection in lung SBRT Become familiar with the various immobilization strategies for lung SBRT, including technology for respiratory motion management Understand the benefits and pitfalls of applying multi imaging modality (4D CT imaging, MRI, PET) for tumor volume delineation and motion extent determination for lung SBRT Understand established prescription regimes and OAR dose limits.« less

Dynamic PET image reconstruction integrating temporal regularization associated with respiratory motion correction for applications in oncology

NASA Astrophysics Data System (ADS)

Merlin, Thibaut; Visvikis, Dimitris; Fernandez, Philippe; Lamare, Frédéric

2018-02-01

Respiratory motion reduces both the qualitative and quantitative accuracy of PET images in oncology. This impact is more significant for quantitative applications based on kinetic modeling, where dynamic acquisitions are associated with limited statistics due to the necessity of enhanced temporal resolution. The aim of this study is to address these drawbacks, by combining a respiratory motion correction approach with temporal regularization in a unique reconstruction algorithm for dynamic PET imaging. Elastic transformation parameters for the motion correction are estimated from the non-attenuation-corrected PET images. The derived displacement matrices are subsequently used in a list-mode based OSEM reconstruction algorithm integrating a temporal regularization between the 3D dynamic PET frames, based on temporal basis functions. These functions are simultaneously estimated at each iteration, along with their relative coefficients for each image voxel. Quantitative evaluation has been performed using dynamic FDG PET/CT acquisitions of lung cancer patients acquired on a GE DRX system. The performance of the proposed method is compared with that of a standard multi-frame OSEM reconstruction algorithm. The proposed method achieved substantial improvements in terms of noise reduction while accounting for loss of contrast due to respiratory motion. Results on simulated data showed that the proposed 4D algorithms led to bias reduction values up to 40% in both tumor and blood regions for similar standard deviation levels, in comparison with a standard 3D reconstruction. Patlak parameter estimations on reconstructed images with the proposed reconstruction methods resulted in 30% and 40% bias reduction in the tumor and lung region respectively for the Patlak slope, and a 30% bias reduction for the intercept in the tumor region (a similar Patlak intercept was achieved in the lung area). Incorporation of the respiratory motion correction using an elastic model along with a temporal regularization in the reconstruction process of the PET dynamic series led to substantial quantitative improvements and motion artifact reduction. Future work will include the integration of a linear FDG kinetic model, in order to directly reconstruct parametric images.

Dynamic PET image reconstruction integrating temporal regularization associated with respiratory motion correction for applications in oncology.

PubMed

Merlin, Thibaut; Visvikis, Dimitris; Fernandez, Philippe; Lamare, Frédéric

2018-02-13

Respiratory motion reduces both the qualitative and quantitative accuracy of PET images in oncology. This impact is more significant for quantitative applications based on kinetic modeling, where dynamic acquisitions are associated with limited statistics due to the necessity of enhanced temporal resolution. The aim of this study is to address these drawbacks, by combining a respiratory motion correction approach with temporal regularization in a unique reconstruction algorithm for dynamic PET imaging. Elastic transformation parameters for the motion correction are estimated from the non-attenuation-corrected PET images. The derived displacement matrices are subsequently used in a list-mode based OSEM reconstruction algorithm integrating a temporal regularization between the 3D dynamic PET frames, based on temporal basis functions. These functions are simultaneously estimated at each iteration, along with their relative coefficients for each image voxel. Quantitative evaluation has been performed using dynamic FDG PET/CT acquisitions of lung cancer patients acquired on a GE DRX system. The performance of the proposed method is compared with that of a standard multi-frame OSEM reconstruction algorithm. The proposed method achieved substantial improvements in terms of noise reduction while accounting for loss of contrast due to respiratory motion. Results on simulated data showed that the proposed 4D algorithms led to bias reduction values up to 40% in both tumor and blood regions for similar standard deviation levels, in comparison with a standard 3D reconstruction. Patlak parameter estimations on reconstructed images with the proposed reconstruction methods resulted in 30% and 40% bias reduction in the tumor and lung region respectively for the Patlak slope, and a 30% bias reduction for the intercept in the tumor region (a similar Patlak intercept was achieved in the lung area). Incorporation of the respiratory motion correction using an elastic model along with a temporal regularization in the reconstruction process of the PET dynamic series led to substantial quantitative improvements and motion artifact reduction. Future work will include the integration of a linear FDG kinetic model, in order to directly reconstruct parametric images.

Dynamic MRI of Grid-Tagged Hyperpolarized Helium-3 for the Assessment of Lung Motion During Breathing

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cai Jing; Sheng Ke; Benedict, Stanley H.

2009-09-01

Purpose: To develop a dynamic magnetic resonance imaging (MRI) tagging technique using hyperpolarized helium-3 (HP He-3) to track lung motion. Methods and Materials: An accelerated non-Cartesian k-space trajectory was used to gain acquisition speed, at the cost of introducing image artifacts, providing a viable strategy for obtaining whole-lung coverage with adequate temporal resolution. Multiple-slice two-dimensional dynamic images of the lung were obtained in three healthy subjects after inhaling He-3 gas polarized to 35%-40%. Displacement, strain, and ventilation maps were computed from the observed motion of the grid peaks. Results: Both temporal and spatial variations of pulmonary mechanics were observed inmore » normal subjects, including shear motion between different lobes of the same lung. Conclusion: These initial results suggest that dynamic imaging of grid-tagged hyperpolarized magnetization may potentially be a powerful tool for observing and quantifying pulmonary biomechanics on a regional basis and for assessing, validating, and improving lung deformable image registration algorithms.« less

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chao, M; Yuan, Y; Lo, Y

Purpose: To develop a novel strategy to extract the lung tumor motion from cone beam CT (CBCT) projections by an active contour model with interpolated respiration learned from diaphragm motion. Methods: Tumor tracking on CBCT projections was accomplished with the templates derived from planning CT (pCT). There are three major steps in the proposed algorithm: 1) The pCT was modified to form two CT sets: a tumor removed pCT and a tumor only pCT, the respective digitally reconstructed radiographs DRRtr and DRRto following the same geometry of the CBCT projections were generated correspondingly. 2) The DRRtr was rigidly registered withmore » the CBCT projections on the frame-by-frame basis. Difference images between CBCT projections and the registered DRRtr were generated where the tumor visibility was appreciably enhanced. 3) An active contour method was applied to track the tumor motion on the tumor enhanced projections with DRRto as templates to initialize the tumor tracking while the respiratory motion was compensated for by interpolating the diaphragm motion estimated by our novel constrained linear regression approach. CBCT and pCT from five patients undergoing stereotactic body radiotherapy were included in addition to scans from a Quasar phantom programmed with known motion. Manual tumor tracking was performed on CBCT projections and was compared to the automatic tracking to evaluate the algorithm accuracy. Results: The phantom study showed that the error between the automatic tracking and the ground truth was within 0.2mm. For the patients the discrepancy between the calculation and the manual tracking was between 1.4 and 2.2 mm depending on the location and shape of the lung tumor. Similar patterns were observed in the frequency domain. Conclusion: The new algorithm demonstrated the feasibility to track the lung tumor from noisy CBCT projections, providing a potential solution to better motion management for lung radiation therapy.« less

DOE Office of Scientific and Technical Information (OSTI.GOV)

Larner, J.

In this interactive session, lung SBRT patient cases will be presented to highlight real-world considerations for ensuring safe and accurate treatment delivery. An expert panel of speakers will discuss challenges specific to lung SBRT including patient selection, patient immobilization techniques, 4D CT simulation and respiratory motion management, target delineation for treatment planning, online treatment alignment, and established prescription regimens and OAR dose limits. Practical examples of cases, including the patient flow thought the clinical process are presented and audience participation will be encouraged. This panel session is designed to provide case demonstration and review for lung SBRT in terms ofmore » (1) clinical appropriateness in patient selection, (2) strategies for simulation, including 4D and respiratory motion management, and (3) applying multi imaging modality (4D CT imaging, MRI, PET) for tumor volume delineation and motion extent, and (4) image guidance in treatment delivery. Learning Objectives: Understand the established requirements for patient selection in lung SBRT Become familiar with the various immobilization strategies for lung SBRT, including technology for respiratory motion management Understand the benefits and pitfalls of applying multi imaging modality (4D CT imaging, MRI, PET) for tumor volume delineation and motion extent determination for lung SBRT Understand established prescription regimes and OAR dose limits.« less

Intensity-Based Registration for Lung Motion Estimation

NASA Astrophysics Data System (ADS)

Cao, Kunlin; Ding, Kai; Amelon, Ryan E.; Du, Kaifang; Reinhardt, Joseph M.; Raghavan, Madhavan L.; Christensen, Gary E.

Image registration plays an important role within pulmonary image analysis. The task of registration is to find the spatial mapping that brings two images into alignment. Registration algorithms designed for matching 4D lung scans or two 3D scans acquired at different inflation levels can catch the temporal changes in position and shape of the region of interest. Accurate registration is critical to post-analysis of lung mechanics and motion estimation. In this chapter, we discuss lung-specific adaptations of intensity-based registration methods for 3D/4D lung images and review approaches for assessing registration accuracy. Then we introduce methods for estimating tissue motion and studying lung mechanics. Finally, we discuss methods for assessing and quantifying specific volume change, specific ventilation, strain/ stretch information and lobar sliding.

Local respiratory motion correction for PET/CT imaging: Application to lung cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lamare, F., E-mail: frederic.lamare@chu-bordeaux.fr; Fernandez, P.; Fayad, H.

Purpose: Despite multiple methodologies already proposed to correct respiratory motion in the whole PET imaging field of view (FOV), such approaches have not found wide acceptance in clinical routine. An alternative can be the local respiratory motion correction (LRMC) of data corresponding to a given volume of interest (VOI: organ or tumor). Advantages of LRMC include the use of a simple motion model, faster execution times, and organ specific motion correction. The purpose of this study was to evaluate the performance of LMRC using various motion models for oncology (lung lesion) applications. Methods: Both simulated (NURBS based 4D cardiac-torso phantom)more » and clinical studies (six patients) were used in the evaluation of the proposed LRMC approach. PET data were acquired in list-mode and synchronized with respiration. The implemented approach consists first in defining a VOI on the reconstructed motion average image. Gated PET images of the VOI are subsequently reconstructed using only lines of response passing through the selected VOI and are used in combination with a center of gravity or an affine/elastic registration algorithm to derive the transformation maps corresponding to the respiration effects. Those are finally integrated in the reconstruction process to produce a motion free image over the lesion regions. Results: Although the center of gravity or affine algorithm achieved similar performance for individual lesion motion correction, the elastic model, applied either locally or to the whole FOV, led to an overall superior performance. The spatial tumor location was altered by 89% and 81% for the elastic model applied locally or to the whole FOV, respectively (compared to 44% and 39% for the center of gravity and affine models, respectively). This resulted in similar associated overall tumor volume changes of 84% and 80%, respectively (compared to 75% and 71% for the center of gravity and affine models, respectively). The application of the nonrigid deformation model in LRMC led to over an order of magnitude gain in computational efficiency of the correction relative to the application of the deformable model to the whole FOV. Conclusions: The results of this study support the use of LMRC as a flexible and efficient correction approach for respiratory motion effects for single lesions in the thoracic area.« less

SU-D-BRC-05: Effects of Motion and Variable RBE in a Lung Patient Treated with Passively Scattered Protons

DOE Office of Scientific and Technical Information (OSTI.GOV)

Mirkovic, D; Titt, U; Mohan, R

2016-06-15

Purpose: To evaluate effects of motion and variable relative biological effectiveness (RBE) in a lung cancer patient treated with passively scattered proton therapy using dose volume histograms associated with patient dose computed using three different methods. Methods: A proton treatment plan of a lung cancer patient optimized using clinical treatment planning system (TPS) was used to construct a detailed Monte Carlo (MC) model of the beam delivery system and the patient specific aperture and compensator. A phase space file containing all particles transported through the beam line was collected at the distal surface of the range compensator and subsequently transportedmore » through two different patient models. The first model was based on the average CT used by the TPS and the second model included all 10 phases of the corresponding 4DCT. The physical dose and proton linear energy transfer (LET) were computed in each voxel of two models and used to compute constant and variable RBE MC dose on average CT and 4D CT. The MC computed doses were compared to the TPS dose using dose volume histograms for relevant structures. Results: The results show significant differences in doses to the target and critical structures suggesting the need for more accurate proton dose computation methods. In particular, the 4D dose shows reduced coverage of the target and higher dose to the spinal cord, while variable RBE dose shows higher lung dose. Conclusion: The methodology developed in this pilot study is currently used for the analysis of a cohort of ∼90 lung patients from a clinical trial comparing proton and photon therapy for lung cancer. The results from this study will help us in determining the clinical significance of more accurate dose computation models in proton therapy.« less

High-performance C-arm cone-beam CT guidance of thoracic surgery

NASA Astrophysics Data System (ADS)

Schafer, Sebastian; Otake, Yoshito; Uneri, Ali; Mirota, Daniel J.; Nithiananthan, Sajendra; Stayman, J. W.; Zbijewski, Wojciech; Kleinszig, Gerhard; Graumann, Rainer; Sussman, Marc; Siewerdsen, Jeffrey H.

2012-02-01

Localizing sub-palpable nodules in minimally invasive video-assisted thoracic surgery (VATS) presents a significant challenge. To overcome inherent problems of preoperative nodule tagging using CT fluoroscopic guidance, an intraoperative C-arm cone-beam CT (CBCT) image-guidance system has been developed for direct localization of subpalpable tumors in the OR, including real-time tracking of surgical tools (including thoracoscope), and video-CBCT registration for augmentation of the thoracoscopic scene. Acquisition protocols for nodule visibility in the inflated and deflated lung were delineated in phantom and animal/cadaver studies. Motion compensated reconstruction was implemented to account for motion induced by the ventilated contralateral lung. Experience in CBCT-guided targeting of simulated lung nodules included phantoms, porcine models, and cadavers. Phantom studies defined low-dose acquisition protocols providing contrast-to-noise ratio sufficient for lung nodule visualization, confirmed in porcine specimens with simulated nodules (3-6mm diameter PE spheres, ~100-150HU contrast, 2.1mGy). Nodule visibility in CBCT of the collapsed lung, with reduced contrast according to air volume retention, was more challenging, but initial studies confirmed visibility using scan protocols at slightly increased dose (~4.6-11.1mGy). Motion compensated reconstruction employing a 4D deformation map in the backprojection process reduced artifacts associated with motion blur. Augmentation of thoracoscopic video with renderings of the target and critical structures (e.g., pulmonary artery) showed geometric accuracy consistent with camera calibration and the tracking system (2.4mm registration error). Initial results suggest a potentially valuable role for CBCT guidance in VATS, improving precision in minimally invasive, lungconserving surgeries, avoid critical structures, obviate the burdens of preoperative localization, and improve patient safety.

MRI-guided tumor tracking in lung cancer radiotherapy

NASA Astrophysics Data System (ADS)

Cerviño, Laura I.; Du, Jiang; Jiang, Steve B.

2011-07-01

Precise tracking of lung tumor motion during treatment delivery still represents a challenge in radiation therapy. Prototypes of MRI-linac hybrid systems are being created which have the potential of ionization-free real-time imaging of the tumor. This study evaluates the performance of lung tumor tracking algorithms in cine-MRI sagittal images from five healthy volunteers. Visible vascular structures were used as targets. Volunteers performed several series of regular and irregular breathing. Two tracking algorithms were implemented and evaluated: a template matching (TM) algorithm in combination with surrogate tracking using the diaphragm (surrogate was used when the maximum correlation between the template and the image in the search window was less than specified), and an artificial neural network (ANN) model based on the principal components of a region of interest that encompasses the target motion. The mean tracking error ē and the error at 95% confidence level e95 were evaluated for each model. The ANN model led to ē = 1.5 mm and e95 = 4.2 mm, while TM led to ē = 0.6 mm and e95 = 1.0 mm. An extra series was considered separately to evaluate the benefit of using surrogate tracking in combination with TM when target out-of-plane motion occurs. For this series, the mean error was 7.2 mm using only TM and 1.7 mm when the surrogate was used in combination with TM. Results show that, as opposed to tracking with other imaging modalities, ANN does not perform well in MR-guided tracking. TM, however, leads to highly accurate tracking. Out-of-plane motion could be addressed by surrogate tracking using the diaphragm, which can be easily identified in the images.

Segmentation and tracking of lung nodules via graph-cuts incorporating shape prior and motion from 4D CT.

PubMed

Cha, Jungwon; Farhangi, Mohammad Mehdi; Dunlap, Neal; Amini, Amir A

2018-01-01

We have developed a robust tool for performing volumetric and temporal analysis of nodules from respiratory gated four-dimensional (4D) CT. The method could prove useful in IMRT of lung cancer. We modified the conventional graph-cuts method by adding an adaptive shape prior as well as motion information within a signed distance function representation to permit more accurate and automated segmentation and tracking of lung nodules in 4D CT data. Active shape models (ASM) with signed distance function were used to capture the shape prior information, preventing unwanted surrounding tissues from becoming part of the segmented object. The optical flow method was used to estimate the local motion and to extend three-dimensional (3D) segmentation to 4D by warping a prior shape model through time. The algorithm has been applied to segmentation of well-circumscribed, vascularized, and juxtapleural lung nodules from respiratory gated CT data. In all cases, 4D segmentation and tracking for five phases of high-resolution CT data took approximately 10 min on a PC workstation with AMD Phenom II and 32 GB of memory. The method was trained based on 500 breath-held 3D CT data from the LIDC data base and was tested on 17 4D lung nodule CT datasets consisting of 85 volumetric frames. The validation tests resulted in an average Dice Similarity Coefficient (DSC) = 0.68 for all test data. An important by-product of the method is quantitative volume measurement from 4D CT from end-inspiration to end-expiration which will also have important diagnostic value. The algorithm performs robust segmentation of lung nodules from 4D CT data. Signed distance ASM provides the shape prior information which based on the iterative graph-cuts framework is adaptively refined to best fit the input data, preventing unwanted surrounding tissue from merging with the segmented object. © 2017 American Association of Physicists in Medicine.

Correspondence model-based 4D VMAT dose simulation for analysis of local metastasis recurrence after extracranial SBRT

NASA Astrophysics Data System (ADS)

Sothmann, T.; Gauer, T.; Wilms, M.; Werner, R.

2017-12-01

The purpose of this study is to introduce a novel approach to incorporate patient-specific breathing variability information into 4D dose simulation of volumetric arc therapy (VMAT)-based stereotactic body radiotherapy (SBRT) of extracranial metastases. Feasibility of the approach is illustrated by application to treatment planning and motion data of lung and liver metastasis patients. The novel 4D dose simulation approach makes use of a regression-based correspondence model that allows representing patient motion variability by breathing signal-steered interpolation and extrapolation of deformable image registration motion fields. To predict the internal patient motion during treatment with only external breathing signal measurements being available, the patients’ internal motion information and external breathing signals acquired during 4D CT imaging were correlated. Combining the correspondence model, patient-specific breathing signal measurements during treatment and time-resolved information about dose delivery, reconstruction of a motion variability-affected dose becomes possible. As a proof of concept, the proposed approach is illustrated by a retrospective 4D simulation of VMAT-based SBRT treatment of ten patients with 15 treated lung and liver metastases and known clinical endpoints for the individual metastases (local metastasis recurrence yes/no). Resulting 4D-simulated dose distributions were compared to motion-affected dose distributions estimated by standard 4D CT-only dose accumulation and the originally (i.e. statically) planned dose distributions by means of GTV D98 indices (dose to 98% of the GTV volume). A potential linkage of metastasis-specific endpoints to differences between GTV D98 indices of planned and 4D-simulated dose distributions was analyzed.

SU-E-I-80: Quantification of Respiratory and Cardiac Motion Effect in SPECT Acquisitions Using Anthropomorphic Models: A Monte Carlo Simulation Study

DOE Office of Scientific and Technical Information (OSTI.GOV)

Papadimitroulas, P; Kostou, T; Kagadis, G

Purpose: The purpose of the present study was to quantify, evaluate the impact of cardiac and respiratory motion on clinical nuclear imaging protocols. Common SPECT and scintigraphic scans are studied using Monte Carlo (MC) simulations, comparing the resulted images with and without motion. Methods: Realistic simulations were executed using the GATE toolkit and the XCAT anthropomorphic phantom as a reference model for human anatomy. Three different radiopharmaceuticals based on 99mTc were studied, namely 99mTc-MDP, 99mTc—N—DBODC and 99mTc—DTPA-aerosol for bone, myocardium and lung scanning respectively. The resolution of the phantom was set to 3.5 mm{sup 3}. The impact of the motionmore » on spatial resolution was quantified using a sphere with 3.5 mm diameter and 10 separate time frames, in the ECAM modeled SPECT scanner. Finally, respiratory motion impact on resolution and imaging of lung lesions was investigated. The MLEM algorithm was used for data reconstruction, while the literature derived biodistributions of the pharmaceuticals were used as activity maps in the simulations. Results: FWHM was extracted for a static and a moving sphere which was ∼23 cm away from the entrance of the SPECT head. The difference in the FWHM was 20% between the two simulations. Profiles in thorax were compared in the case of bone scintigraphy, showing displacement and blurring of the bones when respiratory motion was inserted in the simulation. Large discrepancies were noticed in the case of myocardium imaging when cardiac motion was incorporated during the SPECT acquisition. Finally the borders of the lungs are blurred when respiratory motion is included resulting to a dislocation of ∼2.5 cm. Conclusion: As we move to individualized imaging and therapy procedures, quantitative and qualitative imaging is of high importance in nuclear diagnosis. MC simulations combined with anthropomorphic digital phantoms can provide an accurate tool for applications like motion correction techniques’ optimization. This research has been co-funded by the European Union (European Social Fund) and Greek national resources under the framework of the ‘Archimedes III: Funding of Research Groups in TEI of Athens’ project of the ‘Education & Lifelong Learning’ Operational Programme.« less

Tissue Feature-Based and Segmented Deformable Image Registration for Improved Modeling of the Shear Movement of the Lungs

PubMed Central

Xie, Yaoqin; Chao, Ming; Xing, Lei

2009-01-01

Purpose To report a tissue feature-based image registration strategy with explicit inclusion of the differential motions of thoracic structures. Methods and Materials The proposed technique started with auto-identification of a number of corresponding points with distinct tissue features. The tissue feature points were found by using the scale-invariant feature transform (SIFT) method. The control point pairs were then sorted into different “colors” according to the organs they reside and used to model the involved organs individually. A thin-plate spline (TPS) method was used to register a structure characterized by the control points with a given “color”. The proposed technique was applied to study a digital phantom case, three lung and three liver cancer patients. Results For the phantom case, a comparison with the conventional TPS method showed that the registration accuracy was markedly improved when the differential motions of the lung and chest wall were taken into account. On average, the registration error and the standard deviation (SD) of the 15 points against the known ground truth are reduced from 3.0 mm to 0.5 mm and from 1.5 mm to 0.2 mm, respectively, when the new method was used. Similar level of improvement was achieved for the clinical cases. Conclusions The segmented deformable approach provides a natural and logical solution to model the discontinuous organ motions and greatly improves the accuracy and robustness of deformable registration. PMID:19545792

Real-time soft tissue motion estimation for lung tumors during radiotherapy delivery.

PubMed

Rottmann, Joerg; Keall, Paul; Berbeco, Ross

2013-09-01

To provide real-time lung tumor motion estimation during radiotherapy treatment delivery without the need for implanted fiducial markers or additional imaging dose to the patient. 2D radiographs from the therapy beam's-eye-view (BEV) perspective are captured at a frame rate of 12.8 Hz with a frame grabber allowing direct RAM access to the image buffer. An in-house developed real-time soft tissue localization algorithm is utilized to calculate soft tissue displacement from these images in real-time. The system is tested with a Varian TX linear accelerator and an AS-1000 amorphous silicon electronic portal imaging device operating at a resolution of 512 × 384 pixels. The accuracy of the motion estimation is verified with a dynamic motion phantom. Clinical accuracy was tested on lung SBRT images acquired at 2 fps. Real-time lung tumor motion estimation from BEV images without fiducial markers is successfully demonstrated. For the phantom study, a mean tracking error <1.0 mm [root mean square (rms) error of 0.3 mm] was observed. The tracking rms accuracy on BEV images from a lung SBRT patient (≈20 mm tumor motion range) is 1.0 mm. The authors demonstrate for the first time real-time markerless lung tumor motion estimation from BEV images alone. The described system can operate at a frame rate of 12.8 Hz and does not require prior knowledge to establish traceable landmarks for tracking on the fly. The authors show that the geometric accuracy is similar to (or better than) previously published markerless algorithms not operating in real-time.

3D CFD Simulation of Plug Dynamics and Splitting through a Bifurcating Airway Model

NASA Astrophysics Data System (ADS)

Hoi, Cory; Raessi, Mehdi

2017-11-01

Respiratory distress syndrome (RDS) occurs because of pulmonary surfactant insufficiency in the lungs of preterm infants. The common medical procedure to treat RDS, called surfactant respiratory therapy (SRT), involves instilling liquid surfactant plugs into the pulmonary airways. SRT's effectiveness highly depends on the ability to deliver surfactant through the complex branching airway network. Experimental and computational efforts have been made to understand complex fluid dynamics of liquid plug motion through the lung airways in order to increase SRT's response rate. However, previous computational work used 2D airway model geometries and studied plug dynamics of a pre-split plug. In this work, we present CFD simulations of surfactant plug motion through a 3D bifurcating airway model. In our 3D y-tube geometry representing the lung airways, we are not limited by 2D or pre-split plug assumptions. The airway walls are covered with a pre-existing liquid film. Using a passive scalar marking the surfactant plug, the plug splitting and surfactant film deposition is studied under various airway orientations. Exploring the splitting process and liquid distribution in a 3D geometry will advance our understanding of surfactant delivery and will increase the effectiveness of SRT.

MO-G-18C-03: Evaluation of Deformable Image Registration for Lung Motion Estimation Using Hyperpolarized Gas Tagging MRI

DOE Office of Scientific and Technical Information (OSTI.GOV)

Huang, Q; Zhang, Y; Liu, Y

2014-06-15

Purpose: Hyperpolarized gas (HP) tagging MRI is a novel imaging technique for direct measurement of lung motion during breathing. This study aims to quantitatively evaluate the accuracy of deformable image registration (DIR) in lung motion estimation using HP tagging MRI as references. Methods: Three healthy subjects were imaged using the HP MR tagging, as well as a high-resolution 3D proton MR sequence (TrueFISP) at the end-of-inhalation (EOI) and the end-of-exhalation (EOE). Ground truth of lung motion and corresponding displacement vector field (tDVF) was derived from HP tagging MRI by manually tracking the displacement of tagging grids between EOI and EOE.more » Seven different DIR methods were applied to the high-resolution TrueFISP MR images (EOI and EOE) to generate the DIR-based DVFs (dDVF). The DIR methods include Velocity (VEL), MIM, Mirada, multi-grid B-spline from Elastix (MGB) and 3 other algorithms from DIRART toolbox (Double Force Demons (DFD), Improved Lucas-Kanade (ILK), and Iterative Optical Flow (IOF)). All registrations were performed by independent experts. Target registration error (TRE) was calculated as tDVF – dDVF. Analysis was performed for the entire lungs, and separately for the upper and lower lungs. Results: Significant differences between tDVF and dDVF were observed. Besides the DFD and IOF algorithms, all other dDVFs showed similarity in deformation magnitude distribution but away from the ground truth. The average TRE for entire lung ranged 2.5−23.7mm (mean=8.8mm), depending on the DIR method and subject's breathing amplitude. Larger TRE (13.3–23.7mm) was found in subject with larger breathing amplitude of 45.6mm. TRE was greater in lower lung (2.5−33.9 mm, mean=12.4mm) than that in upper lung (2.5−11.9 mm, mean=5.8mm). Conclusion: Significant differences were observed in lung motion estimation between the HP gas tagging MRI method and the DIR methods, especially when lung motion is large. Large variation among different DIR methods was also observed.« less

MO-E-BRB-03: Panel Member

DOE Office of Scientific and Technical Information (OSTI.GOV)

Salter, B.

2016-06-15

In this interactive session, lung SBRT patient cases will be presented to highlight real-world considerations for ensuring safe and accurate treatment delivery. An expert panel of speakers will discuss challenges specific to lung SBRT including patient selection, patient immobilization techniques, 4D CT simulation and respiratory motion management, target delineation for treatment planning, online treatment alignment, and established prescription regimens and OAR dose limits. Practical examples of cases, including the patient flow thought the clinical process are presented and audience participation will be encouraged. This panel session is designed to provide case demonstration and review for lung SBRT in terms ofmore » (1) clinical appropriateness in patient selection, (2) strategies for simulation, including 4D and respiratory motion management, and (3) applying multi imaging modality (4D CT imaging, MRI, PET) for tumor volume delineation and motion extent, and (4) image guidance in treatment delivery. Learning Objectives: Understand the established requirements for patient selection in lung SBRT Become familiar with the various immobilization strategies for lung SBRT, including technology for respiratory motion management Understand the benefits and pitfalls of applying multi imaging modality (4D CT imaging, MRI, PET) for tumor volume delineation and motion extent determination for lung SBRT Understand established prescription regimes and OAR dose limits.« less

MO-E-BRB-01: Panel Member

DOE Office of Scientific and Technical Information (OSTI.GOV)

Benedict, S.

2016-06-15

In this interactive session, lung SBRT patient cases will be presented to highlight real-world considerations for ensuring safe and accurate treatment delivery. An expert panel of speakers will discuss challenges specific to lung SBRT including patient selection, patient immobilization techniques, 4D CT simulation and respiratory motion management, target delineation for treatment planning, online treatment alignment, and established prescription regimens and OAR dose limits. Practical examples of cases, including the patient flow thought the clinical process are presented and audience participation will be encouraged. This panel session is designed to provide case demonstration and review for lung SBRT in terms ofmore » (1) clinical appropriateness in patient selection, (2) strategies for simulation, including 4D and respiratory motion management, and (3) applying multi imaging modality (4D CT imaging, MRI, PET) for tumor volume delineation and motion extent, and (4) image guidance in treatment delivery. Learning Objectives: Understand the established requirements for patient selection in lung SBRT Become familiar with the various immobilization strategies for lung SBRT, including technology for respiratory motion management Understand the benefits and pitfalls of applying multi imaging modality (4D CT imaging, MRI, PET) for tumor volume delineation and motion extent determination for lung SBRT Understand established prescription regimes and OAR dose limits.« less

[Simulation of lung motions using an artificial neural network].

PubMed

Laurent, R; Henriet, J; Salomon, M; Sauget, M; Nguyen, F; Gschwind, R; Makovicka, L

2011-04-01

A way to improve the accuracy of lung radiotherapy for a patient is to get a better understanding of its lung motion. Indeed, thanks to this knowledge it becomes possible to follow the displacements of the clinical target volume (CTV) induced by the lung breathing. This paper presents a feasibility study of an original method to simulate the positions of points in patient's lung at all breathing phases. This method, based on an artificial neural network, allowed learning the lung motion on real cases and then to simulate it for new patients for which only the beginning and the end breathing data are known. The neural network learning set is made up of more than 600 points. These points, shared out on three patients and gathered on a specific lung area, were plotted by a MD. The first results are promising: an average accuracy of 1mm is obtained for a spatial resolution of 1 × 1 × 2.5mm(3). We have demonstrated that it is possible to simulate lung motion with accuracy using an artificial neural network. As future work we plan to improve the accuracy of our method with the addition of new patient data and a coverage of the whole lungs. Copyright © 2010 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.

Joint correction of respiratory motion artifact and partial volume effect in lung/thoracic PET/CT imaging.

PubMed

Chang, Guoping; Chang, Tingting; Pan, Tinsu; Clark, John W; Mawlawi, Osama R

2010-12-01

Respiratory motion artifacts and partial volume effects (PVEs) are two degrading factors that affect the accuracy of image quantification in PET/CT imaging. In this article, the authors propose a joint motion and PVE correction approach (JMPC) to improve PET quantification by simultaneously correcting for respiratory motion artifacts and PVE in patients with lung/thoracic cancer. The objective of this article is to describe this approach and evaluate its performance using phantom and patient studies. The proposed joint correction approach incorporates a model of motion blurring, PVE, and object size/shape. A motion blurring kernel (MBK) is then estimated from the deconvolution of the joint model, while the activity concentration (AC) of the tumor is estimated from the normalization of the derived MBK. To evaluate the performance of this approach, two phantom studies and eight patient studies were performed. In the phantom studies, two motion waveforms-a linear sinusoidal and a circular motion-were used to control the motion of a sphere, while in the patient studies, all participants were instructed to breathe regularly. For the phantom studies, the resultant MBK was compared to the true MBK by measuring a correlation coefficient between the two kernels. The measured sphere AC derived from the proposed method was compared to the true AC as well as the ACs in images exhibiting PVE only and images exhibiting both PVE and motion blurring. For the patient studies, the resultant MBK was compared to the motion extent derived from a 4D-CT study, while the measured tumor AC was compared to the AC in images exhibiting both PVE and motion blurring. For the phantom studies, the estimated MBK approximated the true MBK with an average correlation coefficient of 0.91. The tumor ACs following the joint correction technique were similar to the true AC with an average difference of 2%. Furthermore, the tumor ACs on the PVE only images and images with both motion blur and PVE effects were, on average, 75% and 47.5% (10%) of the true AC, respectively, for the linear (circular) motion phantom study. For the patient studies, the maximum and mean AC/SUV on the PET images following the joint correction are, on average, increased by 125.9% and 371.6%, respectively, when compared to the PET images with both PVE and motion. The motion extents measured from the derived MBK and 4D-CT exhibited an average difference of 1.9 mm. The proposed joint correction approach can improve the accuracy of PET quantification by simultaneously compensating for the respiratory motion artifacts and PVE in lung/thoracic PET/CT imaging.

Equation Discovery for Model Identification in Respiratory Mechanics of the Mechanically Ventilated Human Lung

NASA Astrophysics Data System (ADS)

Ganzert, Steven; Guttmann, Josef; Steinmann, Daniel; Kramer, Stefan

Lung protective ventilation strategies reduce the risk of ventilator associated lung injury. To develop such strategies, knowledge about mechanical properties of the mechanically ventilated human lung is essential. This study was designed to develop an equation discovery system to identify mathematical models of the respiratory system in time-series data obtained from mechanically ventilated patients. Two techniques were combined: (i) the usage of declarative bias to reduce search space complexity and inherently providing the processing of background knowledge. (ii) A newly developed heuristic for traversing the hypothesis space with a greedy, randomized strategy analogical to the GSAT algorithm. In 96.8% of all runs the applied equation discovery system was capable to detect the well-established equation of motion model of the respiratory system in the provided data. We see the potential of this semi-automatic approach to detect more complex mathematical descriptions of the respiratory system from respiratory data.

CT fluoroscopy-guided robotically-assisted lung biopsy

NASA Astrophysics Data System (ADS)

Xu, Sheng; Fichtinger, Gabor; Taylor, Russell H.; Banovac, Filip; Cleary, Kevin

2006-03-01

Lung biopsy is a common interventional radiology procedure. One of the difficulties in performing the lung biopsy is that lesions move with respiration. This paper presents a new robotically assisted lung biopsy system for CT fluoroscopy that can automatically compensate for the respiratory motion during the intervention. The system consists of a needle placement robot to hold the needle on the CT scan plane, a radiolucent Z-frame for registration of the CT and robot coordinate systems, and a frame grabber to obtain the CT fluoroscopy image in real-time. The CT fluoroscopy images are used to noninvasively track the motion of a pulmonary lesion in real-time. The position of the lesion in the images is automatically determined by the image processing software and the motion of the robot is controlled to compensate for the lesion motion. The system was validated under CT fluoroscopy using a respiratory motion simulator. A swine study was also done to show the feasibility of the technique in a respiring animal.

Comparison of lung tumor motion measured using a model-based 4DCT technique and a commercial protocol.

PubMed

O'Connell, Dylan; Shaverdian, Narek; Kishan, Amar U; Thomas, David H; Dou, Tai H; Lewis, John H; Lamb, James M; Cao, Minsong; Tenn, Stephen; Percy, Lee P; Low, Daniel A

To compare lung tumor motion measured with a model-based technique to commercial 4-dimensional computed tomography (4DCT) scans and describe a workflow for using model-based 4DCT as a clinical simulation protocol. Twenty patients were imaged using a model-based technique and commercial 4DCT. Tumor motion was measured on each commercial 4DCT dataset and was calculated on model-based datasets for 3 breathing amplitude percentile intervals: 5th to 85th, 5th to 95th, and 0th to 100th. Internal target volumes (ITVs) were defined on the 4DCT and 5th to 85th interval datasets and compared using Dice similarity. Images were evaluated for noise and rated by 2 radiation oncologists for artifacts. Mean differences in tumor motion magnitude between commercial and model-based images were 0.47 ± 3.0, 1.63 ± 3.17, and 5.16 ± 4.90 mm for the 5th to 85th, 5th to 95th, and 0th to 100th amplitude intervals, respectively. Dice coefficients between ITVs defined on commercial and 5th to 85th model-based images had a mean value of 0.77 ± 0.09. Single standard deviation image noise was 11.6 ± 9.6 HU in the liver and 6.8 ± 4.7 HU in the aorta for the model-based images compared with 57.7 ± 30 and 33.7 ± 15.4 for commercial 4DCT. Mean model error within the ITV regions was 1.71 ± 0.81 mm. Model-based images exhibited reduced presence of artifacts at the tumor compared with commercial images. Tumor motion measured with the model-based technique using the 5th to 85th percentile breathing amplitude interval corresponded more closely to commercial 4DCT than the 5th to 95th or 0th to 100th intervals, which showed greater motion on average. The model-based technique tended to display increased tumor motion when breathing amplitude intervals wider than 5th to 85th were used because of the influence of unusually deep inhalations. These results suggest that care must be taken in selecting the appropriate interval during image generation when using model-based 4DCT methods. Copyright © 2017 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.

Real-time soft tissue motion estimation for lung tumors during radiotherapy delivery

PubMed Central

Rottmann, Joerg; Keall, Paul; Berbeco, Ross

2013-01-01

Purpose: To provide real-time lung tumor motion estimation during radiotherapy treatment delivery without the need for implanted fiducial markers or additional imaging dose to the patient. Methods: 2D radiographs from the therapy beam's-eye-view (BEV) perspective are captured at a frame rate of 12.8 Hz with a frame grabber allowing direct RAM access to the image buffer. An in-house developed real-time soft tissue localization algorithm is utilized to calculate soft tissue displacement from these images in real-time. The system is tested with a Varian TX linear accelerator and an AS-1000 amorphous silicon electronic portal imaging device operating at a resolution of 512 × 384 pixels. The accuracy of the motion estimation is verified with a dynamic motion phantom. Clinical accuracy was tested on lung SBRT images acquired at 2 fps. Results: Real-time lung tumor motion estimation from BEV images without fiducial markers is successfully demonstrated. For the phantom study, a mean tracking error <1.0 mm [root mean square (rms) error of 0.3 mm] was observed. The tracking rms accuracy on BEV images from a lung SBRT patient (≈20 mm tumor motion range) is 1.0 mm. Conclusions: The authors demonstrate for the first time real-time markerless lung tumor motion estimation from BEV images alone. The described system can operate at a frame rate of 12.8 Hz and does not require prior knowledge to establish traceable landmarks for tracking on the fly. The authors show that the geometric accuracy is similar to (or better than) previously published markerless algorithms not operating in real-time. PMID:24007146

SU-F-BRB-01: How Effective Is Abdominal Compression at Reducing Lung Motion? An Analysis Using Deformable Image Registration Within Different Sub-Regions of the Lung

DOE Office of Scientific and Technical Information (OSTI.GOV)

Paradiso, D; Pearce, A; Leszczynski, K

2015-06-15

Purpose: To investigate the effectiveness of employing abdominal compression (AC) in reducing motion for the target region and sub-regions of the lung as part of the planning process for radiation therapy. Methods: Fourteen patients with early lung cancer were scanned with 4DCT and it was determined that target motion exceeded our institutional limit of > 8 mm motion and received a repeat 4DCT with AC. For each 4DCT, deformable image registration (DIR) was used to map the max inhale to the max exhale phase to determine the deformation vector fields (DVF). DIR was performed with Morphons and Demons algorithms. Themore » mean DVF was used to represent that sub-region for each patient. The magnitudes of the mean DVF were quantified for the target and 12 sub-regions in the AP, LR SI directions. The sub-regions were contoured on each lung as (add prefix R or L for lung): Upper-Anterior (UA), Upper-Posterior (UP), Mid-Anterior (MA), Mid-Posterior (MP), Lower-Anterior (LA) and Lower-Posterior (LP). Results: The min/max SI motion for the target on the uncompressed 4DCT was 8mm/24.5 mm. The magnitude of decrease in SI was greatest in the RLP region (3.7±4.0mm) followed by target region (3.3±2.2mm) and finally the LLP region (3.0±3.5mm). The magnitude of decrease in 3D vector followed the same trend; RLP (3.5±2.2mm) then GTV (3.5±2.6mm) then LLP (2.7±3.8mm). 79% of the cases had a SI decrease of >12.5%, 43% had a SI decrease of >25% and 21% had a SI decrease of >50% as compared to the motion on the uncompressed 4DCT. Conclusion: AC is useful in reducing motion with the largest decreases observed in the lower posterior regions of the lungs. However, it should be noted that AC will not greatly decrease motion for all cases as 21% of cases did not reduce SI motion more than 12.5% of initial motion.« less

Positron emission tomography-based evidence of low-amplitude respiratory motion in patients with chronic obstructive pulmonary disease.

PubMed

Daouk, Joël; Bailly, Pascal; Kamimura, Mitsuhiro; Sacksick, David; Jounieaux, Vincent; Meyer, Marc-Etienne

2015-05-01

Chronic obstructive pulmonary disease (COPD) is characterized by low vital capacity and tidal volume, which translate into smaller respiratory motions. We sought to demonstrate the limited respiratory motion in COPD by comparing respiratory-gated and free-breathing positron emission tomography (PET) images of lung nodules ("CT-based" and "Ungated" images) in patients with and without COPD. We studied 74 lung lesions (37 malignant) in 60 patients (23 patients with COPD; 37 without). An Ungated PET examination was followed by a CT-based acquisition. Maximum standard uptake value (SUVmax) for each lesion on PET images was measured. On CT images, we checked for the presence of emphysema and pleural adhesions or indentations associated with the nodules. Lastly, we used univariate and then multivariate analyses to determine the lung function parameters possibly affecting respiratory motion in patients with and without COPD. The mean "CT-based" vs. "Ungated" difference in SUVmax was 0.3 and 0.6 for patients with and without COPD, respectively. Statistical analysis revealed that lesion site, hyperinflation and pleural indentation were independently associated with a difference in SUVmax. PET lung lesion images in patients with COPD are barely influenced by respiratory motion. Thoracic hyperinflation in patients with COPD was found to be independently associated with an effect of respiratory motion on PET images. Moreover, pleural indentation limits the respiratory motion of lung nodules, regardless of the presence or absence of COPD.

SU-F-J-119: Pilot Study On the Location-Based Lung Motion Assessment

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lee, TK; Ewald, A

2016-06-15

Purpose: In most of lung treatment cases with various radiotherapy beam modalities, 4DCT images are obtained in order to define ITV. ITV is defined with the signal from motion monitoring system, e.g. RPM. However, the signal is not consistent with tumor motion because it varies with location, its size, age, gender, etc. In the present study, the location-based motion assessment is presented. Methods: 4DCT images of 70 patients were reviewed: 28-left-lung and 42-right-lung patients; 36-female and 34-male patients; the age range of 51.2–89.9; tumor-size range of 0.75–9.50cm with 25% of these adherent to bony-anatomy. Philips Big-Bore Simulation CT and RPMmore » systems were used. The study was performed as follows. First, RPM signal and tumor motion in superior-inferior direction was compared. Second, the tumor size and its motion amplitude in all directions were measured at multiple locations. Third, the average tumor motion was calculated to assess general motion amplitudes at various locations. Results: RPM amplitude is not consistent with lung tumor motion amplitude. The tumors of similar sizes at similar location present various motion amplitude up to 1.1cm difference, but in average, the standard deviation was <0.5cm. Almost regardless of tumor sizes, the tumor motion was greatest at lower lobe location (>=1.0cm), and the smallest at upper lobe location and when adherent to bony-anatomy (<=0.5cm). Conclusion: The tumor size affects the motion amplitude less than does the tumor location. However, as the study results indicate that tumor motion has noticeable variation and so further study with more patient cases is needed. Also, for the same patient, the RPM signal presents instability of breathing, and clinically the patient with the instability of RPM breathing of <=10% is selected for respiratory-gated radiotherapy and ∼25% of patients under current study was treated. Patient-specific motion-uncertainty margins are considered to be added following further study.« less

Modeling respiratory motion for reducing motion artifacts in 4D CT images.

PubMed

Zhang, Yongbin; Yang, Jinzhong; Zhang, Lifei; Court, Laurence E; Balter, Peter A; Dong, Lei

2013-04-01

Four-dimensional computed tomography (4D CT) images have been recently adopted in radiation treatment planning for thoracic and abdominal cancers to explicitly define respiratory motion and anatomy deformation. However, significant image distortions (artifacts) exist in 4D CT images that may affect accurate tumor delineation and the shape representation of normal anatomy. In this study, the authors present a patient-specific respiratory motion model, based on principal component analysis (PCA) of motion vectors obtained from deformable image registration, with the main goal of reducing image artifacts caused by irregular motion during 4D CT acquisition. For a 4D CT image set of a specific patient, the authors calculated displacement vector fields relative to a reference phase, using an in-house deformable image registration method. The authors then used PCA to decompose each of the displacement vector fields into linear combinations of principal motion bases. The authors have demonstrated that the regular respiratory motion of a patient can be accurately represented by a subspace spanned by three principal motion bases and their projections. These projections were parameterized using a spline model to allow the reconstruction of the displacement vector fields at any given phase in a respiratory cycle. Finally, the displacement vector fields were used to deform the reference CT image to synthesize CT images at the selected phase with much reduced image artifacts. The authors evaluated the performance of the in-house deformable image registration method using benchmark datasets consisting of ten 4D CT sets annotated with 300 landmark pairs that were approved by physicians. The initial large discrepancies across the landmark pairs were significantly reduced after deformable registration, and the accuracy was similar to or better than that reported by state-of-the-art methods. The proposed motion model was quantitatively validated on 4D CT images of a phantom and a lung cancer patient by comparing the synthesized images and the original images at different phases. The synthesized images matched well with the original images. The motion model was used to reduce irregular motion artifacts in the 4D CT images of three lung cancer patients. Visual assessment indicated that the proposed approach could reduce severe image artifacts. The shape distortions around the diaphragm and tumor regions were mitigated in the synthesized 4D CT images. The authors have derived a mathematical model to represent the regular respiratory motion from a patient-specific 4D CT set and have demonstrated its application in reducing irregular motion artifacts in 4D CT images. The authors' approach can mitigate shape distortions of anatomy caused by irregular breathing motion during 4D CT acquisition.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Thomas, D; O’Connell, D; Lamb, J

Purpose: To demonstrate real-time dose calculation of free-breathing MRI guided Co−60 treatments, using a motion model and Monte-Carlo dose calculation to accurately account for the interplay between irregular breathing motion and an IMRT delivery. Methods: ViewRay Co-60 dose distributions were optimized on ITVs contoured from free-breathing CT images of lung cancer patients. Each treatment plan was separated into 0.25s segments, accounting for the MLC positions and beam angles at each time point. A voxel-specific motion model derived from multiple fast-helical free-breathing CTs and deformable registration was calculated for each patient. 3D images for every 0.25s of a simulated treatment weremore » generated in real time, here using a bellows signal as a surrogate to accurately account for breathing irregularities. Monte-Carlo dose calculation was performed every 0.25s of the treatment, with the number of histories in each calculation scaled to give an overall 1% statistical uncertainty. Each dose calculation was deformed back to the reference image using the motion model and accumulated. The static and real-time dose calculations were compared. Results: Image generation was performed in real time at 4 frames per second (GPU). Monte-Carlo dose calculation was performed at approximately 1frame per second (CPU), giving a total calculation time of approximately 30 minutes per treatment. Results show both cold- and hot-spots in and around the ITV, and increased dose to contralateral lung as the tumor moves in and out of the beam during treatment. Conclusion: An accurate motion model combined with a fast Monte-Carlo dose calculation allows almost real-time dose calculation of a free-breathing treatment. When combined with sagittal 2D-cine-mode MRI during treatment to update the motion model in real time, this will allow the true delivered dose of a treatment to be calculated, providing a useful tool for adaptive planning and assessing the effectiveness of gated treatments.« less

SU-E-J-235: Audiovisual Biofeedback Improves the Correlation Between Internal and External Respiratory Motion

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lee, D; Pollock, S; Keall, P

Purpose: External respiratory surrogates are often used to predict internal lung tumor motion for beam gating but the assumption of correlation between external and internal surrogates is not always verified resulting in amplitude mismatch and time shift. To test the hypothesis that audiovisual (AV) biofeedback improves the correlation between internal and external respiratory motion, in order to improve the accuracy of respiratory-gated treatments for lung cancer radiotherapy. Methods: In nine lung cancer patients, 2D coronal and sagittal cine-MR images were acquired across two MRI sessions (pre- and mid-treatment) with (1) free breathing (FB) and (2) AV biofeedback. External anterior-posterior (AP)more » respiratory motions of (a) chest and (b) abdomen were simultaneously acquired with physiological measurement unit (PMU, 3T Skyra, Siemens Healthcare Erlangen, Germany) and real-time position management (RPM) system (Varian, Palo Alto, USA), respectively. Internal superior-inferior (SI) respiratory motions of (c) lung tumor (i.e. centroid of auto-segmented lung tumor) and (d) diaphragm (i.e. upper liver dome) were measured from individual cine-MR images across 32 dataset. The four respiratory motions were then synchronized with the cine-MR image acquisition time. Correlation coefficients were calculated in the time variation of two nominated respiratory motions: (1) chest-abdomen, (2) abdomen-diaphragm and (3) diaphragm-lung tumor. The three combinations were compared between FB and AV biofeedback. Results: Compared to FB, AV biofeedback improved chest-abdomen correlation by 17% (p=0.005) from 0.75±0.23 to 0.90±0.05 and abdomen-diaphragm correlation by 4% (p=0.058) from 0.91±0.11 to 0.95±0.05. Compared to FB, AV biofeedback improved diaphragm-lung tumor correlation by 12% (p=0.023) from 0.65±0.21 to 0.74±0.16. Conclusions: Our results demonstrated that AV biofeedback significantly improved the correlation of internal and external respiratory motion, thus suggesting the need of AV biofeedback in respiratory-gated treatments.« less

Comparison of spirometry and abdominal height as four-dimensional computed tomography metrics in lung

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lu Wei; Low, Daniel A.; Parikh, Parag J.

2005-07-15

An important consideration in four-dimensional CT scanning is the selection of a breathing metric for sorting the CT data and modeling internal motion. This study compared two noninvasive breathing metrics, spirometry and abdominal height, against internal air content, used as a surrogate for internal motion. Both metrics were shown to be accurate, but the spirometry showed a stronger and more reproducible relationship than the abdominal height in the lung. The abdominal height was known to be affected by sensor placement and patient positioning while the spirometer exhibited signal drift. By combining these two, a normalization of the drift-free metric tomore » tidal volume may be generated and the overall metric precision may be improved.« less

Toward efficient biomechanical-based deformable image registration of lungs for image-guided radiotherapy

NASA Astrophysics Data System (ADS)

Al-Mayah, Adil; Moseley, Joanne; Velec, Mike; Brock, Kristy

2011-08-01

Both accuracy and efficiency are critical for the implementation of biomechanical model-based deformable registration in clinical practice. The focus of this investigation is to evaluate the potential of improving the efficiency of the deformable image registration of the human lungs without loss of accuracy. Three-dimensional finite element models have been developed using image data of 14 lung cancer patients. Each model consists of two lungs, tumor and external body. Sliding of the lungs inside the chest cavity is modeled using a frictionless surface-based contact model. The effect of the type of element, finite deformation and elasticity on the accuracy and computing time is investigated. Linear and quadrilateral tetrahedral elements are used with linear and nonlinear geometric analysis. Two types of material properties are applied namely: elastic and hyperelastic. The accuracy of each of the four models is examined using a number of anatomical landmarks representing the vessels bifurcation points distributed across the lungs. The registration error is not significantly affected by the element type or linearity of analysis, with an average vector error of around 2.8 mm. The displacement differences between linear and nonlinear analysis methods are calculated for all lungs nodes and a maximum value of 3.6 mm is found in one of the nodes near the entrance of the bronchial tree into the lungs. The 95 percentile of displacement difference ranges between 0.4 and 0.8 mm. However, the time required for the analysis is reduced from 95 min in the quadratic elements nonlinear geometry model to 3.4 min in the linear element linear geometry model. Therefore using linear tetrahedral elements with linear elastic materials and linear geometry is preferable for modeling the breathing motion of lungs for image-guided radiotherapy applications.

Experimental validation of the van Herk margin formula for lung radiation therapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ecclestone, Gillian; Heath, Emily; Bissonnette, Jean-Pierre

2013-11-15

Purpose: To validate the van Herk margin formula for lung radiation therapy using realistic dose calculation algorithms and respiratory motion modeling. The robustness of the margin formula against variations in lesion size, peak-to-peak motion amplitude, tissue density, treatment technique, and plan conformity was assessed, along with the margin formula assumption of a homogeneous dose distribution with perfect plan conformity.Methods: 3DCRT and IMRT lung treatment plans were generated within the ORBIT treatment planning platform (RaySearch Laboratories, Sweden) on 4DCT datasets of virtual phantoms. Random and systematic respiratory motion induced errors were simulated using deformable registration and dose accumulation tools available withinmore » ORBIT for simulated cases of varying lesion sizes, peak-to-peak motion amplitudes, tissue densities, and plan conformities. A detailed comparison between the margin formula dose profile model, the planned dose profiles, and penumbra widths was also conducted to test the assumptions of the margin formula. Finally, a correction to account for imperfect plan conformity was tested as well as a novel application of the margin formula that accounts for the patient-specific motion trajectory.Results: The van Herk margin formula ensured full clinical target volume coverage for all 3DCRT and IMRT plans of all conformities with the exception of small lesions in soft tissue. No dosimetric trends with respect to plan technique or lesion size were observed for the systematic and random error simulations. However, accumulated plans showed that plan conformity decreased with increasing tumor motion amplitude. When comparing dose profiles assumed in the margin formula model to the treatment plans, discrepancies in the low dose regions were observed for the random and systematic error simulations. However, the margin formula respected, in all experiments, the 95% dose coverage required for planning target volume (PTV) margin derivation, as defined by the ICRU; thus, suitable PTV margins were estimated. The penumbra widths calculated in lung tissue for each plan were found to be very similar to the 6.4 mm value assumed by the margin formula model. The plan conformity correction yielded inconsistent results which were largely affected by image and dose grid resolution while the trajectory modified PTV plans yielded a dosimetric benefit over the standard internal target volumes approach with up to a 5% decrease in the V20 value.Conclusions: The margin formula showed to be robust against variations in tumor size and motion, treatment technique, plan conformity, as well as low tissue density. This was validated by maintaining coverage of all of the derived PTVs by 95% dose level, as required by the formal definition of the PTV. However, the assumption of perfect plan conformity in the margin formula derivation yields conservative margin estimation. Future modifications to the margin formula will require a correction for plan conformity. Plan conformity can also be improved by using the proposed trajectory modified PTV planning approach. This proves especially beneficial for tumors with a large anterior–posterior component of respiratory motion.« less

How does knee pain affect trunk and knee motion during badminton forehand lunges?

PubMed

Huang, Ming-Tung; Lee, Hsing-Hsan; Lin, Cheng-Feng; Tsai, Yi-Ju; Liao, Jen-Chieh

2014-01-01

Badminton requires extensive lower extremity movement and a precise coordination of the upper extremity and trunk movements. Accordingly, this study investigated motions of the trunk and the knee, control of dynamic stability and muscle activation patterns of individuals with and without knee pain. Seventeen participants with chronic knee pain and 17 healthy participants participated in the study and performed forehand forward and backward diagonal lunges. This study showed that those with knee pain exhibited smaller knee motions in frontal and horizontal planes during forward lunge but greater knee motions in sagittal plane during backward lunge. By contrast, in both tasks, the injured group showed a smaller value on the activation level of the paraspinal muscles in pre-impact phase, hip-shoulder separation angle, trunk forward inclination range and peak centre of mass (COM) velocity. Badminton players with knee pain adopt a more conservative movement pattern of the knee to minimise recurrence of knee pain. The healthy group exhibit better weight-shifting ability due to a greater control of the trunk and knee muscles. Training programmes for badminton players with knee pain should be designed to improve both the neuromuscular control and muscle strength of the core muscles and the knee extensor with focus on the backward lunge motion.

Evaluation of a pulmonary strain model by registration of dynamic CT scans

NASA Astrophysics Data System (ADS)

Pomeroy, Marc; Liang, Zhengrong; Brehm, Anthony

2017-03-01

Idiopathic pulmonary fibrosis (IPF) is a chronic fibrotic lung disease that develops in adults without any known cause. It is an interstitial lung disease in which the lung tissue becomes scarred and stiffens, ultimately leading to respiratory failure. This disease currently has no cure with limited treatment options, leading to an average survival time of 3-5 years after diagnosis. In this paper we employ a mathematical model simulating the lung parenchyma as hexagons with elastic forces applied to connecting vertices and opposing vertices. Using an image registration algorithm, we obtain trajectories of 4D-CT scans of a healthy patient, and one suffering from IPF. Converting the image trajectories into a hexagonal lattice, we fit the model parameters to match the respiratory motion seen for both patients across multiple image slices. We found the model could decently describe the healthy lung slices, with a minimum average error between corresponding vertices to be 1.66 mm. For the fibrotic lung slices the model was less accurate, maintaining a higher average error across all slices. Using the optimized parameters, we apply the forces predicted from the model using the image trajectory positions for each phase. Although the error is large, the spring constant values determined for the fibrotic patient were not as high as we expected, and more often than not determined to be lower than corresponding healthy lung slices. However, the net force distribution for some of those slices was still found to be greater than the healthy lung counterparts. Other modifications to the model, including additional directional components and which vertices were receiving with the limited sample size available, a clear distinction between the healthy and fibrotic lung cannot yet be made by this model.

Use of MV and kV imager correlation for maintaining continuous real-time 3D internal marker tracking during beam interruptions

NASA Astrophysics Data System (ADS)

Wiersma, R. D.; Riaz, N.; Dieterich, Sonja; Suh, Yelin; Xing, L.

2009-01-01

The integration of onboard kV imaging together with a MV electronic portal imaging device (EPID) on linear accelerators (LINAC) can provide an easy to implement real-time 3D organ position monitoring solution for treatment delivery. Currently, real-time MV-kV tracking has only been demonstrated by simultaneous imagining by both MV and kV imaging devices. However, modalities such as step-and-shoot IMRT (SS-IMRT), which inherently contain MV beam interruptions, can lead to loss of target information necessary for 3D localization. Additionally, continuous kV imaging throughout the treatment delivery can lead to high levels of imaging dose to the patient. This work demonstrates for the first time how full 3D target tracking can be maintained even in the presence of such beam interruption, or MV/kV beam interleave, by use of a relatively simple correlation model together with MV-kV tracking. A moving correlation model was constructed using both present and prior positions of the marker in the available MV or kV image to compute the position of the marker on the interrupted imager. A commercially available radiotherapy system, equipped with both MV and kV imaging devices, was used to deliver typical SS-IMRT lung treatment plans to a 4D phantom containing internally embedded metallic markers. To simulate actual lung tumor motion, previous recorded 4D lung patient motion data were used. Lung tumor motion data of five separate patients were inputted into the 4D phantom, and typical SS-IMRT lung plans were delivered to simulate actual clinical deliveries. Application of the correlation model to SS-IMRT lung treatment deliveries was found to be an effective solution for maintaining continuous 3D tracking during 'step' beam interruptions. For deliveries involving five or more gantry angles with 50 or more fields per plan, the positional errors were found to have <=1 mm root mean squared error (RMSE) in all three spatial directions. In addition to increasing the robustness of MV-kV tracking against beam interruption, it was also found that use of correlation can be an effective way of lowering kV dose to the patient and for increasing kV image quality by reduction of MV scatter interference.

[4D-CT-based plan target volume (PTV) definition compared with conventional PTV definition using general margin in radiotherapy for lung cancer].

PubMed

Ju, Xiao; Li, Minghui; Zhou, Zongmei; Zhang, Ke; Han, Wei; Fu, Guishan; Cao, Ying; Wang, Lyuhua

2014-01-01

To investigate the dosimetric benefit of 4D-CT in the planning target volume (PTV) definition process compared with conventional PTV definition using general margin in radiotherapy of lung cancer. A set of 4D-CT images and multiphase helical CT scans were obtained in 10 patients with lung cancer. The radiotherapeutic plans based on PTV determined by 4D-CT and in addition of general margin were performed, respectively. The 3D motion of the centroid of GTV and the 3D spatial motion vectors were calculated. The differences of the two kinds of PTVs, mean lung dose (MLD), V5,V10,V15,V20 of total lung, mean heart dose (MHD), V30 and V40 of heart, D99 and D95 were compared, and the correlation between them and the 3D spatial motion vector was analyzed. The PTV4D in eight patients were smaller than PTVconv, with a mean reduction of (13.0 ± 8.0)% (P = 0.018). In other two patients, whose respiration motion was great, PTV4D was larger than PTVconv. The mean 3D spatial motion vector of GTV centroid was (0.78 ± 0.72)cm. By using 4D-CT, the mean reduction of MLD was (8.6 ± 9.9)% (P = 0.037). V5, V10, V15, V20 of total lung were decreased averagely by (7.2 ± 10.5)%, (5.5 ± 8.9)%, (6.5 ± 8.4)% and (5.7 ± 7.4)%, respectively (P < 0.05 for all). There was a significant positive correlation between PTV4D/PTVconv and the 3D spatial motion vector of the GTV centroid (P = 0.008). A significant inverse correlation was found between D994D/D99conv and the 3D spatial motion vector of the GTV centroid (P = 0.002). D994D/D99conv, (MLDconv-MLD4D) /MLDconv, total lung (V5conv-V54D)/V5conv, total lung (V10conv-V104D)/V10conv, (MHDconv-MHD4D)/MHDconv, heart (V30conv-V304D)/V30conv were inversely correlated with PTV4D/PTVconv (P < 0.05 for all). 4D-CT can be used to evaluate the respiration motion of lung tumor accurately. The 4D-CT-based PTV definition and radiotherapeutic planing can reduce the volume of PTV in patients with small respiration motion, increase the intra-target dose, and decrease the dose of normal tissue sequentially. For patients with large respiration motion, especially those more than 1.5-2 cm, this method can avoid target miss, meanwhile, not increase the dose of normal tissue significantly.

Performance assessment of a programmable five degrees-of-freedom motion platform for quality assurance of motion management techniques in radiotherapy.

PubMed

Huang, Chen-Yu; Keall, Paul; Rice, Adam; Colvill, Emma; Ng, Jin Aun; Booth, Jeremy T

2017-09-01

Inter-fraction and intra-fraction motion management methods are increasingly applied clinically and require the development of advanced motion platforms to facilitate testing and quality assurance program development. The aim of this study was to assess the performance of a 5 degrees-of-freedom (DoF) programmable motion platform HexaMotion (ScandiDos, Uppsala, Sweden) towards clinically observed tumor motion range, velocity, acceleration and the accuracy requirements of SABR prescribed in AAPM Task Group 142. Performance specifications for the motion platform were derived from literature regarding the motion characteristics of prostate and lung tumor targets required for real time motion management. The performance of the programmable motion platform was evaluated against (1) maximum range, velocity and acceleration (5 DoF), (2) static position accuracy (5 DoF) and (3) dynamic position accuracy using patient-derived prostate and lung tumor motion traces (3 DoF). Translational motion accuracy was compared against electromagnetic transponder measurements. Rotation was benchmarked with a digital inclinometer. The static accuracy and reproducibility for translation and rotation was <0.1 mm or <0.1°, respectively. The accuracy of reproducing dynamic patient motion was <0.3 mm. The motion platform's range met the need to reproduce clinically relevant translation and rotation ranges and its accuracy met the TG 142 requirements for SABR. The range, velocity and acceleration of the motion platform are sufficient to reproduce lung and prostate tumor motion for motion management. Programmable motion platforms are valuable tools in the investigation, quality assurance and commissioning of motion management systems in radiation oncology.

Kinematic determinants of weapon velocity during the fencing lunge in experienced épée fencers.

PubMed

Bottoms, Lindsay; Greenhalgh, Andrew; Sinclair, Jonathan

2013-01-01

The lunge is the most common attack in fencing, however there is currently a paucity of published research investigating the kinematics of this movement. The aim of this study was to investigate if kinematics measured during the épée fencing lunge had a significant effect on sword velocity at touch and whether there were any key movement tactics that produced the maximum velocity. Lower extremity kinematic data were obtained from fourteen right handed club épée fencers using a 3D motion capture system as they completed simulated lunges. A forward stepwise multiple linear regression was performed on the data. The overall regression model yielded an Adj R2 of 0.74, p ≤ 0.01. The results show that the rear lower extremity's knee range of motion, peak hip flexion and the fore lower extremity's peak hip flexion all in the sagittal plane were significant predictors of sword velocity. The results indicate that flexion of the rear extremity's knee is an important predictor, suggesting that the fencer sits low in their stance to produce power during the lunge. Furthermore it would appear that the magnitude of peak flexion of the fore extremity's hip was a significant indicator of sword velocity suggesting movement of fore limbs should also be considered in lunge performance.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cifter, G; Redler, G; Lee, C

Purpose: Compared to traditional radiotherapy techniques, stereotactic body radiation therapy (SBRT) provides more favorable outcomes during the treatment of certain lung tumors. Despite advancements in image guidance, accurate target localization still remains a challenge. In this work, we expand our knowledge of a novel scatter imaging modality in order to develop a real-time tumor localization method using scattered photons from the patient during treatment. Methods: Images of the QUASAR™ Respiratory Motion Phantom were taken by irradiating it on a Varian TrueBeam accelerator. The scattered radiation was detected using a flat panel-based pinhole camera detection system. Two motion settings were investigated:more » static and dynamic. In the former, the lung tumor was manually shifted between imaging. In the latter, the lung tumor was set to move at a certain frequency and amplitude while the images were acquired continuously for one minute. The accuracy of tumor localization and the irradiation time required to distinguish the lung tumor were studied. Results: The comparison of measured and expected location of the lung tumor during static motion was shown to be under standard deviation (STD) of 0.064 with a mean STD of 0.031cm. The dynamic motion was taken at a rate of 1400 MU/min for one minute and the measured location of the lung tumor was then compared with the QUASAR phantom’s sinusoidal motion pattern and the agreement found to be at an average STD of 0.275cm. The location of the lung tumor was investigated using aggregate images consisting of 1 or 2 frames/image and the change was below STD of 0.30cm. The lung tumor also appeared to be blurrier in images consisting of two frames. Conclusion: Based on our preliminary results real-time image guidance using the scatter imaging modality to localize and track tumors during lung SBRT has the potential to become clinical reality.« less

SU-D-17A-02: Four-Dimensional CBCT Using Conventional CBCT Dataset and Iterative Subtraction Algorithm of a Lung Patient

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hu, E; Lasio, G; Yi, B

2014-06-01

Purpose: The Iterative Subtraction Algorithm (ISA) method generates retrospectively a pre-selected motion phase cone-beam CT image from the full motion cone-beam CT acquired at standard rotation speed. This work evaluates ISA method with real lung patient data. Methods: The goal of the ISA algorithm is to extract motion and no- motion components form the full reconstruction CBCT. The workflow consists of subtracting from the full CBCT all of the undesired motion phases and obtain a motion de-blurred single-phase CBCT image, followed by iteration of this subtraction process. ISA is realized as follows: 1) The projections are sorted to various phases,more » and from all phases, a full reconstruction is performed to generate an image CTM. 2) Generate forward projections of CTM at the desired phase projection angles, the subtraction of projection and the forward projection will reconstruct a CTSub1, which diminishes the desired phase component. 3) By adding back the CTSub1 to CTm, no motion CBCT, CTS1, can be computed. 4) CTS1 still contains residual motion component. 5) This residual motion component can be further reduced by iteration.The ISA 4DCBCT technique was implemented using Varian Trilogy accelerator OBI system. To evaluate the method, a lung patient CBCT dataset was used. The reconstruction algorithm is FDK. Results: The single phase CBCT reconstruction generated via ISA successfully isolates the desired motion phase from the full motion CBCT, effectively reducing motion blur. It also shows improved image quality, with reduced streak artifacts with respect to the reconstructions from unprocessed phase-sorted projections only. Conclusion: A CBCT motion de-blurring algorithm, ISA, has been developed and evaluated with lung patient data. The algorithm allows improved visualization of a single phase motion extracted from a standard CBCT dataset. This study has been supported by National Institute of Health through R01CA133539.« less

Four-dimensional multislice computed tomography for determination of respiratory lung tumor motion in conformal radiotherapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Leter, Edward M.; Cademartiri, Filippo; Levendag, Peter C.

2005-07-01

Purpose: We used four-dimensional multislice spiral computed tomography (MSCT) to determine respiratory lung-tumor motion and compared this strategy to common clinical practice in conformal radiotherapy treatment-planning imaging. Methods and Materials: The entire lung volume of 10 consecutive patients with 14 lung metastases were scanned by a 16-slice MSCT. During the scans, patients were instructed to breathe through a spirometer that was connected to a laptop computer. For each patient, 10 stacks of 1.5-mm slices, equally distributed throughout the respiratory cycle, were reconstructed from the acquired MSCT data. The lung tumors were manually contoured in each data set. For each patient,more » the tumor-volume contours of all data sets were copied to 1 data set, which allowed determination of the volume that encompassed all 10 lung-tumor positions (i.e., the tumor-traversed volume [TTV]) during the respiratory cycle. The TTV was compared with the 10 tumor volumes contoured for each patient, to which an empiric respiratory-motion margin was added. The latter target volumes were designated internal-motion included tumor volume (IMITV). Results: The TTV measurements were significantly smaller than the reference IMITV measurements (5.2 {+-} 10.2 cm{sup 3} and 10.1 {+-} 13.7 cm{sup 3}, respectively). All 10 IMITVs for 2 of the 4 tumors in 1 subject completely encompassed the TTV. All 10 IMITVs for 3 tumors in 2 patients did not show overlap with up to 35% of the corresponding TTV. The 10 IMITVs for the remaining tumors either completely encompassed the corresponding TTV or did not show overlap with up to 26% of the corresponding TTV. Conclusions: We found that individualized determination of respiratory lung-tumor motion by four-dimensional respiratory-gated MSCT represents a better and simple strategy to incorporate periodic physiologic motion compared with a generalized approach. The former strategy can, therefore, improve common and state-of-the-art clinical practice in conformal radiotherapy.« less

SU-E-J-31: Monitor Interfractional Variation of Tumor Respiratory Motion Using 4D KV Conebeam Computed Tomography for Stereotactic Body Radiation Therapy of Lung Cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Tai, A; Prior, P; Gore, E

Purpose: 4DCT has been widely used to generate internal tumor volume (ITV) for a lung tumor for treatment planning. However, lung tumors may show different respiratory motion on the treatment day. The purpose of this study is to evaluate 4D KV conebeam computed tomography (CBCT) for monitoring tumor interfractional motion variation between simulation and each fraction of stereotactic body radiation therapy (SBRT) for lung cancer. Methods: 4D KV CBCT was acquired with the Elekta XVI system. The accuracy of 4D KV CBCT for image-guided radiation therapy (IGRT) was tested with a dynamic thorax motion phantom (CIRS, Virginia) with a linearmore » amplitude of 2 cm. In addition, an adult anthropomorphic phantom (Alderson, Rando) with optically stimulated luminescence (OSL) dosimeters embedded at the center and periphery of a slab of solid water was used to measure the dose of 4D KV CBCT and to compare it with the dose with 3D KV CBCT. The image registration was performed by aligning\\ each phase images of 4D KV CBCT to the planning images and the final couch shifts were calculated as a mean of all these individual shifts along each direction.A workflow was established based on these quality assurance tests for lung cancer patients. Results: 4D KV CBCT does not increase imaging dose in comparison to 3D KV CBCT. Acquisition of 4D KV CBCT is 4 minutes as compared to 2 minutes for 3D KV CBCT. Most of patients showed a small daily variation of tumor respiratory motion about 2 mm. However, some patients may have more than 5 mm variations of tumor respiratory motion. Conclusion: The radiation dose does not increase with 4D KV CBCT. 4D KV CBCT is a useful tool for monitoring interfractional variations of tumor respiratory motion before SBRT of lung cancer patients.« less

SU-C-BRF-05: Design and Geometric Validation of An Externally and Internally Deformable, Programmable Lung Motion Phantom

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cheung, Y; Sawant, A

Purpose: Most clinically-deployed strategies for respiratory motion management in lung radiotherapy (e.g., gating, tracking) use external markers that serve as surrogates for tumor motion. However, typical lung phantoms used to validate these strategies are rigid-exterior+rigid-interior or rigid-exterior+deformable-interior. Neither class adequately represents the human anatomy, which is deformable internally as well as externally. We describe the construction and experimental validation of a more realistic, externally- and internally-deformable, programmable lung phantom. Methods: The outer shell of a commercially-available lung phantom (RS- 1500, RSD Inc.) was used. The shell consists of a chest cavity with a flexible anterior surface, and embedded vertebrae, rib-cagemore » and sternum. A 3-axis platform was programmed with sinusoidal and six patient-recorded lung tumor trajectories. The platform was used to drive a rigid foam ‘diaphragm’ that compressed/decompressed the phantom interior. Experimental characterization comprised of mapping the superior-inferior (SI) and anterior-posterior (AP) trajectories of external and internal radioopaque markers with kV x-ray fluoroscopy and correlating these with optical surface monitoring using the in-room VisionRT system. Results: The phantom correctly reproduced the programmed motion as well as realistic effects such as hysteresis. The reproducibility of marker trajectories over multiple runs for sinusoidal as well as patient traces, as characterized by fluoroscopy, was within 0.4 mm RMS error for internal as well as external markers. The motion trajectories of internal and external markers as measured by fluoroscopy were found to be highly correlated (R=0.97). Furthermore, motion trajectories of arbitrary points on the deforming phantom surface, as recorded by the VisionRT system also showed a high correlation with respect to the fluoroscopically-measured trajectories of internal markers (R=0.92). Conclusion: We have developed a realistic externally- and internally-deformable lung phantom that will serve as a valuable tool for clinical QA and motion management research. This work was supported through funding from the NIH and VisionRT Ltd. Amit Sawant has research funding from Varian Medical Systems, VisionRT and Elekta.« less

An externally and internally deformable, programmable lung motion phantom

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cheung, Yam; Sawant, Amit, E-mail: amit.sawant@utsouthwestern.edu

Purpose: Most clinically deployed strategies for respiratory motion management in lung radiotherapy (e.g., gating and tracking) use external markers that serve as surrogates for tumor motion. However, typical lung phantoms used to validate these strategies are based on a rigid exterior and a rigid or a deformable-interior. Such designs do not adequately represent respiration because the thoracic anatomy deforms internally as well as externally. In order to create a closer approximation of respiratory motion, the authors describe the construction and experimental testing of an externally as well as internally deformable, programmable lung phantom. Methods: The outer shell of a commerciallymore » available lung phantom (RS-1500, RSD, Inc.) was used. The shell consists of a chest cavity with a flexible anterior surface, and embedded vertebrae, rib-cage and sternum. A custom-made insert was designed using a piece of natural latex foam block. A motion platform was programmed with sinusoidal and ten patient-recorded lung tumor trajectories. The platform was used to drive a rigid foam “diaphragm” that compressed/decompressed the phantom interior. Experimental characterization comprised of determining the reproducibility and the external–internal correlation of external and internal marker trajectories extracted from kV x-ray fluoroscopy. Experiments were conducted to illustrate three example applications of the phantom—(i) validating the geometric accuracy of the VisionRT surface photogrammetry system; (ii) validating an image registration tool, NiftyReg; and (iii) quantifying the geometric error due to irregular motion in four-dimensional computed tomography (4DCT). Results: The phantom correctly reproduced sinusoidal and patient-derived motion, as well as realistic respiratory motion-related effects such as hysteresis. The reproducibility of marker trajectories over multiple runs for sinusoidal as well as patient traces, as characterized by fluoroscopy, was within 0.25 mm RMS error. The motion trajectories of internal and external radio-opaque markers as measured by fluoroscopy were found to be highly correlated (R > 0.95). Using the phantom, it was demonstrated that the motion trajectories of regions-of-interest on the surface as measured by VisionRT are highly consistent with corresponding fluoroscopically acquired surface marker trajectories, with RMS errors within 0.26 mm. Furthermore, it was shown that the trajectories of external and internal marker trajectories derived from NiftyReg deformation vector fields were within 1 mm root mean square errors comparing to trajectories obtained by segmenting markers from individual fluoro frames. Finally, it was shown that while 4DCT can be used to localize internal markers for sinusoidal motion with reasonable accuracy, the localization error increases significantly (by a factor of ∼2) in the presence of cycle-to-cycle variations that are observed in patient-derived respiratory motion. Conclusions: The authors have developed a realistic externally and internally deformable, programmable lung phantom that will serve as a valuable tool for clinical and investigational motion management studies in thoracic and abdominal radiation therapies.« less

Estimating 4D CBCT from prior information and extremely limited angle projections using structural PCA and weighted free-form deformation for lung radiotherapy

PubMed Central

Harris, Wendy; Zhang, You; Yin, Fang-Fang; Ren, Lei

2017-01-01

Purpose To investigate the feasibility of using structural-based principal component analysis (PCA) motion-modeling and weighted free-form deformation to estimate on-board 4D-CBCT using prior information and extremely limited angle projections for potential 4D target verification of lung radiotherapy. Methods A technique for lung 4D-CBCT reconstruction has been previously developed using a deformation field map (DFM)-based strategy. In the previous method, each phase of the 4D-CBCT was generated by deforming a prior CT volume. The DFM was solved by a motion-model extracted by global PCA and free-form deformation (GMM-FD) technique, using a data fidelity constraint and deformation energy minimization. In this study, a new structural-PCA method was developed to build a structural motion-model (SMM) by accounting for potential relative motion pattern changes between different anatomical structures from simulation to treatment. The motion model extracted from planning 4DCT was divided into two structures: tumor and body excluding tumor, and the parameters of both structures were optimized together. Weighted free-form deformation (WFD) was employed afterwards to introduce flexibility in adjusting the weightings of different structures in the data fidelity constraint based on clinical interests. XCAT (computerized patient model) simulation with a 30 mm diameter lesion was simulated with various anatomical and respirational changes from planning 4D-CT to onboard volume to evaluate the method. The estimation accuracy was evaluated by the Volume-Percent-Difference (VPD)/Center-of-Mass-Shift (COMS) between lesions in the estimated and “ground-truth” on board 4D-CBCT. Different onboard projection acquisition scenarios and projection noise levels were simulated to investigate their effects on the estimation accuracy. The method was also evaluated against 3 lung patients. Results The SMM-WFD method achieved substantially better accuracy than the GMM-FD method for CBCT estimation using extremely small scan angles or projections. Using orthogonal 15° scanning angles, the VPD/COMS were 3.47±2.94% and 0.23±0.22mm for SMM-WFD and 25.23±19.01% and 2.58±2.54mm for GMM-FD among all 8 XCAT scenarios. Compared to GMM-FD, SMM-WFD was more robust against reduction of the scanning angles down to orthogonal 10° with VPD/COMS of 6.21±5.61% and 0.39±0.49mm, and more robust against reduction of projection numbers down to only 8 projections in total for both orthogonal-view 30° and orthogonal-view 15° scan angles. SMM-WFD method was also more robust than the GMM-FD method against increasing levels of noise in the projection images. Additionally, the SMM-WFD technique provided better tumor estimation for all three lung patients compared to the GMM-FD technique. Conclusion Compared to the GMM-FD technique, the SMM-WFD technique can substantially improve the 4D-CBCT estimation accuracy using extremely small scan angles and low number of projections to provide fast low dose 4D target verification. PMID:28079267

The Impact of Optimal Respiratory Gating and Image Noise on Evaluation of Intratumor Heterogeneity on 18F-FDG PET Imaging of Lung Cancer.

PubMed

Grootjans, Willem; Tixier, Florent; van der Vos, Charlotte S; Vriens, Dennis; Le Rest, Catherine C; Bussink, Johan; Oyen, Wim J G; de Geus-Oei, Lioe-Fee; Visvikis, Dimitris; Visser, Eric P

2016-11-01

Accurate measurement of intratumor heterogeneity using parameters of texture on PET images is essential for precise characterization of cancer lesions. In this study, we investigated the influence of respiratory motion and varying noise levels on quantification of textural parameters in patients with lung cancer. We used an optimal-respiratory-gating algorithm on the list-mode data of 60 lung cancer patients who underwent 18 F-FDG PET. The images were reconstructed using a duty cycle of 35% (percentage of the total acquired PET data). In addition, nongated images of varying statistical quality (using 35% and 100% of the PET data) were reconstructed to investigate the effects of image noise. Several global image-derived indices and textural parameters (entropy, high-intensity emphasis, zone percentage, and dissimilarity) that have been associated with patient outcome were calculated. The clinical impact of optimal respiratory gating and image noise on assessment of intratumor heterogeneity was evaluated using Cox regression models, with overall survival as the outcome measure. The threshold for statistical significance was adjusted for multiple comparisons using Bonferroni correction. In the lower lung lobes, respiratory motion significantly affected quantification of intratumor heterogeneity for all textural parameters (P < 0.007) except entropy (P > 0.007). The mean increase in entropy, dissimilarity, zone percentage, and high-intensity emphasis was 1.3% ± 1.5% (P = 0.02), 11.6% ± 11.8% (P = 0.006), 2.3% ± 2.2% (P = 0.002), and 16.8% ± 17.2% (P = 0.006), respectively. No significant differences were observed for lesions in the upper lung lobes (P > 0.007). Differences in the statistical quality of the PET images affected the textural parameters less than respiratory motion, with no significant difference observed. The median follow-up time was 35 mo (range, 7-39 mo). In multivariate analysis for overall survival, total lesion glycolysis and high-intensity emphasis were the two most relevant image-derived indices and were considered to be independent significant covariates for the model regardless of the image type considered. The tested textural parameters are robust in the presence of respiratory motion artifacts and varying levels of image noise. © 2016 by the Society of Nuclear Medicine and Molecular Imaging, Inc.

Validity of clinical outcome measures to evaluate ankle range of motion during the weight-bearing lunge test.

PubMed

Hall, Emily A; Docherty, Carrie L

2017-07-01

To determine the concurrent validity of standard clinical outcome measures compared to laboratory outcome measure while performing the weight-bearing lunge test (WBLT). Cross-sectional study. Fifty participants performed the WBLT to determine dorsiflexion ROM using four different measurement techniques: dorsiflexion angle with digital inclinometer at 15cm distal to the tibial tuberosity (°), dorsiflexion angle with inclinometer at tibial tuberosity (°), maximum lunge distance (cm), and dorsiflexion angle using a 2D motion capture system (°). Outcome measures were recorded concurrently during each trial. To establish concurrent validity, Pearson product-moment correlation coefficients (r) were conducted, comparing each dependent variable to the 2D motion capture analysis (identified as the reference standard). A higher correlation indicates strong concurrent validity. There was a high correlation between each measurement technique and the reference standard. Specifically the correlation between the inclinometer placement at 15cm below the tibial tuberosity (44.9°±5.5°) and the motion capture angle (27.0°±6.0°) was r=0.76 (p=0.001), between the inclinometer placement at the tibial tuberosity angle (39.0°±4.6°) and the motion capture angle was r=0.71 (p=0.001), and between the distance from the wall clinical measure (10.3±3.0cm) to the motion capture angle was r=0.74 (p=0.001). This study determined that the clinical measures used during the WBLT have a high correlation with the reference standard for assessing dorsiflexion range of motion. Therefore, obtaining maximum lunge distance and inclinometer angles are both valid assessments during the weight-bearing lunge test. Copyright © 2016 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Correlation of primary middle and distal esophageal cancers motion with surrounding tissues using four-dimensional computed tomography.

PubMed

Wang, Wei; Li, Jianbin; Zhang, Yingjie; Shao, Qian; Xu, Min; Guo, Bing; Shang, Dongping

2016-01-01

To investigate the correlation of gross tumor volume (GTV) motion with the structure of interest (SOI) motion and volume variation for middle and distal esophageal cancers using four-dimensional computed tomography (4DCT). Thirty-three patients with middle or distal esophageal carcinoma underwent 4DCT simulation scan during free breathing. All image sets were registered with 0% phase, and the GTV, apex of diaphragm, lung, and heart were delineated on each phase of the 4DCT data. The position of GTV and SOI was identified in all 4DCT phases, and the volume of lung and heart was also achieved. The phase relationship between the GTV and SOI was estimated through Pearson's correlation test. The mean peak-to-peak displacement of all primary tumors in the lateral (LR), anteroposterior (AP), and superoinferior (SI) directions was 0.13 cm, 0.20 cm, and 0.30 cm, respectively. The SI peak-to-peak motion of the GTV was defined as the greatest magnitude of motion. The displacement of GTV correlated well with heart in three dimensions and significantly associated with bilateral lung in LR and SI directions. A significant correlation was found between the GTV and apex of the diaphragm in SI direction (r left=0.918 and r right=0.928). A significant inverse correlation was found between GTV motion and varying lung volume, but the correlation was not significant with heart (r LR=-0.530, r AP=-0.531, and r SI=-0.588) during respiratory cycle. For middle and distal esophageal cancers, GTV should expand asymmetric internal margins. The primary tumor motion has quite good correlation with diaphragm, heart, and lung.

Imaging and dosimetric errors in 4D PET/CT-guided radiotherapy from patient-specific respiratory patterns: a dynamic motion phantom end-to-end study

NASA Astrophysics Data System (ADS)

Bowen, S. R.; Nyflot, M. J.; Herrmann, C.; Groh, C. M.; Meyer, J.; Wollenweber, S. D.; Stearns, C. W.; Kinahan, P. E.; Sandison, G. A.

2015-05-01

Effective positron emission tomography / computed tomography (PET/CT) guidance in radiotherapy of lung cancer requires estimation and mitigation of errors due to respiratory motion. An end-to-end workflow was developed to measure patient-specific motion-induced uncertainties in imaging, treatment planning, and radiation delivery with respiratory motion phantoms and dosimeters. A custom torso phantom with inserts mimicking normal lung tissue and lung lesion was filled with [18F]FDG. The lung lesion insert was driven by six different patient-specific respiratory patterns or kept stationary. PET/CT images were acquired under motionless ground truth, tidal breathing motion-averaged (3D), and respiratory phase-correlated (4D) conditions. Target volumes were estimated by standardized uptake value (SUV) thresholds that accurately defined the ground-truth lesion volume. Non-uniform dose-painting plans using volumetrically modulated arc therapy were optimized for fixed normal lung and spinal cord objectives and variable PET-based target objectives. Resulting plans were delivered to a cylindrical diode array at rest, in motion on a platform driven by the same respiratory patterns (3D), or motion-compensated by a robotic couch with an infrared camera tracking system (4D). Errors were estimated relative to the static ground truth condition for mean target-to-background (T/Bmean) ratios, target volumes, planned equivalent uniform target doses, and 2%-2 mm gamma delivery passing rates. Relative to motionless ground truth conditions, PET/CT imaging errors were on the order of 10-20%, treatment planning errors were 5-10%, and treatment delivery errors were 5-30% without motion compensation. Errors from residual motion following compensation methods were reduced to 5-10% in PET/CT imaging, <5% in treatment planning, and <2% in treatment delivery. We have demonstrated that estimation of respiratory motion uncertainty and its propagation from PET/CT imaging to RT planning, and RT delivery under a dose painting paradigm is feasible within an integrated respiratory motion phantom workflow. For a limited set of cases, the magnitude of errors was comparable during PET/CT imaging and treatment delivery without motion compensation. Errors were moderately mitigated during PET/CT imaging and significantly mitigated during RT delivery with motion compensation. This dynamic motion phantom end-to-end workflow provides a method for quality assurance of 4D PET/CT-guided radiotherapy, including evaluation of respiratory motion compensation methods during imaging and treatment delivery.

Imaging and dosimetric errors in 4D PET/CT-guided radiotherapy from patient-specific respiratory patterns: a dynamic motion phantom end-to-end study.

PubMed

Bowen, S R; Nyflot, M J; Herrmann, C; Groh, C M; Meyer, J; Wollenweber, S D; Stearns, C W; Kinahan, P E; Sandison, G A

2015-05-07

Effective positron emission tomography / computed tomography (PET/CT) guidance in radiotherapy of lung cancer requires estimation and mitigation of errors due to respiratory motion. An end-to-end workflow was developed to measure patient-specific motion-induced uncertainties in imaging, treatment planning, and radiation delivery with respiratory motion phantoms and dosimeters. A custom torso phantom with inserts mimicking normal lung tissue and lung lesion was filled with [(18)F]FDG. The lung lesion insert was driven by six different patient-specific respiratory patterns or kept stationary. PET/CT images were acquired under motionless ground truth, tidal breathing motion-averaged (3D), and respiratory phase-correlated (4D) conditions. Target volumes were estimated by standardized uptake value (SUV) thresholds that accurately defined the ground-truth lesion volume. Non-uniform dose-painting plans using volumetrically modulated arc therapy were optimized for fixed normal lung and spinal cord objectives and variable PET-based target objectives. Resulting plans were delivered to a cylindrical diode array at rest, in motion on a platform driven by the same respiratory patterns (3D), or motion-compensated by a robotic couch with an infrared camera tracking system (4D). Errors were estimated relative to the static ground truth condition for mean target-to-background (T/Bmean) ratios, target volumes, planned equivalent uniform target doses, and 2%-2 mm gamma delivery passing rates. Relative to motionless ground truth conditions, PET/CT imaging errors were on the order of 10-20%, treatment planning errors were 5-10%, and treatment delivery errors were 5-30% without motion compensation. Errors from residual motion following compensation methods were reduced to 5-10% in PET/CT imaging, <5% in treatment planning, and <2% in treatment delivery. We have demonstrated that estimation of respiratory motion uncertainty and its propagation from PET/CT imaging to RT planning, and RT delivery under a dose painting paradigm is feasible within an integrated respiratory motion phantom workflow. For a limited set of cases, the magnitude of errors was comparable during PET/CT imaging and treatment delivery without motion compensation. Errors were moderately mitigated during PET/CT imaging and significantly mitigated during RT delivery with motion compensation. This dynamic motion phantom end-to-end workflow provides a method for quality assurance of 4D PET/CT-guided radiotherapy, including evaluation of respiratory motion compensation methods during imaging and treatment delivery.

Imaging and dosimetric errors in 4D PET/CT-guided radiotherapy from patient-specific respiratory patterns: a dynamic motion phantom end-to-end study

PubMed Central

Bowen, S R; Nyflot, M J; Hermann, C; Groh, C; Meyer, J; Wollenweber, S D; Stearns, C W; Kinahan, P E; Sandison, G A

2015-01-01

Effective positron emission tomography/computed tomography (PET/CT) guidance in radiotherapy of lung cancer requires estimation and mitigation of errors due to respiratory motion. An end-to-end workflow was developed to measure patient-specific motion-induced uncertainties in imaging, treatment planning, and radiation delivery with respiratory motion phantoms and dosimeters. A custom torso phantom with inserts mimicking normal lung tissue and lung lesion was filled with [18F]FDG. The lung lesion insert was driven by 6 different patient-specific respiratory patterns or kept stationary. PET/CT images were acquired under motionless ground truth, tidal breathing motion-averaged (3D), and respiratory phase-correlated (4D) conditions. Target volumes were estimated by standardized uptake value (SUV) thresholds that accurately defined the ground-truth lesion volume. Non-uniform dose-painting plans using volumetrically modulated arc therapy (VMAT) were optimized for fixed normal lung and spinal cord objectives and variable PET-based target objectives. Resulting plans were delivered to a cylindrical diode array at rest, in motion on a platform driven by the same respiratory patterns (3D), or motion-compensated by a robotic couch with an infrared camera tracking system (4D). Errors were estimated relative to the static ground truth condition for mean target-to-background (T/Bmean) ratios, target volumes, planned equivalent uniform target doses (EUD), and 2%-2mm gamma delivery passing rates. Relative to motionless ground truth conditions, PET/CT imaging errors were on the order of 10–20%, treatment planning errors were 5–10%, and treatment delivery errors were 5–30% without motion compensation. Errors from residual motion following compensation methods were reduced to 5–10% in PET/CT imaging, < 5% in treatment planning, and < 2% in treatment delivery. We have demonstrated that estimation of respiratory motion uncertainty and its propagation from PET/CT imaging to RT planning, and RT delivery under a dose painting paradigm is feasible within an integrated respiratory motion phantom workflow. For a limited set of cases, the magnitude of errors was comparable during PET/CT imaging and treatment delivery without motion compensation. Errors were moderately mitigated during PET/CT imaging and significantly mitigated during RT delivery with motion compensation. This dynamic motion phantom end-to-end workflow provides a method for quality assurance of 4D PET/CT-guided radiotherapy, including evaluation of respiratory motion compensation methods during imaging and treatment delivery. PMID:25884892

Evaluation of deformable image registration and a motion model in CT images with limited features.

PubMed

Liu, F; Hu, Y; Zhang, Q; Kincaid, R; Goodman, K A; Mageras, G S

2012-05-07

Deformable image registration (DIR) is increasingly used in radiotherapy applications and provides the basis for a previously described model of patient-specific respiratory motion. We examine the accuracy of a DIR algorithm and a motion model with respiration-correlated CT (RCCT) images of software phantom with known displacement fields, physical deformable abdominal phantom with implanted fiducials in the liver and small liver structures in patient images. The motion model is derived from a principal component analysis that relates volumetric deformations with the motion of the diaphragm or fiducials in the RCCT. Patient data analysis compares DIR with rigid registration as ground truth: the mean ± standard deviation 3D discrepancy of liver structure centroid positions is 2.0 ± 2.2 mm. DIR discrepancy in the software phantom is 3.8 ± 2.0 mm in lung and 3.7 ± 1.8 mm in abdomen; discrepancies near the chest wall are larger than indicated by image feature matching. Marker's 3D discrepancy in the physical phantom is 3.6 ± 2.8 mm. The results indicate that visible features in the images are important for guiding the DIR algorithm. Motion model accuracy is comparable to DIR, indicating that two principal components are sufficient to describe DIR-derived deformation in these datasets.

Adaptive Radiation for Lung Cancer

PubMed Central

Gomez, Daniel R.; Chang, Joe Y.

2011-01-01

The challenges of lung cancer radiotherapy are intra/inter-fraction tumor/organ anatomy/motion changes and the need to spare surrounding critical structures. Evolving radiotherapy technologies, such as four-dimensional (4D) image-based motion management, daily on-board imaging and adaptive radiotherapy based on volumetric images over the course of radiotherapy, have enabled us to deliver higher dose to target while minimizing normal tissue toxicities. The image-guided radiotherapy adapted to changes of motion and anatomy has made the radiotherapy more precise and allowed ablative dose delivered to the target using novel treatment approaches such as intensity-modulated radiation therapy, stereotactic body radiation therapy, and proton therapy in lung cancer, techniques used to be considered very sensitive to motion change. Future clinical trials using real time tracking and biological adaptive radiotherapy based on functional images are proposed. PMID:20814539

Analysis of free breathing motion using artifact reduced 4D CT image data

NASA Astrophysics Data System (ADS)

Ehrhardt, Jan; Werner, Rene; Frenzel, Thorsten; Lu, Wei; Low, Daniel; Handels, Heinz

2007-03-01

The mobility of lung tumors during the respiratory cycle is a source of error in radiotherapy treatment planning. Spatiotemporal CT data sets can be used for studying the motion of lung tumors and inner organs during the breathing cycle. We present methods for the analysis of respiratory motion using 4D CT data in high temporal resolution. An optical flow based reconstruction method was used to generate artifact-reduced 4D CT data sets of lung cancer patients. The reconstructed 4D CT data sets were segmented and the respiratory motion of tumors and inner organs was analyzed. A non-linear registration algorithm is used to calculate the velocity field between consecutive time frames of the 4D data. The resulting velocity field is used to analyze trajectories of landmarks and surface points. By this technique, the maximum displacement of any surface point is calculated, and regions with large respiratory motion are marked. To describe the tumor mobility the motion of the lung tumor center in three orthogonal directions is displayed. Estimated 3D appearance probabilities visualize the movement of the tumor during the respiratory cycle in one static image. Furthermore, correlations between trajectories of the skin surface and the trajectory of the tumor center are determined and skin regions are identified which are suitable for prediction of the internal tumor motion. The results of the motion analysis indicate that the described methods are suitable to gain insight into the spatiotemporal behavior of anatomical and pathological structures during the respiratory cycle.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Dhou, S; Cai, W; Hurwitz, M

Purpose: The goal of this study is to quantify the interfraction reproducibility of patient-specific motion models derived from 4DCBCT acquired on the day of treatment of lung cancer stereotactic body radiotherapy (SBRT) patients. Methods: Motion models are derived from patient 4DCBCT images acquired daily over 3–5 fractions of treatment by 1) applying deformable image registration between each 4DCBCT image and a reference phase from that day, resulting in a set of displacement vector fields (DVFs), and 2) performing principal component analysis (PCA) on the DVFs to derive a motion model. The motion model from the first day of treatment ismore » compared to motion models from each successive day of treatment to quantify variability in motion models generated from different days. Four SBRT patient datasets have been acquired thus far in this IRB approved study. Results: Fraction-specific motion models for each fraction and patient were derived and PCA eigenvectors and their associated eigenvalues are compared for each fraction. For the first patient dataset, the average root mean square error between the first two eigenvectors associated with the highest two eigenvalues, in four fractions was 0.1, while it was 0.25 between the last three PCA eigenvectors associated with the lowest three eigenvalues. It was found that the eigenvectors and eigenvalues of PCA motion models for each treatment fraction have variations and the first few eigenvectors are shown to be more stable across treatment fractions than others. Conclusion: Analysis of this dataset showed that the first two eigenvectors of the PCA patient-specific motion models derived from 4DCBCT were stable over the course of several treatment fractions. The third, fourth, and fifth eigenvectors had larger variations.« less

Challenges and opportunities in patient-specific, motion-managed and PET/CT-guided radiation therapy of lung cancer: review and perspective

PubMed Central

2012-01-01

The increasing interest in combined positron emission tomography (PET) and computed tomography (CT) to guide lung cancer radiation therapy planning has been well documented. Motion management strategies during treatment simulation PET/CT imaging and treatment delivery have been proposed to improve the precision and accuracy of radiotherapy. In light of these research advances, why has translation of motion-managed PET/CT to clinical radiotherapy been slow and infrequent? Solutions to this problem are as complex as they are numerous, driven by large inter-patient variability in tumor motion trajectories across a highly heterogeneous population. Such variation dictates a comprehensive and patient-specific incorporation of motion management strategies into PET/CT-guided radiotherapy rather than a one-size-fits-all tactic. This review summarizes challenges and opportunities for clinical translation of advances in PET/CT-guided radiotherapy, as well as in respiratory motion-managed radiotherapy of lung cancer. These two concepts are then integrated into proposed patient-specific workflows that span classification schemes, PET/CT image formation, treatment planning, and adaptive image-guided radiotherapy delivery techniques. PMID:23369522

A biomechanical modeling-guided simultaneous motion estimation and image reconstruction technique (SMEIR-Bio) for 4D-CBCT reconstruction

NASA Astrophysics Data System (ADS)

Huang, Xiaokun; Zhang, You; Wang, Jing

2018-02-01

Reconstructing four-dimensional cone-beam computed tomography (4D-CBCT) images directly from respiratory phase-sorted traditional 3D-CBCT projections can capture target motion trajectory, reduce motion artifacts, and reduce imaging dose and time. However, the limited numbers of projections in each phase after phase-sorting decreases CBCT image quality under traditional reconstruction techniques. To address this problem, we developed a simultaneous motion estimation and image reconstruction (SMEIR) algorithm, an iterative method that can reconstruct higher quality 4D-CBCT images from limited projections using an inter-phase intensity-driven motion model. However, the accuracy of the intensity-driven motion model is limited in regions with fine details whose quality is degraded due to insufficient projection number, which consequently degrades the reconstructed image quality in corresponding regions. In this study, we developed a new 4D-CBCT reconstruction algorithm by introducing biomechanical modeling into SMEIR (SMEIR-Bio) to boost the accuracy of the motion model in regions with small fine structures. The biomechanical modeling uses tetrahedral meshes to model organs of interest and solves internal organ motion using tissue elasticity parameters and mesh boundary conditions. This physics-driven approach enhances the accuracy of solved motion in the organ’s fine structures regions. This study used 11 lung patient cases to evaluate the performance of SMEIR-Bio, making both qualitative and quantitative comparisons between SMEIR-Bio, SMEIR, and the algebraic reconstruction technique with total variation regularization (ART-TV). The reconstruction results suggest that SMEIR-Bio improves the motion model’s accuracy in regions containing small fine details, which consequently enhances the accuracy and quality of the reconstructed 4D-CBCT images.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Myronakis, M; Cai, W; Dhou, S

Purpose: To determine if 4DCT-based motion modeling and external surrogate motion measured during treatment simulation can enhance prediction of residual tumor motion and duty cycle during treatment delivery. Methods: This experiment was conducted using simultaneously recorded tumor and external surrogate motion acquired over multiple fractions of lung cancer radiotherapy. These breathing traces were combined with the XCAT phantom to simulate CT images. Data from the first day was used to estimate the residual tumor motion and duty cycle both directly from the 4DCT (the current clinical standard), and from external-surrogate based motion modeling. The accuracy of these estimated residual tumormore » motions and duty cycles are evaluated by comparing to the measured internal/external motions from other treatment days. Results: All calculations were done for 25% and 50% duty cycles. The results indicated that duty cycle derived from 4DCT information alone is not enough to accurately predict duty cycles during treatment. Residual tumor motion was determined from the recorded data and compared with the estimated residual tumor motion from 4DCT. Relative differences in residual tumor motion varied from −30% to 55%, suggesting that more information is required to properly predict residual tumor motion. Compared to estimations made from 4DCT, in three out of four patients examined, the 30 seconds of motion modeling data was able to predict the duty cycle with better accuracy than 4DCT. No improvement was observed in prediction of residual tumor motion for this dataset. Conclusion: Motion modeling during simulation has the potential to enhance 4DCT and provide more information about target motion, duty cycles, and delivered dose. Based on these four patients, 30 seconds of motion modeling data produced improve duty cycle estimations but showed no measurable improvement in residual tumor motion prediction. More patient data is needed to verify this Result. I would like to acknowledge funding from MRA, VARIAN Medical Systems, Inc.« less

4D-CT motion estimation using deformable image registration and 5D respiratory motion modeling.

PubMed

Yang, Deshan; Lu, Wei; Low, Daniel A; Deasy, Joseph O; Hope, Andrew J; El Naqa, Issam

2008-10-01

Four-dimensional computed tomography (4D-CT) imaging technology has been developed for radiation therapy to provide tumor and organ images at the different breathing phases. In this work, a procedure is proposed for estimating and modeling the respiratory motion field from acquired 4D-CT imaging data and predicting tissue motion at the different breathing phases. The 4D-CT image data consist of series of multislice CT volume segments acquired in ciné mode. A modified optical flow deformable image registration algorithm is used to compute the image motion from the CT segments to a common full volume 3D-CT reference. This reference volume is reconstructed using the acquired 4D-CT data at the end-of-exhalation phase. The segments are optimally aligned to the reference volume according to a proposed a priori alignment procedure. The registration is applied using a multigrid approach and a feature-preserving image downsampling maxfilter to achieve better computational speed and higher registration accuracy. The registration accuracy is about 1.1 +/- 0.8 mm for the lung region according to our verification using manually selected landmarks and artificially deformed CT volumes. The estimated motion fields are fitted to two 5D (spatial 3D+tidal volume+airflow rate) motion models: forward model and inverse model. The forward model predicts tissue movements and the inverse model predicts CT density changes as a function of tidal volume and airflow rate. A leave-one-out procedure is used to validate these motion models. The estimated modeling prediction errors are about 0.3 mm for the forward model and 0.4 mm for the inverse model.

IGRT/ART phantom with programmable independent rib cage and tumor motion

DOE Office of Scientific and Technical Information (OSTI.GOV)

Haas, Olivier C. L., E-mail: o.haas@coventry.ac.uk; Mills, John A.; Land, Imke

2014-02-15

Purpose: This paper describes the design and experimental evaluation of the Methods and Advanced Equipment for Simulation and Treatment in Radiation Oncology (MAESTRO) thorax phantom, a new anthropomorphic moving ribcage combined with a 3D tumor positioning system to move target inserts within static lungs. Methods: The new rib cage design is described and its motion is evaluated using Vicon Nexus, a commercial 3D motion tracking system. CT studies at inhale and exhale position are used to study the effect of rib motion and tissue equivalence. Results: The 3D target positioning system and the rib cage have millimetre accuracy. Each axismore » of motion can reproduce given trajectories from files or individually programmed sinusoidal motion in terms of amplitude, period, and phase shift. The maximum rib motion ranges from 7 to 20 mm SI and from 0.3 to 3.7 mm AP with LR motion less than 1 mm. The repeatability between cycles is within 0.16 mm root mean square error. The agreement between CT electron and mass density for skin, ribcage, spine hard and inner bone as well as cartilage is within 3%. Conclusions: The MAESTRO phantom is a useful research tool that produces programmable 3D rib motions which can be synchronized with 3D internal target motion. The easily accessible static lungs enable the use of a wide range of inserts or can be filled with lung tissue equivalent and deformed using the target motion system.« less

CT Fluoroscopy-Guided Lung Biopsy with Novel Steerable Biopsy Canula: Ex-Vivo Evaluation in Ventilated Porcine Lung Explants

DOE Office of Scientific and Technical Information (OSTI.GOV)

Schaefer, Philipp J., E-mail: jp.schaefer@rad.uni-kiel.de; Fabel, Michael; Bolte, Hendrik

2010-08-15

The purpose was to evaluate ex-vivo a prototype of a novel biopsy canula under CT fluoroscopy-guidance in ventilated porcine lung explants in respiratory motion simulations. Using an established chest phantom for porcine lung explants, n = 24 artificial lesions consisting of a fat-wax-Lipiodol mixture (approx. 70HU) were placed adjacent to sensible structures such as aorta, pericardium, diaphragm, bronchus and pulmonary artery. A piston pump connected to a reservoir beneath a flexible silicone reconstruction of a diaphragm simulated respiratory motion by rhythmic inflation and deflation of 1.5 L water. As biopsy device an 18-gauge prototype biopsy canula with a lancet-like, helicallymore » bended cutting edge was used. The artificial lesions were punctured under CT fluoroscopy-guidance (SOMATOM Sensation 64, Siemens, Erlangen, Germany; 30mAs/120 kV/5 mm slice thickness) implementing a dedicated protocol for CT fluoroscopy-guided lung biopsy. The mean-diameter of the artificial lesions was 8.3 {+-} 2.6 mm, and the mean-distance of the phantom wall to the lesions was 54.1 {+-} 13.5 mm. The mean-displacement of the lesions by respiratory motion was 14.1 {+-} 4.0 mm. The mean-duration of CT fluoroscopy was 9.6 {+-} 5.1 s. On a 4-point scale (1 = central; 2 = peripheral; 3 = marginal; 4 = off target), the mean-targeted precision was 1.9 {+-} 0.9. No misplacement of the biopsy canula affecting adjacent structures could be detected. The novel steerable biopsy canula proved to be efficient in the ex-vivo set-up. The chest phantom enabling respiratory motion and the steerable biopsy canula offer a feasible ex-vivo system for evaluating and training CT fluoroscopy-guided lung biopsy adapted to respiratory motion.« less

Impact of respiratory motion correction and spatial resolution on lesion detection in PET: a simulation study based on real MR dynamic data

NASA Astrophysics Data System (ADS)

Polycarpou, Irene; Tsoumpas, Charalampos; King, Andrew P.; Marsden, Paul K.

2014-02-01

The aim of this study is to investigate the impact of respiratory motion correction and spatial resolution on lesion detectability in PET as a function of lesion size and tracer uptake. Real respiratory signals describing different breathing types are combined with a motion model formed from real dynamic MR data to simulate multiple dynamic PET datasets acquired from a continuously moving subject. Lung and liver lesions were simulated with diameters ranging from 6 to 12 mm and lesion to background ratio ranging from 3:1 to 6:1. Projection data for 6 and 3 mm PET scanner resolution were generated using analytic simulations and reconstructed without and with motion correction. Motion correction was achieved using motion compensated image reconstruction. The detectability performance was quantified by a receiver operating characteristic (ROC) analysis obtained using a channelized Hotelling observer and the area under the ROC curve (AUC) was calculated as the figure of merit. The results indicate that respiratory motion limits the detectability of lung and liver lesions, depending on the variation of the breathing cycle length and amplitude. Patients with large quiescent periods had a greater AUC than patients with regular breathing cycles and patients with long-term variability in respiratory cycle or higher motion amplitude. In addition, small (less than 10 mm diameter) or low contrast (3:1) lesions showed the greatest improvement in AUC as a result of applying motion correction. In particular, after applying motion correction the AUC is improved by up to 42% with current PET resolution (i.e. 6 mm) and up to 51% for higher PET resolution (i.e. 3 mm). Finally, the benefit of increasing the scanner resolution is small unless motion correction is applied. This investigation indicates high impact of respiratory motion correction on lesion detectability in PET and highlights the importance of motion correction in order to benefit from the increased resolution of future PET scanners.

SU-F-J-138: An Extension of PCA-Based Respiratory Deformation Modeling Via Multi-Linear Decomposition

DOE Office of Scientific and Technical Information (OSTI.GOV)

Iliopoulos, AS; Sun, X; Pitsianis, N

Purpose: To address and lift the limited degree of freedom (DoF) of globally bilinear motion components such as those based on principal components analysis (PCA), for encoding and modeling volumetric deformation motion. Methods: We provide a systematic approach to obtaining a multi-linear decomposition (MLD) and associated motion model from deformation vector field (DVF) data. We had previously introduced MLD for capturing multi-way relationships between DVF variables, without being restricted by the bilinear component format of PCA-based models. PCA-based modeling is commonly used for encoding patient-specific deformation as per planning 4D-CT images, and aiding on-board motion estimation during radiotherapy. However, themore » bilinear space-time decomposition inherently limits the DoF of such models by the small number of respiratory phases. While this limit is not reached in model studies using analytical or digital phantoms with low-rank motion, it compromises modeling power in the presence of relative motion, asymmetries and hysteresis, etc, which are often observed in patient data. Specifically, a low-DoF model will spuriously couple incoherent motion components, compromising its adaptability to on-board deformation changes. By the multi-linear format of extracted motion components, MLD-based models can encode higher-DoF deformation structure. Results: We conduct mathematical and experimental comparisons between PCA- and MLD-based models. A set of temporally-sampled analytical trajectories provides a synthetic, high-rank DVF; trajectories correspond to respiratory and cardiac motion factors, including different relative frequencies and spatial variations. Additionally, a digital XCAT phantom is used to simulate a lung lesion deforming incoherently with respect to the body, which adheres to a simple respiratory trend. In both cases, coupling of incoherent motion components due to a low model DoF is clearly demonstrated. Conclusion: Multi-linear decomposition can enable decoupling of distinct motion factors in high-rank DVF measurements. This may improve motion model expressiveness and adaptability to on-board deformation, aiding model-based image reconstruction for target verification. NIH Grant No. R01-184173.« less

Deformable registration of the inflated and deflated lung in cone-beam CT-guided thoracic surgery: Initial investigation of a combined model- and image-driven approach

PubMed Central

Uneri, Ali; Nithiananthan, Sajendra; Schafer, Sebastian; Otake, Yoshito; Stayman, J. Webster; Kleinszig, Gerhard; Sussman, Marc S.; Prince, Jerry L.; Siewerdsen, Jeffrey H.

2013-01-01

Purpose: Surgical resection is the preferred modality for curative treatment of early stage lung cancer, but localization of small tumors (<10 mm diameter) during surgery presents a major challenge that is likely to increase as more early-stage disease is detected incidentally and in low-dose CT screening. To overcome the difficulty of manual localization (fingers inserted through intercostal ports) and the cost, logistics, and morbidity of preoperative tagging (coil or dye placement under CT-fluoroscopy), the authors propose the use of intraoperative cone-beam CT (CBCT) and deformable image registration to guide targeting of small tumors in video-assisted thoracic surgery (VATS). A novel algorithm is reported for registration of the lung from its inflated state (prior to pleural breach) to the deflated state (during resection) to localize surgical targets and adjacent critical anatomy. Methods: The registration approach geometrically resolves images of the inflated and deflated lung using a coarse model-driven stage followed by a finer image-driven stage. The model-driven stage uses image features derived from the lung surfaces and airways: triangular surface meshes are morphed to capture bulk motion; concurrently, the airways generate graph structures from which corresponding nodes are identified. Interpolation of the sparse motion fields computed from the bounding surface and interior airways provides a 3D motion field that coarsely registers the lung and initializes the subsequent image-driven stage. The image-driven stage employs an intensity-corrected, symmetric form of the Demons method. The algorithm was validated over 12 datasets, obtained from porcine specimen experiments emulating CBCT-guided VATS. Geometric accuracy was quantified in terms of target registration error (TRE) in anatomical targets throughout the lung, and normalized cross-correlation. Variations of the algorithm were investigated to study the behavior of the model- and image-driven stages by modifying individual algorithmic steps and examining the effect in comparison to the nominal process. Results: The combined model- and image-driven registration process demonstrated accuracy consistent with the requirements of minimally invasive VATS in both target localization (∼3–5 mm within the target wedge) and critical structure avoidance (∼1–2 mm). The model-driven stage initialized the registration to within a median TRE of 1.9 mm (95% confidence interval (CI) maximum = 5.0 mm), while the subsequent image-driven stage yielded higher accuracy localization with 0.6 mm median TRE (95% CI maximum = 4.1 mm). The variations assessing the individual algorithmic steps elucidated the role of each step and in some cases identified opportunities for further simplification and improvement in computational speed. Conclusions: The initial studies show the proposed registration method to successfully register CBCT images of the inflated and deflated lung. Accuracy appears sufficient to localize the target and adjacent critical anatomy within ∼1–2 mm and guide localization under conditions in which the target cannot be discerned directly in CBCT (e.g., subtle, nonsolid tumors). The ability to directly localize tumors in the operating room could provide a valuable addition to the VATS arsenal, obviate the cost, logistics, and morbidity of preoperative tagging, and improve patient safety. Future work includes in vivo testing, optimization of workflow, and integration with a CBCT image guidance system. PMID:23298134

Deformable registration of the inflated and deflated lung in cone-beam CT-guided thoracic surgery: initial investigation of a combined model- and image-driven approach.

PubMed

Uneri, Ali; Nithiananthan, Sajendra; Schafer, Sebastian; Otake, Yoshito; Stayman, J Webster; Kleinszig, Gerhard; Sussman, Marc S; Prince, Jerry L; Siewerdsen, Jeffrey H

2013-01-01

Surgical resection is the preferred modality for curative treatment of early stage lung cancer, but localization of small tumors (<10 mm diameter) during surgery presents a major challenge that is likely to increase as more early-stage disease is detected incidentally and in low-dose CT screening. To overcome the difficulty of manual localization (fingers inserted through intercostal ports) and the cost, logistics, and morbidity of preoperative tagging (coil or dye placement under CT-fluoroscopy), the authors propose the use of intraoperative cone-beam CT (CBCT) and deformable image registration to guide targeting of small tumors in video-assisted thoracic surgery (VATS). A novel algorithm is reported for registration of the lung from its inflated state (prior to pleural breach) to the deflated state (during resection) to localize surgical targets and adjacent critical anatomy. The registration approach geometrically resolves images of the inflated and deflated lung using a coarse model-driven stage followed by a finer image-driven stage. The model-driven stage uses image features derived from the lung surfaces and airways: triangular surface meshes are morphed to capture bulk motion; concurrently, the airways generate graph structures from which corresponding nodes are identified. Interpolation of the sparse motion fields computed from the bounding surface and interior airways provides a 3D motion field that coarsely registers the lung and initializes the subsequent image-driven stage. The image-driven stage employs an intensity-corrected, symmetric form of the Demons method. The algorithm was validated over 12 datasets, obtained from porcine specimen experiments emulating CBCT-guided VATS. Geometric accuracy was quantified in terms of target registration error (TRE) in anatomical targets throughout the lung, and normalized cross-correlation. Variations of the algorithm were investigated to study the behavior of the model- and image-driven stages by modifying individual algorithmic steps and examining the effect in comparison to the nominal process. The combined model- and image-driven registration process demonstrated accuracy consistent with the requirements of minimally invasive VATS in both target localization (∼3-5 mm within the target wedge) and critical structure avoidance (∼1-2 mm). The model-driven stage initialized the registration to within a median TRE of 1.9 mm (95% confidence interval (CI) maximum = 5.0 mm), while the subsequent image-driven stage yielded higher accuracy localization with 0.6 mm median TRE (95% CI maximum = 4.1 mm). The variations assessing the individual algorithmic steps elucidated the role of each step and in some cases identified opportunities for further simplification and improvement in computational speed. The initial studies show the proposed registration method to successfully register CBCT images of the inflated and deflated lung. Accuracy appears sufficient to localize the target and adjacent critical anatomy within ∼1-2 mm and guide localization under conditions in which the target cannot be discerned directly in CBCT (e.g., subtle, nonsolid tumors). The ability to directly localize tumors in the operating room could provide a valuable addition to the VATS arsenal, obviate the cost, logistics, and morbidity of preoperative tagging, and improve patient safety. Future work includes in vivo testing, optimization of workflow, and integration with a CBCT image guidance system.

Estimating 4D-CBCT from prior information and extremely limited angle projections using structural PCA and weighted free-form deformation for lung radiotherapy.

PubMed

Harris, Wendy; Zhang, You; Yin, Fang-Fang; Ren, Lei

2017-03-01

To investigate the feasibility of using structural-based principal component analysis (PCA) motion-modeling and weighted free-form deformation to estimate on-board 4D-CBCT using prior information and extremely limited angle projections for potential 4D target verification of lung radiotherapy. A technique for lung 4D-CBCT reconstruction has been previously developed using a deformation field map (DFM)-based strategy. In the previous method, each phase of the 4D-CBCT was generated by deforming a prior CT volume. The DFM was solved by a motion model extracted by a global PCA and free-form deformation (GMM-FD) technique, using a data fidelity constraint and deformation energy minimization. In this study, a new structural PCA method was developed to build a structural motion model (SMM) by accounting for potential relative motion pattern changes between different anatomical structures from simulation to treatment. The motion model extracted from planning 4DCT was divided into two structures: tumor and body excluding tumor, and the parameters of both structures were optimized together. Weighted free-form deformation (WFD) was employed afterwards to introduce flexibility in adjusting the weightings of different structures in the data fidelity constraint based on clinical interests. XCAT (computerized patient model) simulation with a 30 mm diameter lesion was simulated with various anatomical and respiratory changes from planning 4D-CT to on-board volume to evaluate the method. The estimation accuracy was evaluated by the volume percent difference (VPD)/center-of-mass-shift (COMS) between lesions in the estimated and "ground-truth" on-board 4D-CBCT. Different on-board projection acquisition scenarios and projection noise levels were simulated to investigate their effects on the estimation accuracy. The method was also evaluated against three lung patients. The SMM-WFD method achieved substantially better accuracy than the GMM-FD method for CBCT estimation using extremely small scan angles or projections. Using orthogonal 15° scanning angles, the VPD/COMS were 3.47 ± 2.94% and 0.23 ± 0.22 mm for SMM-WFD and 25.23 ± 19.01% and 2.58 ± 2.54 mm for GMM-FD among all eight XCAT scenarios. Compared to GMM-FD, SMM-WFD was more robust against reduction of the scanning angles down to orthogonal 10° with VPD/COMS of 6.21 ± 5.61% and 0.39 ± 0.49 mm, and more robust against reduction of projection numbers down to only 8 projections in total for both orthogonal-view 30° and orthogonal-view 15° scan angles. SMM-WFD method was also more robust than the GMM-FD method against increasing levels of noise in the projection images. Additionally, the SMM-WFD technique provided better tumor estimation for all three lung patients compared to the GMM-FD technique. Compared to the GMM-FD technique, the SMM-WFD technique can substantially improve the 4D-CBCT estimation accuracy using extremely small scan angles and low number of projections to provide fast low dose 4D target verification. © 2017 American Association of Physicists in Medicine.

The Role of Collateral Paths in Long-Range Diffusion of 3He in Lungs

PubMed Central

Conradi, Mark S.; Yablonskiy, Dmitriy A.; Woods, Jason C.; Gierada, David S.; Bartel, Seth-Emil T.; Haywood, Susan E.; Menard, Christopher

2008-01-01

Rationale and Objectives The hyperpolarized 3He long-range diffusion coefficient (LRDC) in lungs is sensitive to changes in lung structure due to emphysema, reflecting the increase in collateral paths resulting from tissue destruction. However, no clear understanding of LRDC in healthy lungs has emerged. Here we compare LRDC measured in healthy lungs with computer simulations of diffusion along the airway tree with no collateral connections. Materials and Methods Computer simulations of diffusion of spatially modulated spin magnetization were performed in computer generated, symmetric-branching models of lungs and compared with existing LRDC measurements in canine and human lungs. Results The simulations predict LRDC values of order 0.001 cm2/s, approximately 20 times smaller than the measured LRDC. We consider and rule out possible mechanisms for LRDC not included in the simulations: incomplete breath hold, cardiac motion, and passage of dissolved 3He through airway walls. However, a very low density of small (micron) holes in the airways is shown to account for the observed LRDC. Conclusion It is proposed that LRDC in healthy lungs is determined by small collateral pathways. PMID:18486004

Head and pelvic movement asymmetry during lungeing in horses with symmetrical movement on the straight.

PubMed

Rhodin, M; Roepstorff, L; French, A; Keegan, K G; Pfau, T; Egenvall, A

2016-05-01

Lungeing is commonly used as part of standard lameness examinations in horses. Knowledge of how lungeing influences motion symmetry in sound horses is needed. The aim of this study was to objectively evaluate the symmetry of vertical head and pelvic motion during lungeing in a large number of horses with symmetric motion during straight line evaluation. Cross-sectional prospective study. A pool of 201 riding horses, all functioning well and considered sound by their owners, were evaluated in trot on a straight line and during lungeing to the left and right. From this pool, horses with symmetric vertical head and pelvic movement during the straight line trot (n = 94) were retained for analysis. Vertical head and pelvic movements were measured with body mounted uniaxial accelerometers. Differences between vertical maximum and minimum head (HDmax, HDmin) and pelvic (PDmax, PDmin) heights between left and right forelimb and hindlimb stances were compared between straight line trot and lungeing in either direction. Vertical head and pelvic movements during lungeing were more asymmetric than during trot on a straight line. Common asymmetric patterns seen in the head were more upward movement during push-off of the outside forelimb and less downward movement during impact of the inside limb. Common asymmetric patterns seen in the pelvis were less upward movement during push-off of the outside hindlimb and less downward movement of the pelvis during impact of the inside hindlimb. Asymmetric patterns in one lunge direction were frequently not the same as in the opposite direction. Lungeing induces systematic asymmetries in vertical head and pelvic motion patterns in horses that may not be the same in both directions. These asymmetries may mask or mimic fore- or hindlimb lameness. © 2015 The Authors. Equine Veterinary Journal published by John Wiley & Sons Ltd on behalf of EVJ Ltd.

Accuracy of the dose-shift approximation in estimating the delivered dose in SBRT of lung tumors considering setup errors and breathing motions.

PubMed

Karlsson, Kristin; Lax, Ingmar; Lindbäck, Elias; Poludniowski, Gavin

2017-09-01

Geometrical uncertainties can result in a delivered dose to the tumor different from that estimated in the static treatment plan. The purpose of this project was to investigate the accuracy of the dose calculated to the clinical target volume (CTV) with the dose-shift approximation, in stereotactic body radiation therapy (SBRT) of lung tumors considering setup errors and breathing motion. The dose-shift method was compared with a beam-shift method with dose recalculation. Included were 10 patients (10 tumors) selected to represent a variety of SBRT-treated lung tumors in terms of tumor location, CTV volume, and tumor density. An in-house developed toolkit within a treatment planning system allowed the shift of either the dose matrix or a shift of the beam isocenter with dose recalculation, to simulate setup errors and breathing motion. Setup shifts of different magnitudes (up to 10 mm) and directions as well as breathing with different peak-to-peak amplitudes (up to 10:5:5 mm) were modeled. The resulting dose-volume histograms (DVHs) were recorded and dose statistics were extracted. Generally, both the dose-shift and beam-shift methods resulted in calculated doses lower than the static planned dose, although the minimum (D 98% ) dose exceeded the prescribed dose in all cases, for setup shifts up to 5 mm. The dose-shift method also generally underestimated the dose compared with the beam-shift method. For clinically realistic systematic displacements of less than 5 mm, the results demonstrated that in the minimum dose region within the CTV, the dose-shift method was accurate to 2% (root-mean-square error). Breathing motion only marginally degraded the dose distributions. Averaged over the patients and shift directions, the dose-shift approximation was determined to be accurate to approximately 2% (RMS) within the CTV, for clinically relevant geometrical uncertainties for SBRT of lung tumors.

Response of cricket and spider motion-sensing hairs to airflow pulsations

PubMed Central

Kant, R.; Humphrey, J. A. C.

2009-01-01

Closed-form analytical solutions are presented for the angular displacement, velocity and acceleration of motion-sensing filiform hairs exposed to airflow pulsations of short time duration. The specific situations of interest correspond to a spider intentionally moving towards a cricket, or an insect unintentionally moving towards or flying past a spider. The trichobothria of the spider Cupiennius salei and the cercal hairs of the cricket Gryllus bimaculatus are explored. Guided by earlier work, the spatial characteristics of the velocity field due to a flow pulsation are approximated by the local incompressible flow field due to a moving sphere. This spatial field is everywhere modulated in time by a Gaussian function represented by the summation of an infinite Fourier series, thus allowing an exploration of the spectral dependence of hair motion. Owing to their smaller total inertia, torsional restoring constant and total damping constant, short hairs are found to be significantly more responsive than long hairs to a flow pulsation. It is also found that the spider trichobothria are underdamped, while the cercal hairs of the cricket are overdamped. As a consequence, the spider hairs are more responsive to sudden air motions. Analysis shows that while two spiders of different characteristic sizes and lunge velocities can generate pulsations with comparable energy content, the associated velocity fields display different patterns of spatial decay with distance from the pulsation source. As a consequence, a small spider lunging at a high velocity generates a smaller telltale far-field velocity signal than a larger spider lunging at a lower velocity. The results obtained are in broad agreement with several of the observations and conclusions derived from combined flow and behavioural experiments performed by Casas et al. for running spiders, and by Dangles et al. for spiders and a physical model of spiders lunging at crickets. PMID:19324674

WE-AB-303-11: Verification of a Deformable 4DCT Motion Model for Lung Tumor Tracking Using Different Driving Surrogates

DOE Office of Scientific and Technical Information (OSTI.GOV)

Woelfelschneider, J; Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, DE; Seregni, M

2015-06-15

Purpose: Tumor tracking is an advanced technique to treat intra-fractionally moving tumors. The aim of this study is to validate a surrogate-driven model based on four-dimensional computed tomography (4DCT) that is able to predict CT volumes corresponding to arbitrary respiratory states. Further, the comparison of three different driving surrogates is evaluated. Methods: This study is based on multiple 4DCTs of two patients treated for bronchial carcinoma and metastasis. Analyses for 18 additional patients are currently ongoing. The motion model was estimated from the planning 4DCT through deformable image registration. To predict a certain phase of a follow-up 4DCT, the modelmore » considers for inter-fractional variations (baseline correction) and intra-fractional respiratory parameters (amplitude and phase) derived from surrogates. In this evaluation, three different approaches were used to extract the motion surrogate: for each 4DCT phase, the 3D thoraco-abdominal surface motion, the body volume and the anterior-posterior motion of a virtual single external marker defined on the sternum were investigated. The estimated volumes resulting from the model were compared to the ground-truth clinical 4DCTs using absolute HU differences in the lung volume and landmarks localized using the Scale Invariant Feature Transform (SIFT). Results: The results show absolute HU differences between estimated and ground-truth images with median values limited to 55 HU and inter-quartile ranges (IQR) lower than 100 HU. Median 3D distances between about 1500 matching landmarks are below 2 mm for 3D surface motion and body volume methods. The single marker surrogates Result in increased median distances up to 0.6 mm. Analyses for the extended database incl. 20 patients are currently in progress. Conclusion: The results depend mainly on the image quality of the initial 4DCTs and the deformable image registration. All investigated surrogates can be used to estimate follow-up 4DCT phases, however uncertainties decrease for three-dimensional approaches. This work was funded in parts by the German Research Council (DFG) - KFO 214/2.« less

A Novel Respiratory Motion Perturbation Model Adaptable to Patient Breathing Irregularities

PubMed Central

Yuan, Amy; Wei, Jie; Gaebler, Carl P.; Huang, Hailiang; Olek, Devin; Li, Guang

2016-01-01

Purpose To develop a physical, adaptive motion perturbation model to predict tumor motion using feedback from dynamic measurement of breathing conditions to compensate for breathing irregularities. Methods and Materials A novel respiratory motion perturbation (RMP) model was developed to predict tumor motion variations caused by breathing irregularities. This model contained 2 terms: the initial tumor motion trajectory, measured from 4-dimensional computed tomography (4DCT) images, and motion perturbation, calculated from breathing variations in tidal volume (TV) and breathing pattern (BP). The motion perturbation was derived from the patient-specific anatomy, tumor-specific location, and time-dependent breathing variations. Ten patients were studied, and 2 amplitude-binned 4DCT images for each patient were acquired within 2 weeks. The motion trajectories of 40 corresponding bifurcation points in both 4DCT images of each patient were obtained using deformable image registration. An in-house 4D data processing toolbox was developed to calculate the TV and BP as functions of the breathing phase. The motion was predicted from the simulation 4DCT scan to the treatment 4DCT scan, and vice versa, resulting in 800 predictions. For comparison, noncorrected motion differences and the predictions from a published 5-dimensional model were used. Results The average motion range in the superoinferior direction was 9.4 ± 4.4 mm, the average ΔTV ranged from 10 to 248 mm3 (−26% to 61%), and the ΔBP ranged from 0 to 0.2 (−71% to 333%) between the 2 4DCT scans. The mean noncorrected motion difference was 2.0 ± 2.8 mm between 2 4DCT motion trajectories. After applying the RMP model, the mean motion difference was reduced significantly to 1.2 ± 1.8 mm (P = .0018), a 40% improvement, similar to the 1.2 ± 1.8 mm (P = .72) predicted with the 5-dimensional model. Conclusions A novel physical RMP model was developed with an average accuracy of 1.2 ± 1.8 mm for interfraction motion prediction, similar to that of a published lung motion model. This physical RMP was analytically derived and is able to adapt to breathing irregularities. Further improvement of this RMP model is under investigation. PMID:27745981

A Novel Respiratory Motion Perturbation Model Adaptable to Patient Breathing Irregularities

DOE Office of Scientific and Technical Information (OSTI.GOV)

Yuan, Amy; Wei, Jie; Gaebler, Carl P.

Purpose: To develop a physical, adaptive motion perturbation model to predict tumor motion using feedback from dynamic measurement of breathing conditions to compensate for breathing irregularities. Methods and Materials: A novel respiratory motion perturbation (RMP) model was developed to predict tumor motion variations caused by breathing irregularities. This model contained 2 terms: the initial tumor motion trajectory, measured from 4-dimensional computed tomography (4DCT) images, and motion perturbation, calculated from breathing variations in tidal volume (TV) and breathing pattern (BP). The motion perturbation was derived from the patient-specific anatomy, tumor-specific location, and time-dependent breathing variations. Ten patients were studied, and 2more » amplitude-binned 4DCT images for each patient were acquired within 2 weeks. The motion trajectories of 40 corresponding bifurcation points in both 4DCT images of each patient were obtained using deformable image registration. An in-house 4D data processing toolbox was developed to calculate the TV and BP as functions of the breathing phase. The motion was predicted from the simulation 4DCT scan to the treatment 4DCT scan, and vice versa, resulting in 800 predictions. For comparison, noncorrected motion differences and the predictions from a published 5-dimensional model were used. Results: The average motion range in the superoinferior direction was 9.4 ± 4.4 mm, the average ΔTV ranged from 10 to 248 mm{sup 3} (−26% to 61%), and the ΔBP ranged from 0 to 0.2 (−71% to 333%) between the 2 4DCT scans. The mean noncorrected motion difference was 2.0 ± 2.8 mm between 2 4DCT motion trajectories. After applying the RMP model, the mean motion difference was reduced significantly to 1.2 ± 1.8 mm (P=.0018), a 40% improvement, similar to the 1.2 ± 1.8 mm (P=.72) predicted with the 5-dimensional model. Conclusions: A novel physical RMP model was developed with an average accuracy of 1.2 ± 1.8 mm for interfraction motion prediction, similar to that of a published lung motion model. This physical RMP was analytically derived and is able to adapt to breathing irregularities. Further improvement of this RMP model is under investigation.« less

Assessing breathing motion by shape matching of lung and diaphragm surfaces

NASA Astrophysics Data System (ADS)

Urschler, Martin; Bischof, Horst

2005-04-01

Studying complex thorax breating motion is an important research topic for accurate fusion of functional and anatomical data, radiotherapy planning or reduction of breathing motion artifacts. We investigate segmented CT lung, airway and diaphragm surfaces at several different breathing states between Functional Residual and Total Lung Capacity. In general, it is hard to robustly derive corresponding shape features like curvature maxima from lung and diaphragm surfaces since diaphragm and rib cage muscles tend to deform the elastic lung tissue such that e.g. ridges might disappear. A novel registration method based on the shape context approach for shape matching is presented where we extend shape context to 3D surfaces. The shape context approach was reported as a promising method for matching 2D shapes without relying on extracted shape features. We use the point correspondences for a non-rigid thin-plate-spline registration to get deformation fields that describe the movement of lung and diaphragm. Our validation consists of experiments on phantom and real sheep thorax data sets. Phantom experiments make use of shapes that are manipulated with known transformations that simulate breathing behaviour. Real thorax data experiments use a data set showing lungs and diaphragm at 5 distinct breathing states, where we compare subsets of the data sets and qualitatively and quantitatively asses the registration performance by using manually identified corresponding landmarks.

Characterizing spatiotemporal information loss in sparse-sampling-based dynamic MRI for monitoring respiration-induced tumor motion in radiotherapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Arai, Tatsuya J.; Nofiele, Joris; Yuan, Qing

Purpose: Sparse-sampling and reconstruction techniques represent an attractive strategy to achieve faster image acquisition speeds, while maintaining adequate spatial resolution and signal-to-noise ratio in rapid magnetic resonance imaging (MRI). The authors investigate the use of one such sequence, broad-use linear acquisition speed-up technique (k-t BLAST) in monitoring tumor motion for thoracic and abdominal radiotherapy and examine the potential trade-off between increased sparsification (to increase imaging speed) and the potential loss of “true” information due to greater reliance on a priori information. Methods: Lung tumor motion trajectories in the superior–inferior direction, previously recorded from ten lung cancer patients, were replayed usingmore » a motion phantom module driven by an MRI-compatible motion platform. Eppendorf test tubes filled with water which serve as fiducial markers were placed in the phantom. The modeled rigid and deformable motions were collected in a coronal image slice using balanced fast field echo in conjunction with k-t BLAST. Root mean square (RMS) error was used as a metric of spatial accuracy as measured trajectories were compared to input data. The loss of spatial information was characterized for progressively increasing acceleration factor from 1 to 16; the resultant sampling frequency was increased approximately from 2.5 to 19 Hz when the principal direction of the motion was set along frequency encoding direction. In addition to the phantom study, respiration-induced tumor motions were captured from two patients (kidney tumor and lung tumor) at 13 Hz over 49 s to demonstrate the impact of high speed motion monitoring over multiple breathing cycles. For each subject, the authors compared the tumor centroid trajectory as well as the deformable motion during free breathing. Results: In the rigid and deformable phantom studies, the RMS error of target tracking at the acquisition speed of 19 Hz was approximately 0.3–0.4 mm, which was smaller than the reconstructed pixel resolution of 0.67 mm. In the patient study, the dynamic 2D MRI enabled the monitoring of cycle-to-cycle respiratory variability present in the tumor position. It was seen that the range of centroid motion as well as the area covered due to target motion during each individual respiratory cycle was underestimated compared to the entire motion range observed over multiple breathing cycles. Conclusions: The authors’ initial results demonstrate that sparse-sampling- and reconstruction-based dynamic MRI can be used to achieve adequate image acquisition speeds without significant information loss for the task of radiotherapy guidance. Such monitoring can yield spatial and temporal information superior to conventional offline and online motion capture methods used in thoracic and abdominal radiotherapy.« less

Characterizing spatiotemporal information loss in sparse-sampling-based dynamic MRI for monitoring respiration-induced tumor motion in radiotherapy.

PubMed

Arai, Tatsuya J; Nofiele, Joris; Madhuranthakam, Ananth J; Yuan, Qing; Pedrosa, Ivan; Chopra, Rajiv; Sawant, Amit

2016-06-01

Sparse-sampling and reconstruction techniques represent an attractive strategy to achieve faster image acquisition speeds, while maintaining adequate spatial resolution and signal-to-noise ratio in rapid magnetic resonance imaging (MRI). The authors investigate the use of one such sequence, broad-use linear acquisition speed-up technique (k-t BLAST) in monitoring tumor motion for thoracic and abdominal radiotherapy and examine the potential trade-off between increased sparsification (to increase imaging speed) and the potential loss of "true" information due to greater reliance on a priori information. Lung tumor motion trajectories in the superior-inferior direction, previously recorded from ten lung cancer patients, were replayed using a motion phantom module driven by an MRI-compatible motion platform. Eppendorf test tubes filled with water which serve as fiducial markers were placed in the phantom. The modeled rigid and deformable motions were collected in a coronal image slice using balanced fast field echo in conjunction with k-t BLAST. Root mean square (RMS) error was used as a metric of spatial accuracy as measured trajectories were compared to input data. The loss of spatial information was characterized for progressively increasing acceleration factor from 1 to 16; the resultant sampling frequency was increased approximately from 2.5 to 19 Hz when the principal direction of the motion was set along frequency encoding direction. In addition to the phantom study, respiration-induced tumor motions were captured from two patients (kidney tumor and lung tumor) at 13 Hz over 49 s to demonstrate the impact of high speed motion monitoring over multiple breathing cycles. For each subject, the authors compared the tumor centroid trajectory as well as the deformable motion during free breathing. In the rigid and deformable phantom studies, the RMS error of target tracking at the acquisition speed of 19 Hz was approximately 0.3-0.4 mm, which was smaller than the reconstructed pixel resolution of 0.67 mm. In the patient study, the dynamic 2D MRI enabled the monitoring of cycle-to-cycle respiratory variability present in the tumor position. It was seen that the range of centroid motion as well as the area covered due to target motion during each individual respiratory cycle was underestimated compared to the entire motion range observed over multiple breathing cycles. The authors' initial results demonstrate that sparse-sampling- and reconstruction-based dynamic MRI can be used to achieve adequate image acquisition speeds without significant information loss for the task of radiotherapy guidance. Such monitoring can yield spatial and temporal information superior to conventional offline and online motion capture methods used in thoracic and abdominal radiotherapy.

Characterizing spatiotemporal information loss in sparse-sampling-based dynamic MRI for monitoring respiration-induced tumor motion in radiotherapy

PubMed Central

Arai, Tatsuya J.; Nofiele, Joris; Madhuranthakam, Ananth J.; Yuan, Qing; Pedrosa, Ivan; Chopra, Rajiv; Sawant, Amit

2016-01-01

Purpose: Sparse-sampling and reconstruction techniques represent an attractive strategy to achieve faster image acquisition speeds, while maintaining adequate spatial resolution and signal-to-noise ratio in rapid magnetic resonance imaging (MRI). The authors investigate the use of one such sequence, broad-use linear acquisition speed-up technique (k-t BLAST) in monitoring tumor motion for thoracic and abdominal radiotherapy and examine the potential trade-off between increased sparsification (to increase imaging speed) and the potential loss of “true” information due to greater reliance on a priori information. Methods: Lung tumor motion trajectories in the superior–inferior direction, previously recorded from ten lung cancer patients, were replayed using a motion phantom module driven by an MRI-compatible motion platform. Eppendorf test tubes filled with water which serve as fiducial markers were placed in the phantom. The modeled rigid and deformable motions were collected in a coronal image slice using balanced fast field echo in conjunction with k-t BLAST. Root mean square (RMS) error was used as a metric of spatial accuracy as measured trajectories were compared to input data. The loss of spatial information was characterized for progressively increasing acceleration factor from 1 to 16; the resultant sampling frequency was increased approximately from 2.5 to 19 Hz when the principal direction of the motion was set along frequency encoding direction. In addition to the phantom study, respiration-induced tumor motions were captured from two patients (kidney tumor and lung tumor) at 13 Hz over 49 s to demonstrate the impact of high speed motion monitoring over multiple breathing cycles. For each subject, the authors compared the tumor centroid trajectory as well as the deformable motion during free breathing. Results: In the rigid and deformable phantom studies, the RMS error of target tracking at the acquisition speed of 19 Hz was approximately 0.3–0.4 mm, which was smaller than the reconstructed pixel resolution of 0.67 mm. In the patient study, the dynamic 2D MRI enabled the monitoring of cycle-to-cycle respiratory variability present in the tumor position. It was seen that the range of centroid motion as well as the area covered due to target motion during each individual respiratory cycle was underestimated compared to the entire motion range observed over multiple breathing cycles. Conclusions: The authors’ initial results demonstrate that sparse-sampling- and reconstruction-based dynamic MRI can be used to achieve adequate image acquisition speeds without significant information loss for the task of radiotherapy guidance. Such monitoring can yield spatial and temporal information superior to conventional offline and online motion capture methods used in thoracic and abdominal radiotherapy. PMID:27277029

Control of Respiratory Motion by Hypnosis Intervention during Radiotherapy of Lung Cancer I

PubMed Central

Deng, Jie; Xie, Yaoqin

2013-01-01

The uncertain position of lung tumor during radiotherapy compromises the treatment effect. To effectively control respiratory motion during radiotherapy of lung cancer without any side effects, a novel control scheme, hypnosis, has been introduced in lung cancer treatment. In order to verify the suggested method, six volunteers were selected with a wide range of distribution of age, weight, and chest circumference. A set of experiments have been conducted for each volunteer, under the guidance of the professional hypnotist. All the experiments were repeated in the same environmental condition. The amplitude of respiration has been recorded under the normal state and hypnosis, respectively. Experimental results show that the respiration motion of volunteers in hypnosis has smaller and more stable amplitudes than in normal state. That implies that the hypnosis intervention can be an alternative way for respiratory control, which can effectively reduce the respiratory amplitude and increase the stability of respiratory cycle. The proposed method will find useful application in image-guided radiotherapy. PMID:24093100

SU-E-J-182: Reproducibility of Tumor Motion Probability Distribution Function in Stereotactic Body Radiation Therapy of Lung Using Real-Time Tumor-Tracking Radiotherapy System

DOE Office of Scientific and Technical Information (OSTI.GOV)

Shiinoki, T; Hanazawa, H; Park, S

2015-06-15

Purpose: We aim to achieve new four-dimensional radiotherapy (4DRT) using the next generation real-time tumor-tracking (RTRT) system and flattening-filter-free techniques. To achieve new 4DRT, it is necessary to understand the respiratory motion of tumor. The purposes of this study were: 1.To develop the respiratory motion analysis tool using log files. 2.To evaluate the reproducibility of tumor motion probability distribution function (PDF) during stereotactic body RT (SBRT) of lung tumor. Methods: Seven patients having fiducial markers closely implanted to the lung tumor were enrolled in this study. The positions of fiducial markers were measured using the RTRT system (Mitsubishi Electronics Co.,more » JP) and recorded as two types of log files during the course of SBRT. For each patients, tumor motion range and tumor motion PDFs in left-right (LR), anterior-posterior (AP) and superior-inferior (SI) directions were calculated using log files of all beams per fraction (PDFn). Fractional PDF reproducibility (Rn) was calculated as Kullback-Leibler (KL) divergence between PDF1 and PDFn of tumor motion. The mean of Rn (Rm) was calculated for each patient and correlated to the patient’s mean tumor motion range (Am). The change of Rm during the course of SBRT was also evluated. These analyses were performed using in-house developed software. Results: The Rm were 0.19 (0.07–0.30), 0.14 (0.07–0.32) and 0.16 (0.09–0.28) in LR, AP and SI directions, respectively. The Am were 5.11 mm (2.58–9.99 mm), 7.81 mm (2.87–15.57 mm) and 11.26 mm (3.80–21.27 mm) in LR, AP and SI directions, respectively. The PDF reproducibility decreased as the tumor motion range increased in AP and SI direction. That decreased slightly through the course of RT in SI direction. Conclusion: We developed the respiratory motion analysis tool for 4DRT using log files and quantified the range and reproducibility of respiratory motion for lung tumors.« less

Quantification of lung tumor rotation with automated landmark extraction using orthogonal cine MRI images

NASA Astrophysics Data System (ADS)

Paganelli, Chiara; Lee, Danny; Greer, Peter B.; Baroni, Guido; Riboldi, Marco; Keall, Paul

2015-09-01

The quantification of tumor motion in sites affected by respiratory motion is of primary importance to improve treatment accuracy. To account for motion, different studies analyzed the translational component only, without focusing on the rotational component, which was quantified in a few studies on the prostate with implanted markers. The aim of our study was to propose a tool able to quantify lung tumor rotation without the use of internal markers, thus providing accurate motion detection close to critical structures such as the heart or liver. Specifically, we propose the use of an automatic feature extraction method in combination with the acquisition of fast orthogonal cine MRI images of nine lung patients. As a preliminary test, we evaluated the performance of the feature extraction method by applying it on regions of interest around (i) the diaphragm and (ii) the tumor and comparing the estimated motion with that obtained by (i) the extraction of the diaphragm profile and (ii) the segmentation of the tumor, respectively. The results confirmed the capability of the proposed method in quantifying tumor motion. Then, a point-based rigid registration was applied to the extracted tumor features between all frames to account for rotation. The median lung rotation values were  -0.6   ±   2.3° and  -1.5   ±   2.7° in the sagittal and coronal planes respectively, confirming the need to account for tumor rotation along with translation to improve radiotherapy treatment.

Evaluation of lung tumor motion management in radiation therapy with dynamic MRI

NASA Astrophysics Data System (ADS)

Park, Seyoun; Farah, Rana; Shea, Steven M.; Tryggestad, Erik; Hales, Russell; Lee, Junghoon

2017-03-01

Surrogate-based tumor motion estimation and tracing methods are commonly used in radiotherapy despite the lack of continuous real time 3D tumor and surrogate data. In this study, we propose a method to simultaneously track the tumor and external surrogates with dynamic MRI, which allows us to evaluate their reproducible correlation. Four MRIcompatible fiducials are placed on the patient's chest and upper abdomen, and multi-slice 2D cine MRIs are acquired to capture the lung and whole tumor, followed by two-slice 2D cine MRIs to simultaneously track the tumor and fiducials, all in sagittal orientation. A phase-binned 4D-MRI is first reconstructed from multi-slice MR images using body area as a respiratory surrogate and group-wise registration. The 4D-MRI provides 3D template volumes for different breathing phases. 3D tumor position is calculated by 3D-2D template matching in which 3D tumor templates in 4D-MRI reconstruction and the 2D cine MRIs from the two-slice tracking dataset are registered. 3D trajectories of the external surrogates are derived via matching a 3D geometrical model to the fiducial segmentations on the 2D cine MRIs. We tested our method on five lung cancer patients. Internal target volume from 4D-CT showed average sensitivity of 86.5% compared to the actual tumor motion for 5 min. 3D tumor motion correlated with the external surrogate signal, but showed a noticeable phase mismatch. The 3D tumor trajectory showed significant cycle-to-cycle variation, while the external surrogate was not sensitive enough to capture such variations. Additionally, there was significant phase mismatch between surrogate signals obtained from fiducials at different locations.

The long- and short-term variability of breathing induced tumor motion in lung and liver over the course of a radiotherapy treatment.

PubMed

Dhont, Jennifer; Vandemeulebroucke, Jef; Burghelea, Manuela; Poels, Kenneth; Depuydt, Tom; Van Den Begin, Robbe; Jaudet, Cyril; Collen, Christine; Engels, Benedikt; Reynders, Truus; Boussaer, Marlies; Gevaert, Thierry; De Ridder, Mark; Verellen, Dirk

2018-02-01

To evaluate the short and long-term variability of breathing induced tumor motion. 3D tumor motion of 19 lung and 18 liver lesions captured over the course of an SBRT treatment were evaluated and compared to the motion on 4D-CT. An implanted fiducial could be used for unambiguous motion information. Fast orthogonal fluoroscopy (FF) sequences, included in the treatment workflow, were used to evaluate motion during treatment. Several motion parameters were compared between different FF sequences from the same fraction to evaluate the intrafraction variability. To assess interfraction variability, amplitude and hysteresis were compared between fractions and with the 3D tumor motion registered by 4D-CT. Population based margins, necessary on top of the ITV to capture all motion variability, were calculated based on the motion captured during treatment. Baseline drift in the cranio-caudal (CC) or anterior-poster (AP) direction is significant (ie. >5 mm) for a large group of patients, in contrary to intrafraction amplitude and hysteresis variability. However, a correlation between intrafraction amplitude variability and mean motion amplitude was found (Pearson's correlation coefficient, r = 0.72, p < 10 -4 ). Interfraction variability in amplitude is significant for 46% of all lesions. As such, 4D-CT accurately captures the motion during treatment for some fractions but not for all. Accounting for motion variability during treatment increases the PTV margins in all directions, most significantly in CC from 5 mm to 13.7 mm for lung and 8.0 mm for liver. Both short-term and day-to-day tumor motion variability can be significant, especially for lesions moving with amplitudes above 7 mm. Abandoning passive motion management strategies in favor of more active ones is advised. Copyright © 2017 Elsevier B.V. All rights reserved.

A biomechanical modeling guided simultaneous motion estimation and image reconstruction technique (SMEIR-Bio) for 4D-CBCT reconstruction

NASA Astrophysics Data System (ADS)

Huang, Xiaokun; Zhang, You; Wang, Jing

2017-03-01

Four-dimensional (4D) cone-beam computed tomography (CBCT) enables motion tracking of anatomical structures and removes artifacts introduced by motion. However, the imaging time/dose of 4D-CBCT is substantially longer/higher than traditional 3D-CBCT. We previously developed a simultaneous motion estimation and image reconstruction (SMEIR) algorithm, to reconstruct high-quality 4D-CBCT from limited number of projections to reduce the imaging time/dose. However, the accuracy of SMEIR is limited in reconstructing low-contrast regions with fine structure details. In this study, we incorporate biomechanical modeling into the SMEIR algorithm (SMEIR-Bio), to improve the reconstruction accuracy at low-contrast regions with fine details. The efficacy of SMEIR-Bio is evaluated using 11 lung patient cases and compared to that of the original SMEIR algorithm. Qualitative and quantitative comparisons showed that SMEIR-Bio greatly enhances the accuracy of reconstructed 4D-CBCT volume in low-contrast regions, which can potentially benefit multiple clinical applications including the treatment outcome analysis.

Interplay effect on a 6-MV flattening-filter-free linear accelerator with high dose rate and fast multi-leaf collimator motion treating breast and lung phantoms.

PubMed

Netherton, Tucker; Li, Yuting; Nitsch, Paige; Shaitelman, Simona; Balter, Peter; Gao, Song; Klopp, Ann; Muruganandham, Manickam; Court, Laurence

2018-06-01

Using a new linear accelerator with high dose rate (800 MU/min), fast MLC motions (5.0 cm/s), fast gantry rotation (15 s/rotation), and 1 cm wide MLCs, we aimed to quantify the effects of complexity, arc number, and fractionation on interplay for breast and lung treatments under target motion. To study lung interplay, eight VMAT plans (1-6 arcs) and four-nine-field sliding-window IMRT plans varying in complexity were created. For the breast plans, four-four-field sliding-window IMRT plans were created. Using the Halcyon 1.0 linear accelerator, each plan was delivered five times each under sinusoidal breathing motion to a phantom with 20 implanted MOSFET detectors; MOSFET dose (cGy), delivery time, and MU/cGy values were recorded. Maximum and mean dose deviations were calculated from MOSFET data. The number of MOSFETs with at least 19 of 20 detectors agreeing with their expected dose within 5% per fraction was calculated across 10 6 iterations to model dose deviation as function of fraction number for all plan variants. To put interplay plans into clinical context, additional IMRT and VMAT plans were created and delivered for the sites of head and neck, prostate, whole brain, breast, pelvis, and lung. Average modulation and interplay effect were compared to those from conventional linear accelerators, as reported from previous studies. The mean beam modulation for plans created for the Halcyon 1.0 linear accelerator was 2.9 MU/cGy (two- to four-field IMRT breast plans), 6.2 MU/cGy (at least five-field IMRT), and 3.6 MU/cGy (four-arc VMAT). To achieve treatment plan objectives, Halcyon 1.0 VMAT plans require more arcs and modulation than VMAT on conventional linear accelerators. Maximum and mean dose deviations increased with increasing plan complexity under tumor motion for breast and lung treatments. Concerning VMAT plans under motion, maximum, and mean dose deviations were higher for one arc than for two arcs regardless of plan complexity. For plan variants with maximum dose deviations greater than 3.7%, dose deviation as a function of fraction number was protracted. For treatments on the Halcyon 1.0 linear accelerator, the convergence of dose deviation with fraction number happened more slowly than reported for conventional linear accelerators. However, if plan complexity is reduced for IMRT and if tumor motion is less than ~10-mm, interplay is greatly reduced. To minimize dose deviations across multiple fractions for dynamic targets, we recommend limiting treatment plan complexity and avoiding one-arc VMAT on the Halcyon 1.0 linear accelerator when interplay is a concern. © 2018 American Association of Physicists in Medicine.

Fetal lung apparent diffusion coefficient measurement using diffusion-weighted MRI at 3 Tesla: Correlation with gestational age.

PubMed

Afacan, Onur; Gholipour, Ali; Mulkern, Robert V; Barnewolt, Carol E; Estroff, Judy A; Connolly, Susan A; Parad, Richard B; Bairdain, Sigrid; Warfield, Simon K

2016-12-01

To evaluate the feasibility of using diffusion-weighted magnetic resonance imaging (DW-MRI) to assess the fetal lung apparent diffusion coefficient (ADC) at 3 Tesla (T). Seventy-one pregnant women (32 second trimester, 39 third trimester) were scanned with a twice-refocused Echo-planar diffusion-weighted imaging sequence with 6 different b-values in 3 orthogonal diffusion orientations at 3T. After each scan, a region-of-interest (ROI) mask was drawn to select a region in the fetal lung and an automated robust maximum likelihood estimation algorithm was used to compute the ADC parameter. The amount of motion in each scan was visually rated. When scans with unacceptable levels of motion were eliminated, the lung ADC values showed a strong association with gestational age (P < 0.01), increasing dramatically between 16 and 27 weeks and then achieving a plateau around 27 weeks. We show that to get reliable estimates of ADC values of fetal lungs, a multiple b-value acquisition, where motion is either corrected or considered, can be performed. J. Magn. Reson. Imaging 2016;44:1650-1655. © 2016 International Society for Magnetic Resonance in Medicine.

SU-F-T-560: Measurement of Dose Blurring Effect Due to Respiratory Motion for Lung Stereotactic Body Radiation Therapy (SBRT) Using Monte Carlo Based Calculation Algorithm

DOE Office of Scientific and Technical Information (OSTI.GOV)

Badkul, R; Pokhrel, D; Jiang, H

2016-06-15

Purpose: Intra-fractional tumor motion due to respiration may potentially compromise dose delivery for SBRT of lung tumors. Even sufficient margins are used to ensure there is no geometric miss of target volume, there is potential dose blurring effect may present due to motion and could impact the tumor coverage if motions are larger. In this study we investigated dose blurring effect of open fields as well as Lung SBRT patients planned using 2 non-coplanar dynamic conformal arcs(NCDCA) and few conformal beams(CB) calculated with Monte Carlo (MC) based algorithm utilizing phantom with 2D-diode array(MapCheck) and ion-chamber. Methods: SBRT lung patients weremore » planned on Brainlab-iPlan system using 4D-CT scan and ITV were contoured on MIP image set and verified on all breathing phase image sets to account for breathing motion and then 5mm margin was applied to generate PTV. Plans were created using two NCDCA and 4-5 CB 6MV photon calculated using XVMC MC-algorithm. 3 SBRT patients plans were transferred to phantom with MapCheck and 0.125cc ion-chamber inserted in the middle of phantom to calculate dose. Also open field 3×3, 5×5 and 10×10 were calculated on this phantom. Phantom was placed on motion platform with varying motion from 5, 10, 20 and 30 mm with duty cycle of 4 second. Measurements were carried out for open fields as well 3 patients plans at static and various degree of motions. MapCheck planar dose and ion-chamber reading were collected and compared with static measurements and computed values to evaluate the dosimetric effect on tumor coverage due to motion. Results: To eliminate complexity of patients plan 3 simple open fields were also measured to see the dose blurring effect with the introduction of motion. All motion measured ionchamber values were normalized to corresponding static value. For open fields 5×5 and 10×10 normalized central axis ion-chamber values were 1.00 for all motions but for 3×3 they were 1 up to 10mm motion and 0.97 and 0.87 for 20 and 30mm motion respectively. For SBRT plans central axis dose values were within 1% upto 10mm motions but decreased to average of 5% for 20mm and 8% for 30mm motion. Mapcheck comparison with static showed penumbra enlargement due to motion blurring at the edges of the field for 3×3,5×5,10×10 pass rates were 88% to 12%, 100% to 43% and 100% to 63% respectively as motion increased from 5 to 30mm. For SBRT plans MapCheck mean pass rate were decreased from 73.8% to 39.5% as motion increased from 5mm to 30mm. Conclusion: Dose blurring effect has been seen in open fields as well as SBRT lung plans using NCDCA with CB which worsens with increasing respiratory motion and decreasing field size(tumor size). To reduce this effect larger margins and appropriate motion reduction techniques should be utilized.« less

MO-FG-BRA-07: Intrafractional Motion Effect Can Be Minimized in Tomotherapy Stereotactic Body Radiotherapy (SBRT)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Price, A; Chang, S; Matney, J

2016-06-15

Purpose: Tomotherapy has unique challenges in handling intrafractional motion compared to conventional LINAC. In this study, we analyzed the impact of intrafractional motion on cumulative dosimetry using actual patient motion data and investigated real time jaw/MLC compensation approaches to minimize the motion-induced dose discrepancy in Tomotherapy SBRT treatment. Methods: Intrafractional motion data recorded in two CyberKnife lung treatment cases through fiducial tracking and two LINAC prostate cases through Calypso tracking were used in this study. For each treatment site, one representative case has an average motion (6mm) and one has a large motion (10mm for lung and 15mm for prostate).more » The cases were re-planned on Tomotherapy for SBRT. Each case was planned with 3 different jaw settings: 1cm static, 2.5cm dynamic, and 5cm dynamic. 4D dose accumulation software was developed to compute dose with the recorded motions and theoretically compensate motions by modifying original jaw and MLC to track the trajectory of the tumor. Results: PTV coverage in Tomotherapy SBRT for patients with intrafractional motion depends on motion type, amplitude and plan settings. For the prostate patient with large motion, PTV coverage changed from 97.2% (motion-free) to 47.1% (target motion-included), 96.6% to 58.5% and 96.3% to 97.8% for the 1cm static jaw, 2.5cm dynamic jaw and 5cm dynamic jaw setting, respectively. For the lung patient with large motion, PTV coverage discrepancies showed a similar trend of change. When the jaw and MLC compensation program was engaged, the motion compromised PTV coverage was recovered back to >95% for all cases and plans. All organs at risk (OAR) were spared with < 5% increase from original motion-free plans. Conclusion: Tomotherapy SBRT is less motion-impacted when 5cm dynamic jaw is used. Once the motion pattern is known, the jaw and MLC compensation program can largely minimize the compromised target coverage and OAR sparing.« less

Methods of in-vivo mouse lung micro-CT

NASA Astrophysics Data System (ADS)

Recheis, Wolfgang A.; Nixon, Earl; Thiesse, Jacqueline; McLennan, Geoffrey; Ross, Alan; Hoffman, Eric

2005-04-01

Micro-CT will have a profound influence on the accumulation of anatomical and physiological phenotypic changes in natural and transgenetic mouse models. Longitudinal studies will be greatly facilitated, allowing for a more complete and accurate description of events if in-vivo studies are accomplished. The purpose of the ongoing project is to establish a feasible and reproducible setup for in-vivo mouse lung micro-computed tomography (μCT). We seek to use in-vivo respiratory-gated μCT to follow mouse models of lung disease with subsequent recovery of the mouse. Methodologies for optimizing scanning parameters and gating for the in-vivo mouse lung are presented. A Scireq flexiVent ventilated the gas-anesthetized mice at 60 breaths/minute, 30 cm H20 PEEP, 30 ml/kg tidal volume and provided a respiratory signal to gate a Skyscan 1076 μCT. Physiologic monitoring allowed the control of vital functions and quality of anesthesia, e.g. via ECG monitoring. In contrary to longer exposure times with ex-vivo scans, scan times for in-vivo were reduced using 35μm pixel size, 158ms exposure time and 18μm pixel size, 316ms exposure time to reduce motion artifacts. Gating via spontaneous breathing was also tested. Optimal contrast resolution was achieved at 50kVp, 200μA, applying an aluminum filter (0.5mm). There were minimal non-cardiac related motion artifacts. Both 35μm and 1μm voxel size images were suitable for evaluation of the airway lumen and parenchymal density. Total scan times were 30 and 65 minutes respectively. The mice recovered following scanning protocols. In-vivo lung scanning with recovery of the mouse delivered reasonable image quality for longitudinal studies, e.g. mouse asthma models. After examining 10 mice, we conclude μCT is a feasible tool evaluating mouse models of lung pathology in longitudinal studies with increasing anatomic detail available for evaluation as one moves from in-vivo to ex-vivo studies. Further developments include automated bronchial tree segmentation and airway wall thickness measurement tools. Improvements in Hounsfield unit calibration have to be performed when the interest of the study lies in determining and quantifying parenchymal changes and rely on estimating partial volume contributions of underlying structures to voxel densities.

An anthropomorphic breathing phantom of the thorax for testing new motion mitigation techniques for pencil beam scanning proton therapy

NASA Astrophysics Data System (ADS)

Perrin, R. L.; Zakova, M.; Peroni, M.; Bernatowicz, K.; Bikis, C.; Knopf, A. K.; Safai, S.; Fernandez-Carmona, P.; Tscharner, N.; Weber, D. C.; Parkel, T. C.; Lomax, A. J.

2017-03-01

Motion-induced range changes and incorrectly placed dose spots strongly affect the quality of pencil-beam-scanned (PBS) proton therapy, especially in thoracic tumour sites, where density changes are large. Thus motion-mitigation techniques are necessary, which must be validated in a realistic patient-like geometry. We report on the development and characterisation of a dynamic, anthropomorphic, thorax phantom that can realistically mimic thoracic motions and anatomical features for verifications of proton and photon 4D treatments. The presented phantom is of an average thorax size, and consists of inflatable, deformable lungs surrounded by a skeleton and skin. A mobile ‘tumour’ is embedded in the lungs in which dosimetry devices (such as radiochromic films) can be inserted. Motion of the tumour and deformation of the thorax is controlled via a custom made pump system driving air into and out of the lungs. Comprehensive commissioning tests have been performed to evaluate the mechanical performance of the phantom, its visibility on CT and MR imaging and its feasibility for dosimetric validation of 4D proton treatments. The phantom performed well on both regular and irregular pre-programmed breathing curves, reaching peak-to-peak amplitudes in the tumour of  <20 mm. Some hysteresis in the inflation versus deflation phases was seen. All materials were clearly visualised in CT scans, and all, except the bone and lung components, were MRI visible. Radiochromic film measurements in the phantom showed that imaging for repositioning was required (as for a patient treatment). Dosimetry was feasible with Gamma Index agreements (4%/4 mm) between film dose and planned dose  >90% in the central planes of the target. The results of this study demonstrate that this anthropomorphic thorax phantom is suitable for imaging and dosimetric studies in a thoracic geometry closely-matched to lung cancer patients under realistic motion conditions.

3D dosimetric validation of motion compensation concepts in radiotherapy using an anthropomorphic dynamic lung phantom

NASA Astrophysics Data System (ADS)

Mann, P.; Witte, M.; Moser, T.; Lang, C.; Runz, A.; Johnen, W.; Berger, M.; Biederer, J.; Karger, C. P.

2017-01-01

In this study, we developed a new setup for the validation of clinical workflows in adaptive radiation therapy, which combines a dynamic ex vivo porcine lung phantom and three-dimensional (3D) polymer gel dosimetry. The phantom consists of an artificial PMMA-thorax and contains a post mortem explanted porcine lung to which arbitrary breathing patterns can be applied. A lung tumor was simulated using the PAGAT (polyacrylamide gelatin gel fabricated at atmospheric conditions) dosimetry gel, which was evaluated in three dimensions by magnetic resonance imaging (MRI). To avoid bias by reaction with oxygen and other materials, the gel was collocated inside a BAREX™ container. For calibration purposes, the same containers with eight gel samples were irradiated with doses from 0 to 7 Gy. To test the technical feasibility of the system, a small spherical dose distribution located completely within the gel volume was planned. Dose delivery was performed under static and dynamic conditions of the phantom with and without motion compensation by beam gating. To verify clinical target definition and motion compensation concepts, the entire gel volume was homogeneously irradiated applying adequate margins in case of the static phantom and an additional internal target volume in case of dynamically operated phantom without and with gated beam delivery. MR-evaluation of the gel samples and comparison of the resulting 3D dose distribution with the planned dose distribution revealed a good agreement for the static phantom. In case of the dynamically operated phantom without motion compensation, agreement was very poor while additional application of motion compensation techniques restored the good agreement between measured and planned dose. From these experiments it was concluded that the set up with the dynamic and anthropomorphic lung phantom together with 3D-gel dosimetry provides a valuable and versatile tool for geometrical and dosimetrical validation of motion compensated treatment concepts in adaptive radiotherapy.

Optimum location of external markers using feature selection algorithms for real‐time tumor tracking in external‐beam radiotherapy: a virtual phantom study

PubMed Central

Nankali, Saber; Miandoab, Payam Samadi; Baghizadeh, Amin

2016-01-01

In external‐beam radiotherapy, using external markers is one of the most reliable tools to predict tumor position, in clinical applications. The main challenge in this approach is tumor motion tracking with highest accuracy that depends heavily on external markers location, and this issue is the objective of this study. Four commercially available feature selection algorithms entitled 1) Correlation‐based Feature Selection, 2) Classifier, 3) Principal Components, and 4) Relief were proposed to find optimum location of external markers in combination with two “Genetic” and “Ranker” searching procedures. The performance of these algorithms has been evaluated using four‐dimensional extended cardiac‐torso anthropomorphic phantom. Six tumors in lung, three tumors in liver, and 49 points on the thorax surface were taken into account to simulate internal and external motions, respectively. The root mean square error of an adaptive neuro‐fuzzy inference system (ANFIS) as prediction model was considered as metric for quantitatively evaluating the performance of proposed feature selection algorithms. To do this, the thorax surface region was divided into nine smaller segments and predefined tumors motion was predicted by ANFIS using external motion data of given markers at each small segment, separately. Our comparative results showed that all feature selection algorithms can reasonably select specific external markers from those segments where the root mean square error of the ANFIS model is minimum. Moreover, the performance accuracy of proposed feature selection algorithms was compared, separately. For this, each tumor motion was predicted using motion data of those external markers selected by each feature selection algorithm. Duncan statistical test, followed by F‐test, on final results reflected that all proposed feature selection algorithms have the same performance accuracy for lung tumors. But for liver tumors, a correlation‐based feature selection algorithm, in combination with a genetic search algorithm, proved to yield best performance accuracy for selecting optimum markers. PACS numbers: 87.55.km, 87.56.Fc PMID:26894358

Optimum location of external markers using feature selection algorithms for real-time tumor tracking in external-beam radiotherapy: a virtual phantom study.

PubMed

Nankali, Saber; Torshabi, Ahmad Esmaili; Miandoab, Payam Samadi; Baghizadeh, Amin

2016-01-08

In external-beam radiotherapy, using external markers is one of the most reliable tools to predict tumor position, in clinical applications. The main challenge in this approach is tumor motion tracking with highest accuracy that depends heavily on external markers location, and this issue is the objective of this study. Four commercially available feature selection algorithms entitled 1) Correlation-based Feature Selection, 2) Classifier, 3) Principal Components, and 4) Relief were proposed to find optimum location of external markers in combination with two "Genetic" and "Ranker" searching procedures. The performance of these algorithms has been evaluated using four-dimensional extended cardiac-torso anthropomorphic phantom. Six tumors in lung, three tumors in liver, and 49 points on the thorax surface were taken into account to simulate internal and external motions, respectively. The root mean square error of an adaptive neuro-fuzzy inference system (ANFIS) as prediction model was considered as metric for quantitatively evaluating the performance of proposed feature selection algorithms. To do this, the thorax surface region was divided into nine smaller segments and predefined tumors motion was predicted by ANFIS using external motion data of given markers at each small segment, separately. Our comparative results showed that all feature selection algorithms can reasonably select specific external markers from those segments where the root mean square error of the ANFIS model is minimum. Moreover, the performance accuracy of proposed feature selection algorithms was compared, separately. For this, each tumor motion was predicted using motion data of those external markers selected by each feature selection algorithm. Duncan statistical test, followed by F-test, on final results reflected that all proposed feature selection algorithms have the same performance accuracy for lung tumors. But for liver tumors, a correlation-based feature selection algorithm, in combination with a genetic search algorithm, proved to yield best performance accuracy for selecting optimum markers.

In vivo contact kinematics and contact forces of the knee after total knee arthroplasty during dynamic weight-bearing activities.

PubMed

Varadarajan, Kartik M; Moynihan, Angela L; D'Lima, Darryl; Colwell, Clifford W; Li, Guoan

2008-07-19

Analysis of polyethylene component wear and implant loosening in total knee arthroplasty (TKA) requires precise knowledge of in vivo articular motion and loading conditions. This study presents a simultaneous in vivo measurement of tibiofemoral articular contact forces and contact kinematics in three TKA patients. These measurements were accomplished via a dual fluoroscopic imaging system and instrumented tibial implants, during dynamic single leg lunge and chair rising-sitting. The measured forces and contact locations were also used to determine mediolateral distribution of axial contact forces. Contact kinematics data showed a medial pivot during flexion of the knee, for all patients in the study. Average axial forces were higher for lunge compared to chair rising-sitting (224% vs. 187% body weight). In this study, we measured peak anteroposterior and mediolateral forces averaging 13.3% BW during lunge and 18.5% BW during chair rising-sitting. Mediolateral distributions of axial contact force were both patient and activity specific. All patients showed equitable medial-lateral loading during lunge but greater loads at the lateral compartment during chair rising-sitting. The results of this study may enable more accurate reproduction of in vivo loads and articular motion patterns in wear simulators and finite element models. This in turn may help advance our understanding of factors limiting longevity of TKA implants, such as aseptic loosening and polyethylene component wear, and enable improved TKA designs.

Continuous Positive Airway Pressure for Motion Management in Stereotactic Body Radiation Therapy to the Lung: A Controlled Pilot Study

DOE Office of Scientific and Technical Information (OSTI.GOV)

Goldstein, Jeffrey D.; Lawrence, Yaacov R.; Sackler School of Medicine, Tel Aviv University, Tel Aviv

Objective: To determine the effect of continuous positive airway pressure (CPAP) on tumor motion, lung volume, and dose to critical organs in patients receiving stereotactic body radiation therapy (SBRT) for lung tumors. Methods and Materials: After institutional review board approval in December 2013, patients with primary or secondary lung tumors referred for SBRT underwent 4-dimensional computed tomographic simulation twice: with free breathing and with CPAP. Tumor excursion was calculated by subtracting the vector of the greatest dimension of the gross tumor volume (GTV) from the internal target volume (ITV). Volumetric and dosimetric determinations were compared with the Wilcoxon signed-rank test.more » CPAP was used during treatment if judged beneficial. Results: CPAP was tolerated well in 10 of the 11 patients enrolled. Ten patients with 18 lesions were evaluated. The use of CPAP decreased tumor excursion by 0.5 ± 0.8 cm, 0.4 ± 0.7 cm, and 0.6 ± 0.8 cm in the superior–inferior, right–left, and anterior–posterior planes, respectively (P≤.02). Relative to free breathing, the mean ITV reduction was 27% (95% confidence interval [CI] 16%-39%, P<.001). CPAP significantly augmented lung volume, with a mean absolute increase of 915 ± 432 cm{sup 3} and a relative increase of 32% (95% CI 21%-42%, P=.003), contributing to a 22% relative reduction (95% CI 13%-32%, P=.001) in mean lung dose. The use of CPAP was also associated with a relative reduction in mean heart dose by 29% (95% CI 23%-36%, P=.001). Conclusion: In this pilot study, CPAP significantly reduced lung tumor motion compared with free breathing. The smaller ITV, the planning target volume (PTV), and the increase in total lung volume associated with CPAP contributed to a reduction in lung and heart dose. CPAP was well tolerated, reproducible, and simple to implement in the treatment room and should be evaluated further as a novel strategy for motion management in radiation therapy.« less

An optimized two-photon method for in vivo lung imaging reveals intimate cell collaborations during infection

NASA Astrophysics Data System (ADS)

Fiole, Daniel; Deman, Pierre; Trescos, Yannick; Douady, Julien; Tournier, Jean-Nicolas

2013-02-01

Lung tissue motion arising from breathing and heart beating has been described as the largest annoyance of in vivo imaging. Consequently, infected lung tissue has never been imaged in vivo thus far, and little is known concerning the kinetics of the mucosal immune system at the cellular level. We have developed an optimized post-processing strategy to overcome tissue motion, based upon two-photon and second harmonic generation (SHG) microscopy. In contrast to previously published data, we have freed the lung parenchyma from any strain and depression in order to maintain the lungs under optimal physiological parameters. Excitation beams swept the sample throughout normal breathing and heart movements, allowing the collection of many images. Given that tissue motion is unpredictably, it was essential to sort images of interest. This step was enhanced by using SHG signal from collagen as a reference for sampling and realignment phases. A normalized cross-correlation criterion was used between a manually chosen reference image and rigid transformations of all others. Using CX3CR1+/gfp mice this process allowed the collection of high resolution images of pulmonary dendritic cells (DCs) interacting with Bacillus anthracis spores, a Gram-positive bacteria responsible for anthrax disease. We imaged lung tissue for up to one hour, without interrupting normal lung physiology. Interestingly, our data revealed unexpected interactions between DCs and macrophages, two specialized phagocytes. These contacts may participate in a better coordinate immune response. Our results not only demonstrate the phagocytizing task of lung DCs but also infer a cooperative role of alveolar macrophages and DCs.

SU-E-J-90: Lobar-Level Lung Ventilation Analysis Using 4DCT and Deformable Image Registration

DOE Office of Scientific and Technical Information (OSTI.GOV)

Du, K; Bayouth, J; Patton, T

2015-06-15

Purpose: To assess regional changes in human lung ventilation and mechanics using four-dimensional computed tomography (4DCT) and deformable image registration. This work extends our prior analysis of the entire lung to a lobe-based analysis. Methods: 4DCT images acquired from 20 patients prior to radiation therapy (RT) were used for this analysis. Jacobian ventilation and motion maps were computed from the displacement field after deformable image registration between the end of expiration breathing phase and the end of inspiration breathing phase. The lobes were manually segmented on the reference phase by a medical physicist expert. The voxel-by-voxel ventilation and motion magnitudemore » for all subjects were grouped by lobes and plotted into cumulative voxel frequency curves respectively. In addition, to eliminate the effect of different breathing efforts across subjects, we applied the inter-subject equivalent lung volume (ELV) method on a subset of the cohort and reevaluated the lobar ventilation. Results: 95% of voxels in the lung are expanding during inspiration. However, some local regions of lung tissue show far more expansion than others. The greatest expansion with respiration occurs within the lower lobes; between exhale and inhale the median expansion in lower lobes is approximately 15%, while the median expansion in upper lobes is 10%. This appears to be driven by a subset of lung tissues within the lobe that have greater expansion; twice the number of voxels in the lower lobes (20%) expand by > 30% when compared to the upper lobes (10%). Conclusion: Lung ventilation and motion show significant difference on the lobar level. There are different lobar fractions of driving voxels that contribute to the major expansion of the lung. This work was supported by NIH grant CA166703.« less

Sound transmission in porcine thorax through airway insonification.

PubMed

Peng, Ying; Dai, Zoujun; Mansy, Hansen A; Henry, Brian M; Sandler, Richard H; Balk, Robert A; Royston, Thomas J

2016-04-01

Many pulmonary injuries and pathologies may lead to structural and functional changes in the lungs resulting in measurable sound transmission changes on the chest surface. Additionally, noninvasive imaging of externally driven mechanical wave motion in the chest (e.g., using magnetic resonance elastography) can provide information about lung structural property changes and, hence, may be of diagnostic value. In the present study, a comprehensive computational simulation (in silico) model was developed to simulate sound wave propagation in the airways, lung, and chest wall under normal and pneumothorax conditions. Experiments were carried out to validate the model. Here, sound waves with frequency content from 50 to 700 Hz were introduced into airways of five porcine subjects via an endotracheal tube, and transmitted waves were measured by scanning laser Doppler vibrometry at the chest wall surface. The computational model predictions of decreased sound transmission with pneumothorax were consistent with experimental measurements. The in silico model can also be used to visualize wave propagation inside and on the chest wall surface for other pulmonary pathologies, which may help in developing and interpreting diagnostic procedures that utilize sound and vibration.

Sound transmission in porcine thorax through airway insonification

PubMed Central

Dai, Zoujun; Mansy, Hansen A.; Henry, Brian M.; Sandler, Richard H.; Balk, Robert A.; Royston, Thomas J.

2015-01-01

Many pulmonary injuries and pathologies may lead to structural and functional changes in the lungs resulting in measurable sound transmission changes on the chest surface. Additionally, noninvasive imaging of externally driven mechanical wave motion in the chest (e.g., using magnetic resonance elastography) can provide information about lung structural property changes and, hence, may be of diagnostic value. In the present study, a comprehensive computational simulation (in silico) model was developed to simulate sound wave propagation in the airways, lung, and chest wall under normal and pneumothorax conditions. Experiments were carried out to validate the model. Here, sound waves with frequency content from 50 to 700 Hz were introduced into airways of five porcine subjects via an endotracheal tube, and transmitted waves were measured by scanning laser Doppler vibrometry at the chest wall surface. The computational model predictions of decreased sound transmission with pneumothorax were consistent with experimental measurements. The in silico model can also be used to visualize wave propagation inside and on the chest wall surface for other pulmonary pathologies, which may help in developing and interpreting diagnostic procedures that utilize sound and vibration. PMID:26280512

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lu, Bo, E-mail: luboufl@gmail.com; Park, Justin C.; Fan, Qiyong

Purpose: Accurately localizing lung tumor localization is essential for high-precision radiation therapy techniques such as stereotactic body radiation therapy (SBRT). Since direct monitoring of tumor motion is not always achievable due to the limitation of imaging modalities for treatment guidance, placement of fiducial markers on the patient’s body surface to act as a surrogate for tumor position prediction is a practical alternative for tracking lung tumor motion during SBRT treatments. In this work, the authors propose an innovative and robust model to solve the multimarker position optimization problem. The model is able to overcome the major drawbacks of the sparsemore » optimization approach (SOA) model. Methods: The principle-component-analysis (PCA) method was employed as the framework to build the authors’ statistical prediction model. The method can be divided into two stages. The first stage is to build the surrogate tumor matrix and calculate its eigenvalues and associated eigenvectors. The second stage is to determine the “best represented” columns of the eigenvector matrix obtained from stage one and subsequently acquire the optimal marker positions as well as numbers. Using 4-dimensional CT (4DCT) and breath hold CT imaging data, the PCA method was compared to the SOA method with respect to calculation time, average prediction accuracy, prediction stability, noise resistance, marker position consistency, and marker distribution. Results: The PCA and SOA methods which were both tested were on all 11 patients for a total of 130 cases including 4DCT and breath-hold CT scenarios. The maximum calculation time for the PCA method was less than 1 s with 64 752 surface points, whereas the average calculation time for the SOA method was over 12 min with 400 surface points. Overall, the tumor center position prediction errors were comparable between the two methods, and all were less than 1.5 mm. However, for the extreme scenarios (breath hold), the prediction errors for the PCA method were not only smaller, but were also more stable than for the SOA method. Results obtained by imposing a series of random noises to the surrogates indicated that the PCA method was much more noise resistant than the SOA method. The marker position consistency tests using various combinations of 4DCT phases to construct the surrogates suggested that the marker position predictions of the PCA method were more consistent than those of the SOA method, in spite of surrogate construction. Marker distribution tests indicated that greater than 80% of the calculated marker positions fell into the high cross correlation and high motion magnitude regions for both of the algorithms. Conclusions: The PCA model is an accurate, efficient, robust, and practical model for solving the multimarker position optimization problem to predict lung tumor motion during SBRT treatments. Due to its generality, PCA model can also be applied to other imaging guidance system whichever using surface motion as the surrogates.« less

TH-AB-202-05: BEST IN PHYSICS (JOINT IMAGING-THERAPY): First Online Ultrasound-Guided MLC Tracking for Real-Time Motion Compensation in Radiotherapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ipsen, S; Bruder, R; Schweikard, A

Purpose: While MLC tracking has been successfully used for motion compensation of moving targets, current real-time target localization methods rely on correlation models with x-ray imaging or implanted electromagnetic transponders rather than direct target visualization. In contrast, ultrasound imaging yields volumetric data in real-time (4D) without ionizing radiation. We report the first results of online 4D ultrasound-guided MLC tracking in a phantom. Methods: A real-time tracking framework was installed on a 4D ultrasound station (Vivid7 dimension, GE) and used to detect a 2mm spherical lead marker inside a water tank. The volumetric frame rate was 21.3Hz (47ms). The marker wasmore » rigidly attached to a motion stage programmed to reproduce nine tumor trajectories (five prostate, four lung). The 3D marker position from ultrasound was used for real-time MLC aperture adaption. The tracking system latency was measured and compensated by prediction for lung trajectories. To measure geometric accuracy, anterior and lateral conformal fields with 10cm circular aperture were delivered for each trajectory. The tracking error was measured as the difference between marker position and MLC aperture in continuous portal imaging. For dosimetric evaluation, 358° VMAT fields were delivered to a biplanar diode array dosimeter using the same trajectories. Dose measurements with and without MLC tracking were compared to a static reference dose using a 3%/3 mm γ-test. Results: The tracking system latency was 170ms. The mean root-mean-square tracking error was 1.01mm (0.75mm prostate, 1.33mm lung). Tracking reduced the mean γ-failure rate from 13.9% to 4.6% for prostate and from 21.8% to 0.6% for lung with high-modulation VMAT plans and from 5% (prostate) and 18% (lung) to 0% with low modulation. Conclusion: Real-time ultrasound tracking was successfully integrated with MLC tracking for the first time and showed similar accuracy and latency as other methods while holding the potential to measure target motion non-invasively. SI was supported by the Graduate School for Computing in Medicine and Life Science, German Excellence Initiative [grant DFG GSC 235/1].« less

An initial study on the estimation of time-varying volumetric treatment images and 3D tumor localization from single MV cine EPID images

PubMed Central

Mishra, Pankaj; Li, Ruijiang; Mak, Raymond H.; Rottmann, Joerg; Bryant, Jonathan H.; Williams, Christopher L.; Berbeco, Ross I.; Lewis, John H.

2014-01-01

Purpose: In this work the authors develop and investigate the feasibility of a method to estimate time-varying volumetric images from individual MV cine electronic portal image device (EPID) images. Methods: The authors adopt a two-step approach to time-varying volumetric image estimation from a single cine EPID image. In the first step, a patient-specific motion model is constructed from 4DCT. In the second step, parameters in the motion model are tuned according to the information in the EPID image. The patient-specific motion model is based on a compact representation of lung motion represented in displacement vector fields (DVFs). DVFs are calculated through deformable image registration (DIR) of a reference 4DCT phase image (typically peak-exhale) to a set of 4DCT images corresponding to different phases of a breathing cycle. The salient characteristics in the DVFs are captured in a compact representation through principal component analysis (PCA). PCA decouples the spatial and temporal components of the DVFs. Spatial information is represented in eigenvectors and the temporal information is represented by eigen-coefficients. To generate a new volumetric image, the eigen-coefficients are updated via cost function optimization based on digitally reconstructed radiographs and projection images. The updated eigen-coefficients are then multiplied with the eigenvectors to obtain updated DVFs that, in turn, give the volumetric image corresponding to the cine EPID image. Results: The algorithm was tested on (1) Eight digital eXtended CArdiac-Torso phantom datasets based on different irregular patient breathing patterns and (2) patient cine EPID images acquired during SBRT treatments. The root-mean-squared tumor localization error is (0.73 ± 0.63 mm) for the XCAT data and (0.90 ± 0.65 mm) for the patient data. Conclusions: The authors introduced a novel method of estimating volumetric time-varying images from single cine EPID images and a PCA-based lung motion model. This is the first method to estimate volumetric time-varying images from single MV cine EPID images, and has the potential to provide volumetric information with no additional imaging dose to the patient. PMID:25086523

An initial study on the estimation of time-varying volumetric treatment images and 3D tumor localization from single MV cine EPID images

DOE Office of Scientific and Technical Information (OSTI.GOV)

Mishra, Pankaj, E-mail: pankaj.mishra@varian.com; Mak, Raymond H.; Rottmann, Joerg

2014-08-15

Purpose: In this work the authors develop and investigate the feasibility of a method to estimate time-varying volumetric images from individual MV cine electronic portal image device (EPID) images. Methods: The authors adopt a two-step approach to time-varying volumetric image estimation from a single cine EPID image. In the first step, a patient-specific motion model is constructed from 4DCT. In the second step, parameters in the motion model are tuned according to the information in the EPID image. The patient-specific motion model is based on a compact representation of lung motion represented in displacement vector fields (DVFs). DVFs are calculatedmore » through deformable image registration (DIR) of a reference 4DCT phase image (typically peak-exhale) to a set of 4DCT images corresponding to different phases of a breathing cycle. The salient characteristics in the DVFs are captured in a compact representation through principal component analysis (PCA). PCA decouples the spatial and temporal components of the DVFs. Spatial information is represented in eigenvectors and the temporal information is represented by eigen-coefficients. To generate a new volumetric image, the eigen-coefficients are updated via cost function optimization based on digitally reconstructed radiographs and projection images. The updated eigen-coefficients are then multiplied with the eigenvectors to obtain updated DVFs that, in turn, give the volumetric image corresponding to the cine EPID image. Results: The algorithm was tested on (1) Eight digital eXtended CArdiac-Torso phantom datasets based on different irregular patient breathing patterns and (2) patient cine EPID images acquired during SBRT treatments. The root-mean-squared tumor localization error is (0.73 ± 0.63 mm) for the XCAT data and (0.90 ± 0.65 mm) for the patient data. Conclusions: The authors introduced a novel method of estimating volumetric time-varying images from single cine EPID images and a PCA-based lung motion model. This is the first method to estimate volumetric time-varying images from single MV cine EPID images, and has the potential to provide volumetric information with no additional imaging dose to the patient.« less

GIFTed Demons: deformable image registration with local structure-preserving regularization using supervoxels for liver applications

PubMed Central

Gleeson, Fergus V.; Brady, Michael; Schnabel, Julia A.

2018-01-01

Abstract. Deformable image registration, a key component of motion correction in medical imaging, needs to be efficient and provides plausible spatial transformations that reliably approximate biological aspects of complex human organ motion. Standard approaches, such as Demons registration, mostly use Gaussian regularization for organ motion, which, though computationally efficient, rule out their application to intrinsically more complex organ motions, such as sliding interfaces. We propose regularization of motion based on supervoxels, which provides an integrated discontinuity preserving prior for motions, such as sliding. More precisely, we replace Gaussian smoothing by fast, structure-preserving, guided filtering to provide efficient, locally adaptive regularization of the estimated displacement field. We illustrate the approach by applying it to estimate sliding motions at lung and liver interfaces on challenging four-dimensional computed tomography (CT) and dynamic contrast-enhanced magnetic resonance imaging datasets. The results show that guided filter-based regularization improves the accuracy of lung and liver motion correction as compared to Gaussian smoothing. Furthermore, our framework achieves state-of-the-art results on a publicly available CT liver dataset. PMID:29662918

GIFTed Demons: deformable image registration with local structure-preserving regularization using supervoxels for liver applications.

PubMed

Papież, Bartłomiej W; Franklin, James M; Heinrich, Mattias P; Gleeson, Fergus V; Brady, Michael; Schnabel, Julia A

2018-04-01

Deformable image registration, a key component of motion correction in medical imaging, needs to be efficient and provides plausible spatial transformations that reliably approximate biological aspects of complex human organ motion. Standard approaches, such as Demons registration, mostly use Gaussian regularization for organ motion, which, though computationally efficient, rule out their application to intrinsically more complex organ motions, such as sliding interfaces. We propose regularization of motion based on supervoxels, which provides an integrated discontinuity preserving prior for motions, such as sliding. More precisely, we replace Gaussian smoothing by fast, structure-preserving, guided filtering to provide efficient, locally adaptive regularization of the estimated displacement field. We illustrate the approach by applying it to estimate sliding motions at lung and liver interfaces on challenging four-dimensional computed tomography (CT) and dynamic contrast-enhanced magnetic resonance imaging datasets. The results show that guided filter-based regularization improves the accuracy of lung and liver motion correction as compared to Gaussian smoothing. Furthermore, our framework achieves state-of-the-art results on a publicly available CT liver dataset.

SU-E-J-234: Application of a Breathing Motion Model to ViewRay Cine MR Images

DOE Office of Scientific and Technical Information (OSTI.GOV)

O’Connell, D. P.; Thomas, D. H.; Dou, T. H.

2015-06-15

Purpose: A respiratory motion model previously used to generate breathing-gated CT images was used with cine MR images. Accuracy and predictive ability of the in-plane models were evaluated. Methods: Sagittalplane cine MR images of a patient undergoing treatment on a ViewRay MRI/radiotherapy system were acquired before and during treatment. Images were acquired at 4 frames/second with 3.5 × 3.5 mm resolution and a slice thickness of 5 mm. The first cine frame was deformably registered to following frames. Superior/inferior component of the tumor centroid position was used as a breathing surrogate. Deformation vectors and surrogate measurements were used to determinemore » motion model parameters. Model error was evaluated and subsequent treatment cines were predicted from breathing surrogate data. A simulated CT cine was created by generating breathing-gated volumetric images at 0.25 second intervals along the measured breathing trace, selecting a sagittal slice and downsampling to the resolution of the MR cines. A motion model was built using the first half of the simulated cine data. Model accuracy and error in predicting the remaining frames of the cine were evaluated. Results: Mean difference between model predicted and deformably registered lung tissue positions for the 28 second preview MR cine acquired before treatment was 0.81 +/− 0.30 mm. The model was used to predict two minutes of the subsequent treatment cine with a mean accuracy of 1.59 +/− 0.63 mm. Conclusion: Inplane motion models were built using MR cine images and evaluated for accuracy and ability to predict future respiratory motion from breathing surrogate measurements. Examination of long term predictive ability is ongoing. The technique was applied to simulated CT cines for further validation, and the authors are currently investigating use of in-plane models to update pre-existing volumetric motion models used for generation of breathing-gated CT planning images.« less

Four-Dimensional CT of the Diaphragm in Children: Initial Experience

PubMed Central

2018-01-01

Objective To evaluate the technical feasibility of four-dimensional (4D) CT for the functional evaluation of the pediatric diaphragm. Materials and Methods In 22 consecutive children (median age 3.5 months, age range 3 days–3 years), 4D CT was performed to assess diaphragm motion. Diaphragm abnormalities were qualitatively evaluated and diaphragm motion was quantitatively measured on 4D CT. Lung density changes between peak inspiration and expiration were measured in the basal lung parenchyma. The diaphragm motions and lung density changes measured on 4D CT were compared between various diaphragm conditions. In 11 of the 22 children, chest sonography was available for comparison. Results Four-dimensional CT demonstrated normal diaphragm (n = 8), paralysis (n = 10), eventration (n = 3), and diffusely decreased motion (n = 1). Chest sonography demonstrated normal diaphragm (n = 2), paralysis (n = 6), eventration (n = 2), and right pleural effusion (n = 1). The sonographic findings were concordant with the 4D CT findings in 90.9% (10/11) of the patients. In diaphragm paralysis, the affected diaphragm motion was significantly decreased compared with the contralateral normal diaphragm motion (−1.1 ± 2.2 mm vs. 7.6 ± 3.8 mm, p = 0.005). The normal diaphragms showed significantly greater motion than the paralyzed diaphragms (4.5 ± 2.1 mm vs. −1.1 ± 2.2 mm, p < 0.0001), while the normal diaphragm motion was significantly smaller than the motion of the contralateral normal diaphragm in paralysis (4.5 ± 2.1 mm vs. 7.6 ± 3.8 mm, p = 0.01). Basal lung density change of the affected side was significantly smaller than that of the contralateral side in diaphragm paralysis (89 ± 73 Hounsfield units [HU] vs. 180 ± 71 HU, p = 0.03), while no significant differences were found between the normal diaphragms and the paralyzed diaphragms (136 ± 66 HU vs. 89 ± 73 HU, p = 0.1) or between the normal diaphragms and the contralateral normal diaphragms in paralysis (136 ± 66 HU vs. 180 ± 71 HU, p = 0.1). Conclusion The functional evaluation of the pediatric diaphragm is feasible with 4D CT in select children. PMID:29354007

Impact of respiratory motion on worst-case scenario optimized intensity modulated proton therapy for lung cancers.

PubMed

Liu, Wei; Liao, Zhongxing; Schild, Steven E; Liu, Zhong; Li, Heng; Li, Yupeng; Park, Peter C; Li, Xiaoqiang; Stoker, Joshua; Shen, Jiajian; Keole, Sameer; Anand, Aman; Fatyga, Mirek; Dong, Lei; Sahoo, Narayan; Vora, Sujay; Wong, William; Zhu, X Ronald; Bues, Martin; Mohan, Radhe

2015-01-01

We compared conventionally optimized intensity modulated proton therapy (IMPT) treatment plans against worst-case scenario optimized treatment plans for lung cancer. The comparison of the 2 IMPT optimization strategies focused on the resulting plans' ability to retain dose objectives under the influence of patient setup, inherent proton range uncertainty, and dose perturbation caused by respiratory motion. For each of the 9 lung cancer cases, 2 treatment plans were created that accounted for treatment uncertainties in 2 different ways. The first used the conventional method: delivery of prescribed dose to the planning target volume that is geometrically expanded from the internal target volume (ITV). The second used a worst-case scenario optimization scheme that addressed setup and range uncertainties through beamlet optimization. The plan optimality and plan robustness were calculated and compared. Furthermore, the effects on dose distributions of changes in patient anatomy attributable to respiratory motion were investigated for both strategies by comparing the corresponding plan evaluation metrics at the end-inspiration and end-expiration phase and absolute differences between these phases. The mean plan evaluation metrics of the 2 groups were compared with 2-sided paired Student t tests. Without respiratory motion considered, we affirmed that worst-case scenario optimization is superior to planning target volume-based conventional optimization in terms of plan robustness and optimality. With respiratory motion considered, worst-case scenario optimization still achieved more robust dose distributions to respiratory motion for targets and comparable or even better plan optimality (D95% ITV, 96.6% vs 96.1% [P = .26]; D5%- D95% ITV, 10.0% vs 12.3% [P = .082]; D1% spinal cord, 31.8% vs 36.5% [P = .035]). Worst-case scenario optimization led to superior solutions for lung IMPT. Despite the fact that worst-case scenario optimization did not explicitly account for respiratory motion, it produced motion-resistant treatment plans. However, further research is needed to incorporate respiratory motion into IMPT robust optimization. Copyright © 2015 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.

SU-E-T-452: Impact of Respiratory Motion On Robustly-Optimized Intensity-Modulated Proton Therapy to Treat Lung Cancers

DOE Office of Scientific and Technical Information (OSTI.GOV)

Liu, W; Schild, S; Bues, M

Purpose: We compared conventionally optimized intensity-modulated proton therapy (IMPT) treatment plans against the worst-case robustly optimized treatment plans for lung cancer. The comparison of the two IMPT optimization strategies focused on the resulting plans' ability to retain dose objectives under the influence of patient set-up, inherent proton range uncertainty, and dose perturbation caused by respiratory motion. Methods: For each of the 9 lung cancer cases two treatment plans were created accounting for treatment uncertainties in two different ways: the first used the conventional Method: delivery of prescribed dose to the planning target volume (PTV) that is geometrically expanded from themore » internal target volume (ITV). The second employed the worst-case robust optimization scheme that addressed set-up and range uncertainties through beamlet optimization. The plan optimality and plan robustness were calculated and compared. Furthermore, the effects on dose distributions of the changes in patient anatomy due to respiratory motion was investigated for both strategies by comparing the corresponding plan evaluation metrics at the end-inspiration and end-expiration phase and absolute differences between these phases. The mean plan evaluation metrics of the two groups were compared using two-sided paired t-tests. Results: Without respiratory motion considered, we affirmed that worst-case robust optimization is superior to PTV-based conventional optimization in terms of plan robustness and optimality. With respiratory motion considered, robust optimization still leads to more robust dose distributions to respiratory motion for targets and comparable or even better plan optimality [D95% ITV: 96.6% versus 96.1% (p=0.26), D5% - D95% ITV: 10.0% versus 12.3% (p=0.082), D1% spinal cord: 31.8% versus 36.5% (p =0.035)]. Conclusion: Worst-case robust optimization led to superior solutions for lung IMPT. Despite of the fact that robust optimization did not explicitly account for respiratory motion it produced motion-resistant treatment plans. However, further research is needed to incorporate respiratory motion into IMPT robust optimization.« less

MO-B-201-01: Overcoming the Challenges of Motion Management in Current Lung SBRT Practice

DOE Office of Scientific and Technical Information (OSTI.GOV)

Shang, C.

The motion management in stereotactic body radiation therapy (SBRT) is a key to success for a SBRT program, and still an on-going challenging task. A major factor is that moving structures behave differently than standing structures when examined by imaging modalities, and thus require special considerations and employments. Understanding the motion effects to these different imaging processes is a prerequisite for a decent motion management program. The commonly used motion control techniques to physically restrict tumor motion, if adopted correctly, effectively increase the conformity and accuracy of hypofractionated treatment. The effective application of such requires one to understand the mechanicsmore » of the application and the related physiology especially related to respiration. The image-guided radiation beam control, or tumor tracking, further realized the endeavor for precision-targeting. During tumor tracking, the respiratory motion is often constantly monitored by non-ionizing beam sources using the body surface as its surrogate. This then has to synchronize with the actual internal tumor motion. The latter is often accomplished by stereo X-ray imaging or similar techniques. With these advanced technologies, one may drastically reduce the treated volume and increase the clinicians’ confidence for a high fractional ablative radiation dose. However, the challenges in implementing the motion management may not be trivial and is dependent on each clinic case. This session of presentations is intended to provide an overview of the current techniques used in managing the tumor motion in SBRT, specifically for routine lung SBRT, proton based treatments, and newly-developed MR guided RT. Learning Objectives: Through this presentation, the audience will understand basic roles of commonly used imaging modalities for lung cancer studies; familiarize the major advantages and limitations of each discussed motion control methods; familiarize the major advantages and limitations of each discussed radiation beam control methodology and tumor tacking method; understand the key points in motion management for a high quality SBRT program.« less

MO-B-201-02: Motion Management for Proton Lung SBR

DOE Office of Scientific and Technical Information (OSTI.GOV)

Flampouri, S.

The motion management in stereotactic body radiation therapy (SBRT) is a key to success for a SBRT program, and still an on-going challenging task. A major factor is that moving structures behave differently than standing structures when examined by imaging modalities, and thus require special considerations and employments. Understanding the motion effects to these different imaging processes is a prerequisite for a decent motion management program. The commonly used motion control techniques to physically restrict tumor motion, if adopted correctly, effectively increase the conformity and accuracy of hypofractionated treatment. The effective application of such requires one to understand the mechanicsmore » of the application and the related physiology especially related to respiration. The image-guided radiation beam control, or tumor tracking, further realized the endeavor for precision-targeting. During tumor tracking, the respiratory motion is often constantly monitored by non-ionizing beam sources using the body surface as its surrogate. This then has to synchronize with the actual internal tumor motion. The latter is often accomplished by stereo X-ray imaging or similar techniques. With these advanced technologies, one may drastically reduce the treated volume and increase the clinicians’ confidence for a high fractional ablative radiation dose. However, the challenges in implementing the motion management may not be trivial and is dependent on each clinic case. This session of presentations is intended to provide an overview of the current techniques used in managing the tumor motion in SBRT, specifically for routine lung SBRT, proton based treatments, and newly-developed MR guided RT. Learning Objectives: Through this presentation, the audience will understand basic roles of commonly used imaging modalities for lung cancer studies; familiarize the major advantages and limitations of each discussed motion control methods; familiarize the major advantages and limitations of each discussed radiation beam control methodology and tumor tacking method; understand the key points in motion management for a high quality SBRT program.« less

Development of deformable moving lung phantom to simulate respiratory motion in radiotherapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kim, Jina; Lee, Youngkyu; Shin, Hunjoo

Radiation treatment requires high accuracy to protect healthy organs and destroy the tumor. However, tumors located near the diaphragm constantly move during treatment. Respiration-gated radiotherapy has significant potential for the improvement of the irradiation of tumor sites affected by respiratory motion, such as lung and liver tumors. To measure and minimize the effects of respiratory motion, a realistic deformable phantom is required for use as a gold standard. The purpose of this study was to develop and study the characteristics of a deformable moving lung (DML) phantom, such as simulation, tissue equivalence, and rate of deformation. The rate of changemore » of the lung volume, target deformation, and respiratory signals were measured in this study; they were accurately measured using a realistic deformable phantom. The measured volume difference was 31%, which closely corresponds to the average difference in human respiration, and the target movement was − 30 to + 32 mm. The measured signals accurately described human respiratory signals. This DML phantom would be useful for the estimation of deformable image registration and in respiration-gated radiotherapy. This study shows that the developed DML phantom can exactly simulate the patient's respiratory signal and it acts as a deformable 4-dimensional simulation of a patient's lung with sufficient volume change.« less

Markerless EPID image guided dynamic multi-leaf collimator tracking for lung tumors

NASA Astrophysics Data System (ADS)

Rottmann, J.; Keall, P.; Berbeco, R.

2013-06-01

Compensation of target motion during the delivery of radiotherapy has the potential to improve treatment accuracy, dose conformity and sparing of healthy tissue. We implement an online image guided therapy system based on soft tissue localization (STiL) of the target from electronic portal images and treatment aperture adaptation with a dynamic multi-leaf collimator (DMLC). The treatment aperture is moved synchronously and in real time with the tumor during the entire breathing cycle. The system is implemented and tested on a Varian TX clinical linear accelerator featuring an AS-1000 electronic portal imaging device (EPID) acquiring images at a frame rate of 12.86 Hz throughout the treatment. A position update cycle for the treatment aperture consists of four steps: in the first step at time t = t0 a frame is grabbed, in the second step the frame is processed with the STiL algorithm to get the tumor position at t = t0, in a third step the tumor position at t = ti + δt is predicted to overcome system latencies and in the fourth step, the DMLC control software calculates the required leaf motions and applies them at time t = ti + δt. The prediction model is trained before the start of the treatment with data representing the tumor motion. We analyze the system latency with a dynamic chest phantom (4D motion phantom, Washington University). We estimate the average planar position deviation between target and treatment aperture in a clinical setting by driving the phantom with several lung tumor trajectories (recorded from fiducial tracking during radiotherapy delivery to the lung). DMLC tracking for lung stereotactic body radiation therapy without fiducial markers was successfully demonstrated. The inherent system latency is found to be δt = (230 ± 11) ms for a MV portal image acquisition frame rate of 12.86 Hz. The root mean square deviation between tumor and aperture position is smaller than 1 mm. We demonstrate the feasibility of real-time markerless DMLC tracking with a standard LINAC-mounted (EPID).

TH-AB-202-01: Daily Lung Tumor Motion Characterization On EPIDs Using a Markerless Tiling Model

DOE Office of Scientific and Technical Information (OSTI.GOV)

Rozario, T; University of Texas at Dallas, Richardson, TX; Chiu, T

Purpose: Tracking lung tumor motion in real time allows for target dose escalation while simultaneously reducing dose to sensitive structures, thus increasing local control without increasing toxicity. We present a novel intra-fractional markerless lung tumor tracking algorithm using MV treatment beam images acquired during treatment delivery. Strong signals superimposed on the tumor significantly reduced the soft tissue resolution; while different imaging modalities involved introduce global imaging discrepancies. This reduced the comparison accuracies. A simple yet elegant Tiling algorithm is reported to overcome the aforementioned issues. Methods: MV treatment beam images were acquired continuously in beam’s eye view (BEV) by anmore » electronic portal imaging device (EPID) during treatment and analyzed to obtain tumor positions on every frame. Every frame of the MV image was simulated by a composite of two components with separate digitally reconstructed radiographs (DRRs): all non-moving structures and the tumor. This Titling algorithm divides the global composite DRR and the corresponding MV projection into sub-images called tiles. Rigid registration is performed independently on tile-pairs in order to improve local soft tissue resolution. This enables the composite DRR to be transformed accurately to match the MV projection and attain a high correlation value through a pixel-based linear transformation. The highest cumulative correlation for all tile-pairs achieved over a user-defined search range indicates the 2-D coordinates of the tumor location on the MV projection. Results: This algorithm was successfully applied to cine-mode BEV images acquired during two SBRT plans delivered five times with different motion patterns to each of two phantoms. Approximately 15000 beam’s eye view images were analyzed and tumor locations were successfully identified on every projection with a maximum/average error of 1.8 mm / 1.0 mm. Conclusion: Despite the presence of strong anatomical signal overlapping with tumor images, this markerless detection algorithm accurately tracks intrafractional lung tumor motions. This project is partially supported by an Elekta research grant.« less

A margin model to account for respiration-induced tumour motion and its variability

NASA Astrophysics Data System (ADS)

Coolens, Catherine; Webb, Steve; Shirato, H.; Nishioka, K.; Evans, Phil M.

2008-08-01

In order to reduce the sensitivity of radiotherapy treatments to organ motion, compensation methods are being investigated such as gating of treatment delivery, tracking of tumour position, 4D scanning and planning of the treatment, etc. An outstanding problem that would occur with all these methods is the assumption that breathing motion is reproducible throughout the planning and delivery process of treatment. This is obviously not a realistic assumption and is one that will introduce errors. A dynamic internal margin model (DIM) is presented that is designed to follow the tumour trajectory and account for the variability in respiratory motion. The model statistically describes the variation of the breathing cycle over time, i.e. the uncertainty in motion amplitude and phase reproducibility, in a polar coordinate system from which margins can be derived. This allows accounting for an additional gating window parameter for gated treatment delivery as well as minimizing the area of normal tissue irradiated. The model was illustrated with abdominal motion for a patient with liver cancer and tested with internal 3D lung tumour trajectories. The results confirm that the respiratory phases around exhale are most reproducible and have the smallest variation in motion amplitude and phase (approximately 2 mm). More importantly, the margin area covering normal tissue is significantly reduced by using trajectory-specific margins (as opposed to conventional margins) as the angular component is by far the largest contributor to the margin area. The statistical approach to margin calculation, in addition, offers the possibility for advanced online verification and updating of breathing variation as more data become available.

Regional Lung Ventilation Analysis Using Temporally Resolved Magnetic Resonance Imaging.

PubMed

Kolb, Christoph; Wetscherek, Andreas; Buzan, Maria Teodora; Werner, René; Rank, Christopher M; Kachelrie, Marc; Kreuter, Michael; Dinkel, Julien; Heuel, Claus Peter; Maier-Hein, Klaus

We propose a computer-aided method for regional ventilation analysis and observation of lung diseases in temporally resolved magnetic resonance imaging (4D MRI). A shape model-based segmentation and registration workflow was used to create an atlas-derived reference system in which regional tissue motion can be quantified and multimodal image data can be compared regionally. Model-based temporal registration of the lung surfaces in 4D MRI data was compared with the registration of 4D computed tomography (CT) images. A ventilation analysis was performed on 4D MR images of patients with lung fibrosis; 4D MR ventilation maps were compared with corresponding diagnostic 3D CT images of the patients and 4D CT maps of subjects without impaired lung function (serving as reference). Comparison between the computed patient-specific 4D MR regional ventilation maps and diagnostic CT images shows good correlation in conspicuous regions. Comparison to 4D CT-derived ventilation maps supports the plausibility of the 4D MR maps. Dynamic MRI-based flow-volume loops and spirograms further visualize the free-breathing behavior. The proposed methods allow for 4D MR-based regional analysis of tissue dynamics and ventilation in spontaneous breathing and comparison of patient data. The proposed atlas-based reference coordinate system provides an automated manner of annotating and comparing multimodal lung image data.

Magnetic particle motions within living cells. Physical theory and techniques.

PubMed Central

Valberg, P A; Butler, J P

1987-01-01

Body tissues are not ferromagnetic, but ferromagnetic particles can be present as contaminants or as probes in the lungs and in other organs. The magnetic domains of these particles can be aligned by momentary application of an external magnetic field; the magnitude and time course of the resultant remanent field depend on the quantity of magnetic material and the degree of particle motion. The interpretation of magnetometric data requires an understanding of particle magnetization, agglomeration, random motion, and both rotation and translation in response to magnetic fields. We present physical principles relevant to magnetometry and suggest models for intracellular particle motion driven by thermal, elastic, or cellular forces. The design principles of instrumentation for magnetizing intracellular particles and for detecting weak remanent magnetic fields are described. Such magnetic measurements can be used for noninvasive studies of particle clearance from the body or of particle motion within body tissues and cells. Assumptions inherent to this experimental approach and possible sources of artifact are considered and evaluated. PMID:3676435

MO-FG-BRA-09: Towards an Optimal Breath-Holding Procedure for Radiotherapy: Differences in Organ Motion During Inhalation and Exhalation Breath-Holds

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lens, E; Gurney-Champion, O; Horst, A van der

Purpose: Breath-holding (BH) is often used to reduce organ motion during radiotherapy. The aim of this study was to determine the differences in pancreatic and diaphragmatic motion during BH between inhalation and exhalation BHs with variable lung volumes and to investigate whether motion increases/decreases during BH. Methods: Sixteen healthy volunteers were asked to perform four different 60-second BHs, from fully inflated to fully deflated lungs (i.e. lung volumes of: 100%, ∼70%, ∼30% and 0% of inspiratory capacity) three times (total of 192 BHs). During each BH, we obtained single-slice (coronal) magnetic-resonance scans with spatial resolution 0.93×0.93×8.0 mm3 and temporal resolutionmore » 0.6 s. We used 2-dimensional image correlation to obtain the motion of pancreatic head and diaphragm during BH. Motion magnitude in inferior-superior direction was obtained by determining the maximum displacement during BH. Results: Pancreatic and diaphragmatic drifts occurred during BH and were mostly in the superior direction. We observed significantly smaller pancreatic and diaphragmatic motion magnitudes in inferior-superior direction during exhalation BHs (BH{sub 30%} and BH{sub 0%}) compared to inhalation BHs (BH{sub 100%} and BH{sub 70%}). The mean motion magnitudes of the pancreatic head were 7.0, 6.5, 4.4 and 4.2 mm during BH{sub 100%}, BH{sub 70%}, BH{sub 30%} and BH{sub 0%}, respectively, and mean BH durations were 59.9, 59.1, 59.0 and 52.7 s. For the diaphragm, mean motion magnitudes were 9.8, 9.0, 5.6 and 4.3 mm, respectively. When considering 30-second BHs, as often used in the clinic, the motion was most pronounced during the first 10 s and excluding these from the analysis (yielding an effective BH period of 20 s) significantly reduced (P≤0.002) organ motion. Conclusion: Organ motion was significantly smaller during exhalation BHs compared to inhalation BHs. Also, motion was largest at the start of BH. Hence, waiting for 10 s may significantly decrease motion of the pancreas and diaphragm during treatment.« less

Magnetic Resonance Microscopy of the Lung

NASA Astrophysics Data System (ADS)

Johnson, G. Allan

1999-11-01

The lung presents both challenges and opportunities for study by magnetic resonance imaging (MRI). The technical challenges arise from respiratory and cardiac motion, limited signal from the tissues, and unique physical structure of the lung. These challenges are heightened in magnetic resonance microscopy (MRM) where the spatial resolution may be up to a million times higher than that of conventional MRI. The development of successful techniques for MRM of the lung present enormous opportunities for basic studies of lung structure and function, toxicology, environmental stress, and drug discovery by permitting investigators to study this most essential organ nondestructively in the live animal. Over the last 15 years, scientists at the Duke Center for In Vivo Microscopy have developed techniques for MRM in the live animal through an interdisciplinary program of biology, physics, chemistry, electrical engineering, and computer science. This talk will focus on the development of specialized radiofrequency coils for lung imaging, projection encoding methods to limit susceptibility losses, specialized support structures to control and monitor physiologic motion, and the most recent development of hyperpolarized gas imaging with ^3He and ^129Xe.

Margin selection to compensate for loss of target dose coverage due to target motion during external‐beam radiation therapy of the lung

PubMed Central

Osei, Ernest; Barnett, Rob

2015-01-01

The aim of this study is to provide guidelines for the selection of external‐beam radiation therapy target margins to compensate for target motion in the lung during treatment planning. A convolution model was employed to predict the effect of target motion on the delivered dose distribution. The accuracy of the model was confirmed with radiochromic film measurements in both static and dynamic phantom modes. 502 unique patient breathing traces were recorded and used to simulate the effect of target motion on a dose distribution. A 1D probability density function (PDF) representing the position of the target throughout the breathing cycle was generated from each breathing trace obtained during 4D CT. Changes in the target D95 (the minimum dose received by 95% of the treatment target) due to target motion were analyzed and shown to correlate with the standard deviation of the PDF. Furthermore, the amount of target D95 recovered per millimeter of increased field width was also shown to correlate with the standard deviation of the PDF. The sensitivity of changes in dose coverage with respect to target size was also determined. Margin selection recommendations that can be used to compensate for loss of target D95 were generated based on the simulation results. These results are discussed in the context of clinical plans. We conclude that, for PDF standard deviations less than 0.4 cm with target sizes greater than 5 cm, little or no additional margins are required. Targets which are smaller than 5 cm with PDF standard deviations larger than 0.4 cm are most susceptible to loss of coverage. The largest additional required margin in this study was determined to be 8 mm. PACS numbers: 87.53.Bn, 87.53.Kn, 87.55.D‐, 87.55.Gh

SU-E-J-80: Interplay Effect Between VMAT Intensity Modulation and Tumor Motion in Hypofractioned Lung Treatment, Investigated with 3D Pressage Dosimeter

DOE Office of Scientific and Technical Information (OSTI.GOV)

Touch, M; Duke University Medical Center, Durham, NC; Wu, Q

2014-06-01

Purpose: To demonstrate an embedded tissue equivalent presage dosimeter for measuring 3D doses in moving tumors and to study the interplay effect between the tumor motion and intensity modulation in hypofractioned Volumetric Modulated Arc Therapy(VMAT) lung treatment. Methods: Motion experiments were performed using cylindrical Presage dosimeters (5cm diameter by 7cm length) mounted inside the lung insert of a CIRS thorax phantom. Two different VMAT treatment plans were created and delivered in three different scenarios with the same prescribed dose of 18 Gy. Plan1, containing a 2 centimeter spherical CTV with an additional 2mm setup margin, was delivered on a stationarymore » phantom. Plan2 used the same CTV except expanded by 1 cm in the Sup-Inf direction to generate ITV and PTV respectively. The dosimeters were irradiated in static and variable motion scenarios on a Truebeam system. After irradiation, high resolution 3D dosimetry was performed using the Duke Large Field-of-view Optical-CT Scanner, and compared to the calculated dose from Eclipse. Results: In the control case (no motion), good agreement was observed between the planned and delivered dose distributions as indicated by 100% 3D Gamma (3% of maximum planned dose and 3mm DTA) passing rates in the CTV. In motion cases gamma passing rates was 99% in CTV. DVH comparisons also showed good agreement between the planned and delivered dose in CTV for both control and motion cases. However, differences of 15% and 5% in dose to PTV were observed in the motion and control cases respectively. Conclusion: With very high dose nature of a hypofraction treatment, significant effect was observed only motion is introduced to the target. This can be resulted from the motion of the moving target and the modulation of the MLC. 3D optical dosimetry can be of great advantage in hypofraction treatment dose validation studies.« less

On the stability of lung parenchymal lesions with applications to early pneumothorax diagnosis.

PubMed

Bhandarkar, Archis R; Banerjee, Rohan; Seshaiyer, Padmanabhan

2013-01-01

Spontaneous pneumothorax, a prevalent medical challenge in most trauma cases, is a form of sudden lung collapse closely associated with risk factors such as lung cancer and emphysema. Our work seeks to explore and quantify the currently unknown pathological factors underlying lesion rupture in pneumothorax through biomechanical modeling. We hypothesized that lesion instability is closely associated with elastodynamic strain of the pleural membrane from pulsatile air flow and collagen-elastin dynamics. Based on the principles of continuum mechanics and fluid-structure interaction, our proposed model coupled isotropic tissue deformation with pressure from pulsatile air motion and the pleural fluid. Next, we derived mathematical instability criteria for our ordinary differential equation system and then translated these mathematical instabilities to physically relevant structural instabilities via the incorporation of a finite energy limiter. The introduction of novel biomechanical descriptions for collagen-elastin dynamics allowed us to demonstrate that changes in the protein structure can lead to a transition from stable to unstable domains in the material parameter space for a general lesion. This result allowed us to create a novel streamlined algorithm for detecting material instabilities in transient lung CT scan data via analyzing deformations in a local tissue boundary.

SU-G-JeP3-13: Use of Volumetric Indices to Study the Viability of Respiratory Gating in Conjunction with Abdominal Compression in the Management of Non-Small Cell Lung Cancer Tumors Using Stereotactic Body Radiation Therapy Under the Conditions of Controlled Breathing

DOE Office of Scientific and Technical Information (OSTI.GOV)

Malhotra, H; Gomez, J

Purpose: AAPM TG-76 report advises lung patients experiencing tumor motion >5mm to use some form of motion management with even smaller limit for complex/special procedures like SBRT. Generally, either respiratory gating or abdominal compression is used for motion management. In this retrospective study, we are using an innovative index, Volumetric Indices (VI) = (GTVnn AND GTV{sub 50+}Xmm)/(GTVnn) to quantify how much of the tumor remains within 1, 2, and 3mm margins throughout the breathing cycle using GTV{sub 50+}Xmm margin on GTV{sub 50}[nn=0,10,20,…90]. Using appropriate limits, VI can provide tumor motion information and to check if RPM gates could have beenmore » used in conjunction with abdominal compression to better manage tumor motion. Methods: 64 SBRT patients with a total of 67 lung tumors were studied. 4DCT scans were taken, fully capturing tumor motion throughout the 10 phases of the breathing cycle. For each phase, Gross Tumor Volume (GTV) was segmented and appropriates structures were defined to determine VI values. For the 2mm margin, VI values less than 0.95 for peripheral lesions and 0.97 for central lesions indicate tumor movement greater than 4mm. VI values for 1mm and 3mm margins were also analyzed signifying tumor motion of 2mm & 6mm, respectively. Results: Of the 64 patients, 35 (55%) had motion greater than 4mm & could have benefited from respiratory gating. For 5/8 (63%) middle lobe lesions, 21/27 (78%) lower lobe lesions, and 10/32 (31%) upper lobe lesions, gating could have resulted in smaller ITV. 32/55 (58%) peripheral lesions and 4/12 (33%) central lesions could have had gating. Average ITV decreased by 1.25cc (11.43%) and average VI increased by 0.11. Conclusion: Out of 64 patients, 55% exhibited motion greater than 4mm even with abdominal compression. Even with abdominalcompression, lung tumors can move >4mm as the degree of pressure which a patient can tolerate, is patient specific.« less

Simultaneous tumor and surrogate motion tracking with dynamic MRI for radiation therapy planning

NASA Astrophysics Data System (ADS)

Park, Seyoun; Farah, Rana; Shea, Steven M.; Tryggestad, Erik; Hales, Russell; Lee, Junghoon

2018-01-01

Respiration-induced tumor motion is a major obstacle for achieving high-precision radiotherapy of cancers in the thoracic and abdominal regions. Surrogate-based estimation and tracking methods are commonly used in radiotherapy, but with limited understanding of quantified correlation to tumor motion. In this study, we propose a method to simultaneously track the lung tumor and external surrogates to evaluate their spatial correlation in a quantitative way using dynamic MRI, which allows real-time acquisition without ionizing radiation exposure. To capture the lung and whole tumor, four MRI-compatible fiducials are placed on the patient’s chest and upper abdomen. Two different types of acquisitions are performed in the sagittal orientation including multi-slice 2D cine MRIs to reconstruct 4D-MRI and two-slice 2D cine MRIs to simultaneously track the tumor and fiducials. A phase-binned 4D-MRI is first reconstructed from multi-slice MR images using body area as a respiratory surrogate and groupwise registration. The 4D-MRI provides 3D template volumes for different breathing phases. 3D tumor position is calculated by 3D-2D template matching in which 3D tumor templates in the 4D-MRI reconstruction and the 2D cine MRIs from the two-slice tracking dataset are registered. 3D trajectories of the external surrogates are derived via matching a 3D geometrical model of the fiducials to their segmentations on the 2D cine MRIs. We tested our method on ten lung cancer patients. Using a correlation analysis, the 3D tumor trajectory demonstrates a noticeable phase mismatch and significant cycle-to-cycle motion variation, while the external surrogate was not sensitive enough to capture such variations. Additionally, there was significant phase mismatch between surrogate signals obtained from the fiducials at different locations.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hu, L; Yin, F; Cai, J

Purpose: To develop a methodology of constructing physiological-based virtual thorax phantom based on hyperpolarized (HP) gas tagging MRI for evaluating deformable image registration (DIR). Methods: Three healthy subjects were imaged at both the end-of-inhalation (EOI) and the end-of-exhalation (EOE) phases using a high-resolution (2.5mm isovoxel) 3D proton MRI, as well as a hybrid MRI which combines HP gas tagging MRI and a low-resolution (4.5mm isovoxel) proton MRI. A sparse tagging displacement vector field (tDVF) was derived from the HP gas tagging MRI by tracking the displacement of tagging grids between EOI and EOE. Using the tDVF and the high-resolution MRmore » images, we determined the motion model of the entire thorax in the following two steps: 1) the DVF inside of lungs was estimated based on the sparse tDVF using a novel multi-step natural neighbor interpolation method; 2) the DVF outside of lungs was estimated from the DIR between the EOI and EOE images (Velocity AI). The derived motion model was then applied to the high-resolution EOI image to create a deformed EOE image, forming the virtual phantom where the motion model provides the ground truth of deformation. Five DIR methods were evaluated using the developed virtual phantom. Errors in DVF magnitude (Em) and angle (Ea) were determined and compared for each DIR method. Results: Among the five DIR methods, free form deformation produced DVF results that are most closely resembling the ground truth (Em=1.04mm, Ea=6.63°). The two DIR methods based on B-spline produced comparable results (Em=2.04mm, Ea=13.66°; and Em =2.62mm, Ea=17.67°), and the two optical-flow methods produced least accurate results (Em=7.8mm; Ea=53.04°; Em=4.45mm, Ea=31.02°). Conclusion: A methodology for constructing physiological-based virtual thorax phantom based on HP gas tagging MRI has been developed. Initial evaluation demonstrated its potential as an effective tool for robust evaluation of DIR in the lung.« less

Respiratory gating during stereotactic body radiotherapy for lung cancer reduces tumor position variability.

PubMed

Saito, Tetsuo; Matsuyama, Tomohiko; Toya, Ryo; Fukugawa, Yoshiyuki; Toyofuku, Takamasa; Semba, Akiko; Oya, Natsuo

2014-01-01

We evaluated the effects of respiratory gating on treatment accuracy in lung cancer patients undergoing lung stereotactic body radiotherapy by using electronic portal imaging device (EPID) images. Our study population consisted of 30 lung cancer patients treated with stereotactic body radiotherapy (48 Gy/4 fractions/4 to 9 days). Of these, 14 were treated with- (group A) and 16 without gating (group B); typically the patients whose tumors showed three-dimensional respiratory motion ≧5 mm were selected for gating. Tumor respiratory motion was estimated using four-dimensional computed tomography images acquired during treatment simulation. Tumor position variability during all treatment sessions was assessed by measuring the standard deviation (SD) and range of tumor displacement on EPID images. The two groups were compared for tumor respiratory motion and position variability using the Mann-Whitney U test. The median three-dimensional tumor motion during simulation was greater in group A than group B (9 mm, range 3-30 mm vs. 2 mm, range 0-4 mm; p<0.001). In groups A and B the median SD of the tumor position was 1.1 mm and 0.9 mm in the craniocaudal- (p = 0.24) and 0.7 mm and 0.6 mm in the mediolateral direction (p = 0.89), respectively. The median range of the tumor position was 4.0 mm and 3.0 mm in the craniocaudal- (p = 0.21) and 2.0 mm and 1.5 mm in the mediolateral direction (p = 0.20), respectively. Although patients treated with respiratory gating exhibited greater respiratory tumor motion during treatment simulation, tumor position variability in the EPID images was low and comparable to patients treated without gating. This demonstrates the benefit of respiratory gating.

Towards fluoroscopic respiratory gating for lung tumours without radiopaque markers

NASA Astrophysics Data System (ADS)

Berbeco, Ross I.; Mostafavi, Hassan; Sharp, Gregory C.; Jiang, Steve B.

2005-10-01

Due to the risk of pneumothorax, many clinicians are reluctant to implant radiopaque markers within patients' lungs for the purpose of radiographic or fluoroscopic tumour localization. We propose a method of gated therapy using fluoroscopic information without the implantation of radiopaque markers. The method presented here does not rely on any external motion signal either. Breathing phase information is found by analysing the fluoroscopic intensity fluctuations in the lung. As the lungs fill/empty, the radiological pathlength through them shortens/lengthens, giving brighter/darker fluoroscopic intensities. The phase information is combined with motion-enhanced template matching to turn the beam on when the tumour is in the desired location. A study based on patient data is presented to demonstrate the feasibility of this procedure. The resulting beam-on pattern is similar to that produced by an external gating system. The only discrepancies occur briefly and at the gate edges.

A motion phantom study on helical tomotherapy: the dosimetric impacts of delivery technique and motion

NASA Astrophysics Data System (ADS)

Kanagaki, Brian; Read, Paul W.; Molloy, Janelle A.; Larner, James M.; Sheng, Ke

2007-01-01

Helical tomotherapy (HT) can potentially be used for lung cancer treatment including stereotactic radiosurgery because of its advanced image guidance and its ability to deliver highly conformal dose distributions. However, previous theoretical and simulation studies reported that the effect of respiratory motion on statically planned tomotherapy treatments may cause substantial differences between the calculated and actual delivered radiation isodose distribution, particularly when the treatment is hypofractionated. In order to determine the dosimetric effects of motion upon actual HT treatment delivery, phantom film dosimetry measurements were performed under static and moving conditions using a clinical HT treatment unit. The motion phantom system was constructed using a programmable motor, a base, a moving platform and a life size lung heterogeneity phantom with wood inserts representing lung tissue with a 3.0 cm diameter spherical tumour density equivalent insert. In order to determine the effects of different motion and tomotherapy delivery parameters, treatment plans were created using jaw sizes of 1.04 cm and 2.47 cm, with incremental gantry rotation periods between the minimum allowed (10 s) and the maximum allowed (60 s). The couch speed varied from 0.009 cm s-1 to 0.049 cm s-1, and delivered to a phantom under static and dynamic conditions with peak-to-peak motion amplitudes of 1.2 cm and 2 cm and periods of 3 and 5 s to simulate human respiratory motion of lung tumours. A cylindrical clinical target volume (CTV) was contoured to tightly enclose the tumour insert. 2.0 Gy was prescribed to 95% of the CTV. Two-dimensional dose was measured by a Kodak EDR2 film. Dynamic phantom doses were then quantitatively compared to static phantom doses in terms of axial dose profiles, cumulative dose volume histograms (DVH), percentage of CTV receiving the prescription dose and the minimum dose received by 95% of the CTV. The larger motion amplitude resulted in more under-dosing at the ends of the CTV in the axis of motion, and this effect was greater for the smaller jaw size plans. Due to the size of the penumbra, the 2.47 cm jaw plans provide adequate coverage for smaller amplitudes of motion, ±0.6 cm in our experiment, without adding any additional margin in the axis of motion to the treatment volume. The periodic heterogeneous patterns described by previous studies were not observed from the single fraction of the phantom measurement. Besides the jaw sizes, CTV dose coverage is not significantly dependent on machine and phantom motion periods. The lack of adverse synchronization patterns from both results validate that HT is a safe technique for treating moving target and hypofractionation.

Wavelet-space correlation imaging for high-speed MRI without motion monitoring or data segmentation.

PubMed

Li, Yu; Wang, Hui; Tkach, Jean; Roach, David; Woods, Jason; Dumoulin, Charles

2015-12-01

This study aims to (i) develop a new high-speed MRI approach by implementing correlation imaging in wavelet-space, and (ii) demonstrate the ability of wavelet-space correlation imaging to image human anatomy with involuntary or physiological motion. Correlation imaging is a high-speed MRI framework in which image reconstruction relies on quantification of data correlation. The presented work integrates correlation imaging with a wavelet transform technique developed originally in the field of signal and image processing. This provides a new high-speed MRI approach to motion-free data collection without motion monitoring or data segmentation. The new approach, called "wavelet-space correlation imaging", is investigated in brain imaging with involuntary motion and chest imaging with free-breathing. Wavelet-space correlation imaging can exceed the speed limit of conventional parallel imaging methods. Using this approach with high acceleration factors (6 for brain MRI, 16 for cardiac MRI, and 8 for lung MRI), motion-free images can be generated in static brain MRI with involuntary motion and nonsegmented dynamic cardiac/lung MRI with free-breathing. Wavelet-space correlation imaging enables high-speed MRI in the presence of involuntary motion or physiological dynamics without motion monitoring or data segmentation. © 2014 Wiley Periodicals, Inc.

Wavelet-space Correlation Imaging for High-speed MRI without Motion Monitoring or Data Segmentation

PubMed Central

Li, Yu; Wang, Hui; Tkach, Jean; Roach, David; Woods, Jason; Dumoulin, Charles

2014-01-01

Purpose This study aims to 1) develop a new high-speed MRI approach by implementing correlation imaging in wavelet-space, and 2) demonstrate the ability of wavelet-space correlation imaging to image human anatomy with involuntary or physiological motion. Methods Correlation imaging is a high-speed MRI framework in which image reconstruction relies on quantification of data correlation. The presented work integrates correlation imaging with a wavelet transform technique developed originally in the field of signal and image processing. This provides a new high-speed MRI approach to motion-free data collection without motion monitoring or data segmentation. The new approach, called “wavelet-space correlation imaging”, is investigated in brain imaging with involuntary motion and chest imaging with free-breathing. Results Wavelet-space correlation imaging can exceed the speed limit of conventional parallel imaging methods. Using this approach with high acceleration factors (6 for brain MRI, 16 for cardiac MRI and 8 for lung MRI), motion-free images can be generated in static brain MRI with involuntary motion and nonsegmented dynamic cardiac/lung MRI with free-breathing. Conclusion Wavelet-space correlation imaging enables high-speed MRI in the presence of involuntary motion or physiological dynamics without motion monitoring or data segmentation. PMID:25470230

SU-D-18A-07: Towards 6-Degree-Of-Freedom Real-Time Motion Management in Cancer Radiotherapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Huang, C.Y.; Keall, P; Nasehi Tehrani, J

2014-06-01

Purpose: Lung tumor motion has been identified as a major issue that deteriorates treatment efficacy for radiotherapy, especially for SBRT. As tighter PTV margins are applied due to translational compensation, tumor rotation will become the dominant factor limiting tumor targeting accuracy. This is the world-first study quantifies lung tumor rotation by utilizing kV images with fiducial markers and a step towards 6-degree-of-freedom real-time cancer radiotherapy. Methods: Three or four gold coils were implanted as tumor surrogates in 3 lung cancer patients. 50 fractions of 8- minute, 10 Hz 4D CBCT projections were acquired for the patients immediately prior or aftermore » radiotherapy. The fiducial marker positions are segmented, reconstructed and used to determine tumour rotation by the iterative closest point algorithm. Different data acceptance and filtering methods were applied to accept data or smooth the marker trajectory. Results: The average rotation angles around the left/ right (LR), superior/inferior (SI), anterior/posterior (AP) rotations were found to be 0.8±4.2, -0.8±4.5 and 1.7±3.1 degrees respectively. For 28% of the treatment time, the lung tumors rotated more than 5° around the SI axis. Respiration-induced rotational motion was detected in 2 of the 3 lung patients. This can be explained by the patient developed atelectasis during the treatment period. Interestingly, no heart beating component of rotation was observed in the power spectrum. Different rotational types were observed within the patient cohort with large variations in the magnitude of the rotation between patients. Conclusions: For the first time, continuous tumor rotation has been measured for lung patients with gold fiducial markers. Tumors were found to undergo rotations of more than 5° for almost a third of the total treatment time. The study also demonstrated the feasibility of using continuously kV images for real-time lung tumour motion adaptive radiotherapy which can potentially reduce treatment margins and side effects. The authors acknowledge the financial support of an NHMRC Australia Fellowship.« less

Investigation of pulmonary acoustic simulation: comparing airway model generation techniques

NASA Astrophysics Data System (ADS)

Henry, Brian; Dai, Zoujun; Peng, Ying; Mansy, Hansen A.; Sandler, Richard H.; Royston, Thomas

2014-03-01

Alterations in the structure and function of the pulmonary system that occur in disease or injury often give rise to measurable spectral, spatial and/or temporal changes in lung sound production and transmission. These changes, if properly quantified, might provide additional information about the etiology, severity and location of trauma, injury, or pathology. With this in mind, the authors are developing a comprehensive computer simulation model of pulmonary acoustics, known as The Audible Human Project™. Its purpose is to improve our understanding of pulmonary acoustics and to aid in interpreting measurements of sound and vibration in the lungs generated by airway insonification, natural breath sounds, and external stimuli on the chest surface, such as that used in elastography. As a part of this development process, finite element (FE) models were constructed of an excised pig lung that also underwent experimental studies. Within these models, the complex airway structure was created via two methods: x-ray CT image segmentation and through an algorithmic means called Constrained Constructive Optimization (CCO). CCO was implemented to expedite the segmentation process, as airway segments can be grown digitally. These two approaches were used in FE simulations of the surface motion on the lung as a result of sound input into the trachea. Simulation results were compared to experimental measurements. By testing how close these models are to experimental measurements, we are evaluating whether CCO can be used as a means to efficiently construct physiologically relevant airway trees.

Six Degrees-of-Freedom Prostate and Lung Tumor Motion Measurements Using Kilovoltage Intrafraction Monitoring

DOE Office of Scientific and Technical Information (OSTI.GOV)

Huang, Chen-Yu; Tehrani, Joubin Nasehi; Ng, Jin Aun

2015-02-01

Purpose: Tumor positional uncertainty has been identified as a major issue that deteriorates the efficacy of radiation therapy. Tumor rotational movement, which is not well understood, can result in significant geometric and dosimetric inaccuracies. The objective of this study was to measure 6 degrees-of-freedom (6 DoF) prostate and lung tumor motion, focusing on the more novel rotation, using kilovoltage intrafraction monitoring (KIM). Methods and Materials: Continuous kilovoltage (kV) projections of tumors with gold fiducial markers were acquired during radiation therapy for 267 fractions from 10 prostate cancer patients and immediately before or after radiation therapy for 50 fractions from 3more » lung cancer patients. The 6 DoF motion measurements were determined from the individual 3-dimensional (3D) marker positions, after using methods to reject spurious and smooth noisy data, using an iterative closest point algorithm. Results: There were large variations in the magnitude of the tumor rotation among different fractions and patients. Various rotational patterns were observed. The average prostate rotation angles around the left-right (LR), superior-inferior (SI), and anterior-posterior (AP) axes were 1.0 ± 5.0°, 0.6 ± 3.3°, and 0.3 ± 2.0°, respectively. For 35% of the time, the prostate rotated more than 5° about the LR axis, indicating the need for intrafractional adaptation during radiation delivery. For lung patients, the average LR, SI, and AP rotation angles were 0.8 ± 4.2°, −0.8 ± 4.5°, and 1.7 ± 3.1°, respectively. For about 30% of the time, the lung tumors rotated more than 5° around the SI axis. Respiration-induced rotation was detected in 2 of the 3 lung patients. Conclusions: The prostate and lung tumors were found to undergo rotations of more than 5° for about a third of the time. The lung tumor data represent the first 6 DoF tumor motion measured by kV images. The 6 DoF KIM method can enable rotational and translational adaptive radiation therapy and potentially reduce treatment margins.« less

WE-AB-303-08: Direct Lung Tumor Tracking Using Short Imaging Arcs

DOE Office of Scientific and Technical Information (OSTI.GOV)

Shieh, C; Huang, C; Keall, P

2015-06-15

Purpose: Most current tumor tracking technologies rely on implanted markers, which suffer from potential toxicity of marker placement and mis-targeting due to marker migration. Several markerless tracking methods have been proposed: these are either indirect methods or have difficulties tracking lung tumors in most clinical cases due to overlapping anatomies in 2D projection images. We propose a direct lung tumor tracking algorithm robust to overlapping anatomies using short imaging arcs. Methods: The proposed algorithm tracks the tumor based on kV projections acquired within the latest six-degree imaging arc. To account for respiratory motion, an external motion surrogate is used tomore » select projections of the same phase within the latest arc. For each arc, the pre-treatment 4D cone-beam CT (CBCT) with tumor contours are used to estimate and remove the contribution to the integral attenuation from surrounding anatomies. The position of the tumor model extracted from 4D CBCT of the same phase is then optimized to match the processed projections using the conjugate gradient method. The algorithm was retrospectively validated on two kV scans of a lung cancer patient with implanted fiducial markers. This patient was selected as the tumor is attached to the mediastinum, representing a challenging case for markerless tracking methods. The tracking results were converted to expected marker positions and compared with marker trajectories obtained via direct marker segmentation (ground truth). Results: The root-mean-squared-errors of tracking were 0.8 mm and 0.9 mm in the superior-inferior direction for the two scans. Tracking error was found to be below 2 and 3 mm for 90% and 98% of the time, respectively. Conclusions: A direct lung tumor tracking algorithm robust to overlapping anatomies was proposed and validated on two scans of a lung cancer patient. Sub-millimeter tracking accuracy was observed, indicating the potential of this algorithm for real-time guidance applications.« less

Time-Adjusted Internal Target Volume: A Novel Approach Focusing on Heterogeneity of Tumor Motion Based on 4-Dimensional Computed Tomography Imaging for Radiation Therapy Planning of Lung Cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Nishibuchi, Ikuno; Department of Radiation Oncology, Hiroshima Prefectural Hospital, Hiroshima; Kimura, Tomoki, E-mail: tkkimura@hiroshima-u.ac.jp

2014-08-01

Purpose: To consider nonuniform tumor motion within the internal target volume (ITV) by defining time-adjusted ITV (TTV), a volume designed to include heterogeneity of tumor existence on the basis of 4-dimensional computed tomography (4D-CT). Methods and Materials: We evaluated 30 lung cancer patients. Breath-hold CT (BH-CT) and free-breathing 4D-CT scans were acquired for each patient. The tumors were manually delineated using a lung CT window setting (window, 1600 HU; level, −300 HU). Tumor in BH-CT images was defined as gross tumor volume (GTV), and the sum of tumors in 4D-CT images was defined as ITV-4D. The TTV images were generatedmore » from the 4D-CT datasets, and the tumor existence probability within ITV-4D was calculated. We calculated the TTV{sub 80} value, which is the percentage of the volume with a tumor existence probability that exceeded 80% on ITV-4D. Several factors that affected the TTV{sub 80} value, such as the ITV-4D/GTV ratio or tumor centroid deviation, were evaluated. Results: Time-adjusted ITV images were acquired for all patients, and tumor respiratory motion heterogeneity was visualized. The median (range) ITV-4D/GTV ratio and median tumor centroid deviation were 1.6 (1.0-4.1) and 6.3 mm (0.1-30.3 mm), respectively. The median TTV{sub 80} value was 43.3% (2.9-98.7%). Strong correlations were observed between the TTV{sub 80} value and the ITV-4D/GTV ratio (R=−0.71) and tumor centroid deviation (R=−0.72). The TTV images revealed the tumor motion pattern features within ITV. Conclusions: The TTV images reflected nonuniform tumor motion, and they revealed the tumor motion pattern features, suggesting that the TTV concept may facilitate various aspects of radiation therapy planning of lung cancer while incorporating respiratory motion in the future.« less

Sci-Thur PM: YIS - 03: Comparing 4D-VMAT, Gated-VMAT and 3D-VMAT in SBRT treatment of lung cancer.

PubMed

Chin, E; Loewen, S; Nichol, A; Otto, K

2012-07-01

To evaluate the treatment plan qualities of 4D-VMAT, gated-VMAT and 3D-VMAT in the treatment of non-small cell lung cancer (NSCLC) in stereotactic body radiation therapy (SBRT). 4D-VMAT is a motion compensation strategy that aims to exploit relative target and OAR motion to increase OAR sparing over 3D-VMAT without the long treatment times associated with gated-VMAT. The 4D-VMAT algorithm incorporates the entire patient respiratory cycle and 4D-CT in the optimization process. Resulting treatment plans synchronize the delivery of each MLC aperture to a specific phase of the target motion. Using software developed in Matlab™, SBRT treatment plans for 4D-VMAT, gated-VMAT and 3D-VMAT were generated on 3 patients with NSCLC. Tumour motion ranged from 1.4-3.4 cm. The fractionation scheme was 48Gy in 4 fractions with the GTV receiving 100% of the prescribed dose. For gated-VMAT, the treatment window constrained residual tumour motion to 3 mm or less corresponding to duty cycles of 40-60%. In 3D-VMAT, the ITV was generated by merging the GTV from all phases. A b-spline transformation model was used to register the 4D-CT images and DVHs were calculated from total dose accumulated on the max expiration phase. For the majority of OARs, gated-VMAT provided the greatest radiation sparing but significantly extended treatment times (25-35 gantry interruptions/arc). For 3D-VMAT, only 2 patients had clinically acceptable plans that met all the strict dose limits. OAR sparing in 4D-VMAT was comparable to gated-VMAT but with significantly improved delivery efficiency. © 2012 American Association of Physicists in Medicine.

An ovine in vivo framework for tracheobronchial stent analysis.

PubMed

McGrath, Donnacha J; Thiebes, Anja Lena; Cornelissen, Christian G; O'Shea, Mary B; O'Brien, Barry; Jockenhoevel, Stefan; Bruzzi, Mark; McHugh, Peter E

2017-10-01

Tracheobronchial stents are most commonly used to restore patency to airways stenosed by tumour growth. Currently all tracheobronchial stents are associated with complications such as stent migration, granulation tissue formation, mucous plugging and stent strut fracture. The present work develops a computational framework to evaluate tracheobronchial stent designs in vivo. Pressurised computed tomography is used to create a biomechanical lung model which takes into account the in vivo stress state, global lung deformation and local loading from pressure variation. Stent interaction with the airway is then evaluated for a number of loading conditions including normal breathing, coughing and ventilation. Results of the analysis indicate that three of the major complications associated with tracheobronchial stents can potentially be analysed with this framework, which can be readily applied to the human case. Airway deformation caused by lung motion is shown to have a significant effect on stent mechanical performance, including implications for stent migration, granulation formation and stent fracture.

Anthropomorphic thorax phantom for cardio-respiratory motion simulation in tomographic imaging

NASA Astrophysics Data System (ADS)

Bolwin, Konstantin; Czekalla, Björn; Frohwein, Lynn J.; Büther, Florian; Schäfers, Klaus P.

2018-02-01

Patient motion during medical imaging using techniques such as computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET), or single emission computed tomography (SPECT) is well known to degrade images, leading to blurring effects or severe artifacts. Motion correction methods try to overcome these degrading effects. However, they need to be validated under realistic conditions. In this work, a sophisticated anthropomorphic thorax phantom is presented that combines several aspects of a simulator for cardio-respiratory motion. The phantom allows us to simulate various types of cardio-respiratory motions inside a human-like thorax, including features such as inflatable lungs, beating left ventricular myocardium, respiration-induced motion of the left ventricle, moving lung lesions, and moving coronary artery plaques. The phantom is constructed to be MR-compatible. This means that we can not only perform studies in PET, SPECT and CT, but also inside an MRI system. The technical features of the anthropomorphic thorax phantom Wilhelm are presented with regard to simulating motion effects in hybrid emission tomography and radiotherapy. This is supplemented by a study on the detectability of small coronary plaque lesions in PET/CT under the influence of cardio-respiratory motion, and a study on the accuracy of left ventricular blood volumes.

Effect of respiratory gating on reducing lung motion artifacts in PET imaging of lung cancer.

PubMed

Nehmeh, S A; Erdi, Y E; Ling, C C; Rosenzweig, K E; Squire, O D; Braban, L E; Ford, E; Sidhu, K; Mageras, G S; Larson, S M; Humm, J L

2002-03-01

Positron emission tomography (PET) has shown an increase in both sensitivity and specificity over computed tomography (CT) in lung cancer. However, motion artifacts in the 18F fluorodioxydoglucose (FDG) PET images caused by respiration persists to be an important factor in degrading PET image quality and quantification. Motion artifacts lead to two major effects: First, it affects the accuracy of quantitation, producing a reduction of the measured standard uptake value (SUV). Second, the apparent lesion volume is overestimated. Both impact upon the usage of PET images for radiation treatment planning. The first affects the visibility, or contrast, of the lesion. The second results in an increase in the planning target volume, and consequently a greater radiation dose to the normal tissues. One way to compensate for this effect is by applying a multiple-frame capture technique. The PET data are then acquired in synchronization with the respiratory motion. Reduction in smearing due to gating was investigated in both phantoms and patient studies. Phantom studies showed a dependence of the reduction in smearing on the lesion size, the motion amplitude, and the number of bins used for data acquisition. These studies also showed an improvement in the target-to-background ratio, and a more accurate measurement of the SUV. When applied to one patient, respiratory gating showed a 28% reduction in the total lesion volume, and a 56.5% increase in the SUV. This study was conducted as a proof of principle that a gating technique can effectively reduce motion artifacts in PET image acquisition.

Pulmonary imaging using respiratory motion compensated simultaneous PET/MR

PubMed Central

Dutta, Joyita; Huang, Chuan; Li, Quanzheng; El Fakhri, Georges

2015-01-01

Purpose: Pulmonary positron emission tomography (PET) imaging is confounded by blurring artifacts caused by respiratory motion. These artifacts degrade both image quality and quantitative accuracy. In this paper, the authors present a complete data acquisition and processing framework for respiratory motion compensated image reconstruction (MCIR) using simultaneous whole body PET/magnetic resonance (MR) and validate it through simulation and clinical patient studies. Methods: The authors have developed an MCIR framework based on maximum a posteriori or MAP estimation. For fast acquisition of high quality 4D MR images, the authors developed a novel Golden-angle RAdial Navigated Gradient Echo (GRANGE) pulse sequence and used it in conjunction with sparsity-enforcing k-t FOCUSS reconstruction. The authors use a 1D slice-projection navigator signal encapsulated within this pulse sequence along with a histogram-based gate assignment technique to retrospectively sort the MR and PET data into individual gates. The authors compute deformation fields for each gate via nonrigid registration. The deformation fields are incorporated into the PET data model as well as utilized for generating dynamic attenuation maps. The framework was validated using simulation studies on the 4D XCAT phantom and three clinical patient studies that were performed on the Biograph mMR, a simultaneous whole body PET/MR scanner. Results: The authors compared MCIR (MC) results with ungated (UG) and one-gate (OG) reconstruction results. The XCAT study revealed contrast-to-noise ratio (CNR) improvements for MC relative to UG in the range of 21%–107% for 14 mm diameter lung lesions and 39%–120% for 10 mm diameter lung lesions. A strategy for regularization parameter selection was proposed, validated using XCAT simulations, and applied to the clinical studies. The authors’ results show that the MC image yields 19%–190% increase in the CNR of high-intensity features of interest affected by respiratory motion relative to UG and a 6%–51% increase relative to OG. Conclusions: Standalone MR is not the traditional choice for lung scans due to the low proton density, high magnetic susceptibility, and low T2∗ relaxation time in the lungs. By developing and validating this PET/MR pulmonary imaging framework, the authors show that simultaneous PET/MR, unique in its capability of combining structural information from MR with functional information from PET, shows promise in pulmonary imaging. PMID:26133621

Pulmonary imaging using respiratory motion compensated simultaneous PET/MR.

PubMed

Dutta, Joyita; Huang, Chuan; Li, Quanzheng; El Fakhri, Georges

2015-07-01

Pulmonary positron emission tomography (PET) imaging is confounded by blurring artifacts caused by respiratory motion. These artifacts degrade both image quality and quantitative accuracy. In this paper, the authors present a complete data acquisition and processing framework for respiratory motion compensated image reconstruction (MCIR) using simultaneous whole body PET/magnetic resonance (MR) and validate it through simulation and clinical patient studies. The authors have developed an MCIR framework based on maximum a posteriori or MAP estimation. For fast acquisition of high quality 4D MR images, the authors developed a novel Golden-angle RAdial Navigated Gradient Echo (GRANGE) pulse sequence and used it in conjunction with sparsity-enforcing k-t FOCUSS reconstruction. The authors use a 1D slice-projection navigator signal encapsulated within this pulse sequence along with a histogram-based gate assignment technique to retrospectively sort the MR and PET data into individual gates. The authors compute deformation fields for each gate via nonrigid registration. The deformation fields are incorporated into the PET data model as well as utilized for generating dynamic attenuation maps. The framework was validated using simulation studies on the 4D XCAT phantom and three clinical patient studies that were performed on the Biograph mMR, a simultaneous whole body PET/MR scanner. The authors compared MCIR (MC) results with ungated (UG) and one-gate (OG) reconstruction results. The XCAT study revealed contrast-to-noise ratio (CNR) improvements for MC relative to UG in the range of 21%-107% for 14 mm diameter lung lesions and 39%-120% for 10 mm diameter lung lesions. A strategy for regularization parameter selection was proposed, validated using XCAT simulations, and applied to the clinical studies. The authors' results show that the MC image yields 19%-190% increase in the CNR of high-intensity features of interest affected by respiratory motion relative to UG and a 6%-51% increase relative to OG. Standalone MR is not the traditional choice for lung scans due to the low proton density, high magnetic susceptibility, and low T2 (∗) relaxation time in the lungs. By developing and validating this PET/MR pulmonary imaging framework, the authors show that simultaneous PET/MR, unique in its capability of combining structural information from MR with functional information from PET, shows promise in pulmonary imaging.

Maintaining tumor targeting accuracy in real-time motion compensation systems for respiration-induced tumor motion.

PubMed

Malinowski, Kathleen; McAvoy, Thomas J; George, Rohini; Dieterich, Sonja; D'Souza, Warren D

2013-07-01

To determine how best to time respiratory surrogate-based tumor motion model updates by comparing a novel technique based on external measurements alone to three direct measurement methods. Concurrently measured tumor and respiratory surrogate positions from 166 treatment fractions for lung or pancreas lesions were analyzed. Partial-least-squares regression models of tumor position from marker motion were created from the first six measurements in each dataset. Successive tumor localizations were obtained at a rate of once per minute on average. Model updates were timed according to four methods: never, respiratory surrogate-based (when metrics based on respiratory surrogate measurements exceeded confidence limits), error-based (when localization error ≥ 3 mm), and always (approximately once per minute). Radial tumor displacement prediction errors (mean ± standard deviation) for the four schema described above were 2.4 ± 1.2, 1.9 ± 0.9, 1.9 ± 0.8, and 1.7 ± 0.8 mm, respectively. The never-update error was significantly larger than errors of the other methods. Mean update counts over 20 min were 0, 4, 9, and 24, respectively. The same improvement in tumor localization accuracy could be achieved through any of the three update methods, but significantly fewer updates were required when the respiratory surrogate method was utilized. This study establishes the feasibility of timing image acquisitions for updating respiratory surrogate models without direct tumor localization.

SU-F-T-123: The Simulated Effect of the Breath-Hold Reproducibility Treating Locally-Advanced Lung Cancer with Pencil Beam Scanned Proton Therapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Dueck, J; Department of Oncology, Rigshospitalet, Copenhagen; Niels Bohr Institute, University of Copenhagen, Copenhagen

Purpose: The breath-hold (BH) technique has been suggested to mitigate motion and reduce target coverage degradation due to motion effects. The aim of this study was to investigate the effect of inter-BH residual motion on the dose distribution for pencil beam scanned (PBS) proton therapy of locally-advanced lung cancer patients. Methods: A dataset of visually-guided BH CT scans was acquired (10 scans per patient) taken from five lung cancer patients: three intra-fractionally repeated CT scans on treatment days 2,16 and 31, in addition to the day 0 planning CT scan. Three field intensity-modulated proton therapy (IMPT) plans were constructed onmore » the planning CT scan. Dose delivery on fraction 2, 16 and 31 were simulated on the three consecutive CT scans, assuming BH duration of 20s and soft tissue match. The dose was accumulated in the planning CT using deformable image registration, and scaled to simulate the full treatment of 66Gy(RBE) in 33 fractions. Results: The mean dose to the lungs and heart, and maximum dose to the spinal cord and esophagus were within 1% of the planned dose. The CTV V95% decreased and the inhomogeneity (D5%–D95%) increased on average 4.1% (0.4–12.2%) and 5.8% (2.2–13.4%), respectively, over the five patient cases. Conclusion: The results showed that the BH technique seems to spare the OARs in spite of inter-BH residual motion. However, small degradation of target coverage occurred for all patients, with 3/5 patients having a decrease in V95% ≤1%. For the remaining two patients, where V95% decreased up to 12%, the cause could be related to treatment related anatomical changes and, as in photon therapy, plan adaptation may be necessary to ensure target coverage. This study showed that BH could be a potential treatment option to reliably mitigate motion for the treatment of locally-advanced lung cancer using PBS proton therapy.« less

Abdominal organ motion during inhalation and exhalation breath-holds: pancreatic motion at different lung volumes compared.

PubMed

Lens, Eelco; Gurney-Champion, Oliver J; Tekelenburg, Daniël R; van Kesteren, Zdenko; Parkes, Michael J; van Tienhoven, Geertjan; Nederveen, Aart J; van der Horst, Astrid; Bel, Arjan

2016-11-01

Contrary to what is commonly assumed, organs continue to move during breath-holding. We investigated the influence of lung volume on motion magnitude during breath-holding and changes in velocity over the duration of breath-holding. Sixteen healthy subjects performed 60-second inhalation breath-holds in room-air, with lung volumes of ∼100% and ∼70% of the inspiratory capacity, and exhalation breath-holds, with lung volumes of ∼30% and ∼0% of the inspiratory capacity. During breath-holding, we obtained dynamic single-slice magnetic-resonance images with a time-resolution of 0.6s. We used 2-dimensional image correlation to obtain the diaphragmatic and pancreatic velocity and displacement during breath-holding. Organ velocity was largest in the inferior-superior direction and was greatest during the first 10s of breath-holding, with diaphragm velocities of 0.41mm/s, 0.29mm/s, 0.16mm/s and 0.15mm/s during BH 100% , BH 70% , BH 30% and BH 0% , respectively. Organ motion magnitudes were larger during inhalation breath-holds (diaphragm moved 9.8 and 9.0mm during BH 100% and BH 70% , respectively) than during exhalation breath-holds (5.6 and 4.3mm during BH 30% and BH 0% , respectively). Using exhalation breath-holds rather than inhalation breath-holds and delaying irradiation until after the first 10s of breath-holding may be advantageous for irradiation of abdominal tumors. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Poster — Thur Eve — 66: Robustness Assessment of a Novel IMRT Planning Method for Lung Radiotherapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ahanj, M.; Bissonnette, J.-P.; Heath, E.

2014-08-15

Conventional radiotherapy treatment planning for lung cancer accounts for tumour motion by increasing the beam apertures. We recently developed an IMRT planning strategy which uses reduced beam apertures in combination with an edge enhancing boost of 110% of the prescription dose to the volume that corresponds to the portion of the CTV that moves outside of the reduced beam. Previous results showed that this approach ensures target coverage while reducing lung dose. In the current study, we evaluate the robustness of this boost volume approach to changes in respiratory motion, including amplitude and phase weight variations. ITV and boost volumemore » plans were generated for 5 NSCLC patients with respiratory motion amplitudes ranging from 1 to 2 cm. A standard 5mm PTV margin was used for all plans. The ORBIT treatment planning tool was used to plan and accumulate dose over 10 respiratory phases defined by the 4DCT datasets. For the phase weight variation study, dose was accumulated for three scenarios: equally-weighted-phases, higher weight assigned to exhale phases and higher weight assigned to inhale phases. For the amplitude variation study, a numerical phantom was used to generate 4DCT datasets corresponding to 7 mm, 10 mm and 14 mm motion amplitudes. Preliminary results found that delivered plans for all phase weight scenarios were clinically acceptable. When normalized to mean lung dose, the boost volume plan delivered 5% more dose to the CTV which indicates the potential for dose escalation using this approach.« less

Assessment of CF lung disease using motion corrected PROPELLER MRI: a comparison with CT.

PubMed

Ciet, Pierluigi; Serra, Goffredo; Bertolo, Silvia; Spronk, Sandra; Ros, Mirco; Fraioli, Francesco; Quattrucci, Serena; Assael, M Baroukh; Catalano, Carlo; Pomerri, Fabio; Tiddens, Harm A W M; Morana, Giovanni

2016-03-01

To date, PROPELLER MRI, a breathing-motion-insensitive technique, has not been assessed for cystic fibrosis (CF) lung disease. We compared this technique to CT for assessing CF lung disease in children and adults. Thirty-eight stable CF patients (median 21 years, range 6-51 years, 22 female) underwent MRI and CT on the same day. Study protocol included respiratory-triggered PROPELLER MRI and volumetric CT end-inspiratory and -expiratory acquisitions. Two observers scored the images using the CF-MRI and CF-CT systems. Scores were compared with intra-class correlation coefficient (ICC) and Bland-Altman plots. The sensitivity and specificity of MRI versus CT were calculated. MRI sensitivity for detecting severe CF bronchiectasis was 0.33 (CI 0.09-0.57), while specificity was 100% (CI 0.88-1). ICCs for bronchiectasis and trapped air were as follows: MRI-bronchiectasis (0.79); CT-bronchiectasis (0.85); MRI-trapped air (0.51); CT-trapped air (0.87). Bland-Altman plots showed an MRI tendency to overestimate the severity of bronchiectasis in mild CF disease and underestimate bronchiectasis in severe disease. Motion correction in PROPELLER MRI does not improve assessment of CF lung disease compared to CT. However, the good inter- and intra-observer agreement and the high specificity suggest that MRI might play a role in the short-term follow-up of CF lung disease (i.e. pulmonary exacerbations). PROPELLER MRI does not match CT sensitivity to assess CF lung disease. PROPELLER MRI has lower sensitivity than CT to detect severe bronchiectasis. PROPELLER MRI has good to very good intra- and inter-observer variability. PROPELLER MRI can be used for short-term follow-up studies in CF.

Poster — Thur Eve — 31: Dosimetric Effect of Respiratory Motion on RapidArc Lung SBRT Treatment Delivered by TrueBeam Linear Accelerator

DOE Office of Scientific and Technical Information (OSTI.GOV)

Jiang, Runqing; Zhan, Lixin; Osei, Ernest

2014-08-15

Volumetric modulated arc therapy (VMAT) allows fast delivery of stereotactic radiotherapy. However, the discrepancies between the calculated and delivered dose distributions due to respiratory motion and dynamic multileaf collimators (MLCs) interplay are not avoidable. The purpose of this study is to investigate RapidArc lung SBRT treatment delivered by the flattening filter-free (FFF) beam and flattened beam with Varian TrueBeam machine. CIRS Dynamic Thorax Phantom with in-house made lung tumor insertion was CT scanned both in free breathing and 4DCT. 4DCT was used to determine the internal target volume. The free breathing CT scan was used for treatment planning. A 5more » mm margin was given to ITV to generate a planning target volume. Varian Eclipse treatment planning was used to generate RapidArc plans based on the 6 MV flattened beam and 6MV FFF beam. The prescription dose was 48 Gy in 4 fractions. At least 95% of PTV was covered by the prescribed dose. The RapidArc plans with 6 MV flattened beam and 6MV FFF beam were delivered with Varian TrueBeam machine. The dosimetric measurements were performed with Gafchromic XR-RV3 film, which was placed in the lung tumor insertion. The interplay between the dynamic MLC-based delivery of VMAT and the respiratory motion of the tumor degraded target coverage and created undesired hot or cold dose spots inside the lung tumor. Lung SBRT RapidArc treatments delivered by the FFF beam of TrueBeam linear accelerator is superior to the flattened beam. Further investigation will be performed by Monte Carlo simulation.« less

Reproducibility of tumor motion probability distribution function in stereotactic body radiation therapy of lung cancer.

PubMed

Zhang, Fan; Hu, Jing; Kelsey, Chris R; Yoo, David; Yin, Fang-Fang; Cai, Jing

2012-11-01

To evaluate the reproducibility of tumor motion probability distribution function (PDF) in stereotactic body radiation therapy (SBRT) of lung cancer using cine megavoltage (MV) images. Cine MV images of 20 patients acquired during three-dimensional conformal (6-11 beams) SBRT treatments were retrospectively analyzed to extract tumor motion trajectories. For each patient, tumor motion PDFs were generated per fraction (PDF(n)) using three selected "usable" beams. Patients without at least three usable beams were excluded from the study. Fractional PDF reproducibility (R(n)) was calculated as the Dice similarity coefficient between PDF(n) to a "ground-truth" PDF (PDF(g)), which was generated using the selected beams of all fractions. The mean of R(n), labeled as R(m), was calculated for each patient and correlated to the patient's mean tumor motion rang (A(m)). Change of R(m) during the course of SBRT treatments was also evaluated. Intra- and intersubject coefficient of variation (CV) of R(m) and A(m) were determined. Thirteen patients had at least three usable beams and were analyzed. The mean of R(m) was 0.87 (range, 0.84-0.95). The mean of A(m) was 3.18 mm (range, 0.46-7.80 mm). R(m) was found to decrease as A(m) increases following an equation of R(m) = 0.17e(-0.9Am) + 0.84. R(m) also decreased slightly throughout the course of treatments. Intersubject CV of R(m) (0.05) was comparable to intrasubject CV of R(m) (range, 0.02-0.09); intersubject CV of A(m) (0.73) was significantly greater than intrasubject CV of A(m) (range, 0.09-0.24). Tumor motion PDF can be determined using cine MV images acquired during the treatments. The reproducibility of lung tumor motion PDF decreased exponentially as the tumor motion range increased and decreased slightly throughout the course of the treatments. Copyright © 2012 Elsevier Inc. All rights reserved.

SU-E-T-639: Proton Dose Calculation for Irregular Motion Using a Sliding Interface

DOE Office of Scientific and Technical Information (OSTI.GOV)

Phillips, J; Gueorguiev, G; Grassberger, C

2015-06-15

Purpose: While many techniques exist to evaluate dose to regularly moving lung targets, there are few available to calculate dose at tumor positions not present in the 4DCT. We have previously developed a method that extrapolates an existing dose to a new tumor location. In this abstract, we present a novel technique that accounts for relative anatomical shifts at the chest wall interface. We also utilize this procedure to simulate breathing motion functions on a cohort of eleven patients. Amplitudes exceeding the original range of motion were used to evaluate coverage using several aperture and smearing beam settings. Methods: Themore » water-equivalent depth (WED) technique requires an initial dose and CT image at the corresponding tumor position. Each dose volume was converted from its Cartesian geometry into a beam-specific radiological depth space. The sliding chest wall interface was determined by converting the lung contour into this same space. Any dose proximal to the initial boundary of the warped lung contour was held fixed, while the remaining distal dose was moved in the direction of motion along the interface. Results: V95 coverage was computed for each patient using the updated algorithm. Incorporation of the sliding motion yielded large dose differences, with gamma pass rates as low as 69.7% (3mm, 3%) and V95 coverage differences up to 2.0%. Clinical coverage was maintained for most patients with 5 mm excess simulated breathing motion, and up to 10 mm of excess motion was tolerated for a subset of patients and beam settings. Conclusion: We have established a method to determine the maximum allowable excess breathing motion for a given plan on a patient-by-patient basis. By integrating a sliding chest wall interface into our dose calculation technique, we have analyzed the robustness of breathing patterns that differ during treatment from at the time of 4DCT acquisition.« less

Computer simulation of airflow through a multi-generation tracheobronchial conducting airway

DOE Office of Scientific and Technical Information (OSTI.GOV)

Fan, B.; Cheng, Yung-Sung; Yeh, Hsu-Chi

1995-12-01

Knowledge of airflow patterns in the human lung is important for an analysis of lung diseases and drug delivery of aerosolized medicine for medical treatment. However, very little systematic information is available on the pattern of airflow in the lung and on how this pattern affects the deposition of toxicants in the lung, and the efficacy of aerosol drug therapy. Most previous studies have only considered the airflow through a single bifurcating airway. However, the flow in a network of more than one bifurcation is more complicated due to the effect of interrelated lung generations. Because of the variation ofmore » airway geometry and flow condition from generation to generation, a single bifurcating airway cannot be taken as a representative for the others in different generations. The flow in the network varies significantly with airway generations because of a redistribution of axial momentum by the secondary flow motions. The influence of the redistribution of flow is expected in every generation. Therefore, a systematic information of the airflow through a multi-generation tracheobronchial conducting airway is needed, and it becomes the purpose of this study. This study has provided information on airflow in a lung model which is necessary to the study of the deposition of toxicants and therapeutic aerosols.« less

Carbon nanotube based respiratory gated micro-CT imaging of a murine model of lung tumors with optical imaging correlation

NASA Astrophysics Data System (ADS)

Burk, Laurel M.; Lee, Yueh Z.; Heathcote, Samuel; Wang, Ko-han; Kim, William Y.; Lu, Jianping; Zhou, Otto

2011-03-01

Current optical imaging techniques can successfully measure tumor load in murine models of lung carcinoma but lack structural detail. We demonstrate that respiratory gated micro-CT imaging of such models gives information about structure and correlates with tumor load measurements by optical methods. Four mice with multifocal, Kras-induced tumors expressing firefly luciferase were imaged against four controls using both optical imaging and respiratory gated micro-CT. CT images of anesthetized animals were acquired with a custom CNT-based system using 30 ms x-ray pulses during peak inspiration; respiration motion was tracked with a pressure sensor beneath each animal's abdomen. Optical imaging based on the Luc+ signal correlating with tumor load was performed on a Xenogen IVIS Kinetix. Micro-CT images were post-processed using Osirix, measuring lung volume with region growing. Diameters of the largest three tumors were measured. Relationships between tumor size, lung volumes, and optical signal were compared. CT images and optical signals were obtained for all animals at two time points. In all lobes of the Kras+ mice in all images, tumors were visible; the smallest to be readily identified measured approximately 300 microns diameter. CT-derived tumor volumes and optical signals related linearly, with r=0.94 for all animals. When derived for only tumor bearing animals, r=0.3. The trend of each individual animal's optical signal tracked correctly based on the CT volumes. Interestingly, lung volumes also correlated positively with optical imaging data and tumor volume burden, suggesting active remodeling.

SU-G-JeP3-04: Estimating 4D CBCT from Prior Information and Extremely Limited Angle Projections Using Structural PCA and Weighted Free-Form Deformation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Harris, W; Yin, F; Zhang, Y

Purpose: To investigate the feasibility of using structure-based principal component analysis (PCA) motion-modeling and weighted free-form deformation to estimate on-board 4D-CBCT using prior information and extremely limited angle projections for potential 4D target verification of lung radiotherapy. Methods: A technique for lung 4D-CBCT reconstruction has been previously developed using a deformation field map (DFM)-based strategy. In the previous method, each phase of the 4D-CBCT was generated by deforming a prior CT volume. The DFM was solved by a motion-model extracted by global PCA and a free-form deformation (GMM-FD) technique, using data fidelity constraint and the deformation energy minimization. In thismore » study, a new structural-PCA method was developed to build a structural motion-model (SMM) by accounting for potential relative motion pattern changes between different anatomical structures from simulation to treatment. The motion model extracted from planning 4DCT was divided into two structures: tumor and body excluding tumor, and the parameters of both structures were optimized together. Weighted free-form deformation (WFD) was employed afterwards to introduce flexibility in adjusting the weightings of different structures in the data fidelity constraint based on clinical interests. XCAT (computerized patient model) simulation with a 30 mm diameter lesion was simulated with various anatomical and respirational changes from planning 4D-CT to onboard volume. The estimation accuracy was evaluated by the Volume-Percent-Difference (VPD)/Center-of-Mass-Shift (COMS) between lesions in the estimated and “ground-truth” on board 4D-CBCT. Results: Among 6 different XCAT scenarios corresponding to respirational and anatomical changes from planning CT to on-board using single 30° on-board projections, the VPD/COMS for SMM-WFD was reduced to 10.64±3.04%/1.20±0.45mm from 21.72±9.24%/1.80±0.53mm for GMM-FD. Using 15° orthogonal projections, the VPD/COMS was further reduced to 1.91±0.86%/0.31±0.42mm based on SMM-WFD. Conclusion: Compared to GMM-FD technique, the SMM-WFD technique can substantially improve the 4D-CBCT estimation accuracy using extremely small scan angles to provide ultra-fast 4D verification. This work was supported by the National Institutes of Health under Grant No. R01-CA184173 and a research grant from Varian Medical Systems.« less

Analysis of Carina Position as Surrogate Marker for Delivering Phase-Gated Radiotherapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Weide, Lineke van der; Soernsen de Koste, John R. van; Lagerwaard, Frank J.

2008-07-15

Purpose: Respiratory gating can mitigate the effect of tumor mobility in radiotherapy (RT) for lung cancer. Because the tumor is generally not visualized, external surrogates of tumor position are used to trigger respiration-gated RT. We evaluated the suitability of the carina position as a surrogate in respiration-gated RT. Methods and Materials: A total of 30 four-dimensional (4D) computed tomography (CT) scans from 14 patients with lung cancer were retrospectively analyzed. Both uncoached (free breathing) and audio-coached 4D-CT scans were acquired from 9 patients, and 12 uncoached 4D-CT scans were acquired from 5 other patients during a 2-4-week period of stereotacticmore » RT. The repeat scans were co-registered. The carina position was identified on the coronal cut planes in all 4D-CT phases. The correlation between the carina position and the total lung volume for each phase was determined, and the reproducibility of the carina position was studied in the 5 patients with repeat uncoached 4D-CT scans. Results: The mean extent of carina motion in 21 uncoached scans was 5.3 {+-} 1.6 mm in the craniocaudal (CC), 2.3 {+-} 1.4 mm in the anteroposterior, and 1.5 {+-} 0.7 mm in the mediolateral direction. Audio coaching resulted in a twofold increase in carina mobility in all directions. The CC carina position correlated with changes in the total lung volume (R = 0.89 {+-} 0.14), but the correlation was better for the audio-coached than for the uncoached 4D-CT scans (R = 0.93 {+-} 0.08 vs. R = 0.85 {+-} 0.17; paired t test, p = 0.034). Preliminary data from the 5 patients indicated that the CC carina motion correlated better with tumor motion than did the motion of the diaphragm. Conclusions: The CC position of the carina correlated well with the total lung volume, indicating that the carina is a good surrogate for verifying the total lung volume during respiration-gated RT.« less

EFFECTS OF TUMORS ON INHALED PHARMACOLOGIC DRUGS: II. PARTICLE MOTION

EPA Science Inventory

ABSTRACT

Computer simulations were conducted to describe drug particle motion in human lung bifurcations with tumors. The computations used FIDAP with a Cray T90 supercomputer. The objective was to better understand particle behavior as affected by particle characteristics...

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chiu, T; Kearney, V; Liu, H

Purpose: Dynamic tumor tracking or motion compensation techniques have proposed to modify beam delivery following lung tumor motion on the flight. Conventional treatment plan QA could be performed in advance since every delivery may be different. Markerless lung tumor tracking using beams eye view EPID images provides a best treatment evaluation mechanism. The purpose of this study is to improve the accuracy of the online markerless lung tumor motion tracking method. Methods: The lung tumor could be located on every frame of MV images during radiation therapy treatment by comparing with corresponding digitally reconstructed radiograph (DRR). A kV-MV CT correspondingmore » curve is applied on planning kV CT to generate MV CT images for patients in order to enhance the similarity between DRRs and MV treatment images. This kV-MV CT corresponding curve was obtained by scanning a same CT electron density phantom by a kV CT scanner and MV scanner (Tomotherapy) or MV CBCT. Two sets of MV DRRs were then generated for tumor and anatomy without tumor as the references to tracking the tumor on beams eye view EPID images. Results: Phantom studies were performed on a Varian TrueBeam linac. MV treatment images were acquired continuously during each treatment beam delivery at 12 gantry angles by iTools. Markerless tumor tracking was applied with DRRs generated from simulated MVCT. Tumors were tracked on every frame of images and compared with expected positions based on programed phantom motion. It was found that the average tracking error were 2.3 mm. Conclusion: This algorithm is capable of detecting lung tumors at complicated environment without implanting markers. It should be noted that the CT data has a slice thickness of 3 mm. This shows the statistical accuracy is better than the spatial accuracy. This project has been supported by a Varian Research Grant.« less

SU-F-T-292: Imaging and Radiation Oncology Core (IROC) Houston QA Center’s Anthropomorphic Phantom Program

DOE Office of Scientific and Technical Information (OSTI.GOV)

Mehrens, H; Lewis, B; Lujano, C

2016-06-15

Purpose: To describe the results of IROC Houston’s international and domestic end-to-end QA phantom irradiations. Methods: IROC Houston has anthropomorphic lung, liver, head and neck, prostate, SRS and spine phantoms that are used for credentialing and quality assurance purposes. The phantoms include structures that closely mimic targets and organs at risk and are made from tissue equivalent materials: high impact polystyrene, solid water, cork and acrylic. Motion tables are used to mimic breathing motion for some lung and liver phantoms. Dose is measured with TLD and radiochromic film in various planes within the target of the phantoms. Results: The mostmore » common phantom requested is the head and neck followed by the lung phantom. The head and neck phantom was sent to 800 domestic and 148 international sites between 2011 and 2015, with average pass rates of 89% and 92%, respectively. During the past five years, a general upward trend exists regarding demand for the lung phantom for both international and domestic sites with international sites more than tripling from 5 (2011) to 16 (2015) and domestic sites doubling from 66 (2011) to 152 (2015). The pass rate for lung phantoms has been consistent from year to year despite this large increase in the number of phantoms irradiated with an average pass rate of 85% (domestic) and 95% (international) sites. The percentage of lung phantoms used in combination with motions tables increased from 38% to 79% over the 5 year time span. Conclusion: The number of domestic and international sites irradiating the head and neck and lung phantoms continues to increase and the pass rates remained constant. These end-to-end QA tests continue to be a crucial part of clinical trial credentialing and institution quality assurance. This investigation was supported by IROC grant CA180803 awarded by the NCI.« less

Experimental investigation of particle deposition mechanisms in the lung acinus using microfluidic models.

NASA Astrophysics Data System (ADS)

Fishler, Rami; Mulligan, Molly; Dubowski, Yael; Sznitman, Josue; Sznitman Lab-department of Biomedical Engineering Team; Dubowski Lab-faculty of Civil; Environmental Engineering Team

2014-11-01

In order to experimentally investigate particle deposition mechanisms in the deep alveolated regions of the lungs, we have developed a novel microfluidic device mimicking breathing acinar flow conditions directly at the physiological scale. The model features an anatomically-inspired acinar geometry with five dichotomously branching airway generations lined with periodically expanding and contracting alveoli. Deposition patterns of airborne polystyrene microspheres (spanning 0.1 μm to 2 μm in diameter) inside the airway tree network compare well with CFD simulations and reveal the roles of gravity and Brownian motion on particle deposition sites. Furthermore, measured trajectories of incense particles (0.1-1 μm) inside the breathing device show a critical role for Brownian diffusion in determining the fate of inhaled sub-micron particles by enabling particles to cross from the acinar ducts into alveolar cavities, especially during the short time lag between inhalation and exhalation phases.

Biomechanical analysis of knee and trunk in badminton players with and without knee pain during backhand diagonal lunges.

PubMed

Lin, Cheng-Feng; Hua, Shiang-Hua; Huang, Ming-Tung; Lee, Hsing-Hsan; Liao, Jen-Chieh

2015-01-01

The contribution of core neuromuscular control to the dynamic stability of badminton players with and without knee pain during backhand lunges has not been investigated. Accordingly, this study compared the kinematics of the lower extremity, the trunk movement, the muscle activation and the balance performance of knee-injured and knee-uninjured badminton players when performing backhand stroke diagonal lunges. Seventeen participants with chronic knee pain (injured group) and 17 healthy participants (control group) randomly performed two diagonal backhand lunges in the forward and backward directions, respectively. This study showed that the injured group had lower frontal and horizontal motions of the knee joint, a smaller hip-shoulder separation angle and a reduced trunk tilt angle. In addition, the injured group exhibited a greater left paraspinal muscle activity, while the control group demonstrated a greater activation of the vastus lateralis, vastus medialis and medial gastrocnemius muscle groups. Finally, the injured group showed a smaller distance between centre of mass (COM) and centre of pressure, and a lower peak COM velocity when performing the backhand backward lunge tasks. In conclusion, the injured group used reduced knee and trunk motions to complete the backhand lunge tasks. Furthermore, the paraspinal muscles contributed to the lunge performance of the individuals with knee pain, whereas the knee extensors and ankle plantar flexor played a greater role for those without knee pain.

Use of diffusion-weighted magnetic resonance imaging to distinguish between lung cancer and focal inflammatory lesions: a comparison of intravoxel incoherent motion derived parameters and apparent diffusion coefficient.

PubMed

Deng, Yu; Li, Xinchun; Lei, Yongxia; Liang, Changhong; Liu, Zaiyi

2016-11-01

Background Using imaging techniques to diagnose malignant and inflammatory lesions in the lung can be challenging. Purpose To compare intravoxel incoherent motion (IVIM) and apparent diffusion coefficient (ADC) magnetic resonance imaging (MRI) analysis in their ability to discriminate lung cancer from focal inflammatory lung lesions. Material and Methods Thirty-eight patients with lung masses were included: 30 lung cancers and eight inflammatory lesions. Patients were imaged with 3.0T MRI diffusion weighted imaging (DWI) using 10 b values (range, 0-1000 s/mm 2 ). Tissue diffusivity ( D), pseudo-diffusion coefficient ( D*), and perfusion fraction ( f) were calculated using segmented biexponential analysis. ADC (total) was calculated with monoexponential fitting of the DWI data. D, D*, f, and ADC were compared between lung cancer and inflammatory lung lesions. Receiver operating characteristic analysis was performed for all DWI parameters. Results The ADC was significantly higher for inflammatory lesions than for lung cancer ([1.21 ± 0.20] × 10 -3 mm 2 /s vs. [0.97 ± 0.15] × 10 -3 mm 2 /s; P = 0.004). By IVIM, f was found to be significantly higher in inflammatory lesions than lung cancer ([46.10 ± 12.92] % vs. [29.29 ± 10.89] %; P = 0.005). There was no difference in D and D* between lung cancer and inflammatory lesions ( P = 0.747 and 0.124, respectively). f showed comparable diagnostic performance with ADC in differentiating lung cancer from inflammatory lung lesions, with areas under the curve of 0.833 and 0.826, sensitivity 80.0% and 73.3%, and specificity 75.0% and 87.5%, respectively. Conclusion The IVIM parameter f value provides comparable diagnostic performance with ADC and could be used as a surrogate marker for differentiating lung cancer from inflammatory lesions.

Very High Dose-Rate Radiobiology and Radiation Therapy for Lung Cancer

DTIC Science & Technology

2015-02-01

most dramatic example is stereotactic ablative radiotherapy ( SABR )/ stereotactic body radiation therapy (SBRT), highly focused and accurate...significant motion, thus increasing the precision and accuracy of lung SABR /SBRT. Objective: We propose to develop a new type of RT system for early stage

SU-E-T-538: Does Abdominal Compression Through Prone Patient Position Reduce Respiratory Motion in Lung Cancer Radiotherapy?

DOE Office of Scientific and Technical Information (OSTI.GOV)

Catron, T; Rosu, M; Weiss, E

2014-06-01

Purpose: This study assesses the effect of physiological abdominal compression from prone positioning by comparing respiratory-induced tumor movements in supine and prone positions. Methods: 19 lung cancer patients underwent repeated supine and prone free-breathing 4DCT scans. The effect of patient position on motion magnitude was investigated for tumors, lymph nodes (9 cases), and subgroups of central (11 cases), peripheral (8 cases) and small peripheral tumors (5 cases), by evaluating the population average excursions, absolute and relative to a carina-point. Results: Absolute motion analysis: In prone, motion increased by ~20% for tumors and ~25% for lymph nodes. Central tumors moved moremore » compared to peripheral tumors in both supine and prone (~22%, and ~4% respectively). Central tumors movement increased by ~12% in prone. For peripheral tumors the increase in prone position was ~25% (~40% and 29% changes on along RL and AP directions). Motion relative to carina-point analysis: Overall, tumor excursions relative to carina-point increased by ~17% in prone. Lymph node relative magnitudes were lower by ~4%. Likewise, the central tumors moved ~7% less in prone. The subgroup of peripheral tumors exhibited increased amplitudes by ~44%; the small peripheral tumors had even larger relative displacements in prone (~46%). Conclusion: Tumor and lymph node movement in the patient population from this study averaged to be higher in prone than in supine position. Results from carina analysis also suggest that peripheral tissues have more physiologic freedom of motility when placed in the prone position, regardless of size. From these observations we should continue to avoid prone positioning for all types of primary lung tumor, suggesting that patients should receive radiotherapy for primary lung cancer in supine position to minimize target tissue mobility during normal respiratory effort. Further investigation will include more patients with peripheral tumors to validate our observations.« less

Real-time out-of-plane artifact subtraction tomosynthesis imaging using prior CT for scanning beam digital x-ray system

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wu, Meng, E-mail: mengwu@stanford.edu; Fahrig, Rebecca

2014-11-01

Purpose: The scanning beam digital x-ray system (SBDX) is an inverse geometry fluoroscopic system with high dose efficiency and the ability to perform continuous real-time tomosynthesis in multiple planes. This system could be used for image guidance during lung nodule biopsy. However, the reconstructed images suffer from strong out-of-plane artifact due to the small tomographic angle of the system. Methods: The authors propose an out-of-plane artifact subtraction tomosynthesis (OPAST) algorithm that utilizes a prior CT volume to augment the run-time image processing. A blur-and-add (BAA) analytical model, derived from the project-to-backproject physical model, permits the generation of tomosynthesis images thatmore » are a good approximation to the shift-and-add (SAA) reconstructed image. A computationally practical algorithm is proposed to simulate images and out-of-plane artifacts from patient-specific prior CT volumes using the BAA model. A 3D image registration algorithm to align the simulated and reconstructed images is described. The accuracy of the BAA analytical model and the OPAST algorithm was evaluated using three lung cancer patients’ CT data. The OPAST and image registration algorithms were also tested with added nonrigid respiratory motions. Results: Image similarity measurements, including the correlation coefficient, mean squared error, and structural similarity index, indicated that the BAA model is very accurate in simulating the SAA images from the prior CT for the SBDX system. The shift-variant effect of the BAA model can be ignored when the shifts between SBDX images and CT volumes are within ±10 mm in the x and y directions. The nodule visibility and depth resolution are improved by subtracting simulated artifacts from the reconstructions. The image registration and OPAST are robust in the presence of added respiratory motions. The dominant artifacts in the subtraction images are caused by the mismatches between the real object and the prior CT volume. Conclusions: Their proposed prior CT-augmented OPAST reconstruction algorithm improves lung nodule visibility and depth resolution for the SBDX system.« less

Differential Motion Between Mediastinal Lymph Nodes and Primary Tumor in Radically Irradiated Lung Cancer Patients

DOE Office of Scientific and Technical Information (OSTI.GOV)

Schaake, Eva E.; Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam; Rossi, Maddalena M.G.

2014-11-15

Purpose/Objective: In patients with locally advanced lung cancer, planning target volume margins for mediastinal lymph nodes and tumor after a correction protocol based on bony anatomy registration typically range from 1 to 1.5 cm. Detailed information about lymph node motion variability and differential motion with the primary tumor, however, is lacking from large series. In this study, lymph node and tumor position variability were analyzed in detail and correlated to the main carina to evaluate possible margin reduction. Methods and Materials: Small gold fiducial markers (0.35 × 5 mm) were placed in the mediastinal lymph nodes of 51 patients with non-small cell lung cancermore » during routine diagnostic esophageal or bronchial endoscopic ultrasonography. Four-dimensional (4D) planning computed tomographic (CT) and daily 4D cone beam (CB) CT scans were acquired before and during radical radiation therapy (66 Gy in 24 fractions). Each CBCT was registered in 3-dimensions (bony anatomy) and 4D (tumor, marker, and carina) to the planning CT scan. Subsequently, systematic and random residual misalignments of the time-averaged lymph node and tumor position relative to the bony anatomy and carina were determined. Additionally, tumor and lymph node respiratory amplitude variability was quantified. Finally, required margins were quantified by use of a recipe for dual targets. Results: Relative to the bony anatomy, systematic and random errors ranged from 0.16 to 0.32 cm for the markers and from 0.15 to 0.33 cm for the tumor, but despite similar ranges there was limited correlation (0.17-0.71) owing to differential motion. A large variability in lymph node amplitude between patients was observed, with an average motion of 0.56 cm in the cranial-caudal direction. Margins could be reduced by 10% (left-right), 27% (cranial-caudal), and 10% (anteroposterior) for the lymph nodes and −2%, 15%, and 7% for the tumor if an online carina registration protocol replaced a protocol based on bony anatomy registration. Conclusions: Detailed analysis revealed considerable lymph node position variability, differential motion, and respiratory motion. Planning target volume margins can be reduced up to 27% in lung cancer patients when the carina registration replaces bony anatomy registration.« less

Quantifying the accuracy of the tumor motion and area as a function of acceleration factor for the simulation of the dynamic keyhole magnetic resonance imaging method.

PubMed

Lee, Danny; Greer, Peter B; Pollock, Sean; Kim, Taeho; Keall, Paul

2016-05-01

The dynamic keyhole is a new MR image reconstruction method for thoracic and abdominal MR imaging. To date, this method has not been investigated with cancer patient magnetic resonance imaging (MRI) data. The goal of this study was to assess the dynamic keyhole method for the task of lung tumor localization using cine-MR images reconstructed in the presence of respiratory motion. The dynamic keyhole method utilizes a previously acquired a library of peripheral k-space datasets at similar displacement and phase (where phase is simply used to determine whether the breathing is inhale to exhale or exhale to inhale) respiratory bins in conjunction with central k-space datasets (keyhole) acquired. External respiratory signals drive the process of sorting, matching, and combining the two k-space streams for each respiratory bin, thereby achieving faster image acquisition without substantial motion artifacts. This study was the first that investigates the impact of k-space undersampling on lung tumor motion and area assessment across clinically available techniques (zero-filling and conventional keyhole). In this study, the dynamic keyhole, conventional keyhole and zero-filling methods were compared to full k-space dataset acquisition by quantifying (1) the keyhole size required for central k-space datasets for constant image quality across sixty four cine-MRI datasets from nine lung cancer patients, (2) the intensity difference between the original and reconstructed images in a constant keyhole size, and (3) the accuracy of tumor motion and area directly measured by tumor autocontouring. For constant image quality, the dynamic keyhole method, conventional keyhole, and zero-filling methods required 22%, 34%, and 49% of the keyhole size (P < 0.0001), respectively, compared to the full k-space image acquisition method. Compared to the conventional keyhole and zero-filling reconstructed images with the keyhole size utilized in the dynamic keyhole method, an average intensity difference of the dynamic keyhole reconstructed images (P < 0.0001) was minimal, and resulted in the accuracy of tumor motion within 99.6% (P < 0.0001) and the accuracy of tumor area within 98.0% (P < 0.0001) for lung tumor monitoring applications. This study demonstrates that the dynamic keyhole method is a promising technique for clinical applications such as image-guided radiation therapy requiring the MR monitoring of thoracic tumors. Based on the results from this study, the dynamic keyhole method could increase the imaging frequency by up to a factor of five compared with full k-space methods for real-time lung tumor MRI.

Maintaining tumor targeting accuracy in real-time motion compensation systems for respiration-induced tumor motion

PubMed Central

Malinowski, Kathleen; McAvoy, Thomas J.; George, Rohini; Dieterich, Sonja; D’Souza, Warren D.

2013-01-01

Purpose: To determine how best to time respiratory surrogate-based tumor motion model updates by comparing a novel technique based on external measurements alone to three direct measurement methods. Methods: Concurrently measured tumor and respiratory surrogate positions from 166 treatment fractions for lung or pancreas lesions were analyzed. Partial-least-squares regression models of tumor position from marker motion were created from the first six measurements in each dataset. Successive tumor localizations were obtained at a rate of once per minute on average. Model updates were timed according to four methods: never, respiratory surrogate-based (when metrics based on respiratory surrogate measurements exceeded confidence limits), error-based (when localization error ≥3 mm), and always (approximately once per minute). Results: Radial tumor displacement prediction errors (mean ± standard deviation) for the four schema described above were 2.4 ± 1.2, 1.9 ± 0.9, 1.9 ± 0.8, and 1.7 ± 0.8 mm, respectively. The never-update error was significantly larger than errors of the other methods. Mean update counts over 20 min were 0, 4, 9, and 24, respectively. Conclusions: The same improvement in tumor localization accuracy could be achieved through any of the three update methods, but significantly fewer updates were required when the respiratory surrogate method was utilized. This study establishes the feasibility of timing image acquisitions for updating respiratory surrogate models without direct tumor localization. PMID:23822413

Reduction of irregular breathing artifacts in respiration-correlated CT images using a respiratory motion model.

PubMed

Hertanto, Agung; Zhang, Qinghui; Hu, Yu-Chi; Dzyubak, Oleksandr; Rimner, Andreas; Mageras, Gig S

2012-06-01

Respiration-correlated CT (RCCT) images produced with commonly used phase-based sorting of CT slices often exhibit discontinuity artifacts between CT slices, caused by cycle-to-cycle amplitude variations in respiration. Sorting based on the displacement of the respiratory signal yields slices at more consistent respiratory motion states and hence reduces artifacts, but missing image data (gaps) may occur. The authors report on the application of a respiratory motion model to produce an RCCT image set with reduced artifacts and without missing data. Input data consist of CT slices from a cine CT scan acquired while recording respiration by monitoring abdominal displacement. The model-based generation of RCCT images consists of four processing steps: (1) displacement-based sorting of CT slices to form volume images at 10 motion states over the cycle; (2) selection of a reference image without gaps and deformable registration between the reference image and each of the remaining images; (3) generation of the motion model by applying a principal component analysis to establish a relationship between displacement field and respiration signal at each motion state; (4) application of the motion model to deform the reference image into images at the 9 other motion states. Deformable image registration uses a modified fast free-form algorithm that excludes zero-intensity voxels, caused by missing data, from the image similarity term in the minimization function. In each iteration of the minimization, the displacement field in the gap regions is linearly interpolated from nearest neighbor nonzero intensity slices. Evaluation of the model-based RCCT examines three types of image sets: cine scans of a physical phantom programmed to move according to a patient respiratory signal, NURBS-based cardiac torso (NCAT) software phantom, and patient thoracic scans. Comparison in physical motion phantom shows that object distortion caused by variable motion amplitude in phase-based sorting is visibly reduced with model-based RCCT. Comparison of model-based RCCT to original NCAT images as ground truth shows best agreement at motion states whose displacement-sorted images have no missing slices, with mean and maximum discrepancies in lung of 1 and 3 mm, respectively. Larger discrepancies correlate with motion states having a larger number of missing slices in the displacement-sorted images. Artifacts in patient images at different motion states are also reduced. Comparison with displacement-sorted patient images as a ground truth shows that the model-based images closely reproduce the ground truth geometry at different motion states. Results in phantom and patient images indicate that the proposed method can produce RCCT image sets with reduced artifacts relative to phase-sorted images, without the gaps inherent in displacement-sorted images. The method requires a reference image at one motion state that has no missing data. Highly irregular breathing patterns can affect the method's performance, by introducing artifacts in the reference image (although reduced relative to phase-sorted images), or in decreased accuracy in the image prediction of motion states containing large regions of missing data. © 2012 American Association of Physicists in Medicine.

Audiovisual biofeedback improves the correlation between internal/external surrogate motion and lung tumor motion.

PubMed

Lee, Danny; Greer, Peter B; Paganelli, Chiara; Ludbrook, Joanna Jane; Kim, Taeho; Keall, Paul

2018-03-01

Breathing management can reduce breath-to-breath (intrafraction) and day-by-day (interfraction) variability in breathing motion while utilizing the respiratory motion of internal and external surrogates for respiratory guidance. Audiovisual (AV) biofeedback, an interactive personalized breathing motion management system, has been developed to improve reproducibility of intra- and interfraction breathing motion. However, the assumption of the correlation of respiratory motion between surrogates and tumors is not always verified during medical imaging and radiation treatment. Therefore, the aim of the study was to test the hypothesis that the correlation of respiratory motion between surrogates and tumors is the same under free breathing without guidance (FB) and with AV biofeedback guidance for voluntary motion management. For 13 lung cancer patients receiving radiotherapy, 2D coronal and sagittal cine-MR images were acquired across two MRI sessions (pre- and mid-treatment) with two breathing conditions: (a) FB and (b) AV biofeedback, totaling 88 patient measurements. Simultaneously, the external respiratory motion of the abdomen was measured. The internal respiratory motion of the diaphragm and lung tumor was retrospectively measured from 2D coronal and sagittal cine-MR images. The correlation of respiratory motion between surrogates and tumors was calculated using Pearson's correlation coefficient for: (a) abdomen to tumor (abdomen-tumor) and (b) diaphragm to tumor (diaphragm-tumor). The correlations were compared between FB and AV biofeedback using several metrics: abdomen-tumor and diaphragm-tumor correlations with/without ≥5 mm tumor motion range and with/without adjusting for phase shifts between the signals. Compared to FB, AV biofeedback improved abdomen-tumor correlation by 11% (p = 0.12) from 0.53 to 0.59 and diaphragm-tumor correlation by 13% (p = 0.02) from 0.55 to 0.62. Compared to FB, AV biofeedback improved abdomen-tumor correlation by 17% (p = 0.01) and diaphragm-tumor correlation by 15% (p < 0.01) while correcting 0.3 s (p = 0.54) and 0.2 s (p = 0.19) phase shifts, respectively. In addition, AV biofeedback with ≥5 mm tumor motion range, compared to FB improved abdomen-tumor correlation by 14% (p = 0.18) and diaphragm-tumor correlation by 17% (p = 0.01). The highest abdomen-tumor and diaphragm-tumor correlations were found using ≥5 mm tumor motion range and phase shifts, resulting in a 12% improvement in AV biofeedback. Our results demonstrated that AV biofeedback improves the correlation of respiratory motion between surrogates and the tumor. This suggests a need for AV biofeedback for respiratory guidance utilizing respiratory surrogates during image-guided and MRI-guided radiotherapy in thoracic regions. © 2018 American Association of Physicists in Medicine.

The influence of surfactant on the propagation of a semi-infinite bubble through a liquid-filled compliant channel

PubMed Central

Halpern, David; Gaver, Donald P.

2012-01-01

We investigate the influence of a soluble surfactant on the steady-state motion of a finger of air through a compliant channel. This study provides a basic model from which to understand the fluid–structure interactions and physicochemical hydrodynamics of pulmonary airway reopening. Airway closure occurs in lung diseases such as respiratory distress syndrome and acute respiratory distress syndrome as a result of fluid accumulation and surfactant insufficiency. This results in ‘compliant collapse’ with the airway walls buckled and held in apposition by a liquid occlusion that blocks the passage of air. Airway reopening is essential to the recovery of adequate ventilation, but has been associated with ventilator-induced lung injury because of the exposure of airway epithelial cells to large interfacial flow-induced pressure gradients. Surfactant replacement is helpful in modulating this deleterious mechanical stimulus, but is limited in its effectiveness owing to slow surfactant adsorption. We investigate the effect of surfactant on micro-scale models of reopening by computationally modelling the steady two-dimensional motion of a semi-infinite bubble propagating through a liquid-filled compliant channel doped with soluble surfactant. Many dimensionless parameters affect reopening, but we primarily investigate how the reopening pressure pb depends upon the capillary number Ca (the ratio of viscous to surface tension forces), the adsorption depth parameter λ (a bulk concentration parameter) and the bulk Péclet number Peb (the ratio of bulk convection to diffusion). These studies demonstrate a dependence of pb on λ, and suggest that a critical bulk concentration must be exceeded to operate as a low-surface-tension system. Normal and tangential stress gradients remain largely unaffected by physicochemical interactions – for this reason, further biological studies are suggested that will clarify the role of wall flexibility and surfactant on the protection of the lung from atelectrauma. PMID:22997476

Dependence of muscle moment arms on in-vivo three-dimensional kinematics of the knee

PubMed Central

Navacchia, Alessandro; Kefala, Vasiliki; Shelburne, Kevin B.

2016-01-01

Quantification of muscle moment arms is important for clinical evaluation of muscle pathology and treatment, and for estimating muscle and joint forces in musculoskeletal models. Moment arms estimated with musculoskeletal models often assume a default motion of the knee derived from measurements of passive cadaveric flexion. However, knee kinematics are unique to each person and activity. The objective of this study was to estimate moment arms of the knee muscles with in vivo subject- and activity-specific kinematics from seven healthy subjects performing seated knee extension and single-leg lunge to show changes between subjects and activities. 3D knee motion was measured with a high-speed stereo-radiography system. Moment arms of ten muscles were estimated in OpenSim by replacing the default knee motion with in vivo measurements. Estimated inter-subject moment arm variability was similar to previously reported in vitro measurements. RMS deviations up to 9.0 mm (35.2% of peak value) were observed between moment arms estimated with subject-specific knee extension and passive cadaveric motion. The degrees of freedom that most impacted inter-activity differences were superior/inferior and anterior/posterior translations. Musculoskeletal simulations used to estimate in vivo muscle forces and joint loads may provide significantly different results when subject- and activity-specific kinematics are implemented. PMID:27620064

Dependence of Muscle Moment Arms on In Vivo Three-Dimensional Kinematics of the Knee.

PubMed

Navacchia, Alessandro; Kefala, Vasiliki; Shelburne, Kevin B

2017-03-01

Quantification of muscle moment arms is important for clinical evaluation of muscle pathology and treatment, and for estimating muscle and joint forces in musculoskeletal models. Moment arms estimated with musculoskeletal models often assume a default motion of the knee derived from measurements of passive cadaveric flexion. However, knee kinematics are unique to each person and activity. The objective of this study was to estimate moment arms of the knee muscles with in vivo subject- and activity-specific kinematics from seven healthy subjects performing seated knee extension and single-leg lunge to show changes between subjects and activities. 3D knee motion was measured with a high-speed stereo-radiography system. Moment arms of ten muscles were estimated in OpenSim by replacing the default knee motion with in vivo measurements. Estimated inter-subject moment arm variability was similar to previously reported in vitro measurements. RMS deviations up to 9.0 mm (35.2% of peak value) were observed between moment arms estimated with subject-specific knee extension and passive cadaveric motion. The degrees of freedom that most impacted inter-activity differences were superior/inferior and anterior/posterior translations. Musculoskeletal simulations used to estimate in vivo muscle forces and joint loads may provide significantly different results when subject- and activity-specific kinematics are implemented.

A sliding-control switch stabilizes synchronized states in a model of actuated cilia

NASA Astrophysics Data System (ADS)

Buchmann, Amy; Cortez, Ricardo; Fauci, Lisa

2017-11-01

A key function of cilia, flexible hairlike appendages located on the surface of a cell, is the transport of mucus in the lungs, where the cilia self-organize forming a metachronal wave that propels the surrounding fluid. Cilia also play an important role in the locomotion of ciliated microswimmers and other biological processes. To analyze the coordinated movement of cilia interacting through a fluid, we model each cilium as an elastic, actuated body whose beat pattern is driven by a geometric switch that drives the motion of the power and recovery strokes. The cilia are coupled to the viscous fluid using a numerical method based upon a centerline distribution of regularized Stokeslets. We first characterize the beat cycle and flow produced by a single cilium and then present results on the synchronization states between two cilia that show that the in-phase equilibrium is unstable while the anti-phase equilibrium is stable under the geometric switch model. Adding a sliding-control switching mechanism stabilizes the in-phase motion.

Diffusion Lung Imaging with Hyperpolarized Gas MRI

PubMed Central

Yablonskiy, Dmitriy A; Sukstanskii, Alexander L; Quirk, James D

2015-01-01

Lung imaging using conventional 1H MRI presents great challenges due to low density of lung tissue, lung motion and very fast lung tissue transverse relaxation (typical T2* is about 1-2 ms). MRI with hyperpolarized gases (3He and 129Xe) provides a valuable alternative due to a very strong signal originated from inhaled gas residing in the lung airspaces and relatively slow gas T2* relaxation (typical T2* is about 20-30 ms). Though in vivo human experiments should be done very fast – usually during a single breath-hold. In this review we describe the recent developments in diffusion lung MRI with hyperpolarized gases. We show that a combination of modeling results of gas diffusion in lung airspaces and diffusion measurements with variable diffusion-sensitizing gradients allows extracting quantitative information on the lung microstructure at the alveolar level. This approach, called in vivo lung morphometry, allows from a less than 15-second MRI scan, providing quantitative values and spatial distributions of the same physiological parameters as are measured by means of the “standard” invasive stereology (mean linear intercept, surface-to-volume ratio, density of alveoli, etc.). Besides, the approach makes it possible to evaluate some advanced Weibel parameters characterizing lung microstructure - average radii of alveolar sacs and ducts, as well as the depth of their alveolar sleeves. Such measurements, providing in vivo information on the integrity of pulmonary acinar airways and their changes in different diseases, are of great importance and interest to a broad range of physiologists and clinicians. We also discuss a new type of experiments that are based on the in vivo lung morphometry technique combined with quantitative CT measurements as well as with the Gradient Echo MRI measurements of hyperpolarized gas transverse relaxation in the lung airspaces. Such experiments provide additional information on the blood vessel volume fraction, specific gas volume, the length of acinar airways, and allows evaluation of lung parenchymal and non-parenchymal tissue. PMID:26676342

Novel use of pleural ultrasound can identify malignant entrapped lung prior to effusion drainage.

PubMed

Salamonsen, Matthew R; Lo, Ada K C; Ng, Arnold C T; Bashirzadeh, Farzad; Wang, William Y S; Fielding, David I K

2014-11-01

The presence of entrapped lung changes the appropriate management of malignant pleural effusion from pleurodesis to insertion of an indwelling pleural catheter. No methods currently exist to identify entrapped lung prior to effusion drainage. Our objectives were to develop a method to identify entrapped lung using tissue movement and deformation (strain) analysis with ultrasonography and compare it to the existing technique of pleural elastance (PEL). Prior to drainage, 81 patients with suspected malignant pleural effusion underwent thoracic ultrasound using an echocardiogram machine. Images of the atelectatic lower lobe were acquired during breath hold, allowing motion and strain related to the cardiac impulse to be analyzed using motion mode (M mode) and speckle-tracking imaging, respectively. PEL was measured during effusion drainage. The gold-standard diagnosis of entrapped lung was the consensus opinion of two interventional pulmonologists according to postdrainage imaging. Participants were randomly divided into development and validation sets. Both total movement and strain were significantly reduced in entrapped lung. Using data from the development set, the area under the receiver-operating curves for the diagnosis of entrapped lung was 0.86 (speckle tracking), 0.79 (M mode), and 0.69 (PEL). Using respective cutoffs of 6%, 1 mm, and 19 cm H2O on the validation set, the sensitivity/specificity was 71%/85% (speckle tracking), 50%/85% (M mode), and 40%/100% (PEL). This novel ultrasound technique can identify entrapped lung prior to effusion drainage, which could allow appropriate choice of definitive management (pleurodesis vs indwelling catheter), reducing the number of interventions required to treat malignant pleural effusion.

Quantifying the impact of respiratory-gated 4D CT acquisition on thoracic image quality: a digital phantom study.

PubMed

Bernatowicz, K; Keall, P; Mishra, P; Knopf, A; Lomax, A; Kipritidis, J

2015-01-01

Prospective respiratory-gated 4D CT has been shown to reduce tumor image artifacts by up to 50% compared to conventional 4D CT. However, to date no studies have quantified the impact of gated 4D CT on normal lung tissue imaging, which is important in performing dose calculations based on accurate estimates of lung volume and structure. To determine the impact of gated 4D CT on thoracic image quality, the authors developed a novel simulation framework incorporating a realistic deformable digital phantom driven by patient tumor motion patterns. Based on this framework, the authors test the hypothesis that respiratory-gated 4D CT can significantly reduce lung imaging artifacts. Our simulation framework synchronizes the 4D extended cardiac torso (XCAT) phantom with tumor motion data in a quasi real-time fashion, allowing simulation of three 4D CT acquisition modes featuring different levels of respiratory feedback: (i) "conventional" 4D CT that uses a constant imaging and couch-shift frequency, (ii) "beam paused" 4D CT that interrupts imaging to avoid oversampling at a given couch position and respiratory phase, and (iii) "respiratory-gated" 4D CT that triggers acquisition only when the respiratory motion fulfills phase-specific displacement gating windows based on prescan breathing data. Our framework generates a set of ground truth comparators, representing the average XCAT anatomy during beam-on for each of ten respiratory phase bins. Based on this framework, the authors simulated conventional, beam-paused, and respiratory-gated 4D CT images using tumor motion patterns from seven lung cancer patients across 13 treatment fractions, with a simulated 5.5 cm(3) spherical lesion. Normal lung tissue image quality was quantified by comparing simulated and ground truth images in terms of overall mean square error (MSE) intensity difference, threshold-based lung volume error, and fractional false positive/false negative rates. Averaged across all simulations and phase bins, respiratory-gating reduced overall thoracic MSE by 46% compared to conventional 4D CT (p ∼ 10(-19)). Gating leads to small but significant (p < 0.02) reductions in lung volume errors (1.8%-1.4%), false positives (4.0%-2.6%), and false negatives (2.7%-1.3%). These percentage reductions correspond to gating reducing image artifacts by 24-90 cm(3) of lung tissue. Similar to earlier studies, gating reduced patient image dose by up to 22%, but with scan time increased by up to 135%. Beam paused 4D CT did not significantly impact normal lung tissue image quality, but did yield similar dose reductions as for respiratory-gating, without the added cost in scanning time. For a typical 6 L lung, respiratory-gated 4D CT can reduce image artifacts affecting up to 90 cm(3) of normal lung tissue compared to conventional acquisition. This image improvement could have important implications for dose calculations based on 4D CT. Where image quality is less critical, beam paused 4D CT is a simple strategy to reduce imaging dose without sacrificing acquisition time.

[Computed tomography of the lungs. A step into the fourth dimension].

PubMed

Dinkel, J; Hintze, C; Rochet, N; Thieke, C; Biederer, J

2009-08-01

To discuss the techniques for four dimensional computed tomography of the lungs in tumour patients. The image acquisition in CT can be done using respiratory gating in two different ways: the helical or cine mode. In the helical mode, the couch moves continuously during image and respiratory signal acquisition. In the cine mode, the couch remains in the same position during at least one complete respiratory cycle and then moves to next position. The 4D images are either acquired prospectively or reconstructed retrospectively with dedicated algorithms in a freely selectable respiratory phase. The time information required for motion depiction in 4D imaging can be obtained with tolerable motion artefacts. Partial projection and stepladder-artifacts are occurring predominantly close to the diaphragm, where the displacement is most prominent. Due to the long exposure times, radiation exposure is significantly higher compared to a simple breathhold helical acquisition. Therefore, the use of 4D-CT is restricted to only specific indications (i.e. radiotherapy planning). 4D-CT of the lung allows evaluating the respiration-correlated displacement of lungs and tumours in space for radiotherapy planning.

The importance of phrenic nerve preservation and its effect on long-term postoperative lung function after pneumonectomy.

PubMed

Kocher, Gregor J; Poulson, Jannie Lysgaard; Blichfeldt-Eckhardt, Morten Rune; Elle, Bo; Schmid, Ralph A; Licht, Peter B

2016-04-01

The importance of phrenic nerve preservation during pneumonectomy remains controversial. We previously demonstrated that preservation of the phrenic nerve in the immediate postoperative period preserved lung function by 3-5% but little is known about its long-term effects. We, therefore, decided to investigate the effect of temporary ipsilateral cervical phrenic nerve block on dynamic lung volumes in mid- to long-term pneumonectomy patients. We investigated 14 patients after a median of 9 years post pneumonectomy (range: 1-15 years). Lung function testing (spirometry) and fluoroscopic and/or sonographic assessment of diaphragmatic motion on the pneumonectomy side were performed before and after ultrasonographic-guided ipsilateral cervical phrenic nerve block by infiltration with lidocaine. Ipsilateral phrenic nerve block was successfully achieved in 12 patients (86%). In the remaining 2 patients, diaphragmatic motion was already paradoxical before the nerve block. We found no significant difference on dynamic lung function values (FEV1 'before' 1.39 ± 0.44 vs FEV1 'after' 1.38 ± 0.40; P = 0.81). Induction of a temporary diaphragmatic palsy did not significantly influence dynamic lung volumes in mid- to long-term pneumonectomy patients, suggesting that preservation of the phrenic nerve is of greater importance in the immediate postoperative period after pneumonectomy. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

4D planning over the full course of fractionation: assessment of the benefit of tumor trailing

NASA Astrophysics Data System (ADS)

McQuaid, D.; Bortfeld, T.

2011-11-01

Tumor trailing techniques have been proposed as a method of reducing the problem of intrafraction motion in radiotherapy. However the dosimetric assessment of trailing strategies is complicated by the requirement to study dose deposition over a full fraction delivery. Common 4D planning strategies allowing assessment of dosimetric motion effects study a single cycle acquired with 4DCT. In this paper, a methodology to assess dose deposited over an entire treatment course is advanced and used to assess the potential benefit of tumor trailing strategies for lung cancer patients. Two digital phantoms mimicking patient anatomy were each programmed to follow the tumor respiratory trajectory observed from 33 lung cancer patients. The two phantoms were designed to represent the cases of a small (volume = 13.6 cm3) and large (volume = 181.7 cm3) lung lesion. Motion margins required to obtain CTV coverage by 95% of the prescription dose to 90% of the available cases were computed for a standard treatment strategy and a trailing treatment strategy. The trailing strategy facilitated a margin reduction of over 30% relative to the conventional delivery. When the dose was computed across the entire delivery for the 33 cases, the trailing strategy was found to significantly reduce the underdosage to the outlier cases and the reduced trailing margin facilitated a 15% (small lesion) and 4% (large lesion) reduction for the mean lung dose and 7% (small lesion) and 10% (large lesion) for the mean esophagus dose. Finally, for comparison an ideal continuous tracking strategy was assessed and found to further reduce the mean lung and esophagus dose. However, this improvement comes at the price of increased delivery complexity and increased reliance on tumor localization accuracy.

High-pitch Helical Dual-source Computed Tomographic Pulmonary Angiography: Comparing Image Quality in Inspiratory Breath-hold and During Free Breathing.

PubMed

Ajlan, Amr M; Binzaqr, Salma; Jadkarim, Dalia A; Jamjoom, Lamia G; Leipsic, Jonathon

2016-01-01

The purpose of this study was to compare qualitative and quantitative image parameters of dual-source high-pitch helical computed tomographic pulmonary angiography (CTPA) in breath-holding (BH) versus free-breathing (FB) patients. Ninety-nine consented patients (61 female individuals; mean age±SD, 49±18.7 y) were randomized into BH (n=45) versus FB (n=54) high-pitch helical CTPA. Patient characteristics and CTPA radiation doses were analyzed. Two readers assessed for pulmonary embolism (PE), transient interruption of contrast, and respiratory and cardiac motion. The readers used a subjective 3-point scale to rate the pulmonary artery opacification and lung parenchymal appearance. A single reader assessed mean pulmonary artery signal intensity, noise, contrast, signal to noise ratio, and contrast to noise ratio. PE was diagnosed in 16% BH and 19% FB patients. CTPAs of both groups were of excellent or acceptable quality for PE evaluation and of similar mean radiation doses (1.3 mSv). Transient interruption of contrast was seen in 5/45 (11%) BH and 5/54 (9%) FB patients (not statistically significant, P=0.54). No statistically significant difference was noted in cardiac, diaphragmatic, and lung parenchymal motion. Lung parenchymal assessment was excellent in all cases, except for 5/54 (9%) motion-affected FB cases with acceptable quality (statistically significant, P=0.03). No CTPA was considered nondiagnostic by any of the readers. No objective image quality differences were noted between both groups (P>0.05). High-pitch helical CTPA acquired during BH or in FB yields comparable image quality for the diagnosis of PE and lung pathology, with low radiation exposure. Only a modest increase in lung parenchymal artifacts is encountered in FB high-pitch helical CTPA.

SU-E-P-41: Imaging Coordination of Cone Beam CT, On-Board Image Conjunction with Optical Image Guidance for SBRT Treatment with Respiratory Motion Management

DOE Office of Scientific and Technical Information (OSTI.GOV)

Liu, Y; Campbell, J

2015-06-15

Purpose: To spare normal tissue for SBRT lung/liver patients, especially for patients with significant tumor motion, image guided respiratory motion management has been widely implemented in clinical practice. The purpose of this study was to evaluate imaging coordination of cone beam CT, on-board X-ray image conjunction with optical image guidance for SBRT treatment with motion management. Methods: Currently in our clinic a Varian Novlis Tx was utilized for treating SBRT patients implementing CBCT. A BrainLAB X-ray ExacTrac imaging system in conjunction with optical guidance was primarily used for SRS patients. CBCT and X-ray imaging system were independently calibrated with 1.0more » mm tolerance. For SBRT lung/liver patients, the magnitude of tumor motion was measured based-on 4DCT and the measurement was analyzed to determine if patients would be beneficial with respiratory motion management. For patients eligible for motion management, an additional CT with breath holding would be scanned and used as primary planning CT and as reference images for Cone beam CT. During the SBRT treatment, a CBCT with pause and continuing technology would be performed with patients holding breath, which may require 3–4 partially scanned CBCT to combine as a whole CBCT depending on how long patients capable of holding breath. After patients being setup by CBCT images, the ExactTrac X-ray imaging system was implemented with patients’ on-board X-ray images compared to breath holding CT-based DRR. Results: For breath holding patients SBRT treatment, after initially localizing patients with CBCT, we then position patients with ExacTrac X-ray and optical imaging system. The observed deviations of real-time optical guided position average at 3.0, 2.5 and 1.5 mm in longitudinal, vertical and lateral respectively based on 35 treatments. Conclusion: The respiratory motion management clinical practice improved our physician confidence level to give tighter tumor margin for sparing normal tissue for SBRT lung/liver patients.« less

Reproducibility of Tumor Motion Probability Distribution Function in Stereotactic Body Radiation Therapy of Lung Cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zhang Fan; Medical Physics Graduate Program, Duke University, Durham, North Carolina; Hu Jing

2012-11-01

Purpose: To evaluate the reproducibility of tumor motion probability distribution function (PDF) in stereotactic body radiation therapy (SBRT) of lung cancer using cine megavoltage (MV) images. Methods and Materials: Cine MV images of 20 patients acquired during three-dimensional conformal (6-11 beams) SBRT treatments were retrospectively analyzed to extract tumor motion trajectories. For each patient, tumor motion PDFs were generated per fraction (PDF{sub n}) using three selected 'usable' beams. Patients without at least three usable beams were excluded from the study. Fractional PDF reproducibility (R{sub n}) was calculated as the Dice similarity coefficient between PDF{sub n} to a 'ground-truth' PDF (PDF{submore » g}), which was generated using the selected beams of all fractions. The mean of R{sub n}, labeled as R{sub m}, was calculated for each patient and correlated to the patient's mean tumor motion rang (A{sub m}). Change of R{sub m} during the course of SBRT treatments was also evaluated. Intra- and intersubject coefficient of variation (CV) of R{sub m} and A{sub m} were determined. Results: Thirteen patients had at least three usable beams and were analyzed. The mean of R{sub m} was 0.87 (range, 0.84-0.95). The mean of A{sub m} was 3.18 mm (range, 0.46-7.80 mm). R{sub m} was found to decrease as A{sub m} increases following an equation of R{sub m} = 0.17e{sup -0.9Am} + 0.84. R{sub m} also decreased slightly throughout the course of treatments. Intersubject CV of R{sub m} (0.05) was comparable to intrasubject CV of R{sub m} (range, 0.02-0.09); intersubject CV of A{sub m} (0.73) was significantly greater than intrasubject CV of A{sub m} (range, 0.09-0.24). Conclusions: Tumor motion PDF can be determined using cine MV images acquired during the treatments. The reproducibility of lung tumor motion PDF decreased exponentially as the tumor motion range increased and decreased slightly throughout the course of the treatments.« less

Dependence of subject-specific parameters for a fast helical CT respiratory motion model on breathing rate: an animal study

NASA Astrophysics Data System (ADS)

O'Connell, Dylan; Thomas, David H.; Lamb, James M.; Lewis, John H.; Dou, Tai; Sieren, Jered P.; Saylor, Melissa; Hofmann, Christian; Hoffman, Eric A.; Lee, Percy P.; Low, Daniel A.

2018-02-01

To determine if the parameters relating lung tissue displacement to a breathing surrogate signal in a previously published respiratory motion model vary with the rate of breathing during image acquisition. An anesthetized pig was imaged using multiple fast helical scans to sample the breathing cycle with simultaneous surrogate monitoring. Three datasets were collected while the animal was mechanically ventilated with different respiratory rates: 12 bpm (breaths per minute), 17 bpm, and 24 bpm. Three sets of motion model parameters describing the correspondences between surrogate signals and tissue displacements were determined. The model error was calculated individually for each dataset, as well asfor pairs of parameters and surrogate signals from different experiments. The values of one model parameter, a vector field denoted α which related tissue displacement to surrogate amplitude, determined for each experiment were compared. The mean model error of the three datasets was 1.00  ±  0.36 mm with a 95th percentile value of 1.69 mm. The mean error computed from all combinations of parameters and surrogate signals from different datasets was 1.14  ±  0.42 mm with a 95th percentile of 1.95 mm. The mean difference in α over all pairs of experiments was 4.7%  ±  5.4%, and the 95th percentile was 16.8%. The mean angle between pairs of α was 5.0  ±  4.0 degrees, with a 95th percentile of 13.2 mm. The motion model parameters were largely unaffected by changes in the breathing rate during image acquisition. The mean error associated with mismatched sets of parameters and surrogate signals was 0.14 mm greater than the error achieved when using parameters and surrogate signals acquired with the same breathing rate, while maximum respiratory motion was 23.23 mm on average.

SU-E-J-18: Evaluation of the Effectiveness of Compression Methods in SBRT for Lung.

PubMed

Liao, Y; Tolekids, G; Yao, R; Templeton, A; Sensakovic, W; Chu, J

2012-06-01

This study aims to evaluate the effectiveness of compression in immobilizing tumor during stereotactic body radiotherapy (SBRT) for lung cancer. Published data have demonstrated bigger respiratory motion in lower lobe than in upper lobe during normal breathing. We hypothesize that 4DCT-based patient selection and abdominal compression would immobilize lung tumor volumes effectively, regardless of their location. We retrospectively reviewed 12 SBRT lung cases treated with Trilogy® (Varian Medical System, Palo Alto, CA). Either compression plate or Vac-LokTM was used as abdomen compression of the SBRT immobilization system (Body Pro-LokTM, CIVCO) to restrict patients' breathing during CT simulation and treatment delivery. These cases are grouped into 2 categories: lower and upper lobe tumor, each with 6 cases. Records for 33 treatments were studied. On each treatment day, the patient was set up to the bony anatomy using kV-kV-match. A CBCT was performed to further set up the patient to the tumor based on the soft tissue information. The shifts from CBCT-setup were analyzed as displacement vectors demonstrating the magnitude of the tumor motion relative to the bony anatomy. The mean magnitude of displacement vectors for upper lobe and lower lobe were 3.7±2.7 and 4.2±6.3, [1S.D.] mm, respectively. The Wilcoxon rank sum test indicates that the difference in the displacement vector between the two groups is not statistically significant (p-value = 0.33). The magnitude of shifts from CBCT were small with mean value <5mm in SBRT lung treatments. No statistically significant difference were observed in the displacement of tumor between lower and upper lobes. With limited sample size, this suggests that our current 4DCT screening/abdominal compression approach is effective in restricting the respiration-induced tumor motion despite its location within the lung. We plan to confirm this Result in additional patients. © 2012 American Association of Physicists in Medicine.

SU-F-J-99: Dose Accumulation and Evaluation in Lung SBRT Among All Phases of Respiration

DOE Office of Scientific and Technical Information (OSTI.GOV)

Azcona, JD; Barbes, B; Aristu, J

Purpose: To calculate the total planning dose on lung tumors (GTV) by accumulating the dose received in all respiration phases. Methods: A patient 4D planning CT (phase-binned, from a Siemens Somatom CT) was used to locate the GTV of a lung tumor in all respiratory phases with Pinnacle (v9.10). GTV contours defined in all phases were projected to the reference phase, where the ITV was defined. Centroids were calculated for all the GTV projections. No deformation or rotation was taken into account. The only GTV contour as defined in the reference phase was voxelized to track each voxel individually. Wemore » accumulated the absorbed dose in different phases on each voxel. A 3DCRT and a VMAT plan were designed on the reference phase fulfilling the ITV dosimetric requirements, using the 10MV FFF photon model from an Elekta Versa linac. ITV-to-PTV margins were set to 5mm. In-house developed MATLAB code was used for tumor voxeling and dose accumulation, assuming that the dose distribution planned in the reference phase behaved as a “dose-cloud” during patient breathing. Results: We tested the method on a patient 4DCT set of images exhibiting limited tumor motion (<5mm). For the 3DCRT plan, D95 was calculated for the GTV with motion and for the ITV, showing an agreement of 0.04%. For the VMAT plan, we calculated the D95 for every phase as if the GTV in that phase had received the whole treatment. Differences in D95 for all phases are within 1%, and estimate the potential interplay effect during delivery. Conclusion: A method for dose accumulation and assessment was developed that can compare GTV motion with ITV dosage, and estimate the potential interplay effect for VMAT plans. Work in progress includes the incorporation of deformable image registration and 4D CBCT dose calculation for dose reconstruction and assessment during treatment.« less

Structure and function of airway surface layer of the human lungs & mobility of probe particles in complex fluids

NASA Astrophysics Data System (ADS)

Cai, Liheng

Numerous infectious particles such as bacteria and pathogens are deposited on the airway surface of the human lungs during our daily breathing. To avoid infection the lung has evolved to develop a smart and powerful defense system called mucociliary clearance. The airway surface layer is a critical component of this mucus clearance system, which consists of two parts: (1) a mucus layer, that traps inhaled particles and transports them out of the lung by cilia-generated flow; and (2) a periciliary layer, that provides a favorable environment for ciliary beating and cell surface lubrication. For 75 years, it has been dogma that a single gel-like mucus layer, which is composed of secreted mucin glycoproteins, is transported over a "watery" periciliary layer. This one-gel model, however, does not explain fundamental features of the normal system, e.g. formation of a distinct mucus layer, nor accurately predict how the mucus clearance system fails in disease. In the first part of this thesis we propose a novel "Gel-on-Brush" model with a mucus layer (the "gel") and a "brush-like" periciliary layer, composed of mucins tethered to the luminal of airway surface, and supporting data accurately describes both the biophysical and cell biological bases for normal mucus clearance and its failure in disease. Our "Gel-on-Brush" model describes for the first time how and why mucus is efficiently cleared in health and unifies the pathogenesis of major human diseases, including cystic fibrosis and chronic obstructive pulmonary disease. It is expected that this "Gel-on-Brush" model of airway surface layer opens new directions for treatments of airway diseases. A dilemma regarding the function of mucus is that, although mucus traps any inhaled harmful particulates, it also poses a long-time problem for drug delivery: mobility of cargos carrying pharmaceutical agents is slowed down in mucus. The second part of this thesis aims to answer the question: can we theoretically understand the relation between the motion of a probe particle and the local structure and dynamics of complex fluids such as mucus, or even one step back, simple polymer solutions and gels? It is well known that the thermal motion of a particle in simple solutions like water can be described by Stokes-Einstein relation, in which the mean-square displacement of the particle is (1) linearly proportional to time and (2) inversely proportional to the bulk viscosity of the solution. We found that these two statements become questionable if the particle size is relatively small and the solutions become complex fluids such as polymer solutions and gels. The motion of small particles with size smaller than the entanglement length (network mesh size) of a polymer solution (gel) is sub-diffusive with mean-square displacement proportional to the square root of time at relatively short time scales. Even at long time scales at which the mean-square displacement of the particles is diffusive, the mean-square displacement of the particles is not necessarily determined by the bulk viscosity, and is inversely proportional to an effective viscosity that is much smaller than the bulk value. An interesting question related to the particle motion in polymer gels is whether particles with size larger than the network mesh size can move through the gel? An intuitive answer would be that such large particles are trapped by the local network cages. We argue that the large particles can still diffuse via hopping mechanism, i.e., particles can wait for fluctuations of surrounding network cages that could be large enough to allow them to slip though. This hopping diffusion can be applied to understand the motion of large particles subjected to topological constraints such as permanent or reversible crosslinked networks as well as entanglements in high molecular weight polymer solutions, melts, and networks.

The development of a 4D treatment planning methodology to simulate the tracking of central lung tumors in an MRI-linac.

PubMed

Al-Ward, Shahad M; Kim, Anthony; McCann, Claire; Ruschin, Mark; Cheung, Patrick; Sahgal, Arjun; Keller, Brian M

2018-01-01

Targeting and tracking of central lung tumors may be feasible on the Elekta MRI-linac (MRL) due to the soft-tissue visualization capabilities of MRI. The purpose of this work is to develop a novel treatment planning methodology to simulate tracking of central lung tumors with the MRL and to quantify the benefits in OAR sparing compared with the ITV approach. Full 4D-CT datasets for five central lung cancer patients were selected to simulate the condition of having 4D-pseudo-CTs derived from 4D-MRI data available on the MRL with real-time tracking capabilities. We used the MRL treatment planning system to generate two plans: (a) with a set of MLC-defined apertures around the target at each phase of the breathing ("4D-MRL" method); (b) with a fixed set of fields encompassing the maximum inhale and exhale of the breathing cycle ("ITV" method). For both plans, dose accumulation was performed onto a reference phase. To further study the potential benefits of a 4D-MRL method, the results were stratified by tumor motion amplitude, OAR-to-tumor proximity, and the relative OAR motion (ROM). With the 4D-MRL method, the reduction in mean doses was up to 3.0 Gy and 1.9 Gy for the heart and the lung. Moreover, the lung's V12.5 Gy was spared by a maximum of 300 cc. Maximum doses to serial organs were reduced by up to 6.1 Gy, 1.5 Gy, and 9.0 Gy for the esophagus, spinal cord, and the trachea, respectively. OAR dose reduction with our method depended on the tumor motion amplitude and the ROM. Some OARs with large ROMs and in close proximity to the tumor benefited from tracking despite small tumor amplitudes. We developed a novel 4D tracking methodology for the MRL for central lung tumors and quantified the potential dosimetric benefits compared with our current ITV approach. © 2017 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, Inc. on behalf of American Association of Physicists in Medicine.

Evaluation of respiration-correlated digital tomosynthesis in lung.

PubMed

Santoro, Joseph; Kriminski, Sergey; Lovelock, D Michael; Rosenzweig, Kenneth; Mostafavi, Hassan; Amols, Howard I; Mageras, Gig S

2010-03-01

Digital tomosynthesis (DTS) with a linear accelerator-mounted imaging system provides a means of reconstructing tomographic images from radiographic projections over a limited gantry arc, thus requiring only a few seconds to acquire. Its application in the thorax, however, often results in blurred images from respiration-induced motion. This work evaluates the feasibility of respiration-correlated (RC) DTS for soft-tissue visualization and patient positioning. Image data acquired with a gantry-mounted kilovoltage imaging system while recording respiration were retrospectively analyzed from patients receiving radiotherapy for non-small-cell lung carcinoma. Projection images spanning an approximately 30 degrees gantry arc were sorted into four respiration phase bins prior to DTS reconstruction, which uses a backprojection, followed by a procedure to suppress structures above and below the reconstruction plane of interest. The DTS images were reconstructed in planes at different depths through the patient and normal to a user-selected angle close to the center of the arc. The localization accuracy of RC-DTS was assessed via a comparison with CBCT. Evaluation of RC-DTS in eight tumors shows visible reduction in image blur caused by the respiratory motion. It also allows the visualization of tumor motion extent. The best image quality is achieved at the end-exhalation phase of the respiratory motion. Comparison of RC-DTS with respiration-correlated cone-beam CT in determining tumor position, motion extent and displacement between treatment sessions shows agreement in most cases within 2-3 mm, comparable in magnitude to the intraobserver repeatability of the measurement. These results suggest the method's applicability for soft-tissue image guidance in lung, but must be confirmed with further studies in larger numbers of patients.

A dosimetric comparison of real-time adaptive and non-adaptive radiotherapy: A multi-institutional study encompassing robotic, gimbaled, multileaf collimator and couch tracking.

PubMed

Colvill, Emma; Booth, Jeremy; Nill, Simeon; Fast, Martin; Bedford, James; Oelfke, Uwe; Nakamura, Mitsuhiro; Poulsen, Per; Worm, Esben; Hansen, Rune; Ravkilde, Thomas; Scherman Rydhög, Jonas; Pommer, Tobias; Munck Af Rosenschold, Per; Lang, Stephanie; Guckenberger, Matthias; Groh, Christian; Herrmann, Christian; Verellen, Dirk; Poels, Kenneth; Wang, Lei; Hadsell, Michael; Sothmann, Thilo; Blanck, Oliver; Keall, Paul

2016-04-01

A study of real-time adaptive radiotherapy systems was performed to test the hypothesis that, across delivery systems and institutions, the dosimetric accuracy is improved with adaptive treatments over non-adaptive radiotherapy in the presence of patient-measured tumor motion. Ten institutions with robotic(2), gimbaled(2), MLC(4) or couch tracking(2) used common materials including CT and structure sets, motion traces and planning protocols to create a lung and a prostate plan. For each motion trace, the plan was delivered twice to a moving dosimeter; with and without real-time adaptation. Each measurement was compared to a static measurement and the percentage of failed points for γ-tests recorded. For all lung traces all measurement sets show improved dose accuracy with a mean 2%/2mm γ-fail rate of 1.6% with adaptation and 15.2% without adaptation (p<0.001). For all prostate the mean 2%/2mm γ-fail rate was 1.4% with adaptation and 17.3% without adaptation (p<0.001). The difference between the four systems was small with an average 2%/2mm γ-fail rate of <3% for all systems with adaptation for lung and prostate. The investigated systems all accounted for realistic tumor motion accurately and performed to a similar high standard, with real-time adaptation significantly outperforming non-adaptive delivery methods. Copyright © 2016 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

The characteristics of dose at mass interface on lung cancer Stereotactic Body Radiotherapy (SBRT) simulation

NASA Astrophysics Data System (ADS)

Wulansari, I. H.; Wibowo, W. E.; Pawiro, S. A.

2017-05-01

In lung cancer cases, there exists a difficulty for the Treatment Planning System (TPS) to predict the dose at or near the mass interface. This error prediction might influence the minimum or maximum dose received by lung cancer. In addition to target motion, the target dose prediction error also contributes in the combined error during the course of treatment. The objective of this work was to verify dose plan calculated by adaptive convolution algorithm in Pinnacle3 at the mass interface against a set of measurement. The measurement was performed using Gafchromic EBT 3 film in static and dynamic CIRS phantom with amplitudes of 5 mm, 10 mm, and 20 mm in superior-inferior motion direction. Static and dynamic phantom were scanned with fast CT and slow CT before planned. The results showed that adaptive convolution algorithm mostly predicted mass interface dose lower than the measured dose in a range of -0,63% to 8,37% for static phantom in fast CT scanning and -0,27% to 15,9% for static phantom in slow CT scanning. In dynamic phantom, this algorithm was predicted mass interface dose higher than measured dose up to -89% for fast CT and varied from -17% until 37% for slow CT. This interface of dose differences caused the dose mass decreased in fast CT, except for 10 mm motion amplitude, and increased in slow CT for the greater amplitude of motion.

Implications of free breathing motion assessed by 4D-computed tomography on the delivered dose in radiotherapy for esophageal cancer.

PubMed

Duma, Marciana Nona; Berndt, Johannes; Rondak, Ina-Christine; Devecka, Michal; Wilkens, Jan J; Geinitz, Hans; Combs, Stephanie Elisabeth; Oechsner, Markus

2015-01-01

The aim of this study was to assess the effect of breathing motion on the delivered dose in esophageal cancer 3-dimensional (3D)-conformal radiotherapy (3D-CRT), intensity-modulated radiotherapy (IMRT), and volumetric modulated arc therapy (VMAT). We assessed 16 patients with esophageal cancer. All patients underwent 4D-computed tomography (4D-CT) for treatment planning. For each of the analyzed patients, 1 3D-CRT, 1 IMRT, and 1 VMAT (RapidArc-RA) plan were calculated. Each of the 3 initial plans was recalculated on the 4D-CT (for the maximum free inspiration and maximum free expiration) to assess the effect of breathing motion. We assessed the minimum dose (Dmin) and mean dose (Dmean) to the esophagus within the planning target volume, the volume changes of the lungs, the Dmean and the total lung volume receiving at least 40Gy (V40), and the V30, V20, V10, and V5. For the heart we assessed the Dmean and the V25. Over all techniques and all patients the change in Dmean as compared with the planned Dmean (planning CT [PCT]) to the esophagus was 0.48% in maximum free inspiration (CT_insp) and 0.55% in maximum free expiration (CT_exp). The Dmin CT_insp change was 0.86% and CT_exp change was 0.89%. The Dmean change of the lungs (heart) was in CT_insp 1.95% (2.89%) and 3.88% (2.38%) in CT_exp. In all, 4 patients had a clinically relevant change of the dose (≥ 5% Dmean to the heart and the lungs) between inspiration and expiration. These patients had a very cranially or caudally situated tumor. There are no relevant differences in the delivered dose to the regions of interest among the 3 techniques. Breathing motion management could be considered to achieve a better sparing of the lungs or heart in patients with cranially or caudally situated tumors. Copyright © 2015 American Association of Medical Dosimetrists. Published by Elsevier Inc. All rights reserved.

Implications of free breathing motion assessed by 4D-computed tomography on the delivered dose in radiotherapy for esophageal cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Duma, Marciana Nona, E-mail: Marciana.Duma@mri.tum.de; Berndt, Johannes; Rondak, Ina-Christine

2015-01-01

The aim of this study was to assess the effect of breathing motion on the delivered dose in esophageal cancer 3-dimensional (3D)-conformal radiotherapy (3D-CRT), intensity-modulated radiotherapy (IMRT), and volumetric modulated arc therapy (VMAT). We assessed 16 patients with esophageal cancer. All patients underwent 4D-computed tomography (4D-CT) for treatment planning. For each of the analyzed patients, 1 3D-CRT, 1 IMRT, and 1 VMAT (RapidArc—RA) plan were calculated. Each of the 3 initial plans was recalculated on the 4D-CT (for the maximum free inspiration and maximum free expiration) to assess the effect of breathing motion. We assessed the minimum dose (D{sub min})more » and mean dose (D{sub mean}) to the esophagus within the planning target volume, the volume changes of the lungs, the D{sub mean} and the total lung volume receiving at least 40 Gy (V{sub 40}), and the V{sub 30}, V{sub 20}, V{sub 10}, and V{sub 5}. For the heart we assessed the D{sub mean} and the V{sub 25}. Over all techniques and all patients the change in D{sub mean} as compared with the planned D{sub mean} (planning CT [PCT]) to the esophagus was 0.48% in maximum free inspiration (CT-insp) and 0.55% in maximum free expiration (CT-exp). The D{sub min} CT-insp change was 0.86% and CT-exp change was 0.89%. The D{sub mean} change of the lungs (heart) was in CT-insp 1.95% (2.89%) and 3.88% (2.38%) in CT-exp. In all, 4 patients had a clinically relevant change of the dose (≥ 5% D{sub mean} to the heart and the lungs) between inspiration and expiration. These patients had a very cranially or caudally situated tumor. There are no relevant differences in the delivered dose to the regions of interest among the 3 techniques. Breathing motion management could be considered to achieve a better sparing of the lungs or heart in patients with cranially or caudally situated tumors.« less

SU-E-J-115: Correlation of Displacement Vector Fields Calculated by Deformable Image Registration Algorithms with Motion Parameters of CT Images with Well-Defined Targets and Controlled-Motion

DOE Office of Scientific and Technical Information (OSTI.GOV)

Jaskowiak, J; Ahmad, S; Ali, I

Purpose: To investigate correlation of displacement vector fields (DVF) calculated by deformable image registration algorithms with motion parameters in helical axial and cone-beam CT images with motion artifacts. Methods: A mobile thorax phantom with well-known targets with different sizes that were made from water-equivalent material and inserted in foam to simulate lung lesions. The thorax phantom was imaged with helical, axial and cone-beam CT. The phantom was moved with a cyclic motion with different motion amplitudes and frequencies along the superior-inferior direction. Different deformable image registration algorithms including demons, fast demons, Horn-Shunck and iterative-optical-flow from the DIRART software were usedmore » to deform CT images for the phantom with different motion patterns. The CT images of the mobile phantom were deformed to CT images of the stationary phantom. Results: The values of displacement vectors calculated by deformable image registration algorithm correlated strongly with motion amplitude where large displacement vectors were calculated for CT images with large motion amplitudes. For example, the maximal displacement vectors were nearly equal to the motion amplitudes (5mm, 10mm or 20mm) at interfaces between the mobile targets lung tissue, while the minimal displacement vectors were nearly equal to negative the motion amplitudes. The maximal and minimal displacement vectors matched with edges of the blurred targets along the Z-axis (motion-direction), while DVF’s were small in the other directions. This indicates that the blurred edges by phantom motion were shifted largely to match with the actual target edge. These shifts were nearly equal to the motion amplitude. Conclusions: The DVF from deformable-image registration algorithms correlated well with motion amplitude of well-defined mobile targets. This can be used to extract motion parameters such as amplitude. However, as motion amplitudes increased, image artifacts increased significantly and that limited image quality and poor correlation between the motion amplitude and DVF was obtained.« less

The Audible Human Project: Modeling Sound Transmission in the Lungs and Torso

NASA Astrophysics Data System (ADS)

Dai, Zoujun

Auscultation has been used qualitatively by physicians for hundreds of years to aid in the monitoring and diagnosis of pulmonary diseases. Alterations in the structure and function of the pulmonary system that occur in disease or injury often give rise to measurable changes in lung sound production and transmission. Numerous acoustic measurements have revealed the differences of breath sounds and transmitted sounds in the lung under normal and pathological conditions. Compared to the extensive cataloging of lung sound measurements, the mechanism of sound transmission in the pulmonary system and how it changes with alterations of lung structural and material properties has received less attention. A better understanding of sound transmission and how it is altered by injury and disease might improve interpretation of lung sound measurements, including new lung imaging modalities that are based on an array measurement of the acoustic field on the torso surface via contact sensors or are based on a 3-dimensional measurement of the acoustic field throughout the lungs and torso using magnetic resonance elastography. A long-term goal of the Audible Human Project (AHP ) is to develop a computational acoustic model that would accurately simulate generation, transmission and noninvasive measurement of sound and vibration within the pulmonary system and torso caused by both internal (e.g. respiratory function) and external (e.g. palpation) sources. The goals of this dissertation research, fitting within the scope of the AHP, are to develop specific improved theoretical understandings, computational algorithms and experimental methods aimed at transmission and measurement. The research objectives undertaken in this dissertation are as follows. (1) Improve theoretical modeling and experimental identification of viscoelasticity in soft biological tissues. (2) Develop a poroviscoelastic model for lung tissue vibroacoustics. (3) Improve lung airway acoustics modeling and its coupling to the lung parenchyma; and (4) Develop improved techniques in array acoustic measurement on the torso surface of sound transmitted through the pulmonary system and torso. Tissue Viscoelasticity. Two experimental identification approaches of shear viscoelasticity were used. The first approach is to directly estimate the frequency-dependent surface wave speed and then to optimize the coefficients in an assumed viscoelastic model type. The second approach is to measure the complex-valued frequency response function (FRF) between the excitation location and points at known radial distances. The FRF has embedded in it frequency-dependent information about both surface wave phase speed and attenuation that can be used to directly estimate the complex shear modulus. The coefficients in an assumed viscoelastic tissue model type can then be optimized. Poroviscoelasticity Model for Lung Vibro-acoustics. A poroviscoelastic model based on Biot theory of wave propagation in porous media was used for compression waves in the lungs. This model predicts a fast compression wave speed close to the one predicted by the effective medium theory at low frequencies and an additional slow compression wave due to the out of phase motion of the air and the lung parenchyma. Both compression wave speeds vary with frequency. The fast compression wave speed and attenuation were measured on an excised pig lung under two different transpulmonary pressures. Good agreement was achieved between the experimental observation and theoretical predictions. Sound Transmission in Airways and Coupling to Lung Parenchyma. A computer generated airway tree was simplified to 255 segments and integrated into the lung geometry from the Visible Human Male for numerical simulations. Acoustic impedance boundary conditions were applied at the ends of the terminal segments to represent the unmodeled downstream airway segments. Experiments were also carried out on a preserved pig lung and similar trends of lung surface velocity distribution were observed between the experiments and simulations. This approach provides a feasible way of simplifying the airway tree and greatly reduces the computation time. Acoustic Measurements of Sound Transmission in Human Subjects. Scanning laser Doppler vibrometry (SLDV) was used as a gold standard for transmitted sound measurements on a human subject. A low cost piezodisk sensor array was also constructed as an alternative to SLDV. The advantages and disadvantages of each technique are discussed.

A new index for characterizing micro-bead motion in a flow induced by ciliary beating: Part I, experimental analysis.

PubMed

Bottier, Mathieu; Blanchon, Sylvain; Pelle, Gabriel; Bequignon, Emilie; Isabey, Daniel; Coste, André; Escudier, Estelle; Grotberg, James B; Papon, Jean-François; Filoche, Marcel; Louis, Bruno

2017-07-01

Mucociliary clearance is one of the major lines of defense of the respiratory system. The mucus layer coating the pulmonary airways is moved along and out of the lung by the activity of motile cilia, thus expelling the particles trapped in it. Here we compare ex vivo measurements of a Newtonian flow induced by cilia beating (using micro-beads as tracers) and a mathematical model of this fluid flow, presented in greater detail in a second companion article. Samples of nasal epithelial cells placed in water are recorded by high-speed video-microscopy and ciliary beat pattern is inferred. Automatic tracking of micro-beads, used as markers of the flow generated by cilia motion, enables us also to assess the velocity profile as a function of the distance above the cilia. This profile is shown to be essentially parabolic. The obtained experimental data are used to feed a 2D mathematical and numerical model of the coupling between cilia, fluid, and micro-bead motion. From the model and the experimental measurements, the shear stress exerted by the cilia is deduced. Finally, this shear stress, which can easily be measured in the clinical setting, is proposed as a new index for characterizing the efficiency of ciliary beating.

A new index for characterizing micro-bead motion in a flow induced by ciliary beating: Part I, experimental analysis

PubMed Central

Bottier, Mathieu; Blanchon, Sylvain; Pelle, Gabriel; Bequignon, Emilie; Coste, André; Escudier, Estelle; Grotberg, James B.; Papon, Jean-François

2017-01-01

Mucociliary clearance is one of the major lines of defense of the respiratory system. The mucus layer coating the pulmonary airways is moved along and out of the lung by the activity of motile cilia, thus expelling the particles trapped in it. Here we compare ex vivo measurements of a Newtonian flow induced by cilia beating (using micro-beads as tracers) and a mathematical model of this fluid flow, presented in greater detail in a second companion article. Samples of nasal epithelial cells placed in water are recorded by high-speed video-microscopy and ciliary beat pattern is inferred. Automatic tracking of micro-beads, used as markers of the flow generated by cilia motion, enables us also to assess the velocity profile as a function of the distance above the cilia. This profile is shown to be essentially parabolic. The obtained experimental data are used to feed a 2D mathematical and numerical model of the coupling between cilia, fluid, and micro-bead motion. From the model and the experimental measurements, the shear stress exerted by the cilia is deduced. Finally, this shear stress, which can easily be measured in the clinical setting, is proposed as a new index for characterizing the efficiency of ciliary beating. PMID:28708889

Comparison of anisotropic aperture based intensity modulated radiotherapy with 3D-conformal radiotherapy for the treatment of large lung tumors.

PubMed

Simeonova, Anna; Abo-Madyan, Yasser; El-Haddad, Mostafa; Welzel, Grit; Polednik, Martin; Boggula, Ramesh; Wenz, Frederik; Lohr, Frank

2012-02-01

IMRT allows dose escalation for large lung tumors, but respiratory motion may compromise delivery. A treatment plan that modulates fluence predominantly in the transversal direction and leaves the fluence identical in the direction of the breathing motion may reduce this problem. Planning-CT-datasets of 20 patients with Stage I-IV non small cell lung cancer (NSCLC) formed the basis of this study. A total of two IMRT plans and one 3D plan were created for each patient. Prescription dose was 60 Gy to the CTV and 70 Gy to the GTV. For the 3D plans an energy of 18 MV photons was used. IMRT plans were calculated for 6 MV photons with 13 coplanar and with 17 noncoplanar beams. Robustness of the used method of anisotropic modulation toward breathing motion was tested in a 13-field IMRT plan. As a consequence of identical prescription doses, mean target doses were similar for 3D and IMRT. Differences between 3D and 13- and 17-field IMRT were significant for CTV Dmin (43 Gy vs. 49.1 Gy vs. 48.6 Gy; p<0.001) and CTV D(95) (53.2 Gy vs. 55.0 Gy vs. 55.4 Gy; p=0.001). The D(mean) of the contralateral lung was significantly lower in the 17-field plans (17-field IMRT vs. 13- vs. 3D: 12.5 Gy vs. 14.8 Gy vs. 15.8 Gy: p<0.05). The spinal cord dose limit of 50 Gy was always respected in IMRT plans and only in 17 of 20 3D-plans. Heart D(max) was only marginally reduced with IMRT (3D vs. 13- vs. 17-field IMRT: 38.2 Gy vs. 36.8 Gy vs. 37.8 Gy). Simulated breathing motion caused only minor changes in the IMRT dose distribution (~0.5-1 Gy). Anisotropic modulation of IMRT improves dose delivery over 3D-RT and renders IMRT plans robust toward breathing induced organ motion, effectively preventing interplay effects. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Limited Impact of Setup and Range Uncertainties, Breathing Motion, and Interplay Effects in Robustly Optimized Intensity Modulated Proton Therapy for Stage III Non-small Cell Lung Cancer.

PubMed

Inoue, Tatsuya; Widder, Joachim; van Dijk, Lisanne V; Takegawa, Hideki; Koizumi, Masahiko; Takashina, Masaaki; Usui, Keisuke; Kurokawa, Chie; Sugimoto, Satoru; Saito, Anneyuko I; Sasai, Keisuke; Van't Veld, Aart A; Langendijk, Johannes A; Korevaar, Erik W

2016-11-01

To investigate the impact of setup and range uncertainties, breathing motion, and interplay effects using scanning pencil beams in robustly optimized intensity modulated proton therapy (IMPT) for stage III non-small cell lung cancer (NSCLC). Three-field IMPT plans were created using a minimax robust optimization technique for 10 NSCLC patients. The plans accounted for 5- or 7-mm setup errors with ±3% range uncertainties. The robustness of the IMPT nominal plans was evaluated considering (1) isotropic 5-mm setup errors with ±3% range uncertainties; (2) breathing motion; (3) interplay effects; and (4) a combination of items 1 and 2. The plans were calculated using 4-dimensional and average intensity projection computed tomography images. The target coverage (TC, volume receiving 95% of prescribed dose) and homogeneity index (D2 - D98, where D2 and D98 are the least doses received by 2% and 98% of the volume) for the internal clinical target volume, and dose indexes for lung, esophagus, heart and spinal cord were compared with that of clinical volumetric modulated arc therapy plans. The TC and homogeneity index for all plans were within clinical limits when considering the breathing motion and interplay effects independently. The setup and range uncertainties had a larger effect when considering their combined effect. The TC decreased to <98% (clinical threshold) in 3 of 10 patients for robust 5-mm evaluations. However, the TC remained >98% for robust 7-mm evaluations for all patients. The organ at risk dose parameters did not significantly vary between the respective robust 5-mm and robust 7-mm evaluations for the 4 error types. Compared with the volumetric modulated arc therapy plans, the IMPT plans showed better target homogeneity and mean lung and heart dose parameters reduced by about 40% and 60%, respectively. In robustly optimized IMPT for stage III NSCLC, the setup and range uncertainties, breathing motion, and interplay effects have limited impact on target coverage, dose homogeneity, and organ-at-risk dose parameters. Copyright © 2016 Elsevier Inc. All rights reserved.

SU-F-J-132: Evaluation of CTV-To-PTV Expansion for Whole Breast Radiotherapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Burgdorf, B; Freedman, G; Teo, B

2016-06-15

Purpose: The current standard CTV-to-PTV expansion for whole breast radiotherapy (WBRT) is 7mm, as recommended by RTOG-1005.This expansion is derived from the uncertainty due to patient positioning (±5mm) and respiratory motion (±5mm). We evaluated the expansion needed for respiratory motion uncertainty using 4DCT. After determining the appropriate expansion margins, RT plans were generated to evaluate the reduction in heart and lung dose. Methods: 4DCT images were acquired during treatment simulation and retrospectively analyzed for 34 WBRT patients. Breast CTVs were contoured on the maximum inhale and exhale phase. Breast CTV displacement was measured in the L-R, A-P, and SUP-INF directionsmore » using rigid registration between phase images. Averaging over the 34 patients, we determined the margin due to respiratory motion. Plans were generated for 10 left-sided cases comparing the new expansion with the 7mm PTV expansion. Results: The results for respiratory motion uncertainty are shown in Table 1. Drawing on previous work by White et al at Princess Margaret Hospital (1) (see supporting document for reference) which studied the uncertainty due to patient positioning, we concluded that, in total, a 5mm expansion was sufficient. The results for our suggested PTV margin are shown in Table 2, combining the patient positioning results from White et al with our respiratory motion results. The planning results demonstrating the heart and lung dose differences in the 5mm CTV-to-PTV expanded plan compared to the 7mm plan are shown in Table 3. Conclusion: Our work evaluating the expansion needed for respiratory motion along with previous work evaluating the expansion needed for setup uncertainty shows that a CTV-to-PTV expansion of 5mm is acceptable and conservative. By reducing the PTV expansion, significant dose reduction to the heart and lung are achievable.« less

Registration of organs with sliding interfaces and changing topologies

NASA Astrophysics Data System (ADS)

Berendsen, Floris F.; Kotte, Alexis N. T. J.; Viergever, Max A.; Pluim, Josien P. W.

2014-03-01

Smoothness and continuity assumptions on the deformation field in deformable image registration do not hold for applications where the imaged objects have sliding interfaces. Recent extensions to deformable image registration that accommodate for sliding motion of organs are limited to sliding motion along approximately planar surfaces or cannot model sliding that changes the topological configuration in case of multiple organs. We propose a new extension to free-form image registration that is not limited in this way. Our method uses a transformation model that consists of uniform B-spline transformations for each organ region separately, which is based on segmentation of one image. Since this model can create overlapping regions or gaps between regions, we introduce a penalty term that minimizes this undesired effect. The penalty term acts on the surfaces of the organ regions and is optimized simultaneously with the image similarity. To evaluate our method registrations were performed on publicly available inhale-exhale CT scans for which performances of other methods are known. Target registration errors are computed on dense landmark sets that are available with these datasets. On these data our method outperforms the other methods in terms of target registration error and, where applicable, also in terms of overlap and gap volumes. The approximation of the other methods of sliding motion along planar surfaces is reasonably well suited for the motion present in the lung data. The ability of our method to handle sliding along curved boundaries and for changing region topology configurations was demonstrated on synthetic images.

A new index for characterizing micro-bead motion in a flow induced by ciliary beating: Part II, modeling

PubMed Central

Bottier, Mathieu; Peña Fernández, Marta; Pelle, Gabriel; Grotberg, James B.

2017-01-01

Mucociliary clearance is one of the major lines of defense of the human respiratory system. The mucus layer coating the airways is constantly moved along and out of the lung by the activity of motile cilia, expelling at the same time particles trapped in it. The efficiency of the cilia motion can experimentally be assessed by measuring the velocity of micro-beads traveling through the fluid surrounding the cilia. Here we present a mathematical model of the fluid flow and of the micro-beads motion. The coordinated movement of the ciliated edge is represented as a continuous envelope imposing a periodic moving velocity boundary condition on the surrounding fluid. Vanishing velocity and vanishing shear stress boundary conditions are applied to the fluid at a finite distance above the ciliated edge. The flow field is expanded in powers of the amplitude of the individual cilium movement. It is found that the continuous component of the horizontal velocity at the ciliated edge generates a 2D fluid velocity field with a parabolic profile in the vertical direction, in agreement with the experimental measurements. Conversely, we show than this model can be used to extract microscopic properties of the cilia motion by extrapolating the micro-bead velocity measurement at the ciliated edge. Finally, we derive from these measurements a scalar index providing a direct assessment of the cilia beating efficiency. This index can easily be measured in patients without any modification of the current clinical procedures. PMID:28708866

Evaluation of normal lung tissue complication probability in gated and conventional radiotherapy using the 4D XCAT digital phantom.

PubMed

Shahzadeh, Sara; Gholami, Somayeh; Aghamiri, Seyed Mahmood Reza; Mahani, Hojjat; Nabavi, Mansoure; Kalantari, Faraz

2018-06-01

The present study was conducted to investigate normal lung tissue complication probability in gated and conventional radiotherapy (RT) as a function of diaphragm motion, lesion size, and its location using 4D-XCAT digital phantom in a simulation study. Different time series of 3D-CT images were generated using the 4D-XCAT digital phantom. The binary data obtained from this phantom were then converted to the digital imaging and communication in medicine (DICOM) format using an in-house MATLAB-based program to be compatible with our treatment planning system (TPS). The 3D-TPS with superposition computational algorithm was used to generate conventional and gated plans. Treatment plans were generated for 36 different XCAT phantom configurations. These included four diaphragm motions of 20, 25, 30 and 35 mm, three lesion sizes of 3, 4, and 5 cm in diameter and each tumor was placed in four different lung locations (right lower lobe, right upper lobe, left lower lobe and left upper lobe). The complication of normal lung tissue was assessed in terms of mean lung dose (MLD), the lung volume receiving ≥20 Gy (V20), and normal tissue complication probability (NTCP). The results showed that the gated RT yields superior outcomes in terms of normal tissue complication compared to the conventional RT. For all cases, the gated radiation therapy technique reduced the mean dose, V20, and NTCP of lung tissue by up to 5.53 Gy, 13.38%, and 23.89%, respectively. The results of this study showed that the gated RT provides significant advantages in terms of the normal lung tissue complication, compared to the conventional RT, especially for the lesions near the diaphragm. Copyright © 2018 Elsevier Ltd. All rights reserved.

A multicentre 'end to end' dosimetry audit of motion management (4DCT-defined motion envelope) in radiotherapy.

PubMed

Palmer, Antony L; Nash, David; Kearton, John R; Jafari, Shakardokht M; Muscat, Sarah

2017-12-01

External dosimetry audit is valuable for the assurance of radiotherapy quality. However, motion management has not been rigorously audited, despite its complexity and importance for accuracy. We describe the first end-to-end dosimetry audit for non-SABR (stereotactic ablative body radiotherapy) lung treatments, measuring dose accumulation in a moving target, and assessing adequacy of target dose coverage. A respiratory motion lung-phantom with custom-designed insert was used. Dose was measured with radiochromic film, employing triple-channel dosimetry and uncertainty reduction. The host's 4DCT scan, outlining and planning techniques were used. Measurements with the phantom static and then moving at treatment delivery separated inherent treatment uncertainties from motion effects. Calculated and measured dose distributions were compared by isodose overlay, gamma analysis, and we introduce the concept of 'dose plane histograms' for clinically relevant interpretation of film dosimetry. 12 radiotherapy centres and 19 plans were audited: conformal, IMRT (intensity modulated radiotherapy) and VMAT (volumetric modulated radiotherapy). Excellent agreement between planned and static-phantom results were seen (mean gamma pass 98.7% at 3% 2 mm). Dose blurring was evident in the moving-phantom measurements (mean gamma pass 88.2% at 3% 2 mm). Planning techniques for motion management were adequate to deliver the intended moving-target dose coverage. A novel, clinically-relevant, end-to-end dosimetry audit of motion management strategies in radiotherapy is reported. Copyright © 2017 Elsevier B.V. All rights reserved.

Motion mitigation for lung cancer patients treated with active scanning proton therapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Grassberger, Clemens, E-mail: Grassberger.Clemens@mgh.harvard.edu; Dowdell, Stephen; Sharp, Greg

2015-05-15

Purpose: Motion interplay can affect the tumor dose in scanned proton beam therapy. This study assesses the ability of rescanning and gating to mitigate interplay effects during lung treatments. Methods: The treatments of five lung cancer patients [48 Gy(RBE)/4fx] with varying tumor size (21.1–82.3 cm{sup 3}) and motion amplitude (2.9–30.6 mm) were simulated employing 4D Monte Carlo. The authors investigated two spot sizes (σ ∼ 12 and ∼3 mm), three rescanning techniques (layered, volumetric, breath-sampled volumetric) and respiratory gating with a 30% duty cycle. Results: For 4/5 patients, layered rescanning 6/2 times (for the small/large spot size) maintains equivalent uniformmore » dose within the target >98% for a single fraction. Breath sampling the timing of rescanning is ∼2 times more effective than the same number of continuous rescans. Volumetric rescanning is sensitive to synchronization effects, which was observed in 3/5 patients, though not for layered rescanning. For the large spot size, rescanning compared favorably with gating in terms of time requirements, i.e., 2x-rescanning is on average a factor ∼2.6 faster than gating for this scenario. For the small spot size however, 6x-rescanning takes on average 65% longer compared to gating. Rescanning has no effect on normal lung V{sub 20} and mean lung dose (MLD), though it reduces the maximum lung dose by on average 6.9 ± 2.4/16.7 ± 12.2 Gy(RBE) for the large and small spot sizes, respectively. Gating leads to a similar reduction in maximum dose and additionally reduces V{sub 20} and MLD. Breath-sampled rescanning is most successful in reducing the maximum dose to the normal lung. Conclusions: Both rescanning (2–6 times, depending on the beam size) as well as gating was able to mitigate interplay effects in the target for 4/5 patients studied. Layered rescanning is superior to volumetric rescanning, as the latter suffers from synchronization effects in 3/5 patients studied. Gating minimizes the irradiated volume of normal lung more efficiently, while breath-sampled rescanning is superior in reducing maximum doses to organs at risk.« less

Quantifying the accuracy of the tumor motion and area as a function of acceleration factor for the simulation of the dynamic keyhole magnetic resonance imaging method

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lee, Danny; Pollock, Sean; Keall, Paul, E-mail: paul.keall@sydney.edu.au

2016-05-15

Purpose: The dynamic keyhole is a new MR image reconstruction method for thoracic and abdominal MR imaging. To date, this method has not been investigated with cancer patient magnetic resonance imaging (MRI) data. The goal of this study was to assess the dynamic keyhole method for the task of lung tumor localization using cine-MR images reconstructed in the presence of respiratory motion. Methods: The dynamic keyhole method utilizes a previously acquired a library of peripheral k-space datasets at similar displacement and phase (where phase is simply used to determine whether the breathing is inhale to exhale or exhale to inhale)more » respiratory bins in conjunction with central k-space datasets (keyhole) acquired. External respiratory signals drive the process of sorting, matching, and combining the two k-space streams for each respiratory bin, thereby achieving faster image acquisition without substantial motion artifacts. This study was the first that investigates the impact of k-space undersampling on lung tumor motion and area assessment across clinically available techniques (zero-filling and conventional keyhole). In this study, the dynamic keyhole, conventional keyhole and zero-filling methods were compared to full k-space dataset acquisition by quantifying (1) the keyhole size required for central k-space datasets for constant image quality across sixty four cine-MRI datasets from nine lung cancer patients, (2) the intensity difference between the original and reconstructed images in a constant keyhole size, and (3) the accuracy of tumor motion and area directly measured by tumor autocontouring. Results: For constant image quality, the dynamic keyhole method, conventional keyhole, and zero-filling methods required 22%, 34%, and 49% of the keyhole size (P < 0.0001), respectively, compared to the full k-space image acquisition method. Compared to the conventional keyhole and zero-filling reconstructed images with the keyhole size utilized in the dynamic keyhole method, an average intensity difference of the dynamic keyhole reconstructed images (P < 0.0001) was minimal, and resulted in the accuracy of tumor motion within 99.6% (P < 0.0001) and the accuracy of tumor area within 98.0% (P < 0.0001) for lung tumor monitoring applications. Conclusions: This study demonstrates that the dynamic keyhole method is a promising technique for clinical applications such as image-guided radiation therapy requiring the MR monitoring of thoracic tumors. Based on the results from this study, the dynamic keyhole method could increase the imaging frequency by up to a factor of five compared with full k-space methods for real-time lung tumor MRI.« less

The use of CT density changes at internal tissue interfaces to correlate internal organ motion with an external surrogate

NASA Astrophysics Data System (ADS)

Gaede, Stewart; Carnes, Gregory; Yu, Edward; Van Dyk, Jake; Battista, Jerry; Lee, Ting-Yim

2009-01-01

The purpose of this paper is to describe a non-invasive method to monitor the motion of internal organs affected by respiration without using external markers or spirometry, to test the correlation with external markers, and to calculate any time shift between the datasets. Ten lung cancer patients were CT scanned with a GE LightSpeed Plus 4-Slice CT scanner operating in a ciné mode. We retrospectively reconstructed the raw CT data to obtain consecutive 0.5 s reconstructions at 0.1 s intervals to increase image sampling. We defined regions of interest containing tissue interfaces, including tumour/lung interfaces that move due to breathing on multiple axial slices and measured the mean CT number versus respiratory phase. Tumour motion was directly correlated with external marker motion, acquired simultaneously, using the sample coefficient of determination, r2. Only three of the ten patients showed correlation higher than r2 = 0.80 between tumour motion and external marker position. However, after taking into account time shifts (ranging between 0 s and 0.4 s) between the two data sets, all ten patients showed correlation better than r2 = 0.8. This non-invasive method for monitoring the motion of internal organs is an effective tool that can assess the use of external markers for 4D-CT imaging and respiratory-gated radiotherapy on a patient-specific basis.

The use of CT density changes at internal tissue interfaces to correlate internal organ motion with an external surrogate.

PubMed

Gaede, Stewart; Carnes, Gregory; Yu, Edward; Van Dyk, Jake; Battista, Jerry; Lee, Ting-Yim

2009-01-21

The purpose of this paper is to describe a non-invasive method to monitor the motion of internal organs affected by respiration without using external markers or spirometry, to test the correlation with external markers, and to calculate any time shift between the datasets. Ten lung cancer patients were CT scanned with a GE LightSpeed Plus 4-Slice CT scanner operating in a ciné mode. We retrospectively reconstructed the raw CT data to obtain consecutive 0.5 s reconstructions at 0.1 s intervals to increase image sampling. We defined regions of interest containing tissue interfaces, including tumour/lung interfaces that move due to breathing on multiple axial slices and measured the mean CT number versus respiratory phase. Tumour motion was directly correlated with external marker motion, acquired simultaneously, using the sample coefficient of determination, r(2). Only three of the ten patients showed correlation higher than r(2) = 0.80 between tumour motion and external marker position. However, after taking into account time shifts (ranging between 0 s and 0.4 s) between the two data sets, all ten patients showed correlation better than r(2) = 0.8. This non-invasive method for monitoring the motion of internal organs is an effective tool that can assess the use of external markers for 4D-CT imaging and respiratory-gated radiotherapy on a patient-specific basis.

Quantifying the impact of respiratory-gated 4D CT acquisition on thoracic image quality: A digital phantom study

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bernatowicz, K., E-mail: kingab@student.ethz.ch; Knopf, A.; Lomax, A.

Purpose: Prospective respiratory-gated 4D CT has been shown to reduce tumor image artifacts by up to 50% compared to conventional 4D CT. However, to date no studies have quantified the impact of gated 4D CT on normal lung tissue imaging, which is important in performing dose calculations based on accurate estimates of lung volume and structure. To determine the impact of gated 4D CT on thoracic image quality, the authors developed a novel simulation framework incorporating a realistic deformable digital phantom driven by patient tumor motion patterns. Based on this framework, the authors test the hypothesis that respiratory-gated 4D CTmore » can significantly reduce lung imaging artifacts. Methods: Our simulation framework synchronizes the 4D extended cardiac torso (XCAT) phantom with tumor motion data in a quasi real-time fashion, allowing simulation of three 4D CT acquisition modes featuring different levels of respiratory feedback: (i) “conventional” 4D CT that uses a constant imaging and couch-shift frequency, (ii) “beam paused” 4D CT that interrupts imaging to avoid oversampling at a given couch position and respiratory phase, and (iii) “respiratory-gated” 4D CT that triggers acquisition only when the respiratory motion fulfills phase-specific displacement gating windows based on prescan breathing data. Our framework generates a set of ground truth comparators, representing the average XCAT anatomy during beam-on for each of ten respiratory phase bins. Based on this framework, the authors simulated conventional, beam-paused, and respiratory-gated 4D CT images using tumor motion patterns from seven lung cancer patients across 13 treatment fractions, with a simulated 5.5 cm{sup 3} spherical lesion. Normal lung tissue image quality was quantified by comparing simulated and ground truth images in terms of overall mean square error (MSE) intensity difference, threshold-based lung volume error, and fractional false positive/false negative rates. Results: Averaged across all simulations and phase bins, respiratory-gating reduced overall thoracic MSE by 46% compared to conventional 4D CT (p ∼ 10{sup −19}). Gating leads to small but significant (p < 0.02) reductions in lung volume errors (1.8%–1.4%), false positives (4.0%–2.6%), and false negatives (2.7%–1.3%). These percentage reductions correspond to gating reducing image artifacts by 24–90 cm{sup 3} of lung tissue. Similar to earlier studies, gating reduced patient image dose by up to 22%, but with scan time increased by up to 135%. Beam paused 4D CT did not significantly impact normal lung tissue image quality, but did yield similar dose reductions as for respiratory-gating, without the added cost in scanning time. Conclusions: For a typical 6 L lung, respiratory-gated 4D CT can reduce image artifacts affecting up to 90 cm{sup 3} of normal lung tissue compared to conventional acquisition. This image improvement could have important implications for dose calculations based on 4D CT. Where image quality is less critical, beam paused 4D CT is a simple strategy to reduce imaging dose without sacrificing acquisition time.« less

A spatiotemporal-based scheme for efficient registration-based segmentation of thoracic 4-D MRI.

PubMed

Yang, Y; Van Reeth, E; Poh, C L; Tan, C H; Tham, I W K

2014-05-01

Dynamic three-dimensional (3-D) (four-dimensional, 4-D) magnetic resonance (MR) imaging is gaining importance in the study of pulmonary motion for respiratory diseases and pulmonary tumor motion for radiotherapy. To perform quantitative analysis using 4-D MR images, segmentation of anatomical structures such as the lung and pulmonary tumor is required. Manual segmentation of entire thoracic 4-D MRI data that typically contains many 3-D volumes acquired over several breathing cycles is extremely tedious, time consuming, and suffers high user variability. This requires the development of new automated segmentation schemes for 4-D MRI data segmentation. Registration-based segmentation technique that uses automatic registration methods for segmentation has been shown to be an accurate method to segment structures for 4-D data series. However, directly applying registration-based segmentation to segment 4-D MRI series lacks efficiency. Here we propose an automated 4-D registration-based segmentation scheme that is based on spatiotemporal information for the segmentation of thoracic 4-D MR lung images. The proposed scheme saved up to 95% of computation amount while achieving comparable accurate segmentations compared to directly applying registration-based segmentation to 4-D dataset. The scheme facilitates rapid 3-D/4-D visualization of the lung and tumor motion and potentially the tracking of tumor during radiation delivery.

MO-B-201-00: Motion Management in Current Stereotactic Body Radiation Therapy (SBRT) Practice

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

The motion management in stereotactic body radiation therapy (SBRT) is a key to success for a SBRT program, and still an on-going challenging task. A major factor is that moving structures behave differently than standing structures when examined by imaging modalities, and thus require special considerations and employments. Understanding the motion effects to these different imaging processes is a prerequisite for a decent motion management program. The commonly used motion control techniques to physically restrict tumor motion, if adopted correctly, effectively increase the conformity and accuracy of hypofractionated treatment. The effective application of such requires one to understand the mechanicsmore » of the application and the related physiology especially related to respiration. The image-guided radiation beam control, or tumor tracking, further realized the endeavor for precision-targeting. During tumor tracking, the respiratory motion is often constantly monitored by non-ionizing beam sources using the body surface as its surrogate. This then has to synchronize with the actual internal tumor motion. The latter is often accomplished by stereo X-ray imaging or similar techniques. With these advanced technologies, one may drastically reduce the treated volume and increase the clinicians’ confidence for a high fractional ablative radiation dose. However, the challenges in implementing the motion management may not be trivial and is dependent on each clinic case. This session of presentations is intended to provide an overview of the current techniques used in managing the tumor motion in SBRT, specifically for routine lung SBRT, proton based treatments, and newly-developed MR guided RT. Learning Objectives: Through this presentation, the audience will understand basic roles of commonly used imaging modalities for lung cancer studies; familiarize the major advantages and limitations of each discussed motion control methods; familiarize the major advantages and limitations of each discussed radiation beam control methodology and tumor tacking method; understand the key points in motion management for a high quality SBRT program.« less

Live small-animal X-ray lung velocimetry and lung micro-tomography at the Australian Synchrotron Imaging and Medical Beamline.

PubMed

Murrie, Rhiannon P; Morgan, Kaye S; Maksimenko, Anton; Fouras, Andreas; Paganin, David M; Hall, Chris; Siu, Karen K W; Parsons, David W; Donnelley, Martin

2015-07-01

The high flux and coherence produced at long synchrotron beamlines makes them well suited to performing phase-contrast X-ray imaging of the airways and lungs of live small animals. Here, findings of the first live-animal imaging on the Imaging and Medical Beamline (IMBL) at the Australian Synchrotron are reported, demonstrating the feasibility of performing dynamic lung motion measurement and high-resolution micro-tomography. Live anaesthetized mice were imaged using 30 keV monochromatic X-rays at a range of sample-to-detector propagation distances. A frame rate of 100 frames s(-1) allowed lung motion to be determined using X-ray velocimetry. A separate group of humanely killed mice and rats were imaged by computed tomography at high resolution. Images were reconstructed and rendered to demonstrate the capacity for detailed, user-directed display of relevant respiratory anatomy. The ability to perform X-ray velocimetry on live mice at the IMBL was successfully demonstrated. High-quality renderings of the head and lungs visualized both large structures and fine details of the nasal and respiratory anatomy. The effect of sample-to-detector propagation distance on contrast and resolution was also investigated, demonstrating that soft tissue contrast increases, and resolution decreases, with increasing propagation distance. This new capability to perform live-animal imaging and high-resolution micro-tomography at the IMBL enhances the capability for investigation of respiratory diseases and the acceleration of treatment development in Australia.

Automatic assessment of average diaphragm motion trajectory from 4DCT images through machine learning.

PubMed

Li, Guang; Wei, Jie; Huang, Hailiang; Gaebler, Carl Philipp; Yuan, Amy; Deasy, Joseph O

2015-12-01

To automatically estimate average diaphragm motion trajectory (ADMT) based on four-dimensional computed tomography (4DCT), facilitating clinical assessment of respiratory motion and motion variation and retrospective motion study. We have developed an effective motion extraction approach and a machine-learning-based algorithm to estimate the ADMT. Eleven patients with 22 sets of 4DCT images (4DCT1 at simulation and 4DCT2 at treatment) were studied. After automatically segmenting the lungs, the differential volume-per-slice (dVPS) curves of the left and right lungs were calculated as a function of slice number for each phase with respective to the full-exhalation. After 5-slice moving average was performed, the discrete cosine transform (DCT) was applied to analyze the dVPS curves in frequency domain. The dimensionality of the spectrum data was reduced by using several lowest frequency coefficients ( f v ) to account for most of the spectrum energy (Σ f v 2 ). Multiple linear regression (MLR) method was then applied to determine the weights of these frequencies by fitting the ground truth-the measured ADMT, which are represented by three pivot points of the diaphragm on each side. The 'leave-one-out' cross validation method was employed to analyze the statistical performance of the prediction results in three image sets: 4DCT1, 4DCT2, and 4DCT1 + 4DCT2. Seven lowest frequencies in DCT domain were found to be sufficient to approximate the patient dVPS curves ( R = 91%-96% in MLR fitting). The mean error in the predicted ADMT using leave-one-out method was 0.3 ± 1.9 mm for the left-side diaphragm and 0.0 ± 1.4 mm for the right-side diaphragm. The prediction error is lower in 4DCT2 than 4DCT1, and is the lowest in 4DCT1 and 4DCT2 combined. This frequency-analysis-based machine learning technique was employed to predict the ADMT automatically with an acceptable error (0.2 ± 1.6 mm). This volumetric approach is not affected by the presence of the lung tumors, providing an automatic robust tool to evaluate diaphragm motion.

Feasibility study of the diagnosis and monitoring of cystic fibrosis in pediatric patients using stationary digital chest tomosynthesis

NASA Astrophysics Data System (ADS)

Potuzko, Marci; Shan, Jing; Pearce, Caleb; Lee, Yueh Z.; Lu, Jianping; Zhou, Otto

2015-03-01

Digital chest tomosynthesis (DCT) is a 3D imaging modality which has been shown to approach the diagnostic capability of CT, but uses only one-tenth the radiation dose of CT. One limitation of current commercial DCT is the mechanical motion of the x-ray source which prolongs image acquisition time and introduces motion blurring in images. By using a carbon nanotube (CNT) x-ray source array, we have developed a stationary digital chest tomosynthesis (s- DCT) system which can acquire tomosynthesis images without mechanical motion, thus enhancing the image quality. The low dose and high quality 3D image makes the s-DCT system a viable imaging tool for monitoring cystic fibrosis (CF) patients. The low dose is especially important in pediatric patients who are both more radiosensitive and have a longer lifespan for radiation symptoms to develop. The purpose of this research is to evaluate the feasibility of using s-DCT as a faster, lower dose means for diagnosis and monitoring of CF in pediatric patients. We have created an imaging phantom by injecting a gelatinous mucus substitute into porcine lungs and imaging the lungs from within an anthropomorphic hollow chest phantom in order to mimic the human conditions of a CF patient in the laboratory setting. We have found that our s-DCT images show evidence of mucus plugging in the lungs and provide a clear picture of the airways in the lung, allowing for the possibility of using s- DCT to supplement or replace CT as the imaging modality for CF patients.

3D delivered dose assessment using a 4DCT-based motion model

PubMed Central

Cai, Weixing; Hurwitz, Martina H.; Williams, Christopher L.; Dhou, Salam; Berbeco, Ross I.; Seco, Joao; Mishra, Pankaj; Lewis, John H.

2015-01-01

Purpose: The purpose of this work is to develop a clinically feasible method of calculating actual delivered dose distributions for patients who have significant respiratory motion during the course of stereotactic body radiation therapy (SBRT). Methods: A novel approach was proposed to calculate the actual delivered dose distribution for SBRT lung treatment. This approach can be specified in three steps. (1) At the treatment planning stage, a patient-specific motion model is created from planning 4DCT data. This model assumes that the displacement vector field (DVF) of any respiratory motion deformation can be described as a linear combination of some basis DVFs. (2) During the treatment procedure, 2D time-varying projection images (either kV or MV projections) are acquired, from which time-varying “fluoroscopic” 3D images of the patient are reconstructed using the motion model. The DVF of each timepoint in the time-varying reconstruction is an optimized linear combination of basis DVFs such that the 2D projection of the 3D volume at this timepoint matches the projection image. (3) 3D dose distribution is computed for each timepoint in the set of 3D reconstructed fluoroscopic images, from which the total effective 3D delivered dose is calculated by accumulating deformed dose distributions. This approach was first validated using two modified digital extended cardio-torso (XCAT) phantoms with lung tumors and different respiratory motions. The estimated doses were compared to the dose that would be calculated for routine 4DCT-based planning and to the actual delivered dose that was calculated using “ground truth” XCAT phantoms at all timepoints. The approach was also tested using one set of patient data, which demonstrated the application of our method in a clinical scenario. Results: For the first XCAT phantom that has a mostly regular breathing pattern, the errors in 95% volume dose (D95) are 0.11% and 0.83%, respectively for 3D fluoroscopic images reconstructed from kV and MV projections compared to the ground truth, which is clinically comparable to 4DCT (0.093%). For the second XCAT phantom that has an irregular breathing pattern, the errors are 0.81% and 1.75% for kV and MV reconstructions, both of which are better than that of 4DCT (4.01%). In the case of real patient, although it is impossible to obtain the actual delivered dose, the dose estimation is clinically reasonable and demonstrates differences between 4DCT and MV reconstruction-based dose estimates. Conclusions: With the availability of kV or MV projection images, the proposed approach is able to assess delivered doses for all respiratory phases during treatment. Compared to the planning dose based on 4DCT, the dose estimation using reconstructed 3D fluoroscopic images was as good as 4DCT for regular respiratory pattern and was a better dose estimation for the irregular respiratory pattern. PMID:26127043

3D delivered dose assessment using a 4DCT-based motion model

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cai, Weixing; Hurwitz, Martina H.; Williams, Christopher L.

Purpose: The purpose of this work is to develop a clinically feasible method of calculating actual delivered dose distributions for patients who have significant respiratory motion during the course of stereotactic body radiation therapy (SBRT). Methods: A novel approach was proposed to calculate the actual delivered dose distribution for SBRT lung treatment. This approach can be specified in three steps. (1) At the treatment planning stage, a patient-specific motion model is created from planning 4DCT data. This model assumes that the displacement vector field (DVF) of any respiratory motion deformation can be described as a linear combination of some basismore » DVFs. (2) During the treatment procedure, 2D time-varying projection images (either kV or MV projections) are acquired, from which time-varying “fluoroscopic” 3D images of the patient are reconstructed using the motion model. The DVF of each timepoint in the time-varying reconstruction is an optimized linear combination of basis DVFs such that the 2D projection of the 3D volume at this timepoint matches the projection image. (3) 3D dose distribution is computed for each timepoint in the set of 3D reconstructed fluoroscopic images, from which the total effective 3D delivered dose is calculated by accumulating deformed dose distributions. This approach was first validated using two modified digital extended cardio-torso (XCAT) phantoms with lung tumors and different respiratory motions. The estimated doses were compared to the dose that would be calculated for routine 4DCT-based planning and to the actual delivered dose that was calculated using “ground truth” XCAT phantoms at all timepoints. The approach was also tested using one set of patient data, which demonstrated the application of our method in a clinical scenario. Results: For the first XCAT phantom that has a mostly regular breathing pattern, the errors in 95% volume dose (D95) are 0.11% and 0.83%, respectively for 3D fluoroscopic images reconstructed from kV and MV projections compared to the ground truth, which is clinically comparable to 4DCT (0.093%). For the second XCAT phantom that has an irregular breathing pattern, the errors are 0.81% and 1.75% for kV and MV reconstructions, both of which are better than that of 4DCT (4.01%). In the case of real patient, although it is impossible to obtain the actual delivered dose, the dose estimation is clinically reasonable and demonstrates differences between 4DCT and MV reconstruction-based dose estimates. Conclusions: With the availability of kV or MV projection images, the proposed approach is able to assess delivered doses for all respiratory phases during treatment. Compared to the planning dose based on 4DCT, the dose estimation using reconstructed 3D fluoroscopic images was as good as 4DCT for regular respiratory pattern and was a better dose estimation for the irregular respiratory pattern.« less

Rib kinematics during lung ventilation in the American alligator (Alligator mississippiensis): an XROMM analysis

PubMed Central

Moritz, Sabine; Codd, Jonathan; Sellers, William I.

2017-01-01

ABSTRACT The current hypothesis regarding the mechanics of breathing in crocodylians is that the double-headed ribs, with both a capitulum and tuberculum, rotate about a constrained axis passing through the two articulations; moreover, this axis shifts in the caudal thoracic ribs, as the vertebral parapophysis moves from the centrum to the transverse process. Additionally, the ventral ribcage in crocodylians is thought to possess additional degrees of freedom through mobile intermediate ribs. In this study, X-ray reconstruction of moving morphology (XROMM) was used to quantify rib rotation during breathing in American alligators. Whilst costovertebral joint anatomy predicted overall patterns of motion across the ribcage (decreased bucket handle motion and increased calliper motion), there were significant deviations: anatomical axes overestimated pump handle motion and, generally, ribs in vivo rotate about all three body axes more equally than predicted. The intermediate ribs are mobile, with a high degree of rotation measured about the dorsal intracostal joints, especially in the more caudal ribs. Motion of the sternal ribs became increasingly complex caudally, owing to a combination of the movements of the vertebral and intermediate segments. As the crocodylian ribcage is sometimes used as a model for the ancestral archosaur, these results have important implications for how rib motion is reconstructed in fossil taxa, and illustrate the difficulties in reconstructing rib movement based on osteology alone. PMID:28855323

The effect of irregular breathing patterns on internal target volumes in four-dimensional CT and cone-beam CT images in the context of stereotactic lung radiotherapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Clements, N.; Kron, T.; Roxby, P.

2013-02-15

Purpose: Stereotactic lung radiotherapy is complicated by tumor motion from patient respiration. Four-dimensional CT (4DCT) imaging is a motion compensation method used in treatment planning to generate a maximum intensity projection (MIP) internal target volume (ITV). Image guided radiotherapy during treatment may involve acquiring a volumetric cone-beam CT (CBCT) image and visually aligning the tumor to the planning 4DCT MIP ITV contour. Moving targets imaged with CBCT can appear blurred and currently there are no studies reporting on the effect that irregular breathing patterns have on CBCT volumes and their alignment to 4DCT MIP ITV contours. The objective of thismore » work was therefore to image a phantom moving with irregular breathing patterns to determine whether any configurations resulted in errors in volume contouring or alignment. Methods: A Perspex thorax phantom was used to simulate a patient. Three wooden 'lung' inserts with embedded Perspex 'lesions' were moved up to 4 cm with computer-generated motion patterns, and up to 1 cm with patient-specific breathing patterns. The phantom was imaged on 4DCT and CBCT with the same acquisition settings used for stereotactic lung patients in the clinic and the volumes on all phantom images were contoured. This project assessed the volumes for qualitative and quantitative changes including volume, length of the volume, and errors in alignment between CBCT volumes and 4DCT MIP ITV contours. Results: When motion was introduced 4DCT and CBCT volumes were reduced by up to 20% and 30% and shortened by up to 7 and 11 mm, respectively, indicating that volume was being under-represented at the extremes of motion. Banding artifacts were present in 4DCT MIP images, while CBCT volumes were largely reduced in contrast. When variable amplitudes from patient traces were used and CBCT ITVs were compared to 4DCT MIP ITVs there was a distinct trend in reduced ITV with increasing amplitude that was not seen when compared to true ITVs. Breathing patterns with a rest period following expiration resulted in well-defined superior edges and were better aligned using an edge-to-edge alignment technique. In most cases, sinusoidal motion patterns resulted in the closest agreements to true values and the smallest misalignments. Conclusions: Strategies are needed to compensate for volume losses at the extremes of motion for both 4DCT MIP and CBCT images for larger and varied amplitudes, and for patterns with rest periods following expiration. Lesions moving greater than 2 cm would warrant larger treatment margins added to the 4DCT MIP ITV to account for the volume being under-represented at the extremes of motion. Lesions moving with a rest period following expiration would be better aligned using an edge-to-edge alignment technique. Sinusoidal patterns represented the ideal clinical scenario, reinforcing the importance of investigating clinically relevant motions and their effects on 4DCT MIP and CBCT volumes. Since most patients do not breathe sinusoidally this may lead to misinterpretation of previous studies using only sinusoidal motion.« less

The effect of irregular breathing patterns on internal target volumes in four-dimensional CT and cone-beam CT images in the context of stereotactic lung radiotherapy.

PubMed

Clements, N; Kron, T; Franich, R; Dunn, L; Roxby, P; Aarons, Y; Chesson, B; Siva, S; Duplan, D; Ball, D

2013-02-01

Stereotactic lung radiotherapy is complicated by tumor motion from patient respiration. Four-dimensional CT (4DCT) imaging is a motion compensation method used in treatment planning to generate a maximum intensity projection (MIP) internal target volume (ITV). Image guided radiotherapy during treatment may involve acquiring a volumetric cone-beam CT (CBCT) image and visually aligning the tumor to the planning 4DCT MIP ITV contour. Moving targets imaged with CBCT can appear blurred and currently there are no studies reporting on the effect that irregular breathing patterns have on CBCT volumes and their alignment to 4DCT MIP ITV contours. The objective of this work was therefore to image a phantom moving with irregular breathing patterns to determine whether any configurations resulted in errors in volume contouring or alignment. A Perspex thorax phantom was used to simulate a patient. Three wooden "lung" inserts with embedded Perspex "lesions" were moved up to 4 cm with computer-generated motion patterns, and up to 1 cm with patient-specific breathing patterns. The phantom was imaged on 4DCT and CBCT with the same acquisition settings used for stereotactic lung patients in the clinic and the volumes on all phantom images were contoured. This project assessed the volumes for qualitative and quantitative changes including volume, length of the volume, and errors in alignment between CBCT volumes and 4DCT MIP ITV contours. When motion was introduced 4DCT and CBCT volumes were reduced by up to 20% and 30% and shortened by up to 7 and 11 mm, respectively, indicating that volume was being under-represented at the extremes of motion. Banding artifacts were present in 4DCT MIP images, while CBCT volumes were largely reduced in contrast. When variable amplitudes from patient traces were used and CBCT ITVs were compared to 4DCT MIP ITVs there was a distinct trend in reduced ITV with increasing amplitude that was not seen when compared to true ITVs. Breathing patterns with a rest period following expiration resulted in well-defined superior edges and were better aligned using an edge-to-edge alignment technique. In most cases, sinusoidal motion patterns resulted in the closest agreements to true values and the smallest misalignments. Strategies are needed to compensate for volume losses at the extremes of motion for both 4DCT MIP and CBCT images for larger and varied amplitudes, and for patterns with rest periods following expiration. Lesions moving greater than 2 cm would warrant larger treatment margins added to the 4DCT MIP ITV to account for the volume being under-represented at the extremes of motion. Lesions moving with a rest period following expiration would be better aligned using an edge-to-edge alignment technique. Sinusoidal patterns represented the ideal clinical scenario, reinforcing the importance of investigating clinically relevant motions and their effects on 4DCT MIP and CBCT volumes. Since most patients do not breathe sinusoidally this may lead to misinterpretation of previous studies using only sinusoidal motion.

Comparison of Joint Loading in Badminton Lunging between Professional and Amateur Badminton Players

PubMed Central

Fu, Lin

2017-01-01

The knee and ankle are the two most injured joints associated with the sport of badminton. This study evaluates biomechanical factors between professional and amateur badminton players using an injury mechanism model. The aim of this study was to investigate the kinematic motion and kinetic loading differences of the right knee and ankle while performing a maximal right lunge. Amateur players exhibited greater ankle range of motion (p < 0.05, r = 0.89) and inversion joint moment (p < 0.05, r = 0.54) in the frontal plane as well as greater internal joint rotation moment (p < 0.05, r = 0.28) in the horizontal plane. In contrast, professional badminton players presented a greater knee joint moment in the sagittal (p < 0.05, r = 0.59) and frontal (p < 0.05, r = 0.37) planes, which may be associated with increased knee ligamentous injury risk. To avoid injury, the players need to forcefully extend the knee with internal rotation, strengthen the muscles around the ankle ligament, and maximise joint coordination during training. The injuries recorded and the forces responsible for the injuries seem to have developed during training activity. Training programmes and injury prevention strategies for badminton players should account for these findings to reduce potential injury to the ankle and knee. PMID:28694684

DOE Office of Scientific and Technical Information (OSTI.GOV)

Beaudry, J.; Bergman, A.; British Columbia Cancer Agency - Vancouver Centre, Vancouver, BC

Lung tumours move due to respiratory motion. This is managed during planning by acquiring a 4DCT and capturing the excursion of the GTV (gross tumour volume) throughout the breathing cycle within an IGTV (Internal Gross Tumour Volume) contour. Patients undergo a verification cone-beam CT (CBCT) scan immediately prior to treatment. 3D reconstructed images do not consider tumour motion, resulting in image artefacts, such as blurring. This may lead to difficulty in identifying the tumour on reconstructed images. It would be valuable to create a 4DCBCT reconstruction of the tumour motion to confirm that does indeed remain within the planned IGTV.more » CBCT projections of a Quasar Respiratory Motion Phantom are acquired in Treatment mode (half-fan scan) on a Varian TrueBeam accelerator. This phantom contains a mobile, low-density lung insert with an embedded 3cm diameter tumour object. It is programmed to create a 15s periodic, 2cm (sup/inf) displacement. A Varian Real-time Position Management (RPM) tracking-box is placed on the phantom breathing platform. Breathing phase information is automatically integrated into the projection image files. Using in-house Matlab programs and RTK (Reconstruction Tool Kit) open-source toolboxes, the projections are re-binned into 10 phases and a 4DCBCT scan reconstructed. The planning IGTV is registered to the 4DCBCT and the tumour excursion is verified to remain within the planned contour. This technique successfully reconstructs 4DCBCT images using clinical modes for a breathing phantom. UBC-BCCA ethics approval has been obtained to perform 4DCBCT reconstructions on lung patients (REB#H12-00192). Clinical images will be accrued starting April 2014.« less

Respiratory motion correction in 4D-PET by simultaneous motion estimation and image reconstruction (SMEIR)

PubMed Central

Kalantari, Faraz; Li, Tianfang; Jin, Mingwu; Wang, Jing

2016-01-01

In conventional 4D positron emission tomography (4D-PET), images from different frames are reconstructed individually and aligned by registration methods. Two issues that arise with this approach are as follows: 1) the reconstruction algorithms do not make full use of projection statistics; and 2) the registration between noisy images can result in poor alignment. In this study, we investigated the use of simultaneous motion estimation and image reconstruction (SMEIR) methods for motion estimation/correction in 4D-PET. A modified ordered-subset expectation maximization algorithm coupled with total variation minimization (OSEM-TV) was used to obtain a primary motion-compensated PET (pmc-PET) from all projection data, using Demons derived deformation vector fields (DVFs) as initial motion vectors. A motion model update was performed to obtain an optimal set of DVFs in the pmc-PET and other phases, by matching the forward projection of the deformed pmc-PET with measured projections from other phases. The OSEM-TV image reconstruction was repeated using updated DVFs, and new DVFs were estimated based on updated images. A 4D-XCAT phantom with typical FDG biodistribution was generated to evaluate the performance of the SMEIR algorithm in lung and liver tumors with different contrasts and different diameters (10 to 40 mm). The image quality of the 4D-PET was greatly improved by the SMEIR algorithm. When all projections were used to reconstruct 3D-PET without motion compensation, motion blurring artifacts were present, leading up to 150% tumor size overestimation and significant quantitative errors, including 50% underestimation of tumor contrast and 59% underestimation of tumor uptake. Errors were reduced to less than 10% in most images by using the SMEIR algorithm, showing its potential in motion estimation/correction in 4D-PET. PMID:27385378

Respiratory motion correction in 4D-PET by simultaneous motion estimation and image reconstruction (SMEIR)

NASA Astrophysics Data System (ADS)

Kalantari, Faraz; Li, Tianfang; Jin, Mingwu; Wang, Jing

2016-08-01

In conventional 4D positron emission tomography (4D-PET), images from different frames are reconstructed individually and aligned by registration methods. Two issues that arise with this approach are as follows: (1) the reconstruction algorithms do not make full use of projection statistics; and (2) the registration between noisy images can result in poor alignment. In this study, we investigated the use of simultaneous motion estimation and image reconstruction (SMEIR) methods for motion estimation/correction in 4D-PET. A modified ordered-subset expectation maximization algorithm coupled with total variation minimization (OSEM-TV) was used to obtain a primary motion-compensated PET (pmc-PET) from all projection data, using Demons derived deformation vector fields (DVFs) as initial motion vectors. A motion model update was performed to obtain an optimal set of DVFs in the pmc-PET and other phases, by matching the forward projection of the deformed pmc-PET with measured projections from other phases. The OSEM-TV image reconstruction was repeated using updated DVFs, and new DVFs were estimated based on updated images. A 4D-XCAT phantom with typical FDG biodistribution was generated to evaluate the performance of the SMEIR algorithm in lung and liver tumors with different contrasts and different diameters (10-40 mm). The image quality of the 4D-PET was greatly improved by the SMEIR algorithm. When all projections were used to reconstruct 3D-PET without motion compensation, motion blurring artifacts were present, leading up to 150% tumor size overestimation and significant quantitative errors, including 50% underestimation of tumor contrast and 59% underestimation of tumor uptake. Errors were reduced to less than 10% in most images by using the SMEIR algorithm, showing its potential in motion estimation/correction in 4D-PET.

Quantification of organ motion based on an adaptive image-based scale invariant feature method

DOE Office of Scientific and Technical Information (OSTI.GOV)

Paganelli, Chiara; Peroni, Marta; Baroni, Guido

2013-11-15

Purpose: The availability of corresponding landmarks in IGRT image series allows quantifying the inter and intrafractional motion of internal organs. In this study, an approach for the automatic localization of anatomical landmarks is presented, with the aim of describing the nonrigid motion of anatomo-pathological structures in radiotherapy treatments according to local image contrast.Methods: An adaptive scale invariant feature transform (SIFT) was developed from the integration of a standard 3D SIFT approach with a local image-based contrast definition. The robustness and invariance of the proposed method to shape-preserving and deformable transforms were analyzed in a CT phantom study. The application ofmore » contrast transforms to the phantom images was also tested, in order to verify the variation of the local adaptive measure in relation to the modification of image contrast. The method was also applied to a lung 4D CT dataset, relying on manual feature identification by an expert user as ground truth. The 3D residual distance between matches obtained in adaptive-SIFT was then computed to verify the internal motion quantification with respect to the expert user. Extracted corresponding features in the lungs were used as regularization landmarks in a multistage deformable image registration (DIR) mapping the inhale vs exhale phase. The residual distances between the warped manual landmarks and their reference position in the inhale phase were evaluated, in order to provide a quantitative indication of the registration performed with the three different point sets.Results: The phantom study confirmed the method invariance and robustness properties to shape-preserving and deformable transforms, showing residual matching errors below the voxel dimension. The adapted SIFT algorithm on the 4D CT dataset provided automated and accurate motion detection of peak to peak breathing motion. The proposed method resulted in reduced residual errors with respect to standard SIFT, providing a motion description comparable to expert manual identification, as confirmed by DIR.Conclusions: The application of the method to a 4D lung CT patient dataset demonstrated adaptive-SIFT potential as an automatic tool to detect landmarks for DIR regularization and internal motion quantification. Future works should include the optimization of the computational cost and the application of the method to other anatomical sites and image modalities.« less

Compensation for large thorax excursions in EIT imaging.

PubMed

Schullcke, B; Krueger-Ziolek, S; Gong, B; Mueller-Lisse, U; Moeller, K

2016-09-01

Besides the application of EIT in the intensive care unit it has recently also been used in spontaneously breathing patients suffering from asthma bronchiole, cystic fibrosis (CF) or chronic obstructive pulmonary disease (COPD). In these cases large thorax excursions during deep inspiration, e.g. during lung function testing, lead to artifacts in the reconstructed images. In this paper we introduce a new approach to compensate for image artifacts resulting from excursion induced changes in boundary voltages. It is shown in a simulation study that boundary voltage change due to thorax excursion on a homogeneous model can be used to modify the measured voltages and thus reduce the impact of thorax excursion on the reconstructed images. The applicability of the method on human subjects is demonstrated utilizing a motion-tracking-system. The proposed technique leads to fewer artifacts in the reconstructed images and improves image quality without substantial increase in computational effort, making the approach suitable for real-time imaging of lung ventilation. This might help to establish EIT as a supplemental tool for lung function tests in spontaneously breathing patients to support clinicians in diagnosis and monitoring of disease progression.

Simultaneous motion estimation and image reconstruction (SMEIR) for 4D cone-beam CT

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wang, Jing; Gu, Xuejun

2013-10-15

Purpose: Image reconstruction and motion model estimation in four-dimensional cone-beam CT (4D-CBCT) are conventionally handled as two sequential steps. Due to the limited number of projections at each phase, the image quality of 4D-CBCT is degraded by view aliasing artifacts, and the accuracy of subsequent motion modeling is decreased by the inferior 4D-CBCT. The objective of this work is to enhance both the image quality of 4D-CBCT and the accuracy of motion model estimation with a novel strategy enabling simultaneous motion estimation and image reconstruction (SMEIR).Methods: The proposed SMEIR algorithm consists of two alternating steps: (1) model-based iterative image reconstructionmore » to obtain a motion-compensated primary CBCT (m-pCBCT) and (2) motion model estimation to obtain an optimal set of deformation vector fields (DVFs) between the m-pCBCT and other 4D-CBCT phases. The motion-compensated image reconstruction is based on the simultaneous algebraic reconstruction technique (SART) coupled with total variation minimization. During the forward- and backprojection of SART, measured projections from an entire set of 4D-CBCT are used for reconstruction of the m-pCBCT by utilizing the updated DVF. The DVF is estimated by matching the forward projection of the deformed m-pCBCT and measured projections of other phases of 4D-CBCT. The performance of the SMEIR algorithm is quantitatively evaluated on a 4D NCAT phantom. The quality of reconstructed 4D images and the accuracy of tumor motion trajectory are assessed by comparing with those resulting from conventional sequential 4D-CBCT reconstructions (FDK and total variation minimization) and motion estimation (demons algorithm). The performance of the SMEIR algorithm is further evaluated by reconstructing a lung cancer patient 4D-CBCT.Results: Image quality of 4D-CBCT is greatly improved by the SMEIR algorithm in both phantom and patient studies. When all projections are used to reconstruct a 3D-CBCT by FDK, motion-blurring artifacts are present, leading to a 24.4% relative reconstruction error in the NACT phantom. View aliasing artifacts are present in 4D-CBCT reconstructed by FDK from 20 projections, with a relative error of 32.1%. When total variation minimization is used to reconstruct 4D-CBCT, the relative error is 18.9%. Image quality of 4D-CBCT is substantially improved by using the SMEIR algorithm and relative error is reduced to 7.6%. The maximum error (MaxE) of tumor motion determined from the DVF obtained by demons registration on a FDK-reconstructed 4D-CBCT is 3.0, 2.3, and 7.1 mm along left–right (L-R), anterior–posterior (A-P), and superior–inferior (S-I) directions, respectively. From the DVF obtained by demons registration on 4D-CBCT reconstructed by total variation minimization, the MaxE of tumor motion is reduced to 1.5, 0.5, and 5.5 mm along L-R, A-P, and S-I directions. From the DVF estimated by SMEIR algorithm, the MaxE of tumor motion is further reduced to 0.8, 0.4, and 1.5 mm along L-R, A-P, and S-I directions, respectively.Conclusions: The proposed SMEIR algorithm is able to estimate a motion model and reconstruct motion-compensated 4D-CBCT. The SMEIR algorithm improves image reconstruction accuracy of 4D-CBCT and tumor motion trajectory estimation accuracy as compared to conventional sequential 4D-CBCT reconstruction and motion estimation.« less

A state-based probabilistic model for tumor respiratory motion prediction

NASA Astrophysics Data System (ADS)

Kalet, Alan; Sandison, George; Wu, Huanmei; Schmitz, Ruth

2010-12-01

This work proposes a new probabilistic mathematical model for predicting tumor motion and position based on a finite state representation using the natural breathing states of exhale, inhale and end of exhale. Tumor motion was broken down into linear breathing states and sequences of states. Breathing state sequences and the observables representing those sequences were analyzed using a hidden Markov model (HMM) to predict the future sequences and new observables. Velocities and other parameters were clustered using a k-means clustering algorithm to associate each state with a set of observables such that a prediction of state also enables a prediction of tumor velocity. A time average model with predictions based on average past state lengths was also computed. State sequences which are known a priori to fit the data were fed into the HMM algorithm to set a theoretical limit of the predictive power of the model. The effectiveness of the presented probabilistic model has been evaluated for gated radiation therapy based on previously tracked tumor motion in four lung cancer patients. Positional prediction accuracy is compared with actual position in terms of the overall RMS errors. Various system delays, ranging from 33 to 1000 ms, were tested. Previous studies have shown duty cycles for latencies of 33 and 200 ms at around 90% and 80%, respectively, for linear, no prediction, Kalman filter and ANN methods as averaged over multiple patients. At 1000 ms, the previously reported duty cycles range from approximately 62% (ANN) down to 34% (no prediction). Average duty cycle for the HMM method was found to be 100% and 91 ± 3% for 33 and 200 ms latency and around 40% for 1000 ms latency in three out of four breathing motion traces. RMS errors were found to be lower than linear and no prediction methods at latencies of 1000 ms. The results show that for system latencies longer than 400 ms, the time average HMM prediction outperforms linear, no prediction, and the more general HMM-type predictive models. RMS errors for the time average model approach the theoretical limit of the HMM, and predicted state sequences are well correlated with sequences known to fit the data.

Effect of a 4-week elastic resistance band training regimen on back kinematics in horses trotting in-hand and on the lunge.

PubMed

Pfau, T; Simons, V; Rombach, N; Stubbs, N; Weller, R

2017-11-01

Training and rehabilitation techniques aiming at improving core muscle strength may result in increased dynamic stability of the equine vertebral column. A system of elastic resistance bands is suggested to provide proprioceptive feedback during motion to encourage recruitment of core abdominal and hindquarter musculature for improved dynamic stability. To quantify the effects of a specific resistance band system on back kinematics during trot in-hand and lungeing at beginning and end of a 4-week exercise programme. Quantitative analysis of back movement before/after a 4-week exercise programme. Inertial sensor data were collected from seven horses at weeks 1 and 4 of an exercise protocol with elastic resistance bands. Translational (dorsoventral, mediolateral) and rotational (roll, pitch) range of motion of six landmarks from poll to coccygeal region were quantified during trot in-hand (hard surface) and during lungeing (soft surface, both reins) with/without elastic exercise bands. A mixed model (P<0.05) evaluated the effects of exercise bands, time (week) and movement direction (straight, left, right). The bands reduced roll, pitch and mediolateral displacement in the thoracolumbar region (all P≤0.04). At week 4, independent of band usage, rotational movement (withers, thoracic) was reduced while dorsoventral movement (thoracic, coccygeal) increased. Increased back movement was measured in 80% of back movement parameters during lungeing. Comparing each horse without and with bands without a control group does not distinguish whether the differences measured between weeks 1 and 4 are related to use of the bands, or only to the exercise regimen. Results suggest that the elastic resistance bands reduce mediolateral and rotational movement of the thoracolumbar region (increase dynamic stability) in trot. Further studies should investigate the underlying mechanism with reference to core abdominal and hindquarter muscle recruitment and study the long-term effects. The Summary is available in Chinese - see Supporting Information. © 2017 EVJ Ltd.

Classification of coronary artery calcifications according to motion artifacts in chest CT using a convolutional neural network

NASA Astrophysics Data System (ADS)

Šprem, Jurica; de Vos, Bob D.; de Jong, Pim A.; Viergever, Max A.; Išgum, Ivana

2017-02-01

Coronary artery calcification (CAC) is a strong and independent predictor of cardiovascular events (CVEs). CAC can be quantified in chest CT scans acquired in lung screening. However, in these images the reproducibility of CAC quantification is compromised by cardiac motion that occurs during scanning, thereby limiting the reproducibility of CVE risk assessment. We present a system for the identification of CACs strongly affected by cardiac motion artifacts by using a convolutional neural network (CNN). This study included 125 chest CT scans from the National Lung Screening Trial (NLST). Images were acquired with CT scanners from four different vendors (GE, Siemens, Philips, Toshiba) with varying tube voltage, image resolution settings, and without ECG synchronization. To define the reference standard, an observer manually identified CAC lesions and labeled each according to the presence of cardiac motion: strongly affected (positive), mildly affected/not affected (negative). A CNN was designed to automatically label the identified CAC lesions according to the presence of cardiac motion by analyzing a patch from the axial CT slice around each lesion. From 125 CT scans, 9201 CAC lesions were analyzed. 8001 lesions were used for training (19% positive) and the remaining 1200 (50% positive) were used for testing. The proposed CNN achieved a classification accuracy of 85% (86% sensitivity, 84% specificity). The obtained results demonstrate that the proposed algorithm can identify CAC lesions that are strongly affected by cardiac motion. This could facilitate further investigation into the relation of CAC scoring reproducibility and the presence of cardiac motion artifacts.

Initial clinical observations of intra- and interfractional motion variation in MR-guided lung SBRT.

PubMed

Thomas, David H; Santhanam, Anand; Kishan, Amar U; Cao, Minsong; Lamb, James; Min, Yugang; O'Connell, Dylan; Yang, Yingli; Agazaryan, Nzhde; Lee, Percy; Low, Daniel

2018-02-01

To evaluate variations in intra- and interfractional tumour motion, and the effect on internal target volume (ITV) contour accuracy, using deformable image registration of real-time two-dimensional-sagittal cine-mode MRI acquired during lung stereotactic body radiation therapy (SBRT) treatments. Five lung tumour patients underwent free-breathing SBRT treatments on the ViewRay system, with dose prescribed to a planning target volume (defined as a 3-6 mm expansion of the 4DCT-ITV). Sagittal slice cine-MR images (3.5 × 3.5 mm 2 pixels) were acquired through the centre of the tumour at 4 frames per second throughout the treatments (3-4 fractions of 21-32 min). Tumour gross tumour volumes (GTVs) were contoured on the first frame of the MR cine and tracked for the first 20 min of each treatment using offline optical-flow based deformable registration implemented on a GPU cluster. A ground truth ITV (MR-ITV 20 min ) was formed by taking the union of tracked GTV contours. Pseudo-ITVs were generated from unions of the GTV contours tracked over 10 s segments of image data (MR-ITV 10 s ). Differences were observed in the magnitude of median tumour displacement between days of treatments. MR-ITV 10 s areas were as small as 46% of the MR-ITV 20 min . An ITV offers a "snapshot" of breathing motion for the brief period of time the tumour is imaged on a specific day. Real-time MRI over prolonged periods of time and over multiple treatment fractions shows that ITV size varies. Further work is required to investigate the dosimetric effect of these results. Advances in knowledge: Five lung tumour patients underwent free-breathing MRI-guided SBRT treatments, and their tumours tracked using deformable registration of cine-mode MRI. The results indicate that variability of both intra- and interfractional breathing amplitude should be taken into account during planning of lung radiotherapy.

Comparison of breathing gated CT images generated using a 5DCT technique and a commercial clinical protocol in a porcine model

PubMed Central

O’Connell, Dylan P.; Thomas, David H.; Dou, Tai H.; Lamb, James M.; Feingold, Franklin; Low, Daniel A.; Fuld, Matthew K.; Sieren, Jered P.; Sloan, Chelsea M.; Shirk, Melissa A.; Hoffman, Eric A.; Hofmann, Christian

2015-01-01

Purpose: To demonstrate that a “5DCT” technique which utilizes fast helical acquisition yields the same respiratory-gated images as a commercial technique for regular, mechanically produced breathing cycles. Methods: Respiratory-gated images of an anesthetized, mechanically ventilated pig were generated using a Siemens low-pitch helical protocol and 5DCT for a range of breathing rates and amplitudes and with standard and low dose imaging protocols. 5DCT reconstructions were independently evaluated by measuring the distances between tissue positions predicted by a 5D motion model and those measured using deformable registration, as well by reconstructing the originally acquired scans. Discrepancies between the 5DCT and commercial reconstructions were measured using landmark correspondences. Results: The mean distance between model predicted tissue positions and deformably registered tissue positions over the nine datasets was 0.65 ± 0.28 mm. Reconstructions of the original scans were on average accurate to 0.78 ± 0.57 mm. Mean landmark displacement between the commercial and 5DCT images was 1.76 ± 1.25 mm while the maximum lung tissue motion over the breathing cycle had a mean value of 27.2 ± 4.6 mm. An image composed of the average of 30 deformably registered images acquired with a low dose protocol had 6 HU image noise (single standard deviation) in the heart versus 31 HU for the commercial images. Conclusions: An end to end evaluation of the 5DCT technique was conducted through landmark based comparison to breathing gated images acquired with a commercial protocol under highly regular ventilation. The techniques were found to agree to within 2 mm for most respiratory phases and most points in the lung. PMID:26133604

Quantitative Evaluation of PET Respiratory Motion Correction Using MR Derived Simulated Data

NASA Astrophysics Data System (ADS)

Polycarpou, Irene; Tsoumpas, Charalampos; King, Andrew P.; Marsden, Paul K.

2015-12-01

The impact of respiratory motion correction on quantitative accuracy in PET imaging is evaluated using simulations for variable patient specific characteristics such as tumor uptake and respiratory pattern. Respiratory patterns from real patients were acquired, with long quiescent motion periods (type-1) as commonly observed in most patients and with long-term amplitude variability as is expected under conditions of difficult breathing (type-2). The respiratory patterns were combined with an MR-derived motion model to simulate real-time 4-D PET-MR datasets. Lung and liver tumors were simulated with diameters of 10 and 12 mm and tumor-to-background ratio ranging from 3:1 to 6:1. Projection data for 6- and 3-mm PET resolution were generated for the Philips Gemini scanner and reconstructed without and with motion correction using OSEM (2 iterations, 23 subsets). Motion correction was incorporated into the reconstruction process based on MR-derived motion fields. Tumor peak standardized uptake values (SUVpeak) were calculated from 30 noise realizations. Respiratory motion correction improves the quantitative performance with the greatest benefit observed for patients of breathing type-2. For breathing type-1 after applying motion correction, SUVpeak of 12-mm liver tumor with 6:1 contrast was increased by 46% for a current PET resolution (i.e., 6 mm) and by 47% for a higher PET resolution (i.e., 3 mm). Furthermore, the results of this study indicate that the benefit of higher scanner resolution is small unless motion correction is applied. In particular, for large liver tumor (12 mm) with low contrast (3:1) after motion correction, the SUVpeak was increased by 34% for 6-mm resolution and by 50% for a higher PET resolution (i.e., 3-mm resolution. This investigation indicates that there is a high impact of respiratory motion correction on tumor quantitative accuracy and that motion correction is important in order to benefit from the increased resolution of future PET scanners.

Limited Impact of Setup and Range Uncertainties, Breathing Motion, and Interplay Effects in Robustly Optimized Intensity Modulated Proton Therapy for Stage III Non-small Cell Lung Cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Inoue, Tatsuya; Widder, Joachim; Dijk, Lisanne V. van

2016-11-01

Purpose: To investigate the impact of setup and range uncertainties, breathing motion, and interplay effects using scanning pencil beams in robustly optimized intensity modulated proton therapy (IMPT) for stage III non-small cell lung cancer (NSCLC). Methods and Materials: Three-field IMPT plans were created using a minimax robust optimization technique for 10 NSCLC patients. The plans accounted for 5- or 7-mm setup errors with ±3% range uncertainties. The robustness of the IMPT nominal plans was evaluated considering (1) isotropic 5-mm setup errors with ±3% range uncertainties; (2) breathing motion; (3) interplay effects; and (4) a combination of items 1 and 2.more » The plans were calculated using 4-dimensional and average intensity projection computed tomography images. The target coverage (TC, volume receiving 95% of prescribed dose) and homogeneity index (D{sub 2} − D{sub 98}, where D{sub 2} and D{sub 98} are the least doses received by 2% and 98% of the volume) for the internal clinical target volume, and dose indexes for lung, esophagus, heart and spinal cord were compared with that of clinical volumetric modulated arc therapy plans. Results: The TC and homogeneity index for all plans were within clinical limits when considering the breathing motion and interplay effects independently. The setup and range uncertainties had a larger effect when considering their combined effect. The TC decreased to <98% (clinical threshold) in 3 of 10 patients for robust 5-mm evaluations. However, the TC remained >98% for robust 7-mm evaluations for all patients. The organ at risk dose parameters did not significantly vary between the respective robust 5-mm and robust 7-mm evaluations for the 4 error types. Compared with the volumetric modulated arc therapy plans, the IMPT plans showed better target homogeneity and mean lung and heart dose parameters reduced by about 40% and 60%, respectively. Conclusions: In robustly optimized IMPT for stage III NSCLC, the setup and range uncertainties, breathing motion, and interplay effects have limited impact on target coverage, dose homogeneity, and organ-at-risk dose parameters.« less

SU-E-T-330: Dosimetric Impact of Intrafraction Respiratory Motion On Lung SBRT Treatment Using Cyberknife 0-View Tracking Mode

DOE Office of Scientific and Technical Information (OSTI.GOV)

Rao, M; Chen, F; Cotrutz, C

2015-06-15

Purpose: To investigate the influence of respiratory motion on the delivered dose in lung stereotactic body radiotherapy (SBRT) using Cyberknife (CK) 0-View tracking mode. Methods: CT scans at inspiration and expiration of an anthropomorphic motion phantom were fused base on the spine and an internal target volume (ITV) was created. A 5mm expansion around the ITV resulted in the planning target volume. Three CK plans were generated in Accuray MultiPlan using Lung Optimization Tracking 0-View technique with the minimum MU per beam set to (a) 5MU, (b) 15MU and (c) 30MU, respectively. Doses were calculated on the expiration CT usingmore » Monte-Carlo algorithm. Each plan was delivered 5 times with a range of different starting phases in the respiratory cycle to assess the dose variation due to interplay effect. The delivered dose was measured with EBT3 Gafchromic film which was inserted in the moving target of the phantom. The target motion range is 3 cm in superior-inferior (SI) direction with the breathing period of 5 seconds. Results: The gamma analysis (5%/2mm) of the dose with the films in the transverse plane resulted in average passing rate of 95.5±4.1%, 96.7±2.6%, and 96.2±2.5% for plan (a), (b), and (c), respectively. For the sagittal films, the average passing rate was 91.1±4.9%, 92.1±3.6%, and 92.3±2.9% for the three plans, respectively. The disagreement between measurement and dose calculations were mostly on the target edges in SI direction. The mean measured versus calculated dose differences at the edge of target in SI direction were (a) 3.9±4.8%, (b) 2.4±3.3%, and (c) 2.2±3.2% for the three plans, respectively. Conclusions: The plans with low-MU beams (below 10MU) tend to cause slightly larger dose variation. However in terms of target coverage, the overall clinical dosimetric impact of the intrafraction respiratory motion in lung SBRT is insignificant when averaged over 3∼5 fractions.« less

Augmenting regional and targeted delivery in the pulmonary acinus using magnetic particles

PubMed Central

Ostrovski, Yan; Hofemeier, Philipp; Sznitman, Josué

2016-01-01

Background It has been hypothesized that by coupling magnetic particles to inhaled therapeutics, the ability to target specific lung regions (eg, only acinar deposition), or even more so specific points in the lung (eg, tumor targeting), can be substantially improved. Although this method has been proven feasible in seminal in vivo studies, there is still a wide gap in our basic understanding of the transport phenomena of magnetic particles in the pulmonary acinar regions of the lungs, including particle dynamics and deposition characteristics. Methods Here, we present computational fluid dynamics-discrete element method simulations of magnetically loaded microdroplet carriers in an anatomically inspired, space-filling, multi-generation acinar airway tree. Breathing motion is modeled by kinematic sinusoidal displacements of the acinar walls, during which droplets are inhaled and exhaled. Particle dynamics are governed by viscous drag, gravity, and Brownian motion as well as the external magnetic force. In particular, we examined the roles of droplet diameter and volume fraction of magnetic material within the droplets under two different breathing maneuvers. Results and discussion Our results indicate that by using magnetic-loaded droplets, 100% of the particles that enter are deposited in the acinar region. This is consistent across all particle sizes investigated (ie, 0.5–3.0 µm). This is best achieved through a deep inhalation maneuver combined with a breath-hold. Particles are found to penetrate deep into the acinus and disperse well, while the required amount of magnetic material is maintained low (<2.5%). Although particles in the size range of ~90–500 nm typically show the lowest deposition fractions, our results suggest that this feature could be leveraged to augment targeted delivery. PMID:27547034

Control of a HexaPOD treatment couch for robot-assisted radiotherapy.

PubMed

Hermann, Christian; Ma, Lei; Wilbert, Jürgen; Baier, Kurt; Schilling, Klaus

2012-10-01

Moving tumors, for example in the vicinity of the lungs, pose a challenging problem in radiotherapy, as healthy tissue should not be irradiated. Apart from gating approaches, one standard method is to irradiate the complete volume within which a tumor moves plus a safety margin containing a considerable volume of healthy tissue. This work deals with a system for tumor motion compensation using the HexaPOD® robotic treatment couch (Medical Intelligence GmbH, Schwabmünchen, Germany). The HexaPOD, carrying the patient during treatment, is instructed to perform translational movements such that the tumor motion, from the beams-eye view of the linear accelerator, is eliminated. The dynamics of the HexaPOD are characterized by time delays, saturations, and other non-linearities that make the design of control a challenging task. The focus of this work lies on two control methods for the HexaPOD that can be used for reference tracking. The first method uses a model predictive controller based on a model gained through system identification methods, and the second method uses a position control scheme useful for reference tracking. We compared the tracking performance of both methods in various experiments with real hardware using ideal reference trajectories, prerecorded patient trajectories, and human volunteers whose breathing motion was compensated by the system.

Experimentally studied dynamic dose interplay does not meaningfully affect target dose in VMAT SBRT lung treatments.

PubMed

Stambaugh, Cassandra; Nelms, Benjamin E; Dilling, Thomas; Stevens, Craig; Latifi, Kujtim; Zhang, Geoffrey; Moros, Eduardo; Feygelman, Vladimir

2013-09-01

The effects of respiratory motion on the tumor dose can be divided into the gradient and interplay effects. While the interplay effect is likely to average out over a large number of fractions, it may play a role in hypofractionated [stereotactic body radiation therapy (SBRT)] treatments. This subject has been extensively studied for intensity modulated radiation therapy but less so for volumetric modulated arc therapy (VMAT), particularly in application to hypofractionated regimens. Also, no experimental study has provided full four-dimensional (4D) dose reconstruction in this scenario. The authors demonstrate how a recently described motion perturbation method, with full 4D dose reconstruction, is applied to describe the gradient and interplay effects during VMAT lung SBRT treatments. VMAT dose delivered to a moving target in a patient can be reconstructed by applying perturbations to the treatment planning system-calculated static 3D dose. Ten SBRT patients treated with 6 MV VMAT beams in five fractions were selected. The target motion (motion kernel) was approximated by 3D rigid body translation, with the tumor centroids defined on the ten phases of the 4DCT. The motion was assumed to be periodic, with the period T being an average from the empirical 4DCT respiratory trace. The real observed tumor motion (total displacement ≤ 8 mm) was evaluated first. Then, the motion range was artificially increased to 2 or 3 cm. Finally, T was increased to 60 s. While not realistic, making T comparable to the delivery time elucidates if the interplay effect can be observed. For a single fraction, the authors quantified the interplay effect as the maximum difference in the target dosimetric indices, most importantly the near-minimum dose (D99%), between all possible starting phases. For the three- and five-fractions, statistical simulations were performed when substantial interplay was found. For the motion amplitudes and periods obtained from the 4DCT, the interplay effect is negligible (<0.2%). It is also small (0.9% average, 2.2% maximum) when the target excursion increased to 2-3 cm. Only with large motion and increased period (60 s) was a significant interplay effect observed, with D99% ranging from 16% low to 17% high. The interplay effect was statistically significantly lower for the three- and five-fraction statistical simulations. Overall, the gradient effect dominates the clinical situation. A novel method was used to reconstruct the volumetric dose to a moving tumor during lung SBRT VMAT deliveries. With the studied planning and treatment technique for realistic motion periods, regardless of the amplitude, the interplay has nearly no impact on the near-minimum dose. The interplay effect was observed, for study purposes only, with the period comparable to the VMAT delivery time.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ahmed, Raef S.; Shen, Sui; Ove, Roger

We wanted to describe a technique for the implementation of intensity-modulated radiotherapy (IMRT) with a real-time position monitor (RPM) respiratory gating system for the treatment of pleural space with intact lung. The technique is illustrated by a case of pediatric osteosarcoma, metastatic to the pleura of the right lung. The patient was simulated in the supine position where a breathing tracer and computed tomography (CT) scans synchronized at end expiration were acquired using the RPM system. The gated CT images were used to define target volumes and critical structures. Right pleural gated IMRT delivered at end expiration was prescribed tomore » a dose of 44 Gy, with 55 Gy delivered to areas of higher risk via simultaneous integrated boost (SIB) technique. IMRT was necessary to avoid exceeding the tolerance of intact lung. Although very good coverage of the target volume was achieved with a shell-shaped dose distribution, dose over the targets was relatively inhomogeneous. Portions of target volumes necessarily intruded into the right lung, the liver, and right kidney, limiting the degree of normal tissue sparing that could be achieved. The radiation doses to critical structures were acceptable and well tolerated. With intact lung, delivering a relatively high dose to the pleura with acceptable doses to surrounding normal tissues using respiratory gated pleural IMRT is feasible. Treatment delivery during a limited part of the respiratory cycle allows for reduced CT target volume motion errors, with reduction in the portion of the planning margin that accounts for respiratory motion, and subsequent increase in the therapeutic ratio.« less

WE-DE-209-03: Spirometric Motion Management System

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hadley, S.

Breast radiation therapy is associated with some risk of lung toxicity as well as cardiac toxicity for left-sided cases. Radiation doses to the lung and heart can be reduced by using the deep inspiration breath hold (DIBH) technique, in which the patient is simulated and treated during the deep inspiration phase of the breathing cycle. During DIBH, the heart is usually displaced posteriorly, inferiorly, and to the right, effectively expanding the distance between the heart and the breast/chest wall. As a result, the distance between the medial treatment field border and heart/lung is increased. Also, in a majority of DIBHmore » patients, the air drawn into the thoracic cavity increases the total lung volume. The DIBH was discussed by an AAPM Task Group 10 years ago in the AAPM TG 76 report. However, DIBH is still not the standard of care in many clinics, which may be partially due to challenges associated with its implementation. Therefore, this seccion will focus primarily on how to clinically implement four different DIBH techniques: (1) Active Breathing Control, (2) Spirometric Motion Management, (3) 3D Surface Image-Guided, and (4) Self-held Breath Control with Respiratory Monitoring and Feedback Guidance. Learning Objectives: Describe the physical displacement of the heart and the change in lung volume during DIBH and discuss dosimetric consequences of those changes. Provide an overview of the technical aspects. Describe work flow for patient simulation and treatment. Give an overview of commissioning and routine. Provide practical tips for clinical implementation.« less

Machine Learning of Three-dimensional Right Ventricular Motion Enables Outcome Prediction in Pulmonary Hypertension: A Cardiac MR Imaging Study.

PubMed

Dawes, Timothy J W; de Marvao, Antonio; Shi, Wenzhe; Fletcher, Tristan; Watson, Geoffrey M J; Wharton, John; Rhodes, Christopher J; Howard, Luke S G E; Gibbs, J Simon R; Rueckert, Daniel; Cook, Stuart A; Wilkins, Martin R; O'Regan, Declan P

2017-05-01

Purpose To determine if patient survival and mechanisms of right ventricular failure in pulmonary hypertension could be predicted by using supervised machine learning of three-dimensional patterns of systolic cardiac motion. Materials and Methods The study was approved by a research ethics committee, and participants gave written informed consent. Two hundred fifty-six patients (143 women; mean age ± standard deviation, 63 years ± 17) with newly diagnosed pulmonary hypertension underwent cardiac magnetic resonance (MR) imaging, right-sided heart catheterization, and 6-minute walk testing with a median follow-up of 4.0 years. Semiautomated segmentation of short-axis cine images was used to create a three-dimensional model of right ventricular motion. Supervised principal components analysis was used to identify patterns of systolic motion that were most strongly predictive of survival. Survival prediction was assessed by using difference in median survival time and area under the curve with time-dependent receiver operating characteristic analysis for 1-year survival. Results At the end of follow-up, 36% of patients (93 of 256) died, and one underwent lung transplantation. Poor outcome was predicted by a loss of effective contraction in the septum and free wall, coupled with reduced basal longitudinal motion. When added to conventional imaging and hemodynamic, functional, and clinical markers, three-dimensional cardiac motion improved survival prediction (area under the receiver operating characteristic curve, 0.73 vs 0.60, respectively; P < .001) and provided greater differentiation according to difference in median survival time between high- and low-risk groups (13.8 vs 10.7 years, respectively; P < .001). Conclusion A machine-learning survival model that uses three-dimensional cardiac motion predicts outcome independent of conventional risk factors in patients with newly diagnosed pulmonary hypertension. Online supplemental material is available for this article.

SU-E-T-428: Feasibility Study of 4D Image Reconstruction by Organ Motion Vector Extension Based On Portal Images

DOE Office of Scientific and Technical Information (OSTI.GOV)

Yoon, J; Jung, J; Yeo, I

2015-06-15

Purpose: To develop and to test a method to generate a new 4D CT images of the treatment day from the old 4D CT and the portal images of the day when the motion extent exceeded from that represented by plan CTs. Methods: A motion vector of a moving tumor in a patient may be extended to reconstruct the tumor position when the motion extent exceeded from that represented by plan CTs. To test this, 1. a phantom that consists of a polystyrene cylinder (tumor) embedded in cork (lung) was placed on a moving platform with 4 sec/cycle and amplitudesmore » of 1 cm and 2 cm, and was 4D-scanned. 2. A 6MV photon beam was irradiated on the moving phantoms and cineEPID images were obtained. 3. A motion vector of the tumor was acquired from 4D CT images of the phantom with 1 cm amplitude. 4. From cine EPID images of the phantom with the 2 cm amplitude, various motion extents (0.3 cm, 0.5 cm, etc) were acquired and programmed into the motion vector, producing CT images at each position. 5. The reconstructed CT images were then compared with pre-acquired “reference” 4D CT images at each position (i.e. phase). Results: The CT image was reconstructed and compared with the reference image, showing a slight mismatch in the transition direction limited by voxel size (slice thickness) in CT image. Due to the rigid nature of the phantom studied, the modeling the displacement of the center of object was sufficient. When deformable tumors are to be modeled, more complex scheme is necessary, which utilize cine EPID and 4D CT images. Conclusion: The new idea of CT image reconstruction was demonstrated. Deformable tumor movements need to be considered in the future.« less

SU-E-E-11: Novel Matching Module for Respiration-Gated Motion Tumor of Cone-Beam Computed Tomography (CBCT) to 4DCT

DOE Office of Scientific and Technical Information (OSTI.GOV)

Yu, P; Tsai, Y; Nien, H

2015-06-15

Purpose: Four dimensional computed tomography (4DCT) scans reliably record whole respiratory phase and generate internal target volumes (ITV) for radiotherapy planning. However, image guiding with cone-beam computed tomography (CBCT) cannot acquire all or specific respiratory phases. This study was designed to investigate the correlation between average CT and Maximum Intensity Projection (MIP) from 4DCT and CBCT. Methods: Retrospective respiratory gating were performed by GE Discovery CT590 RT. 4DCT and CBCT data from CRIS Dynamic Thorax Phantom with simulated breathing mode were analyzed. The lung tissue equivalent material encompassed 3 cm sphere tissue equivalent material. Simulated breathing cycle period was setmore » as 4 seconds, 5 seconds and 6 seconds for representing variation of patient breathing cycle time, and the sphere material moved toward inferior and superior direction with 1 cm amplitude simulating lung tumor motion during respiration. Results: Under lung window, the volume ratio of CBCT scans to ITVs derived from 10 phases average scans was 1.00 ± 0.02, and 1.03 ± 0.03 for ratio of CBCT scans to MIP scans. Under abdomen window, the ratio of CBCT scans to ITVs derived from 10 phases average scans was 0.39 ± 0.06, and 0.06 ± 0.00 for ratio of CBCT scans to MIP scans. There was a significant difference between lung window Result and abdomen window Result. For reducing image guiding uncertainty, CBCT window was set with width 500 and level-250. The ratio of CBCT scans to ITVs derived from 4 phases average scans with abdomen window was 1.19 ± 0.02, and 1.06 ± 0.01 for ratio of CBCT to MIP scans. Conclusion: CBCT images with suitable window width and level can efficiently reduce image guiding uncertainty for patient with mobile tumor. By our setting, we can match motion tumor to gating tumor location on planning CT more accurately neglecting other motion artifacts during CBCT scans.« less

A Locally Adaptive Regularization Based on Anisotropic Diffusion for Deformable Image Registration of Sliding Organs

PubMed Central

Pace, Danielle F.; Aylward, Stephen R.; Niethammer, Marc

2014-01-01

We propose a deformable image registration algorithm that uses anisotropic smoothing for regularization to find correspondences between images of sliding organs. In particular, we apply the method for respiratory motion estimation in longitudinal thoracic and abdominal computed tomography scans. The algorithm uses locally adaptive diffusion tensors to determine the direction and magnitude with which to smooth the components of the displacement field that are normal and tangential to an expected sliding boundary. Validation was performed using synthetic, phantom, and 14 clinical datasets, including the publicly available DIR-Lab dataset. We show that motion discontinuities caused by sliding can be effectively recovered, unlike conventional regularizations that enforce globally smooth motion. In the clinical datasets, target registration error showed improved accuracy for lung landmarks compared to the diffusive regularization. We also present a generalization of our algorithm to other sliding geometries, including sliding tubes (e.g., needles sliding through tissue, or contrast agent flowing through a vessel). Potential clinical applications of this method include longitudinal change detection and radiotherapy for lung or abdominal tumours, especially those near the chest or abdominal wall. PMID:23899632

A locally adaptive regularization based on anisotropic diffusion for deformable image registration of sliding organs.

PubMed

Pace, Danielle F; Aylward, Stephen R; Niethammer, Marc

2013-11-01

We propose a deformable image registration algorithm that uses anisotropic smoothing for regularization to find correspondences between images of sliding organs. In particular, we apply the method for respiratory motion estimation in longitudinal thoracic and abdominal computed tomography scans. The algorithm uses locally adaptive diffusion tensors to determine the direction and magnitude with which to smooth the components of the displacement field that are normal and tangential to an expected sliding boundary. Validation was performed using synthetic, phantom, and 14 clinical datasets, including the publicly available DIR-Lab dataset. We show that motion discontinuities caused by sliding can be effectively recovered, unlike conventional regularizations that enforce globally smooth motion. In the clinical datasets, target registration error showed improved accuracy for lung landmarks compared to the diffusive regularization. We also present a generalization of our algorithm to other sliding geometries, including sliding tubes (e.g., needles sliding through tissue, or contrast agent flowing through a vessel). Potential clinical applications of this method include longitudinal change detection and radiotherapy for lung or abdominal tumours, especially those near the chest or abdominal wall.

SU-G-BRA-13: An Advanced Deformable Lung Phantom for Analyzing the Dosimetric Impact of Respiratory Motion

DOE Office of Scientific and Technical Information (OSTI.GOV)

Shin, D; Kang, S; Kim, D

2016-06-15

Purpose: The difference between three-dimensional (3D) and four-dimensional (4D) dose is affected by factors such as tumor size and motion. To quantitatively analyze the effects of these factors, a phantom that can independently control for each factor is required. The purpose of this study is to develop a deformable lung phantom with the above attributes and evaluate characteristics. Methods: A phantom was designed to simulate diaphragm motion with amplitude in the range 1 to 7 cm and various periods of regular breathing. To simulate different size tumors, tumors were produced by pouring liquid silicone into custom molds created by amore » 3D printer. The accuracy of phantom diaphragm motion was assessed using calipers and protractor. To control tumor motion, tumor trajectories were evaluated using 4D computed tomography (CT), and diaphragm-tumor correlation curve was calculated by curve fitting method. Three-dimensional dose and 4D dose were calculated and compared according to tumor motion. Results: The accuracy of phantom diaphragm motion was less than 1 mm. Maximum tumor motion amplitudes in the left-right and anterior-posterior directions were 0.08 and 0.12 cm, respectively, in a 10 cm{sup 3} tumor, and 0.06 and 0.27 cm, respectively, in a 90 cm{sup 3} tumor. The diaphragm-tumor correlation curve showed that tumor motion in the superior-inferior direction was increased with increasing diaphragm motion. In the 10 cm{sup 3} tumor, the tumor motion was larger than the 90 cm{sup 3} tumor. According to tumor motion, variation of dose difference between 3D and 4D was identified. Conclusion: The developed phantom can independently control factors such as tumor size and motion. In potentially, this phantom can be used to quantitatively analyze the dosimetric impact of respiratory motion according to the factors that influence the difference between 3D and 4D dose. This research was supported by the Mid-career Researcher Program through NRF funded by the Ministry of Science, ICT & Future Planning of Korea (NRF-2014R1A2A1A10050270) and by the Radiation Technology R&D program through the National Research Foundation of Korea funded by the Ministry of Science, ICT & Future Planning (No. 2013M2A2A7038291)« less

Intracellular dynamics and fate of polystyrene nanoparticles in A549 Lung epithelial cells monitored by image (cross-) correlation spectroscopy and single particle tracking.

PubMed

Deville, Sarah; Penjweini, Rozhin; Smisdom, Nick; Notelaers, Kristof; Nelissen, Inge; Hooyberghs, Jef; Ameloot, Marcel

2015-10-01

Novel insights in nanoparticle (NP) uptake routes of cells, their intracellular trafficking and subcellular targeting can be obtained through the investigation of their temporal and spatial behavior. In this work, we present the application of image (cross-) correlation spectroscopy (IC(C)S) and single particle tracking (SPT) to monitor the intracellular dynamics of polystyrene (PS) NPs in the human lung carcinoma A549 cell line. The ensemble kinetic behavior of NPs inside the cell was characterized by temporal and spatiotemporal image correlation spectroscopy (TICS and STICS). Moreover, a more direct interpretation of the diffusion and flow detected in the NP motion was obtained by SPT by monitoring individual NPs. Both techniques demonstrate that the PS NP transport in A549 cells is mainly dependent on microtubule-assisted transport. By applying spatiotemporal image cross-correlation spectroscopy (STICCS), the correlated motions of NPs with the early endosomes, late endosomes and lysosomes are identified. PS NPs were equally distributed among the endolysosomal compartment during the time interval of the experiments. The cotransport of the NPs with the lysosomes is significantly larger compared to the other cell organelles. In the present study we show that the complementarity of ICS-based techniques and SPT enables a consistent elaborate model of the complex behavior of NPs inside biological systems. Copyright © 2015 Elsevier B.V. All rights reserved.

Electromagnetic guided couch and multileaf collimator tracking on a TrueBeam accelerator

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hansen, Rune; Ravkilde, Thomas; Worm, Esben Schjødt

2016-05-15

Purpose: Couch and MLC tracking are two promising methods for real-time motion compensation during radiation therapy. So far, couch and MLC tracking experiments have mainly been performed by different research groups, and no direct comparison of couch and MLC tracking of volumetric modulated arc therapy (VMAT) plans has been published. The Varian TrueBeam 2.0 accelerator includes a prototype tracking system with selectable couch or MLC compensation. This study provides a direct comparison of the two tracking types with an otherwise identical setup. Methods: Several experiments were performed to characterize the geometric and dosimetric performance of electromagnetic guided couch and MLCmore » tracking on a TrueBeam accelerator equipped with a Millennium MLC. The tracking system latency was determined without motion prediction as the time lag between sinusoidal target motion and the compensating motion of the couch or MLC as recorded by continuous MV portal imaging. The geometric and dosimetric tracking accuracies were measured in tracking experiments with motion phantoms that reproduced four prostate and four lung tumor trajectories. The geometric tracking error in beam’s eye view was determined as the distance between an embedded gold marker and a circular MLC aperture in continuous MV images. The dosimetric tracking error was quantified as the measured 2%/2 mm gamma failure rate of a low and a high modulation VMAT plan delivered with the eight motion trajectories using a static dose distribution as reference. Results: The MLC tracking latency was approximately 146 ms for all sinusoidal period lengths while the couch tracking latency increased from 187 to 246 ms with decreasing period length due to limitations in the couch acceleration. The mean root-mean-square geometric error was 0.80 mm (couch tracking), 0.52 mm (MLC tracking), and 2.75 mm (no tracking) parallel to the MLC leaves and 0.66 mm (couch), 1.14 mm (MLC), and 2.41 mm (no tracking) perpendicular to the leaves. The motion-induced gamma failure rate was in mean 0.1% (couch tracking), 8.1% (MLC tracking), and 30.4% (no tracking) for prostate motion and 2.9% (couch), 2.4% (MLC), and 41.2% (no tracking) for lung tumor motion. The residual tracking errors were mainly caused by inadequate adaptation to fast lung tumor motion for couch tracking and to prostate motion perpendicular to the MLC leaves for MLC tracking. Conclusions: Couch and MLC tracking markedly improved the geometric and dosimetric accuracies of VMAT delivery. However, the two tracking types have different strengths and weaknesses. While couch tracking can correct perfectly for slowly moving targets such as the prostate, MLC tracking may have considerably larger dose errors for persistent target shift perpendicular to the MLC leaves. Advantages of MLC tracking include faster dynamics with better adaptation to fast moving targets, the avoidance of moving the patient, and the potential to track target rotations and deformations.« less

Combination of intensity-based image registration with 3D simulation in radiation therapy.

PubMed

Li, Pan; Malsch, Urban; Bendl, Rolf

2008-09-07

Modern techniques of radiotherapy like intensity modulated radiation therapy (IMRT) make it possible to deliver high dose to tumors of different irregular shapes at the same time sparing surrounding healthy tissue. However, internal tumor motion makes precise calculation of the delivered dose distribution challenging. This makes analysis of tumor motion necessary. One way to describe target motion is using image registration. Many registration methods have already been developed previously. However, most of them belong either to geometric approaches or to intensity approaches. Methods which take account of anatomical information and results of intensity matching can greatly improve the results of image registration. Based on this idea, a combined method of image registration followed by 3D modeling and simulation was introduced in this project. Experiments were carried out for five patients 4DCT lung datasets. In the 3D simulation, models obtained from images of end-exhalation were deformed to the state of end-inhalation. Diaphragm motions were around -25 mm in the cranial-caudal (CC) direction. To verify the quality of our new method, displacements of landmarks were calculated and compared with measurements in the CT images. Improvement of accuracy after simulations has been shown compared to the results obtained only by intensity-based image registration. The average improvement was 0.97 mm. The average Euclidean error of the combined method was around 3.77 mm. Unrealistic motions such as curl-shaped deformations in the results of image registration were corrected. The combined method required less than 30 min. Our method provides information about the deformation of the target volume, which we need for dose optimization and target definition in our planning system.

Systematic evaluation of four-dimensional hybrid depth scanning for carbon-ion lung therapy.

PubMed

Mori, Shinichiro; Furukawa, Takuji; Inaniwa, Taku; Zenklusen, Silvan; Nakao, Minoru; Shirai, Toshiyuki; Noda, Koji

2013-03-01

Irradiation of a moving target with a scanning beam requires a comprehensive understanding of organ motion as well as a robust dose error mitigation technique. The authors studied the effects of intrafractional respiratory motion for carbon-ion pencil beam scanning with phase-controlled rescanning on dose distributions for lung tumors. To address density variations, they used 4DCT data. Dose distributions for various rescanning methods, such as simple layer rescanning (LR), volumetric rescanning, and phase-controlled rescanning (PCR), were calculated for a lung phantom and a lung patient studies. To ensure realism, they set the scanning parameters such as scanning velocity and energy variation time to be similar to those used at our institution. Evaluation metrics were determined with regard to clinical relevance, and consisted of (i) phase-controlled rescanning, (ii) sweep direction, (iii) target motion (direction and amplitude), (iv) respiratory cycle, and (v) prescribed dose. Spot weight maps were calculated by using a beam field-specific target volume, which takes account of range variations for respective respiratory phases. To emphasize the impact of intrafractional motion on the dose distribution, respiratory gating was not used. The accumulated dose was calculated by applying a B-spline-based deformable image registration, and the results for phase-controlled layered rescanning (PCRL) and phase-controlled volumetric rescanning (PCRV) were compared. For the phantom study, simple LR was unable to improve the dose distributions for an increased number of rescannings. The phase-controlled technique without rescanning (1×PCRL and 1×PCRV) degraded dose conformity significantly due to a reduced scan velocity. In contrast, 4×PCRL or more significantly and consistently improved dose distribution. PCRV showed interference effects, but in general also improved dose homogeneity with higher numbers of rescannings. Dose distributions with single PCRL∕PCRV with a sweep direction perpendicular to motion direction showed large hot∕cold spots; however, this effect vanished with higher numbers of rescannings for both methods. Similar observations were obtained for the other dose metrics, such as target motion (SI∕AP), amplitude (6-22 mm peak-to-peak) and respiratory period (3.0-5.0 s). For four or more rescannings, both methods showed significantly better results, albeit that volumetric PCR was more affected by interference effects, which lead to severe degradation of a few dose distributions. The clinical example showed the same tendencies as the phantom study. Dose assessment metrics (D95, Dmax∕Dmin, homogeneity index) were improved with an increasing number of PCRL∕PCRV, but with PCRL being more robust. PCRL requires a longer treatment time than PCRV for high numbers of rescannings in the NIRS scanning system but is more robust. Although four or more rescans provided good dose homogeneity and conformity, the authors prefer to use more rescannings for clinical cases to further minimize dose degradation effects due to organ motion.

Organ motion due to respiration: the state of the art and applications in interventional radiology and radiation oncology

NASA Astrophysics Data System (ADS)

Cleary, Kevin R.; Mulcahy, Maureen; Piyasena, Rohan; Zhou, Tong; Dieterich, Sonja; Xu, Sheng; Banovac, Filip; Wong, Kenneth H.

2005-04-01

Tracking organ motion due to respiration is important for precision treatments in interventional radiology and radiation oncology, among other areas. In interventional radiology, the ability to track and compensate for organ motion could lead to more precise biopsies for applications such as lung cancer screening. In radiation oncology, image-guided treatment of tumors is becoming technically possible, and the management of organ motion then becomes a major issue. This paper will review the state-of-the-art in respiratory motion and present two related clinical applications. Respiratory motion is an important topic for future work in image-guided surgery and medical robotics. Issues include how organs move due to respiration, how much they move, how the motion can be compensated for, and what clinical applications can benefit from respiratory motion compensation. Technology that can be applied for this purpose is now becoming available, and as that technology evolves, the subject will become an increasingly interesting and clinically valuable topic of research.

Utility of Electrocardiography (ECG)-Gated Computed Tomography (CT) for Preoperative Evaluations of Thymic Epithelial Tumors.

PubMed

Ozawa, Yoshiyuki; Hara, Masaki; Nakagawa, Motoo; Shibamoto, Yuta

2016-01-01

Preoperative evaluation of invasion to the adjacent organs is important for the thymic epithelial tumors on CT. The purpose of our study was to evaluate the utility of electrocardiography (ECG)-gated CT for assessing thymic epithelial tumors with regard to the motion artifacts produced and the preoperative diagnostic accuracy of the technique. Forty thymic epithelial tumors (36 thymomas and 4 thymic carcinomas) were examined with ECG-gated contrast-enhanced CT using a dual source scanner. The scan delay after the contrast media injection was 30 s for the non-ECG-gated CT and 100 s for the ECG-gated CT. Two radiologists blindly evaluated both the non-ECG-gated and ECG-gated CT images for motion artifacts and determined whether the tumors had invaded adjacent structures (mediastinal fat, superior vena cava, brachiocephalic veins, aorta, pulmonary artery, pericardium, or lungs) on each image. Motion artifacts were evaluated using a 3-grade scale. Surgical and pathological findings were used as a reference standard for tumor invasion. Motion artifacts were significantly reduced for all structures by ECG gating ( p =0.0089 for the lungs and p <0.0001 for the other structures). Non-ECG-gated CT and ECG-gated CT demonstrated 79% and 95% accuracy, respectively, during assessments of pericardial invasion ( p =0.03). ECG-gated CT reduced the severity of motion artifacts and might be useful for preoperative assessment whether thymic epithelial tumors have invaded adjacent structures.

Utility of Electrocardiography (ECG)-Gated Computed Tomography (CT) for Preoperative Evaluations of Thymic Epithelial Tumors

PubMed Central

Ozawa, Yoshiyuki; Hara, Masaki; Nakagawa, Motoo; Shibamoto, Yuta

2016-01-01

Summary Background Preoperative evaluation of invasion to the adjacent organs is important for the thymic epithelial tumors on CT. The purpose of our study was to evaluate the utility of electrocardiography (ECG)-gated CT for assessing thymic epithelial tumors with regard to the motion artifacts produced and the preoperative diagnostic accuracy of the technique. Material/Methods Forty thymic epithelial tumors (36 thymomas and 4 thymic carcinomas) were examined with ECG-gated contrast-enhanced CT using a dual source scanner. The scan delay after the contrast media injection was 30 s for the non-ECG-gated CT and 100 s for the ECG-gated CT. Two radiologists blindly evaluated both the non-ECG-gated and ECG-gated CT images for motion artifacts and determined whether the tumors had invaded adjacent structures (mediastinal fat, superior vena cava, brachiocephalic veins, aorta, pulmonary artery, pericardium, or lungs) on each image. Motion artifacts were evaluated using a 3-grade scale. Surgical and pathological findings were used as a reference standard for tumor invasion. Results Motion artifacts were significantly reduced for all structures by ECG gating (p=0.0089 for the lungs and p<0.0001 for the other structures). Non-ECG-gated CT and ECG-gated CT demonstrated 79% and 95% accuracy, respectively, during assessments of pericardial invasion (p=0.03). Conclusions ECG-gated CT reduced the severity of motion artifacts and might be useful for preoperative assessment whether thymic epithelial tumors have invaded adjacent structures. PMID:27920842

SU-C-209-02: 3D Fluoroscopic Image Generation From Patient-Specific 4DCBCT-Based Motion Models Derived From Clinical Patient Images

DOE Office of Scientific and Technical Information (OSTI.GOV)

Dhou, S; Cai, W; Hurwitz, M

Purpose: We develop a method to generate time varying volumetric images (3D fluoroscopic images) using patient-specific motion models derived from four-dimensional cone-beam CT (4DCBCT). Methods: Motion models are derived by selecting one 4DCBCT phase as a reference image, and registering the remaining images to it. Principal component analysis (PCA) is performed on the resultant displacement vector fields (DVFs) to create a reduced set of PCA eigenvectors that capture the majority of respiratory motion. 3D fluoroscopic images are generated by optimizing the weights of the PCA eigenvectors iteratively through comparison of measured cone-beam projections and simulated projections generated from the motionmore » model. This method was applied to images from five lung-cancer patients. The spatial accuracy of this method is evaluated by comparing landmark positions in the 3D fluoroscopic images to manually defined ground truth positions in the patient cone-beam projections. Results: 4DCBCT motion models were shown to accurately generate 3D fluoroscopic images when the patient cone-beam projections contained clearly visible structures moving with respiration (e.g., the diaphragm). When no moving anatomical structure was clearly visible in the projections, the 3D fluoroscopic images generated did not capture breathing deformations, and reverted to the reference image. For the subset of 3D fluoroscopic images generated from projections with visibly moving anatomy, the average tumor localization error and the 95th percentile were 1.6 mm and 3.1 mm respectively. Conclusion: This study showed that 4DCBCT-based 3D fluoroscopic images can accurately capture respiratory deformations in a patient dataset, so long as the cone-beam projections used contain visible structures that move with respiration. For clinical implementation of 3D fluoroscopic imaging for treatment verification, an imaging field of view (FOV) that contains visible structures moving with respiration should be selected. If no other appropriate structures are visible, the images should include the diaphragm. This project was supported, in part, through a Master Research Agreement with Varian Medical Systems, Inc, Palo Alto, CA.« less

Technical aspects of real time positron emission tracking for gated radiotherapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chamberland, Marc; Xu, Tong, E-mail: txu@physics.carleton.ca; McEwen, Malcolm R.

2016-02-15

Purpose: Respiratory motion can lead to treatment errors in the delivery of radiotherapy treatments. Respiratory gating can assist in better conforming the beam delivery to the target volume. We present a study of the technical aspects of a real time positron emission tracking system for potential use in gated radiotherapy. Methods: The tracking system, called PeTrack, uses implanted positron emission markers and position sensitive gamma ray detectors to track breathing motion in real time. PeTrack uses an expectation–maximization algorithm to track the motion of fiducial markers. A normalized least mean squares adaptive filter predicts the location of the markers amore » short time ahead to account for system response latency. The precision and data collection efficiency of a prototype PeTrack system were measured under conditions simulating gated radiotherapy. The lung insert of a thorax phantom was translated in the inferior–superior direction with regular sinusoidal motion and simulated patient breathing motion (maximum amplitude of motion ±10 mm, period 4 s). The system tracked the motion of a {sup 22}Na fiducial marker (0.34 MBq) embedded in the lung insert every 0.2 s. The position of the was marker was predicted 0.2 s ahead. For sinusoidal motion, the equation used to model the motion was fitted to the data. The precision of the tracking was estimated as the standard deviation of the residuals. Software was also developed to communicate with a Linac and toggle beam delivery. In a separate experiment involving a Linac, 500 monitor units of radiation were delivered to the phantom with a 3 × 3 cm photon beam and with 6 and 10 MV accelerating potential. Radiochromic films were inserted in the phantom to measure spatial dose distribution. In this experiment, the period of motion was set to 60 s to account for beam turn-on latency. The beam was turned off when the marker moved outside of a 5-mm gating window. Results: The precision of the tracking in the IS direction was 0.53 mm for a sinusoidally moving target, with an average count rate ∼250 cps. The average prediction error was 1.1 ± 0.6 mm when the marker moved according to irregular patient breathing motion. Across all beam deliveries during the radiochromic film measurements, the average prediction error was 0.8 ± 0.5 mm. The maximum error was 2.5 mm and the 95th percentile error was 1.5 mm. Clear improvement of the dose distribution was observed between gated and nongated deliveries. The full-width at halfmaximum of the dose profiles of gated deliveries differed by 3 mm or less than the static reference dose distribution. Monitoring of the beam on/off times showed synchronization with the location of the marker within the latency of the system. Conclusions: PeTrack can track the motion of internal fiducial positron emission markers with submillimeter precision. The system can be used to gate the delivery of a Linac beam based on the position of a moving fiducial marker. This highlights the potential of the system for use in respiratory-gated radiotherapy.« less

SU-D-207A-05: Investigating Sparse-Sampled MRI for Motion Management in Thoracic Radiotherapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sabouri, P; Sawant, A; Arai, T

Purpose: Sparse sampling and reconstruction-based MRI techniques represent an attractive strategy to achieve sufficiently high image acquisition speed while maintaining image quality for the task of radiotherapy guidance. In this study, we examine rapid dynamic MRI using a sparse sampling sequence k-t BLAST in capturing motion-induced, cycle-to-cycle variations in tumor position. We investigate the utility of long-term MRI-based motion monitoring as a means of better characterizing respiration-induced tumor motion compared to a single-cycle 4DCT. Methods: An MRI-compatible, programmable, deformable lung motion phantom with eleven 1.5 ml water marker tubes was placed inside a 3.0 T whole-body MR scanner (Philips Ingenia).more » The phantom was programmed with 10 lung tumor motion traces previously recorded using the Synchrony system. 2D+t image sequences of a coronal slice were acquired using a balanced-SSFP sequence combined with k-t BLAST (accn=3, resolution=0.66×0.66×5 mm3; acquisition time = 110 ms/slice). kV fluoroscopic (ground truth) and 4DCT imaging was performed with the same phantom setup and motion trajectories. Marker positions in all three modalities were segmented and tracked using an opensource deformable image registration package, NiftyReg. Results: Marker trajectories obtained from rapid MRI exhibited <1 mm error compared to kv Fluoro trajectories in the presence of complex motion including baseline shifts and changes in respiratory amplitude, indicating the ability of MRI to monitor motion with adequate geometric fidelity for the purpose of radiotherapy guidance. In contrast, the trajectory derived from 4DCT exhibited significant errors up to 6 mm due to cycle-to-cycle variations and baseline shifts. Consequently, 4DCT was found to underestimate the range of marker motion by as much as 50%. Conclusion: Dynamic MRI is a promising tool for radiotherapy motion management as it permits for longterm, dose-free, soft-tissue-based monitoring of motion, yielding richer and more accurate information about tumor position and motion range compared to the current state-of-the-art, 4DCT. This work was partially supported through research funding from National Institutes of Health (R01CA169102).« less

Individualized Margins in 3D Conformal Radiotherapy Planning for Lung Cancer: Analysis of Physiological Movements and Their Dosimetric Impacts

DOE Office of Scientific and Technical Information (OSTI.GOV)

Germain, Francois; Beaulieu, Luc; Fortin, Andre

2008-04-01

In conformal radiotherapy planning for lung cancer, respiratory movements are not taken into account when a single computed tomography (CT) scan is performed. This study examines tumor movements to design individualized margins to account for these movements and evaluates their dosimetric impacts on planning volume. Fifteen patients undergoing CT-based planning for radical radiotherapy for localized lung cancer formed the study cohort. A reference plan was constructed based on reference gross, clinical, and planning target volumes (rGTV, rCTV, and rPTV, respectively). The reference plans were compared with individualized plans using individualized margins obtained by using 5 serial CT scans to generatemore » individualized target volumes (iGTV, iCTV, and iPTV). Three-dimensional conformal radiation therapy was used for plan generation using 6- and 23-MV photon beams. Ten plans for each patient were generated and dose-volume histograms (DVHs) were calculated. Comparisons of volumetric and dosimetric parameters were performed using paired Student t-tests. Relative to the rGTV, the total volume occupied by the superimposed GTVs increased progressively with each additional CT scans. With the use of all 5 scans, the average increase in GTV was 52.1%. For the plans with closest dosimetric coverage, target volume was smaller (iPTV/rPTV ratio 0.808) but lung irradiation was only slightly decreased. Reduction in the proportion of lung tissue that received 20 Gy or more outside the PTV (V20) was observed both for 6-MV plans (-0.73%) and 23-MV plans (-0.65%), with p = 0.02 and p = 0.04, respectively. In conformal RT planning for the treatment of lung cancer, the use of serial CT scans to evaluate respiratory motion and to generate individualized margins to account for these motions produced only a limited lung sparing advantage.« less

SU-F-303-11: Implementation and Applications of Rapid, SIFT-Based Cine MR Image Binning and Region Tracking

DOE Office of Scientific and Technical Information (OSTI.GOV)

Mazur, T; Wang, Y; Fischer-Valuck, B

2015-06-15

Purpose: To develop a novel and rapid, SIFT-based algorithm for assessing feature motion on cine MR images acquired during MRI-guided radiotherapy treatments. In particular, we apply SIFT descriptors toward both partitioning cine images into respiratory states and tracking regions across frames. Methods: Among a training set of images acquired during a fraction, we densely assign SIFT descriptors to pixels within the images. We cluster these descriptors across all frames in order to produce a dictionary of trackable features. Associating the best-matching descriptors at every frame among the training images to these features, we construct motion traces for the features. Wemore » use these traces to define respiratory bins for sorting images in order to facilitate robust pixel-by-pixel tracking. Instead of applying conventional methods for identifying pixel correspondences across frames we utilize a recently-developed algorithm that derives correspondences via a matching objective for SIFT descriptors. Results: We apply these methods to a collection of lung, abdominal, and breast patients. We evaluate the procedure for respiratory binning using target sites exhibiting high-amplitude motion among 20 lung and abdominal patients. In particular, we investigate whether these methods yield minimal variation between images within a bin by perturbing the resulting image distributions among bins. Moreover, we compare the motion between averaged images across respiratory states to 4DCT data for these patients. We evaluate the algorithm for obtaining pixel correspondences between frames by tracking contours among a set of breast patients. As an initial case, we track easily-identifiable edges of lumpectomy cavities that show minimal motion over treatment. Conclusions: These SIFT-based methods reliably extract motion information from cine MR images acquired during patient treatments. While we performed our analysis retrospectively, the algorithm lends itself to prospective motion assessment. Applications of these methods include motion assessment, identifying treatment windows for gating, and determining optimal margins for treatment.« less

On the interplay effects with proton scanning beams in stage III lung cancer.

PubMed

Li, Yupeng; Kardar, Laleh; Li, Xiaoqiang; Li, Heng; Cao, Wenhua; Chang, Joe Y; Liao, Li; Zhu, Ronald X; Sahoo, Narayan; Gillin, Michael; Liao, Zhongxing; Komaki, Ritsuko; Cox, James D; Lim, Gino; Zhang, Xiaodong

2014-02-01

To assess the dosimetric impact of interplay between spot-scanning proton beam and respiratory motion in intensity-modulated proton therapy (IMPT) for stage III lung cancer. Eleven patients were sampled from 112 patients with stage III nonsmall cell lung cancer to well represent the distribution of 112 patients in terms of target size and motion. Clinical target volumes (CTVs) and planning target volumes (PTVs) were defined according to the authors' clinical protocol. Uniform and realistic breathing patterns were considered along with regular- and hypofractionation scenarios. The dose contributed by a spot was fully calculated on the computed tomography (CT) images corresponding to the respiratory phase that the spot is delivered, and then accumulated to the reference phase of the 4DCT to generate the dynamic dose that provides an estimation of what might be delivered under the influence of interplay effect. The dynamic dose distributions at different numbers of fractions were compared with the corresponding 4D composite dose which is the equally weighted average of the doses, respectively, computed on respiratory phases of a 4DCT image set. Under regular fractionation, the average and maximum differences in CTV coverage between the 4D composite and dynamic doses after delivery of all 35 fractions were no more than 0.2% and 0.9%, respectively. The maximum differences between the two dose distributions for the maximum dose to the spinal cord, heart V40, esophagus V55, and lung V20 were 1.2 Gy, 0.1%, 0.8%, and 0.4%, respectively. Although relatively large differences in single fraction, correlated with small CTVs relative to motions, were observed, the authors' biological response calculations suggested that this interfractional dose variation may have limited biological impact. Assuming a hypofractionation scenario, the differences between the 4D composite and dynamic doses were well confined even for single fraction. Despite the presence of interplay effect, the delivered dose may be reliably estimated using the 4D composite dose. In general the interplay effect may not be a primary concern with IMPT for lung cancers for the authors' institution. The described interplay analysis tool may be used to provide additional confidence in treatment delivery.

MO-FG-BRA-08: Swarm Intelligence-Based Personalized Respiratory Gating in Lung SAbR

DOE Office of Scientific and Technical Information (OSTI.GOV)

Modiri, A; Sabouri, P; Sawant, A

Purpose: Respiratory gating is widely deployed as a clinical motion-management strategy in lung radiotherapy. In conventional gating, the beam is turned on during a pre-determined phase window; typically, around end-exhalation. In this work, we challenge the notion that end-exhalation is always the optimal gating phase. Specifically, we use a swarm-intelligence-based, inverse planning approach to determine the optimal respiratory phase and MU for each beam with respect to (i) the state of the anatomy at each phase and (ii) the time spent in that state, estimated from long-term monitoring of the patient’s breathing motion. Methods: In a retrospective study of fivemore » lung cancer patients, we compared the dosimetric performance of our proposed personalized gating (PG) with that of conventional end-of-exhale gating (CEG) and a previously-developed, fully 4D-optimized plan (combined with MLC tracking delivery). For each patient, respiratory phase probabilities (indicative of the time duration of the phase) were estimated over 2 minutes from lung tumor motion traces recorded previously using the Synchrony system (Accuray Inc.). Based on this information, inverse planning optimization was performed to calculate the optimal respiratory gating phase and MU for each beam. To ensure practical deliverability, each PG beam was constrained to deliver the assigned MU over a time duration comparable to that of CEG delivery. Results: Maximum OAR sparing for the five patients achieved by the PG and the 4D plans compared to CEG plans was: Esophagus Dmax [PG:57%, 4D:37%], Heart Dmax [PG:71%, 4D:87%], Spinal cord Dmax [PG:18%, 4D:68%] and Lung V13 [PG:16%, 4D:31%]. While patients spent the most time in exhalation, the PG-optimization chose end-exhale only for 28% of beams. Conclusion: Our novel gating strategy achieved significant dosimetric improvements over conventional gating, and approached the upper limit represented by fully 4D optimized planning while being significantly simpler and more clinically translatable. This work was partially supported through research funding from National Institutes of Health (R01CA169102) and Varian Medical Systems, Palo Alto, CA, USA.« less

In vivo imaging of the pathophysiological changes and neutrophil dynamics in influenza virus-infected mouse lungs.

PubMed

Ueki, Hiroshi; Wang, I-Hsuan; Fukuyama, Satoshi; Katsura, Hiroaki; da Silva Lopes, Tiago Jose; Neumann, Gabriele; Kawaoka, Yoshihiro

2018-06-25

The pathophysiological changes that occur in lungs infected with influenza viruses are poorly understood. Here we established an in vivo imaging system that combines two-photon excitation microscopy and fluorescent influenza viruses of different pathogenicity. This approach allowed us to monitor and correlate several parameters and physiological changes including the spread of infection, pulmonary permeability, pulmonary perfusion speed, number of recruited neutrophils in infected lungs, and neutrophil motion in the lungs of live mice. Several physiological changes were larger and occurred earlier in mice infected with a highly pathogenic H5N1 influenza virus compared with those infected with a mouse-adapted human strain. These findings demonstrate the potential of our in vivo imaging system to provide novel information about the pathophysiological consequences of virus infections.

SU-E-J-172: A Quantitative Assessment of Lung Tumor Motion Using 4DCT Imaging Under Conditions of Controlled Breathing in the Management of Non-Small Cell Lung Cancer (NSCLC) Using Stereotactic Body Radiation Therapy (SBRT)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Mohatt, D; Gomez, J; Singh, A

Purpose: To study breathing related tumor motion amplitudes by lung lobe location under controlled breathing conditions used in Stereotactic Body Radiation Therapy (SBRT) for NSCLC. Methods: Sixty-five NSCLC SBRT patients since 2009 were investigated. Patients were categorized based on tumor anatomic location (RUL-17, RML-7, RLL-18, LUL-14, LLL-9). A 16-slice CT scanner [GE RT16 Pro] along with Varian Realtime Position Management (RPM) software was used to acquire the 4DCT data set using 1.25 mm slice width. Images were binned in 10 phases, T00 being at maximum inspiration ' T50 at maximum expiration phase. Tumor volume was segmented in T50 using themore » CT-lung window and its displacement were measured from phase to phase in all three axes; superiorinferior, anterior-posterior ' medial-lateral at the centroid level of the tumor. Results: The median tumor movement in each lobe was as follows: RUL= 3.8±2.0 mm (mean ITV: 9.5 cm{sup 3}), RML= 4.7±2.8 mm (mean ITV: 9.2 cm{sup 3}), RLL=6.6±2.6 mm (mean ITV: 12.3 cm{sup 3}), LUL=3.8±2.4 mm (mean ITV: 18.5 cm{sup 3}), ' LLL=4.7±2.5 mm (mean ITV: 11.9 cm{sup 3}). The median respiratory cycle for all patients was found to be 3.81 ± 1.08 seconds [minimum 2.50 seconds, maximum 7.07 seconds]. The tumor mobility incorporating breathing cycle was RUL = 0.95±0.49 mm/s, RML = 1.35±0.62 mm/s, RLL = 1.83±0.71 mm/s, LUL = 0.98 ±0.50 mm/s, and LLL = 1.15 ±0.53 mm/s. Conclusion: Our results show that tumor displacement is location dependent. The range of motion and mobility increases as the location of the tumor nears the diaphragm. Under abdominal compression, the magnitude of tumor motion is reduced by as much as a factor of 2 in comparison to reported tumor magnitudes under conventional free breathing conditions. This study demonstrates the utility of abdominal compression in reducing the tumor motion leading to reduced ITV and planning tumor volumes (PTV)« less

Interfraction variation in lung tumor position with abdominal compression during stereotactic body radiotherapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Mampuya, Wambaka Ange; Nakamura, Mitsuhiro; Matsuo, Yukinori

2013-09-15

Purpose: To assess the effect of abdominal compression on the interfraction variation in tumor position in lung stereotactic body radiotherapy (SBRT) using cone-beam computed tomography (CBCT) in a larger series of patients with large tumor motion amplitude.Methods: Thirty patients with lung tumor motion exceeding 8 mm who underwent SBRT were included in this study. After translational and rotational initial setup error was corrected based on bone anatomy, CBCT images were acquired for each fraction. The residual interfraction variation was defined as the difference between the centroid position of the visualized target in three dimensions derived from CBCT scans and thosemore » derived from averaged intensity projection images. The authors compared the magnitude of the interfraction variation in tumor position between patients treated with [n= 16 (76 fractions)] and without [n= 14 (76 fractions)] abdominal compression.Results: The mean ± standard deviation (SD) of the motion amplitude in the longitudinal direction before abdominal compression was 19.9 ± 7.3 (range, 10–40) mm and was significantly (p < 0.01) reduced to 12.4 ± 5.8 (range, 5–30) mm with compression. The greatest variance of the interfraction variation with abdominal compression was observed in the longitudinal direction, with a mean ± SD of 0.79 ± 3.05 mm, compared to −0.60 ± 2.10 mm without abdominal compression. The absolute values of the 95th percentile of the interfraction variation for one side in each direction were 3.97/6.21 mm (posterior/anterior), 4.16/3.76 mm (caudal/cranial), and 2.90/2.32 mm (right/left) without abdominal compression, and 2.14/5.03 mm (posterior/anterior), 3.93/9.23 mm (caudal/cranial), and 2.37/5.45 mm (right/left) with abdominal compression. An absolute interfraction variation greater than 5 mm was observed in six (9.2%) fractions without and 13 (17.1%) fractions with abdominal compression.Conclusions: Abdominal compression was effective for reducing the amplitude of tumor motion. However, in most of the authors’ patients, the use of abdominal compression seemed to increase the interfraction variation in tumor position, despite reducing lung tumor motion. The daily tumor position deviated more systematically from the tumor position in the planning CT scan in the lateral and longitudinal directions in patients treated with abdominal compression compared to those treated without compression. Therefore, target matching is required to correct or minimize the interfraction variation.« less

Ground reaction forces and knee kinetics during single and repeated badminton lunges.

PubMed

Lam, Wing Kai; Ding, Rui; Qu, Yi

2017-03-01

Repeated movement (RM) lunge that frequently executed in badminton might be used for footwear evaluation. This study examined the influence of single movement (SM) and RM lunges on the ground reaction forces (GRFs) and knee kinetics during the braking phase of a badminton lunge step. Thirteen male university badminton players performed left-forward lunges in both SM and RM sessions. Force platform and motion capturing system were used to measure GRFs and knee kinetics variables. Paired t-test was performed to determine any significant differences between SM and RM lunges regarding mean and coefficient of variation (CV) in each variable. The kinetics results indicated that compared to SM lunges, the RM lunges had shorter contact time and generated smaller maximum loading rate of impact force, peak knee anterior-posterior force, and peak knee sagittal moment but generated larger peak horizontal resultant forces (Ps < 0.05). Additionally, the RM lunges had lower CV for peak knee medial-lateral and vertical forces (Ps < 0.05). These results suggested that the RM testing protocols had a distinct loading response and adaptation pattern during lunge and that the RM protocol showed higher within-trial reliability, which may be beneficial for the knee joint loading evaluation under different interventions.

Feasibility Study for Markerless Tracking of Lung Tumors in Stereotactic Body Radiotherapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Richter, Anne, E-mail: richter_a3@klinik.uni-wuerzburg.d; Wilbert, Juergen; Baier, Kurt

2010-10-01

Purpose: To evaluate the feasibility and accuracy of a method for markerless tracking of lung tumors in electronic portal imaging device (EPID) movies and to analyze intra- and interfractional variations in tumor motion. Methods and Materials: EPID movies were acquired during stereotactic body radiotherapy (SBRT) given to 40 patients with 49 pulmonary targets and retrospectively analyzed. Tumor visibility and tracking accuracy were determined by three observers. Tumor motion of 30 targets was analyzed in detail via four-dimensional computed tomography (4DCT) and EPID in the superior-inferior direction for intra- and interfractional variations. Results: Tumor visibility was sufficient for markerless tracking inmore » 47% of the EPID movies. Tumor size and visibility in the DRR were correlated with visibility in the EPID images. The difference between automatic and manual tracking was a maximum of 2 mm for 98.3% in the x direction and 89.4% in the y direction. Motion amplitudes in 4DCT images (range, 0.7-17.9 mm; median, 4.9 mm) were closely correlated with amplitudes in the EPID movies. Intrafractional and interfractional variability of tumor motion amplitude were of similar magnitude: 1 mm on average to a maximum of 4 mm. A change in moving average of more than {+-}1 mm, {+-}2 mm, and {+-}4 mm were observed in 47.1%, 17.1%, and 4.5% of treatment time for all trajectories, respectively. Mean tumor velocity was 3.4 mm/sec, to a maximum 61 mm/sec. Conclusions: Tracking of pulmonary tumors in EPID images without implanted markers was feasible in 47% of all treatment beams. 4DCT is representative of the evaluation of mean breathing motion on average, but larger deviations occurred in target motion between treatment planning and delivery effort a monitoring during delivery.« less

WE-G-BRD-02: Characterizing Information Loss in a Sparse-Sampling-Based Dynamic MRI Sequence (k-T BLAST) for Lung Motion Monitoring

DOE Office of Scientific and Technical Information (OSTI.GOV)

Arai, T; Nofiele, J; Sawant, A

2015-06-15

Purpose: Rapid MRI is an attractive, non-ionizing tool for soft-tissue-based monitoring of respiratory motion in thoracic and abdominal radiotherapy. One big challenge is to achieve high temporal resolution while maintaining adequate spatial resolution. K-t BLAST, sparse-sampling and reconstruction sequence based on a-priori information represents a potential solution. In this work, we investigated how much “true” motion information is lost as a-priori information is progressively added for faster imaging. Methods: Lung tumor motions in superior-inferior direction obtained from ten individuals were replayed into an in-house, MRI-compatible, programmable motion platform (50Hz refresh and 100microns precision). Six water-filled 1.5ml tubes were placed onmore » it as fiducial markers. Dynamic marker motion within a coronal slice (FOV: 32×32cm{sup 2}, resolution: 0.67×0.67mm{sup 2}, slice-thickness: 5mm) was collected on 3.0T body scanner (Ingenia, Philips). Balanced-FFE (TE/TR: 1.3ms/2.5ms, flip-angle: 40degrees) was used in conjunction with k-t BLAST. Each motion was repeated four times as four k-t acceleration factors 1, 2, 5, and 16 (corresponding frame rates were 2.5, 4.7, 9.8, and 19.1Hz, respectively) were compared. For each image set, one average motion trajectory was computed from six marker displacements. Root mean square error (RMS) was used as a metric of spatial accuracy where measured trajectories were compared to original data. Results: Tumor motion was approximately 10mm. The mean(standard deviation) of respiratory rates over ten patients was 0.28(0.06)Hz. Cumulative distributions of tumor motion frequency spectra (0–25Hz) obtained from the patients showed that 90% of motion fell on 3.88Hz or less. Therefore, the frame rate must be a double or higher for accurate monitoring. The RMS errors over patients for k-t factors of 1, 2, 5, and 16 were.10(.04),.17(.04), .21(.06) and.26(.06)mm, respectively. Conclusions: K-t factor of 5 or higher can cover the high frequency component of tumor respiratory motion, while the estimated error of spatial accuracy was approximately.2mm.« less

Four-dimensional optical coherence tomography imaging of total liquid ventilated rats

NASA Astrophysics Data System (ADS)

Kirsten, Lars; Schnabel, Christian; Gaertner, Maria; Koch, Edmund

2013-06-01

Optical coherence tomography (OCT) can be utilized for the spatially and temporally resolved visualization of alveolar tissue and its dynamics in rodent models, which allows the investigation of lung dynamics on the microscopic scale of single alveoli. The findings could provide experimental input data for numerical simulations of lung tissue mechanics and could support the development of protective ventilation strategies. Real four-dimensional OCT imaging permits the acquisition of several OCT stacks within one single ventilation cycle. Thus, the entire four-dimensional information is directly obtained. Compared to conventional virtual four-dimensional OCT imaging, where the image acquisition is extended over many ventilation cycles and is triggered on pressure levels, real four-dimensional OCT is less vulnerable against motion artifacts and non-reproducible movement of the lung tissue over subsequent ventilation cycles, which widely reduces image artifacts. However, OCT imaging of alveolar tissue is affected by refraction and total internal reflection at air-tissue interfaces. Thus, only the first alveolar layer beneath the pleura is visible. To circumvent this effect, total liquid ventilation can be carried out to match the refractive indices of lung tissue and the breathing medium, which improves the visibility of the alveolar structure, the image quality and the penetration depth and provides the real structure of the alveolar tissue. In this study, a combination of four-dimensional OCT imaging with total liquid ventilation allowed the visualization of the alveolar structure in rat lung tissue benefiting from the improved depth range beneath the pleura and from the high spatial and temporal resolution.

TU-AB-BRA-06: BEST IN PHYSICS (JOINT IMAGING-THERAPY): An MRI Compatible Externally and Internally Deformable Lung Motion Phantom for Multi-Modality IGRT

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sabouri, P; Sawant, A; Arai, T

Purpose: MRI has become an attractive tool for tumor motion management. Current MR-compatible phantoms are only capable of reproducing translational motion. This study describes the construction and validation of a more realistic, MRI-compatible lung phantom that is deformable internally as well as externally. We demonstrate a radiotherapy application of this phantom by validating the geometric accuracy of the open-source deformable image registration software NiftyReg (UCL, UK). Methods: The outer shell of a commercially-available dynamic breathing torso phantom was filled with natural latex foam with eleven water tubes. A rigid foam cut-out served as the diaphragm. A high-precision programmable, in-house, MRI-compatiblemore » motion platform was used to drive the diaphragm. The phantom was imaged on a 3T scanner (Philips, Ingenia). Twenty seven tumor traces previously recorded from lung cancer patients were programmed into the phantom and 2D+t image sequences were acquired using a sparse-sampling sequence k-t BLAST (accn=3, resolution=0.66×0.66×5mm3; acquisition-time=110ms/slice). The geometric fidelity of the MRI-derived trajectories was validated against those obtained via fluoroscopy using the on board kV imager on a Truebeam linac. NiftyReg was used to perform frame by frame deformable image registration. The location of each marker predicted by using NiftyReg was compared with the values calculated by intensity-based segmentation on each frame. Results: In all cases, MR trajectories were within 1 mm of corresponding fluoroscopy trajectories. RMSE between centroid positions obtained from segmentation with those obtained by NiftyReg varies from 0.1 to 0.21 mm in the SI direction and 0.08 to 0.13 mm in the LR direction showing the high accuracy of deformable registration. Conclusion: We have successfully designed and demonstrated a phantom that can accurately reproduce deformable motion under a variety of imaging modalities including MRI, CT and x-ray fluodoscopy, making it an invaluable research tool for validating novel motion management strategies. This work was partially supported through research funding from National Institutes of Health (R01CA169102).« less

An Evaluation of Two Internal Surrogates for Determining the Three-Dimensional Position of Peripheral Lung Tumors

DOE Office of Scientific and Technical Information (OSTI.GOV)

Spoelstra, Femke; Soernsen de Koste, John R. van; Vincent, Andrew

2009-06-01

Purpose: Both carina and diaphragm positions have been used as surrogates during respiratory-gated radiotherapy. We studied the correlation of both surrogates with three-dimensional (3D) tumor position. Methods and Materials: A total of 59 repeat artifact-free four-dimensional (4D) computed tomography (CT) scans, acquired during uncoached breathing, were identified in 23 patients with Stage I lung cancer. Repeat scans were co-registered to the initial 4D CT scan, and tumor, carina, and ipsilateral diaphragm were manually contoured in all phases of each 4D CT data set. Correlation between positions of carina and diaphragm with 3D tumor position was studied by use of log-likelihoodmore » ratio statistics. Models to predict 3D tumor position from internal surrogates at end inspiration (EI) and end expiration (EE) were developed, and model accuracy was tested by calculating SDs of differences between predicted and actual tumor positions. Results: Motion of both the carina and diaphragm significantly correlated with tumor motion, but log-likelihood ratios indicated that the carina was more predictive for tumor position. When craniocaudal tumor position was predicted by use of craniocaudal carina positions, the SDs of the differences between the predicted and observed positions were 2.2 mm and 2.4 mm at EI and EE, respectively. The corresponding SDs derived with the diaphragm positions were 3.7 mm and 3.9 mm at EI and EE, respectively. Prediction errors in the other directions were comparable. Prediction accuracy was similar at EI and EE. Conclusions: The carina is a better surrogate of 3D tumor position than diaphragm position. Because residual prediction errors were observed in this analysis, additional studies will be performed using audio-coached scans.« less

SU-F-T-563: Delivered Dose Reconstruction of Moving Targets for Gated Volumetric Modulated Arc Therapy (VMAT)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chung, H; Cho, S; Jeong, C

2016-06-15

Purpose: Actual delivered dose of moving tumors treated with gated volumetric arc therapy (VMAT) may significantly differ from the planned dose assuming static target. In this study, we developed a method which reconstructs actual delivered dose distribution of moving target by taking into account both tumor motion and dynamic beam delivery of gated VMAT, and applied to abdominal tumors. Methods: Fifteen dual-arc VMAT plans (Eclipse, Varian Medical Systems) for 5 lung, 5 pancreatic, and 5 liver cancer patients treated with gated VMAT stereotactic body radiotherapy (SBRT) were studied. For reconstruction of the delivered dose distribution, we divided each original arcmore » beam into control-point-wise sub-beams, and applied beam isocenter shifting to each sub-beam to reflect the tumor motion. The tumor positions as a function of beam delivery were estimated by synchronizing the beam delivery with the respiratory signal which acquired during treatment. For this purpose, an in-house program (MATLAB, Mathworks) was developed to convert the original DICOM plan data into motion-involved treatment plan. The motion-involved DICOM plan was imported into Eclipse for dose calculation. The reconstructed delivered dose was compared to the plan dose using the dose coverage of gross tumor volume (GTV) and dose distribution of organs at risk (OAR). Results: The mean GTV dose coverage difference between the reconstructed delivered dose and the plan dose was 0.2 % in lung and pancreas cases, and no difference in liver cases. Mean D1000cc of ipsilateral lungs was reduced (0.8 ± 1.4cGy). Conclusion: We successfully developed a method of delivered dose reconstruction taking into account both respiratory tumor motion and dynamic beam delivery, and applied it to abdominal tumors treated with gated VAMT. No significant deterioration of delivered dose distribution indicates that interplay effect would be minimal even in the case of gated SBRT. This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIP) (No. 2015038710)« less

Projection-data based temporal maximum attenuation computed tomography: determination of internal target volume for lung cancer against intra-fraction motion

NASA Astrophysics Data System (ADS)

Mori, Shinichiro; Kanematsu, Nobuyuki; Asakura, Hiroshi; Endo, Masahiro

2007-02-01

The concept of internal target volume (ITV) is highly significant in radiotherapy for the lung, an organ which is hampered by organ motion. To date, different methods to obtain the ITV have been published and are therefore available. To define ITV, we developed a new method by adapting a time filter to the four-dimensional CT scan technique (4DCT) which is projection-data processing (4D projection data maximum attenuation (4DPM)), and compared it with reconstructed image processing (4D image maximum intensity projection (4DIM)) using a phantom and clinical evaluations. 4DIM and 4DPM captured accurate maximum intensity volume (MIV), that is tumour encompassing volume, easily. Although 4DIM increased the CT number 1.8 times higher than 4DPM, 4DPM provided the original tumour CT number for MIV via a reconstruction algorithm. In the patient with lung fibrosis honeycomb, the MIV with 4DIM is 0.7 cm larger than that for cine imaging in the cranio-caudal direction. 4DPM therefore provided an accurate MIV independent of patient characteristics and reconstruction conditions. These findings indicate the usefulness of 4DPM in determining ITV in radiotherapy.

Combined Electrocardiography- and Respiratory-Triggered CT of the Lung to Reduce Respiratory Misregistration Artifacts between Imaging Slabs in Free-Breathing Children: Initial Experience.

PubMed

Goo, Hyun Woo; Allmendinger, Thomas

2017-01-01

Cardiac and respiratory motion artifacts degrade the image quality of lung CT in free-breathing children. The aim of this study was to evaluate the effect of combined electrocardiography (ECG) and respiratory triggering on respiratory misregistration artifacts on lung CT in free-breathing children. In total, 15 children (median age 19 months, range 6 months-8 years; 7 boys), who underwent free-breathing ECG-triggered lung CT with and without respiratory-triggering were included. A pressure-sensing belt of a respiratory gating system was used to obtain the respiratory signal. The degree of respiratory misregistration artifacts between imaging slabs was graded on a 4-point scale (1, excellent image quality) on coronal and sagittal images and compared between ECG-triggered lung CT studies with and without respiratory triggering. A p value < 0.05 was considered significant. Lung CT with combined ECG and respiratory triggering showed significantly less respiratory misregistration artifacts than lung CT with ECG triggering only (1.1 ± 0.4 vs. 2.2 ± 1.0, p = 0.003). Additional respiratory-triggering reduces respiratory misregistration artifacts on ECG-triggered lung CT in free-breathing children.

Imaging a moving lung tumor with megavoltage cone beam computed tomography

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gayou, Olivier, E-mail: ogayou@wpahs.org; Colonias, Athanasios

2015-05-15

Purpose: Respiratory motion may affect the accuracy of image guidance of radiation treatment of lung cancer. A cone beam computed tomography (CBCT) image spans several breathing cycles, resulting in a blurred object with a theoretical size equal to the sum of tumor size and breathing motion. However, several factors may affect this theoretical relationship. The objective of this study was to analyze the effect of tumor motion on megavoltage (MV)-CBCT images, by comparing target sizes on simulation and pretreatment images of a large cohort of lung cancer patients. Methods: Ninety-three MV-CBCT images from 17 patients were analyzed. Internal target volumesmore » were contoured on each MV-CBCT dataset [internal target volume (ITV{sub CB})]. Their extent in each dimension was compared to that of two volumes contoured on simulation 4-dimensional computed tomography (4D-CT) images: the combination of the tumor contours of each phase of the 4D-CT (ITV{sub 4D}) and the volume contoured on the average CT calculated from the 4D-CT phases (ITV{sub ave}). Tumor size and breathing amplitude were assessed by contouring the tumor on each CBCT raw projection where it could be unambiguously identified. The effect of breathing amplitude on the quality of the MV-CBCT image reconstruction was analyzed. Results: The mean differences between the sizes of ITV{sub CB} and ITV{sub 4D} were −1.6 ± 3.3 mm (p < 0.001), −2.4 ± 3.1 mm (p < 0.001), and −7.2 ± 5.3 mm (p < 0.001) in the anterior/posterior (AP), left/right (LR), and superior/inferior (SI) directions, respectively, showing that MV-CBCT underestimates the full target size. The corresponding mean differences between ITV{sub CB} and ITV{sub ave} were 0.3 ± 2.6 mm (p = 0.307), 0.0 ± 2.4 mm (p = 0.86), and −4.0 ± 4.3 mm (p < 0.001), indicating that the average CT image is more representative of what is visible on MV-CBCT in the AP and LR directions. In the SI directions, differences between ITV{sub CB} and ITV{sub ave} could be separated into two groups based on tumor motion: −3.2 ± 3.2 mm for tumor motion less than 15 mm and −10.9 ± 6.3 mm for tumor motion greater than 15 mm. Deviations of measured target extents from their theoretical values derived from tumor size and motion were correlated with motion amplitude similarly for both MV-CBCT and average CT images, suggesting that the two images were subject to similar motion artifacts for motion less than 15 mm. Conclusions: MV-CBCT images are affected by tumor motion and tend to under-represent the full target volume. For tumor motion up to 15 mm, the volume contoured on average CT is comparable to that contoured on the MV-CBCT. Therefore, the average CT should be used in image registration for localization purposes, and the standard 5 mm PTV margin seems adequate. For tumor motion greater than 15 mm, an additional setup margin may need to be used to account for the increased uncertainty in tumor localization.« less

Design of a multimodal (1H/23Na MR/CT) anthropomorphic thorax phantom.

PubMed

Neumann, Wiebke; Lietzmann, Florian; Schad, Lothar R; Zöllner, Frank G

2017-06-01

This work proposes a modular, anthropomorphic MR and CT thorax phantom that enables the comparison of experimental studies for quantitative evaluation of deformable, multimodal image registration algorithms and realistic multi-nuclear MR imaging techniques. A human thorax phantom was developed with insertable modules representing lung, liver, ribs and additional tracking spheres. The quality of human tissue mimicking characteristics was evaluated for 1 H and 23 Na MR as well as CT imaging. The position of landmarks in the lung lobes was tracked during CT image acquisition at several positions during breathing cycles. 1 H MR measurements of the liver were repeated after seven months to determine long term stability. The modules possess HU, T 1 and T 2 values comparable to human tissues (lung module: -756±148HU, artificial ribs: 218±56HU (low CaCO 3 concentration) and 339±121 (high CaCO 3 concentration), liver module: T 1 =790±28ms, T 2 =65±1ms). Motion analysis showed that the landmarks in the lung lobes follow a 3D trajectory similar to human breathing motion. The tracking spheres are well detectable in both CT and MRI. The parameters of the tracking spheres can be adjusted in the following ranges to result in a distinct signal: HU values from 150 to 900HU, T 1 relaxation time from 550ms to 2000ms, T 2 relaxation time from 40ms to 200ms. The presented anthropomorphic multimodal thorax phantom fulfills the demands of a simple, inexpensive system with interchangeable components. In future, the modular design allows for complementing the present set up with additional modules focusing on specific research targets such as perfusion studies, 23 Na MR quantification experiments and an increasing level of complexity for motion studies. Copyright © 2016. Published by Elsevier GmbH.

Intrafractional Baseline Shift or Drift of Lung Tumor Motion During Gated Radiation Therapy With a Real-Time Tumor-Tracking System.

PubMed

Takao, Seishin; Miyamoto, Naoki; Matsuura, Taeko; Onimaru, Rikiya; Katoh, Norio; Inoue, Tetsuya; Sutherland, Kenneth Lee; Suzuki, Ryusuke; Shirato, Hiroki; Shimizu, Shinichi

2016-01-01

To investigate the frequency and amplitude of baseline shift or drift (shift/drift) of lung tumors in stereotactic body radiation therapy (SBRT), using a real-time tumor-tracking radiation therapy (RTRT) system. Sixty-eight patients with peripheral lung tumors were treated with SBRT using the RTRT system. One of the fiducial markers implanted near the tumor was used for the real-time monitoring of the intrafractional tumor motion every 0.033 seconds by the RTRT system. When baseline shift/drift is determined by the system, the position of the treatment couch is adjusted to compensate for the shift/drift. Therefore, the changes in the couch position correspond to the baseline shift/drift in the tumor motion. The frequency and amount of adjustment to the couch positions in the left-right (LR), cranio-caudal (CC), and antero-posterior (AP) directions have been analyzed for 335 fractions administered to 68 patients. The average change in position of the treatment couch during the treatment time was 0.45 ± 2.23 mm (mean ± standard deviation), -1.65 ± 5.95 mm, and 1.50 ± 2.54 mm in the LR, CC, and AP directions, respectively. Overall the baseline shift/drift occurs toward the cranial and posterior directions. The incidence of baseline shift/drift exceeding 3 mm was 6.0%, 15.5%, 14.0%, and 42.1% for the LR, CC, AP, and for the square-root of sum of 3 directions, respectively, within 10 minutes of the start of treatment, and 23.0%, 37.6%, 32.5%, and 71.6% within 30 minutes. Real-time monitoring and frequent adjustments of the couch position and/or adding appropriate margins are suggested to be essential to compensate for possible underdosages due to baseline shift/drift in SBRT for lung cancers. Copyright © 2016 Elsevier Inc. All rights reserved.

Robustness of the Voluntary Breath-Hold Approach for the Treatment of Peripheral Lung Tumors Using Hypofractionated Pencil Beam Scanning Proton Therapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Dueck, Jenny, E-mail: jenny.dueck@psi.ch; Center for Proton Therapy, Paul Scherrer Institut, Villigen PSI; Niels Bohr Institute, University of Copenhagen, Copenhagen

Purpose: The safe clinical implementation of pencil beam scanning (PBS) proton therapy for lung tumors is complicated by the delivery uncertainties caused by breathing motion. The purpose of this feasibility study was to investigate whether a voluntary breath-hold technique could limit the delivery uncertainties resulting from interfractional motion. Methods and Materials: Data from 15 patients with peripheral lung tumors previously treated with stereotactic radiation therapy were included in this study. The patients had 1 computed tomographic (CT) scan in voluntary breath-hold acquired before treatment and 3 scans during the treatment course. PBS proton treatment plans with 2 fields (2F) andmore » 3 fields (3F), respectively, were calculated based on the planning CT scan and subsequently recalculated on the 3 repeated CT scans. Recalculated plans were considered robust if the V{sub 95%} (volume receiving ≥95% of the prescribed dose) of the gross target volume (GTV) was within 5% of what was expected from the planning CT data throughout the simulated treatment. Results: A total of 14/15 simulated treatments for both 2F and 3F met the robustness criteria. Reduced V{sub 95%} was associated with baseline shifts (2F, P=.056; 3F, P=.008) and tumor size (2F, P=.025; 3F, P=.025). Smaller tumors with large baseline shifts were also at risk for reduced V{sub 95%} (interaction term baseline/size: 2F, P=.005; 3F, P=.002). Conclusions: The breath-hold approach is a realistic clinical option for treating lung tumors with PBS proton therapy. Potential risk factors for reduced V{sub 95%} are small targets in combination with large baseline shifts. On the basis of these results, the baseline shift of the tumor should be monitored (eg, through image guided therapy), and appropriate measures should be taken accordingly. The intrafractional motion needs to be investigated to confirm that the breath-hold approach is robust.« less

SU-E-J-153: Reconstructing 4D Cone Beam CT Images for Clinical QA of Lung SABR Treatments

DOE Office of Scientific and Technical Information (OSTI.GOV)

Beaudry, J; Bergman, A; British Columbia Cancer Agency, Vancouver, BC

Purpose: To verify that the planned Primary Target Volume (PTV) and Internal Gross Tumor Volume (IGTV) fully enclose a moving lung tumor volume as visualized on a pre-SABR treatment verification 4D Cone Beam CT. Methods: Daily 3DCBCT image sets were acquired immediately prior to treatment for 10 SABR lung patients using the on-board imaging system integrated into a Varian TrueBeam (v1.6: no 4DCBCT module available). Respiratory information was acquired during the scan using the Varian RPM system. The CBCT projections were sorted into 8 bins offline, both by breathing phase and amplitude, using in-house software. An iterative algorithm based onmore » total variation minimization, implemented in the open source reconstruction toolkit (RTK), was used to reconstruct the binned projections into 4DCBCT images. The relative tumor motion was quantified by tracking the centroid of the tumor volume from each 4DCBCT image. Following CT-CBCT registration, the planning CT volumes were compared to the location of the CBCT tumor volume as it moves along its breathing trajectory. An overlap metric quantified the ability of the planned PTV and IGTV to contain the tumor volume at treatment. Results: The 4DCBCT reconstructed images visibly show the tumor motion. The mean overlap between the planned PTV (IGTV) and the 4DCBCT tumor volumes was 100% (94%), with an uncertainty of 5% from the 4DCBCT tumor volume contours. Examination of the tumor motion and overlap metric verify that the IGTV drawn at the planning stage is a good representation of the tumor location at treatment. Conclusion: It is difficult to compare GTV volumes from a 4DCBCT and a planning CT due to image quality differences. However, it was possible to conclude the GTV remained within the PTV 100% of the time thus giving the treatment staff confidence that SABR lung treatements are being delivered accurately.« less

Motion compensation for robotic lung tumour radiotherapy in remote locations: A personalised medicine approach

NASA Astrophysics Data System (ADS)

Ionescu, Clara M.; Copot, Cosmin; Verellen, Dirk

2017-03-01

The purpose of this work is to integrate the concept of patient-in-the-closed-loop application with tumour treatment of cancer-diagnosed patients in remote areas. The generic closed loop control objective is effective synchronisation of the radiation focus to the movement of a lung tissue tumour during actual breathing of the patient. This is facilitated by accurate repositioning of a robotic arm manipulator, i.e. we emulate the Cyberknife Robotic Radiosurgery system. Predictive control with disturbance filter is used in this application in a minimalistic model design. Performance of the control structure is validated by means of simulation using real recorded breathing patterns from patients measured in 3D space. Latency in communication protocol is taken into account, given telerobotics involve autonomous operation of a robot interacting with a human being in different location. Our results suggest that the proposed closed loop control structure has practical potential to individualise the treatment and improves accuracy by at least 15%.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Matney, Jason; Park, Peter C.; The University of Texas Graduate School of Biomedical Sciences, Houston, Texas

Purpose: To quantify and compare the effects of respiratory motion on paired passively scattered proton therapy (PSPT) and intensity modulated photon therapy (IMRT) plans; and to establish the relationship between the magnitude of tumor motion and the respiratory-induced dose difference for both modalities. Methods and Materials: In a randomized clinical trial comparing PSPT and IMRT, radiation therapy plans have been designed according to common planning protocols. Four-dimensional (4D) dose was computed for PSPT and IMRT plans for a patient cohort with respiratory motion ranging from 3 to 17 mm. Image registration and dose accumulation were performed using grayscale-based deformable imagemore » registration algorithms. The dose–volume histogram (DVH) differences (4D-3D [3D = 3-dimensional]) were compared for PSPT and IMRT. Changes in 4D-3D dose were correlated to the magnitude of tumor respiratory motion. Results: The average 4D-3D dose to 95% of the internal target volume was close to zero, with 19 of 20 patients within 1% of prescribed dose for both modalities. The mean 4D-3D between the 2 modalities was not statistically significant (P<.05) for all dose–volume histogram indices (mean ± SD) except the lung V5 (PSPT: +1.1% ± 0.9%; IMRT: +0.4% ± 1.2%) and maximum cord dose (PSPT: +1.5 ± 2.9 Gy; IMRT: 0.0 ± 0.2 Gy). Changes in 4D-3D dose were correlated to tumor motion for only 2 indices: dose to 95% planning target volume, and heterogeneity index. Conclusions: With our current margin formalisms, target coverage was maintained in the presence of respiratory motion up to 17 mm for both PSPT and IMRT. Only 2 of 11 4D-3D indices (lung V5 and spinal cord maximum) were statistically distinguishable between PSPT and IMRT, contrary to the notion that proton therapy will be more susceptible to respiratory motion. Because of the lack of strong correlations with 4D-3D dose differences in PSPT and IMRT, the extent of tumor motion was not an adequate predictor of potential dosimetric error caused by breathing motion.« less

New Ideas for Speech Recognition and Related Technologies

DOE Office of Scientific and Technical Information (OSTI.GOV)

Holzrichter, J F

The ideas relating to the use of organ motion sensors for the purposes of speech recognition were first described by.the author in spring 1994. During the past year, a series of productive collaborations between the author, Tom McEwan and Larry Ng ensued and have lead to demonstrations, new sensor ideas, and algorithmic descriptions of a large number of speech recognition concepts. This document summarizes the basic concepts of recognizing speech once organ motions have been obtained. Micro power radars and their uses for the measurement of body organ motions, such as those of the heart and lungs, have been demonstratedmore » by Tom McEwan over the past two years. McEwan and I conducted a series of experiments, using these instruments, on vocal organ motions beginning in late spring, during which we observed motions of vocal folds (i.e., cords), tongue, jaw, and related organs that are very useful for speech recognition and other purposes. These will be reviewed in a separate paper. Since late summer 1994, Lawrence Ng and I have worked to make many of the initial recognition ideas more rigorous and to investigate the applications of these new ideas to new speech recognition algorithms, to speech coding, and to speech synthesis. I introduce some of those ideas in section IV of this document, and we describe them more completely in the document following this one, UCRL-UR-120311. For the design and operation of micro-power radars and their application to body organ motions, the reader may contact Tom McEwan directly. The capability for using EM sensors (i.e., radar units) to measure body organ motions and positions has been available for decades. Impediments to their use appear to have been size, excessive power, lack of resolution, and lack of understanding of the value of organ motion measurements, especially as applied to speech related technologies. However, with the invention of very low power, portable systems as demonstrated by McEwan at LLNL researchers have begun to think differently about practical applications of such radars. In particular, his demonstrations of heart and lung motions have opened up many new areas of application for human and animal measurements.« less

Magnetic resonance imaging of pediatric lung parenchyma, airways, vasculature, ventilation, and perfusion: state of the art.

PubMed

Liszewski, Mark C; Hersman, F William; Altes, Talissa A; Ohno, Yoshiharu; Ciet, Pierluigi; Warfield, Simon K; Lee, Edward Y

2013-07-01

Magnetic resonance (MR) imaging is a noninvasive imaging modality, particularly attractive for pediatric patients given its lack of ionizing radiation. Despite many advantages, the physical properties of the lung (inherent low signal-to-noise ratio, magnetic susceptibility differences at lung-air interfaces, and respiratory and cardiac motion) have posed technical challenges that have limited the use of MR imaging in the evaluation of thoracic disease in the past. However, recent advances in MR imaging techniques have overcome many of these challenges. This article discusses these advances in MR imaging techniques and their potential role in the evaluation of thoracic disorders in pediatric patients. Copyright © 2013 Elsevier Inc. All rights reserved.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lu, W; Feigenberg, S; Yi, B

Purpose: To report practical issues and solutions in reconstructing and using 4DCT to account for respiratory motion in radiotherapy planning. Methods: Quiet breathing 4DCT was used to account for respiratory motion for patients with lung or upper abdomen tumor. A planning CT and a 4DCT were acquired consecutively with a Philips Brilliance CT scanner and Varian RPM System. The projections were reconstructed into 10 phases. In Pinnacle RTP system, we contour a GTV in each phase and unite all 10 GTVs as ITV. The ITV is then mapped to the planning CT. We describe practical issues, their causes, our solutionsmore » and reasoning during this process. Results: In 6 months, 9 issues were reported for 8 patients with lung cancer. For two patients, part of the GTV (∼50% and 10%) in planning CT fell outside the ITV in 4DCT. There was a 7 mm variation in first patient back position because less restricted immobilization had to be used. The second discrepancy was due to moderate variation in breathing amplitude. We extended the ITV to include the GTV since both variations may likely happen during treatment. A LUL tumor showed no motion due to a 10-s long no-breathing period. An RLL tumor appeared double due to an abnormally deeper breath at the tumor region. We repeated 4DCT reiterating the importance of quiet, regular breathing. One patient breathed too light to generate RPM signal. Two issues (no motion in lung, incomplete images in 90% phase) were due to incorrect tag positions. Two unexplainable errors disappeared when repeating reconstruction. In summary, 5 issues were patient-related and 4 were technique issues. Conclusion: Improving breathing regularity avoided large artifacts in 4DCT. One needs to closely monitor patient breathing. For uncontrollable variations, larger PTVs are necessary which requires appropriate communication between physics and the treating physician.« less

Effects of intrafractional motion on water equivalent pathlength in respiratory-gated heavy charged particle beam radiotherapy.

PubMed

Mori, Shinichiro; Chen, George T Y; Endo, Masahiro

2007-09-01

To analyze the water equivalent pathlength (WEL) fluctuations resulting from cardiac motion and display these variations on a beam's-eye-view image; the analysis provides insight into the accuracy of lung tumor irradiation with heavy charged particle beams. Volumetric cine computed tomography (CT) images were obtained on 7 lung cancer patients under free-breathing conditions with a 256-multislice CT scanner. Cardiac phase was determined by selecting systole and diastole. A WEL difference image (DeltaWEL) was calculated by subtracting the WEL image at end-systole from that at end-diastole at respiratory exhalation phase. Two calculation regions were defined: Region 1 was limited to the volume defined by planes bounding the heart; Region 2 included the entire body thickness for a given beam's-eye-view angle. The DeltaWEL values observed in Region 1 showed fluctuations at the periphery of the heart that varied from 20.4 (SD, 5.2) mm WEL to -15.6 (3.2) mm WEL. The areas over which these range perturbation values were observed were 36.8 (32.4) mm(2) and 6.0 (2.8) mm(2) for positive and negative WEL, respectively. The WEL fluctuations in Region 2 increased by approximately 3-4 mm WEL, whereas negative WEL fluctuations changed by approximately -4 to -5 mm WEL, compared with WEL for Region 1; areas over 20 mm WEL changes in Region 2 increased by 9 mm(2) for positive DeltaWEL and 2 mm(2) for negative DeltaWEL. Cine CT with a 256-multislice CT scanner captures both volumetric cardiac and respiratory motion with a temporal resolution sufficient to estimate range fluctuations by these motions. This information can be used to assess the range perturbations that charged particle beams may experience in irradiation of lung or esophageal tumors adjacent to the heart.

SU-E-J-194: Continuous Patient Surface Monitoring and Motion Analysis During Lung SBRT

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chung, E; Rioux, A; Benedict, S

2015-06-15

Purpose: Continuous monitoring of the SBRT lung patient motion during delivery is critical for ensuring adequate target volume margins in stereotactic body radiotherapy (SBRT). This work assesses the deviation of the patient surface motion using a real-time surface tracking system throughout treatment delivery. Methods: Our SBRT protocol employs abdominal compression to reduce the diaphragm movement to within 1 cm, and this is confirmed daily with fluoroscopy. Most patients are prescribed 3–5 fractions, and on treatment day a repeat motion analysis with fluoroscopy is performed, followed by a kV CBCT is aligned with the original planning CT image for 3D setupmore » confirmation. During this entire process a patient surface data restricted to whole chest or the sternum at the middle of the breathing cycle was captured using AlignRT optical surface tracking system and defined as a reference surface. For 10 patients, the deviation of the patient position from the reference surface was recorded during the SBRT delivery in the anterior-posterior (AP) direction at 3–6 measurements per second. Results: On average, the patient position deviated from the reference surface more than 4 mm, 3 mm and 2 mm in the AP direction for 0.95%, 3.7% and 11.1% of the total treatment time, respectively. Only one of the 10 patients showed that the maximum deviation of the patient surface during the SBRT delivery was greater than 1 cm. The average deviation of the patient surface from the reference surface during the SBRT delivery was not greater than 1.6 mm for any patient. Conclusion: This investigation indicates that AP motion can be significant even though the frequency is low. Continuous monitoring during SBRT has demonstrated value in monitoring patient motion ensuring that margins selected for SBRT are appropriate, and the use of non-ionizing and high-frequency imaging can provide useful indicators of motion during treatment.« less

SU-E-J-158: Audiovisual Biofeedback Reduces Image Artefacts in 4DCT: A Digital Phantom Study

DOE Office of Scientific and Technical Information (OSTI.GOV)

Pollock, S; Kipritidis, J; Lee, D

2015-06-15

Purpose: Irregular breathing motion has a deleterious impact on 4DCT image quality. The breathing guidance system: audiovisual biofeedback (AVB) is designed to improve breathing regularity, however, its impact on 4DCT image quality has yet to be quantified. The purpose of this study was to quantify the impact of AVB on thoracic 4DCT image quality by utilizing the digital eXtended Cardiac Torso (XCAT) phantom driven by lung tumor motion patterns. Methods: 2D tumor motion obtained from 4 lung cancer patients under two breathing conditions (i) without breathing guidance (free breathing), and (ii) with guidance (AVB). There were two breathing sessions, yieldingmore » 8 tumor motion traces. This tumor motion was synchronized with the XCAT phantom to simulate 4DCT acquisitions under two acquisition modes: (1) cine mode, and (2) prospective respiratory-gated mode. Motion regularity was quantified by the root mean square error (RMSE) of displacement. The number of artefacts was visually assessed for each 4DCT and summed up for each breathing condition. Inter-session anatomic reproducibility was quantified by the mean absolute difference (MAD) between the Session 1 4DCT and Session 2 4DCT. Results: AVB improved tumor motion regularity by 30%. In cine mode, the number of artefacts was reduced from 61 in free breathing to 40 with AVB, in addition to AVB reducing the MAD by 34%. In gated mode, the number of artefacts was reduced from 63 in free breathing to 51 with AVB, in addition to AVB reducing the MAD by 23%. Conclusion: This was the first study to compare the impact of breathing guidance on 4DCT image quality compared to free breathing, with AVB reducing the amount of artefacts present in 4DCT images in addition to improving inter-session anatomic reproducibility. Results thus far suggest that breathing guidance interventions could have implications for improving radiotherapy treatment planning and interfraction reproducibility.« less

Systematic evaluation of four-dimensional hybrid depth scanning for carbon-ion lung therapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Mori, Shinichiro; Furukawa, Takuji; Inaniwa, Taku

2013-03-15

Purpose: Irradiation of a moving target with a scanning beam requires a comprehensive understanding of organ motion as well as a robust dose error mitigation technique. The authors studied the effects of intrafractional respiratory motion for carbon-ion pencil beam scanning with phase-controlled rescanning on dose distributions for lung tumors. To address density variations, they used 4DCT data. Methods: Dose distributions for various rescanning methods, such as simple layer rescanning (LR), volumetric rescanning, and phase-controlled rescanning (PCR), were calculated for a lung phantom and a lung patient studies. To ensure realism, they set the scanning parameters such as scanning velocity andmore » energy variation time to be similar to those used at our institution. Evaluation metrics were determined with regard to clinical relevance, and consisted of (i) phase-controlled rescanning, (ii) sweep direction, (iii) target motion (direction and amplitude), (iv) respiratory cycle, and (v) prescribed dose. Spot weight maps were calculated by using a beam field-specific target volume, which takes account of range variations for respective respiratory phases. To emphasize the impact of intrafractional motion on the dose distribution, respiratory gating was not used. The accumulated dose was calculated by applying a B-spline-based deformable image registration, and the results for phase-controlled layered rescanning (PCR{sub L}) and phase-controlled volumetric rescanning (PCR{sub V}) were compared. Results: For the phantom study, simple LR was unable to improve the dose distributions for an increased number of rescannings. The phase-controlled technique without rescanning (1 Multiplication-Sign PCR{sub L} and 1 Multiplication-Sign PCR{sub V}) degraded dose conformity significantly due to a reduced scan velocity. In contrast, 4 Multiplication-Sign PCR{sub L} or more significantly and consistently improved dose distribution. PCR{sub V} showed interference effects, but in general also improved dose homogeneity with higher numbers of rescannings. Dose distributions with single PCR{sub L}/PCR{sub V} with a sweep direction perpendicular to motion direction showed large hot/cold spots; however, this effect vanished with higher numbers of rescannings for both methods. Similar observations were obtained for the other dose metrics, such as target motion (SI/AP), amplitude (6-22 mm peak-to-peak) and respiratory period (3.0-5.0 s). For four or more rescannings, both methods showed significantly better results, albeit that volumetric PCR was more affected by interference effects, which lead to severe degradation of a few dose distributions. The clinical example showed the same tendencies as the phantom study. Dose assessment metrics (D95, Dmax/Dmin, homogeneity index) were improved with an increasing number of PCR{sub L}/PCR{sub V}, but with PCR{sub L} being more robust. Conclusions: PCR{sub L} requires a longer treatment time than PCR{sub V} for high numbers of rescannings in the NIRS scanning system but is more robust. Although four or more rescans provided good dose homogeneity and conformity, the authors prefer to use more rescannings for clinical cases to further minimize dose degradation effects due to organ motion.« less

Experimental investigation of a general real-time 3D target localization method using sequential kV imaging combined with respiratory monitoring.

PubMed

Cho, Byungchul; Poulsen, Per; Ruan, Dan; Sawant, Amit; Keall, Paul J

2012-11-21

The goal of this work was to experimentally quantify the geometric accuracy of a novel real-time 3D target localization method using sequential kV imaging combined with respiratory monitoring for clinically realistic arc and static field treatment delivery and target motion conditions. A general method for real-time target localization using kV imaging and respiratory monitoring was developed. Each dimension of internal target motion T(x, y, z; t) was estimated from the external respiratory signal R(t) through the correlation between R(t(i)) and the projected marker positions p(x(p), y(p); t(i)) on kV images by a state-augmented linear model: T(x, y, z; t) = aR(t) + bR(t - τ) + c. The model parameters, a, b, c, were determined by minimizing the squared fitting error ∑‖p(x(p), y(p); t(i)) - P(θ(i)) · (aR(t(i)) + bR(t(i) - τ) + c)‖(2) with the projection operator P(θ(i)). The model parameters were first initialized based on acquired kV arc images prior to MV beam delivery. This method was implemented on a trilogy linear accelerator consisting of an OBI x-ray imager (operating at 1 Hz) and real-time position monitoring (RPM) system (30 Hz). Arc and static field plans were delivered to a moving phantom programmed with measured lung tumour motion from ten patients. During delivery, the localization method determined the target position and the beam was adjusted in real time via dynamic multileaf collimator (DMLC) adaptation. The beam-target alignment error was quantified by segmenting the beam aperture and a phantom-embedded fiducial marker on MV images and analysing their relative position. With the localization method, the root-mean-squared errors of the ten lung tumour traces ranged from 0.7-1.3 mm and 0.8-1.4 mm during the single arc and five-field static beam delivery, respectively. Without the localization method, these errors ranged from 3.1-7.3 mm. In summary, a general method for real-time target localization using kV imaging and respiratory monitoring has been experimentally investigated for arc and static field delivery. The average beam-target error was 1 mm.

Experimental investigation of a general real-time 3D target localization method using sequential kV imaging combined with respiratory monitoring

NASA Astrophysics Data System (ADS)

Cho, Byungchul; Poulsen, Per; Ruan, Dan; Sawant, Amit; Keall, Paul J.

2012-11-01

The goal of this work was to experimentally quantify the geometric accuracy of a novel real-time 3D target localization method using sequential kV imaging combined with respiratory monitoring for clinically realistic arc and static field treatment delivery and target motion conditions. A general method for real-time target localization using kV imaging and respiratory monitoring was developed. Each dimension of internal target motion T(x, y, z; t) was estimated from the external respiratory signal R(t) through the correlation between R(ti) and the projected marker positions p(xp, yp; ti) on kV images by a state-augmented linear model: T(x, y, z; t) = aR(t) + bR(t - τ) + c. The model parameters, a, b, c, were determined by minimizing the squared fitting error ∑‖p(xp, yp; ti) - P(θi) · (aR(ti) + bR(ti - τ) + c)‖2 with the projection operator P(θi). The model parameters were first initialized based on acquired kV arc images prior to MV beam delivery. This method was implemented on a trilogy linear accelerator consisting of an OBI x-ray imager (operating at 1 Hz) and real-time position monitoring (RPM) system (30 Hz). Arc and static field plans were delivered to a moving phantom programmed with measured lung tumour motion from ten patients. During delivery, the localization method determined the target position and the beam was adjusted in real time via dynamic multileaf collimator (DMLC) adaptation. The beam-target alignment error was quantified by segmenting the beam aperture and a phantom-embedded fiducial marker on MV images and analysing their relative position. With the localization method, the root-mean-squared errors of the ten lung tumour traces ranged from 0.7-1.3 mm and 0.8-1.4 mm during the single arc and five-field static beam delivery, respectively. Without the localization method, these errors ranged from 3.1-7.3 mm. In summary, a general method for real-time target localization using kV imaging and respiratory monitoring has been experimentally investigated for arc and static field delivery. The average beam-target error was 1 mm.

The effect of respiratory induced density variations on non-TOF PET quantitation in the lung.

PubMed

Holman, Beverley F; Cuplov, Vesna; Hutton, Brian F; Groves, Ashley M; Thielemans, Kris

2016-04-21

Accurate PET quantitation requires a matched attenuation map. Obtaining matched CT attenuation maps in the thorax is difficult due to the respiratory cycle which causes both motion and density changes. Unlike with motion, little attention has been given to the effects of density changes in the lung on PET quantitation. This work aims to explore the extent of the errors caused by pulmonary density attenuation map mismatch on dynamic and static parameter estimates. Dynamic XCAT phantoms were utilised using clinically relevant (18)F-FDG and (18)F-FMISO time activity curves for all organs within the thorax to estimate the expected parameter errors. The simulations were then validated with PET data from 5 patients suffering from idiopathic pulmonary fibrosis who underwent PET/Cine-CT. The PET data were reconstructed with three gates obtained from the Cine-CT and the average Cine-CT. The lung TACs clearly displayed differences between true and measured curves with error depending on global activity distribution at the time of measurement. The density errors from using a mismatched attenuation map were found to have a considerable impact on PET quantitative accuracy. Maximum errors due to density mismatch were found to be as high as 25% in the XCAT simulation. Differences in patient derived kinetic parameter estimates and static concentration between the extreme gates were found to be as high as 31% and 14%, respectively. Overall our results show that respiratory associated density errors in the attenuation map affect quantitation throughout the lung, not just regions near boundaries. The extent of this error is dependent on the activity distribution in the thorax and hence on the tracer and time of acquisition. Consequently there may be a significant impact on estimated kinetic parameters throughout the lung.

The effect of respiratory induced density variations on non-TOF PET quantitation in the lung

NASA Astrophysics Data System (ADS)

Holman, Beverley F.; Cuplov, Vesna; Hutton, Brian F.; Groves, Ashley M.; Thielemans, Kris

2016-04-01

Accurate PET quantitation requires a matched attenuation map. Obtaining matched CT attenuation maps in the thorax is difficult due to the respiratory cycle which causes both motion and density changes. Unlike with motion, little attention has been given to the effects of density changes in the lung on PET quantitation. This work aims to explore the extent of the errors caused by pulmonary density attenuation map mismatch on dynamic and static parameter estimates. Dynamic XCAT phantoms were utilised using clinically relevant 18F-FDG and 18F-FMISO time activity curves for all organs within the thorax to estimate the expected parameter errors. The simulations were then validated with PET data from 5 patients suffering from idiopathic pulmonary fibrosis who underwent PET/Cine-CT. The PET data were reconstructed with three gates obtained from the Cine-CT and the average Cine-CT. The lung TACs clearly displayed differences between true and measured curves with error depending on global activity distribution at the time of measurement. The density errors from using a mismatched attenuation map were found to have a considerable impact on PET quantitative accuracy. Maximum errors due to density mismatch were found to be as high as 25% in the XCAT simulation. Differences in patient derived kinetic parameter estimates and static concentration between the extreme gates were found to be as high as 31% and 14%, respectively. Overall our results show that respiratory associated density errors in the attenuation map affect quantitation throughout the lung, not just regions near boundaries. The extent of this error is dependent on the activity distribution in the thorax and hence on the tracer and time of acquisition. Consequently there may be a significant impact on estimated kinetic parameters throughout the lung.

Lung tumor motion change during stereotactic body radiotherapy (SBRT): an evaluation using MRI

PubMed Central

Olivier, Kenneth R.; Li, Jonathan G.; Liu, Chihray; Newlin, Heather E.; Schmalfuss, Ilona; Kyogoku, Shinsuke; Dempsey, James F.

2014-01-01

The purpose of this study is to investigate changes in lung tumor internal target volume during stereotactic body radiotherapy treatment (SBRT) using magnetic resonance imaging (MRI). Ten lung cancer patients (13 tumors) undergoing SBRT (48 Gy over four consecutive days) were evaluated. Each patient underwent three lung MRI evaluations: before SBRT (MRI‐1), after fraction 3 of SBRT (MRI‐3), and three months after completion of SBRT (MRI‐3m). Each MRI consisted of T1‐weighted images in axial plane through the entire lung. A cone‐beam CT (CBCT) was taken before each fraction. On MRI and CBCT taken before fractions 1 and 3, gross tumor volume (GTV) was contoured and differences between the two volumes were compared. Median tumor size on CBCT before fractions 1 (CBCT‐1) and 3 (CBCT‐3) was 8.68 and 11.10 cm3, respectively. In 12 tumors, the GTV was larger on CBCT‐3 compared to CBCT‐1 (median enlargement, 1.56 cm3). Median tumor size on MRI‐1, MRI‐3, and MRI‐3m was 7.91, 11.60, and 3.33 cm3, respectively. In all patients, the GTV was larger on MRI‐3 compared to MRI‐1 (median enlargement, 1.54 cm3). In all patients, GTV was smaller on MRI‐3m compared to MRI‐1 (median shrinkage, 5.44 cm3). On CBCT and MRI, all patients showed enlargement of the GTV during the treatment week of SBRT, except for one patient who showed minimal shrinkage (0.86 cm3). Changes in tumor volume are unpredictable; therefore, motion and breathing must be taken into account during treatment planning, and image‐guided methods should be used, when treating with large fraction sizes. PACS number: 87.53.Ly PMID:24892328

The effects of intra-fraction organ motion on the delivery of intensity-modulated field with a multileaf collimator.

PubMed

Chui, Chen-Shou; Yorke, Ellen; Hong, Linda

2003-07-01

Intensity-modulated radiation therapy can be conveniently delivered with a multileaf collimator. With this method, the entire field is not delivered at once, but rather it is composed of many subfields defined by the leaf positions as a function of beam on time. At any given instant, only these subfields are delivered. During treatment, if the organ moves, part of the volume may move in or out of these subfields. Due to this interplay between organ motion and leaf motion the delivered dose may be different from what was planned. In this work, we present a method that calculates the effects of organ motion on delivered dose. The direction of organ motion may be parallel or perpendicular to the leaf motion, and the effect can be calculated for a single fraction or for multiple fractions. Three breast patients and four lung patients were included in this study,with the amplitude of the organ motion varying from +/- 3.5 mm to +/- 10 mm, and the period varying from 4 to 8 seconds. Calculations were made for these patients with and without organ motion, and results were examined in terms of isodose distribution and dose volume histograms. Each calculation was repeated ten times in order to estimate the statistical uncertainties. For selected patients, calculations were also made with conventional treatment technique. The effects of organ motion on conventional techniques were compared relative to that on IMRT techniques. For breast treatment, the effect of organ motion primarily broadened the penumbra at the posterior field edge. The dose in the rest of the treatment volume was not significantly affected. For lung treatment, the effect also broadened the penumbra and degraded the coverage of the planning target volume (PTV). However, the coverage of the clinical target volume (CTV) was not much affected, provided the PTV margin was adequate. The same effects were observed for both IMRT and conventional treatment techniques. For the IMRT technique, the standard deviations of ten samples of a 30-fraction calculation were very small for all patients, implying that over a typical treatment course of 30 fractions, the delivered dose was very close to the expected value. Hence, under typical clinical conditions, the effect of organ motion on delivered dose can be calculated without considering the interplay between the organ motion and the leaf motion. It can be calculated as the weighted average of the dose distribution without organ motion with the distribution of organ motion. Since the effects of organ motion on dose were comparable for both IMRT and conventional techniques, the PTV margin should remain the same for both techniques.

A dose error evaluation study for 4D dose calculations

NASA Astrophysics Data System (ADS)

Milz, Stefan; Wilkens, Jan J.; Ullrich, Wolfgang

2014-10-01

Previous studies have shown that respiration induced motion is not negligible for Stereotactic Body Radiation Therapy. The intrafractional breathing induced motion influences the delivered dose distribution on the underlying patient geometry such as the lung or the abdomen. If a static geometry is used, a planning process for these indications does not represent the entire dynamic process. The quality of a full 4D dose calculation approach depends on the dose coordinate transformation process between deformable geometries. This article provides an evaluation study that introduces an advanced method to verify the quality of numerical dose transformation generated by four different algorithms. The used transformation metric value is based on the deviation of the dose mass histogram (DMH) and the mean dose throughout dose transformation. The study compares the results of four algorithms. In general, two elementary approaches are used: dose mapping and energy transformation. Dose interpolation (DIM) and an advanced concept, so called divergent dose mapping model (dDMM), are used for dose mapping. The algorithms are compared to the basic energy transformation model (bETM) and the energy mass congruent mapping (EMCM). For evaluation 900 small sample regions of interest (ROI) are generated inside an exemplary lung geometry (4DCT). A homogeneous fluence distribution is assumed for dose calculation inside the ROIs. The dose transformations are performed with the four different algorithms. The study investigates the DMH-metric and the mean dose metric for different scenarios (voxel sizes: 8 mm, 4 mm, 2 mm, 1 mm 9 different breathing phases). dDMM achieves the best transformation accuracy in all measured test cases with 3-5% lower errors than the other models. The results of dDMM are reasonable and most efficient in this study, although the model is simple and easy to implement. The EMCM model also achieved suitable results, but the approach requires a more complex programming structure. The study discloses disadvantages for the bETM and for the DIM. DIM yielded insufficient results for large voxel sizes, while bETM is prone to errors for small voxel sizes.

A dose error evaluation study for 4D dose calculations.

PubMed

Milz, Stefan; Wilkens, Jan J; Ullrich, Wolfgang

2014-11-07

Previous studies have shown that respiration induced motion is not negligible for Stereotactic Body Radiation Therapy. The intrafractional breathing induced motion influences the delivered dose distribution on the underlying patient geometry such as the lung or the abdomen. If a static geometry is used, a planning process for these indications does not represent the entire dynamic process. The quality of a full 4D dose calculation approach depends on the dose coordinate transformation process between deformable geometries. This article provides an evaluation study that introduces an advanced method to verify the quality of numerical dose transformation generated by four different algorithms.The used transformation metric value is based on the deviation of the dose mass histogram (DMH) and the mean dose throughout dose transformation. The study compares the results of four algorithms. In general, two elementary approaches are used: dose mapping and energy transformation. Dose interpolation (DIM) and an advanced concept, so called divergent dose mapping model (dDMM), are used for dose mapping. The algorithms are compared to the basic energy transformation model (bETM) and the energy mass congruent mapping (EMCM). For evaluation 900 small sample regions of interest (ROI) are generated inside an exemplary lung geometry (4DCT). A homogeneous fluence distribution is assumed for dose calculation inside the ROIs. The dose transformations are performed with the four different algorithms.The study investigates the DMH-metric and the mean dose metric for different scenarios (voxel sizes: 8 mm, 4 mm, 2 mm, 1 mm; 9 different breathing phases). dDMM achieves the best transformation accuracy in all measured test cases with 3-5% lower errors than the other models. The results of dDMM are reasonable and most efficient in this study, although the model is simple and easy to implement. The EMCM model also achieved suitable results, but the approach requires a more complex programming structure. The study discloses disadvantages for the bETM and for the DIM. DIM yielded insufficient results for large voxel sizes, while bETM is prone to errors for small voxel sizes.

Human heart rate variability relation is unchanged during motion sickness

NASA Technical Reports Server (NTRS)

Mullen, T. J.; Berger, R. D.; Oman, C. M.; Cohen, R. J.

1998-01-01

In a study of 18 human subjects, we applied a new technique, estimation of the transfer function between instantaneous lung volume (ILV) and instantaneous heart rate (HR), to assess autonomic activity during motion sickness. Two control recordings of ILV and electrocardiogram (ECG) were made prior to the development of motion sickness. During the first, subjects were seated motionless, and during the second they were seated rotating sinusoidally about an earth vertical axis. Subjects then wore prism goggles that reverse the left-right visual field and performed manual tasks until they developed moderate motion sickness. Finally, ILV and ECG were recorded while subjects maintained a relatively constant level of sickness by intermittent eye closure during rotation with the goggles. Based on analyses of ILV to HR transfer functions from the three conditions, we were unable to demonstrate a change in autonomic control of heart rate due to rotation alone or due to motion sickness. These findings do not support the notion that moderate motion sickness is manifested as a generalized autonomic response.

Clinical Research Abstracts of the British Equine Veterinary Association Congress 2015.

PubMed

Simons, V; Weller, R; Stubbs, N C; Rombach, N; Pfau, T

2015-09-01

Training and rehabilitation techniques which improve core muscle strength are beneficial for improvement of dynamic stability of the equine vertebral column. The Equiband™ system, consisting of resistance bands attached to a customised saddle pad, is suggested to provide constant proprioceptive feedback during motion to encourage recruitment of abdominal and hindquarter musculature. To quantify the effect of the Equiband™ system on back kinematics and movement symmetry. Longitudinal intervention study. Quantitative analysis of back movement and gait symmetry before/after a 4-week exercise programme. Inertial sensor data was collected from 7 horses at Weeks 0 and 4 of a fixed exercise protocol. Analysis with and without the Equiband™ system was completed at trot in hand on a hard surface, and for both reins on the lunge on a soft surface. Six back kinematic and 3 movement symmetry parameters were calculated according to published methods. Movement symmetry values were side-corrected to allow comparison between reins on the lunge. A mixed model (P<0.05) evaluated the effects of the Equiband™ system over time, and trotting direction on back kinematic and movement symmetry parameters. The Equiband™ system significantly reduced (all P<0.02) roll, pitch and mediolateral displacement in the cranial-mid thoracic region. Across all horses, back displacement and range of motion values were significantly greater (P<0.01) on the lunge than in a straight line, movement symmetry was consistent with having corrected all horses to be left-sided. Preliminary results suggest the Equiband™ system may aid dynamic stabilisation of the vertebral column. Ethical animal research: This study was authorised by the Ethics and Welfare Committee of the Royal Veterinary College, London (URN Approval Number 1238). Written consent was obtained from the owner/keeper of each animal. Royal Veterinary College. Competing interests: N.C. Stubbs and N. Rombach developed the Equiband™ system. The remaining authors have no competing interests. © 2015 The Author(s). Equine Veterinary Journal © 2015 EVJ Ltd.

Biomechanical simulation of thorax deformation using finite element approach.

PubMed

Zhang, Guangzhi; Chen, Xian; Ohgi, Junji; Miura, Toshiro; Nakamoto, Akira; Matsumura, Chikanori; Sugiura, Seiryo; Hisada, Toshiaki

2016-02-06

The biomechanical simulation of the human respiratory system is expected to be a useful tool for the diagnosis and treatment of respiratory diseases. Because the deformation of the thorax significantly influences airflow in the lungs, we focused on simulating the thorax deformation by introducing contraction of the intercostal muscles and diaphragm, which are the main muscles responsible for the thorax deformation during breathing. We constructed a finite element model of the thorax, including the rib cage, intercostal muscles, and diaphragm. To reproduce the muscle contractions, we introduced the Hill-type transversely isotropic hyperelastic continuum skeletal muscle model, which allows the intercostal muscles and diaphragm to contract along the direction of the fibres with clinically measurable muscle activation and active force-length relationship. The anatomical fibre orientations of the intercostal muscles and diaphragm were introduced. Thorax deformation consists of movements of the ribs and diaphragm. By activating muscles, we were able to reproduce the pump-handle and bucket-handle motions for the ribs and the clinically observed motion for the diaphragm. In order to confirm the effectiveness of this approach, we simulated the thorax deformation during normal quiet breathing and compared the results with four-dimensional computed tomography (4D-CT) images for verification. Thorax deformation can be simulated by modelling the respiratory muscles according to continuum mechanics and by introducing muscle contractions. The reproduction of representative motions of the ribs and diaphragm and the comparison of the thorax deformations during normal quiet breathing with 4D-CT images demonstrated the effectiveness of the proposed approach. This work may provide a platform for establishing a computational mechanics model of the human respiratory system.

A model of acoustic transmission in the respiratory system.

PubMed

Wodicka, G R; Stevens, K N; Golub, H L; Cravalho, E G; Shannon, D C

1989-09-01

A theoretical model of sound transmission from within the respiratory tract to the chest wall due to the motion of the walls of the large airways was developed. The vocal tract, trachea, and the first five bronchial generations are represented over the frequency range from 100 to 600 Hz by an equivalent acoustic circuit. This circuit allows the estimation of the magnitude of airway wall motion in response to an acoustic perturbation at the mouth. The radiation of sound through the surrounding lung parenchyma is represented as a cylindrical wave in a homogeneous mixture of air bubbles in water. The effect of thermal losses associated with the polytropic compressions and expansions of these bubbles by the acoustic wave is included and the chest wall is represented as a massive boundary to the wave propagation. The model estimates the magnitude of acceleration over the extrathoracic trachea and at three locations on the posterior chest wall in the same vertical plane. The predicted spectral characteristics of transmission are consistent with previous experimental observations. This theoretical approach suggests that the locations of the spectral peaks are a strong function of the geometry and the wall properties of the airways, while the attenuation at higher frequencies is primarily associated with the absorption of sound in the parenchyma.

WE-AB-204-09: Respiratory Motion Correction in 4D-PET by Simultaneous Motion Estimation and Image Reconstruction (SMEIR)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kalantari, F; Wang, J; Li, T

2015-06-15

Purpose: In conventional 4D-PET, images from different frames are reconstructed individually and aligned by registration methods. Two issues with these approaches are: 1) Reconstruction algorithms do not make full use of all projections statistics; and 2) Image registration between noisy images can Result in poor alignment. In this study we investigated the use of simultaneous motion estimation and image reconstruction (SMEIR) method for cone beam CT for motion estimation/correction in 4D-PET. Methods: Modified ordered-subset expectation maximization algorithm coupled with total variation minimization (OSEM- TV) is used to obtain a primary motion-compensated PET (pmc-PET) from all projection data using Demons derivedmore » deformation vector fields (DVFs) as initial. Motion model update is done to obtain an optimal set of DVFs between the pmc-PET and other phases by matching the forward projection of the deformed pmc-PET and measured projections of other phases. Using updated DVFs, OSEM- TV image reconstruction is repeated and new DVFs are estimated based on updated images. 4D XCAT phantom with typical FDG biodistribution and a 10mm diameter tumor was used to evaluate the performance of the SMEIR algorithm. Results: Image quality of 4D-PET is greatly improved by the SMEIR algorithm. When all projections are used to reconstruct a 3D-PET, motion blurring artifacts are present, leading to a more than 5 times overestimation of the tumor size and 54% tumor to lung contrast ratio underestimation. This error reduced to 37% and 20% for post reconstruction registration methods and SMEIR respectively. Conclusion: SMEIR method can be used for motion estimation/correction in 4D-PET. The statistics is greatly improved since all projection data are combined together to update the image. The performance of the SMEIR algorithm for 4D-PET is sensitive to smoothness control parameters in the DVF estimation step.« less

Spot Weight Adaptation for Moving Target in Spot Scanning Proton Therapy.

PubMed

Morel, Paul; Wu, Xiaodong; Blin, Guillaume; Vialette, Stéphane; Flynn, Ryan; Hyer, Daniel; Wang, Dongxu

2015-01-01

This study describes a real-time spot weight adaptation method in spot-scanning proton therapy for moving target or moving patient, so that the resultant dose distribution closely matches the planned dose distribution. The method proposed in this study adapts the weight (MU) of the delivering pencil beam to that of the target spot; it will actually hit during patient/target motion. The target spot that a certain delivering pencil beam may hit relies on patient monitoring and/or motion modeling using four-dimensional (4D) CT. After the adapted delivery, the required total weight [Monitor Unit (MU)] for this target spot is then subtracted from the planned value. With continuous patient motion and continuous spot scanning, the planned doses to all target spots will eventually be all fulfilled. In a proof-of-principle test, a lung case was presented with realistic temporal and motion parameters; the resultant dose distribution using spot weight adaptation was compared to that without using this method. The impact of the real-time patient/target position tracking or prediction was also investigated. For moderate motion (i.e., mean amplitude 0.5 cm), D95% to the planning target volume (PTV) was only 81.5% of the prescription (RX) dose; with spot weight adaptation PTV D95% achieves 97.7% RX. For large motion amplitude (i.e., 1.5 cm), without spot weight adaptation PTV D95% is only 42.9% of RX; with spot weight adaptation, PTV D95% achieves 97.7% RX. Larger errors in patient/target position tracking or prediction led to worse final target coverage; an error of 3 mm or smaller in patient/target position tracking is preferred. The proposed spot weight adaptation method was able to deliver the planned dose distribution and maintain target coverage when patient motion was involved. The successful implementation of this method would rely on accurate monitoring or prediction of patient/target motion.

Poster — Thur Eve — 30: 4D VMAT dose calculation methodology to investigate the interplay effect: experimental validation using TrueBeam Developer Mode and Gafchromic film

DOE Office of Scientific and Technical Information (OSTI.GOV)

Teke, T; Milette, MP; Huang, V

2014-08-15

The interplay effect between the tumor motion and the radiation beam modulation during a VMAT treatment delivery alters the delivered dose distribution from the planned one. This work present and validate a method to accurately calculate the dose distribution in 4D taking into account the tumor motion, the field modulation and the treatment starting phase. A QUASAR™ respiratory motion phantom was 4D scanned with motion amplitude of 3 cm and with a 3 second period. A static scan was also acquired with the lung insert and the tumor contained in it centered. A VMAT plan with a 6XFFF beam wasmore » created on the averaged CT and delivered on a Varian TrueBeam and the trajectory log file was saved. From the trajectory log file 10 VMAT plans (one for each breathing phase) and a developer mode XML file were created. For the 10 VMAT plans, the tumor motion was modeled by moving the isocentre on the static scan, the plans were re-calculated and summed in the treatment planning system. In the developer mode, the tumor motion was simulated by moving the couch dynamically during the treatment. Gafchromic films were placed in the QUASAR phantom static and irradiated using the developer mode. Different treatment starting phase were investigated (no phase shift, maximum inhalation and maximum exhalation). Calculated and measured isodose lines and profiles are in very good agreement. For each starting phase, the dose distribution exhibit significant differences but are accurately calculated with the methodology presented in this work.« less

Synchrotron-based dynamic computed tomography of tissue motion for regional lung function measurement

PubMed Central

Dubsky, Stephen; Hooper, Stuart B.; Siu, Karen K. W.; Fouras, Andreas

2012-01-01

During breathing, lung inflation is a dynamic process involving a balance of mechanical factors, including trans-pulmonary pressure gradients, tissue compliance and airway resistance. Current techniques lack the capacity for dynamic measurement of ventilation in vivo at sufficient spatial and temporal resolution to allow the spatio-temporal patterns of ventilation to be precisely defined. As a result, little is known of the regional dynamics of lung inflation, in either health or disease. Using fast synchrotron-based imaging (up to 60 frames s−1), we have combined dynamic computed tomography (CT) with cross-correlation velocimetry to measure regional time constants and expansion within the mammalian lung in vivo. Additionally, our new technique provides estimation of the airflow distribution throughout the bronchial tree during the ventilation cycle. Measurements of lung expansion and airflow in mice and rabbit pups are shown to agree with independent measures. The ability to measure lung function at a regional level will provide invaluable information for studies into normal and pathological lung dynamics, and may provide new pathways for diagnosis of regional lung diseases. Although proof-of-concept data were acquired on a synchrotron, the methodology developed potentially lends itself to clinical CT scanning and therefore offers translational research opportunities. PMID:22491972

Combined Electrocardiography- and Respiratory-Triggered CT of the Lung to Reduce Respiratory Misregistration Artifacts between Imaging Slabs in Free-Breathing Children: Initial Experience

PubMed Central

Allmendinger, Thomas

2017-01-01

Objective Cardiac and respiratory motion artifacts degrade the image quality of lung CT in free-breathing children. The aim of this study was to evaluate the effect of combined electrocardiography (ECG) and respiratory triggering on respiratory misregistration artifacts on lung CT in free-breathing children. Materials and Methods In total, 15 children (median age 19 months, range 6 months–8 years; 7 boys), who underwent free-breathing ECG-triggered lung CT with and without respiratory-triggering were included. A pressure-sensing belt of a respiratory gating system was used to obtain the respiratory signal. The degree of respiratory misregistration artifacts between imaging slabs was graded on a 4-point scale (1, excellent image quality) on coronal and sagittal images and compared between ECG-triggered lung CT studies with and without respiratory triggering. A p value < 0.05 was considered significant. Results Lung CT with combined ECG and respiratory triggering showed significantly less respiratory misregistration artifacts than lung CT with ECG triggering only (1.1 ± 0.4 vs. 2.2 ± 1.0, p = 0.003). Conclusion Additional respiratory-triggering reduces respiratory misregistration artifacts on ECG-triggered lung CT in free-breathing children. PMID:28860904

Quantitative MRI study of the permeability of peritumoral brain edema in lung cancer patients with brain metastases.

PubMed

Wang, Dan; Wang, Ming-Liang; Li, Yue-Hua

2017-08-15

To use Ktrans to evaluate the aggressiveness and vascular permeability of peritumoral edema in cases of lung cancer brain metastases. A total of 68 lung cancer patients with 92 metastatic brain lesions were enrolled (20 metastatic lesions only in the gray matter - group 1; and 72 metastatic lesions located in the gray and white matter junction - group 2). All patients underwent MRI examination, which involved a dual angle (2° and 15°) enhanced T1W-VIBE (volume interpolated breath-hold examination) sequence to calculate the T1 parameter map. We used the enhanced T1-3D sequence to measure the tumor volume. The vascular permeability coefficient (Ktrans) was calculated using the single-compartment Tofts model, motion registration, and quick input mode. We examined the correlations of Ktrans with the edema index (EI), Ktrans with the tumor volume, and Ktrans with the histological expression of MMP-9 or VEGF in the original lung tumor using Pearson's' correlation analysis. Ktrans and EI were highly correlated in group 2 (r=0.66687; P<0.001) and not correlated in group 1 (r=0.33096; P=0.15405). Ktrans was also moderately related to the positive expression of MMP-9 (r=0.50912; P<0.001) and VEGF (r=0.36995; P=0.00138) There is statistical correlation between Ktrans and EI for group 2, and no statistical correlation between Ktrans and EI for group 1. The Ktrans of the peritumoral brain edema may be used to indicate the aggressiveness and vascular permeability of brain metastases in patients with lung cancer. Copyright © 2017 Elsevier B.V. All rights reserved.

A radial sampling strategy for uniform k-space coverage with retrospective respiratory gating in 3D ultrashort-echo-time lung imaging.

PubMed

Park, Jinil; Shin, Taehoon; Yoon, Soon Ho; Goo, Jin Mo; Park, Jang-Yeon

2016-05-01

The purpose of this work was to develop a 3D radial-sampling strategy which maintains uniform k-space sample density after retrospective respiratory gating, and demonstrate its feasibility in free-breathing ultrashort-echo-time lung MRI. A multi-shot, interleaved 3D radial sampling function was designed by segmenting a single-shot trajectory of projection views such that each interleaf samples k-space in an incoherent fashion. An optimal segmentation factor for the interleaved acquisition was derived based on an approximate model of respiratory patterns such that radial interleaves are evenly accepted during the retrospective gating. The optimality of the proposed sampling scheme was tested by numerical simulations and phantom experiments using human respiratory waveforms. Retrospectively, respiratory-gated, free-breathing lung MRI with the proposed sampling strategy was performed in healthy subjects. The simulation yielded the most uniform k-space sample density with the optimal segmentation factor, as evidenced by the smallest standard deviation of the number of neighboring samples as well as minimal side-lobe energy in the point spread function. The optimality of the proposed scheme was also confirmed by minimal image artifacts in phantom images. Human lung images showed that the proposed sampling scheme significantly reduced streak and ring artifacts compared with the conventional retrospective respiratory gating while suppressing motion-related blurring compared with full sampling without respiratory gating. In conclusion, the proposed 3D radial-sampling scheme can effectively suppress the image artifacts due to non-uniform k-space sample density in retrospectively respiratory-gated lung MRI by uniformly distributing gated radial views across the k-space. Copyright © 2016 John Wiley & Sons, Ltd.

Comparison of dual and single exposure techniques in dual-energy chest radiography.

PubMed

Ho, J T; Kruger, R A; Sorenson, J A

1989-01-01

Conventional chest radiography is the most effective tool for lung cancer detection and diagnosis; nevertheless, a high percentage of lung cancer tumors are missed because of the overlap of lung nodule image contrast with bone image contrast in a chest radiograph. Two different energy subtraction strategies, dual exposure and single exposure techniques, were studied for decomposing a radiograph into bone-free and soft tissue-free images to address this problem. For comparing the efficiency of these two techniques in lung nodule detection, the performances of the techniques were evaluated on the basis of residual tissue contrast, energy separation, and signal-to-noise ratio. The evaluation was based on both computer simulation and experimental verification. The dual exposure technique was found to be better than the single exposure technique because of its higher signal-to-noise ratio and greater residual tissue contrast. However, x-ray tube loading and patient motion are problems.

SU-C-210-01: Are Clinically Relevant Dosimetric Endpoints Significantly Better with Gating of Lung SBRT Vs. ITV-Based Treatment?: Results of a Large Cohort Investigation Analyzing Predictive Dosimetric Indicators as a Function of Tumor Volume and Motion Amplitude

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kim, J; Zhao, B; Ajlouni, M

2015-06-15

Purpose: To quantitatively compare patient internal target volume (ITV)-based plans with retrospectively generated gated plans to evaluate potential dosimetric improvements in lung toxicity from gated radiotherapy. Methods: Evaluation was conducted for 150 stereotactic body radiation therapy (SBRT) treatment plans for 128 early-stage (T1–T3, <5cm) NSCLC patients. PTV margins were: ITV+5 mm (ITV-plan) and GTV+5 mm (Gated-plan). ITV-based and gated treatment plans were compared on the same free-breathing CT. ITV-based plan constraints were used to re-optimize and recalculate new gated plans. Plans were generated for 3 fractionation regimens: 3×18Gy, 4×12Gy (original), and 5×10Gy. Physical dose was converted to equivalent dose inmore » 2Gy fractions (EQD2), which was used to determine mean lung dose (MLD) and percent volume of lung receiving ≥20Gy (V20). MLD and V20 differences between gating and ITV-based plans were analyzed as a function of both three-dimensional (3D) motion and tumor volume. The low dose region, V5, was also evaluated. Results: MLD and V20 differences between gated and ITV-based plans were larger for lower (1.48±1.32Gy and 1.44±1.29%) than for upper lobe tumors (0.89±0.74Gy and 0.92±0.71%) due to smaller tumor motion (2.9±3.4mm) compared to lower lobe tumors (8.1±6.1mm). Average differences of <1–2% were noted in V5 between ITV and gated plans. Dosimetric differences between gating and ITV-based methods increased with increasing tumor motion and decreasing tumor volume. Overall, average MLD (8.04±3.92Gy) and V20 (8.29±4.33%) values for ITV-based plans were already well below clinical guidelines, even for the 3×18Gy dose scheme, for which largest differences were noted relative to gated plans. Similar results were obtained for 5×10Gy and 4×12Gy regimens. Conclusion: Clinically relevant improvement in pulmonary toxicity, based on predictors of radiation pneumonitis (MLD and V20) was not generally observed, though improvement for tumors with 3D motion >15 mm, mainly concentrated in peripheral lower lobe tumors, may be considered clinically relevant. Work supported in part by a grant from Varian Medical systems, Palo Alto, CA.« less

Multiple template-based fluoroscopic tracking of lung tumor mass without implanted fiducial markers

NASA Astrophysics Data System (ADS)

Cui, Ying; Dy, Jennifer G.; Sharp, Gregory C.; Alexander, Brian; Jiang, Steve B.

2007-10-01

Precise lung tumor localization in real time is particularly important for some motion management techniques, such as respiratory gating or beam tracking with a dynamic multi-leaf collimator, due to the reduced clinical tumor volume (CTV) to planning target volume (PTV) margin and/or the escalated dose. There might be large uncertainties in deriving tumor position from external respiratory surrogates. While tracking implanted fiducial markers has sufficient accuracy, this procedure may not be widely accepted due to the risk of pneumothorax. Previously, we have developed a technique to generate gating signals from fluoroscopic images without implanted fiducial markers using a template matching method (Berbeco et al 2005 Phys. Med. Biol. 50 4481-90, Cui et al 2007 Phys. Med. Biol. 52 741-55). In this paper, we present an extension of this method to multiple-template matching for directly tracking the lung tumor mass in fluoroscopy video. The basic idea is as follows: (i) during the patient setup session, a pair of orthogonal fluoroscopic image sequences are taken and processed off-line to generate a set of reference templates that correspond to different breathing phases and tumor positions; (ii) during treatment delivery, fluoroscopic images are continuously acquired and processed; (iii) the similarity between each reference template and the processed incoming image is calculated; (iv) the tumor position in the incoming image is then estimated by combining the tumor centroid coordinates in reference templates with proper weights based on the measured similarities. With different handling of image processing and similarity calculation, two such multiple-template tracking techniques have been developed: one based on motion-enhanced templates and Pearson's correlation score while the other based on eigen templates and mean-squared error. The developed techniques have been tested on six sequences of fluoroscopic images from six lung cancer patients against the reference tumor positions manually determined by a radiation oncologist. The tumor centroid coordinates automatically detected using both methods agree well with the manually marked reference locations. The eigenspace tracking method performs slightly better than the motion-enhanced method, with average localization errors less than 2 pixels (1 mm) and the error at a 95% confidence level of about 2-4 pixels (1-2 mm). This work demonstrates the feasibility of direct tracking of a lung tumor mass in fluoroscopic images without implanted fiducial markers using multiple reference templates.

On the interplay effects with proton scanning beams in stage III lung cancer

PubMed Central

Li, Yupeng; Kardar, Laleh; Li, Xiaoqiang; Li, Heng; Cao, Wenhua; Chang, Joe Y.; Liao, Li; Zhu, Ronald X.; Sahoo, Narayan; Gillin, Michael; Liao, Zhongxing; Komaki, Ritsuko; Cox, James D.; Lim, Gino; Zhang, Xiaodong

2014-01-01

Purpose: To assess the dosimetric impact of interplay between spot-scanning proton beam and respiratory motion in intensity-modulated proton therapy (IMPT) for stage III lung cancer. Methods: Eleven patients were sampled from 112 patients with stage III nonsmall cell lung cancer to well represent the distribution of 112 patients in terms of target size and motion. Clinical target volumes (CTVs) and planning target volumes (PTVs) were defined according to the authors' clinical protocol. Uniform and realistic breathing patterns were considered along with regular- and hypofractionation scenarios. The dose contributed by a spot was fully calculated on the computed tomography (CT) images corresponding to the respiratory phase that the spot is delivered, and then accumulated to the reference phase of the 4DCT to generate the dynamic dose that provides an estimation of what might be delivered under the influence of interplay effect. The dynamic dose distributions at different numbers of fractions were compared with the corresponding 4D composite dose which is the equally weighted average of the doses, respectively, computed on respiratory phases of a 4DCT image set. Results: Under regular fractionation, the average and maximum differences in CTV coverage between the 4D composite and dynamic doses after delivery of all 35 fractions were no more than 0.2% and 0.9%, respectively. The maximum differences between the two dose distributions for the maximum dose to the spinal cord, heart V40, esophagus V55, and lung V20 were 1.2 Gy, 0.1%, 0.8%, and 0.4%, respectively. Although relatively large differences in single fraction, correlated with small CTVs relative to motions, were observed, the authors' biological response calculations suggested that this interfractional dose variation may have limited biological impact. Assuming a hypofractionation scenario, the differences between the 4D composite and dynamic doses were well confined even for single fraction. Conclusions: Despite the presence of interplay effect, the delivered dose may be reliably estimated using the 4D composite dose. In general the interplay effect may not be a primary concern with IMPT for lung cancers for the authors' institution. The described interplay analysis tool may be used to provide additional confidence in treatment delivery. PMID:24506612

Motion compensation using a suctioning stabilizer for intravital microscopy

PubMed Central

Vinegoni, Claudio; Lee, Sungon; Gorbatov, Rostic; Weissleder, Ralph

2013-01-01

Motion artifacts continue to present a major challenge to single cell imaging in cardiothoracic organs such as the beating heart, blood vessels, or lung. In this study, we present a new water-immersion suctioning stabilizer that enables minimally invasive intravital fluorescence microscopy using water-based stick objectives. The stabilizer works by reducing major motion excursions and can be used in conjunction with both prospective or retrospective gating approaches. We show that the new approach offers cellular resolution in the beating murine heart without perturbing normal physiology. In addition, because this technique allows multiple areas to be easily probed, it offers the opportunity for wide area coverage at high resolution. PMID:24086796

DOE Office of Scientific and Technical Information (OSTI.GOV)

Rottmann, J; Berbeco, R; Keall, P

Purpose: To maximize normal tissue sparing for treatments requiring motion encompassing margins. Motion mitigation techniques including DMLC or couch tracking can freeze tumor motion within the treatment aperture potentially allowing for smaller treatment margins and thus better sparing of normal tissue. To enable for a safe application of this concept in the clinic we propose adapting margins dynamically in real-time during radiotherapy delivery based on personalized tumor localization confidence. To demonstrate technical feasibility we present a phantom study. Methods: We utilize a realistic anthropomorphic dynamic thorax phantom with a lung tumor model embedded close to the spine. The tumor, amore » 3D-printout of a patient's GTV, is moved 15mm peak-to-peak by diaphragm compression and monitored by continuous EPID imaging in real-time. Two treatment apertures are created for each beam, one representing ITV -based and the other GTV-based margin expansion. A soft tissue localization (STiL) algorithm utilizing the continuous EPID images is employed to freeze tumor motion within the treatment aperture by means of DMLC tracking. Depending on a tracking confidence measure (TCM), the treatment aperture is adjusted between the ITV and the GTV leaf. Results: We successfully demonstrate real-time personalized margin adjustment in a phantom study. We measured a system latency of about 250 ms which we compensated by utilizing a respiratory motion prediction algorithm (ridge regression). With prediction in place we observe tracking accuracies better than 1mm. For TCM=0 (as during startup) an ITV-based treatment aperture is chosen, for TCM=1 a GTV-based aperture and for 0« less

SU-F-T-634: Feasibility Study of Respiratory Gated RapidArc SBRT Using a 6MV FFF Photon Beam

DOE Office of Scientific and Technical Information (OSTI.GOV)

Dou, K; Safaraz, M; Rodgers, J

Purpose: To conduct a feasibility study on retrospective respiratory gating and marker tracking for lung stereotactic body radiotherapy (SBRT) with a gated RapidArc delivery using a 6MV flattened filter free photon mode. Methods: A CIRS dynamic thorax phantom Model 008A with different inserts was used for treatment planning and respiratory gating. 4D CT had a free breathing simulation followed by a respiration gated, ten phased CT using a Philips Brilliance CT with a Varian RPM respiratory gating system. The internal target volume was created from the ten phase gated CT images, followed by exporting to a Varian Eclipse TPS v11more » for treatment planning on the free breath images. Both MIP and AIP were also generated for comparison of planning and target motion tracking. The planned dose was delivered with a 6MV FFF photon beam from a Varian TrueBeam accelerator. Gated target motion was also verified by tracking the implanted makers during delivery using continuous kV imaging in addition to CBCT, kV and MV localization and verification. Results: Gating was studied in three situations of lower, normal, and faster breathing at a respiratory cycle of 5, 15 and 25 breaths per minute, respectively. 4D treatment planning was performed at a normal breathing of 15 breaths per minute. The gated patterns obtained using the TrueBeam IR camera were compared with the planned ones while gating operation was added prior to delivery . Gating was realized only when the measured respiratory patterns matched to the planned ones. The gated target motion was verified within the tolerance by kV and MV imaging. Either free breathing CT or averaged CT images were studied to be good for image guidance to align the target. Conclusion: Gated RapidArc SBRT delivered with a 6MV FFF photon beam is realized using a dynamic lung phantom.« less

Four-dimensional layer-stacking carbon-ion beam dose distribution by use of a lung numeric phantom.

PubMed

Mori, Shinichiro; Kumagai, Motoki; Miki, Kentaro

2015-07-01

To extend layer-stacking irradiation to accommodate intrafractional organ motion, we evaluated the carbon-ion layer-stacking dose distribution using a numeric lung phantom. We designed several types of range compensators. The planning target volume was calculated from the respective respiratory phases for consideration of intrafractional beam range variation. The accumulated dose distribution was calculated by registering of the dose distributions at respective phases to that at the reference phase. We evaluated the dose distribution based on the following six parameters: motion displacement, direction, gating window, respiratory cycle, range-shifter change time, and prescribed dose. All parameters affected the dose conformation to the moving target. By shortening of the gating window, dose metrics for superior-inferior (SI) and anterior-posterior (AP) motions were decreased from a D95 of 94 %, Dmax of 108 %, and homogeneity index (HI) of 23 % at T00-T90, to a D95 of 93 %, Dmax of 102 %, and HI of 20 % at T40-T60. In contrast, all dose metrics except the HI were independent of respiratory cycle. All dose metrics in SI motion were almost the same in respective motion displacement, with a D95 of 94 %, Dmax of 108 %, Dmin of 89 %, and HI of 23 % for the ungated phase, and D95 of 93 %, Dmax of 102 %, Dmin of 85 %, and HI of 20 % for the gated phase. The dose conformation to a moving target was improved by the gating strategy and by an increase in the prescribed dose. A combination of these approaches is a practical means of adding them to existing treatment protocols without modifications.

Impact of Audio-Coaching on the Position of Lung Tumors

DOE Office of Scientific and Technical Information (OSTI.GOV)

Haasbeek, Cornelis J.A.; Spoelstra, Femke; Lagerwaard, Frank J.

2008-07-15

Purpose: Respiration-induced organ motion is a major source of positional, or geometric, uncertainty in thoracic radiotherapy. Interventions to mitigate the impact of motion include audio-coached respiration-gated radiotherapy (RGRT). To assess the impact of coaching on average tumor position during gating, we analyzed four-dimensional computed tomography (4DCT) scans performed both with and without audio-coaching. Methods and Materials: Our RGRT protocol requires that an audio-coached 4DCT scan is performed when the initial free-breathing 4DCT indicates a potential benefit with gating. We retrospectively analyzed 22 such paired scans in patients with well-circumscribed tumors. Changes in lung volume and position of internal target volumesmore » (ITV) generated in three consecutive respiratory phases at both end-inspiration and end-expiration were analyzed. Results: Audio-coaching increased end-inspiration lung volumes by a mean of 10.2% (range, -13% to +43%) when compared with free breathing (p = 0.001). The mean three-dimensional displacement of the center of ITV was 3.6 mm (SD, 2.5; range, 0.3-9.6mm), mainly caused by displacement in the craniocaudal direction. Displacement of ITV caused by coaching was more than 5 mm in 5 patients, all of whom were in the subgroup of 9 patients showing total tumor motion of 10 mm or more during both coached and uncoached breathing. Comparable ITV displacements were observed at end-expiration phases of the 4DCT. Conclusions: Differences in ITV position exceeding 5 mm between coached and uncoached 4DCT scans were detected in up to 56% of mobile tumors. Both end-inspiration and end-expiration RGRT were susceptible to displacements. This indicates that the method of audio-coaching should remain unchanged throughout the course of treatment.« less

A comparative study of the target volume definition in radiotherapy with «Slow CT Scan» vs. 4D PET/CT Scan in early stages non-small cell lung cancer.

PubMed

Molla, M; Anducas, N; Simó, M; Seoane, A; Ramos, M; Cuberas-Borros, G; Beltran, M; Castell, J; Giralt, J

To evaluate the use of 4D PET/CT to quantify tumor respiratory motion compared to the «Slow»-CT (CTs) in the radiotherapy planning process. A total of 25 patients with inoperable early stage non small cell lung cancer (NSCLC) were included in the study. Each patient was imaged with a CTs (4s/slice) and 4D PET/CT. The adequacy of each technique for respiratory motion capture was evaluated using the volume definition for each of the following: Internal target volume (ITV) 4D and ITVslow in relation with the volume defined by the encompassing volume of 4D PET/CT and CTs (ITVtotal). The maximum distance between the edges of the volume defined by each technique to that of the total volume was measured in orthogonal beam's eye view. The ITV4D showed less differences in relation with the ITVtotal in both the cranio-caudal and the antero-posterior axis compared to the ITVslow. The maximum differences were 0.36mm in 4D PET/CTand 0.57mm in CTs in the antero-posterior axis. 4D PET/CT resulted in the definition of more accurate (ITV4D/ITVtotal 0.78 vs. ITVs/ITVtotal 0.63), and larger ITVs (19.9 cc vs. 16.3 cc) than those obtained with CTs. Planning with 4D PET/CT in comparison with CTs, allows incorporating tumor respiratory motion and improving planning radiotherapy of patients in early stages of lung cancer. Copyright © 2016 Elsevier España, S.L.U. y SEMNIM. All rights reserved.

Lung tumor tracking in fluoroscopic video based on optical flow

PubMed Central

Xu, Qianyi; Hamilton, Russell J.; Schowengerdt, Robert A.; Alexander, Brian; Jiang, Steve B.

2008-01-01

Respiratory gating and tumor tracking for dynamic multileaf collimator delivery require accurate and real-time localization of the lung tumor position during treatment. Deriving tumor position from external surrogates such as abdominal surface motion may have large uncertainties due to the intra- and interfraction variations of the correlation between the external surrogates and internal tumor motion. Implanted fiducial markers can be used to track tumors fluoroscopically in real time with sufficient accuracy. However, it may not be a practical procedure when implanting fiducials bronchoscopically. In this work, a method is presented to track the lung tumor mass or relevant anatomic features projected in fluoroscopic images without implanted fiducial markers based on an optical flow algorithm. The algorithm generates the centroid position of the tracked target and ignores shape changes of the tumor mass shadow. The tracking starts with a segmented tumor projection in an initial image frame. Then, the optical flow between this and all incoming frames acquired during treatment delivery is computed as initial estimations of tumor centroid displacements. The tumor contour in the initial frame is transferred to the incoming frames based on the average of the motion vectors, and its positions in the incoming frames are determined by fine-tuning the contour positions using a template matching algorithm with a small search range. The tracking results were validated by comparing with clinician determined contours on each frame. The position difference in 95% of the frames was found to be less than 1.4 pixels (∼0.7 mm) in the best case and 2.8 pixels (∼1.4 mm) in the worst case for the five patients studied. PMID:19175094

Lung tumor tracking in fluoroscopic video based on optical flow.

PubMed

Xu, Qianyi; Hamilton, Russell J; Schowengerdt, Robert A; Alexander, Brian; Jiang, Steve B

2008-12-01

Respiratory gating and tumor tracking for dynamic multileaf collimator delivery require accurate and real-time localization of the lung tumor position during treatment. Deriving tumor position from external surrogates such as abdominal surface motion may have large uncertainties due to the intra- and interfraction variations of the correlation between the external surrogates and internal tumor motion. Implanted fiducial markers can be used to track tumors fluoroscopically in real time with sufficient accuracy. However, it may not be a practical procedure when implanting fiducials bronchoscopically. In this work, a method is presented to track the lung tumor mass or relevant anatomic features projected in fluoroscopic images without implanted fiducial markers based on an optical flow algorithm. The algorithm generates the centroid position of the tracked target and ignores shape changes of the tumor mass shadow. The tracking starts with a segmented tumor projection in an initial image frame. Then, the optical flow between this and all incoming frames acquired during treatment delivery is computed as initial estimations of tumor centroid displacements. The tumor contour in the initial frame is transferred to the incoming frames based on the average of the motion vectors, and its positions in the incoming frames are determined by fine-tuning the contour positions using a template matching algorithm with a small search range. The tracking results were validated by comparing with clinician determined contours on each frame. The position difference in 95% of the frames was found to be less than 1.4 pixels (approximately 0.7 mm) in the best case and 2.8 pixels (approximately 1.4 mm) in the worst case for the five patients studied.

Proton radiography and fluoroscopy of lung tumors: A Monte Carlo study using patient-specific 4DCT phantoms

PubMed Central

Han, Bin; Xu, X. George; Chen, George T. Y.

2011-01-01

Purpose: Monte Carlo methods are used to simulate and optimize a time-resolved proton range telescope (TRRT) in localization of intrafractional and interfractional motions of lung tumor and in quantification of proton range variations. Methods: The Monte Carlo N-Particle eXtended (MCNPX) code with a particle tracking feature was employed to evaluate the TRRT performance, especially in visualizing and quantifying proton range variations during respiration. Protons of 230 MeV were tracked one by one as they pass through position detectors, patient 4DCT phantom, and finally scintillator detectors that measured residual ranges. The energy response of the scintillator telescope was investigated. Mass density and elemental composition of tissues were defined for 4DCT data. Results: Proton water equivalent length (WEL) was deduced by a reconstruction algorithm that incorporates linear proton track and lateral spatial discrimination to improve the image quality. 4DCT data for three patients were used to visualize and measure tumor motion and WEL variations. The tumor trajectories extracted from the WEL map were found to be within ∼1 mm agreement with direct 4DCT measurement. Quantitative WEL variation studies showed that the proton radiograph is a good representation of WEL changes from entrance to distal of the target. Conclusions:MCNPX simulation results showed that TRRT can accurately track the motion of the tumor and detect the WEL variations. Image quality was optimized by choosing proton energy, testing parameters of image reconstruction algorithm, and comparing to ground truth 4DCT. The future study will demonstrate the feasibility of using the time resolved proton radiography as an imaging tool for proton treatments of lung tumors. PMID:21626923

Four-dimensional volume-of-interest reconstruction for cone-beam computed tomography-guided radiation therapy.

PubMed

Ahmad, Moiz; Balter, Peter; Pan, Tinsu

2011-10-01

Data sufficiency are a major problem in four-dimensional cone-beam computed tomography (4D-CBCT) on linear accelerator-integrated scanners for image-guided radiotherapy. Scan times must be in the range of 4-6 min to avoid undersampling artifacts. Various image reconstruction algorithms have been proposed to accommodate undersampled data acquisitions, but these algorithms are computationally expensive, may require long reconstruction times, and may require algorithm parameters to be optimized. The authors present a novel reconstruction method, 4D volume-of-interest (4D-VOI) reconstruction which suppresses undersampling artifacts and resolves lung tumor motion for undersampled 1-min scans. The 4D-VOI reconstruction is much less computationally expensive than other 4D-CBCT algorithms. The 4D-VOI method uses respiration-correlated projection data to reconstruct a four-dimensional (4D) image inside a VOI containing the moving tumor, and uncorrelated projection data to reconstruct a three-dimensional (3D) image outside the VOI. Anatomical motion is resolved inside the VOI and blurred outside the VOI. The authors acquired a 1-min. scan of an anthropomorphic chest phantom containing a moving water-filled sphere. The authors also used previously acquired 1-min scans for two lung cancer patients who had received CBCT-guided radiation therapy. The same raw data were used to test and compare the 4D-VOI reconstruction with the standard 4D reconstruction and the McKinnon-Bates (MB) reconstruction algorithms. Both the 4D-VOI and the MB reconstructions suppress nearly all the streak artifacts compared with the standard 4D reconstruction, but the 4D-VOI has 3-8 times greater contrast-to-noise ratio than the MB reconstruction. In the dynamic chest phantom study, the 4D-VOI and the standard 4D reconstructions both resolved a moving sphere with an 18 mm displacement. The 4D-VOI reconstruction shows a motion blur of only 3 mm, whereas the MB reconstruction shows a motion blur of 13 mm. With graphics processing unit hardware used to accelerate computations, the 4D-VOI reconstruction required a 40-s reconstruction time. 4D-VOI reconstruction effectively reduces undersampling artifacts and resolves lung tumor motion in 4D-CBCT. The 4D-VOI reconstruction is computationally inexpensive compared with more sophisticated iterative algorithms. Compared with these algorithms, our 4D-VOI reconstruction is an attractive alternative in 4D-CBCT for reconstructing target motion without generating numerous streak artifacts.

Four-dimensional volume-of-interest reconstruction for cone-beam computed tomography-guided radiation therapy

PubMed Central

Ahmad, Moiz; Balter, Peter; Pan, Tinsu

2011-01-01

Purpose: Data sufficiency are a major problem in four-dimensional cone-beam computed tomography (4D-CBCT) on linear accelerator-integrated scanners for image-guided radiotherapy. Scan times must be in the range of 4–6 min to avoid undersampling artifacts. Various image reconstruction algorithms have been proposed to accommodate undersampled data acquisitions, but these algorithms are computationally expensive, may require long reconstruction times, and may require algorithm parameters to be optimized. The authors present a novel reconstruction method, 4D volume-of-interest (4D-VOI) reconstruction which suppresses undersampling artifacts and resolves lung tumor motion for undersampled 1-min scans. The 4D-VOI reconstruction is much less computationally expensive than other 4D-CBCT algorithms. Methods: The 4D-VOI method uses respiration-correlated projection data to reconstruct a four-dimensional (4D) image inside a VOI containing the moving tumor, and uncorrelated projection data to reconstruct a three-dimensional (3D) image outside the VOI. Anatomical motion is resolved inside the VOI and blurred outside the VOI. The authors acquired a 1-min. scan of an anthropomorphic chest phantom containing a moving water-filled sphere. The authors also used previously acquired 1-min scans for two lung cancer patients who had received CBCT-guided radiation therapy. The same raw data were used to test and compare the 4D-VOI reconstruction with the standard 4D reconstruction and the McKinnon-Bates (MB) reconstruction algorithms. Results: Both the 4D-VOI and the MB reconstructions suppress nearly all the streak artifacts compared with the standard 4D reconstruction, but the 4D-VOI has 3–8 times greater contrast-to-noise ratio than the MB reconstruction. In the dynamic chest phantom study, the 4D-VOI and the standard 4D reconstructions both resolved a moving sphere with an 18 mm displacement. The 4D-VOI reconstruction shows a motion blur of only 3 mm, whereas the MB reconstruction shows a motion blur of 13 mm. With graphics processing unit hardware used to accelerate computations, the 4D-VOI reconstruction required a 40-s reconstruction time. Conclusions: 4D-VOI reconstruction effectively reduces undersampling artifacts and resolves lung tumor motion in 4D-CBCT. The 4D-VOI reconstruction is computationally inexpensive compared with more sophisticated iterative algorithms. Compared with these algorithms, our 4D-VOI reconstruction is an attractive alternative in 4D-CBCT for reconstructing target motion without generating numerous streak artifacts. PMID:21992381

Motion-compensated cone beam computed tomography using a conjugate gradient least-squares algorithm and electrical impedance tomography imaging motion data.

PubMed

Pengpen, T; Soleimani, M

2015-06-13

Cone beam computed tomography (CBCT) is an imaging modality that has been used in image-guided radiation therapy (IGRT). For applications such as lung radiation therapy, CBCT images are greatly affected by the motion artefacts. This is mainly due to low temporal resolution of CBCT. Recently, a dual modality of electrical impedance tomography (EIT) and CBCT has been proposed, in which the high temporal resolution EIT imaging system provides motion data to a motion-compensated algebraic reconstruction technique (ART)-based CBCT reconstruction software. High computational time associated with ART and indeed other variations of ART make it less practical for real applications. This paper develops a motion-compensated conjugate gradient least-squares (CGLS) algorithm for CBCT. A motion-compensated CGLS offers several advantages over ART-based methods, including possibilities for explicit regularization, rapid convergence and parallel computations. This paper for the first time demonstrates motion-compensated CBCT reconstruction using CGLS and reconstruction results are shown in limited data CBCT considering only a quarter of the full dataset. The proposed algorithm is tested using simulated motion data in generic motion-compensated CBCT as well as measured EIT data in dual EIT-CBCT imaging. © 2015 The Author(s) Published by the Royal Society. All rights reserved.

Relationship of the functional movement screen in-line lunge to power, speed, and balance measures.

PubMed

Hartigan, Erin H; Lawrence, Michael; Bisson, Brian M; Torgerson, Erik; Knight, Ryan C

2014-05-01

The in-line lunge of the Functional Movement Screen (FMS) evaluates lateral stability, balance, and movement asymmetries. Athletes who score poorly on the in-line lunge should avoid activities requiring power or speed until scores are improved, yet relationships between the in-line lunge scores and other measures of balance, power, and speed are unknown. (1) Lunge scores will correlate with center of pressure (COP), maximum jump height (MJH), and 36.6-meter sprint time and (2) there will be no differences between limbs on lunge scores, MJH, or COP. Descriptive laboratory study. Level 3. Thirty-seven healthy, active participants completed the first 3 tasks of the FMS (eg, deep squat, hurdle step, in-line lunge), unilateral drop jumps, and 36.6-meter sprints. A 3-dimensional motion analysis system captured MJH. Force platforms measured COP excursion. A laser timing system measured 36.6-m sprint time. Statistical analyses were used to determine whether a relationship existed between lunge scores and COP, MJH, and 36.6-m speed (Spearman rho tests) and whether differences existed between limbs in lunge scores (Wilcoxon signed-rank test), MJH, and COP (paired t tests). Lunge scores were not significantly correlated with COP, MJH, or 36.6-m sprint time. Lunge scores, COP excursion, and MJH were not statistically different between limbs. Performance on the FMS in-line lunge was not related to balance, power, or speed. Healthy participants were symmetrical in lunging measures and MJH. Scores on the FMS in-line lunge should not be attributed to power, speed, or balance performance without further examination. However, assessing limb symmetry appears to be clinically relevant.

SU-F-J-135: Tumor Displacement-Based Binning for Respiratory-Gated Time-Independent 5DCT Treatment Planning

DOE Office of Scientific and Technical Information (OSTI.GOV)

Yang, L; O’Connell, D; Lee, P

2016-06-15

Purpose: A published 5DCT breathing motion model enables image reconstruction at any user-selected breathing phase, defined by the model as a specific amplitude (v) and rate (f). Generation of reconstructed phase-specific CT scans will be required for time-independent radiation dose distribution simulations. This work answers the question: how many amplitude and rate bins are required to describe the tumor motion with a specific spatial resolution? Methods: 19 lung-cancer patients with 21 tumors were scanned using a free-breathing 5DCT protocol, employing an abdominally positioned pneumatic-bellows breathing surrogate and yielding voxel-specific motion model parameters α and β corresponding to motion as amore » function of amplitude and rate, respectively. Tumor GTVs were contoured on the first (reference) of 25 successive free-breathing fast helical CT image sets. The tumor displacements were binned into widths of 1mm to 5mm in 1mm steps and the total required number of bins recorded. The simulation evaluated the number of bins needed to encompass 100% of the breathing-amplitude and between the 5th and 95th percentile amplitudes to exclude breathing outliers. Results: The mean respiration-induced tumor motion was 9.90mm ± 7.86mm with a maximum of 25mm. The number of bins required was a strong function of the spatial resolution and varied widely between patients. For example, for 2mm bins, between 1–13 amplitude bins and 1–9 rate bins were required to encompass 100% of the breathing amplitude, while 1–6 amplitude bins and 1–3 rate bins were required to encompass 90% of the breathing amplitude. Conclusion: The strong relationship between number of bins and spatial resolution as well as the large variation between patients implies that time-independent radiation dose distribution simulations should be conducted using patient-specific data and that the breathing conditions will have to be carefully considered. This work will lead to the assessment of the dosimetric impact of binning resolution. This study is supported by Siemens Healthcare.« less

A novel four-dimensional radiotherapy planning strategy from a tumor-tracking beam's eye view

NASA Astrophysics Data System (ADS)

Li, Guang; Cohen, Patrice; Xie, Huchen; Low, Daniel; Li, Diana; Rimner, Andreas

2012-11-01

To investigate the feasibility of four-dimensional radiotherapy (4DRT) planning from a tumor-tracking beam's eye view (ttBEV) with reliable gross tumor volume (GTV) delineation, realistic normal tissue representation, high planning accuracy and low clinical workload, we propose and validate a novel 4D conformal planning strategy based on a synthesized 3.5D computed tomographic (3.5DCT) image with a motion-compensated tumor. To recreate patient anatomy from a ttBEV in the moving tumor coordinate system for 4DRT planning (or 4D planning), the centers of delineated GTVs in all phase CT images of 4DCT were aligned, and then the aligned CTs were averaged to produce a new 3.5DCT image. This GTV-motion-compensated CT contains a motionless target (with motion artifacts minimized) and motion-blurred normal tissues (with a realistic temporal density average). Semi-automatic threshold-based segmentation of the tumor, lung and body was applied, while manual delineation was used for other organs at risk (OARs). To validate this 3.5DCT-based 4D planning strategy, five patients with peripheral lung lesions of small size (<5 cm3) and large motion range (1.2-3.5 cm) were retrospectively studied for stereotactic body radiotherapy (SBRT) using 3D conformal radiotherapy planning tools. The 3.5DCT-based 4D plan (3.5DCT plan) with 9-10 conformal beams was compared with the 4DCT-based 4D plan (4DCT plan). The 4DCT plan was derived from multiple 3D plans based on all phase CT images, each of which used the same conformal beam configuration but with an isocenter shift to aim at the moving tumor and a minor beam aperture and weighting adjustment to maintain plan conformality. The dose-volume histogram (DVH) of the 4DCT plan was created with two methods: one is an integrated DVH (iDVH4D), which is defined as the temporal average of all 3D-phase-plan DVHs, and the other (DVH4D) is based on the dose distribution in a reference phase CT image by dose warping from all phase plans using the displacement vector field (DVF) from a free-form deformable image registration (DIR). The DVH3.5D (for the 3.5DCT plan) was compared with both iDVH4D and DVH4D. To quantify the DVH difference between the 3.5DCT plan and the 4DCT plan, two methods were used: relative difference (%) of the areas underneath the DVH curves and the volumes receiving more than 20% (V20) and 50% (V50) of prescribed dose of these 4D plans. The volume of the delineated GTV from different phase CTs varied dramatically from 24% to 112% among the five patients, whereas the GTV from 3.5DCT deviated from the averaged GTV in 4DCT by only -6%±6%. For planning tumor volume (PTV) coverage, the difference between the DVH3.5D and iDVH4D was negligible (<1% area), whereas the DVH3.5D and DVH4D were quite different, due to DIR uncertainty (˜2 mm), which propagates to PTV dose coverage with a pronounced uncertainty for small tumors (0.3-4.0 cm3) in stereotactic plans with sharp dose falloff around PTV. For OARs, such as the lung, heart, cord and esophagus, the three DVH curves (DVH3.5D, DVH4D and iDVH4D) were found to be almost identical for the same patients, especially in high-dose regions. For the tumor-containing lung, the relative difference of the areas underneath the DVH curves was found to be small (5.3% area on average), of which 65% resulted from the low-dose region (D < 20%). The averaged V20 difference between the two 4D plans was 1.2% ± 0.8%. For the mean lung dose (MLD), the 3.5DCT plan differed from the 4DCT plan by -1.1%±1.3%. GTV-motion-compensated CT (3.5DCT) produces an accurate and reliable GTV delineation, which is close to the mean GTV from 4DCT. The 3.5DCT plan is equivalent to the 4DCT plan with <1% dose difference to the PTV and negligible dose difference in OARs. The 3.5DCT approach simplifies 4D planning and provides accurate dose calculation without a substantial increase of clinical workload for motion-tracking delivery to treat small peripheral lung tumors with large motion.

3D cine magnetic resonance imaging of rat lung ARDS using gradient-modulated SWIFT with retrospective respiratory gating

NASA Astrophysics Data System (ADS)

Kobayashi, Naoharu; Lei, Jianxun; Utecht, Lynn; Garwood, Michael; Ingbar, David H.; Bhargava, Maneesh

2015-03-01

SWeep Imaging with Fourier Transformation (SWIFT) with gradient modulation and DC navigator retrospective gating is introduced as a 3D cine magnetic resonance imaging (MRI) method for the lung. In anesthetized normal rats, the quasi-simultaneous excitation and acquisition in SWIFT enabled extremely high sensitivity to the fast-decaying parenchymal signals (TE=~4 μs), which are invisible with conventional MRI techniques. Respiratory motion information was extracted from DC navigator signals and the SWIFT data were reconstructed to 3D cine images with 16 respiratory phases. To test this technique's capabilities, rats exposed to > 95% O2 for 60 hours for induction of acute respiratory distress syndrome (ARDS), were imaged and compared with normal rat lungs (N=7 and 5 for ARDS and normal groups, respectively). SWIFT images showed lung tissue density differences along the gravity direction. In the cine SWIFT images, a parenchymal signal drop at the inhalation phase was consistently observed for both normal and ARDS rats due to lung inflation (i.e. decrease of the proton density), but the drop was less for ARDS rats. Depending on the respiratory phase and lung region, the lungs from the ARDS rats showed 1-24% higher parenchymal signal intensities relative to the normal rat lungs, likely due to accumulated extravascular water (EVLW). Those results demonstrate that SWIFT has high enough sensitivity for detecting the lung proton density changes due to gravity, different phases of respiration and accumulation of EVLW in the rat ARDS lungs.

Treatment planning with intensity modulated particle therapy for multiple targets in stage IV non-small cell lung cancer

NASA Astrophysics Data System (ADS)

Anderle, Kristjan; Stroom, Joep; Vieira, Sandra; Pimentel, Nuno; Greco, Carlo; Durante, Marco; Graeff, Christian

2018-01-01

Intensity modulated particle therapy (IMPT) can produce highly conformal plans, but is limited in advanced lung cancer patients with multiple lesions due to motion and planning complexity. A 4D IMPT optimization including all motion states was expanded to include multiple targets, where each target (isocenter) is designated to specific field(s). Furthermore, to achieve stereotactic treatment planning objectives, target and OAR weights plus objective doses were automatically iteratively adapted. Finally, 4D doses were calculated for different motion scenarios. The results from our algorithm were compared to clinical stereotactic body radiation treatment (SBRT) plans. The study included eight patients with 24 lesions in total. Intended dose regimen for SBRT was 24 Gy in one fraction, but lower fractionated doses had to be delivered in three cases due to OAR constraints or failed plan quality assurance. The resulting IMPT treatment plans had no significant difference in target coverage compared to SBRT treatment plans. Average maximum point dose and dose to specific volume in OARs were on average 65% and 22% smaller with IMPT. IMPT could also deliver 24 Gy in one fraction in a patient where SBRT was limited due to the OAR vicinity. The developed algorithm shows the potential of IMPT in treatment of multiple moving targets in a complex geometry.

Craniocaudal Safety Margin Calculation Based on Interfractional Changes in Tumor Motion in Lung SBRT Assessed With an EPID in Cine Mode

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ueda, Yoshihiro, E-mail: ueda-yo@mc.pref.osaka.jp; Miyazaki, Masayoshi; Nishiyama, Kinji

2012-07-01

Purpose: To evaluate setup error and interfractional changes in tumor motion magnitude using an electric portal imaging device in cine mode (EPID cine) during the course of stereotactic body radiation therapy (SBRT) for non-small-cell lung cancer (NSCLC) and to calculate margins to compensate for these variations. Materials and Methods: Subjects were 28 patients with Stage I NSCLC who underwent SBRT. Respiratory-correlated four-dimensional computed tomography (4D-CT) at simulation was binned into 10 respiratory phases, which provided average intensity projection CT data sets (AIP). On 4D-CT, peak-to-peak motion of the tumor (M-4DCT) in the craniocaudal direction was assessed and the tumor centermore » (mean tumor position [MTP]) of the AIP (MTP-4DCT) was determined. At treatment, the tumor on cone beam CT was registered to that on AIP for patient setup. During three sessions of irradiation, peak-to-peak motion of the tumor (M-cine) and the mean tumor position (MTP-cine) were obtained using EPID cine and in-house software. Based on changes in tumor motion magnitude ( Increment M) and patient setup error ( Increment MTP), defined as differences between M-4DCT and M-cine and between MTP-4DCT and MTP-cine, a margin to compensate for these variations was calculated with Stroom's formula. Results: The means ({+-}standard deviation: SD) of M-4DCT and M-cine were 3.1 ({+-}3.4) and 4.0 ({+-}3.6) mm, respectively. The means ({+-}SD) of Increment M and Increment MTP were 0.9 ({+-}1.3) and 0.2 ({+-}2.4) mm, respectively. Internal target volume-planning target volume (ITV-PTV) margins to compensate for Increment M, Increment MTP, and both combined were 3.7, 5.2, and 6.4 mm, respectively. Conclusion: EPID cine is a useful modality for assessing interfractional variations of tumor motion. The ITV-PTV margins to compensate for these variations can be calculated.« less

Experimental and Computational Studies of Sound Transmission in a Branching Airway Network Embedded in a Compliant Viscoelastic Medium

PubMed Central

Dai, Zoujun; Peng, Ying; Mansy, Hansen A.; Sandler, Richard H.; Royston, Thomas J.

2015-01-01

Breath sounds are often used to aid in the diagnosis of pulmonary disease. Mechanical and numerical models could be used to enhance our understanding of relevant sound transmission phenomena. Sound transmission in an airway mimicking phantom was investigated using a mechanical model with a branching airway network embedded in a compliant viscoelastic medium. The Horsfield self-consistent model for the bronchial tree was adopted to topologically couple the individual airway segments into the branching airway network. The acoustics of the bifurcating airway segments were measured by microphones and calculated analytically. Airway phantom surface motion was measured using scanning laser Doppler vibrometry. Finite element simulations of sound transmission in the airway phantom were performed. Good agreement was achieved between experiments and simulations. The validated computational approach can provide insight into sound transmission simulations in real lungs. PMID:26097256

Experimental and computational studies of sound transmission in a branching airway network embedded in a compliant viscoelastic medium

NASA Astrophysics Data System (ADS)

Dai, Zoujun; Peng, Ying; Mansy, Hansen A.; Sandler, Richard H.; Royston, Thomas J.

2015-03-01

Breath sounds are often used to aid in the diagnosis of pulmonary disease. Mechanical and numerical models could be used to enhance our understanding of relevant sound transmission phenomena. Sound transmission in an airway mimicking phantom was investigated using a mechanical model with a branching airway network embedded in a compliant viscoelastic medium. The Horsfield self-consistent model for the bronchial tree was adopted to topologically couple the individual airway segments into the branching airway network. The acoustics of the bifurcating airway segments were measured by microphones and calculated analytically. Airway phantom surface motion was measured using scanning laser Doppler vibrometry. Finite element simulations of sound transmission in the airway phantom were performed. Good agreement was achieved between experiments and simulations. The validated computational approach can provide insight into sound transmission simulations in real lungs.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chang, Joe Y., E-mail: jychang@mdanderson.org; Jabbour, Salma K.; De Ruysscher, Dirk

Radiation dose escalation has been shown to improve local control and survival in patients with non–small cell lung cancer in some studies, but randomized data have not supported this premise, possibly owing to adverse effects. Because of the physical characteristics of the Bragg peak, proton therapy (PT) delivers minimal exit dose distal to the target volume, resulting in better sparing of normal tissues in comparison to photon-based radiation therapy. This is particularly important for lung cancer given the proximity of the lung, heart, esophagus, major airways, large blood vessels, and spinal cord. However, PT is associated with more uncertainty becausemore » of the finite range of the proton beam and motion for thoracic cancers. PT is more costly than traditional photon therapy but may reduce side effects and toxicity-related hospitalization, which has its own associated cost. The cost of PT is decreasing over time because of reduced prices for the building, machine, maintenance, and overhead, as well as newer, shorter treatment programs. PT is improving rapidly as more research is performed particularly with the implementation of 4-dimensional computed tomography–based motion management and intensity modulated PT. Given these controversies, there is much debate in the oncology community about which patients with lung cancer benefit significantly from PT. The Particle Therapy Co-operative Group (PTCOG) Thoracic Subcommittee task group intends to address the issues of PT indications, advantages and limitations, cost-effectiveness, technology improvement, clinical trials, and future research directions. This consensus report can be used to guide clinical practice and indications for PT, insurance approval, and clinical or translational research directions.« less

DOE Office of Scientific and Technical Information (OSTI.GOV)

Liu, H; Manning, M; Sintay, B

Purpose: Tumor motion in lung SBRT is typically managed by creating an internal target volume (ITV) based on 4D-CT information. Another option, which may reduce lung dose and imaging artifact, is to use a breath hold (BH) during simulation and delivery. Here we evaluate the reproducibility of tumor position at repeated BH using a newly released spirometry system. Methods: Three patients underwent multiple BH CT’s at simulation. All patients underwent a BH cone beam CT (CBCT) prior to each treatment. All image sets were registered to a patient’s first simulation CT based on local bony anatomy. The gross tumor volumemore » (GTV), and the diaphragm or the apex of the lung were contoured on the first image set and expanded in 1 mm increments until the GTVs and diaphragms on all image sets were included inside an expanded structure. The GTV and diaphragm margins necessary to encompass the structures were recorded. Results: The first patient underwent 2 BH CT’s and fluoroscopy at simulation, the remaining patients underwent 3 BH CT’s at simulation. In all cases the GTV’s remained within 1 mm expansions and the diaphragms remained within 2 mm expansions on repeat scans. Each patient underwent 3 daily BH CBCT’s. In all cases the GTV’s remained within a 2 mm expansions, and the diaphragms (or lung apex in one case) remained within 2 mm expansions at daily BH imaging. Conclusions: These case studies demonstrate spirometry as an effective tool for limiting tumor motion (and imaging artifact) and facilitating reproducible tumor positioning over multiple set-ups and BH’s. This work was partially supported by Qfix.« less

Action of the isolated canine diaphragm on the lower ribs at high lung volumes.

PubMed

De Troyer, André; Wilson, Theodore A

2014-10-15

The normal diaphragm has an inspiratory action on the lower ribs, but subjects with chronic obstructive pulmonary disease commonly have an inward displacement of the lateral portions of the lower rib cage during inspiration. This paradoxical displacement, conventionally called 'Hoover's sign', has traditionally been attributed to the direct action of radially oriented diaphragmatic muscle fibres. In the present study, the inspiratory intercostal muscles in all interspaces in anaesthetized dogs were severed so that the diaphragm was the only muscle active during inspiration. The displacements of the lower ribs along the craniocaudal and laterolateral axes and the changes in pleural pressure (∆Ppl) and transdiaphragmatic pressure were measured during occluded breaths and mechanical ventilation at different lung volumes between functional residual capacity (FRC) and total lung capacity. From these data, the separate effects on rib displacement of ∆Ppl and of the force exerted by the diaphragm on the ribs were determined. Isolated spontaneous diaphragm contraction at FRC displaced the lower ribs cranially and outward, but this motion was progressively reversed into a caudal and inward motion as lung volume increased. However, although the force exerted by the diaphragm on the ribs decreased with increasing volume, it continued to displace the ribs cranially and outward. These observations suggest that Hoover's sign is usually caused by the decrease in the zone of apposition and, thus, by the dominant effect of ∆Ppl on the lower ribs, rather than an inward pull from the diaphragm. © 2014 The Authors. The Journal of Physiology © 2014 The Physiological Society.

Automated volume of interest delineation and rendering of cone beam CT images in interventional cardiology

NASA Astrophysics Data System (ADS)

Lorenz, Cristian; Schäfer, Dirk; Eshuis, Peter; Carroll, John; Grass, Michael

2012-02-01

Interventional C-arm systems allow the efficient acquisition of 3D cone beam CT images. They can be used for intervention planning, navigation, and outcome assessment. We present a fast and completely automated volume of interest (VOI) delineation for cardiac interventions, covering the whole visceral cavity including mediastinum and lungs but leaving out rib-cage and spine. The problem is addressed in a model based approach. The procedure has been evaluated on 22 patient cases and achieves an average surface error below 2mm. The method is able to cope with varying image intensities, varying truncations due to the limited reconstruction volume, and partially with heavy metal and motion artifacts.

SU-G-BRA-08: Diaphragm Motion Tracking Based On KV CBCT Projections with a Constrained Linear Regression Optimization

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wei, J; Chao, M

2016-06-15

Purpose: To develop a novel strategy to extract the respiratory motion of the thoracic diaphragm from kilovoltage cone beam computed tomography (CBCT) projections by a constrained linear regression optimization technique. Methods: A parabolic function was identified as the geometric model and was employed to fit the shape of the diaphragm on the CBCT projections. The search was initialized by five manually placed seeds on a pre-selected projection image. Temporal redundancies, the enabling phenomenology in video compression and encoding techniques, inherent in the dynamic properties of the diaphragm motion together with the geometrical shape of the diaphragm boundary and the associatedmore » algebraic constraint that significantly reduced the searching space of viable parabolic parameters was integrated, which can be effectively optimized by a constrained linear regression approach on the subsequent projections. The innovative algebraic constraints stipulating the kinetic range of the motion and the spatial constraint preventing any unphysical deviations was able to obtain the optimal contour of the diaphragm with minimal initialization. The algorithm was assessed by a fluoroscopic movie acquired at anteriorposterior fixed direction and kilovoltage CBCT projection image sets from four lung and two liver patients. The automatic tracing by the proposed algorithm and manual tracking by a human operator were compared in both space and frequency domains. Results: The error between the estimated and manual detections for the fluoroscopic movie was 0.54mm with standard deviation (SD) of 0.45mm, while the average error for the CBCT projections was 0.79mm with SD of 0.64mm for all enrolled patients. The submillimeter accuracy outcome exhibits the promise of the proposed constrained linear regression approach to track the diaphragm motion on rotational projection images. Conclusion: The new algorithm will provide a potential solution to rendering diaphragm motion and ultimately improving tumor motion management for radiation therapy of cancer patients.« less

MO-FG-BRA-02: A Feasibility Study of Integrating Breathing Audio Signal with Surface Surrogates for Respiratory Motion Management

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lei, Y; Zhu, X; Zheng, D

Purpose: Tracking the surrogate placed on patient skin surface sometimes leads to problematic signals for certain patients, such as shallow breathers. This in turn impairs the 4D CT image quality and dosimetric accuracy. In this pilot study, we explored the feasibility of monitoring human breathing motion by integrating breathing sound signal with surface surrogates. Methods: The breathing sound signals were acquired though a microphone attached adjacently to volunteer’s nostrils, and breathing curve were analyzed using a low pass filter. Simultaneously, the Real-time Position Management™ (RPM) system from Varian were employed on a volunteer to monitor respiratory motion including both shallowmore » and deep breath modes. The similar experiment was performed by using Calypso system, and three beacons taped on volunteer abdominal region to capture breath motion. The period of each breathing curves were calculated with autocorrelation functions. The coherence and consistency between breathing signals using different acquisition methods were examined. Results: Clear breathing patterns were revealed by the sound signal which was coherent with the signal obtained from both the RPM system and Calypso system. For shallow breathing, the periods of breathing cycle were 3.00±0.19 sec (sound) and 3.00±0.21 sec (RPM); For deep breathing, the periods were 3.49± 0.11 sec (sound) and 3.49±0.12 sec (RPM). Compared with 4.54±0.66 sec period recorded by the calypso system, the sound measured 4.64±0.54 sec. The additional signal from sound could be supplement to the surface monitoring, and provide new parameters to model the hysteresis lung motion. Conclusion: Our preliminary study shows that the breathing sound signal can provide a comparable way as the RPM system to evaluate the respiratory motion. It’s instantaneous and robust characteristics facilitate it possibly to be a either independently or as auxiliary methods to manage respiratory motion in radiotherapy.« less

Diffusion-weighted magnetic resonance imaging for assessment of lung lesions: repeatability of the apparent diffusion coefficient measurement.

PubMed

Bernardin, L; Douglas, N H M; Collins, D J; Giles, S L; O'Flynn, E A M; Orton, M; deSouza, N M

2014-02-01

To establish repeatability of apparent diffusion coefficients (ADCs) acquired from free-breathing diffusion-weighted magnetic resonance imaging (DW-MRI) in malignant lung lesions and investigate effects of lesion size, location and respiratory motion. Thirty-six malignant lung lesions (eight patients) were examined twice (1- to 5-h interval) using T1-weighted, T2-weighted and axial single-shot echo-planar DW-MRI (b = 100, 500, 800 s/mm(2)) during free-breathing. Regions of interest around target lesions on computed b = 800 s/mm(2) images by two independent observers yielded ADC values from maps (pixel-by-pixel fitting using all b values and a mono-exponential decay model). Intra- and inter-observer repeatability was assessed per lesion, per patient and by lesion size (> or <2 cm) or location. ADCs were similar between observers (mean ± SD, 1.15 ± 0.28 × 10(-3) mm(2)/s, observer 1; 1.15 ± 0.29 × 10(-3) mm(2)/s, observer 2). Intra-observer coefficients of variation of the mean [median] ADC per lesion and per patient were 11% [11.4%], 5.7% [5.7%] for observer 1 and 9.2% [9.5%], 3.9% [4.7%] for observer 2 respectively; inter-observer values were 8.9% [9.3%] (per lesion) and 3.0% [3.7%] (per patient). Inter-observer coefficient of variation (CoV) was greater for lesions <2 cm (n = 20) compared with >2 cm (n = 16) (10.8% vs 6.5% ADCmean, 11.3% vs 6.7% ADCmedian) and for mid (n = 14) vs apical (n = 9) or lower zone (n = 13) lesions (13.9%, 2.7%, 3.8% respectively ADCmean; 14.2%, 2.8%, 4.7% respectively ADCmedian). Free-breathing DW-MRI of whole lung achieves good intra- and inter-observer repeatability of ADC measurements in malignant lung tumours. • Diffusion-weighted MRI of the lung can be satisfactorily acquired during free-breathing • DW-MRI demonstrates high contrast between primary and metastatic lesions and normal lung • Apparent diffusion coefficient (ADC) measurements in lung tumours are repeatable and reliable • ADC offers potential in assessing response in lung metastases in clinical trials.

Intrafractional Baseline Shift or Drift of Lung Tumor Motion During Gated Radiation Therapy With a Real-Time Tumor-Tracking System

DOE Office of Scientific and Technical Information (OSTI.GOV)

Takao, Seishin; Miyamoto, Naoki; Matsuura, Taeko

2016-01-01

Purpose: To investigate the frequency and amplitude of baseline shift or drift (shift/drift) of lung tumors in stereotactic body radiation therapy (SBRT), using a real-time tumor-tracking radiation therapy (RTRT) system. Methods and Materials: Sixty-eight patients with peripheral lung tumors were treated with SBRT using the RTRT system. One of the fiducial markers implanted near the tumor was used for the real-time monitoring of the intrafractional tumor motion every 0.033 seconds by the RTRT system. When baseline shift/drift is determined by the system, the position of the treatment couch is adjusted to compensate for the shift/drift. Therefore, the changes in the couch positionmore » correspond to the baseline shift/drift in the tumor motion. The frequency and amount of adjustment to the couch positions in the left-right (LR), cranio-caudal (CC), and antero-posterior (AP) directions have been analyzed for 335 fractions administered to 68 patients. Results: The average change in position of the treatment couch during the treatment time was 0.45 ± 2.23 mm (mean ± standard deviation), −1.65 ± 5.95 mm, and 1.50 ± 2.54 mm in the LR, CC, and AP directions, respectively. Overall the baseline shift/drift occurs toward the cranial and posterior directions. The incidence of baseline shift/drift exceeding 3 mm was 6.0%, 15.5%, 14.0%, and 42.1% for the LR, CC, AP, and for the square-root of sum of 3 directions, respectively, within 10 minutes of the start of treatment, and 23.0%, 37.6%, 32.5%, and 71.6% within 30 minutes. Conclusions: Real-time monitoring and frequent adjustments of the couch position and/or adding appropriate margins are suggested to be essential to compensate for possible underdosages due to baseline shift/drift in SBRT for lung cancers.« less

MO-FG-BRA-06: Electromagnetic Beacon Insertion in Lung Cancer Patients and Resultant Surrogacy Errors for Dynamic MLC Tumour Tracking

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hardcastle, N; Booth, J; Caillet, V

Purpose: To assess endo-bronchial electromagnetic beacon insertion and to quantify the geometric accuracy of using beacons as a surrogate for tumour motion in real-time multileaf collimator (MLC) tracking of lung tumours. Methods: The LIGHT SABR trial is a world-first clinical trial in which the MLC leaves move with lung tumours in real time on a standard linear accelerator. Tracking is performed based on implanted electromagnetic beacons (CalypsoTM, Varian Medical Systems, USA) as a surrogate for tumour motion. Five patients have been treated and have each had three beacons implanted endo-bronchially under fluoroscopic guidance. The centre of mass (C.O.M) has beenmore » used to adapt the MLC in real-time. The geometric error in using the beacon C.O.M as a surrogate for tumour motion was measured by measuring the tumour and beacon C.O.M in all phases of the respiratory cycle of a 4DCT. The surrogacy error was defined as the difference in beacon and tumour C.O.M relative to the reference phase (maximum exhale). Results: All five patients have had three beacons successfully implanted with no migration between simulation and end of treatment. Beacon placement relative to tumour C.O.M varied from 14 to 74 mm and in one patient spanned two lobes. Surrogacy error was measured in each patient on the simulation 4DCT and ranged from 0 to 3 mm. Surrogacy error as measured on 4DCT was subject to artefacts in mid-ventilation phases. Surrogacy error was a function of breathing phase and was typically larger at maximum inhale. Conclusion: Beacon placement and thus surrogacy error is a major component of geometric uncertainty in MLC tracking of lung tumours. Surrogacy error must be measured on each patient and incorporated into margin calculation. Reduction of surrogacy error is limited by airway anatomy, however should be taken into consideration when performing beacon insertion and planning. This research is funded by Varian Medical Systems via a collaborative research agreement.« less

TH-AB-BRA-08: Simulated Tumor Tracking in An MRI Linac for Lung Tumor Lesions Using the Monaco Treatment Planning System

DOE Office of Scientific and Technical Information (OSTI.GOV)

Al-Ward, S; Kim, A; McCann, C

2016-06-15

Purpose: To simulate tumor tracking in an Elekta MRI-linac (MRL) and to compare this tracking method with our current ITV approach in terms of OAR sparing for lung cancer patients. Methods: Five SABR-NSCLC patients with central lung tumors were selected for reasons of potential enhancement of tumor-tissue delineation using MRI. The Monaco TPS was used to compare the current clinical ITV approach to a simulated, novel tracking method which used a 7MV MRL beam in the presence of an orthogonal 1.5 T magnetic field (4D-MRL method). In the simulated tracking scenario, achieved using the virtual couch shift (VCS), the PTVmore » was defined using an isotropic 5mm margin applied to the GTV of each phase, as acquired from an 8-phase amplitude-binned 4DCT. These VCS plans were optimized and weighted on each phase. The dose weighting was performed using the patient-specific breathing traces. The doses were accumulated on the inhale phase. The two methods were compared by assessing the OAR DVHs. Results: The 4D-MRL method resulted in a reduced target volume (by an average of 29% over all patients). The benefits of using an MRL tracking system depended on the tumor motion amplitude and the relative OAR motion (ROM) to the target. The reduction in mean doses to parallel organs was up to 3 Gy for the heart and 2.1 Gy for the lung. The reductions in maximum doses to serial organs were up to 9.4 Gy, 5.6 Gy, and 8.7 Gy for the esophagus, spinal cord, and the trachea, respectively. Serial organs benefited from MRL tracking when the ROM was ≥ 0.3 cm despite small tumor motion amplitude in some cases. Conclusions: This work demonstrated the potential benefit for an MRL tracking system to spare OARs in SABR-NSCLC patients with central tumors. The benefits are embodied in the target volume reduction. This project was made possible with the financial support of Elekta.« less

Hearing of the African lungfish (Protopterus annectens) suggests underwater pressure detection and rudimentary aerial hearing in early tetrapods.

PubMed

Christensen, Christian Bech; Christensen-Dalsgaard, Jakob; Madsen, Peter Teglberg

2015-02-01

In the transition from an aquatic to a terrestrial lifestyle, vertebrate auditory systems have undergone major changes while adapting to aerial hearing. Lungfish are the closest living relatives of tetrapods and their auditory system may therefore be a suitable model of the auditory systems of early tetrapods such as Acanthostega. Therefore, experimental studies on the hearing capabilities of lungfish may shed light on the possible hearing capabilities of early tetrapods and broaden our understanding of hearing across the water-to-land transition. Here, we tested the hypotheses that (i) lungfish are sensitive to underwater pressure using their lungs as pressure-to-particle motion transducers and (ii) lungfish can detect airborne sound. To do so, we used neurophysiological recordings to estimate the vibration and pressure sensitivity of African lungfish (Protopterus annectens) in both water and air. We show that lungfish detect underwater sound pressure via pressure-to-particle motion transduction by air volumes in their lungs. The morphology of lungfish shows no specialized connection between these air volumes and the inner ears, and so our results imply that air breathing may have enabled rudimentary pressure detection as early as the Devonian era. Additionally, we demonstrate that lungfish in spite of their atympanic middle ear can detect airborne sound through detection of sound-induced head vibrations. This strongly suggests that even vertebrates with no middle ear adaptations for aerial hearing, such as the first tetrapods, had rudimentary aerial hearing that may have led to the evolution of tympanic middle ears in recent tetrapods. © 2015. Published by The Company of Biologists Ltd.

Negative Coulomb damping, limit cycles, and self-oscillation of the vocal folds

NASA Astrophysics Data System (ADS)

Fulcher, Lewis P.; Scherer, Ronald C.; Melnykov, Artem; Gateva, Vesela; Limes, Mark E.

2006-05-01

An effective one-mass model of phonation is developed. It borrows the salient features of the classic two-mass model of human speech developed by Ishizaka, Matsudaira, and Flanagan. Their model is based on the idea that the oscillating vocal folds maintain their motion by deriving energy from the flow of air through the glottis. We argue that the essence of the action of the aerodynamic forces on the vocal folds is captured by negative Coulomb damping, which acts on the oscillator to energize it. A viscous force is added to include the effects of tissue damping. The solutions to this single oscillator model show that when it is excited by negative Coulomb damping, it will reach a limit cycle. Displacements, phase portraits, and energy histories are presented for two underdamped linear oscillators. A nonlinear force is added so that the variations of the fundamental frequency and the open quotient with lung pressure are comparable to the behavior of the two-mass model.

Joint Kinetics and Kinematics During Common Lower Limb Rehabilitation Exercises.

PubMed

Comfort, Paul; Jones, Paul Anthony; Smith, Laura Constance; Herrington, Lee

2015-10-01

Unilateral body-weight exercises are commonly used to strengthen the lower limbs during rehabilitation after injury, but data comparing the loading of the limbs during these tasks are limited. To compare joint kinetics and kinematics during 3 commonly used rehabilitation exercises. Descriptive laboratory study. Laboratory. A total of 9 men (age = 22.1 ± 1.3 years, height = 1.76 ± 0.08 m, mass = 80.1 ± 12.2 kg) participated. Participants performed the single-legged squat, forward lunge, and reverse lunge with kinetic data captured via 2 force plates and 3-dimensional kinematic data collected using a motion-capture system. Peak ground reaction forces, maximum joint angles, and peak sagittal-joint moments. We observed greater eccentric and concentric peak vertical ground reaction forces during the single-legged squat than during both lunge variations (P ≤ .001). Both lunge variations demonstrated greater knee and hip angles than did the single-legged squat (P < .001), but we observed no differences between lunges (P > .05). Greater dorsiflexion occurred during the single-legged squat than during both lunge variations (P < .05), but we noted no differences between lunge variations (P = .70). Hip-joint moments were greater during the forward lunge than during the reverse lunge (P = .003) and the single-legged squat (P = .011). Knee-joint moments were greater in the single-legged squat than in the reverse lunge (P < .001) but not greater in the single-legged squat than in the forward lunge (P = .41). Ankle-joint moments were greater during the single-legged squat than during the forward lunge (P = .002) and reverse lunge (P < .001). Appropriate loading progressions for the hip should begin with the single-legged squat and progress to the reverse lunge and then the forward lunge. In contrast, loading progressions for the knee and ankle should begin with the reverse lunge and progress to the forward lunge and then the single-legged squat.

The respiratory system under weightlessness

NASA Technical Reports Server (NTRS)

Paiva, M.; Engel, L. A.; Hughes, J. M. B.; Guy, H. J.; Prisk, G. K.; West, J. B.

1987-01-01

Studies of pulmonary functions at rest to be studied on Spacelab mission D-2 are introduced. Gravity dependence of the distribution of ventilation (single breath washout, multibreath washout-washin); chest wall shape and motion; and the vascular compartment (lung blood flow, capillary volume, liquid content, diffusive capacity) are discussed.

Monitoring the state of the human airways by analysis of respiratory sound

NASA Technical Reports Server (NTRS)

Hardin, J. C.; Patterson, J. L., Jr.

1978-01-01

A mechanism whereby sound is generated by the motion of vortices in the human lung is described. This mechanism is believed to be responsible for most of the sound which is generated both on inspiration and expiration in normal lungs. Mathematical expressions for the frequencies of sound generated, which depend only upon the axial flow velocity and diameters of the bronchi, are derived. This theory allows the location within the bronchial tree from which particular sounds emanate to be determined. Redistribution of pulmonary blood volume following transition from earth gravity to the weightless state probably alters the caliber of certain airways and doubtless alters sound transmission properties of the lung. We believe that these changes can be monitored effectively and non-invasively by spectral analysis of pulmonary sound.

Monitoring the state of the human airways by analysis of respiratory sound

NASA Technical Reports Server (NTRS)

Hardin, J. C.; Patterson, J. L. Jr

1979-01-01

A mechanism whereby sound is generated by the motion of vortices in the human lung is described. This mechanism is believed to be responsible for most of the sound which is generated both on inspiration and expiration in normal lungs. Mathematical expressions for the frequencies of sound generated, which depend only upon the axial flow velocity and diameters of the bronchi, are derived. This theory allows the location within the bronchial tree from which particular sounds emanate to be determined. Redistribution of pulmonary blood volume following transition from Earth gravity to the weightless state probably alters the caliber of certain airways and doubtless alters sound transmission properties of the lung. We believe that these changes can be monitored effectively and non-invasively by spectral analysis of pulmonary sound.

SU-E-T-427: Cell Surviving Fractions Derived From Tumor-Volume Variation During Radiotherapy for Non-Small Cell Lung Cancer: Comparison with Predictive Assays

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chvetsov, A; Schwartz, J; Mayr, N

2014-06-01

Purpose: To show that a distribution of cell surviving fractions S{sub 2} in a heterogeneous group of patients can be derived from tumor-volume variation curves during radiotherapy for non-small cell lung cancer. Methods: Our analysis was based on two data sets of tumor-volume variation curves for heterogeneous groups of 17 patients treated for nonsmall cell lung cancer with conventional dose fractionation. The data sets were obtained previously at two independent institutions by using megavoltage (MV) computed tomography (CT). Statistical distributions of cell surviving fractions S{sup 2} and cell clearance half-lives of lethally damaged cells T1/2 have been reconstructed in eachmore » patient group by using a version of the two-level cell population tumor response model and a simulated annealing algorithm. The reconstructed statistical distributions of the cell surviving fractions have been compared to the distributions measured using predictive assays in vitro. Results: Non-small cell lung cancer presents certain difficulties for modeling surviving fractions using tumor-volume variation curves because of relatively large fractional hypoxic volume, low gradient of tumor-volume response, and possible uncertainties due to breathing motion. Despite these difficulties, cell surviving fractions S{sub 2} for non-small cell lung cancer derived from tumor-volume variation measured at different institutions have similar probability density functions (PDFs) with mean values of 0.30 and 0.43 and standard deviations of 0.13 and 0.18, respectively. The PDFs for cell surviving fractions S{sup 2} reconstructed from tumor volume variation agree with the PDF measured in vitro. Comparison of the reconstructed cell surviving fractions with patient survival data shows that the patient survival time decreases as the cell surviving fraction increases. Conclusion: The data obtained in this work suggests that the cell surviving fractions S{sub 2} can be reconstructed from the tumor volume variation curves measured during radiotherapy with conventional fractionation. The proposed method can be used for treatment evaluation and adaptation.« less

Assessment of interpatient heterogeneity in tumor radiosensitivity for nonsmall cell lung cancer using tumor-volume variation data

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chvetsov, Alexei V., E-mail: chvetsov2@gmail.com; Schwartz, Jeffrey L.; Mayr, Nina

2014-06-15

Purpose: In our previous work, the authors showed that a distribution of cell surviving fractionsS{sub 2} in a heterogeneous group of patients could be derived from tumor-volume variation curves during radiotherapy for head and neck cancer. In this research study, the authors show that this algorithm can be applied to other tumors, specifically in nonsmall cell lung cancer. This new application includes larger patient volumes and includes comparison of data sets obtained at independent institutions. Methods: Our analysis was based on two data sets of tumor-volume variation curves for heterogeneous groups of 17 patients treated for nonsmall cell lung cancermore » with conventional dose fractionation. The data sets were obtained previously at two independent institutions by using megavoltage computed tomography. Statistical distributions of cell surviving fractionsS{sub 2} and clearance half-lives of lethally damaged cells T{sub 1/2} have been reconstructed in each patient group by using a version of the two-level cell population model of tumor response and a simulated annealing algorithm. The reconstructed statistical distributions of the cell surviving fractions have been compared to the distributions measured using predictive assays in vitro. Results: Nonsmall cell lung cancer presents certain difficulties for modeling surviving fractions using tumor-volume variation curves because of relatively large fractional hypoxic volume, low gradient of tumor-volume response, and possible uncertainties due to breathing motion. Despite these difficulties, cell surviving fractionsS{sub 2} for nonsmall cell lung cancer derived from tumor-volume variation measured at different institutions have similar probability density functions (PDFs) with mean values of 0.30 and 0.43 and standard deviations of 0.13 and 0.18, respectively. The PDFs for cell surviving fractions S{sub 2} reconstructed from tumor volume variation agree with the PDF measured in vitro. Conclusions: The data obtained in this work, when taken together with the data obtained previously for head and neck cancer, suggests that the cell surviving fractionsS{sub 2} can be reconstructed from the tumor volume variation curves measured during radiotherapy with conventional fractionation. The proposed method can be used for treatment evaluation and adaptation.« less

Assessment of interpatient heterogeneity in tumor radiosensitivity for nonsmall cell lung cancer using tumor-volume variation data.

PubMed

Chvetsov, Alexei V; Yartsev, Slav; Schwartz, Jeffrey L; Mayr, Nina

2014-06-01

In our previous work, the authors showed that a distribution of cell surviving fractions S2 in a heterogeneous group of patients could be derived from tumor-volume variation curves during radiotherapy for head and neck cancer. In this research study, the authors show that this algorithm can be applied to other tumors, specifically in nonsmall cell lung cancer. This new application includes larger patient volumes and includes comparison of data sets obtained at independent institutions. Our analysis was based on two data sets of tumor-volume variation curves for heterogeneous groups of 17 patients treated for nonsmall cell lung cancer with conventional dose fractionation. The data sets were obtained previously at two independent institutions by using megavoltage computed tomography. Statistical distributions of cell surviving fractions S2 and clearance half-lives of lethally damaged cells T(1/2) have been reconstructed in each patient group by using a version of the two-level cell population model of tumor response and a simulated annealing algorithm. The reconstructed statistical distributions of the cell surviving fractions have been compared to the distributions measured using predictive assays in vitro. Nonsmall cell lung cancer presents certain difficulties for modeling surviving fractions using tumor-volume variation curves because of relatively large fractional hypoxic volume, low gradient of tumor-volume response, and possible uncertainties due to breathing motion. Despite these difficulties, cell surviving fractions S2 for nonsmall cell lung cancer derived from tumor-volume variation measured at different institutions have similar probability density functions (PDFs) with mean values of 0.30 and 0.43 and standard deviations of 0.13 and 0.18, respectively. The PDFs for cell surviving fractions S2 reconstructed from tumor volume variation agree with the PDF measured in vitro. The data obtained in this work, when taken together with the data obtained previously for head and neck cancer, suggests that the cell surviving fractions S2 can be reconstructed from the tumor volume variation curves measured during radiotherapy with conventional fractionation. The proposed method can be used for treatment evaluation and adaptation.

Effect of Immobilization and Performance Status on Intrafraction Motion for Stereotactic Lung Radiotherapy: Analysis of 133 Patients

DOE Office of Scientific and Technical Information (OSTI.GOV)

Li, Winnie, E-mail: winnie.li@rmp.uhn.on.ca; Department of Radiation Oncology, University of Toronto, Toronto, Ontario; Purdie, Thomas G.

2011-12-01

Purpose: To assess intrafractional geometric accuracy of lung stereotactic body radiation therapy (SBRT) patients treated with volumetric image guidance. Methods and Materials: Treatment setup accuracy was analyzed in 133 SBRT patients treated via research ethics board-approved protocols. For each fraction, a localization cone-beam computed tomography (CBCT) scan was acquired for soft-tissue registration to the internal target volume, followed by a couch adjustment for positional discrepancies greater than 3 mm, verified with a second CBCT scan. CBCT scans were also performed at intrafraction and end fraction. Patient positioning data from 2047 CBCT scans were recorded to determine systematic ({Sigma}) and randommore » ({sigma}) uncertainties, as well as planning target volume margins. Data were further stratified and analyzed by immobilization method (evacuated cushion [n = 75], evacuated cushion plus abdominal compression [n = 33], or chest board [n = 25]) and by patients' Eastern Cooperative Oncology Group performance status (PS): 0 (n = 31), 1 (n = 70), or 2 (n = 32). Results: Using CBCT internal target volume was matched within {+-}3 mm in 16% of all fractions at localization, 89% at verification, 72% during treatment, and 69% after treatment. Planning target volume margins required to encompass residual setup errors after couch corrections (verification CBCT scans) were 4 mm, and they increased to 5 mm with target intrafraction motion (post-treatment CBCT scans). Small differences (<1 mm) in the cranial-caudal direction of target position were observed between the immobilization cohorts in the localization, verification, intrafraction, and post-treatment CBCT scans (p < 0.01). Positional drift varied according to patient PS, with the PS 1 and 2 cohorts drifting out of position by mid treatment more than the PS 0 cohort in the cranial-caudal direction (p = 0.04). Conclusions: Image guidance ensures high geometric accuracy for lung SBRT irrespective of immobilization method or PS. A 5-mm setup margin suffices to address intrafraction motion. This setup margin may be further reduced by strategies such as frequent image guidance or volumetric arc therapy to correct or limit intrafraction motion.« less

Effect of immobilization and performance status on intrafraction motion for stereotactic lung radiotherapy: analysis of 133 patients.

PubMed

Li, Winnie; Purdie, Thomas G; Taremi, Mojgan; Fung, Sharon; Brade, Anthony; Cho, B C John; Hope, Andrew; Sun, Alexander; Jaffray, David A; Bezjak, Andrea; Bissonnette, Jean-Pierre

2011-12-01

To assess intrafractional geometric accuracy of lung stereotactic body radiation therapy (SBRT) patients treated with volumetric image guidance. Treatment setup accuracy was analyzed in 133 SBRT patients treated via research ethics board-approved protocols. For each fraction, a localization cone-beam computed tomography (CBCT) scan was acquired for soft-tissue registration to the internal target volume, followed by a couch adjustment for positional discrepancies greater than 3 mm, verified with a second CBCT scan. CBCT scans were also performed at intrafraction and end fraction. Patient positioning data from 2047 CBCT scans were recorded to determine systematic (Σ) and random (σ) uncertainties, as well as planning target volume margins. Data were further stratified and analyzed by immobilization method (evacuated cushion [n=75], evacuated cushion plus abdominal compression [n=33], or chest board [n=25]) and by patients' Eastern Cooperative Oncology Group performance status (PS): 0 (n=31), 1 (n=70), or 2 (n=32). Using CBCT internal target volume was matched within ±3 mm in 16% of all fractions at localization, 89% at verification, 72% during treatment, and 69% after treatment. Planning target volume margins required to encompass residual setup errors after couch corrections (verification CBCT scans) were 4 mm, and they increased to 5 mm with target intrafraction motion (post-treatment CBCT scans). Small differences (<1 mm) in the cranial-caudal direction of target position were observed between the immobilization cohorts in the localization, verification, intrafraction, and post-treatment CBCT scans (p<0.01). Positional drift varied according to patient PS, with the PS 1 and 2 cohorts drifting out of position by mid treatment more than the PS 0 cohort in the cranial-caudal direction (p=0.04). Image guidance ensures high geometric accuracy for lung SBRT irrespective of immobilization method or PS. A 5-mm setup margin suffices to address intrafraction motion. This setup margin may be further reduced by strategies such as frequent image guidance or volumetric arc therapy to correct or limit intrafraction motion. Copyright © 2011 Elsevier Inc. All rights reserved.

Feasibility of predicting tumor motion using online data acquired during treatment and a generalized neural network optimized with offline patient tumor trajectories.

PubMed

Teo, Troy P; Ahmed, Syed Bilal; Kawalec, Philip; Alayoubi, Nadia; Bruce, Neil; Lyn, Ethan; Pistorius, Stephen

2018-02-01

The accurate prediction of intrafraction lung tumor motion is required to compensate for system latency in image-guided adaptive radiotherapy systems. The goal of this study was to identify an optimal prediction model that has a short learning period so that prediction and adaptation can commence soon after treatment begins, and requires minimal reoptimization for individual patients. Specifically, the feasibility of predicting tumor position using a combination of a generalized (i.e., averaged) neural network, optimized using historical patient data (i.e., tumor trajectories) obtained offline, coupled with the use of real-time online tumor positions (obtained during treatment delivery) was examined. A 3-layer perceptron neural network was implemented to predict tumor motion for a prediction horizon of 650 ms. A backpropagation algorithm and batch gradient descent approach were used to train the model. Twenty-seven 1-min lung tumor motion samples (selected from a CyberKnife patient dataset) were sampled at a rate of 7.5 Hz (0.133 s) to emulate the frame rate of an electronic portal imaging device (EPID). A sliding temporal window was used to sample the data for learning. The sliding window length was set to be equivalent to the first breathing cycle detected from each trajectory. Performing a parametric sweep, an averaged error surface of mean square errors (MSE) was obtained from the prediction responses of seven trajectories used for the training of the model (Group 1). An optimal input data size and number of hidden neurons were selected to represent the generalized model. To evaluate the prediction performance of the generalized model on unseen data, twenty tumor traces (Group 2) that were not involved in the training of the model were used for the leave-one-out cross-validation purposes. An input data size of 35 samples (4.6 s) and 20 hidden neurons were selected for the generalized neural network. An average sliding window length of 28 data samples was used. The average initial learning period prior to the availability of the first predicted tumor position was 8.53 ± 1.03 s. Average mean absolute error (MAE) of 0.59 ± 0.13 mm and 0.56 ± 0.18 mm were obtained from Groups 1 and 2, respectively, giving an overall MAE of 0.57 ± 0.17 mm. Average root-mean-square-error (RMSE) of 0.67 ± 0.36 for all the traces (0.76 ± 0.34 mm, Group 1 and 0.63 ± 0.36 mm, Group 2), is comparable to previously published results. Prediction errors are mainly due to the irregular periodicities between cycles. Since the errors from Groups 1 and 2 are within the same range, it demonstrates that this model can generalize and predict on unseen data. This is a first attempt to use an averaged MSE error surface (obtained from the prediction of different patients' tumor trajectories) to determine the parameters of a generalized neural network. This network could be deployed as a plug-and-play predictor for tumor trajectory during treatment delivery, eliminating the need for optimizing individual networks with pretreatment patient data. © 2017 American Association of Physicists in Medicine.

4D imaging for target definition in stereotactic radiotherapy for lung cancer.

PubMed

Slotman, Ben J; Lagerwaard, Frank J; Senan, Suresh

2006-01-01

Stereotactic radiotherapy of Stage I lung tumors has been reported to result in high local control rates that are far superior to those obtained with conventional radiotherapy techniques, and which approach those achieved with primary surgery. Breathing-induced motion of tumor and target tissues is an important issue in this technique and careful attention should be paid to the contouring and the generation of individualized margins. We describe our experience with the use of 4DCT scanning for this group of patients, the use of post-processing tools and the potential benefits of respiratory gating.

CompuLung: a multimedia CBL on pulmonary auscultation.

PubMed Central

Mangione, S.; Dennis, S.

1992-01-01

Cardio-pulmonary auscultation, a time honored art, is suffering a declining interest caused by competing diagnostic technology and inadequate training of physicians. Overreliance on diagnostic technology is expensive, not cost-effective and bound to lead to loss of our clinical heritage. We need novel methods to teach and revive this art. Computer-Based Learning (CBL), particularly multimedia supporting graphics plus sound-and-motion pictures, appears to be ideally suited for teaching and sharpening this skill. We present in this paper a multimedia CBL ("CompuLung"), that provides the user with a comprehensive and interactive tutorial on pulmonary auscultation. PMID:1482999

Impact of respiratory-correlated CT sorting algorithms on the choice of margin definition for free-breathing lung radiotherapy treatments.

PubMed

Thengumpallil, Sheeba; Germond, Jean-François; Bourhis, Jean; Bochud, François; Moeckli, Raphaël

2016-06-01

To investigate the impact of Toshiba phase- and amplitude-sorting algorithms on the margin strategies for free-breathing lung radiotherapy treatments in the presence of breathing variations. 4D CT of a sphere inside a dynamic thorax phantom was acquired. The 4D CT was reconstructed according to the phase- and amplitude-sorting algorithms. The phantom was moved by reproducing amplitude, frequency, and a mix of amplitude and frequency variations. Artefact analysis was performed for Mid-Ventilation and ITV-based strategies on the images reconstructed by phase- and amplitude-sorting algorithms. The target volume deviation was assessed by comparing the target volume acquired during irregular motion to the volume acquired during regular motion. The amplitude-sorting algorithm shows reduced artefacts for only amplitude variations while the phase-sorting algorithm for only frequency variations. For amplitude and frequency variations, both algorithms perform similarly. Most of the artefacts are blurring and incomplete structures. We found larger artefacts and volume differences for the Mid-Ventilation with respect to the ITV strategy, resulting in a higher relative difference of the surface distortion value which ranges between maximum 14.6% and minimum 4.1%. The amplitude- is superior to the phase-sorting algorithm in the reduction of motion artefacts for amplitude variations while phase-sorting for frequency variations. A proper choice of 4D CT sorting algorithm is important in order to reduce motion artefacts, especially if Mid-Ventilation strategy is used. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Deep Inspiration Breath Hold—Based Radiation Therapy: A Clinical Review

DOE Office of Scientific and Technical Information (OSTI.GOV)

Boda-Heggemann, Judit, E-mail: judit.boda-heggemann@umm.de; Knopf, Antje-Christin; Simeonova-Chergou, Anna

Several recent developments in linear accelerator–based radiation therapy (RT) such as fast multileaf collimators, accelerated intensity modulation paradigms like volumeric modulated arc therapy and flattening filter-free (FFF) high-dose-rate therapy have dramatically shortened the duration of treatment fractions. Deliverable photon dose distributions have approached physical complexity limits as a consequence of precise dose calculation algorithms and online 3-dimensional image guided patient positioning (image guided RT). Simultaneously, beam quality and treatment speed have continuously been improved in particle beam therapy, especially for scanned particle beams. Applying complex treatment plans with steep dose gradients requires strategies to mitigate and compensate for motion effectsmore » in general, particularly breathing motion. Intrafractional breathing-related motion results in uncertainties in dose delivery and thus in target coverage. As a consequence, generous margins have been used, which, in turn, increases exposure to organs at risk. Particle therapy, particularly with scanned beams, poses additional problems such as interplay effects and range uncertainties. Among advanced strategies to compensate breathing motion such as beam gating and tracking, deep inspiration breath hold (DIBH) gating is particularly advantageous in several respects, not only for hypofractionated, high single-dose stereotactic body RT of lung, liver, and upper abdominal lesions but also for normofractionated treatment of thoracic tumors such as lung cancer, mediastinal lymphomas, and breast cancer. This review provides an in-depth discussion of the rationale and technical implementation of DIBH gating for hypofractionated and normofractionated RT of intrathoracic and upper abdominal tumors in photon and proton RT.« less

20 CFR 410.637 - Hearing on new issues.

Code of Federal Regulations, 2011 CFR

2011-04-01

..., TITLE IV-BLACK LUNG BENEFITS (1969- ) Determinations of Disability, Other Determinations, Administrative... party or his own motion, in addition to the matters brought before him by the request for hearing, give... or a related matter, and whether arising subsequent to the request for hearing, which may affect the...

20 CFR 410.637 - Hearing on new issues.

Code of Federal Regulations, 2010 CFR

2010-04-01

..., TITLE IV-BLACK LUNG BENEFITS (1969- ) Determinations of Disability, Other Determinations, Administrative... party or his own motion, in addition to the matters brought before him by the request for hearing, give... or a related matter, and whether arising subsequent to the request for hearing, which may affect the...

The physiological basis of Glottal electromagnetic micropower sensors (GEMS) and their use in defining an excitation function for the human vocal tract

NASA Astrophysics Data System (ADS)

Burnett, Gregory Clell

1999-10-01

The definition, use, and physiological basis of Glottal Electromagnetic Micropower Sensors (GEMS) is presented. These sensors are a new type of low power (<20 milliwatts radiated) microwave regime (900 MHz to 2.5 GHz) multi-purpose motion sensor developed at the Lawrence Livermore National Laboratory. The GEMS are sensitive to movement in an adjustable field of view (FOV) surrounding the antennae. In this thesis, the GEMS has been utilized for speech research, targeted to receive motion signals from the subglottal region of the trachea. The GEMS signal is analyzed to determine the physiological source of the signal, and this information is used to calculate the subglottal pressure, effectively an excitation function for the human vocal tract. For the first time, an excitation function may be calculated in near real time using a noninvasive procedure. Several experiments and models are presented to demonstrate that the GEMS signal is representative of the motion of the subglottal posterior wall of the trachea as it vibrates in response to the pressure changes caused by the folds as they modulate the airflow supplied by the lungs. The vibrational properties of the tracheal wall are modeled using a lumped-element circuit model. Taking the output of the vocal tract to be the audio pressure captured by a microphone and the input to be the subglottal pressure, the transfer function of the vocal tract (including the nasal cavities) can be approximated every 10-30 milliseconds using an autoregressive moving-average model. Unlike the currently utilized method of transfer function approximation, this new method only involves noninvasive GEMS measurements and digital signal processing and does not demand the difficult task of obtaining precise physical measurements of the tract and subsequent estimation of the transfer function using its cross-sectional area. The ability to measure the physical motion of the trachea enables a significant number of potential applications, ranging from very accurate pitch detection to speech synthesis, speaker verification, and speech recognition.

Numerical study of dynamic glottis and tidal breathing on respiratory sounds in a human upper airway model

PubMed Central

Wang, Zhaoxuan; Talaat, Khaled; Glide-Hurst, Carri; Dong, Haibo

2018-01-01

Background Human snores are caused by vibrating anatomical structures in the upper airway. The glottis is a highly variable structure and a critical organ regulating inhaled flows. However, the effects of the glottis motion on airflow and breathing sound are not well understood, while static glottises have been implemented in most previous in silico studies. The objective of this study is to develop a computational acoustic model of human airways with a dynamic glottis and quantify the effects of glottis motion and tidal breathing on airflow and sound generation. Methods Large eddy simulation and FW-H models were adopted to compute airflows and respiratory sounds in an image-based mouth-lung model. User-defined functions were developed that governed the glottis kinematics. Varying breathing scenarios (static vs. dynamic glottis; constant vs. sinusoidal inhalations) were simulated to understand the effects of glottis motion and inhalation pattern on sound generation. Pressure distributions were measured in airway casts with different glottal openings for model validation purpose. Results Significant flow fluctuations were predicted in the upper airways at peak inhalation rates or during glottal constriction. The inhalation speed through the glottis was the predominating factor in the sound generation while the transient effects were less important. For all frequencies considered (20–2500 Hz), the static glottis substantially underestimated the intensity of the generated sounds, which was most pronounced in the range of 100–500 Hz. Adopting an equivalent steady flow rather than a tidal breathing further underestimated the sound intensity. An increase of 25 dB in average was observed for the life condition (sine-dynamic) compared to the idealized condition (constant-rigid) for the broadband frequencies, with the largest increase of approximately 40 dB at the frequency around 250 Hz. Conclusion Results show that a severely narrowing glottis during inhalation, as well as flow fluctuations in the downstream trachea, can generate audible sound levels. PMID:29101633

Numerical study of dynamic glottis and tidal breathing on respiratory sounds in a human upper airway model.

PubMed

Xi, Jinxiang; Wang, Zhaoxuan; Talaat, Khaled; Glide-Hurst, Carri; Dong, Haibo

2018-05-01

Human snores are caused by vibrating anatomical structures in the upper airway. The glottis is a highly variable structure and a critical organ regulating inhaled flows. However, the effects of the glottis motion on airflow and breathing sound are not well understood, while static glottises have been implemented in most previous in silico studies. The objective of this study is to develop a computational acoustic model of human airways with a dynamic glottis and quantify the effects of glottis motion and tidal breathing on airflow and sound generation. Large eddy simulation and FW-H models were adopted to compute airflows and respiratory sounds in an image-based mouth-lung model. User-defined functions were developed that governed the glottis kinematics. Varying breathing scenarios (static vs. dynamic glottis; constant vs. sinusoidal inhalations) were simulated to understand the effects of glottis motion and inhalation pattern on sound generation. Pressure distributions were measured in airway casts with different glottal openings for model validation purpose. Significant flow fluctuations were predicted in the upper airways at peak inhalation rates or during glottal constriction. The inhalation speed through the glottis was the predominating factor in the sound generation while the transient effects were less important. For all frequencies considered (20-2500 Hz), the static glottis substantially underestimated the intensity of the generated sounds, which was most pronounced in the range of 100-500 Hz. Adopting an equivalent steady flow rather than a tidal breathing further underestimated the sound intensity. An increase of 25 dB in average was observed for the life condition (sine-dynamic) compared to the idealized condition (constant-rigid) for the broadband frequencies, with the largest increase of approximately 40 dB at the frequency around 250 Hz. Results show that a severely narrowing glottis during inhalation, as well as flow fluctuations in the downstream trachea, can generate audible sound levels.

A Bayesian approach to real-time 3D tumor localization via monoscopic x-ray imaging during treatment delivery.

PubMed

Li, Ruijiang; Fahimian, Benjamin P; Xing, Lei

2011-07-01

Monoscopic x-ray imaging with on-board kV devices is an attractive approach for real-time image guidance in modern radiation therapy such as VMAT or IMRT, but it falls short in providing reliable information along the direction of imaging x-ray. By effectively taking consideration of projection data at prior times and/or angles through a Bayesian formalism, the authors develop an algorithm for real-time and full 3D tumor localization with a single x-ray imager during treatment delivery. First, a prior probability density function is constructed using the 2D tumor locations on the projection images acquired during patient setup. Whenever an x-ray image is acquired during the treatment delivery, the corresponding 2D tumor location on the imager is used to update the likelihood function. The unresolved third dimension is obtained by maximizing the posterior probability distribution. The algorithm can also be used in a retrospective fashion when all the projection images during the treatment delivery are used for 3D localization purposes. The algorithm does not involve complex optimization of any model parameter and therefore can be used in a "plug-and-play" fashion. The authors validated the algorithm using (1) simulated 3D linear and elliptic motion and (2) 3D tumor motion trajectories of a lung and a pancreas patient reproduced by a physical phantom. Continuous kV images were acquired over a full gantry rotation with the Varian TrueBeam on-board imaging system. Three scenarios were considered: fluoroscopic setup, cone beam CT setup, and retrospective analysis. For the simulation study, the RMS 3D localization error is 1.2 and 2.4 mm for the linear and elliptic motions, respectively. For the phantom experiments, the 3D localization error is < 1 mm on average and < 1.5 mm at 95th percentile in the lung and pancreas cases for all three scenarios. The difference in 3D localization error for different scenarios is small and is not statistically significant. The proposed algorithm eliminates the need for any population based model parameters in monoscopic image guided radiotherapy and allows accurate and real-time 3D tumor localization on current standard LINACs with a single x-ray imager.

Clinical Study of Orthogonal-View Phase-Matched Digital Tomosynthesis for Lung Tumor Localization.

PubMed

Zhang, You; Ren, Lei; Vergalasova, Irina; Yin, Fang-Fang

2017-01-01

Compared to cone-beam computed tomography, digital tomosynthesis imaging has the benefits of shorter scanning time, less imaging dose, and better mechanical clearance for tumor localization in radiation therapy. However, for lung tumors, the localization accuracy of the conventional digital tomosynthesis technique is affected by the lack of depth information and the existence of lung tumor motion. This study investigates the clinical feasibility of using an orthogonal-view phase-matched digital tomosynthesis technique to improve the accuracy of lung tumor localization. The proposed orthogonal-view phase-matched digital tomosynthesis technique benefits from 2 major features: (1) it acquires orthogonal-view projections to improve the depth information in reconstructed digital tomosynthesis images and (2) it applies respiratory phase-matching to incorporate patient motion information into the synthesized reference digital tomosynthesis sets, which helps to improve the localization accuracy of moving lung tumors. A retrospective study enrolling 14 patients was performed to evaluate the accuracy of the orthogonal-view phase-matched digital tomosynthesis technique. Phantom studies were also performed using an anthropomorphic phantom to investigate the feasibility of using intratreatment aggregated kV and beams' eye view cine MV projections for orthogonal-view phase-matched digital tomosynthesis imaging. The localization accuracy of the orthogonal-view phase-matched digital tomosynthesis technique was compared to that of the single-view digital tomosynthesis techniques and the digital tomosynthesis techniques without phase-matching. The orthogonal-view phase-matched digital tomosynthesis technique outperforms the other digital tomosynthesis techniques in tumor localization accuracy for both the patient study and the phantom study. For the patient study, the orthogonal-view phase-matched digital tomosynthesis technique localizes the tumor to an average (± standard deviation) error of 1.8 (0.7) mm for a 30° total scan angle. For the phantom study using aggregated kV-MV projections, the orthogonal-view phase-matched digital tomosynthesis localizes the tumor to an average error within 1 mm for varying magnitudes of scan angles. The pilot clinical study shows that the orthogonal-view phase-matched digital tomosynthesis technique enables fast and accurate localization of moving lung tumors.

SU-E-T-06: 4D Particle Swarm Optimization to Enable Lung SBRT in Patients with Central And/or Large Tumors

DOE Office of Scientific and Technical Information (OSTI.GOV)

Modiri, A; Gu, X; Hagan, A

2015-06-15

Purpose: Patients presenting with large and/or centrally-located lung tumors are currently considered ineligible for highly potent regimens such as SBRT due to concerns of toxicity to normal tissues and organs-at-risk (OARs). We present a particle swarm optimization (PSO)-based 4D planning technique, designed for MLC tracking delivery, that exploits the temporal dimension as an additional degree of freedom to significantly improve OAR-sparing and reduce toxicity to levels clinically considered as acceptable for SBRT administration. Methods: Two early-stage SBRT-ineligible NSCLC patients were considered, presenting with tumors of maximum dimensions of 7.4cm (central-right lobe; 1.5cm motion) and 11.9cm (upper-right lobe; 1cm motion). Inmore » each case, the target and normal structures were manually contoured on each of the ten 4DCT phases. Corresponding ten initial 3D-conformal plans (Pt#1: 7-beams; Pt#2: 9-beams) were generated using the Eclipse planning system. Using 4D-PSO, fluence weights were optimized over all beams and all phases (70 and 90 apertures for Pt1&2, respectively). Doses to normal tissues and OARs were compared with clinicallyestablished lung SBRT guidelines based on RTOG-0236. Results: The PSO-based 4D SBRT plan yielded tumor coverage and dose—sparing for parallel and serial OARs within the SBRT guidelines for both patients. The dose-sparing compared to the clinically-delivered conventionallyfractionated plan for Patient 1 (Patient 2) was: heart Dmean = 11% (33%); lung V20 = 16% (21%); lung Dmean = 7% (20%); spinal cord Dmax = 5% (16%); spinal cord Dmean = 7% (33%); esophagus Dmax = 0% (18%). Conclusion: Truly 4D planning can significantly reduce dose to normal tissues and OARs. Such sparing opens up the possibility of using highly potent and effective regimens such as lung SBRT for patients who were conventionally considered SBRT non-eligible. Given the large, non-convex solution space, PSO represents an attractive, parallelizable tool to successfully achieve a globally optimal solution for this problem. This work was supported through funding from the National Institutes of Health and Varian Medical Systems.« less

MO-FG-BRA-04: A Novel Time Weighted Density Correction for Stereotactic Lung Radiotherapy: A Phantom Study

DOE Office of Scientific and Technical Information (OSTI.GOV)

Mohatt, D; Malhotra, H

Purpose: Conventional treatment plans for lung radiotherapy are created using either the free breathing (FB) scheme which represents the tumor at an arbitrary breathing phase of the patient’s respiratory cycle, or the average computed tomography (ACT) intensity projection over 10-binned phases. Neither method is entirely accurate because of the absence of time dependence of tumor movement. In the present “Hybrid” method, the HU of tumor in 3D space is determined by relative weighting of the HU of the tumor and lung in proportion to the time they spend at that location during the entire breathing cycle. Methods: A Quasar respiratorymore » motion phantom was employed to simulate lung tumor movement. Utilizing 4DCT image scans, volumetric modulated arc therapy (VMAT) plans were generated for three treatment planning scenarios which included conventional FB and ACT schemes, along with a third alternative Hybrid approach. Our internal target volume (ITV) hybrid structure was created using Boolean operation in Eclipse (ver. 11) treatment planning system, where independent sub-regions created by the gross tumor volume (GTV) overlap from the 10 motion phases were each assigned a time weighted CT value. The dose-volume-histograms (DVH) for each scheme were compared and analyzed. Results: Using our hybrid technique, we have demonstrated a reduction of 1.9% – 3.4% in total monitor units with respect to conventional treatment planning strategies, along with a 6 fold improvement in high dose spillage over the FB plan. The higher density ACT and Hybrid schemes also produced a slight enhancement in target conformity and reduction in low dose spillage. Conclusion: All treatment plans created in this study exceeded RTOG protocol criteria. Our results determine the free breathing approach yields an inaccurate account of the target treatment density. A significant decrease in unnecessary lung irradiation can be achieved by implementing Hybrid HU method with ACT method second best.« less

Breathing-motion-compensated robotic guided stereotactic body radiation therapy : Patterns of failure analysis.

PubMed

Stera, Susanne; Balermpas, Panagiotis; Chan, Mark K H; Huttenlocher, Stefan; Wurster, Stefan; Keller, Christian; Imhoff, Detlef; Rades, Dirk; Dunst, Jürgen; Rödel, Claus; Hildebrandt, Guido; Blanck, Oliver

2018-02-01

We retrospectively evaluated the patterns of failure for robotic guided real-time breathing-motion-compensated (BMC) stereotactic body radiation therapy (SBRT) in the treatment of tumors in moving organs. Between 2011 and 2016, a total of 198 patients with 280 lung, liver, and abdominal tumors were treated with BMC-SBRT. The median gross tumor volume (GTV) was 12.3 cc (0.1-372.0 cc). Medians of mean GTV BED α/β = 10   Gy (BED = biological effective dose) was 148.5 Gy 10 (31.5-233.3 Gy 10 ) and prescribed planning target volume (PTV) BED α/β = 10   Gy was 89.7 Gy 10 (28.8-151.2 Gy 10 ), respectively. We analyzed overall survival (OS) and local control (LC) based on various factors, including BEDs with α/β ratios of 15 Gy (lung metastases), 21 Gy (primary lung tumors), and 27 Gy (liver metastases). Median follow-up was 10.4 months (2.0-59.0 months). The 2‑year actuarial LC was 100 and 86.4% for primary early and advanced stage lung tumors, respectively, 100% for lung metastases, 82.2% for liver metastases, and 90% for extrapulmonary extrahepatic metastases. The 2‑year OS rate was 47.9% for all patients. In uni- and multivariate analysis, comparatively lower PTV prescription dose (equivalence of 3 × 12-13 Gy) and higher average GTV dose (equivalence of 3 × 18 Gy) to current practice were significantly associated with LC. For OS, Karnofsky performance score (100%), gender (female), and SBRT without simultaneous chemotherapy were significant prognostic factors. Grade 3 side effects were rare (0.5%). Robotic guided BMC-SBRT can be considered a safe and effective treatment for solid tumors in moving organs. To reach sufficient local control rates, high average GTV doses are necessary. Further prospective studies are warranted to evaluate these points.

3D printer generated thorax phantom with mobile tumor for radiation dosimetry

NASA Astrophysics Data System (ADS)

Mayer, Rulon; Liacouras, Peter; Thomas, Andrew; Kang, Minglei; Lin, Liyong; Simone, Charles B.

2015-07-01

This article describes the design, construction, and properties of an anthropomorphic thorax phantom with a moving surrogate tumor. This novel phantom permits detection of dose both inside and outside a moving tumor and within the substitute lung tissue material. A 3D printer generated the thorax shell composed of a chest wall, spinal column, and posterior regions of the phantom. Images of a computed tomography scan of the thorax from a patient with lung cancer provided the template for the 3D printing. The plastic phantom is segmented into two materials representing the muscle and bones, and its geometry closely matches a patient. A surrogate spherical plastic tumor controlled by a 3D linear stage simulates a lung tumor's trajectory during normal breathing. Sawdust emulates the lung tissue in terms of average and distribution in Hounsfield numbers. The sawdust also provides a forgiving medium that permits tumor motion and sandwiching of radiochromic film inside the mobile surrogate plastic tumor for dosimetry. A custom cork casing shields the film and tumor and eliminates film bending during extended scans. The phantom, lung tissue surrogate, and radiochromic film are exposed to a seven field plan based on an ECLIPSE plan for 6 MV photons from a Trilogy machine delivering 230 cGy to the isocenter. The dose collected in a sagittal plane is compared to the calculated plan. Gamma analysis finds 8.8% and 5.5% gamma failure rates for measurements of large amplitude trajectory and static measurements relative to the large amplitude plan, respectively. These particular gamma analysis results were achieved using parameters of 3% dose and 3 mm, for regions receiving doses >150 cGy. The plan assumes a stationary detection grid unlike the moving radiochromic film and tissues. This difference was experimentally observed and motivated calculated dose distributions that incorporated the phase of the tumor periodic motion. These calculations modestly improve agreement between the measured and intended doses.

3D printer generated thorax phantom with mobile tumor for radiation dosimetry.

PubMed

Mayer, Rulon; Liacouras, Peter; Thomas, Andrew; Kang, Minglei; Lin, Liyong; Simone, Charles B

2015-07-01

This article describes the design, construction, and properties of an anthropomorphic thorax phantom with a moving surrogate tumor. This novel phantom permits detection of dose both inside and outside a moving tumor and within the substitute lung tissue material. A 3D printer generated the thorax shell composed of a chest wall, spinal column, and posterior regions of the phantom. Images of a computed tomography scan of the thorax from a patient with lung cancer provided the template for the 3D printing. The plastic phantom is segmented into two materials representing the muscle and bones, and its geometry closely matches a patient. A surrogate spherical plastic tumor controlled by a 3D linear stage simulates a lung tumor's trajectory during normal breathing. Sawdust emulates the lung tissue in terms of average and distribution in Hounsfield numbers. The sawdust also provides a forgiving medium that permits tumor motion and sandwiching of radiochromic film inside the mobile surrogate plastic tumor for dosimetry. A custom cork casing shields the film and tumor and eliminates film bending during extended scans. The phantom, lung tissue surrogate, and radiochromic film are exposed to a seven field plan based on an ECLIPSE plan for 6 MV photons from a Trilogy machine delivering 230 cGy to the isocenter. The dose collected in a sagittal plane is compared to the calculated plan. Gamma analysis finds 8.8% and 5.5% gamma failure rates for measurements of large amplitude trajectory and static measurements relative to the large amplitude plan, respectively. These particular gamma analysis results were achieved using parameters of 3% dose and 3 mm, for regions receiving doses >150 cGy. The plan assumes a stationary detection grid unlike the moving radiochromic film and tissues. This difference was experimentally observed and motivated calculated dose distributions that incorporated the phase of the tumor periodic motion. These calculations modestly improve agreement between the measured and intended doses.

3D printer generated thorax phantom with mobile tumor for radiation dosimetry

DOE Office of Scientific and Technical Information (OSTI.GOV)

Mayer, Rulon; Liacouras, Peter; Thomas, Andrew

2015-07-15

This article describes the design, construction, and properties of an anthropomorphic thorax phantom with a moving surrogate tumor. This novel phantom permits detection of dose both inside and outside a moving tumor and within the substitute lung tissue material. A 3D printer generated the thorax shell composed of a chest wall, spinal column, and posterior regions of the phantom. Images of a computed tomography scan of the thorax from a patient with lung cancer provided the template for the 3D printing. The plastic phantom is segmented into two materials representing the muscle and bones, and its geometry closely matches amore » patient. A surrogate spherical plastic tumor controlled by a 3D linear stage simulates a lung tumor’s trajectory during normal breathing. Sawdust emulates the lung tissue in terms of average and distribution in Hounsfield numbers. The sawdust also provides a forgiving medium that permits tumor motion and sandwiching of radiochromic film inside the mobile surrogate plastic tumor for dosimetry. A custom cork casing shields the film and tumor and eliminates film bending during extended scans. The phantom, lung tissue surrogate, and radiochromic film are exposed to a seven field plan based on an ECLIPSE plan for 6 MV photons from a Trilogy machine delivering 230 cGy to the isocenter. The dose collected in a sagittal plane is compared to the calculated plan. Gamma analysis finds 8.8% and 5.5% gamma failure rates for measurements of large amplitude trajectory and static measurements relative to the large amplitude plan, respectively. These particular gamma analysis results were achieved using parameters of 3% dose and 3 mm, for regions receiving doses >150 cGy. The plan assumes a stationary detection grid unlike the moving radiochromic film and tissues. This difference was experimentally observed and motivated calculated dose distributions that incorporated the phase of the tumor periodic motion. These calculations modestly improve agreement between the measured and intended doses.« less

4D CT-based Treatment Planning for Intensity-Modulated Radiation Therapy and Proton Therapy for Distal Esophagus Cancer

PubMed Central

Zhang, Xiaodong; Zhao, Kuai-Le; Guerrero, Thomas M.; McGuire, Sean E.; Yaremko, Brian; Komaki, Ritsuko; Cox, James D.; Hui, Zhouguang; Li, Yupeng; Newhauser, Wayne D.; Mohan, Radhe; Liao, Zhongxing

2008-01-01

Purpose To compare three-dimensional (3D) and 4D computed tomography (CT)– based treatment plans for proton therapy or intensity-modulated radiation therapy (IMRT) for esophageal cancer in terms of doses to the lung, heart, and spinal cord and variations in target coverage and normal tissue sparing. Materials and Methods IMRT and proton plans for 15 patients with distal esophageal cancer were designed from the 3D average CT scans and then recalculated on 10 4D CT data sets. Dosimetric data were compared for tumor coverage and normal tissue sparing. Results Compared with IMRT, median lung volumes exposed to 5,10, and 20 Gy and mean lung dose were reduced by 35.6%, 20.5%,5.8%, and 5.1 Gy for a two-beam proton plan and by 17.4%,8.4%,5%, and 2.9 Gy for a three-beam proton plan. The greater lung sparing in the two-beam proton plan was achieved at the expense of less conformity to the target (conformity index CI=1.99) and greater irradiation of the heart (heart-V40=41.8%) compared with the IMRT plan(CI=1.55, heart-V40=35.7%) or the three-beam proton plan (CI=1.46, heart-V40=27.7%). Target coverage differed by more than 2% between the 3D and 4D plans for patients with substantial diaphragm motion in the three-beam proton and IMRT plans. The difference in spinal cord maximum dose between 3D and 4D plans could exceed 5 Gy for the proton plans partly owing to variations in stomach gas-filling. Conclusions Proton therapy provided significantly better sparing of lung than did IMRT. Diaphragm motion and stomach gas-filling must be considered in evaluating target coverage and cord doses. PMID:18722278

Four-dimensional computed tomography-based treatment planning for intensity-modulated radiation therapy and proton therapy for distal esophageal cancer.

PubMed

Zhang, Xiaodong; Zhao, Kuai-le; Guerrero, Thomas M; McGuire, Sean E; Yaremko, Brian; Komaki, Ritsuko; Cox, James D; Hui, Zhouguang; Li, Yupeng; Newhauser, Wayne D; Mohan, Radhe; Liao, Zhongxing

2008-09-01

To compare three-dimensional (3D) and four-dimensional (4D) computed tomography (CT)-based treatment plans for proton therapy or intensity-modulated radiation therapy (IMRT) for esophageal cancer in terms of doses to the lung, heart, and spinal cord and variations in target coverage and normal tissue sparing. The IMRT and proton plans for 15 patients with distal esophageal cancer were designed from the 3D average CT scans and then recalculated on 10 4D CT data sets. Dosimetric data were compared for tumor coverage and normal tissue sparing. Compared with IMRT, median lung volumes exposed to 5, 10, and 20 Gy and mean lung dose were reduced by 35.6%, 20.5%, 5.8%, and 5.1 Gy for a two-beam proton plan and by 17.4%, 8.4%, 5%, and 2.9 Gy for a three-beam proton plan. The greater lung sparing in the two-beam proton plan was achieved at the expense of less conformity to the target (conformity index [CI], 1.99) and greater irradiation of the heart (heart-V40, 41.8%) compared with the IMRT plan(CI, 1.55, heart-V40, 35.7%) or the three-beam proton plan (CI, 1.46, heart-V40, 27.7%). Target coverage differed by more than 2% between the 3D and 4D plans for patients with substantial diaphragm motion in the three-beam proton and IMRT plans. The difference in spinal cord maximum dose between 3D and 4D plans could exceed 5 Gy for the proton plans partly owing to variations in stomach gas filling. Proton therapy provided significantly better sparing of lung than did IMRT. Diaphragm motion and stomach gas-filling must be considered in evaluating target coverage and cord doses.

Lung Cancer Risk Prediction Model Incorporating Lung Function: Development and Validation in the UK Biobank Prospective Cohort Study.

PubMed

Muller, David C; Johansson, Mattias; Brennan, Paul

2017-03-10

Purpose Several lung cancer risk prediction models have been developed, but none to date have assessed the predictive ability of lung function in a population-based cohort. We sought to develop and internally validate a model incorporating lung function using data from the UK Biobank prospective cohort study. Methods This analysis included 502,321 participants without a previous diagnosis of lung cancer, predominantly between 40 and 70 years of age. We used flexible parametric survival models to estimate the 2-year probability of lung cancer, accounting for the competing risk of death. Models included predictors previously shown to be associated with lung cancer risk, including sex, variables related to smoking history and nicotine addiction, medical history, family history of lung cancer, and lung function (forced expiratory volume in 1 second [FEV1]). Results During accumulated follow-up of 1,469,518 person-years, there were 738 lung cancer diagnoses. A model incorporating all predictors had excellent discrimination (concordance (c)-statistic [95% CI] = 0.85 [0.82 to 0.87]). Internal validation suggested that the model will discriminate well when applied to new data (optimism-corrected c-statistic = 0.84). The full model, including FEV1, also had modestly superior discriminatory power than one that was designed solely on the basis of questionnaire variables (c-statistic = 0.84 [0.82 to 0.86]; optimism-corrected c-statistic = 0.83; p FEV1 = 3.4 × 10 -13 ). The full model had better discrimination than standard lung cancer screening eligibility criteria (c-statistic = 0.66 [0.64 to 0.69]). Conclusion A risk prediction model that includes lung function has strong predictive ability, which could improve eligibility criteria for lung cancer screening programs.

Evaluation of the reproducibility of lung motion probability distribution function (PDF) using dynamic MRI.

PubMed

Cai, Jing; Read, Paul W; Altes, Talissa A; Molloy, Janelle A; Brookeman, James R; Sheng, Ke

2007-01-21

Treatment planning based on probability distribution function (PDF) of patient geometries has been shown a potential off-line strategy to incorporate organ motion, but the application of such approach highly depends upon the reproducibility of the PDF. In this paper, we investigated the dependences of the PDF reproducibility on the imaging acquisition parameters, specifically the scan time and the frame rate. Three healthy subjects underwent a continuous 5 min magnetic resonance (MR) scan in the sagittal plane with a frame rate of approximately 10 f s-1, and the experiments were repeated with an interval of 2 to 3 weeks. A total of nine pulmonary vessels from different lung regions (upper, middle and lower) were tracked and the dependences of their displacement PDF reproducibility were evaluated as a function of scan time and frame rate. As results, the PDF reproducibility error decreased with prolonged scans and appeared to approach equilibrium state in subjects 2 and 3 within the 5 min scan. The PDF accuracy increased in the power function with the increase of frame rate; however, the PDF reproducibility showed less sensitivity to frame rate presumably due to the randomness of breathing which dominates the effects. As the key component of the PDF-based treatment planning, the reproducibility of the PDF affects the dosimetric accuracy substantially. This study provides a reference for acquiring MR-based PDF of structures in the lung.

Modeling and optimization of a time-resolved proton radiographic imaging system for proton cancer treatment

NASA Astrophysics Data System (ADS)

Han, Bin

This dissertation describes a research project to test the clinical utility of a time-resolved proton radiographic (TRPR) imaging system by performing comprehensive Monte Carlo simulations of a physical device coupled with realistic lung cancer patient anatomy defined by 4DCT for proton therapy. A time-resolved proton radiographic imaging system was modeled through Monte Carlo simulations. A particle-tracking feature was employed to evaluate the performance of the proton imaging system, especially in its ability to visualize and quantify proton range variations during respiration. The Most Likely Path (MLP) algorithm was developed to approximate the multiple Coulomb scattering paths of protons for the purpose of image reconstruction. Spatial resolution of ˜ 1 mm and range resolution of 1.3% of the total range were achieved using the MLP algorithm. Time-resolved proton radiographs of five patient cases were reconstructed to track tumor motion and to calculate water equivalent length variations. By comparing with direct 4DCT measurement, the accuracy of tumor tracking was found to be better than 2 mm in five patient cases. Utilizing tumor tracking information to reduce margins to the planning target volume, a gated treatment plan was compared with un-gated treatment plan. The equivalent uniform dose (EUD) and the normal tissue complication probability (NTCP) were used to quantify the gain in the quality of treatments. The EUD of the OARs was found to be reduced up to 11% and the corresponding NTCP of organs at risk (OARs) was found to be reduced up to 16.5%. These results suggest that, with image guidance by proton radiography, dose to OARs can be reduced and the corresponding NTCPs can be significantly reduced. The study concludes that the proton imaging system can accurately track the motion of the tumor and detect the WEL variations, leading to potential gains in using image-guided proton radiography for lung cancer treatments.

Reproducibility of lung tumor position and reduction of lung mass within the planning target volume using active breathing control (ABC).

PubMed

Cheung, Patrick C F; Sixel, Katharina E; Tirona, Romeo; Ung, Yee C

2003-12-01

The active breathing control (ABC) device allows for temporary immobilization of respiratory motion by implementing a breath hold at a predefined relative lung volume and air flow direction. The purpose of this study was to quantitatively evaluate the ability of the ABC device to immobilize peripheral lung tumors at a reproducible position, increase total lung volume, and thereby reduce lung mass within the planning target volume (PTV). Ten patients with peripheral non-small-cell lung cancer tumors undergoing radiotherapy had CT scans of their thorax with and without ABC inspiration breath hold during the first 5 days of treatment. Total lung volumes were determined from the CT data sets. Each peripheral lung tumor was contoured by one physician on all CT scans to generate gross tumor volumes (GTVs). The lung density and mass contained within a 1.5-cm PTV margin around each peripheral tumor was calculated using CT numbers. Using the center of the GTV from the Day 1 ABC scan as the reference, the displacement of subsequent GTV centers on Days 2 to 5 for each patient with ABC applied was calculated in three dimensions. With the use of ABC inspiration breath hold, total lung volumes increased by an average of 42%. This resulted in an average decrease in lung mass of 18% within a standard 1.5-cm PTV margin around the GTV. The average (+/- standard deviation) displacement of GTV centers with ABC breath hold applied was 0.3 mm (+/- 1.8 mm), 1.2 mm (+/- 2.3 mm), and 1.1 mm (+/- 3.5 mm) in the lateral direction, anterior-posterior direction, and superior-inferior direction, respectively. Results from this study indicate that there remains some inter-breath hold variability in peripheral lung tumor position with the use of ABC inspiration breath hold, which prevents significant PTV margin reduction. However, lung volumes can significantly increase, thereby decreasing the mass of lung within a standard PTV.

Simulation of dosimetric consequences of 4D-CT-based motion margin estimation for proton radiotherapy using patient tumor motion data

NASA Astrophysics Data System (ADS)

Koybasi, Ozhan; Mishra, Pankaj; St. James, Sara; Lewis, John H.; Seco, Joao

2014-02-01

For the radiation treatment of lung cancer patients, four-dimensional computed tomography (4D-CT) is a common practice used clinically to image tumor motion and subsequently determine the internal target volume (ITV) from the maximum intensity projection (MIP) images. ITV, which is derived from short pre-treatment 4D-CT scan (<6 s per couch position), may not adequately cover the extent of tumor motion during the treatment, particularly for patients that exhibit a large respiratory variability. Inaccurate tumor localization may result in under-dosage of the tumor or over-dosage of the surrounding tissues. The purpose of this study is therefore to assess the degree of tumor under-dosage in case of regular and irregular breathing for proton radiotherapy using ITV-based treatment planning. We place a spherical lesion into a modified XCAT phantom that is also capable of producing 4D images based on irregular breathing, and move the tumor according to real tumor motion data, which is acquired over multiple days by tracking gold fiducial markers implanted into the lung tumors of patients. We derive ITVs by taking the union of all tumor positions during 6 s of tumor motion in the phantom using the first day patient tumor tracking data. This is equivalent to ITVs generated clinically from cine-mode 4D-CT MIP images. The treatment plans created for different ITVs are then implemented on dynamic phantoms with tumor motion governed by real tumor tracking data from consecutive days. By comparing gross tumor volume dose distribution on days of ‘treatment’ with the ITV dose distribution, we evaluate the deviation of the actually delivered dose from the predicted dose. Our results have shown that the proton treatment planning on ITV derived from pre-treatment cine-mode 4D-CT can result in under-dosage (dose covering 95% of volume) of the tumor by up to 25.7% over 3 min of treatment for the patient with irregular respiratory motion. Tumor under-dosage is less significant for the patient with relatively regular breathing. We have demonstrated that proton therapy using the pre-treatment 4D-CT based ITV method can lead to significant under-dosage of the tumor, highlighting the need for daily customization to generate a target volume that represents tumor positions during the treatment more accurately.

Clinical evaluation of respiration-induced attenuation uncertainties in pulmonary 3D PET/CT.

PubMed

Kruis, Matthijs F; van de Kamer, Jeroen B; Vogel, Wouter V; Belderbos, José Sa; Sonke, Jan-Jakob; van Herk, Marcel

2015-12-01

In contemporary positron emission tomography (PET)/computed tomography (CT) scanners, PET attenuation correction is performed by means of a CT-based attenuation map. Respiratory motion can however induce offsets between the PET and CT data. Studies have demonstrated that these offsets can cause errors in quantitative PET measures. The purpose of this study is to quantify the effects of respiration-induced CT differences on the attenuation correction of pulmonary 18-fluordeoxyglucose (FDG) 3D PET/CT in a patient population and to investigate contributing factors. For 32 lung cancer patients, 3D-CT, 4D-PET and 4D-CT data were acquired. The 4D FDG PET data were attenuation corrected (AC) using a free-breathing 3D-CT (3D-AC), the end-inspiration CT (EI-AC), the end-expiration CT (EE-AC) or phase-by-phase (P-AC). After reconstruction and AC, the 4D-PET data were averaged. In the 4Davg data, we measured maximum tumour standardised uptake value (SUV)max in the tumour, SUVmean in a lung volume of interest (VOI) and average SUV (SUVmean) in a muscle VOI. On the 4D-CT, we measured the lung volume differences and CT number changes between inhale and exhale in the lung VOI. Compared to P-AC, we found -2.3% (range -9.7% to 1.2%) lower tumour SUVmax in EI-AC and 2.0% (range -0.9% to 9.5%) higher SUVmax in EE-AC. No differences in the muscle SUV were found. The use of 3D-AC led to respiration-induced SUVmax differences up to 20% compared to the use of P-AC. SUVmean differences in the lung VOI between EI-AC and EE-AC correlated to average CT differences in this region (ρ = 0.83). SUVmax differences in the tumour correlated to the volume changes of the lungs (ρ = -0.55) and the motion amplitude of the tumour (ρ = 0.53), both as measured on the 4D-CT. Respiration-induced CT variations in clinical data can in extreme cases lead to SUV effects larger than 10% on PET attenuation correction. These differences were case specific and correlated to differences in CT number in the lungs.

The role of anisotropic expansion for pulmonary acinar aerosol deposition

PubMed Central

Hofemeier, Philipp; Sznitman, Josué

2016-01-01

Lung deformations at the local pulmonary acinar scale are intrinsically anisotropic. Despite progress in imaging modalities, the true heterogeneous nature of acinar expansion during breathing remains controversial, where our understanding of inhaled aerosol deposition still widely emanates from studies under self-similar, isotropic wall motions. Building on recent 3D models of multi-generation acinar networks, we explore in numerical simulations how different hypothesized scenarios of anisotropic expansion influence deposition outcomes of inhaled aerosols in the acinar depths. While the broader range of particles acknowledged to reach the acinar region (dp = 0.005–5.0 μm) are largely unaffected by the details of anisotropic expansion under tidal breathing, our results suggest nevertheless that anisotropy modulates the deposition sites and fractions for a narrow band of sub-micron particles (dp ~ 0.5–0.75 μm), where the fate of aerosols is greatly intertwined with local convective flows. Our findings underscore how intrinsic aerosol motion (i.e. diffusion, sedimentation) undermines the role of anisotropic wall expansion that is often attributed in determining aerosol mixing and acinar deposition. PMID:27614613

The role of anisotropic expansion for pulmonary acinar aerosol deposition.

PubMed

Hofemeier, Philipp; Sznitman, Josué

2016-10-03

Lung deformations at the local pulmonary acinar scale are intrinsically anisotropic. Despite progress in imaging modalities, the true heterogeneous nature of acinar expansion during breathing remains controversial, where our understanding of inhaled aerosol deposition still widely emanates from studies under self-similar, isotropic wall motions. Building on recent 3D models of multi-generation acinar networks, we explore in numerical simulations how different hypothesized scenarios of anisotropic expansion influence deposition outcomes of inhaled aerosols in the acinar depths. While the broader range of particles acknowledged to reach the acinar region (d p =0.005-5.0μm) are largely unaffected by the details of anisotropic expansion under tidal breathing, our results suggest nevertheless that anisotropy modulates the deposition sites and fractions for a narrow band of sub-micron particles (d p ~0.5-0.75μm), where the fate of aerosols is greatly intertwined with local convective flows. Our findings underscore how intrinsic aerosol motion (i.e. diffusion, sedimentation) undermines the role of anisotropic wall expansion that is often attributed in determining aerosol mixing and acinar deposition. Copyright © 2016 Elsevier Ltd. All rights reserved.

Particle dynamics and deposition in true-scale pulmonary acinar models.

PubMed

Fishler, Rami; Hofemeier, Philipp; Etzion, Yael; Dubowski, Yael; Sznitman, Josué

2015-09-11

Particle transport phenomena in the deep alveolated airways of the lungs (i.e. pulmonary acinus) govern deposition outcomes following inhalation of hazardous or pharmaceutical aerosols. Yet, there is still a dearth of experimental tools for resolving acinar particle dynamics and validating numerical simulations. Here, we present a true-scale experimental model of acinar structures consisting of bifurcating alveolated ducts that capture breathing-like wall motion and ensuing respiratory acinar flows. We study experimentally captured trajectories of inhaled polydispersed smoke particles (0.2 to 1 μm in diameter), demonstrating how intrinsic particle motion, i.e. gravity and diffusion, is crucial in determining dispersion and deposition of aerosols through a streamline crossing mechanism, a phenomenon paramount during flow reversal and locally within alveolar cavities. A simple conceptual framework is constructed for predicting the fate of inhaled particles near an alveolus by identifying capture and escape zones and considering how streamline crossing may shift particles between them. In addition, we examine the effect of particle size on detailed deposition patterns of monodispersed microspheres between 0.1-2 μm. Our experiments underline local modifications in the deposition patterns due to gravity for particles ≥0.5 μm compared to smaller particles, and show good agreement with corresponding numerical simulations.

Particle dynamics and deposition in true-scale pulmonary acinar models

PubMed Central

Fishler, Rami; Hofemeier, Philipp; Etzion, Yael; Dubowski, Yael; Sznitman, Josué

2015-01-01

Particle transport phenomena in the deep alveolated airways of the lungs (i.e. pulmonary acinus) govern deposition outcomes following inhalation of hazardous or pharmaceutical aerosols. Yet, there is still a dearth of experimental tools for resolving acinar particle dynamics and validating numerical simulations. Here, we present a true-scale experimental model of acinar structures consisting of bifurcating alveolated ducts that capture breathing-like wall motion and ensuing respiratory acinar flows. We study experimentally captured trajectories of inhaled polydispersed smoke particles (0.2 to 1 μm in diameter), demonstrating how intrinsic particle motion, i.e. gravity and diffusion, is crucial in determining dispersion and deposition of aerosols through a streamline crossing mechanism, a phenomenon paramount during flow reversal and locally within alveolar cavities. A simple conceptual framework is constructed for predicting the fate of inhaled particles near an alveolus by identifying capture and escape zones and considering how streamline crossing may shift particles between them. In addition, we examine the effect of particle size on detailed deposition patterns of monodispersed microspheres between 0.1–2 μm. Our experiments underline local modifications in the deposition patterns due to gravity for particles ≥0.5 μm compared to smaller particles, and show good agreement with corresponding numerical simulations. PMID:26358580

Roller-massager application to the quadriceps and knee-joint range of motion and neuromuscular efficiency during a lunge.

PubMed

Bradbury-Squires, David J; Noftall, Jennifer C; Sullivan, Kathleen M; Behm, David G; Power, Kevin E; Button, Duane C

2015-02-01

Roller massagers are used as a recovery and rehabilitative tool to initiate muscle relaxation and improve range of motion (ROM) and muscular performance. However, research demonstrating such effects is lacking. To determine the effects of applying a roller massager for 20 and 60 seconds on knee-joint ROM and dynamic muscular performance. Randomized controlled clinical trial. University laboratory. Ten recreationally active men (age = 26.6 ± 5.2 years, height = 175.3 ± 4.3 cm, mass = 84.4 ± 8.8 kg). Participants performed 3 randomized experimental conditions separated by 24 to 48 hours. In condition 1 (5 repetitions of 20 seconds) and condition 2 (5 repetitions of 60 seconds), they applied a roller massager to the quadriceps muscles. Condition 3 served as a control condition in which participants sat quietly. Visual analog pain scale, electromyography (EMG) of the vastus lateralis (VL) and biceps femoris during roller massage and lunge, and knee-joint ROM. We found no differences in pain between the 20-second and 60-second roller-massager conditions. During 60 seconds of roller massage, pain was 13.5% (5.7 ± 0.70) and 20.6% (6.2 ± 0.70) greater at 40 seconds and 60 seconds, respectively, than at 20 seconds (P < .05). During roller massage, VL and biceps femoris root mean square (RMS) EMG was 8% and 7%, respectively, of RMS EMG recorded during maximal voluntary isometric contraction. Knee-joint ROM was 10% and 16% greater in the 20-second and 60-second roller-massager conditions, respectively, than the control condition (P < .05). Finally, average lunge VL RMS EMG decreased as roller-massage time increased (P < .05). Roller massage was painful and induced muscle activity, but it increased knee-joint ROM and neuromuscular efficiency during a lunge.

Time series analyses of breathing patterns of lung cancer patients using nonlinear dynamical system theory.

PubMed

Tewatia, D K; Tolakanahalli, R P; Paliwal, B R; Tomé, W A

2011-04-07

The underlying requirements for successful implementation of any efficient tumour motion management strategy are regularity and reproducibility of a patient's breathing pattern. The physiological act of breathing is controlled by multiple nonlinear feedback and feed-forward couplings. It would therefore be appropriate to analyse the breathing pattern of lung cancer patients in the light of nonlinear dynamical system theory. The purpose of this paper is to analyse the one-dimensional respiratory time series of lung cancer patients based on nonlinear dynamics and delay coordinate state space embedding. It is very important to select a suitable pair of embedding dimension 'm' and time delay 'τ' when performing a state space reconstruction. Appropriate time delay and embedding dimension were obtained using well-established methods, namely mutual information and the false nearest neighbour method, respectively. Establishing stationarity and determinism in a given scalar time series is a prerequisite to demonstrating that the nonlinear dynamical system that gave rise to the scalar time series exhibits a sensitive dependence on initial conditions, i.e. is chaotic. Hence, once an appropriate state space embedding of the dynamical system has been reconstructed, we show that the time series of the nonlinear dynamical systems under study are both stationary and deterministic in nature. Once both criteria are established, we proceed to calculate the largest Lyapunov exponent (LLE), which is an invariant quantity under time delay embedding. The LLE for all 16 patients is positive, which along with stationarity and determinism establishes the fact that the time series of a lung cancer patient's breathing pattern is not random or irregular, but rather it is deterministic in nature albeit chaotic. These results indicate that chaotic characteristics exist in the respiratory waveform and techniques based on state space dynamics should be employed for tumour motion management.

Target position uncertainty during visually guided deep-inspiration breath-hold radiotherapy in locally advanced lung cancer.

PubMed

Scherman Rydhög, Jonas; Riisgaard de Blanck, Steen; Josipovic, Mirjana; Irming Jølck, Rasmus; Larsen, Klaus Richter; Clementsen, Paul; Lars Andersen, Thomas; Poulsen, Per Rugaard; Fredberg Persson, Gitte; Munck Af Rosenschold, Per

2017-04-01

The purpose of this study was to estimate the uncertainty in voluntary deep-inspiration breath-hold (DIBH) radiotherapy for locally advanced non-small cell lung cancer (NSCLC) patients. Perpendicular fluoroscopic movies were acquired in free breathing (FB) and DIBH during a course of visually guided DIBH radiotherapy of nine patients with NSCLC. Patients had liquid markers injected in mediastinal lymph nodes and primary tumours. Excursion, systematic- and random errors, and inter-breath-hold position uncertainty were investigated using an image based tracking algorithm. A mean reduction of 2-6mm in marker excursion in DIBH versus FB was seen in the anterior-posterior (AP), left-right (LR) and cranio-caudal (CC) directions. Lymph node motion during DIBH originated from cardiac motion. The systematic- (standard deviation (SD) of all the mean marker positions) and random errors (root-mean-square of the intra-BH SD) during DIBH were 0.5 and 0.3mm (AP), 0.5 and 0.3mm (LR), 0.8 and 0.4mm (CC), respectively. The mean inter-breath-hold shifts were -0.3mm (AP), -0.2mm (LR), and -0.2mm (CC). Intra- and inter-breath-hold uncertainty of tumours and lymph nodes were small in visually guided breath-hold radiotherapy of NSCLC. Target motion could be substantially reduced, but not eliminated, using visually guided DIBH. Copyright © 2017 Elsevier B.V. All rights reserved.

Practical use of advanced mouse models for lung cancer.

PubMed

Safari, Roghaiyeh; Meuwissen, Ralph

2015-01-01

To date a variety of non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC) mouse models have been developed that mimic human lung cancer. Chemically induced or spontaneous lung cancer in susceptible inbred strains has been widely used, but the more recent genetically engineered somatic mouse models recapitulate much better the genotype-phenotype correlations found in human lung cancer. Additionally, improved orthotopic transplantation of primary human cancer tissue fragments or cells into lungs of immune-compromised mice can be valuable tools for preclinical research such as antitumor drug tests. Here we give a short overview of most somatic mouse models for lung cancer that are currently in use. We accompany each different model with a description of its practical use and application for all major lung tumor types, as well as the intratracheal injection or direct injection of fresh or freeze-thawed tumor cells or tumor cell lines into lung parenchyma of recipient mice. All here presented somatic mouse models are based on the ability to (in) activate specific alleles at a time, and in a tissue-specific cell type, of choice. This spatial-temporal controlled induction of genetic lesions allows the selective introduction of main genetic lesions in an adult mouse lung as found in human lung cancer. The resulting conditional somatic mouse models can be used as versatile powerful tools in basic lung cancer research and preclinical translational studies alike. These distinctively advanced lung cancer models permit us to investigate initiation (cell of origin) and progression of lung cancer, along with response and resistance to drug therapy. Cre/lox or FLP/frt recombinase-mediated methods are now well-used techniques to develop tissue-restricted lung cancer in mice with tumor-suppressor gene and/or oncogene (in)activation. Intranasal or intratracheal administration of engineered adenovirus-Cre or lentivirus-Cre has been optimized for introducing Cre recombinase activity into pulmonary tissues, and we discuss here the different techniques underlying these applications. Concomitant with Cre/Flp recombinase-based models are the tetracycline (Tet)-inducible bitransgenic systems in which presence or absence of doxycycline can turn the expression of a specific oncogene on or off. The use of several Tet-inducible lung cancer models for NSCLC is presented here in which the reversal of oncogene expression led to complete tumor regression and provided us with important insight of how oncogene dependence influence lung cancer survival and growth. As alternative to Tet-inducible models, we discuss the application of reversible expressed, transgenic mutant estrogen receptor (ER) fusion proteins, which are regulated via systemic tamoxifen administration. Most of the various lung cancer models can be combined through the generation of transgenic compound mice so that the use of these somatic mouse models can be even more enhanced for the study of specific molecular pathways that facilitate growth and maintenance of lung cancer. Finally, this description of the practical application and methodology of mouse models for lung cancer should be helpful in assisting researchers to make the best choices and optimal use of (existing) somatic models that suits the specific experimental needs in their study of lung cancer.

Multi-phase simultaneous segmentation of tumor in lung 4D-CT data with context information.

PubMed

Shen, Zhengwen; Wang, Huafeng; Xi, Weiwen; Deng, Xiaogang; Chen, Jin; Zhang, Yu

2017-01-01

Lung 4D computed tomography (4D-CT) plays an important role in high-precision radiotherapy because it characterizes respiratory motion, which is crucial for accurate target definition. However, the manual segmentation of a lung tumor is a heavy workload for doctors because of the large number of lung 4D-CT data slices. Meanwhile, tumor segmentation is still a notoriously challenging problem in computer-aided diagnosis. In this paper, we propose a new method based on an improved graph cut algorithm with context information constraint to find a convenient and robust approach of lung 4D-CT tumor segmentation. We combine all phases of the lung 4D-CT into a global graph, and construct a global energy function accordingly. The sub-graph is first constructed for each phase. A context cost term is enforced to achieve segmentation results in every phase by adding a context constraint between neighboring phases. A global energy function is finally constructed by combining all cost terms. The optimization is achieved by solving a max-flow/min-cut problem, which leads to simultaneous and robust segmentation of the tumor in all the lung 4D-CT phases. The effectiveness of our approach is validated through experiments on 10 different lung 4D-CT cases. The comparison with the graph cut without context constraint, the level set method and the graph cut with star shape prior demonstrates that the proposed method obtains more accurate and robust segmentation results.

Multislice CT perfusion imaging of the lung in detection of pulmonary embolism

NASA Astrophysics Data System (ADS)

Hong, Helen; Lee, Jeongjin

2006-03-01

We propose a new subtraction technique for accurately imaging lung perfusion and efficiently detecting pulmonary embolism in chest MDCT angiography. Our method is composed of five stages. First, optimal segmentation technique is performed for extracting same volume of the lungs, major airway and vascular structures from pre- and post-contrast images with different lung density. Second, initial registration based on apex, hilar point and center of inertia (COI) of each unilateral lung is proposed to correct the gross translational mismatch. Third, initial alignment is refined by iterative surface registration. For fast and robust convergence of the distance measure to the optimal value, a 3D distance map is generated by the narrow-band distance propagation. Fourth, 3D nonlinear filter is applied to the lung parenchyma to compensate for residual spiral artifacts and artifacts caused by heart motion. Fifth, enhanced vessels are visualized by subtracting registered pre-contrast images from post-contrast images. To facilitate visualization of parenchyma enhancement, color-coded mapping and image fusion is used. Our method has been successfully applied to ten patients of pre- and post-contrast images in chest MDCT angiography. Experimental results show that the performance of our method is very promising compared with conventional methods with the aspects of its visual inspection, accuracy and processing time.

Highly accurate fast lung CT registration

NASA Astrophysics Data System (ADS)

Rühaak, Jan; Heldmann, Stefan; Kipshagen, Till; Fischer, Bernd

2013-03-01

Lung registration in thoracic CT scans has received much attention in the medical imaging community. Possible applications range from follow-up analysis, motion correction for radiation therapy, monitoring of air flow and pulmonary function to lung elasticity analysis. In a clinical environment, runtime is always a critical issue, ruling out quite a few excellent registration approaches. In this paper, a highly efficient variational lung registration method based on minimizing the normalized gradient fields distance measure with curvature regularization is presented. The method ensures diffeomorphic deformations by an additional volume regularization. Supplemental user knowledge, like a segmentation of the lungs, may be incorporated as well. The accuracy of our method was evaluated on 40 test cases from clinical routine. In the EMPIRE10 lung registration challenge, our scheme ranks third, with respect to various validation criteria, out of 28 algorithms with an average landmark distance of 0.72 mm. The average runtime is about 1:50 min on a standard PC, making it by far the fastest approach of the top-ranking algorithms. Additionally, the ten publicly available DIR-Lab inhale-exhale scan pairs were registered to subvoxel accuracy at computation times of only 20 seconds. Our method thus combines very attractive runtimes with state-of-the-art accuracy in a unique way.

Measurement of vibration-induced volumetric strain in the human lung.

PubMed

Hirsch, Sebastian; Posnansky, Oleg; Papazoglou, Sebastian; Elgeti, Thomas; Braun, Jürgen; Sack, Ingolf

2013-03-01

Noninvasive image-based measurement of intrinsic tissue pressure is of great interest in the diagnosis and characterization of diseases. Therefore, we propose to exploit the capability of phase-contrast MRI to measure three-dimensional vector fields of tissue motion for deriving volumetric strain induced by external vibration. Volumetric strain as given by the divergence of mechanical displacement fields is related to tissue compressibility and is thus sensitive to the state of tissue pressure. This principle is demonstrated by the measurement of three-dimensional vector fields of 50-Hz oscillations in a compressible agarose phantom and in the lungs of nine healthy volunteers. In the phantom, the magnitude of the oscillating divergence increased by about 400% with 4.8 bar excess air pressure, corresponding to an effective-medium compression modulus of 230 MPa. In lungs, the averaged divergence magnitude increased in all volunteers (N = 9) between 7 and 78% from expiration to inspiration. Measuring volumetric strain by MRI provides a compression-sensitive parameter of tissue mechanics, which varies with the respiratory state in the lungs. In future clinical applications for diagnosis and characterization of lung emphysema, fibrosis, or cancer, divergence-sensitive MRI may serve as a noninvasive marker sensitive to disease-related alterations of regional elastic recoil pressure in the lungs. Copyright © 2012 Wiley Periodicals, Inc.

TH-EF-BRA-08: A Novel Technique for Estimating Volumetric Cine MRI (VC-MRI) From Multi-Slice Sparsely Sampled Cine Images Using Motion Modeling and Free Form Deformation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Harris, W; Yin, F; Wang, C

Purpose: To develop a technique to estimate on-board VC-MRI using multi-slice sparsely-sampled cine images, patient prior 4D-MRI, motion-modeling and free-form deformation for real-time 3D target verification of lung radiotherapy. Methods: A previous method has been developed to generate on-board VC-MRI by deforming prior MRI images based on a motion model(MM) extracted from prior 4D-MRI and a single-slice on-board 2D-cine image. In this study, free-form deformation(FD) was introduced to correct for errors in the MM when large anatomical changes exist. Multiple-slice sparsely-sampled on-board 2D-cine images located within the target are used to improve both the estimation accuracy and temporal resolution ofmore » VC-MRI. The on-board 2D-cine MRIs are acquired at 20–30frames/s by sampling only 10% of the k-space on Cartesian grid, with 85% of that taken at the central k-space. The method was evaluated using XCAT(computerized patient model) simulation of lung cancer patients with various anatomical and respirational changes from prior 4D-MRI to onboard volume. The accuracy was evaluated using Volume-Percent-Difference(VPD) and Center-of-Mass-Shift(COMS) of the estimated tumor volume. Effects of region-of-interest(ROI) selection, 2D-cine slice orientation, slice number and slice location on the estimation accuracy were evaluated. Results: VCMRI estimated using 10 sparsely-sampled sagittal 2D-cine MRIs achieved VPD/COMS of 9.07±3.54%/0.45±0.53mm among all scenarios based on estimation with ROI-MM-ROI-FD. The FD optimization improved estimation significantly for scenarios with anatomical changes. Using ROI-FD achieved better estimation than global-FD. Changing the multi-slice orientation to axial, coronal, and axial/sagittal orthogonal reduced the accuracy of VCMRI to VPD/COMS of 19.47±15.74%/1.57±2.54mm, 20.70±9.97%/2.34±0.92mm, and 16.02±13.79%/0.60±0.82mm, respectively. Reducing the number of cines to 8 enhanced temporal resolution of VC-MRI by 25% while maintaining the estimation accuracy. Estimation using slices sampled uniformly through the tumor achieved better accuracy than slices sampled non-uniformly. Conclusions: Preliminary studies showed that it is feasible to generate VC-MRI from multi-slice sparsely-sampled 2D-cine images for real-time 3D-target verification. This work was supported by the National Institutes of Health under Grant No. R01-CA184173 and a research grant from Varian Medical Systems.« less

Microarray Meta-Analysis Identifies Acute Lung Injury Biomarkers in Donor Lungs That Predict Development of Primary Graft Failure in Recipients

PubMed Central

Haitsma, Jack J.; Furmli, Suleiman; Masoom, Hussain; Liu, Mingyao; Imai, Yumiko; Slutsky, Arthur S.; Beyene, Joseph; Greenwood, Celia M. T.; dos Santos, Claudia

2012-01-01

Objectives To perform a meta-analysis of gene expression microarray data from animal studies of lung injury, and to identify an injury-specific gene expression signature capable of predicting the development of lung injury in humans. Methods We performed a microarray meta-analysis using 77 microarray chips across six platforms, two species and different animal lung injury models exposed to lung injury with or/and without mechanical ventilation. Individual gene chips were classified and grouped based on the strategy used to induce lung injury. Effect size (change in gene expression) was calculated between non-injurious and injurious conditions comparing two main strategies to pool chips: (1) one-hit and (2) two-hit lung injury models. A random effects model was used to integrate individual effect sizes calculated from each experiment. Classification models were built using the gene expression signatures generated by the meta-analysis to predict the development of lung injury in human lung transplant recipients. Results Two injury-specific lists of differentially expressed genes generated from our meta-analysis of lung injury models were validated using external data sets and prospective data from animal models of ventilator-induced lung injury (VILI). Pathway analysis of gene sets revealed that both new and previously implicated VILI-related pathways are enriched with differentially regulated genes. Classification model based on gene expression signatures identified in animal models of lung injury predicted development of primary graft failure (PGF) in lung transplant recipients with larger than 80% accuracy based upon injury profiles from transplant donors. We also found that better classifier performance can be achieved by using meta-analysis to identify differentially-expressed genes than using single study-based differential analysis. Conclusion Taken together, our data suggests that microarray analysis of gene expression data allows for the detection of “injury" gene predictors that can classify lung injury samples and identify patients at risk for clinically relevant lung injury complications. PMID:23071521

Role of collateral paths in long-range diffusion in lungs

PubMed Central

Bartel, Seth-Emil T.; Haywood, Susan E.; Woods, Jason C.; Chang, Yulin V.; Menard, Christopher; Yablonskiy, Dmitriy A.; Gierada, David S.; Conradi, Mark S.

2010-01-01

The long-range apparent diffusion coefficient (LRADC) of 3He gas in lungs, measured over times of several seconds and distances of 1–3 cm, probes the connections between the airways. Previous work has shown the LRADC to be small in health and substantially elevated in emphysema, reflecting tissue destruction, which is known to create collateral pathways. To better understand what controls LRADC, we report computer simulations and measurements of 3He gas diffusion in healthy lungs. The lung is generated with a random algorithm using well-defined rules, yielding a three-dimensional set of nodes or junctions, each connected by airways to one parent node and two daughters; airway dimensions are taken from published values. Spin magnetization in the simulated lung is modulated sinusoidally, and the diffusion equation is solved to 1,000 s. The modulated magnetization decays with a time constant corresponding to an LRADC of ~0.001 cm2/s, which is smaller by a factor of ~20 than the values in healthy lungs measured here and previously in vivo and in explanted lungs. It appears that collateral gas pathways, not present in the simulations, are functional in healthy lungs; they provide additional and more direct routes for long-range motion than the canonical airway tree. This is surprising, inasmuch as collateral ventilation is believed to be physiologically insignificant in healthy lungs. We discuss the effect on LRADC of small collateral connections through airway walls and rule out other possible mechanisms. The role of collateral paths is supported by measurements of smaller LRADC in pigs, where collateral ventilation is known to be smaller. PMID:18292298

Assessment of regional ventilation and deformation using 4D-CT imaging for healthy human lungs during tidal breathing

PubMed Central

Jahani, Nariman; Choi, Jiwoong; Iyer, Krishna; Hoffman, Eric A.

2015-01-01

This study aims to assess regional ventilation, nonlinearity, and hysteresis of human lungs during dynamic breathing via image registration of four-dimensional computed tomography (4D-CT) scans. Six healthy adult humans were studied by spiral multidetector-row CT during controlled tidal breathing as well as during total lung capacity and functional residual capacity breath holds. Static images were utilized to contrast static vs. dynamic (deep vs. tidal) breathing. A rolling-seal piston system was employed to maintain consistent tidal breathing during 4D-CT spiral image acquisition, providing required between-breath consistency for physiologically meaningful reconstructed respiratory motion. Registration-derived variables including local air volume and anisotropic deformation index (ADI, an indicator of preferential deformation in response to local force) were employed to assess regional ventilation and lung deformation. Lobar distributions of air volume change during tidal breathing were correlated with those of deep breathing (R2 ≈ 0.84). Small discrepancies between tidal and deep breathing were shown to be likely due to different distributions of air volume change in the left and the right lungs. We also demonstrated an asymmetric characteristic of flow rate between inhalation and exhalation. With ADI, we were able to quantify nonlinearity and hysteresis of lung deformation that can only be captured in dynamic images. Nonlinearity quantified by ADI is greater during inhalation, and it is stronger in the lower lobes (P < 0.05). Lung hysteresis estimated by the difference of ADI between inhalation and exhalation is more significant in the right lungs than that in the left lungs. PMID:26316512

SU-G-TeP1-06: Fast GPU Framework for Four-Dimensional Monte Carlo in Adaptive Intensity Modulated Proton Therapy (IMPT) for Mobile Tumors

DOE Office of Scientific and Technical Information (OSTI.GOV)

Botas, P; Heidelberg University, Heidelberg; Grassberger, C

Purpose: To demonstrate the feasibility of fast Monte Carlo (MC) treatment planning and verification using four-dimensional CT (4DCT) for adaptive IMPT for lung cancer patients. Methods: A validated GPU MC code, gPMC, has been linked to the patient database at our institution and employed to compute the dose-influence matrices (Dij) on the planning CT (pCT). The pCT is an average of the respiratory motion of the patient. The Dijs and patient structures were fed to the optimizer to calculate a treatment plan. To validate the plan against motion, a 4D dose distribution averaged over the possible starting phases is calculatedmore » using the 4DCT and a model of the time structure of the delivered spot map. The dose is accumulated using vector maps created by a GPU-accelerated deformable image registration program (DIR) from each phase of the 4DCT to the reference phase using the B-spline method. Calculation of the Dij matrices and the DIR are performed on a cluster, with each field and vector map calculated in parallel. Results: The Dij production takes ∼3.5s per beamlet for 10e6 protons, depending on the energy and the CT size. Generating a plan with 4D simulation of 1000 spots in 4 fields takes approximately 1h. To test the framework, IMPT plans for 10 lung cancer patients were generated for validation. Differences between the planned and the delivered dose of 19% in dose to some organs at risk and 1.4/21.1% in target mean dose/homogeneity with respect to the plan were observed, suggesting potential for improvement if adaptation is considered. Conclusion: A fast MC treatment planning framework has been developed that allows reliable plan design and verification for mobile targets and adaptation of treatment plans. This will significantly impact treatments for lung tumors, as 4D-MC dose calculations can now become part of planning strategies.« less

Joint Kinetics and Kinematics During Common Lower Limb Rehabilitation Exercises

PubMed Central

Comfort, Paul; Jones, Paul Anthony; Smith, Laura Constance; Herrington, Lee

2015-01-01

Context  Unilateral body-weight exercises are commonly used to strengthen the lower limbs during rehabilitation after injury, but data comparing the loading of the limbs during these tasks are limited. Objective  To compare joint kinetics and kinematics during 3 commonly used rehabilitation exercises. Design  Descriptive laboratory study. Setting  Laboratory. Patients or Other Participants  A total of 9 men (age = 22.1 ± 1.3 years, height = 1.76 ± 0.08 m, mass = 80.1 ± 12.2 kg) participated. Intervention(s)  Participants performed the single-legged squat, forward lunge, and reverse lunge with kinetic data captured via 2 force plates and 3-dimensional kinematic data collected using a motion-capture system. Main Outcome Measure(s)  Peak ground reaction forces, maximum joint angles, and peak sagittal-joint moments. Results  We observed greater eccentric and concentric peak vertical ground reaction forces during the single-legged squat than during both lunge variations (P ≤ .001). Both lunge variations demonstrated greater knee and hip angles than did the single-legged squat (P < .001), but we observed no differences between lunges (P > .05). Greater dorsiflexion occurred during the single-legged squat than during both lunge variations (P < .05), but we noted no differences between lunge variations (P = .70). Hip-joint moments were greater during the forward lunge than during the reverse lunge (P = .003) and the single-legged squat (P = .011). Knee-joint moments were greater in the single-legged squat than in the reverse lunge (P < .001) but not greater in the single-legged squat than in the forward lunge (P = .41). Ankle-joint moments were greater during the single-legged squat than during the forward lunge (P = .002) and reverse lunge (P < .001). Conclusions  Appropriate loading progressions for the hip should begin with the single-legged squat and progress to the reverse lunge and then the forward lunge. In contrast, loading progressions for the knee and ankle should begin with the reverse lunge and progress to the forward lunge and then the single-legged squat. PMID:26418958

SU-E-T-560: Inter- and Intra-Fraction Variations in Esophageal Dose for Lung Cancer Patients, and the Impact of Setup Technique and Treatment Modality.

PubMed

Carroll, M; Cheung, J; Zhang, L; Court, L

2012-06-01

To understand the dose-response of the esophagus in photon and proton therapy, it is important to appreciate the variations in delivered dose caused by inter- and intra-fraction motion. Four lung cancer patients were identified who had experienced grade 3 esophagitis during their treatment, and for whom their esophagus was close, but not encompassed by, the treatment volume. Each patient had been treated with proton therapy using 35-37 2Gy fractions, and had received weekly 4DCT imaging. IMRT plans were also created using the same treatment planning constraints. In-house image registration software was used to deform the esophagus contour from the treatment plan to each phase of the 4DCT for each weekly image set. Daily setup using both bony and soft tissue (GTV) registration was simulated, and the treatment dose calculated for each CT image. Changes to the esophagus DVH relative to the treatment plan were quantified in terms of the relative volume of the esophagus receiving 45, 55, and 65Gy (V45, V55 and V65). For all combinations of treatment modality (photon, proton) and setup method (bony, GTV), intra-fraction motion resulted in a range of V45, V55 and V65 from 3.6 to 5.5%. Inter-fraction motion comparing daily exhale or inhale phases showed the range of V45, V55 and V65 from 8.5 to 18.6% (exhale) and 9.8 to 16.3% (inhale). Inter-fractional motion resulted in larger variations in dose delivered to the esophagus than intra-fractional motion. The inter-fraction range for V45, V55 and V65 varied by around 10% between patients. The treatment modality (photon, proton) and setup technique (bony, GTV) had minimal impact on the results. © 2012 American Association of Physicists in Medicine.

Optimisation of quantitative lung SPECT applied to mild COPD: a software phantom simulation study.

PubMed

Norberg, Pernilla; Olsson, Anna; Alm Carlsson, Gudrun; Sandborg, Michael; Gustafsson, Agnetha

2015-01-01

The amount of inhomogeneities in a (99m)Tc Technegas single-photon emission computed tomography (SPECT) lung image, caused by reduced ventilation in lung regions affected by chronic obstructive pulmonary disease (COPD), is correlated to disease advancement. A quantitative analysis method, the CVT method, measuring these inhomogeneities was proposed in earlier work. To detect mild COPD, which is a difficult task, optimised parameter values are needed. In this work, the CVT method was optimised with respect to the parameter values of acquisition, reconstruction and analysis. The ordered subset expectation maximisation (OSEM) algorithm was used for reconstructing the lung SPECT images. As a first step towards clinical application of the CVT method in detecting mild COPD, this study was based on simulated SPECT images of an advanced anthropomorphic lung software phantom including respiratory and cardiac motion, where the mild COPD lung had an overall ventilation reduction of 5%. The best separation between healthy and mild COPD lung images as determined using the CVT measure of ventilation inhomogeneity and 125 MBq (99m)Tc was obtained using a low-energy high-resolution collimator (LEHR) and a power 6 Butterworth post-filter with a cutoff frequency of 0.6 to 0.7 cm(-1). Sixty-four reconstruction updates and a small kernel size should be used when the whole lung is analysed, and for the reduced lung a greater number of updates and a larger kernel size are needed. A LEHR collimator and 125 (99m)Tc MBq together with an optimal combination of cutoff frequency, number of updates and kernel size, gave the best result. Suboptimal selections of either cutoff frequency, number of updates and kernel size will reduce the imaging system's ability to detect mild COPD in the lung phantom.

A method for the elimination of artefacts in electric field plethysmography of the lung.

PubMed

Pfützner, H; Futschik, K; Doblander, A; Schenz, G; Zwick, H

1990-01-01

The reliability of electric plethysmography for respiration monitoring is reduced by artefacts caused by the cardiac activity, by motions, electromagnetic cross-talk and others. For artefact suppression, a constant-current field-plethysmography technique is discussed which uses the voltage of an auxiliary electrode in addition to the conventional four-electrode arrangement. By means of a differential amplifier, a respiration signal is produced which is almost entirely free from heart artefacts, while the intensity of additional artefacts is suppressed. In principle, the technique can also be used for the separate determination of the ventilation intensity of the two lungs.

Non-contrast-enhanced perfusion and ventilation assessment of the human lung by means of fourier decomposition in proton MRI.

PubMed

Bauman, Grzegorz; Puderbach, Michael; Deimling, Michael; Jellus, Vladimir; Chefd'hotel, Christophe; Dinkel, Julien; Hintze, Christian; Kauczor, Hans-Ulrich; Schad, Lothar R

2009-09-01

Assessment of regional lung perfusion and ventilation has significant clinical value for the diagnosis and follow-up of pulmonary diseases. In this work a new method of non-contrast-enhanced functional lung MRI (not dependent on intravenous or inhalative contrast agents) is proposed. A two-dimensional (2D) true fast imaging with steady precession (TrueFISP) pulse sequence (TR/TE = 1.9 ms/0.8 ms, acquisition time [TA] = 112 ms/image) was implemented on a 1.5T whole-body MR scanner. The imaging protocol comprised sets of 198 lung images acquired with an imaging rate of 3.33 images/s in coronal and sagittal view. No electrocardiogram (ECG) or respiratory triggering was used. A nonrigid image registration algorithm was applied to compensate for respiratory motion. Rapid data acquisition allowed observing intensity changes in corresponding lung areas with respect to the cardiac and respiratory frequencies. After a Fourier analysis along the time domain, two spectral lines corresponding to both frequencies were used to calculate the perfusion- and ventilation-weighted images. The described method was applied in preliminary studies on volunteers and patients showing clinical relevance to obtain non-contrast-enhanced perfusion and ventilation data.

Particle transport and deposition: basic physics of particle kinetics

PubMed Central

Tsuda, Akira; Henry, Frank S.; Butler, James P.

2015-01-01

The human body interacts with the environment in many different ways. The lungs interact with the external environment through breathing. The enormously large surface area of the lung with its extremely thin air-blood barrier is exposed to particles suspended in the inhaled air. Whereas the particle-lung interaction may cause deleterious effects on health if the inhaled pollutant aerosols are toxic, this interaction can be beneficial for disease treatment if the inhaled particles are therapeutic aerosolized drug. In either case, an accurate estimation of dose and sites of deposition in the respiratory tract is fundamental to understanding subsequent biological response, and the basic physics of particle motion and engineering knowledge needed to understand these subjects is the topic of this chapter. A large portion of this chapter deals with three fundamental areas necessary to the understanding of particle transport and deposition in the respiratory tract. These are: 1) the physical characteristics of particles, 2) particle behavior in gas flow, and 3) gas flow patterns in the respiratory tract. Other areas, such as particle transport in the developing lung and in the diseased lung are also considered. The chapter concludes with a summary and a brief discussion of areas of future research. PMID:24265235

Noncalcified Lung Nodules: Volumetric Assessment with Thoracic CT

PubMed Central

Gavrielides, Marios A.; Kinnard, Lisa M.; Myers, Kyle J.; Petrick, Nicholas

2009-01-01

Lung nodule volumetry is used for nodule diagnosis, as well as for monitoring tumor response to therapy. Volume measurement precision and accuracy depend on a number of factors, including image-acquisition and reconstruction parameters, nodule characteristics, and the performance of algorithms for nodule segmentation and volume estimation. The purpose of this article is to provide a review of published studies relevant to the computed tomographic (CT) volumetric analysis of lung nodules. A number of underexamined areas of research regarding volumetric accuracy are identified, including the measurement of nonsolid nodules, the effects of pitch and section overlap, and the effect of respiratory motion. The need for public databases of phantom scans, as well as of clinical data, is discussed. The review points to the need for continued research to examine volumetric accuracy as a function of a multitude of interrelated variables involved in the assessment of lung nodules. Understanding and quantifying the sources of volumetric measurement error in the assessment of lung nodules with CT would be a first step toward the development of methods to minimize that error through system improvements and to correctly account for any remaining error. © RSNA, 2009 PMID:19332844

Development and validation of risk models to select ever-smokers for CT lung-cancer screening

PubMed Central

Katki, Hormuzd A.; Kovalchik, Stephanie A.; Berg, Christine D.; Cheung, Li C.; Chaturvedi, Anil K.

2016-01-01

Importance The US Preventive Services Task Force (USPSTF) recommends computed-tomography (CT) lung-cancer screening for ever-smokers ages 55-80 years who smoked at least 30 pack-years with no more than 15 years since quitting. However, selecting ever-smokers for screening using individualized lung-cancer risk calculations may be more effective and efficient than current USPSTF recommendations. Objective Comparison of modeled outcomes from risk-based CT lung-screening strategies versus USPSTF recommendations. Design/Setting/Participants Empirical risk models for lung-cancer incidence and death in the absence of CT screening using data on ever-smokers from the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (PLCO; 1993-2009) control group. Covariates included age, education, sex, race, smoking intensity/duration/quit-years, Body Mass Index, family history of lung-cancer, and self-reported emphysema. Model validation in the chest radiography groups of the PLCO and the National Lung Screening Trial (NLST; 2002-2009), with additional validation of the death model in the National Health Interview Survey (NHIS; 1997-2001), a representative sample of the US. Models applied to US ever-smokers ages 50-80 (NHIS 2010-2012) to estimate outcomes of risk-based selection for CT lung-screening, assuming screening for all ever-smokers yields the percent changes in lung-cancer detection and death observed in the NLST. Exposure Annual CT lung-screening for 3 years. Main Outcomes and Measures Model validity: calibration (number of model-predicted cases divided by number of observed cases (Estimated/Observed)) and discrimination (Area-Under-Curve (AUC)). Modeled screening outcomes: estimated number of screen-avertable lung-cancer deaths, estimated screening effectiveness (number needed to screen (NNS) to prevent 1 lung-cancer death). Results Lung-cancer incidence and death risk models were well-calibrated in PLCO and NLST. The lung-cancer death model calibrated and discriminated well for US ever-smokers ages 50-80 (NHIS 1997-2001: Estimated/Observed=0.94, 95%CI=0.84-1.05; AUC=0.78, 95%CI=0.76-0.80). Under USPSTF recommendations, the models estimated 9.0 million US ever-smokers would qualify for lung-cancer screening and 46,488 (95%CI=43,924-49,053) lung-cancer deaths were estimated as screen-avertable over 5 years (estimated NNS=194, 95%CI=187-201). In contrast, risk-based selection screening the same number of ever-smokers (9.0 million) at highest 5-year lung-cancer risk (≥1.9%), was estimated to avert 20% more deaths (55,717; 95%CI=53,033-58,400) and was estimated to reduce the estimated NNS by 17% (NNS=162, 95%CI=157-166). Conclusions and Relevance Among a cohort of US ever-smokers age 50-80 years, application of a risk-based model for CT screening for lung cancer compared with a model based on USPSTF recommendations was estimated to be associated with a greater number of lung-cancer deaths prevented over 5 years along with a lower NNS to prevent 1 lung-cancer death. PMID:27179989

Development and Validation of Risk Models to Select Ever-Smokers for CT Lung Cancer Screening.

PubMed

Katki, Hormuzd A; Kovalchik, Stephanie A; Berg, Christine D; Cheung, Li C; Chaturvedi, Anil K

2016-06-07

The US Preventive Services Task Force (USPSTF) recommends computed tomography (CT) lung cancer screening for ever-smokers aged 55 to 80 years who have smoked at least 30 pack-years with no more than 15 years since quitting. However, selecting ever-smokers for screening using individualized lung cancer risk calculations may be more effective and efficient than current USPSTF recommendations. Comparison of modeled outcomes from risk-based CT lung-screening strategies vs USPSTF recommendations. Empirical risk models for lung cancer incidence and death in the absence of CT screening using data on ever-smokers from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO; 1993-2009) control group. Covariates included age; education; sex; race; smoking intensity, duration, and quit-years; body mass index; family history of lung cancer; and self-reported emphysema. Model validation in the chest radiography groups of the PLCO and the National Lung Screening Trial (NLST; 2002-2009), with additional validation of the death model in the National Health Interview Survey (NHIS; 1997-2001), a representative sample of the United States. Models were applied to US ever-smokers aged 50 to 80 years (NHIS 2010-2012) to estimate outcomes of risk-based selection for CT lung screening, assuming screening for all ever-smokers, yield the percent changes in lung cancer detection and death observed in the NLST. Annual CT lung screening for 3 years beginning at age 50 years. For model validity: calibration (number of model-predicted cases divided by number of observed cases [estimated/observed]) and discrimination (area under curve [AUC]). For modeled screening outcomes: estimated number of screen-avertable lung cancer deaths and estimated screening effectiveness (number needed to screen [NNS] to prevent 1 lung cancer death). Lung cancer incidence and death risk models were well calibrated in PLCO and NLST. The lung cancer death model calibrated and discriminated well for US ever-smokers aged 50 to 80 years (NHIS 1997-2001: estimated/observed = 0.94 [95%CI, 0.84-1.05]; AUC, 0.78 [95%CI, 0.76-0.80]). Under USPSTF recommendations, the models estimated 9.0 million US ever-smokers would qualify for lung cancer screening and 46,488 (95% CI, 43,924-49,053) lung cancer deaths were estimated as screen-avertable over 5 years (estimated NNS, 194 [95% CI, 187-201]). In contrast, risk-based selection screening of the same number of ever-smokers (9.0 million) at highest 5-year lung cancer risk (≥1.9%) was estimated to avert 20% more deaths (55,717 [95% CI, 53,033-58,400]) and was estimated to reduce the estimated NNS by 17% (NNS, 162 [95% CI, 157-166]). Among a cohort of US ever-smokers aged 50 to 80 years, application of a risk-based model for CT screening for lung cancer compared with a model based on USPSTF recommendations was estimated to be associated with a greater number of lung cancer deaths prevented over 5 years, along with a lower NNS to prevent 1 lung cancer death.

Free-breathing pediatric chest MRI: Performance of self-navigated golden-angle ordered conical ultrashort echo time acquisition.

PubMed

Zucker, Evan J; Cheng, Joseph Y; Haldipur, Anshul; Carl, Michael; Vasanawala, Shreyas S

2018-01-01

To assess the feasibility and performance of conical k-space trajectory free-breathing ultrashort echo time (UTE) chest magnetic resonance imaging (MRI) versus four-dimensional (4D) flow and effects of 50% data subsampling and soft-gated motion correction. Thirty-two consecutive children who underwent both 4D flow and UTE ferumoxytol-enhanced chest MR (mean age: 5.4 years, range: 6 days to 15.7 years) in one 3T exam were recruited. From UTE k-space data, three image sets were reconstructed: 1) one with all data, 2) one using the first 50% of data, and 3) a final set with soft-gating motion correction, leveraging the signal magnitude immediately after each excitation. Two radiologists in blinded fashion independently scored image quality of anatomical landmarks on a 5-point scale. Ratings were compared using Wilcoxon rank-sum, Wilcoxon signed-ranks, and Kruskal-Wallis tests. Interobserver agreement was assessed with the intraclass correlation coefficient (ICC). For fully sampled UTE, mean scores for all structures were ≥4 (good-excellent). Full UTE surpassed 4D flow for lungs and airways (P < 0.001), with similar pulmonary artery (PA) quality (P = 0.62). 50% subsampling only slightly degraded all landmarks (P < 0.001), as did motion correction. Subsegmental PA visualization was possible in >93% scans for all techniques (P = 0.27). Interobserver agreement was excellent for combined scores (ICC = 0.83). High-quality free-breathing conical UTE chest MR is feasible, surpassing 4D flow for lungs and airways, with equivalent PA visualization. Data subsampling only mildly degraded images, favoring lesser scan times. Soft-gating motion correction overall did not improve image quality. 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;47:200-209. © 2017 International Society for Magnetic Resonance in Medicine.

Cine Computed Tomography Without Respiratory Surrogate in Planning Stereotactic Radiotherapy for Non-Small-Cell Lung Cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Riegel, Adam C. B.A.; Chang, Joe Y.; Vedam, Sastry S.

2009-02-01

Purpose: To determine whether cine computed tomography (CT) can serve as an alternative to four-dimensional (4D)-CT by providing tumor motion information and producing equivalent target volumes when used to contour in radiotherapy planning without a respiratory surrogate. Methods and Materials: Cine CT images from a commercial CT scanner were used to form maximum intensity projection and respiratory-averaged CT image sets. These image sets then were used together to define the targets for radiotherapy. Phantoms oscillating under irregular motion were used to assess the differences between contouring using cine CT and 4D-CT. We also retrospectively reviewed the image sets for 26more » patients (27 lesions) at our institution who had undergone stereotactic radiotherapy for Stage I non-small-cell lung cancer. The patients were included if the tumor motion was >1 cm. The lesions were first contoured using maximum intensity projection and respiratory-averaged CT image sets processed from cine CT and then with 4D-CT maximum intensity projection and 10-phase image sets. The mean ratios of the volume magnitude were compared with intraobserver variation, the mean centroid shifts were calculated, and the volume overlap was assessed with the normalized Dice similarity coefficient index. Results: The phantom studies demonstrated that cine CT captured a greater extent of irregular tumor motion than did 4D-CT, producing a larger tumor volume. The patient studies demonstrated that the gross tumor defined using cine CT imaging was similar to, or slightly larger than, that defined using 4D-CT. Conclusion: The results of our study have shown that cine CT is a promising alternative to 4D-CT for stereotactic radiotherapy planning.« less

Gating based on internal/external signals with dynamic correlation updates.

PubMed

Wu, Huanmei; Zhao, Qingya; Berbeco, Ross I; Nishioka, Seiko; Shirato, Hiroki; Jiang, Steve B

2008-12-21

Precise localization of mobile tumor positions in real time is critical to the success of gated radiotherapy. Tumor positions are usually derived from either internal or external surrogates. Fluoroscopic gating based on internal surrogates, such as implanted fiducial markers, is accurate however requiring a large amount of imaging dose. Gating based on external surrogates, such as patient abdominal surface motion, is non-invasive however less accurate due to the uncertainty in the correlation between tumor location and external surrogates. To address these complications, we propose to investigate an approach based on hybrid gating with dynamic internal/external correlation updates. In this approach, the external signal is acquired at high frequency (such as 30 Hz) while the internal signal is sparsely acquired (such as 0.5 Hz or less). The internal signal is used to validate and update the internal/external correlation during treatment. Tumor positions are derived from the external signal based on the newly updated correlation. Two dynamic correlation updating algorithms are introduced. One is based on the motion amplitude and the other is based on the motion phase. Nine patients with synchronized internal/external motion signals are simulated retrospectively to evaluate the effectiveness of hybrid gating. The influences of different clinical conditions on hybrid gating, such as the size of gating windows, the optimal timing for internal signal acquisition and the acquisition frequency are investigated. The results demonstrate that dynamically updating the internal/external correlation in or around the gating window will reduce false positive with relatively diminished treatment efficiency. This improvement will benefit patients with mobile tumors, especially greater for early stage lung cancers, for which the tumors are less attached or freely floating in the lung.

Sci-Fri PM: Radiation Therapy, Planning, Imaging, and Special Techniques - 04: Assessment of intra-fraction motion during lung SABR VMAT using a custom abdominal compression device

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hyde, Derek; Robinson, Mark; Araujo, Cynthia

2016-08-15

Purpose: Lung SABR patients are treated using Volumetrically Modulated Arc Therapy (VMAT), utilizing 2 arcs with Conebeam CT (CBCT) image-guidance prior to each arc. Intra-fraction imaging can prolong treatment time (up to 20%), and the aim of this study is to determine if it is necessary. Methods: We utilize an in-house abdominal compression device to minimize respiratory motion, 4DCT to define the ITV, a 5 mm PTV margin and a 2–3 mm PRV margin. We treated 23 patients with VMAT, fifteen were treated to 48 Gy in 4 fractions, while eight were treated with up to 60 Gy in 8more » fractions. Intrafraction motion was assessed by the translational errors recorded for the second CBCT. Results: There was no significant difference (t-test, p=0.93) in the intra-fraction motion between the patients treated with 4 and 8 fractions, or between the absolute translations in each direction (ANOVA, p=0.17). All 124 intra-fraction CBCT images were analysed and 95% remained localized within the 5 mm PTV margin The mean magnitude of the vector displacement was 1.8 mm. Conclusions: For patients localized with an abdominal compression device, the intrafraction CBCT image may not be necessary, if it is only the tumor coverage that is of concern, as the patients are typically well within the 5 mm PTV margin. On the other hand, if there is a structure with a smaller PRV margin, an intrafraction CBCT is recommended to ensure that the dose limit for the organ at risk is not exceeded.« less

Three-dimensional ballistocardiography and respiratory motion in sustained microgravity

NASA Technical Reports Server (NTRS)

Prisk, G. K.; Verhaeghe, S.; Padeken, D.; Hamacher, H.; Paiva, M.; West, J. B. (Principal Investigator)

2001-01-01

BACKGROUND: We measured the three-dimensional ballistocardiogram (BCG) in a free-floating subject in sustained microgravity during spaceflight to test the usefulness of such measurements for future non-invasive monitoring of cardiac function, and to examine the effects of respiratory movement on the BCG in three axes. METHODS: Acceleration was measured using a three-axis accelerometer fastened to the lumbar region of the subject while simultaneous recordings of ECG, and respiratory motion via impedance plethysmography were also made. Data were recorded during a 146-s period of inactivity on the part of the subject during which time there was no contact with the spacecraft. RESULTS: Total body motion due to respiratory activity was consistent with that calculated from the known action of the diaphragm and conservation of momentum. The accelerations due to cardiac activity, ensemble averaged over the R-R interval, were greatest along the head-to-foot axis. Maximum amplitude of the HIJK complex of the BCG generated by ventricular ejection was greatest in the head to foot axis (approximately 70 x 10(-3) m x s(-2)), but there were also substantial accelerations along the dorsoventral axis of up to 43 10(-3) m x s(-2), that are not measured interrestrial two-dimensional studies. The amplitude of the BCG was strongly affected by lung volume, with accelerations being reduced 50 to 70% between end-inspiration and end-expiration. CONCLUSIONS: These data suggest a greatly reduced transmission of the cardiac motion to the body at end-expiration (FRC) than at higher lung volumes. The BCG might be further developed as a non-invasive means of monitoring parameters such as stroke volume in microgravity.

Coordination Between Ribs Motion and Thoracoabdominal Volumes in Swimmers During Respiratory Maneuvers

PubMed Central

Sarro, Karine J.; Silvatti, Amanda P.; Barros, Ricardo M. L.

2008-01-01

This work aimed to verify if swimmers present better chest wall coordination during breathing than healthy non-athletes analyzing the correlation between ribs motion and the variation of thoracoabdominal volumes. The results of two up-to-date methods based on videogrammetry were correlated in this study. The first one measured the volumes of 4 separate compartments of the chest wall (superior thorax, inferior thorax, superior abdomen and inferior abdomen) as a function of time. The second calculated the rotation angle of the 2nd to the 10th ribs around the quasi-transversal axis also in function of time. The chest wall was represented by 53 markers, attached to the ribs, vertebrae, thorax and abdomen of 15 male swimmers and of 15 non- athletes. A kinematical analysis system equipped with 6 digital video cameras (60Hz) was used to obtain the 3D coordinates of the markers. Correlating the curves of ribs rotation angles with the curves of the separate volumes, swimmers presented higher values than non-athletes when the superior and inferior abdomen were considered and the highest correlation values were found in swimmers for the inferior thorax. These results suggest a better coordination between ribs motion and thoracoabdominal volumes in swimmers, indicating the prevalent and coordinated action of the diaphragm and abdominal muscles to inflate and deflate the chest wall. The results further suggest that swimming practice leads to the formation of an optimized breathing pattern and can partially explain the higher lung volumes found in these athletes reported in literature. Key pointsThe study revealed that swimmers present higher correlation between the ribs motion and the variation of abdominal volumes than non-swimmers, suggesting that swimming practice might lead to the formation of an optimized breathing pattern, increasing the coordination between the thoracoabdominal volumes and the ribs motion.No previous work was found in the literature reporting this optimized breathing pattern in swimmers.The higher coordination between the thoracoabdominal volumes and the ribs motion found in swimmers can partially explain the higher lung volumes reported in literature for these athletes. PMID:24149449

DOE Office of Scientific and Technical Information (OSTI.GOV)

Yan, H; Medin, P; Jiang, S

Purpose: In-treatment tumor localization is critical for the management of tumor motion in lung cancer radiotherapy. Conventional tumor-tracking methods using a kV or MV x-ray projection has limited contrast. To facilitate real-time, marker-less and low-dose in-treatment image tumor tracking, we propose a novel scheme using Compton scatter imaging. This study reports Monte Carlo (MC) simulations on this scheme for the purpose of proof-of-principle. Methods: A slit x-ray beam along the patient superior-inferior (SI) direction is directed to the patient, intersecting the patient lung at a 2D plane containing majority part of the tumor motion trajectory. X-ray photons are scattered duemore » to Compton effect from this plane, which are spatially collimated by, e.g., a pinhole, on one side of the plane and then captured by a detector behind it. The captured image, after correcting for x-ray attenuation and scatter angle variation, reflects the electron density, which allows visualization of the instantaneous anatomy on this plane. We performed MC studies on a phantom and a patient case for the initial test of this proposed method. Results: In the phantom case, the contrast-resolution calculated using tumor/lung as foreground/background for kV fluoroscopy, cone-beam CT, and scattering image were 0.0625, 0.6993, and 0.5290, respectively. In the patient case, tumor motion can be clearly observed in the scatter images. Compared to fluoroscopy, scattering imaging also significantly reduced imaging dose because of its narrower beam design. Conclusion: MC simulation studies demonstrated the potential of the proposed scheme in terms of capturing the instantaneous anatomy of a patient on a 2D plane. Clear visualization of the tumor will probably facilitate ‘marker-less’ and ‘real-time’ tumor tracking with low imaging dose. NIH (1R01CA154747-01, 1R21CA178787-01A1 and 1R21EB017978-01A1)« less

Motion artifact detection in four-dimensional computed tomography images

NASA Astrophysics Data System (ADS)

Bouilhol, G.; Ayadi, M.; Pinho, R.; Rit, S.; Sarrut, D.

2014-03-01

Motion artifacts appear in four-dimensional computed tomography (4DCT) images because of suboptimal acquisition parameters or patient breathing irregularities. Frequency of motion artifacts is high and they may introduce errors in radiation therapy treatment planning. Motion artifact detection can be useful for image quality assessment and 4D reconstruction improvement but manual detection in many images is a tedious process. We propose a novel method to evaluate the quality of 4DCT images by automatic detection of motion artifacts. The method was used to evaluate the impact of the optimization of acquisition parameters on image quality at our institute. 4DCT images of 114 lung cancer patients were analyzed. Acquisitions were performed with a rotation period of 0.5 seconds and a pitch of 0.1 (74 patients) or 0.081 (40 patients). A sensitivity of 0.70 and a specificity of 0.97 were observed. End-exhale phases were less prone to motion artifacts. In phases where motion speed is high, the number of detected artifacts was systematically reduced with a pitch of 0.081 instead of 0.1 and the mean reduction was 0.79. The increase of the number of patients with no artifact detected was statistically significant for the 10%, 70% and 80% respiratory phases, indicating a substantial image quality improvement.

Animal Models of Fibrotic Lung Disease

PubMed Central

Lawson, William E.; Oury, Tim D.; Sisson, Thomas H.; Raghavendran, Krishnan; Hogaboam, Cory M.

2013-01-01

Interstitial lung fibrosis can develop as a consequence of occupational or medical exposure, as a result of genetic defects, and after trauma or acute lung injury leading to fibroproliferative acute respiratory distress syndrome, or it can develop in an idiopathic manner. The pathogenesis of each form of lung fibrosis remains poorly understood. They each result in a progressive loss of lung function with increasing dyspnea, and most forms ultimately result in mortality. To better understand the pathogenesis of lung fibrotic disorders, multiple animal models have been developed. This review summarizes the common and emerging models of lung fibrosis to highlight their usefulness in understanding the cell–cell and soluble mediator interactions that drive fibrotic responses. Recent advances have allowed for the development of models to study targeted injuries of Type II alveolar epithelial cells, fibroblastic autonomous effects, and targeted genetic defects. Repetitive dosing in some models has more closely mimicked the pathology of human fibrotic lung disease. We also have a much better understanding of the fact that the aged lung has increased susceptibility to fibrosis. Each of the models reviewed in this report offers a powerful tool for studying some aspect of fibrotic lung disease. PMID:23526222

A fully synthetic lung model for wound-ballistic experiments-First results.

PubMed

Bolliger, S A; Poschmann, S A; Thali, M J; Eggert, S

2017-06-01

Today, synthetic models have all but replaced animal and corpse models in examining damage to soft-tissues and skeletal structures by ballistic trauma. As, however, non-solid organs such as the lungs, have not been able to be replaced by a fully synthetic model we attempted to create such a model. 20% ordnance gelatine was frothed with a household mixer and cooled to stable foam. Several of these foam blocks were then stuck together with liquid gelatine and placed between 10% gelatine blocks. As controls, we embedded pig lungs in gelatine and compared the wound channels seen in computed tomography created upon shooting with 9mm Luger. The fully synthetic models displayed radiological and physical densities comparable to real lungs. The wound profile characteristics of the fully synthetic lung models were very similar to the semisynthetic swine-gelatine models regarding the permanent wound cavity. Furthermore, in both semi- and fully synthetic models we detected a ring surrounding the permanent wound channel, most likely representing the remnants of the temporary wound cavity. Our results indicate that this fully synthetic lung model is a viable substitute for ballistic experiments on lungs. We believe that further research on the temporary wound channel in lungs is possible with this model in order to provide more insight into the effect of ballistic trauma to the lungs not seen otherwise. Copyright © 2017 Elsevier B.V. All rights reserved.

Applying Risk Prediction Models to Optimize Lung Cancer Screening: Current Knowledge, Challenges, and Future Directions.

PubMed

Sakoda, Lori C; Henderson, Louise M; Caverly, Tanner J; Wernli, Karen J; Katki, Hormuzd A

2017-12-01

Risk prediction models may be useful for facilitating effective and high-quality decision-making at critical steps in the lung cancer screening process. This review provides a current overview of published lung cancer risk prediction models and their applications to lung cancer screening and highlights both challenges and strategies for improving their predictive performance and use in clinical practice. Since the 2011 publication of the National Lung Screening Trial results, numerous prediction models have been proposed to estimate the probability of developing or dying from lung cancer or the probability that a pulmonary nodule is malignant. Respective models appear to exhibit high discriminatory accuracy in identifying individuals at highest risk of lung cancer or differentiating malignant from benign pulmonary nodules. However, validation and critical comparison of the performance of these models in independent populations are limited. Little is also known about the extent to which risk prediction models are being applied in clinical practice and influencing decision-making processes and outcomes related to lung cancer screening. Current evidence is insufficient to determine which lung cancer risk prediction models are most clinically useful and how to best implement their use to optimize screening effectiveness and quality. To address these knowledge gaps, future research should be directed toward validating and enhancing existing risk prediction models for lung cancer and evaluating the application of model-based risk calculators and its corresponding impact on screening processes and outcomes.

In-vivo patellar tracking in individuals with patellofemoral pain and healthy individuals.

PubMed

Esfandiarpour, Fateme; Lebrun, Constance M; Dhillon, Sukhvinder; Boulanger, Pierre

2018-02-28

Understanding of the exact cause of patellofemoral pain has been limited by methodological challenges to evaluate in-vivo joint motion. This study compared six degree-of-freedom patellar motion during a dynamic lunge task between individuals with patellofemoral pain and healthy individuals. Knee joints of eight females with patellofemoral pain and ten healthy females were imaged using a CT scanner in supine lying position, then by a dual-orthogonal fluoroscope while they performed a lunge. To quantify patellar motion, the three-dimensional models of the knee bones, reconstructed from CT scans, were registered on the fluoroscopy images using the Fluomotion registration software. At full knee extension, the patella was in a significantly laterally tilted (PFP: 11.77° ± 7.58° vs. healthy: 0.86° ± 4.90°; p = 0.002) and superiorly shifted (PFP: 17.49 ± 8.44 mm vs. healthy: 9.47 ± 6.16 mm, p = 0. 033) position in the patellofemoral pain group compared with the healthy group. There were also significant differences between the groups for patellar tilt at 45°, 60°, and 75° of knee flexion, and for superior-inferior shift of the patella at 30° flexion (p ≤ 0.031). In the non-weight-bearing knee extended position, the patella was in a significantly laterally tilted position in the patellofemoral pain group (7.44° ± 6.53°) compared with the healthy group (0.71° ± 4.99°). These findings suggest the critical role of passive and active patellar stabilizers as potential causative factors for patellar malalignment/maltracking. Future studies should investigate the associations between patellar kinematics with joint morphology, muscle activity, and tendon function in a same sample for a thorough understanding of the causes of patellofemoral pain. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

SU-E-J-246: A Deformation-Field Map Based Liver 4D CBCT Reconstruction Method Using Gold Nanoparticles as Constraints

DOE Office of Scientific and Technical Information (OSTI.GOV)

Harris, W; Zhang, Y; Ren, L

2014-06-01

Purpose: To investigate the feasibility of using nanoparticle markers to validate liver tumor motion together with a deformation field map-based four dimensional (4D) cone-beam computed tomography (CBCT) reconstruction method. Methods: A technique for lung 4D-CBCT reconstruction has been previously developed using a deformation field map (DFM)-based strategy. In this method, each phase of the 4D-CBCT is considered as a deformation of a prior CT volume. The DFM is solved by a motion modeling and free-form deformation (MM-FD) technique, using a data fidelity constraint and the deformation energy minimization. For liver imaging, there is low contrast of a liver tumor inmore » on-board projections. A validation of liver tumor motion using implanted gold nanoparticles, along with the MM-FD deformation technique is implemented to reconstruct onboard 4D CBCT liver radiotherapy images. These nanoparticles were placed around the liver tumor to reflect the tumor positions in both CT simulation and on-board image acquisition. When reconstructing each phase of the 4D-CBCT, the migrations of the gold nanoparticles act as a constraint to regularize the deformation field, along with the data fidelity and the energy minimization constraints. In this study, multiple tumor diameters and positions were simulated within the liver for on-board 4D-CBCT imaging. The on-board 4D-CBCT reconstructed by the proposed method was compared with the “ground truth” image. Results: The preliminary data, which uses reconstruction for lung radiotherapy suggests that the advanced reconstruction algorithm including the gold nanoparticle constraint will Resultin volume percentage differences (VPD) between lesions in reconstructed images by MM-FD and “ground truth” on-board images of 11.5% (± 9.4%) and a center of mass shift of 1.3 mm (± 1.3 mm) for liver radiotherapy. Conclusion: The advanced MM-FD technique enforcing the additional constraints from gold nanoparticles, results in improved accuracy for reconstructing on-board 4D-CBCT of liver tumor. Varian medical systems research grant.« less

Dosimetric impact of geometric errors due to respiratory motion prediction on dynamic multileaf collimator-based four-dimensional radiation delivery

DOE Office of Scientific and Technical Information (OSTI.GOV)

Vedam, S.; Docef, A.; Fix, M.

2005-06-15

The synchronization of dynamic multileaf collimator (DMLC) response with respiratory motion is critical to ensure the accuracy of DMLC-based four dimensional (4D) radiation delivery. In practice, however, a finite time delay (response time) between the acquisition of tumor position and multileaf collimator response necessitates predictive models of respiratory tumor motion to synchronize radiation delivery. Predicting a complex process such as respiratory motion introduces geometric errors, which have been reported in several publications. However, the dosimetric effect of such errors on 4D radiation delivery has not yet been investigated. Thus, our aim in this work was to quantify the dosimetric effectsmore » of geometric error due to prediction under several different conditions. Conformal and intensity modulated radiation therapy (IMRT) plans for a lung patient were generated for anterior-posterior/posterior-anterior (AP/PA) beam arrangements at 6 and 18 MV energies to provide planned dose distributions. Respiratory motion data was obtained from 60 diaphragm-motion fluoroscopy recordings from five patients. A linear adaptive filter was employed to predict the tumor position. The geometric error of prediction was defined as the absolute difference between predicted and actual positions at each diaphragm position. Distributions of geometric error of prediction were obtained for all of the respiratory motion data. Planned dose distributions were then convolved with distributions for the geometric error of prediction to obtain convolved dose distributions. The dosimetric effect of such geometric errors was determined as a function of several variables: response time (0-0.6 s), beam energy (6/18 MV), treatment delivery (3D/4D), treatment type (conformal/IMRT), beam direction (AP/PA), and breathing training type (free breathing/audio instruction/visual feedback). Dose difference and distance-to-agreement analysis was employed to quantify results. Based on our data, the dosimetric impact of prediction (a) increased with response time, (b) was larger for 3D radiation therapy as compared with 4D radiation therapy, (c) was relatively insensitive to change in beam energy and beam direction, (d) was greater for IMRT distributions as compared with conformal distributions, (e) was smaller than the dosimetric impact of latency, and (f) was greatest for respiration motion with audio instructions, followed by visual feedback and free breathing. Geometric errors of prediction that occur during 4D radiation delivery introduce dosimetric errors that are dependent on several factors, such as response time, treatment-delivery type, and beam energy. Even for relatively small response times of 0.6 s into the future, dosimetric errors due to prediction could approach delivery errors when respiratory motion is not accounted for at all. To reduce the dosimetric impact, better predictive models and/or shorter response times are required.« less

Models of Lung Transplant Research: a consensus statement from the National Heart, Lung, and Blood Institute workshop.

PubMed

Lama, Vibha N; Belperio, John A; Christie, Jason D; El-Chemaly, Souheil; Fishbein, Michael C; Gelman, Andrew E; Hancock, Wayne W; Keshavjee, Shaf; Kreisel, Daniel; Laubach, Victor E; Looney, Mark R; McDyer, John F; Mohanakumar, Thalachallour; Shilling, Rebecca A; Panoskaltsis-Mortari, Angela; Wilkes, David S; Eu, Jerry P; Nicolls, Mark R

2017-05-04

Lung transplantation, a cure for a number of end-stage lung diseases, continues to have the worst long-term outcomes when compared with other solid organ transplants. Preclinical modeling of the most common and serious lung transplantation complications are essential to better understand and mitigate the pathophysiological processes that lead to these complications. Various animal and in vitro models of lung transplant complications now exist and each of these models has unique strengths. However, significant issues, such as the required technical expertise as well as the robustness and clinical usefulness of these models, remain to be overcome or clarified. The National Heart, Lung, and Blood Institute (NHLBI) convened a workshop in March 2016 to review the state of preclinical science addressing the three most important complications of lung transplantation: primary graft dysfunction (PGD), acute rejection (AR), and chronic lung allograft dysfunction (CLAD). In addition, the participants of the workshop were tasked to make consensus recommendations on the best use of these complimentary models to close our knowledge gaps in PGD, AR, and CLAD. Their reviews and recommendations are summarized in this report. Furthermore, the participants outlined opportunities to collaborate and directions to accelerate research using these preclinical models.

Gender differences in patellofemoral load during the epee fencing lunge.

PubMed

Sinclair, J; Bottoms, L

2015-01-01

Clinical analyses have shown that injuries and pain linked specifically to fencing training/competition were prevalent in 92.8% of fencers. Patellofemoral pain is the most common chronic injury in athletic populations and females are considered to be more susceptible to this pathology. This study aimed to examine gender differences in patellofemoral contact forces during the fencing lunge. Patellofemoral contact forces were obtained from eight male and eight female club level epee fencers using an eight-camera 3D motion capture system and force platform data as they completed simulated lunges. Independent t-tests were performed on the data to determine whether gender differences in patellofemoral contact forces were present. The results show that females were associated with significantly greater patellofemoral contact force parameters in comparison with males. This suggests that female fencers may be at greater risk from patellofemoral pathology as a function of fencing training/competition.

Restricted diffusion in a model acinar labyrinth by NMR: Theoretical and numerical results

NASA Astrophysics Data System (ADS)

Grebenkov, D. S.; Guillot, G.; Sapoval, B.

2007-01-01

A branched geometrical structure of the mammal lungs is known to be crucial for rapid access of oxygen to blood. But an important pulmonary disease like emphysema results in partial destruction of the alveolar tissue and enlargement of the distal airspaces, which may reduce the total oxygen transfer. This effect has been intensively studied during the last decade by MRI of hyperpolarized gases like helium-3. The relation between geometry and signal attenuation remained obscure due to a lack of realistic geometrical model of the acinar morphology. In this paper, we use Monte Carlo simulations of restricted diffusion in a realistic model acinus to compute the signal attenuation in a diffusion-weighted NMR experiment. We demonstrate that this technique should be sensitive to destruction of the branched structure: partial removal of the interalveolar tissue creates loops in the tree-like acinar architecture that enhance diffusive motion and the consequent signal attenuation. The role of the local geometry and related practical applications are discussed.

Anatomy and bronchoscopy of the porcine lung. A model for translational respiratory medicine.

PubMed

Judge, Eoin P; Hughes, J M Lynne; Egan, Jim J; Maguire, Michael; Molloy, Emer L; O'Dea, Shirley

2014-09-01

The porcine model has contributed significantly to biomedical research over many decades. The similar size and anatomy of pig and human organs make this model particularly beneficial for translational research in areas such as medical device development, therapeutics and xenotransplantation. In recent years, a major limitation with the porcine model was overcome with the successful generation of gene-targeted pigs and the publication of the pig genome. As a result, the role of this model is likely to become even more important. For the respiratory medicine field, the similarities between pig and human lungs give the porcine model particular potential for advancing translational medicine. An increasing number of lung conditions are being studied and modeled in the pig. Genetically modified porcine models of cystic fibrosis have been generated that, unlike mouse models, develop lung disease similar to human cystic fibrosis. However, the scientific literature relating specifically to porcine lung anatomy and airway histology is limited and is largely restricted to veterinary literature and textbooks. Furthermore, methods for in vivo lung procedures in the pig are rarely described. The aims of this review are to collate the disparate literature on porcine lung anatomy, histology, and microbiology; to provide a comparison with the human lung; and to describe appropriate bronchoscopy procedures for the pig lungs to aid clinical researchers working in the area of translational respiratory medicine using the porcine model.

Microfabrication of human organs-on-chips.

PubMed

Huh, Dongeun; Kim, Hyun Jung; Fraser, Jacob P; Shea, Daniel E; Khan, Mohammed; Bahinski, Anthony; Hamilton, Geraldine A; Ingber, Donald E

2013-11-01

'Organs-on-chips' are microengineered biomimetic systems containing microfluidic channels lined by living human cells, which replicate key functional units of living organs to reconstitute integrated human organ-level pathophysiology in vitro. These microdevices can be used to test efficacy and toxicity of drugs and chemicals, and to create in vitro models of human disease. Thus, they potentially represent low-cost alternatives to conventional animal models for pharmaceutical, chemical and environmental applications. Here we describe a protocol for the fabrication, microengineering and operation of these microfluidic organ-on-chip systems. First, microengineering is used to fabricate a multilayered microfluidic device that contains two parallel elastomeric microchannels separated by a thin porous flexible membrane, along with two full-height, hollow vacuum chambers on either side; this requires ∼3.5 d to complete. To create a 'breathing' lung-on-a-chip that mimics the mechanically active alveolar-capillary interface of the living human lung, human alveolar epithelial cells and microvascular endothelial cells are cultured in the microdevice with physiological flow and cyclic suction applied to the side chambers to reproduce rhythmic breathing movements. We describe how this protocol can be easily adapted to develop other human organ chips, such as a gut-on-a-chip lined by human intestinal epithelial cells that experiences peristalsis-like motions and trickling fluid flow. Also, we discuss experimental techniques that can be used to analyze the cells in these organ-on-chip devices.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Petasecca, M., E-mail: marcop@uow.edu.au; Newall, M. K.; Aldosari, A. H.

Purpose: Spatial and temporal resolutions are two of the most important features for quality assurance instrumentation of motion adaptive radiotherapy modalities. The goal of this work is to characterize the performance of the 2D high spatial resolution monolithic silicon diode array named “MagicPlate-512” for quality assurance of stereotactic body radiation therapy (SBRT) and stereotactic radiosurgery (SRS) combined with a dynamic multileaf collimator (MLC) tracking technique for motion compensation. Methods: MagicPlate-512 is used in combination with the movable platform HexaMotion and a research version of radiofrequency tracking system Calypso driving MLC tracking software. The authors reconstruct 2D dose distributions of smallmore » field square beams in three modalities: in static conditions, mimicking the temporal movement pattern of a lung tumor and tracking the moving target while the MLC compensates almost instantaneously for the tumor displacement. Use of Calypso in combination with MagicPlate-512 requires a proper radiofrequency interference shielding. Impact of the shielding on dosimetry has been simulated by GEANT4 and verified experimentally. Temporal and spatial resolutions of the dosimetry system allow also for accurate verification of segments of complex stereotactic radiotherapy plans with identification of the instant and location where a certain dose is delivered. This feature allows for retrospective temporal reconstruction of the delivery process and easy identification of error in the tracking or the multileaf collimator driving systems. A sliding MLC wedge combined with the lung motion pattern has been measured. The ability of the MagicPlate-512 (MP512) in 2D dose mapping in all three modes of operation was benchmarked by EBT3 film. Results: Full width at half maximum and penumbra of the moving and stationary dose profiles measured by EBT3 film and MagicPlate-512 confirm that motion has a significant impact on the dose distribution. Motion, no motion, and motion with MLC tracking profiles agreed within 1 and 0.4 mm, respectively, for all field sizes tested. Use of electromagnetic tracking system generates a fluctuation of the detector baseline up to 10% of the full scale signal requiring a proper shielding strategy. MagicPlate-512 is also able to reconstruct the dose variation pulse-by-pulse in each pixel of the detector. An analysis of the dose transients with motion and motion with tracking shows that the tracking feedback algorithm used for this experiment can compensate effectively only the effect of the slower transient components. The fast changing components of the organ motion can contribute only to discrepancy of the order of 15% in penumbral region while the slower components can change the dose profile up to 75% of the expected dose. Conclusions: MagicPlate-512 is shown to be, potentially, a valid alternative to film or 2D ionizing chambers for quality assurance dosimetry in SRS or SBRT. Its high spatial and temporal resolutions allow for accurate reconstruction of the profile in any conditions with motion and with tracking of the motion. It shows excellent performance to reconstruct the dose deposition in real time or retrospectively as a function of time for detailed analysis of the effect of motion in a specific pixel or area of interest.« less

Ankle-Dorsiflexion Range of Motion After Ankle Self-Stretching Using a Strap

PubMed Central

Jeon, In-cheol; Kwon, Oh-yun; Yi, Chung-Hwi; Cynn, Heon-Seock; Hwang, Ui-jae

2015-01-01

Context  A variety of ankle self-stretching exercises have been recommended to improve ankle-dorsiflexion range of motion (DFROM) in individuals with limited ankle dorsiflexion. A strap can be applied to stabilize the talus and facilitate anterior glide of the distal tibia at the talocrural joint during ankle self-stretching exercises. Novel ankle self-stretching using a strap (SSS) may be a useful method of improving ankle DFROM. Objective  To compare the effects of 2 ankle-stretching techniques (static stretching versus SSS) on ankle DFROM. Design  Randomized controlled clinical trial. Setting  University research laboratory. Patients or Other Participants  Thirty-two participants with limited active dorsiflexion (<20°) while sitting (14 women and 18 men) were recruited. Main Outcome Measure(s)  The participants performed 2 ankle self-stretching techniques (static stretching and SSS) for 3 weeks. Active DFROM (ADFROM), passive DFROM (PDFROM), and the lunge angle were measured. An independent t test was used to compare the improvements in these values before and after the 2 stretching interventions. The level of statistical significance was set at α = .05. Results  Active DFROM and PDFROM were greater in both stretching groups after the 3-week interventions. However, ADFROM, PDFROM, and the lunge angle were greater in the SSS group than in the static-stretching group (P < .05). Conclusions  Ankle SSS is recommended to improve ADFROM, PDFROM, and the lunge angle in individuals with limited DFROM. PMID:26633750