Collimator based tracking with an add-on multileaf collimator: Moduleaf.

Radiotherapy is one of the most important methods used for the treatment of cancer. Irradiating a moving target is also one of the most challenging tasks to accomplish in modern radiotherapy. We have developed a tracking system by modifying an add-on collimator, the Siemens Moduleaf, for realtime applications in radiotherapy. As the add-on collimator works nearly completely independently of the linear accelerator (LinAc), no modifications to the latter were necessary. The adaptations to the Moduleaf were mainly software-based. In order to reduce the complexity of the system, outdated electronic parts were replaced with newer components where practical.Verification was performed by measuring the latency of the system as well as the impact on applied dose to a predefined target volume, moving in the leaf's travel direction. Latency measurements in the software were accomplished by comparing the target and current positions of the leaves. For dose measurements, a Gafchromic EBT2 film was placed beneath the target 4D phantom, in between solid water plates and moved alongside with it. Comparing the dose distribution on the film with a moving target between 'tracking disabled' towards 'tracking enabled' functions resulted in penumbra widths of 23 mm to 4 mm for 0.1 Hz sinusoidal movements with an amplitude of 32 mm, respectively. The maximum speed was therefore 20 mm s(-1). Latency was measured to be less than 50 ms for the signal runtimes. Based on the results, a tracking-capable add-on collimator seems to be a useful tool for reducing the margins for the treatment of small, slow-moving targets.

Image quality improvements of electronic portal imaging devices by multi-level gain calibration and temperature correction.

Amorphous silicon (aSi:H) flat panel detectors are prevalent in radiotherapy for megavoltage imaging tasks. Any clinical and dosimetrical application requires a well-defined dose response of the system to achieve meaningful results. Due to radiation damages, panels deteriorate and the linearity of pixel response to dose as well as the stability with regard to changing operating temperatures get worse with time. Using a single level gain correction can lead to an error of about 23% when irradiating a flood field image with 100 MU min(-1) on an old detector. A multi-level gain (MLG) correction is introduced, emending the nonlinearities and subpanel-related artifacts caused by insufficient radiation hardness of amplifiers in the read-out electronics. With rising temperature, offset values typically increase (up to 300 gray values) while the response at higher dose values per frame remain constant for a majority of pixels. To account for temperature-related image artifacts, two additional temperature correction methods have been developed. MLG in combination with temperature corrections can re-establish the aSi:H image quality to the performance required by reliable medical verification tools. Furthermore, the life span and recalibration intervals of these costly devices can be prolonged decisively.

Three-dimensional surface scanning for accurate patient positioning and monitoring during breast cancer radiotherapy.

PURPOSE: Clinical evaluation of an optical three-dimensional surface scanning (3D-SS) system for patient positioning and monitoring during radiotherapy (RT) for breast cancer. MATERIALS AND METHODS: A ceiling-mounted scanner was developed to acquire multiple 3D body surface images and tested in 14 conservatively operated breast cancer patients. A reference skin surface was derived from the planning computed tomography (CT) scan as basis for rigid registration with the surface scans. In addition to electronic portal images (EPIs), optical scans were acquired at three defined time points before and during daily RT. Patient setup was guided by laser alignments and corrected according to EPI findings. The accuracy of the 3D-SS system was validated by comparison of the optical scans to EPIs generated in parallel. Interfraction shifts were investigated by comparison of the first 3D-SS image with the reference body outline. Intrafractional motions were analysed by comparing the three daily surface scans with the first EPI. RESULTS: Comparison of EPIs and 3D-SS images revealed good accordance (- 0.05±0.94 mm). Analysis of daily patient positions revealed average deviations of 0.4±2.4 mm laterally, 0.3±1.9 mm longitudinally and 0.2±3.3 mm vertically. After 2 weeks, a systematic interfraction shift in patient positioning was noted, particularly in the vertical direction (4.9±0.56 mm), which was attributed to patients progressively relaxing. 3D-SS images showed intrafractional shifts of 1.2±0.7 mm over a time course of 2 min. CONCLUSION: Optical surface scanning is a simple, fast and reproducible method for breast cancer patient alignment. Particularly for more sophisticated irradiation techniques, it helps to improve accuracy in patient positioning during radiotherapy without the exposure to additional ionizing radiation.

Auto-masked 2D/3D image registration and its validation with clinical cone-beam computed tomography.

Image-guided alignment procedures in radiotherapy aim at minimizing discrepancies between the planned and the real patient setup. For that purpose, we developed a 2D/3D approach which rigidly registers a computed tomography (CT) with two x-rays by maximizing the agreement in pixel intensity between the x-rays and the corresponding reconstructed radiographs from the CT. Moreover, the algorithm selects regions of interest (masks) in the x-rays based on 3D segmentations from the pre-planning stage. For validation, orthogonal x-ray pairs from different viewing directions of 80 pelvic cone-beam CT (CBCT) raw data sets were used. The 2D/3D results were compared to corresponding standard 3D/3D CBCT-to-CT alignments. Outcome over 8400 2D/3D experiments showed that parametric errors in root mean square were <0.18° (rotations) and <0.73 mm (translations), respectively, using rank correlation as intensity metric. This corresponds to a mean target registration error, related to the voxels of the lesser pelvis, of <2 mm in 94.1% of the cases. From the results we conclude that 2D/3D registration based on sequentially acquired orthogonal x-rays of the pelvis is a viable alternative to CBCT-based approaches if rigid alignment on bony anatomy is sufficient, no volumetric intra-interventional data set is required and the expected error range fits the individual treatment prescription.