Four-dimensional dose distributions of step-and-shoot IMRT delivered with real-time tumor tracking for patients with irregular breathing: constant dose rate vs dose rate regulation.

PURPOSE: Dose-rate-regulated tracking (DRRT) is a tumor tracking strategy that programs the MLC to track the tumor under regular breathing and adapts to breathing irregularities during delivery using dose rate regulation. Constant-dose-rate tracking (CDRT) is a strategy that dynamically repositions the beam to account for intrafractional 3D target motion according to real-time information of target location obtained from an independent position monitoring system. The purpose of this study is to illustrate the differences in the effectiveness and delivery accuracy between these two tracking methods in the presence of breathing irregularities. METHODS: Step-and-shoot IMRT plans optimized at a reference phase were extended to remaining phases to generate 10-phased 4D-IMRT plans using segment aperture morphing (SAM) algorithm, where both tumor displacement and deformation were considered. A SAM-based 4D plan has been demonstrated to provide better plan quality than plans not considering target deformation. However, delivering such a plan requires preprogramming of the MLC aperture sequence. Deliveries of the 4D plans using DRRT and CDRT tracking approaches were simulated assuming the breathing period is either shorter or longer than the planning day, for 4 IMRT cases: two lung and two pancreatic cases with maximum GTV centroid motion greater than 1 cm were selected. In DRRT, dose rate was regulated to speed up or slow down delivery as needed such that each planned segment is delivered at the planned breathing phase. In CDRT, MLC is separately controlled to follow the tumor motion, but dose rate was kept constant. In addition to breathing period change, effect of breathing amplitude variation on target and critical tissue dose distribution is also evaluated. RESULTS: Delivery of preprogrammed 4D plans by the CDRT method resulted in an average of 5% increase in target dose and noticeable increase in organs at risk (OAR) dose when patient breathing is either 10% faster or slower than the planning day. In contrast, DRRT method showed less than 1% reduction in target dose and no noticeable change in OAR dose under the same breathing period irregularities. When ±20% variation of target motion amplitude was present as breathing irregularity, the two delivery methods show compatible plan quality if the dose distribution of CDRT delivery is renormalized. CONCLUSIONS: Delivery of 4D-IMRT treatment plans, stemmed from 3D step-and-shoot IMRT and preprogrammed using SAM algorithm, is simulated for two dynamic MLC-based real-time tumor tracking strategies: with and without dose-rate regulation. Comparison of cumulative dose distribution indicates that the preprogrammed 4D plan is more accurately and efficiently conformed using the DRRT strategy, as it compensates the interplay between patient breathing irregularity and tracking delivery without compromising the segment-weight modulation.

Iterative image reconstruction for PROPELLER-MRI using the nonuniform fast fourier transform.

PURPOSE: To investigate an iterative image reconstruction algorithm using the nonuniform fast Fourier transform (NUFFT) for PROPELLER (Periodically Rotated Overlapping ParallEL Lines with Enhanced Reconstruction) MRI. MATERIALS AND METHODS: Numerical simulations, as well as experiments on a phantom and a healthy human subject were used to evaluate the performance of the iterative image reconstruction algorithm for PROPELLER, and compare it with that of conventional gridding. The trade-off between spatial resolution, signal to noise ratio, and image artifacts, was investigated for different values of the regularization parameter. The performance of the iterative image reconstruction algorithm in the presence of motion was also evaluated. RESULTS: It was demonstrated that, for a certain range of values of the regularization parameter, iterative reconstruction produced images with significantly increased signal to noise ratio, reduced artifacts, for similar spatial resolution, compared with gridding. Furthermore, the ability to reduce the effects of motion in PROPELLER-MRI was maintained when using the iterative reconstruction approach. CONCLUSION: An iterative image reconstruction technique based on the NUFFT was investigated for PROPELLER MRI. For a certain range of values of the regularization parameter, the new reconstruction technique may provide PROPELLER images with improved image quality compared with conventional gridding.

Four-dimensional intensity-modulated radiation therapy planning for dynamic tracking using a direct aperture deformation (DAD) method.

PURPOSE: Planning for the delivery of intensity-modulated radiation therapy (IMRT) to a moving target, referred to as four-dimensional (4D) IMRT planning, is a crucial step for achieving the treatment objectives for sites that move during treatment delivery. The authors proposed a simplistic method that accounts for both rigid and nonrigid respiration-induced target motion based on 4D computed tomography (4DCT) data sets. METHODS: A set of MLC apertures and weights was first optimized on a reference phase of a 4DCT data set. At each beam angle, the apertures were morphed from the reference phase to each of the remaining phases according to the relative shape changes in the beam's eye view of the target. Three different planning schemes were evaluated for two lung cases and one pancreas patient: (1) Individually optimizing each breathing phase; (2) optimizing the reference phase and shifting the optimized apertures to other breathing phases based on a rigid-body image registration; and (3) optimizing the reference phase and deforming the optimized apertures to the other phases based on the deformation and translation of target contours. Planning results using scheme 1 serves as the "gold standard" for plan quality assessment; scheme 2 is the method previously proposed in the literature; and scheme 3 is the method the authors proposed in this article. The optimization results were compared between the three schemes for all three cases. RESULTS: The proposed scheme 3 is comparable to scheme 1 in plan quality, and provides improved target coverage and conformity with similar normal tissue dose compared with scheme 2. CONCLUSIONS: Direct aperture deformation method for 4D IMRT planning improves upon methods that only consider rigid-body motion and achieves a plan quality close to that optimized for each of the phases.

Verification of MLC based real-time tumor tracking using an electronic portal imaging device.

PURPOSE: The authors have developed a novel technique using an electronic portal imaging device (EPID) to verify the geometrical accuracy of delivery of dose-rate-regulated tracking (DRRT). This technique, called verification of real-time tracking with EPID (VORTE), can potentially be used for both on-line and off-line quality assurance (QA) of MLC-based dynamic tumor tracking. METHODS: The shape and position of target as a function of time, which is assumed to be known, is projected onto the EPID plane. This projected sequence of apertures as a function of time (target motion) is then used as the reference. The accuracy of dynamic MLC tracking can then be assessed by how well the delivered beam follows this projected target motion without the use of a physical moving phantom. The beam apertures controlled by DRRT (aperture motion) is detected by the EPID as a function of time. The aperture motion is compared to the target motion to evaluate tracking error introduced by DRRT. The accuracy of VORTE was measured using film measurements of ten static fields. The VORTE for dynamic tumor tracking was tested with several target motions, including (1) rigid-body two-dimensional (2-D) cyclic motion in the superior-inferior direction with various period and amplitude; (2) the above 2-D cyclic motion plus cyclic deformation; and (3) 2-D cyclic motion with both deformation and rotation. For each target motion, the controlled aperture motion resulting from DRRT was acquired at approximately 8 Hz using EPID in the continuous-acquisition mode. Leaf positions in all captured frames were measured from the EPID and compared to their expected positions. The passing rate of 2 mm criteria for all leaves from all frames was calculated for each of the four patterns of tumor motion. Additionally, the root-mean-square (RMS) deviations of the centroid of the apertures between the designed and delivered beams were calculated for all three cases. RESULTS: The accuracy of MLC-leaf position determination by VORTE is 0.5 mm (1 standard deviation) by comparison to film measurements. With DRRT, the passing rates using the 2 mm criteria for all acquired frames are 100% for the 2-D displacement, 99% for the 2-D displacement with deformation, and 88% for the 2-D displacement combined with both deformation and rotation. The RMS deviations are 0.6 mm for the 2-D displacement, 1.0 mm for the 2-D displacement with deformation, and 1.1 mm for the 2-D displacement combined with both deformation and rotation. CONCLUSIONS: The VORTE can measure the accuracy of MLC-based tumor tracking without the necessity of employing a moving phantom. Moreover, it can be used for complex target motion (i.e., 2-D displacement combined with deformation and rotation) that is difficult to create with physical moving phantoms. Therefore, the VORTE and the novel QA process illustrated by this study have a great potential for verifying real-time tumor tracking.

A tractography comparison between turboprop and spin-echo echo-planar diffusion tensor imaging.

The development of accurate, non-invasive methods for mapping white matter fiber-tracts is of critical importance. However, fiber-tracking is typically performed on diffusion tensor imaging (DTI) data obtained with echo-planar-based imaging techniques (EPI), which suffer from susceptibility-related image artifacts, and image warping due to eddy-currents. Thus, a number of white matter fiber-bundles mapped using EPI-based DTI data are distorted and/or terminated early. This severely limits the clinical potential of fiber-tracking. In contrast, Turboprop-MRI provides images with significantly fewer susceptibility and eddy-current-related artifacts than EPI. The purpose of this work was to compare fiber-tracking results obtained from DTI data acquired with Turboprop-DTI and EPI-based DTI. It was shown that, in brain regions near magnetic field inhomogeneities, white matter fiber-bundles obtained with EPI-based DTI were distorted and/or partially detected, when magnetic susceptibility-induced distortions were not corrected. After correction, residual distortions were still present and several fiber-tracts remained partially detected. In contrast, when using Turboprop-DTI data, all traced fiber-tracts were in agreement with known anatomy. The inter-session reproducibility of tractography results was higher for Turboprop than EPI-based DTI data in regions near field inhomogeneities. Thus, Turboprop may be a more appropriate DTI data acquisition technique for tracing white matter fibers near regions with significant magnetic susceptibility differences, as well as in longitudinal studies of such fibers. However, the intra-session reproducibility of tractography results was higher for EPI-based than Turboprop DTI data. Thus, EPI-based DTI may be more advantageous for tracing fibers minimally affected by field inhomogeneities.

Planning 4D intensity-modulated arc therapy for tumor tracking with a multileaf collimator.

This study introduces a practical four-dimensional (4D) planning scheme of IMAT using 4D computed tomography (4D CT) for planning tumor tracking with dynamic multileaf beam collimation. We assume that patients can breathe regularly, i.e. the same way as during 4D CT with an unchanged period and amplitude, and that the start of 4D-IMAT delivery can be synchronized with a designated respiratory phase. Each control point of the IMAT-delivery process can be associated with an image set of 4D CT at a specified respiratory phase. Target is contoured at each respiratory phase without a motion-induced margin. A 3D-IMAT plan is first optimized on a reference-phase image set of 4D CT. Then, based on the projections of the planning target volume in the beam's eye view at different respiratory phases, a 4D-IMAT plan is generated by transforming the segments of the optimized 3D plan by using a direct aperture deformation method. Compensation for both translational and deformable tumor motion is accomplished, and the smooth delivery of the transformed plan is ensured by forcing connectivity between adjacent angles (control points). It is envisioned that the resultant plans can be delivered accurately using the dose rate regulated tracking method which handles breathing irregularities (Yi et al 2008 Med. Phys. 35 3955-62).This planning process is straightforward and only adds a small step to current clinical 3D planning practice. Our 4D planning scheme was tested on three cases to evaluate dosimetric benefits. The created 4D-IMAT plans showed similar dose distributions as compared with the 3D-IMAT plans on a single static phase, indicating that our method is capable of eliminating the dosimetric effects of breathing induced target motion. Compared to the 3D-IMAT plans with large treatment margins encompassing respiratory motion, our 4D-IMAT plans reduced radiation doses to surrounding normal organs and tissues.

Optimization of white matter tractography for pre-surgical planning and image-guided surgery.

Accurate localization of white matter fiber tracts in relation to brain tumors is a goal of critical importance to the neurosurgical community. White matter fiber tractography by means of diffusion tensor magnetic resonance imaging (DTI) is the only non-invasive method that can provide estimates of brain connectivity. However, conventional tractography methods are based on data acquisition techniques that suffer from image distortions and artifacts. Thus, a large percentage of white matter fiber bundles are distorted, and/or terminated early, while others are completely undetected. This severely limits the potential of fiber tractography in pre-surgical planning and image-guided surgery. In contrast, Turboprop-DTI is a technique that provides images with significantly fewer distortions and artifacts than conventional DTI data acquisition methods. The purpose of this study was to evaluate fiber tracking results obtained from Turboprop-DTI data. It was demonstrated that Turboprop may be a more appropriate DTI data acquisition technique for tracing white matter fibers than conventional DTI methods, especially in applications such as pre-surgical planning and image-guided surgery.

White matter tractography by means of Turboprop diffusion tensor imaging.

White matter fiber-tractography by means of diffusion tensor imaging (DTI) is a noninvasive technique that provides estimates of the structural connectivity of the brain. However, conventional fiber-tracking methods using DTI are based on echo-planar image acquisitions (EPI), which suffer from image distortions and artifacts due to magnetic susceptibility variations and eddy currents. Thus, a large percentage of white matter fiber bundles that are mapped using EPI-based DTI data are distorted, and/or terminated early, while others are completely undetected. This severely limits the potential of fiber-tracking techniques. In contrast, Turboprop imaging is a multiple-shot gradient and spin-echo (GRASE) technique that provides images with significantly fewer susceptibility and eddy current-related artifacts than EPI. The purpose of this work was to evaluate the performance of fiber-tractography techniques when using data obtained with Turboprop-DTI. All fiber pathways that were mapped were found to be in agreement with the anatomy. There were no visible distortions in any of the traced fiber bundles, even when these were located in the vicinity of significant magnetic field inhomogeneities. Additionally, the Turboprop-DTI data used in this research were acquired in less than 19 min of scan time. Thus, Turboprop appears to be a promising DTI data acquisition technique for tracing white matter fibers.

Contribution of cardiac-induced brain pulsation to the noise of the diffusion tensor in Turboprop diffusion tensor imaging (DTI).

PURPOSE: To assess the effects of cardiac-induced brain pulsation on the noise of the diffusion tensor in Turboprop (a form of periodically rotated overlapping parallel lines with enhanced reconstruction [PROPELLER] imaging) diffusion tensor imaging (DTI). MATERIALS AND METHODS: A total of six healthy human subjects were imaged with cardiac-gated as well as nongated Turboprop DTI. Gated and nongated Turboprop DTI datasets were also simulated using actual data acquired exclusively during the diastolic or systolic period of the cardiac cycle. The total variance of the diffusion tensor (TVDT) was measured and compared between acquisitions. RESULTS: The TVDT near the ventricles was significantly reduced in cardiac-gated compared to nongated Turboprop DTI acquisitions. Furthermore, the effects of brain pulsation were reduced, but not eliminated, when increasing the amount of data collected. Finally, data corrupted by cardiac-induced pulsation were not consistently detected by the step of the conventional Turboprop reconstruction algorithm that evaluates the quality of data in different blades. Thus, the inherent quality weighting of the conventional Turboprop reconstruction algorithm was unable to compensate for the increased noise in the diffusion tensor due to brain pulsation. CONCLUSION: Cardiac-induced brain pulsation increases the TVDT in Turboprop DTI. Use of cardiac gating to limit data acquisition to the diastolic period of the cardiac cycle reduces the TVDT at the expense of imaging time.