A computerized framework for monitoring four-dimensional dose distributions during stereotactic body radiation therapy using a portal dose image-based 2D/3D registration approach.

ABSTRACT

A computerized framework for monitoring four-dimensional (4D) dose distributions during stereotactic body radiation therapy based on a portal dose image (PDI)-based 2D/3D registration approach has been proposed in this study. Using the PDI-based registration approach, simulated 4D "treatment" CT images were derived from the deformation of 3D planning CT images so that a 2D planning PDI could be similar to a 2D dynamic clinical PDI at a breathing phase. The planning PDI was calculated by applying a dose calculation algorithm (a pencil beam convolution algorithm) to the geometry of the planning CT image and a virtual water equivalent phantom. The dynamic clinical PDIs were estimated from electronic portal imaging device (EPID) dynamic images including breathing phase data obtained during a treatment. The parameters of the affine transformation matrix were optimized based on an objective function and a gamma pass rate using a Levenberg-Marquardt (LM) algorithm. The proposed framework was applied to the EPID dynamic images of ten lung cancer patients, which included 183 frames (mean 18.3 per patient). The 4D dose distributions during the treatment time were successfully obtained by applying the dose calculation algorithm to the simulated 4D "treatment" CT images. The mean±standard deviation (SD) of the percentage errors between the prescribed dose and the estimated dose at an isocenter for all cases was 3.25±4.43%. The maximum error for the ten cases was 14.67% (prescribed dose 1.50Gy, estimated dose 1.72Gy), and the minimum error was 0.00%. The proposed framework could be feasible for monitoring the 4D dose distribution and dose errors within a patient's body during treatment.