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  • IMRT  (6)
  • 1
    Keywords: IRRADIATION ; radiotherapy ; Germany ; LUNG ; THERAPY ; ALGORITHM ; CT ; imaging ; INFORMATION ; SYSTEM ; SYSTEMS ; EXPOSURE ; TISSUE ; computed tomography ; validation ; NUCLEAR-MEDICINE ; TIME ; PATIENT ; COMPLEX ; MARKER ; SIGNAL ; PERFORMANCE ; MARKERS ; REGION ; REGISTRATION ; LOCALIZATION ; COMPUTED-TOMOGRAPHY ; MOTION ; nuclear medicine ; GATED RADIOTHERAPY ; IMRT ; ORDER ; radiology ; RE ; THERAPIES ; breathing cycle ; methods ; NUCLEAR ; technique ; MUTUAL INFORMATION ; RESPIRATORY MOTION ; phantom ; ENGLAND ; PREDICT ; MAXIMIZATION ; tumor motion ; MEDICINE ; X-RAY ; particle therapy ; LIMITS ; POSITION ; CONE-BEAM CT ; LUNG-TUMORS
    Abstract: Respiratory motion limits the potential of modern high-precision radiotherapy techniques such as IMRT and particle therapy. Due to the uncertainty of tumour localization, the ability of achieving dose conformation often cannot be exploited sufficiently, especially in the case of lung tumours. Various methods have been proposed to track the position of tumours using external signals, e. g. with the help of a respiratory belt or by observing external markers. Retrospectively gated time-resolved x-ray computed tomography (4D CT) studies prior to therapy can be used to register the external signals with the tumour motion. However, during treatment the actual motion of internal structures may be different. Direct control of tissue motion by online imaging during treatment promises more precise information. On the other hand, it is more complex, since a larger amount of data must be processed in order to determine the motion. Three major questions arise from this issue. Firstly, can the motion that has occurred be precisely determined in the images? Secondly, how large must, respectively how small can, the observed region be chosen to get a reliable signal? Finally, is it possible to predict the proximate tumour location within sufficiently short acquisition times to make this information available for gating irradiation? Based on multiple studies on a porcine lung phantom, we have tried to examine these questions carefully. We found a basic characteristic of the breathing cycle in images using the image similarity method normalized mutual information. Moreover, we examined the performance of the calculations and proposed an image-based gating technique. In this paper, we present the results and validation performed with a real patient data set. This allows for the conclusion that it is possible to build up a gating system based on image data, solely, or ( at least in avoidance of an exceeding exposure dose) to verify gates proposed by the various external systems
    Type of Publication: Journal article published
    PubMed ID: 18495978
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  • 2
    Keywords: CT ; REGISTRATION ; INTENSITY-MODULATED RADIOTHERAPY ; FAILURE ; IMRT ; head and neck cancer ; DELINEATION ; IGRT ; QUANTITATIVE PERTECHNETATE SCINTIGRAPHY ; SALIVARY-GLAND FUNCTION ; Adaptive RT ; STAGE NASOPHARYNGEAL CARCINOMA ; TARGET VOLUME
    Abstract: PURPOSE: To present an approach to fast, interfractional adaptive RT in intensity-modulated radiation therapy (IMRT) of head and neck tumors in clinical routine. Ensuring adequate patient position throughout treatment proves challenging in high-precision RT despite elaborate immobilization. Because of weight loss, treatment plans must be adapted to account for requiring supportive therapy incl. feeding tube or parenteral nutrition without treatment breaks. METHODS AND MATERIALS: In-room CT position checks are used to create adapted IMRT treatment plans by stereotactic correlation to the initial setup, and volumes are adapted to the new geometry. New IMRT treatment plans are prospectively created on the basis of position control scans using the initial optimization parameters in KonRad without requiring complete reoptimization and thus facilitating quick replanning in daily routine. Patients treated for squamous cell head and neck cancer (SCCHN) in 2006-2007 were evaluated as to necessity/number of replannings, weight loss, dose, and plan parameters. RESULTS: Seventy-two patients with SCCHN received IMRT to the primary site and lymph nodes (median dose 70.4 Gy). All patients received concomitant chemotherapy requiring supportive therapy by feeding tube or parenteral nutrition. Median weight loss was 7.8 kg, median volume loss was approximately 7%. Fifteen of 72 patients required adaptation of their treatment plans at least once. Target coverage was improved by up to 10.7% (median dose). The increase of dose to spared parotid without replanning was 11.7%. Replanning including outlining and optimization was feasible within 2 hours for each patient, and treatment could be continued without any interruptions. CONCLUSION: To preserve high-quality dose application, treatment plans must be adapted to anatomical changes. Replanning based on position control scans therefore presents a practical approach in clinical routine. In the absence of clinically usable online correction methods, this approach allows significant improvement of target volume coverage and continuous parotid sparing without treatment delays.
    Type of Publication: Journal article published
    PubMed ID: 21310549
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  • 3
    Keywords: CANCER ; radiotherapy ; tumor ; COMBINATION ; Germany ; LUNG ; PROSTATE ; ALGORITHM ; CT ; imaging ; INFORMATION ; lung cancer ; LUNG-CANCER ; MASK ; TISSUE ; TIME ; PATIENT ; COMPLEX ; COMPLEXES ; CONTRAST ; treatment ; TARGET ; ACQUISITION ; EXPERIENCE ; VECTOR ; NUMBER ; prostate cancer ; PROSTATE-CANCER ; REGISTRATION ; BEAM ; DELIVERY ; HEAD ; CANCER-PATIENTS ; MULTILEAF COLLIMATOR ; treatment planning ; BODY ; CANCER PATIENTS ; LINEAR-ACCELERATOR ; RECONSTRUCTION ; IMRT ; PATIENT FIXATION ; IMPLEMENTATION ; INCREASE ; chordoma ; LEVEL ; methods ; fractionated stereotactic radiotherapy ; technique ; MUTUAL INFORMATION ; cancer research ; cone beam CT ; LANDMARK ; INCREASES ; CLINICAL IMPLEMENTATION ; ACCELERATOR ; WORKLOAD
    Abstract: ABSTRACT: BACKGROUND: The purpose of the study was the clinical implementation of a kV cone beam CT (CBCT) for setup correction in radiotherapy. PATIENTS AND METHODS: For evaluation of the setup correction workflow, six tumor patients (lung cancer, sacral chordoma, head-and-neck and paraspinal tumor, and two prostate cancer patients) were selected. All patients were treated with fractionated stereotactic radiotherapy, five of them with intensity modulated radiotherapy (IMRT). For patient fixation, a scotch cast body frame or a vacuum pillow, each in combination with a scotch cast head mask, were used. The imaging equipment, consisting of an x-ray tube and a flat panel imager (FPI), was attached to a Siemens linear accelerator according to the in-line approach, i.e. with the imaging beam mounted opposite to the treatment beam sharing the same isocenter. For dose delivery, the treatment beam has to traverse the FPI which is mounted in the accessory tray below the multi-leaf collimator. For each patient, a predefined number of imaging projections over a range of at least 200 degrees were acquired. The fast reconstruction of the 3D-CBCT dataset was done with an implementation of the Feldkamp-David-Kress (FDK) algorithm. For the registration of the treatment planning CT with the acquired CBCT, an automatic mutual information matcher and manual matching was used. RESULTS AND DISCUSSION: Bony landmarks were easily detected and the table shifts for correction of setup deviations could be automatically calculated in all cases. The image quality was sufficient for a visual comparison of the desired target point with the isocenter visible on the CBCT. Soft tissue contrast was problematic for the prostate of an obese patient, but good in the lung tumor case. The detected maximum setup deviation was 3 mm for patients fixated with the body frame, and 6 mm for patients positioned in the vacuum pillow. Using an action level of 2 mm translational error, a target point correction was carried out in 4 cases. The additional workload of the described workflow compared to a normal treatment fraction led to an extra time of about 10-12 minutes, which can be further reduced by streamlining the different steps. CONCLUSION: The cone beam CT attached to a LINAC allows the acquisition of a CT scan of the patient in treatment position directly before treatment. Its image quality is sufficient for determining target point correction vectors. With the presented workflow, a target point correction within a clinically reasonable time frame is possible. This increases the treatment precision, and potentially the complex patient fixation techniques will become dispensable
    Type of Publication: Journal article published
    PubMed ID: 16723023
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  • 4
    Keywords: ONCOLOGY ; radiology ; IMRT ; nuclear medicine ; imaging ; SYSTEM ; NEW-YORK ; NUCLEAR-MEDICINE ; PROSTATE ; interactive ; MEDICINE ; USA ; NUCLEAR
    Type of Publication: Meeting abstract published
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  • 5
    Keywords: OPTIMIZATION ; radiotherapy ; tumor ; COMBINATION ; Germany ; LUNG ; MODEL ; MODELS ; THERAPY ; CT ; imaging ; INFORMATION ; SYSTEM ; VOLUME ; TISSUE ; TUMORS ; ACCURACY ; NUCLEAR-MEDICINE ; radiation ; TIME ; PATIENT ; QUALITY ; SIMULATION ; TARGET ; RADIATION-THERAPY ; REGISTRATION ; MOTION ; PROJECT ; HEALTHY ; nuclear medicine ; IMRT ; radiology ; RE ; THERAPIES ; intensity ; radiation therapy ; analysis ; methods ; NUCLEAR ; 3D ; technique ; ENGLAND ; IMPROVEMENT ; tumor motion ; MEDICINE ; modeling ; SHAPE ; DISPLACEMENT ; DOSE OPTIMIZATION ; FEM ; LARGE-DEFORMATION
    Abstract: 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
    Type of Publication: Journal article published
    PubMed ID: 18685088
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  • 6
    Keywords: radiotherapy ; PATTERNS ; RECURRENCE ; REGISTRATION ; CHILDREN ; UNCERTAINTIES ; IMRT ; CRANIOSPINAL IRRADIATION ; intensity-modulated radiation therapy ; PEDIATRIC MEDULLOBLASTOMA ; Setup uncertainties ; Image-guided radiation therapy
    Abstract: PURPOSE: To evaluate local positioning errors of the lumbar spine during fractionated intensity-modulated radiotherapy of patients treated with craniospinal irradiation and to assess the impact of rotational error correction on these uncertainties for one patient setup correction strategy. METHODS AND MATERIALS: 8 patients (6 adults, 2 children) treated with helical tomotherapy for craniospinal irradiation were retrospectively chosen for this analysis. Patients were immobilized with a deep-drawn Aquaplast head mask. Additionally to daily megavoltage control computed tomography scans of the skull, once-a-week positioning of the lumbar spine was assessed. Therefore, patient setup was corrected by a target point correction, derived from a registration of the patient's skull. The residual positioning variations of the lumbar spine were evaluated applying a rigid-registration algorithm. The impact of different rotational error corrections was simulated. RESULTS: After target point correction, residual local positioning errors of the lumbar spine varied considerably. Craniocaudal axis rotational error correction did not improve or deteriorate these translational errors, whereas simulation of a rotational error correction of the right-left and anterior-posterior axis increased these errors by a factor of 2 to 3. CONCLUSION: The patient fixation used allows for deformations between the patient's skull and spine. Therefore, for the setup correction strategy evaluated in this study, generous margins for the lumbar spinal target volume are needed to prevent a local geographic miss. With any applied correction strategy, it needs to be evaluated whether or not a rotational error correction is beneficial.
    Type of Publication: Journal article published
    PubMed ID: 20888708
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