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S870
ESTRO 36 2017
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EP-1628 Analysis of prostate SBRT treatments using 3D
transperineal ultrasound image guidance methods
M. Szegedi
1
, C. Boehm
1
, B. Ager
1
, V. Sarkar
1
, P. Rassiah-
Szegedi
1
, H. Zhao
1
, L. Huang
1
, J. Huang
1
, A. Paxton
1
, F.
Su
1
, J. Tward
1
, B. Salter
1
1
University of Utah Huntsman Cancer Hospital, Radiation
Oncology, Salt Lake City, USA
Purpose or Objective
A 2nd generation 3D ultrasound image guidance (USIG)
system (Clarity, Elekta Inc), that allows for transperineal
(TP) localization and intra-fractional tracking of the
prostate has been used in SBRT of the prostate at our
institution. We have analyzed 35 patients (175 fractions)
regarding the localization and tracking performance of our
USIG based prostate SBRT protocol.
Material and Methods
Our clinical workflow for prostate SBRT (5 fractions of 7.25
Gy each) involves setting the patient up based on skin
tattoos and using TP localization for image guidance. A
trans-abdominal (TA) ultrasound study (BAT, Nomos Inc) is
also performed to independently check the patient’s
position once TP-USIG-based shifts are applied. A detailed
description of our workflow has been presented before
[1].
Once the TP-based alignment has been approved by both
a physicist and physician with extensive USIG experience,
TP-based tracking is initiated. During the treatment, the
beam is manually switched off for any migrations greater
than 3 mm in any direction. If this migration occurs for
more than 5 seconds, the patient’s position is re-adjusted
before treatment resumption.
For all 175 treatments in the present cohort, the tracking
data was analyzed to determine the number of incidents
and duration the target’s excursion was greater than 3
mm. Further we evaluate the potential for partial PTV
miss, by subtracting couch movement from target
movement shown in Figure 1, showing the potential
excursion if no corrective action was taken and contrast
this with the PTV margins used.
Results
Figure 2 shows the number of instances where the position
of a patient had to be corrected. Only 10 of the 35 patients
did not require any corrective action. In two patients
(cases 29 and 32), the position had to be corrected more
than 20 times over the five fractions.
Conclusion
With more than 70% of the patients analyzed requiring
repositioning, it is clear that intra-fractional tracking
should be used when treating with a hypo-fractionated
approach, where large excursions should be avoided.
Lastly we will present the early follow up data (average
follow up 1.5 years) of rate and type of complications
observed and contrast it to our non-tracked SBRT
population. This will indicate if SBRT tracking does
prevent over-radiation of sensitive structures.
References: [1]
Salter BJ et al., 3D Transperineal
Ultrasound Image Guidance Methods for Prostate SBRT
Radiotherapy Treatment, Radiotherapy and Oncology,
115,
S460.
Figure 1: Example of the tracking of one patient in one
dimension and the subtraction of table movement.
Figure 2: Number of events a corrective positional shift
was required during treatment per patient. Each blue dot
represents one of the 35 patients. Only 10 patients did not
require a corrective action to bring the PTV within
tolerance levels (3mm or less).
EP-1629 Lung tumor tracking using CBCT-based
respiratory motion models driven by external
surrogates
A. Fassi
1
, A. Bombardieri
1
, G.B. Ivaldi
2
, M. Liotta
3
, P.
Tabarelli de Fatis
3
, I. Meaglia
2
, P. Porcu
2
, M. Riboldi
1
, G.
Baroni
1
1
Politecnico di Milano, Dipartimento di Elettronica
Informazione e Bioingegneria, Milano, Italy
2
Istituti Clinici Scientifici Maugeri, Radiation Oncology
Department, Pavia, Italy
3
Istituti Clinici Scientifici Maugeri, Medical Physics
Division, Pavia, Italy
Purpose or Objective
The aim was to investigate the use of time-resolved (4D)
Cone-Beam CT (CBCT) to build a patient-specific
respiratory motion model driven by a surface-based
breathing surrogate. The proposed approach was applied
for the real-time intra-fraction tracking of lung tumors.
Material and Methods
The study included two lung cancer patients treated with
stereotactic body radiotherapy. Two CBCT scans, acquired
at the beginning and at the end of the first treatment
fraction, were analyzed for each patient. Seven passive
markers were positioned on anatomical landmarks of the
patients' thoraco-abdominal surface. Markers 3D
coordinates were continuously acquired during all CBCT
scans through an optical tracking system (SMART-DX 100,
BTS Bioengineering), synchronized with the acquisition of
CBCT projections. A breathing surrogate was obtained
from the trajectory of all surface markers. The external
surrogate was used to reconstruct the 4D CBCT using the
motion-compensated algorithm [1]. A deformable
respiratory motion model [2] was built from the 4D CBCT
of the first scan. The breathing phase and amplitude given
as input to the motion model were estimated from the
external surrogate. The accuracy of the proposed tracking
approach was evaluated on both the first and the second
CBCT scan, after compensating for baseline shifts. Tumor
positions estimated in 3D with the motion model were
projected at the corresponding angle and compared to the
real tumor trajectory semi-automatically identified on
CBCT projections.