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Feasibility study of ultrasound imaging for stereotactic body radiation therapy with active breathing coordinator in pancreatic cancer

PURPOSE: Stereotactic body radiation therapy (SBRT) allows for high radiation doses to be delivered to the pancreatic tumors with limited toxicity. Nevertheless, the respiratory motion of the pancreas introduces major uncertainty during SBRT. Ultrasound imaging is a non‐ionizing, non‐invasive, and r...

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Autores principales: Su, Lin, Iordachita, Iulian, Zhang, Yin, Lee, Junghoon, Ng, Sook Kien, Jackson, Juan, Hooker, Ted, Wong, John, Herman, Joseph M., Sen, H. Tutkun, Kazanzides, Peter, Lediju Bell, Muyinatu A., Yang, Chen, Ding, Kai
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5529166/
https://www.ncbi.nlm.nih.gov/pubmed/28574192
http://dx.doi.org/10.1002/acm2.12100
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author Su, Lin
Iordachita, Iulian
Zhang, Yin
Lee, Junghoon
Ng, Sook Kien
Jackson, Juan
Hooker, Ted
Wong, John
Herman, Joseph M.
Sen, H. Tutkun
Kazanzides, Peter
Lediju Bell, Muyinatu A.
Yang, Chen
Ding, Kai
author_facet Su, Lin
Iordachita, Iulian
Zhang, Yin
Lee, Junghoon
Ng, Sook Kien
Jackson, Juan
Hooker, Ted
Wong, John
Herman, Joseph M.
Sen, H. Tutkun
Kazanzides, Peter
Lediju Bell, Muyinatu A.
Yang, Chen
Ding, Kai
author_sort Su, Lin
collection PubMed
description PURPOSE: Stereotactic body radiation therapy (SBRT) allows for high radiation doses to be delivered to the pancreatic tumors with limited toxicity. Nevertheless, the respiratory motion of the pancreas introduces major uncertainty during SBRT. Ultrasound imaging is a non‐ionizing, non‐invasive, and real‐time technique for intrafraction monitoring. A configuration is not available to place the ultrasound probe during pancreas SBRT for monitoring. METHODS AND MATERIALS: An arm‐bridge system was designed and built. A CT scan of the bridge‐held ultrasound probe was acquired and fused to ten previously treated pancreatic SBRT patient CTs as virtual simulation CTs. Both step‐and‐shoot intensity‐modulated radiation therapy (IMRT) and volumetric‐modulated arc therapy (VMAT) planning were performed on virtual simulation CT. The accuracy of our tracking algorithm was evaluated by programmed motion phantom with simulated breath‐hold 3D movement. An IRB‐approved volunteer study was also performed to evaluate feasibility of system setup. Three healthy subjects underwent the same patient setup required for pancreas SBRT with active breath control (ABC). 4D ultrasound images were acquired for monitoring. Ten breath‐hold cycles were monitored for both phantom and volunteers. For the phantom study, the target motion tracked by ultrasound was compared with motion tracked by the infrared camera. For the volunteer study, the reproducibility of ABC breath‐hold was assessed. RESULTS: The volunteer study results showed that the arm‐bridge system allows placement of an ultrasound probe. The ultrasound monitoring showed less than 2 mm reproducibility of ABC breath‐hold in healthy volunteers. The phantom monitoring accuracy is 0.14 ± 0.08 mm, 0.04 ± 0.1 mm, and 0.25 ± 0.09 mm in three directions. On dosimetry part, 100% of virtual simulation plans passed protocol criteria. CONCLUSIONS: Our ultrasound system can be potentially used for real‐time monitoring during pancreas SBRT without compromising planning quality. The phantom study showed high monitoring accuracy of the system, and the volunteer study showed feasibility of the clinical workflow.
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spelling pubmed-55291662018-04-02 Feasibility study of ultrasound imaging for stereotactic body radiation therapy with active breathing coordinator in pancreatic cancer Su, Lin Iordachita, Iulian Zhang, Yin Lee, Junghoon Ng, Sook Kien Jackson, Juan Hooker, Ted Wong, John Herman, Joseph M. Sen, H. Tutkun Kazanzides, Peter Lediju Bell, Muyinatu A. Yang, Chen Ding, Kai J Appl Clin Med Phys Radiation Oncology Physics PURPOSE: Stereotactic body radiation therapy (SBRT) allows for high radiation doses to be delivered to the pancreatic tumors with limited toxicity. Nevertheless, the respiratory motion of the pancreas introduces major uncertainty during SBRT. Ultrasound imaging is a non‐ionizing, non‐invasive, and real‐time technique for intrafraction monitoring. A configuration is not available to place the ultrasound probe during pancreas SBRT for monitoring. METHODS AND MATERIALS: An arm‐bridge system was designed and built. A CT scan of the bridge‐held ultrasound probe was acquired and fused to ten previously treated pancreatic SBRT patient CTs as virtual simulation CTs. Both step‐and‐shoot intensity‐modulated radiation therapy (IMRT) and volumetric‐modulated arc therapy (VMAT) planning were performed on virtual simulation CT. The accuracy of our tracking algorithm was evaluated by programmed motion phantom with simulated breath‐hold 3D movement. An IRB‐approved volunteer study was also performed to evaluate feasibility of system setup. Three healthy subjects underwent the same patient setup required for pancreas SBRT with active breath control (ABC). 4D ultrasound images were acquired for monitoring. Ten breath‐hold cycles were monitored for both phantom and volunteers. For the phantom study, the target motion tracked by ultrasound was compared with motion tracked by the infrared camera. For the volunteer study, the reproducibility of ABC breath‐hold was assessed. RESULTS: The volunteer study results showed that the arm‐bridge system allows placement of an ultrasound probe. The ultrasound monitoring showed less than 2 mm reproducibility of ABC breath‐hold in healthy volunteers. The phantom monitoring accuracy is 0.14 ± 0.08 mm, 0.04 ± 0.1 mm, and 0.25 ± 0.09 mm in three directions. On dosimetry part, 100% of virtual simulation plans passed protocol criteria. CONCLUSIONS: Our ultrasound system can be potentially used for real‐time monitoring during pancreas SBRT without compromising planning quality. The phantom study showed high monitoring accuracy of the system, and the volunteer study showed feasibility of the clinical workflow. John Wiley and Sons Inc. 2017-06-02 /pmc/articles/PMC5529166/ /pubmed/28574192 http://dx.doi.org/10.1002/acm2.12100 Text en © 2017 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, Inc. on behalf of American Association of Physicists in Medicine. This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Radiation Oncology Physics
Su, Lin
Iordachita, Iulian
Zhang, Yin
Lee, Junghoon
Ng, Sook Kien
Jackson, Juan
Hooker, Ted
Wong, John
Herman, Joseph M.
Sen, H. Tutkun
Kazanzides, Peter
Lediju Bell, Muyinatu A.
Yang, Chen
Ding, Kai
Feasibility study of ultrasound imaging for stereotactic body radiation therapy with active breathing coordinator in pancreatic cancer
title Feasibility study of ultrasound imaging for stereotactic body radiation therapy with active breathing coordinator in pancreatic cancer
title_full Feasibility study of ultrasound imaging for stereotactic body radiation therapy with active breathing coordinator in pancreatic cancer
title_fullStr Feasibility study of ultrasound imaging for stereotactic body radiation therapy with active breathing coordinator in pancreatic cancer
title_full_unstemmed Feasibility study of ultrasound imaging for stereotactic body radiation therapy with active breathing coordinator in pancreatic cancer
title_short Feasibility study of ultrasound imaging for stereotactic body radiation therapy with active breathing coordinator in pancreatic cancer
title_sort feasibility study of ultrasound imaging for stereotactic body radiation therapy with active breathing coordinator in pancreatic cancer
topic Radiation Oncology Physics
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5529166/
https://www.ncbi.nlm.nih.gov/pubmed/28574192
http://dx.doi.org/10.1002/acm2.12100
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