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1 March 2019 Comparisons of 6 fps volume-rendered x-ray digital tomosynthesis TumoTrak-guided to 2D-MRI-guided radiotherapy of lung cancer
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Abstract
Retrospective kV x-ray 4DCT treatment planning for lung cancer MV linac treatment is becoming a standard-of-care for this widely used procedure for the largest cancer cause-of-death in the US. It currently provides the best estimate of a fixed-in-time but undulating and closed 3D "shell" to which a minimum curative-intent radiation dose should be delivered to provide the best estimated patient survival and the least morbidity, usually characterized by quantitative dose-volume-histograms (DVHs). Unfortunately this closed shell volume or internal target volume (ITV) currently has to be increased enough to enclose the full range of respiratory lesion motion (plus set-up etc. uncertainties) which cannot yet be accurately determined in real time during treatment delivery. With accurate motion-tracking, the planning target volume (PTV) or outer “shell” may be reduced by up to 40%. However there is no single 2D plane that precisely follows the reduced-PTV-volume’s 3D respiratory motion, currently best estimated by the retrospective hand contouring by a trained and experienced MD radiation oncology MD using the full 3D-time information of 4DCT. Once available, 3D motion tracking in real time has the potential to substantially decrease DVH doses to surrounding organs-at-risk (OARs), while maintaining or raising the curative-intent dose to the lesion itself. The assertion argued here is that, the 3D volume-rendered imaging of lung cancer lesion-trajectories in real-time from TumoTrak digital x-ray tomosythesis, has the potential to provide more accurate 3D motion tracking and improved dose delivery at lower cost than the real time, 2D single slice imaging of MRI-guided radiotherapy.
© (2019) COPYRIGHT Society of Photo-Optical Instrumentation Engineers (SPIE). Downloading of the abstract is permitted for personal use only.
Larry Partain, Stanley Benedict, Namho Kim, Megan Daly, Austin Ely, Andrew Hernandez, Samuel Song, Micheal Weil, Vitaliy Ziskin, Kyle Foletta, John Boone, and Douglas Boyd "Comparisons of 6 fps volume-rendered x-ray digital tomosynthesis TumoTrak-guided to 2D-MRI-guided radiotherapy of lung cancer", Proc. SPIE 10948, Medical Imaging 2019: Physics of Medical Imaging, 109483L (1 March 2019); https://doi.org/10.1117/12.2511993
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