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STRUTTURA COMPLESSA LABORATORIO DI FISICA MEDICA E SISTEMI ESPERTI IRE - ROMA. Direttore Prof. Marcello Benassi. POSITIONING ACCURACY WITH EXACTRAC X-RAY: OUR EXPERIENCE. Dott. Vicente Bruzzaniti. EXTERNAL BEAM RADIOTHERAPY: SOME PROBLEMS. 1. Clinical uncertainties.

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slide1

STRUTTURA COMPLESSA LABORATORIO DI FISICA MEDICA E SISTEMI ESPERTI IRE - ROMA

Direttore Prof. Marcello Benassi

Evolving Strategies in Radiation Oncology - "Setup Accuracy with Exactrac" Laboratorio di Fisica Medica e Sistemi Esperti IFO - Dott Vicente Bruzzaniti

slide2

POSITIONING ACCURACY WITH EXACTRAC X-RAY: OUR EXPERIENCE

Dott. Vicente Bruzzaniti

Evolving Strategies in Radiation Oncology - "Setup Accuracy with Exactrac" Laboratorio di Fisica Medica e Sistemi Esperti IFO - Dott Vicente Bruzzaniti

slide3

EXTERNAL BEAM RADIOTHERAPY:

SOME PROBLEMS

1. Clinical uncertainties

2. Geometrical uncertainties

Evolving Strategies in Radiation Oncology - "Setup Accuracy with Exactrac" Laboratorio di Fisica Medica e Sistemi Esperti IFO - Dott Vicente Bruzzaniti

slide4

DIFFICULTIES IN IDENTIFYNG THE TARGET VOLUME FROM CT SLICES

IDENTIFICATION OF GROSS TUMOR VOLUME (GTV) AND CLINICAL TUMOR VOLUME (CTV)ACCORDING TO ICRU REPORT 50

Clinical uncertainties

Evolving Strategies in Radiation Oncology - "Setup Accuracy with Exactrac" Laboratorio di Fisica Medica e Sistemi Esperti IFO - Dott Vicente Bruzzaniti

slide5

Geometrical uncertainties

Internal motion

Patient Positioning

Evolving Strategies in Radiation Oncology - "Setup Accuracy with Exactrac" Laboratorio di Fisica Medica e Sistemi Esperti IFO - Dott Vicente Bruzzaniti

slide6

INTERNAL ORGAN MOTION DURING ENTIRE TREATMENT

IDENTIFICATION OF INTERNAL TARGET VOLUME (ITV)

Geometrical uncertainties due to internal organ motion

INTERNAL TARGET VOLUME(ITV) = CLINICAL TARGET VOLUME (CTV) + INTERNAL MARGIN (IM) ACCORDING TO ICRU REPORT 62

Evolving Strategies in Radiation Oncology - "Setup Accuracy with Exactrac" Laboratorio di Fisica Medica e Sistemi Esperti IFO - Dott Vicente Bruzzaniti

slide7

PROBLEMS IN OBTAINING COINCIDENCE BETWEEN PLANNING ISOCENTER AND LINAC ISOCENTER DURING PATIENT POSITIONING

IDENTIFICATION OF PLANNING TARGET VOLUME (PTV)

Geometrical uncertainties due toPatientPositioning

PLANNING TARGET VOLUME(PTV) = INTERNAL TARGET VOLUME (ITV) + SETUP MARGIN (SM) ACCORDING TO ICRU REPORT 62

Evolving Strategies in Radiation Oncology - "Setup Accuracy with Exactrac" Laboratorio di Fisica Medica e Sistemi Esperti IFO - Dott Vicente Bruzzaniti

slide8

We need to

In a perfect world…..

SM 0

DOSE ESCALATION: higher Tumor Control ProbabilityBUT higher Normal Tissues Complications Probability

Exclude as much healthy tissue as possible from irradiated zone: MARGIN REDUCTION

HIGHER POSITIONING ACCURACY

SM=0 PTV=ITV

Evolving Strategies in Radiation Oncology - "Setup Accuracy with Exactrac" Laboratorio di Fisica Medica e Sistemi Esperti IFO - Dott Vicente Bruzzaniti

slide9

Original margin

Reduced margin

Example: IMRT allows for better isodose conformation to desired target shape.

Allows forbetter sparing of critical structures ONCE GIVEN a higher accuracy in patient positioning (SM0 , PTVITV)

Evolving Strategies in Radiation Oncology - "Setup Accuracy with Exactrac" Laboratorio di Fisica Medica e Sistemi Esperti IFO - Dott Vicente Bruzzaniti

to obtain a higher positioning accuracy
TO OBTAIN A HIGHER POSITIONING ACCURACY:

MEGAVOLTAGE EPID

EXACTRAC SYSTEM

Evolving Strategies in Radiation Oncology - "Setup Accuracy with Exactrac" Laboratorio di Fisica Medica e Sistemi Esperti IFO - Dott Vicente Bruzzaniti

slide11

EXACTRAC SYSTEM

EXACTRAC INFRARED MODULE

Remote IR-guided Couch Control

Stand- alone

As a tool for

EXACTRAC X-RAY MODULE

Patient positioning using external IR reflecting markers

Patient positioning using internal structures as markers

Evolving Strategies in Radiation Oncology - "Setup Accuracy with Exactrac" Laboratorio di Fisica Medica e Sistemi Esperti IFO - Dott Vicente Bruzzaniti

slide12

Our investigation:

Verification of Exactrac X rays positioning accuracy in prostate treatment with prone patients

Comparisons between portal films taken at 0 - 90° gantry position and corresponding DRRs from Brainscan TPS

Evolving Strategies in Radiation Oncology - "Setup Accuracy with Exactrac" Laboratorio di Fisica Medica e Sistemi Esperti IFO - Dott Vicente Bruzzaniti

slide13

ExacTrac X-Ray

Evolving Strategies in Radiation Oncology - "Setup Accuracy with Exactrac" Laboratorio di Fisica Medica e Sistemi Esperti IFO - Dott Vicente Bruzzaniti

slide14

EXACTRAC INFRARED COMPONENTS

CT identifiable

Can be place everywhere

IR REFLECTING SKIN MARKERS

IR CAMERAS

IR markers guide

VIDEO CAMERA

Permanent room and patient monitoring

Exactrac-Linac Integration

Couch control from outside treatment room

REMOTE COUCH CONTROL

Evolving Strategies in Radiation Oncology - "Setup Accuracy with Exactrac" Laboratorio di Fisica Medica e Sistemi Esperti IFO - Dott Vicente Bruzzaniti

slide15

FLAT PANEL

EXACTRAC INFRARED INTEGRATION COMPONENTS: EXACTRAC X-RAYS COMPONENTS

X-RAYS SOURCE

X RAY TUBE (150 kVmax)

Amorphous Silicon detector

Radiological Images Acquisition

NEEDED COMPONENT FOR BOTH SISTEMS

RT Planning computation and evaluation

Isocenter coordinates export

DRRs computation along X-rays tubes directions

TPS – BRAINSCAN

Brain Lab LTD

Evolving Strategies in Radiation Oncology - "Setup Accuracy with Exactrac" Laboratorio di Fisica Medica e Sistemi Esperti IFO - Dott Vicente Bruzzaniti

slide16

PATIENT ARRANGEMENT PREVIOUS TO CT ACQUISITION

DEFLATION OF PERSONAL VACUUM CUSHION

IR REFLECTING SKIN MARKERS PLACING

Evolving Strategies in Radiation Oncology - "Setup Accuracy with Exactrac" Laboratorio di Fisica Medica e Sistemi Esperti IFO - Dott Vicente Bruzzaniti

slide17

CT SCANNING OF PATIENT WITH IR REFLECTING MARKERS

DICOM IMAGES TRANSFER TO TPS (BRAIN SCAN-BRAIN LAB)

SKIN MARKERS DETECTION FROM TPS (BRAIN SCAN: localization)

FROM BRAINSCAN TPS (LOCALIZATION)

3D RECONSTRUCTION OF SKIN MARKERS DISTRIBUTION

Evolving Strategies in Radiation Oncology - "Setup Accuracy with Exactrac" Laboratorio di Fisica Medica e Sistemi Esperti IFO - Dott Vicente Bruzzaniti

slide18

PLANNING AND PLAN VALIDATION

APPROXIMATE POSITIONING OF PATIENT AT ISOCENTER AND BEGINING OF AUTOMATED EXACTRAC POSITIONING PROCEDURE

Evolving Strategies in Radiation Oncology - "Setup Accuracy with Exactrac" Laboratorio di Fisica Medica e Sistemi Esperti IFO - Dott Vicente Bruzzaniti

slide19

PROCEDURE

Flat panel

Evolving Strategies in Radiation Oncology - "Setup Accuracy with Exactrac" Laboratorio di Fisica Medica e Sistemi Esperti IFO - Dott Vicente Bruzzaniti

slide20

PROCEDURE

Automatic couch displacement for first radiogram acquisition

Pos. 1

Flat panel

Evolving Strategies in Radiation Oncology - "Setup Accuracy with Exactrac" Laboratorio di Fisica Medica e Sistemi Esperti IFO - Dott Vicente Bruzzaniti

slide21

PROCEDURE

Automatic couch displacement for second radiogram acquisition

Pos. 1

Pos. 2

Flat panel

Evolving Strategies in Radiation Oncology - "Setup Accuracy with Exactrac" Laboratorio di Fisica Medica e Sistemi Esperti IFO - Dott Vicente Bruzzaniti

slide22

DRR’s COMPUTATION ALONG X-RAY TUBES DIRECTIONS USING PATIENT’S CT DATA

COMPARISON BETWEEN DRRs AND RADIOGRAPHIC SHOTS

Evolving Strategies in Radiation Oncology - "Setup Accuracy with Exactrac" Laboratorio di Fisica Medica e Sistemi Esperti IFO - Dott Vicente Bruzzaniti

slide23

ISOCENTER POSITION SEARCH BY MEANS OF IMAGE FUSION BETWEEN RADIOGRAMS AND CORRESPONDING DRRs

Evolving Strategies in Radiation Oncology - "Setup Accuracy with Exactrac" Laboratorio di Fisica Medica e Sistemi Esperti IFO - Dott Vicente Bruzzaniti

slide24

PATIENT POSITIONING AT ISOCENTER

COUCH POSITIONING ACCORDING TO CALCULATED SHIFT

MATCH

Evolving Strategies in Radiation Oncology - "Setup Accuracy with Exactrac" Laboratorio di Fisica Medica e Sistemi Esperti IFO - Dott Vicente Bruzzaniti

definition of evaluated quantities
Definition of evaluated quantities
  • Sistematic setup error on single patient: average of measured difference in isocenter position between 0-90 portal films and computed DRRs on brainscan
  • Random setup error on single patient: standard deviation of measured difference in isocenter position between 0-90 portal films and computed DRRs on brainscan
  • Method Error on patient population: average of errors given in 1
  • Sistematic setup error on patient population: standard deviation of errors given in1
  • Random setup error on patient population: standard deviation of errors given in2

Evolving Strategies in Radiation Oncology - "Setup Accuracy with Exactrac" Laboratorio di Fisica Medica e Sistemi Esperti IFO - Dott Vicente Bruzzaniti

slide26

POSITIONING ACCURACY WITH EXACTRAC X-RAY: OUR EXPERIENCE

RESULTS

Evolving Strategies in Radiation Oncology - "Setup Accuracy with Exactrac" Laboratorio di Fisica Medica e Sistemi Esperti IFO - Dott Vicente Bruzzaniti

slide27

RANDOM ERRORS

slong = 0,9 mm

sant post = 0,8 mm

RANDOM ERROR ON POPULATION

slat lat = 1,1 mm

Evolving Strategies in Radiation Oncology - "Setup Accuracy with Exactrac" Laboratorio di Fisica Medica e Sistemi Esperti IFO - Dott Vicente Bruzzaniti

slide28

METHODERROR

long= -0,3 mm

ant post= 0,8 mm

lat lat= -0,8 mm

SISTEMATIC ERRORS AND METHODERROR

slong = 1,3 mm

sant post = 1,6 mm

SISTEMATIC ERROR ON POPULATION

slat lat = 1,5 mm

Evolving Strategies in Radiation Oncology - "Setup Accuracy with Exactrac" Laboratorio di Fisica Medica e Sistemi Esperti IFO - Dott Vicente Bruzzaniti

slide29

Dott MARCO D’ANDREA

Prof. MARCELLO BENASSI

REGARDS

Prof. GIORGIO ARCANGELI

Dott. GIUSEPPE GIOVINAZZO

Sig VINCENZO LUNGHI

Evolving Strategies in Radiation Oncology - "Setup Accuracy with Exactrac" Laboratorio di Fisica Medica e Sistemi Esperti IFO - Dott Vicente Bruzzaniti

slide30

FINE

Evolving Strategies in Radiation Oncology - "Setup Accuracy with Exactrac" Laboratorio di Fisica Medica e Sistemi Esperti IFO - Dott Vicente Bruzzaniti

definition of evaluated quantities1
Definition of evaluated quantities
  • Sistematic setup error on single patient: average of measured difference in isocenter position between 0-90 portal films and computed DRRs on brainscan
  • Random setup error on single patient: standard deviation of measured difference in isocenter position between 0-90 portal films and computed DRRs on brainscan
  • Method Error on patient population: average of errors given in 1
  • Sistematic setup error on patient population: standard deviation of errors given in 1
  • Random setup error on patient population: standard deviation of errors given in2

Evolving Strategies in Radiation Oncology - "Setup Accuracy with Exactrac" Laboratorio di Fisica Medica e Sistemi Esperti IFO - Dott Vicente Bruzzaniti

definition of evaluated quantities2
Definition of evaluated quantities
  • Sistematic setup error on single patient: average of measured difference in isocenter position between 0-90 portal films and computed DRRs on brainscan
  • Random setup error on single patient: standard deviation of measured difference in isocenter position between 0-90 portal films and computed DRRs on brainscan
  • Method Error on patient population: average of errors given in 1
  • Sistematic setup error on patient population: standard deviation of errors given in1
  • Random setup error on patient population: standard deviation of errors given in 2

Evolving Strategies in Radiation Oncology - "Setup Accuracy with Exactrac" Laboratorio di Fisica Medica e Sistemi Esperti IFO - Dott Vicente Bruzzaniti

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