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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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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


POSITIONING ACCURACY WITH EXACTRAC X-RAY: OUR EXPERIENCE ESPERTI IRE - ROMA

Dott. Vicente Bruzzaniti

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


EXTERNAL BEAM RADIOTHERAPY: ESPERTI IRE - ROMA

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


DIFFICULTIES IN IDENTIFYNG THE TARGET VOLUME FROM CT SLICES ESPERTI IRE - ROMA

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


Geometrical uncertainties ESPERTI IRE - ROMA

Internal motion

Patient Positioning

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


INTERNAL ORGAN MOTION DURING ENTIRE TREATMENT ESPERTI IRE - ROMA

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


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


We need to AND LINAC ISOCENTER DURING PATIENT POSITIONING

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


Original margin AND LINAC ISOCENTER DURING PATIENT POSITIONING

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: AND LINAC ISOCENTER DURING PATIENT POSITIONING

MEGAVOLTAGE EPID

EXACTRAC SYSTEM

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


EXACTRAC SYSTEM AND LINAC ISOCENTER DURING PATIENT POSITIONING

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


Our investigation: AND LINAC ISOCENTER DURING PATIENT POSITIONING

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


ExacTrac X-Ray AND LINAC ISOCENTER DURING PATIENT POSITIONING

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


EXACTRAC INFRARED COMPONENTS AND LINAC ISOCENTER DURING PATIENT POSITIONING

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


FLAT PANEL AND LINAC ISOCENTER DURING PATIENT POSITIONING

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


PATIENT ARRANGEMENT PREVIOUS TO CT ACQUISITION AND LINAC ISOCENTER DURING PATIENT POSITIONING

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


CT SCANNING OF PATIENT WITH IR REFLECTING MARKERS AND LINAC ISOCENTER DURING PATIENT POSITIONING

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


PLANNING AND PLAN VALIDATION AND LINAC ISOCENTER DURING PATIENT POSITIONING

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


PROCEDURE AND LINAC ISOCENTER DURING PATIENT POSITIONING

Flat panel

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


PROCEDURE AND LINAC ISOCENTER DURING PATIENT POSITIONING

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


PROCEDURE AND LINAC ISOCENTER DURING PATIENT POSITIONING

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


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


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


PATIENT POSITIONING AT ISOCENTER RADIOGRAMS AND CORRESPONDING DRRs

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 RADIOGRAMS AND CORRESPONDING DRRs

  • 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


POSITIONING ACCURACY WITH EXACTRAC X-RAY: OUR EXPERIENCE RADIOGRAMS AND CORRESPONDING DRRs

RESULTS

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


RANDOM ERRORS RADIOGRAMS AND CORRESPONDING DRRs

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


METHOD RADIOGRAMS AND CORRESPONDING DRRsERROR

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


Dott MARCO D’ANDREA RADIOGRAMS AND CORRESPONDING DRRs

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


FINE RADIOGRAMS AND CORRESPONDING DRRs

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 RADIOGRAMS AND CORRESPONDING DRRs

  • 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 RADIOGRAMS AND CORRESPONDING DRRs

  • 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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