Correction of patient positioning errors based on in-line cone beam CTs: clinical implementation and first experiences.
BACKGROUND: The purpose of the study was the clinical implementation of a kV cone beam CT (CBCT) for setup correction in radiotherapy. PATIENTS AND METHODS: For evaluation of the setup correction workflow, six tumor patients (lung cancer, sacral chordoma, head-and-neck and paraspinal tumor, and two prostate cancer patients) were selected. All patients were treated with fractionated stereotactic radiotherapy, five of them with intensity modulated radiotherapy (IMRT). For patient fixation, a scotch cast body frame or a vacuum pillow, each in combination with a scotch cast head mask, were used. The imaging equipment, consisting of an x-ray tube and a flat panel imager (FPI), was attached to a Siemens linear accelerator according to the in-line approach, i.e. with the imaging beam mounted opposite to the treatment beam sharing the same isocenter. For dose delivery, the treatment beam has to traverse the FPI which is mounted in the accessory tray below the multi-leaf collimator. For each patient, a predefined number of imaging projections over a range of at least 200 degrees were acquired. The fast reconstruction of the 3D-CBCT dataset was done with an implementation of the Feldkamp-David-Kress (FDK) algorithm. For the registration of the treatment planning CT with the acquired CBCT, an automatic mutual information matcher and manual matching was used. RESULTS AND DISCUSSION: Bony landmarks were easily detected and the table shifts for correction of setup deviations could be automatically calculated in all cases. The image quality was sufficient for a visual comparison of the desired target point with the isocenter visible on the CBCT. Soft tissue contrast was problematic for the prostate of an obese patient, but good in the lung tumor case. The detected maximum setup deviation was 3 mm for patients fixated with the body frame, and 6 mm for patients positioned in the vacuum pillow. Using an action level of 2 mm translational error, a target point correction was carried out in 4 cases. The additional workload of the described workflow compared to a normal treatment fraction led to an extra time of about 10-12 minutes, which can be further reduced by streamlining the different steps. CONCLUSION: The cone beam CT attached to a LINAC allows the acquisition of a CT scan of the patient in treatment position directly before treatment. Its image quality is sufficient for determining target point correction vectors. With the presented workflow, a target point correction within a clinically reasonable time frame is possible. This increases the treatment precision, and potentially the complex patient fixation techniques will become dispensable. (+info)
Cone-beam micro-CT system based on LabVIEW software.
Construction of a cone-beam computed tomography (CBCT) system for laboratory research usually requires integration of different software and hardware components. As a result, building and operating such a complex system require the expertise of researchers with significantly different backgrounds. Additionally, writing flexible code to control the hardware components of a CBCT system combined with designing a friendly graphical user interface (GUI) can be cumbersome and time consuming. An intuitive and flexible program structure, as well as the program GUI for CBCT acquisition, is presented in this note. The program was developed in National Instrument's Laboratory Virtual Instrumentation Engineering Workbench (LabVIEW) graphical language and is designed to control a custom-built CBCT system but has been also used in a standard angiographic suite. The hardware components are commercially available to researchers and are in general provided with software drivers which are LabVIEW compatible. The program structure was designed as a sequential chain. Each step in the chain takes care of one or two hardware commands at a time; the execution of the sequence can be modified according to the CBCT system design. We have scanned and reconstructed over 200 specimens using this interface and present three examples which cover different areas of interest encountered in laboratory research. The resulting 3D data are rendered using a commercial workstation. The program described in this paper is available for use or improvement by other researchers. (+info)
On-line target position localization in the presence of respiration: a comparison of two methods.
PURPOSE: To compare two "four-dimensional" methods for image-guided target localization in the presence of respiration. METHODS AND MATERIALS: Four-dimensional image guidance was performed with two methods. A respiration-correlated computed tomography (RCCT) was acquired on a CT simulator, and an average CT (AVG-CT) image was generated from the RCCT. A respiration-correlated cone-beam CT (RC-CBCT) and a free-breathing cone-beam CT (FB-CBCT) were acquired. The "RCCT method" consisted of calculating the mean target position on both the RCCT and RC-CBCT, registering the RCCT to the RC-CBCT, and determining the shift in the mean target position from the planned mean position. The "AVG-CT method" consisted of registering the AVG-CT to the FB-CBCT. The ability of each to measure the shift in the mean target position was compared, both in a respiratory phantom and in 8 patients. RESULTS: In phantom, the RCCT and AVG-CT methods were able to measure the true mean target position to within 0.15 cm and 0.10 cm, respectively. In the patient study, the mean error between the methods was 0.13 cm (left-right), 0.14 cm (anterior-posterior), and 0.10 cm (cranio-caudal). The error was not observed to vary with tumor position or magnitude of tumor motion. CONCLUSIONS: Respiration may impact the on-line image guidance process. The RCCT method enables localization of the mean tumor position and measurement of changes in the motion pattern, whereas the AVG-CT method is simple, fast, and easily implemented. We found the methods to be nearly equivalent in detecting shifts in the mean tumor position. (+info)
Development of three-dimensional FE modeling system from the limited cone beam CT images for orthodontic tipping tooth movement.
Previously, numerous three-dimensional finite element (FE) models of the dentoalveolar complex have been developed and stress analyses of orthodontic tooth movements were reported. Most of the models were, however, developed based on average anatomical data, but not on individual data. The aim of this study, therefore, was to investigate dentoalveolar stress distribution by lingual and distal tipping tooth movements using FE models of individual teeth based on the limited cone beam CT (3DX) images. Three extracted teeth (lower canine, upper molar, and lower molar) were used to test the three-dimensional reconstruction procedure in terms of accuracy and reproducibility in linear dimensions and sizes. From the stress analysis of the three different models, the equivalent stress in tipping movement concentrated at the cervical region of the PDL and bone crest in all teeth. It was suggested that the FE modeling technique based on 3DX in this study is recommended for the individual determination of optimal orthodontic force for effective tooth movement. (+info)
Balancing radiation dose and image quality: clinical applications of neck volume CT.
Monte Carlo investigations of megavoltage cone-beam CT using thick, segmented scintillating detectors for soft tissue visualization.
Megavoltage cone-beam computed tomography (MV CBCT) is a highly promising technique for providing volumetric patient position information in the radiation treatment room. Such information has the potential to greatly assist in registering the patient to the planned treatment position, helping to ensure accurate delivery of the high energy therapy beam to the tumor volume while sparing the surrounding normal tissues. Presently, CBCT systems using conventional MV active matrix flat-panel imagers (AMFPIs), which are commonly used in portal imaging, require a relatively large amount of dose to create images that are clinically useful. This is due to the fact that the phosphor screen detector employed in conventional MV AMFPIs utilizes only approximately 2% of the incident radiation (for a 6 MV x-ray spectrum). Fortunately, thick segmented scintillating detectors can overcome this limitation, and the first prototype imager has demonstrated highly promising performance for projection imaging at low doses. It is therefore of definite interest to examine the potential performance of such thick, segmented scintillating detectors for MV CBCT. In this study, Monte Carlo simulations of radiation energy deposition were used to examine reconstructed images of cylindrical CT contrast phantoms, embedded with tissue-equivalent objects. The phantoms were scanned at 6 MV using segmented detectors having various design parameters (i.e., detector thickness as well as scintillator and septal wall materials). Due to constraints imposed by the nature of this study, the size of the phantoms was limited to approximately 6 cm. For such phantoms, the simulation results suggest that a 40 mm thick, segmented CsI detector with low density septal walls can delineate electron density differences of approximately 2.3% and 1.3% at doses of 1.54 and 3.08 cGy, respectively. In addition, it was found that segmented detectors with greater thickness, higher density scintillator material, or lower density septal walls exhibit higher contrast-to-noise performance. Finally, the performance of various segmented detectors obtained at a relatively low dose (1.54 cGy) was compared with that of a phosphor screen similar to that employed in conventional MV AMFPIs. This comparison indicates that for a phosphor screen to achieve the same contrast-to-noise performance as the segmented detectors approximately 18 to 59 times more dose is required, depending on the configuration of the segmented detectors. (+info)
In vivo comparison of conventional and cone beam CT synthesized cephalograms.