Dataset Information

The non-Gaussian nature of prostate motion based on real-time intrafraction tracking.

ABSTRACT: The objective of this work is to test the validity of the Gaussian approximation for prostate motion through characterization of its spatial distribution.Real-time intrafraction prostate motion was observed using Calypso 4-dimensional (4D) nonradioactive electromagnetic tracking system. We report the results from a total of 1024 fractions from 31 prostate cancer patients. First, the correlation of prostate motion in right/left (RL), anteroposterior (AP), and superoinferior (SI) direction were determined using Pearson's correlation of coefficient. Then the spatial distribution of prostate motion was analyzed for individual fraction, individual patient including all fractions, and all patients including all fractions. The displacement in RL, AP, SI, oblique, or total direction is fitted into a Gaussian distribution, and a Lilliefors test was used to evaluate the validity of the hypothesis that the displacement is normally distributed.There is high correlation in AP/SI direction (61% of fractions with medium or strong correlation). This is consistent with the longitudinal oblique motion of the prostate, and likely the effect from respiration on an organ confined within the genitourinary diaphragm with the rectum sitting posteriorly and bladder sitting superiorly. In all directions, the non-Gaussian distribution is more common for individual fraction, individual patient including all fractions, and all patients including all fractions. The spatial distribution of prostate motion shows an elongated shape in oblique direction, indicating a higher range of motion in the AP and SI directions.Our results showed that the prostate motion is highly correlated in AP and SI direction, indicating an oblique motion preference. In addition, the spatial distribution of prostate motion is elongated in an oblique direction, indicating that the organ motion dosimetric modeling using Gaussian kernel may need to be modified to account for the particular organ motion character of prostate.

SUBMITTER: Lin Y

PROVIDER: S-EPMC4764058 | biostudies-literature | 2013 Oct

REPOSITORIES: biostudies-literature

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The non-Gaussian nature of prostate motion based on real-time intrafraction tracking.

Lin Yuting Y Liu Tian T Yang Wells W Yang Xiaofeng X Khan Mohammad K MK

International journal of radiation oncology, biology, physics 20130709 2

<h4>Purpose</h4>The objective of this work is to test the validity of the Gaussian approximation for prostate motion through characterization of its spatial distribution.<h4>Methods and materials</h4>Real-time intrafraction prostate motion was observed using Calypso 4-dimensional (4D) nonradioactive electromagnetic tracking system. We report the results from a total of 1024 fractions from 31 prostate cancer patients. First, the correlation of prostate motion in right/left (RL), anteroposterior ( ...[more]

PMID: 23849698

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Project description:PurposeProstate motion during radiation therapy (ie, intrafraction motion) can cause unwanted loss of radiation dose to the prostate and increased dose to the surrounding organs at risk. A compact but general statistical description of this motion could be useful for simulation of radiation therapy delivery or margin calculations. We investigated whether prostate motion could be modeled with a random walk model.Methods and materialsProstate motion recorded during 548 radiation therapy fractions in 17 patients was analyzed and used for input in a random walk prostate motion model. The recorded motion was categorized on the basis of whether any transient excursions (ie, rapid prostate motion in the anterior and superior direction followed by a return) occurred in the trace and transient motion. This was separately modeled as a large step in the anterior/superior direction followed by a returning large step. Random walk simulations were conducted with and without added artificial transient motion using either motion data from all observed traces or only traces without transient excursions as model input, respectively.ResultsA general estimate of motion was derived with reasonable agreement between simulated and observed traces, especially during the first 5 minutes of the excursion-free simulations. Simulated and observed diffusion coefficients agreed within 0.03, 0.2 and 0.3 mm2/min in the left/right, superior/inferior, and anterior/posterior directions, respectively. A rapid increase in variance at the start of observed traces was difficult to reproduce and seemed to represent the patient's need to adjust before treatment. This could be estimated somewhat using artificial transient motion.ConclusionsRandom walk modeling is feasible and recreated the characteristics of the observed prostate motion. Introducing artificial transient motion did not improve the overall agreement, although the first 30 seconds of the traces were better reproduced. The model provides a simple estimate of prostate motion during delivery of radiation therapy.

Project description:BackgroundSurface-guided radiation therapy (SGRT) employs a non-invasive real-time optical surface imaging (OSI) technique for patient surface motion monitoring during radiotherapy. The main purpose of this study is to verify the real-time tracking accuracy of SGRT for respiratory motion and provide a fitting method to detect the time delay of gating.MethodsA respiratory motion phantom was utilized to simulate respiratory motion using 17 cosine breathing pattern curves with various periods and amplitudes. The motion tracking of the phantom was performed by the Catalyst™ system. The tracking accuracy of the system (with period and amplitude variations) was evaluated by analyzing the adjusted coefficient of determination (A_R2) and root mean square error (RMSE). Furthermore, 13 actual respiratory curves, which were categorized into regular and irregular patterns, were selected and then simulated by the phantom. The Fourier transform was applied to the respiratory curves, and tracking accuracy was compared through the quantitative analyses of curve similarity using the Pearson correlation coefficient (PCC). In addition, the time delay of amplitude-based respiratory-gating radiotherapy based on the OSI system with various beam hold times was tested using film dosimetry for the Elekta Versa-HD and Varian Edge linacs. A dose convolution-fitting method was provided to accurately measure the beam-on and beam-off time delays.ResultsA_R2 and RMSE for the cosine curves were 0.9990-0.9996 and 0.110-0.241 mm for periods ranging from 1 s to 10 s and 0.9990-0.9994 and 0.059-0.175 mm for amplitudes ranging from 3 mm to 15 mm. The PCC for the actual respiratory curves ranged from 0.9955 to 0.9994, which was not significantly affected by breathing patterns. For gating radiotherapy, the average beam-on and beam-off time delays were 1664 ± 72 and 25 ± 30 ms for Versa-HD and 303 ± 45 and 34 ± 25 ms for Edge, respectively. The time delay was relatively stable as the beam hold time increased.ConclusionsThe OSI technique provides high accuracy for respiratory motion tracking. The proposed dose convolution-fitting method can accurately measure the time delay of respiratory-gating radiotherapy. When the OSI technique is used for respiratory-gating radiotherapy, the time delay for the beam-on is considerably longer than the beam-off.

Project description:BackgroundStereotactic Body Radiotherapy (SBRT) is as a standard treatment for prostate cancer (PCa). Tight margins and high dose gradients are needed, and the precise localization of the target is mandatory. Our retrospective study reports our experience regarding the evaluation of intrafraction prostate motion during LINAC-based SBRT evaluated with a novel electromagnetic (EM) tracking device. This device consists of an integrated Foley catheter with a transmitter connected to a receiver placed on the treatment table.MethodsWe analyzed 31 patients who received LINAC-based SBRT using flattening filter-free (FFF) volumetric modulated arc therapy (VMAT). The patients were scheduled to be treated for primary (n = 27) or an intraprostatic recurrent PCa (n = 4). A simulation CT scan was conducted while the patients had a filled bladder (100-150 cc) and an empty rectum, and an EM tracking device was used. The same rectal and bladder conditions were employed during the treatment. The patients received 36.25 Gy delivered over five consecutive fractions on the whole prostate and 40 Gy on the nodule(s) visible via MRI, both delivered with a Simultaneous Integrated Boost approach. The CTV-to-PTV margin was 2 mm for both the identified treatment volumes. Patient positioning was verified with XVI ConeBeam-CT (CBCT) matching before each fraction. When the signals exceeded a 2 mm threshold in any of the three spatial directions, the treatment was manually interrupted. A new XVI CBCT was performed if this offset lasted >20 s.ResultsWe analyzed data about 155 fractions. The median and mean treatment times, calculated per fraction, were 10 m31 s and 12 m44 s (range: 6 m36 s-65 m28 s), and 95% of the fractions were delivered with a maximum time of 27 m48 s. During treatment delivery, the mean and median number of XVI CBCT operations realized during the treatment were 2 and 1 (range: 0-11). During the treatment, the prostate was outside the CTV-to-PTV margin (2 mm), thus necessitating the stoppage of the delivery +/- a reacquisition of the XVI CBCT for 11.2%, 8.9%, and 3.9% of the delivery time in the vertical, longitudinal, and lateral direction, respectively.ConclusionsWe easily integrated an EM-transmitter-based gating for prostate LINAC-based SBRT into our normal daily workflow. Using this system, a 2 mm CTV-to-PTV margin could be safely applied. A small number of fractions showed a motion exceeding the predefined 2 mm threshold, which would have otherwise gone undetected without intrafraction motion management.

Dataset Information

The non-Gaussian nature of prostate motion based on real-time intrafraction tracking.

Publications

The non-Gaussian nature of prostate motion based on real-time intrafraction tracking.

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