4D registration and 4D verification of lung tumor position for stereotactic volumetric modulated arc therapy using respiratory-correlated cone-beam CT

Abstract

We propose a clinical workflow of stereotactic volumetric modulated arc therapy (VMAT) for a lung tumor from planning to tumor position verification using 4D planning computed tomography (CT) and 4D cone-beam CT (CBCT). A 4D CT scanner, an Anzai belt and a BodyFix were employed to obtain 10-phase respiratory-correlated CT data for a lung patient under constrained breathing conditions. A planning target volume (PTV) was defined by adding a 5-mm margin to an internal target volume created from 10 clinical target volumes, each of which was delineated on each of the 10-phase planning CT data. A single-arc VMAT plan was created with a D95 prescription dose of 50 Gy in four fractions on the maximum exhalation phase CT images. The PTV contours were exported to a kilovoltage CBCT X-ray Volume Imaging (XVI) equipped with a linear accelerator (linac). Immediately before treatment, 10-phase 4D CBCT images were reconstructed leading to animated lung tumor imaging. Initial bone matching was performed between frame-averaged 4D planning CT and frame-averaged 4D CBCT datasets. Subsequently, the imported PTV contours and the animated moving tumor were simultaneously displayed on the XVI monitor, and a manual 4D registration was interactively performed on the monitor until the moving tumor was symmetrically positioned inside the PTV. A VMAT beam was delivered to the patient and during the delivery further 4D CBCT projection data were acquired to verify the tumor position. The entire process was repeated for each fraction. It was confirmed that the moving tumor was positioned inside the PTV during the VMAT delivery.

Flattening filter-free technique in volumetric modulated arc therapy for lung stereotactic body radiotherapy: A clinical comparison with the flattening filter technique

“…Gross tumor volume (GTV) was delineated in each respiratory phase using the lung window (window, 1,600 HU; level, -300 HU). These 10 GTVs were fused to form the internal target volume (ITV) and then a uniform 5 mm margin was added to create the planning target volume (PTV) (20)(21)(22).…”

Radiation pneumonitis after stereotactic radiation therapy for lung cancer

“…We had used irradiation dose of 48 Gy in 4 fractions (Figure 1). We also used 4D cone beam computed tomography (CT) to evaluate internal target volume and tumor motion just before SBRT, with the result that the margin between the internal target volume and the PTV became narrower [40,41] .…”

SPARE: Sparse‐view reconstruction challenge for 4D cone‐beam CT from a 1‐min scan

“…The emergence of 4D cone‐beam computed tomography (CBCT) has enabled onboard verification of target location and motion range while reducing motion artifacts. Compared to three‐dimensional (3D)‐CBCT, 4D‐CBCT has been shown to reduce setup errors and enable measurement of daily target motion …”

“…Compared to three-dimensional (3D)-CBCT, 4D-CBCT has been shown to reduce setup errors 2 and enable measurement of daily target motion. 3 Conventionally, 4D-CBCT images are computed by sorting the projections into different respiratory bins, and reconstructing separately using the Feldkamp-Davis-Kress (FDK) algorithm. 4 This leads to longer acquisition time (3-4 min) and higher imaging dose compared to a standard CBCT scan, which takes one minute to acquire.…”