A 4D ultrasound real-time tracking system for external beam radiotherapy of upper abdominal lesions under breath-hold

Sihono, Dwi Seno Kuncoro; Vogel, Lena; Weiß, Christel; Thölking, J.; Wenz, Frederik; Lohr, Frank; Boda-Heggemann, Judit; Wertz, H.

doi:10.1007/s00066-016-1076-7

Cited by 13 publications

(9 citation statements)

References 23 publications

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“…This seems to be in line with the robotic radiosurgery system used in the early animal studies; however, this system required implanted fiducial markers or radiopaque landmarks in or near the target [33], while MRI does not. Other methods of motion compensation include ultrasound tracking [63], gating [64], or both [65]; however, they have not been systematically tested for RA/CRS yet.…”

Section: Technical Studies For Cardiac Radiosurgerymentioning

confidence: 99%

Radiosurgery for ventricular tachycardia: preclinical and clinical evidence and study design for a German multi-center multi-platform feasibility trial (RAVENTA)

et al. 2020

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Background Single-session high-dose stereotactic radiotherapy (radiosurgery) is a new treatment option for otherwise untreatable patients suffering from refractory ventricular tachycardia (VT). In the initial single-center case studies and feasibility trials, cardiac radiosurgery has led to significant reductions of VT burden with limited toxicities. However, the full safety profile remains largely unknown. Methods/design In this multi-center, multi-platform clinical feasibility trial which we plan is to assess the initial safety profile of radiosurgery for ventricular tachycardia (RAVENTA). High-precision image-guided single-session radiosurgery with 25 Gy will be delivered to the VT substrate determined by high-definition endocardial electrophysiological mapping. The primary endpoint is safety in terms of successful dose delivery without severe treatment-related side effects in the first Jürgen Dunst and Hendrik Bonnemeier have equally contributed to this work. This is the first publication for the RAVENTA study.

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Section: Technical Studies For Cardiac Radiosurgerymentioning

confidence: 99%

Radiosurgery for ventricular tachycardia: preclinical and clinical evidence and study design for a German multi-center multi-platform feasibility trial (RAVENTA)

et al. 2020

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“…Fortgeschrittene Bewegungsmanagementverfahren können hier einen signifikanten Vorteil in der lokalen Kontrolle von Lebermetastasen erzielen [23]. Dabei besteht das Problem, dass die meisten modernen Linearbeschleuniger mit Stereotaxieeignung (mit Ausnahme neuer hybrider MR- [29] oder ultraschallgeführter [30,31] Systeme, für die bislang jedoch nur wenige klinische Ergebnisse publiziert sind) auf röntgenbasierte Bildgebung ausgelegt sind, wobei sich intra-hepatische Strukturen in der Leber aber i. d. R. nicht auf Röntgenbildern oder Lagerungs-CT-Aufnahmen (Cone-Beam-Computertomografie, CBCT) abgrenzen lassen. Am häufigsten wurde daher in der klinischen Routine bislang das sog.…”

Section: Stereotaktische Strahlentherapie Im Körperstammbereichunclassified

“…Diese Fiducial-Marker werden zumeist minimalinvasiv mittels CToder Ultraschallbildführung perkutan über 17-22 G (Gauge) dicke Nadeln implantiert [8,19,33]. [28,30].…”

Section: Stereotaktische Strahlentherapie Im Körperstammbereichunclassified

Stereotaktische Strahlentherapie für Lebermetastasen

et al. 2019

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ZusammenfassungIn dieser Übersichtsarbeit wird der aktuelle Stand der stereotaktischen Strahlentherapie im Bereich des Körperstamms (SBRT) als Lokaltherapie für Patienten mit Lebermetastasen im Zustand der Oligometastasierung, Oligoprogression und Oligorekurrenz mit Fokus auf aktuelle Publikationen aus dem deutschsprachigen Raum dargelegt. Moderne SBRT-Techniken umfassen heute neben der präzisen Bildgebung auch Gating- und Tracking-Techniken, welche die Lokaltherapie von Lebermetastasen effektiver gemacht haben. Damit und mit zentralen Tumordosisoptimierungen lassen sich hohe lokale Kontrollraten von langfristig bis über 90% erreichen, die mit minimalen schweren Nebenwirkungsraten von unter 1% und 5-Jahres-Überlebensraten von mehr als 30% in selektionierten (inoperablen) Patientenkollektiven einhergehen. Durch hybride Ultraschall- oder MRT-Bestrahlungssysteme kann zukünftig die teils aktuell technisch erforderliche Fiducial-Marker-Implantation überwunden werden. Die SBRT stellt aufgrund der aktuellen Ergebnislage für Patienten mit Lebermetastasen eine wertvolle Ergänzung des therapeutischen Armamentariums als ebenbürtige Alternative zu minimalinvasiven ablativen Verfahren oder in Kombination mit anderen lokalen oder systemischen Behandlungen im interdisziplinären Kontext dar.

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“…Real‐time positioning verification techniques are currently available, such as fluoroscopy, optical, and magnetic resonance linear accelerator (linac) systems. The use of fluoroscopy in an external beam setting is presently a matter of debate due to the increased patient dose . Magnetic resonance linacs can provide real time treatment verification with good tissue contrast; however, their use in radiation oncology is still low .…”

Section: Introductionmentioning

confidence: 99%

An investigation of clinical treatment field delivery verification using cherenkov imaging: IMRT positioning shifts and field matching

et al. 2018

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Purpose: Cherenkov light emission has been shown to correlate with ionizing radiation dose delivery in solid tissue. An important clinical application of Cherenkov light is the real-time verification of radiation treatment delivery in vivo. To test the feasibility of treatment field verification, Cherenkov light images were acquired concurrent with radiation beam delivery to standard and anthropomorphic phantoms. Specifically, we tested two clinical treatment scenarios: (a) Observation of field overlaps or gaps in matched 3D fields and (b) Patient positioning shifts during intensity modulated radiation therapy (IMRT) field delivery. Further development of this technique would allow real-time detection of treatment delivery errors on the order of millimeters so that patient safety and treatment quality can be improved. Methods: Cherenkov light emission was captured using a PI-MAX4 intensified charge coupled device (ICCD) system (Princeton Instruments). All radiation delivery was performed using a Varian Trilogy linear accelerator (linac) operated at 6 MV or 18 MV for photon and 6 MeV or 16 MeV for electron studies. Field matching studies were conducted with photon and electron beams at gantry angles of 0°, 15°, and 45°. For each modality and gantry angle, a total of three data sets were acquired. Overlap and gap distances of 0, 2, 5, and 10 mm were tested and delivered to solid phantom material of 30 9 30 9 5 cm 3 . Phantom materials used were white plastic water and brown solid water. Tests were additionally performed on an anthropomorphic phantom with an irregular surface. Positioning shift studies were performed using IMRT fields delivered to a thoracic anthropomorphic phantom. For thoracic phantom measurements, the camera was placed laterally to observe the entire right side of the phantom. Fields were delivered with known translational patient positioning shifts in four directions. Changes in the Cherenkov fluence were evaluated through the generation of difference maps from unshifted Cherenkov images. All images were evaluated using ImageJ, Python, and MATLAB software packages. Results: For matched fields, Cherenkov images were able to quantitate matched field separations with discrepancies between 2 and 4 mm, depending on gantry angle and beam energy or modality. For all photon and electron beams delivered at a gantry angle of 0°, image analysis indicated average discrepancies of less than 2 mm for all field gaps and overlaps, with 83% of matched fields exhibiting discrepancies less than 1 mm. Beams delivered obliquely to the phantom surface exhibited average discrepancies as high as 4 mm for electron beams delivered at large oblique angles. Finally, for IMRT field delivery, vertical and lateral patient positioning shifts of 2 mm were detected in some cases, indicating the potential detectability threshold of using this technique alone. Conclusions: Our study indicates that Cherenkov imaging can be used to support and bolster current treatment delivery verification techniques, improving our ability to recog...

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A 4D ultrasound real-time tracking system for external beam radiotherapy of upper abdominal lesions under breath-hold

Abstract: The US system showed a good tracking performance in 4D motion phantoms. The tracking capability of surrogate structures for upper abdominal lesions in DIBH fulfills clinical requirements. Further investigation in a larger cohort of patients is underway.

Cited by 13 publications

References 23 publications

Radiosurgery for ventricular tachycardia: preclinical and clinical evidence and study design for a German multi-center multi-platform feasibility trial (RAVENTA)

Radiosurgery for ventricular tachycardia: preclinical and clinical evidence and study design for a German multi-center multi-platform feasibility trial (RAVENTA)

Stereotaktische Strahlentherapie für Lebermetastasen

An investigation of clinical treatment field delivery verification using cherenkov imaging: IMRT positioning shifts and field matching

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