image guided in radiation therapy (igrt) · image guided in radiation therapy (igrt) diagnosis...
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Chumpot Kakanaporn Med Phys
Radiation Oncology Siriraj Hospital
Image Guided in Radiation Therapy (IGRT)
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Diagnosis Simulation Tx Planning Tx Delivery Tx Verification
• X-ray
• CT
• MRI
• NM
• Patho
EBT Process
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Preparing for treatment • Simulation (Imaging for planning) • Treatment planning (pre-treatment review) • Pretreatment verification
Treatment Treatment setup (Image guidance:IGRT) Treatment delivery (IGRT review) On treatment verification
Process of Care for ERT
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Positioning and Immobilization is still key to reduce set up error !!
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Immobilization systems
In many cases it is not enough.
Personalized cushions
Vacuum cushions
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IMMOBILIZATION DOES NOT ALWAYS WORK!
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Nasopharyngeal Cancer
Day 1 Day 17 Day 27
Todd Pawlicki PhD (UCSD)
Tumor shrink
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Tumor Cross-sectional View
of Patient’s Chest
Tumor
Some motion is mostly Anterior / Posterior
Some motion is mostly Superior / Inferior
All tumor motion is Complex
Tumor Motion During Respiration
All tumor motion is complex
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The tumor moves with time
Set-up Error Organ Motion
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Set-up Error Organ Motion
Organ Deformation
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Patient positioning and verification
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Image Guided in Radiation Therapy (IGRT)
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Prefer a more focused definition
• Distinguish between
Image-based RT…. use of imaging to
define the target and normal tissues for
treatment planning
Image-guided RT ….. use of imaging
to monitor and modify treatment
What is IGRT?
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The vision is to detect deformations
and motion between fractions (inter-
fractional IGRT) and during irradiation
(intra-fractional IGRT), and to correct
for these changes either by gating or
tracking of the irradiation beam.
Image Guided Radiation Therapy
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Image Guided Radiation Therapy
It is critical to keep the consistency of the patient geometry throughout the whole treatment course.
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18
Portal Films
Taken during (or directly before) treatment with: – beam from the
treatment unit
– patient in treatment position
– shielding in place
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Electronic Portal Images
A filmless way to verify field location
Mounted on the linac
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MEGAVOLTAGE IMAGE
Not Clear Not Well Defined
Electronic Portal Image
Portal imaging
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CT DRR
MV
KV-KV
CT DRR
KV
KV-MV
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CLEAR WELL DEFINED
IMAGE
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Radiographic
localization systems
Non-radiographic
localization systems
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A. Ultrasound B. Video based Laser based surface imaging system C. RF Tracking
A.Portal imaging B. Radiography C. CT D.Fluoroscopy
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Radiographic localization systems
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A. Portal imaging
B. Radiography B.1.CyberKnife
B.2.BrainLab ExacTrac system
B.3.Gantry-mounted kilovoltage imaging system
C.Computed tomography
C.1.CT-on-rails
C.2.kV Cone-beam CT
C.3.MV Fan-beam CT
Room-Mounted system
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D.Fluoroscopy
D.1. C-arm fuoroscopy
D.2.Varian on-board imager OBI and Elekta synergy XVI
D.3.Dedicated in-room fuoroscopy (Hokkaido University School ofMedicine).
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Room-Mounted X-Ray Systems
CyberKnife imaging system
Radiography
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Novalis/TrueBeam imaging system
Room-Mounted X-Ray Systems
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TrueBeam STx system?
X-ray Tube
aSi Flat Panel Detectors
Infrared Camera System
BrainLAB Couch Mount
OBI
Flat Panel Detectors
for KV x-ray
Infrared Camera System
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Room based KV imaging system (Real time tracking radiation therapy)
Shirato, et al
Kilovoltage radiograph and fluoroscopy: room-based system
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Gantry-Mounted X-Ray Systems
Elekta Synergy System Varian Trilogy system Siemens Artiste
Synergy XVI and On-Board Imager OBI that can be used
in radiographic, fluoroscopic, and cone-beam CT modes.
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IGRT_CBCT
kV Cone-beam CT
C.Computed tomography
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MV Tomographic Imaging
Tomotherapy Unit
3.5 MV Photon for CT Imaging
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Non-radiographic localization and positioning
systems
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3D Autopositioning (ExacTrac)
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Ultrasound
Planning
Treatment
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COMPARISON
COUCH MOVING
REGISTRATION
US ACQUSITION
SEGMENTATION
Scan
Treatment
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Radiofrequency tracking
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Optical systems-Patient surface tracking (AlignRT)
VisionRT is a video-based three-dimensional (3D) surface imaging system. It uses images of skin surfaces of a patient in 3D before and during radiotherapy treatment.
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Optical systems_Patient surface tracking (C-Rad)
The Catalyst is a laser positioning scanning system used for patient set-up, patient monitoring and gating within radiotherapy. The system consists of a projector which projects light on the desired surface and a camera that captures the projected light on the surface.
Reference image live image both images matched together
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Thanks!!
“No matter how good is the beam, if the target is not where we thought”.
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Task Group 75: The management of imaging dose during image-guided radiotherapy Task Group 104: The Role of In-Room kV X-Ray Imaging for Patient setup and Target Localization Task Group 135: Quality Assurance for Robotic Radiosurgery Task Group 142: Quality assurance of medical accelerators Task Group 154: Quality Assurance of Ultrasound-Guided External beam Radiotherapy for Prostate Cancer Task Group 179: Quality Assurance for image-guided radiation therapy utilizing CT-based technologies