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Clinical validation of the Varian Truebeam intra-fraction motion review (IMR) system for prostate treatment guidance

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Abstract

This study quantified the performance of Intra-fraction Motion Review (IMR) during prostate Stereotactic Body Radiotherapy (SBRT) treatments. IMR was evaluated using prostate motion data from patients treated in an SBRT clinical trial (PROMETHEUS, NCT00587990).IMR measured prostate displacements were compared to those of two 3D motion management methods: Kilovoltage Intra-fraction Motion management (KIM) and MV/kV triangulation. A planning study assessing the impact of a defined prostate motion (2–5 mm) on the PTV  coverage with and without IMR was performed. A clinically relevant IMR search region for prostate cancer SBRT treatments was determined using a customised anthropomorphic pelvis phantom with implanted gold seeds and a motion platform. IMR showed submillimeter agreement with corresponding 2D projections from both KIM and MV/kV triangulation. However, IMR detected actual displacements consistently in considerably fewer frames than KIM (3D), with the actual numbers depending on the settings. The Default Search Region (DSR) method employing a circular search region proved superior to user-contoured structures in detecting clinically relevant prostate motion. Reducing the DSR search region radius can reduce the impact of the 2D nature of IMR and improve the detectability of actual motion (by 10% per 0.5 mm reduction) but must be balanced against increased beam interruptions from minor, clinically irrelevant motion. The use of IMR for SBRT prostate treatments has the potential to improve target dose coverage (minimum dose to 98% of the PTV, D98%) by > 20% compared to treatment without IMR. Calculated D98% of IMR monitored treatments with motion was within 1.5% of plans without motion.

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References

  1. Li HS et al (2008) Dosimetric consequences of intrafraction prostate motion. Int J Radiat Oncol Biol Phys 71(3):801–812

    Article  PubMed  Google Scholar 

  2. Rossi MM et al (2016) Intrafraction motion in stereotactic body radiation therapy for non-small cell lung cancer: intensity modulated radiation therapy versus volumetric modulated arc therapy. Int J Radiat Oncol Biol Phys 95(2):835–843

    Article  PubMed  Google Scholar 

  3. Keall P (2011) Locating and targeting moving tumors with radiation beams. Front Radiat Ther Oncol 43:118–131

    Article  PubMed  Google Scholar 

  4. Bertholet J et al (2019) Real-time intrafraction motion monitoring in external beam radiotherapy. Phys Med Biol 64(15):15TR01

    Article  PubMed  PubMed Central  Google Scholar 

  5. O'Neill AG et al (2016) Fiducial marker guided prostate radiotherapy: a review. Br J Radiol 89(1068):20160296

    Article  PubMed  PubMed Central  Google Scholar 

  6. Kaur G et al (2019) Assessment of the accuracy of truebeam intrafraction motion review (IMR) system for prostate treatment guidance. Australas Phys Eng Sci Med 42(2):585–598

    Article  PubMed  Google Scholar 

  7. Korpics MC et al (2020) Utilizing the TrueBeam Advanced Imaging Package to monitor intrafraction motion with periodic kV imaging and automatic marker detection during VMAT prostate treatments. J Appl Clin Med Phys 21(3):184–191

    Article  PubMed  PubMed Central  Google Scholar 

  8. Cetnar A et al (2021) Prospective dual-surrogate validation study of periodic imaging during treatment for accurately monitoring intrafraction motion of prostate cancer patients. Radiother Oncol 157:40–46

    Article  PubMed  Google Scholar 

  9. Pryor D et al (2019) Phase 2 multicenter study of gantry-based stereotactic radiotherapy boost for intermediate and high risk prostate cancer (PROMETHEUS). Front Oncol 9:217

    Article  PubMed  PubMed Central  Google Scholar 

  10. Richardson M et al (2018) PROstate Multicentre External beam radioTHErapy Using a Stereotactic boost: the PROMETHEUS study protocol. BMC Cancer 18(1):588

    Article  PubMed  PubMed Central  Google Scholar 

  11. Hunt MA et al (2016) Simultaneous MV–kV imaging for intrafractional motion management during volumetric-modulated arc therapy delivery. J Appl Clin Med Phys 17(2):473–486

    Article  PubMed  PubMed Central  Google Scholar 

  12. Ng JA et al (2012) Kilovoltage intrafraction monitoring for prostate intensity modulated arc therapy: first clinical results. Int J Radiat Oncol Biol Phys 84(5):e655–e661

    Article  PubMed  PubMed Central  Google Scholar 

  13. Kim JH et al (2018) The accuracy and precision of Kilovoltage Intrafraction Monitoring (KIM) six degree-of-freedom prostate motion measurements during patient treatments. Radiother Oncol 126(2):236–243

    Article  PubMed  Google Scholar 

  14. Keall PJ et al (2016) Real-time 3D image guidance using a standard LINAC: measured motion, accuracy, and precision of the first prospective clinical trial of kilovoltage intrafraction monitoring-guided gating for prostate cancer radiation therapy. Int J Radiat Oncol Biol Phys 94(5):1015–1021

    Article  PubMed  Google Scholar 

  15. Huang E et al (2002) Intrafraction prostate motion during IMRT for prostate cancer. Int J Radiat Oncol Biol Phys 53(2):261–268

    Article  PubMed  Google Scholar 

  16. Gao Y et al (2020) Quantifying intra-fractional prostate motion trajectory for establishing a new gating strategy: a preliminary study. Int J Radiat Oncol Biol Phys 108(3):e327

    Article  Google Scholar 

  17. Juneja P et al (2017) Quantification of intrafraction prostate motion and its dosimetric effect on VMAT. Australas Phys Eng Sci Med 40(2):317–324

    Article  PubMed  Google Scholar 

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Acknowledgements

This work was supported and funded by a research Grant from Varian Medical System.

Funding

This study was funded by the Varian Medical systems (Research and Collaboration Approval).

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Authors and Affiliations

  1. Department of Radiation Oncology, The Mater Hospital, Rocklands Road, Crows Nest, Sydney, NSW, 2065, Australia

    Guneet Kaur

  2. Department of Radiation Oncology, Calvary Mater Newcastle Hospital, Newcastle, NSW, Australia

    Guneet Kaur, Joerg Lehmann, Peter B. Greer, Jarad Martin & John Simpson

  3. School of Information and Physical Sciences, College of Engineering, Science and Environment, University of Newcastle, Newcastle, NSW, Australia

    Joerg Lehmann, Peter B. Greer & John Simpson

  4. Institute of Medical Physics, School of Physics, University of Sydney, Sydney, NSW, Australia

    Joerg Lehmann

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  1. Guneet Kaur
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  4. Jarad Martin
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  5. John Simpson
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by GK, JL, PG, JM, JS. The first draft of the manuscript was written by GK and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Guneet Kaur.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Ethics approval for this PROMETHEUS clinical trial was granted by the South Western Sydney Local Health District Human Research Ethics Committee on the 2/12/2013 Reference Number HREC/13/LPOOL/311.

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Written informed consent was obtained from all participants.

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Kaur, G., Lehmann, J., Greer, P.B. et al. Clinical validation of the Varian Truebeam intra-fraction motion review (IMR) system for prostate treatment guidance. Phys Eng Sci Med 46, 131–140 (2023). https://doi.org/10.1007/s13246-022-01204-5

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  • DOI: https://doi.org/10.1007/s13246-022-01204-5

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