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

Ein 4D-Ultraschall-Tracking-System für die externe Radiotherapie bei Oberbauchläsionen unter Atemanhalt

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Abstract

Background and purpose

To evaluate a novel four-dimensional (4D) ultrasound (US) tracking system for external beam radiotherapy of upper abdominal lesions under computer-controlled deep-inspiration breath-hold (DIBH).

Materials and methods

The tracking accuracy of the research 4D US system was evaluated using two motion phantoms programmed with sinusoidal and breathing patterns to simulate free breathing and DIBH. Clinical performance was evaluated with five healthy volunteers. US datasets were acquired in computer-controlled DIBH with varying angular scanning angles. Tracked structures were renal pelvis (spherical structure) and portal/liver vein branches (non-spherical structure). An external marker was attached to the surface of both phantoms and volunteers as a secondary object to be tracked by an infrared camera for comparison.

Results

Phantom measurements showed increased accuracy of US tracking with decreasing scanning range/increasing scanning frequency. The probability of lost tracking was higher for small scanning ranges (43.09% for 10° and 13.54% for 20°).The tracking success rates in healthy volunteers during DIBH were 93.24 and 89.86% for renal pelvis and portal vein branches, respectively. There was a strong correlation between marker motion and US tracking for the majority of analyzed breath-holds: 84.06 and 88.41% of renal pelvis target results and 82.26 and 91.94% of liver vein target results in anteroposterior and superoinferior directions, respectively; Pearson’s correlation coefficient was between 0.71 and 0.99.

Conclusion

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.

Zusammenfassung

Hintergrund und Ziel

Evaluation eines neuen vierdimensionalen (4D) Ultraschall(US)-Tracking-Systems für die externe Strahlentherapie von Oberbauchläsionen unter computergesteuertem tiefem Atemanhalt (DIBH).

Material und Methoden

Die Tracking-Genauigkeit des 4D-US-Systems wurde mittels zweier Bewegungsphantome, die mit sinusförmigen und atmungsähnlichen Bewegungsmustern zur Simulation der freien Atmung und DIBH programmiert wurden, bestimmt. Die klinische Leistungsfähigkeit des Systems wurde an 5 gesunden Probanden untersucht. US-Datensätze wurden in computergesteuertem DIBH mit unterschiedlichen Scanwinkeln erfasst. Die getrackten Strukturen waren Nierenbecken (kugelförmige Struktur) und Portal-/Lebervenenzweige (nicht kugelförmige Struktur). Zum Vergleich wurde ein externer Marker als sekundäres, von einer Infrarotkamera getracktes Objekt auf der Oberfläche beider Phantome und Probanden angebracht.

Ergebnisse

Phantommessungen zeigten eine erhöhte Genauigkeit des US-Trackings, wenn der Scanbereich verkleinert wurde. Die Wahrscheinlichkeit für einen Verlust der zu trackenden Struktur war für kleine Scanbereiche höher (43,09 % für 10°; 13,54 % für 20°). Die Tracking-Erfolgsraten bei gesunden Probanden während DIBH waren 93,24 % und 89,86 % für Nierenbecken bzw. Pfortaderäste. Die Mehrheit der untersuchten Atemanhaltephasen wies eine starke Korrelation zwischen der Bewegung des Markers und dem US-Tracking auf: 84,06 und 88,41 % für Nierenbeckentargets und 82,26 und 91,94 % für Lebervenentargets jeweils in anteroposteriorer und superoinferiorer Richtung; der Pearson-Korrelationskoeffizient lag zwischen 0,71 und 0,99.

Schlussfolgerung

Das US-System zeigte eine gute Tracking-Leistung in 4D-Bewegungsphantomen. Die Tracking-Fähigkeit von Surrogat-Strukturen für Oberbauchläsionen in DIBH erfüllt die klinischen Anforderungen. Weitere Untersuchungen in einer größeren Patientengruppe sind im Gange.

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Authors and Affiliations

  1. Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer Ufer 1–3, 68167, Mannheim, Germany

    Dwi Seno Kuncoro Sihono MSc, Lena Vogel MSc, Johannes Thölking MSc, Frederik Wenz MD, Frank Lohr MD, Judit Boda-Heggemann MD, Ph.D & Hansjörg Wertz Ph.D

  2. Department of Biomathematics and Medical Statistics, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany

    Christel Weiß Ph.D

  3. Struttura Complessa di Radioterapia, Dipartimento di Oncologia, Az. Ospedaliero-Universitaria di Modena, Modena, Italy

    Frank Lohr MD

Authors
  1. Dwi Seno Kuncoro Sihono MSc
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  2. Lena Vogel MSc
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  3. Christel Weiß Ph.D
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  4. Johannes Thölking MSc
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  5. Frederik Wenz MD
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  7. Judit Boda-Heggemann MD, Ph.D
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  8. Hansjörg Wertz Ph.D
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Corresponding author

Correspondence to Dwi Seno Kuncoro Sihono MSc.

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Conflict of interest

D.S.K. Sihono, L. Vogel, C. Weiß, and J. Thölking declare that they have no competing interests. F. Lohr received research grants from Elekta and IBA, teaching honoria from Elekta and IBA, board honoria from C‑Rad, and works for the IBA advisory board. F. Wenz received research grant and teaching honoraria from Elekta, and works as consultant and for the advisory board of Elekta. J. Boda-Heggemann received a research grant, teaching honoraria, and travel expenses from Elekta. H. Wertz received a research grant and teaching honoraria from Elekta and IBA.

Additional information

Judit Boda-Heggemann and Hansjörg Wertz contributed equally to the manuscript.

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Sihono, D.S.K., Vogel, L., Weiß, C. et al. A 4D ultrasound real-time tracking system for external beam radiotherapy of upper abdominal lesions under breath-hold. Strahlenther Onkol 193, 213–220 (2017). https://doi.org/10.1007/s00066-016-1076-7

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  • DOI: https://doi.org/10.1007/s00066-016-1076-7

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