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ELPHA: Dynamically deformable liver phantom for real-time motion-adaptive radiotherapy treatments.


Ehrbar, Stefanie; Jöhl, Alexander; Kühni, Michael; Meboldt, Mirko; Ozkan Elsen, Ece; Tanner, Christine; Goksel, Orcun; Klöck, Stephan; Unkelbach, Jan; Guckenberger, Matthias; Tanadini-Lang, Stephanie (2019). ELPHA: Dynamically deformable liver phantom for real-time motion-adaptive radiotherapy treatments. Medical Physics, 46(2):839-850.

Abstract

PURPOSE Real-time motion-adaptive radiotherapy of intrahepatic tumors needs to account for motion and deformations of the liver and the target location within. Phantoms representative of anatomical deformations are required to investigate and improve dynamic treatments. A deformable phantom capable of testing motion-detection and motion-mitigation techniques is presented here. METHODS The dynamically dEformable Liver PHAntom (ELPHA) was designed to fulfill three main constraints: First, a reproducibly deformable anatomy is required. Second, the phantom should provide multi-modality imaging contrast for motion detection. Third, a time-resolved dosimetry system to measure temporal effects should be provided. An artificial liver with vasculature was casted from soft silicone mixtures. The silicones allow for deformation and radiographic image contrast, while added cellulose provides ultrasonic contrast. An actuator was used for compressing the liver in the inferior direction according to a prescribed respiratory motion trace. Electromagnetic (EM) transponders integrated in ELPHA help provide ground truth motion traces. They were used to quantify the motion reproducibility of the phantom and to validate motion-detection based on ultrasound imaging. A two-dimensional ultrasound probe was used to follow the position of the vessels with a template-matching algorithm. This detected vessel motion was compared to the EM transponder signal by calculating the root-mean square error (RMSE). ELPHA was then used to investigate the dose deposition of dynamic treatment deliveries. Two dosimetry systems, radio-chromic film and plastic scintillation dosimeters (PSD), were integrated in ELPHA. The PSD allow for time-resolved measurement of the delivered dose, which was compared to a time-resolved dose of the treatment planning system. Film and PSD were used to investigate dose delivery to the deforming phantom without motion compensation and with treatment-couch tracking for motion compensation. RESULTS ELPHA showed densities of 66 and 45 HU in the liver and the surrounding tissues. A high motion reproducibility with a submillimeter RMSE (<0.32 mm) was measured. The motion of the vasculature detected with ultrasound agreed well with the EM transponder position (RMSE <1 mm). A time-resolved dosimetry system with a 1 Hz time resolution was achieved with the PSD. The agreement of the planned and measured dose to the PSD decreased with increasing motion amplitude: A dosimetric RMSE of 1.2, 2.1 and 2.7 cGy/s was measured for motion amplitudes of 8, 16 and 24 mm, respectively. With couch tracking as motion compensation, these values decreased to 1.1, 1.4 and 1.4 cGy/s. This is closer to the static situation with 0.7 cGy/s. Film measurements showed that couch tracking was able to compensate for motion with a mean target dose within 5% of the static situation (-5% to +1%), which was higher than in the uncompensated cases (-41% to -1%). CONCLUSIONS ELPHA is a deformable liver phantom with high motion reproducibility. It was demonstrated to be suitable for the verification of motion-detection and motion-mitigation modalities. Based on the multi-modality image contrast, a high accuracy of ultrasound based motion detection was shown. With the time-resolved dosimetry system, ELPHA is suitable for performance assessment of real-time motion-adaptive radiotherapy, as was shown exemplary with couch tracking. This article is protected by copyright. All rights reserved.

Abstract

PURPOSE Real-time motion-adaptive radiotherapy of intrahepatic tumors needs to account for motion and deformations of the liver and the target location within. Phantoms representative of anatomical deformations are required to investigate and improve dynamic treatments. A deformable phantom capable of testing motion-detection and motion-mitigation techniques is presented here. METHODS The dynamically dEformable Liver PHAntom (ELPHA) was designed to fulfill three main constraints: First, a reproducibly deformable anatomy is required. Second, the phantom should provide multi-modality imaging contrast for motion detection. Third, a time-resolved dosimetry system to measure temporal effects should be provided. An artificial liver with vasculature was casted from soft silicone mixtures. The silicones allow for deformation and radiographic image contrast, while added cellulose provides ultrasonic contrast. An actuator was used for compressing the liver in the inferior direction according to a prescribed respiratory motion trace. Electromagnetic (EM) transponders integrated in ELPHA help provide ground truth motion traces. They were used to quantify the motion reproducibility of the phantom and to validate motion-detection based on ultrasound imaging. A two-dimensional ultrasound probe was used to follow the position of the vessels with a template-matching algorithm. This detected vessel motion was compared to the EM transponder signal by calculating the root-mean square error (RMSE). ELPHA was then used to investigate the dose deposition of dynamic treatment deliveries. Two dosimetry systems, radio-chromic film and plastic scintillation dosimeters (PSD), were integrated in ELPHA. The PSD allow for time-resolved measurement of the delivered dose, which was compared to a time-resolved dose of the treatment planning system. Film and PSD were used to investigate dose delivery to the deforming phantom without motion compensation and with treatment-couch tracking for motion compensation. RESULTS ELPHA showed densities of 66 and 45 HU in the liver and the surrounding tissues. A high motion reproducibility with a submillimeter RMSE (<0.32 mm) was measured. The motion of the vasculature detected with ultrasound agreed well with the EM transponder position (RMSE <1 mm). A time-resolved dosimetry system with a 1 Hz time resolution was achieved with the PSD. The agreement of the planned and measured dose to the PSD decreased with increasing motion amplitude: A dosimetric RMSE of 1.2, 2.1 and 2.7 cGy/s was measured for motion amplitudes of 8, 16 and 24 mm, respectively. With couch tracking as motion compensation, these values decreased to 1.1, 1.4 and 1.4 cGy/s. This is closer to the static situation with 0.7 cGy/s. Film measurements showed that couch tracking was able to compensate for motion with a mean target dose within 5% of the static situation (-5% to +1%), which was higher than in the uncompensated cases (-41% to -1%). CONCLUSIONS ELPHA is a deformable liver phantom with high motion reproducibility. It was demonstrated to be suitable for the verification of motion-detection and motion-mitigation modalities. Based on the multi-modality image contrast, a high accuracy of ultrasound based motion detection was shown. With the time-resolved dosimetry system, ELPHA is suitable for performance assessment of real-time motion-adaptive radiotherapy, as was shown exemplary with couch tracking. This article is protected by copyright. All rights reserved.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Radiation Oncology
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:1 February 2019
Deposited On:23 Jan 2019 14:00
Last Modified:25 Sep 2019 00:02
Publisher:American Association of Physicists in Medicine
ISSN:0094-2405
OA Status:Closed
Publisher DOI:https://doi.org/10.1002/mp.13359
PubMed ID:30588635

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