Ultrafast single breath-hold cone-beam CT lung cancer imaging with faster linac gantry rotation

• Verfasst von: Arns, Anna Maria [VerfasserIn]
• Verfasst von: Wertz, Hansjörg [VerfasserIn]
• Verfasst von: Boda-Heggemann, Judit [VerfasserIn]
• Verfasst von: Schneider, Frank [VerfasserIn]
• Verfasst von: Blessing, Manuel [VerfasserIn]
• Verfasst von: Abo-Madyan, Yasser [VerfasserIn]
• Verfasst von: Steil, Volker [VerfasserIn]
• Verfasst von: Fleckenstein, Jens [VerfasserIn]
• Titel: Ultrafast single breath-hold cone-beam CT lung cancer imaging with faster linac gantry rotation
• Verf.angabe: Anna Arns, Hansjoerg Wertz, Judit Boda-Heggemann, Frank Schneider, Manuel Blessing, Yasser Abo-Madyan, Volker Steil, Frederik Wenz, Jens Fleckenstein
• E-Jahr: 2019
• Jahr: June 2019
• Umfang: 8 S.
• Fussnoten: Gesehen am 18.11.2019 ; Available online 16 March 2019
• Titel Quelle: Enthalten in: Radiotherapy and oncology
• Ort Quelle: Amsterdam [u.a.] : Elsevier Science, 1983
• Jahr Quelle: 2019
• Band/Heft Quelle: 135(2019), Seite 78-85
• ISSN Quelle: 1879-0887
• DOI: doi:10.1016/j.radonc.2019.02.004
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: CBCT
• Sach-SW: IGRT
• Sach-SW: Lung DIBH
• Sach-SW: Single breath-hold imaging
• Sach-SW: Ultrafast imaging
• K10plus-PPN: 1682035808

Abstract

Purpose - Lung tumors treated with hypo-fractionated deep-inspiration breath-hold stereotactic body radiotherapy benefit from fast imaging and treatment. Single breath-hold cone-beam-CT (CBCT) could reduce motion artifacts and improve treatment precision. Thus, gantry speed was accelerated to 18°/s, limiting acquisition time to 10-20s. Image quality, dosimetry and registration accuracy were compared with standard-CBCT (3°/s). - Methods and materials - For proof-of-concept, image quality was analyzed following customer acceptance tests, CT-dose index measured, and registration accuracy determined with an off-centered ball-bearing-phantom. A lung-tumor patient was simulated with differently shaped tumor-mimicking inlays in a thorax-phantom. Signal-to-noise-ratio, contrast-to-noise-ratio and geometry of the inlays quantified image quality. Dose was measured in representative positions. Registration accuracy was determined with inlays scanned in pre-defined positions. Manual, automatic (clinical software) and objective-automatic (in-house-developed) registration was performed on planning-CT, offsets between results and applied shifts were compared. - Results - Image quality of ultrafast-CBCT was adequate for high-contrast areas, despite contrast-reduction of ∼80% due to undersampling. Dose-output was considerably reduced by 60-83% in presented setup; variations are due to gantry-braking characteristics. Registration accuracy was maintained better than 1mm, mean displacement errors were 0.0±0.2mm with objective-automatic registration. Ultrafast-CBCT showed no significant registration differences to standard-CBCT. - Conclusions - This study of first tests with faster gantry rotation of 18°/s showed promising results for ultrafast high-contrast lung tumor CBCT imaging within single breath-hold of 10-20s. Such fast imaging times, in combination with fast treatment delivery, could pave the way for intra-fractional combined imaging and treatment within one breath-hold phase, and thus mitigate residual motion and increase treatment accuracy and patient comfort. Even generally speaking, faster gantry rotation could set a benchmark with immense clinical impact where time matters most: palliative patient care, general reduction in uncertainty, and increase in patient throughput especially important for emerging markets with high patient numbers.