Daily ultrasound-based image-guided targeting for radiotherapy of upper abdominal malignancies

Martin Fuss, Bill J. Salter, Sean X. Cavanaugh, Cristina Fuss, Amir Sadeghi, Clifton D. Fuller, Ardow Ameduri, James M. Hevezi, Terence S. Herman, Charles Thomas

Research output: Contribution to journalArticle

103 Citations (Scopus)

Abstract

Purpose Development and implementation of a strategy to use a stereotactic ultrasound (US)-based image-guided targeting device (BAT) to align intensity-modulated radiotherapy (IMRT) target volumes accurately in the upper abdomen. Because the outlines of such targets may be poorly visualized by US, we present a method that uses adjacent vascular guidance structures as surrogates for the target position. We assessed the potential for improvement of daily repositioning and the feasibility of daily application. Methods and materials A total of 62 patients were treated by sequential tomotherapeutic IMRT between October 2000 and June 2003 for cholangiocarcinoma and gallbladder carcinoma (n = 10), hepatocellular carcinoma (n = 10), liver metastases (n = 11), pancreatic carcinoma (n = 20), neuroblastoma (n = 3), and other abdominal and retroperitoneal tumors (n = 8). The target volumes (TVs) and organs at risk were delineated in contrast-enhanced CT data sets. Additionally, vascular guidance structures in close anatomic relation to the TV, or within the TV, were delineated. Throughout the course of IMRT, US BAT images were acquired during daily treatment positioning. In addition to the anatomic structures typically used for US targeting (e.g., the TV and dose-limiting organs at risk), CT contours of guidance structures were superimposed onto the real-time acquired axial and sagittal US images, and target position adjustments, as indicated by the system, were performed accordingly. We report the BAT-derived distribution of shifts in the three principal room axes compared with a skin-mark-based setup, as well as the time required to perform BAT alignment. The capability of the presented method to improve target alignment was assessed in 15 patients by comparing the organ and fiducial position between the respective treatment simulation CT with a control CT study after US targeting in the CT suite. Results A total of 1,337 BAT alignments were attempted. US images were not useful in 56 setups (4.2%), mainly because of limited visibility due to daily variations in colonic and gastric air. US imaging was facilitated in intrahepatic tumors and asthenic patients. The mean ± SD shift from the skin mark position was 4.9 ± 4.35, 6.0 ± 5.31, and 6.0 ± 6.7 mm in the x, y, and z direction, respectively. The mean magnitude vector of three-dimensional alignment correction was 11.4 ± 7.6 mm. The proportion of daily alignments corrected by a magnitude of >10, >15, and >20 mm was 48.9%, 25.1%, and 12.7%, respectively. The magnitude of shifts in the principal directions, as well as the three-dimensional vector of displacement, was statistically significant (test against the zero hypothesis) at p

Original languageEnglish (US)
Pages (from-to)1245-1256
Number of pages12
JournalInternational Journal of Radiation Oncology Biology Physics
Volume59
Issue number4
DOIs
StatePublished - Jul 15 2004
Externally publishedYes

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Image-Guided Radiotherapy
Intensity-Modulated Radiotherapy
Organs at Risk
radiation therapy
Blood Vessels
Neoplasms
Skin
alignment
Cholangiocarcinoma
Gallbladder
Neuroblastoma
organs
Abdomen
Hepatocellular Carcinoma
Ultrasonography
Stomach
cancer
Air
Neoplasm Metastasis
Carcinoma

Keywords

  • Image-guided targeting
  • IMRT
  • Liver cancer
  • Pancreatic cancer
  • Patient positioning
  • Ultrasound

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation

Cite this

Daily ultrasound-based image-guided targeting for radiotherapy of upper abdominal malignancies. / Fuss, Martin; Salter, Bill J.; Cavanaugh, Sean X.; Fuss, Cristina; Sadeghi, Amir; Fuller, Clifton D.; Ameduri, Ardow; Hevezi, James M.; Herman, Terence S.; Thomas, Charles.

In: International Journal of Radiation Oncology Biology Physics, Vol. 59, No. 4, 15.07.2004, p. 1245-1256.

Research output: Contribution to journalArticle

Fuss, Martin ; Salter, Bill J. ; Cavanaugh, Sean X. ; Fuss, Cristina ; Sadeghi, Amir ; Fuller, Clifton D. ; Ameduri, Ardow ; Hevezi, James M. ; Herman, Terence S. ; Thomas, Charles. / Daily ultrasound-based image-guided targeting for radiotherapy of upper abdominal malignancies. In: International Journal of Radiation Oncology Biology Physics. 2004 ; Vol. 59, No. 4. pp. 1245-1256.
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AU - Salter, Bill J.

AU - Cavanaugh, Sean X.

AU - Fuss, Cristina

AU - Sadeghi, Amir

AU - Fuller, Clifton D.

AU - Ameduri, Ardow

AU - Hevezi, James M.

AU - Herman, Terence S.

AU - Thomas, Charles

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N2 - Purpose Development and implementation of a strategy to use a stereotactic ultrasound (US)-based image-guided targeting device (BAT) to align intensity-modulated radiotherapy (IMRT) target volumes accurately in the upper abdomen. Because the outlines of such targets may be poorly visualized by US, we present a method that uses adjacent vascular guidance structures as surrogates for the target position. We assessed the potential for improvement of daily repositioning and the feasibility of daily application. Methods and materials A total of 62 patients were treated by sequential tomotherapeutic IMRT between October 2000 and June 2003 for cholangiocarcinoma and gallbladder carcinoma (n = 10), hepatocellular carcinoma (n = 10), liver metastases (n = 11), pancreatic carcinoma (n = 20), neuroblastoma (n = 3), and other abdominal and retroperitoneal tumors (n = 8). The target volumes (TVs) and organs at risk were delineated in contrast-enhanced CT data sets. Additionally, vascular guidance structures in close anatomic relation to the TV, or within the TV, were delineated. Throughout the course of IMRT, US BAT images were acquired during daily treatment positioning. In addition to the anatomic structures typically used for US targeting (e.g., the TV and dose-limiting organs at risk), CT contours of guidance structures were superimposed onto the real-time acquired axial and sagittal US images, and target position adjustments, as indicated by the system, were performed accordingly. We report the BAT-derived distribution of shifts in the three principal room axes compared with a skin-mark-based setup, as well as the time required to perform BAT alignment. The capability of the presented method to improve target alignment was assessed in 15 patients by comparing the organ and fiducial position between the respective treatment simulation CT with a control CT study after US targeting in the CT suite. Results A total of 1,337 BAT alignments were attempted. US images were not useful in 56 setups (4.2%), mainly because of limited visibility due to daily variations in colonic and gastric air. US imaging was facilitated in intrahepatic tumors and asthenic patients. The mean ± SD shift from the skin mark position was 4.9 ± 4.35, 6.0 ± 5.31, and 6.0 ± 6.7 mm in the x, y, and z direction, respectively. The mean magnitude vector of three-dimensional alignment correction was 11.4 ± 7.6 mm. The proportion of daily alignments corrected by a magnitude of >10, >15, and >20 mm was 48.9%, 25.1%, and 12.7%, respectively. The magnitude of shifts in the principal directions, as well as the three-dimensional vector of displacement, was statistically significant (test against the zero hypothesis) at p

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