Investigation of the change in marker geometry during respiration motion: a preliminary study for dynamic-multi-leaf real-time tumor tracking.

Background: The use of stereotactic body radiotherapy (SBRT) is rapidly increasing. Presently, the most accurate method uses fiducial markers implanted near the tumor. A shortcoming of this method is that the beams turn off during the majority of the respiratory cycle, resulting in a prolonged treatment time.

Adaptive external gating based on the updating method of internal/external correlation and gating window before each beam delivery.

The purpose of this study is to evaluate the performance of an adaptive gating method, which is designed to accommodate the beam-to-beam and day-to-day variation of the internal/external correlation, as well as the real tumor position during respiratory-gated fractionated radiotherapy. We define a two-step procedure: (1) before each treatment, target positions are detected and synchronized with an external surrogate for establishing the internal/external correlation model and determining the position of the gating window, and then (2) during the delivery of the treatment beam, the gating is triggered by an external signal based on the updated internal/external correlation and window position. This correlation is described by a linear-quadratic model including a time shift between the internal and external signals.

Clinical characteristics and computed tomography findings in children with 2009 pandemic influenza A (H1N1) viral pneumonia.

In this article we review the clinical characteristics and computed tomography (CT) findings in children with 2009 pandemic H1N1 influenza viral pneumonia. The medical charts of 88 children with pandemic H1N1 influenza virus infection, admitted to our hospital in Japan from 10 August to 28 December 2009, were reviewed; we compared the clinical features of these children with those of 61 children admitted with seasonal influenza A during the previous 3 seasons. Of 88 patients, 53 (60%) had radiographic findings consistent with pneumonia and 34 patients underwent a chest computed tomography (CT) scan.

Image-guided adaptive gating of lung cancer radiotherapy: a computer simulation study.

The purpose of this study is to investigate the effect that image-guided adaptation of the gating window during treatment could have on the residual tumor motion, by simulating different gated radiotherapy techniques. There are three separate components of this simulation: (1) the 'Hokkaido Data', which are previously measured 3D data of lung tumor motion tracks and the corresponding 1D respiratory signals obtained during the entire ungated radiotherapy treatments of eight patients, (2) the respiratory gating protocol at our institution and the imaging performed under that protocol and (3) the actual simulation in which the Hokkaido Data are used to select tumor position information that could have been collected based on the imaging performed under our gating protocol. We simulated treatments with a fixed gating window and a gating window that is updated during treatment.

Evaluation of the need for simultaneous orthogonal gated setup imaging.

Image-guided patient setup for respiratory-gated radiotherapy often relies on a pair of respiratory-gated orthogonal radiographs, acquired one after the other. This study quantifies the error due to changes in the internal/external correlation which may affect asynchronous (non-simultaneous) imaging. The dataset from eight patients includes internal and external coordinates acquired at 30Hz during multi-fraction SBRT treatments using the Mitsubishi RTRT system coupled with an external surrogate gating device.

Synchronous monitoring of external/internal respiratory motion: validity of respiration-gated radiotherapy for liver tumors.

Purpose: Four-dimensional (4D) radiotherapy, in particular respiration gating for the treatment of lung tumors, is gaining popularity. Its utility for other sites, however, has not been investigated fully. The purpose of this study was to see whether 4D therapy is feasible for liver tumors.

Gating based on internal/external signals with dynamic correlation updates.

Precise localization of mobile tumor positions in real time is critical to the success of gated radiotherapy. Tumor positions are usually derived from either internal or external surrogates. Fluoroscopic gating based on internal surrogates, such as implanted fiducial markers, is accurate however requiring a large amount of imaging dose.

A real-time dynamic-MLC control algorithm for delivering IMRT to targets undergoing 2D rigid motion in the beam's eye view.

An MLC control algorithm for delivering intensity modulated radiation therapy (IMRT) to targets that are undergoing two-dimensional (2D) rigid motion in the beam's eye view (BEV) is presented. The goal of this method is to deliver 3D-derived fluence maps over a moving patient anatomy. Target motion measured prior to delivery is first used to design a set of planned dynamic-MLC (DMLC) sliding-window leaf trajectories.

Exhale fluctuation in respiratory-gated radiotherapy of the lung: a pitfall of respiratory gating shown in a synchronized internal/external marker recording study.

Purpose: For optimal respiratory-gated radiotherapy, exhale fluctuation was assessed by monitoring internal fiducials in a synchronized internal/external marker detection system.

Methods: Synchronized internal/external position data were collected during the entire course of treatments for 12 lung patients with 24 fiducials. Baseline was determined in the exhale phase during pre-treatment observation time, and a gating level of external waves was set in each treatment session in a simulation of respiratory-gated radiotherapy.

Internal-external correlation investigations of respiratory induced motion of lung tumors.

In gated radiation therapy procedures, the lung tumor position is used directly (by implanted radiopaque markers) or indirectly (by external surrogate methods) to decrease the volume of irradiated healthy tissue. Due to a risk of pneumothorax, many clinics do not implant fiducials, and the gated treatment is primarily based on a respiratory induced external signal. The external surrogate method relies upon the assumption that the internal tumor motion is well correlated with the external respiratory induced motion, and that this correlation is constant in time.

Adaptive prediction of respiratory motion for motion compensation radiotherapy.

One potential application of image-guided radiotherapy is to track the target motion in real time, then deliver adaptive treatment to a dynamic target by dMLC tracking or respiratory gating. However, the existence of a finite time delay (or a system latency) between the image acquisition and the response of the treatment system to a change in tumour position implies that some kind of predictive ability should be included in the real-time dynamic target treatment. If diagnostic x-ray imaging is used for the tracking, the dose given over a whole image-guided radiotherapy course can be significant.

Accuracy of tumor motion compensation algorithm from a robotic respiratory tracking system: a simulation study.

The Synchrony Respiratory Tracking System (RTS) is a treatment option of the CyberKnife robotic treatment device to irradiate extra-cranial tumors that move due to respiration. Advantages of RTS are that patients can breath normally and that there is no loss of linac duty cycle such as with gated therapy. Tracking is based on a measured correspondence model (linear or polynomial) between internal tumor motion and external (chest/abdominal) marker motion.

Residual motion of lung tumors in end-of-inhale respiratory gated radiotherapy based on external surrogates.

It has been noted that some lung tumors exhibit large periodic motion due to respiration. To limit the amount of dose to healthy lung tissues, many clinics have begun gating radiotherapy treatment using externally placed surrogates. It has been observed by several institutions that the end-of-exhale (EOE) tumor position is more reproducible than other phases of the breathing cycle, so the gating window is often set there.

Carcinoma of the floor of the mouth: a case treated with precisely controlled external beam radiotherapy.

A new external radiotherapy system has been developed for head and neck cancer and a case with T2 oral floor carcinoma treated with this system is presented in this report. The system consists of real-time tumor-tracking equipment and a gold-marker implanted mouthpiece. Accuracy of the order of 2 mm was achieved during the entire course of fractionated radiotherapy (a total of 52.

Residual motion of lung tumours in gated radiotherapy with external respiratory surrogates.

Due to respiration, many tumours in the thorax and abdomen may move as much as 3 cm peak-to-peak during radiation treatment. To mitigate motion-induced irradiation of normal lung tissue, clinics have employed external markers to gate the treatment beam. This technique assumes that the correlation between the external surface and the internal tumour position remains constant inter-fractionally and intra-fractionally.

High dose three-dimensional conformal boost (3DCB) using an orthogonal diagnostic X-ray set-up for patients with gynecological malignancy: a new application of real-time tumor-tracking system.

The feasibility and accuracy of high dose three-dimensional conformal boost (3DCB) using three internal fiducial markers and a two-orthogonal X-ray set-up of the real-time tumor-tracking system on patients with gynecological malignacy were investigated in 10 patients. The standard deviation of the distribution of systematic deviations (Sigma) was reduced from 3.8, 4.

Reflux in the left ovarian vein: analysis of MDCT findings in asymptomatic women.

Objective: The aim of this study was to clarify the CT features of ovarian vein reflux in asymptomatic women and to determine the possible cause of the reflux.

Materials And Methods: One hundred ten multiparous or uniparous and 41 nulliparous asymptomatic women were examined on MDCT. Degree, pathway, and associated findings of ovarian vein reflux were evaluated.

Pilot study of modified version of CHOP plus radiotherapy for early-stage aggressive non-Hodgkin's lymphoma of the head and neck.

Purpose: To evaluate the safety and efficacy of a modified version of cyclophosphamide, doxorubicin, vincristine, prednisone (pirarubicin, cyclophosphamide, vincristine, and prednisone [THP-COP]) plus radiotherapy for early-stage aggressive non-Hodgkin's lymphoma of the head and neck.

Methods And Materials: Between December 1993 and December 1999, 41 patients with early-stage non-Hodgkin's lymphoma with intermediate-grade histologic features were enrolled in our study. The mean patient age was 51 years.

Registration accuracy and possible migration of internal fiducial gold marker implanted in prostate and liver treated with real-time tumor-tracking radiation therapy (RTRT).

Background And Purpose: We have developed a linear accelerator synchronized with a fluoroscopic real-time tumor-tracking system to reduce errors due to setup and organ motion. In the real-time tumor-tracking radiation therapy (RTRT) system, the accuracy of tumor tracking depends on the registration of the marker's coordinates. The registration accuracy and possible migration of the internal fiducial gold marker implanted into prostate and liver was investigated.