• Title/Summary/Keyword: 호흡추적치료

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호흡을 고려한 고정밀 방사선치료를 위한 임상적 고려

  • Park, Hui-Cheol;Jo, Byeong-Cheol;Kim, Su-San;O, Do-Hun;Bae, Hun-Sik
    • Proceedings of the Korean Society of Medical Physics Conference
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    • 2005.04a
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    • pp.16-21
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    • 2005
  • 방사선치료를 하는데 호흡을 다루는 문제는 매우 중요하다. 호흡으로 인한 인체의 움직임은 종양, 정상조직의 위치 등을 변화시킴으로써 표적체적 설정을 다루는 ICRU definition에 영향을 미칠 뿐만 아니라 일반적인 방사선치료의 단계별 과정에 큰 영향을 끼친다. 본 연제에서는 방사선치료의 과정 중 호흡을 고려한 영상획득, 방사선치료계획, 정도보증 등 주로 의학 물리적 관점에서 세부적으로 다루어야 할 문제들은 논외로 하고, 환자의 호흡을 모니터하고 다루어 호흡에 따른 맞춤치료를 하는 방법들을 개관해 보고자 한다. 또한, 호흡을 다루는 각각의 방법에 따른 임상적 고려사항들에 대해서도 언급하고자 한다. 각각의 기관에서 호흡을 고려한 고정밀 방사선치료를 시행하는데 있어 적절한 전략 및 프로토콜을 세우고, 이를 환자를 대상으로 정확하게 수행하기 위해서는 호흡이 방사선치료 전반에 미치는 영향을 각각의 단계별로 정확하게 이해하는 것이 선행되어야 할 것이다.

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Performance Evaluation of the Tumor Tracking Method Using Beam on/off Interface for the Treatment of Irregular Breathing (호흡이 불규칙한 환자의 치료를 위한 Beam on/off Interface를 이용한 종양 추적 치료 방법의 성능 평가)

  • Lee, Minsik
    • Journal of the Korean Society of Radiology
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    • v.12 no.3
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    • pp.343-349
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    • 2018
  • Dose rate regulated tracking is known to be an efficient method which adaptively delivers tracking treatments when patient breathing is irregular. The Motion Management Interface (MMI, Varian Medical System, CA), which provides beam on/off switching during treatment is available for clinic. Study is to test if delivering the adaptive tumor tracking is feasible for irregular breathing using beam switching with MMI. 55 free breathing RPM traces acquired from lung cancer patients are used. The first day RPM traces of the patients are utilized to design preprogrammed tracking MLC patterns, of which periods are intentionally reduced by 20% in order to catch up the variation of patient breathing irregularity in the treatment day. Eligibility criteria for this technique are the variation of amplitude and period less than 20%. An algorithm which determines beam on/off every 100 ms by considering the preprogrammed (MLC) positions and current breathing positions is developed. Tracking error and delivery efficacy are calculated by simulating the beam-switching adaptive tracking from the RPM traces. Breathing patterns of 38 patients (70%) met the eligibility criteria. Tracking errors of all of the cases who meet the criteria are less than 2 mm (average 1.4 mm) and the average delivery efficacy was 71%. Those of rest of the cases are 1.9 mm and 48%. Adaptive tracking with beam switching is feasible if patient selection is based on the eligibility criteria.

Patient Respiratory Motion Tracking Using Visual Coded Markers (시각 부호화 마커를 이용한 환자의 호흡 추적)

  • Wijenayake, Udaya;Park, Soon-Yong
    • Journal of the Institute of Electronics and Information Engineers
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    • v.51 no.12
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    • pp.111-122
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    • 2014
  • As radiotherapy has become one of the widely used techniques in cancer treatment, accurate tracking of patient's respiratory motion is considered to be more important in treatment planning and dose calculations. Inaccurate motion tracking can cause severe issues such as errors in target/normal tissue delineation and increasing the volume of healthy tissues exposed to high doses. Different methods have been introduced to estimate the respiratory motion, but most of them require some electronic devices or expensive materials. As an inexpensive and easy to use alternative to the previous methods, we propose a new 3D respiratory motion tracking method by using stereo vision techniques of detecting and decoding visual coded markers.

An accuracy analysis of Cyberknife tumor tracking radiotherapy according to unpredictable change of respiration (예측 불가능한 호흡 변화에 따른 사이버나이프 종양 추적 방사선 치료의 정확도 분석)

  • Seo, jung min;Lee, chang yeol;Huh, hyun do;Kim, wan sun
    • The Journal of Korean Society for Radiation Therapy
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    • v.27 no.2
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    • pp.157-166
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    • 2015
  • Purpose : Cyber-Knife tumor tracking system, based on the correlation relationship between the position of a tumor which moves in response to the real time respiratory cycle signal and respiration was obtained by the LED marker attached to the outside of the patient, the location of the tumor to predict in advance, the movement of the tumor in synchronization with the therapeutic device to track real-time tumor, is a system for treating. The purpose of this study, in the cyber knife tumor tracking radiation therapy, trying to evaluate the accuracy of tumor tracking radiation therapy system due to the change in the form of unpredictable sudden breathing due to cough and sleep. Materials and Methods : Breathing Log files that were used in the study, based on the Respiratory gating radiotherapy and Cyber-knife tracking radiosurgery breathing Log files of patients who received herein, measured using the Log files in the form of a Sinusoidal pattern and Sudden change pattern. it has been reconstituted as possible. Enter the reconstructed respiratory Log file cyber knife dynamic chest Phantom, so that it is possible to implement a motion due to respiration, add manufacturing the driving apparatus of the existing dynamic chest Phantom, Phantom the form of respiration we have developed a program that can be applied to. Movement of the phantom inside the target (Ball cube target) was driven by the displacement of three sizes of according to the size of the respiratory vertical (Superior-Inferior) direction to the 5 mm, 10 mm, 20 mm. Insert crosses two EBT3 films in phantom inside the target in response to changes in the target movement, the End-to-End (E2E) test provided in Cyber-Knife manufacturer depending on the form of the breathing five times each. It was determined by carrying. Accuracy of tumor tracking system is indicated by the target error by analyzing the inserted film, additional E2E test is analyzed by measuring the correlation error while being advanced. Results : If the target error is a sine curve breathing form, the size of the target of the movement is in response to the 5 mm, 10 mm, 20 mm, respectively, of the average $1.14{\pm}0.13mm$, $1.05{\pm}0.20mm$, with $2.37{\pm}0.17mm$, suddenly for it is variations in breathing, respective average $1.87{\pm}0.19mm$, $2.15{\pm}0.21mm$, and analyzed with $2.44{\pm}0.26mm$. If the correlation error can be defined by the length of the displacement vector in the target track is a sinusoidal breathing mode, the size of the target of the movement in response to 5 mm, 10 mm, 20 mm, respective average $0.84{\pm}0.01mm$, $0.70{\pm}0.13mm$, with $1.63{\pm}0.10mm$, if it is a variant of sudden breathing respective average $0.97{\pm}0.06mm$, $1.44{\pm}0.11mm$, and analyzed with $1.98{\pm}0.10mm$. The larger the correlation error values in both the both the respiratory form, the target error value is large. If the motion size of the target of the sine curve breathing form is greater than or equal to 20 mm, was measured at 1.5 mm or more is a recommendation value of both cyber knife manufacturer of both error value. Conclusion : There is a tendency that the correlation error value between about target error value magnitude of the target motion is large is increased, the error value becomes large in variation of rapid respiration than breathing the form of a sine curve. The more the shape of the breathing large movements regular shape of sine curves target accuracy of the tumor tracking system can be judged to be reduced. Using the algorithm of Cyber-Knife tumor tracking system, when there is a change in the sudden unpredictable respiratory due patient coughing during treatment enforcement is to stop the treatment, it is assumed to carry out the internal target validation process again, it is necessary to readjust the form of respiration. Patients under treatment is determined to be able to improve the treatment of accuracy to induce the observed form of regular breathing and put like to see the goggles monitor capable of the respiratory form of the person.

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Measurement of Respiratory Motion Signals for Respiratory Gating Radiation Therapy (호흡동조 방사선치료를 위한 호흡 움직임 신호 측정)

  • Chung, Jin-Beom;Chung, Won-Kyun;Kim, Yon-Lae;Lee, Jeong-Woo;Suh, Tae-Suk
    • Proceedings of the Korean Society of Medical Physics Conference
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    • 2005.04a
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    • pp.59-63
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    • 2005
  • Respiration motion causes movement of internal structures in the thorax and abdomen, making accurate delivery of radiation therapy to tumors in those areas a challenge. Accounting for such motion during treatment, therefore, has the potential to reduce margins drawn around the clinical target volume (CTV), resulting in a lower dose to normal tissues (e.g., lung and liver) and thus a lower risk of treatment induced complications. Among the techniques that explicitly account for intrafraction motion are breath-hold, respiration gating, and 4D or tumor-tracking techniques. Respiration gating methods periodically turn the beam on when the patient's respiration signal is in a certain part of the respiratory cycle (generally end-inhale or end-exhale). These techniques require acquisition of some form of respiration motion signal (infrared reflective markers, spirometry, strain gauge, thermistor, video tracking of chest outlines and fluoroscopic tracking of implanted markers are some of the techniques employed to date), which is assumed to be correlated with internal anatomy motion. In preliminary study for the respiratory gating radiation therapy, we performed to measurement of this respiration motion signal. In order to measure the respiratory motion signals of patient, respiration measurement system (RMS) was composed with three sensor (spirometer, thermistor, and belt transducer), 4 channel data acquisition system and mobile computer. For two patients, we performed to evaluation of respiratory cycle and shape with RMS. We observed under this system that respiratory cycle is generally periodic but asymmetric, with the majority of time spent. As expected, RMS traced patient's respiration each other well and be easily handled for application.

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Estimation of CyberKnife Respiratory Tracking System Using Moving Phantom (동적 팬톰을 이용한 사이버나이프 호흡동기 추적장치의 위치 정확성 평가)

  • Seo, Jae-Hyuk;Kang, Young-Nam;Jang, Ji-Sun;Shin, Hun-Joo;Jung, Ji-Young;Choi, Byong-Ock;Choi, Ihl-Bohng;Lee, Dong-Joon;Kwon, Soo-Il;Lim, Jong-Soo
    • Progress in Medical Physics
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    • v.20 no.4
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    • pp.324-330
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    • 2009
  • In this study, we evaluated accuracy and usefulness of CyberKnife Respiratory Tracking System ($Synchrony^{TM}$, Accuray, USA) about a moving during stereotactic radiosurgery. For this study, we used moving phantom that can move the target. We also used Respiratory Tracking System called Synchrony of the Cyberknife in order to track the moving target. For treatment planning of the moving target, we obtained an image using 4D-CT. To measure dose distribution and point dose at the moving target, ion chamber (0.62 cc) and gafchromic EBT film were used. We compared dose distribution (80% isodose line of prescription dose) of static target to that of moving target in order to evaluate the accuracy of Respiratory Tracking System. We also measured the point dose at the target. The mean difference of synchronization for TLS (target localization system) and Synchrony were $11.5{\pm}3.09\;mm$ for desynchronization and $0.14{\pm}0.08\;mm$ for synchronization. The mean difference between static target plan and moving target plan using 4D CT images was $0.18{\pm}0.06\;mm$. And, the accuracy of Respiratory Tracking System was less 1 mm. Estimation of usefulness in Respiratory Tracking System was $17.39{\pm}0.14\;mm$ for inactivity and $1.37{\pm}0.11\;mm$ for activity. The mean difference of absolute dose was $0.68{\pm}0.38%$ in static target and $1.31{\pm}0.81%$ in moving target. As a conclusion, when we treat about the moving target, we consider that it is important to use 4D-CT and the Respiratory Tracking System. In this study, we confirmed the accuracy and usefulness of Respiratory Tracking System in the Cyberknife.

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Accuracy Evaluation of Tumor Therapy during Respiratory Gated Radiation Therapy (호흡동조방사선 치료 시 종양 치료의 정확도 평가)

  • Jang, Eun-Sung;Kang, Soo-Man;Lee, Chol-Soo;Kang, Se-Sik
    • The Journal of Korean Society for Radiation Therapy
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    • v.22 no.2
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    • pp.113-122
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    • 2010
  • Purpose: To evaluate the accuracy of a target position at static and dynamic state by using Dynamic phantom for the difference between tumor's actual movement during respiratory gated radiation therapy and skin movement measured by RPM (Real-time Position Management). Materials and Methods: It self-produced Dynamic phantom that moves two-dimensionally to measure a tumor moved by breath. After putting marker block on dynamic phantom, it analyzed the amplitude and status change depending on respiratory time setup in advance by using RPM. It places marker block on dynamic phantom based on this result, inserts Gafchromic EBT film into the target, and investigates 5 Gy respectively at static and dynamic state. And it scanned investigated Gafchromic EBT film and analyzed dose distribution by using automatic calculation. Results: As a result of an analysis of Gafchromic EBT film's radiation amount at static and dynamic state, it could be known that dose distribution involving 90% is distributed within margin of error of 3 mm. Conclusion: As a result of an analysis of dose distribution's change depending on patient's respiratory cycle during respiratory gated radiation therapy, it is expected that the treatment would be possible within recommended margin of error at ICRP 60.

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Evaluation of Real-time Measurement Liver Tumor's Movement and $Synchrony^{TM}$ System's Accuracy of Radiosurgery using a Robot CyberKnife (로봇사이버나이프를 이용한 간 종양의 실시간 움직임 측정과 방사선수술 시 호흡추적장치의 정확성 평가)

  • Kim, Gha-Jung;Shim, Su-Jung;Kim, Jeong-Ho;Min, Chul-Kee;Chung, Weon-Kuu
    • Radiation Oncology Journal
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    • v.26 no.4
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    • pp.263-270
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    • 2008
  • Purpose: This study aimed to quantitatively measure the movement of tumors in real-time and evaluate the treatment accuracy, during the treatment of a liver tumor patient, who underwent radiosurgery with a Synchrony Respiratory motion tracking system of a robot CyberKnife. Materials and Methods: The study subjects included 24 liver tumor patients who underwent CyberKnife treatment, which included 64 times of treatment with the Synchrony Respiratory motion tracking system ($Synchrony^{TM}$). The treatment involved inserting 4 to 6 acupuncture needles into the vicinity of the liver tumor in all the patients using ultrasonography as a guide. A treatment plan was set up using the CT images for treatment planning uses. The position of the acupuncture needle was identified for every treatment time by Digitally Reconstructed Radiography (DRR) prepared at the time of treatment planning and X-ray images photographed in real-time. Subsequent results were stored through a Motion Tracking System (MTS) using the Mtsmain.log treatment file. In this way, movement of the tumor was measured. Besides, the accuracy of radiosurgery using CyberKnife was evaluated by the correlation errors between the real-time positions of the acupuncture needles and the predicted coordinates. Results: The maximum and the average translational movement of the liver tumor were measured 23.5 mm and $13.9{\pm}5.5\;mm$, respectively from the superior to the inferior direction, 3.9 mm and $1.9{\pm}0.9mm$, respectively from left to right, and 8.3 mm and $4.9{\pm}1.9\;mm$, respectively from the anterior to the posterior direction. The maximum and the average rotational movement of the liver tumor were measured to be $3.3^{\circ}$ and $2.6{\pm}1.3^{\circ}$, respectively for X (Left-Right) axis rotation, $4.8^{\circ}$ and $2.3{\pm}1.0^{\circ}$, respectively for Y (Crania-Caudal) axis rotation, $3.9^{\circ}$ and $2.8{\pm}1.1^{\circ}$, respectively for Z (Anterior-Posterior) axis rotation. In addition, the average correlation error, which represents the treatment's accuracy was $1.1{\pm}0.7\;mm$. Conclusion: In this study real-time movement of a liver tumor during the radiosurgery could be verified quantitatively and the accuracy of the radiosurgery with the Synchrony Respiratory motion tracking system of robot could be evaluated. On this basis, the decision of treatment volume in radiosurgery or conventional radiotherapy and useful information on the movement of liver tumor are supposed to be provided.

4-Dimensional Imaging and Planning (4차원 영상 및 치료계획)

  • Jo, Byeong-Cheol;Park, Hui-Cheol;Kim, Su-San;O, Do-Hun;Bae, Hun-Sik
    • Proceedings of the Korean Society of Medical Physics Conference
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    • 2005.04a
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    • pp.11-15
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    • 2005
  • 입체조형 및 세기조절 방사선치료가 보편화되어 가고 있는 현 시점에서, 치료율을 높이기 위해 종양처방선량은 증가시키는 반면 부작용은 최소화하고자 하는 요구가 증가하고 있다. 셋업오차 및 체내운동(internal motion)은 이러한 요구를 충족시키는데 대한 한계로 작용하고 있다. 4차원방사선치료(4-dimensional radiation therapy)는 체내운동을 최소화시키거나 또는 움직임을 추적하여 방사선치료를 시행함으로써 “종양선량최대화/정상조직선량최소화”라는 고정밀방사선치료의 요구에 부응할 수 있는 치료기술로 기대를 모으고 있다. 체내운동은 호흡에 의한 움직임과 같이 단기적으로 발생되는 조사분할내(intra-fraction)와 종양의 수축, 체중 변화 등과 같이 장기적으로 발생하는 조사분할간(inter-fraction)움직임으로 구분되는데, 본 연제에서는 주로 조사분할내 움직임, 즉 호흡에 의한 움직임에 대처하는 4차원방사선치료를 위한 동적영상 획득 및 방사선치료계획과정에 초점을 맞추어 소개하고자 한다.

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Accuracy Evaluation of CyberKnife $Synchrony^{TM}$ Respiratory Tracking System Using Phantom (Phantom을 이용한 사이버나이프 $Synchrony^{TM}$ 호흡 추적장치의 정확성 평가)

  • Kim, Gha-Jung;Bae, Seok-Hwan;Lim, Chang-Seon;Kim, Chong-Yeal
    • Journal of Radiation Protection and Research
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    • v.34 no.3
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    • pp.137-143
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    • 2009
  • This study was conducted to evaluate the accuracy of CyberKnife $Synchrony^{TM}$ respiratory tracking system which was applied to Stereotactic Radiosurgery (SRS) for moving tumors in chest and abdomen with breathing motion. For accurate evaluation, gold fiducial marks were implanted into a moving phantom. The moving phantom was a cube imbedding an acryl ball as a target. The acryl ball was prescribed to 20 Gy at 70% of isodose curve in a virtual treatment and radiochromic films were inserted into the acryl ball for dose verification and tracking accuracy evaluation. The evaluation of position tracking consists of two parts: fiducial mark tracking in a stationary phantom and $Synchrony^{TM}$ respiratory tracking in a moving phantom. Each measurement was done in three directions and was repeated to 5 times. Range of position error was 0.1957 mm to 0.6520 mm in the stationary phantom and 0.4405 mm to 0.7665 mm in the moving phantom. Average position error was 0.3926 mm and 0.5673 mm in the stationary phantom and the moving phantom respectively. This study evaluates the accuracy of CyberKnife $Synchrony^{TM}$ Respiratory tracking system, and confirms the usefulness when it's used for Stereotactic Radiosurgery of body organs.