An externally and internally deformable, programmable lung motion phantom

Purpose: Most clinically deployed strategies for respiratory motion management in lung radiotherapy (e.g., gating and tracking) use external markers that serve as surrogates for tumor motion. However, typical lung phantoms used to validate these strategies are based on a rigid exterior and a rigid or a deformable-interior. Such designs do not adequately represent respiration because the thoracic anatomy deforms internally as well as externally. In order to create a closer approximation of respiratory motion, the authors describe the construction and experimental testing of an externally as well as internally deformable, programmable lung phantom.Methods: The outer shell of a commercially available lung phantom (RS-1500, RSD, Inc.) was used. The shell consists of a chest cavity with a flexible anterior surface, and embedded vertebrae, rib-cage and sternum. A custom-made insert was designed using a piece of natural latex foam block. A motion platform was programmed with sinusoidal and ten patient-recorded lung tumor trajectories. The platform was used to drive a rigid foam "diaphragm" that compressed/decompressed the phantom interior. Experimental characterization comprised of determining the reproducibility and the external-internal correlation of external and internal marker trajectories extracted from kV x-ray fluoroscopy. Experiments were conducted to illustrate three example applications of the phantom-(i) validating the geometric accuracy of the VisionRT surface photogrammetry system; (ii) validating an image registration tool, NiftyReg; and (iii) quantifying the geometric error due to irregular motion in four-dimensional computed tomography (4DCT). Results: The phantom correctly reproduced sinusoidal and patient-derived motion, as well as realistic respiratory motion-related effects such as hysteresis. The reproducibility of marker trajectories over multiple runs for sinusoidal as well as patient traces, as characterized by fluoroscopy, was within 0.25 mm RMS error. The motion trajectories of internal and external radio-opaque markers as measured by fluoroscopy were found to be highly correlated (R > 0.95). Using the phantom, it was demonstrated that the motion trajectories of regions-of-interest on the surface as measured by VisionRT are highly consistent with corresponding fluoroscopically acquired surface marker trajectories, with RMS errors within 0.26 mm. Furthermore, it was shown that the trajectories of external and internal marker trajectories derived from NiftyReg deformation vector fields were within 1 mm root mean square errors comparing to trajectories obtained by segmenting markers from individual fluoro frames. Finally, it was shown that while 4DCT can be used to localize internal markers for sinusoidal motion with reasonable accuracy, the localization error increases significantly (by a factor of ∼2) in the presence of cycle-to-cycle variations that are observed in patient-derived respiratory motion. Conclusions: The authors have developed a realistic externally and internally deformable, programmable lung phantom that will serve as a valuable tool for clinical and investigational motion management studies in thoracic and abdominal radiation therapies.