Electromagnetic-guided dynamic multileaf collimator tracking enables motion management for intensity-modulated arc therapy

Paul J. Keall; Amit Sawant; Byungchul Cho; Dan Ruan; Junqing Wu; Per Poulsen; Jay Petersen; Laurence J. Newell; Herbert Cattell; Stine Korreman

doi:10.1016/j.ijrobp.2010.03.011

Electromagnetic-guided dynamic multileaf collimator tracking enables motion management for intensity-modulated arc therapy

Paul J. Keall, Amit Sawant, Byungchul Cho, Dan Ruan, Junqing Wu, Per Poulsen, Jay Petersen, Laurence J. Newell, Herbert Cattell, Stine Korreman

Radiation Oncology

Research output: Contribution to journal › Article › peer-review

57 Scopus citations

Abstract

Purpose: Intensity-modulated arc therapy (IMAT) is attractive because of high-dose conformality and efficient delivery. However, managing intrafraction motion is challenging for IMAT. The purpose of this research was to develop and investigate electromagnetically guided dynamic multileaf collimator (DMLC) tracking as an enabling technology to treat moving targets during IMAT. Methods and Materials: A real-time three-dimensional DMLC-based target tracking system was developed and integrated with a linear accelerator. The DMLC tracking software inputs a real-time electromagnetically measured target position and the IMAT plan, and dynamically creates new leaf positions directed at the moving target. Low- and high-modulation IMAT plans were created for lung and prostate cancer cases. The IMAT plans were delivered to a three-axis motion platform programmed with measured patient motion. Dosimetric measurements were acquired by placing an ion chamber array on the moving platform. Measurements were acquired with tracking, without tracking (current clinical practice), and with the phantom in a static position (reference). Analysis of dose distribution differences from the static reference used a γ-test. Results: On average, 1.6% of dose points for the lung plans and 1.2% of points for the prostate plans failed the 3-mm/3% γ-test with tracking; without tracking, 34% and 14% (respectively) of points failed the γ-test. The delivery time was the same with and without tracking. Conclusions: Electromagnetic-guided DMLC target tracking with IMAT has been investigated for the first time. Dose distributions to moving targets with DMLC tracking were significantly superior to those without tracking. There was no loss of treatment efficiency with DMLC tracking.

Original language	English (US)
Pages (from-to)	312-320
Number of pages	9
Journal	International Journal of Radiation Oncology Biology Physics
Volume	79
Issue number	1
DOIs	https://doi.org/10.1016/j.ijrobp.2010.03.011
State	Published - Jan 1 2011

Keywords

Motion management
arc therapy
tumor tracking

ASJC Scopus subject areas

Radiation
Oncology
Radiology Nuclear Medicine and imaging
Cancer Research

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10.1016/j.ijrobp.2010.03.011

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Keall, P. J., Sawant, A., Cho, B., Ruan, D., Wu, J., Poulsen, P., Petersen, J., Newell, L. J., Cattell, H., & Korreman, S. (2011). Electromagnetic-guided dynamic multileaf collimator tracking enables motion management for intensity-modulated arc therapy. International Journal of Radiation Oncology Biology Physics, 79(1), 312-320. https://doi.org/10.1016/j.ijrobp.2010.03.011

Keall, PJ, Sawant, A, Cho, B, Ruan, D, Wu, J, Poulsen, P, Petersen, J, Newell, LJ, Cattell, H & Korreman, S 2011, 'Electromagnetic-guided dynamic multileaf collimator tracking enables motion management for intensity-modulated arc therapy', International Journal of Radiation Oncology Biology Physics, vol. 79, no. 1, pp. 312-320. https://doi.org/10.1016/j.ijrobp.2010.03.011

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title = "Electromagnetic-guided dynamic multileaf collimator tracking enables motion management for intensity-modulated arc therapy",

abstract = "Purpose: Intensity-modulated arc therapy (IMAT) is attractive because of high-dose conformality and efficient delivery. However, managing intrafraction motion is challenging for IMAT. The purpose of this research was to develop and investigate electromagnetically guided dynamic multileaf collimator (DMLC) tracking as an enabling technology to treat moving targets during IMAT. Methods and Materials: A real-time three-dimensional DMLC-based target tracking system was developed and integrated with a linear accelerator. The DMLC tracking software inputs a real-time electromagnetically measured target position and the IMAT plan, and dynamically creates new leaf positions directed at the moving target. Low- and high-modulation IMAT plans were created for lung and prostate cancer cases. The IMAT plans were delivered to a three-axis motion platform programmed with measured patient motion. Dosimetric measurements were acquired by placing an ion chamber array on the moving platform. Measurements were acquired with tracking, without tracking (current clinical practice), and with the phantom in a static position (reference). Analysis of dose distribution differences from the static reference used a γ-test. Results: On average, 1.6% of dose points for the lung plans and 1.2% of points for the prostate plans failed the 3-mm/3% γ-test with tracking; without tracking, 34% and 14% (respectively) of points failed the γ-test. The delivery time was the same with and without tracking. Conclusions: Electromagnetic-guided DMLC target tracking with IMAT has been investigated for the first time. Dose distributions to moving targets with DMLC tracking were significantly superior to those without tracking. There was no loss of treatment efficiency with DMLC tracking.",

keywords = "Motion management, arc therapy, tumor tracking",

author = "Keall, {Paul J.} and Amit Sawant and Byungchul Cho and Dan Ruan and Junqing Wu and Per Poulsen and Jay Petersen and Newell, {Laurence J.} and Herbert Cattell and Stine Korreman",

note = "Funding Information: The authors appreciate the use of the lung motion data provided by Sonja Dieterich (Stanford), the prostate motion data provided by Patrick Kupelian and Katja Langen (MD Anderson Orlando), rotation matrix coding by David Carlson (now at Yale), Rapidarc planning from Ed Mok (Stanford), phantom modifications from Fred van den Haak (Stanford), and experimental assistance from Yolanda Aarons (Peter MacCallum Institute), Marianne Falk (Rigshospitalet, Copenhagen, and Lund University), and Yelin Suh (Stanford). Mark Wanlass (Stanford) answered many machine-related pages in the late evening and on weekends. The authors thanks Michelle Svatos (Varian), who contributed to and supported this project in many aspects and was instrumental in bringing the hardware components together. Thanks are also expressed to Libby Roberts (Stanford) for reviewing the manuscript and improving the clarity. Research support from Calypso Medical Technologies, Varian Medical Systems, and the National Institutes of Health is gratefully acknowledged. Thanks also are expressed to the reviewers whose observations and suggestions substantially improved the clarity of the manuscript. ",

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doi = "10.1016/j.ijrobp.2010.03.011",

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T1 - Electromagnetic-guided dynamic multileaf collimator tracking enables motion management for intensity-modulated arc therapy

AU - Keall, Paul J.

AU - Sawant, Amit

AU - Cho, Byungchul

AU - Ruan, Dan

AU - Wu, Junqing

AU - Poulsen, Per

AU - Petersen, Jay

AU - Newell, Laurence J.

AU - Cattell, Herbert

AU - Korreman, Stine

N1 - Funding Information: The authors appreciate the use of the lung motion data provided by Sonja Dieterich (Stanford), the prostate motion data provided by Patrick Kupelian and Katja Langen (MD Anderson Orlando), rotation matrix coding by David Carlson (now at Yale), Rapidarc planning from Ed Mok (Stanford), phantom modifications from Fred van den Haak (Stanford), and experimental assistance from Yolanda Aarons (Peter MacCallum Institute), Marianne Falk (Rigshospitalet, Copenhagen, and Lund University), and Yelin Suh (Stanford). Mark Wanlass (Stanford) answered many machine-related pages in the late evening and on weekends. The authors thanks Michelle Svatos (Varian), who contributed to and supported this project in many aspects and was instrumental in bringing the hardware components together. Thanks are also expressed to Libby Roberts (Stanford) for reviewing the manuscript and improving the clarity. Research support from Calypso Medical Technologies, Varian Medical Systems, and the National Institutes of Health is gratefully acknowledged. Thanks also are expressed to the reviewers whose observations and suggestions substantially improved the clarity of the manuscript.

PY - 2011/1/1

Y1 - 2011/1/1

N2 - Purpose: Intensity-modulated arc therapy (IMAT) is attractive because of high-dose conformality and efficient delivery. However, managing intrafraction motion is challenging for IMAT. The purpose of this research was to develop and investigate electromagnetically guided dynamic multileaf collimator (DMLC) tracking as an enabling technology to treat moving targets during IMAT. Methods and Materials: A real-time three-dimensional DMLC-based target tracking system was developed and integrated with a linear accelerator. The DMLC tracking software inputs a real-time electromagnetically measured target position and the IMAT plan, and dynamically creates new leaf positions directed at the moving target. Low- and high-modulation IMAT plans were created for lung and prostate cancer cases. The IMAT plans were delivered to a three-axis motion platform programmed with measured patient motion. Dosimetric measurements were acquired by placing an ion chamber array on the moving platform. Measurements were acquired with tracking, without tracking (current clinical practice), and with the phantom in a static position (reference). Analysis of dose distribution differences from the static reference used a γ-test. Results: On average, 1.6% of dose points for the lung plans and 1.2% of points for the prostate plans failed the 3-mm/3% γ-test with tracking; without tracking, 34% and 14% (respectively) of points failed the γ-test. The delivery time was the same with and without tracking. Conclusions: Electromagnetic-guided DMLC target tracking with IMAT has been investigated for the first time. Dose distributions to moving targets with DMLC tracking were significantly superior to those without tracking. There was no loss of treatment efficiency with DMLC tracking.

AB - Purpose: Intensity-modulated arc therapy (IMAT) is attractive because of high-dose conformality and efficient delivery. However, managing intrafraction motion is challenging for IMAT. The purpose of this research was to develop and investigate electromagnetically guided dynamic multileaf collimator (DMLC) tracking as an enabling technology to treat moving targets during IMAT. Methods and Materials: A real-time three-dimensional DMLC-based target tracking system was developed and integrated with a linear accelerator. The DMLC tracking software inputs a real-time electromagnetically measured target position and the IMAT plan, and dynamically creates new leaf positions directed at the moving target. Low- and high-modulation IMAT plans were created for lung and prostate cancer cases. The IMAT plans were delivered to a three-axis motion platform programmed with measured patient motion. Dosimetric measurements were acquired by placing an ion chamber array on the moving platform. Measurements were acquired with tracking, without tracking (current clinical practice), and with the phantom in a static position (reference). Analysis of dose distribution differences from the static reference used a γ-test. Results: On average, 1.6% of dose points for the lung plans and 1.2% of points for the prostate plans failed the 3-mm/3% γ-test with tracking; without tracking, 34% and 14% (respectively) of points failed the γ-test. The delivery time was the same with and without tracking. Conclusions: Electromagnetic-guided DMLC target tracking with IMAT has been investigated for the first time. Dose distributions to moving targets with DMLC tracking were significantly superior to those without tracking. There was no loss of treatment efficiency with DMLC tracking.

KW - Motion management

KW - arc therapy

KW - tumor tracking

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Electromagnetic-guided dynamic multileaf collimator tracking enables motion management for intensity-modulated arc therapy

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