emerging image guided and adaptive RT technologies Flashcards

1
Q

what is Image guidance

A

involves use of any imaging to aid decision making
main decision in RT is whether to treat and how/when to treat

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2
Q

rationale for IGRT

A

increase precision and accuracy in RT
reduced toxicity with the potential for dose escalation and improved tumour control
conformity
dose escalation
reduce inter and intra fraction errors

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3
Q

Treatment technologies

A

conventional LINAC
Tomo
halcyon
VERO SBRT
Cyberknife
MRL
Proton therapy

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4
Q

IGRT technologies

A

planar - 2D
Volumetric -3D and 4D
Ionising
non-ionising

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5
Q

conventional LINAC

A

3DCRT, IMRT, VMAT, SBRT delivery
Planar MV
Planar KV

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6
Q

Planar kV vs MV imaging

A

pros: better resolution and contrast than MV
Lower imaging dose
Requires additional LINAC Hardware
Similar workflow to traditional MV methods
widely available and utilised

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7
Q

Fiducial markers

A

routinely used for prostate irradiation
small gold seeds
surrogate for prostate match to fiducials to overcome factor such as: bladder filling, rectal filling and patient motion

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8
Q

Fiducial markers Strengths

A

FMs surrogate of prostate motion
very fast method of localisation
staff have great confidence when aligning FMs
very low intra-and inter observer variability

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9
Q

fiducial markers weakness

A

associated expense
invasive procedure
some patients ineligible
rely on few discrete points to localise the prostate
evaluation of nearby organs and deformation of the target is difficult

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10
Q

volumetric MVCBCT

A

use the treatment beam and EPID to acquire CBCT
Low contrast - high energy
good for artefacts
same isocentre of imaging and treatment

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11
Q

kVCBCT imaging

A

orthogonal to MV source
kV source
flat panel detector

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12
Q

full-fan versus half-fan

A

full fan: head due to narrow FOV
half fan: chest/prostate, takes longer than full fan

Both reduces beam hardening effect and scatter

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13
Q

when to replan

A

disease progression
disease response
weight loss

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14
Q

varian ETHOS

A

ETHOS therapy
FDA approval
uses AI and ML to create contours and generate adapted plans for physician review within minutes, while a patient is on the treatment couch

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15
Q

cyberknife technology

A

two ceiling-mounted kV sources
two floor-mounted aSi detectors
process:
1. fiducial placement
2. setup and imaging
3. planning
4. treatment and follow up

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16
Q

Exactrac stereoscopic kV imaging

A

two floor-mounted kV sources
two ceiling-mounted aSi detectors
available as add-on for Varian, Elekta and Siemens Linacs
Allows frameless radiosurgery

17
Q

VERO SBRT technology

A

ring gantry similar to tomotherapy
MV source
Stereoscopic kV imaging
unrestrcited imaging

18
Q

CT on rails

A

Patient setup on CT couch (BBs placed on reference marks)
CT scan performed
table rotated 180 degrees
patient positioned at treatment isocentre
Diagnostic quality CT reviewed
table position adjusted

19
Q

Limit CT on rails

A

considerable differences between in room CT and EPI exist
Couch sag that occurs at the CT on rails gantry could not be totally corrected for
other confounding factors are:
- action of rotating the couch
- associated time lag between image acquisitions
- EPI image quality and outlining uncertainties

20
Q

Helical TomoTherapy (HT) Imaging

A

MV beam source placed on a ring gantry
MV fan beam - CT
provides less sot tissue contrast than kV CT but less artefacts from high Z material

21
Q

MR linac

A

MRIdian system
MRIdian Linac system
Elekta Unity

22
Q

Challenges in development phases for MRL

A

RF interference between linac and magnetic field
affects: radiation dose distribution and MR iamge quality
increased imaging complexity
Education for RO/RT staff

23
Q

non-ionising technologies

A

Calypso system
3D ultrasound
Optical surface imaging

24
Q

Calypso 4D localisation system

A

limited to implanted markers
continuous, real time monitoring of the prostate

25
Calypso workflow
1. transponders permanently implanted 2. electromagnetic array is positioned above the treatment site. array sends signal that excites the transponders, which communicate the location of the target 3. System detects tumour movement in real time and if required, the RT can pause treatment to make adjustments 4. Varian Calypso system links with our linear accelerator which produces and delivers
26
advantages of Calypso
rapid, high dose rate treatment is always on target Setup and delivery times are decreased Reduced treatment margins Reduced GI, GU and sexual complications
27
Ultrasound Guided technologies
not as common as other imaging modalities previous system suffered from significant systematic errors --> inaccurate treatment localisation --> US probe traditional 2D - hard to interpret, operator dependent strong motivation to have inexpensive, non-IR, real-time guidance method but confidence needs to be restored
28
3D US
verify target position without ionising radiation marketed for breast and prostate can be used to monitor target over time also used for patient alignment in the treatment room Clarity and BAT system
29
SGRT
Rapidly growing technique which uses stereo vision technology to track patients surface in 3D, for both setup and motion management during radiotherapy
30
SGRT applications
setup: SGRT helps speed up and improve the accuracy of setup treatment: SGRT can reduce the need for immobilisation while helping to ensure the patient is in the correct position for treatment in all 6 degrees of freedom 4DCT: SGRT enables contactless, non-invasive reconstruction of 4DCT data
31
SGRT workflow
reference surface model: acquiring a 3D surface with alignRT at simulation At each treatment fraction, the system images the current patient position this image is registered to the reference surface couch shifts then calculated to correct inconsistencies between actual and planned positions. will alert RTs of gross movement
32
Disadvantage of SGRT
no information on internal motion
33
Varian RPM
Non-invasive, video based system uses an infrared tracking camera and a reflective marker array measures the patient's respiratory pattern and range of motion, displays as a waveform reflectors act as surrogate for patient's respiratory cycle
34
Disadvantages of Calypso
More invasive as seeds are required
35
Clarity
Ultrasound system using TRUS or TPUS More commonly used TPUS for continual matching Can be applied in both simulation and treatment Can be used for patient aligament in the treatment room Can verify the target position without additional ionising radiation Provides real time monitoring of prostate
36
Clarity technology
ultrasound probe is calibrated to the same isocentre as the CT system • series of reflective markers used to track its position in space • enables the volumetric ultrasound image to be automatically fused with the planning CT • providing additional information for contouring • no extra appointment is needed
37
BAT
Can be used for patient alignment in the treatment room Can verify the target position without additional ionising radiation Provides real-time monitoring of the target Requires only 90 seconds for scanning and repositioning