Toward quantitative intrafractional monitoring in paraspinal SBRT using a proprietary software application: Clinical implementation and patient results Journal Article
| Authors: | Fan, Q.; Pham, H.; Li, X.; Zhang, P.; Zhang, L.; Fu, Y.; Huang, B.; Li, C.; Cuaron, J.; Cerviño, L.; Moran, J. M.; Li, T. |
| Article Title: | Toward quantitative intrafractional monitoring in paraspinal SBRT using a proprietary software application: Clinical implementation and patient results |
| Abstract: | Objective. We report on paraspinal motion and the clinical implementation of our proprietary software that leverages Varian’s intrafraction motion review (IMR) capability for quantitative tracking of the spine during paraspinal SBRT. The work is based on our prior development and analysis on phantoms. Approach. To address complexities in patient anatomy, digitally reconstructed radiographs (DRR’s) that highlight only the spine or hardware were constructed as tracking reference. Moreover, a high-pass filter and first-pass coarse search were implemented to enhance registration accuracy and stability. For evaluation, 84 paraspinal SBRT patients with sites spanning across the entire vertebral column were enrolled with prescriptions ranging from 24 to 40 Gy in one to five fractions. Treatments were planned and delivered with 9 IMRT beams roughly equally distributed posteriorly. IMR was triggered every 200 or 500 MU for each beam. During treatment, the software grabbed the IMR image, registered it with the corresponding DRR, and displayed the motion result in near real-time on auto-pilot mode. Four independent experts completed offline manual registrations as ground truth for tracking accuracy evaluation. Main results. Our software detected ≥1.5 mm and ≥2 mm motions among 17.1% and 6.6% of 1371 patient images, respectively, in either lateral or longitudinal direction. In the validation set of 637 patient images, 91.9% of the tracking errors compared to manual registration fell within ±0.5 mm in either direction. Given a motion threshold of 2 mm, the software accomplished a 98.7% specificity and a 93.9% sensitivity in deciding whether to interrupt treatment for patient re-setup. Significance. Significant intrafractional motion exists in certain paraspinal SBRT patients, supporting the need for quantitative motion monitoring during treatment. Our improved software achieves high motion tracking accuracy clinically and provides reliable guidance for treatment intervention. It offers a practical solution to ensure accurate delivery of paraspinal SBRT on a conventional Linac platform. © 2024 Institute of Physics and Engineering in Medicine. |
| Keywords: | adult; aged; intensity modulated radiation therapy; prescription; diagnosis; radiosurgery; spine; patient treatment; stereotactic body radiation therapy; motion; software; linear accelerator; paraspinal; intrafractional motion; intrafraction motion; proprietary software; human; female; article; motion analysis; spine sbrt; application programs; software applications; markerless tracking; motion tracking; imr; intrafraction motion review; intrafractional motion tracking; software application; high pass filters |
| Journal Title: | Physics in Medicine and Biology |
| Volume: | 69 |
| Issue: | 4 |
| ISSN: | 0031-9155 |
| Publisher: | IOP Publishing Ltd |
| Date Published: | 2024-02-21 |
| Start Page: | 045015 |
| Language: | English |
| DOI: | 10.1088/1361-6560/ad2099 |
| PUBMED: | 38241714 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PDF -- Corresponding author are MSK authors: Qiyong Fan and Tianfang Li -- Source: Scopus |
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