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Real-Time Personalized Margins

J Rottmann

J Rottmann1*, P Keall2 , R Berbeco1 , (1) Brigham and Woman's Hospital / Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, (2) University of Sydney, Australia


TU-F-17A-7 Tuesday 4:30PM - 6:00PM Room: 17A

Purpose: To maximize normal tissue sparing for treatments requiring motion encompassing margins. Motion mitigation techniques including DMLC or couch tracking can freeze tumor motion within the treatment aperture potentially allowing for smaller treatment margins and thus better sparing of normal tissue. To enable for a safe application of this concept in the clinic we propose adapting margins dynamically in real-time during radiotherapy delivery based on personalized tumor localization confidence. To demonstrate technical feasibility we present a phantom study.
Methods: We utilize a realistic anthropomorphic dynamic thorax phantom with a lung tumor model embedded close to the spine. The tumor, a 3D-printout of a patient’s GTV, is moved 15mm peak-to-peak by diaphragm compression and monitored by continuous EPID imaging in real-time. Two treatment apertures are created for each beam, one representing ITV -based and the other GTV-based margin expansion. A soft tissue localization (STiL) algorithm utilizing the continuous EPID images is employed to freeze tumor motion within the treatment aperture by means of DMLC tracking. Depending on a tracking confidence measure (TCM), the treatment aperture is adjusted between the ITV and the GTV leaf.
Results: We successfully demonstrate real-time personalized margin adjustment in a phantom study. We measured a system latency of about 250 ms which we compensated by utilizing a respiratory motion prediction algorithm (ridge regression). With prediction in place we observe tracking accuracies better than 1mm. For TCM=0 (as during startup) an ITV-based treatment aperture is chosen, for TCM=1 a GTV-based aperture and for 0Conclusions: We have proposed and demonstrated a concept to safely shrink treatment margins during radiotherapy and adapt to tracking confidence in real-time. Normal tissue sparing is maximized. The worst case scenario results in delivering a plan with standard margins used in the clinic today.

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