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Gabriele GUIDI
Medical Physicist
Medical Physics Dpt, University Hospital “Policlinico”, MO
N Maffei, C Vecchi, G Baldazzi
Physics Dpt, University of Bologna
G M Mistretta, A Ciarmatori, T Costi
Medical Physics Dpt, University Hospital “Policlinico”, Modena
Disclosures
No conflicts of interest to disclose
Co-Funding:
• Italian Ministry of Health (MoH2010, GR-2010-2318757)
Dose warping methods for IGRT and Adaptive RT: dose accumulation based on
organ motion and anatomical variations of the patients during radiation
therapy treatments
• Tecnologie Avanzate S.r.l. (Italy): Co-Partner of MoH2010, GR-2010-2318757
NO CONFLICTS OF INTEREST TO DISCLOSE
Adaptive Radiation Therapy (ART) is a state-of-the-art approach that uses a feedback process to
account for patient-specific anatomic and/or biological changes, thus, delivering highly
individualized radiation therapy for cancer patients.
Needs for Clinical Practice:
1. Image Guided System
2. Fast Re-Contouring
3. Fast Re-calculation
4. Tools for Real-Time QA or Simulation
5. Predictive Tools for Biomechanical Approach
[Malone 2014] Malone C, Rock L, Skourou C, Efficacy evaluation of
retrospectively applying the Varian normal breathing predictive filter for
volume definition and artifact reduction in 4D CT lung patients, Journal of
Applied Clinical Medical Physics, vol 15, num 3.
What is Available?
1. Daily Setup Images (e.g. MVCT/kVCT)
2. Automatic PTV/OARs contouring
3. DIR and/or Warping methods
4. Hybrid deformable algorithms
5. Dose Accumulation algorithm
6. Workflow automation (Scripting, GPU, Cluster, iCloud)
7. Tracking/Robotic Systems (e.g.VisionRT, CyberKnife, ExaPot, X-Ray)
8. Predictive analysis
1. Neural Networks
2. Bayesian Network validation
ADAPTIVE RADIATION THERAPY
Tracking
WHAT IS THE PROBLEM?
BREATHING
MOTION
Approximate localization of
TUMOR & OAR
With 4DCT and/or
Gating System
Breathing Phase
Reconstruction
With Standard CT
(Mean Object
Positions)
Correlation between
External & Internal
Motion ??
4DCT Breathing Motion
Contour GTV
Spatial-time
position
4D function
correlate to BPM
Simulate irregular BREATHING +
GTV spatial positions phases
Vision RT
Aim:
BIOMECHANICAL APPROACH
InfraRed /UltraSound
SENSOR
8 RIBs with 4 angular speed
Prototype “LINAC”
2 TUMOR with 4 DOF
EV3 BRICK:
Linux wireless CPU,
LabVIEW programmable
30 cm
24 cm
[Jeong 2011] Jeong H S, Han Y, Kum O et al., Development And
Evaluation of a Phantom for Multi-purpose Dosimetry in IMRT,
Nuclear Engineering And Technology, Vol.43 No.4 , 2011.
REAL-TIME ROBOT
Freedom offered by building bricks
Low-cost/home-made solution
Pediatric scale
Plastic materials avoid artifacts
Complete versatility with LabVIEW dedicated software
[Cruz-Martín 2012] Cruz-Martín A, Fernández-Madrigal J A,
Galindo C et al., A LEGO Mindstorms NXT approach for teaching
at Data Acquisition, Control Systems Engineering and Real-Time
Systems undergraduate courses, Computers & Education 59
(2012) 974–988.
ADVANTAGES FROM LEGO APPROACH
Human 4D simulation reproducible
4DCT, MESH RECONSTRUCTION
AND OBJECT TRACKING/CONTOURING
Quasar phantom, interfaced
with VisionRT software,
reproduces BPM
Through sensors, the ROBOT
emulates in real-time patient’s
breathing motion
BREATHING REAL-TIME SIMULATION
4D Breathing Simulation
Tracking Tumor Simulation
(12 BPM)
[Castillo 2014] Castillo S J, Castillo R, Balter P, et al., Assessment of a
quantitative metric for 4D CT artifact evaluation by observer consensus,
Journal of Applied Clinical Medical Physics, vol 15, num 3.
PRELIMINARY RESULTS
PROTOTYPE TARGET MOTION SIMULATION vs. 4DCT ACQUISITION
We can move and reproduce the 4D motion using surrogate signals
… 4D Motion QA (Quality Assurance) and biomechanical analysis is feasible
Organ motion and deformation can lead divergence of treatments compared to the initial
constraints
Standard CT “freeze” images of Tumor and OAR
An anthropomorphic phantom can simulate the human physiology to follow and predict
changes in morpho-dosimetry using external surrogate
4DCT allows to follow dynamics parameters of breathing (spatial time localization)
CONCLUSIONS
LEGO MINDSTOMRS can help to prototype idea and make some experimental with low cost
Adaptive Radiation Therapy for LUNG disease requires adequate representation of the
anatomical ROI for a correct calculation of the amount of dose delivered
A correlation between internal organ motion and the breathing sinogram is fundamental
Creation of real models in conjunction with predictive analysis could increase accuracy of
treatments and ensuring that dose distributions are aligned with therapeutic targets
Internal – External correlation can be investigated using surrogate and anthropomorphic
phantom (…or using LEGO solutions)
TAKE HOME MESSAGE
GR-2010-2318757 - G.Guidi
- 2010 Ricerca Finalizzata e Giovani Ricercatori -
Ministero della Salute
“That’s too much!!!”
(Praha 2009 : Tomotherapy Meeting)
THANK YOU FOR YOUR ATTENTION
ACKNOWLEDGE
Suggestions
Questions?
MOST VALUABLE?
..RESEARCH TEAM

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Real-time model for adaptive radiation therapy a biomechanical approach using a lego mindstorms

  • 1. Gabriele GUIDI Medical Physicist Medical Physics Dpt, University Hospital “Policlinico”, MO N Maffei, C Vecchi, G Baldazzi Physics Dpt, University of Bologna G M Mistretta, A Ciarmatori, T Costi Medical Physics Dpt, University Hospital “Policlinico”, Modena
  • 2. Disclosures No conflicts of interest to disclose Co-Funding: • Italian Ministry of Health (MoH2010, GR-2010-2318757) Dose warping methods for IGRT and Adaptive RT: dose accumulation based on organ motion and anatomical variations of the patients during radiation therapy treatments • Tecnologie Avanzate S.r.l. (Italy): Co-Partner of MoH2010, GR-2010-2318757 NO CONFLICTS OF INTEREST TO DISCLOSE
  • 3. Adaptive Radiation Therapy (ART) is a state-of-the-art approach that uses a feedback process to account for patient-specific anatomic and/or biological changes, thus, delivering highly individualized radiation therapy for cancer patients. Needs for Clinical Practice: 1. Image Guided System 2. Fast Re-Contouring 3. Fast Re-calculation 4. Tools for Real-Time QA or Simulation 5. Predictive Tools for Biomechanical Approach [Malone 2014] Malone C, Rock L, Skourou C, Efficacy evaluation of retrospectively applying the Varian normal breathing predictive filter for volume definition and artifact reduction in 4D CT lung patients, Journal of Applied Clinical Medical Physics, vol 15, num 3. What is Available? 1. Daily Setup Images (e.g. MVCT/kVCT) 2. Automatic PTV/OARs contouring 3. DIR and/or Warping methods 4. Hybrid deformable algorithms 5. Dose Accumulation algorithm 6. Workflow automation (Scripting, GPU, Cluster, iCloud) 7. Tracking/Robotic Systems (e.g.VisionRT, CyberKnife, ExaPot, X-Ray) 8. Predictive analysis 1. Neural Networks 2. Bayesian Network validation ADAPTIVE RADIATION THERAPY
  • 4. Tracking WHAT IS THE PROBLEM? BREATHING MOTION Approximate localization of TUMOR & OAR With 4DCT and/or Gating System Breathing Phase Reconstruction With Standard CT (Mean Object Positions) Correlation between External & Internal Motion ??
  • 5. 4DCT Breathing Motion Contour GTV Spatial-time position 4D function correlate to BPM Simulate irregular BREATHING + GTV spatial positions phases Vision RT Aim: BIOMECHANICAL APPROACH
  • 6. InfraRed /UltraSound SENSOR 8 RIBs with 4 angular speed Prototype “LINAC” 2 TUMOR with 4 DOF EV3 BRICK: Linux wireless CPU, LabVIEW programmable 30 cm 24 cm [Jeong 2011] Jeong H S, Han Y, Kum O et al., Development And Evaluation of a Phantom for Multi-purpose Dosimetry in IMRT, Nuclear Engineering And Technology, Vol.43 No.4 , 2011. REAL-TIME ROBOT
  • 7. Freedom offered by building bricks Low-cost/home-made solution Pediatric scale Plastic materials avoid artifacts Complete versatility with LabVIEW dedicated software [Cruz-Martín 2012] Cruz-Martín A, Fernández-Madrigal J A, Galindo C et al., A LEGO Mindstorms NXT approach for teaching at Data Acquisition, Control Systems Engineering and Real-Time Systems undergraduate courses, Computers & Education 59 (2012) 974–988. ADVANTAGES FROM LEGO APPROACH Human 4D simulation reproducible
  • 8. 4DCT, MESH RECONSTRUCTION AND OBJECT TRACKING/CONTOURING
  • 9. Quasar phantom, interfaced with VisionRT software, reproduces BPM Through sensors, the ROBOT emulates in real-time patient’s breathing motion BREATHING REAL-TIME SIMULATION 4D Breathing Simulation Tracking Tumor Simulation
  • 10. (12 BPM) [Castillo 2014] Castillo S J, Castillo R, Balter P, et al., Assessment of a quantitative metric for 4D CT artifact evaluation by observer consensus, Journal of Applied Clinical Medical Physics, vol 15, num 3. PRELIMINARY RESULTS
  • 11. PROTOTYPE TARGET MOTION SIMULATION vs. 4DCT ACQUISITION We can move and reproduce the 4D motion using surrogate signals … 4D Motion QA (Quality Assurance) and biomechanical analysis is feasible
  • 12. Organ motion and deformation can lead divergence of treatments compared to the initial constraints Standard CT “freeze” images of Tumor and OAR An anthropomorphic phantom can simulate the human physiology to follow and predict changes in morpho-dosimetry using external surrogate 4DCT allows to follow dynamics parameters of breathing (spatial time localization) CONCLUSIONS LEGO MINDSTOMRS can help to prototype idea and make some experimental with low cost
  • 13. Adaptive Radiation Therapy for LUNG disease requires adequate representation of the anatomical ROI for a correct calculation of the amount of dose delivered A correlation between internal organ motion and the breathing sinogram is fundamental Creation of real models in conjunction with predictive analysis could increase accuracy of treatments and ensuring that dose distributions are aligned with therapeutic targets Internal – External correlation can be investigated using surrogate and anthropomorphic phantom (…or using LEGO solutions) TAKE HOME MESSAGE
  • 14. GR-2010-2318757 - G.Guidi - 2010 Ricerca Finalizzata e Giovani Ricercatori - Ministero della Salute “That’s too much!!!” (Praha 2009 : Tomotherapy Meeting) THANK YOU FOR YOUR ATTENTION ACKNOWLEDGE