Six-degrees-of-freedom pelvic bone monitoring on 2D kV intrafraction images to enable multi-target tracking for locally advanced prostate cancer.

Abstract

Patients with locally advanced prostate cancer require the prostate and pelvic lymph nodes to be irradiated simultaneously during radiation therapy treatment. However, relative motion between treatment targets decreases dosimetric conformity. Current treatment methods mitigate this error by having large treatment margins and often prioritize the prostate at patient setup at the cost of lymph node coverage. Treatment accuracy can be improved through real-time multi-target adaptation which requires simultaneous motion monitoring of both the prostate and lymph node targets. This study developed and evaluated an intrafraction pelvic bone motion monitoring method as a surrogate for pelvic lymph node displacement to be combined with prostate motion monitoring to enable multi-target six-degrees-of-freedom (6DoF) tracking using 2D kV projections acquired during treatment. A method to monitor pelvic bone translation and rotation was developed and retrospectively applied to images from 20 patients treated in the TROG 15.01 Stereotactic Prostate Ablative Radiotherapy with Kilovoltage Intrafraction Monitoring (KIM) trial. The pelvic motion monitoring method performed template matching to calculate the 6DoF position of the pelvis from 2D kV images. The method first generated a library of digitally reconstructed radiographs (DRRs) for a range of imaging angles and pelvic rotations. The normalized 2D cross-correlations were then calculated for each incoming kV image and a subset of DRRs and the DRR with the maximum correlation coefficient was used to estimate the pelvis translation and rotation. Translation of the pelvis in the unresolved direction was calculated using a 3D Gaussian probability estimation method. Prostate motion was measured using the KIM marker tracking method. The pelvic motion monitoring method was compared to the ground truth obtained from a 6DoF rigid registration of the CBCT and CT. The geometric errors of the pelvic motion monitoring method demonstrated sub-mm and sub-degree accuracy and precision in the translational directions ( , , ) and rotational directions ( , , ). The 3D relative displacement between the prostate and pelvic bones exceeded 2, 3, 5, and 7mm for approximately 66%, 44%, 12%, and 7% of the images. Accurate intrafraction pelvic bone motion monitoring in 6DoF was demonstrated on 2D kV images, providing a necessary tool for real-time multi-target motion-adapted treatment.