TH-AB-202-12: The First Clinical Implementation of a Real-Time Six Degree of Freedom Tracking System During Radiation Therapy

Abstract

Purpose: In current practice, imaging is typically performed prior to treatment; the cancer target motion during treatment is unknown. We present the first clinical implementation of real time Kilovoltage Intrafraction Monitoring (KIM) system which tracks the cancer target translational and rotational motions during treatment. Methods: KIM technology: KIM estimates the 3D position of the target tumour based on segmented 2D positions of the three implanted fiducials in each of the kV images (125 kV, 10 mA at 11 fps) taken continuously during the treatment arc. The 2D-3D target estimation is based on a probability distribution function, obtained during pre-treatment CBCT. Rotations about each axis with the centroid of the markers as the pivot were calculated using the iterative closest point algorithm in real time. Patient: A patient with prostate adenocarcinoma undergoing stereotactic body radiotherapy (SBRT) with 36.25 Gy delivered in 5 fractions (Varian TrueBeam, 6X, VMAT) was enrolled in the study. The trial complies with Australian ethical and regulatory standards. Results: Of the 5 fractions of treatment the patient received, KIM was utilised successfully in 4 fractions with 3 couch shifts due to large persistent prostate movements (>2mm for more than 5 seconds). KIM translational accuracy and precision in comparison with post treatment kV-MV triangulation are 0.28±0.59 mm, −0.19±0.25 mm and 0.23±0.69 mm in the Left-Right, Superior-Inferior and Anterior-Posterior directions, respectively. KIM rotational accuracy as compared with triangulation is: 0.429°±2.22°, −0.44°±4.7° and 0.06°±1.08° in the roll, pitch and yaw direction, respectively. Conclusion: The first six degree of freedom KIM system was successfully implemented clinically. The presented KIM system has sub-millimeters accuracy and precision in all three translational axes, and less than 1° of mean error in all three rotational axes. Acknowledgement: This work is supported by Cancer Australia grants APPXXX, APPYYY.