Patient Coordinate System Research Articles

IEC accelerator beam coordinate transformations for clinical Monte Carlo simulation from a phase space or full BEAMnrc particle source

Monte Carlo simulation of clinical treatment plans require, in general, a coordinate transformation to describe the incident radiation field orientation on a patient phantom coordinate system. The International Electrotechnical Commission (IEC) has defined an accelerator coordinate system along with positive directions for gantry, couch and collimator rotations. In order to describe the incident beam's orientation with respect to the patient's coordinate system, DOSXYZnrc simulations often require transformation of the accelerator's gantry, couch and collimator angles to describe the incident beam. Similarly, versions of the voxelized Monte Carlo code (VMC(++)) require non-trivial transformation of the accelerator's gantry, couch and collimator angles to standard Euler angles α, β, γ, to describe an incident phase space source orientation with respect to the patient's coordinate system. The transformations, required by each of these Monte Carlo codes to transport phase spaces through a phantom, have been derived with a rotation operator approach. The transformations have been tested and verified against the Eclipse treatment planning system.

MO‐D‐BRB‐05: A Novel Dynamic MLC Leaf Sequencing Algorithm for 4D Treatment with Deformable Target Motion Correction

Purpose: To investigate a dynamic MLC (DMLC) leaf sequencing method for the 4D IMRT delivery. Materials and methods: A 4D CT was obtained and 10 phase CT data sets were created retrospectively. Individual IMRT plan was generated for each phase on Pinnacle treatment planning station, and a 4D plan was created using a deformable image registration technique. Based on the DMLC leaf sequences generated from the plan of each phase, the non‐rigid motion corrected 4D leaf sequence was created by matching the time indexes of the leaf sequences and the breathing cycles of each phase. The 4D leaf sequence was iteratively adjusted for the maximum leaf speed to avoid any beam hold‐offs. At the same time, a rigid motion corrected 4D leaf sequence was calculated by adjusting the leaf center corresponding to the center of mass position of the target in each phase. The opening density map (ODM) of the 4D plan was used to create a traditional no‐motion corrected leaf sequence. All three leaf sequences were delivered by Varian 2100 C/D with Millennium 120 leaf DMLC. The MatriXX (IBA Dosimetry) was used to measure the delivered fluence map every 40 ms. The delivered fluence maps were registered back to the patient's coordinate system. Results: Using the 4D plan ODM as reference, the fluence map from the non‐rigid motion corrected 4D leaf sequence showed a maximum dosimetric difference of 3%. However, the fluence maps from the rigid motion corrected 4D leaf sequence and the no‐motion corrected leaf sequence showed maximum dosimetric differences of 30%. Conclusion: For 4D plan DMLC delivery, the non‐rigid motion corrected leaf sequencing, the rigid motion corrected 4D leaf sequencing and the no‐motion corrected leaf sequencing were investigated. Results showed that the non‐rigid motion corrected leaf sequencing is the one that closest deliverers the 4D plan.

A CT-free, intra-operative planning and navigation system for minimally invasive anterior spinal surgery – an accuracy study

Objective: A comprehensive study was performed to evaluate the accuracy of a newly developed CT-free, intra-operative planning and navigation system for anterior spine surgery.Materials and Methods: Instruments and an image intensifier were tracked using the SurgiGATE® navigation system. A laboratory study was performed on 27 plastic vertebrae. Fiducial markers were implanted in the vertebrae for accuracy evaluation purposes, and a dynamic reference base was placed on the vertebrae to establish a patient coordinate system (P-COS). Two fluoroscopic images were used for intra-operative planning. The graft bed plan was recorded in P-COS, followed by surgical formation of the graft bed, which was visualized. To evaluate the accuracy, the vertebrae were scanned with CT, and the markers were used to calculate an accurate paired-point registered transformation between the CT coordinate system and P-COS.Results: Using the new SPO module, accurate planning and navigation of a resection of the vertebral body is possible using two fluoroscopic images. The overall mean error between the planned resection volume and the actual resection was 0.98 mm. In addition, the module can serve as an educational tool for training spine surgeons.Conclusions: The new fluoroscopy-based system can be used safely for accurate performance of anterior resection during spondylodesis. New methods for safe and accurate registration during anterior spine surgery need to be developed.

Robust visual tracking of multiple surgical instruments for laparoscopic surgery

In order to use pre-operative images during an intervention for navigation, they must be registered to the patient's co-ordinate system in the operating theatre or to an intra-operative image. For the registration to be valid in the case of patient movements, the registration must be updated or the patient movement must be tracked. One problem in this area is the registration of intra-operatively acquired X-ray fluoroscopies with 3D CT images obtained before the intervention as well as motion tracking for this setup. The result can be used to support the placement of pedicle screws in spine surgery or aortic endoprostheses in transfemoral endovascular aneurysm management (TEAM). The different approaches to 2D/3D registration are discussed and a novel voxel-based method is presented: using a small part of the CT image covering only the vertebra of interest, pseudo-projections are computed and the resulting vertebra template is compared to the X-ray projection using a new similarity measure which is called pattern intensity. Application, performance and registration accuracy are discussed and demonstrated by application to images of a TEAM procedure and of a spine phantom.

2D/3D registration and motion tracking for surgical interventions

In order to use pre-operative images during an intervention for navigation, they must be registered to the patient's co-ordinate system in the operating theatre or to an intra-operative image. For the registration to be valid in the case of patient movements, the registration must be updated or the patient movement must be tracked. One problem in this area is the registration of intra-operatively acquired X-ray fluoroscopies with 3D CT images obtained before the intervention as well as motion tracking for this setup. The result can be used to support the placement of pedicle screws in spine surgery or aortic endoprostheses in transfemoral endovascular aneurysm management (TEAM). The different approaches to 2D/3D registration are discussed and a novel voxel-based method is presented: using a small part of the CT image covering only the vertebra of interest, pseudo-projections are computed and the resulting vertebra template is compared to the X-ray projection using a new similarity measure which is called pattern intensity. Application, performance and registration accuracy are discussed and demonstrated by application to images of a TEAM procedure and of a spine phantom.