Uncertainty In Target Localization Research Articles

In-vivo quality assurance of dynamic tumor tracking (DTT) for liver SABR using EPID images.

To assess dynamic tumor tracking (DTT) target localization uncertainty for in-vivo marker-based stereotactic ablative radiotherapy (SABR) treatments of the liver using electronic-portal-imaging-device (EPID) images. The Planning Target Volume (PTV) margin contribution for DTT is estimated. Phantom and patient EPID images were acquired during non-coplanar 3DCRT-DTT delivered on a Vero4DRT linac. A chain-code algorithm was applied to detect Multileaf Collimator (MLC)-defined radiation field edges. Gold-seed markers were detected using a connected neighbor algorithm. For each EPID image, the absolute differences between the measured center-of-mass (COM) of the markers relative to the aperture-center (Tracking Error, (ET )) was reported in pan, tilt, and 2D-vector directions at the isocenter-plane. An acrylic cube phantom implanted with gold-seed markers was irradiated with non-coplanar 3DCRT-DTT beams and EPID images collected. Patient Study: Eight liver SABR patients were treated with non-coplanar 3DCRT-DTT beams. All patients had three to four implanted gold-markers. In-vivo EPID images were analyzed. Phantom Study: On the 125 EPID images collected, 100% of the markers were identified. The average±SD of ET were 0.24±0.21, 0.47±0.38, and 0.58±0.37mm in pan, tilt and 2D directions, respectively. Patient Study: Of the 1430 EPID patient images acquired, 78% had detectable markers. Over all patients, the average±SD of ET was 0.33±0.41mm in pan, 0.63±0.75mm in tilt and 0.77±0.80mm in 2D directions The random 2D-error, σ, for all patients was 0.79mm and the systematic 2D-error, Σ, was 0.20mm. Using the Van Herk margin formula 1.1mm planning target margin can represent the marker based DTT uncertainty. Marker-based DTT uncertainty can be evaluated in-vivo on a field-by-field basis using EPID images. This information can contribute to PTV margin calculations for DTT.

PO-1694 Target localization uncertainty in Gamma Knife SRS: Comparison of three frame-based workflows

PO-1694 Target localization uncertainty in Gamma Knife SRS: Comparison of three frame-based workflows

Stronger saccadic suppression of displacement and blanking effect in children.

Humans do not notice small displacements to objects that occur during saccades, termed saccadic suppression of displacement (SSD), and this effect is reduced when a blank is introduced between the pre- and postsaccadic stimulus (Bridgeman, Hendry, & Stark, 1975; Deubel, Schneider, & Bridgeman, 1996). While these effects have been studied extensively in adults, it is unclear how these phenomena are characterized in children. A potentially related mechanism, saccadic suppression of contrast sensitivity—a prerequisite to achieve a stable percept—is stronger for children (Bruno, Brambati, Perani, & Morrone, 2006). However, the evidence for how transsaccadic stimulus displacements may be suppressed or integrated is mixed. While they can integrate basic visual feature information from an early age, they cannot integrate multisensory information (Gori, Viva, Sandini, & Burr, 2008; Nardini, Jones, Bedford, & Braddick, 2008), suggesting a failure in the ability to integrate more complex sensory information. We tested children 7 to 12 years old and adults 19 to 23 years old on their ability to perceive intrasaccadic stimulus displacements, with and without a postsaccadic blank. Results showed that children had stronger SSD than adults and a larger blanking effect. Children also had larger undershoots and more variability in their initial saccade endpoints, indicating greater intrinsic uncertainty, and they were faster in executing corrective saccades to account for these errors. Together, these results suggest that children may have a greater internal expectation or prediction of saccade error than adults; thus, the stronger SSD in children may be due to higher intrinsic uncertainty in target localization or saccade execution.

Assessment of sequence dependent geometric distortion in contrast-enhanced MR images employed in stereotactic radiosurgery treatment planning

This work focuses on MR-related sequence dependent geometric distortions, which are associated with B0 inhomogeneity and patient-induced distortion (susceptibility differences and chemical shift effects), in MR images used in stereotactic radiosurgery (SRS) applications. Emphasis is put on characterizing distortion at target brain areas identified by gadolinium diethylenetriamine pentaacetic acid (Gd-DTPA) paramagnetic contrast agent uptake.A custom-made phantom for distortion detection was modified to accommodate two small cylindrical inserts, simulating small brain targets. The inserts were filled with Gd-DTPA solutions of various concentrations (0–20 mM). The phantom was scanned at 1.5 T unit using both the reversed read gradient polarity (to determine the overall distortion as reflected by the inserts centroid offset) and the field mapping (to determine B0 inhomogeneity related distortion in the vicinity of the inserts) techniques. Post-Gd patient images involving a total of 10 brain metastases/targets were also studied using a similar methodology.For the specific imaging conditions, contrast agent presence was found to evidently affect phantom insert position, with centroid offset extending up to 0.068 mm mM−1 (0.208 ppm mM−1). The Gd-DTPA induced distortion in patient images was of the order of 0.5 mm for the MRI protocol used, in agreement with the phantom results. Total localization uncertainty of metastases-targets in patient images ranged from 0.35 mm to 0.87 mm, depending on target location, with an average value of 0.54 mm (2.24 ppm). This relative wide range of target localization uncertainty results from the fact that the B0 inhomogeneity distortion vector in a specific location may add to or partly counterbalance Gd-DTPA induced distortion, thus increasing or decreasing, respectively, the total sequence dependent distortion.Although relatively small, the sequence dependent distortion in Gd-DTPA enhanced brain images can be easily taken into account for SRS treatment planning and target definition purposes by carefully inspecting both the forward and reversed polarity series.

Uncertainty evaluation of distributed Large-Scale-Metrology systems by a Monte Carlo approach

Distributed systems for Large-Scale-Metrology applications generally include a set of angular and/or distance sensors, distributed around the measurement volume, and some targets to be localized, in contact with the measured object's surface. For these systems, estimating the uncertainty in target localization is far from trivial, as it may be affected by several factors: uncertainty in sensor calibration and angular/distance measurements, relative position between targets and sensors, etc. This paper proposes a novel approach based on the combined use of the Multivariate Law of Propagation of Uncertainty and Monte Carlo method. Preliminary results and experimental tests are presented and discussed.

Averaging is not everything: The saccade global effect weakens with increasing stimulus size

When two elements are presented closely aligned, the average saccade endpoint will generally be located in between these two elements. This ‘global effect’ has been explained in terms of the center of gravity account which states that the saccade endpoint is based on the relative saliency of the different elements in the visual display. In the current study, we tested one of the implications of the center of gravity account: when two elements are presented closely aligned with the same size and the same distance from central fixation, the saccade should land on the intermediate location, irrespective of the stimulus size. To this end, two equally-sized elements were presented simultaneously and participants were required to execute an eye movement to the visual information presented on the display. Results showed that the strongest global effect was observed in the condition with smaller stimuli, whereas the saccade averaging was weaker when larger stimuli were presented. In a second experiment, in which only one element was presented, we observed that the width of the distribution of saccade endpoints is influenced by stimulus size in that the distribution is broader with smaller stimuli. We conclude that perfect saccade averaging is not always the default response by the oculomotor system. There appears to be a tendency to initiate an eye movement towards one of the visual elements, which becomes stronger with increasing stimulus size. This effect might be explained by an increased uncertainty in target localization for smaller stimuli, resulting in a higher probability of the merging of two stimulus representations into one representation.

Metabolic and Anatomic Tumor Volume Measurements using Four-dimensional (4D) PET-CT for Mobile Tumors in the Thorax and Abdomen

In the era of image-guided radiation therapy, uncertainty in target localization and configuration as seen on CT and PET scans can contribute greatly to uncertainty in treatment planning and delivery. In this study we utilized 4D PET-CT to compare two types of metabolic (PET) volume measurements with anatomic (CT) volume measurements in tumors of the thorax and abdomen subject to respiratory motion.

Combined kV and MV imaging for real‐time tracking of implanted fiducial markersa)

In the presence of intrafraction organ motion, target localization uncertainty can greatly hamper the advantage of highly conformal dose techniques such as intensity modulated radiation therapy (IMRT). To minimize the adverse dosimetric effect caused by tumor motion, a real-time knowledge of the tumor position is required throughout the beam delivery process. The recent integration of onboard kV diagnostic imaging together with MV electronic portal imaging devices on linear accelerators can allow for real-time three-dimensional (3D) tumor position monitoring during a treatment delivery. The aim of this study is to demonstrate a near real-time 3D internal fiducial tracking system based on the combined use of kV and MV imaging. A commercially available radiotherapy system equipped with both kV and MV imaging systems was used in this work. A hardware video frame grabber was used to capture both kV and MV video streams simultaneously through independent video channels at 30 frames per second. The fiducial locations were extracted from the kV and MV images using a software tool. The geometric tracking capabilities of the system were evaluated using a pelvic phantom with embedded fiducials placed on a moveable stage. The maximum tracking speed of the kV/MV system is approximately 9 Hz, which is primarily limited by the frame rate of the MV imager. The geometric accuracy of the system is found to be on the order of less than 1 mm in all three spatial dimensions. The technique requires minimal hardware modification and is potentially useful for image-guided radiation therapy systems.

The Sources of Variability in Saccadic Eye Movements

Our movements are variable, but the origin of this variability is poorly understood. We examined the sources of variability in human saccadic eye movements. In two experiments, we measured the spatiotemporal variability in saccade trajectories as a function of movement direction and amplitude. One of our new observations is that the variability in movement direction is smaller for purely horizontal and vertical saccades than for saccades in oblique directions. We also found that saccade amplitude, duration, and peak velocity are all correlated with one another. To determine the origin of the observed variability, we estimated the noise in motor commands from the observed spatiotemporal variability, while taking into account the variability resulting from uncertainty in localization of the target. This analysis revealed that uncertainty in target localization is the major source of variability in saccade endpoints, whereas noise in the magnitude of the motor commands explains a slightly smaller fraction. In addition, there is temporal variability such that saccades with a longer than average duration have a smaller than average peak velocity. This noise model has a large generality because it correctly predicts the variability in other data sets, which contain saccades starting from very different initial locations. Because the temporal noise most likely originates in movement planning, and the motor command noise in movement execution, we conclude that uncertainty in sensory signals and noise in movement planning and execution all contribute to the variability in saccade trajectories. These results are important for understanding how the brain controls movement.

Unifying multisensory signals across time and space.

The brain integrates information from multiple sensory modalities and, through this process, generates a coherent and apparently seamless percept of the external world. Although multisensory integration typically binds information that is derived from the same event, when multisensory cues are somewhat discordant they can result in illusory percepts such as the "ventriloquism effect." These biases in stimulus localization are generally accompanied by the perceptual unification of the two stimuli. In the current study, we sought to further elucidate the relationship between localization biases, perceptual unification and measures of a participant's uncertainty in target localization (i.e., variability). Participants performed an auditory localization task in which they were also asked to report on whether they perceived the auditory and visual stimuli to be perceptually unified. The auditory and visual stimuli were delivered at a variety of spatial (0 degrees, 5 degrees, 10 degrees, 15 degrees ) and temporal (200, 500, 800 ms) disparities. Localization bias and reports of perceptual unity occurred even with substantial spatial (i.e., 15 degrees ) and temporal (i.e., 800 ms) disparities. Trial-by-trial comparison of these measures revealed a striking correlation: regardless of their disparity, whenever the auditory and visual stimuli were perceived as unified, they were localized at or very near the light. In contrast, when the stimuli were perceived as not unified, auditory localization was often biased away from the visual stimulus. Furthermore, localization variability was significantly less when the stimuli were perceived as unified. Intriguingly, on non-unity trials such variability increased with decreasing disparity. Together, these results suggest strong and potentially mechanistic links between the multiple facets of multisensory integration that contribute to our perceptual Gestalt.

Ultrasound-Guided Optical Tomographic Imaging of Malignant and Benign Breast Lesions: Initial Clinical Results of 19 Cases

The diagnosis of solid benign and malignant tumors presents a unique challenge to all noninvasive imaging modalities. Ultrasound is used in conjunction with mammography to differentiate simple cysts from solid lesions. However, the overlapping appearances of benign and malignant lesions make ultrasound less useful in differentiating solid lesions, resulting in a large number of benign biopsies. Optical tomography using near-infrared diffused light has great potential for imaging functional parameters of 1) tumor hemoglobin concentration, 2) oxygen saturation, 3) metabolism, as well as other tumor distinguishing characteristics. These parameters can differentiate benign from malignant lesions. However, optical tomography, when used alone, suffers from low spatial resolution and target localization uncertainty due to intensive light scattering. Our aim is to combine diffused light imaging with ultrasound in a novel way for the detection and diagnosis of solid lesions. Initial findings of two earlystage invasive carcinomas, one combined fibroadenoma and fibrocystic change with scattered foci of lobular neoplasia/lobular carcinoma in situ, 16 benign lesions are reported in this paper. The invasive cancer cases reveal about two-fold greater total hemoglobin concentration (mean 119 μmol) than benign cases (mean 67 μmol), suggest that the discrimination of benign and malignant breast lesions might be enhanced by this type of achievable optical quantification with ultrasound localization. Furthermore, the small invasive cancers are well localized and have wavelength-dependent appearance in optical absorption maps, whereas the benign lesions appear diffused and relatively wavelength-independent.

Required treatment margin for coronary endovascular brachytherapy with iridium-192 seed ribbon

Purpose: Preliminary clinical trials (SCRIPPS I, WRIST and Gamma 1) employing catheter-based endovascular brachytherapy (EVBT) with iridium-192 (Ir-192) seeds show promising results in reducing restenosis after coronary intervention. Failure analysis of these studies showed a significant number of restenosis at the treatment margin called “edge effect.” The objective of this study is to investigate the factors that contribute to the adequacy of treatment margin. Methods and materials: The factors contributing to the margins are penumbra effect at the end of the seed train, uncertainty in target localization, longitudinal seed movement during cardiac cycle and barotrauma due to stent deployment. The magnitudes of the penumbra effect, which refers to the tapering off the prescribed isodose line near the ends of the source train, were calculated for various source lengths of Ir-192 seed ribbon using AAPM TG-43 algorithm. Uncertainty in target localization refers to the fact that the visual estimation of proximal and distal extent of the injury is not accurate, and this can be obtained by comparing the “estimate” from the interventional cardiologist with careful review of the cine-angiogram. Longitudinal seed movements relative to the coronary vessel during the cardiac cycle were determined by frame-by-frame reviewing cine-angiograms of 30 patients. The proximal and distal source points were measured in reference to branching vessels during the contrast phase of the cine-angiogram. The maximum proximal and distal longitudinal movement was captured and source displacement was measured from the closest proximal and distal branching vessel. Barotrauma, additional injury to the vessel arising from the stent deployment balloon, was obtained by reviewing specifications from commercially available stent delivery systems. Results: The penumbra effect ranges from 3.9 to 4.5 mm for 6–22 Ir-192 seed ribbons. The uncertainty in target localization is within 3 mm for our interventional cardiologists. The results of seed movements were categorized by three major coronary vessels and by proximal versus distal ends. The mean and standard deviation of seed movement are 1.1 and 0.8 mm, respectively. The average length of barotrauma beyond the stent margins for reviewed stents was 1.7 mm, ranging from 0.5 to 2.5 mm. Conclusion: A minimum of 8-mm treatment margin is recommended for coronary vascular brachytherapy with Ir-192 seed ribbon. This was derived by considering the above contributing factors. Excessive margins should be avoided due to possible increase risk of late effect. By providing adequate treatment margins, one can avoid geographic miss; hence, one can further improve the effect of EVBT in reducing restenosis.

How long is enough? Defining the treatment length in endovascular brachytherapy.

The International Commission on Radiation Units and Measurement (IRCU) 50 has clearly defined treatment volumes in radiation therapy in the management of neoplasms. These concepts are applied to the field of endovascular brachytherapy (EVBT) for the prevention of postangioplasty restenosis. The following definitions are proposed: gross target length (GTL) is defined as the narrowed segment of the artery that requires intervention. Clinical target length (CTL) is defined as the intervened or injured length, which could be due to angioplasty, stent strut injury, stent deployment, or debulking procedures. Planning target length (PTL) is the CTL plus a margin to account for heart/catheter movement and uncertainty in target localization. The final treatment length (TL) is the PTL plus the effect of penumbra. The accurate specification of treatment length serves several important purposes. Based on an understanding of the different factors constituting the treatment length, adequate margins can be provided beyond the GTL; this will avoid geographic misses and minimize edge failures. These definitions of target length ensure treatment consistency and provide a standard terminology for communication among practitioners of EVBT, something of critical importance in the conduct of multi-institutional trials in this new and multidisciplinary therapy. Finally, since the efficacy of EVBT is critically dependent on the precision of radiation delivery, these guidelines ensure that the benefits of EVBT seen in prospective randomized trials can be translated into daily clinical practice at the community level.