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Computed Tomography-guided Time-domain Diffuse Fluorescence Tomography in Small Animals for Localization of Cancer Biomarkers
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Daily image-guided localization for neuroblastoma.

Chris Beltran1, Atmaram S Pai Panandiker, Matthew J Krasin

  • 1Department of Radiological Sciences, St. Jude Children's Research Hospital, Memphis, TN, USA. chris.beltran@stjude.org

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Summary

Daily cone beam CT (CBCT) imaging significantly reduces setup margins for pediatric neuroblastoma patients, minimizing radiation exposure to healthy tissues. Ultrasound localization proved unreliable for this application.

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Area of Science:

  • Radiation Oncology
  • Medical Imaging
  • Pediatric Oncology

Background:

  • Accurate patient positioning is crucial for effective radiation therapy, especially in pediatric oncology.
  • Neuroblastoma treatment often requires precise targeting to minimize dose to sensitive organs.
  • Traditional setup margins may lead to excessive radiation exposure in young patients.

Purpose of the Study:

  • To quantify the necessary setup margins for pediatric neuroblastoma patients undergoing radiation therapy.
  • To evaluate the efficacy of cone beam CT (CBCT) and ultrasound for daily patient localization.
  • To determine if daily CBCT imaging can reduce setup margins and associated normal tissue dose.

Main Methods:

  • Ten pediatric neuroblastoma patients underwent daily pretreatment CBCT and every-other-day post-treatment CBCT for interfractional and intrafraction movement analysis.
  • Localization was performed using CBCT-to-CT registration in the lumbar spine region.
  • Ultrasound localization of kidneys was performed in four patients for comparison with CBCT shifts.

Main Results:

  • Without daily CBCT, setup margins of 5.4 mm (lateral), 5.6 mm (longitudinal), and 5.9 mm (vertical) were required.
  • Incorporating daily CBCT reduced these margins to 1.5 mm (lateral), 2.1 mm (longitudinal), and 1.7 mm (vertical).
  • Ultrasound localization shifts showed no correlation with CBCT-derived shifts, indicating high variability.

Conclusions:

  • Daily CBCT-based localization of the lumbar spine effectively reduces setup margins for pediatric neuroblastoma patients.
  • Reduced margins decrease radiation exposure to normal tissues in this vulnerable population.
  • Further investigation into internal margins is needed before planning target volume (PTV) reduction.