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Dynamic Lung Tumor Tracking for Stereotactic Ablative Body Radiation Therapy

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Effect of audio instruction on tracking errors using a four-dimensional image-guided radiotherapy system.

Mitsuhiro Nakamura¹, Akira Sawada, Nobutaka Mukumoto

¹Kyoto University. m_nkmr@kuhp.kyoto-u.ac.jp.

Journal of Applied Clinical Medical Physics

|September 17, 2013

Summary

Audio instruction did not reduce X-ray Tracking errors in lung cancer patients, despite improving breathing regularity. Increased respiratory velocity, not irregularity, was linked to higher tracking errors.

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Area of Science:

Medical Physics
Radiotherapy Technology
Image-Guided Interventions

Background:

X-ray image-based tracking (X-ray Tracking) is crucial for real-time target localization in radiotherapy.
Previous studies indicated that irregular respiratory patterns can increase X-ray Tracking errors.
Audio instruction is hypothesized to improve respiratory periodicity and potentially reduce tracking errors.

Purpose of the Study:

To evaluate the impact of audio instruction on X-ray Tracking errors during continuous kV X-ray imaging.
To determine if improved breathing regularity from audio cues translates to reduced tracking inaccuracies.

Main Methods:

Utilized the Vero4DRT (MHI-TM2000) system for X-ray Tracking with a steel ball target.
Employed anterior-posterior abdominal skin-surface displacements from ten lung cancer patients as surrogates for tumor motion.
Developed a sequential predictive model using the Levinson-Durbin algorithm to estimate future 3D target positions.
Compared total tracking system errors (ET) between free breathing and audio instruction conditions.

Main Results:

Audio instruction significantly improved breathing regularity (p < 0.01).
The mean 95th percentile of tracking errors (E95T) was 1.7 ± 0.5 mm under free breathing and 1.9 ± 0.5 mm under audio instruction.
No significant difference was found in tracking errors between the two conditions (p = 0.21).
Rapid respiratory velocity, not irregularity, was identified as a significant factor increasing tracking errors.

Conclusions:

Audio instruction, while enhancing breathing regularity, did not lead to a reduction in X-ray Tracking errors.
Increased respiratory velocity associated with audio cues may counteract the benefits of improved regularity.
Further research is needed to optimize respiratory guidance techniques for minimizing X-ray Tracking errors.