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Treatment of Liver Metastases Using an Internal Target Volume Method for Stereotactic Body Radiotherapy

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WE-G-BRCD-08: Virtual Couch Shift (VCS) by Online Plan Re-Optimization for the MRI Linear Accelerator.

G Bol^1,2, S Hissoiny^1,2, J Lagendijk^1,2

¹University Medical Center Utrecht, Utrecht, The Netherlands.

Medical Physics

|May 19, 2017

Summary

This study developed a fast and accurate system for online re-optimization in MRI-guided radiotherapy, enabling "virtual couch shift" (VCS) to adapt treatment plans for patient anatomy changes. The system ensures accurate dose delivery, paving the way for real-time adaptive radiotherapy.

Keywords:

Anatomy Intensity modulated radiation therapy Kidneys Linear accelerators Magnetic fields Magnetic resonance imaging Medical imaging Optimization Sequence analysis Tissues

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Area of Science:

Medical Physics
Radiation Oncology
Image-Guided Therapy

Background:

MRI-guided radiotherapy offers continuous patient anatomy updates, including organ deformation and translation.
Adapting treatment plans based on online MRI images is crucial for accurate dose delivery.
The intensity-modulated radiation therapy (IMRT) optimization system must be fast and robust for daily plan regeneration.

Purpose of the Study:

To develop and validate a fast and accurate system for online re-optimization to perform "virtual couch shift" (VCS) in MRI-guided radiotherapy.
To assess the system's ability to regenerate clinically acceptable IMRT plans after patient anatomy translations.

Main Methods:

Utilized a GPU-based Monte-Carlo dose engine (GPUMCD) and a fast inverse dose optimization algorithm (FIDO).
Regenerated IMRT plans for four phantom and two clinical cases (cervix, kidney) following translations up to 34 mm.
Evaluated plan differences using the gamma criterion (2%/2 mm) and relative D99 target coverage.

Main Results:

The system accurately reproduced initial dose distributions after anatomical translations.
Achieved 99.2% target voxel and 97.2% organs-at-risk (OAR) voxel agreement with the gamma criterion.
Regeneration times were 141 seconds for cervix and 14 seconds for kidney cases.

Conclusions:

A fast and accurate system for VCS via online re-optimization in MRI-guided radiotherapy has been developed.
The system shows potential for compensating patient rotations and tissue deformation, advancing towards real-time adaptive treatment planning and delivery.