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Radiological Investigation III: Pulmonary Angiogram and PET Scan01:13

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Radiological investigations are paramount in the diagnosis and management of various pulmonary diseases. Two essential investigations are the Pulmonary Angiogram and the Positron Emission Tomography (PET) Scan.
Pulmonary Angiogram
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Dynamic Lung Tumor Tracking for Stereotactic Ablative Body Radiation Therapy
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Static couch non-coplanar arc selection optimization for lung SBRT treatment planning.

John D Lincoln1, R Lee MacDonald1,2,3, Alasdair Syme1,2,3

  • 1Department of Physics and Atmospheric Science, Dalhousie University, Canada.

Physics in Medicine and Biology
|June 27, 2023
PubMed
Summary

This study introduces a novel arc trajectory optimization algorithm for lung SBRT, significantly reducing radiation dose to organs-at-risk (OARs) while maintaining treatment conformity. The method combines beam's eye view (BEV) information with mean arc distance (MAD) for improved planning.

Keywords:
SABRSBRTextra-cranialnon-coplanaroptimizationradiotherapystereotactic

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Area of Science:

  • Radiation Oncology
  • Medical Physics
  • Image-Guided Therapy

Background:

  • Non-coplanar arc geometry optimizations in stereotactic body radiotherapy (SBRT) leverage beam's eye view (BEV) geometric overlap to minimize dose to organs-at-risk (OARs).
  • Mean arc distance (MAD) has been developed as a metric to quantify the spatial sampling of 4π steradians by arc trajectories.

Purpose of the Study:

  • To integrate enhanced BEV overlap information with MAD for generating static couch lung SBRT treatment plans.
  • To develop a novel arc trajectory optimization algorithm for C-arm linear accelerator delivery.

Main Methods:

  • An algorithm using the Moller-Trumbore ray-triangle intersection method computed OAR dose cost, combined with MAD for 100,000 random arc trajectory combinations.
  • A pathfinding algorithm selected final trajectories by balancing MAD and 4π cost contributions.
  • The methodology was evaluated on 18 lung SBRT patients and compared against a clinical treatment template protocol.

Main Results:

  • Maximum dose reductions were observed in five of six OARs, including significant reductions for the esophagus, trachea, spinal cord, large bronchus, and aorta.
  • Mean dose to the contralateral lung was significantly reduced, though mean dose and V5Gy to the ipsilateral lung showed significant increases.
  • Paddick conformity index remained below the 1.2 limit for both techniques, indicating maintained target conformity.

Conclusions:

  • Static couch non-coplanar arc optimization effectively reduces OAR dose in lung SBRT.
  • The developed algorithm successfully balances OAR dose reduction and target conformity for clinical implementation.
  • This approach offers a promising strategy for improving treatment safety in lung SBRT.