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Translating Live EPID based Inspiration Level Assessment (LEILA) into clinical practice
Jose A Baeza-Ortega1, Natalie Kong2, Jane Ludbrook3
1School of Information and Physical Sciences, University of Newcastle, Newcastle, Australia.
Summary
The LEILA system enhances deep inspiration breath hold (DIBH) breast radiotherapy by using electronic portal imaging device (EPID) images for real-time internal anatomy monitoring. This clinic-ready application improves accuracy and reproducibility with minimal workload.
Area of Science:
- Medical Physics
- Radiation Oncology
- Image-Guided Therapy
Background:
- Deep inspiration breath hold (DIBH) is crucial for minimizing patient motion and reducing radiation exposure to organs at risk during breast radiotherapy.
- Effective DIBH relies on consistent patient breathing patterns, typically monitored using external surrogates.
- Real-time verification of internal anatomy during DIBH is essential for accurate treatment delivery.
Purpose of the Study:
- To describe the development and implementation of the LEILA system, a real-time verification tool for DIBH breast radiotherapy.
- To utilize electronic portal imaging device (EPID) images for monitoring internal anatomy during DIBH.
- To establish LEILA as a clinic-ready application for enhanced DIBH accuracy and reproducibility.
Main Methods:
- The LEILA system employs a fluence model to predict EPID images during treatment planning, estimating lung depths (LDs) and skin distances (SDs).
- During treatment, EPID images are acquired, and differences in LDs and SDs are quantified in real-time.
- A pilot study validated the LEILA system's feasibility by monitoring DIBH alongside the existing motion management strategy.
Main Results:
- The LEILA system was successfully deployed on Varian TrueBeam linear accelerators with aS1200 EPIDs, demonstrating low latency (average image processing time of 74.0 ms).
- Analysis of 17 monitored beams showed average differences in mid-lung depths and skin distances of -1.2 mm ± 3.1 mm and 1.5 mm ± 4.1 mm, respectively.
- The system effectively quantifies deviations in internal anatomy during DIBH.
Conclusions:
- The LEILA system offers a streamlined, automated workflow that meets clinical needs with minimal additional workload for healthcare professionals.
- LEILA accurately assesses the accuracy and reproducibility of DIBH, providing immediate feedback on deviations.
- The system offers retrospective insights that can be used to refine DIBH monitoring strategies for improved patient outcomes.
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