Orthogonal ray imaging: from dose monitoring in external beam therapy to low-dose morphologic imaging with scanned megavoltage X-rays

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1 ray imaging: from dose monitoring in external beam therapy to low-dose morphologic imaging with scanned megavoltage X-rays Hugo Simões, Miguel Capela, Ana Cavaco, Paulo Fonte, Maria do Carmo Lopes, Paulo J. B. M. Rachinhas, Paula Soares, Paulo C. P. S. Simões, Paulo Crespo LIP, IPOCFG, E.P.E., CHUC, E.P.E., UC PRS2013: PROTECÇÃO RADIOLÓGICA NA SAÚDE 2013 LISBON, PORTUGAL September 18, 2013

2 1 2 Dose monitoring in external beam therapy with head lung with a PMMA phantom 3 Low-dose morphologic imaging with lung with a PMMA phantom 4 Conclusions and 5 Sep. 18, 2013 PRS2013: PROTECÇÃO RADIOLÓGICA NA SAÚDE 2013 H. Simões et al. 2 / 15

3 Need for image guided radiotherapy (IGRT) and adaptive radiotherapy (ART) External beam radiation therapy (RT) is the use of radiation aiming at the treatment of tumors (curative intent) or at the reduction of cancer disease (palliative intent) Modern RT allows for increasingly higher conformality Such conformality aims at maximizing radiation dose in the tumor and minimizing side effects in healthy tissue Patient mispositioning (between treatment fractions) and anatomical and/or morphologic changes (e.g cardiorespiratory and bowel movements, tumor or healthy tissue shrinkage/swelling) can compromise such conformality Sep. 18, 2013 PRS2013: PROTECÇÃO RADIOLÓGICA NA SAÚDE 2013 H. Simões et al. 3 / 15

4 Need for image guided radiotherapy (IGRT) and adaptive radiotherapy (ART) Patient morphologic alterations/mispositionings in RT Engelsman and Bert 2011 Lüchtenborg PhD 2012 High conformality requires high precision and accuracy. Hence, RT monitoring techniques are highly desirable Sep. 18, 2013 PRS2013: PROTECÇÃO RADIOLÓGICA NA SAÚDE 2013 H. Simões et al. 4 / 15

5 head lung 2. Dose monitoring in external beam therapy with 2.1 Detection of photons at approximately right angles Determination of positional deviations from the planning Real-time dose monitoring Allows for potential intervention whenever needed (ART), without additional dosage to the patient Cunha et al, IEEE TNS, 2013 Simões et al IEEE TNS, 2013 Battaglia et al, IEEE NSS & MIC, 2012 Sep. 18, 2013 PRS2013: PROTECÇÃO RADIOLÓGICA NA SAÚDE 2013 H. Simões et al. 5 / 15

6 2. Dose monitoring in external beam therapy with 2.2 head PRELIMINARY head lung RTMON IMAGE Morphologic change detectable with imaging Sep. 18, 2013 PRS2013: PROTECÇÃO RADIOLÓGICA NA SAÚDE 2013 H. Simões et al. 6 / 15

7 head lung 2. Dose monitoring in external beam therapy with 3.3 lung PLANNED SHIFTED PRELIMINARY CT IMAGE DOSE DISTRIBUTION RTMON IMAGE SHRINKED Sep. 18, 2013 PRS2013: PROTECÇÃO RADIOLÓGICA NA SAÚDE 2013 H. Simões et al. 7 / 15

8 2. Dose monitoring in external beam therapy with 2.4 with a PMMA phantom Setup implemented at IPOCFG, E.P.E. (IPO-Coimbra) head lung Linux-based remote and local DAQ (data Acquisition) Temperature monitor Single-pixel collimator Heterogeneous phantom Linac head Linac head Shielding Beam Phantom Detector Scintillator Collimator Air cavity z x Sep. 18, 2013 PRS2013: PROTECÇÃO RADIOLÓGICA NA SAÚDE 2013 H. Simões et al. 8 / 15

9 head lung 2. Dose monitoring in external beam therapy with 2.4 with a PMMA phantom Good visual correlation between measured data and simulated dose profile Simões et al, IEEE TNS, 2013 Sep. 18, 2013 PRS2013: PROTECÇÃO RADIOLÓGICA NA SAÚDE 2013 H. Simões et al. 9 / 15

10 Simulated: lung 3. Low-dose morphologic imaging with 3.1 3D imaging: a pencil-like photon beam traverses the patient at known coordinates (X, Y); the detector slice hit by an emerging photon yields the Z coordinate Scan area can be limited to the tumor only: organs at risk with minimal to null dose exposure Allows for targeted on-board imaging with low dose Simões et al, IEEE NSS & MIC, 2012 Battaglia et al, IEEE NSS & MIC, 2012 Sep. 18, 2013 PRS2013: PROTECÇÃO RADIOLÓGICA NA SAÚDE 2013 H. Simões et al. 10 / 15 U. C. PATENT PENDING

11 Simulated: lung 3. Low-dose morphologic imaging with 3.2 lung PLANNED PRELIMINARY CT IMAGE DOSE DISTRIBUTION ORTHOCT IMAGE SHRINKED SHIFTED Sep. 18, 2013 PRS2013: PROTECÇÃO RADIOLÓGICA NA SAÚDE 2013 H. Simões et al. 11 / 15

12 Simulated: lung 3. Low-dose morphologic imaging with 3.3 with a PMMA phantom Good visual correlation between measured data and simulated dose profile ZOOM IN CENTRAL AIR CAVITY A 2-mm deviation is clearly distinguishable Simões et al, IEEE NSS & MIC, 2012 Sep. 18, 2013 PRS2013: PROTECÇÃO RADIOLÓGICA NA SAÚDE 2013 H. Simões et al. 12 / 15

13 4. Conclusions and Conclusions: images show high visual correlation with the prescribed dose and with patient structures, representing a high potential asset for image-guided RT, ART, and in-vivo dose verification. Scanned shows high visual correlation with (1) phantom anatomic structures and (2) tumor in lung region even at low doses. The experimental results are promising; a good correlation between the experimental profile and the simulated dose has been obtained. Working only with experimental raw data, a phantom deviation of 2 mm has already been detected. Ongoing work: Investigate the usefulness of orthogonal ray imaging ( & ) techniques to assist other cancer modalities (e.g. prostate, breast). Parameterize and build two small multi-pixel prototypes ( & ) and test them in radiotherapy environment. Sep. 18, 2013 PRS2013: PROTECÇÃO RADIOLÓGICA NA SAÚDE 2013 H. Simões et al. 13 / 15

14 LIP: Prof. Rui Ferreira Marques, MSc. Rui Alves, Eng. Nuno Dias, Joaquim Oliveira, João Silva, former Prof. Miguel Oliveira, Dr. Alberto Blanco, Paulo Martins, Sharif Ghithan, Patrícia Cambraia Lopes, Ricardo Caeiro University of Coimbra Milipeia: Prof. Pedro Vieira Alberto, Luís Pinto, Pedro Almeida DITS: Eng. João Simões, Eng. Marta Costa e Silva, Dr. a Laura Alho, Dr. a Tânia Covas Institute of Oncology of Coimbra (IPOCFG, E.P.E.): Dr. a Brígida Ferreira (on leave from Univ. Aveiro), MSc. Josefina Mateus Institute of Oncology of Porto (IPOPFG, E.P.E.): Prof. João Santos, Dr. Isabel Bravo, Joana Silva, M.D. Helena Pereira University of Seville: Prof. Paco Sánchez Doblado, Prof. Antonio Leal Plaza, Ana Rita Barbeiro, Bianey Palma Alumni: Marco Pinto, Micaela Cunha, Joana Gonçalves, Liliana Sampaio, Ricardo J. Ferreira, Henrique M. Saraiva, Maria Cristina Battaglia Philips Research Europe, Eindhoven: Dr. Pedro Rodrigues, Dr. Andreia Trindade Other: Prof. Vincenzo Bellini (University of Catania and INFN), Dr. Evaristo Cisbani (National Institute of Health - Rome and INFN), Nayara Faria Sep. 18, 2013 PRS2013: PROTECÇÃO RADIOLÓGICA NA SAÚDE 2013 H. Simões et al. 14 / 15

15 Thank you for your attention Sep. 18, 2013 PRS2013: PROTECÇÃO RADIOLÓGICA NA SAÚDE 2013 H. Simões et al. 15 / 15

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