ArticleMedical physics2025
Megavoltage intrafraction monitoring and position uncertainty in gimbaled markerless dynamic tumor tracking treatment of lung tumors.
Article in Medical physics, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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2 citing papers in PubMed.
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5 authors.
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Abstract
backgroundThe clinical realization of markerless dynamic tumor tracking (MLDTT) has prompted a new paradigm shift to intrafraction imaging-based quality assurance (QA). During MLDTT treatment using a gimbaled accelerator, the megavoltage (MV) imager serves as an independent system to leverage real-time intrafraction monitoring. Soft-tissue feature tracking has shown promise for tumor localization in confined MV projections, but studies demonstrating its application in clinical MLDTT treatments are scarse. PURPOSE: To validate MV image-based dense soft-tissue feature tracking for intrafraction position monitoring of lung tumors during MLDTT stereotactic body radiotherapy (SBRT), and report on the resolved geometric uncertainty.
methodsTen non-small cell lung cancer (NSCLC) patients underwent MLDTT-SBRT using a commercial gimbal-based system. During treatment, beam's-eye-view (BEV) projection images were captured at ∼3 frames s
resultsMV tracking was successful for 89.7% of (unmodulated) 3DCRT fields, as well as 82.4% of (modulated) control points (CPs) and subfields (SFs) for IMRT and field-in-field 3DCRT deliveries. The MV tracking accuracy was dependent on the traversed anatomy, tumor visibility, and occlusion by the MLC. The mean MV tracking accuracy was 1.2 mm (pan) and 1.4 mm (tilt), and a resultant 2D accuracy of 1.8 mm. The MV tracking performance within 2 mm was observed in 92.1% (pan) and 86.6% (tilt), respectively. The mean aperture-target positional uncertainty smaller than 3 mm/5 mm was observed in 94.4/97.9% (pan) and 89.6/96.7% (tilt) of the time. The group Σ and σ were 0.5 mm/0.8 mm (pan), and 0.7 mm/1.2 mm (tilt), compared to 0.3 mm/0.5 mm (pan), and 0.6 mm/0.9 mm (tilt) based on the manual ground truth.
conclusionMV imaging coupled with the soft-tissue feature tracker algorithm constitutes a valuable non-invasive method for independent intrafraction surveillance. Tracking multiple features has shown the potential to improve position estimation, notwithstanding obstruction, and occlusion challenges, facilitating the quantification of the geometric uncertainty of MLDTT treatment.
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