4D Analysis in Radiation Oncology: The Implications for Adaptive Lung Cancer Therapy Checkpoint

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4D Analysis in Radiation Oncology The
Implications for Adaptive Lung Cancer
Therapy Checkpoint

• Project Leader Ashkon Shaahinfar
• Mentors Dr. Eric Ford Dr. Todd McNutt

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Today Radiation Therapy

• General practice of using free-breathing planning
  CT (breath-hold used at JHMI)
• Therapy is based on day 0 CT throughout treatment

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Future Adaptive Radiation Therapy

• Advantages
• Improved geometric coverage of tumor via repeated
  CT and breath-hold CT
• Subsequent ability to ? volume of dose and ?
  integral dose to tumor
• Implications
• TODAY 2-year local control for NSCLC
• Stage 1 and 2 ? 50 Stage 3 ? 20
• Potential for Improvement
• Stage 1 and 2 ? 82 Stage 3 ? 50

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Goals

• Conduct a proof of concept study with Pinnacle
  treatment planning software and existing patient
  data.
• Show quantitatively that breath-hold CT is
  preferable to the free-breathing method
• Show quantitatively that repeated CT is
  preferable to single CT
• Provide efficient means of conducting analyses

Original, Revised
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Progress 4D-CT Tumor Motion Analysis
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Deliverables Minimum

• Revised
• Learn to use Pinnacle software
• Quantify respiratory motion at day 0. Compare
  with all days n (where data is available). (3
  patients)
• Develop MatLab program for automated motion
  visualization / analysis

• Original
• Learn to use Pinnacle software
• Quantify respiratory motion at day 0. Compare
  with all days n (where data is available). (4-5
  patients)

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Deliverables Expected

• Revised
• Quantify and compare the envelope of 4D volume
  (estimate of free-breathing treatment volume)
  with breath-hold treatment volume. Conduct
  geometric comparison analysis. (3
  patients)
• Quantify evolution of lung tumor volume through
  the course of (30 days) treatment. Conduct
  geometric comparison analysis of treatment plan
  volume and tumor volume. (3 patients)

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Deliverables Maximum

• Revised
• Assess advantages of breath-hold (as compared to
  free-breathing) through dosimetric
  quantifications and comparisons.
• Assess advantages of geometric margin reduction
  and increased geometric accuracy through
  dosimetric quantifications and comparisons.
• Develop Java-based software for 4D viewing
  (respiratory motion animation) of DICOM images
  (removed) ? an expected deliverable of Donalds
  group

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Updated Project Timeline
Original, Revised
Complete Reading List Learn Pinnacle
software 4D-CT, day 0, patient 1 4D-CT, day 0-n,
4 (3) patients Develop MatLab program FB vs. BH
geometric, all patients Repeated CT geometric,
all pts. Dosimetric analyses
3/6/06
3/27/06
4/10/06
3/13/06
4/7/06
4/28/06
5/5/06
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Dependencies
Original, Updated

• Pinnacle software resolved (learned to use
  Pinnacle)
• Radiation Oncology Dept. access I arrive between
  8 am and 5 pm on weekdays
• Access to dedicated computer workstation (for
  storage of results, etc) Pinnacle system
  available second workstation available but
  software still unlicensed (Dr. McNutt will
  license)
• Patient data (repeated CT and 4D CT) data is
  made available on Dr. Fords computer maintain
  contact with Dr. Ford as needed to ensure data is
  placed in a location available to me

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Preliminary Results Excel Centroid Graphs

• Relative Displacement of GTV Centroid through
  Respiratory Phases (Patient 1)

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Preliminary Results pt1rescan1.jpg MatLab
Visualization Software Output
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Preliminary Results MatLab Visualization
Program Complete

• FUNCTION SPECIFICATION
• main(patientNum, scanName), calls --gt
• Data Input
• numPoints getNumPoints(fileName)
• dataAllPhases readVTK(fileName)
• Post-input processing
• dataAllPhases centerData(dataAllPhases),
  calls getCentroid
• Calculation
• centroid getCentroid(dataAllPhases)
• centroid, trajMaxXPoints, trajMinXPoints,
  trajMaxYPoints, trajMinYPionts, trajMaxZPoints,
  trajMinZPoints getTrajectories(dataAllPhases)

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Questions?

• Thank you for your attention.