Precision IORT – Image guided intraoperative radiation therapy (igIORT) using online treatment planning including tissue heterogeneity correction |
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| Institution: | 1. Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Germany;2. Orthopaedic and Trauma Surgery Center, University Medical Center Mannheim, University of Heidelberg, Germany;1. Novosibirsk State Medical University, Novosibirsk, Russian Federation;2. European Medical Center, Moscow, Russian Federation;3. Department of Neurosurgery, Klinik Hirslanden, Zurich, Switzerland;1. Imaging Research Laboratories, Robarts Research Institute, Western University, London, Ontario, Canada;2. Biomedical Engineering Graduate Program, Claudette MacKay-Lassonde Pavilion, Western University, London, Ontario, Canada;3. Department of Radiation Oncology, British Columbia Cancer Agency, Cancer Center for the Southern Interior, Kelowna, British Columbia, Canada;4. Department of Medical Physics, British Columbia Cancer Agency, Cancer Center for the Southern Interior, Kelowna, British Columbia, Canada;6. Department of Physics and Astronomy, Elliot Building, University of Victoria, Victoria, British Columbia, Canada;5. Departments of Medical Biophysics and Medical Imaging, Medical Sciences Building, Western University, London, Ontario, Canada;1. Haaglanden Medical Center, Department of Medical Physics, Leidschendam, The Netherlands;2. Haaglanden Medical Center, Department of Surgery, Leidschendam, The Netherlands;3. Haaglanden Medical Center, Department of Radiotherapy, Leidschendam, The Netherlands;4. Leiden University Medical Center, Department of Radiation Oncology, Leiden, The Netherlands |
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| Abstract: | BackgroundTo the present date, IORT has been eye and hand guided without treatment planning and tissue heterogeneity correction. This limits the precision of the application and the precise documentation of the location and the deposited dose in the tissue. Here we present a set-up where we use image guidance by intraoperative cone beam computed tomography (CBCT) for precise online Monte Carlo treatment planning including tissue heterogeneity correction.Materials and methodsAn IORT was performed during balloon kyphoplasty using a dedicated Needle Applicator. An intraoperative CBCT was registered with a pre-op CT. Treatment planning was performed in Radiance using a hybrid Monte Carlo algorithm simulating dose in homogeneous (MCwater) and heterogeneous medium (MChet). Dose distributions on CBCT and pre-op CT were compared with each other. Spinal cord and the metastasis doses were evaluated.ResultsThe MCwater calculations showed a spherical dose distribution as expected. The minimum target dose for the MChet simulations on pre-op CT was increased by 40% while the maximum spinal cord dose was decreased by 35%. Due to the artefacts on the CBCT the comparison between MChet simulations on CBCT and pre-op CT showed differences up to 50% in dose.ConclusionsigIORT and online treatment planning improves the accuracy of IORT. However, the current set-up is limited by CT artefacts. Fusing an intraoperative CBCT with a pre-op CT allows the combination of an accurate dose calculation with the knowledge of the correct source/applicator position. This method can be also used for pre-operative treatment planning followed by image guided surgery. |
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| Keywords: | Intraoperative radiotherapy Intrabeam Kypho IORT Treatment planning Radiance |
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