Dose-guided patient positioning in proton radiotherapy using multicriteria-optimization

Research output: Contribution to journalResearch articleContributedpeer-review

Contributors

  • Christopher Kurz - , Ludwig Maximilian University of Munich (Author)
  • Philipp Süss - , Fraunhofer Institute for Industrial Mathematics (ITWM) (Author)
  • Carolin Arnsmeyer - , TUD Dresden University of Technology (Author)
  • Jonas Haehnle - , Fraunhofer Institute for Industrial Mathematics (ITWM) (Author)
  • Katrin Teichert - , Fraunhofer Institute for Industrial Mathematics (ITWM) (Author)
  • Guillaume Landry - , Ludwig Maximilian University of Munich (Author)
  • Jan Hofmaier - , Ludwig Maximilian University of Munich (Author)
  • Florian Exner - , TUD Dresden University of Technology (Author)
  • Lucas Hille - , Ludwig Maximilian University of Munich (Author)
  • Florian Kamp - , Ludwig Maximilian University of Munich (Author)
  • Christian Thieke - , Ludwig Maximilian University of Munich (Author)
  • Ute Ganswindt - , Ludwig Maximilian University of Munich (Author)
  • Chiara Valentini - , Department of Radiation Oncology, University Hospital Carl Gustav Carus Dresden, TUD Dresden University of Technology (Author)
  • Tobias Hölscher - , Department of Radiation Oncology, University Hospital Carl Gustav Carus Dresden, TUD Dresden University of Technology (Author)
  • Esther Troost - , National Center for Tumor Diseases (Partners: UKD, MFD, HZDR, DKFZ), Department of Radiation Oncology, TUD Dresden University of Technology, University Hospital Carl Gustav Carus Dresden, German Cancer Research Center (DKFZ), Helmholtz-Zentrum Dresden-Rossendorf (Author)
  • Mechthild Krause - , National Center for Tumor Diseases (Partners: UKD, MFD, HZDR, DKFZ), Department of Radiation Oncology, TUD Dresden University of Technology, University Hospital Carl Gustav Carus Dresden, German Cancer Research Center (DKFZ), Helmholtz-Zentrum Dresden-Rossendorf (Author)
  • Claus Belka - , Ludwig Maximilian University of Munich, German Cancer Research Center (DKFZ) (Author)
  • Karl Heinz Küfer - , Fraunhofer Institute for Industrial Mathematics (ITWM) (Author)
  • Katia Parodi - , Ludwig Maximilian University of Munich (Author)
  • Christian Richter - , German Cancer Consortium (Partner: DKTK, DKFZ), OncoRay ZIC - National Center for Radiation Research in Oncology (Partners: UKD, HZDR), Department of Radiation Oncology, TUD Dresden University of Technology, University Hospital Carl Gustav Carus Dresden, Helmholtz-Zentrum Dresden-Rossendorf (Author)

Abstract

Proton radiotherapy (PT) requires accurate target alignment before each treatment fraction, ideally utilizing 3D in-room X-ray computed tomography (CT) imaging. Typically, the optimal patient position is determined based on anatomical landmarks or implanted markers. In the presence of non-rigid anatomical changes, however, the planning scenario cannot be exactly reproduced and positioning should rather aim at finding the optimal position in terms of the actually applied dose. In this work, dose-guided patient alignment, implemented as multicriterial optimization (MCO) problem, was investigated in the scope of intensity-modulated and double-scattered PT (IMPT and DSPT) for the first time. A method for automatically determining the optimal patient position with respect to pre-defined clinical goals was implemented. Linear dose interpolation was used to access a continuous space of potential patient shifts. Fourteen head and neck (H&N) and eight prostate cancer patients with up to five repeated CTs were included. Dose interpolation accuracy was evaluated and the potential dosimetric advantages of dose-guided over bony-anatomy-based patient alignment investigated by comparison of clinically relevant target and organ-at-risk (OAR) dose-volume histogram (DVH) parameters. Dose interpolation was found sufficiently accurate with average pass-rates of 90% and 99% for an exemplary H&N and prostate patient, respectively, using a 2% dose-difference criterion. Compared to bony-anatomy-based alignment, the main impact of automated MCO-based dose-guided positioning was a reduced dose to the serial OARs (spinal cord and brain stem) for the H&N cohort. For the prostate cohort, under-dosage of the target structures could be efficiently diminished. Limitations of dose-guided positioning were mainly found in reducing target over-dosage due to weight loss for H&N patients, which might require adaptation of the treatment plan. Since labor-intense online quality-assurance is not required for dose-guided patient positioning, it might, nevertheless, be considered an interesting alternative to full online re-planning for initially mitigating the effects of anatomical changes.

Details

Original languageEnglish
Pages (from-to)216-228
Number of pages13
JournalZeitschrift fur Medizinische Physik
Volume29
Issue number3
Publication statusPublished - Aug 2019
Peer-reviewedYes

External IDs

PubMed 30409729
ORCID /0000-0003-4261-4214/work/147143124

Keywords

Sustainable Development Goals

Keywords

  • Dose-guided patient positioning, Head and neck cancer, Prostate cancer, Proton therapy