• Radiation Oncology Journal
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• v.25 no.1
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• pp.54-61
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• 2007

[ $\underline{Purpose}$ ]: The purpose of this study is to develop a practical method for determining accurate marker positions for prostate cancer radiotherapy using CT images and kV x-ray images obtained from the use of the on- board imager (OBI). $\underline{Materials\;and\;Methods}$: Three gold seed markers were implanted into the reference position inside a prostate gland by a urologist. Multiple digital image processing techniques were used to determine seed marker position and the center-of-mass (COM) technique was employed to determine a representative reference seed marker position. A setup discrepancy can be estimated by comparing a computed $COM_{OBI}$ with the reference $COM_{CT}$. A proposed algorithm was applied to a seed phantom and to four prostate cancer patients with seed implants treated in our clinic. $\underline{Results}$: In the phantom study, the calculated $COM_{CT}$ and $COM_{OBI}$ agreed with $COM_{actual}$ within a millimeter. The algorithm also could localize each seed marker correctly and calculated $COM_{CT}$ and $COM_{OBI}$ for all CT and kV x-ray image sets, respectively. Discrepancies of setup errors between 2D-2D matching results using the OBI application and results using the proposed algorithm were less than one millimeter for each axis. The setup error of each patient was in the range of $0.1{\pm}2.7{\sim}1.8{\pm}6.6\;mm$ in the AP direction, $0.8{\pm}1.6{\sim}2.0{\pm}2.7\;mm$ in the SI direction and $-0.9{\pm}1.5{\sim}2.8{\pm}3.0\;mm$ in the lateral direction, even though the setup error was quite patient dependent. $\underline{Conclusion}$: As it took less than 10 seconds to evaluate a setup discrepancy, it can be helpful to reduce the setup correction time while minimizing subjective factors that may be user dependent. However, the on-line correction process should be integrated into the treatment machine control system for a more reliable procedure.

• Progress in Medical Physics
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• v.18 no.3
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• pp.118-125
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• 2007

In this study we estimated a geometric correlation among digitally reconstructed radiographic image (DRRI), kV x-ray image (kVXI) from the On-Board Imager (OBI) and electric portal image (EPI). To verify geometric correspondence of DRRI, kVXI and EPI, specially designed phantom with indexed 6 ball bearings (BBs) were employed. After accurate setup of the phantom on a treatment couch using orthogonal EPIs, we acquired set of orthogonal kVXIs and EPIs then compared the absolute positions of the center of the BBs calculated at each phantom plane for kVXI and EPI respectively. We also checked matching result for obliquely incident beam (gantry angle of $315^{\circ}$) after 2D-2D matching provided by OBI application. A reference EPI obtained after initial setup of the phantom was compared with 10 series of EPIs acquired after each 2D-2D matching. Imaginary setup errors were generated from -5 mm to 5 mm at each couch motion direction. Calculated positions of all center positions of the BBs at three different images were agreed with the actual points within a millimeter and each other. Calculated center positions of the BBs from the reference and obtained EPIs after 2D-2D matching agreed within a millimeter. We could tentatively conclude that the OBI system was mechanically quite reliable for image guided radiation therapy (IGRT) purpose.

• Progress in Medical Physics
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• v.17 no.2
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• pp.67-76
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• 2006

We evaluated the accuracy of a patient setup error correction due to reference image quality for a 2D-2D matching process. Digitally reconstructed radiographs (DRRs) generated by use of the Pinnacle3 and the Eclipse for various regions of a humanoid phantom and a patient for different CT slice thickness were employed as a reference images and kV X-ray Images from the On-Board Imager were registered to the reference DRRs. In comparison of the DRRs and profiles, DRR image quality was getting worse with an increase of CT image slice thickness. However there were only slight differences of setup errors evaluation between matching results for good and poor reference DRRs. Although DRR image quality did not strongly affect to the 2D-2D matching accuracy, there are still potential errors for matching procedure, therefore we recommend that DRR images are needed to be generated with less than 3mm slice thickness for 2D-2D matching.

• The Journal of Korean Society for Radiation Therapy
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• v.25 no.2
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• pp.123-129
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• 2013

Purpose: The way check the movement of the fiducial marker insertion in the treatment of patients with prostate cancer. However the existing methods of fiducial marker verification process difficult to identify the specific location of the marker behind the femur and pelvic bone. So to study the evaluation of maker match with using kilo voltage (KV) X-ray by On-board imager to both oblique verification method. Materials and Methods: Five patients were selected for rectal ballooning and inserted fiducial marker. Compare the position of the fiducial marker of reference plan 2D/2D Anterior/Posterior verification method and 2D/2D both oblique verification method. So to measurement the shift score of X, Y, Z (axis) and measure exposure dose given to patients and compare matching time. Results: 2 dimensional OBI KV X-ray imaging using two-dimensional matching image are orthogonal, so locating fiducial marker matching clear and useful DRR (digital reconstruction radiography) OBI souce angle ($45^{\circ}/315^{\circ}$) matching most useful. 2D/2D both oblique verification method was able to see clearly marker behind the pelvic bone. Also matching time can be reduced accordingly. According to the method of each matching results for each patient in each treatment fraction, X, Y, and Z axis the Mean $value{\pm}SD$ (standard deviation) is X axis (AP/LAT: $0.4{\pm}1.67$, OBLIQUE: $0.4{\pm}1.82$) mm, Y axis (AP/LAT: $0.7{\pm}1.73$, OBLIQUE: $0.2{\pm}1.77$) mm, Z axis (AP/LAT: $0.8{\pm}1.94$, OBLIQUE:$1.5{\pm}2.8$) mm. In addition, the KV X-ray source dose radiation exposure given to the patient taking average when AP/LAT matching is (0.1/2.1) cGY, when $315^{\circ}/45^{\circ}$ matching is (0.27/0.26) cGY. Conclusion: In conclusion for inserted fiducial marker of prostate cancer patients 2D/2D both oblique matching method is more accurate verification than 2D/2D AP/LAT matching method. Also the matching time less than the 2D/2D AP/LAT matching method. Taken as the amount of radiation exposure to patients less than was possible. Suggest would improve the treatment quality of care patients more useful to establish a protocol such as case.

• The Journal of Korean Society for Radiation Therapy
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• v.24 no.1
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• pp.39-43
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• 2012

Purpose: In hospital image-guided radiation therapy in patients with bladder cancer to enhance the reproducibility of the appropriate amount, depending on the patient's condition, and image-guided injection of saline system (On-Board Imager system, OBI, VARIAN, USA) three of the Cone-Beam CT dimensional matching (3D-3D matching) to be the treatment. In this study, the treatment of patients with bladder cancer at Cone-Beam CT image obtained through the analysis of the bones based matching and matching based on the bladder to learn about the differences, the bladder's volume change injected saline solution by looking at the bladder for the treatment of patients with a more appropriate image matching is to assess how the discussion. Materials and Methods: At our hospital from January 2009 to April 2010 admitted for radiation therapy patients, 7 patients with bladder cancer using a Folly catheter of residual urine in the bladder after removing the amount determined according to individual patient enough to inject saline CT-Sim was designed after the treatment plan. After that, using OBI before treatment to confirm position with Cone-Beam CT scan was physician in charge of matching was performed in all patients. CBCT images using a total of 45 bones, bladder, based on image matching and image matching based on the difference were analyzed. In addition, changes in bladder volume of Eclipse (version 8.0, VARIAN, USA) persuaded through. Results: Bones, one based image matching based on the bladder and re-matching the X axis is the difference between the average $3{\pm}2mm$, Y axis, $1.8{\pm}1.3mm$, Z-axis travel distance is $2.3{\pm}1.7mm$ and the overall $4.8{\pm}2.0mm$, respectively. The volume of the bladder compared to the baseline showed a difference of $4.03{\pm}3.97%$. Conclusion: Anatomical location and nature of the bladder due to internal movement of the bones, even after matching with the image of the bladder occurred in different locations. In addition, the volume of saline-filled bladder showed up the difference between the 4.03 percent, but matched in both images to be included in the planned volumes were able to confirm. Thus, after injection of saline into the bladder base by providing a more accurate image matching will be able to conduct therapy.

• The Journal of Korean Society for Radiation Therapy
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• v.21 no.1
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• pp.33-39
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• 2009

Purpose: The aim of this study is to compare patient's body posture and its position at the time of simulation with one at the treatment room using On-board Imaging (OBI) and CT (CBCT). The detected offsets are compared with position errors of Rando Phantom that are practically applied. After that, Rando Phantom's position is selected by moving couch based on detected deviations. In addition, the errors between real measured values of Rando Phantom position and theoretical ones is compared. And we will evaluate target position's accuracy of KV X-ray imaging's 2D and CBCT's 3D one. Materials and Methods: Using the Rando Phantom (Alderson Research Laboratories Inc. Stanford. CT, USA) which simulated human body's internal structure, we will set up Rando Phantom on the treatment couch after implementing simulation and RTP according to the same ways as the real radioactive treatment. We tested Rando Phantom that are assumed to have accurate position with different 3 methods. We measured setup errors on the axis of X, Y and Z, and got mean standard deviation errors by repeating tests 10 times on each tests. Results: The difference between mean detection error and standard deviation are as follows; lateral 0.4+/-0.3 mm, longitudinal 0.6+/-0.5 mm, vertical 0.4+/-0.2 mm which all within 0~10 mm. The couch shift variable after positioning that are comparable to residual errors are 0.3+/-0.1, 0.5+/-0.1, and 0.3+/-0.1 mm. The mean detection errors by longitudinal shift between 20~40 mm are 0.4+/-0.3 in lateral, 0.6+/-0.5 in longitudinal, 0.5+/-0.3 in vertical direction. The detection errors are all within range of 0.3~0.5 mm. Residual errors are within 0.2~0.5 mm. Each values are mean values based on 3 tests. Conclusion: Phantom is based on treatment couch shift and error within the average 5mm can be gained by the diminution detected by image registration based on OBI and CBCT. Therefore, the selection of target position which depends on OBI and CBCT could be considered as useful.

• The Journal of Korean Society for Radiation Therapy
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• v.22 no.1
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• pp.1-10
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• 2010

Purpose: The effect of artifact was analyzed, which occurs from fiducial marker during the liver Image Guided Radiation Therapy (IGRT) using the fiducial marker. Materials and Methods: The size of artifact of fixed fiducial marker and length of mobile fiducial marker locus were measured using the On-Board Imager system (OBI) and CT simulator, and 2D-2D matching and 3D-3D matching were carried out, respectively, and at this time, the coordinates transition value of couch was analyzed. Results: The measurement of fixed fiducial marker artifact size indicated CT 4.90, 8.10, 12.90, 19.70 mm and OBI 5.60, 10.60, 14.70, 29.40 mm based on the reference CT slice thickness of 1.25, 2.50, 5.00, and 10.00 mm. Meanwhile, the measurement of mobile fiducial marker locus length indicated CT 42.00, 43.10, 46.50 mm, and OBI 43.40, 46.00, 49.30 mm. The coordinates transition of 1.00, 2.00, and 8.00 mm occurred between 2D-2D matching and 3D-3D matching. Conclusion: It was confirmed that the therapy error increased during IGRT due to the influence of artifact when CT slice thickness increased. Thus, it may be desirable to acquire the image less than 2.50 mm in slice thickness when IGRT is implemented using the fiducial marker.

• Journal of radiological science and technology
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• v.40 no.4
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• pp.613-620
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• 2017

Planning dose must be delivered accurately for radiation therapy. Also, It must be needed accurately setup. However, patient positioning images were need for accuracy setup. Then patient positioning images is followed by additional exposure to radiation. For 45 points in the phantom, we measured the doses for 6 MV and 10 MV photon beams, OBI(On Board Imager) and CBCT(Conebeam Computed Tomography) using OSLD(Optically Stimulated Luminescent Dosimeter). We compared the differences in the cases where posture confirmation imaging at each point was added to the treatment dose. Also, we tried to propose a photography cycle that satisfies the 5% recommended by AAPM(The American Association of Physicists in Medicine). As a result, a maximum of 98.6 cGy was obtained at a minimum of 45.27 cGy at the 6 MV, a maximum of 99.66 cGy at a minimum of 53.34 cGy at the 10 MV, a maximum of 2.64 cGy at the minimum of 0.19 cGy for the OBI and a maximum of 17.18 cGy at the minimum of 0.54 cGy for the CBCT.The ratio of the radiation dose to the treatment dose is 3.49% in the case of 2D imaging and the maximum is 22.65% in the case of 3D imaging. Therefore, tolerance of 2D image is 1 exposure per day, and 3D image is 1 exposure per week. And it is need to calculation of separate in the parallelism at additional study.

• Radiation Oncology Journal
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• v.27 no.1
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• pp.42-48
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• 2009

Purpose: The introduction of image guided radiation therapy/four-dimensional radiation therapy (IGRT/4DRT) potentially increases the accumulated dose to patients from imaging and verification processes as compared to conventional practice. It is therefore essential to investigate the level of the imaging dose to patients when IGRT/4DRT devices are installed. The imaging dose level was monitored and was compared with the use of pre-IGRT practice. Materials and Methods: A four-dimensional CT (4DCT) unit (GE, Ultra Light Speed 16), a simulator (Varian Acuity) and Varian IX unit with an on-board imager (OBI) and cone beam CT (CBCT) were installed. The surface doses to a RANDO phantom (The Phantom Laboratory, Salem, NY USA) were measured with the newly installed devices and with pre-existing devices including a single slice CT scanner (GE, Light Speed), a simulator (Varian Ximatron) and L-gram linear accelerator (Varian, 2100C Linac). The surface doses were measured using thermo luminescent dosimeters (TLDs) at eight sites-the brain, eye, thyroid, chest, abdomen, ovary, prostate and pelvis. Results: Compared to imaging with the use of single slice non-gated CT, the use of 4DCT imaging increased the dose to the chest and abdomen approximately ten-fold ($1.74{\pm}0.34$ cGy versus $23.23{\pm}3.67$cGy). Imaging doses with the use of the Acuity simulator were smaller than doses with the use of the Ximatron simulator, which were $0.91{\pm}0.89$ cGy versus $6.77{\pm}3.56$ cGy, respectively. The dose with the use of the electronic portal imaging device (EPID; Varian IX unit) was approximately 50% of the dose with the use of the L-gram linear accelerator ($1.83{\pm}0.36$ cGy versus $3.80{\pm}1.67$ cGy). The dose from the OBI for fluoroscopy and low-dose mode CBCT were $0.97{\pm}0.34$ cGy and $2.3{\pm}0.67$ cGy, respectively. Conclusion: The use of 4DCT is the major source of an increase of the radiation (imaging) dose to patients. OBI and CBCT doses were small, but the accumulated dose associated with everyday verification need to be considered.

• Progress in Medical Physics
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• v.21 no.4
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• pp.360-366
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• 2010

To generate on-board digital tomosynthesis (DTS) for three-dimensionalimage-guided radiation therapy (IGRT) as an alternative to conventional portal imaging or on-board cone-beam computed tomography (CBCT), two clinical cases (liver and bladder) were selected to illustrate the capabilities of on-board DTS for IGRT. DTS images were generated from subsets of CBCT projection data (45, 162 projections) using half-fan mode scanning with a Feldkamp-type reconstruction algorithm. Digital tomosynthesis slices appeared similar to coincident CBCT planes and yielded substantially more anatomic information. Improved bony and soft-tissue visibility in DTS images is likely to improve target localization compared with radiographic verification techniques and might allow for daily localization of a soft-tissue target. Digital tomosynthesis might allow targeting of the treatment volume on the basis of daily localization.