PURPOSE: Until now, real-time image guided adaptive radiation therapy (IGART) has been the domain of dedicated cancer radiotherapy systems. The purpose of this study was to clinically implement and investigate real-time IGART using a standard linear accelerator. MATERIALS/ METHODS: We developed and implemented two real-time technologies for standard linear accelerators: (1) Kilovoltage Intrafraction Monitoring (KIM) that finds the target and (2) multileaf collimator (MLC) tracking that aligns the radiation beam to the target. Eight prostate SABR patients were treated with this real-time IGART technology. The feasibility, geometric accuracy and the dosimetric fidelity were measured. RESULTS: Thirty-nine out of forty fractions with real-time IGART were successful (95% confidence interval 87-100%). The geometric accuracy of the KIM system was -0.1 ± 0.4, 0.2 ± 0.2 and -0.1 ± 0.6 mm in the LR, SI and AP directions, respectively. The dose reconstruction showed that real-time IGART more closely reproduced the planned dose than that without IGART. For the largest motion fraction, with real-time IGART 100% of the CTV received the prescribed dose; without real-time IGART only 95% of the CTV would have received the prescribed dose. CONCLUSION: The clinical implementation of real-time image-guided adaptive radiotherapy on a standard linear accelerator using KIM and MLC tracking is feasible. This achievement paves the way for real-time IGART to be a mainstream treatment option.
PURPOSE: Until now, real-time image guided adaptive radiation therapy (IGART) has been the domain of dedicated cancer radiotherapy systems. The purpose of this study was to clinically implement and investigate real-time IGART using a standard linear accelerator. MATERIALS/ METHODS: We developed and implemented two real-time technologies for standard linear accelerators: (1) Kilovoltage Intrafraction Monitoring (KIM) that finds the target and (2) multileaf collimator (MLC) tracking that aligns the radiation beam to the target. Eight prostate SABR patients were treated with this real-time IGART technology. The feasibility, geometric accuracy and the dosimetric fidelity were measured. RESULTS: Thirty-nine out of forty fractions with real-time IGART were successful (95% confidence interval 87-100%). The geometric accuracy of the KIM system was -0.1 ± 0.4, 0.2 ± 0.2 and -0.1 ± 0.6 mm in the LR, SI and AP directions, respectively. The dose reconstruction showed that real-time IGART more closely reproduced the planned dose than that without IGART. For the largest motion fraction, with real-time IGART 100% of the CTV received the prescribed dose; without real-time IGART only 95% of the CTV would have received the prescribed dose. CONCLUSION: The clinical implementation of real-time image-guided adaptive radiotherapy on a standard linear accelerator using KIM and MLC tracking is feasible. This achievement paves the way for real-time IGART to be a mainstream treatment option.
Authors: Paul J Keall; Doan Trang Nguyen; Ricky O'Brien; Pengpeng Zhang; Laura Happersett; Jenny Bertholet; Per R Poulsen Journal: Int J Radiat Oncol Biol Phys Date: 2018-04-14 Impact factor: 7.038
Authors: Yijun Ding; Warren G Campbell; Moyed Miften; Yevgeniy Vinogradskiy; Karyn A Goodman; Tracey Schefter; Bernard L Jones Journal: Pract Radiat Oncol Date: 2019-04-02
Authors: Sarah Han-Oh; Colin Hill; Ken Kang-Hsin Wang; Kai Ding; Jean L Wright; Sara Alcorn; Jeffrey Meyer; Joseph Herman; Amol Narang Journal: Adv Radiat Oncol Date: 2021-01-22
Authors: Casper Gammelmark Muurholm; Thomas Ravkilde; Robin De Roover; Simon Skouboe; Rune Hansen; Wouter Crijns; Tom Depuydt; Per R Poulsen Journal: Med Phys Date: 2022-04-25 Impact factor: 4.506
Authors: Carri K Glide-Hurst; Percy Lee; Adam D Yock; Jeffrey R Olsen; Minsong Cao; Farzan Siddiqui; William Parker; Anthony Doemer; Yi Rong; Amar U Kishan; Stanley H Benedict; X Allen Li; Beth A Erickson; Jason W Sohn; Ying Xiao; Evan Wuthrick Journal: Int J Radiat Oncol Biol Phys Date: 2020-10-24 Impact factor: 7.038