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Table of Contents
Intro
Preface
Acknowledgements
Author biography
B Paul Ravindran
Foreword
Chapter 1 Introduction and historical perspective
1.1 Principle of radiotherapy
1.2 Methods of radiotherapy delivery
1.2.1 Three-dimensional conformal radiation therapy (3D-CRT)
1.2.2 Intensity modulated radiotherapy
1.2.3 Volumetric modulated arc therapy (VMAT)
1.2.4 Helical tomotherapy
1.3 The need for imaging in radiotherapy
1.3.1 2D image guidance-portal imaging
1.3.2 Kilo voltage planar imaging
1.3.3 Volumetric image guidance
1.3.4 Volumetric imaging with CBCT
1.3.5 Molecular imaging-based guidance-biology-guided radiotherapy
1.4 Non-radiological image guidance systems
1.4.1 Ultrasound based image guidance
1.4.2 Magnetic resonance image based image guidance
1.4.3 Surface guided radiotherapy (SGRT)
1.5 The advantages of IGRT
References
Chapter 2 Two-dimensional (2D) off-line image guidance in radiation therapy
2.1 Radiographic film for image guidance
2.1.1 The need for a metal screen film detector
2.1.2 Clinical use of films for portal imaging in radiotherapy
2.1.3 Geometry issues with portal films
2.1.4 Converting to digital images
2.2 Computed radiography for image guidance
2.2.1 Introduction
2.2.2 CR plates-the PSP plates
2.2.3 The physics of PSP plate imaging
2.2.4 CR reader
2.2.5 CR readout process
2.2.6 Imaging characteristics of CR
2.2.7 Use of CR for patient setup verification
2.2.8 Portal imaging using cobalt-60 machine
2.2.9 Portal imaging with CR on linear accelerator
2.2.10 Histogram equalization
2.2.11 CR image registration
2.3 Advantages in the use of CR for portal imaging
2.4 Summary
References
Chapter 3 Electronic portal imaging devices
3.1 Introduction
3.2 Video camera-based EPID
3.2.1 The detector.
3.3 Fibre optic-based EPID
3.3.1 Issues with the fibre optic EPID
3.4 Liquid ion chamber-based EPID
3.5 Active-matrix, flat-panel imager (AMFPI)-based EPIDs
3.5.1 Direct conversion flat-panel imagers
3.5.2 Indirect conversion EPIDs
3.5.3 Issues with commercially available AMFPIs
3.5.4 Ghosting and noise
3.6 Clinical use of EPID
3.6.1 General workflow with EPID
3.6.2 Use of fiducial markers with EPID
3.6.3 4D radiotherapy using implanted marker tracking with EPID
3.6.4 Errors, on-line and off-line correction strategies
3.6.5 Combining uncertainties to derive planning margins
3.6.6 Correction strategies
3.7 Summary
References
Chapter 4 Two-dimensional (2D) kilovoltage image guidance systems
4.1 Kilovoltage (kV) x-ray-based stereoscopic imaging system
4.1.1 The BrainLAB ExacTrac x-ray 6D stereotactic image-guided radiation therapy (IGRT) system
4.1.2 ExacTrac dynamic-consolidated SGRT and IGRT
4.1.3 The CyberKnife system
4.1.4 Pros and cons of stereoscopic imaging systems
4.2 Gantry‐mounted two‐dimensional kV IGRT systems
4.2.1 Historical perspective
4.2.2 Commercial gantry-mounted 2D-kV IGRT systems
4.2.3 kV x-ray integrated Elekta linear accelerator (XVI)
4.2.4 kV x-ray integrated Varian linac (OBI)
4.2.5 Use of kV x-ray system for setup verification
4.2.6 Marker (seed)-based position verification
4.2.7 Metal artifact reduction (MAR)
4.2.8 Marker migration
4.3 Summary
References
Chapter 5 Volumetric radiological image guidance systems
5.1 Introduction
5.1.1 Development of the CT scanner
5.1.2 CT reconstruction
5.1.3 Fan beam reconstruction
5.2 CT on rails (in-room CT)
5.2.1 Workflow of the CT on-rails IGRT system
5.2.2 Uncertainties in CT on-rails system
5.2.3 Clinical applications and advantages of CT on-rails IGRT system.
5.3 Tomotherapy
5.3.1 MVCT IGRT in tomotherapy
5.3.2 MVCT imaging system in tomotherapy
5.3.3 kV CT in tomotherapy
5.3.4 The IGRT workflow with tomotherapy
5.4 CBCT-based image guidance
5.4.1 CBCT image reconstruction
5.4.2 MV CBCT
5.4.3 Development of MV CBCT systems
5.5 Halcyon unit
5.5.1 IGRT workflow with the Halcyon unit
5.6 kV CBCT-based IGRT
5.6.1 Halcyon unit with kV CBCT
5.6.2 Vero 4D IGRT system
5.6.3 Sidharth II IGRT system
5.6.4 C-Arm based CBCT system
5.6.5 Bow-tie filters
5.6.6 Extended longitudinal FOV Image guidance
5.6.7 Respiratory correlated CBCT (4D CBCT)
5.6.8 4D CBCT reconstruction
5.6.9 Streaking artifacts reduction
5.6.10 Image quality with number of projections
5.7 Image registration
5.7.1 Fundamentals of image registration
5.7.2 DIR
5.7.3 Feature space and similarity measures
5.7.4 Transformation model
5.7.5 Application of DIR in radiation oncology
5.8 Clinical applications of 3D image guidance
5.8.1 ART
5.9 Summary
References
Chapter 6 Commissioning, quality assurance and dose during IGRT
6.1 Introduction
6.2 Quality assurance program requirements
6.2.1 Safety
6.2.2 Geometric accuracy
6.2.3 Image quality
6.3 Commissioning and quality assurance of EPID
6.3.1 Mechanical calibration
6.3.2 Mechanical and safety test
6.3.3 Measures of imager performance
6.3.4 Image calibration
6.3.5 EPID software commissioning
6.3.6 Quality assurance of EPID
6.4 Commissioning and quality assurance of the stereoscopic imaging system
6.4.1 BrainLab ExacTrac x-ray 6D stereotactic IGRT system
6.4.2 Alignment of ExacTrac x-ray system with linear accelerator isocentre
6.4.3 Periodic quality assurance for ExacTrac system
6.4.4 The CyberKnife system.
6.5 Commissioning and quality assurance of CT on-rails IGRT system
6.5.1 Geometric accuracy
6.5.2 Image quality
6.5.3 Laser
6.5.4 End-to-end test
6.6 Commissioning and quality assurance of the TomoTherapy MV image guidance system
6.6.1 Geometry test
6.6.2 Image quality tests
6.7 Halcyon IGRT unit
6.7.1 Safety interlocks
6.7.2 Geometry test
6.8 Gantry mounted kV x-ray based planar and CBCT imaging system
6.8.1 Geometric calibration
6.8.2 Calibration of x-ray parameters
6.8.3 Image calibration: planar kV images
6.8.4 kV CBCT images
6.8.5 Scale and distance accuracy
6.8.6 Contrast resolution
6.8.7 Spatial resolution
6.8.8 Uniformity and noise
6.8.9 HU calibration and accuracy
6.8.10 Image registration
6.8.11 Safety tests
6.9 Dose during image guidance
6.9.1 Introduction
6.9.2 Why is imaging dose management important?
6.9.3 Dose during portal imaging
6.9.4 Stereoscopic imaging dose
6.9.5 Dose during CT on rails
6.9.6 Dose during MVCT
6.9.7 Imaging dose with MV CBCT
6.9.8 Dose during kV CBCT
6.9.9 Managing imaging dose
6.10 Summary
References
Chapter 7 US for image guidance in external beam radiation therapy
7.1 Introduction
7.2 Physics of US imaging
7.3 US frequency
7.4 Scanning modes
7.5 US imaging techniques
7.5.1 Transrectal US (TRUS) imaging
7.5.2 TAUS imaging
7.5.3 TPUS imaging
7.6 Three-dimensional (3D) US imaging
7.7 US-based commercial IGRT systems
7.7.1 The BAT system
7.7.2 Sonarray®
7.7.3 Clarity® system
7.8 Workflow for inter-fraction and intra-fraction US imaging
7.8.1 Inter-fraction imaging
7.8.2 Intra-fraction imaging
7.8.3 Organ motion estimating techniques with US (4D US)
7.9 Commissioning and quality assurance of a US-based IGRT system
7.9.1 Lasers
7.9.2 System calibration.
7.9.3 Phantom offset test
7.9.4 Laser offset test
7.9.5 Optical system stability test
7.9.6 Image quality and its consistency test
7.9.7 End-to-end tests
7.10 Advantages of a US IGRT system
7.11 Challenges in the use of US system for IGRT
7.12 Summary
References
Chapter 8 Magnetic resonance image-guided radiotherapy (MRIgRT)
8.1 Introduction
8.2 Physics of MRI
8.2.1 Production of net magnetic field and the hydrogen protons
8.2.2 Precession
8.2.3 Radiofrequency (RF) energy and resonance
8.2.4 T1 relaxation
8.2.5 T2 relaxation
8.2.6 Repetition time (TR) and echo time (TE)
8.2.7 MR pulse sequences
8.3 The challenges in integrating MRI to a linac for image guidance
8.3.1 Effect of magnetic field on linac
8.3.2 Electron focusing effect (EFE)
8.3.3 Electron return effect (ERE)
8.3.4 Effect on the MR image due to the presence of the linac
8.3.5 MR linac orientation
8.4 MRIgRT systems
8.4.1 ViewRay MR-linac
8.4.2 The Unity MRIgRT system
8.4.3 Aurora-RT™ MR linac
8.4.4 The Australian MRI-linac program
8.4.5 Sequential system with MR guidance
8.5 Summary
References
Chapter 9 Optical surface scanning: surface-guided radiotherapy (SGRT)
9.1 The science behind surface guidance
9.2 Clinical SGRT systems
9.2.1 Registration with reference surface
9.3 The AlignRT system
9.3.1 The functioning of AlignRT
9.3.2 Calibration and quality assurance of AlignRT system
9.4 The Catalyst™/Sentinel™ system
9.4.1 The Sentinel™ system
9.4.2 The Catalyst™ system
9.4.3 QA of Catalyst™ and Sentinel™ systems
9.5 Advantages of SGRT
9.6 Limitations of surface tracking systems
9.6.1 Sensitivity to external factors
9.6.2 System latency
9.6.3 Correlation between surface and internal anatomy
9.7 Summary
References.
Preface
Acknowledgements
Author biography
B Paul Ravindran
Foreword
Chapter 1 Introduction and historical perspective
1.1 Principle of radiotherapy
1.2 Methods of radiotherapy delivery
1.2.1 Three-dimensional conformal radiation therapy (3D-CRT)
1.2.2 Intensity modulated radiotherapy
1.2.3 Volumetric modulated arc therapy (VMAT)
1.2.4 Helical tomotherapy
1.3 The need for imaging in radiotherapy
1.3.1 2D image guidance-portal imaging
1.3.2 Kilo voltage planar imaging
1.3.3 Volumetric image guidance
1.3.4 Volumetric imaging with CBCT
1.3.5 Molecular imaging-based guidance-biology-guided radiotherapy
1.4 Non-radiological image guidance systems
1.4.1 Ultrasound based image guidance
1.4.2 Magnetic resonance image based image guidance
1.4.3 Surface guided radiotherapy (SGRT)
1.5 The advantages of IGRT
References
Chapter 2 Two-dimensional (2D) off-line image guidance in radiation therapy
2.1 Radiographic film for image guidance
2.1.1 The need for a metal screen film detector
2.1.2 Clinical use of films for portal imaging in radiotherapy
2.1.3 Geometry issues with portal films
2.1.4 Converting to digital images
2.2 Computed radiography for image guidance
2.2.1 Introduction
2.2.2 CR plates-the PSP plates
2.2.3 The physics of PSP plate imaging
2.2.4 CR reader
2.2.5 CR readout process
2.2.6 Imaging characteristics of CR
2.2.7 Use of CR for patient setup verification
2.2.8 Portal imaging using cobalt-60 machine
2.2.9 Portal imaging with CR on linear accelerator
2.2.10 Histogram equalization
2.2.11 CR image registration
2.3 Advantages in the use of CR for portal imaging
2.4 Summary
References
Chapter 3 Electronic portal imaging devices
3.1 Introduction
3.2 Video camera-based EPID
3.2.1 The detector.
3.3 Fibre optic-based EPID
3.3.1 Issues with the fibre optic EPID
3.4 Liquid ion chamber-based EPID
3.5 Active-matrix, flat-panel imager (AMFPI)-based EPIDs
3.5.1 Direct conversion flat-panel imagers
3.5.2 Indirect conversion EPIDs
3.5.3 Issues with commercially available AMFPIs
3.5.4 Ghosting and noise
3.6 Clinical use of EPID
3.6.1 General workflow with EPID
3.6.2 Use of fiducial markers with EPID
3.6.3 4D radiotherapy using implanted marker tracking with EPID
3.6.4 Errors, on-line and off-line correction strategies
3.6.5 Combining uncertainties to derive planning margins
3.6.6 Correction strategies
3.7 Summary
References
Chapter 4 Two-dimensional (2D) kilovoltage image guidance systems
4.1 Kilovoltage (kV) x-ray-based stereoscopic imaging system
4.1.1 The BrainLAB ExacTrac x-ray 6D stereotactic image-guided radiation therapy (IGRT) system
4.1.2 ExacTrac dynamic-consolidated SGRT and IGRT
4.1.3 The CyberKnife system
4.1.4 Pros and cons of stereoscopic imaging systems
4.2 Gantry‐mounted two‐dimensional kV IGRT systems
4.2.1 Historical perspective
4.2.2 Commercial gantry-mounted 2D-kV IGRT systems
4.2.3 kV x-ray integrated Elekta linear accelerator (XVI)
4.2.4 kV x-ray integrated Varian linac (OBI)
4.2.5 Use of kV x-ray system for setup verification
4.2.6 Marker (seed)-based position verification
4.2.7 Metal artifact reduction (MAR)
4.2.8 Marker migration
4.3 Summary
References
Chapter 5 Volumetric radiological image guidance systems
5.1 Introduction
5.1.1 Development of the CT scanner
5.1.2 CT reconstruction
5.1.3 Fan beam reconstruction
5.2 CT on rails (in-room CT)
5.2.1 Workflow of the CT on-rails IGRT system
5.2.2 Uncertainties in CT on-rails system
5.2.3 Clinical applications and advantages of CT on-rails IGRT system.
5.3 Tomotherapy
5.3.1 MVCT IGRT in tomotherapy
5.3.2 MVCT imaging system in tomotherapy
5.3.3 kV CT in tomotherapy
5.3.4 The IGRT workflow with tomotherapy
5.4 CBCT-based image guidance
5.4.1 CBCT image reconstruction
5.4.2 MV CBCT
5.4.3 Development of MV CBCT systems
5.5 Halcyon unit
5.5.1 IGRT workflow with the Halcyon unit
5.6 kV CBCT-based IGRT
5.6.1 Halcyon unit with kV CBCT
5.6.2 Vero 4D IGRT system
5.6.3 Sidharth II IGRT system
5.6.4 C-Arm based CBCT system
5.6.5 Bow-tie filters
5.6.6 Extended longitudinal FOV Image guidance
5.6.7 Respiratory correlated CBCT (4D CBCT)
5.6.8 4D CBCT reconstruction
5.6.9 Streaking artifacts reduction
5.6.10 Image quality with number of projections
5.7 Image registration
5.7.1 Fundamentals of image registration
5.7.2 DIR
5.7.3 Feature space and similarity measures
5.7.4 Transformation model
5.7.5 Application of DIR in radiation oncology
5.8 Clinical applications of 3D image guidance
5.8.1 ART
5.9 Summary
References
Chapter 6 Commissioning, quality assurance and dose during IGRT
6.1 Introduction
6.2 Quality assurance program requirements
6.2.1 Safety
6.2.2 Geometric accuracy
6.2.3 Image quality
6.3 Commissioning and quality assurance of EPID
6.3.1 Mechanical calibration
6.3.2 Mechanical and safety test
6.3.3 Measures of imager performance
6.3.4 Image calibration
6.3.5 EPID software commissioning
6.3.6 Quality assurance of EPID
6.4 Commissioning and quality assurance of the stereoscopic imaging system
6.4.1 BrainLab ExacTrac x-ray 6D stereotactic IGRT system
6.4.2 Alignment of ExacTrac x-ray system with linear accelerator isocentre
6.4.3 Periodic quality assurance for ExacTrac system
6.4.4 The CyberKnife system.
6.5 Commissioning and quality assurance of CT on-rails IGRT system
6.5.1 Geometric accuracy
6.5.2 Image quality
6.5.3 Laser
6.5.4 End-to-end test
6.6 Commissioning and quality assurance of the TomoTherapy MV image guidance system
6.6.1 Geometry test
6.6.2 Image quality tests
6.7 Halcyon IGRT unit
6.7.1 Safety interlocks
6.7.2 Geometry test
6.8 Gantry mounted kV x-ray based planar and CBCT imaging system
6.8.1 Geometric calibration
6.8.2 Calibration of x-ray parameters
6.8.3 Image calibration: planar kV images
6.8.4 kV CBCT images
6.8.5 Scale and distance accuracy
6.8.6 Contrast resolution
6.8.7 Spatial resolution
6.8.8 Uniformity and noise
6.8.9 HU calibration and accuracy
6.8.10 Image registration
6.8.11 Safety tests
6.9 Dose during image guidance
6.9.1 Introduction
6.9.2 Why is imaging dose management important?
6.9.3 Dose during portal imaging
6.9.4 Stereoscopic imaging dose
6.9.5 Dose during CT on rails
6.9.6 Dose during MVCT
6.9.7 Imaging dose with MV CBCT
6.9.8 Dose during kV CBCT
6.9.9 Managing imaging dose
6.10 Summary
References
Chapter 7 US for image guidance in external beam radiation therapy
7.1 Introduction
7.2 Physics of US imaging
7.3 US frequency
7.4 Scanning modes
7.5 US imaging techniques
7.5.1 Transrectal US (TRUS) imaging
7.5.2 TAUS imaging
7.5.3 TPUS imaging
7.6 Three-dimensional (3D) US imaging
7.7 US-based commercial IGRT systems
7.7.1 The BAT system
7.7.2 Sonarray®
7.7.3 Clarity® system
7.8 Workflow for inter-fraction and intra-fraction US imaging
7.8.1 Inter-fraction imaging
7.8.2 Intra-fraction imaging
7.8.3 Organ motion estimating techniques with US (4D US)
7.9 Commissioning and quality assurance of a US-based IGRT system
7.9.1 Lasers
7.9.2 System calibration.
7.9.3 Phantom offset test
7.9.4 Laser offset test
7.9.5 Optical system stability test
7.9.6 Image quality and its consistency test
7.9.7 End-to-end tests
7.10 Advantages of a US IGRT system
7.11 Challenges in the use of US system for IGRT
7.12 Summary
References
Chapter 8 Magnetic resonance image-guided radiotherapy (MRIgRT)
8.1 Introduction
8.2 Physics of MRI
8.2.1 Production of net magnetic field and the hydrogen protons
8.2.2 Precession
8.2.3 Radiofrequency (RF) energy and resonance
8.2.4 T1 relaxation
8.2.5 T2 relaxation
8.2.6 Repetition time (TR) and echo time (TE)
8.2.7 MR pulse sequences
8.3 The challenges in integrating MRI to a linac for image guidance
8.3.1 Effect of magnetic field on linac
8.3.2 Electron focusing effect (EFE)
8.3.3 Electron return effect (ERE)
8.3.4 Effect on the MR image due to the presence of the linac
8.3.5 MR linac orientation
8.4 MRIgRT systems
8.4.1 ViewRay MR-linac
8.4.2 The Unity MRIgRT system
8.4.3 Aurora-RT™ MR linac
8.4.4 The Australian MRI-linac program
8.4.5 Sequential system with MR guidance
8.5 Summary
References
Chapter 9 Optical surface scanning: surface-guided radiotherapy (SGRT)
9.1 The science behind surface guidance
9.2 Clinical SGRT systems
9.2.1 Registration with reference surface
9.3 The AlignRT system
9.3.1 The functioning of AlignRT
9.3.2 Calibration and quality assurance of AlignRT system
9.4 The Catalyst™/Sentinel™ system
9.4.1 The Sentinel™ system
9.4.2 The Catalyst™ system
9.4.3 QA of Catalyst™ and Sentinel™ systems
9.5 Advantages of SGRT
9.6 Limitations of surface tracking systems
9.6.1 Sensitivity to external factors
9.6.2 System latency
9.6.3 Correlation between surface and internal anatomy
9.7 Summary
References.