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S. White



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    P2.05 - Poster Session with Presenters Present (ID 463)

    • Event: WCLC 2016
    • Type: Poster Presenters Present
    • Track: Radiotherapy
    • Presentations: 1
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      P2.05-043 - Lung Tumour Motion Kilovoltage Intrafraction Monitoring (KIM): First Clinical Results (ID 5538)

      14:30 - 14:30  |  Author(s): S. White

      • Abstract

      Background:
      Lung tumour positional uncertainty has been identified as a major issue that deteriorates the efficacy of radiotherapy. The recent development of the Kilovoltage intrafraction monitoring (KIM) which uses widely available gantry-mounted kilovoltage (kV) imager has been applied to prostate motion monitoring. This study reports the first clinical result of KIM for lung cancer radiotherapy with an Elekta machine.

      Methods:
      A locally advanced stage IIIlung cancer patient undergoing conventionally fractionated VMAT was enrolled in an ethics-approved study of KIM. A Gold Anchor fiducial marker (0.4 mm diameter x 20 mm length) was implanted in the tumour near the right hilum (Fig 1, left). kV images were acquired at 5.5 Hz during treatment. Post-treatment, markers were segmented and reconstructed to obtain 3D tumour trajectories. A Microsoft Kinect audio and depth sensing device was also mounted on the couch to get the external respiratory signal. Figure 1 Figure 1. kV image of the Gold Anchor marker (left) and the KIM measured lung tumour 3D motion and the external Kinect signal (right).



      Results:
      Our method was successfully applied for the first KIM lung patient. The fiducial marker was visible on 62.9% of the kV images. The average lung tumour motion (mean ± SD) in superior-inferior (SI), anterior-posterior (AP) left-right (LR), directions were 0.27±7.52, -0.09±3.37, and -0.64±4.55 mm respectively. Seven fractions of lung tumour 3D motion and Kinect external signal were acquired, with the representative result illustrated (Fig 1, right).

      Conclusion:
      This is the first time that KIM has been used for intrafractional tumour motion monitoring during lung cancer radiotherapy, and also the first implementation of KIM on an Elekta imaging platform. This clinical translational research milestone paves the way for the broad implementation of image guidance to facilitate the detection and correction of geometric error for lung radiotherapy, and resultant improved clinical outcomes.