Potential Non-Gantry Solutions for Isocentric Patient Irradiation - - PowerPoint PPT Presentation

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Potential Non-Gantry Solutions for Isocentric Patient Irradiation - - PowerPoint PPT Presentation

Mar 31, 2024 286 likes •759 views

Potential Non-Gantry Solutions for Isocentric Patient Irradiation with Heavier Ions Rich Levy, M.D, Ph.D. ABC Foundation Formerly: Medical Scientist, LBNL Professor of Rad Onc, LLUMC Outline Isocentric: Definition and Concepts

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SLIDE 1

Potential Non-Gantry Solutions for Isocentric Patient Irradiation with Heavier Ions

Rich Levy, M.D, Ph.D. ABC Foundation Formerly: Medical Scientist, LBNL Professor of Rad Onc, LLUMC

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SLIDE 2

Outline

  • “Isocentric”: Definition and Concepts
  • Stereographic 2D Projections of Sphere
  • Beam Entry Access Angles for a Sphere
  • Traditional Fixed Horizontal Beam
  • Traditional Gantry Beam
  • Potential of Fixed Vertical & 45º Beams
  • Potential of Isocentric Patient Positioner
  • Internal Fiducials Feedback
  • Be a Rocket Scientist!
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SLIDE 3

“Isocentric” Definitions and Concepts

  • Six Degrees of Freedom
  • X, Y, Z -- traditional orthogonal axes
  • Roll, Yaw, Pitch -- rotational deviation
  • Roll -- about the horizontal axis

parallel to the long axis of the body

  • Yaw -- about the vertical axis
  • Pitch -- about the horizontal axis

perpendicular to long axis of the body

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SLIDE 4

Isocentric Table: STAR

Beam Access Entry Angles Axial (roll) Sagittal (pitch) Coronal (yaw) Axial (roll) Sagittal (pitch) Coronal (yaw)

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SLIDE 5

Isocentric Table: STAR

Beam Access Entry Angles Axial (roll) Sagittal (pitch) Coronal (yaw) Axial (roll) Sagittal (pitch) Coronal (yaw)

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SLIDE 6

Equatorial (lateral) and Polar (superior) Stereographic Projection (2D) Views of the Earth

Lateral View Superior View

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SLIDE 7

Lateral 2D Projection Superior 2D Projection Lateral View Superior View

Projections of Lateral and Superior Views of Sphere: Cartesian and Spherical Coordinates

z y z x

Azimuthal angle (longitude) “Polar” angle (latitude)

P P O x z

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SLIDE 8

Equatorial (lateral) and Polar (superior) Stereographic Projection (2D) Views of the Earth

Lateral View Superior View

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SLIDE 9

Vertical (z)Axis

+90º 0º

Lateral View: Spherical Beam Vector Access

  • 90º

Equator

(Horizontal (y) Axis)

x y z A = 4πr2 Isocenter

= Non-Access

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SLIDE 10

x

  • Superior View: Spherical Beam Vector Access

0º 90º

Vertical (z) Axis Equator

(Horizontal (x) Axis) 180º

z x y A = 4πr2 Isocenter

= Non-Access

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SLIDE 11

Vertical (z)Axis

+90º 0º

Lateral View: Spherical Beam Vector Access

  • 90º

Equator

(Horizontal (y) Axis)

x y z A = 4πr2 Complete Beam Access Isocenter

= Access

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SLIDE 12

x

  • Superior View: Spherical Beam Vector Access

0º 90º

Vertical (z) Axis Equator

(Horizontal (x) Axis) 180º

z x y A = 4πr2 Complete Beam Access Isocenter

= Access

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SLIDE 13

Horizontal Beam ± 0º Roll Vertical Axis

360º

+90º 0º

Lateral View: Fixed Horizontal Beam Access Equator

(Horizontal Axis)

Horizontal axis roll: ±0º Vertical axis yaw: 360º Isocenter

= Access = Non-Access

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SLIDE 14

x

  • Superior View: Fixed Horizontal Beam Access

Horizontal Beam ± 0º Roll

0º 90º

Vertical (z) Axis Equator

(Horizontal Axis) 180º

Horizontal axis roll: ±0º Vertical axis yaw: 360º Isocenter

= Access = Non-Access

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SLIDE 15

Gantry Beam ± 0º Yaw

360º

+90º 0º

Lateral View: Traditional Gantry Beam Access Horizontal axis roll: 360º Vertical axis yaw: ±0º Equator

(Horizontal Axis)

Isocenter

= Access = Non-Access

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SLIDE 16

Gantry Beam ± 0º Yaw

360º

+90º 0º

Superior View: Traditional Gantry Beam Access Horizontal axis roll: 360º Vertical axis yaw: ±0º Equator

(Horizontal Axis)

Isocenter

= Access = Non-Access

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SLIDE 17

+90º 0º

Lateral View: Traditional Gantry + Table Rotation

  • 90º

Equator

(Horizontal Axis)

Vertical (z)Axis Independent Horizontal axis roll: 360º & Vertical axis yaw: 360º Combined Beam Access Isocenter

= Access = Non-Access

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SLIDE 18

x

  • Superior View: Traditional Gantry + Table Rotation

0º 90º

Equator

Horizontal Axis 180º 90º

Vertical (z) Axis Independent Horizontal axis roll: 360º & Vertical axis yaw: 360º Combined Beam Access Isocenter

= Access = Non-Access

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SLIDE 19

Horizontal Beam ± 0º Roll Vertical Axis

360º

+90º 0º

Equator

(Horizontal Axis)

Horizontal axis roll: ±0º Vertical axis yaw: 360º

Lateral View: Fixed Horizontal Beam Access (±0º Roll)

Isocenter

= Access = Non-Access

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SLIDE 20

Horizontal Beam ± 15º Roll Vertical Axis

360º

+90º +75º +60º +30º +15º 0º

Lateral View: Fixed Horizontal Beam Access (±15º Roll)

Horizontal axis roll: ±15º Vertical axis yaw: 360º Equator

(Horizontal Axis)

Isocenter

= Access = Non-Access

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SLIDE 21

x

  • Superior View: Fixed Horizontal Beam Access (±15º Roll)

Horizontal Beam ± 15º

15º 0º 30º 60º 75º 90º

Vertical Axis Horizontal axis roll: ±15º Vertical axis yaw: 360º Equator

(Horizontal Axis)

Roll Isocenter

= Access = Non-Access

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SLIDE 22

Vertical Beam ± 15º Vertical Axis

360º

+90º +75º +60º +30º +15º 0º

Lateral View: Fixed Combo H/V Beams Access (±15º Roll)

Horizontal axis roll: ±15º Vertical axis yaw: 360º Equator

(Horizontal Axis)

Horizontal Beam ± 15º Roll Roll Isocenter

= Access = Non-Access

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SLIDE 23

x

  • Superior View: Fixed Combo H/V Beams Access (±15º Roll)

Vertical Beam ± 15º Roll Horizontal Beam ± 15º Roll

15º 0º 30º 60º 75º 90º

Vertical Axis Horizontal axis roll: ±15º Vertical axis yaw: 360º Equator

(Horizontal Axis)

Isocenter

= Access = Non-Access

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SLIDE 24

Vertical Beam ± 15º Vertical Axis

360º

+90º +75º +60º +30º +15º 0º

Lateral View: Fixed Combo H/V/45º Beams Access (±15º Roll)

Horizontal axis roll: ±15º Vertical axis yaw: 360º

Equator

(Horizontal Axis)

Horizontal Beam ± 15º Roll Roll 45º Beam ± 15º Roll Isocenter

= Access = Non-Access

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SLIDE 25

x

  • Superior View: Fixed Beams

Vertical Beam ± 15º Roll 45º Beam ± 15º Roll Horiz Beam ± 15º Roll

15º 0º 30º 60º 75º 90º

Vertical Axis

Horizontal axis roll: ±15º Vertical axis yaw: 360º

Equator

(Horizontal Axis)

Isocenter

= Access = Non-Access

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SLIDE 26

Isocentric T able: STAR

45º Roll 90º Roll

T ext

Rolled Position for Oblique Fields

Brain: ~No organ motion! Reliable fiducials!

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SLIDE 27

Isocentric T able: STAR

45º Roll 90º Roll

T ext

Rolled Position for Oblique Fields

Other Target Volumes: Organ Motion? Roll Effects?

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SLIDE 28

Organ Motion, Roll Effects and Beam Scanning

  • Organ Motion?
  • Hearts beat, Lungs breathe
  • Diaphragm moves, GI has tract peristalsis
  • Roll Effects on Target Volume
  • Is supine the only reproducible position?
  • ±15º or decubitus position (±90º) roll?
  • Distortion of target volume?
  • Rx planning scan in Rx position(s)?
  • Beam Scanning
  • Must recognize and account for motion
  • Internal target volume, critical organs?
  • Fiducials: anatomic & implanted (Au, RF)
  • Hardware Mounting: Fixed vs Gantry?
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SLIDE 29

Horizontal Beam ± 22.5º Roll Vert Beam ± 22.5º 45º Beam ± 22.5º Roll Vertical Axis

360º

+90º +75º +60º +30º +15º 0º

Lateral View: Fixed Beams Added Access

Horizontal axis roll: ±22.5º Vertical axis yaw: 360º

Equator

(Horizontal Axis)

Roll Isocenter

= Access = Non-Access

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SLIDE 30

Craniospinal Irradiation with X-Rays Pediatric, Prone, ± Intubation

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SLIDE 31

LET’S DO IT!

31

Bussiere and Adams, 2003

Craniospinal Irradiation: Medulloblastoma

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SLIDE 32

Horizontal Beam ± 22.5º Roll Vert Beam ± 22.5º 45º Beam ± 22.5º Roll Vertical Axis

360º

+90º +75º +60º +30º +15º 0º

Lateral View: Fixed Beams Added Access

Horizontal axis roll: ±22.5º Vertical axis yaw: 360º

Equator

(Horizontal Axis)

Roll Isocenter 45º Beam ± 22.5º Roll Vert Beam ± 22.5º

Prone Position = Access = Non-Access

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SLIDE 33

x

  • Superior/Inferior Views: Fixed Beams

Vertical Beam ± 22.5º Roll 45º Beam ± 22.5º Roll Horizontal Beam ± 22.5º Roll

15º 0º 30º 60º 75º 90º

Vertical Axis Added Access

Horizontal axis roll: ±22.5º Vertical axis yaw: 360º

Equator

(Horizontal Axis)

Isocenter

= Access = Non-Access

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SLIDE 34

Vertical (z)Axis

+90º 0º

Lateral View: Spherical Beam Vector Access

  • 90º

Equator

(Horizontal (y) Axis)

x y z A = 4πr2 Complete Beam Access Isocenter

= Access = Non-Access

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SLIDE 35

x

  • Sup/Inf Views: Spherical Beam Vector Access

0º 90º

Vertical (z) Axis Equator

(Horizontal (x) Axis) 180º

z x y A = 4πr2 Complete Beam Access Isocenter

= Access = Non-Access

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SLIDE 36

36

ISAH: LBNL, 1950s (p+ and He)

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SLIDE 37

37

Proton Tx Harvard Cyclotron Lab (Early 1960’s)

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SLIDE 38

LET’S DO IT!

38

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SLIDE 39

HCL Radiosurgery

Pre-1991 STAR: 1991-2001

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SLIDE 40

Isocentric T able: STAR

R2 R1 Z X Y

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SLIDE 41

Isocentric T able: STAR

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SLIDE 42

Isocentric T able: STAR

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SLIDE 43

Isocentric T able: STAR

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SLIDE 44

Isocentric Table: STAR

Beam Access Entry Angles Axial (roll) Sagittal (pitch) Coronal (yaw)

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SLIDE 45

STAR: 6-FIELD RX

Beams: RL, LL, LAO, RPO, SUP, SAO

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SLIDE 46

Conclusions (I)

  • Broad Range of Beam Entry Angles with:
  • Fixed H/V and 45º beams
  • Isocentric tables with
  • 360º yaw (about vertical axis)
  • ±15-22.5º roll (about horiz axis)
  • supine & prone positioning
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SLIDE 47

Conclusions (II)

  • Obtain Treatment Planning Scans in

Anticipated Angle(s) of Roll Rotation

  • Verify Position via Internal Fiducials
  • Gantries Make Treatment Easier ...
  • But lack of one is NOT a show-stopper!
  • Even gantries NEED isocentric tables!
  • Beam Scanning is the Real Deal
  • BE A ROCKET SCIENTIST!