Chuxiong Ding,
Ding Ph.D.,
Ph D Cheng-Hui
Cheng Hui Chang
Chang, Ph
Ph.D.,
D Joshua Haslam
Haslam,
Ph.D., Robert Timmerman, M.D., Timothy Solberg, Ph.D.
• Respiratory Motion
Dosimetric
Difference
DEPT OF RADIATION ONCOLOGY
Linac Based Lung Cancer SBRT-
SBRT-
T
Tumor Localization
L li ti
• SBRT Frame: immobilization,, localization.
• Cone Beam CT
Lower Threshold
Beam On /
Off
Indicator
GTV PTV
0%
50%
90%
PTV3D GTV
ITV PTV4D
DEPT OF RADIATION ONCOLOGY
Study Protocol GTV
PTV4D
0% … 50% … 90%
Synchrony
ITV, PTV3D, MIP, and
AVG images
4D calculation
GTV, PTV4D,
50% phase CT
0%
% 50%
% 90%
%
… …
Deformable Registration
50% phase
GTV
DEPT OF RADIATION ONCOLOGY PTV4D
Result (1): Dose to Tumor
Patient 1
1 a
0.8
GTV C b
GTV_Cyber
0.6 b
Volume
PTV4D_Cyber
GTV SBRT
PTV4D SBRT
0.4
0.2
c
0
0 20 40 60 80
Dose (Gy)
• Tumor coverage
• Tumor dose homogeneous
DEPT OF RADIATION ONCOLOGY • Maximum Dose
Result (1): Dose to Tumor
DHI for GTV Maximum point dose to
(D20-D
D80)/Dprespcription GTV (Gy)
Volume
0.6 PTV4D_Cyber
5.93 2.38 74.3 66.9 GTV SBRT
PTV4D SBRT
0.4
11.28 5.43 75 2
75.2 71 3
71.3
0.2
Cyber
6.24 5.84 73.3 73.2
0
Dose (Gy)
(G )
75 0±2 0
75.0±2.0 70 7±2 3
70.7±2.3
8.71±1.87 3.35±1.47
Patient 1
1
0.8
GTV_Cyber
0.6
Volume
PTV4D_Cyber
GTV SBRT
PTV4D SBRT
0.4
0.2
0
0 20 40 60 80
Dose (Gy)
DEPT OF RADIATION ONCOLOGY
Result (2): Dose to Lung
Institutional Dose Limit for Lung
SBRT: 1000cc lung get less than
13.5Gy
V20
Dose to
1000cc Lung
10.00
9.00
Anterior Middle Posterior
8.00
7.00
6 00
6.00
y)
Dose (Gy
Cyberknife
5.00
Linac SBRT
4.00
3.00
2.00
1.00
0.00
1 2 3 4 5 6 7 8
Patients
vs.