ultrasound guided radiotherapy for pancreatic...
TRANSCRIPT
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July 31, 2017
Ultrasound Guided Radiotherapy for Pancreatic Cancer
K. Ding, PhD, DABRAssistant Professor, Johns Hopkins School of Medicine
AAPM 2017, Denver, CO – 07/30-08/03, 2017
RADIATION ONCOLOGY &MOLECULAR RADIATION SCIENCES
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Disclosure
• This research is supported in part by – USGRT: NCI CA161613, Elekta– EUSGRT: JHU Rad Onc Discovery Grant,
Augmenix
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Learning Objectives
• The audience will learn the major components including ultrasound imaging, coordinate calibration, probe positioning and image tracking for ultrasound monitoring in radiotherapy for pancreatic cancer
• The audience will learn how to incorporate the real-time ultrasound monitoring with existing pancreatic cancer treatment clinical workflow
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Pancreas Cancer
• 4th leading cause of cancer-related death in US• Typically late presentation of disease
– Only 15-20% of patients are considered resectable• 5-year overall survival after
pancreaticoduodenectomy (whipple surgery)– 25-30% for node-negative disease– 10% for node-positive disease
• More recent data suggest outcomes may be improving over time
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Breath hold monitoring during pancreas SBRT
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USGRT components
6*Elekta Clarity user manual*L.S. Thomas, Diagnostic ultrasound imaging: inside out. Elsevier academic press, 2017.
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CT/US Sim
*L. Su et al, Feasibility study of ultrasound imaging for stereotactic body radiation therapy with active breathing coordinator in pancreatic cancer, JACMP 2017 7
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Ultrasound contouring
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Probe impact on planning
*L. Su et al, Feasibility study of ultrasound imaging for stereotactic body radiation therapy with active breathing coordinator in pancreatic cancer, JACMP 2017, Issue 4 9
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Probe impact on planning
Duo V15 = 5.96 cc < 9ccDuo V20 = 1.59 cc < 3ccDuo V33 = 0.0 cc < 1ccPTV V33 = 90.09% >90%
Sto V15 = 8.52 cc < 9ccSto V20 = 1.45 cc < 3ccSto V33 = 0.0 cc < 1cc
Bowel V15 = 6.68 cc < 9ccBowel V20 = 1.44 cc < 3ccBowel V33 = 0.0 cc < 1cc
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Treatment setup
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CBCT initial setup
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Ultrasound monitoring
*L. Su et al, Feasibility study of ultrasound imaging for stereotactic body radiation therapy with active breathing coordinator in pancreatic cancer, JACMP 2017, Issue 4 13
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Robotic arm for gated proton therapy
*Collaboration with Dr. Haibo Lin, University of Pennsylvania Proton Center 14
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Visual servoingautomatically place probe
*H.T. Sen et al, Cooperative control with ultrasound guidance for radiation therapy, Frontier Oncology 2016*H.T. Sen et al, System Integration and In Vivo Testing of a Robot for Ultrasound Guidance and Monitoring
During Radiotherapy, IEEE TBME, 2017(7), Issue Highlight15
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Play Movie
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Ultrasound probe controlled by robotic arm
Real time ultrasound image being registered to reference image
*H.T. Sen et al, Cooperative control with ultrasound guidance for radiation therapy, Frontier Oncology 2016*H.T. Sen et al, System Integration and In Vivo Testing of a Robot for Ultrasound Guidance and Monitoring
During Radiotherapy, IEEE TBME, 2017(7), Issue Highlight
Visual servoingautomatically place probe
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Tracking relies on imaging speed
0.3 Hz, 45º sweeping angle 1 Hz, 15º sweeping angle 11 Hz, 3º sweeping angle
Ground truth (optical tracking) *Collaboration with Drs. Tuathan O'Shea and Emma Harris PhD, Institute of Cancer Research, Royal Marsden
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*P. Huang et al, Respiration-Induced Landmark Motion Tracking in Ultrasound Guided Radiotherapy, AAPM 2017, Abstract SU-F-708-4 18
Fast tracking (15ms/frame)
The similarity of SFA signalFrame Indexing vs. Template Matching
Training Stage
Frame Indexing
Template Matching
Coarse tracking Refinement
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Biodegradable hydrogel with endoscopic ultrasound guidance
Duodenum Duodenum
D D
PP
19*Z. Feng et al, A Dose Predication Model for Duodenum Sparing in Pancreatic Cancer with Biodegradable Hydrogel Spacer, AAPM2017, Abstract SU-K-FS1-1
Gel
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Biodegradable hydrogel with endoscopic ultrasound guidance
*P. Huang et al, Real-Time Tracking of Endoscopic Ultrasound Guided Hydrogel Injection Using Template Matching, AAPM 2017, Abstract SU-K-601-17 20
P
DGel
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Biodegradable hydrogel with endoscopic ultrasound guidance
12.7mm
Duo V15 = 3.33 ccDuo V20 = 1.27 ccDuo V33 = 0.01 ccPTV V33 = 80.36% (!)
Pre-Injection Plan with Duo priority
Pre-Injection Plan with PTV priority
Post-Injection Plan
Duo V15 = 7.07 ccDuo V20 = 3.86 cc (!)Duo V33 = 0.15 ccPTV V33 = 95.01%
Duo V15 = 2.02 ccDuo V20 = 0.36 ccDuo V33 = 0.0 ccPTV V33 = 97.87%
*A. Rao et al, Novel Use of a Hydrogel Spacer to Separate the Head of the Pancreas and Duodenum for Radiotherapy for Pancreatic Cancer, ASTRO 2017
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Conclusions
• Ultrasound guidance can be used for motion monitoring in radiotherapy for pancreatic cancer
• Clinical workflow has to be adapted to incorporate the changes
• Endoscopic ultrasound can guide the injection of hydrogel to potentially reduce the duodenum dose
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AcknowledgementUSGRT team
• Radiation Oncology– John Wong, Lin Su, Yin Zhang, Sook Kien Ng, Junghoon Lee, Ken Wang, Ted Hooker, Joseph
Herman, Harry Quon, Phuoc Tran, Danny Song• Engineering
– Iulian Iordachita, H. Tutkun Sen, Peter Kazanzides, Muyinatu A. Lediju Bell, Emad Boctor• Radiology
– Jinyuan Zhou, Chen Yang• The Institution of Cancer Research Radiation Oncology
– Tuathan O’shea, Emma Harris• University of Pennsylvania Radiation Oncology
– Haibo Lin• Shandong Normal University
– Dengwang Li, Pu Huang, Ziwei Feng
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AcknowledgementEUSGRT team
• Radiation Oncology– Avani Rao, Joseph Herman, Lauren Rosati, Jeffrey Schultz, Stephen Clarke, John Wong, Amol
Narang, Lin Su, Sook Kien Ng, Todd McNutt, Joe Moore, Sierra Cheng• Gastroenterology
– Eun Shin, Seonghun Kim• Surgery
– Jin He, Richard Burkhart• Pathology
– Kevin Waters• Radiology
– Michael Schar, Lauri Pipitone, Juls Meyers, Hugh Wall, Jorge Guzman, Eleni Liapi, Stephanie Coquia, Bob De Jong
• Molecular and Comparative Pathobiology– Caroline Garrett, Sarah Beck, Anna Goodroe
• Industrial Partners– Augmenix (hydrogel): Kolbein Kolste, Patrick Campbell– Pentax (EUS): Robin Rynn
• Shandong Normal University– Dengwang Li, Pu Huang, Ziwei Feng
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Questions
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