Implementation of Advanced Image Guided Radiation Therapy

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1 Image Acquisition Course Outline Principles, characteristics& applications of the available modalities Image Processing in the T x room Image guided treatment delivery What can / can t we do in the room Image Processing over the course Re-planning using structure propagation, dose mapping and accumulation Course Outline Image Acquisition Jeff Siewerdsen Principles, Johns characteristics& Hopkins University applications of the available modalities Image Processing in the T x room Jan-Jakob Sonke Image guided AVL/Netherlands treatment delivery Cancer Institute What can / can t we do in the room Image Processing over the course Marc L Kessler Re-planning The using University structure of Michigan propagation, dose mapping and accumulation Disclosure Statement National Center Institute U.S. National Institutes of Health 1

2 Look here! Acknowledgements I have received slides, images and ideas from many wonderful people, several of which are in this room! Adaptive Radiotherapy Jaffray/ PMH Real time On-line Off-line Temporal Scales of Intervention Adaptive Radiotherapy Imaging On-line really Off-line Off-line Imaging downstream, upstream and iterative data flow lots of decisions at lots of times 2

3 Adaptive Radiotherapy Jeff taught us how images are acquired and the pros and cons of the different modalities for measuring different features of the patient Jan-Jakob taught us about image processing and how we can adapt to certainchanges of the patient but he ran out of knobs to twiddle ^ eventually How Many Knobs? X B = T(X A,{ ß}) X B = T(X A,{ ß(X A )}) Global Rigid Local Rigid Fully Deformable 3, 6, 3 x# voxels Too Few? Too Many? How Many Knobs? Spatially invariant Rigid, Similarity, Affine fewer knobs Spatially variant Thin-plate splines B-splines, Cubic splines Dense deformation fields more knobs 3

4 6 Knobs /Entire FOV Sonke/ NKI Pareto Frontier? & CB 6 Knobs / Limited FOV Sonke/ NKI & CB 6 Knobs / Multiple FOV Sonke/ NKI Interpolate between separate registrations using Thin-plate splines & CB 4

5 Lot s of Knobs / Entire FOV from PET Registration using B-splines Registration Framework 10,000 ft View Sonke/ NKI Fixed image Metric Similarity Optimizer Mapped Image Adjusted Parameters Floating image Interpolator Geometric Transformation Transformer Multi-resolution B-Splines Coarse Fine 5

6 Registration Metric Multi-resolution B-Splines Registration Metric vs. Iteration Low Res Iteration Number Change in knot spacing High Res Lot s of Knobs / Entire FOV notice bolus Registration using B-splines Lot s of Knobs / Entire FOV Visual validation looks good! 6

7 How many degrees of freedom are needed to carry out (accurate) deformable image registration? 20% % 13% 27% 13% x number of voxels 5. More than 12 and less than 3 x # voxels How many degrees of freedom are needed to carry out (accurate) deformable image registration? x number of voxels 5. More than 12 and less than 3 x # voxels How Many Knobs? X B = T(X A,{ ß}) X B = T(X A,{ ß(X A )}) Global Rigid Local Rigid Fully Deformable 3, 6, 12 3 x# voxels Too Few? Too Many? 7

8 How Many Knobs? We usually don t really know use more than we need depends on the situation ^ clinical How Many Knobs? Deformable image registration is an over determined and under constrained problem Under Constrained? Sonke/ NKI Registration using B-splines 8

9 How to Constrain? Sonke/ NKI Tell the algorithm what is what Label bones and don t let them warp! Registration Framework 10,000 ft View Sonke/ NKI Fixed image Metric Similarity Optimizer Mapped Image Adjusted Parameters Floating image Interpolator Geometric Transformation Transformer Add Some Physics! E total = E similarity + αe stiffness intensity similarity metric tissue-dependent regularization E vol = w c (x) detj T (x) 1 2 dx 9

10 Add Some Physics! Sonke/ NKI CB deformed w/ and w/o Adaptive Radiotherapy Imaging Imaging downstream, upstream and iterative data flow lots of decisions at lots of times Adaptive Radiotherapy 10

11 Adaptive Radiotherapy Adaptive Radiotherapy Adaptive Radiotherapy Imaging Imaging downstream, upstream and iterative data flow lots of decisions at lots of times 11

12 Adaptive Radiotherapy Imaging Imaging the scanners to the planners to the T x machine Radiotherapy Classic Imaging the scanners to the planners to the T x machine Adaptive Radiotherapy Imaging Reuse the contours already defined Estimate 3D dose already delivered 12

13 Image Processing Tools Deformable image registration Compute the transformation that relates the coordinates of objects in two imaging studies Contour and dose mapping Map information such as anatomic contours and doses from one image study to another Outlines contours Data Propagation data just at boundaries Voxel data dose & image values dataat everypoint Deformable Registration Dong / MDACC Registration using Demons 13

14 Deformable Registration Dong / MDACC Registration using Demons Contour Propagation Dong / MDACC Cut and Paste Structures Contour Propagation Dong / MDACC Cut and Paste Structures 14

15 Contour Propagation Dong / MDACC Cut and Paste Structures Contour Propagation Dong / MDACC Apply deformation to Structures Contour Propagation Dong / MDACC Deform Stuctures 15

16 Contour Propagation Circa 1985? Drawn Contours Derive the Contour Contour Propagation Circa 1985 Drawn Contours Derived Contours Contour Propagation Stack MR Outlines Circa 1985 Create a 3D Model a b Transform and Slice Apply Outlines to c d Structure Transfer Between Sets of Three Dimensional Medical Imaging Data, G.T.Y.Chen, M.Kessler, and S. Pitluck, Proceedings of the National Computer Graphics Association, Dallas, TX, voliii, pp (1985) 16

17 Orientation Matters Differences due to sampling plane and voxel shape! Axial Target Coronal Target Jeff we want small isotropic voxels! Contours defined on one DICOM image study can be transferred to another DICOM image study by: 1. using cut and paste 2. registering the two imaging studies then mapping the structures using the resulting geometric transformation 3. transferring the contours and images to a DICOM server using IHE-RO and then reading them back in 4. scaling the contours by the ratio of the different pixel sizes 5. It is not possible to transfer contours between imaging studies Contours defined on one DICOM image study can be transferred to another DICOM image study by: 1. using cut and paste 2. registering the two imaging studies then mapping the structures using the resulting geometric transformation 3. transferring the contours and images to a DICOM server using IHE-RO and then reading them back in 4. scaling the contours by the ratio of the different pixel sizes 5. It is not possible to transfer contours between imaging studies 17

18 Dose Mapping Rosu/ UM Volume A Volume B Dose Mapping Rosu/ UM Volume of a voxel changes C C Volume A Volume B Dose Mapping Dong / MDACC Apply deformation to dose grid 18

19 Dose Algebra Pouliot/ UCSF CB day n CB day m Dose Algebra Subtraction of two mapped doses Pouliot/ UCSF Change in shape Increased cord dose DoseDifference (%) >5% >10% Dose Mapping Dealing with volume elements that may: change shape / appear / disappear need proper spatial re-sampling don t necessarily add in a linear fashion need some sort of radiobiology? exist in homogenous intensity regions hard to evaluate registration 19

20 Dose Mapping Dealing with volume elements that may: change shape / appear / disappear need proper spatial re-sampling don t necessarily add in a linear fashion need some sort of radiobiology? exist in homogenous intensity regions hard to evaluate registration The major difference in the process of transferring doses and contours between two DICOM studies 1. Doses depend on tissue density and contours do not 2. Doses do not change once they are delivered, contours do 3. Transferring doses is more time consuming than transferring contours 4. Transferring doses requires registration at every voxel, transferring contours requires this only at boundaries 5. Transferring doses requires knowledge of the alpha-beta ratio and transferring contour does not The major difference in the process of transferring doses and contours between two DICOM studies 1. Doses depend on tissue density and contours do not 2. Doses do not change once they are delivered, contours do 3. Transferring doses is more time consuming than transferring contours 4. Transferring doses requires registration at every voxel, transferring contours requires this only at boundaries 5. Transferring doses requires knowledge of the alpha-beta ratio and transferring contour does not 20

21 Implementation of Advanced Image Guided Final Thoughts Final Thoughts Need sufficient information in the on-line loop to indicate the need for off-line loop Off-line loop may require additional and different information Efficiency and circumstances will drive the relative use of the loops New technology in image acquisition and processing may help to merge the loops Thank you for your attention! 21

22 Visualization of Deformations Color overlay of magnitude Deformation of uniform grid Overlay of Arrow glyphs 22

23 Vector Field Critical Points Tittlemeyer, et al. Attractor Repellor Rotation Center Saddle Point (I) Saddle Point (II) Optical Flow Algorithm Foskey/UNC Image A Image B Optical Flow Algorithm Foskey/UNC Image A Image B 23

24 Optical Flow Algorithm Foskey/UNC Optical Flow Algorithm Foskey/UNC Optical Flow Algorithm Foskey/UNC 24

25 Results Use of masking No masking Mask using segmented lung/abdomen Note ribs (and tissue ) near diaphragm Ribs not affected by lung regi 25

26 Data Mapping Data Mapping Adaptive Radiotherapy 26

27 Adaptive Radiotherapy Don t Get caught Build this crazy contraption piece-by by-piece as you race around the track! Adaptive Radiotherapy Don t Get caught It s fun to build this comical wonder but woe to the mouse that gets caught under! 27

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