Maria Golish, CMD, RTT, BS

Transcription

1 Maria Golish, CMD, RTT, BS

2 Thank you auto-segmentation!!

3 Had a limited role in early days of Radiotherapy Mostly based in Diagnostic Radiology department Slowly increased importance in RT department Currently every step involves Imaging

4 Diagnosis Simulation Treatment Planning Physics QA On treatment verification Image guided treatment

5 Finding the edges of an anatomical site or tumor and identifying that as a structure

6 Subjective Inconsistent Difficult to accomplish when artifacts are present Time consuming

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8 Involves combining multiple image sets into one coordinate system

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12 Organ delineation software Can include multiple samples for better outcome Models an organ s shape using a mesh of the structures surface Tools to add, edit, and modify

13 Screenshot courtesy of Philips Pinnacle³

14 Screenshot courtesy of Philips Pinnacle³

15 Step 1: Position mesh over organ Step 2: Automatic adaptation of the organ mesh₂ E ttttt = w iii E iii + E eee Screenshot courtesy of Philips Pinnacle³

16 Uses Gradient values to define organ surface Video courtesy of Philips Pinnacle³

17 Best fit vs Weighted average

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21 A way of manipulating an image so the geometric correspondence of 2 or more images is improved

22 Image courtesy of Mirada Medical, UK

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24 Image courtesy of Mirada Medical, UK

25 Images courtesy of Mirada Medical, UK

26 Image courtesy of Mirada Medical, UK

27 Image courtesy of Mirada Medical, UK

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29 Image courtesy of Philips Pinnacle³

30 Image courtesy of Philips Pinnacle³

31 Image courtesy of Mirada Medical, UK

32 The lymph node region in green was defined as another region of interest. Image courtesy of Mirada Medical, UK

33 Image courtesy of Mirada Medical, UK

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35 So what structures am I supposed to contour?

36 Atlas.aspx

37 CTGTV is the gross target volume defined on CT, will be a composite volume of the primary tumor mass (GTVT) and nodal diseases (GTVN) ₃ las.aspx

38 The primary tumor should be contoured on CT images under a standard lung window/level for its lung borders and under a mediastinal window/level for the borders adjacent to mediastinum ₃ as.aspx

39 Mandatory Critical Structures Lung, Esophagus, & Spinal Cord Brachial Plexus Chest Wall Pericardium, Heart and Great Vessels

40 Brachial Plexus This is only required for patients with tumors of upper lobes. Only the ipsilateral brachialplex is required. This will include the spinal nerves exiting the neuroforamine from top of C5 to top of T2. In contrast to prior RTOG lung studies of contouring the major trunks of the brachial plexus with inclusion of subclavian and axillary vessels, this trial requests contouring the nerves according to the CT anatomy on every other CT slice. The structure should extend at least 3 cm above the PTV. ₃

41 Int. J. Radiation Oncology Biol. Phys., Vol. 72, No. 5, pp , 2008

42 Int. J. Radiation Oncology Biol. Phys., Vol. 72, No. 5, pp. 1363, 2008

43 Conclusion Image Registration Image Segmentation Model Based Segmentation Auto-Segmentation with Atlases Deformable Image Registration RTOG Corelab contouring assistance

44 Thank You!!

45 1) 2) Michael R. Kaus, Todd McNutt, PhD, Jim Shoenbill, MSc, Model-Based Segmentation, for treatment with Pinnacle³, Philips Medical Systems, August 2006, ) gatlas.aspx 4) WILLIAM H. HALL, M.D.,* MICHAEL GUIOU, PH.D.,* NANCY Y. LEE, M.D.,y ARTHUR DUBLIN, M.D. et al.. DEVELOPMENT AND VALIDATION OF A STANDARDIZED METHOD FOR CONTOURING THE BRACHIAL PLEXUS: PRELIMINARY DOSIMETRIC ANALYSIS AMONG PATIENTS TREATED WITH IMRT FOR HEAD-AND- NECK CANCER, Int. J. Radiation Oncology Biol. Phys., Vol. 72, No. 5, pp , ) Wu Zhou and Yaoqin Xie, Interactive Multigrid Refinement for Deformable Image Registration, BioMed Research International, Volume 5 September 2013, Article ID