18 March 2015 Navigated marker placement for motion compensation in radiotherapy
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Abstract
Radiotherapy is frequently used to treat unoperated or partially resected tumors. Tumor movement, e.g. caused by respiration, is a major challenge in this context. Markers can be implanted around the tumor prior to radiation therapy for accurate tracking of tumor movement. However, accurate placement of these markers while keeping a secure margin around the target and while taking into account critical structures is a difficult task. Computer-assisted needle insertion has been an active field of research in the past decades. However, the challenge of navigated marker placement for motion compensated radiotherapy has not yet been addressed. This work presents a system to support marker implantation for radiotherapy under consideration of safety margins and optimal marker configuration. It is designed to allow placement of markers both percutaneously and during an open liver surgery. To this end, we adapted the previously proposed EchoTrack system which integrates ultrasound (US) imaging and electromagnetic (EM) tracking in a single mobile modality. The potential of our new marker insertion concept was evaluated in a phantom study by inserting sets of three markers around dedicated targets (n=22) simultaneously spacing the markers evenly around the target as well as placing the markers in a defined distance to the target. In all cases the markers were successfully placed in a configuration fulfilling the predefined criteria. This includes a minimum distance of 18.9 ± 2.4 mm between marker and tumor as well as a divergence of 2.1 ± 1.5 mm from the planned marker positions. We conclude that our system has high potential to facilitate the placement of markers in suitable configurations for surgeons without extensive experience in needle punctions as high quality configurations were obtained even by medical non-experts.
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A. Winterstein, A. Winterstein, K. März, K. März, A. M. Franz, A. M. Franz, M. Hafezi, M. Hafezi, N. Fard, N. Fard, F. Sterzing, F. Sterzing, A. Mehrabi, A. Mehrabi, L. Maier-Hein, L. Maier-Hein, } "Navigated marker placement for motion compensation in radiotherapy", Proc. SPIE 9415, Medical Imaging 2015: Image-Guided Procedures, Robotic Interventions, and Modeling, 94151K (18 March 2015); doi: 10.1117/12.2081808; https://doi.org/10.1117/12.2081808
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