Developing Negotiated Imaging Modules: The University of Leeds experience Jane Arezina
Clinical experience with ProteusONE imaging systems · PDF fileClinical experience with...
Transcript of Clinical experience with ProteusONE imaging systems · PDF fileClinical experience with...
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Clinical experience with ProteusONE imaging systems at WKCC
Kuan Ling (Gwen), Chen, Ph.D.
September 25, 2017
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Willis-Knighton Proton Therapy Center
Willis-Knighton Health System 4 Hospitals in Shreveport/Bossier City, Louisiana
IBA ProteusONE
Partial gantry rotation 220 degree
Treatment field size Maximum 20 x 24 cm2
Beam delivery modality Pencil beam scanning (PBS) only
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WKCC IBA ProteusOne Timeline
Entered Negotiations May 2011
Contract Signed Sep. 2011
Groundbreaking Feb. 2012
Cyclotron and Gantry Arrival Aug.- Oct. 2013
Started Beam Tuning Dec. 2013
Started PBS Calibration Feb. 2014
Acceptance Test and Commission Jul. 1st, 2014
First Patient Treated Sep. 9th, 2014
CBCT Installed Sep. 24th, 2015
Upgraded to AI2.0 (CBCT LFOV) Jun. 2017 (not clinical yet)
358 patients treated Sep. 17th, 2017
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To Date Proton Treatment Statistics
Re-treat – 8%4
GU-Prostate43%
Brain15%
H/N12%
Lung8% GI
6%
GU-GYN6%
Breast/CW4%
Lymphoma2%
Spine2%
Sacroma1%
GU-other1%Other
6%
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IBA Image-Guided Therapy System
Software adaPTinsight
Hardware Stereoscopic X-ray system
(dual source mode)
2D oblique (OB1-OB2)
Nozzle Imager
3D CBCT
2D orthogonal (single source mode)
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IBA Imaging System Specification
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Stereoscopic X-ray system Nozzle imager
X-Ray Tube Flat Panel
Stereo X-ray
Flat Panels
X-Ray Tubes
Under Ground
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IBA Imaging System Specification
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Specifications Stereo Oblique Nozzle Imager
Flat Panel Type Amorphous silicon Amorphous silicon
Image Mode 2D 2D, 3D
Scan Diameters (FOV) n/a 25cm (currently)
Scan Length (S-I FOV) n/a 26 cm
Source to Axis Distance 250 cm 100 cm
Imager to Axis Distance 82 cm 55 cm
Flat Panel Array 1440 x 1560 px 2881 x 2881 px
Flat Panel Physical Size 38.0 x 32.8 cm2 50.8 x 51.8 cm2
Panel Sensitive Area at ISO 22 x 20 cm2 28 x 28 cm2
Pixel Size at Isocenter 0.1 mm 0.1 mm
Max. Gantry Speed (CBCT) n/a 3, 6 deg/s
CBCT Frame Rate n/a 7.5 fr/s
Elekta Versa XVI
Amorphous silicon
2D, 3D and 4D
27, 41 & 50 cm
Up to 27cm
100 cm
54 cm
1024 x 1024 px
42.5 x 42.5 cm2
27 x 27 cm2
0.25 mm
1 deg/s
5.5 fr/s
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IBA Imaging System – CBCT Dose
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Scan
ProtocolFOV
Acquisition
Angle
Gantry
Speed (°/s)
Scan Parameters CTDIweighted
(mGy)kVp mA ms
Head HD Small 205 3 100 25 12 8.2
Head SD Small 205 6 100 25 12 4.4
Thorax Small 205 3 110 25 12 6.4
Pelvis Small 205 3 120 40 12 12.5
AI 2.0 (Large FOV)
Thorax Large434
(dual half scan)6 110 50 12 10.6
Pelvis Large434
(dual half scan)6 120 64 12 15.7
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WKCC Current Clinical Application
Site Stereo Oblique CBCT 2D Orthogonal
Brain V A A
Head/Neck V A A
Thorax/Lung V A A
Thorax/Lung (BH) V A* A
Breast/ Chest Wall V A --
Abdomen (BH) V A* A
Pelvis V A --
Prostate A & V A (weekly) --
Prostate Bed V A A
Extremities V A A
– A: Patient Position Alignment – V: Patient Position Verification – *not used clinically
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Brain
CBCT is best for alignment
Stereo oblique is difficult for alignment (rotational uncertainty)
Oblique Ortho
CBCT
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Head/Neck
CBCT is best for alignment
Stereo oblique is difficult for alignment (rotational uncertainty)11
ObliqueCBCT
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Lung
Free breathing CBCT
Breath hold CBCT for BH is feasible
but not used clinically currently
CBCT
Oblique
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Lung
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CBCT
re-CT
Planning CT
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Pelvis
Landmark Bony structures
Both CBCT and stereo oblique are good for setup
CBCT Oblique
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Prostate
Landmark Fiducial
Stereo oblique is good for daily alignment
Weekly CBCT
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CBCT
Oblique
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Prostate Bed
Landmark Rectal balloon w/ contrast
Bony structures
CBCT SI direction w/ balloon
AP, RL direction w/ bone
CBCT
Ortho
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WKCC Experience Summary
CBCT essential for H/N, thorax, abdomen, pelvis (prostate bed)
LFOV is useful for breast, pelvis
Stereo Oblique Bony structure
Fiducials
Video of LFOV
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Questions?
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