WE-G-213CD-05: Beam's-Eye-View Prostate Motion Detection during Arc Radiotherapy.

PURPOSE To track prostate motion during clinical arc radiotherapy using a novel statistical motion tracking algorithm in both phantom and patient systems. METHODS For the phantom study, a dynamic phantom with a custom tumor model and radiopaque fiducials was used. For the patient study, the clinical data from two prostate patients were acquired during volumetric modulated arc therapy (VMAT). For each patient, two gold fiducials (X-Mark, 1cm and 2cm in length) were implanted in the prostate. A total of 35 fractions with 2-field full arcs were delivered. Beam's-eye- view (BEV) images were acquired in cine mode every five fractions at a frame rate of 2 fps.The prostate motion was measured by two sequential steps: fiducial detection and motion estimation. In the first step, a wavelet- based block matching filter was used to suppress the noise and enhance the fiducials in the BEV images. A trajectory of detected fiducials was generated along the projection angles. Sequentially, the prostate motion was tracked using a statistical maximum a posteriori (MAP) algorithm. The 3-D fiducial position was estimated by maximizing the probability of displacement of 2-D projections. RESULTS A total of 8,400 BEV images were processed for this study. The phantom experiments showed that the baseline accuracy of estimation is 0.69+/-0.56 mm. For patient 1, intra- fraction prostate motion was measured to be 0.98+/-0.51 mm for all fractions, and individual fraction motion less than 1 mm. For patient 2, intra- fraction motion was 1.12+/-0.65 mm for all fractions. However, an exceptionally large displacement was measured as 4.9+/-0.74mm in one of the fractions. CONCLUSIONS Prostate motion during arc-therapy can be rigorously tracked to an accuracy of one millimeter. This technique is well suited for in-treatment room target tracking and post-therapy evaluation. Varian Medical Systems Inc.