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Biomedical subjects

Martin J Murphy

Publications and source records attributed to Martin J Murphy.

15 recordsLinked to original sources
PubMed2006

Comparative performance of linear and nonlinear neural networks to predict irregular breathing.

Breathing adaptation during external-beam radiotherapy is a matter of great concern because uncompensated tumour motion requires extended treatment margins that endanger sensitive tissue. Compensation strategies include beam gating, collimator tracking and robotic beam re-alignment. All of these schemes have a system latency of up to several hundred milliseconds, which calls in turn for predictive control loops. Irregularities in breathing make prediction difficult. We have evaluated the performance of two classes of control loop algorithms-the linear adaptive filter and the adaptive nonlinear neural network-for highly irregular patient breathing behaviours. The neural network demonstrated robust adaptability to all of the observed breathing patterns while the linear filter failed in a significant percentage of cases. For those cases where the linear filter could function, it made less accurate predictions than the neural network. Because the neural network presents no additional computational burden in the control loop we conclude that it is the preferred choice among heuristic predictive algorithms.

Algorithms↗
PubMed2006

Geometric accuracy of a real-time target tracking system with dynamic multileaf collimator tracking system.

PURPOSE: Dynamically compensating for target motion during radiotherapy will increase treatment accuracy. A laboratory system for real-time target tracking with a dynamic MLC has been developed. In this study, the geometric accuracy limits of this DMLC target tracking system were evaluated. METHODS AND MATERIALS: A motion simulator was programmed to follow patient-derived tumor motion paths, parallel to the leaf motion direction. A target attached to the simulator was optically tracked, and the leaf positions adjusted to continually align the DMLC beam aperture to the target. Analysis of the tracking accuracy was based on video images of the target and beam alignment. The system response time was determined and the tracking error measured. Response time-corrected tracking accuracy was also calculated to investigate the accuracy limits of an improved system. RESULTS: The response time of the system is 160 +/- 2 ms. The geometric precision for tracking patient motion is 0.6 to 1.1 mm (1 sigma) for the 3 patient datasets tested, with tracking errors relative to the original patient motion of 35, 40, and 100%. CONCLUSIONS: A DMLC target tracking system has been developed that can account for detected motion parallel to the leaf motion direction. The tracking error has a negligible systematic component. Reducing the response time will further increase the overall system accuracy.

Calibration↗
PubMed2006

The management of respiratory motion in radiation oncology report of AAPM Task Group 76.

This document is the report of a task group of the AAPM and has been prepared primarily to advise medical physicists involved in the external-beam radiation therapy of patients with thoracic, abdominal, and pelvic tumors affected by respiratory motion. This report describes the magnitude of respiratory motion, discusses radiotherapy specific problems caused by respiratory motion, explains techniques that explicitly manage respiratory motion during radiotherapy and gives recommendations in the application of these techniques for patient care, including quality assurance (QA) guidelines for these devices and their use with conformal and intensity modulated radiotherapy. The technologies covered by this report are motion-encompassing methods, respiratory gated techniques, breath-hold techniques, forced shallow-breathing methods, and respiration-synchronized techniques. The main outcome of this report is a clinical process guide for managing respiratory motion. Included in this guide is the recommendation that tumor motion should be measured (when possible) for each patient for whom respiratory motion is a concern. If target motion is greater than 5 mm, a method of respiratory motion management is available, and if the patient can tolerate the procedure, respiratory motion management technology is appropriate. Respiratory motion management is also appropriate when the procedure will increase normal tissue sparing. Respiratory motion management involves further resources, education and the development of and adherence to QA procedures.

Guidelines as Topic↗
PubMed2005

Demonstration of a forward iterative method to reconstruct brachytherapy seed configurations from x-ray projections.

By monitoring brachytherapy seed placement and determining the actual configuration of the seeds in vivo, one can optimize the treatment plan during the process of implantation. Two or more radiographic images from different viewpoints can in principle allow one to reconstruct the configuration of implanted seeds uniquely. However, the reconstruction problem is complicated by several factors: (1) the seeds can overlap and cluster in the images; (2) the images can have distortion that varies with viewpoint when a C-arm fluoroscope is used; (3) there can be uncertainty in the imaging viewpoints; (4) the angular separation of the imaging viewpoints can be small owing to physical space constraints; (5) there can be inconsistency in the number of seeds detected in the images; and (6) the patient can move while being imaged. We propose and conceptually demonstrate a novel reconstruction method that handles all of these complications and uncertainties in a unified process. The method represents the three-dimensional seed and camera configurations as parametrized models that are adjusted iteratively to conform to the observed radiographic images. The morphed model seed configuration that best reproduces the appearance of the seeds in the radiographs is the best estimate of the actual seed configuration. All of the information needed to establish both the seed configuration and the camera model is derived from the seed images without resort to external calibration fixtures. Furthermore, by comparing overall image content rather than individual seed coordinates, the process avoids the need to establish correspondence between seed identities in the several images. The method has been shown to work robustly in simulation tests that simultaneously allow for unknown individual seed positions, uncertainties in the imaging viewpoints and variable image distortion.

Algorithms↗
PubMed2005

On using an adaptive neural network to predict lung tumor motion during respiration for radiotherapy applications.

In this study we address the problem of predicting the position of a moving lung tumor during respiration on the basis of external breathing signals--a technique used for beam gating, tracking, and other dynamic motion management techniques in radiation therapy. We demonstrate the use of neural network filters to correlate tumor position with external surrogate markers while simultaneously predicting the motion ahead in time, for situations in which neither the breathing pattern nor the correlation between moving anatomical elements is constant in time. One pancreatic cancer patient and two lung cancer patients with mid/upper lobe tumors were fluoroscopically imaged to observe tumor motion synchronously with the movement of external chest markers during free breathing. The external marker position was provided as input to a feed-forward neural network that correlated the marker and tumor movement to predict the tumor position up to 800 ms in advance. The predicted tumor position was compared to its observed position to establish the accuracy with which the filter could dynamically track tumor motion under nonstationary conditions. These results were compared to simplified linear versions of the filter. The two lung cancer patients exhibited complex respiratory behavior in which the correlation between surrogate marker and tumor position changed with each cycle of breathing. By automatically and continuously adjusting its parameters to the observations, the neural network achieved better tracking accuracy than the fixed and adaptive linear filters. Variability and instability in human respiration complicate the task of predicting tumor position from surrogate breathing signals. Our results show that adaptive signal-processing filters can provide more accurate tumor position estimates than simpler stationary filters when presented with nonstationary breathing motion.

Biophysical Phenomena↗
PubMed2004

Tracking moving organs in real time.

In an ideal radiotherapy procedure, the treatment system would continuously adapt the radiation beam delivery to changes in the tumor position. The development of such a tracking capability has been underway for more than 10 years, beginning with the CyberKnife image-guided radiosurgery system. In that time, much has been learned about the nature of tumor motion and the technical issues that it presents to a practical real-time tracking system. In this article, I will review the basic concepts behind existing and proposed radiotherapy beam-tracking systems, show clinical evidence of the types of movement that are encountered in real-time tracking situations, describe the corresponding technical problems and solutions, and discuss the unresolved issues in making real-time tumor tracking a practical response to tumor motion.

Humans↗
PubMed2003

Patterns of patient movement during frameless image-guided radiosurgery.

PURPOSE: Image-guided radiosurgery aligns the treatment beam to the target site by using a radiographic imaging system to locate anatomic landmarks associated with the treatment target. Because the procedure is performed without a rigid frame, the precision of dose alignment can be affected by patient movement. Movement is limited by noninvasive restraints and compensated by remeasuring the target position at short intervals throughout treatment and then realigning the beam. Frameless image-guided radiosurgery has been used at our institution to treat 250 cranial, 23 spinal, 9 lung, and 3 pancreas cases involving malignant and benign tumors as well as vascular malformations. We have analyzed the target position records for all of these cases to assess the frequency, magnitude, and case-by-case patterns of patient movement. METHODS AND MATERIALS: The position of the treatment site during image-guided radiosurgery was measured at approximately 1-2-min intervals, on average, using orthogonal amorphous silicon X-ray cameras and an image registration process that determined all six degrees of freedom in the target's position. The change in position from one measurement to the next was indicative of patient movement. RESULTS: The treatment site position along each axis of translation was observed to vary by an average of 0.45 mm for the cranium, 0.53 mm for the cervical spine, 0.53 mm for the lumbar and thoracic spine, 1.06 mm for the lung, and 1.50 mm for the pancreas. Half of all cranial cases showed systematic drifting of the target away from the initial setup position. CONCLUSION: Using noninvasive restraints and supports, short-term movement of the head and spine during image-guided radiosurgery was limited to a radius of 0.8 mm, which satisfies the prevailing standard for radiosurgical dose alignment precision, but maintaining this margin of error throughout a treatment fraction requires regular monitoring of the target site's position.

Brain Neoplasms↗
PubMed2003

Stereotactic radiosurgery for lung tumors: preliminary report of a phase I trial.

BACKGROUND: Stereotactic radiosurgery is well established for the treatment of intracranial neoplasms but its use for lung tumors is novel. METHODS: Twenty-three patients with biopsy-proven lung tumors were recruited into a two-institution, dose-escalation, phase I clinical trial using a frameless stereotactic radiosurgery system (CyberKnife). Fifteen patients had primary lung tumors and 8 had metastatic tumors. The age range was 23 to 87 years (mean, 63 years). After undergoing computed tomography-guided percutaneous placement of two to four small metal fiducials directly into the tumor, patients received 1,500 cGY of radiation in a single fraction using a linear accelerator mounted on a computer-controlled robotic arm. Safety, feasibility, and efficacy were studied. RESULTS: Nine patients were treated with a breath-holding technique, and 14 with a respiratory-gating, automated, robotic technique. Tumor size ranged from 1 to 5 cm in maximal diameter. There were four complications related to fiducial placement: three pneumothoraces requiring chest tube insertion and one emphysema exacerbation. There were no grade 3 to 5 radiation-related complications. Follow-up ranged from 1 to 26 months (mean, 7.0 months). Radiographic response was scored as complete in 2 patients, partial in 15, stable in 4, and progressive in 2. Four patients died of non-treatment-related causes at 1, 5, 9, and 11 months after radiation. CONCLUSIONS: Single-fraction stereotactic radiosurgery is safe and feasible for the treatment of selected lung tumors. Additional studies are planned to investigate the optimal radiation dose, best motion-suppression technique, and overall treatment efficacy.

Adult↗
PubMed2002

The effectiveness of breath-holding to stabilize lung and pancreas tumors during radiosurgery.

PURPOSE: To evaluate the effect of breath-holding on the short-term reproducibility and long-term variability of tumor position during image-guided radiosurgery. METHOD: Thirteen patients have undergone single-fraction radiosurgery treatments during which the tumor was repeatedly imaged radiographically to observe its position. The imaging data were used to monitor the efficacy of breath-holding and to periodically readjust the alignment of the treatment beam with the tumor. These measurements have allowed the effects of breathing, heartbeat, patient movement, and instrumental uncertainties to be separately identified in the record of tumor position. RESULTS: During inspiration breath-holding, the lung tumor position was reproducible to within 1 mm, on average, in the direction of maximum displacement during regular breathing, and to within 1.8 mm in three dimensions overall. The pancreas tumor position in three dimensions was reproducible to within 2.5 mm on average. Some patients showed a slow, steady drift of tumor position during the extended sequence of breath-holds, which was compensated by periodic retargeting of the treatment beam. CONCLUSION: Breath-holding can allow the reduction of tumor motion dosimetry margins to 2 mm or less for lung cancer treatments, provided that the treatment system can detect and adapt to long-term variations in the mean tumor position during a lengthy treatment fraction.

Humans↗
PubMed2002

Issues in respiratory motion compensation during external-beam radiotherapy.

PURPOSE: To investigate how respiration influences the motion of lung and pancreas tumors and to relate the observations to treatment procedures intended to improve dose alignment by predicting the moving tumor's position from external breathing indicators. METHODS AND MATERIALS: Breathing characteristics for five healthy subjects were observed by optically tracking the displacement of the chest and abdomen, and by measuring tidal air volume with a spirometer. Fluoroscopic imaging of five radiotherapy patients detected the motion of lung and pancreas tumors synchronously with external breathing indicators. RESULTS: The external and fluoroscopic data showed a wide range of behavior in the normal breathing pattern and its effects on the position of lung and pancreas tumors. This included transient phase shifts between two different external measures of breathing that diminished to zero over a period of minutes, modulated phase shifts between tumor and chest wall motion, and other complex phenomena. CONCLUSIONS: Respiratory compensation strategies that infer tumor position from external breathing signals, including methods of beam gating and dynamic beam tracking, require three-dimensional knowledge of the tumor's motion trajectory as well as the ability to detect and adapt to transient and continuously changing characteristics of respiratory motion during treatment.

Abdomen↗
PubMed2002

Fiducial-based targeting accuracy for external-beam radiotherapy.

The accuracy of fiducial-based alignment of external radiotherapy beams is analyzed. The study considers three basic computational methods to determine the target position--the exact closed-form solution for three fiducials, the solution via singular value decomposition for four or more fiducials, and the iterative solution for any number of fiducials--and assesses their accuracy, robustness, and efficiency. Particular attention is paid to inaccuracies arising from the variability of fiducial positions in soft tissue. In nearly every test case it is found that all three solution methods, when properly implemented, yield the same result for the target position, but that the method of singular value decomposition must be modified to distinguish rotations from reflections. When an accurate measure of the rotation of the target site is needed, four fiducials give much better results than three, while more than five fiducials gain little further improvement.

Algorithms↗