Biomedical subjects

E Fontenla

Publications and source records attributed to E Fontenla.

5 recordsLinked to original sources

PubMed2001

Using serial imaging data to model variabilities in organ position and shape during radiotherapy.

A model is proposed for incorporating the effects of organ motion into the calculation of dose in a statistical fashion based on serial imaging measurements of organ motion. These measurements can either come from a previously studied population of patients, or they can be specific to the particular patient undergoing therapy. The statistical distribution underlying the measurements of organ motion, including the changes in organ shape, is reconstructed non-parametrically without requiring any assumptions about its functional form. The model is thus capable of simulating organ motions that are not present in the original measurements, yet nonetheless come from the same underlying statistical distribution. The present model overcomes two particular limitations of many organ motion models: (a) the fact that they do not account for changes in organ shape, and (b) the fact that they make physically unrealistic assumptions about the functional form of the statistical distribution of organ motion, such as assuming that it is Gaussian. The present model can form the foundation of methods for the more accurate and clinically relevant calculation of the dose to the target volume and normal tissues.

Algorithms↗

PubMed2001

Numerical analysis of a model of organ motion using serial imaging measurements from prostate radiotherapy.

We previously proposed a model for incorporating the effects of organ motion, including the changes in organ shape, into the calculation of dose in a statistical fashion based on serial imaging measurements of organ motion. In the present paper, numerical studies were used to investigate how the accuracy of the statistical calculation of dose depends on the number of organ motion measurements provided as input into the model. The dose calculated statistically with the model was consistently more accurate than the one obtained by directly resampling the serial measurements of organ motion. It was also more robust relative to the random variabilities present in the input organ motion measurements. The results confirm that the model can reproduce the statistical distribution of the organ motions measured in a serial imaging study, including the changes in organ shape, without making any assumptions about the functional form of this distribution. The model allows a more accurate calculation of dose to be performed from a given number of measurements of organ motion than would otherwise be obtained by directly resampling the measured data. It thus maximizes the information that is extracted from serial imaging measurements.

Algorithms↗

PubMed2001

A variable critical-volume model for normal tissue complication probability.

Predicting late-term normal-tissue complication probability (NTCP) after radiotherapy is an important factor in the optimization of conformal radiotherapy. We propose a new NTCP model, based on the properties of the high dose region. The principal assumption of the new model is that a whole-organ complication will occur when the radiation damage to a normal organ volume (a portion of the total organ) exceeds a threshold value. The dose threshold for complications varies with the size of the volume (percent of the total organ). We hypothesize that a complication occurs if the complication threshold is exceeded for any organ volume. We used the average dose to a volume as a measure of radiation damage to that volume. Also, we used the power law to scale the average dose to various organ volumes to a whole-organ equivalent dose, and to identify the volume with the most harmful dose-size combination-the critical volume. We used a logistic distribution to calculate the probability that the patient will develop a complication, given the dose delivered to the critical volume. We used a maximum likelihood fit to estimate the model parameters for late-term rectal complications in a set of patients treated for prostate carcinoma with external photon beam radiotherapy (EBRT). Good correspondence was found between the experimental data and the model predictions.

Algorithms↗

PubMed1996

Implications of 3-dimensional target shape and motion in aperture design.

To determine the shape of a radiation beam aperture a margin is typically applied to the clinical target volume (CTV) to yield the planning target volume (PTV), and the aperture is then determined from the projection of the PTV onto the aperture plane. This margin accounts for setup variability and organ motion originating from respiration or other physiologic processes. The use of either a uniform margin, or alternatively one which takes into account only the expected magnitude and direction of target motion, fails to account for the three-dimensional nature of the target; such a method neglects the volumetric effect of target shape on the fractional target volume irradiated when the target shifts partially out of the aperture. A mathematical framework is developed to analyze and illustrate the consequences of irradiating an irregular target shape in the presence of target motion. The effect of target shape on volume coverage is demonstrated for selected cases involving conventional BEV aperture design techniques. The volumetric implications of target shape are considered from two complementary points of view. The first involves transformation into a "displacement space," which isolates the volumetric effect of the shape of the target allowing it to be studied independently of the probability distribution of target motion. The second point of view combines the effects of the 3D target shape and the probability distribution of motion in a manner independent of beam direction to yield a 3D "target distribution." The two points of view represent distinct starting points for computation of the expected value of fractional target volume coverage in the presence of target motion. In certain cases it may be beneficial to (1) employ "target distributions" for the target and normal tissues in place of the conventional static PTV and, (2) include the aperture shape, on equal footing with parameters such as beam weights and energies, into a quantitative optimization process explicitly accounting for uncertainties in the position of the target volume and critical structures.

Equipment Design↗

PubMed1995

Evaluation of changes in the size and location of the prostate, seminal vesicles, bladder, and rectum during a course of external beam radiation therapy.

PURPOSE: To document the size and location of the prostate, seminal vesicles, bladder, and rectum throughout the course of external beam radiotherapy. The frequency and range of motion of these organs are quantified. METHODS AND MATERIALS: Ten patients with localized carcinoma of the prostate had conventional simulation followed immediately by a treatment planning computed tomography scan (TPCT0). Once treatment was initiated, each patient had a weekly CT (TPCT1-N) before or after his daily treatment. Anatomical structures from CT were delineated on a computer workstation for analysis. The serial CT sets were spatially registered to the initial scan using image correlation software that brings into congruence the bony pelvis of the different scans. The location of the prostate, seminal vesicles, bladder, and rectum on subsequent scans were compared to TPCT0, as well as to each other. RESULTS: Prostate volumes were observed to vary by an average of +/- 10% during the course of radiation therapy, while the seminal vesicle volumes varied by as much as 100%. Bladder and rectal volumes varied by +/- 30%. Compared to TPCT0, movement of the prostate was demonstrated in all patients. Quantitation of the center-of-mass (CM) showed motion of less than 1 mm in the left-right direction, while motion ranging from 0 to +/- 1 cm was observed in the anterior-posterior and superior-inferior directions. The individual standard deviations of these motions varied from approximately 1-5 mm. These variations were correlated to changes in the dimensions of the bladder and rectum. CONCLUSIONS: Changes in the location of the prostate, seminal vesicles, and normal tissue volumes during the course of radiation therapy occur and have dosimetric consequences that may impact tumor control and normal tissue complication probabilities. Conformal therapy for prostate cancer will require the incorporation of knowledge of the anatomic relationships of these structures as a function of time. Therefore, these uncertainties must be taken into account when designing treatment plans and in considering dose escalation trials.

Humans↗