Download Discussion Items Central Area Health Services Cancer Care

Discussion Items
Image Registration in
Radiotherapy:
Consider the Costs as well as the
Benefits
•Information about the Royal
Brisbane Hospital
•Benefits of Image Registration
•Use of image registration at the
RBH
•Costs of image registration
•Work processes
Kevina Choma
Central Area Health Services
Cancer Care Services - RBH
Medicare Benefits Schedule
Discussion Items
•Information about the Royal
Brisbane Hospital
•Benefits of Image Registration
•Use of image registration at the
RBH
•Costs of image registration
•Work processes
Benefits of Image Registration
Benefits of Image Registration
•The ability to better visualise the GTV
and PTV
Benefits of Image Registration
CT based PTV
PET based PTV
Benefits of Image Registration
•The ability to better visualise the GTV
and PTV
•Account for tumour motion through
duration of scan
•Reduced interobserver variations
•Reduction in PTV size for some
patients leading to dose escalation
Benefits of Image Registration
CT–MRI image fusion: delineation of the clinical target volume (CTV) and critical organs. Red line, CT CTV; yellow line, MRI
CTV; blue line, rectum (CT); green line, bladder (CT).
Potential Sources of Error
•Choose the best technique
•Mismatching non-rigid structures
Sannazzari, G., Ragona, R., Redda, M, Giglioli, F., Isolato, G., Guarneri, A., (2002), CT-MRI Image Fusion for Delineation of Volumes in ThreeDimensional Conformal Radiation Therapy in the Treatment of Localized Prostate Cancer. The British Journal of Radiology, 75: 603-607.
Potential Sources of Error
Potential Sources of Error
Potential Sources of Error
Potential Sources of Error
•Choose the best technique
•Mismatching non-rigid structures
•Image Resolution differences
between modalities
•Window levels
Discussion Items
•Information about the Royal
Brisbane Hospital
•Benefits of Image Registration
•Use of image registration at the
RBH
•Costs of image registration
•Work processes
Image Registration Workload
Image Registration Workload by
Modality
Tumour Type per Modality -PET
Tumour Type per Modality-MRI
Tumour Type per Modality -CT
Discussion Items
Start-up Costs
•Information about the Royal
Brisbane Hospital
•Benefits of Image Registration
•Use of image registration at the
RBH
•Costs of image registration
•Work processes
Treatment planning system
$1,600,000
Data transfer system
$12-30,000
Flat Top Couch
$20,000
Stabilisation equipment
$10,000
Wall mounted lasers
$19,500
Same equipment for RT dept
$10,000
Staff Training
approx 56 FTE hours
Ongoing Costs
Imaging study
$800
Patient travel/inconvenience up to ~
$600
RT staff in MI department
25FTE hrs/month
Registration and QA
15FTE hrs/month
Opportunity costs 25 less patients simulated/month
40 FTE hrs/month
RO QA time
RO voluming time
Discussion Items
•Information about the Royal
Brisbane Hospital
•Benefits of Image Registration
•Use of image registration at the
RBH
•Costs of image registration
•Work processes
Ongoing Costs
Increased complexity of planning and treatment
Ongoing staff training
~ 11/2 FTE hrs/month
Poor registrations – reduced value to patient and
increased time involved in performing registration
Work Processes
•Collaboration with Medical Imaging department
•Use of PET transmission scan for registration
•Alignment of patient appointments
•Limitation on staff who can perform
registrations
•Use the PET transmission scan as the planning
study
•Use of software based mutual information
algorithm
Conclusion
•The use of image registration potentially
benefits patients having radiation therapy
treatment provided it is used correctly.
•Demand for this tool is increasing
•Important to develop and maintain processes
to ensure quality and cost effectiveness
Thanks for your attention
Thank you to Greg Rattray for advice and
helping with the images
References
References
1. Department of Health and Aging, Medicare Benefits Schedule Book (2007), Australian
Government, Canberra, ACT.
2. Lavrenkov, K., Christian, J., Partridge, M., Niotiskou,E., Cook, G., Parker, M., Bedford, J., Brada,
M. (2007), A Potential to Reduce Pulmonary Toxicity: The Use of Perfusion SPECT with IMRT
for Functional Lung Avoidance in Radiotherapy of Non-Small Cell Lung Cancer. Radiotherapy
and Oncology, 83: 156-62.
3. Rajasekar, D., Datta, N., Gupta, R., Pradhan, P., (2003), Multimodality Image Fusion in Dose
Escalation Studies of Brain Tumours. Journal of Applied Clinical Medical Physics, 4(1); 8-16.
4. Harrison,R., (2006), Imaging in Radiotherapy Treatment Planning and Delivery. The British
Journal of Radiology, 79: S1.
5. Lagerwaard,F., van de Vaart, P., Voet, P., Nijssen-Visser, M., Schuchhard-Schipper, H., Joosten,
H., Oei, S., Senan, S., (2002), Can Errors in Reconstructing Pre-Chemotherapy Target Volumes
Contribute to the Inferiority of Sequential Chemoradiation in Stage III Non-Small Cell Lung
Cancer? Lung Cancer, 38: 297-301.
6. Senan, S., De Ruysscher, D., (2005) Critical Review fo PET-CT for Radiotherapy Planning in
Lung Cancer. Critical Reviews in Oncology/Hematology, 56: 345-351.
7. Moureau-Zabotto,L., Touboul, E., Lerouge, D., Deniaud-Alexandre, E., Grahek, D., Foulquier, J.,
Petegnief, Y., Gres, B., El Balaa, H., Kerrou K., Montravers, F., Keraudy, K., Tiret,E., Gendre, J.,
Grange, J., Houry, S., Talbot, J., (2005), Impact of CT and 18F-Deoxyglucose Positron Emission
Tomography Image Fusion for Conformal Radiotherapy in Esophageal Carcinoma. International
Journal of Radiation Oncology Biology Physics, 63(2): 340-345.
8. Fox, J., Rengan R., O’Meara,W., Yorke,E., Erdi, Y., Nehmeh, S., Leibel, S., Rosenzweig, K.,
(2005), Does Registration of PET and Planning CT Images Decrease Interobserver and
Intraobserver Variation in Delineating Tumor Volumes for Non-Small-Cell Lung Cancer.
International Journal of Radiation Oncology Biology Physics, 62(1): 70-75.
9. Riegel, A., Berson, A., Destian, S., Ng, T., Tena, L., Mitnick, R., Wong, P., (2006), Variability of
Gross Tumor Volume Delineation in Head-and-Neck Cancer Using CT and PET/CT Fusion.
International Journal of Radiation Oncology Biology Physics, 65(3): 726-732.
10. Breen, S., Publicover, J., De Silva, S., Pond, G., Brock, K., O’Sullivan, B., Cummings, B.,
Dawson, L., Keller, A., Kim, J., Ringash, J., Yu, E., Hendler, A., Waldron, J., (2007),
Intraobserver and Interobserver Variability in GTV Delineation on FDG-PET-CT Images of Head
and Neck Cancer Patients. International Journal of Radiation Oncology Biology Physics, 68 (3):
763-770.
11. Zelefsky, M., Yamada, Y., Fuks, Z., Zhang, Z., Hunt, M., Cahlon, O., Park., J., Shippy, A.,
(2008)Long-Term Results of Conformal Radiotherapy for Prostate Cancer: Impact of Dose
Escalation on Biochemical Tumor Control and Distant Metastases-Free Survival Outcomes.
International Journal of Radiation Oncology Biology Physics, Article in Press (February 2008): 16.
12. Kuban, D., Tucker, S., Dong, L., Starkschall G., Huang, E., Cheung, R., Lee, A., Pollack, A.,
(2008), Long-Term Results of the M.D. Anderson Randomized Dose-Escalation Trial for Prostate
Cancer. International Journal of Radiation Oncology Biology Physics, 70(1): 67-74.
13. Rengan, R., Rosenzweig, K., Venkatraman, E., Koutcher, L., Fox, J., Nayak., R., Amols, H.,
Yorke, E., Jackson, A., Ling, C., Leibel, S., (2004), Improved Local Contol with Higher Doses of
Radiation in Large-Volume Stage III Non-Small-Cell Lung Cancer. International Journal of
Radiation Oncology Biology Physics, 60(3): 741-747.
14. Wulf, J., Baier, K., Mueller, G., Flentje, M., (2005), Dose-Response in Stereotactic Irradiation of
Lung Tumors. Radiotherapy and Oncology, 77: 83-87.
15. Rasch, C., Barillot, I., Remeijer, P., Touw, A., van Herk, M., Lebesque, J., (1999), Definition of
the Prostate in CT and MRI: A Multiobserver Study. International Journal of Radiation Oncology
Biology Physics, 43(1): 57-66.
16. Sannazzari, G., Ragona, R., Redda, M, Giglioli, F., Isolato, G., Guarneri, A., (2002), CT-MRI
Image Fusion for Delineation of Volumes in Three-Dimensional Conformal Radiation Therapy in
the Treatment of Localized Prostate Cancer. The British Journal of Radiology, 75: 603-607.
17. Lips, I., Dehnad, H., Kruger, A., van Moorselaar, J., van der Heide, U., Battermann, J., van
Vulpen, M., (2007) Health-Related Quality of Life in Patients with Locally Advanced Prostate
Cancer after 76 gy Intensity-Modulated Radiotherapy vs 70gy Conformal Radiotherapy in a
Prospective and Longitudinal Study. International Journal of Radiation Oncology Biology
Physics, 69(3): 656-661.
18. Greco, C., Rosenzweig, K., Cascini, G., Tamburrini, O.,(2007), Current Status of PET/CT for
Tumour Volume Definition in Radiotherapy Treatment Planning for Non-Small Cell Lung Cancer
(NSCLC). Lung Cancer, 57: 125-134.
19. Sarkar, A., Santiago, R., Smith, R., Kassaee, A., (2005), Comparison of Manual vs Automated
Multimodality (CT-MR) Image Registration for Brain Tumours. Medical Dosimetry, 30(1): 20-24.
20. Ireland, R., Dyker, K., Carber, D., Wood, S., Hanney, M., Tindale, W., Woodhouse, N., Hoggard,
N., Conway, Robinson, M., (2007) Nonrigid Image Registration for Head and Neck Cancer
Radiotherapy Treatment Planning with PET/CT. International Journal of Radiation Oncology
Biology Physics, 68(3): 952-957.
Come to Australia for
16th ISRRT World Congress
Gold Coast - Australia
“Tomorrow and Beyond: Connecting and
Communicating”
9 – 12 September, 2010
For enquiries email [email protected]
See us at the booth in Durban 2008