Prog Med Phys.  2021 Jun;32(2):40-49. 10.14316/pmp.2021.32.2.40.

In-House Developed Surface-Guided Repositioning and Monitoring System to Complement In-Room Patient Positioning System for Spine Radiosurgery

• Kim KH
• Lee H
• Sohn MJ
• Mun CW

• KMID: 2516963
• DOI: http://doi.org/10.14316/pmp.2021.32.2.40

Abstract

Purpose
This study aimed to develop a surface-guided radiosurgery system customized for a neurosurgery clinic that could be used as an auxiliary system for improving the accuracy, monitoring the movements of patients while performing hypofractionated radiosurgery, and minimizing the geometric misses.
Methods
RGB-D cameras were installed in the treatment room and a monitoring system was constructed to perform a three-dimensional (3D) scan of the body surface of the patient and to express it as a point cloud. This could be used to confirm the exact position of the body of the patient and monitor their movements during radiosurgery. The image from the system was matched with the computed tomography (CT) image, and the positional accuracy was compared and analyzed in relation to the existing system to evaluate the accuracy of the setup.
Results
The user interface was configured to register the patient and display the setup image to position the setup location by matching the 3D points on the body of the patient with the CT image. The error rate for the position difference was within 1-mm distance (min, 一0.21 mm; max, 0.63 mm). Compared with the existing system, the differences were found to be as follows: x=0.08 mm, y=0.13 mm, and z=0.26 mm.
Conclusions
We developed a surface-guided repositioning and monitoring system that can be customized and applied in a radiation surgery environment with an existing linear accelerator. It was confirmed that this system could be easily applied for accurate patient repositioning and intertreatment motion monitoring.

Keyword

Spine radiosurgery; Patient repositioning; Patient monitoring; Point cloud; Surfaceguided radiosurgery

Figure

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  Fig. 1 Three-dimensional surface modeling system architecture and surface-guided radiosurgery (SGRS) in the treatment room: (a) the architecture of the image acquisition using the depth camera, (b) the surface imaging profile in sagittal plane, and (c) the installed SGRS in the treatment room. IR, infrared; LINAC, linear accelerator .

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  Fig. 2 Acquired three-dimensional images using RGB-D cameras: (a) left, (b) center, (c) right direction, and (d) integrated images through the cameras.

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  Fig. 3 Image registration process and user interface integration. 3D, three-dimensional; CT, computed tomography.

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  Fig. 4 Surface-guided radiosurgery user interface in the treatment room. (a) The user interface for the patient setup matching. (b) The phantom experiment using our surface-guided reposition and monitoring system. CT, computed tomography.

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  Fig. 5 Image registration results of surface-guided image to computed tomography (CT) for a phantom and clinical case. (a) The 3D image registration result for a phantom CT and point cloud. (b) The image registration process in the same coordinate plane. (c) The final image in which the point cloud and CT images are registered.

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  Fig. 6 Multi-fractional setup trials using Hausdorff distance in difference plots.

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  Fig. 7 Multi-fractional setup trials involving existing system (ExacTrac, BrainLab, Munich, Germany) and the developed surface-guided radiosurgery (SGRS) in difference plots. (a) The location accuracy of the developed system for the multi-fractional setup trials. (b) The difference for the x, y, and z axis.

Reference

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