Online 4D ultrasound guidance for real-time motion compensation by MLC tracking

PURPOSE: With the trend in radiotherapy moving toward dose escalation and hypofractionation, the need for highly accurate targeting increases. While MLC tracking is already being successfully used for motion compensation of moving targets in the prostate, current real-time target localization methods rely on repeated x-ray imaging and implanted fiducial markers or electromagnetic transponders rather than direct target visualization. In contrast, ultrasound imaging can yield volumetric data in real-time (3D + time = 4D) without ionizing radiation. The authors report the first results of combining these promising techniques-online 4D ultrasound guidance and MLC tracking-in a phantom. METHODS: A software framework for real-time target localization was installed directly on a 4D ultrasound station and used to detect a 2 mm spherical lead marker inside a water tank. The lead marker was rigidly attached to a motion stage programmed to reproduce nine characteristic tumor trajectories chosen from large databases (five prostate, four lung). The 3D marker position detected by ultrasound was transferred to a computer program for MLC tracking at a rate of 21.3 Hz and used for real-time MLC aperture adaption on a conventional linear accelerator. The tracking system latency was measured using sinusoidal trajectories and compensated for by applying a kernel density prediction algorithm for the lung traces. To measure geometric accuracy, static anterior and lateral conformal fields as well as a 358° arc with a 10 cm circular aperture were delivered for each trajectory. The two-dimensional (2D) geometric tracking error was measured as the difference between marker position and MLC aperture center in continuously acquired portal images. For dosimetric evaluation, VMAT treatment plans with high and low modulation were delivered to a biplanar diode array dosimeter using the same trajectories. Dose measurements with and without MLC tracking were compared to a static reference dose using 3%/3 mm and 2%/2 mm γ-tests. RESULTS: The overall tracking system latency was 172 ms. The mean 2D root-mean-square tracking error was 1.03 mm (0.80 mm prostate, 1.31 mm lung). MLC tracking improved the dose delivery in all cases with an overall reduction in the γ-failure rate of 91.2% (3%/3 mm) and 89.9% (2%/2 mm) compared to no motion compensation. Low modulation VMAT plans had no (3%/3 mm) or minimal (2%/2 mm) residual γ-failures while tracking reduced the γ-failure rate from 17.4% to 2.8% (3%/3 mm) and from 33.9% to 6.5% (2%/2 mm) for plans with high modulation. CONCLUSIONS: Real-time 4D ultrasound tracking was successfully integrated with online MLC tracking for the first time. The developed framework showed an accuracy and latency comparable with other MLC tracking methods while holding the potential to measure and adapt to target motion, including rotation and deformation, noninvasively

Attenuation of the Calypso® system in a linear accelerator

Mestrado em Radiações Aplicadas às Tecnologias da SaúdeAccuracy is the keyword when it comes to radiotherapy. More advanced treatments usually take more time, so immobilization is mandatory. However, immobilization does not resolve the intrafraction motion problem, whether it is caused by natural processes such as breathing and heart beating or patient intentional movement. This question led to the development of the Calypso® 4D Localization System. This is a system that monitors internal movement when treating allowing to interrupt and to correct any shift that occurs during treatment (intrafraction motion). That way it is possible to detect when the patient moves and also to account for internal movement. This technology was recently acquired and installed in Champalimaud Clinical Center. Considering that I am a radiation therapist in this center where the purpose is to ensure good quality of administered treatments, I could not do but to direct this work towards the field in which I dwell daily. It is advisable to study the effect of any new equipment in treatment delivery and that gives the opportunity to acquire and to explore local data. In the first part of this work, a review on state-of-the-art literature is provided (previously submitted in December 2013 and accepted in May 2014), as to allow for a fully comprehension of the subject discussed here: how Calypso® system works, its advantages when compared to other monitoring systems available and how it is being used around the world. After knowing how Calypso® works, one question is inevitable. In order to monitor the patient continuously an array is positioned above the patient during the treatment and the treatment planning system does not account for that. How much dose does the array attenuate? The second part of this work assesses this subject. A study was performed by measuring the transmitted radiation of several beams (with beam energy, field size and gantry angle variation) with and without the array in the beam path and the attenuation was calculated and analyzed (previously submitted in May). Finally, the third part of this work studies radiation attenuation in treatment tabletops. It was noted when Calypso® system was being installed that changing the treatment table was part of the installation process. For the system to work properly no electric conductive materials are allowed in the array’s volume detection, as the system functions by electromagnetic detection. Carbon fiber is an electric conductive material so the Varian Exact IGRT tabletop was replaced by a table with the two exchangeable inserts kVueTM Universal Tip Insert (carbon fibre) and kVueTM Calypso ® Varian Insert (kevlar). A study was performed in order to determine if there was any loss in treatment administration quality due to the radiation attenuated in the treatment tabletop. Radiation measurements were performed without tabletop and also with each of the three tabletops (with beam energy, field size and gantry angle variation). Attenuation was calculated for the three tabletops. It was assessed if new tabletops attenuated more or less radiation than the original one, and it was considered if it was adequate not to switch between kVueTM Calypso® Varian and kVueTM Universal Tip tabletops according to the use of calypso system or not, respectively. It is noteworthy that the Master Commission authorized the presentation of this work as three scientific articles written in English, with the purpose of future publication in international, peer-reviewed journals. In order to do so it respects some criteria related to this objective.info:eu-repo/semantics/publishedVersio

Cancer Detection Using Advanced UWB Microwave Technology

Medical diagnosis and subsequent treatment efficacy hinge on innovative imaging modalities. Among these, Microwave Imaging (MWI) has emerged as a compelling approach, offering safe and cost-efficient visualization of the human body. This comprehensive research explores the potential of the Huygens principle-based microwave imaging algorithm, specifically focusing on its prowess in cancer, lesion, and infection detection. Extensive experimentation employing meticulously crafted phantoms validates the algorithm’s robustness. In the context of lung infections, this study harnesses the power of Huygens-based microwave imaging to detect lung-COVID-19 infections. Employing Microstrip and horn antennas within a frequency range of 1 to 5 GHz and a multi-bistatic setup in an anechoic chamber, the research utilizes phantoms mimicking human torso dimensions and dielectric properties. Notably, the study achieves a remarkable detection capability, attaining a signal-to-clutter ratio of 7 dB during image reconstruction using S21 signals.A higher SCR ratio indicates better contrast and clarity of the detected inclusion, which is essential for reliable medical imaging. It is noteworthy that this achievement is realized in free space without necessitating coupling liquid, underscoring the algorithm’s practicality. Furthermore, the research delves into the validation of Huygens Principle (HP)-based microwave imaging in detecting intricate lung lesions. Utilizing a meticulously designed multi-layered phantom with characteristics closely mirroring human anatomy, the study spans frequency bands from 0.5 GHz to 3 GHz within an anechoic chamber. The outcomes are compelling, demonstrating consistent lesion detection within reconstructed images. Impressively, the signal-to-clutter ratio post-artifact removal surges to 13.4 dB, affirming the algorithm’s potential in elevating medical imaging precision. To propel the capabilities of MWI further, this research unveils a novel device: 3D microwave imaging rooted in Huygens principle. Leveraging MammoWave device’s capabilities, the study ventures into 3D image reconstruction. Dedicated phantoms housing 3D structured inclusions, each embodying distinct dielectric properties, serve as the experimental bedrock. Through an intricate interplay of data acquisition and processing, the study attains a laudable feat: seamless 3D visualization of inclusions across various z-axis planes, accompanied by minimal dimensional error not exceeding 7.5%. In a parallel exploration, spiral-like measurement configurations enter the spotlight. These configurations, meticulously tailored along the z-axis, yield promising results. The research unveils an innovative approach to reducing measurement time while safeguarding imaging fidelity. Notably, spiral-like measurements achieve a notable 50% reduction in measurement time, albeit with slight trade-offs. Signal-to-clutter ratios experience a modest reduction, and there is a minor increase in dimensional analysis error, which remains within the confines of 3.5%. The research findings serve as a testament to MWI’s efficacy across diverse medical domains. The success in lung infection and lesion detection underscores its potential impact on medical diagnostics. Moreover, the foray into 3D imaging and the strategic exploration of measurement configurations lay the foundation for future advancements in microwave imaging technologies. As a result, the outcomes of this research promise to reshape the landscape of accurate and efficient medical imaging modalities

Brain and Human Body Modeling

This open access book describes modern applications of computational human modeling with specific emphasis in the areas of neurology and neuroelectromagnetics, depression and cancer treatments, radio-frequency studies and wireless communications. Special consideration is also given to the use of human modeling to the computational assessment of relevant regulatory and safety requirements. Readers working on applications that may expose human subjects to electromagnetic radiation will benefit from this book’s coverage of the latest developments in computational modelling and human phantom development to assess a given technology’s safety and efficacy in a timely manner. Describes construction and application of computational human models including anatomically detailed and subject specific models; Explains new practices in computational human modeling for neuroelectromagnetics, electromagnetic safety, and exposure evaluations; Includes a survey of modern applications for which computational human models are critical; Describes cellular-level interactions between the human body and electromagnetic fields

Brain and Human Body Modeling

This open access book describes modern applications of computational human modeling with specific emphasis in the areas of neurology and neuroelectromagnetics, depression and cancer treatments, radio-frequency studies and wireless communications. Special consideration is also given to the use of human modeling to the computational assessment of relevant regulatory and safety requirements. Readers working on applications that may expose human subjects to electromagnetic radiation will benefit from this book’s coverage of the latest developments in computational modelling and human phantom development to assess a given technology’s safety and efficacy in a timely manner. Describes construction and application of computational human models including anatomically detailed and subject specific models; Explains new practices in computational human modeling for neuroelectromagnetics, electromagnetic safety, and exposure evaluations; Includes a survey of modern applications for which computational human models are critical; Describes cellular-level interactions between the human body and electromagnetic fields

1-D broadside-radiating leaky-wave antenna based on a numerically synthesized impedance surface

A newly-developed deterministic numerical technique for the automated design of metasurface antennas is applied here for the first time to the design of a 1-D printed Leaky-Wave Antenna (LWA) for broadside radiation. The surface impedance synthesis process does not require any a priori knowledge on the impedance pattern, and starts from a mask constraint on the desired far-field and practical bounds on the unit cell impedance values. The designed reactance surface for broadside radiation exhibits a non conventional patterning; this highlights the merit of using an automated design process for a design well known to be challenging for analytical methods. The antenna is physically implemented with an array of metal strips with varying gap widths and simulation results show very good agreement with the predicted performance

Beam scanning by liquid-crystal biasing in a modified SIW structure

A fixed-frequency beam-scanning 1D antenna based on Liquid Crystals (LCs) is designed for application in 2D scanning with lateral alignment. The 2D array environment imposes full decoupling of adjacent 1D antennas, which often conflicts with the LC requirement of DC biasing: the proposed design accommodates both. The LC medium is placed inside a Substrate Integrated Waveguide (SIW) modified to work as a Groove Gap Waveguide, with radiating slots etched on the upper broad wall, that radiates as a Leaky-Wave Antenna (LWA). This allows effective application of the DC bias voltage needed for tuning the LCs. At the same time, the RF field remains laterally confined, enabling the possibility to lay several antennas in parallel and achieve 2D beam scanning. The design is validated by simulation employing the actual properties of a commercial LC medium

Optimization and validation of a new 3D-US imaging robot to detect, localize and quantify lower limb arterial stenoses

L’athérosclérose est une maladie qui cause, par l’accumulation de plaques lipidiques, le durcissement de la paroi des artères et le rétrécissement de la lumière. Ces lésions sont généralement localisées sur les segments artériels coronariens, carotidiens, aortiques, rénaux, digestifs et périphériques. En ce qui concerne l’atteinte périphérique, celle des membres inférieurs est particulièrement fréquente. En effet, la sévérité de ces lésions artérielles est souvent évaluée par le degré d’une sténose (réduction >50 % du diamètre de la lumière) en angiographie, imagerie par résonnance magnétique (IRM), tomodensitométrie ou échographie. Cependant, pour planifier une intervention chirurgicale, une représentation géométrique artérielle 3D est notamment préférable. Les méthodes d’imagerie par coupe (IRM et tomodensitométrie) sont très performantes pour générer une imagerie tridimensionnelle de bonne qualité mais leurs utilisations sont dispendieuses et invasives pour les patients. L’échographie 3D peut constituer une avenue très prometteuse en imagerie pour la localisation et la quantification des sténoses. Cette modalité d’imagerie offre des avantages distincts tels la commodité, des coûts peu élevés pour un diagnostic non invasif (sans irradiation ni agent de contraste néphrotoxique) et aussi l’option d’analyse en Doppler pour quantifier le flux sanguin. Étant donné que les robots médicaux ont déjà été utilisés avec succès en chirurgie et en orthopédie, notre équipe a conçu un nouveau système robotique d’échographie 3D pour détecter et quantifier les sténoses des membres inférieurs. Avec cette nouvelle technologie, un radiologue fait l’apprentissage manuel au robot d’un balayage échographique du vaisseau concerné. Par la suite, le robot répète à très haute précision la trajectoire apprise, contrôle simultanément le processus d’acquisition d’images échographiques à un pas d’échantillonnage constant et conserve de façon sécuritaire la force appliquée par la sonde sur la peau du patient. Par conséquent, la reconstruction d’une géométrie artérielle 3D des membres inférieurs à partir de ce système pourrait permettre une localisation et une quantification des sténoses à très grande fiabilité. L’objectif de ce projet de recherche consistait donc à valider et optimiser ce système robotisé d’imagerie échographique 3D. La fiabilité d’une géométrie reconstruite en 3D à partir d’un système référentiel robotique dépend beaucoup de la précision du positionnement et de la procédure de calibration. De ce fait, la précision pour le positionnement du bras robotique fut évaluée à travers son espace de travail avec un fantôme spécialement conçu pour simuler la configuration des artères des membres inférieurs (article 1 - chapitre 3). De plus, un fantôme de fils croisés en forme de Z a été conçu pour assurer une calibration précise du système robotique (article 2 - chapitre 4). Ces méthodes optimales ont été utilisées pour valider le système pour l’application clinique et trouver la transformation qui convertit les coordonnées de l’image échographique 2D dans le référentiel cartésien du bras robotisé. À partir de ces résultats, tout objet balayé par le système robotique peut être caractérisé pour une reconstruction 3D adéquate. Des fantômes vasculaires compatibles avec plusieurs modalités d’imagerie ont été utilisés pour simuler différentes représentations artérielles des membres inférieurs (article 2 - chapitre 4, article 3 - chapitre 5). La validation des géométries reconstruites a été effectuée à l`aide d`analyses comparatives. La précision pour localiser et quantifier les sténoses avec ce système robotisé d’imagerie échographique 3D a aussi été déterminée. Ces évaluations ont été réalisées in vivo pour percevoir le potentiel de l’utilisation d’un tel système en clinique (article 3- chapitre 5).Atherosclerosis is a disease caused by the accumulation of lipid deposits inducing the remodeling and hardening of the vessel wall, which leads to a progressive narrowing of arteries. These lesions are generally located on the coronary, carotid, aortic, renal, digestive and peripheral arteries. With regards to peripheral vessels, lower limb arteries are frequently affected. The severity of arterial lesions are evaluated by the stenosis degree (reduction > 50.0 % of the lumen diameter) using angiography, magnetic resonance angiography (MRA), computed tomography (CT) and ultrasound (US). However, to plan a surgical therapeutic intervention, a 3D arterial geometric representation is notably preferable. Imaging methods such as MRA and CT are very efficient to generate a three-dimensional imaging of good quality even though their use is expensive and invasive for patients. 3D-ultrasound can be perceived as a promising avenue in imaging for the location and the quantification of stenoses. This non invasive, non allergic (i.e, nephrotoxic contrast agent) and non-radioactive imaging modality offers distinct advantages in convenience, low cost and also multiple diagnostic options to quantify blood flow in Doppler. Since medical robots already have been used with success in surgery and orthopedics, our team has conceived a new medical 3D-US robotic imaging system to localize and quantify arterial stenoses in lower limb vessels. With this new technology, a clinician manually teaches the robotic arm the scanning path. Then, the robotic arm repeats with high precision the taught trajectory and controls simultaneously the ultrasound image acquisition process at even sampling and preserves safely the force applied by the US probe. Consequently, the reconstruction of a lower limb arterial geometry in 3D with this system could allow the location and quantification of stenoses with high accuracy. The objective of this research project consisted in validating and optimizing this 3D-ultrasound imaging robotic system. The reliability of a 3D reconstructed geometry obtained with 2D-US images captured with a robotic system depends considerably on the positioning accuracy and the calibration procedure. Thus, the positioning accuracy of the robotic arm was evaluated in the workspace with a lower limb-mimicking phantom design (article 1 - chapter 3). In addition, a Z-phantom was designed to assure a precise calibration of the robotic system. These optimal methods were used to validate the system for the clinical application and to find the transformation which converts image coordinates of a 2D-ultrasound image into the robotic arm referential. From these results, all objects scanned by the robotic system can be adequately reconstructed in 3D. Multimodal imaging vascular phantoms of lower limb arteries were used to evaluate the accuracy of the 3D representations (article 2 - chapter 4, article 3 - chapter 5). The validation of the reconstructed geometry with this system was performed by comparing surface points with the manufacturing vascular phantom file surface points. The accuracy to localize and quantify stenoses with the 3D-ultrasound robotic imaging system was also determined. These same evaluations were analyzed in vivo to perceive the feasibility of the study

The Largest Unethical Medical Experiment in Human History

This monograph describes the largest unethical medical experiment in human history: the implementation and operation of non-ionizing non-visible EMF radiation (hereafter called wireless radiation) infrastructure for communications, surveillance, weaponry, and other applications. It is unethical because it violates the key ethical medical experiment requirement for “informed consent” by the overwhelming majority of the participants. The monograph provides background on unethical medical research/experimentation, and frames the implementation of wireless radiation within that context. The monograph then identifies a wide spectrum of adverse effects of wireless radiation as reported in the premier biomedical literature for over seven decades. Even though many of these reported adverse effects are extremely severe, the true extent of their severity has been grossly underestimated. Most of the reported laboratory experiments that produced these effects are not reflective of the real-life environment in which wireless radiation operates. Many experiments do not include pulsing and modulation of the carrier signal, and most do not account for synergistic effects of other toxic stimuli acting in concert with the wireless radiation. These two additions greatly exacerbate the severity of the adverse effects from wireless radiation, and their neglect in current (and past) experimentation results in substantial under-estimation of the breadth and severity of adverse effects to be expected in a real-life situation. This lack of credible safety testing, combined with depriving the public of the opportunity to provide informed consent, contextualizes the wireless radiation infrastructure operation as an unethical medical experiment