Comparisons of 6 fps volume-rendered x-ray digital tomosynthesis TumoTrak-guided to 2D-MRI-guided radiotherapy of lung cancer

Larry Partain, Stanley Benedict, Namho Kim, Megan Daly, Austin Ely, Andrew Hernandez, Samuel Song, Micheal Weil, Vitaliy Ziskin, Kyle Foletta, John Boone, Douglas Boyd

Research output: Chapter in Book/Report/Conference proceedingConference contribution

3 Scopus citations


Retrospective kV x-ray 4DCT treatment planning for lung cancer MV linac treatment is becoming a standard-of-care for this widely used procedure for the largest cancer cause-of-death in the US. It currently provides the best estimate of a fixed-in-time but undulating and closed 3D shell to which a minimum curative-intent radiation dose should be delivered to provide the best estimated patient survival and the least morbidity, usually characterized by quantitative dose-volume-histograms (DVHs). Unfortunately this closed shell volume or internal target volume (ITV) currently has to be increased enough to enclose the full range of respiratory lesion motion (plus set-up etc. uncertainties) which cannot yet be accurately determined in real time during treatment delivery. With accurate motion-tracking, the planning target volume (PTV) or outer "shell" may be reduced by up to 40%. However there is no single 2D plane that precisely follows the reduced-PTV-volume's 3D respiratory motion, currently best estimated by the retrospective hand contouring by a trained and experienced MD radiation oncology MD using the full 3D-time information of 4DCT. Once available, 3D motion tracking in real time has the potential to substantially decrease DVH doses to surrounding organs-at-risk (OARs), while maintaining or raising the curative-intent dose to the lesion itself. The assertion argued here is that, the 3D volume-rendered imaging of lung cancer lesion-trajectories in real-time from TumoTrak digital x-ray tomosythesis, has the potential to provide more accurate 3D motion tracking and improved dose delivery at lower cost than the real time, 2D single slice imaging of MRI-guided radiotherapy.

Original languageEnglish (US)
Title of host publicationMedical Imaging 2019
Subtitle of host publicationPhysics of Medical Imaging
EditorsHilde Bosmans, Guang-Hong Chen, Taly Gilat Schmidt
ISBN (Electronic)9781510625433
StatePublished - Jan 1 2019
EventMedical Imaging 2019: Physics of Medical Imaging - San Diego, United States
Duration: Feb 17 2019Feb 20 2019

Publication series

NameProgress in Biomedical Optics and Imaging - Proceedings of SPIE
ISSN (Print)1605-7422


ConferenceMedical Imaging 2019: Physics of Medical Imaging
Country/TerritoryUnited States
CitySan Diego


  • Digital tomosynthesis
  • Image guidance
  • Kilovoltage x-ray
  • Lung radiotherapy
  • MRI
  • Real-time

ASJC Scopus subject areas

  • Electronic, Optical and Magnetic Materials
  • Atomic and Molecular Physics, and Optics
  • Biomaterials
  • Radiology Nuclear Medicine and imaging


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