Real-time Image Registration for 3-D Ultrasound Guided Partial Breast Irradiation

描述(申请人提供)：乳腺癌是美国女性最常见的恶性肿瘤。据估计，每年新诊断的乳腺癌有22.5万人。外照射乳腺局部照射(EB-PBI)是治疗I、II期乳腺癌的一种无创、省时、经济的放射治疗方法。然而，由于治疗计划中靶区体积的错误描述以及治疗过程中肿块切除空洞和乳房变形，EB-PBI的治疗质量受到靶区定位不准确的影响。目前在我所现有的EB-PBI中集成了一台体积型乳腺超声扫描仪(VBUS)，可实现对乳腺图像的机载处理。本项目的目的是开发一种实时图像配准工具，将计划计算机断层扫描(CT)图像自动配准到计划或正在治疗的三维超声乳腺图像上。我们计划测试这样一种假设：1)实时可变形图像配准(DIR)算法的实施将使我们能够建模乳房和肿块切除腔随着治疗过程的变形，以及2)这一新开发的计算工具将使我们能够通过根据最新的患者解剖结构优化治疗计划来提高给药剂量的精度和辅助正常组织的节省。我们的具体目标和可衡量的目标是：1)开发基于GPU的超高速图像配准工具，用于超声和CT图像配准；2)通过对一系列数字体模、实验体模和真实患者的数据集进行顺序测试，验证和评估所开发的配准工具；3)演示实时图像配准工具的开发将使精确的目标定位和最佳剂量分布成为可能。该项目的成功将提供一种利用机载治疗超声图像以高效和准确的方式定位治疗目标体积的方法。因此，它将提高治疗的精确度，同时节省邻近的健康组织，从而提高乳腺癌患者护理的治疗质量。此外，这项工作中开发的一般方法学对乳腺癌以外的各种癌症的放射治疗具有广泛的适用性。 公共卫生相关性：本项目通过开发实时图像配准计算工具，创新性地将三维超声乳房成像技术融入在线自适应乳房放射治疗系统。这一在线自适应乳房放射治疗范例将通过精确定位靶区和最佳补偿乳房解剖变化，大幅提高乳腺癌患者护理的治疗质量。

DESCRIPTION (provided by applicant): Breast cancer is the most common malignancy of women in the USA. It is estimated that 225,000 new breast cancers are diagnosed every year. External beam partial breast irradiation (EB-PBI) is a non-invasive, time- efficient and cost-effective radiation therapy treatment paradigm for stage I and II breast cancer. However, the treatment quality of EB-PBI suffers from inaccurate target location due to the misrepresentation of target volume during treatment planning and lumpectomy cavity and breast deformation during the treatment course. Onboard treatment breast image is currently available by integer a volumetric breast ultrasound scanner (VBUS) into the existing EB-PBI in our institute. The object of this project is to develop a real-time image registration tool to automatically register the planning computed tomography (CT) image to the planning or on- treatment 3-D ultrasound breast image. We plan to test the hypothesis that 1) the implementation of the real- time deformable image registration (DIR) algorithm will enable us to model the breast and lumpectomy cavity deformation as treatment progresses and 2) this new developed computational tool will permit us to improve the precision of delivery dose and sparing of adjunct normal tissue by optimizing the treatment plan in accordant with up-to-date patient anatomy. Our specific aims and measurable objectives are: 1) to develop a GPU-based ultrafast image registration tool for ultrasound and CT images registration; 2) to validate and assess the developed registration tool by sequentially testing on series of digital phantoms, experimental phantoms, and real patients' data sets; 3) to demonstrate that development of the real-time image registration tool will enable precise target location and optimal dose distribution. The success of the proposed project will provide a method that utilizes on-board treatment ultrasound images to locate treatment target volume in an efficient and accurate way. Consequently it will enhance the therapeutic quality of breast cancer patient care by improving the precision of treatment delivery while sparing adjacent healthy tissues. Additionally, the general methodology developed in this work has a broad applicability to the radiation therapy of a variety of cancers other than breast cancer. PUBLIC HEALTH RELEVANCE: This project is to innovatively incorporate the 3-D ultrasound breast imaging technique into the online adaptive breast radiotherapy system through developing a real-time image registration computational tool. This online adaptive breast radiotherapy paradigm will substantially improve the therapeutic quality of breast cancer patient care by precisely locating target volume and optimally compensating for breast anatomy changes.