Defense Date


Document Type


Degree Name

Doctor of Philosophy


Biomedical Engineering

First Advisor

Ding-Yu Fei


Organ motion and inaccurate patient positioning may compromise radiation therapy outcome. With the aid of image guidance, it is possible to allow for a more accurate organ motion and motion control study, which could lead to the reduction of irradiated healthy tissues and possible dose escalation to the target volume to achieve better treatment results. The studies on the organ motion and image guidance were divided into the following four sections. The first, the interfractional setup uncertainties from day-to-day treatment and intrafractional internal organ motion within the daily treatment from five different anatomic sites were studied with Helical TomoTherapy unit. The pre-treatment mega voltage computed tomography (MVCT) provided the real-time tumor and organ shift coordinates, and can be used to improve the accuracy of patient positioning. The interfractional system errors and random errors were analyzed and the suggested margins for HN, brain, prostate, abdomen and lung were derived. The second, lung stereotactic body radiation therapy using the MIDCO BodyLoc whole body stereotactic localizer combined with TomoTherapy MVCT image guidance were investigated for the possible target and organ motion reduction. The comparison of 3D displacement with and without BodyLoc immobilization showed that, suppression of internal organ motion was improved by using BodyLoc in this study. The third, respiration related tumor motion was accurately studied with the four dimensional computed tomography (4DCT). Deformable registration between different breathing phases was performed to estimate the motion trajectory for lung tumor. Optimization is performed by minimizing the mean squared difference in intensity, and is implemented with a multi-resolution, gradient descent procedure. The fourth, lung tumor mobility and dosimetric benefits were compared with different PTV obtained from 3DCT and 4DCT. The results illustrated that the PTV3D not only included excess normal tissues but also might result in missed target tissue. The normal tissue complication probability (NTCP) from 4D plan was statistically significant smaller than 3D plan for both ipsilateral lung and heart.


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