Discussion Items. Discussion Items. Medicare Benefits Schedule. Image Registration in Radiotherapy: Consider the Costs as well as the Benefits

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Image Registration in

Radiotherapy:

Consider the Costs as well as the

Benefits

Kevina Choma

Discussion Items

•Information about the Royal

Brisbane Hospital

•Benefits of Image Registration

•Use of image registration at the

RBH

•Costs of image registration

•Work processes

Central Area Health Services

Cancer Care Services - RBH

Medicare Benefits Schedule

Discussion Items

•Information about the Royal

Brisbane Hospital

•Benefits of Image Registration

•Use of image registration at the

RBH

•Costs of image registration

•Work processes

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Benefits of Image Registration

•The ability to better visualise the GTV

and PTV

Benefits of Image Registration

Benefits of Image Registration

CT based PTV

PET based PTV

Benefits of Image Registration

•The ability to better visualise the GTV

and PTV

•Account for tumour motion through

duration of scan

•Reduced interobserver variations

•Reduction in PTV size for some

patients leading to dose escalation

Benefits of Image Registration

CT–MRI image fusion: delineation of the clinical target volume (CTV) and critical organs. Red line, CT CTV; yellow line, MRI CTV; blue line, rectum (CT); green line, bladder (CT).

Sannazzari, G., Ragona, R., Redda, M, Giglioli, F., Isolato, G., Guarneri, A., (2002), CT-MRI Image Fusion for Delineation of Volumes in Three-Dimensional Conformal Radiation Therapy in the Treatment of Localized Prostate Cancer. The British Journal of Radiology, 75: 603-607.

Potential Sources of Error

•Choose the best technique

•Mismatching non-rigid structures

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Potential Sources of Error

Potential Sources of Error

Potential Sources of Error

Potential Sources of Error

•Choose the best technique

•Mismatching non-rigid structures

•Image Resolution differences

between modalities

•Window levels

Discussion Items

•Information about the Royal

Brisbane Hospital

•Benefits of Image Registration

•Use of image registration at the

RBH

•Costs of image registration

•Work processes

(4)

Image Registration Workload by

Modality

Tumour Type per Modality -PET

Tumour Type per Modality-MRI

Tumour Type per Modality -CT

Discussion Items

•Information about the Royal

Brisbane Hospital

•Benefits of Image Registration

•Use of image registration at the

RBH

•Costs of image registration

•Work processes

Start-up Costs

Treatment planning system

$1,600,000

Data transfer system

$12-30,000

Flat Top Couch

$20,000

Stabilisation equipment

$10,000

Wall mounted lasers

$19,500

Same equipment for RT dept

$10,000

Staff Training

approx 56 FTE hours

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Ongoing Costs

Imaging study

$800

Patient travel/inconvenience up to ~

$600

RT staff in MI department

25FTE hrs/month

Registration and QA

15FTE hrs/month

Opportunity costs 25 less patients simulated/month

40 FTE hrs/month

RO QA time

RO voluming time

Ongoing Costs

Increased complexity of planning and treatment

Ongoing staff training

~ 11/2 FTE hrs/month

Poor registrations – reduced value to patient and

increased time involved in performing registration

Discussion Items

•Information about the Royal

Brisbane Hospital

•Benefits of Image Registration

•Use of image registration at the

RBH

•Costs of image registration

•Work processes

Work Processes

•Collaboration with Medical Imaging department

•Use of PET transmission scan for registration

•Alignment of patient appointments

•Limitation on staff who can perform

registrations

•Use the PET transmission scan as the planning

study

•Use of software based mutual information

algorithm

Conclusion

•The use of image registration potentially

benefits patients having radiation therapy

treatment provided it is used correctly.

•Demand for this tool is increasing

•Important to develop and maintain processes

to ensure quality and cost effectiveness

Thanks for your attention

Thank you to Greg Rattray for advice and

helping with the images

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References

1. Department of Health and Aging, Medicare Benefits Schedule Book (2007), Australian Government, Canberra, ACT.

2. Lavrenkov, K., Christian, J., Partridge, M., Niotiskou,E., Cook, G., Parker, M., Bedford, J., Brada, M. (2007), A Potential to Reduce Pulmonary Toxicity: The Use of Perfusion SPECT with IMRT for Functional Lung Avoidance in Radiotherapy of Non-Small Cell Lung Cancer. Radiotherapy and Oncology, 83: 156-62.

3. Rajasekar, D., Datta, N., Gupta, R., Pradhan, P., (2003), Multimodality Image Fusion in Dose Escalation Studies of Brain Tumours. Journal of Applied Clinical Medical Physics,4(1); 8-16. 4. Harrison,R., (2006), Imaging in Radiotherapy Treatment Planning and Delivery. The British

Journal of Radiology, 79: S1.

5. Lagerwaard,F., van de Vaart, P., Voet, P., Nijssen-Visser, M., Schuchhard-Schipper, H., Joosten, H., Oei, S., Senan, S., (2002), Can Errors in Reconstructing Pre-Chemotherapy Target Volumes Contribute to the Inferiority of Sequential Chemoradiation in Stage III Non-Small Cell Lung Cancer? Lung Cancer, 38: 297-301.

6. Senan, S., De Ruysscher, D., (2005) Critical Review fo PET-CT for Radiotherapy Planning in Lung Cancer. Critical Reviews in Oncology/Hematology,56: 345-351.

7. Moureau-Zabotto,L., Touboul, E., Lerouge, D., Deniaud-Alexandre, E., Grahek, D., Foulquier, J., Petegnief, Y., Gres, B., El Balaa, H., Kerrou K., Montravers, F., Keraudy, K., Tiret,E., Gendre, J., Grange, J., Houry, S., Talbot, J., (2005), Impact of CT and 18F-Deoxyglucose Positron Emission

Tomography Image Fusion for Conformal Radiotherapy in Esophageal Carcinoma. International Journal of Radiation Oncology Biology Physics, 63(2): 340-345.

8. Fox, J., Rengan R., O’Meara,W., Yorke,E., Erdi, Y., Nehmeh, S., Leibel, S., Rosenzweig, K., (2005), Does Registration of PET and Planning CT Images Decrease Interobserver and Intraobserver Variation in Delineating Tumor Volumes for Non-Small-Cell Lung Cancer.

International Journal of Radiation Oncology Biology Physics, 62(1): 70-75. 9. Riegel, A., Berson, A., Destian, S., Ng, T., Tena, L., Mitnick, R., Wong, P., (2006), Variability of

Gross Tumor Volume Delineation in Head-and-Neck Cancer Using CT and PET/CT Fusion.

International Journal of Radiation Oncology Biology Physics, 65(3): 726-732. 10. Breen, S., Publicover, J., De Silva, S., Pond, G., Brock, K., O’Sullivan, B., Cummings, B.,

Dawson, L., Keller, A., Kim, J., Ringash, J., Yu, E., Hendler, A., Waldron, J., (2007), Intraobserver and Interobserver Variability in GTV Delineation on FDG-PET-CT Images of Head and Neck Cancer Patients. International Journal of Radiation Oncology Biology Physics, 68 (3): 763-770.

References

11. Zelefsky, M., Yamada, Y., Fuks, Z., Zhang, Z., Hunt, M., Cahlon, O., Park., J., Shippy, A., (2008)Long-Term Results of Conformal Radiotherapy for Prostate Cancer: Impact of Dose Escalation on Biochemical Tumor Control and Distant Metastases-Free Survival Outcomes.

International Journal of Radiation Oncology Biology Physics, Article in Press (February 2008): 1-6.

12. Kuban, D., Tucker, S., Dong, L., Starkschall G., Huang, E., Cheung, R., Lee, A., Pollack, A., (2008), Long-Term Results of the M.D. Anderson Randomized Dose-Escalation Trial for Prostate Cancer. International Journal of Radiation Oncology Biology Physics, 70(1): 67-74. 13. Rengan, R., Rosenzweig, K., Venkatraman, E., Koutcher, L., Fox, J., Nayak., R., Amols, H.,

Yorke, E., Jackson, A., Ling, C., Leibel, S., (2004), Improved Local Contol with Higher Doses of Radiation in Large-Volume Stage III Non-Small-Cell Lung Cancer. International Journal of Radiation Oncology Biology Physics, 60(3): 741-747.

14. Wulf, J., Baier, K., Mueller, G., Flentje, M., (2005), Dose-Response in Stereotactic Irradiation of Lung Tumors. Radiotherapy and Oncology, 77: 83-87.

15. Rasch, C., Barillot, I., Remeijer, P., Touw, A., van Herk, M., Lebesque, J., (1999), Definition of the Prostate in CT and MRI: A Multiobserver Study. International Journal of Radiation Oncology Biology Physics, 43(1): 57-66.

16. Sannazzari, G., Ragona, R., Redda, M, Giglioli, F., Isolato, G., Guarneri, A., (2002), CT-MRI Image Fusion for Delineation of Volumes in Three-Dimensional Conformal Radiation Therapy in the Treatment of Localized Prostate Cancer. The British Journal of Radiology, 75: 603-607. 17. Lips, I., Dehnad, H., Kruger, A., van Moorselaar, J., van der Heide, U., Battermann, J., van Vulpen, M., (2007) Health-Related Quality of Life in Patients with Locally Advanced Prostate Cancer after 76 gy Intensity-Modulated Radiotherapy vs 70gy Conformal Radiotherapy in a Prospective and Longitudinal Study. International Journal of Radiation Oncology Biology Physics, 69(3): 656-661.

18. Greco, C., Rosenzweig, K., Cascini, G., Tamburrini, O.,(2007), Current Status of PET/CT for Tumour Volume Definition in Radiotherapy Treatment Planning for Non-Small Cell Lung Cancer (NSCLC). Lung Cancer, 57: 125-134.

19. Sarkar, A., Santiago, R., Smith, R., Kassaee, A., (2005), Comparison of Manual vs Automated Multimodality (CT-MR) Image Registration for Brain Tumours. Medical Dosimetry, 30(1): 20-24. 20. Ireland, R., Dyker, K., Carber, D., Wood, S., Hanney, M., Tindale, W., Woodhouse, N., Hoggard,

N., Conway, Robinson, M., (2007) Nonrigid Image Registration for Head and Neck Cancer Radiotherapy Treatment Planning with PET/CT. International Journal of Radiation Oncology Biology Physics, 68(3): 952-957.

16

th

ISRRT World Congress

Gold Coast - Australia

“Tomorrow and Beyond: Connecting and

Communicating”

9 – 12 September, 2010

Come to Australia for

For enquiries email events@air.asn.au

See us at the booth in Durban 2008

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