All patients underwent fluoro-deoxy-glucose positron emission tomography and computed tomography (FDG-PET-CT) for staging, usually contrast-enhanced. All patients underwent planning CT with a slice thickness of 2.5 mm and a four-dimensional (4D)-CT on a dedicated CT simulator (General Electric RT16, General Electric Company, Boston). Two different 4D image acquisition procedures were used according to the date of patient inclusion in the study. Initially, a 3 phase CT including a physiological inspiration, expiration and free breathing were performed. From the end of 2009, a 10 phase 4D-CT using the Real-time Position Management (RPM®, Varian Medical Systems, Palo Alto, CA, USA) device was used. Patients were immobilized with a thermoplastic mask. In 2010, the diaphragmatic compression was added. Images were transferred to the Eclipse planning system (TPS; Eclipse version 8 to 11 during this period, Varian Medical Systems, Palo Alto, CA, USA).
Real time position management rpm
Manufactured by Agilent Technologies
Sourced in United States
RPM® is a real-time position management system from Agilent Technologies. It provides accurate and reliable tracking of sample position within a laboratory instrument.
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9 protocols using real time position management rpm
1
4D-CT Simulation and FDG-PET-CT Staging for Lung Cancer
2
4D CT Imaging with Respiratory Gating
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4D images from the GE Lightspeed CT scanner were also analyzed with Average Intensity Projection (AIP) and Maximum Intensity Projection (MIP). 4D CT scans were done with phase sorting from Varian Real-time Position Management™ (RPM) with a sinusoidal phantom oscillation cycle. AIP is a set of CT images with average intensity (HU signals) of the pixel at the same location after sorting; MIP is a set of composite CT images with maximum intensity (HU signals) of the pixel at the same location after sorting.
3
Immobilized 4D CT Imaging Protocol
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The patients were immobilized in the supine position with their arms raised above head using vacuum bags. First, the axial scan was performed during free-breathing using Philip Brilliance big bore CT scanner (Philips Medical Systems, Inc., Cleveland, OH, USA). And then patients were conducted spiral scan and 4D scan consecutively, the image layer thickness was set to 3 mm. The axial scan cycle (scan + in-couch time) was 2.8 s. The pitch was 0.938 under spiral scanning. 4D technique was a kind of slow spiral scan mode, which would adjust the pitch according to respiratory rate in 4D scanning (pitch: 0.09 ~ 0.15) [8 (link)]. The respiratory signal was recorded with the Real-Time Position Management (RPM, Varian Medical Systems, Palo Alto, CA, USA) by tracking the trajectory of the infrared markers placed on the patient’s abdomen [9 (link)]. The respiratory signal was transferred to the CT scanning device, where the respiratory phase was matched with the acquired image(s). The 4D volume data were reconstructed into ten sequence images of different respiration phase (0%, 10%, 20% …90%) according to the respiration signal acquired by the RPM system, the 0% phase corresponded to the end-inhalation and the 50% phase corresponded to the end-exhalation. The ten sequence images were reconstructed with the same thickness of 3 mm.
4
4DCT Acquisition and Analysis Protocol
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4DCTs were performed using a GE Lightspeed CT-scan for 15 patients (slice thickness: 2.5 mm) then, due to a change in equipment, Siemens Big Bore CT-scan for the other 15 patients (slice thickness: 1 mm). For the acquisition of the breathing signal, a Varian Real-time Position Management (RPM) was used. Acquisitions were conducted in a free-breathing mode, without fiducial markers. Two 4DCTs (4DCT1 and 4DCT2) were performed on all patients, on two different days (at 24- or 48-h intervals). Patients received no specific breathing instructions (no coaching). Patients were placed in an Orfit All-In-One (AIO) position, either with their arms raised without mask, or arms parallel to their body with a five-point mask encompassing the head and shoulders. Images were separated into 10 phases (0% to 90%) which divided the breathing cycle equally. Phase 0% corresponded to maximum inspiration and phase 50%, approximately maximum expiration. An “average” scan was calculated representing an average image of these 10 phases.
5
4DCT-Based Respiratory Motion Tracking for Radiotherapy
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All patients were placed on the treatment bed in the supine position, fixed by a thermoplastic mask or vacuum bag and scanned with a Brilliance CT Big Bore device (Philips Healthcare, The Netherlands) to obtain 4DCT scans under quiet breathing. An infrared fluorescence module was placed in the sagittal process of the patient’s chest, while an infrared camera acquisition module was placed at the end of the bed to obtain the patient’s motion track. The obtained data were transmitted to a real-time position management system (Real-time Position Management, RPM; Varian Medical Systems, USA) to obtain the patient's respiratory signal. The respiratory cycle was divided into 10 phases: 0%, 10%, 20%, … 90%, of which 50% was the end-inspiratory phase. The corresponding CT images CT0, CT10, CT20, … CT90, were reconstructed in each phase. The average density projection image CTavg was obtained based on the above 10 CTs. Each patient underwent two 4DCT scans before treatment and after 20 fractions of treatment. The scanning thickness and interval were both 3 mm. The scanning range was from 3 cm above the clavicle to the lower abdomen.
6
4DCT Imaging of Swine for Radiation Therapy
7
4D-CT Lung Cancer GTV Analysis
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The 4D-CT images of lung cancer were retrospectively studied in this study. In order to see the GTV dependency, the combination of three phase (40%–60%, 30%–70%, and 0%–90%) selections which most frequently used phase selections and two reconstruction methods (MIP and Min-IP) applied to each 4D-CT case (Table 1 ).
Total 20 cases from lung cancer patients recently completed respiratory gated radiation therapy were selected. The cases could be roughly classified in four segments: right upper lobe (RUL), right lower lobe (RLL), left upper lobe (LUL), and left lower lobe (LLL) (Table 2 ). These patients’ 4D-CT images were sorted in MIP and already treated in 40%–60% duty cycle using Real-time Position Management (RPM; Varian Medical Systems Inc., Palo Alto, CA, USA) system.
Total 20 cases from lung cancer patients recently completed respiratory gated radiation therapy were selected. The cases could be roughly classified in four segments: right upper lobe (RUL), right lower lobe (RLL), left upper lobe (LUL), and left lower lobe (LLL) (
8
Retrospective Analysis of Left-Sided Breast Cancer Radiotherapy
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We retrospectively analyzed the data including the parameters of CT planning scan images and Radiation plan for 67 left-sided BC consecutive patients from The Second Affiliated Hospital of Guangxi Medical University who received RT after breast-conserving surgery (BCS) or mastectomy. Due to the retrospective study design, informed consent was not required. The study was approved by The Second Affiliated Hospital of Guangxi Medical University Ethics Committee (approval No. 2023-KY0003). The study was conducted in accordance with the Declaration of Helsinki (as revised in 2013). Clinical staging and molecular subtype of all patients followed the Guidelines of the Chinese Society of Clinical Oncology (17 (link)). Three days before the CT simulation, patients in the DIBH group were trained by a physical therapist to hold their breath. The CT scans started after the chest had stabilized at the maximum height. A minimal breath-hold duration of at least 30 seconds was considered suitable (18 (link)). FB patients maintained smooth breathing during scanning. Real-time position management (RPM; Varian Medical Systems, Palo Alto, CA, USA) was used to measure the patients’ respiration. An overview of the detailed procedure is shown in Figure 1 .
9
Inclined Breast CT Scans with DIBH
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Patients were scanned on an inclined breast board, using 3mm slices on a 16-slice Philips Big Bore CT scanner (Philips Healthcare, Andover, MA). Due to capacity and resource implications, DIBH scans were usually acquired during a separate appointment from the FB scan. It is acknowledged this may be a limitation of the study, however this was performed due to logistics and resource limitations. Patient position for DIBH scan was reproduced to match that of the FB scan. A minimum of three practice breath holds were performed to ensure patients understood the instructions, could maintain breath hold for the required time and that breath hold level was consistent. Varian Realtime Position Management (RPM) (Varian Medical Systems, Inc, Palo Alto, CA) was used to record and monitor breathing.
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