Real-time cancer targeting on a standard linear accelerator.

 

The Problem

  • The human body is a dynamic system
  • Tumours moves during radiotherapy treatment.
  • Standard treatment does not consider motion during irradiation

Our solution

  • Real-time tumour motion monitoring on a standard linear accelerator
  • Purely software solution
  • 6 degrees of freedom monitoring: sub-mm and sub-degree accuracy

How KIM works

 

Intellectual Property

Three granted US patents

    • US 8379794: Method to estimate position, motion of a target with a single X-ray imager
    • US 9084888: Segmentation method
    • US 9314219: Estimation of real-time rotation and translation of a target with a single X-ray imager

Clinical trials

Trial name Description Status/Findings
KIM Pilot for localised prostate cancer Single institution study with KIM (NCT01742403) Funded by Cancer Australia.

55 patients treated to date.

Stereotactic Prostate Adaptive Radiotherapy using KIM (SPARK) Multi-centre Cancer Australia-funded trial with KIM (NCT02397317) Funded by Cancer Australia.

46/48 patients treated.

Two first in human papers (6DoF and beam tracking).

Liver Ablative Radiotherapy with KIM (LARK) Multi-centre Cancer Australia-funded trial for liver cancer SABR (with US/European collaborators) Funded by Cancer Australia. Ethics approved, preparing for patient 1 of 46 total.
KIM fOr Advanced Local prostAte cancer (KOALA) The prostate and skeletal anatomy motion will be simultaneously targeted with KIM Ethics Approved.

Technology in development.

To start in 2020

SPIne Cancer treatment with KIM (SPICK) Use of KIM for an extreme image guidance challenge – monitoring spine motion during treatment In development.

To start in 2020

Conclusions and future work

Kilovoltage Intrafraction Monitoring is a novel real-time tumour localization modality which has successfully been implemented clinically on a patient cohort of 10 patients. Several advantages of Kilovoltage Intrafraction Monitoring include:

  • Being the most accurate real-time tumour localization modality in the world so far (0.46 mm)
  • Low barrier to clinical implementation
  • Widespread applicability

However, one disadvantage of Kilovoltage Intrafraction Monitoring is that it delivers kilovoltage dose to the patient.

Kilovoltage Intrafraction Monitoring allows for the position of the tumour to be determined in real-time. This information can be used to adapt to the motion of the tumour via several strategies. Some of these strategies include radiation beam gating and real-time tumour tracking.

Research Opportunities

For more information and enquiries contact Dr Doan Trang Nguyen

Publications

Nguyen DT, Booth JT, Caillet V, Hardcastle N, Briggs A, Haddad C, Eade T, O’Brien R, Keall PJ. An augmented correlation framework for the estimation of tumour translational and rotational motion during external beam radiotherapy treatments using intermittent monoscopic x-ray imaging and an external respiratory signal. Phys Med Biol. 2018 Oct 9;63(20). doi: 10.1088/1361-6560/aadf2c. [More Information]

Keall PJ, Nguyen DT, O’Brien R, Caillet V, Hewson E, Poulsen PR, Bromley R, Bell L, Eade T, Kneebone A, Martin J, Booth JT. The first clinical implementation of real-time image-guided adaptive radiotherapy using a standard linear accelerator. Radiother Oncol. 2018 Apr;127(1):6-11. doi:10.1016/j.radonc.2018.01.001. [More Information]

Kim, JH., T. Nguyen, DT, Booth, J., Huang, C., Fuangrod, T, Poulsen, P., O’Brien, R., Caillet, V., Eade, T., Kneebone, A., Keall, P. (2018). The accuracy and precision of Kilovoltage Intrafraction Monitoring (KIM) six degree-of-freedom prostate motion measurements during patient treatments. Radiotherapy and Oncology. 126(2). (236-243) [More Information]

Nguyen, D., O’Brien, R., Kim, J., Huang, C., Wilton, L., Greer, P., Legge, K., Booth, J., Poulsen, P., Martin, J., Keall, P. (2017). The first clinical implementation of a real-time six degree of freedom target tracking system during radiation therapy based on Kilovoltage Intrafraction Monitoring (KIM). Radiotherapy and Oncology, 123(1), 37-42. [More Information]

Kim, J., Nguyen, D., Huang, C., Fuangrod, T., Caillet, V., O’Brien, R., Poulsen, P., Booth, J., Keall, P. (2017). Quantifying the accuracy and precision of a novel real-time 6 degree-of-freedom kilovoltage intrafraction monitoring (KIM) target tracking system. Physics in Medicine and Biology, 62(14), 5744-5759. [More Information]

Keall, P., Ng, J., Juneja, P., O’Brien, R., Huang, C., Colvill, E., Caillet, V., Simpson, E., Poulsen, P., Kneebone, A., Eade, T., Booth, J. (2016). Real-Time 3D Image Guidance Using a Standard LINAC: Measured Motion, Accuracy, and Precision of the First Prospective Clinical Trial of Kilovoltage Intrafraction Monitoringe-Guided Gating for Prostate Cancer Radiation Therapy. International Journal of Radiation Oncology: Biology Physics, 94(5), 1015-1021. [More Information]

Keall, P., Ng, J., O’Brien, R., Colvill, E., Huang, C., Poulsen, P., Flederlius, W., Juneja, P., Simpson, E., Bell, L., Booth, J., et al (2015). The first clinical treatment with kilovoltage intrafraction monitoring (KIM): A real-time image guidance method. Medical Physics, 42(1), 354-358. [More Information]

Huang, C., Nasehi Tehrani, J., Ng, J., Booth, J., Keall, P. (2015). Six Degrees-of-Freedom Prostate and Lung Tumor Motion Measurements Using Kilovoltage Intrafraction Monitoring. International Journal of Radiation Oncology: Biology Physics, 91(2), 368-375. [More Information]

Wallace, D., Ng, J., Keall, P., O’Brien, R., Poulsen, P., Juneja, P., Booth, J. (2015). Determining appropriate imaging parameters for kilovoltage intrafraction monitoring: an experimental phantom study. Physics in Medicine and Biology, 60(12), 4835-4847. [More Information]

Ng, J., Booth, J., O’Brien, R., Colvill, E., Huang, C., Poulsen, P., Keall, P. (2014). Quality assurance for the clinical implementation of kilovoltage intrafraction monitoring for prostate cancer VMAT. Medical Physics, 41(11), 111712-1-111712-9. [More Information]

Ng, J., Booth, J., Poulsen, P., Kuncic, Z., Keall, P. (2013). Estimation of effective imaging dose for kilovoltage intratreatment monitoring of the prostate position during cancer radiotherapy. Physics in Medicine and Biology, 58(17), 5983-5996. [More Information]

Nasehi Tehrani, J., O’Brien, R., Poulsen, P., Keall, P. (2013). Real-time estimation of prostate tumor rotation and translation with a kV imaging system based on an iterative closest point algorithm. Physics in Medicine and Biology, 58(23), 8517-8533. [More Information]

Ng, J., Booth, J., Poulsen, P., Fledelius, W., Worm, E., Eade, T., Hegi-Johnson, F., Kneebone, A., Kuncic, Z., Keall, P. (2012). Kilovoltage intrafraction monitoring for prostate intensity modulated arc therapy: First clinical results. International Journal of Radiation: Oncology – Biology – Physics, 84(5), e655-e661. [More Information]

Crocker, J., Ng, J., Keall, P., Booth, J. (2012). Measurement of patient imaging dose for real-time kilovoltage x-ray intrafraction tumour position monitoring in prostate patients. Physics in Medicine and Biology, 57(10), 2969-2980. [More Information]

Wu, J., Ruan, D., Cho, B., Sawant, A., Petersen, J., Newell, L., Cattell, H., Keall, P. (2012). Electromagnetic Detection and Real-Time DMLC Adaptation to Target Rotation During Radiotherapy. International Journal of Radiation: Oncology – Biology – Physics, 82(3), e545-e553. [More Information]

Yoon, J., Sawant, A., Suh, Y., Cho, B., Suh, T., Keall, P. (2011). Experimental investigation of a moving averaging algorithm for motion perpendicular to the leaf travel direction in dynamic MLC target tracking. Medical Physics, 38(7), 3924-3931. [More Information]

Cho, B., Poulsen, P., Sawant, A., Ruan, D., Keall, P. (2011). Real-Time Target Position Estimation Using Stereoscopic Kilovoltage/Megavoltage Imaging and External Respiratory Monitoring for Dynamic Multileaf Collimator Tracking. International Journal of Radiation: Oncology – Biology – Physics, 79(1), 269-278. [More Information]

Poulsen, P., Cho, B., Ruan, D., Sawant, A., Keall, P. (2010). Dynamic Multileaf Collimator Tracking of Respiratory Target Motion Based on a Single Kilovoltage Imager During Arc Radiotherapy. International Journal of Radiation: Oncology – Biology – Physics, 77(2), 600-607. [More Information]

Poulsen, P., Cho, B., Sawant, A., Keall, P. (2010). Implementation of a new method for dynamic multileaf collimator tracking of prostate motion in arc radiotherapy using a single kV imager. International Journal of Radiation: Oncology – Biology – Physics, 76(3), 914-923. [More Information]

Cho, B., Poulsen, P., Keall, P. (2010). Real-time tumor tracking using sequential kV imaging combined with respiratory monitoring: a general framework applicable to commonly used IGRT systems. Physics in Medicine and Biology, 55(12), 3299-3316. [More Information]