title: Multi-institutional feasibility study of a fast patient localization method in total marrow irradiation with helical tomotherapy: a global health initiative by the international consortium of total marrow irradiation.
abstract: OBJECTIVE
  To develop, characterize, and implement a fast patient localization method for total marrow irradiation.
  
  
  METHODS
  Topographic images were acquired using megavoltage computed tomography (MVCT) detector data by delivering static orthogonal beams while the couch traversed through the gantry. Geometric and detector response corrections were performed to generate a megavoltage topogram (MVtopo). We also generated kilovoltage topograms (kVtopo) from the projection data of 3-dimensional CT images to reproduce the same geometry as helical tomotherapy. The MVtopo imaging dose and the optimal image acquisition parameters were investigated. A multi-institutional phantom study was performed to verify the image registration uncertainty. Forty-five MVtopo images were acquired and analyzed with in-house image registration software.
  
  
  RESULTS
  The smallest jaw size (front and backup jaws of 0) provided the best image contrast and longitudinal resolution. Couch velocity did not affect the image quality or geometric accuracy. The MVtopo dose was less than the MVCT dose. The image registration uncertainty from the multi-institutional study was within 2.8 mm. In patient localization, the differences in calculated couch shift between the registration with MVtopo-kVtopo and MVCT-kVCT images in lateral, cranial-caudal, and vertical directions were 2.2 ± 1.7 mm, 2.6 ± 1.4 mm, and 2.7 ± 1.1 mm, respectively. The imaging time in MVtopo acquisition at the couch speed of 3 cm/s was <1 minute, compared with ≥15 minutes in MVCT for all patients.
  
  
  CONCLUSIONS
  Whole-body MVtopo imaging could be an effective alternative to time-consuming MVCT for total marrow irradiation patient localization.
authors.affiliation: Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Takahashi
authors.affiliation: Department of Radiation Oncology, Instituto Nazionale per la Ricerca sul Cancro-National Institute for Cancer Research and University of Genoa, Genoa, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Vagge
authors.affiliation: Department of Radiation Oncology, Instituto Nazionale per la Ricerca sul Cancro-National Institute for Cancer Research and University of Genoa, Genoa, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Agostinelli
authors.affiliation: Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors.forename: Eunyoung
authors.initials: E
authors.lastname: Han
authors.affiliation: Department of Radiation Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice, Poland.
authors.forename: Lukasz
authors.initials: L
authors.lastname: Matulewicz
authors.affiliation: Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany.
authors.forename: Kai
authors.initials: K
authors.lastname: Schubert
authors.affiliation: Department of Therapeutic Radiology, University of Minnesota, Minneapolis, Minnesota; Minnesota Super Computer Institute, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Ravishankar
authors.initials: R
authors.lastname: Chityala
authors.affiliation: Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors.forename: Vaneerat
authors.initials: V
authors.lastname: Ratanatharathorn
authors.affiliation: Department of Radiotherapy, Universitair Ziekenhuis Brussel, Brussels, Belgium.
authors.forename: Koen
authors.initials: K
authors.lastname: Tournel
authors.affiliation: Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors.forename: Jose A
authors.initials: JA
authors.lastname: Penagaricano
authors.affiliation: Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany.
authors.forename: Sterzing
authors.initials: S
authors.lastname: Florian
authors.affiliation: Department of Radiation Oncology, Integrated Center of Oncology-René Gauducheau, Saint-Herblain Cédex, France.
authors.forename: Marc-Andre
authors.initials: MA
authors.lastname: Mahe
authors.affiliation: Divisions of Hematology, Oncology, and Bone Marrow Transplantation, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Verneris
authors.affiliation: Department of Medicine, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Weisdorf
authors.affiliation: Department of Radiation Oncology, Instituto Nazionale per la Ricerca sul Cancro-National Institute for Cancer Research and University of Genoa, Genoa, Italy.
authors.forename: Renzo
authors.initials: R
authors.lastname: Corvo
authors.affiliation: Department of Therapeutic Radiology, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Kathryn E
authors.initials: KE
authors.lastname: Dusenbery
authors.affiliation: Department of Radiotherapy, Universitair Ziekenhuis Brussel, Brussels, Belgium.
authors.forename: Guy
authors.initials: G
authors.lastname: Storme
authors.affiliation: Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota; Department of Therapeutic Radiology, University of Minnesota, Minneapolis, Minnesota. Electronic address: huixx019@umn.edu.
authors.forename: Susanta K
authors.initials: SK
authors.lastname: Hui
mesh_terms: D001853:Bone Marrow / Q000000981:diagnostic imaging; D002985:Clinical Protocols; D005240:Feasibility Studies; D014943:Global Health; D006801:Humans; D007568:Jaw / Q000000981:diagnostic imaging; D019047:Phantoms, Imaging; D011881:Radiotherapy, Computer-Assisted / Q000379:methods*; D020266:Radiotherapy, Conformal / Q000379:methods*; D013997:Time Factors; D036542:Tomography, Spiral Computed / Q000379:methods; D019172:Transplantation Conditioning / Q000379:methods*; D014916:Whole-Body Irradiation