Development of an in vitro diaphragm motion reproduction system.

This study developed an in vitro diaphragm motion reproduction system (IVDMRS) based on noninvasive and real-time ultrasound imaging to track the internal displacement of the human diaphragm and diaphragm phantoms with a respiration simulation system (RSS). An ultrasound image tracking algorithm (UITA) was used to retrieve the displacement data of the tracking target and reproduce the diaphragm motion in real time using a red laser to irradiate the diaphragm phantom in vitro. This study also recorded the respiration patterns in 10 volunteers. Both simulated and the respiration patterns in 10 human volunteers signals were input to the RSS for conducting experiments involving the reproduction of diaphragm motion in vitro using the IVDMRS. The reproduction accuracy of the IVDMRS was calculated and analyzed. The results indicate that the respiration frequency substantially affects the correlation between ultrasound and kV images, as well as the reproduction accuracy of the IVDMRS due to the system delay time (0.35s) of ultrasound imaging and signal transmission. The utilization of a phase lead compensator (PLC) reduced the error caused by this delay, thereby improving the reproduction accuracy of the IVDMRS by 14.09-46.98%. Applying the IVDMRS in clinical treatments will allow medical staff to monitor the target displacements in real time by observing the movement of the laser beam. If the target displacement moves outside the planning target volume (PTV), the treatment can be immediately stopped to ensure that healthy tissues do not receive high doses of radiation.

An autotuning respiration compensation system based on ultrasound image tracking.

The purpose of this study was to develop an ultrasound image tracking algorithm (UITA) for extracting the exact displacement of internal organs caused by respiratory motion. The program can track organ displacements in real time, and analyze the displacement signals associated with organ displacements via a respiration compensating system (RCS). The ultrasound imaging system is noninvasive and has a high spatial resolution and a high frame rate (around 32 frames/s), which reduces the radiation doses that patients receive during computed tomography and X-ray observations. This allows for the continuous noninvasive observation and compensation of organ displacements simultaneously during a radiation therapy session.This study designed a UITA for tracking the motion of a specific target, such as the human diaphragm. Simulated diaphragm motion driven by a respiration simulation system was observed with an ultrasound imaging system, and then the induced diaphragm displacements were calculated by our proposed UITA. These signals were used to adjust the gain of the RCS so that the amplitudes of the compensation signals were close to the target movements. The inclination angle of the ultrasound probe with respect to the surface of the abdomen affects the results of ultrasound image displacement tracking. Therefore, the displacement of the phantom was verified by a LINAC with different inclination-angle settings of the ultrasound probe. The experimental results indicate that the best inclination angle of the ultrasound probe is 40 degrees, since this results in the target displacement of the ultrasound images being close to the actual target motion. The displacement signals of the tracking phantom and the opposing displacement signals created by the RCS were compared to assess the positioning accuracy of our proposed ultrasound image tracking technique combined with the RCS.When the ultrasound probe was inclined by 40 degrees in simulated respiration experiments using sine waves, the correlation between the target displacement on the ultrasound images and the actual target displacement was around 97%, and all of the compensation rates exceeded 94% after activating the RCS. Furthermore, the diaphragm movements on the ultrasound images of three patients could be captured by our image tracking technique. The test results show that our algorithm could achieve precise point locking and tracking functions on the diaphragm. This study has demonstrated the feasibility of the proposed ultrasound image tracking technique combined with the RCS for compensating for organ displacements caused by respiratory motion.This study has shown that the proposed ultrasound image tracking technique combined with the RCS can provide real-time compensation of respiratory motion during radiation therapy, without increasing the overall treatment time. In addition, the system has modest space requirements and is easy to operate.

The feasibility of the auto tuning respiratory compensation system with ultrasonic image tracking technique.

The purpose of this study is to assess the feasibility of using the analytical technique of ultrasound images in combination with an auto tumor localization system. During respiration, the activity of breathing in and out causes organs displacement at the lower lobe of the lung, and the maximum displacement range happens in the Superior-Inferior (SI) direction. Therefore, in this study all the tumor positioning is in SI direction under respiratory compensation, in which the compensations are carried out to the organs at the lower lobe and adjacent to the lower lobe of lung.In this research, due to the processes of ultrasound imaging generation, image analysis and signal transmission, when the captured respiratory signals are sent to auto tumor localization system, there was a signal time delay. The total delay time of the entire signal transmission process was 0.254 ± 0.023 seconds (with the lowest standard deviation) after implementing a series of analyses. To compensate for this signal delay time (0.254 ± 0.023 sec), a phase lead compensator (PLC) was designed and built into the auto tumor localization system. By analyzing the impact of the delay time and the respiratory waveforms under different frequencies on the phase lead compensator, an overall system delay time can be configured. Results showed as the respiratory frequency increased, variable value ``a'' and the subsequent gain ``k'' in the controller becomes larger. Moreover, value ``a'' and ``k'' increased as the system delay time increased when the respiratory frequency was fixed. The relationship of value ``a'' and ``k'' to the respiratory frequency can be obtained by using the curve fitting method to compensate for the respiratory motion for tumor localization. Through the comparison of the uncompensated signal and the compensated signal performed by the auto tumor localization system on the simulated respiratory signal, the feasibility of using ultrasound image analysis technology combined with the developed auto tumor localization system can be evaluated. The results show that the simulated respiratory signals under different frequencies of 0.5, 0.333, 0.25, 0.2 and 0.167 Hz with phase lead compensators were improved and stabilized. The compensation rate increased to the range of 7.04$∼ $18.82%, and the final compensation rate is about 97%. Therefore the auto tumor localization system combined with the ultrasound image analysis techniques is feasible.In this study, the developed ultrasound image analysis techniques combined into the auto tumor localization system has the following four advantages: (1) It is a non-invasive way (ultrasonic images) to monitor the entire compensating process of the active respiration instead of using a C-arm (invasive) to observe the organs motion. (2) During radiation therapy, the whole treatment process can be continuous, which can save the overall treatment time. (3) It is an independent system, which can be mounted onto any treatment couch. (4) Users can operate this system easily without the need of prior complicated training process.

Verification and compensation of respiratory motion using an ultrasound imaging system.

PURPOSE: The purpose of this study was to determine if it is feasible to use ultrasound imaging as an aid for moving the treatment couch during diagnosis and treatment procedures associated with radiation therapy, in order to offset organ displacement caused by respiratory motion. A noninvasive ultrasound system was used to replace the C-arm device during diagnosis and treatment with the aims of reducing the x-ray radiation dose on the human body while simultaneously being able to monitor organ displacements. METHODS: This study used a proposed respiratory compensating system combined with an ultrasound imaging system to monitor the compensation effect of respiratory motion. The accuracy of the compensation effect was verified by fluoroscopy, which means that fluoroscopy could be replaced so as to reduce unnecessary radiation dose on patients. A respiratory simulation system was used to simulate the respiratory motion of the human abdomen and a strain gauge (respiratory signal acquisition device) was used to capture the simulated respiratory signals. The target displacements could be detected by an ultrasound probe and used as a reference for adjusting the gain value of the respiratory signal used by the respiratory compensating system. This ensured that the amplitude of the respiratory compensation signal was a faithful representation of the target displacement. RESULTS: The results show that performing respiratory compensation with the assistance of the ultrasound images reduced the compensation error of the respiratory compensating system to 0.81-2.92 mm, both for sine-wave input signals with amplitudes of 5, 10, and 15 mm, and human respiratory signals; this represented compensation of the respiratory motion by up to 92.48%. In addition, the respiratory signals of 10 patients were captured in clinical trials, while their diaphragm displacements were observed simultaneously using ultrasound. Using the respiratory compensating system to offset, the diaphragm displacement resulted in compensation rates of 60%-84.4%. CONCLUSIONS: This study has shown that a respiratory compensating system combined with noninvasive ultrasound can provide real-time compensation of the respiratory motion of patients.