www.buffalo.edu

QUASAR programmable respiratory motion platform has three modes of operation in the platform: oscillation mode, rotation mode and position mode.

●System is controlled by software ●Motions are programmable ●Provides superior-inferior direction ●Not accurate representation of respiratory motion ●Not precise motion tracking of lung cancer tumors

●Create a completely wireless system ● 2nd round of prototyping ● Improve machining process and materials ●Complete tumor tracking studies ●Create system to allow user to input patient data

There will be three designs for this platform, including: cylindrical insert, wall system, and bed system.

Bed-system provides superior - inferior direction (y-direction), including:

○ Thomson rods and bearings ○Wood bed ○ Nema-17-stepper motor ○ Belt ○ Provide a motion in AP direction for the tumor ○Maximum moving distance of 8.0 cm. (6.0 cm is required)

Tumor holder ○ Threaded rod will connect with a motor through a coupling

and provide the SI motion ○ The smooth rod will secure a system and prevent any tremor ○ Both rods will place through two holes designed in the tumor holder

○Hollow space in one end with a distance of 2.0 cm depth to Wall-system provides anterior - posterior direction (z-direction), including:

○ Thomson rod ○ Wood wall ○ Nema-17-stepper motor ○ Tumor holder ○ Be secure perpendicular with a wood bed in a bed system

Abstract

Existing ApproachProject Purpose

Design

Background

Testing and Results

QUASAR Programmable Respiratory Motion Tumor Insert Daniel Shin; An Tran; Jessica Traub; Kunyu Wu

Faculty Advisor: Dr. Iris Wang, PhD and Zheng Zheng Xu

Department of Biomedical Engineering, State University of New York at Buffalo

Roswell Park Cancer InstituteAcknowledgements

References• https://www.roswellpark.org/newsroom/roswell-park-logos • Modulus Medical Devices Inc., Programmable Respiratory Motion Platform - User's Guide • Cella, David F., Amy E. Bonomi, Stephen R. Lloyd, David S. Tulsky, Edward Kaplan, and Philip Bonomi. "Reliability

and Validity of the Functional Assessment of Cancer Therapy—lung (FACT-L) Quality of Life Instrument." ScienceDirect 12, no. 3 (June 1995): 199-220. Accessed March 22, 2016. http://www.sciencedirect.com/science/article/pii/016950029500450F.

• "Lung Cancer." NIHSeniorHealth:. N.p., n.d. Web. 04 Nov. 2015. <http://nihseniorhealth.gov/lungcancer/lungcancerdefined/01.html>.

• Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2012, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2012/, based on November 2014 SEER data submission, posted to the SEER web site, April 2015.

• "CT Quality Assurance Protocol and Its Validation in Various Ministry of Health Hospitals in Oman." World Congress on Medical Physics and Biomedical Engineering. Ed. Dossel Olaf and Schlegel Wolfgang. 1st ed. Vol. 25/3. Springer, 2009. 76. Print.

• "Staging of Lung Cancer." Patient Information Series. American Thoracic Society Patient Education Series, 9 Sept. 2013. Web. 4 Nov. 2015.

Future Work and Other Applications

Figure 5: Insert 3.5. The hollow space allow to motion in range of 0 - 3.5 cm. The tumor holder will be able to move in SI direction with a maximum distance of 3.5 cm.

Lung and bronchus cancer is a serious and prominent disease compared to other cancers. Lung cancer is difficult to be treated without any side effects. Currently, the QUASAR Programmable Respiratory Motion Phantom is designed to simulate the breathing motion of a patient, intended to increase the overall testing capabilities for radiation therapy of lung cancer research. This existing approach improves the precision and accuracy of such radiation therapies but only provides one direction, Superior-Inferior (SI). The goal of this project is to design a tumor insert in order to simulate breathing motion in the Anterior-Posterior (AP) direction and in the Superior and Inferior (SI) direction. This design is beneficial to achieve greater precision and accuracy for tracking lung cancer tumors for radiation therapy using the unidirectional QUASAR respiratory motion phantom as well as a way to improve patient treatment.

Non-small cell lung cancer(NSCLC) ●Common but grow and spread faster ●Difficult to detect in early stage

Small cell lung cancer (SCLC) ●Limited Stage - Occur in one lung ●Extensive Stage - Spread to the other lung

Four different stages of NSCLC based on TNM system ●Stage I - Cancer may be present in the underlying

lung tissues, but the lymph nodes remain unaffected ●Stage II - Cancer may have spread to nearby lymph nodes ●Stage III - Cancer is continuing to spread from the

lungs to the lymph nodes or to nearby structures and organs ●Stage IV - Cancer has metastasized throughout the

body and may now affect the liver, bones or brain

Figure 2: Four different stages of non-small cell lung cancer

Design a platform ! Can support around 3 pounds ! Be able to move in anterior - posterior direction (z-direction) ! Be able to move in superior - inferior direction (y-direction) ! Made of material that does not cause noise and scattering of the

X- Ray photons ! Material should have similar attenuation coefficient number to lung

! Be able to adjust the amplitude and frequency of the motion ! Be able to transport

Project Goals! Have similar breathe rate to humans for tumor tracking research (2D)

! Produce anterior - posterior direction (z-direction) motion ! Produce superior - inferior direction (y-direction) motion ! Can be tested under CT machine ! Can be programmed with various amplitudes and frequencies ! Can easily be transported Software Programs

Figure 7: User Interface - user can adjust the amplitude (A) and period (T)

● Technologies: Image-guided radiation therapy (IGRT) and respiratory gating

●Use body imaging techniques and high beam radiation to track and treat the tumor in the body

● To improve the precision and accuracy of radiation therapies: QUASAR Programmable Respiratory Motion Phantom ○ Simulates the breathing motion of a patient which increases the

overall testing capabilities for radiation therapy ○Contains a body oval, a drive unit, a respiratory phantom mass,

cylindrical cedar inserts, a chest wall platform and power supply ○Designed for dosimetric and non-dosimetric measurement while

testing a moving object ○Contains motion of a cylindrical cedar insert moving in the

Superior and Inferior (SI) direction [1] ○Chest wall platform works as a third-party motion tracking

system and is linked to the QUASAR phantom ○Only unidirectional motion. Breathing motion of the lungs are in 3D

• Dimensions of the bed system is satisfied the requirement. • Tumor holder - Dowel round wood(1-⅛’’) - Reduced machining cost.

• Cylindrical insert - Laser CNC slices of cork adhered by E6000 glue to achieve complete insert. It satisfied the diameter of the cylindrical insert space QUASAR. It satisfied the space requirement for the tumor holder for motion in the Y-direction and Z-direction.

• Material Testing: Both tumor holders satisfied the CT test seen in figure 8. One was coated with nail lacquer and the other was not. They were compared to the existing QUASAR insert material.

• Software Testing: Each motor was tested individually and together for their accuracy. The period and amplitude were measured manually. The results of each trial are seen in table 1.

Preliminary Sketch

Figure 4: Programmable Motion Platform. This image shows a better view of a whole system, including: cylindrical insert, wall system and bed system.

Our prototype

Cylindrical insert ○ Be the same size as the QUASAR’s insert ○ Provide a space through all the insert for the tumor to move ○Hollow space will fit the size of a tumor holder ○Maximum IS motion: 1.0 - 4.0 cm ○ Average IS motion: 2.0 - 3.0 cm ○ Period - 6 seconds

Figure 3: QUASAR Programmable Respiratory Platform

Figure 1: QUASAR Programmable Respiratory Phantom

Table 1: Amplitude and Period Testing and Results

A B

Figure 6: (A) Tumor Insert System. Side View. Finished design with both z-direction and y-direction, and tumor holder. (B) Tumor Insert System. Corner view of completed design.

Interface Trial Failure/Success

Reason for Failure Interface Trial Failure/

SuccessReason for Failure

Up1 F Exceed input

Z -Amplitude

1 S N/A2 S N/A 2 S N/A3 S N/A 3 S N/A

Down1 F Exceed input

Y - Amplitude

1 S N/A2 S N/A 2 S N/A3 S N/A 3 S N/A

Left1 F Exceed input

Z - Time Delay

1 S N/A2 S N/A 2 S N/A3 S N/A 3 S N/A

Right1 F Exceed input

Y – Time Delay

1 S N/A2 S N/A 2 S N/A3 S N/A 3 S N/A

Z – Time Period

1 F Exceed input

Y – Time Period

1 F Exceed input2 F Exceed input 2 F Exceed input3 F Exceed input 3 F Exceed input4 S N/A 4 S N/A

Both Motor

1 S N/A2 S N/A

1. The Arduino program is uploaded to the Arduino Board. The function of the code is to control the motor through the driver. 2. The user interface is written in the Processing Environment. 3. On the interface, there are three sections to control the motor in the Y-direction and the Z-direction. Each motor has two text boxes to let the user input the amplitude and time period. Running both motors allows the user input a time delay for either motor. For each motor, there are two buttons: ‘run’ and ‘stop’. Run starts the code and the movement of the motor. Stop causes the motors to terminate movement. There is a clock and there are controls to adjust the Z-direction up and down and the Y-direction left and right.

Figure 8: CT Testing Results. HU Profile showing both the tumor holder material with and with out nail lacquer compared to original QUASAR insert material.