Patient specific Tumormodeling ; Eye-Tracking; Computer Vsion; Proton Beam Radiotherapie
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Technology plays an increasingly important role in modern medicine - and ophthalmology is no exception. Various new laser treatments, optical coherence tomography, digital fundus photography are only a few of the many advancements in recent years. Ocular oncology is another field that has been revolutionized by the progress of radiotherapy. Today, tumors of the eye such as choroidal melanoma are often treated by charged particle beam irradiation. Within this general class of radiotherapies, proton beam therapy is particularly successful, because it allows for a very accurate and sharp delineation of the irradiated volume. This enables the radiologist to spare as much healthy tissue as possible, but at the same time maximize the therapeutic success. Due to the close proximity of many crucial structures in the eye, such as the optic nerve head, the macula, the ciliary body and the lens, this is especially important.By nature, proton beam radiotherapy is a non-invasive treatment. However, the way it is performed today requires a surgery prior to the actual radiation treatment. Apart from being associated with some risk, the sole purpose of this surgery is to suture reference markers onto the bulbus that are used later for spatial referencing of the tumor during irradiation. In this project we propose a new treatment scheme which will eliminate the need for a pre-treatment surgery. This will significantly increase the patient's safety and comfort, but also considerably reduce the overall cost. It will also open the treatment to more ophthalmologists, because the currently required surgery is technically very demanding and consequently the outcome of the whole treatment procedure is therefore highly observer dependent.The proposed treatment scheme requires a completely new spatial referencing method. We suggest to use a video based eye tracking system for spatial referencing of the patient's eye. A patient specific eye model will be used to infer the position and orientation of the posterior structures of the eye from the tracked anterior parts. The model will incorporate various imaging modalities, such as MRI, CT and fundus photographs, to improve the tumor modeling and hence to provide higher accuracy and better diagnostic value. Moreover, the use of a fully automatic eye tracking system will increase the patient's safety during the irradiation session. Currently, a technician supervising the treatment actively monitors the gaze direction of the patient and interrupts the procedure if necessary, for example in case of sudden eye motions. Compared to the human observer the eye tracking system will react to problems with less delay, which eliminates yet another risk factor of the procedure.We are confident that thorough validation of the system will prove the superiority of the new treatment regime over the current strategy. Our proposed system will be safer, more cost-effective and more accessible to patients suffering from these serious diseases.