Proceedings of the ASME 2009 Summer Bioengineering Conference (SBC2009)
June 17-21, Resort at Squaw Creek, Lake Tahoe, CA, USA
DEVELOPMENT OF A PATIENT-SPECIFIC NONLINEAR FINITE ELEMENT MODEL FOR
THE SIMULATION OF LUNG MOTION DURING CANCER RADIATION THERAPY
Jaesung Eom (1) , Chengyu Shi (2), George Xu (1), Suvranu De (1)
(1) Department of Mechanical, Aerospace and
Nuclear Engineering, Rensselaer Polytechnic
Institute, Troy, New York
ABSTRACT
Respiratory motion causes either over-dose to the tumor or under-
dose to the organ at risk in radiation therapy treatment for cancer. In
order to characterize the motion, a nonlinear finite element model of
the lungs has been developed based on 4D computed tomography (CT)
data of a cancer patient with a tumor in the right lung. pressure-volume
(PV) curve data was applied to deform the model in real time.
Realistic results are obtained when contact conditions are imposed
between the pleura and the thoracic cavity.
INTRODUCTION
Radiation therapy is one of the most effective cancer management
approaches. In external beam radiation treatment, a lethal radiation
dose is delivered through precisely conformed external radiation to the
tumor while sparing the adjacent healthy tissues. However, the current
paradigm is based on an assumption that both tumor location and
shape are known and remain unchanged during the course of radiation
delivery. Such a favorable rigid-body relationship does not exist in
anatomical sites such as the thoracic cavity and the abdomen, owing
predominantly to respiratory motions. When the tumor-bearing normal
organs move during radiation therapy, discrepancies between planned
and actually delivered radiation doses can be quite significant. As a
result, although higher radiation doses have shown better local tumor
control, organ motions have unfortunately required less aggressive
treatment strategies having relatively large dose margin to tolerate
potential targeting errors. Hence, it is important to be able to predict
lung motion as part of radiation therapy and know the tumor local in
real time.
Previously developed models have included image-based
techniques, e.g., deformable image registration (DIR) based method
for respiratory motion has been introduced from 4D CT images in [1].
1 Copyright © 2009 by ASME
SBC2009-206169
(2) Department of Radiation Oncology,
University of Texas Health Science Center
at San Antonio, San Antonio, Texas
The difficulty in finding accurate voxel matching between two images
has prompted the development of more accurate physics based
techniques [2]. However, current models mostly apply displacement
boundary conditions to the lung model which is physiologically
incorrect.
To overcome these problems, a patient specific non-linear finite
element (FE) lung model which is simulated based on physiological
conditions has been developed. During inspiration, the diaphragm and
external intercostals contract, increasing the thoracic volume. The
resulting decrease in alveolar pressure causes air to enter the lungs.
Expiration, on the other hand, is passive and the diaphragm relaxes
reducing the thoracic volume and increasing the pressure. The chest
pressure-volume (PV) curve is constructed by plotting lung volumes
against pleural pressures that are estimated from esophageal pressures
[3]. We use such PV curve data to drive lung motion to simulate
breathing.
MATERIAL AND METHODS
A finite element model of the lungs has been developed based on
4D CT images of a cancer patient with a tumor in the right lung.
Figure 1. Geometric modeling with CAD surface
reconstruction
The 4D CT data was categorized based on external breathing curves
into 10 phases. We contoured the 10 phase images into different ROIs
(regions of interest). Subsequently, we selected the end of expiration
(EE) state and the end of inspiration (EI) states. In this study, we have
used the CAD surface reconstruction approach to convert the ROIs
into FE meshes (Figure 1). The primary surfaces were generated from
ROI contour lines in Rhinoceros 3D (Robert McNeel & Associates,
Seattle, WA). From these surfaces, NURBS-based CAD surfaces were
reconstructed and converted into suitable FE meshes using
HYPERMESH (Altair Engineering, Troy, MI). This approach greatly
simplifies the procedure presented in [2] which includes iso-surface
construction, several iterative mesh smoothing, relaxing and
decimation. It also gave us better flexibility to build a FE model than
conventional mesh construction from CT scans. The FE model had
66704 tetrahedral elements and 55947 dofs in total (Figure 2).
Tumor = GTV
(Nonlinear material)
Lungs
Body = Thoracic Cavity
(Nonlinear material)
(Linear material)
Figure 2. Finite element models including a body (Thoracic
cavity), a tumor (Gross target volume) and lungs
The lung tissue has been modeled as a hyperelastic material with
the following expression [4]
0W  c exp  a1Exx2  a2 E yy2  2a4 Exx E yy   c exp  a1Ex2x  a2 Ezz2
1 1
2 2
2a4 Exx Ezz   c exp  a1Ezz2  a2 E yy2  2a4 Ezz E yy 
1 relevant PV curve data to simulate respiratory motion. The PV
2 relationship enables simulation of the lung over the entire breathing
where 0W is the strain energy per unit volume, c, a1, a2, a4 are
material constants derived from experiments, and Exx, Exy etc. are the
components of the Green strain.
A distributed time varying pressure load is applied to the surface
of the lung model. The pressure is obtained from a sinusoidal PV
curve. Notably, the PV curve represents the elastic properties of the
lung including nonlinearity with the lung becoming stiffer at higher
volumes and hysteresis between inflation and deflation. The
simulation is carries out using a standard finite element software code
ABAQUS (Dassault Systems, Providence, RI). Frictionless contact is
modeled between the lungs and the thoracic cavity.
Figure 3. Displacement of the right lung at EI in (cm) a) with
contact condition, b) without contact condition
RESULTS
The simulations have been carried out on an Intel Core2
Quadcore 2.83 GHz CPU machine with 8 GB RAM. Figure 3 shows
the displacement field of the lung with and without contact conditions
at EI. It is clear that unless the pleural sliding is appropriately treated,
the relatively large lung motion in SI direction is not captured.
Tracking tumor motion is a central issue of this research. In
Figure 4 we plot the displacement of the center of the tumor over a
breathing cycle. In [5] it has been reported that the average tumor
motion at the upper lobe are 1.47 (SD=0.98) mm in the LR direction,
2.33 (1.016) mm in SI direction, and 1.95 (1.01) mm in the AP
direction [5]. As shown in Figure 4, tumor motions at EI (2s in
breathing time) are within the range of this motion.
 LR   AP   SI   Magnitude
0.35
0.30
0.25
0.20
Displacement (cm)
0.15
0.10
0.05
0.00
-0.05
-0.10
-0.15
-0.20
-0.25
-0.30
0 1 2 3 4
Breathing time (s)
Figure 4. Displacement at the center of the lungs over a
breathing cycle
DISCUSSION
We have presented a non-linear FE model of lung motion for
(1) radiation therapy. For the first time, we have used the physiologically
cycle. In terms of modeling, we have used the CAD surface
reconstruction approach to construct the computational mesh from 4D
CT scanned images. This avoids multiple smoothing procedures and
increases accuracy. Measurement and characterization of the PV
curve is our next goal.
ACKNOWLEDGEMENTS
The authors would like to gratefully acknowledge the funding support
from NIH/NLM grant R01LM009362. The first author would also like
to acknowledge fruitful discussions with Mr. Y. Na.
REFERENCE
1. Yang, D., et al., 4DCT Motion Estimation and Modeling.
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3. West, J., Respiratory Physiology: The Essentials. 7 ed. 2007:
Williams & Wilkins.
4. ZENG, Y., D. YAGER, and Y. FUNG, Measurement of the
mechanical properties of the human lung tissue. Journal of
Biomechanical Engineering, 1987. 109(2): p. 169-174.
5. Seppenwoolde, Y., et al., Precise and real-time measurement of
3D tumor motion in lung due to breathing and heartbeat,
measured during radiotherapy. International Journal of Radiation
Oncology Biology Physics, 2002. 53: p. 822-834.
2 Copyright © 2009 by ASME