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Iramina H, Tsuneda M, Okamoto H, Kadoya N, Mukumoto N, Toyota M, Fukunaga J, Fujita Y, Tohyama N, Onishi H, Nakamura M. Multi-institutional questionnaire-based survey on online adaptive radiotherapy performed using commercial systems in Japan in 2023. Radiol Phys Technol 2024; 17:581-595. [PMID: 39028438 DOI: 10.1007/s12194-024-00828-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 07/12/2024] [Accepted: 07/13/2024] [Indexed: 07/20/2024]
Abstract
In this study, we aimed to conduct a survey on the current clinical practice of, staffing for, commissioning of, and staff training for online adaptive radiotherapy (oART) in the institutions that installed commercial oART systems in Japan, and to share the information with institutions that will implement oART systems in future. A web-based questionnaire, containing 107 questions, was distributed to nine institutions in Japan. Data were collected from November to December 2023. Three institutions each with the MRIdian (ViewRay, Oakwood Village, OH, USA), Unity (Elekta AB, Stockholm, Sweden), and Ethos (Varian Medical Systems, Palo Alto, CA, USA) systems completed the questionnaire. One institution (MRIdian) had not performed oART by the response deadline. Each institution had installed only one oART system. Hypofractionation, and moderate hypofractionation or conventional fractionation were employed in the MRIdian/Unity and Ethos systems, respectively. The elapsed time for the oART process was faster with the Ethos than with the other systems. All institutions added additional staff for oART. Commissioning periods differed among the oART systems owing to provision of beam data from the vendors. Chambers used during commissioning measurements differed among the institutions. Institutional training was provided by all nine institutions. To the best of our knowledge, this was the first survey about oART performed using commercial systems in Japan. We believe that this study will provide useful information to institutions that installed, are installing, or are planning to install oART systems.
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Affiliation(s)
- Hiraku Iramina
- Adaptive Radiotherapy Working Group (ART-WG), QA/QC Committee, Japan Society of Medical Physics, Tokyo, Japan
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, 54 Kawahara-Cho, Shogoin, Sakyo-Ku, Kyoto-Shi, Kyoto, 606-8507, Japan
| | - Masato Tsuneda
- Adaptive Radiotherapy Working Group (ART-WG), QA/QC Committee, Japan Society of Medical Physics, Tokyo, Japan
- Department of Radiation Oncology, MR Linac ART Division, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-Ku, Chiba-Shi, Chiba, 260-8670, Japan
| | - Hiroyuki Okamoto
- Adaptive Radiotherapy Working Group (ART-WG), QA/QC Committee, Japan Society of Medical Physics, Tokyo, Japan
- Radiation Safety and Quality Assurance Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan
| | - Noriyuki Kadoya
- Adaptive Radiotherapy Working Group (ART-WG), QA/QC Committee, Japan Society of Medical Physics, Tokyo, Japan
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-Machi, Aoba-Ku, Sendai-Shi, Miyagi, 980-8574, Japan
| | - Nobutaka Mukumoto
- Adaptive Radiotherapy Working Group (ART-WG), QA/QC Committee, Japan Society of Medical Physics, Tokyo, Japan
- Department of Radiation Oncology, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahi-Machi, Abeno-Ku, Osaka-Shi, Osaka, 545-8585, Japan
| | - Masahiko Toyota
- Adaptive Radiotherapy Working Group (ART-WG), QA/QC Committee, Japan Society of Medical Physics, Tokyo, Japan
- Division of Radiology, Department of Clinical Technology, Kagoshima University Hospital, 8-35-1 Sakuragaoka, Kagoshima-Shi, Kagoshima, 890-8520, Japan
| | - Junichi Fukunaga
- Adaptive Radiotherapy Working Group (ART-WG), QA/QC Committee, Japan Society of Medical Physics, Tokyo, Japan
- Division of Radiology, Department of Medical Technology, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-Ku, Fukuoka-Shi, Fukuoka, 812-8582, Japan
| | - Yukio Fujita
- Adaptive Radiotherapy Working Group (ART-WG), QA/QC Committee, Japan Society of Medical Physics, Tokyo, Japan
- Department of Radiation Oncology, MR Linac ART Division, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-Ku, Chiba-Shi, Chiba, 260-8670, Japan
- Department of Radiological Sciences, Komazawa University, 1-23-1 Komazawa, Setagaya-Ku, Tokyo, 154-8525, Japan
| | - Naoki Tohyama
- Department of Radiological Sciences, Komazawa University, 1-23-1 Komazawa, Setagaya-Ku, Tokyo, 154-8525, Japan
| | - Hiroshi Onishi
- Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo-Shi, Yamanashi, 409-3898, Japan
| | - Mitsuhiro Nakamura
- Adaptive Radiotherapy Working Group (ART-WG), QA/QC Committee, Japan Society of Medical Physics, Tokyo, Japan.
- Department of Advanced Medical Physics, Graduate School of Medicine, Kyoto University, 53 Kawahara-Cho, Shogoin, Sakyo-Ku, Kyoto-Shi, Kyoto, 606-8507, Japan.
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Baker CR, Pease M, Sexton DP, Abumoussa A, Chambless LB. Artificial intelligence innovations in neurosurgical oncology: a narrative review. J Neurooncol 2024; 169:489-496. [PMID: 38958849 PMCID: PMC11341589 DOI: 10.1007/s11060-024-04757-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 06/24/2024] [Indexed: 07/04/2024]
Abstract
PURPOSE Artificial Intelligence (AI) has become increasingly integrated clinically within neurosurgical oncology. This report reviews the cutting-edge technologies impacting tumor treatment and outcomes. METHODS A rigorous literature search was performed with the aid of a research librarian to identify key articles referencing AI and related topics (machine learning (ML), computer vision (CV), augmented reality (AR), virtual reality (VR), etc.) for neurosurgical care of brain or spinal tumors. RESULTS Treatment of central nervous system (CNS) tumors is being improved through advances across AI-such as AL, CV, and AR/VR. AI aided diagnostic and prognostication tools can influence pre-operative patient experience, while automated tumor segmentation and total resection predictions aid surgical planning. Novel intra-operative tools can rapidly provide histopathologic tumor classification to streamline treatment strategies. Post-operative video analysis, paired with rich surgical simulations, can enhance training feedback and regimens. CONCLUSION While limited generalizability, bias, and patient data security are current concerns, the advent of federated learning, along with growing data consortiums, provides an avenue for increasingly safe, powerful, and effective AI platforms in the future.
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Affiliation(s)
- Clayton R Baker
- Vanderbilt University School of Medicine, Nashville, TN, USA.
| | - Matthew Pease
- Department of Neurosurgery, Indiana University, Indianapolis, IN, USA
| | - Daniel P Sexton
- Department of Neurosurgery, Duke University, Durham, NC, USA
| | - Andrew Abumoussa
- Department of Neurosurgery, University of North Carolina at Chapel Hill Hospitals, Chapel Hill, NC, USA
| | - Lola B Chambless
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA
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Lievens Y, Janssens S, Lambrecht M, Engels H, Geets X, Jansen N, Moretti L, Remouchamps V, Roosens S, Stellamans K, Verellen D, Weltens C, Weytjens R, Van Damme N. Coverage with evidence development program on stereotactic body radiotherapy in Belgium (2013-2019): a nationwide registry-based prospective study. THE LANCET REGIONAL HEALTH. EUROPE 2024; 44:100992. [PMID: 39045286 PMCID: PMC11265534 DOI: 10.1016/j.lanepe.2024.100992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 06/06/2024] [Accepted: 06/18/2024] [Indexed: 07/25/2024]
Abstract
Background Although stereotactic body radiotherapy (SBRT) was progressively adopted in clinical practice in Belgium, a reimbursement request in 2011 was not granted because of remaining clinical and economic uncertainty. A coverage with evidence development (CED) program on SBRT started in 2013, with the aim to assess clinical and technical patterns-of-care in Belgium and monitor survival per indication, in view of supporting inclusion in the reimbursement system. Methods The Belgian National Institute for Health and Disability Insurance (NIHDI) initiated this prospective observational registry. Participating departments, using SBRT in clinical practice, signed the 'NIHDI convention'. Eligible patients had a primary tumour (PT) or oligometastatic disease (OMD). Patient, tumour, and treatment characteristics were collected through an online module of the Belgian Cancer Registry, prerequisite for financing. Five-year overall survival (5YOS) and 30- and 90-days mortality were primary outcomes, derived from vital status information. Findings Between 10/2013 and 12/2019, 20 of the 24 accredited radiotherapy departments participated, 6 were academic. Registered cases per department ranged from 21 to 867. Of 5675 registrations analysed, the majority had good performance status and limited number of lesions. Enrolment of PTs remained stable over time, OMDs almost doubled. Peripheral lung lesions dominated in PTs as in OMDs. Other metastases were (para)spinal, 'non-standard' and hepatic. Thirty- and 90-days mortalities remained below 0.5% [95% CI 0.3%-0.8%] respectively 2.1% [95% CI 1.6%-2.7%]. 5YOS varied by indication, primary prostate patients performing best (85%, 95% CI [76%, 96%]), those with liver metastases worst (19%, 95% CI [15%, 24%]). Better OS was observed in academic departments, department size did not significantly impact survival. OMD survival was better in 2018-19. Interpretation CED can be used to define patterns-of-care and real-life outcome of innovative radiotherapy. As the observed survival for different indications was in line with outcome in emerging literature, SBRT was included in the Belgian reimbursement system as of January 2020. Funding NIHDI financed participating departments per registered case.
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Affiliation(s)
- Yolande Lievens
- Radiation Oncology Department, Ghent University Hospital and Ghent University, Ghent, Belgium
| | | | - Maarten Lambrecht
- Radiation Oncology Department, University Hospital Leuven, Leuven, Belgium
| | - Hilde Engels
- Belgian National Institute for Health and Disability Insurance, Brussels, Belgium
| | - Xavier Geets
- Radiation Oncology Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Nicolas Jansen
- Radiation Oncology Department, CHU de Liège, Liège, Belgium
| | - Luigi Moretti
- Radiation Oncology Department, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Vincent Remouchamps
- Radiation Oncology Department, CHU UCL, Namur, Site Sainte Elisabeth, Belgium
| | - Sander Roosens
- Belgian National Institute for Health and Disability Insurance, Brussels, Belgium
| | | | - Dirk Verellen
- Radiation Oncology Department Iridium Netwerk/University of Antwerp, Wilrijk, Belgium
| | - Caroline Weltens
- Radiation Oncology Department, University Hospital Leuven, Leuven, Belgium
| | - Reinhilde Weytjens
- Radiation Oncology Department Iridium Netwerk/University of Antwerp, Wilrijk, Belgium
| | | | - Belgian College for Physicians of Radiation Oncology Centres
- Radiation Oncology Department, Ghent University Hospital and Ghent University, Ghent, Belgium
- Belgian Cancer Registry, Brussels, Belgium
- Radiation Oncology Department, University Hospital Leuven, Leuven, Belgium
- Belgian National Institute for Health and Disability Insurance, Brussels, Belgium
- Radiation Oncology Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
- Radiation Oncology Department, CHU de Liège, Liège, Belgium
- Radiation Oncology Department, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
- Radiation Oncology Department, CHU UCL, Namur, Site Sainte Elisabeth, Belgium
- Radiation Oncology Department, AZ Groeninge, Kortrijk, Belgium
- Radiation Oncology Department Iridium Netwerk/University of Antwerp, Wilrijk, Belgium
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Lim JS, Au Yong TPT, Boon CS, Boon IS. Radiomics in Oncology and Radiology: Statistical Significance Versus Clinical Significance. Clin Oncol (R Coll Radiol) 2024; 36:e342. [PMID: 38777705 DOI: 10.1016/j.clon.2024.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 05/03/2024] [Indexed: 05/25/2024]
Affiliation(s)
- J S Lim
- School of Medicine, University of Southampton, Southampton, UK
| | - T P T Au Yong
- Department of Radiology, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - C S Boon
- Department of Clinical Oncology, Raigmore Hospital, Inverness, Scotland, UK
| | - I S Boon
- Department of Clinical Oncology, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
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Osong B, Hasannejadasl H, van der Poel H, Vanneste B, van Roermund J, Aben K, Van Soest J, Van Oort I, Hochstenbach L, Bloemen- van Gurp EJ, Dekker A, Fijten RR. The value of PROMs for predicting erectile dysfunction in prostate cancer patients with Bayesian network. Tech Innov Patient Support Radiat Oncol 2024; 31:100234. [PMID: 39188594 PMCID: PMC11345401 DOI: 10.1016/j.tipsro.2024.100234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 12/03/2023] [Accepted: 01/04/2024] [Indexed: 08/28/2024] Open
Abstract
Purpose This study aims to develop and externally validate a clinically plausible Bayesian network structure to predict one-year erectile dysfunction in prostate cancer patients by combining expert knowledge with evidence from data using clinical and Patient-reported outcome measures (PROMs) data. In addition, compare and contrast structures that stem from PROM information and routine clinical data. Summary of background For men with localized prostate cancer, choosing the optimal treatment can be challenging since each option comes with different side effects, such as erectile dysfunction, which negatively impacts their quality of life. Our previous findings demonstrate that logistic regression models are able to identify patients at high risk of erectile dysfunction. However, methods such as Bayesian networks may be more successful, as they intricately represent the causal relations between the variables. Patients and methods 946 prostate cancer patients from 65 Dutch hospitals were considered to develop the Bayesian network structure. Continuous variables were discretized before analysis based on expert opinions and literature. Patients with missing information and variables with more than 25% of missing information were excluded. Prostate cancer treating physicians first determined the relationships (arcs) between the available variables. The structures were then modified based on algorithmically derived structures using the hill-climbing algorithm. Structural Performance was evaluated based on the area under the curve (AUC) values and calibration plots on the training and test data. Results BMI and prostate volume via MRI were excluded from this analysis due to their high percentage of missingness (>45 %). The final cohort was reduced to 505 and 216 after excluding 157 and 68 patients with missing information, respectively. The AUC of the PROM structure was better than the clinical structure in both the train and test data. The structure that combined both sources of information had an AUC value of 0.94 (0.92 - 0.96) and 0.84171 (0.77 91) in the train and test data, respectively. Conclusion Bayesian network structures derived from PROM information by complimenting expert knowledge with evidence from the data produce a clinically plausible structure that is more performant than structures from clinical data. Our study supports the growing global recognition of incorporating the patient's perspective in outcomes research for better decision-making and optimal outcomes. However, a structure that combines both sources of information gives a more holistic view of the patient with actionable insights and improved discriminative power.
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Affiliation(s)
- Biche Osong
- Department of Radiation Oncology (MAASTRO), Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Reproduction, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Hajar Hasannejadasl
- Department of Radiation Oncology (MAASTRO), Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Reproduction, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Henk van der Poel
- Department of Urology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Ben Vanneste
- Department of Radiation Oncology (MAASTRO), Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Reproduction, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Joep van Roermund
- Department of Urology, Maastricht University Medical Center, the Netherlands
| | - Katja Aben
- Department of Research Development, Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands
| | - Johan Van Soest
- Department of Radiation Oncology (MAASTRO), Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Reproduction, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Inge Van Oort
- Department of Urology, Radboud university Medical Center, Nijmegen, the Netherlands
| | - Laura Hochstenbach
- Department of Urology, Maastricht University Medical Center, the Netherlands
| | - Esther J. Bloemen- van Gurp
- Department of Radiation Oncology (MAASTRO), Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Reproduction, Maastricht University Medical Centre, Maastricht, the Netherlands
- Department of Urology, Netherlands Cancer Institute, Amsterdam, the Netherlands
- Department of Urology, Maastricht University Medical Center, the Netherlands
- Department of Research Development, Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands
| | - Andre Dekker
- Department of Radiation Oncology (MAASTRO), Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Reproduction, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Rianne R.R. Fijten
- Department of Radiation Oncology (MAASTRO), Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Reproduction, Maastricht University Medical Centre, Maastricht, the Netherlands
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Siddiq S, Murray V, Tyagi N, Borman P, Gui C, Crane C, Wu C, Otazo R. MR signature matching (MRSIGMA) implementation for true real-time free-breathing volumetric imaging with sub-200 ms latency on an MR-Linac. Magn Reson Med 2024; 92:1162-1176. [PMID: 38576131 PMCID: PMC11209806 DOI: 10.1002/mrm.30097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 02/20/2024] [Accepted: 03/14/2024] [Indexed: 04/06/2024]
Abstract
PURPOSE Develop a true real-time implementation of MR signature matching (MRSIGMA) for free-breathing 3D MRI with sub-200 ms latency on the Elekta Unity 1.5T MR-Linac. METHODS MRSIGMA was implemented on an external computer with a network connection to the MR-Linac. Stack-of-stars with partial kz sampling was used to accelerate data acquisition and ReconSocket was employed for simultaneous data transmission. Movienet network computed the 4D MRI motion dictionary and correlation analysis was used for signature matching. A programmable 4D MRI phantom was utilized to evaluate MRSIGMA with respect to a ground-truth translational motion reference. In vivo validation was performed on patients with pancreatic cancer, where 15 patients were employed to train Movienet and 7 patients to test the real-time implementation of MRSIGMA. Dice coefficients between real-time MRSIGMA and a retrospectively computed 4D reference were used to evaluate motion tracking performance. RESULTS Motion dictionary was computed in under 5 s. Signature acquisition and matching presented 173 ms latency on the phantom and 193 ms on patients. MRSIGMA presented a mean error of 1.3-1.6 mm for all phantom experiments, which was below the 2 mm acquisition resolution along the motion direction. The Dice coefficient over time between MRSIGMA and reference contours was 0.88 ± 0.02 (GTV), 0.87 ± 0.02(duodenum-stomach), and 0.78 ± 0.02(small bowel), demonstrating high motion tracking performance for both tumor and organs at risk. CONCLUSION The real-time implementation of MRSIGMA enabled true real-time free-breathing 3D MRI with sub-200 ms imaging latency on a clinical MR-Linac system, which can be used for treatment monitoring, adaptive radiotherapy and dose accumulation mapping in tumors affected by respiratory motion.
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Affiliation(s)
- Saad Siddiq
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Victor Murray
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Neelam Tyagi
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Pim Borman
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Chengcheng Gui
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Christopher Crane
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Can Wu
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ricardo Otazo
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Canters R, van der Klugt K, Trier Taasti V, Buijsen J, Ta B, Steenbakkers I, Houben R, Vilches-Freixas G, Berbee M. Robustness of intensity modulated proton treatment of esophageal cancer for anatomical changes and breathing motion. Radiother Oncol 2024; 198:110409. [PMID: 38917884 DOI: 10.1016/j.radonc.2024.110409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 05/26/2024] [Accepted: 06/18/2024] [Indexed: 06/27/2024]
Abstract
BACKGROUND AND PURPOSE In this study, we assessed the robustness of intensity modulated proton therapy (IMPT) in esophageal cancer for anatomical variations during treatment. METHODS The first sixty esophageal cancer patients, treated clinically with chemoradiotherapy were included. The treatment planning strategy was based on an internal target volume (ITV) approach, where the ITV was created from the clinical target volumes (CTVs) delineated on all phases of a 4DCT. For optimization, a 3 mm isotropic margin was added to the ITV, combined with robust optimization using 5 mm setup and 3 % range uncertainty. Each patient received weekly repeat CTs (reCTs). Robust plan re-evaluation on all reCTs, and a robust dose summation was performed. To assess the factors influencing ITV coverage, a multivariate linear regression analysis was performed. Additionally, clinical adaptations were evaluated. RESULTS The target coverage was adequate (ITV V94%>98 % on the robust voxel-wise minimum dose) on most reCTs (91 %), and on the summed dose in 92 % of patients. Significant predictors for ITV coverage in the multivariate analysis were diaphragm baseline shift and water equivalent depth (WED) of the ITV in the beam direction. Underdosage of the ITV mainly occurred in week 1 and 4, leading to treatment adaptation of eight patients, all on the first reCT. CONCLUSION Our IMPT treatment of esophageal cancer is robust for anatomical variations. Adaptation appears to be most effective in the first week of treatment. Diaphragm baseline shifts and WED are predictive factors for ITV underdosage, and should be incorporated in an adaptation protocol.
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Affiliation(s)
- Richard Canters
- Department of Radiation Oncology (MAASTRO), GROW-School for Oncology, Maastricht University Medical Center, Maastricht, the Netherlands.
| | - Kim van der Klugt
- Department of Radiation Oncology (MAASTRO), GROW-School for Oncology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Vicki Trier Taasti
- Department of Radiation Oncology (MAASTRO), GROW-School for Oncology, Maastricht University Medical Center, Maastricht, the Netherlands; Aarhus University, Danish Centre for Particle Therapy, Denmark
| | - Jeroen Buijsen
- Department of Radiation Oncology (MAASTRO), GROW-School for Oncology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Bastiaan Ta
- Department of Radiation Oncology (MAASTRO), GROW-School for Oncology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Inge Steenbakkers
- Department of Radiation Oncology (MAASTRO), GROW-School for Oncology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Ruud Houben
- Department of Radiation Oncology (MAASTRO), GROW-School for Oncology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Gloria Vilches-Freixas
- Department of Radiation Oncology (MAASTRO), GROW-School for Oncology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Maaike Berbee
- Department of Radiation Oncology (MAASTRO), GROW-School for Oncology, Maastricht University Medical Center, Maastricht, the Netherlands
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Vander Veken L, Van Ooteghem G, Ghaye B, Razavi A, Dechambre D, Geets X. Lung and Liver Stereotactic Body Radiation Therapy During Mechanically Assisted Deep Inspiration Breath-Holds: A Prospective Feasibility Trial. Adv Radiat Oncol 2024; 9:101563. [PMID: 39155885 PMCID: PMC11327938 DOI: 10.1016/j.adro.2024.101563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 06/08/2024] [Indexed: 08/20/2024] Open
Abstract
Purpose Radiation therapy for tumors subject to breathing-related motion during breath-holds (BHs) has the potential to substantially reduce the irradiated volume. Mechanically assisted and noninvasive ventilation (MANIV) could ensure the target repositioning accuracy during each BH while facilitating treatment feasibility through oxygen supplementation and a perfectly replicated mechanical support. However, there is currently no clinical evidence substantiating the use of MANIV-induced BH for moving tumors. The aim of this work was, therefore, to evaluate the technique's performance under real treatment conditions. Methods and Materials Patients eligible for lung or liver stereotactic body radiation therapy were prospectively included in a single-arm trial. The primary endpoint corresponded to the treatment feasibility with MANIV. Secondary outcomes comprised intrafraction geometric uncertainties extracted from real-time imaging, tolerance to BH, and treatment time. Results Treatment was successfully delivered in 92.9% (13/14) of patients: 1 patient with a liver tumor was excluded because of a mechanically induced gastric insufflation displacing the liver cranially by more than 1 cm. In the left-right/anteroposterior/craniocaudal directions, the recalculated safety margins based on intrafraction positional data were 4.6 mm/5.1 mm/5.6 mm and 4.7 mm/7.3 mm/5.9 mm for lung and liver lesions, respectively. Compared with the free-breathing internal target volume and midposition approaches, the average reduction in the planning target volume with MANIV reached -47.2% ± 15.3%, P < .001, and -29.4% ± 19.2%, P = .007, for intrathoracic tumors and -23.3% ± 12.4%, P < .001, and -9.3% ± 15.3%, P = .073, for upper abdominal tumors, respectively. For 1 liver lesion, large caudal drifts of occasionally more than 1 cm were measured. The total slot time was 53.1 ± 10.6 minutes with a BH comfort level of 80.1% ± 10.6%. Conclusions MANIV enables high treatment feasibility within a nonselected population. Accurate intrafraction tumor repositioning is achieved for lung tumors. Because of occasional intra-BH caudal drifts, pretreatment assessment of BH stability for liver lesions is, however, recommended.
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Affiliation(s)
- Loïc Vander Veken
- UCLouvain, Institut de Recherche Experimentale et Clinique (IREC), Center of Molecular Imaging, Radiotherapy and Oncology (MIRO), Brussels, Belgium
- Radiation Oncology Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Geneviève Van Ooteghem
- UCLouvain, Institut de Recherche Experimentale et Clinique (IREC), Center of Molecular Imaging, Radiotherapy and Oncology (MIRO), Brussels, Belgium
- Radiation Oncology Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Benoît Ghaye
- Radiology Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Ariane Razavi
- Radiation Oncology Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - David Dechambre
- Radiation Oncology Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Xavier Geets
- UCLouvain, Institut de Recherche Experimentale et Clinique (IREC), Center of Molecular Imaging, Radiotherapy and Oncology (MIRO), Brussels, Belgium
- Radiation Oncology Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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Borderías-Villarroel E, Barragán-Montero A, Sterpin E. Time is NTCP: Should we maximize patient throughput or perform online adaptation on proton therapy systems? Radiother Oncol 2024; 198:110389. [PMID: 38885906 DOI: 10.1016/j.radonc.2024.110389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 06/12/2024] [Accepted: 06/14/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND Compared to conventional radiotherapy (XT), proton therapy (PT) may improve normal tissue complication probabilities (NTCP). However, PT typically requires higher adaptation rates due to an increased sensitivity to anatomical changes. Systematic online adaptation may address this issue, but it requires additional replanning time, decreasing patient throughput. Therefore, less patients would benefit in such case from PT for a given machine capacity, with results in worse NTCP. AIM To investigate the trade-off between PT patient throughput and NTCP gain as a function of the time needed for adaptation. METHODS A retrospective database of 14 lung patients with two repeated 4DCTs was used to compare NTCP values between XT and PT for NTCP2ym (2-year mortality), NTCPdysphagia and NTCPpneumonitis. Four scenarios were considered for PT: no adaptation using clinical robustness parameters (4D robust optimization, 3 % range error and PTV-equivalent setup errors); systematic online adaptation with clinical robustness parameters; setup errors reduced to 4 mm and to 2 mm. Dose was accumulated on the planning CT. The number of patients treated with PT depended on the extra time needed for adaptation, assuming an 8-hours capacity (assuming 14 patients a day; thus minimum 34.2 min per treatment session if there is no or instantaneous adaptation). RESULTS Baseline NTCP gains (PT against XT without adaptation) equaled 6.9 %, 6.1 %, and 7.7 % for NTCP2ym, NTCPdysphagia and NTCPpneumonitis, respectively. Using instantaneous online adaptation and setup errors of 2 mm, the overall gains were then 10.7 %, 13.6 % and 12.4 %. Taking into account loss of capacity, 13.7 min was the maximum extra-time allowed to complete adaptation and maintain an advantage on all three metrics for the 2-mm setup error scenario. CONCLUSION This study highlights the critical importance of keeping short online adaptation times when using systems with limited capacity like PT.
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Affiliation(s)
- E Borderías-Villarroel
- UCLouvain, Institut de recherche expérimentale et clinique, Molecular Imaging and Radiation Oncology (MIRO) Laboratory, Brussels, Belgium
| | - A Barragán-Montero
- UCLouvain, Institut de recherche expérimentale et clinique, Molecular Imaging and Radiation Oncology (MIRO) Laboratory, Brussels, Belgium
| | - E Sterpin
- UCLouvain, Institut de recherche expérimentale et clinique, Molecular Imaging and Radiation Oncology (MIRO) Laboratory, Brussels, Belgium; KU Leuven, Department of Oncology, Laboratory of external radiotherapy, Leuven, Belgium; Particle Therapy Interuniversity Center Leuven - PARTICLE, Leuven, Belgium.
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10
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Bookbinder A, Selvaraj B, Zhao X, Yang Y, Bell BI, Pennock M, Tsai P, Tomé WA, Isabelle Choi J, Lin H, Simone CB, Guha C, Kang M. Validation and reproducibility of in vivo dosimetry for pencil beam scanned FLASH proton treatment in mice. Radiother Oncol 2024; 198:110404. [PMID: 38942121 DOI: 10.1016/j.radonc.2024.110404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 06/07/2024] [Accepted: 06/19/2024] [Indexed: 06/30/2024]
Abstract
PURPOSE To investigate quality assurance (QA) techniques for in vivo dosimetry and establish its routine uses for proton FLASH small animal experiments with a saturated monitor chamber. METHODS AND MATERIALS 227 mice were irradiated at FLASH or conventional (CONV) dose rates with a 250 MeV FLASH-capable proton beamline using pencil beam scanning to characterize the proton FLASH effect on abdominal irradiation and examining various endpoints. A 2D strip ionization chamber array (SICA) detector was positioned upstream of collimation and used for in vivo dose monitoring during irradiation. Before each irradiation series, SICA signal was correlated with the isocenter dose at each delivered dose rate. Dose, dose rate, and 2D dose distribution for each mouse were monitored with the SICA detector. RESULTS Calibration curves between the upstream SICA detector signal and the delivered dose at isocenter had good linearity with minimal R2 values of 0.991 (FLASH) and 0.985 (CONV), and slopes were consistent for each modality. After reassigning mice, standard deviations were less than 1.85 % (FLASH) and 0.83 % (CONV) for all dose levels, with no individual subject dose falling outside a ± 3.6 % range of the designated dose. FLASH fields had a field-averaged dose rate of 79.0 ± 0.8 Gy/s and mean local average dose rate of 160.6 ± 3.0 Gy/s. In vivo dosimetry allowed for the accurate detection of variation between the delivered and the planned dose. CONCLUSION In vivo dosimetry benefits FLASH experiments through enabling real-time dose and dose rate monitoring allowing mouse cohort regrouping when beam fluctuation causes delivered dose to vary from planned dose.
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Affiliation(s)
| | | | | | - Yunjie Yang
- New York Proton Center, New York, NY, USA; Departments of Radiation Oncology and Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Brett I Bell
- Department of Radiation Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA; Department of Pathology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Michael Pennock
- Department of Radiation Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
| | - Pingfang Tsai
- New York Proton Center, New York, NY, USA; Departments of Radiation Oncology and Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Wolfgang A Tomé
- Department of Radiation Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA; Institute for Onco-Physics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - J Isabelle Choi
- New York Proton Center, New York, NY, USA; Departments of Radiation Oncology and Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Haibo Lin
- New York Proton Center, New York, NY, USA; Departments of Radiation Oncology and Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Radiation Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
| | - Charles B Simone
- New York Proton Center, New York, NY, USA; Departments of Radiation Oncology and Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Chandan Guha
- Department of Radiation Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA; Department of Pathology, Albert Einstein College of Medicine, Bronx, NY, USA; Institute for Onco-Physics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Minglei Kang
- New York Proton Center, New York, NY, USA; Departments of Radiation Oncology and Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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11
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Villegas F, Dal Bello R, Alvarez-Andres E, Dhont J, Janssen T, Milan L, Robert C, Salagean GAM, Tejedor N, Trnková P, Fusella M, Placidi L, Cusumano D. Challenges and opportunities in the development and clinical implementation of artificial intelligence based synthetic computed tomography for magnetic resonance only radiotherapy. Radiother Oncol 2024; 198:110387. [PMID: 38885905 DOI: 10.1016/j.radonc.2024.110387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 06/13/2024] [Accepted: 06/13/2024] [Indexed: 06/20/2024]
Abstract
Synthetic computed tomography (sCT) generated from magnetic resonance imaging (MRI) can serve as a substitute for planning CT in radiation therapy (RT), thereby removing registration uncertainties associated with multi-modality imaging pairing, reducing costs and patient radiation exposure. CE/FDA-approved sCT solutions are nowadays available for pelvis, brain, and head and neck, while more complex deep learning (DL) algorithms are under investigation for other anatomic sites. The main challenge in achieving a widespread clinical implementation of sCT lies in the absence of consensus on sCT commissioning and quality assurance (QA), resulting in variation of sCT approaches across different hospitals. To address this issue, a group of experts gathered at the ESTRO Physics Workshop 2022 to discuss the integration of sCT solutions into clinics and report the process and its outcomes. This position paper focuses on aspects of sCT development and commissioning, outlining key elements crucial for the safe implementation of an MRI-only RT workflow.
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Affiliation(s)
- Fernanda Villegas
- Department of Oncology-Pathology, Karolinska Institute, Solna, Sweden; Radiotherapy Physics and Engineering, Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Solna, Sweden
| | - Riccardo Dal Bello
- Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Emilie Alvarez-Andres
- OncoRay - National Center for Radiation Research in Oncology, Medical Faculty and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany; Faculty of Medicine Carl Gustav Carus, TUD Dresden University of Technology, Dresden, Germany
| | - Jennifer Dhont
- Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (H.U.B), Institut Jules Bordet, Department of Medical Physics, Brussels, Belgium; Université Libre De Bruxelles (ULB), Radiophysics and MRI Physics Laboratory, Brussels, Belgium
| | - Tomas Janssen
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Lisa Milan
- Medical Physics Unit, Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Charlotte Robert
- UMR 1030 Molecular Radiotherapy and Therapeutic Innovations, ImmunoRadAI, Paris-Saclay University, Institut Gustave Roussy, Inserm, Villejuif, France; Department of Radiation Oncology, Gustave Roussy, Villejuif, France
| | - Ghizela-Ana-Maria Salagean
- Faculty of Physics, Babes-Bolyai University, Cluj-Napoca, Romania; Department of Radiation Oncology, TopMed Medical Centre, Targu Mures, Romania
| | - Natalia Tejedor
- Department of Medical Physics and Radiation Protection, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Petra Trnková
- Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | - Marco Fusella
- Department of Radiation Oncology, Abano Terme Hospital, Italy
| | - Lorenzo Placidi
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Rome, Italy.
| | - Davide Cusumano
- Mater Olbia Hospital, Strada Statale Orientale Sarda 125, Olbia, Sassari, Italy
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Luximon DC, Neylon J, Ritter T, Agazaryan N, Hegde JV, Steinberg ML, Low DA, Lamb JM. Results of an Artificial Intelligence-Based Image Review System to Detect Patient Misalignment Errors in a Multi-institutional Database of Cone Beam Computed Tomography-Guided Radiation Therapy. Int J Radiat Oncol Biol Phys 2024; 120:243-252. [PMID: 38485098 DOI: 10.1016/j.ijrobp.2024.02.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 02/15/2024] [Accepted: 02/28/2024] [Indexed: 04/17/2024]
Abstract
PURPOSE Present knowledge of patient setup and alignment errors in image guided radiation therapy (IGRT) relies on voluntary reporting, which is thought to underestimate error frequencies. A manual retrospective patient-setup misalignment error search is infeasible owing to the bulk of cases to be reviewed. We applied a deep learning-based misalignment error detection algorithm (EDA) to perform a fully automated retrospective error search of clinical IGRT databases and determine an absolute gross patient misalignment error rate. METHODS AND MATERIALS The EDA was developed to analyze the registration between planning scans and pretreatment cone beam computed tomography scans, outputting a misalignment score ranging from 0 (most unlikely) to 1 (most likely). The algorithm was trained using simulated translational errors on a data set obtained from 680 patients treated at 2 radiation therapy clinics between 2017 and 2022. A receiver operating characteristic analysis was performed to obtain target thresholds. DICOM Query and Retrieval software was integrated with the EDA to interact with the clinical database and fully automate data retrieval and analysis during a retrospective error search from 2016 to 2017 and from 2021 to 2022 for the 2 institutions, respectively. Registrations were flagged for human review using both a hard-thresholding method and a prediction trending analysis over each individual patient's treatment course. Flagged registrations were manually reviewed and categorized as errors (>1 cm misalignment at the target) or nonerrors. RESULTS A total of 17,612 registrations were analyzed by the EDA, resulting in 7.7% flagged events. Three previously reported errors were successfully flagged by the EDA, and 4 previously unreported vertebral body misalignment errors were discovered during case reviews. False positive cases often displayed substantial image artifacts, patient rotation, and soft tissue anatomy changes. CONCLUSIONS Our results validated the clinical utility of the EDA for bulk image reviews and highlighted the reliability and safety of IGRT, with an absolute gross patient misalignment error rate of 0.04% ± 0.02% per delivered fraction.
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Affiliation(s)
- Dishane C Luximon
- Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, California.
| | - Jack Neylon
- Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Timothy Ritter
- Department of Medical Physics, Virginia Commonwealth University, Richmond, Virginia
| | - Nzhde Agazaryan
- Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, California
| | - John V Hegde
- Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Michael L Steinberg
- Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Daniel A Low
- Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, California
| | - James M Lamb
- Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, California
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13
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Lemaeva A, Gulidov I, Smyk D, Agapova Y, Koryakin S, Eremina I, Gantsova E, Fatkhudinov T, Kaprin A, Gordon K. A single-center experience of the upright proton therapy for skull-base chordomas and chondrosarcomas: Updated results. Clin Transl Radiat Oncol 2024; 48:100814. [PMID: 39044782 PMCID: PMC11263508 DOI: 10.1016/j.ctro.2024.100814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 06/14/2024] [Accepted: 06/29/2024] [Indexed: 07/25/2024] Open
Abstract
Aim To access efficacy and safety of the upright proton therapy for the skull-base chordomas and chondrosarcomas. Materials and methods The study encompasses single-center experience of proton therapy in chordomas (CA) and chondrosarcomas (CSA) of skull-base localization. We evaluate overall survival, local control and toxicity. Tumor response was assessed in accordance with RANO criteria. Treatment-related toxicity was evaluated with the help of CTCAE v 5.0 scale. Results Proton therapy in the upright position was utilized for 51pts (patients) with CA-CSA (40 pts with chordoma and 11pts with chondrosarcoma) at the A. Tsyb Medical Radiological Research Center in 2016-2023. Median tumor volume constituted 30 cm3 (IQR (interquartile range) 15-41 cm3). Median total dose was 70 GyRBE. Median number of fractions was 35. Overall survival (OS) at 1-, 2- and 3-year rates reached 98.0 %, 88.6 % and 82.7 %, respectively. Median follow-up time was 36 months. The 1-, 2- and 3-year local control (LC) rates constituted, respectively, 98 %, 78.6 % and 66.3 %. Prior surgery showed statistically significant association with better prognosis (p = 0.023). Brainstem-to-tumor dose coverage compromise became the major pattern of LC failure (p = 0.03). The late radiation toxicity reactions included temporal lobe necrosis grade 2 in 2 pts, xerostomia grade 1 in 1pt, radiation cataract grade 2 in 1pt and persistent headache grade 2 in 4 pts. Severe late toxicity reactions were observed in 2 cases (4 %): 1 myelitis grade 3 and brainstem damage grade 5 in 1pt. Conclusion Local control was achieved in the majority of patients receiving the scanning-beam upright proton therapy for skull-base CA-CSA. The LC rates after a surgery-radiotherapy combination treatment were higher compared with irradiation alone. Pattern of failure is mostly brainstem-tumor dose compromise. The high OS and LC rates were accompanied by low toxicity incidence. Even in complex case of the skull base CA-CSA upright proton therapy shows promising clinical outcomes.
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Affiliation(s)
- Alyona Lemaeva
- A. Tsyb Medical Radiological Research Center – Branch of the National Medical Radiological Research Center, Obninsk, Russia
| | - Igor Gulidov
- A. Tsyb Medical Radiological Research Center – Branch of the National Medical Radiological Research Center, Obninsk, Russia
| | - Daniil Smyk
- A. Tsyb Medical Radiological Research Center – Branch of the National Medical Radiological Research Center, Obninsk, Russia
| | - Yuliya Agapova
- Obninsk Institute for Nuclear Power Engineering, National Research Nuclear University MEPhI, Obninsk, Russia
| | - Sergey Koryakin
- A. Tsyb Medical Radiological Research Center – Branch of the National Medical Radiological Research Center, Obninsk, Russia
| | - Irina Eremina
- Medical Institution, P. Lumumba People’s Friendship University of Russia, Moscow, Russia
| | - Elena Gantsova
- Medical Institution, P. Lumumba People’s Friendship University of Russia, Moscow, Russia
| | - Timur Fatkhudinov
- Medical Institution, P. Lumumba People’s Friendship University of Russia, Moscow, Russia
| | - Andrey Kaprin
- A. Tsyb Medical Radiological Research Center – Branch of the National Medical Radiological Research Center, Obninsk, Russia
- Medical Institution, P. Lumumba People’s Friendship University of Russia, Moscow, Russia
| | - Konstantin Gordon
- A. Tsyb Medical Radiological Research Center – Branch of the National Medical Radiological Research Center, Obninsk, Russia
- Medical Institution, P. Lumumba People’s Friendship University of Russia, Moscow, Russia
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14
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Belikhin MA, Chernyaev AP, Pryanichnikov AA. High-speed bioimpedance-based gating system for radiotherapy: Prototype and proof of principle. J Appl Clin Med Phys 2024:e14491. [PMID: 39194180 DOI: 10.1002/acm2.14491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 06/18/2024] [Accepted: 07/16/2024] [Indexed: 08/29/2024] Open
Abstract
PURPOSE To investigate a novel bioimpedance-based respiratory gating system (BRGS) designed for external beam radiotherapy and to evaluate its technical characteristics in comparison with existing similar systems. MATERIALS AND METHODS The BRGS was tested on three healthy volunteers in free breathing and breath-hold patterns under laboratory conditions. Its parameters, including the time delay (TD) between the actual impedance change and the gating signal, temperature drift, root mean square (RMS) noise, and signal-to-noise ratio (SNR), were measured and analyzed. RESULTS The gate-on TD and the gate-off TD were found to be 9.0 ± 2.0 ms [mean ± standard deviation (M ± SD)] and 7.2 ± 1.3 ms, respectively. The temperature drift of the BRGS output signal was 0.02 Ω after 30 min of operation. RMS noise averaged 0.14 ± 0.05 Ω (M ± SD) for all subjects and varied from 0.08 to 0.20 Ω with repeated measurements. A significant difference in SNR (p < 0.001) was observed between subjects, ranging from 4 to 15. CONCLUSION The evaluated bioimpedance-based gating system showed a high performance in real-time respiratory monitoring and may potentially be used as an external surrogate guidance for respiratory-gated external beam radiotherapy. Direct comparison with commercially available systems, 4D correlation studies, and expansion of the patient sample are goals for future preclinical studies.
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Affiliation(s)
| | | | - Alexander A Pryanichnikov
- Division of Biomedical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
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15
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Episkopakis A, Margaroni V, Karaiskos P, Koutsouveli E, Marinos N, Pappas EP. Relative profile measurements in 1.5T MR-linacs: investigation of central axis deviations. Phys Med Biol 2024; 69:175015. [PMID: 39137816 DOI: 10.1088/1361-6560/ad6ed7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Accepted: 08/13/2024] [Indexed: 08/15/2024]
Abstract
Objective. In 1.5 T MR-linacs, the absorbed dose central axis (CAX) deviates from the beam's CAX due to inherent profile asymmetry. In addition, a measured CAX deviation may be biased due to potential lateral (to the beam) effective point of measurement (EPOML) shifts of the detector employed. By investigating CAX deviations, the scope of this study is to determine a set ofEPOMLshifts for profile measurements in 1.5 T MR-linacs.Approach. The Semiflex 3D ion chamber and microDiamond detector (PTW, Germany) were considered in the experimental study while three more detectors were included in the Monte Carlo (MC) study. CAX deviations in the crossline and inline profiles were calculated based on inflection points of the 10×10 cm2field, at five centers. In MC simulations, the experimental setup was reproduced. A small water voxel was simulated to calculate CAX deviation without the impact of the detector-specificEPOMLshift.Main results. All measurements were consistent among the five centers. MC-based and experimental measurements were in agreement within uncertainties. Placing the microDiamond in the vertical orientation does not appear to affect the detector'sEPOML, which is on its central longitudinal axis. For the Semiflex 3D in the crossline direction, the CAX deviation was 2.3 mm, i.e. 1 mm larger than the ones measured using the microDiamond and simulated considering the ideal water detector. Thus, anEPOMLshift of 1 mm is recommended for crossline profile measurements under both Semiflex 3D orientations. For the inline profile, anEPOMLshift of -0.5 mm was determined only for the parallel configuration. In the MC study, CAX deviations were found detector- and orientation-dependent. The dead volume is responsible for theEPOMLshift only in the inline profile and under the parallel orientation.Significance. This work contributes to data availability on the correction or mitigation of the magnetic field-induced changes in the detectors' response.
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Affiliation(s)
- Anastasios Episkopakis
- Medical Physics Laboratory, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias, 115 27 Athens, Greece
- Global Clinical Operations, Elekta Ltd, Fleming Way, RH10 99RR Crawley, West Sussex, United Kingdom
| | - Vasiliki Margaroni
- Medical Physics Laboratory, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias, 115 27 Athens, Greece
| | - Pantelis Karaiskos
- Medical Physics Laboratory, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias, 115 27 Athens, Greece
| | - Efi Koutsouveli
- Medical Physics Department, Hygeia Hospital, Kifisias Avenue and 4 Erythrou Stavrou, Marousi, 151 23 Athens, Greece
| | - Nikolas Marinos
- Global Clinical Operations, Elekta Ltd, Fleming Way, RH10 99RR Crawley, West Sussex, United Kingdom
| | - Eleftherios P Pappas
- Medical Physics Laboratory, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias, 115 27 Athens, Greece
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Hobbis D, Armstrong MD, Patel SH, Tegtmeier RC, Laughlin BS, Chitsazzadeh S, Clouser EL, Smetanick JL, Pettit J, Gagneur JD, Stoker JB, Rong Y, Buckey CR. Comprehensive clinical implementation, workflow, and FMEA of bespoke silicone bolus cast from 3D printed molds using open-source resources. J Appl Clin Med Phys 2024:e14498. [PMID: 39189817 DOI: 10.1002/acm2.14498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 05/09/2024] [Accepted: 07/12/2024] [Indexed: 08/28/2024] Open
Abstract
BACKGROUND Bolus materials have been used for decades in radiotherapy. Most frequently, these materials are utilized to bring dose closer to the skin surface to cover superficial targets optimally. While cavity filling, such as nasal cavities, is desirable, traditional commercial bolus is lacking, requiring other solutions. Recently, investigators have worked on utilizing 3D printing technology, including commercially available solutions, which can overcome some challenges with traditional bolus. PURPOSE To utilize failure modes and effects analysis (FMEA) to successfully implement a comprehensive 3D printed bolus solution to replace commercial bolus in our clinic using a series of open-source (or free) software products. METHODS 3D printed molds for bespoke bolus were created by exporting the DICOM structures of the bolus designed in the treatment planning system and manipulated to create a multipart mold for 3D printing. A silicone (Ecoflex 00-30) mixture is poured into the mold and cured to form the bolus. Molds for sheet bolus of five thicknesses were also created. A comprehensive FMEA was performed to guide workflow adjustments and QA steps. RESULTS The process map identified 39 and 30 distinct steps for the bespoke and flat sheet bolus workflows, respectively. The corresponding FMEA highlighted 119 and 86 failure modes, with 69 shared between the processes. Misunderstanding of plan intent was a potential cause for most of the highest-scoring failure modes, indicating that physics and dosimetry involvement early in the process is paramount. CONCLUSION FMEA informed the design and implementation of QA steps to guarantee a safe and high-quality comprehensive implementation of silicone bolus from 3D printed molds. This approach allows for greater adaptability not afforded by traditional bolus, as well as potential dissemination to other clinics due to the open-source nature of the workflow.
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Affiliation(s)
- Dean Hobbis
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, Arizona, USA
- Department of Radiation Oncology, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Michael D Armstrong
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Samir H Patel
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Riley C Tegtmeier
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, Arizona, USA
- University of South Florida Morsani College of Medicine and Tampa General Hospital Cancer Institute
| | - Brady S Laughlin
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Shadi Chitsazzadeh
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Edward L Clouser
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | | | - Justin Pettit
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Justin D Gagneur
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Joshua B Stoker
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Yi Rong
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Courtney R Buckey
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, Arizona, USA
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Rojas-López JA, Cabrera-Santiago A, Adragna C, Ibarra-Ortega BE, López-Luna JE, Contreras-Rodríguez JA, Martínez-Ortiz E. Commissioning of MRI-guided gynaecological brachytherapy using an MR-linac. Biomed Phys Eng Express 2024; 10:055032. [PMID: 39111326 DOI: 10.1088/2057-1976/ad6c54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 08/07/2024] [Indexed: 08/28/2024]
Abstract
Purpose. To evaluate the feasibility of use of an 1.5 T magnetic resonance (MR)-linear accelerator MR-linac for imaging in gynaecologic high-dose-rate (HDR) brachytherapy.Method. Commissioning measurements for MR images quality control, geometric distortion, dwell position accuracy, applicator reconstruction and end-to-end test for a tandem-and-ring applicator were performed following the recommendations of American Brachytherapy Society, International Commission on Radiation Units and Measurements and Report of the Brachytherapy Working Group of the Spanish Society of Medical Physics. The values for MR-based IGABT were compared to the corresponding values with computed tomography (CT).Results. Measured distorsions for the MR images were less than 0.50 mm compared to the CT images. The differences between 3D displacements for all dwell positions were 0.66 mm and 0.62 mm for the tandem and ring, respectively. The maximum difference is 0.64 mm for the distances from the applicator tip obtained using the films. The CT and MR dose differences for the right and left 'A' points were 0.9% and -0.7%, respectively. Similar results were observed in terms of dose distribution for CT and Mr The gamma passing rate was 99.3% and 99.5%, respectively.Conclusion. The use of MR images from an MR-linac used in a radiotherapy service for gynaecological brachytherapy was proved to be feasible, safe and precise as the geometrical differences were less than 1 mm, and the dosimetric differences were less than 1% when comparing to the use of CT images for the same purpose.
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Affiliation(s)
- José Alejandro Rojas-López
- Hospital Almater SA de CV, Álvaro Obregón 1100, Segunda Sección, Mexicali, Baja California, Mexico
- Facultad de Astronomía, Matemáticas, Física y Computación, Universidad Nacional de Córdoba, Av. Medina Allende s/n, Ciudad Universitaria, CP:X5000HUA, Córdoba, Argentina
| | - Alexis Cabrera-Santiago
- Hospital Almater SA de CV, Álvaro Obregón 1100, Segunda Sección, Mexicali, Baja California, Mexico
- Unidad de Especialidades Médicas de Oncología, Av Claridad, Plutarco Elías Calles, 21376, Mexicali, Baja California, Mexico
| | - Celeste Adragna
- Instituto Oulton, Av Vélez Sarsfield 652, Córdoba, Argentina
| | | | - José Eleazar López-Luna
- Hospital Almater SA de CV, Álvaro Obregón 1100, Segunda Sección, Mexicali, Baja California, Mexico
| | | | - Efraín Martínez-Ortiz
- Hospital Almater SA de CV, Álvaro Obregón 1100, Segunda Sección, Mexicali, Baja California, Mexico
- Unidad de Especialidades Médicas de Oncología, Av Claridad, Plutarco Elías Calles, 21376, Mexicali, Baja California, Mexico
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Cavinato S, Scaggion A, Paiusco M. Technical note: A software tool to extract complexity metrics from radiotherapy treatment plans. Med Phys 2024. [PMID: 39186793 DOI: 10.1002/mp.17365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 08/08/2024] [Accepted: 08/09/2024] [Indexed: 08/28/2024] Open
Abstract
BACKGROUND Complexity metrics are mathematical quantities designed to quantify aspects of radiotherapy treatment plans that may affect both their deliverability and dosimetric accuracy. Despite numerous studies investigating their utility, there remains a notable absence of shared tools for their extraction. PURPOSE This study introduces UCoMX (Universal Complexity Metrics Extractor), a software package designed for the extraction of complexity metrics from the DICOM-RT plan files of radiotherapy treatments. METHODS UCoMX is developed around two extraction engines: VCoMX (VMAT Complexity Metrics Extractor) for VMAT/IMRT plans, and TCoMX (Tomotherapy Complexity Metrics Extractor) tailored for Helical Tomotherapy plans. The software, built using Matlab, is freely available in both Matlab-based and stand-alone versions. More than 90 complexity metrics, drawn from relevant literature, are implemented in the package: 43 for VMAT/IMRT and 51 for Helical Tomotherapy. RESULTS The package is designed to read DICOM-RT plan files generated by most commercially available Treatment Planning Systems (TPSs), across various treatment units. A reference dataset containing VMAT, IMRT, and Helical Tomotherapy plans is provided to serve as a reference for comparing UCoMX with other in-house systems available at other centers. CONCLUSION UCoMX offers a straightforward solution for extracting complexity metrics from radiotherapy plans. Its versatility is enhanced through different versions, including Matlab-based and stand-alone, and its compatibility with a wide range of commercially available TPSs and treatment units. UCoMX presents a free, user-friendly tool empowering researchers to compute the complexity of treatment plans efficiently.
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Affiliation(s)
- Samuele Cavinato
- Medical Physics Department, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Alessandro Scaggion
- Medical Physics Department, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Marta Paiusco
- Medical Physics Department, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
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19
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Kunkyab T, Magliari A, Jirasek A, Mou B, Hyde D. Semi-automated vertex placement for lattice radiotherapy and dosimetric verification using 3D polymer gel dosimetry. J Appl Clin Med Phys 2024:e14489. [PMID: 39186819 DOI: 10.1002/acm2.14489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 06/03/2024] [Accepted: 06/28/2024] [Indexed: 08/28/2024] Open
Abstract
PURPOSE To evaluate the feasibility of an open-source, semi-automated, and reproducible vertex placement tool to improve the efficiency of lattice radiotherapy (LRT) planning. We used polymer gel dosimetry with a Cone Beam CT (CBCT) readout to commission this LRT technique. MATERIAL AND METHODS We generated a volumetric modulated arc therapy (VMAT)-based LRT plan on a 2 L NIPAM polymer gel dosimeter using our Eclipse Acuros version 15.6 AcurosXB beam model, and also recalculated the plan with a pre-clinical Acuros v18.0 dose calculation algorithm with the enhanced leaf modelling (ELM). With the assistance of the MAAS-SFRThelper software, a lattice vertex diameter of 1.5 cm and center-to-center spacing of 3 cm were used to place the spheres in a hexagonal, closed packed structure. The verification plan included four gantry arcs with 15°, 345°, 75°, 105° collimator angles. The spheres were prescribed 20 Gy to 50% of their combined volume. The 6 MV Flattening Filter Free beam energy was used to deliver the verification plan. The dosimetric accuracy of the LRT delivery was evaluated with 1D dose profiles, 2D isodose maps, and a 3D global gamma analysis. RESULTS Qualitative comparisons between the 1D dose profiles of the Eclipse plan and measured gel showed good consistency at the prescription dose mark. The average diameter measured 13.3 ± 0.2 mm (gel for v15.6), 12.6 mm (v15.6 plan), 13.1 ± 0.2 mm (gel for v18.0), and 12.3 mm (v18.0 plan). 3D gamma analysis showed that all gamma pass percent were > 95% except at 1% and 2% at the 1 mm distance to agreement criteria. CONCLUSION This study presents a novel application of gel dosimetry in verifying the dosimetric accuracy of LRT, achieving excellent 3D gamma results. The treatment planning was facilitated by publicly available software that automatically placed the vertices for consistency and efficiency.
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Affiliation(s)
- Tenzin Kunkyab
- Department of Computer Science, Mathematics, Physics and Statistics, The University of British Columbia Okanagan, Kelowna, British Columbia, Canada
- BC Cancer, Kelowna, British Columbia, Canada
| | | | - Andrew Jirasek
- Department of Computer Science, Mathematics, Physics and Statistics, The University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Benjamin Mou
- BC Cancer, Kelowna, British Columbia, Canada
- Department of Surgery, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Derek Hyde
- Department of Computer Science, Mathematics, Physics and Statistics, The University of British Columbia Okanagan, Kelowna, British Columbia, Canada
- BC Cancer, Kelowna, British Columbia, Canada
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20
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Park J, Reiners K, Wei Ho M, Huh S, Liu C, Johnson P, Zhang Y. Investigation of linear energy transfer (LET)-dependence behavior and dosimetric response of a flat-panel detector in pencil beam scanning proton therapy. Phys Med 2024; 125:104508. [PMID: 39186892 DOI: 10.1016/j.ejmp.2024.104508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 05/09/2024] [Accepted: 08/23/2024] [Indexed: 08/28/2024] Open
Abstract
PURPOSE This study aims to elucidate the dependence of the flat-panel detector's response on the linear energy transfer (LET) and evaluate the practical viability of employing flat-panel detectors in proton dosimetry applications through LET-dependent correction factors. METHODS The study assessed the flat-panel detector's response across varying depths using solid water and distinct 100, 150, and 200 MeV proton beams by comparing the flat-panel readings against reference doses measured with an ionization chamber. A Monte Carlo code was used to derive LET values, and an LET-dependent response correction factor was determined based on the ratio of the uncorrected flat-panel dose to the ionization chamber dose. The implications of this under-response correction were validated by applying it to a measurement involving a spread-out Bragg peak (SOBP), followed by a comparative analysis against doses calculated using the Monte Carlo code and MatriXX ONE measurement. RESULTS The association between LET and the flat-panel detector's under-response displayed a positive correlation that intensified with increasing LET values. Notably, with a 10 keV/µm LET value, the detector's under-response reached 50 %, while the measurement points in the SOBP demonstrated under-response greater than 20 %. However, post-correction, the adjusted flat-panel profile closely aligned with the Monte Carlo profile, yielding a 2-dimensional 3 %/3mm gamma passing rate of 100 % at various verification depths. CONCLUSION This study successfully defined the link between LET and the responsiveness of flat-panel detectors for proton dosimetric measurements and established a foundational framework for integrating flat-panel detectors in clinical proton dosimetry applications.
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Affiliation(s)
- Jiyeon Park
- University of Florida Health Proton Therapy Institute, Jacksonville, FL, USA; Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Keaton Reiners
- University of Florida Health Proton Therapy Institute, Jacksonville, FL, USA; Medical Physics Graduate Program, University of Florida College of Medicine, Gainesville, FL, USA
| | - Meng Wei Ho
- Proton and Radiation Therapy Center, Department of Radiation Oncology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Soon Huh
- University of Florida Health Proton Therapy Institute, Jacksonville, FL, USA; Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Chunbo Liu
- Department of Radiation Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Perry Johnson
- University of Florida Health Proton Therapy Institute, Jacksonville, FL, USA; Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Yawei Zhang
- University of Florida Health Proton Therapy Institute, Jacksonville, FL, USA; Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA.
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21
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Zhang J, Chen W, Joshi T, Uyanik M, Zhang X, Loh PL, Jog V, Bruce R, Garrett J, McMillan A. RobMedNAS: searching robust neural network architectures for medical image synthesis. Biomed Phys Eng Express 2024; 10:055029. [PMID: 39137798 PMCID: PMC11346166 DOI: 10.1088/2057-1976/ad6e87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 08/07/2024] [Accepted: 08/13/2024] [Indexed: 08/15/2024]
Abstract
Investigating U-Net model robustness in medical image synthesis against adversarial perturbations, this study introduces RobMedNAS, a neural architecture search strategy for identifying resilient U-Net configurations. Through retrospective analysis of synthesized CT from MRI data, employing Dice coefficient and mean absolute error metrics across critical anatomical areas, the study evaluates traditional U-Net models and RobMedNAS-optimized models under adversarial attacks. Findings demonstrate RobMedNAS's efficacy in enhancing U-Net resilience without compromising on accuracy, proposing a novel pathway for robust medical image processing.
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Affiliation(s)
- Jinnian Zhang
- Electrical and Computer Engineering, University of Wisconsin-Madison, Madison, United States of America
| | - Weijie Chen
- Electrical and Computer Engineering, University of Wisconsin-Madison, Madison, United States of America
| | - Tanmayee Joshi
- Electrical and Computer Engineering, University of Wisconsin-Madison, Madison, United States of America
| | - Meltem Uyanik
- Medical Physics, University of Wisconsin-Madison, Madison, United States of America
| | - Xiaomin Zhang
- Computer Science, University of Wisconsin-Madison, Madison, United States of America
| | - Po-Ling Loh
- Pure Mathematics and Mathematical Statistics, University of Cambridge, Cambridge, United Kingdom
| | - Varun Jog
- Pure Mathematics and Mathematical Statistics, University of Cambridge, Cambridge, United Kingdom
| | - Richard Bruce
- Radiology, University of Wisconsin-Madison, Madison, United States of America
| | - John Garrett
- Radiology, University of Wisconsin-Madison, Madison, United States of America
| | - Alan McMillan
- Electrical and Computer Engineering, University of Wisconsin-Madison, Madison, United States of America
- Medical Physics, University of Wisconsin-Madison, Madison, United States of America
- Radiology, University of Wisconsin-Madison, Madison, United States of America
- Biomedical Engineering, University of Wisconsin-Madison, Madison, United States of America
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22
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Jiang L, Ye Y, Feng Z, Liu W, Cao Y, Zhao X, Zhu X, Zhang H. Stereotactic body radiation therapy for the primary tumor and oligometastases versus the primary tumor alone in patients with metastatic pancreatic cancer. Radiat Oncol 2024; 19:111. [PMID: 39160547 PMCID: PMC11334573 DOI: 10.1186/s13014-024-02493-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 07/19/2024] [Indexed: 08/21/2024] Open
Abstract
BACKGROUND Local therapies may benefit patients with oligometastatic cancer. However, there were limited data about pancreatic cancer. Here, we compared the efficacy and safety of stereotactic body radiation therapy (SBRT) to the primary tumor and all oligometastases with SBRT to the primary tumor alone in patients with metastatic pancreatic cancer. METHODS A retrospective review of patients with synchronous oligometastatic pancreatic cancer (up to 5 lesions) receiving SBRT to all lesions (including all oligometastases and the primary tumor) were performed. Another comparable group of patients with similar baseline characteristics, including metastatic burden, SBRT doses, and chemotherapy regimens, receiving SBRT to the primary tumor alone were identified. The primary endpoint was overall survival (OS). The secondary endpoints were progression frees survival (PFS), polyprogression free survival (PPFS) and adverse events. RESULTS There were 59 and 158 patients receiving SBRT to all lesions and to the primary tumor alone. The median OS of patients with SBRT to all lesions and the primary tumor alone was 10.9 months (95% CI 10.2-11.6 months) and 9.3 months (95% CI 8.8-9.8 months) (P < 0.001). The median PFS of two groups was 6.5 months (95% CI 5.6-7.4 months) and 4.1 months (95% CI 3.8-4.4 months) (P < 0.001). The median PPFS of two groups was 9.8 months (95% CI 8.9-10.7 months) and 7.8 months (95% CI 7.2-8.4 months) (P < 0.001). Additionally, 14 (23.7%) and 32 (20.2%) patients in two groups had grade 3 or 4 treatment-related toxicity. CONCLUSIONS SBRT to all oligometastases and the primary tumor in patients with pancreatic cancer may improve survival, which needs prospective verification.
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Affiliation(s)
- Lingong Jiang
- Department of Radiation Oncology, Changhai Hospital affiliated to Naval Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Yusheng Ye
- Department of Radiation Oncology, Changhai Hospital affiliated to Naval Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Zhiru Feng
- Department of Radiation Oncology, Changhai Hospital affiliated to Naval Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Wenyu Liu
- Department of Hepatobiliary and Pancreatic Surgery, Changhai Hospital affiliated to Naval Medical University, Shanghai, China
| | - Yangsen Cao
- Department of Radiation Oncology, Changhai Hospital affiliated to Naval Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Xianzhi Zhao
- Department of Radiation Oncology, Changhai Hospital affiliated to Naval Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Xiaofei Zhu
- Department of Radiation Oncology, Changhai Hospital affiliated to Naval Medical University, 168 Changhai Road, Shanghai, 200433, China.
| | - Huojun Zhang
- Department of Radiation Oncology, Changhai Hospital affiliated to Naval Medical University, 168 Changhai Road, Shanghai, 200433, China.
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Tani K, Wakita A, Tohyama N, Fujita Y. Dosimetric impact of calibration coefficients determined using linear accelerator photon and electron beams for ionization chamber in an on-site dosimetry audit. JOURNAL OF RADIATION RESEARCH 2024:rrae054. [PMID: 39154377 DOI: 10.1093/jrr/rrae054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 06/18/2024] [Indexed: 08/20/2024]
Abstract
This study aimed to clarify the dosimetric impact of calibration beam quality for calibration coefficients of the absorbed dose to water for an ionization chamber in an on-site dosimetry audit. Institution-measured doses of 200 photon and 184 electron beams were compared with the measured dose using one year data before and after the calibration of the ionization chamber used. For photon and electron reference dosimetry, the agreements of the institution-measured dose against two measured doses in this audit were evaluated using the calibration coefficients determined using 60Co (${N}_{D,\mathrm{w},{}^{60}\mathrm{Co}}$) and linear accelerator (linac) (${N}_{D,\mathrm{w},Q}$) beams. For electron reference dosimetry, the agreement of two institution-measured doses against the measured dose was evaluated using${N}_{D,\mathrm{w},Q}$. Institution-measured doses were evaluated using direct- and cross-calibration coefficients. For photon reference dosimetry, the mean differences and standard deviation (SD) of institution-measured dose against the measured dose using ${N}_{D,\mathrm{w},{}^{60}\mathrm{Co}}$ and ${N}_{D,\mathrm{w},Q}$ were -0.1% ± 0.4% and -0.3% ± 0.4%, respectively. For electron reference dosimetry, the mean differences and SD of institution-measured dose using the direct-calibration coefficient against the measured dose using ${N}_{D,\mathrm{w},{}^{60}\mathrm{Co}}$ and ${N}_{D,\mathrm{w},Q}$ were 1.3% ± 0.8% and 0.8% ± 0.8%, respectively. Further, the mean differences and SD of institution-measured dose using the cross-calibration coefficient against the measured dose using ${N}_{D,\mathrm{w},Q}$ were -0.1% ± 0.6%. For photon beams, the dosimetric impact of introducing calibration coefficients determined using linac beams was small. For electron beams, it was larger, and the measured dose using ${N}_{D,\mathrm{w},Q}$ was most consistent with the institution-measured dose, which was evaluated using a cross-calibration coefficient.
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Affiliation(s)
- Kensuke Tani
- Division of Medical Physics, EuroMediTech Co., Ltd, 2-20-4 Higashi-Gotanda, Shinagawa, Tokyo 141-0022, Japan
| | - Akihisa Wakita
- Division of Medical Physics, EuroMediTech Co., Ltd, 2-20-4 Higashi-Gotanda, Shinagawa, Tokyo 141-0022, Japan
| | - Naoki Tohyama
- Department of Health Sciences, Komazawa University, 1-23-1 Komazawa, Setagaya, Tokyo 154-8525, Japan
| | - Yukio Fujita
- Department of Health Sciences, Komazawa University, 1-23-1 Komazawa, Setagaya, Tokyo 154-8525, Japan
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Takagi H, Takeda K, Kadoya N, Inoue K, Endo S, Takahashi N, Yamamoto T, Umezawa R, Jingu K. Development of deep learning-based novel auto-segmentation for the prostatic urethra on planning CT images for prostate cancer radiotherapy. Radiol Phys Technol 2024:10.1007/s12194-024-00832-8. [PMID: 39143386 DOI: 10.1007/s12194-024-00832-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 08/07/2024] [Accepted: 08/08/2024] [Indexed: 08/16/2024]
Abstract
Urinary toxicities are one of the serious complications of radiotherapy for prostate cancer, and dose-volume histogram of prostatic urethra has been associated with such toxicities in previous reports. Previous research has focused on estimating the prostatic urethra, which is difficult to delineate in CT images; however, these studies, which are limited in number, mainly focused on cases undergoing brachytherapy uses low-dose-rate sources and do not involve external beam radiation therapy (EBRT). In this study, we aimed to develop a deep learning-based method of determining the position of the prostatic urethra in patients eligible for EBRT. We used contour data from 430 patients with localized prostate cancer. In all cases, a urethral catheter was placed when planning CT to identify the prostatic urethra. We used 2D and 3D U-Net segmentation models. The input images included the bladder and prostate, while the output images focused on the prostatic urethra. The 2D model determined the prostate's position based on results from both coronal and sagittal directions. Evaluation metrics included the average distance between centerlines. The average centerline distances for the 2D and 3D models were 2.07 ± 0.87 mm and 2.05 ± 0.92 mm, respectively. Increasing the number of cases while maintaining equivalent accuracy as we did in this study suggests the potential for high generalization performance and the feasibility of using deep learning technology for estimating the position of the prostatic urethra.
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Affiliation(s)
- Hisamichi Takagi
- Course of Radiological Technology, Health Sciences, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, 980-8575, Japan.
| | - Ken Takeda
- Course of Radiological Technology, Health Sciences, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, 980-8575, Japan
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Noriyuki Kadoya
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Koki Inoue
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
- Elith Inc., Shibuya, Tokyo, Japan
| | - Shiki Endo
- Course of Radiological Technology, Health Sciences, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, 980-8575, Japan
| | - Noriyoshi Takahashi
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takaya Yamamoto
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Rei Umezawa
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Keiichi Jingu
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
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Kadhim M, Haraldsson A, Kügele M, Enocson H, Bäck S, Ceberg S. Surface guided ring gantry radiotherapy in deep inspiration breath hold for breast cancer patients. J Appl Clin Med Phys 2024:e14463. [PMID: 39138877 DOI: 10.1002/acm2.14463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/22/2024] [Accepted: 06/24/2024] [Indexed: 08/15/2024] Open
Abstract
PURPOSE This study investigated the use of surface guided radiotherapy (SGRT) in combination with a tomotherapy treatment mode using discrete delivery angles for deep inspiration breath hold (DIBH) treatments of breast cancer (bc). We aimed to assess the feasibility and dosimetric advantages of this approach. MATERIALS AND METHODS We evaluated camera occlusion in the Radixact treatment system bore and the stability of DIBH signals during couch movement. The SGRT system's ability to maintain signal and surface image accuracy was analyzed at different depths within the bore. Dosimetric parameters were compared and measured for 20 left-sided bc patients receiving TomoDirect (TD) tangential radiotherapy in both DIBH and free breathing (FB). RESULTS The SGRT system maintained surface coverage and precise DIBH-signal at depths up to 40 cm beyond the treatment center. Camera occlusion occurred in the clavicular and neck regions due to the patient's morphology and gantry geometry. Nonetheless, the system accurately detected respiratory motion for all measurements. The DIBH plans significantly (p < 0.001) reduced mean heart and left anterior descending artery (LAD) radiation doses by up to 40%, with a 50% reduction in near-maximum heart and LAD doses, respectively. No significant dosimetric differences between DIBH and FB were observed in other investigated parameters and volumes. CONCLUSIONS Camera occlusion and couch movement minimally impacted the real-time surface image accuracy needed for DIBH treatments of bc. DIBH reduced heart and LAD radiation doses significantly compared to FB, indicating the feasibility and dosimetric benefits of combining these modalities.
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Affiliation(s)
- Mustafa Kadhim
- Department of Medical Radiation Physics, Lund University, Lund, Sweden
- Radiation Physics, Department of Hematology, Oncology, and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - André Haraldsson
- Department of Medical Radiation Physics, Lund University, Lund, Sweden
- Radiation Physics, Department of Hematology, Oncology, and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Malin Kügele
- Department of Medical Radiation Physics, Lund University, Lund, Sweden
- Radiation Physics, Department of Hematology, Oncology, and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Hedda Enocson
- Department of Medical Radiation Physics, Lund University, Lund, Sweden
- Radiation Physics, Department of Hematology, Oncology, and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Sven Bäck
- Department of Medical Radiation Physics, Lund University, Lund, Sweden
- Radiation Physics, Department of Hematology, Oncology, and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Sofie Ceberg
- Department of Medical Radiation Physics, Lund University, Lund, Sweden
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Jiao S, Zhao X, Zhou P, Geng M. Technical note: MR image-based synthesis CT for CyberKnife robotic stereotactic radiosurgery. Biomed Phys Eng Express 2024; 10:057002. [PMID: 39094608 DOI: 10.1088/2057-1976/ad6a62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 08/02/2024] [Indexed: 08/04/2024]
Abstract
The purpose of this study is to investigate whether deep learning-based sCT images enable accurate dose calculation in CK robotic stereotactic radiosurgery. A U-net convolutional neural network was trained using 2446 MR-CT pairs and used it to translate 551 MR images to sCT images for testing. The sCT of CK patient was encapsulated into a quality assurance (QA) validation phantom for dose verification. The CT value difference between CT and sCT was evaluated using mean absolute error (MAE) and the statistical significance of dose differences between CT and sCT was tested using the Wilcoxon signed rank test. For all CK patients, the MAE value of the whole brain region did not exceed 25 HU. The percentage dose difference between CT and sCT was less than ±0.4% on GTV (D2(Gy), -0.29%, D95(Gy), -0.09%), PTV (D2(Gy), -0.25%, D95(Gy), -0.10%), and brainstem (max dose(Gy), 0.31%). The percentage dose difference between CT and sCT for most regions of interest (ROIs) was no more than ±0.04%. This study extended MR-based sCT prediction to CK robotic stereotactic radiosurgery, expanding the application scenarios of MR-only radiation therapy. The results demonstrated the remarkable accuracy of dose calculation on sCT for patients treated with CK robotic stereotactic radiosurgery.
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Affiliation(s)
- Shengxiu Jiao
- Department of Nuclear Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China
| | - Xiaoqian Zhao
- Department of Nuclear Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China
| | - Peng Zhou
- Department of Cancer Center, Daping Hospital, Army Medical University, Chongqing People's Republic of China
| | - Mingying Geng
- Department of Cancer Center, Daping Hospital, Army Medical University, Chongqing People's Republic of China
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Rabe M, Kurz C, Thummerer A, Landry G. Artificial intelligence for treatment delivery: image-guided radiotherapy. Strahlenther Onkol 2024:10.1007/s00066-024-02277-9. [PMID: 39138806 DOI: 10.1007/s00066-024-02277-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 07/07/2024] [Indexed: 08/15/2024]
Abstract
Radiation therapy (RT) is a highly digitized field relying heavily on computational methods and, as such, has a high affinity for the automation potential afforded by modern artificial intelligence (AI). This is particularly relevant where imaging is concerned and is especially so during image-guided RT (IGRT). With the advent of online adaptive RT (ART) workflows at magnetic resonance (MR) linear accelerators (linacs) and at cone-beam computed tomography (CBCT) linacs, the need for automation is further increased. AI as applied to modern IGRT is thus one area of RT where we can expect important developments in the near future. In this review article, after outlining modern IGRT and online ART workflows, we cover the role of AI in CBCT and MRI correction for dose calculation, auto-segmentation on IGRT imaging, motion management, and response assessment based on in-room imaging.
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Affiliation(s)
- Moritz Rabe
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Bavaria, Germany
| | - Christopher Kurz
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Bavaria, Germany
| | - Adrian Thummerer
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Bavaria, Germany
| | - Guillaume Landry
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Bavaria, Germany.
- German Cancer Consortium (DKTK), partner site Munich, a partnership between the DKFZ and the LMU University Hospital Munich, Marchioninistraße 15, 81377, Munich, Bavaria, Germany.
- Bavarian Cancer Research Center (BZKF), Marchioninistraße 15, 81377, Munich, Bavaria, Germany.
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Bertholet J, Guyer G, Mueller S, Loebner HA, Volken W, Aebersold DM, Manser P, Fix MK. Robust optimization and assessment of dynamic trajectory and mixed-beam arc radiotherapy: a preliminary study. Phys Med Biol 2024; 69:165032. [PMID: 39079553 DOI: 10.1088/1361-6560/ad6950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 07/30/2024] [Indexed: 08/13/2024]
Abstract
Objective.Dynamic trajectory radiotherapy (DTRT) and dynamic mixed-beam arc therapy (DYMBARC) exploit non-coplanarity and, for DYMBARC, simultaneously optimized photon and electron beams. Margin concepts to account for set-up uncertainties during delivery are ill-defined for electron fields. We develop robust optimization for DTRT&DYMBARC and compare dosimetric plan quality and robustness for both techniques and both optimization strategies for four cases.Approach.Cases for different treatment sites and clinical target volume (CTV) to planning target volume (PTV) margins,m, were investigated. Dynamic gantry-table-collimator photon paths were optimized to minimize PTV/organ-at-risk (OAR) overlap in beam's-eye-view and minimize potential photon multileaf collimator (MLC) travel. For DYMBARC plans, non-isocentric partial electron arcs or static fields with shortened source-to-surface distance (80 cm) were added. Direct aperture optimization (DAO) was used to simultaneously optimize MLC-based intensity modulation for both photon and electron beams yielding deliverable PTV-based DTRT&DYMBARC plans. Robust-optimized plans used the same paths/arcs/fields. DAO with stochastic programming was used for set-up uncertainties with equal weights in all translational directions and magnitudeδsuch thatm= 0.7δ. Robust analysis considered random errors in all directions with or without an additional systematic error in the worst 3D direction for the adjacent OARs.Main results.Electron contribution was 7%-41% of target dose depending on the case and optimization strategy for DYMBARC. All techniques achieved similar CTV coverage in the nominal (no error) scenario. OAR sparing was overall better in the DYMBARC plans than in the DTRT plans and DYMBARC plans were generally more robust to the considered uncertainties. OAR sparing was better in the PTV-based than in robust-optimized plans for OARs abutting or overlapping with the target volume, but more affected by uncertainties.Significance.Better plan robustness can be achieved with robust optimization than with margins. Combining electron arcs/fields with non-coplanar photon trajectories further improves robustness and OAR sparing.
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Affiliation(s)
- Jenny Bertholet
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital, and University of Bern, 3010 Bern, Switzerland
| | - Gian Guyer
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital, and University of Bern, 3010 Bern, Switzerland
| | - Silvan Mueller
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital, and University of Bern, 3010 Bern, Switzerland
| | - Hannes A Loebner
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital, and University of Bern, 3010 Bern, Switzerland
| | - Werner Volken
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital, and University of Bern, 3010 Bern, Switzerland
| | - Daniel M Aebersold
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital, and University of Bern, 3010 Bern, Switzerland
| | - Peter Manser
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital, and University of Bern, 3010 Bern, Switzerland
| | - Michael K Fix
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital, and University of Bern, 3010 Bern, Switzerland
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Iarkin V, de Jong EEC, Hendrix R, Verhaegen F, Wolfs CJA. Turning the attention to time-resolved EPID-images: treatment error classification with transformer multiple instance learning. Phys Med Biol 2024; 69:165030. [PMID: 39084643 DOI: 10.1088/1361-6560/ad69f6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 07/31/2024] [Indexed: 08/02/2024]
Abstract
Objective.The aim of this work was to develop a novel artificial intelligence-assistedin vivodosimetry method using time-resolved (TR) dose verification data to improve quality of external beam radiotherapy.Approach. Although threshold classification methods are commonly used in error classification, they may lead to missing errors due to the loss of information resulting from the compression of multi-dimensional electronic portal imaging device (EPID) data into one or a few numbers. Recent research has investigated the classification of errors on time-integrated (TI)in vivoEPID images, with convolutional neural networks showing promise. However, it has been observed previously that TI approaches may cancel out the error presence onγ-maps during dynamic treatments. To address this limitation, simulated TRγ-maps for each volumetric modulated arc radiotherapy angle were used to detect treatment errors caused by complex patient geometries and beam arrangements. Typically, such images can be interpreted as a set of segments where only set class labels are provided. Inspired by recent weakly supervised approaches on histopathology images, we implemented a transformer based multiple instance learning approach and utilized transfer learning from TI to TRγ-maps.Main results. The proposed algorithm performed well on classification of error type and error magnitude. The accuracy in the test set was up to 0.94 and 0.81 for 11 (error type) and 22 (error magnitude) classes of treatment errors, respectively.Significance. TR dose distributions can enhance treatment delivery decision-making, however manual data analysis is nearly impossible due to the complexity and quantity of this data. Our proposed model efficiently handles data complexity, substantially improving treatment error classification compared to models that leverage TI data.
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Affiliation(s)
- Viacheslav Iarkin
- Department of Radiation Oncology (Maastro), GROW Research Institute for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Evelyn E C de Jong
- Department of Radiation Oncology (Maastro), GROW Research Institute for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Rutger Hendrix
- Medical Image Analysis group, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Frank Verhaegen
- Department of Radiation Oncology (Maastro), GROW Research Institute for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Cecile J A Wolfs
- Department of Radiation Oncology (Maastro), GROW Research Institute for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
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Mukwada G, Chamunyonga C, Rowshanfarzad P, Gill S, Ebert MA. Insights into the dosimetric and geometric characteristics of stereotactic radiosurgery for multiple brain metastases: A systematic review. PLoS One 2024; 19:e0307088. [PMID: 39121064 PMCID: PMC11315342 DOI: 10.1371/journal.pone.0307088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Accepted: 06/30/2024] [Indexed: 08/11/2024] Open
Abstract
BACKGROUND GammaKnife (GK) and CyberKnife (CK) have been the mainstay stereotactic radiosurgery (SRS) solution for multiple brain metastases (MBM) for several years. Recent technological advancement has seen an increase in single-isocentre C-arm linac-based SRS. This systematic review focuses on dosimetric and geometric insights into contemporary MBM SRS and thereby establish if linac-based SRS has matured to match the mainstay SRS delivery systems. METHODS The PubMed, Web of Science and Scopus databases were interrogated which yielded 891 relevant articles that narrowed to 20 articles after removing duplicates and applying the inclusion and exclusion criteria. Primary studies which reported the use of SRS for treatment of MBM SRS and reported the technical aspects including dosimetry were included. The review was limited to English language publications from January 2015 to August 2023. Only full-length papers were included in the final analysis. Opinion papers, commentary pieces, letters to the editor, abstracts, conference proceedings and editorials were excluded. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. The reporting of conformity indices (CI) and gradient indices, V12Gy, monitor units and the impact of translational and rotational shifts were extracted and analysed. RESULTS The single-isocentre technique for MBM dominated recent SRS studies and the most studied delivery platforms were Varian. The C-arm linac-based SRS plan quality and normal brain tissue sparing was comparable to GK and CK and in some cases better. The most used nominal beam energy was 6FFF, and optimised couch and collimator angles could reduce mean normal brain dose by 11.3%. Reduction in volume of the healthy brain receiving a certain dose was dependent on the number and size of the metastases and the relative geometric location. GK and CK required 4.5-8.4 times treatment time compared with linac-based SRS. Rotational shifts caused larger changes in CI in C-arm linac-based single-isocentre SRS. CONCLUSION C-arm linac-based SRS produced comparable MBM plan quality and the delivery is notably shorter compared to GK and CK SRS.
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Affiliation(s)
- Godfrey Mukwada
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Hospital Ave, Nedlands, Western Australia, Australia
- School of Physics, Mathematics and Computing, University of Western Australia, Crawley, Western Australia, Australia
| | - Crispen Chamunyonga
- School of Clinical Sciences, Discipline of Radiation Therapy, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Pejman Rowshanfarzad
- School of Physics, Mathematics and Computing, University of Western Australia, Crawley, Western Australia, Australia
- Centre for Advanced Technologies in Cancer Research (CATCR), Perth, Western Australia, Australia
| | - Suki Gill
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Hospital Ave, Nedlands, Western Australia, Australia
- School of Physics, Mathematics and Computing, University of Western Australia, Crawley, Western Australia, Australia
| | - Martin A. Ebert
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Hospital Ave, Nedlands, Western Australia, Australia
- School of Physics, Mathematics and Computing, University of Western Australia, Crawley, Western Australia, Australia
- Centre for Advanced Technologies in Cancer Research (CATCR), Perth, Western Australia, Australia
- School of Medicine and Population Health, University of Wisconsin, Madison, Wisconsin, United States of America
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Huang Y, Gomaa A, Höfler D, Schubert P, Gaipl U, Frey B, Fietkau R, Bert C, Putz F. Principles of artificial intelligence in radiooncology. Strahlenther Onkol 2024:10.1007/s00066-024-02272-0. [PMID: 39105746 DOI: 10.1007/s00066-024-02272-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 06/17/2024] [Indexed: 08/07/2024]
Abstract
PURPOSE In the rapidly expanding field of artificial intelligence (AI) there is a wealth of literature detailing the myriad applications of AI, particularly in the realm of deep learning. However, a review that elucidates the technical principles of deep learning as relevant to radiation oncology in an easily understandable manner is still notably lacking. This paper aims to fill this gap by providing a comprehensive guide to the principles of deep learning that is specifically tailored toward radiation oncology. METHODS In light of the extensive variety of AI methodologies, this review selectively concentrates on the specific domain of deep learning. It emphasizes the principal categories of deep learning models and delineates the methodologies for training these models effectively. RESULTS This review initially delineates the distinctions between AI and deep learning as well as between supervised and unsupervised learning. Subsequently, it elucidates the fundamental principles of major deep learning models, encompassing multilayer perceptrons (MLPs), convolutional neural networks (CNNs), recurrent neural networks (RNNs), transformers, generative adversarial networks (GANs), diffusion-based generative models, and reinforcement learning. For each category, it presents representative networks alongside their specific applications in radiation oncology. Moreover, the review outlines critical factors essential for training deep learning models, such as data preprocessing, loss functions, optimizers, and other pivotal training parameters including learning rate and batch size. CONCLUSION This review provides a comprehensive overview of deep learning principles tailored toward radiation oncology. It aims to enhance the understanding of AI-based research and software applications, thereby bridging the gap between complex technological concepts and clinical practice in radiation oncology.
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Affiliation(s)
- Yixing Huang
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, 91054, Erlangen, Germany.
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054, Erlangen, Germany.
| | - Ahmed Gomaa
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, 91054, Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054, Erlangen, Germany
| | - Daniel Höfler
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, 91054, Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054, Erlangen, Germany
| | - Philipp Schubert
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, 91054, Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054, Erlangen, Germany
| | - Udo Gaipl
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054, Erlangen, Germany
- Translational Radiobiology, Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, 91054, Erlangen, Germany
| | - Benjamin Frey
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054, Erlangen, Germany
- Translational Radiobiology, Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, 91054, Erlangen, Germany
| | - Rainer Fietkau
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, 91054, Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054, Erlangen, Germany
| | - Christoph Bert
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, 91054, Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054, Erlangen, Germany
| | - Florian Putz
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, 91054, Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054, Erlangen, Germany
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Fransson S, Strand R, Tilly D. Deep learning-based dose prediction for magnetic resonance-guided prostate radiotherapy. Med Phys 2024. [PMID: 39106418 DOI: 10.1002/mp.17312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 07/05/2024] [Accepted: 07/08/2024] [Indexed: 08/09/2024] Open
Abstract
BACKGROUND Daily adaptive radiotherapy, as performed with the Elekta Unity MR-Linac, requires choosing between different adaptation methods, namely ATP (Adapt to Position) and ATS (Adapt to Shape), where the latter requires daily re-contouring to obtain a dose plan tailored to the daily anatomy. These steps are inherently resource-intensive, and quickly predicting the dose distribution and the dosimetric evaluation criteria while the patient is on the table could facilitate a fast selection of adaptation method and decrease the treatment times. PURPOSE In this work, we aimed to develop a deep-learning-based dose-prediction pipeline for prostate MR-Linac treatments. METHODS Two hundred twelve MR-images, structure sets, and dose distributions from 35 prostate patients treated with 6.1 Gy for 7 or 6 fractions at our MR-Linac were included, split into train/test partitions of 152/60 images, respectively. A deep-learning segmentation network was trained to segment the CTV (prostate), bladder, and rectum. A second network was trained to predict the dose distribution based on manually delineated structures. At inference, the predicted segmentations acted as input to the dose prediction network, and the predicted dose was compared to the true (optimized in the treatment planning system) dose distribution. RESULTS Median DSC values from the segmentation network were 0.90/0.94/0.87 for CTV/bladder/rectum. Predicted segmentations as input to the dose prediction resulted in mean differences between predicted and true doses of 0.7%/0.7%/1.7% (relative to the prescription dose) for D98%/D95%/D2% for the CTV. For the bladder, the difference was 0.7%/0.3% for Dmean/D2% and for the rectum 0.1/0.2/0.2 pp (percentage points) for V33Gy/V38Gy/V41Gy. In comparison, true segmentations as input resulted in differences of 1.1%/0.9%/1.6% for CTV, 0.5%/0.4% for bladder, and 0.7/0.4/0.3 pp for the rectum. Only D2% for CTV and Dmean/D2% for bladder were found to be statistically significantly better when using true structures instead of predicted structures as input to the dose prediction. CONCLUSIONS Small differences in the fulfillment of clinical dose-volume constraints are seen between utilizing deep-learning predicted structures as input to a dose prediction network and manual structures. Overall mean differences <2% indicate that the dose-prediction pipeline is useful as a decision support tool where differences are >2%.
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Affiliation(s)
- Samuel Fransson
- Department of Medical Physics, Uppsala University Hospital, Uppsala, Sweden
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Robin Strand
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Department of Information Technology, Uppsala University, Uppsala, Sweden
| | - David Tilly
- Department of Medical Physics, Uppsala University Hospital, Uppsala, Sweden
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
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Ren J, Teuwen J, Nijkamp J, Rasmussen M, Gouw Z, Grau Eriksen J, Sonke JJ, Korreman S. Enhancing the reliability of deep learning-based head and neck tumour segmentation using uncertainty estimation with multi-modal images. Phys Med Biol 2024; 69:165018. [PMID: 39059432 DOI: 10.1088/1361-6560/ad682d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 07/26/2024] [Indexed: 07/28/2024]
Abstract
Objective.Deep learning shows promise in autosegmentation of head and neck cancer (HNC) primary tumours (GTV-T) and nodal metastases (GTV-N). However, errors such as including non-tumour regions or missing nodal metastases still occur. Conventional methods often make overconfident predictions, compromising reliability. Incorporating uncertainty estimation, which provides calibrated confidence intervals can address this issue. Our aim was to investigate the efficacy of various uncertainty estimation methods in improving segmentation reliability. We evaluated their confidence levels in voxel predictions and ability to reveal potential segmentation errors.Approach.We retrospectively collected data from 567 HNC patients with diverse cancer sites and multi-modality images (CT, PET, T1-, and T2-weighted MRI) along with their clinical GTV-T/N delineations. Using the nnUNet 3D segmentation pipeline, we compared seven uncertainty estimation methods, evaluating them based on segmentation accuracy (Dice similarity coefficient, DSC), confidence calibration (Expected Calibration Error, ECE), and their ability to reveal segmentation errors (Uncertainty-Error overlap using DSC, UE-DSC).Main results.Evaluated on the hold-out test dataset (n= 97), the median DSC scores for GTV-T and GTV-N segmentation across all uncertainty estimation methods had a narrow range, from 0.73 to 0.76 and 0.78 to 0.80, respectively. In contrast, the median ECE exhibited a wider range, from 0.30 to 0.12 for GTV-T and 0.25 to 0.09 for GTV-N. Similarly, the median UE-DSC also ranged broadly, from 0.21 to 0.38 for GTV-T and 0.22 to 0.36 for GTV-N. A probabilistic network-PhiSeg method consistently demonstrated the best performance in terms of ECE and UE-DSC.Significance.Our study highlights the importance of uncertainty estimation in enhancing the reliability of deep learning for autosegmentation of HNC GTV. The results show that while segmentation accuracy can be similar across methods, their reliability, measured by calibration error and uncertainty-error overlap, varies significantly. Used with visualisation maps, these methods may effectively pinpoint uncertainties and potential errors at the voxel level.
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Affiliation(s)
- Jintao Ren
- Danish Centre for Particle Therapy, Aarhus University Hospital, Palle Juul-Jensens Boulevard 25, 8200 Aarhus N, Denmark
- Department of Oncology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 25, 8200 Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 25, 8200 Aarhus N, Denmark
| | - Jonas Teuwen
- Department of Radiation Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Jasper Nijkamp
- Danish Centre for Particle Therapy, Aarhus University Hospital, Palle Juul-Jensens Boulevard 25, 8200 Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 25, 8200 Aarhus N, Denmark
| | - Mathis Rasmussen
- Danish Centre for Particle Therapy, Aarhus University Hospital, Palle Juul-Jensens Boulevard 25, 8200 Aarhus N, Denmark
- Department of Oncology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 25, 8200 Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 25, 8200 Aarhus N, Denmark
| | - Zeno Gouw
- Department of Radiation Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Jesper Grau Eriksen
- Department of Oncology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 25, 8200 Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 25, 8200 Aarhus N, Denmark
| | - Jan-Jakob Sonke
- Department of Radiation Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Stine Korreman
- Danish Centre for Particle Therapy, Aarhus University Hospital, Palle Juul-Jensens Boulevard 25, 8200 Aarhus N, Denmark
- Department of Oncology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 25, 8200 Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 25, 8200 Aarhus N, Denmark
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Ding X, Jiang X, Zheng H, Shi H, Wang B, Chan S. MARes-Net: multi-scale attention residual network for jaw cyst image segmentation. Front Bioeng Biotechnol 2024; 12:1454728. [PMID: 39161348 PMCID: PMC11330813 DOI: 10.3389/fbioe.2024.1454728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Accepted: 07/25/2024] [Indexed: 08/21/2024] Open
Abstract
Jaw cyst is a fluid-containing cystic lesion that can occur in any part of the jaw and cause facial swelling, dental lesions, jaw fractures, and other associated issues. Due to the diversity and complexity of jaw images, existing deep-learning methods still have challenges in segmentation. To this end, we propose MARes-Net, an innovative multi-scale attentional residual network architecture. Firstly, the residual connection is used to optimize the encoder-decoder process, which effectively solves the gradient disappearance problem and improves the training efficiency and optimization ability. Secondly, the scale-aware feature extraction module (SFEM) significantly enhances the network's perceptual abilities by extending its receptive field across various scales, spaces, and channel dimensions. Thirdly, the multi-scale compression excitation module (MCEM) compresses and excites the feature map, and combines it with contextual information to obtain better model performance capabilities. Furthermore, the introduction of the attention gate module marks a significant advancement in refining the feature map output. Finally, rigorous experimentation conducted on the original jaw cyst dataset provided by Quzhou People's Hospital to verify the validity of MARes-Net architecture. The experimental data showed that precision, recall, IoU and F1-score of MARes-Net reached 93.84%, 93.70%, 86.17%, and 93.21%, respectively. Compared with existing models, our MARes-Net shows its unparalleled capabilities in accurately delineating and localizing anatomical structures in the jaw cyst image segmentation.
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Affiliation(s)
- Xiaokang Ding
- College of Mechanical Engineering, Quzhou University, Quzhou, China
| | - Xiaoliang Jiang
- College of Mechanical Engineering, Quzhou University, Quzhou, China
| | - Huixia Zheng
- Department of Stomatology, Quzhou People’s Hospital, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou, China
| | - Hualuo Shi
- College of Mechanical Engineering, Quzhou University, Quzhou, China
- School of Mechanical Engineering, Hangzhou Dianzi University, Hangzhou, China
| | - Ban Wang
- School of Mechanical Engineering, Hangzhou Dianzi University, Hangzhou, China
| | - Sixian Chan
- College of Computer Science and Technology, Zhejiang University of Technology, Hangzhou, China
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Tsui T, Podgorsak A, Roeske JC, Small W, Refaat T, Kang H. Geometric and dosimetric evaluation for breast and regional nodal auto-segmentation structures. J Appl Clin Med Phys 2024:e14461. [PMID: 39092893 DOI: 10.1002/acm2.14461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 04/09/2024] [Accepted: 06/23/2024] [Indexed: 08/04/2024] Open
Abstract
The accuracy of artificial intelligence (AI) generated contours for intact-breast and post-mastectomy radiotherapy plans was evaluated. Geometric and dosimetric comparisons were performed between auto-contours (ACs) and manual-contours (MCs) produced by physicians for target structures. Breast and regional nodal structures were manually delineated on 66 breast cancer patients. ACs were retrospectively generated. The characteristics of the breast/post-mastectomy chestwall (CW) and regional nodal structures (axillary [AxN], supraclavicular [SC], internal mammary [IM]) were geometrically evaluated by Dice similarity coefficient (DSC), mean surface distance, and Hausdorff Distance. The structures were also evaluated dosimetrically by superimposing the MC clinically delivered plans onto the ACs to assess the impact of utilizing ACs with target dose (Vx%) evaluation. Positive geometric correlations between volume and DSC for intact-breast, AxN, and CW were observed. Little or anti correlations between volume and DSC for IM and SC were shown. For intact-breast plans, insignificant dosimetric differences between ACs and MCs were observed for AxNV95% (p = 0.17) and SCV95% (p = 0.16), while IMNV90% ACs and MCs were significantly different. The average V95% for intact-breast MCs (98.4%) and ACs (97.1%) were comparable but statistically different (p = 0.02). For post-mastectomy plans, AxNV95% (p = 0.35) and SCV95% (p = 0.08) were consistent between ACs and MCs, while IMNV90% was significantly different. Additionally, 94.1% of AC-breasts met ΔV95% variation <5% when DSC > 0.7. However, only 62.5% AC-CWs achieved the same metrics, despite AC-CWV95% (p = 0.43) being statistically insignificant. The AC intact-breast structure was dosimetrically similar to MCs. The AC AxN and SC may require manual adjustments. Careful review should be performed for AC post-mastectomy CW and IMN before treatment planning. The findings of this study may guide the clinical decision-making process for the utilization of AI-driven ACs for intact-breast and post-mastectomy plans. Before clinical implementation of this auto-segmentation software, an in-depth assessment of agreement with each local facilities MCs is needed.
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Affiliation(s)
- Tiffany Tsui
- Department of Radiation Oncology, Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois, USA
- Department of Radiation Oncology, Cardinal Bernard Cancer Center, Maywood, Illinois, USA
| | - Alexander Podgorsak
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York, USA
| | - John C Roeske
- Department of Radiation Oncology, Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois, USA
- Department of Radiation Oncology, Cardinal Bernard Cancer Center, Maywood, Illinois, USA
| | - William Small
- Department of Radiation Oncology, Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois, USA
- Department of Radiation Oncology, Cardinal Bernard Cancer Center, Maywood, Illinois, USA
| | - Tamer Refaat
- Department of Radiation Oncology, Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois, USA
- Department of Radiation Oncology, Cardinal Bernard Cancer Center, Maywood, Illinois, USA
| | - Hyejoo Kang
- Department of Radiation Oncology, Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois, USA
- Department of Radiation Oncology, Cardinal Bernard Cancer Center, Maywood, Illinois, USA
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Du S, Gong G, Chen M, Liu R, Meng K, Yin Y. The effect of time-delayed contrast-enhanced scanning in determining the gross tumor target volume of large-volume brain metastases. Radiother Oncol 2024; 197:110330. [PMID: 38768715 DOI: 10.1016/j.radonc.2024.110330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 04/07/2024] [Accepted: 05/01/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND AND PURPOSE To assess the variation of large-volume brain metastases (BMs) boundaries and shapes using enhanced magnetic resonance (MR) scanning with different delay times and to provide a basis for determining the gross tumor target volume (GTV) for radiotherapy of BMs. MATERIALS AND METHODS We prospectively enrolled 155 patients initially diagnosed with BMs (561 lesions > 1 cm). Contrast-enhanced (CE) T1-weighted imaging scans were performed 1, 3, 5, 10, 18, and 20 min after gadolinium-based contrast agent injection and GTVs were determined as GTV-1min, GTV-3min, GTV-5min, GTV-10min, GTV-18min, and GTV-20min, respectively, which were subsequently fused in different phases. Fusion of the six GTVs was defined as GTV-total, which was set as the reference GTV. The volume, shape, and signal intensity of the GTVs and brain white matter (BWM) were compared at different delay times. RESULTS GTV-3min, GTV-5min, GTV-10min, GTV-18min, and GTV-20min volumes increased by 2.2 %, 3.8 %, 6.5 %, 9.5 %, and 10.6 %, respectively (P < 0.05) compared with GTV-1min. Compared with GTV-total, GTV-1min, GTV-3min, GTV-5min, GTV-10min, GTV-18min, and GTV-20min volumes reduced by 25.4 %, 22.1 %, 18.7 %, 15.0 %, 11.2 %, and 10.3 %, respectively (P < 0.05). Compared with GTV-total, 29 (51.8 %) fused GTVs had a volume reduction rate < 5 %, 45 (80.4 %) had a Dice similarity coefficient > 0.95, and all contained GTV-10min, GTV-18min or GTV-20min. The signal intensity ratio between the GTV and BWM peaked at 5 min (0.351 ± 0.24). CONCLUSION Enhanced MR scans with different delay times show significant differences in the boundaries and shapes of large-volume BMs, and time-delayed multi-phase CE scanning should be used in GTV determination, with time phases ≥ 10 min being mandatory.
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Affiliation(s)
- Shanshan Du
- Department of Oncology, Afliated Hospital of Southwest Medical University, No.25 Taiping Street, Jiangyang District, Luzhou 646000, Sichuan, China; Department of Radiation Oncology Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Ji Yan Road No.440, 250117 Jinan, China
| | - Guanzhong Gong
- Department of Radiation Oncology Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Ji Yan Road No.440, 250117 Jinan, China
| | - Mingming Chen
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Rui Liu
- Department of Radiation Oncology Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Ji Yan Road No.440, 250117 Jinan, China
| | - Kangning Meng
- Department of Radiation Oncology Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Ji Yan Road No.440, 250117 Jinan, China
| | - Yong Yin
- Department of Radiation Oncology Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Ji Yan Road No.440, 250117 Jinan, China.
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Balaji S, Wiley N, Poorman ME, Kolind SH. Low-field MRI for use in neurological diseases. Curr Opin Neurol 2024; 37:381-391. [PMID: 38813835 DOI: 10.1097/wco.0000000000001282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
PURPOSE OF REVIEW To review recent clinical uses of low-field magnetic resonance imaging (MRI) to guide incorporation into neurological practice. RECENT FINDINGS Use of low-field MRI has been demonstrated in applications including tumours, vascular pathologies, multiple sclerosis, brain injury, and paediatrics. Safety, workflow, and image quality have also been evaluated. SUMMARY Low-field MRI has the potential to increase access to critical brain imaging for patients who otherwise may not obtain imaging in a timely manner. This includes areas such as the intensive care unit and emergency room, where patients could be imaged at the point of care rather than be transported to the MRI scanner. Such systems are often more affordable than conventional systems, allowing them to be more easily deployed in resource constrained settings. A variety of systems are available on the market or in a research setting and are currently being used to determine clinical uses for these devices. The utility of such devices must be fully evaluated in clinical scenarios before adoption into standard practice can be achieved. This review summarizes recent clinical uses of low-field MR as well as safety, workflows, and image quality to aid practitioners in assessing this new technology.
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Affiliation(s)
- Sharada Balaji
- Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Neale Wiley
- Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Shannon H Kolind
- Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Medicine (Neurology)
- Department of Radiology
- International Collaboration on Repair Discoveries, Blusson Spinal Cord Centre, University of British Columbia, Vancouver, British Columbia, Canada
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Hurkmans C, Bibault JE, Brock KK, van Elmpt W, Feng M, David Fuller C, Jereczek-Fossa BA, Korreman S, Landry G, Madesta F, Mayo C, McWilliam A, Moura F, Muren LP, El Naqa I, Seuntjens J, Valentini V, Velec M. A joint ESTRO and AAPM guideline for development, clinical validation and reporting of artificial intelligence models in radiation therapy. Radiother Oncol 2024; 197:110345. [PMID: 38838989 DOI: 10.1016/j.radonc.2024.110345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Accepted: 05/23/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND AND PURPOSE Artificial Intelligence (AI) models in radiation therapy are being developed with increasing pace. Despite this, the radiation therapy community has not widely adopted these models in clinical practice. A cohesive guideline on how to develop, report and clinically validate AI algorithms might help bridge this gap. METHODS AND MATERIALS A Delphi process with all co-authors was followed to determine which topics should be addressed in this comprehensive guideline. Separate sections of the guideline, including Statements, were written by subgroups of the authors and discussed with the whole group at several meetings. Statements were formulated and scored as highly recommended or recommended. RESULTS The following topics were found most relevant: Decision making, image analysis, volume segmentation, treatment planning, patient specific quality assurance of treatment delivery, adaptive treatment, outcome prediction, training, validation and testing of AI model parameters, model availability for others to verify, model quality assurance/updates and upgrades, ethics. Key references were given together with an outlook on current hurdles and possibilities to overcome these. 19 Statements were formulated. CONCLUSION A cohesive guideline has been written which addresses main topics regarding AI in radiation therapy. It will help to guide development, as well as transparent and consistent reporting and validation of new AI tools and facilitate adoption.
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Affiliation(s)
- Coen Hurkmans
- Department of Radiation Oncology, Catharina Hospital, Eindhoven, the Netherlands; Department of Electrical Engineering, Technical University Eindhoven, Eindhoven, the Netherlands.
| | | | - Kristy K Brock
- Departments of Imaging Physics and Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Wouter van Elmpt
- Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Mary Feng
- University of California San Francisco, San Francisco, CA, USA
| | - Clifton David Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer, Houston, TX
| | - Barbara A Jereczek-Fossa
- Dept. of Oncology and Hemato-oncology, University of Milan, Milan, Italy; Dept. of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Stine Korreman
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Danish Center for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Guillaume Landry
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany; German Cancer Consortium (DKTK), Partner Site Munich, a Partnership between DKFZ and LMU University Hospital Munich, Germany; Bavarian Cancer Research Center (BZKF), Partner Site Munich, Munich, Germany
| | - Frederic Madesta
- Department of Computational Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Institute for Applied Medical Informatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Center for Biomedical Artificial Intelligence (bAIome), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Chuck Mayo
- Institute for Healthcare Policy and Innovation, University of Michigan, USA
| | - Alan McWilliam
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
| | - Filipe Moura
- CrossI&D Lisbon Research Center, Portuguese Red Cross Higher Health School Lisbon, Portugal
| | - Ludvig P Muren
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Danish Center for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Issam El Naqa
- Department of Machine Learning, Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Jan Seuntjens
- Princess Margaret Cancer Centre, Radiation Medicine Program, University Health Network & Departments of Radiation Oncology and Medical Biophysics, University of Toronto, Toronto, Canada
| | - Vincenzo Valentini
- Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Michael Velec
- Radiation Medicine Program, Princess Margaret Cancer Centre and Department of Radiation Oncology, University of Toronto, Toronto, Canada
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van Grinsven EE, Cialdella F, Gmelich Meijling Y, Verhoeff JJC, Philippens MEP, van Zandvoort MJE. Individualized trajectories in postradiotherapy neurocognitive functioning of patients with brain metastases. Neurooncol Pract 2024; 11:441-451. [PMID: 39006520 PMCID: PMC11241367 DOI: 10.1093/nop/npae024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/16/2024] Open
Abstract
Background The increasing incidence of brain metastases (BMs) and improved survival rates underscore the necessity to investigate the effects of treatments on individuals. The aim of this study was to evaluate the individual trajectories of subjective and objective cognitive performance after radiotherapy in patients with BMs. Methods The study population consisted of adult patients with BMs referred for radiotherapy. A semi-structured interview and comprehensive neurocognitive assessment (NCA) were used to assess both subjective and objective cognitive performance before, 3 months and ≥ 11 months after radiotherapy. Reliable change indices were used to identify individual, clinically meaningful changes. Results Thirty-six patients completed the 3-month follow-up, and 14 patients completed the ≥ 11-months follow-up. Depending on the domain, subjective cognitive decline was reported by 11-22% of patients. In total, 50% of patients reported subjective decline in at least one cognitive domain. Intracranial progression 3 months postradiotherapy was a risk-factor for self-reported deterioration (P = .031). Objective changes were observed across all domains, with a particular vulnerability for decline in memory at 3 months postradiotherapy. The majority of patients (81%) experienced both a deterioration as well as improvement (eg, mixed response) in objective cognitive functioning. Results were similar for the long-term follow-up (3 to ≥11 months). No risk factors for objective cognitive change 3 months postradiotherapy were identified. Conclusions Our study revealed that the majority of patients with BMs will show a mixed cognitive response following radiotherapy, reflecting the complex impact. This underscores the importance of patient-tailored NCAs 3 months postradiotherapy to guide optimal rehabilitation strategies.
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Affiliation(s)
- Eva E van Grinsven
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - Fia Cialdella
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Yoniet Gmelich Meijling
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - Joost J C Verhoeff
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marielle E P Philippens
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Martine J E van Zandvoort
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
- Department of Experimental Psychology and Helmholtz Institute, Utrecht University, The Netherlands
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Fu W, Zhang Y, Mehta K, Chen A, Musunuru HB, Pucci P, Kubis J, Huq MS. Evaluating intra-fractional tumor motion in lung stereotactic radiotherapy with deep inspiration breath-hold. J Appl Clin Med Phys 2024; 25:e14414. [PMID: 38803045 PMCID: PMC11302799 DOI: 10.1002/acm2.14414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 04/19/2024] [Accepted: 05/08/2024] [Indexed: 05/29/2024] Open
Abstract
PURPOSE To evaluate the intra-fractional tumor motion in lung stereotactic body radiotherapy (SBRT) with deep inspiration breath-hold (DIBH), and to investigate the adequacy of the current planning target volume (PTV) margins. METHODS Twenty-eight lung SBRT patients with DIBH were selected in this study. Among the lesions, twenty-three were at right or left lower lobe, two at right middle lobe, and three at right or left upper lobe. Post-treatment gated cone-beam computed tomography (CBCT) was acquired to quantify the intra-fractional tumor shift at each treatment. These obtained shifts were then used to calculate the required PTV margin, which was compared with the current applied margin of 5 mm margin in anterior-posterior (AP) and right-left (RL) directions and 8 mm in superior-inferior (SI) direction. The beam delivery time was prolonged with DIBH. The actual beam delivery time with DIBH (Tbeam_DIBH) was compared with the beam delivery time without DIBH (Tbeam_wo_DIBH) for the corresponding SBRT plan. RESULTS A total of 113 treatments were analyzed. At six treatments (5.3%), the shifts exceeded the tolerance defined by the current PTV margin. The average shifts were 0.0 ± 1.9 mm, 0.1±1.5 mm, and -0.5 ± 3.7 mm in AP, RL, and SI directions, respectively. The required PTV margins were determined to be 4.5, 3.9, and 7.4 mm in AP, RL, and SI directions, respectively. The average Tbeam_wo_DIBH and Tbeam_DIBH were 2.4 ± 0.4 min and 3.6 ± 1.5 min, respectively. The average treatment slot for lung SBRT with DIBH was 25.3 ± 7.9 min. CONCLUSION Intra-fractional tumor motion is the predominant source of treatment uncertainties in CBCT-guided lung SBRT with DIBH. The required PTV margin should be determined based on data specific to each institute, considering different techniques and populations. Our data indicate that our current applied PTV margin is adequate, and it is possible to reduce further in the RL direction. The time increase of Tbeam_DIBH, relative to the treatment slot, is not clinically significant.
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Affiliation(s)
- Weihua Fu
- Department of Radiation OncologyUniversity of Pittsburgh School of Medicine and UPMC Hillman Cancer CenterPittsburghPennsylvaniaUSA
| | - Yongqian Zhang
- Department of Radiation OncologyUniversity of Pittsburgh School of Medicine and UPMC Hillman Cancer CenterPittsburghPennsylvaniaUSA
| | - Kiran Mehta
- Department of Radiation OncologyUniversity of Pittsburgh School of Medicine and UPMC Hillman Cancer CenterPittsburghPennsylvaniaUSA
| | - Alex Chen
- Department of Radiation OncologyUniversity of Pittsburgh School of Medicine and UPMC Hillman Cancer CenterPittsburghPennsylvaniaUSA
| | - Hima Bindu Musunuru
- Department of Radiation OncologyUniversity of Pittsburgh School of Medicine and UPMC Hillman Cancer CenterPittsburghPennsylvaniaUSA
| | - Pietro Pucci
- Department of Radiation OncologyUniversity of Pittsburgh School of Medicine and UPMC Hillman Cancer CenterPittsburghPennsylvaniaUSA
| | - Jason Kubis
- Department of Radiation OncologyUniversity of Pittsburgh School of Medicine and UPMC Hillman Cancer CenterPittsburghPennsylvaniaUSA
| | - M. Saiful Huq
- Department of Radiation OncologyUniversity of Pittsburgh School of Medicine and UPMC Hillman Cancer CenterPittsburghPennsylvaniaUSA
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Wang N, Fan J, Xu Y, Yan L, Chen D, Wang W, Men K, Dai J, Liu Z. Clinical implementation and evaluation of deep learning-assisted automatic radiotherapy treatment planning for lung cancer. Phys Med 2024; 124:104492. [PMID: 39094213 DOI: 10.1016/j.ejmp.2024.104492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 07/12/2024] [Accepted: 07/23/2024] [Indexed: 08/04/2024] Open
Abstract
PURPOSE The purpose of the study is to investigate the clinical application of deep learning (DL)-assisted automatic radiotherapy planning for lung cancer. METHODS A DL model was developed for predicting patient-specific doses, trained and validated on a dataset of 235 patients with diverse target volumes and prescriptions. The model was integrated into clinical workflow with DL-predicted objective functions. The automatic plans were retrospectively designed for additional 50 treated manual volumetric modulated arc therapy (VMAT) plans. A comparison was made between automatic and manual plans in terms of dosimetric indexes, monitor units (MUs) and planning time. Plan quality metric (PQM) encompassing these indexes was evaluated, with higher PQM values indicating superior plan quality. Qualitative evaluations of two plans were conducted by four reviewers. RESULTS The PQM score was 40.7 ± 13.1 for manual plans and 40.8 ± 13.5 for automatic plans (P = 0.75). Compared to manual plans, the targets coverage and homogeneity of automatic plans demonstrated no significant difference. Manual plans exhibited better sparing for lung in V5 (difference: 1.8 ± 4.2 %, P = 0.02), whereas automatic plans showed enhanced sparing for heart in V30 (difference: 1.4 ± 4.7 %, P = 0.02) and for spinal cord in Dmax (difference: 0.7 ± 4.7 Gy, P = 0.04). The planning time and MUs of automatic plans were significantly reduced by 70.5 ± 20.0 min and 97.4 ± 82.1. Automatic plans were deemed acceptable in 88 % of the reviews (176/200). CONCLUSIONS The DL-assisted approach for lung cancer notably decreased planning time and MUs, while demonstrating comparable or superior quality relative to manual plans. It has the potential to provide benefit to lung cancer patients.
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Affiliation(s)
- Ningyu Wang
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
| | - Jiawei Fan
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China; Shanghai Clinical Research Center for Radiation Oncology, China; Shanghai Key Laboratory of Radiation Oncology, Shanghai 200032, China.
| | - Yingjie Xu
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
| | - Lingling Yan
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
| | - Deqi Chen
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Wenqing Wang
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Kuo Men
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
| | - Jianrong Dai
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
| | - Zhiqiang Liu
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
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Moore LC, Nematollahi F, Li L, Meyers SM, Kisling K. Improving 3D dose prediction for breast radiotherapy using novel glowing masks and gradient-weighted loss functions. Med Phys 2024. [PMID: 39088756 DOI: 10.1002/mp.17326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 06/17/2024] [Accepted: 07/08/2024] [Indexed: 08/03/2024] Open
Abstract
BACKGROUND The quality of treatment plans for breast cancer can vary greatly. This variation could be reduced by using dose prediction to automate treatment planning. Our work investigates novel methods for training deep-learning models that are capable of producing high-quality dose predictions for breast cancer treatment planning. PURPOSE The goal of this work was to compare the performance impact of two novel techniques for deep learning dose prediction models for tangent field treatments for breast cancer. The first technique, a "glowing" mask algorithm, encodes the distance from a contour into each voxel in a mask. The second, a gradient-weighted mean squared error (MSE) loss function, emphasizes the error in high-dose gradient regions in the predicted image. METHODS Four 3D U-Net deep learning models were trained using the planning CT and contours of the heart, lung, and tumor bed as inputs. The dataset consisted of 305 treatment plans split into 213/46/46 training/validation/test sets using a 70/15/15% split. We compared the impact of novel "glowing" anatomical mask inputs and a novel gradient-weighted MSE loss function to their standard counterparts, binary anatomical masks, and MSE loss, using an ablation study methodology. To assess performance, we examined the mean error and mean absolute error (ME/MAE) in dose across all within-body voxels, the error in mean dose to heart, ipsilateral lung, and tumor bed, dice similarity coefficient (DSC) across isodose volumes defined by 0%-100% prescribed dose thresholds, and gamma analysis (3%/3 mm). RESULTS The combination of novel glowing masks and gradient weighted loss function yielded the best-performing model in this study. This model resulted in a mean ME of 0.40%, MAE of 2.70%, an error in mean dose to heart and lung of -0.10 and 0.01 Gy, and an error in mean dose to the tumor bed of -0.01%. The median DSC at 50/95/100% isodose levels were 0.91/0.87/0.82. The mean 3D gamma pass rate (3%/3 mm) was 93%. CONCLUSIONS This study found the combination of novel anatomical mask inputs and loss function for dose prediction resulted in superior performance to their standard counterparts. These results have important implications for the field of radiotherapy dose prediction, as the methods used here can be easily incorporated into many other dose prediction models for other treatment sites. Additionally, this dose prediction model for breast radiotherapy has sufficient performance to be used in an automated planning pipeline for tangent field radiotherapy and has the major benefit of not requiring a PTV for accurate dose prediction.
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Affiliation(s)
- Lance C Moore
- Radiation Medicine and Applied Sciences, University of California, La Jolla, San Diego, California, USA
| | - Fatemeh Nematollahi
- Radiation Medicine and Applied Sciences, University of California, La Jolla, San Diego, California, USA
| | - Lingyi Li
- Radiation Medicine and Applied Sciences, University of California, La Jolla, San Diego, California, USA
| | - Sandra M Meyers
- Radiation Medicine and Applied Sciences, University of California, La Jolla, San Diego, California, USA
| | - Kelly Kisling
- Radiation Medicine and Applied Sciences, University of California, La Jolla, San Diego, California, USA
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Sterpin E, Widesott L, Poels K, Hoogeman M, Korevaar EW, Lowe M, Molinelli S, Fracchiolla F. Robustness evaluation of pencil beam scanning proton therapy treatment planning: A systematic review. Radiother Oncol 2024; 197:110365. [PMID: 38830538 DOI: 10.1016/j.radonc.2024.110365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 04/30/2024] [Accepted: 05/29/2024] [Indexed: 06/05/2024]
Abstract
Compared to conventional radiotherapy using X-rays, proton therapy, in principle, allows better conformity of the dose distribution to target volumes, at the cost of greater sensitivity to physical, anatomical, and positioning uncertainties. Robust planning, both in terms of plan optimization and evaluation, has gained high visibility in publications on the subject and is part of clinical practice in many centers. However, there is currently no consensus on the methods and parameters to be used for robust optimization or robustness evaluation. We propose to overcome this deficiency by following the modified Delphi consensus method. This method first requires a systematic review of the literature. We performed this review using the PubMed and Web Of Science databases, via two different experts. Potential conflicts were resolved by a third expert. We then explored the different methods before focusing on clinical studies that evaluate robustness on a significant number of patients. Many robustness assessment methods are proposed in the literature. Some are more successful than others and their implementation varies between centers. Moreover, they are not all statistically or mathematically equivalent. The most sophisticated and rigorous methods have seen more limited application due to the difficulty of their implementation and their lack of widespread availability.
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Affiliation(s)
- E Sterpin
- KU Leuven - Department of Oncology, Laboratory of Experimental Radiotherapy, Leuven, Belgium; UCLouvain - Institution de Recherche Expérimentale et Clinique, Center of Molecular Imaging Radiotherapy and Oncology (MIRO), Brussels, Belgium; Particle Therapy Interuniversity Center Leuven - PARTICLE, Leuven, Belgium.
| | - L Widesott
- Proton Therapy Center - UO Fisica Sanitaria, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - K Poels
- Particle Therapy Interuniversity Center Leuven - PARTICLE, Leuven, Belgium; UZ Leuven, Department of Radiation Oncology, Leuven, Belgium
| | - M Hoogeman
- Erasmus Medical Center, Cancer Institute, Department of Radiotherapy, Rotterdam, the Netherlands; HollandPTC, Delft, the Netherlands
| | - E W Korevaar
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, the Netherlands
| | - M Lowe
- Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, UK
| | - S Molinelli
- Fondazione CNAO - Medical Physics Unit, Pavia, Italy
| | - F Fracchiolla
- Proton Therapy Center - UO Fisica Sanitaria, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
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Kocak B, Akinci D'Antonoli T, Ates Kus E, Keles A, Kala A, Kose F, Kadioglu M, Solak S, Sunman S, Temiz ZH. Self-reported checklists and quality scoring tools in radiomics: a meta-research. Eur Radiol 2024; 34:5028-5040. [PMID: 38180530 DOI: 10.1007/s00330-023-10487-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 11/11/2023] [Accepted: 11/24/2023] [Indexed: 01/06/2024]
Abstract
OBJECTIVE To evaluate the use of reporting checklists and quality scoring tools for self-reporting purposes in radiomics literature. METHODS Literature search was conducted in PubMed (date, April 23, 2023). The radiomics literature was sampled at random after a sample size calculation with a priori power analysis. A systematic assessment for self-reporting, including the use of documentation such as completed checklists or quality scoring tools, was conducted in original research papers. These eligible papers underwent independent evaluation by a panel of nine readers, with three readers assigned to each paper. Automatic annotation was used to assist in this process. Then, a detailed item-by-item confirmation analysis was carried out on papers with checklist documentation, with independent evaluation of two readers. RESULTS The sample size calculation yielded 117 papers. Most of the included papers were retrospective (94%; 110/117), single-center (68%; 80/117), based on their private data (89%; 104/117), and lacked external validation (79%; 93/117). Only seven papers (6%) had at least one self-reported document (Radiomics Quality Score (RQS), Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis (TRIPOD), or Checklist for Artificial Intelligence in Medical Imaging (CLAIM)), with a statistically significant binomial test (p < 0.001). Median rate of confirmed items for all three documents was 81% (interquartile range, 6). For quality scoring tools, documented scores were higher than suggested scores, with a mean difference of - 7.2 (standard deviation, 6.8). CONCLUSION Radiomic publications often lack self-reported checklists or quality scoring tools. Even when such documents are provided, it is essential to be cautious, as the accuracy of the reported items or scores may be questionable. CLINICAL RELEVANCE STATEMENT Current state of radiomic literature reveals a notable absence of self-reporting with documentation and inaccurate reporting practices. This critical observation may serve as a catalyst for motivating the radiomics community to adopt and utilize such tools appropriately, thereby fostering rigor, transparency, and reproducibility of their research, moving the field forward. KEY POINTS • In radiomics literature, there has been a notable absence of self-reporting with documentation. • Even if such documents are provided, it is critical to exercise caution because the accuracy of the reported items or scores may be questionable. • Radiomics community needs to be motivated to adopt and appropriately utilize the reporting checklists and quality scoring tools.
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Affiliation(s)
- Burak Kocak
- Department of Radiology, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Basaksehir, Istanbul, 34480, Turkey.
| | - Tugba Akinci D'Antonoli
- Institute of Radiology and Nuclear Medicine, Cantonal Hospital Baselland, Liestal, Switzerland
| | - Ece Ates Kus
- Department of Neuroradiology, Klinikum Lippe, Lemgo, Germany
| | - Ali Keles
- Department of Radiology, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Basaksehir, Istanbul, 34480, Turkey
| | - Ahmet Kala
- Department of Radiology, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Basaksehir, Istanbul, 34480, Turkey
| | - Fadime Kose
- Department of Radiology, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Basaksehir, Istanbul, 34480, Turkey
| | - Mehmet Kadioglu
- Department of Radiology, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Basaksehir, Istanbul, 34480, Turkey
| | - Sila Solak
- Department of Radiology, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Basaksehir, Istanbul, 34480, Turkey
| | - Seyma Sunman
- Department of Radiology, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Basaksehir, Istanbul, 34480, Turkey
| | - Zisan Hayriye Temiz
- Department of Radiology, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Basaksehir, Istanbul, 34480, Turkey
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Tham BZ, Aleman DM, Nordström H, Nygren N, Coolens C. Treatment Planning Methods for Dose Painting by Numbers Treatment in Gamma Knife Radiosurgery. Adv Radiat Oncol 2024; 9:101534. [PMID: 39104874 PMCID: PMC11298584 DOI: 10.1016/j.adro.2024.101534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 03/16/2024] [Indexed: 08/07/2024] Open
Abstract
Purpose Dose painting radiation therapy delivers a nonuniform dose to tumors to account for heterogeneous radiosensitivity. With recent and ongoing development of Gamma Knife machines making large-volume brain tumor treatments more practical, it is increasingly feasible to deliver dose painting treatments. The increased prescription complexity means automated treatment planning is greatly beneficial, and the impact of dose painting on stereotactic radiosurgery (SRS) plan quality has not yet been studied. This research investigates the plan quality achievable for Gamma Knife SRS dose painting treatments when using optimization techniques and automated isocenter placement in treatment planning. Methods and Materials Dose painting prescription functions with varying parameters were applied to convert voxel image intensities to prescriptions for 10 sample cases. To study achievable plan quality and optimization, clinically placed isocenters were used with each dose painting prescription and optimized using a semi-infinite linear programming formulation. To study automated isocenter placement, a grassfire sphere-packing algorithm and a clinically available Leksell gamma plan isocenter fill algorithm were used. Plan quality for each optimized treatment plan was measured with dose painting SRS metrics. Results Optimization can be used to find high quality dose painting plans, and plan quality is affected by the dose painting prescription method. Polynomial function prescriptions show more achievable plan quality than sigmoid function prescriptions even with high mean dose boost. Automated isocenter placement is shown as a feasible method for dose painting SRS treatment, and increasing the number of isocenters improves plan quality. The computational solve time for optimization is within 5 minutes in most cases, which is suitable for clinical planning. Conclusions The impact of dose painting prescription method on achievable plan quality is quantified in this study. Optimization and automated isocenter placement are shown as possible treatment planning methods to obtain high quality plans.
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Affiliation(s)
- Benjamin Z. Tham
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Dionne M. Aleman
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Catherine Coolens
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
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Jia PF, Li YR, Wang LY, Lu XR, Guo X. Radiomics in esophagogastric junction cancer: A scoping review of current status and advances. Eur J Radiol 2024; 177:111577. [PMID: 38905802 DOI: 10.1016/j.ejrad.2024.111577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 06/03/2024] [Accepted: 06/14/2024] [Indexed: 06/23/2024]
Abstract
PURPOSE This scoping review aimed to understand the advances in radiomics in esophagogastric junction (EGJ) cancer and assess the current status of radiomics in EGJ cancer. METHODS We conducted systematic searches of PubMed, Embase, and Web of Science databases from January 18, 2012, to January 15, 2023, to identify radiomics articles related to EGJ cancer. Two researchers independently screened the literature, extracted data, and assessed the quality of the studies using the Radiomics Quality Score (RQS) and the METhodological RadiomICs Score (METRICS) tool, respectively. RESULTS A total of 120 articles were retrieved from the three databases, and after screening, only six papers met the inclusion criteria. These studies investigated the role of radiomics in differentiating adenocarcinoma from squamous carcinoma, diagnosing T-stage, evaluating HER2 overexpression, predicting response to neoadjuvant therapy, and prognosis in EGJ cancer. The median score percentage of RQS was 34.7% (range from 22.2% to 38.9%). The median score percentage of METRICS was 71.2% (range from 58.2% to 84.9%). CONCLUSION Although there is a considerable difference between the RQS and METRICS scores of the included literature, we believe that the research value of radiomics in EGJ cancer has been revealed. In the future, while actively exploring more diagnostic, prognostic, and biological correlation studies in EGJ cancer, greater emphasis should be placed on the standardization and clinical application of radiomics.
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Affiliation(s)
- Ping-Fan Jia
- Department of Medical Imaging, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, China
| | - Yu-Ru Li
- Department of Medical Imaging, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, China
| | - Lu-Yao Wang
- Department of Medical Imaging, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, China
| | - Xiao-Rui Lu
- Department of Medical Imaging, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, China
| | - Xing Guo
- Department of Medical Imaging, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, China.
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Behzadipour M, Palta J, Ma T, Yuan L, Kim S, Kirby S, Torkelson L, Baker J, Koenig T, Khalifa MA, Hawranko R, Richeson D, Fields E, Weiss E, Song WY. Optimization of treatment workflow for 0.35T MR-Linac system. J Appl Clin Med Phys 2024; 25:e14393. [PMID: 38742819 PMCID: PMC11302807 DOI: 10.1002/acm2.14393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 03/15/2024] [Accepted: 04/22/2024] [Indexed: 05/16/2024] Open
Abstract
PURPOSE This study presents a novel and comprehensive framework for evaluating magnetic resonance guided radiotherapy (MRgRT) workflow by integrating the Failure Modes and Effects Analysis (FMEA) approach with Time-Driven Activity-Based Costing (TDABC). We assess the workflow for safety, quality, and economic implications, providing a holistic understanding of the MRgRT implementation. The aim is to offer valuable insights to healthcare practitioners and administrators, facilitating informed decision-making regarding the 0.35T MRIdian MR-Linac system's clinical workflow. METHODS For FMEA, a multidisciplinary team followed the TG-100 methodology to assess the MRgRT workflow's potential failure modes. Following the mitigation of primary failure modes and workflow optimization, a treatment process was established for TDABC analysis. The TDABC was applied to both MRgRT and computed tomography guided RT (CTgRT) for typical five-fraction stereotactic body RT (SBRT) treatments, assessing total workflow and costs associated between the two treatment workflows. RESULTS A total of 279 failure modes were identified, with 31 categorized as high-risk, 55 as medium-risk, and the rest as low-risk. The top 20% risk priority numbers (RPN) were determined for each radiation oncology care team member. Total MRgRT and CTgRT costs were assessed. Implementing technological advancements, such as real-time multi leaf collimator (MLC) tracking with volumetric modulated arc therapy (VMAT), auto-segmentation, and increasing the Linac dose rate, led to significant cost savings for MRgRT. CONCLUSION In this study, we integrated FMEA with TDABC to comprehensively evaluate the workflow and the associated costs of MRgRT compared to conventional CTgRT for five-fraction SBRT treatments. FMEA analysis identified critical failure modes, offering insights to enhance patient safety. TDABC analysis revealed that while MRgRT provides unique advantages, it may involve higher costs. Our findings underscore the importance of exploring cost-effective strategies and key technological advancements to ensure the widespread adoption and financial sustainability of MRgRT in clinical practice.
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Affiliation(s)
- Mojtaba Behzadipour
- Department of Radiation OncologyVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Jatinder Palta
- Department of Radiation OncologyVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Tianjun Ma
- Department of Radiation OncologyVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Lulin Yuan
- Department of Radiation OncologyVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Siyong Kim
- Department of Radiation OncologyVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Suzanne Kirby
- Department of Radiation OncologyVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Laurel Torkelson
- Department of Radiation OncologyVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - James Baker
- Department of Radiation OncologyVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Tammy Koenig
- Department of Radiation OncologyVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Mateb Al Khalifa
- Department of Radiation OncologyVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Robert Hawranko
- Department of Radiation OncologyVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Dylan Richeson
- Department of Radiation OncologyVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Emma Fields
- Department of Radiation OncologyVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Elisabeth Weiss
- Department of Radiation OncologyVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - William Y. Song
- Department of Radiation OncologyVirginia Commonwealth UniversityRichmondVirginiaUSA
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Semeniuk O, Shessel A, Velec M, Fodor T, Rocca CC, Barry A, Lukovic J, Yan M, Mesci A, Kim J, Wong R, Dawson LA, Hosni A, Stanescu T. Development and validation of an MR-driven dose-of-the-day procedure for online adaptive radiotherapy in upper gastrointestinal cancer patients. Phys Med Biol 2024; 69:165009. [PMID: 39048106 DOI: 10.1088/1361-6560/ad6745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 07/23/2024] [Indexed: 07/27/2024]
Abstract
Objective.To develop and validate a dose-of-the-day (DOTD) treatment plan verification procedure for liver and pancreas cancer patients treated with an magnetic resonance (MR)-Linac system.Approach.DOTD was implemented as an automated process that uses 3D datasets collected during treatment delivery. Particularly, the DOTD pipeline's input included the adapt-to-shape (ATS) plan-i.e. 3D-MR dataset acquired at beginning of online session, anatomical contours, dose distribution-and 3D-MR dataset acquired during beam-on (BON). The DOTD automated analysis included (a) ATS-to-BON image intensity-based deformable image registration (DIR), (b) ATS-to-BON contours mapping via DIR, (c) BON-to-ATS contours copying through rigid registration, (d) determining ATS-to-BON dosimetric differences, and (e) PDF report generation. The DIR process was validated by two expert reviewers. ATS-plans were recomputed on BON datasets to assess dose differences. DOTD analysis was performed retrospectively for 75 treatment fractions (12-liver and 5-pancreas patients).Main results.The accuracy of DOTD process relied on DIR and mapped contours quality. Most DIR-generated contours (99.6%) were clinically acceptable. DICE correlated with depreciation of DIR-based region of interest mapping process. The ATS-BON plan difference was found negligible (<1%). The duodenum and large bowel exhibited highest variations, 24% and 39% from fractional values, for 5-fraction liver and pancreas. For liver 1-fraction, a 62% variation was observed for duodenum.Significance.The DOTD methodology provides an automated approach to quantify 3D dosimetric differences between online plans and their delivery. This analysis offers promise as a valuable tool for plan quality assessment and decision-making in the verification stage of the online workflow.
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Affiliation(s)
- Oleksii Semeniuk
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2M9, Canada
| | - Andrea Shessel
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2M9, Canada
| | - Michael Velec
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2M9, Canada
| | - Tudor Fodor
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2M9, Canada
| | - Cathy-Carpino Rocca
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2M9, Canada
| | - Aisling Barry
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2M9, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, ON M5T 1P5, Canada
| | - Jelena Lukovic
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2M9, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, ON M5T 1P5, Canada
| | - Michael Yan
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2M9, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, ON M5T 1P5, Canada
| | - Aruz Mesci
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2M9, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, ON M5T 1P5, Canada
| | - John Kim
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2M9, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, ON M5T 1P5, Canada
| | - Rebecca Wong
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2M9, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, ON M5T 1P5, Canada
| | - Laura A Dawson
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2M9, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, ON M5T 1P5, Canada
| | - Ali Hosni
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2M9, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, ON M5T 1P5, Canada
| | - Teo Stanescu
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2M9, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, ON M5T 1P5, Canada
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON M5S 3G8, Canada
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Bahmanpour A, Ghoreishian SM, Sepahvandi A. Electromagnetic Modulation of Cell Behavior: Unraveling the Positive Impacts in a Comprehensive Review. Ann Biomed Eng 2024; 52:1941-1954. [PMID: 38652384 DOI: 10.1007/s10439-024-03519-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 04/15/2024] [Indexed: 04/25/2024]
Abstract
There are numerous effective procedures for cell signaling, in which humans directly transmit detectable signals to cells to govern their essential behaviors. From a biomedical perspective, the cellular response to the combined influence of electrical and magnetic fields holds significant promise in various domains, such as cancer treatment, targeted drug delivery, gene therapy, and wound healing. Among these modern cell signaling methods, electromagnetic fields (EMFs) play a pivotal role; however, there remains a paucity of knowledge concerning the effects of EMFs across all wavelengths. It's worth noting that most wavelengths are incompatible with human cells, and as such, this study excludes them from consideration. In this review, we aim to comprehensively explore the most effective and current EMFs, along with their therapeutic impacts on various cell types. Specifically, we delve into the influence of alternating electromagnetic fields (AEMFs) on diverse cell behaviors, encompassing proliferation, differentiation, biomineralization, cell death, and cell migration. Our findings underscore the substantial potential of these pivotal cellular behaviors in advancing the treatment of numerous diseases. Moreover, AEMFs wield a significant role in the realms of biomaterials and tissue engineering, given their capacity to decisively influence biomaterials, facilitate non-invasive procedures, ensure biocompatibility, and exhibit substantial efficacy. It is worth mentioning that AEMFs often serve as a last-resort treatment option for various diseases. Much about electromagnetic fields remains a mystery to the scientific community, and we have yet to unravel the precise mechanisms through which wavelengths control cellular fate. Consequently, our understanding and knowledge in this domain predominantly stem from repeated experiments yielding similar effects. In the ensuing sections of this article, we delve deeper into our extended experiments and research.
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Zhang S, Li K, Sun Y, Wan Y, Ao Y, Zhong Y, Liang M, Wang L, Chen X, Pei X, Hu Y, Chen D, Li M, Shan H. Deep Learning for Automatic Gross Tumor Volumes Contouring in Esophageal Cancer Based on Contrast-Enhanced Computed Tomography Images: A Multi-Institutional Study. Int J Radiat Oncol Biol Phys 2024; 119:1590-1600. [PMID: 38432286 DOI: 10.1016/j.ijrobp.2024.02.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 02/02/2024] [Accepted: 02/18/2024] [Indexed: 03/05/2024]
Abstract
PURPOSE To develop and externally validate an automatic artificial intelligence (AI) tool for delineating gross tumor volume (GTV) in patients with esophageal squamous cell carcinoma (ESCC), which can assist in neo-adjuvant or radical radiation therapy treatment planning. METHODS AND MATERIALS In this multi-institutional study, contrast-enhanced CT images from 580 eligible ESCC patients were retrospectively collected. The GTV contours delineated by 2 experts via consensus were used as ground truth. A 3-dimensional deep learning model was developed for GTV contouring in the training cohort and internally and externally validated in 3 validation cohorts. The AI tool was compared against 12 board-certified experts in 25 patients randomly selected from the external validation cohort to evaluate its assistance in improving contouring performance and reducing variation. Contouring performance was measured using dice similarity coefficient (DSC) and average surface distance. Additionally, our previously established radiomics model for predicting pathologic complete response was used to compare AI-generated and ground truth contours, to assess the potential of the AI contouring tool in radiomics analysis. RESULTS The AI tool demonstrated good GTV contouring performance in multicenter validation cohorts, with median DSC values of 0.865, 0.876, and 0.866 and median average surface distance values of 0.939, 0.789, and 0.875 mm, respectively. Furthermore, the AI tool significantly improved contouring performance for half of 12 board-certified experts (DSC values, 0.794-0.835 vs 0.856-0.881, P = .003-0.048), reduced the intra- and interobserver variations by 37.4% and 55.2%, respectively, and saved contouring time by 77.6%. In the radiomics analysis, 88.7% of radiomic features from ground truth and AI-generated contours demonstrated stable reproducibility, and similar pathologic complete response prediction performance for these contours (P = .430) was observed. CONCLUSIONS Our AI contouring tool can improve GTV contouring performance and facilitate radiomics analysis in ESCC patients, which indicates its potential for GTV contouring during radiation therapy treatment planning and radiomics studies.
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Affiliation(s)
- Shuaitong Zhang
- School of Medical Technology, Beijing Institute of Technology, Beijing, China
| | - Kunwei Li
- Department of Radiology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, China; Guangdong Provincial Key Laboratory of Biomedical Imaging and Guangdong Provincial Engineering Research Center of Molecular Imaging, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, China
| | - Yuchen Sun
- School of Medical Technology, Beijing Institute of Technology, Beijing, China
| | - Yun Wan
- Department of Radiology, Xinyi City People's Hospital, Xinyi, Guangdong, China
| | - Yong Ao
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China; State Key Laboratory of Oncology in South China, Guangdong Esophageal Cancer Institute, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Yinghua Zhong
- Department of Radiology, The Third People's Hospital of Zhuhai, Zhuhai, Guangdong, China
| | - Mingzhu Liang
- Department of Radiology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, China
| | - Lizhu Wang
- Department of Radiology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, China
| | - Xiangmeng Chen
- Department of Radiology, Jiangmen Central Hospital, Jiangmen, Guangdong, China
| | - Xiaofeng Pei
- Department of Radiation Oncology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, China
| | - Yi Hu
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China; State Key Laboratory of Oncology in South China, Guangdong Esophageal Cancer Institute, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China.
| | - Duanduan Chen
- School of Medical Technology, Beijing Institute of Technology, Beijing, China.
| | - Man Li
- Department of Radiology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, China.
| | - Hong Shan
- Department of Radiology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, China; Department of Interventional Medicine, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, China.
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