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Yamamoto T, Kabus S. Technical Note: Correction for the effect of breathing variations in CT pulmonary ventilation imaging. Med Phys 2017; 45:322-327. [PMID: 29072320 DOI: 10.1002/mp.12634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 10/16/2017] [Accepted: 10/17/2017] [Indexed: 11/12/2022] Open
Abstract
PURPOSE The accuracy and precision of computed tomography (CT) pulmonary ventilation imaging with conventional CT scanners are limited by breathing variations. We propose a method to correct for the effect of breathing variations in CT ventilation imaging based on external respiratory signals acquired throughout a scan. METHODS The proposed method is based on: (a) calculating voxel-by-voxel abdominal surface motion ranges using four-dimensional (4D) CT image datasets spatiotemporally correlated with external respiratory monitor data, and (b) applying the correction factor, which is defined as the ratio of the overall mean of the abdominal surface motion range in the lungs to that of each voxel, to the CT ventilation value. The performance of the proposed method was investigated by comparing voxel-wise correlations of the uncorrected and corrected CT ventilation images with single-photon emission CT (SPECT) ventilation images as a ground truth for nine patients. CT ventilation images were calculated by deformable image registration of the 4D-CT image datasets, followed by calculation of regional volume changes. A Steiger's Z-test was used to determine the statistical significance of the difference between the correlations for the uncorrected and corrected CT ventilation images. RESULTS The proposed correction method resulted in significant increases (P < 0.05) in the correlation between CT and SPECT ventilation in three patients, trends toward significant increase (P: 0.13-0.18) in two patients, no significant differences in three patients, and a significantly decreased correlation in one patient. The average standard deviation of the abdominal surface motion range in three patients showing significant increases was 0.27 (range 0.10-0.37), which was greater than 0.17 (range 0.07-0.38) in the other six patients. CONCLUSIONS The proposed method to correct for the effect of breathing variations could be readily implemented and has the potential to improve the accuracy of CT ventilation imaging as demonstrated in a nine-patient study.
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Affiliation(s)
- Tokihiro Yamamoto
- Department of Radiation Oncology, University of California Davis School of Medicine, Sacramento, CA, 95817, USA
| | - Sven Kabus
- Department of Digital Imaging, Philips Research, 22335, Hamburg, Germany
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Bahig H, Campeau MP, Lapointe A, Bedwani S, Roberge D, de Guise J, Blais D, Vu T, Lambert L, Chartrand-Lefebvre C, Lord M, Filion E. Phase 1-2 Study of Dual-Energy Computed Tomography for Assessment of Pulmonary Function in Radiation Therapy Planning. Int J Radiat Oncol Biol Phys 2017; 99:334-343. [DOI: 10.1016/j.ijrobp.2017.05.051] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 04/24/2017] [Accepted: 05/30/2017] [Indexed: 12/25/2022]
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Fried DV, Das SK, Marks LB. Imaging Radiation-Induced Normal Tissue Injury to Quantify Regional Dose Response. Semin Radiat Oncol 2017; 27:325-331. [PMID: 28865515 DOI: 10.1016/j.semradonc.2017.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Noninvasive imaging has and will continue to play a pivotal role in the assessment of radiation-induced normal tissue toxicity. In this review, we will examine key literature regarding the use of anatomic and physiological imaging in relation to radiation-induced normal tissue toxicity. Additionally, this review contains a novel methodology for potentially incorporating dose-response data into treatment planning and normal tissue toxicity modeling.
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Affiliation(s)
- David V Fried
- UNC Hospitals, Department of Radiation Oncology, Chapel Hill, NC.
| | - Shiva K Das
- UNC Hospitals, Department of Radiation Oncology, Chapel Hill, NC
| | - Lawrence B Marks
- UNC Hospitals, Department of Radiation Oncology, Chapel Hill, NC
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Tahir BA, Bragg CM, Wild JM, Swinscoe JA, Lawless SE, Hart KA, Hatton MQ, Ireland RH. Impact of field number and beam angle on functional image-guided lung cancer radiotherapy planning. ACTA ACUST UNITED AC 2017; 62:7114-7130. [DOI: 10.1088/1361-6560/aa8074] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Ruhaak J, Polzin T, Heldmann S, Simpson IJA, Handels H, Modersitzki J, Heinrich MP. Estimation of Large Motion in Lung CT by Integrating Regularized Keypoint Correspondences into Dense Deformable Registration. IEEE TRANSACTIONS ON MEDICAL IMAGING 2017; 36:1746-1757. [PMID: 28391192 DOI: 10.1109/tmi.2017.2691259] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
We present a novel algorithm for the registration of pulmonary CT scans. Our method is designed for large respiratory motion by integrating sparse keypoint correspondences into a dense continuous optimization framework. The detection of keypoint correspondences enables robustness against large deformations by jointly optimizing over a large number of potential discrete displacements, whereas the dense continuous registration achieves subvoxel alignment with smooth transformations. Both steps are driven by the same normalized gradient fields data term. We employ curvature regularization and a volume change control mechanism to prevent foldings of the deformation grid and restrict the determinant of the Jacobian to physiologically meaningful values. Keypoint correspondences are integrated into the dense registration by a quadratic penalty with adaptively determined weight. Using a parallel matrix-free derivative calculation scheme, a runtime of about 5 min was realized on a standard PC. The proposed algorithm ranks first in the EMPIRE10 challenge on pulmonary image registration. Moreover, it achieves an average landmark distance of 0.82 mm on the DIR-Lab COPD database, thereby improving upon the state of the art in accuracy by 15%. Our algorithm is the first to reach the inter-observer variability in landmark annotation on this dataset.
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Vinogradskiy Y, Schubert L, Diot Q, Waxweiller T, Koo P, Castillo R, Castillo E, Guerrero T, Rusthoven C, Gaspar L, Kavanagh B, Miften M. Regional Lung Function Profiles of Stage I and III Lung Cancer Patients: An Evaluation for Functional Avoidance Radiation Therapy. Int J Radiat Oncol Biol Phys 2017; 95:1273-80. [PMID: 27354134 DOI: 10.1016/j.ijrobp.2016.02.058] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 02/17/2016] [Accepted: 02/25/2016] [Indexed: 02/01/2023]
Abstract
PURPOSE The development of clinical trials is underway to use 4-dimensional computed tomography (4DCT) ventilation imaging to preferentially spare functional lung in patients undergoing radiation therapy. The purpose of this work was to generate data to aide with clinical trial design by retrospectively characterizing dosimetric and functional profiles for patients with different stages of lung cancer. METHODS AND MATERIALS A total of 118 lung cancer patients (36% stage I and 64% stage III) from 2 institutions were used for the study. A 4DCT-ventilation map was calculated using the patient's 4DCT imaging, deformable image registration, and a density-change-based algorithm. To assess each patient's spatial ventilation profile both quantitative and qualitative metrics were developed, including an observer-based defect observation and metrics based on the ventilation in each lung third. For each patient we used the clinical doses to calculate functionally weighted mean lung doses and metrics that assessed the interplay between the spatial location of the dose and high-functioning lung. RESULTS Both qualitative and quantitative metrics revealed a significant difference in functional profiles between the 2 stage groups (P<.01). We determined that 65% of stage III and 28% of stage I patients had ventilation defects. Average functionally weighted mean lung dose was 19.6 Gy and 5.4 Gy for stage III and I patients, respectively, with both groups containing patients with large spatial overlap between dose and high-function regions. CONCLUSION Our 118-patient retrospective study found that 65% of stage III patients have regionally variant ventilation profiles that are suitable for functional avoidance. Our results suggest that regardless of disease stage, it is possible to have unique spatial interplay between dose and high-functional lung, highlighting the importance of evaluating the function of each patient and developing a personalized functional avoidance treatment approach.
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Affiliation(s)
- Yevgeniy Vinogradskiy
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado.
| | - Leah Schubert
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Quentin Diot
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Timothy Waxweiller
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Phillip Koo
- Department of Radiology, University of Colorado School of Medicine, Aurora, Colorado
| | - Richard Castillo
- Department of Radiation Oncology, University of Texas Medical Branch, Galveston, Texas
| | - Edward Castillo
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan
| | - Thomas Guerrero
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan
| | - Chad Rusthoven
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Laurie Gaspar
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Brian Kavanagh
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Moyed Miften
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
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Hegi-Johnson F, Keall P, Barber J, Bui C, Kipritidis J. Evaluating the accuracy of 4D-CT ventilation imaging: First comparison with Technegas SPECT ventilation. Med Phys 2017; 44:4045-4055. [PMID: 28477378 DOI: 10.1002/mp.12317] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 03/21/2017] [Accepted: 04/05/2017] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Computed tomography ventilation imaging (CTVI) is a highly accessible functional lung imaging modality that can unlock the potential for functional avoidance in lung cancer radiation therapy. Previous attempts to validate CTVI against clinical ventilation single-photon emission computed tomography (V-SPECT) have been hindered by radioaerosol clumping artifacts. This work builds on those studies by performing the first comparison of CTVI with 99m Tc-carbon ('Technegas'), a clinical V-SPECT modality featuring smaller radioaerosol particles with less clumping. METHODS Eleven lung cancer radiotherapy patients with early stage (T1/T2N0) disease received treatment planning four-dimensional CT (4DCT) scans paired with Technegas V/Q-SPECT/CT. For each patient, we applied three different CTVI methods. Two of these used deformable image registration (DIR) to quantify breathing-induced lung density changes (CTVIDIR-HU ), or breathing-induced lung volume changes (CTVIDIR-Jac ) between the 4DCT exhale/inhale phases. A third method calculated the regional product of air-tissue densities (CTVIHU ) and did not involve DIR. Corresponding CTVI and V-SPECT scans were compared using the Dice similarity coefficient (DSC) for functional defect and nondefect regions, as well as the Spearman's correlation r computed over the whole lung. The DIR target registration error (TRE) was quantified using both manual and computer-selected anatomic landmarks. RESULTS Interestingly, the overall best performing method (CTVIHU ) did not involve DIR. For nondefect regions, the CTVIHU , CTVIDIR-HU , and CTVIDIR-Jac methods achieved mean DSC values of 0.69, 0.68, and 0.54, respectively. For defect regions, the respective DSC values were moderate: 0.39, 0.33, and 0.44. The Spearman r-values were generally weak: 0.26 for CTVIHU , 0.18 for CTVIDIR-HU , and -0.02 for CTVIDIR-Jac . The spatial accuracy of CTVI was not significantly correlated with TRE, however the DIR accuracy itself was poor with TRE > 3.6 mm on average, potentially indicative of poor quality 4DCT. Q-SPECT scans achieved good correlations with V-SPECT (mean r > 0.6), suggesting that the image quality of Technegas V-SPECT was not a limiting factor in this study. CONCLUSIONS We performed a validation of CTVI using clinically available 4DCT and Technegas V/Q-SPECT for 11 lung cancer patients. The results reinforce earlier findings that the spatial accuracy of CTVI exhibits significant interpatient and intermethod variability. We propose that the most likely factor affecting CTVI accuracy was poor image quality of clinical 4DCT.
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Affiliation(s)
- Fiona Hegi-Johnson
- Radiation Physics Laboratory, Faculty of Medicine, Sydney University, Camperdown, NSW, 2006, Australia.,Department of Medical Physics, School of Mathematical and Physical Sciences, University of Newcastle, Newcastle, NSW, 2300, Australia.,Radiation Oncology Centre, Seventh Day Adventist Hospital, Wahroonga, NSW 2076, Australia.,Department of Radiation Oncology, Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Vic., 3000, Australia
| | - Paul Keall
- Radiation Physics Laboratory, Faculty of Medicine, Sydney University, Camperdown, NSW, 2006, Australia
| | - Jeff Barber
- Crown Princess Mary Cancer Care Centre, Blacktown Hospital, Blacktown, NSW, 2148, Australia
| | - Chuong Bui
- Department of Nuclear Medicine, Nepean Hospital, Nepean, NSW, 2750, Australia
| | - John Kipritidis
- Radiation Physics Laboratory, Faculty of Medicine, Sydney University, Camperdown, NSW, 2006, Australia.,Department of Radiotherapy, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
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Lee E, Zeng J, Miyaoka RS, Saini J, Kinahan PE, Sandison GA, Wong T, Vesselle HJ, Rengan R, Bowen SR. Functional lung avoidance and response-adaptive escalation (FLARE) RT: Multimodality plan dosimetry of a precision radiation oncology strategy. Med Phys 2017; 44:3418-3429. [PMID: 28453861 DOI: 10.1002/mp.12308] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 03/22/2017] [Accepted: 04/21/2017] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Nonsmall cell lung cancer (NSCLC) patient radiation therapy (RT) is planned without consideration of spatial heterogeneity in lung function or tumor response. We assessed the dosimetric and clinical feasibility of functional lung avoidance and response-adaptive escalation (FLARE) RT to reduce dose to [99m Tc]MAA-SPECT/CT perfused lung while redistributing an escalated boost dose within [18 F]FDG-PET/CT-defined biological target volumes (BTV). METHODS Eight stage IIB-IIIB NSCLC patients underwent FDG-PET/CT and MAA-SPECT/CT treatment planning scans. Perfused lung objectives were derived from scatter/collimator/attenuation-corrected MAA-SPECT uptake relative to ITV-subtracted lung to maintain < 20 Gy mean lung dose (MLD). Prescriptions included 60 Gy to the planning target volume (PTV) and concomitant boost of 74 Gy mean to biological target volumes (BTV = GTV + PET gradient segmentation) scaled to each BTV voxel by relative FDG-PET SUV. Dose-painting-by-numbers prescriptions were integrated into commercial treatment planning systems via uptake threshold discretization. Dose constraints for lung, heart, cord, and esophagus were defined. FLARE RT plans were optimized with volumetric modulated arc therapy (VMAT), proton pencil beam scanning (PBS) with 3%-3 mm robust optimization, and combination of PBS (avoidance) plus VMAT (escalation). The high boost dose region was evaluated within a standardized SUVpeak structure. FLARE RT plans were compared to reference VMAT plans. Linear regression between radiation dose to BTV and normalized FDG PET SUV at every voxel was conducted, from which Pearson linear correlation coefficients and regression slopes were extracted. Spearman rank correlation coefficients were estimated between radiation dose to lung and normalized SPECT uptake. Dosimetric differences between treatment modalities were evaluated by Friedman nonparametric paired test with multiple sampling correction. RESULTS No unacceptable violations of PTV and normal tissue objectives were observed in 24 FLARE RT plans. Compared to reference VMAT plans, FLARE VMAT plans achieved a higher mean dose to BTV (73.7 Gy 98195. 61.3 Gy), higher mean dose to SUVpeak (89.7 Gy vs. 60.8 Gy), and lower mean dose to highly perfused lung (7.3 Gy vs. 14.9 Gy). These dosimetric gains came at the expense of higher mean heart dose (9.4 Gy vs. 5.8 Gy) and higher maximum cord dose (50.1 Gy vs. 44.6 Gy) relative to the reference VMAT plans. Between FLARE plans, FLARE VMAT achieved higher dose to the SUVpeak ROI than FLARE PBS (89.7 Gy vs. 79.2 Gy, P = 0.01), while FLARE PBS delivered lower dose to lung than FLARE VMAT (11.9 Gy vs. 15.6 Gy, P < 0.001). Voxelwise linear dose redistribution slope between BTV dose and FDG PET uptake was higher in magnitude for FLARE PBS + VMAT (0.36 Gy per %SUVmax ) compared to FLARE VMAT (0.27 Gy per %SUVmax ) or FLARE PBS alone (0.17 Gy per %SUVmax ). CONCLUSIONS FLARE RT is clinically feasible with VMAT and PBS. A combination of PBS for functional lung avoidance and VMAT for FDG PET dose escalation balanced target and normal tissue objective tradeoffs. These results provide a technical platform for testing of FLARE RT safety and efficacy within a precision radiation oncology trial.
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Affiliation(s)
- Eunsin Lee
- Department of Radiation Oncology, University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Jing Zeng
- Department of Radiation Oncology, University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Robert S Miyaoka
- Department of Radiology, University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Jatinder Saini
- Seattle Cancer Care Alliance Proton Therapy Center, 1570 N 115th Ave, Seattle, WA, 98133, USA
| | - Paul E Kinahan
- Department of Radiology, University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - George A Sandison
- Department of Radiation Oncology, University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Tony Wong
- Seattle Cancer Care Alliance Proton Therapy Center, 1570 N 115th Ave, Seattle, WA, 98133, USA
| | - Hubert J Vesselle
- Department of Radiology, University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Ramesh Rengan
- Department of Radiation Oncology, University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Stephen R Bowen
- Departments of Radiation Oncology and Radiology, University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA, 98195, USA
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Moriya S, Tachibana H, Kitamura N, Sawant A, Sato M. Dose warping performance in deformable image registration in lung. Phys Med 2017; 37:16-23. [DOI: 10.1016/j.ejmp.2017.03.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 02/13/2017] [Accepted: 03/20/2017] [Indexed: 10/19/2022] Open
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Binkley MS, King MT, Shrager JB, Bush K, Chaudhuri AA, Popat R, Gensheimer MF, Maxim PG, Henry Guo H, Diehn M, Nair VS, Loo BW. Pulmonary function after lung tumor stereotactic ablative radiotherapy depends on regional ventilation within irradiated lung. Radiother Oncol 2017; 123:270-275. [PMID: 28460826 DOI: 10.1016/j.radonc.2017.03.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 03/07/2017] [Accepted: 03/20/2017] [Indexed: 12/17/2022]
Abstract
PURPOSE To determine if regional ventilation within irradiated lung volume predicts change in pulmonary function test (PFT) measurements after stereotactic ablative radiotherapy (SABR) of lung tumors. METHODS We retrospectively identified 27 patients treated from 2007 to 2014 at our institution who received: (1) SABR without prior thoracic radiation; (2) pre-treatment 4-dimensional computed tomography (4-D CT) imaging; (3) pre- and post-SABR PFTs <15months from treatment. We defined the ventilation ratio (VR20BED3) as the quotient of mean ventilation (mean Jacobian-based per-voxel volume change on deformably registered inhale/exhale 4-D CT phases) within the 20Gy biologically effective dose (α/β=3Gy) isodose volume and that of the total lung volume (TLV). RESULTS Most patients had moderate to very severe COPD by GOLD criteria (n=19, 70.1%). Higher VR20BED3 significantly predicted worse change in Forced Expiratory Volume/s normalized by baseline value (ΔFEV1/FEV1pre, p=0.04); n=7 had VR20BED3>1 (high regional ventilation) and worse ΔFEV1/FEV1pre (median=-0.16, range=-0.230 to -0.20). Five had VR20BED3<1 (low regional ventilation) and improved ΔFEV1/FEV1pre (median=0.13, range=0.07 to 0.20). In a multivariable linear model, increasing VR20BED3 and time to post-SABR PFT predicted decreasing ΔFEV1/FEV1pre (R2=0.25, p=0.03). CONCLUSIONS After SABR to high versus low functioning lung regions, we found worsened or improved global pulmonary function, respectively. If pre-SABR VR20BED3 is validated as a predictor of eventual post-SABR PFT in larger studies, it may be used for individualized treatment planning to preserve or even improve pulmonary function after SABR.
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Affiliation(s)
- Michael S Binkley
- Department of Radiation Oncology and Cancer Institute, Stanford University School of Medicine, United States
| | - Martin T King
- Department of Radiation Oncology and Cancer Institute, Stanford University School of Medicine, United States
| | - Joseph B Shrager
- Department of Cardiothoracic Surgery, Division of Thoracic Surgery, Stanford University School of Medicine, United States; Stanford Cancer Institute and Department of Medicine, United States
| | - Karl Bush
- Department of Radiation Oncology and Cancer Institute, Stanford University School of Medicine, United States
| | - Aadel A Chaudhuri
- Department of Radiation Oncology and Cancer Institute, Stanford University School of Medicine, United States
| | - Rita Popat
- Department of Health Research & Policy, Stanford University School of Medicine, United States
| | - Michael F Gensheimer
- Department of Radiation Oncology and Cancer Institute, Stanford University School of Medicine, United States
| | - Peter G Maxim
- Department of Radiation Oncology and Cancer Institute, Stanford University School of Medicine, United States; Stanford Cancer Institute and Department of Medicine, United States
| | - H Henry Guo
- Department of Radiology, Stanford University School of Medicine, United States
| | - Maximilian Diehn
- Department of Radiation Oncology and Cancer Institute, Stanford University School of Medicine, United States; Institute for Stem Cell Biology & Regenerative Medicine, Stanford University School of Medicine, United States; Stanford Cancer Institute and Department of Medicine, United States
| | - Viswam S Nair
- Department of Radiology, Stanford University School of Medicine, United States; Department of Medicine, Division of Pulmonary and Critical Care Medicine, Stanford Cancer Institute and Department of Medicine, United States; Stanford Cancer Institute and Department of Medicine, United States.
| | - Billy W Loo
- Department of Radiation Oncology and Cancer Institute, Stanford University School of Medicine, United States; Stanford Cancer Institute and Department of Medicine, United States.
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Faught AM, Miyasaka Y, Kadoya N, Castillo R, Castillo E, Vinogradskiy Y, Yamamoto T. Evaluating the Toxicity Reduction With Computed Tomographic Ventilation Functional Avoidance Radiation Therapy. Int J Radiat Oncol Biol Phys 2017; 99:325-333. [PMID: 28871982 DOI: 10.1016/j.ijrobp.2017.04.024] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 03/02/2017] [Accepted: 04/12/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE Computed tomographic (CT) ventilation imaging is a new modality that uses 4-dimensional (4D) CT information to calculate lung ventilation. Although retrospective studies have reported on the reduction in dose to functional lung, no work to our knowledge has been published in which the dosimetric improvements have been translated to a reduction in the probability of pulmonary toxicity. Our work estimates the reduction in toxicity for CT ventilation-based functional avoidance planning. METHODS AND MATERIALS Seventy previously treated lung cancer patients who underwent 4DCT imaging were used for the study. CT ventilation maps were calculated with 4DCT deformable image registration and a density change-based algorithm. Pneumonitis was graded on the basis of imaging and clinical presentation. Maximum likelihood methods were used to generate normal tissue complication probability (NTCP) models predicting grade 2 or higher (2+) and grade 3+ pneumonitis as a function of dose (V5 Gy, V10 Gy, V20 Gy, V30 Gy, and mean dose) to functional lung. For 30 patients a functional plan was generated with the goal of reducing dose to the functional lung while meeting Radiation Therapy Oncology Group 0617 constraints. The NTCP models were applied to the functional plans and the clinically used plans to calculate toxicity reduction. RESULTS By the use of functional avoidance planning, absolute reductions in grade 2+ NTCP of 6.3%, 7.8%, and 4.8% were achieved based on the mean fV20 Gy, fV30 Gy, and mean dose to functional lung metrics, respectively. Absolute grade 3+ NTCP reductions of 3.6%, 4.8%, and 2.4% were achieved with fV20 Gy, fV30 Gy, and mean dose to functional lung. Maximum absolute reductions of 52.3% and 16.4% were seen for grade 2+ and grade 3+ pneumonitis for individual patients. CONCLUSION Our study quantifies the possible toxicity reduction from CT ventilation-based functional avoidance planning. Reductions in grades 2+ and 3+ pneumonitis were 7.1% and 4.7% based on mean dose-function metrics, with reductions as high as 52.3% for individual patients. Our work provides seminal data for determining the potential toxicity benefit from incorporating CT ventilation into thoracic treatment planning.
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Affiliation(s)
- Austin M Faught
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado.
| | - Yuya Miyasaka
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Noriyuki Kadoya
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Richard Castillo
- Department of Radiation Oncology, University of Texas Medical Branch of Galveston, League City, Texas
| | - Edward Castillo
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan
| | - Yevgeniy Vinogradskiy
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Tokihiro Yamamoto
- Department of Radiation Oncology, University of California Davis School of Medicine, Sacramento, California
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Waxweiler T, Schubert L, Diot Q, Faught A, Stuhr K, Castillo R, Castillo E, Guerrero T, Rusthoven C, Gaspar L, Kavanagh B, Miften M, Vinogradskiy Y. A complete 4DCT-ventilation functional avoidance virtual trial: Developing strategies for prospective clinical trials. J Appl Clin Med Phys 2017; 18:144-152. [PMID: 28436107 PMCID: PMC5689844 DOI: 10.1002/acm2.12086] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 01/30/2017] [Accepted: 03/08/2017] [Indexed: 12/25/2022] Open
Abstract
Introduction 4DCT‐ventilation is an exciting new imaging modality that uses 4DCT data to calculate lung‐function maps. Because 4DCTs are acquired as standard of care for lung cancer patients undergoing radiotherapy, 4DCT‐ventiltation provides functional information at no extra dosimetric or monetary cost to the patient. The development of clinical trials is underway to use 4DCT‐ventilation imaging to spare functional lung in patients undergoing radiotherapy. The purpose of this work was to perform a virtual trial using retrospective data to develop the practical aspects of a 4DCT‐ventilation functional avoidance clinical trial. Methods The study included 96 stage III lung cancer patients. A 4DCT‐ventilation map was calculated using the patient's 4DCT‐imaging, deformable registration, and a density‐change‐based algorithm. Clinical trial inclusion assessment used quantitative and qualitative metrics based on the patient's spatial ventilation profile. Clinical and functional plans were generated for 25 patients. The functional plan aimed to reduce dose to functional lung while meeting standard target and critical structure constraints. Standard and dose‐function metrics were compared between the clinical and functional plans. Results Our data showed that 69% and 59% of stage III patients have regional variability in function based on qualitative and quantitative metrics, respectively. Functional planning demonstrated an average reduction of 2.8 Gy (maximum 8.2 Gy) in the mean dose to functional lung. Conclusions Our work demonstrated that 60–70% of stage III patients would be eligible for functional planning and that a typical functional lung mean dose reduction of 2.8 Gy can be expected relative to standard clinical plans. These findings provide salient data for the development of functional clinical trials.
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Affiliation(s)
- Timothy Waxweiler
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Leah Schubert
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Quentin Diot
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Austin Faught
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Kelly Stuhr
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Richard Castillo
- Department of Radiation Oncology, University of Texas Medical Branch, Galveston, TX, USA
| | - Edward Castillo
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, USA
| | - Thomas Guerrero
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, USA
| | - Chad Rusthoven
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Laurie Gaspar
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Brian Kavanagh
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Moyed Miften
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Yevgeniy Vinogradskiy
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
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Woodruff HC, Shieh CC, Hegi-Johnson F, Keall PJ, Kipritidis J. Quantifying the reproducibility of lung ventilation images between 4-Dimensional Cone Beam CT and 4-Dimensional CT. Med Phys 2017; 44:1771-1781. [DOI: 10.1002/mp.12199] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 02/17/2017] [Accepted: 02/17/2017] [Indexed: 02/01/2023] Open
Affiliation(s)
- Henry C. Woodruff
- Radiation Physics Laboratory; School of Medicine; University of Sydney; Sydney NSW 2006 Australia
| | - Chun-Chien Shieh
- Radiation Physics Laboratory; School of Medicine; University of Sydney; Sydney NSW 2006 Australia
| | - Fiona Hegi-Johnson
- Radiation Physics Laboratory; School of Medicine; University of Sydney; Sydney NSW 2006 Australia
- Department of Medical Physics; School of Mathematical and Physical Sciences; University of Newcastle; Newcastle NSW 2300 Australia
- Radiation Oncology Centre; Seventh Day Adventist Hospital; Wahroonga NSW Australia
| | - Paul J. Keall
- Radiation Physics Laboratory; School of Medicine; University of Sydney; Sydney NSW 2006 Australia
| | - John Kipritidis
- Radiation Physics Laboratory; School of Medicine; University of Sydney; Sydney NSW 2006 Australia
- Northern Sydney Cancer Center; Royal North Shore Hospital; Sydney NSW 2065 Australia
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Shao J, Hu P. Quantification of regional deformation of the lungs by non-rigid registration of three-dimensional contrast-enhanced magnetic resonance imaging. Quant Imaging Med Surg 2017; 7:177-186. [PMID: 28516043 PMCID: PMC5418144 DOI: 10.21037/qims.2017.01.01] [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: 10/30/2016] [Accepted: 12/02/2016] [Indexed: 11/06/2022]
Abstract
BACKGROUND Assessment of lung function is vital for the diagnosis of a variety of pathological conditions. Research has been proposed to study pulmonary mechanics and kinematics using two-dimensional (2D) magnetic resonance imaging (MRI). This allows estimation of regional lung tissue mechanics but is limited to 2D information. An approach based on three-dimensional (3D) contrast-enhanced MR angiogram of pulmonary blood vessels and a non-rigid image registration technique is proposed for quantification of lung regional deformations, which can potentially be used for assessment of pulmonary parenchymal mechanics and regional ventilation for disease diagnosis without ionizing radiation. METHODS On three volunteers, an end-expiration scan and end-inspiration scan was acquired successively for each volunteer using a 3D breath-hold contrast-enhanced MRI sequence several minutes after gadolinium injection. Subsequently, a rectangle box lung mask is manually selected for each end-expiration scan, applying non-rigid registration algorithms using cubic B-splines as transformations to align each pair of images. This incorporates the Normalized Correlation Coefficient similarity with the bending energy term as cost function with a multi-resolution multi-grid approach. Finally, the lung regional 3D deformations were obtained using the transformations obtained by registration. The alignment accuracy after non-rigid registration was estimated by using a set of branch points of pulmonary blood vessels as anatomical landmarks for each pair of images. RESULTS With contrast enhancement, the pulmonary blood vessel signal was enhanced, which greatly facilitated the non-rigid registration in the lung parenchyma. The average landmarks distances in three pairs of datasets are reduced from 17.9, 20.3 and 16.3 mm, to 1.0, 1.6 and 1.2 mm, respectively, by non-rigid registration. After registration, the average distances error of each pair of datasets was less than 0.6 mm in the right-to-left (RL) direction, less than 0.9 mm in the inferior-to-superior (IS) direction, and less than 1.2 mm in the anterior-to-posterior (AP) direction. CONCLUSIONS Results demonstrated that the proposed method can accurately register lungs with large deformations to evaluate lung regional deformation. It may be used for quantitative assessment of 3D lung regional ventilation avoiding ionizing radiation.
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Affiliation(s)
- Jiaxin Shao
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Peng Hu
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Biomedical Physics Interdepartmental Graduate Program, University of California, Los Angeles, CA, USA
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Vinogradskiy Y, Jackson M, Schubert L, Jones B, Castillo R, Castillo E, Guerrero T, Mitchell J, Rusthoven C, Miften M, Kavanagh B. Assessing the use of 4DCT-ventilation in pre-operative surgical lung cancer evaluation. Med Phys 2017; 44:200-208. [PMID: 28102961 DOI: 10.1002/mp.12026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 10/03/2016] [Accepted: 11/13/2016] [Indexed: 12/25/2022] Open
Abstract
PURPOSE A primary treatment option for lung cancer patients is surgical resection. Patients who have poor lung function prior to surgery are at increased risk of developing serious and life-threatening complications after surgical resection. Surgeons use nuclear medicine ventilation-perfusion (VQ) scans along with pulmonary function test (PFT) information to assess a patient's pre-surgical lung function. The nuclear medicine images and pre-surgery PFTs are used to calculate percent predicted postoperative (%PPO) PFT values by estimating the amount of functioning lung tissue that would be lost with surgical resection. Nuclear medicine imaging is currently considered the standard of care when evaluating the amount of ventilation that would be lost due to surgery. A novel lung function imaging modality has been developed in radiation oncology that uses 4-Dimensional computed tomography data to calculate ventilation maps (4DCT-ventilation). Compared to nuclear medicine, 4DCT-ventilation is cheaper, does not require a radioactive contrast agent, provides a faster imaging procedure, and has improved spatial resolution. In this work we perform a retrospective study to assess the use of 4DCT-ventilation as a pre-operative surgical lung function evaluation tool. Specifically, the purpose of our study was to compare %PPO PFT values calculated with 4DCT-ventilation and %PPO PFT values calculated with nuclear medicine ventilation-perfusion imaging. METHODS The study included 16 lung cancer patients that had undergone 4DCT imaging, nuclear medicine imaging, and had Forced Expiratory Volume in 1 second (FEV1 ) acquired as part of a standard PFT. The 4DCT datasets, spatial registration, and a density-change-based model were used to compute 4DCT-ventilation maps. Both 4DCT-ventilation and nuclear medicine images were used to calculate %PPO FEV1 . The %PPO FEV1 was calculated by scaling the pre-surgical FEV1 by (1-fraction of total resected ventilation); where the resected ventilation was determined using either the 4DCT-ventilation or nuclear medicine imaging. Calculations were done assuming both lobectomy and pneumonectomy resections. The %PPO FEV1 values were compared between the 4DCT-ventilation-based calculations and the nuclear medicine-based calculations using correlation coefficients, average differences, and Receiver Operating Characteristic (ROC) analysis. RESULTS Overall the 4DCT-ventilation derived %PPO FEV1 values agreed well with nuclear medicine-derived %PPO FEV1 data with correlations of 0.99 and 0.81 for lobectomy and pneumonectomy, respectively. The average differences between the 4DCT-ventilation and nuclear medicine-based calculation for %PPO FEV1 were less than 5%. ROC analysis revealed predictive accuracy that ranged from 87.5% to 100% when assessing the ability of 4DCT-ventilation to predict for nuclear medicine-based %PPO FEV1 values. CONCLUSIONS 4DCT-ventilation is an innovative technology developed in radiation oncology that has great potential to translate to the surgical domain. The high correlation results when comparing 4DCT-ventilation to the current standard of care provide a strong rationale for a prospective clinical trial assessing 4DCT-ventilation in the clinical setting. 4DCT-ventilation can reduce the cost and imaging time for patients while providing improved spatial accuracy and quantitative results for surgeons.
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Affiliation(s)
- Yevgeniy Vinogradskiy
- Department of Radiation Oncology, University of Colorado School of Medicine, 1665 Aurora Court, Aurora, CO, 80045, USA
| | - Matthew Jackson
- Department of Radiation Oncology, University of Colorado School of Medicine, 1665 Aurora Court, Aurora, CO, 80045, USA
| | - Leah Schubert
- Department of Radiation Oncology, University of Colorado School of Medicine, 1665 Aurora Court, Aurora, CO, 80045, USA
| | - Bernard Jones
- Department of Radiation Oncology, University of Colorado School of Medicine, 1665 Aurora Court, Aurora, CO, 80045, USA
| | - Richard Castillo
- Department of Radiation Oncology, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA
| | - Edward Castillo
- Department of Radiation Oncology, Beaumont Health System, 3601 W 13 Mile Rd, Royal Oak, MI, 48073, USA
| | - Thomas Guerrero
- Department of Radiation Oncology, Beaumont Health System, 3601 W 13 Mile Rd, Royal Oak, MI, 48073, USA
| | - John Mitchell
- Department of Surgery, University of Colorado School of Medicine, 1665 Aurora Court, Aurora, CO, 80045, USA
| | - Chad Rusthoven
- Department of Radiation Oncology, University of Colorado School of Medicine, 1665 Aurora Court, Aurora, CO, 80045, USA
| | - Moyed Miften
- Department of Radiation Oncology, University of Colorado School of Medicine, 1665 Aurora Court, Aurora, CO, 80045, USA
| | - Brian Kavanagh
- Department of Radiation Oncology, University of Colorado School of Medicine, 1665 Aurora Court, Aurora, CO, 80045, USA
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Yamamoto T, Kent MS, Wisner ER, Johnson LR, Stern JA, Qi L, Fujita Y, Boone JM. Single-energy computed tomography-based pulmonary perfusion imaging: Proof-of-principle in a canine model. Med Phys 2017; 43:3998. [PMID: 27370118 PMCID: PMC5438244 DOI: 10.1118/1.4953188] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Purpose: Radiotherapy (RT) that selectively avoids irradiating highly functional
lung
regions may reduce pulmonary toxicity, which is substantial in lung
cancer RT.
Single-energy computed
tomography
(CT)
pulmonary perfusion imaging has several advantages
(e.g., higher resolution) over other modalities and has great potential for
widespread clinical implementation, particularly in RT. The purpose of this study
was to establish proof-of-principle for single-energy CT perfusion
imaging. Methods: Single-energy CT perfusion imaging is based on the following:
(1) acquisition of end-inspiratory breath-hold CT scans before and
after intravenous injection of iodinated contrast agents, (2)
deformable image
registration (DIR) for spatial mapping of
those two CT
image
data sets,
and (3) subtraction of the precontrast image
data set
from the postcontrast image
data set,
yielding a map of regional Hounsfield unit (HU) enhancement, a surrogate for
regional perfusion. In a protocol approved by the institutional animal care and
use committee, the authors acquired CT scans in the prone position for a total of 14
anesthetized canines (seven canines with normal lungs and seven
canines with diseased lungs). The elastix algorithm was used for DIR. The accuracy
of DIR was evaluated based on the target registration error (TRE) of 50 anatomic
pulmonary landmarks per subject for 10 randomly selected subjects as well as on
singularities (i.e., regions where the displacement vector field is not
bijective). Prior to perfusion computation, HUs of the precontrast end-inspiratory
image were corrected for variation in the lung inflation level
between the precontrast and postcontrast end-inspiratory CT scans, using a
model built from two additional precontrast CT scans at
end-expiration and midinspiration. The authors also assessed spatial heterogeneity
and gravitationally directed gradients of regional perfusion for normal
lung
subjects and diseased lung subjects using a two-sample two-tailed
t-test. Results: The mean TRE (and standard deviation) was 0.6 ± 0.7 mm (smaller than the voxel
dimension) for DIR between pre contrast and postcontrast end-inspiratory
CT
image
data sets.
No singularities were observed in the displacement vector fields. The mean HU
enhancement (and standard deviation) was 37.3 ± 10.5 HU for normal lung subjects and 30.7
± 13.5 HU for diseased lung subjects. Spatial heterogeneity of regional perfusion was
found to be higher for diseased lung subjects than for normal lung subjects, i.e., a
mean coefficient of variation of 2.06 vs 1.59 (p = 0.07). The
average gravitationally directed gradient was strong and significant
(R2 = 0.99, p < 0.01) for
normal lung dogs, whereas it was moderate and nonsignificant
(R2 = 0.61, p = 0.12) for diseased
lung
dogs. Conclusions: This canine study demonstrated the accuracy of DIR with subvoxel TREs on average,
higher spatial heterogeneity of regional perfusion for diseased
lung
subjects than for normal lung subjects, and a strong gravitationally directed gradient
for normal lung subjects, providing proof-of-principle for single-energy
CT
pulmonary perfusion imaging. Further studies such as
comparison with other perfusion imaging modalities will be necessary
to validate the physiological significance.
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Affiliation(s)
- Tokihiro Yamamoto
- Department of Radiation Oncology, University of California Davis School of Medicine, Sacramento, California 95817
| | - Michael S Kent
- Department of Surgical and Radiological Sciences, University of California Davis School of Veterinary Medicine, Davis, California 95616
| | - Erik R Wisner
- Department of Surgical and Radiological Sciences, University of California Davis School of Veterinary Medicine, Davis, California 95616
| | - Lynelle R Johnson
- Department of Medicine and Epidemiology, University of California Davis School of Veterinary Medicine, Davis, California 95616
| | - Joshua A Stern
- Department of Medicine and Epidemiology, University of California Davis School of Veterinary Medicine, Davis, California 95616
| | - Lihong Qi
- Department of Public Health Sciences, University of California Davis, Davis, California 95616
| | - Yukio Fujita
- Department of Radiation Oncology, Tokai University, Isehara, Kanagawa 259-1193, Japan
| | - John M Boone
- Department of Radiology, University of California Davis School of Medicine, Sacramento, California 95817
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Doi Y, Kimura T, Nakashima T, Takeuchi Y, Takahashi I, Nishibuchi I, Murakami Y, Nagata Y. Functional image guided radiation therapy planning in volumetric modulated arc therapy for patients with malignant pleural mesothelioma. Adv Radiat Oncol 2017; 2:183-191. [PMID: 28740930 PMCID: PMC5514243 DOI: 10.1016/j.adro.2017.01.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Revised: 01/18/2017] [Accepted: 01/25/2017] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To investigate the incorporation of functional lung image-derived low-attenuation area (LAA) based on 4-dimensional computed tomography (4D-CT) in volumetric modulated arc therapy (VMAT) planning for patients with malignant pleural mesothelioma (MPM) after extrapleural pneumonectomy. METHODS AND MATERIALS Twelve patients with MPM after extrapleural pneumonectomy were included. The primarily affected side was the right in 6 patients and the left in 6 patients. LAA was generated from 4D-CT data according to CT values with a threshold of less than -860 Hounsfield units (HU). Functional lung image was defined as the area where LAA was excluded from contralateral lung image. Two radiation therapy plans were designed: (1) Plan C, conventional VMAT and (2) Plan F, functional VMAT plan based on the functional lung. Both plans were compared in each patient with respect to the following dosimetric parameters: fV20, V20, fV10, V10, fV5, and V5, the percentages of functional or contralateral lung volumes irradiated with >20 Gy, 10 Gy, or 5 Gy, respectively; functional mean lung dose (fMLD) and mean lung dose (MLD), the mean dose to the functional or contralateral lung, respectively; maximum dose to the cord; mean doses to the liver and heart; and planning target volume homogeneity index. RESULTS fV5 and MLD were significantly lower in Plan F (fV5, median 57.5% in Plan C vs 38.5% in Plan F, P < .01; MLD, median 7.0 Gy in Plan C vs 6.4 Gy in Plan F, P = .04). fV10, V5, and fMLD were also significantly lower in Plan F. Compared with Plan C, planning target volume homogeneity index and liver, heart, and cord doses were not significantly elevated in Plan F. CONCLUSIONS Significant reductions in fV5, fV10, fMLD, V5, and MLD were achieved with the functional image guided VMAT plan without negative effects on other factors. LAA-based functional image guided radiation therapy planning in VMAT is a feasible method to spare the functional lung in patients with MPM.
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Affiliation(s)
- Yoshiko Doi
- Department of Radiation Oncology, Hiroshima University Hospital, Hiroshima City, Japan
| | - Tomoki Kimura
- Department of Radiation Oncology, Hiroshima University Hospital, Hiroshima City, Japan
| | - Takeo Nakashima
- Division of Radiation Oncology, Hiroshima University Hospital, Hiroshima City, Japan
| | - Yuki Takeuchi
- Department of Radiation Oncology, Hiroshima University Hospital, Hiroshima City, Japan
| | - Ippei Takahashi
- Department of Radiation Oncology, Hiroshima University Hospital, Hiroshima City, Japan
| | - Ikuno Nishibuchi
- Department of Radiation Oncology, Hiroshima University Hospital, Hiroshima City, Japan
| | - Yuji Murakami
- Department of Radiation Oncology, Hiroshima University Hospital, Hiroshima City, Japan
| | - Yasushi Nagata
- Department of Radiation Oncology, Hiroshima University Hospital, Hiroshima City, Japan
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Ventilation Series Similarity: A Study for Ventilation Calculation Using Deformable Image Registration and 4DCT to Avoid Motion Artifacts. CONTRAST MEDIA & MOLECULAR IMAGING 2017; 2017:9730380. [PMID: 29097945 PMCID: PMC5623778 DOI: 10.1155/2017/9730380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 07/18/2017] [Accepted: 08/14/2017] [Indexed: 11/18/2022]
Abstract
The major problem with ventilation distribution calculations using DIR and 4DCT is the motion artifacts in 4DCT. Quite often not all phases would exhibit mushroom motion artifacts. If the ventilation series similarity is sufficiently robust, the ventilation distribution can be calculated using only the artifact-free phases. This study investigated the ventilation similarity among the data derived from different respiration phases. Fifteen lung cancer cases were analyzed. In each case, DIR was performed between the end-expiration phase and all other phases. Ventilation distributions were then calculated using the deformation matrices. The similarity was compared between the series ventilation distributions. The correlation between the majority phases was reasonably good, with average SCC values between 0.28 and 0.70 for the original data and 0.30 and 0.75 after smoothing. The better correlation between the neighboring phases, with average SCC values between 0.55 and 0.70 for the original data, revealed the nonlinear property of the dynamic ventilation. DSC analysis showed the same trend. To reduce the errors if motion artifacts are present, the phases without serious mushroom artifacts may be used. To minimize the effect of the nonlinearity in dynamic ventilation, the calculation phase should be chosen as close to the end-inspiration as possible.
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69
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Ireland R, Tahir B, Wild J, Lee C, Hatton M. Functional Image-guided Radiotherapy Planning for Normal Lung Avoidance. Clin Oncol (R Coll Radiol) 2016; 28:695-707. [DOI: 10.1016/j.clon.2016.08.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 07/19/2016] [Accepted: 07/20/2016] [Indexed: 12/25/2022]
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Kanai T, Kadoya N, Ito K, Kishi K, Dobashi S, Yamamoto T, Umezawa R, Matsushita H, Takeda K, Jingu K. Evaluation of four-dimensional computed tomography (4D-CT)-based pulmonary ventilation: The high correlation between 4D-CT ventilation and 81mKr-planar images was found. Radiother Oncol 2016; 119:444-8. [DOI: 10.1016/j.radonc.2016.04.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 04/19/2016] [Accepted: 04/21/2016] [Indexed: 11/25/2022]
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Zhang GG, Latifi K, Du K, Reinhardt JM, Christensen GE, Ding K, Feygelman V, Moros EG. Evaluation of the ΔV 4D CT ventilation calculation method using in vivo xenon CT ventilation data and comparison to other methods. J Appl Clin Med Phys 2016; 17:550-560. [PMID: 27074479 PMCID: PMC5874808 DOI: 10.1120/jacmp.v17i2.5985] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 11/30/2015] [Accepted: 11/25/2015] [Indexed: 12/25/2022] Open
Abstract
Ventilation distribution calculation using 4D CT has shown promising potential in several clinical applications. This study evaluated the direct geometric ventilation calculation method, namely the ΔV method, with xenon-enhanced CT (XeCT) ventilation data from four sheep, and compared it with two other published meth-ods, the Jacobian and the Hounsfield unit (HU) methods. Spearman correlation coefficient (SCC) and Dice similarity coefficient (DSC) were used for the evaluation and comparison. The average SCC with one standard deviation was 0.44 ± 0.13 with a range between 0.29 and 0.61 between the XeCT and ΔV ventilation distributions. The average DSC value for lower 30% ventilation volumes between the XeCT and ΔV ventilation distributions was 0.55 ± 0.07 with a range between 0.48 and 0.63. Ventilation difference introduced by deformable image registration errors improved with smoothing. In conclusion, ventilation distributions generated using ΔV-4D CT and deformable image registration are in reasonably agreement with the in vivo XeCT measured ventilation distribution.
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72
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Kida S, Bal M, Kabus S, Negahdar M, Shan X, Loo BW, Keall PJ, Yamamoto T. CT ventilation functional image-based IMRT treatment plans are comparable to SPECT ventilation functional image-based plans. Radiother Oncol 2016; 118:521-7. [DOI: 10.1016/j.radonc.2016.02.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 01/07/2016] [Accepted: 02/05/2016] [Indexed: 12/25/2022]
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73
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Yamamoto T, Kabus S, Bal M, Keall P, Benedict S, Daly M. The first patient treatment of computed tomography ventilation functional image-guided radiotherapy for lung cancer. Radiother Oncol 2016; 118:227-31. [DOI: 10.1016/j.radonc.2015.11.006] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 10/27/2015] [Accepted: 11/18/2015] [Indexed: 12/25/2022]
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74
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Kipritidis J, Hofman MS, Siva S, Callahan J, Le Roux PY, Woodruff HC, Counter WB, Keall PJ. Estimating lung ventilation directly from 4D CT Hounsfield unit values. Med Phys 2015; 43:33. [DOI: 10.1118/1.4937599] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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75
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Combined Ventilation and Perfusion Imaging Correlates With the Dosimetric Parameters of Radiation Pneumonitis in Radiation Therapy Planning for Lung Cancer. Int J Radiat Oncol Biol Phys 2015; 93:778-87. [DOI: 10.1016/j.ijrobp.2015.08.024] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 08/01/2015] [Accepted: 08/12/2015] [Indexed: 11/24/2022]
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76
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Eslick EM, Bailey DL, Harris B, Kipritidis J, Stevens M, Li BT, Bailey E, Gradinscak D, Pollock S, Htun C, Turner R, Eade T, Aslani A, Snowdon G, Keall PJ. Measurement of preoperative lobar lung function with computed tomography ventilation imaging: progress towards rapid stratification of lung cancer lobectomy patients with abnormal lung function. Eur J Cardiothorac Surg 2015; 49:1075-82. [PMID: 26248634 DOI: 10.1093/ejcts/ezv276] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 07/06/2015] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES In lung cancer preoperative evaluation, functional lung imaging is commonly used to assess lobar function. Computed tomography ventilation (CT-V) imaging is an emerging lung function imaging modality. We compared CT-V imaging assessment of lobar function and its prediction of postoperative lung function to that achieved by (i) positron emission tomography ventilation (PET-V) imaging and (ii) the standard anatomical segment counting (ASC) method. We hypothesized (i) that CT-V and PET-V have similar relative lobar function and (ii) that functional imaging and anatomic assessment (ASC) yield different predicted postoperative (ppo) lung function and therefore could change clinical management. METHODS In this proof-of-concept study, 11 patients were subjected to pulmonary function tests, CT-V and PET-V imaging. The Bland-Altman plot, Pearson's correlation and linear regression analysis were used to assess the agreement between the CT-V-, PET-V- and ASC-based quantification of lobar function and in the ppo lung function. RESULTS CT-V and PET-V imaging demonstrated strong correlations in quantifying relative lobar function (r = 0.96; P < 0.001). A Wilcoxon-signed rank test showed no significant difference in the lobar function estimates between the two imaging modalities (P = 0.83). The Bland-Altman plot also showed no significant differences. The correlation between ASC-based lobar function estimates with ventilation imaging was low, r < 0.45; however, the predictions of postoperative lung function correlated strongly between all three methods. CONCLUSIONS The assessment of lobar function from CT-V imaging correlated strongly with PET-V imaging, but had low correlations with ASC. CT-V imaging may be a useful alternative method in preoperative evaluation for lung cancer patients.
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Affiliation(s)
- Enid M Eslick
- Radiation Physics Laboratory, Sydney Medical School - Central, University of Sydney, Sydney, NSW, Australia
| | - Dale L Bailey
- Sydney Medical School - Northern, University of Sydney, St Leonards, NSW, Australia Department of Nuclear Medicine, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Benjamin Harris
- Sydney Medical School - Northern, University of Sydney, St Leonards, NSW, Australia Department of Sleep and Respiratory Medicine, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - John Kipritidis
- Radiation Physics Laboratory, Sydney Medical School - Central, University of Sydney, Sydney, NSW, Australia
| | - Mark Stevens
- Sydney Medical School - Northern, University of Sydney, St Leonards, NSW, Australia Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Bob T Li
- Sydney Medical School - Northern, University of Sydney, St Leonards, NSW, Australia Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Elizabeth Bailey
- Department of Nuclear Medicine, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Denis Gradinscak
- Department of Nuclear Medicine, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Sean Pollock
- Radiation Physics Laboratory, Sydney Medical School - Central, University of Sydney, Sydney, NSW, Australia
| | - Chris Htun
- Department of Sleep and Respiratory Medicine, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Robin Turner
- School of Public Health and Community Medicine, University of New South Wales, Kensington, NSW, Australia
| | - Thomas Eade
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Ali Aslani
- Department of Nuclear Medicine, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Graeme Snowdon
- Department of Nuclear Medicine, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Paul J Keall
- Radiation Physics Laboratory, Sydney Medical School - Central, University of Sydney, Sydney, NSW, Australia
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Analysis of Long-Term 4-Dimensional Computed Tomography Regional Ventilation After Radiation Therapy. Int J Radiat Oncol Biol Phys 2015; 92:683-90. [DOI: 10.1016/j.ijrobp.2015.02.037] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Revised: 02/14/2015] [Accepted: 02/18/2015] [Indexed: 11/17/2022]
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Kadoya N, Cho SY, Kanai T, Onozato Y, Ito K, Dobashi S, Yamamoto T, Umezawa R, Matsushita H, Takeda K, Jingu K. Dosimetric impact of 4-dimensional computed tomography ventilation imaging-based functional treatment planning for stereotactic body radiation therapy with 3-dimensional conformal radiation therapy. Pract Radiat Oncol 2015; 5:e505-e512. [PMID: 25899221 DOI: 10.1016/j.prro.2015.03.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 01/10/2015] [Accepted: 03/02/2015] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of this study was to clarify the dosimetric impact of 4-dimensional computed tomography (4D-CT)-derived, ventilation-guided functional avoidance for stereotactic body radiation therapy (SBRT) with 3-dimensional conformal radiation therapy. METHODS AND MATERIALS Eleven lung cancer patients with peripheral tumors no greater than 5 cm in size were studied (average planning target volume, 42.4 ± 32.5 cm(3)). Four-dimensional-CT ventilation imaging was performed using deformable image registration for spatial mapping of the peak-exhale 4D-CT image to the peak-inhale 4D-CT image and computation of the Jacobian-based ventilation metric. For each patient, anatomical and functional plans were created using 7 to 9 noncoplanar beams for SBRT (40-56 Gy/4-8 fractions). The anatomical plan was generated without incorporating ventilation information. In the functional plan, functional dose-volume constraints were applied in planning to spare the high-functional lung that was defined as the 90th percentile functional volume. The beam directions of the 2 plans were automatically determined by beam angle optimization. RESULTS The percentage of volume receiving a dose of ≥5 Gy (V5), V10, V20, and mean dose to the high-functional lung were 20.5%, 15.6%, 7.8%, and 4.6 Gy, respectively, for the anatomical plan, whereas they were 12.3%, 8.2%, 4.6%, and 3.2 Gy, respectively, for the functional plan. No significant differences in minimum dose, maximum dose, and conformity index of the planning target volume and in all dosimetric parameters for normal tissues between the anatomical and functional plans were seen. CONCLUSIONS We compared anatomical and functional plans for SBRT with 3-dimensional conformal radiation therapy for the first time. Our results demonstrated that a functional plan for SBRT reduced the dose in the high-functional regions without a significant change in the total lung or planning target volume even if the radiation technique cannot modulate beam intensity. Thus, this technique can be safely used in functional planning for SBRT.
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Affiliation(s)
- Noriyuki Kadoya
- Department of Radiation Oncology, Tohoku University School of Medicine, Sendai, Japan.
| | - Sang Yong Cho
- Department of Radiation Oncology, Tohoku University School of Medicine, Sendai, Japan
| | - Takayuki Kanai
- Department of Radiation Oncology, Tohoku University School of Medicine, Sendai, Japan
| | - Yusuke Onozato
- Department of Radiation Oncology, Tohoku University School of Medicine, Sendai, Japan
| | - Kengo Ito
- Department of Radiation Oncology, Tohoku University School of Medicine, Sendai, Japan
| | - Suguru Dobashi
- Department of Radiological Technology, School of Health Sciences, Faculty of Medicine, Tohoku University, Sendai, Japan
| | - Takaya Yamamoto
- Department of Radiation Oncology, Tohoku University School of Medicine, Sendai, Japan
| | - Rei Umezawa
- Department of Radiation Oncology, Tohoku University School of Medicine, Sendai, Japan
| | - Haruo Matsushita
- Department of Radiation Oncology, Tohoku University School of Medicine, Sendai, Japan
| | - Ken Takeda
- Department of Radiological Technology, School of Health Sciences, Faculty of Medicine, Tohoku University, Sendai, Japan
| | - Keiichi Jingu
- Department of Radiation Oncology, Tohoku University School of Medicine, Sendai, Japan
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Brennan D, Schubert L, Diot Q, Castillo R, Castillo E, Guerrero T, Martel MK, Linderman D, Gaspar LE, Miften M, Kavanagh BD, Vinogradskiy Y. Clinical validation of 4-dimensional computed tomography ventilation with pulmonary function test data. Int J Radiat Oncol Biol Phys 2015; 92:423-9. [PMID: 25817531 DOI: 10.1016/j.ijrobp.2015.01.019] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 01/09/2015] [Accepted: 01/13/2015] [Indexed: 12/25/2022]
Abstract
PURPOSE A new form of functional imaging has been proposed in the form of 4-dimensional computed tomography (4DCT) ventilation. Because 4DCTs are acquired as part of routine care for lung cancer patients, calculating ventilation maps from 4DCTs provides spatial lung function information without added dosimetric or monetary cost to the patient. Before 4DCT-ventilation is implemented it needs to be clinically validated. Pulmonary function tests (PFTs) provide a clinically established way of evaluating lung function. The purpose of our work was to perform a clinical validation by comparing 4DCT-ventilation metrics with PFT data. METHODS AND MATERIALS Ninety-eight lung cancer patients with pretreatment 4DCT and PFT data were included in the study. Pulmonary function test metrics used to diagnose obstructive lung disease were recorded: forced expiratory volume in 1 second (FEV1) and FEV1/forced vital capacity. Four-dimensional CT data sets and spatial registration were used to compute 4DCT-ventilation images using a density change-based and a Jacobian-based model. The ventilation maps were reduced to single metrics intended to reflect the degree of ventilation obstruction. Specifically, we computed the coefficient of variation (SD/mean), ventilation V20 (volume of lung ≤20% ventilation), and correlated the ventilation metrics with PFT data. Regression analysis was used to determine whether 4DCT ventilation data could predict for normal versus abnormal lung function using PFT thresholds. RESULTS Correlation coefficients comparing 4DCT-ventilation with PFT data ranged from 0.63 to 0.72, with the best agreement between FEV1 and coefficient of variation. Four-dimensional CT ventilation metrics were able to significantly delineate between clinically normal versus abnormal PFT results. CONCLUSIONS Validation of 4DCT ventilation with clinically relevant metrics is essential. We demonstrate good global agreement between PFTs and 4DCT-ventilation, indicating that 4DCT-ventilation provides a reliable assessment of lung function. Four-dimensional CT ventilation enables exciting opportunities to assess lung function and create functional avoidance radiation therapy plans. The present work provides supporting evidence for the integration of 4DCT-ventilation into clinical trials.
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Affiliation(s)
| | - Leah Schubert
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Quentin Diot
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Richard Castillo
- Department of Radiation Oncology, The University of Texas Medical Branch, Galveston, Texas
| | - Edward Castillo
- Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan
| | - Thomas Guerrero
- Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan
| | - Mary K Martel
- Department of Radiation Physics, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Derek Linderman
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Laurie E Gaspar
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Moyed Miften
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Brian D Kavanagh
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Yevgeniy Vinogradskiy
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado.
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Kida S. [Toward physiologically-adaptive radiotherapy with lung functional imaging based on 4D CT]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2014; 70:1353-1359. [PMID: 25410344 DOI: 10.6009/jjrt.2014_jsrt_70.11.1353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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