1
|
Avena-Zampieri CL, Dassios T, Milan A, Santos R, Kyriakopoulou V, Cromb D, Hall M, Egloff A, McGovern M, Uus A, Hutter J, Payette K, Rutherford M, Greenough A, Story L. Correlation of fetal lung area with MRI derived pulmonary volume. Early Hum Dev 2024; 194:106047. [PMID: 38851106 DOI: 10.1016/j.earlhumdev.2024.106047] [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: 04/04/2024] [Revised: 05/15/2024] [Accepted: 05/16/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND Neonatal chest-Xray (CXR)s are commonly performed as a first line investigation for the evaluation of respiratory complications. Although lung area derived from CXRs correlates well with functional assessments of the neonatal lung, it is not currently utilised in clinical practice, partly due to the lack of reference ranges for CXR-derived lung area in healthy neonates. Advanced MR techniques now enable direct evaluation of both fetal pulmonary volume and area. This study therefore aims to generate reference ranges for pulmonary volume and area in uncomplicated pregnancies, evaluate the correlation between prenatal pulmonary volume and area, as well as to assess the agreement between antenatal MRI-derived and neonatal CXR-derived pulmonary area in a cohort of fetuses that delivered shortly after the antenatal MRI investigation. METHODS Fetal MRI datasets were retrospectively analysed from uncomplicated term pregnancies and a preterm cohort that delivered within 72 h of the fetal MRI. All examinations included T2 weighted single-shot turbo spin echo images in multiple planes. In-house pipelines were applied to correct for fetal motion using deformable slice-to-volume reconstruction. An MRI-derived lung area was manually segmented from the average intensity projection (AIP) images generated. Postnatal lung area in the preterm cohort was measured from neonatal CXRs within 24 h of delivery. Pearson correlation coefficient was used to correlate MRI-derived lung volume and area. A two-way absolute agreement was performed between the MRI-derived AIP lung area and CXR-derived lung area. RESULTS Datasets from 180 controls and 10 preterm fetuses were suitable for analysis. Mean gestational age at MRI was 28.6 ± 4.2 weeks for controls and 28.7 ± 2.7 weeks for preterm neonates. MRI-derived lung area correlated strongly with lung volumes (p < 0.001). MRI-derived lung area had good agreement with the neonatal CXR-derived lung area in the preterm cohort [both lungs = 0.982]. CONCLUSION MRI-derived pulmonary area correlates well with absolute pulmonary volume and there is good correlation between MRI-derived pulmonary area and postnatal CXR-derived lung area when delivery occurs within a few days of the MRI examination. This may indicate that fetal MRI derived lung area may prove to be useful reference ranges for pulmonary areas derived from CXRs obtained in the perinatal period.
Collapse
Affiliation(s)
- Carla L Avena-Zampieri
- Department of Women and Children's Health King's College London, United Kingdom; Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom.
| | - Theodore Dassios
- Department of Women and Children's Health King's College London, United Kingdom
| | - Anna Milan
- Neonatal Unit, Guy's and St Thomas' NHS Foundation Trust, United Kingdom
| | - Rui Santos
- Children's Radiology Department, Evelina London Children's Hospital, Guy's and St Thomas NHS Foundation Trust, United Kingdom
| | - Vanessa Kyriakopoulou
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom; Department of Biomedical Engineering, School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom
| | - Daniel Cromb
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom
| | - Megan Hall
- Department of Women and Children's Health King's College London, United Kingdom; Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom
| | - Alexia Egloff
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom; Fetal Medicine Unit, Guy's and St Thomas' NHS Foundation Trust, United Kingdom
| | - Matthew McGovern
- Neonatal Unit, Guy's and St Thomas' NHS Foundation Trust, United Kingdom
| | - Alena Uus
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom; Department of Biomedical Engineering, School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom
| | - Jana Hutter
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom
| | - Kelly Payette
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom; Department of Biomedical Engineering, School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom
| | - Mary Rutherford
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom
| | - Anne Greenough
- Department of Women and Children's Health King's College London, United Kingdom
| | - Lisa Story
- Department of Women and Children's Health King's College London, United Kingdom; Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom; Fetal Medicine Unit, Guy's and St Thomas' NHS Foundation Trust, United Kingdom
| |
Collapse
|
2
|
Cooper D, Padilla L, Watson A, Neiderer K, Smith B, Weiss E. Motion-Inclusive Treatment Planning to Assess Normal Tissue Dose for Central Lung Stereotactic Body Radiation Therapy. Adv Radiat Oncol 2024; 9:101525. [PMID: 38948918 PMCID: PMC11214394 DOI: 10.1016/j.adro.2024.101525] [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: 01/02/2023] [Accepted: 04/19/2024] [Indexed: 07/02/2024] Open
Abstract
Purpose For lung stereotactic body radiation therapy, 4-dimensional computed tomography is often used to delineate target volumes, whereas organs at risk (OARs) are typically outlined on either average intensity projection (AIP) or midventilation (MidV = 30% phase) images. AIP has been widely adopted as it represents a true average, but image blurring often precludes accurate contouring of critical structures such as central airways. Here, we compare AIP versus MidV planning for centrally located tumors via respiratory motion-inclusive (RMI) plans to better evaluate dose delivered throughout the breathing cycle. Methods and Materials Independently contoured and optimized AIP and MidV plans were created for 16 treatments and rigidly copied to each of the 10 breathing phase-specific computed tomography image sets. Resulting dose distributions were deformably registered back to the MidV image set (used as reference because of clearer depiction of anatomy compared with motion-blurred AIP) and averaged to create RMI plans. Doses to central OARs were compared between plans. Results Mean absolute dose differences were low for all comparisons (range, 0.01-2.87 Gy); however, individual plans exhibited differences >20 Gy. Dose differences >5 Gy were observed most often for plan comparisons involving AIP-based plans (MidV vs AIP 23, AIP RMI vs AIP 12, MidV RMI vs AIP RMI 7, and MidV RMI vs MidV 8 times). Inclusion of respiratory motion reduced large dose differences. Standard OAR thresholds were exceeded up to 5 times for each plan comparison scenario and always involved proximal bronchial tree D4 cc tolerance dose. AIP-based contours were larger by, on average, 3% to 15%. Conclusions Large dose differences were observed when plans with AIP-based contours were compared with MidV-based contours, indicating that observed dose differences were likely due to contoured volume differences rather than the effect of motion. Because of blurring with AIP images, MidV RMI-based planning may offer a more accurate method to determine dose to critical OARs in the presence of respiratory motion.
Collapse
Affiliation(s)
| | - Laura Padilla
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, California
| | - Amy Watson
- Department of Radiation Oncology, Virginia Commonwealth University Health System, Richmond, Virginia
| | - Keith Neiderer
- Department of Radiation Oncology, Virginia Commonwealth University Health System, Richmond, Virginia
| | - Benjamin Smith
- Department of Radiation Oncology, Virginia Commonwealth University Health System, Richmond, Virginia
| | - Elisabeth Weiss
- Department of Radiation Oncology, Virginia Commonwealth University Health System, Richmond, Virginia
| |
Collapse
|
3
|
Ghareeb F, Boukerroui D, Stroom J, Jackson E, Pereira M, Gooding M, Greco C. An approach to generate synthetic 4DCT datasets to benchmark Mid-Position implementations. Phys Med 2023; 114:103144. [PMID: 37778207 DOI: 10.1016/j.ejmp.2023.103144] [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: 09/27/2022] [Revised: 07/14/2023] [Accepted: 09/21/2023] [Indexed: 10/03/2023] Open
Abstract
PURPOSE The Mid-Position image is constructed from 4DCT data using Deformable Image Registration and can be used as planning CT with reduced PTV volumes. 4DCT datasets currently-available for testing do not provide the corresponding Mid-P images of the datasets. This work describes an approach to generate human-like synthetic 4DCT datasets with the associated Mid-P images that can be used as reference in the validation of Mid-P implementations. METHODS Twenty synthetic 4DCT datasets with the associated reference Mid-P images were generated from twenty clinical 4DCT datasets. Per clinical dataset, an anchor phase was registered to the remaining nine phases to obtain nine Deformable Vector Fields (DVFs). These DVFs were used to warp the anchor phase in order to generate the synthetic 4DCT dataset and the corresponding reference Mid-P image. Similarly, a reference 4D tumor mask dataset and its corresponding Mid-P tumor mask were generated. The generated synthetic datasets and masks were used to compare and benchmark the outcomes of three independent Mid-P implementations using a set of experiments. RESULTS The Mid-P images constructed by the three implementations showed high similarity scores when compared to the reference Mid-P images except for one noisy dataset. The biggest difference in the estimated motion amplitudes (-2.6 mm) was noticed in the Superior-Inferior direction. The statistical analysis showed no significant differences among the three implementations for all experiments. CONCLUSION The described approach and the proposed experiments provide an independent method that can be used in the validation of any Mid-P implementation being developed.
Collapse
Affiliation(s)
- Firass Ghareeb
- Champalimaud Foundation, Department of Radiation Oncology, Lisbon, Portugal
| | | | - Joep Stroom
- Champalimaud Foundation, Department of Radiation Oncology, Lisbon, Portugal.
| | | | - Mariana Pereira
- Champalimaud Foundation, Department of Radiation Oncology, Lisbon, Portugal
| | | | - Carlo Greco
- Champalimaud Foundation, Department of Radiation Oncology, Lisbon, Portugal
| |
Collapse
|
4
|
Burghelea M, Bakkali Tahiri J, Dhont J, Kyndt M, Gulyban A, Szkitsak J, Bogaert E, van Gestel D, Reynaert N. Results of a multicenter 4D computed tomography quality assurance audit: Evaluating image accuracy and consistency. Phys Imaging Radiat Oncol 2023; 28:100479. [PMID: 37694265 PMCID: PMC10485145 DOI: 10.1016/j.phro.2023.100479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 07/28/2023] [Accepted: 07/31/2023] [Indexed: 09/12/2023] Open
Abstract
Background and purpose 4D Computed Tomography (4DCT) technology captures the location and movement of tumors and nearby organs at risk over time. In this study, a multi-institutional multi-vendor 4DCT audit was initiated to assess the accuracy of current imaging protocols. Materials and methods Twelve centers, including thirteen scanners performed a 4DCT acquisition of a dynamic thorax phantom using the institution's own protocol with the in-house breathing monitoring system. Five regular and three irregular breathing patterns were used. Image acquisition and reconstruction were followed by automated image analysis with our in-house developed 4DCT QA program (QAMotion). CT number accuracy, volume deviation, amplitude deviation, and spatial integrity were assessed per pattern using both the segmented volumes and line profiles. Results Regular breathing curves showed relatively accurate results across all institutions, with mean volume and CT number deviations and median amplitude deviation below 2%, 5 HU and 2 mm, respectively. Results obtained for irregular patterns showed more variation across the institutions. Volume and CT number deviations co-occurred with a blurring of the sphere, interpolation, or double-structure artifacts that were confirmed through the line profiles. For some of the irregular patterns, amplitude deviations up to 6 mm were observed. Maximum Intensity Projection (MaxIP) correctly captured the applied motion amplitude with deviations across all institutions within 2 mm except for double amplitude pattern. Conclusions All centers invited to participate in the audit responded positively, highlighting the need for a comprehensive yet easy-to-execute 4DCT quality assurance program. The largest variances between the results from one institution to another confirmed that a standardized 4DCT audit is warranted.
Collapse
Affiliation(s)
- Manuela Burghelea
- Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Institut Jules Bordet, Department of Medical Physics, Brussels, Belgium
- Université Libre De Bruxelles, Radiophysics and MRI physics laboratory, Brussels, Belgium
| | - Jinane Bakkali Tahiri
- Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Institut Jules Bordet, Department of Medical Physics, Brussels, Belgium
- Medical Physics Department, GasthuisZusters Antwerpen Ziekenhuizen, Antwerp, Belgium
| | - Jennifer Dhont
- Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Institut Jules Bordet, Department of Medical Physics, Brussels, Belgium
- Université Libre De Bruxelles, Radiophysics and MRI physics laboratory, Brussels, Belgium
| | | | - Akos Gulyban
- Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Institut Jules Bordet, Department of Medical Physics, Brussels, Belgium
- Université Libre De Bruxelles, Radiophysics and MRI physics laboratory, Brussels, Belgium
| | - Juliane Szkitsak
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Evelien Bogaert
- Department of Radiotherapy-Oncology, Ghent University Hospital, Gent, Belgium
| | - Dirk van Gestel
- Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Institut Jules Bordet, Radiation Oncology Department, Brussels, Belgium
| | - Nick Reynaert
- Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Institut Jules Bordet, Department of Medical Physics, Brussels, Belgium
- Université Libre De Bruxelles, Radiophysics and MRI physics laboratory, Brussels, Belgium
| |
Collapse
|
5
|
Yang Z, Lafata KJ, Chen X, Bowsher J, Chang Y, Wang C, Yin FF. Quantification of lung function on CT images based on pulmonary radiomic filtering. Med Phys 2022; 49:7278-7286. [PMID: 35770964 DOI: 10.1002/mp.15837] [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: 06/14/2021] [Revised: 06/06/2022] [Accepted: 06/08/2022] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To develop a radiomics filtering technique for characterizing spatial-encoded regional pulmonary ventilation information on lung computed tomography (CT). METHODS The lung volume was segmented on 46 CT images, and a 3D sliding window kernel was implemented across the lung volume to capture the spatial-encoded image information. Fifty-three radiomic features were extracted within the kernel, resulting in a fourth-order tensor object. As such, each voxel coordinate of the original lung was represented as a 53-dimensional feature vector, such that radiomic features could be viewed as feature maps within the lungs. To test the technique as a potential pulmonary ventilation biomarker, the radiomic feature maps were compared to paired functional images (Galligas PET or DTPA-SPECT) based on the Spearman correlation (ρ) analysis. RESULTS The radiomic feature maps GLRLM-based Run-Length Non-Uniformity and GLCOM-based Sum Average are found to be highly correlated with the functional imaging. The achieved ρ (median [range]) for the two features are 0.46 [0.05, 0.67] and 0.45 [0.21, 0.65] across 46 patients and 2 functional imaging modalities, respectively. CONCLUSIONS The results provide evidence that local regions of sparsely encoded heterogeneous lung parenchyma on CT are associated with diminished radiotracer uptake and measured lung ventilation defects on PET/SPECT imaging. These findings demonstrate the potential of radiomics to serve as a complementary tool to the current lung quantification techniques and provide hypothesis-generating data for future studies.
Collapse
Affiliation(s)
- Zhenyu Yang
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina, USA
- Medical Physics Graduate Program, Duke Kunshan University, Kunshan, Jiangsu, China
| | - Kyle J Lafata
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina, USA
- Department of Radiology, Duke University, Durham, North Carolina, USA
- Department of Electrical and Computer Engineering, Duke University, Durham, North Carolina, USA
| | - Xinru Chen
- Medical Physics Graduate Program, Duke Kunshan University, Kunshan, Jiangsu, China
| | - James Bowsher
- Medical Physics Graduate Program, Duke Kunshan University, Kunshan, Jiangsu, China
| | - Yushi Chang
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina, USA
| | - Chunhao Wang
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina, USA
| | - Fang-Fang Yin
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina, USA
- Medical Physics Graduate Program, Duke Kunshan University, Kunshan, Jiangsu, China
| |
Collapse
|
6
|
Li H, Dong L, Bert C, Chang J, Flampouri S, Jee KW, Lin L, Moyers M, Mori S, Rottmann J, Tryggestad E, Vedam S. Report of AAPM Task Group 290: Respiratory motion management for particle therapy. Med Phys 2022; 49:e50-e81. [PMID: 35066871 PMCID: PMC9306777 DOI: 10.1002/mp.15470] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 12/28/2021] [Accepted: 01/05/2022] [Indexed: 11/16/2022] Open
Abstract
Dose uncertainty induced by respiratory motion remains a major concern for treating thoracic and abdominal lesions using particle beams. This Task Group report reviews the impact of tumor motion and dosimetric considerations in particle radiotherapy, current motion‐management techniques, and limitations for different particle‐beam delivery modes (i.e., passive scattering, uniform scanning, and pencil‐beam scanning). Furthermore, the report provides guidance and risk analysis for quality assurance of the motion‐management procedures to ensure consistency and accuracy, and discusses future development and emerging motion‐management strategies. This report supplements previously published AAPM report TG76, and considers aspects of motion management that are crucial to the accurate and safe delivery of particle‐beam therapy. To that end, this report produces general recommendations for commissioning and facility‐specific dosimetric characterization, motion assessment, treatment planning, active and passive motion‐management techniques, image guidance and related decision‐making, monitoring throughout therapy, and recommendations for vendors. Key among these recommendations are that: (1) facilities should perform thorough planning studies (using retrospective data) and develop standard operating procedures that address all aspects of therapy for any treatment site involving respiratory motion; (2) a risk‐based methodology should be adopted for quality management and ongoing process improvement.
Collapse
Affiliation(s)
- Heng Li
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Lei Dong
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Christoph Bert
- Department of Radiation Oncology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Joe Chang
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Stella Flampouri
- Department of Radiation Oncology, Emory University, Atlanta, GA, USA
| | - Kyung-Wook Jee
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Liyong Lin
- Department of Radiation Oncology, Emory University, Atlanta, GA, USA
| | - Michael Moyers
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, China
| | - Shinichiro Mori
- Research Center for Charged Particle Therapy, National Institute of Radiological Sciences, Chiba, Japan
| | - Joerg Rottmann
- Center for Proton Therapy, Proton Therapy Singapore, Proton Therapy Pte Ltd, Singapore
| | - Erik Tryggestad
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Sastry Vedam
- Department of Radiation Oncology, University of Maryland, Baltimore, USA
| |
Collapse
|
7
|
Almeida DF, Astudillo P, Vandermeulen D. Three-dimensional image volumes from two-dimensional digitally reconstructed radiographs: A deep learning approach in lower limb CT scans. Med Phys 2021; 48:2448-2457. [PMID: 33690903 DOI: 10.1002/mp.14835] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 03/01/2021] [Accepted: 03/03/2021] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Three-dimensional (3D) reconstructions of the human anatomy have been available for surgery planning or diagnostic purposes for a few years now. The different image modalities usually rely on several consecutive two-dimensional (2D) acquisitions in order to reconstruct the 3D volume. Hence, such acquisitions are expensive, time-demanding and often expose the patient to an undesirable amount of radiation. For such reasons, along the most recent years, several studies have been proposed that extrapolate 3D anatomical features from merely 2D exams such as x rays for implant templating in total knee or hip arthroplasties. METHOD The presented study shows an adaptation of a deep learning-based convolutional neural network to reconstruct 3D volumes from a mere 2D digitally reconstructed radiograph from one of the most extensive lower limb computed tomography datasets available. This novel approach is based on an encoder-decoder architecture with skip connections and a multidimensional Gaussian filter as data augmentation technique. RESULTS The results achieved promising values when compared against the ground truth volumes, quantitatively yielding an average of 0.77 ± 0.05 structured similarity index. CONCLUSIONS A novel deep learning-based approach to reconstruct 3D medical image volumes from a single x-ray image was shown in the present study. The network architecture was validated against the original scans presenting SSIM values of 0.77 ± 0.05 and 0.78 ± 0.06, respectively for the knee and the hip crop.
Collapse
Affiliation(s)
- Diogo F Almeida
- Medical Imaging Research Center (MIRC), Department of Electrical Engineering, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Patricio Astudillo
- Department of Electronics and information systems, UGent - imec, Technologiepark 126, Zwijnaarde, 9052, Belgium
| | - Dirk Vandermeulen
- Medical Imaging Research Center (MIRC), Department of Electrical Engineering, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| |
Collapse
|
8
|
New Data-Driven Gated PET/CT Free of Misregistration Artifacts. Int J Radiat Oncol Biol Phys 2021; 109:1638-1646. [PMID: 33186619 DOI: 10.1016/j.ijrobp.2020.11.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 10/30/2020] [Accepted: 11/05/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE We developed a new data-driven gated (DDG) positron emission tomography (PET)/computed tomography (CT) to improve the registration of CT and DDG PET. METHODS We acquired 10 repeat PET/CT and 35 cine CT scans for the mitigation of misregistration between CT and PET data. We also derived end-expiration phase CT as DDG CT for attenuation correction of DDG PET. Radiation exposure, body mass index (BMI), scan coverage, and effective radiation dose were compared between repeat PET/CT and cine CT. Of the 35 cine CT patients, 14 (capturing 59 total tumors) were compared among average PET/CT (baseline PET attenuation correction by average CT), DDG PET (DDG PET attenuation correction by baseline CT), and DDG PET/CT (DDG PET attenuation correction by DDG CT) for registration and quantification without increasing the scan time for DDG PET. RESULTS Compared with repeat PET/CT, cine CT had significantly lower scan coverage (32.5 ± 11.5 cm vs 15.4 ± 4.7 cm; P < .001) and effective radiation dose (3.7 ± 2.6 mSv vs 1.3 ± 0.6 mSv; P < .01). Repeat PET/CT and cine CT did not differ significantly in BMI or radiation exposure (P > .1). Cine CT saved the scan time for not needing a repeat PET. The SUV ratios of average PET/CT, DDG PET, and DDG PET/CT to baseline PET/CT were 1.14 ± 0.28, 1.28 ± 0.20, and 1.63 ± 0.64, respectively (P < .0001), suggesting that the SUVmax increased consecutively from baseline PET/CT to average PET/CT, DDG PET, and DDG PET/CT. Motion correction with DDG PET had a larger impact on quantification than registration improvement with average CT did. The biggest improvement in quantification was from DDG PET/CT, in which both registration was improved and motion was mitigated. CONCLUSION Our new DDG PET/CT approach alleviates misregistration artifacts and, compared with DDG PET, improves quantification and registration. The use of cine CT in our DDG PET/CT method also reduces the effective radiation dose and scan coverage compared with repeat CT.
Collapse
|
9
|
Czerska K, Emert F, Kopec R, Langen K, McClelland JR, Meijers A, Miyamoto N, Riboldi M, Shimizu S, Terunuma T, Zou W, Knopf A, Rucinski A. Clinical practice vs. state-of-the-art research and future visions: Report on the 4D treatment planning workshop for particle therapy - Edition 2018 and 2019. Phys Med 2021; 82:54-63. [PMID: 33588228 DOI: 10.1016/j.ejmp.2020.12.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 12/09/2020] [Accepted: 12/16/2020] [Indexed: 12/18/2022] Open
Abstract
The 4D Treatment Planning Workshop for Particle Therapy, a workshop dedicated to the treatment of moving targets with scanned particle beams, started in 2009 and since then has been organized annually. The mission of the workshop is to create an informal ground for clinical medical physicists, medical physics researchers and medical doctors interested in the development of the 4D technology, protocols and their translation into clinical practice. The 10th and 11th editions of the workshop took place in Sapporo, Japan in 2018 and Krakow, Poland in 2019, respectively. This review report from the Sapporo and Krakow workshops is structured in two parts, according to the workshop programs. The first part comprises clinicians and physicists review of the status of 4D clinical implementations. Corresponding talks were given by speakers from five centers around the world: Maastro Clinic (The Netherlands), University Medical Center Groningen (The Netherlands), MD Anderson Cancer Center (United States), University of Pennsylvania (United States) and The Proton Beam Therapy Center of Hokkaido University Hospital (Japan). The second part is dedicated to novelties in 4D research, i.e. motion modelling, artificial intelligence and new technologies which are currently being investigated in the radiotherapy field.
Collapse
Affiliation(s)
- Katarzyna Czerska
- Institute of Nuclear Physics Polish Academy of Sciences, PL-31342 Krakow, Poland.
| | - Frank Emert
- Center for Proton Therapy, Paul Scherrer Institute, Switzerland
| | - Renata Kopec
- Institute of Nuclear Physics Polish Academy of Sciences, PL-31342 Krakow, Poland
| | - Katja Langen
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Jamie R McClelland
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Arturs Meijers
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Naoki Miyamoto
- Department of Medical Physics, Hokkaido University Hospital, Sapporo, Hokkaido, Japan; Faculty of Engineering, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Marco Riboldi
- Department of Medical Physics, Ludwig-Maximilians-Universität München, Germany
| | - Shinichi Shimizu
- Department of Medical Physics, Hokkaido University Hospital, Sapporo, Hokkaido, Japan; Department of Radiation Medical Science and Engineering, Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Toshiyuki Terunuma
- Faculty of Medicine, University of Tsukuba, Japan; Proton Medical Research Center, University of Tsukuba Hospital, Japan
| | - Wei Zou
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Antje Knopf
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Antoni Rucinski
- Institute of Nuclear Physics Polish Academy of Sciences, PL-31342 Krakow, Poland
| |
Collapse
|
10
|
Sande EPS, Acosta Roa AM, Hellebust TP. Dose deviations induced by respiratory motion for radiotherapy of lung tumors: Impact of CT reconstruction, plan complexity, and fraction size. J Appl Clin Med Phys 2020; 21:68-79. [PMID: 32166850 PMCID: PMC7170288 DOI: 10.1002/acm2.12847] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 02/03/2020] [Accepted: 02/08/2020] [Indexed: 11/11/2022] Open
Abstract
A thorax phantom was used to assess radiotherapy dose deviations induced by respiratory motion of the target volume. Both intensity modulated and static, non‐modulated treatment plans were planned on CT scans of the phantom. The plans were optimized using various CT reconstructions, to investigate whether they had an impact on robustness to target motion during delivery. During irradiation, the target was programmed to simulate respiration‐induced motion of a lung tumor, using both patient‐specific and sinusoidal motion patterns in three dimensions. Dose was measured in the center of the target using an ion chamber. Differences between reference measurements with a stationary target and dynamic measurements were assessed. Possible correlations between plan complexity metrics and measured dose deviations were investigated. The maximum observed motion‐induced dose differences were 7.8% and 4.5% for single 2 Gy and 15 Gy fractions, respectively. The measurements performed with the largest target motion amplitude in the superior–inferior direction yielded the largest dosimetric deviations. For 2 Gy fractionation schemes, the summed dose deviation after 33 fractions is likely to be less than 2%. Measured motion‐induced dose deviations were significantly larger for one CT reconstruction compared to all the others. Static, non‐modulated plans showed superior robustness to target motion during delivery. Moderate correlations between the modulation complexity score applied to VMAT (MCSv) and measured dose deviations were found for 15 Gy SBRT treatment plans. Correlations between other plan complexity metrics and measured dose deviations were not found.
Collapse
Affiliation(s)
- Erlend P S Sande
- Department of Medical Physics, Oslo University Hospital, Oslo, Norway
| | - Ana M Acosta Roa
- Department of Medical Physics, Oslo University Hospital, Oslo, Norway
| | - Taran P Hellebust
- Department of Medical Physics, Oslo University Hospital, Oslo, Norway.,Department of Physics, University of Oslo, Oslo, Norway
| |
Collapse
|
11
|
Yan Y, Lu Z, Liu Z, Luo W, Shao S, Tan L, Ma X, Liu J, Drokow EK, Ren J. Dosimetric comparison between three- and four-dimensional computerised tomography radiotherapy for breast cancer. Oncol Lett 2019; 18:1800-1814. [PMID: 31423248 PMCID: PMC6607180 DOI: 10.3892/ol.2019.10467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 04/12/2019] [Indexed: 02/07/2023] Open
Abstract
At present, methods of radiotherapy simulation for breast cancer based on four-dimensional computerised tomography (4D-CT) or three-dimensional CT (3D-CT) simulation remain controversial. In the present study, 7 patients with residual breast tissue received whole breast radiotherapy based on 3D-CT and 4D-CT simulation. For the 4D-CT plan, four types of CT images were produced, including images of the end of inspiration and the end of expiration, and images acquired by the maximal intensity projection (MIP) and average intensity projection (AIP). In the 3D-CT plan, the clinical target volume (CTV) and plan target volume (PTV) were marginally higher compared with the 4D-CT plan. In addition, the minimum point dose of the target volume (Dmin), the maximum point dose of the target volume (Dmax) and the mean point dose of the target volume (Dmean) of the CTV and PTV in the MIP and AIP plans were marginally higher compared with the 3D-CT plan. For the contralateral breast (C-B), volumes of the 4D-CT plan were markedly lower compared with the 3D-CT plan. Furthermore, Dmin, Dmax and Dmean of the 3D-CT plan were higher compared with the AIP and MIP plans. For the ipsilateral lungs (I-L), volumes of the 3D-CT and AIP plans were higher compared with the MIP plan. Furthermore, when breast lesions were on the left side, for the heart, the volume receiving no less than 40% of the prescription dose (V40) and the volume receiving no less than 30% of the prescription dose (V30) of the MIP and AIP plans were slightly lower compared with those of the 3D plan. In conclusion, 4D-CT radiotherapy based on the MIP and AIP plans provides a slightly smaller radiation area and slightly higher radiotherapy dosage of the CTV and PTV compared with 3D-CT radiotherapy for breast radiotherapy. Therefore, the MIP and AIP plans prevent C-B radiation exposure and improve sparing of the heart and I-L.
Collapse
Affiliation(s)
- Yanli Yan
- Department of Radiotherapy, Oncology Department, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Zhou Lu
- Department of Radiotherapy, Oncology Department, Xi'an Gaoxin Hospital, Xi'an, Shaanxi 710075, P.R. China
| | - Zi Liu
- Department of Radiotherapy, Oncology Department, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Wei Luo
- Department of Radiotherapy, Oncology Department, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Shuai Shao
- Department of Radiotherapy, Oncology Department, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Li Tan
- Department of Radiotherapy, Oncology Department, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Xiaowei Ma
- Department of Radiotherapy, Oncology Department, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Jiaxin Liu
- Department of Radiotherapy, Oncology Department, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Emmanuel Kwateng Drokow
- Department of Radiotherapy, Oncology Department, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Juan Ren
- Department of Radiotherapy, Oncology Department, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| |
Collapse
|
12
|
Jin P, Machiels M, Crama KF, Visser J, van Wieringen N, Bel A, Hulshof MCCM, Alderliesten T. Dosimetric Benefits of Midposition Compared With Internal Target Volume Strategy for Esophageal Cancer Radiation Therapy. Int J Radiat Oncol Biol Phys 2019; 103:491-502. [PMID: 30253234 DOI: 10.1016/j.ijrobp.2018.09.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 09/07/2018] [Accepted: 09/18/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE Both midposition (MidP) and internal target volume (ITV) strategies can take the respiration-induced target motion into account. This study aimed to compare these 2 strategies in terms of clinical target volume (CTV) coverage and dose to organs at risk (OARs) for esophageal cancer radiation therapy (RT). METHODS AND MATERIALS Fifteen patients with esophageal cancer were included retrospectively for neoadjuvant RT planning. Per patient, a 10-phase, 4-dimensional (4D) computed tomography (CT) scan (4D-CT) was acquired with CTV and OARs delineated on the 20% phase. The MidP-CT scan was reconstructed based on deformable image registration between the 20% phase and the other 9 phases; thereby, the CTV and OARs delineations were propagated and an ITV was constructed. Both MidP and ITV strategies were used for treatment planning, yielding the planned dose. Next, these plans were applied to the 10-phase 4D-CT to calculate the dose distribution for each phase of the 4D-CT. On the basis of the deformable image registration, these calculated dose distributions were warped and averaged to yield the accumulated 4D dose. Subsequently, we compared, in terms of CTV coverage and dose to OARs, the planned dose with the accumulated 4D dose and the MidP strategy with the ITV strategy. RESULTS The differences between the planned dose and the accumulated 4D dose were limited and clinically irrelevant. In 14 patients, both MidP and ITV strategies showed V95% > 98% for the CTV. Compared with the ITV strategy, the MidP strategy showed a significant reduction of approximately 10% in the dose-volume histogram parameters for the lungs, heart, and liver (P < .001, Wilcoxon signed-rank test). CONCLUSIONS Compared with the ITV strategy, the MidP strategy in treatment planning can lead to a reduction of approximately 10% in the dose to OARs, with an adequate CTV coverage for esophageal cancer RT.
Collapse
Affiliation(s)
- Peng Jin
- Department of Radiation Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands.
| | - Mélanie Machiels
- Department of Radiation Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Koen F Crama
- Department of Radiation Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Jorrit Visser
- Department of Radiation Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Niek van Wieringen
- Department of Radiation Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Arjan Bel
- Department of Radiation Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Maarten C C M Hulshof
- Department of Radiation Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Tanja Alderliesten
- Department of Radiation Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| |
Collapse
|