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Zhang X, Yan D, Xiao H, Zhong R. Modeling of artificial intelligence-based respiratory motion prediction in MRI-guided radiotherapy: a review. Radiat Oncol 2024; 19:140. [PMID: 39380013 PMCID: PMC11463122 DOI: 10.1186/s13014-024-02532-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2024] [Accepted: 09/26/2024] [Indexed: 10/10/2024] Open
Abstract
The advancement of precision radiotherapy techniques, such as volumetric modulated arc therapy (VMAT), stereotactic body radiotherapy (SBRT), and particle therapy, highlights the importance of radiotherapy in the treatment of cancer, while also posing challenges for respiratory motion management in thoracic and abdominal tumors. MRI-guided radiotherapy (MRIgRT) stands out as state-of-art real-time respiratory motion management approach owing to the non-ionizing radiation nature and superior soft-tissue contrast characteristic of MR imaging. In clinical practice, MR imaging often operates at a frequency of 4 Hz, resulting in approximately a 300 ms system latency of MRIgRT. This system latency decreases the accuracy of respiratory motion management in MRIgRT. Artificial intelligence (AI)-based respiratory motion prediction has recently emerged as a promising solution to address the system latency issues in MRIgRT, particularly for advanced contour prediction and volumetric prediction. However, implementing AI-based respiratory motion prediction faces several challenges including the collection of training datasets, the selection of prediction methods, and the formulation of complex contour and volumetric prediction problems. This review presents modeling approaches of AI-based respiratory motion prediction in MRIgRT, and provides recommendations for achieving consistent and generalizable results in this field.
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Affiliation(s)
- Xiangbin Zhang
- Radiotherapy Physics and Technology Center, Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041, P.R. China
| | - Di Yan
- Radiotherapy Physics and Technology Center, Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041, P.R. China
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, USA
| | - Haonan Xiao
- Department of Radiation Oncology and Physics, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
- Shandong Provincial Key Medical and Health Laboratory of Pediatric Cancer Precision Radiotherapy, Jinan, China
| | - Renming Zhong
- Radiotherapy Physics and Technology Center, Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041, P.R. China.
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Dunn A, Wagner S, Sussman D. Scoping review of magnetic resonance motion imaging phantoms. MAGMA (NEW YORK, N.Y.) 2024; 37:791-805. [PMID: 38739218 DOI: 10.1007/s10334-024-01164-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 03/28/2024] [Accepted: 04/29/2024] [Indexed: 05/14/2024]
Abstract
To review and analyze the currently available MRI motion phantoms. Publications were collected from the Toronto Metropolitan University Library, PubMed, and IEEE Xplore. Phantoms were categorized based on the motions they generated: linear/cartesian, cardiac-dilative, lung-dilative, rotational, deformation or rolling. Metrics were extracted from each publication to assess the motion mechanisms, construction methods, as well as phantom validation. A total of 60 publications were reviewed, identifying 48 unique motion phantoms. Translational movement was the most common movement (used in 38% of phantoms), followed by cardiac-dilative (27%) movement and rotational movement (23%). The average degrees of freedom for all phantoms were determined to be 1.42. Motion phantom publications lack quantification of their impact on signal-to-noise ratio through standardized testing. At present, there is a lack of phantoms that are designed for multi-role as many currently have few degrees of freedom.
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Affiliation(s)
- Alexander Dunn
- Department of Electrical, Computer, and Biomedical Engineering, Toronto Metropolitan University, Toronto, Canada
- Institute for Biomedical Engineering, Science and Technology (iBEST) at Toronto Metropolitan University and St. Michael's Hospital, Toronto, Canada
| | - Sophie Wagner
- Department of Electrical, Computer, and Biomedical Engineering, Toronto Metropolitan University, Toronto, Canada
- Institute for Biomedical Engineering, Science and Technology (iBEST) at Toronto Metropolitan University and St. Michael's Hospital, Toronto, Canada
| | - Dafna Sussman
- Department of Electrical, Computer, and Biomedical Engineering, Toronto Metropolitan University, Toronto, Canada.
- Institute for Biomedical Engineering, Science and Technology (iBEST) at Toronto Metropolitan University and St. Michael's Hospital, Toronto, Canada.
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada.
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3
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Keenan KE, Jordanova KV, Ogier SE, Tamada D, Bruhwiler N, Starekova J, Riek J, McCracken PJ, Hernando D. Phantoms for Quantitative Body MRI: a review and discussion of the phantom value. MAGMA (NEW YORK, N.Y.) 2024; 37:535-549. [PMID: 38896407 PMCID: PMC11417080 DOI: 10.1007/s10334-024-01181-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 05/18/2024] [Accepted: 06/11/2024] [Indexed: 06/21/2024]
Abstract
In this paper, we review the value of phantoms for body MRI in the context of their uses for quantitative MRI methods research, clinical trials, and clinical imaging. Certain uses of phantoms are common throughout the body MRI community, including measuring bias, assessing reproducibility, and training. In addition to these uses, phantoms in body MRI methods research are used for novel methods development and the design of motion compensation and mitigation techniques. For clinical trials, phantoms are an essential part of quality management strategies, facilitating the conduct of ethically sound, reliable, and regulatorily compliant clinical research of both novel MRI methods and therapeutic agents. In the clinic, phantoms are used for development of protocols, mitigation of cost, quality control, and radiotherapy. We briefly review phantoms developed for quantitative body MRI, and finally, we review open questions regarding the most effective use of a phantom for body MRI.
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Affiliation(s)
- Kathryn E Keenan
- Physical Measurement Laboratory, National Institute of Standards and Technology, NIST, 325 Broadway, Boulder, CO, 80305, USA.
| | - Kalina V Jordanova
- Physical Measurement Laboratory, National Institute of Standards and Technology, NIST, 325 Broadway, Boulder, CO, 80305, USA
| | - Stephen E Ogier
- Physical Measurement Laboratory, National Institute of Standards and Technology, NIST, 325 Broadway, Boulder, CO, 80305, USA
- Department of Physics, University of Colorado Boulder, Boulder, CO, USA
| | | | - Natalie Bruhwiler
- Physical Measurement Laboratory, National Institute of Standards and Technology, NIST, 325 Broadway, Boulder, CO, 80305, USA
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Wu TC, Smith LM, Woolf D, Faivre-Finn C, Lee P. Exploring the Advantages and Challenges of MR-Guided Radiotherapy in Non-Small-Cell Lung Cancer: Who are the Optimal Candidates? Semin Radiat Oncol 2024; 34:56-63. [PMID: 38105094 DOI: 10.1016/j.semradonc.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
The landscape of lung radiotherapy (RT) has rapidly evolved over the past decade with modern RT and surgical techniques, systemic therapies, and expanding indications for RT. To date, 2 MRI-guided RT (MRgRT) units, 1 using a 0.35T magnet and 1 using a 1.5T magnet, are available for commercial use with more systems in the pipeline. MRgRT offers distinct advantages such as real-time target tracking, margin reduction, and on-table treatment adaptation, which may help overcome many of the common challenges associated with thoracic RT. Nonetheless, the use of MRI for image guidance and the current MRgRT units also have intrinsic limitations. In this review article, we will discuss clinical experiences to date, advantages, challenges, and future directions of MRgRT to the lung.
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Affiliation(s)
- Trudy C Wu
- Department of Radiation Oncology, University of California, Los Angeles, CA
| | - Lauren M Smith
- Department of Radiation Oncology, University of California, Los Angeles, CA
| | - David Woolf
- Radiotherapy Related Research, The Christie NHS Foundation Trust, Manchester, United Kingdom.; Division of Cancer Sciences, The University of Manchester, Manchester, United Kingdom
| | - Corinne Faivre-Finn
- Radiotherapy Related Research, The Christie NHS Foundation Trust, Manchester, United Kingdom.; Division of Cancer Sciences, The University of Manchester, Manchester, United Kingdom
| | - Percy Lee
- Department of Radiation Oncology, City of Hope National Medical Center, Los Angeles, CA..
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Lombardo E, Dhont J, Page D, Garibaldi C, Künzel LA, Hurkmans C, Tijssen RHN, Paganelli C, Liu PZY, Keall PJ, Riboldi M, Kurz C, Landry G, Cusumano D, Fusella M, Placidi L. Real-time motion management in MRI-guided radiotherapy: Current status and AI-enabled prospects. Radiother Oncol 2024; 190:109970. [PMID: 37898437 DOI: 10.1016/j.radonc.2023.109970] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 10/19/2023] [Accepted: 10/22/2023] [Indexed: 10/30/2023]
Abstract
MRI-guided radiotherapy (MRIgRT) is a highly complex treatment modality, allowing adaptation to anatomical changes occurring from one treatment day to the other (inter-fractional), but also to motion occurring during a treatment fraction (intra-fractional). In this vision paper, we describe the different steps of intra-fractional motion management during MRIgRT, from imaging to beam adaptation, and the solutions currently available both clinically and at a research level. Furthermore, considering the latest developments in the literature, a workflow is foreseen in which motion-induced over- and/or under-dosage is compensated in 3D, with minimal impact to the radiotherapy treatment time. Considering the time constraints of real-time adaptation, a particular focus is put on artificial intelligence (AI) solutions as a fast and accurate alternative to conventional algorithms.
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Affiliation(s)
- Elia Lombardo
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Jennifer Dhont
- Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (H.U.B), Institut Jules Bordet, Department of Medical Physics, Brussels, Belgium; Université Libre De Bruxelles (ULB), Radiophysics and MRI Physics Laboratory, Brussels, Belgium
| | - Denis Page
- University of Manchester, Division of Cancer Sciences, Manchester, United Kingdom
| | - Cristina Garibaldi
- IEO, Unit of Radiation Research, European Institute of Oncology IRCCS, Milan, Italy
| | - Luise A Künzel
- National Center for Tumor Diseases (NCT), Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany; Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany
| | - Coen Hurkmans
- Department of Radiation Oncology, Catharina Hospital, Eindhoven, the Netherlands
| | - Rob H N Tijssen
- Department of Radiation Oncology, Catharina Hospital, Eindhoven, the Netherlands
| | - Chiara Paganelli
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milano, Italy
| | - Paul Z Y Liu
- Image X Institute, University of Sydney Central Clinical School, Sydney, NSW, Australia; Department of Medical Physics, Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
| | - Paul J Keall
- Image X Institute, University of Sydney Central Clinical School, Sydney, NSW, Australia; Department of Medical Physics, Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
| | - Marco Riboldi
- Department of Medical Physics, Faculty of Physics, LMU Munich, Munich, Germany
| | - Christopher Kurz
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Guillaume Landry
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany; German Cancer Consortium (DKTK), Partner Site Munich, a Partnership between DKFZ and LMU University Hospital Munich, Germany; Bavarian Cancer Research Center (BZKF), Partner Site Munich, Munich, Germany
| | | | - Marco Fusella
- Department of Radiation Oncology, Abano Terme Hospital, Italy.
| | - Lorenzo Placidi
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
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Dong Y, Hu P, Li X, Liu W, Yan B, Yang F, Ford JC, Portelance L, Yang Y. Dosimetry impact of distinct gating strategies in cine MR image-guided breath-hold pancreatic cancer radiotherapy. J Appl Clin Med Phys 2023; 24:e14078. [PMID: 37335543 PMCID: PMC10562039 DOI: 10.1002/acm2.14078] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 05/12/2023] [Accepted: 06/06/2023] [Indexed: 06/21/2023] Open
Abstract
PURPOSE To investigate the dosimetry effects of different gating strategies in cine magnetic resonance imaging (MRI)-guided breath-hold pancreatic cancer radiotherapy. METHODS Two cine MRI-based gating strategies were investigated: a tumor contour-based gating strategy at a gating threshold of 0-5% and a tumor displacement-based gating strategy at a gating threshold of 3-5 mm. The cine MRI videos were obtained from 17 pancreatic cancer patients who received MRI-guided radiation therapy. We calculated the tumor displacement in each cine MR frame that satisfied the gating threshold and obtained the proportion of frames with different displacements. We generated IMRT and VMAT plans using a 33 Gy prescription, and motion plans were generated by adding up all isocenter-shift plans corresponding to different tumor displacements. The dose parameters of GTV, PTV, and organs at risk (OAR) were compared between the original and motion plans. RESULTS In both gating strategies, the difference was significant in PTV coverage but not in GTV coverage between the original and motion plans. OAR dose parameters deteriorate with increasing gating threshold. The beam duty cycle increased from 19.5±14.3% (median 18.0%) to 60.8±15.6% (61.1%) for gating thresholds from 0% to 5% in tumor contour-based gating and from 51.7±11.5% (49.7%) to 67.3±12.4% (67.1%) for gating thresholds from 3 to 5 mm in tumor displacement-based gating. CONCLUSION In tumor contour-based gating strategy, the dose delivery accuracy deteriorates while the dose delivery efficiency improves with increasing gating thresholds. To ensure treatment efficiency, the gating threshold might be no less than 3%. A threshold up to 5% may be acceptable in terms of the GTV coverage. The displacement-based gating strategy may serve as a potential alternative to the tumor contour based gating strategy, in which the gating threshold of approximately 4 mm might be a good choice for reasonably balancing the dose delivery accuracy and efficiency.
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Affiliation(s)
- Yuyan Dong
- Department of Engineering and Applied PhysicsUniversity of Science and Technology of ChinaHefeiAnhuiChina
| | - Panpan Hu
- Department of Engineering and Applied PhysicsUniversity of Science and Technology of ChinaHefeiAnhuiChina
- Department of Radiation Oncologythe First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of ChinaHefeiAnhuiChina
| | - Xiaoyang Li
- Department of Engineering and Applied PhysicsUniversity of Science and Technology of ChinaHefeiAnhuiChina
- Department of Radiation Oncologythe First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of ChinaHefeiAnhuiChina
| | - Wei Liu
- Department of Radiation Oncologythe First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of ChinaHefeiAnhuiChina
| | - Bing Yan
- Department of Radiation Oncologythe First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of ChinaHefeiAnhuiChina
| | - Fei Yang
- The Miller School of MedicineUniversity of MiamiMiamiFloridaUSA
| | | | | | - Yidong Yang
- Department of Engineering and Applied PhysicsUniversity of Science and Technology of ChinaHefeiAnhuiChina
- Department of Radiation Oncologythe First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of ChinaHefeiAnhuiChina
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7
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Bernchou U, Schytte T, Bertelsen A, Lorenzen EL, Brink C, Mahmood F. Impact of abdominal compression on intra-fractional motion and delivered dose in magnetic resonance image-guided adaptive radiation ablation of adrenal gland metastases. Phys Med 2023; 114:102682. [PMID: 37717398 DOI: 10.1016/j.ejmp.2023.102682] [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: 06/30/2023] [Revised: 08/08/2023] [Accepted: 09/11/2023] [Indexed: 09/19/2023] Open
Abstract
PURPOSE The current study investigated the impact of abdominal compression on motion and the delivered dose during non-gated, magnetic resonance image (MRI)-guided radiation ablation of adrenal gland metastases. METHODS Thirty-one patients with adrenal gland metastases treated to 45-60 Gy in 3-8 fractions on a 1.5 T MRI-linac were included in the study. The patients were breathing freely (n = 14) or with motion restricted by using an abdominal compression belt (n = 17). The time-resolved position of the target in online 2D cine MR images acquired during treatment was assessed and used to estimate the dose delivered to the GTV and abutting luminal organs at risk (OAR). RESULTS The median (range) 3D root-mean-square target position error was significantly higher in patients treated without a compression belt [2.9 (1.9-5.6) mm] compared to patients using the belt [2.1 (1.2-3.5) mm] (P < 0.01). The median (range) GTV V95% was significantly reduced from planned 98.6 (65.9-100) % to delivered 96.5 (64.5-99.9) % due to motion (P < 0.01). Most prominent dose reductions were found in patients showing either large target drift or respiration motion and were mainly treated without abdominal compression. Motion did not lead to an increased number of constraint violations for luminal OAR. CONCLUSIONS Acceptable target coverage and dose to OAR was observed in the vast majority of patients despite intra-fractional motion during adaptive MRI-guided radiation ablation. The use of abdominal compression significantly reduced the target position error and prevented the most prominent target coverage degradations and is, therefore, recommended as motion management at MRI-linacs.
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Affiliation(s)
- Uffe Bernchou
- Laboratory of Radiation Physics, Department of Oncology, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense C, Denmark; Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19 3., 5000 Odense C, Denmark.
| | - Tine Schytte
- Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19 3., 5000 Odense C, Denmark; Department of Oncology, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense C, Denmark.
| | - Anders Bertelsen
- Laboratory of Radiation Physics, Department of Oncology, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense C, Denmark.
| | - Ebbe Laugaard Lorenzen
- Laboratory of Radiation Physics, Department of Oncology, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense C, Denmark.
| | - Carsten Brink
- Laboratory of Radiation Physics, Department of Oncology, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense C, Denmark; Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19 3., 5000 Odense C, Denmark.
| | - Faisal Mahmood
- Laboratory of Radiation Physics, Department of Oncology, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense C, Denmark; Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19 3., 5000 Odense C, Denmark.
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8
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Li Y, Li Z, Zhu J, Li B, Shu H, Ge D. Online prediction for respiratory movement compensation: a patient-specific gating control for MRI-guided radiotherapy. Radiat Oncol 2023; 18:149. [PMID: 37697360 PMCID: PMC10496354 DOI: 10.1186/s13014-023-02341-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 08/31/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND This study aims to validate the effectiveness of linear regression for motion prediction of internal organs or tumors on 2D cine-MR and to present an online gating signal prediction scheme that can improve the accuracy of MR-guided radiotherapy for liver and lung cancer. MATERIALS AND METHODS We collected 2D cine-MR sequences of 21 liver cancer patients and 10 lung cancer patients to develop a binary gating signal prediction algorithm that forecasts the crossing-time of tumor motion traces relative to the target threshold. Both 0.4 s and 0.6 s prediction windows were tested using three linear predictors and three recurrent neural networks (RNNs), given the system delay of 0.5 s. Furthermore, an adaptive linear regression model was evaluated using only the first 30 s as the burn-in period, during which the model parameters were adapted during the online prediction process. The accuracy of the predicted traces was measured using amplitude metrics (MAE, RMSE, and R2), and in addition, we proposed three temporal metrics, namely crossing error, gating error, and gating accuracy, which are more relevant to the nature of the gating signals. RESULTS In both 0.6 s and 0.4 s prediction cases, linear regression outperformed other methods, demonstrating significantly smaller amplitude errors compared to the RNNs (P < 0.05). The proposed algorithm with adaptive linear regression had the best performance with an average gating accuracy of 98.3% and 98.0%, a gating error of 44 ms and 45 ms, for liver cancer and lung cancer patients, respectively. CONCLUSION A functional online gating control scheme was developed with an adaptive linear regression that is both more cost-efficient and accurate than sophisticated RNN based methods in all studied metrics.
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Affiliation(s)
- Yang Li
- Laboratory of Image Science and Technology, School of Computer Science and Engineering, Southeast University, Nanjing, 210096, Jiangsu, People's Republic of China
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117, Shandong, People's Republic of China
- L.T.S.I., Inserm UMR 1099 - Université de Rennes, Campus de Beaulieu - Bat. 22, 35042, Rennes, France
- Jiangsu Provincial Joint International Research Laboratory of Medical Information Processing, Centre de Recherche en Information Biomédicale, Sino-Français (CRIBs), Rennes, France
| | - Zhenjiang Li
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117, Shandong, People's Republic of China
| | - Jian Zhu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117, Shandong, People's Republic of China
| | - Baosheng Li
- Laboratory of Image Science and Technology, School of Computer Science and Engineering, Southeast University, Nanjing, 210096, Jiangsu, People's Republic of China.
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117, Shandong, People's Republic of China.
| | - Huazhong Shu
- Laboratory of Image Science and Technology, School of Computer Science and Engineering, Southeast University, Nanjing, 210096, Jiangsu, People's Republic of China.
- Jiangsu Provincial Joint International Research Laboratory of Medical Information Processing, Centre de Recherche en Information Biomédicale, Sino-Français (CRIBs), Rennes, France.
| | - Di Ge
- L.T.S.I., Inserm UMR 1099 - Université de Rennes, Campus de Beaulieu - Bat. 22, 35042, Rennes, France.
- Jiangsu Provincial Joint International Research Laboratory of Medical Information Processing, Centre de Recherche en Information Biomédicale, Sino-Français (CRIBs), Rennes, France.
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Klavsen MF, Ankjærgaard C, Boye K, Behrens CP, Vogelius IR, Ehrbar S, Baumgartl M, Rippke C, Buchele C, Renkamp CK, Santurio GV, Andersen CE. Accumulated dose implications from systematic dose-rate transients in gated treatments with Viewray MRIdian accelerators. Biomed Phys Eng Express 2023; 9:065001. [PMID: 37591227 DOI: 10.1088/2057-1976/acf138] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 08/17/2023] [Indexed: 08/19/2023]
Abstract
The combination of magnetic resonance (MR) imaging and linear accelerators (linacs) into MR-Linacs enables continuous MR imaging and advanced gated treatments of patients. Previously, a dose-rate transient (∼8% reduced dose rate during the initial 0.5 s of each beam) was identified for a Viewray MRIdian MR-Linac (Klavsenet al2022Radiation Measurement106759). Here, the dose-rate transient is studied in more detail at four linacs of the same type at different hospitals. The implications of dose-rate transients were examined for gated treatments. The dose-rate transients were investigated using dose-per pulse measurements with organic plastic scintillators in three experiments: (i) A gated treatment with the scintillator placed in a moving target in a dynamic phantom, (ii) a gated treatment with the same dynamic conditions but with the scintillator placed in a stationary target, and (iii) measurements in a water-equivalent material to examine beam quality deviations at a dose-per-pulse basis. Gated treatments (i) compared with non-gated treatments with a static target in the same setup showed a broadening of accumulated dose profiles due to motion (dose smearing). The linac with the largest dose-rate transient had a reduced accumulated dose of up to (3.1 ± 0.65) % in the center of the PTV due to the combined dose smearing and dose-rate transient effect. Dose-rate transients were found to vary between different machines. Two MR-Linacs showed initial dose-rate transients that could not be identified from conventional linearity tests. The source of the transients includes an initial change in photon fluence rate and an initial change in x-ray beam quality. For gated treatments, this caused a reduction of more than 1% dose delivered at the central part of the beam for the studied, cyclic-motion treatment plan. Quality assurance of this effect should be considered when gated treatment with the Viewray MRIdian is implemented clinically.
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Affiliation(s)
- M F Klavsen
- DTU Health Tech, Technical University of Denmark, Roskilde, Denmark
| | - C Ankjærgaard
- DTU Health Tech, Technical University of Denmark, Roskilde, Denmark
| | - K Boye
- Dept. of Oncology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - C P Behrens
- DTU Health Tech, Technical University of Denmark, Roskilde, Denmark
- Dept. of Oncology, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark
| | - I R Vogelius
- Dept. of Oncology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen- Copenhagen, Denmark
| | - S Ehrbar
- Dept. of Radiation Oncology, University Hospital Zürich and University of Zürich, Zürich, Switzerland
| | - M Baumgartl
- Dept. of Radiation Oncology, University Hospital Zürich and University of Zürich, Zürich, Switzerland
| | - C Rippke
- Dept. of Oncology, University Hospital Heidelberg, Heidelberg, Germany
| | - C Buchele
- Dept. of Oncology, University Hospital Heidelberg, Heidelberg, Germany
| | - C K Renkamp
- Dept. of Oncology, University Hospital Heidelberg, Heidelberg, Germany
| | - G V Santurio
- Dept. of Oncology, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark
| | - C E Andersen
- DTU Health Tech, Technical University of Denmark, Roskilde, Denmark
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10
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Price AT, Schiff JP, Laugeman E, Maraghechi B, Schmidt M, Zhu T, Reynoso F, Hao Y, Kim T, Morris E, Zhao X, Hugo GD, Vlacich G, DeSelm CJ, Samson PP, Baumann BC, Badiyan SN, Robinson CG, Kim H, Henke LE. Initial clinical experience building a dual CT- and MR-guided adaptive radiotherapy program. Clin Transl Radiat Oncol 2023; 42:100661. [PMID: 37529627 PMCID: PMC10388162 DOI: 10.1016/j.ctro.2023.100661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 06/12/2023] [Accepted: 07/20/2023] [Indexed: 08/03/2023] Open
Abstract
Introduction Our institution was the first in the world to clinically implement MR-guided adaptive radiotherapy (MRgART) in 2014. In 2021, we installed a CT-guided adaptive radiotherapy (CTgART) unit, becoming one of the first clinics in the world to build a dual-modality ART clinic. Herein we review factors that lead to the development of a high-volume dual-modality ART program and treatment census over an initial, one-year period. Materials and Methods The clinical adaptive service at our institution is enabled with both MRgART (MRIdian, ViewRay, Inc, Mountain View, CA) and CTgART (ETHOS, Varian Medical Systems, Palo Alto, CA) platforms. We analyzed patient and treatment information including disease sites treated, radiation dose and fractionation, and treatment times for patients on these two platforms. Additionally, we reviewed our institutional workflow for creating, verifying, and implementing a new adaptive workflow on either platform. Results From October 2021 to September 2022, 256 patients were treated with adaptive intent at our institution, 186 with MRgART and 70 with CTgART. The majority (106/186) of patients treated with MRgART had pancreatic cancer, and the most common sites treated with CTgART were pelvis (23/70) and abdomen (20/70). 93.0% of treatments on the MRgART platform were stereotactic body radiotherapy (SBRT), whereas only 72.9% of treatments on the CTgART platform were SBRT. Abdominal gated cases were allotted a longer time on the CTgART platform compared to the MRgART platform, whereas pelvic cases were allotted a shorter time on the CTgART platform when compared to the MRgART platform. Our adaptive implementation technique has led to six open clinical trials using MRgART and seven using CTgART. Conclusions We demonstrate the successful development of a dual platform ART program in our clinic. Ongoing efforts are needed to continue the development and integration of ART across platforms and disease sites to maximize access and evidence for this technique worldwide.
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Affiliation(s)
- Alex T. Price
- University Hospitals/Case Western Reserve University, Department of Radiation Oncology, Cleveland, OH, USA
| | - Joshua P. Schiff
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO, USA
| | - Eric Laugeman
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO, USA
| | - Borna Maraghechi
- City of Hope Orange County, Department of Radiation Oncology, Irvine, CA, USA
| | - Matthew Schmidt
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO, USA
| | - Tong Zhu
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO, USA
| | - Francisco Reynoso
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO, USA
| | - Yao Hao
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO, USA
| | - Taeho Kim
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO, USA
| | - Eric Morris
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO, USA
| | - Xiaodong Zhao
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO, USA
| | - Geoffrey D. Hugo
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO, USA
| | - Gregory Vlacich
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO, USA
| | - Carl J. DeSelm
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO, USA
| | - Pamela P. Samson
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO, USA
| | - Brian C. Baumann
- Springfield Clinic, Department of Radiation Oncology, Springfield, IL, USA
| | - Shahed N. Badiyan
- University of Texas Southwestern Medical Center, Department of Radiation Oncology, Dallas, TX, USA
| | - Clifford G. Robinson
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO, USA
| | - Hyun Kim
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO, USA
| | - Lauren E. Henke
- University Hospitals/Case Western Reserve University, Department of Radiation Oncology, Cleveland, OH, USA
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11
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Nakayama H, Okamoto H, Nakamura S, Iijima K, Chiba T, Takemori M, Nakaichi T, Mikasa S, Fujii K, Sakasai T, Kuwahara J, Miura Y, Fujiyama D, Tsunoda Y, Hanzawa T, Igaki H, Chang W. Film measurement and analytical approach for assessing treatment accuracy and latency in a magnetic resonance-guided radiotherapy system. J Appl Clin Med Phys 2023; 24:e13915. [PMID: 36934441 PMCID: PMC10161048 DOI: 10.1002/acm2.13915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 11/25/2022] [Accepted: 01/12/2023] [Indexed: 03/20/2023] Open
Abstract
PURPOSE We measure the dose distribution of gated delivery for different target motions and estimate the gating latency in a magnetic resonance-guided radiotherapy (MRgRT) system. METHOD The dose distribution accuracy of the gated MRgRT system (MRIdian, Viewray) was investigated using an in-house-developed phantom that was compatible with the magnetic field and gating method. This phantom contains a simulated tumor and a radiochromic film (EBT3, Ashland, Inc.). To investigate the effect of the number of beam switching and target velocity on the dose distribution, two types of target motions were applied. One is that the target was periodically moved at a constant velocity of 5 mm/s with different pause times (0, 1, 3, 10, and 20 s) between the motions. During different pause times, different numbers of beams were switched on/off. The other one is that the target was moved at velocities of 3, 5, 8, and 10 mm/s without any pause (i.e., continuous motion). The gated method was applied to these motions at MRIdian, and the dose distributions in each condition were measured using films. To investigate the relation between target motion and dose distribution in the gating method, we compared the results of the gamma analysis of the calculated and measured dose distributions. Moreover, we analytically estimated the gating latencies from the dose distributions measured using films and the gamma analysis results. RESULTS The gamma pass rate linearly decreased with increasing beam switching and target velocity. The overall gating latencies of beam-hold and beam-on were 0.51 ± 0.17 and 0.35 ± 0.05 s, respectively. CONCLUSIONS Film measurements highlighted the factors affecting the treatment accuracy of the gated MRgRT system. Our analytical approach, employing gamma analysis on films, can be used to estimate the overall latency of the gated MRgRT system.
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Affiliation(s)
- Hiroki Nakayama
- Radiation Safety and Quality Assurance Division, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan.,Department of Radiological Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Higashioku, Arakawa-ku, Tokyo, Japan
| | - Hiroyuki Okamoto
- Radiation Safety and Quality Assurance Division, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Satoshi Nakamura
- Radiation Safety and Quality Assurance Division, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Kotaro Iijima
- Radiation Safety and Quality Assurance Division, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Takahito Chiba
- Radiation Safety and Quality Assurance Division, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan.,Department of Radiological Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Higashioku, Arakawa-ku, Tokyo, Japan
| | - Mihiro Takemori
- Radiation Safety and Quality Assurance Division, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan.,Department of Radiological Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Higashioku, Arakawa-ku, Tokyo, Japan
| | - Tetsu Nakaichi
- Radiation Safety and Quality Assurance Division, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Shohei Mikasa
- Radiation Safety and Quality Assurance Division, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Kyohei Fujii
- Department of Radiation Sciences, Komazawa University, Setagaya-ku, Tokyo, Japan
| | - Tatsuya Sakasai
- Department of Radiological Technology, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Junichi Kuwahara
- Radiation Safety and Quality Assurance Division, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan.,Department of Radiological Technology, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Yuki Miura
- Department of Radiological Technology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Daisuke Fujiyama
- Department of Radiological Technology, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Yuki Tsunoda
- Department of Radiological Technology, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Takuma Hanzawa
- Department of Radiological Technology, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Hiroshi Igaki
- Department of Radiation Oncology, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Weishan Chang
- Department of Radiological Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Higashioku, Arakawa-ku, Tokyo, Japan
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12
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Price AT, Schiff JP, Zhu T, Mazur T, Kavanaugh JA, Maraghechi B, Green O, Kim H, Spraker MB, Henke LE. First treatments for Lattice stereotactic body radiation therapy using magnetic resonance image guided radiation therapy. Clin Transl Radiat Oncol 2023; 39:100577. [PMID: 36718251 PMCID: PMC9883196 DOI: 10.1016/j.ctro.2023.100577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 12/29/2022] [Accepted: 01/04/2023] [Indexed: 01/09/2023] Open
Abstract
Two abdominal patients were treated with Lattice stereotactic body radiation therapy (SBRT) using magnetic resonance guided radiation therapy (MRgRT). This is one of the first reported treatments of Lattice SBRT with the use of MRgRT. A description of the treatment approach and planning considerations were incorporated into this report. MRgRT Lattice SBRT delivered similar planning quality metrics to established dosimetric parameters for Lattice SBRT. Increased signal intensity were seen in the MRI treatments for one of the patients during the course of treatment.
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Affiliation(s)
- Alex T. Price
- Department of Radiation Oncology, University Hospitals, Cleveland, OH, USA
- Corresponding author.
| | - Joshua P. Schiff
- Department of Radiation Oncology, Washington University in St Louis School of Medicine, St. Louis, MO, USA
| | - Tong Zhu
- Department of Radiation Oncology, Washington University in St Louis School of Medicine, St. Louis, MO, USA
| | - Thomas Mazur
- Department of Radiation Oncology, Washington University in St Louis School of Medicine, St. Louis, MO, USA
| | | | - Borna Maraghechi
- Department of Radiation Oncology, Washington University in St Louis School of Medicine, St. Louis, MO, USA
| | - Olga Green
- Varian Medical Systems, Inc., Palo Alto, CA, USA
| | - Hyun Kim
- Department of Radiation Oncology, Washington University in St Louis School of Medicine, St. Louis, MO, USA
| | | | - Lauren E. Henke
- Department of Radiation Oncology, University Hospitals, Cleveland, OH, USA
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13
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Charters JA, Abdulkadir Y, O'Connell D, Yang Y, Lamb JM. Dosimetric evaluation of respiratory gating on a 0.35-T magnetic resonance-guided radiotherapy linac. J Appl Clin Med Phys 2022; 23:e13666. [PMID: 35950272 PMCID: PMC9815517 DOI: 10.1002/acm2.13666] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 05/13/2022] [Accepted: 05/16/2022] [Indexed: 01/11/2023] Open
Abstract
PURPOSE The commercial 0.35-T magnetic resonance imaging (MRI)-guided radiotherapy vendor ViewRay recently introduced upgraded real-time imaging frame rates based on compressed sensing techniques. Furthermore, additional motion tracking algorithms were made available. Compressed sensing allows for increased image frame rates but may compromise image quality. To assess the impact of this upgrade on respiratory gating accuracy, we evaluated gated dose distributions pre- and post-upgrade using a motion phantom and radiochromic film. METHODS Seven motion waveforms (four artificial, two patient-derived free-breathing, and one breath-holding) were used to drive an MRI-compatible motion phantom. A treatment plan was developed to deliver a 3-cm diameter spherical dose distribution typical of a stereotactic body radiotherapy plan. Gating was performed using 4-frames per second (fps) imaging pre-upgrade on the "default" tracking algorithm and 8-fps post-upgrade using the "small mobile targets" (SMT) and "large deforming targets" (LDT) tracking algorithms. Radiochromic film was placed in a moving insert within the phantom to measure dose. The planned and delivered dose distributions were compared using the gamma index with 3%/3-mm criteria. Dose-area histograms were produced to calculate the dose to 95% (D95) of the sphere planning target volume (PTV) and two simulated gross tumor volumes formed by contracting the PTV by 3 and 5 mm, respectively. RESULTS Gamma pass rates ranged from 18% to 93% over the 21 combinations of breathing trace and gating conditions examined. D95 ranged from 206 to 514 cGy. On average, the LDT algorithm yielded lower gamma and D95 values than the default and SMT algorithms. CONCLUSION Respiratory gating at 8 fps with the new tracking algorithms provides similar gating performance to the original algorithm with 4 fps, although the LDT algorithm had lower accuracy for our non-deformable target. This indicates that the choice of deformable image registration algorithm should be chosen deliberately based on whether the target is rigid or deforming.
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Affiliation(s)
- John A. Charters
- Department of Radiation OncologyDavid Geffen School of Medicine at UCLAUniversity of CaliforniaLos AngelesLos AngelesCaliforniaUSA
| | - Yasin Abdulkadir
- Department of Radiation OncologyDavid Geffen School of Medicine at UCLAUniversity of CaliforniaLos AngelesLos AngelesCaliforniaUSA
| | - Dylan O'Connell
- Department of Radiation OncologyDavid Geffen School of Medicine at UCLAUniversity of CaliforniaLos AngelesLos AngelesCaliforniaUSA
| | - Yingli Yang
- Department of Radiation OncologyDavid Geffen School of Medicine at UCLAUniversity of CaliforniaLos AngelesLos AngelesCaliforniaUSA
| | - James M. Lamb
- Department of Radiation OncologyDavid Geffen School of Medicine at UCLAUniversity of CaliforniaLos AngelesLos AngelesCaliforniaUSA
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14
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Ehrbar S, Braga Käser S, Chamberlain M, Krayenbühl J, Wilke L, Mayinger M, Garcia Schüler H, Guckenberger M, Andratschke N, Tanadini-Lang S. MR-guided beam gating: Residual motion, gating efficiency and dose reconstruction for stereotactic treatments of the liver and lung. Radiother Oncol 2022; 174:101-108. [PMID: 35839937 DOI: 10.1016/j.radonc.2022.07.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 06/01/2022] [Accepted: 07/07/2022] [Indexed: 01/10/2023]
Abstract
PURPOSE This study aims to investigate the efficiency and the geometric as well as the dosimetric benefit of magnetic-resonance guided beam gating for stereotactic treatments in moving organs. METHOD Patients treated with MR-guided (MRIdian system) SBRT for lung (n = 10) and liver (n = 10) targets were analyzed. Breath-hold gating was performed based on lesion tracking in sagittal cine MRI images. The target offset from the geometric center of the gating window with and without gating was evaluated. A dose reconstruction workflow based on convolution of these 2D position-probability maps and the daily 3D dose distribution was used to estimate the daily delivered dose including motion. The dose to the clinical target volume (CTV) and to a 2-cm ring structure around the planning target volume were evaluated. RESULTS The applied gating protocol resulted in a mean (±standard deviation) gating efficiency of 55%±16%. Over all patients, the mean target offset (2D-root-mean-square error) was 8.3 ± 4.3 mm, which reduced to 2.4 ± 0.6 mm during gating. The dose reconstruction showed a mean deviation in CTV coverage (D95) from the static plans of -1.7%±1.8% with gating and -12.0%±8.4% if no gating would have been used. The mean dose (Dmean) in the ring structure, with respect to the static plans, showed mean deviations of -0.1%±0.3% with gating and -1.6%±1.8% without gating. CONCLUSION The MRIdian system enables gating based on the inner anatomy and the implemented dose reconstruction workflow demonstrated geometric robust delivery of the planned radiation doses.
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Affiliation(s)
- Stefanie Ehrbar
- Department of Radiation Oncology, University Hospital Zürich and University of Zürich, Zürich, Switzerland.
| | - Sarah Braga Käser
- Department of Radiation Oncology, University Hospital Zürich and University of Zürich, Zürich, Switzerland
| | - Madalyne Chamberlain
- Department of Radiation Oncology, University Hospital Zürich and University of Zürich, Zürich, Switzerland
| | - Jérôme Krayenbühl
- Department of Radiation Oncology, University Hospital Zürich and University of Zürich, Zürich, Switzerland
| | - Lotte Wilke
- Department of Radiation Oncology, University Hospital Zürich and University of Zürich, Zürich, Switzerland
| | - Michael Mayinger
- Department of Radiation Oncology, University Hospital Zürich and University of Zürich, Zürich, Switzerland
| | - Helena Garcia Schüler
- Department of Radiation Oncology, University Hospital Zürich and University of Zürich, Zürich, Switzerland
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zürich and University of Zürich, Zürich, Switzerland
| | - Nicolaus Andratschke
- Department of Radiation Oncology, University Hospital Zürich and University of Zürich, Zürich, Switzerland
| | - Stephanie Tanadini-Lang
- Department of Radiation Oncology, University Hospital Zürich and University of Zürich, Zürich, Switzerland
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15
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Choun HJ, Kim JI, Choi CH, Jung S, Jin H, Wu HG, Chie EK, Park JM. Performance evaluation of a visual guidance patient-controlled respiratory gating system for respiratory-gated magnetic-resonance image-guided radiation therapy. Phys Eng Sci Med 2022; 45:809-816. [PMID: 35723860 DOI: 10.1007/s13246-022-01144-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 05/20/2022] [Accepted: 05/23/2022] [Indexed: 10/18/2022]
Abstract
The performance of a visual guidance patient-controlled (VG-PC) respiratory gating system for magnetic-resonance (MR) image-guided radiation therapy (MR-IGRT) was evaluated through a clinical trial of patients with either lung or liver cancer. Patients can voluntarily control their respiration utilizing the VG-PC respiratory gating system. The system enables patients to view near-real-time cine planar MR images projected inside the bore of MR-IGRT systems or an external screen. Twenty patients who had received stereotactic ablative radiotherapy (SABR) for lung or liver cancer were prospectively selected for this study. Before the first treatment, comprehensive instruction on the VG-PC respiratory gating system was provided to the patients. Respiratory-gated MR-IGRT was performed for each patient with it in the first fraction and then without it in the second fraction. For both the fractions, the total treatment time, beam-off time owing to the respiratory gating, and number of beam-off events were analyzed. The average total treatment time, beam-off time, and number of beam-off events with the system were 1507.3 s, 679.5 s, and 185, respectively, and those without the system were 2023.7 s (p < 0.001), 1195.0 s (p < 0.001), and 380 times (p < 0.001), respectively. The VG-PC respiratory gating system improved treatment efficiency through a reduction in the beam-off time, the number of beam-off events, and consequently the total treatment time when performing respiratory-gated MR-IGRT for lung and liver SABR.
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Affiliation(s)
- Hyung Jin Choun
- Interdisciplinary Program in Bioengineering, Seoul National University, Seoul, Korea.,Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Jung-In Kim
- Department of Radiation Oncology , Seoul National University Hospital, Seoul, Korea.,Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
| | - Chang Heon Choi
- Department of Radiation Oncology , Seoul National University Hospital, Seoul, Korea.,Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
| | - Seongmoon Jung
- Department of Radiation Oncology , Seoul National University Hospital, Seoul, Korea.,Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Hyeongmin Jin
- Department of Radiation Oncology , Seoul National University Hospital, Seoul, Korea.,Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Hong-Gyun Wu
- Department of Radiation Oncology , Seoul National University Hospital, Seoul, Korea.,Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.,Department of Radiation Oncology , Seoul National University College of Medicine, Seoul, Korea
| | - Eui Kyu Chie
- Department of Radiation Oncology , Seoul National University Hospital, Seoul, Korea.,Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.,Department of Radiation Oncology , Seoul National University College of Medicine, Seoul, Korea
| | - Jong Min Park
- Interdisciplinary Program in Bioengineering, Seoul National University, Seoul, Korea. .,Department of Radiation Oncology , Seoul National University Hospital, Seoul, Korea. .,Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea. .,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea. .,Department of Radiation Oncology , Seoul National University College of Medicine, Seoul, Korea. .,Robotics Research Laboratory for Extreme Environments, Advanced Institutes of Convergence Technology, Suwon, Korea.
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16
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Wong OL, Law MWK, Poon DMC, Yung RWH, Yu SK, Cheung KY, Yuan J. A pilot study of respiratory motion characterization in the abdomen using a fast volumetric 4D‐MRI for MR‐guided radiotherapy. PRECISION RADIATION ONCOLOGY 2022. [DOI: 10.1002/pro6.1153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Oi Lei Wong
- Research Department Hong Kong Sanatorium & Hospital, Happy Valley Hong Kong Hong Kong SAR China
| | - Max Wai Kong Law
- Medical Physics Department Hong Kong Sanatorium & Hospital, Happy Valley Hong Kong Hong Kong SAR China
| | - Darren Ming Chun Poon
- Comprehensive Oncology Center Hong Kong Sanatorium & Hospital, Happy Valley Hong Kong Hong Kong SAR China
| | - Raymond Wai Hung Yung
- Research Department Hong Kong Sanatorium & Hospital, Happy Valley Hong Kong Hong Kong SAR China
| | - Siu ki Yu
- Medical Physics Department Hong Kong Sanatorium & Hospital, Happy Valley Hong Kong Hong Kong SAR China
| | - Kin yin Cheung
- Medical Physics Department Hong Kong Sanatorium & Hospital, Happy Valley Hong Kong Hong Kong SAR China
| | - Jing Yuan
- Research Department Hong Kong Sanatorium & Hospital, Happy Valley Hong Kong Hong Kong SAR China
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17
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Price AT, Kennedy WR, Henke LE, Brown SR, Green OL, Thomas MA, Ginn J, Zoberi I. Implementing stereotactic accelerated partial breast irradiation using magnetic resonance guided radiation therapy. Radiother Oncol 2021; 164:275-281. [PMID: 34624406 DOI: 10.1016/j.radonc.2021.09.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 09/06/2021] [Accepted: 09/20/2021] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Accelerated partial breast irradiation (APBI) seeks to reduce irradiated volumes and radiation exposure for patients while maintaining acceptable clinical outcomes. Magnetic resonance image-guided radiotherapy (MRgRT) provides excellent soft-tissue contrast for treatment localization, which can reduce setup uncertainty, thus reducing margins in the external beam setting. Additionally, stereotactic body radiotherapy (SBRT)-style regimens with high gradients can also be executed. This MR-guided stereotactic APBI (MRgS-APBI) approach can be utilized for a lower number of fractions and spare a greater volume of healthy tissues compared to conventional 3D external beam APBI. METHODS Our MRgS-APBI program was developed for two prospective non-randomized phase I/II clinical trials (20Gyx1 and 8.5Gyx3). Both breast SBRT treatment planning and MRgRT delivery techniques were described in this study. Simulation included both CT and MRI with specialized immobilization to accommodate MR-guided setup and cine-MRI treatment gating. Dosimetry data from 48 single-fraction and 19 three-fraction patients were collected and evaluated. This included planning objectives and SBRT-specific indices. During treatment, setup errors were calculated to evaluate setup reproducibility and duty cycle was calculated using cine-MRI data during gated delivery. RESULTS In both the single- and three- fraction trials combined, 88.5% of the possible dosimetric objectives across all patients were met during planning. The majority of the planning objectives were easily achievable indicating the potential for stricter objectives for subsequent S-APBI treatments. The average magnitude of setup uncertainties was 1.0 cm ± 0.6 cm across all treatments. In the three-fraction trial, the average beam-on duty-cycle for the MRI-gated delivery was 83.0 ± 13.0%. There were no technical MRgS-APBI related issues that resulted in discontinuation of treatment across all patients. CONCLUSION SBRT-style dosimetry and delivery for APBI is feasible using MR-guidance. The program development and dosimetric outcomes reported here can serve as a guide for other institutions considering the clinical implementation of MR-guided stereotactic APBI.
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Affiliation(s)
- Alex T Price
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States
| | - William R Kennedy
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States
| | - Lauren E Henke
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States
| | - Sean R Brown
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States
| | - Olga L Green
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States
| | - Maria A Thomas
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States
| | - John Ginn
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States
| | - Imran Zoberi
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States.
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18
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Cuccia F, Alongi F, Belka C, Boldrini L, Hörner-Rieber J, McNair H, Rigo M, Schoenmakers M, Niyazi M, Slagter J, Votta C, Corradini S. Patient positioning and immobilization procedures for hybrid MR-Linac systems. Radiat Oncol 2021; 16:183. [PMID: 34544481 PMCID: PMC8454038 DOI: 10.1186/s13014-021-01910-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 09/09/2021] [Indexed: 02/08/2023] Open
Abstract
Hybrid magnetic resonance (MR)-guided linear accelerators represent a new horizon in the field of radiation oncology. By harnessing the favorable combination of on-board MR-imaging with the possibility to daily recalculate the treatment plan based on real-time anatomy, the accuracy in target and organs-at-risk identification is expected to be improved, with the aim to provide the best tailored treatment. To date, two main MR-linac hybrid machines are available, Elekta Unity and Viewray MRIdian. Of note, compared to conventional linacs, these devices raise practical issues due to the positioning phase for the need to include the coil in the immobilization procedure and in order to perform the best reproducible positioning, also in light of the potentially longer treatment time. Given the relative novelty of this technology, there are few literature data regarding the procedures and the workflows for patient positioning and immobilization for MR-guided daily adaptive radiotherapy. In the present narrative review, we resume the currently available literature and provide an overview of the positioning and setup procedures for all the anatomical districts for hybrid MR-linac systems.
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Affiliation(s)
- Francesco Cuccia
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar Di Valpolicella, VR, Italy.
| | - Filippo Alongi
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar Di Valpolicella, VR, Italy
- University of Brescia, Brescia, Italy
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Luca Boldrini
- Radiology, Radiation Oncology and Hematology Department, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Roma, Italy
| | - Juliane Hörner-Rieber
- Department of Radiation Oncology, University Hospital of Heidelberg, National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany
| | - Helen McNair
- The Royal Marsden NHS Foundation Trust, and Institute of Cancer Research Sutton, Surrey, UK
| | - Michele Rigo
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar Di Valpolicella, VR, Italy
| | - Maartje Schoenmakers
- Department of Radiation Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Maximilian Niyazi
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Judith Slagter
- Department of Radiation Oncology - Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Claudio Votta
- Radiology, Radiation Oncology and Hematology Department, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Roma, Italy
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
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19
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Yoon SM, Luterstein E, Chu FI, Cao M, Lamb J, Agazaryan N, Low D, Raldow A, Steinberg ML, Lee P. Clinical outcomes of stereotactic magnetic resonance image-guided adaptive radiotherapy for primary and metastatic tumors in the abdomen and pelvis. Cancer Med 2021; 10:5897-5906. [PMID: 34288538 PMCID: PMC8419771 DOI: 10.1002/cam4.4139] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/02/2021] [Accepted: 07/03/2021] [Indexed: 12/25/2022] Open
Abstract
Purpose Stereotactic body radiotherapy (SBRT) delivers ablative doses with excellent local control. However, implementing SBRT for abdominal and pelvic tumors has been limited by the risk for treatment‐related gastrointestinal toxicity. MRI‐guided radiotherapy may ameliorate these risks and increase the therapeutic ratio. We report the clinical outcomes of stereotactic MRI‐guided adaptive radiotherapy (SMART) for primary and metastatic tumors in the abdomen and pelvis. Methods From November 2014 to August 2017, the first 106 consecutive patients with 121 tumors in the abdomen and pelvis were treated with SMART at a single institution. Of the cohort, 41.5%, 15.1%, and 43.4% had primary, locally recurrent, and oligometastatic tumors, respectively. SMART was delivered using a tri‐cobalt‐60 gantry with on‐board 0.35 Tesla MRI with respiratory breath‐hold and daily adaptive re‐planning when anatomically necessary. A median of 40Gy in five fractions was prescribed. The Common Terminology Criteria for Adverse Events v.4.03 was used to score treatment‐related toxicities. Local control (LC), progression‐free survival (PFS), and overall survival (OS) were estimated using Kaplan–Meier method. Results Of the 510 treatments, seventy‐one (13.9%) were adapted. Fatigue, nausea, and pain were the most common acute toxicities. 0.9 and 0% of patients experienced acute grade three and four toxicities, respectively. 5.2 and 2.1% of patients experienced late grade three and four toxicities, respectively. After a median follow‐up of 20.4 months, the 2‐year LC rate was 74% on a per‐lesion basis. Two‐year LC was 96% for lesions that were treated with BED10≥100 versus 69% for BED10<100 (p = 0.02). PFS was significantly different between patients with and without locally controlled tumors (2‐year PFS 21 vs. 8%, p = 0.03). Two‐year OS was 57% for the entire cohort. Conclusions Favorable LC and PFS outcomes were observed with minimal morbidity for tumors in the abdomen and pelvis treated with SMART. Future prospective clinical trials to validate these findings are warranted.
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Affiliation(s)
- Stephanie M Yoon
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA
| | - Elaine Luterstein
- University of California San Diego School of Medicine, San Diego, CA, USA
| | - Fang-I Chu
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA
| | - Minsong Cao
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA
| | - James Lamb
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA
| | - Nzhde Agazaryan
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA
| | - Daniel Low
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA
| | - Ann Raldow
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA
| | - Michael L Steinberg
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA
| | - Percy Lee
- Department of Radiation Oncology, MD Anderson Cancer Center, University of Texas, Houston, TX, USA
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20
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Matrosic CK, Culberson W, Shepard A, Jupitz S, Bednarz B. 3D dosimetric validation of ultrasound-guided radiotherapy with a dynamically deformable abdominal phantom. Phys Med 2021; 84:159-167. [PMID: 33901860 DOI: 10.1016/j.ejmp.2021.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/01/2021] [Accepted: 04/06/2021] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES The purpose of this study was to dosimetrically benchmark gel dosimetry measurements in a dynamically deformable abdominal phantom for intrafraction image guidance through a multi-dosimeter comparison. Once benchmarked, the study aimed to perform a proof-of-principle study for validation measurements of an ultrasound image-guided radiotherapy delivery system. METHODS The phantom was dosimetrically benchmarked by delivering a liver VMAT plan and measuring the 3D dose distribution with DEFGEL dosimeters. Measured doses were compared to the treatment planning system and measurements acquired with radiochromic film and an ion chamber. The ultrasound image guidance validation was performed for a hands-free ultrasound transducer for the tracking of liver motion during treatment. RESULTS Gel dosimeters were compared to the TPS and film measurements, showing good qualitative dose distribution matches, low γ values through most of the high dose region, and average 3%/5 mm γ-analysis pass rates of 99.2%(0.8%) and 90.1%(0.8%), respectively. Gel dosimeter measurements matched ion chamber measurements within 3%. The image guidance validation study showed the measurement of the treatment delivery improvements due to the inclusion of the ultrasound image guidance system. Good qualitative matching of dose distributions and improvements of the γ-analysis results were observed for the ultrasound-gated dosimeter compared to the ungated dosimeter. CONCLUSIONS DEFGEL dosimeters in phantom showed good agreement with the planned dose and other dosimeters for dosimetric benchmarking. Ultrasound image guidance validation measurements showed good proof-of-principle of the utility of the phantom system as a method of validating ultrasound-based image guidance systems and potentially other image guidance methods.
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Affiliation(s)
- Charles K Matrosic
- School of Medicine and Public Health, Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, United States.
| | - Wesley Culberson
- School of Medicine and Public Health, Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, United States
| | - Andrew Shepard
- School of Medicine and Public Health, Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, United States
| | - Sydney Jupitz
- School of Medicine and Public Health, Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, United States
| | - Bryan Bednarz
- School of Medicine and Public Health, Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, United States
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21
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Thorwarth D, Low DA. Technical Challenges of Real-Time Adaptive MR-Guided Radiotherapy. Front Oncol 2021; 11:634507. [PMID: 33763369 PMCID: PMC7982516 DOI: 10.3389/fonc.2021.634507] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 01/26/2021] [Indexed: 12/18/2022] Open
Abstract
In the past few years, radiotherapy (RT) has experienced a major technological innovation with the development of hybrid machines combining magnetic resonance (MR) imaging and linear accelerators. This new technology for MR-guided cancer treatment has the potential to revolutionize the field of adaptive RT due to the opportunity to provide high-resolution, real-time MR imaging before and during treatment application. However, from a technical point of view, several challenges remain which need to be tackled to ensure safe and robust real-time adaptive MR-guided RT delivery. In this manuscript, several technical challenges to MR-guided RT are discussed. Starting with magnetic field strength tradeoffs, the potential and limitations for purely MR-based RT workflows are discussed. Furthermore, the current status of real-time 3D MR imaging and its potential for real-time RT are summarized. Finally, the potential of quantitative MR imaging for future biological RT adaptation is highlighted.
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Affiliation(s)
- Daniela Thorwarth
- Section for Biomedical Physics, Department of Radiation Oncology, University of Tübingen, Tübingen, Germany
| | - Daniel A Low
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA, United States
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22
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Stark LS, Andratschke N, Baumgartl M, Bogowicz M, Chamberlain M, Dal Bello R, Ehrbar S, Girbau Garcia Z, Guckenberger M, Krayenbühl J, Pouymayou B, Rudolf T, Vuong D, Wilke L, Zamburlini M, Tanadini-Lang S. Dosimetric and geometric end-to-end accuracy of a magnetic resonance guided linear accelerator. Phys Imaging Radiat Oncol 2020; 16:109-112. [PMID: 33458353 PMCID: PMC7807549 DOI: 10.1016/j.phro.2020.09.013] [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: 06/12/2020] [Revised: 09/29/2020] [Accepted: 09/30/2020] [Indexed: 11/24/2022] Open
Abstract
The introduction of real-time imaging by magnetic resonance guided linear accelerators (MR-Linacs) enabled adaptive treatments and gating on the tumor position. Different end-to-end tests monitored the accuracy of our MR-Linac during the first year of clinical operation. We report on the stability of these tests covering a static, adaptive and gating workflow. Film measurements showed gamma passing rates of 96.4% ± 3.4% for the static tests (five measurements) and for the two adaptive tests 98.9% and 99.99%, respectively (criterion 2%/2mm). The gated point dose measurements in the breathing phantom were 2.7% lower than in the static phantom.
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Affiliation(s)
- Luisa S. Stark
- University Hospital Zürich, Department of Radiation Oncology, Zurich, Switzerland
| | - Nicolaus Andratschke
- University Hospital Zürich, Department of Radiation Oncology, Zurich, Switzerland
| | - Michael Baumgartl
- University Hospital Zürich, Department of Radiation Oncology, Zurich, Switzerland
| | - Marta Bogowicz
- University Hospital Zürich, Department of Radiation Oncology, Zurich, Switzerland
| | - Madalyne Chamberlain
- University Hospital Zürich, Department of Radiation Oncology, Zurich, Switzerland
| | - Riccardo Dal Bello
- University Hospital Zürich, Department of Radiation Oncology, Zurich, Switzerland
| | - Stefanie Ehrbar
- University Hospital Zürich, Department of Radiation Oncology, Zurich, Switzerland
| | - Zaira Girbau Garcia
- University Hospital Zürich, Department of Radiation Oncology, Zurich, Switzerland
| | | | - Jérôme Krayenbühl
- University Hospital Zürich, Department of Radiation Oncology, Zurich, Switzerland
| | - Bertrand Pouymayou
- University Hospital Zürich, Department of Radiation Oncology, Zurich, Switzerland
| | - Thomas Rudolf
- University Hospital Zürich, Department of Radiation Oncology, Zurich, Switzerland
| | - Diem Vuong
- University Hospital Zürich, Department of Radiation Oncology, Zurich, Switzerland
| | - Lotte Wilke
- University Hospital Zürich, Department of Radiation Oncology, Zurich, Switzerland
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Witt JS, Rosenberg SA, Bassetti MF. MRI-guided adaptive radiotherapy for liver tumours: visualising the future. Lancet Oncol 2020; 21:e74-e82. [PMID: 32007208 DOI: 10.1016/s1470-2045(20)30034-6] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 12/01/2019] [Accepted: 12/02/2019] [Indexed: 12/12/2022]
Abstract
MRI-guided radiotherapy is a novel and rapidly evolving technology that might enhance the risk-benefit ratio. Through direct visualisation of the tumour and the nearby healthy tissues, the radiation oncologist can deliver highly accurate treatment even to mobile targets. Each individual treatment can be customised to changing anatomy, potentially reducing the risk of radiation-related toxicities while simultaneously increasing the dose delivered to the tumour. MRI-guided radiotherapy offers a new tool for the radiation oncologist, and creates an opportunity to achieve durable local control of liver tumours that might not otherwise be possible. Future work will allow us to expand the population eligible for curative-intent radiotherapy, optimise and customise radiation doses to specific tumours, and hopefully create opportunities for improving outcomes through machine learning and radiomics-based approaches. This Review outlines the current and future applications for MRI-guided radiotherapy with respect to metastatic and primary liver cancers.
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Affiliation(s)
- Jacob S Witt
- Department of Human Oncology, University of Wisconsin-Madison, Madison, WI, USA
| | - Stephen A Rosenberg
- Department of Radiation Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Michael F Bassetti
- Department of Human Oncology, University of Wisconsin-Madison, Madison, WI, USA.
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24
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Ginn JS, Low DA, Lamb JM, Ruan D. A motion prediction confidence estimation framework for prediction-based radiotherapy gating. Med Phys 2020; 47:3297-3304. [PMID: 32415857 DOI: 10.1002/mp.14236] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 04/05/2020] [Accepted: 05/05/2020] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Motion prediction can compensate for latency in image-guided radiotherapy and has been an active area of research. However, motion predictions are subject to error and variations. We have developed and evaluated a novel motion prediction confidence estimation framework to improve the efficacy and robustness of prediction-based radiotherapy gating decision-making. The specific scenario of adaptive gating in magnetic resonance imaging (MRI)-guided radiotherapy is studied as an example, but the method generalizes to other modalities and motion management setups. METHODS The proposed prediction confidence estimator is based on a generic training/testing paradigm and consists of a weighted combination of three components: the prediction model's goodness of fit, variation in the prediction using a leave-one-out process and the velocity of the tracked target. Roughly, these terms quantify respectively the consistency between prediction and the training data, the robustness of model inference, and the stability due to target speed. The weight parameters and the action level in triggering beam-off decision are optimized. The method is assessed and validated in 8 healthy volunteer and 13 patient studies using a 0.35T MRI-guided radiotherapy system predicting 0.25-0.33 s ahead. The effect of the action level on the predicted gating decision accuracy, beam-on positive predictive value (PPV) and median distance between the predicted and ground-truth target centroids were evaluated. Statistical significance was evaluated using a paired t-test. The tradeoff between these performance metrics and gating duty cycle was assessed. RESULTS Use of the confidence estimator threshold increased gating accuracy by up to 2.42%, increased PPV by up to 3.00%, and reduced the median centroid distance up to 0.28 mm. The confidence estimator threshold on average increased gating accuracy to 96.5% (P = 2.08 × 10-4 ), increased PPV to 96.7% (P = 1.46 × 10-5 ), reduced the median centroid distance to 0.54 mm (P = 1.71 × 10-5 ) at the cost of reducing the gating duty cycle by 14.3% to 48.5%. Hyperparameter tuning revealed that contrary to intuition, the velocity term offered only minimal performance improvement in some cases but also introduced potential stability issues. The combination of goodness of fit and leave-one-out prediction variation provided the most effective confidence estimator, yielding universally better performance in gating decisions. CONCLUSION Confidence estimation utilizing prediction model fitness criterion and validation principles can complement prediction methods to guide MRI-guided radiotherapy gating. Results from both volunteer and patient studies showed improved gating quality.
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Affiliation(s)
- John S Ginn
- Department of Radiation Oncology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Daniel A Low
- Department of Radiation Oncology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - James M Lamb
- Department of Radiation Oncology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Dan Ruan
- Department of Radiation Oncology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, 90095, USA
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25
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Respiratory Motion Prediction Using Fusion-Based Multi-Rate Kalman Filtering and Real-Time Golden-Angle Radial MRI. IEEE Trans Biomed Eng 2020; 67:1727-1738. [DOI: 10.1109/tbme.2019.2944803] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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26
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First prospective clinical evaluation of feasibility and patient acceptance of magnetic resonance-guided radiotherapy in Germany. Strahlenther Onkol 2020; 196:691-698. [PMID: 32002567 PMCID: PMC7385000 DOI: 10.1007/s00066-020-01578-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 01/07/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE Magnetic resonance-guided radiotherapy (MRgRT) has recently been introduced in our institution. As MRgRT requires high patient compliance compared to conventional techniques and can be associated with prolonged treatment times, feasibility and patient tolerance were prospectively assessed using patient-reported outcome questionnaires (PRO-Q). MATERIALS AND METHODS Forty-three patients were enrolled in a prospective observational study and treated with MRgRT on a low-field hybrid Magnetic Resonance Linear Accelerator system (MR-Linac) between April 2018 and April 2019. For assistance in gated breath-hold delivery using cine-MRI, a video feedback system was installed. PRO-Qs consisted of questions on MR-related complaints and also assessed aspects of active patient participation. RESULTS The most commonly treated anatomic sites were nodal metastases and liver lesions. The mean treatment time was 34 min with a mean beam-on time of 2:17 min. Gated stereotactic body radiotherapy (SBRT) was applied in 47% of all patients. Overall, patients scored MRgRT as positive or at least tolerable in the PRO‑Q. Almost two thirds of patients (65%) complained about at least one item of the PRO‑Q (score ≥4), mainly concerning coldness, paresthesia, and uncomfortable positioning. All patients reported high levels of satisfaction with their active role using the video feedback system in breath-hold delivery. CONCLUSION MRgRT was successfully implemented in our clinic and well tolerated by all patients, despite MR-related complaints and complaints about uncomfortable immobilization. Prospective clinical studies are in development for further evaluation of MRgRT and for quantification of the benefit of MR-guided on-table adaptive radiotherapy.
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Ginn JS, Ruan D, Low DA, Lamb JM. An image regression motion prediction technique for MRI-guided radiotherapy evaluated in single-plane cine imaging. Med Phys 2019; 47:404-413. [PMID: 31808161 DOI: 10.1002/mp.13948] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 11/29/2019] [Accepted: 11/29/2019] [Indexed: 12/31/2022] Open
Abstract
PURPOSE To develop and evaluate a novel motion prediction method for magnetic resonance image (MRI)-guided radiotherapy applications. This method, which we deem "image regression," predicts future tissue motion based on a weighted combination of previously observed motion states. Motion predictions are derived from a sliding window of recent motion states which are defined by a temporal sequence of images. A key advantage of this method compared to other motion prediction methods is that its computational complexity scales weekly with the number of spatial points predicted. Applications of gating latency reduction and improvement in deformable registration-based target tracking are demonstrated. METHODS The image regression (IR) motion prediction method was developed and evaluated using 26.9 h of real-time imaging acquired from eight healthy volunteers and 13 patients using a 0.35 T MRI-guided radiotherapy system. Motion predictions were performed 0.25-0.33 s into the future using a weighted sum of previously observed motion states with image similarity-derived weights. The set of previously observed motion states were continuously updated to incorporate the changes in breathing patterns. The accuracy of the predicted radiotherapy gating decision, beam-on positive predictive value (PPV), and predicted vs ground-truth target centroid position errors are reported. The IR technique was compared against no prediction, linear extrapolation, and an established autoregressive linear prediction algorithm. The usage of IR to initialize the deformable registration and enhance the target tracking was demonstrated in the healthy volunteer studies. Deformable registration with IR initialization was compared to the initialization performed by current clinical software: no initialization, previous image registration initialization and linear motion extrapolation initialization. RESULTS The average IR-predicted radiation beam gating decision accuracy was 95.8%, with a PPV of 95.7%, and median and 95th percentile centroid position errors of 0.63 and 2.08 mm, respectively. Compared to the autoregressive linear prediction method, gating accuracy was 1.15% greater, PPV was 1.61% greater, and median and 95th percentile centroid distances were 0.21 and 0.23 mm smaller. The IR-initialized registration on average converged within 0.50 mm of the ground-truth position in fewer than 10 iterations whereas the next best initialization method required more than 25 iterations. CONCLUSIONS Image regression motion prediction has the potential to reduce the gating latencies and improve the speed and accuracy of deformable registration-based target tracking in MRI-guided radiotherapy.
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Affiliation(s)
- John S Ginn
- Department of Radiation Oncology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Dan Ruan
- Department of Radiation Oncology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Daniel A Low
- Department of Radiation Oncology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - James M Lamb
- Department of Radiation Oncology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, 90095, USA
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28
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Mittauer KE, Dunkerley DA, Yadav P, Bayouth JE. Characterization and longitudinal assessment of daily quality assurance for an MR-guided radiotherapy (MRgRT) linac. J Appl Clin Med Phys 2019; 20:27-36. [PMID: 31633882 PMCID: PMC6839363 DOI: 10.1002/acm2.12735] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 07/01/2019] [Accepted: 08/29/2019] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To describe and characterize daily machine quality assurance (QA) for an MR-guided radiotherapy (MRgRT) linac system, in addition to reporting a longitudinal assessment of the dosimetric and mechanical stability over a 7-month period of clinical operation. METHODS Quality assurance procedures were developed to evaluate MR imaging/radiation isocenter, imaging and patient handling system, and linear accelerator stability. A longitudinal assessment was characterized for safety interlocks, laser and imaging isocenter coincidence, imaging and radiation (RT) isocentricity, radiation dose rate and output, couch motion, and MLC positioning. A cylindrical water phantom and an MR-compatible A1SL detector were utilized. MR and RT isocentricity and MLC positional accuracy was quantified through dose measured with a 0.40 cm2 x 0.83 cm2 field at each cardinal angle. The relationship between detector response to MR/RT isocentricity and MLC positioning was established through introducing known errors in phantom position. RESULTS Correlation was found between detector response and introduced positional error (N = 27) with coefficients of determination of 0.9996 (IEC-X), 0.9967 (IEC-Y), 0.9968 (IEC-Z) in each respective shift direction. The relationship between dose (DoseMR/RT+MLC ) and the vector magnitude of MLC and MR/RT positional error (Errormag ) was calculated to be a nonlinear response and resembled a quadratic function: DoseMR/RT+MLC [%] = -0.0253 Errormag [mm]2 - 0.0195 Errormag [mm]. For the temporal assessment (N = 7 months), safety interlocks were functional. Laser coincidence to MR was within ±2.0 mm (99.6%) and ±1.0 mm (86.8%) over the 7-month assessment. IGRT position-reposition shifts were within ±2.0 mm (99.4%) and ±1.0 mm (92.4%). Output was within ±3% (99.4%). Mean MLC and MR/RT isocenter accuracy was 1.6 mm, averaged across cardinal angles for the 7-month period. CONCLUSIONS The linac and IGRT accuracy of an MR-guided radiotherapy system has been validated and monitored over seven months for daily QA. Longitudinal assessment demonstrated a drift in dose rate, but temporal assessment of output, MLC position, and isocentricity has been stable.
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Affiliation(s)
- Kathryn E. Mittauer
- Department of Human OncologySchool of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWIUSA
- Department of Radiation OncologyMiami Cancer InstituteBaptist Health South FloridaMiamiFLUSA
| | - David A.P. Dunkerley
- Department of Human OncologySchool of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWIUSA
| | - Poonam Yadav
- Department of Human OncologySchool of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWIUSA
| | - John E. Bayouth
- Department of Human OncologySchool of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWIUSA
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Massaccesi M, Cusumano D, Boldrini L, Dinapoli N, Fionda B, Teodoli S, Azario L, Mattiucci GC, Balducci M, Cellini F, Valentini V. A new frontier of image guidance: Organs at risk avoidance with MRI-guided respiratory-gated intensity modulated radiotherapy: Technical note and report of a case. J Appl Clin Med Phys 2019; 20:194-198. [PMID: 31055870 PMCID: PMC6560311 DOI: 10.1002/acm2.12575] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 02/20/2019] [Accepted: 03/11/2019] [Indexed: 01/28/2023] Open
Abstract
The case of a 50‐year‐old man affected by a rhabdomiosarcoma metastatic lesion in the left flank Is reported. The patient was addressed to 50.4 Gy radiotherapy with concomitant chemotherapy in order to locally control the lesion. A Tri‐60‐Co magnetic resonance hybrid radiotherapy unit was used for treatment delivery and a respiratory gating protocol was applied for the different breathing phases (Free Breathing, Deep Inspiration Breath Hold and Final Expiration Breath Hold). Three intensity modulated radiation therapy (IMRT) plans were calculated and Final Expiration Breath Hold plan was finally selected due to the absence of PTV coverage differences and better organs at risk sparing (i.e. kidneys). This case report suggests that organs at risk avoidance with MRI‐guided respiratory‐gated Radiotherapy is feasible and particularly advantageous whenever sparing the organs at risk is of utmost dosimetric or clinical importance.
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Affiliation(s)
- Mariangela Massaccesi
- Dipartimento di Diagnostica per Immagini, UOC di Radioterapia Oncologica, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Davide Cusumano
- Dipartimento di Diagnostica per Immagini, UOC di Fisica Sanitaria, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.,Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Boldrini
- Dipartimento di Diagnostica per Immagini, UOC di Radioterapia Oncologica, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.,Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Nicola Dinapoli
- Dipartimento di Diagnostica per Immagini, UOC di Radioterapia Oncologica, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Bruno Fionda
- Dipartimento di Diagnostica per Immagini, UOC di Radioterapia Oncologica, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Stefania Teodoli
- Dipartimento di Diagnostica per Immagini, UOC di Fisica Sanitaria, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Luigi Azario
- Dipartimento di Diagnostica per Immagini, UOC di Fisica Sanitaria, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.,Istituto di Fisica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gian Carlo Mattiucci
- Dipartimento di Diagnostica per Immagini, UOC di Radioterapia Oncologica, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.,Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Mario Balducci
- Dipartimento di Diagnostica per Immagini, UOC di Radioterapia Oncologica, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.,Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Cellini
- Dipartimento di Diagnostica per Immagini, UOC di Radioterapia Oncologica, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Vincenzo Valentini
- Dipartimento di Diagnostica per Immagini, UOC di Radioterapia Oncologica, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.,Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy
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Klüter S. Technical design and concept of a 0.35 T MR-Linac. Clin Transl Radiat Oncol 2019; 18:98-101. [PMID: 31341983 PMCID: PMC6630153 DOI: 10.1016/j.ctro.2019.04.007] [Citation(s) in RCA: 204] [Impact Index Per Article: 40.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 04/05/2019] [Accepted: 04/06/2019] [Indexed: 01/28/2023] Open
Abstract
The integration of magnetic resonance (MR) imaging and linear accelerators into hybrid treatment systems has made MR-guided radiation therapy a clinical reality. This work summarizes the technical design of a 0.35 T MR-Linac and corresponding clinical concepts. The system facilitates 3D-conformal as well as IMRT treatments with 6MV photons. Daily MR imaging provides superior soft-tissue contrast for patient setup and also enables on-table adaption of treatment plans, which is fully integrated into the treatment workflow of the system. Automated beam gating during delivery is facilitated by cine MR imaging and structure tracking. Combining different novel features compared to conventional image-guided radiotherapy, this technology offers the potential for margin reduction as well as dose escalation.
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Affiliation(s)
- Sebastian Klüter
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg Institute for Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany
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Ginn JS, Ruan D, Low DA, Lamb JM. Multislice motion modeling for MRI-guided radiotherapy gating. Med Phys 2019; 46:465-474. [PMID: 30570755 PMCID: PMC6370044 DOI: 10.1002/mp.13350] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 11/15/2018] [Accepted: 12/13/2018] [Indexed: 12/25/2022] Open
Abstract
PURPOSE On-board magnetic resonance imaging (MRI) greatly enhances real-time target tracking capability during radiotherapy treatments. However, multislice and volumetric MRI techniques are frame rate limited and introduce unacceptable latency between the target moving out of position and the beam being turned off. We present a technique to estimate continuous volumetric tissue motion using motion models built from a repeated acquisition of a stack of MR slices. Applications including multislice target visualization and out-of-slice motion estimation during MRI-guided radiotherapy are demonstrated. METHODS Eight healthy volunteer studies were performed using a 0.35 T MRI-guided radiotherapy system. Images were acquired at three frames per second in an interleaved fashion across ten adjacent sagittal slice positions covering 4.5 cm using a balanced steady-state-free precession sequence. A previously published five-dimensional (5D) linear motion model used for MRI-guided radiotherapy gating was extended to include multiple slices. This model utilizes an external respiratory bellows signal recorded during imaging to simultaneously estimate motion across all imaged slices. For comparison to an image-based approach, the manifold learning technique local linear embedding (LLE) was used to derive a respiratory surrogate for motion modeling. Manifolds for every slice were aligned during LLE in a group-wise fashion, enabling motion estimation outside the current imaged slice using a motion model, a process which we denote as mSGA. Additionally, a method is developed to evaluate out-of-slice motion estimates. The multislice motion model was evaluated in a single slice with each newly acquired image using a leave-one-out approach. Model-generated gating decision accuracy and beam-on positive predictive value (PPV) are reported along with the median and 95th percentile distance between model and ground truth target centroids. RESULTS The average model gating decision accuracy and PPV across all volunteer studies was 93.7% and 92.8% using the 5D model, and 96.8% and 96.1% using the mSGA model, respectively. The median and 95th percentile distance between model and ground truth target centroids was 0.91 and 2.90 mm, respectively, using the 5D model and 0.58 and 1.49 mm using the mSGA model, averaged over all eight subjects. The mSGA motion model provided a statistically significant improvement across all evaluation metrics compared to the external surrogate-based 5D model. CONCLUSION The proposed techniques for out-of-slice target motion estimation demonstrated accuracy likely sufficient for clinical use. Results indicate the mSGA model may provide higher accuracy, however, the external surrogate-based model allows for unbiased in vivo accuracy evaluation.
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Affiliation(s)
- John S. Ginn
- Department of Radiation OncologyDavid Geffen School of MedicineUniversity of California Los AngelesLos AngelesCA90095USA
| | - Dan Ruan
- Department of Radiation OncologyDavid Geffen School of MedicineUniversity of California Los AngelesLos AngelesCA90095USA
| | - Daniel A. Low
- Department of Radiation OncologyDavid Geffen School of MedicineUniversity of California Los AngelesLos AngelesCA90095USA
| | - James M. Lamb
- Department of Radiation OncologyDavid Geffen School of MedicineUniversity of California Los AngelesLos AngelesCA90095USA
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Online Target Volume Estimation and Prediction from an Interlaced Slice Acquisition - A Manifold Embedding and Learning Approach. ARTIFICIAL INTELLIGENCE IN RADIATION THERAPY 2019. [DOI: 10.1007/978-3-030-32486-5_10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Ginn JS, O'Connell D, Thomas DH, Low DA, Lamb JM. Model-Interpolated Gating for Magnetic Resonance Image-Guided Radiation Therapy. Int J Radiat Oncol Biol Phys 2018; 102:885-894. [PMID: 29970314 PMCID: PMC6542358 DOI: 10.1016/j.ijrobp.2018.05.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 04/03/2018] [Accepted: 05/02/2018] [Indexed: 12/25/2022]
Abstract
PURPOSE To develop and validate a technique for radiation therapy gating using slow (≤1 frame per second) magnetic resonance imaging (MRI) and a motion model. Proposed uses of the technique include radiation therapy gating using T2-weighted images and conducting additional imaging studies during gated treatments. METHODS AND MATERIALS The technique uses a physiologically guided breathing motion model to interpolate deformed target position between 2-dimensional (2D) MRI images acquired every 1 to 3 seconds. The model is parameterized by a 1-dimensional respiratory bellows surrogate and is continuously updated with the most recently acquired 2D images. A phantom and 8 volunteers were imaged with a 0.35T MRI-guided radiation therapy system. A balanced steady-state free precession sequence with a 2D frame rate of 3 frames per second was used to evaluate the technique. The accuracy and beam-on positive predictive value (PPV) of the model-based gating decisions were evaluated using the gating decisions derived from imaging as a ground truth. A T2-weighted gating offline proof-of-concept study using a half-Fourier, single-shot, turbo-spin echo sequence is reported. RESULTS Model-interpolated gating accuracy, beam-on PPV, and median absolute distances between model and image-tracked target centroids were, on average, 98.3%, 98.4%, and 0.33 mm, respectively, in the balanced steady-state free precession phantom studies and 93.7%, 92.1%, and 0.86 mm, respectively, in the volunteer studies. T2 model-interpolated gating in 6 volunteers yielded an average accuracy and PPV of 94.3% and 92.5%, respectively, and the mean absolute median distance between modeled and imaged target centroids was 0.86 mm. CONCLUSIONS This work demonstrates the concept of model-interpolated gating for MRI-guided radiation therapy. The technique was found to be potentially sufficiently accurate for clinical use. Further development is needed to accommodate out-of-plane motion and the use of an internal MR-based respiratory surrogate.
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Affiliation(s)
- John S Ginn
- Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.
| | - Dylan O'Connell
- Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - David H Thomas
- Department of Radiation Oncology, University of Colorado School of Medicine, University of Colorado, Aurora, Colorado
| | - Daniel A Low
- Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - James M Lamb
- Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
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van Sörnsen de Koste JR, Palacios MA, Bruynzeel AME, Slotman BJ, Senan S, Lagerwaard FJ. MR-guided Gated Stereotactic Radiation Therapy Delivery for Lung, Adrenal, and Pancreatic Tumors: A Geometric Analysis. Int J Radiat Oncol Biol Phys 2018; 102:858-866. [PMID: 30061007 DOI: 10.1016/j.ijrobp.2018.05.048] [Citation(s) in RCA: 106] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 12/11/2017] [Accepted: 05/16/2018] [Indexed: 12/25/2022]
Abstract
PURPOSE We implemented magnetic resonance-guided breath-hold stereotactic body radiation therapy in combination with visual feedback using the MRIdian system. Both accuracy of gated delivery and reproducibility of tumor positions were studied. METHODS AND MATERIALS Tumor tracking is realized through repeated magnetic resonance imaging in a single sagittal plane at 4 frames per second with deformable image registration. An in-room monitor allowed visualization of the tracked gross tumor volume (GTV) contour and the planning target volume (PTV) (GTV + 3 mm), which was the gating boundary. For each delivery, a predefined threshold-region of interest percentage (ROI%) allows a percentage of GTV area to be outside the gating boundary before a beam-hold is triggered. Accuracy of gated delivery and tumor position reproducibility during breath-holds was analyzed for 15 patients (87 fractions) with lung, adrenal, and pancreas tumors. For each fraction, we analyzed (1) reproducibility of system-tracked GTV centroid position within the PTV; (2) geometric coverage of GTV area within the PTV; (3) treatment duty cycle efficiency; (4) effects of threshold ROI% settings on treatment duty cycle efficiency and GTV area coverage; and (5) beam-off latency effect on mean GTV coverage. RESULTS For lung, adrenal, and pancreatic tumors, grouped 5th to 95th percentile distributions of GTV centroid positions in the dorsoventral direction, relative to PTV-center of mass (COM), were, respectively, -3.3 mm to 2.8 mm, -2.5 mm to 3.7 mm, and -4.4 mm to 2.9 mm. Corresponding distributions in the craniocaudal direction were -2.6 mm to 4.6 mm, -4.1 mm to 4.4 mm, and -4.4 mm to 4.5 mm, respectively. Mean GTV areas encompassed during beam-on for all fractions were 94.6%, 94.3%, and 95.3% for lung, adrenal, and pancreas tumors, respectively. Mean treatment duty cycle efficiency ranged from 67% to 87% for these tumors. Use of higher threshold-ROI% resulted in increased duty cycle efficiency, at the cost of a small decrease in GTV area coverage. The beam-off latency had a marginal impact on the GTV coverage. CONCLUSIONS Gated stereotactic body radiation therapy delivery during breath-hold, real-time magnetic resonance guidance resulted in at least 95% geometric GTV coverage in lung, adrenal, and pancreatic tumors.
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Affiliation(s)
| | - Miguel A Palacios
- Department of Radiation Oncology, VU medical center, Amsterdam, The Netherlands
| | - Anna M E Bruynzeel
- Department of Radiation Oncology, VU medical center, Amsterdam, The Netherlands
| | - Ben J Slotman
- Department of Radiation Oncology, VU medical center, Amsterdam, The Netherlands
| | - Suresh Senan
- Department of Radiation Oncology, VU medical center, Amsterdam, The Netherlands
| | - Frank J Lagerwaard
- Department of Radiation Oncology, VU medical center, Amsterdam, The Netherlands
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Mittauer K, Paliwal B, Hill P, Bayouth JE, Geurts MW, Baschnagel AM, Bradley KA, Harari PM, Rosenberg S, Brower JV, Wojcieszynski AP, Hullett C, Bayliss RA, Labby ZE, Bassetti MF. A New Era of Image Guidance with Magnetic Resonance-guided Radiation Therapy for Abdominal and Thoracic Malignancies. Cureus 2018; 10:e2422. [PMID: 29872602 PMCID: PMC5985918 DOI: 10.7759/cureus.2422] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Magnetic resonance-guided radiation therapy (MRgRT) offers advantages for image guidance for radiotherapy treatments as compared to conventional computed tomography (CT)-based modalities. The superior soft tissue contrast of magnetic resonance (MR) enables an improved visualization of the gross tumor and adjacent normal tissues in the treatment of abdominal and thoracic malignancies. Online adaptive capabilities, coupled with advanced motion management of real-time tracking of the tumor, directly allow for high-precision inter-/intrafraction localization. The primary aim of this case series is to describe MR-based interventions for localizing targets not well-visualized with conventional image-guided technologies. The abdominal and thoracic sites of the lung, kidney, liver, and gastric targets are described to illustrate the technological advancement of MR-guidance in radiotherapy.
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Affiliation(s)
- Kathryn Mittauer
- Department of Human Oncology, University of Wisconsin - Madison, Madison, USA
| | - Bhudatt Paliwal
- Department of Human Oncology, University of Wisconsin - Madison, Madison, USA
| | - Patrick Hill
- Department of Human Oncology, University of Wisconsin - Madison, Madison, USA
| | - John E Bayouth
- Department of Human Oncology, University of Wisconsin - Madison, Madison, USA
| | - Mark W Geurts
- Department of Human Oncology, University of Wisconsin - Madison, Madison, USA
| | - Andrew M Baschnagel
- Department of Human Oncology, University of Wisconsin - Madison, Madison, USA
| | - Kristin A Bradley
- Department of Human Oncology, University of Wisconsin - Madison, Madison, USA
| | - Paul M Harari
- Department of Human Oncology, University of Wisconsin - Madison, Madison, USA
| | - Stephen Rosenberg
- Department of Human Oncology, University of Wisconsin - Madison, Madison, USA
| | - Jeffrey V Brower
- Radiation Oncology, Wentworth Douglas Hospital, Seacoast Cancer Center, Dover, USA
| | | | - Craig Hullett
- Department of Human Oncology, University of Wisconsin - Madison, Madison, USA
| | - R A Bayliss
- Department of Human Oncology, University of Wisconsin - Madison, Madison, USA
| | - Zacariah E Labby
- Department of Human Oncology, University of Wisconsin - Madison, Madison, USA
| | - Michael F Bassetti
- Department of Human Oncology, University of Wisconsin - Madison, Madison, USA
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Lamb J, Cao M, Kishan A, Agazaryan N, Thomas DH, Shaverdian N, Yang Y, Ray S, Low DA, Raldow A, Steinberg ML, Lee P. Online Adaptive Radiation Therapy: Implementation of a New Process of Care. Cureus 2017; 9:e1618. [PMID: 29104835 PMCID: PMC5663325 DOI: 10.7759/cureus.1618] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Onboard magnetic resonance imaging (MRI) guided radiotherapy is now clinically available in nine centers in the world. This technology has facilitated the clinical implementation of online adaptive radiotherapy (OART), or the ability to alter the daily treatment plan based on tumor and anatomical changes in real-time while the patient is on the treatment table. However, due to the time sensitive nature of OART, implementation in a large and busy clinic has many potential obstacles as well as patient-related safety considerations. In this work, we have described the implementation of this new process of care in the Department of Radiation Oncology at the University of California, Los Angeles (UCLA). We describe the rationale, the initial challenges such as treatment time considerations, technical issues during the process of re-contouring, re-optimization, quality assurance, as well as our current solutions to overcome these challenges. In addition, we describe the implementation of a coverage system with a physician of the day as well as online planners (physicists or dosimetrists) to oversee each OART treatment with patient-specific 'hand-off' directives from the patient's treating physician. The purpose of this effort is to streamline the process without compromising treatment quality and patient safety. As more MRI-guided radiotherapy programs come online, we hope that our experience can facilitate successful adoption of OART in a way that maximally benefits the patient.
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Affiliation(s)
- James Lamb
- Department of Radiation Oncology, University of California, Los Angeles
| | - Minsong Cao
- Department of Radiation Oncology, University of California, Los Angeles
| | - Amar Kishan
- Department of Radiation Oncology, University of California, Los Angeles
| | - Nzhde Agazaryan
- Department of Radiation Oncology, University of California, Los Angeles
| | - David H Thomas
- Department of Radiation Oncology, University of Colorado, Denver
| | - Narek Shaverdian
- Department of Radiation Oncology, University of California, Los Angeles
| | - Yingli Yang
- Department of Radiation Oncology, University of California, Los Angeles
| | - Suzette Ray
- Department of Radiation Oncology, University of California, Los Angeles
| | - Daniel A Low
- Department of Radiation Oncology, University of California, Los Angeles
| | - Ann Raldow
- Department of Radiation Oncology, University of California, Los Angeles
| | | | - Percy Lee
- Department of Radiation Oncology, University of California, Los Angeles
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