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Habermann FNOJ, Schmitt D, Failing T, Ziegler DA, Fischer J, Fischer LA, Guhlich M, Bendrich S, Knaus O, Overbeck TR, Treiber H, von Hammerstein-Equord A, Koch R, El Shafie R, Rieken S, Leu M, Dröge LH. And Yet It Moves: Clinical Outcomes and Motion Management in Stereotactic Body Radiation Therapy (SBRT) of Centrally Located Non-Small Cell Lung Cancer (NSCLC): Shedding Light on the Internal Organ at Risk Volume (IRV) Concept. Cancers (Basel) 2024; 16:231. [PMID: 38201658 PMCID: PMC10778176 DOI: 10.3390/cancers16010231] [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: 12/04/2023] [Revised: 12/27/2023] [Accepted: 12/28/2023] [Indexed: 01/12/2024] Open
Abstract
The internal organ at risk volume (IRV) concept might improve toxicity profiles in stereotactic body radiation therapy (SBRT) for non-small cell lung cancer (NSCLC). We studied (1) clinical aspects in central vs. peripheral tumors, (2) the IRV concept in central tumors, (3) organ motion, and (4) associated normal tissue complication probabilities (NTCPs). We analyzed patients who received SBRT for NSCLC (clinical aspects, n = 78; motion management, n = 35). We found lower biologically effective doses, larger planning target volume sizes, higher lung doses, and worse locoregional control for central vs. peripheral tumors. Organ motion was greater in males and tall patients (bronchial tree), whereas volume changes were lower in patients with a high body mass index (BMI) (esophagus). Applying the IRV concept (retrospectively, without new optimization), we found an absolute increase of >10% in NTCPs for the bronchial tree in three patients. This study emphasizes the need to optimize methods to balance dose escalation with toxicities in central tumors. There is evidence that organ motion/volume changes could be more pronounced in males and tall patients, and less pronounced in patients with higher BMI. Since recent studies have made efforts to further subclassify central tumors to refine treatment, the IRV concept should be considered for optimal risk assessment.
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Affiliation(s)
- Felix-Nikolai Oschinka Jegor Habermann
- Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany; (F.-N.O.J.H.); (D.S.); (D.A.Z.); (J.F.); (L.A.F.); (M.G.); (S.B.); (R.E.S.); (S.R.); (M.L.)
- Göttingen Comprehensive Cancer Center (G-CCC), University Medical Center Göttingen, Von-Bar-Str. 2/4, 37075 Göttingen, Germany; (T.R.O.); (H.T.); (A.v.H.-E.); (R.K.)
| | - Daniela Schmitt
- Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany; (F.-N.O.J.H.); (D.S.); (D.A.Z.); (J.F.); (L.A.F.); (M.G.); (S.B.); (R.E.S.); (S.R.); (M.L.)
- Göttingen Comprehensive Cancer Center (G-CCC), University Medical Center Göttingen, Von-Bar-Str. 2/4, 37075 Göttingen, Germany; (T.R.O.); (H.T.); (A.v.H.-E.); (R.K.)
| | - Thomas Failing
- Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany; (F.-N.O.J.H.); (D.S.); (D.A.Z.); (J.F.); (L.A.F.); (M.G.); (S.B.); (R.E.S.); (S.R.); (M.L.)
- Göttingen Comprehensive Cancer Center (G-CCC), University Medical Center Göttingen, Von-Bar-Str. 2/4, 37075 Göttingen, Germany; (T.R.O.); (H.T.); (A.v.H.-E.); (R.K.)
- Institute of Medical Physics and Radiation Protection (IMPS), University of Applied Sciences, Wiesenstr. 14, 35390 Gießen, Germany
| | - David Alexander Ziegler
- Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany; (F.-N.O.J.H.); (D.S.); (D.A.Z.); (J.F.); (L.A.F.); (M.G.); (S.B.); (R.E.S.); (S.R.); (M.L.)
- Göttingen Comprehensive Cancer Center (G-CCC), University Medical Center Göttingen, Von-Bar-Str. 2/4, 37075 Göttingen, Germany; (T.R.O.); (H.T.); (A.v.H.-E.); (R.K.)
| | - Jann Fischer
- Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany; (F.-N.O.J.H.); (D.S.); (D.A.Z.); (J.F.); (L.A.F.); (M.G.); (S.B.); (R.E.S.); (S.R.); (M.L.)
- Göttingen Comprehensive Cancer Center (G-CCC), University Medical Center Göttingen, Von-Bar-Str. 2/4, 37075 Göttingen, Germany; (T.R.O.); (H.T.); (A.v.H.-E.); (R.K.)
| | - Laura Anna Fischer
- Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany; (F.-N.O.J.H.); (D.S.); (D.A.Z.); (J.F.); (L.A.F.); (M.G.); (S.B.); (R.E.S.); (S.R.); (M.L.)
- Göttingen Comprehensive Cancer Center (G-CCC), University Medical Center Göttingen, Von-Bar-Str. 2/4, 37075 Göttingen, Germany; (T.R.O.); (H.T.); (A.v.H.-E.); (R.K.)
| | - Manuel Guhlich
- Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany; (F.-N.O.J.H.); (D.S.); (D.A.Z.); (J.F.); (L.A.F.); (M.G.); (S.B.); (R.E.S.); (S.R.); (M.L.)
- Göttingen Comprehensive Cancer Center (G-CCC), University Medical Center Göttingen, Von-Bar-Str. 2/4, 37075 Göttingen, Germany; (T.R.O.); (H.T.); (A.v.H.-E.); (R.K.)
| | - Stephanie Bendrich
- Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany; (F.-N.O.J.H.); (D.S.); (D.A.Z.); (J.F.); (L.A.F.); (M.G.); (S.B.); (R.E.S.); (S.R.); (M.L.)
- Göttingen Comprehensive Cancer Center (G-CCC), University Medical Center Göttingen, Von-Bar-Str. 2/4, 37075 Göttingen, Germany; (T.R.O.); (H.T.); (A.v.H.-E.); (R.K.)
| | - Olga Knaus
- Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany; (F.-N.O.J.H.); (D.S.); (D.A.Z.); (J.F.); (L.A.F.); (M.G.); (S.B.); (R.E.S.); (S.R.); (M.L.)
- Göttingen Comprehensive Cancer Center (G-CCC), University Medical Center Göttingen, Von-Bar-Str. 2/4, 37075 Göttingen, Germany; (T.R.O.); (H.T.); (A.v.H.-E.); (R.K.)
| | - Tobias Raphael Overbeck
- Göttingen Comprehensive Cancer Center (G-CCC), University Medical Center Göttingen, Von-Bar-Str. 2/4, 37075 Göttingen, Germany; (T.R.O.); (H.T.); (A.v.H.-E.); (R.K.)
- Department of Hematology and Medical Oncology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany
| | - Hannes Treiber
- Göttingen Comprehensive Cancer Center (G-CCC), University Medical Center Göttingen, Von-Bar-Str. 2/4, 37075 Göttingen, Germany; (T.R.O.); (H.T.); (A.v.H.-E.); (R.K.)
- Department of Hematology and Medical Oncology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany
| | - Alexander von Hammerstein-Equord
- Göttingen Comprehensive Cancer Center (G-CCC), University Medical Center Göttingen, Von-Bar-Str. 2/4, 37075 Göttingen, Germany; (T.R.O.); (H.T.); (A.v.H.-E.); (R.K.)
- Department of Cardio-Thoracic and Vascular Surgery, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany
| | - Raphael Koch
- Göttingen Comprehensive Cancer Center (G-CCC), University Medical Center Göttingen, Von-Bar-Str. 2/4, 37075 Göttingen, Germany; (T.R.O.); (H.T.); (A.v.H.-E.); (R.K.)
- Department of Hematology and Medical Oncology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany
| | - Rami El Shafie
- Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany; (F.-N.O.J.H.); (D.S.); (D.A.Z.); (J.F.); (L.A.F.); (M.G.); (S.B.); (R.E.S.); (S.R.); (M.L.)
- Göttingen Comprehensive Cancer Center (G-CCC), University Medical Center Göttingen, Von-Bar-Str. 2/4, 37075 Göttingen, Germany; (T.R.O.); (H.T.); (A.v.H.-E.); (R.K.)
| | - Stefan Rieken
- Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany; (F.-N.O.J.H.); (D.S.); (D.A.Z.); (J.F.); (L.A.F.); (M.G.); (S.B.); (R.E.S.); (S.R.); (M.L.)
- Göttingen Comprehensive Cancer Center (G-CCC), University Medical Center Göttingen, Von-Bar-Str. 2/4, 37075 Göttingen, Germany; (T.R.O.); (H.T.); (A.v.H.-E.); (R.K.)
| | - Martin Leu
- Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany; (F.-N.O.J.H.); (D.S.); (D.A.Z.); (J.F.); (L.A.F.); (M.G.); (S.B.); (R.E.S.); (S.R.); (M.L.)
- Göttingen Comprehensive Cancer Center (G-CCC), University Medical Center Göttingen, Von-Bar-Str. 2/4, 37075 Göttingen, Germany; (T.R.O.); (H.T.); (A.v.H.-E.); (R.K.)
| | - Leif Hendrik Dröge
- Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany; (F.-N.O.J.H.); (D.S.); (D.A.Z.); (J.F.); (L.A.F.); (M.G.); (S.B.); (R.E.S.); (S.R.); (M.L.)
- Göttingen Comprehensive Cancer Center (G-CCC), University Medical Center Göttingen, Von-Bar-Str. 2/4, 37075 Göttingen, Germany; (T.R.O.); (H.T.); (A.v.H.-E.); (R.K.)
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Dossun C, Niederst C, Noel G, Meyer P. Evaluation of DIR algorithm performance in real patients for radiotherapy treatments: A systematic review of operator-dependent strategies. Phys Med 2022; 101:137-157. [PMID: 36007403 DOI: 10.1016/j.ejmp.2022.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/21/2022] [Accepted: 08/16/2022] [Indexed: 11/15/2022] Open
Abstract
PURPOSE The performance of deformable medical image registration (DIR) algorithms has become a major concern. METHODS We aimed to obtain updated information on DIR algorithm performance quantification through a literature review of articles published between 2010 and 2022. We focused only on studies using operator-based methods to treat real patients. The PubMed, Google Scholar and Embase databases were searched following PRISMA guidelines. RESULTS One hundred and seven articles were identified. The mean number of patients and registrations per publication was 20 and 63, respectively. We found 23 different geometric metrics appearing at least twice, and the dosimetric impact of DIR was quantified in 32 articles. Forty-eight different at-risk organs were described, and target volumes were studied in 43 publications. Prostate, head-and-neck and thoracic locations represented more than ¾ of the studied locations. We summarized the type of DIR and the images used, and other key elements. Intra/interobserver variability, threshold values and the correlation between metrics were also discussed. CONCLUSIONS This literature review covers the past decade and should facilitate the implementation of DIR algorithms in clinical practice by providing practical and pertinent information to quantify their performance on real patients.
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Affiliation(s)
- C Dossun
- Department of Radiotherapy, Institut de Cancerologie Strasbourg Europe (ICANS), Strasbourg, France
| | - C Niederst
- Department of Radiotherapy, Institut de Cancerologie Strasbourg Europe (ICANS), Strasbourg, France
| | - G Noel
- Department of Radiotherapy, Institut de Cancerologie Strasbourg Europe (ICANS), Strasbourg, France
| | - P Meyer
- Department of Radiotherapy, Institut de Cancerologie Strasbourg Europe (ICANS), Strasbourg, France; ICUBE, CNRS UMR 7357, Team IMAGES, Strasbourg, France.
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Chen Y, Gong G, Wang Y, Liu C, Su Y, Wang L, Yang B, Yin Y. Comparative Evaluation of 4-Dimensional Computed Tomography and 4-Dimensional Magnetic Resonance Imaging to Delineate the Target of Primary Liver Cancer. Technol Cancer Res Treat 2021; 20:15330338211045499. [PMID: 34617855 PMCID: PMC8504652 DOI: 10.1177/15330338211045499] [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] [Indexed: 12/24/2022] Open
Abstract
Purpose: To evaluate the feasibility of 4-dimensional magnetic resonance imaging (4DMRI) in establishing the target of primary liver cancer in comparison with 4-dimensional computed tomography (4DCT). Methods and Materials: A total of 23 patients with primary liver cancer who received radiotherapy were selected, and 4DCT and T2w-4DMRI simulations were conducted to obtain 4DCT and T2w-4DMRI simulation images. The 4DCT and T2w-4DMRI data were sorted into 10 and 8 respiratory phase bins, respectively. The liver and gross tumor volumes (GTVs) were delineated in all images using programmed clinical workflows under tumor delineation guidelines. The internal organs at risk volumes (IRVs) and internal target volumes (ITVs) were the unions of all the phase livers and GTVs, respectively. Then, the artifacts, liver volume, GTV, and motion range in 4DCT and T2w-4DMRI were compared. Results: The mean GTV volume based on 4DMRI was 136.42 ± 231.27 cm3, which was 25.04 cm3 (15.5%) less than that of 4DCT (161.46 ± 280.29 cm3). The average volume of ITV determined by 4DMRI was 166.12 ± 270.43 cm3, which was 22.44 cm3 (11.9%) less than that determined by 4DCT (188.56 ± 307.57 cm3). Liver volume and IRV in 4DMRI increased by 4.0% and 6.6%, respectively, compared with 4DCT. The difference in tumor motion by T2w-4DMRI based on the centroid was greater than that of 4DCT in the L/R, A/P, and S/I directions, and the average displacement differences were 2.6, 2.8, and 6.9 mm, respectively. The severe artifacts in 4DCT were 47.8% (11/23) greater than in 4DMRI 17.4% (4/23). Conclusions: Compared with 4DCT, T2-weighted and navigator-triggered 4DMRI produces fewer artifacts and larger motion differences in hepatic intrafraction tumors, which is a feasible technique for primary liver cancer treatment planning.
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Affiliation(s)
- Yukai Chen
- East China University of Technology, Nanchang, Jiangxi, China
| | - Guanzhong Gong
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong Province, China
| | - Yinxing Wang
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong Province, China
| | - Chenlu Liu
- School of Nuclear Science and Technology, University of South China, Hengyang, China
| | - Ya Su
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong Province, China
| | - Lizhen Wang
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong Province, China
| | - Bo Yang
- East China University of Technology, Nanchang, Jiangxi, China
| | - Yong Yin
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong Province, China
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Nie X, Rimner A, Li G. Feasibility of MR-guided radiotherapy using beam-eye-view 2D-cine with tumor-volume projection. Phys Med Biol 2021; 66:045020. [PMID: 33361569 DOI: 10.1088/1361-6560/abd66a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE Current magnetic resonance imaging (MRI) guided radiotherapy (MRgRT) applies sagittal/coronal 2D-cine to monitor major tumor motions, however, the beam eye's view (BEV) with volumetric tumor projection would be the best measure for radiation beam conformality, independent of tumor through-plane motion. The goal is to assess the feasibility, accuracy, and performance of the BEV approach. METHODS Beam-specific BEV 2D-cine with volume-projected tumor contours were simulated to establish a 2D/3D tumor match against a tumor-motion library based on multi-breath time-resolved (TR) 4DMRI images. Two BEV-library-matching methods were developed: (1) fast screening with tumor center-of-mass (∆COM), in-plane area ratio, and DICE similarity, and finalizing with the highest DICE score and (2) DICE screening for top-3 candidates and finalizing with rigid registration. A 4D-XCAT digital phantom and 8 lung-cancer patients were used for assessment. For each patient, 3 sets of 40 s TR-4DMRI were acquired at 2 Hz and 6 representative BEV were created with the isocenter set at tumor COM in mid-respiration. One TR-4DMRI set (40 × 2 = 80-images) was used to simulate BEV 2D-cine and the other two (160-images) were used to create a library. The matching result was validated against the ground truth within the test set. Using a leave-one-out strategy, the success rate, accuracy, and speed of tumor matching were assessed for volume-projected tumors over 11520 time-points (=8patients•3sets•80images•6BEVs). RESULTS Volume-projected tumor contour area on the 6 BEVs varies by 60% ± 8% and [Formula: see text] (in-plane/volume-projected) varies by 82% ± 9%. The [Formula: see text] changes with tumor shape, orientation, and through-plane motion. Method-1 produces 96% matching success (ΔCOM = 0.7 ± 0.2 mm, [Formula: see text]=1.01 ± 0.02, Dice=0.92 ± 0.02) with the computational time of 15 ± 1 ms/match, while method-2 produces 94% ± 1% success (ΔCOM = 0.2 ± 0.1 mm, [Formula: see text]=1.00 ± 0.01, Dice = 0.94 ± 0.02) with 223 ± 13 ms/match. CONCLUSION This study has demonstrated the feasibility, accuracy, and benefits of BEV 2D-cine imaging with tumor-volume projection, allowing real-time tumor motion monitoring and beam conformality checking. Further clinical evaluation is necessary before MRgRT applications.
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Affiliation(s)
- Xingyu Nie
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States of America
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Nardone V, Giugliano FM, Reginelli A, Sangiovanni A, Mormile M, Iadanza L, Cappabianca S, Guida C. 4D CT analysis of organs at risk (OARs) in stereotactic radiotherapy. Radiother Oncol 2020; 151:10-14. [PMID: 32622777 DOI: 10.1016/j.radonc.2020.06.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 06/25/2020] [Accepted: 06/26/2020] [Indexed: 12/25/2022]
Abstract
Internal organs at risk volumes (IRV) represent the propagation of organs at risk (OARs) in 4DCT. Sixty consecutive patients that underwent 4DCT for thoracic stereotactic radiotherapy were analyzed and IRVs for heart, trachea, esophagus, bronchial tree, great vessels, and spinal cord were calculated. IRVs were then tested for the respect of dose constraints. IRVs were significantly bigger than standard OARs (p-value <0.001 for all the IRVs). IRVs that did not respect the dose constraints were, respectively, 7/60 (11.7%) for Heart IRV, 6/60 (10%) for Esophagus IRV, 11/60 (18.3%) for Trachea IRV, 16/60 (26.6%) for Bronchial Tree and 0/60 (0%) for great vessel and spinal cord IRV. In the subset of central targets, the percentage of plans that can be unacceptable taking into consideration OARs motion reaches 42%. The correlation of IRVs with clinical parameters and toxicity deserves future investigations in prospective trials.
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Affiliation(s)
- Valerio Nardone
- Unit of Radiation Oncology, Ospedale del Mare, Naples, Italy.
| | | | - Alfonso Reginelli
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Angelo Sangiovanni
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Maria Mormile
- Unit of Radiation Oncology, Ospedale del Mare, Naples, Italy
| | - Luciano Iadanza
- Unit of Radiation Oncology, Rummo General Hospital, Benevento, Italy
| | - Salvatore Cappabianca
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Cesare Guida
- Unit of Radiation Oncology, Ospedale del Mare, Naples, Italy
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Shono N, Ninni B, King F, Kato T, Tokuda J, Fujimoto T. Simulated accuracy assessment of small footprint body-mounted probe alignment device for MRI-guided cryotherapy of abdominal lesions. Med Phys 2020; 47:2337-2349. [PMID: 32141080 PMCID: PMC7889307 DOI: 10.1002/mp.14116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 02/19/2020] [Accepted: 02/19/2020] [Indexed: 12/11/2022] Open
Abstract
PURPOSE Magnetic resonance imaging (MRI)-guided percutaneous cryotherapy of abdominal lesions, an established procedure, uses MRI to guide and monitor the cryoablation of lesions. Methods to precisely guide cryotherapy probes with a minimum amount of trial-and-error are yet to be established. To aid physicians in attaining precise probe alignment without trial-and-error, a body-mounted motorized cryotherapy-probe alignment device (BMCPAD) with motion compensation was clinically tested in this study. The study also compared the contribution of body motion and organ motion compensation to the guidance accuracy of a body-mounted probe alignment device. METHODS The accuracy of guidance using the BMCPAD was prospectively measured during MRI-guided percutaneous cryotherapies before insertion of the probes. Clinical parameters including patient age, types of anesthesia, depths of the target, and organ sites of target were collected. By using MR images of the target organs and fiducial markers embedded in the BMCPAD, we retrospectively simulated the guidance accuracy with body motion compensation, organ motion compensation, and no compensation. The collected data were analyzed to test the impact of motion compensation on the guidance accuracy. RESULTS Thirty-seven physical guidance of probes were prospectively recorded for sixteen completed cases. The accuracy of physical guidance using the BMCPAD was 13.4 ± 11.1 mm. The simulated accuracy of guidance with body motion compensation, organ motion compensation, and no compensation was 2.4 ± 2.9 mm, 2.2 ± 1.6 mm, and 3.5 ± 2.9 mm, respectively. Data analysis revealed that the body motion compensation and organ motion compensation individually impacted the improvement in the accuracy of simulated guidance. Moreover, the difference in the accuracy of guidance either by body motion compensation or organ motion compensation was not statistically significant. The major clinical parameters impacting the accuracy of guidance were the body and organ motions. Patient age, types of anesthesia, depths of the target, and organ sites of target did not influence the accuracy of guidance using BMCPAD. The magnitude of body surface movement and organ movement exhibited mutual statistical correlation. CONCLUSIONS The BMCPAD demonstrated guidance accuracy comparable to that of previously reported devices for CT-guided procedures. The analysis using simulated motion compensation revealed that body motion compensation and organ motion compensation individually impact the improvement in the accuracy of device-guided cryotherapy probe alignment. Considering the correlation between body and organ movements, we also determined that body motion compensation using the ring fiducial markers in the BMCPAD can be solely used to address both body and organ motions in MRI-guided cryotherapy.
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Affiliation(s)
- Naoyuki Shono
- Radiology, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Brian Ninni
- Radiology, Brigham and Women’s Hospital, Boston, MA 02115, USA
- Canon Healthcare Optics Research Laboratory Boston, Cambridge, MA 02139, USA
| | - Franklin King
- Radiology, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Takahisa Kato
- Radiology, Brigham and Women’s Hospital, Boston, MA 02115, USA
- Canon Healthcare Optics Research Laboratory Boston, Cambridge, MA 02139, USA
| | - Junichi Tokuda
- Radiology, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Takahiro Fujimoto
- Division of Clinical Radiology Service, Kyoto University Hospital, Kyoto, Kyoto 606-8507, Japan
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Nie X, Saleh Z, Kadbi M, Zakian K, Deasy J, Rimner A, Li G. A super-resolution framework for the reconstruction of T2-weighted (T2w) time-resolved (TR) 4DMRI using T1w TR-4DMRI as the guidance. Med Phys 2020; 47:3091-3102. [PMID: 32166757 DOI: 10.1002/mp.14136] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 01/30/2020] [Accepted: 03/05/2020] [Indexed: 12/25/2022] Open
Abstract
PURPOSE The purpose of this study was to develop T2-weighted (T2w) time-resolved (TR) four-dimensional magnetic resonance imaging (4DMRI) reconstruction technique with higher soft-tissue contrast for multiple breathing cycle motion assessment by building a super-resolution (SR) framework using the T1w TR-4DMRI reconstruction as guidance. METHODS The multi-breath T1w TR-4DMRI was reconstructed by deforming a high-resolution (HR: 2 × 2 × 2 mm3 ) volumetric breath-hold (BH, 20s) three-dimensional magnetic resonance imaging (3DMRI) image to a series of low-resolution (LR: 5 × 5 × 5 mm3 ) 3D cine images at a 2Hz frame rate in free-breathing (FB, 40 s) using an enhanced Demons algorithm, namely [T1BH →FB] reconstruction. Within the same imaging session, respiratory-correlated (RC) T2w 4DMRI (2 × 2 × 2 mm3 ) was acquired based on an internal navigator to gain HR T2w (T2HR ) in three states (full exhalation and mid and full inhalation) in ~5 min. Minor binning artifacts in the RC-4DMRI were automatically identified based on voxel intensity correlation (VIC) between consecutive slices as outliers (VIC < VICmean -σ) and corrected by deforming the artifact slices to interpolated slices from the adjacent slices iteratively until no outliers were identified. A T2HR image with minimal deformation (<1 cm at the diaphragm) from the T1BH image was selected for multi-modal B-Spline deformable image registration (DIR) to establish the T2HR -T1BH voxel correspondence. Two approaches to reconstruct T2w TR-4DMRI were investigated: (A) T2HR →[T1BH →FB]: to deform T2w HR to T1w BH only as T1w TR-4DMRI was reconstructed, and combine the two displacement vector fields (DVFs) to reconstruct T2w TR-4DMRI, and (B) [T2HR ←T1BH ]→FB: to deform T1w BH to T2w HR first and apply the deformed T1w BH to reconstruct T2w TR-4DMRI. The reconstruction times were similar, 8-12 min per volume. To validate the two methods, T2w- and T1w-mapped 4D XCAT digital phantoms were utilized with three synthetic spherical tumors (ϕ = 2.0, 3.0, and 4.0 cm) in the lower or mid lobes as the ground truth to evaluate the tumor location (the center of mass, COM), size (volume ratio, %V), and shape (Dice index). Six lung cancer patients were scanned under an IRB-approved protocol and the T2w TR-4DMRI images reconstructed from the two methods were compared based on the preservation of the three tumor characteristics. The local tumor-contained image quality was also characterized using the VIC and structure similarity (SSIM) indexes. RESULTS In the 4D digital phantom, excellent tumor alignment after T2HR -T1HR DIR is achieved: ∆COM = 0.8 ± 0.5 mm, %V = 1.06 ± 0.02, and Dice = 0.91 ± 0.03, in both deformation directions using the DIR-target image as the reference. In patients, binning artifacts are corrected with improved image quality: average VIC increases from 0.92 ± 0.03 to 0.95 ± 0.01. Both T2w TR-4DMRI reconstruction methods produce similar tumor alignment errors ∆COM = 2.9 ± 0.6 mm. However, method B ([T2HR ←T1BH ]→FB) produces superior results in preserving more T2w tumor features with a higher %V = 0.99 ± 0.03, Dice = 0.81 ± 0.06, VIC = 0.85 ± 0.06, and SSIM = 0.65 ± 0.10 in the T2w TR-4DMRI images. CONCLUSIONS This study has demonstrated the feasibility of T2w TR-4DMRI reconstruction with high soft-tissue contrast and adequately-preserved tumor position, size, and shape in multiple breathing cycles. The T2w-centric DIR (method B) produces a superior solution for the SR-based framework of T2w TR-4DMRI reconstruction with highly preserved tumor characteristics and local image features, which are useful for tumor delineation and motion management in radiation therapy.
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Affiliation(s)
- Xingyu Nie
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Ziad Saleh
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Mo Kadbi
- Philips Healthcare, MR Therapy, Cleveland, OH, USA
| | - Kristen Zakian
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Joseph Deasy
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Andreas Rimner
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Guang Li
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
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Zhang J, Srivastava S, Wang C, Beckham T, Johnson C, Dutta P, Shepherd A, Mechalakos J, Hunt M, Wu A, Rimner A, Li G. Clinical evaluation of 4D MRI in the delineation of gross and internal tumor volumes in comparison with 4DCT. J Appl Clin Med Phys 2020; 20:51-60. [PMID: 31538719 PMCID: PMC6753727 DOI: 10.1002/acm2.12699] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 06/15/2019] [Accepted: 07/23/2019] [Indexed: 02/06/2023] Open
Abstract
Purpose To evaluate clinical utility of respiratory‐correlated (RC) four‐dimensional magnetic resonance imaging (4DMRI) for lung tumor delineation and motion assessment, in comparison with the current clinical standard of 4D computed tomography (4DCT). Methods and Materials A prospective T2‐weighted (T2w) RC‐4DMRI technique was applied to acquire coronal 4DMRI images for 14 lung cancer patients (16 lesions) during free breathing (FB) under an IRB‐approved protocol, together with a breath‐hold (BH) T1w 3DMRI and axial 4DMRI. Clinical simulation CT and 4DCT were acquired within 2 h. An internal navigator was applied to trigger amplitude‐binned 4DMRI acquisition whereas a bellows or real‐time position management (RPM) was used in the 4DCT reconstruction. Six radiation oncologists manually delineated the gross and internal tumor volumes (GTV and ITV) in 399 3D images using programmed clinical workflows under a tumor delineation guideline. The ITV was the union of GTVs within the breathing cycle without margin. Average GTV and motion range were assessed and ITV variation between 4DMRI and 4DCT was evaluated using the Dice similarity index, mean distance agreement (MDA), and volume difference. Results The mean tumor volume is similar between 4DCT (GTV4DCT = 1.0, as the reference) and T2w‐4DMRI (GTVT2wMR = 0.97), but smaller in T1w MRI (GTVT1wMR = 0.76), suggesting possible peripheral edema around the tumor. Average GTV variation within the breathing cycle (22%) in 4DMRI is slightly greater than 4DCT (17%). GTV motion variation (−4 to 12 mm) and ITV variation (∆VITV=−25 to 95%) between 4DCT and 4DMRI are large, confirmed by relatively low ITV similarity (Dice = 0.72 ± 0.11) and large MDA = 2.9 ± 1.5 mm. Conclusion Average GTVs are similar between T2w‐4DMRI and 4DCT, but smaller by 25% in T1w BH MRI. Physician training and breathing coaching may be necessary to reduce ITV variability between 4DMRI and 4DCT. Four‐dimensional magnetic resonance imaging is a promising and viable technique for clinical lung tumor delineation and motion assessment.
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Affiliation(s)
- Jingjing Zhang
- Department of Radiation Oncology, Zhongshan Hospital of Sun Yat-Sen University, Zhongshan, China.,Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Shreya Srivastava
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Chunyu Wang
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Thomas Beckham
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Christopher Johnson
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Pinaki Dutta
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Annemarie Shepherd
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - James Mechalakos
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Margie Hunt
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Abraham Wu
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Andreas Rimner
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Guang Li
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
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Li G, Liu Y, Nie X. Respiratory-Correlated (RC) vs. Time-Resolved (TR) Four-Dimensional Magnetic Resonance Imaging (4DMRI) for Radiotherapy of Thoracic and Abdominal Cancer. Front Oncol 2019; 9:1024. [PMID: 31681573 PMCID: PMC6798178 DOI: 10.3389/fonc.2019.01024] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 09/23/2019] [Indexed: 12/25/2022] Open
Abstract
Recent technological and clinical advancements of both respiratory-correlated (RC) and time-resolved (TR) four-dimensional magnetic resonance imaging (4DMRI) techniques are reviewed in light of tumor/organ motion simulation, monitoring, and assessment in radiotherapy. For radiotherapy of thoracic and abdominal cancer, respiratory-induced tumor motion, and motion variation due to breathing irregularities are the major uncertainties in treatment. RC-4DMRI is developed to assess tumor motion for treatment planning, whereas TR-4DMRI is developed to assess both motion and motion variation for treatment planning, delivery and assessment. RC-4DMRI is reconstructed to provide one-breathing-cycle motion, similar to 4D computed tomography (4DCT), the current clinical standard, but with higher soft-tissue contrast, no ionizing radiation, and less binning artifacts due to the use of an internal respiratory surrogate. Recent studies have shown that its spatial resolution has reached or exceeded that of 4DCT and scanning time becomes clinically acceptable. TR-4DMRI is recently developed with an adequate spatiotemporal resolution to assess tumor motion and motion variations for treatment simulation, delivery and assessment. The super-resolution approach is most promising since it can image any organ/body motion, whereas RC-4D MRI are limited to resolve only respiration-induced motion and some TR-4DMRI approaches may more or less depend on RC-4DMRI. TR-4DMRI provides multi-breath motion data that are useful not only in MR-guided radiotherapy but also for building a patient-specific motion model to guide radiotherapy treatment using an non-MR-equipped linear accelerator. Based on 4DMRI motion data, motion-corrected dynamic contrast imaging and diffusion-weighted imaging have also been reported, aiming to facilitate tumor delineation for more accurate radiotherapy targeting. Both RC- and TR-4DMRI have been evaluated for potential clinical applications, such as delineation of tumor volumes, where sufficiently high spatial resolution and large field-of-view are required. The 4DMRI techniques are promising to play a role in motion assessment in radiotherapy treatment planning, delivery, assessment, and adaptation.
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Affiliation(s)
- Guang Li
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, United States
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