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Robinson A. Letter to the Editor: reply to "Comparison of patient setup accuracy for optical surface-guided and X-ray-guided imaging with respect to the impact on intracranial stereotactic radiotherapy". Strahlenther Onkol 2024; 200:642-643. [PMID: 38578508 PMCID: PMC11186858 DOI: 10.1007/s00066-024-02223-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/25/2024] [Indexed: 04/06/2024]
Affiliation(s)
- Adi Robinson
- Department of Radiation Oncology, AdventHealth Celebration, 380 Celebration Place Suite 100, 34747, Celebration, FL, USA.
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Rudat V, Shi Y, Zhao R, Yu W. Setup margins based on the inter- and intrafractional setup error of left-sided breast cancer radiotherapy using deep inspiration breath-hold technique (DIBH) and surface guided radiotherapy (SGRT). J Appl Clin Med Phys 2024; 25:e14271. [PMID: 38273673 PMCID: PMC11163505 DOI: 10.1002/acm2.14271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/27/2023] [Accepted: 12/29/2023] [Indexed: 01/27/2024] Open
Abstract
PURPOSE The use of volumetric modulated arc therapy (VMAT), simultaneous integrated boost (SIB), and hypofractionated regimen requires adequate patient setup accuracy to achieve an optimal outcome. The purpose of this study was to assess the setup accuracy of patients receiving left-sided breast cancer radiotherapy using deep inspiration breath-hold technique (DIBH) and surface guided radiotherapy (SGRT) and to calculate the corresponding setup margins. METHODS The patient setup accuracy between and within radiotherapy fractions was measured by comparing the 6DOF shifts made by the SGRT system AlignRT with the shifts made by kV-CBCT. Three hundred and three radiotherapy fractions of 23 left-sided breast cancer patients using DIBH and SGRT were used for the analysis. All patients received pre-treatment DIBH training and visual feedback during DIBH. An analysis of variance (ANOVA) was used to test patient setup differences for statistical significance. The corresponding setup margins were calculated using the van Herk's formula. RESULTS The intrafractional patient setup accuracy was significantly better than the interfractional setup accuracy (p < 0.001). The setup margin for the combined inter- and intrafractional setup error was 4, 6, and 4 mm in the lateral, longitudinal, and vertical directions if based on SGRT alone. The intrafractional error contributed ≤1 mm to the calculated setup margins. CONCLUSION With SGRT, excellent intrafractional and acceptable interfractional patient setup accuracy can be achieved for the radiotherapy of left-sided breast cancer using DIBH and modern radiation techniques. This allows for reducing the frequency of kV-CBCTs, thereby saving treatment time and radiation exposure.
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Affiliation(s)
- Volker Rudat
- Department of Radiation OncologyJiahui International Cancer Center Shanghai, Jiahui HealthShanghaiChina
| | - Yanyan Shi
- Department of Radiation OncologyJiahui International Cancer Center Shanghai, Jiahui HealthShanghaiChina
| | - Ruping Zhao
- Department of Radiation OncologyJiahui International Cancer Center Shanghai, Jiahui HealthShanghaiChina
| | - Wei Yu
- Department of Radiation OncologyJiahui International Cancer Center Shanghai, Jiahui HealthShanghaiChina
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Schöpe M, Sahlmann J, Jaschik S, Findeisen A, Klautke G. Comparison of patient setup accuracy for optical surface-guided and X-ray-guided imaging with respect to the impact on intracranial stereotactic radiotherapy. Strahlenther Onkol 2024; 200:60-70. [PMID: 37971534 DOI: 10.1007/s00066-023-02170-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 10/11/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE The objective of this work is to estimate the patient positioning accuracy of a surface-guided radiation therapy (SGRT) system using an optical surface scanner compared to an X‑ray-based imaging system (IGRT) with respect to their impact on intracranial stereotactic radiotherapy (SRT) and intracranial stereotactic radiosurgery (SRS). METHODS Patient positioning data, both acquired with SGRT and IGRT systems at the same linacs, serve as a basis for determination of positioning accuracy. A total of 35 patients with two different open face masks (578 datasets) were positioned using X‑ray stereoscopic imaging and the patient position inside the open face mask was recorded using SGRT. The measurement accuracy of the SGRT system (in a "standard" and an SRS mode with higher resolution) was evaluated using both IGRT and SGRT patient positioning datasets taking into account the measurement errors of the X‑ray system. Based on these clinically measured datasets, the positioning accuracy was estimated using Monte Carlo (MC) simulations. The relevant evaluation criterion, as standard of practice in cranial SRT, was the 95th percentile. RESULTS The interfractional measurement displacement vector of the SGRT system, σSGRT, in high resolution mode was estimated at 2.5 mm (68th percentile) and 5 mm (95th percentile). If the standard resolution was used, σSGRT increased by about 20%. The standard deviation of the axis-related σSGRT of the SGRT system ranged between 1.5 and 1.8 mm interfractionally and 0.5 and 1.0 mm intrafractionally. The magnitude of σSGRT is mainly due to the principle of patient surface scanning and not due to technical limitations or vendor-specific issues in software or hardware. Based on the resulting σSGRT, MC simulations served as a measure for the positioning accuracy for non-coplanar couch rotations. If an SGRT system is used as the only patient positioning device in non-coplanar fields, interfractional positioning errors of up to 6 mm and intrafractional errors of up to 5 mm cannot be ruled out. In contrast, MC simulations resulted in a positioning error of 1.6 mm (95th percentile) using the IGRT system. The cause of positioning errors in the SGRT system is mainly a change in the facial surface relative to a defined point in the brain. CONCLUSION In order to achieve the necessary geometric accuracy in cranial stereotactic radiotherapy, use of an X‑ray-based IGRT system, especially when treating with non-coplanar couch angles, is highly recommended.
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Affiliation(s)
- Michael Schöpe
- Department of Radiation Oncology, Klinikum Chemnitz gGmbH, Bürgerstraße 2, 09113, Chemnitz, Germany
| | - Jacob Sahlmann
- Department of Radiation Oncology, Klinikum Chemnitz gGmbH, Bürgerstraße 2, 09113, Chemnitz, Germany
| | - Stefan Jaschik
- Department of Radiation Oncology, Klinikum Chemnitz gGmbH, Bürgerstraße 2, 09113, Chemnitz, Germany.
| | - Anne Findeisen
- Department of Radiation Oncology, Klinikum Chemnitz gGmbH, Bürgerstraße 2, 09113, Chemnitz, Germany
| | - Gunther Klautke
- Department of Radiation Oncology, Klinikum Chemnitz gGmbH, Bürgerstraße 2, 09113, Chemnitz, Germany
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Ben Bouchta Y, Gardner M, Sengupta C, Johnson J, Keall P. The Remove-the-Mask Open-Source head and neck Surface-Guided radiation therapy system. Phys Imaging Radiat Oncol 2024; 29:100541. [PMID: 38327762 PMCID: PMC10847032 DOI: 10.1016/j.phro.2024.100541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 12/22/2023] [Accepted: 01/24/2024] [Indexed: 02/09/2024] Open
Abstract
Background and Purpose Surface Guided Radiotherapy (SGRT) for head and neck radiotherapy is challenging as obstructions are common and non-rigid facial motion can compromise surface accuracy. The purpose of this work was to develop and benchmark the Remove the Mask (RtM) SGRT system, an open-source system especially designed to address the challenges faced in radiotherapy of head and neck cancer. Materials and Methods The accuracy of the RtM SGRT system was benchmarked using a head phantom positioned on a robotic motion platform capable of sub-millimetre accuracy which was used to induce unidirectional shifts and to reproduce three real head motion traces. We also assessed the accuracy of the system in ten humans volunteers. The ground truth motion of the volunteers was obtained using a commercial motion capture system with an accuracy < 0.3 mm. Results The mean tracking error of the RtM SGRT system for the ten volunteers was of -0.1 ± 0.4 mm -0.6 ± 0.6 mm and 0.3 ± 0.2 mm, and 0.0 ± 0.2° 0.0 ± 0.1° and 0.0 ± 0.2° for translations and rotations along the left-right, superior-inferior and anterior-posterior axes respectively and we also found similar results in measurements with the head phantom. Forced facial motion was associated with lower tracking accuracy. The RtM SGRT system achieved submillimetre accuracy. Conclusion The RtM SGRT system is a low-cost, easy to build and open-source SGRT system that can achieve an accuracy that meets international commissioning guidelines. Its open-source and modular design allows for the development and easy translation of novel surface tracking techniques.
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Affiliation(s)
| | - Mark Gardner
- The University of Sydney, Camperdown, NSW 2050, Australia
| | | | - Julia Johnson
- The University of Sydney, Camperdown, NSW 2050, Australia
| | - Paul Keall
- The University of Sydney, Camperdown, NSW 2050, Australia
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Stanley DN, Covington E, Harms J, Pogue J, Cardenas CE, Popple RA. Evaluation and correlation of patient movement during online adaptive radiotherapy with CBCT and a surface imaging system. J Appl Clin Med Phys 2023; 24:e14133. [PMID: 37643456 PMCID: PMC10691620 DOI: 10.1002/acm2.14133] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/10/2023] [Accepted: 08/06/2023] [Indexed: 08/31/2023] Open
Abstract
PURPOSE With the clinical implementation of kV-CBCT-based daily online-adaptive radiotherapy, the ability to monitor, quantify, and correct patient movement during adaptive sessions is paramount. With sessions lasting between 20-45 min, the ability to detect and correct for small movements without restarting the entire session is critical to the adaptive workflow and dosimetric outcome. The purpose of this study was to quantify and evaluate the correlation of observed patient movement with machine logs and a surface imaging (SI) system during adaptive radiation therapy. METHODS Treatment machine logs and SGRT registration data log files for 1972 individual sessions were exported and analyzed. For each session, the calculated shifts from a pre-delivery position verification CBCT were extracted from the machine logs and compared to the SGRT registration data log files captured during motion monitoring. The SGRT calculated shifts were compared to the reported shifts of the machine logs for comparison for all patients and eight disease site categories. RESULTS The average (±STD) net displacement of the SGRT shifts were 2.6 ± 3.4 mm, 2.6 ± 3.5 mm, and 3.0 ± 3.2 in the lateral, longitudinal, and vertical directions, respectively. For the treatment machine logs, the average net displacements in the lateral, longitudinal, and vertical directions were 2.7 ± 3.7 mm, 2.6 ± 3.7 mm, and 3.2 ± 3.6 mm. The average difference (Machine-SGRT) was -0.1 ± 1.8 mm, 0.2 ± 2.1 mm, and -0.5 ± 2.5 mm for the lateral, longitudinal, and vertical directions. On average, a movement of 5.8 ± 5.6 mm and 5.3 ± 4.9 mm was calculated prior to delivery for the CBCT and SGRT systems, respectively. The Pearson correlation coefficient between CBCT and SGRT shifts was r = 0.88. The mean and median difference between the treatment machine logs and SGRT log files was less than 1 mm for all sites. CONCLUSION Surface imaging should be used to monitor and quantify patient movement during adaptive radiotherapy.
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Affiliation(s)
- Dennis N. Stanley
- Department of Radiation OncologyUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Elizabeth Covington
- Department of Radiation OncologyUniversity of Alabama at BirminghamBirminghamAlabamaUSA
- Department of Radiation OncologyMichigan MedicineAnn ArborMichiganUSA
| | - Joseph Harms
- Department of Radiation OncologyUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Joel Pogue
- Department of Radiation OncologyUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Carlos E. Cardenas
- Department of Radiation OncologyUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Richard A. Popple
- Department of Radiation OncologyUniversity of Alabama at BirminghamBirminghamAlabamaUSA
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Lai JL, Liu SP, Jiang XX, Liu J, Li A, Li B, Li XK, Ye XJ, Lei KJ, Zhou L. Can Optical Surface Imaging Replace Non-coplanar Cone-beam Computed Tomography for Non-coplanar Set-up Verification in Single-isocentre Non-coplanar Stereotactic Radiosurgery and Hypofractionated Stereotactic Radiotherapy for Single and Multiple Brain Metastases? Clin Oncol (R Coll Radiol) 2023; 35:e657-e665. [PMID: 37778972 DOI: 10.1016/j.clon.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 08/03/2023] [Accepted: 09/18/2023] [Indexed: 10/03/2023]
Abstract
AIMS To conduct a direct comparison regarding the non-coplanar positioning accuracy between the optical surface imaging system Catalyst HDTM and non-coplanar cone-beam computed tomography (NC-CBCT) in intracranial single-isocentre non-coplanar stereotactic radiosurgery (SRS) and hypofractionated stereotactic radiotherapy (HSRT). MATERIALS AND METHODS Twenty patients with between one and five brain metastases who underwent single-isocentre non-coplanar volumetric modulated arc therapy (NC-VMAT) SRS or HSRT were enrolled in this study. For each non-zero couch angle, both Catalyst HDTM and NC-CBCT were used for set-up verification prior to beam delivery. The set-up error reported by Catalyst HDTM was compared with the set-up error derived from NC-CBCT, which was defined as the gold standard. Additionally, the dose delivery accuracy of each non-coplanar field after using Catalyst HDTM and NC-CBCT for set-up correction was measured with SRS MapCHECKTM. RESULTS The median set-up error differences (absolute values) between the two positioning methods were 0.30 mm, 0.40 mm, 0.50 mm, 0.15°, 0.10° and 0.10° in the vertical, longitudinal, lateral, yaw, pitch and roll directions, respectively. The largest absolute set-up error differences regarding translation and rotation were 1.5 mm and 1.1°, which occurred in the longitudinal and yaw directions, respectively. Only 35.71% of the pairs of measurements were within the tolerance of 0.5 mm and 0.5° simultaneously. In addition, the non-coplanar field with NC-CBCT correction yielded a higher gamma passing rate than that with Catalyst HDTM correction (P < 0.05), especially for evaluation criteria of 1%/1 mm with a median increase of 12.8%. CONCLUSIONS Catalyst HDTM may not replace NC-CBCT for non-coplanar set-up corrections in single-isocentre NC-VMAT SRS and HSRT for single and multiple brain metastases. The potential role of Catalyst HDTM in intracranial SRS/HSRT needs to be further studied in the future.
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Affiliation(s)
- J L Lai
- Radiotherapy Physics & Technology Center, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - S P Liu
- Radiotherapy Physics & Technology Center, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - X X Jiang
- Radiotherapy Physics & Technology Center, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - J Liu
- Department of Oncology, Chengdu First People's Hospital, Chengdu, Sichuan, China
| | - A Li
- Radiotherapy Physics & Technology Center, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - B Li
- Radiotherapy Physics & Technology Center, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - X K Li
- West China Clinical Medical College of Sichuan University, Chengdu, Sichuan, China
| | - X J Ye
- Department of Oncology, Yibin Second People's Hospital, Yibin, Sichuan, China
| | - K J Lei
- Department of Oncology, Yibin Second People's Hospital, Yibin, Sichuan, China
| | - L Zhou
- Thoracic Oncology Ward, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China.
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Rudat V, Shi Y, Zhao R, Xu S, Yu W. Setup accuracy and margins for surface-guided radiotherapy (SGRT) of head, thorax, abdomen, and pelvic target volumes. Sci Rep 2023; 13:17018. [PMID: 37813917 PMCID: PMC10562432 DOI: 10.1038/s41598-023-44320-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 10/06/2023] [Indexed: 10/11/2023] Open
Abstract
The goal of the study was to evaluate the inter- and intrafractional patient setup accuracy of target volumes located in the head, thoracic, abdominal, and pelvic regions when using SGRT, by comparing it with that of laser alignment using patient skin marks, and to calculate the corresponding setup margins. A total of 2303 radiotherapy fractions of 183 patients were analyzed. All patients received daily kilovoltage cone-beam computed tomography scans (kV-CBCT) for online verification. From November 2019 until September 2020, patient setup was performed using laser alignment with patient skin marks, and since October 2020, using SGRT. The setup accuracy was measured by the six degrees of freedom (6DOF) corrections based on the kV-CBCT. The corresponding setup margins were calculated using the van Herk formula. Analysis of variance (ANOVA) was used to evaluate the impact of multiple factors on the setup accuracy. The inter-fractional patient setup accuracy was significantly better using SGRT compared to laser alignment with skin marks. The mean three-dimensional vector of the translational setup deviation of tumors located in the thorax, abdomen, and pelvis using SGRT was 3.6 mm (95% confidence interval (CI) 3.3 mm to 3.9 mm) and 4.5 mm using laser alignment with skin marks (95% CI 3.9 mm to 5.2 mm; p = 0.001). Calculation of setup margins for the combined inter- and intra-fractional setup error revealed similar setup margins using SGRT and kV-CBCT once a week compared to laser alignment with skin marks and kV-CBCT every other day. Furthermore, comparable setup margins were found for open-face thermoplastic masks with AlignRT compared to closed-face thermoplastic masks with laser alignment and mask marks. SGRT opens the possibility to reduce the number of CBCTs while maintaining sufficient setup accuracy. The advantage is a reduction of imaging dose and overall treatment time. Open-face thermoplastic masks may be used instead of closed-face thermoplastic masks to increase the patient's comfort.
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Affiliation(s)
- Volker Rudat
- Department of Radiation Oncology, Jiahui International Cancer Center Shanghai, Jiahui Health, Shanghai, China.
| | - Yanyan Shi
- Department of Radiation Oncology, Jiahui International Cancer Center Shanghai, Jiahui Health, Shanghai, China
| | - Ruping Zhao
- Department of Radiation Oncology, Jiahui International Cancer Center Shanghai, Jiahui Health, Shanghai, China
| | - Shuyin Xu
- Department of Radiation Oncology, Jiahui International Cancer Center Shanghai, Jiahui Health, Shanghai, China
| | - Wei Yu
- Department of Radiation Oncology, Jiahui International Cancer Center Shanghai, Jiahui Health, Shanghai, China
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Covington EL, Stanley DN, Sullivan RJ, Riley KO, Fiveash JB, Popple RA. Commissioning and clinical evaluation of the IDENTIFY TM surface imaging system for frameless stereotactic radiosurgery. J Appl Clin Med Phys 2023; 24:e14058. [PMID: 37289550 PMCID: PMC10562042 DOI: 10.1002/acm2.14058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 04/26/2023] [Accepted: 05/11/2023] [Indexed: 06/10/2023] Open
Abstract
PURPOSE To commission and assess the clinical performance of a new commercial surface imaging (SI) system by analyzing intra-fraction motion from the initial cohort of patients treated with frameless stereotactic radiosurgery (fSRS). METHODS The IDENTIFYTM SI system was commissioned for clinical use on an Edge (Varian Medical Systems, Palo Alto, CA) linear accelerator. All patients who received intracranial radiotherapy with HyperArcTM (Varian Medical Systems, Palo Alto, CA) were immobilized with the EncompassTM (Qfix, Avondale, PA) thermoplastic mask and monitored for intra-fraction motion with SI. IDENTIFYTM log files were correlated with trajectory log files to correlate treatment parameters with SI-reported offsets. IDENTIFYTM reported offsets were correlated with gantry and couch angles to assess system performance for obstructed and clear camera field of view. Data were stratified by race to evaluate performance differences due to skin tone. RESULTS All commissioning data were found to meet recommended tolerances. IDENTIFYTM was used to monitor intra-fraction motion on 1164 fractions from 386 patients. The median magnitude of translational SI reported offsets at the end of treatment was 0.27 mm. SI reported offsets were shown to increase when camera pods are blocked by the gantry with larger increases seen at non-zero couch angles. With camera obstruction, the median magnitude of the SI reported offset was 0.50 and 0.80 mm for White and Black patients, respectively. CONCLUSIONS IDENTIFYTM performance during fSRS is comparable to other commercially available SI systems where offsets are shown to increase at non-zero couch angles and during camera pod blockage.
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Affiliation(s)
- Elizabeth L. Covington
- Department of Radiation OncologyUniversity of Alabama at BirminghamBirminghamAlabamaUSA
- Department of Radiation OncologyUniversity of MichiganAnn ArborMichiganUSA
| | - Dennis N. Stanley
- Department of Radiation OncologyUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Rodney J. Sullivan
- Department of Radiation OncologyUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Kristen O. Riley
- Department of NeurosurgeryUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - John B. Fiveash
- Department of Radiation OncologyUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Richard A. Popple
- Department of Radiation OncologyUniversity of Alabama at BirminghamBirminghamAlabamaUSA
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Darréon J, Massabeau C, Geffroy C, Maroun P, Simon L. Surface-guided radiotherapy overview: Technical aspects and clinical applications. Cancer Radiother 2023; 27:504-510. [PMID: 37558608 DOI: 10.1016/j.canrad.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 07/05/2023] [Accepted: 07/07/2023] [Indexed: 08/11/2023]
Abstract
In radiotherapy, patient positioning has long been ensured by ionizing imaging (kV or MV). Over the past ten years, surface-guided radiotherapy has appeared in radiotherapy departments. It is a continuous three-dimensional acquisition of the surface of the patient, based on the use of several optical cameras. The acquired surface is compared to an expected surface (usually taken from the planning scanner). Operators can constantly appreciate poor position, anatomical deformity or patient shift. Thus, the system allows an aid to the positioning of the patient, possibly without tattooing, but also a follow-up of the patient during the duration of the session. The most obvious contribution of the system concerns the treatment of the breast. In fact, for this location, the bone registration is not ideal and the target is visible in surface-guided radiotherapy. These systems also make it possible to treat in deep inspiration breath hold. But several other locations can benefit from it (pelvis, thorax, etc.).
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Affiliation(s)
- J Darréon
- Medical Physics Department, institut Paoli-Calmettes, Marseille, France.
| | - C Massabeau
- Département de radiothérapie, Oncopole Claudius-Regaud (OCR), institut universitaire du cancer de Toulouse Oncopole (IUCT O), Toulouse, France
| | - C Geffroy
- Centre Eugène-Marquis, Rennes, France
| | - P Maroun
- Institut radiothérapie Sud de l'Oise, Creil, France
| | - L Simon
- Département de radiothérapie, Oncopole Claudius-Regaud (OCR), institut universitaire du cancer de Toulouse Oncopole (IUCT O), Toulouse, France; Inserm, équipe Radopt, CNRS, centre de recherches en cancérologie de Toulouse (CRCT), université Paul-Sabatier Toulouse III, Toulouse, France
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Yamamoto Y, Ohira S, Kanayama N, Inui S, Ueda Y, Koike Y, Miyazaki M, Nishio T, Koizumi M, Konishi K. Comparison of dosimetric parameters and robustness for rotational errors in fractionated stereotactic irradiation using automated noncoplanar volumetric modulated arc therapy for patients with brain metastases: single- versus multi-isocentric technique. Radiol Phys Technol 2023; 16:310-318. [PMID: 37093409 DOI: 10.1007/s12194-023-00720-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 04/10/2023] [Accepted: 04/11/2023] [Indexed: 04/25/2023]
Abstract
To compare the dosimetric parameters of automated noncoplanar volumetric modulated arc therapy plans using single-isocentric (SIC) and multi-isocentric (MIC) techniques for patients with two brain metastases (BMs) in stereotactic irradiation and to evaluate the robustness of rotational errors. The SIC and MIC plans were retrospectively generated (35 Gy/five fractions) for 58 patients. Subsequently, a receiver operating characteristic curve analysis between the tumor surface distance (TSD) and V25Gy was performed to determine the thresholds for the brain tissue. The SIC and MIC plans were recalculated based on the rotational images to evaluate the dosimetric impact of rotational error. The MIC plans showed better brain tissue sparing for TSD > 6.6 cm. The SIC plans provided a significantly better conformity index for TSD ≤ 6.6 cm, while significantly lower gradient index was obtained (3.22 ± 0.56vs. 3.30 ± 0.57, p < 0.05) in the MIC plans with TSD > 6.6 cm. For organs at risk (OARs) (brainstem, chiasm, lens, optic nerves, and retinas), D0.1 cc was significantly lower (p < 0.05) in the MIC plans than in the SIC plans. The prescription dose could be delivered (D99%) to the gross tumor volume (GTV) for patients with TSD ≤ 6.6 cm when the rotational error was < 1°, whereas 31% of the D99% of GTV fell below the prescription dose with TSD > 6.6 cm. MIC plans can be an optimal approach for reducing doses to OARs and providing robustness against rotational errors in BMs with TSD > 6.6 cm.
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Affiliation(s)
- Yuki Yamamoto
- Department of Medical Physics and Engineering, Osaka University Graduate School of Medicine, Suita, Japan
| | - Shingo Ohira
- Department of Radiation Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, Osaka, 537-8567, Japan.
| | - Naoyuki Kanayama
- Department of Radiation Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, Osaka, 537-8567, Japan
| | - Shoki Inui
- Department of Radiation Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, Osaka, 537-8567, Japan
| | - Yoshihiro Ueda
- Department of Radiation Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, Osaka, 537-8567, Japan
| | - Yuhei Koike
- Department of Radiology, Kansai Medical University, Osaka, Japan
| | - Masayoshi Miyazaki
- Department of Radiation Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, Osaka, 537-8567, Japan
| | - Teiji Nishio
- Department of Medical Physics and Engineering, Osaka University Graduate School of Medicine, Suita, Japan
| | - Masahiko Koizumi
- Department of Medical Physics and Engineering, Osaka University Graduate School of Medicine, Suita, Japan
| | - Koji Konishi
- Department of Radiation Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, Osaka, 537-8567, Japan
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Nguyen D, Khodri M, Sporea C, Reinoso R, Jacob Y, Farah J. Investigating the robustness of the AlignRT InBore™ co-calibration process and determining the overall tracking errors. Phys Med 2023; 108:102567. [PMID: 36996575 DOI: 10.1016/j.ejmp.2023.102567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 02/05/2023] [Accepted: 03/18/2023] [Indexed: 03/30/2023] Open
Abstract
OBJECTIVE To determine the overall tracking errors inherent to the co-calibration procedure of AlignRT InBore™'s (Vision RT Ltd., London, UK) ceiling-mounted and ring-mounted cameras. METHODS Extrinsic calibration errors related to the mismatch between ceiling and InBore cameras' isocentres and treatment isocentre were determined using MV images and the SRS package and compared to traditional plate-based error. Next, using a realistic anthropomorphic female phantom, intrinsic calibration errors were determined while varying source-skin distance (80 to 100 cm), breast board inclination (0° to 12.5°), room lighting conditions (0 to 258 lx), skin colour (dark, white and natural skin colour), and pod occlusion. RESULTS MV images of the cube proved plate-based calibration to suffer from large errors especially in the vertical direction (up to 2 mm). Intrinsic calibration errors were considerably lower. Indeed, RTD values of ceiling and InBore cameras showed little variability with isocentre depth (within 1.0 mm/0.4°), surface orientation and breast board inclination (within 0.7 mm/0.3°), changing lighting conditions (within 0.1 mm/0.2°), skin colour/tone (within 0.3 mm/0.3°) and camera pod occlusion (within 0.3 mm/0.2°). CONCLUSION The use of MV-images proved critical to maintain co-calibrating errors of ceiling and InBore cameras to Halcyon's treatment isocentre below 1 mm.
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Lai J, Liu S, Liu J, Li X, Chen J, Jia Y, Lei K, Zhou L. Clinical Feasibility of Using Single-isocentre Non-coplanar Volumetric Modulated Arc Therapy Combined with Non-coplanar Cone Beam Computed Tomography in Hypofractionated Stereotactic Radiotherapy for Five or Fewer Multiple Intracranial Metastases. Clin Oncol (R Coll Radiol) 2023; 35:408-416. [PMID: 37002009 DOI: 10.1016/j.clon.2023.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 01/08/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023]
Abstract
AIMS To evaluate the clinical feasibility of single-isocentre non-coplanar volumetric modulated arc therapy (NC-VMAT) with non-coplanar cone beam computed tomography (NC-CBCT) in hypofractionated stereotactic radiotherapy (HSRT) for five or fewer multiple brain metastases. MATERIALS AND METHODS Ten patients with multiple brain metastases who underwent single-isocentre NC-VMAT HSRT with limited couch rotations (within ±45°) and NC-CBCT with a limited scanning range (150-200°) were included in the current analysis. Conventional single-isocentre coplanar VMAT (C-VMAT) plans were generated and compared with NC-VMAT plans. The intracranial response and toxicities of single-isocentre NC-VMAT HSRT were also evaluated. RESULTS Compared with C-VMAT, NC-VMAT generated better target conformity (P < 0.05), a lower gradient index (P < 0.05) and better normal brain tissue sparing, especially for volume ≥12 Gy, with a median reduction of 12.65 cm3. For 45° couch rotation, NC-CBCT produced sufficient image quality to differentiate bony anatomy, even with a 150° scanning range, which could be successfully used for patient set-up correction. After NC-CBCT, 57.1% of the measured non-coplanar set-up errors exceeded the threshold value. The median gamma passing rate of NC-VMAT was higher than that of C-VMAT plans (P < 0.05). The non-coplanar beam of NC-VMAT with NC-CBCT corrections exhibited superior gamma passing rate to that without NC-CBCT corrections. The intracranial objective response rate and disease control rate for all patients were 80% (8/10) and 100% (10/10), respectively, and the most common toxicities were headache (20%) and dizziness (20%). CONCLUSION NC-VMAT with limited couch rotation (within ±45°) combined with NC-CBCT with a limited scanning range (150-200°) markedly improves the plan quality and set-up accuracy in single-isocentre multiple-target HSRT.
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Perrett B, Ukath J, Horgan E, Noble C, Ramachandran P. A Framework for ExacTrac Dynamic Commissioning for Stereotactic Radiosurgery and Stereotactic Ablative Radiotherapy. J Med Phys 2022; 47:398-408. [PMID: 36908493 PMCID: PMC9997535 DOI: 10.4103/jmp.jmp_67_22] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 11/23/2022] [Accepted: 11/24/2022] [Indexed: 01/11/2023] Open
Abstract
This paper aims to provide guidance and a framework for commissioning tests and tolerances for the ExacTrac Dynamic image-guided and surface-guided radiotherapy (SGRT) system. ExacTrac Dynamic includes a stereoscopic X-ray system, a structured light projector, stereoscopic cameras, thermal camera for SGRT, and has the capability to track breath holds and internal markers. The system provides fast and accurate image guidance and intrafraction guidance for stereotactic radiosurgery and stereotactic ablative radiotherapy. ExacTrac Dynamic was commissioned on a recently installed Elekta Versa HD. Commissioning tests are described including safety, isocenter calibration, dosimetry, image quality, data transfer, SGRT stability, SGRT localization, gating, fusion, implanted markers, breath hold, and end-to-end testing. Custom phantom designs have been implemented for assessment of the deep inspiration breath-hold workflow, the implanted markers workflow, and for gating tests where remote-controlled movement of a phantom is required. Commissioning tests were all found to be in tolerance, with maximum translational and rotational deviations in SGRT of 0.3 mm and 0.4°, respectively, and X-ray image fusion reproducibility standard deviation of 0.08 mm. Tolerances were based on published documents and upon the performance characteristics of the system as specified by the vendor. The unique configuration of ExacTrac Dynamic requires the end user to design commissioning tests that validate the system for use in the clinical implementation adopted in the department. As there are multiple customizable workflows available, tests should be designed around these workflows, and can be ongoing as workflows are progressively introduced into departmental procedures.
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Affiliation(s)
- Ben Perrett
- Department of Radiation Oncology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Jaysree Ukath
- Department of Radiation Oncology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Emma Horgan
- Department of Radiation Oncology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Chris Noble
- Department of Radiation Oncology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Prabhakar Ramachandran
- Department of Radiation Oncology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
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Jursinic P, Jordan K, Chen C. Positions of radiation isocenter and the couch rotation center established by Winston-Lutz and optical measurements. Tech Innov Patient Support Radiat Oncol 2022; 21:46-50. [PMID: 35243044 PMCID: PMC8861408 DOI: 10.1016/j.tipsro.2022.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 01/30/2022] [Accepted: 01/31/2022] [Indexed: 12/31/2022] Open
Abstract
Purpose To compare x-ray and optical imaging methods for measuring the relative position of radiation isocenter and couch rotation center. To show the impact of radiation isocenter size and target motion on the margins for target contours. Methods Winston-Lutz measurements are made using EPID images. Image analysis was done with public domain software, ImageJ, and spreadsheets written in Microsoft Excel. A comparison between the center of a high density test object and center of the MLC collimated beam is used to judge the relative position of the radiation isocenter in space for gantry and couch rotation. Additionally, motion of the target with couch rotation is determined with an optical imaging system. Five different accelerators, two TrueBeams, a Trilogy, and two VersaHDs, were assessed by Winston-Lutz and optical methods. Results The shift in the radiation isocenter with gantry rotation is found to be a tri-axial ellipsoid. Shifts in the target position with respect to radiation isocenter with couch rotation were between 0.4 and 0.6 mm. The Winston-Lutz and optical method determination of couch rotation center agreed within measurement uncertainty. Conclusions Image analysis yields precise data on linear accelerator radiation isocenter and rotation centers of the couch. The Winston-Lutz and optical methods agreed within measurement uncertainty.
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Affiliation(s)
- Paul Jursinic
- West Michigan Cancer Center, 200 North Park St., Kalamazoo, MI 49007, USA
- Corresponding author.
| | - Karl Jordan
- St. Vincent’s Private Hospital, Merrion Road, Dublin 4 D04 N2E0, Ireland
| | - Chen Chen
- West Michigan Cancer Center, 200 North Park St., Kalamazoo, MI 49007, USA
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Al-Hallaq HA, Cerviño L, Gutierrez AN, Havnen-Smith A, Higgins SA, Kügele M, Padilla L, Pawlicki T, Remmes N, Smith K, Tang X, Tomé WA. AAPM task group report 302: Surface guided radiotherapy. Med Phys 2022; 49:e82-e112. [PMID: 35179229 PMCID: PMC9314008 DOI: 10.1002/mp.15532] [Citation(s) in RCA: 68] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 12/26/2021] [Accepted: 02/05/2022] [Indexed: 11/06/2022] Open
Abstract
The clinical use of surface imaging has increased dramatically with demonstrated utility for initial patient positioning, real-time motion monitoring, and beam gating in a variety of anatomical sites. The Therapy Physics Subcommittee and the Imaging for Treatment Verification Working Group of the American Association of Physicists in Medicine commissioned Task Group 302 to review the current clinical uses of surface imaging and emerging clinical applications. The specific charge of this task group was to provide technical guidelines for clinical indications of use for general positioning, breast deep-inspiration breath-hold (DIBH) treatment, and frameless stereotactic radiosurgery (SRS). Additionally, the task group was charged with providing commissioning and on-going quality assurance (QA) requirements for surface guided radiation therapy (SGRT) as part of a comprehensive QA program including risk assessment. Workflow considerations for other anatomic sites and for computed tomography (CT) simulation, including motion management are also discussed. Finally, developing clinical applications such as stereotactic body radiotherapy (SBRT) or proton radiotherapy are presented. The recommendations made in this report, which are summarized at the end of the report, are applicable to all video-based SGRT systems available at the time of writing. Review current use of non-ionizing surface imaging functionality and commercially available systems. Summarize commissioning and on-going quality assurance (QA) requirements of surface image-guided systems, including implementation of risk or hazard assessment of surface guided radiotherapy as a part of a total quality management program (e.g., TG-100). Provide clinically relevant technical guidelines that include recommendations for the use of SGRT for general patient positioning, breast DIBH, and frameless brain SRS, including potential pitfalls to avoid when implementing this technology. Discuss emerging clinical applications of SGRT and associated QA implications based on evaluation of technology and risk assessment. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Hania A Al-Hallaq
- Department of Radiation & Cellular Oncology, University of Chicago, Chicago, IL, 60637, USA
| | - Laura Cerviño
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Alonso N Gutierrez
- Department of Radiation Oncology, Miami Cancer Institute, Miami, FL, 33173, USA
| | | | - Susan A Higgins
- Department of Therapeutic Radiology, Yale University, New Haven, CT, 06520, USA
| | - Malin Kügele
- Department of Hematology, Oncology and Radiation Physics, Skåne University, Lund, 221 00, Sweden.,Medical Radiation Physics, Department of Clinical Sciences, Lund University, Lund, 221 00, Sweden
| | - Laura Padilla
- Department of Radiation Medicine & Applied Sciences, University of California, San Diego, La Jolla, CA, 92093, USA
| | - Todd Pawlicki
- Department of Radiation Medicine & Applied Sciences, University of California, San Diego, La Jolla, CA, 92093, USA
| | - Nicholas Remmes
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Koren Smith
- IROC Rhode Island, University of Massachusetts Chan Medical School, Lincoln, RI, 02865, USA
| | | | - Wolfgang A Tomé
- Department of Radiation Oncology and Department of Neurology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, 10461, USA
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Brown TAD, Ayers RG, Popple RA. Commissioning a multileaf collimator virtual cone for the stereotactic radiosurgery of trigeminal neuralgia. J Appl Clin Med Phys 2022; 23:e13562. [PMID: 35157356 PMCID: PMC9121036 DOI: 10.1002/acm2.13562] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 12/15/2021] [Accepted: 02/02/2022] [Indexed: 11/13/2022] Open
Abstract
A multileaf collimator (MLC), virtual‐cone treatment technique has been commissioned for trigeminal neuralgia (TGN) at Tri‐Cities Cancer Center (TCCC). This novel technique was initially developed at the University of Alabama in Birmingham (UAB); it is designed to produce a spherical dose profile similar to a fixed, 5‐mm conical collimator distribution. Treatment is delivered with a 10‐MV flattening‐filter‐free (FFF) beam using a high‐definition MLC on a Varian Edge linear accelerator. Absolute dose output and profile measurements were performed in a 20 × 20 × 14 cm3 solid‐water phantom using an Exradin W2 scintillation detector and Gafchromic EBT3 film. Dose output constancy for the virtual cone was evaluated over 6 months using an Exradin A11 parallel plate chamber. The photo‐neutron dose generated by these treatments was assessed at distances of 50 and 100 cm from isocenter using a Ludlum Model 30–7 Series Neutron Meter. TGN treatments at TCCC have been previously delivered at 6‐MV FFF using a 5‐mm stereotactic cone. To assess the dosimetric impact of using a virtual cone, eight patients previously treated for TGN with a 5‐mm cone were re‐planned using a virtual cone. Seven patients have now been treated for TGN using a virtual cone at TCCC. Patient‐specific quality assurance was performed for each patient using Gafchromic EBT‐XD film inside a Standard Imaging Stereotactic Dose Verification Phantom. The commissioning results demonstrate that the virtual‐cone dosimetry, first described at UAB, is reproducible on a second Edge linear accelerator at an independent clinical site. The virtual cone is a credible alternative to a physical, stereotactic cone for the treatment of TGN at TCCC.
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Affiliation(s)
| | - Rex G Ayers
- Northwest Medical Physics Center, Lynnwood, Washington, USA
| | - Richard A Popple
- Department of Radiation Oncology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
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Brain Linac-Based Radiation Therapy: "Test Drive" of New Immobilization Solution and Surface Guided Radiation Therapy. J Pers Med 2021; 11:jpm11121351. [PMID: 34945823 PMCID: PMC8709255 DOI: 10.3390/jpm11121351] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 12/03/2021] [Accepted: 12/07/2021] [Indexed: 01/17/2023] Open
Abstract
AIM To test inter-fraction reproducibility, intrafraction stability, technician aspects, and patient/physician's comfort of a dedicated immobilization solution for Brain Linac-based radiation therapy (RT). METHODS A pitch-enabled head positioner with an open-face mask were used and, to evaluate inter- and intrafraction variations, 1-3 Cone-Beam Computed Tomography (CBCT) were performed. Surface Guided Radiation Therapy (SGRT) was used to evaluate intrafraction variations at 3 time points: initial (i), final (f), and monitoring (m) (before, end, and during RT). Data regarding technician mask aspect were collected. RESULTS Between October 2019 and April 2020, 69 patients with brain disease were treated: 45 received stereotactic RT and 24 conventional RT; 556 treatment sessions and 863 CBCT's were performed. Inter-fraction CBCT mean values were longitudinally 0.9 mm, laterally 0.8 mm, vertically 1.1 mm, roll 0.58°, pitch 0.59°, yaw 0.67°. Intrafraction CBCT mean values were longitudinally 0.3 mm, laterally 0.3 mm, vertically 0.4 mm, roll 0.22°, pitch 0.33°, yaw 0.24°. SGRT intrafraction mean values were: i_, m_, f_ longitudinally 0.09 mm, 0.45 mm, 0.31 mm; i_, m_, f_ laterally 0.07 mm, 0.36 mm, 0.20 mm; i_, m_, f_ vertically 0.06 mm, 0.31 mm, 0.22 mm; i_, m_, f_ roll 0.025°, 0.208°, 0.118°; i_, m_, f_ pitch 0.036°, 0.307°, 0.194°; i_, m_, f_ yaw 0.039°, 0.274°, 0.189°. CONCLUSIONS This immobilization solution is reproducible and stable. Combining CBCT and SGRT data confirm that 1 mm CTV-PTV margin for Linac-based SRT was adequate. Using open-face mask and SGRT, for conventional RT, radiological imaging could be omitted.
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De Ornelas M, Diwanji T, Monterroso I, Bossart E, Yechieli R, Dogan N, Mellon EA. Assessment of intra-fraction motion during automated linac-based SRS treatment delivery with an open face mask system. Phys Med 2021; 92:69-74. [PMID: 34871889 DOI: 10.1016/j.ejmp.2021.11.012] [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: 06/23/2021] [Revised: 11/17/2021] [Accepted: 11/24/2021] [Indexed: 10/19/2022] Open
Abstract
PURPOSE/OBJECTIVE To evaluate intra-fraction target shift during automated mono-isocentric linac-based stereotactic radiosurgery with open-face mask system and optical real-time tracking. MATERIALS/METHODS Ninety-five patients were treated using automated linac-based stereotactic radiosurgery in 1-5 fractions with single isocenter for a total of 195 fractions. During treatment, patient positioning was tracked real-time with optical surface guidance and immobilized with a rigid open-face mask. Patients were re-positioned if optical surface guidance error exceeded 1 mm magnitude or 1°. Translational and rotational intra-fractional changes were determined by post-treatment CBCT matched to the planning CT. Target specific error was calculated by translation and rotation matrices applied to isocenter and target spatial coordinates. RESULTS For 132 fractions with isocenter within a single target, the median shift magnitude was 0.40 mm with a maximum shift of 1.17 mm. A total of 398 targets treated for plans having multiple or single targets that lied outside isocenter, resulted in a median shift magnitude of 0.46 mm, with median translational shifts of 0.20 mm and 0.20° rotational shifts. A 1 mm PTV margin was insufficient in 18% of targets at a distance greater than 6 cm away from isocenter, but sufficient for 96% of targets within 6 cm. CONCLUSIONS The findings of this study support 1 mm PTV expansion due to intra-fraction motion to ensure target coverage for plans with isocenter placement less than 6 cm away from the targets.
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Affiliation(s)
- Mariluz De Ornelas
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, FL, USA.
| | - Tejan Diwanji
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Irene Monterroso
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Elizabeth Bossart
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Raphael Yechieli
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Nesrin Dogan
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Eric A Mellon
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, FL, USA
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Koo J, Nardella L, Degnan M, Andreozzi J, Yu HHM, Penagaricano J, Johnstone PAS, Oliver D, Ahmed K, Rosenberg SA, Wuthrick E, Diaz R, Feygelman V, Latifi K, Moros EG, Redler G. Triggered kV Imaging During Spine SBRT for Intrafraction Motion Management. Technol Cancer Res Treat 2021; 20:15330338211063033. [PMID: 34855577 PMCID: PMC8649431 DOI: 10.1177/15330338211063033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose: To monitor intrafraction motion during spine stereotactic body radiotherapy(SBRT) treatment delivery with readily available technology, we implemented triggered kV imaging using the on-board imager(OBI) of a modern medical linear accelerator with an advanced imaging package. Methods: Triggered kV imaging for intrafraction motion management was tested with an anthropomorphic phantom and simulated spine SBRT treatments to the thoracic and lumbar spine. The vertebral bodies and spinous processes were contoured as the image guided radiotherapy(IGRT) structures specific to this technique. Upon each triggered kV image acquisition, 2D projections of the IGRT structures were automatically calculated and updated at arbitrary angles for display on the kV images. Various shifts/rotations were introduced in x, y, z, pitch, and yaw. Gantry-angle-based triggering was set to acquire kV images every 45°. A group of physicists/physicians(n = 10) participated in a survey to evaluate clinical efficiency and accuracy of clinical decisions on images containing various phantom shifts. This method was implemented clinically for treatment of 42 patients(94 fractions) with 15 second time-based triggering. Result: Phantom images revealed that IGRT structure accuracy and therefore utility of projected contours during triggered imaging improved with smaller CT slice thickness. Contouring vertebra superior and inferior to the treatment site was necessary to detect clinically relevant phantom rotation. From the survey, detectability was proportional to the shift size in all shift directions and inversely related to the CT slice thickness. Clinical implementation helped evaluate robustness of patient immobilization. Based on visual inspection of projected IGRT contours on planar kV images, appreciable intrafraction motion was detected in eleven fractions(11.7%). Discussion: Feasibility of triggered imaging for spine SBRT intrafraction motion management has been demonstrated in phantom experiments and implementation for patient treatments. This technique allows efficient, non-invasive monitoring of patient position using the OBI and patient anatomy as a direct visual guide.
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Affiliation(s)
- Jihye Koo
- 7831University of South Florida, 33620, USA.,25301H. Lee Moffitt Cancer Center, 33612, USA
| | | | - Michael Degnan
- 549472The Ohio State University, 43210, Columbus, OH, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | - Gage Redler
- 25301H. Lee Moffitt Cancer Center, 33612, USA
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Dekker J, van Wagenberg TP, de Smet M, Essers M, Kusters M, de Kruijf W. Geometrical analysis for motion monitoring of rigid bodies with optical surface scanning in radiation oncology. Phys Imaging Radiat Oncol 2021; 20:105-110. [PMID: 34901475 PMCID: PMC8640514 DOI: 10.1016/j.phro.2021.11.006] [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: 06/02/2021] [Revised: 11/15/2021] [Accepted: 11/17/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND PURPOSE Surface guided radiotherapy can be used to improve patient setup and for accurate intra-fraction motion monitoring in correspondence to the isocenter. For a clinical relevant motion analysis the actual displacement of the entire clinical target volume (CTV) is necessary. Therefore, the aim of this study was to develop a novel assessment method for intra-fraction motion for rigid body structures based on motion data and a geometrical analysis. MATERIALS AND METHODS A threshold value on the volume coverage (VC(t)) of the CTV by the planning target volume (PTV) was proposed as online motion monitoring method. Moreover, offline analysis was performed by using heat maps and by calculating VCx, the volume coverage for at least x% of treatment time. The method was applied retrospectively to patient treatment data for whole brain radiation treatment without a thermoplastic mask. RESULTS In 132 out of 142 fractions in total the proportion of the CTV that was inside the PTV for at least 99% of the time (VC99) was more than 95%, for a CTV-to-PTV margin of 5 mm. The source-voxel heat map showed which part of the CTV had a reduced coverage and the target heat map showed the movement of the CTV. CONCLUSION Instead of using an action threshold on the movements of the isocenter, a threshold on the VC(t) of the CTV by the PTV was proposed. The heat maps and resulting values of VCx can be used to adapt the VC(t) threshold or the CTV-to-PTV margin for subsequent fractions.
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Affiliation(s)
- Janita Dekker
- Instituut Verbeeten, Klinische Fysica & Instrumentatie, Postbus 90120, 5000 LA Tilburg, The Netherlands
| | - Teun Pieter van Wagenberg
- Instituut Verbeeten, Klinische Fysica & Instrumentatie, Postbus 90120, 5000 LA Tilburg, The Netherlands
- Department of Biomedical Engineering, Eindhoven University of Technology, Den Dolech 2, 5612 AZ Eindhoven, The Netherlands
| | - Mariska de Smet
- Instituut Verbeeten, Klinische Fysica & Instrumentatie, Postbus 90120, 5000 LA Tilburg, The Netherlands
| | - Marion Essers
- Instituut Verbeeten, Klinische Fysica & Instrumentatie, Postbus 90120, 5000 LA Tilburg, The Netherlands
| | - Martijn Kusters
- Department of Radiation Oncology, Radboud University Medical Center, Geert Grooteplein 32, 6525 GA Nijmegen, The Netherlands
| | - Willy de Kruijf
- Instituut Verbeeten, Klinische Fysica & Instrumentatie, Postbus 90120, 5000 LA Tilburg, The Netherlands
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Naim A, Mansouri S, Saidi K, ELBaydaoui R, Mesradi MR. Innovative Non-Irradiating and Non-Invasive Per Fraction Control System in Radiotherapy: Surface-Guided Radiation Therapy Experience of Casablanca Cancer Center. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose: Evaluation of the added value of radiotherapy guided by the cutaneous
surface in the positioning and monitoring of the radiotherapy
Patients and Methods: This study included 21 consecutive patients treated with an
accelerator dedicated to "True Beam®" stereotactic radiotherapy whose sessions were
monitored by an Optical Surface Monitoring System: "OSMS®". Excluded from our
study were treatments controlled exclusively by radiological imaging (IGRT).
Positioning variabilities were compared between conventional imaging and skin
surface infrared (OSMS) monitoring. Conventional imaging was in the form of
standard radiography (KV) performed during the treatment session or three-
dimensional by a series of Cone Beam computerized tomography (CBCT) scanned
images made at the beginning and end of The total time of the session and
the positioning variability’s in the 3 planes were
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Results: The results of our study show that the cutaneous surface monitoring allowed
to obtain a faster alignment of the patient with an improvement in the overall time of
the session with a mean at 32% [14.5-49.27%], likewise a sub-millimeter positioning
quality for all locations with a median longitudinal distance of 0.02 cm [0-0.66], 01
cm verticality [0-0.32] and laterality 0.02 cm [0-0.77] This benefit is significantly
greater for cerebral and Head and neck’s localizations
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Conclusion: Optical Surface Monitoring System (OSMS®) is a non-invasive and non-
irradiating means that allows reliable and fast
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Covington EL, Popple RA. A Low-Cost Method to Assess the Performance of Surface Guidance Imaging Systems at Non-Zero Couch Angles. Cureus 2021; 13:e14278. [PMID: 33959456 PMCID: PMC8093097 DOI: 10.7759/cureus.14278] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
A procedure is presented to assess performance at non-zero couch angles and perform routine quality assurance (QA) on surface-guided radiotherapy (SGRT) imaging systems used for stereotactic radiosurgery (SRS). A low-cost anthropomorphic phantom was used to assess the system under patient-like conditions. The phantom is embedded with a tungsten ball bearing (BB) to facilitate the use of surface imaging (SI) with concurrent megavoltage (MV) imaging to cross-compare and validate SI-reported offsets. Data analysis is done via in-house software that utilized the SGRT system’s log files for automated analysis. This procedure enables users to assess and inter-compare MV-reported offsets with their SGRT system. The analysis provides SGRT system residual error so that users are aware of inherent offsets present in addition to increases in translational offsets due to couch walkout. The procedure was validated with two commercial SGRT systems. The procedure can be used with any surface imaging system and linear accelerator system.
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Affiliation(s)
| | - Richard A Popple
- Radiation Oncology, University of Alabama at Birmingham, Birmingham, USA
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Popple RA, Brown MH, Thomas EM, Willey CD, Cardan RA, Covington EL, Riley KO, Markert JM, Bredel M, Fiveash JB. Transition From Manual to Automated Planning and Delivery of Volumetric Modulated Arc Therapy Stereotactic Radiosurgery: Clinical, Dosimetric, and Quality Assurance Results. Pract Radiat Oncol 2021; 11:e163-e171. [PMID: 33632630 DOI: 10.1016/j.prro.2020.10.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/24/2020] [Accepted: 10/21/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Properly planned single isocenter volumetric modulated arc therapy (VMAT) radiosurgery plans exhibit high quality and efficiency. We report here the largest clinical experience to date, to our knowledge, comparing manual planning with a new automated platform designed to standardize and simplify radiosurgery planning and delivery processes. METHODS We treated 693 patients with single isocenter VMAT radiosurgical plans generated by either our conventional manual (mVMAT) or a recently implemented automated (HyperArcTM) technique. All plans targeted the gross tumor volume without margin. Radiochromic film was used for patient-specific quality assurance (PSQA). We evaluated local control and toxicity data for a subgroup of 107 patients having 377 metastatic tumors that were treated with HyperArc. RESULTS The median Radiation Therapy Oncology Group (RTOG) conformity index was 1.14 and was not different between the 2 techniques. The median Paddick gradient index was 5.42 for HyperArc versus 7.09 for mVMAT (P < .001). The median mean brain doses were 4.6% and 5.1% for HyperArc and mVMAT, respectively (P = .04). The PSQA for both techniques met clinical criteria, but 97% of the HyperArc plans satisfied the gamma tolerance limit recommended by the American Association of Physicists in Medicine Task Group No. 218, compared with 94% of the mVMAT plans (P = .02). The median treatment-planning times were not significantly different. The median treatment times were 10.5 and 11.4 minutes for HyperArc and mVMAT, respectively (P < .001). The Kaplan-Meier estimate of local control was 90.1% at 1 year. CONCLUSIONS HyperArc produces high-quality radiosurgical plans that are at least as good as mVMAT plans created by an expert manual planner with easier planning and more efficient delivery workflow. A less experienced planner can produce very high-quality radiosurgical plans even for patients with more than 10 targets. The use of a single-isocenter technique for multiple targets with no PTV margin did not compromise clinical outcomes, and 1-year local control for treated targets remained congruent with historical series.
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Affiliation(s)
- Richard A Popple
- Department of Radiation Oncology, The University of Alabama at Birmingham, Birmingham, Alabama.
| | - Matthew H Brown
- Department of Radiation Oncology, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Evan M Thomas
- Department of Radiation Oncology, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Christopher D Willey
- Department of Radiation Oncology, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Rex A Cardan
- Department of Radiation Oncology, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Elizabeth L Covington
- Department of Radiation Oncology, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Kristen O Riley
- Department of Neurosurgery, The University of Alabama at Birmingham, Birmingham, Alabama
| | - James M Markert
- Department of Neurosurgery, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Markus Bredel
- Department of Radiation Oncology, The University of Alabama at Birmingham, Birmingham, Alabama
| | - John B Fiveash
- Department of Radiation Oncology, The University of Alabama at Birmingham, Birmingham, Alabama
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Bossart E, Mellon EA, Monterroso I, Elsayyad N, Diwanji T, Samuels S, Dogan N. Assessment of single isocenter linear accelerator radiosurgery for metastases and base of skull lesions. Phys Med 2020; 81:1-8. [PMID: 33278764 DOI: 10.1016/j.ejmp.2020.11.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 08/22/2020] [Accepted: 11/07/2020] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Newer technology for stereotactic radiosurgery (SRS) should be assessed for different multi-leaf collimators (MLC). OBJECTIVE Assess plan quality of an automated, frameless, linear accelerator based (linac) planning and delivery system (HyperArc) for SRS using both standard MLC (SMLC) and high definition MLC (HDMLC) compared to a cobalt-60 based SRS system (Gamma Knife, GK). METHODS We re-planned twenty GK Perfexion-treated SRS patients (27 lesions) for HyperArc using SMLC and HDMLC. We assessed plan quality using the following metrics: gradient index (GI), Paddick and RTOG conformity indices (CIPaddick, CIRTOG), volume receiving half of prescription isodose (PIVhalf) and maximum dose to 0.03 cc for brainstem, optic chiasm and optic nerves, and V12Gy for brain-GTV. RESULTS Linac plans had better conformity with HDMLC being most conformal. GK exhibited better GI. PIVhalf demonstrated no statistically significant difference between HDMLC and GK, and SMLC was nominally worse than GK. Mean PIVhalf was generally 0.85 cc larger for SMLC than HDMLC. For TV > 1.0 cc, the relative differences in CIRTOG, GI, and PIVhalf for SMLC vs. HDMLC were less than 21%. For TV less than < 1.0 cc, there were more obvious relative differences for SMLC vs. HDMLC in CIRTOG (mean 146%, max 700%), GI (mean 49%, max 162%), and PIVhalf (mean 77%, max 522%). Organ at risk doses were met in all plans. CONCLUSIONS New linac-based plans positively compare to GK plans overall. HDMLC should be strongly considered for treatment of lesions < 1.0 cc given the significant improvements in conformity and PIVhalf over SMLC.
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Affiliation(s)
- Elizabeth Bossart
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Eric A Mellon
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Irene Monterroso
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Nagy Elsayyad
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Tejan Diwanji
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Stuart Samuels
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Nesrin Dogan
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
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Covington EL, Stanley DN, Fiveash JB, Thomas EM, Marcrom SR, Bredel M, Willey CD, Riley KO, Popple RA. Surface guided imaging during stereotactic radiosurgery with automated delivery. J Appl Clin Med Phys 2020; 21:90-95. [PMID: 33095971 PMCID: PMC7769383 DOI: 10.1002/acm2.13066] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/29/2020] [Accepted: 09/22/2020] [Indexed: 01/31/2023] Open
Abstract
PURPOSE To report on the use of surface guided imaging during frameless intracranial stereotactic radiotherapy with automated delivery via HyperArcTM (Varian Medical Systems, Palo Alto, CA). METHODS All patients received intracranial radiotherapy with HyperArcTM and were monitored for intrafraction motion by the AlignRT® (VisionRT, London, UK) surface imaging (SI) system. Immobilization was with the EncompassTM (Qfix, Avondale, PA) aquaplast mask device. AlignRT® log files were correlated with trajectory log files to correlate treatment parameters with SI reported offsets. SI reported offsets were correlated with gantry angle and analyzed for performance issues at non-zero couch angles and during camera-pod blockage during gantry motion. Demographics in the treatment management system were used to identify race and determine if differences in SI reported offsets are due to skin tone settings. RESULTS A total of 981 fractions were monitored over 14 months and 819 were analyzed. The median AlignRT® reported motion from beginning to the end of treatment was 0.24 mm. The median offset before beam on at non-zero couch angles was 0.55 mm. During gantry motion when camera pods are blocked, the median magnitude was below 1 mm. Median magnitude of offsets at non-zero couch angles was not found to be significantly different for patients stratified by race. CONCLUSIONS Surface image guidance is a viable alternative to scheduled mid-treatment imaging for monitoring intrafraction motion during stereotactic radiosurgery with automated delivery.
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Affiliation(s)
- Elizabeth L Covington
- Department of Radiation Oncology, University of Alabama - Birmingham, Birmingham, AL, USA
| | - Dennis N Stanley
- Department of Radiation Oncology, University of Alabama - Birmingham, Birmingham, AL, USA
| | - John B Fiveash
- Department of Radiation Oncology, University of Alabama - Birmingham, Birmingham, AL, USA
| | - Evan M Thomas
- Department of Radiation Oncology, University of Alabama - Birmingham, Birmingham, AL, USA
| | - Samuel R Marcrom
- Department of Radiation Oncology, University of Alabama - Birmingham, Birmingham, AL, USA
| | - Marcus Bredel
- Department of Radiation Oncology, University of Alabama - Birmingham, Birmingham, AL, USA
| | - Christopher D Willey
- Department of Radiation Oncology, University of Alabama - Birmingham, Birmingham, AL, USA
| | - Kristen O Riley
- Department of Neurosurgery, University of Alabama - Birmingham, Birmingham, AL, USA
| | - Richard A Popple
- Department of Radiation Oncology, University of Alabama - Birmingham, Birmingham, AL, USA
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Pallotta S, Kugele M, Redapi L, Ceberg S. Validation of a commercial deformable image registration for surface-guided radiotherapy using an ad hoc-developed deformable phantom. Med Phys 2020; 47:6310-6318. [PMID: 33034065 DOI: 10.1002/mp.14527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/31/2020] [Accepted: 09/30/2020] [Indexed: 12/15/2022] Open
Abstract
PURPOSE The use of optical surface systems (OSSs) for patient setup verification in external radiation therapy is increasing. To manage potential deformations in a patient's anatomy, a novel deformable image registration (DIR) tool has been applied in a commercial OSS. In this study we investigate the accuracy of the DIR as compared to rigid image registration (RR). METHODS AND MATERIALS The positioning accuracy of the DIR and RR implemented in the OSS was investigated using an ad hoc-developed anthropomorphic deformable phantom, named Mary. The phantom consists of 33 slices of expanded polystyrene slabs shaped thus to simulate part of a female body. Anatomical details, simulating the ribs and spinal cord, together with 10 inner targets at different depths are included in thorax and abdominal parts. Mary is capable of realistic body movements and deformations, such as head and arm rotations, body torsion and moderate breast/abdomen swelling. The accuracy of DIR and RR was investigated for four internal targets after deliberately deforming the phantom nine times. Breast and abdomen enlargements and torsions around x, y, and z axes were applied. For reference purposes, rigid displacements (where Mary's anatomy was kept intact) were included. The phantom was positioned on the linac couch under the OSS guidance and for each target and displacement a CBCT was acquired. The accuracy of DIR and RR was assessed evaluating the difference in means of absolute values between CBCT and the OSS registration parameters (lateral, longitudinal, vertical, rot, pitch, and roll), using both a reference surface extracted from CT (CTr) or acquired with the OSS (OSSr). A comparison of the four different combinations, DIR + OSSr, DIR + CTr, RR + OSSr, and RR + CTr, was carried out to evaluate the position accuracy for the various combinations. Finally, the positioning accuracy of the different target positions using only OSSr was investigated for the DIR. A paired sample Wilcoxon signed-rank test (P < 0.05) and a two-tailed Mann-Whitney test (P < 0.05) were carried out. RESULTS The DIR in combination with OSSr showed significantly (P < 0.05) improved positioning accuracy in the lateral and longitudinal directions and in pitch, compared to RR, when deformations were applied to Mary. The positioning accuracy improved from 1.9 ± 1.5 mm, 1.1 ± 0.8 mm to 1.1 ± 1.2 mm, 0.6 ± 0.5 mm in lateral and longitudinal directions, respectively, and from 0.8 ± 0.6° to 0.4 ± 0.4° in pitch, using DIR compared to RR. Both the DIR and RR showed a similar positioning accuracy when rigid displacements of Mary were applied. For DIR, the OSSr generally showed improved calculation accuracy compared to CTr. Independent of the reference image used, the target position influenced the registration accuracy, and hence, one target could not be evaluated using RR due to its inability to calculate the correct position. CONCLUSIONS Improved positioning accuracy was observed for DIR with respect to RR when deformations of Mary's anatomy were applied. For both DIR and RR, improved positioning accuracy was observed using OSSr as compared to CTr. The position of the target inside the phantom influenced the positioning accuracy for DIR.
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Affiliation(s)
- Stefania Pallotta
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy.,Medical Physics Unit AOU Careggi, Florence, Italy
| | - Malin Kugele
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden.,Medical Radiation Physics, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Laura Redapi
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Sofie Ceberg
- Medical Radiation Physics, Department of Clinical Sciences, Lund University, Lund, Sweden
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Freislederer P, Kügele M, Öllers M, Swinnen A, Sauer TO, Bert C, Giantsoudi D, Corradini S, Batista V. Recent advanced in Surface Guided Radiation Therapy. Radiat Oncol 2020; 15:187. [PMID: 32736570 PMCID: PMC7393906 DOI: 10.1186/s13014-020-01629-w] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 07/21/2020] [Indexed: 01/27/2023] Open
Abstract
The growing acceptance and recognition of Surface Guided Radiation Therapy (SGRT) as a promising imaging technique has supported its recent spread in a large number of radiation oncology facilities. Although this technology is not new, many aspects of it have only recently been exploited. This review focuses on the latest SGRT developments, both in the field of general clinical applications and special techniques.SGRT has a wide range of applications, including patient positioning with real-time feedback, patient monitoring throughout the treatment fraction, and motion management (as beam-gating in free-breathing or deep-inspiration breath-hold). Special radiotherapy modalities such as accelerated partial breast irradiation, particle radiotherapy, and pediatrics are the most recent SGRT developments.The fact that SGRT is nowadays used at various body sites has resulted in the need to adapt SGRT workflows to each body site. Current SGRT applications range from traditional breast irradiation, to thoracic, abdominal, or pelvic tumor sites, and include intracranial localizations.Following the latest SGRT applications and their specifications/requirements, a stricter quality assurance program needs to be ensured. Recent publications highlight the need to adapt quality assurance to the radiotherapy equipment type, SGRT technology, anatomic treatment sites, and clinical workflows, which results in a complex and extensive set of tests.Moreover, this review gives an outlook on the leading research trends. In particular, the potential to use deformable surfaces as motion surrogates, to use SGRT to detect anatomical variations along the treatment course, and to help in the establishment of personalized patient treatment (optimized margins and motion management strategies) are increasingly important research topics. SGRT is also emerging in the field of patient safety and integrates measures to reduce common radiotherapeutic risk events (e.g. facial and treatment accessories recognition).This review covers the latest clinical practices of SGRT and provides an outlook on potential applications of this imaging technique. It is intended to provide guidance for new users during the implementation, while triggering experienced users to further explore SGRT applications.
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Affiliation(s)
- P. Freislederer
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - M. Kügele
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
- Medical Radiation Physics, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - M. Öllers
- Maastricht Radiation Oncology (MAASTRO), Maastricht, the Netherlands
| | - A. Swinnen
- Maastricht Radiation Oncology (MAASTRO), Maastricht, the Netherlands
| | - T.-O. Sauer
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - C. Bert
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - D. Giantsoudi
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | - S. Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - V. Batista
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor diseases (NCT), Heidelberg, Germany
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Swinnen ACC, Öllers MC, Loon Ong C, Verhaegen F. The potential of an optical surface tracking system in non-coplanar single isocenter treatments of multiple brain metastases. J Appl Clin Med Phys 2020; 21:63-72. [PMID: 32237274 PMCID: PMC7324699 DOI: 10.1002/acm2.12866] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 01/23/2020] [Accepted: 02/24/2020] [Indexed: 12/25/2022] Open
Abstract
To evaluate the accuracy of a commercial optical surface tracking (OST) system and to demonstrate how it can be implemented to monitor patient positioning during non‐coplanar single isocenter stereotactic treatments of brain metastases. A 3‐camera OST system was used (Catalyst HD™, C‐RAD) on a TruebeamSTx with a 6DoF couch. The setup accuracy and agreement between the OST system, and CBCT and kV‐MV imaging at couch angles 0° and 270°, respectively, were examined. Film measurements at 3 depths in the Rando‐Alderson phantom were performed using a single isocenter non‐coplanar VMAT plan containing 4 brain lesions. Setup of the phantom was performed with CBCT at couch 0° and subsequently monitored by OST at other couch angles. Setup data for 7 volunteers were collected to evaluate the accuracy and reproducibility of the OST system at couch angles 0°, 45°, 90°, 315°, and 270°. These results were also correlated to the couch rotation offsets obtained by a Winston‐Lutz (WL) test. The Rando‐Alderson phantom, as well as volunteers, were fixated using open face masks (Orfit). For repeated tests with the Rando‐Alderson phantom, deviations between rotational and translational isocenter corrections for CBCT and OST systems are always within 0.2° (pitch, roll, yaw), and 0.1mm and 0.5mm (longitudinal, lateral, vertical) for couch positions 0° and 270°, respectively. Dose deviations between the film and TPS doses in the center of the 4 lesions were −1.2%, −0.1%, −0.0%, and −1.9%. Local gamma evaluation criteria of 2%/2 mm and 3%/1 mm yielded pass rates of 99.2%, 99.2%, 98.6%, 89.9% and 98.8%, 97.5%, 81.7%, 78.1% for the 4 lesions. Regarding the volunteers, the mean translational and rotational isocenter shift values were (0.24 ± 0.09) mm and (0.15 ± 0.07) degrees. Largest isocenter shifts were found for couch angles 45˚ and 90˚, confirmed by WL couch rotation offsets. Patient monitoring during non‐coplanar VMAT treatments of brain metastases is feasible with submillimeter accuracy.
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Affiliation(s)
| | | | - Chin Loon Ong
- Department of Radiation Oncology, HagaZiekenhuis, Den Haag, the Netherlands
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