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Tseng CL, Zeng KL, Mellon EA, Soltys SG, Ruschin M, Lau AZ, Lutsik NS, Chan RW, Detsky J, Stewart J, Maralani PJ, Sahgal A. Evolving concepts in margin strategies and adaptive radiotherapy for glioblastoma: A new future is on the horizon. Neuro Oncol 2024; 26:S3-S16. [PMID: 38437669 PMCID: PMC10911794 DOI: 10.1093/neuonc/noad258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024] Open
Abstract
Chemoradiotherapy is the standard treatment after maximal safe resection for glioblastoma (GBM). Despite advances in molecular profiling, surgical techniques, and neuro-imaging, there have been no major breakthroughs in radiotherapy (RT) volumes in decades. Although the majority of recurrences occur within the original gross tumor volume (GTV), treatment of a clinical target volume (CTV) ranging from 1.5 to 3.0 cm beyond the GTV remains the standard of care. Over the past 15 years, the incorporation of standard and functional MRI sequences into the treatment workflow has become a routine practice with increasing adoption of MR simulators, and new integrated MR-Linac technologies allowing for daily pre-, intra- and post-treatment MR imaging. There is now unprecedented ability to understand the tumor dynamics and biology of GBM during RT, and safe CTV margin reduction is being investigated with the goal of improving the therapeutic ratio. The purpose of this review is to discuss margin strategies and the potential for adaptive RT for GBM, with a focus on the challenges and opportunities associated with both online and offline adaptive workflows. Lastly, opportunities to biologically guide adaptive RT using non-invasive imaging biomarkers and the potential to define appropriate volumes for dose modification will be discussed.
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Affiliation(s)
- Chia-Lin Tseng
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - K Liang Zeng
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
- Department of Radiation Oncology, Simcoe Muskoka Regional Cancer Program, Royal Victoria Regional Health Centre, University of Toronto, Toronto, Ontario, Canada
| | - Eric A Mellon
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Scott G Soltys
- Department of Radiation Oncology, Stanford University, Stanford, California, USA
| | - Mark Ruschin
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Angus Z Lau
- Physical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Natalia S Lutsik
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Rachel W Chan
- Physical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Jay Detsky
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - James Stewart
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Pejman J Maralani
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Arjun Sahgal
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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Holtzman Gazit M, Faran R, Stepovoy K, Peles O, Shamir RR. Post-operative glioblastoma multiforme segmentation with uncertainty estimation. Front Hum Neurosci 2022; 16:932441. [PMID: 36405078 PMCID: PMC9669429 DOI: 10.3389/fnhum.2022.932441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 09/28/2022] [Indexed: 11/06/2022] Open
Abstract
Segmentation of post-operative glioblastoma multiforme (GBM) is essential for the planning of Tumor Treating Fields (TTFields) treatment and other clinical applications. Recent methods developed for pre-operative GBM segmentation perform poorly on post-operative GBM MRI scans. In this paper we present a method for the segmentation of GBM in post-operative patients. Our method incorporates an ensemble of segmentation networks and the Kullback–Leibler divergence agreement score in the objective function to estimate the prediction label uncertainty and cope with noisy labels and inter-observer variability. Moreover, our method integrates the surgery type and computes non-tumorous tissue delineation to automatically segment the tumor. We trained and validated our method on a dataset of 340 enhanced T1 MRI scans of patients that were treated with TTFields (270 scans for train and 70 scans for test). For validation, we developed a tool that uses the uncertainty map along with the segmentation result. Our tool allows visualization and fast editing of the tissues to improve the results dependent on user preference. Three physicians reviewed and graded our segmentation and editing tool on 12 different MRI scans. The validation set average (SD) Dice scores were 0.81 (0.11), 0.71 (0.24), 0.64 (0.25), and 0.68 (0.19) for whole-tumor, resection, necrotic-core, and enhancing-tissue, respectively. The physicians rated 72% of the segmented GBMs acceptable for treatment planning or better. Another 22% can be edited manually in a reasonable time to achieve a clinically acceptable result. According to these results, the proposed method for GBM segmentation can be integrated into TTFields treatment planning software in order to shorten the planning process. To conclude, we have extended a state-of-the-art pre-operative GBM segmentation method with surgery-type, anatomical information, and uncertainty visualization to facilitate a clinically viable segmentation of post-operative GBM for TTFields treatment planning.
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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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4
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Srinivasan S, Dasgupta A, Chatterjee A, Baheti A, Engineer R, Gupta T, Murthy V. The Promise of Magnetic Resonance Imaging in Radiation Oncology Practice in the Management of Brain, Prostate, and GI Malignancies. JCO Glob Oncol 2022; 8:e2100366. [PMID: 35609219 PMCID: PMC9173575 DOI: 10.1200/go.21.00366] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Magnetic resonance imaging (MRI) has a key role to play at multiple steps of the radiotherapy (RT) treatment planning and delivery process. Development of high-precision RT techniques such as intensity-modulated RT, stereotactic ablative RT, and particle beam therapy has enabled oncologists to escalate RT dose to the target while restricting doses to organs at risk (OAR). MRI plays a critical role in target volume delineation in various disease sites, thus ensuring that these high-precision techniques can be safely implemented. Accurate identification of gross disease has also enabled selective dose escalation as a means to widen the therapeutic index. Morphological and functional MRI sequences have also facilitated an understanding of temporal changes in target volumes and OAR during a course of RT, allowing for midtreatment volumetric and biological adaptation. The latest advancement in linear accelerator technology has led to the incorporation of an MRI scanner in the treatment unit. MRI-guided RT provides the opportunity for MRI-only workflow along with online adaptation for either target or OAR or both. MRI plays a key role in post-treatment response evaluation and is an important tool for guiding decision making. In this review, we briefly discuss the RT-related applications of MRI in the management of brain, prostate, and GI malignancies.
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Affiliation(s)
- Shashank Srinivasan
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Archya Dasgupta
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Abhishek Chatterjee
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Akshay Baheti
- Department of Radiodiagnosis, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Reena Engineer
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Tejpal Gupta
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Vedang Murthy
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
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5
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Stewart J, Sahgal A, Chan AKM, Soliman H, Tseng CL, Detsky J, Myrehaug S, Atenafu EG, Helmi A, Perry J, Keith J, Jane Lim-Fat M, Munoz DG, Zadeh G, Shultz DB, Das S, Coolens C, Alcaide-Leon P, Maralani PJ. Pattern of Recurrence of Glioblastoma Versus Grade 4 IDH-Mutant Astrocytoma Following Chemoradiation: A Retrospective Matched-Cohort Analysis. Technol Cancer Res Treat 2022; 21:15330338221109650. [PMID: 35762826 PMCID: PMC9247382 DOI: 10.1177/15330338221109650] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background and Purpose: To quantitatively compare the recurrence
patterns of glioblastoma (isocitrate dehydrogenase-wild type) versus grade 4
isocitrate dehydrogenase-mutant astrocytoma (wild type isocitrate dehydrogenase
and mutant isocitrate dehydrogenase, respectively) following primary
chemoradiation. Materials and Methods: A retrospective matched
cohort of 22 wild type isocitrate dehydrogenase and 22 mutant isocitrate
dehydrogenase patients were matched by sex, extent of resection, and corpus
callosum involvement. The recurrent gross tumor volume was compared to the
original gross tumor volume and clinical target volume contours from
radiotherapy planning. Failure patterns were quantified by the incidence and
volume of the recurrent gross tumor volume outside the gross tumor volume and
clinical target volume, and positional differences of the recurrent gross tumor
volume centroid from the gross tumor volume and clinical target volume.
Results: The gross tumor volume was smaller for wild type
isocitrate dehydrogenase patients compared to the mutant isocitrate
dehydrogenase cohort (mean ± SD: 46.5 ± 26.0 cm3 vs
72.2 ± 45.4 cm3, P = .026). The recurrent gross
tumor volume was 10.7 ± 26.9 cm3 and 46.9 ± 55.0 cm3
smaller than the gross tumor volume for the same groups
(P = .018). The recurrent gross tumor volume extended outside
the gross tumor volume in 22 (100%) and 15 (68%) (P= .009) of
wild type isocitrate dehydrogenase and mutant isocitrate dehydrogenase patients,
respectively; however, the volume of recurrent gross tumor volume outside the
gross tumor volume was not significantly different (12.4 ± 16.1 cm3
vs 8.4 ± 14.2 cm3, P = .443). The recurrent gross
tumor volume centroid was within 5.7 mm of the closest gross tumor volume edge
for 21 (95%) and 22 (100%) of wild type isocitrate dehydrogenase and mutant
isocitrate dehydrogenase patients, respectively. Conclusion: The
recurrent gross tumor volume extended beyond the gross tumor volume less often
in mutant isocitrate dehydrogenase patients possibly implying a differential
response to chemoradiotherapy and suggesting isocitrate dehydrogenase status
might be used to personalize radiotherapy. The results require validation in
prospective randomized trials.
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Affiliation(s)
- James Stewart
- Department of Radiation Oncology, Sunnybrook 151192Odette Cancer Centre, Toronto, Ontario, Canada
| | - Arjun Sahgal
- Department of Radiation Oncology, Sunnybrook 151192Odette Cancer Centre, Toronto, Ontario, Canada.,Department of Radiation Oncology, 7938University of Toronto, Toronto, Ontario, Canada
| | - Aimee K M Chan
- Department of Medical Imaging, 7938University of Toronto, 71545Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Hany Soliman
- Department of Radiation Oncology, Sunnybrook 151192Odette Cancer Centre, Toronto, Ontario, Canada.,Department of Radiation Oncology, 7938University of Toronto, Toronto, Ontario, Canada
| | - Chia-Lin Tseng
- Department of Radiation Oncology, Sunnybrook 151192Odette Cancer Centre, Toronto, Ontario, Canada.,Department of Radiation Oncology, 7938University of Toronto, Toronto, Ontario, Canada
| | - Jay Detsky
- Department of Radiation Oncology, Sunnybrook 151192Odette Cancer Centre, Toronto, Ontario, Canada.,Department of Radiation Oncology, 7938University of Toronto, Toronto, Ontario, Canada
| | - Sten Myrehaug
- Department of Radiation Oncology, Sunnybrook 151192Odette Cancer Centre, Toronto, Ontario, Canada.,Department of Radiation Oncology, 7938University of Toronto, Toronto, Ontario, Canada
| | - Eshetu G Atenafu
- Department of Biostatistics, 7938University of Toronto, 7989University Health Network, Toronto, Ontario, Canada
| | - Ali Helmi
- Department of Medical Imaging, 7938University of Toronto, 71545Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - James Perry
- Division of Neurology, 7938University of Toronto, 71545Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Julia Keith
- Department of Laboratory Medicine & Pathobiology, 7938University of Toronto, 71545Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Mary Jane Lim-Fat
- Division of Neurology, 7938University of Toronto, 71545Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - David G Munoz
- Department of Pathology, 7938University of Toronto, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Gelareh Zadeh
- Division of Neurosurgery, Department of Surgery, 7938University of Toronto, 7989University Health Network, Toronto, Ontario, Canada
| | - David B Shultz
- Department of Radiation Oncology, 7938University of Toronto, Toronto, Ontario, Canada.,Department of Radiation Oncology, 7989University Health Network, Toronto, Ontario, Canada
| | - Sunit Das
- Division of Neurosurgery, Department of Surgery, 7938University of Toronto, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Catherine Coolens
- Department of Radiation Oncology, 7938University of Toronto, Toronto, Ontario, Canada.,Department of Radiation Oncology, 7989University Health Network, Toronto, Ontario, Canada
| | - Paula Alcaide-Leon
- Department of Medical Imaging, 7938University of Toronto, 7989University Health Network, Toronto, Ontario, Canada
| | - Pejman Jabehdar Maralani
- Department of Medical Imaging, 7938University of Toronto, 71545Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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6
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Stewart J, Sahgal A, Lee Y, Soliman H, Tseng CL, Detsky J, Husain Z, Ho L, Das S, Maralani PJ, Lipsman N, Stanisz G, Perry J, Chen H, Atenafu EG, Campbell M, Lau AZ, Ruschin M, Myrehaug S. Quantitating Interfraction Target Dynamics During Concurrent Chemoradiation for Glioblastoma: A Prospective Serial Imaging Study. Int J Radiat Oncol Biol Phys 2020; 109:736-746. [PMID: 33068687 DOI: 10.1016/j.ijrobp.2020.10.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/18/2020] [Accepted: 10/05/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE Magnetic resonance image (MRI) guided radiation therapy has the potential to improve outcomes for glioblastoma by adapting to tumor changes during radiation therapy. This study quantifies interfraction dynamics (tumor size, position, and geometry) based on sequential magnetic resonance imaging scans obtained during standard 6-week chemoradiation. METHODS AND MATERIALS Sixty-one patients were prospectively imaged with gadolinium-enhanced T1 (T1c) and T2/FLAIR axial sequences at planning (Fx0), fraction 10 (Fx10), fraction 20 (Fx20), and 1 month after the final fraction of chemoradiation therapy (P1M). Gross tumor volumes (GTVs) and clinical target volumes (CTVs) were contoured at all time points. Target dynamics were quantified by absolute volume (V), volume relative to Fx0 (Vrel), and the migration distance (dmigrate; the linear displacement of the GTV or CTV relative to Fx0). Temporal changes were assessed using a linear mixed-effects model. RESULTS Median volumes at Fx0, Fx10, Fx20, and P1M for the GTV were 18.4 cm3 (range, 1.1-110.5 cm3), 14.7 cm3 (range, 0.9-115.1 cm3), 13.7 cm3 (range, 0.6-174.2 cm3), and 13.0 cm3 (range, 0.9-76.3 cm3), respectively, with corresponding median Vrel of 0.88 at Fx10, 0.77 at Fx20, and 0.71 at P1M relative to Fx0 (P < .001 for all). The GTV (CTV) migration distances were greater than 5 mm in 46% (54%) of patients at Fx10, 50% (58%) of patients at Fx20, and 52% (57%) of patients at P1M. Dynamic tumor morphologic changes were observed, with 40% of patients exhibiting a decreased GTV (Vrel ≤1) with a dmigrate >5 mm during chemoradiation therapy. CONCLUSIONS Clinically meaningful tumor dynamics were observed during chemoradiation therapy for glioblastoma, supporting evaluation of daily MRI guided radiation therapy and treatment plan adaptation.
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Affiliation(s)
- James Stewart
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, Toronto, Canada
| | - Arjun Sahgal
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Young Lee
- Department of Radiation Oncology, University of Toronto, Toronto, Canada; Department of Medical Physics, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
| | - Hany Soliman
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Chia-Lin Tseng
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Jay Detsky
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Zain Husain
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Ling Ho
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, Toronto, Canada
| | - Sunit Das
- Division of Neurosurgery and Centre for Ethics, St. Michael's Hospital, Toronto, Canada; The Arthur and Sonia Labatt Brain Tumour Research Centre, SickKids Hospital, Toronto, Canada; Division of Neurosurgery, University of Toronto, Toronto, Canada
| | - Pejman Jabehdar Maralani
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Nir Lipsman
- Division of Neurosurgery, University of Toronto, Toronto, Canada; Department of Physical Sciences, Sunnybrook Research Institute, Toronto, Canada; Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Greg Stanisz
- Department of Physical Sciences, Sunnybrook Research Institute, Toronto, Canada; Department of Medical Biophysics University of Toronto, Toronto, Canada; Department of Neurosurgery and Pediatric Neurosurgery, Medical University, Lublin, Poland
| | - James Perry
- Division of Neurology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Hanbo Chen
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, Toronto, Canada
| | - Eshetu G Atenafu
- Department of Biostatistics, University Health Network, University of Toronto, Toronto, Canada
| | - Mikki Campbell
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, Toronto, Canada
| | - Angus Z Lau
- Department of Physical Sciences, Sunnybrook Research Institute, Toronto, Canada; Department of Medical Biophysics University of Toronto, Toronto, Canada
| | - Mark Ruschin
- Department of Radiation Oncology, University of Toronto, Toronto, Canada; Department of Medical Physics, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
| | - Sten Myrehaug
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada.
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7
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Cheng DC, Chi JH, Yang SN, Liu SH. Organ Contouring for Lung Cancer Patients with a Seed Generation Scheme and Random Walks. SENSORS (BASEL, SWITZERLAND) 2020; 20:E4823. [PMID: 32858982 PMCID: PMC7506591 DOI: 10.3390/s20174823] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 08/20/2020] [Accepted: 08/24/2020] [Indexed: 12/25/2022]
Abstract
In this study, we proposed a semi-automated and interactive scheme for organ contouring in radiotherapy planning for patients with non-small cell lung cancers. Several organs were contoured, including the lungs, airway, heart, spinal cord, body, and gross tumor volume (GTV). We proposed some schemes to automatically generate and vanish the seeds of the random walks (RW) algorithm. We considered 25 lung cancer patients, whose computed tomography (CT) images were obtained from the China Medical University Hospital (CMUH) in Taichung, Taiwan. The manual contours made by clinical oncologists were taken as the gold standard for comparison to evaluate the performance of our proposed method. The Dice coefficient between two contours of the same organ was computed to evaluate the similarity. The average Dice coefficients for the lungs, airway, heart, spinal cord, and body and GTV segmentation were 0.92, 0.84, 0.83, 0.73, 0.85 and 0.66, respectively. The computation time was between 2 to 4 min for a whole CT sequence segmentation. The results showed that our method has the potential to assist oncologists in the process of radiotherapy treatment in the CMUH, and hopefully in other hospitals as well, by saving a tremendous amount of time in contouring.
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Affiliation(s)
- Da-Chuan Cheng
- Department of Biomedical Imaging and Radiological Science, China Medical University, Taichung City 40402, Taiwan;
| | - Jen-Hong Chi
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore 169608, Singapore;
| | - Shih-Neng Yang
- Department of Biomedical Imaging and Radiological Science, China Medical University, Taichung City 40402, Taiwan;
- Department of Radiation Oncology, China Medical University Hospital, Taichung City 40447, Taiwan
| | - Shing-Hong Liu
- Department of Computer Science and Information Engineering Chaoyang University of Technology, Taichung City 41349, Taiwan
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