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Hou WH, Chen MB, Chou R, Chen AY. Intra-fractional corrections and clinical outcomes in frameless image-guided radiosurgery for trigeminal neuralgia. JOURNAL OF RADIOSURGERY AND SBRT 2024; 9:135-143. [PMID: 39087055 PMCID: PMC11288655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 01/26/2024] [Indexed: 08/02/2024]
Abstract
Purpose Precision targeting is crucial to successful stereotactic radiosurgery for trigeminal neuralgia (TGN). We investigated the impact of intra-fractional 6-dimensional corrections during frameless image-guided radiosurgery (IGRS) for pain outcome in TGN patients. Materials and methods A total of 41 sets of intra-fractional corrections from 35 patients with TGN treated by frameless IGRS from 2009 to 2013 were retrospectively studied. For each IGRS, the intra-fractional 6-dimensional shifts were conducted at 6 couch angles. Clinical pain outcome was recorded according the Barrow Neurological Institute (BNI) 5-points score. The relationship in 6-dimensional corrections and absolute translational distances between patients with pain relief score points <2 versus ≥2 were analyzed. Results The absolute mean lateral, longitudinal, and vertical translational shifts were 0.46 ± 0.15 mm, 0.36 ± 0.16 mm and 0.21 ± 0.08 mm, respectively, with 97% of translational shifts being within 0.7 mm. The absolute mean lateral (pitch), longitudinal (roll), and vertical (yaw) rotational corrections are 0.33 ± 0.24°, 0.18 ± 0.09°, and 0.27 ± 0.15°, respectively, with 97% of rotational corrections being within 0.6°. The median follow-up duration for pain outcome was 26 months after IGRS. The average calculated absolute shift for patients with pain relief <2 and ≥2 BNI points, were 0.228 ± 0.008 mm and 0.259 ± 0.007 mm, respectively. There was no statistically significant difference in the translational shifts, rotational corrections or absolute distances between these two patient groups. Conclusions Our data demonstrate high spatial targeting accuracy of frameless IGRS for TGN with only nominal intra-fraction 6-dimensional corrections.
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Affiliation(s)
- Wei-Hsien Hou
- Department of Radiation Oncology, Guam Regional Medical City, Dededo, Guam, USA
| | - Michelle B. Chen
- Department of Radiation Oncology, Sacramento Medical Center, The Permanente Medical Group, Sacramento, CA, USA
| | - Rachel Chou
- Department of Radiation Oncology, Sacramento Medical Center, The Permanente Medical Group, Sacramento, CA, USA
| | - Allan Y. Chen
- College of Medicine, California Northstate University, Elk Grove, CA, USA
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Janssen J, Brouwer CL, Staal FH, van Herpt HE, Both S, Langendijk JA, Aluwini S. Simple immobilization for stereotactic radiotherapy aimed at pelvic metastases. Phys Imaging Radiat Oncol 2023; 27:100460. [PMID: 37435559 PMCID: PMC10331836 DOI: 10.1016/j.phro.2023.100460] [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: 02/09/2023] [Revised: 06/15/2023] [Accepted: 06/15/2023] [Indexed: 07/13/2023] Open
Abstract
Stereotactic body radiotherapy (SBRT) is increasingly applied for pelvic oligometastases of prostate cancer, and currently no simple immobilization method is available for cone beam computed tomography (CBCT)-guided treatment. We assessed patient set-up and intrafraction motion using simple immobilization during CBCT-guided pelvic SBRT. Forty patients were immobilized with basic arm- head- and knee support and either a thermoplastic cushion or a foam cushion. Analysis of 454 CBCTs showed mean intrafraction translation <3.0 mm in 94% of fractions and mean intrafraction rotation <1.5° in 95% of fractions. Therefore, simple immobilization ensured stable patient positioning during CBCT-guided pelvic SBRT.
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Affiliation(s)
- Jorinde Janssen
- Corresponding author at: University Medical Center Groningen, Department of Radiation Oncology, Hanzeplein 1, 9713GZ Groningen, the Netherlands.
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Han C, Amini A, Wong JYC, Liang J, Qing K, Watkins WT, Zhang S, Williams TM, Liu A. Comparison of intrafractional motion with two frameless immobilization systems in surface-guided intracranial stereotactic radiosurgery. J Appl Clin Med Phys 2022; 23:e13613. [PMID: 35441441 PMCID: PMC9195026 DOI: 10.1002/acm2.13613] [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: 12/20/2021] [Revised: 03/12/2022] [Accepted: 04/21/2022] [Indexed: 11/28/2022] Open
Abstract
Purpose/objectives The aim of this study is to compare intrafractional motion using two commercial non‐invasive immobilization systems for linac‐based intracranial stereotactic radiosurgery (SRS) under guidance with a surface‐guided radiotherapy (SGRT) system. Materials/methods Twenty‐one patients who received intracranial SRS were retrospectively selected. Ten patients were immobilized with a vacuum fixation biteplate system, while 11 patients were immobilized with an open‐face mask system. A setup margin of 1 mm was used in treatment planning. Real‐time surface motion data in 37 treatment fractions using the vacuum fixation system and 44 fractions using the open‐face mask were recorded by an SGRT system. Variances of intrafractional motion along three translational directions and three rotational directions were compared between the two immobilization techniques with Levene's tests. Intrafractional motion variation over time during treatments was also evaluated. Results Using the vacuum fixation system, the average and standard deviations of the shifts were 0.01 ± 0.18 mm, ‐0.06 ± 0.30 mm, and 0.02 ± 0.26 mm in the anterior–posterior (AP), superior–inferior (SI), and left–right (LR) directions, and ‐0.02 ± 0.19°, ‐0.01 ± 0.13°, and 0.01 ± 0.13° for rotations in yaw, roll, and pitch, respectively; using the open‐face mask system, the average and standard deviations of the shifts were ‐0.06 ± 0.20 mm, ‐0.02 ± 0.35 mm, and 0.01 ± 0.40 mm in the AP, SI, and LR directions, and were 0.05 ± 0.23°, 0.02 ± 0.21°, and 0.00 ± 0.16° for rotations in yaw, roll, and pitch, respectively. There was a significant increase in intrafractional motion variance over time during treatments. Conclusion Patients with the vacuum fixation system had significantly smaller intrafractional motion variation compared to those with the open‐face mask system. Using intrafractional motion techniques such as surface imaging system is recommended to minimize dose deviation due to intrafractional motion. The increase in intrafractional motion over time indicates clinical benefits with shorter treatment time.
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Affiliation(s)
- Chunhui Han
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California, USA
| | - Arya Amini
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California, USA
| | - Jeffrey Y C Wong
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California, USA
| | - Jieming Liang
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California, USA
| | - Kun Qing
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California, USA
| | - W Tyler Watkins
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California, USA
| | - Sean Zhang
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California, USA
| | - Terence M Williams
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California, USA
| | - An Liu
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California, USA
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Hayashi R, Miyazaki K, Takao S, Yokokawa K, Tanaka S, Matsuura T, Taguchi H, Katoh N, Shimizu S, Umegaki K, Miyamoto N. Real-time CT image generation based on voxel-by-voxel modeling of internal deformation by utilizing the displacement of fiducial markers. Med Phys 2021; 48:5311-5326. [PMID: 34260755 DOI: 10.1002/mp.15095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/17/2021] [Accepted: 07/07/2021] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To show the feasibility of real-time CT image generation technique utilizing internal fiducial markers that facilitate the evaluation of internal deformation. METHODS In the proposed method, a linear regression model that can derive internal deformation from the displacement of fiducial markers is built for each voxel in the training process before the treatment session. Marker displacement and internal deformation are derived from the four-dimensional computed tomography (4DCT) dataset. In the treatment session, the three-dimensional deformation vector field is derived according to the marker displacement, which is monitored by the real-time imaging system. The whole CT image can be synthesized by deforming the reference CT image with a deformation vector field in real-time. To show the feasibility of the technique, image synthesis accuracy and tumor localization accuracy were evaluated using the dataset generated by extended NURBS-Based Cardiac-Torso (XCAT) phantom and clinical 4DCT datasets from six patients, containing 10 CT datasets each. In the validation with XCAT phantom, motion range of the tumor in training data and validation data were about 10 and 15 mm, respectively, so as to simulate motion variation between 4DCT acquisition and treatment session. In the validation with patient 4DCT dataset, eight CT datasets from the 4DCT dataset were used in the training process. Two excluded inhale CT datasets can be regarded as the datasets with large deformations more than training dataset. CT images were generated for each respiratory phase using the corresponding marker displacement. Root mean squared error (RMSE), normalized RMSE (NRMSE), and structural similarity index measure (SSIM) between the original CT images and the synthesized CT images were evaluated as the quantitative indices of the accuracy of image synthesis. The accuracy of tumor localization was also evaluated. RESULTS In the validation with XCAT phantom, the mean NRMSE, SSIM, and three-dimensional tumor localization error were 7.5 ± 1.1%, 0.95 ± 0.02, and 0.4 ± 0.3 mm, respectively. In the validation with patient 4DCT dataset, the mean RMSE, NRMSE, SSIM, and three-dimensional tumor localization error in six patients were 73.7 ± 19.6 HU, 9.2 ± 2.6%, 0.88 ± 0.04, and 0.8 ± 0.6 mm, respectively. These results suggest that the accuracy of the proposed technique is adequate when the respiratory motion is within the range of the training dataset. In the evaluation with a marker displacement larger than that of the training dataset, the mean RMSE, NRMSE, and tumor localization error were about 100 HU, 13%, and <2.0 mm, respectively, except for one case having large motion variation. The performance of the proposed method was similar to those of previous studies. Processing time to generate the volumetric image was <100 ms. CONCLUSION We have shown the feasibility of the real-time CT image generation technique for volumetric imaging.
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Affiliation(s)
- Risa Hayashi
- Graduate School of Engineering, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Koichi Miyazaki
- Faculty of Engineering, Hokkaido University, Sapporo, Hokkaido, Japan.,Department of Medical Physics, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Seishin Takao
- Faculty of Engineering, Hokkaido University, Sapporo, Hokkaido, Japan.,Department of Medical Physics, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Kohei Yokokawa
- Faculty of Engineering, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Sodai Tanaka
- Faculty of Engineering, Hokkaido University, Sapporo, Hokkaido, Japan.,Department of Medical Physics, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Taeko Matsuura
- Faculty of Engineering, Hokkaido University, Sapporo, Hokkaido, Japan.,Department of Medical Physics, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Hiroshi Taguchi
- Department of Radiation Oncology, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Norio Katoh
- Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Shinichi Shimizu
- Department of Medical Physics, Hokkaido University Hospital, Sapporo, Hokkaido, Japan.,Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Kikuo Umegaki
- Faculty of Engineering, Hokkaido University, Sapporo, Hokkaido, Japan.,Department of Medical Physics, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Naoki Miyamoto
- Faculty of Engineering, Hokkaido University, Sapporo, Hokkaido, Japan.,Department of Medical Physics, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
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Amaya D, Shinde A, Wohlers C, Wong KCC, Novak J, Neylon J, Han C, Liu A, Dandapani S, Glaser S. Dosimetric comparison of multiple vs single isocenter technique for linear accelerator-based stereotactic radiosurgery: The Importance of the six degree couch. J Appl Clin Med Phys 2021; 22:45-49. [PMID: 34021698 PMCID: PMC8200442 DOI: 10.1002/acm2.13286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 04/02/2021] [Accepted: 04/15/2021] [Indexed: 11/06/2022] Open
Abstract
PURPOSE Single isocenter technique (SIT) for linear accelerator-based stereotactic radiosurgery (SRS) is feasible. However, SIT introduces the potential for rotational error which can lead to geographical miss. Additional planning treatment volume (PTV) margin is required when using SIT. With the six degrees of freedom (6DoF) couch, rotational error can be minimized. We sought to evaluate the effect of the 6DoF couch on the dosimetry of patients with multiple brain metastases treated with SIT. MATERIALS AND METHODS Ten consecutive patients treated with SRS to ≥3 metastases were identified. Original treatments had MIT plans (MITP). The lesions were replanned using SIT. Lesions 5-10 cm from isocenter had an additional 1mm of margin. Patients were replanned with these additional margins to account for inability to correct rotational error (SITPM). Multiple dosimetric variables and time metrics were evaluated. Dosimetry planning time (DPT) and patient treatment time (PTT) were evaluated. Statistics were calculated using the Wilcoxon signed-rank test. RESULTS A total of 73 brain metastases receiving SRS, to a median of 6 lesions per patient, were identified. MITPs treated 73 lesions with 63 isocenters. On average, MITPs had a 19.2% higher brain V12 than SITPs (P = 0.017). For creation of SITPM, 30 lesions required 1 mm of additional margin, while none required 2 mm of margin. This increased V12 by 47.8% on average per patient (P = 0.008) from SITP to SITPM. DPT was 5.5 hours for SITP, while median for MITP was 12.5 hours (P = 0.005) PTT was 30 minutes for SITP, while median for MITP was 144 minutes (P = 0.005). CONCLUSIONS SITPs are comparable to MITPs if rotational error can be corrected with the use of a 6DoF couch. Increasing margin to account for rotational error leads to a nearly 50% increase in V12, which could result in higher rates of radiation necrosis. Time savings are significant using SIT.
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Affiliation(s)
- Dania Amaya
- Department of Radiation OncologyCity of Hope National Medical CenterDuarteCAUSA
| | - Ashwin Shinde
- Department of Radiation OncologyCity of Hope National Medical CenterDuarteCAUSA
| | - Christopher Wohlers
- Department of Radiation OncologyCity of Hope National Medical CenterDuarteCAUSA
| | - Ka Chun Carson Wong
- Department of Radiation OncologyCity of Hope National Medical CenterDuarteCAUSA
| | - Jennifer Novak
- Department of Radiation OncologyCity of Hope National Medical CenterDuarteCAUSA
| | - John Neylon
- Department of Radiation OncologyCity of Hope National Medical CenterDuarteCAUSA
| | - Chunhui Han
- Department of Radiation OncologyCity of Hope National Medical CenterDuarteCAUSA
| | - An Liu
- Department of Radiation OncologyCity of Hope National Medical CenterDuarteCAUSA
| | - Savita Dandapani
- Department of Radiation OncologyCity of Hope National Medical CenterDuarteCAUSA
| | - Scott Glaser
- Department of Radiation OncologyCity of Hope National Medical CenterDuarteCAUSA
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Rojas-López JA, Díaz Moreno RM, Venencia CD. Use of genetic algorithm for PTV optimization in single isocenter multiple metastases radiosurgery treatments with Brainlab Elements™. Phys Med 2021; 86:82-90. [PMID: 34062337 DOI: 10.1016/j.ejmp.2021.05.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 05/15/2021] [Accepted: 05/22/2021] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To optimize PTV margins for single isocenter multiple metastases stereotactic radiosurgery through a genetic algorithm (GA) that determines the maximum effective displacement of each target (GTV) due to rotations. METHOD 10 plans were optimized. The plans were created with Elements Multiple Mets™ (Brainlab AG, Munchen, Germany) from a predefined template. The mean number of metastases per plan was 5 ± 2 [3,9] and the mean volume of GTV was 1.1 ± 1.3 cc [0.02, 5.1]. PTV margin criterion was based on GTV-isocenter distance and target dimensions. The effective displacement to perform specific rotational combination (roll, pitch, yaw) was optimized by GA. The original plans were re-calculated using the PTV optimized margin and new dosimetric variations were obtained. The Dmean, D99, Paddick conformity index (PCI), gradient index (GI) and dose variations in healthy brain were studied. RESULTS Regarding targets located shorter than 50 mm from the isocenter, the maximum calculated displacement was 2.5 mm. The differences between both PTV margin criteria were statistically significant for Dmean (p = 0.0163), D99 (p = 0.0439), PCI (p = 0.0242), GI (p = 0.0160) and for healthy brain V12 (p = 0.0218) and V10 (p = 0.0264). CONCLUSION The GA allows to determine an optimized PTV margin based on the maximum displacement. Optimized PTV margins reduce the detriment of dosimetric parameters. Greater PTV margins are associated with an increase in healthy brain volume.
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Impact of a vacuum cushion on intrafraction motion during online adaptive MR-guided SBRT for pelvic and para-aortic lymph node oligometastases. Radiother Oncol 2020; 154:110-117. [PMID: 32950531 DOI: 10.1016/j.radonc.2020.09.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 09/09/2020] [Accepted: 09/10/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND PURPOSE Vacuum cushion immobilization is commonly used during stereotactic body radiotherapy (SBRT) to reduce intrafraction motion. We investigated target and bony anatomy intrafraction motion (translations and rotations) during online adaptive SBRT on an MR-linac for pelvic/para-aortic lymph node metastases with and without vacuum cushion. MATERIALS AND METHODS Thirty-nine patients underwent 5x7 Gy SBRT on a 1.5T MR-linac, 19 patients were treated with vacuum cushion, 19 without and 1 patient sequentially with and without. Intrafraction motion was calculated for target lymph nodes (GTVs) and nearby bony anatomy, for three time intervals (pre-position verification (PV), pre-post, PV-post, relating to the online MRI scans) per treatment fraction. RESULTS Vacuum cushion immobilization significantly reduced anterior-posterior translations for the pre-PV and pre-post intervals, for bony anatomy and pre-post interval for GTV (p < 0.05). Mean GTV intrafraction motion reduction in posterior direction was 0.7 mm (95% confidence interval 0.3-1.1 mm) for pre-post interval (mean time = 32 min). Shifts in other directions were not significantly reduced. More motion occurred in pre-PV interval than in PV-post interval (mean time = 16 min for both); vacuum cushion immobilization did not reduce intrafraction motion during the beam-on period. CONCLUSION A vacuum cushion reduces GTV and bony anatomy intrafraction motion in posterior direction during pelvic/para-aortic lymph node SBRT. This motion reduction was found for the first 16 min per session. For single targets this motion can be corrected for directly with an MR-linac. Intrafraction motion was not reduced during the second half of the session, the period of radiotherapy delivery on an MR-linac. Vacuum cushion immobilization may not be necessary for patients with single lymph node oligometastases undergoing SBRT on an MR-linac.
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