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Callens D, Benazzouz C, Stessens L, Piot W, Nulens A, Lambrecht M, Berkovic P, Daisne JF. A prospective randomized study comparing two frameless immobilization systems for cranial stereotactic radiotherapy. Tech Innov Patient Support Radiat Oncol 2024; 30:100249. [PMID: 38623575 PMCID: PMC11017338 DOI: 10.1016/j.tipsro.2024.100249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 03/14/2024] [Accepted: 04/02/2024] [Indexed: 04/17/2024] Open
Abstract
Introduction The Dual Shell Encompass Fibreplast™ System (DS-Encompass) by CQ Medical™ is validated for frameless immobilization in stereotactic brain radiotherapy. An alternative mask model has been proposed with the rear shell replaced by a Moldcare® cushion (M-Encompass). To validate the use of this model in our cranial stereotactic workflow method including HyperArc™, we performed a prospective randomized study comparing inter-and intrafractional motion and patients comfort between both masks. Materials & Methods A prospective randomized study between DS-Encompass and M-Encompass was conducted involving 60 participants. Stratification between DS-Encompass and M-Encompass was carried out based on the fractionation scheme. Treatment plans were created with HyperArc™. During treatment, surface guidance was used for patient positioning and monitoring. A pre-treatment cone-beam CT (CBCT) was acquired to correct interfractional motion and a post-treatment CBCT was acquired to quantify the intrafractional motion. Patients reported comfort was analyzed with a Likert-scale at the end of the treatment. Unpaired t-tests were conducted to determine the level of significance. Results No significant difference in interfractional translations is present. A significant difference is revealed in roll-axis rotation, where DS-Encompass allows for smaller deviations. Since interfractional motion can be corrected through daily CBCT-scans and 6D-couch corrections, they are clinically irrelevant. Intrafractional motion does not differ significantly and remains below 0.5 mm and 0.5° for both systems. There is no statistical difference in patient-reported comfort. Conclusion We conclude that Encompass with Moldcare offers a safe alternative to Duall Shell Encompass for non-coplanar stereotactic brain radiotherapy. There is no significant difference in intrafractional motion nor difference in comfort levels.
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Affiliation(s)
- Dylan Callens
- Laboratory of Experimental Radiotherapy, Catholic University of Leuven, Leuven, Belgium
- Department of Radiation Oncology, University Hospitals of Leuven, Leuven, Belgium
| | - Chahrazad Benazzouz
- Department of Radiation Oncology, University Hospitals of Leuven, Leuven, Belgium
| | - Lise Stessens
- Department of Radiation Oncology, University Hospitals of Leuven, Leuven, Belgium
| | - Wout Piot
- Department of Radiation Oncology, University Hospitals of Leuven, Leuven, Belgium
| | - An Nulens
- Department of Radiation Oncology, University Hospitals of Leuven, Leuven, Belgium
| | - Maarten Lambrecht
- Laboratory of Experimental Radiotherapy, Catholic University of Leuven, Leuven, Belgium
- Department of Radiation Oncology, University Hospitals of Leuven, Leuven, Belgium
- Leuven Cancer Institute (LKI), Leuven, Belgium
| | - Patrick Berkovic
- Laboratory of Experimental Radiotherapy, Catholic University of Leuven, Leuven, Belgium
- Department of Radiation Oncology, University Hospitals of Leuven, Leuven, Belgium
| | - Jean-François Daisne
- Laboratory of Experimental Radiotherapy, Catholic University of Leuven, Leuven, Belgium
- Department of Radiation Oncology, University Hospitals of Leuven, Leuven, Belgium
- Leuven Cancer Institute (LKI), Leuven, Belgium
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Seravalli E, Kroon PS, Bolle S, Dunlea C, Harrabi SB, Laprie A, Lassen-Ramshad Y, Whitfield G, Janssens GO. Surface guided radiotherapy practice in paediatric oncology: a survey on behalf of the SIOPE Radiation Oncology Working Group. Br J Radiol 2024; 97:1044-1049. [PMID: 38445717 DOI: 10.1093/bjr/tqae049] [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: 09/20/2023] [Revised: 01/06/2024] [Accepted: 02/20/2024] [Indexed: 03/07/2024] Open
Abstract
INTRODUCTION Surface guided radiotherapy (SGRT) is increasingly being implemented to track patient's surface movement and position during radiation therapy. However, limited information is available on the SGRT use in paediatrics. The aim of this double survey was to map SIOPE (European Society for Paediatric Oncology)-affiliated centres using SGRT and to gain information on potential indications, observed, or expected benefits. METHODS A double online survey was distributed to 246 SIOPE-affiliated radiotherapy (RT) centres. Multiple choices, yes/no, and open answers were included. The first survey (41 questions) was active from February to March 2021. A shortened version (13 questions) was repeated in March 2023 to detect trends in SGRT use within the same community. RESULTS Respectively, 76/142 (54%) and 28/142 (20%) responding centres used and planned to use SGRT clinically, including 4/34 (12%) new centres since 2021. Among the SGRT users, 33/76 (43%) already applied this technology to paediatric treatments. The main benefits of improved patient comfort, better monitoring of intrafraction motion, and more accurate initial patient set-up expected by future users did not differ from current SGRT-users (P = .893). Among non-SGRT users, the main hurdles to implement SGRT were costs and time for installation. In paediatrics, SGRT is applied to all anatomical sites. CONCLUSION This work provides information on the practice of SGRT in paediatrics across SIOPE-affiliated RT centres which can serve as a basis for departments when considering the purchase of SGRT systems. ADVANCES IN KNOWLEDGE Since little information is available in the literature on the use of SGRT in paediatrics, the results of this double survey can serve as a basis for departments treating children when considering the purchase of an SGRT system.
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Affiliation(s)
- Enrica Seravalli
- Department of Radiation Oncology, University Medical Center Utrecht, 3508 GA, The Netherlands
| | - Petra S Kroon
- Department of Radiation Oncology, University Medical Center Utrecht, 3508 GA, The Netherlands
| | - Stephanie Bolle
- Department of Radiation Oncology, Gustave Roussy Campus, Villejuif 94 800, France
| | - Cathy Dunlea
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London NW1 2PB, United Kingdom
| | - Semi B Harrabi
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg 69120, Germany
| | - Anne Laprie
- Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse 31100, France
| | - Yasmin Lassen-Ramshad
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus DK-8200, Denmark
| | - Gillian Whitfield
- The Christie NHS Foundation Trust and Division of Cancer Sciences, University of Manchester, Manchester Cancer Research Centre, Manchester Academic Health Science Centre, Manchester M20 4BX, United Kingdom
| | - Geert O Janssens
- Department of Radiation Oncology, University Medical Center Utrecht, 3508 GA, The Netherlands
- Princess Maxima Center for Pediatric Oncology, Utrecht 3582CS, The Netherlands
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Chen X, Liu L, Wang Y, Huang X, Cai W, Rong X, Lin L, Liu J, Jiang X. Surface guided radiation therapy with an innovative open-face mask and mouth bite: patient motion management in brain stereotactic radiotherapy. Clin Transl Oncol 2024; 26:424-433. [PMID: 37395988 DOI: 10.1007/s12094-023-03260-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 06/18/2023] [Indexed: 07/04/2023]
Abstract
INTRODUCTION To guarantee treatment reproducibility and stability, immobilization devices are essential. Additionally, surface-guided radiation therapy (SGRT) serves as an accurate complement to frameless stereotactic radiosurgery (SRS) and stereotactic radiotherapy (SRT) by aiding patient positioning and real-time monitoring, especially when non-coplanar fields are in use. At our institute, we have developed a surface-guided SRS (SG-SRS) workflow that incorporates our innovative open-face mask (OM) and mouth bite (MB) to guarantee a precise and accurate dose delivery. METHODS This study included 40 patients, and all patients were divided into closed mask (CM) and open-face mask (OM) groups according to different positioning flow. Cone beam computed tomography (CBCT) scans were performed, and the registration results were recorded before and after the treatment. Then Bland-Altman method was used to analyze the consistency of AlignRT-guided positioning errors and CBCT scanning results in the OM group. The error changes between 31 fractions in one patient were recorded to evaluate the feasibility of monitoring during treatment. RESULTS The median of translation error between stages of the AlignRT positioning process was (0.03-0.07) cm, and the median of rotation error was (0.20-0.40)°, which were significantly better than those of the Fraxion positioning process (0.09-0.11) cm and (0.60-0.75)°. The mean bias values between the AlignRT guided positioning errors and CBCT were 0.01 cm, - 0.07 cm, 0.03 cm, - 0.30°, - 0.08° and 0.00°. The 31 inter-fractional errors of a single patient monitored by SGRT were within 0.10 cm and 0.50°. CONCLUSIONS The application of the SGRT with an innovative open-face mask and mouth bite device could achieve precision positioning accuracy and stability, and the accuracy of the AlignRT system exhibits excellent constancy with the CBCT gold standard. The non-coplanar radiation field monitoring can provide reliable support for motion management in fractional treatment.
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Affiliation(s)
- Xuemei Chen
- Department of Radiotherapy, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Lu Liu
- Department of Radiotherapy, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yajuan Wang
- Department of Radiotherapy, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xiaotong Huang
- Department of Radiotherapy, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Weixun Cai
- Department of Radiotherapy, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xiaodong Rong
- Department of Radiotherapy, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Liuwen Lin
- Department of Radiotherapy, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jindi Liu
- Department of Radiotherapy, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China.
| | - Xiaobo Jiang
- Department of Radiotherapy, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China.
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Bodensohn R, Maier SH, Belka C, Minniti G, Niyazi M. Stereotactic Radiosurgery of Multiple Brain Metastases: A Review of Treatment Techniques. Cancers (Basel) 2023; 15:5404. [PMID: 38001664 PMCID: PMC10670108 DOI: 10.3390/cancers15225404] [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: 08/31/2023] [Revised: 10/22/2023] [Accepted: 11/11/2023] [Indexed: 11/26/2023] Open
Abstract
The advancement of systemic targeted treatments has led to improvements in the management of metastatic disease, particularly in terms of survival outcomes. However, brain metastases remain less responsive to systemic therapies, underscoring the significance of local interventions for comprehensive disease control. Over the past years, the threshold for treating brain metastases through stereotactic radiosurgery has risen. Yet, as the number of treated metastases increases, treatment complexity and duration also escalate. This trend has made multi-isocenter radiosurgery treatments, such as those with the Gamma Knife, challenging to plan and lengthy for patients. In contrast, single-isocenter approaches employing linear accelerators offer an efficient and expeditious treatment option. This review delves into the literature, comparing different linear-accelerator-based techniques with each other and in relation to dedicated systems, focusing on dosimetric considerations and feasibility.
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Affiliation(s)
- Raphael Bodensohn
- Department of Radiation Oncology, University Hospital Tübingen, 72076 Tübingen, Germany;
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, 72076 Tübingen, Germany
| | - Sebastian H. Maier
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, 81377 Munich, Germany; (S.H.M.); (C.B.)
| | - Claus Belka
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, 81377 Munich, Germany; (S.H.M.); (C.B.)
- German Cancer Consortium (DKTK), Partner Site Munich, A Partnership between DKFZ and LMU University Hospital, 81377 Munich, Germany
- Bavarian Cancer Research Center (BZKF), Munich, Germany
| | - Giuseppe Minniti
- IRCCS Neuromed, 86077 Pozzilli, Italy;
- Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza University of Rome, Policlinico Umberto I, 00161 Rome, Italy
| | - Maximilian Niyazi
- Department of Radiation Oncology, University Hospital Tübingen, 72076 Tübingen, Germany;
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, 72076 Tübingen, Germany
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, 81377 Munich, Germany; (S.H.M.); (C.B.)
- German Cancer Consortium (DKTK), Partner Site Tübingen, A Partnership between DKFZ and University Hospital, 72076 Tübingen, Germany
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Xie K, Gao L, Zhang H, Zhang S, Xi Q, Zhang F, Sun J, Lin T, Sui J, Ni X. Inpainting truncated areas of CT images based on generative adversarial networks with gated convolution for radiotherapy. Med Biol Eng Comput 2023:10.1007/s11517-023-02809-y. [PMID: 36897469 DOI: 10.1007/s11517-023-02809-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 02/20/2023] [Indexed: 03/11/2023]
Abstract
This study aimed to inpaint the truncated areas of CT images by using generative adversarial networks with gated convolution (GatedConv) and apply these images to dose calculations in radiotherapy. CT images were collected from 100 patients with esophageal cancer under thermoplastic membrane placement, and 85 cases were used for training based on randomly generated circle masks. In the prediction stage, 15 cases of data were used to evaluate the accuracy of the inpainted CT in anatomy and dosimetry based on the mask with a truncated volume covering 40% of the arm volume, and they were compared with the inpainted CT synthesized by U-Net, pix2pix, and PConv with partial convolution. The results showed that GatedConv could directly and effectively inpaint incomplete CT images in the image domain. For the results of U-Net, pix2pix, PConv, and GatedConv, the mean absolute errors for the truncated tissue were 195.54, 196.20, 190.40, and 158.45 HU, respectively. The mean dose of the planning target volume, heart, and lung in the truncated CT was statistically different (p < 0.05) from those of the ground truth CT ([Formula: see text]). The differences in dose distribution between the inpainted CT obtained by the four models and [Formula: see text] were minimal. The inpainting effect of clinical truncated CT images based on GatedConv showed better stability compared with the other models. GatedConv can effectively inpaint the truncated areas with high image quality, and it is closer to [Formula: see text] in terms of image visualization and dosimetry than other inpainting models.
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Affiliation(s)
- Kai Xie
- Radiotherapy Department, Second People's Hospital of Changzhou, Nanjing Medical University, Changzhou, 213000, China
- Jiangsu Province Engineering Research Center of Medical Physics, Changzhou, 213000, China
| | - Liugang Gao
- Radiotherapy Department, Second People's Hospital of Changzhou, Nanjing Medical University, Changzhou, 213000, China
- Jiangsu Province Engineering Research Center of Medical Physics, Changzhou, 213000, China
| | - Heng Zhang
- Center for Medical Physics, Nanjing Medical University, Changzhou, 213003, China
- Key Laboratory of Medical Physics, Changzhou, 213000, China
| | - Sai Zhang
- Center for Medical Physics, Nanjing Medical University, Changzhou, 213003, China
- Key Laboratory of Medical Physics, Changzhou, 213000, China
| | - Qianyi Xi
- Center for Medical Physics, Nanjing Medical University, Changzhou, 213003, China
- Key Laboratory of Medical Physics, Changzhou, 213000, China
| | - Fan Zhang
- Center for Medical Physics, Nanjing Medical University, Changzhou, 213003, China
- Key Laboratory of Medical Physics, Changzhou, 213000, China
| | - Jiawei Sun
- Radiotherapy Department, Second People's Hospital of Changzhou, Nanjing Medical University, Changzhou, 213000, China
- Jiangsu Province Engineering Research Center of Medical Physics, Changzhou, 213000, China
| | - Tao Lin
- Radiotherapy Department, Second People's Hospital of Changzhou, Nanjing Medical University, Changzhou, 213000, China
- Jiangsu Province Engineering Research Center of Medical Physics, Changzhou, 213000, China
| | - Jianfeng Sui
- Radiotherapy Department, Second People's Hospital of Changzhou, Nanjing Medical University, Changzhou, 213000, China
- Jiangsu Province Engineering Research Center of Medical Physics, Changzhou, 213000, China
| | - Xinye Ni
- Radiotherapy Department, Second People's Hospital of Changzhou, Nanjing Medical University, Changzhou, 213000, China.
- Jiangsu Province Engineering Research Center of Medical Physics, Changzhou, 213000, China.
- Center for Medical Physics, Nanjing Medical University, Changzhou, 213003, China.
- Key Laboratory of Medical Physics, Changzhou, 213000, China.
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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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Sato K, Kanai T, Lee SH, Miyasaka Y, Chai H, Souda H, Iwai T, Sato R, Goto N, Kawamura T. Development of a quantitative analysis method for assessing patient body surface deformation using an optical surface tracking system. Radiol Phys Technol 2022; 15:367-378. [PMID: 36040622 DOI: 10.1007/s12194-022-00676-0] [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: 03/06/2022] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 11/24/2022]
Abstract
This study aimed to develop a new method to quantitatively analyze body shape changes in patients during radiotherapy without additional radiation exposure using an optical surface tracking system. This method's accuracy was evaluated using a cubic phantom with a known shift. Surface images of three-dimensionally printed phantoms, which simulated the head and neck shapes of real patients before and after treatment, were used to create a deformation surface area histogram. The near-maximum deformation value covering an area of 2 cm2 in the surface image (Def-2cm2) was calculated. A volumetric modulated arc therapy (VMAT) plan was also created on the pre-treatment phantom, and the dose distribution was recalculated on the post-treatment phantom to compare the dose indices. Surface images of four patients were analyzed to evaluate Def-2cm2 and examine whether this method can be used in clinical cases. Experiments with the cubic phantom resulted in a mean deformation error of 0.08 mm. With head and neck phantoms, the Def-2cm2 value was 17.5 mm, and the dose that covered 95% of the planning target volume in the VMAT plan decreased by 11.7%, indicating that deformation of the body surface may affect the dose distribution. Although analysis of the clinical data showed no clinically relevant deformation in any of the cases, slight skin sagging and respiratory changes in the body surface were observed. The proposed method can quantitatively and accurately evaluate the deformation of a body surface. This method is expected to be used to make decisions regarding modifications to treatment plans.
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Affiliation(s)
- Kimihiko Sato
- Department of Heavy Particle Medical Science, Yamagata University Graduate School of Medical Science, 2-2-2 Iidanishi, Yamagata, 990-9585, Japan
- Department of Radiology, Nihonkai General Hospital, 30 Akiho-chou, Sakata, Yamagata, 998-8501, Japan
| | - Takayuki Kanai
- Department of Heavy Particle Medical Science, Yamagata University Graduate School of Medical Science, 2-2-2 Iidanishi, Yamagata, 990-9585, Japan.
| | - Sung Hyun Lee
- Department of Heavy Particle Medical Science, Yamagata University Graduate School of Medical Science, 2-2-2 Iidanishi, Yamagata, 990-9585, Japan
| | - Yuya Miyasaka
- Department of Heavy Particle Medical Science, Yamagata University Graduate School of Medical Science, 2-2-2 Iidanishi, Yamagata, 990-9585, Japan
| | - Hongbo Chai
- Department of Heavy Particle Medical Science, Yamagata University Graduate School of Medical Science, 2-2-2 Iidanishi, Yamagata, 990-9585, Japan
| | - Hikaru Souda
- Department of Heavy Particle Medical Science, Yamagata University Graduate School of Medical Science, 2-2-2 Iidanishi, Yamagata, 990-9585, Japan
| | - Takeo Iwai
- Department of Heavy Particle Medical Science, Yamagata University Graduate School of Medical Science, 2-2-2 Iidanishi, Yamagata, 990-9585, Japan
| | - Ryuji Sato
- Department of Radiology, Nihonkai General Hospital, 30 Akiho-chou, Sakata, Yamagata, 998-8501, Japan
| | - Naoki Goto
- Department of Radiology, Nihonkai General Hospital, 30 Akiho-chou, Sakata, Yamagata, 998-8501, Japan
| | - Tsukasa Kawamura
- Department of Radiology, Nihonkai General Hospital, 30 Akiho-chou, Sakata, Yamagata, 998-8501, Japan
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Da Silva Mendes V, Reiner M, Huang L, Reitz D, Straub K, Corradini S, Niyazi M, Belka C, Kurz C, Landry G, Freislederer P. ExacTrac Dynamic workflow evaluation: Combined surface optical/thermal imaging and X-ray positioning. J Appl Clin Med Phys 2022; 23:e13754. [PMID: 36001389 DOI: 10.1002/acm2.13754] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 07/07/2022] [Accepted: 07/19/2022] [Indexed: 11/09/2022] Open
Abstract
In modern radiotherapy (RT), especially for stereotactic radiotherapy or stereotactic radiosurgery treatments, image guidance is essential. Recently, the ExacTrac Dynamic (EXTD) system, a new combined surface-guided RT and image-guided RT (IGRT) system for patient positioning, monitoring, and tumor targeting, was introduced in clinical practice. The purpose of this study was to provide more information about the geometric accuracy of EXTD and its workflow in a clinical environment. The surface optical/thermal- and the stereoscopic X-ray imaging positioning systems of EXTD was evaluated and compared to cone-beam computed tomography (CBCT). Additionally, the congruence with the radiation isocenter was tested. A Winston Lutz test was executed several times over 1 year, and repeated end-to-end positioning tests were performed. The magnitude of the displacements between all systems, CBCT, stereoscopic X-ray, optical-surface imaging, and MV portal imaging was within the submillimeter range, suggesting that the image guidance provided by EXTD is accurate at any couch angle. Additionally, results from the evaluation of 14 patients with intracranial tumors treated with open-face masks are reported, and limited differences with a maximum of 0.02 mm between optical/thermal- and stereoscopic X-ray imaging were found. As the optical/thermal positioning system showed a comparable accuracy to other IGRT systems, and due to its constant monitoring capability, it can be an efficient tool for detecting intra-fractional motion and for real-time tracking of the surface position during RT.
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Affiliation(s)
| | - Michael Reiner
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Lili Huang
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Daniel Reitz
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Katrin Straub
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Maximilian Niyazi
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Christopher Kurz
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Guillaume Landry
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Philipp Freislederer
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
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Li G. Advances and potential of optical surface imaging in radiotherapy. Phys Med Biol 2022; 67:10.1088/1361-6560/ac838f. [PMID: 35868290 PMCID: PMC10958463 DOI: 10.1088/1361-6560/ac838f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 07/22/2022] [Indexed: 11/12/2022]
Abstract
This article reviews the recent advancements and future potential of optical surface imaging (OSI) in clinical applications as a four-dimensional (4D) imaging modality for surface-guided radiotherapy (SGRT), including OSI systems, clinical SGRT applications, and OSI-based clinical research. The OSI is a non-ionizing radiation imaging modality, offering real-time 3D surface imaging with a large field of view (FOV), suitable for in-room interactive patient setup, and real-time motion monitoring at any couch rotation during radiotherapy. So far, most clinical SGRT applications have focused on treating superficial breast cancer or deep-seated brain cancer in rigid anatomy, because the skin surface can serve as tumor surrogates in these two clinical scenarios, and the procedures for breast treatments in free-breathing (FB) or at deep-inspiration breath-hold (DIBH), and for cranial stereotactic radiosurgery (SRS) and radiotherapy (SRT) are well developed. When using the skin surface as a body-position surrogate, SGRT promises to replace the traditional tattoo/laser-based setup. However, this requires new SGRT procedures for all anatomical sites and new workflows from treatment simulation to delivery. SGRT studies in other anatomical sites have shown slightly higher accuracy and better performance than a tattoo/laser-based setup. In addition, radiographical image-guided radiotherapy (IGRT) is still necessary, especially for stereotactic body radiotherapy (SBRT). To go beyond the external body surface and infer an internal tumor motion, recent studies have shown the clinical potential of OSI-based spirometry to measure dynamic tidal volume as a tumor motion surrogate, and Cherenkov surface imaging to guide and assess treatment delivery. As OSI provides complete datasets of body position, deformation, and motion, it offers an opportunity to replace fiducial-based optical tracking systems. After all, SGRT has great potential for further clinical applications. In this review, OSI technology, applications, and potential are discussed since its first introduction to radiotherapy in 2005, including technical characterization, different commercial systems, and major clinical applications, including conventional SGRT on top of tattoo/laser-based alignment and new SGRT techniques attempting to replace tattoo/laser-based setup. The clinical research for OSI-based tumor tracking is reviewed, including OSI-based spirometry and OSI-guided tumor tracking models. Ongoing clinical research has created more SGRT opportunities for clinical applications beyond the current scope.
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Affiliation(s)
- Guang Li
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, United States of America
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10
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Freislederer P, Batista V, Öllers M, Buschmann M, Steiner E, Kügele M, Fracchiolla F, Corradini S, de Smet M, Moura F, Perryck S, Dionisi F, Nguyen D, Bert C, Lehmann J. ESTRO-ACROP guideline on surface guided radiation therapy. Radiother Oncol 2022; 173:188-196. [PMID: 35661677 DOI: 10.1016/j.radonc.2022.05.026] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 05/26/2022] [Indexed: 10/18/2022]
Abstract
Surface guidance systems enable patient positioning and motion monitoring without using ionising radiation. Surface Guided Radiation Therapy (SGRT) has therefore been widely adopted in radiation therapy in recent years, but guidelines on workflows and specific quality assurance (QA) are lacking. This ESTRO-ACROP guideline aims to give recommendations concerning SGRT roles and responsibilities and highlights common challenges and potential errors. Comprehensive guidelines for procurement, acceptance, commissioning, and QA of SGRT systems installed on computed tomography (CT) simulators, C-arm linacs, closed-bore linacs, and particle therapy treatment systems are presented that will help move to a consensus among SGRT users and facilitate a safe and efficient implementation and clinical application of SGRT.
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Affiliation(s)
- P Freislederer
- Department of Radiation Oncology, LMU University Hospital, Munich, Germany.
| | - V Batista
- Department of Radiation Oncology, Heidelberg University Hospital, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
| | - M Öllers
- Department of Radiotherapy, MAASTRO, Maastricht, The Netherlands
| | - M Buschmann
- Department of Radiation Oncology, Medical University of Vienna/AKH Wien, Austria
| | - E Steiner
- Institute for Radiation Oncology and Radiotherapy, Landesklinikum Wiener Neustadt, Austria
| | - M Kügele
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - F Fracchiolla
- Azienda Provinciale per i Servizi Sanitari (APSS) Protontherapy Department, Trento, Italy
| | - S Corradini
- Department of Radiation Oncology, LMU University Hospital, Munich, Germany
| | - M de Smet
- Department of Medical Physics & Instrumentation, Institute Verbeeten, Tilburg, The Netherlands
| | - F Moura
- Hospital CUF Descobertas, Department of Radiation Oncology, Lisbon, Portugal
| | - S Perryck
- Department of Radiation Oncology, University Hospital Zürich, Switzerland
| | - F Dionisi
- Department of Radiation Oncology, IRCSS Regina Elena National Cancer Institute, Rome, Italy
| | - D Nguyen
- Centre de Radiothérapie de Mâcon, France
| | - C Bert
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - J Lehmann
- Radiation Oncology Department, Calvary Mater Newcastle, Australia; School of Information and Physical Sciences, University of Newcastle, Australia; Institute of Medical Physics, University of Sydney, Australia
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11
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Chow VUY, Cheung MLM, Kan MWK, Chan ATC. Shift detection discrepancy between ExacTrac Dynamic system and cone‐beam computed tomography. J Appl Clin Med Phys 2022; 23:e13567. [PMID: 35188333 PMCID: PMC9121052 DOI: 10.1002/acm2.13567] [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] [Received: 08/29/2021] [Revised: 01/12/2022] [Accepted: 02/03/2022] [Indexed: 02/01/2023] Open
Abstract
Accurate detection of patient shift is essential during radiation therapy such that optimal dose is delivered to the tumor while minimizing radiation to surrounding normal tissues. The shift detectability of a newly developed optical surface and thermal tracking system, which was known as ExacTrac Dynamic (EXTD), was evaluated by comparing its performance with the image guidance under cone‐beam computed tomography (CBCT). Anthropomorphic cranial and pelvis phantoms with internal bone‐like structures and external heat pad were utilized to study the shift detection discrepancy between EXTD system and CBCT. Random displacements within the range of ± 2 cm for translations and ± 2 degrees for rotations were intentionally applied to the phantom. Positional shifts detected by optical surface and thermal tracking (EXTD_Thml), stereoscopic X‐ray (EXTD_Xray), and CBCT were compared in 6 degrees of freedom. The translational difference between EXTD_Thml and CBCT was 0.57 ± 0.41 mm and 0.66 ± 0.40 mm for cranial and pelvis phantom, respectively, while it was 0.60 ± 0.43 mm and 0.76 ± 0.49 mm between EXTD_Xray and CBCT, respectively. For rotational movement, the difference between EXTD_Thml and CBCT was 0.19 ± 0.16° and 0.19 ± 0.22° for cranial and pelvis phantom, respectively, while it was 0.13 ± 0.18° and 0.65 ± 0.46° between EXTD_Xray and CBCT, respectively. This study demonstrated that the EXTD system with thermal mapping ability could offer comparable accuracy for shift detection with CBCT on both cranial and pelvis phantoms.
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Affiliation(s)
- Vivian U. Y. Chow
- Department of Clinical Oncology Prince of Wales Hospital Hong Kong SAR China
| | | | - Monica W. K. Kan
- Department of Clinical Oncology Prince of Wales Hospital Hong Kong SAR China
- Department of Clinical Oncology The Chinese University of Hong Kong Hong Kong SAR China
| | - Anthony T. C. Chan
- Department of Clinical Oncology Prince of Wales Hospital Hong Kong SAR China
- Department of Clinical Oncology The Chinese University of Hong Kong Hong Kong SAR China
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12
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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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13
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Yoon JW, Park S, Cheong KH, Kang SK, Han TJ. Combined effect of dose gradient and rotational error on prescribed dose coverage for single isocenter multiple brain metastases in frameless stereotactic radiotherapy. Radiat Oncol 2021; 16:169. [PMID: 34465331 PMCID: PMC8406565 DOI: 10.1186/s13014-021-01893-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 08/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate the combined effect of rotational error and dose gradient on target dose coverage in frameless stereotactic radiotherapy. METHODS Three spherical targets of different diameters (1, 1.5, and 2 cm) were drawn and placed equidistantly on the same axial brain computed tomography (CT) images. To test the different isocenter-target distances, 2.5- and 5-cm configurations were prepared. Volumetric modulated arc therapy plans were created for different dose gradients from the target, in which the dose gradients were modified using the maximum dose inside the target. To simulate the rotational error, CT images and targets were rotated in two ways by 0.5°, 1°, and 2°, in which one rotation was in the axial plane and the other was in three dimensions. The initial optimized plan parameters were copied to the rotated CT sets, and the doses were recalculated. The coverage degradation after rotation was analyzed according to the target dislocation and 12-Gy volume. RESULTS A shallower dose gradient reduced the loss of target coverage under target dislocation, and the effect was clearer for small targets. For example, the coverage of the 1-cm target under 1-mm dislocation increased from 93 to 95% by increasing the Paddick gradient index from 5.0 to 7.9. At the same time, the widely accepted necrosis indicator, the 12-Gy volume, increased from 1.2 to 3.5 cm3, which remained in the tolerable range. From the differential dose volume histogram (DVH) analysis, the shallower dose gradient ensured that the dose-deficient under-covered target volume received a higher dose similar to that in the prescription. CONCLUSIONS For frameless stereotactic brain radiotherapy, the gradient, alongside the margin addition, can be adjusted as an ancillary parameter for small targets to increase target coverage or at least limit coverage reduction in conditions with probable positioning error.
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Affiliation(s)
- Jai-Woong Yoon
- Department of Radiation Oncology, Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Soah Park
- Department of Radiation Oncology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Kwang-Ho Cheong
- Department of Radiation Oncology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Sei-Kwon Kang
- Department of Radiation Oncology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
| | - Tae Jin Han
- Department of Radiation Oncology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
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14
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Decabooter E, Swinnen AC, Öllers MC, Göpfert F, Verhaegen F. Operation and calibration of the novel PTW 1600SRS detector for the verification of single isocenter stereotactic radiosurgery treatments of multiple small brain metastases. Br J Radiol 2021; 94:20210473. [PMID: 34111967 PMCID: PMC8248213 DOI: 10.1259/bjr.20210473] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Objectives: The aim of this work was to evaluate the operation of the 1600SRS detector and to develop a calibration procedure for verifying the dose delivered by a single isocenter stereotactic radiosurgery (SRS) treatment of small multiple brain metastases (BM). Methods: 14 clinical treatment cases were selected with the number of BM ranging from 2 to 11. The dosimetric agreement was investigated between the calculated and the measured dose by an OCTAVIUS 1600SRS array detector in an OCTAVIUS 4D phantom equipped with dedicated SRS top. The cross-calibration procedure deviated from the manufacturer’s as it applied field sizes and dose rates corresponding to the volumetric modulated arc therapy segments in each plan. Results: Measurements with a plan specific cross-calibration showed mean ± standard deviation (SD) agreement scores for cut-off values 50%, 80%, 95%, of 98.6 ± 1.7%, 96.5 ± 4.6%, 97.3 ± 4.4% for the 6 MV plans respectively, and 98.6 ± 1.5%, 96.6 ± 4.0% 96.4 ± 6.3%, for the 6 MV flattening filter free (FFF) plans respectively. Using the default calibration procedure instead of the plan specific calibration could lead to a combined systematic dose offset of 4.1% for our treatment plans. Conclusion: The 1600SRS detector array with the 4D phantom offers an accurate solution to perform routine quality assurance measurements of single isocenter SRS treatments of multiple BM. This work points out the necessity of an adapted cross-calibration procedure. Advances in knowledge: A dedicated calibration procedure enables accurate dosimetry with the 1600SRS detector for small field single isocenter SRS treatment of multiple brain metastases for a large amount of BM.
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Affiliation(s)
- Esther Decabooter
- Department of Radiation Oncology (Maastro clinic), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Ans Cc Swinnen
- Department of Radiation Oncology (Maastro clinic), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Michel C Öllers
- Department of Radiation Oncology (Maastro clinic), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | | | - Frank Verhaegen
- Department of Radiation Oncology (Maastro clinic), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, The Netherlands
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15
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Fonseca GP, Baer-Beck M, Fournie E, Hofmann C, Rinaldi I, Ollers MC, van Elmpt WJC, Verhaegen F. Evaluation of novel AI-based extended field-of-view CT reconstructions. Med Phys 2021; 48:3583-3594. [PMID: 33978240 PMCID: PMC8362147 DOI: 10.1002/mp.14937] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/27/2021] [Accepted: 04/30/2021] [Indexed: 01/14/2023] Open
Abstract
Purpose Modern computed tomography (CT) scanners have an extended field‐of‐view (eFoV) for reconstructing images up to the bore size, which is relevant for patients with higher BMI or non‐isocentric positioning due to fixation devices. However, the accuracy of the image reconstruction in eFoV is not well known since truncated data are used. This study introduces a new deep learning‐based algorithm for extended field‐of‐view reconstruction and evaluates the accuracy of the eFoV reconstruction focusing on aspects relevant for radiotherapy. Methods A life‐size three‐dimensional (3D) printed thorax phantom, based on a patient CT for which eFoV was necessary, was manufactured and used as reference. The phantom has holes allowing the placement of tissue mimicking inserts used to evaluate the Hounsfield unit (HU) accuracy. CT images of the phantom were acquired using different configurations aiming to evaluate geometric and HU accuracy in the eFoV. Image reconstruction was performed using a state‐of‐the‐art reconstruction algorithm (HDFoV), commercially available, and the novel deep learning‐based approach (HDeepFoV). Five patient cases were selected to evaluate the performance of both algorithms on patient data. There is no ground truth for patients so the reconstructions were qualitatively evaluated by five physicians and five medical physicists. Results The phantom geometry reconstructed with HDFoV showed boundary deviations from 1.0 to 2.5 cm depending on the volume of the phantom outside the regular scan field of view. HDeepFoV showed a superior performance regardless of the volume of the phantom within eFOV with a maximum boundary deviation below 1.0 cm. The maximum HU (absolute) difference for soft issue inserts is below 79 and 41 HU for HDFoV and HDeepFoV, respectively. HDeepFoV has a maximum deviation of −18 HU for an inhaled lung insert while HDFoV reached a 229 HU difference. The qualitative evaluation of patient cases shows that the novel deep learning approach produces images that look more realistic and have fewer artifacts. Conclusion To be able to reconstruct images outside the sFoV of the CT scanner there is no alternative than to use some kind of extrapolated data. In our study, we proposed and investigated a new deep learning‐based algorithm and compared it to a commercial solution for eFoV reconstruction. The deep learning‐based algorithm showed superior performance in quantitative evaluations based on phantom data and in qualitative assessments of patient data.
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Affiliation(s)
- Gabriel Paiva Fonseca
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, 6229 ET, The Netherlands
| | | | | | | | - Ilaria Rinaldi
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, 6229 ET, The Netherlands
| | - Michel C Ollers
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, 6229 ET, The Netherlands
| | - Wouter J C van Elmpt
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, 6229 ET, The Netherlands
| | - Frank Verhaegen
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, 6229 ET, The Netherlands
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16
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Kojima H, Takemura A, Kurokawa S, Ueda S, Noto K, Yokoyama H, Takamatsu S. Evaluation of technical performance of optical surface imaging system using conventional and novel stereotactic radiosurgery algorithms. J Appl Clin Med Phys 2020; 22:58-68. [PMID: 33369014 PMCID: PMC7882109 DOI: 10.1002/acm2.13152] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 11/20/2020] [Accepted: 12/08/2020] [Indexed: 01/18/2023] Open
Abstract
The Catalyst HD (C-RAD Positioning AB, Uppsala, Sweden) optical surface imaging (OSI) system is able to manage interfractional patient positioning, intrafractional motion monitoring, and non-contact respiratory gating without x-ray exposure for radiation therapy. In recent years, a novel high-precision surface registration algorithm for stereotactic radiosurgery (SRS algorithm) has been released. This study aimed to evaluate the technical performance of the OSI system using rigid phantoms, by comparing the conventional and SRS algorithms. To determine the system's technical performance, isocenter displacements were calculated by surface image registration via the OSI system using head, thorax, and pelvis rigid phantoms. The reproducibility of positioning was evaluated by the mean value calculated by repeating the registration 10 times, without moving each phantom. The accuracy of positioning was evaluated by the mean value of the residual error, where the 10 offset values given to each phantom were subtracted from the isocenter displacement values. The stability of motion monitoring was evaluated by measuring isocenter drift during 20 min and averaging it over 10 measurements. For the head phantom, all tests were compared with the mask types and algorithms. As a result, for all sites and both algorithms, the reproducibility, accuracy, and stability for translation and rotation were <0.1 mm and <0.1°, <1.0 mm and <1.0°, and <0.1 mm and <0.1°, respectively. In particular, the SRS algorithm had a small absolute error and standard deviation of calculated isocenter displacement, and a significantly higher reproducibility and accuracy than the conventional algorithm (P < 0.01). There was no difference in the stability between the algorithms (P = 0.0280). The SRS algorithm was found to be suitable for the treatment of rigid body sites with less deformation and small area, such as the head and face.
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Affiliation(s)
- Hironori Kojima
- Department of Radiology, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan.,Division of Health Sciences, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Akihiro Takemura
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Shogo Kurokawa
- Department of Radiation Technology, Shizuoka General Hospital, Shizuoka, Shizuoka, Japan
| | - Shinichi Ueda
- Department of Radiology, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan
| | - Kimiya Noto
- Department of Radiology, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan
| | - Haruna Yokoyama
- Department of Radiology, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan.,Division of Health Sciences, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Shigeyuki Takamatsu
- Department of Radiation Therapy, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan
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Barnes M, Yeo A, Thompson K, Phillips C, Kron T, Hardcastle N. A retrospective analysis of setup and intrafraction positional variation in stereotactic radiotherapy treatments. J Appl Clin Med Phys 2020; 21:109-119. [PMID: 33140915 PMCID: PMC7769413 DOI: 10.1002/acm2.13076] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 09/10/2020] [Accepted: 09/25/2020] [Indexed: 01/11/2023] Open
Abstract
PURPOSE The aim of this study was to provide a comprehensive assessment of patient intrafraction motion in linac-based frameless stereotactic radiosurgery (SRS) and radiotherapy (SRT). METHODS A retrospective review was performed on 101 intracranial SRS/SRT patients immobilized with the Klarity stereotactic thermoplastic mask (compatible with the Brainlab frameless stereotactic system) and aligned on a 6 Degree of Freedom (DoF) couch with the Brainlab ExacTrac image guidance system. Both pretreatment and intrafraction correction data are provided as observed by the ExacTrac system. The effects of couch angle and treatment duration on positioning outcomes are also explored. RESULTS Initial setup data for patients is shown to vary by up to ±4.18 mm, ±2.97°, but when corrected with a single x-ray image set with ExacTrac, patient positions are corrected to within ±2.11 mm, ±2.27°. Intrafraction patient motion is shown to be uniformly random and independent of both time and couch angle. Patient motion was also limited to within approximately 3 mm, 3° by the thermoplastic mask. CONCLUSIONS Our results indicate that since patient intrafraction motion is unrelated to couch rotation and treatment duration, intrafraction patient monitoring in 6 DoF is required to minimize intracranial SRS/SRT margins.
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Affiliation(s)
- Micah Barnes
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Imaging and Medical Beamline, Australian Nuclear Science and Technology Organisation - Australian Synchrotron, Clayton, VIC, Australia
| | - Adam Yeo
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,School of Science, RMIT University, Melbourne, VIC, Australia
| | - Kenton Thompson
- Department of Radiation Therapy Services, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Claire Phillips
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Tomas Kron
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia.,Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia
| | - Nicholas Hardcastle
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia.,Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia
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18
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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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