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Nozawa Y, Ohta T, Katano A, Yamashita H, Nakagawa K. Diaphragm Tracking System That Superimposes Planned Diaphragm Contours on Kilovolt Cine Images During Multiple Breath-Hold Volumetric Modulated Arc Therapy for Abdominal Tumors. Cureus 2024; 16:e67540. [PMID: 39314620 PMCID: PMC11417412 DOI: 10.7759/cureus.67540] [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] [Accepted: 08/22/2024] [Indexed: 09/25/2024] Open
Abstract
We recently published a phantom validation of our diaphragm tracking system, DiaTrak, on an Elekta linear accelerator with an integrated cone-beam computed tomography (CBCT) unit for multiple breath-hold volumetric modulated arc therapy of abdominal tumors, where the diaphragm position was compared between digitally reconstructed radiography (DRR) and kilovolt (kV) projection streaming images by template matching. In the present report, the visual feedback of the diaphragm position was added to the reported system. DICOM-RT diaphragm contour data were additionally exported from a treatment planning system to the DiaTrak PC. Following phantom localization by registering the CBCT to the planning CT images, a projected diaphragm contour was overlaid on each DRR image, whereas another two projected diaphragm contours were superimposed on each kV projection cine image every 180 ms after shifting ±5 mm (set as breath-hold tolerance) in the craniocaudal direction during gantry rotation. It was visually confirmed that the projected diaphragm surface was observed within the two contour lines on the kV cine window. The diaphragm registration errors of the localized phantom were also calculated based on image cross-correlation between the DRR and the projection cine images every 180 ms. It was found that the mean diaphragm registration error was -0.29 mm with a standard deviation of 0.32 mm during the gantry rotation. In conclusion, a new interface for the 5 mm tolerance check was proposed to provide direct visual feedback, thereby giving a sense of assurance to the attending radiotherapy technologists. The calculated diaphragm registration errors were relatively small compared to the tolerance of 5 mm, and therefore it is considered clinically acceptable.
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Affiliation(s)
- Yuki Nozawa
- Radiology, University of Tokyo Hospital, Tokyo, JPN
| | - Takeshi Ohta
- Radiology, University of Tokyo Hospital, Tokyo, JPN
| | | | | | - Keiichi Nakagawa
- Comprehensive Radiatiion Oncology, University of Tokyo, Tokyo, JPN
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Kaestner L, Streb L, Hetjens S, Buergy D, Sihono DS, Fleckenstein J, Kalisch I, Eckl M, Giordano FA, Lohr F, Stieler F, Boda-Heggemann J. Surface guidance compared with ultrasound-based monitoring and diaphragm position in cone-beam computed tomography during abdominal stereotactic radiotherapy in breath-hold. Phys Imaging Radiat Oncol 2023; 27:100455. [PMID: 37720462 PMCID: PMC10500027 DOI: 10.1016/j.phro.2023.100455] [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: 01/02/2023] [Revised: 05/30/2023] [Accepted: 05/31/2023] [Indexed: 09/19/2023] Open
Abstract
Background and purpose Spirometry induced deep-inspiration-breath-hold (DIBH) reduces intrafractional motion during upper abdominal stereotactic body radiotherapy (SBRT). The aim of this prospective study was to evaluate whether surface scanning (SGRT) is an adequate surrogate for monitoring residual internal motion during DIBH. Residual motion detected by SGRT was compared with experimental 4D-ultrasound (US) and an internal motion detection benchmark (diaphragm-dome-position in kV cone-beam computed tomography (CBCT) projections). Materials and methods Intrafractional monitoring was performed with SGRT and US in 460 DIBHs of 12 patients. Residual motion detected by all modalities (SGRT (anterior-posterior (AP)), US (AP, craniocaudal (CC)) and CBCT (CC)) was analyzed. Agreement analysis included Wilcoxon signed rank test, Maloney and Rastogi's test, Pearson's correlation coefficient (PCC) and interclass correlation coefficient (ICC). Results Interquartile range was 0.7 mm (US(AP)), 0.8 mm (US(CC)), 0.9 mm (SGRT) and 0.8 mm (CBCT). SGRT(AP) vs. CBCT(CC) and US(CC) vs. CBCT(CC) showed comparable agreement (PCCs 0.53 and 0.52, ICCs 0.51 and 0.49) with slightly higher precision of CBCT(CC). Most agreement was observed for SGRT(AP) vs. US(AP) with largest PCC (0.61) and ICC (0.60), least agreement for SGRT(AP) vs. US(CC) with smallest PCC (0.44) and ICC (0.42). Conclusions Residual motion detected during spirometry induced DIBH is small. SGRT alone is no sufficient surrogate for residual internal motion in all patients as some high velocity motion could not be detected. Observed patient-specific residual errors may require individualized PTV-margins.
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Affiliation(s)
- Lena Kaestner
- University Medical Center Mannheim, Department of Radiation Oncology, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Lara Streb
- University Medical Center Mannheim, Department of Radiation Oncology, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Svetlana Hetjens
- University Medical Center Mannheim, Department of Medical Statistics and Biomathematics, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Daniel Buergy
- University Medical Center Mannheim, Department of Radiation Oncology, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Dwi S.K. Sihono
- University Medical Center Mannheim, Department of Radiation Oncology, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
- Departemen Fisika, FMIPA, Universitas Indonesia, Depok 16424, Indonesia
| | - Jens Fleckenstein
- University Medical Center Mannheim, Department of Radiation Oncology, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Iris Kalisch
- University Medical Center Mannheim, Department of Radiation Oncology, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Miriam Eckl
- University Medical Center Mannheim, Department of Radiation Oncology, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Frank A. Giordano
- University Medical Center Mannheim, Department of Radiation Oncology, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Frank Lohr
- University Medical Center Mannheim, Department of Radiation Oncology, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
- Struttura Complessa di Radioterapia, Dipartimento di Oncologia, Az. Ospedaliero-Universitaria di Modena, Largo del Pozzo 71, 41122 Modena, Italy
| | - Florian Stieler
- University Medical Center Mannheim, Department of Radiation Oncology, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Judit Boda-Heggemann
- University Medical Center Mannheim, Department of Radiation Oncology, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
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Wang Y, Fu T, Wang Y, Xiao D, Lin Y, Fan J, Song H, Liu F, Yang J. Multi 3: multi-templates siamese network with multi-peaks detection and multi-features refinement for target tracking in ultrasound image sequences. Phys Med Biol 2022; 67. [DOI: 10.1088/1361-6560/ac9032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 09/07/2022] [Indexed: 11/11/2022]
Abstract
Abstract
Objective. Radiation therapy requires a precise target location. However, respiratory motion increases the uncertainties of the target location. Accurate and robust tracking is significant for improving operation accuracy. Approach. In this work, we propose a tracking framework Multi3, including a multi-templates Siamese network, multi-peaks detection and multi-features refinement, for target tracking in ultrasound sequences. Specifically, we use two templates to provide the location and deformation of the target for robust tracking. Multi-peaks detection is applied to extend the set of potential target locations, and multi-features refinement is designed to select an appropriate location as the tracking result by quality assessment. Main results. The proposed Multi3 is evaluated on a public dataset, i.e. MICCAI 2015 challenge on liver ultrasound tracking (CLUST), and our clinical dataset provided by the Chinese People’s Liberation Army General Hospital. Experimental results show that Multi3 achieves accurate and robust tracking in ultrasound sequences (0.75 ± 0.62 mm and 0.51 ± 0.32 mm tracking errors in two datasets). Significance. The proposed Multi3 is the most robust method on the CLUST 2D benchmark set, exhibiting potential in clinical practice.
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Nie X, Li G. Real-Time 2D MR Cine From Beam Eye's View With Tumor-Volume Projection to Ensure Beam-to-Tumor Conformality for MR-Guided Radiotherapy of Lung Cancer. Front Oncol 2022; 12:898771. [PMID: 35847879 PMCID: PMC9277147 DOI: 10.3389/fonc.2022.898771] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 05/20/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose To minimize computation latency using a predictive strategy to retrieve and project tumor volume onto 2D MR beam eye’s view (BEV) cine from time-resolved four-dimensional magnetic resonance imaging (TR-4DMRI) libraries (inhalation/exhalation) for personalized MR-guided intensity-modulated radiotherapy (IMRT) or volumetric-modulated arc therapy (VMAT). Methods Two time-series forecasting algorithms, autoregressive (AR) modeling and deep-learning-based long short-term memory (LSTM), were applied to predict the diaphragm position in the next 2D BEV cine to identify a motion-matched and hysteresis-accounted image to retrieve the tumor volume from the inhalation/exhalation TR-4DMRI libraries. Three 40-s TR-4DMRI (2 Hz, 3 × 80 images) per patient of eight lung cancer patients were used to create patient-specific inhalation/exhalation 4DMRI libraries, extract diaphragmatic waveforms, and interpolate them to f = 4 and 8 Hz to match 2D cine frame rates. Along a (40•f)-timepoint waveform, 30•f training timepoints were moved forward to produce 3×(10•f-1) predictions. The accuracy of position prediction was assessed against the waveform ground truth. The accuracy of tumor volume projections was evaluated using the center-of-mass difference (∆COM) and Dice similarity index against the TR-4DMRI ground truth for both IMRT (six beam angles, 30° interval) and VMAT (240/480 beam angles, 1.5°/0.75° interval, at 4/8 Hz, respectively). Results The accuracy of the first-timepoint prediction is 0.36 ± 0.10 mm (AR) and 0.62 ± 0.21 mm (LSTM) at 4 Hz and 0.06 ± 0.02 mm (AR) and 0.18 ± 0.06 mm (LSTM) at 8 Hz. A 10%–20% random error in prediction-library matching increases the overall uncertainty slightly. For both IMRT and VMAT, the accuracy of projected tumor volume contours on 2D BEV cine is ∆COM = 0.39 ± 0.13 mm and DICE = 0.97 ± 0.02 at 4 Hz and ∆COM = 0.10 ± 0.04 mm and DICE = 1.00 ± 0.00 at 8Hz. Conclusion This study demonstrates the feasibility of accurately predicting respiratory motion during 2D BEV cine imaging, identifying a motion-matched and hysteresis-accounted tumor volume, and projecting tumor volume contour on 2D BEV cine for real-time assessment of beam-to-tumor conformality, promising for optimal personalized MR-guided radiotherapy.
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Affiliation(s)
- Xingyu Nie
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, United States.,Department of Radiology, University of Kentucky, Lexington, KY, United States
| | - Guang Li
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, United States
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Dunkerley DAP, Hyer DE, Snyder JE, St-Aubin JJ, Anderson CM, Caster JM, Smith MC, Buatti JM, Yaddanapudi S. Clinical Implementational and Site-Specific Workflows for a 1.5T MR-Linac. J Clin Med 2022; 11:jcm11061662. [PMID: 35329988 PMCID: PMC8954784 DOI: 10.3390/jcm11061662] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/11/2022] [Accepted: 03/15/2022] [Indexed: 01/27/2023] Open
Abstract
MR-guided adaptive radiotherapy (MRgART) provides opportunities to benefit patients through enhanced use of advanced imaging during treatment for many patients with various cancer treatment sites. This novel technology presents many new challenges which vary based on anatomic treatment location, technique, and potential changes of both tumor and normal tissue during treatment. When introducing new treatment sites, considerations regarding appropriate patient selection, treatment planning, immobilization, and plan-adaption criteria must be thoroughly explored to ensure adequate treatments are performed. This paper presents an institution’s experience in developing a MRgART program for a 1.5T MR-linac for the first 234 patients. The paper suggests practical treatment workflows and considerations for treating with MRgART at different anatomical sites, including imaging guidelines, patient immobilization, adaptive workflows, and utilization of bolus.
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Milewski A, Li G. Stability and Reliability of Enhanced External-Internal Motion Correlation via Dynamic Phase-Shift Corrections Over 30-min Timeframe for Respiratory-Gated Radiotherapy. Technol Cancer Res Treat 2022; 21:15330338221111592. [PMID: 35880289 PMCID: PMC9340341 DOI: 10.1177/15330338221111592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
To assess the stability of patient-specific phase shifts between external- and
internal-respiratory motion waveforms, the reliability of enhanced
external–internal correlation with phase-shift correction, and the feasibility
of guiding respiratory-gated radiotherapy (RGRT) over 30 min. In this clinical
feasibility investigation, external bellows and internal-navigator waveforms
were simultaneously and prospectively acquired along with two four-dimensional
magnetic resonance imaging (4DMRI) scans (6–15 m each) with 15–20 m intervals in
10 volunteers. A bellows was placed 5 cm inferior to the xiphoid to monitor
abdominal motion, and an MR navigator was used to track the diaphragmatic
motion. The mean phase-domain (MPD) method was applied, which combines three
individual phase-calculating methods: phase-space oval fitting, principal
component analysis, and analytic signal analysis, weighted by the reciprocal of
their residual errors (RE) excluding outliers (RE >2σ). The time-domain
cross-correlation (TCC) analysis was applied for comparison. Dynamic phase-shift
correction was performed based on the phase shift detected on the fly within two
10 s moving datasets. Simulating bellows-triggered gating, the median and 95%
confidence interval for the navigator's position at beam-on/beam-off and %harm
(percentage of beam-on time outside the safety margin) were calculated. Averaged
across all subjects, the mean phase shifts are found indistinguishable
(p > .05) between scan 1 (55˚ ± 9˚) and scan 2
(59˚ ± 11˚). Using the MPD method the averaged correlation increases from
0.56 ± 0.22 to 0.85 ± 0.11 for scan 1 and from 0.47 ± 0.30 to 0.84 ± 0.08 for
scan 2. The TCC correction results in similar results. After phase-shift
correction, the number of cases that were suitable for amplitude gating (with
<10%harm) increased from 2 to 17 out of 20 cases. A patient-specific, stable
phase-shift between the external and internal motions was observed and corrected
using the MPD and TCC methods, producing long-lasting enhanced motion
correlation over 30m. Phase-shift correction offers a feasible strategy for
improving the accuracy of tumor-motion prediction during RGRT.
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Affiliation(s)
- Andrew Milewski
- Department of Medical Physics, 5803Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Guang Li
- Department of Medical Physics, 5803Memorial Sloan Kettering Cancer Center, New York, NY, USA
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