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Zhao H, Sarkar V, St James S, Paxton A, Su FF, Price RG, Dial C, Poppe M, Gaffney D, Salter B. Verification of surface-guided radiation therapy (SGRT) alignment for proton breast and chest wall patients by comparison to CT-on-rails and kV-2D alignment. J Appl Clin Med Phys 2024; 25:e14263. [PMID: 38268200 PMCID: PMC10860439 DOI: 10.1002/acm2.14263] [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: 03/27/2023] [Revised: 12/10/2023] [Accepted: 12/20/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Surface-guided radiation therapy (SGRT) systems have been widely installed and utilized on linear accelerators. However, the use of SGRT with proton therapy is still a newly developing field, and published reports are currently very limited. PURPOSE To assess the clinical application and alignment agreement of SGRT with CT-on-rails (CTOR) and kV-2D image-guided radiation therapy (IGRT) for breast treatment using proton therapy. METHODS Four patients receiving breast or chest wall treatment with proton therapy were the subjects of this study. Patient #1's IGRT modalities were a combination of kV-2D and CTOR. CTOR was the only imaging modality for patients #2 and #3, and kV-2D was the only imaging modality for patient #4. The patients' respiratory motions were assessed using a 2-min surface position recorded by the SGRT system during treatment. SGRT offsets reported after IGRT shifts were recorded for each fraction of treatment. The agreement between SGRT and either kV-2D or CTOR was evaluated. RESULTS The respiratory motion amplitude was <4 mm in translation and <2.0° in rotation for all patients. The mean and maximum amplitude of SGRT offsets after application of IGRT shifts were ≤(2.6 mm, 1.6° ) and (6.8 mm, 4.5° ) relative to kV-2D-based IGRT; ≤(3.0 mm, 2.6° ) and (5.0 mm, 4.7° ) relative to CTOR-based IGRT without breast tissue inflammation. For patient #3, breast inflammation was observed for the last three fractions of treatment, and the maximum SGRT offsets post CTOR shifts were up to (14.0 mm, 5.2° ). CONCLUSIONS Due to the overall agreement between SGRT and IGRT within reasonable tolerance, SGRT has the potential to serve as a valuable auxiliary IGRT tool for proton breast treatment and may improve the efficiency of proton breast treatment.
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Affiliation(s)
- Hui Zhao
- Radiation Oncology DepartmentUniversity of UtahSalt Lake CityUtahUSA
| | - Vikren Sarkar
- Radiation Oncology DepartmentUniversity of UtahSalt Lake CityUtahUSA
| | - Sara St James
- Radiation Oncology DepartmentUniversity of UtahSalt Lake CityUtahUSA
| | - Adam Paxton
- Radiation Oncology DepartmentUniversity of UtahSalt Lake CityUtahUSA
| | | | - Ryan G. Price
- Radiation Oncology DepartmentUniversity of UtahSalt Lake CityUtahUSA
| | - Christian Dial
- Radiation Oncology DepartmentUniversity of UtahSalt Lake CityUtahUSA
| | - Matthew Poppe
- Radiation Oncology DepartmentUniversity of UtahSalt Lake CityUtahUSA
| | - David Gaffney
- Radiation Oncology DepartmentUniversity of UtahSalt Lake CityUtahUSA
| | - Bill Salter
- Radiation Oncology DepartmentUniversity of UtahSalt Lake CityUtahUSA
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Peng H, Yang H, Lei J, Dai X, Cao P, Jin F, Luo H. Optimal fractionation and timing of weekly cone-beam CT in daily surface-guided radiotherapy for breast cancer. Radiat Oncol 2023; 18:112. [PMID: 37408037 DOI: 10.1186/s13014-023-02279-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 05/08/2023] [Indexed: 07/07/2023] Open
Abstract
PURPOSE Surface-guided radiotherapy (SGRT) has been demonstrated to be a promising supplement to cone-beam computed tomography (CBCT) in adjuvant breast cancer radiotherapy, but a rational combination mode is lacking in clinical practice. The aim of this study was to explore this mode and investigate its impact on the setup and dose accuracy. METHODS AND MATERIALS Daily SGRT and weekly CBCT images were acquired for 23 patients with breast cancer who received conventional fractionated radiotherapy after lumpectomy. Sixteen modes were acquired by randomly selecting one (CBCT1), two (CBCTij), three (CBCTijk), four (CBCTijkl), and five (CBCT12345) images from the CBCT images for fusion with the SGRT. The CTV-PTV margins, OAR doses, and dose coverage (V95%) of PTV and CTV was calculated based on SGRT setup errors with different regions of interest (ROIs). Dose correlations between these modalities were investigated using Pearson and Spearman's methods. Patient-specific parameters were recorded to assess their impact on dose. RESULTS The CTV-PTV margins decreased with increasing CBCT frequencies and were close to 5 mm for CBCTijkl and CBCT12345. For the ipsilateral breast ROI, SGRT errors were larger in the AP direction, and target doses were higher in all modes than in the whole breast ROI (P < 0.05). In the ipsilateral ROI, the target dose correlations between all modes increased with increasing CBCT time intervals, decreased, and then increased with increasing CBCT frequencies, with the inflection point being CBCT participation at week 5. The dose deviations in CBCT123, CBCT124, CBCT125, CBCTijkl, and CBCT12345 were minimal and did not differ significantly (P > 0.05). There was excellent agreement between CBCT124 and CBCT1234, and between (CBCTijkl, CBCT12345) and CBCT125 in determining the classification for the percentage of PTV deviation (Kappa = 0.704-0.901). In addition, there were weak correlations between the patient's Dips_b (ipsilateral breast diameter with bolus) and CTV doses in modes with CBCT participation at week 4 (R = 0.270 to 0.480). CONCLUSIONS Based on weekly CBCT, these modes with ipsilateral ROI and a combination of daily SGRT and a CBCT frequency of ≥ 3 were recommended, and CBCT was required at weeks 1 and 2 for CBCTijk.
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Affiliation(s)
- Haiyan Peng
- Departments of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing, People's Republic of China
| | - Han Yang
- Departments of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing, People's Republic of China
| | - Jinyan Lei
- Departments of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing, People's Republic of China
| | - Xinyao Dai
- Departments of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing, People's Republic of China
| | - Panpan Cao
- Departments of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing, People's Republic of China
| | - Fu Jin
- Departments of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing, People's Republic of China.
| | - Huanli Luo
- Departments of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing, People's Republic of China.
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Zhang Z, Li D, Peng F, Tan Z, Yang P, Peng Z, Li X, Qi X, Sun W, Liu Y, Wang Y. Evaluation of Hybrid VMAT Advantages and Robustness Considering Setup Errors Using Surface Guided Dose Accumulation for Internal Lymph Mammary Nodes Irradiation of Postmastectomy Radiotherapy. Front Oncol 2022; 12:907181. [PMID: 35936730 PMCID: PMC9354548 DOI: 10.3389/fonc.2022.907181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/20/2022] [Indexed: 11/14/2022] Open
Abstract
Objectives Setup error is a key factor affecting postmastectomy radiotherapy (PMRT) and irradiation of the internal mammary lymph nodes is the most investigated aspect for PMRT patients. In this study, we evaluated the robustness, radiobiological, and dosimetric benefits of the hybrid volumetric modulated arc therapy (H-VMAT) planning technique based on the setup error in dose accumulation using a surface-guided system for radiation therapy. Methods We retrospectively selected 32 patients treated by a radiation oncologist and evaluated the clinical target volume (CTV), including internal lymph node irradiation (IMNIs), and considered the planning target volume (PTV) margin to be 5 mm. Three different planning techniques were evaluated: tangential-VMAT (T-VMAT), intensity-modulated radiation therapy (IMRT), and H-VMAT. The interfraction and intrafraction setup errors were analyzed in each field and the accumulated dose was evaluated as the patients underwent daily surface-guided monitoring. These parameters were included while evaluating CTV coverage, the dose required for the left anterior descending artery (LAD) and the left ventricle (LV), the normal tissue complication probability (NTCP) for the heart and lungs, and the second cancer complication probability (SCCP) for contralateral breast (CB). Results When the setup error was accounted for dose accumulation, T-VMAT (95.51%) and H-VMAT (95.48%) had a higher CTV coverage than IMRT (91.25%). In the NTCP for the heart, H-VMAT (0.04%) was higher than T-VMAT (0.01%) and lower than IMRT (0.2%). However, the SCCP (1.05%) of CB using H-VMAT was lower than that using T-VMAT (2%) as well as delivery efficiency. And T-VMAT (3.72) and IMRT (10.5).had higher plan complexity than H-VMAT (3.71). Conclusions In this study, based on the dose accumulation of setup error for patients with left-sided PMRT with IMNI, we found that the H-VMAT technique was superior for achieving an optimum balance between target coverage, OAR dose, complication probability, plan robustness, and complexity.
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Affiliation(s)
- Zhe Zhang
- Department of Radiation Oncology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Daming Li
- Department of Radiation Oncology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Feng Peng
- Department of Radiation Oncology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Zhibo Tan
- Department of Radiation Oncology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Pengfei Yang
- Department of Radiation Oncology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Zhaoming Peng
- Department of Radiation Oncology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Xin Li
- Department of Radiation Oncology, Peking University Shenzhen Hospital, Shenzhen, China
- Hong Kong University of Science and Technology Medical Center, Shenzhen-Peking University, Shenzhen, China
| | - Xinyue Qi
- Department of Statistics and Data Science, Southern University of Science and Technology, Shenzhen, China
| | - Weixiao Sun
- Department of Statistics and Data Science, Southern University of Science and Technology, Shenzhen, China
| | - Yajie Liu
- Department of Radiation Oncology, Peking University Shenzhen Hospital, Shenzhen, China
- Hong Kong University of Science and Technology Medical Center, Shenzhen-Peking University, Shenzhen, China
- *Correspondence: Yajie Liu, ; Yuenan Wang,
| | - Yuenan Wang
- Department of Radiation Oncology, Peking University Shenzhen Hospital, Shenzhen, China
- Department of Statistics and Data Science, Southern University of Science and Technology, Shenzhen, China
- *Correspondence: Yajie Liu, ; Yuenan Wang,
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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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Li H, Hrinivich WT, Chen H, Sheikh K, Ho MW, Ger R, Liu D, Hales RK, Voong KR, Halthore A, Deville C. Evaluating Proton Dose and Associated Range Uncertainty Using Daily Cone-Beam CT. Front Oncol 2022; 12:830981. [PMID: 35449577 PMCID: PMC9016186 DOI: 10.3389/fonc.2022.830981] [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: 12/07/2021] [Accepted: 03/02/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose This study aimed to quantitatively evaluate the range uncertainties that arise from daily cone-beam CT (CBCT) images for proton dose calculation compared to CT using a measurement-based technique. Methods For head and thorax phantoms, wedge-shaped intensity-modulated proton therapy (IMPT) treatment plans were created such that the gradient of the wedge intersected and was measured with a 2D ion chamber array. The measured 2D dose distributions were compared with 2D dose planes extracted from the dose distributions using the IMPT plan calculated on CT and CBCT. Treatment plans of a thymoma cancer patient treated with breath-hold (BH) IMPT were recalculated on 28 CBCTs and 9 CTs, and the resulting dose distributions were compared. Results The range uncertainties for the head phantom were determined to be 1.2% with CBCT, compared to 0.5% for CT, whereas the range uncertainties for the thorax phantom were 2.1% with CBCT, compared to 0.8% for CT. The doses calculated on CBCT and CT were similar with similar anatomy changes. For the thymoma patient, the primary source of anatomy change was the BH uncertainty, which could be up to 8 mm in the superior-inferior (SI) direction. Conclusion We developed a measurement-based range uncertainty evaluation method with high sensitivity and used it to validate the accuracy of CBCT-based range and dose calculation. Our study demonstrated that the CBCT-based dose calculation could be used for daily dose validation in selected proton patients.
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Affiliation(s)
- Heng Li
- Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - William T Hrinivich
- Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Hao Chen
- Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Khadija Sheikh
- Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Meng Wei Ho
- Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Rachel Ger
- Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Dezhi Liu
- Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Russell Kenneth Hales
- Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Khinh Ranh Voong
- Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Aditya Halthore
- Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Curtiland Deville
- Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Pakela JM, Knopf A, Dong L, Rucinski A, Zou W. Management of Motion and Anatomical Variations in Charged Particle Therapy: Past, Present, and Into the Future. Front Oncol 2022; 12:806153. [PMID: 35356213 PMCID: PMC8959592 DOI: 10.3389/fonc.2022.806153] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 02/04/2022] [Indexed: 12/14/2022] Open
Abstract
The major aim of radiation therapy is to provide curative or palliative treatment to cancerous malignancies while minimizing damage to healthy tissues. Charged particle radiotherapy utilizing carbon ions or protons is uniquely suited for this task due to its ability to achieve highly conformal dose distributions around the tumor volume. For these treatment modalities, uncertainties in the localization of patient anatomy due to inter- and intra-fractional motion present a heightened risk of undesired dose delivery. A diverse range of mitigation strategies have been developed and clinically implemented in various disease sites to monitor and correct for patient motion, but much work remains. This review provides an overview of current clinical practices for inter and intra-fractional motion management in charged particle therapy, including motion control, current imaging and motion tracking modalities, as well as treatment planning and delivery techniques. We also cover progress to date on emerging technologies including particle-based radiography imaging, novel treatment delivery methods such as tumor tracking and FLASH, and artificial intelligence and discuss their potential impact towards improving or increasing the challenge of motion mitigation in charged particle therapy.
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Affiliation(s)
- Julia M Pakela
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, United States
| | - Antje Knopf
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.,Department I of Internal Medicine, Center for Integrated Oncology Cologne, University Hospital of Cologne, Cologne, Germany
| | - Lei Dong
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, United States
| | - Antoni Rucinski
- Institute of Nuclear Physics, Polish Academy of Sciences, Krakow, Poland
| | - Wei Zou
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, United States
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