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Trnková P, Dasu A, Placidi L, Stock M, Toma-Dasu I, Brouwer CL, Gosling A, Jouglar E, Kristensen I, Martin V, Moinuddin S, Pasquie I, Peters S, Pica A, Plaude S, Righetto R, Rombi B, Thariat J, van der Weide H, Hoffmann A, Bolsi A. Patterns of practice of image guided particle therapy for cranio-spinal irradiation: A site specific multi-institutional survey of European Particle Therapy Network. Phys Med 2024; 123:103407. [PMID: 38906046 DOI: 10.1016/j.ejmp.2024.103407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 04/22/2024] [Accepted: 06/07/2024] [Indexed: 06/23/2024] Open
Abstract
PURPOSE To investigate the current practice patterns in image-guided particle therapy (IGPT) for cranio-spinal irradiation (CSI). METHODS A multi-institutional survey was distributed to European particle therapy centres to analyse all aspects of IGPT. Based on the survey results, a Delphi consensus analysis was developed to define minimum requirements and optimal workflow for clinical practice. The centres participating in the institutional survey were invited to join the Delphi process. RESULTS Eleven centres participated in the survey. Imaging for treatment planning was rather similar among the centres with Computed Tomography (CT) being the main modality. For positioning verification, 2D IGPT was more commonly used than 3D IGPT. Two centres performed routinely imaging for plan adaptation, by the rest ad hoc. Eight centres participated in the Delphi consensus analysis. The full consensus was reached on the use of CT imaging without contrast for treatment planning and the role of magnetic resonance imaging (MRI) in target and organs-at-risk delineation. There was an agreement on the necessity to perform patient position verification and correction before each isocentre. The most important outcome was the clear need for standardization and harmonization of the workflow. CONCLUSION There were differences in CSI IGPT clinical practice among the European particle therapy centres. Moreover, the optimal workflow as identified by experts was not yet reached. There is a strong need for consensus guidelines. The state-of-the-art imaging technology and protocols need to be implemented into clinical practice to improve the quality of IGPT for CSI.
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Affiliation(s)
- Petra Trnková
- Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria.
| | - Alexandru Dasu
- The Skandion Clinic, Uppsala, Sweden; Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Lorenzo Placidi
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Department of Diagnostic Imaging, Oncological Radiotherapy and Haematology, Rome, Italy
| | - Markus Stock
- MedAustron Ion Therapy Centre, Wiener Neustadt, Austria; Karl Landsteiner University of Health Sciences, Wiener Neustadt, Austria
| | - Iuliana Toma-Dasu
- Medical Radiation Physics, Department of Physics, Stockholm University, Stockholm, Sweden; Department of Oncology and Pathology, Karolinska Institute, Stockholm, Sweden
| | - Charlotte L Brouwer
- University of Groningen, University Medical Centre Groningen, Department of Radiation Oncology, the Netherlands
| | - Andrew Gosling
- Department of Radiotherapy Physics, University College London Hospitals NHS Foundation Trust, London, UK
| | - Emmanuel Jouglar
- Department of Radiation Oncology, Institute Curie, PSL Research University, Orsay, Paris, France
| | - Ingrid Kristensen
- Radiation Physics, Department of Haematology, Oncology and Radiation Physics, Skåne University Hospital, Sweden
| | - Valentine Martin
- Department of Radiation Oncology, Institute Gustave Roussy, Villejuif, France
| | - Syed Moinuddin
- Department of Radiotherapy, University College London Hospitals NHS Foundation Trust, London, UK
| | - Isabelle Pasquie
- Department of Radiation Oncology, Institute Curie, PSL Research University, Orsay, Paris, France
| | - Sarah Peters
- Department of Particle Therapy, University Hospital Essen, Germany; West German Proton Therapy Centre Essen (WPE), Essen, Germany
| | - Alessia Pica
- Centre for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
| | - Sandija Plaude
- West German Proton Therapy Centre Essen (WPE), Essen, Germany
| | - Roberto Righetto
- Medical Physics Unit, Santa Chiara Hospital, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - Barbara Rombi
- Proton Therapy Unit, Santa Chiara Hospital, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - Juliette Thariat
- Department of Radiotherapy, Centre François Baclesse, Caen, France
| | - Hiske van der Weide
- University of Groningen, University Medical Centre Groningen, Department of Radiation Oncology, the Netherlands
| | - Aswin Hoffmann
- OncoRay - National Centre for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden and Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany; Department of Radiotherapy and Radiation Oncology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Alessandra Bolsi
- Centre for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
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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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