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Oar B, Brown A, Newman G, Boles A, Rumley CN, Doyle R, Baines J, Tan A. Improvement in male pelvis magnetic resonance image contouring following radiologist-delivered training. J Med Radiat Sci 2024; 71:114-122. [PMID: 37740640 PMCID: PMC10920942 DOI: 10.1002/jmrs.727] [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: 12/06/2022] [Accepted: 09/07/2023] [Indexed: 09/24/2023] Open
Abstract
INTRODUCTION The magnetic resonance linear accelerator (MRL) combines both magnetic resonance imaging and a linear accelerator, allowing for daily treatment adaptation. This study aimed to assess the impact of radiologist-delivered training in magnetic resonance (MR) contouring of relevant structures within the male pelvis. METHODS Two radiation oncologists, two radiation oncology registrars and seven radiation therapists completed contouring on 10 male pelvis MR datasets both pre- and post-training. A 2-hour MR anatomy training session was delivered by a radiologist, who also provided the 'gold standard' contours. The pre- and post-training contours were compared against the gold standard with Dice similarity coefficient (DSC) and Hausdorff distances calculated; and the pre- and post-confidence scores and timing were compared. RESULTS The improvement in DSC were significant in prostate, rectum and seminal vesicles, with a post-training median DSC of 0.87 ± 0.06, 0.92 ± 0.04 and 0.80 ± 0.14, respectively. The median Hausdorff improved with a median of 1.46 ± 0.78 mm, 0.52 ± 0.32 mm and 1.11 ± 0.86 mm for prostate, rectum and seminal vesicles, respectively. Bladder concordance was high both pre- and post-training. Urethra contours improved post-training, however, remained difficult to contour with a median post-DSC of 0.51 ± 0.24. Overall, confidence scoring improved (P < 0.001) and timing decreased by an average of 4.4 ± 16.4 min post-training. CONCLUSION Radiologist-delivered training improved concordance of male pelvis contouring on MR datasets. Further work is required in the identification of urethra on MRs. These findings are of importance in the MRL adaptive workflow.
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Affiliation(s)
- Bronwyn Oar
- Townsville University HospitalTownsvilleQueenslandAustralia
| | - Amy Brown
- Townsville University HospitalTownsvilleQueenslandAustralia
- Queensland University of TechnologyBrisbaneQueenslandAustralia
- James Cook UniversityTownsvilleQueenslandAustralia
| | - Glen Newman
- Townsville University HospitalTownsvilleQueenslandAustralia
| | - Alan Boles
- Queensland XRayTownsvilleQueenslandAustralia
| | - Christopher N. Rumley
- Townsville University HospitalTownsvilleQueenslandAustralia
- James Cook UniversityTownsvilleQueenslandAustralia
| | - Rachel Doyle
- Townsville University HospitalTownsvilleQueenslandAustralia
| | - John Baines
- Townsville University HospitalTownsvilleQueenslandAustralia
- James Cook UniversityTownsvilleQueenslandAustralia
| | - Alex Tan
- Townsville University HospitalTownsvilleQueenslandAustralia
- James Cook UniversityTownsvilleQueenslandAustralia
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Farris MK, Razavian NB, Hughes RT, Ververs JD, Snavely AC, Leyrer CM, Tye KE, Allen LF, Pacholke HD, Weaver KE, Bunch PM, Chan MD, Clark H, Puthoff G, Farris JC, Steber CR, Wentworth S, Levine BJ, Nightingale CL, Ponnatapura J. Bridging the Communication Gaps: A Prospective Single-Arm Pilot Study Testing the Feasibility of Interdisciplinary Radiotherapy Planning in Locally Advanced Lung Cancer. Acad Radiol 2023; 30:2566-2573. [PMID: 36759296 PMCID: PMC10404636 DOI: 10.1016/j.acra.2023.01.019] [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: 12/13/2022] [Revised: 01/05/2023] [Accepted: 01/15/2023] [Indexed: 02/09/2023]
Abstract
RATIONALE AND OBJECTIVES The treatment of locally advanced lung cancer (LALC) with radiotherapy (RT) can be challenging. Multidisciplinary collaboration between radiologists and radiation oncologists (ROs) may optimize RT planning, reduce uncertainty in follow-up imaging interpretation, and improve outcomes. MATERIALS AND METHODS In this prospective clinical treatment trial (clinicaltrials.gov NCT04844736), 37 patients receiving definitive RT for LALC, six attending ROs, and three thoracic radiologists were consented and enrolled across four treatment centers. Prior to RT plan finalization, representative computed tomography (CT) slices with overlaid outlines of preliminary irradiation targets were shared with the team of radiologists. The primary endpoint was to assess feasibility of receiving feedback no later than 4 business days of RT simulation on at least 50% of plans. RESULTS Thirty-seven patients with lung cancer were enrolled, and 35 of 37 RT plans were reviewed. Of the 35 patients reviewed, mean age was 69 years. For 27 of 37 plans (73%), feedback was received within 4 or fewer days (interquartile range 3-4 days). Thirteen of 35 cases (37%) received feedback that the delineated target potentially did not include all sites suspicious for tumor involvement. In total, changes to the RT plan were recommended for over- or undercoverage in 16 of 35 cases (46%) and implemented in all cases. Radiology review resulted in no treatment delays and substantial changes to irradiated volumes: gross tumor volume, -1.9 to +96.1%; planning target volume, -37.5 to +116.5%. CONCLUSION Interdisciplinary collaborative RT planning using a simplified workflow was feasible, produced no treatment delays, and prompted substantial changes in RT targets.
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Affiliation(s)
- Michael K Farris
- Department of Radiation Oncology, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157.
| | - Niema B Razavian
- Department of Radiation Oncology, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157
| | - Ryan T Hughes
- Department of Radiation Oncology, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157
| | - James D Ververs
- Department of Radiation Oncology, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157
| | - Anna C Snavely
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Charles M Leyrer
- Department of Radiation Oncology, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157
| | - Karen E Tye
- Department of Radiation Oncology, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157
| | - Laura F Allen
- Department of Radiation Oncology, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157
| | - Heather D Pacholke
- Department of Radiation Oncology, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157
| | - Kathryn E Weaver
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Paul M Bunch
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Michael D Chan
- Department of Radiation Oncology, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157
| | - Hollins Clark
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Gregory Puthoff
- Department of Radiology, Medical University of South Carolina, Charleston, South Carolina
| | - Joshua C Farris
- Department of Radiation Oncology, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157
| | - Cole R Steber
- Department of Radiation Oncology, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157
| | - Stacy Wentworth
- Department of Radiation Oncology, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157
| | - Beverly J Levine
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Chandylen L Nightingale
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Kishigami Y, Nakamura M, Nakao M, Okamoto H, Takahashi A, Igaki H. Three-dimensional assessment of interfractional cervical and uterine motions using daily magnetic resonance images to determine margins and timing of replanning. J Appl Clin Med Phys 2023; 24:e14073. [PMID: 37317937 PMCID: PMC10562032 DOI: 10.1002/acm2.14073] [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: 02/26/2023] [Revised: 05/09/2023] [Accepted: 05/31/2023] [Indexed: 06/16/2023] Open
Abstract
PURPOSE This study was conducted to determine the margins and timing of replanning by assessing the daily interfractional cervical and uterine motions using magnetic resonance (MR) images. METHODS Eleven patients with cervical cancer, who underwent intensity-modulated radiotherapy (IMRT) in 23-25 fractions, were considered in this study. The daily and reference MR images were converted into three-dimensional (3D) shape models. Patient-specific anisotropic margins were calculated from the proximal 95% of vertices located outside the surface of the reference model. Population-based margins were defined as the 90th percentile values of the patient-specific margins. The expanded volume of interest (expVOI) for the cervix and uterus was generated by expanding the reference model based on the population-based margin to calculate the coverage for daily deformable mesh models. For comparison, expVOIconv was generated using conventional margins: right (R), left (L), anterior (A), posterior (P), superior (S), and inferior (I) were (5, 5, 15, 15, 10, 10) and (10, 10, 20, 20, 15, 15) mm for the cervix and uterus, respectively. Subsequently, a replanning scenario was developed based on the cervical volume change. ExpVOIini and expVOIreplan were generated before and after replanning, respectively. RESULTS Population-based margins were (R, L, A, P, S, I) of (7, 7, 11, 6, 11, 8) and (14, 13, 27, 19, 15, 21) mm for the cervix and uterus, respectively. The timing of replanning was found to be the 16th fraction, and the volume of expVOIreplan decreased by >30% compared to that of expVOIini . However, margins cannot be reduced to ensure equivalent coverage after replanning. CONCLUSION We determined the margins and timing of replanning through detailed daily analysis. The margins of the cervix were smaller than conventional margins in some directions, while the margins of the uterus were larger in almost all directions. A margin equivalent to that at the initial planning was required for replanning.
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Affiliation(s)
- Yukako Kishigami
- Department, of Advanced Medical Physics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Mitsuhiro Nakamura
- Department, of Advanced Medical Physics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Megumi Nakao
- Department of Biomedical Engineering and Intelligence, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroyuki Okamoto
- Radiation Safety and Quality Assurance Division, National Cancer Center Hospital, Tokyo, Japan
| | - Ayaka Takahashi
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroshi Igaki
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
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Lee HH, Wang CY, Chen ST, Lu TY, Chiang CH, Huang MY, Huang CJ. Electron stream effect in 0.35 Tesla magnetic resonance image guided radiotherapy for breast cancer. Front Oncol 2023; 13:1147775. [PMID: 37519814 PMCID: PMC10373926 DOI: 10.3389/fonc.2023.1147775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 06/26/2023] [Indexed: 08/01/2023] Open
Abstract
Purpose This research aimed to analyze electron stream effect (ESE) during magnetic resonance image guided radiotherapy (MRgRT) for breast cancer patients on a MR-Linac (0.35 Tesla, 6MV), with a focus on the prevention of redundant radiation exposure. Materials and methods RANDO phantom was used with and without the breast attachment in order to represent the patients after breast conserving surgery (BCS) and those received modified radical mastectomy (MRM). The prescription dose is 40.05 Gy in fifteen fractions for whole breast irradiation (WBI) or 20 Gy single shot for partial breast irradiation (PBI). Thirteen different portals of intensity-modulated radiation therapy were created. And then we evaluated dose distribution in five areas (on the skin of the tip of the nose, the chin, the neck, the abdomen and the thyroid.) outside of the irradiated field with and without 0.35 Tesla. In addition, we added a piece of bolus with the thickness of 1cm on the skin in order to compare the ESE difference with and without a bolus. Lastly, we loaded two patients' images for PBI comparison. Results We found that 0.35 Tesla caused redundant doses to the skin of the chin and the neck as high as 9.79% and 5.59% of the prescription dose in the BCS RANDO model, respectively. For RANDO phantom without the breast accessory (simulating MRM), the maximal dose increase were 8.71% and 4.67% of the prescription dose to the skin of the chin and the neck, respectively. Furthermore, the bolus we added efficiently decrease the unnecessary dose caused by ESE up to 59.8%. Conclusion We report the first physical investigation on successful avoidance of superfluous doses on a 0.35T MR-Linac for breast cancer patients. Future studies of MRgRT on the individual body shape and its association with ESE influence is warranted.
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Affiliation(s)
- Hsin-Hua Lee
- Ph.D. Program in Environmental and Occupational Medicine, Kaohsiung Medical University and National Health Research Institutes, Kaohsiung, Taiwan
- Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Radiation Oncology, Faculty of Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Center for Cancer Research, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chun-Yen Wang
- Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shan-Tzu Chen
- Department of Medical Imaging, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan
| | - Tzu-Ying Lu
- Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Cheng-Han Chiang
- Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Yii Huang
- Ph.D. Program in Environmental and Occupational Medicine, Kaohsiung Medical University and National Health Research Institutes, Kaohsiung, Taiwan
- Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Radiation Oncology, Faculty of Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Center for Cancer Research, Kaohsiung Medical University, Kaohsiung, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chih-Jen Huang
- Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Radiation Oncology, Faculty of Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Center for Cancer Research, Kaohsiung Medical University, Kaohsiung, Taiwan
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Guzene L, Beddok A, Nioche C, Modzelewski R, Loiseau C, Salleron J, Thariat J. Assessing Interobserver Variability in the Delineation of Structures in Radiation Oncology: A Systematic Review. Int J Radiat Oncol Biol Phys 2023; 115:1047-1060. [PMID: 36423741 DOI: 10.1016/j.ijrobp.2022.11.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 11/04/2022] [Accepted: 11/09/2022] [Indexed: 11/23/2022]
Abstract
PURPOSE The delineation of target volumes and organs at risk is the main source of uncertainty in radiation therapy. Numerous interobserver variability (IOV) studies have been conducted, often with unclear methodology and nonstandardized reporting. We aimed to identify the parameters chosen in conducting delineation IOV studies and assess their performances and limits. METHODS AND MATERIALS We conducted a systematic literature review to highlight major points of heterogeneity and missing data in IOV studies published between 2018 and 2021. For the main used metrics, we did in silico analyses to assess their limits in specific clinical situations. RESULTS All disease sites were represented in the 66 studies examined. Organs at risk were studied independently of tumor site in 29% of reviewed IOV studies. In 65% of studies, statistical analyses were performed. No gold standard (GS; ie, reference) was defined in 36% of studies. A single expert was considered as the GS in 21% of studies, without testing intraobserver variability. All studies reported both absolute and relative indices, including the Dice similarity coefficient (DSC) in 68% and the Hausdorff distance (HD) in 42%. Limitations were shown in silico for small structures when using the DSC and dependence on irregular shapes when using the HD. Variations in DSC values were large between studies, and their thresholds were inconsistent. Most studies (51%) included 1 to 10 cases. The median number of observers or experts was 7 (range, 2-35). The intraclass correlation coefficient was reported in only 9% of cases. Investigating the feasibility of studying IOV in delineation, a minimum of 8 observers with 3 cases, or 11 observers with 2 cases, was required to demonstrate moderate reproducibility. CONCLUSIONS Implementation of future IOV studies would benefit from a more standardized methodology: clear definitions of the gold standard and metrics and a justification of the tradeoffs made in the choice of the number of observers and number of delineated cases should be provided.
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Affiliation(s)
- Leslie Guzene
- Department of Radiation Oncology, University Hospital of Amiens, Amiens, France
| | - Arnaud Beddok
- Department of Radiation Oncology, Institut Curie, Paris/Saint-Cloud/Orsay, France; Laboratory of Translational Imaging in Oncology (LITO), InsermUMR, Institut Curie, Orsay, France
| | - Christophe Nioche
- Laboratory of Translational Imaging in Oncology (LITO), InsermUMR, Institut Curie, Orsay, France
| | - Romain Modzelewski
- LITIS - EA4108-Quantif, Normastic, University of Rouen, and Nuclear Medicine Department, Henri Becquerel Center, Rouen, France
| | - Cedric Loiseau
- Department of Radiation Oncology, Centre François Baclesse; ARCHADE Research Community Caen, France; Département de Biostatistiques, Institut de Cancérologie de Lorraine, Vandœuvre-lès-Nancy, France
| | - Julia Salleron
- Département de Biostatistiques, Institut de Cancérologie de Lorraine, Vandœuvre-lès-Nancy, France
| | - Juliette Thariat
- Department of Radiation Oncology, Centre François Baclesse; ARCHADE Research Community Caen, France; Laboratoire de Physique Corpusculaire, Caen, France; Unicaen-Université de Normandie, Caen, France.
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Kumar S, Holloway L, Boxer M, Ling Yap M, Chlap P, Moses D, Vinod S. Variability of gross tumour volume delineation: MRI and CT based tumour and lymph node delineation for Lung radiotherapy. Radiother Oncol 2021; 167:292-299. [PMID: 34896156 DOI: 10.1016/j.radonc.2021.11.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 11/30/2021] [Accepted: 11/30/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To compare gross tumour volume (GTV) delineation of lung cancer on magnetic resonance imaging (MRI) and positron emission tomography (PET) versus computed tomography (CT) and PET. METHODS Three experienced thoracic radiation oncologists delineated GTVs on twenty-six patients with lung cancer, based on CT registered to PET, T2-weighted MRI registered to PET and T1-weighted MRI registered with PET. All observers underwent education on reviewing T1 and T2 images along with guidance on window and level setup. Interobserver and intermodality variation was performed based ondice similarity coefficient (DSC), Hausdorff distance (HD), and average Hausdorff distance (AvgHD) metrics. To compute interobserver variability (IOV) a simultaneous truth and performance level estimation (STAPLE) volume for each image modality was used as reference volume. For intermodality analysis, each observers CT based primary and nodal GTV was used as reference volume. RESULTS A mean DSC of 0.9 across all observers for primary GTV (GTVp) and a DSC of > 0.7 for nodal GTV (GTVn) was demonstrated for IOV. Mean T2 and T1 GTVp and GTVn were smaller than CT GTVp and GTVn but the difference in volume between modalities was not statistically significant. Significant difference (p<0.01) for GTVp and GTVn was found between T2 and T1 GTVp and GTVn compared to CT GTVp and GTVn based on DSC metrics. Large variation in volume similarity was noted based on HD of up-to 5.4cm for observer volumes compared to STAPLE volume. CONCLUSION Interobserver variability in GTV delineation was similar for MRI and PET versus CT and PET. The significant difference between MRI compared to CT delineated volumes needs to be further explored.
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Affiliation(s)
- Shivani Kumar
- South West Sydney Cancer Services, Liverpool, NSW, Australia; Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia; South Western Sydney Clinical School, University of New South Australia, Sydney, NSW, Australia
| | - Lois Holloway
- South West Sydney Cancer Services, Liverpool, NSW, Australia; Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia; South Western Sydney Clinical School, University of New South Australia, Sydney, NSW, Australia; Institute of Medical Physics, School of Physics, University of Sydney, Sydney, NSW Australia; School of Mathematical and Physical Sciences, University of Newcastle, Newcastle, NSW Australia; Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW Australia
| | - Miriam Boxer
- South West Sydney Cancer Services, Liverpool, NSW, Australia; ICON Cancer Centre, Concord, NSW, Australia
| | - Mei Ling Yap
- South West Sydney Cancer Services, Liverpool, NSW, Australia; Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia; South Western Sydney Clinical School, University of New South Australia, Sydney, NSW, Australia; School of Medicine, Western Sydney University, Campbelltown, NSW, Australia; Sydney Medical School, Public Health, University of Sydney, Sydney, NSW, Australia
| | - Phillip Chlap
- South West Sydney Cancer Services, Liverpool, NSW, Australia; Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia; South Western Sydney Clinical School, University of New South Australia, Sydney, NSW, Australia
| | - Daniel Moses
- Prince of Wales Hospital, Sydney, NSW, Australia; School of Medical Sciences, Faculty of Medicine, The University of New South Wales, Sydney, NSW, Australia
| | - Shalini Vinod
- South West Sydney Cancer Services, Liverpool, NSW, Australia; Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia; South Western Sydney Clinical School, University of New South Australia, Sydney, NSW, Australia
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Inter-observer variations of the tumor bed delineation for patients after breast conserving surgery in preoperative magnetic resonance and computed tomography scan fusion. BMC Cancer 2021; 21:838. [PMID: 34284752 PMCID: PMC8293511 DOI: 10.1186/s12885-021-08546-5] [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: 03/27/2021] [Accepted: 07/07/2021] [Indexed: 11/28/2022] Open
Abstract
Purpose Tumor bed (TB) delineation based on preoperative magnetic resonance imaging (pre-MRI) fused with postoperative computed tomography (post-CT) were compared to post-CT only to define pre-MRI may aid in improving the accuracy of delineation. Methods and materials The pre-MRI imaging of 10 patients underwent radiotherapy (RT) after breast conserving surgery (BCS) were reviewed. Post-CT scans were acquired in the same prone position as pre-MRI. Pre-MRI and post-CT automatically match and then manual alignment was given to enhance fusion consistency. Three radiation oncologists and 2 radiologists delineated the clinical target volume (CTV) for CT-based. The gross target volume (GTV) of pre-MRI-based was determined by the volume of tumor acquired with 6 sequences: T1, T2, T2W-SPAIR, DWI, dyn-eTHRIVE and sdyn-eTHRIVE, expended 10 mm to form the CTV-pre-MRI. Planning target volume (PTV) for each sequence was determined by CTV extended 15 mm, trimmed to 3 mm from skin and the breast-chest wall interface. The variability of the TB delineation were developed as follows: the mean volume, conformity index (CI) and dice coefficient (DC). Results The mean volumes of CTV and PTV delineated with CT were all larger than those with pre-MRI. The lower inter-observer variability was observed from PTV, especially in sdyn-eTHRIVE in all sequences. For each sequence of pre-MRI, all DCs were larger than post-CT, and the largest DC was observed by sdyn-eTHRIVE sequence fusion to post-CT. The overlap for PTV was significantly improved in the pre-MRI-based compared with the CT-based. Conclusions TB volumes based on pre-MRI were smaller than post-CT with CVS increased. Pre-MRI provided a more precise definition of the TB with observers performed a smaller inter-observer variability than CT. Pre-MRI, especially in sdyn-eTHRIVE sequence, should help in reducing treatment volumes with the improved accuracy of TB delineation of adjuvant RT of breast cancer.
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Knobe S, Dzierma Y, Wenske M, Berdel C, Fleckenstein J, Melchior P, Palm J, Nuesken FG, Hunt A, Engwer C, Surulescu C, Yilmaz U, Reith W, Rübe C. Feasibility and clinical usefulness of modelling glioblastoma migration in adjuvant radiotherapy. Z Med Phys 2021; 32:149-158. [PMID: 33966944 PMCID: PMC9948823 DOI: 10.1016/j.zemedi.2021.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 03/01/2021] [Accepted: 03/18/2021] [Indexed: 11/16/2022]
Abstract
Glioblastoma (GBM) is one of the most common primary brain tumours in adults, with a dismal prognosis despite aggressive multimodality treatment by a combination of surgery and adjuvant radiochemotherapy. A detailed knowledge of the spreading of glioma cells in the brain might allow for more targeted escalated radiotherapy, aiming to reduce locoregional relapse. Recent years have seen the development of a large variety of mathematical modelling approaches to predict glioma migration. The aim of this study is hence to evaluate the clinical applicability of a detailed micro- and meso-scale mathematical model in radiotherapy. First and foremost, a clinical workflow is established, in which the tumour is automatically segmented as input data and then followed in time mathematically based on the diffusion tensor imaging data. The influence of several free model parameters is individually evaluated, then the full model is retrospectively validated for a collective of 3 GBM patients treated at our institution by varying the most important model parameters to achieve optimum agreement with the tumour development during follow-up. Agreement of the model predictions with the real tumour growth as defined by manual contouring based on the follow-up MRI images is analyzed using the dice coefficient. The tumour evolution over 103-212 days follow-up could be predicted by the model with a dice coefficient better than 60% for all three patients. In all cases, the final tumour volume was overestimated by the model by a factor between 1.05 and 1.47. To evaluate the quality of the agreement between the model predictions and the ground truth, we must keep in mind that our gold standard relies on a single observer's (CB) manually-delineated tumour contours. We therefore decided to add a short validation of the stability and reliability of these contours by an inter-observer analysis including three other experienced radiation oncologists from our department. In total, a dice coefficient between 63% and 89% is achieved between the four different observers. Compared with this value, the model predictions (62-66%) perform reasonably well, given the fact that these tumour volumes were created based on the pre-operative segmentation and DTI.
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Affiliation(s)
- Sven Knobe
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Center, Homburg/Saar, Germany.
| | - Yvonne Dzierma
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Michael Wenske
- Institute for Analysis and Numerics, University of Muenster, Muenster, Germany
| | - Christian Berdel
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Jochen Fleckenstein
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Patrick Melchior
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Jan Palm
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Frank G. Nuesken
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Center, Homburg/Saar, Germany
| | | | - Christian Engwer
- Institute for Analysis and Numerics, University of Muenster, Muenster, Germany
| | - Christina Surulescu
- Felix Klein Centre for Mathematics, University of Kaiserslautern, Kaiserslautern, Germany
| | - Umut Yilmaz
- Department of Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Wolfgang Reith
- Department of Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Christian Rübe
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Center, Homburg/Saar, Germany
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Batumalai V, Burke S, Roach D, Lim K, Dinsdale G, Jameson M, Ochoa C, Veera J, Holloway L, Vinod S. Impact of dosimetric differences between CT and MRI derived target volumes for external beam cervical cancer radiotherapy. Br J Radiol 2020; 93:20190564. [PMID: 32516544 DOI: 10.1259/bjr.20190564] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVES The use of MRI is becoming more prevalent in cervical cancer external beam radiotherapy (RT). The aim of this study was to investigate the impact of dosimetric differences between CT and MRI-derived target volumes for cervical cancer external beam RT. METHODS An automated planning technique for volumetric modulated arc therapy was developed. Two automated planning plans were generated for 18 cervical cancer patients where planning target volumes (PTVs) were generated based on CT or MRI data alone. Dose metrics for planning target volumes and organs at risk (OARs) were compared to analyse any differences based on imaging modality. RESULTS All treatment plans were clinically acceptable. Bladder doses (V40) were lower in MRI-based plans (p = 0.04, 53.6 ± 17.2 % vs 60.3 ± 13.1 % for MRI vs CT, respectively). The maximum dose for left iliac crest showed lower doses in CT-based plans (p = 0.02, 47.8 ± 0.7 Gy vs 47.4 ± 0.4 Gy MRI vs CT, respectively). No significant differences were seen for other OARs. CONCLUSIONS The dosimetric differences of CT- and MRI-based contouring variability for this study was small. CT remains the standard imaging modality for volume delineation for these patients. ADVANCES IN KNOWLEDGE This is the first study to evaluate the dosimetric implications of imaging modality on target and OAR doses in cervical cancer external beam RT.
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Affiliation(s)
- Vikneswary Batumalai
- Department of Radiation Oncology, South Western Sydney Local Health District, New South Wales, Australia.,Ingham Institute for Applied Medical Research, New South Wales, Australia.,South Western Clinical School, University of New South Wales, New South Wales, Australia
| | - Siobhan Burke
- Department of Radiation Oncology, South Western Sydney Local Health District, New South Wales, Australia
| | - Dale Roach
- Ingham Institute for Applied Medical Research, New South Wales, Australia.,South Western Clinical School, University of New South Wales, New South Wales, Australia
| | - Karen Lim
- Department of Radiation Oncology, South Western Sydney Local Health District, New South Wales, Australia.,South Western Clinical School, University of New South Wales, New South Wales, Australia
| | - Glen Dinsdale
- Department of Radiation Oncology, South Western Sydney Local Health District, New South Wales, Australia
| | - Michael Jameson
- Department of Radiation Oncology, South Western Sydney Local Health District, New South Wales, Australia.,Ingham Institute for Applied Medical Research, New South Wales, Australia.,South Western Clinical School, University of New South Wales, New South Wales, Australia.,Centre for Medical Radiation Physics, University of Wollongong, New South Wales, Australia
| | - Cesar Ochoa
- Department of Radiation Oncology, South Western Sydney Local Health District, New South Wales, Australia
| | | | - Lois Holloway
- Department of Radiation Oncology, South Western Sydney Local Health District, New South Wales, Australia.,Ingham Institute for Applied Medical Research, New South Wales, Australia.,South Western Clinical School, University of New South Wales, New South Wales, Australia.,Centre for Medical Radiation Physics, University of Wollongong, New South Wales, Australia.,Institute of Medical Physics, School of Physics, University of Sydney, New South Wales, Australia
| | - Shalini Vinod
- Department of Radiation Oncology, South Western Sydney Local Health District, New South Wales, Australia.,Ingham Institute for Applied Medical Research, New South Wales, Australia.,South Western Clinical School, University of New South Wales, New South Wales, Australia
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Fausto A, Fanizzi A, Volterrani L, Mazzei FG, Calabrese C, Casella D, Marcasciano M, Massafra R, La Forgia D, Mazzei MA. Feasibility, Image Quality and Clinical Evaluation of Contrast-Enhanced Breast MRI Performed in a Supine Position Compared to the Standard Prone Position. Cancers (Basel) 2020; 12:cancers12092364. [PMID: 32825583 PMCID: PMC7564182 DOI: 10.3390/cancers12092364] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/12/2020] [Accepted: 08/19/2020] [Indexed: 11/16/2022] Open
Abstract
Background: To assess the feasibility, image quality and diagnostic value of contrast-enhanced breast magnetic resonance imaging (MRI) performed in a supine compared to a prone position. Methods: One hundred and fifty-one patients who had undergone a breast MRI in both the standard prone and supine position were evaluated retrospectively. Two 1.5 T MR scanners were used with the same image resolution, sequences and contrast medium in all examinations. The image quality and the number and dimensions of lesions were assessed by two expert radiologists in an independent and randomized fashion. Two different classification systems were used. Histopathology was the standard of reference. Results: Two hundred and forty MRIs from 120 patients were compared. The analysis revealed 134 MRIs with monofocal (U), 68 with multifocal (M) and 38 with multicentric (C) lesions. There was no difference between the image quality and number of lesions in the prone and supine examinations. A significant difference in the lesion extension was observed between the prone and supine position. No significant differences emerged in the classification of the lesions detected in the prone compared to the supine position. Conclusions: It is possible to perform breast MRI in a supine position with the same image quality, resolution and diagnostic value as in a prone position. In the prone position, the lesion dimensions are overestimated with a higher wash-in peak than in the supine position.
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Affiliation(s)
- Alfonso Fausto
- Department of Diagnostic Imaging, University Hospital of Siena, Azienda Ospedaliera Universitaria Senese, 53100 Siena, Italy;
- Correspondence: ; Tel.: +39-0577585287 or +39-3477601341
| | - Annarita Fanizzi
- Struttura Semplice Dipartimentale di Fisica Sanitaria, IRCCS Istituto Tumori “Giovanni Paolo II”, 70124 Bari, Italy; (A.F.); (R.M.)
| | - Luca Volterrani
- Department of Medical, Surgical and Neuro Sciences, Unit of Diagnostic Imaging, University Hospital of Siena, Azienda Ospedaliera Universitaria Senese, 53100 Siena, Italy; (L.V.); (M.A.M.)
| | - Francesco Giuseppe Mazzei
- Department of Diagnostic Imaging, University Hospital of Siena, Azienda Ospedaliera Universitaria Senese, 53100 Siena, Italy;
| | | | - Donato Casella
- Department of Oncologic and Reconstructive Breast Surgery, Azienda Ospedaliera Universitaria Senese, University Hospital of Siena, 53100 Siena, Italy;
| | - Marco Marcasciano
- Unità di Oncologia Chirurgica Ricostruttiva della Mammella, “Spedali Riuniti” di Livorno, Breast Unit Integrata di Livorno Cecina, Piombino Elba, Azienda USL Toscana Nord Ovest, 57100 Livorno, Italy;
| | - Raffaella Massafra
- Struttura Semplice Dipartimentale di Fisica Sanitaria, IRCCS Istituto Tumori “Giovanni Paolo II”, 70124 Bari, Italy; (A.F.); (R.M.)
| | - Daniele La Forgia
- Struttura Semplice Dipartimentale di Radiologia Senologica, IRCCS Istituto Tumori “Giovanni Paolo II”, 70124 Bari, Italy;
| | - Maria Antonietta Mazzei
- Department of Medical, Surgical and Neuro Sciences, Unit of Diagnostic Imaging, University Hospital of Siena, Azienda Ospedaliera Universitaria Senese, 53100 Siena, Italy; (L.V.); (M.A.M.)
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