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Grover J, Liu P, Dong B, Shan S, Whelan B, Keall P, Waddington DEJ. Super-resolution neural networks improve the spatiotemporal resolution of adaptive MRI-guided radiation therapy. COMMUNICATIONS MEDICINE 2024; 4:64. [PMID: 38575723 PMCID: PMC10994938 DOI: 10.1038/s43856-024-00489-9] [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: 05/23/2023] [Accepted: 03/22/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Magnetic resonance imaging (MRI) offers superb non-invasive, soft tissue imaging of the human body. However, extensive data sampling requirements severely restrict the spatiotemporal resolution achievable with MRI. This limits the modality's utility in real-time guidance applications, particularly for the rapidly growing MRI-guided radiation therapy approach to cancer treatment. Recent advances in artificial intelligence (AI) could reduce the trade-off between the spatial and the temporal resolution of MRI, thus increasing the clinical utility of the imaging modality. METHODS We trained deep learning-based super-resolution neural networks to increase the spatial resolution of real-time MRI. We developed a framework to integrate neural networks directly onto a 1.0 T MRI-linac enabling real-time super-resolution imaging. We integrated this framework with the targeting system of the MRI-linac to demonstrate real-time beam adaptation with super-resolution-based imaging. We tested the integrated system using large publicly available datasets, healthy volunteer imaging, phantom imaging, and beam tracking experiments using bicubic interpolation as a baseline comparison. RESULTS Deep learning-based super-resolution increases the spatial resolution of real-time MRI across a variety of experiments, offering measured performance benefits compared to bicubic interpolation. The temporal resolution is not compromised as measured by a real-time adaptation latency experiment. These two effects, an increase in the spatial resolution with a negligible decrease in the temporal resolution, leads to a net increase in the spatiotemporal resolution. CONCLUSIONS Deployed super-resolution neural networks can increase the spatiotemporal resolution of real-time MRI. This has applications to domains such as MRI-guided radiation therapy and interventional procedures.
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Affiliation(s)
- James Grover
- Image X Institute, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
- Department of Medical Physics, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia.
| | - Paul Liu
- Image X Institute, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Department of Medical Physics, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
| | - Bin Dong
- Department of Medical Physics, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
| | - Shanshan Shan
- Image X Institute, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Department of Medical Physics, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
- State Key Laboratory of Radiation Medicine and Protection, School for Radiological and Interdisciplinary Sciences (RAD-X), Collaborative Innovation Center of Radiation Medicine of Jiangsu Higher Education Institutions, Soochow University, Suzhou, Jiangsu, China
| | - Brendan Whelan
- Image X Institute, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Department of Medical Physics, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
| | - Paul Keall
- Image X Institute, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Department of Medical Physics, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
| | - David E J Waddington
- Image X Institute, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Department of Medical Physics, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
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Kim T, Laugeman E, Kiser K, Schiff J, Marasini S, Price A, Gach HM, Knutson N, Samson P, Robinson C, Hatscher C, Henke L. Feasibility of surface-guidance combined with CBCT for intra-fractional breath-hold motion management during Ethos RT. J Appl Clin Med Phys 2024; 25:e14242. [PMID: 38178622 PMCID: PMC11005966 DOI: 10.1002/acm2.14242] [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: 08/10/2023] [Revised: 11/08/2023] [Accepted: 11/28/2023] [Indexed: 01/06/2024] Open
Abstract
PURPOSE High-quality CBCT and AI-enhanced adaptive planning techniques allow CBCT-guided stereotactic adaptive radiotherapy (CT-STAR) to account for inter-fractional anatomic changes. Studies of intra-fractional respiratory motion management with a surface imaging solution for CT-STAR have not been fully conducted. We investigated intra-fractional motion management in breath-hold Ethos-based CT-STAR and CT-SBRT (stereotactic body non-adaptive radiotherapy) using optical surface imaging combined with onboard CBCTs. METHODS Ten cancer patients with mobile lower lung or upper abdominal malignancies participated in an IRB-approved clinical trial (Phase I) of optical surface image-guided Ethos CT-STAR/SBRT. In the clinical trial, a pre-configured gating window (± 2 mm in AP direction) on optical surface imaging was used for manually triggering intra-fractional CBCT acquisition and treatment beam irradiation during breath-hold (seven patients for the end of exhalation and three patients for the end of inhalation). Two inter-fractional CBCTs at the ends of exhalation and inhalation in each fraction were acquired to verify the primary direction and range of the tumor/imaging-surrogate (donut-shaped fiducial) motion. Intra-fractional CBCTs were used to quantify the residual motion of the tumor/imaging-surrogate within the pre-configured breath-hold window in the AP direction. Fifty fractions of Ethos RT were delivered under surface image-guidance: Thirty-two fractions with CT-STAR (adaptive RT) and 18 fractions with CT-SBRT (non-adaptive RT). The residual motion of the tumor was quantified by determining variations in the tumor centroid position. The dosimetric impact on target coverage was calculated based on the residual motion. RESULTS We used 46 fractions for the analysis of intra-fractional residual motion and 43 fractions for the inter-fractional motion analysis due to study constraints. Using the image registration method, 43 pairs of inter-fractional CBCTs and 100 intra-fractional CBCTs attached to dose maps were analyzed. In the motion range study (image registration) from the inter-fractional CBCTs, the primary motion (mean ± std) was 16.6 ± 9.2 mm in the SI direction (magnitude: 26.4 ± 11.3 mm) for the tumors and 15.5 ± 7.3 mm in the AP direction (magnitude: 20.4 ± 7.0 mm) for the imaging-surrogate, respectively. The residual motion of the tumor (image registration) from intra-fractional breath-hold CBCTs was 2.2 ± 2.0 mm for SI, 1.4 ± 1.4 mm for RL, and 1.3 ± 1.3 mm for AP directions (magnitude: 3.5 ± 2.1 mm). The ratio of the actual dose coverage to 99%, 90%, and 50% of the target volume decreased by 0.95 ± 0.11, 0.96 ± 0.10, 0.99 ± 0.05, respectively. The mean percentage of the target volume covered by the prescribed dose decreased by 2.8 ± 4.4%. CONCLUSION We demonstrated the intra-fractional motion-managed treatment strategy in breath-hold Ethos CT-STAR/SBRT using optical surface imaging and CBCT. While the controlled residual tumor motion measured at 3.5 mm exceeded the predetermined setup value of 2 mm, it is important to note that this motion still fell within the clinically acceptable range defined by the PTV margin of 5 mm. Nonetheless, additional caution is needed with intra-fractional motion management in breath-hold Ethos CT-STAR/SBRT using optical surface imaging and CBCT.
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Affiliation(s)
- Taeho Kim
- Radiation OncologyWashington University School of MedicineWashingtonUSA
| | - Eric Laugeman
- Radiation OncologyWashington University School of MedicineWashingtonUSA
| | - Kendall Kiser
- Radiation OncologyWashington University School of MedicineWashingtonUSA
| | - Joshua Schiff
- Radiation OncologyWashington University School of MedicineWashingtonUSA
| | - Shanti Marasini
- Radiation OncologyWashington University School of MedicineWashingtonUSA
| | - Alex Price
- Radiation OncologyWashington University School of MedicineWashingtonUSA
- Radiation OncologyUniversity HospitalsCase Western Reserve University
| | - H Michael Gach
- Radiation OncologyWashington University School of MedicineWashingtonUSA
- Radiology and Biomedical EngineeringWashington University School of MedicineWashingtonUSA
| | - Nels Knutson
- Radiation OncologyWashington University School of MedicineWashingtonUSA
| | - Pamela Samson
- Radiation OncologyWashington University School of MedicineWashingtonUSA
| | - Clifford Robinson
- Radiation OncologyWashington University School of MedicineWashingtonUSA
| | - Casey Hatscher
- Radiation OncologyWashington University School of MedicineWashingtonUSA
| | - Lauren Henke
- Radiation OncologyWashington University School of MedicineWashingtonUSA
- Radiation OncologyUniversity HospitalsCase Western Reserve University
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Zhang X, Liu W, Xu F, He W, Song Y, Li G, Zhang Y, Dai G, Xiao Q, Meng Q, Zeng X, Bai S, Zhong R. Neural signals-based respiratory motion tracking: a proof-of-concept study. Phys Med Biol 2023; 68:195015. [PMID: 37683675 DOI: 10.1088/1361-6560/acf819] [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: 03/30/2023] [Accepted: 09/08/2023] [Indexed: 09/10/2023]
Abstract
Objective.Respiratory motion tracking techniques can provide optimal treatment accuracy for thoracoabdominal radiotherapy and robotic surgery. However, conventional imaging-based respiratory motion tracking techniques are time-lagged owing to the system latency of medical linear accelerators and surgical robots. This study aims to investigate the precursor time of respiratory-related neural signals and analyze the potential of neural signals-based respiratory motion tracking.Approach.The neural signals and respiratory motion from eighteen healthy volunteers were acquired simultaneously using a 256-channel scalp electroencephalography (EEG) system. The neural signals were preprocessed using the MNE python package to extract respiratory-related EEG neural signals. Cross-correlation analysis was performed to assess the precursor time and cross-correlation coefficient between respiratory-related EEG neural signals and respiratory motion.Main results.Respiratory-related neural signals that precede the emergence of respiratory motion are detectable via non-invasive EEG. On average, the precursor time of respiratory-related EEG neural signals was 0.68 s. The representative cross-correlation coefficients between EEG neural signals and respiratory motion of the eighteen healthy subjects varied from 0.22 to 0.87.Significance.Our findings suggest that neural signals have the potential to compensate for the system latency of medical linear accelerators and surgical robots. This indicates that neural signals-based respiratory motion tracking is a potential promising solution to respiratory motion and could be useful in thoracoabdominal radiotherapy and robotic surgery.
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Affiliation(s)
- Xiangbin Zhang
- Radiotherapy Physics and Technology Center, Cancer Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Wenjie Liu
- Machine Intelligence Laboratory, College of Computer Science, Sichuan University, Chengdu, People's Republic of China
| | - Feng Xu
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Weizhong He
- Magstim Electrical Geodesics, Inc, Plymouth, MA, United States of America
| | - Yingpeng Song
- Radiotherapy Physics and Technology Center, Cancer Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Guangjun Li
- Radiotherapy Physics and Technology Center, Cancer Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Yingjie Zhang
- Radiotherapy Physics and Technology Center, Cancer Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Guyu Dai
- Radiotherapy Physics and Technology Center, Cancer Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Qing Xiao
- Radiotherapy Physics and Technology Center, Cancer Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Qianqian Meng
- Radiotherapy Physics and Technology Center, Cancer Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Xianhu Zeng
- Radiotherapy Physics and Technology Center, Cancer Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Sen Bai
- Radiotherapy Physics and Technology Center, Cancer Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Renming Zhong
- Radiotherapy Physics and Technology Center, Cancer Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China
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Sasaki M, Nakamura M, Ashida R, Nakata M, Yoshimura M, Mizowaki T. Assessing target localization accuracy across different soft-tissue matching protocols using end-exhalation breath-hold cone-beam computed tomography in patients with pancreatic cancer. JOURNAL OF RADIATION RESEARCH 2023:rrad048. [PMID: 37336503 DOI: 10.1093/jrr/rrad048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 03/23/2023] [Indexed: 06/21/2023]
Abstract
The purpose of this study was to retrospectively assess target localization accuracy across different soft-tissue matching protocols using cone-beam computed tomography (CBCT) in a large sample of patients with pancreatic cancer and to estimate the optimal margin size for each protocol. Fifty-four consecutive patients with pancreatic cancer who underwent 15-fraction volumetric modulated arc therapy under the end-exhalation breath-hold condition were enrolled. Two soft-tissue matching protocols were used according to the resectability classification, including gross tumor volume (GTV) matching for potentially resectable tumors and planning target volume (PTV) matching for borderline resectable or unresectable tumors. The tolerance of the target localization error in both matching protocols was set to 5 mm in any direction. The optimal margin size for each soft-tissue matching protocol was calculated from the systematic and random errors of the inter- and intrafraction positional variations using the van Herk formula. The inter- and intrafraction positional variations of PTV matching were smaller than those of GTV matching. The percentage of target localization errors exceeding 5 mm in the first CBCT scan of each fraction in the superior-inferior direction was 12.6 and 4.8% for GTV and PTV matching, respectively. The optimal margin sizes for GTV and PTV matching were 3.7 and 2.7, 5.4 and 4.1 and 3.9 and 3.0 mm in the anterior-posterior, superior-inferior and left-right directions, respectively. Target localization accuracy in PTV matching was higher than that in GTV matching. By setting the tolerance of the target localization error, treatment can be successful within the planned margin size.
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Affiliation(s)
- Makoto Sasaki
- Division of Clinical Radiology Service, Kyoto University Hospital, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Mitsuhiro Nakamura
- Department of Information Technology and Medical Engineering, Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawaharacho, Shogoin, Sakyo-ku, Kyoto 606-8397, Japan
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto University, Kyoto 606-8507, Japan
| | - Ryo Ashida
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto University, Kyoto 606-8507, Japan
| | - Manabu Nakata
- Division of Clinical Radiology Service, Kyoto University Hospital, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Michio Yoshimura
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto University, Kyoto 606-8507, Japan
| | - Takashi Mizowaki
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto University, Kyoto 606-8507, Japan
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Waddington DEJ, Hindley N, Koonjoo N, Chiu C, Reynolds T, Liu PZY, Zhu B, Bhutto D, Paganelli C, Keall PJ, Rosen MS. Real-time radial reconstruction with domain transform manifold learning for MRI-guided radiotherapy. Med Phys 2023; 50:1962-1974. [PMID: 36646444 PMCID: PMC10809819 DOI: 10.1002/mp.16224] [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: 05/23/2022] [Revised: 12/07/2022] [Accepted: 12/27/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND MRI-guidance techniques that dynamically adapt radiation beams to follow tumor motion in real time will lead to more accurate cancer treatments and reduced collateral healthy tissue damage. The gold-standard for reconstruction of undersampled MR data is compressed sensing (CS) which is computationally slow and limits the rate that images can be available for real-time adaptation. PURPOSE Once trained, neural networks can be used to accurately reconstruct raw MRI data with minimal latency. Here, we test the suitability of deep-learning-based image reconstruction for real-time tracking applications on MRI-Linacs. METHODS We use automated transform by manifold approximation (AUTOMAP), a generalized framework that maps raw MR signal to the target image domain, to rapidly reconstruct images from undersampled radial k-space data. The AUTOMAP neural network was trained to reconstruct images from a golden-angle radial acquisition, a benchmark for motion-sensitive imaging, on lung cancer patient data and generic images from ImageNet. Model training was subsequently augmented with motion-encoded k-space data derived from videos in the YouTube-8M dataset to encourage motion robust reconstruction. RESULTS AUTOMAP models fine-tuned on retrospectively acquired lung cancer patient data reconstructed radial k-space with equivalent accuracy to CS but with much shorter processing times. Validation of motion-trained models with a virtual dynamic lung tumor phantom showed that the generalized motion properties learned from YouTube lead to improved target tracking accuracy. CONCLUSION AUTOMAP can achieve real-time, accurate reconstruction of radial data. These findings imply that neural-network-based reconstruction is potentially superior to alternative approaches for real-time image guidance applications.
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Affiliation(s)
- David E. J. Waddington
- Image X Institute, Faculty of Medicine and HealthThe University of SydneySydneyAustralia
- Department of Medical PhysicsIngham Institute for Applied Medical ResearchLiverpoolNSWAustralia
- A. A. Martinos Center for Biomedical ImagingMassachusetts General HospitalCharlestownMassachusettsUSA
| | - Nicholas Hindley
- Image X Institute, Faculty of Medicine and HealthThe University of SydneySydneyAustralia
- A. A. Martinos Center for Biomedical ImagingMassachusetts General HospitalCharlestownMassachusettsUSA
| | - Neha Koonjoo
- A. A. Martinos Center for Biomedical ImagingMassachusetts General HospitalCharlestownMassachusettsUSA
| | - Christopher Chiu
- Image X Institute, Faculty of Medicine and HealthThe University of SydneySydneyAustralia
| | - Tess Reynolds
- Image X Institute, Faculty of Medicine and HealthThe University of SydneySydneyAustralia
| | - Paul Z. Y. Liu
- Image X Institute, Faculty of Medicine and HealthThe University of SydneySydneyAustralia
- Department of Medical PhysicsIngham Institute for Applied Medical ResearchLiverpoolNSWAustralia
| | - Bo Zhu
- A. A. Martinos Center for Biomedical ImagingMassachusetts General HospitalCharlestownMassachusettsUSA
| | - Danyal Bhutto
- A. A. Martinos Center for Biomedical ImagingMassachusetts General HospitalCharlestownMassachusettsUSA
- Department of Biomedical EngineeringBoston UniversityBostonMassachusettsUSA
| | - Chiara Paganelli
- Dipartimento di Elettronica, Informazione e BioingegneriaPolitecnico di MilanoMilanItaly
| | - Paul J. Keall
- Image X Institute, Faculty of Medicine and HealthThe University of SydneySydneyAustralia
- Department of Medical PhysicsIngham Institute for Applied Medical ResearchLiverpoolNSWAustralia
| | - Matthew S. Rosen
- A. A. Martinos Center for Biomedical ImagingMassachusetts General HospitalCharlestownMassachusettsUSA
- Department of PhysicsHarvard UniversityCambridgeMassachusettsUSA
- Harvard Medical SchoolBostonMassachusettsUSA
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Zhang X, Song X, Li G, Duan L, Wang G, Dai G, Song Y, Li J, Bai S. Machine Learning Radiomics Model for External and Internal Respiratory Motion Correlation Prediction in Lung Tumor. Technol Cancer Res Treat 2022; 21:15330338221143224. [PMID: 36476136 PMCID: PMC9742719 DOI: 10.1177/15330338221143224] [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: 12/13/2022] Open
Abstract
Objectives: The complexity and specificity of lung tumor motion render it necessary to determine the external and internal correlation individually before applying indirect tumor tracking. However, the correlation cannot be determined from patient respiratory and tumor clinical characteristics before treatment. The purpose of this study is to present a machine learning model for an external/internal correlation prediction that is based on computed tomography (CT) radiomic features. Methods: 4-dimensional computed tomography (4DCT) images of 67 patients were collected retrospectively, and the external/internal correlation of lung tumor was calculated based on Spearman's rank correlation coefficient. Radiomic features were extracted from average intensity projection and the light gradient boosting machine (LightGBM)-based cross-validation (the recursive elimination method) was used for feature selection. The LightGBM framework forecasting models with classification thresholds 0.7, 0.8, and 0.9 are established using stratified 5-fold cross-validation. Model performance was assessed using receiver operating characteristics, sensitivity, and specificity. Results: There were 16, 18, and 13 features selected for models 0.7, 0.8, and 0.9, respectively. Texture features are of great importance in external/internal correlation prediction compared to other features in all models. The sensitivities of the predictions in models 0.7, 0.8, and 0.9 were 0.800 ± 0.126, 0.829 ± 0.140, and 0.864 ± 0.086, respectively. The specificities were 0.771 ± 0.114, 0.936 ± 0.0581, and 0.839 ± 0.101, whereas the area under the curve (AUC) was 0.837, 0.946, and 0.877, respectively. Conclusions: Our findings indicate that radiomics is an effective tool for respiratory motion correlation prediction, which can extract tumor motion characteristics. We proposed a machine learning framework for correlation prediction in the motion management strategy for lung tumor patients.
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Affiliation(s)
- Xiangyu Zhang
- Radiotherapy Physics and Technology Center, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xinyu Song
- Radiotherapy Physics and Technology Center, Cancer Center, West China Hospital, Sichuan University, Chengdu, China,Department of Radiation Oncology, Cancer Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Guangjun Li
- Radiotherapy Physics and Technology Center, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Lian Duan
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Guangyu Wang
- Radiotherapy Physics and Technology Center, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Guyu Dai
- Radiotherapy Physics and Technology Center, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Ying Song
- Radiotherapy Physics and Technology Center, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Jing Li
- Radiotherapy Physics and Technology Center, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Sen Bai
- Radiotherapy Physics and Technology Center, Cancer Center, West China Hospital, Sichuan University, Chengdu, China,Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China,Sen Bai, MS, Radiotherapy Physics and Technology Center, Cancer Center, West China Hospital, Sichuan University, Chengdu, China.
Guangjun Li, MS, Radiotherapy Physics and Technology Center, Cancer Center, West China Hospital, Sichuan University, Chengdu, China.
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Keijnemans K, Borman PTS, Uijtewaal P, Woodhead PL, Raaymakers BW, Fast MF. A hybrid 2D/4D-MRI methodology using simultaneous multislice imaging for radiotherapy guidance. Med Phys 2022; 49:6068-6081. [PMID: 35694905 PMCID: PMC9545880 DOI: 10.1002/mp.15802] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/18/2022] [Accepted: 05/27/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose Respiratory motion management is important in abdominothoracic radiotherapy. Fast imaging of the tumor can facilitate multileaf collimator (MLC) tracking that allows for smaller treatment margins, while repeatedly imaging the full field‐of‐view is necessary for 4D dose accumulation. This study introduces a hybrid 2D/4D‐MRI methodology that can be used for simultaneous MLC tracking and dose accumulation on a 1.5 T Unity MR‐linac (Elekta AB, Stockholm, Sweden). Methods We developed a hybrid 2D/4D‐MRI methodology that uses a simultaneous multislice (SMS) accelerated MRI sequence, which acquires two coronal slices simultaneously and repeatedly cycles through slice positions over the image volume. As a result, the fast 2D imaging can be used prospectively for MLC tracking and the SMS slices can be sorted retrospectively into respiratory‐correlated 4D‐MRIs for dose accumulation. Data were acquired in five healthy volunteers with an SMS‐bTFE and SMS‐TSE MRI sequence. For each sequence, a prebeam dataset and a beam‐on dataset were acquired simulating the two phases of MR‐linac treatments. Prebeam data were used to generate a 4D‐based motion model and a reference mid‐position volume, while beam‐on data were used for real‐time motion extraction and reconstruction of beam‐on 4D‐MRIs. In addition, an in‐silico computational phantom was used for validation of the hybrid 2D/4D‐MRI methodology. MLC tracking experiments were performed with the developed methodology, for which real‐time SMS data reconstruction was enabled on the scanner. A 15‐beam 8× 7.5 Gy intensity‐modulated radiotherapy plan for lung stereotactic body radiotherapy with isotropic 3 mm GTV‐to‐PTV margins was created. Dosimetry experiments were performed using a 4D motion phantom. The latency between target motion and updating the radiation beam was determined and compensated. Local gamma analyses were performed to quantify dose differences compared to a static reference delivery, and dose area histograms (DAHs) were used to quantify the GTV and PTV coverage. Results In‐vivo data acquisition and MLC tracking experiments were successfully performed with the developed hybrid 2D/4D‐MRI methodology. Real‐time liver–lung interface motion estimation had a Pearson's correlation of 0.996 (in‐vivo) and 0.998 (in‐silico). A median (5th–95th percentile) error of 0.0 (−0.9 to 0.7) mm and 0.0 (−0.2 to 0.2) mm was found for real‐time motion estimation for in‐vivo and in‐silico, respectively. Target motion prediction beyond the liver–lung interface had a median root mean square error of 1.6 mm (in‐vivo) and 0.5 mm (in‐silico). Beam‐on 4D MRI reconstruction required a median amount of data equal to an acquisition time of 2:21–3:17 min, which was 20% less data compared to the prebeam‐derived 4D‐MRI. System latency was reduced from 501 ± 12 ms to −1 ± 3 ms (SMS‐TSE) and from 398 ± 10 ms to −10 ± 4 ms (SMS‐bTFE) by a linear regression prediction filter. The local gamma analysis agreed within −3.8% to 3.3% (SMS‐bTFE) and −5.3% to 10% (SMS‐TSE) with a reference MRI sequence. The DAHs revealed a relative D98% GTV coverage between 97% and 100% (SMS‐bTFE) and 100% and 101% (SMS‐TSE) compared to the static reference. Conclusions The presented 2D/4D‐MRI methodology demonstrated the potential for accurately extracting real‐time motion for MLC tracking in abdominothoracic radiotherapy, while simultaneously reconstructing contiguous respiratory‐correlated 4D‐MRIs for dose accumulation.
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Affiliation(s)
- Katrinus Keijnemans
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Pim T S Borman
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Prescilla Uijtewaal
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Peter L Woodhead
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.,Elekta AB, kungstensgatan 18, 113 57 Stockholm, Sweden
| | - Bas W Raaymakers
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Martin F Fast
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
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Liang E, Dolan JL, Morris ED, Vono J, Bazan LF, Lu M, Glide-Hurst CK. Application of Continuous Positive Airway Pressure for Thoracic Respiratory Motion Management: An Assessment in a Magnetic Resonance Imaging–Guided Radiation Therapy Environment. Adv Radiat Oncol 2022; 7:100889. [PMID: 35198838 PMCID: PMC8844850 DOI: 10.1016/j.adro.2021.100889] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 12/06/2021] [Indexed: 12/22/2022] Open
Abstract
Purpose Patient tolerability of magnetic resonance (MR)–guided radiation treatment delivery is limited by the need for repeated deep inspiratory breath holds (DIBHs). This volunteer study assessed the feasibility of continuous positive airway pressure (CPAP) with and without DIBH for respiratory motion management during radiation treatment with an MR-linear accelerator (MR-linac). Methods and Materials MR imaging safety was first addressed by placing the CPAP device in an MR-safe closet and configuring a tube circuit via waveguide to the magnet bore. Reproducibility and linearity of the final configuration were assessed. Six healthy volunteers underwent thoracic imaging in a 0.35T MR-linac, with one free breathing (FB) and 2 DIBH acquisitions being obtained at 5 pressures from 0 to 15 cm-H2O. Lung and heart volumes and positions were recorded; repeatability was assessed by comparing 2 consecutive DIBH scans. Blinded reviewers graded images for motion artifact using a 3-point grading scale. Participants completed comfort and perception surveys before and after imaging sessions. Results Compared with FB alone, FB-10, FB-12, and FB-15 cm H2O significantly increased lung volumes (+23%, +34%, +44%; all P <.05) and inferiorly displaced the heart (0.86 cm, 0.96 cm, 1.18 cm; all P < . 05). Lung volumes were significantly greater with DIBH-0 cm H2O compared with FB-15 cm H2O (+105% vs +44%, P = .01), and DIBH-15 cm H2O yielded additional volume increase (+131% vs +105%, P = .01). Adding CPAP to DIBH decreased lung volume differences between consecutive breath holds (correlation coefficient 0.97 at 15 cm H2O vs 0.00 at 0 cm H2O). The addition of 15 cm H2O CPAP reduced artifact scores (P = .03) compared with FB; all DIBH images (0-15 cm H2O) had less artifact (P < .01). Conclusions This work demonstrates the feasibility of integrating CPAP in an MR-linac environment in healthy volunteers. Extending this work to a larger patient cohort is warranted to further establish the role of CPAP as an alternative and concurrent approach to DIBH in MR-guided radiation therapy.
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Affiliation(s)
- Evan Liang
- Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan
- Corresponding author: Evan Liang, MD
| | - Jennifer L. Dolan
- Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan
| | - Eric D. Morris
- Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan
- Department of Radiation Oncology, University of California, Los Angeles, California
| | - Jonathan Vono
- Department of Pulmonary and Sleep Medicine, Henry Ford Health System, Detroit, Michigan
| | - Luisa F. Bazan
- Department of Pulmonary and Sleep Medicine, Henry Ford Health System, Detroit, Michigan
| | - Mei Lu
- Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan
| | - Carri K. Glide-Hurst
- Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan
- Department of Human Oncology, University of Wisconsin, Madison, Wisconsin
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Yamauchi R, Mizuno N, Itazawa T, Masuda T, Akiyama S, Kawamori J. Assessment of visual feedback system for reproducibility of voluntary deep inspiration breath hold in left-sided breast radiotherapy. J Med Imaging Radiat Sci 2021; 52:544-551. [PMID: 34538757 DOI: 10.1016/j.jmir.2021.08.018] [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: 04/15/2021] [Revised: 08/22/2021] [Accepted: 08/31/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Deep inspiration breath-hold (DIBH) for left-sided breast cancer radiotherapy reduces the dose exposure of the heart and left anterior descending coronary artery. DIBH requires the patient to maintain an adequate breath-hold position during their daily radiotherapy fraction. This study aimed to assess the reproducibility of the breath-hold position by implementing DIBH with visual feedback (VF) system. METHODS Forty-three patients who underwent left-sided radiotherapy with DIBH were reviewed. Data from 35 patients who underwent DIBH with VF (VF-DIBH) were compared with data from 8 patients who underwent DIBH with audio coaching (AC-DIBH). Reproducibility during radiotherapy was evaluated using the portal images obtained. Images were acquired daily during the tangential field treatment with DIBH. The distances between the field edge and chest wall at the central beam axis were manually measured on the portal image and digital reconstruction radiograph (DRR). The displacements of the chest wall during radiotherapy were assessed by subtracting the measurement made on the portal image from the DRR measurement. The overall average distances for the VF-DIBH and AC-DIBH cohorts were compared to assess reproducibility. The statistical analysis was performed using Mann-Whitney U tests (p < 0.05). RESULTS The mean chest wall displacement (±2 SD) was 0.59 ± 3.64 mm for VF-DIBH and 2.09 ± 4.96 mm for AC-DIBH, respectively. This value differed significantly between the VF-DIBH and AC-DIBH cohorts (p < 0.001). CONCLUSION In DIBH radiotherapy, the implementation of VF was confirmed to improve breath-hold position reproducibility, and the utility of VF for DIBH was demonstrated.
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Affiliation(s)
- Ryohei Yamauchi
- Department of Radiation Oncology, St. Luke's International Hospital, Tokyo, Japan.
| | - Norifumi Mizuno
- Department of Radiation Oncology, St. Luke's International Hospital, Tokyo, Japan
| | - Tomoko Itazawa
- Department of Radiation Oncology, St. Luke's International Hospital, Tokyo, Japan
| | - Tomoyuki Masuda
- Department of Radiation Oncology, St. Luke's International Hospital, Tokyo, Japan
| | - Shinobu Akiyama
- Department of Radiation Oncology, St. Luke's International Hospital, Tokyo, Japan
| | - Jiro Kawamori
- Department of Radiation Oncology, St. Luke's International Hospital, Tokyo, Japan
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10
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He P, Li Q. Motion management with variable cycle-based respiratory guidance method for carbon-ion pencil beam scanning treatment. Phys Med 2021; 87:99-105. [PMID: 34134014 DOI: 10.1016/j.ejmp.2021.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/09/2021] [Accepted: 06/04/2021] [Indexed: 02/08/2023] Open
Abstract
PURPOSE A novel variable cycle-based respiratory guidance method was proposed to synchronize the patterns between patients' breathing and the magnetic excitation of synchrotron under the mode of full-energy depth scanning beam delivery, in order to improve the treatment precision and efficiency for carbon ion therapy. METHODS Audio-visual biofeedback system with variable cycle-based respiratory guidance method was developed. We enrolled 6 healthy volunteers and a simulation study of the fixed cycle-based and variable cycle-based respiratory guidance with three treatment fractions was performed. A total of 72 breathing curves were collected for 4D dose calculations with three 4DCT datasets of lung tumor cases. Target dose coverage (D95: the percent dose covering 95% of the target), dose homogeneity (D5-D95), and treatment time were analyzed. The Wilcoxon signed-rank test was used for statistical difference analysis, and p < 0.05 was considered significant. RESULTS With the variable cycle-based respiratory guidance method, the breath hold phase of breathing curve could be synchronized with the synchrotron flat-top phase over time. The dose homogeneity was improved by factors of 1.94-2.92 compared to the fixed cycle-based respiratory guidance maneuvers alone or in combination with gating technique. Moreover, the treatment efficiency increased by 11-23%, depending on the duty cycle settings of the gating window. CONCLUSIONS The proposed variable cycle-based respiratory guidance method could improve both the treatment efficiency and precision under the mode of the full-energy depth scanning beam delivery for synchrotron-based carbon ion therapy.
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Affiliation(s)
- Pengbo He
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou 730000, China; Key Laboratory of Heavy Ion Radiation Biology and Medicine of Chinese Academy of Sciences, Lanzhou 730000, China; Key Laboratory of Basic Research on Heavy Ion Radiation Application in Medicine, Gansu Province, Lanzhou 730000, China; University of Chinese Academy of Sciences, Beijing 100049, China
| | - Qiang Li
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou 730000, China; Key Laboratory of Heavy Ion Radiation Biology and Medicine of Chinese Academy of Sciences, Lanzhou 730000, China; Key Laboratory of Basic Research on Heavy Ion Radiation Application in Medicine, Gansu Province, Lanzhou 730000, China; University of Chinese Academy of Sciences, Beijing 100049, China.
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11
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Remy C, Ahumada D, Labine A, Côté JC, Lachaine M, Bouchard H. Potential of a probabilistic framework for target prediction from surrogate respiratory motion during lung radiotherapy. Phys Med Biol 2021; 66. [PMID: 33761479 DOI: 10.1088/1361-6560/abf1b8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 03/23/2021] [Indexed: 12/25/2022]
Abstract
Purpose.Respiration-induced motion introduces significant positioning uncertainties in radiotherapy treatments for thoracic sites. Accounting for this motion is a non-trivial task commonly addressed with surrogate-based strategies and latency compensating techniques. This study investigates the potential of a new unified probabilistic framework to predict both future target motion in real-time from a surrogate signal and associated uncertainty.Method.A Bayesian approach is developed, based on a Kalman filter theory adapted specifically for surrogate measurements. Breathing motions are collected simultaneously from a lung target, two external surrogates (abdominal and thoracic markers) and an internal surrogate (liver structure) for 9 volunteers during 4 min, in which severe breathing changes occur to assess the robustness of the method. A comparison with an artificial non-linear neural network (NN) is performed, although no confidence interval prediction is provided. A static worst-case scenario and a simple static design are investigated.Results.Although the NN can reduce the prediction errors from thoracic surrogate in some cases, the Bayesian framework outperforms in most cases the NN when using the other surrogates: bias on predictions is reduced by 38% and 16% on average when using respectively the liver and the abdomen for the simple scenario, and by respectively 40% and 31% for the worst-case scenario. The standard deviation of residuals is reduced on average by up to 42%. The Bayesian method is also found to be more robust to increasing latencies. The thoracic marker appears to be less reliable to predict the target position, while the liver shows to be a better surrogate. A statistical test confirms the significance of both observations.Conclusion.The proposed framework predicts both the future target position and the associated uncertainty, which can be valuably used to further assist motion management decisions. Further investigation is required to improve the predictions by using an adaptive version of the proposed framework.
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Affiliation(s)
- Charlotte Remy
- Département de physique, Université de Montréal, Complexe des sciences, 1375 Avenue Thérèse-Lavoie-Roux, Montréal, Québec H2V 0B3, Canada.,Centre de recherche du Centre hospitalier de l'Université de Montréal, 900 Rue Saint-Denis, Montréal, Québec, H2X 0A9, Canada
| | - Daniel Ahumada
- Département de physique, Université de Montréal, Complexe des sciences, 1375 Avenue Thérèse-Lavoie-Roux, Montréal, Québec H2V 0B3, Canada.,Centre de recherche du Centre hospitalier de l'Université de Montréal, 900 Rue Saint-Denis, Montréal, Québec, H2X 0A9, Canada
| | - Alexandre Labine
- Département de physique, Université de Montréal, Complexe des sciences, 1375 Avenue Thérèse-Lavoie-Roux, Montréal, Québec H2V 0B3, Canada.,Centre de recherche du Centre hospitalier de l'Université de Montréal, 900 Rue Saint-Denis, Montréal, Québec, H2X 0A9, Canada
| | - Jean-Charles Côté
- Département de radio-oncologie, Centre hospitalier de l'Université de Montréal (CHUM), 1560 rue Sherbrooke est, Montréal, Québec H2L 4M1, Canada
| | - Martin Lachaine
- Elekta Ltd., 2050 de Bleury, Suite 200, Montréal, Québec H3A2J5, Canada
| | - Hugo Bouchard
- Département de physique, Université de Montréal, Complexe des sciences, 1375 Avenue Thérèse-Lavoie-Roux, Montréal, Québec H2V 0B3, Canada.,Centre de recherche du Centre hospitalier de l'Université de Montréal, 900 Rue Saint-Denis, Montréal, Québec, H2X 0A9, Canada.,Département de radio-oncologie, Centre hospitalier de l'Université de Montréal (CHUM), 1560 rue Sherbrooke est, Montréal, Québec H2L 4M1, Canada
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12
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Peeters STH, Vaassen F, Hazelaar C, Vaniqui A, Rousch E, Tissen D, Van Enckevort E, De Wolf M, Öllers MC, van Elmpt W, Verhoeven K, Van Loon JGM, Vosse BA, De Ruysscher DKM, Vilches-Freixas G. Visually guided inspiration breath-hold facilitated with nasal high flow therapy in locally advanced lung cancer. Acta Oncol 2021; 60:567-574. [PMID: 33295823 DOI: 10.1080/0284186x.2020.1856408] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND PURPOSE Reducing breathing motion in radiotherapy (RT) is an attractive strategy to reduce margins and better spare normal tissues. The objective of this prospective study (NCT03729661) was to investigate the feasibility of irradiation of non-small cell lung cancer (NSCLC) with visually guided moderate deep inspiration breath-hold (IBH) using nasal high-flow therapy (NHFT). MATERIAL AND METHODS Locally advanced NSCLC patients undergoing photon RT were given NHFT with heated humidified air (flow: 40 L/min with 80% oxygen) through a nasal cannula. IBH was monitored by optical surface tracking (OST) with visual feedback. At a training session, patients had to hold their breath as long as possible, without and with NHFT. For the daily cone beam CT (CBCT) and RT treatment in IBH, patients were instructed to keep their BH as long as it felt comfortable. OST was used to analyze stability and reproducibility of the BH, and CBCT to analyze daily tumor position. Subjective tolerance was measured with a questionnaire at 3 time points. RESULTS Of 10 included patients, 9 were treated with RT. Seven (78%) completed the treatment with NHFT as planned. At the training session, the mean BH length without NHFT was 39 s (range 15-86 s), and with NHFT 78 s (range 29-223 s) (p = .005). NHFT prolonged the BH duration by a mean factor of 2.1 (range 1.1-3.9s). The mean overall stability and reproducibility were within 1 mm. Subjective tolerance was very good with the majority of patients having no or minor discomfort caused by the devices. The mean inter-fraction tumor position variability was 1.8 mm (-1.1-8.1 mm;SD 2.4 mm). CONCLUSION NHFT for RT treatment of NSCLC in BH is feasible, well tolerated and significantly increases the breath-hold duration. Visually guided BH with OST is stable and reproducible. We therefore consider this an attractive patient-friendly approach to treat lung cancer patients with RT in BH.
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Affiliation(s)
- Stephanie T. H. Peeters
- Department of Radiation Oncology (MAASTRO), Maastricht University Medical Center, GROW, Maastricht, The Netherlands
| | - Femke Vaassen
- Department of Radiation Oncology (MAASTRO), Maastricht University Medical Center, GROW, Maastricht, The Netherlands
| | - Colien Hazelaar
- Department of Radiation Oncology (MAASTRO), Maastricht University Medical Center, GROW, Maastricht, The Netherlands
| | - Ana Vaniqui
- Department of Radiation Oncology (MAASTRO), Maastricht University Medical Center, GROW, Maastricht, The Netherlands
| | - Eva Rousch
- Department of Radiation Oncology (MAASTRO), Maastricht University Medical Center, GROW, Maastricht, The Netherlands
| | - Debby Tissen
- Department of Radiation Oncology (MAASTRO), Maastricht University Medical Center, GROW, Maastricht, The Netherlands
| | - Esther Van Enckevort
- Department of Radiation Oncology (MAASTRO), Maastricht University Medical Center, GROW, Maastricht, The Netherlands
| | - Michiel De Wolf
- Department of Anesthesiology and Pain Therapy, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Michel C. Öllers
- Department of Radiation Oncology (MAASTRO), Maastricht University Medical Center, GROW, Maastricht, The Netherlands
| | - Wouter van Elmpt
- Department of Radiation Oncology (MAASTRO), Maastricht University Medical Center, GROW, Maastricht, The Netherlands
| | - Karolien Verhoeven
- Department of Radiation Oncology (MAASTRO), Maastricht University Medical Center, GROW, Maastricht, The Netherlands
| | - Judith G. M. Van Loon
- Department of Radiation Oncology (MAASTRO), Maastricht University Medical Center, GROW, Maastricht, The Netherlands
| | - Bettine A. Vosse
- Department of Pulmonology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Dirk K. M. De Ruysscher
- Department of Radiation Oncology (MAASTRO), Maastricht University Medical Center, GROW, Maastricht, The Netherlands
| | - Gloria Vilches-Freixas
- Department of Radiation Oncology (MAASTRO), Maastricht University Medical Center, GROW, Maastricht, The Netherlands
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13
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Caillet V, Zwan B, Briggs A, Hardcastle N, Szymura K, Prodreka A, O’Brien R, Harris BE, Greer P, Haddad C, Jayamanne D, Eade T, Booth J, Keall P. Geometric uncertainty analysis of MLC tracking for lung SABR. ACTA ACUST UNITED AC 2020; 65:235040. [DOI: 10.1088/1361-6560/abb0c6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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14
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Tsai P, Yan G, Liu C, Hung Y, Kahler DL, Park J, Potter N, Li JG, Lu B. Tumor phase recognition using cone‐beam computed tomography projections and external surrogate information. Med Phys 2020; 47:5077-5089. [DOI: 10.1002/mp.14298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 05/10/2020] [Accepted: 05/18/2020] [Indexed: 12/25/2022] Open
Affiliation(s)
- Pingfang Tsai
- Department of Radiation Oncology College of Medicine University of Florida Gainesville Fl32610‐0385 USA
| | - Guanghua Yan
- Department of Radiation Oncology College of Medicine University of Florida Gainesville Fl32610‐0385 USA
| | - Chihray Liu
- Department of Radiation Oncology College of Medicine University of Florida Gainesville Fl32610‐0385 USA
| | - Ying‐Chao Hung
- Department of Statistics National Chengchi University Taipei11604 Taiwan
| | - Darren L. Kahler
- Department of Radiation Oncology College of Medicine University of Florida Gainesville Fl32610‐0385 USA
| | - Ji‐Yeon Park
- Department of Radiation Oncology College of Medicine University of Florida Gainesville Fl32610‐0385 USA
| | - Nick Potter
- Department of Radiation Oncology College of Medicine University of Florida Gainesville Fl32610‐0385 USA
| | - Jonathan G. Li
- Department of Radiation Oncology College of Medicine University of Florida Gainesville Fl32610‐0385 USA
| | - Bo Lu
- Department of Radiation Oncology College of Medicine University of Florida Gainesville Fl32610‐0385 USA
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15
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Vergalasova I, Cai J. A modern review of the uncertainties in volumetric imaging of respiratory-induced target motion in lung radiotherapy. Med Phys 2020; 47:e988-e1008. [PMID: 32506452 DOI: 10.1002/mp.14312] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 05/15/2020] [Accepted: 05/26/2020] [Indexed: 12/25/2022] Open
Abstract
Radiotherapy has become a critical component for the treatment of all stages and types of lung cancer, often times being the primary gateway to a cure. However, given that radiation can cause harmful side effects depending on how much surrounding healthy tissue is exposed, treatment of the lung can be particularly challenging due to the presence of moving targets. Careful implementation of every step in the radiotherapy process is absolutely integral for attaining optimal clinical outcomes. With the advent and now widespread use of stereotactic body radiation therapy (SBRT), where extremely large doses are delivered, accurate, and precise dose targeting is especially vital to achieve an optimal risk to benefit ratio. This has largely become possible due to the rapid development of image-guided technology. Although imaging is critical to the success of radiotherapy, it can often be plagued with uncertainties due to respiratory-induced target motion. There has and continues to be an immense research effort aimed at acknowledging and addressing these uncertainties to further our abilities to more precisely target radiation treatment. Thus, the goal of this article is to provide a detailed review of the prevailing uncertainties that remain to be investigated across the different imaging modalities, as well as to highlight the more modern solutions to imaging motion and their role in addressing the current challenges.
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Affiliation(s)
- Irina Vergalasova
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ, USA
| | - Jing Cai
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong
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16
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Yang Z, Ren L, Yin FF, Liang X, Cai J. Motion robust 4D-MRI sorting based on anatomic feature matching: A digital phantom simulation study. RADIATION MEDICINE AND PROTECTION 2020; 1:41-47. [DOI: 10.1016/j.radmp.2020.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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17
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Uh J, Kadbi M, Hua CH. Effects of age-related breathing characteristics on the performance of four-dimensional magnetic resonance imaging reconstructed by prospective gating for radiation therapy planning. PHYSICS & IMAGING IN RADIATION ONCOLOGY 2019; 11:82-87. [PMID: 33458284 PMCID: PMC7807601 DOI: 10.1016/j.phro.2019.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 09/04/2019] [Accepted: 09/10/2019] [Indexed: 11/04/2022]
Abstract
Background and purpose Four-dimensional magnetic resonance imaging (4D MRI) has advanced recently by incorporating prospective gating, but its performance on pediatric populations has not been investigated. This study aimed to determine the age-related performance of prospective gating, as compared with retrospective sorting. Materials and methods Prospectively gated 4D MRI scans were acquired on a motion phantom driven by real respiratory waveforms obtained from 23 pediatric and young adult patients (aged 5–24 years). The correlations between patient-specific breathing characteristics and the performance of 4D MRI were comparatively evaluated against retrospective sorting for the same scan time. For six patients who underwent both 4D MRI and 4D CT, the internal target volumes (ITVs) determined by the two modalities were compared. Results Longer scan time and greater sorting error were most highly correlated (P < 0.001) with breathing irregularity and extent of diaphragm motion, but age was not a strong covariate because of interindividual variation. Prospective gating was more accurate than retrospective sorting except for those patients with severe breathing irregularity (peak-to-peak coefficient of variation >30%). The ITVs of 4D MRI and 4D CT were comparable (Dice similarity: >90%) unless the breathing characteristics changed between the two imaging sessions. Conclusions For most patients analyzed in this study, prospective gating provided more accurate 4D MRI (95th percentile of deviation: <1.5 mm) than did retrospective sorting within a clinically feasible scan time (median: 5.9 min). The 4D MRI tended to take longer and to give larger sorting errors with deeper and irregular breathers.
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Affiliation(s)
- Jinsoo Uh
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Mo Kadbi
- Philips Healthcare, Gainesville, FL, USA
| | - Chia-Ho Hua
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
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18
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Fujimoto K, Shiinoki T, Yuasa Y, Onizuka R, Yamane M. Evaluation of the effects of motion mitigation strategies on respiration-induced motion in each pancreatic region using cine-magnetic resonance imaging. J Appl Clin Med Phys 2019; 20:42-50. [PMID: 31385418 PMCID: PMC6753735 DOI: 10.1002/acm2.12693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 06/28/2019] [Accepted: 07/19/2019] [Indexed: 01/09/2023] Open
Abstract
Purpose This study aimed to quantify the respiration‐induced motion in each pancreatic region during motion mitigation strategies and to characterize the correlations between this motion and that of the surrogate signals in cine‐magnetic resonance imaging (MRI). We also aimed to evaluate the effects of these motion mitigation strategies in each pancreatic region. Methods Sagittal and coronal two‐dimensional cine‐MR images were obtained in 11 healthy volunteers, eight of whom also underwent imaging with abdominal compression (AC). For each pancreatic region, the magnitude of pancreatic motion with and without motion mitigation and the positional error between the actual and predicted pancreas motion based on surrogate signals were evaluated. Results The magnitude of pancreatic motion with and without AC in the left–right (LR) and superior–inferior (SI) directions varied depending on the pancreatic region. In respiratory gating (RG) assessments based on a surrogate signal, although the correlation was reasonable, the positional error was large in the pancreatic tail region. Furthermore, motion mitigation in the anterior‐posterior and SI directions with RG was more effective than was that with AC in the head region. Conclusions This study revealed pancreatic region‐dependent variations in respiration‐induced motion and their effects on motion mitigation outcomes during AC or RG. The magnitude of pancreatic motion with or without AC and the magnitude of the positional error with RG varied depending on the pancreatic region. Therefore, during radiation therapy for pancreatic cancer, it is important to consider that the effects of motion mitigation during AC or RG may differ depending on the pancreatic region.
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Affiliation(s)
- Koya Fujimoto
- Department of Radiation Oncology, Graduate School of Medicine, Yamaguchi University, Yamaguchi, Japan
| | - Takehiro Shiinoki
- Department of Radiation Oncology, Graduate School of Medicine, Yamaguchi University, Yamaguchi, Japan
| | - Yuki Yuasa
- Department of Radiation Oncology, Graduate School of Medicine, Yamaguchi University, Yamaguchi, Japan
| | - Ryota Onizuka
- Department of Radiological Technology, Yamaguchi University Hospital, Yamaguchi, Japan
| | - Masatoshi Yamane
- Department of Radiological Technology, Yamaguchi University Hospital, Yamaguchi, Japan
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Kalet AM, Cao N, Smith WP, Young L, Wootton L, Stewart RD, Fang LC, Kim J, Horton T, Meyer J. Accuracy and stability of deep inspiration breath hold in gated breast radiotherapy – A comparison of two tracking and guidance systems. Phys Med 2019; 60:174-181. [DOI: 10.1016/j.ejmp.2019.03.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 03/14/2019] [Accepted: 03/24/2019] [Indexed: 01/22/2023] Open
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20
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Ginn JS, O'Connell D, Thomas DH, Low DA, Lamb JM. Model-Interpolated Gating for Magnetic Resonance Image-Guided Radiation Therapy. Int J Radiat Oncol Biol Phys 2018; 102:885-894. [PMID: 29970314 PMCID: PMC6542358 DOI: 10.1016/j.ijrobp.2018.05.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 04/03/2018] [Accepted: 05/02/2018] [Indexed: 12/25/2022]
Abstract
PURPOSE To develop and validate a technique for radiation therapy gating using slow (≤1 frame per second) magnetic resonance imaging (MRI) and a motion model. Proposed uses of the technique include radiation therapy gating using T2-weighted images and conducting additional imaging studies during gated treatments. METHODS AND MATERIALS The technique uses a physiologically guided breathing motion model to interpolate deformed target position between 2-dimensional (2D) MRI images acquired every 1 to 3 seconds. The model is parameterized by a 1-dimensional respiratory bellows surrogate and is continuously updated with the most recently acquired 2D images. A phantom and 8 volunteers were imaged with a 0.35T MRI-guided radiation therapy system. A balanced steady-state free precession sequence with a 2D frame rate of 3 frames per second was used to evaluate the technique. The accuracy and beam-on positive predictive value (PPV) of the model-based gating decisions were evaluated using the gating decisions derived from imaging as a ground truth. A T2-weighted gating offline proof-of-concept study using a half-Fourier, single-shot, turbo-spin echo sequence is reported. RESULTS Model-interpolated gating accuracy, beam-on PPV, and median absolute distances between model and image-tracked target centroids were, on average, 98.3%, 98.4%, and 0.33 mm, respectively, in the balanced steady-state free precession phantom studies and 93.7%, 92.1%, and 0.86 mm, respectively, in the volunteer studies. T2 model-interpolated gating in 6 volunteers yielded an average accuracy and PPV of 94.3% and 92.5%, respectively, and the mean absolute median distance between modeled and imaged target centroids was 0.86 mm. CONCLUSIONS This work demonstrates the concept of model-interpolated gating for MRI-guided radiation therapy. The technique was found to be potentially sufficiently accurate for clinical use. Further development is needed to accommodate out-of-plane motion and the use of an internal MR-based respiratory surrogate.
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Affiliation(s)
- John S Ginn
- Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.
| | - Dylan O'Connell
- Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - David H Thomas
- Department of Radiation Oncology, University of Colorado School of Medicine, University of Colorado, Aurora, Colorado
| | - Daniel A Low
- Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - James M Lamb
- Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
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