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Wei W, Li Z, Xiao Q, Wang G, He H, Luo D, Chen L, Li J, Zhang X, Qin T, Song Y, Li G, Bai S. Quantifying dose uncertainties resulting from cardiorespiratory motion in intensity-modulated proton therapy for cardiac stereotactic body radiotherapy. Front Oncol 2024; 14:1399589. [PMID: 39040445 PMCID: PMC11260676 DOI: 10.3389/fonc.2024.1399589] [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: 03/12/2024] [Accepted: 06/19/2024] [Indexed: 07/24/2024] Open
Abstract
Background Cardiac stereotactic body radiotherapy (CSBRT) with photons efficaciously and safely treats cardiovascular arrhythmias. Proton therapy, with its unique physical and radiobiological properties, can offer advantages over traditional photon-based therapies in certain clinical scenarios, particularly pediatric tumors and those in anatomically challenging areas. However, dose uncertainties induced by cardiorespiratory motion are unknown. Objective This study investigated the effect of cardiorespiratory motion on intensity-modulated proton therapy (IMPT) and the effectiveness of motion-encompassing methods. Methods We retrospectively included 12 patients with refractory arrhythmia who underwent CSBRT with four-dimensional computed tomography (4DCT) and 4D cardiac CT (4DcCT). Proton plans were simulated using an IBA accelerator based on the 4D average CT. The prescription was 25 Gy in a single fraction, with all plans normalized to ensure that 95% of the target volume received the prescribed dose. 4D dose reconstruction was performed to generate 4D accumulated and dynamic doses. Furthermore, dose uncertainties due to the interplay effect of the substrate target and organs at risk (OARs) were assessed. The differences between internal organs at risk volume (IRV) and OARreal (manually contoured on average CT) were compared. In 4D dynamic dose, meeting prescription requirements entails V25 and D95 reaching 95% and 25 Gy, respectively. Results The 4D dynamic dose significantly differed from the 3D static dose. The mean V25 and D95 were 89.23% and 24.69 Gy, respectively, in 4DCT and 94.35% and 24.99 Gy, respectively, in 4DcCT. Eleven patients in 4DCT and six in 4DcCT failed to meet the prescription requirements. Critical organs showed varying dose increases. All metrics, except for Dmean and D50, significantly changed in 4DCT; in 4DcCT, only D50 remained unchanged with regards to the target dose uncertainties induced by the interplay effect. The interplay effect was only significant for the Dmax values of several OARs. Generally, respiratory motion caused a more pronounced interplay effect than cardiac pulsation. Neither IRV nor OARreal effectively evaluated the dose discrepancies of the OARs. Conclusions Complex cardiorespiratory motion can introduce dose uncertainties during IMPT. Motion-encompassing techniques may mitigate but cannot entirely compensate for the dose discrepancies. Individualized 4D dose assessments are recommended to verify the effectiveness and safety of CSBRT.
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Affiliation(s)
- Weige Wei
- Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Radiotherapy Physics & Technology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhibin Li
- Department of Radiotherapy & Oncology, The First Affiliated Hospital of Soochow University, Institute of Radiotherapy & Oncology, Soochow University, Suzhou, China
| | - Qing Xiao
- Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Radiotherapy Physics & Technology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Guangyu Wang
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Haiping He
- Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Radiotherapy Physics & Technology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Dashuang Luo
- Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Radiotherapy Physics & Technology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Li Chen
- Department of Radiotherapy & Oncology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Jing Li
- Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Radiotherapy Physics & Technology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiangyu Zhang
- Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Radiotherapy Physics & Technology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Taolin Qin
- Department of Medical Physics, Brown University, Providence, RI, United States
| | - Ying Song
- Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Radiotherapy Physics & Technology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Guangjun Li
- Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Radiotherapy Physics & Technology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Sen Bai
- Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Radiotherapy Physics & Technology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Dionisi F, Landoni V, Widesott L, Nardangeli A, Fracchiolla F, Siniscalchi B, Soriani A, Turkaj A, Righetto R, Amelio D, Farace P, Goanta L, Trianni A, Lorentini S, Cianchetti M, Sanguineti G. Dosimetric and NTCP advantages of robust proton therapy over robust VMAT for Stage III NSCLC in the immunotherapy era. Phys Med 2024; 123:103410. [PMID: 38878630 DOI: 10.1016/j.ejmp.2024.103410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 04/29/2024] [Accepted: 06/10/2024] [Indexed: 07/13/2024] Open
Abstract
AIMS To assess the robustness and to define the dosimetric and NTCP advantages of pencil-beam-scanning proton therapy (PBSPT) compared with VMAT for unresectable Stage III non-small lung cancer (NSCLC) in the immunotherapy era. MATERIAL AND METHODS 10 patients were re-planned with VMAT and PBSPT using: 1) ITV-based robust optimization with 0.5 cm setup uncertainties and (for PBSPT) 3.5 % range uncertainties on free-breathing CT 2) CTV-based RO including all 4DCTs anatomies. Target coverage (TC), organs at risk dose and TC robustness (TCR), set at V95%, were compared. The NTCP risk for radiation pneumonitis (RP), 24-month mortality (24MM), G2 + acute esophageal toxicity (ET), the dose to the immune system (EDIC) and the left anterior descending (LAD) coronary artery V15 < 10 % were registered. Wilcoxon test was used. RESULTS Both PBSPT methods improved TC and TCR (p < 0.01). The mean lung dose and lung V20 were lower with PBSPT (p < 0.01). Median mean heart dose reduction with PBSPT was 8 Gy (p < 0.001). PT lowered median LAD V15 (p = 0.004). ΔNTCP > 5 % with PBSPT was observed for two patients for RP and for five patients for 24 MM. ΔNTCP for ≥ G2 ET was not in favor of PBSPT for all patients. PBSPT halved median EDIC (4.9/5.1 Gy for ITV/CTV-based VMAT vs 2.3 Gy for both ITV/CTV-based PBSPT, p < 0.01). CONCLUSIONS PBSPT is a robust approach with significant dosimetric and NTCP advantages over VMAT; the EDIC reduction could allow for a better integration with immunotherapy. A clinical benefit for a subset of NSCLC patients is expected.
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Affiliation(s)
- F Dionisi
- Department of Research and Advanced Technology, Radiotherapy Unit, IRCCS Regina Elena National Cancer Institute-Rome, Italy.
| | - V Landoni
- Laboratory of Medical Physics and Expert Systems, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - L Widesott
- Medical Physics Department, APSS, Trento, Italy
| | - A Nardangeli
- Department of Research and Advanced Technology, Radiotherapy Unit, IRCCS Regina Elena National Cancer Institute-Rome, Italy
| | | | | | - A Soriani
- Laboratory of Medical Physics and Expert Systems, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - A Turkaj
- Proton Therapy Unit, APSS, Trento, Italy
| | - R Righetto
- Medical Physics Department, APSS, Trento, Italy
| | - D Amelio
- Proton Therapy Unit, APSS, Trento, Italy
| | - P Farace
- Medical Physics Department, APSS, Trento, Italy
| | - L Goanta
- Department of Research and Advanced Technology, Radiotherapy Unit, IRCCS Regina Elena National Cancer Institute-Rome, Italy
| | - A Trianni
- Medical Physics Department, APSS, Trento, Italy
| | - S Lorentini
- Medical Physics Department, APSS, Trento, Italy
| | | | - G Sanguineti
- Department of Research and Advanced Technology, Radiotherapy Unit, IRCCS Regina Elena National Cancer Institute-Rome, Italy
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Hessels AC, Visser S, Both S, Korevaar EW, Langendijk JA, Wijsman R. A planning study of proton therapy dose escalation for non-small cell lung cancer. Phys Imaging Radiat Oncol 2024; 31:100616. [PMID: 39157295 PMCID: PMC11327929 DOI: 10.1016/j.phro.2024.100616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 07/19/2024] [Accepted: 07/24/2024] [Indexed: 08/20/2024] Open
Abstract
In non-small-cell lung cancer (NSCLC), improving local control through radiotherapy dose escalation might improve survival. However, a photon-based RCT showed increased organ at risk dose exposure and worse overall survival in the dose escalation arm. In this study, intensity-modulated proton therapy plans with dose escalation to the primary tumour were created for 20 NSCLC patients. The mediastinal envelope was delineated to spare structures around the heart. It was possible to increase primary tumour dose up to 74.0 Gy without a significant increase in organ at risk doses and predicted toxicity.
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Affiliation(s)
- Arno C Hessels
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sabine Visser
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Stefan Both
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Erik W Korevaar
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Johannes A Langendijk
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Robin Wijsman
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Vindbæk S, Ehrbar S, Worm E, Muren L, Tanadini-Lang S, Petersen J, Balling P, Poulsen P. Motion-induced dose perturbations in photon radiotherapy and proton therapy measured by deformable liver-shaped 3D dosimeters in an anthropomorphic phantom. Phys Imaging Radiat Oncol 2024; 31:100609. [PMID: 39132555 PMCID: PMC11315221 DOI: 10.1016/j.phro.2024.100609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 06/23/2024] [Accepted: 07/01/2024] [Indexed: 08/13/2024] Open
Abstract
Background and purpose The impact of intrafractional motion and deformations on clinical radiotherapy delivery has so far only been investigated by simulations as well as point and planar dose measurements. The aim of this study was to combine anthropomorphic 3D dosimetry with a deformable abdominal phantom to measure the influence of intra-fractional motion and gating in photon radiotherapy and evaluate the applicability in proton therapy. Material and methods An abdominal phantom was modified to hold a deformable anthropomorphic 3D dosimeter shaped as a human liver. A liver-specific photon radiotherapy and a proton pencil beam scanning therapy plan were delivered to the phantom without motion as well as with 12 mm sinusoidal motion while using either no respiratory gating or respiratory gating. Results Using the stationary irradiation as reference the local 3 %/2 mm 3D gamma index pass rate of the motion experiments in the planning target volume (PTV) was above 97 % (photon) and 78 % (proton) with gating whereas it was below 74 % (photon) and 45 % (proton) without gating. Conclusions For the first time a high-resolution deformable anthropomorphic 3D dosimeter embedded in a deformable abdominal phantom was applied for experimental validation of both photon and proton treatments of targets exhibiting respiratory motion. It was experimentally shown that gating improves dose coverage and the geometrical accuracy for both photon radiotherapy and proton therapy.
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Affiliation(s)
- Simon Vindbæk
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Stefanie Ehrbar
- Department of Radiation Oncology, University Hospital Zürich and University of Zürich, Zürich, Switzerland
| | - Esben Worm
- Department of Medical Physics, Aarhus University Hospital, Aarhus, Denmark
| | - Ludvig Muren
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Stephanie Tanadini-Lang
- Department of Radiation Oncology, University Hospital Zürich and University of Zürich, Zürich, Switzerland
| | - Jørgen Petersen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Medical Physics, Aarhus University Hospital, Aarhus, Denmark
| | - Peter Balling
- Department of Physics and Astronomy, Aarhus University, Aarhus, Denmark
- Interdisciplinary Nanoscience Center, Aarhus University, Aarhus, Denmark
| | - Per Poulsen
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Ranjith CP, Krishnan M, Raveendran V, Chaudhari L, Laskar S. An artificial neural network based approach for predicting the proton beam spot dosimetric characteristics of a pencil beam scanning technique. Biomed Phys Eng Express 2024; 10:035033. [PMID: 38652667 DOI: 10.1088/2057-1976/ad3ce0] [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: 11/29/2023] [Accepted: 04/10/2024] [Indexed: 04/25/2024]
Abstract
Utilising Machine Learning (ML) models to predict dosimetric parameters in pencil beam scanning proton therapy presents a promising and practical approach. The study developed Artificial Neural Network (ANN) models to predict proton beam spot size and relative positional errors using 9000 proton spot data. The irradiation log files as input variables and corresponding scintillation detector measurements as the label values. The ANN models were developed to predict six variables: spot size in thex-axis,y-axis, major axis, minor axis, and relative positional errors in thex-axis andy-axis. All ANN models used a Multi-layer perception (MLP) network using one input layer, three hidden layers, and one output layer. Model performance was validated using various statistical tools. The log file recorded spot size and relative positional errors, which were compared with scintillator-measured data. The Root Mean Squared Error (RMSE) values for the x-spot and y-spot sizes were 0.356 mm and 0.362 mm, respectively. Additionally, the maximum variation for the x-spot relative positional error was 0.910 mm, while for the y-spot, it was 1.610 mm. The ANN models exhibit lower prediction errors. Specifically, the RMSE values for spot size prediction in the x, y, major, and minor axes are 0.053 mm, 0.049 mm, 0.053 mm, and 0.052 mm, respectively. Additionally, the relative spot positional error prediction model for the x and y axes yielded maximum errors of 0.160 mm and 0.170 mm, respectively. The normality of models was validated using the residual histogram and Q-Q plot. The data over fit, and bias were tested using K (k = 5) fold cross-validation, and the maximum RMSE value of the K fold cross-validation among all the six ML models was less than 0.150 mm (R-Square 0.960). All the models showed excellent prediction accuracy. Accurately predicting beam spot size and positional errors enhances efficiency in routine dosimetric checks.
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Affiliation(s)
- C P Ranjith
- Department of Medical Physics, Centre for Interdisciplinary Research, D. Y. Patil Education Society (Deemed to be University), Kolhapur, Maharashtra, India
- Department of Radiation Oncology, Advanced Centre for Treatment Research and Education in Cancer, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Mayakannan Krishnan
- Department of Medical Physics, Centre for Interdisciplinary Research, D. Y. Patil Education Society (Deemed to be University), Kolhapur, Maharashtra, India
| | - Vysakh Raveendran
- Department of Radiation Oncology, Advanced Centre for Treatment Research and Education in Cancer, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Lalit Chaudhari
- Department of Radiation Oncology, Advanced Centre for Treatment Research and Education in Cancer, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Siddhartha Laskar
- Department of Radiation Oncology, Advanced Centre for Treatment Research and Education in Cancer, Homi Bhabha National Institute, Mumbai, Maharashtra, India
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Tominaga Y, Suga M, Takeda M, Yamamoto Y, Akagi T, Kato T, Tokumaru S, Yamamoto M, Oita M. Comparing interplay effects in scanned proton therapy of lung cancer: Free breathing with various layer and volume rescanning versus respiratory gating with different gate widths. Phys Med 2024; 120:103323. [PMID: 38461635 DOI: 10.1016/j.ejmp.2024.103323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 02/07/2024] [Accepted: 03/04/2024] [Indexed: 03/12/2024] Open
Abstract
PURPOSE We investigated interplay effects and treatment time (TT) in scanned proton therapy for lung cancer patients. We compared free-breathing (FB) approaches with multiple rescanning strategies and respiratory-gating (RG) methods with various gating widths to identify the superior irradiation technique. METHODS Plans were created with 4/1, 2/2, and 1/4 layered/volume rescans of FB (L4V1, L2V2, and L1V4), and 50%, 30%, and 10% gating widths of the total respiratory curves (G50, G30, and G10) of the RG plans with L4V1. We calculated 4-dimensional dynamic doses assuming a constant sinusoidal curve for six irradiation methods. The reconstructed doses per fraction were compared with planned doses in terms of dose differences in 99% clinical-target-volume (CTV) (ΔD99%), near-maximum dose differences (ΔD2%) at organs-at-risk (OARs), and TT. RESULTS The mean/minimum CTV ΔD99% values for FB were -1.0%/-4.9%, -0.8%/-4.3%, and -0.1%/-1.0% for L4V1, L2V2, and L1V4, respectively. Those for RG were -0.3%/-1.7%, -0.1%/-1.0%, and 0.0%/-0.5% for G50, G30, and G10, respectively. The CTV ΔD99% of the RGs with less than 50% gate width and the FBs of L1V4 were within the desired tolerance (±3.0%), and the OARs ΔD2% for RG were lower than those for FB. The mean TTs were 90, 326, 824, 158, 203, and 422 s for L4V1, L2V2, L1V4, G50, G30, and G10, respectively. CONCLUSIONS FB (L4V1) is the most efficient treatment, but not necessarily the optimal choice due to interplay effects. To satisfy both TT extensions and interplay, RG with a gate width as large as possible within safety limits is desirable.
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Affiliation(s)
- Yuki Tominaga
- Department of Radiotherapy, Medical Co. Hakuhokai, Osaka Proton Therapy Clinic, 27-9 Kasugadenaka, Konohana-ku, Osaka 554-0022, Japan.
| | - Masaki Suga
- Hyogo Ion Beam Medical Center, 1-2-1, Kouto, Shingucho, Tatsuno, Hyogo 679-5165, Japan
| | - Mikuni Takeda
- Hyogo Ion Beam Medical Center, 1-2-1, Kouto, Shingucho, Tatsuno, Hyogo 679-5165, Japan
| | - Yuki Yamamoto
- Hyogo Ion Beam Medical Center, 1-2-1, Kouto, Shingucho, Tatsuno, Hyogo 679-5165, Japan
| | - Takashi Akagi
- Hyogo Ion Beam Medical Support, 1-2-1, Kouto, Shingucho, Tatsuno, Hyogo 679-5165, Japan
| | - Takahiro Kato
- Department of Radiological Sciences, School of Health Sciences, Fukushima Medical University, 1 Hikariga-oka, Fukushima 960-1295, Japan; Department of Radiation Physics and Technology, Southern Tohoku Proton Therapy Center, Fukushima 172, Yatsuyamada 7 Chome, Koriyama, Fukushima 963-8052, Japan
| | - Sunao Tokumaru
- Hyogo Ion Beam Medical Center, 1-2-1, Kouto, Shingucho, Tatsuno, Hyogo 679-5165, Japan
| | - Michinori Yamamoto
- Department of Radiotherapy, Medical Co. Hakuhokai, Osaka Proton Therapy Clinic, 27-9 Kasugadenaka, Konohana-ku, Osaka 554-0022, Japan
| | - Masataka Oita
- Faculty of Interdisciplinary Science and Engineering in Health Systems, Okayama University, 5-1 Shikata-cho, 2-chome, Kita-ku, Okayama 700-8558, Japan
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Tominaga Y, Oita M, Miyata J, Kato T. Experimental validation of a 4D dynamic dose calculation model for proton pencil beam scanning without spot time stamp considering free-breathing motion. Med Phys 2024; 51:566-578. [PMID: 37672227 DOI: 10.1002/mp.16725] [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: 03/24/2023] [Revised: 07/28/2023] [Accepted: 08/20/2023] [Indexed: 09/07/2023] Open
Abstract
PURPOSE We developed a 4-dimensional dynamic dose (4DDD) calculation model for proton pencil beam scanning (PBS). This model incorporates the spill start time for all energies and uses the remaining irradiated spot time model instead of irradiated spot time logs. This study aimed to validate the calculation accuracy of a log file-based 4DDD model by comparing it with dose measurements performed under free-breathing conditions, thereby serving as an alternative approach to the conventional log file-based system. METHODS Three cubic verification plans were created using a heterogeneous block phantom; these plans were created using 10 phase 4D-CT datasets of the phantom. The CIRS dynamic platform was used to simulate motion with amplitudes of 2.5, 3.75, and 5.0 mm. These plans consisted of eight- and two-layered rescanning techniques. The lateral profiles were measured using a 2D ionization chamber array (2D-array) and EBT3 Gafchromic films at four starting phases, including three sinusoidal curves (periods of 3, 4, and 6 s) and a representative patient curve during actual treatment. 4DDDs were calculated using in-house scripting that assigned a time stamp to each spot and performed dose accumulation using deformable image registration. Furthermore, to evaluate the impact of parameter selection on our 4DDD model calculations, simulations were performed assuming a ±10% change in irradiation time stamp (0.8 ± 0.08 s) and spot scan speed. We evaluated the 2D gamma index and the absolute point doses between the calculated values and the measurements. RESULTS The 2D-array measurements revealed that the gamma scores for the static plans (no motion) and 4DDD plans exceeded 97.5% and 93.9% at 3%/3 mm, respectively. The average gamma score of the 4DDD plans was at least 96.1%. When using EBT3 films, the gamma scores of the 4DDD model exceeded 92.4% and 98.7% at 2%/2 mm and 3%/3 mm, respectively. Regarding the 4DDD point dose differences, more than 95% of the dose regions exhibited discrepancies within ±5.0% for 97.7% of the total points across all plans. The spot time assignment accuracy of our 4DDD model was acceptable even with ±10% sensitivity. However, the accuracy of the scan speed, when varied within ±10% sensitivity, was not acceptable (minimum gamma scores of 82.6% and maximum dose difference of 12.9%). CONCLUSIONS Our 4DDD calculations under free-breathing conditions using amplitudes of less than 5.0 mm were in good agreement with the measurements regardless of the starting phases, breathing curve patterns (between 3 and 6 s periods), and varying numbers of layered rescanning. The proposed system allows us to evaluate actual irradiated doses in various breathing periods, amplitudes, and starting phases, even on PBS machines without the ability to record spot logs.
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Affiliation(s)
- Yuki Tominaga
- Graduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama University, Okayama, Japan
- Osaka Proton Therapy Clinic, Department of Radiotherapy, Medical Co. Hakuhokai, Osaka, Osaka, Japan
| | - Masataka Oita
- Faculty of Interdisciplinary Science and Engineering in Health Systems, Okayama University, Okayama, Okayama, Japan
| | - Junya Miyata
- Graduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama University, Okayama, Japan
- Department of Radiological Technology, Kurashiki Central Hospital, Okayama, Japan
| | - Takahiro Kato
- Department of Radiological Sciences, School of Health Sciences, Fukushima Medical University, Fukushima, Japan
- Department of Radiation Physics and Technology, Southern Tohoku Proton Therapy Center, Koriyama, Fukushima, Japan
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Knäusl B, Belotti G, Bertholet J, Daartz J, Flampouri S, Hoogeman M, Knopf AC, Lin H, Moerman A, Paganelli C, Rucinski A, Schulte R, Shimizu S, Stützer K, Zhang X, Zhang Y, Czerska K. A review of the clinical introduction of 4D particle therapy research concepts. Phys Imaging Radiat Oncol 2024; 29:100535. [PMID: 38298885 PMCID: PMC10828898 DOI: 10.1016/j.phro.2024.100535] [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: 10/11/2023] [Revised: 12/12/2023] [Accepted: 01/04/2024] [Indexed: 02/02/2024] Open
Abstract
Background and purpose Many 4D particle therapy research concepts have been recently translated into clinics, however, remaining substantial differences depend on the indication and institute-related aspects. This work aims to summarise current state-of-the-art 4D particle therapy technology and outline a roadmap for future research and developments. Material and methods This review focused on the clinical implementation of 4D approaches for imaging, treatment planning, delivery and evaluation based on the 2021 and 2022 4D Treatment Workshops for Particle Therapy as well as a review of the most recent surveys, guidelines and scientific papers dedicated to this topic. Results Available technological capabilities for motion surveillance and compensation determined the course of each 4D particle treatment. 4D motion management, delivery techniques and strategies including imaging were diverse and depended on many factors. These included aspects of motion amplitude, tumour location, as well as accelerator technology driving the necessity of centre-specific dosimetric validation. Novel methodologies for X-ray based image processing and MRI for real-time tumour tracking and motion management were shown to have a large potential for online and offline adaptation schemes compensating for potential anatomical changes over the treatment course. The latest research developments were dominated by particle imaging, artificial intelligence methods and FLASH adding another level of complexity but also opportunities in the context of 4D treatments. Conclusion This review showed that the rapid technological advances in radiation oncology together with the available intrafractional motion management and adaptive strategies paved the way towards clinical implementation.
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Affiliation(s)
- Barbara Knäusl
- Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | - Gabriele Belotti
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Jenny Bertholet
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Juliane Daartz
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Mischa Hoogeman
- Department of Medical Physics & Informatics, HollandPTC, Delft, The Netherlands
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Radiotherapy, Rotterdam, The Netherlands
| | - Antje C Knopf
- Institut für Medizintechnik und Medizininformatik Hochschule für Life Sciences FHNW, Muttenz, Switzerland
| | - Haibo Lin
- New York Proton Center, New York, NY, USA
| | - Astrid Moerman
- Department of Medical Physics & Informatics, HollandPTC, Delft, The Netherlands
| | - Chiara Paganelli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Antoni Rucinski
- Institute of Nuclear Physics Polish Academy of Sciences, PL-31342 Krakow, Poland
| | - Reinhard Schulte
- Division of Biomedical Engineering Sciences, School of Medicine, Loma Linda University
| | - Shing Shimizu
- Department of Carbon Ion Radiotherapy, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kristin Stützer
- OncoRay – National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Helmholtz-Zentrum Dresden – Rossendorf, Institute of Radiooncology – OncoRay, Dresden, Germany
| | - Xiaodong Zhang
- Department of Radiation Physics, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ye Zhang
- Center for Proton Therapy, Paul Scherrer Institute, Villigen PSI, Switzerland
| | - Katarzyna Czerska
- Center for Proton Therapy, Paul Scherrer Institute, Villigen PSI, Switzerland
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9
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Knäusl B. The role of 4D particle therapy in daily patient care and research. Phys Imaging Radiat Oncol 2024; 29:100560. [PMID: 38434207 PMCID: PMC10906392 DOI: 10.1016/j.phro.2024.100560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024] Open
Affiliation(s)
- Barbara Knäusl
- Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria
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10
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Janson M, Glimelius L, Fredriksson A, Traneus E, Engwall E. Treatment planning of scanned proton beams in RayStation. Med Dosim 2023; 49:2-12. [PMID: 37996354 DOI: 10.1016/j.meddos.2023.10.009] [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: 09/07/2023] [Revised: 10/17/2023] [Accepted: 10/22/2023] [Indexed: 11/25/2023]
Abstract
The use of scanned proton beams in external beam radiation therapy has seen a rapid development over the past decade. This technique places new demands on treatment planning, as compared to conventional photon-based radiation therapy. In this article, several proton specific functions as implemented in the treatment planning system RayStation are presented. We will cover algorithms for energy layer and spot selection, basic optimization including the handling of spot weight limits, optimization of the linear energy transfer (LET) distribution, robust optimization including the special case of 4D optimization, proton arc planning, and automatic planning using deep learning. We will further present the Monte Carlo (MC) proton dose engine in RayStation to some detail, from the material interpretation of the CT data, through the beam model parameterization, to the actual MC transport mechanism. Useful tools for plan evaluation, including robustness evaluation, and the versatile scripting interface are also described. The overall aim of the paper is to give an overview of some of the key proton planning functions in RayStation, with example usages, and at the same time provide the details about the underlying algorithms that previously have not been fully publicly available.
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11
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Tominaga Y, Suga M, Takeda M, Yamamoto Y, Akagi T, Kato T, Tokumaru S, Yamamoto M, Oita M. Dose-volume comparisons of proton therapy for pencil beam scanning with and without multi-leaf collimator and passive scattering in patients with lung cancer. Med Dosim 2023; 49:13-18. [PMID: 37940436 DOI: 10.1016/j.meddos.2023.10.006] [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: 05/26/2023] [Revised: 10/05/2023] [Accepted: 10/06/2023] [Indexed: 11/10/2023]
Abstract
This study evaluated the dose distributions of proton pencil beam scanning (PBS) with/without a multileaf collimator (MLC) compared to passive scattering (PS) for stage I/II lung cancers. Collimated/uncollimated (PBS+/PBS-) and PS plans were created for 20 patients. Internal-clinical-target-volumes (ICTVs) and planning-target-volumes (PTVs) with a 5 mm margin were defined on the gated CTs. Organs-at-risk (OARs) are defined as the normal lungs, spinal cord, esophagus, and heart. The prescribed dose was 66 Gy relative-biological-effectiveness (RBE) in 10 fractions at the isocenter and 50% volume of the ICTVs for the PS and PBS, respectively. We compared the target and OAR dose statistics from the dose volume histograms. The PBS+ group had a significantly better mean PTV conformity index than the PBS- and PS groups. The mean dose sparing for PBS+ was better than those for PBS- and PS. Only the normal lung doses of PBS- were worse than those of PS. The overall performance of the OAR sparing was in the order of PBS+, PBS-, and PS. The PBS+ plan showed significantly better target homogeneity and OAR sparing than the PBS- and PS plans. PBS requires collimating systems to treat lung cancers with the most OAR sparing while maintaining the target coverage.
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Affiliation(s)
- Yuki Tominaga
- Medical Co. Hakuhokai, Osaka Proton Therapy Clinic, Konohana-ku, Osaka 554-0022, Japan.
| | - Masaki Suga
- Hyogo Ion Beam Medical Center, Tatsuno, Hyogo 679-5165, Japan
| | - Mikuni Takeda
- Hyogo Ion Beam Medical Center, Tatsuno, Hyogo 679-5165, Japan
| | - Yuki Yamamoto
- Hyogo Ion Beam Medical Center, Tatsuno, Hyogo 679-5165, Japan
| | - Takashi Akagi
- Hyogo Ion Beam Medical Center, Tatsuno, Hyogo 679-5165, Japan
| | - Takahiro Kato
- Depertment of Radiological Sciences, School of Health Sciences, Fukushima, Medical University, Fukushima 960-1295, Japan; Depertment of Radiation Physics and Technology, Southern Tohoku Proton Therapy Center, Koriyama, Fukushima 963-8052, Japan
| | - Sunao Tokumaru
- Hyogo Ion Beam Medical Center, Tatsuno, Hyogo 679-5165, Japan
| | - Michinori Yamamoto
- Medical Co. Hakuhokai, Osaka Proton Therapy Clinic, Konohana-ku, Osaka 554-0022, Japan
| | - Masataka Oita
- Faculty of Interdisciplinary Science and Engineering in Health Systems, Okayama University, Okayama 700-8558, Japan
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12
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Jeon C, Lee J, Shin J, Cheon W, Ahn S, Jo K, Han Y. Monte Carlo simulation-based patient-specific QA using machine log files for line-scanning proton radiation therapy. Med Phys 2023; 50:7139-7153. [PMID: 37756652 DOI: 10.1002/mp.16747] [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: 10/31/2022] [Revised: 09/05/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Quality assurance (QA) is a prerequisite for safe and accurate pencil-beam proton therapy. Conventional measurement-based patient-specific QA (pQA) can only verify limited aspects of patient treatment and is labor-intensive. Thus, a better method is needed to ensure the integrity of the treatment plan. PURPOSE Line scanning, which involves continuous and rapid delivery of pencil beams, is a state-of-the-art proton therapy technique. Machine performance in delivering scanning protons is dependent on the complexity of the beam modulations. Moreover, it contributes to patient treatment accuracy. A Monte Carlo (MC) simulation-based QA method that reflects the uncertainty related to the machine during scanning beam delivery was developed and verified for clinical applications to pQA. METHODS Herein, a tool for particle simulation (TOPAS) for nozzle modeling was used, and the code was commissioned against the measurements. To acquire the beam delivery uncertainty for each plan, patient plans were delivered. Furthermore, log files recorded every 60 μs by the monitors downstream of the nozzle were exported from the treatment control system. The spot positions and monitor unit (MU) counts in the log files were converted to dipole magnet strengths and number of particles, respectively, and entered into the TOPAS. For the 68 clinical cases, MC simulations were performed in a solid water phantom, and two-dimensional (2D) absolute dose distributions at 20-mm depth were measured using an ionization chamber array (Octavius 1500, PTW, Freiburg, Germany). Consequently, the MC-simulated 2D dose distributions were compared with the measured data, and the dose distributions in the pre-treatment QA plan created with RayStation (RaySearch Laboratories, Stockholm, Sweden). Absolute dose comparisons were made using gamma analysis with 3%/3 mm and 2%/2 mm criteria for 47 clinical cases without considering daily machine output variation in the MC simulation and 21 cases with daily output variation, respectively. All cases were analyzed with 90% or 95% of passing rate thresholds. RESULTS For 47 clinical cases not considering daily output variations, the absolute gamma passing rates compared with the pre-treatment QA plan were 99.71% and 96.97%, and the standard deviations (SD) were 0.70% and 3.78% with the 3%/3 mm or 2%/2 mm criteria, respectively. Compared with the measurements, the passing rate of 2%/2 mm gamma criterion was 96.76% with 3.99% of SD. For the 21 clinical cases compared with pre-treatment QA plan data and measurements considering daily output variations, the 2%/2 mm absolute gamma analysis result was 98.52% with 1.43% of SD and 97.67% with 2.72% of SD, respectively. With a 95% passing rate threshold of 2%/2 mm criterion, the false-positive and false-negative were 21.8% and 8.3% for without and with considering output variation, respectively. With a 90% threshold, the false-positive and false-negative reduced to 11.4% and 0% for without and with considering output variation, respectively. CONCLUSIONS A log-file-based MC simulation method for patient QA of line-scanning proton therapy was successfully developed. The proposed method exhibited clinically acceptable accuracy, thereby exhibiting a potential to replace the measurement-based dosimetry QA method with a 90% gamma passing rate threshold when applying the 2%/2 mm criterion.
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Affiliation(s)
- Chanil Jeon
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
| | - Jinhyeop Lee
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
| | - Jungwook Shin
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institute of Health, Rockville, Maryland, USA
| | - Wonjoong Cheon
- Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sunghwan Ahn
- Department of Radiation Oncology, Samsung Medical Center, Seoul, Republic of Korea
| | - Kwanghyun Jo
- Department of Radiation Oncology, Samsung Medical Center, Seoul, Republic of Korea
| | - Youngyih Han
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Republic of Korea
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13
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Shiha M, Cygler JE, MacRae R, Heath E. 4D Monte Carlo dose reconstructions using surface motion measurements. Phys Med 2023; 114:103135. [PMID: 37738806 DOI: 10.1016/j.ejmp.2023.103135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/01/2023] [Accepted: 09/13/2023] [Indexed: 09/24/2023] Open
Abstract
PURPOSE To investigate the feasibility of a 4D Monte Carlo based dose reconstruction method to study the dosimetric impact of respiratory motion using surface motion measurements for patients undergoing VMAT treatments for Non-Small Cell Lung Cancer. METHODS The 4Ddefdosxyznrc/EGSnrc algorithm was used to reconstruct VMAT doses delivered to the patients using machine log files and respiratory traces measured with the RADPOS 4D dosimetry system. The RADPOS sensor was adhered to the patient's abdomen prior to each treatment fraction and its position was used as a surrogate for tumour motion. Treatment log files were synchronized with the patient respiratory traces. Patient specific respiratory models were generated from deformable registration of the inhale and exhale 4DCT images and the respiratory traces. The reconstructed doses were compared to planned doses calculated with DOSXYZnrc/EGSnrc on the average-intensity and the exhale phase CT images. RESULTS Respiratory motion measurements and log files were acquired for 2 patients over 5 treatment fractions each. The motion was predominantly along the anterior/posterior direction (A/P). The average respiratory amplitudes were 8.7 ± 2.7 mm and 10.0 ± 1.2 mm for Patient 1 and 2, respectively. Both patients displayed inter- and intra-fractional variations in the baseline position. Small inter-fractional differences were observed in the reconstructed doses for each patient. Differences between the reconstructed and planned doses were attributed to differences in organ volumes. CONCLUSION The 4D reconstruction method was successfully implemented for the two patients studied. Small differences between the planned and reconstructed doses were observed due to the small tumour motion of these patients.
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Affiliation(s)
- Meaghen Shiha
- Department of Physics, Carleton University, Ottawa, ON K1S 5B6, Canada.
| | - Joanna E Cygler
- Department of Physics, Carleton University, Ottawa, ON K1S 5B6, Canada; Department of Medical Physics, The Ottawa Hospital Cancer Centre, Ottawa, ON K1H 8L6, Canada; Department of Radiology, University of Ottawa, Ottawa, ON K1H 8L6, Canada
| | - Robert MacRae
- Department of Radiology, Division of Radiation Oncology, University of Ottawa, 501 Smyth Road, Ottawa, ON K1H8L6, Canada
| | - Emily Heath
- Department of Physics, Carleton University, Ottawa, ON K1S 5B6, Canada
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14
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Spautz S, Haase L, Tschiche M, Makocki S, Richter C, Troost EG, Stützer K. Comparison of 3D and 4D robustly optimized proton treatment plans for non-small cell lung cancer patients with tumour motion amplitudes larger than 5 mm. Phys Imaging Radiat Oncol 2023; 27:100465. [PMID: 37449022 PMCID: PMC10338142 DOI: 10.1016/j.phro.2023.100465] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/22/2023] [Accepted: 06/23/2023] [Indexed: 07/18/2023] Open
Abstract
Background and purpose There is no consensus about an ideal robust optimization (RO) strategy for proton therapy of targets with large intrafractional motion. We investigated the plan robustness of 3D and different 4D RO strategies. Materials and methods For eight non-small cell lung cancer patients with clinical target volume (CTV) motion >5 mm, different RO approaches were investigated: 3DRO considering the average CT (AvgCT) with a target density override, 4DRO considering three/all 4DCT phases, and 4DRO considering the AvgCT and three/all 4DCT phases. Robustness against setup/range errors, interplay effects based on breathing and machine log file data for deliveries with/without rescanning, and interfractional anatomical changes were analyzed for target coverage and OAR sparing. Results All nominal plans fulfilled the clinical requirements with individual CTV coverage differences <2pp; 4DRO without AvgCT generated the most conformal dose distributions. Robustness against setup/range errors was best for 4DRO with AvgCT (18% more passed error scenarios than 3DRO). Interplay effects caused fraction-wise median CTV coverage loss of 3pp and missed maximum dose constraints for heart and esophagus in 18% of scenarios. CTV coverage and OAR sparing fulfilled requirements in all cases when accumulating four interplay scenarios. Interfractional changes caused less target misses for RO with AvgCT compared to 4DRO without AvgCT (≤42%/33% vs. ≥56%/44% failed single/accumulated scenarios). Conclusions All RO strategies provided acceptable plans with equally low robustness against interplay effects demanding other mitigation than rescanning to ensure fraction-wise target coverage. 4DRO considering three phases and the AvgCT provided best compromise on planning effort and robustness.
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Affiliation(s)
- Saskia Spautz
- OncoRay – National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden, Rossendorf, Fetscherstraße 74, PF 41, 01307 Dresden, Germany
| | - Leon Haase
- OncoRay – National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden, Rossendorf, Fetscherstraße 74, PF 41, 01307 Dresden, Germany
| | - Maria Tschiche
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, PF 50, 01307 Dresden, Germany
| | - Sebastian Makocki
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, PF 50, 01307 Dresden, Germany
| | - Christian Richter
- OncoRay – National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden, Rossendorf, Fetscherstraße 74, PF 41, 01307 Dresden, Germany
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, PF 50, 01307 Dresden, Germany
- Helmholtz-Zentrum Dresden – Rossendorf, Institute of Radiooncology – OncoRay, Bautzner Landstraße 400, 01328 Dresden, Germany
- German Cancer Consortium (DKTK), Partner Site Dresden, and German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69192 Heidelberg, Germany
| | - Esther G.C. Troost
- OncoRay – National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden, Rossendorf, Fetscherstraße 74, PF 41, 01307 Dresden, Germany
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, PF 50, 01307 Dresden, Germany
- Helmholtz-Zentrum Dresden – Rossendorf, Institute of Radiooncology – OncoRay, Bautzner Landstraße 400, 01328 Dresden, Germany
- German Cancer Consortium (DKTK), Partner Site Dresden, and German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69192 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Partner Site Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany, and; Helmholtz Association / Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany; Im Neuenheimer Feld 280, 69192 Heidelberg, Germany
| | - Kristin Stützer
- OncoRay – National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden, Rossendorf, Fetscherstraße 74, PF 41, 01307 Dresden, Germany
- Helmholtz-Zentrum Dresden – Rossendorf, Institute of Radiooncology – OncoRay, Bautzner Landstraße 400, 01328 Dresden, Germany
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15
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Knäusl B, Taasti VT, Poulsen P, Muren LP. Surveying the clinical practice of treatment adaptation and motion management in particle therapy. Phys Imaging Radiat Oncol 2023; 27:100457. [PMID: 37361612 PMCID: PMC10285555 DOI: 10.1016/j.phro.2023.100457] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023] Open
Affiliation(s)
- Barbara Knäusl
- Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | - Vicki T Taasti
- Department of Radiation Oncology (Maastro), GROW - School for Oncology and Reproduction, Maastricht, University Medical Centre+, Maastricht, The Netherlands
| | - Per Poulsen
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
- Department of Oncology, Aarhus University, Aarhus, Denmark
| | - Ludvig P Muren
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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16
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Lebbink F, Stocchiero S, Fossati P, Engwall E, Georg D, Stock M, Knäusl B. Parameter based 4D dose calculations for proton therapy. Phys Imaging Radiat Oncol 2023; 27:100473. [PMID: 37520640 PMCID: PMC10374597 DOI: 10.1016/j.phro.2023.100473] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 07/06/2023] [Accepted: 07/10/2023] [Indexed: 08/01/2023] Open
Abstract
Background and purpose Retrospective log file-based analysis provides the actual dose delivered based on the patient's breathing and the daily beam-delivery dynamics. To predict the motion sensitivity of the treatment plan on a patient-specific basis before treatment start a prospective tool is required. Such a parameter-based tool has been investigated with the aim to be used in clinical routine. Materials and Methods 4D dose calculations (4DDC) were performed for seven cancer patients with small breathing motion treated with scanned pulsed proton beams. Validation of the parameter-based 4DDC (p-4DDC) method was performed with an anthropomorphic phantom and patient data employing measurements and a log file-based 4DDC tool. The dose volume histogram parameters (Dx%) were investigated for the target and the organs at risk, compared to static and the file-based approach. Results The difference between the measured and the p-4DDC dose was within the deviation of the measurements. The maximum deviation was 0.4Gy. For the planning target volume D98% varied up to 15% compared to the static scenario, while the results from the log file and p-4DDC agreed within 2%. For the liver patients, D33%liver deviated up to 35% compared to static and 10% comparing the two 4DDC tools, while for the pancreas patients the D1%stomach varied up to 45% and 11%, respectively. Conclusion The results showed that p-4DDC could be used prospectively. The next step will be the clinical implementation of the p-4DDC tool, which can support a decision to either adapt the treatment plan or apply motion mitigation strategies.
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Affiliation(s)
- Franciska Lebbink
- Medical University of Vienna, Department of Radiation Oncology, Vienna, Austria
- MedAustron Ion Therapy Centre, Wiener Neustadt, Austria
| | - Silvia Stocchiero
- Medical University of Vienna, Department of Radiation Oncology, Vienna, Austria
- MedAustron Ion Therapy Centre, Wiener Neustadt, Austria
| | - Piero Fossati
- MedAustron Ion Therapy Centre, Wiener Neustadt, Austria
- Karl Landsteiner University of Health Sciences, Wiener Neustadt, Austria
| | | | - Dietmar Georg
- Medical University of Vienna, Department of Radiation Oncology, Vienna, Austria
- MedAustron Ion Therapy Centre, Wiener Neustadt, Austria
| | - Markus Stock
- MedAustron Ion Therapy Centre, Wiener Neustadt, Austria
- Karl Landsteiner University of Health Sciences, Wiener Neustadt, Austria
| | - Barbara Knäusl
- Medical University of Vienna, Department of Radiation Oncology, Vienna, Austria
- MedAustron Ion Therapy Centre, Wiener Neustadt, Austria
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de Jong BA, Battinelli C, Free J, Wagenaar D, Engwall E, Janssens G, Langendijk JA, Korevaar EW, Both S. Spot scanning proton arc therapy reduces toxicity in oropharyngeal cancer patients. Med Phys 2023; 50:1305-1317. [PMID: 36373893 DOI: 10.1002/mp.16098] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 07/28/2022] [Accepted: 10/24/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Proton arc technology has recently shown dosimetric gains for various treatment indications. The increased number of beams and energy layers (ELs) in proton arc plans, increases the degrees of freedom in plan optimization and thereby flexibility to spare dose in organs at risk (OARs). A relationship exists between dosimetric plan quality, delivery efficiency, the number of ELs -and beams in a proton arc plan. PURPOSE This work aims to investigate the effect of the number of beams and ELs in a proton arc plan, on toxicity and delivery time for oropharyngeal cancer patients (OPC) selected for intensity modulated proton therapy (IMPT) based on the Dutch model-based approach. METHODS The EL reduction algorithm iteratively selects ELs from beams equidistantly spaced over a 360° arc. The beams in the final plan may contain multiple ELs, making them suited for static delivery on the studied treatment machine. The produced plans can therefore be called "step and shoot" proton arc plans. The number of beams and ELs were varied to determine the relationship with the planning cost function value, normal tissue complication probability (NTCP) and delivery time. Proton arc plans with robust target coverage and optimal energy layer reduction (ELR) settings to reduce NTCP, were generated for 10 OPC patients. Proton arc plans were compared to clinical volumetric modulated arc therapy (VMAT) and IMPT plans in terms of integral dose, OAR dose, NTCP for xerostomia and dysphagia and delivery time. Furthermore, dose-weighted average linear energy transfer (LETd ) distributions were compared between the IMPT and proton arc plans. A dry run delivery of a plan containing 20 beams and 360 ELs was performed to evaluate delivery time and accuracy. RESULTS We found 360 ELs distributed over 30 beams generated proton arc plans with near minimal expected plan toxicity. Relative to corresponding IMPT and VMAT plans, an average reduction of 21 ± 3% and 58 ± 10% in integral dose was observed. D m e a n $_{mean}$ was reduced most in the pharyngeal constrictor muscle (PCM) medius structure, with on average 9.0 ± 4.2 Gy(RBE) (p = 0.0002) compared to the clinical IMPT plans. The average NTCP for grade≥2 and grade≥3 xerostomia at 6 months after treatment significantly decreased with 4.7 ± 1.8% (p = 0.002) and 1.7 ± 0.8% (p = 0.002), respectively, while the average NTCP for grade≥2 and grade≥3 dysphagia decreased with 4.4 ± 2.9% (p = 0.002) and 0.9 ± 0.4% (p = 0.002), respectively, increasing the benefit of protons relative to VMAT. For a "step and shoot" proton arc delivery with auto beam sequencing the estimated delivery time is 11 min, similar to the delivery time of a 6-field IMPT treatment. Gamma analysis between the planned and delivered dose distribution resulted in a 99.99% pass rate using 1mm/1% dose difference/distance to agreement criteria. CONCLUSIONS "Step and shoot" proton arc demonstrates potential to further reduce toxicity compared to IMPT and VMAT in OPC treatment. By employing 360 ELs and 30 beams in the proposed ELR method, delivery time can reach clinically acceptable levels without compromising plan toxicity when automatic beam sequencing is available.
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Affiliation(s)
- Bas A de Jong
- Department of Radiation Oncology, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Jeffrey Free
- Department of Radiation Oncology, University Medical Center Groningen, Groningen, The Netherlands
| | - Dirk Wagenaar
- Department of Radiation Oncology, University Medical Center Groningen, Groningen, The Netherlands
| | - Erik Engwall
- Research and Development, RaySearch Laboratories AB, Stockholm, Sweden
| | - Guillaume Janssens
- Research and Development, Ion Beam Applications SA, Louvain-la-Neuve, Belgium
| | - Johannes A Langendijk
- Department of Radiation Oncology, University Medical Center Groningen, Groningen, The Netherlands
| | - Erik W Korevaar
- Department of Radiation Oncology, University Medical Center Groningen, Groningen, The Netherlands
| | - Stefan Both
- Department of Radiation Oncology, University Medical Center Groningen, Groningen, The Netherlands
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18
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Clinical 3D/4D cumulative proton dose assessment methods for thoracic tumours with large motion. Radiother Oncol 2023; 182:109575. [PMID: 36822356 DOI: 10.1016/j.radonc.2023.109575] [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: 11/30/2022] [Revised: 01/31/2023] [Accepted: 02/12/2023] [Indexed: 02/25/2023]
Abstract
PURPOSE Despite the anticipated clinical benefits of intensity-modulated proton therapy (IMPT), plan robustness may be compromised due to its sensitivity to patient treatment uncertainties, especially for tumours with large motion. In this study, we investigated treatment course-wise plan robustness for intra-thoracic tumours with large motion comparing a 4D pre-clinical evaluation method (4DREM) to our clinical 3D/4D dose reconstruction and accumulation methods. MATERIALS AND METHODS Twenty patients with large target motion (>10 mm) were treated with five times layered rescanned IMPT. The 3D-robust optimised plans were generated on the averaged planning 4DCT. Using multiple 4DCTs, treatment plan robustness was assessed on a weekly and treatment course-wise basis through the 3D robustness evaluation method (3DREM, based on averaged 4DCTs), the 4D robustness evaluation method (4DREM, including the time structure of treatment delivery and 4DCT phases) and 4D dose reconstruction and accumulation (4DREAL, based on fraction-wise information). RESULTS Baseline target motion for all patients ranged from 11-17 mm. For the offline adapted course-wise dose assessment, adequate target dose coverage was found for all patients. The target volume receiving 95% of the prescription dose was consistent between methods with 16/20 patients showing differences < 1%. 4DREAL showed the highest target coverage (99.8 ± 0.6%, p < 0.001), while no differences were observed between 3DREM and 4DREM (99.3 ± 1.3% and 99.4 ± 1.1%, respectively). CONCLUSION Our results show that intra-thoracic tumours can be adequately treated with IMPT in free breathing for target motion amplitudes up to 17 mm employing any of the accumulation methods. Anatomical changes, setup and range errors demonstrated a more severe impact on target coverage than motion in these patients treated with fractionated proton radiotherapy.
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Inter- and intrafractional 4D dose accumulation for evaluating ΔNTCP robustness in lung cancer. Radiother Oncol 2023; 182:109488. [PMID: 36706960 DOI: 10.1016/j.radonc.2023.109488] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/12/2023] [Accepted: 01/18/2023] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND PURPOSE Model-based selection of proton therapy patients relies on a predefined reduction in normal tissue complication probability (NTCP) with respect to photon therapy. The decision is necessarily made based on the treatment plan, but NTCP can be affected when the delivered treatment deviates from the plan due to delivery inaccuracies. Especially for proton therapy of lung cancer, this can be important because of tissue density changes and, with pencil beam scanning, the interplay effect between the proton beam and breathing motion. MATERIALS AND METHODS In this work, we verified whether the expected benefit of proton therapy is retained despite delivery inaccuracies by reconstructing the delivered treatment using log-file based dose reconstruction and inter- and intrafractional accumulation. Additionally, the importance of two uncertain parameters for treatment reconstruction, namely deformable image registration (DIR) algorithm and α/β ratio, was assessed. RESULTS The expected benefit or proton therapy was confirmed in 97% of all studied cases, despite regular differences up to 2 percent point (p.p.) NTCP between the delivered and planned treatments. The choice of DIR algorithm affected NTCP up to 1.6 p.p., an order of magnitude higher than the effect of α/β ratio. CONCLUSION For the patient population and treatment technique employed, the predicted clinical benefit for patients selected for proton therapy was confirmed for 97.0% percent of all cases, although the NTCP based proton selection was subject to 2 p.p. variations due to delivery inaccuracies.
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20
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Nankali S, Worm ES, Thomsen JB, Stick LB, Bertholet J, Høyer M, Weber B, Mortensen HR, Poulsen PR. Intrafraction tumor motion monitoring and dose reconstruction for liver pencil beam scanning proton therapy. Front Oncol 2023; 13:1112481. [PMID: 36937392 PMCID: PMC10019817 DOI: 10.3389/fonc.2023.1112481] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 02/13/2023] [Indexed: 03/06/2023] Open
Abstract
Background Pencil beam scanning (PBS) proton therapy can provide highly conformal target dose distributions and healthy tissue sparing. However, proton therapy of hepatocellular carcinoma (HCC) is prone to dosimetrical uncertainties induced by respiratory motion. This study aims to develop intra-treatment tumor motion monitoring during respiratory gated proton therapy and combine it with motion-including dose reconstruction to estimate the delivered tumor doses for individual HCC treatment fractions. Methods Three HCC-patients were planned to receive 58 GyRBE (n=2) or 67.5 GyRBE (n=1) of exhale respiratory gated PBS proton therapy in 15 fractions. The treatment planning was based on the exhale phase of a 4-dimensional CT scan. Daily setup was based on cone-beam CT (CBCT) imaging of three implanted fiducial markers. An external marker block (RPM) on the patient's abdomen was used for exhale gating in free breathing. This study was based on 5 fractions (patient 1), 1 fraction (patient 2) and 6 fractions (patient 3) where a post-treatment control CBCT was available. After treatment, segmented 2D marker positions in the post-treatment CBCT projections provided the estimated 3D motion trajectory during the CBCT by a probability-based method. An external-internal correlation model (ECM) that estimated the tumor motion from the RPM motion was built from the synchronized RPM signal and marker motion in the CBCT. The ECM was then used to estimate intra-treatment tumor motion. Finally, the motion-including CTV dose was estimated using a dose reconstruction method that emulates tumor motion in beam's eye view as lateral spot shifts and in-depth motion as changes in the proton beam energy. The CTV homogeneity index (HI) The CTV homogeneity index (HI) was calculated as D 2 % - D 98 % D 50 % × 100 % . Results The tumor position during spot delivery had a root-mean-square error of 1.3 mm in left-right, 2.8 mm in cranio-caudal and 1.7 mm in anterior-posterior directions compared to the planned position. On average, the CTV HI was larger than planned by 3.7%-points (range: 1.0-6.6%-points) for individual fractions and by 0.7%-points (range: 0.3-1.1%-points) for the average dose of 5 or 6 fractions. Conclusions A method to estimate internal tumor motion and reconstruct the motion-including fraction dose for PBS proton therapy of HCC was developed and demonstrated successfully clinically.
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Affiliation(s)
- Saber Nankali
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- *Correspondence: Saber Nankali,
| | | | - Jakob Borup Thomsen
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | | | - Jenny Bertholet
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Morten Høyer
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Britta Weber
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Per Rugaard Poulsen
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
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21
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Duetschler A, Prendi J, Safai S, Weber DC, Lomax AJ, Zhang Y. Limitations of phase-sorting based pencil beam scanned 4D proton dose calculations under irregular motion. Phys Med Biol 2022; 68. [PMID: 36571234 DOI: 10.1088/1361-6560/aca9b6] [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: 09/12/2022] [Accepted: 12/07/2022] [Indexed: 12/12/2022]
Abstract
Objective.4D dose calculation (4DDC) for pencil beam scanned (PBS) proton therapy is typically based on phase-sorting of individual pencil beams onto phases of a single breathing cycle 4DCT. Understanding the dosimetric limitations and uncertainties of this approach is essential, especially for the realistic treatment scenario with irregular free breathing motion.Approach.For three liver and three lung cancer patient CTs, the deformable multi-cycle motion from 4DMRIs was used to generate six synthetic 4DCT(MRI)s, providing irregular motion (11/15 cycles for liver/lung; tumor amplitudes ∼4-18 mm). 4DDCs for two-field plans were performed, with the temporal resolution of the pencil beam delivery (4-200 ms) or with 8 phases per breathing cycle (500-1000 ms). For the phase-sorting approach, the tumor center motion was used to determine the phase assignment of each spot. The dose was calculated either using the full free breathing motion or individually repeating each single cycle. Additionally, the use of an irregular surrogate signal prior to 4DDC on a repeated cycle was simulated. The CTV volume with absolute dose differences >5% (Vdosediff>5%) and differences in CTVV95%andD5%-D95%compared to the free breathing scenario were evaluated.Main results.Compared to 4DDC considering the full free breathing motion with finer spot-wise temporal resolution, 4DDC based on a repeated single 4DCT resulted inVdosediff>5%of on average 34%, which resulted in an overestimation ofV95%up to 24%. However, surrogate based phase-sorting prior to 4DDC on a single cycle 4DCT, reduced the averageVdosediff>5%to 16% (overestimationV95%up to 19%). The 4DDC results were greatly influenced by the choice of reference cycle (Vdosediff>5%up to 55%) and differences due to temporal resolution were much smaller (Vdosediff>5%up to 10%).Significance.It is important to properly consider motion irregularity in 4D dosimetric evaluations of PBS proton treatments, as 4DDC based on a single 4DCT can lead to an underestimation of motion effects.
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Affiliation(s)
- A Duetschler
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen PSI, CH, Switzerland.,Department of Physics, ETH Zürich, 8092 Zürich, CH, Switzerland
| | - J Prendi
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen PSI, CH, Switzerland.,Department of Physics, University of Basel, 4056 Basel, CH, Switzerland
| | - S Safai
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen PSI, CH, Switzerland
| | - D C Weber
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen PSI, CH, Switzerland.,Department of Radiation Oncology, University Hospital of Zürich, 8091 Zürich, CH, Switzerland.,Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, CH, Switzerland
| | - A J Lomax
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen PSI, CH, Switzerland.,Department of Physics, ETH Zürich, 8092 Zürich, CH, Switzerland
| | - Ye Zhang
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen PSI, CH, Switzerland
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22
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Thummerer A, Seller Oria C, Zaffino P, Visser S, Meijers A, Guterres Marmitt G, Wijsman R, Seco J, Langendijk JA, Knopf AC, Spadea MF, Both S. Deep learning-based 4D-synthetic CTs from sparse-view CBCTs for dose calculations in adaptive proton therapy. Med Phys 2022; 49:6824-6839. [PMID: 35982630 PMCID: PMC10087352 DOI: 10.1002/mp.15930] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/20/2022] [Accepted: 08/08/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Time-resolved 4D cone beam-computed tomography (4D-CBCT) allows a daily assessment of patient anatomy and respiratory motion. However, 4D-CBCTs suffer from imaging artifacts that affect the CT number accuracy and prevent accurate proton dose calculations. Deep learning can be used to correct CT numbers and generate synthetic CTs (sCTs) that can enable CBCT-based proton dose calculations. PURPOSE In this work, sparse view 4D-CBCTs were converted into 4D-sCT utilizing a deep convolutional neural network (DCNN). 4D-sCTs were evaluated in terms of image quality and dosimetric accuracy to determine if accurate proton dose calculations for adaptive proton therapy workflows of lung cancer patients are feasible. METHODS A dataset of 45 thoracic cancer patients was utilized to train and evaluate a DCNN to generate 4D-sCTs, based on sparse view 4D-CBCTs reconstructed from projections acquired with a 3D acquisition protocol. Mean absolute error (MAE) and mean error were used as metrics to evaluate the image quality of single phases and average 4D-sCTs against 4D-CTs acquired on the same day. The dosimetric accuracy was checked globally (gamma analysis) and locally for target volumes and organs-at-risk (OARs) (lung, heart, and esophagus). Furthermore, 4D-sCTs were also compared to 3D-sCTs. To evaluate CT number accuracy, proton radiography simulations in 4D-sCT and 4D-CTs were compared in terms of range errors. The clinical suitability of 4D-sCTs was demonstrated by performing a 4D dose reconstruction using patient specific treatment delivery log files and breathing signals. RESULTS 4D-sCTs resulted in average MAEs of 48.1 ± 6.5 HU (single phase) and 37.7 ± 6.2 HU (average). The global dosimetric evaluation showed gamma pass ratios of 92.3% ± 3.2% (single phase) and 94.4% ± 2.1% (average). The clinical target volume showed high agreement in D98 between 4D-CT and 4D-sCT, with differences below 2.4% for all patients. Larger dose differences were observed in mean doses of OARs (up to 8.4%). The comparison with 3D-sCTs showed no substantial image quality and dosimetric differences for the 4D-sCT average. Individual 4D-sCT phases showed slightly lower dosimetric accuracy. The range error evaluation revealed that lung tissues cause range errors about three times higher than the other tissues. CONCLUSION In this study, we have investigated the accuracy of deep learning-based 4D-sCTs for daily dose calculations in adaptive proton therapy. Despite image quality differences between 4D-sCTs and 3D-sCTs, comparable dosimetric accuracy was observed globally and locally. Further improvement of 3D and 4D lung sCTs could be achieved by increasing CT number accuracy in lung tissues.
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Affiliation(s)
- Adrian Thummerer
- Department, of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Carmen Seller Oria
- Department, of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Paolo Zaffino
- Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy
| | - Sabine Visser
- Department, of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Arturs Meijers
- Department, of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
| | - Gabriel Guterres Marmitt
- Department, of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Robin Wijsman
- Department, of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Joao Seco
- Department of Biomedical Physics in Radiation Oncology, Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Germany.,Department of Physics and Astronomy, Heidelberg University, Heidelberg, Germany
| | - Johannes Albertus Langendijk
- Department, of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Antje Christin Knopf
- Department, of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department I of Internal Medicine, Center for Integrated Oncology Cologne, University Hospital of Cologne, Cologne, Germany
| | - Maria Francesca Spadea
- Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy
| | - Stefan Both
- Department, of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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23
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Hoffmann L, Mortensen H, Shamshad M, Berbee M, Bizzocchi N, Bütof R, Canters R, Defraene G, Lykkegaard Ehmsen M, Fiorini F, Haustermans K, Hulley R, Korevaar EW, Clarke M, Makocki S, Muijs CT, Murray L, Nicholas O, Nordsmark M, Radhakrishna G, Thomas M, Troost EGC, Vilches-Freixas G, Visser S, Weber DC, Sloth Møller D. Treatment planning comparison in the PROTECT-trial randomising proton versus photon beam therapy in oesophageal cancer: results from eight european centres. Radiother Oncol 2022; 172:32-41. [PMID: 35513132 DOI: 10.1016/j.radonc.2022.04.029] [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: 01/09/2022] [Revised: 04/06/2022] [Accepted: 04/28/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To compare dose distributions and robustness in treatment plans from eight European centres in preparation for the European randomized phase-III PROTECT-trial investigating the effect of proton therapy (PT) versus photon therapy (XT) for oesophageal cancer. MATERIALS AND METHODS All centres optimized one PT and one XT nominal plan using delineated 4DCT scans for four patients receiving 50.4Gy(RBE) in 28 fractions. Target volume receiving 95% of prescribed dose (V95%iCTVtotal) should be >99%. Robustness towards setup, range, and respiration was evaluated. The plans were recalculated on a surveillance 4DCT (sCT) acquired at fraction ten and robustness evaluation was performed to evaluate the effect of respiration and inter-fractional anatomical changes. RESULTS All PT and XT plans complied with V95%iCTVtotal>99% for the nominal plan and V95%iCTVtotal>97% for all respiratory and robustness scenarios. Lung and heart dose varied considerably between centres for both modalities. The difference in mean lung dose and mean heart dose between each pair of XT and PT plans was in median [range] 4.8Gy [1.1;7.6] and 8.4Gy [1.9;24.5], respectively. Patients B and C showed large inter-fractional anatomical changes on sCT. For patient B, the minimum V95%iCTVtotal in the worst-case robustness scenario was 45% and 94% for XT and PT, respectively. For patient C, the minimum V95%iCTVtotal was 57% and 72% for XT and PT, respectively. Patient A and D showed minor inter-fractional changes and the minimum V95%iCTVtotal was >85%. CONCLUSION Large variability in dose to the lungs and heart was observed for both modalities. Inter-fractional anatomical changes led to larger target dose deterioration for XT than PT plans.
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Affiliation(s)
- Lone Hoffmann
- Department of Medical Physics, Aarhus University Hospital, Denmark; Dept. of Clinical Medicine, Faculty of Health Sciences, Aarhus University, Aarhus, Denmark.
| | - Hanna Mortensen
- Danish Center for Particle Therapy, Aarhus University Hospital, Denmark
| | - Muhammad Shamshad
- Department of Medical Physics, Aarhus University Hospital, Denmark; Dept. of Clinical Medicine, Faculty of Health Sciences, Aarhus University, Aarhus, Denmark; Danish Center for Particle Therapy, Aarhus University Hospital, Denmark
| | - Maaike Berbee
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, The Netherlands
| | - Nicola Bizzocchi
- Center for Proton Therapy, Paul Scherrer Institut, Villigen, Switzerland
| | - Rebecca Bütof
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany
| | - Richard Canters
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, The Netherlands
| | - Gilles Defraene
- KU Leuven - University of Leuven - Department of Oncology - Laboratory of Experimental Radiotherapy, Leuven, Belgium
| | | | | | - Karin Haustermans
- KU Leuven - University of Leuven - Department of Oncology - Laboratory of Experimental Radiotherapy, Leuven, Belgium; University Hospitals Leuven, Department of Radiation Oncology, Leuven, Belgium
| | - Ryan Hulley
- South West Wales Cancer Centre, Swansea University Board, UL AND Swansea University Medical School, United Kingdom
| | - Erik W Korevaar
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Matthew Clarke
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Sebastian Makocki
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany
| | - Christina T Muijs
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Luke Murray
- Rutherford Cancer Centre, Shinfield, Reading, United Kingdom
| | - Owen Nicholas
- South West Wales Cancer Centre, Swansea University Board, UL AND Swansea University Medical School, United Kingdom
| | | | | | - Melissa Thomas
- KU Leuven - University of Leuven - Department of Oncology - Laboratory of Experimental Radiotherapy, Leuven, Belgium; University Hospitals Leuven, Department of Radiation Oncology, Leuven, Belgium
| | - Esther G C Troost
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany; Institute of Radiooncology - OncoRay, Helmholtz-Zentrum Dresden-Rossendorf, Rossendorf, Germany; German Cancer Consortium (DKTK), Partner Site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany; National Center for Tumor Diseases (NCT), Partner Site Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Helmholtz Association / Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany
| | - Gloria Vilches-Freixas
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, The Netherlands
| | - Sabine Visser
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Damien C Weber
- Center for Proton Therapy, Paul Scherrer Institut, Villigen, Switzerland; Radiation Oncology Department, University Hospital Zurich, Zurich, Switzerland
| | - Ditte Sloth Møller
- Department of Medical Physics, Aarhus University Hospital, Denmark; Dept. of Clinical Medicine, Faculty of Health Sciences, Aarhus University, Aarhus, Denmark
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24
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Meschini G, Vai A, Barcellini A, Fontana G, Molinelli S, Mastella E, Pella A, Vitolo V, Imparato S, Orlandi E, Ciocca M, Baroni G, Paganelli C. Time-resolved MRI for off-line treatment robustness evaluation in carbon-ion radiotherapy of pancreatic cancer. Med Phys 2022; 49:2386-2395. [PMID: 35124811 PMCID: PMC9306947 DOI: 10.1002/mp.15510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 09/28/2021] [Accepted: 01/20/2022] [Indexed: 11/25/2022] Open
Abstract
PURPOSE In this study, we investigate the use of magnetic resonance imaging (MRI) for the clinical evaluation of gating treatment robustness in carbon-ion radiotherapy (CIRT) of pancreatic cancer. Indeed, MRI allows radiation-free repeated scans and fast dynamic sequences for time-resolved (TR) imaging (cine-MRI), providing information on inter- and intra-fraction cycle-to-cycle variations of respiratory motion. MRI can therefore support treatment planning and verification, overcoming the limitations of the current clinical standard, that is, four-dimensional computed tomography (4DCT), which describes an "average" breathing cycle neglecting breathing motion variability. METHODS We integrated a technique to generate a virtual CT (vCT) from 3D MRI with a method for 3D reconstruction from 2D cine-MRI, to produce TR vCTs for dose recalculations. For eight patients, the method allowed evaluating inter-fraction variations at end-exhale and intra-fraction cycle-to-cycle variability within the gating window in terms of tumor displacement and dose to the target and organs at risk. RESULTS The median inter-fraction tumor motion was in the range 3.33-12.16 mm, but the target coverage was robust (-0.4% median D95% variation). Concerning cycle-to-cycle variations, the gating technique was effective in limiting tumor displacement (1.35 mm median gating motion) and corresponding dose variations (-3.9% median D95% variation). The larger exposure of organs at risk (duodenum and stomach) was caused by inter-fraction motion, whereas intra-fraction cycle-to-cycle dose variations were limited. CONCLUSIONS This study proposed a method for the generation of TR vCTs from MRI, which enabled an off-line evaluation of gating treatment robustness and suggested its feasibility to support treatment planning of pancreatic tumors in CIRT.
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Affiliation(s)
- Giorgia Meschini
- Department of Electronics, Information and BioengineeringPolitecnico di MilanoMilanItaly
| | - Alessandro Vai
- Medical Physics UnitNational Center for Oncological Hadrontherapy (Fondazione CNAO)PaviaItaly
| | - Amelia Barcellini
- Clinical DepartmentNational Center for Oncological Hadrontherapy (Fondazione CNAO)PaviaItaly
| | - Giulia Fontana
- Clinical Bioengineering UnitNational Center for Oncological Hadrontherapy (Fondazione CNAO)PaviaItaly
| | - Silvia Molinelli
- Medical Physics UnitNational Center for Oncological Hadrontherapy (Fondazione CNAO)PaviaItaly
| | - Edoardo Mastella
- Medical Physics UnitNational Center for Oncological Hadrontherapy (Fondazione CNAO)PaviaItaly
| | - Andrea Pella
- Clinical Bioengineering UnitNational Center for Oncological Hadrontherapy (Fondazione CNAO)PaviaItaly
| | - Viviana Vitolo
- Clinical DepartmentNational Center for Oncological Hadrontherapy (Fondazione CNAO)PaviaItaly
| | - Sara Imparato
- Radiology UnitNational Center for Oncological Hadrontherapy (Fondazione CNAO)PaviaItaly
| | - Ester Orlandi
- Clinical DepartmentNational Center for Oncological Hadrontherapy (Fondazione CNAO)PaviaItaly
| | - Mario Ciocca
- Medical Physics UnitNational Center for Oncological Hadrontherapy (Fondazione CNAO)PaviaItaly
| | - Guido Baroni
- Department of Electronics, Information and BioengineeringPolitecnico di MilanoMilanItaly
- Clinical Bioengineering UnitNational Center for Oncological Hadrontherapy (Fondazione CNAO)PaviaItaly
| | - Chiara Paganelli
- Department of Electronics, Information and BioengineeringPolitecnico di MilanoMilanItaly
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25
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Spautz S, Jakobi A, Meijers A, Peters N, Löck S, Knopf AC, Troost EGC, Richter C, Stützer K. Experimental validation of 4D log file-based proton dose reconstruction for interplay assessment considering amplitude-sorted 4DCTs. Med Phys 2022; 49:3538-3549. [PMID: 35342943 DOI: 10.1002/mp.15625] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 02/01/2022] [Accepted: 03/13/2022] [Indexed: 11/06/2022] Open
Abstract
PURPOSE The unpredictable interplay between dynamic proton therapy delivery and target motion in the thorax can lead to severe dose distortions. A fraction-wise four-dimensional (4D) dose reconstruction workflow allows for the assessment of the applied dose after patient treatment while considering the actual beam delivery sequence extracted from machine log files, the recorded breathing pattern and the geometric information from a 4D computed tomography scan (4DCT). Such an algorithm capable of accounting for amplitude-sorted 4DCTs was implemented and its accuracy as well as its sensitivity to input parameter variations was experimentally evaluated. METHODS An anthropomorphic thorax phantom with a movable insert containing a target surrogate and a radiochromic film was irradiated with a monoenergetic field for various 1D target motion forms (sin, sin4) and peak-to-peak amplitudes (5/10/15/20/30 mm). The measured characteristic film dose distributions were compared to the respective sections in the 4D reconstructed doses using a 2D γ-analysis (3mm, 3%); γ-pass rates were derived for different dose grid resolutions (1mm/3mm) and deformable image registrations (DIR, automatic/manual) applied during the 4D dose reconstruction process. In an additional analysis, the sensitivity of reconstructed dose distributions against potential asynchronous timing of the motion and machine log files was investigated for both a monoenergetic field and more realistic 4D robustly optimized fields by artificially introduced offsets of ± 1/5/25/50/250 ms. The resulting dose distributions with asynchronized log files were compared to those with synchronized log files by means of a 3D γ-analysis (1mm, 1%) and the evaluation of absolute dose differences. RESULTS The induced characteristic interplay patterns on the films were well reproduced by the 4D dose reconstruction with 2D γ-pass rates ≥95% for almost all cases with motion magnitudes ≤15 mm. In general, the 2D γ-pass rates showed a significant decrease for larger motion amplitudes and increase when using a finer dose grid resolution but were not affected by the choice of motion form (sin, sin4). There was also a trend, though not statistically significant, towards the manually defined DIR for better quality of the reconstructed dose distributions in the area imaged by the film. The 4D dose reconstruction results for the monoenergetic as well as the 4D robustly optimized fields were robust against small asynchronies between motion and machine log files of up to 5 ms, which is in the order of potential network latencies. CONCLUSIONS We have implemented a 4D log file-based proton dose reconstruction that accounts for amplitude-sorted 4DCTs. Its accuracy was proven to be clinically acceptable for target motion magnitudes of up to 15 mm. Particular attention should be paid to the synchronization of the log file generating systems as the reconstructed dose distribution may vary with log file asynchronies larger than those caused by realistic network delays. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Saskia Spautz
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany
| | - Annika Jakobi
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany.,Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiooncology - OncoRay, Dresden, Germany.,Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Arturs Meijers
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Nils Peters
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany.,Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiooncology - OncoRay, Dresden, Germany
| | - Steffen Löck
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany.,Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,German Cancer Consortium (DKTK), Partner Site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Antje-Christin Knopf
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department 1 of Internal Medicine, Center for Integrated Oncology Cologne, University Hospital of Cologne, Cologne, Germany
| | - Esther G C Troost
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany.,Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiooncology - OncoRay, Dresden, Germany.,Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,German Cancer Consortium (DKTK), Partner Site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany.,National Center for Tumor Diseases (NCT), Partner Site Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany, and; Helmholtz Association / Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany
| | - Christian Richter
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany.,Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiooncology - OncoRay, Dresden, Germany.,Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,German Cancer Consortium (DKTK), Partner Site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Kristin Stützer
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany.,Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiooncology - OncoRay, Dresden, Germany
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Pakela JM, Knopf A, Dong L, Rucinski A, Zou W. Management of Motion and Anatomical Variations in Charged Particle Therapy: Past, Present, and Into the Future. Front Oncol 2022; 12:806153. [PMID: 35356213 PMCID: PMC8959592 DOI: 10.3389/fonc.2022.806153] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 02/04/2022] [Indexed: 12/14/2022] Open
Abstract
The major aim of radiation therapy is to provide curative or palliative treatment to cancerous malignancies while minimizing damage to healthy tissues. Charged particle radiotherapy utilizing carbon ions or protons is uniquely suited for this task due to its ability to achieve highly conformal dose distributions around the tumor volume. For these treatment modalities, uncertainties in the localization of patient anatomy due to inter- and intra-fractional motion present a heightened risk of undesired dose delivery. A diverse range of mitigation strategies have been developed and clinically implemented in various disease sites to monitor and correct for patient motion, but much work remains. This review provides an overview of current clinical practices for inter and intra-fractional motion management in charged particle therapy, including motion control, current imaging and motion tracking modalities, as well as treatment planning and delivery techniques. We also cover progress to date on emerging technologies including particle-based radiography imaging, novel treatment delivery methods such as tumor tracking and FLASH, and artificial intelligence and discuss their potential impact towards improving or increasing the challenge of motion mitigation in charged particle therapy.
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Affiliation(s)
- Julia M. Pakela
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, United States
| | - Antje Knopf
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Department I of Internal Medicine, Center for Integrated Oncology Cologne, University Hospital of Cologne, Cologne, Germany
| | - Lei Dong
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, United States
| | - Antoni Rucinski
- Institute of Nuclear Physics, Polish Academy of Sciences, Krakow, Poland
| | - Wei Zou
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, United States
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Troost EGC, Menkel S, Tschiche M, Thiele J, Jaster M, Haak D, Kunath D. Towards online adaptive proton therapy: first report of plan-library-based plan-of-the-day approach. Acta Oncol 2022; 61:231-234. [PMID: 34697985 DOI: 10.1080/0284186x.2021.1994154] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- E. G. C. Troost
- OncoRay – National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Institute of Radiooncology – OncoRay, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
- German Cancer Consortium (DKTK), Partner Site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Partner Site Dresden, Dresden, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; and Helmholtz Association/Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany
| | - S. Menkel
- OncoRay – National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - M. Tschiche
- OncoRay – National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - J. Thiele
- OncoRay – National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - M. Jaster
- OncoRay – National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - D. Haak
- OncoRay – National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - D. Kunath
- OncoRay – National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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Knopf AC, Czerska K, Fracchiolla F, Graeff C, Molinelli S, Rinaldi I, Rucincki A, Sterpin E, Stützer K, Trnkova P, Zhang Y, Chang JY, Giap H, Liu W, Schild SE, Simone CB, Lomax AJ, Meijers A. Clinical necessity of multi-image based (4DMIB) optimization for targets affected by respiratory motion and treated with scanned particle therapy – a comprehensive review. Radiother Oncol 2022; 169:77-85. [DOI: 10.1016/j.radonc.2022.02.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 01/31/2022] [Accepted: 02/14/2022] [Indexed: 12/28/2022]
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Paganetti H, Botas P, Sharp GC, Winey B. Adaptive proton therapy. Phys Med Biol 2021; 66:10.1088/1361-6560/ac344f. [PMID: 34710858 PMCID: PMC8628198 DOI: 10.1088/1361-6560/ac344f] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 10/28/2021] [Indexed: 12/25/2022]
Abstract
Radiation therapy treatments are typically planned based on a single image set, assuming that the patient's anatomy and its position relative to the delivery system remains constant during the course of treatment. Similarly, the prescription dose assumes constant biological dose-response over the treatment course. However, variations can and do occur on multiple time scales. For treatment sites with significant intra-fractional motion, geometric changes happen over seconds or minutes, while biological considerations change over days or weeks. At an intermediate timescale, geometric changes occur between daily treatment fractions. Adaptive radiation therapy is applied to consider changes in patient anatomy during the course of fractionated treatment delivery. While traditionally adaptation has been done off-line with replanning based on new CT images, online treatment adaptation based on on-board imaging has gained momentum in recent years due to advanced imaging techniques combined with treatment delivery systems. Adaptation is particularly important in proton therapy where small changes in patient anatomy can lead to significant dose perturbations due to the dose conformality and finite range of proton beams. This review summarizes the current state-of-the-art of on-line adaptive proton therapy and identifies areas requiring further research.
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Affiliation(s)
- Harald Paganetti
- Department of Radiation Oncology, Physics Division, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Pablo Botas
- Department of Radiation Oncology, Physics Division, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- Foundation 29 of February, Pozuelo de Alarcón, Madrid, Spain
| | - Gregory C Sharp
- Department of Radiation Oncology, Physics Division, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Brian Winey
- Department of Radiation Oncology, Physics Division, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
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30
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Extension of RBE-weighted 4D particle dose calculation for non-periodic motion. Phys Med 2021; 91:62-72. [PMID: 34715550 DOI: 10.1016/j.ejmp.2021.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 10/01/2021] [Accepted: 10/05/2021] [Indexed: 01/02/2023] Open
Abstract
PURPOSE Highly conformal scanned Carbon Ion Radiotherapy (CIRT) might permit dose escalation and improved local control in advanced stage thoracic tumors, but is challenged by target motion. Dose calculation algorithms typically assume a periodically repeating, regular motion. To assess the effect of realistic, irregular motion, new algorithms of validated accuracy are needed. METHODS We extended an in-house treatment planning system to calculate RBE-weighted dose distributions in CIRT on non-periodic CT image sequences. Dosimetric accuracy was validated experimentally on a moving, time-resolved ionization chamber array. Log-file based dose reconstructions were compared by gamma analysis and correlation to measurements at every intermediate detector frame during delivery. The impact of irregular motion on treatment quality was simulated on a virtual 4DCT thorax phantom. Periodic motion was compared to motion with varying amplitude and period ± baseline drift. Rescanning as a mitigation strategy was assessed on all scenarios. RESULTS In experimental validation, average gamma pass rates were 99.89+-0.30% for 3%/3 mm and 88.2+-2.2% for 2%/2 mm criteria. Average correlation for integral dose distributions was 0.990±0.002. Median correlation for single 200 ms frames was 0.947±0.006. In the simulations, irregular motion deteriorated V95 target coverage to 81.2%, 76.6% and 79.0% for regular, irregular motion and irregular motion with base-line drift, respectively. Rescanning restored V95 to >98% for both scenarios without baseline drift, but not with additional baseline drift at 83.7%. CONCLUSIONS The validated algorithm permits to study the effects of irregular motion and to develop and adapt appropriate motion mitigation techniques.
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Visser S, den Otter LA, Ribeiro CO, Korevaar EW, Both S, Langendijk JA, Muijs CT, Sijtsema NM, Knopf A. Diaphragm-Based Position Verification to Improve Daily Target Dose Coverage in Proton and Photon Radiation Therapy Treatment of Distal Esophageal Cancer. Int J Radiat Oncol Biol Phys 2021; 112:463-474. [PMID: 34530091 DOI: 10.1016/j.ijrobp.2021.09.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 08/21/2021] [Accepted: 09/06/2021] [Indexed: 12/23/2022]
Abstract
PURPOSE In modern conformal radiation therapy of distal esophageal cancer, target coverage can be affected by variations in the diaphragm position. We investigated if daily position verification (PV) extended by a diaphragm position correction would optimize target dose coverage for esophageal cancer treatment. METHODS AND MATERIALS For 15 esophageal cancer patients, intensity modulated proton therapy (IMPT) and volumetric modulated arc therapy (VMAT) plans were computed. Displacements of the target volume were correlated with diaphragm displacements using repeated 4-dimensional computed tomography images to determine the correction needed to account for diaphragm variations. Afterwards, target coverage was evaluated for 3 PV approaches based on: (1) bony anatomy (PV_B), (2) bony anatomy corrected for the diaphragm position (PV_BD) and (3) target volume (PV_T). RESULTS The cranial-caudal mean target displacement was congruent with almost half of the diaphragm displacement (y = 0.459x), which was used for the diaphragm correction in PV_BD. Target dose coverage using PV_B was adequate for most patients with diaphragm displacements up till 10 mm (≥94% of the dose in 98% of the volume [D98%]). For larger displacements, the target coverage was better maintained by PV_T and PV_BD. Overall, PV_BD accounted best for target displacements, especially in combination with tissue density variations (D98%: IMPT 94% ± 5%, VMAT 96% ± 5%). Diaphragm displacements of more than 10 mm were observed in 22% of the cases. CONCLUSIONS PV_B was sufficient to achieve adequate target dose coverage in case of small deviations in diaphragm position. However, large deviations of the diaphragm were best mitigated by PV_BD. To detect the cases where target dose coverage could be compromised due to diaphragm position variations, we recommend monitoring of the diaphragm position before treatment through online imaging.
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Affiliation(s)
- Sabine Visser
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - Lydia A den Otter
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Cássia O Ribeiro
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Erik W Korevaar
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Stefan Both
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Johannes A Langendijk
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Christina T Muijs
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Nanna M Sijtsema
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Antje Knopf
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Visser S, Neh H, Oraboni Ribeiro C, Korevaar EW, Meijers A, Poppe B, Sijtsema NM, Both S, Langendijk JA, Muijs CT, Knopf AC. Assessment of a diaphragm override strategy for robustly optimized proton therapy planning for esophageal cancer patients. Med Phys 2021; 48:5674-5683. [PMID: 34289123 PMCID: PMC9291176 DOI: 10.1002/mp.15114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 01/03/2021] [Accepted: 06/23/2021] [Indexed: 12/25/2022] Open
Abstract
Purpose To ensure target coverage in the treatment of esophageal cancer, a density override to the region of diaphragm motion can be applied in the optimization process. Here, we evaluate the benefit of this approach during robust optimization for intensity modulated proton therapy (IMPT) planning. Materials and methods For 10 esophageal cancer patients, two robustly optimized IMPT plans were created either using (WDO) or not using (NDO) a diaphragm density override of 1.05 g/cm3 during plan optimization. The override was applied to the excursion of the diaphragm between exhale and inhale. Initial robustness evaluation was performed for plan acceptance (setup errors of 8 mm, range errors of ±3%), and subsequently, on all weekly repeated 4DCTs (setup errors of 2 mm, range errors of ±3%). Target coverage and hotspots were analyzed on the resulting voxel‐wise minimum (Vwmin) and voxel‐wise maximum (Vwmax) dose distributions. Results The nominal dose distributions were similar for both WDO and NDO plans. However, visual inspection of the Vwmax of the WDO plans showed hotspots behind the right diaphragm override region. For one patient, target coverage and hotspots improved by applying the diaphragm override. We found no differences in target coverage in the weekly evaluations between the two approaches. Conclusion The diaphragm override approach did not result in a clinical benefit in terms of planning and interfractional robustness. Therefore, we do not see added value in employing this approach as a default option during robust optimization for IMPT planning in esophageal cancer.
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Affiliation(s)
- Sabine Visser
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Hendrike Neh
- Division for Medical Radiation Physics, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Cássia Oraboni Ribeiro
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Erik W Korevaar
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Arturs Meijers
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Björn Poppe
- Division for Medical Radiation Physics, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Nanna M Sijtsema
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Stefan Both
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Johannes A Langendijk
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Christina T Muijs
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Antje C Knopf
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Division for Medical Radiation Physics, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
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Ribeiro CO, Visser S, Korevaar EW, Sijtsema NM, Anakotta RM, Dieters M, Both S, Langendijk JA, Wijsman R, Muijs CT, Meijers A, Knopf A. Towards the clinical implementation of intensity-modulated proton therapy for thoracic indications with moderate motion: Robust optimised plan evaluation by means of patient and machine specific information. Radiother Oncol 2021; 157:210-218. [DOI: 10.1016/j.radonc.2021.01.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 12/09/2020] [Accepted: 01/06/2021] [Indexed: 02/09/2023]
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Nenoff L, Matter M, Amaya EJ, Josipovic M, Knopf AC, Lomax AJ, Persson GF, Ribeiro CO, Visser S, Walser M, Weber DC, Zhang Y, Albertini F. Dosimetric influence of deformable image registration uncertainties on propagated structures for online daily adaptive proton therapy of lung cancer patients. Radiother Oncol 2021; 159:136-143. [PMID: 33771576 DOI: 10.1016/j.radonc.2021.03.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 03/14/2021] [Accepted: 03/15/2021] [Indexed: 12/25/2022]
Abstract
PURPOSE A major burden of introducing an online daily adaptive proton therapy (DAPT) workflow is the time and resources needed to correct the daily propagated contours. In this study, we evaluated the dosimetric impact of neglecting the online correction of the propagated contours in a DAPT workflow. MATERIAL AND METHODS For five NSCLC patients with nine repeated deep-inspiration breath-hold CTs, proton therapy plans were optimised on the planning CT to deliver 60 Gy-RBE in 30 fractions. All repeated CTs were registered with six different clinically used deformable image registration (DIR) algorithms to the corresponding planning CT. Structures were propagated rigidly and with each DIR algorithm and reference structures were contoured on each repeated CT. DAPT plans were optimised with the uncorrected, propagated structures (propagated DAPT doses) and on the reference structures (ideal DAPT doses), non-adapted doses were recalculated on all repeated CTs. RESULTS Due to anatomical changes occurring during the therapy, the clinical target volume (CTV) coverage of the non-adapted doses reduces on average by 9.7% (V95) compared to an ideal DAPT doses. For the propagated DAPT doses, the CTV coverage was always restored (average differences in the CTV V95 < 1% compared to the ideal DAPT doses). Hotspots were always reduced with any DAPT approach. CONCLUSION For the patients presented here, a benefit of online DAPT was shown, even if the daily optimisation is based on propagated structures with some residual uncertainties. However, a careful (offline) structure review is necessary and corrections can be included in an offline adaption.
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Affiliation(s)
- Lena Nenoff
- Paul Scherrer Institute, Center for Proton Therapy, Switzerland; Department of Physics, ETH Zurich, Switzerland.
| | - Michael Matter
- Paul Scherrer Institute, Center for Proton Therapy, Switzerland; Department of Physics, ETH Zurich, Switzerland
| | | | - Mirjana Josipovic
- Department of Oncology, Rigshospitalet Copenhagen University Hospital, Denmark
| | - Antje-Christin Knopf
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Antony John Lomax
- Paul Scherrer Institute, Center for Proton Therapy, Switzerland; Department of Physics, ETH Zurich, Switzerland
| | - Gitte F Persson
- Department of Oncology, Rigshospitalet Copenhagen University Hospital, Denmark; Department of Oncology, Herlev-Gentofte Hospital Copenhagen University Hospital, Denmark; Department of Clinical Medicine, Faculty of Medical Sciences, University of Copenhagen, Denmark
| | - Cássia O Ribeiro
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Sabine Visser
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Marc Walser
- Paul Scherrer Institute, Center for Proton Therapy, Switzerland
| | - Damien Charles Weber
- Paul Scherrer Institute, Center for Proton Therapy, Switzerland; Department of Radiation Oncology, University Hospital Zurich, Switzerland; Department of Radiation Oncology, University Hospital Bern, Switzerland
| | - Ye Zhang
- Paul Scherrer Institute, Center for Proton Therapy, Switzerland
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35
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Paganetti H, Beltran C, Both S, Dong L, Flanz J, Furutani K, Grassberger C, Grosshans DR, Knopf AC, Langendijk JA, Nystrom H, Parodi K, Raaymakers BW, Richter C, Sawakuchi GO, Schippers M, Shaitelman SF, Teo BKK, Unkelbach J, Wohlfahrt P, Lomax T. Roadmap: proton therapy physics and biology. Phys Med Biol 2021; 66. [DOI: 10.1088/1361-6560/abcd16] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 11/23/2020] [Indexed: 12/12/2022]
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den Boer E, Wulff J, Mäder UI, Engwall E, Bäumer C, Perko Z, Timmermann B. Technical Note: Investigating interplay effects in pencil beam scanning proton therapy with a 4D XCAT phantom within the RayStation treatment planning system. Med Phys 2021; 48:1448-1455. [PMID: 33411339 DOI: 10.1002/mp.14709] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 12/27/2020] [Accepted: 12/30/2020] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Pencil beam scanning (PBS) for moving targets is known to be impacted by interplay effects. Four-dimensional computed tomography (4DCT)-based motion evaluation is crucial for understanding interplay and developing mitigation strategies. Availability of high-quality 4DCTs with variable breathing traces is limited. Purpose of this work is the development of a framework for interplay analysis using 4D-XCAT phantoms in conjunction with time-resolved irradiation patterns in a commercial treatment planning system (TPS). Four-dimensional dynamically accumulated dose distributions (4DDDs) are simulated in an in-silico study for a PBS liver treatment. METHODS An XCAT phantom with 50 phases, varying linearly in amplitude each by 1 mm, was combined with the RayStation TPS (7.99.10). Deformable registration was used with time-resolved dose calculation, mapping XCAT phases to motion signals. To illustrate the applicability of the method a two-field liver irradiation plan was used. A variety sin4 type motion signals, varying in amplitude (1-20 mm), period (1.6-5.2 s) and phase (0-2π) were applied. Either single variable variations or random combinations were selected. The interplay effect within a clinical target (5 cm diameter) was characterized in terms of homogeneity index (HI5), with and without five paintings. In total 2092 scenarios were analyzed within RayStation. RESULTS A framework is presented for interplay research, allowing for flexibility in determining motion management techniques, increasing reproducibility, and enabling comparisons of different methods. A case study showed the interplay effect was correlated with amplitude and strongly affected by the starting phase, leading to large variance. The average of all scenarios (single fraction) resulted in HI5 of 0.31 (±0.11), while introduction of five times layered repainting reduced this to 0.11(±0.03). CONCLUSION The developed framework, which uses the XCAT phantom and RayStation, allows detailed analysis of motion in context of PBS with comparable results to clinical cases. Flexibility in defining motion patterns for detailed anatomies in combination with time-resolved dose calculation, facilitates investigation of optimal treatment and motion mitigation strategies.
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Affiliation(s)
- Erik den Boer
- West German Proton Therapy Center Essen (WPE), Essen, Germany.,Technical University Delft, Delft, Netherlands
| | - Jörg Wulff
- West German Proton Therapy Center Essen (WPE), Essen, Germany.,University Hospital Essen, Essen, Germany.,West German Cancer Center (WTZ), Essen, Germany.,Institute of Medical Physics and Radiation Protection (IMPS), Technical University Mittelhessen, Gießen, Germany
| | - UIf Mäder
- Institute of Medical Physics and Radiation Protection (IMPS), Technical University Mittelhessen, Gießen, Germany
| | | | - Christian Bäumer
- West German Proton Therapy Center Essen (WPE), Essen, Germany.,University Hospital Essen, Essen, Germany.,West German Cancer Center (WTZ), Essen, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany.,TU Dortmund University, Dortmund, Germany
| | | | - Beate Timmermann
- West German Proton Therapy Center Essen (WPE), Essen, Germany.,University Hospital Essen, Essen, Germany.,West German Cancer Center (WTZ), Essen, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany.,Department of Particle Therapy, Essen, Germany
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Czerska K, Emert F, Kopec R, Langen K, McClelland JR, Meijers A, Miyamoto N, Riboldi M, Shimizu S, Terunuma T, Zou W, Knopf A, Rucinski A. Clinical practice vs. state-of-the-art research and future visions: Report on the 4D treatment planning workshop for particle therapy - Edition 2018 and 2019. Phys Med 2021; 82:54-63. [PMID: 33588228 DOI: 10.1016/j.ejmp.2020.12.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 12/09/2020] [Accepted: 12/16/2020] [Indexed: 12/18/2022] Open
Abstract
The 4D Treatment Planning Workshop for Particle Therapy, a workshop dedicated to the treatment of moving targets with scanned particle beams, started in 2009 and since then has been organized annually. The mission of the workshop is to create an informal ground for clinical medical physicists, medical physics researchers and medical doctors interested in the development of the 4D technology, protocols and their translation into clinical practice. The 10th and 11th editions of the workshop took place in Sapporo, Japan in 2018 and Krakow, Poland in 2019, respectively. This review report from the Sapporo and Krakow workshops is structured in two parts, according to the workshop programs. The first part comprises clinicians and physicists review of the status of 4D clinical implementations. Corresponding talks were given by speakers from five centers around the world: Maastro Clinic (The Netherlands), University Medical Center Groningen (The Netherlands), MD Anderson Cancer Center (United States), University of Pennsylvania (United States) and The Proton Beam Therapy Center of Hokkaido University Hospital (Japan). The second part is dedicated to novelties in 4D research, i.e. motion modelling, artificial intelligence and new technologies which are currently being investigated in the radiotherapy field.
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Affiliation(s)
- Katarzyna Czerska
- Institute of Nuclear Physics Polish Academy of Sciences, PL-31342 Krakow, Poland.
| | - Frank Emert
- Center for Proton Therapy, Paul Scherrer Institute, Switzerland
| | - Renata Kopec
- Institute of Nuclear Physics Polish Academy of Sciences, PL-31342 Krakow, Poland
| | - Katja Langen
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Jamie R McClelland
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Arturs Meijers
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Naoki Miyamoto
- Department of Medical Physics, Hokkaido University Hospital, Sapporo, Hokkaido, Japan; Faculty of Engineering, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Marco Riboldi
- Department of Medical Physics, Ludwig-Maximilians-Universität München, Germany
| | - Shinichi Shimizu
- Department of Medical Physics, Hokkaido University Hospital, Sapporo, Hokkaido, Japan; Department of Radiation Medical Science and Engineering, Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Toshiyuki Terunuma
- Faculty of Medicine, University of Tsukuba, Japan; Proton Medical Research Center, University of Tsukuba Hospital, Japan
| | - Wei Zou
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Antje Knopf
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Antoni Rucinski
- Institute of Nuclear Physics Polish Academy of Sciences, PL-31342 Krakow, Poland
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Alina G, Krieger M, Jud C, Duetschler A, Salomir R, Bieri O, Bauman G, Nguyen D, Weber DC, Lomax AJ, Zhang Y, Cattin PC. Liver-ultrasound based motion modelling to estimate 4D dose distributions for lung tumours in scanned proton therapy. ACTA ACUST UNITED AC 2020; 65:235050. [DOI: 10.1088/1361-6560/abaa26] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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39
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Ribeiro CO, Terpstra J, Janssens G, Langendijk JA, Both S, Muijs CT, Wijsman R, Knopf A, Meijers A. Evaluation of continuous beam rescanning versus pulsed beam in pencil beam scanned proton therapy for lung tumours. Phys Med Biol 2020; 65:23NT01. [PMID: 33120367 DOI: 10.1088/1361-6560/abc5c8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The treatment of moving targets with pencil beam scanned proton therapy (PBS-PT) may rely on rescanning strategies to smooth out motion induced dosimetric disturbances. PBS-PT machines, such as Proteus®Plus (PPlus) and Proteus®One (POne), deliver a continuous or a pulsed beam, respectively. In PPlus, scaled (or no) rescanning can be applied, while POne implies intrinsic 'rescanning' due to its pulsed delivery. We investigated the efficacy of these PBS-PT delivery types for the treatment of lung tumours. In general, clinically acceptable plans were achieved, and PPlus and POne showed similar effectiveness.
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Affiliation(s)
- Cássia O Ribeiro
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Anthropomorphic lung phantom based validation of in-room proton therapy 4D-CBCT image correction for dose calculation. Z Med Phys 2020; 32:74-84. [PMID: 33248812 PMCID: PMC9948846 DOI: 10.1016/j.zemedi.2020.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 09/18/2020] [Accepted: 09/23/2020] [Indexed: 12/27/2022]
Abstract
PURPOSE Ventilation-induced tumour motion remains a challenge for the accuracy of proton therapy treatments in lung patients. We investigated the feasibility of using a 4D virtual CT (4D-vCT) approach based on deformable image registration (DIR) and motion-aware 4D CBCT reconstruction (MA-ROOSTER) to enable accurate daily proton dose calculation using a gantry-mounted CBCT scanner tailored to proton therapy. METHODS Ventilation correlated data of 10 breathing phases were acquired from a porcine ex-vivo functional lung phantom using CT and CBCT. 4D-vCTs were generated by (1) DIR of the mid-position 4D-CT to the mid-position 4D-CBCT (reconstructed with the MA-ROOSTER) using a diffeomorphic Morphons algorithm and (2) subsequent propagation of the obtained mid-position vCT to the individual 4D-CBCT phases. Proton therapy treatment planning was performed to evaluate dose calculation accuracy of the 4D-vCTs. A robust treatment plan delivering a nominal dose of 60Gy was generated on the average intensity image of the 4D-CT for an approximated internal target volume (ITV). Dose distributions were then recalculated on individual phases of the 4D-CT and the 4D-vCT based on the optimized plan. Dose accumulation was performed for 4D-vCT and 4D-CT using DIR of each phase to the mid position, which was chosen as reference. Dose based on the 4D-vCT was then evaluated against the dose calculated on 4D-CT both, phase-by-phase as well as accumulated, by comparing dose volume histogram (DVH) values (Dmean, D2%, D98%, D95%) for the ITV, and by a 3D-gamma index analysis (global, 3%/3mm, 5Gy, 20Gy and 30Gy dose thresholds). RESULTS Good agreement was found between the 4D-CT and 4D-vCT-based ITV-DVH curves. The relative differences ((CT-vCT)/CT) between accumulated values of ITV Dmean, D2%, D95% and D98% for the 4D-CT and 4D-vCT-based dose distributions were -0.2%, 0.0%, -0.1% and -0.1%, respectively. Phase specific values varied between -0.5% and 0.2%, -0.2% and 0.5%, -3.5% and 1.5%, and -5.7% and 2.3%. The relative difference of accumulated Dmean over the lungs was 2.3% and Dmean for the phases varied between -5.4% and 5.8%. The gamma pass-rates with 5Gy, 20Gy and 30Gy thresholds for the accumulated doses were 96.7%, 99.6% and 99.9%, respectively. Phase-by-phase comparison yielded pass-rates between 86% and 97%, 88% and 98%, and 94% and 100%. CONCLUSIONS Feasibility of the suggested 4D-vCT workflow using proton therapy specific imaging equipment was shown. Results indicate the potential of the method to be applied for daily 4D proton dose estimation.
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Mitigation of motion effects in pencil-beam scanning - Impact of repainting on 4D robustly optimized proton treatment plans for hepatocellular carcinoma. Z Med Phys 2020; 32:63-73. [PMID: 33131995 PMCID: PMC9948857 DOI: 10.1016/j.zemedi.2020.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 07/29/2020] [Accepted: 08/14/2020] [Indexed: 12/27/2022]
Abstract
Proton fields delivered by the active scanning technique can be interfered with the intrafractional motion. This in-silico study seeks to mitigate the dosimetric impacts of motion artifacts, especially its interplay with the time-modulated dose delivery. Here four-dimensional (4d) robust optimization and dose repainting, which is the multiple application of the same field with reduced fluence, were combined. Two types of repainting were considered: layered and volumetric repainting. The time-resolved dose calculation, which is necessary to quantify the interplay effect, was integrated into the treatment planning system and validated. Nine clinical cases of hepatocellular carcinoma (HCC) showing motion in the range of 0.4-1.5cm were studied. It was found that the repainted delivery of 4D robustly optimized plans reduced the impact of interplay effect as quantified by the homogeneity index within the clinical target volume (CTV) to a tolerable level. Similarly, the fractional over- and underdosage was reduced sufficiently for some HCC cases to achieve the purpose of motion management. This holds true for both investigated types of repainting with small dosimetric advantages of volume repainting over layered repainting. Volume repainting, however, cannot be applied clinically in proton centers with slow energy changes. Thus, it served as a reference in the in-silico evaluation. It is recommended to perform the dynamic dose calculation for individual cases to judge if robust optimization in conjunction with repainting is sufficient to keep the interplay effect within bounds.
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Head and neck IMPT probabilistic dose accumulation: Feasibility of a 2 mm setup uncertainty setting. Radiother Oncol 2020; 154:45-52. [PMID: 32898561 DOI: 10.1016/j.radonc.2020.09.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 08/14/2020] [Accepted: 09/02/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To establish optimal robust optimization uncertainty settings for clinical head and neck cancer (HNC) patients undergoing 3D image-guided pencil beam scanning (PBS) proton therapy. METHODS We analyzed ten consecutive HNC patients treated with 70 and 54.25 GyRBE to the primary and prophylactic clinical target volumes (CTV) respectively using intensity-modulated proton therapy (IMPT). Clinical plans were generated using robust optimization with 5 mm/3% setup/range uncertainties (RayStation v6.1). Additional plans were created for 4, 3, 2 and 1 mm setup and 3% range uncertainty and for 3 mm setup and 3%, 2% and 1% range uncertainty. Systematic and random error distributions were determined for setup and range uncertainties based on our quality assurance program. From these, 25 treatment scenarios were sampled for each plan, each consisting of a systematic setup and range error and daily random setup errors. Fraction doses were calculated on the weekly verification CT closest to the date of treatment as this was considered representative of the daily patient anatomy. RESULTS Plans with a 2 mm/3% setup/range uncertainty setting adequately covered the primary and prophylactic CTV (V95 ≥ 99% in 98.8% and 90.8% of the treatment scenarios respectively). The average organ-at-risk dose decreased with 1.1 GyRBE/mm setup uncertainty reduction and 0.5 GyRBE/1% range uncertainty reduction. Normal tissue complication probabilities decreased by 2.0%/mm setup uncertainty reduction and by 0.9%/1% range uncertainty reduction. CONCLUSION The results of this study indicate that margin reduction below 3 mm/3% is possible but requires a larger cohort to substantiate clinical introduction.
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Meijers A, Knopf AC, Crijns AP, Ubbels JF, Niezink AG, Langendijk JA, Wijsman R, Both S. Evaluation of interplay and organ motion effects by means of 4D dose reconstruction and accumulation. Radiother Oncol 2020; 150:268-274. [DOI: 10.1016/j.radonc.2020.07.055] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 07/14/2020] [Accepted: 07/23/2020] [Indexed: 12/29/2022]
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44
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Meijers A, Seller OC, Free J, Bondesson D, Seller Oria C, Rabe M, Parodi K, Landry G, Langendijk JA, Both S, Kurz C, Knopf AC. Assessment of range uncertainty in lung-like tissue using a porcine lung phantom and proton radiography. ACTA ACUST UNITED AC 2020; 65:155014. [DOI: 10.1088/1361-6560/ab91db] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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45
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den Otter LA, Anakotta RM, Weessies M, Roos CTG, Sijtsema NM, Muijs CT, Dieters M, Wijsman R, Troost EGC, Richter C, Meijers A, Langendijk JA, Both S, Knopf AC. Investigation of inter-fraction target motion variations in the context of pencil beam scanned proton therapy in non-small cell lung cancer patients. Med Phys 2020; 47:3835-3844. [PMID: 32573792 PMCID: PMC7586844 DOI: 10.1002/mp.14345] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/01/2020] [Accepted: 06/14/2020] [Indexed: 12/25/2022] Open
Abstract
Purpose For locally advanced‐stage non‐small cell lung cancer (NSCLC), inter‐fraction target motion variations during the whole time span of a fractionated treatment course are assessed in a large and representative patient cohort. The primary objective is to develop a suitable motion monitoring strategy for pencil beam scanning proton therapy (PBS‐PT) treatments of NSCLC patients during free breathing. Methods Weekly 4D computed tomography (4DCT; 41 patients) and daily 4D cone beam computed tomography (4DCBCT; 10 of 41 patients) scans were analyzed for a fully fractionated treatment course. Gross tumor volumes (GTVs) were contoured and the 3D displacement vectors of the centroid positions were compared for all scans. Furthermore, motion amplitude variations in different lung segments were statistically analyzed. The dosimetric impact of target motion variations and target motion assessment was investigated in exemplary patient cases. Results The median observed centroid motion was 3.4 mm (range: 0.2–12.4 mm) with an average variation of 2.2 mm (range: 0.1–8.8 mm). Ten of 32 patients (31.3%) with an initial motion <5 mm increased beyond a 5‐mm motion amplitude during the treatment course. Motion observed in the 4DCBCT scans deviated on average 1.5 mm (range: 0.0–6.0 mm) from the motion observed in the 4DCTs. Larger motion variations for one example patient compromised treatment plan robustness while no dosimetric influence was seen due to motion assessment biases in another example case. Conclusions Target motion variations were investigated during the course of radiotherapy for NSCLC patients. Patients with initial GTV motion amplitudes of < 2 mm can be assumed to be stable in motion during the treatment course. For treatments of NSCLC patients who exhibit motion amplitudes of > 2 mm, 4DCBCT should be considered for motion monitoring due to substantial motion variations observed.
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Affiliation(s)
- Lydia A den Otter
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, 9713 GZ, The Netherlands
| | - Renske M Anakotta
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, 9713 GZ, The Netherlands
| | - Menkedina Weessies
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, 9713 GZ, The Netherlands
| | - Catharina T G Roos
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, 9713 GZ, The Netherlands
| | - Nanna M Sijtsema
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, 9713 GZ, The Netherlands
| | - Christina T Muijs
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, 9713 GZ, The Netherlands
| | - Margriet Dieters
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, 9713 GZ, The Netherlands
| | - Robin Wijsman
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, 9713 GZ, The Netherlands
| | - Esther G C Troost
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden, Rossendorf, Germany.,Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiooncology, OncoRay, Germany.,Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,Partner Site Dresden, and German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany.,National Center for Tumor Diseases (NCT), Partner Site Dresden, Dresden, Germany
| | - Christian Richter
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden, Rossendorf, Germany.,Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiooncology, OncoRay, Germany.,Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,Partner Site Dresden, and German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Arturs Meijers
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, 9713 GZ, The Netherlands
| | - Johannes A Langendijk
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, 9713 GZ, The Netherlands
| | - Stefan Both
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, 9713 GZ, The Netherlands
| | - Antje-Christin Knopf
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, 9713 GZ, The Netherlands
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Kostiukhina N, Palmans H, Stock M, Knopf A, Georg D, Knäusl B. Time-resolved dosimetry for validation of 4D dose calculation in PBS proton therapy. Phys Med Biol 2020; 65:125015. [PMID: 32340002 DOI: 10.1088/1361-6560/ab8d79] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Four-dimensional dose calculation (4D-DC) is crucial for predicting the dosimetric outcome in the presence of intra-fractional organ motion. Time-resolved dosimetry can provide significant insights into 4D pencil beam scanning dose accumulation and is therefore irreplaceable for benchmarking 4D-DC. In this study a novel approach of time-resolved dosimetry using five PinPoint ionization chambers (ICs) embedded in an anthropomorphic dynamic phantom was employed and validated against beam delivery details. Beam intensity variations as well as the beam delivery time structure were well reflected with an accuracy comparable to the temporal resolution of the IC measurements. The 4D dosimetry approach was further applied for benchmarking the 4D-DC implemented in the RayStation 6.99 treatment planning system. Agreement between computed values and measurements was investigated for (i) partial doses based on individual breathing phases, and (ii) temporally distributed cumulative doses. For varied beam delivery and patient-related parameters the average unsigned dose difference for (i) was 0.04 ± 0.03 Gy over all considered IC measurement values, while the prescribed physical dose was 2 Gy. By implementing (ii), a strong effect of the dose gradient on measurement accuracy was observed. The gradient originated from scanned beam energy modulation and target motion transversal to the beam. Excluding measurements in the high gradient the relative dose difference between measurements and 4D-DCs for a given treatment plan at the end of delivery was 3.5% on average and 6.6% at maximum over measurement points inside the target. Overall, the agreement between 4D dose measurements in the moving phantom and retrospective 4D-DC was found to be comparable to the static dose differences for all delivery scenarios. The presented 4D-DC has been proven to be suitable for simulating treatment deliveries with various beam- as well as patient-specific parameters and can therefore be employed for dosimetric validation of different motion mitigation techniques.
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Affiliation(s)
- N Kostiukhina
- Division of Medical Radiation Physics, Department of Radiation Oncology, Medical University of Vienna/AKH Vienna, Vienna, Austria. Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Vienna, Austria
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47
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4D strategies for lung tumors treated with hypofractionated scanning proton beam therapy: Dosimetric impact and robustness to interplay effects. Radiother Oncol 2020; 146:213-220. [DOI: 10.1016/j.radonc.2020.02.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 02/26/2020] [Accepted: 02/28/2020] [Indexed: 12/13/2022]
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48
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Lee E, Perry D, Speth J, Zhang Y, Xiao Z, Mascia A. Measurement-based study on characterizing symmetric and asymmetric respiratory motion interplay effect on target dose distribution in the proton pencil beam scanning. J Appl Clin Med Phys 2020; 21:59-67. [PMID: 32170992 PMCID: PMC7170285 DOI: 10.1002/acm2.12846] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 01/17/2020] [Accepted: 02/10/2020] [Indexed: 12/25/2022] Open
Abstract
Pencil beam scanning proton therapy makes possible intensity modulation, resulting in improved target dose conformity and organ‐at‐risk (OAR) dose sparing. This benefit, however, results in increased sensitivity to certain clinical and beam delivery parameters, such as respiratory motion. These effects can cause plan degeneration, which could lead to decreased tumor dose or increased OAR dose. This study evaluated the measurements of proton pencil beam scanning delivery made with a 2D ion chamber array in solid water on a 1D motion platform, where respiratory motion was simulated using sine and cosine4 waves representing sinusoidal symmetric and realistic asymmetric breathing motions, respectively. Motion amplitudes were 0.5 cm and 1 cm corresponding to 1 cm and 2 cm of maximum respiratory excursions, respectively, with 5 sec fixed breathing cycle. The treatment plans were created to mimic spherical targets of 3 cm or 10 cm diameter located at 5 cm or 1 cm depth in solid water phantom. A reference RBE dose of 200 cGy per fraction was delivered in 1, 5, 10, and 15 fractions for each dataset. We evaluated dose conformity and uniformity at the center plane of targets by using the Conformation Number and the Homogeneity Index, respectively. Results indicated that dose conformity as well as homogeneity was more affected by motion for smaller targets. Dose conformity was better achieved for symmetric breathing patterns than asymmetric breathing patterns regardless of the number of fractions. The presence of a range shifter with shallow targets reduced the motion effect by improving dose homogeneity. While motion effects are known to be averaged out over the course of multifractional treatments, this might not be true for proton pencil beam scanning under asymmetrical breathing pattern.
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Affiliation(s)
- Eunsin Lee
- Department of Radiation Oncology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Daniel Perry
- Department of Radiation Oncology, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Joseph Speth
- Department of Radiation Oncology, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Yongbin Zhang
- Department of Radiation Oncology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Zhiyan Xiao
- Department of Radiation Oncology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Anthony Mascia
- Department of Radiation Oncology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Albertini F, Matter M, Nenoff L, Zhang Y, Lomax A. Online daily adaptive proton therapy. Br J Radiol 2020; 93:20190594. [PMID: 31647313 PMCID: PMC7066958 DOI: 10.1259/bjr.20190594] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 10/15/2019] [Accepted: 10/22/2019] [Indexed: 12/11/2022] Open
Abstract
It is recognized that the use of a single plan calculated on an image acquired some time before the treatment is generally insufficient to accurately represent the daily dose to the target and to the organs at risk. This is particularly true for protons, due to the physical finite range. Although this characteristic enables the generation of steep dose gradients, which is essential for highly conformal radiotherapy, it also tightens the dependency of the delivered dose to the range accuracy. In particular, the use of an outdated patient anatomy is one of the most significant sources of range inaccuracy, thus affecting the quality of the planned dose distribution. A plan should be ideally adapted as soon as anatomical variations occur, ideally online. In this review, we describe in detail the different steps of the adaptive workflow and discuss the challenges and corresponding state-of-the art developments in particular for an online adaptive strategy.
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Affiliation(s)
| | | | | | - Ye Zhang
- Paul Scherrer Institute, Center for Proton Therapy, Switzerland
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50
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Platform for automatic patient quality assurance via Monte Carlo simulations in proton therapy. Phys Med 2020; 70:49-57. [PMID: 31968277 DOI: 10.1016/j.ejmp.2019.12.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 11/21/2019] [Accepted: 12/18/2019] [Indexed: 12/31/2022] Open
Abstract
For radiation therapy, it is crucial to ensure that the delivered dose matches the planned dose. Errors in the dose calculations done in the treatment planning system (TPS), treatment delivery errors, other software bugs or data corruption during transfer might lead to significant differences between predicted and delivered doses. As such, patient specific quality assurance (QA) of dose distributions, through experimental validation of individual fields, is necessary. These measurement based approaches, however, are performed with 2D detectors, with limited resolution and in a water phantom. Moreover, they are work intensive and often impose a bottleneck to treatment efficiency. In this work, we investigated the potential to replace measurement-based approach with a simulation-based patient specific QA using a Monte Carlo (MC) code as independent dose calculation engine in combination with treatment log files. Our developed QA platform is composed of a web interface, servers and computation scripts, and is capable to autonomously launch simulations, identify and report dosimetric inconsistencies. To validate the beam model of independent MC engine, in-water simulations of mono-energetic layers and 30 SOBP-type dose distributions were performed. Average Gamma passing ratio 99 ± 0.5% for criteria 2%/2 mm was observed. To demonstrate feasibility of the proposed approach, 10 clinical cases such as head and neck, intracranial indications and craniospinal axis, were retrospectively evaluated via the QA platform. The results obtained via QA platform were compared to QA results obtained by measurement-based approach. This comparison demonstrated consistency between the methods, while the proposed approach significantly reduced in-room time required for QA procedures.
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