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Volz L, Korte J, Martire MC, Zhang Y, Hardcastle N, Durante M, Kron T, Graeff C. Opportunities and challenges of upright patient positioning in radiotherapy. Phys Med Biol 2024; 69:18TR02. [PMID: 39159668 DOI: 10.1088/1361-6560/ad70ee] [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: 02/21/2024] [Accepted: 08/19/2024] [Indexed: 08/21/2024]
Abstract
Objective.Upright positioning has seen a surge in interest as a means to reduce radiotherapy (RT) cost, improve patient comfort, and, in selected cases, benefit treatment quality. In particle therapy (PT) in particular, eliminating the need for a gantry can present massive cost and facility footprint reduction. This review discusses the opportunities of upright RT in perspective of the open challenges.Approach.The clinical, technical, and workflow challenges that come with the upright posture have been extracted from an extensive literature review, and the current state of the art was collected in a synergistic perspective from photon and particle therapy. Considerations on future developments and opportunities are provided.Main results.Modern image guidance is paramount to upright RT, but it is not clear which modalities are essential to acquire in upright posture. Using upright MRI or upright CT, anatomical differences between upright/recumbent postures have been observed for nearly all body sites. Patient alignment similar to recumbent positioning was achieved in small patient/volunteer cohorts with prototype upright positioning systems. Possible clinical advantages, such as reduced breathing motion in upright position, have been reported, but limited cohort sizes prevent resilient conclusions on the treatment impact. Redesign of RT equipment for upright positioning, such as immobilization accessories for various body regions, is necessary, where several innovations were recently presented. Few clinical studies in upright PT have already reported promising outcomes for head&neck patients.Significance.With more evidence for benefits of upright RT emerging, several centers worldwide, particularly in PT, are installing upright positioning devices or have commenced upright treatment. Still, many challenges and open questions remain to be addressed to embed upright positioning firmly in the modern RT landscape. Guidelines, professionals trained in upright patient positioning, and large-scale clinical studies are required to bring upright RT to fruition.
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Affiliation(s)
- Lennart Volz
- Biophysics, GSI Helmholtz Center for Heavy Ion Research GmbH, Darmstadt, Germany
| | - James Korte
- Department of Physical Science, Peter MacCallum Cancer Centere, Melbourne, Australia
- Department of Biomedical Engineering, University of Melbourne, Melbourne, Australia
| | - Maria Chiara Martire
- Biophysics, GSI Helmholtz Center for Heavy Ion Research GmbH, Darmstadt, Germany
| | - Ye Zhang
- Center for Proton Therapy, Paul Scherrer Institut, Villigen-PSI, Switzerland
| | - Nicholas Hardcastle
- Department of Physical Science, Peter MacCallum Cancer Centere, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, Australia
| | - Marco Durante
- Biophysics, GSI Helmholtz Center for Heavy Ion Research GmbH, Darmstadt, Germany
- Institute for Condensed Matter Physics, Technical University Darmstadt, Darmstadt, Germany
| | - Tomas Kron
- Department of Physical Science, Peter MacCallum Cancer Centere, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, Australia
| | - Christian Graeff
- Biophysics, GSI Helmholtz Center for Heavy Ion Research GmbH, Darmstadt, Germany
- Department for Electronic Engineering and Computer Science, Technical University Darmstadt, Darmstadt, Germany
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Kissick MW, Panaino C, Criscuolo A, Hayes J, Hoffman C, Mackie R, Schreuder AN. Calculation method for novel upright CT scanner isodose curves. J Appl Clin Med Phys 2024; 25:e14377. [PMID: 38695845 PMCID: PMC11244660 DOI: 10.1002/acm2.14377] [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: 11/27/2023] [Revised: 04/07/2024] [Accepted: 04/12/2024] [Indexed: 07/14/2024] Open
Abstract
PURPOSE A computational method based on Monte-Carlo calculations is presented and used to calculate isodose curves for a new upright and tilting CT scanner useful for radiation protection purposes. METHODS The TOPAS code platform with imported CAD files for key components was used to construct a calculation space for the scanner. A sphere of water acts as the patient would by creating scatter out of the bore. Maximum intensity dose maps are calculated for various possible tilt angles to make sure radiation protection for site planning uses the maximum possible dose everywhere. RESULTS The resulting maximum intensity isodose lines are more rounded than ones for just a single tilt angle and so closer to isotropic. These maximum intensity curves are closer to the isotropic assumption used in CTDI or DLP based methods of site planning and radiation protection. The isodose lines are similar to those of a standard CT scanner, just tilted upwards. There is more metal above the beam that lessens the dose above versus below isocenter. CONCLUSION Aside from the orientation, this upright scanner is very similar to a typical CT scanner, and nothing different for shielding needs to be done for this new upright tilting CT scanner, because an isotropic scatter source is often assumed for any CT scanner.
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Affiliation(s)
- Michael W Kissick
- Leo Cancer Care, Ltd., Middleton, Wisconsin, USA
- Department of Medical Physics, University of Wisconsin - Madison, Madison, Wisconsin, USA
| | | | - Anthony Criscuolo
- Engineering and Physical Sciences, University of Surrey, Guildford, UK
- Medical Radiation Physics, National Physical Laboratory, Teddington, UK
| | - John Hayes
- Leo Cancer Care, Ltd., Middleton, Wisconsin, USA
| | | | - Rockwell Mackie
- Leo Cancer Care, Ltd., Middleton, Wisconsin, USA
- Department of Medical Physics, University of Wisconsin - Madison, Madison, Wisconsin, USA
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Northway SK, Vallejo BM, Liu L, Hansen EE, Tang S, Mah D, MacEwan IJ, Urbanic JJ, Chang C. A quantitative framework for patient-specific collision detection in proton therapy. J Appl Clin Med Phys 2024; 25:e14247. [PMID: 38131514 PMCID: PMC11005990 DOI: 10.1002/acm2.14247] [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: 08/08/2023] [Revised: 09/28/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Beam modifying accessories for proton therapy often need to be placed in close proximity of the patient for optimal dosimetry. However, proton treatment units are larger in size and as a result the planned treatment geometry may not be achievable due to collisions with the patient. A framework that can accurately simulate proton treatment geometry is desired. PURPOSE A quantitative framework was developed to model patient-specific proton treatment geometry, minimize air gap, and avoid collisions. METHODS The patient's external contour is converted into the International Electrotechnique Commission (IEC) gantry coordinates following the patient's orientation and each beam's gantry and table angles. All snout components are modeled by three-dimensional (3D) geometric shapes such as columns, cuboids, and frustums. Beam-specific parameters such as isocenter coordinates, snout type and extension are used to determine if any point on the external contour protrudes into the various snout components. A 3D graphical user interface is also provided to the planner to visualize the treatment geometry. In case of a collision, the framework's analytic algorithm quantifies the maximum protrusion of the external contour into the snout components. Without a collision, the framework quantifies the minimum distance of the external contour from the snout components and renders a warning if such distance is less than 5 cm. RESULTS Three different snout designs are modeled. Examples of potential collision and its aversion by snout retraction are demonstrated. Different patient orientations, including a sitting treatment position, as well as treatment plans with multiple isocenters, are successfully modeled in the framework. Finally, the dosimetric advantage of reduced air gap enabled by this framework is demonstrated by comparing plans with standard and reduced air gaps. CONCLUSION Implementation of this framework reduces incidence of collisions in the treatment room. In addition, it enables the planners to minimize the air gap and achieve better plan dosimetry.
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Affiliation(s)
- Stephen K. Northway
- Department of Radiation Medicine and Applied SciencesUniversity of California at San DiegoLa JollaCaliforniaUSA
- California Protons Cancer Therapy CenterSan DiegoCaliforniaUSA
| | - Bailey M. Vallejo
- Department of Radiation Medicine and Applied SciencesUniversity of California at San DiegoLa JollaCaliforniaUSA
- California Protons Cancer Therapy CenterSan DiegoCaliforniaUSA
| | - Lawrence Liu
- Department of Radiation Medicine and Applied SciencesUniversity of California at San DiegoLa JollaCaliforniaUSA
- California Protons Cancer Therapy CenterSan DiegoCaliforniaUSA
| | - Emily E. Hansen
- Department of Radiation Medicine and Applied SciencesUniversity of California at San DiegoLa JollaCaliforniaUSA
- California Protons Cancer Therapy CenterSan DiegoCaliforniaUSA
| | - Shikui Tang
- Texas Center for Proton TherapyIrvingTexasUSA
| | - Dennis Mah
- ProCure Proton Therapy CenterSomersetNew JerseyUSA
| | - Iain J. MacEwan
- Department of Radiation Medicine and Applied SciencesUniversity of California at San DiegoLa JollaCaliforniaUSA
- California Protons Cancer Therapy CenterSan DiegoCaliforniaUSA
| | - James J. Urbanic
- Department of Radiation Medicine and Applied SciencesUniversity of California at San DiegoLa JollaCaliforniaUSA
- California Protons Cancer Therapy CenterSan DiegoCaliforniaUSA
| | - Chang Chang
- Department of Radiation Medicine and Applied SciencesUniversity of California at San DiegoLa JollaCaliforniaUSA
- California Protons Cancer Therapy CenterSan DiegoCaliforniaUSA
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Schreuder A(N, Hsi W, Greenhalgh J, Kissick M, Lis M, Underwood TSA, Freeman H, Bauer M, Towe S, Mackie R. Anatomical changes in the male pelvis between the supine and upright positions-A feasibility study for prostate treatments in the upright position. J Appl Clin Med Phys 2023; 24:e14099. [PMID: 37488974 PMCID: PMC10647982 DOI: 10.1002/acm2.14099] [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: 10/31/2022] [Revised: 05/26/2023] [Accepted: 06/22/2023] [Indexed: 07/26/2023] Open
Abstract
Treating and imaging patients in the upright orientation is gaining acceptance in radiation oncology and radiology and has distinct advantages over the recumbent position. An IRB approved study to investigate the positions and orientations of the male pelvic organs between the supine and upright positions was conducted. The study comprised of scanning 15 male volunteers (aged 55-75 years) on a 0.6 T Fonar MRI scanner in the supine and upright positions with a full bladder and in the upright position with an empty bladder. The Pelvic study revealed that in the upright position the 1. Position and shape of the prostate are not impacted significantly by bladder fill. 2. Distance between the sacrum and the anterior bladder wall is significantly smaller. 3. Anterior-Posterior length and the bladder width is significantly larger. 4. Seminal vesicles are pushed down by the bladder. 5. Top of the penile bulb is further away from the apex of the prostate. These observed differences could positively impact upright prostate treatments by 1. Reducing the risk of small bowel approximating the treatment volume. 2. Prostate treatments can be done with a reduced focus on bladder fill. 3. Radiation beams for treating intermediate risk prostrate can be made smaller or a larger portion of the seminal vesicles can be treated with the same beam size than typically used for supine treatments. 4. Reducing the average dose to the penile bulb.
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Affiliation(s)
| | - Wen‐Chien Hsi
- University of Arkansas for Medical Sciences (UAMS)Department of Radiation OncologyLittle Rock, ArkansasUSA
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Yan S, Ngoma TA, Ngwa W, Bortfeld TR. Global democratisation of proton radiotherapy. Lancet Oncol 2023; 24:e245-e254. [PMID: 37269856 DOI: 10.1016/s1470-2045(23)00184-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/05/2023] [Accepted: 04/19/2023] [Indexed: 06/05/2023]
Abstract
Proton radiotherapy is an advanced treatment option compared with conventional x-ray treatment, delivering much lower doses of radiation to healthy tissues surrounding the tumour. However, proton therapy is currently not widely available. In this Review, we summarise the evolution of proton therapy to date, together with the benefits to patients and society. These developments have led to an exponential growth in the number of hospitals using proton radiotherapy worldwide. However, the gap between the number of patients who should be treated with proton radiotherapy and those who have access to it remains large. We summarise the ongoing research and development that is contributing to closing this gap, including the improvement of treatment efficiency and efficacy, and advances in fixed-beam treatments that do not require an enormously large, heavy, and costly gantry. The ultimate goal of decreasing the size of proton therapy machines to fit into standard treatment rooms appears to be within reach, and we discuss future research and development opportunities to achieve this goal.
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Affiliation(s)
- Susu Yan
- Division of Radiation Biophysics, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| | - Twalib A Ngoma
- Department Clinical Oncology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Wilfred Ngwa
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Department of Information and Sciences, ICT University, Yaoundé, Cameroon
| | - Thomas R Bortfeld
- Division of Radiation Biophysics, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Volz L, Sheng Y, Durante M, Graeff C. Considerations for Upright Particle Therapy Patient Positioning and Associated Image Guidance. Front Oncol 2022; 12:930850. [PMID: 35965576 PMCID: PMC9372451 DOI: 10.3389/fonc.2022.930850] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 06/17/2022] [Indexed: 11/16/2022] Open
Abstract
Particle therapy is a rapidly growing field in cancer therapy. Worldwide, over 100 centers are in operation, and more are currently in construction phase. The interest in particle therapy is founded in the superior target dose conformity and healthy tissue sparing achievable through the particles’ inverse depth dose profile. This physical advantage is, however, opposed by increased complexity and cost of particle therapy facilities. Particle therapy, especially with heavier ions, requires large and costly equipment to accelerate the particles to the desired treatment energy and steer the beam to the patient. A significant portion of the cost for a treatment facility is attributed to the gantry, used to enable different beam angles around the patient for optimal healthy tissue sparing. Instead of a gantry, a rotating chair positioning system paired with a fixed horizontal beam line presents a suitable cost-efficient alternative. Chair systems have been used already at the advent of particle therapy, but were soon dismissed due to increased setup uncertainty associated with the upright position stemming from the lack of dedicated image guidance systems. Recently, treatment chairs gained renewed interest due to the improvement in beam delivery, commercial availability of vertical patient CT imaging and improved image guidance systems to mitigate the problem of anatomical motion in seated treatments. In this review, economical and clinical reasons for an upright patient positioning system are discussed. Existing designs targeted for particle therapy are reviewed, and conclusions are drawn on the design and construction of chair systems and associated image guidance. Finally, the different aspects from literature are channeled into recommendations for potential upright treatment layouts, both for retrofitting and new facilities.
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Affiliation(s)
- Lennart Volz
- Biophysics, GSI Helmholtz Center for Heavy Ion Research GmbH, Darmstadt, Germany.,Department of Medical Physics, Shanghai Proton and Heavy Ion Center, Shanghai, China
| | - Yinxiangzi Sheng
- Biophysics, GSI Helmholtz Center for Heavy Ion Research GmbH, Darmstadt, Germany.,Department of Medical Physics, Shanghai Proton and Heavy Ion Center, Shanghai, China
| | - Marco Durante
- Biophysics, GSI Helmholtz Center for Heavy Ion Research GmbH, Darmstadt, Germany.,Institute of Condensed Matter Physics, Technical University of Darmstadt, Darmstadt, Germany
| | - Christian Graeff
- Biophysics, GSI Helmholtz Center for Heavy Ion Research GmbH, Darmstadt, Germany.,Institute of Electrical Engineering and Information Technology, Technical University of Darmstadt, Darmstadt, Germany
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Abstract
In order to support the development of high–precision spacecraft, the current state of the Stewart vibration isolation platform in the field of aerospace micro–vibration was surveyed. First, based on analyses of the causes and characteristics of spacecraft micro–vibration, the principles, characteristics, advantages and disadvantages of four vibration isolation technologies are summarized. Second, the development process of the Stewart vibration isolation platform, from structural proposal and theoretical calculation to application in various fields, is introduced. Then, the current state of kinematics, dynamics and braking control algorithms of the Stewart platform is investigated, and related work on rigid/flexible platforms in the field of aerospace micro–vibration is introduced in detail. Finally, the idea that the Stewart platform can be fabricated by 4D printing technology is proposed. The novel Stewart platform can be combined with artificial intelligence algorithms and advanced control strategies, allowing for further development in the direction of an integrated omnidirectional, full–frequency and multi–function platform with variable stiffness.
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Biological Dose Optimization for Particle Arc Therapy using Helium and Carbon Ions. Int J Radiat Oncol Biol Phys 2022; 114:334-348. [PMID: 35490991 DOI: 10.1016/j.ijrobp.2022.04.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 04/11/2022] [Accepted: 04/19/2022] [Indexed: 11/22/2022]
Abstract
PURPOSE To present biological dose optimization for particle arc therapy using helium and carbon ions. METHODS Treatment plan planning and optimization procedures were developed for spot-scanning hadron arc (SHArc) delivery using the RayStation TPS and a GPU-accelerated dose engine (†TPS-XXX). The SHArc optimization algorithm is applicable for charged particle beams and determines angle-dependencies for spot/energy selection with three main initiatives: i) achieve standard clinical optimization goals and constraints for target and OARs, ii) target dose robustness and iii) increasing LET in the target volume. Three patient cases previously treated at the †INSTITUTION-XXX were selected for evaluation of conventional versus arc delivery for the two clinical particle beams (helium [4He] and carbon [12C] ions): glioblastoma, prostate-adenocarcinoma and skull-base chordoma. Biological dose and dose-averaged linear energy transfer (LETd) distributions for SHArc were evaluated against conventional planning techniques (VMAT and IMPT2F) applying the modified microdosimetric kinetic model (mMKM) for considering bio-effect with (α/β)x=2Gy. Clinical viability and deliverability were assessed via evaluation of plan quality, robustness and irradiation time. RESULTS For all investigated patient cases, SHArc treatment optimizations met planning goals and constraints for target coverage and OARs, exhibiting acceptable target coverage and reduced normal tissue volumes with effective dose >10GyRBE compared to conventional 2F planning. For carbon ions, LETd was increased in the target volume from ∼40-60keV/µm to ∼80-140keV/µm for SHArc compared to conventional treatments. Favorable LETd distributions were possible with the SHArc approach, with maximum LETd in CTV/GTV and potential reductions of high-LET regions in normal tissues and OARs. Compared to VMAT, SHArc affords substantial reductions in normal tissue dose (40-70%). CONCLUSION SHArc therapy offers potential treatment benefits such as increased normal tissue sparing from higher doses >10GyRBE, enhanced target LETd, and potential reduction in high-LET components in OARs. Findings justify further development of robust SHArc treatment planning towards potential clinical translation.
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Hegarty S, Hardcastle N, Korte J, Kron T, Everitt S, Rahim S, Hegi-Johnson F, Franich R. Please Place Your Seat in the Full Upright Position: A Technical Framework for Landing Upright Radiation Therapy in the 21 st Century. Front Oncol 2022; 12:821887. [PMID: 35311128 PMCID: PMC8929673 DOI: 10.3389/fonc.2022.821887] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 01/27/2022] [Indexed: 12/20/2022] Open
Abstract
Delivering radiotherapy to patients in an upright position can allow for increased patient comfort, reduction in normal tissue irradiation, or reduction of machine size and complexity. This paper gives an overview of the requirements for the delivery of contemporary arc and modulated radiation therapy to upright patients. We explore i) patient positioning and immobilization, ii) simulation imaging, iii) treatment planning and iv) online setup and image guidance. Treatment chairs have been designed to reproducibly position seated patients for treatment and can be augmented by several existing immobilisation systems or promising emerging technologies such as soft robotics. There are few solutions for acquiring CT images for upright patients, however, cone beam computed tomography (CBCT) scans of upright patients can be produced using the imaging capabilities of standard Linacs combined with an additional patient rotation device. While these images will require corrections to make them appropriate for treatment planning, several methods indicate the viability of this approach. Treatment planning is largely unchanged apart from translating gantry rotation to patient rotation, allowing for a fixed beam with a patient rotating relative to it. Rotation can be provided by a turntable during treatment delivery. Imaging the patient with the same machinery as used in treatment could be advantageous for online plan adaption. While the current focus is using clinical linacs in existing facilities, developments in this area could also extend to lower-cost and mobile linacs and heavy ion therapy.
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Affiliation(s)
- Sarah Hegarty
- School of Science, RMIT University, Melbourne, VIC, Australia.,Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Nicholas Hardcastle
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia.,Sir Peter MacCallum Department of Oncology, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Parkville, VIC, Australia
| | - James Korte
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Department of Biomedical Engineering, School of Engineering, University of Melbourne, Melbourne, VIC, Australia
| | - Tomas Kron
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia.,Sir Peter MacCallum Department of Oncology, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Parkville, VIC, Australia
| | - Sarah Everitt
- Sir Peter MacCallum Department of Oncology, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Parkville, VIC, Australia.,Department of Radiation Therapy, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Sulman Rahim
- Department of Radiation Therapy, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Fiona Hegi-Johnson
- Sir Peter MacCallum Department of Oncology, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Parkville, VIC, Australia.,Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Rick Franich
- School of Science, RMIT University, Melbourne, VIC, Australia.,Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
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Ramesh P, Liu H, Gu W, Sheng K. Fixed Beamline Optimization for Intensity Modulated Carbon-Ion Therapy. IEEE TRANSACTIONS ON RADIATION AND PLASMA MEDICAL SCIENCES 2022; 6:288-293. [PMID: 36092271 PMCID: PMC9457306 DOI: 10.1109/trpms.2021.3092296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A major obstacle for the adoption of heavy ion therapy is the cost and technical difficulties to construct and maintain a rotational gantry. Many heavy ion treatment facilities instead choose to construct fixed beamlines as a compromise, which we propose to mitigate with optimized treatment couch angle. We formulate the integrated beam orientation and scanning spot optimization problem as a quadratic cost function with a group sparsity regularization term. The optimization problem is efficiently solved using fast iterative shrinkage-thresholding algorithm (FISTA). To test the method, we created the fixed beamline plans with couch rotation (FBCR) and without couch rotation (FB) for intensity modulated carbon-ion therapy (IMCT) and compared with the ideal scenario where both the couch and gantry have 360 degrees of freedom (GCR). FB, FBCR, and GCR IMCT plans were compared for ten pancreas cases. The FBCR plans show comparable PTV coverage and OAR doses for each pancreas case. In conclusion, the dosimetric limitation of fixed beams in heavy ion radiotherapy may be largely mitigated with integrated beam orientation optimization of the couch rotation.
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Affiliation(s)
- Pavitra Ramesh
- Physics and Biology in Medicine interdepartmental program, University of California Los Angeles, Los Angeles, CA 90025 USA
| | - Hengjie Liu
- Physics and Biology in Medicine interdepartmental program, University of California Los Angeles, Los Angeles, CA 90025 USA
| | - Wenbo Gu
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA 19104 USA
| | - Ke Sheng
- Physics and Biology in Medicine interdepartmental program, University of California Los Angeles, Los Angeles, CA 90025 USA
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11
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Durante M, Debus J, Loeffler JS. Physics and biomedical challenges of cancer therapy with accelerated heavy ions. NATURE REVIEWS. PHYSICS 2021; 3:777-790. [PMID: 34870097 PMCID: PMC7612063 DOI: 10.1038/s42254-021-00368-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Radiotherapy should have low toxicity in the entrance channel (normal tissue) and be very effective in cell killing in the target region (tumour). In this regard, ions heavier than protons have both physical and radiobiological advantages over conventional X-rays. Carbon ions represent an excellent combination of physical and biological advantages. There are a dozen carbon-ion clinical centres in Europe and Asia, and more under construction or at the planning stage, including the first in the USA. Clinical results from Japan and Germany are promising, but a heated debate on the cost-effectiveness is ongoing in the clinical community, owing to the larger footprint and greater expense of heavy ion facilities compared with proton therapy centres. We review here the physical basis and the clinical data with carbon ions and the use of different ions, such as helium and oxygen. Research towards smaller and cheaper machines with more effective beam delivery is necessary to make particle therapy affordable. The potential of heavy ions has not been fully exploited in clinics and, rather than there being a single 'silver bullet', different particles and their combination can provide a breakthrough in radiotherapy treatments in specific cases.
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Affiliation(s)
- Marco Durante
- Biophysics Department, GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
- Institute of Condensed Matter Physics, Technische Universität Darmstadt, Darmstadt, Germany
| | - Jürgen Debus
- Department of Radiation Oncology and Heidelberg Ion Beam Therapy Center, Heidelberg University Hospital, Heidelberg, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jay S. Loeffler
- Departments of Radiation Oncology and Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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12
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Sun J, Kong L, Chen Z, You D, Mao J, Guan X, Wu X, Sheng Y. Clinical Implementation of a 6D Treatment Chair for Fixed Ion Beam Lines. Front Oncol 2021; 11:694749. [PMID: 34249751 PMCID: PMC8260974 DOI: 10.3389/fonc.2021.694749] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 05/31/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose To verify the practicality and safety of a treatment chair with six degrees of freedom (6DTC) through demonstrating the efficacy of the workflow in clinical settings and analyzing the obtained technical data, including intra-fraction patient movement during the use of the 6DTC. Materials and Methods A clinical study was designed and conducted to test the clinical treatment workflow and the safety of the 6DTC. Based on the demonstrated dosimetric advantages, fifteen patients with head and neck tumors were selected and treated with the 6DTC. The positional error at the first beam position (PE-B1) and the second beam position (PE-B2) were analyzed and compared with the results from daily quality assurance (QA) procedures of the 6DTC and imaging system performed each day before clinical treatment. The intra-fraction patient movement was derived from the total patient alignment positional error and the QA data based on a Gaussian distribution formulism. Results The QA results showed sub-millimeter mechanical accuracy of the 6DTC over the course of the clinical study. For 150 patient treatment fractions, the mean deviations between PE-B1 and PE-B2 were 0.13mm (SD 0.88mm), 0.25mm (SD 1.17mm), -0.57mm (SD 0.85mm), 0.02° (SD 0.35°), 0.00° (SD 0.37°), and -0.02° (SD 0.37°) in the x, y, z (translational), and u, v, w (rotational) directions, respectively. The calculated intra-fraction patient movement was -0.08mm (SD 0.56mm), 0.71mm (SD 1.12mm), -0.52mm (SD 0.84mm), 0.10° (SD 0.32°), 0.09° (SD 0.36°), and -0.04° (SD 0.36°) in the x, y, z, u, v, w directions, respectively. Conclusions The performance stability of the 6DTC was satisfactory. The position accuracy and intra-fraction patient movement in an upright posture with the 6DTC were verified and found adequate for clinical implementation.
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Affiliation(s)
- Jiayao Sun
- Department of Medical Physics, Shanghai Proton and Heavy Ion Center, Shanghai, China.,Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai, China.,Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
| | - Lin Kong
- Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai, China.,Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China.,Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, China
| | - Zhi Chen
- Department of Medical Physics, Shanghai Proton and Heavy Ion Center, Shanghai, China.,Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai, China.,Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
| | - Dan You
- Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai, China.,Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China.,Department of Medical Physics, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, China
| | - Jingfang Mao
- Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai, China.,Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China.,Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, China
| | - Xiyin Guan
- Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai, China.,Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China.,Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Shanghai, China
| | - Xiaodong Wu
- Department of Medical Physics, Shanghai Proton and Heavy Ion Center, Shanghai, China.,Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai, China.,Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
| | - Yinxiangzi Sheng
- Department of Medical Physics, Shanghai Proton and Heavy Ion Center, Shanghai, China.,Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai, China.,Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
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Mein S, Tessonnier T, Kopp B, Harrabi S, Abdollahi A, Debus J, Haberer T, Mairani A. Spot-Scanning Hadron Arc (SHArc) Therapy: A Study With Light and Heavy Ions. Adv Radiat Oncol 2021; 6:100661. [PMID: 33817410 PMCID: PMC8010580 DOI: 10.1016/j.adro.2021.100661] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 12/29/2020] [Accepted: 01/18/2021] [Indexed: 12/27/2022] Open
Abstract
PURPOSE To evaluate the clinical potential of spot-scanning hadron arc (SHArc) therapy with a heavy-ion gantry. METHODS AND MATERIALS A series of in silico studies was conducted via treatment plan optimization in FRoG and the RayStation TPS to compare SHArc therapy against reference plans using conventional techniques with single, parallel-opposed, and 3-field configurations for 3 clinical particle beams (protons [p], helium [4He], and carbon [12C] ions). Tests were performed on water-equivalent cylindrical phantoms for simple targets and clinical-like scenarios with an organ-at-risk in proximity of the target. Effective dose and dose-averaged linear energy transfer (LETD) distributions for SHArc were evaluated against conventional planning techniques applying the modified microdosimetric kinetic model for considering bio-effect with (α/β)x = 2 Gy. A model for hypoxia-induced tumor radio-resistance was developed for particle therapy with dependence on oxygen concentration and particle species/energy (Zeff/β)2 to investigate the impact on effective dose. RESULTS SHArc plans exhibited similar target coverage with unique treatment attributes and distributions compared with conventional planning, with carbon ions demonstrating the greatest potential for tumor control and normal tissue sparing among the arc techniques. All SHArc plans exhibited a low-dose bath outside the target volume with a reduced maximum dose in normal tissues compared with single, parallel-opposed, and 3-field configuration plans. Moreover, favorable LETD distributions were made possible using the SHArc approach, with maximum LETD in the r = 5 mm tumor core (~8 keVμm-1, ~30 keVμm-1, and ~150 keVμm-1 for p, 4He, and 12C ions, respectively) and reductions of high-LET regions in normal tissues and organs-at-risk compared with static treatment beam delivery. CONCLUSION SHArc therapy offers potential treatment benefits such as increased normal tissue sparing. Without explicit consideration of oxygen concentration during treatment planning and optimization, SHArc-C may mitigate tumor hypoxia-induced loss of efficacy. Findings justify further development of robust SHArc treatment planning toward potential clinical translation.
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Affiliation(s)
- Stewart Mein
- Clinical Cooperation Unit Translational Radiation Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital (UKHD) and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Division of Molecular and Translational Radiation Oncology, Department of Radiation Oncology, Heidelberg Faculty of Medicine (MFHD) and Heidelberg University Hospital (UKHD), Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg, Germany
- German Cancer Consortium (DKTK) Core-Center Heidelberg, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Oncology (NCRO), Heidelberg University and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Thomas Tessonnier
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Benedikt Kopp
- Clinical Cooperation Unit Translational Radiation Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital (UKHD) and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Division of Molecular and Translational Radiation Oncology, Department of Radiation Oncology, Heidelberg Faculty of Medicine (MFHD) and Heidelberg University Hospital (UKHD), Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg, Germany
- German Cancer Consortium (DKTK) Core-Center Heidelberg, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Oncology (NCRO), Heidelberg University and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Physics and Astronomy, Heidelberg University, Germany
| | - Semi Harrabi
- German Cancer Consortium (DKTK) Core-Center Heidelberg, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Oncology (NCRO), Heidelberg University and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Amir Abdollahi
- Clinical Cooperation Unit Translational Radiation Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital (UKHD) and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Division of Molecular and Translational Radiation Oncology, Department of Radiation Oncology, Heidelberg Faculty of Medicine (MFHD) and Heidelberg University Hospital (UKHD), Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg, Germany
- German Cancer Consortium (DKTK) Core-Center Heidelberg, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Oncology (NCRO), Heidelberg University and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jürgen Debus
- German Cancer Consortium (DKTK) Core-Center Heidelberg, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Oncology (NCRO), Heidelberg University and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Faculty of Physics and Astronomy, Heidelberg University, Germany
- National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Thomas Haberer
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Andrea Mairani
- Clinical Cooperation Unit Translational Radiation Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital (UKHD) and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- National Centre of Oncological Hadrontherapy (CNAO), Medical Physics, Pavia, Italy
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Maes D, Janson M, Regmi R, Egan A, Rosenfeld A, Bloch C, Wong T, Saini J. Validation and practical implementation of seated position radiotherapy in a commercial TPS for proton therapy. Phys Med 2020; 80:175-185. [PMID: 33189048 DOI: 10.1016/j.ejmp.2020.10.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 09/30/2020] [Accepted: 10/29/2020] [Indexed: 12/31/2022] Open
Abstract
PURPOSE This work aims to validate new 6D couch features and their implementation for seated radiotherapy in RayStation (RS) treatment planning system (TPS). MATERIALS AND METHODS In RS TPS, new 6D couch features are (i) chair support device, (ii) patient treatment option of "Sitting: face towards the front of the chair", and (iii) patient support pitch and roll capabilities. The validation of pitch and roll was performed by comparing TPS generated DRRs with planar x-rays. Dosimetric tests through measurement by 2D ion chamber array were performed for beams created with varied scanning and treatment orientation and 6D couch rotations. For the implementation of 6D couch features for treatments in a seated position, the TPS and oncology information system (Mosaiq) settings are described for a commercial chair. An end-to-end test using an anthropomorphic phantom was performed to test the complete workflow from simulation to treatment delivery. RESULTS The 6D couch features were found to have a consistent implementation that met IEC 61712 standard. The DRRs were found to have an acceptable agreement with planar x-rays based on visual inspection. For dose map comparison between measured and calculated, the gamma index analysis for all the beams was >95% at a 3% dose-difference and 3 mm distance-to-agreement tolerances. For an end-to end-testing, the phantom was successfully set up at isocenter in the seated position and treatment was delivered. CONCLUSIONS Chair-based treatments in a seated position can be implemented in RayStation through the use of newly released 6D couch features.
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Affiliation(s)
- Dominic Maes
- Seattle Cancer Care Alliance Proton Therapy Center, 1570 N 115th St., Seattle, WA 98133, United States; Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW 2500, Australia
| | - Martin Janson
- RaySearch Laboratories, Sveavägen 44, 111 34 Stockholm, Sweden
| | - Rajesh Regmi
- Seattle Cancer Care Alliance Proton Therapy Center, 1570 N 115th St., Seattle, WA 98133, United States
| | - Alexander Egan
- Seattle Cancer Care Alliance Proton Therapy Center, 1570 N 115th St., Seattle, WA 98133, United States
| | - Anatoly Rosenfeld
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW 2500, Australia
| | - Charles Bloch
- Seattle Cancer Care Alliance Proton Therapy Center, 1570 N 115th St., Seattle, WA 98133, United States; Departments of Radiation Oncology, University of Washington School of Medicine, 1959 NE Pacific St., Seattle, WA 98195, United States
| | - Tony Wong
- Seattle Cancer Care Alliance Proton Therapy Center, 1570 N 115th St., Seattle, WA 98133, United States; Departments of Radiation Oncology, University of Washington School of Medicine, 1959 NE Pacific St., Seattle, WA 98195, United States
| | - Jatinder Saini
- Seattle Cancer Care Alliance Proton Therapy Center, 1570 N 115th St., Seattle, WA 98133, United States; Departments of Radiation Oncology, University of Washington School of Medicine, 1959 NE Pacific St., Seattle, WA 98195, United States.
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