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Freislederer P, Batista V, Öllers M, Buschmann M, Steiner E, Kügele M, Fracchiolla F, Corradini S, de Smet M, Moura F, Perryck S, Dionisi F, Nguyen D, Bert C, Lehmann J. ESTRO-ACROP guideline on surface guided radiation therapy. Radiother Oncol 2022; 173:188-196. [PMID: 35661677 DOI: 10.1016/j.radonc.2022.05.026] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 05/26/2022] [Indexed: 10/18/2022]
Abstract
Surface guidance systems enable patient positioning and motion monitoring without using ionising radiation. Surface Guided Radiation Therapy (SGRT) has therefore been widely adopted in radiation therapy in recent years, but guidelines on workflows and specific quality assurance (QA) are lacking. This ESTRO-ACROP guideline aims to give recommendations concerning SGRT roles and responsibilities and highlights common challenges and potential errors. Comprehensive guidelines for procurement, acceptance, commissioning, and QA of SGRT systems installed on computed tomography (CT) simulators, C-arm linacs, closed-bore linacs, and particle therapy treatment systems are presented that will help move to a consensus among SGRT users and facilitate a safe and efficient implementation and clinical application of SGRT.
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Affiliation(s)
- P Freislederer
- Department of Radiation Oncology, LMU University Hospital, Munich, Germany.
| | - V Batista
- Department of Radiation Oncology, Heidelberg University Hospital, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
| | - M Öllers
- Department of Radiotherapy, MAASTRO, Maastricht, The Netherlands
| | - M Buschmann
- Department of Radiation Oncology, Medical University of Vienna/AKH Wien, Austria
| | - E Steiner
- Institute for Radiation Oncology and Radiotherapy, Landesklinikum Wiener Neustadt, Austria
| | - M Kügele
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - F Fracchiolla
- Azienda Provinciale per i Servizi Sanitari (APSS) Protontherapy Department, Trento, Italy
| | - S Corradini
- Department of Radiation Oncology, LMU University Hospital, Munich, Germany
| | - M de Smet
- Department of Medical Physics & Instrumentation, Institute Verbeeten, Tilburg, The Netherlands
| | - F Moura
- Hospital CUF Descobertas, Department of Radiation Oncology, Lisbon, Portugal
| | - S Perryck
- Department of Radiation Oncology, University Hospital Zürich, Switzerland
| | - F Dionisi
- Department of Radiation Oncology, IRCSS Regina Elena National Cancer Institute, Rome, Italy
| | - D Nguyen
- Centre de Radiothérapie de Mâcon, France
| | - C Bert
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - J Lehmann
- Radiation Oncology Department, Calvary Mater Newcastle, Australia; School of Information and Physical Sciences, University of Newcastle, Australia; Institute of Medical Physics, University of Sydney, Australia
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Jiang P, Liu Z, Jiang W, Qu A, Sun H, Wang J. Detection of setup errors with a body-surface laser-scanning system for whole-breast irradiation after breast-conserving surgery. J Appl Clin Med Phys 2022; 23:e13578. [PMID: 35293667 PMCID: PMC9121044 DOI: 10.1002/acm2.13578] [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: 11/19/2020] [Revised: 12/23/2022] [Accepted: 02/15/2022] [Indexed: 11/06/2022] Open
Abstract
PURPOSE We compared the setup errors determined by an optical imaging system (OSIS) in women who received breast-conserving surgery (BCS) followed by whole-breast radiotherapy (WBRT) with those from cone-beam computed tomography (CBCT) carried out routinely. METHODS We compared 130 setup errors in 10 patients undergoing WBRT following BCS by analyzing the translational and rotational couch shifts via CBCT and OSIS. Patients were treated with intensity-modulated radiotherapy (IMRT). The patient outline extracted from the planning reference Computed tomography (CT) was used as the reference for OSIS and CBCT alignment during treatment. We detected the setup uncertainty using CBCT and OSIS at the first five fractionations of RT and then twice a week. RESULTS The absolute translational setup error (mean ± Standard deviation (SD)) in x (lateral), y (longitudinal), and z (vertical) axes detected by the OSIS was 0.14 ± 0.18, 0.15 ± 0.14, and 0.13 ± 0.13 cm, respectively. The rotational setup error (mean ± SD) in Rx (pitch), Ry (roll), and Rz (yaw) axes was 0.77 ± 0.54, 0.76 ± 0.61, and 1.23 ± 0.95, respectively. Significant difference is observed only in one direction (Rx, p = 0.03) in the paired setup errors obtaining from OSIS and CBCT, without significant differences in five directions. CONCLUSION OSIS is a repeatable and reliable system that can be used to detect misalignments with accuracy, which is capable of supplementing CBCT for WBRT after BCS. We believe that an OSIS may be easier to use, quicker, and reduce overall dose as this method of patient alignment does not require ionizing radiation.
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Affiliation(s)
- Ping Jiang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Ziyi Liu
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Weijuan Jiang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Ang Qu
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Haitao Sun
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Junjie Wang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
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Johnson PB, Jackson A, Saki M, Feldman E, Bradley J. Patient posture correction and alignment using mixed reality visualization and the HoloLens 2. Med Phys 2021; 49:15-22. [PMID: 34780068 DOI: 10.1002/mp.15349] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 10/08/2021] [Accepted: 11/02/2021] [Indexed: 12/17/2022] Open
Abstract
PURPOSE The purpose of this study was to develop and preliminarily test a radiotherapy system for patient posture correction and alignment using mixed reality (MixR) visualization. The write-up of this work also provides an opportunity to introduce the concepts and technology of MixR for a medical physics audience who may be unfamiliar with the topic. METHODS A MixR application was developed for on optical-see-through head-mounted display (HoloLens 2) allowing a user to simultaneously and directly view a patient and a reference hologram derived from their simulation CT scan. The hologram provides a visual reference for the exact posture needed during treatment and is initialized in relation to the origin of a radiotherapy device using marker-based tracking. The system further provides marker-less tracking that allows the user tofreely navigate the room as they view and align the patient from various angles. The system was preliminarily tested using both a rigid (pelvis) and nonrigid (female mannequin) anthropomorphic phantom. Each phantom was aligned via hologram and accuracy quantified using CBCT and CT. RESULTS A fully realized system was developed. Rigid registration accuracy was on the order of 3.0 ± 1.5 mm based on the performance of three users repeating alignment five times each. The lateral direction showed the most variability among users and was associated with the largest off-sets (approximately 2.0 mm). For nonrigid alignment, the MixR setup outperformed a setup based on three-point alignment and setup photos, the latter of which showed a difference in arm position of 2 cm and a torso roll of 6-7°. CONCLUSIONS MixR visualization is a rapidly emerging domain that has the potential to significantly impact the field of medicine. The current application is an illustration of this and highlights the advantages of MixR for patient setup in radiation oncology. The key feature of the system is the way in which it transforms nonrigid registration into rigid registration by providing an efficient, portable, and cost-effective mechanism for reproducing patient posture without the use of ionizing radiation. Preliminary estimates of registration accuracy indicate clinical viability and form the foundation for further development and clinical testing.
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Affiliation(s)
- Perry B Johnson
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida, USA.,University of Florida Health Proton Therapy Institute, Jacksonville, Florida, USA
| | - Amanda Jackson
- Department of Radiology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Mohammad Saki
- University of Florida Health Proton Therapy Institute, Jacksonville, Florida, USA
| | - Emily Feldman
- University of Florida Health Proton Therapy Institute, Jacksonville, Florida, USA
| | - Julie Bradley
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida, USA.,University of Florida Health Proton Therapy Institute, Jacksonville, Florida, USA
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Kim JI, Chung JH, Kwon O, Min Park J, Wu HG. Correlation between 3D scanner image and MRI for tracking volume changes in head and neck cancer patients. J Appl Clin Med Phys 2021; 22:86-93. [PMID: 33522671 PMCID: PMC7984490 DOI: 10.1002/acm2.13181] [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: 04/10/2020] [Revised: 10/16/2020] [Accepted: 12/21/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction We investigated the correlation between optical surface imaging using a three‐dimensional (3D) scanner and magnetic resonance imaging (MRI) for suggesting feasibility in the clinical process of tracking volume changes in head and neck patients during radiation treatment. Methods Ten patients were divided into two groups depending on the location of their tumor (i.e., right or left side). With weekly imaging data, the change in volume based on MRI was evaluated during the treatment course. Four volumes of interest (VOIs) were calculated on the 3D surface image of the facial and cervical areas using an optical 3D scanner, and the correlation between volumetric parameters were analyzed. Results The target volume changed significantly overall for both groups. The changes parotid volume reduced by up to 3.8% and 28.0% for groups A (right side) and B (left side), respectively. In Group A, VOI 1 on the facial area and VOI 3 on the cervical area decreased gradually during the treatment course by up to 3.3% and 10.7%, respectively. In Group B, only VOI 4 decreased gradually during the treatment course and reduced by up to 9.2%. In group A, the change in target volume correlated strongly with right‐side parotid, VOI 1, and VOI 3, respectively. The parotid also showed strong correlations with VOIs (P < 0.01). The weight loss was strongly correlated with either PTV or parotid without statistical significance (P > 0.05). In group B (left side), the change in target volume correlated strongly with each volumetric parameter, including weight loss. For individual patient, PTV showed more correlation with VOIs on the cervical area than VOIs on the facial area. Conclusions An optical 3D scanner can be applied to track changes in volume without radiation exposure during treatment and the optical surface image correlated with MRI.
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Affiliation(s)
- Jung-In Kim
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea.,Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
| | - Joo-Hyun Chung
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea
| | - Ohyun Kwon
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Jong Min Park
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea.,Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.,Robotics Research Laboratory for Extreme Environments, Advanced Institutes of Convergence Technology, Suwon, Korea
| | - Hong-Gyun Wu
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea.,Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.,Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
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Zhang W, Li R, You D, Su Y, Dong W, Ma Z. Dosimetry and Feasibility Studies of Volumetric Modulated Arc Therapy With Deep Inspiration Breath-Hold Using Optical Surface Management System for Left-Sided Breast Cancer Patients. Front Oncol 2020; 10:1711. [PMID: 33014848 PMCID: PMC7494967 DOI: 10.3389/fonc.2020.01711] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 07/31/2020] [Indexed: 01/29/2023] Open
Abstract
Background During radiotherapy (RT) procedure of breast cancer, portions of the heart and lung will receive some radiation dose, which may result in acute and late toxicities. In the current study, we report the experience of our single institution with organs at risk (OARs)–sparing RT with deep inspiration breath hold (DIBH) using an Optical Surface Management System (OSMS) and compare the dosimetric parameters with that of free breathing (FB). Patients and Methods Forty-eight cases diagnosed as early stage left-sided breast cancer scheduled for postoperative RT were enrolled. The OSMS was used to monitor the breathing magnitude and track the real-time respiratory status, which can control a stable lung and heart volume during RT delivery under DIBH. We did the dosimetric analysis of the heart, left anterior descending (LAD) coronary artery, lungs, and contralateral breast under FB and DIBH plans. Results Compared with FB–volumetric-modulated arc therapy (FB-VMAT), DIBH-VMAT resulted in significantly changed volumes to the heart and lungs receiving irradiation dose. The average mean heart dose and average D2%, V5, and V10 showed significant differences between the DIBH and FB techniques. For the LAD coronary artery, we found significantly reduced average mean dose, D2%, and V10 with DIBH. Similar results were also found in the lungs and contralateral breast. The use of flattening-filter–free decreased treatment time compared with the flat beam mode in our VMAT (p < 0.05). For the 48 patients, there were no significant differences in the lateral, longitudinal, and vertical directions between OSMS and cone beam CT. Conclusions DIBH-VMAT with OSMS is very feasible in daily practice with excellent patient compliance in our single-center experience. Note that OSMS is an effective tool that may allow easier-to-achieve precise positioning and better and shorter position-verify time. Meanwhile, compared with FB, DIBH was characterized by lower doses to OARs, which may reduce the probability of cardiac and pulmonary complications in the future.
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Affiliation(s)
- Wei Zhang
- Department of Radiation Oncology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Ruisheng Li
- Department of Medical Imaging, Yantai Yuhuangding Hospital, Yantai, China
| | - Dong You
- Department of Radiation Oncology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Yi Su
- Department of Radiation Oncology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Wei Dong
- Department of Radiation Oncology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Zhao Ma
- Department of Radiation Oncology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
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Saito M, Sano N, Kuriyama K, Komiyama T, Marino K, Aoki S, Maehata Y, Suzuki H, Ueda K, Onishi H. New method for measurement of chest surface motion in lung cancer patients: Quantification using a technique of deformable image registration. Med Dosim 2020; 46:111-116. [PMID: 32972812 DOI: 10.1016/j.meddos.2020.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 08/27/2020] [Accepted: 09/11/2020] [Indexed: 11/29/2022]
Abstract
The purpose of this study was to measure the motion of the chest surface during breath-holding treatment for lung cancer using deformable image registration (DIR). Forty non-small-cell lung cancer patients treated with breath-holding stereotactic body radiation therapy were retrospectively examined. First, intensity-based DIR between 2 breath-holding computed tomography (CT) images was performed. Subsequently, deformation vector field (DVF) for all dimensions (left-right, anterior-posterior, and superior-inferior) was calculated from the result. For the analysis of chest surface, the DVF value of the only chest surface area was extracted after the chest surface was divided into 12 regions of interest (ROI) based on anatomy. Additionally, for the analysis of the correlation with the internal tumor motion, the median value of DVF for each surface ROI and the motion of the center of gravity of the tumor volume were used. It was possible to calculate the motion of chest surface without any outliers for all patients. For the average of 12 surface ROIs, the motion of 3D chest surface was within 2 mm (30 cases), 3 mm (8 cases), and 4 mm (2 cases). There was no correlation between the motion of the chest surface and that of the tumor for all 12 surface ROIs. We proposed a technique to evaluate the surface motion using DIR between multiple CT images. It could be a useful tool to calculate the motion of chest surface.
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Affiliation(s)
- Masahide Saito
- Department of Radiology, University of Yamanashi, Yamanashi, Japan.
| | - Naoki Sano
- Department of Radiology, University of Yamanashi, Yamanashi, Japan
| | - Kengo Kuriyama
- Department of Radiology, University of Yamanashi, Yamanashi, Japan
| | | | - Kan Marino
- Department of Radiology, University of Yamanashi, Yamanashi, Japan
| | - Shinichi Aoki
- Department of Radiology, University of Yamanashi, Yamanashi, Japan
| | | | - Hidekazu Suzuki
- Department of Radiology, University of Yamanashi, Yamanashi, Japan
| | - Koji Ueda
- Department of Radiology, University of Yamanashi, Yamanashi, Japan
| | - Hiroshi Onishi
- Department of Radiology, University of Yamanashi, Yamanashi, Japan
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Variability in lymph node irradiation in patients with breast cancer-results from a multi-center survey in German-speaking countries. Strahlenther Onkol 2019; 196:15-22. [PMID: 31722060 DOI: 10.1007/s00066-019-01537-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 10/23/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Lymph node irradiation in breast cancer has gained complexity due to recently published studies and technical innovations which then led to changes in international guidelines. We sought to determine real-time variability in lymph node irradiation in clinical practice in German-speaking countries. METHODS The Department of Radiation Oncology, Technical University of Munich (TUM), developed an online-based questionnaire focusing on the indication, target definition, and treatment technique of lymph node irradiation in patients with breast cancer. The invitation to participate in the survey was sent to members of the German Society of Radiation Oncology (DEGRO) by e‑mail. The results of the survey were exported from the online platform into SPSS for a detailed analysis. RESULTS In total, 100 physicians completed the questionnaire between 05/2019 and 06/2019. Despite the existence of several treatment and contouring guidelines, we observed large variability of lymph node irradiation: The guideline recommendation for internal mammary irradiation is not consistently implemented in clinical practice and irradiation of the axilla after positive SLNB (sentinel lymph node biopsy) or ALND (axillary lymph node dissection) is handled very differently. Furthermore, in most clinics, the ESTRO (European Society for Therapeutic Radiology and Oncology) contouring consensus is not used, and PTV (planning target volume) definitions and margins vary considerably. CONCLUSION Further clinical studies should be performed with a particular focus on radiotherapy for lymphatic drainage to support and amend the existing guidelines. These studies should establish a more standardized treatment of the lymph node regions in clinical practice. Quality assurance should enforce broad implementation of consensus recommendations.
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Sarmadi H, Muñoz-Salinas R, Álvaro Berbís M, Luna A, Medina-Carnicer R. 3D Reconstruction and alignment by consumer RGB-D sensors and fiducial planar markers for patient positioning in radiation therapy. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2019; 180:105004. [PMID: 31421609 DOI: 10.1016/j.cmpb.2019.105004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 07/30/2019] [Accepted: 07/31/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND AND OBJECTIVE Patient positioning is a crucial step in radiation therapy, for which non-invasive methods have been developed based on surface reconstruction using optical 3D imaging. However, most solutions need expensive specialized hardware and a careful calibration procedure that must be repeated over time.This paper proposes a fast and cheap patient positioning method based on inexpensive consumer level RGB-D sensors. METHODS The proposed method relies on a 3D reconstruction approach that fuses, in real-time, artificial and natural visual landmarks recorded from a hand-held RGB-D sensor. The video sequence is transformed into a set of keyframes with known poses, that are later refined to obtain a realistic 3D reconstruction of the patient. The use of artificial landmarks allows our method to automatically align the reconstruction to a reference one, without the need of calibrating the system with respect to the linear accelerator coordinate system. RESULTS The experiments conducted show that our method obtains a median of 1 cm in translational error, and 1∘of rotational error with respect to reference pose. Additionally, the proposed method shows as visual output overlayed poses (from the reference and the current scene) and an error map that can be used to correct the patient's current pose to match the reference pose. CONCLUSIONS A novel approach to obtain 3D body reconstructions for patient positioning without requiring expensive hardware or dedicated graphic cards is proposed. The method can be used to align in real time the patient's current pose to a preview pose, which is a relevant step in radiation therapy.
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Affiliation(s)
- Hamid Sarmadi
- Instituto Maimónides de Investigación en Biomedicina (IMIBIC), Avenida Menéndez Pidal s/n, Córdoba 14004, Spain.
| | - Rafael Muñoz-Salinas
- Computing and Numerical Analysis Department, Edificio Einstein, Córdoba University, Campus de Rabanales, Córdoba 14071, Spain; Instituto Maimónides de Investigación en Biomedicina (IMIBIC), Avenida Menéndez Pidal s/n, Córdoba 14004, Spain.
| | | | - Antonio Luna
- Health Time, Clínica las Nieves, Carmelo Torres 2, Jaén 23007, Spain.
| | - R Medina-Carnicer
- Computing and Numerical Analysis Department, Edificio Einstein, Córdoba University, Campus de Rabanales, Córdoba 14071, Spain; Instituto Maimónides de Investigación en Biomedicina (IMIBIC), Avenida Menéndez Pidal s/n, Córdoba 14004, Spain.
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Development and accuracy evaluation of a single-camera intra-bore surface scanning system for radiotherapy in an O-ring linac. Phys Imaging Radiat Oncol 2019; 11:21-26. [PMID: 33458272 PMCID: PMC7807582 DOI: 10.1016/j.phro.2019.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 06/28/2019] [Accepted: 07/03/2019] [Indexed: 11/22/2022] Open
Abstract
Background and purpose Current commercial surface scanning systems are not able to monitor patients during radiotherapy fractions in closed-bore linacs during adaptive workflows. In this work a surface scanning system for monitoring in an O-ring linac is proposed. Methods and materials A depth camera was mounted at the backend of the bore. The acquired surface point cloud was transformed to the linac coordinate system after a cube detection calibration step. The real-time surface was registered using an Iterative Closest Point algorithm to a reference region-of-interest of the body contour from the planning CT and of a depth camera surface acquisition from the first fraction. The positioning accuracy was investigated using anthropomorphic 3D-printed phantoms with embedded markers: a head, hand and breast. To simulate clinically observed positioning errors, each phantom was placed 24 times with 0-10 mm and 0-8° offsets from the planned position. At every position a cone-beam CT (CBCT) was acquired and a surface registration performed. The surface registration error was determined as the difference between the surface registration and the CBCT-to-CT fiducial marker registration. Results The registration errors were (mean ± SD): lat: 0.4 ± 0.8 mm, vert: -0.2 ± 0.2 mm, long: 0.3 ± 0.5 mm and Yaw: -0.2 ± 0.6°, Pitch: 0.4 ± 0.2°, Roll: 0.5 ± 0.8° for the body contour reference, and lat: -0.7 ± 0.7 mm, vert: 0.3 ± 0.2 mm, long: 0.2 ± 0.5 mm and Yaw: -0.5 ± 0.5°, Pitch: 0.1 ± 0.3°, Roll: -0.7 ± 0.7° for the captured surface reference. Conclusion The proposed single camera intra-bore surface system was capable of accurately detecting phantom displacements and allows intrafraction motion monitoring for surface guided radiotherapy inside the bore of O-ring gantries.
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Pazos M, Walter F, Reitz D, Schönecker S, Konnerth D, Schäfer A, Rottler M, Alongi F, Freislederer P, Niyazi M, Belka C, Corradini S. Impact of surface-guided positioning on the use of portal imaging and initial set-up duration in breast cancer patients. Strahlenther Onkol 2019; 195:964-971. [PMID: 31332457 DOI: 10.1007/s00066-019-01494-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 06/27/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The impact of optical surface guidance on the use of portal imaging and the initial set-up duration in patients receiving postoperative radiotherapy of the breast or chest wall was investigated. MATERIAL AND METHODS A retrospective analysis was performed including breast cancer patients who received postoperative radiotherapy between January 2016 and December 2016. One group of patients received treatment before the optical surface scanner was installed (no-OSS) and the other group was positioned using the additional information derived by the optical surface scanner (OSS). The duration of the initial set-up was recorded for each patient and a comparison of both groups was performed. Accordingly, the differences between planned and actually acquired portal images during the course of radiotherapy were compared between both groups. RESULTS A total of 180 breast cancer patients were included (90 no-OSS, 90 OSS) in this analysis. Of these, 30 patients with left-sided breast cancer received radiotherapy in deep inspiration breath hold (DIBH). The mean set-up time was 10 min and 18 s and no significant difference between the two groups of patients was found (p = 0.931). The mean set-up time in patients treated without DIBH was 9 min and 45 s compared to 13 min with DIBH (p < 0.001), as portal imaging was performed in DIBH. No significant difference was found in the number of acquired to the planned number of portal images during the entire radiotherapy treatment for both groups (p = 0.287). CONCLUSION Optical surface imaging is a valuable addition for primary patient set-up. The findings confirm that the addition of surface-based imaging did not prolong the clinical workflow and had no significant impact on the number of portal verification images carried out during the course of radiotherapy.
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Affiliation(s)
- Montserrat Pazos
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Franziska Walter
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany.
| | - Daniel Reitz
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Stephan Schönecker
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Dinah Konnerth
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Annemarie Schäfer
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Maya Rottler
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Filippo Alongi
- Advanced Radiation Oncology Department, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar-Verona, Italy.,University of Brescia, Brescia, Italy
| | - Philipp Freislederer
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Maximilian Niyazi
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
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Shimizu H, Sasaki K, Aoyama T, Matsushima S, Isomura T, Fukuma H, Tachibana H, Kodaira T. Development of twist‐correction system for radiotherapy of head and neck cancer patients. J Appl Clin Med Phys 2019; 20:128-134. [PMID: 31222881 PMCID: PMC6612693 DOI: 10.1002/acm2.12667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 04/04/2019] [Accepted: 05/05/2019] [Indexed: 11/09/2022] Open
Abstract
To propose a concept for correcting the twist between the head and neck and the body frequently occurring in radiotherapy patients and to develop a prototype device for achieving this. Furthermore, the operational accuracy of this device under no load was evaluated. We devised a concept for correcting the twist of patients by adjustment of the three rotation (pitch, roll, and yaw) angles in two independent plates connected by a joint (fulcrum). The two plates (head and neck plate and body plate) rotate around the fulcrum by adjusting screws under each of them. A prototype device was created to materialize this concept. First, after all adjusting screws were set to the zero position, the rotation angle of each plate was measured by a digital goniometer. Repeatability was evaluated by performing 20 repeated measurements. Next, to confirm the rotational accuracy of each plate of the prototype device, the calculated rotation angles for 20 combinations of patterns of traveled distances of the adjusting screws were compared with those measured by the digital goniometer and cone‐beam computed tomography (CT). The repeatability (standard deviation: SD) of the pitch, roll, and yaw angles of the head and neck plate was 0.04°, 0.05°, and 0.03°, and the repeatability (SD) of the body plate was 0.05°, 0.04°, and 0.04°, respectively. The mean differences ± SD between the calculated and measured pitch, roll, and yaw angles for the head and neck plate with the digital goniometer were 0.00 ± 0.06°, −0.01 ± 0.06°, and −0.04 ± 0.04°, respectively. The differences for the body plate were −0.03 ± 0.04°, 0.03 ± 0.05°, and 0.02 ± 0.05°, respectively. Results of the cone‐beam CT were similar to those of the digital goniometer. The prototype device exhibited good performance regarding the rotational accuracy and repeatability under no load. The clinical implementation of this concept is expected to reduce the residual error of the patient position due to the twist.
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Affiliation(s)
- Hidetoshi Shimizu
- Department of Radiation Oncology Aichi Cancer Center Hospital Aichi Japan
- Graduate School of Radiological Technology Gunma Prefectural College of Health Sciences Gunma Japan
| | - Koji Sasaki
- Graduate School of Radiological Technology Gunma Prefectural College of Health Sciences Gunma Japan
| | - Takahiro Aoyama
- Department of Radiation Oncology Aichi Cancer Center Hospital Aichi Japan
| | - Shigeru Matsushima
- Department of Diagnostic and Interventional Radiology Aichi Cancer Center Hospital Aichi Japan
| | - Taiki Isomura
- Department of Radiation Oncology Aichi Cancer Center Hospital Aichi Japan
| | - Hiroshi Fukuma
- Department of Radiology Nagoya City University Hospital Aichi Japan
| | - Hiroyuki Tachibana
- Department of Radiation Oncology Aichi Cancer Center Hospital Aichi Japan
| | - Takeshi Kodaira
- Department of Radiation Oncology Aichi Cancer Center Hospital Aichi Japan
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12
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Kost S, Guo B, Xia P, Shah C. Assessment of Setup Accuracy Using Anatomical Landmarks for Breast and Chest Wall Irradiation With Surface Guided Radiation Therapy. Pract Radiat Oncol 2019; 9:239-247. [DOI: 10.1016/j.prro.2019.03.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 02/14/2019] [Accepted: 03/13/2019] [Indexed: 10/27/2022]
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13
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Carl G, Reitz D, Schönecker S, Pazos M, Freislederer P, Reiner M, Alongi F, Niyazi M, Ganswindt U, Belka C, Corradini S. Optical Surface Scanning for Patient Positioning in Radiation Therapy: A Prospective Analysis of 1902 Fractions. Technol Cancer Res Treat 2019; 17:1533033818806002. [PMID: 30453842 PMCID: PMC6243634 DOI: 10.1177/1533033818806002] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Purpose/Objective: Reproducible patient positioning remains one of the major challenges in modern radiation therapy. Recently, optical surface scanners have been introduced into clinical practice in addition to well-established positioning systems, such as room laser and skin marks. The aim of this prospective study was to evaluate setup errors of the optical surface scanner Catalyst HD (C-RAD AB) in different anatomic regions. Material/Methods: Between October 2016 and June 2017 a total of 1902 treatment sessions in 110 patients were evaluated. The workflow of this study included conventional setup procedures using laser-based positioning with skin marks and an additional registration of the 3-dimensional (3D) deviations detected by the Catalyst system. The deviations of the surface-based method were then compared to the corrections of cone beam computed tomography alignment which was considered as gold standard. A practical Catalyst setup error was calculated between the translational deviations of the surface scanner and the laser positioning. Two one-sided t tests for equivalence were used for statistical analysis. Results: Data analysis revealed total deviations of 0.09 mm ± 2.03 mm for the lateral axis, 0.07 mm ± 3.21 mm for the longitudinal axis, and 0.44 mm ± 3.08 mm vertical axis for the Catalyst system, compared to −0.06 ± 3.54 mm lateral, 0.53 ± 3.47 mm longitudinal, and 0.19 ± 3.49 mm vertical for the laser positioning compared to cone beam computed tomography. The lowest positional deviations were found in the cranial region, and larger deviations occurred in the thoracic and abdominal sites. A statistical comparison using 2 one-sided t tests showed a general concordance of the 2 methods (P ≤ 0.036), excluding the vertical direction of the abdominal region (P = 0.198). Conclusion: The optical surface scanner Catalyst HD is a reliable and feasible patient positioning system without any additional radiation exposure. From the head to the thoracic and abdominal region, a decrease in accuracy was observed within a comparable range for Catalyst and laser-assisted positioning.
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Affiliation(s)
- G Carl
- 1 Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany.,Authors have contributed equally to this study
| | - D Reitz
- 1 Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany.,Authors have contributed equally to this study
| | - S Schönecker
- 1 Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - M Pazos
- 1 Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - P Freislederer
- 1 Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - M Reiner
- 1 Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - F Alongi
- 2 Department of Radiation Oncology, Sacro Cuore Don Calabria Hospital, Negrar-Verona, Italy.,3 University of Brescia, Brescia, Italy
| | - M Niyazi
- 1 Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - U Ganswindt
- 1 Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany.,4 Department of Therapeutic Radiology and Oncology, Innsbruck Medical University, Innsbruck, Austria
| | - C Belka
- 1 Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - S Corradini
- 1 Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
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14
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Reitz D, Carl G, Schönecker S, Pazos M, Freislederer P, Niyazi M, Ganswindt U, Alongi F, Reiner M, Belka C, Corradini S. Real-time intra-fraction motion management in breast cancer radiotherapy: analysis of 2028 treatment sessions. Radiat Oncol 2018; 13:128. [PMID: 30012156 PMCID: PMC6048710 DOI: 10.1186/s13014-018-1072-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 07/04/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Intra-fraction motion represents a crucial issue in the era of precise radiotherapy in several settings, including breast irradiation. To date, only few data exist on real-time measured intra-fraction motion in breast cancer patients. Continuous surface imaging using visible light offers the capability to monitor patient movements in three-dimensional space without any additional radiation exposure. The aim of the present study was to quantify the uncertainties of possible intra-fractional motion during breast radiotherapy. MATERIAL AND METHODS One hundred and four consecutive patients that underwent postoperative radiotherapy following breast conserving surgery or mastectomy were prospectively evaluated during 2028 treatment sessions. During each treatment session the patients' motion was continuously measured using the Catalyst™ optical surface scanner (C-RAD AB, Sweden) and compared to a reference scan acquired at the beginning of each session. The Catalyst system works through an optical surface imaging with light emitting diode (LED) light and reprojection captured by a charge coupled device (CCD) camera, which provide target position control during treatment delivery with a motion detection accuracy of 0.5 mm. For 3D surface reconstruction, the system uses a non-rigid body algorithm to calculate the distance between the surface and the isocentre and using the principle of optical triangulation. Three-dimensional deviations and relative position differences during the whole treatment fraction were calculated by the system and analyzed statistically. RESULTS Overall, the maximum magnitude of the deviation vector showed a mean change of 1.93 mm ± 1.14 mm (standard deviation [SD]) (95%-confidence interval: [0.48-4.65] mm) and a median change of 1.63 mm during dose application (beam-on time only). Along the lateral and longitudinal axis changes were quite similar (0.18 mm ± 1.06 mm vs. 0.17 mm ± 1.32 mm), on the vertical axis the mean change was 0.68 mm ± 1.53 mm. The mean treatment session time was 154 ± 53 (SD) seconds and the mean beam-on time only was 55 ± 16 s. According to Friedman's test differences in the distributions of the three possible directions (lateral, longitudinal and vertical) were significant (p < 0.01), in post-hoc analysis there were no similarities between any two of the three directions. CONCLUSION The optical surface imaging system is an accurate and easy tool for real-time motion management in breast cancer radiotherapy. Intra-fraction motion was reported within five millimeters in all directions. Thus, intra-fraction motion in our series of 2028 treatment sessions seems to be of minor clinical relevance in postoperative radiotherapy of breast cancer.
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Affiliation(s)
- D. Reitz
- Department of Radiation Oncology, University Hospital, Marchioninistr 15, 81377 Munich LMU, Munich, Germany
| | - G. Carl
- Department of Radiation Oncology, University Hospital, Marchioninistr 15, 81377 Munich LMU, Munich, Germany
| | - S. Schönecker
- Department of Radiation Oncology, University Hospital, Marchioninistr 15, 81377 Munich LMU, Munich, Germany
| | - M. Pazos
- Department of Radiation Oncology, University Hospital, Marchioninistr 15, 81377 Munich LMU, Munich, Germany
| | - P. Freislederer
- Department of Radiation Oncology, University Hospital, Marchioninistr 15, 81377 Munich LMU, Munich, Germany
| | - M. Niyazi
- Department of Radiation Oncology, University Hospital, Marchioninistr 15, 81377 Munich LMU, Munich, Germany
| | - U. Ganswindt
- Department of Radiation Oncology, University Hospital, Marchioninistr 15, 81377 Munich LMU, Munich, Germany
- Department of Radiation Oncology, Medical University, Innsbruck, Austria
| | - F. Alongi
- Department of Radiation Oncology, Sacro Cuore Don Calabria Hospital, Verona, Negrar Italy
- University of Brescia, Brescia, Italy
| | - M. Reiner
- Department of Radiation Oncology, University Hospital, Marchioninistr 15, 81377 Munich LMU, Munich, Germany
| | - C. Belka
- Department of Radiation Oncology, University Hospital, Marchioninistr 15, 81377 Munich LMU, Munich, Germany
| | - S. Corradini
- Department of Radiation Oncology, University Hospital, Marchioninistr 15, 81377 Munich LMU, Munich, Germany
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15
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Tyran M, Tallet A, Resbeut M, Ferre M, Favrel V, Fau P, Moureau-Zabotto L, Darreon J, Gonzague L, Benkemouche A, Varela-Cagetti L, Salem N, Farnault B, Acquaviva MA, Mailleux H. Safety and benefit of using a virtual bolus during treatment planning for breast cancer treated with arc therapy. J Appl Clin Med Phys 2018; 19:463-472. [PMID: 29959819 PMCID: PMC6123145 DOI: 10.1002/acm2.12398] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 05/25/2018] [Accepted: 05/31/2018] [Indexed: 12/19/2022] Open
Abstract
Purpose This study evaluates the benefit of a virtual bolus method for volumetric modulated arc therapy (VMAT) plan optimization to compensate breast modifications that may occur during breast treatment. Methods Ten files were replanned with VMAT giving 50 Gy to the breast and 47 Gy to the nodes within 25 fractions. The planning process used a virtual bolus for the first optimization, then the monitors units were reoptimized without bolus, after fixing the segments shapes. Structures and treatment planning were exported on a second scanner (CT) performed during treatment as a consequence to modifications in patient's anatomy. The comparative end‐point was clinical target volume's coverage. The first analysis compared the VMAT plans made using the virtual bolus method (VB‐VMAT) to the plans without using it (NoVB‐VMAT) on the first simulation CT. Then, the same analysis was performed on the second CT. Finally, the level of degradation of target volume coverage between the two CT using VB‐VMAT was compared to results using a standard technique of forward‐planned multisegment technique (Tan‐IMRT). Results Using a virtual bolus for VMAT does not degrade dosimetric results on the first CT. No significant result in favor of the NoVB‐VMAT plans was noted. The VB‐VMAT method led to significant better dose distribution on a second CT with modified anatomies compared to NoVB‐VMAT. The clinical target volume's coverage by 95% (V95%) of the prescribed dose was 98.9% [96.1–99.6] on the second CT for VB‐VMAT compared to 92.6% [85.2–97.7] for NoVB‐VMAT (P = 0.0002). The degradation of the target volume coverage for VB‐VMAT is not worse than for Tan‐IMRT: the median differential of V95% between the two CT was 0.9% for VMAT and 0.7% for Tan‐IMRT (P = 1). Conclusion This study confirms the safety and benefit of using a virtual bolus during the VMAT planning process to compensate potential breast shape modifications.
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Affiliation(s)
- Marguerite Tyran
- Department of Radiation-Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Agnes Tallet
- Department of Radiation-Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Michel Resbeut
- Department of Radiation-Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Marjorie Ferre
- Department of Radiation-Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Veronique Favrel
- Department of Radiation-Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Pierre Fau
- Department of Radiation-Oncology, Institut Paoli-Calmettes, Marseille, France
| | | | - Julien Darreon
- Department of Radiation-Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Laurence Gonzague
- Department of Radiation-Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Ahcene Benkemouche
- Department of Radiation-Oncology, Institut Paoli-Calmettes, Marseille, France
| | | | - Naji Salem
- Department of Radiation-Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Bertrand Farnault
- Department of Radiation-Oncology, Institut Paoli-Calmettes, Marseille, France
| | | | - Hugues Mailleux
- Department of Radiation-Oncology, Institut Paoli-Calmettes, Marseille, France
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16
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Optical Surface Management System for Patient Positioning in Interfractional Breast Cancer Radiotherapy. BIOMED RESEARCH INTERNATIONAL 2018; 2018:6415497. [PMID: 29511688 PMCID: PMC5817315 DOI: 10.1155/2018/6415497] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 11/16/2017] [Indexed: 11/17/2022]
Abstract
Background The Optical Surface Management System (OSMS) is a simple, fast, reproducible, and accurate solution for patient set-up and can minimize random day-to-day set-up errors. However, studies in breast cancer patients are rare. Objective To analyze 200 patient set-ups in 20 patients with breast cancer by comparing the OSMS with the conventional cone-beam computed tomography (CBCT). Method Displacements from concurrent OSMS and CBCT registrations were compared in a total of 200 setups of 20 patients to analyze the interfractional displacement and positioning displacement in three dimensions (lateral, longitudinal, and vertical directions). Results The interfractional displacement on the lateral, longitudinal, and vertical directions for OSMS versus CBCT was 0.049 ± 0.254 versus 0.041 ± 0.244 centimeters (cm); 0.018 ± 0.261 versus 0.040 ± 0.242 cm; 0.062 ± 0.254 versus 0.065 ± 0.240 cm, respectively, without any significant difference (all P > 0.05). The duration for CBCT scan was about 60 seconds (s), while that for image processing, matching, and couch displacement was at least 5 minutes (min). The average scanning time with OSMS was less than 20 s, and the total duration for positioning was less than 1 min. Conclusion OSMS is an efficient tool to improve the accuracy and increase the speed for verifying the patient positioning in radiotherapy for breast cancer.
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17
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Cravo Sá A, Fermento A, Neves D, Ferreira S, Silva T, Marques Coelho C, Vaandering A, Roma A, Quaresma S, Bonnarens E. Radiotherapy setup displacements in breast cancer patients: 3D surface imaging experience. Rep Pract Oncol Radiother 2018; 23:61-67. [PMID: 29379398 PMCID: PMC5773710 DOI: 10.1016/j.rpor.2017.12.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 12/27/2017] [Indexed: 01/15/2023] Open
Abstract
AIM In this study, we intend to compare two different setup procedures for female breast cancer patients. BACKGROUND Imaging in radiotherapy provides a precise localization of the tumour, increasing the accuracy of the treatment delivery in breast cancer. MATERIALS AND METHODS Twenty breast cancer patients who underwent whole breast radiotherapy (WBRT) were selected for this study. Patients were divided into two groups of ten. Group one (G1) was positioned by tattoos and then the patient positioning was adjusted with the aid of AlignRT (Vision RT, London, UK). In group two (G2), patients were positioned only by tattoos. For both groups, the first 15 fractions were analyzed, a daily kilovoltage (kV) cone beam computed tomography (CBCT) image was made and then the rotational and translational displacements and, posteriorly, the systematic (Σ) and random (σ) errors were analyzed. RESULTS The comparison of CBCT displacements for the two groups showed a statistically significant difference in the translational left-right (LR) direction (ρ = 0.03), considering that the procedure with AlignRT system has smaller lateral displacements. The results of systematic (Σ) and random (σ) errors showed that for translational displacements the group positioned only by tattoos (G2) demonstrated higher values of errors when compared with the group positioned with the aid of AlignRT (G1). CONCLUSIONS AlignRT could help the positioning of breast cancer patients; however, it should be used with another imaging method.
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Affiliation(s)
- Ana Cravo Sá
- Área Científica de Radioterapia, Escola Superior de Tecnologia da Saúde de Lisboa – Instituto Politécnico de Lisboa, Avenida D. João II, lote 4.69.01, 1990-096 Lisboa, Portugal
| | - Ana Fermento
- Área Científica de Radioterapia, Escola Superior de Tecnologia da Saúde de Lisboa – Instituto Politécnico de Lisboa, Avenida D. João II, lote 4.69.01, 1990-096 Lisboa, Portugal
| | - Dalila Neves
- Área Científica de Radioterapia, Escola Superior de Tecnologia da Saúde de Lisboa – Instituto Politécnico de Lisboa, Avenida D. João II, lote 4.69.01, 1990-096 Lisboa, Portugal
| | - Sara Ferreira
- Área Científica de Radioterapia, Escola Superior de Tecnologia da Saúde de Lisboa – Instituto Politécnico de Lisboa, Avenida D. João II, lote 4.69.01, 1990-096 Lisboa, Portugal
| | - Teresa Silva
- Área Científica de Radioterapia, Escola Superior de Tecnologia da Saúde de Lisboa – Instituto Politécnico de Lisboa, Avenida D. João II, lote 4.69.01, 1990-096 Lisboa, Portugal
| | - Carina Marques Coelho
- Área Científica de Radioterapia, Escola Superior de Tecnologia da Saúde de Lisboa – Instituto Politécnico de Lisboa, Avenida D. João II, lote 4.69.01, 1990-096 Lisboa, Portugal
| | - Aude Vaandering
- Service de Radiothérapie Oncologique, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, 1200 Bruxelles, Belgium
| | - Ana Roma
- Service de Radiothérapie Oncologique, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, 1200 Bruxelles, Belgium
| | - Sérgio Quaresma
- Service de Radiothérapie Oncologique, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, 1200 Bruxelles, Belgium
| | - Emmanuel Bonnarens
- Service de Radiothérapie Oncologique, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, 1200 Bruxelles, Belgium
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Kellermeier M, Herbolzheimer J, Kreppner S, Lotter M, Strnad V, Bert C. Electromagnetic tracking (EMT) technology for improved treatment quality assurance in interstitial brachytherapy. J Appl Clin Med Phys 2017; 18:211-222. [PMID: 28291934 PMCID: PMC5689872 DOI: 10.1002/acm2.12021] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 10/27/2016] [Indexed: 11/09/2022] Open
Abstract
Electromagnetic Tracking (EMT) is a novel technique for error detection and quality assurance (QA) in interstitial high dose rate brachytherapy (HDR-iBT). The purpose of this study is to provide a concept for data acquisition developed as part of a clinical evaluation study on the use of EMT during interstitial treatment of breast cancer patients. The stability, accuracy, and precision of EMT-determined dwell positions were quantified. Dwell position reconstruction based on EMT was investigated on CT table, HDR table and PDR bed to examine the influence on precision and accuracy in a typical clinical workflow. All investigations were performed using a precise PMMA phantom. The track of catheters inserted in that phantom was measured by manually inserting a 5 degree of freedom (DoF) sensor while recording the position of three 6DoF fiducial sensors on the phantom surface to correct motion influences. From the corrected data, dwell positions were reconstructed along the catheter's track. The accuracy of the EMT-determined dwell positions was quantified by the residual distances to reference dwell positions after using a rigid registration. Precision and accuracy were investigated for different phantom-table and sensor-field generator (FG) distances. The measured precision of the EMT-determined dwell positions was ≤ 0.28 mm (95th percentile). Stability tests showed a drift of 0.03 mm in the first 20 min of use. Sudden shaking of the FG or (large) metallic objects close to the FG degrade the precision. The accuracy with respect to the reference dwell positions was on all clinical tables < 1 mm at 200 mm FG distance and 120 mm phantom-table distance. Phantom measurements showed that EMT-determined localization of dwell positions in HDR-iBT is stable, precise, and sufficiently accurate for clinical assessment. The presented method may be viable for clinical applications in HDR-iBT, like implant definition, error detection or quantification of uncertainties. Further clinical investigations are needed.
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Affiliation(s)
- Markus Kellermeier
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstraße 27, 91054, Erlangen, Germany
| | - Jens Herbolzheimer
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstraße 27, 91054, Erlangen, Germany
| | - Stephan Kreppner
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstraße 27, 91054, Erlangen, Germany
| | - Michael Lotter
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstraße 27, 91054, Erlangen, Germany
| | - Vratislav Strnad
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstraße 27, 91054, Erlangen, Germany
| | - Christoph Bert
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstraße 27, 91054, Erlangen, Germany
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Glock F, Vogel M, Naumann S, Kuehnapfel A, Scholz M, Hiemisch A, Kirsten T, Rieger K, Koerner A, Loeffler M, Kiess W. Validity and intraobserver reliability of three-dimensional scanning compared with conventional anthropometry for children and adolescents from a population-based cohort study. Pediatr Res 2017; 81:736-744. [PMID: 28052064 DOI: 10.1038/pr.2016.274] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Accepted: 11/03/2016] [Indexed: 11/09/2022]
Abstract
BACKGROUND Conventional anthropometric measurements are time consuming and require well trained medical staff. To use three-dimensional whole body laser scanning in daily clinical work, validity, and reliability have to be confirmed. METHODS We compared a whole body laser scanner with conventional anthropometry in a group of 473 children and adolescents from the Leipzig Research Centre for Civilization Diseases (LIFE-Child). Concordance correlation coefficients (CCC) were calculated separately for sex, weight, and age to assess validity. Overall CCC (OCCC) was used to analyze intraobserver reliability. RESULTS Body height and the circumferences of waist, hip, upper arm, and calf had an "excellent" (CCC ≥ 0.9); neck and thigh circumference, a "good" (CCC ≥ 0.7); and head circumference, a "low" (CCC < 0.5) degree of concordance over the complete study population. We observed dependencies of validity on sex, weight, and age. Intraobserver reliability of both techniques is "excellent" (OCCC ≥ 0.9). CONCLUSION Scanning is faster, requires less intensive staff training and provides more information. It can be used in an epidemiologic setting with children and adolescents but some measurements should be considered with caution due to reduced agreement with conventional anthropometry.
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Affiliation(s)
- Fabian Glock
- LIFE - Leipzig Research Centre for Civilization Diseases, Leipzig University, Leipzig, Germany.,Hospital for Children and Adolescents - Centre for Pediatric Research, Leipzig University, Leipzig, Germany
| | - Mandy Vogel
- LIFE - Leipzig Research Centre for Civilization Diseases, Leipzig University, Leipzig, Germany
| | - Stephanie Naumann
- LIFE - Leipzig Research Centre for Civilization Diseases, Leipzig University, Leipzig, Germany
| | - Andreas Kuehnapfel
- LIFE - Leipzig Research Centre for Civilization Diseases, Leipzig University, Leipzig, Germany.,Institute for Medical Informatics, Statistics and Epidemiology, Leipzig University, Leipzig, Germany
| | - Markus Scholz
- LIFE - Leipzig Research Centre for Civilization Diseases, Leipzig University, Leipzig, Germany.,Institute for Medical Informatics, Statistics and Epidemiology, Leipzig University, Leipzig, Germany
| | - Andreas Hiemisch
- LIFE - Leipzig Research Centre for Civilization Diseases, Leipzig University, Leipzig, Germany.,Hospital for Children and Adolescents - Centre for Pediatric Research, Leipzig University, Leipzig, Germany
| | - Toralf Kirsten
- LIFE - Leipzig Research Centre for Civilization Diseases, Leipzig University, Leipzig, Germany
| | - Kristin Rieger
- LIFE - Leipzig Research Centre for Civilization Diseases, Leipzig University, Leipzig, Germany.,Hospital for Children and Adolescents - Centre for Pediatric Research, Leipzig University, Leipzig, Germany
| | - Antje Koerner
- LIFE - Leipzig Research Centre for Civilization Diseases, Leipzig University, Leipzig, Germany.,Hospital for Children and Adolescents - Centre for Pediatric Research, Leipzig University, Leipzig, Germany
| | - Markus Loeffler
- LIFE - Leipzig Research Centre for Civilization Diseases, Leipzig University, Leipzig, Germany.,Institute for Medical Informatics, Statistics and Epidemiology, Leipzig University, Leipzig, Germany
| | - Wieland Kiess
- LIFE - Leipzig Research Centre for Civilization Diseases, Leipzig University, Leipzig, Germany.,Hospital for Children and Adolescents - Centre for Pediatric Research, Leipzig University, Leipzig, Germany
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Walter F, Freislederer P, Belka C, Heinz C, Söhn M, Roeder F. Evaluation of daily patient positioning for radiotherapy with a commercial 3D surface-imaging system (Catalyst™). Radiat Oncol 2016; 11:154. [PMID: 27881158 PMCID: PMC5122202 DOI: 10.1186/s13014-016-0728-1] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 11/15/2016] [Indexed: 11/17/2022] Open
Abstract
Background To report our initial clinical experience with the novel surface imaging system Catalyst™ (C-RAD AB, Sweden) in connection with an Elekta Synergy linear accelerator for daily patient positioning in patients undergoing radiation therapy. Methods We retrospectively analyzed the patient positioning of 154 fractions in 25 patients applied to thoracic, abdominal, and pelvic body regions. Patients were routinely positioned based on skin marks, shifted to the calculated isocenter position and treated after correction via cone beam CT which served as gold standard. Prior to CBCT an additional surface scan by the Catalyst™ system was performed and compared to a reference surface image cropped from the planning CT to obtain shift vectors for an optimal surface match. These shift vectors were subtracted from the vectors obtained by CBCT correction to assess the theoretical setup error that would have occurred if the patients had been positioned using solely the Catalyst™ system. The mean theoretical set up-error and its standard deviation were calculated for all measured fractions and the results were compared to patient positioning based on skin marks only. Results Integration of the surface scan into the clinical workflow did not result in a significant time delay. Regarding the entire group, the mean setup error by using skin marks only was 0.0 ± 2.1 mm in lateral, −0.4 ± 2.4 mm in longitudinal, and 1.1 ± 2.6 mm vertical direction. The mean theoretical setup error that would have occurred using solely the Catalyst™ was −0.1 ± 2.1 mm laterally, −1.8 ± 5.4 mm longitudinally, and 1.4 ± 3.2 mm vertically. No significant difference was found in any direction. For thoracic targets the mean setup error based on the Catalyst™ was 0.6 ± 2.6 mm laterally, −5.0 ± 7.9 mm longitudinally, and 0.5 ± 3.2 mm vertically. For abdominal targets, the mean setup error was 0.3 ± 2.2 mm laterally, 2.6 ± 1.8 mm longitudinally, and 2.1 ± 5.5 mm vertically. For pelvic targets, the setup error was −0.9 ± 1.5 mm laterally, −1.7 ± 2.8 mm longitudinally, and 1.6 ± 2.2 mm vertically. A significant difference between Catalyst™ and skin mark based positioning was only observed in longitudinal direction of pelvic targets. Conclusion Optical surface scanning using Catalyst™ seems potentially useful for daily positioning at least to complement usual imaging modalities in most patients with acceptable accuracy, although a significant improvement compared to skin mark based positioning could not be derived from the evaluated data. However, this effect seemed to be rather caused by the unexpected high accuracy of skin mark based positioning than by inaccuracy using the Catalyst™. Further on, surface registration in longitudinal axis seemed less reliable especially in pelvic localization. Therefore further prospective evaluation based on strictly predefined protocols is needed to determine the optimal scanning approaches and parameters.
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Affiliation(s)
- F Walter
- Department of Radiation Oncology, University Hospital of LMU Munich, Marchioninistr 15, 81377, Munich, Germany.
| | - P Freislederer
- Department of Radiation Oncology, University Hospital of LMU Munich, Marchioninistr 15, 81377, Munich, Germany
| | - C Belka
- Department of Radiation Oncology, University Hospital of LMU Munich, Marchioninistr 15, 81377, Munich, Germany
| | - C Heinz
- Department of Radiation Oncology, University Hospital of LMU Munich, Marchioninistr 15, 81377, Munich, Germany
| | - M Söhn
- Department of Radiation Oncology, University Hospital of LMU Munich, Marchioninistr 15, 81377, Munich, Germany
| | - F Roeder
- Department of Radiation Oncology, University Hospital of LMU Munich, Marchioninistr 15, 81377, Munich, Germany.,Department of Molecular Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
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Kim Y, Li R, Na YH, Lee R, Xing L. Accuracy of surface registration compared to conventional volumetric registration in patient positioning for head-and-neck radiotherapy: a simulation study using patient data. Med Phys 2015; 41:121701. [PMID: 25471948 DOI: 10.1118/1.4898103] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE 3D optical surface imaging has been applied to patient positioning in radiation therapy (RT). The optical patient positioning system is advantageous over conventional method using cone-beam computed tomography (CBCT) in that it is radiation free, frameless, and is capable of real-time monitoring. While the conventional radiographic method uses volumetric registration, the optical system uses surface matching for patient alignment. The relative accuracy of these two methods has not yet been sufficiently investigated. This study aims to investigate the theoretical accuracy of the surface registration based on a simulation study using patient data. METHODS This study compares the relative accuracy of surface and volumetric registration in head-and-neck RT. The authors examined 26 patient data sets, each consisting of planning CT data acquired before treatment and patient setup CBCT data acquired at the time of treatment. As input data of surface registration, patient's skin surfaces were created by contouring patient skin from planning CT and treatment CBCT. Surface registration was performed using the iterative closest points algorithm by point-plane closest, which minimizes the normal distance between source points and target surfaces. Six degrees of freedom (three translations and three rotations) were used in both surface and volumetric registrations and the results were compared. The accuracy of each method was estimated by digital phantom tests. RESULTS Based on the results of 26 patients, the authors found that the average and maximum root-mean-square translation deviation between the surface and volumetric registrations were 2.7 and 5.2 mm, respectively. The residual error of the surface registration was calculated to have an average of 0.9 mm and a maximum of 1.7 mm. CONCLUSIONS Surface registration may lead to results different from those of the conventional volumetric registration. Only limited accuracy can be achieved for patient positioning with an approach based solely on surface information.
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Affiliation(s)
- Youngjun Kim
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California 94305 and Center for Bionics, Korea Institute of Science and Technology, Seoul 136-791, South Korea
| | - Ruijiang Li
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California 94305
| | - Yong Hum Na
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California 94305
| | - Rena Lee
- Department of Radiation Oncology, Ewha Womans University School of Medicine, Seoul 158-710, South Korea
| | - Lei Xing
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California 94305
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Hepp R, Ammerpohl M, Morgenstern C, Nielinger L, Erichsen P, Abdallah A, Galalae R. Deep inspiration breath-hold (DIBH) radiotherapy in left-sided breast cancer: Dosimetrical comparison and clinical feasibility in 20 patients. Strahlenther Onkol 2015; 191:710-6. [PMID: 25893323 DOI: 10.1007/s00066-015-0838-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 03/25/2015] [Indexed: 01/16/2023]
Abstract
BACKGROUND Adjuvant radiotherapy after breast-conserving surgery (BCS) for breast cancer (BC) is a well-established indication. The risk of ischaemic heart disease after radiotherapy for BC increases linearly with the heart mean dose with no apparent threshold. Radiotherapy to the left breast in deep inspiration breath-hold (DIBH) reduces the dose to the heart. A new linac system with an integrated surface scanner (SS) for DIBH treatments was recently installed in our department. We tested it for potential benefits, safety, patients' acceptance/compliance and associated additional workload. MATERIALS AND METHODS Twenty consecutive patients following BCS for breast carcinoma of the left side were enrolled in our institutional DIBH protocol. We compared dose to the heart and ipsilateral lung (IL) between plans in DIBH and free breathing (FB) using standard defined parameters: mean dose, maximal dose to a volume of 2 cm(3) (D2 cm (3)), volume receiving ≥ 5 Gy (V5), 10 Gy (V10), 15 Gy (V15) and 20 Gy (V20). Comparison of median calculated dose values was performed using a two-tailed Wilcoxon signed rank test. RESULTS DIBH was associated with a statistically significant reduction (p < 0.001) in all studied parameters for the heart and the IL. In 16 of 20 patients the heart D2 cm (3) was less than 42 Gy in DIBH. In FB the heart D2 cm (3) was ≥ 42 Gy in 17 of 20 patients. The median daily treatment time was 9 min. CONCLUSION Radiotherapy of the left breast in DIBH using a SS could easily be incorporated into daily routine and is associated with significant dose reduction to the heart and IL.
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Affiliation(s)
- Rodrigo Hepp
- Klinik für Strahlentherapie und Radioonkologie, Evangelische Kliniken Gelsenkirchen, Munckelstraße 27, 45879, Gelsenkirchen, Deutschland,
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Liu F, Yang Q, Cong W, Wang G. Dynamic bowtie filter for cone-beam/multi-slice CT. PLoS One 2014; 9:e103054. [PMID: 25051067 PMCID: PMC4106881 DOI: 10.1371/journal.pone.0103054] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 06/27/2014] [Indexed: 11/19/2022] Open
Abstract
A pre-patient attenuator ("bowtie filter" or "bowtie") is used to modulate an incoming x-ray beam as a function of the angle of the x-ray with respect to a patient to balance the photon flux on a detector array. While the current dynamic bowtie design is focused on fan-beam geometry, in this study we propose a methodology for dynamic bowtie design in multi-slice/cone-beam geometry. The proposed 3D dynamic bowtie is an extension of the 2D prior art. The 3D bowtie consists of a highly attenuating bowtie (HB) filled in with heavy liquid and a weakly attenuating bowtie (WB) immersed in the liquid of the HB. The HB targets a balanced flux distribution on a detector array when no object is in the field of view (FOV). The WB compensates for an object in the FOV, and hence is a scaled-down version of the object. The WB is rotated and translated in synchrony with the source rotation and patient translation so that the overall flux balance is maintained on the detector array. First, the mathematical models of different scanning modes are established for an elliptical water phantom. Then, a numerical simulation study is performed to compare the performance of the scanning modes in the cases of the water phantom and a patient cross-section without any bowtie and with a dynamic bowtie. The dynamic bowtie can equalize the numbers of detected photons in the case of the water phantom. In practical cases, the dynamic bowtie can effectively reduce the dynamic range of detected signals inside the FOV. Furthermore, the WB can be individualized using a 3D printing technique as the gold standard. We have extended the dynamic bowtie concept from 2D to 3D by using highly attenuating liquid and moving a scale-reduced negative copy of an object being scanned. Our methodology can be applied to reduce radiation dose and facilitate photon-counting detection.
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Affiliation(s)
- Fenglin Liu
- Key Lab of Optoelectronic Technology and System, Engineering Research Center of Industrial Computed Tomography Nondestructive Testing, Ministry of Education, Chongqing University, Chongqing, China
- Biomedical Imaging Center, Center for Biotechnology and Interdisciplinary Studies, Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, New York, United States of America
- * E-mail:
| | - Qingsong Yang
- Biomedical Imaging Center, Center for Biotechnology and Interdisciplinary Studies, Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, New York, United States of America
| | - Wenxiang Cong
- Biomedical Imaging Center, Center for Biotechnology and Interdisciplinary Studies, Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, New York, United States of America
| | - Ge Wang
- Biomedical Imaging Center, Center for Biotechnology and Interdisciplinary Studies, Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, New York, United States of America
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Thomsen MS, Harrov U, Fledelius W, Poulsen PR. Inter- and intra-fraction geometric errors in daily image-guided radiotherapy of free-breathing breast cancer patients measured with continuous portal imaging. Acta Oncol 2014; 53:802-8. [PMID: 24739061 DOI: 10.3109/0284186x.2014.905700] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Daily image-guided radiotherapy (IGRT) using two orthogonal setup images may be inaccurate for breast cancer patients treated in free breathing because the setup images may capture the patient in a breathing phase that is not representative of the mean anatomy. The aim of this study was to quantify the setup errors in breast radiotherapy after image-guided setup correction based on two orthogonal setup images acquired in free breathing. METHODS AND MATERIALS For 16 breast cancer patients with daily image-pair based IGRT, continuous portal imaging (7.5 Hz) were acquired at each treatment fraction during the delivery of the two tangential fields. For each portal image, the chest wall position relative to the planned position was determined in the imager direction orthogonal to the cranio-caudal direction. It yielded the time resolved setup error in this direction throughout the 16 treatment courses. RESULTS The mean absolute setup error exceeded 5 mm in 0.9% (first field) and 1.8% (last field) of the treatments. The group mean error (M) and the standard deviations of the random (σ) and systematic (Σ) setup errors were M=-0.7 mm, Σ=1.1 mm, σ=1.5 mm (first field) and M=-0.2 mm, Σ=1.4 mm, σ=1.7 mm (last field). The negative sign of M indicates that less lung than planned was included in the treatment fields. Intra-field peak-to-peak chest wall motion amplitudes were patient dependent with patient mean values of 2.0±0.7 mm [range 1.1-3.2 mm]. The largest observed intra-field motion amplitude was 8 mm. CONCLUSION Image-guided setup based on orthogonal planar images acquired in free breathing without synchronization with the respiratory phase was found to result in accurate tangential breast radiotherapy with only few outliers.
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Affiliation(s)
- Mette S Thomsen
- Department of Medical Physics, Aarhus University Hospital , Denmark
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Leitzen C, Wilhelm-Buchstab T, Garbe S, Lütter C, Müdder T, Simon B, Schild H, Schüller H. Quality of patient positioning during cerebral tomotherapy irradiation using different mask systems. Strahlenther Onkol 2013; 190:382-5. [DOI: 10.1007/s00066-013-0496-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 10/24/2013] [Indexed: 12/25/2022]
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Sedlmayer F, Sautter-Bihl ML, Budach W, Dunst J, Fastner G, Feyer P, Fietkau R, Haase W, Harms W, Souchon R, Wenz F, Sauer R. DEGRO practical guidelines: radiotherapy of breast cancer I: radiotherapy following breast conserving therapy for invasive breast cancer. Strahlenther Onkol 2013; 189:825-33. [PMID: 24002382 PMCID: PMC3825416 DOI: 10.1007/s00066-013-0437-8] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE The aim of the present paper is to update the practical guidelines for postoperative adjuvant radiotherapy of breast cancer published in 2007 by the breast cancer expert panel of the German Society for Radiooncology (Deutsche Gesellschaft für Radioonkologie, DEGRO). The present recommendations are based on a revision of the German interdisciplinary S-3 guidelines published in July 2012. METHODS A comprehensive survey of the literature concerning radiotherapy following breast conserving therapy (BCT) was performed using the search terms "breast cancer", "radiotherapy", and "breast conserving therapy". Data from lately published meta-analyses, recent randomized trials, and guidelines of international breast cancer societies, yielding new aspects compared to 2007, provided the basis for defining recommendations according to the criteria of evidence-based medicine. In addition to the more general statements of the DKG (Deutsche Krebsgesellschaft), this paper addresses indications, target definition, dosage, and technique of radiotherapy of the breast after conservative surgery for invasive breast cancer. RESULTS Among numerous reports on the effect of radiotherapy during BCT published since the last recommendations, the recent EBCTCG report builds the largest meta-analysis so far available. In a 15 year follow-up on 10,801 patients, whole breast irradiation (WBI) halves the average annual rate of disease recurrence (RR 0.52, 0.48-0.56) and reduces the annual breast cancer death rate by about one sixth (RR 0.82, 0.75-0.90), with a similar proportional, but different absolute benefit in prognostic subgroups (EBCTCG 2011). Furthermore, there is growing evidence that risk-adapted dose augmentation strategies to the tumor bed as well as the implementation of high precision RT techniques (e.g., intraoperative radiotherapy) contribute substantially to a further reduction of local relapse rates. A main focus of ongoing research lies in partial breast irradiation strategies as well as WBI hypofractionation schedules. The potential of both in replacing normofractionated WBI has not yet been finally clarified. CONCLUSION After breast conserving surgery, no subgroup even in low risk patients has yet been identified for whom radiotherapy can be safely omitted without compromising local control and, hence, cancer-specific survival. In most patients, this translates into an overall survival benefit.
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Affiliation(s)
- F Sedlmayer
- Department of Radiotherapy and Radiation Oncology, LKH Salzburg, Paracelsus Medical University Hospital, Muellner Haupstr. 48, Salzburg, Austria,
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