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Wu TC, Lee A, Suh R, Oughourlian TC, Abtin F, Hagio MA, Park SJ, Chang AJ, Moghanaki D. Salvage percutaneous high-dose-rate brachyablation after stereotactic body radiation therapy for early-stage non-small cell lung cancer. J Contemp Brachytherapy 2024; 16:150-155. [PMID: 38808204 PMCID: PMC11129647 DOI: 10.5114/jcb.2024.139103] [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: 01/30/2024] [Accepted: 03/25/2024] [Indexed: 05/30/2024] Open
Abstract
Patients with primary tumor progression after stereotactic body radiation therapy (SBRT) for stage I non-small cell lung cancer (NSCLC) have a second chance at complete tumor eradication with salvage local therapies, including lung resection, repeat course of SBRT, and percutaneous ablative therapies. In this paper, we presented our institution's initial experience with percutaneous high-dose-rate (HDR) brachyablation for a relapsed stage I NSCLC that had been treated with SBRT 4.3 years earlier. Lung tumor measuring approximately 5 cm in maximum tumor dimension at the time of relapse was histopathologically confirmed to be persistent squamous cell carcinoma, and successfully treated with a single fraction of 24 Gy with HDR brachyablation. Treatment was delivered via two percutaneous catheters inserted under CT-guidance, and treated in less than 20 minutes. The patient was discharged home later the same day without the need for a chest tube, and has been monitored with serial surveillance scans every 3 to 6 months without evidence of further lung cancer progression or complications at 2.8 years post-HDR brachyablation procedure and 7.8 years after initial SBRT.
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Affiliation(s)
- Trudy C. Wu
- Department of Radiation Oncology, University of California, Los Angeles, CA, United States
| | - Alan Lee
- Department of Radiation Oncology, University of California, Los Angeles, CA, United States
| | - Robert Suh
- Department of Radiology, University of California, Los Angeles, CA, United States
| | - Talia C. Oughourlian
- Department of Radiation Oncology, University of California, Los Angeles, CA, United States
| | - Fereidoun Abtin
- Department of Radiology, University of California, Los Angeles, CA, United States
| | - Mary Ann Hagio
- Department of Radiation Oncology, University of California, Los Angeles, CA, United States
| | - Sang-June Park
- Department of Radiation Oncology, University of California, Los Angeles, CA, United States
| | - Albert J. Chang
- Department of Radiation Oncology, University of California, Los Angeles, CA, United States
| | - Drew Moghanaki
- Department of Radiation Oncology, University of California, Los Angeles, CA, United States
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Nomura Y, Watanabe H, Tomisato H, Kawashima S, Miura M. Gumbel distribution-based technique enables quantitative comparison between streak metal artifacts of multidetector row CT and cone-beam CT: a phantom study. Phys Eng Sci Med 2023; 46:801-812. [PMID: 37052806 DOI: 10.1007/s13246-023-01252-5] [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: 12/02/2022] [Accepted: 03/27/2023] [Indexed: 04/14/2023]
Abstract
Cone-beam computed tomography (CBCT), derived from multidetector row CT (MDCT), has a high spatial resolution and has recently been applied to various organs. One of the severe limitations common to CBCT and MDCT is metal artifacts. In particular, streak metal artifacts (SMAs) between multiple metal materials often hinder diagnosis. However, no studies have quantitatively compared the strength of SMAs in MDCT and CBCT. Nomura et al. reported an evaluation method specialized in SMAs of CBCT using the Gumbel distribution (GD), which can also be applied to SMAs of MDCT (Oral Surg Oral Med Oral Pathol Oral Radiol 131: 494-502, 2021, https://doi.org/10.1016/J.OOOO.2020.08.031 ). This study aimed to quantitatively compare SMAs occurring between titanium materials on MDCT and CBCT images using the GD-based method. The SMAs were investigated as follows: A hydroxyapatite block was sandwiched between two titanium rods to generate an SMA. They were placed in an acrylic phantom, simulating a human head, and scanned using an MDCT scanner and two CBCT scanners. The obtained images were analyzed using Gumbel plots and location parameters, and the SMA strength was calculated. The results showed that the SMAs on the MDCT images were significantly weaker than those on the CBCT images. In the CBCT scans, a smaller volume CT dose index value caused stronger SMAs. These results indicate that MDCT is more advantageous than CBCT in terms of SMA reduction when bone morphology between titanium materials must be evaluated. The characteristic should be considered in clinical cases.
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Affiliation(s)
- Yoshikazu Nomura
- Department of Dental Radiology and Radiation Oncology, Graduate School, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan.
| | - Hiroshi Watanabe
- Department of Dental Radiology and Radiation Oncology, Graduate School, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan
| | - Hiroshi Tomisato
- Radiology Center, Division of Integrated Facilities, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Sakurako Kawashima
- Department of Dental Radiology and Radiation Oncology, Graduate School, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan
| | - Masahiko Miura
- Department of Dental Radiology and Radiation Oncology, Graduate School, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan
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McDonald BA, Zachiu C, Christodouleas J, Naser MA, Ruschin M, Sonke JJ, Thorwarth D, Létourneau D, Tyagi N, Tadic T, Yang J, Li XA, Bernchou U, Hyer DE, Snyder JE, Bubula-Rehm E, Fuller CD, Brock KK. Dose accumulation for MR-guided adaptive radiotherapy: From practical considerations to state-of-the-art clinical implementation. Front Oncol 2023; 12:1086258. [PMID: 36776378 PMCID: PMC9909539 DOI: 10.3389/fonc.2022.1086258] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 12/21/2022] [Indexed: 01/27/2023] Open
Abstract
MRI-linear accelerator (MR-linac) devices have been introduced into clinical practice in recent years and have enabled MR-guided adaptive radiation therapy (MRgART). However, by accounting for anatomical changes throughout radiation therapy (RT) and delivering different treatment plans at each fraction, adaptive radiation therapy (ART) highlights several challenges in terms of calculating the total delivered dose. Dose accumulation strategies-which typically involve deformable image registration between planning images, deformable dose mapping, and voxel-wise dose summation-can be employed for ART to estimate the delivered dose. In MRgART, plan adaptation on MRI instead of CT necessitates additional considerations in the dose accumulation process because MRI pixel values do not contain the quantitative information used for dose calculation. In this review, we discuss considerations for dose accumulation specific to MRgART and in relation to current MR-linac clinical workflows. We present a general dose accumulation framework for MRgART and discuss relevant quality assurance criteria. Finally, we highlight the clinical importance of dose accumulation in the ART era as well as the possible ways in which dose accumulation can transform clinical practice and improve our ability to deliver personalized RT.
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Affiliation(s)
- Brigid A. McDonald
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Cornel Zachiu
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Mohamed A. Naser
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Mark Ruschin
- Department of Radiation Oncology, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Jan-Jakob Sonke
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Daniela Thorwarth
- Section for Biomedical Physics, Department of Radiation Oncology, University of Tuebingen, Tuebingen, Germany
| | - Daniel Létourneau
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Neelam Tyagi
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY, United States
| | - Tony Tadic
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Jinzhong Yang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - X. Allen Li
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Uffe Bernchou
- Laboratory of Radiation Physics, Department of Oncology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Daniel E. Hyer
- Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Jeffrey E. Snyder
- Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | | | - Clifton D. Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Kristy K. Brock
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
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Dosimetric impact of rotational set-up errors in high-risk prostate cancer. POLISH JOURNAL OF MEDICAL PHYSICS AND ENGINEERING 2022. [DOI: 10.2478/pjmpe-2022-0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Introduction: Cone-beam computed tomography (CBCT) provides an excellent solution to quantitative assessment and correction of patient set-up errors during radiotherapy. However, most linear accelerators are equipped with conventional therapy tables that can be moved in three translational directions and perform only yaw rotation. Uncorrected roll and pitch result in rotational set-up errors, particularly when the distance from the isocenter to the target border is large. The aim of this study was to investigate the impact of rotational errors on the dose delivered to the clinical target volume (CTV), the planning target volume (PTV) and organs at risk (OAR).
Material and methods: 30 patients with prostate cancer treated with VMAT technique had daily CBCT scans (840 CBCTs in total) prior to treatment delivery. The rotational errors remaining after on-line correction were retrospectively analysed. The sum plans simulating the dose distribution during the treatment course were calculated for selected patients with significant rotational errors.
Results: The dose delivered to the prostate bed CTV reported in the sum plan was not lower than in the original plan for all selected patients. For four patients from the selected group, the D98% for prostate bed PTV was less than 95%. The V47.88Gy for pelvic lymph nodes PTV was less than 98% for two of the selected patients.
Conclusions: The analysis of the dosimetric parameters showed that the impact of uncorrected rotations is not clinically significant in terms of the dose delivered to OAR and the dose coverage of CTV. However, the PTV dose coverage is correlated with distance away from the isocenter and is smaller than planned.
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Cheng T, Zhang Z, Yang X, Lu S, Qian D, Wang X, Zhu H. Automatic delineation of organ at risk in cervical cancer radiotherapy based on ensemble learning. ZHONG NAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF CENTRAL SOUTH UNIVERSITY. MEDICAL SCIENCES 2022; 47:1058-1064. [PMID: 36097773 PMCID: PMC10950118 DOI: 10.11817/j.issn.1672-7347.2022.220101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES The automatic delineation of organs at risk (OARs) can help doctors make radiotherapy plans efficiently and accurately, and effectively improve the accuracy of radiotherapy and the therapeutic effect. Therefore, this study aims to propose an automatic delineation method for OARs in cervical cancer scenarios of both after-loading and external irradiation. At the same time, the similarity of OARs structure between different scenes is used to improve the segmentation accuracy of OARs in difficult segmentations. METHODS Our ensemble model adopted the strategy of ensemble learning. The model obtained from the pre-training based on the after-loading and external irradiation was introduced into the integrated model as a feature extraction module. The data in different scenes were trained alternately, and the personalized features of the OARs within the model and the common features of the OARs between scenes were introduced. Computer tomography (CT) images for 84 cases of after-loading and 46 cases of external irradiation were collected as the train data set. Five-fold cross-validation was adopted to split training sets and test sets. The five-fold average dice similarity coefficient (DSC) served as the figure-of-merit in evaluating the segmentation model. RESULTS The DSCs of the OARs (the rectum and bladder in the after-loading images and the bladder in the external irradiation images) were higher than 0.7. Compared with using an independent residual U-net (convolutional networks for biomedical image segmentation) model [residual U-net (Res-Unet)] delineate OARs, the proposed model can effectively improve the segmentation performance of difficult OARs (the sigmoid in the after-loading CT images and the rectum in the external irradiation images), and the DSCs were increased by more than 3%. CONCLUSIONS Comparing to the dedicated models, our ensemble model achieves the comparable result in segmentation of OARs for different treatment options in cervical cancer radiotherapy, which may be shorten time for doctors to sketch OARs and improve doctor's work efficiency.
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Affiliation(s)
- Tingting Cheng
- Department of Oncology, Xiangya Hospital, Central South University, Changsha 410008.
- National Clinical Research Center for Geriatric Diseases, Xiangya Hospital, Changsha 410008.
| | - Zijian Zhang
- Department of Oncology, Xiangya Hospital, Central South University, Changsha 410008.
- National Clinical Research Center for Geriatric Diseases, Xiangya Hospital, Changsha 410008.
| | - Xin Yang
- Guangzhou Perception Vision Medical Technologies Limited Company, Guangzhou 510530
| | - Shanfu Lu
- Guangzhou Perception Vision Medical Technologies Limited Company, Guangzhou 510530
| | - Dongdong Qian
- Guangzhou Perception Vision Medical Technologies Limited Company, Guangzhou 510530
| | - Xianliang Wang
- Department of Radiotherapy Center, Sichuan Cancer Hospital, Chengdu 610041, China
| | - Hong Zhu
- Department of Oncology, Xiangya Hospital, Central South University, Changsha 410008
- National Clinical Research Center for Geriatric Diseases, Xiangya Hospital, Changsha 410008
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Davies LSC, McHugh L, Aznar M, Lindsay J, Eccles C. Streamlining the image-guided radiotherapy process for proton beam therapy. Br J Radiol 2021; 94:20210764. [PMID: 34520675 PMCID: PMC8631028 DOI: 10.1259/bjr.20210764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/08/2021] [Accepted: 08/24/2021] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES This work evaluated the on-treatment imaging workflow in the UK's first proton beam therapy (PBT) centre, with a view to reducing times and unnecessary imaging doses to patients. METHODS Imaging dose and timing data from the first 20 patients (70% paediatrics, 30% TYA/adult) treated with PBT using the initial image-guided PBT (IGPBT) workflow of a 2-dimensional kilo-voltage (2DkV), followed by cone-beam computed-tomography (CBCT) and repeat 2DkV was included. Pearson correlations and Bland-Altman analysis were used to describe correlations between 2DkV and CBCT images to determine if any images were superfluous. RESULTS 229 treatment sessions were evaluated. Patient repositioning following the initial 2DkV (i2DkV) was required on 19 (8.3%) fractions. This three-step process resulted in an additional mean imaging dose of 3.4 mGy per patient, and 5.1 minutes on the treatment bed for the patient, over a whole course of PBT, compared to a two-step workflow (removing the i2DkV image). Correspondence between the mean displacements from i2DkV and CBCT was high, with R = 0.94, 0.94 and 0.80 in the anteroposterior, superiorinferior and right-left directions, respectively. Bland-Altman analysis showed very little bias and narrow limits of agreement. CONCLUSIONS Removing the i2DkV, streamlining to a two-step workflow, would reduce treatment times and imaging dose, and has been implemented as standard verification protocol. For challenging cases (e.g. paediatric patients under GA), further investigations are required before the three-step workflow can be modified. ADVANCES IN KNOWLEDGE This is the first report assessing a preliminary imaging protocol in PBT in the UK and determining a way to reduce dose and time, which ultimately benefits the patient.
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Affiliation(s)
| | - Louise McHugh
- Department of Radiotherapy, The Christie NHS Foundation Trust, Manchester, UK
| | - Marianne Aznar
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Josh Lindsay
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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The first internal electromagnetic motion monitoring implementation for stereotactic liver radiotherapy in China: procedures and preliminary results. J Cancer Res Clin Oncol 2021; 148:1429-1436. [PMID: 34226975 DOI: 10.1007/s00432-021-03726-z] [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: 03/21/2021] [Accepted: 07/01/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Respiratory motion may compromise the dose delivery accuracy in liver stereotactic body radiation therapy (SBRT). Motion management can improve treatment delivery. However, external surrogate signal may be unstable and inaccurate. This study reports the first case of liver SBRT based on internal electromagnetic motion monitoring (Calypso, Varian Medical Systems, USA) in China. MATERIALS AND METHODS The patient with a primary liver cancer was treated with respiratory-gated SBRT guided by three implanted electromagnetic transponders. The treatment was carried out in breath-hold end-exhale with beam-on when the centroid of the three transponders drifted within 5 mm (left-right (LR), anterior-posterior (AP) and cranio-caudal (CC) directions) from the planned position. The motion monitoring treatments were delivered in breath-hold end-exhale mode with the energy of 6 MV in FFF mode with 1200 monitor units (MU) per minute. For each fraction, QA results, intertransponder distances, geometric checks as well as tumor motion logs were explicitly recorded. RESULTS Comparing with the plan data, distance variances between each two transponders were - 0.56 ± 0.32 mm, 0.17 ± 0.33 mm and - 0.82 ± 0.68 mm. Geometric residual, the pitch, roll and yaw angles were 0.48 ± 0.21 mm (threshold 2.0 mm), 2.17° ± 1.85° (threshold 10°), - 2.42° ± 1.51° (threshold 10°) and 1.67° ± 1.07° (threshold 10°), respectively. The delivery time of the five fields were 13.8 s, 13.1 s, 11.2 s, 11.6 s, and 11.6 s with the average value of 12.3 ± 1.1 s. Treatment duration of each fraction ranged from 6.2 to 21.4 min, with the average value of 11.3 ± 5.0 min. CONCLUSIONS The first case of liver SBRT patient of China based on internal electromagnetic motion monitoring was performed. The system had a high tracking accuracy, and it did not delay the treatment time. In addition, the patient did not show any severe side effects except for grade I myelotoxicity. The internal electromagnetic motion monitoring system provides a real-time and direct way to track liver tumor targets.
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Fonseca GP, Baer-Beck M, Fournie E, Hofmann C, Rinaldi I, Ollers MC, van Elmpt WJC, Verhaegen F. Evaluation of novel AI-based extended field-of-view CT reconstructions. Med Phys 2021; 48:3583-3594. [PMID: 33978240 PMCID: PMC8362147 DOI: 10.1002/mp.14937] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/27/2021] [Accepted: 04/30/2021] [Indexed: 01/14/2023] Open
Abstract
Purpose Modern computed tomography (CT) scanners have an extended field‐of‐view (eFoV) for reconstructing images up to the bore size, which is relevant for patients with higher BMI or non‐isocentric positioning due to fixation devices. However, the accuracy of the image reconstruction in eFoV is not well known since truncated data are used. This study introduces a new deep learning‐based algorithm for extended field‐of‐view reconstruction and evaluates the accuracy of the eFoV reconstruction focusing on aspects relevant for radiotherapy. Methods A life‐size three‐dimensional (3D) printed thorax phantom, based on a patient CT for which eFoV was necessary, was manufactured and used as reference. The phantom has holes allowing the placement of tissue mimicking inserts used to evaluate the Hounsfield unit (HU) accuracy. CT images of the phantom were acquired using different configurations aiming to evaluate geometric and HU accuracy in the eFoV. Image reconstruction was performed using a state‐of‐the‐art reconstruction algorithm (HDFoV), commercially available, and the novel deep learning‐based approach (HDeepFoV). Five patient cases were selected to evaluate the performance of both algorithms on patient data. There is no ground truth for patients so the reconstructions were qualitatively evaluated by five physicians and five medical physicists. Results The phantom geometry reconstructed with HDFoV showed boundary deviations from 1.0 to 2.5 cm depending on the volume of the phantom outside the regular scan field of view. HDeepFoV showed a superior performance regardless of the volume of the phantom within eFOV with a maximum boundary deviation below 1.0 cm. The maximum HU (absolute) difference for soft issue inserts is below 79 and 41 HU for HDFoV and HDeepFoV, respectively. HDeepFoV has a maximum deviation of −18 HU for an inhaled lung insert while HDFoV reached a 229 HU difference. The qualitative evaluation of patient cases shows that the novel deep learning approach produces images that look more realistic and have fewer artifacts. Conclusion To be able to reconstruct images outside the sFoV of the CT scanner there is no alternative than to use some kind of extrapolated data. In our study, we proposed and investigated a new deep learning‐based algorithm and compared it to a commercial solution for eFoV reconstruction. The deep learning‐based algorithm showed superior performance in quantitative evaluations based on phantom data and in qualitative assessments of patient data.
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Affiliation(s)
- Gabriel Paiva Fonseca
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, 6229 ET, The Netherlands
| | | | | | | | - Ilaria Rinaldi
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, 6229 ET, The Netherlands
| | - Michel C Ollers
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, 6229 ET, The Netherlands
| | - Wouter J C van Elmpt
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, 6229 ET, The Netherlands
| | - Frank Verhaegen
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, 6229 ET, The Netherlands
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Decazes P, Hinault P, Veresezan O, Thureau S, Gouel P, Vera P. Trimodality PET/CT/MRI and Radiotherapy: A Mini-Review. Front Oncol 2021; 10:614008. [PMID: 33614497 PMCID: PMC7890017 DOI: 10.3389/fonc.2020.614008] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 12/22/2020] [Indexed: 12/12/2022] Open
Abstract
Computed tomography (CT) has revolutionized external radiotherapy by making it possible to visualize and segment the tumors and the organs at risk in a three-dimensional way. However, if CT is a now a standard, it presents some limitations, notably concerning tumor characterization and delineation. Its association with functional and anatomical images, that are positron emission tomography (PET) and magnetic resonance imaging (MRI), surpasses its limits. This association can be in the form of a trimodality PET/CT/MRI. The objective of this mini-review is to describe the process of performing this PET/CT/MRI trimodality for radiotherapy and its potential clinical applications. Trimodality can be performed in two ways, either a PET/MRI fused to a planning CT (possibly with a pseudo-CT generated from the MRI for the planning), or a PET/CT fused to an MRI and then registered to a planning CT (possibly the CT of PET/CT if calibrated for radiotherapy). These examinations should be performed in the treatment position, and in the second case, a patient transfer system can be used between the PET/CT and MRI to limit movement. If trimodality requires adapted equipment, notably compatible MRI equipment with high-performance dedicated coils, it allows the advantages of the three techniques to be combined with a synergistic effect while limiting their disadvantages when carried out separately. Trimodality is already possible in clinical routine and can have a high clinical impact and good inter-observer agreement, notably for head and neck cancers, brain tumor, prostate cancer, cervical cancer.
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Affiliation(s)
- Pierre Decazes
- Nuclear Medicine Department, Henri Becquerel Cancer Center, Rouen, France.,QuantIF-LITIS EA4108, University of Rouen, Rouen, France
| | | | - Ovidiu Veresezan
- Radiotherapy Department, Henri Becquerel Cancer Center, Rouen, France
| | - Sébastien Thureau
- Nuclear Medicine Department, Henri Becquerel Cancer Center, Rouen, France.,QuantIF-LITIS EA4108, University of Rouen, Rouen, France.,Radiotherapy Department, Henri Becquerel Cancer Center, Rouen, France
| | - Pierrick Gouel
- Nuclear Medicine Department, Henri Becquerel Cancer Center, Rouen, France.,QuantIF-LITIS EA4108, University of Rouen, Rouen, France
| | - Pierre Vera
- Nuclear Medicine Department, Henri Becquerel Cancer Center, Rouen, France.,QuantIF-LITIS EA4108, University of Rouen, Rouen, France
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