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Szlag M, Stankiewicz M, Kellas-Ślęczka S, Stąpór-Fudzińska M, Cholewka A, Pruefer A, Wojcieszek P. Comparison of image registration methods in patients with non-melanoma skin cancer treated with superficial brachytherapy. Phys Imaging Radiat Oncol 2024; 31:100631. [PMID: 39262679 PMCID: PMC11387206 DOI: 10.1016/j.phro.2024.100631] [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: 02/27/2024] [Revised: 08/14/2024] [Accepted: 08/15/2024] [Indexed: 09/13/2024] Open
Abstract
The accumulated dose from sequential treatments of metachronous non-melanoma skin cancer can be assessed using image registration, although guidelines for selecting the appropriate algorithm are lacking. This study shows the impact of rigid (RIR), deformable (DIR) and deformable structure-based (SDIR) algorithms on the skin dose. DIR increased: the maximum dose (39.2 Gy vs 9.4 Gy), the dose to 0.1 cm3 (16.4 Gy vs 7.8 Gy) and the dose to 2 cm3 (7.6 Gy vs 5.7 Gy). RIR only affected the maximum dose, which increased to 17.0 Gy. SDIR correctly translated the dose maps, as none of the parameters changed significantly.
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Affiliation(s)
- Marta Szlag
- Maria Sklodowska-Curie National Research Institute of Oncology Gliwice branch Wybrzeże Armii Krajowej Street 15, 44-101 Gliwice, Poland
| | - Magdalena Stankiewicz
- Maria Sklodowska-Curie National Research Institute of Oncology Gliwice branch Wybrzeże Armii Krajowej Street 15, 44-101 Gliwice, Poland
| | - Sylwia Kellas-Ślęczka
- Maria Sklodowska-Curie National Research Institute of Oncology Gliwice branch Wybrzeże Armii Krajowej Street 15, 44-101 Gliwice, Poland
| | - Małgorzata Stąpór-Fudzińska
- Maria Sklodowska-Curie National Research Institute of Oncology Gliwice branch Wybrzeże Armii Krajowej Street 15, 44-101 Gliwice, Poland
| | - Agnieszka Cholewka
- Maria Sklodowska-Curie National Research Institute of Oncology Gliwice branch Wybrzeże Armii Krajowej Street 15, 44-101 Gliwice, Poland
| | - Agnieszka Pruefer
- Maria Sklodowska-Curie National Research Institute of Oncology Gliwice branch Wybrzeże Armii Krajowej Street 15, 44-101 Gliwice, Poland
| | - Piotr Wojcieszek
- Maria Sklodowska-Curie National Research Institute of Oncology Gliwice branch Wybrzeże Armii Krajowej Street 15, 44-101 Gliwice, Poland
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2
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Kim H, Lee YC, Benedict SH, Dyer B, Price M, Rong Y, Ravi A, Leung E, Beriwal S, Bernard ME, Mayadev J, Leif JRL, Xiao Y. Dose Summation Strategies for External Beam Radiation Therapy and Brachytherapy in Gynecologic Malignancy: A Review from the NRG Oncology and NCTN Medical Physics Subcommittees. Int J Radiat Oncol Biol Phys 2021; 111:999-1010. [PMID: 34147581 PMCID: PMC8594937 DOI: 10.1016/j.ijrobp.2021.06.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 06/08/2021] [Accepted: 06/10/2021] [Indexed: 11/26/2022]
Abstract
Definitive, nonsurgical management of gynecologic malignancies involves external beam radiation therapy (EBRT) and/or brachytherapy (BT). Summation of the cumulative dose is critical to assess the total biologic effective dose to targets and organs at risk. Cumulative dose calculation from EBRT and BT can be performed with or without image registration (IR) and biologic dose summation. Among these dose summation strategies, linear addition of dose-volume histogram (DVH) parameters without IR is the global standard for composite dose reporting. This approach stems from an era without image guidance and simple external beam and brachytherapy treatment approaches. With technological advances, EBRT and high-dose-rate BT have evolved to allow for volume-based treatment planning and delivery. Modern conformal therapeutic radiation involves volumetric or intensity modulated EBRT, capable of simultaneously treating multiple targets at different specified dose levels. Therefore, given the complexity of modern radiation treatment, the linear addition of DVH parameters from EBRT and high-dose-rate BT is challenging to represent the combined dose distribution. Deformable image registration (DIR) between EBRT and image guided brachytherapy (IGBT) data sets may provide a more nuanced calculation of multimodal dose accumulation. However, DIR is still nascent in this regard, and needs further development for accuracy and efficiency for clinical use. Biologic dose summation can combine physical dose maps from EBRT and each IGBT fraction, thereby generating a composite DVH from the biologic effective dose. However, accurate radiobiologic parameters are tissue-dependent and not well characterized. A combination of voxel-based DIR and biologic weighted dose maps may be the best approximation of dose accumulation but remains invalidated. The purpose of this report is to review dose summation strategies for EBRT and BT, including conventional equivalent dose in 2-Gy fractions dose summation without image registration, physical dose summation using 3-dimensional rigid IR and DIR, and biologic dose summation. We also provide general clinical workflows for IGBT with a focus on cervical cancer.
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Affiliation(s)
- Hayeon Kim
- Department of Radiation Oncology, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Yongsook C Lee
- Department of Radiation Oncology, Miami Cancer Institute | Baptist Health South Florida, Miami, Florida
| | - Stanley H Benedict
- Department of Radiation Oncology, University of California at Davis Cancer Center, Sacramento, California.
| | - Brandon Dyer
- Department of Radiation Oncology, University of Washington, Seattle, Washington
| | - Michael Price
- Department of Radiation Oncology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Yi Rong
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, Arizona
| | - Ananth Ravi
- Molli Surgical INC, Department of Radiation Oncology, University of Toronto, Department of Physics, Ryerson University, Toronto, Ontario, Canada
| | - Eric Leung
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Odette Cancer Centre, University of Toronto, Toronto, Ontario
| | - Sushil Beriwal
- Department of Radiation Oncology, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Mark E Bernard
- Department of Radiation Oncology, University of Kentucky, Lexington, Kentucky
| | - Jyoti Mayadev
- Department of Radiation Oncology, University of California at San Diego, San Diego, La Jolla, California
| | - Jessica R L Leif
- Department of Radiation Physics, IROC Houston QA Center, MD Anderson Cancer Center, Houston, Texas
| | - Ying Xiao
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
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Wang B, Hu W, Shan G, Xu X. Estimating the accumulative dose uncertainty for intracavitary and interstitial brachytherapy. Biomed Eng Online 2021; 20:106. [PMID: 34663336 PMCID: PMC8524953 DOI: 10.1186/s12938-021-00942-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 10/03/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Image-guided adaptive brachytherapy shows the ability to deliver high doses to tumors while sparing normal tissues. However, interfraction dose delivery introduces uncertainties to high dose estimation, which relates to normal tissue toxicity. The purpose of this study was to investigate the high-dose regions of two applicator approaches in brachytherapy. METHOD For 32 cervical cancer patients, the CT images from each fraction were wrapped to a reference image, and the displacement vector field (DVF) was calculated with a hybrid intensity-based deformable registration algorithm. The fractional dose was then accumulated to calculate the position and the overlap of high dose (D2cc) during multiple fractions. RESULT The overall Dice similarity coefficient (DSC) of the deformation algorithm for the bladder and the rectum was (0.97 and 0.91). No significant difference was observed between the two applicators. However, the location of the intracavitary brachytherapy (ICBT) high-dose region was relatively concentrated. The overlap volume of bladder and rectum D2cc was 0.42 and 0.71, respectively, which was higher than that of interstitial brachytherapy (ISBT) (0.26 and 0.31). The cumulative dose was overestimated in ISBT cases when using the GEC-recommended method. The ratio of bladder and rectum D2cc to the GEC method was 0.99 and 1, respectively, which was higher than that of the ISBT method (0.96 and 0.94). CONCLUSION High-dose regions for brachytherapy based on different applicator types were different. The 3D-printed ICBT has better high-dose region consistency than freehand ISBT and hence is more predictable.
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Affiliation(s)
- Binbing Wang
- Department of Radiation Physics, Zhejiang Key Laboratory of Radiation Oncology, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, No. 1. East Banshan Road, Gongshu District, Hangzhou, 310022 Zhejiang China
| | - Weibiao Hu
- Taizhou Hospital of Zhejiang Province, Taizhou, 318000 Zhejiang China
| | - Guoping Shan
- Department of Radiation Physics, Zhejiang Key Laboratory of Radiation Oncology, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, No. 1. East Banshan Road, Gongshu District, Hangzhou, 310022 Zhejiang China
| | - Xiaoxian Xu
- Department of Radiation Physics, Zhejiang Key Laboratory of Radiation Oncology, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, No. 1. East Banshan Road, Gongshu District, Hangzhou, 310022 Zhejiang China
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Mohammadi R, Shokatian I, Salehi M, Arabi H, Shiri I, Zaidi H. Deep learning-based auto-segmentation of organs at risk in high-dose rate brachytherapy of cervical cancer. Radiother Oncol 2021; 159:231-240. [DOI: 10.1016/j.radonc.2021.03.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/20/2021] [Accepted: 03/24/2021] [Indexed: 12/11/2022]
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Zhang Y, Kashani R, Cao Y, Lawrence TS, Johansson A, Balter JM. A hierarchical model of abdominal configuration changes extracted from golden angle radial magnetic resonance imaging. Phys Med Biol 2021; 66:045018. [PMID: 33361579 PMCID: PMC7993537 DOI: 10.1088/1361-6560/abd66e] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Abdominal organs are subject to a variety of physiological forces that superimpose their effects to influence local motion and configuration. These forces not only include breathing, but can also arise from cyclic antral contractions and a range of slow configuration changes. To elucidate each individual motion pattern as well as their combined effects, a hierarchical motion model was built for characterization of these 3 motion modes (characterized as deformation maps between states) using golden angle radial MR signals. Breathing motions are characterized first. Antral contraction states are then reconstructed after breathing motion-induced deformation are corrected; slow configuration change states are further extracted from breathing motion-corrected image reconstructions. The hierarchical model is established based on these multimodal states, which can be either individually shown or combined to demonstrate any arbitrary composited motion patterns. The model was evaluated using 20 MR scans acquired from 9 subjects. Poor reproducibility of breathing motions both within as well as between scan sessions was observed, with an average intra-subject difference of 1.6 cycles min-1 for average breathing frequencies of 12.0 cycles min-1. Antral contraction frequency distributions were more stable than breathing, but also presented poor reproducibility between scans with an average difference of 0.3 cycles min-1 for average frequencies of 3.2 cycles min-1. The magnitudes of motions beyond breathing were found to be significant, with 14.4 and 33.8 mm maximal motions measured from antral contraction and slow configuration changes, respectively. Hierarchical motion models have potential in multiple applications in radiotherapy, including improving the accuracy of dose delivery estimation, providing guidance for margin creation, and supporting advanced decisions and strategies for immobilization, treatment monitoring and gating.
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Affiliation(s)
- Yuhang Zhang
- Department of Radiation Oncology, University of Michigan, United States of America
- Department of Biomedical Engineering, University of Michigan, United States of America
| | - Rojano Kashani
- Department of Radiation Oncology, University of Michigan, United States of America
| | - Yue Cao
- Department of Radiation Oncology, University of Michigan, United States of America
- Department of Biomedical Engineering, University of Michigan, United States of America
- Department of Radiology, University of Michigan, United States of America
| | - Theodore S Lawrence
- Department of Radiation Oncology, University of Michigan, United States of America
| | - Adam Johansson
- Department of Surgical Sciences, Uppsala University, Sweden
| | - James M Balter
- Department of Radiation Oncology, University of Michigan, United States of America
- Department of Biomedical Engineering, University of Michigan, United States of America
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6
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Glaser SM, Mohindra P, Mahantshetty U, Beriwal S. Complications of intracavitary brachytherapy for gynecologic cancers and their management: A comprehensive review. Brachytherapy 2021; 20:984-994. [PMID: 33478905 DOI: 10.1016/j.brachy.2020.11.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 11/21/2020] [Accepted: 11/23/2020] [Indexed: 10/22/2022]
Abstract
Intracavitary gynecologic brachytherapy in the form of tandem-based brachytherapy and vaginal cylinder-based brachytherapy represents a fundamental component of the treatment of women with cervical or uterine cancer due to the ability to deliver a therapeutic dose of radiation with sharp dose falloff. This results in highly effective treatment in terms of oncologic outcomes with an overall favorable toxicity profile. Still, complications and side effects of brachytherapy do exist. While advances in brachytherapy techniques have led to a significant decrease in the rates of toxicity, a thorough understanding of the potential complications is crucial to ensuring optimal outcomes for women with gynecologic cancer undergoing brachytherapy. Use of equivalent dose at 2 Gy per fraction (EQD2) models has allowed incorporation of external beam radiotherapy dose to the brachytherapy dose leading to development of consolidated dose constraints for organs-at-risk in the modern era. This manuscript offers a comprehensive review of potential complications associated with intracavitary brachytherapy for gynecologic cancer including predictive factors, mitigation tactics, and management strategies.
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Affiliation(s)
- Scott M Glaser
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA.
| | - Pranshu Mohindra
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
| | | | - Sushil Beriwal
- Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA
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7
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Accuracy of registrations between cone-beam computed tomography and conventional computed tomography images and dose mapping methods in RaySearch software for the bladder during brachytherapy of cervical cancer patients. J Contemp Brachytherapy 2021; 12:593-600. [PMID: 33437308 PMCID: PMC7787205 DOI: 10.5114/jcb.2020.101693] [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: 09/03/2020] [Accepted: 10/29/2020] [Indexed: 11/19/2022] Open
Abstract
Purpose The aim of the study was to assess selected methods of image registration available in the RaySearch software and their impact on the accuracy of mapping of doses deposited in the bladder during brachytherapy (BRT) of cervical cancer in images used during external beam radiotherapy (EBRT). Material and methods The study was based on data from ten patients. Cone-beam computed tomography (CBCT) images (BRT) were aligned with CT images (EBRT) using four registration methods: Reg_1 (rigid), Reg_2a, Reg_2b (hybrid), and Reg_3 (biomechanical). Image mapping accuracy was evaluated based on bladder’s anatomy. Sørensen-Dice coefficient (DSC) values were analyzed for all the registrations. Discrepancies between triangular mesh points set on the basis of bladder contours were analyzed. Dose distributions from BRT were transformed according to registration results and mapped on CT images. Original BRT doses deposited in 2 cm3 volume of the bladder were compared to those transformed and associated with bladder’s volume determined on CT images. Results Mean DSC values amounted to 0.36 (Reg_1), 0.87 and 0.88 (Reg_2a and Reg_2b), and 0.97 (Reg_3). Significant differences were found between DSC for the following comparisons: Reg_3/Reg_1 (p = 0.001), Reg_2a/Reg_1 (p = 0.011), and Reg_2b/Reg_1 (p = 0.014). The lowest discrepancies between triangular mesh points were for Reg_3 (p < 0.001, Reg_3 vs. Reg_1, and p = 0.039, Reg_3 vs. Reg_2b). Finally, the lowest discrepancies between the original and transformed doses were found for Reg_3. Nevertheless, only 5 out of 10 observations for Reg_3 yielded error of less than 5%. Conclusions Biomechanical registration (Reg_3) enabled the most accurate alignment between CBCT and CT images. Satisfactory registration results of anatomical structures do not guarantee a correct mapping of primary BRT doses on the bladder delineated on CT images during EBRT. The results of dose transformation based on biomechanical registration had an error of less than 5% for only 50% of the observations.
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8
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Zeng J, Chen J, Zhang D, Meng M, Zhang B, Qu P, Pang Q, Wang P. Assessing cumulative dose distributions in combined external beam radiotherapy and intracavitary brachytherapy for cervical cancer by treatment planning based on deformable image registration. Transl Cancer Res 2020; 9:6107-6115. [PMID: 35117222 PMCID: PMC8798938 DOI: 10.21037/tcr-20-1196] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 08/21/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND This study aimed to validate the feasibility of deformable image registration (DIR) in assessing the cumulative dose distributions in combined external beam radiotherapy (EBRT) and intracavitary brachytherapy (ICBT) for cervical cancer. METHODS This retrospective study included 23 patients with stage IIB disease treated with combined EBRT to the whole pelvis (50.4 Gy in 28 fractions) using an intensity-modulated radiotherapy technique with 6-MV X-ray, followed by three-dimensional (3D) ICBT (28 Gy in 4 fractions). Tumor gross target volume at diagnosis (GTV-Tinit), tumor gross target volume before brachytherapy, high-risk clinical target volume (HR-CTV), intermediate-risk clinical target volume (IR-CTV), and parametrium and organs at risk were recontoured on computed tomography images of EBRT and ICBT, respectively. The dose-volume parameters were also determined. The DIR results were reviewed using MIM Maestro (Reg Review) and modified by function (Reg Refine). To evaluate the accuracy of DIR, DIR-based cumulative dose-volume histogram (DVH) parameters and simple DVH parameter addition were compared using Wilcoxon rank-sum tests. RESULTS The cumulative dose distributions of EBRT and four ICBT sessions were successfully illustrated using DIR. The mean tumor diameters were 68.35 cm3 at diagnosis and 29.63 cm3 at ICBT initiation. The mean tumor regression was 56.6%. The median minimum dose covering 90% (D90) of HR-CTV, GTV-Tinit, IR-CTV, and parametrium were 69.58±4.94, 68.81±7.98, 59.28±3.78, and 60.97±1.1 Gyα/β=10, respectively, for DIR and 69.11±5.68, 68.49±8.62, 58.89±3.59, and 61±1.49 Gyα/β=10, respectively, with conventional simple DVH parameter addition.No statistically significant differences in dosimetric parameters were observed between the two methods. CONCLUSIONS Although there were limitations in the DIR accuracy, DIR-based dose accumulation was significantly beneficial in visually showing the cumulative dose distribution in the target area to clinicians in combined radiotherapy for cervical cancer in routine clinical practice.
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Affiliation(s)
- Jing Zeng
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Centre for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin, China
- Department of Gynecologic Oncology, Tianjin Central Hospital of Gynecology Obstetrics, Affiliated Hospital of Nankai University, Tianjin, China
| | - Jie Chen
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Centre for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin, China
| | - Daguang Zhang
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Centre for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin, China
| | - Maobin Meng
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Centre for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin, China
| | - Bailin Zhang
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Centre for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin, China
| | - Pengpeng Qu
- Department of Gynecologic Oncology, Tianjin Central Hospital of Gynecology Obstetrics, Affiliated Hospital of Nankai University, Tianjin, China
| | - Qingsong Pang
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Centre for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin, China
| | - Ping Wang
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Centre for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin, China
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Tanderup K, Nesvacil N, Kirchheiner K, Serban M, Spampinato S, Jensen NBK, Schmid M, Smet S, Westerveld H, Ecker S, Mahantshetty U, Swamidas J, Chopra S, Nout R, Tan LT, Fokdal L, Sturdza A, Jürgenliemk-Schulz I, de Leeuw A, Lindegaard JC, Kirisits C, Pötter R. Evidence-Based Dose Planning Aims and Dose Prescription in Image-Guided Brachytherapy Combined With Radiochemotherapy in Locally Advanced Cervical Cancer. Semin Radiat Oncol 2020; 30:311-327. [DOI: 10.1016/j.semradonc.2020.05.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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10
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Dyer BA, Yuan Z, Qiu J, Shi L, Wright C, Benedict SH, Valicenti R, Mayadev JS, Rong Y. Clinical feasibility of MR-assisted CT-based cervical brachytherapy using MR-to-CT deformable image registration. Brachytherapy 2020; 19:447-456. [DOI: 10.1016/j.brachy.2020.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 01/16/2020] [Accepted: 03/01/2020] [Indexed: 12/21/2022]
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11
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Swamidas J, Kirisits C, De Brabandere M, Hellebust TP, Siebert FA, Tanderup K. Image registration, contour propagation and dose accumulation of external beam and brachytherapy in gynecological radiotherapy. Radiother Oncol 2020; 143:1-11. [DOI: 10.1016/j.radonc.2019.08.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 08/23/2019] [Accepted: 08/28/2019] [Indexed: 02/07/2023]
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12
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Bohoudi O, Lagerwaard FJ, Bruynzeel AM, Niebuhr NI, Johnen W, Senan S, Slotman BJ, Pfaffenberger A, Palacios MA. End-to-end empirical validation of dose accumulation in MRI-guided adaptive radiotherapy for prostate cancer using an anthropomorphic deformable pelvis phantom. Radiother Oncol 2019; 141:200-207. [DOI: 10.1016/j.radonc.2019.09.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 09/12/2019] [Accepted: 09/14/2019] [Indexed: 10/25/2022]
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13
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Kuznetsova S, Grendarova P, Roy S, Sinha R, Thind K, Ploquin N. Structure guided deformable image registration for treatment planning CT and post stereotactic body radiation therapy (SBRT) Primovist ® (Gd-EOB-DTPA) enhanced MRI. J Appl Clin Med Phys 2019; 20:109-118. [PMID: 31755658 PMCID: PMC6909124 DOI: 10.1002/acm2.12773] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 07/12/2019] [Accepted: 10/23/2019] [Indexed: 01/01/2023] Open
Abstract
The purpose of this study was to assess the performance of structure‐guided deformable image registration (SG‐DIR) relative to rigid registration and DIR using TG‐132 recommendations. This assessment was performed for image registration of treatment planning computed tomography (CT) and magnetic resonance imaging (MRI) scans with Primovist® contrast agent acquired post stereotactic body radiation therapy (SBRT). SBRT treatment planning CT scans and posttreatment Primovist® MRI scans were obtained for 14 patients. The liver was delineated on both sets of images and matching anatomical landmarks were chosen by a radiation oncologist. Rigid registration, DIR, and two types of SG‐DIR (using liver contours only; and using liver structures along with anatomical landmarks) were performed for each set of scans. TG‐132 recommended metrics were estimated which included Dice Similarity Coefficient (DSC), Mean Distance to Agreement (MDA), Target Registration Error (TRE), and Jacobian determinant. Statistical analysis was performed using Wilcoxon Signed Rank test. The median (range) DSC for rigid registration was 0.88 (0.77–0.89), 0.89 (0.81–0.93) for DIR, and 0.90 (0.86–0.94) for both types of SG‐DIR tested in this study. The median MDA was 4.8 mm (3.7–6.8 mm) for rigid registration, 3.4 mm (2.4–8.7 mm) for DIR, 3.2 mm (2.0–5.2 mm) for SG‐DIR where liver structures were used to guide the registration, and 2.8 mm (2.1–4.2 mm) for the SG‐DIR where liver structures and anatomical landmarks were used to guide the registration. The median TRE for rigid registration was 7.2 mm (0.5–23 mm), 6.8 mm (0.7–30.7 mm) for DIR, 6.1 mm (1.1–20.5 mm) for the SG‐DIR guided by only the liver structures, and 4.1 mm (0.8–19.7 mm) for SG‐DIR guided by liver contours and anatomical landmarks. The SG‐DIR shows higher liver conformality as per TG‐132 metrics and lowest TRE compared to rigid registration and DIR in Velocity AI software for the purpose of registering treatment planning CT and post‐SBRT MRI for the liver region. It was found that TRE decreases when liver contours and corresponding anatomical landmarks guide SG‐DIR.
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Affiliation(s)
- Svetlana Kuznetsova
- Department of Physics and Astronomy, University of Calgary, Calgary, Alberta, Canada
| | - Petra Grendarova
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Soumyajit Roy
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada.,Department of Radiation Oncology, The Ottawa Hospital Cancer Program, University of Ottawa, Ottawa, Ontario, Canada
| | - Rishi Sinha
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Kundan Thind
- Department of Physics and Astronomy, University of Calgary, Calgary, Alberta, Canada.,Department of Oncology, University of Calgary, Calgary, Alberta, Canada.,Department of Medical Physics, Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Nicolas Ploquin
- Department of Physics and Astronomy, University of Calgary, Calgary, Alberta, Canada.,Department of Oncology, University of Calgary, Calgary, Alberta, Canada.,Department of Medical Physics, Tom Baker Cancer Centre, Calgary, Alberta, Canada
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Xu Z, Traughber BJ, Fredman E, Albani D, Ellis RJ, Podder TK. Appropriate Methodology for EBRT and HDR Intracavitary/Interstitial Brachytherapy Dose Composite and Clinical Plan Evaluation for Patients With Cervical Cancer. Pract Radiat Oncol 2019; 9:e559-e571. [PMID: 31238167 DOI: 10.1016/j.prro.2019.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 04/16/2019] [Accepted: 06/10/2019] [Indexed: 11/17/2022]
Abstract
PURPOSE This study assessed the appropriateness of full parameter addition (FPA) methods with respect to the 3-dimensional deformable dose composite method for evaluating combined external beam radiation therapy (EBRT) and intracavitary brachytherapy (ICBT). METHODS AND MATERIALS A total of 22 patients who received EBRT and high-dose-rate ICBT were retrospectively evaluated. Split-ring and tandem applicators were used for all patients. Additional interstitial needles were used for 5 patients to supplement the implant. Deformable image registrations were performed to deform the secondary EBRT and ICBT planning computed tomography (CT) images onto the reference CT from the third fraction of ICBT. The Dice similarity coefficient was used to evaluate the quality of deformable registration. Doses were transferred to the reference CT, scaled to the equivalent dose in 2-Gy fractions and combined to create the dose composite. Eight dose-accumulation methods were evaluated and compared. D2cc and D0.1cc for organs at risk were investigated. RESULTS The differences in D2cc for rectum, bladder, sigmoid, and bowel between the FPA method for whole-pelvis EBRT and ICBT, calculated using an old American Brachytherapy Society worksheet (FPA_Eh + I_old) and deformable composite for EBRT with boosts and ICBT (Def_E + B + I) were -2.19 ± 1.37 Gyα/β = 3, -0.64 ± 1.13 Gyα/β = 3, -2.06 ± 2.71 Gyα/β = 3, and -1.59 ± 0.89 Gyα/β = 3, respectively. The differences in D2cc for rectum, bladder, sigmoid, and bowel between the new ABS worksheet (FPA_Eh + B + I_abs) and the Def_E + B + I method were 1.21 ± 1.22 Gy α/β = 3, 1.93 ± 1.38 Gyα/β = 3, 0.72 ± 1.12 Gyα/β = 3, and 1.19 ± 1.46 Gyα/β = 3, respectively. Differences in dose-volume histogram parameter values among Def_E + B + I and other FPA methods were not statistically significant (P > .05). CONCLUSIONS Compared with the FPA-based method, deformable registration-based dose composites demonstrated lower OAR D2cc and D0.1cc values; however, the differences were not statistically significant. The current ABS-recommended FPA-based sheet can serve as an acceptable plan evaluation tool for clinical purposes.
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Affiliation(s)
- Zhengzheng Xu
- Department of Radiation Oncology, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
| | - Bryan J Traughber
- Department of Radiation Oncology, University Hospitals Cleveland Medical Center, Cleveland, Ohio; School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Elisha Fredman
- Department of Radiation Oncology, University Hospitals Cleveland Medical Center, Cleveland, Ohio; School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - David Albani
- Department of Radiation Oncology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Rodney J Ellis
- Department of Radiation Oncology, University Hospitals Cleveland Medical Center, Cleveland, Ohio; School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Tarun K Podder
- Department of Radiation Oncology, University Hospitals Cleveland Medical Center, Cleveland, Ohio; School of Medicine, Case Western Reserve University, Cleveland, Ohio
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Evaluation of deformable image registration algorithm for determination of accumulated dose for brachytherapy of cervical cancer patients. J Contemp Brachytherapy 2019; 11:469-478. [PMID: 31749857 PMCID: PMC6854864 DOI: 10.5114/jcb.2019.88762] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 09/17/2019] [Indexed: 12/30/2022] Open
Abstract
Purpose This study was designed to assess the dose accumulation (DA) of bladder and rectum between brachytherapy fractions using hybrid-based deformable image registration (DIR) and compare it with the simple summation (SS) approach of GEC-ESTRO in cervical cancer patients. Material and methods Patients (n = 137) with cervical cancer treated with 3D conformal radiotherapy and three fractions of high-dose-rate brachytherapy were selected. CT images were acquired to delineate organs at risk and targets according to GEC-ESTRO recommendations. In order to determine the DA for the bladder and rectum, hybrid-based DIR was done for three different fractions of brachytherapy and the results were compared with the standard GEC-ESTRO method. Also, we performed a phantom study to calculate the uncertainty of the hybrid-based DIR algorithm for contour matching and dose mapping. Results The mean ± standard deviation (SD) of the Dice similarity coefficient (DICE), Jaccard, Hausdorff distance (HD) and mean distance to agreement (MDA) in the DIR process were 0.94 ±0.02, 0.89 ±0.03, 8.44 ±3.56 and 0.72 ±0.22 for bladder and 0.89 ±0.05, 0.80 ±0.07, 15.46 ±10.14 and 1.19 ±0.59 for rectum, respectively. The median (Q1, Q3; maximum) GyEQD2 differences of total D2cc between DIR-based and SS methods for the bladder and rectum were reduced by –1.53 (–0.86, –2.98; –9.17) and –1.38 (–0.80, –2.14; –7.11), respectively. The mean ± SD of DICE, Jaccard, HD, and MDA for contour matching were 0.98 ±0.008, 0.97 ±0.01, 2.00 ±0.70 and 0.20 ±0.04, respectively for large deformation. Maximum uncertainty of dose mapping was about 3.58%. Conclusions The hybrid-based DIR algorithm demonstrated low registration uncertainty for both contour matching and dose mapping. The DA difference between DIR-based and SS approaches was statistically significant for both bladder and rectum and hybrid-based DIR showed potential to assess DA between brachytherapy fractions.
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Rigaud B, Simon A, Castelli J, Lafond C, Acosta O, Haigron P, Cazoulat G, de Crevoisier R. Deformable image registration for radiation therapy: principle, methods, applications and evaluation. Acta Oncol 2019; 58:1225-1237. [PMID: 31155990 DOI: 10.1080/0284186x.2019.1620331] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background: Deformable image registration (DIR) is increasingly used in the field of radiation therapy (RT) to account for anatomical deformations. The aims of this paper are to describe the main applications of DIR in RT and discuss current DIR evaluation methods. Methods: Articles on DIR published from January 2000 to October 2018 were extracted from PubMed and Science Direct. Our search was restricted to articles that report data obtained from humans, were written in English, and address DIR methods for RT. A total of 207 articles were selected from among 2506 identified in the search process. Results: At planning, DIR is used for organ delineation using atlas-based segmentation, deformation-based planning target volume definition, functional planning and magnetic resonance imaging-based dose calculation. In image-guided RT, DIR is used for contour propagation and dose calculation on per-treatment imaging. DIR is also used to determine the accumulated dose from fraction to fraction in external beam RT and brachytherapy, both for dose reporting and adaptive RT. In the case of re-irradiation, DIR can be used to estimate the cumulated dose of the two irradiations. Finally, DIR can be used to predict toxicity in voxel-wise population analysis. However, the evaluation of DIR remains an open issue, especially when dealing with complex cases such as the disappearance of matter. To quantify DIR uncertainties, most evaluation methods are limited to geometry-based metrics. Software companies have now integrated DIR tools into treatment planning systems for clinical use, such as contour propagation and fraction dose accumulation. Conclusions: DIR is increasingly important in RT applications, from planning to toxicity prediction. DIR is routinely used to reduce the workload of contour propagation. However, its use for complex dosimetric applications must be carefully evaluated by combining quantitative and qualitative analyses.
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Affiliation(s)
- Bastien Rigaud
- CLCC Eugène Marquis, University of Rennes, Inserm , Rennes , France
| | - Antoine Simon
- CLCC Eugène Marquis, University of Rennes, Inserm , Rennes , France
| | - Joël Castelli
- CLCC Eugène Marquis, University of Rennes, Inserm , Rennes , France
| | - Caroline Lafond
- CLCC Eugène Marquis, University of Rennes, Inserm , Rennes , France
| | - Oscar Acosta
- CLCC Eugène Marquis, University of Rennes, Inserm , Rennes , France
| | - Pascal Haigron
- CLCC Eugène Marquis, University of Rennes, Inserm , Rennes , France
| | - Guillaume Cazoulat
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center , Houston , TX , USA
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Rigaud B, Klopp A, Vedam S, Venkatesan A, Taku N, Simon A, Haigron P, de Crevoisier R, Brock KK, Cazoulat G. Deformable image registration for dose mapping between external beam radiotherapy and brachytherapy images of cervical cancer. Phys Med Biol 2019; 64:115023. [PMID: 30913542 DOI: 10.1088/1361-6560/ab1378] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
For locally advanced cervical cancer (LACC), anatomy correspondence with and without BT applicator needs to be quantified to merge the delivered doses of external beam radiation therapy (EBRT) and brachytherapy (BT). This study proposed and evaluated different deformable image registration (DIR) methods for this application. Twenty patients who underwent EBRT and BT for LACC were retrospectively analyzed. Each patient had a pre-BT CT at EBRT boost (without applicator) and a CT and MRI at BT (with applicator). The evaluated DIR methods were the diffeomorphic Demons, commercial intensity and hybrid methods, and three different biomechanical models. The biomechanical models considered different boundary conditions (BCs). The impact of the BT devices insertion on the anatomy was quantified. DIR method performances were quantified using geometric criteria between the original and deformed contours. The BT dose was deformed toward the pre-CT BT by each DIR method. The impact of boundary conditions to drive the biomechanical model was evaluated based on the deformation vector field and dose differences. The GEC-ESTRO guideline dose indices were reported. Large organ displacements, deformations, and volume variations were observed between the pre-BT and BT anatomies. Rigid registration and intensity-based DIR resulted in poor geometric accuracy with mean Dice similarity coefficient (DSC) inferior to 0.57, 0.63, 0.42, 0.32, and 0.43 for the rectum, bladder, vagina, cervix and uterus, respectively. Biomechanical models provided a mean DSC of 0.96 for all the organs. By considering the cervix-uterus as one single structure, biomechanical models provided a mean DSC of 0.88 and 0.94 for the cervix and uterus, respectively. The deformed doses were represented for each DIR method. Caution should be used when performing DIR for this application as standard techniques may have unacceptable results. The biomechanical model with the cervix-uterus as one structure provided the most realistic deformations to propagate the BT dose toward the EBRT boost anatomy.
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Affiliation(s)
- B Rigaud
- Univ Rennes, CLCC Eugène Marquis, Inserm, LTSI-UMR 1099, F-35000 Rennes, France. Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States of America. Author to whom any correspondence should be addressed
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Dosimetric evaluation of Point A and volume-based high-dose-rate plans: a single institution study on adaptive brachytherapy planning for cervical cancer. J Contemp Brachytherapy 2018; 10:202-210. [PMID: 30038639 PMCID: PMC6052381 DOI: 10.5114/jcb.2018.76782] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 04/18/2018] [Indexed: 12/21/2022] Open
Abstract
Purpose External beam radiation therapy (EBRT) and brachytherapy (BT) with concurrent cisplatin is the standard of care for locally advanced cervical cancer. The applicability of image-guided adaptive volume-based high-dose-rate (HDR) intracavitary brachytherapy planning is an active area of investigation. In this study, we examined whether volume-based HDR-BT (HDRVOL) plans leads to more conformal plans compared to Point A (HDRPointA)-based plans. Material and methods Two hundred and forty HDRPointA plans from 48 cervical cancer patients treated with chemoradiotherapy were retrospectively collected. Point A plans were renormalized with respect to the high-risk clinical target volume (HR-CTV) for the HDRVOL plans. The doses to organs at risk (OAR; rectum, sigmoid, and bladder), and HR-CTV and the conformal index were compared between HDRPointA and HDRVOL plans. Results HDRVOL plans resulted in a 6-12% reduction in the total dose (EBRT + HDR-BT) to 0.1 cc, 1.0 cc, and 2.0 cc of the OAR as well as an 8-37% reduction in the dose to 2 cc of OAR per HDR-BT fraction compared to HDRPointA plans. Differences in the conformal indexes between the two groups of plans showed an 18-31% relative increase per HDR-BT fraction for HDRVOL plans. The D90 of the HR-CTV was reduced by 11% by HDRVOL planning and had a median dose of 86 Gy. Conclusions Our study reports the relative improvement in OAR doses per HDR-BT fraction by HDRVOL planning compared to HDRPointA planning and demonstrates the dosimetric advantages of volume-based HDR-BT planning in creating more conformal plans.
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Dose warping uncertainties for the accumulated rectal wall dose in cervical cancer brachytherapy. Brachytherapy 2018; 17:449-455. [DOI: 10.1016/j.brachy.2017.10.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 09/13/2017] [Accepted: 10/01/2017] [Indexed: 01/24/2023]
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Vickress J, Battista J, Barnett R, Yartsev S. Representing the dosimetric impact of deformable image registration errors. Phys Med Biol 2017; 62:N391-N403. [PMID: 28800299 DOI: 10.1088/1361-6560/aa8133] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Deformable image registration (DIR) is emerging as a tool in radiation therapy for calculating the cumulative dose distribution across multiple fractions of treatment. Unfortunately, due to the variable nature of DIR algorithms and dependence of performance on image quality, registration errors can result in dose accumulation errors. In this study, landmarked images were used to characterize the DIR error throughout an image space and determine its impact on dosimetric analysis. Ten thoracic 4DCT images with 300 landmarks per image study matching the end-inspiration and end-expiration phases were obtained from 'dir-labs'. DIR was performed using commercial software MIM Maestro. The range of dose uncertainty (RDU) was calculated at each landmark pair as the maximum and minimum of the doses within a sphere around the landmark in the end-expiration phase. The radius of the sphere was defined by a measure of DIR error which included either the actual DIR error, mean DIR error per study, constant errors of 2 or 5 mm, inverse consistency error, transitivity error or the distance discordance metric (DDM). The RDUs were evaluated using the magnitude of dose uncertainty (MDU) and inclusion rate (IR) of actual error lying within the predicted RDU. The RDU was calculated for 300 landmark pairs on each 4DCT study for all measures of DIR error. The most representative RDU was determined using the actual DIR error with a MDU of 2.5 Gy and IR of 97%. Across all other measures of DIR error, the DDM was most predictive with a MDU of 2.5 Gy and IR of 86%, closest to the actual DIR error. The proposed method represents the range of dosimetric uncertainty of DIR error using either landmarks at specific voxels or measures of registration accuracy throughout the volume.
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Affiliation(s)
- Jason Vickress
- Department of Medical Biophysics, University of Western Ontario, London, ON, Canada
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Structure-based deformable image registration: Added value for dose accumulation of external beam radiotherapy and brachytherapy in cervical cancer. Radiother Oncol 2017; 123:319-324. [DOI: 10.1016/j.radonc.2017.03.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 01/27/2017] [Accepted: 03/13/2017] [Indexed: 11/23/2022]
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Kadoya N, Miyasaka Y, Nakajima Y, Kuroda Y, Ito K, Chiba M, Sato K, Dobashi S, Yamamoto T, Takahashi N, Kubozono M, Takeda K, Jingu K. Evaluation of deformable image registration between external beam radiotherapy and HDR brachytherapy for cervical cancer with a 3D-printed deformable pelvis phantom. Med Phys 2017; 44:1445-1455. [PMID: 28214368 DOI: 10.1002/mp.12168] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 12/13/2016] [Accepted: 02/10/2017] [Indexed: 11/09/2022] Open
Abstract
PURPOSE In this study, we developed a 3D-printed deformable pelvis phantom for evaluating spatial DIR accuracy. We then evaluated the spatial DIR accuracies of various DIR settings for cervical cancer. METHODS A deformable female pelvis phantom was created based on patient CT data using 3D printing. To create the deformable uterus phantom, we first 3D printed both a model of uterus and a model of the internal cavities of the vagina and uterus. We then made a mold using the 3D printed uterus phantom. Finally, urethane was poured into the mold with the model of the internal cavities in place, creating the deformable uterus phantom with a cavity into which an applicator could be inserted. To create the deformable bladder phantom, we first 3D printed models of the bladder and of the same bladder scaled down by 2 mm. We then made a mold using the larger bladder model. Finally, silicone was poured into the mold with the smaller bladder model in place to create the deformable bladder phantom with a wall thickness of 2 mm. To emulate the anatomical bladder, water was poured into the created bladder. We acquired phantom image without applicator for EBRT. Then, we inserted the applicator into the phantom to simulate BT. In this situation, we scanned the phantom again to obtain the phantom image for BT. We performed DIR using the two phantom images in two cases: Case A, with full bladder (170 ml) in both EBRT and BT images; and Case B with full bladder in the BT image and half-full bladder (100 ml) in the EBRT image. DIR was evaluated using Dice similarity coefficients (DSCs) and 31 landmarks for the uterus and 25 landmarks for the bladder. A hybrid intensity and structure DIR algorithm implemented in RayStation with four DIR settings was evaluated. RESULTS On visual inspection, reasonable agreement in shape of the uterus between the phantom and patient CT images was observed for both EBRT and BT, although some regional disagreements in shape of the bladder and rectum were apparent. The created phantom could reproduce the actual patient's uterus deformation by the applicator. For both Case A and B, large variation was seen in landmark error among the four DIR parameters. In addition, although DSCs were comparable, moderate differences in landmark error existed between the two different DIR parameters selected from the four DIR parameters (i.e., DSC = 0.96, landmark error = 13.2 ± 5.7 mm vs. DSC = 0.97, landmark error = 9.7 ± 4.0 mm). This result suggests that landmark error evaluation might thus be more effective than DSC for evaluating DIR accuracy. CONCLUSIONS Our developed phantom enabled the evaluation of spatial DIR accuracy for the female pelvic region for the first time. Although the DSCs are high, the spatial errors can still be significant and our developed phantom facilitates their quantification. Our results showed that optimization is needed to identify suitable DIR settings. For determining suitable DIR settings, our method of evaluating spatial DIR accuracy using the 3D-printed phantom may prove helpful.
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Affiliation(s)
- Noriyuki Kadoya
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, 980-8574, Japan
| | - Yuya Miyasaka
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, 980-8574, Japan
| | - Yujiro Nakajima
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, 980-8574, Japan
| | - Yoshihiro Kuroda
- Department of Bioengineering, Graduate School of Engineering Science, Osaka University, Osaka, 565-0871, Japan
| | - Kengo Ito
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, 980-8574, Japan
| | - Mizuki Chiba
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, 980-8574, Japan
| | - Kiyokazu Sato
- Department of Radiology, Tohoku University Hospital, Sendai, 980-8574, Japan
| | - Suguru Dobashi
- Department of Therapeutic Radiology, Tohoku University School of Medicine, Miyagi, 980-8574, Japan
| | - Takaya Yamamoto
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, 980-8574, Japan
| | - Noriyoshi Takahashi
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, 980-8574, Japan
| | - Masaki Kubozono
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, 980-8574, Japan
| | - Ken Takeda
- Department of Therapeutic Radiology, Tohoku University School of Medicine, Miyagi, 980-8574, Japan
| | - Keiichi Jingu
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, 980-8574, Japan
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Wang J, Tanderup K, Cunha A, Damato AL, Cohen GN, Kudchadker RJ, Mourtada F. Magnetic resonance imaging basics for the prostate brachytherapist. Brachytherapy 2017; 16:715-727. [PMID: 28396178 DOI: 10.1016/j.brachy.2017.03.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Revised: 02/23/2017] [Accepted: 03/04/2017] [Indexed: 11/27/2022]
Abstract
Magnetic resonance imaging (MRI) is increasingly being used in radiation therapy, and integration of MRI into brachytherapy in particular is becoming more common. We present here a systematic review of the basic physics and technical aspects of incorporating MRI into prostate brachytherapy. Terminology and MRI system components are reviewed along with typical work flows in prostate high-dose-rate and low-dose-rate brachytherapy. In general, the brachytherapy workflow consists of five key components: diagnosis, implantation, treatment planning (scan + plan), implant verification, and delivery. MRI integration is discussed for diagnosis; treatment planning; and MRI-guided brachytherapy implants, in which MRI is used to guide the physical insertion of the brachytherapy applicator or needles. Considerations and challenges for establishing an MRI brachytherapy program are also discussed.
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Affiliation(s)
- Jihong Wang
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Kari Tanderup
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Adam Cunha
- Department of Radiation Oncology, University of California-San Francisco, CA
| | - Antonio L Damato
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Gil'ad N Cohen
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Rajat J Kudchadker
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Firas Mourtada
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, TX; Department of Radiation Oncology, Helen F. Graham Cancer Center, Newark, DE; Department of Radiation Oncology, Bodine Cancer Center, Thomas Jefferson University, Philadelphia, PA.
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Deformable image registration for cervical cancer brachytherapy dose accumulation: Organ at risk dose–volume histogram parameter reproducibility and anatomic position stability. Brachytherapy 2017; 16:387-392. [DOI: 10.1016/j.brachy.2016.12.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 11/27/2016] [Accepted: 12/14/2016] [Indexed: 01/11/2023]
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Moulton CR, House MJ, Lye V, Tang CI, Krawiec M, Joseph DJ, Denham JW, Ebert MA. Accumulation of rectum dose-volume metrics for prostate external beam radiotherapy combined with brachytherapy: Evaluating deformably registered dose distribution addition using parameter-based addition. J Med Imaging Radiat Oncol 2017; 61:534-542. [PMID: 28185419 DOI: 10.1111/1754-9485.12593] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 12/29/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION To investigate the accuracy of deriving dose-volume histogram (DVH) parameters from deformably registered data by comparing values with the simple addition of DVHs from each phase of a combined external beam radiotherapy (EBRT)/high-dose-rate (HDR-BT) brachytherapy prostate treatment. METHODS Eighty-two patients received EBRT in 23 fractions of 2 Gy and HDR-BT TG43 in three fractions of 6.5 Gy. The HDR-BT CT was deformably registered to the EBRT CT. The rectum D0.1cc , D1cc , D2cc and D10cc were calculated in two ways. (i) Parameter-adding: the EBRT DVH parameters (or the EBRT prescription dose) were added to the unregistered HDR-BT DVH parameters. (ii) Distribution-adding: the parameters were extracted after the EBRT doses were 3D-summed with the registered HDR-BT doses. Resulting differences between the parameters were investigated. RESULTS The D0.1cc , D1cc and D2cc from parameter-adding were 21.3% (P < 0.001), 6.3% (P < 0.001) and 3.5% (P < 0.001) smaller than those from distribution-adding. The D10cc was 2.2% (P = 0.015) larger for distribution-adding. CONCLUSION Distribution-adding was confounded by unsystematic inter/intra-observer rectum-contouring errors and registration accuracy near the anterior rectal wall. Consequently, clinical use of distribution-adding to assess rectal doses requires careful contour and registration evaluation.
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Affiliation(s)
- Calyn R Moulton
- School of Physics, University of Western Australia, Crawley, Western Australia, Australia
| | - Michael J House
- School of Physics, University of Western Australia, Crawley, Western Australia, Australia
| | - Victoria Lye
- Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Colin I Tang
- Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Michele Krawiec
- Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - David J Joseph
- Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.,School of Surgery, University of Western Australia, Crawley, Western Australia, Australia
| | - James W Denham
- School of Medicine and Population Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Martin A Ebert
- School of Physics, University of Western Australia, Crawley, Western Australia, Australia.,Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
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Zakariaee R, Hamarneh G, Brown CJ, Gaudet M, Aquino-Parsons C, Spadinger I. Bladder accumulated dose in image-guided high-dose-rate brachytherapy for locally advanced cervical cancer and its relation to urinary toxicity. Phys Med Biol 2016; 61:8408-8424. [PMID: 27845913 DOI: 10.1088/0031-9155/61/24/8408] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The purpose of this study was to estimate locally accumulated dose to the bladder in multi-fraction high-dose-date (HDR) image-guided intracavitary brachytherapy (IG-ICBT) for cervical cancer, and study the locally-accumulated dose parameters as predictors of late urinary toxicity. A retrospective study of 60 cervical cancer patients who received five HDR IG-ICBT sessions was performed. The bladder outer and inner surfaces were segmented for all sessions and a bladder-wall contour point-set was created in MATLAB. The bladder-wall point-sets for each patient were registered using a deformable point-set registration toolbox called coherent point drift (CPD), and the fraction doses were accumulated. Various dosimetric and volumetric parameters were calculated using the registered doses, including [Formula: see text] (minimum dose to the most exposed n-cm3 volume of bladder wall), r V n Gy (wall volume receiving at least m Gy), and [Formula: see text] (minimum equivalent biologically weighted dose to the most exposed n-cm3 of bladder wall), where n = 1/2/5/10 and m = 3/5/10. Minimum dose to contiguous 1 and 2 cm3 hot-spot volumes was also calculated. The unregistered dose volume histogram (DVH)-summed equivalent of [Formula: see text] and [Formula: see text] parameters (i.e. [Formula: see text] and [Formula: see text]) were determined for comparison. Late urinary toxicity was assessed using the LENT-SOMA scale, with toxicity Grade 0-1 categorized as Controls and Grade 2-4 as Cases. A two-sample t-test was used to identify the differences between the means of Control and Case groups for all parameters. A binomial logistic regression was also performed between the registered dose parameters and toxicity grouping. Seventeen patients were in the Case and 43 patients in the Control group. Contiguous values were on average 16 and 18% smaller than parameters for 1 and 2 cm3 volumes, respectively. Contiguous values were on average 26 and 27% smaller than parameters. The only statistically significant finding for Case versus Control based on both methods of analysis was observed for r V3 Gy (p = 0.01). DVH-summed parameters based on unregistered structure volumes overestimated the bladder dose in our patients, particularly when contiguous high dose volumes were considered. The bladder-wall volume receiving at least 3 Gy of accumulated dose may be a parameter of interest in further investigations of Grade 2+ urinary toxicity.
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Affiliation(s)
- Roja Zakariaee
- Department of Physics and Astronomy, University of British Columbia, Vancouver, BC, Canada. British Columbia Cancer Agency, Vancouver Centre, Vancouver, BC, Canada
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Anatomic structure-based deformable image registration of brachytherapy implants in the treatment of locally advanced cervix cancer. Brachytherapy 2016; 15:584-92. [DOI: 10.1016/j.brachy.2016.04.390] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 03/25/2016] [Accepted: 04/21/2016] [Indexed: 01/19/2023]
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Reniers B, Janssens G, Orban de Xivry J, Landry G, Verhaegen F. Dose distribution for gynecological brachytherapy with dose accumulation between insertions: Feasibility study. Brachytherapy 2016; 15:504-513. [DOI: 10.1016/j.brachy.2016.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 03/14/2016] [Accepted: 03/14/2016] [Indexed: 10/21/2022]
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