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Gao Y, Yoon S, Ma TM, Yang Y, Sheng K, Low DA, Ballas L, Steinberg ML, Kishan AU, Cao M. Intra-fractional geometric and dose/volume metric variations of magnetic resonance imaging-guided stereotactic radiotherapy of prostate bed after radical prostatectomy. Phys Imaging Radiat Oncol 2024; 30:100573. [PMID: 38585371 PMCID: PMC10997948 DOI: 10.1016/j.phro.2024.100573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 03/22/2024] [Accepted: 03/22/2024] [Indexed: 04/09/2024] Open
Abstract
Background and purpose Magnetic Resonance Imaging (MRI)-guided Stereotactic body radiotherapy (SBRT) treatment to prostate bed after radical prostatectomy has garnered growing interests. The aim of this study is to evaluate intra-fractional anatomic and dose/volume metric variations for patients receiving this treatment. Materials and methods Nineteen patients who received 30-34 Gy in 5 fractions on a 0.35T MR-Linac were included. Pre- and post-treatment MRIs were acquired for each fraction (total of 75 fractions). The Clinical Target Volume (CTV), bladder, rectum, and rectal wall were contoured on all images. Volumetric changes, Hausdorff distance, Mean Distance to Agreement (MDA), and Dice similarity coefficient (DSC) for each structure were calculated. Median value and Interquartile range (IQR) were recorded. Changes in target coverage and Organ at Risk (OAR) constraints were compared and evaluated using Wilcoxon rank sum tests at a significant level of 0.05. Results Bladder had the largest volumetric changes, with a median volume increase of 48.9 % (IQR 28.9-76.8 %) and a median MDA of 5.1 mm (IQR 3.4-7.1 mm). Intra-fractional CTV volume remained stable with a median volume change of 1.2 % (0.0-4.8 %). DSC was 0.97 (IQR 0.94-0.99). For the dose/volume metrics, there were no statistically significant changes observed except for an increase in bladder hotspot and a decrease of bladder V32.5 Gy and mean dose. The CTV V95% changed from 99.9 % (IQR 98.8-100 %) to 99.6 % (IQR 93.9-100 %). Conclusion Despite intra-fractional variations of OARs, CTV coverage remained stable during MRI-guided SBRT treatments for the prostate bed.
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Affiliation(s)
- Yu Gao
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Radiation Oncology, Stanford University, Palo Alto, CA, USA
| | - Stephanie Yoon
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Radiation Oncology, City of Hope, Duarte, CA, USA
| | - Ting Martin Ma
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Radiation Oncology, University of Washington, Seattle, WA, USA
| | - Yingli Yang
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Radiation Oncology, Shanghai Ruijin Hospital, China
| | - Ke Sheng
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, CA, USA
| | - Daniel A. Low
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Leslie Ballas
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Michael L. Steinberg
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Amar U Kishan
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Minsong Cao
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA, USA
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Guo B, Stephans K, Godley A, Kolar M, Magnelli A, Tendulkar R, Mian O, Majkszak D, Xia P. Transperineal ultrasound is a good alternative for intra-fraction motion monitoring for prostate stereotactic body radiotherapy. J Appl Clin Med Phys 2023; 24:e14021. [PMID: 37144947 PMCID: PMC10562017 DOI: 10.1002/acm2.14021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 01/27/2023] [Accepted: 04/16/2023] [Indexed: 05/06/2023] Open
Abstract
PURPOSES To report our experience in a prospective study of implementing a transperineal ultrasound system to monitor intra-fractional prostate motion for prostate stereotactic body radiotherapy (SBRT). MATERIAL AND METHODS This IRB-approved prospective study included 23 prostate SBRT patients treated between 04/2016 and 11/2019 at our institution. The prescription doses were 36.25 Gy to the Low-Dose planning target volume (LD-PTV) and 40 Gy to the High-Dose PTV (HD-PTV) in five fractions with 3 mm planning margins. The transperineal ultrasound system was successfully used in 110 of the 115 fractions. For intra-fraction prostate motion, the real-time prostate displacements measured by ultrasound were exported for analysis. The percentage of time prostate movement exceeded a 2 mm threshold was calculated for each fraction of all patients. T-test was used for all statistical comparisons. RESULTS Ultrasound image quality was adequate for prostate delineation and prostate motion tracking. The setup time for each fraction under ultrasound-guided prostate SBRT was 15.0 ± 4.9 min and the total treatment time per fraction was 31.8 ± 10.5 min. The presence of an ultrasound probe did not compromise the contouring of targets or critical structures. For intra-fraction motion, prostate movement exceeded 2 mm tolerance in 23 of 110 fractions for 11 of 23 patients. For all fractions, the mean percentage of time when the prostate moved more than 2 mm in any direction during each fraction was 7%, ranging from 0% to 62% of a fraction. CONCLUSION Ultrasound-guided prostate SBRT is a good option for intra-fraction motion monitoring with clinically acceptable efficiency.
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Affiliation(s)
- Bingqi Guo
- Department of Radiation OncologyTaussig Cancer CenterCleveland ClinicClevelandOhioUSA
| | - Kevin Stephans
- Department of Radiation OncologyTaussig Cancer CenterCleveland ClinicClevelandOhioUSA
| | - Andrew Godley
- Department of Radiation OncologyTaussig Cancer CenterCleveland ClinicClevelandOhioUSA
| | - Matt Kolar
- Department of Radiation OncologyTaussig Cancer CenterCleveland ClinicClevelandOhioUSA
| | - Anthony Magnelli
- Department of Radiation OncologyTaussig Cancer CenterCleveland ClinicClevelandOhioUSA
| | - Rahul Tendulkar
- Department of Radiation OncologyTaussig Cancer CenterCleveland ClinicClevelandOhioUSA
| | - Omar Mian
- Department of Radiation OncologyTaussig Cancer CenterCleveland ClinicClevelandOhioUSA
| | - David Majkszak
- Department of Radiation OncologyTaussig Cancer CenterCleveland ClinicClevelandOhioUSA
| | - Ping Xia
- Department of Radiation OncologyTaussig Cancer CenterCleveland ClinicClevelandOhioUSA
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Lefebvre TL, Brown E, Hacker L, Else T, Oraiopoulou ME, Tomaszewski MR, Jena R, Bohndiek SE. The Potential of Photoacoustic Imaging in Radiation Oncology. Front Oncol 2022; 12:803777. [PMID: 35311156 PMCID: PMC8928467 DOI: 10.3389/fonc.2022.803777] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 02/07/2022] [Indexed: 12/16/2022] Open
Abstract
Radiotherapy is recognized globally as a mainstay of treatment in most solid tumors and is essential in both curative and palliative settings. Ionizing radiation is frequently combined with surgery, either preoperatively or postoperatively, and with systemic chemotherapy. Recent advances in imaging have enabled precise targeting of solid lesions yet substantial intratumoral heterogeneity means that treatment planning and monitoring remains a clinical challenge as therapy response can take weeks to manifest on conventional imaging and early indications of progression can be misleading. Photoacoustic imaging (PAI) is an emerging modality for molecular imaging of cancer, enabling non-invasive assessment of endogenous tissue chromophores with optical contrast at unprecedented spatio-temporal resolution. Preclinical studies in mouse models have shown that PAI could be used to assess response to radiotherapy and chemoradiotherapy based on changes in the tumor vascular architecture and blood oxygen saturation, which are closely linked to tumor hypoxia. Given the strong relationship between hypoxia and radio-resistance, PAI assessment of the tumor microenvironment has the potential to be applied longitudinally during radiotherapy to detect resistance at much earlier time-points than currently achieved by size measurements and tailor treatments based on tumor oxygen availability and vascular heterogeneity. Here, we review the current state-of-the-art in PAI in the context of radiotherapy research. Based on these studies, we identify promising applications of PAI in radiation oncology and discuss the future potential and outstanding challenges in the development of translational PAI biomarkers of early response to radiotherapy.
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Affiliation(s)
- Thierry L. Lefebvre
- Department of Physics, University of Cambridge, Cambridge, United Kingdom
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom
| | - Emma Brown
- Department of Physics, University of Cambridge, Cambridge, United Kingdom
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom
| | - Lina Hacker
- Department of Physics, University of Cambridge, Cambridge, United Kingdom
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom
| | - Thomas Else
- Department of Physics, University of Cambridge, Cambridge, United Kingdom
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom
| | - Mariam-Eleni Oraiopoulou
- Department of Physics, University of Cambridge, Cambridge, United Kingdom
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom
| | - Michal R. Tomaszewski
- Department of Cancer Physiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States
| | - Rajesh Jena
- Department of Oncology, University of Cambridge, Cambridge, United Kingdom
| | - Sarah E. Bohndiek
- Department of Physics, University of Cambridge, Cambridge, United Kingdom
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom
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DI Franco R, Borzillo V, Alberti D, Ametrano G, Petito A, Coppolaro A, Tarantino I, Rossetti S, Pignata S, Iovane G, Perdonà S, Quarto G, Grimaldi G, Izzo A, Castaldo L, Muscariello R, Serra M, Facchini G, Muto P. Acute Toxicity in Hypofractionated/Stereotactic Prostate Radiotherapy of Elderly Patients: Use of the Image-guided Radio Therapy (IGRT) Clarity System. In Vivo 2021; 35:1849-1856. [PMID: 33910872 DOI: 10.21873/invivo.12447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/17/2021] [Accepted: 03/25/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND The use of intra-fractional monitoring and correction of prostate position with the Image Guided Radio Therapy (IGRT) system can increase the spatial accuracy of dose delivery. Clarity is a system used for intrafraction prostate-motion management, it provides a real-time visualization of prostate with a transperineal ultrasound. The aim of this study was to evaluate the use of Clarity-IGRT on proper intrafraction alignment and monitoring, its impact on Planning Tumor Volume margin and on urinary and rectal toxicity in elderly patients not eligible for surgery. PATIENTS AND METHODS Twenty-five elderly prostate cancer patients, median age=75 years (range=75-90 years) were treated with Volumetric Radiotherapy and Clarity-IGRT using 3 different schemes: A) 64.5/72 Gray (Gy) in 30 fractions on prostate and seminal vesicles (6 patients); B) 35 Gy in 5 fractions on prostate and seminal vesicles (12 patients); C): 35 Gy in 5 fractions on prostate (7 patients). Ultrasound identification of the overlapped structures to the detected ones during simulation has been used in each session. A specific software calculates direction and entity of necessary shift to obtain the perfect match. The average misalignment in the three-dimensional space has been determined and shown in a box-plot. RESULTS All patients completed treatment with mild-moderate toxicity. During treatment, genitourinary toxicity was 32% Grade 1; 4% Grade 2, rectal was 4% Grade 1. At follow-up of 3 months, genitourinary toxicity was 20% Grade 1; 4% Grade 2, rectal toxicity was 4% Grade 2. At follow-up of 6 months, genitourinary toxicity was 4% Grade 1; 4% Grade 2. Rectal toxicity was 4% Grade 2. CONCLUSION Radiotherapy with the Clarity System allows a reduction of PTV margins, the amount of fractions can be reduced increasing the total dose, not exacerbating urinary and rectal toxicity with greater patient's compliance.
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Affiliation(s)
- Rossella DI Franco
- Department of Radiation Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy;
| | - Valentina Borzillo
- Department of Radiation Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
| | - Domingo Alberti
- Department of Radiation Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
| | - Gianluca Ametrano
- Department of Radiation Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
| | - Angela Petito
- Department of Radiation Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
| | - Andrea Coppolaro
- Department of Radiation Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
| | - Ilaria Tarantino
- Department of Radiation Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
| | - Sabrina Rossetti
- Departmental Unit Of Clinical and Experimental Uro-Andrologic Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
| | - Sandro Pignata
- Departmental Unit Of Clinical and Experimental Uro-Andrologic Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
| | - Gelsomina Iovane
- Departmental Unit Of Clinical and Experimental Uro-Andrologic Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
| | - Sisto Perdonà
- Uro-Gynecological Department, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
| | - Giuseppe Quarto
- Uro-Gynecological Department, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
| | - Giovanni Grimaldi
- Uro-Gynecological Department, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
| | - Alessandro Izzo
- Uro-Gynecological Department, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
| | - Luigi Castaldo
- Uro-Gynecological Department, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
| | - Raffaele Muscariello
- Uro-Gynecological Department, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
| | - Marcello Serra
- Department of Radiation Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
| | - Gaetano Facchini
- Department of Hospital Medicine, Unit of Medical Oncology, ASL Napoli 2 Nord, "S.M. delle Grazie" Hospital, Pozzuoli, Italy
| | - Paolo Muto
- Department of Radiation Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
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5
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Grimwood A, Thomas K, Kember S, Aldis G, Lawes R, Brigden B, Francis J, Henegan E, Kerner M, Delacroix L, Gordon A, Tree A, Harris EJ, McNair HA. Factors affecting accuracy and precision in ultrasound guided radiotherapy. Phys Imaging Radiat Oncol 2021; 18:68-77. [PMID: 34258411 PMCID: PMC8254201 DOI: 10.1016/j.phro.2021.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 05/04/2021] [Accepted: 05/11/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND PURPOSE Transperineal ultrasound (TPUS) is used clinically for directly assessing prostate motion. Factors affecting accuracy and precision in TPUS motion estimation must be assessed to realise its full potential. METHODS AND MATERIALS Patients were imaged using volumetric TPUS during the Clarity-Pro trial (NCT02388308). Prostate motion was measured online at patient set-up and offline by experienced observers. Cone beam CT with markers was used as a comparator and observer performance was also quantified. The influence of different clinical factors was examined to establish specific recommendations towards efficacious ultrasound guided radiotherapy. RESULTS From 330 fractions in 22 patients, offline observer random errors were 1.5 mm, 1.3 mm, 1.9 mm (left-right, superior-inferior, anteroposterior respectively). Errors increased in fractions exhibiting poor image quality to 3.3 mm, 3.3 mm and 6.8 mm. Poor image quality was associated with inconsistent probe placement, large anatomical changes and unfavourable imaging conditions within the patient. Online matching exhibited increased observer errors of: 3.2 mm, 2.9 mm and 4.7 mm. Four patients exhibited large systematic residual errors, of which three had poor quality images. Patient habitus showed no correlation with observer error, residual error, or image quality. CONCLUSIONS TPUS offers the unique potential to directly assess inter- and intra-fraction motion on conventional linacs. Inconsistent image quality, inexperienced operators and the pressures of the clinical environment may degrade precision and accuracy. Experienced operators are essential and cross-centre standards for training and QA should be established that build upon current guidance. Greater use of automation technologies may further minimise uncertainties.
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Affiliation(s)
- Alexander Grimwood
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Radiotherapy Department, Royal Marsden NHS Foundation Trust, Sutton SM2 5PT, United Kingdom
- Joint Department of Physics, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Radiotherapy Department, Royal Marsden NHS Foundation Trust, Sutton SM2 5PT, United Kingdom
| | - Karen Thomas
- Department of Statistics and Computing, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Radiotherapy Department, Royal Marsden NHS Foundation Trust, Sutton SM2 5PT, United Kingdom
| | - Sally Kember
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Radiotherapy Department, Royal Marsden NHS Foundation Trust, Sutton SM2 5PT, United Kingdom
| | - Georgina Aldis
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Radiotherapy Department, Royal Marsden NHS Foundation Trust, Sutton SM2 5PT, United Kingdom
| | - Rebekah Lawes
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Radiotherapy Department, Royal Marsden NHS Foundation Trust, Sutton SM2 5PT, United Kingdom
| | - Beverley Brigden
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Radiotherapy Department, Royal Marsden NHS Foundation Trust, Sutton SM2 5PT, United Kingdom
| | - Jane Francis
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Radiotherapy Department, Royal Marsden NHS Foundation Trust, Sutton SM2 5PT, United Kingdom
| | - Emer Henegan
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Radiotherapy Department, Royal Marsden NHS Foundation Trust, Sutton SM2 5PT, United Kingdom
| | - Melanie Kerner
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Radiotherapy Department, Royal Marsden NHS Foundation Trust, Sutton SM2 5PT, United Kingdom
| | - Louise Delacroix
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Radiotherapy Department, Royal Marsden NHS Foundation Trust, Sutton SM2 5PT, United Kingdom
| | - Alexandra Gordon
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Radiotherapy Department, Royal Marsden NHS Foundation Trust, Sutton SM2 5PT, United Kingdom
| | - Alison Tree
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Radiotherapy Department, Royal Marsden NHS Foundation Trust, Sutton SM2 5PT, United Kingdom
| | - Emma J. Harris
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Radiotherapy Department, Royal Marsden NHS Foundation Trust, Sutton SM2 5PT, United Kingdom
- Joint Department of Physics, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Radiotherapy Department, Royal Marsden NHS Foundation Trust, Sutton SM2 5PT, United Kingdom
| | - Helen A. McNair
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Radiotherapy Department, Royal Marsden NHS Foundation Trust, Sutton SM2 5PT, United Kingdom
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Grimwood A, Rivaz H, Zhou H, McNair HA, Jakubowski K, Bamber JC, Tree AC, Harris EJ. Improving 3D ultrasound prostate localisation in radiotherapy through increased automation of interfraction matching. Radiother Oncol 2020; 149:134-141. [PMID: 32387546 PMCID: PMC7456791 DOI: 10.1016/j.radonc.2020.04.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 04/22/2020] [Accepted: 04/25/2020] [Indexed: 12/04/2022]
Abstract
BACKGROUND AND PURPOSE Daily image guidance is standard care for prostate radiotherapy. Innovations which improve the accuracy and efficiency of ultrasound guidance are needed, particularly with respect to reducing interobserver variation. This study explores automation tools for this purpose, demonstrated on the Elekta Clarity Autoscan®. The study was conducted as part of the Clarity-Pro trial (NCT02388308). MATERIALS AND METHODS Ultrasound scan volumes were collected from 32 patients. Prostate matches were performed using two proposed workflows and the results compared with Clarity's proprietary software. Gold standard matches derived from manually localised landmarks provided a reference. The two workflows incorporated a custom 3D image registration algorithm, which was benchmarked against a third-party application (Elastix). RESULTS Significant reductions in match errors were reported from both workflows compared to standard protocol. Median (IQR) absolute errors in the left-right, anteroposterior and craniocaudal axes were lowest for the Manually Initiated workflow: 0.7(1.0) mm, 0.7(0.9) mm, 0.6(0.9) mm compared to 1.0(1.7) mm, 0.9(1.4) mm, 0.9(1.2) mm for Clarity. Median interobserver variation was ≪0.01 mm in all axes for both workflows compared to 2.2 mm, 1.7 mm, 1.5 mm for Clarity in left-right, anteroposterior and craniocaudal axes. Mean matching times was also reduced to 43 s from 152 s for Clarity. Inexperienced users of the proposed workflows attained better match precision than experienced users on Clarity. CONCLUSION Automated image registration with effective input and verification steps should increase the efficacy of interfraction ultrasound guidance compared to the current commercially available tools.
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Affiliation(s)
- Alexander Grimwood
- Division of Radiotherapy and Imaging, The Institute of Cancer Research and Royal Marsden Hospital Trust, Sutton, UK
| | - Hassan Rivaz
- Department of Electrical and Computer Engineering, Concordia University, Montreal, Canada
| | - Hang Zhou
- Department of Electrical and Computer Engineering, Concordia University, Montreal, Canada
| | - Helen A McNair
- Division of Radiotherapy and Imaging, The Institute of Cancer Research and Royal Marsden Hospital Trust, Sutton, UK
| | | | - Jeffrey C Bamber
- Division of Radiotherapy and Imaging, The Institute of Cancer Research and Royal Marsden Hospital Trust, Sutton, UK
| | - Alison C Tree
- Division of Radiotherapy and Imaging, The Institute of Cancer Research and Royal Marsden Hospital Trust, Sutton, UK
| | - Emma J Harris
- Division of Radiotherapy and Imaging, The Institute of Cancer Research and Royal Marsden Hospital Trust, Sutton, UK.
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7
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Shanker MD, Kim AN, Brown A, Tan AH. Anatomical and dosimetric assessment of the prostate apex: A pilot comparison of image-guided transperineal ultrasound to conventional computed tomography simulation. J Med Imaging Radiat Oncol 2020; 64:839-844. [PMID: 32383303 DOI: 10.1111/1754-9485.13045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 04/09/2020] [Accepted: 04/14/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Inaccuracies in prostate apex contour delineation based on simulation computed tomography (CT) imaging can impact treatment outcomes and toxicity profiles for prostate cancer radiotherapy. Transperineal ultrasound (TPUS) is a non-invasive imaging modality that can improve delineation of prostate volumes. We performed a pilot analysis to assess for differences in anatomical position between conventional CT and a TPUS delineated prostate apex and determined whether these translated into a clinically significant difference in apical point dose. METHODS A 2D 5 MHz TPUS autoscan image guidance system was utilised during definitive intensity-modulated radiotherapy (IMRT) for prostate cancer. Distances were measured from a fixed reference point to prostate apex on both US and CT in the mid-sagittal plane. Differences between groups were assessed using the Wilcoxon sign rank test with a two-tailed significance of α = 0.05. RESULTS Fifty-nine consecutive patients were independently assessed. There was strong evidence of a difference between CT and TPUS delineated apex position (P = 0.0075). Median apex position was 3.6 mm caudal on TPUS vs. CT imaging (95% CI: 2.5-4.8 mm). There was strong evidence of a difference in point dose between CT and TPUS delineated apex (P = 0.0029). Median point dose at the TPUS contoured apex was 1.9 Gy lower than CT (95% CI: 0.7-3.1 Gy) corresponding to 98% of prescribed dose. CONCLUSIONS This study demonstrates a difference in anatomical delineation of prostate apex position between CT imaging compared to TPUS, corresponding to a statistically significant difference in apex point dose. Further analysis will determine whether this translates to a clinically significant difference in outcomes.
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Affiliation(s)
- Mihir D Shanker
- Queensland Health, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Anna Nh Kim
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,ICON Cancer Centre, Brisbane, Queensland, Australia
| | - Amy Brown
- Queensland Health, Brisbane, Queensland, Australia.,Townsville Cancer Centre, Townsville Hospital and Health Service, Queensland, Australia.,James Cook University, Townsville, Queensland, Australia
| | - Alex Hm Tan
- Queensland Health, Brisbane, Queensland, Australia.,Townsville Cancer Centre, Townsville Hospital and Health Service, Queensland, Australia.,James Cook University, Townsville, Queensland, Australia
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8
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Splinter M, Bostel T, Sachpazidis I, Fechter T, Zamboglou C, Jäkel O, Huber PE, Debus J, Baltas D, Nicolay NH. Dosimetric Impact of Interfractional Variations for Post-prostatectomy Radiotherapy to the Prostatic Fossa-Relevance for the Frequency of Position Verification Imaging and Treatment Adaptation. Front Oncol 2019; 9:1191. [PMID: 31788450 PMCID: PMC6856079 DOI: 10.3389/fonc.2019.01191] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 10/21/2019] [Indexed: 12/15/2022] Open
Abstract
Background and purpose: To analyze divergences between the planned and applied treatment doses for post-prostatectomy radiotherapy to the prostatic fossa on a voxel-by-voxel basis based on interfractional anatomic variations and imaging frequency. Materials and methods: For 10 patients receiving intensity-modulated postoperative radiotherapy to the prostatic fossa, position verification was carried out by daily in-room CT imaging in treatment position (340 fraction CTs). Applied fraction doses were recalculated on daily CT scans, and treatment doses were accumulated on a voxel-by-voxel basis after deformable image registration. To simulate weekly imaging, derived weekly position correction vectors were used to rigidly register all daily scans of the respective treatment week onto the planning CT before dose accumulation. Detailed dose statistics of the prescribed and applied treatment doses were compared in relation to the frequency of position verification imaging. Derived NTCP and Pinjury values were calculated for the rectum and bladder. Results: Despite a large variability in the pelvic anatomy, daily CT-based patient repositioning resulted in largely negligible deviations of the analyzed dose-volume, conformity, and uniformity parameters from the planned doses for post-prostatectomy radiotherapy, and only the bladder exhibited significant increases in the accumulated mean and median doses. Derived NTCP for the applied doses to the rectum and bladder and Pinjury values did not significantly deviate from the treatment plan. In contrast, weekly CT-based repositioning resulted in significant decreases of the PTV coverage and dose conformity as well as large deviations of the applied doses to the rectum and bladder from the planned doses. Consecutively, NTCP for the rectum and Pinjury were found falsely reduced for weekly patient repositioning. Conclusions: Our data indicate for the first time in a voxel-by-voxel analysis that daily imaging is required for reliable adaptive delivery of intensity-modulated radiotherapy to the prostatic fossa. This work will help guiding adaptive treatment strategies for post-prostatectomy radiotherapy.
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Affiliation(s)
- Mona Splinter
- Medical Physics in Radiation Oncology, German Cancer Research Center, Heidelberg, Germany.,Clinical Cooperation Unit "Radiation Oncology, German Cancer Research Center, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany
| | - Tilman Bostel
- Clinical Cooperation Unit "Radiation Oncology, German Cancer Research Center, Heidelberg, Germany.,Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Department of Radiation Oncology, University Medical Center Mainz, Mainz, Germany
| | - Ilias Sachpazidis
- Department of Radiation Oncology, Medical Center - University of Freiburg, Freiburg, Germany.,German Cancer Consortium (DKTK), Partner Site Freiburg, German Cancer Research Center, Heidelberg, Germany
| | - Tobias Fechter
- Department of Radiation Oncology, Medical Center - University of Freiburg, Freiburg, Germany.,German Cancer Consortium (DKTK), Partner Site Freiburg, German Cancer Research Center, Heidelberg, Germany
| | - Constantinos Zamboglou
- Department of Radiation Oncology, Medical Center - University of Freiburg, Freiburg, Germany.,German Cancer Consortium (DKTK), Partner Site Freiburg, German Cancer Research Center, Heidelberg, Germany
| | - Oliver Jäkel
- Medical Physics in Radiation Oncology, German Cancer Research Center, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany
| | - Peter E Huber
- Clinical Cooperation Unit "Radiation Oncology, German Cancer Research Center, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany.,Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Jürgen Debus
- Clinical Cooperation Unit "Radiation Oncology, German Cancer Research Center, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany.,Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Dimos Baltas
- Department of Radiation Oncology, Medical Center - University of Freiburg, Freiburg, Germany.,German Cancer Consortium (DKTK), Partner Site Freiburg, German Cancer Research Center, Heidelberg, Germany
| | - Nils H Nicolay
- Clinical Cooperation Unit "Radiation Oncology, German Cancer Research Center, Heidelberg, Germany.,Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Department of Radiation Oncology, Medical Center - University of Freiburg, Freiburg, Germany.,German Cancer Consortium (DKTK), Partner Site Freiburg, German Cancer Research Center, Heidelberg, Germany
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9
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Bertholet J, Knopf A, Eiben B, McClelland J, Grimwood A, Harris E, Menten M, Poulsen P, Nguyen DT, Keall P, Oelfke U. Real-time intrafraction motion monitoring in external beam radiotherapy. Phys Med Biol 2019; 64:15TR01. [PMID: 31226704 PMCID: PMC7655120 DOI: 10.1088/1361-6560/ab2ba8] [Citation(s) in RCA: 113] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 05/10/2019] [Accepted: 06/21/2019] [Indexed: 12/25/2022]
Abstract
Radiotherapy (RT) aims to deliver a spatially conformal dose of radiation to tumours while maximizing the dose sparing to healthy tissues. However, the internal patient anatomy is constantly moving due to respiratory, cardiac, gastrointestinal and urinary activity. The long term goal of the RT community to 'see what we treat, as we treat' and to act on this information instantaneously has resulted in rapid technological innovation. Specialized treatment machines, such as robotic or gimbal-steered linear accelerators (linac) with in-room imaging suites, have been developed specifically for real-time treatment adaptation. Additional equipment, such as stereoscopic kilovoltage (kV) imaging, ultrasound transducers and electromagnetic transponders, has been developed for intrafraction motion monitoring on conventional linacs. Magnetic resonance imaging (MRI) has been integrated with cobalt treatment units and more recently with linacs. In addition to hardware innovation, software development has played a substantial role in the development of motion monitoring methods based on respiratory motion surrogates and planar kV or Megavoltage (MV) imaging that is available on standard equipped linacs. In this paper, we review and compare the different intrafraction motion monitoring methods proposed in the literature and demonstrated in real-time on clinical data as well as their possible future developments. We then discuss general considerations on validation and quality assurance for clinical implementation. Besides photon RT, particle therapy is increasingly used to treat moving targets. However, transferring motion monitoring technologies from linacs to particle beam lines presents substantial challenges. Lessons learned from the implementation of real-time intrafraction monitoring for photon RT will be used as a basis to discuss the implementation of these methods for particle RT.
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Affiliation(s)
- Jenny Bertholet
- Joint Department of Physics, Institute of Cancer Research and Royal Marsden NHS
Foundation Trust, London, United
Kingdom
- Author to whom any correspondence should be
addressed
| | - Antje Knopf
- Department of Radiation Oncology,
University Medical Center
Groningen, University of Groningen, The
Netherlands
| | - Björn Eiben
- Department of Medical Physics and Biomedical
Engineering, Centre for Medical Image Computing, University College London, London,
United Kingdom
| | - Jamie McClelland
- Department of Medical Physics and Biomedical
Engineering, Centre for Medical Image Computing, University College London, London,
United Kingdom
| | - Alexander Grimwood
- Joint Department of Physics, Institute of Cancer Research and Royal Marsden NHS
Foundation Trust, London, United
Kingdom
| | - Emma Harris
- Joint Department of Physics, Institute of Cancer Research and Royal Marsden NHS
Foundation Trust, London, United
Kingdom
| | - Martin Menten
- Joint Department of Physics, Institute of Cancer Research and Royal Marsden NHS
Foundation Trust, London, United
Kingdom
| | - Per Poulsen
- Department of Oncology, Aarhus University Hospital, Aarhus,
Denmark
| | - Doan Trang Nguyen
- ACRF Image X Institute, University of Sydney, Sydney,
Australia
- School of Biomedical Engineering,
University of Technology
Sydney, Sydney, Australia
| | - Paul Keall
- ACRF Image X Institute, University of Sydney, Sydney,
Australia
| | - Uwe Oelfke
- Joint Department of Physics, Institute of Cancer Research and Royal Marsden NHS
Foundation Trust, London, United
Kingdom
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10
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Zhou S, Luo L, Li J, Lin M, Chen L, Shao J, Lu S, Ma Y, Zhang Y, Chen W, Liu M, Liu S, He L. Analyses of the factors influencing the accuracy of three-dimensional ultrasound in comparison with cone-beam CT in image-guided radiotherapy for prostate cancer with or without pelvic lymph node irradiation. Radiat Oncol 2019; 14:22. [PMID: 30696488 PMCID: PMC6352439 DOI: 10.1186/s13014-019-1217-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 01/08/2019] [Indexed: 11/16/2022] Open
Abstract
Background Three-dimensional ultrasound (3DUS) is an attractive option in image-guided radiotherapy (IGRT) for prostate cancer (PCa) patients. However, the potential factors influencing the accuracy of 3DUS in comparison with cone-beam CT (CBCT) in IGRT for PCa patients haven’t been clearly identified. Methods The differences between US/US and CBCT/CT registrations were analyzed over 586 and 580 sessions for 24 and 25 PCa patients treated with or without pelvic lymph node irradiation, respectively. The clinical factors that may influence registration differences were also evaluated. Results The average discrepancies between US/US and CBCT/CT registrations were − 0.28 ± 5.28 mm, − 0.16 ± 3.48 mm, and − 0.47 ± 4.31 mm in the superior-inferior (SI), left-right (LR), and anterior-posterior (AP) directions, respectively. The discrepancies were respectively less than 5 mm longitudinally, laterally, and vertically in 64.4 and 70.1%, 84.9 and 89.2%, and 75.9 and 79.1% of the patients treated with or without pelvic lymph node irradiation, respectively. The registration differences were significantly smaller at least in one direction in patients younger than 70 years, without pelvic lymph node irradiation, guided by transperineal ultrasonography and had a bladder volume smaller than 300 mL. Conclusions Age, irradiated regions, 3DUS modality, and bladder volume are important factors that may influence the differences between US/US and CBCT/CT registrations. 3DUS guidance is more feasible for younger PCa patients with a better control of bladder volume during the treatment and those who did not undergo pelvic lymph node irradiation. Electronic supplementary material The online version of this article (10.1186/s13014-019-1217-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sha Zhou
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, No. 651, Dongfeng Road East, Guangzhou, 510060, China
| | - Liling Luo
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, No. 651, Dongfeng Road East, Guangzhou, 510060, China
| | - Jibin Li
- Department of Clinical Research, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Maosheng Lin
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, No. 651, Dongfeng Road East, Guangzhou, 510060, China
| | - Li Chen
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, No. 651, Dongfeng Road East, Guangzhou, 510060, China
| | - Jianhui Shao
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, No. 651, Dongfeng Road East, Guangzhou, 510060, China
| | - Shipei Lu
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, No. 651, Dongfeng Road East, Guangzhou, 510060, China
| | - Yaru Ma
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, No. 651, Dongfeng Road East, Guangzhou, 510060, China
| | - Yingting Zhang
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, No. 651, Dongfeng Road East, Guangzhou, 510060, China
| | - Wenfen Chen
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, No. 651, Dongfeng Road East, Guangzhou, 510060, China
| | - Mengzhong Liu
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, No. 651, Dongfeng Road East, Guangzhou, 510060, China
| | - Shiliang Liu
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, No. 651, Dongfeng Road East, Guangzhou, 510060, China.
| | - Liru He
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, No. 651, Dongfeng Road East, Guangzhou, 510060, China.
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11
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Graeff C, Bert C. Noninvasive cardiac arrhythmia ablation with particle beams. Med Phys 2018; 45:e1024-e1035. [DOI: 10.1002/mp.12595] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 09/05/2017] [Accepted: 09/17/2017] [Indexed: 12/31/2022] Open
Affiliation(s)
- Christian Graeff
- GSI Helmholzzentrum für Schwerionenforschung GmbH 64291 Darmstadt Germany
| | - Christoph Bert
- Department of Radiation Oncology Universitätsklinikum Erlangen Friedrich‐Alexander‐Universität 91054 Erlangen‐Nürnberg Germany
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12
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Han B, Najafi M, Cooper DT, Lachaine M, von Eyben R, Hancock S, Hristov D. Evaluation of transperineal ultrasound imaging as a potential solution for target tracking during hypofractionated radiotherapy for prostate cancer. Radiat Oncol 2018; 13:151. [PMID: 30126434 PMCID: PMC6102861 DOI: 10.1186/s13014-018-1097-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 08/10/2018] [Indexed: 12/11/2022] Open
Abstract
Background Emerging hypofractionated prostate radiotherapy regimens require solutions for accurate target tracking during beam delivery. The goal of this study is to evaluate the performance of the Clarity ultrasound monitoring system for prostate motion tracking. Methods Five prostate patients underwent continuous perineum ultrasound imaging during their daily treatments. Initial absolute 3D positions of fiducials implanted in the prostate were estimated from the KV images. Fiducial positions in MV images acquired during beam delivery were compared with predicted positions based on Clarity 3D tracking. The uncertainty in the comparison results was evaluated in a phantom validation study. Results Continuous real-time ultrasound motion tracking was recorded in 5 patients and 167 fractions for overall of 39.7 h. Phantom validation of the proposed procedure demonstrated that predicted and observed fiducial positions agree within 1.1 mm. In patients agreement between predicted and actual fiducial positions varied between 1.3 mm and 3.3 mm. On average ultrasound tracking reduced the maximum localization error in patients by 20% on average. With the motion corrected, the duration prostate beyond 1 mm from its initial treatment position can be reduced from 37 to 22% of the total treatment time. Conclusion Real-time ultrasound tracking reduces uncertainty in prostate position due to intra-fractional motion. Trial registration IRB Protocol #27372. Date of registration of trial: 12/17/2013.
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Affiliation(s)
- Bin Han
- Department of Radiation Oncology, School of Medicine, Stanford University, 875 Blake Wilbur Drive, Room G203, Palo Alto, CA, 94304, USA
| | - Mohammad Najafi
- Department of Radiation Oncology, School of Medicine, Stanford University, 875 Blake Wilbur Drive, Room G203, Palo Alto, CA, 94304, USA
| | - David T Cooper
- Elekta Ltd, 2050 Bleury Suite 200, Montréal, QC, H3A 2J5, Canada
| | - Martin Lachaine
- Elekta Ltd, 2050 Bleury Suite 200, Montréal, QC, H3A 2J5, Canada
| | - Rie von Eyben
- Department of Radiation Oncology, School of Medicine, Stanford University, 875 Blake Wilbur Drive, Room G203, Palo Alto, CA, 94304, USA
| | - Steven Hancock
- Department of Radiation Oncology, School of Medicine, Stanford University, 875 Blake Wilbur Drive, Room G203, Palo Alto, CA, 94304, USA
| | - Dimitre Hristov
- Department of Radiation Oncology, School of Medicine, Stanford University, 875 Blake Wilbur Drive, Room G203, Palo Alto, CA, 94304, USA.
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13
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The Use of Ultrasound Imaging in the External Beam Radiotherapy Workflow of Prostate Cancer Patients. BIOMED RESEARCH INTERNATIONAL 2018; 2018:7569590. [PMID: 29619375 PMCID: PMC5829356 DOI: 10.1155/2018/7569590] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 12/13/2017] [Accepted: 12/28/2017] [Indexed: 12/16/2022]
Abstract
External beam radiotherapy (EBRT) is one of the curative treatment options for prostate cancer patients. The aim of this treatment option is to irradiate tumor tissue, while sparing normal tissue as much as possible. Frequent imaging during the course of the treatment (image guided radiotherapy) allows for determination of the location and shape of the prostate (target) and of the organs at risk. This information is used to increase accuracy in radiation dose delivery resulting in better tumor control and lower toxicity. Ultrasound imaging is harmless for the patient, it is cost-effective, and it allows for real-time volumetric organ tracking. For these reasons, it is an ideal technique for image guidance during EBRT workflows. Review papers have been published in which the use of ultrasound imaging in EBRT workflows for different cancer sites (prostate, breast, etc.) was extensively covered. This new review paper aims at providing the readers with an update on the current status for prostate cancer ultrasound guided EBRT treatments.
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14
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Yu AS, Najafi M, Hristov DH, Phillips T. Intrafractional Tracking Accuracy of a Transperineal Ultrasound Image Guidance System for Prostate Radiotherapy. Technol Cancer Res Treat 2017; 16:1067-1078. [PMID: 29332454 PMCID: PMC5762073 DOI: 10.1177/1533034617728643] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE The aim of this study is to evaluate the tracking accuracy of a commercial ultrasound system under relevant treatment conditions and demonstrate its clinical utility for detecting significant treatment deviations arising from inadvertent intrafractional target motion. METHODS A multimodality male pelvic phantom was used to simulate prostate image-guided radiotherapy with the system under evaluation. Target motion was simulated by placing the phantom on a motion platform. The tracking accuracy of the ultrasound system was evaluated using an independent optical tracking system under the conditions of beam-on, beam-off, poor image quality with an acoustic shadow introduced, and different phantom motion cycles. The time delay between the ultrasound-detected and actual phantom motion was investigated. A clinical case example of prostate treatment is presented as a demonstration of the utility of the system in practice. RESULTS Time delay between the motion phantom and ultrasound tracking system is 223 ± 45.2 milliseconds including video and optical tracking system frame rates. The tracking accuracy and precision were better with a longer period. The precision of ultrasound tracking performance in the axial (superior-inferior) direction was better than that in the lateral (left-right) direction (root mean square errors are 0.18 and 0.25 mm, respectively). The accuracy of ultrasound tracking performance in the lateral direction was better than that in the axial direction (the mean position errors are 0.23 and 0.45 mm, respectively). Interference by radiation and image quality do not affect tracking ability significantly. Further, utilizing the tracking system as part of a clinical study for prostate treatment further verified the accuracy and clinical appropriateness. CONCLUSIONS It is feasible to use transperineal ultrasound daily to monitor prostate motion during treatment. Our results verify the accuracy and precision of an ultrasound system under typical external beam treatment conditions and further demonstrate that the tracking system was able to identify important prostate shifts in a clinical case.
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Affiliation(s)
- Amy S Yu
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford University, Stanford, CA, USA
| | - Mohammad Najafi
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford University, Stanford, CA, USA
| | - Dimitre H Hristov
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford University, Stanford, CA, USA
| | - Tiffany Phillips
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford University, Stanford, CA, USA
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15
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Vilotte F, Antoine M, Bobin M, Latorzeff I, Supiot S, Richaud P, Thomas L, Leduc N, Guérif S, Iriondo-Alberdi J, de Crevoisier R, Sargos P. Post-Prostatectomy Image-Guided Radiotherapy: The Invisible Target Concept. Front Oncol 2017; 7:34. [PMID: 28337425 PMCID: PMC5343009 DOI: 10.3389/fonc.2017.00034] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 02/24/2017] [Indexed: 12/17/2022] Open
Abstract
In the era of intensity-modulated radiation therapy, image-guided radiotherapy (IGRT) appears crucial to control dose delivery and to promote dose escalation while allowing healthy tissue sparing. The place of IGRT following radical prostatectomy is poorly described in the literature. This review aims to highlight some key points on the different IGRT techniques applicable to prostatic bed radiotherapy. Furthermore, methods used to evaluate target motion and to reduce planning target volume margins will also be explored.
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Affiliation(s)
- Florent Vilotte
- Department of Radiotherapy, Institut Bergonié , Bordeaux Cedex , France
| | - Mickael Antoine
- Department of Medical Physics, Institut Bergonié , Bordeaux Cedex , France
| | - Maxime Bobin
- Department of Radiotherapy, Institut Bergonié , Bordeaux Cedex , France
| | - Igor Latorzeff
- Department of Radiotherapy, Groupe ONCORAD, Clinique Pasteur , Toulouse , France
| | - Stéphane Supiot
- Department of Radiotherapy, Institut de Cancérologie de L'Ouest René Gauducheau , Nantes , France
| | - Pierre Richaud
- Department of Radiotherapy, Institut Bergonié , Bordeaux Cedex , France
| | - Laurence Thomas
- Department of Radiotherapy, Institut Bergonié , Bordeaux Cedex , France
| | - Nicolas Leduc
- Department of Radiotherapy, Institut Bergonié , Bordeaux Cedex , France
| | - Stephane Guérif
- Department of Radiotherapy, CHU de Poitier , Poitiers , France
| | | | | | - Paul Sargos
- Department of Radiotherapy, Institut Bergonié , Bordeaux Cedex , France
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16
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Comparison of prostate positioning guided by three-dimensional transperineal ultrasound and cone beam CT. Strahlenther Onkol 2016; 193:221-228. [PMID: 27928626 DOI: 10.1007/s00066-016-1084-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 11/09/2016] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The accuracy of a transperineal three-dimensional ultrasound system (3DUS) was assessed for prostate positioning and compared to fiducial- and bone-based positioning in kV cone beam computed tomography (CBCT) during definitive radiotherapy of prostate cancer. METHODS Each of the 7 patients had three fiducial markers implanted into the prostate before treatment. Prostate positioning was simultaneously measured by 3DUS and CBCT before each fraction. In total, 177 pairs of 3DUS and CBCT scans were collected. Bone-match and seed-match were performed for each CBCT. Using seed-match as a reference, the accuracy of 3DUS and bone-match was evaluated. Systematic and random errors as well as optimal setup margins were calculated for 3DUS and bone-match. RESULTS The discrepancy between 3DUS and seed-match in CBCT (average ± standard deviation) was 0.0 ± 1.7 mm laterally, 0.2 ± 2.0 mm longitudinally, and 0.3 ± 1.7 mm vertically. Using seed-match as a reference, systematic errors for 3DUS were 1.2 mm, 1.1 mm, and 0.9 mm; and random errors were 1.4 mm, 1.8 mm, and 1.6 mm, on lateral, longitudinal, and vertical axes, respectively. By analogy, the difference of bone-match to seed-match was 0.1 ± 1.1 mm laterally, 1.3 ± 3.8 mm longitudinally, and 1.3 ± 4.5 mm vertically. Systematic errors were 0.5 mm, 2.2 mm, and 2.6 mm; and random errors were 1.0 mm, 3.1 mm, and 3.9 mm on lateral, longitudinal, and vertical axes, respectively. The accuracy of 3DUS was significantly higher than that of bone-match on longitudinal and vertical axes, but not on the lateral axis. CONCLUSION Image-guided radiotherapy of prostate cancer based on transperineal 3DUS was feasible, with overall small discrepancy to seed-match in CBCT in this retrospective study. Compared to bone-match, transperineal 3DUS achieved higher accuracy on longitudinal and vertical axes.
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17
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Shakir SI, Udrescu C, Enachescu C, Rouviere O, Arion S, Caraivan I, Chapet O. Transrectal implantation and stability of gold markers in prostate bed for salvage radiotherapy of macroscopic recurrences. Phys Med 2016; 32:1422-1427. [PMID: 27810195 DOI: 10.1016/j.ejmp.2016.10.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 10/13/2016] [Accepted: 10/14/2016] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND AND PURPOSE The objective of the study was to verify the stability of gold markers in the prostatic bed (PB) during salvage radiotherapy. MATERIAL AND METHODS Seven patients, diagnosed with a macroscopic nodule visible on MRI, underwent targeted MRI-guided biopsies. Three gold markers were implanted into the PB close to the relapsing nodule for CT/MRI fusion. A dose of 60Gy was delivered using IMRT to the PB followed by a dose escalation up to 72Gy to the macroscopic nodule. Daily anterior and left-lateral kV-images were acquired for repositioning. The coordinates of the center of each marker were measured on the two kV-images. The distance variations (Dvar) of the markers in the first session and the subsequent ones were compared. RESULTS No marker was lost during treatment. The average distance between markers was 7.8mm. The average Dvar was 0.8mm, in absolute value. A total of 380/528 (72%) Dvar were ⩽1mm. A Dvar greater than 2mm was observed in 5.7% of measurements, with a maximum value of 4.8mm. CONCLUSIONS Despite the absence of the prostate, the implantation of gold markers in the PB remains feasible, with Dvar often less than 2mm, and could be used to develop new approaches of salvage focal radiotherapy on the macroscopic relapse after prostatectomy.
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Affiliation(s)
- Shakir I Shakir
- Department of Radiation Oncology, Centre Hospitalier Lyon Sud, 165 Chemin du Grand Revoyet, 69495 Pierre-Benite, France
| | - Corina Udrescu
- Department of Radiation Oncology, Centre Hospitalier Lyon Sud, 165 Chemin du Grand Revoyet, 69495 Pierre-Benite, France; Department of Medical Physics, Centre Hospitalier Lyon Sud, 165 Chemin du Grand Revoyet, 69495 Pierre Benite, France
| | - Ciprian Enachescu
- Department of Radiation Oncology, Centre Hospitalier Lyon Sud, 165 Chemin du Grand Revoyet, 69495 Pierre-Benite, France
| | - Olivier Rouviere
- Department of Urological Radiology, Hôpital Edouard Herriot, 5 Place d'Arsonval, 69003 Lyon, France
| | - Simona Arion
- Department of Urological Radiology, Hôpital Edouard Herriot, 5 Place d'Arsonval, 69003 Lyon, France
| | - Ionela Caraivan
- Department of Radiation Oncology, Centre Hospitalier Lyon Sud, 165 Chemin du Grand Revoyet, 69495 Pierre-Benite, France
| | - Olivier Chapet
- Department of Radiation Oncology, Centre Hospitalier Lyon Sud, 165 Chemin du Grand Revoyet, 69495 Pierre-Benite, France.
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18
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Trivedi A, Ashikaga T, Hard D, Archambault J, Lachaine M, Cooper DT, Wallace HJ. Development of 3-dimensional transperineal ultrasound for image guided radiation therapy of the prostate: Early evaluations of feasibility and use for inter- and intrafractional prostate localization. Pract Radiat Oncol 2016; 7:e27-e33. [PMID: 27742558 DOI: 10.1016/j.prro.2016.08.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 08/05/2016] [Accepted: 08/30/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Transperineal ultrasound (TPUS) allows for continuous imaging of the prostate gland, but the accuracy of TPUS has not been rigorously studied. We determined the feasibility of prostate imaging with TPUS and subsequently compared prostate localization with TPUS and computed tomography (CT). METHODS AND MATERIALS We completed 2 sequential evaluations of TPUS. The feasibility study included 15 men with localized prostate cancer and tested if TPUS adequately imaged the prostate. Image qualities of the prostate and adjacent normal structures were measured. The subsequent study included 17 men who at the time of initial radiation treatment planning and in 3 subsequent sessions had CT and TPUS imaging performed and compared. RESULTS Feasibility of TPUS was confirmed in the first trial. After expected hardware and software modifications were completed, TPUS provided near complete edge definition of the prostate in the final 5 patients in the feasibility trial. The second study allowed for the comparison of 30 image sets. The differences between TPUS and CT in each direction (mean + standard deviation) were found to be 0.06 ± 2.86 mm (anteroposterior), 0.49 ± 3.49 mm (superoinferior), and 0.63 ± 3.27 mm (left-right), with no significant difference between the 2 modalities (all P > .32). The Euclidean distance variance using the 2 techniques was 5.25 ± 1.79 mm, which was significantly different. CONCLUSIONS TPUS provides good imaging of the prostate gland. We noted excellent correlation in gland localization when TPUS is compared with CT scans when comparing routine 3-dimensional positional data. Euclidean distance variation suggests the potential that summation of small errors may in fact lead to significant differences in actual gland positional certainty. The reported difference is within the range of standard planning target volume expansion however requires additional evaluation.
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Affiliation(s)
- Apoorva Trivedi
- Medical student, University of Vermont College of Medicine, Burlington, Vermont
| | - Takamura Ashikaga
- Medical Biostatistics, University of Vermont College of Medicine, Burlington, Vermont
| | - Daphne Hard
- Radiation Oncology, University of Vermont Medical Center, Burlington, Vermont
| | - Jessica Archambault
- Radiation Oncology, University of Vermont Medical Center, Burlington, Vermont
| | | | | | - Harold James Wallace
- Medical Biostatistics, University of Vermont College of Medicine, Burlington, Vermont; University of Vermont Cancer Center, Burlington, Vermont.
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The role of medical physics in prostate cancer radiation therapy. Phys Med 2016; 32:435-7. [PMID: 27095755 DOI: 10.1016/j.ejmp.2016.03.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 03/29/2016] [Accepted: 03/29/2016] [Indexed: 01/20/2023] Open
Abstract
Medical physics, both as a scientific discipline and clinical service, hugely contributed and still contributes to the advances in the radiotherapy of prostate cancer. The traditional translational role in developing and safely implementing new technology and methods for better optimizing, delivering and monitoring the treatment is rapidly expanding to include new fields such as quantitative morphological and functional imaging and the possibility of individually predicting outcome and toxicity. The pivotal position of medical physicists in treatment personalization probably represents the main challenge of current and next years and needs a gradual change of vision and training, without losing the traditional and fundamental role of physicists to guarantee a high quality of the treatment. The current focus issue is intended to cover traditional and new fields of investigation in prostate cancer radiation therapy with the aim to provide up-to-date reference material to medical physicists daily working to cure prostate cancer patients. The papers presented in this focus issue touch upon present and upcoming challenges that need to be met in order to further advance prostate cancer radiation therapy. We suggest that there is a smart future for medical physicists willing to perform research and innovate, while they continue to provide high-quality clinical service. However, physicists are increasingly expected to actively integrate their implicitly translational, flexible and high-level skills within multi-disciplinary teams including many clinical figures (first of all radiation oncologists) as well as scientists from other disciplines.
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