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Braschi EL, Morris CG, Yeung AR, De Leo AN. Impact of Maximum Point Dose Within the Planning Target Volume on Local Control of Nonsmall Cell Lung Cancer Treated With Stereotactic Body Radiotherapy. Am J Clin Oncol 2024; 47:217-222. [PMID: 38148589 DOI: 10.1097/coc.0000000000001081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
BACKGROUND No consensus exists on the maximum dose delivered to the planning target volume (PTV) in the delivery of stereotactic body radiotherapy (SBRT) for primary lung cancer. We investigated whether higher biologically effective doses (BED) within the PTV were associated with improved tumor control. METHODS We reviewed patients with early-stage, node-negative nonsmall cell lung cancer who received curative-intent SBRT between 2005 and 2018. We calculated the maximum BED (maxBED) within the PTV for all patients, analyzing outcomes using the cumulative incidence method and Fine-Gray test statistics to assess prognostic impact. RESULTS We analyzed 171 patients (median age, 70.2; range, 43 to 90 y) with 181 lung nodules. Median follow-up was 2.7 years (range, 0.1 to 12 y) for all patients and 4.2 years (range, 0.2 to 8.4 y) for living patients. Median maximum tumor diameter was 1.9 cm (range, 0.7 to 5.6 cm). Patients received a prescription of 48 or 50 Gy in 4 or 5 fractions, respectively, except for one who received 60 Gy in 5 fractions. Median maxBED was 120 Gy (range, 101 to 171 Gy). There was no difference in the 3-year local control (LC) rate among patients treated with a maxBED<120 Gy versus ≥120 Gy ( P =0.83). CONCLUSIONS No significant differences in LC were observed between patients with early-stage nonsmall cell lung cancer treated with SBRT in 4 or 5 fractions with a maxBED≥120 Gy. However, a higher maxBED trended toward improved LC rates, suggesting a maxBED threshold greater than 120 Gy may be needed to improve LC rates.
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Affiliation(s)
- Erica L Braschi
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL
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Malatesta T, Scaggion A, Giglioli FR, Belmonte G, Casale M, Colleoni P, Falco MD, Giuliano A, Linsalata S, Marino C, Moretti E, Richetto V, Sardo A, Russo S, Mancosu P. Patient specific quality assurance in SBRT: a systematic review of measurement-based methods. Phys Med Biol 2023; 68:21TR01. [PMID: 37625437 DOI: 10.1088/1361-6560/acf43a] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 08/25/2023] [Indexed: 08/27/2023]
Abstract
This topical review focuses on Patient-Specific Quality Assurance (PSQA) approaches to stereotactic body radiation therapy (SBRT). SBRT requires stricter accuracy than standard radiation therapy due to the high dose per fraction and the limited number of fractions. The review considered various PSQA methods reported in 36 articles between 01/2010 and 07/2022 for SBRT treatment. In particular comparison among devices and devices designed for SBRT, sensitivity and resolution, verification methodology, gamma analysis were specifically considered. The review identified a list of essential data needed to reproduce the results in other clinics, highlighted the partial miss of data reported in scientific papers, and formulated recommendations for successful implementation of a PSQA protocol.
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Affiliation(s)
- Tiziana Malatesta
- Medical Physics Unit, Department of Radiotherapy and Medical Oncology and Radiology, Fatebenefratelli Isola Tiberina-Gemelli Isola Hospital, Rome, Italy
| | - Alessandro Scaggion
- Medical Physics Department, Veneto Institute of Oncology IOV - IRCCS, Padova, Italy
| | | | - Gina Belmonte
- Medical Physics Department, San Luca Hospital, Lucca, Italy
| | - Michelina Casale
- Medical Physics Unit, Azienda Ospedaliera 'Santa Maria', Terni, Italy
| | - Paolo Colleoni
- UOC Medical Physics Unit-ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Maria Daniela Falco
- Department of Radiation Oncology, 'SS. Annunziata' Hospital, 'G. D'Annunzio' University, Chieti, Italy
| | - Alessia Giuliano
- Medical Physics Unit, Pisa University Hospital 'Azienda Ospedaliero-Universitaria Pisana', Pisa, Italy
| | - Stefania Linsalata
- Medical Physics Unit, Pisa University Hospital 'Azienda Ospedaliero-Universitaria Pisana', Pisa, Italy
| | - Carmelo Marino
- Medical Physics and Radioprotection Unit, Humanitas Istituto Clinico Catanese, Misterbianco (CT), Italy
| | - Eugenia Moretti
- Division of Medical Physics, Department of Oncology, ASUFC Udine, Italy
| | - Veronica Richetto
- Medical Physics Unit, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy
| | - Anna Sardo
- UOSD Medical Physics, ASLCN2, Verduno, Italy
| | - Serenella Russo
- Medical Physics Unit, Azienda USL Toscana Centro, Florence, Italy
| | - Pietro Mancosu
- Medical Physics Unit of Radiotherapy Department, IRCCS Humanitas Research Hospital, Rozzano - Milano, Italy
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Inoue K, Matsukawa H, Kasai Y, Edamitsu K, Matsumoto K, Suetsugu Y, Hirose TA, Fukunaga JI, Shioyama Y, Sasaki T. Difference in target dose distributions between Acuros XB and collapsed cone convolution/superposition and the impact of the tumor locations in clinical cases of stereotactic ablative body radiotherapy for lung cancer. J Cancer Res Ther 2023; 19:1261-1266. [PMID: 37787293 DOI: 10.4103/jcrt.jcrt_1740_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
Objectives The objective of the study is to analyze the difference in target dose distributions between Acuros XB (AXB) and collapsed cone convolution (CCC)/superposition and the impact of the tumor locations in clinical cases of stereotactic ablative body radiotherapy (SABR) for lung cancer. Materials and Methods Ninety-six patients underwent SABR for lung cancers Kyushu University Hospital from 2014 to 2017. We recalculated clinical plans originally calculated by AXB using CCC with the identical monitor units (MUs) and beam arrangements. We calculated the following dosimetric parameters: maximum dose (Dmax), minimum dose (Dmin), homogeneity index (HI), conformity index (CI), and D95 of the planning target volume (PTV). We investigated the difference between the results of two calculations and examined the impact of tumor location. Moreover, we determined the target central dose using a thorax phantom and assessed the calculation accuracy of the two algorithms for each fraction. Results CCC significantly overestimated the dose to PTV, compared to AXB (P < 0.05). The mean differences of Dmax, Dmin, and D95 were 1.17, 1.95, and 1.85 Gy, respectively. The mean differences of HI and CI were 0.02 and - 0.06. Dmin, HI, and D95 had significant correlations with the tumor location, and the difference was greater when the PTV was included the chest wall (P < 0.05). The discrepancy between the calculated and irradiated dose was 2.48% for CCC, whereas it was 0.14% for AXB. Conclusions We demonstrated that CCC significantly overestimated the dose to PTV relative to AXB in clinical cases of lung SABR.
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Affiliation(s)
- Keiki Inoue
- Department of Health Sciences, Division of Medical Quantum Radiation Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hideaki Matsukawa
- Department of Radiology, Hospital of University of Occupational and Environmental Health, Fukuoka, Japan
| | - Yuki Kasai
- Department of Radiology, Nagoya City University Hospital, Nagoya, Japan
| | - Kana Edamitsu
- Department of Radiology, Kitakyushu Municipal Medical Center, Japan
| | | | - Yoshiki Suetsugu
- Department of Health Sciences, Division of Medical Quantum Radiation Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Taka-Aki Hirose
- Department of Radiology, Medical Technology, Kyush University Hospital, Fukuoka, Japan
| | - Jun-Ichi Fukunaga
- Department of Radiology, Medical Technology, Kyush University Hospital, Fukuoka, Japan
| | | | - Tomonari Sasaki
- Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
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Martinez-Zubiaurre I, Hellevik T. Cancer-associated fibroblasts in radiotherapy: Bystanders or protagonists? Cell Commun Signal 2023; 21:108. [PMID: 37170098 PMCID: PMC10173661 DOI: 10.1186/s12964-023-01093-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 02/26/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND The primary goal of radiotherapy (RT) is to induce cellular damage on malignant cells; however, it is becoming increasingly recognized the important role played by the tumor microenvironment (TME) in therapy outcomes. Therapeutic irradiation of tumor lesions provokes profound cellular and biological reconfigurations within the TME that ultimately may influence the fate of the therapy. MAIN CONTENT Cancer-associated fibroblasts (CAFs) are known to participate in all stages of cancer progression and are increasingly acknowledged to contribute to therapy resistance. Accumulated evidence suggests that, upon radiation, fibroblasts/CAFs avoid cell death but instead enter a permanent senescent state, which in turn may influence the behavior of tumor cells and other components of the TME. Despite the proposed participation of senescent fibroblasts on tumor radioprotection, it is still incompletely understood the impact that RT has on CAFs and the ultimate role that irradiated CAFs have on therapy outcomes. Some of the current controversies may emerge from generalizing observations obtained using normal fibroblasts and CAFs, which are different cell entities that may respond differently to radiation exposure. CONCLUSION In this review we present current knowledge on the field of CAFs role in radiotherapy; we discuss the potential tumorigenic functions of radiation-induced senescent fibroblasts and CAFs and we make an effort to integrate the knowledge emerging from preclinical experimentation with observations from the clinics. Video Abstract.
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Affiliation(s)
- Inigo Martinez-Zubiaurre
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Postbox 6050, 9037, Langnes, Tromsö, Norway.
| | - Turid Hellevik
- Department of Radiation Oncology, University Hospital of North Norway, Postbox 100, 9038, Tromsö, Norway
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Development and evaluation of a three-step automatic planning technique for lung Stereotactic Body Radiation Therapy based on performance examination of advanced settings in Pinnacle's auto-planning module. Appl Radiat Isot 2022; 189:110434. [DOI: 10.1016/j.apradiso.2022.110434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 08/16/2022] [Accepted: 08/24/2022] [Indexed: 11/22/2022]
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Wei Z, Peng X, He L, Wang J, Liu Z, Xiao J. Treatment plan comparison of volumetric-modulated arc therapy to intensity-modulated radiotherapy in lung stereotactic body radiotherapy using either 6- or 10-MV photon energies. J Appl Clin Med Phys 2022; 23:e13714. [PMID: 35808973 PMCID: PMC9359046 DOI: 10.1002/acm2.13714] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 05/05/2022] [Accepted: 06/10/2022] [Indexed: 02/05/2023] Open
Abstract
Purpose The aim of this study was to dosimetrically compare volumetric‐modulated arc therapy (VMAT) with intensity‐modulated radiotherapy (IMRT) techniques using either 6‐ or 10‐MV photon beam energies in lung stereotactic body radiation therapy (SBRT) plans. Methods Thirty patients with primary or metastatic lung tumors eligible for SBRT were randomly selected. VMAT and IMRT treatment plans using either 6‐ or 10‐MV photon energies were generated through automatic SBRT planning software in the RayStation treatment planning system. Results For planning target volume, there was no difference in D95% for all plans, whereas D2% and D50% were significantly increased by 5.22%–5.98% and 2.47%–2.59%, respectively, using VMAT6/10‐MV plans compared to IMRT6/10‐MV plans. When comparing the Dmax of organs at risk (OARs), VMAT6/10‐MV was 18.32%–47.95% lower than IMRT6/10‐MV for almost all OARs. VMAT6/10‐MV obviously decreased Dmean, V5Gy, V10Gy, and V20Gy of whole lung by 9.68%–20.92% than IMRT6/10‐MV. Similar results were found when comparing VMAT6‐MV with IMRT10‐MV or VMAT10‐MV with IMRT6‐MV. The differences in the D2%, heterogeneity index, and conformity index between 6‐ and 10‐MV plans are not statistically significant. Plans using 6‐MV performed 4.68%–8.91% lower levels of Dmax of spinal cord, esophagus, great vessels, and trachea and proximal bronchial tree than those using 10‐MV plans. Similarly, Dmean, V5Gy, V10Gy, and V20Gy of whole lung were also reduced by 2.79%–5.25% using 6‐MV. For dose fall‐off analysis, the D2cm and R50% of VMAT6/10‐MV were lower than those of IMRT6/10‐MV. Dose fall‐off curve based on 10 rings was steeper for VMAT plans than IMRT plans regardless of the energy used. Conclusions For lung SBRT plans, VMAT‐based plans significantly reduced OARs dose and steepened dose fall‐off curves compared to IMRT‐based plans. A 6‐MV energy level was a better choice than 10‐MV for lung SBRT. In addition, the dose differences between different techniques were more obvious than those between different energy levels.
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Affiliation(s)
- Zhigong Wei
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xingchen Peng
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ling He
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jingjing Wang
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zheran Liu
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jianghong Xiao
- Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Yoosuf AM, Ahmad MB, AlShehri S, Alhadab A, Alqathami M. Investigation of optimum minimum segment width on VMAT plan quality and deliverability: A comprehensive dosimetric and clinical evaluation using DVH analysis. J Appl Clin Med Phys 2021; 22:29-40. [PMID: 34592787 PMCID: PMC8598144 DOI: 10.1002/acm2.13417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/23/2021] [Accepted: 08/24/2021] [Indexed: 12/15/2022] Open
Abstract
Purpose Minimum segment width (MSW) plays a fundamental role in the shaping of optimized apertures and creation of segments of varying sizes and shapes in complex radiotherapy treatment plans. The purpose of this work was to study the effect of MSW on dose distribution in patients planned with VMAT for various treatment sites using dose volume histogram (DVH) analysis. Materials and methods For the validation of optimum MSW, 125 clinical treatment plans were evaluated. Five groups were identified (brain, head and neck, thorax, pelvis, and extremity), and five cases were chosen from each group. For each case, five plans were created with different MSW (0.5, 0.8, 1.0, 1.25, and 1.5 cm). The quality of treatment plans created using different MSW were compared using dosimetric indicators such as target coverage (D98—dose to 98% of the planning target volume (PTV), maximum dose (D2—maximum dose to 2% of the PTV), monitor units (MU), and DVH parameters related to organs at risk (OAR). The effect of the MSW on delivery accuracy was quantitatively analyzed using the measured fluence utilizing ionization chamber‐based transmission detector and model‐based dose verification system. Traditional global gamma analysis (2%, 2 mm) and dose volume information was gathered for the PTV and organs at risk and compared for different MSWs. Results A total of 125 plans were created and compared across five groups. In terms of treatment plan quality, the plans using MSW of 0.5 cm was found to be superior in all groups. PTV coverage (D98) decreased significantly (p < 0.05) as the MSW increased. Similarly, the maximum dose (D2) was found to be increased significantly (p < 0.05) as the MSW increased from 0.5 cm, with MSW of 1.5 cm being the least in terms of plan quality for both PTVs and OARs. In terms of plan deliverability using DVH analysis, treatment planning system (TPS) compared to measured fluence, VMAT plans produced with MSW of 0.5 cm showed a better dosimetric index and a smaller deviation for both PTVs and OARs. The deliverability of the plans deteriorated as the MSW increased. Conclusion Dose volume histogram (DVH) analysis demonstrated that treatment plans with minimal MSW showed better plan quality and deliverability and provided clinical relevance as compared to gamma index analysis.
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Affiliation(s)
- Ab Mohamed Yoosuf
- Department of Radiation Oncology, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Muhammad Bilal Ahmad
- Department of Radiation Oncology, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Salem AlShehri
- Department of Radiation Oncology, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abdulrahman Alhadab
- Department of Radiation Oncology, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Mamdouh Alqathami
- Department of Radiation Oncology, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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Critchfield LS, Visak J, Bernard ME, Randall ME, McGarry RC, Pokhrel D. Automation and integration of a novel restricted single-isocenter stereotactic body radiotherapy (a-RESIST) method for synchronous two lung lesions. J Appl Clin Med Phys 2021; 22:56-65. [PMID: 34032380 PMCID: PMC8292708 DOI: 10.1002/acm2.13259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/19/2021] [Accepted: 03/29/2021] [Indexed: 11/12/2022] Open
Abstract
Synchronous treatment of two lung lesions using a single-isocenter volumetric modulated arc therapy (VMAT) stereotactic body radiation therapy (SBRT) plan can decrease treatment time and reduce the impact of intrafraction motion. However, alignment of both lesions on a single cone beam CT (CBCT) can prove difficult and may lead to setup errors and unacceptable target coverage loss. A Restricted Single-Isocenter Stereotactic Body Radiotherapy (RESIST) method was created to minimize setup uncertainties and provide treatment delivery flexibility. RESIST utilizes a single-isocenter placed at patient's midline and allows both lesions to be planned separately but treated in the same session. Herein is described a process of automation of this novel RESIST method. Automation of RESIST significantly reduced treatment planning time while maintaining the benefits of RESIST. To demonstrate feasibility, ten patients with two lung lesions previously treated with a single-isocenter clinical VMAT plan were replanned manually with RESIST (m-RESIST) and with automated RESIST (a-RESIST). a-RESIST method automatically sets isocenter, creates beam geometry, chooses appropriate dose calculation algorithms, and performs VMAT optimization using an in-house trained knowledge-based planning model for lung SBRT. Both m-RESIST and a-RESIST showed lower dose to normal tissues compared to manually planned clinical VMAT although a-RESIST provided slightly inferior, but still clinically acceptable, dose conformity and gradient indices. However, a-RESIST significantly reduced the treatment planning time to less than 20 min and provided a higher dose to the lung tumors. The a-RESIST method provides guidance for inexperienced planners by standardizing beam geometry and plan optimization using DVH estimates. It produces clinically acceptable two lesions VMAT lung SBRT plans efficiently. We have further validated a-RESIST on phantom measurement and independent pretreatment dose verification of another four selected 2-lesions lung SBRT patients and implemented clinically. Further development of a-RESIST for more than two lung lesions and refining this approach for extracranial oligometastastic abdominal/pelvic SBRT, including development of automated simulated collision detection algorithm, merits future investigation.
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Affiliation(s)
- Lana Sanford Critchfield
- Medical Physics Graduate ProgramDepartment of Radiation MedicineUniversity of KentuckyLexingtonKY40508USA
| | - Justin Visak
- Medical Physics Graduate ProgramDepartment of Radiation MedicineUniversity of KentuckyLexingtonKY40508USA
| | - Mark E Bernard
- Medical Physics Graduate ProgramDepartment of Radiation MedicineUniversity of KentuckyLexingtonKY40508USA
| | - Marcus E Randall
- Medical Physics Graduate ProgramDepartment of Radiation MedicineUniversity of KentuckyLexingtonKY40508USA
| | - Ronald C McGarry
- Medical Physics Graduate ProgramDepartment of Radiation MedicineUniversity of KentuckyLexingtonKY40508USA
| | - Damodar Pokhrel
- Medical Physics Graduate ProgramDepartment of Radiation MedicineUniversity of KentuckyLexingtonKY40508USA
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Sevillano D, Núñez LM, Chevalier M, García-Vicente F. Application of discrete cosine transform to assess the effect of tumor motion variations on the definition of ITV in lung and liver SBRT. Phys Med 2021; 84:132-140. [PMID: 33894583 DOI: 10.1016/j.ejmp.2021.03.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 03/25/2021] [Accepted: 03/31/2021] [Indexed: 12/25/2022] Open
Abstract
PURPOSE To use Discrete Cosine Transform to include tumor motion variations on ITV definition of SBRT patients. METHODS Data from 66 patients was collected. 2D planar fluoroscopy images (FI) were available for 54 patients. Daily CBCT projections (CBCTp) from 29 patients were employed to measure interfraction amplitude variability. Systematic amplitude variations were obtained from 17 patients with data from both FI and CBCTp. Tumor motion curves obtained from FI were characterized with a Cosine model (CM), based on cosine functions to the power of 2, 4 or 6, and DCT. Performance of both models was evaluated by means of R2 coefficient and by comparing their results on Internal Target Volume (ITV) margins against those calculated from original tumor motion curves. Amplitude variations from CBCTp, as well as estimations of baseline shift variations were added to the DCT model to account for their effect on ITV margins. RESULTS DCT replicated tumor motion curves with a mean R2 values for all patients of 0.86, 0.91 and 0.96 for the lateral (LAT), anterior-posterior (AP) and cranio-caudal (CC) directions respectively. CM yielded worst results, with R2 values of 0.64, 0.61 and 0.74 in the three directions. Interfraction amplitude variation increased ITV margins by a 9%, while baseline shift variability implied a 40% and 80-100% increase for normalized values of baseline shift of 0.2 and 0.4 respectively. CONCLUSIONS Probability distribution functions of tumor positions can be successfully characterized with DCT. This permits to include tumor motion variablilities obtained from patient population into patient specific ITVs.
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Affiliation(s)
- D Sevillano
- Department of Medical Physics, Hospital Universitario Ramón y Cajal, Madrid, Spain.
| | - L M Núñez
- Biomedical Engineering, ETSIT, Universidad Politécnica de Madrid, Madrid, Spain
| | - M Chevalier
- Medical Physics, Department of Radiology, Rehabilitation and Physiotherapy, Universidad Complutense de Madrid, Madrid, Spain
| | - F García-Vicente
- Department of Medical Physics, Hospital Universitario Ramón y Cajal, Madrid, Spain
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Mancosu P, Russo S, Antonucci AR, Stasi M. Lean Thinking to manage a national working group on physics aspects of Stereotactic Body Radiation Therapy. Med Phys 2021; 48:2050-2056. [PMID: 33598932 DOI: 10.1002/mp.14783] [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: 09/01/2020] [Revised: 01/21/2021] [Accepted: 02/09/2021] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To report how the adoption of a Lean Thinking mindset in the management of a national working group (WG) on the physics of stereotactic body radiation therapy (SBRT) contributed to achieve SBRT standardization objectives. METHODS Vision for the WG has been established as fragmentation reduction and process harmonization enhancement in SBRT for Italian centers. Two main research themes of the technical aspects of SBRT emerged as areas with major standardization improvement needs, small field dosimetry and SBRT planning comparisons, to be investigated through multi-institutional studies. The management of the WG leveraged on the Lean concept of fostering self-organization in a non-hierarchical environment. Four progressive involvement levels were defined for each study. No specific "scientific" pre-experience was required to propose and coordinate a project, just requiring a voluntary commitment. People engagement was measured in terms of number of published articles. The standardization goals have been conducted through a simplified "5S" (Sort, Set in Order, Shine, Standardize, and Sustain) methodology, first considering a phase of awareness (the first three "S"), then identifying and implementing standardization actions (the last two "S"). RESULTS Since the beginning, 157 medical physicists joined the AIFM/SBRT-WG. Twenty-four papers/reviews/letters have been published in the period 2014-2019 on major radiation oncology journals, authored by >100 physicists (>50% working in small hospitals). Six over 12 first authors worked in peripheral/small hospitals, with no prior publication as first author. These studies contributed to the awareness and standardization phases for both small-field dosimetry and planning. In particular, errors in small-field measurements in 8% of centers were detected thanks to a generalized output factor curve in function of the effective field size created by averaging data available from different Linacs. Furthermore, planner's experience in SBRT was correlated with dosimetric parameters in the awareness phase; while sharing median dose volume histograms (DVHs) reduced variability among centers while keeping the same level of plan complexity. Finally, all the dosimetric parameters statistically significant to the planner experience during the awareness phase, were no longer significantly different in the standardization phase. CONCLUSIONS The experience of our SBRT-WG has shown how a Lean Thinking mindset could foster the SBRT procedure standardization and spread the physics of SBRT knowledge, enhancing personal growth. Our expectation is to inspire other scientific societies that have to deal with fragmented contexts or pursue processes harmonization through Lean principles.
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Affiliation(s)
- Pietro Mancosu
- Medical Physics Unit, Radiotherapy Department, IRCCS Humanitas Research Hospital, Milano, Italy
| | - Serenella Russo
- Medical Physics Unit, Azienda USL Toscana Centro, Firenze, Italy
| | | | - Michele Stasi
- Medical Physics Department, A.O. Ordine Mauriziano di Torino, Turin, Italy
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Desai D, Narayanasamy G, Bimali M, Cordrey I, Elasmar H, Srinivasan S, Johnson EL. Cleaning the dose falloff in lung SBRT plan. J Appl Clin Med Phys 2020; 22:100-108. [PMID: 33285036 PMCID: PMC7856511 DOI: 10.1002/acm2.13113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 10/07/2020] [Accepted: 11/11/2020] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To investigate a planning technique that can possibly reduce low-to-intermediate dose spillage (measured by R50%, D2cm values) in lung SBRT plans. MATERIALS AND METHODS Dose falloff outside the target was studied retrospectively in 102 SBRT VMAT plans of lung tumor. Plans having R50% and/or D2cm higher than recommended tolerances in RTOG protocols 0813 and 0915 were replanned with new optimization constraints using novel shell structures and novel constraints. Violations in the RTOG R50% value can be rectified with a dose constraint to a novel shell structure ("OptiForR50"). The construction of structure OptiForR50% and the novel optimization criteria translate the RTOG goals for R50% into direct inputs for the optimizer. Violations in the D2cm can be rectified using constraints on a 0.5 cm thick shell structure with inner surface 2cm from the PTV surface. Wilcoxon signed-rank test was used to compare differences in dose conformity, volume of hot spots, R50%, D2cm of the target in addition to the OAR doses. A two-sided P-value of 0.05 was used to assess statistical significance. RESULTS Among 102 lung SBRT plans with PTV sizes ranging from 5 to 179 cc, 32 plans with violations in R50% or D2cm were reoptimized. The mean reduction in R50% (4.68 vs 3.89) and D2cm (56.49 vs 52.51) was statistically significant both having P < 0.01. Target conformity index, volume of 105% isodose contour outside PTV, normal lung V20, and mean dose to heart and aorta were significantly lowered with P < 0.05. CONCLUSION The novel planning methodology using multiple shells including the novel OptiForR50 shell with precisely calculated dimensions and optimizer constraints lead to significantly lower values of R50% and D2cm and lower dose spillage in lung SBRT plans. All plans were successfully brought into the zone of no RTOG violations.
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Affiliation(s)
| | - Ganesh Narayanasamy
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Milan Bimali
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | | | | | - Ellis Lee Johnson
- Department of Radiation Medicine, University of Kentucky, Lexington, KY, USA
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12
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Merlotti A, Bonomo P, Ragona R, Trovò M, Alongi F, Mazzola R, Vigna Taglianti R, Gianello L, Reali A, Bergesio F, Lucio F, Boriano A, De Maggi A, Russi E. Dose prescription in SBRT for early-stage non-small cell lung cancer: are we all speaking the same language? TUMORI JOURNAL 2020; 107:182-187. [PMID: 32515301 DOI: 10.1177/0300891620929425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Stereotactic body radiation therapy is increasingly used in the treatment of early-stage lung cancers. Guidelines provide indications regarding the constraints to the organs at risk (OARs) and the minimum coverage of the planning target volume but do not suggest optimal dose distribution. Data on dose distribution from the different published series are not comparable due to different prescription modalities and reported dose parameters. METHODS We conducted a review of the published data on dose prescription, focusing on the role of homogeneity on local tumor control, and present suggestions on how to specify and report the prescriptions to permit comparisons between studies or between cases from different centers. CONCLUSIONS To identify the dose-prescription modality that better correlates with oncologic outcomes, future studies should guarantee a close uniformity of dose distribution between cases and complete dose parameters reporting for treatment volumes and OARs.
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Affiliation(s)
- Anna Merlotti
- Radiation Oncology, Santa Croce e Carle Hospital, Cuneo, Italy
| | | | | | - Marco Trovò
- Department of Radiation Oncology, Azienda Sanitaria Universitaria Integrata UD, Udine, Italy
| | - Filippo Alongi
- Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy
| | - Rosario Mazzola
- Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy
| | | | - Luca Gianello
- Radiation Oncology, Santa Croce e Carle Hospital, Cuneo, Italy
| | - Alessia Reali
- Radiation Oncology, Santa Croce e Carle Hospital, Cuneo, Italy
| | | | | | | | | | - Elvio Russi
- Radiation Oncology, Santa Croce e Carle Hospital, Cuneo, Italy
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13
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A national survey on technology and quality assurance for stereotactic body radiation therapy. Phys Med 2019; 65:6-14. [DOI: 10.1016/j.ejmp.2019.07.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 07/26/2019] [Accepted: 07/30/2019] [Indexed: 12/22/2022] Open
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14
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Chun M, Joon An H, Kwon O, Oh DH, Park JM, Kim JI. Impact of plan parameters and modulation indices on patient-specific QA results for standard and stereotactic VMAT. Phys Med 2019; 62:83-94. [PMID: 31153402 DOI: 10.1016/j.ejmp.2019.05.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 05/03/2019] [Accepted: 05/04/2019] [Indexed: 12/30/2022] Open
Abstract
PURPOSE To demonstrate the impact of modulation indices and plan parameters on the gamma passing rates (GPR) of patient-specific quality assurance of standard and stereotactic volumetric modulated arc therapy (VMAT) plans. METHODS A total of 758 patients' QA plans were utilized, including standard VMAT plans with Trilogy (n = 87, group A) and TreuBeam STx (n = 332, group B), and 339 stereotactic VMAT plans with TrueBeam STx (group C). Modulation indices were obtained considering the speed and acceleration of the multileaf collimator (MLC) (MIs, MIa), and MLC, gantry speed, and dose rate changes (MIt). The mean aperture size (MA), monitor unit (MU), and amount of jaw tracking (%JT) were acquired. Gamma analysis was performed with 2 mm/2% and 1 mm/2% for the standard and stereotactic VMAT plans, respectively. Statistical analyses were performed to investigate the correlation between modulation index/plan parameters and GPR. RESULTS Spearman's rank correlation to GPRs with MIs, MIa, and MIt, were -0.44, -0.45, and -0.46 for group A; -0.39, -0.37, and -0.38 for group B; and -0.04, -0.11, and -0.10 for group C, respectively. While MU and MA showed significant correlations in all groups, %JT showed a significant correlation only with stereotactic VMAT plans. The most influential parameter combinations were MU-MA (rs = 0.50), MIs-%JT (rs = 0.43), and MU-%JT (rs = 0.38) for groups A, B, and C, respectively. CONCLUSIONS MLC modulation mostly affected the GPR in the delivery of standard VMAT plans, while MU and %JT showed more importance in stereotactic VMAT plans.
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Affiliation(s)
- Minsoo Chun
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea; Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea; Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Hyun Joon An
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea; Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ohyun Kwon
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Do Hoon Oh
- Department of Radiation Oncology, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Jong Min Park
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea; Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea; Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea; Center for Convergence Research on Robotics, Advanced Institutes of Convergence Technology, Suwon, Republic of Korea
| | - Jung-In Kim
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea; Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea; Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea.
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15
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Alharthi T, Arumugam S, Vial P, Holloway L, Thwaites D. EPID sensitivity to delivery errors for pre-treatment verification of lung SBRT VMAT plans. Phys Med 2019; 59:37-46. [PMID: 30928064 DOI: 10.1016/j.ejmp.2019.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 01/31/2019] [Accepted: 02/10/2019] [Indexed: 12/31/2022] Open
Abstract
PURPOSE To study the sensitivity of an Electronic Portal Imaging Device (EPID) in detecting delivery errors for VMAT lung stereotactic body radiotherapy (SBRT) using the Collapsed Arc method. METHODS Baseline VMAT plans and plans with errors intentionally introduced were generated for 15 lung SBRT patients. Three types of errors were introduced by modifying collimator angles and multi-leaf collimator (MLC) field sizes (MLCFS) and MLC shifts by ±5, ±2, and ±1° or millimeters. A total of 103 plans were measured with EPID on an Elekta Synergy Linear Accelerator (Agility MLC) and compared to both the original treatment planning system (TPS) Collapsed Arc dose matrix and the no-error plan baseline EPID measurements. Gamma analysis was performed using the OmniPro-I'mRT (IBA Dosimetry) software and gamma criteria of 1%/1 mm, 2%/1 mm, 2%/2 mm, and 3%/3. RESULTS When the error-introduced EPID measured dose matrices were compared to the TPS matrices, the majority of simulated errors were detected with gamma tolerance of 2%/1 mm and 1%/1 mm. When the error-introduced EPID measured dose matrices were compared to the baseline EPID measurements, all the MLCFS and MLC shift errors, and ±5°collimator errors were detected using 2%/1 mm and 1%/1 mm gamma criteria. CONCLUSION This work demonstrates the feasibility and effectiveness of the collapsed arc technique and EPID for pre-treatment verification of lung SBRT VMAT plans. The EPID was able to detect the majority of MLC and the larger collimator errors with sensitivity to errors depending on the gamma tolerances.
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Affiliation(s)
- Thahabah Alharthi
- Institute of Medical Physics, School of Physics, The University of Sydney, Sydney, New South Wales, Australia; School of Medicine, Taif University, Taif, Saudi Arabia; Liverpool and Macarthur Cancer Therapy Centers, Liverpool, NSW, Australia; Ingham Institute for Applied Medical Research, Sydney, NSW, Australia.
| | - Sankar Arumugam
- Liverpool and Macarthur Cancer Therapy Centers, Liverpool, NSW, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Phil Vial
- Liverpool and Macarthur Cancer Therapy Centers, Liverpool, NSW, Australia; Ingham Institute for Applied Medical Research, Sydney, NSW, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Lois Holloway
- Institute of Medical Physics, School of Physics, The University of Sydney, Sydney, New South Wales, Australia; Liverpool and Macarthur Cancer Therapy Centers, Liverpool, NSW, Australia; Ingham Institute for Applied Medical Research, Sydney, NSW, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia; Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia
| | - David Thwaites
- Institute of Medical Physics, School of Physics, The University of Sydney, Sydney, New South Wales, Australia
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SBRT planning for spinal metastasis: indications from a large multicentric study. Strahlenther Onkol 2018; 195:226-235. [PMID: 30353349 DOI: 10.1007/s00066-018-1383-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 10/08/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND The dosimetric variability in spine stereotactic body radiation therapy (SBRT) planning was investigated in a large number of centres to identify crowd knowledge-based solutions. METHODS Two spinal cases were planned by 48 planners (38 centres). The required prescription dose (PD) was 3 × 10 Gy and the planning target volume (PTV) coverage request was: VPD > 90% (minimum request: VPD > 80%). The dose constraints were: planning risk volume (PRV) spinal cord: V18Gy < 0.35 cm3, V21.9 Gy < 0.03 cm3; oesophagus: V17.7 Gy < 5 cm3, V25.2 Gy < 0.03 cm3. Planners who did not fulfil the protocol requirements were asked to re-optimize the plans, using the results of planners with the same technology. Statistical analysis was performed to assess correlations between dosimetric results and planning parameters. A quality index (QI) was defined for scoring plans. RESULTS In all, 12.5% of plans did not meet the protocol requirements. After re-optimization, 98% of plans fulfilled the constraints, showing the positive impact of knowledge sharing. Statistical analysis showed a significant correlation (p < 0.05) between the homogeneity index (HI) and PTV coverage for both cases, while the correlation between HI and spinal cord sparing was significant only for the single dorsal PTV case. Moreover, the multileaf collimator leaf thickness correlated with the spinal cord sparing. Planners using comparable delivery/planning system techniques produced different QI, highlighting the impact of the planner's skills in the optimization process. CONCLUSION Both the technology and the planner's skills are fundamentally important in spine SBRT planning optimization. Knowledge sharing helped to follow the plan objectives.
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17
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Vloet A, Li W, Giuliani M, Seco P, Silver L, Sun A, Bissonnette JP. Comparison of residual geometric errors obtained for lung SBRT under static beams and VMAT techniques: Implications for PTV margins. Phys Med 2018; 52:129-132. [PMID: 30139601 DOI: 10.1016/j.ejmp.2018.07.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 07/09/2018] [Accepted: 07/24/2018] [Indexed: 10/28/2022] Open
Affiliation(s)
- Anita Vloet
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada
| | - Winnie Li
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada; Department of Radiation Oncology, University of Toronto, Canada
| | - Meredith Giuliani
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada; Department of Radiation Oncology, University of Toronto, Canada
| | - Petula Seco
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada
| | - Lauren Silver
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada
| | - Alexander Sun
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada; Department of Radiation Oncology, University of Toronto, Canada
| | - Jean-Pierre Bissonnette
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada; Department of Radiation Oncology, University of Toronto, Canada.
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18
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SBRT for pancreatic cancer: In regard of Bohoudi et al. Radiother Oncol 2018; 127:509-510. [DOI: 10.1016/j.radonc.2018.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 03/26/2018] [Accepted: 04/01/2018] [Indexed: 12/31/2022]
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Alharthi T, Pogson EM, Arumugam S, Holloway L, Thwaites D. Pre-treatment verification of lung SBRT VMAT plans with delivery errors: Toward a better understanding of the gamma index analysis. Phys Med 2018; 49:119-128. [DOI: 10.1016/j.ejmp.2018.04.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 03/06/2018] [Accepted: 04/04/2018] [Indexed: 12/31/2022] Open
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20
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Mancosu P, Nisbet A, Jornet N. Editorial: The role of medical physics in lung SBRT. Phys Med 2018; 45:205-206. [PMID: 29325801 DOI: 10.1016/j.ejmp.2018.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 01/03/2018] [Indexed: 12/24/2022] Open
Abstract
Stereotactic body radiation therapy (SBRT) has become a standard treatment for non-operable patients with early stage non-small cell lung cancer (NSCLC). In this context, medical physics community has largely helped in the starting and the growth of this technique. In fact, SBRT requires the convergence of many different features for delivering large doses in few fractions to small moving target in an heterogeneous medium. The special issue of last month, was focused on the different physics challenges in lung SBRT. Eleven reviews were presented, covering: imaging for treatment planning and for treatment assessment; dosimetry and planning optimization; treatment delivery possibilities; image guidance during delivery; radiobiology. The current cutting edge role of medical physics was reported. We aimed to give a complete overview of different aspects of lung SBRT that would be of interest to both physicists implementing this technique in their institutions and more experienced physicists that would be inspired to start research projects in areas that still need further developments. We also feel that the role that medical physicists have played in the development and safe implementation of SBRT, particularly in lung region, can be taken as an excellent example to be translated to other areas, not only in Radiation Oncology but also in other health sectors.
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Affiliation(s)
- Pietro Mancosu
- Medical Physics service, Radiotherapy department, Humanitas Cancer Center, Rozzano-Milan, Italy.
| | - Andrew Nisbet
- Department of Medical Physics, Royal Surrey County Hospital, United Kingdom; Department of Physics, Faculty of Engineering & Physical Sciences, University of Surrey, United Kingdom
| | - Núria Jornet
- Servei de Radiofísica i Radioprotecció, Hospital Sant Pau, Barcelona, Spain
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21
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Dosimetric effect of uncorrected rotations in lung SBRT with stereotactic imaging guidance. Phys Med 2017; 42:197-202. [DOI: 10.1016/j.ejmp.2017.09.135] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 09/20/2017] [Accepted: 09/23/2017] [Indexed: 12/25/2022] Open
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22
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Kawata Y, Arimura H, Ikushima K, Jin Z, Morita K, Tokunaga C, Yabu-Uchi H, Shioyama Y, Sasaki T, Honda H, Sasaki M. Impact of pixel-based machine-learning techniques on automated frameworks for delineation of gross tumor volume regions for stereotactic body radiation therapy. Phys Med 2017; 42:141-149. [PMID: 29173908 DOI: 10.1016/j.ejmp.2017.08.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 08/21/2017] [Accepted: 08/26/2017] [Indexed: 01/03/2023] Open
Abstract
The aim of this study was to investigate the impact of pixel-based machine learning (ML) techniques, i.e., fuzzy-c-means clustering method (FCM), and the artificial neural network (ANN) and support vector machine (SVM), on an automated framework for delineation of gross tumor volume (GTV) regions of lung cancer for stereotactic body radiation therapy. The morphological and metabolic features for GTV regions, which were determined based on the knowledge of radiation oncologists, were fed on a pixel-by-pixel basis into the respective FCM, ANN, and SVM ML techniques. Then, the ML techniques were incorporated into the automated delineation framework of GTVs followed by an optimum contour selection (OCS) method, which we proposed in a previous study. The three-ML-based frameworks were evaluated for 16 lung cancer cases (six solid, four ground glass opacity (GGO), six part-solid GGO) with the datasets of planning computed tomography (CT) and 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT images using the three-dimensional Dice similarity coefficient (DSC). DSC denotes the degree of region similarity between the GTVs contoured by radiation oncologists and those estimated using the automated framework. The FCM-based framework achieved the highest DSCs of 0.79±0.06, whereas DSCs of the ANN-based and SVM-based frameworks were 0.76±0.14 and 0.73±0.14, respectively. The FCM-based framework provided the highest segmentation accuracy and precision without a learning process (lowest calculation cost). Therefore, the FCM-based framework can be useful for delineation of tumor regions in practical treatment planning.
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Affiliation(s)
- Yasuo Kawata
- Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Hidetaka Arimura
- Faculty of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
| | - Koujirou Ikushima
- Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Ze Jin
- Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Kento Morita
- Department of Health Sciences, School of Medicine, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Chiaki Tokunaga
- Department of Medical Technology, Kyushu University Hospital, 3-1-1, Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Hidetake Yabu-Uchi
- Faculty of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Yoshiyuki Shioyama
- Saga Heavy Ion Medical Accelerator in Tosu, 415, Harakoga-cho, Tosu 841-0071, Japan
| | - Tomonari Sasaki
- Faculty of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Hiroshi Honda
- Faculty of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Masayuki Sasaki
- Faculty of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
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