1
|
Hoshida K, Ohishi A, Mizoguchi A, Ohkura S, Kawata H. The effects of mega-voltage CT scan parameters on offline adaptive radiation therapy. Radiol Phys Technol 2024; 17:248-257. [PMID: 38334889 DOI: 10.1007/s12194-023-00773-8] [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] [Received: 08/09/2023] [Revised: 12/20/2023] [Accepted: 12/27/2023] [Indexed: 02/10/2024]
Abstract
TomoTherapy involves image-guided radiation therapy (IGRT) using Mega-voltage CT (MVCT) for each treatment session. The acquired MVCT images can be utilized for the retrospective assessment of dose distribution. The TomoTherapy provides 18 distinct imaging conditions that can be selected based on a combination of algorithms, acquisition pitch, and slice interval. We investigated the accuracy of dose calculation and deformable image registration (DIR) depending on MVCT scan parameters and their effects on adaptive radiation therapy (ART). We acquired image values for density calibration tables (IVDTs) under 18 different MVCT conditions and compared them. The planning CT (pCT) was performed using a thoracic phantom, and an esophageal intensity-modulated radiation therapy (IMRT) plan was created. MVCT images of the thoracic phantom were acquired under each of the 18 conditions, and dose recalculation was performed. DIR was performed on the MVCT images acquired under each condition. The accuracy of DIR, depending on the MVCT scan parameters, was compared using the mean distance to agreement (MDA) and Dice similarity coefficient (DSC). The dose distribution calculated on the MVCT images was deformed using deformed vector fields (DVF). No significant differences were observed in the results of the 18 IVDTs. The esophageal IMRT plan also showed a small dose difference. Regarding verifying the DIR accuracy, the MDA increased, and the DSC decreased as the acquisition pitch and slice interval increased. The difference between the dose distributions after dose mapping was comparable to that before DIR. The MVCT scan parameters had little effect on ART.
Collapse
Affiliation(s)
- Kento Hoshida
- Department of Radiology, Kurume University Hospital, 67 Asahimachi, Kurume, Fukuoka, 830-0011, Japan.
| | - Ayumu Ohishi
- Department of Radiology, Kurume University Hospital, 67 Asahimachi, Kurume, Fukuoka, 830-0011, Japan
| | - Asumi Mizoguchi
- Department of Radiology, Kurume University Hospital, 67 Asahimachi, Kurume, Fukuoka, 830-0011, Japan
| | - Sunao Ohkura
- Department of Radiology, Kurume University Hospital, 67 Asahimachi, Kurume, Fukuoka, 830-0011, Japan
| | - Hidemichi Kawata
- Department of Radiology, Kurume University Hospital, 67 Asahimachi, Kurume, Fukuoka, 830-0011, Japan
| |
Collapse
|
2
|
Delaby N, Barateau A, Chiavassa S, Biston MC, Chartier P, Graulières E, Guinement L, Huger S, Lacornerie T, Millardet-Martin C, Sottiaux A, Caron J, Gensanne D, Pointreau Y, Coutte A, Biau J, Serre AA, Castelli J, Tomsej M, Garcia R, Khamphan C, Badey A. Practical and technical key challenges in head and neck adaptive radiotherapy: The GORTEC point of view. Phys Med 2023; 109:102568. [PMID: 37015168 DOI: 10.1016/j.ejmp.2023.102568] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 02/15/2023] [Accepted: 03/18/2023] [Indexed: 04/05/2023] Open
Abstract
Anatomical variations occur during head and neck (H&N) radiotherapy (RT) treatment. These variations may result in underdosage to the target volume or overdosage to the organ at risk. Replanning during the treatment course can be triggered to overcome this issue. Due to technological, methodological and clinical evolutions, tools for adaptive RT (ART) are becoming increasingly sophisticated. The aim of this paper is to give an overview of the key steps of an H&N ART workflow and tools from the point of view of a group of French-speaking medical physicists and physicians (from GORTEC). Focuses are made on image registration, segmentation, estimation of the delivered dose of the day, workflow and quality assurance for an implementation of H&N offline and online ART. Practical recommendations are given to assist physicians and medical physicists in a clinical workflow.
Collapse
|
3
|
Scholey JE, Rajagopal A, Vasquez EG, Sudhyadhom A, Larson PEZ. Generation of synthetic megavoltage CT for MRI-only radiotherapy treatment planning using a 3D deep convolutional neural network. Med Phys 2022; 49:6622-6634. [PMID: 35870154 PMCID: PMC9588542 DOI: 10.1002/mp.15876] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 06/10/2022] [Accepted: 07/01/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Megavoltage computed tomography (MVCT) has been implemented on many radiotherapy treatment machines for on-board anatomical visualization, localization, and adaptive dose calculation. Implementing an MR-only workflow by synthesizing MVCT from magnetic resonance imaging (MRI) would offer numerous advantages for treatment planning and online adaptation. PURPOSE In this work, we sought to synthesize MVCT (sMVCT) datasets from MRI using deep learning to demonstrate the feasibility of MRI-MVCT only treatment planning. METHODS MVCTs and T1-weighted MRIs for 120 patients treated for head-and-neck cancer were retrospectively acquired and co-registered. A deep neural network based on a fully-convolutional 3D U-Net architecture was implemented to map MRI intensity to MVCT HU. Input to the model were volumetric patches generated from paired MRI and MVCT datasets. The U-Net was initialized with random parameters and trained on a mean absolute error (MAE) objective function. Model accuracy was evaluated on 18 withheld test exams. sMVCTs were compared to respective MVCTs. Intensity-modulated volumetric radiotherapy (IMRT) plans were generated on MVCTs of four different disease sites and compared to plans calculated onto corresponding sMVCTs using the gamma metric and dose-volume-histograms (DVHs). RESULTS MAE values between sMVCT and MVCT datasets were 93.3 ± 27.5, 78.2 ± 27.5, and 138.0 ± 43.4 HU for whole body, soft tissue, and bone volumes, respectively. Overall, there was good agreement between sMVCT and MVCT, with bone and air posing the greatest challenges. The retrospective dataset introduced additional deviations due to sinus filling or tumor growth/shrinkage between scans, differences in external contours due to variability in patient positioning, or when immobilization devices were absent from diagnostic MRIs. Dose distributions of IMRT plans evaluated for four test cases showed close agreement between sMVCT and MVCT images when evaluated using DVHs and gamma dose metrics, which averaged to 98.9 ± 1.0% and 96.8 ± 2.6% analyzed at 3%/3 mm and 2%/2 mm, respectively. CONCLUSIONS MVCT datasets can be generated from T1-weighted MRI using a 3D deep convolutional neural network with dose calculation on a sample sMVCT in close agreement with the MVCT. These results demonstrate the feasibility of using MRI-derived sMVCT in an MR-only treatment planning workflow.
Collapse
Affiliation(s)
- Jessica E Scholey
- Department of Radiation Oncology, The University of California, San Francisco; San Francisco, CA 94158 USA
| | - Abhejit Rajagopal
- Department of Radiology and Biomedical Imaging, The University of California, San Francisco; San Francisco, CA 94158 USA
| | - Elena Grace Vasquez
- Department of Physics, The University of California, Berkeley; Berkeley, CA 94720 USA
| | - Atchar Sudhyadhom
- Department of Radiation Oncology, Brigham & Women’s Hospital/Dana-Farber Cancer Institute/Harvard Medical School, Boston, MA; 02115 USA
| | - Peder Eric Zufall Larson
- Department of Radiology and Biomedical Imaging, The University of California, San Francisco; San Francisco, CA 94158 USA
| |
Collapse
|
4
|
Adaptive radiation therapy: When, how and what are the benefits that literature provides? Cancer Radiother 2021; 26:622-636. [PMID: 34688548 DOI: 10.1016/j.canrad.2021.08.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 08/21/2021] [Accepted: 08/24/2021] [Indexed: 11/21/2022]
Abstract
PURPOSE To identify from the current literature when is the right time to replan and to assign thresholds for the optimum process of replanning. Nowadays, adaptive radiotherapy (ART) for head and neck cancer plays an exceptional role consisting of an evaluation procedure of the prominent anatomical and dosimetric variations. By performing complex radiotherapy methods, the credibility of the therapeutic result is crucial. Image guided radiotherapy (IGRT) was developed to ensure locoregional control and thus changes that might occur during radiotherapy be dealt with. MATERIALS AND METHODS An electronic research of articles published in PubMed/MEDLINE and Science Direct databases from January 2004 to October 2020 was performed. Among a total of 127 studies assessed for eligibility, 85 articles were ultimately retained for the review. RESULTS The most noticeable changes have been reported in the middle fraction of the treatment. Therefore, the suggested optimal time to replan is between the third and the fourth week. Anatomical deviations>1cm in the external contour, average weight loss>10%, violation in the dose coverage of the targets>5%, and violation in the dose of the peripherals were some of the thresholds that are currently used, and which lead to replanning. CONCLUSION ART may decrease toxicity and improve local-control. Whether it is beneficial or not, depends ultimately on each patient. However, more investigation of the changes should be performed in future prospective studies to obtain more accurate results.
Collapse
|
5
|
Iliadou V, Economopoulos TL, Karaiskos P, Kouloulias V, Platoni K, Matsopoulos GK. Deformable image registration to assist clinical decision for radiotherapy treatment adaptation for head and neck cancer patients. Biomed Phys Eng Express 2021; 7. [PMID: 34265756 DOI: 10.1088/2057-1976/ac14d1] [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: 05/05/2021] [Accepted: 07/15/2021] [Indexed: 11/12/2022]
Abstract
Head and neck (H&N) cancer patients often present anatomical and geometrical changes in tumors and organs at risk (OARs) during radiotherapy treatment. These changes may result in the need to adapt the existing treatment planning, using an expert's subjective opinion, for offline adaptive radiotherapy and a new treatment planning before each treatment, for online adaptive radiotherapy. In the present study, a fast methodology is proposed to assist in planning adaptation clinical decision using tumor and parotid glands percentage volume changes during treatment. The proposed approach was applied to 40 Η&Ν cases, with one planning Computed Tomography (pCT) image and CBCT scans for 6 weeks of treatment per case. Deformable registration was used for each patient's pCT image alignment to its weekly CBCT. The calculated transformations were used to align each patient's anatomical structures to the weekly anatomy. Clinical target volume (CTV) and parotid gland volume percentage changes were calculated in each case. The accuracy of the achieved image alignment was validated qualitatively and quantitatively. Furthermore, statistical analysis was performed to test if there is a statistically significant correlation between CTV and parotid glands volume percentage changes. Average MDA for CTV and parotid glands between corresponding structures defined by an expert in CBCTs and automatically calculated through registration was 1.4 ± 0.1 mm and 1.5 ± 0.1 mm, respectively. The mean registration time of the first CBCT image registration for 40 cases was lower than 3.4 min. Five patients show more than 20% tumor volume change. Six patients show more than 30% parotid glands volume change. Ten out of 40 patients proposed for planning adaptation. All the statistical tests performed showed no correlation between CTV/parotid glands percentage volume changes. The aim to assist in clinical decision making on a fast and automatic way was achieved using the proposed methodology, thereby reducing workload in clinical practice.
Collapse
Affiliation(s)
- Vasiliki Iliadou
- School of Electrical and Computer Engineering, National Technical University of Athens, Athens, Greece
| | - Theodore L Economopoulos
- School of Electrical and Computer Engineering, National Technical University of Athens, Athens, Greece
| | - Pantelis Karaiskos
- Medical Physics Laboratory, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Vasileios Kouloulias
- 2nd Department of Radiology, Radiotherapy Unit, ATTIKON University Hospital, Athens, Greece
| | - Kalliopi Platoni
- 2nd Department of Radiology, Radiotherapy Unit, ATTIKON University Hospital, Athens, Greece
| | - George K Matsopoulos
- School of Electrical and Computer Engineering, National Technical University of Athens, Athens, Greece
| |
Collapse
|
6
|
Eckl M, Hoppen L, Sarria GR, Boda-Heggemann J, Simeonova-Chergou A, Steil V, Giordano FA, Fleckenstein J. Evaluation of a cycle-generative adversarial network-based cone-beam CT to synthetic CT conversion algorithm for adaptive radiation therapy. Phys Med 2020; 80:308-316. [PMID: 33246190 DOI: 10.1016/j.ejmp.2020.11.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 10/29/2020] [Accepted: 11/05/2020] [Indexed: 12/17/2022] Open
Abstract
PURPOSE Image-guided radiation therapy could benefit from implementing adaptive radiation therapy (ART) techniques. A cycle-generative adversarial network (cycle-GAN)-based cone-beam computed tomography (CBCT)-to-synthetic CT (sCT) conversion algorithm was evaluated regarding image quality, image segmentation and dosimetric accuracy for head and neck (H&N), thoracic and pelvic body regions. METHODS Using a cycle-GAN, three body site-specific models were priorly trained with independent paired CT and CBCT datasets of a kV imaging system (XVI, Elekta). sCT were generated based on first-fraction CBCT for 15 patients of each body region. Mean errors (ME) and mean absolute errors (MAE) were analyzed for the sCT. On the sCT, manually delineated structures were compared to deformed structures from the planning CT (pCT) and evaluated with standard segmentation metrics. Treatment plans were recalculated on sCT. A comparison of clinically relevant dose-volume parameters (D98, D50 and D2 of the target volume) and 3D-gamma (3%/3mm) analysis were performed. RESULTS The mean ME and MAE were 1.4, 29.6, 5.4 Hounsfield units (HU) and 77.2, 94.2, 41.8 HU for H&N, thoracic and pelvic region, respectively. Dice similarity coefficients varied between 66.7 ± 8.3% (seminal vesicles) and 94.9 ± 2.0% (lungs). Maximum mean surface distances were 6.3 mm (heart), followed by 3.5 mm (brainstem). The mean dosimetric differences of the target volumes did not exceed 1.7%. Mean 3D gamma pass rates greater than 97.8% were achieved in all cases. CONCLUSIONS The presented method generates sCT images with a quality close to pCT and yielded clinically acceptable dosimetric deviations. Thus, an important prerequisite towards clinical implementation of CBCT-based ART is fulfilled.
Collapse
Affiliation(s)
- Miriam Eckl
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Germany
| | - Lea Hoppen
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Germany.
| | - Gustavo R Sarria
- Department of Radiology and Radiation Oncology, University Hospital Bonn, Germany
| | - Judit Boda-Heggemann
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Germany
| | - Anna Simeonova-Chergou
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Germany
| | - Volker Steil
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Germany
| | - Frank A Giordano
- Department of Radiology and Radiation Oncology, University Hospital Bonn, Germany
| | - Jens Fleckenstein
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Germany
| |
Collapse
|
7
|
Giacometti V, Hounsell AR, McGarry CK. A review of dose calculation approaches with cone beam CT in photon and proton therapy. Phys Med 2020; 76:243-276. [DOI: 10.1016/j.ejmp.2020.06.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 06/04/2020] [Accepted: 06/22/2020] [Indexed: 01/12/2023] Open
|
8
|
Takemura A, Kaido R, Idesako M, Kadman B, Kojima H, Ueda S. [Database of Radiotherapy Plan Image for Deformable Image Registration]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2020; 76:500-504. [PMID: 32435034 DOI: 10.6009/jjrt.2020_jsrt_76.5.500] [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: 06/11/2023]
Abstract
Guidelines require commissioning for deformable image registration (DIR) software before clinical use. The accuracy of DIR software depends upon data used. If common datasets for the DIR commissioning are available, the DIR results using the common datasets would be useful as an accuracy benchmark. Thus, the DIR-database (DIR-DB) was developed for DIR accuracy check and was open to access, which included radiotherapy plan data. This study was approved by Institutional Review Board (IRB). The DIR-DB recorded radiotherapy plans which had been finished on June 2017 and which at least two radiotherapy plans were built for a case in a treatment course. Cone-beam computed tomography (CBCT) images for patient setup were also collected and recorded in the DIR-DB, if it is available. All recorded data were anonymized and were allowed to access by users in Japan with the IRB approval. The accuracy metrics of DIR; Hausdorff distance, mean distance to agreement, Dice similarity coefficient, Jaccard were put up on the DIR-DB web site. The number of recorded cases were 11 cases for head and neck, 16 cases for thorax, 7 cases for abdomen, 8 cases for pelvis and 6 cases for prostate treated with brachytherapy. The number of case for CBCT was 17 cases. It was meaningful for DIR accuracy check in Japan that the DIR-DB and DIR results using the data in the database were released.
Collapse
Affiliation(s)
- Akihiro Takemura
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University
| | - Ryoto Kaido
- Division of Health Sciences, Graduate School of Medical Sciences, Kanazawa University
- Department of Radiology, University of Fukui Hospital
| | - Miki Idesako
- Division of Health Sciences, Graduate School of Medical Sciences, Kanazawa University
| | - Boriphat Kadman
- Division of Health Sciences, Graduate School of Medical Sciences, Kanazawa University
| | - Hironori Kojima
- Division of Health Sciences, Graduate School of Medical Sciences, Kanazawa University
- Department of Radiology, Kanazawa University Hospital
| | - Shinichi Ueda
- Department of Radiology, Kanazawa University Hospital
| |
Collapse
|
9
|
Mori M, Dell'Oca I, Branchini M, Foti S, Broggi S, Perna L, Cattaneo GM, Calandrino R, Di Muzio NG, Fiorino C. Monitoring skin dose changes during image-guided helical tomotherapy for head and neck cancer patients. Strahlenther Onkol 2019; 196:243-251. [PMID: 31586231 DOI: 10.1007/s00066-019-01520-y] [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] [Received: 05/15/2019] [Accepted: 09/10/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE An increase of skin dose during head and neck cancer (HNC) radiotherapy is potentially dangerous. Aim of this study was to quantify skin dose variation and to assess the need of planning adaptation (ART) to counteract it. METHODS Planning CTs of 32 patients treated with helical tomotherapy (HT) according to a Simultaneous Integrated Boost (SIB) technique delivering 54/66 Gy in 30 fractions were deformably co-registered to MVCTs taken at fractions 15 and 30; in addition, the first fraction was also considered. The delivered dose-of-the-day was calculated on the corresponding deformed images. Superficial body layers (SL) were considered as a surrogate for skin, considering a layer thickness of 2 mm. Variations of SL DVH (∆SL) during therapy were quantified, focusing on ∆SL95% (i.e., 62.7 Gy). RESULTS Small changes (within ± 1 cc for ∆SL95%) were seen in 15/32 patients. Only 2 patients experienced ∆SL95% > 1 cc in at least one of the two monitored fractions. Negative ∆SL95% > 1 cc (up to 17 cc) were much more common (15/32 patients). The trend of skin dose changes was mostly detected at the first fraction. Negative changes were correlated with the presence of any overlap between PTV and SL at planning and were explained in terms of how the planning system optimizes the PTV dose coverage near the skin. Acute toxicity was associated with planning DVH and this association was not improved if considering DVHs referring to fractions 15/30. CONCLUSION About half of the patients treated with SIB with HT for HNC experienced a skin-sparing effect during therapy; only 6% experienced an increase. Our findings do not support skin-sparing ART, while suggesting the introduction of improved skin-sparing planning techniques.
Collapse
Affiliation(s)
- Martina Mori
- Medical Physics, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milano, Italy.
| | - Italo Dell'Oca
- Radiotherapy, San Raffaele Scientific Institute, Milano, Italy
| | - Marco Branchini
- Medical Physics, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milano, Italy
| | - Silvia Foti
- Radiotherapy, San Raffaele Scientific Institute, Milano, Italy
| | - Sara Broggi
- Medical Physics, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milano, Italy
| | - Lucia Perna
- Medical Physics, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milano, Italy
| | | | - Riccardo Calandrino
- Medical Physics, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milano, Italy
| | | | - Claudio Fiorino
- Medical Physics, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milano, Italy
| |
Collapse
|
10
|
État des lieux de la radiothérapie adaptative en 2019 : de la mise en place à l’utilisation clinique. Cancer Radiother 2019; 23:581-591. [DOI: 10.1016/j.canrad.2019.07.142] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 07/12/2019] [Indexed: 12/20/2022]
|
11
|
Rigaud B, Simon A, Castelli J, Lafond C, Acosta O, Haigron P, Cazoulat G, de Crevoisier R. Deformable image registration for radiation therapy: principle, methods, applications and evaluation. Acta Oncol 2019; 58:1225-1237. [PMID: 31155990 DOI: 10.1080/0284186x.2019.1620331] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background: Deformable image registration (DIR) is increasingly used in the field of radiation therapy (RT) to account for anatomical deformations. The aims of this paper are to describe the main applications of DIR in RT and discuss current DIR evaluation methods. Methods: Articles on DIR published from January 2000 to October 2018 were extracted from PubMed and Science Direct. Our search was restricted to articles that report data obtained from humans, were written in English, and address DIR methods for RT. A total of 207 articles were selected from among 2506 identified in the search process. Results: At planning, DIR is used for organ delineation using atlas-based segmentation, deformation-based planning target volume definition, functional planning and magnetic resonance imaging-based dose calculation. In image-guided RT, DIR is used for contour propagation and dose calculation on per-treatment imaging. DIR is also used to determine the accumulated dose from fraction to fraction in external beam RT and brachytherapy, both for dose reporting and adaptive RT. In the case of re-irradiation, DIR can be used to estimate the cumulated dose of the two irradiations. Finally, DIR can be used to predict toxicity in voxel-wise population analysis. However, the evaluation of DIR remains an open issue, especially when dealing with complex cases such as the disappearance of matter. To quantify DIR uncertainties, most evaluation methods are limited to geometry-based metrics. Software companies have now integrated DIR tools into treatment planning systems for clinical use, such as contour propagation and fraction dose accumulation. Conclusions: DIR is increasingly important in RT applications, from planning to toxicity prediction. DIR is routinely used to reduce the workload of contour propagation. However, its use for complex dosimetric applications must be carefully evaluated by combining quantitative and qualitative analyses.
Collapse
Affiliation(s)
- Bastien Rigaud
- CLCC Eugène Marquis, University of Rennes, Inserm , Rennes , France
| | - Antoine Simon
- CLCC Eugène Marquis, University of Rennes, Inserm , Rennes , France
| | - Joël Castelli
- CLCC Eugène Marquis, University of Rennes, Inserm , Rennes , France
| | - Caroline Lafond
- CLCC Eugène Marquis, University of Rennes, Inserm , Rennes , France
| | - Oscar Acosta
- CLCC Eugène Marquis, University of Rennes, Inserm , Rennes , France
| | - Pascal Haigron
- CLCC Eugène Marquis, University of Rennes, Inserm , Rennes , France
| | - Guillaume Cazoulat
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | | |
Collapse
|
12
|
Esteyrie V, Gleyzolle B, Lusque A, Graff P, Modesto A, Rives M, Lapeyre M, Desrousseaux J, Graulières E, Hangard G, Arnaud FX, Ferrand R, Delord JP, Poublanc M, Mounier M, Filleron T, Laprie A. The GIRAFE phase II trial on MVCT-based "volumes of the day" and "dose of the day" addresses when and how to implement adaptive radiotherapy for locally advanced head and neck cancer. Clin Transl Radiat Oncol 2019; 16:34-39. [PMID: 30949592 PMCID: PMC6429538 DOI: 10.1016/j.ctro.2019.02.006] [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: 01/10/2019] [Revised: 02/22/2019] [Accepted: 02/23/2019] [Indexed: 11/25/2022] Open
Abstract
During exclusive curative radiotherapy for head and neck tumors, the patient's organs at risk (OAR) and target volumes frequently change size and shape, leading to a risk of higher toxicity and lower control than expected on planned dosimetry. Adaptive radiotherapy is often necessary but 1) tools are needed to define the optimal time for replanning, and 2) the subsequent workflow is time-consuming. We designed a prospective study to evaluate 1) the validity of automatically deformed contours on the daily MVCT, in order to safely use the "dose-of the day" tool to check daily if replanning is necessary; 2) the automatically deformed contours on the replanning CT and the time gained in the replanning workflow. Forty-eight patients with T3-T4 and/or involved node >2 cm head and neck squamous cell carcinomas, planned for curative radiotherapy without surgery, will be enrolled. They will undergo treatment with helical IMRT including daily repositioning MVCTs. The contours proposed will be compared weekly on intermediate planning CTs (iCTs) on weeks 3, 4, 5 and 6. On these iCTs both manual recontouring and automated deformable registration of the initial contours will be compared with the contours automatically defined on the MVCT. The primary objective is to evaluate the Dice similarity coefficient (DSC) of the volumes of each parotid gland. The secondary objectives will evaluate, for target volumes and all OARs: the DSC, the mean distance to agreement, and the average surface-to-surface distance. Time between the automatic and the manual recontouring workflows will be compared.
Collapse
Key Words
- ART, adaptive radiotherapy
- CT, computed tomography
- CTV, clinical target volume
- DIR, deformable image registration
- DSC, Dice similarity coefficient
- GTV, gross tumor volume
- H&N, head and neck
- ICRU, international commission on radiation units and measurements
- IGRT, image-guided radiotherapy
- IMRT, intensity-modulated radiotherapy
- IUCT, Institut Universitaire du cancer de Toulouse
- MVCT, megavoltage computed tomography
- OAR, organ at risk
- PET, positron emission tomography
- PTV, planning target volume
- iCT, intermediate computed tomography
Collapse
Affiliation(s)
- Vincent Esteyrie
- Radiation Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse, Oncopole, Toulouse, France
| | | | - Amélie Lusque
- Biostatistics Unit, Institut Claudius Regaud-, Institut Universitaire du Cancer de Toulouse - Oncopole Toulouse, France
| | - Pierre Graff
- Radiation Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse, Oncopole, Toulouse, France
| | - Anouchka Modesto
- Radiation Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse, Oncopole, Toulouse, France
| | - Michel Rives
- Radiation Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse, Oncopole, Toulouse, France
| | - Michel Lapeyre
- Radiation Oncology, Centre Jean Perrin, Clermont-Ferrand, France
| | - Jacques Desrousseaux
- Radiation Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse, Oncopole, Toulouse, France
| | - Eliane Graulières
- Engineering and Medical Physics, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse - Oncopole. Toulouse, France
| | - Gregory Hangard
- Engineering and Medical Physics, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse - Oncopole. Toulouse, France
| | - François-Xavier Arnaud
- Engineering and Medical Physics, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse - Oncopole. Toulouse, France
| | - Regis Ferrand
- Engineering and Medical Physics, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse - Oncopole. Toulouse, France
| | - Jean-Pierre Delord
- Clinical Trials Office , Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse - Oncopole. Toulouse, France
| | - Muriel Poublanc
- Clinical Trials Office , Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse - Oncopole. Toulouse, France
| | - Muriel Mounier
- Clinical Trials Office , Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse - Oncopole. Toulouse, France
| | - Thomas Filleron
- Biostatistics Unit, Institut Claudius Regaud-, Institut Universitaire du Cancer de Toulouse - Oncopole Toulouse, France
| | - Anne Laprie
- Radiation Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse, Oncopole, Toulouse, France
| |
Collapse
|
13
|
Skin DVHs predict cutaneous toxicity in Head and Neck Cancer patients treated with Tomotherapy. Phys Med 2019; 59:133-141. [PMID: 30824367 DOI: 10.1016/j.ejmp.2019.02.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 02/13/2019] [Accepted: 02/15/2019] [Indexed: 01/09/2023] Open
Abstract
PURPOSE To explore the association between planning skin dose-volume data and acute cutaneous toxicity after Radio-chemotherapy for Head and Neck (HN) cancer patients. METHODS Seventy HN patients were treated with Helical Tomotherapy (HT) with radical intent (SIB technique: 54/66 Gy to PTV1/PTV2 in 30fr) ± chemotherapy superficial body layer 2 mm thick (SL2) was delineated on planning CT. CTCAE v4.0 acute skin toxicity data were available. Absolute average Dose-Volume Histograms (DVH) of SL2 were calculated for patients with severe (G3) and severe/moderate (G3/G2) skin acute toxicities. Differences against patients with none/mild toxicity (G0/G1) were analyzed to define the most discriminative regions of SL2 DVH; univariable and multivariable logistic analyses were performed on DVH values, CTV volume, age, sex, chemotherapy. RESULTS Sixty-one % of patients experienced G2/G3 toxicity (rate of G3 = 19%). Differences in skin DVHs were significant in the range 53-68Gy (p-values: 0.005-0.01). V56/V64 were the most predictive parameters for G2/G3 (OR = 1.12, 95%CI = 1.03-1.21, p = 0.001) and G3 (OR = 1.13, 95%CI = 1.01-1.26, p = 0.027) with best cut-off of 7.7cc and 2.7cc respectively. The logistic model for V56 was well calibrated being both, slope and R2, close to 1. Average V64 were 2.2cc and 6cc for the two groups (G3 vs G0-G2 toxicity); the logistic model for V64 was quite well calibrated, with a slope close to 1 and R2 equal to 0.60. CONCLUSION SL2 DVH is associated with the risk of acute skin toxicity. Constraining V64 < 3cc (equivalent to a 4x4cm2 skin surface) should keep the risk of G3 toxicity below or around 10%.
Collapse
|
14
|
Image quality and dose evaluation of MVCT TomoTherapy acquisitions: A phantom study. Phys Med 2019; 57:200-206. [PMID: 30738526 DOI: 10.1016/j.ejmp.2019.01.009] [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: 10/29/2018] [Revised: 12/22/2018] [Accepted: 01/08/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The aim of this study is to evaluate the dose delivered and the image quality of pre-treatment MVCT images with Hi-Art TomoTherapy system, varying acquisition and reconstruction parameters. MATERIALS AND METHODS Catphan 500 MVCT images were acquired with all acquisition pitch and reconstruction intervals; image quality was evaluated in terms of noise, uniformity, contrast linearity, contrast-to-noise ratio (CNR) and spatial resolution with the Modulation Transfer Function (MTF). Dose was evaluated as Multi Slice Average Dose (MSADw) and measurements were performed with the Standard TomoTherapy® Quality Assurance Kit composed by the TomoTherapy Phantom, the Exradin A1SL ion chamber and TomoElectrometer. For each pitch-reconstruction interval, acquisitions were repeated 5 times. RESULTS Differences in noise and uniformity, though statistically significant in some cases, were very small: noise ranged from 2.3% for Coarse - 3 mm to 2.4% for Coarse - 6 mm, while uniformity passed from 99.5% for Coarse - 6 mm to 99.8% for Normal - 4 mm. No differences at all were found for CNR for high and low density inserts, while MTF was higher for pitch Coarse, even if no differences in spatial resolution were observed visually (spatial resolution was up to 4 lp/cm for all combinations of pitch and reconstruction interval). Dose was dependent on pitch, being 1.0 cGy for Coarse, 1.5 cGy for Normal and 2.85 cGy for Fine. CONCLUSIONS We observed negligible differences in image quality among different pitch and reconstruction interval, thus, considerations regarding pre-treatment imaging modalities should be based only on dose delivered and on the desired resolution along the cranio-caudal axis for image-guided radiotherapy and adaptive radiotherapy purposes.
Collapse
|
15
|
Muñoz-Montplet C, Marruecos J, Buxó M, Jurado-Bruggeman D, Romera-Martínez I, Bueno M, Vilanova JC. Dosimetric impact of Acuros XB dose-to-water and dose-to-medium reporting modes on VMAT planning for head and neck cancer. Phys Med 2018; 55:107-115. [DOI: 10.1016/j.ejmp.2018.10.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 10/19/2018] [Accepted: 10/30/2018] [Indexed: 11/28/2022] Open
|
16
|
Mihaylov IB, Moros EG. Integral dose based inverse optimization objective function promises lower toxicity in head-and-neck. Phys Med 2018; 54:77-83. [PMID: 30337013 PMCID: PMC9608394 DOI: 10.1016/j.ejmp.2018.06.635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 05/24/2018] [Accepted: 06/22/2018] [Indexed: 10/28/2022] Open
Abstract
PURPOSE The voxels in a CT data sets contain density information. Besides its use in dose calculation density has no other application in modern radiotherapy treatment planning. This work introduces the use of density information by integral dose minimization in radiotherapy treatment planning for head-and-neck squamous cell carcinoma (HNSCC). MATERIALS AND METHODS Eighteen HNSCC cases were studied. For each case two intensity modulated radiotherapy (IMRT) plans were created: one based on dose-volume (DV) optimization, and one based on integral dose minimization (Energy hereafter) inverse optimization. The target objective functions in both optimization schemes were specified in terms of minimum, maximum, and uniform doses, while the organs at risk (OAR) objectives were specified in terms of DV- and Energy-objectives respectively. Commonly used dosimetric measures were applied to assess the performance of Energy-based optimization. In addition, generalized equivalent uniform doses (gEUDs) were evaluated. Statistical analyses were performed to estimate the performance of this novel inverse optimization paradigm. RESULTS Energy-based inverse optimization resulted in lower OAR doses for equivalent target doses and isodose coverage. The statistical tests showed dose reduction to the OARs with Energy-based optimization ranging from ∼2% to ∼15%. CONCLUSIONS Integral dose minimization based inverse optimization for HNSCC promises lower doses to nearby OARs. For comparable therapeutic effect the incorporation of density information into the optimization cost function allows reduction in the normal tissue doses and possibly in the risk and the severity of treatment related toxicities.
Collapse
Affiliation(s)
- Ivaylo B Mihaylov
- Department of Radiation Oncology, University of Miami, 1475 NW 12th Ave, Suite 1500, Miami, FL 33136, United States.
| | - Eduardo G Moros
- Radiation Oncology and Diagnostic Imaging, H. Lee Moffitt Cancer Center, 12902 Magnolia Dr., Tampa, FL 33612, United States
| |
Collapse
|
17
|
Branchini M, Broggi S, Dell'Oca I, Cattaneo GM, Calandrino R, Di Muzio NG, Fiorino C. Skin dose calculation during radiotherapy of head and neck cancer using deformable image registration of planning and mega-voltage computed tomography scans. Phys Imaging Radiat Oncol 2018; 8:44-50. [PMID: 33458416 PMCID: PMC7807680 DOI: 10.1016/j.phro.2018.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 11/21/2018] [Accepted: 11/22/2018] [Indexed: 11/29/2022] Open
Abstract
Background and Purpose Head-Neck (HN) patients may experience severe acute skin complications that can cause treatment interruption and increase the risk of late fibrosis. This study assessed a method for accurately monitoring skin dose changes during helical tomotherapy for HN cancer based on deformable image registration of planning computed tomography (CT) and mega-voltage CT (MVCT). Materials and Methods Planning CTs of nine patients were deformably registered to mid-treatment MVCT (MV15) images resulting in CTdef images. The original plans were recalculated on both CTdef and mid-treatment kilo-voltage CT (CT15) taken as ground truth. Superficial layers (SL) of the body with thicknesses of 2, 3 and 5 mm (SL2, SL3, SL5) were considered as derma surrogates. SL V95%, V97%, V98%, V100%, V102%, V105% and V107% of the prescribed PTV dose were extracted for CT15/CTdef and compared (considering patients with skin dose > 95%). For comparison, doses were calculated directly on the calibrated MVCT and analyzed in the same way. Results Differences between SL2/SL3/SL5 V95%-V107% in CT15/CTdef were very small: for eight of nine patients the difference between the considered SL2 Vd% computed on CTdef and CT15 was less than 1.4 cm3 for all d%. A larger value was found when using MVCT for skin dose calculation (4.8 cm3 for SL2), although CTdef body contour matched CT15 body with accuracy similar to that of MV15. Conclusions Deforming the planning CT-to-MVCT was shown to be accurate considering external body contours and skin DVHs. The method was able to accurately identify superficial overdosing.
Collapse
Affiliation(s)
- Marco Branchini
- Department of Medical Physics, San Raffaele Scientific Institute, Milano, Italy
| | - Sara Broggi
- Department of Medical Physics, San Raffaele Scientific Institute, Milano, Italy
| | - Italo Dell'Oca
- Department of Radiotherapy, San Raffaele Scientific Institute, Milano, Italy
| | | | - Riccardo Calandrino
- Department of Medical Physics, San Raffaele Scientific Institute, Milano, Italy
| | | | - Claudio Fiorino
- Department of Medical Physics, San Raffaele Scientific Institute, Milano, Italy
- Corresponding author at: Medical Physics Department, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milano, MI, Italy.
| |
Collapse
|
18
|
Paganelli C, Meschini G, Molinelli S, Riboldi M, Baroni G. “Patient-specific validation of deformable image registration in radiation therapy: Overview and caveats”. Med Phys 2018; 45:e908-e922. [DOI: 10.1002/mp.13162] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 07/30/2018] [Accepted: 08/24/2018] [Indexed: 12/26/2022] Open
Affiliation(s)
- Chiara Paganelli
- Dipartimento di Elettronica, Informazione e Bioingegneria; Politecnico di Milano; Milano 20133 Italy
| | - Giorgia Meschini
- Dipartimento di Elettronica, Informazione e Bioingegneria; Politecnico di Milano; Milano 20133 Italy
| | | | - Marco Riboldi
- Department of Medical Physics; Ludwig-Maximilians-Universitat Munchen; Munich 80539 Germany
| | - Guido Baroni
- Dipartimento di Elettronica, Informazione e Bioingegneria; Politecnico di Milano; Milano 20133 Italy
- Centro Nazionale di Adroterapia Oncologica; Pavia 27100 Italy
| |
Collapse
|