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Zhang Y, Jiang Z, Zhang Y, Ren L. A review on 4D cone-beam CT (4D-CBCT) in radiation therapy: Technical advances and clinical applications. Med Phys 2024; 51:5164-5180. [PMID: 38922912 PMCID: PMC11321939 DOI: 10.1002/mp.17269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 03/05/2024] [Accepted: 06/01/2024] [Indexed: 06/28/2024] Open
Abstract
Cone-beam CT (CBCT) is the most commonly used onboard imaging technique for target localization in radiation therapy. Conventional 3D CBCT acquires x-ray cone-beam projections at multiple angles around the patient to reconstruct 3D images of the patient in the treatment room. However, despite its wide usage, 3D CBCT is limited in imaging disease sites affected by respiratory motions or other dynamic changes within the body, as it lacks time-resolved information. To overcome this limitation, 4D-CBCT was developed to incorporate a time dimension in the imaging to account for the patient's motion during the acquisitions. For example, respiration-correlated 4D-CBCT divides the breathing cycles into different phase bins and reconstructs 3D images for each phase bin, ultimately generating a complete set of 4D images. 4D-CBCT is valuable for localizing tumors in the thoracic and abdominal regions where the localization accuracy is affected by respiratory motions. This is especially important for hypofractionated stereotactic body radiation therapy (SBRT), which delivers much higher fractional doses in fewer fractions than conventional fractionated treatments. Nonetheless, 4D-CBCT does face certain limitations, including long scanning times, high imaging doses, and compromised image quality due to the necessity of acquiring sufficient x-ray projections for each respiratory phase. In order to address these challenges, numerous methods have been developed to achieve fast, low-dose, and high-quality 4D-CBCT. This paper aims to review the technical developments surrounding 4D-CBCT comprehensively. It will explore conventional algorithms and recent deep learning-based approaches, delving into their capabilities and limitations. Additionally, the paper will discuss the potential clinical applications of 4D-CBCT and outline a future roadmap, highlighting areas for further research and development. Through this exploration, the readers will better understand 4D-CBCT's capabilities and potential to enhance radiation therapy.
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Affiliation(s)
- Yawei Zhang
- University of Florida Proton Therapy Institute, Jacksonville, FL 32206, USA
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL 32608, USA
| | - Zhuoran Jiang
- Medical Physics Graduate Program, Duke University, Durham, NC 27710, USA
| | - You Zhang
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, TX 75390, USA
| | - Lei Ren
- Department of Radiation Oncology, University of Maryland, Baltimore, MD 21201, USA
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Leipold V, Alerić I, Mlinarić M, Kosmina D, Stanić F, Kasabašić M, Štimac D, Kaučić H, Ursi G, Schwarz K, Nikolić I, Klapan D, Schwarz D. Optimizing Choice of Skin Surrogates for Surface-Guided Stereotactic Body Radiotherapy of Lung Lesions Using Four-Dimensional Computed Tomography. Cancers (Basel) 2024; 16:2358. [PMID: 39001420 PMCID: PMC11240798 DOI: 10.3390/cancers16132358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 06/23/2024] [Accepted: 06/25/2024] [Indexed: 07/16/2024] Open
Abstract
Image-guided radiotherapy supported by surface guidance can help to track lower lung lesions' respiratory motion while reducing a patient's exposure to ionizing radiation. However, it is not always clear how the skin's respiratory motion magnitude and its correlation with the lung lesion's respiratory motion vary between different skin regions of interest (ROI). Four-dimensional computed tomography (4DCT) images provide information on both the skin and lung respiratory motion and are routinely acquired for the purpose of treatment planning in our institution. An analysis of 4DCT images for 57 patients treated in our institution has been conducted to provide information on the respiratory motion magnitudes of nine skin ROIs of the torso, a tracking structure (TS) representing a lower lung lobe lesion, as well as the respiratory motion correlations between the nine ROIs and the TS. The effects of gender and the adipose tissue volume and distribution on these correlations and magnitudes have been analyzed. Significant differences between the ROIs in both the respiratory motion magnitudes and their correlations with the TS have been detected. An overall negative correlation between the ROI respiratory magnitudes and the adipose tissue has been detected for ROIs with rib cage support. A weak to moderate negative correlation between the adipose tissue volume and ROI-to-TS respiratory correlations has been detected for upper thorax ROIs. The respiratory magnitudes in regions without rib support tend to be larger for men than for women, but no differences in the ROI-to-TS correlation between sexes have been detected. The described findings should be considered when choosing skin surrogates for lower lung lesion motion management.
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Affiliation(s)
- Vanda Leipold
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
- Specialty Hospital Radiochirurgia Zagreb, 10431 Sveta Nedelja, Croatia (D.K.); (H.K.)
| | - Ivana Alerić
- Specialty Hospital Radiochirurgia Zagreb, 10431 Sveta Nedelja, Croatia (D.K.); (H.K.)
| | - Mihaela Mlinarić
- Specialty Hospital Radiochirurgia Zagreb, 10431 Sveta Nedelja, Croatia (D.K.); (H.K.)
| | - Domagoj Kosmina
- Specialty Hospital Radiochirurgia Zagreb, 10431 Sveta Nedelja, Croatia (D.K.); (H.K.)
| | - Fran Stanić
- Bitwise Solutions d.o.o., 10000 Zagreb, Croatia
| | - Mladen Kasabašić
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Damir Štimac
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Hrvoje Kaučić
- Specialty Hospital Radiochirurgia Zagreb, 10431 Sveta Nedelja, Croatia (D.K.); (H.K.)
| | - Giovanni Ursi
- Specialty Hospital Radiochirurgia Zagreb, 10431 Sveta Nedelja, Croatia (D.K.); (H.K.)
| | - Karla Schwarz
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Igor Nikolić
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
- Specialty Hospital Radiochirurgia Zagreb, 10431 Sveta Nedelja, Croatia (D.K.); (H.K.)
- School of Medicine, University of Mostar, 88000 Mostar, Bosnia and Herzegovina
| | - Denis Klapan
- Faculty of Dental Medicine and Health Osijek, 31000 Osijek, Croatia
| | - Dragan Schwarz
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
- Specialty Hospital Radiochirurgia Zagreb, 10431 Sveta Nedelja, Croatia (D.K.); (H.K.)
- Faculty of Medicine, Juraj Dobrila University of Pula, 52100 Pula, Croatia
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Lee J, Kim YJ, Goh Y, Yang E, Kim HU, Song SY, Kim YS. Application of surface-guided radiation therapy in prostate cancer: comparative analysis of differences with skin marking-guided patient setup. Radiat Oncol J 2023; 41:172-177. [PMID: 37793626 PMCID: PMC10556842 DOI: 10.3857/roj.2023.00521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/10/2023] [Accepted: 08/23/2023] [Indexed: 10/06/2023] Open
Abstract
PURPOSE Surface-guided radiation therapy is an image-guided method using optical surface imaging that has recently been adopted for patient setup and motion monitoring during treatment. We aimed to determine whether the surface guide setup is accurate and efficient compared to the skin-marking guide in prostate cancer treatment. MATERIALS AND METHODS The skin-marking setup was performed, and vertical, longitudinal, and lateral couch values (labeled as "M") were recorded. Subsequently, the surface-guided setup was conducted, and couch values (labeled as "S") were recorded. After performing cone-beam computed tomography (CBCT), the final couch values was recorded (labeled as "C"), and the shift value was calculated (labeled as "Gap (M-S)," "Gap (M-C)," "Gap (S-C)") and then compared. Additionally, the setup times for the skin marking and surface guides were also compared. RESULTS One hundred and twenty-five patients were analyzed, totaling 2,735 treatment fractions. Gap (M-S) showed minimal differences in the vertical, longitudinal, and lateral averages (-0.03 cm, 0.07 cm, and 0.06 cm, respectively). Gap (M-C) and Gap (S-C) exhibited a mean difference of 0.04 cm (p = 0.03) in the vertical direction, a mean difference of 0.35 cm (p = 0.52) in the longitudinal direction, and a mean difference of 0.11 cm (p = 0.91) in the lateral direction. There was no correlation between shift values and patient characteristics. The average setup time of the skin-marking guide was 6.72 minutes, and 7.53 minutes for the surface guide. CONCLUSION There was no statistically significant difference between the surface and skin-marking guides regarding final CBCT shift values and no correlation between translational shift values and patient characteristics. We also observed minimal difference in setup time between the two methods. Therefore, the surface guide can be considered an accurate and time-efficient alternative to skin-marking guides.
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Affiliation(s)
- Jaeha Lee
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yeon Joo Kim
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Youngmoon Goh
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eunyeong Yang
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ha Un Kim
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Si Yeol Song
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Seok Kim
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Belikhin M, Pryanichnikov A, Balakin V, Shemyakov A, Zhogolev P, Chernyaev A. High-speed low-noise optical respiratory monitoring for spot scanning proton therapy. Phys Med 2023; 112:102612. [PMID: 37329740 DOI: 10.1016/j.ejmp.2023.102612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 04/24/2023] [Accepted: 05/30/2023] [Indexed: 06/19/2023] Open
Abstract
PURPOSE To investigate a novel optical markerless respiratory sensor for surface guided spot scanning proton therapy and to measure its main technical characteristics. METHODS The main characteristics of the respiratory sensor including sensitivity, linearity, noise, signal-to-noise, and time delay were measured using a dynamic phantom and electrical measuring equipment on a laboratory stand. The respiratory signals of free breathing and deep-inspiration breath-hold patterns were acquired for various distances with a volunteer. A comparative analysis of this sensor with existing commercially available and experimental respiratory monitoring systems was carried out based on several criteria including principle of operation, patient contact, application to proton therapy, distance range, accuracy (noise, signal-to-noise ratio), and time delay (sampling rate). RESULTS The sensor provides optical respiratory monitoring of the chest surface over a distance range of 0.4-1.2 m with the RMS noise of 0.03-0.60 mm, SNR of 40-15 dB (for motion with peak-to-peak of 10 mm), and time delay of 1.2 ± 0.2 ms. CONCLUSIONS The investigated optical respiratory sensor was found to be appropriate to use in surface guided spot scanning proton therapy. This sensor combined with a fast respiratory signal processing algorithm may provide accurate beam control and a fast response in patients' irregular breathing movements. A careful study of correlation between the respiratory signal and 4DCT data of tumor position will be required before clinical implementation.
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Affiliation(s)
- Mikhail Belikhin
- JSC Protom., Protvino 142281, Russian Federation; Lomonosov Moscow State University, Moscow 119992, Russian Federation.
| | - Alexander Pryanichnikov
- Division of Biomedical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg 69120, Germany.
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Kaestner L, Streb L, Hetjens S, Buergy D, Sihono DS, Fleckenstein J, Kalisch I, Eckl M, Giordano FA, Lohr F, Stieler F, Boda-Heggemann J. Surface guidance compared with ultrasound-based monitoring and diaphragm position in cone-beam computed tomography during abdominal stereotactic radiotherapy in breath-hold. Phys Imaging Radiat Oncol 2023; 27:100455. [PMID: 37720462 PMCID: PMC10500027 DOI: 10.1016/j.phro.2023.100455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 05/30/2023] [Accepted: 05/31/2023] [Indexed: 09/19/2023] Open
Abstract
Background and purpose Spirometry induced deep-inspiration-breath-hold (DIBH) reduces intrafractional motion during upper abdominal stereotactic body radiotherapy (SBRT). The aim of this prospective study was to evaluate whether surface scanning (SGRT) is an adequate surrogate for monitoring residual internal motion during DIBH. Residual motion detected by SGRT was compared with experimental 4D-ultrasound (US) and an internal motion detection benchmark (diaphragm-dome-position in kV cone-beam computed tomography (CBCT) projections). Materials and methods Intrafractional monitoring was performed with SGRT and US in 460 DIBHs of 12 patients. Residual motion detected by all modalities (SGRT (anterior-posterior (AP)), US (AP, craniocaudal (CC)) and CBCT (CC)) was analyzed. Agreement analysis included Wilcoxon signed rank test, Maloney and Rastogi's test, Pearson's correlation coefficient (PCC) and interclass correlation coefficient (ICC). Results Interquartile range was 0.7 mm (US(AP)), 0.8 mm (US(CC)), 0.9 mm (SGRT) and 0.8 mm (CBCT). SGRT(AP) vs. CBCT(CC) and US(CC) vs. CBCT(CC) showed comparable agreement (PCCs 0.53 and 0.52, ICCs 0.51 and 0.49) with slightly higher precision of CBCT(CC). Most agreement was observed for SGRT(AP) vs. US(AP) with largest PCC (0.61) and ICC (0.60), least agreement for SGRT(AP) vs. US(CC) with smallest PCC (0.44) and ICC (0.42). Conclusions Residual motion detected during spirometry induced DIBH is small. SGRT alone is no sufficient surrogate for residual internal motion in all patients as some high velocity motion could not be detected. Observed patient-specific residual errors may require individualized PTV-margins.
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Affiliation(s)
- Lena Kaestner
- University Medical Center Mannheim, Department of Radiation Oncology, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Lara Streb
- University Medical Center Mannheim, Department of Radiation Oncology, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Svetlana Hetjens
- University Medical Center Mannheim, Department of Medical Statistics and Biomathematics, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Daniel Buergy
- University Medical Center Mannheim, Department of Radiation Oncology, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Dwi S.K. Sihono
- University Medical Center Mannheim, Department of Radiation Oncology, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
- Departemen Fisika, FMIPA, Universitas Indonesia, Depok 16424, Indonesia
| | - Jens Fleckenstein
- University Medical Center Mannheim, Department of Radiation Oncology, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Iris Kalisch
- University Medical Center Mannheim, Department of Radiation Oncology, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Miriam Eckl
- University Medical Center Mannheim, Department of Radiation Oncology, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Frank A. Giordano
- University Medical Center Mannheim, Department of Radiation Oncology, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Frank Lohr
- University Medical Center Mannheim, Department of Radiation Oncology, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
- Struttura Complessa di Radioterapia, Dipartimento di Oncologia, Az. Ospedaliero-Universitaria di Modena, Largo del Pozzo 71, 41122 Modena, Italy
| | - Florian Stieler
- University Medical Center Mannheim, Department of Radiation Oncology, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Judit Boda-Heggemann
- University Medical Center Mannheim, Department of Radiation Oncology, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
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Crop F, Laffarguette J, Achag I, Pasquier D, Mirabel X, Cayez R, Lacornerie T. Evaluation of surface image guidance and Deep inspiration Breath Hold technique for breast treatments with Halcyon. Phys Med 2023; 108:102564. [PMID: 36989980 DOI: 10.1016/j.ejmp.2023.102564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/13/2022] [Accepted: 03/14/2023] [Indexed: 03/29/2023] Open
Abstract
PURPOSE To evaluate the accuracy/agreement of a three-camera Catalyst Surface Guided Radiation Therapy (SGRT) system on a closed-gantry Halcyon for Free-Breathing (FB) and Deep Inspiration Breath Hold (DIBH) breast-only treatments. METHODS The SGRT positioning agreement with Halcyon couch and cone-beam computed tomography (CBCT) was evaluated on phantom and by evaluation of 2401 FB and 855 DIBH breast-only treatment sessions. The DIBH agreement was evaluated using a programmable moving support. Dose agreement was evaluated for manual SGRT-assisted beam interruption and Halcyon arc beam interruption. RESULTS Geometrical phantom agreement was < 0.4 mm. Couch and SGRT agreement for an anthropomorphic phantom resulted in 95% limits of agreement in Right-Left/Feet-Head/Posterior-Anterior (RL/FH/PA) directions of respectively ± 0.4/0.8/0.5 mm and ± 1.1/1.1/0.6 mm in the virtual and real isocenter. FB-SGRT-assisted patient positioning compared to CBCT positioning resulted in RL/FH/PA systematic differences of -0.1/0.1/2.0 mm with standard deviations of 2.7/2.8/2.4 mm. This mean systematic difference had three origins: a) couch sag/isocenter difference of ≤ 0.5 mm. b) Average reconstructed FB-CBCT images do not visually represent the average respiratory position. c) CBCT-based positioning focused on the inner thoracic interface, which can introduce a mean positioning difference between SGRT and CBCT. Manual SGRT-assisted beam interruption and arc interruptions resulted in mean gamma passing rates > 97% (0.5%/0.5 mm) and mean absolute differences < 0.3%. CONCLUSIONS Accuracy was comparable with breast-only C-arm SGRT techniques, with different tradeoffs. Depending on the patient's morphology, real-time tracking accuracy in the real isocenter can be reduced. This study demonstrates possible discordances between SGRT and CBCT positioning for breast.
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Gorecki A, Sorgato V, Mazzara C, Clément S, Fric D, Farah J. SurVolT: Surface to Volume conversion Tool. A proof of concept. Phys Med 2023; 108:102566. [PMID: 36989979 DOI: 10.1016/j.ejmp.2023.102566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 02/02/2023] [Accepted: 03/18/2023] [Indexed: 03/29/2023] Open
Abstract
PURPOSE To develop SurVolT, a conversion tool able to apply volumetric changes to DICOM Computed Tomography (CT) data using daily surface (obj) data acquired with AlignRT® (VisionRT Ltd.), primarily designed and validated for breast treatments. MATERIALS AND METHODS SurVolT proceeds in 4 steps: 1. AlignRT .obj files extraction, 2. Contour deformation where the surface data points are matched to the initial external contour on a Region Of Interest, ROImatch, on which the anatomy is supposed to be unchanged. Then, external contour substitution is performed on the ROIttt covering the treated breast area. This is validated on a female torso phantom with a tissue-equivalent bolus mimicking an edema. The Planning Treatment Volume (PTV) contour from the initial CT is also deformed according to the new external contour in the ROIttt. 3. Volumetric data estimation according to the new external contour, validated on an anthropomorphic pelvis phantom. 4. Import of new DICOM data into the Treatment Planning System (TPS). Finally, the workflow is applied on a first patient presenting an anatomical change during the treatment. RESULTS The validation of step 2 and 3 shows a bolus thickness estimation of 5.8±1.2mm (expected 5 mm) and the non-rigid deformation of initial CT images follows the new external contour at the ROIttt bolus site while revealing negligible deformation elsewhere. CONCLUSION This first proof of concept introducing a Surface Guided Radiotherapy (SGRT) tool allowing daily surface data to volume conversion is a fundamental step toward SGRT-based adaptive radiotherapy.
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Varasteh M, Ali A, Esteve S, Jeevanandam P, Göpfert F, Irvine DM, Hounsell AR, McGarry CK. Patient specific evaluation of breathing motion induced interplay effects. Phys Med 2023; 105:102501. [PMID: 36529007 DOI: 10.1016/j.ejmp.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 09/18/2022] [Accepted: 11/23/2022] [Indexed: 12/23/2022] Open
Abstract
PURPOSE In lung SABR, interplay between target motion and dynamically changing beam parameters can affect the target coverage. To identify the potential need for motion-management techniques, a comprehensive methodology for pre-treatment estimation of interplay effects has been implemented. METHODS In conjunction with an alpha-version of VeriSoft and OCTAVIUS 4D (PTW-Freiburg, Germany), a method is presented to calculate a virtual, motion-simulated 3D dose distribution based on measurement data acquired in a stationary phantom and a subsequent correction with time-dependent target-motion patterns. In-house software has been developed to create user-defined motion patterns based on either simplistic or real patient-breathing patterns including the definition of the exact beam starting phase. The approach was validated by programmed couch and phantom motion during beam delivery. Five different breathing traces with extremely altered beam-on phases (0 % and 50 % respiratory phase) and a superior-inferior motion altitude of 25 mm were used to probe the influence of interplay effects for 14 lung SABR plans. Gamma analysis (2 %/2mm) was used for quantification. RESULTS Validation measurements resulted in >98 % pass rates. Regarding the interplay effect evaluation, gamma pass rates of <92 % were observed for sinusoidal breathing patterns with <25 number of breaths per delivery time (NBs) and realistic patterns with <18 NBs. CONCLUSION The potential influence of interplay effects on the target coverage is highly dependent on the patient's breathing behaviour. The presented moving-platform-free approach can be used for verification of ITV-based treatment plans to identify whether the clinical goals are achievable without explicit use of a respiratory management technique.
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Affiliation(s)
- Mohammad Varasteh
- Centre for Cancer Research and Cell Biology, Queen's University, Belfast, UK
| | - Asmaa Ali
- Centre for Cancer Research and Cell Biology, Queen's University, Belfast, UK
| | - Sergio Esteve
- Northern Ireland Cancer Centre, Belfast City Hospital, Belfast, UK
| | | | | | - Denise M Irvine
- Centre for Cancer Research and Cell Biology, Queen's University, Belfast, UK; Northern Ireland Cancer Centre, Belfast City Hospital, Belfast, UK
| | - Alan R Hounsell
- Centre for Cancer Research and Cell Biology, Queen's University, Belfast, UK; Northern Ireland Cancer Centre, Belfast City Hospital, Belfast, UK
| | - Conor K McGarry
- Centre for Cancer Research and Cell Biology, Queen's University, Belfast, UK; Northern Ireland Cancer Centre, Belfast City Hospital, Belfast, UK
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Santoro M, Della Gala G, Paolani G, Zagni F, Strolin S, Civollani S, Calderoni L, Cappelli A, Mosconi C, Lodi Rizzini E, Tabacchi E, Morganti AG, Fanti S, Golfieri R, Strigari L. A novel tool for motion-related dose inaccuracies reduction in 99mTc-MAA SPECT/CT images for SIRT planning. Phys Med 2022; 98:98-112. [PMID: 35526374 DOI: 10.1016/j.ejmp.2022.04.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 04/05/2022] [Accepted: 04/27/2022] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION In Selective Internal Radiation Therapy (SIRT), 90Y is administered to primary/secondary hepatic lesions. An accurate pre-treatment planning using 99mTc-MAA SPECT/CT allows the assessment of its feasibility and of the activity to be injected. Unfortunately, SPECT/CT suffers from patient-specific respiratory motion which causes artifacts and absorbed dose inaccuracies. In this study, a data-driven solution was developed to correct the respiratory motion. METHODS The tool realigns the barycenter of SPECT projection images and shifts them to obtain a fine registration with the attenuation map. The tool was validated using a modified dynamic phantom with several breathing patterns. We compared the absorbed dose distributions derived from uncorrected(Dm)/corrected(Dc) images with static ones(Ds) in terms of γ-passing rates, 210 Gy isodose volumes, dose-volume histograms and percentage differences of mean doses (i.e., ΔD¯m and ΔD¯c, respectively). The tool was applied to twelve SIRT patients and the Bland-Altman analysis was performed on mean doses. RESULTS In the phantom study, the agreement between Dc and Ds was higher (γ-passing rates generally > 90%) than Dm and Ds. The isodose volumes in Dc were closer than Dm to Ds, with differences up to 10% and 30% respectively. A reduction from a median ΔD¯m = -19.3% to ΔD¯c = -0.9%, from ΔD¯m = -42.8% to ΔD¯c = -7.0% and from ΔD¯m = 1586% to ΔD¯c = 47.2% was observed in liver-, tumor- and lungs-like structures. The Bland-Altman analysis on patients showed variations (±50 Gy) and (±4 Gy) between D¯c and D¯m of tumor and lungs, respectively. CONCLUSION The proposed tool allowed the correction of 99mTc-MAA SPECT/CT images, improving the accuracy of the absorbed dose distribution.
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Affiliation(s)
- Miriam Santoro
- Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Giuseppe Della Gala
- Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Giulia Paolani
- Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Federico Zagni
- Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Silvia Strolin
- Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Simona Civollani
- Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Letizia Calderoni
- Nuclear Medicine Unit, IRCCS Azienda Ospedaliero, University of Bologna, 40138 Bologna, Italy
| | - Alberta Cappelli
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Cristina Mosconi
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Elisa Lodi Rizzini
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Elena Tabacchi
- Nuclear Medicine Unit, IRCCS Azienda Ospedaliero, University of Bologna, 40138 Bologna, Italy
| | | | - Stefano Fanti
- Nuclear Medicine Unit, IRCCS Azienda Ospedaliero, University of Bologna, 40138 Bologna, Italy
| | - Rita Golfieri
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Lidia Strigari
- Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy.
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Algranati C, Strigari L. Imaging Strategies in Proton Therapy for Thoracic Tumors: A Mini Review. Front Oncol 2022; 12:833364. [PMID: 35515119 PMCID: PMC9063639 DOI: 10.3389/fonc.2022.833364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 02/09/2022] [Indexed: 11/13/2022] Open
Abstract
Proton beam therapy (PBT) is often more attractive for its high gradient dose distributions than other treatment modalities with external photon beams. However, in thoracic lesions treated particularly with pencil beam scanning (PBS) proton beams, several dosimetric issues are addressed. The PBS approach may lead to large hot or cold spots in dose distributions delivered to the patients, potentially affecting the tumor control and/or increasing normal tissue side effects. This delivery method particularly benefits image-guided approaches. Our paper aims at reviewing imaging strategies and their technological trends for PBT in thoracic lesions. The focus is on the use of imaging strategies in simulation, planning, positioning, adaptation, monitoring, and delivery of treatment and how changes in the anatomy of thoracic tumors are handled with the available tools and devices in PBT. Starting from bibliographic research over the past 5 years, retrieving 174 papers, major key questions, and implemented solutions were identified and discussed; the results aggregated and presented following the methodology of analysis of expert interviews.
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Affiliation(s)
- Carlo Algranati
- Proton Therapy Department, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale (DIMES), University of Bologna, Bologna, Italy
| | - Lidia Strigari
- Department of Medical Physics, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- *Correspondence: Lidia Strigari,
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