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Fleury E, Pignol JP, Kiliç E, Milder M, van Rij C, Naus N, Yavuzyigitoglu S, den Toom W, Zolnay A, Spruijt K, van Vulpen M, Trnková P, Hoogeman M. Comparison of stereotactic radiotherapy and protons for uveal melanoma patients. Phys Imaging Radiat Oncol 2024; 31:100605. [PMID: 39050744 PMCID: PMC11268348 DOI: 10.1016/j.phro.2024.100605] [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: 01/22/2024] [Revised: 06/21/2024] [Accepted: 06/25/2024] [Indexed: 07/27/2024] Open
Abstract
Background and purpose Uveal melanoma (UM) is the most common primary ocular malignancy. We compared fractionated stereotactic radiotherapy (SRT) with proton therapy, including toxicity risks for UM patients. Materials and methods For a total of 66 UM patients from a single center, SRT dose distributions were compared to protons using the same planning CT. Fourteen dose-volume parameters were compared in 2-Gy equivalent dose per fraction (EQD2). Four toxicity profiles were evaluated: maculopathy, optic-neuropathy, visual acuity impairment (Profile I); neovascular glaucoma (Profile II); radiation-induced retinopathy (Profile III); and dry-eye syndrome (Profile IV). For Profile III, retina Mercator maps were generated to visualize the geographical location of dose differences. Results In 9/66 cases, (14 %) proton plans were superior for all dose-volume parameters. Higher T stages benefited more from protons in Profile I, especially tumors located within 3 mm or less from the optic nerve. In Profile II, only 9/66 cases resulted in a better proton plan. In Profile III, better retina volume sparing was always achievable with protons, with a larger gain for T3 tumors. In Profile IV, protons always reduced the risk of toxicity with a median RBE-weighted EQD2 reduction of 15.3 Gy. Conclusions This study reports the first side-by-side imaging-based planning comparison between protons and SRT for UM patients. Globally, while protons appear almost always better regarding the risk of optic-neuropathy, retinopathy and dry-eye syndrome, for other toxicity like neovascular glaucoma, a plan comparison is warranted. Choice would depend on the prioritization of risks.
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Affiliation(s)
- Emmanuelle Fleury
- Erasmus Medical Center Cancer Institute, University Medical Center, Department of Radiotherapy, Rotterdam, The Netherlands
- HollandPTC, Delft, The Netherlands
| | | | - Emine Kiliç
- Erasmus Medical Center, Department of Ophthalmology, Rotterdam, The Netherlands
- Erasmus Medical Center, Department of Clinical Genetics, Rotterdam, The Netherlands
| | - Maaike Milder
- Erasmus Medical Center Cancer Institute, University Medical Center, Department of Radiotherapy, Rotterdam, The Netherlands
| | - Caroline van Rij
- Erasmus Medical Center Cancer Institute, University Medical Center, Department of Radiotherapy, Rotterdam, The Netherlands
| | - Nicole Naus
- Erasmus Medical Center, Department of Ophthalmology, Rotterdam, The Netherlands
| | | | - Wilhelm den Toom
- Erasmus Medical Center Cancer Institute, University Medical Center, Department of Radiotherapy, Rotterdam, The Netherlands
| | - Andras Zolnay
- Erasmus Medical Center Cancer Institute, University Medical Center, Department of Radiotherapy, Rotterdam, The Netherlands
| | | | | | - Petra Trnková
- Erasmus Medical Center Cancer Institute, University Medical Center, Department of Radiotherapy, Rotterdam, The Netherlands
- Medical University of Vienna, Department of Radiation Oncology, Vienna, Austria
| | - Mischa Hoogeman
- Erasmus Medical Center Cancer Institute, University Medical Center, Department of Radiotherapy, Rotterdam, The Netherlands
- HollandPTC, Delft, The Netherlands
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Yazici G, Kiratli H, Ozyigit G, Sari SY, Elmali A, Yilmaz MT, Koc I, Deliktas O, Gumeler E, Cengiz M, Zorlu F. Every other day stereotactic radiation therapy for the treatment of uveal melanoma decreases toxicity. Radiother Oncol 2022; 176:39-45. [PMID: 36184996 DOI: 10.1016/j.radonc.2022.09.010] [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: 06/15/2022] [Revised: 09/07/2022] [Accepted: 09/12/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE To report the long-term results of stereotactic radiosurgery and fractionated stereotactic radiation therapy (SRS/FSRT) in patients with uveal melanoma (UM). MATERIALS AND METHODS We retrospectively evaluated the results of patients treated between 2007 and 2019. The primary endpoints were local control (LC), local recurrence-free survival (LRFS), enucleation-free survival (EFS) and treatment toxicity. RESULTS 443 patients with 445 UMs were treated via CyberKnife®. According to the COMS classification, 70% of the tumors were small/medium and 30% were large. Median total RT dose was 54 Gy, median BED10 was 151 Gy. After a median 74-months follow-up, SRS/FSRT yielded an 83% overall LC rate. The 5- and 10-year LRFS rate was 74% and 56%, respectively. Patient age and the COMS size were prognostic for all survival endpoints. An increased SRS/FSRT dose was associated with higher LRFS and EFS rates. SRS/FSRT-related toxicity was observed in 49% of the eyes. Median visual acuity (VA) significantly deteriorated after SRS/FSRT in 76% of the treated eyes. The overall eye preservation rate was 62%, and the 5- and 10-year EFS rate was 64% and 36%, respectively. The delivery of FSRT every other day resulted in a significantly lower rate of toxicity and enucleation compared to FSRT on consecutive days. CONCLUSION A total dose of ≥45 Gy and BED10Gy ≥ 112.5 SRS/FSRT is associated with a higher LC rate in patients with UM. Despite the favorable outcomes, treatment toxicity is the major limitation of this treatment. Toxicity and enucleation can be minimized by treating the eye every other day.
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Affiliation(s)
- Gozde Yazici
- Hacettepe University, Faculty of Medicine, Department of Radiation Oncology, Ankara, Turkey.
| | - Hayyam Kiratli
- Hacettepe University, Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey.
| | - Gokhan Ozyigit
- Hacettepe University, Faculty of Medicine, Department of Radiation Oncology, Ankara, Turkey.
| | - Sezin Yuce Sari
- Hacettepe University, Faculty of Medicine, Department of Radiation Oncology, Ankara, Turkey
| | - Aysenur Elmali
- Elazig Fethi Sekin City Hospital, Department of Radiation Oncology, Elazig, Turkey
| | - Melek Tugce Yilmaz
- Hacettepe University, Faculty of Medicine, Department of Radiation Oncology, Ankara, Turkey
| | - Irem Koc
- Hacettepe University, Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
| | - Ozge Deliktas
- Tunceli State Hospital, Department of Ophthalmology, Tunceli, Turkey
| | - Ekim Gumeler
- Hacettepe University, Faculty of Medicine, Department of Radiology, Ankara, Turkey.
| | - Mustafa Cengiz
- Hacettepe University, Faculty of Medicine, Department of Radiation Oncology, Ankara, Turkey
| | - Faruk Zorlu
- Hacettepe University, Faculty of Medicine, Department of Radiation Oncology, Ankara, Turkey.
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Stereotactic irradiation on linear accelerator - ultrasound versus MRI in choroidal melanoma volume calculation. BMC Ophthalmol 2022; 22:333. [PMID: 35931996 PMCID: PMC9356474 DOI: 10.1186/s12886-022-02558-w] [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: 03/06/2022] [Accepted: 07/28/2022] [Indexed: 11/10/2022] Open
Abstract
Background Stereotactic irradiation is one of the treatment modalities for intraocular uveal melanoma. The study’s purpose was to describe the background of stereotactic one-day session radiosurgery, how the comparison in the difference between the tumor volume measured values from the magnetic resonance imaging (MRI) method and the ultrasound method was related to it, and which method was more precise to be used for tumor regression after irradiation. Methods The group of 147 patients with choroidal melanoma was treated by stereotactic irradiation on the linear accelerator with a single dose of 35.0 Gy. During the standard treatment process the uveal melanoma volumes, needed for dose calculation, were obtained using MRI from the individual stereotactic planning scheme and by ultrasound from the ultrasound device. All volumes were statistically compared using the paired t-test, and for the visualization purpose, the Bland-Altman plot was used. Results In the group of patients, it was 70 (47.6%) males and 77 (52.4%) females. The tumor volume median was from MRI equal to 0.44 cm3 and from ultrasound equal to 0.53 cm3. The difference between the ultrasound and the MRI volume measured values was statistically significant. However, the Bland-Altman plot clearly documents that the two methods are in agreement and can be used interchangeably. In most of the cases, the measured values of the ultrasound-calculated volume achieved slightly higher measured values. Conclusions The calculation of the intraocular uveal tumor volume is a crucial part of the stereotactic irradiation treatment. The ultrasound volume measured values were in most of the cases higher than the measured values from the MRI. Although the methods are comparable and can be used interchangeably, we are recommending using the more precise MRI method not only during the treatment but also on later regular medical checks of tumor regression or progression.
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Via R, Hennings F, Fattori G, Pica A, Lomax A, Weber DC, Baroni G, Hrbacek J. Technical Note: Benchmarking automated eye tracking and human detection for motion monitoring in ocular proton therapy. Med Phys 2020; 47:2237-2241. [PMID: 32037578 DOI: 10.1002/mp.14087] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 01/17/2020] [Accepted: 02/03/2020] [Indexed: 11/06/2022] Open
Abstract
PURPOSE Ocular proton therapy is an effective therapeutic option for patients affected with uveal melanomas. An optical eye-tracking system (ETS) aiming at noninvasive motion monitoring was developed and tested in a clinical scenario. MATERIALS AND METHODS The ETS estimates eye position and orientation at 25 frames per second using the three-dimensional position of pupil and cornea curvature centers identified, in the treatment room, through stereoscopic optical imaging and infrared eye illumination. Its capabilities for automatic detection of eye motion were retrospectively evaluated on 60 treatment fractions. Then, the ETS performance was benchmarked against the clinical standard based on visual control and manual beam interruption. RESULTS Eye-tracking system detected eye position successfully in 97% of all available frames. Eye-tracking system-based eye monitoring during therapy guarantees quicker response to involuntary eye motions than manual beam interruptions and avoids unnecessary beam interruptions. CONCLUSIONS Eye-tracking system shows promise for on-line monitoring of eye motion. Its introduction in the clinical workflow will guarantee a swifter treatment course for the patient and the clinical personnel.
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Affiliation(s)
- Riccardo Via
- Paul Scherrer Institut (PSI), Center for Proton Therapy, 5232, Villigen PSI, Switzerland
| | - Fabian Hennings
- Paul Scherrer Institut (PSI), Center for Proton Therapy, 5232, Villigen PSI, Switzerland
| | - Giovanni Fattori
- Paul Scherrer Institut (PSI), Center for Proton Therapy, 5232, Villigen PSI, Switzerland
| | - Alessia Pica
- Paul Scherrer Institut (PSI), Center for Proton Therapy, 5232, Villigen PSI, Switzerland
| | - Antony Lomax
- Paul Scherrer Institut (PSI), Center for Proton Therapy, 5232, Villigen PSI, Switzerland
| | - Damien Charles Weber
- Paul Scherrer Institut (PSI), Center for Proton Therapy, 5232, Villigen PSI, Switzerland.,Department of Radiation Oncology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.,Department of Radiation Oncology, University Hospital Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Guido Baroni
- Dipartimento di Elettronica Informazione e Bioingegneria, Politecnico di Milano, Milano, 20133, Italy
| | - Jan Hrbacek
- Paul Scherrer Institut (PSI), Center for Proton Therapy, 5232, Villigen PSI, Switzerland
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Clinical experience of stereotactic radiosurgery at a linear accelerator for intraocular melanoma. Melanoma Res 2018; 27:463-468. [PMID: 28520637 DOI: 10.1097/cmr.0000000000000364] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Long-term results with linear accelerator LINAC-based stereotactic radiosurgery for intraocular uveal malignant melanoma were assessed. A retrospective study was carried out of patients with uveal melanoma after a 1-day session stereotactic radiosurgery at LINAC in Slovakia. In the period 2001-2015, a group of 150 patients with uveal melanoma (139 choroidal melanoma, 11 ciliary body melanoma) was treated. The median tumor volume at baseline was 0.5 cm (with range from 0.2 to 1.6 cm). Tumors ranged in size from 2.4 to 20.8 mm in basal diameter and from 2.0 to 18.3 mm in thickness. The therapeutic dose was 35.0 Gy by 99% of dose volume histogram. Older age at treatment was correlated with the largest basal tumor diameter, tumor thickness, and TNM stage. The survival after stereotactic irradiation was 96% in 1 year, 93% in 2 years, 84% in 5 years, 80% in 7 years, and 53% in 11 years. In 20 (13.3%) patients, secondary enucleation was necessary because of complications (secondary glaucoma). Enucleation-free interval ranged from 1 to 6 years. The median age at death was lower (65.7 years) for patients who died from metastatic disease than for those who died from any other cause (75.0 years). Survival rates at 5-year intervals and the need for secondary enucleation because of complications after linear accelerator irradiation are comparable to other techniques.
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Via R, Fassi A, Fattori G, Fontana G, Pella A, Tagaste B, Riboldi M, Ciocca M, Orecchia R, Baroni G. Optical eye tracking system for real-time noninvasive tumor localization in external beam radiotherapy. Med Phys 2016; 42:2194-202. [PMID: 25979013 DOI: 10.1118/1.4915921] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE External beam radiotherapy currently represents an important therapeutic strategy for the treatment of intraocular tumors. Accurate target localization and efficient compensation of involuntary eye movements are crucial to avoid deviations in dose distribution with respect to the treatment plan. This paper describes an eye tracking system (ETS) based on noninvasive infrared video imaging. The system was designed for capturing the tridimensional (3D) ocular motion and provides an on-line estimation of intraocular lesions position based on a priori knowledge coming from volumetric imaging. METHODS Eye tracking is performed by localizing cornea and pupil centers on stereo images captured by two calibrated video cameras, exploiting eye reflections produced by infrared illumination. Additionally, torsional eye movements are detected by template matching in the iris region of eye images. This information allows estimating the 3D position and orientation of the eye by means of an eye local reference system. By combining ETS measurements with volumetric imaging for treatment planning [computed tomography (CT) and magnetic resonance (MR)], one is able to map the position of the lesion to be treated in local eye coordinates, thus enabling real-time tumor referencing during treatment setup and irradiation. Experimental tests on an eye phantom and seven healthy subjects were performed to assess ETS tracking accuracy. RESULTS Measurements on phantom showed an overall median accuracy within 0.16 mm and 0.40° for translations and rotations, respectively. Torsional movements were affected by 0.28° median uncertainty. On healthy subjects, the gaze direction error ranged between 0.19° and 0.82° at a median working distance of 29 cm. The median processing time of the eye tracking algorithm was 18.60 ms, thus allowing eye monitoring up to 50 Hz. CONCLUSIONS A noninvasive ETS prototype was designed to perform real-time target localization and eye movement monitoring during ocular radiotherapy treatments. The device aims at improving state-of-the-art invasive procedures based on surgical implantation of radiopaque clips and repeated acquisition of X-ray images, with expected positive effects on treatment quality and patient outcome.
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Affiliation(s)
- Riccardo Via
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milano 20133, Italy
| | - Aurora Fassi
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milano 20133, Italy
| | - Giovanni Fattori
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milano 20133, Italy
| | - Giulia Fontana
- CNAO Centro Nazionale di Adroterapia Oncologica, Pavia 27100, Italy
| | - Andrea Pella
- CNAO Centro Nazionale di Adroterapia Oncologica, Pavia 27100, Italy
| | - Barbara Tagaste
- CNAO Centro Nazionale di Adroterapia Oncologica, Pavia 27100, Italy
| | - Marco Riboldi
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milano 20133, Italy and CNAO Centro Nazionale di Adroterapia Oncologica, Pavia 27100, Italy
| | - Mario Ciocca
- CNAO Centro Nazionale di Adroterapia Oncologica, Pavia 27100, Italy
| | - Roberto Orecchia
- CNAO Centro Nazionale di Adroterapia Oncologica, Pavia 27100, Italy and European Institute of Oncology, Milano 20141, Italy
| | - Guido Baroni
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milano 20133, Italy and CNAO Centro Nazionale di Adroterapia Oncologica, Pavia 27100, Italy
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Rüegsegger MB, Geiser D, Steiner P, Pica A, Aebersold DM, Kowal JH. Noninvasive referencing of intraocular tumors for external beam radiation therapy using optical coherence tomography: A proof of concept. Med Phys 2014; 41:081704. [DOI: 10.1118/1.4885975] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Phillips C, Pope K, Hornby C, Chesson B, Cramb J, Bressel M. Novel 3D conformal technique for treatment of choroidal melanoma with external beam photon radiotherapy. J Med Imaging Radiat Oncol 2013; 57:230-6. [PMID: 23551786 DOI: 10.1111/1754-9485.12012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Accepted: 08/19/2012] [Indexed: 11/29/2022]
Abstract
INTRODUCTION To report a 3D conformal radiotherapy (3D-CRT) technique that utilises a specific eye immobilisation and treatment set-up method as an alternative to stereotactic radiotherapy (SRT), for treatment of juxtapapillary choroidal melanoma (CM) and report early treatment outcomes of this technique. METHODS A contact lens and rod system was designed to provide eye immobilisation and a treatment reference point for 3D-CRT. The technique is described in detail in the body of the paper. A retrospective chart review was conducted to report freedom from local progression (FFLP) and radiation toxicity in a cohort of patients treated with a dose of 50 Gy in five fractions. RESULTS Eleven eligible patients with juxtapapillary CM were treated between 2003 and 2009. The median follow-up was 3.2 years (range 1.2-5.3). The FFLP was 100% (95% confidence interval 71.5-100). The reproducibility of the set-up and eye immobilisation for fractionation was excellent. The mean dose to the planning target volume was 51.4 Gy (interquartilic range 51.0-51.9). Normal tissue dose constraints were achieved; however, the quality of the 3D-CRT plan was variable. The highest acute radiation toxicity score was Common Toxicity Criteria version 3 grade 1. Vision outcomes were poor. CONCLUSION In this small series, a novel non-stereotactic technique was found to be an accurate method for the treatment of CM with a high rate of freedom from tumour progression, in keeping with the SRT series. The quality of the conformal plan was variable. Investigation of the optimal dose-fractionation schedule to minimise late radiation toxicity without compromise of tumour control is the focus of ongoing clinical research at our centre.
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Affiliation(s)
- Claire Phillips
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
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One-day session LINAC-based stereotactic radiosurgery of posterior uveal melanoma. Eur J Ophthalmol 2012; 22:226-35. [PMID: 21534252 DOI: 10.5301/ejo.2011.7733] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2011] [Indexed: 11/20/2022]
Abstract
PURPOSE LINAC-based stereotactic radiosurgery (SRS) of posterior uveal melanoma is a conservative method to treat uveal melanoma. METHODS This was a retrospective clinic-based study of patients with posterior uveal melanoma in stage T2/T3 who underwent 1-day session SRS at LINAC accelerator or SRS plus combined methods from 2001 to 2008. RESULTS Thirty-nine patients with posterior uveal melanoma were treated with SRS (age 25-80 years, median 54 years). Median tumor volume at baseline was 0.6 cm3 (range 0.2-1.3 cm3). The therapeutic dose (TD) was 35.0 Gy, median of maximal dose applied was 49.0 Gy (range 37.0-60.0 Gy). Patient data were analyzed in groups: group 1, single SRS irradiation; group 2, SRS with subsequent endoresection or cyclectomy or additional transpupillary thermotherapy (TTT) or brachytherapy by Ru106 plaques; group 3a, enucleation after single SRS; group 3b, enucleation after SRS and endoresection/cyclectomy or TTT or brachytherapy Ru106. In patients with visual acuity of 20/40 or better, the median rate of best-corrected visual acuity (BCVA) decline was higher than that of the total and significantly higher than the rate of decline in the complementary group of patients with BCVA less than 20/40 (p=0.0077; Mann-Whitney U test). CONCLUSIONS One-step LINAC-based SRS with a single dose 35.0 Gy is a method to treat middle-stage posterior uveal melanoma and to preserve the eye globe or as the first step of combined methods: irradiation before endoresection or cyclectomy.
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Fassi A, Riboldi M, Forlani CF, Baroni G. Optical eye tracking system for noninvasive and automatic monitoring of eye position and movements in radiotherapy treatments of ocular tumors. APPLIED OPTICS 2012; 51:2441-2450. [PMID: 22614424 DOI: 10.1364/ao.51.002441] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Accepted: 03/06/2012] [Indexed: 06/01/2023]
Abstract
A noninvasive eye tracking system based on infrared 3-D video-oculographic techniques is proposed for the automatic monitoring of eye position and orientation in external beam radiotherapy of ocular tumors. The presented method can be applied for the real-time estimation of lesion position and tumor-beam misalignments, allowing automatic patient setup and eye movement gated treatments. A prototypal eye tracker was developed and tested on five subjects, achieving gaze estimation errors of 0.5° and eye monitoring frequencies of 125 Hz. The proposed application can potentially improve quality and efficacy of ocular radiotherapy treatments, currently based on invasive, qualitative, and manual control procedures.
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Affiliation(s)
- Aurora Fassi
- Department of Bioengineering, Politecnico di Milano, 20133 Milano, Italy.
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Suit H, DeLaney T, Goldberg S, Paganetti H, Clasie B, Gerweck L, Niemierko A, Hall E, Flanz J, Hallman J, Trofimov A. Proton vs carbon ion beams in the definitive radiation treatment of cancer patients. Radiother Oncol 2010; 95:3-22. [DOI: 10.1016/j.radonc.2010.01.015] [Citation(s) in RCA: 170] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2009] [Revised: 01/22/2010] [Accepted: 01/23/2010] [Indexed: 02/03/2023]
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Somani S, Sahgal A, Krema H, Heydarian M, McGowan H, Payne D, Xu W, Michaels H, Laperriere N, Simpson ER. Stereotactic radiotherapy in the treatment of juxtapapillary choroidal melanoma: 2-year follow-up. Can J Ophthalmol 2009; 44:61-5. [DOI: 10.3129/i08-177] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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