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Liang X, Liu C, Shen J, Flampouri S, Park JC, Lu B, Yaddanapudi S, Tan J, Furutani KM, Beltran CJ. Impact of proton PBS machine operating parameters on the effectiveness of layer rescanning for interplay effect mitigation in lung SBRT treatment. J Appl Clin Med Phys 2024; 25:e14342. [PMID: 38590112 PMCID: PMC11244664 DOI: 10.1002/acm2.14342] [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: 12/22/2023] [Revised: 02/07/2024] [Accepted: 03/13/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Rescanning is a common technique used in proton pencil beam scanning to mitigate the interplay effect. Advances in machine operating parameters across different generations of particle therapy systems have led to improvements in beam delivery time (BDT). However, the potential impact of these improvements on the effectiveness of rescanning remains an underexplored area in the existing research. METHODS We systematically investigated the impact of proton machine operating parameters on the effectiveness of layer rescanning in mitigating interplay effect during lung SBRT treatment, using the CIRS phantom. Focused on the Hitachi synchrotron particle therapy system, we explored machine operating parameters from our institution's current (2015) and upcoming systems (2025A and 2025B). Accumulated dynamic 4D dose were reconstructed to assess the interplay effect and layer rescanning effectiveness. RESULTS Achieving target coverage and dose homogeneity within 2% deviation required 6, 6, and 20 times layer rescanning for the 2015, 2025A, and 2025B machine parameters, respectively. Beyond this point, further increasing the number of layer rescanning did not further improve the dose distribution. BDTs without rescanning were 50.4, 24.4, and 11.4 s for 2015, 2025A, and 2025B, respectively. However, after incorporating proper number of layer rescanning (six for 2015 and 2025A, 20 for 2025B), BDTs increased to 67.0, 39.6, and 42.3 s for 2015, 2025A, and 2025B machine parameters. Our data also demonstrated the potential problem of false negative and false positive if the randomness of the respiratory phase at which the beam is initiated is not considered in the evaluation of interplay effect. CONCLUSION The effectiveness of layer rescanning for mitigating interplay effect is affected by machine operating parameters. Therefore, past clinical experiences may not be applicable to modern machines.
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Affiliation(s)
- Xiaoying Liang
- Department of Radiation OncologyMayo ClinicJacksonvilleFloridaUSA
| | - Chunbo Liu
- Department of Radiation OncologyThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
| | - Jiajian Shen
- Department of Radiation OncologyMayo ClinicPhoenixArizonaUSA
| | - Stella Flampouri
- Department of Radiation OncologyWinship Cancer InstituteEmory UniversityAtlantaUSA
| | - Justin C. Park
- Department of Radiation OncologyMayo ClinicJacksonvilleFloridaUSA
| | - Bo Lu
- Department of Radiation OncologyMayo ClinicJacksonvilleFloridaUSA
| | | | - Jun Tan
- Department of Radiation OncologyMayo ClinicJacksonvilleFloridaUSA
| | | | - Chris J. Beltran
- Department of Radiation OncologyMayo ClinicJacksonvilleFloridaUSA
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Cao YH, Bourbonne V, Lucia F, Schick U, Bert J, Jaouen V, Visvikis D. CT respiratory motion synthesis using joint supervised and adversarial learning. Phys Med Biol 2024; 69:095001. [PMID: 38537289 DOI: 10.1088/1361-6560/ad388a] [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: 11/20/2023] [Accepted: 03/27/2024] [Indexed: 04/16/2024]
Abstract
Objective.Four-dimensional computed tomography (4DCT) imaging consists in reconstructing a CT acquisition into multiple phases to track internal organ and tumor motion. It is commonly used in radiotherapy treatment planning to establish planning target volumes. However, 4DCT increases protocol complexity, may not align with patient breathing during treatment, and lead to higher radiation delivery.Approach.In this study, we propose a deep synthesis method to generate pseudo respiratory CT phases from static images for motion-aware treatment planning. The model produces patient-specific deformation vector fields (DVFs) by conditioning synthesis on external patient surface-based estimation, mimicking respiratory monitoring devices. A key methodological contribution is to encourage DVF realism through supervised DVF training while using an adversarial term jointly not only on the warped image but also on the magnitude of the DVF itself. This way, we avoid excessive smoothness typically obtained through deep unsupervised learning, and encourage correlations with the respiratory amplitude.Main results.Performance is evaluated using real 4DCT acquisitions with smaller tumor volumes than previously reported. Results demonstrate for the first time that the generated pseudo-respiratory CT phases can capture organ and tumor motion with similar accuracy to repeated 4DCT scans of the same patient. Mean inter-scans tumor center-of-mass distances and Dice similarity coefficients were 1.97 mm and 0.63, respectively, for real 4DCT phases and 2.35 mm and 0.71 for synthetic phases, and compares favorably to a state-of-the-art technique (RMSim).Significance.This study presents a deep image synthesis method that addresses the limitations of conventional 4DCT by generating pseudo-respiratory CT phases from static images. Although further studies are needed to assess the dosimetric impact of the proposed method, this approach has the potential to reduce radiation exposure in radiotherapy treatment planning while maintaining accurate motion representation. Our training and testing code can be found athttps://github.com/cyiheng/Dynagan.
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Affiliation(s)
- Y-H Cao
- LaTIM, UMR Inserm 1101, Université de Bretagne Occidentale, IMT Atlantique, Brest, France
| | - V Bourbonne
- LaTIM, UMR Inserm 1101, Université de Bretagne Occidentale, IMT Atlantique, Brest, France
- CHRU Brest University Hospital, Brest, France
| | - F Lucia
- LaTIM, UMR Inserm 1101, Université de Bretagne Occidentale, IMT Atlantique, Brest, France
- CHRU Brest University Hospital, Brest, France
| | - U Schick
- LaTIM, UMR Inserm 1101, Université de Bretagne Occidentale, IMT Atlantique, Brest, France
- CHRU Brest University Hospital, Brest, France
| | - J Bert
- LaTIM, UMR Inserm 1101, Université de Bretagne Occidentale, IMT Atlantique, Brest, France
- CHRU Brest University Hospital, Brest, France
| | - V Jaouen
- LaTIM, UMR Inserm 1101, Université de Bretagne Occidentale, IMT Atlantique, Brest, France
- IMT Atlantique, Brest, France
| | - D Visvikis
- LaTIM, UMR Inserm 1101, Université de Bretagne Occidentale, IMT Atlantique, Brest, France
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Qubala A, Shafee J, Batista V, Liermann J, Winter M, Piro D, Jäkel O. Comparative evaluation of a surface-based respiratory monitoring system against a pressure sensor for 4DCT image reconstruction in phantoms. J Appl Clin Med Phys 2024; 25:e14174. [PMID: 37815197 PMCID: PMC10860430 DOI: 10.1002/acm2.14174] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 09/21/2023] [Accepted: 09/26/2023] [Indexed: 10/11/2023] Open
Abstract
Four-dimensional computed tomography (4DCT), which relies on breathing-induced motion, requires realistic surrogate information of breathing variations to reconstruct the tumor trajectory and motion variability of normal tissues accurately. Therefore, the SimRT surface-guided respiratory monitoring system has been installed on a Siemens CT scanner. This work evaluated the temporal and spatial accuracy of SimRT versus our commonly used pressure sensor, AZ-733 V. A dynamic thorax phantom was used to reproduce regular and irregular breathing patterns acquired by SimRT and Anzai. Various parameters of the recorded breathing patterns, including mean absolute deviations (MAD), Pearson correlations (PC), and tagging precision, were investigated and compared to ground-truth. Furthermore, 4DCT reconstructions were analyzed to assess the volume discrepancy, shape deformation and tumor trajectory. Compared to the ground-truth, SimRT more precisely reproduced the breathing patterns with a MAD range of 0.37 ± 0.27 and 0.92 ± 1.02 mm versus Anzai with 1.75 ± 1.54 and 5.85 ± 3.61 mm for regular and irregular breathing patterns, respectively. Additionally, SimRT provided a more robust PC of 0.994 ± 0.009 and 0.936 ± 0.062 for all investigated breathing patterns. Further, the peak and valley recognition were found to be more accurate and stable using SimRT. The comparison of tumor trajectories revealed discrepancies up to 7.2 and 2.3 mm for Anzai and SimRT, respectively. Moreover, volume discrepancies up to 1.71 ± 1.62% and 1.24 ± 2.02% were found for both Anzai and SimRT, respectively. SimRT was validated across various breathing patterns and showed a more precise and stable breathing tracking, (i) independent of the amplitude and period, (ii) and without placing any physical devices on the patient's body. These findings resulted in a more accurate temporal and spatial accuracy, thus leading to a more realistic 4DCT reconstruction and breathing-adapted treatment planning.
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Affiliation(s)
- Abdallah Qubala
- Heidelberg Ion Beam Therapy Center (HIT)HeidelbergGermany
- Faculty of MedicineUniversity of HeidelbergHeidelbergGermany
- National Center for Radiation Research in Oncology (NCRO)Heidelberg Institute of Radiation Oncology (HIRO)HeidelbergGermany
| | - Jehad Shafee
- Heidelberg Ion Beam Therapy Center (HIT)HeidelbergGermany
- Saarland University of Applied SciencesSaarbrueckenGermany
| | - Vania Batista
- National Center for Radiation Research in Oncology (NCRO)Heidelberg Institute of Radiation Oncology (HIRO)HeidelbergGermany
- Department of Radiation OncologyHeidelberg University HospitalHeidelbergGermany
| | - Jakob Liermann
- Heidelberg Ion Beam Therapy Center (HIT)HeidelbergGermany
- National Center for Radiation Research in Oncology (NCRO)Heidelberg Institute of Radiation Oncology (HIRO)HeidelbergGermany
- Department of Radiation OncologyHeidelberg University HospitalHeidelbergGermany
- National Center for Tumor Diseases (NCT)HeidelbergGermany
| | - Marcus Winter
- Heidelberg Ion Beam Therapy Center (HIT)HeidelbergGermany
- National Center for Radiation Research in Oncology (NCRO)Heidelberg Institute of Radiation Oncology (HIRO)HeidelbergGermany
| | - Daniel Piro
- Heidelberg Ion Beam Therapy Center (HIT)HeidelbergGermany
- Saarland University of Applied SciencesSaarbrueckenGermany
| | - Oliver Jäkel
- Heidelberg Ion Beam Therapy Center (HIT)HeidelbergGermany
- National Center for Radiation Research in Oncology (NCRO)Heidelberg Institute of Radiation Oncology (HIRO)HeidelbergGermany
- National Center for Tumor Diseases (NCT)HeidelbergGermany
- Department of Medical Physics in Radiation OncologyGerman Cancer Research Center (DKFZ)HeidelbergGermany
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Qubala A, Shafee J, Tessonnier T, Horn J, Winter M, Naumann J, Jäkel O. Characteristics of breathing-adapted gating using surface guidance for use in particle therapy: A phantom-based end-to-end test from CT simulation to dose delivery. J Appl Clin Med Phys 2024; 25:e14249. [PMID: 38128056 PMCID: PMC10795430 DOI: 10.1002/acm2.14249] [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: 10/10/2023] [Revised: 12/07/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023] Open
Abstract
To account for intra-fractional tumor motion during dose delivery in radiotherapy, various treatment strategies are clinically implemented such as breathing-adapted gating and irradiating the tumor during specific breathing phases. In this work, we present a comprehensive phantom-based end-to-end test of breathing-adapted gating utilizing surface guidance for use in particle therapy. A commercial dynamic thorax phantom was used to reproduce regular and irregular breathing patterns recorded by the GateRT respiratory monitoring system. The amplitudes and periods of recorded breathing patterns were analysed and compared to planned patterns (ground-truth). In addition, the mean absolute deviations (MAD) and Pearson correlation coefficients (PCC) between the measurements and ground-truth were assessed. Measurements of gated and non-gated irradiations were also analysed with respect to dosimetry and geometry, and compared to treatment planning system (TPS). Further, the latency time of beam on/off was evaluated. Compared to the ground-truth, measurements performed with GateRT showed amplitude differences between 0.03 ± 0.02 mm and 0.26 ± 0.03 mm for regular and irregular breathing patterns, whilst periods of both breathing patterns ranged with a standard deviation between 10 and 190 ms. Furthermore, the GateRT software precisely acquired breathing patterns with a maximum MAD of 0.30 ± 0.23 mm. The PCC constantly ranged between 0.998 and 1.000. Comparisons between TPS and measured dose profiles indicated absolute mean dose deviations within institutional tolerances of ±5%. Geometrical beam characteristics also varied within our institutional tolerances of 1.5 mm. The overall time delays were <60 ms and thus within both recommended tolerances published by ESTRO and AAPM of 200 and 100 ms, respectively. In this study, a non-invasive optical surface-guided workflow including image acquisition, treatment planning, patient positioning and gated irradiation at an ion-beam gantry was investigated, and shown to be clinically viable. Based on phantom measurements, our results show a clinically-appropriate spatial, temporal, and dosimetric accuracy when using surface guidance in the clinical setting, and the results comply with international and institutional guidelines and tolerances.
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Affiliation(s)
- Abdallah Qubala
- Heidelberg Ion Beam Therapy Center (HIT)HeidelbergGermany
- Faculty of MedicineUniversity of HeidelbergHeidelbergGermany
- National Center for Radiation Research in Oncology (NCRO)Heidelberg Institute of Radiation Oncology (HIRO)HeidelbergGermany
| | - Jehad Shafee
- Heidelberg Ion Beam Therapy Center (HIT)HeidelbergGermany
- Saarland University of Applied SciencesSaarbrueckenGermany
| | - Thomas Tessonnier
- Heidelberg Ion Beam Therapy Center (HIT)HeidelbergGermany
- National Center for Radiation Research in Oncology (NCRO)Heidelberg Institute of Radiation Oncology (HIRO)HeidelbergGermany
| | - Julian Horn
- Heidelberg Ion Beam Therapy Center (HIT)HeidelbergGermany
- National Center for Radiation Research in Oncology (NCRO)Heidelberg Institute of Radiation Oncology (HIRO)HeidelbergGermany
| | - Marcus Winter
- Heidelberg Ion Beam Therapy Center (HIT)HeidelbergGermany
- National Center for Radiation Research in Oncology (NCRO)Heidelberg Institute of Radiation Oncology (HIRO)HeidelbergGermany
| | - Jakob Naumann
- Heidelberg Ion Beam Therapy Center (HIT)HeidelbergGermany
- National Center for Radiation Research in Oncology (NCRO)Heidelberg Institute of Radiation Oncology (HIRO)HeidelbergGermany
| | - Oliver Jäkel
- Heidelberg Ion Beam Therapy Center (HIT)HeidelbergGermany
- National Center for Radiation Research in Oncology (NCRO)Heidelberg Institute of Radiation Oncology (HIRO)HeidelbergGermany
- Department of Medical Physics in Radiation OncologyGerman Cancer Research Center (DKFZ)HeidelbergGermany
- National Center for Tumor Diseases (NCT)HeidelbergGermany
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Adachi T, Nagasawa R, Nakamura M, Kakino R, Mizowaki T. Vulnerabilities of radiomic features to respiratory motion on four-dimensional computed tomography-based average intensity projection images: A phantom study. J Appl Clin Med Phys 2022; 23:e13498. [PMID: 35088515 PMCID: PMC8906211 DOI: 10.1002/acm2.13498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 05/11/2021] [Accepted: 09/11/2021] [Indexed: 12/25/2022] Open
Abstract
PURPOSE To evaluate the influence of respiratory motion on the robustness of radiomic features on four-dimensional computed tomography (4DCT)-based average intensity projection (AIP) images by employing an anthropomorphic chest phantom. METHODS Three spherical objects (φ30 mm), namely, acrylic (100 Hounsfield unit [HU], homogeneous), rubber (-140 HU, homogeneous), and cork (-630 HU, heterogeneous), were moved with motion amplitudes of 0, 1, 2.5, 4, 6, 8, and 10 mm in the phantom, and 4DCT scans were repeated at four different locations. Thereafter, the AIP images were generated considering the average of the 10 respiratory phases of the 4DCT images. Further, the targets were manually delineated on the AIP images in the lung window setting. A total of 851 radiomic features, including 107 unfiltered features and 744 wavelet filter-based features, were extracted from the region of interest for each material. The feature robustness among the different target motion amplitude (ε) was evaluated by normalizing the feature variability of the target motion relative to the variability of data from 573 patients with early-stage non-small cell lung cancer. The features with absolute ε values ≤0.5 were considered highly robust to target motions. RESULTS The percentage of robust unfiltered and wavelet filter-based features with a motion amplitude of 1 mm was greater than 83.2% and 93.4%, respectively; however, the percentage decreased by more than 24.3% and 17.6%, respectively, for motion amplitudes greater than 2.5 mm. The movement of cork had a small effect on the feature robustness compared to that of acrylic and rubber, regardless of the target motion amplitudes. CONCLUSIONS Our phantom study demonstrated that target motion amplitudes ≤1 mm led to the robustness of radiomic features on the 4DCT-based AIP images of thoracic regions. The frequency components and directions of the wavelet filters may be essential factors in 4DCT-based radiomic analysis.
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Affiliation(s)
- Takanori Adachi
- Division of Medical Physics, Department of Information Technology and Medical Engineering, Human Health Sciences, Graduate School of Medicine, Kyoto University, Sakyo-ku, Japan.,Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Sakyo-ku, Japan
| | - Ryoko Nagasawa
- Division of Medical Physics, Department of Information Technology and Medical Engineering, Human Health Sciences, Graduate School of Medicine, Kyoto University, Sakyo-ku, Japan
| | - Mitsuhiro Nakamura
- Division of Medical Physics, Department of Information Technology and Medical Engineering, Human Health Sciences, Graduate School of Medicine, Kyoto University, Sakyo-ku, Japan.,Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Sakyo-ku, Japan
| | - Ryo Kakino
- Division of Medical Physics, Department of Information Technology and Medical Engineering, Human Health Sciences, Graduate School of Medicine, Kyoto University, Sakyo-ku, Japan.,Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Sakyo-ku, Japan
| | - Takashi Mizowaki
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Sakyo-ku, Japan
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Trémolières P, Gonzalez-Moya A, Paumier A, Mege M, Blanchecotte J, Theotime C, Autret D, Dufreneix S. Lung stereotactic body radiation therapy: personalized PTV margins according to tumor location and number of four-dimensional CT scans. Radiat Oncol 2022; 17:5. [PMID: 35012579 PMCID: PMC8751327 DOI: 10.1186/s13014-021-01973-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 12/21/2021] [Indexed: 12/25/2022] Open
Abstract
Objectives To characterise the motion of pulmonary tumours during stereotactic body radiation therapy (SBRT) and to evaluate different margins when creating the planning target volume (PTV) on a single 4D CT scan (4DCT). Methods We conducted a retrospective single-site analysis on 30 patients undergoing lung SBRT. Two 4DCTs (4DCT1 and 4DCT2) were performed on all patients. First, motion was recorded for each 4DCT in anterior–posterior (AP), superior-inferior (SI) and rightleft (RL) directions. Then, we used 3 different margins (3,4 and 5 mm) to create the PTV, from the internal target volume (ITV) of 4DCT1 only (PTV D1 + 3, PTV D1 + 4, PTV D1 + 5). We compared, using the Dice coefficient, the volumes of these 3 PTVs, to the PTV actually used for the treatment (PTVttt). Finally, new treatment plans were calculated using only these 3 PTVs. We studied the ratio of the D2%, D50% and D98% between each new plan and the plan actually used for the treatment (D2% PTVttt, D50% PTVttt, D50% ITVttt D98% PTVttt). Results 30 lesions were studied. The greatest motion was observed in the SI axis (8.8 ± 6.6 [0.4–25.8] mm). The Dice index was higher when comparing PTVttt to PTV D1 + 4 mm (0.89 ± 0.04 [0.82–0.98]). Large differences were observed when comparing plans relative to PTVttt and PTV D1 + 3 for D98% PTVttt (0.85 ± 0.24 [0.19–1.00]). and also for D98% ITVttt (0.93 ± 0.12 [0.4–1.0]).D98% PTVttt (0.85 ± 0.24 [0.19–1.00], p value = 0.003) was statistically different when comparing plans relative to PTVttt and PTV D1 + 3. No stastistically differences were observed when comparing plans relative to PTVttt and PTV D1 + 4. A difference greater than 10% relative to D98% PTVttt was found for only in one UL lesion, located under the carina. Conclusion A single 4DCT appears feasible for upper lobe lesions located above the carina, using a 4-mm margin to generate the PTV. Advance in knowledge Propostion of a personalized SBRT treatment (number of 4DCT, margins) according to tumor location (above or under the carina).
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Affiliation(s)
- Pierre Trémolières
- Department of Radiation Oncology, Institut de Cancérologie de L'Ouest Angers, 15 Rue A Boquel, 49055, Angers Cedex 02, France.
| | - Ana Gonzalez-Moya
- Department of Radiation Oncology, Institut de Cancérologie de L'Ouest Angers, 15 Rue A Boquel, 49055, Angers Cedex 02, France
| | - Amaury Paumier
- Department of Radiation Oncology, Institut de Cancérologie de L'Ouest Angers, 15 Rue A Boquel, 49055, Angers Cedex 02, France
| | - Martine Mege
- Department of Radiation Oncology, Institut de Cancérologie de L'Ouest Angers, 15 Rue A Boquel, 49055, Angers Cedex 02, France
| | - Julien Blanchecotte
- Department of Radiation Oncology, Institut de Cancérologie de L'Ouest Angers, 15 Rue A Boquel, 49055, Angers Cedex 02, France
| | - Christelle Theotime
- Department of Medical Physics, Institut de Cancérologie de L'Ouest Angers, 15 Rue A Boquel, 49055, Angers Cedex 02, France
| | - Damien Autret
- Department of Medical Physics, Institut de Cancérologie de L'Ouest Angers, 15 Rue A Boquel, 49055, Angers Cedex 02, France
| | - Stéphane Dufreneix
- Department of Medical Physics, Institut de Cancérologie de L'Ouest Angers, 15 Rue A Boquel, 49055, Angers Cedex 02, France
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Han B, Wu B, Hu F, Ma Y, Wang H, Han X, Liu G, Guo Y. Simulation of dosimetric consequences of intrafraction variation of tumor drift in lung cancer stereotactic body radiotherapy. Front Oncol 2022; 12:1010411. [PMID: 36891502 PMCID: PMC9987420 DOI: 10.3389/fonc.2022.1010411] [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: 08/03/2022] [Accepted: 11/17/2022] [Indexed: 12/14/2022] Open
Abstract
Objective The purpose of this study was to investigate the target dose discrepancy caused by intrafraction variation during stereotactic body radiotherapy (SBRT) for lung cancer. Methods Intensity-modulated radiation therapy (IMRT) plans were designed based on average computed tomography (AVG CT) utilizing the planning target volume (PTV) surrounding the 65% and 85% prescription isodoses in both phantom and patient cases. Variation was simulated by shifting the nominal plan isocenter along six directions from 0.5 mm to 4.5 mm with a 1-mm step size to produce a series of perturbed plans. The dose discrepancy between the initial plan and the perturbed plans was calculated as the percentage of the initial plan. Dose indices, including ΔD99 for internal target volume (ITV) and gross tumor volume (GTV), were adopted as endpoint samples. The mean dose discrepancy was calculated under the 3-dimensional space distribution. Results We found that motion can lead to serious dose degradation of the target and ITV in lung SBRT, especially during SBRT with PTV surrounding the lower isodose line. Lower isodose line may lead to larger dose discrepancy, while make steeper dose fall-off gradient. This phenomenon was compromised when 3-dimensional space distribution was considered. Discussion This result may provide a prospective reference for target dose degradation due to motion during lung SBRT treatment.
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Affiliation(s)
- Bin Han
- The First Affiliated Hospital of Zhengzhou University, Henan, Zhengzhou, China
| | - Bian Wu
- Cancer Center, Union Hospital, Huazhong University of Science and Technology, Tongji Medical College, Wuhan, China
| | - Fala Hu
- School of Mathematics and Statistics, Wuhan University, Hubei, Wuhan, China
| | - Yangguang Ma
- The First Affiliated Hospital of Zhengzhou University, Henan, Zhengzhou, China
| | - Haiyang Wang
- The First Affiliated Hospital of Zhengzhou University, Henan, Zhengzhou, China
| | - Xinwei Han
- The First Affiliated Hospital of Zhengzhou University, Henan, Zhengzhou, China
| | - Gang Liu
- Cancer Center, Union Hospital, Huazhong University of Science and Technology, Tongji Medical College, Wuhan, China
| | - Yuexin Guo
- The First Affiliated Hospital of Zhengzhou University, Henan, Zhengzhou, China
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The assessment of consecutive 4D-CT scans during simulation for lung stereotactic body radiation therapy patients. POLISH JOURNAL OF MEDICAL PHYSICS AND ENGINEERING 2020. [DOI: 10.2478/pjmpe-2020-0023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Abstract
Purpose: To evaluate the breathing amplitude, tumor motion, patient positioning, and treatment volumes among consecutive four-dimensional computed tomography (4D-CT) scans, during the simulation for lung stereotactic body radiation therapy (SBRT).
Material and methods: The variation and shape of the breathing amplitude, patient positioning, and treatment volumes were evaluated for 55 lung cancer patients after consecutive 4D-CT acquisitions, scanned at one-week intervals. The impact of variation in the breathing amplitude on lung tumor motion was determined for 20 patients. The gross tumor volume (GTV) was contoured from a free-breathing CT scan and at ten phases of the respiratory cycle, for both 4D-CTs (440 phases in total).
Results: Breathing amplitude decreased by 3.6 (3.4-4.9) mm, tumor motion by 3.2 (0.4-5.0) mm while breathing period increased by 4 (2-6) s, inter-scan for 20 patients. Intra-scan variation was 4 times greater for the breathing amplitude, 5 times for the breathing period, and 8 times for the breathing cycle, comparing irregular versus regular breathing patterns for 55 patients. Using coaching, the breathing amplitude increases 3 to 8 mm, and the breathing period 2 to 6 s. Differences in the contoured treatment volumes were less than 10% between consecutive scans. Patient positioning remained stable, with a small inter-scan difference of 1.1 (0.6-1.4) mm.
Conclusion: Decreasing the inter-scan breathing amplitude decreases the tumor motion reciprocally. When the breathing amplitude decreases, the breathing period increases at inter- and intra-scan, especially during irregular breathing. Coaching improves respiration, keeping the initial shape of the breathing amplitude. Contoured treatment volumes and patient positioning were reproducible through successive scans.
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Dhont J, Verellen D, Mollaert I, Vanreusel V, Vandemeulebroucke J. RealDRR - Rendering of realistic digitally reconstructed radiographs using locally trained image-to-image translation. Radiother Oncol 2020; 153:213-219. [PMID: 33039426 DOI: 10.1016/j.radonc.2020.10.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/30/2020] [Accepted: 10/01/2020] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Digitally reconstructed radiographs (DRRs) represent valuable patient-specific pre-treatment training data for tumor tracking algorithms. However, using current rendering methods, the similarity of the DRRs to real X-ray images is limited, requires time-consuming measurements and/or are computationally expensive. In this study we present RealDRR, a novel framework for highly realistic and computationally efficient DRR rendering. MATERIALS AND METHODS RealDRR consists of two components applied sequentially to render a DRR. First, a raytracer is applied for forward projection from 3D CT data to a 2D image. Second, a conditional Generative Adverserial Network (cGAN) is applied to translate the 2D forward projection to a realistic 2D DRR. The planning CT and CBCT projections from a CIRS thorax phantom and 6 radiotherapy patients (3 prostate, 3 brain) were split in training and test sets for evaluating the intra-patient, inter-patient and inter-anatomical region generalization performance of the trained framework. Several image similarity metrics, as well as a verification based on template matching, were used between the rendered DRRs and respective CBCT projections in the test sets, and results were compared to those of a current state-of-the-art DRR rendering method. RESULTS When trained on 800 CBCT projection images from two patients and tested on a third unseen patient from either anatomical region, RealDRR outperformed the current state-of-the-art with statistical significance on all metrics (two-sample t-test, p < 0.05). Once trained, the framework is able to render 100 highly realistic DRRs in under two minutes. CONCLUSION A novel framework for realistic and efficient DRR rendering was proposed. As the framework requires a reasonable amount of computational resources, the internal parameters can be tailored to imaging systems and protocols through on-site training on retrospective imaging data.
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Affiliation(s)
- Jennifer Dhont
- Department of Electronics and Informatics (ETRO), Vrije Universiteit Brussel, Brussels, Belgium; Imec, Leuven, Belgium; Faculty of Medicine and Pharmaceutical Sciences, Vrije Universiteit Brussel, Brussels, Belgium.
| | - Dirk Verellen
- Iridium Kankernetwerk, Antwerp, Belgium; University of Antwerp, Faculty of Medicine and Health Sciences, Antwerp, Belgium
| | | | | | - Jef Vandemeulebroucke
- Department of Electronics and Informatics (ETRO), Vrije Universiteit Brussel, Brussels, Belgium; Imec, Leuven, Belgium
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10
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Thengumpallil S, Racine D, Germond J, Péguret N, Bourhis J, Bochud F, Moeckli R. Retrospective analysis of the impact of respiratory motion in treatment margins for frameless lung SBRT based on respiratory-correlated CBCT data-sets. J Appl Clin Med Phys 2020; 21:170-178. [PMID: 32996669 PMCID: PMC7592980 DOI: 10.1002/acm2.13034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 08/19/2020] [Accepted: 08/25/2020] [Indexed: 12/25/2022] Open
Abstract
PURPOSE To investigate the impact of respiratory motion in the treatment margins for lung SBRT frameless treatments and to validate our treatment margins using 4D CBCT data analysis. METHODS Two hundred and twenty nine fractions with early stage NSCLC were retrospectively analyzed. All patients were treated in frameless and free breathing conditions. The treatment margins were calculated according to van Herk equation in Mid-Ventilation. For each fraction, three 4D CBCT scans, pre- and postcorrection, and posttreatment, were acquired to assess target baseline shift, target localization accuracy and intra-fraction motion errors. A bootstrap analysis was performed to assess the minimum number of patients required to define treatment margins. RESULTS The retrospectively calculated target-baseline shift, target localization accuracy and intra-fraction motion errors agreed with the literature. The best tailored margins to our cohort of patients were retrospectively computed and resulted in agreement with already published data. The bootstrap analysis showed that fifteen patients were enough to assess treatment margins. CONCLUSIONS The treatment margins applied to our patient's cohort resulted in good agreement with the retrospectively calculated margins based on 4D CBCT data. Moreover, the bootstrap analysis revealed to be a promising method to verify the reliability of the applied treatment margins for safe lung SBRT delivery.
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Affiliation(s)
| | - Damien Racine
- Institute of Radiation PhysicsLausanne University HospitalLausanneSwitzerland
| | | | | | - Jean Bourhis
- Department of Radiation OncologyLausanne University HospitalLausanneSwitzerland
| | - François Bochud
- Institute of Radiation PhysicsLausanne University HospitalLausanneSwitzerland
| | - Raphaël Moeckli
- Institute of Radiation PhysicsLausanne University HospitalLausanneSwitzerland
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11
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Kawamura T, Fujii Y, Tokura S, Kaneda K, Fujita M, Murakami N, Kuriyama Y, Miyawaki D, Hase M. [Dose Verification for Respiratory-gated VMAT-SBRT Using Real-time Tumor Tracking System]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2020; 76:674-688. [PMID: 32684560 DOI: 10.6009/jjrt.2020_jjrt_76.7.674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Recently, the introduction of various novel technologies in clinical settings has improved the accuracy of radiation therapy. Stereotactic body radiation therapy (SBRT) involves the delivery of an accurate radiation dose to the tumor with a minimal impact on normal tissues using various measures to address changes in the tumor position due to respiratory displacement. The SyncTraX FX4 real-time tumor tracking system (Shimadzu Corporation) introduced in our hospital tracks the actual tumor location by radioscopically monitoring a metallic marker that is placed in the vicinity of the tumor. However, there have been no reports yet on respiratory-gated volumetric modulated arc therapy (VMAT)-SBRT using a real-time tumor tracking system. This study aimed to develop an irradiation procedure for respiratory-gated VMAT-SBRT using a real-time tumor tracking system and to evaluate radiation doses therein. In this study, we found that absolute doses with respiratory gating did not deviate by more than ±1.0% from those without respiratory gating. In addition, the pass rate in gamma analysis using GAFCHROMIC EBT3 was ³95% with the pass criteria in dose difference, distance to agreement, and threshold being 2%, 2 mm, and 10%, respectively. Furthermore, a trajectory log file analysis did not reveal any significant error causes. Thus, these data indicate that respiratory-gated VMAT-SBRT can be applied clinically.
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Affiliation(s)
- Tetsuro Kawamura
- Department of Radiological Technology, Kakogawa Central City Hospital
| | - Yusuke Fujii
- Department of Radiological Technology, Kakogawa Central City Hospital
| | - Shinsuke Tokura
- Department of Radiological Technology, Kakogawa Central City Hospital
| | - Kazunori Kaneda
- Department of Radiological Technology, Kakogawa Central City Hospital
| | - Masahiro Fujita
- Department of Radiological Technology, Kakogawa Central City Hospital
| | - Naoki Murakami
- Department of Radiological Technology, Kakogawa Central City Hospital
| | - Yukiharu Kuriyama
- Department of Radiological Technology, Kakogawa Central City Hospital
| | - Daisuke Miyawaki
- Division of Radiation Oncology, Kobe University Graduate School of Medicine
| | - Mamoru Hase
- Department of Radiology, Kakogawa Central City Hospital
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12
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Schmitt D, Blanck O, Gauer T, Fix MK, Brunner TB, Fleckenstein J, Loutfi-Krauss B, Manser P, Werner R, Wilhelm ML, Baus WW, Moustakis C. Technological quality requirements for stereotactic radiotherapy : Expert review group consensus from the DGMP Working Group for Physics and Technology in Stereotactic Radiotherapy. Strahlenther Onkol 2020; 196:421-443. [PMID: 32211939 PMCID: PMC7182540 DOI: 10.1007/s00066-020-01583-2] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 01/13/2020] [Indexed: 12/25/2022]
Abstract
This review details and discusses the technological quality requirements to ensure the desired quality for stereotactic radiotherapy using photon external beam radiotherapy as defined by the DEGRO Working Group Radiosurgery and Stereotactic Radiotherapy and the DGMP Working Group for Physics and Technology in Stereotactic Radiotherapy. The covered aspects of this review are 1) imaging for target volume definition, 2) patient positioning and target volume localization, 3) motion management, 4) collimation of the irradiation and beam directions, 5) dose calculation, 6) treatment unit accuracy, and 7) dedicated quality assurance measures. For each part, an expert review for current state-of-the-art techniques and their particular technological quality requirement to reach the necessary accuracy for stereotactic radiotherapy divided into intracranial stereotactic radiosurgery in one single fraction (SRS), intracranial fractionated stereotactic radiotherapy (FSRT), and extracranial stereotactic body radiotherapy (SBRT) is presented. All recommendations and suggestions for all mentioned aspects of stereotactic radiotherapy are formulated and related uncertainties and potential sources of error discussed. Additionally, further research and development needs in terms of insufficient data and unsolved problems for stereotactic radiotherapy are identified, which will serve as a basis for the future assignments of the DGMP Working Group for Physics and Technology in Stereotactic Radiotherapy. The review was group peer-reviewed, and consensus was obtained through multiple working group meetings.
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Affiliation(s)
- Daniela Schmitt
- Klinik für Radioonkologie und Strahlentherapie, National Center for Radiation Research in Oncology (NCRO), Heidelberger Institut für Radioonkologie (HIRO), Universitätsklinikum Heidelberg, Heidelberg, Germany.
| | - Oliver Blanck
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Tobias Gauer
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Michael K Fix
- Abteilung für Medizinische Strahlenphysik und Universitätsklinik für Radio-Onkologie, Inselspital-Universitätsspital Bern, Universität Bern, Bern, Switzerland
| | - Thomas B Brunner
- Universitätsklinik für Strahlentherapie, Universitätsklinikum Magdeburg, Magdeburg, Germany
| | - Jens Fleckenstein
- Klinik für Strahlentherapie und Radioonkologie, Universitätsmedizin Mannheim, Universität Heidelberg, Mannheim, Germany
| | - Britta Loutfi-Krauss
- Klinik für Strahlentherapie und Onkologie, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
| | - Peter Manser
- Abteilung für Medizinische Strahlenphysik und Universitätsklinik für Radio-Onkologie, Inselspital-Universitätsspital Bern, Universität Bern, Bern, Switzerland
| | - Rene Werner
- Institut für Computational Neuroscience, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Maria-Lisa Wilhelm
- Klinik für Strahlentherapie, Universitätsmedizin Rostock, Rostock, Germany
| | - Wolfgang W Baus
- Klinik für Radioonkologie, CyberKnife- und Strahlentherapie, Universitätsklinikum Köln, Cologne, Germany
| | - Christos Moustakis
- Klinik für Strahlentherapie-Radioonkologie, Universitätsklinikum Münster, Münster, Germany
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13
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Rabe M, Thieke C, Düsberg M, Neppl S, Gerum S, Reiner M, Nicolay NH, Schlemmer H, Debus J, Dinkel J, Landry G, Parodi K, Belka C, Kurz C, Kamp F. Real‐time 4DMRI‐based internal target volume definition for moving lung tumors. Med Phys 2020; 47:1431-1442. [DOI: 10.1002/mp.14023] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 12/20/2019] [Accepted: 01/07/2020] [Indexed: 12/25/2022] Open
Affiliation(s)
- Moritz Rabe
- Department of Radiation Oncology University Hospital, LMU Munich Munich 81377 Germany
| | - Christian Thieke
- Department of Radiation Oncology University Hospital, LMU Munich Munich 81377 Germany
| | - Mathias Düsberg
- Department of Radiation Oncology Klinikum rechts der Isar, Technical University Munich 81675 Germany
| | - Sebastian Neppl
- Department of Radiation Oncology University Hospital, LMU Munich Munich 81377 Germany
| | - Sabine Gerum
- Department of Radiation Oncology University Hospital, LMU Munich Munich 81377 Germany
| | - Michael Reiner
- Department of Radiation Oncology University Hospital, LMU Munich Munich 81377 Germany
| | | | | | - Jürgen Debus
- Department of Radiation Oncology University Hospital of Heidelberg Heidelberg 69120 Germany
- Heidelberg Institute of Radiation Oncology (HIRO) Heidelberg 69120 Germany
| | - Julien Dinkel
- Department of Radiology University Hospital, LMU Munich Munich 81377 Germany
| | - Guillaume Landry
- Department of Radiation Oncology University Hospital, LMU Munich Munich 81377 Germany
- Department of Medical Physics Ludwig‐Maximilians‐Universität München (LMU Munich) Garching 85748 Germany
| | - Katia Parodi
- Department of Medical Physics Ludwig‐Maximilians‐Universität München (LMU Munich) Garching 85748 Germany
| | - Claus Belka
- Department of Radiation Oncology University Hospital, LMU Munich Munich 81377 Germany
- German Cancer Consortium (DKTK) Munich 81377 Germany
| | - Christopher Kurz
- Department of Radiation Oncology University Hospital, LMU Munich Munich 81377 Germany
- Department of Medical Physics Ludwig‐Maximilians‐Universität München (LMU Munich) Garching 85748 Germany
| | - Florian Kamp
- Department of Radiation Oncology University Hospital, LMU Munich Munich 81377 Germany
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14
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Van Ooteghem G, Dasnoy-Sumell D, Lee JA, Geets X. Mechanically-assisted and non-invasive ventilation for radiation therapy: A safe technique to regularize and modulate internal tumour motion. Radiother Oncol 2019; 141:283-291. [PMID: 31653574 DOI: 10.1016/j.radonc.2019.09.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 09/06/2019] [Accepted: 09/23/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE Current motion mitigation strategies, like margins, gating, and tracking, deal with geometrical uncertainties in the tumour position, induced by breathing during radiotherapy (RT). However, they often overlook motion variability in amplitude, respiratory rate, or baseline position, when breathing spontaneously. Consequently, this may negatively affect the delivered dose conformality in comparison to the plan. We previously demonstrated on volunteers that 3 different modes of mechanically-assisted and non-invasive ventilation (MANIV) may reduce variability in breathing motion. The volume-controlled mode (VC) constraints the amplitude and respiratory rate (RR) in physiologic condition. The shallow-controlled mode (SH), derived from VC, increases the RR and decreases amplitude. The slow-controlled mode (SL) induces repeated breath holds with constrained ventilation pressure. In this study, we compared these mechanical ventilation modes to spontaneous breathing or breath hold and assessed their tolerance and effects on internal tumour motion in patients receiving RT. MATERIAL AND METHODS The VC and SH modes were evaluated in ten patients with lung or liver cancers (cohort A). The SL mode was evaluated in 12 left breast cancer patients (cohort B). After a training and simulation session, the patients underwent 2 MRI sessions to analyze the internal motion of breast and tumour. RESULTS MANIV was well tolerated, without any adverse events or oxymetric changes, even in patients with respiratory comorbidities. In cohort A, when compared to spontaneous breathing (SP), VC reduced significantly inter-session variations of the tumour motion amplitude (p = 0.01), as well as intra- and inter-session variations of the RR (p < 0.05). As to SH, the RR increased, while its variations within and across sessions decreased when compared to SP (p < 0.001). SH reduced the median amplitude of the tumour motion by 6.1 mm or 38.2% (p ≤ 0.01) compared to VC. In cohort B, breast position stability over the end-inspiratory plateaus obtained spontaneously or with SL remained similar. Median duration of the plateaus in SL was 16.6 s. CONCLUSION MANIV is a safe and well tolerated ventilation technique for patients receiving radiotherapy. MANIV could thus make current motion mitigation strategies less critical and more robust. Clinical implementation might be considered, provided the ventilation mode is carefully selected with respect to the treatment indication and patient individualities.
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Affiliation(s)
- Geneviève Van Ooteghem
- Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique (IREC), Center of Molecular Imaging, Radiotherapy and Oncology (MIRO), Brussels, Belgium; Cliniques Universitaires Saint Luc, Department of Radiation Oncology, Brussels, Belgium.
| | - Damien Dasnoy-Sumell
- Université Catholique de Louvain, ImagX-R, Institute of Information and Communication Technologies, Electronics and Applied Mathematics, Louvain-La-Neuve, Belgium
| | - John Aldo Lee
- Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique (IREC), Center of Molecular Imaging, Radiotherapy and Oncology (MIRO), Brussels, Belgium
| | - Xavier Geets
- Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique (IREC), Center of Molecular Imaging, Radiotherapy and Oncology (MIRO), Brussels, Belgium; Cliniques Universitaires Saint Luc, Department of Radiation Oncology, Brussels, Belgium
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15
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De Oliveira Duarte S, Rancoule C, He MY, Baury M, Sotton S, Vallard A, Espenel S, Guy JB, Guillaume É, Vial N, Magné N, Rehailia-Blanchard A. Use of 4D-CT for radiotherapy planning and reality in France: Data from a national survey. Cancer Radiother 2019; 23:395-400. [PMID: 31331842 DOI: 10.1016/j.canrad.2019.02.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 02/15/2019] [Accepted: 02/21/2019] [Indexed: 12/25/2022]
Abstract
PURPOSE Lung and some digestive tumours move during a respiratory cycle. Four-dimensional scanography (4D-CT) is commonly used in treatment planning to account for respiratory motion. Although many French radiotherapy centres are now equipped, there are no guidelines on this subject to date. We wanted to draw up a description of the use of the 4D-CT for the treatment planning in France. METHODS AND MATERIAL We conducted a survey in all French radiotherapy centres between March and April 2017. RESULTS One hundred and seventy-two were contacted. The participation rate was 88.37%. The use of the 4D-CT seems to be common and concerned planning for 15.28% of kidney and adrenal cancers, 19.72% of pancreatic cancers, 27.78% of oesophageal cancers and 73.24% of lung cancers in case of normofractionated treatments. The use of the 4D-CT was also widespread in the case of stereotactic body radiation therapy: with 61.11% in the case of pulmonary irradiation and 34.72% in the case of hepatic irradiation. Many centres declared they carried out several 4D-CT for treatment planning (29, 55% in case of stereotactic body radiation therapy for lung tumours and 20% for liver tumours). Private centres tend to repeat 4D-CT more. CONCLUSION Although the use of the 4D-CT appears to be developing, it remains very heterogeneous. To date, the repetition of the 4D-CT has been very poorly studied and could be the subject of clinical studies, allowing to define in which indications and for which populations there is a real benefit.
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Affiliation(s)
- S De Oliveira Duarte
- Département de radiothérapie, Institut de cancérologie de la Loire Lucien-Neuwirth, 108, bis, avenue Albert-Raimond, 42270 Saint-Priest-en-Jarez, France; CS 60032, École universitaire de physique et d'ingénierie, université Clermont-Auvergne, 49, boulevard François-Mitterrand, 63001 Clermont-Ferrand, France
| | - C Rancoule
- Département de radiothérapie, Institut de cancérologie de la Loire Lucien-Neuwirth, 108, bis, avenue Albert-Raimond, 42270 Saint-Priest-en-Jarez, France
| | - M Y He
- Département de radiothérapie, Institut de cancérologie de la Loire Lucien-Neuwirth, 108, bis, avenue Albert-Raimond, 42270 Saint-Priest-en-Jarez, France; Oncology department, Affiliated Hospital of Guizhou Medical University, China
| | - M Baury
- Département de radiothérapie, Institut de cancérologie de la Loire Lucien-Neuwirth, 108, bis, avenue Albert-Raimond, 42270 Saint-Priest-en-Jarez, France
| | - S Sotton
- Département de radiothérapie, Institut de cancérologie de la Loire Lucien-Neuwirth, 108, bis, avenue Albert-Raimond, 42270 Saint-Priest-en-Jarez, France
| | - A Vallard
- Département de radiothérapie, Institut de cancérologie de la Loire Lucien-Neuwirth, 108, bis, avenue Albert-Raimond, 42270 Saint-Priest-en-Jarez, France
| | - S Espenel
- Département de radiothérapie, Institut de cancérologie de la Loire Lucien-Neuwirth, 108, bis, avenue Albert-Raimond, 42270 Saint-Priest-en-Jarez, France
| | - J-B Guy
- Département de radiothérapie, Institut de cancérologie de la Loire Lucien-Neuwirth, 108, bis, avenue Albert-Raimond, 42270 Saint-Priest-en-Jarez, France
| | - É Guillaume
- Département de radiothérapie, Institut de cancérologie de la Loire Lucien-Neuwirth, 108, bis, avenue Albert-Raimond, 42270 Saint-Priest-en-Jarez, France
| | - N Vial
- Département de radiothérapie, Institut de cancérologie de la Loire Lucien-Neuwirth, 108, bis, avenue Albert-Raimond, 42270 Saint-Priest-en-Jarez, France
| | - N Magné
- Département de radiothérapie, Institut de cancérologie de la Loire Lucien-Neuwirth, 108, bis, avenue Albert-Raimond, 42270 Saint-Priest-en-Jarez, France
| | - A Rehailia-Blanchard
- Département de radiothérapie, Institut de cancérologie de la Loire Lucien-Neuwirth, 108, bis, avenue Albert-Raimond, 42270 Saint-Priest-en-Jarez, France.
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16
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Both four-dimensional computed tomography and four-dimensional cone beam computed tomography under-predict lung target motion during radiotherapy. Radiother Oncol 2019; 135:65-73. [DOI: 10.1016/j.radonc.2019.02.019] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 02/21/2019] [Accepted: 02/24/2019] [Indexed: 12/25/2022]
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Rouabhi O, Gross B, Bayouth J, Xia J. The Dosimetric and Temporal Effects of Respiratory-Gated, High-Dose-Rate Radiation Therapy in Patients With Lung Cancer. Technol Cancer Res Treat 2019; 18:1533033818816072. [PMID: 30803374 PMCID: PMC6313263 DOI: 10.1177/1533033818816072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Purpose: To evaluate the dosimetric and temporal effects of high-dose-rate respiratory-gated
radiation therapy in patients with lung cancer. Methods: Treatment plans from 5 patients with lung cancer (3 nongated and 2 gated at 80EX-80IN)
were retrospectively evaluated. Prescription dose for these patients varied from 8 to 18
Gy/fraction with 3 to 5 treatment fractions. Using the same treatment planning criteria,
4 new treatment plans, corresponding to 4 gating windows (20EX-20IN, 40EX-40IN,
60EX-60IN, and 80EX-80IN), were generated for each patient. Mean tumor dose, mean lung
dose, and lung V20 were used to assess the dosimetric effects. A MATLAB algorithm was
developed to compute treatment time. Results: Mean lung dose and lung V20 were on average reduced between −16.1% to −6.0% and −20.0%
to −7.2%, respectively, for gated plans when compared to the corresponding nongated
plans, and between −5.8% to −4.2% and −7.0% to −5.4%, respectively, for plans with
smaller gating windows when compared to the corresponding plans gated at 80EX-80IN.
Treatment delivery times of gated plans using high-dose rate were reduced on average
between −19.7% (−0.10 min/100 MU) and −27.2% (−0.13 min/100 MU) for original nongated
plans and −15.6% (−0.15 min/100 MU) and −20.3% (−0.19 min/100 MU) for original
80EX-80IN-gated plans. Conclusion: Respiratory-gated radiation therapy in patients with lung cancer can reduce lung dose
while maintaining tumor dose. Because treatment delivery during gated therapy is
discontinuous, total treatment time may be prolonged. However, this increase in
treatment time can be offset by increasing the dose delivery rate. Estimation of
treatment time may be helpful in selecting patients for respiratory gating and choosing
appropriate gating windows.
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Affiliation(s)
- Ouided Rouabhi
- 1 Department of Radiation Oncology, University of Iowa, Iowa, IA, USA
| | - Brandie Gross
- 1 Department of Radiation Oncology, University of Iowa, Iowa, IA, USA
| | - John Bayouth
- 1 Department of Radiation Oncology, University of Iowa, Iowa, IA, USA.,2 Department of Human Oncology, University of Wisconsin-Madison, Madison, WI, USA
| | - Junyi Xia
- 1 Department of Radiation Oncology, University of Iowa, Iowa, IA, USA
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Van Ooteghem G, Dasnoy-Sumell D, Lambrecht M, Reychler G, Liistro G, Sterpin E, Geets X. Mechanically-assisted non-invasive ventilation: A step forward to modulate and to improve the reproducibility of breathing-related motion in radiation therapy. Radiother Oncol 2019; 133:132-139. [PMID: 30935569 DOI: 10.1016/j.radonc.2018.12.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 12/27/2018] [Accepted: 12/27/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE When using highly conformal radiotherapy techniques, a stabilized breathing pattern could greatly benefit the treatment of mobile tumours. Therefore, we assessed the feasibility of Mechanically-assisted non-invasive ventilation (MANIV) on unsedated volunteers, and its ability to stabilize and modulate the breathing pattern over time. MATERIALS AND METHODS Twelve healthy volunteers underwent 2 sessions of dynamic MRI under 4 ventilation modes: spontaneous breathing (SP), volume-controlled mode (VC) that imposes regular breathing in physiologic conditions, shallow-controlled mode (SH) that intends to lower amplitudes while increasing the breathing rate, and slow-controlled mode (SL) that mimics end-inspiratory breath-holds. The last 3 modes were achieved under respirator without sedation. The motion of the diaphragm was tracked along the breathing cycles on MRI images and expressed in position, breathing amplitude, and breathing period for intra- and inter-session analyses. In addition, end-inspiratory breath-hold duration and position stability were analysed during the SL mode. RESULTS MANIV was well-tolerated by all volunteers, without adverse event. The MRI environment led to more discomfort than MANIV itself. Compared to SP, VC and SH modes improved the inter-session reproducibility of the amplitude (by 43% and 47% respectively) and significantly stabilized the intra- and inter-session breathing rate (p < 0.001). Compared to VC, SH mode significantly reduced the intra-session mean amplitude (36%) (p < 0.002), its variability (42%) (p < 0.001), and the intra-session baseline shift (26%) (p < 0.001). The SL mode achieved end-inspiratory plateaus lasting more than 10 s. CONCLUSION MANIV offers exciting perspectives for motion management. It improves its intra- and inter-session reproducibility and should facilitate respiratory tracking, gating or margin techniques for both photon and proton treatments.
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Affiliation(s)
- Geneviève Van Ooteghem
- Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique (IREC), Molecular Imaging, Radiotherapy and Oncology (MIRO), Brussels, Belgium; Cliniques Universitaires Saint Luc, Department of Radiation Oncology, Brussels, Belgium.
| | - Damien Dasnoy-Sumell
- Université Catholique de Louvain, ImagX-R, Institute of Information and Communication Technologies, Electronics and Applied Mathematics, Louvain-La-Neuve, Belgium.
| | - Maarten Lambrecht
- University Hospitals Leuven Gasthuisberg, Department of Radiation Oncology, Leuven, Belgium; Katholieke Universiteit Leuven, Department of Oncology, Laboratory of Experimental Radiotherapy, Leuven, Belgium.
| | - Grégory Reychler
- Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ENT & Dermatologie, Brussels, Belgium.
| | - Giuseppe Liistro
- Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ENT & Dermatologie, Brussels, Belgium.
| | - Edmond Sterpin
- Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique (IREC), Molecular Imaging, Radiotherapy and Oncology (MIRO), Brussels, Belgium; Katholieke Universiteit Leuven, Department of Oncology, Laboratory of Experimental Radiotherapy, Leuven, Belgium.
| | - Xavier Geets
- Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique (IREC), Molecular Imaging, Radiotherapy and Oncology (MIRO), Brussels, Belgium; Cliniques Universitaires Saint Luc, Department of Radiation Oncology, Brussels, Belgium.
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Liu G, Hu F, Ding X, Li X, Shao Q, Wang Y, Yang J, Quan H. Simulation of dosimetry impact of 4DCT uncertainty in 4D dose calculation for lung SBRT. Radiat Oncol 2019; 14:1. [PMID: 30621744 PMCID: PMC6323842 DOI: 10.1186/s13014-018-1191-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 11/21/2018] [Indexed: 11/10/2022] Open
Abstract
Background Due to the heterogeneity of patient’s individual respiratory motion pattern in lung stereotactic body radiotherapy (SBRT), treatment planning dose assessment using a traditional four-dimensional computed tomography (4DCT_traditional) images based on a uniform breathing curve may not represent the true treatment dose delivered to the patient. The purpose of this study was to evaluate the accumulated dose discrepancy between based on the 4DCT_traditional and true 4DCT (4DCT_true) that incorporated with the patient’s real entire breathing motion. The study also explored a novel 4D robust planning strategy to compensate for such heterogeneity respiratory motion uncertainties. Methods Simulated and measured patient specific breathing curves were used to generate 4D targets motion CT images. Volumetric-modulated arc therapy (VMAT) was planned using two arcs. Accumulated dose was obtained by recalculating the plan dose on each individual phase image and then deformed the dose from each phase image to the reference image. The “4 D dose” (D4D) and “true dose” (Dtrue) were the accumulated dose based on the 4DCT_traditional and 4DCT_true respectively. The average worse case dose discrepancy (\documentclass[12pt]{minimal}
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\begin{document}$$ \overline{\Delta D} $$\end{document}ΔD¯) between D4D and Dtrue in all treatment fraction was calculated to evaluate dosimetric /planning parameters and correlate them with the heterogeneity of respiratory-induced motion patterns. A novel 4D robust optimization strategy for VMAT (4D Ro-VMAT) based on the probability density function(pdf) of breathing curve was proposed to improve the target coverage in the presence of heterogeneity respiratory motion. The data were assessed with a paired t-tests. Results With increasing breathing amplitude from 5 to 20 mm, target \documentclass[12pt]{minimal}
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\begin{document}$$ \overline{\Delta {D}_{99}} $$\end{document}ΔD99¯, \documentclass[12pt]{minimal}
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\begin{document}$$ \overline{\Delta {D}_{95}} $$\end{document}ΔD95¯ increased from 1.59,1.39 to 10.15%,8.66% respectively. When the standard deviation of breathing amplitude increased from 15 to 35% of the mean amplitude, \documentclass[12pt]{minimal}
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\begin{document}$$ \overline{\Delta {D}_{95}} $$\end{document}ΔD95¯ increased from 4.06,3.48 to 10.25%,6.63% respectively. The 4D Ro-VMAT plan significantly improve the target dose compared to VMAT plan. Conclusion When the breathing curve amplitude is more than 10 mm and standard deviation of amplitude is higher than 25% of mean amplitude, special care is needed to choose an appropriated dose accumulation approach to evaluate lung SBRT plan target coverage robustness. The proposed 4D Ro_VMAT strategy based on the pdf of patient specific breathing curve could effectively compensate such uncertainties.
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Affiliation(s)
- Gang Liu
- Key Laboratory of Artificial Micro- and Nano- structures of Ministry of Education and Center for Electronic Microscopy, School of Physics and Technology, Wuhan University, Wuhan, 430072, China.,Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Fala Hu
- School of Mathematics and Statistics, Wuhan University, Wuhan, 430072, China
| | - Xuanfeng Ding
- Proton Therapy Center Beaumont Health, Royal Oak, MI, 48074, USA
| | - Xiaoqiang Li
- Proton Therapy Center Beaumont Health, Royal Oak, MI, 48074, USA
| | - Qihong Shao
- Wuhan Zhongyuan Electronics Group Co. LTD, Wuhan, 430205, China
| | - Yuenan Wang
- Cancer Hospital Chinese Academy of Medical Sciences, Shenzhen Center, Shenzhen, 518000, China
| | - Jing Yang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Hong Quan
- Key Laboratory of Artificial Micro- and Nano- structures of Ministry of Education and Center for Electronic Microscopy, School of Physics and Technology, Wuhan University, Wuhan, 430072, China.
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Shepherd A, James SS, Rengan R. The Practicality of ICRU and Considerations for Future ICRU Definitions. Semin Radiat Oncol 2018; 28:201-206. [PMID: 29933880 DOI: 10.1016/j.semradonc.2018.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The International Commission on Radiation Units and Measurements (ICRU) volumes are standardized volume definitions used in radiation oncology practice that have evolved over time to account for advancements in technology and radiation planning. The current definitions have strengths but also practical limitations. The main limitation is related to the process of accounting for tumor motion during treatment. As radiotherapeutic techniques become more precise, motion interplay effects and anatomical changes during treatment must be taken into account to ensure accurate and safe delivery of treatment. Adaptive replanning can help to mitigate the effect of these uncertainties and widen the therapeutic ratio by maximizing dose to the tumor and protecting critical normal structures. As adaptive replanning becomes more common, standardization of how adaptive therapy is implemented and reported will become necessary.
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Affiliation(s)
- Annemarie Shepherd
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY.
| | - Sara St James
- Department of Radiation Oncology, University of Washington, Seattle, WA
| | - Ramesh Rengan
- Department of Radiation Oncology, University of Washington, Seattle, WA
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21
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Huijskens SC, van Dijk IWEM, Visser J, Balgobind BV, Rasch CRN, Alderliesten T, Bel A. Predictive value of pediatric respiratory-induced diaphragm motion quantified using pre-treatment 4DCT and CBCTs. Radiat Oncol 2018; 13:198. [PMID: 30305118 PMCID: PMC6180457 DOI: 10.1186/s13014-018-1143-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 09/30/2018] [Indexed: 12/25/2022] Open
Abstract
Background In adults, a single pre-treatment four-dimensional CT (4D-CT) acquisition is often used to account for respiratory-induced target motion during radiotherapy. However, studies have indicated that a 4D-CT is not always representative for respiratory motion. Our aim was to investigate whether respiratory-induced diaphragm motion in children on a single pre-treatment 4DCT can accurately predict respiratory-induced diaphragm motion as observed on cone beam CTs (CBCTs). Methods Twelve patients (mean age 14.5 yrs.; range 8.6–17.9 yrs) were retrospectively included based on visibility of the diaphragm on abdominal or thoracic imaging data acquired during free breathing. A 4DCT for planning purposes and daily/weekly CBCTs (total 125; range 4–29 per patient) acquired prior to dose delivery were available. The amplitude, corresponding to the difference in position of the diaphragm in cranial-caudal direction in end-inspiration and end-expiration phases, was extracted from the 4DCT (A4DCT). The amplitude in CBCTs (ACBCT) was defined as displacement between averaged in- and expiration diaphragm positions on corresponding projection images, and the distribution of ACBCT was compared to A4DCT (one-sample t-test, significance level p < 0.05). Results Over all patients, the mean A4DCT was 10.4 mm and the mean ACBCT 11.6 mm. For 9/12 patients, A4DCT differed significantly (p < 0.05) from ACBCT. Differences > 3 mm were found in 69/125 CBCTs (55%), with A4DCT mostly underestimating ACBCT. For 7/12 patients, diaphragm positions differed significantly from the baseline position. Conclusion Respiratory-induced diaphragm motion determined on 4DCT does not accurately predict the daily respiratory-induced diaphragm motion observed on CBCTs, as the amplitude and baseline position differed statistically significantly in the majority of patients. Regular monitoring of respiratory motion during the treatment course using CBCTs could yield a higher accuracy when a daily adaptation to the actual breathing amplitude takes place. Electronic supplementary material The online version of this article (10.1186/s13014-018-1143-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sophie C Huijskens
- Department of Radiation Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Office Z1-217, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands.
| | - Irma W E M van Dijk
- Department of Radiation Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Office Z1-217, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Jorrit Visser
- Department of Radiation Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Office Z1-217, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Brian V Balgobind
- Department of Radiation Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Office Z1-217, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Coen R N Rasch
- Department of Radiation Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Office Z1-217, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Tanja Alderliesten
- Department of Radiation Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Office Z1-217, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Arjan Bel
- Department of Radiation Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Office Z1-217, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
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22
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Wang X, Wang JZ, Li JB, Zhang YJ, Li FX, Wang W, Guo YL, Shao Q, Xu M, Liu XJ, Wang Y. Changes in cardiac volume determined with repeated enhanced 4DCT during chemoradiotherapy for esophageal cancer. Radiat Oncol 2018; 13:181. [PMID: 30227865 PMCID: PMC6145198 DOI: 10.1186/s13014-018-1121-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 08/30/2018] [Indexed: 12/25/2022] Open
Abstract
Background Concurrent chemoradiotherapy is considered curative intent treatment for patients with non-operative esophageal cancer. Radiation-induced heart damage receives much attention. We performed repeated four-dimensional computed tomography (4DCT) to detect changes in cardiac volume during radiotherapy for esophageal cancer patients, and explored potential factors responsible for those changes. Methods Forty-six patients with esophageal cancer underwent enhanced 4DCT and three-dimensional (3D) CT scans before radiotherapy and every 10 fractions during treatment. The heart was contoured on 3DCT images, 4DCT end expiratory (EE) images and 4DCT maximum intensity projection (MIP) images by the same radiation oncologist. Heart volumes and other relative parameters were compared by the SPSS software package, version 19.0. Results Compared with its initial value, heart volume was smaller at the 10th fraction (reduction = 3.27%, 4.45% and 4.52% on 3DCT, EE and MIP images, respectively, p < 0.05) and the 20th fraction (reduction = 6.05%, 5.64% and 4.51% on 3DCT, EE and MIP images, respectively, p < 0.05), but not at the 30th fraction. Systolic and diastolic blood pressures were reduced (by 16.95 ± 16.69 mmHg and 7.14 ± 11.64 mmHg, respectively, both p < 0.05) and the heart rate was elevated by 5.27 ± 6.25 beats/min (p < 0.05) after radiotherapy. None of the potential explanatory variables correlated with heart volume changes. Conclusions Cardiac volume reduced significantly from an early treatment stage and maintained the reduction until the middle stage. The heart volume changes observed on 3DCT and 4DCT were consistent during radiotherapy. The changes in heart volume, blood pressure and heart rate may be valuable indicators of cardiac impairment and target dose changes.
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Affiliation(s)
- Xue Wang
- School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan, Shandong Province, China.,Department of Thoracic Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Sciences, No. 440 Jiyan Road, Jinan, 250117, Shandong Province, China
| | - Jin-Zhi Wang
- Department of Thoracic Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Sciences, No. 440 Jiyan Road, Jinan, 250117, Shandong Province, China.
| | - Jian-Bin Li
- Department of Thoracic Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Sciences, No. 440 Jiyan Road, Jinan, 250117, Shandong Province, China.
| | - Ying-Jie Zhang
- Department of Thoracic Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Sciences, No. 440 Jiyan Road, Jinan, 250117, Shandong Province, China
| | - Feng-Xiang Li
- Department of Thoracic Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Sciences, No. 440 Jiyan Road, Jinan, 250117, Shandong Province, China
| | - Wei Wang
- Department of Thoracic Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Sciences, No. 440 Jiyan Road, Jinan, 250117, Shandong Province, China
| | - Yan-Luan Guo
- Department of PET-CT Room, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, Shandong Province, China
| | - Qian Shao
- Department of Thoracic Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Sciences, No. 440 Jiyan Road, Jinan, 250117, Shandong Province, China
| | - Min Xu
- Department of Thoracic Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Sciences, No. 440 Jiyan Road, Jinan, 250117, Shandong Province, China
| | - Xi-Jun Liu
- Department of Thoracic Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Sciences, No. 440 Jiyan Road, Jinan, 250117, Shandong Province, China
| | - Yue Wang
- Medical imaging department, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, Shandong Province, China
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23
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Cusumano D, Dhont J, Boldrini L, Chiloiro G, Teodoli S, Massaccesi M, Fionda B, Cellini F, Azario L, Vandemeulebroucke J, De Spirito M, Valentini V, Verellen D. Predicting tumour motion during the whole radiotherapy treatment: a systematic approach for thoracic and abdominal lesions based on real time MR. Radiother Oncol 2018; 129:456-462. [PMID: 30144955 DOI: 10.1016/j.radonc.2018.07.025] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 07/06/2018] [Accepted: 07/29/2018] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Aim of this study was to investigate the ability of pre-treatment four dimensional computed tomography (4DCT) to capture respiratory-motion observed in thoracic and abdominal lesions during treatment. Treatment motion was acquired using full-treatment cine-MR acquisitions. Results of this analysis were compared to the ability of 30 seconds (s) cine Magnetic Resonance (MR) to estimate the same parameters. METHODS A 4DCT and 30 s cine-MR (ViewRay, USA) were acquired on the simulation day for 7 thoracic and 13 abdominal lesions. Mean amplitude, intra- and inter-fraction amplitude variability, and baseline drift were extracted from the full treatment data acquired by 2D cine-MR, and correlated to the motion on pre-treatment 30 s cine-MR and 4DCT. Using the full treatment data, safety margins on the ITV, necessary to account for all motion variability from 4DCT observed during treatment, were calculated. Mean treatment amplitudes were 2 ± 1 mm and 5 ± 3 mm in the anteroposterior (AP) and craniocaudal (CC) direction, respectively. Differences between mean amplitude during treatment and amplitude on 4DCT or during 30 s cine-MR were not significant, but 30 s cine-MR was more accurate than 4DCT. Intra-fraction amplitude variability was positively correlated with both 30 s cine-MR and 4DCT amplitude. Inter-fraction amplitude variability was minimal. RESULTS Mean baseline drift over all fractions and patients equalled 1 ± 1 mm in both CC and AP direction, but drifts per fraction up to 16 mm (CC) and 12 mm (AP) were observed. Margins necessary on the ITV ranged from 0 to 8 mm in CC and 0 to 5 mm in AP direction. Neither amplitude on 4DCT nor during 30 s cine MR is correlated to the magnitude of drift or the necessary margins in both directions. CONCLUSION Lesions moving with small amplitude show limited amplitude variability throughout treatment, making passive motion management strategies seem adequate. However, other variations such as baseline drifts and shifts still cause significant geometrical uncertainty, favouring real-time monitoring and an active approach for all lesions influenced by respiratory motion.
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Affiliation(s)
- Davide Cusumano
- U.O.C. Fisica Sanitaria, Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Roma, Italia; Istituto di Radiologia, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Jennifer Dhont
- Vrije Universiteit Brussel (VUB), Faculty of Medicine and Pharmacy, Pleinlaan 2, B-1050 Brussels, Belgium; Vrije Universiteit Brussel (VUB), Department of Electronics and Informatics (ETRO), Pleinlaan 2, B-1050 Brussels, Belgium; imec, Kapeldreef 75, B-3001 Leuven, Belgium
| | - Luca Boldrini
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Roma, Italia.
| | - Giuditta Chiloiro
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Roma, Italia; U.O.C. Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Roma, Italia
| | - Stefania Teodoli
- U.O.C. Fisica Sanitaria, Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Roma, Italia
| | - Mariangela Massaccesi
- U.O.C. Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Roma, Italia
| | - Bruno Fionda
- U.O.C. Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Roma, Italia
| | - Francesco Cellini
- U.O.C. Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Roma, Italia
| | - Luigi Azario
- U.O.C. Fisica Sanitaria, Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Roma, Italia; Istituto di Fisica, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Jef Vandemeulebroucke
- Vrije Universiteit Brussel (VUB), Department of Electronics and Informatics (ETRO), Pleinlaan 2, B-1050 Brussels, Belgium; imec, Kapeldreef 75, B-3001 Leuven, Belgium
| | - Marco De Spirito
- U.O.C. Fisica Sanitaria, Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Roma, Italia; Istituto di Fisica, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Vincenzo Valentini
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Roma, Italia; U.O.C. Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Roma, Italia
| | - Dirk Verellen
- Vrije Universiteit Brussel (VUB), Faculty of Medicine and Pharmacy, Pleinlaan 2, B-1050 Brussels, Belgium; Department of Radiotherapy, GZA Ziekenhuizen - Sint Augustinus, Iridium Kankernetwerk, Antwerp, Belgium
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Wohlfahrt P, Troost EGC, Hofmann C, Richter C, Jakobi A. Clinical Feasibility of Single-Source Dual-spiral 4D Dual-Energy CT for Proton Treatment Planning Within the Thoracic Region. Int J Radiat Oncol Biol Phys 2018; 102:830-840. [PMID: 30003998 DOI: 10.1016/j.ijrobp.2018.06.044] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 06/17/2018] [Accepted: 06/27/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE Single-source dual-spiral dual-energy computed tomography (DECT) provides additional patient information but is prone to motion between the 2 consecutively acquired computed tomography (CT) scans. Here, the clinical applicability of dual-spiral time-resolved DECT (4D-DECT) for proton treatment planning within the thoracic region was evaluated. METHODS AND MATERIALS Dual-spiral 4D-DECT scans of 3 patients with lung cancer were acquired. For time-averaged datasets and 4 breathing phases, the geometric conformity of 80 kVp and 140 kVp 4D-DECT scans before image post-processing was assessed by normalized cross correlation (NCC). Additionally, the conformity of the corresponding DECT-derived 58 keV and 79 keV pseudo-monoenergetic CT datasets after image post-processing, including deformable image registration (DIR), was determined. To analyze the reliability of proton dose calculation, clinical (PlanClin) and artificial worst-case (PlanWorstCase, targeting the diaphragm) treatment plans were calculated on 140 kVp and 79 keV datasets and compared with gamma analyses (0.1% dose-difference and 1 mm distance-to-agreement criterion). The applicability of a patient-specific DECT-based prediction of stopping-power ratio (SPR) was investigated and proton range shifts compared with the clinical heuristic CT-number-to-SPR conversion were assessed. Finally, the delineation variability of an experienced radiation oncologist was quantified. RESULTS Dual-spiral 4D-DECT scans without DIR showed a high geometric conformity, with an average NCC ± standard deviation of 98.7% ± 1.0% when including all patient voxels or 88.2% ± 7.8% when considering only lung. DIR improved the conformity, leading to an average NCC of 99.9% ± 0.1% and 99.6% ± 0.5%, respectively. PlanClin dose distributions on 140 kVp and 79 keV datasets were similar, with an average gamma passing rate of 99.9% (99.2%-100%). The worst-case evaluation still revealed high passing rates (99.3% on average, 92.4% as minimum). Clinically relevant mean range shifts of 2.2% ± 1.2% were determined between patient-specific DECT-based SPR prediction and clinical heuristic CT-number-to-SPR conversion. The intra-observer delineation variability was slightly reduced using additional DECT-derived datasets. CONCLUSIONS The 79 keV pseudo-monoenergetic CT datasets can be consistently obtained from dual-spiral 4D-DECT and are applicable for dose calculation. Patient-specific DECT-based SPR prediction performed well and potentially reduces range uncertainty in proton therapy of patients with lung cancer.
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Affiliation(s)
- Patrick Wohlfahrt
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany; Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiooncology - OncoRay, Dresden, Germany.
| | - Esther G C Troost
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany; Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiooncology - OncoRay, Dresden, Germany; Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; National Center for Tumor Diseases (NCT), Partner Site Dresden, Germany; German Cancer Consortium (DKTK), Partner Site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Christian Richter
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany; Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiooncology - OncoRay, Dresden, Germany; Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; German Cancer Consortium (DKTK), Partner Site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Annika Jakobi
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany; Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiooncology - OncoRay, Dresden, Germany; Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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Hegi F, D'Souza M, Azzi M, De Ruysscher D. Comparing the Outcomes of Stereotactic Ablative Radiotherapy and Non-Stereotactic Ablative Radiotherapy Definitive Radiotherapy Approaches to Thoracic Malignancy: A Systematic Review and Meta-Analysis. Clin Lung Cancer 2018; 19:199-212. [DOI: 10.1016/j.cllc.2017.11.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 11/09/2017] [Accepted: 11/17/2017] [Indexed: 12/25/2022]
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The long- and short-term variability of breathing induced tumor motion in lung and liver over the course of a radiotherapy treatment. Radiother Oncol 2018; 126:339-346. [DOI: 10.1016/j.radonc.2017.09.001] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 09/01/2017] [Accepted: 09/03/2017] [Indexed: 11/19/2022]
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Barrett S. On-Treatment Verification for Lung Stereotactic Ablative Radiation Therapy. J Med Imaging Radiat Sci 2017; 48:343-345. [PMID: 31047468 DOI: 10.1016/j.jmir.2017.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 09/12/2017] [Accepted: 09/12/2017] [Indexed: 12/25/2022]
Affiliation(s)
- Sarah Barrett
- Applied Radiation Therapy Trinity Research Group, Trinity College Dublin, The University of Dublin, Dublin 8, Ireland.
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Comparison of lung tumor motion measured using a model-based 4DCT technique and a commercial protocol. Pract Radiat Oncol 2017; 8:e175-e183. [PMID: 29429921 DOI: 10.1016/j.prro.2017.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 10/28/2017] [Accepted: 11/08/2017] [Indexed: 11/22/2022]
Abstract
PURPOSE To compare lung tumor motion measured with a model-based technique to commercial 4-dimensional computed tomography (4DCT) scans and describe a workflow for using model-based 4DCT as a clinical simulation protocol. METHODS AND MATERIALS Twenty patients were imaged using a model-based technique and commercial 4DCT. Tumor motion was measured on each commercial 4DCT dataset and was calculated on model-based datasets for 3 breathing amplitude percentile intervals: 5th to 85th, 5th to 95th, and 0th to 100th. Internal target volumes (ITVs) were defined on the 4DCT and 5th to 85th interval datasets and compared using Dice similarity. Images were evaluated for noise and rated by 2 radiation oncologists for artifacts. RESULTS Mean differences in tumor motion magnitude between commercial and model-based images were 0.47 ± 3.0, 1.63 ± 3.17, and 5.16 ± 4.90 mm for the 5th to 85th, 5th to 95th, and 0th to 100th amplitude intervals, respectively. Dice coefficients between ITVs defined on commercial and 5th to 85th model-based images had a mean value of 0.77 ± 0.09. Single standard deviation image noise was 11.6 ± 9.6 HU in the liver and 6.8 ± 4.7 HU in the aorta for the model-based images compared with 57.7 ± 30 and 33.7 ± 15.4 for commercial 4DCT. Mean model error within the ITV regions was 1.71 ± 0.81 mm. Model-based images exhibited reduced presence of artifacts at the tumor compared with commercial images. CONCLUSION Tumor motion measured with the model-based technique using the 5th to 85th percentile breathing amplitude interval corresponded more closely to commercial 4DCT than the 5th to 95th or 0th to 100th intervals, which showed greater motion on average. The model-based technique tended to display increased tumor motion when breathing amplitude intervals wider than 5th to 85th were used because of the influence of unusually deep inhalations. These results suggest that care must be taken in selecting the appropriate interval during image generation when using model-based 4DCT methods.
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Sloth Møller D, Knap MM, Nyeng TB, Khalil AA, Holt MI, Kandi M, Hoffmann L. Difference in target definition using three different methods to include respiratory motion in radiotherapy of lung cancer. Acta Oncol 2017; 56:1604-1609. [PMID: 28885090 DOI: 10.1080/0284186x.2017.1373848] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Minimizing the planning target volume (PTV) while ensuring sufficient target coverage during the entire respiratory cycle is essential for free-breathing radiotherapy of lung cancer. Different methods are used to incorporate the respiratory motion into the PTV. MATERIAL AND METHODS Fifteen patients were analyzed. Respiration can be included in the target delineation process creating a respiratory GTV, denoted iGTV. Alternatively, the respiratory amplitude (A) can be measured based on the 4D-CT and A can be incorporated in the margin expansion. The GTV expanded by A yielded GTV + resp, which was compared to iGTV in terms of overlap. Three methods for PTV generation were compared. PTVdel (delineated iGTV expanded to CTV plus PTV margin), PTVσ (GTV expanded to CTV and A was included as a random uncertainty in the CTV to PTV margin) and PTV∑ (GTV expanded to CTV, succeeded by CTV linear expansion by A to CTV + resp, which was finally expanded to PTV∑). RESULTS Deformation of tumor and lymph nodes during respiration resulted in volume changes between the respiratory phases. The overlap between iGTV and GTV + resp showed that on average 7% of iGTV was outside the GTV + resp implying that GTV + resp did not capture the tumor during the full deformable respiration cycle. A comparison of the PTV volumes showed that PTVσ was smallest and PTVΣ largest for all patients. PTVσ was in mean 14% (31 cm3) smaller than PTVdel, while PTVdel was 7% (20 cm3) smaller than PTVΣ. CONCLUSIONS PTVσ yields the smallest volumes but does not ensure coverage of tumor during the full respiratory motion due to tumor deformation. Incorporating the respiratory motion in the delineation (PTVdel) takes into account the entire respiratory cycle including deformation, but at the cost, however, of larger treatment volumes. PTVΣ should not be used, since it incorporates the disadvantages of both PTVdel and PTVσ.
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Affiliation(s)
- Ditte Sloth Møller
- Department of Medical Physics, Aarhus University Hospital, Aarhus C, Denmark
| | | | - Tine Bisballe Nyeng
- Department of Medical Physics, Aarhus University Hospital, Aarhus C, Denmark
| | - Azza Ahmed Khalil
- Department of Oncology, Aarhus University Hospital, Aarhus C, Denmark
| | | | - Maria Kandi
- Department of Oncology, Aarhus University Hospital, Aarhus C, Denmark
| | - Lone Hoffmann
- Department of Medical Physics, Aarhus University Hospital, Aarhus C, Denmark
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Motion monitoring during a course of lung radiotherapy with anchored electromagnetic transponders : Quantification of inter- and intrafraction motion and variability of relative transponder positions. Strahlenther Onkol 2017; 193:840-847. [PMID: 28733724 PMCID: PMC5614910 DOI: 10.1007/s00066-017-1183-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 06/30/2017] [Indexed: 11/14/2022]
Abstract
Purpose Anchored electromagnetic transponders for tumor motion monitoring during lung radiotherapy were clinically evaluated. First, intrafractional motion patterns were analyzed as well as their interfractional variations. Second, intra- and interfractional changes of the geometric transponder positions were investigated. Materials and methods Intrafractional motion data from 7 patients with an upper or middle lobe tumor and three implanted transponders each was used to calculate breathing amplitudes, overall motion amount and motion midlines in three mutual perpendicular directions and three-dimensionally (3D) for 162 fractions. For 6 patients intra- and interfractional variations in transponder distances and in the size of the triangle defined by the transponder locations over the treatment course were determined. Results Mean 3D values of all fractions were up to 4.0, 4.6 and 3.4 mm per patient for amplitude, overall motion amount and midline deviation, respectively. Intrafractional transponder distances varied with standard deviations up to 3.2 mm, while a maximal triangle shrinkage of 36.5% over 39 days was observed. Conclusions Electromagnetic real-time motion monitoring was feasible for all patients. Detected respiratory motion was on average modest in this small cohort without lower lobe tumors, but changes in motion midline were of the same size as the amplitudes and greater midline motion can be observed in some fractions. Intra- and interfractional variations of the geometric transponder positions can be large, so for reliable motion management correlation between transponder and tumor motion needs to be evaluated per patient. Electronic supplementary material The online version of this article (doi: 10.1007/s00066-017-1183-0) contains supplementary material, which is available to authorized users.
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Jin P, Hulshof MC, van Wieringen N, Bel A, Alderliesten T. Interfractional variability of respiration-induced esophageal tumor motion quantified using fiducial markers and four-dimensional cone-beam computed tomography. Radiother Oncol 2017; 124:147-154. [DOI: 10.1016/j.radonc.2017.05.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 05/18/2017] [Accepted: 05/21/2017] [Indexed: 01/25/2023]
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Yoganathan SA, Maria Das KJ, Agarwal A, Kumar S. Magnitude, Impact, and Management of Respiration-induced Target Motion in Radiotherapy Treatment: A Comprehensive Review. J Med Phys 2017; 42:101-115. [PMID: 28974854 PMCID: PMC5618455 DOI: 10.4103/jmp.jmp_22_17] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 05/31/2017] [Accepted: 07/11/2017] [Indexed: 12/11/2022] Open
Abstract
Tumors in thoracic and upper abdomen regions such as lungs, liver, pancreas, esophagus, and breast move due to respiration. Respiration-induced motion introduces uncertainties in radiotherapy treatments of these sites and is regarded as a significant bottleneck in achieving highly conformal dose distributions. Recent developments in radiation therapy have resulted in (i) motion-encompassing, (ii) respiratory gating, and (iii) tracking methods for adapting the radiation beam aperture to account for the respiration-induced target motion. The purpose of this review is to discuss the magnitude, impact, and management of respiration-induced tumor motion.
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Affiliation(s)
- S. A. Yoganathan
- Department of Radiotherapy, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - K. J. Maria Das
- Department of Radiotherapy, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Arpita Agarwal
- Department of Radiotherapy, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Shaleen Kumar
- Department of Radiotherapy, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Schwarz M, Cattaneo GM, Marrazzo L. Geometrical and dosimetrical uncertainties in hypofractionated radiotherapy of the lung: A review. Phys Med 2017; 36:126-139. [DOI: 10.1016/j.ejmp.2017.02.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 12/23/2016] [Accepted: 02/14/2017] [Indexed: 12/25/2022] Open
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Zhang Y, Yang Y, Fu W, Li X, Li T, Heron DE, Huq MS. 4D VMAT planning and verification technique for dynamic tracking using a direct aperture deformation (DAD) method. J Appl Clin Med Phys 2017; 18:50-61. [PMID: 28300367 PMCID: PMC5466079 DOI: 10.1002/acm2.12053] [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: 05/25/2016] [Revised: 12/14/2016] [Accepted: 12/16/2016] [Indexed: 11/16/2022] Open
Abstract
We developed a four‐dimensional volumetric modulated arc therapy (4D VMAT) planning technique for moving targets using a direct aperture deformation (DAD) method and investigated its feasibility for clinical use. A 3D VMAT plan was generated on a reference phase of a 4D CT dataset. The plan was composed of a set of control points including the beam angle, MLC apertures and weights. To generate the 4D VMAT plan, these control points were assigned to the closest respiratory phases using the temporal information of the gantry angle and respiratory curve. Then, a DAD algorithm was used to deform the beam apertures at each control point to the corresponding phase to compensate for the tumor motion and shape changes. Plans for a phantom and five lung cases were included in this study to evaluate the proposed technique. Dosimetric comparisons were performed between 4D and 3D VMAT plans. Plan verification was implemented by delivering the 4D VMAT plans on a moving QUASAR™ phantom driven with patient‐specific respiratory curves. The phantom study showed that the 4D VMAT plan generated with the DAD method was comparable to the ideal 3D VMAT plan. DVH comparisons indicated that the planning target volume (PTV) coverages and minimum doses were nearly invariant, and no significant difference in lung dosimetry was observed. Patient studies revealed that the GTV coverage was nearly the same; although the PTV coverage dropped from 98.8% to 94.7%, and the mean dose decreased from 64.3 to 63.8 Gy on average. For the verification measurements, the average gamma index pass rate was 98.6% and 96.5% for phantom 3D and 4D VMAT plans with 3%/3 mm criteria. For patient plans, the average gamma pass rate was 96.5% (range 94.5–98.5%) and 95.2% (range 94.1–96.1%) for 3D and 4D VMAT plans. The proposed 4D VMAT planning technique using the DAD method is feasible to incorporate the intra‐fraction organ motion and shape change into a 4D VMAT planning. It has great potential to provide high plan quality and delivery efficiency for moving targets.
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Affiliation(s)
- Yongqian Zhang
- Department of Radiation Oncology; University of Pittsburgh Cancer Institute; Pittsburgh PA 15232 USA
| | - Yong Yang
- Department of Radiation Oncology; Stanford University; Stanford CA 94305 USA
| | - Weihua Fu
- Department of Radiation Oncology; University of Pittsburgh Cancer Institute; Pittsburgh PA 15232 USA
| | - Xiang Li
- Department of Radiation Oncology; Memorial Sloan-Kettering Cancer Center; New York NY 10065 USA
| | - Tianfang Li
- Department of Radiation Oncology; Memorial Sloan-Kettering Cancer Center; New York NY 10065 USA
| | - Dwight E. Heron
- Department of Radiation Oncology; University of Pittsburgh Cancer Institute; Pittsburgh PA 15232 USA
| | - M. Saiful. Huq
- Department of Radiation Oncology; University of Pittsburgh Cancer Institute; Pittsburgh PA 15232 USA
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Analysis of Lung Tumor Motion in a Large Sample: Patterns and Factors Influencing Precise Delineation of Internal Target Volume. Int J Radiat Oncol Biol Phys 2016; 96:751-758. [DOI: 10.1016/j.ijrobp.2016.08.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 07/07/2016] [Accepted: 08/10/2016] [Indexed: 12/25/2022]
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Ablative dose proton beam therapy for stage I and recurrent non-small cell lung carcinomas : Ablative dose PBT for NSCLC. Strahlenther Onkol 2016; 192:649-57. [PMID: 27282279 DOI: 10.1007/s00066-016-0985-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 04/21/2016] [Indexed: 12/25/2022]
Abstract
PURPOSE To evaluate the efficacy and safety of ablative dose hypofractionated proton beam therapy (PBT) for patients with stage I and recurrent non-small cell lung carcinoma (NSCLC). PATIENTS AND METHODS A total of 55 patients with stage I (n = 42) and recurrent (n = 13) NSCLC underwent hypofractionated PBT and were retrospectively reviewed. A total dose of 50-72 CGE (cobalt gray equivalent) in 5-12 fractions was delivered. RESULTS The median follow-up duration was 29 months (range 4-95 months). There were 24 deaths (43.6%) during the follow-up period: 11 died of disease progression and 13 from other causes. Kaplan-Meier overall survival rate (OS) at 3 years was 54.9% and the median OS was 48.6 months (range 4-95 months). Local progression was observed in 7 patients and the median time to local progression was 9.3 months (range 5-14 months). Cumulative actuarial local control rate (LCR), lymph node metastasis-free survival, and distant metastasis-free survival rates at 3 years were 85.4, 78.4, and 76.5%, respectively. Larger tumor diameter was significantly associated with poorer LCR (3-year: 94% for ≤3 cm vs. 65% for >3 cm, p = 0.006) on univariate analysis and also an independent prognostic factor for LCR (HR 6.9, 95% CI = 1.3-37.8, p = 0.026) on multivariate analysis. No grade 3 or 4 treatment-related toxicities developed. One grade 5 treatment-related adverse event occurred in a patient with symptomatic idiopathic pulmonary fibrosis. CONCLUSIONS Ablative dose hypofractionated PBT was safe and promising for stage I and recurrent NSCLC.
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Rankine L, Wan H, Parikh P, Maughan N, Poulsen P, DeWees T, Klein E, Santanam L. Cone-Beam Computed Tomography Internal Motion Tracking Should Be Used to Validate 4-Dimensional Computed Tomography for Abdominal Radiation Therapy Patients. Int J Radiat Oncol Biol Phys 2016; 95:818-26. [PMID: 27020102 DOI: 10.1016/j.ijrobp.2016.01.047] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 12/31/2015] [Accepted: 01/27/2016] [Indexed: 11/27/2022]
Abstract
PURPOSE To demonstrate that fiducial tracking during pretreatment Cone-Beam CT (CBCT) can accurately measure tumor motion and that this method should be used to validate 4-dimensional CT (4DCT) margins before each treatment fraction. METHODS AND MATERIALS For 31 patients with abdominal tumors and implanted fiducial markers, tumor motion was measured daily with CBCT and fluoroscopy for 202 treatment fractions. Fiducial tracking and maximum-likelihood algorithms extracted 3-dimensional fiducial trajectories from CBCT projections. The daily internal margin (IM) (ie, range of fiducial motion) was calculated for CBCT and fluoroscopy as the 5th-95th percentiles of displacement in each cardinal direction. The planning IM from simulation 4DCT (IM4DCT) was considered adequate when within ±1.2 mm (anterior-posterior, left-right) and ±3 mm (superior-inferior) of the daily measured IM. We validated CBCT fiducial tracking as an accurate predictive measure of intrafraction motion by comparing the daily measured IMCBCT with the daily IM measured by pretreatment fluoroscopy (IMpre-fluoro); these were compared with pre- and posttreatment fluoroscopy (IMfluoro) to identify those patients who could benefit from imaging during treatment. RESULTS Four-dimensional CT could not accurately predict intrafractional tumor motion for ≥80% of fractions in 94% (IMCBCT), 97% (IMpre-fluoro), and 100% (IMfluoro) of patients. The IMCBCT was significantly closer to IMpre-fluoro than IM4DCT (P<.01). For patients with median treatment time t < 7.5 minutes, IMCBCT was in agreement with IMfluoro for 93% of fractions (superior-inferior), compared with 63% for the t > 7.5 minutes group, demonstrating the need for patient-specific intratreatment imaging. CONCLUSIONS Tumor motion determined from 4DCT simulation does not accurately predict the daily motion observed on CBCT or fluoroscopy. Cone-beam CT could replace fluoroscopy for pretreatment verification of simulation IM4DCT, reducing patient setup time and imaging dose. Patients with treatment time t > 7.5 minutes could benefit from the addition of intratreatment imaging.
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Affiliation(s)
- Leith Rankine
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Hanlin Wan
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Parag Parikh
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Nichole Maughan
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Per Poulsen
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Todd DeWees
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Eric Klein
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Lakshmi Santanam
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri, USA.
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Takao S, Miyamoto N, Matsuura T, Onimaru R, Katoh N, Inoue T, Sutherland KL, Suzuki R, Shirato H, Shimizu S. Intrafractional Baseline Shift or Drift of Lung Tumor Motion During Gated Radiation Therapy With a Real-Time Tumor-Tracking System. Int J Radiat Oncol Biol Phys 2016; 94:172-180. [DOI: 10.1016/j.ijrobp.2015.09.024] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 09/08/2015] [Indexed: 10/23/2022]
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Ueda Y, Oohira S, Isono M, Miyazaki M, Teshima T. Asymmetric margin setting at the cranial and caudal sides in respiratory gated and non-gated stereotactic body radiotherapy for lung cancer. Br J Radiol 2015; 89:20150499. [PMID: 26693594 DOI: 10.1259/bjr.20150499] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To evaluate total errors, including setup errors, and tumour motion changes with a electronic portal imaging device (EPID) cine at the cranial and caudal sides in respiratory gated and non-gated radiotherapy. METHODS Co-ordinates of the tumour centres (TCs) in the craniocaudal direction were obtained by using four-dimensional CT (4DCT) for each bin and EPID cine frame. During the 100% duty cycle (DC100), 50% duty cycle (DC50) and 30% duty cycle (DC30), both centred on the 50 phase, the co-ordinates of the TCs were compared at the most cranial and caudal positions on both 4DCT and EPID cine. RESULTS During DC100, total errors were -0.2 ± 2.1 and 1.1 ± 2.6 mm at the cranial and caudal sides, respectively. During DC50, the corresponding values were -0.2 ± 2.1 and 1.7 ± 3.2 mm, respectively; during DC30, they were -0.1 ± 2.1 and 1.8 ± 2.9 mm, respectively. The tumour motion changes at the caudal side were strongly correlated with tumour motion observed on 4DCT during DC100 (R(2) = 0.59). CONCLUSION Total errors and tumour motion changes on the caudal side were larger than on the cranial side because of the patients' breathing levels. Owing to variations of the TCs at beam-trigger events, the larger margin was required at the caudal side in gated radiotherapy. ADVANCES IN KNOWLEDGE Variations of the TCs were evaluated at the cranial and caudal sides separately. Providing some margins to compensate for tumour motion changes was a significant requirement at the caudal side in gated and non-gated radiotherapy.
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Affiliation(s)
- Yoshihiro Ueda
- 1 Department of Radiation Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.,2 Department of Radiation Oncology, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Shingo Oohira
- 1 Department of Radiation Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.,3 Department of Medical Physics and Engineering, Osaka University Graduate School of Medicine, Suita, Japan
| | - Masaru Isono
- 1 Department of Radiation Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Masayoshi Miyazaki
- 1 Department of Radiation Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Teruki Teshima
- 1 Department of Radiation Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
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Deep Inspiration Breath Hold-Based Radiation Therapy: A Clinical Review. Int J Radiat Oncol Biol Phys 2015; 94:478-92. [PMID: 26867877 DOI: 10.1016/j.ijrobp.2015.11.049] [Citation(s) in RCA: 154] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 11/03/2015] [Accepted: 11/29/2015] [Indexed: 01/06/2023]
Abstract
Several recent developments in linear accelerator-based radiation therapy (RT) such as fast multileaf collimators, accelerated intensity modulation paradigms like volumeric modulated arc therapy and flattening filter-free (FFF) high-dose-rate therapy have dramatically shortened the duration of treatment fractions. Deliverable photon dose distributions have approached physical complexity limits as a consequence of precise dose calculation algorithms and online 3-dimensional image guided patient positioning (image guided RT). Simultaneously, beam quality and treatment speed have continuously been improved in particle beam therapy, especially for scanned particle beams. Applying complex treatment plans with steep dose gradients requires strategies to mitigate and compensate for motion effects in general, particularly breathing motion. Intrafractional breathing-related motion results in uncertainties in dose delivery and thus in target coverage. As a consequence, generous margins have been used, which, in turn, increases exposure to organs at risk. Particle therapy, particularly with scanned beams, poses additional problems such as interplay effects and range uncertainties. Among advanced strategies to compensate breathing motion such as beam gating and tracking, deep inspiration breath hold (DIBH) gating is particularly advantageous in several respects, not only for hypofractionated, high single-dose stereotactic body RT of lung, liver, and upper abdominal lesions but also for normofractionated treatment of thoracic tumors such as lung cancer, mediastinal lymphomas, and breast cancer. This review provides an in-depth discussion of the rationale and technical implementation of DIBH gating for hypofractionated and normofractionated RT of intrathoracic and upper abdominal tumors in photon and proton RT.
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Rouabhi O, Ma M, Bayouth J, Xia J. Impact of temporal probability in 4D dose calculation for lung tumors. J Appl Clin Med Phys 2015; 16:110-118. [PMID: 26699562 PMCID: PMC5691019 DOI: 10.1120/jacmp.v16i6.5517] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 07/05/2015] [Accepted: 07/01/2015] [Indexed: 12/25/2022] Open
Abstract
The purpose of this study was to evaluate the dosimetric uncertainty in 4D dose calculation using three temporal probability distributions: uniform distribution, sinusoidal distribution, and patient‐specific distribution derived from the patient respiratory trace. Temporal probability, defined as the fraction of time a patient spends in each respiratory amplitude, was evaluated in nine lung cancer patients. Four‐dimensional computed tomography (4D CT), along with deformable image registration, was used to compute 4D dose incorporating the patient's respiratory motion. First, the dose of each of 10 phase CTs was computed using the same planning parameters as those used in 3D treatment planning based on the breath‐hold CT. Next, deformable image registration was used to deform the dose of each phase CT to the breath‐hold CT using the deformation map between the phase CT and the breath‐hold CT. Finally, the 4D dose was computed by summing the deformed phase doses using their corresponding temporal probabilities. In this study, 4D dose calculated from the patient‐specific temporal probability distribution was used as the ground truth. The dosimetric evaluation matrix included: 1) 3D gamma analysis, 2) mean tumor dose (MTD), 3) mean lung dose (MLD), and 4) lung V20. For seven out of nine patients, both uniform and sinusoidal temporal probability dose distributions were found to have an average gamma passing rate >95% for both the lung and PTV regions. Compared with 4D dose calculated using the patient respiratory trace, doses using uniform and sinusoidal distribution showed a percentage difference on average of −0.1%±0.6% and −0.2%±0.4% in MTD, −0.2%±1.9% and −0.2%±1.3% in MLD, 0.09%±2.8% and −0.07%±1.8% in lung V20, −0.1%±2.0% and 0.08%±1.34% in lung V10, 0.47%±1.8% and 0.19%±1.3% in lung V5, respectively. We concluded that four‐dimensional dose computed using either a uniform or sinusoidal temporal probability distribution can approximate four‐dimensional dose computed using the patient‐specific respiratory trace. PACS number: 87.55.D‐
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Lischalk JW, Kole TP, Anjum HM, Obayomi-Davies O, Rashid A, Unger K. Four-dimensional computed tomography prediction of inter- and intrafractional upper gastrointestinal tumor motion during fractionated stereotactic body radiation therapy. Pract Radiat Oncol 2015; 6:176-182. [PMID: 26746816 DOI: 10.1016/j.prro.2015.10.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 09/25/2015] [Accepted: 10/08/2015] [Indexed: 12/25/2022]
Abstract
PURPOSE Respiratory-induced tumor motion of upper gastrointestinal (GI) tumors during radiation therapy is often assessed using a single 4-dimensional computed tomography (4D-CT) and presumed to be representative during fractionated treatment regimens. The purpose of this study was to examine the intra- and interfraction correlations of tumor motion between pretreatment 4D-CT and real-time fiducial-based motion tracking in patients treated with fractionated stereotactic body radiation therapy (SBRT) for upper GI malignancies. METHODS AND MATERIALS Fourteen patients with upper GI tumors underwent fractionated SBRT using the CyberKnife radiosurgical system with Synchrony respiratory motion management. Before treatment, each patient underwent a free-breathing 4D-CT scan and fiducial motion was tracked for each phase of the respiratory cycle. Real-time fiducial positions recorded during delivery of each SBRT fraction were extracted from the CyberKnife planning system. Displacements were compared between those predicted by 4D-CT and those recorded by Synchrony during treatment in the left-right (LR), anteroposterior (AP), and superoinferior (SI) directions. RESULTS The 4D-CT scans demonstrated little correlation with real-time mean fiducial displacement as determined by Pearson correlation with coefficients of 0.45, 0.52, and 0.63 in the SI, AP, and LR directions, respectively. Cohort-averaged maximum fiducial displacements based on 4D-CT and real-time tracking were measured to be 3.86 ± 1.40 mm versus 10.73 ± 7.03 mm, 2.29 ± 1.02 mm versus 4.44 ± 3.33 mm, and 1.45 ± 0.49 mm versus 2.67 ± 2.49 mm in the SI, AP, and LR directions, respectively. Mean fiducial displacements were greater than that predicted by the maximum displacements on the corresponding 4D-CT scan in 39%, 22%, and 25% of SBRT fractions in the SI, AP, and LR directions, respectively. CONCLUSIONS Comparison of 4D-CT with real-time fiducial tracking demonstrated significant inter- and intrafractional discrepancies, particularly in the SI direction, which could result in compromise of target coverage when planning with a single free-breathing 4D-CT.
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Affiliation(s)
- Jonathan W Lischalk
- Department of Radiation Medicine, Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC.
| | - Thomas P Kole
- Department of Radiation Medicine, Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC
| | - Hozaifa M Anjum
- Department of Radiation Medicine, Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC
| | - Olusola Obayomi-Davies
- Department of Radiation Medicine, Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC
| | - Abdul Rashid
- Department of Radiation Medicine, Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC
| | - Keith Unger
- Department of Radiation Medicine, Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC
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Duma MN, Berndt J, Rondak IC, Devecka M, Wilkens JJ, Geinitz H, Combs SE, Oechsner M. Implications of free breathing motion assessed by 4D-computed tomography on the delivered dose in radiotherapy for esophageal cancer. Med Dosim 2015; 40:378-82. [PMID: 26419857 DOI: 10.1016/j.meddos.2015.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 07/03/2015] [Accepted: 07/29/2015] [Indexed: 12/25/2022]
Abstract
The aim of this study was to assess the effect of breathing motion on the delivered dose in esophageal cancer 3-dimensional (3D)-conformal radiotherapy (3D-CRT), intensity-modulated radiotherapy (IMRT), and volumetric modulated arc therapy (VMAT). We assessed 16 patients with esophageal cancer. All patients underwent 4D-computed tomography (4D-CT) for treatment planning. For each of the analyzed patients, 1 3D-CRT, 1 IMRT, and 1 VMAT (RapidArc-RA) plan were calculated. Each of the 3 initial plans was recalculated on the 4D-CT (for the maximum free inspiration and maximum free expiration) to assess the effect of breathing motion. We assessed the minimum dose (Dmin) and mean dose (Dmean) to the esophagus within the planning target volume, the volume changes of the lungs, the Dmean and the total lung volume receiving at least 40Gy (V40), and the V30, V20, V10, and V5. For the heart we assessed the Dmean and the V25. Over all techniques and all patients the change in Dmean as compared with the planned Dmean (planning CT [PCT]) to the esophagus was 0.48% in maximum free inspiration (CT_insp) and 0.55% in maximum free expiration (CT_exp). The Dmin CT_insp change was 0.86% and CT_exp change was 0.89%. The Dmean change of the lungs (heart) was in CT_insp 1.95% (2.89%) and 3.88% (2.38%) in CT_exp. In all, 4 patients had a clinically relevant change of the dose (≥ 5% Dmean to the heart and the lungs) between inspiration and expiration. These patients had a very cranially or caudally situated tumor. There are no relevant differences in the delivered dose to the regions of interest among the 3 techniques. Breathing motion management could be considered to achieve a better sparing of the lungs or heart in patients with cranially or caudally situated tumors.
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Affiliation(s)
- Marciana Nona Duma
- Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München, München, Germany.
| | - Johannes Berndt
- Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Ina-Christine Rondak
- Institute of Medical Statistics and Epidemiology, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Michal Devecka
- Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Jan J Wilkens
- Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Hans Geinitz
- Department of Radiation Oncology, Krankenhaus Barmherzige Schwestern Linz, Austria
| | - Stephanie Elisabeth Combs
- Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Markus Oechsner
- Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München, München, Germany
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Wang W, Yuan F, Wang G, Lin Z, Pan Y, Chen L. Three-dimensional conformal radiotherapy by delineations on CT-based simulation in different respiratory phases for the treatment of senile patients with non-small cell lung cancer. Onco Targets Ther 2015; 8:2461-7. [PMID: 26392773 PMCID: PMC4573072 DOI: 10.2147/ott.s86642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
AIM This study aimed to evaluate the application of three-dimensional conformal radiotherapy (3D-CRT) for elderly patients with non-small cell lung cancer (NSCLC) based on computed tomography (CT) simulations in different respiratory phases. METHODS A total of 64 patients aged >70 years old with NSCLC were treated by 3D-CRT using CT images in different respiratory phases. The gross tumor volumes (GTVs) at the end of inspiration and end of expiration were combined to obtain the total GTV, which was close to the motional range of tumors during respiration, and no additional expansion of the clinical target volume (CTAV) to planning target volume (PTV) (CTAV:PTV) was included during the recording of respiratory movements. Patients were also planned according to the classic 3D-CRT approach. Efficacy, prognostic factors, and side effects were evaluated. RESULTS Compared with the classic approach, the average PTV was 18.9% lower (median: 17.3%), and the average lung volume receiving a prescribed dose for a tumor was 22.4% lower (median: 20.9%). The 1-, 2-, and 3-year survival rates were 70.6%, 54.9%, and 29.4%, respectively, with an overall tumor response rate of 79.7%. The Karnofsky performance status and N stage were independent prognostic factors, whereas age was not. CONCLUSION Without affecting therapeutic effects, CT simulations in different respiratory phases were well-tolerated in elderly patients with NSCLC, could effectively reduce PTV, and could improve the quality of life.
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Affiliation(s)
- Weifeng Wang
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China ; Department of Radiation Oncology, Haikou municipal hospital, Haikou, Hainan Province, People's Republic of China
| | - Feng Yuan
- Department of Radiation Oncology, Haikou municipal hospital, Haikou, Hainan Province, People's Republic of China
| | - Guoping Wang
- Department of Radiation Oncology, Haikou municipal hospital, Haikou, Hainan Province, People's Republic of China
| | - Zhiren Lin
- Department of Radiation Oncology, Haikou municipal hospital, Haikou, Hainan Province, People's Republic of China
| | - Yanling Pan
- Department of Radiation Oncology, Haikou municipal hospital, Haikou, Hainan Province, People's Republic of China
| | - Longhua Chen
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China
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Respiratory motion variability of primary tumors and lymph nodes during radiotherapy of locally advanced non-small-cell lung cancers. Radiat Oncol 2015; 10:133. [PMID: 26071910 PMCID: PMC4476088 DOI: 10.1186/s13014-015-0435-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 06/01/2015] [Indexed: 12/25/2022] Open
Abstract
Background and purpose The need for target adjustment due to respiratory motion variation and the value of carina as a motion surrogate is evaluated for locally advanced non-small-cell lung cancer. Material and methods Using weekly 4D CTs (with audio-visual biofeedback) of 12 patients, respiratory motion variation of primary tumors (PT), lymph nodes (LN) and carina (C) were determined. Results Mean (SD) 3D respiratory motion ranges of PT, LN and C were 4 (3), 5 (3) and 5 (3) mm. PT and LN (p = 0.003), and LN and C motion range were correlated (p = 0.03). Only 20 %/5 % of all scans had variations >3 mm/5 mm. Large respiratory motion range on the initial scan was associated with larger during-treatment variations for PT (p = 0.03) and LN (p = 0.001). Mean (SD) 3D relative displacements of PT-C, LN-C and PT-LN were each 6 (2) mm. Variations of displacements >3 mm/5 mm were observed in 28 %/6 % of scans for PT-LN, 20 %/9 % for PT-C, and 20 %/8 % for LN-C. Conclusions Motion reassessment is recommended in patients with large initial motion range. Relative motion-related displacements between PT and LN were larger than PT and LN motion alone. Both PT and C appear to be comparable surrogates for LN respiratory motion.
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Adaptive motion mapping in pancreatic SBRT patients using Fourier transforms. Radiother Oncol 2015; 115:217-22. [PMID: 25890573 DOI: 10.1016/j.radonc.2015.03.029] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 03/23/2015] [Accepted: 03/27/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND PURPOSE Recent studies suggest that 4DCT is unable to accurately measure respiratory-induced pancreatic tumor motion. In this work, we assessed the daily motion of pancreatic tumors treated with SBRT, and developed adaptive strategies to predict and account for this motion. MATERIALS AND METHODS The daily motion trajectory of pancreatic tumors during CBCT acquisition was calculated using a model which reconstructs the instantaneous 3D position in each 2D CBCT projection image. We developed a metric (termed "Spectral Coherence," SC) based on the Fourier frequency spectrum of motion in the SI direction, and analyzed the ability of SC to predict motion-based errors and classify patients according to motion characteristics. RESULTS The amplitude of daily motion exceeded the predictions of pre-treatment 4DCT imaging by an average of 3.0mm, 2.3mm, and 3.5mm in the AP/LR/SI directions. SC was correlated with daily motion differences and tumor dose coverage. In a simulated adaptive protocol, target margins were adjusted based on SC, resulting in significant increases in mean target D95, D99, and minimum dose. CONCLUSION Our Fourier-based approach differentiates between consistent and inconsistent motion characteristics of respiration and correlates with daily motion deviations from pre-treatment 4DCT. The feasibility of an SC-based adaptive protocol was demonstrated, and this patient-specific respiratory information was used to improve target dosimetry by expanding coverage in inconsistent breathers while shrinking treatment volumes in consistent breathers.
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GUIDI G, MAFFEI N, CIARMATORI A, MISTRETTA MG, GOTTARDI G, COSTI T, GUIDI G, MAFFEI N, VECCHI C, BALDAZZI G, BERTONI F. REAL-TIME LUNG TUMOUR MOTION MODELING FOR ADAPTIVE RADIATION THERAPY USING LEGO MINDSTORMS. J MECH MED BIOL 2015. [DOI: 10.1142/s0219519415400199] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
An anthropomorphic phantom was built using LEGO Mindstorms® and programmed in LabVIEW® for Adaptive Radiation Therapy (ART) purpose, to simulate the processes of breathing in the lung district during treatments. A thoracic cavity is prototyped by means of an 8 ribs apparatus and 2 artificial tumor masses, driven by intelligent brick LINUX® OS CPU. An optical surface tracking system (VisionRT®) and a QUASAR™ phantom allow correlation between physiological, robotic motion and surrogated signal. Patient's breathing phases are acquired instantaneously by InfraRed/UltraSound sensors. Through 4DCT images, tumor center of mass are individuated and tracked during respiration, to link internal–external organs motion. To quantify the degree of divergences due to dynamics organs deformation, a 4D function was obtained and simulated by our phantom. Sinusoidal signals (6, 10, 12, 15 and 17 Breaths per Minute-BPM) were used for evaluating and commissioning, thereby obtained a correlation coefficient (0.90–0.94) between QUASAR and LEGO. Validated on ideal conditions, phantom was tested in clinical practice. Breaths and CT study of 12 patients were analyzed. Fitting of real breath sinograms returned a mean R value of 0.94 (0.83–0.98) with best model performance achieved in signals with respiratory frequency less than 20 BPM. By using LEGO it is possible to reproduce real patients conditions and simulate normal and even abnormal behavior during the course of therapy, allowing spatial motion estimation.
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Affiliation(s)
- G. GUIDI
- Medical Physics Department, Az.Ospedaliero-Universitaria di Modena, Modena Italy, via del Pozzo 71, 40121 Modena, Italy
| | - N. MAFFEI
- Medical Physics Department, Az.Ospedaliero-Universitaria di Modena, Modena Italy, via del Pozzo 71, 40121 Modena, Italy
| | - A. CIARMATORI
- Medical Physics Department, Az.Ospedaliero-Universitaria di Modena, Modena Italy, via del Pozzo 71, 40121 Modena, Italy
| | - M. G. MISTRETTA
- Medical Physics Department, Az.Ospedaliero-Universitaria di Modena, Modena Italy, via del Pozzo 71, 40121 Modena, Italy
| | - G. GOTTARDI
- Medical Physics Department, Az.Ospedaliero-Universitaria di Modena, Modena Italy, via del Pozzo 71, 40121 Modena, Italy
| | - T. COSTI
- Medical Physics Department, Az.Ospedaliero-Universitaria di Modena, Modena Italy, via del Pozzo 71, 40121 Modena, Italy
| | - G. GUIDI
- Physics Department, University of Bologna, via Berti Pichat 6/2, 40127 Bologna, Italy
| | - N. MAFFEI
- Physics Department, University of Bologna, via Berti Pichat 6/2, 40127 Bologna, Italy
| | - C. VECCHI
- Physics Department, University of Bologna, via Berti Pichat 6/2, 40127 Bologna, Italy
| | - G. BALDAZZI
- Physics Department, University of Bologna, via Berti Pichat 6/2, 40127 Bologna, Italy
| | - F. BERTONI
- Radiation Oncology Department, Az.Ospedaliero-Universitaria di Modena, Modena Italy, via del Pozzo 71, 40121 Modena, Italy
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Castillo SJ, Castillo R, Castillo E, Pan T, Ibbott G, Balter P, Hobbs B, Guerrero T. Evaluation of 4D CT acquisition methods designed to reduce artifacts. J Appl Clin Med Phys 2015; 16:4949. [PMID: 26103169 PMCID: PMC4504190 DOI: 10.1120/jacmp.v16i2.4949] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 11/21/2014] [Accepted: 11/09/2014] [Indexed: 12/25/2022] Open
Abstract
Four-dimensional computed tomography (4D CT) is used to account for respiratory motion in radiation treatment planning, but artifacts resulting from the acquisition and postprocessing limit its accuracy. We investigated the efficacy of three experimental 4D CT acquisition methods to reduce artifacts in a prospective institutional review board approved study. Eighteen thoracic patients scheduled to undergo radiation therapy received standard clinical 4D CT scans followed by each of the alternative 4D CT acquisitions: 1) data oversampling, 2) beam gating with breathing irregularities, and 3) rescanning the clinical acquisition acquired during irregular breathing. Relative values of a validated correlation-based artifact metric (CM) determined the best acquisition method per patient. Each 4D CT was processed by an extended phase sorting approach that optimizes the quantitative artifact metric (CM sorting). The clinical acquisitions were also postprocessed by phase sorting for artifact comparison of our current clinical implementation with the experimental methods. The oversampling acquisition achieved the lowest artifact presence among all acquisitions, achieving a 27% reduction from the current clinical 4D CT implementation (95% confidence interval = 34-20). The rescan method presented a significantly higher artifact presence from the clinical acquisition (37%; p < 0.002), the gating acquisition (26%; p < 0.005), and the oversampling acquisition (31%; p < 0.001), while the data lacked evidence of a significant difference between the clinical, gating, and oversampling methods. The oversampling acquisition reduced artifact presence from the current clinical 4D CT implementation to the largest degree and provided the simplest and most reproducible implementation. The rescan acquisition increased artifact presence significantly, compared to all acquisitions, and suffered from combination of data from independent scans over which large internal anatomic shifts occurred.
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Watkins WT, Moore JA, Gordon J, Hugo GD, Siebers JV. Multiple anatomy optimization of accumulated dose. Med Phys 2014; 41:111705. [PMID: 25370619 DOI: 10.1118/1.4896104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To investigate the potential advantages of multiple anatomy optimization (MAO) for lung cancer radiation therapy compared to the internal target volume (ITV) approach. METHODS MAO aims to optimize a single fluence to be delivered under free-breathing conditions such that the accumulated dose meets the plan objectives, where accumulated dose is defined as the sum of deformably mapped doses computed on each phase of a single four dimensional computed tomography (4DCT) dataset. Phantom and patient simulation studies were carried out to investigate potential advantages of MAO compared to ITV planning. Through simulated delivery of the ITV- and MAO-plans, target dose variations were also investigated. RESULTS By optimizing the accumulated dose, MAO shows the potential to ensure dose to the moving target meets plan objectives while simultaneously reducing dose to organs at risk (OARs) compared with ITV planning. While consistently superior to the ITV approach, MAO resulted in equivalent OAR dosimetry at planning objective dose levels to within 2% volume in 14/30 plans and to within 3% volume in 19/30 plans for each lung V20, esophagus V25, and heart V30. Despite large variations in per-fraction respiratory phase weights in simulated deliveries at high dose rates (e.g., treating 4/10 phases during single fraction beams) the cumulative clinical target volume (CTV) dose after 30 fractions and per-fraction dose were constant independent of planning technique. In one case considered, however, per-phase CTV dose varied from 74% to 117% of prescription implying the level of ITV-dose heterogeneity may not be appropriate with conventional, free-breathing delivery. CONCLUSIONS MAO incorporates 4DCT information in an optimized dose distribution and can achieve a superior plan in terms of accumulated dose to the moving target and OAR sparing compared to ITV-plans. An appropriate level of dose heterogeneity in MAO plans must be further investigated.
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Affiliation(s)
- W Tyler Watkins
- Department of Radiation Oncology, University of Virginia, Charlottesville, Virginia 22908 and Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia 23298
| | - Joseph A Moore
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland 21231 and Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia 23298
| | - James Gordon
- Henry Ford Health System, Detroit, Michigan 48202 and Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia 23298
| | - Geoffrey D Hugo
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia 23298
| | - Jeffrey V Siebers
- Department of Radiation Oncology, University of Virginia, Charlottesville, Virginia 22908 and Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia 23298
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Lens E, van der Horst A, Kroon PS, van Hooft JE, Dávila Fajardo R, Fockens P, van Tienhoven G, Bel A. Differences in respiratory-induced pancreatic tumor motion between 4D treatment planning CT and daily cone beam CT, measured using intratumoral fiducials. Acta Oncol 2014; 53:1257-64. [PMID: 24758251 DOI: 10.3109/0284186x.2014.905699] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND In radiotherapy, the magnitude of respiratory-induced tumor motion is often measured using a single four-dimensional computed tomography (4DCT). This magnitude is required to determine the internal target volume. The aim of this study was to compare the magnitude of respiratory-induced motion of pancreatic tumors on a single 4DCT with the motion on daily cone beam CT (CBCT) scans during a 3-5-week fractionated radiotherapy scheme. In addition, we investigated changes in the respiratory motion during the treatment course. MATERIAL AND METHODS The mean peak-to-peak motion (i.e. magnitude of motion) of pancreatic tumors was measured for 18 patients using intratumoral gold fiducials visible on CBCT scans made prior to each treatment fraction (10-27 CBCTs per patient; 401 CBCTs in total). For each patient, these magnitudes were compared to the magnitude measured on 4DCT. Possible time trends were investigated by applying linear fits to the tumor motion determined from daily CBCTs as a function of treatment day. RESULTS We found a significant (p ≤ 0.01) difference between motion magnitude on 4DCT and on CBCT in superior-inferior, anterior-posterior and left-right direction, in 13, 9 and 12 of 18 patients, respectively. In the anterior- posterior and left-right direction no fractions had a difference ≥ 5 mm. In the superior-inferior direction the difference was ≥ 5 mm for 17% of the 401 fractions. In this direction, a significant (p ≤ 0.05) time trend in tumor motion was observed in 4 of 18 patients, but all trends were small (- 0.17-0.10 mm/day) and did not explain the large differences in motion magnitude between 4DCT and CBCT. CONCLUSION A single measurement of the respiratory-induced motion magnitude of pancreatic tumors using 4DCT is often not representative for the magnitude during daily treatment over a 3-5-week radiotherapy scheme. For this patient group it may be beneficial to introduce breath-hold to eliminate respiratory-induced tumor motion.
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Affiliation(s)
- Eelco Lens
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam , Amsterdam , The Netherlands
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