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Sidhu C, Tang C, Scott A, Yamini Ramamurty H, Yagnik L, Morey S, Phillips M, Jacques A, Thomas R. Feasibility, safety and outcomes of stereotactic radiotherapy for ultra-central thoracic oligometastatic disease guided by linear endobronchial ultrasound-inserted fiducials. Radiother Oncol 2024:110547. [PMID: 39332638 DOI: 10.1016/j.radonc.2024.110547] [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: 05/03/2024] [Revised: 09/09/2024] [Accepted: 09/13/2024] [Indexed: 09/29/2024]
Abstract
BACKGROUND & PURPOSE Local treatment of oligometastases has been found to improve survival and prognosis. Stereotactic body radiotherapy (SBRT) has emerged as a treatment option for oligometastases but its use in ultra-central (UC) areas can cause significant toxicity and mortality. Fiducial markers (FM) can be used to improve SBRT accuracy, and can be inserted in the central thorax using linear endobronchial ultrasound (EBUS) bronchoscopy. Outcomes of FM-guided SBRT for UC thoracic oligometastases is unknown. METHODS A single-centre retrospective study investigating the feasibility, safety and outcomes of both linear EBUS-inserted FMs and subsequent FM-guided SBRT for UC-oligometastatic disease. Motion analyses of FMs were also performed. RESULTS Thirty outpatients underwent 32 EBUS-FM insertion procedures with 100 % success, and no major procedural mortality or morbidity. Minor complications were 4.8 % incidence of delayed FM-displacement. UC FM-guided SBRT was completed in 20 patients with 99.9 % fractions delivered. Median SBRT dose delivered was 40 Gy over a median of 8 fractions. Majority of adverse events were Grade 1 and there was no SBRT-related mortality. Local control with SBRT was 95 %, with overall survival at 1-year and 3-years of 90 % and 56.3 % respectively. Median overall survival after SBRT was 43.6 months. FM movements in UC areas were recorded being greatest in the superior-inferior axis. CONCLUSION Combined linear EBUS sampling and FM-insertion in UC thoracic oligometastatic disease is feasible and safe. UC-SBRT to oligometastases using FM guidance was found to have minimal complications and associated with moderate survival up to 3 years post-treatment.
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Affiliation(s)
- Calvin Sidhu
- School of Health Sciences, Edith Cowan University, Joondalup, Australia; Institute for Respiratory Health, Perth, Australia.
| | - Colin Tang
- School of Health Sciences, Edith Cowan University, Joondalup, Australia; Department of Radiation Oncology, Sir Charles Gairdner Hospital, Perth, Australia; Institute for Respiratory Health, Perth, Australia
| | - Alison Scott
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Perth, Australia; Institute for Respiratory Health, Perth, Australia
| | - Hema Yamini Ramamurty
- Department of Respiratory Medicine, Queen Elizabeth Hospital, Kota Kinabalu, Malaysia; Institute for Respiratory Health, Perth, Australia
| | - Lokesh Yagnik
- Department of Respiratory Medicine, Fiona Stanley Hospital, Perth, Australia; Institute for Respiratory Health, Perth, Australia
| | - Sue Morey
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Australia; Institute for Respiratory Health, Perth, Australia
| | - Martin Phillips
- Macquarie University Hospital, Sydney, Australia; Institute for Respiratory Health, Perth, Australia
| | - Angela Jacques
- Institute of Health Research, University of Notre Dame, Fremantle, Australia; Institute for Respiratory Health, Perth, Australia
| | - Rajesh Thomas
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Australia; Institute of Health Research, University of Notre Dame, Fremantle, Australia; School of Medicine, University of Western Australia, Perth, Australia; Institute for Respiratory Health, Perth, Australia
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Yu YH, Yen TY, Hung SK, Chen SH, Wang KY. A 3D-printed phantom for stereotactic body radiation therapy simulation. Biomed Phys Eng Express 2024; 10:025034. [PMID: 38350115 DOI: 10.1088/2057-1976/ad28cd] [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: 10/19/2023] [Accepted: 02/13/2024] [Indexed: 02/15/2024]
Abstract
In modern radiation therapy for lung cancer, examining the uncertainty between tumor motion and beam delivery is vitally important. To lower the radiation dose delivery to the patient's normal tissue, narrowing the irradiation field margin to hit the tumor accurately is critical. Thus we proposed a phantom that simulates the thorax and lung tumor's motions by employing a 3D printing technique. The lung tumor is controlled by a linear miniature Delta robot arm, with a maximum displacement of 20 mm in each direction. When we simulated the thoracic breathing movements at 12 mm in A-P (Anterior-Posterior), the control errors were within 10%. The average tracking errors of the prosthetic tumor were within 1.1 mm. Therefore, the 3D-printed phantom with a robot arm can provide a reliable simulation for training and dosimetry measurement before lung radiotherapy, especially SBRT.
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Affiliation(s)
- Ying-Hao Yu
- Department of Electrical Engineering and AIM-HI, National Chung Cheng University, Taiwan
| | - Tsung-Yu Yen
- Department of Radiation Oncology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Shih-Kai Hung
- Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Shi-He Chen
- Department of Electrical Engineering and AIM-HI, National Chung Cheng University, Taiwan
| | - Kuei-Ying Wang
- Department of Nursing, Chang-Jung Christian University, Taiwan
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Momin S, Lei Y, Tian Z, Wang T, Roper J, Kesarwala AH, Higgins K, Bradley JD, Liu T, Yang X. Lung tumor segmentation in 4D CT images using motion convolutional neural networks. Med Phys 2021; 48:7141-7153. [PMID: 34469001 DOI: 10.1002/mp.15204] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 08/19/2021] [Accepted: 08/25/2021] [Indexed: 01/01/2023] Open
Abstract
PURPOSE Manual delineation on all breathing phases of lung cancer 4D CT image datasets can be challenging, exhaustive, and prone to subjective errors because of both the large number of images in the datasets and variations in the spatial location of tumors secondary to respiratory motion. The purpose of this work is to present a new deep learning-based framework for fast and accurate segmentation of lung tumors on 4D CT image sets. METHODS The proposed DL framework leverages motion region convolutional neural network (R-CNN). Through integration of global and local motion estimation network architectures, the network can learn both major and minor changes caused by tumor motion. Our network design first extracts tumor motion information by feeding 4D CT images with consecutive phases into an integrated backbone network architecture, locating volume-of-interest (VOIs) via a regional proposal network and removing irrelevant information via a regional convolutional neural network. Extracted motion information is then advanced into the subsequent global and local motion head network architecture to predict corresponding deformation vector fields (DVFs) and further adjust tumor VOIs. Binary masks of tumors are then segmented within adjusted VOIs via a mask head. A self-attention strategy is incorporated in the mask head network to remove any noisy features that might impact segmentation performance. We performed two sets of experiments. In the first experiment, a five-fold cross-validation on 20 4D CT datasets, each consisting of 10 breathing phases (i.e., 200 3D image volumes in total). The network performance was also evaluated on an additional unseen 200 3D images volumes from 20 hold-out 4D CT datasets. In the second experiment, we trained another model with 40 patients' 4D CT datasets from experiment 1 and evaluated on additional unseen nine patients' 4D CT datasets. The Dice similarity coefficient (DSC), center of mass distance (CMD), 95th percentile Hausdorff distance (HD95 ), mean surface distance (MSD), and volume difference (VD) between the manual and segmented tumor contour were computed to evaluate tumor detection and segmentation accuracy. The performance of our method was quantitatively evaluated against four different methods (VoxelMorph, U-Net, network without global and local networks, and network without attention gate strategy) across all evaluation metrics through a paired t-test. RESULTS The proposed fully automated DL method yielded good overall agreement with the ground truth for contoured tumor volume and segmentation accuracy. Our model yielded significantly better values of evaluation metrics (p < 0.05) than all four competing methods in both experiments. On hold-out datasets of experiment 1 and 2, our method yielded DSC of 0.86 and 0.90 compared to 0.82 and 0.87, 0.75 and 0.83, 081 and 0.89, and 0.81 and 0.89 yielded by VoxelMorph, U-Net, network without global and local networks, and networks without attention gate strategy. Tumor VD between ground truth and our method was the smallest with the value of 0.50 compared to 0.99, 1.01, 0.92, and 0.93 for between ground truth and VoxelMorph, U-Net, network without global and local networks, and networks without attention gate strategy, respectively. CONCLUSIONS Our proposed DL framework of tumor segmentation on lung cancer 4D CT datasets demonstrates a significant promise for fully automated delineation. The promising results of this work provide impetus for its integration into the 4D CT treatment planning workflow to improve the accuracy and efficiency of lung radiotherapy.
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Affiliation(s)
- Shadab Momin
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Yang Lei
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Zhen Tian
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Tonghe Wang
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Justin Roper
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Aparna H Kesarwala
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Kristin Higgins
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Jeffrey D Bradley
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Tian Liu
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Xiaofeng Yang
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
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Ayadi M, Baudier T, Bouilhol G, Dupuis P, Boissard P, Pinho R, Krason A, Rit S, Claude L, Sarrut D. Mid-position treatment strategy for locally advanced lung cancer: a dosimetric study. Br J Radiol 2020; 93:20190692. [PMID: 32293191 PMCID: PMC10993224 DOI: 10.1259/bjr.20190692] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 03/20/2020] [Accepted: 03/30/2020] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE The internal target volume (ITV) strategy generates larger planning target volumes (PTVs) in locally advanced non-small cell lung cancer (LA-NSCLC) than the Mid-position (Mid-p) strategy. We investigated the benefit of the Mid-p strategy regarding PTV reduction and dose to the organs at risk (OARs). METHODS 44 patients with LA-NSCLC were included in a randomized clinical study to compare ITV and Mid-p strategies. GTV were delineated by a physician on maximum intensity projection images and on Mid-p images from four-dimensional CTs. CTVs were obtained by adding 6 mm uniform margin for microscopic extension. CTV to PTV margins were calculated using the van Herk's recipe for setup and delineation errors. For the Mid-p strategy, the mean target motion amplitude was added as a random error. For both strategies, three-dimensional conformal plans delivering 60-66 Gy to PTV were performed. PTVs, dose-volume parameters for OARs (lung, esophagus, heart, spinal cord) were reported and compared. RESULTS With the Mid-p strategy, the median of volume reduction was 23.5 cm3 (p = 0.012) and 8.8 cm3 (p = 0.0083) for PTVT and PTVN respectively; the median mean lung dose reduction was 0.51 Gy (p = 0.0057). For 37.1% of the patients, delineation errors led to smaller PTV with the ITV strategy than with the Mid-p strategy. CONCLUSION PTV and mean lung dose were significantly reduced using the Mid-p strategy. Delineation uncertainty can unfavorably impact the advantage. ADVANCES IN KNOWLEDGE To the best of our knowledge, this is the first dosimetric comparison study between ITV and Mid-p strategies for LA-NSCLC.
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Affiliation(s)
- M. Ayadi
- Radiotherapy and Physics Department, Leon Berard Cancer Center,
28, rue Laennec F-69373, Lyon,
France
| | - T. Baudier
- Univ Lyon, INSA-Lyon, Université Lyon 1, CNRS, Inserm,
Centre Léon Bérard, CREATIS UMR 5220, U1206,
F-69373, Lyon,
France
| | - G. Bouilhol
- Department of Radiotherapy, Hartmann Radiotherapy Center,
American Hospital of Paris,
Neuilly, France
| | - P. Dupuis
- Radiotherapy and Physics Department, Leon Berard Cancer Center,
28, rue Laennec F-69373, Lyon,
France
| | - P. Boissard
- Radiotherapy and Physics Department, Leon Berard Cancer Center,
28, rue Laennec F-69373, Lyon,
France
| | - R. Pinho
- Univ Lyon, INSA-Lyon, Université Lyon 1, CNRS, Inserm,
Centre Léon Bérard, CREATIS UMR 5220, U1206,
F-69373, Lyon,
France
| | - A. Krason
- Univ Lyon, INSA-Lyon, Université Lyon 1, CNRS, Inserm,
Centre Léon Bérard, CREATIS UMR 5220, U1206,
F-69373, Lyon,
France
| | - S. Rit
- Univ Lyon, INSA-Lyon, Université Lyon 1, CNRS, Inserm,
Centre Léon Bérard, CREATIS UMR 5220, U1206,
F-69373, Lyon,
France
| | - L. Claude
- Radiotherapy and Physics Department, Leon Berard Cancer Center,
28, rue Laennec F-69373, Lyon,
France
| | - D. Sarrut
- Univ Lyon, INSA-Lyon, Université Lyon 1, CNRS, Inserm,
Centre Léon Bérard, CREATIS UMR 5220, U1206,
F-69373, Lyon,
France
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Wang S, Xing HX, Li J, Zhang YJ, Fan TY, Yuan SH, Hu XD, Xu M. Correlation of displacement of mediastinal metastatic lymph nodes with adjacent organs in non-small cell lung cancer on four-dimensional computed tomography. PRECISION RADIATION ONCOLOGY 2019. [DOI: 10.1002/pro6.64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Suzhen Wang
- Shandong Cancer Hospital Affiliated to Shandong University; Department of Radiation Oncology; Shandong China
| | - Huai-Xin Xing
- Shandong Cancer Hospital & Institute; Department of Anesthesiology; Shandong China
| | - Jianbin Li
- Shandong Cancer Hospital Affiliated to Shandong University; Department of Radiation Oncology; Shandong Cancer Hospital & Institute; Shandong China
| | | | - Ting-Yong Fan
- Shandong Cancer Hospital & Institute; Shandong China
| | | | - Xu-Dong Hu
- Shandong Cancer Hospital & Institute; Shandong China
| | - Min Xu
- Shandong Cancer Hospital & Institute; Shandong China
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Haefner MF, Verma V, Bougatf N, Mielke T, Tonndorf-Martini E, König L, Rwigema JCM, Simone 2nd CB, Uhlmann L, Eichhorn F, Winter H, Grosch H, Haberer T, Herfarth K, Debus J, Rieken S. Dosimetric comparison of advanced radiotherapy approaches using photon techniques and particle therapy in the postoperative management of thymoma. Acta Oncol 2018; 57:1713-1720. [PMID: 30264630 DOI: 10.1080/0284186x.2018.1502467] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND The purpose of this study was to compare dosimetric differences related to target volume and organs-at-risk (OAR) using 3D-conformal radiotherapy (3DCRT), volumetric modulated arc therapy (VMAT), TomoTherapy (Tomo), proton radiotherapy (PRT), and carbon ion radiotherapy (CIRT) as part of postoperative thymoma irradiation. MATERIAL AND METHODS This single-institutional analysis included 10 consecutive patients treated with adjuvant radiotherapy between December 2013 and September 2016. CT-datasets and respective RT-structures were anonymized and plans for all investigated RT modalities (3DCRT, VMAT, Tomo, PRT, CIRT) were optimized for a total dose of 50 Gy in 25 fractions. Comparisons between target volume and OAR dosimetric parameters were performed using the Wilcoxon rank-sum test. RESULTS The best target volume coverage (mean PTV V95% for all patients) was observed for Tomo (97.9%), PRT (97.6%), and CIRT (96.6%) followed by VMAT (85.4%) and 3DCRT (74.7%). PRT and CIRT both significantly reduced mean doses to the lungs, breasts, heart, and esophagus, as well as the spinal cord maximum dose compared with photon modalities. Among photon-based techniques, VMAT showed improved OAR sparing over 3DCRT. Tomo was associated with considerable low-dose exposure to the lungs, breasts, and heart. CONCLUSIONS Particle radiotherapy (PRT, CIRT) showed superior OAR sparing and optimal target volume coverage. The observed dosimetric advantages are expected to reduce toxicity rates. However, their clinical impact must be investigated prospectively.
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Affiliation(s)
- Matthias Felix Haefner
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg, Germany
- National Center of Radiation Research in Oncology (NCRO) Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany
| | - Vivek Verma
- Department of Radiation Oncology, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Nina Bougatf
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg, Germany
- National Center of Radiation Research in Oncology (NCRO) Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany
| | - Thomas Mielke
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg, Germany
- National Center of Radiation Research in Oncology (NCRO) Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany
| | - Eric Tonndorf-Martini
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg, Germany
| | - Laila König
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg, Germany
- National Center of Radiation Research in Oncology (NCRO) Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany
| | | | - Charles B. Simone 2nd
- Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, MD, USA
| | - Lorenz Uhlmann
- Institute of Medical Biometry and Informatics (IMBI), Heidelberg, Germany
| | - Florian Eichhorn
- Department of Thoracic Surgery, Thoraxklinik Heidelberg University Hospital, Heidelberg, Germany
| | - Hauke Winter
- Department of Thoracic Surgery, Thoraxklinik Heidelberg University Hospital, Heidelberg, Germany
| | - Heidrun Grosch
- Department of Thoracic Oncology, Thoraxklinik Heidelberg University Hospital, Heidelberg, Germany
| | - Thomas Haberer
- Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg, Germany
- National Center of Radiation Research in Oncology (NCRO) Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany
| | - Klaus Herfarth
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg, Germany
- National Center of Radiation Research in Oncology (NCRO) Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg, Germany
- National Center of Radiation Research in Oncology (NCRO) Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany
| | - Stefan Rieken
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg, Germany
- National Center of Radiation Research in Oncology (NCRO) Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany
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Tseng YD, Wootton L, Nyflot M, Apisarnthanarax S, Rengan R, Bloch C, Sandison G, St. James S. 4D computed tomography scans for conformal thoracic treatment planning: is a single scan sufficient to capture thoracic tumor motion? ACTA ACUST UNITED AC 2018; 63:02NT03. [DOI: 10.1088/1361-6560/aaa44e] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Fast MF, Eiben B, Menten MJ, Wetscherek A, Hawkes DJ, McClelland JR, Oelfke U. Tumour auto-contouring on 2d cine MRI for locally advanced lung cancer: A comparative study. Radiother Oncol 2017; 125:485-491. [PMID: 29029832 PMCID: PMC5736170 DOI: 10.1016/j.radonc.2017.09.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 08/11/2017] [Accepted: 09/13/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Radiotherapy guidance based on magnetic resonance imaging (MRI) is currently becoming a clinical reality. Fast 2d cine MRI sequences are expected to increase the precision of radiation delivery by facilitating tumour delineation during treatment. This study compares four auto-contouring algorithms for the task of delineating the primary tumour in six locally advanced (LA) lung cancer patients. MATERIAL AND METHODS Twenty-two cine MRI sequences were acquired using either a balanced steady-state free precession or a spoiled gradient echo imaging technique. Contours derived by the auto-contouring algorithms were compared against manual reference contours. A selection of eight image data sets was also used to assess the inter-observer delineation uncertainty. RESULTS Algorithmically derived contours agreed well with the manual reference contours (median Dice similarity index: ⩾0.91). Multi-template matching and deformable image registration performed significantly better than feature-driven registration and the pulse-coupled neural network (PCNN). Neither MRI sequence nor image orientation was a conclusive predictor for algorithmic performance. Motion significantly degraded the performance of the PCNN. The inter-observer variability was of the same order of magnitude as the algorithmic performance. CONCLUSION Auto-contouring of tumours on cine MRI is feasible in LA lung cancer patients. Despite large variations in implementation complexity, the different algorithms all have relatively similar performance.
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Affiliation(s)
- Martin F Fast
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom.
| | - Björn Eiben
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, United Kingdom.
| | - Martin J Menten
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Andreas Wetscherek
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - David J Hawkes
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, United Kingdom
| | - Jamie R McClelland
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, United Kingdom
| | - Uwe Oelfke
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
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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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De Ruysscher D, Faivre-Finn C, Moeller D, Nestle U, Hurkmans CW, Le Péchoux C, Belderbos J, Guckenberger M, Senan S. European Organization for Research and Treatment of Cancer (EORTC) recommendations for planning and delivery of high-dose, high precision radiotherapy for lung cancer. Radiother Oncol 2017; 124:1-10. [PMID: 28666551 DOI: 10.1016/j.radonc.2017.06.003] [Citation(s) in RCA: 135] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 04/25/2017] [Accepted: 06/05/2017] [Indexed: 12/23/2022]
Abstract
PURPOSE To update literature-based recommendations for techniques used in high-precision thoracic radiotherapy for lung cancer, in both routine practice and clinical trials. METHODS A literature search was performed to identify published articles that were considered clinically relevant and practical to use. Recommendations were categorised under the following headings: patient positioning and immobilisation, Tumour and nodal changes, CT and FDG-PET imaging, target volumes definition, radiotherapy treatment planning and treatment delivery. An adapted grading of evidence from the Infectious Disease Society of America, and for models the TRIPOD criteria, were used. RESULTS Recommendations were identified for each of the above categories. CONCLUSION Recommendations for the clinical implementation of high-precision conformal radiotherapy and stereotactic body radiotherapy for lung tumours were identified from the literature. Techniques that were considered investigational at present are highlighted.
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Affiliation(s)
- Dirk De Ruysscher
- Maastricht University Medical Center+, Department of Radiation Oncology (Maastro Clinic), GROW Research Institute, The Netherlands; KU Leuven, Radiation Oncology, Belgium.
| | - Corinne Faivre-Finn
- Division of Cancer Sciences University of Manchester, Christie NHS Foundation Trust, UK
| | - Ditte Moeller
- Aarhus University Hospital, Department of Oncology, Denmark
| | - Ursula Nestle
- Freiburg University Medical Center (DKTK partner site), Department of Radiation Oncology, Germany; Department of Radiation Oncology, Kliniken Maria Hilf, Moenchengladbach, Germany
| | - Coen W Hurkmans
- Catharina Hospital, Department of Radiation Oncology, Eindhoven, The Netherlands
| | | | - José Belderbos
- Netherlands Cancer Institute, Department of Radiation Oncology, Amsterdam, The Netherlands
| | | | - Suresh Senan
- VU University Medical Center, Department of Radiation Oncology, Amsterdam, The Netherlands
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Sorger H, Hofstad EF, Amundsen T, Langø T, Bakeng JBL, Leira HO. A multimodal image guiding system for Navigated Ultrasound Bronchoscopy (EBUS): A human feasibility study. PLoS One 2017; 12:e0171841. [PMID: 28182758 PMCID: PMC5300184 DOI: 10.1371/journal.pone.0171841] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 01/26/2017] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) is the endoscopic method of choice for confirming lung cancer metastasis to mediastinal lymph nodes. Precision is crucial for correct staging and clinical decision-making. Navigation and multimodal imaging can potentially improve EBUS-TBNA efficiency. AIMS To demonstrate the feasibility of a multimodal image guiding system using electromagnetic navigation for ultrasound bronchoschopy in humans. METHODS Four patients referred for lung cancer diagnosis and staging with EBUS-TBNA were enrolled in the study. Target lymph nodes were predefined from the preoperative computed tomography (CT) images. A prototype convex probe ultrasound bronchoscope with an attached sensor for position tracking was used for EBUS-TBNA. Electromagnetic tracking of the ultrasound bronchoscope and ultrasound images allowed fusion of preoperative CT and intraoperative ultrasound in the navigation software. Navigated EBUS-TBNA was used to guide target lymph node localization and sampling. Navigation system accuracy was calculated, measured by the deviation between lymph node position in ultrasound and CT in three planes. Procedure time, diagnostic yield and adverse events were recorded. RESULTS Preoperative CT and real-time ultrasound images were successfully fused and displayed in the navigation software during the procedures. Overall navigation accuracy (11 measurements) was 10.0 ± 3.8 mm, maximum 17.6 mm, minimum 4.5 mm. An adequate sample was obtained in 6/6 (100%) of targeted lymph nodes. No adverse events were registered. CONCLUSIONS Electromagnetic navigated EBUS-TBNA was feasible, safe and easy in this human pilot study. The clinical usefulness was clearly demonstrated. Fusion of real-time ultrasound, preoperative CT and electromagnetic navigational bronchoscopy provided a controlled guiding to level of target, intraoperative overview and procedure documentation.
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Affiliation(s)
- Hanne Sorger
- Department of Circulation and Imaging, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Thoracic Medicine, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Medicine, Levanger Hospital, North-Trøndelag Health Trust, Norway
| | - Erlend Fagertun Hofstad
- Department of Medical Technology, SINTEF Technology and Society, Trondheim, Norway
- Norwegian National Advisory Unit for Ultrasound and image-guided therapy, St. Olavs Hospital, Trondheim, Norway
| | - Tore Amundsen
- Department of Circulation and Imaging, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Thoracic Medicine, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Thomas Langø
- Department of Medical Technology, SINTEF Technology and Society, Trondheim, Norway
- Norwegian National Advisory Unit for Ultrasound and image-guided therapy, St. Olavs Hospital, Trondheim, Norway
| | - Janne Beate Lervik Bakeng
- Department of Medical Technology, SINTEF Technology and Society, Trondheim, Norway
- Norwegian National Advisory Unit for Ultrasound and image-guided therapy, St. Olavs Hospital, Trondheim, Norway
| | - Håkon Olav Leira
- Department of Circulation and Imaging, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Thoracic Medicine, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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Li Y, Ma JL, Chen X, Tang FW, Zhang XZ. 4DCT and CBCT based PTV margin in Stereotactic Body Radiotherapy(SBRT) of non-small cell lung tumor adhered to chest wall or diaphragm. Radiat Oncol 2016; 11:152. [PMID: 27846900 PMCID: PMC5111250 DOI: 10.1186/s13014-016-0724-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Accepted: 10/31/2016] [Indexed: 12/21/2022] Open
Abstract
Background Large tumor motion often leads to larger treatment volumes, especially the lung tumor located in lower lobe and adhered to chest wall or diaphragm. The purpose of this work is to investigate the impacts of planning target volume (PTV) margin on Stereotactic Body Radiotherapy (SBRT) in non-small cell lung cancer (NSCLC). Methods Subjects include 20 patients with the lung tumor located in lower lobe and adhered to chest wall or diaphragm who underwent SBRT. Four-dimensional computed tomography (4DCT) were acquired at simulation to evaluate the tumor intra-fractional centroid and boundary changes, and Cone-beam Computer Tomography (CBCT) were acquired during each treatment to evaluate the tumor inter-fractional set-up displacement. The margin to compensate for tumor variations uncertainties was calculated with various margin calculated recipes published in the exiting literatures. Results The means (±standard deviation) of tumor centroid changes were 0.16 (±0.13) cm, 0.22 (±0.15) cm, and 1.37 (±0.81) cm in RL, AP, and SI directions, respectively. The means (±standard deviation) of tumor edge changes were 0.21 (±0.18) cm, 0.50 (±0.23) cm, and 0.19 (±0.44) cm in RL, AP, and SI directions, respectively. The means (±standard deviation) of tumor set-up displacement were 0.03 (±0.24) cm, 0.02 (±0.26) cm, and 0.02 (±0.43) cm in RL, AP, and SI directions, respectively. The PTV margin to compensate for lung cancer tumor variations uncertainties were 0.88, 0.98 and 2.68 cm in RL, AP and SI directions, which were maximal among all margin recipes. Conclusions 4DCT and CBCT imaging are appropriate to account for the tumor intra-fractional centroid, boundary variations and inter-fractional set-up displacement. The PTV margin to compensate for lung cancer tumor variations uncertainties can be obtained. Our results show that a conventional 1.0 cm margin in the SI plane dose not suffice to compensate the geometrical variety of the tumor located in lower lobe and adhered to chest wall and diaphragm.
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Affiliation(s)
- Yi Li
- Department of Radiation Oncology, The First Affiliated Hospital, Xi'an Jiaotong University of Medical College, Xi'an, Shaanxi, 710061, China
| | - Jing-Lu Ma
- Department of Radiation Oncology, The First Affiliated Hospital, Xi'an Jiaotong University of Medical College, Xi'an, Shaanxi, 710061, China
| | - Xin Chen
- Department of Radiation Oncology, The First Affiliated Hospital, Xi'an Jiaotong University of Medical College, Xi'an, Shaanxi, 710061, China
| | - Feng-Wen Tang
- Department of Radiation Oncology, The First Affiliated Hospital, Xi'an Jiaotong University of Medical College, Xi'an, Shaanxi, 710061, China
| | - Xiao-Zhi Zhang
- Department of Radiation Oncology, The First Affiliated Hospital, Xi'an Jiaotong University of Medical College, Xi'an, Shaanxi, 710061, China.
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Wong VYW, Baker CR, Leung TW, Tung SY. A design of a DICOM-RT-based tool box for nonrigid 4D dose calculation. J Appl Clin Med Phys 2016; 17:99-111. [PMID: 27074476 PMCID: PMC5875557 DOI: 10.1120/jacmp.v17i2.5935] [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: 07/02/2015] [Revised: 11/25/2015] [Accepted: 11/13/2015] [Indexed: 11/23/2022] Open
Abstract
The study was aimed to introduce a design of a DICOM-RT-based tool box to facilitate 4D dose calculation based on deformable voxel-dose registration. The computational structure and the calculation algorithm of the tool box were explicitly discussed in the study. The tool box was written in MATLAB in conjunction with CERR. It consists of five main functions which allow a) importation of DICOM-RT-based 3D dose plan, b) deformable image registration, c) tracking voxel doses along breathing cycle, d) presentation of temporal dose distribution at different time phase, and e) derivation of 4D dose. The efficacy of using the tool box for clinical application had been verified with nine clinical cases on retrospective-study basis. The logistic and the robustness of the tool box were tested with 27 applications and the results were shown successful with no computational errors encountered. In the study, the accumulated dose coverage as a function of planning CT taken at end-inhale, end-exhale, and mean tumor position were assessed. The results indicated that the majority of the cases (67%) achieved maximum target coverage, while the planning CT was taken at the temporal mean tumor position and 56% at the end-exhale position. The comparable results to the literature imply that the studied tool box can be reliable for 4D dose calculation. The authors suggest that, with proper application, 4D dose calculation using deformable registration can provide better dose evaluation for treatment with moving target.
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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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Kesarwala AH, Ko CJ, Ning H, Xanthopoulos E, Haglund KE, O'Meara WP, Simone CB, Rengan R. Intensity-modulated proton therapy for elective nodal irradiation and involved-field radiation in the definitive treatment of locally advanced non-small-cell lung cancer: a dosimetric study. Clin Lung Cancer 2015; 16:237-44. [PMID: 25604729 PMCID: PMC4410064 DOI: 10.1016/j.cllc.2014.12.001] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Revised: 11/26/2014] [Accepted: 12/01/2014] [Indexed: 12/25/2022]
Abstract
BACKGROUND Photon involved-field (IF) radiation therapy (IFRT), the standard for locally advanced (LA) non-small cell lung cancer (NSCLC), results in favorable outcomes without increased isolated nodal failures, perhaps from scattered dose to elective nodal stations. Because of the high conformality of intensity-modulated proton therapy (IMPT), proton IFRT could increase nodal failures. We investigated the feasibility of IMPT for elective nodal irradiation (ENI) in LA-NSCLC. PATIENTS AND METHODS IMPT IFRT plans were generated to the same total dose of 66.6-72 Gy received by 20 LA-NSCLC patients treated with photon IFRT. IMPT ENI plans were generated to 46 cobalt Gray equivalent (CGE) to elective nodal planning treatment volumes (PTV) plus 24 CGE to IF-PTVs. RESULTS Proton IFRT and ENI improved the IF-PTV percentage of volume receiving 95% of the prescribed dose (D95) by 4% (P < .01) compared with photon IFRT. All evaluated dosimetric parameters improved significantly with both proton plans. The lung percentage of volume receiving 20 Gy/CGE (V20) and mean lung dose decreased 18% (P < .01) and 36% (P < .01), respectively, with proton IFRT, and 11% (P = .03) and 26% (P < .01) with ENI. The mean esophagus dose decreased 16% with IFRT and 12% with ENI; heart V25 decreased 63% with both (all P < .01). CONCLUSION This study demonstrates the feasibility of IMPT for LA-NSCLC ENI. Potential decreased toxicity indicates that IMPT could allow ENI while maintaining a favorable therapeutic ratio compared with photon IFRT.
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Affiliation(s)
- Aparna H Kesarwala
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD.
| | - Christine J Ko
- Division of Radiation Oncology, Department of Radiology, Walter Reed National Military Medical Center, Bethesda, MD
| | - Holly Ning
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Eric Xanthopoulos
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - Karl E Haglund
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - William P O'Meara
- Division of Radiation Oncology, Department of Radiology, Walter Reed National Military Medical Center, Bethesda, MD
| | - Charles B Simone
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - Ramesh Rengan
- Department of Radiation Oncology, University of Washington, Seattle, WA
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Johnston AJ, Holder A, Bishop SM, See TC, Streater CT. Evaluation of the Sherlock 3CG Tip Confirmation System on peripherally inserted central catheter malposition rates. Anaesthesia 2014; 69:1322-30. [DOI: 10.1111/anae.12785] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2014] [Indexed: 11/26/2022]
Affiliation(s)
- A. J. Johnston
- John Farman Intensive Care Unit; Addenbrooke's Hospital; Cambridge University Hospitals NHS Foundation Trust; Cambridge UK
| | - A. Holder
- John Farman Intensive Care Unit; Addenbrooke's Hospital; Cambridge University Hospitals NHS Foundation Trust; Cambridge UK
| | - S. M. Bishop
- John Farman Intensive Care Unit; Addenbrooke's Hospital; Cambridge University Hospitals NHS Foundation Trust; Cambridge UK
| | - T. C. See
- Department of Radiology; Addenbrooke's Hospital; Cambridge University Hospitals NHS Foundation Trust; Cambridge UK
| | - C. T. Streater
- Vascular Access Unit; Addenbrooke's Hospital; Cambridge University Hospitals NHS Foundation Trust; Cambridge UK
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Ge Y, O'Brien RT, Shieh CC, Booth JT, Keall PJ. Toward the development of intrafraction tumor deformation tracking using a dynamic multi-leaf collimator. Med Phys 2014; 41:061703. [PMID: 24877798 PMCID: PMC4032435 DOI: 10.1118/1.4873682] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Revised: 03/31/2014] [Accepted: 04/14/2014] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Intrafraction deformation limits targeting accuracy in radiotherapy. Studies show tumor deformation of over 10 mm for both single tumor deformation and system deformation (due to differential motion between primary tumors and involved lymph nodes). Such deformation cannot be adapted to with current radiotherapy methods. The objective of this study was to develop and experimentally investigate the ability of a dynamic multi-leaf collimator (DMLC) tracking system to account for tumor deformation. METHODS To compensate for tumor deformation, the DMLC tracking strategy is to warp the planned beam aperture directly to conform to the new tumor shape based on real time tumor deformation input. Two deformable phantoms that correspond to a single tumor and a tumor system were developed. The planar deformations derived from the phantom images in beam's eye view were used to guide the aperture warping. An in-house deformable image registration software was developed to automatically trigger the registration once new target image was acquired and send the computed deformation to the DMLC tracking software. Because the registration speed is not fast enough to implement the experiment in real-time manner, the phantom deformation only proceeded to the next position until registration of the current deformation position was completed. The deformation tracking accuracy was evaluated by a geometric target coverage metric defined as the sum of the area incorrectly outside and inside the ideal aperture. The individual contributions from the deformable registration algorithm and the finite leaf width to the tracking uncertainty were analyzed. Clinical proof-of-principle experiment of deformation tracking using previously acquired MR images of a lung cancer patient was implemented to represent the MRI-Linac environment. Intensity-modulated radiation therapy (IMRT) treatment delivered with enabled deformation tracking was simulated and demonstrated. RESULTS The first experimental investigation of adapting to tumor deformation has been performed using simple deformable phantoms. For the single tumor deformation, the A(u)+A(o) was reduced over 56% when deformation was larger than 2 mm. Overall, the total improvement was 82%. For the tumor system deformation, the A(u)+A(o) reductions were all above 75% and the total A(u)+A(o) improvement was 86%. Similar coverage improvement was also found in simulating deformation tracking during IMRT delivery. The deformable image registration algorithm was identified as the dominant contributor to the tracking error rather than the finite leaf width. The discrepancy between the warped beam shape and the ideal beam shape due to the deformable registration was observed to be partially compensated during leaf fitting due to the finite leaf width. The clinical proof-of-principle experiment demonstrated the feasibility of intrafraction deformable tracking for clinical scenarios. CONCLUSIONS For the first time, we developed and demonstrated an experimental system that is capable of adapting the MLC aperture to account for tumor deformation. This work provides a potentially widely available management method to effectively account for intrafractional tumor deformation. This proof-of-principle study is the first experimental step toward the development of an image-guided radiotherapy system to treat deforming tumors in real-time.
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Affiliation(s)
- Yuanyuan Ge
- Radiation Physics Laboratory, University of Sydney, NSW 2006, Australia
| | - Ricky T O'Brien
- Radiation Physics Laboratory, University of Sydney, NSW 2006, Australia
| | - Chun-Chien Shieh
- Radiation Physics Laboratory, University of Sydney, NSW 2006, Australia
| | - Jeremy T Booth
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW 2065, Australia
| | - Paul J Keall
- Radiation Physics Laboratory, University of Sydney, NSW 2006, Australia
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Nelms BE, Opp D, Zhang G, Moros E, Feygelman V. Motion as perturbation. II. Development of the method for dosimetric analysis of motion effects with fixed-gantry IMRT. Med Phys 2014; 41:061704. [PMID: 24877799 DOI: 10.1118/1.4873691] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE In this work, the feasibility of implementing a motion-perturbation approach to accurately estimate volumetric dose in the presence of organ motion--previously demonstrated for VMAT--is studied for static gantry IMRT. The method's accuracy is improved for the voxels that have very low planned dose but acquire appreciable dose due to motion. The study describes the modified algorithm and its experimental validation and provides an example of a clinical application. METHODS A contoured region-of-interest is propagated according to the predefined motion kernel throughout time-resolved 4D phantom dose grids. This timed series of 3D dose grids is produced by the measurement-guided dose reconstruction algorithm, based on an irradiation of a static ARCCHECK (AC) helical dosimeter array (Sun Nuclear Corp., Melbourne, FL). Each moving voxel collects dose over the dynamic simulation. The difference in dose-to-moving voxel vs dose-to-static voxel in-phantom forms the basis of a motion perturbation correction that is applied to the corresponding voxel in the patient dataset. A new method to synchronize the accelerator and dosimeter clocks, applicable to fixed-gantry IMRT, was developed. Refinements to the algorithm account for the excursion of low dose voxels into high dose regions, causing appreciable dose increase due to motion (LDVE correction). For experimental validation, four plans using TG-119 structure sets and objectives were produced using segmented IMRT direct machine parameters optimization in Pinnacle treatment planning system (v. 9.6, Philips Radiation Oncology Systems, Fitchburg, WI). All beams were delivered with the gantry angle of 0°. Each beam was delivered three times: (1) to the static AC centered on the room lasers; (2) to a static phantom containing a MAPCHECK2 (MC2) planar diode array dosimeter (Sun Nuclear); and (3) to the moving MC2 phantom. The motion trajectory was an ellipse in the IEC XY plane, with 3 and 1.5 cm axes. The period was 5 s, with the resulting average motion speed of 1.45 cm/s. The motion-perturbed high resolution (2 mm voxel) volumetric dose grids on the MC2 phantom were generated for each beam. From each grid, a coronal dose plane at the detector level was extracted and compared to the corresponding moving MC2 measurement, using gamma analysis with both global (G) and local (L) dose-error normalization. RESULTS Using the TG-119 criteria of (3%G/3 mm), per beam average gamma analysis passing rates exceeded 95% in all cases. No individual beam had a passing rate below 91%. LDVE correction eliminated systematic disagreement patterns at the beams' aperture edges. In a representative example, application of LDVE correction improved (2%L/2 mm) gamma analysis passing rate for an IMRT beam from 74% to 98%. CONCLUSIONS The effect of motion on the moving region-of-interest IMRT dose can be estimated with a standard, static phantom QA measurement, provided the motion characteristics are independently known from 4D CT or otherwise. The motion-perturbed absolute dose estimates were validated by the direct planar diode array measurements, and were found to reliably agree with them in a homogeneous phantom.
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Affiliation(s)
| | - Daniel Opp
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida 33612
| | - Geoffrey Zhang
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida 33612
| | - Eduardo Moros
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida 33612
| | - Vladimir Feygelman
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida 33612
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Rosenzweig KE, Sura S. Image-Guided Radiation Therapy. Lung Cancer 2014. [DOI: 10.1002/9781118468791.ch20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Riegel AC, Bucci MK, Mawlawi OR, Ahmad M, Luo D, Chandler A, Pan T. Defining internal target volume using positron emission tomography for radiation therapy planning of moving lung tumors. J Appl Clin Med Phys 2014; 15:4600. [PMID: 24423860 PMCID: PMC5711243 DOI: 10.1120/jacmp.v15i1.4600] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 09/25/2013] [Accepted: 08/24/2013] [Indexed: 11/23/2022] Open
Abstract
Substantial disagreement exists over appropriate PET segmentation techniques for non-small cell lung cancer. Currently, no segmentation algorithm explicitly considers tumor motion in determining tumor borders. We developed an automatic PET segmentation model as a function of target volume, motion extent, and source-to-background ratio (the VMSBR model). The purpose of this work was to apply the VMSBR model and six other segmentation algorithms to a sample of lung tumors. PET and 4D CT were performed in the same imaging session for 23 patients (24 tumors) for radiation therapy planning. Internal target volumes (ITVs) were autosegmented on maximum intensity projection (MIP) of cine CT. ITVs were delineated on PET using the following methods: 15%, 35%, and 42% of maximum activity concentration, standardized uptake value (SUV) of 2.5 g/mL, 15% of mean activity concentration plus background, a linear function of mean SUV, and the VMSBR model. Predicted threshold values from each method were compared to measured optimal threshold values, and resulting volume magnitudes were compared to cine-CT-derived ITV. Correlation between predicted and measured threshold values ranged from slopes of 0.29 for the simplest single-threshold techniques to 0.90 for the VMSBR technique. R2 values ranged from 0.07 for the simplest single-threshold techniques to 0.86 for the VMSBR technique. The VMSBR segmentation technique that included volume, motion, and source-to-background ratio, produced accurate ITVs in patients when compared with cine-CT-derived ITV.
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Motion-specific internal target volumes for FDG-avid mediastinal and hilar lymph nodes. Radiother Oncol 2013; 109:112-6. [PMID: 24044792 DOI: 10.1016/j.radonc.2013.07.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Revised: 07/23/2013] [Accepted: 07/27/2013] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND PURPOSE To quantify the benefit of motion-specific internal target volumes for FDG-avid mediastinal and hilar lymph nodes generated using 4D-PET, vs. conventional internal target volumes generated using non-respiratory gated PET and 4D-CT scans. MATERIALS AND METHODS Five patients with FDG-avid tumors metastatic to 11 hilar or mediastinal lymph nodes were imaged with respiratory-correlated FDG-PET (4D-PET) and 4D-CT. FDG-avid nodes were contoured by a radiation oncologist in two ways. Standard-of-care volumes were contoured using conventional un-gated PET, 4D-CT, and breath-hold CT. A second, motion-specific, set of volumes were contoured using 4D-PET.Contours based on 4D-PET corresponded directly to an internal target volume (ITV(4D)), whereas contours based on un-gated PET were expanded by a series of exploratory isotropic margins (from 5 to 13 mm) based on literature recommendations on lymph node motion to form internal target volumes (ITV(3D)). RESULTS A 13 mm expansion of the un-gated PET nodal volume was needed to cover the ITV(4D) for 10 of 11 nodes studied. The ITV(3D) based on a 13 mm expansion included on average 45 cm(3) of tissue that was not included in the ITV(4D). CONCLUSIONS Motion-specific lymph-node internal target volumes generated from 4D-PET imaging could be used to improve accuracy and/or reduce normal-tissue irradiation compared to the standard-of-care un-gated PET based internal target volumes.
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Stambaugh C, Nelms BE, Dilling T, Stevens C, Latifi K, Zhang G, Moros E, Feygelman V. Experimentally studied dynamic dose interplay does not meaningfully affect target dose in VMAT SBRT lung treatments. Med Phys 2013; 40:091710. [DOI: 10.1118/1.4818255] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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Johnston AJ, Bishop SM, Martin L, See TC, Streater CT. Defining peripherally inserted central catheter tip position and an evaluation of insertions in one unit. Anaesthesia 2013; 68:484-91. [PMID: 23488895 DOI: 10.1111/anae.12188] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2013] [Indexed: 11/28/2022]
Abstract
Peripherally inserted central catheters are increasingly used to provide access to the central venous circulation. They are commonly positioned 'blind' using a variety of anthropometric techniques and operator experience to direct insertion length. Malposition rates are poorly defined because of differing insertion techniques, difficulties defining anatomical tip position on chest radiographs, controversy over what constitutes an adequate catheter position and possible differences between patient groups. We have developed a reproducible method to define catheter positions on chest radiograph and have applied this in a retrospective analysis of 256 ICU and 243 non-ICU catheter insertions over a 6-month period. Two different definitions were used for adequate position. 'Blind' positioning of peripherally inserted central catheters was associated with a definition-dependent malposition rate of 42-76%. Malposition rates were significantly higher in ICU patients. Emerging technologies may assist in reducing these high rates.
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Affiliation(s)
- A J Johnston
- John Farman Intensive Care Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
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The intracavitary ECG method for positioning the tip of central venous catheters: results of an Italian multicenter study. J Vasc Access 2013; 13:357-65. [PMID: 22328361 DOI: 10.5301/jva.2012.9020] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2011] [Indexed: 12/11/2022] Open
Abstract
PURPOSE The aim of this multicenter study was to assess the feasibility, safety, and accuracy of the intracavitary ECG method for real-time positioning of the tip of different types of central venous catheters. METHODS A total of 1444 catheter insertions in adult patients were studied in eight Italian centers (539 ports, 245 PICCs, 325 tunneled CVCs, 335 non-tunneled CVCs). Patients with no visible P wave at the standard baseline ECG were excluded. Depending on the type of catheter and its purpose, the target was to position the tip either (a) at the cavo-atrial junction, or (b) in the lower third of the superior vena cava, or (c) in the upper part of the atrium. The final position was verified by a post-procedural chest x-ray. RESULTS The method was feasible in 99.3% of all cases. There were no complications potentially related to the method itself. At the final x-ray control, 83% of all tips were positioned exactly at the target; 12.4% were positioned within 1-2 cm from the target, but still in a correct central position; only 3.8% were malpositioned. The mismatch between intra-procedural ECG method and post-procedural x-ray was significantly lower when the x-ray was taken in supine position. CONCLUSIONS Our multicenter study confirms that the intracavitary ECG method for real time verification of tip position is accurate, safe, feasible in all adult patients and applicable to any type of short-term or long-term central venous access device.
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Wang S, Li J, Zhang Y, Wang W, Li F, Fan T, Xu M, Shao Q. Measurement of intra-fraction displacement of the mediastinal metastatic lymph nodes using four-dimensional CT in non-small cell lung cancer. Korean J Radiol 2012; 13:417-24. [PMID: 22778563 PMCID: PMC3384823 DOI: 10.3348/kjr.2012.13.4.417] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Accepted: 12/29/2011] [Indexed: 11/15/2022] Open
Abstract
Objective To measure the intra-fraction displacements of the mediastinal metastatic lymph nodes by using four-dimensional CT (4D-CT) in non-small cell lung cancer (NSCLC). Materials and Methods Twenty-four patients with NSCLC, who were to be treated by using three dimensional conformal radiation therapy (3D-CRT), underwent a 4D-CT simulation during free breathing. The mediastinal metastatic lymph nodes were delineated on the CT images of 10 phases of the breath cycle. The lymph nodes were grouped as the upper, middle and lower mediastinal groups depending on the mediastinal regions. The displacements of the center of the lymph node in the left-right (LR), anterior-posterior (AP), and superior-inferior (SI) directions were measured. Results The mean displacements of the center of the mediastinal lymph node in the LR, AP, and SI directions were 2.24 mm, 1.87 mm, and 3.28 mm, respectively. There were statistically significant differences between the displacements in the SI and LR, and the SI and AP directions (p < 0.05). For the middle and lower mediastinal lymph nodes, the displacement difference between the AP and SI was statistically significant (p = 0.005; p = 0.015), while there was no significant difference between the LR and AP directions (p < 0.05). Conclusion The metastatic mediastinal lymph node movements are different in the LR, AP, and SI directions in patients with NSCLC, particularly for the middle and lower mediastinal lymph nodes. The spatial non-uniform margins should be considered for the metastatic mediastinal lymph nodes in involved-field radiotherapy.
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Affiliation(s)
- Suzhen Wang
- Department of Radiation Oncology, Shandong Cancer Hospital & Institute, Jinan 250117, China
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Yu P, Sheah K, Poh CL. Automating the tracking of lymph nodes in follow-up studies of thoracic CT images. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2012; 106:150-159. [PMID: 20934774 DOI: 10.1016/j.cmpb.2010.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Revised: 08/31/2010] [Accepted: 09/14/2010] [Indexed: 05/30/2023]
Abstract
The study of lymph node features over time is of great clinical significance. Tracking of the same lymph node in CT images over time is done manually in the current clinical practice, which is tedious and lack of consistency. In this paper, we propose a search scheme to automate the process. Regions of interest (ROIs) are located by mapping the center point of lymph node based on the transformation found in the rigid registration. Similarity values between ROI of the template image and ROIs of repository images are compared, the highest of which decides the best match. Our method generated a success rate of 82% in determining the corresponding image in follow-up scan with the same lymph node as in baseline. The location of the lymph node in the corresponding image is tracked and estimated by mapping the lymph node center at baseline image using the transformation obtained from both affine and free-form deformation (FFD) registration. FFD performs better than affine registration in tracking the lymph node location. All lymph nodes in our study are tracked successfully by the suggested points which fall within the boundary of the same node in the corresponding follow-up images using FFD registration.
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Affiliation(s)
- Peicong Yu
- Division of Bioengineering, School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore
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Robertson SP, Weiss E, Hugo GD. Localization accuracy from automatic and semi-automatic rigid registration of locally-advanced lung cancer targets during image-guided radiation therapy. Med Phys 2012; 39:330-41. [PMID: 22225303 DOI: 10.1118/1.3671929] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE To evaluate localization accuracy resulting from rigid registration of locally-advanced lung cancer targets using fully automatic and semi-automatic protocols for image-guided radiation therapy. METHODS Seventeen lung cancer patients, fourteen also presenting with involved lymph nodes, received computed tomography (CT) scans once per week throughout treatment under active breathing control. A physician contoured both lung and lymph node targets for all weekly scans. Various automatic and semi-automatic rigid registration techniques were then performed for both individual and simultaneous alignments of the primary gross tumor volume (GTV(P)) and involved lymph nodes (GTV(LN)) to simulate the localization process in image-guided radiation therapy. Techniques included "standard" (direct registration of weekly images to a planning CT), "seeded" (manual prealignment of targets to guide standard registration), "transitive-based" (alignment of pretreatment and planning CTs through one or more intermediate images), and "rereferenced" (designation of a new reference image for registration). Localization error (LE) was assessed as the residual centroid and border distances between targets from planning and weekly CTs after registration. RESULTS Initial bony alignment resulted in centroid LE of 7.3 ± 5.4 mm and 5.4 ± 3.4 mm for the GTV(P) and GTV(LN), respectively. Compared to bony alignment, transitive-based and seeded registrations significantly reduced GTV(P) centroid LE to 4.7 ± 3.7 mm (p = 0.011) and 4.3 ± 2.5 mm (p < 1 × 10(-3)), respectively, but the smallest GTV(P) LE of 2.4 ± 2.1 mm was provided by rereferenced registration (p < 1 × 10(-6)). Standard registration significantly reduced GTV(LN) centroid LE to 3.2 ± 2.5 mm (p < 1 × 10(-3)) compared to bony alignment, with little additional gain offered by the other registration techniques. For simultaneous target alignment, centroid LE as low as 3.9 ± 2.7 mm and 3.8 ± 2.3 mm were achieved for the GTV(P) and GTV(LN), respectively, using rereferenced registration. CONCLUSIONS Target shape, volume, and configuration changes during radiation therapy limited the accuracy of standard rigid registration for image-guided localization in locally-advanced lung cancer. Significant error reductions were possible using other rigid registration techniques, with LE approaching the lower limit imposed by interfraction target variability throughout treatment.
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Affiliation(s)
- Scott P Robertson
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia 23298, USA
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Senthi S, Senan S. Imaging for high-precision thoracic radiotherapy. J Thorac Dis 2012; 4:106-8. [PMID: 22833813 PMCID: PMC3378236 DOI: 10.3978/j.issn.2072-1439.2012.03.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Accepted: 03/14/2012] [Indexed: 01/19/2023]
Affiliation(s)
- Sashendra Senthi
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
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Weiss E, Robertson SP, Mukhopadhyay N, Hugo GD. Tumor, lymph node, and lymph node-to-tumor displacements over a radiotherapy series: analysis of interfraction and intrafraction variations using active breathing control (ABC) in lung cancer. Int J Radiat Oncol Biol Phys 2011; 82:e639-45. [PMID: 22197237 DOI: 10.1016/j.ijrobp.2011.08.021] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Revised: 06/12/2011] [Accepted: 08/26/2011] [Indexed: 12/25/2022]
Abstract
PURPOSE To estimate errors in soft tissue-based image guidance due to relative changes between primary tumor (PT) and affected lymph node (LN) position and volume, and to compare the results with bony anatomy-based displacements of PTs and LNs during radiotherapy of lung cancer. METHODS AND MATERIALS Weekly repeated breath-hold computed tomography scans were acquired in 17 lung cancer patients undergoing radiotherapy. PTs and affected LNs were manually contoured on all scans after rigid registration. Interfraction and intrafraction displacements in the centers of mass of PTs and LNs relative to bone, as well as LNs relative to PTs (LN-PT), were calculated. RESULTS The mean volume after 5 weeks was 65% for PTs and 63% for LNs. Systematic and random interfraction displacements were 2.6 to 4.6 mm and 2.7 to 2.9 mm, respectively, for PTs; 2.4 to 3.8 mm and 1.4 to 2.7 mm, respectively, for LNs; and 2.3 to 3.9 mm and 1.9 to 2.8 mm, respectively, for LN-PT. Systematic and random intrafraction displacements were less than 1 mm except in the superoinferior direction. Interfraction LN-PT displacements greater than 3 mm were observed in 67% of fractions and require a safety margin of 12 mm in the lateral direction, 11 mm in the anteroposterior direction, and 9 mm in the superoinferior direction. LN-PT displacements displayed significant time trends (p < 0.0001) and depended on the presence of pathoanatomic conditions of the ipsilateral lung, such as atelectasis. CONCLUSION Interfraction LN-PT displacements were mostly systematic and comparable to bony anatomy-based displacements of PTs or LNs alone. Time trends, large volume changes, and the influence of pathoanatomic conditions underline the importance of soft tissue-based image guidance and the potential of plan adaptation.
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Affiliation(s)
- Elisabeth Weiss
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA 23298, USA.
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Radiothérapie conformationnelle avec modulation d’intensité pour les tumeurs thoraciques : une liaison dangereuse ? Expérience de l’institut Gustave-Roussy dans le traitement des lymphomes hodgkiniens médiastinaux. Cancer Radiother 2011; 15:546-8. [DOI: 10.1016/j.canrad.2011.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2011] [Accepted: 06/16/2011] [Indexed: 12/25/2022]
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Phase I dose escalation trial of hypofractionated limited-field external beam thoracic radiotherapy for limited-stage small cell carcinoma of the lung. Radiother Oncol 2010; 96:78-83. [DOI: 10.1016/j.radonc.2010.05.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2009] [Revised: 05/19/2010] [Accepted: 05/19/2010] [Indexed: 11/22/2022]
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Malinowski KT, Pantarotto JR, Senan S, McAvoy TJ, D'Souza WD. Inferring positions of tumor and nodes in Stage III lung cancer from multiple anatomical surrogates using four-dimensional computed tomography. Int J Radiat Oncol Biol Phys 2010; 77:1553-60. [PMID: 20605343 DOI: 10.1016/j.ijrobp.2009.12.064] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2009] [Revised: 11/12/2009] [Accepted: 12/18/2009] [Indexed: 12/25/2022]
Abstract
PURPOSE To investigate the feasibility of modeling Stage III lung cancer tumor and node positions from anatomical surrogates. METHODS AND MATERIALS To localize their centroids, the primary tumor and lymph nodes from 16 Stage III lung cancer patients were contoured in 10 equal-phase planning four-dimensional (4D) computed tomography (CT) image sets. The centroids of anatomical respiratory surrogates (carina, xyphoid, nipples, mid-sternum) in each image set were also localized. The correlations between target and surrogate positions were determined, and ordinary least-squares (OLS) and partial least-squares (PLS) regression models based on a subset of respiratory phases (three to eight randomly selected) were created to predict the target positions in the remaining images. The three-phase image sets that provided the best predictive information were used to create models based on either the carina alone or all surrogates. RESULTS The surrogate most correlated with target motion varied widely. Depending on the number of phases used to build the models, mean OLS and PLS errors were 1.0 to 1.4 mm and 0.8 to 1.0 mm, respectively. Models trained on the 0%, 40%, and 80% respiration phases had mean (+/- standard deviation) PLS errors of 0.8 +/- 0.5 mm and 1.1 +/- 1.1 mm for models based on all surrogates and carina alone, respectively. For target coordinates with motion >5 mm, the mean three-phase PLS error based on all surrogates was 1.1 mm. CONCLUSIONS Our results establish the feasibility of inferring primary tumor and nodal motion from anatomical surrogates in 4D CT scans of Stage III lung cancer. Using inferential modeling to decrease the processing time of 4D CT scans may facilitate incorporation of patient-specific treatment margins.
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Affiliation(s)
- Kathleen T Malinowski
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD 21201, USA
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Pantarotto JR, Piet AH, Vincent A, van Sörnsen de Koste JR, Senan S. Motion Analysis of 100 Mediastinal Lymph Nodes: Potential Pitfalls in Treatment Planning and Adaptive Strategies. Int J Radiat Oncol Biol Phys 2009; 74:1092-9. [DOI: 10.1016/j.ijrobp.2008.09.031] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2008] [Revised: 07/27/2008] [Accepted: 09/28/2008] [Indexed: 12/25/2022]
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Wang L, Hayes S, Paskalev K, Jin L, Buyyounouski MK, Ma CCM, Feigenberg S. Dosimetric comparison of stereotactic body radiotherapy using 4D CT and multiphase CT images for treatment planning of lung cancer: Evaluation of the impact on daily dose coverage. Radiother Oncol 2009; 91:314-24. [DOI: 10.1016/j.radonc.2008.11.018] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2008] [Revised: 11/12/2008] [Accepted: 11/16/2008] [Indexed: 01/23/2023]
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Ezhil M, Vedam S, Balter P, Choi B, Mirkovic D, Starkschall G, Chang JY. Determination of patient-specific internal gross tumor volumes for lung cancer using four-dimensional computed tomography. Radiat Oncol 2009; 4:4. [PMID: 19173738 PMCID: PMC2645420 DOI: 10.1186/1748-717x-4-4] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2008] [Accepted: 01/27/2009] [Indexed: 12/25/2022] Open
Abstract
Background To determine the optimal approach to delineating patient-specific internal gross target volumes (IGTV) from four-dimensional (4-D) computed tomography (CT) image data sets used in the planning of radiation treatment for lung cancers. Methods We analyzed 4D-CT image data sets of 27 consecutive patients with non-small-cell lung cancer (stage I: 17, stage III: 10). The IGTV, defined to be the envelope of respiratory motion of the gross tumor volume in each 4D-CT data set was delineated manually using four techniques: (1) combining the gross tumor volume (GTV) contours from ten respiratory phases (IGTVAllPhases); (2) combining the GTV contours from two extreme respiratory phases (0% and 50%) (IGTV2Phases); (3) defining the GTV contour using the maximum intensity projection (MIP) (IGTVMIP); and (4) defining the GTV contour using the MIP with modification based on visual verification of contours in individual respiratory phase (IGTVMIP-Modified). Using the IGTVAllPhases as the optimum IGTV, we compared volumes, matching indices, and extent of target missing using the IGTVs based on the other three approaches. Results The IGTVMIP and IGTV2Phases were significantly smaller than the IGTVAllPhases (p < 0.006 for stage I and p < 0.002 for stage III). However, the values of the IGTVMIP-Modified were close to those determined from IGTVAllPhases (p = 0.08). IGTVMIP-Modified also matched the best with IGTVAllPhases. Conclusion IGTVMIP and IGTV2Phases underestimate IGTVs. IGTVMIP-Modified is recommended to improve IGTV delineation in lung cancer.
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Affiliation(s)
- Muthuveni Ezhil
- Department of Radiation Oncology, The University of Texas M, D, Anderson Cancer Center, Houston, USA.
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Use of Maximum Intensity Projections (MIPs) for Target Outlining in 4DCT Radiotherapy Planning. J Thorac Oncol 2008; 3:1433-8. [DOI: 10.1097/jto.0b013e31818e5db7] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Soltys SG, Kalani MYS, Cheshier SH, Szabo KA, Lo A, Chang SD. Stereotactic radiosurgery for a cardiac sarcoma: a case report. Technol Cancer Res Treat 2008; 7:363-8. [PMID: 18783285 DOI: 10.1177/153303460800700502] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Pulmonary artery intimal sarcoma is an uncommon tumor with a poor prognosis. We report a case of a 75-year-old man with a pulmonary artery sarcoma, recurrent following surgical resection. To palliate symptoms of this recurrence, he underwent CyberKnife stereotactic radiosurgery with a clinical and radiographic response of his treated disease. No acute or sub-acute toxicity was seen until the patient's death due to metastatic disease 10 weeks following treatment. The feasibility and short-term safety of this technique are reviewed, with emphasis on the stereotactic planning considerations, such as mediastinal organ movement and radiation tolerance.
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Affiliation(s)
- Scott G Soltys
- Department of Radiation Oncology, Stanford University Medical Center.
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Radiotherapy for lung cancer: clinical impact of recent technical advances. Lung Cancer 2008; 64:1-8. [PMID: 18771814 DOI: 10.1016/j.lungcan.2008.07.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2008] [Revised: 07/07/2008] [Accepted: 07/21/2008] [Indexed: 12/25/2022]
Abstract
Radiation oncology plays an important role in the curative treatment of patients with lung cancer. New technological developments have enabled delivery of higher radiation doses while better sparing surrounding normal tissues, thereby increasing the likelihood of local control without increased toxicity. Multi-modality imaging enables better target definition, improved planning software allows for correct calculation of delivered doses, and tools to verify accurate treatment delivery are now available. A good example of the results of applying these developments is the high local control rates achieved in stage I NSCLC with stereotactic radiotherapy (SRT). These advances are rapidly becoming available outside academic institutions, and pulmonologists, surgeons and medical oncologists need to understand and critically assess the potential impact of such developments in the routine care of their patients. Aspects of cost-effectiveness of technical innovations, as well as the level of evidence required before widespread clinical implementation, will be addressed.
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Samant SS, Xia J, Muyan-Ozcelik P, Owens JD. High performance computing for deformable image registration: Towards a new paradigm in adaptive radiotherapy. Med Phys 2008; 35:3546-53. [PMID: 18777915 DOI: 10.1118/1.2948318] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Sanjiv S Samant
- Department of Nuclear and Radiological Engineering, University of Florida, Gainesville, Florida 32611-8300, USA.
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Tateishi U, Tsukagoshi S, Inokawa H, Okumura M, Moriyama N. Fluctuation in measurements of pulmonary nodule under tidal volume ventilation on four-dimensional computed tomography: preliminary results. Eur Radiol 2008; 18:2132-9. [DOI: 10.1007/s00330-008-1002-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2007] [Revised: 02/25/2008] [Accepted: 02/28/2008] [Indexed: 12/21/2022]
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