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Marasini S, Cole M, Curcuru A, Dyke LM, Gach HM, Flores R, Kim T. Characterization of real-time cine MR imaging distortion on 0.35 T MRgRT with concentric cine imaging QA phantom. Phys Med Biol 2024; 69:065009. [PMID: 38408387 DOI: 10.1088/1361-6560/ad2d33] [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: 09/18/2023] [Accepted: 02/26/2024] [Indexed: 02/28/2024]
Abstract
Objective. Real-time MRgRT uses 2D-cine imaging for target tracking and motion evaluation. Rotation of gantry inducedB0off-resonance, resulting in image artifacts and imaging isocenter-shift precluding MR-guided arc therapy. Standard MRI phantoms designed for higher resolution images face challenges when low-resolution cine imaging is needed to achieve high frame rates. This work aimed to examine the spatial accuracy including geometric distortion and isocenter shift in real-time during gantry rotation on a 0.35 T MR-Linac using the concentric Cine imaging quality assurance (QA) phantom and its associated image analysis software.Approach. The Cine imaging QA phantom consists of two concentric shells of low-T1mineral oil and a central alignment structure. The phantom was scanned on three different MRI systems; 0.55 T Siemens Free.Max, 1.5 T Philips Ingenia, and 0.35 T ViewRay MRIdian MR-Linac using 2D balanced steady-state free precession (bSSFP) imaging sequence. In addition, bSSFP cine MRI with the banding artifact correction was tested on 0.35 T ViewRay MR-Linac. Images from the MR-Linac were acquired with the Linac gantry stationary and rotating from gantry 300°→ 0° and vice versa. Three orthogonal image planes were scanned excluding the 1.5 T Philips Ingenia, where only the axial plane was scanned. The image analysis software calculated the distortion values as well as the isocenter position for each cine frame.Main results. The geometric distortion of cine imaging on MRIs and MR-Linac at gantry stationary are within 1 mm while the substantial geometric distortion of 2 and 2.2 mm were observed on 0.35 T MR-Linac while rotating the gantry clockwise (300°→ 0°) and counterclockwise 0°→ 300° respectively. The average imaging isocenter shift was 0.1 mm for both MRIs and the static gantry and imaging isocenter shift of ≤1.5 mm was observed during the gantry rotation. The imaging isocenter shift decreased by 1 ± 0.2 mm clockwise and counterclockwise withB0compensation.Significance. The concentric Cine imaging QA phantom and its associated software effectively demonstrate the image distortion on real-time cine imaging on regular MRIs and 0.35 T MR-Linac. The results of significant geometric distortion with a rotating gantry in the MR-Linac system require further investigation to alleviate the extent of the image distortion.
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Affiliation(s)
- Shanti Marasini
- Departments of Radiation Oncology, Washington University School of Medicine, St. Louis, MO,United States of America
| | | | - Austen Curcuru
- Departments of Radiation Oncology, Washington University School of Medicine, St. Louis, MO,United States of America
| | - Lara M Dyke
- Departments of Radiation Oncology, Washington University School of Medicine, St. Louis, MO,United States of America
| | - H Michael Gach
- Departments of Radiation Oncology, Washington University School of Medicine, St. Louis, MO,United States of America
- Department of Radiology, Washington University School of Medicine, St. Louis, MO, United States of America
- Departments of Biomedical Engineering, Washington University in St. Louis, MO, United States of America
| | | | - Taeho Kim
- Departments of Radiation Oncology, Washington University School of Medicine, St. Louis, MO,United States of America
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Kim J, Keum KC, Lee H, Hong CS, Park K, Kim JS. Image quality of 4D in-treatment CBCT acquired during lung SBRT using FFF beam: a phantom study. Radiat Oncol 2020; 15:224. [PMID: 32977808 PMCID: PMC7519557 DOI: 10.1186/s13014-020-01668-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 09/14/2020] [Indexed: 12/25/2022] Open
Abstract
Background Rotational beam delivery enables concurrent acquisition of cone-beam CT (CBCT), thereby facilitating further geometric verification of patient setup during radiation treatment. However, it is challenging to acquire CBCT during stereotactic body radiation therapy (SBRT) using flattening-filter free X-ray beams, in which a high radiation dose is delivered. This study presents quantitative evaluation results of the image quality in four-dimensional (4D) in-treatment CBCT acquired during SBRT delivery. Methods The impact of megavoltage (MV) scatter and acquisition parameters on the image quality was evaluated using Catphan 503 and XSight lung tracking phantoms. The in-treatment CBCT images of the phantoms were acquired while delivering 16 SBRT plans. The uniformity, contrast, and contrast-to-noise ratio (CNR) of the in-treatment CBCT images were calculated and compared to those of CBCT images acquired without SBRT delivery. Furthermore, the localizing accuracy of the moving target in the XSight lung phantom was evaluated for 10 respiratory phases. Results The CNR of the 3D-reconstucted Catphan CBCT images was reduced from 6.3 to 2.6 due to the effect of MV treatment scatter. Both for the Catphan and XSight phantoms, the CBCT image quality was affected by the tube current and monitor units (MUs) of the treatment plan. The lung target in the XSight tracking phantom was most visible for extreme phases; the mean CNRs of the lung target in the in-treatment CBCT images (with 40 mA tube current) across the SBRT plans were 3.2 for the end-of-exhalation phase and 3.0 for the end-of-inhalation phase. The lung target was localized with sub-millimeter accuracy for the extreme respiratory phases. Conclusions Full-arc acquisition with an increased tube current (e.g. 40 mA) is recommended to compensate for degradation in the CBCT image quality due to unflattened MV beam scatter. Acquiring in-treatment CBCT with a high-MU treatment beam is also suggested to improve the resulting CBCT image quality.
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Affiliation(s)
- Jihun Kim
- Department of Radiation Oncology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemoon-gu, Seoul, South Korea
| | - Ki Chang Keum
- Department of Radiation Oncology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemoon-gu, Seoul, South Korea
| | - Ho Lee
- Department of Radiation Oncology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemoon-gu, Seoul, South Korea
| | - Chae-Seon Hong
- Department of Radiation Oncology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemoon-gu, Seoul, South Korea
| | - Kwangwoo Park
- Department of Radiation Oncology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemoon-gu, Seoul, South Korea
| | - Jin Sung Kim
- Department of Radiation Oncology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemoon-gu, Seoul, South Korea.
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Estimation of respiratory phases during proton radiotherapy from a 4D-CT and Prompt gamma detection profiles. Phys Med 2019; 64:33-39. [DOI: 10.1016/j.ejmp.2019.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 05/16/2019] [Accepted: 06/15/2019] [Indexed: 11/21/2022] Open
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Nakayama M, Uehara K, Nishimura H, Tamura S, Munetomo Y, Tsudou S, Mayahara H, Mukumoto N, Geso M, Sasaki R. Retrospective assessment of a single fiducial marker tracking regimen with robotic stereotactic body radiation therapy for liver tumours. Rep Pract Oncol Radiother 2019; 24:383-391. [PMID: 31297039 DOI: 10.1016/j.rpor.2019.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 03/22/2019] [Accepted: 06/01/2019] [Indexed: 12/25/2022] Open
Abstract
Aim To investigate tumour motion tracking uncertainties in the CyberKnife Synchrony system with single fiducial marker in liver tumours. Background In the fiducial-based CyberKnife real-time tumour motion tracking system, multiple fiducial markers are generally used to enable translation and rotation corrections during tracking. However, sometimes a single fiducial marker is employed when rotation corrections are not estimated during treatment. Materials and methods Data were analysed for 32 patients with liver tumours where one fiducial marker was implanted. Four-dimensional computed tomography (CT) scans were performed to determine the internal target volume (ITV). Before the first treatment fraction, the CT scans were repeated and the marker migration was determined. Log files generated by the Synchrony system were obtained after each treatment and the correlation model errors were calculated. Intra-fractional spine rotations were examined on the spine alignment images before and after each treatment. Results The mean (standard deviation) ITV margin was 4.1 (2.3) mm, which correlated weakly with the distance between the fiducial marker and the tumour. The mean migration distance of the marker was 1.5 (0.7) mm. The overall mean correlation model error was 1.03 (0.37) mm in the radial direction. The overall mean spine rotations were 0.27° (0.31), 0.25° (0.22), and 0.23° (0.26) for roll, pitch, and yaw, respectively. The treatment time was moderately associated with the correlation model errors and weakly related to spine rotation in the roll and yaw planes. Conclusions More caution and an additional safety margins are required when tracking a single fiducial marker.
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Key Words
- AP, anterior–posterior
- CTV, clinical target volume
- CyberKnife
- Fiducial marker tracking
- GTV, gross tumour volume
- ITV, internal target volume
- LED, light-emitting diode
- LR, left–right
- Liver tumour
- PTV, planning target volume
- SBRT, stereotactic body radiation therapy
- SD, standard deviation
- SI, superior–inferior
- Synchrony system
- XST, Xsight Spine Tracking
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Affiliation(s)
- Masao Nakayama
- Division of Radiation Oncology, Kobe University Graduate School of Medicine, 7-5-2 Kusunokicho, Chuou-ku, Kobe City, Hyogo 650-0017, Japan.,Discipline of Medical Radiations, School of Biomedical & Health Sciences, RMIT University, Bundoora Campus, Victoria 3083, Australia
| | - Kazuyuki Uehara
- Division of Radiation Oncology, Kobe Minimally Invasive Cancer Center, 8-5-1 Minatojima-nakamachi, Chuou-ku, Kobe City, Hyogo 650-0046, Japan
| | - Hideki Nishimura
- Division of Radiation Oncology, Kobe University Graduate School of Medicine, 7-5-2 Kusunokicho, Chuou-ku, Kobe City, Hyogo 650-0017, Japan
| | - Shuhei Tamura
- Division of Radiation Oncology, Kobe Minimally Invasive Cancer Center, 8-5-1 Minatojima-nakamachi, Chuou-ku, Kobe City, Hyogo 650-0046, Japan
| | - Yoshiki Munetomo
- Division of Radiation Oncology, Kobe Minimally Invasive Cancer Center, 8-5-1 Minatojima-nakamachi, Chuou-ku, Kobe City, Hyogo 650-0046, Japan
| | - Shinji Tsudou
- Department of Radiation Oncology, Hyogo Cancer Center, 13-70 Kitaojicho, Akashi City, Hyogo 637-8558, Japan
| | - Hiroshi Mayahara
- Division of Radiation Oncology, Kobe Minimally Invasive Cancer Center, 8-5-1 Minatojima-nakamachi, Chuou-ku, Kobe City, Hyogo 650-0046, Japan
| | - Naritoshi Mukumoto
- Division of Radiation Oncology, Kobe University Graduate School of Medicine, 7-5-2 Kusunokicho, Chuou-ku, Kobe City, Hyogo 650-0017, Japan
| | - Moshi Geso
- Discipline of Medical Radiations, School of Biomedical & Health Sciences, RMIT University, Bundoora Campus, Victoria 3083, Australia
| | - Ryohei Sasaki
- Division of Radiation Oncology, Kobe University Graduate School of Medicine, 7-5-2 Kusunokicho, Chuou-ku, Kobe City, Hyogo 650-0017, Japan
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Liu M, Cygler JE, Vandervoort E. Geometrical tracking accuracy and appropriate PTV margins for robotic radiosurgery of liver lesions by SBRT. Acta Oncol 2019; 58:906-915. [PMID: 30799669 DOI: 10.1080/0284186x.2019.1578896] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Purpose: To assess the geometrical accuracy and estimate adequate PTV margins for liver treatments using the Synchrony respiratory tracking system. Material and methods: Treatment log files are analyzed for 72 liver patients to assess tracking accuracy. The tracking error is calculated as the quadratic sum of the correlation, the predictor and the beam positioning errors. Treatment target rotations and rigid body errors reported by the system are also evaluated. The impact of uncorrected rotations is assessed by rotating the planned dose distribution and reassessing target coverage. Total PTV margins are estimated by summing in quadrature tracking errors and rigid body errors. Relationships are explored between tracking errors, model linearity and motion amplitudes of internal and external markers. Results: Margins of 3, 2, 2 mm in SUP-INF, LT-RT and ANT-POST directions, respectively, are sufficient to account for tracking and beam positioning errors for 95% of patients. If rigid body error is also considered, margins increase to 4 mm isotropic. Rotations could not be corrected for 92% of patients due to imperfect fiducial implantation and limitations in the magnitude of corrections that the system can apply. Uncorrected rotations would lead to average estimated dose reductions of 2.7% ± 5.8% of the prescribed dose for D99 of GTVs (5 mm PTV expansion) in which the target was well covered in the original plan (28 of 31 GTVs). 80% of tracking models exhibit near linear correlation between internal and external marker motions with small tracking errors (<2.2 mm). Conclusions: Isotropic PTV margins considering tracking errors and target rigid body errors could be used for liver SBRT treatments if rotational corrections can be calculated accurately so that systematic rotational offsets can be avoided. The linearity of the internal and external breathing motions might be useful for other types of treatment modalities for liver cancer.
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Affiliation(s)
- Ming Liu
- Department of Physics, Carleton University, Ottawa, Canada
| | - Joanna E. Cygler
- Department of Physics, Carleton University, Ottawa, Canada
- Department of Medical Physics, The Ottawa Hospital Cancer Centre, Ottawa, Canada
- Department of Radiology, University of Ottawa, Ottawa, Canada
| | - Eric Vandervoort
- Department of Physics, Carleton University, Ottawa, Canada
- Department of Medical Physics, The Ottawa Hospital Cancer Centre, Ottawa, Canada
- Department of Radiology, University of Ottawa, Ottawa, Canada
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Ricotti R, Seregni M, Ciardo D, Vigorito S, Rondi E, Piperno G, Ferrari A, Zerella MA, Arculeo S, Francia CM, Sibio D, Cattani F, De Marinis F, Spaggiari L, Orecchia R, Riboldi M, Baroni G, Jereczek-Fossa BA. Evaluation of target coverage and margins adequacy during CyberKnife Lung Optimized Treatment. Med Phys 2018; 45:1360-1368. [DOI: 10.1002/mp.12804] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 12/26/2017] [Accepted: 01/29/2018] [Indexed: 11/10/2022] Open
Affiliation(s)
- Rosalinda Ricotti
- Division of Radiation Oncology; European Institute of Oncology; Milan Italy
| | - Matteo Seregni
- Dipartimento di Elettronica Informazione e Bioingegneria; Politecnico di Milano; Milan Italy
| | - Delia Ciardo
- Division of Radiation Oncology; European Institute of Oncology; Milan Italy
| | - Sabrina Vigorito
- Unit of Medical Physics; European Institute of Oncology; Milan Italy
| | - Elena Rondi
- Unit of Medical Physics; European Institute of Oncology; Milan Italy
| | - Gaia Piperno
- Division of Radiation Oncology; European Institute of Oncology; Milan Italy
| | - Annamaria Ferrari
- Division of Radiation Oncology; European Institute of Oncology; Milan Italy
| | - Maria Alessia Zerella
- Department of Oncology and Hemato-oncology; University of Milan; Milan Italy
- Division of Radiation Oncology; European Institute of Oncology; Milan Italy
| | - Simona Arculeo
- Department of Oncology and Hemato-oncology; University of Milan; Milan Italy
- Division of Radiation Oncology; European Institute of Oncology; Milan Italy
| | - Claudia Maria Francia
- Department of Oncology and Hemato-oncology; University of Milan; Milan Italy
- Division of Radiation Oncology; European Institute of Oncology; Milan Italy
| | - Daniela Sibio
- Department of Oncology and Hemato-oncology; University of Milan; Milan Italy
- Division of Radiation Oncology; European Institute of Oncology; Milan Italy
| | - Federica Cattani
- Unit of Medical Physics; European Institute of Oncology; Milan Italy
| | - Filippo De Marinis
- Division of Thoracic Oncology; European Institute of Oncology; Milan Italy
| | - Lorenzo Spaggiari
- Department of Oncology and Hemato-oncology; University of Milan; Milan Italy
- Division of Thoracic Oncology; European Institute of Oncology; Milan Italy
| | - Roberto Orecchia
- Scientific Directorate; European Institute of Oncology; Milan Italy
- Department of Medical Imaging and Radiation Sciences; European Institute of Oncology; Milan Italy
| | - Marco Riboldi
- Dipartimento di Elettronica Informazione e Bioingegneria; Politecnico di Milano; Milan Italy
| | - Guido Baroni
- Dipartimento di Elettronica Informazione e Bioingegneria; Politecnico di Milano; Milan Italy
- Bioengineering Unit; Centro Nazionale di Adroterapia Oncologica (CNAO); Pavia Italy
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiation Oncology; European Institute of Oncology; Milan Italy
- Department of Oncology and Hemato-oncology; University of Milan; Milan Italy
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Stera S, Balermpas P, Chan MKH, Huttenlocher S, Wurster S, Keller C, Imhoff D, Rades D, Dunst J, Rödel C, Hildebrandt G, Blanck O. Breathing-motion-compensated robotic guided stereotactic body radiation therapy : Patterns of failure analysis. Strahlenther Onkol 2017; 194:143-155. [PMID: 28875297 DOI: 10.1007/s00066-017-1204-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 08/16/2017] [Indexed: 02/07/2023]
Abstract
PURPOSE We retrospectively evaluated the patterns of failure for robotic guided real-time breathing-motion-compensated (BMC) stereotactic body radiation therapy (SBRT) in the treatment of tumors in moving organs. PATIENTS AND METHODS Between 2011 and 2016, a total of 198 patients with 280 lung, liver, and abdominal tumors were treated with BMC-SBRT. The median gross tumor volume (GTV) was 12.3 cc (0.1-372.0 cc). Medians of mean GTV BEDα/β =10 Gy (BED = biological effective dose) was 148.5 Gy10 (31.5-233.3 Gy10) and prescribed planning target volume (PTV) BEDα/β =10 Gy was 89.7 Gy10 (28.8-151.2 Gy10), respectively. We analyzed overall survival (OS) and local control (LC) based on various factors, including BEDs with α/β ratios of 15 Gy (lung metastases), 21 Gy (primary lung tumors), and 27 Gy (liver metastases). RESULTS Median follow-up was 10.4 months (2.0-59.0 months). The 2‑year actuarial LC was 100 and 86.4% for primary early and advanced stage lung tumors, respectively, 100% for lung metastases, 82.2% for liver metastases, and 90% for extrapulmonary extrahepatic metastases. The 2‑year OS rate was 47.9% for all patients. In uni- and multivariate analysis, comparatively lower PTV prescription dose (equivalence of 3 × 12-13 Gy) and higher average GTV dose (equivalence of 3 × 18 Gy) to current practice were significantly associated with LC. For OS, Karnofsky performance score (100%), gender (female), and SBRT without simultaneous chemotherapy were significant prognostic factors. Grade 3 side effects were rare (0.5%). CONCLUSIONS Robotic guided BMC-SBRT can be considered a safe and effective treatment for solid tumors in moving organs. To reach sufficient local control rates, high average GTV doses are necessary. Further prospective studies are warranted to evaluate these points.
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Affiliation(s)
- Susanne Stera
- Department of Radiation Oncology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
| | - Panagiotis Balermpas
- Department of Radiation Oncology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.,Saphir Radiosurgery Center, Frankfurt, Germany
| | - Mark K H Chan
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | | | - Stefan Wurster
- Saphir Radiosurgery Center, Güstrow, Germany.,Department of Radiation Oncology, University Medicine Greifswald, Greifswald, Germany
| | - Christian Keller
- Department of Radiation Oncology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.,Saphir Radiosurgery Center, Frankfurt, Germany
| | - Detlef Imhoff
- Department of Radiation Oncology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Dirk Rades
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Jürgen Dunst
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany.,Department of Radiation Oncology, University Hospital Copenhagen, Copenhagen, Denmark
| | - Claus Rödel
- Department of Radiation Oncology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Guido Hildebrandt
- Department of Radiation Oncology, University Medicine Rostock, Rostock, Germany
| | - Oliver Blanck
- Saphir Radiosurgery Center, Frankfurt, Germany.,Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany.,Saphir Radiosurgery Center, Güstrow, Germany
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Sumida I, Shiomi H, Higashinaka N, Murashima Y, Miyamoto Y, Yamazaki H, Mabuchi N, Tsuda E, Ogawa K. Evaluation of tracking accuracy of the CyberKnife system using a webcam and printed calibrated grid. J Appl Clin Med Phys 2016; 17:74-84. [PMID: 27074474 PMCID: PMC5875552 DOI: 10.1120/jacmp.v17i2.5914] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 11/04/2015] [Accepted: 10/28/2015] [Indexed: 11/23/2022] Open
Abstract
Tracking accuracy for the CyberKnife's Synchrony system is commonly evaluated using a film‐based verification method. We have evaluated a verification system that uses a webcam and a printed calibrated grid to verify tracking accuracy over three different motion patterns. A box with an attached printed calibrated grid and four fiducial markers was attached to the motion phantom. A target marker was positioned at the grid's center. The box was set up using the other three markers. Target tracking accuracy was evaluated under three conditions: 1) stationary; 2) sinusoidal motion with different amplitudes of 5, 10, 15, and 20 mm for the same cycle of 4 s and different cycles of 2, 4, 6, and 8 s with the same amplitude of 15 mm; and 3) irregular breathing patterns in six human volunteers breathing normally. Infrared markers were placed on the volunteers’ abdomens, and their trajectories were used to simulate the target motion. All tests were performed with one‐dimensional motion in craniocaudal direction. The webcam captured the grid's motion and a laser beam was used to simulate the CyberKnife's beam. Tracking error was defined as the difference between the grid's center and the laser beam. With a stationary target, mean tracking error was measured at 0.4 mm. For sinusoidal motion, tracking error was less than 2 mm for any amplitude and breathing cycle. For the volunteers’ breathing patterns, the mean tracking error range was 0.78‐1.67 mm. Therefore, accurate lesion targeting requires individual quality assurance for each patient. PACS number(s): 87.55.D‐, 87.55.km, 87.55.Qr, 87.56.Fc
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Affiliation(s)
- Iori Sumida
- Osaka University Graduate School of Medicine; CyberKnife Center.
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9
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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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10
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Winter JD, Wong R, Swaminath A, Chow T. Accuracy of Robotic Radiosurgical Liver Treatment Throughout the Respiratory Cycle. Int J Radiat Oncol Biol Phys 2015; 93:916-24. [DOI: 10.1016/j.ijrobp.2015.08.031] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 08/12/2015] [Accepted: 08/17/2015] [Indexed: 12/31/2022]
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Poels K, Depuydt T, Verellen D, Gevaert T, Dhont J, Duchateau M, Burghelea M, Boussaer M, Steenbeke F, Collen C, Engels B, Storme G, De Ridder M. Improving the intra-fraction update efficiency of a correlation model used for internal motion estimation during real-time tumor tracking for SBRT patients: fast update or no update? Radiother Oncol 2014; 112:352-9. [PMID: 25443498 DOI: 10.1016/j.radonc.2014.09.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 09/08/2014] [Accepted: 09/16/2014] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE For tumor tracking, a correlation model is used to estimate internal tumor position based on external surrogate motion. When patients experience an internal/external surrogate drift, an update of the correlation model is required to continue tumor tracking. In this study, the accuracy of the internal tumor position estimation for both the clinical available update at discrete points in time (rebuild) and an in-house developed non-clinical online update approach was investigated. METHODS A dynamic phantom with superimposed baseline drifts and 14 SBRT patients, treated with real-time tumor tracking (RTTT) on the Vero system, were retrospectively simulated for three update scenarios, respectively no update, clinical rebuild and 0.5 Hz automated online update of the correlation model. By comparing the target positions based on 0.5 Hz verification X-ray images with the estimated internal tumor positions regarding all three update scenarios, 95th percentile modeling errors (ME95), incidences of full geometrical coverage of the CTV by a 5 mm extended PTV (P₅mm) and population-based PTV margins were calculated. Further, the treatment time reduction was estimated when switching from the clinical rebuild approach to the online correlation model update. RESULTS For dynamic phantom motion with baseline drifts up to 0.4 mm/min, a 0.5 Hz intra-fraction update showed a similar accuracy in terms of ME95 and P5 mm compared to clinical rebuild. For SBRT patients treated on Vero with RTTT, accuracy was improved by 0.5 Hz online update compared to the clinical rebuild protocol, yielding smaller PTV margins (from 3.2 mm to 2.7 mm), reduced ME95,3D (from 4.1 mm to 3.4 mm) and an increased 5th percentile P5 mm (from 90.7% to 96.1%) for the entire patient group. Further, 80% of treatment sessions were reduced in time with on average 5.5 ± 4.1(1 SD)min. CONCLUSION With a fast (0.5 Hz) automated online update of the correlation model, an efficient RTTT workflow with improved geometrical accuracy was obtained.
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Affiliation(s)
- Kenneth Poels
- Department Radiotherapy, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Belgium.
| | - Tom Depuydt
- Department Radiotherapy, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Belgium; Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Dirk Verellen
- Department Radiotherapy, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Belgium
| | - Thierry Gevaert
- Department Radiotherapy, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Belgium
| | - Jennifer Dhont
- Department Radiotherapy, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Belgium
| | - Michael Duchateau
- Department Radiotherapy, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Belgium
| | - Manuela Burghelea
- Department Radiotherapy, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Belgium
| | - Marlies Boussaer
- Department Radiotherapy, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Belgium
| | - Femke Steenbeke
- Department Radiotherapy, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Belgium
| | - Christine Collen
- Department Radiotherapy, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Belgium
| | - Benedikt Engels
- Department Radiotherapy, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Belgium
| | - Guy Storme
- Department Radiotherapy, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Belgium
| | - Mark De Ridder
- Department Radiotherapy, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Belgium
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Chi A, Nguyen NP, Komaki R. The potential role of respiratory motion management and image guidance in the reduction of severe toxicities following stereotactic ablative radiation therapy for patients with centrally located early stage non-small cell lung cancer or lung metastases. Front Oncol 2014; 4:151. [PMID: 25009800 PMCID: PMC4070060 DOI: 10.3389/fonc.2014.00151] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 05/30/2014] [Indexed: 12/25/2022] Open
Abstract
Image guidance allows delivery of very high doses of radiation over a few fractions, known as stereotactic ablative radiotherapy (SABR). This treatment is associated with excellent outcome for early stage non-small cell lung cancer and metastases to the lungs. In the delivery of SABR, central location constantly poses a challenge due to the difficulty of adequately sparing critical thoracic structures that are immediately adjacent to the tumor if an ablative dose of radiation is to be delivered to the tumor target. As of current, various respiratory motion management and image guidance strategies can be used to ensure accurate tumor target localization prior and/or during daily treatment, which allows for maximal and safe reduction of set up margins. The incorporation of both may lead to the most optimal normal tissue sparing and the most accurate SABR delivery. Here, the clinical outcome, treatment related toxicities, and the pertinent respiratory motion management/image guidance strategies reported in the current literature on SABR for central lung tumors are reviewed.
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Affiliation(s)
- Alexander Chi
- Department of Radiation Oncology, Mary Babb Randolph Cancer Center of West Virginia University , Morgantown, WV , USA
| | | | - Ritsuko Komaki
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center , Houston, TX , USA
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Malinowski K, McAvoy TJ, George R, Dieterich S, D'Souza WD. Maintaining tumor targeting accuracy in real-time motion compensation systems for respiration-induced tumor motion. Med Phys 2014; 40:071709. [PMID: 23822413 DOI: 10.1118/1.4808119] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To determine how best to time respiratory surrogate-based tumor motion model updates by comparing a novel technique based on external measurements alone to three direct measurement methods. METHODS Concurrently measured tumor and respiratory surrogate positions from 166 treatment fractions for lung or pancreas lesions were analyzed. Partial-least-squares regression models of tumor position from marker motion were created from the first six measurements in each dataset. Successive tumor localizations were obtained at a rate of once per minute on average. Model updates were timed according to four methods: never, respiratory surrogate-based (when metrics based on respiratory surrogate measurements exceeded confidence limits), error-based (when localization error ≥ 3 mm), and always (approximately once per minute). RESULTS Radial tumor displacement prediction errors (mean ± standard deviation) for the four schema described above were 2.4 ± 1.2, 1.9 ± 0.9, 1.9 ± 0.8, and 1.7 ± 0.8 mm, respectively. The never-update error was significantly larger than errors of the other methods. Mean update counts over 20 min were 0, 4, 9, and 24, respectively. CONCLUSIONS The same improvement in tumor localization accuracy could be achieved through any of the three update methods, but significantly fewer updates were required when the respiratory surrogate method was utilized. This study establishes the feasibility of timing image acquisitions for updating respiratory surrogate models without direct tumor localization.
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Affiliation(s)
- Kathleen Malinowski
- Fischell Department of Bioengineering, A. James Clark School of Engineering, University of Maryland, College Park, Maryland 20742, USA
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Malinowski K, McAvoy TJ, George R, Dieterich S, D'Souza WD. Online monitoring and error detection of real-time tumor displacement prediction accuracy using control limits on respiratory surrogate statistics. Med Phys 2012; 39:2042-8. [PMID: 22482625 DOI: 10.1118/1.3676690] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To evaluate Hotelling's T(2) statistic and the input variable squared prediction error (Q((X))) for detecting large respiratory surrogate-based tumor displacement prediction errors without directly measuring the tumor's position. METHODS Tumor and external marker positions from a database of 188 Cyberknife Synchrony™ lung, liver, and pancreas treatment fractions were analyzed. The first ten measurements of tumor position in each fraction were used to create fraction-specific models of tumor displacement using external surrogates as input; the models were used to predict tumor position from subsequent external marker measurements. A partial least squares (PLS) model with four scores was developed for each fraction to determine T(2) and Q((X)) confidence limits based on the first ten measurements in a fraction. The T(2) and Q((X)) statistics were then calculated for every set of external marker measurements. Correlations between model error and both T(2) and Q((X)) were determined. Receiver operating characteristic analysis was applied to evaluate sensitivities and specificities of T(2), Q((X)), and T(2)∪Q((X)) for predicting real-time tumor localization errors >3 mm over a range of T(2) and Q((X)) confidence limits. RESULTS Sensitivity and specificity of detecting errors >3 mm varied with confidence limit selection. At 95% sensitivity, T(2)∪Q((X)) specificity was 15%, 2% higher than either T(2) or Q((X)) alone. The mean time to alarm for T(2)∪Q((X)) at 95% sensitivity was 5.3 min but varied with a standard deviation of 8.2 min. Results did not differ significantly by tumor site. CONCLUSIONS The results of this study establish the feasibility of respiratory surrogate-based online monitoring of real-time respiration-induced tumor motion model accuracy for lung, liver, and pancreas tumors. The T(2) and Q((X)) statistics were able to indicate whether inferential model errors exceeded 3 mm with high sensitivity. Modest improvements in specificity were achieved by combining T(2) and Q((X)) results.
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Affiliation(s)
- Kathleen Malinowski
- Fischell Department of Bioengineering, University of Maryland, College Park, MD, USA
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