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Choi JI, McCormick B, Park P, Millar M, Walker K, Tung CC, Huang S, Florio P, Chen CC, Lozano A, Hanlon AL, Fox J, Xu AJ, Zinovoy M, Mueller B, Bakst R, LaPlant Q, Braunstein LZ, Khan AJ, Powell SN, Cahlon O. Comparative Evaluation of Proton Therapy and Volumetric Modulated Arc Therapy for Brachial Plexus Sparing in the Comprehensive Reirradiation of High-Risk Recurrent Breast Cancer. Adv Radiat Oncol 2024; 9:101355. [PMID: 38405315 PMCID: PMC10885571 DOI: 10.1016/j.adro.2023.101355] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 08/07/2023] [Indexed: 02/27/2024] Open
Abstract
Purpose Recurrent or new primary breast cancer requiring comprehensive regional nodal irradiation after prior radiation therapy (RT) to the supraclavicular area and upper axilla is challenging due to cumulative brachial plexus (BP) dose tolerance. We assessed BP dose sparing achieved with pencil beam scanning proton therapy (PBS-PT) and photon volumetric modulated arc therapy (VMAT). Methods and Materials In an institutional review board-approved planning study, all patients with ipsilateral recurrent breast cancer treated with PBS-PT re-RT (PBT1) with at least partial BP overlap from prior photon RT were identified. Comparative VMAT plans (XRT1) using matched BP dose constraints were developed. A second pair of proton (PBT2) and VMAT (XRT2) plans using standardized target volumes were created, applying uniform prescription dose of 50.4 per 1.8 Gy and a maximum BP constraint <25 Gy. Incidence of brachial plexopathy was also assessed. Results Ten consecutive patients were identified. Median time between RT courses was 48 months (15-276). Median first, second, and cumulative RT doses were 50.4 Gy (range, 42.6-60.0), 50.4 Gy relative biologic effectiveness (RBE) (45.0-64.4), and 102.4 Gy (RBE) (95.0-120.0), respectively. Median follow-up was 15 months (5-33) and 18 months for living patients (11-33) Mean BP max was 37.5 Gy (RBE) for PBT1 and 36.9 Gy for XRT1. Target volume coverage of V85% (volume receiving 85% of prescription dose), V90%, and V95% were numerically lower for XRT1 versus PBT1. Similarly, axilla I-III and supraclavicular area coverage were significantly higher for PBT2 than XRT2 at dose levels of V55%, V65%, V75%, V85%, and V95%. Only axilla I V55% did not reach significance (P = .06) favoring PBS-PT. Two patients with high cumulative BPmax (95.2 Gy [RBE], 101.6 Gy [RBE]) developed brachial plexopathy symptoms with ulnar nerve distribution neuropathy without pain or weakness (1 of 2 had symptom resolution after 6 months without intervention). Conclusions PBS-PT improved BP sparing and target volume coverage versus VMAT. For patients requiring comprehensive re-RT for high-risk, nonmetastatic breast cancer recurrence with BP overlap and reasonable expectation for prolonged life expectancy, PBT may be the preferred treatment modality.
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Affiliation(s)
- J. Isabelle Choi
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
- New York Proton Center, New York, New York
| | - Beryl McCormick
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Peter Park
- New York Proton Center, New York, New York
| | | | - Katherine Walker
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | | | - Peter Florio
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Alicia Lozano
- Center for Biostatistics and Health Data Science, Department of Statistics, Virginia Tech, Roanoke, Virginia
| | - Alexandra L. Hanlon
- Center for Biostatistics and Health Data Science, Department of Statistics, Virginia Tech, Roanoke, Virginia
| | - Jana Fox
- New York Proton Center, New York, New York
- Department of Radiation Oncology, Montefiore Medical Center
| | - Amy J. Xu
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Melissa Zinovoy
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Boris Mueller
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Richard Bakst
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Radiation Oncology, Mt. Sinai Health System, New York, New York
| | - Quincey LaPlant
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Lior Z. Braunstein
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Atif J. Khan
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Simon N. Powell
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Oren Cahlon
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Radiation Oncology, New York University Langone, New York, New York
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McGee KP, Cao M, Das IJ, Yu V, Witte RJ, Kishan AU, Valle LF, Wiesinger F, De-Colle C, Cao Y, Breen WG, Traughber BJ. The Use of Magnetic Resonance Imaging in Radiation Therapy Treatment Simulation and Planning. J Magn Reson Imaging 2024. [PMID: 38265188 DOI: 10.1002/jmri.29246] [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: 09/05/2023] [Revised: 01/08/2024] [Accepted: 01/08/2024] [Indexed: 01/25/2024] Open
Abstract
Ever since its introduction as a diagnostic imaging tool the potential of magnetic resonance imaging (MRI) in radiation therapy (RT) treatment simulation and planning has been recognized. Recent technical advances have addressed many of the impediments to use of this technology and as a result have resulted in rapid and growing adoption of MRI in RT. The purpose of this article is to provide a broad review of the multiple uses of MR in the RT treatment simulation and planning process, identify several of the most used clinical scenarios in which MR is integral to the simulation and planning process, highlight existing limitations and provide multiple unmet needs thereby highlighting opportunities for the diagnostic MR imaging community to contribute and collaborate with our oncology colleagues. EVIDENCE LEVEL: 5 TECHNICAL EFFICACY: Stage 5.
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Affiliation(s)
- Kiaran P McGee
- Department of Radiology, Mayo Clinic & Foundation, Rochester, Minnesota, USA
| | - Minsong Cao
- Department of Radiation Oncology, University of California, Los Angeles, California, USA
| | - Indra J Das
- Department of Radiation Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Victoria Yu
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Robert J Witte
- Department of Radiology, Mayo Clinic & Foundation, Rochester, Minnesota, USA
| | - Amar U Kishan
- Department of Radiation Oncology, University of California, Los Angeles, California, USA
| | - Luca F Valle
- Department of Radiation Oncology, University of California, Los Angeles, California, USA
| | | | - Chiara De-Colle
- Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Yue Cao
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - William G Breen
- Department of Radiation Oncology, Mayo Clinic & Foundation, Rochester, Minnesota, USA
| | - Bryan J Traughber
- Department of Radiation Oncology, Mayo Clinic & Foundation, Rochester, Minnesota, USA
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Cao X, Gao XS, Li W, Liu P, Qin SB, Dou YB, Li HZ, Shang S, Gu XB, Ma MW, Qi X, Xie M, Wang D. Contouring lumbosacral plexus nerves with MR neurography and MR/CT deformable registration technique. Front Oncol 2022; 12:818953. [DOI: 10.3389/fonc.2022.818953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 10/11/2022] [Indexed: 11/11/2022] Open
Abstract
PurposeIt is difficult to contour nerve structures with the naked eye due to poor differentiation between the nerve structures with other soft tissues on CT images. Magnetic resonance neurography (MRN) has the advantage in nerve visualization. The purpose of this study is to identify one MRN sequence to better assist the delineation of the lumbosacral plexus (LSP) nerves to assess the radiation dose to the LSP using the magnetic resonance (MR)/CT deformable coregistration technique.MethodsA total of 18 cases of patients with prostate cancer and one volunteer with radiation-induced lumbosacral plexopathy (RILSP) were enrolled. The data of simulation CT images and original treatment plans were collected. Two MRN sequences (Lr_NerveVIEW sequence and Cs_NerveVIEW sequence) were optimized from a published MRN sequence (3D NerveVIEW sequence). The nerve visualization ability of the Lr_NerveVIEW sequence and the Cs_NerveVIEW sequence was evaluated via a four-point nerve visualization score (NVS) scale in the first 10 patients enrolled to determine the better MRN sequence for assisting nerve contouring. Deformable registration was applied to the selected MRN sequence and simulation CT images to get fused MR/CT images, on which the LSP was delineated. The contouring of the LSP did not alter treatment planning. The dosimetric data of the LSP nerve were collected from the dose–volume histogram in the original treatment plans. The data of the maximal dose (Dmax) and the location of the maximal radiation point received by the LSP structures were collected.ResultsThe Cs_NerveVIEW sequence gained lower NVS scores than the Lr_NerveVIEW sequence (Z=-2.887, p=0.004). The LSP structures were successfully created in 18 patients and one volunteer with MRN (Lr_NerveVIEW)/CT deformable registration techniques, and the LSP structures conformed with the anatomic distribution. In the patient cohort, the percentage of the LSP receiving doses exceeding 50, 55, and 60 Gy was 68% (12/18), 33% (6/18), and 17% (3/18), respectively. For the volunteer with RILSP, the maximum irradiation dose to his LSP nerves was 69 Gy.ConclusionThe Lr_NerveVIEW MRN sequence performed better than the Cs_NerveVIEW sequence in nerve visualization. The dose in the LSP needs to be measured to understand the potential impact on treatment-induced neuropathy.
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Paczona VR, Capala ME, Deák-Karancsi B, Borzási E, Együd Z, Végváry Z, Kelemen G, Kószó R, Ruskó L, Ferenczi L, Verduijn GM, Petit SF, Oláh J, Cserháti A, Wiesinger F, Hideghéty K. Magnetic Resonance Imaging-Based Delineation of Organs at Risk in the Head and Neck Region. Adv Radiat Oncol 2022; 8:101042. [PMID: 36636382 PMCID: PMC9830100 DOI: 10.1016/j.adro.2022.101042] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 07/24/2022] [Indexed: 01/16/2023] Open
Abstract
Purpose The aim of this article is to establish a comprehensive contouring guideline for treatment planning using only magnetic resonance images through an up-to-date set of organs at risk (OARs), recommended organ boundaries, and relevant suggestions for the magnetic resonance imaging (MRI)-based delineation of OARs in the head and neck (H&N) region. Methods and Materials After a detailed review of the literature, MRI data were collected from the H&N region of healthy volunteers. OARs were delineated in the axial, coronal, and sagittal planes on T2-weighted sequences. Every contour defined was revised by 4 radiation oncologists and subsequently by 2 independent senior experts (H&N radiation oncologist and radiologist). After revision, the final structures were presented to the consortium partners. Results A definitive consensus was reached after multi-institutional review. On that basis, we provided a detailed anatomic and functional description and specific MRI characteristics of the OARs. Conclusions In the era of precision radiation therapy, the need for well-built, straightforward contouring guidelines is on the rise. Precise, uniform, delineation-based, automated OAR segmentation on MRI may lead to increased accuracy in terms of organ boundaries and analysis of dose-dependent sequelae for an adequate definition of normal tissue complication probability.
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Affiliation(s)
- Viktor R. Paczona
- Department of Oncotherapy, University of Szeged, Szeged, Hungary,Corresponding author: Viktor R. Paczona, MD
| | | | | | - Emőke Borzási
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | - Zsófia Együd
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | - Zoltán Végváry
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | - Gyöngyi Kelemen
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | - Renáta Kószó
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | | | | | | | | | - Judit Oláh
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | | | | | - Katalin Hideghéty
- Department of Oncotherapy, University of Szeged, Szeged, Hungary,ELI-HU Non-Profit Ltd, Szeged, Hungary
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Chakraborty S, Chatterjee S. HYPORT adjuvant acute toxicity and patient dosimetry quality assurance results - Interim analysis. Radiother Oncol 2022; 174:59-68. [PMID: 35817323 DOI: 10.1016/j.radonc.2022.07.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 06/21/2022] [Accepted: 07/01/2022] [Indexed: 12/20/2022]
Abstract
BACKGROUND HYPORT adjuvant trial is a randomised phase III open-label noninferiority trial comparing standard moderately hypofractionated 3 week adjuvant radiation therapy in breast cancer with a novel 1-week schedule. The trial was initiated in March 2019 and is open to recruitment with a total sample size of 2100. We report the results of dosimetric quality assurance, acute toxicity and pre planned first interim safety analysis in the first 271 patients. METHODS Stage I-III breast cancer planned for adjuvant radiation therapy to the breast/chest-wall (along with regional nodes as indicated) were randomised to receive 40 Gy/15 fractions/3 weeks or 26 Gy/5 fractions/1 week. For simultaneous integrated boost, the patients in the control arm received 8 Gy/15 fractions/3 weeks, while those in the experimental arm received 6 Gy/5 fractions/1 week (to the tumour bed). For sequential boost, the prescribed dose was 12 Gy/4 fractions/4 days in both arms. Compliance to pre specified dosimetric parameters and acute toxicities were evaluated. RESULT Data of the first 271 patients was analysed of whom 104 patients received tumour bed boost using SIB. All mandatory dosimetric criteria were met apart from one patient with a higher contralateral breast dose due to optimal internal mammary nodal coverage. Overall three patients (1.1%) experienced grade 3 radiation dermatitis (none received SIB), no other Grade 3 or higher toxicities reported. CONCLUSION This acute toxicity interim analysis demonstrates that hypofractionated adjuvant radiotherapy with SIB for patients with breast cancer is feasible, and associated with minimal severe acute toxicities.
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Yoo YS, Jang SW, Kim YS, Choi JA, Oh JH, Jeong JY. Does the Suprascapular Nerve Move within the Suprascapular Notch? Biomechanical Perspective Using the Finite Element Method. Yonsei Med J 2022; 63:657-664. [PMID: 35748077 PMCID: PMC9226829 DOI: 10.3349/ymj.2022.63.7.657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 03/18/2022] [Accepted: 03/29/2022] [Indexed: 11/27/2022] Open
Abstract
PURPOSE We aimed to analyze changes in suprascapular nerve (SSN) position within the suprascapular notch during in vivo shoulder abduction. MATERIALS AND METHODS Three-dimensional models of the shoulder complex were constructed based on magnetic resonance imaging of the brachial plexus (BP-MR) in a patient diagnosed with SSN dysfunction but normal scapular movement. Using BP-MR in neutral position and computed tomography data on shoulder abduction, shoulder abduction was simulated as the transition between two positions of the shoulder complex with overlapping of a neutral and abducted scapula. SSN movement during abduction was evaluated using the finite element method. Contact stress on the SSN was measured in the presence and absence of the transverse scapular ligament (TSL). RESULTS In the neutral position, the SSN ran almost parallel to the front of the TSL until entering the suprascapular notch and slightly contacted the anterior-inferior border of the TSL. As shoulder abduction progressed, contact stress decreased due to gradual loss of contact with the TSL. In the TSL-free scapula, there was no contact stress on the SSN in the neutral position. Towards the end of shoulder abduction, contact stress increased again as the SSN began to contact the base of the suprascapular notch in both TSL conditions. CONCLUSION We identified changes in the position of the SSN path within the suprascapular notch during shoulder abduction. The SSN starts in contact with the TSL and moves toward the base of the suprascapular notch with secondary contact. These findings may provide rationale for TSL release in SSN entrapment.
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Affiliation(s)
| | - Seong-Wook Jang
- Assistive Technology Research Team for Independent Living, Research Institute, National Rehabilitation Center, Seoul, Korea
| | - Yoon Sang Kim
- BioComputing Lab, School of Computer Science and Engineering, Korea University of Technology and Education, Cheonan, Korea
| | - Jung-Ah Choi
- Department of Radiology, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Jung Hyun Oh
- Department of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Jeung Yeol Jeong
- Department of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea.
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Stouthandel MEJ, Pullens P, Bogaert S, Schoepen M, Vangestel C, Achten E, Veldeman L, Van Hoof T. Application of frozen Thiel-embalmed specimens for radiotherapy delineation guideline development: a method to create accurate MRI-enhanced CT datasets. Strahlenther Onkol 2022; 198:582-592. [DOI: 10.1007/s00066-022-01928-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 03/10/2022] [Indexed: 11/30/2022]
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Hrycushko B, van der Kogel AJ, Phillips L, Chhabra A, Folkert MR, Sayre JW, Vernino S, Hassan-Rezaeian N, Yamada Y, Timmerman R, Medin PM. Brachial Plexus Tolerance to Single-Session SAbR in a Pig Model. Int J Radiat Oncol Biol Phys 2021; 112:565-571. [PMID: 34597718 DOI: 10.1016/j.ijrobp.2021.09.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 09/10/2021] [Accepted: 09/21/2021] [Indexed: 12/25/2022]
Abstract
PURPOSE The single-session dose tolerance of the spinal nerves has been observed to be similar to that of the spinal cord in pigs, counter to the perception that peripheral nerves are more tolerant to radiation. This pilot study aims to obtain a first impression of the single-session dose-response of the brachial plexus using pigs as a model. METHODS AND MATERIALS Ten Yucatan minipigs underwent computed tomography and magnetic resonance imaging for treatment planning, followed by single-session stereotactic ablative radiotherapy. A 2.5-cm length of the left-sided brachial plexus cords was irradiated. Pigs were distributed in 3 groups with prescription doses of 16 (n = 3), 19 (n = 4), and 22 Gy (n = 3). Neurologic status was assessed by observation for changes in gait and electrodiagnostic examination. Histopathologic examination was performed with light microscopy of paraffin-embedded sections stained with Luxol fast blue/periodic acid-Schiff and Masson's trichrome. RESULTS Seven of the 10 pigs developed motor deficit to the front limb of the irradiated side, with a latency from 5 to 8 weeks after irradiation. Probit analysis of the maximum nerve dose yields an estimated ED50 of 19.3 Gy for neurologic deficit, but the number of animals was insufficient to estimate 95% confidence intervals. No motor deficits were observed at a maximum dose of 17.6 Gy for any pig. Nerve conduction studies showed an absence of sensory response in all responders and absent or low motor response in most of the responders (71%). All symptomatic pigs showed histologic lesions to the left-sided plexus consistent with radiation-induced neuropathy. CONCLUSIONS The single-session ED50 for symptomatic plexopathy in Yucatan minipigs after irradiation of a 2.5-cm length of the brachial plexus cords was determined to be 19.3 Gy. The dose-response curve overlaps that of the spinal nerves and the spinal cord in the same animal model. The relationship between the brachial plexus tolerance in pigs and humans is unknown, and caution is warranted when extrapolating for clinical use.
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Affiliation(s)
- Brian Hrycushko
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, Texas
| | - Albert J van der Kogel
- Department of Human Oncology, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
| | - Lauren Phillips
- Department of Neurology, UT Southwestern Medical Center, Dallas, Texas
| | - Avneesh Chhabra
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas
| | - Michael R Folkert
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, Texas
| | - James W Sayre
- Departments of Biostatistics; Radiology, University of California Los Angeles, California
| | - Steven Vernino
- Department of Neurology, UT Southwestern Medical Center, Dallas, Texas
| | - Nima Hassan-Rezaeian
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Yoshiya Yamada
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Robert Timmerman
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, Texas
| | - Paul M Medin
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, Texas.
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Vrtovec T, Močnik D, Strojan P, Pernuš F, Ibragimov B. Auto-segmentation of organs at risk for head and neck radiotherapy planning: From atlas-based to deep learning methods. Med Phys 2020; 47:e929-e950. [PMID: 32510603 DOI: 10.1002/mp.14320] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 05/27/2020] [Accepted: 05/29/2020] [Indexed: 02/06/2023] Open
Abstract
Radiotherapy (RT) is one of the basic treatment modalities for cancer of the head and neck (H&N), which requires a precise spatial description of the target volumes and organs at risk (OARs) to deliver a highly conformal radiation dose to the tumor cells while sparing the healthy tissues. For this purpose, target volumes and OARs have to be delineated and segmented from medical images. As manual delineation is a tedious and time-consuming task subjected to intra/interobserver variability, computerized auto-segmentation has been developed as an alternative. The field of medical imaging and RT planning has experienced an increased interest in the past decade, with new emerging trends that shifted the field of H&N OAR auto-segmentation from atlas-based to deep learning-based approaches. In this review, we systematically analyzed 78 relevant publications on auto-segmentation of OARs in the H&N region from 2008 to date, and provided critical discussions and recommendations from various perspectives: image modality - both computed tomography and magnetic resonance image modalities are being exploited, but the potential of the latter should be explored more in the future; OAR - the spinal cord, brainstem, and major salivary glands are the most studied OARs, but additional experiments should be conducted for several less studied soft tissue structures; image database - several image databases with the corresponding ground truth are currently available for methodology evaluation, but should be augmented with data from multiple observers and multiple institutions; methodology - current methods have shifted from atlas-based to deep learning auto-segmentation, which is expected to become even more sophisticated; ground truth - delineation guidelines should be followed and participation of multiple experts from multiple institutions is recommended; performance metrics - the Dice coefficient as the standard volumetric overlap metrics should be accompanied with at least one distance metrics, and combined with clinical acceptability scores and risk assessments; segmentation performance - the best performing methods achieve clinically acceptable auto-segmentation for several OARs, however, the dosimetric impact should be also studied to provide clinically relevant endpoints for RT planning.
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Affiliation(s)
- Tomaž Vrtovec
- Faculty Electrical Engineering, University of Ljubljana, Tržaška cesta 25, Ljubljana, SI-1000, Slovenia
| | - Domen Močnik
- Faculty Electrical Engineering, University of Ljubljana, Tržaška cesta 25, Ljubljana, SI-1000, Slovenia
| | - Primož Strojan
- Institute of Oncology Ljubljana, Zaloška cesta 2, Ljubljana, SI-1000, Slovenia
| | - Franjo Pernuš
- Faculty Electrical Engineering, University of Ljubljana, Tržaška cesta 25, Ljubljana, SI-1000, Slovenia
| | - Bulat Ibragimov
- Faculty Electrical Engineering, University of Ljubljana, Tržaška cesta 25, Ljubljana, SI-1000, Slovenia.,Department of Computer Science, University of Copenhagen, Universitetsparken 1, Copenhagen, D-2100, Denmark
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Stouthandel MEJ, Debbaut C, Deviche J, Truyens B, Veldeman L, Van Hoof T. Using the venous angle as a pressure reservoir to retrogradely fill the subclavian lymphatic trunk with contrast agent for lymphatic mapping. Ann Anat 2020; 232:151562. [PMID: 32562859 DOI: 10.1016/j.aanat.2020.151562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/28/2020] [Accepted: 06/03/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND Visualizing the lymphatic system and recording the spatial relations between the subclavian lymphatic trunk (SLT) and the surrounding anatomical structures will improve radiotherapy treatment planning for breast cancer patients with lymphatic involvement. An experimental approach to retrogradely fill the SLT with contrast agent was explored. METHODS Six Thiel embalmed specimens were bilaterally dissected in the cervical and clavicular region to optimize the new experimental approach. A conservative dissection with minimum distortion of spatial relations between different anatomical structures was developed. A pressure reservoir was created inside the venous angle to allow retrograde filling of the SLT under the influence of time and pressure. RESULTS The new methodology proved feasible, showing successful pressure build-up inside the venous reservoir, resulting in filling of the proximal end of the subclavian lymphatic trunk. The pressures needed to significantly fill the subclavian lymphatic trunk proved to be higher than the pressures that the venous walls could withstand. CONCLUSIONS Thiel embalmed specimens proved useful for optimizing the experimental approach, but the embalming products could have negatively affected the vessel strength. The authors suggest that their method will be applied on fresh frozen specimens in future studies, to obtain SLT filling up to the axillary lymphatic plexus. Our findings also pointed out that there is still a lot to be learned about the anatomical variability of the SLT and its termination sites. The detailed description of our experimental approach offers valuable information for future lymphatic mapping studies.
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Affiliation(s)
- Michael E J Stouthandel
- Department of Human Structure and Repair, Ghent University, C. Heymanslaan 10, Radiotherapy Park, Entrance 98, B-9000, Ghent, Belgium.
| | - Charlotte Debbaut
- IBiTech-bioMMeda, Ghent University, C. Heymanslaan 10, Block B, Entrance 36, B-9000, Ghent, Belgium; Cancer Research Institute Ghent (CRIG), Ghent University, C. Heymanslaan 10, Block B, Entrance 36, B-9000, Ghent, Belgium
| | - Jurgen Deviche
- IBiTech-bioMMeda, Ghent University, C. Heymanslaan 10, Block B, Entrance 36, B-9000, Ghent, Belgium
| | - Bart Truyens
- Department of Radiation Oncology, Ghent University Hospital, C. Heymanslaan 10, Radiotherapy Park, Entrance 98, B-9000, Ghent, Belgium
| | - Liv Veldeman
- Department of Human Structure and Repair, Ghent University, C. Heymanslaan 10, Radiotherapy Park, Entrance 98, B-9000, Ghent, Belgium; Department of Radiation Oncology, Ghent University Hospital, C. Heymanslaan 10, Radiotherapy Park, Entrance 98, B-9000, Ghent, Belgium
| | - Tom Van Hoof
- Department of Human Structure and Repair, Ghent University, C. Heymanslaan 10, Radiotherapy Park, Entrance 98, B-9000, Ghent, Belgium
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Leijnse JN, de Bakker BS, D'Herde K. The brachial plexus - explaining its morphology and variability by a generic developmental model. J Anat 2019; 236:862-882. [PMID: 31814126 DOI: 10.1111/joa.13123] [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: 06/27/2019] [Revised: 10/23/2019] [Accepted: 10/30/2019] [Indexed: 12/01/2022] Open
Abstract
In classic anatomy teaching, the brachial plexus generally features as an enigmatic rote-learned structure, leaving the student with a feeling of complexity. The notion of complexity may increase in dissections, where plexuses significantly differing from the standard plexus model are readily found. This raises questions: what determines the existence and prevalence of variants and to what degree should they be considered anomalous? A model linking brachial plexus morphology and its variability to causative morphological parameters which would also standardize plexus description and teaching would be beneficial. The present study aims to provide such a model by analyzing the context of plexus development and applying this model in the analysis of plexus variability in anatomical specimens. Based on a thorough literature review, a generic developmental model was formulated and different factors of variability defined. In 56 plexuses, the proposed generic principles of plexus variability were found consistent with the variations encountered. Summarized, the modeled generic principles are as follows. Brachial plexus axon bundles grow out into an environment of chemical tracer paths in which constraints and obstacles are present: the geometry of the arm bud, cartilaginous bone precursors and vessels. The overall constancy of these factors generates a gross plexus outline, while the variability in these factors gives rise to typical plexus variations. The usefulness of the model derives from the fact that the variability of the main morphologically determining factors is not random but is the expression of the possibilities of the embryological substrate. Within the model, the major plexus morphological determinant is the segmental position of the subclavian artery, which is determined by the segment level of the intersegmental artery from which it develops. Normally, the subclavian artery develops from intersegmental artery i7. However, the subclavian artery can develop from inferior or superior segmental levels, from intersegmental artery i8 or i6, and possibly also from i9 or i5. Each of these arterial variants creates a typical, morphologically distinct, predictable plexus configuration. Superimposed on these basic plexus configurations, the underlying embryological substrate may develop further variability by integrating remnants of other intersegmental arteries into the arterial network. The resulting plexus configurations are further modified by local factors, e.g. the splitting of outgrowing axon bundles around vessels. A large split in the lateral cord around a large vein or veins crossing from lateral to medial, tangentially cranially over the subclavian artery was found in 54% of the 56 investigated BP and therefore might be added to plexus teaching. The distinct plexus morphologies associated with the subclavian artery segmental levels were further found associated with, among others, typical variations in the pectoral nerves and their ansas; these associations were also modeled. The presented models could allow brachial plexus rote learning to be replaced by a more insightful narrative of formative principles suitable for teaching. Clinically, improved understanding of the relationship between plexus variability and the local anatomical environment should be relevant to brachial plexus surgery and reconstruction.
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Affiliation(s)
- Joris N Leijnse
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium
| | - Bernadette S de Bakker
- Department of Medical Biology, Section Clinical Anatomy & Embryology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Katharina D'Herde
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium
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Yan M, Kong W, Kerr A, Brundage M. The radiation dose tolerance of the brachial plexus: A systematic review and meta-analysis. Clin Transl Radiat Oncol 2019; 18:23-31. [PMID: 31309161 PMCID: PMC6606964 DOI: 10.1016/j.ctro.2019.06.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 06/12/2019] [Indexed: 12/25/2022] Open
Abstract
PURPOSE We performed a systematic review and meta-analysis of studies reporting the incidence of radiation induced brachial plexopathy (RIBP) and the associated radiotherapy doses to this structure. METHODS Databases were queried without language restriction for cohort studies reporting RIBP incidence and associated brachial plexus dose maximum dose (bpDmax). Studies specifying RIBP relative risk (RR) effect size were selected for meta-analysis. RRs for RIBP from each study were converted to a regression coefficient (β) and standard error corresponding to a continuous representation of bpDmax. The adjusted β from individual studies were combined using a random effects model and weighted by inverse variance (1/SE2). The trim and fill approach was used to assess publication bias. RESULTS We identified 25 studies that included 37 unique patient cohorts eligible for analysis. Seventeen cohorts experienced an RIBP incidence ≤5%, of which 6 cohorts exceeded conventional plexus constraints of 60 Gy for bpDmax. Five of the 6 cohorts were simulated with 3D-CT techniques. Meta-analysis of eligible studies demonstrated a significant increase in RIBP risk for each Gy increase in bpDmax (RR, 1.11; 95% CI 1.07-1.15). Results remained significant after adjustment for publication bias and when sensitivity analysis was performed. CONCLUSIONS Our results suggest that current brachial plexus constraints of 60-66 Gy are safe. Meta-analysis provides a log-linear model to quantify the association of brachial plexus dose and RIBP risk, and thus inform the therapeutic ratio for dose escalation. Further prospective studies reporting dosimetric data can better refine this model and inform brachial plexus constraint guidelines.
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Affiliation(s)
- Michael Yan
- Department of Radiation Oncology, Cancer Centre of Southeastern Ontario, Kingston, ON, Canada
| | - Weidong Kong
- Division of Cancer Care and Epidemiology, Queen’s University Cancer Research Institute, Kingston, ON, Canada
| | - Andrew Kerr
- Department of Medical Physics, Cancer Centre of Southeastern Ontario, Kingston, ON, Canada
| | - Michael Brundage
- Department of Radiation Oncology, Cancer Centre of Southeastern Ontario, Kingston, ON, Canada
- Division of Cancer Care and Epidemiology, Queen’s University Cancer Research Institute, Kingston, ON, Canada
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Stouthandel MEJ, Veldeman L, Van Hoof T. Call for a Multidisciplinary Effort to Map the Lymphatic System with Advanced Medical Imaging Techniques: A Review of the Literature and Suggestions for Future Anatomical Research. Anat Rec (Hoboken) 2019; 302:1681-1695. [PMID: 31087787 DOI: 10.1002/ar.24143] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 01/21/2019] [Accepted: 03/09/2019] [Indexed: 12/13/2022]
Abstract
This review intends to rekindle efforts to map the lymphatic system by using a more modern approach, based on medical imaging. The structure, function, and pathologies associated with the lymphatic system are first discussed to highlight the need for more accurately mapping the lymphatic system. Next, the need for an interdisciplinary approach, with a central role for the anatomist, to come up with better maps of the lymphatic system is emphasized. The current approaches on lymphatic system research involving medical imaging will be discussed and suggestions will be made for an all-encompassing effort to thoroughly map the entire lymphatic system. A first-hand account of our integration as anatomists in the radiotherapy department is given as an example of interdisciplinary collaboration. From this account, it will become clear that the interdisciplinary collaboration of anatomists in the clinical disciplines involved in lymphatic system research/treatment still holds great promise in terms of improving clinical regimens that are currently being employed. As such, we hope that our fellow anatomists will join us in an interdisciplinary effort to map the lymphatic system, because this could, in a relatively short timeframe, provide improved treatment options for patients with cancer or lymphatic pathologies all over the world. Anat Rec, 302:1681-1695, 2019. © 2019 American Association for Anatomy.
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Affiliation(s)
| | - Liv Veldeman
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium.,Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Tom Van Hoof
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
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14
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Monten C, Lievens Y, Olteanu LAM, Paelinck L, Speleers B, Deseyne P, Van Den Broecke R, De Neve W, Veldeman L. Highly Accelerated Irradiation in 5 Fractions (HAI-5): Feasibility in Elderly Women With Early or Locally Advanced Breast Cancer. Int J Radiat Oncol Biol Phys 2017; 98:922-930. [PMID: 28366576 DOI: 10.1016/j.ijrobp.2017.01.229] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 01/09/2017] [Accepted: 01/25/2017] [Indexed: 12/25/2022]
Abstract
PURPOSE To investigate, in a prospective phase 1 to 2 trial, the safety and feasibility of delivering external beam radiation therapy in 5 fractions to the breast or thoracic wall, including boost and/or lymph nodes if needed, to women aged ≥65 years with breast cancer. METHODS AND MATERIALS Ninety-five patients aged ≥65 years, referred for adjuvant radiation therapy, were treated in 5 fractions over 12 days with a total dose of 28.5 Gy/5.7 Gy to the breast or thoracic wall and, if indicated, 27 Gy/5.4 Gy to the lymph node regions and 32.5 Gy/6.5 Gy to 34.5 Gy/6.9 Gy to the tumor bed. The primary endpoint was clinically relevant dermatitis (grade ≥2). RESULTS Mean follow-up time was 5.6 months, and mean age was 73.6 years. Clinically relevant dermatitis was observed in 11.6% of patients and only occurred in breast irradiation with boost (17.5% grade 2-3 vs 0% in the no-boost group). Although doses were high, treatment delivery with intensity modulated radiation therapy was swift, except for complex treatments, including lymph nodes for which single-arc volumetric modulated arc therapy was needed to reduce beam-on time. CONCLUSION Accelerated radiation therapy in 5 fractions was technically feasible and resulted in low acute toxicity. Clinically relevant erythema was only observed in patients receiving a boost, but still at an acceptable rate. Although the follow-up is still short, the results on acute toxicity after accelerated radiation therapy were encouraging. A 5-fraction schedule is well tolerated in the elderly and may lower the threshold for radiation therapy in this population.
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Affiliation(s)
- Chris Monten
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium.
| | - Yolande Lievens
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | | | - Leen Paelinck
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Bruno Speleers
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Pieter Deseyne
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Rudy Van Den Broecke
- Department of Obstetrics and Gynaecology, Ghent University Hospital, Ghent, Belgium
| | - Wilfried De Neve
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Liv Veldeman
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
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Boisselier P, Racadot S, Thariat J, Graff P, Pointreau Y. Radiothérapie conformationnelle avec modulation d’intensité des cancers des voies aérodigestives supérieures. Dose de tolérance des tissus sains : moelle épinière et plexus brachial. Cancer Radiother 2016; 20:459-66. [DOI: 10.1016/j.canrad.2016.08.124] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 08/03/2016] [Indexed: 12/25/2022]
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Van de Velde J, Wouters J, Vercauteren T, De Gersem W, Achten E, De Neve W, Van Hoof T. Optimal number of atlases and label fusion for automatic multi-atlas-based brachial plexus contouring in radiotherapy treatment planning. Radiat Oncol 2016; 11:1. [PMID: 26743131 PMCID: PMC4705618 DOI: 10.1186/s13014-015-0579-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 12/30/2015] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The present study aimed to define the optimal number of atlases for automatic multi-atlas-based brachial plexus (BP) segmentation and to compare Simultaneous Truth and Performance Level Estimation (STAPLE) label fusion with Patch label fusion using the ADMIRE® software. The accuracy of the autosegmentations was measured by comparing all of the generated autosegmentations with the anatomically validated gold standard segmentations that were developed using cadavers. MATERIALS AND METHODS Twelve cadaver computed tomography (CT) atlases were used for automatic multi-atlas-based segmentation. To determine the optimal number of atlases, one atlas was selected as a patient and the 11 remaining atlases were registered onto this patient using a deformable image registration algorithm. Next, label fusion was performed by using every possible combination of 2 to 11 atlases, once using STAPLE and once using Patch. This procedure was repeated for every atlas as a patient. The similarity of the generated automatic BP segmentations and the gold standard segmentation was measured by calculating the average Dice similarity (DSC), Jaccard (JI) and True positive rate (TPR) for each number of atlases. These similarity indices were compared for the different number of atlases using an equivalence trial and for the two label fusion groups using an independent sample-t test. RESULTS DSC's and JI's were highest when using nine atlases with both STAPLE (average DSC = 0,532; JI = 0,369) and Patch (average DSC = 0,530; JI = 0,370). When comparing both label fusion algorithms using 9 atlases for both, DSC and JI values were not significantly different. However, significantly higher TPR values were achieved in favour of STAPLE (p < 0,001). When fewer than four atlases were used, STAPLE produced significantly lower DSC, JI and TPR values than did Patch (p = 0,0048). CONCLUSIONS Using 9 atlases with STAPLE label fusion resulted in the most accurate BP autosegmentations (average DSC = 0,532; JI = 0,369 and TPR = 0,760). Only when using fewer than four atlases did the Patch label fusion results in a significantly more accurate autosegmentation than STAPLE.
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Affiliation(s)
- Joris Van de Velde
- Department of Anatomy, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium.
- Department of Radiotherapy, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium.
| | - Johan Wouters
- Department of Anatomy, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium.
| | - Tom Vercauteren
- Department of Radiotherapy, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium.
| | - Werner De Gersem
- Department of Radiotherapy, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium.
| | - Eric Achten
- Department of Radiology, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium.
| | - Wilfried De Neve
- Department of Radiotherapy, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium.
| | - Tom Van Hoof
- Department of Anatomy, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium.
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Van de Velde J, Wouters J, Vercauteren T, De Gersem W, Achten E, De Neve W, Van Hoof T. The effect of morphometric atlas selection on multi-atlas-based automatic brachial plexus segmentation. Radiat Oncol 2015; 10:260. [PMID: 26696278 PMCID: PMC4688981 DOI: 10.1186/s13014-015-0570-x] [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: 10/27/2015] [Accepted: 12/14/2015] [Indexed: 11/29/2022] Open
Abstract
Purpose The present study aimed to measure the effect of a morphometric atlas selection strategy on the accuracy of multi-atlas-based BP autosegmentation using the commercially available software package ADMIRE® and to determine the optimal number of selected atlases to use. Autosegmentation accuracy was measured by comparing all generated automatic BP segmentations with anatomically validated gold standard segmentations that were developed using cadavers. Materials and methods Twelve cadaver computed tomography (CT) atlases were included in the study. One atlas was selected as a patient in ADMIRE®, and multi-atlas-based BP autosegmentation was first performed with a group of morphometrically preselected atlases. In this group, the atlases were selected on the basis of similarity in the shoulder protraction position with the patient. The number of selected atlases used started at two and increased up to eight. Subsequently, a group of randomly chosen, non-selected atlases were taken. In this second group, every possible combination of 2 to 8 random atlases was used for multi-atlas-based BP autosegmentation. For both groups, the average Dice similarity coefficient (DSC), Jaccard index (JI) and Inclusion index (INI) were calculated, measuring the similarity of the generated automatic BP segmentations and the gold standard segmentation. Similarity indices of both groups were compared using an independent sample t-test, and the optimal number of selected atlases was investigated using an equivalence trial. Results For each number of atlases, average similarity indices of the morphometrically selected atlas group were significantly higher than the random group (p < 0,05). In this study, the highest similarity indices were achieved using multi-atlas autosegmentation with 6 selected atlases (average DSC = 0,598; average JI = 0,434; average INI = 0,733). Conclusions Morphometric atlas selection on the basis of the protraction position of the patient significantly improves multi-atlas-based BP autosegmentation accuracy. In this study, the optimal number of selected atlases used was six, but for definitive conclusions about the optimal number of atlases and to improve the autosegmentation accuracy for clinical use, more atlases need to be included.
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Affiliation(s)
- Joris Van de Velde
- Department of Anatomy, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium. .,Department of Radiotherapy, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium.
| | - Johan Wouters
- Department of Anatomy, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium.
| | - Tom Vercauteren
- Department of Radiotherapy, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium.
| | - Werner De Gersem
- Department of Radiotherapy, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium.
| | - Eric Achten
- Department of Radiology, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium.
| | - Wilfried De Neve
- Department of Radiotherapy, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium.
| | - Tom Van Hoof
- Department of Anatomy, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium.
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Van de Velde J, Bogaert S, Vandemaele P, Huysse W, Achten E, Leijnse J, De Neve W, Van Hoof T. Brachial plexus 3D reconstruction from MRI with dissection validation: a baseline study for clinical applications. Surg Radiol Anat 2015; 38:229-36. [DOI: 10.1007/s00276-015-1549-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 08/17/2015] [Indexed: 02/01/2023]
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Van de Velde J, Wouters J, Vercauteren T, De Gersem W, Duprez F, De Neve W, Van Hoof T. Morphometric Atlas Selection for Automatic Brachial Plexus Segmentation. Int J Radiat Oncol Biol Phys 2015; 92:691-8. [PMID: 25956831 DOI: 10.1016/j.ijrobp.2015.02.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 02/17/2015] [Accepted: 02/23/2015] [Indexed: 12/25/2022]
Abstract
PURPOSE The purpose of this study was to determine the effects of atlas selection based on different morphometric parameters, on the accuracy of automatic brachial plexus (BP) segmentation for radiation therapy planning. The segmentation accuracy was measured by comparing all of the generated automatic segmentations with anatomically validated gold standard atlases developed using cadavers. METHODS AND MATERIALS Twelve cadaver computed tomography (CT) atlases (3 males, 9 females; mean age: 73 years) were included in the study. One atlas was selected to serve as a patient, and the other 11 atlases were registered separately onto this "patient" using deformable image registration. This procedure was repeated for every atlas as a patient. Next, the Dice and Jaccard similarity indices and inclusion index were calculated for every registered BP with the original gold standard BP. In parallel, differences in several morphometric parameters that may influence the BP segmentation accuracy were measured for the different atlases. Specific brachial plexus-related CT-visible bony points were used to define the morphometric parameters. Subsequently, correlations between the similarity indices and morphometric parameters were calculated. RESULTS A clear negative correlation between difference in protraction-retraction distance and the similarity indices was observed (mean Pearson correlation coefficient = -0.546). All of the other investigated Pearson correlation coefficients were weak. CONCLUSIONS Differences in the shoulder protraction-retraction position between the atlas and the patient during planning CT influence the BP autosegmentation accuracy. A greater difference in the protraction-retraction distance between the atlas and the patient reduces the accuracy of the BP automatic segmentation result.
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Affiliation(s)
- Joris Van de Velde
- Department of Anatomy, Ghent University, Ghent, Belgium; Department of Radiotherapy, Ghent University, Ghent, Belgium.
| | - Johan Wouters
- Department of Anatomy, Ghent University, Ghent, Belgium
| | - Tom Vercauteren
- Department of Radiotherapy, Ghent University, Ghent, Belgium
| | | | - Fréderic Duprez
- Department of Radiotherapy, Ghent University, Ghent, Belgium
| | | | - Tom Van Hoof
- Department of Anatomy, Ghent University, Ghent, Belgium
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Thomas TO, Refaat T, Choi M, Bacchus I, Sachdev S, Rademaker AW, Sathiaseelan V, Karagianis A, Mittal BB. Brachial plexus dose tolerance in head and neck cancer patients treated with sequential intensity modulated radiation therapy. Radiat Oncol 2015; 10:94. [PMID: 25927572 PMCID: PMC4464874 DOI: 10.1186/s13014-015-0409-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 04/13/2015] [Indexed: 12/25/2022] Open
Abstract
Purpose We aimed to study the radiation induced brachial plexopathy in patients with head and neck squamous cell carcinoma (HNSCC) treated with Sequential Intensity Modulated Radiation Therapy (S-IMRT). Methods and materials This IRB approved study included 68 patients with HNSCC treated consecutively. Detailed dose volume histogram data was generated for ipsilateral and contralateral brachial plexus (BP) volumes receiving a specified dose (Vds) i.e. V50-V75 and dose in Gray covering specified percent of BP volume (Dvs) i.e. D5-D30 and maximum point doses (Dmax). To assess BP injury all patients’ charts were reviewed in detail for sign and symptoms of BP damage. Post-hoc comparisons were done using Tukey-Kramer method to account for multiple significance testing. Results The mean and maximum doses to BP were significantly different (p < .05) based on tumor site, nodal status and tumor stage. The mean volume to the ipsilateral BP for V50, V60, V70, and V75 were 7.01 cc, 4.37 cc, 1.47 cc and 0.24 cc, respectively. The mean dose delivered to ≤5% of ipsilateral BP was 68.70 Gy (median 69.5Gy). None of the patients had acute or late brachial plexopathy or any other significant neurological complications, with a minimum follow up of two years (mean 54 months). Conclusions In this study cohort, at a minimum of two-years follow up, the mean dose of 68.7Gy, a median dose to 69.5Gy to ≤5% of ipsilateral BP, and a median Dmax of 72.96Gy did not result in BP injury when patients were treated with S-IMRT technique. However, longer follow up is needed.
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Affiliation(s)
- Tarita O Thomas
- Department of Radiation Oncology, Northwestern University, Robert H. Lurie Comprehensive Cancer Center, 251 East Huron, LC-178, Chicago, IL, 60611, USA.
| | - Tamer Refaat
- Department of Radiation Oncology, Northwestern University, Robert H. Lurie Comprehensive Cancer Center, 251 East Huron, LC-178, Chicago, IL, 60611, USA. .,Northwestern Medicine Developmental Therapeutics Institute (NMDTI), Chicago, IL, USA. .,Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
| | - Mehee Choi
- Department of Radiation Oncology, Northwestern University, Robert H. Lurie Comprehensive Cancer Center, 251 East Huron, LC-178, Chicago, IL, 60611, USA.
| | - Ian Bacchus
- Department of Radiation Oncology, Northwestern University, Robert H. Lurie Comprehensive Cancer Center, 251 East Huron, LC-178, Chicago, IL, 60611, USA.
| | - Sean Sachdev
- Department of Radiation Oncology, Northwestern University, Robert H. Lurie Comprehensive Cancer Center, 251 East Huron, LC-178, Chicago, IL, 60611, USA.
| | - Alfred W Rademaker
- Department of Preventive Medicine, Northwestern University, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL, USA.
| | - Vythialingam Sathiaseelan
- Department of Radiation Oncology, Northwestern University, Robert H. Lurie Comprehensive Cancer Center, 251 East Huron, LC-178, Chicago, IL, 60611, USA.
| | - Achilles Karagianis
- Department of Radiology, Northwestern University, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL, USA.
| | - Bharat B Mittal
- Department of Radiation Oncology, Northwestern University, Robert H. Lurie Comprehensive Cancer Center, 251 East Huron, LC-178, Chicago, IL, 60611, USA.
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Van de Velde J, De Neve W, Van Hoof T. In Reply to Basu et al. Int J Radiat Oncol Biol Phys 2014; 89:224-5. [DOI: 10.1016/j.ijrobp.2014.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 01/18/2014] [Indexed: 12/01/2022]
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In Regard to Van de Velde et al. Int J Radiat Oncol Biol Phys 2014; 89:224. [DOI: 10.1016/j.ijrobp.2014.01.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 01/18/2014] [Indexed: 12/25/2022]
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Van de Velde J, Vercauteren T, De Gersem W, Wouters J, Vandecasteele K, Vuye P, Vanpachtenbeke F, D’Herde K, Kerckaert I, De Neve W, Van Hoof T. Reliability and accuracy assessment of radiation therapy oncology group-endorsed guidelines for brachial plexus contouring. Strahlenther Onkol 2014; 190:628-32, 634-5. [DOI: 10.1007/s00066-014-0657-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 03/11/2014] [Indexed: 12/25/2022]
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Min M, Roos D, Keating E, Penniment M, Carruthers S, Zanchetta L, Wong K, Shakeshaft J, Baxi S. External evaluation of the Radiation Therapy Oncology Group brachial plexus contouring protocol: Several issues identified. J Med Imaging Radiat Oncol 2014; 58:360-8. [DOI: 10.1111/1754-9485.12175] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 02/17/2014] [Indexed: 12/25/2022]
Affiliation(s)
- Myo Min
- Alan Walker Cancer Centre; Royal Darwin Hospital; Darwin Northern Territory Australia
- Department of Radiation Oncology; Royal Adelaide Hospital; Adelaide South Australia Australia
| | - Daniel Roos
- Department of Radiation Oncology; Royal Adelaide Hospital; Adelaide South Australia Australia
- School of Medicine; University of Adelaide; Adelaide South Australia Australia
| | - Elly Keating
- Alan Walker Cancer Centre; Royal Darwin Hospital; Darwin Northern Territory Australia
| | - Michael Penniment
- Alan Walker Cancer Centre; Royal Darwin Hospital; Darwin Northern Territory Australia
- Department of Radiation Oncology; Royal Adelaide Hospital; Adelaide South Australia Australia
- School of Medicine; University of Adelaide; Adelaide South Australia Australia
| | - Scott Carruthers
- Alan Walker Cancer Centre; Royal Darwin Hospital; Darwin Northern Territory Australia
- Department of Radiation Oncology; Royal Adelaide Hospital; Adelaide South Australia Australia
| | - Lydia Zanchetta
- Alan Walker Cancer Centre; Royal Darwin Hospital; Darwin Northern Territory Australia
- Department of Radiation Oncology; Royal Adelaide Hospital; Adelaide South Australia Australia
| | - Karen Wong
- Department of Radiation Oncology; Royal Adelaide Hospital; Adelaide South Australia Australia
| | - John Shakeshaft
- Alan Walker Cancer Centre; Royal Darwin Hospital; Darwin Northern Territory Australia
| | - Siddhartha Baxi
- Alan Walker Cancer Centre; Royal Darwin Hospital; Darwin Northern Territory Australia
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