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Kneepkens SCM, Marstal K, Polling JR, Jaddoe VWV, Vernooij MW, Poot DHJ, Klaver CCW, Tideman JWL. Eye Size and Shape in Relation to Refractive Error in Children: A Magnetic Resonance Imaging Study. Invest Ophthalmol Vis Sci 2023; 64:41. [PMID: 38153751 PMCID: PMC10756250 DOI: 10.1167/iovs.64.15.41] [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: 08/15/2023] [Accepted: 11/28/2023] [Indexed: 12/29/2023] Open
Abstract
Purpose The purpose of this study was to determine the association between eye shape and volume measured with magnetic resonance imaging (MRI) and optical biometry and with spherical equivalent (SE) in children. Methods For this study, there were 3637 10-year-old children from a population-based birth-cohort study that underwent optical biometry (IOL-master 500) and T2-weighted MRI scanning (height, width, and volume). Cycloplegic refractive error was determined by automated refraction. The MRI images of the eyes were segmented using an automated algorithm combining atlas registration with voxel classification. Associations among optical biometry, anthropometry, MRI measurements, and RE were tested using Pearson correlation. Differences between refractive error groups were tested using ANOVA. Results The mean volume of the posterior segment was 6350 (±680) mm3. Myopic eyes (SE ≤ -0.5 diopters [D]) had 470 mm3 (P < 0.001) and 970 mm3 (P < 0.001) larger posterior segment volume than emmetropic and hyperopic eyes (SE ≥ +2.0D), respectively. The majority of eyes (77.1%) had an oblate shape, but 47.4% of myopic eyes had a prolate shape versus 3.9% of hyperopic eyes. The correlation between SE and MRI-derived posterior segment length (r -0.51, P < 0.001) was stronger than the correlation with height (r -0.30, P < 0.001) or width of the eye (r -0.10, P < 0.001). Conclusions In this study, eye shape at 10 years of age was predominantly oblate, even in eyes with myopia. Of all MRI measurements, posterior segment length was most prominently associated with SE. Whether eye shape predicts future myopia development or progression should be investigated in longitudinal studies.
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Affiliation(s)
- Sander C. M. Kneepkens
- Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
- The Generation R Study Group, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Kasper Marstal
- Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jan-Roelof Polling
- Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Orthoptics, School of Applied Science Utrecht, Utrecht, The Netherlands
| | - Vincent W. V. Jaddoe
- The Generation R Study Group, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Meike W. Vernooij
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Radiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Dirk H. J. Poot
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Caroline C. W. Klaver
- Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
- The Generation R Study Group, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, The Netherlands
- Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
| | - J. Willem L. Tideman
- Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, The Netherlands
- The Generation R Study Group, Erasmus University Medical Center, Rotterdam, The Netherlands
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Jaarsma-Coes MG, Klaassen L, Marinkovic M, Luyten GPM, Vu THK, Ferreira TA, Beenakker JWM. Magnetic Resonance Imaging in the Clinical Care for Uveal Melanoma Patients-A Systematic Review from an Ophthalmic Perspective. Cancers (Basel) 2023; 15:cancers15112995. [PMID: 37296958 DOI: 10.3390/cancers15112995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/24/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023] Open
Abstract
Conversely to most tumour types, magnetic resonance imaging (MRI) was rarely used for eye tumours. As recent technical advances have increased ocular MRI's diagnostic value, various clinical applications have been proposed. This systematic review provides an overview of the current status of MRI in the clinical care of uveal melanoma (UM) patients, the most common eye tumour in adults. In total, 158 articles were included. Two- and three-dimensional anatomical scans and functional scans, which assess the tumour micro-biology, can be obtained in routine clinical setting. The radiological characteristics of the most common intra-ocular masses have been described extensively, enabling MRI to contribute to diagnoses. Additionally, MRI's ability to non-invasively probe the tissue's biological properties enables early detection of therapy response and potentially differentiates between high- and low-risk UM. MRI-based tumour dimensions are generally in agreement with conventional ultrasound (median absolute difference 0.5 mm), but MRI is considered more accurate in a subgroup of anteriorly located tumours. Although multiple studies propose that MRI's 3D tumour visualisation can improve therapy planning, an evaluation of its clinical benefit is lacking. In conclusion, MRI is a complementary imaging modality for UM of which the clinical benefit has been shown by multiple studies.
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Affiliation(s)
- Myriam G Jaarsma-Coes
- Department of Ophthalmology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Lisa Klaassen
- Department of Ophthalmology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Department of Radiation Oncology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Marina Marinkovic
- Department of Ophthalmology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Gregorius P M Luyten
- Department of Ophthalmology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - T H Khanh Vu
- Department of Ophthalmology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Teresa A Ferreira
- Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Jan-Willem M Beenakker
- Department of Ophthalmology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Department of Radiation Oncology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
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Jaarsma-Coes MG, Ferreira TA, Marinkovic M, Vu THK, van Vught L, van Haren GR, Rodrigues MF, Klaver YLB, Verbist BM, Luyten GPM, Rasch CRN, Beenakker JWM. Comparison of Magnetic Resonance Imaging-Based and Conventional Measurements for Proton Beam Therapy of Uveal Melanoma. Ophthalmol Retina 2023; 7:178-188. [PMID: 35840053 DOI: 10.1016/j.oret.2022.06.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 06/17/2022] [Accepted: 06/24/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Conventionally, ocular proton therapy (PT) is planned using measurements obtained by an ophthalmologist using ultrasound, fundoscopy, biometry, and intraoperative assessments. Owing to the recent advances in magnetic resonance imaging (MRI) of uveal melanoma (UM), it is possible to acquire high-resolution 3-dimensional images of the eye, providing the opportunity to incorporate MRI in ocular PT planning. In this study, we described how these measurements can be obtained using MRI, compared the MRI-based measurements with conventional ophthalmic measurements, and identified potential pitfalls for both modalities. DESIGN Cross-sectional study. SUBJECTS Data from 23 consecutive patients with UM treated with PT were retrospectively evaluated. METHODS Magnetic resonance imaging-based measurements of axial length, tumor height and basal diameter, and marker-tumor distances were compared with the conventional ophthalmic measurements, and discrepancies were evaluated in a multidisciplinary setting. MAIN OUTCOME MEASURES Tumor prominence and basal diameters on MRI and ultrasound, axial length on MRI and biometry, tumor-marker distances on MRI and measured intraoperatively. RESULTS The mean absolute differences of the tumor height and basal diameter measurements between ultrasound and MRI were 0.57 mm and 1.44 mm, respectively. Larger absolute differences in height and basal diameter were observed when the full tumor extent was not visible on ultrasound (0.92 mm and 1.67 mm, respectively) compared with when the full tumor extent was visible (0.44 mm and 1.15 mm, respectively). When the full tumor was not visible on ultrasound, MRI was considered more reliable. Tumor-marker distances measured using MRI and intraoperative techniques differed < 1 mm in 55% of the markers. For anteriorly located and mushroom-shaped tumors (25% of the markers), MRI provided more accurate measurements. In flat UM (15% of the markers), however, it was difficult to delineate the tumor on MRI. The mean absolute difference in axial length between optical biometry and MRI was 0.50 mm. The presence of the tumor was found to influence optical biometry in 15 of 22 patients; the remaining patients showed a better agreement (0.30 mm). Magnetic resonance imaging-based biometry was considered more reliable in patients with UM. CONCLUSIONS Magnetic resonance imaging allowed for the 3-dimensional assessment of the tumor and surrounding tissue. In specific patients, it provided a more reliable measurement of axial length, tumor dimensions, and marker-tumor distances and could contribute to a more accurate treatment planning. Nevertheless, a combined evaluation remains advised, especially for flat UM.
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Affiliation(s)
- Myriam G Jaarsma-Coes
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Teresa A Ferreira
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marina Marinkovic
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | - T H Khanh Vu
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | - Luc van Vught
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Guido R van Haren
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Myra F Rodrigues
- HollandPTC, Delft, The Netherlands; Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Yvonne L B Klaver
- HollandPTC, Delft, The Netherlands; Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Berit M Verbist
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands; HollandPTC, Delft, The Netherlands
| | - Gregorius P M Luyten
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | - Coen R N Rasch
- HollandPTC, Delft, The Netherlands; Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jan-Willem M Beenakker
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands.
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Jaarsma-Coes MG, Klaassen L, Verbist BM, Vu TK, Klaver YL, Rodrigues MF, Nabarro C, Luyten GP, Rasch CR, van Herk M, Beenakker JWM. Inter-Observer Variability in MR-Based Target Volume Delineation of Uveal Melanoma. Adv Radiat Oncol 2022; 8:101149. [PMID: 36691449 PMCID: PMC9860418 DOI: 10.1016/j.adro.2022.101149] [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: 06/16/2022] [Accepted: 12/14/2022] [Indexed: 12/26/2022] Open
Abstract
Purpose Several efforts are being undertaken toward MRI-based treatment planning for ocular proton therapy for uveal melanoma (UM). The interobserver variability of the gross target volume (GTV) on magnetic resonance imaging (MRI) is one of the important parameters to design safety margins for a reliable treatment. Therefore, this study assessed the interobserver variation in GTV delineation of UM on MRI. Methods and Materials Six observers delineated the GTV in 10 different patients using the Big Brother contouring software. Patients were scanned at 3T MRI with a surface coil, and tumors were delineated separately on contrast enhanced 3DT1 (T1gd) and 3DT2-weighted scans with an isotropic acquisition resolution of 0.8 mm. Volume difference and overall local variation (median standard deviation of the distance between the delineated contours and the median contour) were analyzed for each GTV. Additionally, the local variation was analyzed for 4 interfaces: sclera, vitreous, retinal detachment, and tumor-choroid interface. Results The average GTV was significantly larger on T1gd (0.57cm3) compared with T2 (0.51cm3, P = .01). A not significant higher interobserver variation was found on T1gd (0.41 mm) compared with T2 (0.35 mm). The largest variations were found at the tumor-choroid interface due to peritumoral enhancement (T1gd, 0.62 mm; T2, 0.52 mm). As a result, a larger part of this tumor-choroid interface appeared to be included on T1gd-based GTVs compared with T2, explaining the smaller volumes on T2. Conclusions The interobserver variation of 0.4 mm on MRI are low with respect to the voxel size of 0.8 mm, enabling small treatment margins. We recommend delineation based on the T1gd-weighted scans, as choroidal tumor extensions might be missed.
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Affiliation(s)
- Myriam G. Jaarsma-Coes
- Leiden University Medical Center, Ophthalmology, Leiden, Netherlands,Leiden University Medical Center, Radiology, Leiden, Netherlands
| | - Lisa Klaassen
- Leiden University Medical Center, Ophthalmology, Leiden, Netherlands,Leiden University Medical Center, Radiology, Leiden, Netherlands
| | - Berit M. Verbist
- Leiden University Medical Center, Radiology, Leiden, Netherlands
| | - T.H. Khanh Vu
- Leiden University Medical Center, Ophthalmology, Leiden, Netherlands
| | - Yvonne L.B. Klaver
- HollandPTC, Radiation oncology, Delft, Netherlands,Leiden University Medical Center, Radiation Oncology, Leiden, Netherlands
| | - Myra F. Rodrigues
- HollandPTC, Radiation oncology, Delft, Netherlands,Leiden University Medical Center, Radiation Oncology, Leiden, Netherlands
| | - Claire Nabarro
- Leiden University Medical Center, Radiology, Leiden, Netherlands
| | | | - Coen R.N. Rasch
- HollandPTC, Radiation oncology, Delft, Netherlands,Leiden University Medical Center, Radiation Oncology, Leiden, Netherlands
| | - Marcel van Herk
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
| | - Jan-Willem M. Beenakker
- Leiden University Medical Center, Ophthalmology, Leiden, Netherlands,Leiden University Medical Center, Radiology, Leiden, Netherlands,Leiden University Medical Center, Radiation Oncology, Leiden, Netherlands,Corresponding author: Jan-Willem M. Beenakker
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Hassan MK, Fleury E, Shamonin D, Fonk LG, Marinkovic M, Jaarsma-Coes MG, Luyten GP, Webb A, Beenakker JW, Stoel B. An Automatic Framework to Create Patient-specific Eye Models From 3D Magnetic Resonance Images for Treatment Selection in Patients With Uveal Melanoma. Adv Radiat Oncol 2021; 6:100697. [PMID: 34660938 PMCID: PMC8503565 DOI: 10.1016/j.adro.2021.100697] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 11/26/2020] [Accepted: 03/25/2021] [Indexed: 12/14/2022] Open
Abstract
PURPOSE The optimal treatment strategy for uveal melanoma (UM) relies on many factors, the most important being tumor size and location. Building on recent developments in high-resolution 3D ocular magnetic resonance imaging (MRI), we developed an automatic image-processing framework to create patient-specific eye models and to subsequently determine the full 3D tumor shape and size automatically. METHODS AND MATERIALS From 15 patients with UM, 3D inversion-recovery gradient-echo (T1-weighted) and 3D fat-suppressed spin-echo (T2-weighted) images were acquired with a 7T MRI scanner. First, the sclera and cornea were segmented from the T2-weighted image by mesh-fitting. The T1- and T2-weighted images were then coregistered. From the registered T1-weighted image, the lens, vitreous body, retinal detachment, and tumor were segmented. Fuzzy C-means clustering was used to differentiate the tumor from retinal detachments. The tumor model was verified and (if needed) edited by an ophthalmic MRI specialist. Subsequently, the prominence and largest basal diameter of the tumor were measured automatically based on the verified contours. These results were compared with manual assessments on the original images and with ultrasound measurements to show the errors in manual analysis. RESULTS The framework successfully created an eye model fully automatically in 12 cases. In these cases, a Dice similarity coefficient (mean surface distance) of 97.7%±0.84% (0.17±0.11 mm) was achieved for the sclera, 96.8%±1.05% (0.20±0.06 mm) for the vitreous body, 91.6%±4.83% (0.15±0.06 mm) for the lens, and 86.0%±7.4% (0.35±0.27 mm) for the tumor. The manual assessments deviated, on average, 0.39±0.31 mm in prominence and 1.7±1.22 mm in basal diameter from the automatic measurements. CONCLUSIONS The described framework combined information from T1- and T2-weighted images to accurately determine tumor boundaries in 3D. The proposed process may have a direct effect on clinical workflow, as it enables an accurate 3D assessment of tumor dimensions, which directly influences therapy selection.
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Affiliation(s)
| | - Emmanuelle Fleury
- Department of Radiation Oncology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Radiation Oncology, HollandPTC, Delft, The Netherlands
| | - Denis Shamonin
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Lorna Grech Fonk
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marina Marinkovic
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | - Myriam G. Jaarsma-Coes
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | - Gregorius P.M. Luyten
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | - Andrew Webb
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jan-Willem Beenakker
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | - Berend Stoel
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
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Fleury E, Trnková P, Spruijt K, Herault J, Lebbink F, Heufelder J, Hrbacek J, Horwacik T, Kajdrowicz T, Denker A, Gerard A, Hofverberg P, Mamalui M, Slopsema R, Pignol J, Hoogeman M. Characterization of the HollandPTC proton therapy beamline dedicated to uveal melanoma treatment and an interinstitutional comparison. Med Phys 2021; 48:4506-4522. [PMID: 34091930 PMCID: PMC8457201 DOI: 10.1002/mp.15024] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/08/2021] [Accepted: 05/25/2021] [Indexed: 12/30/2022] Open
Abstract
PURPOSE Eye-dedicated proton therapy (PT) facilities are used to treat malignant intraocular lesions, especially uveal melanoma (UM). The first commercial ocular PT beamline from Varian was installed in the Netherlands. In this work, the conceptual design of the new eyeline is presented. In addition, a comprehensive comparison against five PT centers with dedicated ocular beamlines is performed, and the clinical impact of the identified differences is analyzed. MATERIAL/METHODS The HollandPTC eyeline was characterized. Four centers in Europe and one in the United States joined the study. All centers use a cyclotron for proton beam generation and an eye-dedicated nozzle. Differences among the chosen ocular beamlines were in the design of the nozzle, nominal energy, and energy spectrum. The following parameters were collected for all centers: technical characteristics and a set of distal, proximal, and lateral region measurements. The measurements were performed with detectors available in-house at each institution. The institutions followed the International Atomic Energy Agency (IAEA) Technical Report Series (TRS)-398 Code of Practice for absolute dose measurement, and the IAEA TRS-398 Code of Practice, its modified version or International Commission on Radiation Units and Measurements Report No. 78 for spread-out Bragg peak normalization. Energy spreads of the pristine Bragg peaks were obtained with Monte Carlo simulations using Geant4. Seven tumor-specific case scenarios were simulated to evaluate the clinical impact among centers: small, medium, and large UM, located either anteriorly, at the equator, or posteriorly within the eye. Differences in the depth dose distributions were calculated. RESULTS A pristine Bragg peak of HollandPTC eyeline corresponded to the constant energy of 75 MeV (maximal range 3.97 g/cm2 in water) with an energy spread of 1.10 MeV. The pristine Bragg peaks for the five participating centers varied from 62.50 to 104.50 MeV with an energy spread variation between 0.10 and 0.70 MeV. Differences in the average distal fall-offs and lateral penumbrae (LPs) (over the complete set of clinically available beam modulations) among all centers were up to 0.25 g/cm2 , and 0.80 mm, respectively. Average distal fall-offs of the HollandPTC eyeline were 0.20 g/cm2 , and LPs were between 1.50 and 2.15 mm from proximal to distal regions, respectively. Treatment time, around 60 s, was comparable among all centers. The virtual source-to-axis distance of 120 cm at HollandPTC was shorter than for the five participating centers (range: 165-350 cm). Simulated depth dose distributions demonstrated the impact of the different beamline characteristics among institutions. The largest difference was observed for a small UM located at the posterior pole, where a proximal dose between two extreme centers was up to 20%. CONCLUSIONS HollandPTC eyeline specifications are in accordance with five other ocular PT beamlines. Similar clinical concepts can be applied to expect the same high local tumor control. Dosimetrical properties among the six institutions induce most likely differences in ocular radiation-related toxicities. This interinstitutional comparison could support further research on ocular post-PT complications. Finally, the findings reported in this study could be used to define dosimetrical guidelines for ocular PT to unify the concepts among institutions.
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Affiliation(s)
- Emmanuelle Fleury
- Department of RadiotherapyErasmus MC Cancer Institute, University Medical Center RotterdamThe Netherlands
- Holland Proton Therapy CenterDelftThe Netherlands
| | - Petra Trnková
- Department of RadiotherapyErasmus MC Cancer Institute, University Medical Center RotterdamThe Netherlands
- Departement of Radiation OncologyMedical University of ViennaViennaAustria
| | - Kees Spruijt
- Holland Proton Therapy CenterDelftThe Netherlands
| | - Joël Herault
- Departement of Radiation OncologyCentre Antoine LacassagneNiceFrance
| | | | - Jens Heufelder
- Helmholtz‐Zentrum Berlin für Materialien und EnergieBerlinGermany
- Department of OphthalmologyCharité ‐ Universitätsmedizin BerlinBerlinGermany
| | - Jan Hrbacek
- Paul Scherrer Institute Center for Proton TherapyVilligenSwitzerland
| | - Tomasz Horwacik
- Institute of Nuclear PhysicsPolish Academy of SciencesKrakówPoland
| | | | - Andrea Denker
- Helmholtz‐Zentrum Berlin für Materialien und EnergieBerlinGermany
| | - Anaïs Gerard
- Departement of Radiation OncologyCentre Antoine LacassagneNiceFrance
| | - Petter Hofverberg
- Departement of Radiation OncologyCentre Antoine LacassagneNiceFrance
| | - Maria Mamalui
- Department of Radiation OncologyUniversity of FloridaGainesvilleFloridaUSA
| | - Roelf Slopsema
- Department of Radiation OncologyEmory Proton Therapy CenterAtlantaGeorgiaUSA
| | | | - Mischa Hoogeman
- Department of RadiotherapyErasmus MC Cancer Institute, University Medical Center RotterdamThe Netherlands
- Holland Proton Therapy CenterDelftThe Netherlands
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Multi-view convolutional neural networks for automated ocular structure and tumor segmentation in retinoblastoma. Sci Rep 2021; 11:14590. [PMID: 34272413 PMCID: PMC8285489 DOI: 10.1038/s41598-021-93905-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 06/29/2021] [Indexed: 11/08/2022] Open
Abstract
In retinoblastoma, accurate segmentation of ocular structure and tumor tissue is important when working towards personalized treatment. This retrospective study serves to evaluate the performance of multi-view convolutional neural networks (MV-CNNs) for automated eye and tumor segmentation on MRI in retinoblastoma patients. Forty retinoblastoma and 20 healthy-eyes from 30 patients were included in a train/test (N = 29 retinoblastoma-, 17 healthy-eyes) and independent validation (N = 11 retinoblastoma-, 3 healthy-eyes) set. Imaging was done using 3.0 T Fast Imaging Employing Steady-state Acquisition (FIESTA), T2-weighted and contrast-enhanced T1-weighted sequences. Sclera, vitreous humour, lens, retinal detachment and tumor were manually delineated on FIESTA images to serve as a reference standard. Volumetric and spatial performance were assessed by calculating intra-class correlation (ICC) and dice similarity coefficient (DSC). Additionally, the effects of multi-scale, sequences and data augmentation were explored. Optimal performance was obtained by using a three-level pyramid MV-CNN with FIESTA, T2 and T1c sequences and data augmentation. Eye and tumor volumetric ICC were 0.997 and 0.996, respectively. Median [Interquartile range] DSC for eye, sclera, vitreous, lens, retinal detachment and tumor were 0.965 [0.950-0.975], 0.847 [0.782-0.893], 0.975 [0.930-0.986], 0.909 [0.847-0.951], 0.828 [0.458-0.962] and 0.914 [0.852-0.958], respectively. MV-CNN can be used to obtain accurate ocular structure and tumor segmentations in retinoblastoma.
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Fleury E, Trnková P, Erdal E, Hassan M, Stoel B, Jaarma‐Coes M, Luyten G, Herault J, Webb A, Beenakker J, Pignol J, Hoogeman M. Three-dimensional MRI-based treatment planning approach for non-invasive ocular proton therapy. Med Phys 2021; 48:1315-1326. [PMID: 33336379 PMCID: PMC7986198 DOI: 10.1002/mp.14665] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 10/05/2020] [Accepted: 11/30/2020] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To develop a high-resolution three-dimensional (3D) magnetic resonance imaging (MRI)-based treatment planning approach for uveal melanomas (UM) in proton therapy. MATERIALS/METHODS For eight patients with UM, a segmentation of the gross tumor volume (GTV) and organs-at-risk (OARs) was performed on T1- and T2-weighted 7 Tesla MRI image data to reconstruct the patient MR-eye. An extended contour was defined with a 2.5-mm isotropic margin derived from the GTV. A broad beam algorithm, which we have called πDose, was implemented to calculate relative proton absorbed doses to the ipsilateral OARs. Clinically favorable gazing angles of the treated eye were assessed by calculating a global weighted-sum objective function, which set penalties for OARs and extreme gazing angles. An optimizer, which we have named OPT'im-Eye-Tool, was developed to tune the parameters of the functions for sparing critical-OARs. RESULTS In total, 441 gazing angles were simulated for every patient. Target coverage including margins was achieved in all the cases (V95% > 95%). Over the whole gazing angles solutions space, maximum dose (Dmax ) to the optic nerve and the macula, and mean doses (Dmean ) to the lens, the ciliary body and the sclera were calculated. A forward optimization was applied by OPT'im-Eye-Tool in three different prioritizations: iso-weighted, optic nerve prioritized, and macula prioritized. In each, the function values were depicted in a selection tool to select the optimal gazing angle(s). For example, patient 4 had a T2 equatorial tumor. The optimization applied for the straight gazing angle resulted in objective function values of 0.46 (iso-weighted situation), 0.90 (optic nerve prioritization) and 0.08 (macula prioritization) demonstrating the impact of that angle in different clinical approaches. CONCLUSIONS The feasibility and suitability of a 3D MRI-based treatment planning approach have been successfully tested on a cohort of eight patients diagnosed with UM. Moreover, a gaze-angle trade-off dose optimization with respect to OARs sparing has been developed. Further validation of the whole treatment process is the next step in the goal to achieve both a non-invasive and a personalized proton therapy treatment.
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Affiliation(s)
- E. Fleury
- Department of Radiation OncologyErasmus Medical CenterRotterdamThe Netherlands
- Department of Radiation OncologyHollandPTCDelftThe Netherlands
| | - P. Trnková
- Department of Radiation OncologyErasmus Medical CenterRotterdamThe Netherlands
- Department of Radiation OncologyHollandPTCDelftThe Netherlands
| | - E. Erdal
- Department of Radiation OncologyHollandPTCDelftThe Netherlands
| | - M. Hassan
- Department of RadiologyLeiden University Medical CenterLeidenThe Netherlands
| | - B. Stoel
- Department of RadiologyLeiden University Medical CenterLeidenThe Netherlands
| | - M. Jaarma‐Coes
- Department of RadiologyLeiden University Medical CenterLeidenThe Netherlands
| | - G. Luyten
- Department of OphthalmologyLeiden University Medical CenterLeidenThe Netherlands
| | - J. Herault
- Department of Radiation OncologyCentre Antoine LacassagneNiceFrance
| | - A. Webb
- Department of RadiologyLeiden University Medical CenterLeidenThe Netherlands
| | - J.‐W. Beenakker
- Department of RadiologyLeiden University Medical CenterLeidenThe Netherlands
- Department of OphthalmologyLeiden University Medical CenterLeidenThe Netherlands
| | - J.‐P. Pignol
- Department of Radiation OncologyDalhousie UniversityHalifaxCanada
| | - M. Hoogeman
- Department of Radiation OncologyErasmus Medical CenterRotterdamThe Netherlands
- Department of Radiation OncologyHollandPTCDelftThe Netherlands
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9
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Niendorf T, Beenakker JWM, Langner S, Erb-Eigner K, Bach Cuadra M, Beller E, Millward JM, Niendorf TM, Stachs O. Ophthalmic Magnetic Resonance Imaging: Where Are We (Heading To)? Curr Eye Res 2021; 46:1251-1270. [PMID: 33535828 DOI: 10.1080/02713683.2021.1874021] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Magnetic resonance imaging of the eye and orbit (MReye) is a cross-domain research field, combining (bio)physics, (bio)engineering, physiology, data sciences and ophthalmology. A growing number of reports document technical innovations of MReye and promote their application in preclinical research and clinical science. Realizing the progress and promises, this review outlines current trends in MReye. Examples of MReye strategies and their clinical relevance are demonstrated. Frontier applications in ocular oncology, refractive surgery, ocular muscle disorders and orbital inflammation are presented and their implications for explorations into ophthalmic diseases are provided. Substantial progress in anatomically detailed, high-spatial resolution MReye of the eye, orbit and optic nerve is demonstrated. Recent developments in MReye of ocular tumors are explored, and its value for personalized eye models derived from machine learning in the treatment planning of uveal melanoma and evaluation of retinoblastoma is highlighted. The potential of MReye for monitoring drug distribution and for improving treatment management and the assessment of individual responses is discussed. To open a window into the eye and into (patho)physiological processes that in the past have been largely inaccessible, advances in MReye at ultrahigh magnetic field strengths are discussed. A concluding section ventures a glance beyond the horizon and explores future directions of MReye across multiple scales, including in vivo electrolyte mapping of sodium and other nuclei. This review underscores the need for the (bio)medical imaging and ophthalmic communities to expand efforts to find solutions to the remaining unsolved problems and technical obstacles of MReye, with the objective to transfer methodological advancements driven by MR physics into genuine clinical value.
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Affiliation(s)
- Thoralf Niendorf
- MRI.TOOLS GmbH, Berlin, Germany.,Berlin Ultrahigh Field Facility, Max Delbrueck Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Jan-Willem M Beenakker
- Department of Ophthalmology and Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Sönke Langner
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, Rostock University Medical Center, Rostock, Germany
| | - Katharina Erb-Eigner
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Meritxell Bach Cuadra
- Center for Biomedical Imaging (CIBM), Lausanne, Switzerland.,Department of Radiology, Lausanne University and University Hospital, Lausanne, Switzerland
| | - Ebba Beller
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, Rostock University Medical Center, Rostock, Germany
| | - Jason M Millward
- Berlin Ultrahigh Field Facility, Max Delbrueck Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | | | - Oliver Stachs
- Department Life, Light & Matter, University Rostock, Rostock, Germany.,Department of Ophthalmology, Rostock University Medical Center, Rostock, Germany
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10
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Via R, Hennings F, Pica A, Fattori G, Beer J, Peroni M, Baroni G, Lomax A, Weber DC, Hrbacek J. Potential and pitfalls of 1.5T MRI imaging for target volume definition in ocular proton therapy. Radiother Oncol 2021; 154:53-59. [DOI: 10.1016/j.radonc.2020.08.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 08/25/2020] [Accepted: 08/26/2020] [Indexed: 12/13/2022]
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11
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Jaarsma-Coes MG, Marinkovic M, Astreinidou E, Schuurmans MS, Peters FP, Luyten GP, Rasch CR, Beenakker JWM. Measuring eye deformation between planning and proton beam therapy position using magnetic resonance imaging. PHYSICS & IMAGING IN RADIATION ONCOLOGY 2020; 16:33-36. [PMID: 33458341 PMCID: PMC7807689 DOI: 10.1016/j.phro.2020.09.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/04/2020] [Accepted: 09/25/2020] [Indexed: 01/22/2023]
Abstract
Eye and tumour deformation due to gravity is less than 0.4 mm. Conformity index between flexed and supine position for eyes is >0.95. Conformity index between flexed and supine position for tumours is >0.85. Supinely acquired MR images can be used for PBT planning.
Proton beam therapy (PBT) for uveal melanoma (UM) is performed in sitting position, while the acquisition of the Magnetic resonance (MR)-images for treatment planning is performed in supine position. We assessed the effect of this difference in position on the eye- and tumour- shape. Seven subjects and six UM-patients were scanned in supine and a seating mimicking position. The distances between the tumour/sclera in both positions were calculated. The median distance between both positions was 0.1 mm. Change in gravity direction produced no substantial changes in sclera and tumour shape, indicating that supinely acquired MR-images can be used to plan ocular-PBT.
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Affiliation(s)
- Myriam G. Jaarsma-Coes
- Ophthalmology, Leiden University Medical Centre, Leiden, Netherlands
- Radiology, C.J. Gorter Centre for High Field MRI, Leiden University Medical Centre, Leiden, Netherlands
- Corresponding author at: Leiden University Medical Center, P.O. 9600, 2300 RC Leiden, The Netherlands.
| | - Marina Marinkovic
- Ophthalmology, Leiden University Medical Centre, Leiden, Netherlands
| | | | - Megan S. Schuurmans
- Radiology, C.J. Gorter Centre for High Field MRI, Leiden University Medical Centre, Leiden, Netherlands
| | - Femke P. Peters
- Radiotherapy, Leiden University Medical Centre, Leiden, Netherlands
| | | | - Coen R.N. Rasch
- Radiotherapy, Leiden University Medical Centre, Leiden, Netherlands
| | - Jan-Willem M. Beenakker
- Ophthalmology, Leiden University Medical Centre, Leiden, Netherlands
- Radiology, C.J. Gorter Centre for High Field MRI, Leiden University Medical Centre, Leiden, Netherlands
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12
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Mishra KK, Afshar A, Thariat J, Shih HA, Scholey JE, Daftari IK, Kacperek A, Pica A, Hrbacek J, Dendale R, Mazal A, Heufelder J, Char DH, Sauerwein WA, Weber DC, Damato BE. Practice Considerations for Proton Beam Radiation Therapy of Uveal Melanoma During the Coronavirus Disease Pandemic: Particle Therapy Co-Operative Group Ocular Experience. Adv Radiat Oncol 2020; 5:682-686. [PMID: 32337386 PMCID: PMC7179507 DOI: 10.1016/j.adro.2020.04.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/07/2020] [Indexed: 01/08/2023] Open
Abstract
Uveal melanoma (UM) is a rare but life-threatening cancer of the eye. In light of the coronavirus disease (COVID-19) pandemic, hospitals and proton eye therapy facilities must analyze several factors to ensure appropriate treatment protocols for patients and provider teams. Practice considerations to limit COVID-19 transmission in the proton ocular treatment setting for UM are necessary. The Particle Therapy Co-Operative Group is the largest international community of particle/proton therapy providers. Participating experts have current or former affiliation with the member institutions of the Particle Therapy Co-Operative Group Ocular subcommittee with long-standing high-volume proton ocular programs. The practices reviewed in this document must be taken in conjunction with local hospital procedures, multidisciplinary recommendations, and regional/national guidelines, as each community may have its unique needs, supplies, and protocols. Importantly, as the pandemic evolves, so will the strategies and recommendations. Given the unique circumstances for UM patients, along with indications of potential ophthalmologic transmission as a result of health care providers working in close proximity to patients and intrinsic infectious risk from eyelashes, tears, and hair, practice strategies may be adapted to reduce the risk of viral transmission. Certainly, providers and health care systems will continue to examine and provide as safe and effective care as possible for patients in the current environment.
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Affiliation(s)
- Kavita K. Mishra
- Ocular Tumor Proton Therapy Program, Department of Radiation Oncology, University of California San Francisco, San Francisco, California
| | - Armin Afshar
- Department of Ophthalmology, University of California San Francisco, San Francisco, California
| | - Juliette Thariat
- Department of Radiation Oncology, Centre François Baclesse, Normandie Universite, Caen, France
| | - Helen A. Shih
- F.H. Burr Proton Therapy Center, Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Jessica E. Scholey
- Ocular Tumor Proton Therapy Program, Department of Radiation Oncology, University of California San Francisco, San Francisco, California
| | - Inder K. Daftari
- Ocular Tumor Proton Therapy Program, Department of Radiation Oncology, University of California San Francisco, San Francisco, California
| | - Andrzej Kacperek
- National Proton Therapy Centre, Clatterbridge Cancer Centre, Wirral, United Kingdom
| | - Alessia Pica
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
| | - Jan Hrbacek
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
| | - Remi Dendale
- Institut Curie Proton Therapy Center, Orsay, France
| | | | - Jens Heufelder
- BerlinProtonen am HZB, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Damien C. Weber
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
| | - Bertil E. Damato
- Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
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