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Dai J, Dong G, Zhang C, He W, Liu L, Wang T, Jiang Y, Zhao W, Zhao X, Xie Y, Liang X. Volumetric tumor tracking from a single cone-beam X-ray projection image enabled by deep learning. Med Image Anal 2024; 91:102998. [PMID: 37857066 DOI: 10.1016/j.media.2023.102998] [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: 08/19/2022] [Revised: 09/19/2023] [Accepted: 10/06/2023] [Indexed: 10/21/2023]
Abstract
Radiotherapy serves as a pivotal treatment modality for malignant tumors. However, the accuracy of radiotherapy is significantly compromised due to respiratory-induced fluctuations in the size, shape, and position of the tumor. To address this challenge, we introduce a deep learning-anchored, volumetric tumor tracking methodology that employs single-angle X-ray projection images. This process involves aligning the intraoperative two-dimensional (2D) X-ray images with the pre-treatment three-dimensional (3D) planning Computed Tomography (CT) scans, enabling the extraction of the 3D tumor position and segmentation. Prior to therapy, a bespoke patient-specific tumor tracking model is formulated, leveraging a hybrid data augmentation, style correction, and registration network to create a mapping from single-angle 2D X-ray images to the corresponding 3D tumors. During the treatment phase, real-time X-ray images are fed into the trained model, producing the respective 3D tumor positioning. Rigorous validation conducted on actual patient lung data and lung phantoms attests to the high localization precision of our method at lowered radiation doses, thus heralding promising strides towards enhancing the precision of radiotherapy.
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Affiliation(s)
- Jingjing Dai
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China
| | - Guoya Dong
- School of Health Sciences and Biomedical Engineering, Hebei University of Technology, Hebei Key Laboratory of Bioelectromagnetics and Neural Engineering, Tianjin Key Laboratory of Bioelectricity and Intelligent Health, 300130, Tianjin, China
| | - Chulong Zhang
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China
| | - Wenfeng He
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China
| | - Lin Liu
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China
| | - Tangsheng Wang
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China
| | - Yuming Jiang
- Department of Radiation Oncology, Wake Forest University School of Medicine, Winston-Salem,North Carolina, 27157, USA
| | - Wei Zhao
- School of Physics, Beihang University, Beijing, 100191, China
| | - Xiang Zhao
- Department of Radiology, Tianjin Medical University General Hospital, 300050, China
| | - Yaoqin Xie
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China
| | - Xiaokun Liang
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China.
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Casutt A, Kinj R, Ozsahin EM, von Garnier C, Lovis A. Fiducial markers for stereotactic lung radiation therapy: review of the transthoracic, endovascular and endobronchial approaches. Eur Respir Rev 2022; 31:31/163/210149. [PMID: 35022258 DOI: 10.1183/16000617.0149-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 09/09/2021] [Indexed: 11/05/2022] Open
Abstract
Stereotactic body radiation therapy is an alternative to surgery for early-stage, inoperable peripheral non-small cell lung cancer. As opposed to linear accelerator (linac)-based (e.g. gating) and free-breathing techniques, CyberKnife® with Synchrony® technology allows accurate radiation delivery by means of a real-time respiratory motion tracking system using, in most cases, metal fiducial markers (FMs) placed in the vicinity of the target. The aims of this review are as follows. First, to describe the safety and efficacy of the transthoracic, endovascular and endobronchial FM insertion techniques for peripheral pulmonary lesions (PPLs). Second, to analyse performance in terms of the migration and tracking rates of different FM types. Recent developments in FM tracking for central lesions will also be reviewed. In conclusion, for PPLs, the endobronchial approach provides a low rate of pneumothorax, offers the possibility of concurrent diagnostic sampling for both the PPL and the lymph nodes, and, finally, reduces the intervention time compared to other techniques. In this context, coil-tailed and coil-spring FMs have shown the lowest migration rate with a consequently high tracking rate.
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Affiliation(s)
- Alessio Casutt
- Division of Pulmonary Medicine, University Hospital of Lausanne, CHUV, Lausanne, Switzerland .,University of Lausanne, UNIL, Lausanne, Switzerland
| | - Rémy Kinj
- University of Lausanne, UNIL, Lausanne, Switzerland.,Dept of Radiation Oncology, University Hospital of Lausanne, CHUV, Lausanne, Switzerland
| | - Esat-Mahmut Ozsahin
- University of Lausanne, UNIL, Lausanne, Switzerland.,Dept of Radiation Oncology, University Hospital of Lausanne, CHUV, Lausanne, Switzerland
| | - Christophe von Garnier
- Division of Pulmonary Medicine, University Hospital of Lausanne, CHUV, Lausanne, Switzerland.,University of Lausanne, UNIL, Lausanne, Switzerland
| | - Alban Lovis
- Division of Pulmonary Medicine, University Hospital of Lausanne, CHUV, Lausanne, Switzerland.,University of Lausanne, UNIL, Lausanne, Switzerland
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3
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Hardcastle N, Briggs A, Caillet V, Angelis G, Chrystall D, Jayamanne D, Shepherd M, Harris B, Haddad C, Eade T, Keall P, Booth J. Quantification of the geometric uncertainty when using implanted markers as a surrogate for lung tumor motion. Med Phys 2021; 48:2724-2732. [PMID: 33626183 DOI: 10.1002/mp.14788] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 11/26/2020] [Accepted: 01/19/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Fiducial markers are used as surrogates for tumor location during radiation therapy treatment. Developments in lung fiducial marker and implantation technology have provided a means to insert markers endobronchially for tracking of lung tumors. This study quantifies the surrogacy uncertainty (SU) when using endobronchially implanted markers as a surrogate for lung tumor position. METHODS We evaluated SU for 17 patients treated in a prospective electromagnetic-guided MLC tracking trial. Tumor and markers were segmented on all phases of treatment planning 4DCTs and all frames of pretreatment kilovoltage fluoroscopy acquired from lateral and frontal views. The difference in tumor and marker position relative to end-exhale position was calculated as the SU for both imaging methods and the distributions of uncertainties analyzed. RESULTS The mean (range) tumor motion amplitude in the 4DCT scan was 5.9 mm (1.7-11.7 mm) in the superior-inferior (SI) direction, 2.2 mm (0.9-5.5 mm) in the left-right (LR) direction, and 3.9 mm (1.2-12.9 mm) in the anterior-posterior (AP) direction. Population-based analysis indicated symmetric SU centered close to 0 mm, with maximum 5th/95th percentile values over all axes of -2.0 mm/2.1 mm with 4DCT, and -2.3/1.3 mm for fluoroscopy. There was poor correlation between the SU measured with 4DCT and that measured with fluoroscopy on a per-patient basis. We observed increasing SU with increasing surrogate motion. Based on fluoroscopy analysis, the mean (95% CI) SU was 5% (2%-8%) of the motion magnitude in the SI direction, 16% (6%-26%) of the motion magnitude in the LR direction, and 33% (23%-42%) of the motion magnitude in the AP direction. There was no dependence of SU on marker distance from the tumor. CONCLUSION We have quantified SU due to use of implanted markers as surrogates for lung tumor motion. Population 95th percentile range are up to 2.3 mm, indicating the approximate contribution of SU to total geometric uncertainty. SU was relatively small compared with the SI motion, but substantial compared with LR and AP motion. Due to uncertainty in estimations of patient-specific SU, it is recommended that population-based margins are used to account for this component of the total geometric uncertainty.
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Affiliation(s)
- Nicholas Hardcastle
- Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia.,Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, 2522, Australia
| | - Adam Briggs
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Reserve Rd St Leonards, NSW, 2065, Australia
| | - Vincent Caillet
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Reserve Rd St Leonards, NSW, 2065, Australia.,ACRF Image X Institute, School of Medicine, University of Sydney, Camperdown, NSW, 2006, Australia
| | - Giorgios Angelis
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Reserve Rd St Leonards, NSW, 2065, Australia.,School of Physics, University of Sydney, Camperdown, NSW, 2042, Australia
| | - Danielle Chrystall
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Reserve Rd St Leonards, NSW, 2065, Australia
| | - Dasantha Jayamanne
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Reserve Rd St Leonards, NSW, 2065, Australia.,School of Medicine, University of Sydney, Camperdown, NSW, 2042, Australia
| | - Meegan Shepherd
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Reserve Rd St Leonards, NSW, 2065, Australia
| | - Ben Harris
- School of Medicine, University of Sydney, Camperdown, NSW, 2042, Australia.,Dept Respiratory and Sleep Medicine, Royal North Shore Hospital, Reserve Rd, St Leonards, NSW, 2065, Australia
| | - Carol Haddad
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Reserve Rd St Leonards, NSW, 2065, Australia
| | - Thomas Eade
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Reserve Rd St Leonards, NSW, 2065, Australia.,School of Medicine, University of Sydney, Camperdown, NSW, 2042, Australia
| | - Paul Keall
- ACRF Image X Institute, School of Medicine, University of Sydney, Camperdown, NSW, 2006, Australia
| | - Jeremy Booth
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Reserve Rd St Leonards, NSW, 2065, Australia.,Institute of Medical Physics, School of Physics, University of Sydney, Camperdown, NSW, 2042, Australia
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4
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Casutt A, Noirez L, Bernasconi M, Koutsokera A, Beigelman-Aubry C, Kinj R, Ozsahin EM, Durham AD, von Garnier C, Lovis A. Endobronchial coil spring fiducial markers for CyberKnife® stereotactic body radiation therapy. Respirology 2021; 26:469-476. [PMID: 33403786 DOI: 10.1111/resp.14006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/15/2020] [Accepted: 12/08/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVE SBRT is an alternative treatment for early-stage inoperable lung cancer. Metallic FM allow to increase tumour tracking precision by CyberKnife®. Currently used techniques for FM placement have many limitations; transthoracic insertion has a high risk for pneumothorax, endovascular insertion requires expertise and dedicated angiography infrastructure and endobronchial linear-gold FM dislocate frequently. This is the first study to assess the safety and efficacy of cs-FM endobronchial insertion under fluoroscopy with or without R-EBUS assessment. METHODS We retrospectively evaluated all consecutive patients undergoing endobronchial cs-FM placement for at least one PPL <25 mm between 10.2015 and 12.2019. TBB of the PPL were performed in case of a typical R-EBUS signal. PPL tracking accuracy by CyberKnife, complications, cs-FM migration rate and procedure duration were analysed. RESULTS A total of 52 patients were treated during 55 procedures and 207 cs-FM were placed in 70 PPL. Tracking was successful for 65 of 70 (93%) PPL. R-EBUS was performed for 33 (47%) PPL and TBB for 9 (13%) PPL. Bronchospasm occurred once and any other complications were observed. Migration of cs-FM occurred in 16 of 207 (8%) cs-FM. Migration was more frequent when the target was in a previously irradiated area (P = 0.022). The median bronchoscopy duration was 31.5 min (n = 48 procedures). CONCLUSION Bronchoscopic cs-FM placement is a rapid and safe procedure. It is associated with a low migration rate and allows precise SBRT delivery. Previous irradiation of the PPL was associated with a higher migration rate.
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Affiliation(s)
- Alessio Casutt
- Department of Pulmonology, University Hospital of Lausanne, CHUV, Lausanne, Switzerland
| | - Leslie Noirez
- Department of Pulmonology, University Hospital of Lausanne, CHUV, Lausanne, Switzerland
| | | | - Angela Koutsokera
- Department of Pulmonology, University Hospital of Lausanne, CHUV, Lausanne, Switzerland
| | - Catherine Beigelman-Aubry
- Department of Radiodiagnostic and Interventional Radiology, University Hospital of Lausanne, CHUV, Lausanne, Switzerland
| | - Rémy Kinj
- Department of Radiation Oncology, University Hospital of Lausanne, CHUV, Lausanne, Switzerland
| | - Esat-Mahmut Ozsahin
- Department of Radiation Oncology, University Hospital of Lausanne, CHUV, Lausanne, Switzerland
| | - André-Dante Durham
- Department of Radiation Oncology, University Hospital of Lausanne, CHUV, Lausanne, Switzerland
| | | | - Alban Lovis
- Department of Pulmonology, University Hospital of Lausanne, CHUV, Lausanne, Switzerland
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5
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Quantitative evaluation of image recognition performance of fiducial markers in real-time tumor-tracking radiation therapy. Phys Med 2019; 65:33-39. [DOI: 10.1016/j.ejmp.2019.08.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 08/01/2019] [Accepted: 08/02/2019] [Indexed: 11/15/2022] Open
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6
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Garner JL, Meireles I, Kemp SV, Shah PL. Fiducial marker implantation using convex probe EBUS and autologous blood. BMJ Case Rep 2019; 12:12/3/e228773. [PMID: 30936356 PMCID: PMC6453308 DOI: 10.1136/bcr-2018-228773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Justin L Garner
- Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Ines Meireles
- Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Samuel V Kemp
- Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Pallav L Shah
- Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
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Bowling MR, Folch EE, Khandhar SJ, Kazakov J, Krimsky WS, LeMense GP, Linden PA, Murillo BA, Nead MA, Pritchett MA, Teba CV, Towe CW, Williams T, Anciano CJ. Fiducial marker placement with electromagnetic navigation bronchoscopy: a subgroup analysis of the prospective, multicenter NAVIGATE study. Ther Adv Respir Dis 2019; 13:1753466619841234. [PMID: 30958102 PMCID: PMC6454637 DOI: 10.1177/1753466619841234] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 03/08/2019] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Fiducial markers (FMs) help direct stereotactic body radiation therapy (SBRT) and localization for surgical resection in lung cancer management. We report the safety, accuracy, and practice patterns of FM placement utilizing electromagnetic navigation bronchoscopy (ENB). METHODS NAVIGATE is a global, prospective, multicenter, observational cohort study of ENB using the superDimension™ navigation system. This prospectively collected subgroup analysis presents the patient demographics, procedural characteristics, and 1-month outcomes in patients undergoing ENB-guided FM placement. Follow up through 24 months is ongoing. RESULTS Two-hundred fifty-eight patients from 21 centers in the United States were included. General anesthesia was used in 68.2%. Lesion location was confirmed by radial endobronchial ultrasound in 34.5% of procedures. The median ENB procedure time was 31.0 min. Concurrent lung lesion biopsy was conducted in 82.6% (213/258) of patients. A mean of 2.2 ± 1.7 FMs (median 1.0 FMs) were placed per patient and 99.2% were accurately positioned based on subjective operator assessment. Follow-up imaging showed that 94.1% (239/254) of markers remained in place. The procedure-related pneumothorax rate was 5.4% (14/258) overall and 3.1% (8/258) grade ⩾ 2 based on the Common Terminology Criteria for Adverse Events scale. The procedure-related grade ⩾ 4 respiratory failure rate was 1.6% (4/258). There were no bronchopulmonary hemorrhages. CONCLUSION ENB is an accurate and versatile tool to place FMs for SBRT and localization for surgical resection with low complication rates. The ability to perform a biopsy safely in the same procedure can also increase efficiency. The impact of practice pattern variations on therapeutic effectiveness requires further study. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02410837.
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Affiliation(s)
- Mark R. Bowling
- Department of Internal Medicine, Division of
Pulmonary, Critical Care and Sleep Medicine, Brody School of Medicine, East
Carolina University, 521a Moye Boulevard, Greenville, NC 27834, USA
| | - Erik E. Folch
- Massachusetts General Hospital, Harvard Medical
School, Boston, MA, USA
| | | | - Jordan Kazakov
- University Hospitals Cleveland Medical Center
and Case Western Reserve School of Medicine, Cleveland, OH, USA
| | | | | | - Philip A. Linden
- University Hospitals Cleveland Medical Center
and Case Western Reserve School of Medicine, Cleveland, OH, USA
| | | | | | - Michael A. Pritchett
- Pulmonary Department, Pinehurst Medical Clinic
and FirstHealth Moore Regional Hospital, Pinehurst, NC, USA
| | - Catalina V. Teba
- University Hospitals Cleveland Medical Center
and Case Western Reserve School of Medicine, Cleveland, OH, USA
| | - Christopher W. Towe
- University Hospitals Cleveland Medical Center
and Case Western Reserve School of Medicine, Cleveland, OH, USA
| | - Terence Williams
- Department of Radiation Oncology, Ohio State
University Wexner Medical Center, Columbus OH, USA Brigham and Women’s
Hospital, Boston, MA, USA
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de Blanck SR, Rydhög JS, Larsen KR, Clementsen PF, Josipovic M, Aznar MC, Af Rosenschöld PM, Jølck RI, Specht L, Andresen TL, Persson GF. Long term safety and visibility of a novel liquid fiducial marker for use in image guided radiotherapy of non-small cell lung cancer. Clin Transl Radiat Oncol 2018; 13:24-28. [PMID: 30258990 PMCID: PMC6154396 DOI: 10.1016/j.ctro.2018.07.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 07/27/2018] [Accepted: 07/31/2018] [Indexed: 11/16/2022] Open
Abstract
Safety and clinical feasibility of injecting a novel liquid fiducial marker for use in image guided radiotherapy in 15 patients with non-small cell lung cancer are reported. No major safety or toxicity issues were encountered. Markers present at start of radiotherapy remained visible in cone beam computed tomography and fluoroscopy images throughout the treatment course and on computed tomography images during follow-up (0-38 months). Marker volume reduction was seen until 9 months after treatment, after which no further marker breakdown was found. No post-treatment migration or marker related complications were found.
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Affiliation(s)
- Steen Riisgaard de Blanck
- Department of Oncology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Jonas Scherman Rydhög
- Department of Oncology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark.,Niels Bohr Institute, University of Copenhagen, Blegdamsvej 17, 2100 Copenhagen, Denmark
| | - Klaus Richter Larsen
- Department of Respiratory Medicine, Bispebjerg Hospital, Bispebjerg Bakke 23, 2400 København, NV, Denmark
| | - Paul Frost Clementsen
- Department of Respiratory Medicine, Gentofte University Hospital and Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, Copenhagen, Denmark
| | - Mirjana Josipovic
- Department of Oncology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark.,Niels Bohr Institute, University of Copenhagen, Blegdamsvej 17, 2100 Copenhagen, Denmark
| | - Marianne Camille Aznar
- Department of Oncology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark.,Niels Bohr Institute, University of Copenhagen, Blegdamsvej 17, 2100 Copenhagen, Denmark
| | - Per Munck Af Rosenschöld
- Department of Oncology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark.,Niels Bohr Institute, University of Copenhagen, Blegdamsvej 17, 2100 Copenhagen, Denmark
| | - Rasmus Irming Jølck
- DTU Nanotech, Department of Micro-and Nanotechnology, Center for Nanomedicine and Theranostics, Technical University of Denmark, Building 345E, Ørsteds Plads, 2800 Kgs. Lyngby, Denmark.,Nanovi Radiotherapy A/S, Diplomvej 373N, 2800 Kgs. Lyngby, Denmark
| | - Lena Specht
- Department of Oncology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Thomas Lars Andresen
- DTU Nanotech, Department of Micro-and Nanotechnology, Center for Nanomedicine and Theranostics, Technical University of Denmark, Building 345E, Ørsteds Plads, 2800 Kgs. Lyngby, Denmark
| | - Gitte Fredberg Persson
- Department of Oncology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark
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9
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Block AM, Patel R, Surucu M, Harkenrider MM, Roeske JC. Evaluation of a template-based algorithm for markerless lung tumour localization on single- and dual-energy kilovoltage images. Br J Radiol 2016; 89:20160648. [PMID: 27730838 PMCID: PMC5604930 DOI: 10.1259/bjr.20160648] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 10/04/2016] [Accepted: 10/10/2016] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To evaluate a template-based matching algorithm on single-energy (SE) and dual-energy (DE) radiographs for markerless localization of lung tumours. METHODS A total of 74 images from 17 patients with Stages IA-IV lung cancer were considered. At the time of radiotherapy treatment, gated end-expiration SE radiographs were obtained at 60 and 120 kVp at different gantry angles (33° anterior and 41° oblique), from which soft-tissue-enhanced DE images were created. A template-based matching algorithm was used to localize individual tumours on both SE and DE radiographs. Tumour centroid co-ordinates obtained from the template-matching software on both SE and DE images were compared with co-ordinates defined by physicians. RESULTS The template-based matching algorithm was able to successfully localize the gross tumor volume within 5 mm on 70% (52/74) of the SE images vs 91% (66/74) of the DE images (p < 0.01). The mean vector differences between the co-ordinates of the template matched by the algorithm and the co-ordinates of the physician-defined ground truth were 3.2 ± 2.8 mm for SE images vs 2.3 ± 1.7 mm for DE images (p = 0.03). CONCLUSION Template-based matching on DE images was more accurate and precise than using SE images. Advances in knowledge: This represents, to the authors' knowledge, the largest study evaluating template matching on clinical SE and DE images, considering not only anterior gantry angles but also oblique angles, suggesting a novel lung tumour matching technique using DE subtraction that is reliable, accurate and precise.
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Affiliation(s)
- Alec M Block
- Department of Radiation Oncology, Loyola University Medical Center, Maywood, IL, USA
| | - Rakesh Patel
- Department of Radiation Oncology, Loyola University Medical Center, Maywood, IL, USA
| | - Murat Surucu
- Department of Radiation Oncology, Loyola University Medical Center, Maywood, IL, USA
| | - Matthew M Harkenrider
- Department of Radiation Oncology, Loyola University Medical Center, Maywood, IL, USA
| | - John C Roeske
- Department of Radiation Oncology, Loyola University Medical Center, Maywood, IL, USA
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