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Le Bao V, Haworth A, Dowling J, Walker A, Arumugam S, Jameson M, Chlap P, Wiltshire K, Keats S, Cloak K, Sidhom M, Kneebone A, Holloway L. Evaluating the relationship between contouring variability and modelled treatment outcome for prostate bed radiotherapy. Phys Med Biol 2024; 69:085008. [PMID: 38471173 DOI: 10.1088/1361-6560/ad3325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 03/12/2024] [Indexed: 03/14/2024]
Abstract
Objectives.Contouring similarity metrics are often used in studies of inter-observer variation and automatic segmentation but do not provide an assessment of clinical impact. This study focused on post-prostatectomy radiotherapy and aimed to (1) identify if there is a relationship between variations in commonly used contouring similarity metrics and resulting dosimetry and (2) identify the variation in clinical target volume (CTV) contouring that significantly impacts dosimetry.Approach.The study retrospectively analysed CT scans of 10 patients from the TROG 08.03 RAVES trial. The CTV, rectum, and bladder were contoured independently by three experienced observers. Using these contours reference simultaneous truth and performance level estimation (STAPLE) volumes were established. Additional CTVs were generated using an atlas algorithm based on a single benchmark case with 42 manual contours. Volumetric-modulated arc therapy (VMAT) treatment plans were generated for the observer, atlas, and reference volumes. The dosimetry was evaluated using radiobiological metrics. Correlations between contouring similarity and dosimetry metrics were calculated using Spearman coefficient (Γ). To access impact of variations in planning target volume (PTV) margin, the STAPLE PTV was uniformly contracted and expanded, with plans created for each PTV volume. STAPLE dose-volume histograms (DVHs) were exported for plans generated based on the contracted/expanded volumes, and dose-volume metrics assessed.Mainresults. The study found no strong correlations between the considered similarity metrics and modelled outcomes. Moderate correlations (0.5 <Γ< 0.7) were observed for Dice similarity coefficient, Jaccard, and mean distance to agreement metrics and rectum toxicities. The observations of this study indicate a tendency for variations in CTV contraction/expansion below 5 mm to result in minor dosimetric impacts.Significance. Contouring similarity metrics must be used with caution when interpreting them as indicators of treatment plan variation. For post-prostatectomy VMAT patients, this work showed variations in contours with an expansion/contraction of less than 5 mm did not lead to notable dosimetric differences, this should be explored in a larger dataset to assess generalisability.
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Affiliation(s)
- Viet Le Bao
- South Western Clinical School, University of New South Wales, Sydney, Australia
- Ingham Institute for Applied Medical Research, Sydney, Australia
| | - Annette Haworth
- Institute of Medical Physics, School of Physics, University of Sydney, Australia
| | - Jason Dowling
- South Western Clinical School, University of New South Wales, Sydney, Australia
- Ingham Institute for Applied Medical Research, Sydney, Australia
| | - Amy Walker
- South Western Clinical School, University of New South Wales, Sydney, Australia
- Ingham Institute for Applied Medical Research, Sydney, Australia
- Liverpool and Macarthur Cancer Therapy Centres, Sydney, Australia
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, Australia
| | - Sankar Arumugam
- South Western Clinical School, University of New South Wales, Sydney, Australia
- Ingham Institute for Applied Medical Research, Sydney, Australia
- Liverpool and Macarthur Cancer Therapy Centres, Sydney, Australia
| | - Michael Jameson
- St Vincent's Clinical School, University of New South Wales, Sydney, Australia
- GenesisCare, Sydney, NSW, Australia
| | - Phillip Chlap
- South Western Clinical School, University of New South Wales, Sydney, Australia
- Ingham Institute for Applied Medical Research, Sydney, Australia
- Liverpool and Macarthur Cancer Therapy Centres, Sydney, Australia
| | - Kirsty Wiltshire
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia
| | - Sarah Keats
- Ingham Institute for Applied Medical Research, Sydney, Australia
- Liverpool and Macarthur Cancer Therapy Centres, Sydney, Australia
| | - Kirrily Cloak
- South Western Clinical School, University of New South Wales, Sydney, Australia
- Ingham Institute for Applied Medical Research, Sydney, Australia
- Liverpool and Macarthur Cancer Therapy Centres, Sydney, Australia
| | - Mark Sidhom
- South Western Clinical School, University of New South Wales, Sydney, Australia
- Liverpool and Macarthur Cancer Therapy Centres, Sydney, Australia
| | | | - Lois Holloway
- South Western Clinical School, University of New South Wales, Sydney, Australia
- Ingham Institute for Applied Medical Research, Sydney, Australia
- Institute of Medical Physics, School of Physics, University of Sydney, Australia
- Liverpool and Macarthur Cancer Therapy Centres, Sydney, Australia
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, Australia
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Brighi C, Keall PJ, Holloway LC, Walker A, Whelan B, de Witt Hamer PC, Verburg N, Aly F, Chen C, Koh ES, Waddington DEJ. An investigation of the conformity, feasibility, and expected clinical benefits of multiparametric MRI-guided dose painting radiotherapy in glioblastoma. Neurooncol Adv 2022; 4:vdac134. [PMID: 36105390 PMCID: PMC9466270 DOI: 10.1093/noajnl/vdac134] [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] [Indexed: 11/14/2022] Open
Abstract
Background New technologies developed to improve survival outcomes for glioblastoma (GBM) continue to have limited success. Recently, image-guided dose painting (DP) radiotherapy has emerged as a promising strategy to increase local control rates. In this study, we evaluate the practical application of a multiparametric MRI model of glioma infiltration for DP radiotherapy in GBM by measuring its conformity, feasibility, and expected clinical benefits against standard of care treatment. Methods Maps of tumor probability were generated from perfusion/diffusion MRI data from 17 GBM patients via a previously developed model of GBM infiltration. Prescriptions for DP were linearly derived from tumor probability maps and used to develop dose optimized treatment plans. Conformity of DP plans to dose prescriptions was measured via a quality factor. Feasibility of DP plans was evaluated by dose metrics to target volumes and critical brain structures. Expected clinical benefit of DP plans was assessed by tumor control probability. The DP plans were compared to standard radiotherapy plans. Results The conformity of the DP plans was >90%. Compared to the standard plans, DP (1) did not affect dose delivered to organs at risk; (2) increased mean and maximum dose and improved minimum dose coverage for the target volumes; (3) reduced minimum dose within the radiotherapy treatment margins; (4) improved local tumor control probability within the target volumes for all patients. Conclusions A multiparametric MRI model of GBM infiltration can enable conformal, feasible, and potentially beneficial dose painting radiotherapy plans.
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Affiliation(s)
- Caterina Brighi
- ACRF Image X Institute, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney , Sydney , Australia
- Ingham Institute for Applied Medical Research , Sydney , Australia
| | - Paul J Keall
- ACRF Image X Institute, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney , Sydney , Australia
- Ingham Institute for Applied Medical Research , Sydney , Australia
| | - Lois C Holloway
- Ingham Institute for Applied Medical Research , Sydney , Australia
- Department of Radiation Oncology, Liverpool and Macarthur Cancer Therapy Centres , Liverpool , Australia
- Centre for Medical Radiation Physics, University of Wollongong , Wollongong, Australia
| | - Amy Walker
- Ingham Institute for Applied Medical Research , Sydney , Australia
- Department of Radiation Oncology, Liverpool and Macarthur Cancer Therapy Centres , Liverpool , Australia
- Centre for Medical Radiation Physics, University of Wollongong , Wollongong, Australia
| | - Brendan Whelan
- ACRF Image X Institute, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney , Sydney , Australia
- Ingham Institute for Applied Medical Research , Sydney , Australia
| | - Philip C de Witt Hamer
- Brain Tumor Center Amsterdam , Amsterdam UMC, Amsterdam , The Netherlands
- Department of Neurosurgery , Amsterdam UMC, Amsterdam , The Netherlands
| | - Niels Verburg
- Brain Tumor Center Amsterdam , Amsterdam UMC, Amsterdam , The Netherlands
- Department of Neurosurgery , Amsterdam UMC, Amsterdam , The Netherlands
| | - Farhannah Aly
- Ingham Institute for Applied Medical Research , Sydney , Australia
- Department of Radiation Oncology, Liverpool and Macarthur Cancer Therapy Centres , Liverpool , Australia
| | - Cathy Chen
- Department of Radiation Oncology, Liverpool and Macarthur Cancer Therapy Centres , Liverpool , Australia
| | - Eng-Siew Koh
- Ingham Institute for Applied Medical Research , Sydney , Australia
- Department of Radiation Oncology, Liverpool and Macarthur Cancer Therapy Centres , Liverpool , Australia
| | - David E J Waddington
- ACRF Image X Institute, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney , Sydney , Australia
- Ingham Institute for Applied Medical Research , Sydney , Australia
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DVH Analyzer: design and algorithm to reveal DVH bands for quantitative analysis of robust radiotherapy treatment plans. HEALTH AND TECHNOLOGY 2021. [DOI: 10.1007/s12553-021-00578-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Dose planning variations related to delineation variations in MRI-guided brachytherapy for locally advanced cervical cancer. Brachytherapy 2020; 19:146-153. [PMID: 32067884 DOI: 10.1016/j.brachy.2020.01.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 01/02/2020] [Accepted: 01/02/2020] [Indexed: 11/23/2022]
Abstract
PURPOSE To examine the variability in prescribed dose due to contouring variations in intracavitary image-guided adaptive brachytherapy for cervical cancer. To identify correlations between dosimetric outcomes and delineation uncertainty metrics. METHODS AND MATERIALS A data set from an EMBRACE sub-study on contouring uncertainties was used, consisting of magnetic resonance images of six patients with cervical cancer delineated by 10 experienced observers (target volumes and organs at risk). Two gold standard contours were generated, an expert consensus and the simultaneous truth and performance level estimation. Plans were individually optimised to all of the contour sets (12 in total). Plans were applied to the gold standard contour sets, and dose volume histogram parameters including D90, D98 and D2cm3 were determined. The variability between plans was assessed. Dose volume histogram parameters and delineation uncertainty metrics were correlated using the Spearman's non-parametric rank correlation. RESULTS There is a dosimetric variability between observers, patients and the gold standard contour used for analysis. Approximately 3 Gy D90 EQD210 variability (SD) was observed for the CTVHR and 1.2-3.6 Gy D2cm3 EQD23 for the organs at risk. The maximum geometric dimensions of the delineations are most commonly correlated with dosimetry changes. Although the correlations are similar across gold standards, the direction of these correlations differs, indicating that the dosimetric outcomes are dependent on the contour that the plan is optimised to. CONCLUSION This study highlights the dosimetric differences interobserver uncertainty in contouring can have for cervical cancer brachytherapy. The importance of carefully choosing a gold standard from which to benchmark is reiterated.
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Jones MP, Martin J, Foo K, Estoesta P, Holloway L, Jameson M. The impact of contour variation on tumour control probability in anal cancer. Radiat Oncol 2018; 13:97. [PMID: 29776418 PMCID: PMC5960192 DOI: 10.1186/s13014-018-1033-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 04/18/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND While intensity modulated radiotherapy (IMRT) has been widely adopted for the treatment of anal cancer (AC), the added contour complexity poses potential risks. This study investigates the impact of contour variation on tumour control probability (TCP) when using IMRT for AC. METHODS Nine Australian centres contoured a single computed tomography dataset of a patient with AC. The same optimised template-based IMRT planning protocol was applied to each contour set to generate nine representative treatment plans and their corresponding dose volume histograms. A geometric analysis was performed on all contours. The TCP was calculated for each plan using the linear quadratic and logitEUD model. RESULTS The median concordance index (CI) for the bladder, head and neck of femur, bone marrow, small bowel and external genitalia was 0.94, 0.88, 0.84, 0.65 and 0.65, respectively. The median CI for the involved nodal, primary tumour and elective clinical target volumes were 0.85, 0.77 and 0.71, respectively. Across the nine plans, the TCP was not significantly different. Variation in TCP between plans increased as tumour cell load increased or radiation dose decreased. CONCLUSIONS When using IMRT for AC, contour variations generated from a common protocol within the limits of minor deviations do not appear to have a significant impact on TCP. Contouring variations may be more critical with increasing tumour cell load or reducing radiotherapy dose.
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Affiliation(s)
- Michael P Jones
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia. .,Department of Radiation Oncology, Calvary Mater Newcastle, Waratah, NSW, Australia.
| | - Jarad Martin
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,Department of Radiation Oncology, Calvary Mater Newcastle, Waratah, NSW, Australia
| | - Kerwyn Foo
- Department of Radiation Oncology, Chris O'Brien Lifehouse, Camperdown, NSW, Australia
| | - Patrick Estoesta
- Department of Radiation Oncology, Chris O'Brien Lifehouse, Camperdown, NSW, Australia
| | - Lois Holloway
- Liverpool and Macarthur Cancer Therapy Centres, Liverpool, NSW, Australia.,Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.,South West Clinical School, Faculty of Medicine, University of New South Wales, Kensington, NSW, Australia.,Institute of Medical Physics, School of Physics, University of Sydney, Camperdown, NSW, Australia.,Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia
| | - Michael Jameson
- Liverpool and Macarthur Cancer Therapy Centres, Liverpool, NSW, Australia.,Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.,South West Clinical School, Faculty of Medicine, University of New South Wales, Kensington, NSW, Australia
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6
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Roach D, Jameson MG, Dowling JA, Ebert MA, Greer PB, Kennedy AM, Watt S, Holloway LC. Correlations between contouring similarity metrics and simulated treatment outcome for prostate radiotherapy. ACTA ACUST UNITED AC 2018; 63:035001. [DOI: 10.1088/1361-6560/aaa50c] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Deshpande S, Geurts M, Vial P, Metcalfe P, Lee M, Holloway L. Clinical significance of treatment delivery errors for helical TomoTherapy nasopharyngeal plans – A dosimetric simulation study. Phys Med 2017; 33:159-169. [PMID: 28110824 DOI: 10.1016/j.ejmp.2017.01.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Revised: 12/06/2016] [Accepted: 01/07/2017] [Indexed: 11/17/2022] Open
Affiliation(s)
- Shrikant Deshpande
- Liverpool and Macarthur Cancer Therapy Centres and Ingham Institute, Sydney, NSW, Australia; Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia.
| | - Mark Geurts
- Department of Human Oncology, School of Medicine and Public Health, University of Wisconsin-Madison, USA.
| | - Philip Vial
- Liverpool and Macarthur Cancer Therapy Centres and Ingham Institute, Sydney, NSW, Australia; Institute of Medical Physics, School of Physics, University of Sydney, Sydney, NSW, Australia.
| | - Peter Metcalfe
- Liverpool and Macarthur Cancer Therapy Centres and Ingham Institute, Sydney, NSW, Australia; Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia.
| | - Mark Lee
- Liverpool and Macarthur Cancer Therapy Centres and Ingham Institute, Sydney, NSW, Australia.
| | - Lois Holloway
- Liverpool and Macarthur Cancer Therapy Centres and Ingham Institute, Sydney, NSW, Australia; Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia; Institute of Medical Physics, School of Physics, University of Sydney, Sydney, NSW, Australia; South West Clinical School, University of New South Wales, Sydney, NSW, Australia.
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Use of planning metrics software for automated feedback to radiotherapy students. JOURNAL OF RADIOTHERAPY IN PRACTICE 2016. [DOI: 10.1017/s1460396916000406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
AbstractBackground and purposePre-registration teaching of radiotherapy planning in a non-clinical setting should allow students the opportunity to develop clinical decision-making skills. Students frequently struggle with their ability to prioritise and optimise multiple objectives when producing a clinically acceptable plan. Emerging software applications providing quantitative assessment of plan quality are designed for clinical use but may have value for teaching these skills. This project aimed to evaluate the potential value of automated feedback to second year BSc (Hons) Radiotherapy students.Materials and methodsAll 26 students studying a pre-registration radiotherapy planning module were provided with automated prediction of relative feasibility for left lung tumour planning targets by planning metrics software. Students were also provided with interim quantitative reports during the development of their plan. Student perceptions of the software were gathered using an anonymous questionnaire. Independent blinded marking of plans was performed after module completion and analysed for correlation with software-assigned marks.ResultsIn total, 25 plans were utilised for marking comparison and 16 students submitted feedback relating to the software. Overall, student feedback was positive regarding the software. A ‘strong’ Spearman’s rank-order correlation (rs=0·7165) was evident between human and computer marks (p=0·000055).ConclusionsAutomated software is capable of providing useful feedback to students as a teaching aid, in particular with regard to relative feasibility of goals. The strong correlation between human and computer marks suggests a role in benchmarking or moderation; however, the narrow scope of assessment parameters suggests value as an adjunct and not a replacement to human marking.
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Jameson MG, McNamara J, Bailey M, Metcalfe PE, Holloway LC, Foo K, Do V, Mileshkin L, Creutzberg CL, Khaw P. Results of the Australasian (Trans-Tasman Oncology Group) radiotherapy benchmarking exercise in preparation for participation in the PORTEC-3 trial. J Med Imaging Radiat Oncol 2016; 60:554-9. [PMID: 27059658 DOI: 10.1111/1754-9485.12447] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 02/19/2016] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Protocol deviations in Randomised Controlled Trials have been found to result in a significant decrease in survival and local control. In some cases, the magnitude of the detrimental effect can be larger than the anticipated benefits of the interventions involved. The implementation of appropriate quality assurance of radiotherapy measures for clinical trials has been found to result in fewer deviations from protocol. This paper reports on a benchmarking study conducted in preparation for the PORTEC-3 trial in Australasia. METHODS A benchmarking CT dataset was sent to each of the Australasian investigators, it was requested they contour and plan the case according to trial protocol using local treatment planning systems. These data was then sent back to Trans-Tasman Oncology Group for collation and analysis. RESULTS Thirty three investigators from eighteen institutions across Australia and New Zealand took part in the study. The mean clinical target volume (CTV) volume was 383.4 (228.5-497.8) cm(3) and the mean dose to a reference gold standard CTV was 48.8 (46.4-50.3) Gy. CONCLUSIONS Although there were some large differences in the contouring of the CTV and its constituent parts, these did not translate into large variations in dosimetry. Where individual investigators had deviations from the trial contouring protocol, feedback was provided. The results of this study will be used to compare with the international study QA for the PORTEC-3 trial.
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Affiliation(s)
- Michael G Jameson
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, New South Wales, Australia.,Liverpool Cancer Therapy Centre, Liverpool, New South Wales, Australia.,Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Jo McNamara
- Illawarra Shoalhaven Cancer & Haematology Network, Illawarra, New South Wales, Australia
| | - Michael Bailey
- Illawarra Shoalhaven Cancer & Haematology Network, Illawarra, New South Wales, Australia
| | - Peter E Metcalfe
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, New South Wales, Australia.,Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Lois C Holloway
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, New South Wales, Australia.,Liverpool Cancer Therapy Centre, Liverpool, New South Wales, Australia.,Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia.,School of Physics, University of Sydney, Sydney, New South Wales, Australia
| | - Kerwyn Foo
- School of Physics, University of Sydney, Sydney, New South Wales, Australia.,Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Viet Do
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Crown Princess Mary Cancer Centre Westmead, Sydney, New South Wales, Australia
| | - Linda Mileshkin
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia.,Australia New Zealand Gynaecological Oncology Group (ANZGOG), Camperdown, New South Wales, Australia
| | - Carien L Creutzberg
- Department of Radiation Oncology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Pearly Khaw
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia.,Australia New Zealand Gynaecological Oncology Group (ANZGOG), Camperdown, New South Wales, Australia
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Whelan B, Kumar S, Dowling J, Begg J, Lambert J, Lim K, Vinod SK, Greer PB, Holloway L. Utilising pseudo-CT data for dose calculation and plan optimization in adaptive radiotherapy. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2015; 38:561-8. [PMID: 26337163 DOI: 10.1007/s13246-015-0376-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 08/31/2015] [Indexed: 11/25/2022]
Abstract
To quantify the dose calculation error and resulting optimization uncertainty caused by performing inverse treatment planning on inaccurate electron density data (pseudo-CT) as needed for adaptive radiotherapy and Magnetic Resonance Imaging (MRI) based treatment planning. Planning Computer Tomography (CT) data from 10 cervix cancer patients was used to generate 4 pseudo-CT data sets. Each pseudo-CT was created based on an available method of assigning electron density to an anatomic image. An inversely modulated radiotherapy (IMRT) plan was developed on each planning CT. The dose calculation error caused by each pseudo-CT data set was quantified by comparing the dose calculated each pseudo-CT data set with that calculated on the original planning CT for the same IMRT plan. The optimization uncertainty introduced by the dose calculation error was quantified by re-optimizing the same optimization parameters on each pseudo-CT data set and comparing against the original planning CT. Dose differences were quantified by assessing the Equivalent Uniform Dose (EUD) for targets and relevant organs at risk. Across all pseudo-CT data sets and all organs, the absolute mean dose calculation error was 0.2 Gy, and was within 2 % of the prescription dose in 98.5 % of cases. Then absolute mean optimisation error was 0.3 Gy EUD, indicating that that inverse optimisation is impacted by the dose calculation error. However, the additional uncertainty introduced to plan optimisation is small compared the sources of variation which already exist. Use of inaccurate electron density data for inverse treatment planning results in a dose calculation error, which in turn introduces additional uncertainty into the plan optimization process. In this study, we showed that both of these effects are clinically acceptable for cervix cancer patients using four different pseudo-CT data sets. Dose calculation and inverse optimization on pseudo-CT is feasible for this patient cohort.
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Affiliation(s)
- Brendan Whelan
- Liverpool and Macarthur Cancer Therapy Centers and Ingham Institute for Applied Medical Science, Room 302, Medical Foundation Building, 92-94 Parramatta Road, Camperdown, Sydney, NSW, 2050, Australia. .,Radiation Physics Laboratory, University of Sydney, Sydney, Australia. .,Institute of Medical Physics, School of Physics, University of Sydney, Sydney, Australia.
| | - Shivani Kumar
- Liverpool and Macarthur Cancer Therapy Centers and Ingham Institute for Applied Medical Science, Room 302, Medical Foundation Building, 92-94 Parramatta Road, Camperdown, Sydney, NSW, 2050, Australia.,University of New South Wales, Sydney, Australia
| | - Jason Dowling
- Australian e-Health Research Centre, CSIRO Computational Informatics, Sydney, Australia
| | - Jarrad Begg
- Liverpool and Macarthur Cancer Therapy Centers and Ingham Institute for Applied Medical Science, Room 302, Medical Foundation Building, 92-94 Parramatta Road, Camperdown, Sydney, NSW, 2050, Australia
| | | | - Karen Lim
- Liverpool and Macarthur Cancer Therapy Centers and Ingham Institute for Applied Medical Science, Room 302, Medical Foundation Building, 92-94 Parramatta Road, Camperdown, Sydney, NSW, 2050, Australia.,University of New South Wales, Sydney, Australia.,University of Western Sydney, Sydney, Australia
| | - Shalini K Vinod
- Liverpool and Macarthur Cancer Therapy Centers and Ingham Institute for Applied Medical Science, Room 302, Medical Foundation Building, 92-94 Parramatta Road, Camperdown, Sydney, NSW, 2050, Australia.,University of New South Wales, Sydney, Australia.,University of Western Sydney, Sydney, Australia
| | - Peter B Greer
- University of Newcastle, Newcastle, Australia.,Calvary Mater Newcastle, Newcastle, Australia
| | - Lois Holloway
- Liverpool and Macarthur Cancer Therapy Centers and Ingham Institute for Applied Medical Science, Room 302, Medical Foundation Building, 92-94 Parramatta Road, Camperdown, Sydney, NSW, 2050, Australia.,Institute of Medical Physics, School of Physics, University of Sydney, Sydney, Australia.,Centre for Medical Radiation Physics, University of Wollongong, Wollongong, Australia.,University of New South Wales, Sydney, Australia
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Jameson MG, Ohanessian L, Batumalai V, Patel V, Holloway LC. Comparison of Oncentra® Brachy IPSA and graphical optimisation techniques: a case study of HDR brachytherapy head and neck and prostate plans. J Med Radiat Sci 2015; 62:168-74. [PMID: 26229683 PMCID: PMC4462990 DOI: 10.1002/jmrs.107] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 04/08/2015] [Accepted: 04/08/2015] [Indexed: 11/15/2022] Open
Abstract
There are a number of different dwell positions and time optimisation options available in the Oncentra® Brachy (Elekta Brachytherapy Solutions, Veenendaal, The Netherlands) brachytherapy treatment planning system. The purpose of this case study was to compare graphical (GRO) and inverse planning by simulated annealing (IPSA) optimisation techniques for interstitial head and neck (HN) and prostate plans considering dosimetry, modelled radiobiology outcome and planning time. Four retrospective brachytherapy patients were chosen for this study, two recurrent HN and two prostatic boosts. Manual GRO and IPSA plans were generated for each patient. Plans were compared using dose–volume histograms (DVH) and dose coverage metrics including; conformity index (CI), homogeneity index (HI) and conformity number (CN). Logit and relative seriality models were used to calculate tumour control probability (TCP) and normal tissue complication probability (NTCP). Approximate planning time was also recorded. There was no significant difference between GRO and IPSA in terms of dose metrics with mean CI of 1.30 and 1.57 (P > 0.05) respectively. IPSA achieved an average HN TCP of 0.32 versus 0.12 for GRO while for prostate there was no significant difference. Mean GRO planning times were greater than 75 min while average IPSA planning times were less than 10 min. Planning times for IPSA were greatly reduced compared to GRO and plans were dosimetrically similar. For this reason, IPSA makes for a useful planning tool in HN and prostate brachytherapy.
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Affiliation(s)
- Michael G Jameson
- Liverpool and Macarthur Cancer Therapy Centres Liverpool, New South Wales, Australia ; Centre for Medical Radiation Physics, University of Wollongong Wollongong, New South Wales, Australia ; Ingham Institute of Applied Medical Research Liverpool, New South Wales, Australia
| | - Lucy Ohanessian
- Liverpool and Macarthur Cancer Therapy Centres Liverpool, New South Wales, Australia
| | - Vikneswary Batumalai
- Liverpool and Macarthur Cancer Therapy Centres Liverpool, New South Wales, Australia ; Ingham Institute of Applied Medical Research Liverpool, New South Wales, Australia ; South Western Sydney Clinical School, School of Medicine University of New South Wales, Australia
| | - Virendra Patel
- Liverpool and Macarthur Cancer Therapy Centres Liverpool, New South Wales, Australia
| | - Lois C Holloway
- Liverpool and Macarthur Cancer Therapy Centres Liverpool, New South Wales, Australia ; Centre for Medical Radiation Physics, University of Wollongong Wollongong, New South Wales, Australia ; Ingham Institute of Applied Medical Research Liverpool, New South Wales, Australia ; South Western Sydney Clinical School, School of Medicine University of New South Wales, Australia ; Institute of Medical Physics, School of Physics, University of Sydney Sydney, New South Wales, Australia
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Robertson SP, Quon H, Kiess AP, Moore JA, Yang W, Cheng Z, Afonso S, Allen M, Richardson M, Choflet A, Sharabi A, McNutt TR. A data-mining framework for large scale analysis of dose-outcome relationships in a database of irradiated head and neck cancer patients. Med Phys 2015; 42:4329-37. [DOI: 10.1118/1.4922686] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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Correlation of contouring variation with modeled outcome for conformal non-small cell lung cancer radiotherapy. Radiother Oncol 2014; 112:332-6. [DOI: 10.1016/j.radonc.2014.03.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 03/21/2014] [Accepted: 03/27/2014] [Indexed: 12/25/2022]
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Jameson MG, De Leon J, Windsor AA, Cloak K, Keats S, Dowling JA, Chandra SS, Vial P, Sidhom M, Holloway L, Metcalfe P. Endorectal balloons in the post prostatectomy setting: do gains in stability lead to more predictable dosimetry? Radiother Oncol 2013; 109:493-7. [PMID: 24044793 DOI: 10.1016/j.radonc.2013.08.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 08/14/2013] [Accepted: 08/15/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE To perform a comparative study assessing potential benefits of endorectal-balloons (ERB) in post-prostatectomy patients. METHOD AND MATERIALS Ten retrospective post-prostatectomy patients treated without ERB and ten prospective patients treated with the ERB in situ were recruited. All patients received IMRT and IGRT using kilovoltage cone-beam computed tomography (kVCBCT). kVCBCT datasets were registered to the planning dataset, recontoured and the original plan recalculated on the kVCBCTs to recreate anatomical conditions during treatment. The imaging, structure and dose data were imported into in-house software for the assessment of geometric variation and cumulative equivalent uniform dose (EUD) in the two groups. RESULTS The difference in location (ΔCOV) for the bladder between planning and each CBCT was similar for each group. The range of mean ΔCOV for the rectum was 0.15-0.58 cm and 0.15-0.59 cm for the non-ERB and ERB groups. For superior-CTV and inferior-CTV the difference between planned and delivered D95% (mean ± SD) for the non-ERB group was 2.1 ± 6.0 Gy and -0.04 ± 0.20 Gy. While for the ERB group the difference in D95% was 8.7 ± 12.6 Gy and 0.003 ± 0.104 Gy. CONCLUSIONS The use of ERBs in the post-prostatectomy setting did improve geometric reproducibility of the target and surrounding normal tissues, however no improvement in dosimetric stability was observed for the margins employed.
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Affiliation(s)
- Michael G Jameson
- Liverpool and Macarthur Cancer Therapy Centres, Australia; Centre for Medical Radiation Physics, University of Wollongong, Australia; Ingham Institute, Australia.
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