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Deng Y, Qiu M, Li Y, Wang C, Zhong J, Xiao Z, Wang C, Chen R. A generalized model of cardiac surface motion for evaluating left anterior descending coronary artery dose in left breast cancer radiotherapy. Med Phys 2024. [PMID: 38922708 DOI: 10.1002/mp.17261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 05/22/2024] [Accepted: 05/22/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Retrospective studies indicate that radiation damage to left anterior descending coronary artery (LAD) may be critical for late-stage radiation-induced cardiac morbidity. Developing a method that accurately depicts LAD motion and perform dose assessment is crucial. PURPOSE To construct a generalized cardiac surface motion model for LAD dose assessment in left breast cancer radiotherapy. METHODS Cine MRI of 25 cases were divided into training and testing sets for model construction, and five external cases were gathered for generalization validation. Motion prediction from average intensity projection images (AIP) surface point cloud to that of each phase was realized by mapping the relationship between datum points and corresponding points with statistical shape modeling (SSM). Root mean square error (RMSE) for predicted corresponding points and Euclidean distance (ED) for predicted surface point cloud were used to assess model's accuracy. LAD dose assessment for 10 left breast cancer radiotherapy cases was perform by model application. RESULTS The RMSE in testing cases and external cases were 0.209 ± 0.020 mm to 0.841 ± 0.074 mm and 0.895 ± 0.093 mm to 1.912 ± 0.138 mm, respectively; while the ED were 1.399 ± 0.029 mm to 1.658 ± 0.100 mm, 1.571 ± 0.080 mm to 1.779 ± 0.104 mm, respectively, proving the generalized model's high accuracy. The volume of LAD characterizing motion range (WPLAD) (2.392 ± 0.639 cm3) was approximately twice that of LAD from superimposed images (SPLAD) (0.927 ± 0.326 cm3) with p < 0.05, and the former's Dmax (3582.06 ± 575.92 cGy) was significantly larger than latter's (3222.71 ± 665.37 cGy) (p < 0.05). While WPLAD's Dmean (1408.06 ± 413.06 cGy) was slightly smaller than that of SPLAD (1504.15 ± 448.03 cGy), the difference did not reach statistical significance (p > 0.05). WPLAD's V20 (23.42% ± 16.62%) was less than SPLAD's (29.18% ± 21.07%) with p < 0.05, but their comparison in V30 and V40 did not yield statistically significant results. It implies the conventional LAD dose assessment ignores motion impact and may not be justified. CONCLUSIONS The generalized cardiac surface motion model informs LAD dose accurate assessment in left breast cancer radiotherapy.
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Affiliation(s)
- Yongjin Deng
- The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, PR China
| | - Minmin Qiu
- The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, PR China
| | - Yangchan Li
- The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, PR China
| | - Chaoyang Wang
- The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, PR China
| | - Jiajian Zhong
- The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, PR China
| | - Zhenhua Xiao
- The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, PR China
| | - Chengtao Wang
- The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, PR China
| | - Ruiwan Chen
- The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, PR China
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Lu W, Hong LX, Yamada N, Berry SL, Song Y, Choi W, Cerviño LI, Tang X, Mechalakos JG, Romesser PB, Powell S, Li G. Comparison of setup accuracy of optical surface image versus orthogonal x-ray images for VMAT of the left breast using deep-inspiration breath-hold. J Appl Clin Med Phys 2023; 24:e14117. [PMID: 37535396 PMCID: PMC10691624 DOI: 10.1002/acm2.14117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/25/2023] [Accepted: 07/18/2023] [Indexed: 08/04/2023] Open
Abstract
To compare the setup accuracy of optical surface image (OSI) versus orthogonal x-ray images (2DkV) using cone beam computed tomography (CBCT) as ground truth for radiotherapy of left breast cancer in deep-inspiration breath-hold (DIBH). Ten left breast DIBH patients treated with volumetric modulated arc therapy (VMAT) were studied retrospectively. OSI, 2DkV, and CBCT were acquired weekly at treatment setup. OSI, 2DkV, and CBCT were registered to planning CT or planning DRR based on a breast surface region of interest (ROI), bony anatomy (chestwall and sternum), and both bony anatomy and breast surface, respectively. These registrations provided couch shifts for each imaging system. The setup errors, or the difference in couch shifts between OSI and CBCT were compared to those between 2DkV and CBCT. A second OSI was acquired during last beam delivery to evaluate intrafraction motion. The median absolute setup errors were (0.21, 0.27, 0.23 cm, 0.6°, 1.3°, 1.0°) for OSI, and (0.26, 0.24, 0.18 cm, 0.9°, 1.0°, 0.6°) for 2DkV in vertical, longitudinal and lateral translations, and in rotation, roll and pitch, respectively. None of the setup errors was significantly different between OSI and 2DkV. For both systems, the systematic and random setup errors were ≤0.6 cm and ≤1.5° in all directions. Nevertheless, larger setup errors were observed in some sessions in both systems. There was no correlation between OSI and CBCT whereas there was modest correlation between 2DkV and CBCT. The intrafraction motion in DIBH detected by OSI was small with median absolute translations <0.2 cm, and rotations ≤0.4°. Though OSI showed comparable and small setup errors as 2DkV, it showed no correlation with CBCT. We concluded that to achieve accurate setup for both bony anatomy and breast surface, daily 2DkV can't be omitted following OSI for left breast patients treated with DIBH VMAT.
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Affiliation(s)
- Wei Lu
- Department of Medical PhysicsMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Linda X. Hong
- Department of Medical PhysicsMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Nelson Yamada
- Department of Medical PhysicsMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Sean L. Berry
- Department of Medical PhysicsMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Yulin Song
- Department of Medical PhysicsMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Wookjin Choi
- Department of Medical PhysicsMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Laura I. Cerviño
- Department of Medical PhysicsMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Xiaoli Tang
- Department of Medical PhysicsMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - James G. Mechalakos
- Department of Medical PhysicsMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Paul B. Romesser
- Department of Radiation OncologyMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Simon Powell
- Department of Radiation OncologyMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Guang Li
- Department of Medical PhysicsMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
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Fu M, Cui Y, Qiu W, Cui Z, Zhang Y, Wang D, Yan S, Zhao Z, Wang Y, Zhu J. In Silico Studies of the Impact of Rotational Errors on Translation Shifts and Dose Distribution in Image-Guided Radiotherapy. Technol Cancer Res Treat 2023; 22:15330338231168763. [PMID: 37050884 PMCID: PMC10102941 DOI: 10.1177/15330338231168763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023] Open
Abstract
Objective: To compare the 6-dimensional errors of different immobilization devices and body regions based on 3-dimensional cone beam computed tomography for image-guided radiotherapy and to further quantitatively evaluate the impact of rotational corrections on translational shifts and dose distribution based on anthropomorphic phantoms. Materials and Methods: Two hundred ninety patients with cone beam computed tomographies from 3835 fractions were retrospectively analyzed for brain, head & neck, chest, abdomen, pelvis, and breast cases. A phantom experiment was conducted to investigate the impact of rotational errors on translational shifts using cone beam computed tomography and the registration system. For the dosimetry study, pitch rotations were simulated by adjusting the breast bracket by ±2.5°. Roll and yaw rotations were simulated by rotating the gantry and couch in the planning system by ±3.0°, respectively. The original plan for the breast region was designed in the computed tomography image space without rotation. With the same planning parameters, the original plan was transplanted into the image space with different rotations for dose recalculation. The effect of these errors on the breast target and organs at risk was assessed by dose-volume histograms. Results: Most of the mean rotational errors in the breast region were >1°. A single uncorrected yaw of 3° caused a change of 2.9 mm in longitudinal translation. A phantom study for the breast region demonstrated that when the pitch rotations were -2.5° and 2.5° and roll and yaw were both 3°, the reductions in the planning target volumes-V50 Gy were 20.07% and 29.58% of the original values, respectively. When the pitch rotation was +2.5°, the left lung V5 Gy and heart Dmean were 7.49% and 165.76 Gy larger, respectively, than the original values. Conclusions: Uncorrected rotations may cause changes in the values and directions of translational shifts. Rotational corrections may improve the patient setup and dose distribution accuracy.
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Affiliation(s)
- Min Fu
- Department of Radiation Oncology Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, People's Republic of China
| | - Yanhua Cui
- Department of Radiation Oncology Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, People's Republic of China
| | - Wenlong Qiu
- Department of Radiation Oncology Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, People's Republic of China
| | - Zhen Cui
- Department of Radiation Oncology Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, People's Republic of China
| | - Yan Zhang
- Department of Radiation Oncology Physics and Technology, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research and Nanjing Medical University Affiliated Cancer Hospital, Nanjing, People's Republic of China
| | - Dandan Wang
- Department of Radiation Oncology Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, People's Republic of China
| | - Shaojie Yan
- Department of Radiation Oncology Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, People's Republic of China
| | - Zengjing Zhao
- Department of Radiation Oncology Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, People's Republic of China
| | - Yungang Wang
- Department of Radiation Oncology Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, People's Republic of China
| | - Jian Zhu
- Department of Radiation Oncology Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, People's Republic of China
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He Y, Chen S, Gao X, Fu L, Kang Z, Liu J, Shi L, Li Y. Robustness of VMAT to setup errors in postmastectomy radiotherapy of left-sided breast cancer: Impact of bolus thickness. PLoS One 2023; 18:e0280456. [PMID: 36693073 PMCID: PMC9873183 DOI: 10.1371/journal.pone.0280456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 12/30/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Volumetric modulated arc therapy (VMAT) with varied bolus thicknesses has been employed in postmastectomy radiotherapy (PMRT) of breast cancer to improve superficial target coverage. However, impact of bolus thickness on plan robustness remains unclear. METHODS The study enrolled ten patients with left-sided breast cancer who received radiotherapy using VMAT with 5 mm and 10 mm bolus (VMAT-5B and VMAT-10B). Inter-fractional setup errors were simulated by introducing a 3 mm shift to isocenter of the original plans in the anterior-posterior, left-right, and inferior-superior directions. The plans (perturbed plans) were recalculated without changing other parameters. Dose volume histograms (DVH) were collected for plan evaluation. Absolute dose differences in DVH endpoints for the clinical target volume (CTV), heart, and left lung between the perturbed plans and the original ones were used for robustness analysis. RESULTS VMAT-10B showed better target coverage, while VMAT-5B was superior in organs-at-risk (OARs) sparing. As expected, small setup errors of 3 mm could induce dose fluctuations in CTV and OARs. The differences in CTV were small in VMAT-5B, with a maximum difference of -1.05 Gy for the posterior shifts. For VMAT-10B, isocenter shifts in the posterior and right directions significantly decreased CTV coverage. The differences were -1.69 Gy, -1.48 Gy and -1.99 Gy, -1.69 Gy for ΔD95% and ΔD98%, respectively. Regarding the OARs, only isocenter shifts in the posterior, right, and inferior directions increased dose to the left lung and the heart. Differences in VMAT-10B were milder than those in VMAT-5B. Specifically, mean heart dose were increased by 0.42 Gy (range 0.10 ~ 0.95 Gy) and 0.20 Gy (range -0.11 ~ 0.72 Gy), and mean dose for the left lung were increased by 1.02 Gy (range 0.79 ~ 1.18 Gy) and 0.68 Gy (range 0.47 ~ 0.84 Gy) in VMAT-5B and VMAT-10B, respectively. High-dose volumes in the organs were increased by approximate 0 ~ 2 and 1 ~ 3 percentage points, respectively. Nevertheless, most of the dosimetric parameters in the perturbed plans were still clinically acceptable. CONCLUSIONS VMAT-5B appears to be more robust to 3 mm setup errors than VMAT-10B. VMAT-5B also resulted in better OARs sparing with acceptable target coverage and dose homogeneity. Therefore 5 mm bolus is recommended for PMRT of left-sided breast cancer using VMAT.
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Affiliation(s)
- Yipeng He
- Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Sijia Chen
- Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Xiang Gao
- Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Lirong Fu
- Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Zheng Kang
- Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Jun Liu
- Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Liwan Shi
- Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Yimin Li
- Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, Xiamen, China
- * E-mail:
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Zhang Y, Zhou H, Chu K, Wu C, Ge Y, Shan G, Zhou J, Cai J, Jin J, Sun W, Chen Y, Huang X. Setup error assessment based on “Sphere-Mask” Optical Positioning System: Results from a multicenter study. Front Oncol 2022; 12:918296. [PMID: 36267985 PMCID: PMC9577199 DOI: 10.3389/fonc.2022.918296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 09/15/2022] [Indexed: 11/15/2022] Open
Abstract
Background The setup accuracy plays an extremely important role in the local control of tumors. The purpose of this study is to verify the feasibility of "Sphere-Mask" Optical Positioning System (S-M_OPS) for fast and accurate setup. Methods From 2016 to 2021, we used S-M_OPS to supervise 15441 fractions in 1981patients (with the cancer in intracalvarium, nasopharynx, esophagus, lung, liver, abdomen or cervix) undergoing intensity-modulated radiation therapy (IMRT), and recorded the data such as registration time and mask deformation. Then, we used S-M_OPS, laser line and cone beam computed tomography (CBCT) for co-setup in 277 fractions, and recorded laser line-guided setup errors and S-M_OPS-guided setup errors with CBCT-guided setup result as the standard. Results S-M_OPS supervision results: The average time for laser line-guided setup was 31.75s. 12.8% of the reference points had an average deviation of more than 2 mm and 5.2% of the reference points had an average deviation of more than 3 mm. Co-setup results: The average time for S-M_OPS-guided setup was 7.47s, and average time for CBCT-guided setup was 228.84s (including time for CBCT scan and manual verification). In the LAT (left/right), VRT (superior/inferior) and LNG (anterior/posterior) directions, laser line-guided setup errors (mean±SD) were -0.21±3.13mm, 1.02±2.76mm and 2.22±4.26mm respectively; the 95% confidence intervals (95% CIs) of laser line-guided setup errors were -6.35 to 5.93mm, -4.39 to 6.43mm and -6.14 to 10.58mm respectively; S-M_OPS-guided setup errors were 0.12±1.91mm, 1.02±1.81mm and -0.10±2.25mm respectively; the 95% CIs of S-M_OPS-guided setup errors were -3.86 to 3.62mm, -2.53 to 4.57mm and -4.51 to 4.31mm respectively. Conclusion S-M_OPS can greatly improve setup accuracy and stability compared with laser line-guided setup. Furthermore, S-M_OPS can provide comparable setup accuracy to CBCT in less setup time.
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Affiliation(s)
- Yan Zhang
- School of Electronic Science and Engineering, Nanjing University, Nanjing, China
| | - Han Zhou
- School of Electronic Science and Engineering, Nanjing University, Nanjing, China
| | - Kaiyue Chu
- Department of Radiotherapy, Nantong Tumor Hospital, Nantong, China
| | - Chuanfeng Wu
- Department of Radiotherapy, Suzhou Municipal Hospital, Suzhou, China
| | - Yun Ge
- School of Electronic Science and Engineering, Nanjing University, Nanjing, China
- *Correspondence: Yun Ge, ; Guoping Shan,
| | - Guoping Shan
- School of Electronic Science and Engineering, Nanjing University, Nanjing, China
- Department of Radiation Physics, Zhejiang Cancer Hospital, Hangzhou, China
- *Correspondence: Yun Ge, ; Guoping Shan,
| | - Jundong Zhou
- Department of Radiotherapy, Suzhou Municipal Hospital, Suzhou, China
| | - Jing Cai
- Department of Radiotherapy, Nantong Tumor Hospital, Nantong, China
| | - Jianhua Jin
- Department of Radiotherapy, Nantong Tumor Hospital, Nantong, China
| | - Weiyu Sun
- School of Electronic Science and Engineering, Nanjing University, Nanjing, China
| | - Ying Chen
- School of Electronic Science and Engineering, Nanjing University, Nanjing, China
| | - Xiaolin Huang
- School of Electronic Science and Engineering, Nanjing University, Nanjing, China
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Mankinen M, Virén T, Seppälä J, Hakkarainen H, Koivumäki T. Dosimetric effect of respiratory motion on planned dose in whole-breast volumetric modulated arc therapy using moderate and ultra-hypofractionation. Radiat Oncol 2022; 17:46. [PMID: 35248114 PMCID: PMC8898500 DOI: 10.1186/s13014-022-02014-5] [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: 09/30/2021] [Accepted: 02/16/2022] [Indexed: 11/24/2022] Open
Abstract
Background and purpose The interplay effect of respiratory motion on the planned dose in free-breathing right-sided whole-breast irradiation (WBI) were studied by simulating hypofractionated VMAT treatment courses. Materials and methods Ten patients with phase-triggered 4D-CT images were included in the study. VMAT plans targeting the right breast were created retrospectively with moderately hypofractionated (40.05 Gy in 15 fractions of 2.67 Gy) and ultra-hypofractionated (26 Gy 5 fractions of 5.2 Gy) schemes. 3D-CRT plans were generated as a reference. All plans were divided into respiratory phase-specific plans and calculated in the corresponding phase images. Fraction-specific dose was formed by deforming and summing the phase-specific doses in the planning image for each fraction. The fraction-specific dose distributions were deformed and superimposed onto the planning image, forming the course-specific respiratory motion perturbed dose distribution. Planned and respiratory motion perturbed doses were compared and changes due to respiratory motion and choice of fractionation were evaluated. Results The respiratory motion perturbed PTV coverage (V95%) decreased by 1.7% and the homogeneity index increased by 0.02 for VMAT techniques, compared to the planned values. Highest decrease in CTV coverage was 0.7%. The largest dose differences were located in the areas of steep dose gradients parallel to respiratory motion. The largest difference in DVH parameters between fractionation schemes was 0.4% of the prescribed dose. Clinically relevant changes to the doses of organs at risk were not observed. One patient was excluded from the analysis due to large respiratory amplitude. Conclusion Respiratory motion of less than 5 mm in magnitude did not result in clinically significant changes in the planned free-breathing WBI dose. The 5 mm margins were sufficient to account for the respiratory motion in terms of CTV dose homogeneity and coverage for VMAT techniques. Steep dose gradients near the PTV edges might decrease the CTV coverage. No clinical significance was found due to the choice of fractionation. Supplementary Information The online version contains supplementary material available at 10.1186/s13014-022-02014-5.
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Li C, Lu Z, He M, Sui J, Lin T, Xie K, Sun J, Ni X. Augmented reality-guided positioning system for radiotherapy patients. J Appl Clin Med Phys 2022; 23:e13516. [PMID: 34985188 PMCID: PMC8906221 DOI: 10.1002/acm2.13516] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 11/18/2021] [Accepted: 12/15/2021] [Indexed: 01/22/2023] Open
Abstract
In modern radiotherapy, error reduction in the patients’ daily setup error is important for achieving accuracy. In our study, we proposed a new approach for the development of an assist system for the radiotherapy position setup by using augmented reality (AR). We aimed to improve the accuracy of the position setup of patients undergoing radiotherapy and to evaluate the error of the position setup of patients who were diagnosed with head and neck cancer, and that of patients diagnosed with chest and abdomen cancer. We acquired the patient's simulation CT data for the three‐dimensional (3D) reconstruction of the external surface and organs. The AR tracking software detected the calibration module and loaded the 3D virtual model. The calibration module was aligned with the Linac isocenter by using room lasers. And then aligned the virtual cube with the calibration module to complete the calibration of the 3D virtual model and Linac isocenter. Then, the patient position setup was carried out, and point cloud registration was performed between the patient and the 3D virtual model, such the patient's posture was consistent with the 3D virtual model. Twenty patients diagnosed with head and neck cancer and 20 patients diagnosed with chest and abdomen cancer in the supine position setup were analyzed for the residual errors of the conventional laser and AR‐guided position setup. Results show that for patients diagnosed with head and neck cancer, the difference between the two positioning methods was not statistically significant (P > 0.05). For patients diagnosed with chest and abdomen cancer, the residual errors of the two positioning methods in the superior and inferior direction and anterior and posterior direction were statistically significant (t = −5.80, −4.98, P < 0.05). The residual errors in the three rotation directions were statistically significant (t = −2.29 to −3.22, P < 0.05). The experimental results showed that the AR technology can effectively assist in the position setup of patients undergoing radiotherapy, significantly reduce the position setup errors in patients diagnosed with chest and abdomen cancer, and improve the accuracy of radiotherapy.
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Affiliation(s)
- Chunying Li
- Department of Radiotherapy, Changzhou Second People's Hospital, Nanjing Medical University, Changzhou, China.,Laboratory of Medical Physics Center, Nanjing Medical University, Jiangning District, Nanjing, China.,Changzhou Key Laboratory of Medical Physics, Changzhou, China
| | - Zhengda Lu
- Department of Radiotherapy, Changzhou Second People's Hospital, Nanjing Medical University, Changzhou, China.,Laboratory of Medical Physics Center, Nanjing Medical University, Jiangning District, Nanjing, China.,Changzhou Key Laboratory of Medical Physics, Changzhou, China
| | - Mu He
- Department of Radiotherapy, Changzhou Second People's Hospital, Nanjing Medical University, Changzhou, China.,Laboratory of Medical Physics Center, Nanjing Medical University, Jiangning District, Nanjing, China.,Changzhou Key Laboratory of Medical Physics, Changzhou, China
| | - Jianfeng Sui
- Department of Radiotherapy, Changzhou Second People's Hospital, Nanjing Medical University, Changzhou, China.,Laboratory of Medical Physics Center, Nanjing Medical University, Jiangning District, Nanjing, China.,Changzhou Key Laboratory of Medical Physics, Changzhou, China
| | - Tao Lin
- Department of Radiotherapy, Changzhou Second People's Hospital, Nanjing Medical University, Changzhou, China.,Laboratory of Medical Physics Center, Nanjing Medical University, Jiangning District, Nanjing, China.,Changzhou Key Laboratory of Medical Physics, Changzhou, China
| | - Kai Xie
- Department of Radiotherapy, Changzhou Second People's Hospital, Nanjing Medical University, Changzhou, China.,Laboratory of Medical Physics Center, Nanjing Medical University, Jiangning District, Nanjing, China.,Changzhou Key Laboratory of Medical Physics, Changzhou, China
| | - Jiawei Sun
- Department of Radiotherapy, Changzhou Second People's Hospital, Nanjing Medical University, Changzhou, China.,Laboratory of Medical Physics Center, Nanjing Medical University, Jiangning District, Nanjing, China.,Changzhou Key Laboratory of Medical Physics, Changzhou, China
| | - Xinye Ni
- Department of Radiotherapy, Changzhou Second People's Hospital, Nanjing Medical University, Changzhou, China.,Laboratory of Medical Physics Center, Nanjing Medical University, Jiangning District, Nanjing, China.,Changzhou Key Laboratory of Medical Physics, Changzhou, China
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Song Y, Peng J, Chen Q, Luo H. Compare of Interfractional Setup Reproducibility Between Vacuum-Lock Bag and Thermoplastic Mask in Radiotherapy for Breast Cancer. Technol Cancer Res Treat 2021; 20:15330338211043037. [PMID: 34554027 PMCID: PMC8490727 DOI: 10.1177/15330338211043037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background: This study aimed to analyze the difference of setup
reproducibility between Vacuum-lock bag and Thermoplastic mask in the
radiotherapy for breast cancer. Methods: A total of 100 invasive
breast carcinoma patients were collected, among whom 50 patients were
immobilized with Vacuum-lock bag (VB group), and the other 50 patients were
immobilized with Thermoplastic mask (TM group). Set up reproducibility in
different axes and comfort levels between two groups at three treatment progress
points during the radiation therapy were collected and analyzed.
Results: The linear regression model showed that fixed device
was an independent factor of radiotherapy setup error (SE). Further subgroup
analysis based on different axes showed that the SE caused by the fixed device
was obvious in all directions. The comfort level in the VB group was
significantly larger than that in the TM group at the beginning of treatment,
reduced as the treatment progress going on, and finally disappeared within three
weeks. Conclusions: Thermoplastic mask could significantly reduce
positioning errors in the radiotherapy of breast cancer. Although more
discomfort was found in the TM group, it could be eliminated as the treatment
progresses.
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Affiliation(s)
- Yaqi Song
- The Affiliated Huaian No.1 People’s Hospital of Nanjing Medical
University, Huaian, Jiangsu, China
| | - Jin Peng
- The Affiliated Huaian No.1 People’s Hospital of Nanjing Medical
University, Huaian, Jiangsu, China
| | - Qianfeng Chen
- The Affiliated Huaian No.1 People’s Hospital of Nanjing Medical
University, Huaian, Jiangsu, China
| | - Honglei Luo
- The Affiliated Huaian No.1 People’s Hospital of Nanjing Medical
University, Huaian, Jiangsu, China
- Honglei Luo, Department of Radiation
Oncology, The Affiliated Huaian No.1 People’s Hospital of Nanjing Medical
University, Jiangsu, Huaian 223300, China.
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9
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Borm KJ, Junker Y, Düsberg M, Devečka M, Münch S, Dapper H, Oechsner M, Combs SE. Impact of CBCT frequency on target coverage and dose to the organs at risk in adjuvant breast cancer radiotherapy. Sci Rep 2021; 11:17378. [PMID: 34462489 PMCID: PMC8405651 DOI: 10.1038/s41598-021-96836-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 08/17/2021] [Indexed: 11/16/2022] Open
Abstract
The current study aims to assess the effect of cone beam computed tomography (CBCT) frequency during adjuvant breast cancer radiotherapy with simultaneous integrated boost (SIB) on target volume coverage and dose to the organs at risk (OAR). 50 breast cancer patients receiving either non-hypofractionated or hypofractionated radiotherapy after lumpectomy including a SIB to the tumor bed were selected for this study. All patients were treated in volumetric modulated arc therapy (VMAT) technique and underwent daily CBCT imaging. In order to estimate the delivered dose during the treatment, the applied fraction doses were recalculated on daily CBCT scans and accumulated using deformable image registration. Based on a total of 2440 dose recalculations, dose coverage in the clinical target volumes (CTV) and OAR was compared depending on the CBCT frequency. The estimated delivered dose (V95%) for breast-CTV and SIB-CTV was significantly lower than the planned dose distribution, irrespective of the CBCT-frequency. Between daily CBCT and CBCT on alternate days, no significant dose differences were found regarding V95% for both, breast-CTV and SIB-CTV. Dose distribution in the OAR was similar for both imaging protocols. Weekly CBCT though led to a significant decrease in dose coverage compared to daily CBCT and a small but significant dose increase in most OAR. Daily CBCT imaging might not be necessary to ensure adequate dose coverage in the target volumes while efficiently sparing the OAR during adjuvant breast cancer radiotherapy with SIB.
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Affiliation(s)
- Kai J Borm
- Department of Radiation Oncology, Klinikum Rechts Der Isar, Medical School, Technical University Munich, Ismaningerstraße 22, 81675, Munich, Germany.
| | - Yannis Junker
- Department of Radiation Oncology, Klinikum Rechts Der Isar, Medical School, Technical University Munich, Ismaningerstraße 22, 81675, Munich, Germany
| | - Mathias Düsberg
- Department of Radiation Oncology, Klinikum Rechts Der Isar, Medical School, Technical University Munich, Ismaningerstraße 22, 81675, Munich, Germany
| | - Michal Devečka
- Department of Radiation Oncology, Klinikum Rechts Der Isar, Medical School, Technical University Munich, Ismaningerstraße 22, 81675, Munich, Germany
| | - Stefan Münch
- Department of Radiation Oncology, Klinikum Rechts Der Isar, Medical School, Technical University Munich, Ismaningerstraße 22, 81675, Munich, Germany
| | - Hendrik Dapper
- Department of Radiation Oncology, Klinikum Rechts Der Isar, Medical School, Technical University Munich, Ismaningerstraße 22, 81675, Munich, Germany
| | - Markus Oechsner
- Department of Radiation Oncology, Klinikum Rechts Der Isar, Medical School, Technical University Munich, Ismaningerstraße 22, 81675, Munich, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, Klinikum Rechts Der Isar, Medical School, Technical University Munich, Ismaningerstraße 22, 81675, Munich, Germany.,Deutsches Konsortium Für Translationale Krebsforschung (DKTK)-Partner Site Munich, Munich, Germany.,Institute of Radiation Medicine, Helmholtzzentrum München, Munich, Germany
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10
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Hoekstra N, Habraken S, Swaak-Kragten A, Pignol JP, Hoogeman M. Fiducial marker motion relative to the tumor bed has a significant impact on PTV margins in partial breast irradiation. Radiother Oncol 2021; 163:1-6. [PMID: 34329655 DOI: 10.1016/j.radonc.2021.07.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/28/2021] [Accepted: 07/19/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION With the introduction of accelerated partial breast irradiation (APBI) and the trend of reducing the number of fractions, the geometric accuracy of treatment delivery becomes critical. APBI patient setup is often based on fiducials, as the seroma is frequently not visible on pretreatment imaging. We assessed the motion of fiducials relative to the tumor bed between planning CT and treatment, and calculated margins to compensate for this motion. METHODS A cohort of seventy patients treated with APBI on a Cyberknife was included. Planning and in-room pretreatment CT scans were registered on the tumor bed. Residual motion of the centers of mass of surgical clips and interstitial gold markers was calculated. We calculated the margins required per desired percentage of patients with 100% CTV coverage, and the systematic and random errors for fiducial motion. RESULTS For a single fraction treatment, a margin of 1.8 mm would ensure 100% CTV coverage in 90% of patients when using surgical clips for patient set-up. When using interstitial markers, the margin should be 2.2 mm. The systematic and random errors were 0.46 mm for surgical clip motion and 0.60 mm for interstitial marker motion. No clinical factors were found predictive for fiducial motion. CONCLUSIONS Fiducial motion relative to the tumor bed between planning CT and APBI treatment is non-negligible and should be included in the PTV margin calculation to prevent geographical miss. Systematic and random errors of fiducial motion were combined with other geometric uncertainties to calculate comprehensive PTV margins for different treatment techniques.
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Affiliation(s)
- Nienke Hoekstra
- Erasmus MC Cancer Institute, Department of Radiation Oncology, Rotterdam, The Netherlands.
| | - Steven Habraken
- Erasmus MC Cancer Institute, Department of Radiation Oncology, Rotterdam, The Netherlands
| | | | | | - Mischa Hoogeman
- Erasmus MC Cancer Institute, Department of Radiation Oncology, Rotterdam, The Netherlands
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11
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Zhou J, Li S, Ye C, Shen K, Li A, Chen G, Li X, Bai S, Wang W, Zhong R. Analysis of local setup errors of sub-regions in cone-beam CT-guided post-mastectomy radiation therapy. JOURNAL OF RADIATION RESEARCH 2021; 61:457-463. [PMID: 32100830 PMCID: PMC7299271 DOI: 10.1093/jrr/rraa007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 11/27/2019] [Indexed: 02/05/2023]
Abstract
The purpose of the study was to quantify local setup errors and evaluate the planning target volume (PTV) margins for sub-regions in cone-beam computed tomography (CBCT)-guided post-mastectomy radiation therapy (PMRT). The local setup errors of 20 patients undergoing CBCT-guided PMRT were analysed retrospectively. Image registration between CBCT and planning CT was performed using four sub-regions of interest (ROIs): the supraclavicular area (SROI), ipsilateral chest wall region (CROI), ipsilateral chest wall plus supraclavicular region (SROI + CROI) and vertebral region (TROI). Bland–Altman analysis, correlation, local setup errors and PTV margins among these ROIs were evaluated. There was no significant consistency or correlation for registration results between the TROI and the CROI or SROI regions on any translational axis. When using the SROI + CROI as the ROI, the systematic error (Σ) and random error (σ) of the local setup errors for the CROI region were 1.81, 1.19 and 1.76 mm and 1.84, 2.64 and 3.00 mm along the medial–lateral (ML), superior–inferior (SI) and anterior–posterior (AP) directions, respectively. The PTV margins for the CROI region were 5.80, 4.82 and 6.50 mm. The Σ and σ of the local setup errors for the SROI region were 1.29, 1.15 and 0.77 mm and 1.96, 2.65 and 2.2 mm, respectively, and the PTV margins were 4.59, 4.73 and 3.47 mm. Large setup errors and local setup errors occur in PMRT. The vertebral body should not be a position surrogate for the supraclavicular region or chest wall. To compensate for the local setup errors, different PTV margins are required, even with CBCT guidance.
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Affiliation(s)
- Jidan Zhou
- Department of Radiotherapy, Division of Radiation Physics, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, P.R. China
| | - Shuai Li
- Department of Radiotherapy, Division of Radiation Physics, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, P.R. China
| | - Chengwei Ye
- Department of Radiotherapy, Division of Radiation Physics, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, P.R. China
| | - Konglong Shen
- Department of Radiotherapy, Division of Radiation Physics, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, P.R. China
| | - An Li
- Department of Radiotherapy, Division of Radiation Physics, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, P.R. China
| | - Gang Chen
- Department of Radiotherapy, Division of Radiation Physics, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, P.R. China
| | - Xiaoyu Li
- Department of Radiotherapy, Division of Radiation Physics, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, P.R. China
| | - Sen Bai
- Department of Radiotherapy, Division of Radiation Physics, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, P.R. China
| | - Weifeng Wang
- Department of Radiotherapy, Jingzhou Central Hospital, the Second Clinical Medical College, Yangtze University, Jingzhou 434020, P.R. China
| | - Renming Zhong
- Department of Radiotherapy, Division of Radiation Physics, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, P.R. China
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12
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Lee DS, Lee YK, Kang YN, Won YG, Park SH, Kim YS, Kim JS, Won HS. Assessment of planning reproducibility in three-dimensional field-in-field radiotherapy technique for breast cancer: impact of surgery-simulation interval. Sci Rep 2021; 11:1556. [PMID: 33452292 PMCID: PMC7810888 DOI: 10.1038/s41598-020-78666-8] [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: 04/07/2020] [Accepted: 10/21/2020] [Indexed: 11/16/2022] Open
Abstract
The three-dimensional field-in-field (3-D FIF) technique for radiotherapy is an advanced, state-of-the-art method that uses multileaf collimators to generate a homogeneous and conformal dose distribution via segmental subfields. The purpose of this study is to evaluate the dosimetric reproducibility of 3-D FIF plans using the original simulation computed tomography (iCT) scans and re-simulation CT (rCT) scans for whole breast irradiation (WBI) schedule. This study enrolled a total of 34 patients. The study population underwent iCT scans for standard WBI and took rCT scans after 45 Gy of WBI for cone down boost plans. The dosimetric parameters (V105%, V103%, V100%, V98%, V95%, V90%, V50%), plan quality indices (conformity index, homogeneity index) and clinical parameters (isocenter-breast axis, isocenter-lung axis, soft tissue volumes within radiation field, lung volumes within radiation field) were assessed. The median time interval from surgery to iCT was 33 days and from iCT to rCT was 35 days. All dosimetric parameters exhibited statistically significant differences between iCT and rCT among cohorts with a surgery-iCT interval of < 60 days. Homogeneity index showed a statistically significant increase from iCT to rCT among all cohorts. Soft tissue volumes (p = 0.001) and isocenter-breast axis (p = 0.032) exhibited statistically significant differences among cohorts with surgery-iCT interval < 60 days. Regarding the reproducibility of the 3-D FIF WBI plans, significant changes were observed in dosimetric and clinical factors, particularly in study cohorts with a surgery-simulation interval < 60 days. The main contributing factor of these transitions seemed to be the changes in volume of the soft tissue within the WBI field. Further confirmative studies are necessary to determine the most suitable timing and technique for WBI.
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Affiliation(s)
- Dong Soo Lee
- Department of Radiation Oncology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Young Kyu Lee
- Department of Radiation Oncology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Young Nam Kang
- Department of Radiation Oncology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yong Gyun Won
- Department of Radiation Oncology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,AbbVie Biopharmaceutical Company, Seoul, Republic of Korea
| | - Seung Hwan Park
- Department of Radiation Oncology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yong Seok Kim
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jeong Soo Kim
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hye Sung Won
- Division of Medical Oncology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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13
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Shen K, Xiong J, Wang Z, Wang W, Li W, Zhou J, Deng Z, Li B, Zhong R. Design of a new breast vacuum bag to reduce the global and local setup errors and to reduce PTV margin in post-mastectomy radiation therapy. JOURNAL OF RADIATION RESEARCH 2020; 61:985-992. [PMID: 32823282 PMCID: PMC7674700 DOI: 10.1093/jrr/rraa066] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/09/2020] [Indexed: 02/05/2023]
Abstract
To design a new breast vacuum bag to reduce global and local setup errors in post-mastectomy radiation therapy (PMRT). A total of 24 PMRT patients were immobilized with an old vacuum bag and 26 PMRT patients were immobilized with a new vacuum bag. The registration results were analysed using four regions of interest (ROI): the global ROI [including the whole region of the planning target volume (PTV), GROI], the supraclavicular area (SROI), the ipsilateral chest wall region (CROI) and the ipsilateral arm region (AROI). The global and local setup errors of the two groups were compared. The global setup errors of the new vacuum group were significantly smaller than those in the old vacuum group with the exception of yaw axes (P < 0.05). The systematic error (Σ) and random error (σ) ranged from 1.21 to 2.13 mm. In the new vacuum group, the local setup errors in the medial-lateral (ML) direction and roll axes for CROI (the Σ and σ ranged from 0.65 to 1.35 mm), and the local setup errors in ML and superior-inferior (SI) directions for SROI were significantly smaller than those in the old vacuum group. The total required PTV margins for the chest wall in ML, SI, and anterior-posterior (AP) were 4.40, 3.12 and 3.77 mm respectively. The new vacuum bag can significantly reduce the global setup errors and local setup errors in PMRT. The respiratory motion of the chest wall was negligible, and the 5 mm PTV margin could cover the local setup errors in PMRT using the new vacuum bag with cone beam CT (CBCT) correction.
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Affiliation(s)
- Konglong Shen
- Department of Radiotherapy, Division of Radiation Physics, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, P.R. China
| | - Jie Xiong
- Radiology Department, West China Hospital, Sichuan University, Chengdu 610041, P.R. China
| | - Zhiguo Wang
- Department of Radiotherapy, Division of Radiation Physics, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, P.R. China
| | - Weifeng Wang
- Jingzhou Central Hospital, the Second Clinical Medical College, Yangtze University, Jinzhou 121001, P.R. China
| | - Wan Li
- Department of Radiotherapy, Division of Radiation Physics, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, P.R. China
| | - Jidan Zhou
- Department of Radiotherapy, Division of Radiation Physics, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, P.R. China
| | - Zhonghua Deng
- Department of Radiotherapy, Division of Radiation Physics, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, P.R. China
| | - Bin Li
- Department of Radiotherapy, Division of Radiation Physics, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, P.R. China
| | - Renming Zhong
- Department of Radiotherapy, Division of Radiation Physics, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, P.R. China
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14
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Liang X, Mailhot Vega RB, Li Z, Zheng D, Mendenhall N, Bradley JA. Dosimetric consequences of image guidance techniques on robust optimized intensity-modulated proton therapy for treatment of breast Cancer. Radiat Oncol 2020; 15:47. [PMID: 32103762 PMCID: PMC7045466 DOI: 10.1186/s13014-020-01495-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 02/17/2020] [Indexed: 01/30/2023] Open
Abstract
PURPOSE To investigate the consequences of residual setup error on target dose distribution using various image registration strategies for breast cancer treated with intensity-modulated proton therapy (IMPT). MATERIALS AND METHODS Among 11 post-lumpectomy patients who received IMPT, 44 dose distributions were computed. For each patient, the original plan (Plan-O) and three verification plans were calculated using different alignments: bony anatomy (VPlan-B), breast tissue (VPlan-T), and skin (VPlan-S). The target coverage were evaluated for each alignment technique. Additionally, 2 subvolumes-BreastNearSkin (1-cm rim of anterior CTV) and BreastNearCW (1-cm rim of posterior CTV)-were created to help localize CTV underdosing. Furthermore, we divided the setup error into the posture error and breast error. Patients with a large posture error and those with good posture setup but a large breast error were identified to evaluate the effect of posture error and breast error. RESULTS For Plan-O, VPlan-B, VPlan-T, and VPlan-S, respectively, the median (interquartile range) breast CTV D95 was 95.7%(94.7-96.3%), 95.1% (93.9-95.7%), 95.2% (94.8-95.6%), and 95.2% (94.9-95.7%); BreastNearCW D95 was 96.9% (95.6-97.3%), 94.8% (93.5-97.0%), 95.6% (94.8-97.0%), 95.6% (94.8-97.1%); and BreastNearSkin D95 was 94.1% (92.7-94.4%), 93.6% (92.2-94.5%), 93.5% (92.4-94.5%), and 94.4% (92.2-94.5%) of the prescription dose. 4/11 patients had ≥1% decrease in breast CTV D95, 1 of whom developed breast edema while the other 3 all had a > 2o posture error. The CTV D95 variation was within 1% for the patients with good posture setup but >2o breast error. CONCLUSION Acceptable target coverage was achieved with all three alignment strategies. Breast tissue and skin alignment maintained the breast target coverage marginally better than bony alignment, with which the posterior CTV along the chest wall is the predominant area affected by under-dosing. For target dose distribution, posture error appears more influential than breast error.
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Affiliation(s)
- Xiaoying Liang
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA.
| | - Raymond B Mailhot Vega
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Zuofeng Li
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Dandan Zheng
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Nancy Mendenhall
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Julie A Bradley
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA
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15
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Zhang Q, Liu J, Ao N, Yu H, Peng Y, Ou L, Zhang S. Secondary cancer risk after radiation therapy for breast cancer with different radiotherapy techniques. Sci Rep 2020; 10:1220. [PMID: 31988348 PMCID: PMC6985127 DOI: 10.1038/s41598-020-58134-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 01/12/2020] [Indexed: 11/09/2022] Open
Abstract
The aim of this study was to estimate the radiation-related secondary cancer risks in organs during the treatment of breast cancer with different radiotherapy techniques, such as three-dimensional conformal radiotherapy (3D-CRT), intensity modulated radiotherapy (IMRT), and volumetric modulated arc therapy (VMAT). The treatment plans for 26 patients with breast cancer who received whole-breast irradiation at a dose of 50 Gy included tangential field 3D-CRT with hard-wedges (W-TF), tangential field IMRT (2F-IMRT), multiple field IMRT (6F-IMRT), and double partial arcs (VMAT). Patients were divided into three groups according to the distance between the contralateral breast (CB) and the body of the sternum. Setup error was simulated by moving the isocenter, and the dose distribution was then recalculated without changing the field fluency distribution. Based on the linear-exponential, the plateau, and the full mechanistic dose-response models, the organ equivalent dose and excess absolute risk were calculated from dose-volume histograms to estimate the secondary cancer risks in organs. Compared with 3D-CRT, IMRT and VMAT showed excellent results regarding tumor conformity and homogeneity; however, the low dose volume to organs was considerably higher in 6F-IMRT and VMAT. Secondary cancer risks for 2F-IMRT were comparable or slightly lower than for W-TF, but considerably lower than for 6F-IMRT or VMAT. After setup error simulation, there was a small increase in secondary cancer risk for 2F-IMRT and an increase of 159% and 318% for 6F-IMRT and VMAT, respectively, compared with W-TF. Although these results were obtained in most patients, they did not necessarily apply to every individual. The secondary cancer risks in the CB decreased significantly in correlation with increased distance for all alternative techniques, although they were higher in VMAT and lower in 2F-IMRT regardless of the distance. After setup error simulation, the increased changes in secondary cancer risks in the CB were comparable between 2F-IMRT, 6F-IMRT, and VMAT, suggesting that the secondary cancer risks in the CB mainly depend on radiotherapy techniques and distance, although the effect of setup error cannot be ignored. In the contralateral lung (CL), the secondary cancer risks were almost independent from distance and depended mainly on radiotherapy techniques; they were rarely affected by setup error. VMAT was associated with a higher secondary cancer risk in the CL. For the ipsilateral lung (IL), the secondary cancer risks were higher than those in other organs because the IL receives high doses to achieve tumor control, and they were relatively lower in VMAT. This warrants special consideration when estimating the secondary cancer risk to the IL. The study results suggested that the optimal radiotherapy method for breast cancer should be determined on an individual basis and according to the balance between secondary cancer risks related to anatomic diversity and setup error, which can prevent blind selection of techniques.
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Affiliation(s)
- Quanbin Zhang
- Radiotherapy center, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China
| | - Jinbo Liu
- State Key Laboratory of Oncology in Southern China, Department of Radiology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Ningjian Ao
- Department of Biomedical Engineering, Jinan University, Guangzhou, China
| | - Hui Yu
- Radiotherapy center, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China
| | - Yingying Peng
- Radiotherapy center, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China
| | - Liya Ou
- Guangzhou Medical University, Guangzhou, China
| | - Shuxu Zhang
- Radiotherapy center, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China.
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16
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Wang W, Yu T, Xu M, Shao Q, Zhang Y, Li J. Setup Error Assessment and Correction in Planar kV Image- Versus Cone Beam CT Image-Guided Radiation Therapy: A Clinical Study of Early Breast Cancer Treated With External Beam Partial Breast Irradiation. Technol Cancer Res Treat 2019; 18:1533033819853847. [PMID: 31159668 PMCID: PMC6552346 DOI: 10.1177/1533033819853847] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Objective: To compare differences in setup error assessment and correction between planar kilovolt images and cone beam computed tomography images for external beam partial breast irradiation during free breathing. Methods: Nineteen patients who received external beam partial breast irradiation after breast-conserving surgery were recruited. Interfraction setup error was acquired using planar kilovolt images and cone beam computed tomography. After online setup correction, the residual error was calculated, and the setup error was compared. The residual error and setup margin were quantified for planar kilovolt and cone beam computed tomography images. Results: The largest setup error was observed in the anteroposterior direction for both cone beam computed tomography and planar kilovolt imaging (−1.45 mm, 1.74 mm). The cone beam computed tomography–based setup error (systematic error [Σ]) was less than the planar kilovolt images based on Σ in the anteroposterior direction (–1.2 mm vs 2.00 mm; P = .005), and no significant differences were observed for random error (σ) in 3 dimensions (P = .948, .376, .314). After online setup correction, cone beam computed tomography significantly reduced the residual setup error compared with planar kilovolt images in the anteroposterior direction (Σ: −0.20 mm vs 0.50 mm, P = .008; σ: 0.45 mm vs 1.34 mm, P = .002). The cone beam computed tomography–based setup margin was smaller than the planar kilovolt image-based setup margin in the anteroposterior direction (−1.39 mm vs 5.57 mm, P = .003; 0.00 mm vs 3.20 mm, P = .003). Conclusions: Discrepancy between the setup errors observed with planar kilovolt and cone beam computed tomography was obvious in the anteroposterior direction. Compared to cone beam computed tomography, the elapsed treatment time was smaller when the initial alignment used kilovolt planar imaging. Whether using planar kilovolt or cone beam computed tomography, residual errors can be reduced to 1.5 mm for external beam partial breast irradiation procedures.
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Affiliation(s)
- Wei Wang
- 1 Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong Province, China
| | - Ting Yu
- 1 Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong Province, China.,2 Department of Graduate School, Tianjin Medical University, Tianjin, China
| | - Min Xu
- 1 Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong Province, China
| | - Qian Shao
- 1 Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong Province, China
| | - Yingjie Zhang
- 1 Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong Province, China
| | - Jianbin Li
- 1 Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong Province, China
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17
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Anjam SM, Banaee N, Rahmani H, Nedaie HA. Determination of geometric accuracy of radiotherapy fields by port film and DRR using Matlab graphical user interface. Med Biol Eng Comput 2018; 57:259-269. [PMID: 30094755 DOI: 10.1007/s11517-018-1852-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Accepted: 05/16/2018] [Indexed: 10/28/2022]
Abstract
The purpose of this study is to determine and verify the exact location of radiation therapy fields by using port-film and digital reconstruction radiograph (DRR) as a low-cost tool. Initially, an appropriate algorithm was written for the application of port film in the megavoltage beam irradiation. Detectable contrast was created for the image and then by using appropriate markers and developed written program by MATLAB as DRrPortRegistartion. Semi-automatic and automatic registration between port-film and DRR images were performed for pelvic and chest phantoms. Then, results were compared with electronic portal imaging device (EPID) images in similar conditions. By using this software, DRR and port film as treatment verification tools, the precision of treatment verification and the accuracy of radiation therapy fields were achieved in the extent of the millimeter. Validation results with EPID demonstrated that the mean absolute average error in angle is equal to 0.59 degrees, 1.70 mm in the X-direction, and 2.42 mm in the Y-direction. The results of this study illustrated that using this software and suitable low-cost hardware in the machines without EPID can increase the precision of treatment verification to the millimeter and it can be introduced as a suitable alternative for EPID in centers for increasing treatment accuracy. Graphical abstract ᅟ.
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Affiliation(s)
- Seyyed Mostafa Anjam
- Department of Medical Radiation Engineering, Central Tehran Branch, Islamic Azad University, Tehran, Iran
| | - Nooshin Banaee
- Department of Medical Radiation Engineering, Central Tehran Branch, Islamic Azad University, Tehran, Iran
| | - Hojjat Rahmani
- Health Care Management Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Hassan Ali Nedaie
- Radiation Oncology Research Centre, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran.
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Breast-shape changes during radiation therapy after breast-conserving surgery. PHYSICS & IMAGING IN RADIATION ONCOLOGY 2018; 6:71-76. [PMID: 33458392 PMCID: PMC7807602 DOI: 10.1016/j.phro.2018.05.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 05/15/2018] [Accepted: 05/23/2018] [Indexed: 11/20/2022]
Abstract
Background & purpose With the introduction of more conformal techniques for breast cancer radiation therapy (RT), motion management is becoming increasingly important. We studied the breast-shape variability during RT after breast-conserving surgery (BCS). Materials & Methods Planning computed tomography (CT) and follow-up cone-beam CT (CBCT) scans were available for 71 fractions of 17 patients undergoing RT after BCS. First, the CT and the CBCT scans were registered on bones. Subsequently, breast-contour data were generated. The CBCT contours were analyzed in 3D in terms of deviations (mean and standard deviation) relative to the contour of the CT scan for the upper medial, lower medial, upper lateral, and lower lateral breast quadrants, and the axilla. Results Regional systematic and random standard deviations of the breast quadrants varied between 1.5 and 2.1 mm and 1.0–1.6 mm, respectively, and were larger for the axilla (3.0 mm). An absolute average shape change of ≥4.0 mm in at least one region was present in 21/71 fractions (30%), predominantly in breast volumes > 800 cc (p = <0.01). Furthermore, seroma was associated with larger shape changes (p = 0.04). Conclusions Breast-shape variability varies between anatomic locations. Changes in the order of 4 mm are frequently observed during RT, especially for large breasts. This should be taken into account in the development of protocols for partial breast irradiation and boost treatment.
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