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Zhang S, Guo C, Xu J, Qian P, Guo J, Liu T, Wu Y, Hong J, Wang Q, He X, Sun L. Quantitative assessment of intertarget position variations based on 4D-CT and 4D-CBCT simulations in single-isocenter multitarget lung stereotactic body radiation therapy. J Cancer Res Clin Oncol 2024; 150:359. [PMID: 39044013 PMCID: PMC11266286 DOI: 10.1007/s00432-024-05836-w] [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: 05/06/2024] [Accepted: 06/04/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND In single-isocenter multitarget stereotactic body radiotherapy (SBRT), geometric miss risks arise from uncertainties in intertarget position. However, its assessment is inadequate, and may be interfered by the reconstructed tumor position errors (RPEs) during simulated CT and cone beam CT (CBCT) acquisition. This study aimed to quantify intertarget position variations and assess factors influencing it. METHODS We analyzed data from 14 patients with 100 tumor pairs treated with single-isocenter SBRT. Intertarget position variation was measured using 4D-CT simulation to assess the intertarget position variations (ΔD) during routine treatment process. Additionally, a homologous 4D-CBCT simulation provided RPE-free comparison to determine the impact of RPEs, and isolating purely tumor motion induced ΔD to evaluate potential contributing factors. RESULTS The median ΔD was 4.3 mm (4D-CT) and 3.4 mm (4D-CBCT). Variations exceeding 5 mm and 10 mm were observed in 31.1% and 5.5% (4D-CT) and 20.4% and 3.4% (4D-CBCT) of fractions, respectively. RPEs necessitated an additional 1-2 mm safety margin. Intertarget distance and breathing amplitude variability showed weak correlations with variation (Rs = 0.33 and 0.31). The ΔD differed significantly by locations (upper vs. lower lobe and right vs. Left lung). Notably, left lung tumor pairs exhibited the highest risk. CONCLUSIONS This study provide a reliable way to assess intertarget position variation by using both 4D-CT and 4D-CBCT simulation. Consequently, single-isocenter SBRT for multiple lung tumors carries high risk of geometric miss. Tumor motion and RPE constitute a substantial portion of intertarget position variation, requiring correspondent strategies to minimize the intertarget uncertainties.
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Affiliation(s)
- Siyu Zhang
- Department of Radiotherapy, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, the Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, 210009, China
| | - Chang Guo
- Department of Radiotherapy, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, the Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, 210009, China
| | - Jun Xu
- Department of Radiotherapy, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, the Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, 210009, China
| | - Pudong Qian
- Department of Radiotherapy, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, the Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, 210009, China
| | - Jiali Guo
- Department of Radiation Oncology, Dantu People's Hospital, Anhui, Maanshan, 243100, China
| | - Tingting Liu
- Department of Radiotherapy, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, the Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, 210009, China
| | - Yifan Wu
- Department of Radiotherapy, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, the Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, 210009, China
| | - Jun Hong
- Department of Radiation Oncology, the Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huaian, 223300, Jiangsu, China
| | - Qi Wang
- Department of Radiotherapy, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, the Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, 210009, China
| | - Xia He
- Department of Radiotherapy, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, the Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, 210009, China.
| | - Li Sun
- Department of Radiotherapy, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, the Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, 210009, China.
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Sasaki H, Morishita T, Irie N, Kojima R, Kiriyama T, Nakamoto A, Nishioka K, Takahashi S, Tanabe Y. Evaluation of the trend of set-up errors during the treatment period using set-up margin in prostate radiotherapy. Med Dosim 2024:S0958-3947(24)00014-1. [PMID: 38556401 DOI: 10.1016/j.meddos.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/24/2024] [Accepted: 02/29/2024] [Indexed: 04/02/2024]
Abstract
Accurate information on set-up error during radiotherapy is essential for determining the optimal number of treatments in hypofractionated radiotherapy for prostate cancer. This necessitates careful control by the radiotherapy staff to assess the patient's condition. This study aimed to develop an evaluation method of the temporal trends in a patient's specific prostate movement during treatment using image matching and margin values. This study included 65 patients who underwent prostate volumetric modulated arc therapy (mean treatment time, 87.2 s). Set-up errors were assessed using bone, inter-, and intra-fraction marker matching across 39 fractions. The set-up margin was determined by dividing the four periods into 39 fractions using Stroom's formula and correlation coefficient. The intra-fraction set-up error was biased in the anterior-superior (AS) direction during treatment. The temporal trend of set-up errors during radiotherapy slightly increased based on bone matching and inter-fraction marker matching, with a 1.6-mm difference in the set-up margin fractions 11 to 20. The correlation coefficient of the mean prostate movement during treatment significantly decreased in the superior-inferior direction, while remaining high in the left-right and anterior-posterior directions. Image matching contributed significantly to the improvement of set-up errors; however, careful attention is needed for prostate movement in the AS direction, particularly during short treatment times. Understanding the trend of set-up errors during the treatment period is essential in numerical information sharing on patient condition and evaluating the margins for tailored hypo-fractionated radiotherapy, considering the facility's image-guided radiation therapy technology.
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Affiliation(s)
- Hinako Sasaki
- Department of Radiological Technology, Faculty of Health Sciences, Okayama University Medical School, Okayama 700-8558, Japan
| | - Takumi Morishita
- Department of Radiological Technology, Faculty of Health Sciences, Okayama University Medical School, Okayama 700-8558, Japan
| | - Naho Irie
- Department of Radiological Technology, Faculty of Health Sciences, Okayama University Medical School, Okayama 700-8558, Japan
| | - Rena Kojima
- Department of Radiological Technology, Faculty of Health Sciences, Okayama University Medical School, Okayama 700-8558, Japan
| | - Tetsukazu Kiriyama
- Department of Radiology, Uwajima City Hospital, Uwajima, Ehime 798-0061, Japan
| | - Akira Nakamoto
- Department of Radiology, Tokuyama Central Hospital, Yamaguchi 745-8522, Japan
| | - Kunio Nishioka
- Department of Radiology, Tokuyama Central Hospital, Yamaguchi 745-8522, Japan
| | - Shotaro Takahashi
- Department of Radiology, Tokuyama Central Hospital, Yamaguchi 745-8522, Japan
| | - Yoshinori Tanabe
- Department of Radiological Technology, Graduate School of Health Sciences, Okayama University, Okayama 700-8558, Japan.
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Tanabe Y. [9. Safer and Ideal Radiation Treatment Planning]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2023; 79:193-195. [PMID: 36804810 DOI: 10.6009/jjrt.2023-2152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Affiliation(s)
- Yoshinori Tanabe
- Faculty of Medicine, Graduate School of Health Sciences, Okayama University
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Tanabe Y, Kiritani M, Deguchi T, Hira N, Tomimoto S. Patient-specific respiratory motion management using lung tumors vs fiducial markers for real-time tumor-tracking stereotactic body radiotherapy. Phys Imaging Radiat Oncol 2022; 25:100405. [PMID: 36655212 PMCID: PMC9841282 DOI: 10.1016/j.phro.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 11/17/2022] [Accepted: 12/21/2022] [Indexed: 12/25/2022] Open
Abstract
Background and purpose In real-time lung tumor-tracking stereotactic body radiotherapy (SBRT), tracking accuracy is related to radiotherapy efficacy. This study aimed to evaluate the respiratory movement relationship between a lung tumor and a fiducial marker position in each direction using four-dimensional (4D) computed tomography (CT) images. Materials and methods A series of 31 patients with a fiducial marker for lung SBRT was retrospectively analyzed using 4DCT. In the upper (UG) and middle and lower lobe groups (MLG), the cross-correlation coefficients of respiratory movement between the lung tumor and fiducial marker position in four directions (anterior-posterior, left-right, superior-inferior [SI], and three-dimensional [3D]) were calculated for each gating window (≤1, ≤2, and ≤ 3 mm). Subsequently, the proportions of phase numbers in unplanned irradiation (with lung tumors outside the gating window and fiducial markers inside the gating window) were calculated for each gating window. Results In the SI and 3D directions, the cross-correlation coefficients were significantly different between UG (mean r = 0.59, 0.63, respectively) and MLG (mean r = 0.95, 0.97, respectively). In both the groups, the proportions of phase numbers in unplanned irradiation were 11 %, 28 %, and 63 % for the ≤ 1-, ≤2-, and ≤ 3-mm gating windows, respectively. Conclusions Compared with MLG, fiducial markers for UG have low cross-correlation coefficients between the lung tumor and the fiducial marker position. Using 4DCT to assess the risk of unplanned irradiation in a gating window setting and selecting a high cross-correlation coefficient fiducial marker in advance are important for accurate treatment using lung SBRT.
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Affiliation(s)
- Yoshinori Tanabe
- Faculty of Medicine, Graduate School of Health Sciences, Okayama University, 2-5-1, Shikata, Kita, Okayama 700-8525, Japan,Corresponding author.
| | - Michiru Kiritani
- Facilty of Health Sciences, Okayama University Medical School, 2-5-1, Shikata, Kita, Okayama 700-8525, Japan
| | - Tomomi Deguchi
- Facilty of Health Sciences, Okayama University Medical School, 2-5-1, Shikata, Kita, Okayama 700-8525, Japan
| | - Nanami Hira
- Facilty of Health Sciences, Okayama University Medical School, 2-5-1, Shikata, Kita, Okayama 700-8525, Japan
| | - Syouta Tomimoto
- Facilty of Health Sciences, Okayama University Medical School, 2-5-1, Shikata, Kita, Okayama 700-8525, Japan
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Tanabe Y, Tanaka H. Statistical evaluation of the effectiveness of dual amplitude-gated stereotactic body radiotherapy using fiducial markers and lung volume. Phys Imaging Radiat Oncol 2022; 24:82-87. [PMID: 36267878 PMCID: PMC9576976 DOI: 10.1016/j.phro.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 09/29/2022] [Accepted: 10/03/2022] [Indexed: 11/07/2022] Open
Abstract
Approximately 30% of the fiducial markers demonstrated a low correlation on comparing lung volumes. Monitoring of lung volume can achieve stable tracking of lung tumors. Dual monitoring by employing the marker and lung volume may possibly avoid the deterioration of monitoring accuracy.
Background and purpose The low tracking accuracy of lung stereotactic body radiotherapy (SBRT) risks reduced treatment efficacy. We used four-dimensional computed tomography (4DCT) images to determine the correlation between changes in fiducial marker positions and lung volume for lung tumors, and we evaluated the effectiveness of the combined use of these images in lung SBRT. Materials and methods Data of 30 patients who underwent fiducial marker placement were retrospectively analyzed. We calculated the motion amplitudes of the center of gravity coordinates of the lung tumor and fiducial markers in each phase and the ipsilateral, contralateral, and bilateral lung volumes using 4DCT. Moreover, we calculated the cross-correlation coefficient between the fiducial marker position and the lung volume changes waveform for the motion amplitude waveform of the lung tumor over three gating windows (all phases, ≤2 mm3, and ≤3 mm3). Results Compared with the lung volume, approximately 30 % of the fiducial markers demonstrated a low correlation with the lung tumor. In the ≤2 mm3 and ≤3 mm3 gating windows, the cross-correlation coefficients between the lung tumor and the optimal marker (r > 0.9: 83 % and 86 %) were significantly different for all fiducial markers (r > 0.9: 39 %, 53 %) and the ipsilateral (r > 0.9: 35 % and 40 %), contralateral (r > 0.9: 44 % and 41 %), and bilateral (r > 0.9: 39 % and 45 %) lung volumes. Conclusions Some of the fiducial markers showed a low correlation with the lung tumor. This study indicated that the combined use of lung volume monitoring can improve tracking accuracy.
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Affiliation(s)
- Yoshinori Tanabe
- Department of Radiological Technology, Graduate School of Health Sciences, Okayama University, 5-1 Shikata-cho, 2-chome, Kita-ku, Okayama-shi, 700-8558, Japan,Corresponding author.
| | - Hidekazu Tanaka
- Department of Radiation Oncology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505, Japan
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Kunii Y, Tanabe Y, Nakamoto A, Nishioka K. Statistical analysis of correlation of gamma passing results for two quality assurance phantoms used for patient-specific quality assurance in volumetric modulated arc radiotherapy. Med Dosim 2022; 47:329-333. [PMID: 35850758 DOI: 10.1016/j.meddos.2022.06.003] [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: 01/19/2022] [Revised: 05/06/2022] [Accepted: 06/16/2022] [Indexed: 10/17/2022]
Abstract
Patient-specific quality assurance (QA) data must be migrated from outdated QA systems to new ones to produce objective results that can be understood by oncologists. We aimed to evaluate a method for obtaining a high correlation of dose distributions according to various gamma passing rates among two types of 2D detectors for the migration of patient-specific QA data of volumetric modulated arc therapy (VMAT). The patient-specific QA of 20 patients undergoing VMAT was measured in two different modes: standard single measurement (SM) mode and multiple merged measurements (MM) techniques using ArcCHECK (AC) and OCTAVIUS (OT). The correlation of the measured and calculated dose distributions was evaluated according to varying gamma passing rates (3%/3 mm, 2%/3 mm, 2%/2 mm, and 1%/1 mm). The gamma passing rates were analyzed using the Anderson-Darling normality test. Treatment plan dose distributions were calculated by intentionally shifting the calculation isocenter position (x,y,z ± 0.5, ± 1.0, ± 1.5, and ± 2.0 mm). The highest correlation between the SM and MM was observed with a gamma passing rate of 1%/1 mm with AC (r = 0.866) and 3%/2 mm with OT (r = 0.916). However, SM and MM did not follow a normal distribution with a rate of 3%/2 mm in OT. The second-highest correlation was obtained with a rate of 2%/2 mm (r = 0.900). Among the two 2D detectors, the highest correlation between the calculated and measured dose distributions was obtained for a gamma passing rate of 1%/1 mm using SM in AC and 2%/2 mm using MM in OT (r = 0.716). Adjusting the gamma passing rate and measurement mode of AC and OT resulted in higher correlations between measured and calculated dose distributions. The high correlation between different 2D detectors objectively indicated a potential migration method. This enabled the sharing of more accurate patient-specific QA data from 2D detectors with different phantoms. A high correlation was observed between the two types of detectors in this study (r = 0.716); therefore, the proposed method should be useful for oncologists to share information regarding patient-specific QA for VMAT.
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Affiliation(s)
- Yuki Kunii
- Department of Radiology, Tokuyama Central Hospital, Shunan, Yamaguchi 745-8522, Japan
| | - Yoshinori Tanabe
- Faculty of Medicine, Graduate School of Health Sciences, Okayama University, Kita-ku, Okayama-shi 700-8558, Japan.
| | - Akira Nakamoto
- Department of Radiology, Tokuyama Central Hospital, Shunan, Yamaguchi 745-8522, Japan
| | - Kunio Nishioka
- Department of Radiology, Tokuyama Central Hospital, Shunan, Yamaguchi 745-8522, Japan
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Tanabe Y. [[Radiation Therapy] 1. Outline of Phantom for Radiotherapy]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2022; 78:1205-1209. [PMID: 36261356 DOI: 10.6009/jjrt.2022-2093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Yoshinori Tanabe
- Faculty of Medicine, Graduate School of Health Sciences, Okayama University
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