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Karius A, Leifeld LM, Strnad V, Fietkau R, Bert C. First implementation of an innovative infra-red camera system integrated into a mobile CBCT scanner for applicator tracking in brachytherapy-Initial performance characterization. J Appl Clin Med Phys 2024; 25:e14364. [PMID: 38626753 PMCID: PMC11244686 DOI: 10.1002/acm2.14364] [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: 01/09/2024] [Revised: 03/24/2024] [Accepted: 03/28/2024] [Indexed: 04/18/2024] Open
Abstract
PURPOSE To enable a real-time applicator guidance for brachytherapy, we used for the first time infra-red tracking cameras (OptiTrack, USA) integrated into a mobile cone-beam computed tomography (CBCT) scanner (medPhoton, Austria). We provide the first description of this prototype and its performance evaluation. METHODS We performed assessments of camera calibration and camera-CBCT registration using a geometric calibration phantom. For this purpose, we first evaluated the effects of intrinsic parameters such as camera temperature or gantry rotations on the tracked marker positions. Afterward, calibrations with various settings (sample number, field of view coverage, calibration directions, calibration distances, and lighting conditions) were performed to identify the requirements for achieving maximum tracking accuracy based on an in-house phantom. The corresponding effects on camera-CBCT registration were determined as well by comparing tracked marker positions to the positions determined via CBCT. Long-term stability was assessed by comparing tracking and a ground-truth on a weekly basis for 6 weeks. RESULTS Robust tracking with positional drifts of 0.02 ± 0.01 mm was feasible using the system after a warm-up period of 90 min. However, gantry rotations affected the tracking and led to inaccuracies of up to 0.70 mm. We identified that 4000 samples and full coverage were required to ensure a robust determination of marker positions and camera-CBCT registration with geometric deviations of 0.18 ± 0.03 mm and 0.42 ± 0.07 mm, respectively. Long-term stability showed deviations of more than two standard deviations from the initial calibration after 3 weeks. CONCLUSION We implemented for the first time a standalone combined camera-CBCT system for tracking in brachytherapy. The system showed high potential for establishing corresponding workflows.
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Affiliation(s)
- Andre Karius
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Lisa Marie Leifeld
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Vratislav Strnad
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Rainer Fietkau
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Christoph Bert
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
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Szkitsak J, Karius A, Fernolendt S, Schubert P, Speer S, Fietkau R, Bert C, Hofmann C. Optimized raw data selection for artifact reduction of breathing controlled four-dimensional sequence scanning. Phys Imaging Radiat Oncol 2024; 30:100584. [PMID: 38803466 PMCID: PMC11128500 DOI: 10.1016/j.phro.2024.100584] [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: 01/08/2024] [Revised: 04/10/2024] [Accepted: 05/02/2024] [Indexed: 05/29/2024] Open
Abstract
Background and purpose Even with most breathing-controlled four-dimensional computed tomography (4DCT) algorithms image artifacts caused by single significant longer breathing still occur, resulting in negative consequences for radiotherapy. Our study presents first phantom examinations of a new optimized raw data selection and binning algorithm, aiming to improve image quality and geometric accuracy without additional dose exposure. Materials and methods To validate the new approach, phantom measurements were performed to assess geometric accuracy (volume fidelity, root mean square error, Dice coefficient of volume overlap) for one- and three-dimensional tumor motion trajectories with and without considering motion hysteresis effects. Scans without significantly longer breathing cycles served as references. Results Median volume deviations between optimized approach and reference of at maximum 1% were obtained considering all movements. In comparison, standard reconstruction yielded median deviations of 9%, 21% and 12% for one-dimensional, three-dimensional, and hysteresis motion, respectively. Measurements in one- and three-dimensional directions reached a median Dice coefficient of 0.970 ± 0.013 and 0.975 ± 0.012, respectively, but only 0.918 ± 0.075 for hysteresis motions averaged over all measurements for the optimized selection. However, for the standard reconstruction median Dice coefficients were 0.845 ± 0.200, 0.868 ± 0.205 and 0.915 ± 0.075 for one- and three-dimensional as well as hysteresis motions, respectively. Median root mean square errors for the optimized algorithm were 30 ± 16 HU2 and 120 ± 90 HU2 for three-dimensional and hysteresis motions, compared to 212 ± 145 HU2 and 130 ± 131 HU2 for the standard reconstruction. Conclusions The algorithm was proven to reduce 4DCT-related artifacts due to missing projection data without further dose exposure. An improvement in radiotherapy treatment planning due to better image quality can be expected.
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Affiliation(s)
- Juliane Szkitsak
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Andre Karius
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | | | - Philipp Schubert
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Stefan Speer
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Rainer Fietkau
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Christoph Bert
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Christian Hofmann
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Siemens Healthcare GmbH, 91301 Forchheim, Germany
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Taasti VT, Wohlfahrt P. From computed tomography innovation to routine clinical application in radiation oncology - A joint initiative of close collaboration. Phys Imaging Radiat Oncol 2024; 29:100550. [PMID: 38390587 PMCID: PMC10881422 DOI: 10.1016/j.phro.2024.100550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024] Open
Affiliation(s)
- Vicki Trier Taasti
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Patrick Wohlfahrt
- Siemens Healthineers, Varian, Cancer Therapy Imaging, Forchheim, Germany
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Grohmann M, Petersen C, Todorovic M. Benefits and considerations in using a novel computed tomography system optimized for radiotherapy planning. Phys Imaging Radiat Oncol 2023; 28:100510. [PMID: 38054031 PMCID: PMC10694773 DOI: 10.1016/j.phro.2023.100510] [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: 01/10/2023] [Revised: 11/08/2023] [Accepted: 11/08/2023] [Indexed: 12/07/2023] Open
Abstract
In this study, we evaluated a novel 16-bit computed tomography (CT) system optimized for radiotherapy planning. Over six months, using various protocols, we conducted 616 scans, with an average of four CT series per session imported into our treatment planning software (TPS). The direct density (DD) reconstruction enabled a single CT number calibration curve for multiple tube voltages. Metal artifacts could be effectively reduced. The 16-bit character permitted dose calculation in high-density regions, while TPS integration challenges remained. In conclusion, our findings emphasize the system's potential benefits and considerations in radiotherapy workflows.
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Affiliation(s)
- Maximilian Grohmann
- Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Cordula Petersen
- Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Manuel Todorovic
- Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
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Burghelea M, Bakkali Tahiri J, Dhont J, Kyndt M, Gulyban A, Szkitsak J, Bogaert E, van Gestel D, Reynaert N. Results of a multicenter 4D computed tomography quality assurance audit: Evaluating image accuracy and consistency. Phys Imaging Radiat Oncol 2023; 28:100479. [PMID: 37694265 PMCID: PMC10485145 DOI: 10.1016/j.phro.2023.100479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 07/28/2023] [Accepted: 07/31/2023] [Indexed: 09/12/2023] Open
Abstract
Background and purpose 4D Computed Tomography (4DCT) technology captures the location and movement of tumors and nearby organs at risk over time. In this study, a multi-institutional multi-vendor 4DCT audit was initiated to assess the accuracy of current imaging protocols. Materials and methods Twelve centers, including thirteen scanners performed a 4DCT acquisition of a dynamic thorax phantom using the institution's own protocol with the in-house breathing monitoring system. Five regular and three irregular breathing patterns were used. Image acquisition and reconstruction were followed by automated image analysis with our in-house developed 4DCT QA program (QAMotion). CT number accuracy, volume deviation, amplitude deviation, and spatial integrity were assessed per pattern using both the segmented volumes and line profiles. Results Regular breathing curves showed relatively accurate results across all institutions, with mean volume and CT number deviations and median amplitude deviation below 2%, 5 HU and 2 mm, respectively. Results obtained for irregular patterns showed more variation across the institutions. Volume and CT number deviations co-occurred with a blurring of the sphere, interpolation, or double-structure artifacts that were confirmed through the line profiles. For some of the irregular patterns, amplitude deviations up to 6 mm were observed. Maximum Intensity Projection (MaxIP) correctly captured the applied motion amplitude with deviations across all institutions within 2 mm except for double amplitude pattern. Conclusions All centers invited to participate in the audit responded positively, highlighting the need for a comprehensive yet easy-to-execute 4DCT quality assurance program. The largest variances between the results from one institution to another confirmed that a standardized 4DCT audit is warranted.
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Affiliation(s)
- Manuela Burghelea
- Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Institut Jules Bordet, Department of Medical Physics, Brussels, Belgium
- Université Libre De Bruxelles, Radiophysics and MRI physics laboratory, Brussels, Belgium
| | - Jinane Bakkali Tahiri
- Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Institut Jules Bordet, Department of Medical Physics, Brussels, Belgium
- Medical Physics Department, GasthuisZusters Antwerpen Ziekenhuizen, Antwerp, Belgium
| | - Jennifer Dhont
- Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Institut Jules Bordet, Department of Medical Physics, Brussels, Belgium
- Université Libre De Bruxelles, Radiophysics and MRI physics laboratory, Brussels, Belgium
| | | | - Akos Gulyban
- Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Institut Jules Bordet, Department of Medical Physics, Brussels, Belgium
- Université Libre De Bruxelles, Radiophysics and MRI physics laboratory, Brussels, Belgium
| | - Juliane Szkitsak
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Evelien Bogaert
- Department of Radiotherapy-Oncology, Ghent University Hospital, Gent, Belgium
| | - Dirk van Gestel
- Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Institut Jules Bordet, Radiation Oncology Department, Brussels, Belgium
| | - Nick Reynaert
- Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Institut Jules Bordet, Department of Medical Physics, Brussels, Belgium
- Université Libre De Bruxelles, Radiophysics and MRI physics laboratory, Brussels, Belgium
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Bakkali Tahiri J, Kyndt M, Dhont J, Gulyban A, Szkitsak J, Bogaert E, Reynaert N, Burghelea M. A comprehensive quality assurance program for four-dimensional computed tomography in radiotherapy. Phys Imaging Radiat Oncol 2023; 27:100475. [PMID: 37560513 PMCID: PMC10407954 DOI: 10.1016/j.phro.2023.100475] [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: 12/23/2022] [Revised: 07/13/2023] [Accepted: 07/19/2023] [Indexed: 08/11/2023] Open
Abstract
This study aimed to develop and validate a comprehensive, reproducible and automatic 4DCT Quality Assurance (QA) workflow (QAMotion) that evaluates image accuracy across various regular and irregular breathing patterns. Volume and amplitude deviations, CT number accuracy, and spatial integrity were used as evaluation metrics. For repeatability tests, tolerances were respected with a mean CT number deviation < 10 HU, volume deviation < 2% and diameter and amplitude deviation < 2 mm except for irregular amplitude curves for which an amplitude deviation up to 6 mm was measured. QAMotion was able to flag image artefacts for our clinical 4DCT system.
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Affiliation(s)
- Jinane Bakkali Tahiri
- Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Institut Jules Bordet, Department of Medical Physics, Brussels, Belgium
- Iridium Netwerk, Radiation Oncology, Antwerp, Belgium
| | | | - Jennifer Dhont
- Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Institut Jules Bordet, Department of Medical Physics, Brussels, Belgium
| | - Akos Gulyban
- Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Institut Jules Bordet, Department of Medical Physics, Brussels, Belgium
| | - Juliane Szkitsak
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Evelien Bogaert
- Department of Radiotherapy-Oncology, Ghent University Hospital, Gent, Belgium
| | - Nick Reynaert
- Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Institut Jules Bordet, Department of Medical Physics, Brussels, Belgium
| | - Manuela Burghelea
- Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Institut Jules Bordet, Department of Medical Physics, Brussels, Belgium
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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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Muacevic A, Adler JR. Experience With Normal Breathhold Planning Scans for Radiosurgery of Moving Targets With Live Tracking. Cureus 2022; 14:e30676. [PMID: 36439614 PMCID: PMC9689837 DOI: 10.7759/cureus.30676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2022] [Indexed: 01/25/2023] Open
Abstract
PURPOSE Utilization of breathhold scans with live tracking has a long track record of good published outcomes for stereotactic body radiation therapy (SBRT) and is recommended by the manufacturer of the Synchrony tracking system. However, the popularity of four-dimensional computed tomography (4DCT) scans challenges the validity of the breathhold scan with live tracking technique. Although this study is not intended to prove the superiority of either method, we demonstrate the feasibility of using the breathhold scans with a phantom test and clinical examples. METHODS A 4DCT of a perfect sphere was scanned at 20 breaths per minute and compared to a 4DCT of a small lung tumor in one patient and a 4DCT of a larger renal tumor in another patient, as well as to fiducial matching in a patient with pancreatic cancer. Normal exhale and normal inhale breathhold CT scans were performed for the pancreatic cancer patient, combined with Synchrony tracking on CyberKnife (Sunnyvale, CA: Accuray) for treatment. RESULTS The 4DCT scan of the phantom exhibited considerable apparent deformation, which must be entirely due to imaging artifact since the perfect sphere in the phantom is known to be completely rigid. The 4DCT of the lung and renal tumors in patients had similar apparent deformation. Usually in patients, from 4DCT alone, it is difficult to determine how much was due to deformation and how much was due to artifact. Fiducial positions in the final normal exhale and normal inhale breathhold scans for Synchrony matched each other within 1mm for the pancreatic cancer patient. CONCLUSION We demonstrated the feasibility of breathhold scans with Synchrony live tracking, as recommended by the manufacturer. More studies will be needed to determine whether this method is better than using a 4DCT.
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