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Dosimetric impact of interfraction prostate and seminal vesicle volume changes and rotation: A post-hoc analysis of a phase III randomized trial of MRI-guided versus CT-guided stereotactic body radiotherapy. Radiother Oncol 2021; 167:203-210. [PMID: 34979212 DOI: 10.1016/j.radonc.2021.12.037] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/10/2021] [Accepted: 12/24/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND PURPOSE Interfraction volumetric changes/rotations in the prostate and proximal seminal vesicles (SVs) might compromise target coverage when tight margins are used for prostate stereotactic body radiotherapy (SBRT). We investigated on-board MRI images from MRI-guided SBRT to better understand this. MATERIALS AND METHODS Twenty consecutive patients treated with MRI-guided prostate SBRT (40 Gy/5 fractions) enrolled on the MRI arm of a phase III randomized trial were included. A 2 mm isotropic margin was used for prostate and proximal SVPTV. Target volume, prostate dimensions, angles of the proximal SV on axial (angle α) and sagittal view (angle θ) were measured on a 0.35 T simulation MRI and five on-board pre-treatment MRIs. Dice coefficient of the targets and target dosimetry were calculated. RESULTS All patients experienced an isotropic increase in prostate volume during SBRT (p = 0.0016): 0.1%, 9.0%, 12.1%, 15.1%, and 14.2% (median) at fractions 1-5, respectively, regardless of baseline volume, which was significantly reduced with neoadjuvant ADT (p = 0.0042). There was minimal interfraction rotation of prostate, however, considerable variations in proximal SV angle α (median 21.5°) and angle θ (median 17.6°) were seen. Median V100% was 97.5% and 87.1% for prostate and proximal SV CTV, respectively. V95%≥95% was achieved in 94% of fractions for the prostate and in 59% for proximal SV. CONCLUSION Prostate volume consistently increased during SBRT. Interfraction prostatic rotation was minimal while rotation of the proximal SV was considerable. Prostate dosimetry was favorable, but online adaptive therapy may be indicated occasionally to account for prostatic swelling and in particular proximal SV rotations.
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De Roover R, Hansen R, Crijns W, Muurholm CG, Poels K, Skouboe S, Haustermans K, Poulsen PR, Depuydt T. Dosimetric impact of intrafraction prostate rotation and accuracy of gating, multi-leaf collimator tracking and couch tracking to manage rotation: An end-to-end validation using volumetric film measurements. Radiother Oncol 2020; 156:10-18. [PMID: 33264640 DOI: 10.1016/j.radonc.2020.11.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/30/2020] [Accepted: 11/24/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND PURPOSE Both gating and tracking can mitigate the deteriorating dosimetric impact of intrafraction translation during prostate stereotactic body radiotherapy (SBRT). However, their ability to manage intrafraction rotation has not yet been thoroughly investigated. The dosimetric accuracy of gating, MLC tracking and couch tracking to manage intrafraction prostate rotation was investigated. MATERIALS AND METHODS Treatment plans for end-to-end tests of prostate SBRT with focal boosting were generated for a dynamic anthropomorphic pelvis phantom. The phantom applied internal lateral rotation (up to 25°) and coupled vertical and longitudinal translation of a radiochromic film stack that was used for dose measurements. Dose was delivered for each plan while the phantom applied motion according to three typical prostate motion traces without compensation (i), with gating (ii), with MLC tracking (iii) or with couch tracking (iv). Measured doses for the four motion compensation strategies were compared with the planned dose in terms of γ-index analysis, target coverage and organs at risk (OAR) sparing. RESULTS Intrafraction rotation reduced the 3%(global)/2mm γ-index passing rate (γPR) for the prostate target volume by median (range) -33.2% (-68.6%, -4.1%) when no motion compensation was applied. The use of motion compensation improved the γPR by 13.2% (-0.4%, 32.9%) for gating, by 6.0% (-0.8%, 27.7%) for MLC tracking and by 11.1% (1.2%, 22.9%) for couch tracking. The three compensation techniques improved the target coverage in most cases. Gating showed better OAR sparing than MLC tracking or couch tracking. CONCLUSIONS Compensation of intrafraction prostate rotation with gating, MLC tracking and couch tracking was investigated experimentally for the first time. All three techniques improved the dosimetric accuracy, but residual motion-related dose errors remained due to the lack of rotation correction.
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Affiliation(s)
- Robin De Roover
- Department of Oncology, KU Leuven, Belgium; Department of Radiation Oncology, University Hospitals Leuven, Belgium.
| | - Rune Hansen
- Department of Medical Physics, Aarhus University Hospital, Denmark.
| | - Wouter Crijns
- Department of Oncology, KU Leuven, Belgium; Department of Radiation Oncology, University Hospitals Leuven, Belgium.
| | | | - Kenneth Poels
- Department of Oncology, KU Leuven, Belgium; Department of Radiation Oncology, University Hospitals Leuven, Belgium.
| | - Simon Skouboe
- Department of Oncology, Aarhus University Hospital, Denmark.
| | - Karin Haustermans
- Department of Oncology, KU Leuven, Belgium; Department of Radiation Oncology, University Hospitals Leuven, Belgium.
| | - Per Rugaard Poulsen
- Department of Oncology, Aarhus University Hospital, Denmark; Danish Center for Particle Therapy, Aarhus University Hospital, Denmark.
| | - Tom Depuydt
- Department of Oncology, KU Leuven, Belgium; Department of Radiation Oncology, University Hospitals Leuven, Belgium.
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Draulans C, De Roover R, van der Heide UA, Haustermans K, Pos F, Smeenk RJ, De Boer H, Depuydt T, Kunze-Busch M, Isebaert S, Kerkmeijer L. Stereotactic body radiation therapy with optional focal lesion ablative microboost in prostate cancer: Topical review and multicenter consensus. Radiother Oncol 2019; 140:131-142. [PMID: 31276989 DOI: 10.1016/j.radonc.2019.06.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 06/13/2019] [Accepted: 06/14/2019] [Indexed: 12/25/2022]
Abstract
Stereotactic body radiotherapy (SBRT) for prostate cancer (PCa) is gaining interest by the recent publication of the first phase III trials on prostate SBRT and the promising results of many other phase II trials. Before long term results became available, the major concern for implementing SBRT in PCa in daily clinical practice was the potential risk of late genitourinary (GU) and gastrointestinal (GI) toxicity. A number of recently published trials, including late outcome and toxicity data, contributed to the growing evidence for implementation of SBRT for PCa in daily clinical practice. However, there exists substantial variability in delivering SBRT for PCa. The aim of this topical review is to present a number of prospective trials and retrospective analyses of SBRT in the treatment of PCa. We focus on the treatment strategies and techniques used in these trials. In addition, recent literature on a simultaneous integrated boost to the tumor lesion, which could create an additional value in the SBRT treatment of PCa, was described. Furthermore, we discuss the multicenter consensus of the FLAME consortium on SBRT for PCa with a focal boost to the macroscopic intraprostatic tumor nodule(s).
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Affiliation(s)
- Cédric Draulans
- Department of Radiation Oncology, University Hospitals Leuven, Belgium; Department of Oncology, KU Leuven, Belgium.
| | - Robin De Roover
- Department of Radiation Oncology, University Hospitals Leuven, Belgium; Department of Oncology, KU Leuven, Belgium.
| | - Uulke A van der Heide
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
| | - Karin Haustermans
- Department of Radiation Oncology, University Hospitals Leuven, Belgium; Department of Oncology, KU Leuven, Belgium.
| | - Floris Pos
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
| | - Robert Jan Smeenk
- Department of Radiation Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - Hans De Boer
- Department of Radiation Oncology, University Medical Center, Utrecht, The Netherlands.
| | - Tom Depuydt
- Department of Radiation Oncology, University Hospitals Leuven, Belgium; Department of Oncology, KU Leuven, Belgium.
| | - Martina Kunze-Busch
- Department of Radiation Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - Sofie Isebaert
- Department of Radiation Oncology, University Hospitals Leuven, Belgium; Department of Oncology, KU Leuven, Belgium.
| | - Linda Kerkmeijer
- Department of Radiation Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands; Department of Radiation Oncology, University Medical Center, Utrecht, The Netherlands.
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Ghadjar P, Fiorino C, Munck Af Rosenschöld P, Pinkawa M, Zilli T, van der Heide UA. ESTRO ACROP consensus guideline on the use of image guided radiation therapy for localized prostate cancer. Radiother Oncol 2019; 141:5-13. [PMID: 31668515 DOI: 10.1016/j.radonc.2019.08.027] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 08/29/2019] [Indexed: 12/18/2022]
Abstract
Use of image-guided radiation therapy (IGRT) helps to account for daily prostate position changes during radiation therapy for prostate cancer. However, guidelines for the use of IGRT are scarce. An ESTRO panel consisting of leading radiation oncologists and medical physicists was assembled to review the literature and formulate a consensus guideline of methods and procedure for IGRT in prostate cases. Advanced methods and procedures are also described which the committee judged relevant to further improve clinical practice. Moreover, ranges for margins for the three most popular IGRT scenarios have been suggested as examples.
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Affiliation(s)
- Pirus Ghadjar
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Germany
| | - Claudio Fiorino
- Department of Medical Physics, San Raffaele Scientific Institute, Milano, Italy
| | - Per Munck Af Rosenschöld
- Radiation Physics, Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Michael Pinkawa
- Department of Radiation Oncology, MediClin Robert Janker Klinik, Bonn, Germany
| | - Thomas Zilli
- Department of Radiation Oncology, Geneva University Hospital, Switzerland
| | - Uulke A van der Heide
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Radiation Oncology, Leiden University Medical Center, The Netherlands.
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Posiewnik M, Piotrowski T. A review of cone-beam CT applications for adaptive radiotherapy of prostate cancer. Phys Med 2019; 59:13-21. [DOI: 10.1016/j.ejmp.2019.02.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 01/29/2019] [Accepted: 02/15/2019] [Indexed: 11/26/2022] Open
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Hashido T, Nakasone S, Fukao M, Ota S, Inoue S. Comparison between manual and automatic image registration in image-guided radiation therapy using megavoltage cone-beam computed tomography with an imaging beam line for prostate cancer. Radiol Phys Technol 2018; 11:392-405. [PMID: 30242570 DOI: 10.1007/s12194-018-0476-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 09/15/2018] [Accepted: 09/15/2018] [Indexed: 12/25/2022]
Abstract
This study aimed to compare and assess the compatibility of the bone-structure-based manual and maximization of mutual information (MMI)-algorithm-based automatic image registration using megavoltage cone-beam computed tomography (MV-CBCT) images acquired with an imaging beam line. A total of 1163 MV-CBCT images from 30 prostate cancer patients were retrospectively analyzed. The differences between setup errors in three directions (left-right, LR; superior-inferior, SI; anterior-posterior, AP) of both registration methods were investigated. Pearson's correlation coefficients (r) and Bland-Altman agreements were evaluated. Agreements were defined by a bias close to zero and 95% limits of agreement (LoA) less than ± 3 mm. The cumulative frequencies of the absolute differences between the two registration methods were calculated to assess the distributions of the setup error differences. There were significant differences (p < 0.001) in the setup errors between both registration methods. There were moderate (SI, r = 0.45) and strong positive correlation coefficients (LR, r = 0.74; AP, r = 0.72), whereas the 95% LoA (bias ± 1.96 × standard deviation of the setup error differences) were - 1.61 ± 4.29 mm (LR), - 0.41 ± 5.45 mm (SI), and 0.67 ± 4.29 mm (AP), revealing no agreements in all directions. The cumulative frequencies (%) of the cases with absolute setup error differences within 3 mm in each direction were 80.83% (LR), 81.86% (SI), and 90.71% (AP), with all directions having large proportions of > 3-mm differences. The MMI-algorithm-based automatic registration is not compatible with the bone-structure-based manual registration and should not be used alone for prostate cancer.
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Affiliation(s)
- Takashi Hashido
- Division of Radiology, Department of Medical Technology, Osaka University Hospital, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Shinya Nakasone
- Division of Radiology, Department of Medical Technology, Osaka University Hospital, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Mari Fukao
- Division of Radiology, Department of Medical Technology, Osaka University Hospital, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Seiichi Ota
- Division of Radiology, Department of Medical Technology, Osaka University Hospital, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Shinichi Inoue
- Division of Radiology, Department of Medical Technology, Osaka University Hospital, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
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McPartlin AJ, Li XA, Kershaw LE, Heide U, Kerkmeijer L, Lawton C, Mahmood U, Pos F, van As N, van Herk M, Vesprini D, van der Voort van Zyp J, Tree A, Choudhury A. MRI-guided prostate adaptive radiotherapy - A systematic review. Radiother Oncol 2016; 119:371-80. [PMID: 27162159 DOI: 10.1016/j.radonc.2016.04.014] [Citation(s) in RCA: 114] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 04/08/2016] [Accepted: 04/09/2016] [Indexed: 11/29/2022]
Abstract
Dose escalated radiotherapy improves outcomes for men with prostate cancer. A plateau for benefit from dose escalation using EBRT may not have been reached for some patients with higher risk disease. The use of increasingly conformal techniques, such as step and shoot IMRT or more recently VMAT, has allowed treatment intensification to be achieved whilst minimising associated increases in toxicity to surrounding normal structures. To support further safe dose escalation, the uncertainties in the treatment target position will need be minimised using optimal planning and image-guided radiotherapy (IGRT). In particular the increasing usage of profoundly hypo-fractionated stereotactic therapy is predicated on the ability to confidently direct treatment precisely to the intended target for the duration of each treatment. This article reviews published studies on the influences of varies types of motion on daily prostate position and how these may be mitigated to improve IGRT in future. In particular the role that MRI has played in the generation of data is discussed and the potential role of the MR-Linac in next-generation IGRT is discussed.
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Affiliation(s)
- A J McPartlin
- The Christie NHS Foundation Trust and Manchester Cancer Research Centre, University of Manchester, Manchester Academic Health Sciences Centre, UK
| | - X A Li
- Medical College of Wisconsin, USA
| | - L E Kershaw
- The Christie NHS Foundation Trust and Manchester Cancer Research Centre, University of Manchester, Manchester Academic Health Sciences Centre, UK
| | - U Heide
- Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, The Netherlands
| | - L Kerkmeijer
- University Medical Center Utrecht, The Netherlands
| | - C Lawton
- Medical College of Wisconsin, USA
| | - U Mahmood
- MD Anderson Cancer Center, Houston, USA
| | - F Pos
- Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, The Netherlands
| | - N van As
- Royal Marsden Hospital, UK; Institute of Cancer Research, UK
| | - M van Herk
- The Christie NHS Foundation Trust and Manchester Cancer Research Centre, University of Manchester, Manchester Academic Health Sciences Centre, UK
| | - D Vesprini
- Sunnybrook Health Sciences Centre, University of Toronto, Canada
| | | | - A Tree
- Royal Marsden Hospital, UK
| | - A Choudhury
- The Christie NHS Foundation Trust and Manchester Cancer Research Centre, University of Manchester, Manchester Academic Health Sciences Centre, UK.
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8
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Shang Q, Sheplan Olsen LJ, Stephans K, Tendulkar R, Xia P. Prostate rotation detected from implanted markers can affect dose coverage and cannot be simply dismissed. J Appl Clin Med Phys 2013; 14:4262. [PMID: 23652257 PMCID: PMC5714427 DOI: 10.1120/jacmp.v14i3.4262] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Revised: 01/29/2013] [Accepted: 01/25/2013] [Indexed: 11/23/2022] Open
Abstract
With implanted markers, daily prostate displacements can be automatically detected with six degrees of freedom. The reported magnitudes of the rotations, however, are often greater than the typical range of a six‐degree treatment couch. The purpose of this study is to quantify geometric and dosimetric effects if the prostate rotations are not corrected (ROT_NC) and if they can be compensated with translational shifts (ROT_C). Forty‐three kilovoltage cone‐beam CTs (KV‐CBCT) with implanted markers from five patients were available for this retrospective study. On each KV‐CBCT, the prostate, bladder, and rectum were manually contoured by a physician. The prostate contours from the planning CT and CBCT were aligned manually to achieve the best overlaps. This contour registration served as the benchmark method for comparison with two marker registration methods: (a) using six degrees of freedom, but rotations were not corrected (ROT_NC); and (b) using three degrees of freedom while compensating rotations into the translational shifts (ROT_C). The center of mass distance (CMD) and overlap index (OI) were used to evaluate these two methods. The dosimetric effects were also analyzed by comparing the dose coverage of the prostate clinical target volume (CTV) in relation to the planning margins. According to our analysis, the detected rotations dominated in the left–right axis with systematic and random components of 4.6° and 4.1°, respectively. When the rotation angles were greater than 10°, the differences in CMD between the two registrations were greater than 5 mm in 85.7% of these fractions; when the rotation angles were greater than 6°, the differences of CMD were greater than 4 mm in 61.1% of these fractions. With 6 mm/4 mm posterior planning margins, the average difference between the dose to 99% (D99) of the prostate in CBCTs and the planning D99 of the prostate was −8.0±12.3% for the ROT_NC registration, and −3.6±9.0% for the ROT_C registration (p=0.01). When the planning margin decreased to 4 mm/2 mm posterior, the average difference in D99 of the prostate was −22.0±16.2% and −15.1±15.2% for the ROT_NC and ROT_C methods, respectively (p<0.05). In conclusion, prostate rotation cannot be simply dismissed, and the impact of the rotational errors depends on the distance between the isocenter and the centroid of implanted markers and the rotation angle. PACS number: 87.55
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Affiliation(s)
- Qingyang Shang
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, OH 44195, USA
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9
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Graf R, Boehmer D, Budach V, Wust P. Interfraction rotation of the prostate as evaluated by kilovoltage X-ray fiducial marker imaging in intensity-modulated radiotherapy of localized prostate cancer. Med Dosim 2012; 37:396-400. [PMID: 22534137 DOI: 10.1016/j.meddos.2012.02.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Revised: 02/10/2012] [Accepted: 02/22/2012] [Indexed: 10/28/2022]
Abstract
To quantify the daily rotation of the prostate during a radiotherapy course using stereoscopic kilovoltage (kV) x-ray imaging and intraprostatic fiducials for localization and positioning correction. From 2005 to 2009, radio-opaque fiducial markers were inserted into 38 patients via perineum into the prostate. The ExacTrac/Novalis Body X-ray 6-day image acquisition system (ET/NB; BrainLab AG, Feldkirchen, Germany) was used to determine and correct the target position. During the first period in 10 patients we recorded all rotation errors but used only Y (table) for correction. For the next 28 patients we used for correction all rotational coordinates, i.e., in addition Z (superior-inferior [SI] or roll) and X (left-right [LR] or tilt/pitch) according to the fiducial marker position by use of the Robotic Tilt Module and Varian Exact Couch. Rotation correction was applied above a threshold of 1° displacement. The systematic and random errors were specified. Overall, 993 software-assisted rotational corrections were performed. The interfraction rotation errors of the prostate as assessed from the radiodense surrogate markers around the three axes Y, Z, and X were on average 0.09, -0.52, and -0.01° with standard deviations of 2.01, 2.30, and 3.95°, respectively. The systematic uncertainty per patient for prostate rotation was estimated with 2.30, 1.56, and 4.13° and the mean random components with 1.81, 2.02, and 3.09°. The largest rotational errors occurred around the X-axis (pitch), but without preferring a certain orientation. Although the error around Z (roll) can be compensated on average by a transformation with 4 coordinates, a significant error around X remains and advocates the full correction with 6 coordinates. Rotational errors as assessed via daily stereoscopic online imaging are significant and dominate around X. Rotation possibly degrades the dosimetric coverage of the target volume and may require suitable strategies for correction.
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Affiliation(s)
- Reinhold Graf
- Charité Universitätsmedizin Berlin, Department of Radiation Oncology, Campus Virchow-Klinikum, Berlin, Germany
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Adamczyk M, Piotrowski T, Adamiak E. Evaluation of combining bony anatomy and soft tissue position correction strategies for IMRT prostate cancer patients. Rep Pract Oncol Radiother 2012; 17:104-9. [PMID: 24377008 PMCID: PMC3863327 DOI: 10.1016/j.rpor.2012.01.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Revised: 11/15/2011] [Accepted: 01/13/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Radiotherapy treatment requires delivering high homogenous dose to target volume while sparing organs at risk. That is why accurate patient positioning is one of the most important steps during the treatment process. It reduces set-up errors which have a strong influence on the doses given to the target and surrounding tissues. AIM The aim of this study was to investigate the efficiency of combining bony anatomy and soft tissue imaging position correction strategies for patients with prostate cancer. MATERIALS AND METHODS The study based on pre-treatment position verification results determined for 10 patients using kV images and CBCT match. At the same patients' position, two orthogonal kV images and set of CT scans were acquired. Both verification methods gave the information about patients' position changes in vertical, longitudinal and lateral directions. RESULTS For 93 verifications, the mean values of kV shifts in vertical, longitudinal and lateral directions equaled: -0.11 ± 0.54 cm, 0.26 ± 0.38 cm and -0.06 ± 0.47 cm, respectively. The same values achieved for CBCT matching equaled: 0.07 ± 0.62 cm, 0.22 ± 0.36 cm and -0.02 ± 0.45 cm. Statistically significant changes between the values of shifts received during the first week of treatment and the rest time of the irradiation process were found for 2 patients in the lateral direction and 2 patients in vertical direction among kV results and for 3 patients in the longitudinal direction among CBCT results. A significant difference between kV and CBCT match results was found in the vertical direction. CONCLUSIONS In clinical practice, CBCT combined with kV or even portal imaging improves precision and effectiveness of prostate cancer treatment accuracy.
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Affiliation(s)
- Marta Adamczyk
- Department of Medical Physics, Greater Poland Cancer Centre, 15 Garbary St., 61-866 Poznań, Poland
| | - Tomasz Piotrowski
- Department of Medical Physics, Greater Poland Cancer Centre, 15 Garbary St., 61-866 Poznań, Poland
| | - Ewa Adamiak
- Radiotherapy Ward I, Greater Poland Cancer Centre, 15 Garbary St., 61-866 Poznań, Poland
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Perks J, Turnbull H, Liu T, Purdy J, Valicenti R. Vector Analysis of Prostate Patient Setup With Image-Guided Radiation Therapy via kV Cone Beam Computed Tomography. Int J Radiat Oncol Biol Phys 2011; 79:915-9. [DOI: 10.1016/j.ijrobp.2010.04.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2009] [Revised: 02/23/2010] [Accepted: 04/06/2010] [Indexed: 10/24/2022]
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Barney BM, Lee RJ, Handrahan D, Welsh KT, Cook JT, Sause WT. Image-guided radiotherapy (IGRT) for prostate cancer comparing kV imaging of fiducial markers with cone beam computed tomography (CBCT). Int J Radiat Oncol Biol Phys 2010; 80:301-5. [PMID: 20864274 DOI: 10.1016/j.ijrobp.2010.06.007] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2010] [Revised: 05/26/2010] [Accepted: 06/08/2010] [Indexed: 11/19/2022]
Abstract
PURPOSE To present our single-institution experience with image-guided radiotherapy comparing fiducial markers and cone-beam computed tomography (CBCT) for daily localization of prostate cancer. METHODS AND MATERIALS From April 2007 to October 2008, 36 patients with prostate cancer received intensity-modulated radiotherapy with daily localization by use of implanted fiducials. Orthogonal kilovoltage (kV) portal imaging preceded all 1244 treatments. Cone-beam computed tomography images were also obtained before 286 treatments (23%). Shifts in the anterior-posterior (AP), superior-inferior (SI), and left-right (LR) dimensions were made from kV fiducial imaging. Cone-beam computed tomography shifts based on soft tissues were recorded. Shifts were compared by use of Bland-Altman limits of agreement. Mean and standard deviation of absolute differences were also compared. A difference of 5 mm or less was acceptable. Subsets including start date, body mass index, and prostate size were analyzed. RESULTS Of 286 treatments, 81 (28%) resulted in a greater than 5.0-mm difference in one or more dimensions. Mean differences in the AP, SI, and LR dimensions were 3.4 ± 2.6 mm, 3.1 ± 2.7 mm, and 1.3 ± 1.6 mm, respectively. Most deviations occurred in the posterior (fiducials, 78%; CBCT, 59%), superior (79%, 61%), and left (57%, 63%) directions. Bland-Altman 95% confidence intervals were -4.0 to 9.3 mm for AP, -9.0 to 5.3 mm for SI, and -4.1 to 3.9 mm for LR. The percentages of shift agreements within ±5 mm were 72.4% for AP, 72.7% for SI, and 97.2% for LR. Correlation between imaging techniques was not altered by time, body mass index, or prostate size. CONCLUSIONS Cone-beam computed tomography and kV fiducial imaging are similar; however, more than one-fourth of CBCT and kV shifts differed enough to affect target coverage. This was even more pronounced with smaller margins (3 mm). Fiducial imaging requires less daily physician input, is less time-consuming, and is our preferred method for prostate image-guided radiotherapy.
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Affiliation(s)
- Brandon M Barney
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, USA.
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13
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Interfraction prostate rotation determined from in-room computerized tomography images. Med Dosim 2010; 36:188-94. [PMID: 21540013 DOI: 10.1016/j.meddos.2010.03.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2009] [Revised: 03/08/2010] [Accepted: 03/09/2010] [Indexed: 11/20/2022]
Abstract
Fiducial markers (FMs) are commonly used as a correction technique for interfraction translations of the prostate. The aim of this investigation was to determine the magnitude of prostate rotations using 2 methods: FM coordinates and the anatomical border of the prostate and rectum. Daily computed tomography (CT) scans (n = 346) of 10 prostate cancer patients with 3 implanted FMs were acquired using the CT on rails. FM coordinates were used to determine rotation in the sagittal, transverse, and coronal planes, and CT contours of the prostate and rectum were used to determine rotation along the sagittal plane. An adaptive technique based on a subset of images (n = 6; planning and first 5 treatment CTs) to reduce systematic rotation errors in the sagittal plane was tested. The standard deviation (SD) of systematic rotation from FM coordinates was 7.6°, 7.7°, and 5.0° in the sagittal, transverse and coronal planes. The corresponding SD of random error was 10.2°, 15.8°, and 6.5°. Errors in the sagittal plane, determined from prostate and rectal contours, were 10.1° (systematic) and 7.7° (random). These results did not correlate with rotation computed from FM coordinates (r = -0.017; p = 0.753, n = 337). The systematic error could be reduced by 43% to 5.6° when the mean prostate position was estimated from 6 CT scans. Prostate rotation is a significant source of error that appears to be more accurately determined using the anatomical border of the prostate and rectum rather than FMs, thus highlighting the utility of CT image guidance.
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Owen R, Kron T, Foroudi F, Milner A, Cox J, Duchesne G, Cleeve L, Zhu L, Cramb J, Sparks L, Laferlita M. Comparison of CT on Rails With Electronic Portal Imaging for Positioning of Prostate Cancer Patients With Implanted Fiducial Markers. Int J Radiat Oncol Biol Phys 2009; 74:906-12. [DOI: 10.1016/j.ijrobp.2009.01.054] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2008] [Revised: 01/23/2009] [Accepted: 01/29/2009] [Indexed: 11/17/2022]
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Boda-Heggemann J, Mennemeyer P, Wertz H, Riesenacker N, Küpper B, Lohr F, Wenz F. Accuracy of ultrasound-based image guidance for daily positioning of the upper abdomen: an online comparison with cone beam CT. Int J Radiat Oncol Biol Phys 2009; 74:892-7. [PMID: 19394160 DOI: 10.1016/j.ijrobp.2009.01.061] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2008] [Revised: 01/17/2009] [Accepted: 01/20/2009] [Indexed: 11/30/2022]
Abstract
PURPOSE Image-guided intensity-modulated radiotherapy can improve protection of organs at risk when large abdominal target volumes are irradiated. We estimated the daily positioning accuracy of ultrasound-based image guidance for abdominal target volumes by a direct comparison of daily imaging obtained with cone beam computed tomography (CBCT). METHODS AND MATERIALS Daily positioning (n = 83 positionings) of 15 patients was completed by using ultrasound guidance after an initial CBCT was obtained. Residual error after ultrasound was estimated by comparison with a second CBCT. Ultrasound image quality was visually rated using a scale of 1 to 4. RESULTS Of 15 patients, 7 patients had good sonographic imaging quality, 5 patients had satisfactory sonographic quality, and 3 patients were excluded because of unsatisfactory sonographic quality. When image quality was good, residual errors after ultrasound were -0.1 +/- 3.11 mm in the x direction (left-right; group systematic error M = -0.09 mm; standard deviation [SD] of systematic error, Sigma = 1.37 mm; SD of the random error, sigma = 2.99 mm), 0.93 +/- 4.31 mm in the y direction (superior-inferior, M = 1.12 mm; Sigma = 2.96 mm; sigma = 3.39 mm), and 0.71 +/- 3.15 mm in the z direction (anteroposterior; M = 1.01 mm; Sigma = 2.46 mm; sigma = 2.24 mm). For patients with satisfactory image quality, residual error after ultrasound was -0.6 +/- 5.26 mm in the x (M = 0.07 mm; Sigma = 5.67 mm; sigma = 4.86 mm), 1.76 +/- 4.92 mm in the y (M = 3.54 mm; Sigma = 4.1 mm; sigma = 5.29 mm), and 1.19 +/- 4.75 mm in the z (M = 0.82 mm; Sigma = 2.86 mm; sigma = 3.05 mm) directions. CONCLUSIONS In patients from whom good sonographic image quality could be obtained, ultrasound improved daily positioning accuracy. In the case of satisfactory image quality, ultrasound guidance improved accuracy compared to that of skin marks only minimally. If sonographic image quality was unsatisfactory, daily CBCT scanning improved treatment accuracy distinctly over that of ultrasound. Use of daily ultrasound or CBCT imaging can help to reduce PTV margins and protect organs at risk compared to the use of skin mark-based positioning.
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Affiliation(s)
- Judit Boda-Heggemann
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany.
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Köhler FM, Boda-Heggemann J, Küpper B, Wolff D, Wertz H, Lohr F, Wenz F. Phantom measurements to quantify the accuracy of a commercially available cone-beam CT gray-value matching algorithm using multiple Fiducials. Strahlenther Onkol 2009; 185:49-55. [PMID: 19224147 DOI: 10.1007/s00066-009-1887-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2008] [Accepted: 08/14/2008] [Indexed: 11/28/2022]
Abstract
PURPOSE : To assess the accuracy of the gray-value matching algorithm (XVI, Elekta) when multiple iodine-125 ((125)I) seeds are used as fiducials. MATERIAL AND METHODS : A phantom, consisting of a plastic box filled with water-dense material containing about 50 dummy seeds, developed primarily as a manual-skill trainer for (125)I seed implantation was used (Figure 1). The phantom was scanned first with a planning CT (PCT) at a slice thickness of 1 mm, 3 mm and 5 mm and with cone-beam CT (CBCT) to be associated with each reference PCT. Matching was performed with the XVI gray-value algorithm. The isocenter was marked with external markers at PCT. After matching, residual error was determined as the difference between planned isocenter and the isocenter that would have been treated based on the matching process. The procedure was performed twice, once without any manipulation (Figure 2) and once with deformation of the seed-bearing dummy prostate by inserting a plug into the phantom aperture that mimics the rectum (Figure 3). RESULTS : For the undeformed phantom the maximal residual error regarding the isocenter after gray-value matching around the seed-bearing region was 0.0 mm in x, y and z directions in case of the PCT with 1 mm thickness. The range of residual error was 0-0.4 mm in case of the PCT with 3 mm and 0-0.8 mm in x, y and z directions in case of 5 mm slice thickness, respectively (Figure 4). For the deformed phantom similar results were obtained (maximum error: 1.1 mm). CONCLUSION : The residual error after seed-based matching regarding the phantom isocenter was < 1.1 mm in all cases and for the clinical situation (3 mm slice thickness) always < 0.4 mm. The algorithm is therefore appropriate for precision radiotherapy.
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Boda-Heggemann J, Köhler FM, Wertz H, Ehmann M, Hermann B, Riesenacker N, Küpper B, Lohr F, Wenz F. Intrafraction motion of the prostate during an IMRT session: a fiducial-based 3D measurement with Cone-beam CT. Radiat Oncol 2008; 3:37. [PMID: 18986517 PMCID: PMC2588616 DOI: 10.1186/1748-717x-3-37] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2008] [Accepted: 11/05/2008] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Image-guidance systems allow accurate interfractional repositioning of IMRT treatments, however, these may require up to 15 minutes. Therefore intrafraction motion might have an impact on treatment precision. 3D geometric data regarding intrafraction prostate motion are rare; we therefore assessed its magnitude with pre- and post-treatment fiducial-based imaging with cone-beam-CT (CBCT). METHODS 39 IMRT fractions in 5 prostate cancer patients after 125I-seed implantation were evaluated. Patient position was corrected based on the 125I-seeds after pre-treatment CBCT. Immediately after treatment delivery, a second CBCT was performed. Differences in bone- and fiducial position were measured by seed-based grey-value matching. RESULTS Fraction time was 13.6 +/- 1.6 minutes. Median overall displacement vector length of 125I-seeds was 3 mm (M = 3 mm, Sigma = 0.9 mm, sigma = 1.7 mm; M: group systematic error, Sigma: SD of systematic error, sigma: SD of random error). Median displacement vector of bony structures was 1.84 mm (M = 2.9 mm, Sigma = 1 mm, sigma = 3.2 mm). Median displacement vector length of the prostate relative to bony structures was 1.9 mm (M = 3 mm, Sigma = 1.3 mm, sigma = 2.6 mm). CONCLUSION a) Overall displacement vector length during an IMRT session is < 3 mm.b) Positioning devices reducing intrafraction bony displacements can further reduce overall intrafraction motion.c) Intrafraction prostate motion relative to bony structures is < 2 mm and may be further reduced by institutional protocols and reduction of IMRT duration.
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Affiliation(s)
- Judit Boda-Heggemann
- Department of Radiation Oncology, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, Mannheim, Germany
| | - Frederick Marc Köhler
- Department of Radiation Oncology, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, Mannheim, Germany
| | - Hansjörg Wertz
- Department of Radiation Oncology, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, Mannheim, Germany
| | - Michael Ehmann
- Department of Radiation Oncology, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, Mannheim, Germany
| | - Brigitte Hermann
- Department of Radiation Oncology, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, Mannheim, Germany
| | - Nadja Riesenacker
- Department of Radiation Oncology, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, Mannheim, Germany
| | - Beate Küpper
- Department of Radiation Oncology, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, Mannheim, Germany
| | - Frank Lohr
- Department of Radiation Oncology, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, Mannheim, Germany
| | - Frederik Wenz
- Department of Radiation Oncology, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, Mannheim, Germany
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Yue NJ, Kim S, Lewis BE, Jabbour S, Narra V, Goyal S, Haffty BG. Optimization of couch translational corrections to compensate for rotational and deformable target deviations in image guided radiotherapy. Med Phys 2008; 35:4375-85. [DOI: 10.1118/1.2977532] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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